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Jor A, Lau NWK, Daryabor A, Koh MWP, Lam WK, Hobara H, Kobayashi T. Effects of foot orthoses on running kinetics and kinematics: A systematic review and meta-analysis. Gait Posture 2024; 109:240-258. [PMID: 38367456 DOI: 10.1016/j.gaitpost.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/14/2024] [Accepted: 02/03/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of higher-order synthesis of clinical trials makes it challenging for clinicians to adopt an evidence-based approach to FOs' prescriptions. RESEARCH QUESTION Do FOs with different modifications alter lower extremity running kinematics and kinetics? METHODS A systematic search of seven databases was conducted from inception to February 2023. The analysis was restricted to healthy adults without foot musculoskeletal impairments and studies that compared the FOs effects with the controls. The methodological quality of the 35 studies that met the eligibility criteria was evaluated using the modified Downs and Black checklist. The random effects model estimated the standardized mean difference (SMD) with 95% confidence intervals and effect sizes. Sub-group analyses based on FOs type were performed to assess the potential effects of the intervention. RESULTS Our findings indicated that both custom and off-the-shelf arch-support FOs reduced peak plantar pressure at the medial heel (SMD=-0.35, and SMD=-1.03), lateral heel (SMD=-0.50, and SMD=-0.53), and medial forefoot (SMD=-0.20, and SMD=-0.27), but increased plantar pressure at the mid-foot (SMD=0.30, and SMD=0.56). Compared with the controls, significant increases (SMD=0.36) in perceived comfort were found with custom FOs. A reduction (SMD=-0.58) in initial ankle inversion was found when a raised heel cup was integrated with arch-support FOs. A medial post integrated with arch support exhibited a reduced ankle (SMD=-1.66) and tibial (SMD=-0.63) range of motion. Custom FOs, however, unfavorably affected the running economy (SMD=-0.25) and perceived exertion (SMD=0.20). SIGNIFICANCE Although FOs have been reported to have some positive biomechanical effects in healthy populations without musculoskeletal impairments or running-related issues, they need to be optimized and generalized to achieve better running performance and prevent injury.
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Affiliation(s)
- Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Noelle W K Lau
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mark W P Koh
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong, China
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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Mai P, Robertz L, Robbin J, Bill K, Weir G, Kurz M, Trudeau MB, Hollander K, Hamill J, Willwacher S. Towards functionally individualised designed footwear recommendation for overuse injury prevention: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:152. [PMID: 37951935 PMCID: PMC10638717 DOI: 10.1186/s13102-023-00760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.
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Affiliation(s)
- Patrick Mai
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg, Germany.
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway.
| | - Leon Robertz
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Johanna Robbin
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg, Germany
| | - Kevin Bill
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Gillian Weir
- Biomechanics Laboratory, University of Massachusetts Amherst, Amherst, MA, USA
| | - Markus Kurz
- Sports Tech Research Centre, Mid Sweden University, Östersund, Sweden
| | | | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Joseph Hamill
- Biomechanics Laboratory, University of Massachusetts Amherst, Amherst, MA, USA
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg, Germany
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Thong-On S, Harutaichun P. Effects of customized insoles with medial wedges on lower extremity kinematics and ultrasonographic findings in plantar fasciitis persons. Sci Rep 2023; 13:8642. [PMID: 37244973 PMCID: PMC10221742 DOI: 10.1038/s41598-023-35862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023] Open
Abstract
The customized insole is widely recommended as an effective intervention for pain reduction and foot function improvement in plantar fasciitis persons. However, it is unclear whether the additional correction of medial wedges could change the kinematics from the only insole. The objectives of this study were thus to compare customized insoles with and without medial wedges on lower extremity kinematics during gait and to determine the short-term effects of the customized insole with medial wedges on pain intensity, foot function, and ultrasonographic findings in plantar fasciitis persons. A within-subject, randomized, crossover design within motion analysis research laboratory was conducted among 35 persons with plantar fasciitis. Main outcome measures included joint motions of the lower extremity and multi-segment foot, pain intensity, foot function, and ultrasonographic findings. The customized insole with medial wedges produced less knee motion in the transverse plane and hallux motion in all planes during the propulsive phase than that without medial wedges (all p < 0.05). After the 3-month follow-up, the insoles with medial wedges decreased pain intensity and increased foot function. Abnormal ultrasonographic findings also decreased significantly after the 3-month treatment of insoles with medial wedges. Customized insoles with medial wedges seem superior to those without medial wedges on both multi-segment foot motion and knee motion during propulsion. Positive outcomes from this study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with plantar fasciitis.Trial registration: TCTR20210928006 (28/09/2021).
