The effect of foot posture on static balance, ankle and knee proprioception in 18-to-25-year-old female student: a cross-sectional study

BACKGROUND & PURPOSE

Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough information to maintain upright stance and are critical in perceiving postural sway. Altered feedback from propreoceptive receptors alters gait and patterns of muscle activation. The position and posture of the foot and ankle may also play an important role in proprioceptive input.Therefore, the current research aims to compare static balance and ankle and knee proprioception in people with and without flexible flatfeet.

METHODOLOGY

91 female students between the ages of 18 and 25 voluntarily participated in this study, of which 24 were in the flexible flatfoot group and 67 were in the regular foot group after evaluating the longitudinal arch of the foot. The position sense of ankle and knee joints were measured using the active reconstruction test of the ankle and knee angle; Static balance was measured using the Sharpened Romberg test. Data were non-normally distributed. Accordingly, non-parametric tests were applied. The Kruskal-Wallis test was applied to compare differences between groups in variables.

RESULT

Kruskal-Wallis test showed a significant difference between two groups of flat feet and normal feet in the variables of static balance and position sense of ankle plantarflexion, ankle dorsiflexion, and knee flexion (p ≤ 0.05). A significant correlation was found between static balance and sense of ankle and knee position in the group with normal feet. The analysis of the regression line also showed that ankle and knee position sense could predict the static balance score in the regular foot group (ankle dorsiflexion position sense 17% (R² = 0.17), ankle plantarflexion position sense 17% (R² = 0.17) and knee flexion position sense 46% (R² = 0.46) explain of changes in static balance).

DISCUSSION & CONCLUSION

Flexible flatfoot soles can cause loss of balance and sense of joint position; therefore, according to this preliminary study, clinicians must be aware and should take into account this possible deficit in the management of these patients.

Comparison of unilateral and bilateral strength ratio, strength and knee proprioception in older adult fallers and non-fallers

BACKGROUND

Asymmetry of lower limb muscle strength and knee proprioception have been linked with risk of falling among elderly with and without history of falling.

OBJECTIVE

This study aimed to determine the comparison of hamstrings to quadriceps strength ratio (CSR) and bilateral knee strength ratio, hamstrings and quadriceps muscles' strength and knee proprioception in elderly male fallers and non-fallers.

METHODS

Sixty older adults, 65 years and older were recruited into faller (fell twice in the last six months) and non-faller groups. Then, the knee extension and flexion strength and proprioception at 45° knee flexion for the dominant leg (DL) and non-dominant legs (NDL) were measured with a Biodex Isokinetic Dynamometer.

RESULTS

The strength of quadriceps and hamstring muscles showed significantly higher values in DL by 5.4 %, 9.2 % and NDL by 11.7 %, 15.5 % in the non-faller compared to the faller (p < 0.05). Significantly greater bilateral asymmetry (>10 % difference) was observed with the quadriceps (p = 0.014, -7.9 %, ES = 0.76) and hamstrings (p < 0.001, -18.4 %, ES = 1.5) as well as reduced CSR (<72 %) by 7.6 % in DL (ES = 0.64) and 11.3 % in NDL (ES = 0.81) with fallers versus non-fallers. Significantly less knee proprioception was found with the DL by -1.5 % (ES = 1.15) and NDL (ES = 1.50) by -2.1 % (p < 0.001) in non-faller compared to faller.

CONCLUSION

It concluded that non-fallers have better strength symmetry, bilateral and unilateral knee strength ratios as well as more sensitive knee proprioception than fallers. It is suggestive that older adult fallers may need to improve bilateral knee strength symmetry and proprioception to prevent the risk of falling.

The effect of 8 weeks of child designed vs teacher designed games on physical fitness and creativity in children 8-10 years

A healthy and active lifestyle should start from an early age, as habits learned in childhood are more likely to endure. This study aimed to compare the effectiveness of child-designed games and teacher-designed games on the physical fitness and creativity of children aged 8-10 years. Thirty children participating in a sports club were randomly divided into two groups: teacher-designed games (TDG) and child-designed games (CDG). Subjects practiced two sessions per week for eight weeks, each session lasting 60 min. Fitness factors, such as strength, muscle endurance, aerobic fitness, agility, speed, and creativity were assessed by valid tests before and after the protocols. A repeated measure analysis of variance (ANOVA) was used to analyze the data. The TDG intervention led to a significant improvement in KTK (37.1% vs. -3.2%) and agility (-3.7% vs. -0.4%) compared to CDG intervention, while CDG intervention was associated with a significant improvement in aerobic capacity (10.1% vs. 3.6%) and in the elaboration of creativity test (23.3% vs. 8.6%). Both groups demonstrated substantial improvements in handgrip strength, static balance, long jump, flexibility, core endurance, and creativity tests, with no significant difference between groups. There were no significant changes in anthropometric features following the intervention. The implementation of combined teacher-designed and child-designed approaches in children's classrooms, in addition to promoting all aspects of physical fitness, may be effective in enhancing physical fitness and creativity.

