Apport des ondes de choc dans le traitement kinésithérapeutique des fasciites plantaires chroniques

peer reviewedINTRODUCTION : La littérature est encore assez contradictoire concernant les effets de la thérapie par ondes de choc radiales appliquées aux fasciites plantaires. L’objet de notre étude est d’évaluer l’efficacité de la thérapie par ondes de choc ajoutée à un traitement de kinésithérapie classique dans la prise en charge des fasciites plantaires chroniques. MATERIEL ET METHODE : Au départ d’une population de 22 sujets, nous avons formé deux groupes de manière randomisée : le groupe E qui a bénéficié d’un traitement combiné d’ondes de choc radiales et de kinésithérapie et le groupe T qui a bénéficié d’une prise en charge kinésithérapeutique classique (standardisée pour les 2 groupes : US, MTP, étirements, renforcement du tibial antérieur, massage et cryothérapie). Les tests utilisés lors de l’évaluation comprenaient : l’échelle visuelle analogique, 2 questionnaires validés («Index de Fonctionnalité du Pied» et «Invalidité du Pied»). Les patients ont été évalués avant le traitement (pré-test), 2 semaines (tests intermédiaires) et 6 semaines (post-tests) après le début du traitement. RESULTATS : Nous observons de manière générale des améliorations dans les deux groupes. Le groupe E enregistre cependant une amélioration plus rapide des paramètres étudiés que le groupe T. Au niveau de la douleur et de l’invalidité, c’est le traitement par les ondes de choc qui induit l’évolution la plus positive. Pour la fonctionnalité, le traitement de kinésithérapie conventionnelle montre l’amélioration la plus grande. La comparaison des évolutions entre les 2 groupes entre-eux ne démontre aucune différence statistiquement significative, mais l’observation des valeurs chiffrées tend à montrer une amélioration plus rapide durable pour le groupe E. CONCLUSION : La combinaison thérapie du traitement kinésithérapeutique des fasciites plantaires chroniques au traitement par ondes de choc semble diminuer la douleur et l’invalidité ainsi qu’améliorer la fonctionnalité du pied plus rapidement. Le traitement de kinésithérapie seul, quant à lui, permettrait, de manière plus lente, d’améliorer également les paramètres douloureux et de la fonctionnalité, mais ce n’est qu’après la prise en charge kinésithérapeutique que les patients ressentent une amélioration de leur invalidité. Cependant, lorsque l’on compare les 2 groupes entre eux 6 semaines après l’initiation du traitement, nous n’observons pas de différence significative pour les 3 critères étudiés

Two biomarkers for the screening of cardiac risk among runners ?

Background Heart-type fatty acid-binding protein (H-FABP) is a low molecular weight protein involved in the intracellular uptake and buffering of long chain fatty in the myocardium. Troponin T is a component of the contractile apparatus of the striated musculature. Both are early markers for acute coronary syndrome. Objective The aim of our study was to compare the results obtained with the H-FABP and the highly sensitive cardiac troponins (hsTnT) and to test their cardiospecificity in healthy runners. Design Prospective, cohort study. Setting Amateur marathon runners. Patients 23 runners (marathon) were enrolled. Interventions We drowned blood samples at three times: just before (T0), just after (T1), and three hours after the end of the race (T3). Main outcome measurements H-FABP and hs-TnT were performed according to the manufacturer's instructions. A linear regression was calculated to observe if there is any correlation between the two biomarkers. Values above the 95th percentile for H-FABP (2.5 ng/mL) and the 99th percentile for hsTnT (14 ng/L) were considered as positive. Results At T0, none of the subjects were positive for hsTnT but 35% were positive for H-FABP; at T1, 83% for hsTnT and 100% for H-FABP; at T3, 83% for hsTnT and 96% for H-FABP. At T0, the regression equation was H-FABP T0=3.9454–0.1001×hsTnT T0; at T1: H-FABP T1=51.838–1.7026×hsTnT T1; at T3: H-FABP T3=47.977–1.6193×hsTnT T3. No correlation was observed between the 2 biomarkers. Conclusion We observed a significant increase of H-FABP and hsTnT in runners. These markers are independent to each other. These values could biologically correspond to a heart ischemia. These biomarkers could be helpful for the screening of cardiac risk among runners

Common Bias and Challenges in Physical and Rehabilitation Medicine Research: How to Tackle Them

The importance of evidence-based medicine is crucial, especially in physical and rehabilitation medicine (PRM), where there is a need to conduct rigorous experimental protocols, as in any medical field. Currently, in clinical practice, therapeutic approaches are often based on empirical data rather than evidence-based medicine. However, the field of PRM faces several challenges that may complicate scientific research. In addition, there is often a lack of appropriate research training in educational programs. In this context, we aim to review the methodological challenges in PRM and provide clear examples for each of them as well as potential solutions when possible. This article will cover the following themes: (1) Choosing the right study design and conducting randomized and benchmarking controlled trials; (2). Selecting the appropriate controlled, placebo or sham condition and the issue of blinding in non-pharmacological trials; (3) The impact of populations' heterogeneity and multi-comorbidities; (4). The challenge of recruitment and adherence; (5). The importance of homogeneity and proper quantification of rehabilitative strategies; and (6). Ethical issues. We are convinced that teaching the basics of scientific research in PRM could help physicians and therapists to choose a treatment based on (novel) scientific evidence. It may also promote scientific research in PRM to develop novel and personalized rehabilitation strategies using rigorous methodologies and randomized or benchmarking controlled trials in order to improve patients' management

