The Biomechanics Research and Innovation Challenge: Development, Implementation, Uptake, and Reflections on the Inaugural Program.

Biomechanics as a discipline is ideally placed to increase awareness and participation of girls and women in science, technology, engineering, and mathematics. A nationwide Biomechanics and Research Innovation Challenge (BRInC) centered on mentoring and role modeling was developed to engage high school girls (mentees) and early-mid-career women (mentors) in the field of biomechanics through the completion of a 100-day research and/or innovation project. This manuscript describes the development, implementation, and uptake of the inaugural BRInC program and synthesizes the research and innovation projects undertaken, providing a framework for adoption of this program within the global biomechanics community. Eighty-seven high school girls in years 9 and 10 (age range: 14-16 y) were mentored in teams (n = 17) by women in biomechanics (n = 24). Using a design thinking approach, teams generated solutions to biomechanics-based problem(s)/research question(s). Eight key reflections on program strengths, as well as areas for improvement and planned changes for future iterations of the BRInC program, are outlined. These key reflections highlight the innovation, impact, and scalability of the program; the importance of a program framework and effective communication tools; and implementation of strategies to sustain the program as well as the importance of diversity and building a sense of community.

Effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy: A randomised crossover trial.

OBJECTIVE: To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. STUDY DESIGN: Randomised crossover trial. SETTING: Biomechanics laboratory. SUBJECTS: 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. INTERVENTIONS: Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. MAIN MEASURES: Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. RESULTS: There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F2,52 = 0.02, p = 0.98; extended position: F2,52 = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F1,26 = 0.94, p = 0.34; extended position: F1,26 = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F1.51,39.17 = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F1,26 = 0.94, p = 0.34). CONCLUSION: Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist.

The immediate effect of multidirectional elastic tape on the passive mechanical properties of the ankle joint.

This study examined the immediate effects of multidirectional elastic tape (MET) on passive ankle joint torque in healthy adults. A randomised crossover trial evaluated four tape conditions (no-tape-NT, low-tension-LT, medium-tension-MT, and high-tension-HT) at two angular speeds on peak dorsiflexion torque, low- (stiffness 1) and high-torque stiffness (stiffness 2), area under the loading curve (AUC) and hysteresis. Twenty-two adults completed the study (17 females; mean (SD): age 26.0 (6.9) years, height 1.7 (0.1) m, body mass 71.1 (20.2) kg. There was no significant condition-by-speed interaction for any ankle torque variable. There was a significant main effect of condition on peak dorsiflexion torque, stiffness 1, and AUC, but not stiffness 2 or hysteresis. Post-hoc tests revealed that peak dorsiflexion torque, stiffness 1 and AUC were significantly lower in the NT condition, compared to the three taped conditions, and between the LT and HT conditions, though the effect sizes were considered small. MET applied with increasing levels of pre-tension, led to a small and incremental increase in stretch resistance and elastic energy stored (range 5.5% to 12.5%) during passive ankle dorsiflexion. Importantly, effect sizes were small and may not translate to measurable improvements in muscle-tendon unit performance during dynamic exercise.

Validity of the PUSH band 2.0 and Speed4lifts to measure velocity during upper and lower body free-weight resistance exercises.

Accuracy and test-retest reliability were assessed for two devices, PUSH Band 2.0 (PUSH) and Speed4lifts. Two identical sessions were performed 6-8 days apart. Twenty rugby league players performed three repetitions with 20%, 40%, 60% and 80% of estimated one repetition maximum for back squat (BS), front squat (FS), and bench press (BP). Velocity was recorded using PUSH, Speed4lifts and 3D motion analysis system (gold standard). Passing-Bablok regression analysis assessed agreement of velocity measures with the gold standard. Intraclass correlation coefficients (ICC) and coefficients of variation (CV) assessed test-retest reliability. PUSH and Speed4lifts were accurate for BS velocities <1.00 m/s and FS velocities <0.65 m/s. PUSH was accurate for BP velocities <0.65 m/s. Speed4lifts was accurate for BP velocities between 0.65-1.00 m/s. PUSH was reliable at all loads (ICC = 0.79-0.92; CV = 2.63-6.89%) except for 20% FS and BP (ICC = 0.49-0.64; CV = 3.13-3.62%). Speed4lifts was reliable at all loads (ICC = 0.70-0.96; CV = 2.57-4.26%) except for 20% BP (ICC = 0.59; CV = 4.59%). These results suggest that both devices are unsuitable for measuring the velocity of BS, FS and BP at faster velocities and at lighter loads.

