Determination of dynamic air gap thickness and analysis of its relationship with firefighters' joint movement

Objectives. The purpose of this study was to calculate the dynamic air gap thickness between the human body and the turnout gear. Relationships between the air gap thickness and joint range of motion (ROM) were also explored. Methods. The air gap thickness and joint ROM of 12 male firefighters walking in a control condition with no self-contained breathing apparatus (SCBA) and three varying-strapped SCBAs were measured using three-dimensional (3D) body scanning and 3D inertial motion capture. The interpolation technique was employed to predict the air gap thickness curve during walking. The dynamic air gap thickness was compared with the joint ROM to see how they relate to the location and percentage of movement restriction. Results. During the walking, the air gap fluctuated as a sine curve. Carrying SCBA reduced the air gap thickness at the trunk most (F = 11.17, p < 0.001, η2 = 0.63), and adjusting the shoulder strap length altered the air gap distribution at the trunk. The reduced air gap at the pelvis caused an incremental restriction on pelvis rotation. Conclusions. A compatibility design of the shoulder strap and hip belt in SCBA with the turnout jacket is suggested.

Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.

Evaluation of joint kinematics in patients with condylar reconstruction using mandibular motion simulation based on intraoral scanning registration

AIM

To summarize the features of condylar kinematics in patients with condylar reconstruction using a mandibular motion simulation method based on intraoral scanning registration.

MATERIALS AND METHODS

Patients undergoing unilateral segmental mandibulectomy and autogenous bone reconstruction as well as healthy volunteers were enrolled in the study. Patients were grouped based on whether the condyles were reconstructed. Mandibular movements were recorded using a jaw tracking system, and kinematic models were simulated after registration. The path inclination of the condyle point, margin of border movement, deviation, and chewing cycle were analyzed. A t test and one-way analysis of variance (ANOVA) were carried out.

RESULTS

A total of 20 patients, including 6 with condylar reconstruction and 14 with condylar preservation as well as 10 healthy volunteers were included. The patients with condylar reconstruction showed flatter movement paths of the condyle points. The mean inclination angle of the condylar movement paths of the patients with condylar reconstruction (0.57 ± 12.54 degrees) was significantly smaller than that of those with condylar preservation (24.70 ± 3.90 degrees, P = 0.014) during both maximum opening and protrusion (7.04 ± 12.21 degrees and 31.12 ± 6.79 degrees, respectively, P = 0.022). The inclination angle of the condylar movement paths of the healthy volunteers was 16.81 ± 3.97 degrees during maximum opening and 21.54 ± 2.80 degrees during protrusion; no significant difference compared with the patients. The condyles of the affected side tended to deviate laterally in all patients during mouth opening and protrusion. Patients with condylar reconstruction showed more severe symptoms of mouth opening limitation and mandibular movement deviation as well as shorter chewing cycles than patients with condylar preservation.

CONCLUSION

Patients with condylar reconstruction showed flatter movement paths of the condyle points, greater lateral motion range, and shorter chewing cycles than those with condylar preservation. The method of mandibular motion simulation based on intraoral scanning registration was feasible to simulate condylar movement.

The study on the relationship between venous ulcer and ankle joint range of motion using ultrasound

BACKGROUND

Chronic venous insufficiency (CVI) often leads to venous ulcers. The relationship between ankle joint range of motion (ROM) and venous ulcers remains under-investigated. This study aims to clarify this relationship using ultrasound imaging.

METHODS

We conducted a study on 20 patients with unilateral venous ulcers. Ankle ROM and popliteal vein blood flow were measured using a goniometer and ultrasound, respectively. The measurements were compared between the affected and unaffected limbs.

RESULTS

A significant reduction in ROM and popliteal vein blood flow was observed in the limbs with venous ulcers compared to the unaffected limbs. The data suggest a correlation between reduced ankle mobility and the development of venous ulcers.

CONCLUSION

The study underscores the importance of maintaining ankle mobility in patients with CVI to prevent venous ulcers. A multifactorial approach is essential for managing these conditions effectively.

Physiologic Motion in the Intact and Unstable Syndesmosis During Plantigrade Weightbearing in Controlled Ankle Motion Boots

Consensus has not been reached for the optimal postoperative care after high ankle sprain and syndesmotic fixation. A potential drawback of earlier return to activity is greater instability of the ankle and fixation failure. The controlled ankle motion (CAM) boot has been an effective implementation to stabilize the leg and may aid in safe early weightbearing status. However, there is insufficient study of its effect on motion in the syndesmosis following injury. Hence, the aim of this cadaveric study was to determine the stability of the ankle with a CAM boot at 3 levels of injury: syndesmosis ligaments intact (no injury), syndesmosis ligaments cut, and syndesmosis and fibula cut. Six cadaveric legs were subjected to each level of injury and axially loaded at 1 Hz between 100 N-1.5 times body weight for 50 seconds, and axial force, axial displacement, and optical tracking data were recorded. It was found that the ankle, when protected by the CAM boot, maintained syndesmosis motion with no difference (p > .05) from the uninjured state, regardless of syndesmotic ligament and fibular injury. This finding was consistent across anterior-posterior, medial-lateral, and superior-inferior axes. Overall, our study may suggest that early weightbearing with a CAM boot maintains a physiologically range of motion in the syndesmosis.

