Deficits in peroneal latency and electromechanical delay in patients with functional ankle instability

The purpose of this study was to compare alterations in peroneal latency and electromechanical delay (EMD) following an inversion perturbation during walking in patients with functional ankle instability (FAI) and with a matched control group. Peroneal latency and EMD were measured from 21 patients with unilateral FAI and 21 controls. Latencies were collected during a random inversion perturbation while walking. EMD measures were collected during stance using a percutaneous stimulus. Two-way ANOVAs were used to detect differences between leg (affected, unaffected) and group (FAI, Control). Functionally unstable ankles displayed delayed peroneus longus (PL) latencies and EMD when compared to the unaffected leg and a matched control group. Peroneal latency and EMD deficits could contribute to recurrence of ankle injury in FAI subjects. How these deficits are associated with the chronic symptoms associated with FAI remains unclear, but gamma activation and subsequent muscle spindle sensitivity likely play a role. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1541–1546, 2009Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64439/1/20934_ftp.pd

The effects of a soccer-specific fitness test on eccentric knee-flexor strength

Context: Physiological fitness testing, such as the Yo-Yo Intermittent Recovery Test (YYIR) is a key requirement of the Elite Player Performance Plan, introduced by the English Premier League. Eccentric hamstring strength has been identified as a risk factor for hamstring injuries in soccer players, with fatigue highlighted to further exasperate this issue. Objective: The aim of the current study was to examine the effect of the YYIR level 1 (YYIR1) on eccentric knee flexor strength assessed using the NordBord in youth soccer players. Design: Experimental design. Setting: Soccer club academy. Participants: A total of 67 male academy soccer players (age = 16.58 [0.57] y; height = 175.45 [5.85] cm; mass = 66.30 [8.21] kg) volunteered to participate in the current study during the English competitive soccer season. Main Outcome Measures: Participants conducted eccentric hamstring strength assessments using the NordBord prior to and immediately postcompletion of the YYIR1, with outcome measures of peak force and peak force relative to body mass recorded. Results: Paired t tests highlighted increased absolute eccentric knee flexor strength values (P < .001) immediately post-YYIR1 for both the dominant and nondominant limbs, with the same trend (P < .001) observed for eccentric strength relative to body mass. Conclusions: The results of this study indicate that the YYIR1 does not induce eccentric knee flexor fatigue and as such is not a valid assessment method to assess the effects of fatigue on hamstring function. However, results do suggest that the NordBord may be considered a viable and more accessible alternative to detect pre–post fitness test/fatigue protocol differences in eccentric knee flexor peak strength while working in the field

Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis : a mixed methods review

BACKGROUND: Chronic peripheral joint pain due to osteoarthritis (OA) is extremely prevalent and a major cause of physical dysfunction and psychosocial distress. Exercise is recommended to reduce joint pain and improve physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) in this population is unknown. OBJECTIVES: To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise. SEARCH METHODS: Review authors searched 23 clinical, public health, psychology and social care databases and 25 other relevant resources including trials registers up to March 2016. We checked reference lists of included studies for relevant studies. We contacted key experts about unpublished studies. SELECTION CRITERIA: To be included in the quantitative synthesis, studies had to be randomised controlled trials of land- or water-based exercise programmes compared with a control group consisting of no treatment or non-exercise intervention (such as medication, patient education) that measured either pain or function and at least one psychosocial outcome (self-efficacy, depression, anxiety, quality of life). Participants had to be aged 45 years or older, with a clinical diagnosis of OA (as defined by the study) or self-reported chronic hip or knee (or both) pain (defined as more than six months' duration). To be included in the qualitative synthesis, studies had to have reported people's opinions and experiences of exercise-based programmes (e.g. their views, understanding, experiences and beliefs about the utility of exercise in the management of chronic pain/OA). DATA COLLECTION AND ANALYSIS: We used standard methodology recommended by Cochrane for the quantitative analysis. For the qualitative analysis, we extracted verbatim quotes from study participants and synthesised studies of patients' views using framework synthesis. We then conducted an integrative review, synthesising the quantitative and qualitative data together. MAIN RESULTS: Twenty-one trials (2372 participants) met the inclusion criteria for quantitative synthesis. There were large variations in the exercise programme's content, mode of delivery, frequency and duration, participant's symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Comparator groups were varied and included normal care; education; and attention controls such as home visits, sham gel and wait list controls. Risk of bias was high in one and unclear risk in five studies regarding the randomisation process, high for 11 studies regarding allocation concealment, high for all 21 studies regarding blinding, and high for three studies and unclear for five studies regarding attrition. Studies did not provide information on adverse effects. There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6% (95% confidence interval (CI) -9% to -4%, (9 studies, 1058 participants), equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6% (95% CI -7.6% to 2.0%; standardised mean difference (SMD) -0.27, 95% CI -0.37 to -0.17, equivalent to reducing (improving) WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function on a 0 to 100 scale from 49.9 to 44.3) (13 studies, 1599 participants)). Self-efficacy was increased by an absolute percent of 1.66% (95% CI 1.08% to 2.20%), although evidence was low quality (SMD 0.46, 95% CI 0.34 to 0.58, equivalent to improving the ExBeliefs score on a 17 to 85 scale from 64.3 to 65.4), with small benefits for depression from moderate quality evidence indicating an absolute percent reduction of 2.4% (95% CI -0.47% to 0.5%) (SMD -0.16, 95% CI -0.29 to -0.02, equivalent to improving depression measured using HADS (Hospital Anxiety and Depression Scale) on a 0 to 21 scale from 3.5 to 3.0) but no clinically or statistically significant effect on anxiety (SMD -0.11, 95% CI -0.26 to 0.05, 2% absolute improvement, 95% CI -5% to 1% equivalent to improving HADS anxiety on a 0 to 21 scale from 5.8 to 5.4; moderate quality evidence). Five studies measured the effect of exercise on health-related quality of life using the 36-item Short Form (SF-36) with statistically significant benefits for social function, increasing it by an absolute percent of 7.9% (95% CI 4.1% to 11.6%), equivalent to increasing SF-36 social function on a 0 to 100 scale from 73.6 to 81.5, although the evidence was low quality. Evidence was downgraded due to heterogeneity of measures, limitations with blinding and lack of detail regarding interventions. For 20/21 studies, there was a high risk of bias with blinding as participants self-reported and were not blinded to their participation in an exercise intervention. Twelve studies (with 6 to 29 participants) met inclusion criteria for qualitative synthesis. Their methodological rigour and quality was generally good. From the patients' perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual's preferences, abilities and needs; challenge inappropriate health beliefs and provide better support. An integrative review, which compared the findings from quantitative trials with low risk of bias and the implications derived from the high-quality studies in the qualitative synthesis, confirmed the importance of these implications. AUTHOR'S CONCLUSIONS: Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people

Over besilaire impressie.

Gecorrigeerd via dispenserDiss. Amsterdam.OPLADEN-RUG0

A MULTI-STATION PROPRIOCEPTIVE EXERCISE PROGRAM IN PATIENTS WITH BILATERAL KNEE OSTEOARTHROSIS: FUNCTIONAL CAPACITY, PAIN AND SENSORIOMOTOR FUNCTION. A RANDOMIZED CONTROLLED TRIAL

We investigated the effects of a multi-station proprioceptive exercise program on functional capacity, perceived knee pain, and sensoriomotor function. Twenty-two patients (aged 41-75 years) with grade 2-3 bilateral knee osteoarthrosis were randomly assigned to two groups: treatment (TR; n = 12) and non-treatment (NONTR; n = 10). TR performed 11 different balance/coordination and proprioception exercises, twice a week for 6 weeks. Functional capacity and perceived knee pain during rest and physical activity was measured. Also knee position sense, kinaesthesia, postural control, isometric and isokinetic knee strength (at 60, 120 and 180°·s-1) measures were taken at baseline and after 6 weeks of training. There was no significant difference in any of the tested variables between TR and NONTR before the intervention period. In TR perceived knee pain during daily activities and functional tests was lessened following the exercise program (p < 0.05). Perceived knee pain was also lower in TR vs. NONTR after training (p < 0.05). The time for rising from a chair, stair climbing and descending improved in TR (p < 0.05) and these values were faster compared with NONTR after training (p < 0.05). Joint position sense (degrees) for active and passive tests and for weight bearing tests improved in TR (p < 0.05) and the values were lower compared with NONTR after training (p < 0.05). Postural control ('eyes closed') also improved for single leg and tandem tests in TR (p < 0.01) and these values were higher compared with NONTR after training. The isometric quadriceps strength of TR improved (p < 0.05) but the values were not significantly different compared with NONTR after training. There was no change in isokinetic strength for TR and NONTR after the training period. The results suggest that using a multi-station proprioceptive exercise program it is possible to improve postural control, functional capacity and decrease perceived knee pain in patients with bilateral knee osteoarthrosi