Validity and Reliability of Using Load-Velocity Relationship Profiles to Establish Back Squat 1 m·s-1 Load.

ABSTRACT: Elsworthy, N, Callaghan, DE, Scanlan, AT, Kertesz, AHM, Kean, CO, Dascombe, BJ, and Guy, JH. Validity and reliability of using load-velocity relationship profiles to establish back squat 1 m·s-1 load. J Strength Cond Res 35(2): 340-346, 2021-Although measuring movement velocity during resistance exercise is being increasingly used to monitor player readiness for competition in team sports, the validity and reliability of using set target velocities has not been examined. This study examined test-retest reliability of the load-velocity relationship during the back squat to predict loads corresponding to a mean velocity of 1 m·s-1 (V1Load), test-retest reliability of mean concentric velocity at V1Load, and criterion validity of mean concentric velocity at V1Load. Twenty-seven resistance-trained male rugby league players completed 2 testing sessions on separate days to establish individualized back squat load-velocity relationship profiles (30, 40, 60, and 80% estimated 1 repetition maximum). Velocity during the back squat was assessed at each load and V1Load derived using individualized linear regression equations. A subset of subjects (n = 18) also performed the back squat at predicted V1Load to examine the test-retest reliability and compare the mean concentric velocity with the predicted target of 1 m·s-1. The mean concentric velocity was consistent across all loads during load-velocity relationship testing (p > 0.05, intraclass correlation coefficient [ICC] ≥0.75, coefficient of variation [CV] ≤5.7%, effect size [ES] ≤0.27), and for predicting V1Load (p = 0.11, ICC = 0.95, CV = 3.9%, ES = 0.11). The mean concentric velocity at V1Load was reliable (ICC = 0.77; CV = 2.6%; ES = 0.39) and not significantly different (p = 0.21) to the target velocity, supporting criterion validity. Individualized load-velocity profiles for the back squat can accurately predict V1Load, and subsequent use of V1Load to assess back squat velocity is valid and reliable. Using V1Load to assess changes in back squat velocity may have application in measuring changes in strength and power or readiness to train.

Decrements in knee extensor and flexor strength are associated with performance fatigue during simulated basketball game-play in adolescent, male players.

This study quantified lower-limb strength decrements and assessed the relationships between strength decrements and performance fatigue during simulated basketball. Ten adolescent, male basketball players completed a circuit-based, basketball simulation. Sprint and jump performance were assessed during each circuit, with knee flexion and extension peak concentric torques measured at baseline, half-time, and full-time. Decrement scores were calculated for all measures. Mean knee flexor strength decrement was significantly (P < 0.05) related to sprint fatigue in the first half (R = 0.65), with dominant knee flexor strength (R = 0.67) and dominant flexor:extensor strength ratio (R = 0.77) decrement significantly (P < 0.05) associated with sprint decrement across the entire game. Mean knee extensor strength (R = 0.71), dominant knee flexor strength (R = 0.80), non-dominant knee flexor strength (R = 0.75), mean knee flexor strength (R = 0.81), non-dominant flexor:extensor strength ratio (R = 0.71), and mean flexor:extensor strength ratio (R = 0.70) decrement measures significantly (P < 0.05) influenced jump fatigue during the entire game. Lower-limb strength decrements may exert an important influence on performance fatigue during basketball activity in adolescent, male players. Consequently, training plans should aim to mitigate lower-limb fatigue to optimise sprint and jump performance during game-play.

Heart Rate Monitoring in Basketball: Applications, Player Responses, and Practical Recommendations.

