Advanced Glycation End Products and Mobility Decline: A Novel Perspective on Aging

Background/Objectives: Advanced Glycation End Products (AGEs) are high-molecular-weight compounds formed through non-enzymatic reactions between sugars and proteins, lipids, or nucleic acids. This study aimed to comprehensively analyze the association between the accumulation of AGEs and lower-limb muscle strength, gait speed, and balance abilities related to mobility in elderly individuals. Methods: This cross-sectional correlational study included 552 community-dwelling older adults. AGE accumulation was assessed using skin autofluorescence (SAF) measured using an AGE reader. Mobility decline factors were evaluated using the sit-to-stand (STS), gait speed (4 m walk tests), single-leg stance (SLS), and Timed Up and Go (TUG) tests. Results: A comparison of the physical function across the quartile groups revealed that the group with the highest SAF values, Q4, exhibited a general decline in STS, gait speed, SLS, and TUG performance when compared with the other groups (p < 0.001). Spearman's correlation analysis revealed that the SAF-AGEs demonstrated significant negative correlations with STS (r = -0.211, p < 0.001), gait speed (r = -0.243, p < 0.001) and SLS (r = -0.201, p < 0.001). Additionally, TUG showed a significant positive correlation (r = 0.239, p < 0.001). In the logistic regression analysis, compared with the Q1 group, the Q4 group had significantly higher odds of low STS performance (odds ratio (OR) = 2.43, p = 0.006), slow gait speed (OR = 2.28, p = 0.002), low SLS performance (OR = 2.52, p = 0.001), and slow TUG (OR = 2.00, p = 0.035). The optimal cutoff value of the SAF for mobility decline was 3.15 (area under the curve 0.694; 95% confidence interval: 0.618-0.771). Conclusions: This study has demonstrated that higher SAF values were associated with decreased lower-limb strength, gait speed, and balance, thereby suggesting that SAF may be a useful screening tool for predicting mobility decline in older adults.

Stair-Climbing Training with Interferential Electrotherapy Improves Knee Muscle Strength, Dynamic Postural Stability, Pain Score, and Physical Activity in Patients with Knee Osteoarthritis

Background/Objective: This study aimed to compare the functional outcomes, such as knee muscle strength, dynamic postural stability, pain scores, and physical activity, in patients with knee osteoarthritis (OA) on stair climbing training with and without interferential electrotherapy (IFE) for 12 weeks. Methods: A total of 40 knee OA patients with Kellgren-Lawrence (K-L) grade ≤ 2 were enrolled (20 stair-climbing training with IFE vs. 20 stair-climbing training without IFE). The knee quadriceps and hamstring muscle strengths were measured using an isokinetic device. The dynamic postural stability was assessed using postural stabilometry. The pain score was evaluated using the visual analog scale (VAS). Physical activity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The WOMAC score was significantly different (p < 0.019) between stair-climbing training with and without IFE in patients with knee OA, while knee muscle strength, dynamic postural stability, or pain score were not (all p > 0.05). Conclusion: Stair-climbing training with IFE was more beneficial for physical activity recovery than stair-climbing training without IFE. Therefore, clinicians and therapists should be aware that stair climbing, which can be practiced in daily life for the management of patients with knee OA, and the addition of IFE may improve physical activity.

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis

Purpose

The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests.

Methods

Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18-60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool.

Results

Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = -0.56; 95% CI = -1.00 to -0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18-1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04-1.75).

Conclusion

Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting.

Level of Evidence

Level III, systematic review with meta-analysis.

Impact of lumbar delayed-onset muscle soreness on postural stability in standing postures

BACKGROUND

Similar impact on proprioception has been observed in participants with lumbar delayed-onset muscle soreness (DOMS) and chronic low back pain (LBP), raising questions about the relevance of lumbar DOMS as a suitable pain model for LBP when assessing back pain-related postural stability changes.

RESEARCH QUESTION

Does lumbar DOMS impact postural stability?

METHODS

Twenty healthy adults participated in this experimental study and underwent a posturographic examination before and 24 to 36 h after a protocol designed to induce lumbar DOMS. Posturographic examination was assessed during quiet standing on both feet with eyes opened (EO), with eyes closed (EC), and on one-leg (OL) standing with eyes opened. Postural stability was assessed through center of pressure (COP) parameters (COP area, velocity, root mean square, mean power frequency) which were compared using repeated measure ANOVA. Moreover, pain, soreness and pressure pain threshold (PPT) on specific muscles were assessed.

RESULTS

There was a significant main effect of the postural condition on all COP variables investigated. More specifically, each COP variable reached a significantly higher value in the OL stance condition than in both EO and EC bipedal conditions (all with p < 0.001). In addition, the COP velocity and the mean power frequency along the anteroposterior direction both reached a significantly higher value in EC than in EO (p < 0.001). In contrast, there was no significant main effect of the DOMS nor significant DOMS X postural condition interaction on any of the COP variables. There was a significant decrease in the PPT value for both the left and right erector spinae muscles, as well as the left biceps femoris.

SIGNIFICANCE

Lumbar DOMS had no impact on postural stability, which contrasts findings in participants with clinical LBP. Although DOMS induces similar trunk sensorimotor adaptations to clinical LBP, it does not appear to trigger similar postural stability adaptations.

