Core stability training effects on lower limb rehabilitation of judokas / Efeitos do treino de estabilidade do core na reabilitação em membros inferiores de judocas / Efectos del entrenamiento de la estabilidad del core en la rehabilitación de los miembros inferiores de judokas

ABSTRACT Introduction Judo is a sport that presents a high incidence of sports injuries. Judo athletes want to master their skills to the maximum. Good physical conditioning is necessary to decrease the incidence of surgeries and achieve better results. Core stability exercises can discretely reduce the likelihood of lower limb injuries in judo athletes. Objective This paper examines the rehabilitation of core stability training effects on lower limb injuries in judokas by case studies. Methods A Chinese judo team member with a lower limb injury underwent core stability training. Isokinetic strength tests, body composition tests, and functional checks explored the athlete's physical recovery after training. Results The athletes' lower limbs progressed with good recovery (P<0.05). Additionally, a recovery in fitness level was also noted (P<0.05). Conclusion Core stability training positively affects recovery from lower limb injuries in judokas. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução O judô é um esporte com alta incidência de lesões esportivas. Atletas de judô querem dominar o máximo de suas habilidades. Para diminuir a incidência de cirurgias e alcançar melhores resultados é necessário um bom condicionamento físico. Os exercícios de estabilidade do core podem reduzir discretamente a probabilidade de lesões nos membros inferiores em judocas. Objetivo Este artigo analisa o efeito da reabilitação com treino de estabilidade do core em lesões de membros inferiores de judocas por meio de estudos de caso. Métodos Um membro da equipe chinesa de judô com lesão de membro inferior realizou treinamento de estabilidade do core. Foram utilizados testes de força isocinética, testes de composição corporal e verificações funcionais para explorar a recuperação física do atleta após o treino. Resultados Os membros inferiores dos atletas evoluíram com boa recuperação (P<0,05). Adicionalmente, notou-se também uma recuperação no nível de aptidão física (P<0,05). Conclusão O treinamento de estabilidade do core afeta positivamente a recuperação de lesões de membros inferiores em judocas. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción El judo es un deporte con alta incidencia de lesiones deportivas. Los atletas de judo quieren dominar el máximo de sus capacidades. Para reducir la incidencia de las cirugías y lograr mejores resultados, es necesario un buen acondicionamiento físico. Los ejercicios de estabilidad del core pueden reducir discretamente la probabilidad de lesiones de las extremidades inferiores en los judokas. Objetivo Este artículo examina el efecto de la rehabilitación con el entrenamiento de la estabilidad del core en las lesiones de las extremidades inferiores en los judokas mediante el estudio de casos. Métodos Un miembro del equipo de judo chino con una lesión en las extremidades inferiores se sometió a un entrenamiento de estabilidad del core. Se utilizaron pruebas de fuerza isocinética, pruebas de composición corporal y controles funcionales para explorar la recuperación física del atleta después del entrenamiento. Resultados Los miembros inferiores de los atletas evolucionaron con una buena recuperación (P<0,05). Además, también se observó una recuperación del nivel de aptitud física (P<0,05). Conclusión El entrenamiento de la estabilidad del core afecta positivamente a la recuperación de las lesiones de las extremidades inferiores en los judokas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Spinal manual therapy and exercises for chronic hamstring injuries in a sprinter: A case report.

INTRODUCTION: Hamstring injuries tend to be chronic in nature and thus require considerable recovery time in athletes. Although some rehabilitation protocols have been previously advocated, there is no consensus in terms of the treatment protocol for chronic hamstring injuries. METHODS: We present the case of a 15-year-old male sprinter who was successfully treated with a combination of manual therapy targeting the lumbosacral region and hamstring-specific exercises. The patient presented with hamstring pain which persisted for 7 weeks. RESULTS: Manual therapy immediately reduced pain and increased muscle strength. The patient was able to run satisfactorily without pain 30 days after the initial intervention. CONCLUSIONS: This case report suggests that the use of manual therapy targeting the lumbosacral region, along with hamstring exercises, may be beneficial in chronic hamstring pain management.

Multipurpose Virtual Reality Environment for Biomedical and Health Applications.

