Do rocker-sole shoes influence postural stability in chronic low back pain? A randomised trial

Effects of auxetic shoe on lumbar spine kinematics and kinetics during gait and drop vertical jump by a combined in vivo and modeling investigation

The present study examined the effects of auxetic shoes on the biomechanics of the spine, as compared to barefoot and conventional shoe conditions, during gait and drop vertical jump (DVJ) activities using a combined in vivo and musculoskeletal modeling approach. Motion and force-plate data as well as electromyographic (EMG) activities of select trunk muscles of 11 individuals were collected during foregoing activities. In DVJ activity, two main phases of first landing (FL) and second landing (SL) were studied. In the FL phase of DVJ noticeable alternations were observed when auxetic shoes were used. That is, compared to the conventional footwear condition, smaller EMG activities in extensor muscles (by ~ 16-29%, p < 0.001), smaller anterior-posterior (AP) distance between the center of pressure of ground reaction force and heel (by ~ 19%, p = 0.002), generally larger maximal hip, knee, and ankle flexion angles (p < 0.005) and finally smaller maximal L5-S1 compression force and maximal external moment (by ~ 12 and 8%, respectively, p < 0.001) were obtained by wearing auxetic shoes. Our results, therefore, indicate that using auxetic shoes can reduce load on the lumbar spine during high-demanding activities such as vertical jump and thus may decrease the musculoskeletal risk of injuries during these activities.

Influence of footwear on postural sway: A systematic review and meta-analysis on barefoot and shod bipedal static posturography in patients and healthy subjects

BACKGROUND

Bipedal static posturography is widely used to assess postural control. However, standardized methods and evidence on the influence of footwear on balance in comparison to barefoot stance is sparse.

RESEARCH QUESTIONS

Is bipedal static posturography applied in a standardized way with respect to demographics and the experimental set-up (systematic review)? Does habitual footwear influence postural control in comparison to barefoot condition during bipedal static posturography in adult patients and healthy subjects (meta-analysis)?

METHODS

For this systematic review and meta-analysis, a comprehensive follow-up literature search was conducted from March 2009 until January 2020 according to the PRISMA guidelines. Original, research articles reporting on bipedal, unsupported, static posturography in adults (≥18 years) were included according to inclusion criteria (age, sex, height, weight, duration, repetitions, visual/foot condition, sampling frequency). Studies comparing habitual footwear with barefoot condition during bipedal static posturography were included for the meta-analysis. Center of pressure parameters (sway velocity, range, root mean square, paths lengths) with subjects having eyes closed (EC) or open (EO) were analyzed using random effects models.

RESULTS

For this systematic review and meta-analysis, 207 and eight out of 5189 studies with 12'341 and 156 subjects, respectively, were eligible. Most studies (89%) reported barefoot, 5% shod, and 6% barefoot and shod measurements. Less than half of studies (44%) included patients of which the minority (13%) suffered from neurological disease. Sway velocity in the anterior-posterior direction was higher in habitual shoes compared to barefoot with EC (SMD: 1.08; 95% CI: 0.68-1.48; p < 0.01; I² = 0%), with EO (SMD: 0.68; 95% CI: 0.11-1.26; p = 0.02; I² = 1%), and in the medio-lateral direction with EC (SMD: 1.30; 95% CI: 0.76-1.85, p < 0.01; I² = 37%).

SIGNIFICANCE

Methodical heterogeneity of bipedal static posturography hampers studies' comparability. Thus, we provide a standardized approach to increase knowledge whether habitual footwear decrease postural control in comparison to barefoot stance.

The effects of shoes and insoles for low back pain: a systematic review and meta-analysis of randomized controlled trials

The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP.

Unstable shoes for the treatment of lower back pain: a meta-analysis of randomized controlled trials

OBJECTIVE

We aimed to perform a systematic review and meta-analysis to compare the treatment effects of unstable shoes and flat shoes on lower back pain patients.

DATA SOURCES

Literature databases, including PubMed, Web of Science, and EMBASE (up to June 2019), were searched systematically.

REVIEW METHODS

Two authors independently screened the retrieved records and identified the randomized controlled trials where patients with lower back pain who wore unstable shoes as intervention and wore flat shoes as a control. Relevant data were extracted for meta-analysis using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the pooled outcome evidence levels.

RESULTS

Five randomized controlled trials and 251 patients were included in the analysis. The meta-analysis results showed that there was a tendency toward a reduction in the Roland-Morris disability questionnaire score (mean difference (MD) -2.16, 95% confidence interval (CI) -4.28 to -0.03, I² = 53%) and pain score (MD -0.84, 95% CI -1.66 to -0.02, I² = 84%) in patients wearing unstable shoes compared to those wearing flat shoes. There was no significant difference in the life quality scores between the unstable shoe and flat shoe groups (MD -0.59, 95% CI -6.18 to 5.01, I² = 0%). Functional disability and pain scores were determined to have very low-quality evidence, and life quality scores were determined to have low-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation analysis.

CONCLUSION

Unstable shoes may be effective in treating lower back pain in the clinic, but the conclusion was limited by the current low-quality studies.

Comparison of standing postural control and gait parameters in people with and without chronic low back pain: a cross-sectional case-control study

Objective

Differences in postural control and gait have been identified between people with and without chronic low back pain (CLBP); however, many previous studies present data from small samples, or have used methodologies with questionable reliability. This study, employing robust methodology, hypothesised that there would be a difference in postural control, and spatiotemporal parameters of gait in people with CLBP compared with asymptomatic individuals.

Methods

This cross-sectional case–control study age-matched and gender-matched 16 CLBP and 16 asymptomatic participants. Participants were assessed barefoot (1) standing, over three 40 s trials, under four posture challenging conditions (2) during gait. Primary outcome was postural stability (assessed by root mean squared error of centre of pressure (CoP) displacement (CoP_RMSEAP) and mean CoP velocity (CoP_VELAP), both in the anteroposterior direction); gait outcomes were hip range of movement and peak moments, walking speed, cadence and stride length, assessed using force plates and a motion analysis system.

Results

There were no differences between groups in CoP_RMSEAP (P=0.26), or CoP_VELAP (P=0.60) for any standing condition. During gait, no differences were observed between groups for spatiotemporal parameters, maximum, minimum and total ranges of hip movement, or peak hip flexor or extensor moments in the sagittal plane.

Conclusions

In contrast to previous research, this study suggests that people with mild to moderate CLBP present with similar standing postural control, and parameters of gait to asymptomatic individuals. Treatments directed at influencing postural stability (eg, standing on a wobble board) or specific parameters of gait may be an unnecessary addition to a treatment programme.