Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis. DESIGN: Systematic review of randomised controlled trials (RCTs). DATA SOURCES: AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023. ELIGIBILITY CRITERIA: RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported. RESULTS: Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of -12.0 points (95% CI -17.1 to -7.0) on a 0-100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (-21.3 (95% CI -38.6 to -4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed. CONCLUSIONS: Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis. PROSPERO REGISTRATION NUMBER: CRD42021224416.

An online survey of clinical practice of Brazilian physical therapists on rehabilitation following rotator cuff repair.

BACKGROUND: Physical therapy is essential to help patients to recover their movements and function following a rotator cuff repair. However, there are uncertainties regarding how long a sling should be used for and when exercises should be started. OBJECTIVE: To investigate the current clinical practice of Brazilian physical therapists treating patients who had a rotator cuff repair. We also explored differences between shoulder specialists and non-specialists. METHODS: An online survey with 38 questions, including a clinical case, regarding the physical therapy clinical practice for patients having a rotator cuff repair. RESULTS: We analyzed 194 responses. Majority of participants were from the Southeast of Brazil (57.5%), had up to 10 years of clinical experience (61.4%) and were not shoulder-specialists (69.8%). Majority of the respondents stated that patients have their first post-operative physical therapy session within the first three weeks (51%). Patients usually use a sling for four to six weeks (60.6%). Passive mobilization is often started in the first-week post-surgery. Fifteen percent of shoulder specialists compared to only six percent of non-shoulder specialists would allow strengthening exercises to start between the first and third weeks post-surgery. CONCLUSION: Physical therapists in Brazil seems to follow similar postoperative programs to other countries. Shoulder specialists allow a faster return to activities and start of strengthening exercises.

Midfoot passive stiffness affects foot and ankle kinematics and kinetics during the propulsive phase of walking.

The midfoot joint complex (MFJC) is related to the mechanics and efficiency of the walking propulsive phase and low midfoot passive stiffness may require compensatory foot and ankle joint moments to avoid excessive pronation and inefficient propulsion. This study aimed to investigate the kinematics and kinetics of the MFJC and ankle during the propulsive phase of walking in subjects with larger and smaller midfoot passive stiffness. MFJC passive stiffness of 20 healthy adult participants, and the kinematics and kinetics of the MFJC (forefoot-rearfoot) and ankle (rearfoot-shank) during the stance phase of walking were measured. The participants were divided equally into two groups according to the MFJC passive stiffness. Ranges of motion (ROM) and mean joint moments were computed for the late stance. Independent t-tests (α = 0.05) revealed that subjects with lower midfoot passive stiffness showed an increased MFJC sagittal ROM (flattened longitudinal arch) (p = 0.002), increased ankle frontal ROM (more everted positions) (p = 0.002), increased MFJC frontal ROM (more inverted positions) (p = 0.019), as well as a tendency for larger ankle sagittal ROM (p = 0.056). They also showed increased MFJC (p = 0.021) and ankle (p = 0.018) moments in the sagittal plane, increased MFJC moment in the frontal plane (p = 0.047) and a tendency for a predominant ankle moment in the frontal (p = 0.058). Foot and ankle joint moments are possible strategies to reduce pronation and improve propulsion, but not sufficient to prevent the altered kinematics related to low midfoot stiffness. Therefore, midfoot passive stiffness is critical for foot and ankle kinematics and kinetics during walking propulsive phase and is a potential target of interventions.

Decreased gastrocnemius temporal muscle activation during gait in elderly women with history of recurrent falls.

Gait dysfunction is a strong issue in elderly women with a history of falls. The purpose of this study was to compare the temporal activity of the ankle muscles during gait in elderly women with and without a history of recurrent falls. Eighty-nine (89) elderly women - one group with a history of falls (45) and another group without (44) - participated in the study. The mean range of temporal activation of the gastrocnemius, tibialis anterior and soleus muscles during gait was obtained using electromyography. The muscles were considered active when the signal magnitude surpassed two standard deviations of the minimal magnitude of the average signal per individual. The results showed that the mean range of gastrocnemius muscle activation of the group of recurrent fallers was significantly shorter, 2.9% (16.9±5.7%) compared to the group without recurrent falls (19.8±6.6%) (p=0.004). The shorter duration in the gastrocnemius muscle activation during stance could possibly affect stability in the support phase, since the gastrocnemius is the main decelerator of the trunk. Clinically, this finding shows the importance of rehabilitation programs for elderly women that focus on strengthening the plantar flexor musculature aiming to reestablish the function and stability of gait and possibly avoiding falls.

Pronação excessiva e varismos de pé e perna: relação com o desenvolvimento de patologias músculo-esqueléticas: revisão de literatura / Excessive pronation and varus alignment of foot and shank: relationship with development of musculoskeletal pathologies: literature review

A literatura propõe mecanismos biomecânicos que relacionam a pronação subtalar excessiva ao desenvolvimento de diversas patologias músculo-esqueléticas. A presença dos desalinhamentos anatômicos antepé varo, retropé varo e tíbia vara pode levar à ocorrência da pronação subtalar excessiva. Entretanto, não existe um consenso sobre a contribuição do padrão de movimento e da presença desses desalinhamentos para o desenvolvimento de patologias. O objetivo deste estudo foi realizar uma revisão da literatura para investigar a influência de varismos aumentados de antepé, retropé e tíbia e da pronação subtalar excessiva no surgimento de patologias músculo-esqueléticas. Foi realizada uma pesquisa bibliográfica sistematizada nas bases Medline, ISI – Web of Science, Lilacs e SciELO, tendo sido selecionados 13 estudos analíticos. Do total de 13 estudos, 10 encontraram associação de patologias no membro inferior com um ou mais dos desalinhamentos anatômicos analisados ou com um ou mais parâmetros cinemáticos relacionadas à pronação subtalar excessiva. A análise dos estudos sugere que a pronação subtalar excessiva e/ou a presença de desalinhamentos que podem levar a esse padrão de movimento são possíveis fatores de risco para o desenvolvimento de patologias músculo-esqueléticas no membro inferior.

The literature proposes biomechanical mechanisms that link excessive subtalar joint pronation to the development of several musculoskeletal pathologies. The presence of forefoot varus, rearfoot varus and tibiofibular varum can lead to the occurrence of excessive subtalar pronation. However, there is no consensus about the contribution of the movement pattern and/or the presence of these anatomical misalignments to the development of pathologies. The aim of the present study was to conduct a literature review in order to investigate the influence of increased varus alignment of forefoot, rearfoot and shank and of excessive subtalar pronation on the development of musculoskeletal pathologies. A systematic literature search was performed in the databases Medline, ISI – Web of Science, Lilacs and SciELO, and 13 analytic studies were selected. Ten studies found significant associations of lower-limb musculoskeletal pathologies with one or more of the anatomical misalignments analyzed or with one or more kinematic parameters related to excessive subtalar pronation. The analysis of the studies suggests that excessive pronation and/or the presence of these anatomical misalagniments should be regarded as possible risk factors for the development of musculoskeletal pathologies in the lower limb.