The Convergent Validity of the SWAY Balance Application to Assess Postural Stability in Military Cadets Recovering from Concussion

Background

Concussions are often accompanied by balance disturbances. Clinically accurate evaluation systems are often expensive, large, and inaccessible to most clinicians. The Sway Balance Mobile Application (SWAY) is an accessible method to quantify balance changes.

Purpose

To determine the known groups and convergent validity of the SWAY to assess balance after a concussion.

Study Design

Case-Control Study.

Methods

Twenty participants with acute concussion and twenty controls were recruited. At initial, one-week, and final return to activity (RTA) evaluations, all participants completed the Sports Concussion Assessment Tool (SCAT-5), and balance control measured by SWAY mBESS and NeuroCom Balance Master Sensory Organization Test (SOT). Mixed model ANOVAs were used to detect differences in SWAY mBESS and NeuroCom SOT scores with time (initial, one-week, final RTA) as the within-subjects factor and group (concussed, healthy) as the between-subjects factor. Spearman's Rho correlations explored the associations between NeuroCom SOT scores, SWAY scores, SCAT-5 symptom scores, and time in days to final RTA.

Results

The sampled population was predominantly male and age (20 ± 1), and BMI differences were insignificant between groups. The SWAY did not detect differences between healthy and concussed participants and did not detect change over time [F(2,40) = .114, p = 0.89; F(2,40)= .276, p =0.60]. When assessing the relationship between the SWAY and the SOT, no correlation was found at any time point (r = -0.317 to -0.062, p > 0.05). Time to RTA demonstrated a moderate correlation with both SCAT-5 symptom severity score (r = .693, p < 0.01) and SCAT-5 total symptom score (r = .611, p < 0.01) at the one-week follow-up.

Conclusion

The SWAY mBESS does not appear to be a valid balance assessment for the concussed patient. The SWAY mBESS in patients with concussion failed to demonstrate convergent validity and did not demonstrate an ability to validate known groups. When assessing the time to final RTA, the one-week post-initial assessment SCAT-5 symptom severity and total scores may help determine the length of recovery in this population.

Level of Evidence

Level 3.

A new balance assessment tool for quantifying balance impairment in patients with motor incomplete spinal cord injury: Pilot study

OBJECTIVE

This study aimed to quantitatively and objectively evaluate the balance impairment in patients with motor incomplete spinal cord injury (SCI) using a new evaluation tool for balance and to assess its role in comprehensive balance assessment.

DESIGN

Retrospective pilot study.

SETTING

Rehabilitation hospital.

PARTICIPANTS

14 patients with motor incomplete spinal cord injury.

INTERVENTIONS

None.

OUTCOME MEASURES

We retrospectively compared and analyzed the results of 14 patients with motor incomplete SCI who underwent various balance assessments, including the FRA510S test, using correlation.

RESULTS

The agreement between the FRA510S and existing balance assessment was confirmed through Bland-Altman plots; moreover, high degree of agreement was observed in Berg Balance Scale in the eye closed state and in Five Times Sit-to-Stand Test in the eye open state.

CONCLUSIONS

It was confirmed that the FRA510S equipment provides quantitative values for balance function. Balance assessment using the FRA510S, along with neurological, electrophysiological, and clinical tests, may provide comprehensive additional information related to falls and gait rehabilitation in patients with SCI.

The Influence of Anthropometric Variables and Filtering Frequency on Center of Pressure Data

Good postural control is considered to be a key component of an active lifestyle, and numerous studies have investigated the Center of Pressure (CoP) as a way of identifying motor deficits. However, the optimal frequency range for assessing CoP variables and the effect of filtering on the relationships between anthropometric variables and CoP are unclear. The aim of this work is to show the relationship between anthropometric variables and different ways of filtering the CoP data. CoP was measured in 221 healthy volunteers using a KISTLER force plate in four different test conditions, both mono and bipedal. The results show no significant changes in the existing correlations of the anthropometric variable values over different filter frequencies between 10 Hz and 13 Hz. Therefore, the findings with regard to anthropometric influences on CoP, with a reasonable but less than ideal filtering of the data, can be applied to other study settings.

Effect of Coronavirus 19 on Maintaining Balance in Skilled Athletes

Preliminary studies have reported that motor control is negatively impacted following an infection of COVID-19. The purpose of this study was to evaluate the effect of COVID-19 on maintaining balance in highly skilled athletes. As part of a larger investigation that was initiated in 2019, twelve professional handball players were recruited to participate in a study that was designed to measure static balance performance. Following the initial pre-test, six participants (body height 184.8 ± 4.7 cm; body weight 85.5 ± 3.3 kg; age 21.3 ± 1.2 years) were infected with COVID-19. The remaining six participants (body height 188.7 ± 2.6 cm; body weight 92.3 ± 3.7 kg; age 26.3 ± 3.3 years) never tested positive for COVID-19 and were presumably not infected with the virus. The experimental design required all the participants to complete an initial balance assessment (pre-test) and a later balance assessment (post-test). To fully analyze our data, we conducted a 2 (condition: COVID, no-COVID) X 2 (test: pre-test, post-test) ANOVA with repeated measures on the second factor. Our analysis revealed that the skilled athletes who contracted COVID-19 had a significant decrease in balance performance from the pre-test that occurred prior to being infected with COVID-19 relative to the post-test that occurred following the COVID-19 infection. Additionally, the skilled athletes who were not infected with COVID-19 did not demonstrate the same deterioration in balance performance in the same period. This study highlights the impact COVID-19 has on static balance performance in a group of highly skilled handball players. Longitudinal studies are needed to fully understand the lasting impacts COVID-19 has on motor behavior.

