Le syndrome fémoropatellaire chez les coureurs : effets de différentes approches de réadaptation basées sur les mécanismes sous-jacents

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2016-2017Soixante-neuf coureurs ayant un syndrome fémoropatellaire (SFP) ont participé à une session d’évaluation pendant laquelle les symptômes et limitations fonctionnelles, la force musculaire, les chaussures de course, la cinématique et la cinétique de course et l’état radiologique du genou atteint ont été évalués. Pendant la technique de course habituelle, l’utilisation de chaussures montrant un niveau de minimalisme plus important tel qu’objectivé par l’Indice minimaliste était associée à une cadence des pas plus élevée ainsi qu’un angle d’inclinaison du pied et une force à l’articulation fémoropatellaire moindres, qui représentent des variables clés dans le traitement du SFP selon la littérature actuelle. Des modifications au patron de course habituel ont permis de diminuer la douleur de façon immédiate chez une portion des coureurs, en lien avec une réduction de la cinétique fémoropatellaire. Chez les attaqueurs du talon, le fait d’augmenter la cadence, de transférer vers une attaque de l’avant-pied et de courir sans bruit ont été les modifications les plus efficaces, en comparaison avec l’augmentation de la cadence et la course sur l’avant-pied chez les attaqueurs non-talon. Les coureurs ont ensuite été assignés à un programme de réadaptation d’une durée de 8 semaines parmi (1) éducation sur les modifications d’entraînement en fonction des symptômes; (2) programme d’exercices en plus de la composante d’éducation; (3) modifications au patron de course en plus de la composante d’éducation. Les trois programmes ont mené à des améliorations significatives sur les niveaux de symptômes et de limitations fonctionnelles. Cependant, bien que les mécanismes sous-jacents aux modifications du patron de course et au programme d’exercices aient bel et bien été modifiés, l’ajout de telles composantes à l’éducation n’a pas procuré de bénéfice supplémentaire à une intervention impliquant seulement l’éducation. Globalement, 78% des coureurs ont atteint le critère de succès clinique au suivi 3 mois après la fin de l’intervention. La combinaison du niveau de symptômes et de limitations fonctionnelles, de la force des extenseurs du genou et de l’intégrité du tendon rotulien a montré la meilleure capacité à prédire le succès clinique suite à une intervention mettant l’emphase sur l’éducation chez cette cohorte de coureurs ayant un SFP.Sixty-nine runners with patellofemoral pain (PFP) took part in a baseline assessment during which their level of symptoms and function, lower limb strength, running shoes, running kinematics and kinetics as well as radiological outcomes were evaluated. During the habitual running pattern, the use of footwear showing a greater level of minimalism as indicated by the Minimalist Index was associated with outcomes that have previously been suggested to treat PFP in runners, namely greater step rate, lower foot inclination angle and lower patellofemoral joint kinetics. Running gait modifications, which were linked with decreased patellofemoral joint kinetics, were efficient in immediately decreasing symptoms in a subset of runners. In rearfoot strikers, the most efficient modifications were increasing step rate, forefoot striking and running softer, while non-rearfoot strikers benefited from increasing step rate and forefoot striking. Runners were then assigned to one of three 8-week rehabilitation programs among (1) education on training modifications based on symptoms; (2) an exercise program in addition to the education component; (3) gait retraining in addition to the education component. All programs led to significant improvements in the levels of symptoms and functional limitations. Even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits. Globally, 78% reached clinical success at the follow-up 3 months after the end of the program. A combination of the level of symptoms and function, knee extensors strength and patellar tendon integrity best predicted clinical success of runners with PFP following an intervention focused on education

Effets d'un programme de réadaptation sur les symptômes et le niveau fonctionnel de coureurs souffrant d'un syndrome fémoropatellaire