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Affiliation(s)
- Suthasinee Thong-On
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, Thailand
| | - Pavinee Harutaichun
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, Thailand.
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Bazett-Jones DM, Neal BS, Legg C, Hart HF, Collins NJ, Barton CJ. Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Med 2023; 53:519-547. [PMID: 36334239 DOI: 10.1007/s40279-022-01781-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. OBJECTIVE We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All study designs (prospective, case-control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. RESULTS We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) - 0.50, 95% confidence interval (CI) - 0.72, - 0.27], lower cadence (limited evidence, SMD - 0.43, 95% CI - 0.74, - 0.12), and shorter stride length (limited evidence, SMD - 0.46, 95% CI - 0.80, - 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD - 0.46, 95% CI - 0.90, - 0.03), smaller peak knee flexion angles (moderate evidence, SMD - 0.30, 95% CI - 0.52, - 0.08), and smaller peak knee extension moments (limited evidence, SMD - 0.41, 95% CI - 0.75, - 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. CONCLUSION A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data. TRIAL REGISTRATION PROSPERO # CRD42019080241.
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Affiliation(s)
- David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA.
| | - Bradley S Neal
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK.,Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Christopher Legg
- Physiotherapy Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Harvi F Hart
- School of Physical Therapy and Bone and Joint Institute, Western University, London, ON, Canada
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia.,Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
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Chen Z, Wu J, Wang X, Ren Z. The effect of foot orthoses for patients with patellofemoral pain syndrome: A systematic review and meta-analysis. Heliyon 2022; 8:e09656. [PMID: 35721679 PMCID: PMC9204664 DOI: 10.1016/j.heliyon.2022.e09656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This research quantitatively studied the benefits of foot orthoses for patients with patellofemoral pain syndrome (PFPS) from five aspects: pain intensity, knee function, sport and recreation function, knee symptoms, and knee related quality of life. Data sources Potential articles were retrieved using five electronic databases (Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang). The search period was from inception to October 17, 2021. Review methods Two researchers independently completed record retrieval and selection, data extraction, and methodological quality assessment. Pooled effect sizes were calculated using a random-effects model or fixed-effect model and a 95% confidence interval (95% CI). Data from six randomized controlled trials (RCT) meeting the inclusion criteria were extracted for meta-analysis with methodological quality assessment scores ranging from seven to ten. Results Results showed that compared to the control group, foot orthoses can significantly improve knee function (SMD = -0.45[-0.74, -0.16], P = 0.002, I 2 = 0%), and improve sport and recreation function (SMD = -0.54[-1.04, -0.03], P = 0.04, I 2 = 0%). But the foot orthoses had no significant effect in pain intensity (SMD = -0.01[-0.32, 0.30], P = 0.95, I 2 = 64), knee injury symptoms (SMD = -0.36[-0.86, 0.14], P = 0.16, I 2 = 0%), and knee related quality of life (SMD = -0.45[-0.95, 0.05], P = 0.08, I 2 = 0%).Subgroup analysis of pain intensity showed that foot orthoses had some effect compared to flat/soft inserts (SMD = -0.28[-0.57, 0.00], P = 0.05, I 2 = 0%). The effect of other treatments (physiotherapy and gait retraining) was significantly better than that of foot orthoses (SMD = 0.45[0.09, 0.80], P = 0.01, I 2 = 46%). Compared with exercise alone, the effect of foot orthoses combined with exercise was more significant (SMD = -0.98[-1.64, -0.32], P = 0.004). Conclusion The findings suggested that foot orthoses significantly improved knee function and sport and recreation function in patients with PFPS, but had no significant effect on pain intensity, knee injury symptoms, and knee related quality of life. This study supported the positive therapeutic effect of foot orthoses on PFPS.
