Therapeutic Effect of Tendon Bone Setting Technique and Sports Training on Joint Injury.

Purpose: In this study, we observe the therapeutic influence on tendon and bone setting technique, combined with sports training on joint injury. Methods: Using the random number method, 50 research objects with joint injuries were divided into two groups: treatment group and control group, and each group had 25 cases. The treatment group was combined with sports training with tendon and bone setting technique, and the control group was given intermediate frequency electrotherapy combined with forearm brace fixation. The scores of visual analogue scale (VAS), forearm pronation and postrotation activity, integral electromyogram (iEMG), and research object-rated wrist evaluation (PRWE) were evaluated and compared before and after treatment, and the curative effect observation (blind method was used in the evaluation process) and research object satisfaction were evaluated. Results: After the treatment, the VAS score of two groups decreased, forearm pronation and pronation activity increased, iEMG value increased, and PRWE scale score decreased (p < 0.05), and compared with the control group, the treatment group's curative effect was better (p < 0.05), and compared with the control group, treatment group's total effective rate was higher (p < 0.05). Conclusion: The method of tendon and bone setting combined with sports training could effectively reduce the pain of research objects with joint injury, improve the rotation range of the forearm, increase the recruitment of the pronator muscles, and improve the wrist function of the research objects, and the curative effect was better than that of medium frequency electrotherapy combined with forearm brace fixation.

Intra- and Inter-Examiner Reliability of the Viladot Method in Children.

OBJECTIVE: The aim of this study was to evaluate the interexaminer and intraexaminer reliability of classification with the Viladot method of plantar impression obtained by means of a footprinting mat. METHODS: Footprints were taken from 40 participants using a footprinting mat. The images were subjected to analysis by 3 independent examiners. To investigate intraexaminer reliability, the analysis was repeated by 1 of the examiners 1 week later. RESULTS: Excellent intraexaminer reliability was found (κ = 1.0; 95% confidence interval [CI], 0.77-1.0; P < .00). For interexaminer reliability, in the right foot high concordance was found for typical feet (κp = 0.76; 95% CI, 0.58-0.93; P < .00) and excellent concordance for cavus feet and flat feet (respectively: κp = 0.86; 95% CI, 0.68-1.0; P < .00; and κp = 0.81; 95% CI, = 0.63-0.99; P < .00). In the left foot high concordance was observed between the 3 evaluators for typical feet and cavus feet (respectively: κp = 0.75; 95% CI, 0.57-0.93; P < .00; and κp = 0.69; 95% CI, 0.51-0.87; P < .00) and excellent concordance for flat feet (κp = 1.0; 95% CI, 0.82-1.0; P < .00). CONCLUSION: The Viladot method is reliable for analyses involving 1 or more examiners, presenting excellent intraexaminer reliability and high to excellent interexaminer reliability. The Viladot method is a reliable (replicable and consistent) instrument, that is, its repeated application to the same subject produces similar results.

Age, Sex, Body Mass Index, and Laterality in the Foot Posture of Adolescents: A Cross Sectional Study.

OBJECTIVE: To investigate the relationship between the right and left foot posture in terms of body mass index (BMI), sex, and age in adolescents aged 10 to 14. METHODS: A total of 1400 adolescents were included. For assessment, the Foot Posture Index (FPI-6) was used. Each foot was assessed and ranked as supinated, normal, or pronated by the sum of the FPI-6 criteria. Each criterion was scored on a scale of -2 to +2, with negative for supinated and positive for pronated posture. A linear mixed model with repeated measures was used for statistical analysis. RESULTS: Sex, BMI, and right and left foot are associated with FPI-6. The total score attributed for male sex (ß = 0.29, P = .04) and the left foot (ß = 0.73, P < .001) was higher (male right foot: mean ± standard deviation [SD], 3.09 ± 2.84, male left foot: 3.76 ± 2.80; female right foot: mean ± SD, 2.28 ± 2.61, female left foot: 3.45 ± 2.66; laterality for left foot: mean ± SD, 3.55 ± 2.71, laterality for right foot: mean ± SD, 2.82 ± 2.7). On the other hand, the correlation coefficient for the BMI was negative (ß = -0.08, P = < .001), which means that the higher the BMI the lower the score attributed to the FPI-6. CONCLUSIONS: The FPI-6 is positively related to the male sex and the left foot-that is, the predicted score is higher, so the feet tend to present with a tendency to pronation. Although BMI is associated with FPI-6, it was not possible to establish a relationship between high BMI and pronation of the feet.

Immediate improvements of supination range of motion and strength following pronator teres muscle friction massage: a clinical trial comparing people with and without supination limited motion.