Virtual reality is a trending, widely accessible, and contemporary technology of increasing utility to biomedical and health applications. However, most implementations of virtual reality environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. This environment can be interfaced with different hardware and data sources, ranging from gyroscopes to fMRI scanners. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific brain regions of interest. Both applications were tested by pilot subjects that unanimously provided very positive feedback, suggesting that appropriately designed VR environments can indeed be robustly and efficiently used for multiple biomedical purposes. We attribute the versatility of our approach on three principles implicit in the design: selectivity, immersiveness, and adaptability. The software, including both applications, is publicly available free of charge, via a GitHub repository, in support of the Open Science Initiative. Although using this software requires specialized hardware and engineering know-how, we anticipate our contribution to catalyze further progress, interdisciplinary collaborations and replicability, with regards to the usage of virtual reality in biomedical and health applications.

Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures.

BACKGROUND: Individuals with lower extremity fractures are often instructed on how much weight to bear on the affected extremity. Previous studies have shown limited therapy compliance in weight bearing during rehabilitation. In this study we investigated the effect of real-time visual biofeedback on weight bearing in individuals with lower extremity fractures in two conditions: full weight bearing and touch-down weight bearing. METHODS: 11 participants with full weight bearing and 12 participants with touch-down weight bearing after lower extremity fractures have been measured with an ambulatory biofeedback system. The participants first walked 15m and the biofeedback system was only used to register the weight bearing. The same protocol was then repeated with real-time visual feedback during weight bearing. The participants could thereby adapt their loading to the desired level and improve therapy compliance. RESULTS: In participants with full weight bearing, real-time visual biofeedback resulted in a significant increase in loading from 50.9±7.51% bodyweight (BW) without feedback to 63.2±6.74%BW with feedback (P=0.0016). In participants with touch-down weight bearing, the exerted lower extremity load decreased from 16.7±9.77kg without feedback to 10.27±4.56kg with feedback (P=0.0718). More important, the variance between individual steps significantly decreased after feedback (P=0.018). CONCLUSIONS: Ambulatory monitoring weight bearing after lower extremity fractures showed that therapy compliance is low, both in full and touch-down weight bearing. Real-time visual biofeedback resulted in significantly higher peak loads in full weight bearing and increased accuracy of individual steps in touch-down weight bearing. Real-time visual biofeedback therefore results in improved therapy compliance after lower extremity fractures.

Professional football players at risk for non-acute groin injuries during the first half of the season: A prospective cohort study in The Netherlands.

OBJECTIVES: To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands. DESIGN: Prospective cohort study. METHODS: Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012-2013 season. RESULTS: A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%). CONCLUSIONS: A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.

Rehabilitation of acute hamstring strain injuries.

Acute hamstring injuries are responsible for significant time loss for athletes. As there are a multitude of injury mechanisms, thorough evaluation is imperative for determining the appropriate plan of care and adequate rehabilitation is required to reduce the risk of recurrent injuries.

Freeing the foot: integrating the foot core system into rehabilitation for lower extremity injuries.

The intrinsic muscles of the foot play a critical role in the regulation of absorption and propulsion during dynamic activities. Dysfunction of these may lead to an increased demand on the remaining components within the foot core system to maintain dynamic foot control, leading to a more rapid breakdown of these contributors and those proximal to the foot. Training the intrinsic foot muscles through a systematic progression of isolation via the short foot exercise offers the opportunity to reincorporate their contribution into the foot core system. This article discusses the function of the intrinsic foot muscles, their contributions to dynamic foot control, and a progressive training paradigm.

Haptic biofeedback for improving compliance with lower-extremity partial weight bearing.