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Affiliation(s)
- Ziyan Chen
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Jinlong Wu
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
- College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Xiaodong Wang
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen, 518060, China
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Kinematic Effect on the Navicular Bone with the Use of Rearfoot Varus Wedge. SENSORS 2022; 22:s22030815. [PMID: 35161560 PMCID: PMC8839556 DOI: 10.3390/s22030815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The rearfoot varus wedge (RVW) is a common treatment for foot pain and valgus deformity. There is research on its effects in the calcaneus, but there is little research on the navicular. More research is needed with the use of RVW due to the relationship that exists between the position of the navicular and the risk of suffering an injury. OBJECTIVES this study sought to understand how RVW can influence the kinematics of the navicular bone, measuring their movement with the 6 SpaceFastrak system. METHODS a total of 60 subjects participated in the study. Two sensors were used to measure the movement of the calcaneus and navicular using RVWs as compared in the barefoot position in a static way. RESULTS there were statistically significant differences, the use of RVWs caused changes in the navicular bone, with subjects reaching the maximum varus movement with the use of RVW 7 mm of 1.35 ± 2.41° (p < 0.001), the maximum plantar movement flexion with the use of RVW 10 mm of 3.93 ± 4.44° (p < 0.001). CONCLUSIONS when RVWs were placed under the calcaneus bone, the navicular bone response was in varus movement too; thus, the use of rearfoot varus wedge can influence the movement of the navicular bone.
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Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, Mai P. Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Med 2022; 52:1863-1877. [PMID: 35247202 PMCID: PMC9325808 DOI: 10.1007/s40279-022-01666-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. OBJECTIVE To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. DESIGN Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). DATA SOURCES PubMed. Connected Papers. The search was performed in February 2021. ELIGIBILITY CRITERIA English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. RESULTS Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. CONCLUSION This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
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Affiliation(s)
- Steffen Willwacher
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Markus Kurz
- grid.29050.3e0000 0001 1530 0805Department of Quality Technology & Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Johanna Robbin
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Matthias Thelen
- grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Joseph Hamill
- grid.266683.f0000 0001 2166 5835Biomechanics Laboratory, University of Massachusetts, Amherst, MA USA
| | - Luke Kelly
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD Australia
| | - Patrick Mai
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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Kunene S, Taukobong N, Ramklass S. Community-based rehabilitation implementation framework to address patellofemoral pain amongst runners in under-resourced communities: Delphi consensus. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1531. [PMID: 34230899 PMCID: PMC8252162 DOI: 10.4102/sajp.v77i1.1531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/19/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Runners in under-resourced communities in parts of South Africa present with a high prevalence of patellofemoral pain (PFP), which affects their level of participation in sporting activities. Therefore, a specific rehabilitation approach is necessary to manage the PFP-related needs of these runners within their means and reach. OBJECTIVE To develop a community-based rehabilitation (CBR) implementation framework for PFP amongst runners in under-resourced communities. METHOD Our study used the Delphi technique to develop an appropriate rehabilitation implementation framework for PFP in community-based settings. Sport medicine experts, involved in the treatment and rehabilitation of PFP, were recruited to participate. The Delphi process consisted of three rounds to attain consensus amongst the experts on the components and elements that could be contained in a rehabilitation implementation framework for the management of PFP. Experts rated the framework items using a five-point Likert scale. RESULTS A total of 19 experts participated in our study: 10 were females and 9 were males of whom 13 were aged between 36 and 55 years. Most were local experts (15) with 11-20 years of clinical experience. Four core rehabilitation implementation items were identified through the Delphi process. These were: (1) the establishment of transdisciplinary rehabilitation teams, (2) upskilling of available clinicians, their assistants and trainers, (3) implementation of a CBR programme at low-level or no-cost and (4) referral of cases to secondary or tertiary institutions for further management. CONCLUSION Consensus was reached for a comprehensive CBR implementation framework aimed at addressing the specific needs of runners with PFP in under-resourced communities. CLINICAL IMPLICATIONS A further study to test the feasibility of the agreed-upon intervention is recommended.