OBJECTIVES: To investigate the effects of friction massage techniques on the pronator teres muscle on supination range of motion (ROM) and supinator strength in individuals with and without limited supination ROM. METHODS: In total, 26 subjects (13 with limited supination ROM and 13 healthy subjects) volunteered to participate in this study. We used a customized wrist cuff. Supination ROM and supinator strength were measured with a 9-axis inertial motion sensor and load cell. The friction massage protocol was executed with the pronator teres muscle in a relaxed position. Then supination ROM and supinator strength were measured again. RESULTS: There was no significant interaction effect on supination ROM, which was significantly greater in the limited supination and control groups. A post hoc t-test revealed that the limited supination group achieved a significantly increased post-test supination ROM (51.7 ± 7.8°) compared to the pre-test value (43.6 ± 5.2°). In addition, the control group achieved a significant increase in post-test supination ROM (67.7 ± 10.0°) compared to the pre-test value (61.4 ± 7.7°). There was no significant interaction effect on supinator strength. Supinator strength was significantly greater in the limited supination and control groups. A post hoc t-test revealed a significant difference in supinator strength between the pre- and post-test values in the limited supination group. DISCUSSION: Friction massage helps restore a limited ROM of the forearm supination motion and immediately increases supinator muscle strength. This technique can be used as an intervention method to improve muscle strength in patients with limited supination ROM.

A comparison of lower limb muscle activation pattern using voluntary response index between pronated and normal foot structures during forward jump landing.

BACKGROUND: Pronated of the foot is one of the important factors contributing to musculoskeletal problems affecting the lower extremities. It is known that in a pronated foot, excessive mechanical load is applied to the lower limb structures which may result in altered biomechanics and muscle activation patterns. The aim of this study was to determine changes in the muscle activation pattern of the lower extremities in individuals with pronated, compared to normal, feet, using the voluntary response index (VRI). METHODS: In this cross sectional study, 15 asymptomatic pronated foot individuals (mean age 23.27 ± 3.28 years) and 15 normal subjects (mean age 23.40 ± 3.11 years) were recruited by simple non-random sampling. Electrical activities of gluteus medius (GM), vastus lateralis (VL), vastus medialis (VM), biceps femoris, semitendinosus (ST), and medial gastrocnemius (MG) muscles were recorded during a forward jump landing task. Voluntary response index (VRI) variables, included similarity index (SI) and magnitude (Mag) were also evaluated. RESULTS: Muscle activity of VM (p < 0.001) and ST (p = 0.010) were significantly higher but VL (p = 0.039) and MG (p = 0.001) were significantly lower in pronated foot, compared to normal subjects. Similarity index was found to be different (p < 0.001) between pronated foot and healthy individuals. No significant difference was found in terms of Mag between the two groups (p = 0.576). CONCLUSION: The altered pattern of lower limb muscle activation identified in the pronated foot during landing may be attributed to the different activation involving VL, VM, MG and ST muscles. Adaptations to the biomechanical effects, due to the pronated foot causing altered activation of VL, VM, MG, and ST muscles, results in an altered pattern of muscle activation. This change in activation pattern may harm the effectiveness of movement control processes; and might also predispose individuals with pronated feet, to injuries. It seems that an altered motor strategy with the aim of minimizing biomechanical changes, predisposes individuals to injuries. However, further large scale studies are needed to support the findings of the present study.

Foot exercise and taping in patients with patellofemoral pain and pronated foot.

This study compared the effect of three foot conditions (untreated, short foot [SF] exercise, and Tape) on knee and ankle muscle activity during forward descending of stairs in subjects with patellofemoral pain syndrome (PFPS) and a pronated foot. Surface electromyography activities in the vastus medialis oblique (VMO), vastus lateralis (VL), and abductor hallucis (AbdH) were recorded during forward descending stairs; Surface electromyography data were expressed as percentages of the maximal voluntary isometric contraction. A total of 18 subjects (6 males and 12 females) with PFPS and a pronated foot participated in the current study. The SF exercise was associated with significantly greater AbdH muscle activity compared to the tape condition during forward descending stairs. However, there was no significant difference in VMO or VL muscle activity, or in the VMO/VL muscle activity ratio, among the three foot conditions. The SF exercise was the most effective method of increasing AbdH muscle activity during forward descending stairs in subjects with PFPS and a pronated foot.

Descending pronation patterns.

This practical paper is a continuation of previous papers presented in this section discussing over-pronation. The focus of this article is the way that the body has evolved to handle pronation forces in a descending manner from trunk to foot. It was written to accompany the "Toe-tal Function" editorial in the 20:2 edition of JBMT, but didn't make it in for publication.