Can different training methods reduce the kinematic risk factors of ACL injuries in children?

According to the research, a lack of neuromuscular control is a major cause of non-contact anterior cruciate ligament (ACL) injury during locomotion. This study aimed to determine the influence of various prescriptive and Constrained Led Approach (CLA) training approaches on lower extremity kinematics and stride length in children aged 3-5 years old while walking and running. Thirty-six children with a mean age of 4.79 years were separated into three groups: 1- prescriptive training group (n = 10), 2- CLA training group (n = 11), and 3- Control group (n = 10). The kinematics of the hip, knee and ankle joints in the sagittal plane at the moment of heel contact and toe-off were recorded before and after six weeks of intervention. According to the MANOVA, there was no statistically significant difference between the two training techniques in the joint angles at heel contact and toe-off during walking and running after intervention (p ≥ 0.05). However, there was a significant difference in the kinematic characteristics of walking and running between the training and the control groups (p ≤ 0.05). The two training techniques showed a statistically significant difference in stride length during running (p ≤ 0.05). The results indicated that prescriptive and CLA training are effective at altering the kinematics and distance factors underlying children's walking and running abilities.

The challenge point framework to improve stepping reaction and balance in children with hemiplegic cerebral palsy: A case series study

PURPOSE

This study investigated the effects of the challenge point framework (CPF) to improve stepping reactions and enhance balance in children with hemiplegic cerebral palsy (HCP). The CPF relates practice variables to the skill level of the individual and task difficulty.

METHODS

Nine children with HCP (age: 7.7±2.4 years) completed six weeks (12 sessions) of a CPF intervention which consisted of progressively fewer sets and repetitions of a stepping reaction task wherein participants sought to improve both step length and reaction rate. Stepping reaction (step length and reaction rate) to a balance perturbation in the anterior, posterior, and lateral directions and static and dynamic balance (via the Pediatric Balance Scale) were measured at baseline, a second baseline 3 weeks later, and post-intervention. Repeated measures ANOVAs determined within-group changes. Cohen's d effect sizes were calculated.

RESULTS

Participants improved balance (d = 0.948, p = 0.010), step length (forward d = 0.938, p = 0.002; backward d = 0.839, p = 0.001; and lateral d = 0.876, p = 0.002), and reaction rate (forward d = 0.249, p = 0.042; backward d = 0.21, p = 0.047; and lateral d = 0.198, p = 0.049).

CONCLUSION

These findings indicate that children with HCP may benefit from completing a CPF program with a motor learning approach. This approach of retraining stepping reactions helped to improve static and dynamic balance. The CPF may aid progression of functional task training in children with HCP aged 4-12, though more studies with a long-term follow-up analysis are needed to confirm this result.

The effects of learning with various noise on Gait Kinematics in 3-to-5-year-old children: a randomized controlled trial

Background

Lack of the neuromuscular control during locomotion in the knee joint leads to an increased risk of anterior cruciate ligament (ACL) injury in children. Hence, we aimed to explore the effects of a repetitive, model-oriented, and self-organized approach on lower limb kinematics during gait in children.

Methods

In randomized controlled trial, 36 children with 4 ± 0.79 years of age from the children gym were randomly (a lottery method) allocated into three groups, including (1) the model-oriented (n = 10), (2) Differential Learning (n = 11), and (3) control (n = 10) groups. Kinematic data of hip, knee, and ankle joints in the sagittal plane were recorded by a GoPro camera at the moments of heel-ground contact and toe-off the ground before and after a 6-week intervention (two sessions per week).

Results

The results indicate a 35% post-intervention increase of ankle dorsiflexion (95% CI: − 5.63 _ − 0.96) in the moment of heel-ground contact in the model-oriented group; however, knee flexion (95% CI: − 1.05 _ 8.34) and hip flexion (95% CI: 3.01 _ 11.78) were respectively decreased by 20% and 20%. After the intervention, moreover, ankle plantar flexion (95% CI: − 9.18 _ − 2.81) and hip extension (95% CI: − 12.87 _ − 3.72) have respectively increased by 37% and 37%, while knee flexion (95% CI: 3.49 _ 11.30) showed a %16 decrease in the moment of toe off the ground. As for the Differential Learning group, ankle dorsiflexion (95% CI: − 5.19 _ − 1.52) increased by 33%, and knee (95% CI: 0.60 _ 5.76) and hip flexion (95% CI: 2.15 _ 7.85) respectively decreased by 17% and 17% at the moment of the heel-ground contact following the intervention. At toe lifting off the ground, the plantar flexion (95% CI: − 7.77 _ − 2.77) increased by 35%, knee flexion (95% CI: 2.17 _ 7.27) decreased to 14%, and hip extension (95% CI: − 9.98 _ − 4.20) increased by %35 following the intervention for the Differential Learning group subjects. Based on the results obtained from the one-way ANOVA, there was a significant difference between these groups and the control group in all kinematic gait variables (p ≤ 0.05). However, no statistically significant differences were found between the two experimental groups.