Berkelmans, DM, Dalbo, VJ, Kean, CO, Milanovic, Z, Stojanovic, E, Stojiljkovic, N, and Scanlan, AT. Heart rate monitoring in basketball: applications, player responses, and practical recommendations. J Strength Cond Res 32(8): 2383-2399, 2018-The aims of this review were to collate the existing literature encompassing heart rate (HR) monitoring in basketball to (a) identify the applications of HR measurement; (b) report HR responses in male and female players during training and game-play; (c) evaluate use of current HR-based training load models; and (d) provide recommendations for future research and best practice approaches for basketball practitioners. Heart rate monitoring in basketball carries 3 primary applications: (a) monitoring exercise intensity; (b) assessing player fatigue status; and (c) quantifying internal training load. When interpreting the available training and game-play HR data in basketball players, key differences have been observed between playing positions and playing levels. Sex- and age-based differences in HR responses during basketball training and game-play are apparent across separate studies; however, further research exploring HR responses in wider player groups is needed, especially in female and junior players. There is also a lack of research directly comparing player HR responses during training and game-play to ascertain the effectiveness of different drills in preparing players for competition. Heart rate-based models have been frequently used to quantify the internal training load in basketball players, including Banister's Training Impulse (TRIMP), Lucia's TRIMP, and Edwards' Summated-Heart-Rate-Zones (SHRZ). The SHRZ model seems to hold practical advantages and better detect changes in player responses across training cycles compared with other approaches. Practical outcomes of this review center on recommendations for position-specific training plans, drills to promote desired cardiovascular stress, analysis of HR outcome measures, and ideal training load monitoring approaches.

Influence of Different Methods to Determine Maximum Heart Rate on Training Load Outcomes in Basketball Players.

Berkelmans, DM, Dalbo, VJ, Fox, JL, Stanton, R, Kean, CO, Giamarelos, KE, Teramoto, M, and Scanlan, AT. Influence of different methods to determine maximum heart rate on training load outcomes in basketball players. J Strength Cond Res 32(11): 3177-3185, 2018-The summated-heart-rate-zones (SHRZ) approach uses heart rate (HR) responses relative to maximum HR (HRmax) to calculate the internal training load (TL). Age-predicted, test-derived, and session-based approaches have all been used to determine HRmax in team sports. The purpose of this study was to determine the effects of using age-predicted, test-derived, and session-based HRmax responses on SHRZ TL in basketball players. Semiprofessional, male basketball players (N = 6) were analyzed during the preparatory training phase. Six age-based approaches were used to predict HRmax including Fox (220 - age); Hossack (206 - [0.567 × age]); Tanaka (208 - [0.7 × age]); Nikolaidis (223 - [1.44 × age]); Nes (211 - [0.64 × age]); and Faff (209.9 - [0.73 × age]). Test-derived HRmax was taken as the highest HR during the Yo-Yo intermittent recovery test (Yo-Yo IRT), whereas session-based HRmax was taken as the higher HR seen during the Yo-Yo IRT or training sessions. Comparisons in SHRZ TL were made at group and individual levels. No significant group differences were evident between SHRZ approaches. Effect size analyses revealed moderate (d = 0.60-0.79) differences between age-predicted, test-derived, and session-based methods across the group and individually in 2 players. The moderate differences between approaches suggest age-predicted, test-derived, and session-based methods to determine HRmax are not interchangeable when calculating SHRZ. Basketball practitioners are encouraged to use individualized HRmax directly measured during field-based tests supplemented with higher HR responses evident during training sessions and games when calculating the SHRZ TL to ensure greatest accuracy.

Physiological and Fatigue Responses Associated With Male and Mixed-Gender Ultimate Frisbee Game Play.