Don't get caught flat footed - how over-pronation may just be a dysfunctional model.

For many years there has been a long-held clinical belief that a flat or over-pronating foot should be supported; yet in every other part of the body it has long been recognised that use of support (if at all) should generally be limited to acute rehabilitation. Why should the foot be any different? To support a biological structure, in the long term, is to weaken it. Panjabi's model of joint stability offers insight into why the idea of arch support, as well-intentioned as it may have been, may be a dysfunctional model. A test (and conditioning exercise) is presented which appears to support the notion that there is no such thing as a flat foot; only a de-conditioned foot.

Results of single-staged rotational osteotomy in a child with congenital proximal radioulnar synostosis: subjective and objective evaluation.

BACKGROUND: For congenital proximal radioulnar synostosis, both conservative and operative treatments have been described. Most of the studies describing surgical interventions are based on subjective evaluation of the forearm function and have used severe degree of forearm pronation as an indication for surgery. This study describes a single-staged rotational osteotomy of the proximal third ulna and distal third radius. The aim of the study was to assess the utility of the described surgical procedure by subjective and objective evaluations of the forearm function. METHODS: Forty-eight children with congenital proximal radioulnar synostosis were evaluated by subjective and objective assessments and were followed up prospectively. Subjective evaluation consisted of a set of 12 questions regarding the basic activities of life. Objective evaluation was made using the Jebsen-Taylor hand-function test and a classification system used by Failla and colleagues for 15 tasks described by Morrey and colleagues. Eleven children were treated conservatively. Thirty-six children underwent a single-staged rotational osteotomy of the proximal third ulna and distal third radius. After surgery, the evaluations were repeated. The mean age at surgery was 8.6±3.7 years, and the mean postoperative follow-up period was 54±13 months. RESULTS: All operated forearms showed a statistically significant improvement in functioning after surgery as per the subjective and objective evaluations. The mean time taken to carry out all activities before surgery was 47.7+10.0 seconds, which significantly reduced to 33.3+6.6 seconds after surgery (P=0.0001) as per the results of the Jebsen-Taylor hand-function test. All good (n=19) and fair (n=11) results were converted to excellent (n=30) after surgery as per the modified Failla classification. There were no neurovascular injuries as compared with other published techniques. Only 1 child had delayed union, and 1 had persistent dorsal angulation at the radial osteotomy site. CONCLUSIONS: For patients with congenital radioulnar synostosis and pronation deformity interfering with function and quality of life, the single-staged rotational osteotomy of the radius and ulna is a good alternative procedure. LEVEL OF EVIDENCE: Level IV--therapeutic.

Ankle variability is amplified in older adults due to lower EMG power from 30-60 Hz.

The purpose of this study was to determine the neuromuscular mechanisms of the involved muscles that contribute to the greater positional variability at the ankle joint in older adults compared with young adults. Eleven young adults (25.6±4.9 years) and nine older adults (76.9±5.9 years) were asked to accurately match and maintain a horizontal target line with 5° dorsiflexion of their ankle for 20 s. The loads were 5 and 15% of the one repetition maximum load (1 RM). The visual gain was kept constant at 1° for all trials. Positional variability was quantified as the standard deviation (SD) of the detrended position signal. The neural activation of the tibialis anterior and soleus muscles was quantified as the normalized EMG amplitude, power spectrum density (PSD; EMG oscillations) and coactivation of the two muscles. As expected, positional variability was greater in older adults (older: 0.11±0.06° vs. young: 0.04±0.02°; p=.003). The only significant neural difference occurred for the PSD of the tibialis anterior muscle, where young adults exhibited significantly greater power than older adults from 30-60 Hz. The amplified positional variability of ankle joint in older adults was associated with lower power from 30-60 Hz oscillations in the tibialis anterior muscle (r(2)=.3, p=.01). These results provide novel evidence that older adults exhibit greater positional variability with the ankle joint relative to young adults likely due to their inability to activate the tibialis anterior muscle from 30-60 Hz.

Muscle fatigue increases the amplitude of fluctuations of tangential forces during isometric contractions.