Is there an association between joint range of motion and muscle strength in young female dancers? And, does it depend on the effects of age and menarche?

Aiming to determine the association between joint range of motion (ROM) and muscle strength; and, the effect of age and menarche on those two factors; 132 pre-and post-menarche dancers, aged 12-14 years were assessed for joint ROM and for muscle strength at the hip, knee and ankle and foot joints. En-pointe ROM was significantly correlated with ankle plantar-flexors' (r = -.184) and with ankle dorsiflexors' muscle strength (r = -.221). Hip external rotation ROM was significantly correlated with knee extensors' strength (r = -.263). Pre-menarche dancers had higher joint ROM compared with post-menarche dancers; yet, dancers at post-menarche were stronger compared to dancers at pre-menarche. The slope coefficient was negative at the age of 12 in hip external rotation and in en-pointe (-0.80 and -0.52, respectively) and became steeper with age (age 13: -3.52 and -3.28, respectively; age 14: -6.31 and -4.42, respectively). Along maturation, dancers with high joints ROM showed reduced muscle strength. Pre-menarche dancers have higher joint ROM, yet reduced muscle strength, compared with post-menarche dancers. As the association between joint ROM and muscle strength might be involved with growth and development, young dancers should be screened along pubertal stages in order to decide the correct curricula and to prevent future injuries.

Effects of load increase on lower extremity kinetic and kinematic variables in the back squat exercise

BACKGROUND

Squats are one of the most widely used weight training methods worldwide, and the single most ubiquitous with regard to multi-joint resistance training.

OBJECTIVE

The objective of the present study was to investigate kinematic and kinetic changes in the lower extremities as a result of load increases during a back squat exercise, and to propose an association between back squats and lower extremity injuries.

METHODS

Eight individuals with experience of back squat training were recruited. The subjects performed back squats with loads of 25%, 50%, 100%, and 125% of their body weight. During the performance, the center of pressure (COP) sway; vertical center of mass (COM) velocity; joint moment; joint range of motion (ROM) of flexion/extension and adduction/abduction; and rotation of the ankle, knee, and hip joints were measured.

RESULTS

The participants' lower extremity joint ROM, vertical COM velocity, and COP variability did not change significantly with changes in weight loading. However, the moments applied to the lower extremity joints differed according to changes in barbell weight. The moments of plantar flexion (f= 54.362, p< 0.001), dorsiflexion (f= 8.475, p< 0.001), knee flexion (f= 12.013, p< 0.001), knee extension (f= 8.581, p< 0.001), hip flexion (f= 5.111, p< 0.001), and hip extension (f= 11.053, p< 0.001) increased in the sagittal plane (flexion/extension). There was also a significant increase in ankle eversion (f= 5.612, p= 0.004), hip abduction (f= 3.242, p= 0.037), and adduction (f= 5.846, p= 0.003) in the frontal plane (adduction/abduction). Among the moment variables in the transverse plane (rotation), there were significant differences in ankle internal rotation (f= 7.043, p= 0.001) and hip external rotation (f= 11.070, p< 0.001).

CONCLUSION

As the barbell load increased, posture and performance were maintained, but rotational moments of the joints differed. It is expected that the joint directions that showed significant differences in this study are likely to be vulnerable to the risk of injury when an excessive load is applied to the body. Examples include the hip adduction moment, hip external rotation moment, and ankle internal rotation moment, and apply regardless of the increase in the rotational moments of joints from load increases.

The interactions between agonist-to-antagonist muscle strength performance and plantar pressure distribution, foot contact area, and impulse in novice ballet dancers

BACKGROUND

Hip, trunk, knee, and ankle/foot muscles may lead to increased variability in the components of balance and plantar pressure distribution (PPD) analysis. However, the role of these muscle groups in the PPD of different ballet techniques in novice ballet dancers has not previously been studied.

OBJECTIVE

Our objective was to examine whether balance and PPD vary among five different ballet techniques and correlate with the agonist-to-antagonist strength performance of trunk, knee, hip, and ankle muscles in adolescent ballet dancers.

METHODS

The anthropometric parameters, muscle strength performance, balance, and PPD of sixty healthy female ballet dancers (age: 14.36 ± 2.18 y) were measured at 48-h intervals.

RESULTS

The forefoot's PPD was significantly greater than the midfoot and rearfoot for all techniques (p= 0.000). The percent plantar load of forefoot during développé à la seconde (side, front, back), passé, and penché was greater than midfoot (166.56%, 161.51%, 168.11%, 165.14%, 174.04%) and rearfoot (47.75%, 32.84%, 43.83%, 48.73%, 49.66) for all techniques, respectively. The forefoot's PPD, impulse, and contact area during all techniques were significantly correlated with the trunk muscle strength ratio (p< 0.05).

CONCLUSION

Ballet dancers with higher trunk muscle strength imbalance showed a greater percentage difference in pressure load between the left and right foot in the anterior and posterior directions, poor balance, aggravated trunk imbalance, increased PPD, contact area, and impulse in the forefoot during each technique.