RENaBack: low back pain patients in rehabilitation-study protocol for a multicenter, randomized controlled trial

BACKGROUND

Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.

METHODS

The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).

DISCUSSION

An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.

TRIAL REGISTRATION

DRKS, DRKS00020373 . Registered on 15 April 2020.

Quantitative assessment of postural balance in patients with chronic anterior cruciate ligament injury- A controlled study

PURPOSE

Evaluation of single and double limb support postural balance in patients with Anterior cruciate ligament (ACL)injury and comparison of the postural strategy adopted after ACL injury/deficiency(ACLD) with that of an age-matched healthy individual.

METHODS

The study group that included 33 subjects confirming inclusion criteria had undergone postural balance assessment using the HUMAC Balance system. The parameters of the center of pressure excursion were recorded on a force plate and compared with age, BMI matched 66 healthy volunteers of control group. The center of pressure excursions was monitored using dependable variables such as sway path length(cm), the average velocity of sway(cm/sec), and the mean COP stability score(%). The mobility component was recorded as the percentage (%) of time spent on each target.

RESULT

A decrease in postural balance in the injury group was evidenced by a statistically significant decrease of stability score(p = 0.015), increase in path length(p = 0.002) and decrease on time on target mean score (p= <0.001),. Although, the stability score path length and average sway velocity scores in the sound limb of the ACLD group showed impaired balance, the differences were not statistically significant (p = 0.180, p = 0.561, and p = 0.639 respectively) when compared with the dominant limb of the control group.

CONCLUSION

HUMAC balance system is an effective and simplified measure for quantifying postural balance. Although overall postural stability in ACL injury is impaired, static postural balance is maintained by the compensatory of strategy of sound limb. However, the quantitative parameters of postural stability for the sound limb, despite of a lower mean value, did not show statistically significant differences from the dominant limb of the controlled group.

An Investigation of Differences in Lower Extremity Biomechanics During Single-Leg Landing From Height Using Bionic Shoes and Normal Shoes

Bionic shoes utilizing an actual foot shape sole structure can alter lower limb’s biomechanics, which may help in the development of specific training or rehabilitation programs. The purpose of this study was to investigate the biomechanical differences in the lower limb during a single-leg landing task using bionic shoes (BS) and normal shoes (NS). Fifteen healthy male subjects participated in this study, sagittal, and frontal plane data were collected during the landing phase (drop landing from 35 cm platform). Our study showed that BS depicted a significantly greater minimum knee flexion angle at initial contact (p = 0.000), a significantly greater minimum (initial contact) hip flexion angle at initial contact (p = 0.009), a significantly smaller sagittal plane total energy dissipation (p = 0.028), a significantly smaller frontal plane total energy dissipation (p = 0.008), a significantly smaller lower limb total energy dissipation (p = 0.017) than NS during the landing phase. SPM analysis revealed that BS depicted a significantly smaller knee joint vertical reaction force during the 13.8–19.8% landing phase (p = 0.01), a significantly smaller anterior tibia shear force during the 14.2–17.5% landing phase (p = 0.024) than NS. BS appears to change lower limb kinematics at initial contact and then readjust the landing strategies for joint work and joint reaction force, thereby reducing the risk of lower limb skeletal muscle injury. BS have great potential for future development and application uses, which may help athletes to reduce lower limb injury risk.

Foot Posture Index Reference Values among Young Adults in Saudi Arabia and Their Association with Anthropometric Determinants, Balance, Functional Mobility, and Hypermobility

Background

The foot posture index (FPI) is a valid, reliable, and multidimensional method for determining foot posture in a wide range of clinical settings. To date, no normative data of healthy young adults in Saudi Arabia have been available for comparison and reference. Hence, this study is aimed at establishing the FPI reference values, gender, and side differences of FPI and their association with anthropometric determinants, balance, functional mobility, and hypermobility.

Methods

FPI was assessed in 581 (291 men and 290 women) healthy young adults aged 18–25 years. The FPI range was obtained for both feet as the sum of the scores (–2, –1, 0, 1, and 2) given to each criterion: (–1 to –12) supinated foot, (0 to +5) neutral foot, and (+6 to +12) pronated foot. The study furthermore assessed the balance using a near tandem balance test, functional mobility by stair ascent and descent test, and joint hypermobility via the Beighton scale.

Results

The average FPI score was 2.76 ± 5.23 for all subjects, 2.98 ± 5.02 for men and 2.55 ± 5.43 for women. Neutral foot posture was most frequent in this study (52.9%). A higher proportion of women had pronated (21.0%) and supinated (11.7%) feet than men which were 16.8% and 10.3%, respectively. This study also confirmed that side differences were found to be significant (p value < 0.001), whereas gender differences were significant only in the normal, pronated, and supinated foot groups.