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Affiliation(s)
- Siyabonga Kunene
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nomathemba Taukobong
- Department of Institutional Planning, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Serela Ramklass
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Hoitz F, Mohr M, Asmussen M, Lam WK, Nigg S, Nigg B. The effects of systematically altered footwear features on biomechanics, injury, performance, and preference in runners of different skill level: a systematic review. FOOTWEAR SCIENCE 2020. [DOI: 10.1080/19424280.2020.1773936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fabian Hoitz
- Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada
| | - Maurice Mohr
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Sports Science, University of Innsbruck, Innsbruck, Austria
| | - Michael Asmussen
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Physical Education, Mount Royal University, Calgary, Alberta, Canada
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Beijing, China
| | - Sandro Nigg
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Benno Nigg
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Immediate effects of foot orthoses on gait biomechanics in individuals with persistent patellofemoral pain. Gait Posture 2020; 77:20-28. [PMID: 31955047 DOI: 10.1016/j.gaitpost.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented; however, the mechanisms by which foot orthoses modulate pain and function are poorly understood. RESEARCH QUESTION This within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in individuals with persistent PFP. METHODS Forty-two participants with persistent PFP (≥3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control); and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05). RESULTS Relative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: -1.00° [-1.48 to -0.53]), stair ascent (-1.06° [-1.66 to -0.45]) and stair decent (-0.94° [-1.40 to -0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (-9.8Nms/kg [-12.7 to -6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (-67.6Nms/kg [-100.7 to -34.6] and -17.5Nms/kg [-23.6 to -11.4], respectively) and descent (-50.4Nms/kg [-77.2 to -23.6] and -11.6Nms/kg [-15.6 to -7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (-3.3Nms/kg [-5.4 to -1.3]). Limited changes were observed at the knee and hip. SIGNIFICANCE In individuals with persistent PFP, small immediate changes in kinematics and angular impulses - primarily at the ankle - were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined.
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Kunene SH, Taukobong NP, Ramklass S. Rehabilitation approaches to anterior knee pain among runners: A scoping review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1342. [PMID: 32161824 PMCID: PMC7059446 DOI: 10.4102/sajp.v76i1.1342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/04/2019] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Many athletes complain of anterior knee pain (AKP) which is the most common clinical problem, with a prevalence of 15% - 45%, posing a threat to their quality of life. Owing to a lack of consensus among clinicians and researchers, the causes and management of AKP remain controversial. OBJECTIVES The aim of this study was to map the range of non-surgical and non-pharmaceutical rehabilitation approaches to AKP among runners. METHOD A scoping review was conducted in five stages: (1) defining the research question, (2) identifying relevant studies, (3) selecting a topic, (4) charting and collecting data and (5) summarising and reporting the results. Included in the study were English original articles on AKP rehabilitation strategies for runners prior to November 2019. Six electronic databases were searched: EBSCOHOST, CINAHL, SPORTDISCUS, PUBMED, COCHRANE and SCOPUS. RESULTS Thirteen out of 1334 articles met the inclusion criteria. Two reviewers independently participated in the screening and extraction of articles. The identified articles included four randomised controlled trials, one systematic review, four observational studies, one cohort study, two case studies and one quasi-experimental study. The following rehabilitation strategies were found to be useful: education, gait re-education, exercise, foot orthoses and multimodal rehabilitation. CONCLUSION This study provided a range of rehabilitation strategies that were found useful in the rehabilitation of AKP. More comprehensive intervention studies are needed to address all physical and non-physical features of AKP. CLINICAL IMPLICATIONS The outcomes of this study make explicit the usefulness of the identified rehabilitation strategies among runners with AKP. These will guide clinicians in the development of rehabilitation programmes for runners.