The aims of this study were to describe the physiological and fatigue responses associated with indoor Ultimate Frisbee game play, compare exercise intensities attained to current activity guidelines, and compare responses between male and mixed-gender game formats. A between-subjects (game format) repeated-measures (time points) observational experimental design was used. Subjects competed in male (n = 10; age: 26.3 ± 7.6 years) or mixed-gender (males: n = 4; 28.5 ± 5.7 years; females: n = 6; 28.3 ± 8.1 years) indoor Ultimate Frisbee game play. Games consisted of 10-minute halves, with heart rate (HR), blood lactate concentration ([BLa]), rating of perceived exertion, and 5-m and 20-m sprint times measured. Durations spent in HR-derived intensity zones and sprint decrements were calculated across games. Mixed-gender game play produced significantly (p ≤ 0.05) higher relative HR (94.3 ± 5.1% vs. 89.6 ± 4.8% HRmax) and [BLa] (8.31 ± 2.22 mmol·L vs. 4.68 ± 1.89 mmol·L) than male game play. Significantly (p ≤ 0.05) longer durations were spent at vigorous (male: 60.2 ± 26.1%; mixed-gender: 36.8 ± 34.8%) and near-maximal (male: 31.6 ± 27.6%; mixed-gender: 58.6 ± 37.7%) exercise intensities than moderate (3.9-7.2%), light (0.7-1.0%), and very light (0-0.1%) intensities in both formats. Limited physiological and sprint fatigue was apparent across games. Subjects primarily performed at vigorous and near-maximal intensities during Ultimate Frisbee. The greater physiological demands encountered during mixed-gender game play might be attributed to underlying gender-mediated cardiovascular differences. These findings support the efficacy of Ultimate Frisbee as a prescriptive exercise tool for health benefit.

Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis.

BACKGROUND: It is unclear whether participation in a randomized controlled trial (RCT), irrespective of assigned treatment, is harmful or beneficial to participants. We compared outcomes for patients with the same diagnoses who did ("insiders") and did not ("outsiders") enter RCTs, without regard to the specific therapies received for their respective diagnoses. METHODS: By searching the MEDLINE (1966-2010), Embase (1980-2010), CENTRAL (1960-2010) and PsycINFO (1880-2010) databases, we identified 147 studies that reported the health outcomes of "insiders" and a group of parallel or consecutive "outsiders" within the same time period. We prepared a narrative review and, as appropriate, meta-analyses of patients' outcomes. RESULTS: We found no clinically or statistically significant differences in outcomes between "insiders" and "outsiders" in the 23 studies in which the experimental intervention was ineffective (standard mean difference in continuous outcomes -0.03, 95% confidence interval [CI] -0.1 to 0.04) or in the 7 studies in which the experimental intervention was effective and was received by both "insiders" and "outsiders" (mean difference 0.04, 95% CI -0.04 to 0.13). However, in 9 studies in which an effective intervention was received only by "insiders," the "outsiders" experienced significantly worse health outcomes (mean difference -0.36, 95% CI -0.61 to -0.12). INTERPRETATION: We found no evidence to support clinically important overall harm or benefit arising from participation in RCTs. This conclusion refutes earlier claims that trial participants are at increased risk of harm.

Effects of a modified shoe on knee load in people with and those without knee osteoarthritis.

OBJECTIVE: To evaluate the effects of a modified shoe that incorporates both lateral wedging and a variable-stiffness sole on knee joint loading in 3 populations: individuals with symptomatic and radiographic knee osteoarthritis (OA), asymptomatic overweight individuals, and asymptomatic healthy weight individuals. METHODS: Ninety participants (30 per group) underwent a 3-dimensional gait analysis across 3 test conditions: modified shoes, standard control shoes, and barefoot. For each condition, the first peak knee adduction moment (KAM) and knee flexion moment (KFM) (both expressed as Nm/[body weight × height]%) as well as the KAM impulse (expressed as Nm.s/[body weight × height]%) were determined. RESULTS: The modified shoes significantly reduced the peak KAM as compared to the control shoes in both the OA (P = 0.002) and the overweight (P = 0.03) groups. In the OA group, there was no significant difference in peak KAM when walking in the modified shoe as compared to walking barefoot. In the overweight and the healthy weight groups, the peak KAM when walking in the modified shoe was significantly higher than that when walking barefoot (P < 0.001). Irrespective of group, the KAM impulse was significantly reduced when walking in the modified shoe as compared to the control shoe (P < 0.001) and was significantly higher during both shoe conditions as compared to walking barefoot (P < 0.001). There was no change in the KFM between walking conditions for any group. CONCLUSION: The findings illustrate that a shoe incorporating both a lateral wedge and a variable-stiffness sole can significantly reduce medial knee joint load. Further research examining the effects of these shoes on pain, function, and structural changes in the joint is warranted.

