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Lu Y, Chen J, Zhang XL. Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis. J Sport Rehabil 2023; 32:818-826. [PMID: 37527818 DOI: 10.1123/jsr.2022-0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. METHODS Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. RESULTS Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P < .001), decreased ankle plantar flexion range (P = .023), ankle resting position more inclined to dorsiflexion (P = .017), increased ankle dorsiflexion stiffness (P = .005), and lower ankle plantar flexion stiffness (P = .034). After exercise intervention, the knee OA group self-reported less knee pain (P < .001), improved physical function (P < .001), increased maximum dorsiflexion (P = .021), and increased plantar flexion range (P < .001). While plantar flexion stiffness increased (P = .037), dorsiflexion stiffness decreased (P = .015) and ankle resting position moved toward dorsiflexion (P = .002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. CONCLUSIONS The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension.
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Affiliation(s)
- Yao Lu
- Qilu Institute of Technology, Qufu, SD,China
| | - Jie Chen
- Qingdao Hengxing University of Science and Technology, Qingdao, SD,China
- Auckland Bioengineering Institute, The University of Auckland, Auckland,New Zealand
| | - Xue-Lin Zhang
- Department of Physical Science, Qufu Normal University, Qufu, SD,China
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Dantas GAF, Sacco ICN, Ferrari AV, Matias AB, Watari R, Oliveira LVM, Marcon TR, Fatore JA, Pott-Junior H, Salvini TF. Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther 2023; 27:100531. [PMID: 37603935 PMCID: PMC10457687 DOI: 10.1016/j.bjpt.2023.100531] [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: 05/16/2022] [Revised: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Foot-ankle exercises could improve pain and function of individuals with KOA and need to be tested. OBJECTIVE To investigate whether an 8-week foot-ankle muscle strengthening program is effective for individuals with KOA to reduce pain and improve function. METHODS In this randomized controlled trial, individuals diagnosed with clinical and radiographic KOA were randomized into the intervention (supervised foot-ankle strengthening exercise program three times a week for 8 weeks) or control (usual care and recommendations of the healthcare team) group. Effectiveness was assessed by changes in clinical and functional outcomes between baseline and 8 weeks with pain as the primary outcome. ANCOVA tests using the intervention group as a reference and sex, body mass index, and baseline values as covariates assessed between-group differences. RESULTS The intervention group showed lower pain scores (-4.4 units; 95%CI = -7.5, -1.1), better function (-7.1 units; 95%CI = -12.7, -1.4), higher total functional score (-11.9 units; 95%CI = -20.7, -3.1), with confidence intervals indicating a potential for the differences to be clinically meaningful, and better scores for the 30-s chair stand test (2.7 repetitions; 95%CI = 1.1, 4.1), with a confidence interval indicating a moderate clinically meaningful difference, compared to the controls. CONCLUSION The 8-week foot-ankle exercise program showed positive, and potentially clinically meaningful, effects on knee pain and physical function among individuals with KOA, when compared to usual care. TRIAL REGISTRATION NCT04154059. https://clinicaltrials.gov/ct2/show/NCT04154059.
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Affiliation(s)
- Glauko A F Dantas
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Department of Physical Therapy, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil.
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Angélica V Ferrari
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Alessandra B Matias
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricky Watari
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Larissa V M Oliveira
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Thainá R Marcon
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - José A Fatore
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Tania F Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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Bai Z, Cao X, Yang Y, Sun X, Dong Y, Wen J, Sun W. Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal. J Pain Res 2022; 15:3523-3536. [PMID: 36394054 PMCID: PMC9651065 DOI: 10.2147/jpr.s386315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors. Methods A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group. Results Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1–2 (IMA1–2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer–Lemeshow test showed a good degree of calibration (χ2 = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737–0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%–70%. Conclusion Second metatarsal length, second metatarsal peak pressure, HVA, IMA1–2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Zixing Bai
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xuhan Cao
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yanjun Yang
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xudong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yongli Dong
- Scientific Research Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Jianmin Wen
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Weidong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Correspondence: Weidong Sun, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Central South Road, Wangjing, Chaoyang District, Beijing, 100102, People’s Republic of China, Tel +86-84739140, Email