After lower-extremity orthopedic trauma and surgery, patients are often advised to restrict weight bearing on the affected limb. Conventional training methods are not effective at enabling patients to comply with recommendations for partial weight bearing. The current study assessed a novel method of using real-time haptic (vibratory/vibrotactile) biofeedback to improve compliance with instructions for partial weight bearing. Thirty healthy, asymptomatic participants were randomized into 1 of 3 groups: verbal instruction, bathroom scale training, and haptic biofeedback. Participants were instructed to restrict lower-extremity weight bearing in a walking boot with crutches to 25 lb, with an acceptable range of 15 to 35 lb. A custom weight bearing sensor and biofeedback system was attached to all participants, but only those in the haptic biofeedback group were given a vibrotactile signal if they exceeded the acceptable range. Weight bearing in all groups was measured with a separate validated commercial system. The verbal instruction group bore an average of 60.3±30.5 lb (mean±standard deviation). The bathroom scale group averaged 43.8±17.2 lb, whereas the haptic biofeedback group averaged 22.4±9.1 lb (P<.05). As a percentage of body weight, the verbal instruction group averaged 40.2±19.3%, the bathroom scale group averaged 32.5±16.9%, and the haptic biofeedback group averaged 14.5±6.3% (P<.05). In this initial evaluation of the use of haptic biofeedback to improve compliance with lower-extremity partial weight bearing, haptic biofeedback was superior to conventional physical therapy methods. Further studies in patients with clinical orthopedic trauma are warranted.

Increased muscle activation following motor imagery during the rehabilitation of the anterior cruciate ligament.

Motor imagery (MI) is the mental representation of an action without any concomitant movement. MI has been used frequently after peripheral injuries to decrease pain and facilitate rehabilitation. However, little is known about the effects of MI on muscle activation underlying the motor recovery. This study aimed to assess the therapeutic effects of MI on the activation of lower limb muscles, as well as on the time course of functional recovery and pain after surgery of the anterior cruciate ligament (ACL). Twelve patients with a torn ACL were randomly assigned to a MI or control group, who both received a series of physiotherapy. Electromyographic activity of the quadriceps, pain, anthropometrical data, and lower limb motor ability were measured throughout a 12-session therapy. The data provided evidence that MI elicited greater muscle activation, even though imagery practice did not result in pain decrease. Muscle activation increase might originate from a redistribution of the central neuronal activity, as there was no anthropometric change in lower limb muscles after imagery practice. This study confirmed the effectiveness of integrating MI in a rehabilitation process by facilitating muscular properties recovery following motor impairment. MI may thus be considered a reliable adjunct therapy to help injured patients to recover motor functions after reconstructive surgery of ACL.

The effects of a closed-chain, eccentric training program on hamstring injuries of a professional football cheerleading team.

OBJECTIVE: Hamstring injuries are a common occurrence among professional football cheerleaders. The purpose of this study is to identify the effects of an eccentric, closed-chain hamstring exercise intervention on hamstring injury-associated pain during the course of the football season among professional football cheerleaders. METHODS: Forty-three female cheerleaders participated in an eccentric, closed-chain hamstring exercise intervention protocol provided by doctors of chiropractic that incorporated loops of elastic-band or Thera-Band Loops (Hygenic Corporation, Akron, OH) during practice and at home during the regular football season. Hamstring injury-related pain was assessed in June, during team selection; in September, at the start of the season; and in December, at the end of season. No intervention was applied between June and September, although the sample participated in 4 hours of practice 2 to 3 times per week. The intervention was applied to the entire sample regardless of hamstring injury-related pain during the regular football season between September and December. The interventions included 2 exercises and were completed bilaterally 2 times per week at each biweekly practice and were encouraged to be done at least 3 additional times per week at home on nonpractice days. RESULTS: Among the subsample who reported hamstring-related injury pain between June and September, the exercise intervention significantly decreased (P < .007) pain between September (6.07 ± 0.58) and December (3.67 ± 0.65). CONCLUSIONS: The eccentric, closed-chain hamstring exercise intervention reduced hamstring injury-related pain among this group of professional football cheerleaders.

A return-to-sport algorithm for acute hamstring injuries.

Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the past 28 years. This failure is most likely due to the following: 1) an over-reliance on treating the symptoms of injury, such as subjective measures of "pain", with drugs and interventions; 2) the risk factors investigated for hamstring injuries have not been related to the actual movements that cause hamstring injuries i.e. not functional; and, 3) a multi-factorial approach to assessment and treatment has not been utilized. The purpose of this clinical commentary is to introduce a model for progression through a return-to-sport rehabilitation following an acute hamstring injury. This model is developed from objective and quantifiable tests (i.e. clinical and functional tests) that are structured into a step-by-step algorithm. In addition, each step in the algorithm includes a treatment protocol. These protocols are meant to help the athlete to improve through each phase safely so that they can achieve the desired goals and progress through the algorithm and back to their chosen sport. We hope that this algorithm can serve as a foundation for future evidence based research and aid in the development of new objective and quantifiable testing methods.

The need for lumbar-pelvic assessment in the resolution of chronic hamstring strain.

A lumbar-pelvic assessment and treatment model based on a review of clinical and anatomical research is presented for consideration in the treatment of chronic hamstring strain. The origin of the biceps femoris muscle attaches to the pelvis at the ischial tuberosity and to the sacrum via the sacrotuberous ligament. The biomechanics of the sacroiliac joint and hip, along with lumbar-pelvic stability, therefore play a significant role in hamstring function. Pelvic asymmetry and/or excessive anterior tilt can lead to increased tension at the biceps origin and increase functional demands on the hamstring group by inhibiting its synergists. Joint proprioceptive mechanisms may play a significant role in re-establishing balance between agonists and antagonists. An appreciation of neuromuscular connections as well as overall lumbar-pelvic structural assessment is recommended in conjunction with lumbar-pelvic strengthening exercises to help resolve chronic hamstring strain.

[Immediate effects of physiotherapy session of lower limb by balneotherapy on postural control]. / Effets immédiats de séances de rééducation des membres inférieurs par balneotherapie sur le contrôle de l'équilibre.

OBJECTIVE: The aim of this study was to compare the immediate effects of standard physiotherapy (S) and balneotherapy (B) on the postural capacity of subjects with lower-limb injuries. METHODS: The postural sway of 12 voluntary subjects was evaluated before (REF1 and REF2) and after two different physiotherapy sessions performed in the swimming pool (B) or under (S). The centre of pressure (CP) trajectory was recorded by use of a force platform. CP displacements in the mediolateral and anteroposterior axes were then separated into two elementary superimposed components: the horizontal motion of the centre of gravity (CG) and the difference between the CP and the vertical projection of the CG (CP-CG). The amplitude of the latter component (CP-CG) is thought to express neuromuscular activity. All trajectories were then analysed in terms of classical and frequency parameters. RESULTS: Postural sway did not differ before and after the physiotherapy sessions. Following both sessions, the mean CG velocity decreased significantly (P<0.5). The area of CP-CG trajectory was diminished solely by the aquatic exercise (P<0.5) and was associated with decreased amplitude of motion along the anteroposterior axis (P<0.05), which suggests decreased neuromuscular activity to maintain posture. CONCLUSION: Interestingly, decreased motion was observed along the anteroposterior axis, which corresponds to ankle movements. Exercising lower-limb muscles under water could reinforce proprioceptive input, resulting in a better postural control.

[Postoperative rehabilitation in patients with peripheral nerve lesions]. / Postoperativna rehabilitacija bolesnika sa lezijom perifernih nerava.

UNLABELLED: Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. MATERIAL AND METHODS: Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3-6 months after injury. In early postoperative Postoperative rehabilitation in patients with peripherial treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual psychiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and psychiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.

Provision of physiotherapy at the Tsing Ma Bridge international marathon and 10 km race in Hong Kong.

This report examines the delivery of sports physiotherapy at the Tsing Ma Bridge marathon and 10 km race in Hong Kong. The incidence, type of injury encountered, and treatment modalities selected are examined. The report also highlights the flexibility required when planning the provision of such a service.

[Bioelectrostimulation in the rehabilitation of patients with gunshot wounds of the peripheral nervous system (a clinico-immunological study)]. / Bioélektrostimuliatsiia v reabilitatsii bol'nykh s ognestrel'nymi raneniiami perifericheskoi nervnoi sistemy (kliniko-immunologicheskoe issledovanie).