Conclusion

The most common foot posture in both genders was ranged from neutral to slight pronation. We also found a correlation between balance with FPI in the supinated and hypersupinated foot groups, functional mobility with FPI of pronated and supinated foot groups, and joint hypermobility with FPI of the hyperpronated foot group.

Acute ankle sprain in athletes: Clinical aspects and algorithmic approach

Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

Dynamic Balance Evaluation: Reliability and Validity of a Computerized Wobble Board

Fusco, A, Giancotti, GF, Fuchs, PX, Wagner, H, Varalda, C, Capranica, L, and Cortis, C. Dynamic balance evaluation: reliability and validity of a computerized wobble board. J Strength Cond Res 34(6): 1709-1715, 2020-Computerized wobble boards (WBs) are inexpensive, transportable, and user-friendly devices to objectively quantify the dynamic balance performances out of laboratory settings, although it has not been established if they are reliable and valid tools. Therefore, the purpose of this study was to determine the reliability and validity of a computerized WB. Thirty-nine (18 females and 21 males) young adults (age: 23.3 ± 2.1 years; body mass: 65.9 ± 1.8 kg; height: 168.2 ± 8.8 cm; leg length: 78.8 ± 5.7 cm; and body mass index: 23.2 ± 2.1 kg·m) participated in the study. Subjects were assessed during 3 separate sessions on different days with a 48-hour rest in between. A total number of 2 WB single limb tests and 1 Y Balance Test (YBT) were performed. The WB performance was registered using the proprietary software and represented by the time spent in the target zone, which represented the 0° tilt angle measured by the triaxial accelerometer in the WB. YBT normalized reach distances were recorded for the anterior, posteromedial, and posterolateral directions. Intraclass correlation coefficient, 95% confidence interval, SEM, minimal detectable change, and Bland-Altman plots were used to evaluate intrasession and intersession reliability, whereas Pearson product moment correlation was used to determine concurrent validity. Reliability ranged from fair to excellent, showing acceptable levels of error and low minimal detectable change. However, all correlation coefficients between WB and YBT outcomes were poor. Despite the 2 methods addressing different aspects of balance performance, WB seems to validly serve its purpose and showed good reliability. Therefore, computerized WBs have the potential to become essential devices for dynamic balance assessment.

The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

BACKGROUND

Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate.

METHODS

Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions.

RESULTS

The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups.

CONCLUSION

Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).

Temporal Kinematic Differences between Forward and Backward Jump-Landing

Backward jump-landing during sports performance will result in dynamic postural instability with a greater risk of injury, and most research studies have focused on forward landing. Differences in kinematic temporal characteristics between single-leg and double-leg backward jump-landing are seldom researched and understood. The purpose of this study was to compare and analyze lower extremity kinematic differences throughout the landing phases of forward and backward jumping using single-leg and double-leg landings (FS and BS, FD and BD). Kinematic data were collected during the landing phases of FS and BS, FD and BD in 45 participants. Through statistical parametric mapping (SPM) analysis, we found that the BS showed smaller hip and knee flexion and greater vertical ground reactive force (VGRF) than the FS during 0–37.42% (p = 0.031), 16.07–32.11% (p = 0.045), and 23.03–17.32% (p = 0.041) landing phases. The BD showed smaller hip and knee flexion than the FD during 0–20.66% (p = 0.047) and 0–100% (p < 0.001) landing phases. Most differences appeared within a time frame during the landing phase at 30–50 ms in which non-contact anterior cruciate ligament (ACL) injuries are thought to occur and are consistent with the identification of risk in biomechanical analysis. A landing strategy that consciously increases the knee and hip flexion angles during backward landing should be considered for people as a measure to avoid injury during the performance of this type of physical activity.

Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes

Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.

Haemodialysis patients have worse postural balance with an associated risk of falls

INTRODUCTION

Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform.

MATERIAL AND METHODS

This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions.

RESULTS

We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m². In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P<.05). The 4 patients with hyponatraemia (Na<136mmol/l) had worse balance in the simultaneous task situation (P=.038). Various drugs, such as insulin (P=.022), antiplatelet agents (P=.036) and beta-blockers (P=.029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area95 and AreaEffect, both pre- and post-haemodialysis (P<.05) than those without falls.

CONCLUSIONS

Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population.

Reliability of a New Test of Balance Function in Healthy and Concussion Populations

Providing quantitative measures of balance and posture is a valuable aid in clinical assessment and in recent years several devices have been introduced that have demonstrated the accurate measure of balance via deviation of center of mass utilizing software algorithms and mobile devices. The purpose of this study was to assess the accuracy of EQ Balance against the Sway^TM Balance System (Sway), another balance device that is currently established as an accurate measure of balance, and to evaluate the test-retest reliability of EQ Balance. Seventy individuals presenting to a sports medicine and concussion clinic volunteered to participate in the assessment of balance utilizing Sway and EQ Balance simultaneously. The group included 25 males and 45 females (mean age: 37.8 ± 14.8, range: 13-65) with and without concussion or other neurological conditions (39 concussed vs. 31 non-neurologically injured, or healthy). Twenty-six of the concussed participants were balance-impaired. Participants performed five postures while holding the mobile device against their chest. Participants held a device holder that secured two devices: one iPhone 6 with EQ Balance and a second iPhone 6 with Sway Balance. The average balance score on all five stances was recorded as the "average balance score". Average balance scores were in statistical agreement between the two methods across the entire group, and for sub-groups according to the Deming regression (p < 0.01). The intra-class correlation (ICC) for the cohort was 0.87 (p < 0.001). Across the cohort, EQ Balance measured significantly worse balance scores in the balance-impaired group, comprised of participants with brain injury who failed a clinical balance screening test, compared to the group without clinically-determined balance impairment (this group includes healthy and some concussed patients). EQ Balance demonstrated safety, as it was considered safe to perform independently (i.e., without an observer) in those with impaired balance, and high test- retest reliability in the healthy and concussed patient population. Statistical agreement was established between the two measures of EQ Balance and Sway Balance for the average balance score across all five stances. The ICC analysis demonstrates strong consistency of the task output between test sessions. Given these results, EQ Balance demonstrates strength as a new balance assessment tool to accurately measure balance performance as part of a unique and novel gamified application in healthy and neurologically injured populations.