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Affiliation(s)
- Siyabonga H Kunene
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba P Taukobong
- Institutional Planning Department, Faculty of Administration and Support, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Serela Ramklass
- School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Acute Effects of Wedge Orthoses and Sex on Iliotibial Band Strain During Overground Running in Nonfatiguing Conditions. J Orthop Sports Phys Ther 2019; 49:743-750. [PMID: 31475615 DOI: 10.2519/jospt.2019.8837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research has identified that iliotibial band (ITB) syndrome is more prevalent in females than in males. It has been theorized that high ITB strain rate is a primary etiological factor for developing ITB syndrome. Orthoses are commonly used to influence gait mechanics and may reduce ITB strain rate by influencing alterations in the kinematic chain. OBJECTIVES To identify how wedge orthoses and sex affect ITB strain and strain rate. METHODS Thirty asymptomatic participants (15 male, 15 female) ran with 7° lateral, 3° lateral, 0° (no wedge), 3° medial, and 7° medial wedges in this within-subject, repeated-measures study. Participants ran overground while data were collected with a motion-capture system and force platform. Iliotibial band strain and strain rate were estimated using a novel 6-degrees-of-freedom musculoskeletal model. A mixed-model multivariate analysis of covariance for between-subject comparison of sex and within-subject comparison of wedge was used. RESULTS There were no significant differences in ITB strain or strain rate between wedge conditions. Females had significantly higher ITB strain and strain rate compared to males. CONCLUSION Clinicians should be aware that medial wedges may not acutely alter ITB strain or strain rate. Females exhibited greater peak ITB strain and strain rate, potentially due to increased hip internal rotation compared to males. Further research is needed to investigate longitudinal effects of the wedges. J Orthop Sports Phys Ther 2019;49(10):743-750. Epub 31 Aug 2019. doi:10.2519/jospt.2019.8837.
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Bonifácio D, Richards J, Selfe J, Curran S, Trede R. Influence and benefits of foot orthoses on kinematics, kinetics and muscle activation during step descent task. Gait Posture 2018; 65:106-111. [PMID: 30558915 DOI: 10.1016/j.gaitpost.2018.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. RESEARCH QUESTION The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). METHODS Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5o rearfoot medial wedge (R), a 5o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). RESULTS Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but reduced knee internal rotation moment compared to the C insole. Abductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. SIGNIFICANCE Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.
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Affiliation(s)
- Douglas Bonifácio
- Postgraduate Program in Rehabilitation and Functional Performance, UFVJM, Diamantina, Brazil
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - James Selfe
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Sarah Curran
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, UK
| | - Renato Trede
- Postgraduate Program in Rehabilitation and Functional Performance, UFVJM, Diamantina, Brazil.
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Relationship Between Lower-Extremity Strength and Subjective Function in Individuals With Patellofemoral Pain. J Sport Rehabil 2018; 27:327-333. [DOI: 10.1123/jsr.2016-0177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Evaluate the relationship between subjective knee function and lower-extremity strength in individuals with patellofemoral pain (PFP). Design: Cohort. Setting: Laboratory. Participants: Participants were 30 individuals with PFP (20 females and 10 males; 76.02 [17.88] kg, 173.04 [7.58] cm, and 24.9 [7] y). Main Outcome Measures: Subjects completed the Activities of Daily Living Scale (ADLS) and had lower-extremity hip and knee isometric strength assessed. Strength was compared between low and high subjective functioning ADLS groups. Correlations for strength and subjective function were assessed, with a linear regression utilized to determine if strength predicted subjective function. Results: Quadriceps strength was significantly greater in the high subjective function group (38.5 [13.9] percent body mass) than in the low subjective function group (27.88 [8.96] percent body mass, P = .02). Significant correlations were seen between the ADLS and all 5 lower-extremity strength measures (r = .376–.535). Quadriceps strength was a strong predictor of subjective function in those with PFP, explaining 28.6% of the total variance in the ADLS. Conclusions: Quadriceps strength was a strong predictor of subjective function when assessed by the ADLS in patients with PFP and significantly greater in those with higher subjective function. A strong relationship exists between self-reported function and lower-extremity strength, suggesting the need to evaluate and treat lower-extremity weakness.
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Sinclair J. Mechanical effects of medial and lateral wedged orthoses during running. Phys Ther Sport 2018; 32:48-53. [PMID: 29747079 DOI: 10.1016/j.ptsp.2018.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/26/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the current investigation was to examine the effects of orthoses with 5° medial and lateral wedges on knee joint kinetics during the stance phase of running. DESIGN Repeated measures. SETTING Laboratory. PARTICIPANTS Twelve recreational runners. OUTCOME MEASUREMENTS Twelve male participants ran over a force platform at 4.0 m/s in three different conditions (medial orthotic, lateral orthotic and no-orthotic). Lower limb kinematics were collected using an 8-camera motion capture system allowing knee kinetics to be quantified using a musculoskeletal modelling approach. Differences in knee joint kinetics between orthotic conditions were examined using one-way repeated measures ANOVA. RESULTS The results showed that peak patellofemoral force was significantly increased in the medial (31.81 N/kg) and lateral (31.29 N/kg) wedged orthoses, in comparison to the no-orthotic (29.61 N/kg) condition. In addition, the peak knee adduction moment was significantly increased in the medial (1.10 Nm/kg) orthoses, in comparison to the lateral (0.87 Nm/kg) condition. CONCLUSIONS The results from this study indicate that lateral orthoses may be effective in attenuating runners risk from medial tibiofemoral compartment OA, but that wedged orthoses may enhance their risk from patellofemoral pain.