Agreement between an automated video-based system and tethered system to measure instantaneous swimming velocity.

Successful performance in competitive swimming requires a swimmer to maximise propulsion and minimise drag, which can be assessed using instantaneous swimming velocity. Many systems exist to quantify velocity, and therefore, it is important to understand the agreement between systems. This study examined the agreement between an automated video-based system and a tethered system to measure instantaneous velocity. Twenty-two competitive swimmers (state level or higher) completed 25 m of each stroke at maximal intensity. The tethered speedometer was attached to the swimmer's waist, while videos of each trial were recorded. The swimmer's head was then automatically tracked using proprietary software, and instantaneous velocity was determined from each system. Bland-Altman plots showed good agreement between the two systems in backstroke (95% Limits of Agreement (LOA): -0.24-0.26 m.s-1) and freestyle (95% LOA: -0.36-0.38 m.s-1) but poorer agreement in butterfly (95% LOA: -0.51-0.53 m.s-1) and breaststroke (95% LOA: -0.88-0.92 m.s-1). The root mean square error was higher in butterfly (0.27 m.s-1) and breaststroke (0.46 m.s-1) compared to backstroke (0.13 m.s-1) and freestyle (0.19 m.s-1). Results demonstrated that the two systems are comparable for measuring instantaneous swimming velocity; however, larger discrepancies are evident for butterfly and breaststroke.

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey.

BACKGROUND AND PURPOSE: Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET). METHODS: Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice. RESULTS: Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice. CONCLUSION: The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

A 100-day mentoring program leads to positive shifts in girls' perceptions and attitudes towards biomechanics and related STEM disciplines.

The gender gap in STEM (Science, Technology, Engineering, and Mathematics) is among the widest across education and professional fields, with an underrepresentation of girls and women, particularly in engineering and biomechanics. This issue begins early in education and worsens as females progress into more senior roles. To address this gap, we designed and implemented the Biomechanics Research and Innovation Challenge (BRInC), a 100-day STEM program focused on mentoring and role modelling to engage high school girls and early-career biomechanists at key phases where they most commonly disengage in STEM. We evaluated the influence of the program on (i) identity and perceptions towards science, engineering, and biomechanics; (ii) attitudes towards biomechanics, maths and science; and (iii) attitudes towards gender bias, education and career aspirations in STEM, within high school girls following participation in the BRInC program. We observed significant and positive shifts in girls' perceptions of both biomechanics and engineering. Participation in the program appeared to lead to favourable shifts in attitudes towards biomechanics, maths, and science and fostered a positive influence on girls' education and career aspirations, igniting an interest in future research opportunities. Innovative STEM engagement programs, such as BRInC, highlight the promising potential of targeted and bespoke approaches to address the underrepresentation of females in biomechanics and STEM-related education and careers. Future programs should strive to enhance socioeconomic and cultural diversity, employ whole of life-cycle approaches by offering programs for girls and women at various phases of the STEM pathway, and prioritize impact assessments to effectively monitor progress.

Pain-free grip strength in individuals with lateral elbow tendinopathy: Between- and within-session reliability of one versus three trials.