The Amount and Temporal Structure of Center of Pressure Fluctuations During Quiet Standing in Patients With Chronic Low Back Pain

The characteristics of postural sway were assessed in quiet standing under three different postural task conditions in 14 patients with nonspecific chronic low back pain and 12 healthy subjects using linear and nonlinear center of pressure parameters. The linear parameters consisted of area, the mean total velocity, sway amplitude, the SD of velocity, and the phase plane portrait. The nonlinear parameters included the Lyapunov exponent, sample entropy, and the correlation dimension. The results showed that the amount of postural sway was higher in the patients with low back pain compared with the healthy subjects. Assessing the nonlinear parameters of the center of pressure showed a lower sample entropy and a higher correlation dimension in the patients with low back pain compared with the healthy subjects. The results of this study demonstrate the greater regularity and higher dimensionality of the center of pressure fluctuations in patients with nonspecific chronic low back pain, which suggests that these patients adopt different postural control strategies to maintain an upright stance.

Ankle muscles activation and postural stability with Star Excursion Balance Test in healthy individuals

INTRODUCTION

The ankle joint, a part of the kinetic chain of the lower limb, plays a significant role in the maintenance of postural stability during bipedal and unipedal balancing activities. This study aimed to evaluate the neuromuscular control of the ankle joint and the postural stability while executing the Star Excursion Balance Test (SEBT), by recording the EMG activity of the extrinsic ankle musculature and the displacement of the center of pressure (CoP).

METHODS

The EMG activity of the tibialis anterior (TA), the peroneus brevis (PB) and the medial and lateral gastrocnemius (GM, GL), along with the anteroposterior and mediolateral displacements (APd and MLd) of CoP as well as the plantar pressure distribution of the supportive lower limb were recorded during reaching to the eight directions of SEBT in 29 healthy, physically active college students (15 males and 14 females; mean ± SD of age 25.6 ± 4.5 yrs.; height: 172.5 ± 8.2 cm; body weight: 67.7 ± 13.6 kg; and BMI: 22.6 ± 2.9 kg/m²).

RESULTS

The tibialis anterior muscle demonstrated the greatest EMG activity during SEBT, followed by the PB, GL and GM muscles. The increased EMG activity of TA and PB during the execution of all posterior-oriented and lateral directions coincided with a decreased APd of CoP and increased reaching distances. The opposite occurred during the execution of all the anterior-oriented and medial directions. The differences among the directions of SEBT regarding the EMG activity of GL, GM and the mediolateral displacement of CoP were, in general, not significant.

CONCLUSIONS

The neuromuscular control of the ankle joint and the associated postural stability during SEBT was highly depended upon the activation level of TA and PB, which should be considered by clinicians and sports specialists when using this test for screening and/or rehabilitation purposes.

Virtual reality interventions for balance prevention and rehabilitation after musculoskeletal lower limb impairments in young up to middle-aged adults: A comprehensive review on used technology, balance outcome measures and observed effects

BACKGROUND

Balance training is an important aspect in prevention and rehabilitation of musculoskeletal lower limb injuries. Virtual reality (VR) is a promising addition or alternative to traditional training. This review aims to provide a comprehensive overview of VR technology and games employed for balance prevention and rehabilitation, balance outcome measures, and effects for both balance prevention and balance rehabilitation following musculoskeletal lower limb impairments.

METHODS

A systematic literature search was conducted in electronic databases to identify all related articles with a longitudinal study design on VR, balance, and prevention or musculoskeletal rehabilitation of the lower limbs in adult subjects between 19 and 65 years.

RESULTS

Eleven articles concerning balance prevention and five articles regarding balance rehabilitation were included. All studies used screen-based VR and off-the-shelf gaming consoles with accompanying games. The Star Excursion Balance Test (SEBT) was the most frequently used outcome measure. Two studies found positive effects of VR balance training in healthy adults, while none reported negative effects. None of the included studies showed a significant difference in balance performance after a VR balance rehabilitation intervention compared to traditional balance training.

CONCLUSION

Few studies have been published concerning musculoskeletal balance rehabilitation and balance prevention in healthy adult subjects. However, the studies published have shown that VR exercises are equally effective compared to traditional balance training for both domains of application. As there is large variability between studies, recommendations for future research are given to prospectively investigate the use of VR technology for balance training.