One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies

Infiltration of Platelet-Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of this study is to evaluate the clinical status and the return to sports activities in patients with chronic proximal patellar tendinopathies. Twenty subjects with chronic proximal patellar tendinopathy benefited from 1 infiltration of PRP coupled with a standardized eccentric rehabilitation. The follow-up (up to 1 year) was assessed by means of a Visual Anologue Scale (VAS), the International Knee Documentation Committee (IKDC) form and the Victorian Institute of Sport Assessment (VISA-P) score. Moreover, subjects had to answer an information questionnaire concerning their life and sports activities. Seventy percents of the patients reported a favourable evolution with decrease of pain, and returned to sports activities. With time, VAS dropped significantly and both IKDC and VISA-P scores improved also significantly. This study confirms that a local injection of PRP coupled with a program of eccentric rehabilitation for treating a chronic jumper’s knee, improves pain symptoms and the functionalit

Impact of different endurance races on the heart: the point of view of the biologist

peer reviewedObjective The aim of this study was to investigate the impact of intense exercise, represented by different endurance races, in relationship with oxidative stress and cardiac markers. In a second time, we tried to demonstrate if oxidative stress induced by physical activity is a physiological or pathological process, and to establish some issues to diagnose the risk of sudden death in athletes. Methods Four populations were compared, a control group of 16 participants “sedentary” (37 ± 4,39 years old), a group of 24 semi-marathon runners (41 years ± 8,76 years old), a group of 28 marathon runners (44,1 ± 8,37 years old) and a group of 33 ultra-trail runners (45,8 ± 8,7 years old). Three blood tests were drowned, one just before, one just after, and the last three hours after the end of the race.Different oxidative and stress and cardiac biomarkers were measured. The ultra-trail runners will be subject to an echocardiography and an ECG pre- and post-race. For statistical analysis, STATISTICA 10 software was used. We performed a non-parametric test of Kruskal-Wallis for independent sample and a Friedman ANOVA for paired samples. Results Myeloperoxydase increased during exercise, but the release is less important according to the level of training of the runners. GSH/GSSG ratio seems to remain stable during the race but it could increase during the 24 hours post-race. There is a decrease in lipidic peroxidation during exercise. But, we note an increase of creatine kinase, isoform MB, myoglobin and C-reactive protein during the race. We observe an increase of troponin T and natriuretic peptide but with a different kinetic than the kinetic obtained for a myocardial infarction. Medical imaging in ultra-trail runners present cardiac adaptations to endurance training, as left ventricular hypertrophy (LVH) and incomplete right bundle branch block (IRBBB). A decrease of systolic and diastolic volumes of the left ventricle and a decrease of longitudinal strain were observed by echocardiography at the end of the race. Conclusion Endurance races induce the income of oxidative stress objectified by different biomarkers increase, but a cell necrosis is not specially observed. In fact, the increase of the cardiac markers during endurance races but may be explained by a transient modification of myocyte permeability, with a release of pool cytosolic. These races may induce micro-muscle damages causing the appearance of an inflammatory process explaining our observations of markers of inflammation. For the medical imaging, it was observed a myocardial adaptation to training and a transient impairment of ventricular function due to dehydration

Épidémiologie des commotions cérébrales dans le sport

editorial reviewedLes commotions cérébrales représentent une préoccupation majeure dans le domaine sportif, affectant entre 1,6 et 3,8 millions d’individus annuellement aux États-Unis, toutes disciplines confondues. La prévalence des commotions varie selon le sport pratiqué, le sexe des participants et le niveau de compétition. Le football américain, le hockey sur glace et le rugby sont identifiés comme les sports avec le plus haut risque de commotions, principalement en raison de leur nature physique et des contacts directs fréquents entre les joueurs. Une prévalence plus élevée est rapportée lors des matchs que lors des entraînements. Les différences de genre dans l’incidence des commotions sont également marquées, les femmes semblant plus susceptibles de subir des commotions dans des sports comparables. Parmi les hypothèses, encore à valider, il y a potentiellement des différences physiologiques comme la force des muscles du cou ou encore en raison de certains facteurs biomécaniques. Ces facteurs pouvant influencer la manière dont les impacts sont absorbés lors des collisions. La distribution géographique des commotions varie avec des études américaines rapportant des taux élevés dans des sports populaires comme le football américain et le hockey sur glace, tandis que l’Europe présente des taux plus élevés dans des sports comme le rugby et le football. Cette variation reflète les différences culturelles et les pratiques sportives prédominantes dans différentes régions. La prévention des commotions nécessite une approche proactive incluant l’éducation, l’utilisation d’équipements de protection et des programmes de renforcement musculaire adaptés afin de réduire les risques de blessures cérébrales et de promouvoir la sécurité des athlètes à tous les niveaux de compétition