Rat Model of Quadriceps Contracture by Joint Immobilization

Muscle contracture is an abnormal pathologic process resulting in fibrosis and muscle atrophy, which can lead to limitation of joint motion. To establish a diagnostic method to detect muscle contracture and a method to control its progression, we investigated an appropriate method to create an animal model of quadriceps contracture using rats. Eighteen Wistar rats were divided into three groups, and bilateral hindlimbs were immobilized with either a cast (Group I), a Velcro hook-and-loop fastener (Group V), or steel wire (Group S) with the knee and ankle joints in extension position for two weeks. Five rats in a control group (Group C) were not immobilized. After two weeks, the progression of quadriceps contracture was assessed by measuring the range of joint motion and pathohistological changes. Muscle atrophy and fibrosis were observed in all immobilization groups. The knee joint range of motion, quadriceps muscle weight, and muscle fiber size decreased only in Group S compared to the other immobilization groups. Stress on rats due to immobilization was less in Group S. These results indicate that Group S is the superior quadriceps contracture model. This model aids research investigating diagnostic and therapeutic methods for muscle contracture in humans and animals.

Effect of Joint Mobilization in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Sensorimotor and range of motion deficits due to chronic ankle instability (CAI) are abnormalities of the movement system that make postural control difficult. This review aimed to quantify the effect of joint mobilization on the range of motion, dynamic balance, and function in individuals with CAI. Randomized controlled trials in which joint mobilization was performed in individuals with CAI were searched for in five international databases (CENTRAL, CINAHL, Embase, MEDLINE, PEDro). Qualitative and quantitative analyses were performed using the risk of bias tool and RevMan 5.4 provided by the Cochrane Library. Nine studies with 364 individuals with CAI were included in this study. This meta-analysis reported that joint mobilization showed significant improvement in the dorsiflexion range of motion (standardized mean difference [SMD] = 1.02, 95% confidence interval [CI]: 0.41 to 1.63) and dynamic balance (SMD = 0.49, 95% CI: 0.06 to 0.78) in individuals with CAI. However, there was no significant improvement in function (patient-oriented outcomes) (SMD = 0.76, 95% CI: -0.00 to 1.52). For individuals with CAI, joint mobilization has limited function but has positive benefits for the dorsiflexion range of motion and dynamic balance.

Effects of High-Intensity Stretch with Moderate Pain and Maximal Intensity Stretch without Pain on Flexibility

In this study, we aimed to identify the time course effects of different intensities of static stretch (SST) (maximal intensity without pain vs. high-intensity with moderate pain) on flexibility. This study included 16 healthy students (8 men and 8 women) who performed 1) 5-minute SST at 100%, 2) 110%, and 3) 120% intensity, as well as 4) no stretching (control) in a random sequence on four separate days. Static passive torque (SPT), hamstring electromyography (EMG), and pain intensity were continuously recorded during SST. We assessed markers of stiffness, range of motion (ROM), and maximal dynamic passive torque (DPTmax) before SST and 0, 15, 30, 45, 60, 75, and 90 minutes after SST. Stiffness decreased and ROM and DPTmax increased significantly immediately after SST at the three different intensity levels (p < 0.05). The effects of SST at 120% intensity were stronger and lasted longer than the effects of SST at 110% and 100% intensity (stiffness: -17%, -9%, and -7%, respectively; ROM: 14%, 10%, and 6%, respectively; DPTmax: 15%, 15%, and 9%, respectively). SPT decreased after SST at all intensities (p < 0.05). SST at 120% intensity caused a significantly greater reduction in SPT than SST at 100% intensity (p < 0.05). Pain intensity and EMG activity increased immediately after the onset of SST at 120% intensity (p < 0.05), although these responses were attenuated over time. Stretching intensity significantly correlated with the degree of change in ROM and stiffness (p < 0.05). These results support our hypothesis that stretch-induced flexibility is amplified and prolonged with an increase in stretch intensity beyond the pain threshold. Additional studies with more participants and different demographics are necessary to examine the generalizability of these findings.

Improving Data Glove Accuracy and Usability Using a Neural Network When Measuring Finger Joint Range of Motion

Data gloves capable of measuring finger joint kinematics can provide objective range of motion information useful for clinical hand assessment and rehabilitation. Data glove sensors are strategically placed over specific finger joints to detect movement of the wearers' hand. The construction of the sensors used in a data glove, the number of sensors used, and their positioning on each finger joint are influenced by the intended use case. Although most glove sensors provide reasonably stable linear output, this stability is influenced externally by the physical structure of the data glove sensors, as well as the wearer's hand size relative to the data glove, and the elastic nature of materials used in its construction. Data gloves typically require a complex calibration method before use. Calibration may not be possible when wearers have disabled hands or limited joint flexibility, and so limits those who can use a data glove within a clinical context. This paper examines and describes a unique approach to calibration and angular calculation using a neural network that improves data glove repeatability and accuracy measurements without the requirement for data glove calibration. Results demonstrate an overall improvement in data glove measurements. This is particularly relevant when the data glove is used with those who have limited joint mobility and cannot physically complete data glove calibration.

