Differences in Foot Characteristics Between Bharatanatyam Dancers and Age-Matched Non-Dancers.

INTRODUCTION: The ankle-foot complex is the third most common site of pain in Indian dancers. In Bharatanatyam dance, rhythmic stamping performed barefoot at varying speeds may influence the height of the medial longitudinal arch, causing structural alteration of the ankle-foot complex. As little information is available on the ankle-foot complex of Bharatanatyam dancers, the present study was conducted to test the hypothesis that foot characteristics of Bharatanatyam dancers differ from those of non-dancers. METHODS: Female professional Bharatanatyam dancers (n=21), aged 18-30 years, with a minimum of 8 years of performance experience after completing formal dance training, and 21 control non-dancers participated in this study. Physical foot examination included navicular drop test and Feiss line. Foot geometry and pedobarography were recorded as participants walked barefoot at self-selected walking pace over a pressure-platform. An average of five gait cycles was computed to analyse maximum peak pressure (MPP), pressure time integral, contact time, and foot geometry of the midfoot, forefoot, great toe, and second to fifth toes. Analysis of covariance was performed for intergroup comparison of all variables with gait speed as a covariate. RESULTS: During walking, dancers presented a higher medial-longitudinal-arch, wider midfoot, and wider forefoot (cm) (p<0.001), indicating an over-pronated foot due to lower medial longitudinal arch height. Total plantar peak pressure (kPa) was 37% higher among dancers, whereas MPP was 24% higher on midfoot and 13% higher on forefoot, indicating greater plantar loading during walking. CONCLUSION: Greater plantar loading and an over-pronated foot during the most commonly performed weight-bearing activity of daily living (e.g., walking) explain the common prevalence of ankle and foot pain among dancers. These findings will inform clinicians and Bharatanatyam dancers on dancer's foot function and guide strategies for prevention and management of foot pain.

Indian (Marathi) version of the Shoulder Pain and Disability Index (SPADI): Translation and validation in patients with adhesive capsulitis.

BACKGROUND: The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi). OBJECTIVE: This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines. METHODS: Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India. RESULTS: The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach's alpha > 0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient > 0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions. CONCLUSION: The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.

Effect of Yogasana Intervention on Standing Balance Performance among People with Diabetic Peripheral Neuropathy: A Pilot Study.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is known to cause impaired balance and eventually increased risk of fall. Yogasanas characterized by slow, gentle transitions into postures with a varying base of support and focus on body awareness during movement hold potential for training balance control. Therefore, the current study aimed to evaluate effect of structured Yogasana intervention compared to conventional balance exercise on static and dynamic balance performance among people with diabetic neuropathy. METHODS: : Thirty-five people with DPN aged 42-70 years were recruited to Yogasana intervention group (n = 11), conventional balance exercises group (n = 10), and Control group (n = 14) following ethical approval. All participants were evaluated at baseline and post 12-week intervention on star excursion balance test, single-limb stance test, and center of pressure (CoP) excursion for balance performance, Modified fall efficacy scale for fear of falls and lower extremity strength using chair stand test and step-up test. RESULTS: Balance performance (static and dynamic measured by star excursion balance test, single-limb stance test, and CoP excursion, lower extremity strength (using chair stand test and step-up test) demonstrated improvement and fear of fall reduced among Yogasana intervention group (p = 0.05) and conventional balance exercises group (p = 0.05) post 12-week intervention. CoP excursion increased in the control group indicating deterioration in balance performance after 12 weeks (p = 0.05). Post hoc comparison revealed that Yogasana intervention was marginally more effective in improving static and dynamic balance performance compared to conventional balance exercises in all variables of standing balance performance (p = 0.025). CONCLUSION: Yogasana and conventional balance exercises were effective in improving static and dynamic balance performance, lower extremity muscle strength, and reducing fear of fall among people with DPN. Yogasana intervention demonstrated marginally greater improvement in static and dynamic balance performance and lower extremity muscle strength compared to conventional exercise.

Evaluation of Early Knee Osteoarthritis Using Biomechanical and Biochemical Markers.

Altered cellular mechano-transduction and biochemistry lead to degeneration of articular cartilage in people with knee osteoarthritis. However, the influence of low-moderate exposure to weight-bearing activity such as squatting on cartilage metabolism has not been adequately studied. The current study explored associations between knee adduction moment (KAM) during walking, biochemical markers and daily squat exposure. 3D gait analysis was used to determine external loads acting on the knee as indicators of joint compressive forces whereas biomarkers-Urine type-II-collagen-telopeptide (uCTxII), antioxidant and phospholipase A2 (PLA2) activity reflected on articular cartilage status. Following ethical approval, 66 participants with varying daily squat exposure (non-squatters [n = 21, exposure = 0 min]; activity of daily living [ADL] squatters [n = 16, exposure = 34 min]; occupational squatters [n = 13, exposure = 102 min]) and people with grade 2-3 knee osteoarthritis (n = 16, exposure = 28 min) were evaluated using 3D gait and biomarker analysis. The PLA2 activity was lowest in ADL squatters while occupational squatters demonstrated highest activity (p < 0.05). KAM and urine biomarker were similar among the groups. Moderate-strong positive association was observed between sweat PLA2 activity and age (r = 0.819, p = 0.004), daily squat exposure and biomarker uCTxII (r = 0.604, p = 0.013), antioxidant activity and Right-KAM (r = -0.917, p = 0.001), and Left-KAM (r = -0.767, p = 0.016), in people with knee OA. Healthy people demonstrated weak positive associations between KAM, uCTxII, and BMI. Associations between non-invasive biomechanical and biochemical markers indicate their potential use to identify early knee osteoarthritis. Studies with larger sample size are necessary to support prescription of body weight joint loading activities such as squatting in moderation, to delay functional decline caused by knee OA.