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Affiliation(s)
- Jonathan Sinclair
- Centre for Applied Sport and Exercise Sciences, School of Sport and Wellbeing, Faculty of Health & Wellbeing, University of Central Lancashire, Lancashire, UK.
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16
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Burston J, Richards J, Selfe J. The effects of three quarter and full length foot orthoses on knee mechanics in healthy subjects and patellofemoral pain patients when walking and descending stairs. Gait Posture 2018; 62:518-522. [PMID: 29684886 DOI: 10.1016/j.gaitpost.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 04/05/2018] [Accepted: 04/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND An increased load of the patellofemoral joint is often attributed to foot function in patients with patellofemoral pain. Foot orthoses are commonly prescribed for this condition; however the mechanisms by which they work are poorly understood. The aim of this study was to investigate the kinematics and kinetics of the knee between patellofemoral pain patients and a group of healthy subjects when using a standardised foot orthosis prescription during walking and step descent. METHOD Fifteen healthy subjects and fifteen patients diagnosed with PFP with a foot posture index greater than 6, had foot orthoses moulded to their feet. They were asked to walk at a self-selected pace and complete a 20 cm step descent using customised orthoses with ¾ and full length wedges. Kinematic and Kinetic data were collected and modelled using Calibrated Anatomical System Technique. RESULTS Significant differences were seen in both the kinematics and kinetics between the healthy group and the PFP patients at the knee. A significant reduction in the knee coronal plane moment was found during the forward continuum phase of step descent when wearing the foot orthoses; this was attributed to a change in the ground reaction force as there were no changes reported in the kinematics of the knee with the orthoses. CONCLUSIONS This study identified potentially clinically important differences in the knee mechanics between the PFP patients and the healthy group during walking and step descent. The foot orthoses reduced the coronal plane knee moment in the PFP patients to a value similar to that of the healthy subjects with no intervention.
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Affiliation(s)
- J Burston
- South West Yorkshire Foundation Trust, Barnsley, UK; Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - J Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK.
| | - J Selfe
- Department of Health Professions, Manchester Metropolitan University, UK
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Fukuchi CA, Lewinson RT, Worobets JT, Stefanyshyn DJ. Effects of Lateral and Medial Wedged Insoles on Knee and Ankle Internal Joint Moments During Walking in Healthy Men. J Am Podiatr Med Assoc 2016; 106:411-418. [PMID: 28033056 DOI: 10.7547/15-077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wedged insoles have been used to treat knee pathologies and to prevent injuries. Although they have received much attention for the study of knee injury, the effects of wedges on ankle joint biomechanics are not well understood. This study sought to evaluate the immediate effects of lateral and medial wedges on knee and ankle internal joint loading and center of pressure (CoP) in men during walking. METHODS Twenty-one healthy men walked at 1.4 m/sec in five footwear conditions: neutral, 6° (LW6) and 9° (LW9) lateral wedges, and 6° (MW6) and 9° (MW9) medial wedges. Peak internal knee abduction moments and angular impulses, internal ankle inversion moments and angular impulses, and mediolateral CoP were analyzed. Analysis of variance with post hoc analysis and Pearson correlations were performed to detect differences between conditions. RESULTS No differences in internal knee joint loading were found between neutral and any of the wedge conditions. However, as the wedge angle increased from medial to lateral, the internal ankle inversion moment (LW6: P = .020; LW9: P < .001; MW6: P = .046; MW9: P < .001) and angular impulse (LW9: P = .012) increased, and the CoP shifted laterally (LW9: P < .001) and medially (MW9: P < .001) compared with the neutral condition. CONCLUSIONS Neither lateral nor medial wedges were effective in altering internal knee joint loading during walking. However, the greater internal ankle inversion moment and angular impulse observed with lateral wedges could lead to a higher risk of ankle injury. Thus, caution should be taken when lateral wedges need to be prescribed.