Conclusions

The results implied that the model-oriented repetitive and the self-organized Differential Learning approach were both appropriate to alter the kinematic gait pattern in the 3–5-year-old children. Previous research has almost exclusively recommended a model-oriented approach to change kinematic patterns and preventing non-contact motor injuries. However, the present study showed that the Differential Learning approach can help children to achieve the same goal by continuously changing environments and stimulating challenges.

Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20130109012078N5 “Prospectively registered” at 14/5/2021.

External Focus or Differential Learning: Is There an Additive Effect on Learning a Futsal Goal Kick?

(1) Background: How to optimally promote the process of acquiring and learning a new motor skill is still one of the fundamental questions often raised in training and movement science, rehabilitation, and physical education. This study is aimed at investigating the effects of differential learning (DL) and the elements of OPTIMAL theory on learning a goal-kicking skill in futsal, especially under the conditions of external and internal foci. (2) Methods: A total of 40 female beginners were randomly assigned to, and equally distributed among, five different interventions. Within a pretest and post-test design, with retention and transfer tests, participants practiced for 12 weeks, involving two 20-min sessions per week. The tests involved a kicking skill test. Data were analyzed with a one-way ANOVA. (3) Results: Statistically significant differences with large effect sizes were found between differential learning (DL) with an external focus, DL with an internal focus, DL with no focus, traditional training with an external focus, and traditional training with control groups in the post-, retention, and transfer tests. (4) Conclusions: The results indicate the clear advantages of DL. It is well worth putting further efforts into investigating a more differentiated application of instructions combined with exercises for DL.

Effects of dual-task training with blood flow restriction on cognitive functions, muscle quality, and circulatory biomarkers in elderly women

This study investigated the effects of an eight-week dual-task training with and without blood flow restriction (BFR) on muscle quality (MQ) biomarkers, physical and cognitive functions in older women. Twenty-four healthy volunteers (62.9 ± 3.1years) were randomly assigned into either dual-task (DT), DT with blood flow restriction (DTBFR), or control (C) group. The experimental groups performed cognitive tasks while walked on a treadmill at 45% of heart rate reserve (HRR), 20 min per session, three sessions per week for eight weeks. The cuff pressure for the DTBFR group was 50% of the calculated arterial blood occlusion and was increased by 10% every 2 weeks. Pre and post-training intervention, biomarkers of MQ and cognitive functions, body composition, maximal strength, and psychological status were measured. There was a significant interaction effect on BDNF, CAF, P3NP, body mass, BMI, fat percentage, visceral fat mass, and total fat mass (p<0.05). Furthermore, a significant interaction effect on knee extension, 30-s stand-up test, 6-min walk test, timed up&go test, and QOL was observed. There was a significant effect of time on MMSE, sleep quality, and mood score. These findings suggested that including BFR to DT training result in greater physiological and psychological responses and should be considered a training method to combat undesired changes associated with increasing age.

Motor learning methods that induce high practice variability reduce kinematic and kinetic risk factors of non-contact ACL injury

The prevention of non-contact anterior cruciate ligament (ACL) injuries often involves movement training, but the effectiveness of different motor learning methods has not been fully investigated. The purpose of this study was therefore to examine the effects of linear pedagogy (LP), nonlinear pedagogy (NLP) and differential learning (DL) motor learning methods on changing kinetic and kinematic factors during expected sidestep cutting related to non-contact ACL injuries. These methods primarily differ in the amount and type of movement variability they induce during practice. Sixty-six beginner male soccer players (27.5 ± 2.7 years, 180.6 ± 4.9 cm, 78.2 ± 4.6 kg) were randomly allocated to a group that trained for 12 weeks with either a LP, NLP or DL type of motor learning methods. All participants completed a biomechanical evaluation of side-step cutting before and after the training period. Analysis of covariance was used to compare post-testing outcomes among the groups while accounting for group differences in baseline performance. Changes in all kinematic and kinetic variables in NLP and DL groups were significantly higher compared to the LP group. Most comparisons were also different between NLP and DL group with the exception of vertical ground reaction force, the knee extension/flexion, knee valgus, and ankle dorsiflexion moments. Our findings indicate that beginner male soccer players may benefit from training programs incorporating NLP or DL versus LP to lower biomechanical factors associated with non-contact ACL injury, most likely because of the associated increased execution variability during training. We discuss that practitioners should consider using the NLP or DL methods, and particular the NLP, during which variability is induced to guide search, when implementing training programs to prevent ACL injuries in soccer.