BACKGROUND: Pain-free grip strength is an important outcome measure in lateral elbow tendinopathy (LET); yet, the reliability and minimum detectable change (MDC) in functional positions are unknown. PURPOSE: The purpose of this study is to examine the between- and within-session pain-free grip strength reliability and MDC in LET. METHODS: Twenty-three individuals with LET completed three pain-free grip strength trials with the elbow flexed and extended. The first trial and the mean of three trials were analyzed. Between-session data were collected 2-28 days apart. Within-session data were collected 20-30 min apart. RESULTS: Between-session intraclass correlation coefficients (ICCs) were good (ICC2,1 = 0.75) for single trials (flexed), excellent (ICC2,1 = 0.89-0.94) for single trials (extended), and excellent for the mean of three trials (both positions). Within-session ICCs were excellent for single (ICC2,1 = 0.89-0.91) and the mean of three trials (ICC2,3 = 0.96-0.98) in both positions. Between-session flexed MDCs were 133 N (single) versus 90 N (mean) and extended MDCs were 118 N (single) versus 92 N (mean). Within-session flexed MDCs were 79 N (single) versus 52 N (mean) and extended MDCs were 125 N (single) versus 46 N (mean). CONCLUSIONS: Using the mean of three trials is recommended, and clinicians can be confident of true change if between-session differences are >92 N and within-session differences are >52 N.

Effects of multidirectional elastic tape on forearm muscle activity and wrist extension during submaximal gripping in individuals with lateral elbow tendinopathy: A randomised crossover trial.

BACKGROUND: Lateral elbow tendinopathy is associated with changes to forearm muscle activity and wrist posture during gripping. Multidirectional elastic tape is thought to exert a deloading effect on underlying musculotendinous structures, which could potentially alter muscle activity or wrist posture. METHODS: This single-blinded randomised crossover trial compared the immediate effects of tensioned multidirectional elastic tape, untensioned control tape, and no tape, in individuals with lateral elbow tendinopathy. Muscle activity of extensor carpi radialis longus and brevis, extensor carpi ulnaris, and extensor digitorum and wrist extension angle were recorded during a submaximal gripping task. Muscle activity was normalised to the maximum amplitude recorded during maximal grip. Change scores were calculated (post-condition minus baseline). Repeated-measure analyses of variance were used to examine between-condition differences. FINDINGS: 27 participants (16 males, mean age (SD): 48.6 (11.9) years) underwent all conditions. Extensor digitorum muscle activity was reduced during the multidirectional elastic tape, compared to control tape and no tape (MD -5.6% [95%CI: -9.9 to -1.3], MD -5.8% [95%CI: -10.2 to -1.4], respectively). Extensor carpi ulnaris muscle activity was reduced during the multidirectional elastic tape, compared to the control tape (mean difference [MD] -3.2% [95%CI: -5.3 to -1.1]), but increased during the control tape, compared to the no tape (MD 2.9% [95%CI: 0.8 to 5.0]). No differences were observed in extensor carpi radialis brevis or longus muscle activity, or extension wrist angle between conditions. INTERPRETATION: A decreased in extensor carpi ulnaris and extensor digitorum muscle activity during multidirectional elastic tape may be evidence of a deloading effect during submaximal gripping.

The biomechanical effects of 3D printed and traditionally made foot orthoses in individuals with unilateral plantar fasciopathy and flat feet.

BACKGROUND: Foot orthoses (FOs) are used to manage foot pathologies such as plantar fasciopathy. 3D printed custom-made FOs are increasingly being manufactured. Although these 3D-printed FOs look like traditionally heat-moulded FOs, there are few studies comparing FOs made using these two different manufacturing processes. RESEARCH QUESTION: How effective are 3D-printed FOs (3D-Print) compared to traditionally-made (Traditional) or no FOs (Control), in changing biomechanical parameters of flat-footed individuals with unilateral plantar fasciopathy? METHODS: Thirteen participants with unilateral plantar fasciopathy walked with shoes under three conditions: Control, 3D-print, and Traditional. 2 × 3 repeated measures analysis of variance (ANOVAs) with Bonferroni post-hoc tests were used to compare discrete kinematic and kinetic variables between limbs and conditions. Waveform analyses were also conducted using statistical parametric mapping (SPM). RESULTS: There was a significant condition main effect for arch height drop (p = 0.01; ηp2 =0.54). There was 0.87 mm (95% CI [-1.84, -0.20]) less arch height drop in 3D-print compared to Traditional. The SPM analyses revealed condition main effects on ankle moment (p < 0.001) and ankle power (p < 0.001). There were significant differences between control condition and both 3D-print and Traditional conditions. For ankle moment and power, there were no differences between 3D-print and Traditional conditions. SIGNIFICANCE: 3D-printed FOs are more effective in reducing arch height drop, whist both FOs lowered ankle plantarflexion moment and power compared to no FOs. The results support the use of 3D-printed FOs as being equally effective as traditionally-made FOs in changing lower limb biomechanics for a population of flat-footed individuals with unilateral plantar fasciopathy.