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Affiliation(s)
- Claudiane A. Fukuchi
- Neuroscience and Cognition Program, Federal University of ABC, São Bernardo do Campo, Brazil
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan T. Lewinson
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jay T. Worobets
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Darren J. Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
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18
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The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion. J Orthop Sports Phys Ther 2016; 46:749-55. [PMID: 27494054 DOI: 10.2519/jospt.2016.6253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.
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Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait Posture 2016; 45:69-82. [PMID: 26979886 DOI: 10.1016/j.gaitpost.2015.11.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/14/2015] [Accepted: 11/28/2015] [Indexed: 02/02/2023]
Abstract
Patellofemoral pain (PFP) is the most prevalent running pathology and associated with multi-level biomechanical factors. This systematic review aims to guide treatment and prevention of PFP by synthesising prospective, observational and intervention studies that measure clinical and biomechanical outcomes in symptomatic running populations. Medline, Web of Science and CINAHL were searched from inception to April 2015 for prospective, case-control or intervention studies in running-related PFP cohorts. Study methodological quality was scored by two independent raters using the modified Downs and Black or PEDro scales, with meta-analysis performed where appropriate. 28 studies were included. Very limited evidence indicates that increased peak hip adduction is a risk factor for PFP in female runners, supported by moderate evidence of a relationship between PFP and increased peak hip adduction, internal rotation and contralateral pelvic drop, as well as reduced peak hip flexion. Limited evidence was also identified that altered peak force and time to peak at foot level is a risk factor for PFP development. Limited evidence from intervention studies indicates that both running retraining and proximal strengthening exercise lead to favourable outcomes in both pain and function, but only running retraining significantly reduces peak hip adduction, suggesting a possible kinematic mechanism. Put together, these findings highlight limited but coherent evidence of altered biomechanics which interventions can alter with resultant symptom change in females with PFP. There is a clear need for high quality prospective studies of intervention efficacy with measurement of explanatory mechanisms.
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Affiliation(s)
- Bradley S Neal
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Christian J Barton
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom; Complete Sports Care, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Rosa Gallie
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Patrick O'Halloran
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
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Hulme A, Finch CF. From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury. Inj Epidemiol 2015; 2:31. [PMID: 26691678 PMCID: PMC4673096 DOI: 10.1186/s40621-015-0064-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022] Open
Abstract
The science of sports injury control, including both its cause and prevention, has largely been informed by a biomedical and mechanistic model of health. Traditional scientific practice in sports injury research has routinely involved collapsing the broader socioecological landscape down in order to analyse individual-level determinants of injury - whether biomechanical and/or behavioural. This approach has made key gains for sports injury prevention research and should be further encouraged and allowed to evolve naturally. However, the public health, Applied Human Factors and Ergonomics, and injury epidemiological literature more broadly, has accepted the value of a socioecological paradigm for better understanding disease and injury processes, and sports injury research will fall further behind unless it does the same. A complementary and alternative conceptual approach towards injury control known as systems thinking that builds on socioecological science, both methodologically and analytically, is readily available and fast developing in other research areas. This review outlines the historical progression of causal concepts in the field of epidemiology over the course of the modern scientific era. From here, causal concepts in injury epidemiology, and models of aetiology as found in the context of sports injury research are presented. The paper finishes by proposing a new research agenda that considers the potential for a systems thinking approach to further enhance sports injury aetiological understanding. A complementary systems paradigm, however, will require that sports injury epidemiologists bring their knowledge and skillsets forwards in an attempt to use, adapt, and even refine existing systems-based approaches. Alongside the natural development of conventional scientific methodologies and analyses in sports injury research, progressing forwards to a systems paradigm is now required.