Measurement Method of Human Lower Limb Joint Range of Motion Through Human-Machine Interaction Based on Machine Vision

To provide stroke patients with good rehabilitation training, the rehabilitation robot should ensure that each joint of the limb of the patient does not exceed its joint range of motion. Based on the machine vision combined with an RGB-Depth (RGB-D) camera, a convenient and quick human-machine interaction method to measure the lower limb joint range of motion of the stroke patient is proposed. By analyzing the principle of the RGB-D camera, the transformation relationship between the camera coordinate system and the pixel coordinate system in the image is established. Through the markers on the human body and chair on the rehabilitation robot, an RGB-D camera is used to obtain their image data with relative position. The threshold segmentation method is used to process the image. Through the analysis of the image data with the least square method and the vector product method, the range of motion of the hip joint, knee joint in the sagittal plane, and hip joint in the coronal plane could be obtained. Finally, to verify the effectiveness of the proposed method for measuring the lower limb joint range of motion of human, the mechanical leg joint range of motion from a lower limb rehabilitation robot, which will be measured by the angular transducers and the RGB-D camera, was used as the control group and experiment group for comparison. The angle difference in the sagittal plane measured by the proposed detection method and angle sensor is relatively conservative, and the maximum measurement error is not more than 2.2 degrees. The angle difference in the coronal plane between the angle at the peak obtained by the designed detection system and the angle sensor is not more than 2.65 degrees. This paper provides an important and valuable reference for the future rehabilitation robot to set each joint range of motion limited in the safe workspace of the patient.

[Effectiveness of arthroscopic 360° capsular release for frozen shoulder]

Objective

To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.

Methods

Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S ₁ level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.

Results

All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T _6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05).

Conclusion

Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.

Immediate effects of TENS and HVPS on pain and range of motion in subacromial pain syndrome: A randomized, placebo-controlled, crossover trial

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) is one of the most common methods for managing shoulder pain, and high voltage pulsed currents (HVPS) may be used for reducing pain. However, their immediate effects on resting pain and pain-free active range of shoulder motion (pfROM) in patients with subacromial pain syndrome (SAPS) have not been studied comparatively, yet.

OBJECTIVES

The aim of this study was to compare the immediate effects of TENS, HVPS and placebo stimulation on shoulder resting pain and pfROM in patients with SAPS.

METHODS

Randomized, placebo-controlled, double-blind, crossover study. One hundred and six patients with SAPS received placebo (predetermined 1st day application), TENS and HVPS with 1-day interval, in a random sequence. Before and after each application, resting pain and pfROM were evaluated by 0-10 cm visual analogue scales and a digital inclinometer, respectively.

RESULTS

Intensity of pain decreased significantly after TENS, HVPS and placebo interventions (p< 0.05). While pfROMs increased significantly after TENS and HVPS (p< 0.05), remained unchanged after placebo, except for internal and external rotations (p> 0.05). The most obvious effects on pain and pfROMs occurred after HVPS (p< 0.05).

CONCLUSION

In patients with SAPS, both HVPS and TENS, but preferably HVPS can be used effectively to decrease pain and increase pfROM.

Concurrent Validity of Equine Joint Range of Motion Measurement: A Novel Digital Goniometer versus Universal Goniometer

Simple Summary

With the growth of the field of equine rehabilitation, there is an increased demand on rehabilitation clinicians to utilize simple and reliable objective outcome assessment tools. Goniometry, the measurement of joint angles, traditionally performed with a universal goniometer (UG), is a commonly utilized assessment tool in monitoring problems of the musculoskeletal system, as well as the progression of rehabilitation interventions. Goniometry has been demonstrated to be of value, being both reliable and valid, in humans and other animal species. There are different types of goniometers, each of which has some benefit, but varies in accessibility, cost, and user-friendliness. This study examined the use of a novel digital goniometer (DG) in the measurement of angles of two joints in a horse, and comparing the measurements to those taken with a UG. The study demonstrated significant differences in range of motion for the carpus and fetlock joint, a 2–3° difference comparing measurements on a sedated horse with corresponding radiographs, a “fair” to “excellent” inter-tester reliability and a “fair” to “almost perfect” intra-tester reliability. The novel DG was found to be easier to use than the UG. In conclusion, the novel DG may serve as a simple tool for measuring joint motion in equine rehabilitation patients.

Abstract

Goniometry is the measurement of joint angles with a conventional universal goniometer (UG) or a digital goniometer (DG). The UG is validated for use in dogs and cats. However, it demands both of the user’s hands when measuring. To avoid this, a novel type of DG has been developed, simplifying measurement by offering single-hand usage. The objective of this study is to examine the concurrent validity of the DG. The study consists of measurement with the DG and UG for flexion of the carpus and fetlock on ten horses, and with the DG in flexion and neutral positioning of the fetlock on a sedated horse and corresponding radiographs, intra- and inter-tester reliability and a survey on user-friendliness. The data were analyzed with ANOVA and intraclass correlation coefficient (ICC), with a significance of p < 0.05. The study showed significant differences in range of motion for the carpus and fetlock joint, a 2–3° difference comparing measurements on a sedated horse with corresponding radiographs, a “fair” to “excellent” inter-tester reliability and a “fair” to “almost perfect” intra-tester reliability, and the DG was easier to use than the UG. In conclusion, the novel DG may serve as a simple tool for measuring joint motion in equine rehabilitation patients.

Continuous moderate intensity versus discontinuous high intensity treadmill running on anterior cruciate ligament laxity and hamstrings flexibility in eumenorrheic women

OBJECTIVE

To differentiate running intensity and menstrual phase effects on knee stability before and after exercise.

METHODS

Ten eumenorrheic aerobically trained females were recruited to determine effects of a randomized crossover design of exercise intensity (85%HRR vs 42.5%HRR) on anterior cruciate ligament laxity (APLAX) and hamstrings flexibility (HF). A KT-2000 arthrometer measured APLAX and a 90-90 supine knee extension (MKE) and sit-and-reach test (SRD) measured HF in follicular (FP) and luteal (LP) menstrual cycle phases.