Exploration of Muscle Activity Using Surface Electromyography While Performing Surya Namaskar.

BACKGROUND: Limited information is available to understand the muscular demands of composite yogasanas such as Surya Namaskar, which is essential to guide prescription of Surya Namaskar in management of commonly prevalent musculoskeletal disorders such as back and knee pain. AIM: Therefore, muscle activation pattern in prime accessible muscles of the trunk and lower extremity, namely lower trapezius, latissimus dorsi, erector spinae, rectus abdominis, gluteus maximus, vastus lateralis, and gastrocnemius, was explored during the traditional 12-pose sequence of Surya Namaskar. METHODOLOGY: Muscle activity of 8 healthy trained yoga practitioners (5 females and 3 males) was recorded using wireless, eight-channel surface electromyography (sEMG) system at a sampling rate of 2000 Hz and bandwidth of 20-450 Hz. Data were processed using EMGworks analysis software, and root mean square values were normalized against muscle activity during maximal voluntary contraction (MVC). RESULTS: The 12-pose sequence of Surya Namaskar activated muscles of the trunk, upper and lower extremities to a varying extent, in each pose. During sustenance, erector spinae demonstrated the highest muscle activation in Hastapadasana (64.7% MVC in Pose 3and 64.3% MVC in Pose 11), lower trapezius during Hastapadasana (41.9% MVC in Pose 3and 39.2% in Pose 11); latissimus dorsi during Bhujangasana (37.4% MVC), Ashtangasana (34.9% MVC), and Parvatasana (34.6% MVC in Pose 8,); gluteus maximus in Ashwa Sanchalanasana (38.5% MVC in Poses 9 and 4); and vastus lateralis in Ashwa Sanchalanasana (34.9% MVC). Rectus abdominis demonstrated low activation throughout Surya Namaskar, presenting the highest activation during Parvatasana (22.8% MVC). All recorded muscles demonstrated greater activation during transition compared to sustenance of pose. CONCLUSION: Surya Namaskar elicited high-to-moderate muscle activation of major postural muscles of the trunk and lower extremity during alternating flexion-extension movements of the spine, supporting its prescription in prevention and management of mechanical low back pain among vulnerable groups of people.

Evaluation of Standing Balance Performance in Indian Classical Dancers.

Indian classical dance involves a constant change of the base of support from stance to low jumps and spins along with intricate footwork. Graceful movement of the torso, shifting from side to side and turning around the axis of the spine, challenges balance. Yet, balance performance remains unexplored in Indian classical dancers. Therefore, the present study aimed to compare the standing balance of 36 active female dancers (18 to 25 years of age) who had performed Indian classical dance for a minimum of 10 years with 36 healthy age-matched women not involved in regular physical activity. Balance was evaluated in static and dynamic conditions of single and dual-limb stance on a force plate using center-of-pressure trajectory and the Star Excursion Balance Test (SEBT). Dancers demonstrated better balance on both instrumented and non-instrumented outcome variables: wide base of support with eyes open and with eyes closed; for 30-second single limb stance with eyes open and with eyes closed; for 13-second dual task in single limb stance; and for 22-second dual task in wide base of support. The SEBT revealed significantly better balance performance of dancers in the three directions tested: anterior, posteromedial, and posterolateral. There was also a strength component of the study on which the dancers achieved significantly higher scores than controls for the three muscle groups tested (gastrocsoleus, gluteus medius, and quadriceps), which can be attributed to their training. These findings can be used to recommend classical dance training to achieve the dual purpose of deriving better balance and stronger bodies and maintaining the Indian dance heritage.

Kinematics of Suryanamaskar Using Three-Dimensional Motion Capture.

BACKGROUND: Suryanamaskar, a composite yogasana consisting of a sequence of 12-consecutive poses, producing a balance between flexion and extension is known to have positive health benefits for obesity and physical fitness management, upper limb muscle endurance, and body flexibility. However, limited information is available on biomechanical demands of Suryanamaskar, i.e., kinematic and kinetic. AIMS: The present study aimed to explore the kinematics of spine, upper, and lower extremity during Suryanamaskar to enhance greater understanding of Suryanamaskar required for safe and precise prescription in the management of musculoskeletal disorders. METHODS: Three-dimensional motion capture of Suryanamaskar was performed on 10 healthy trained yoga practitioners with 12-camera Vicon System (Oxford Metrics Group, UK) at a sampling frequency of 100 Hz using 39 retro-reflective markers. Data were processed using plug-in-gait model. Analog data were filtered at 10Hz. Joint angles of the spine, upper, and lower extremities during 12-subsequent poses were computed within Vicon Nexus. RESULTS: Joint motion was largely symmetrical in all poses except pose 4 and 9. The spine moved through a range of 58° flexion to 44° extension. In the lower quadrant, hip moved from 134° flexion to 15° extension, knee flexed to a maximum of 140°, and 3° hyperextension. Ankle moved in a closed kinematic chain through 40° dorsiflexion to 10° plantarflexion. In the upper quadrant, maximum neck extension was76°, shoulder moved through the overhead extension of 183°-56° flexion, elbow through 22°-116° flexion, and wrist from 85° to 3° wrist extension. CONCLUSIONS: Alternating wide range of transition between flexion and extension during Suryanamaskar holds potential to increase the mobility of almost all body joints, with stretch on anterior and posterior soft tissues and challenge postural balance mechanisms through a varying base of support.