Impact of military type footwear and load carrying workload on postural stability

Postural stability has been shown to be impacted by footwear and task performed. This study analysed the impact of two military footwear, standard boot (STB) and minimalist boot (MTB) on postural stability, before (PRE) and after (POST) a load carriage task. Sixteen participants were tested for postural stability using sensory organisation and motor control tests on Neurocom Equitest™. Postural sway, equilibrium scores and postural latencies were analysed using a two-factor repeated measures ANOVA: boot type (STB-MTB) × time (PRE-POST) load carriage task. Significantly greater postural sway variables, lower balance scores and slower postural latencies were seen in STB and POST load carriage conditions (p < .05). The results suggest that MTB exhibited greater balance compared to STB in balance conditions that rely on somatosensory feedback and that balance is lowered after a load carriage task. Decrements in postural stability could be attributed to boot design characteristics and muscular exertion due to the load carriage task. Practitioner Summary: Maintaining optimal postural stability is crucial in military. Impact of military footwear types and load carriage task on postural stability are addressed. Findings provide footwear design and physical exertion implications on postural stability leading to potential interventions that reduce postural stability decrements; thereby, reducing potential falls and fall related injuries.

The Effects of Exercise Induced Muscle Damage on Knee Joint Torque and Balance Performance

The purpose of this investigation is to determine the effects of exercise induced muscle damage (EIMD) on balance and knee joint torque. Thirteen males and females volunteered to participate in the study. Following a familiarization session, baseline measures were obtained for isometric torque measured during a maximal voluntary isometric contraction (MVIC) for knee flexors and extensors, and ankle dorsi-flexors and plantar-flexors. Additionally, balance performance was tested in double leg (DL), and right single leg (RSL) static and dynamic unstable stability was measured. Participants then performed the muscle damage protocol of front loaded Bulgarian split squats. All measurements were re-assessed for torque and balance immediately and up to 72 h afterwards. A one-way repeated-measures analysis of variance (ANOVA) was used to analyze differences between baseline and all time-points for torque and balance measures. There was a significant time effect for knee extensors MVIC torque, where baseline measures are greater than post EIMD, 24 h and 48 h post EIMD. There was no significant time effect for all balance conditions. These results provide evidence of EIMD following high intensity eccentric exercises with significant reductions in knee extensor torque up to at least 48 h and show that balance was not compromised following EIMD.

The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without

BACKGROUND

Chronic low back pain is associated with lumbar extensor deconditioning. This may contribute to decreased neuromuscular control and balance. However, balance is also influenced by the hip musculature. Thus, the purpose of this study was to examine balance in both asymptomatic participants and those with chronic low back pain, and to examine the relationships among balance, lumbar extension strength, trunk extension endurance, and pain.

METHODS

Forty three asymptomatic participants and 21 participants with non-specific chronic low back pain underwent balance testing using the Star Excursion Balance Test, lumbar extension strength, trunk extension endurance, and pain using a visual analogue scale.

FINDINGS

Significant correlations were found between lumbar extension strength and Star Excursion Balance Test scores in the chronic low back pain group (r = 0.439-0.615) and in the asymptomatic group (r = 0.309-0.411). Correlations in the chronic low back pain group were consistently found in posterior directions. Lumbar extension strength explained ~19.3% to ~37.8% of the variance in Star Excursion Balance Test scores for the chronic low back pain group and ~9.5% to ~16.9% for the asymptomatic group.

INTERPRETATION

These results suggest that the lumbar extensors may be an important factor in determining the motor control dysfunctions, such as limited balance, that arise in chronic low back pain. As such, specific strengthening of this musculature may be an approach to aid in reversing these dysfunctions.

The effect of augmented somatosensory feedback on standing postural sway

Impaired balance resulting from reduced postural control occurs with aging and various medical conditions. Sensory input for balance control is provided by the visual, vestibular and somatosensory systems. Previous research suggests that increased proprioceptive feedback from various lower extremity devices improves balance. Mixed results have been reported with the use of orthoses such as ankle foot orthoses (AFOs). In this study, 20 healthy subjects wore footplates in their shoes or straps around their lower legs in order to imitate the somatosensory feedback produced by wearing AFOs, but without providing ankle restriction. Subjects' standing balance was assessed using force plates and computerized dynamic posturography (the sensory organization test-SOT) to determine if either the footplates or the lower-leg straps would affect standing balance. The results revealed no significant difference with the use of the footplates, however, wearing the straps resulted in reduced postural sway for conditions when visual cue deprivation was combined with manipulation of somatosensory or vestibular feedback. This effect was more pronounced in participants with the poorest baseline measures of balance. These findings suggest that lower extremity devices, such as AFOs, may augment somatosensory feedback that could improve balance during challenging sensory deprivation conditions, independent of orthotic support at the ankle.

The Influence of an Acute Bout of Whole Body Vibration on Human Postural Control Responses

The use of vibrating platforms has become increasingly available, and popular at sports and rehabilitation institutes. Given the discrepancies in the literature regarding whole body vibration (WBV) and human reflexive responses, the purpose of this study was to examine the acute effects of WBV on postural response latencies, as well as associated electromyography measures of the lower extremities during balance perturbations. Reflexive responses during backward and forward balance perturbations were examined before, after, and 10 min after a bout of WBV. The findings suggest that following an acute bout of whole body vibration, muscle activity of the lower extremities is decreased during a reflexive response to an unexpected perturbation, and may be associated with faster reaction time.