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Pereira DB, Souza TSD, Fuzinato CT, Hagihara RJ, Ribeiro AP. Effect of a programme of muscular endurance, balance and gait exercises with and without the use of flexible and minimalist shoes in older women with medial knee osteoarthritis: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e061267. [PMID: 36127099 PMCID: PMC9490635 DOI: 10.1136/bmjopen-2022-061267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Studies have indicated that gait intervention programmes with minimalist shoes are effective for reducing pain, improving functionality and reducing knee joint overload in older women with knee osteoarthritis (OA). Other clinical trials with knee and foot muscle strength training and/or dynamic balance training have also shown clinical and functional effectiveness. Despite promising strategies, there is no evidence of the combination of shoes with gait intervention programmes. Thus, the objective of this randomised clinical trial is to investigate the effects of therapeutic programme of muscular resistance, balance and gait exercises with and without the use of low-cost, flexible shoes on the clinical, functional and biomechanical aspects of older women with medial knee OA. METHODS AND ANALYSIS This randomised controlled trial with blinded evaluators will involve 36 older women. Twenty-four older women with knee OA (medial compartment) will be randomised to the intervention groups with minimalist shoes (GIC; n=12) or in a barefoot condition (GID; n=12), and 12 older women to the control group (n=12). The intervention protocol will consist of knee-foot muscle resistance and static balance training, reactive and proactive dynamic balance training, and gait training with visual feedback. The intervention will have a duration of two consecutive months, twice a week, totalling 16 sessions. The primary outcomes will be walking pain measured by Visual Analogue Scale and questionnaires: Western Ontario McMaster Universities Osteoarthritis Index and Lequesne Algofunctional. The secondary outcomes will be: 6-min walk test, Falls Risk Awareness Questionnaire, Timed Up and Go Test, and distribution of plantar load during gait and balance by pressure platform. Data will be analysed according to an intention-to-treat approach. ETHICS AND DISSEMINATION This study involves human participants and was approved by the ethics committee of the Universidade Santo Amaro, School Medicine, São Paulo/SP, Brazil (N°4.091.006). Participants gave informed consent to participate in the study before taking part. Investigators will communicate trial results to participants and healthcare professionals through scientific databases, social media, publications and conferences. TRIAL REGISTRATION NUMBER RBR-10j4bw25 in Brazilian Clinical Trial Registry.
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Affiliation(s)
- Daniel Borges Pereira
- Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, Universidade Santo Amaro, São Paulo, Brazil
| | - Tatiane Silva de Souza
- Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, Universidade Santo Amaro, São Paulo, Brazil
| | - Carolina Tayama Fuzinato
- Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, Universidade Santo Amaro, São Paulo, Brazil
| | - Rodrigo Jugue Hagihara
- Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, Universidade Santo Amaro, São Paulo, Brazil
| | - Ana Paula Ribeiro
- Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, Universidade Santo Amaro, São Paulo, Brazil
- Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Xu R, Zuo H, Ji Y, Li Q, Wang Z, Liu H, Wang J, Wei Z, Li W, Cong L, Li H, Jin H, Wang J. Effects of Short-Term Limitation of Movement of the First Metatarsophalangeal Joint on the Biomechanics of the Ipsilateral Hip, Knee, and Ankle Joints During Walking. Med Sci Monit 2021; 27:e930081. [PMID: 33664219 PMCID: PMC7941761 DOI: 10.12659/msm.930081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We analyzed the effect of limitation of movement of the first metatarsophalangeal joint (FMJ) on the biomechanics of the lower limbs during walking. MATERIAL AND METHODS Eight healthy college students completed walking under barefoot (BF) and FMJ constraint (FMJC) conditions. We synchronously collected kinematics and dynamics data, and calculated the torque, power, and work of hip, knee, and ankle joints. RESULTS Compared with normal conditions, when the FMJ is restricted from walking, the maximum ankle dorsiflexion angle is significantly increased (P<0.001), the maximum plantar flexion angle is significantly reduced (P<0.001), the maximum plantar flexion torque (P<0.001) and the maximum dorsiflexion torque (P<0.05) increased significantly, the maximum power increased significantly (P<0.001), the minimum power decreased significantly (P<0.001), and the negative work increased significantly (P<0.001). The torque of hip and knee joints increased significantly (P<0.05). CONCLUSIONS After the movement of the FMJ is restricted, the human body mainly compensates and transfers compensation by increasing the angle of dorsiflexion, increasing work and the activity level of surrounding muscles through the ankle joint, thereby increasing the torque load of the knee and hip joints to maintain the dynamic balance of kinematics. FMJC condition increases the energy consumption of the human ankle, knee, and hip joints during walking. The load is compensated by the gradual attenuation of the ankle, knee, and hip. Long-term limitation may cause damage to the posterior calf muscles and increase the incidence of knee arthritis.
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Affiliation(s)
- Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland).,Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jiarui Wang
- Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Zheyi Wei
- Department of Clinical Medicine, Fudan University School of Medicine, Shanghai, China (mainland)
| | - Weihang Li
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China (mainland)
| | - Lin Cong
- Department of Bioengineering, School of Public Health, Jilin University, Changchun, Jilin, China (mainland)
| | - Han Li
- Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jincheng Wang
- Orthopaedic Medical Centre, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
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