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Affiliation(s)
- Adam Hulme
- Australian Centre for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, Victoria 3353 Australia
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Garbalosa JC, Elliott B, Feinn R, Wedge R. The effect of orthotics on intersegmental foot kinematics and the EMG activity of select lower leg muscles. Foot (Edinb) 2015; 25:206-14. [PMID: 26362236 DOI: 10.1016/j.foot.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persons with exertional related leg pain are managed using orthoses. This study aimed to determine the effectiveness of two orthoses in altering foot motion and muscle activity in symptomatic individuals. METHODS 52 subjects with lower extremity pain complaints of a non-traumatic, mechanical origin received one of two orthoses. Foot kinematics and EMG activity were recorded while treadmill walking in 3 footwear conditions. The peak EMG activity of the sandal and sandal orthotic trials (normalized to peak barefoot values) and foot motion during 4 subphases of stance were obtained. Using a multivariate multilevel model via linear mixed models, the effect of orthoses within these phases on motion and EMG was determined. RESULTS An effect of orthotic type was not present for any of the rearfoot or forefoot motions (p>.10). A significant effect of footwear and orthotic type on first ray motion (p<.05) during subphases 2 and 4 was seen. During subphase 4 an interaction effect between footwear condition and orthotic type on tibialis posterior EMG activity (p=.036) was present. CONCLUSION Orthoses are unable to control rear or midfoot motion but appear to control first ray motion and during late stance, affect tibialis posterior muscle activity. Public trials registry number: NCRT02143947.
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Affiliation(s)
- Juan C Garbalosa
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States; Department of Physical Therapy, Quinnipiac University, Hamden, CT, United States.
| | - Bruce Elliott
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States
| | - Richard Feinn
- Frank H Netter, MD, School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Ryan Wedge
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States; Department of Physical Therapy, Quinnipiac University, Hamden, CT, United States
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Lewinson RT, Wiley JP, Humble RN, Worobets JT, Stefanyshyn DJ. Altering Knee Abduction Angular Impulse Using Wedged Insoles for Treatment of Patellofemoral Pain in Runners: A Six-Week Randomized Controlled Trial. PLoS One 2015; 10:e0134461. [PMID: 26230399 PMCID: PMC4521888 DOI: 10.1371/journal.pone.0134461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Determine if a change in internal knee abduction angular impulse (KAAI) is related to pain reduction for runners with patellofemoral pain (PFP) by comparing lateral and medial wedge insole interventions, and increased KAAI and decreased KAAI groups. Design Randomized controlled clinical trial (ClinicalTrials.gov ID# NCT01332110). Setting Biomechanics laboratory and community. Patients Thirty-six runners with physician-diagnosed PFP enrolled in the trial, and 27 were analyzed. Interventions Runners with PFP were randomly assigned to either an experimental 3 mm lateral wedge or control 6 mm medial wedge group. Participants completed a biomechanical gait analysis to quantify KAAIs with their assigned insole, and then used their assigned insole for six-weeks during their regular runs. Usual pain during running was measured at baseline and at six-week follow-up using a visual analog scale. Statistical tests were performed to identify differences between wedge types, differences between biomechanical response types (i.e. increase or decrease KAAI), as well as predictors of pain reduction. Main Outcome Measures Percent change in KAAI relative to neutral, and % change in pain over six weeks. Results Clinically meaningful reductions in pain (>33%) were measured for both footwear groups; however, no significant differences between footwear groups were found (p = 0.697). When participants were regrouped based on KAAI change (i.e., increase or decrease), again, no significant differences in pain reduction were noted (p = 0.146). Interestingly, when evaluating absolute change in KAAI, a significant relationship between absolute % change in KAAI and % pain reduction was observed (R2 = 0.21; p = 0.030), after adjusting for baseline pain levels. Conclusion The greater the absolute % change in KAAI during running, the greater the % reduction in pain over six weeks, regardless of wedge type, and whether KAAIs increased or decreased. Lateral and medial wedge insoles were similar in effectiveness for treatment of PFP. Clinical Relevance Altering KAAI should be a focus of future PFP research. Lateral wedges should be studied further as an alternative therapy to medial wedges for management of PFP. Trial Registration ClinicalTrials.gov NCT01332110
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Affiliation(s)
- Ryan T. Lewinson
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - J. Preston Wiley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - R. Neil Humble
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jay T. Worobets
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Darren J. Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
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Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau C. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 2014; 22:2264-74. [PMID: 24221245 PMCID: PMC4169618 DOI: 10.1007/s00167-013-2759-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 10/28/2013] [Indexed: 01/31/2023]
Abstract
UNLABELLED The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany,
| | | | | | | | | | | | - Christian Liebau
- Asklepios Harzkliniken GmbH Fritz-König-Stift, Bad Harzburg, Germany
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