Immediate comfort perception of 3D-printed foot orthoses in individuals with unilateral heel pain.

BACKGROUND: Custom-made foot orthoses (FOs) play an integral part in managing foot disorders. Traditional FO fabrication is time-consuming and labor intensive. Three-dimensional (3D) printed FOs save time and cost compared with the traditional manufacturing process. To date, the differences in dimensions and comfort perception of these orthoses have not been compared in a pathological population. OBJECTIVE: Compare the dimensions between 3D-printed and traditionally made FOs and comfort perception between 3D-printed, traditionally made, and no FOs in individuals with flatfeet and unilateral heel pain. STUDY DESIGN: Within-subject single-blinded randomized crossover study design. METHODS: Thirteen participants had custom-made FOs using 3D-printing and traditional processes. Orthotic lengths, widths, arch heights, and heel cup heights were compared. Participants performed walking trials under three conditions: (1) no orthoses, (2) 3D-printed orthoses, and (3) traditionally made orthoses. Comfort perception was recorded. Orthotic dimensions were compared using paired t tests, and comfort perception were compared using one-way multiple analysis of variance and Bonferroni post hoc tests. RESULTS: Three-dimensional-printed orthoses were wider, have higher arch heights, and heel cup heights compared with traditionally made FOs (medium to large effect sizes). There was a difference in comfort perception between the three orthotic conditions, F(12,62) = 1.99, P = 0.04; Wilk Λ = 0.521, ηp2= 0.279. Post hoc tests show that there is no difference in comfort perception between the 3D-printed and traditionally made FOs. Both FOs were significantly more comfortable than no orthoses. CONCLUSIONS: Three-dimensional printing seems to be a viable alternative orthotic fabrication option. Future studies should compare the biomechanical effects of 3D-printed and traditionally made FOs.

Preoperative strength training for patients undergoing high tibial osteotomy: a prospective cohort study with historical controls.

STUDY DESIGN: Prospective cohort with historical controls. OBJECTIVE: To examine the effects of a 12-week preoperative high-intensity resistance training program on postoperative outcomes. BACKGROUND: The primary goals of high tibial osteotomy (HTO) are to decrease pain and improve overall function during activities of daily living and participation in sport and recreation in relatively young, active individuals with knee osteoarthritis. However, the postoperative recovery typically requires a considerable period of protected weight-bearing that can result in substantial deficits in muscular strength. METHODS: Fourteen patients (mean ± SD, 48.0 ± 7.8 years; 13 males, 1 females), scheduled for medial opening wedge HTO, completed a 12-week preoperative high-intensity isokinetic resistance training program focusing on quadriceps and hamstrings strength. These patients were matched to baseline clinical and demographic characteristics of 14 patients who previously received a medial opening wedge HTO without preoperative training. All outcomes were measured before and 6 months after surgery. The sport and recreation subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome of interest. Secondary outcomes included the other KOOS subscales, scores on the Lower Extremity Functional Scale, and selected kinematic and kinetic variables obtained from 3-dimensional gait analysis. RESULTS: The patients in the preoperative training group achieved significantly greater scores on the KOOS sport and recreation (mean ± SD, 58.6 ± 16.6 versus 42.1 ± 20.4; mean difference, 16.4; 95% CI: 2.0, 30.9) and activities of daily living (mean ± SD, 85.3 ± 9.3 versus 76.9 ± 12.0; mean difference, 8.4; 95% CI: 0.1, 16.8) subscales. There were no significant differences between groups on other outcomes. CONCLUSION: The present findings suggest preoperative high-intensity resistance training of the quadriceps and hamstrings before HTO improves postoperative functioning in sport, recreation, and activities of daily living. LEVEL OF EVIDENCE: Therapy, level 2b.