RESULTS

Significant difference pre-exercise was observed for both 90N and 120N APLAX in LP compared to FP. Exercise increased APLAX at 90N and 120N in both FP and LP with LP exhibiting larger changes than FP. MKE and SRD increased significantly following exercise but were not different across menstrual phases or between exercise intensities.

CONCLUSION

APLAX taken together with increased HF post-exercise demonstrates a less stable knee joint in the LP before and following exercise.

Is there a relationship between back squat depth, ankle flexibility, and Achilles tendon stiffness?

This study investigated the relationship between back squat depth capacity, ankle dorsiflexion resistance to stretch and maximal range of motion (ROM), and Achilles tendon stiffness of healthy individuals (n = 20). Squat depth capacity was assessed with 2D kinematic analysis. Ankle dorsiflexion maximal ROM was assessed using a smartphone digital goniometry (lunge test) and isokinetic dynamometry (prone test). Ankle dorsiflexion resistance to stretch was assessed during the prone test. Achilles tendon stiffness was estimated at rest [using shear wave elastography (stiffness-SWE)] and during isometric contraction through tendon force-length relationship (using B-mode sonography). Squat depth was associated only with ankle dorsiflexion ROM in the lunge test (r = 0.69, p = 0.001). Ankle dorsiflexion ROM in the lunge test was associated with the ankle resistance to stretch (r = 0.46, p = 0.050) and Achilles tendon stiffness-SWE (r = 0.62, p = 0.005); and it was the only variable different between individuals with low and high squat depth capacity (p = 0.014). No other statistically significant associations were found. In conclusion, back squat depth is associated with ankle dorsiflexion ROM when the knee is flexed, without evident influence of global joint and Achilles tendon mechanical properties.

Non-uniform Stiffness within Gastrocnemius-Achilles tendon Complex Observed after Static Stretching

Higher stiffness of the Achilles tendon (AT) and gastrocnemius have been found to be risk factors associated with Achilles tendinitis. Static stretching (SS) is one intervention that has been investigated to improve the flexibility and therefore reduce injury risk. Previous studies have investigated the acute effect of SS on one region for AT and gastrocnemius morphology and stiffness; however, there is a lack of knowledge about the effect of SS on other regions of the AT and gastrocnemius (e.g., proximal vs. distal, within gastrocnemius). The aims of the present study were: (1) to investigate the acute effects of SS on the shear modulus of the medial gastrocnemius muscles (MG) and lateral gastrocnemius muscles (LG) and AT for different regions; (2) to examine the differences in range of motion (ROM) before and after SS; and (3) to investigate the change of thickness of AT and fascicle length of MG and LG before and after SS. The stiffness of AT and the gastrocnemius, fascicle length of the muscles, thickness of the AT, and maximal ankle joint dorsiflexion angle were measured in thirty healthy subjects (15 males, 15 females) before(pre) and immediately after (post) 5-minute SS. Stretching effects are not homogeneous among different regions. After SS administration, the proximal, middle, and distal regions of MG stiffness decreased by 34.12%, 22.45%, and 25.27%, respectively (p = 0.000), and LG stiffness decreased by 37.71%, 30.47%, and 22.13%, respectively (p = 0.000), whereas AT stiffness increased by 25.73%, 17.01%, and 19.53%, respectively (p= 0.000). ROM of ankle joint increased by 8.02% (p=0.00). Nevertheless, there were no changes in the thickness of AT and fascicle length of the gastrocnemius. These results suggest that non-uniform behaviour is consistently present within the gastrocnemius and AT, and the gastrocnemius heterogeneity is reduced after SS. The stretching maneuver could be effective to increase the flexibility.

Assessment of Shoulder Range of Motion Using a Wireless Inertial Motion Capture Device-A Validation Study

(1) Background: Measuring joint range of motion has traditionally occurred with a universal goniometer or expensive laboratory based kinematic analysis systems. Technological advances in wearable inertial measurement units (IMU) enables limb motion to be measured with a small portable electronic device. This paper aims to validate an IMU, the 'Biokin', for measuring shoulder range of motion in healthy adults; (2) Methods: Thirty participants completed four shoulder movements (forward flexion, abduction, and internal and external rotation) on each shoulder. Each movement was assessed with a goniometer and the IMU by two testers independently. The extent of agreement between each tester's goniometer and IMU measurements was assessed with intra-class correlation coefficients (ICC) and Bland-Altman 95% limits of agreement (LOA). Secondary analysis compared agreement between tester's goniometer or IMU measurements (inter-rater reliability) using ICC's and LOA; (3) Results: Goniometer and IMU measurements for all movements showed high levels of agreement when taken by the same tester; ICCs > 0.90 and LOAs < ±5 degrees. Inter-rater reliability was lower; ICCs ranged between 0.71 to 0.89 and LOAs were outside a prior defined acceptable LOAs (i.e., > ±5 degrees); (4) Conclusions: The current study provides preliminary evidence of the concurrent validity of the Biokin IMU for assessing shoulder movements, but only when a single tester took measurements. Further testing of the Biokin's psychometric properties is required before it can be confidently used in routine clinical practice and research settings.