Immune homeostasis was studied in 35 patients with gunshot injuries of the peripheral nerves in the process of rehabilitation using bioelectrostimulation of the muscles impaired. Parameters of cellular and humoral immunity were determined. Bioelectrostimulation resulted in the regression of preexisting motor, sensitive, vegetovascular and trophic disorders. Cellular and humoral immunity improved: the number of T-lymphocytes, T-helpers, T-suppressors increased, the immunoregulatory index normalized, levels of B-lymphocytes, immunoglobulins G, circulating immune complexes reduced. Thus, bioelectrostimulation in patients with gunshot injuries of the peripheral nerves corrects the disturbed homeostasis and promotes recovery of the functions lost.

[A morphofunctional validation of the use of electrostimulation by paired impulses combined with vibromassage for the treatment of patients with trauma to the peripheral nerves of the extremities]. / Morfofunktsional'noe obosnovanie primeneniia élektrostimuliatsii parnymi impul'sami v sochetanii s vibromassazhem dlia lecheniia bol'nykh s travmami perifericheskikh nervov konechnostei.

The exposure to paired electric impulses and vibromassage promotes completeness of repair in the treatment of injured peripheral nerves of the limb. The effect is achieved due to marked stimulation of myelinization and differentiation of the nerve fibers, regeneration of the nerve system in the denervated muscle.

En miobiofeedback en la reeducación funcional del lesiones del aparato locomotor / In myofeedback in the functional reeducation of leg injuries

Consideramos que las diferentes lesiones del aparato locomotor van a alterar la biomecánica de las diferentes articulaciones, con especial hincapié en los mescanismos de estabilidad. Teniendo como base de tratamiento tres etapas: Inmovilización, Recuperación Funcional y Reentrenamiento al esfuerzo para lograr la reinserción del paciente a sus actividades normales. Luego de un perfodo de inmovilización determinada, hacemos conocer nuestra experiencia en la Reeducación Funcional en base a la aplicación de Miofeedback como una forma diferente de tratamiento a la clásica cinesiterapia pasiva relajada. Se hace una descripción detallada del tipo de lesiones, tiempo de inmovilización, forma de tratamiento, edad, sexo, procedencia, formas de aplicación, tiempo de recuperación de arcos de movimiento, combinación con diferentes técnicas de movilización pasiva. Se concluye con la recomendación de tener un medio eficaz que coadyuve en un 100 por ciento en la recuperación de los arcos articulares.

[Feedback-controlled weight bearing following osteosynthesis of the lower extremity]. / Feedbackgesteuerte Belastungsdosierung nach Osteosynthesen an der unteren Extremität.

Truly partial weight bearing by usual mode of mobilisation after an operation of the lower limb is not a realistic goal. Frequent and massive overloading could recently be shown in a series of patients with joint replacements. Significant improvements in the loading pattern could be demonstrated with the use of an acoustic feedback system. Our goal was to test the clinical application of this method by using a similar system in the form of an insole-installed device. In the same trial, data on the real weight bearing pattern with prescribed loading after osteosyntheses was to be collected with and without the feedback device. We measured weight bearing continuously in two groups of patients. The first group was mobilised in the usual manner whereas the second group was acoustically alerted to overloading when passing the limit of 15 kg by a sensor device in the insole. Our results showed that 40.8% of steps made by patients mobilised in the usual manner were massively overloaded whereas 12.7% of steps in the second feedback-group produced even minor overloading. Apart from certain technical difficulties, the method was well accepted by the patients. The usual method of progressive weight bearing is unreliable. The value of partial weight bearing after internal fixation of the lower limb remains to be evaluated. In cases in which partial weight bearing is recommended, more attention should be paid to observing the prescribed limits and a reliable system that alerts the patient of excessive weight bearing would be most useful. For routine use in clinics a technically more reliable PMT Feedback System has to be developed.

[The use of interference currents in the rehabilitative treatment of patients with fractures of the leg bones]. / Primenenie interferentsionnykh tokov v vosstanovitel'nom lechenii bol'nykh s perelomami kostei goleni.

Interference currents used in early treatment of patients with crural fractures accelarated recovery of the limb functions as a result of stimulation of involuntary muscular activity, reduced tissue adema and increased mobility of the ankle joint.