Low impact weight-bearing exercise in an upright posture achieves greater lumbopelvic stability than overground walking

The aim of this study was to determine the kinematic differences between movements on a new exercise device (EX) that promotes a stable trunk over a moving, unstable base of support, and overground walking (OW). Sixteen male participants performed EX and OW trials while their movements were tracked using a 3D motion capture system. Trunk and pelvis range of motion (ROM) were similar between EX and OW in the sagittal and frontal planes, and reduced for EX in the transverse plane. The pelvis was tilted anteriorly, on average, by about 16 degrees in EX compared to OW. Hip and knee ROM were reduced in EX compared to OW. The exercise device appears to promote similar or reduced lumbopelvic motion, compared to walking, which could contribute to more tonic activity of the local lumbopelvic musculature

Fatigue Induced Changes in Muscle Strength and Gait Following Two Different Intensity, Energy Expenditure Matched Runs

Purpose: To investigate changes in hip and knee strength, kinematics, and running variability following two energy expenditure matched training runs; a medium intensity continuous run (MICR) and a high intensity interval training session (HIIT). Methods: Twenty (10F, 10M) healthy master class runners were recruited. Each participant completed the HIIT consisting of six repetitions of 800 meters with a 1:1 work: rest ratio. The MICR duration was set to match energy expenditure of the HIIT session. Hip and knee muscular strength were examined pre and post both HIIT and MICR. Kinematics and running variability for hip and knee, along with spatiotemporal parameters were assessed at start and end of each run-type. Changes in variables were examined using both 2 x 2 ANOVAs with repeated measures and on an individual level when the change in a variable exceeded the minimum detectable change (MDC). Results: All strength measures exhibited significant reductions at the hip and knee (P < .05) with time for both run-types; 12% following HIIT, 10.6% post MICR. Hip frontal plane kinematics increased post run for both maximum angle (P < 0.001) and range of motion (P = 0.003). Runners exhibited increased running variability for nearly all variables, with the HIIT having a greater effect. Individual assessment revealed that not all runners were effected post run and that following HIIT more runners had reduced muscular strength, altered kinematics and increased running variability. Conclusion: Runners exhibited fatigue induced changes following typical training runs, which could potentially increase risk of injury development. Group and individual assessment revealed different findings where the use of MDC is recommended over that of P values

Sit-to stand ground reaction force changes after hip resurfacing or total hip replacement: a pilot study

Two groups of osteoarthritis patients had their ground reaction forces measured during a sit-to-stand task at three months post-operation. One group had a 32mm femoral head fitted during a total hip replacement procedure and the other group had a hip resurfacing procedure. Three validated orthopaedic score questionnaires and an activity questionnaire were completed prior to surgery and at three months post-operation. This pilot study showed that there were no significant differences in the ground reaction forces in the operated and non-operated limb between the groups although both groups exhibited significantly higher ground reaction forces on the non-operated limb compared to the operated one. None of the orthopaedic scores showed any significant differences between the groups, despite the resurfacing group reporting higher levels of sporting activity at three months postoperation

Countermeasure Development for Lumbopelvic Deconditioning in Space

Physical inactivity and lumbopelvic deconditioning have been linked to increased incidence of non-specific low back pain (LBP) and spinal injury in those who are exposed to microgravity (e.g. astronauts and individuals on long-duration bed rest) and in the general population. Astronauts have an increased risk of experiencing moderate to severe LBP during microgravity exposure and herniated intervertebral discs within 1 year following spaceflight. Atrophy and reduced motor control of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles resulting from periods of deconditioning are linked to non-specific LBP and spinal injury risk in both post-flight astronauts and general populations. However, voluntary recruitment of these two key muscles is difficult and presents a rehabilitation challenge. This chapter reviews the concept of spinal stability as it relates to microgravity, discusses how existing exercise countermeasures used in space do not successfully maintain lumbopelvic muscle size, and introduces the functional readaptive exercise device (FRED) that shows potential to activate the LM and TrA muscles automatically and in a tonic fashion, which has relevance to rehabilitation of both astronaut and terrestrial populations

Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.

Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement of such lesions when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population. A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single surgeon, who was blinded to previous recordings, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude. Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P=0.007, χ2=0.32) and the quadriceps tendon (P=0.029, χ2=0.26), but these associations were at best fair, which could be interpreted as clinically insignificant. In which case incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology

Can patients really make an informed choice? An evaluation of the availability of online information about consultant surgeons in the United Kingdom.

Objectives - The National Health Service (NHS) 'Choose and Book' online scheme, which allows patients to select the location and time of hospital appointments, has now been extended to include the option for patients to select a specific consultant to carry out any necessary treatment. The aim of this study was to determine whether there is sufficient online information about consultants or consultant-led teams for patients to make an informed choice regarding a specific consultant. Design - A web-based analysis of the availability of information. Setting - North of England. Participants - Two hundred websites of orthopaedic surgeons. Main outcome measures - The websites were analysed using a bespoke template that took into account recommendations of the 2010 UK Government white paper. Each website was scored in relation to the availability of specific content relating to each surgeon. Results - The majority of websites detailed authorship information (73.2%), level of professional qualification (98.5%) and area of general (73.7%) and specialist (93.3%) interest. However, approximately 50% of websites provided no information in relation to update cycle, involvement in teaching or research and patient satisfaction. Only five (2.6%) of the websites presented death rates, and none indicated morbidity rates. Conclusions - For patients to be able to make informed choices about their healthcare, surgeons need to ensure that sufficient information is available online, according to the identified limitations of the websites investigated in this study

The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS)

Objectives - Vascular complications are one of the most common causes of early kidney transplant dysfunction. Contrast enhanced ultrasound increases sensitivity to tiny vascular changes.. The aim was to assess the prevalence and size of vascular abnormalities in renal transplantation patients following surgery using 3D CEUS to determine the significance of perfusion defects on renal function. Methods - Ninety nine renal transplant patients underwent 3D CEUS after surgery to quantify perfusion defects as percentage total renal volume (TRV). Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded up to three months post-surgery. Results - In the 99 patients, 20 had perfusion defects (0.2 – 43% TRV). There was a meaningful difference in patients with perfusion defects in eGFR at 1 month (90% CI 2.7 to 19.2 ml/min/1.73m2) and 3 months (90% CI 1.9 to 19.6 ml/min/1.73m2) and in Creatinine at 3 months (90% CI -56 to -8 μmol/L) using a predetermined clinical threshold. Perfusion defect size correlated well with both serum creatinine and eGFR at 3 months (R= 0.80 (p ≤ 0.000) and 0.58 (p= 0.038)). No correlation seen prior to 3 months. Conclusions - Perfusion defects in kidney transplants were more common than expected and were highly likely to reduce renal function at 1-3 months and the size of the defect affected the degree of functional change at 3 months

Why Do Patellofemoral Stabilization Procedures Fail? Keys to Success

In recent years, surgical interventions for patellofemoral joint instability have gained popularity, possibly revitalized by the recent advances in our understanding of patellofemoral joint instability and the introduction of a number of new surgical procedures. This rise in surgical intervention has brought about various complications. In this review article, we present the complications that are associated with 5 main surgical procedures to stabilize the patella-medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral release/lateral retinacular lengthening, and derotation osteotomies. The key to success and potential problems with these surgical techniques are highlighted in the form of "expert takeaways.

Optimal asymmetry and other motion parameters that characterise high-quality female dance

Dance is a universal human behaviour that is observed particularly in courtship contexts, and that provides information that could be useful to potential partners. Here, we use a data-driven approach to pinpoint the movements that discriminate female dance quality. Using 3D motion-capture we recorded women whilst they danced to a basic rhythm. Video clips of 39 resultant avatars were rated for dance quality, and those ratings were compared to quantitative measurements of the movement patterns using multi-level models. Three types of movement contributed independently to high-quality female dance: greater hip swing, more asymmetric movements of the thighs, and intermediate levels of asymmetric movements of the arms. Hip swing is a trait that identifies female movement, and the ability to move limbs asymmetrically (i.e. independently of the other) may attest to well-developed motor control, so long as this limb independence does not verge into uncontrolled pathological movement. We also found that the same level of dance quality could be predicted by different combinations of dance features. Our work opens avenues to exploring the functional significance, informational content, and temporal sequencing of the different types of movement in dance