Stretching Combined with Repetitive Small Length Changes of the Plantar Flexors Enhances Their Passive Extensibility while Not Compromising Strength

Static stretching increases flexibility but can decrease muscle strength; therefore, a method that would avoid the latter has been longed for. In this study, a novel stretching modality was developed that provides repetitive small length changes to the plantar flexor muscles undergoing passive static stretching (minute oscillation stretching). We investigated the effects of minute oscillation stretching on muscle strength and flexibility and its continuance. Isometric plantar flexion strength and maximal ankle joint dorsiflexion angle (dorsiflexion range of motion) were measured in 10 healthy young men (22 ± 2 years) before (pre) and immediately after (post) 3 types of stretching: static stretching, minute oscillation stretching at 15 Hz, and no intervention (control). The dorsiflexion range of motion was also measured at 15, 30, and 60 min post-stretching. Elongation of the medial gastrocnemius and Achilles tendon was determined by ultrasonography. Plantar flexion strength significantly decreased by 4.3 ± 3.5% in static stretching but not in minute oscillation stretching. The dorsiflexion range of motion significantly increased both in static stretching (7.2 ± 8.1%) and minute oscillation stretching (11.2 ± 14.6%), which was accompanied by a significantly larger muscle elongation but not tendon elongation. Elevated dorsiflexion range of motion was maintained until 30 min after minute oscillation stretching, while levels returned to baseline (pre-intervention) 15 min after static stretching. All variables remained unchanged in the control condition. In conclusion, minute oscillation stretching improves extensibility of the muscle belly without decreasing strength. Furthermore, the augmented flexibility to a similar extent to static stretching is retained for 30 min in minute oscillation stretching and within 15 min in static stretching.

Efficacy of Physiotherapy in Reducing Back Pain and Improve Joint Mobility in Older Women

BACKGROUND

Pain of the spine and large appendicular joints may limit the functional mobility of elderly persons and affect their biological fitness. This paper assesses the effects of comprehensive physical therapy in women with lumbar and cervical pain and compares flexibility in the upper and lower body and the range of motion in selected joints.

MATERIAL AND METHODS

Thirty-three women aged 60-75 years completed a 6-week intervention involving group gymnastics to prevent back pain, relaxation techniques, classic massage, transcutaneous electrical nerve stimulation, and ultrasound therapy to the lumbosacral and cervicothoracic regions. Patient outcomes were assessed by measuring upper and lower body flexibility, upper and lower extremity joint and spinal ROM, and self-reported back pain using a Visual Analogue Scale. Differences in means between successive measurements were calculated with a Student t test for dependent groups, while differences in the range of motion in the joints of the right and left limbs were calculated with the NIR test.

RESULTS

The physical therapy significantly improved flexibility of the upper and lower body by increasing the range of motion in selected joints of the limbs and the spine. On completion of the intervention, the intensity of back pain was reduced by 2.9 points in the VAS scale.

CONCLUSIONS

1. The 6-week physical therapy programme desig-ned by us constitutes an effective therapy for pain relief in patients with degenerative changes of the spine. 2. The proposed combination of sonotherapy, elec-tro-therapy and classic massage procedures with general fitness exercises in low positions and au-to-genic training contributed significantly to im-provement in flexibility of the upper and lower part of the body and increasing the range of mo-tion in joints of the lower and upper extremities and the spine in women over 60 years of age. 3. The proposed set of procedures and exercises may be used in women over 60 years of age with the aim of improving selected components of biolo-gical fitness.

Preoperative Ultrasonographic Assessment of the Anterior Pelvic Plane for Personalized Total Hip Replacement

OBJECTIVES

Correct positioning of the acetabular component is a key factor in minimizing the risk of dislocation after total hip replacement (THR) surgery. A "safe" orientation of the cup is usually defined by 2 angles measured between its geometric axis and the anterior pelvic plane. However, in the current state-of-the-art approach to THR surgery, the intraoperative orientation of the anterior pelvic plane cannot be measured. Even less is known about the functional orientation of the pelvis, which determines the postoperative orientation of the cup during the patient's everyday activities. The aim of this article is to present an original approach to personalized THR surgery, in which the necessary measurements are done preoperatively without interfering with the surgical work flow, and the individual orientation of the cup is obtained without navigation using standard tools that are available in the operating room.

METHODS

To quantify the effect of the anatomic conditions on the final orientation of the cup, we measured the orientation of the anterior pelvic plane in 43 patients scheduled for THR using a newly developed noninvasive method based on ultrasonography and mobile devices.

RESULTS

Our results confirm a large variability of the pelvic orientation in both supine and standing positions. We further show how this variability affects the final position of the cup and discuss its consequences for the patient. Finally, we explore a few practical solutions for individualized cup placement, including our own approach, which is based on tilting of the operating table.

CONCLUSIONS

In this work, we show that the common guidelines used today for cup implantation can only be effectively applied to a small portion of the population. In most cases, it is crucial that the orientation of the cup is readjusted for the particular anatomy of the individual patient.