EFFECT OF TIME OF DAY ON THE RELATIONSHIP BETWEEN LACTATE AND VENTILATORY THRESHOLDS: A BRIEF REPORT

The purpose of this investigation was to study the effect of time of day on the relationship between lactate (LT) and ventilatory thresholds (VT) of pulmonary oxygen uptake (VO2). Seven moderately active male volunteers (26.3±3.0 years, 1.74±0.08 m, 76±5 kg) performed a maximal incremental test (increases of 30 W every 2 min) on a cycle ergometer on consecutive days at 0900 h, 1400h and 1900 h in a randomized fashion. The anaerobic threshold was determined using both ventilatory gas analysis and blood lactate measures. Each of the following variables was recorded both at VT and the LT; heart rate (HR, beats.min-1), minute ventilation (VE, L.min-1), respiratory exchange ratio (RER), time to threshold (Time, sec), oxygen uptake (VO2, ml.kg-1.min-1) and VO2 as a percentage of maximal oxygen uptake (%VO2max). The correlations between VT and LT variables analyzed by Pearson product moment correlations for each time of day. ANOVA was used to compare the data obtained at different times of the day. There were no significant differences for the data related to time of day either for ventilatory gas analysis or lactate measurements. The correlation coefficients between VT and LT variables were moderate to high (r=0.56-0.94) for time of day. However, the correlations for HR, VO2, and %VO2max (r=0.81-0.94) were slightly stronger compared with Time, VE and RER (r=0.56-0.88). It was concluded that, the data at VT and LT were not influenced by time of da

Effect of Upper-Extremity Strengthening Exercises on the Lumbar Strength, Disability and Pain of Patients with Chronic Low Back Pain: A Randomized Controlled Study

The present study aimed to analyze the impacts of a low back rehabilitation program accompanied with neck, shoulder and upper back exercises on pain, disability, and physical characteristics of patients with chronic low back pain. Twenty sedentary male patients with chronic low back pain participated in the study on a voluntary basis. The patients were randomly allocated into two groups: a conventional low back exercise group (CE) and a supported exercise group (SE; CE plus upper back, neck, and shoulder exercises). The Modified Oswestry Disability Questionnaire (MODQ) was used to evaluate the disability status and the Visual Analog Scale (VAS) was used to identify the pain states of the patients. In addition, neck, lumbar and shoulder isokinetic and isometric strengths of the patients were evaluated. The CE group performed lumbar stretching, mobilization and stabilization exercises in addition to low-back and abdominal isometric and concentric strengthening exercises. The SE group performed static stretching and isotonic exercises for the neck, upper-back, and shoulder muscles, in addition to the exercises performed in CE group. The exercises were implemented 3 days a week for 6 weeks in both groups. Following the 6-week exercise periods in both groups, statistically significant (p < 0.01) improvements were observed in the patients’ levels of pain and the scores of MODQ reflecting an easing of disability. With respect to the levels of pain and disability, the improvements observed in the SE group was significantly (p < 0.01) greater than the improvement observed in the CE group. Based on the findings of this study, we can conclude that a low back exercise program used in combination with neck, shoulder and upper back exercises reduces the level of pain and disability in patients with chronic low back pain more prominently than conventional low back exercises

Effects of Static and Dynamic Stretching on the Isokinetic Peak Torques and Electromyographic Activities of the Antagonist Muscles

The aim of this study was to investigate if static and dynamic stretching exercises of the knee muscles (quadriceps and hamstring muscles) have any effects on concentric and eccentric isokinetic peak torques and electromyographic amplitudes (EMG) of the antagonist muscles. Twenty healthy male athletes (age between 18-30 years) voluntarily participated in this study. All of the subjects visited the laboratory to complete the following intervention in a randomized order on 5 separate days; (a) non-stretching (control), (b) static stretching of the quadriceps muscles, (c) static stretching of the hamstring muscles, (d) dynamic stretching of the quadriceps muscles, and (e) dynamic stretching of the hamstring muscles. Static stretching exercises either for the quadriceps or the hamstring muscles were carried out at the standing and sitting positions. Subjects performed four successive repetitions of each stretching exercises for 30 seconds in both stretching positions. Similar to static stretching exercises two different stretching modes were designed for dynamic stretching exercises. Concentric and eccentric isokinetic peak torque for the non-stretched antagonist quadriceps or hamstring muscles at angular velocities of 60°/sec and 240°/sec and their concurrent electromyographic (EMG) activities were measured before and immediately after the intervention. Isokinetic peak torques of the non-stretched agonist hamstring and quadriceps muscles did not represent any significant (p > 0.05) differences following static and dynamic stretching of the antagonist quadriceps and hamstring muscles, respectively. Similarly, the EMG activities of the agonist muscles exhibited no significant alterations (p > 0.05) following both stretching exercises of the antagonist muscles. According to the results of the present study it is possible to state that antagonist stretching exercises either in the static or dynamic modes do not affect the isokinetic peak torques and the EMG activities of the non-stretched agonist quadriceps or hamstring muscles