The effectiveness of an exercise programme on dynamic balance in patients with medial knee osteoarthritis: A pilot study

BACKGROUND

Dynamic balance and quiet standing balance are decreased in knee osteoarthritis (OA), with dynamic balance being more affected. This study aimed to investigate the effectiveness of a group exercise programme of lower extremity muscles integrated with education on dynamic balance using the Star Excursion Balance test (SEBT) in knee OA.

METHODS

Experimental before-and-after pilot study design. Nineteen participants with knee OA attended the exercise sessions once a week for six weeks, in addition to home exercises. Before and after the exercise programme, dynamic balance was assessed using the SEBT in the anterior and medial directions in addition to hip and knee muscle strength, pain, and function.

RESULTS

Fourteen participants completed the study. Dynamic balance on the affected side demonstrated significant improvements in the anterior and medial directions (p=0.02 and p=0.01, respectively). The contralateral side demonstrated significant improvements in dynamic balance in the anterior direction (p<0.001). However, balance in the medial direction did not change significantly (p=0.07). Hip and knee muscle strength, pain, and function significantly improved (p<0.05) after the exercise programme.

CONCLUSIONS

This is the first study to explore the effect of an exercise programme on dynamic balance using the SEBT in knee OA. The exercise programme was effective in improving dynamic balance which is required in different activities of daily living where the patients might experience the risk of falling. This might be attributed to the improvement in muscle strength and pain after the exercise programme.

Load release balance test under unstable conditions effectively discriminates between physically active and sedentary young adults

This study investigates test-retest reliability and diagnostic accuracy of the load release balance test under four varied conditions. Young, early and late middle-aged physically active and sedentary subjects performed the test over 2 testing sessions spaced 1week apart while standing on either (1) a stable or (2) an unstable surface with (3) eyes open (EO) and (4) eyes closed (EC), respectively. Results identified that test-retest reliability of parameters of the load release balance test was good to excellent, with high values of ICC (0.78-0.92) and low SEM (7.1%-10.7%). The peak and the time to peak posterior center of pressure (CoP) displacement were significantly lower in physically active as compared to sedentary young adults (21.6% and 21.0%) and early middle-aged adults (22.0% and 20.9%) while standing on a foam surface with EO, and in late middle-aged adults on both unstable (25.6% and 24.5%) and stable support surfaces with EO (20.4% and 20.0%). The area under the ROC curve >0.80 for these variables indicates good discriminatory accuracy. Thus, these variables of the load release balance test measured under unstable conditions have the ability to differentiate between groups of physically active and sedentary adults as early as from 19years of age.

The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction

PURPOSE

Lateral ankle sprain is the most common injury. A previous study demonstrated that patients with mechanical ankle instability suffered deficits in postural control, indicating that structural damage of the lateral ankle ligaments may produce a balance deficit. The purpose of this study was to confirm that lateral ligaments reconstruction could improve postural control in patients with mechanical ankle instability.

METHODS

A total of 15 patients were included in the study. Each patient had a history of an ankle sprain with persistent symptoms of ankle instability and a positive anterior drawer test and had been treated nonoperatively for at least 3 months. All patients were diagnosed with lateral ankle ligaments tear by ultrasonography and magnetic resonance imaging. They underwent arthroscopic debridement and open lateral ankle ligaments reconstruction with a modified Broström procedure. One day before and 6 months after the operation, all of the participants underwent single-limb postural sway tests. The anterior drawer test and the American Orthopedic Foot and Ankle Society scale score were used to evaluate the clinical results in these patients.

RESULTS

At 6 months after the operation, with the patients' eyes closed, there was significantly decreased postural sway in the anteroposterior direction, the circumferential area, and the total path length on the operated ankles compared with those measurements before the operation. With eyes open, however, no difference was found in postural sway before and after the operation.

CONCLUSIONS

Postural control was improved by reconstructing the lateral ligaments.

LEVEL OF EVIDENCE

IV.

Relative appendicular skeletal muscle mass is associated with isokinetic muscle strength and balance in healthy collegiate men

There are few studies on the relationship between skeletal muscle mass and balance in the young ages. We investigated the relationship between appendicular skeletal muscle mass, isokinetic muscle strength of lower extremity, and balance among healthy young men using relative skeletal muscle index. Thirty men were grouped according to relative appendicular skeletal muscle mass index: higher skeletal muscle group (n = 15) and lower skeletal muscle group (n = 15). Static and dynamic balance abilities were measured using the following: a test where participants stood on one leg with eyes closed, a modified Clinical Test of Sensory Interaction on Balance (mCTSIB) with eyes open and eyes closed, a stability test, and limits of stability test. The muscle strength of lower extremities was measured with an isokinetic analyser in hip, knee, and ankle joints. Participants with higher appendicular skeletal muscle mass were significantly more stable in maintaining dynamic balance than those with lower appendicular skeletal muscle mass. Moreover, appendicular skeletal muscle mass index was positively correlated with dynamic balance ability. Participants with higher appendicular skeletal muscle mass had stronger strength in the lower extremity, and there were significant differences in the isokinetic torque ratios between groups. From these results, it can be inferred that higher appendicular skeletal muscle mass relates to muscle strength and the alteration in the peak torque ratio of the lower extremity, contributing to the maintenance of balance.