A new substitute for formalin: Application to embalming cadavers

The development of formalin-free fixatives is an urgent issue in gross anatomy because of the health hazard and the tissue-hardening actions of formalin. We recently identified the fixative, antimicrobial, and preservative effects of N-vinyl-2-pyrrolidone (NVP), a precursor of the water-soluble macromolecular polymer polyvinylpyrrolidone, in animal experiments. The aim of the present study is to investigate whether NVP solution can be used as an alternative to formalin in human cadaveric dissection. Twelve donated cadavers were infused with NVP via the femoral and common carotid arteries using a peristaltic pump. Experienced teaching staff members in our department dissected the cadavers and examined their macroanatomical properties. The NVP-embalmed corpses showed no sign of decomposition or fungal growth. The bodies remained soft and flexible. Notably, the shoulder, elbow, wrist, phalangeal, hip, knee, cervical spine, and temporomandibular joints were highly mobile, almost equivalent to those of living individuals. The range of motion of most joints was greater in the NVP-fixed than formalin-fixed cadavers. Under the dermis, the subcutaneous fat was markedly reduced and the connective tissues were transparent, so the ligaments, cutaneous nerves, and veins were easily discernible. The abdominal wall and the visceral organs remained pliable and elastic, resembling those of fresh cadavers. The lungs, liver, and gastrointestinal tract were moveable in the thoracic and abdominal cavities and were readily isolated. NVP can be used successfully as a fixative and preservative solution for human cadavers; furthermore, NVP-embalmed bodies could be valuable for learning clinical skills and for training, and for developing innovative medical devices. Clin. Anat. 31:90-98, 2018. © 2017 Wiley Periodicals, Inc.

The Effect of Backpack Load Carriage on the Kinetics and Kinematics of Ankle and Knee Joints During Uphill Walking

The purpose of this study was to investigate the effect of load carriage on the kinematics and kinetics of the ankle and knee joints during uphill walking, including joint work, range of motion (ROM), and stance time. Fourteen males walked at a self-selected speed on an uphill (15°) slope wearing military boots and carrying a rifle in hand without a backpack (control condition) and with a backpack. The results showed that the stance time significantly decreased with backpack carriage (p < .05). The mediolateral impulse significantly increased with backpack carriage (p < .05). In the ankle joints, the inversion-eversion, and dorsi-plantar flexion ROM in the ankle joints increased with backpack carriage (p < .05). The greater dorsi-plantar flexion ROM with backpack carriage suggested 1 strategy for obtaining high plantar flexor power during uphill walking. The result of the increased mediolateral impulse and inversion-eversion ROM in the ankle joints indicated an increase in body instability caused by an elevated center of mass with backpack carriage during uphill walking. The decreased stance time indicated that an increase in walking speed could be a compensatory mechanism for reducing the instability of the body during uphill walking while carrying a heavy backpack.

Lower extremity and spine characteristics in young dancers with and without patellofemoral pain

Very little is known about patellofemoral pain syndrome (PPFS) among young dancers. Understanding the mechanism of the injury and implementing a preventative programme are important in order to minimize the risk of PFPS. The aim of the current study is to determine the extent to which factors such as lower extremity and back characteristics are common among dancers with PFPS. The study population included 271 dancers with PFPS and 271 non-injured dancers, aged 10-16 years. All dancers were screened for morphometric profile, dance discipline (h/week), anatomical anomalies (present/absent of scoliosis, genu valgus/varum, etc.), and joint range of motion (measured by goniometer at the hip, knee, ankle, foot, and spinal joints). The predicting factors for PFPS among young dancers (10-11 years old) were: hyper hip abduction (OR = 0.906) and lower back and hamstring flexibility (OR = 3.542); for adolescent dancers (12-14 years old): hyper ankle dorsiflexion (OR = 0.888), hind foot-varum (OR = 0.260), and mobility of patella (OR = 2.666); and, for pre-mature dancers (15-16 years old): scoliosis (OR = 5.209), limited ankle plantar-flexion (OR = 1.060), and limited hip internal rotation (OR = 1.063). In conclusion, extrinsic and intrinsic parameters predisposing the dancers to knee injuries should be identified by screening in early stages of dance classes.

The importance of genetic factors for the development of arthropathy: a longitudinal study of children and adolescents with haemophilia A

Haemophilia A is a congenital bleeding disorder characterised by recurrent haemorrhages into the major joints. Haemophilic arthropathy is a well-established outcome of recurrent joint bleeding; however, it is clear that multiple factors determine the extent and severity of its occurrence. We sought to identify genetic factors related to abnormalities in range of motion (ROM) in the knees, ankles and elbows in a cohort of children and adolescents with haemophilia A not treated primarily with regular prophylaxis. Using data from the Haemophilia Growth and Development Study, we examined associations between 13,342 genetic markers and ROM scores measured at six-month intervals for up to seven years. As a first step, ordered logistic regression models were fit for each joint separately. A subset of SNP markers showing significant effects (p<0.01) on the right and left sides for at least two joints were included in a full model fit using a multivariate generalised linear mixed model assuming an ordinal response. The models contained all ROM scores obtained at all visits. Twenty-five markers analysed in the full model showed either increased or decreased risk of ROM abnormalities at the p<0.001 level. Several genes identified at either the first or second stage of the analysis have been associated with arthritis in a variety of large studies. Our results support the likelihood that risk for haemophilic arthropathy is associated with genetic factors, the identification of which holds promise for further advancing the individualisation of treatment.