La force musculaire ainsi que l'activation musculaire, la cinématique et les forces d'impact lors de la course de 21 coureurs souffrant d'un syndrome fémoropatellaire (SFP) ont été comparés à ceux de 20 coureurs sans douleur afin de déterminer si les coureurs ayant un SFP présentent des déficits au niveau de ces variables. Bien qu'aucune différence entre les groupes n'ait été observée lorsque tous les coureurs étaient considérés, des différences spécifiques au sexe et au type d'attaque au sol ont été notées. Une intervention de réadaptation incluant des exercices de renforcement et de contrôle moteur ainsi que des conseils sur la technique de course et sur la gestion de l'entraînement a ensuite été évaluée chez les coureurs souffrant d’un SFP, et a été démontrée efficace pour améliorer les symptômes et le niveau fonctionnel. La réduction des forces d'impact au sol semble avoir joué un rôle clé dans le succès de l'intervention.Lower limb strength as well as running kinematics, muscle activation and ground reaction forces were compared between 21 runners with and 20 without patellofemoral pain syndrome (PFPS). When considering all runners, no between-group differences were found for all of the variables that had been previously identified as risk factors for developing PFPS. However, sub-analyses revealed differences specific to gender and foot strike pattern. Thereafter, a standardised 8-week rehabilitation intervention, including lower limb strengthening, core strengthening and motor control exercises in addition to advice on running technique and training modifications according to symptoms, was shown effective in improving symptoms and function in runners with PFPS. The reduction in ground reaction forces differentiated between successful and unsuccessful outcomes. Since no change in lower limb strength or proximal running kinematics and muscle activation were found, treatment modalities applied specifically during the task of running may explain rehabilitation success in this population

The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis

International Journal of Exercise Science 16(3): 721-743, 2023. Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design: Systematic review and meta-analysis. Data sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL. Eligibility criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence

Metabolic and performance responses of male runners wearing 3 types of footwear: Nike Vaporfly 4%, Saucony Endorphin racing flats, and their own shoes

Purpose We compared running economy (RE) and 3-km time-trial (TT) variables of runners wearing Nike Vaporfly 4% (VP4), Saucony Endorphin lightweight racing flats (FLAT), and their habitual running (OWN) footwear. Methods Eighteen male recreational runners (age = 33.5 ± 11.9 year (mean ± SD), peak oxygen uptake (VO2peak) = 55.8 ± 4.4 mL/kg·min) attended 4 sessions approximately 7 days apart. The first session consisted of a VO2peak test to inform subsequent RE speeds set at 60%, 70%, and 80% of the speed eliciting VO2peak. In subsequent sessions, treadmill RE and 3-km TTs were assessed in the 3 footwear conditions in a randomized, counterbalanced crossover design. Results Oxygen consumption (mL/kg·min) was less in VP4 (from 4.3% to 4.4%, p ≤ 0.002) and FLAT (from 2.7% to 3.4%, p ≤ 0.092) vs. OWN across intensities, with a non-significant difference between VP4 and FLAT (1.0%–1.7%, p ≥ 0.292). Findings related to energy cost (W/kg) and energetics cost of transport (J/kg·m) were comparable. VP4 3-km TT performance (11:07.6 ± 0:56.6 mm:ss) was enhanced vs. OWN by 16.6 s (2.4%, p = 0.005) and vs. FLAT by 13.0 s (1.8%, p = 0.032). The 3-km times between OWN and FLAT (0.5%, p = 0.747) were similar. Most runners (n = 11, 61%) ran their fastest TT in VP4. Conclusion Overall, VP4 improved laboratory-based RE measures in male recreational runners at relative speeds compared to OWN, but the RE improvements in VP4 were not significant vs. FLAT. More runners exhibited better treadmill TT performances in VP4 (61%) vs. FLAT (22%) and OWN (17%). The variability in RE (–10.3% to 13.3%) and TT (–4.7% to 9.3%) improvements suggests that responses to different types of shoes are individualized and warrant further investigation

Quadriceps strengthening with blood flow restriction for the rehabilitation of patients with knee conditions: A systematic review with meta-analysis.

The purpose of this systematic review with meta-analysis was to compare the effects of low load resistance combined with blood flow restriction (BFR) versus conventional quadriceps strengthening on knee symptoms and function as well as knee extensor strength and muscle thickness in adults with knee conditions.info:eu-repo/semantics/publishe

Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021

International audienceBackground The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/3802

Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021

Background The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/38027info:eu-repo/semantics/publishe