Efficacy of virtual reality-based balance training versus the Biodex balance system training on the body balance of adults

[Purpose] This study investigated efficacy of virtual reality (VR)-based balance training on enhancing balance and postural reactions of adults as a low-cost new modality compared to the established Biodex Balance System (BBS). [Subjects] Thirty normal adults of both genders were divided randomly into two equal-sized experimental groups of 15: BBS balance training and VR balance training. [Methods] The training programmes were conducted in 12 sessions, three 15-min sessions per week. The Nintendo^® Wii Fit Plus (NWFP) and its balance board were used to train of the VR group. Each participant answered a questionnaire concerning usability, enjoyment, balance improvement, and fatigue at the end of the training programs. [Results] The study found a significant increase the measure of mean overall balance (OLB) in both groups. No significant difference was found between the groups, but a significant decrease in the mean balance-test time was found for both groups, with no significant difference between the two training methods. The VR programme was rated highly enjoyable by 81.8% of the group. [Conclusion] The Wii Fit Plus system with the balance board as a new VR balance-training technique, can be considered an effective and enjoyable tool for the training of adults’ body balance.

Return to play after an ankle sprain: guidelines for the podiatric physician

The ankle sprain is the most common injury in sport and has a high incidence of long-term disability. This disability may be partly due to early return to sport before ligament healing has been completed. The podiatric physician can follow sound guidelines for making a return-to-play decision for athletes suffering from an ankle sprain. The decision-making process requires the podiatric physician to monitor the rehabilitation process and then administer patient self-reported questionnaires as well as functional performance tests to assess the status of ankle function after injury.

Multisensory integration and child neurodevelopment

A considerable number of cognitive processes depend on the integration of multisensory information. The brain integrates this information, providing a complete representation of our surrounding world and giving us the ability to react optimally to the environment. Infancy is a period of great changes in brain structure and function that are reflected by the increase of processing capacities of the developing child. However, it is unclear if the optimal use of multisensory information is present early in childhood or develops only later, with experience. The first part of this review has focused on the typical development of multisensory integration (MSI). We have described the two hypotheses on the developmental process of MSI in neurotypical infants and children, and have introduced MSI and its neuroanatomic correlates. The second section has discussed the neurodevelopmental trajectory of MSI in cognitively-challenged infants and children. A few studies have brought to light various difficulties to integrate sensory information in children with a neurodevelopmental disorder. Consequently, we have exposed certain possible neurophysiological relationships between MSI deficits and neurodevelopmental disorders, especially dyslexia and attention deficit disorder with/without hyperactivity.

Difference in postural control between patients with functional and mechanical ankle instability

BACKGROUND

Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI).

METHODS

Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups.

RESULTS

The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision.

CONCLUSIONS

Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people.

CLINICAL RELEVANCE

As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training should also include the contralateral side after a unilateral ankle ligament injured.

Efficacy of the star excursion balance test in detecting reach deficits in subjects with chronic low back pain

STUDY DESIGN

The study design is a case control study.

OBJECTIVES

The objective of this study is to evaluate how chronic low back pain (CLBP) affects the performance of Star Excursion Balance Test (SEBT).

BACKGROUND

Chronic low back pain is associated with paraspinal and other trunk muscle weakness and reduction in coordination of low back muscles. This reduction in muscular strength and coordination contributes to decreased postural stability, balance and neuromuscular control in subjects with CLBP. SEBT is a simple, reliable and valid method of dynamic performance and is an alternative to more sophisticated instrumented methods. However, no study has evaluated the effect of SEBT on CLBP patients.

METHODS AND MEASURES

Ten patients with CLBP (localized back pain, lasting more than 6 months and radiating no further than the buttock with normal neurological examination) and 10 normal age and sex matched subjects (mean age 34.30 + 8.67(range 22-50) participated in this study. All participants completed the SEBT on their dominant leg, and distance measures were collected and compared between groups.

RESULTS

The dependant variable was analysed using independent t-test with p < 0.05. The CLBP group demonstrated significant reductions in excursion distances for all directions of the SEBT compared with the control group, except for the posterior (P) direction (0.281) CONCLUSION: Star Excursion Balance Test is an effective and simple tool to identify and measure reach deficits in patients with CLBP. We recommend using SEBT as an outcome measure to identify dynamic balance, multi-planar excursion and postural control in patients with CLBP.

Immediate Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet

[Purpose] The aim of this study was to determine the immediate effect of short-foot exercise (SFE) on the dynamic balance of subjects with excessively pronated feet. [Subjects] This study included 18 subjects with excessively pronated feet (navicular drop ≥ 10 mm) selected using the navicular drop test. [Methods] The limit of stability (LOS) was measured to determine the changes in the dynamic balance from before and after SFE in the standing and sitting positions. [Result] After the SFE, LOS increased significantly in all areas, namely, the left, right, front, back, and overall. [Conclusion] SFE immediately improved the dynamic balance of subjects with excessively pronated feet. Subsequent studies will be conducted to examine the effects of SFE performed over the long term on postural stability.