The orientation of the resultant force during a given contraction depends on the architecture of the muscles involved, and cooperation among muscles may induce force fluctuations in multiple directions. A novel setup for recording three-dimensional forces was developed to assess the effects of muscle fatigue on submaximal contractions. Fifteen subjects performed isometric dorsiflexions, elbow flexions, knee extensions, plantarflexions, and trunk extensions (12 s, 2.5-80% of maximal voluntary force) before and after a fatigue protocol. Electromyography (EMG) was recorded from relevant muscles. The standard deviation of force in the three directions and the agonist EMG amplitude increased with target force (p<.045), while the coefficient of variation of force and total excursions of the center of pressure showed maximal values at low target forces, reaching a plateau at moderate forces. Fatigue induced higher force fluctuations in task-related and tangential directions and increased agonist EMG amplitude for all muscle groups (p<.04). Fluctuations of tangential forces were greater during knee extensions compared with other muscle groups (p<.007). The present data demonstrate that fatigue increases the amplitude of force fluctuations in task-related and tangential forces. Moreover, alternation of activity between multiple synergist muscles is associated with increased fluctuations of tangential forces, especially during fatigue.

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?

Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30N force was applied 1000 times to the lateral malleolus at a speed of 15N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 times of cyclic loading, the tibia was displaced 0.44+/-0.30mm and 0.75+/-0.36mm, respectively, and the fibula was displaced 0.44+/-0.28mm and 0.92+/-0.39mm, respectively. The average dorsiflexion angle increased from 14.36+/-7.51 degrees to 16.74+/-7.21 degrees after cyclic loading (P<0.05). Movement of the distal tibiofibular joint led to a significant increase in the range of ankle dorsiflexion. These results suggest that tibiofibular JM would be effective for limitation of ankle dorsiflexion.

Differences in range of motion between dominant and nondominant sides of upper and lower extremities.

OBJECTIVE: The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities. METHODS: Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides. RESULTS: The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees . CONCLUSION: The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.

Upper extremities flexibility comparisons of collegiate "soft" martial art practitioners with other athletes.

The aim of this study was to compare the flexibility of the upper extremities in collegiate students involved in Aikido (a kind of soft martial art attracting youth) training with those involved in other sports. Fifty freshmen with a similar frequency of exercise were divided into the Aikido group (n = 18), the upper-body sports group (n = 17), and the lower-body sports group (n = 15) according to the sports that they participated in. Eight classes of range of motion in upper extremities were taken for all subjects by the same clinicians. The Aikido group had significantly better flexibility than the upper-body sports group except for range of motion in shoulder flexion (p = 0.22), shoulder lateral rotation (p > 0.99), and wrist extension (p > 0.99). The Aikido group also had significantly better flexibility than the lower-body sports group (p < 0.01) and the sedentary group (p < 0.01) in all classes of range of motion. The upper-body sports group was significantly more flexible in five classes of range of motion and significantly tighter in range of motion of wrist flexion (p < 0.01) compared to the lower-body sports group. It was concluded that the youths participating in soft martial arts had good upper extremities flexibility that might not result from regular exercise alone.

Impairment of pronation, supination, and body co-ordination in reach-to-grasp tasks in human Parkinson's disease (PD) reveals homology to deficits in animal models.

Animal (monkey, rat, mouse) models are widely used to investigate degenerative processes and potential therapeutic treatments for human Parkinson's disease (PD). One task that has proved useful in these investigations is a reach-to-grasp task (skilled reaching) in which an animal reaches for a piece of food that it then consumes. Rats with extensive unilateral Dopamine depletions are impaired in using the contralateral limb. The qualitative features of posture, lifting and advancing the limb, pronating the paw to grasp food, and in withdrawing and supinating the paw to place the food in the mouth are impaired, as is reaching success. Humans with PD are often described as having poor manual dexterity that worsens as the disease progresses. As there have been no detailed comparisons of reaching movements in the animal models and in PD subjects, the following descriptive analysis was performed. Ten subjects with PD, eight age matched controls and 14 young normal subjects were studied as they used a natural movement of reaching for a small piece of food that they then placed in the mouth to eat. The reaching movements were described using Eshkol-Wachman Movement Notation (EWMN), supplemented with kinematic analyses. From this description, a 21-point rating scale was devised to describe the component movements of the reach. Movements included: orienting the head and eyes to the target, adjusting posture, lifting the hand, shaping and aiming the digits to the target, pronating the hand to grasping the food with a pincer grip, lifting and supinating the hand to transporting the food to the mouth, and further supinating the hand and opening the digits to place food in the mouth, and finally returning the hand to the starting position. Analysis indicated that most aspects of the reaching movements of the PD subjects were significantly different relative to both young control subjects and old control subjects. As compared to the control groups, postural and reaching components of the movements were fragmented, movements were achieved using more proximal segments of the body, and rotatory movements of the hand were limited. The PD subjects did use a pincer grasp to obtain the food, but the grasp was less independent of other digit movements than was observed in the control subjects. These results are discussed in terms of a homology to impairments displayed animal models of PD.