Early initiation of enzyme replacement therapy for the mucopolysaccharidoses

The mucopolysaccharidoses (MPS), a group of rare genetic disorders caused by defects in glycosaminoglycan (GAG) catabolism, are progressive, multi-systemic diseases with a high burden of morbidity. Enzyme replacement therapy (ERT) is available for MPS I, II, and VI, and may improve walking ability, endurance, and pulmonary function as evidenced by data from pivotal trials and extension studies. Despite these demonstrable benefits, cardiac valve disease, joint disease, and skeletal disease, all of which cause significant morbidity, do not generally improve with ERT if pathological changes are already established. Airway disease improves, but usually does not normalize. These limitations can be well understood by considering the varied functions of GAG in the body. Disruption of GAG catabolism has far-reaching effects due to the triggering of secondary pathogenic cascades. It appears that many of the consequences of these secondary pathogenic events, while they may improve on treatment, cannot be fully corrected even with long-term exposure to enzyme, thereby supporting the treatment of patients with MPS before the onset of clinical disease. This review examines the data from clinical trials and other studies in human patients to explore the limits of ERT as currently used, then discusses the pathophysiology, fetal tissue studies, animal studies, and sibling reports to explore the question of how early to treat an MPS patient with a firm diagnosis. The review is followed by an expert opinion on the rationale for and the benefits of early treatment.

The Effect of Aquatic Exercise Therapy on Muscle Strength and Joint's Range of Motion in Hemophilia Patients

BACKGROUND

This study was to evaluate the effect of a period of aquatic exercise therapy on muscle strength and joints range of motion in hemophilia patients.

METHODS

This was a semiexperimental, pretest, post-test study with a control group. This semi-experimental study comprised twenty men suffering moderate hemophilia were selected by convenience sampling method from patients of a referral hospital. They were randomly assigned to intervention and control groups of equal number. The hemophilia patients who were referred to Sayedo-Shohada Hospital enrolled in this study. Twenty men suffering moderate hemophilia were selected using convenience sampling method and then divided randomly into intervention and control groups (10 patients in each group). Subjects of aquatic exercise therapy group underwent activity in water in three sessions (45-60 minutes) per week for 8 weeks, while the control group was only under follow-up and during this period did not experience any effective physical activity. The patients' muscle strength and joint range of motion were evaluated through standard laboratory tools, using an isokinetic dynamometer (Biodex, Systems III) and a standard goniometer in the beginning and at end of the study. Finally, data was analyzed using analysis of covariance (ANCOVA).

RESULTS

The strength of the muscles around the knee joint (to perform extension and flexion movements) increased significantly in the case group while the control group experienced a significant reduction of strength in left leg, but in right leg remarkable change was observed. Range of motion in all joints was improved in the case group, while the control group did not improve significantly.

CONCLUSION

The results showed that aquatic exercise therapy can be a useful method to improve joints' strength and range of motion in hemophilia patients in order to improve their daily functioning and quality of life.

Muscle length and joint range of motion in children with cystic fibrosis compared to children developing typically

PURPOSE

To explore range of motion in children with cystic fibrosis (CF) compared to children developing typically. With the increasing longevity of people with CF, musculoskeletal concerns are becoming more prevalent and should be identified and considered in management plans. Reduced range of motion (ROM) in older people with CF has been demonstrated, and the age at which these changes begin to occur must be explored.

METHODS

Participants were 38 children with CF (aged 7-14 years) and 38 children developing typically, matched for age and gender. Muscle length and joint ROM measurements were compared, using analysis of variance, in the thoracolumbar region (extension, flexion, lateral flexion), upper limb (pectoralis minor, pectoralis major, shoulder horizontal abduction), and lower limb (hip internal and external rotation, hamstrings, gastrocnemius-soleus).

RESULTS

Children with CF had significantly shorter pectoralis minor, pectoralis major, and gastrocnemius-soleus muscles and significantly greater range of shoulder horizontal abduction than matched controls.

CONCLUSION

Altered ROM was identified in children with CF, strengthening the rationale to support proactive physiotherapy management of the musculoskeletal system, aiming to optimize function across the increasing lifespan. Evaluation and management of ROM and its impact on activity and participation are important areas for future research and clinical practice.

Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint

OBJECTIVE

To determine the effect of stretching and jogging on the series elastic muscle stiffness of the plantar flexors and on the range of dorsiflexion at the ankle joint.

METHODS

24 healthy subjects participated in this study. Each subject undertook all of the following protocols, in random order: (1) stretching protocol: five 30 s static stretches with 30 s rest between stretches; (2) aerobic jogging protocol: subjects ran on a treadmill for 10 min at 60% of their maximum age predicted heart rate; (3) combined protocol: subjects ran first and then stretched. A damped oscillation technique was used to measure the series elastic stiffness of the plantar flexors. Dorsiflexion of the ankle was assessed with a weights and pulley system that moved the ankle joint from a neutral position into dorsiflexion passively. Electromyography was used to monitor the activity of the plantar and dorsiflexors during these procedures. The statistical analysis of these data involved an analysis of covariance.

RESULTS

For decreasing series elastic muscle stiffness running was more effective than stretching (P < 0.05). In contrast, the results for range of motion showed that the combination protocol and the stretching only protocol were more effective than the running only protocol (P < 0.05) for increasing dorsiflexion range of motion at the ankle.

CONCLUSIONS

Both jogging and static stretching exercises appear to be beneficial to individuals participating in sporting activities.