Machine Learning Identifies Chronic Low Back Pain Patients from an Instrumented Trunk Bending and Return Test.

Nowadays, the better assessment of low back pain (LBP) is an important challenge, as it is the leading musculoskeletal condition worldwide in terms of years of disability. The objective of this study was to evaluate the relevance of various machine learning (ML) algorithms and Sample Entropy (SampEn), which assesses the complexity of motion variability in identifying the condition of low back pain. Twenty chronic low-back pain (CLBP) patients and 20 healthy non-LBP participants performed 1-min repetitive bending (flexion) and return (extension) trunk movements. Analysis was performed using the time series recorded by three inertial sensors attached to the participants. It was found that SampEn was significantly lower in CLBP patients, indicating a loss of movement complexity due to LBP. Gaussian Naive Bayes ML proved to be the best of the various tested algorithms, achieving 79% accuracy in identifying CLBP patients. Angular velocity of flexion movement was the most discriminative feature in the ML analysis. This study demonstrated that: supervised ML and a complexity assessment of trunk movement variability are useful in the identification of CLBP condition, and that simple kinematic indicators are sensitive to this condition. Therefore, ML could be progressively adopted by clinicians in the assessment of CLBP patients.

Sample Entropy as a Tool to Assess Lumbo-Pelvic Movements in a Clinical Test for Low-Back-Pain Patients.

Low back pain (LBP) obviously reduces the quality of life but is also the world's leading cause of years lived with disability. Alterations in motor response and changes in movement patterns are expected in LBP patients when compared to healthy people. Such changes in dynamics may be assessed by the nonlinear analysis of kinematical time series recorded from one patient's motion. Since sample entropy (SampEn) has emerged as a relevant index measuring the complexity of a given time series, we propose the development of a clinical test based on SampEn of a time series recorded by a wearable inertial measurement unit for repeated bending and returns (b and r) of the trunk. Twenty-three healthy participants were asked to perform, in random order, 50 repetitions of this movement by touching a stool and another 50 repetitions by touching a box on the floor. The angular amplitude of the b and r movement and the sample entropy of the three components of the angular velocity and acceleration were computed. We showed that the repetitive b and r "touch the stool" test could indeed be the basis of a clinical test for the evaluation of low-back-pain patients, with an optimal duration of 70 s, acceptable in daily clinical practice.

Trunk Muscle Aerobic Metabolism Responses in Endurance Athletes, Combat Athletes and Untrained Men.

This study investigated aerobic metabolism responses in trunk muscles during a prolonged trunk extension exercise in athletes and untrained young men. The aim was to analyze the adaptations induced by 2 types of sports: one involving intensive use of trunk muscles (i. e., judo), and one known to induce high aerobic capacity in the whole body (i. e., cycling). Eleven judokas, 10 cyclists and 9 healthy untrained young men performed trunk extension exercises on an isokinetic dynamometer. During the first session, muscle strength was assessed during maximal trunk extension. During a second session, a 5-min exercise was performed to investigate aerobic responses with regard to trunk muscles. The near infrared spectroscopy technique and a gas exchange analyzer were used continuously to evaluate mechanical efficiency, V̇O2 on-set kinetics, trunk muscle deoxygenation and blood volume. Judokas showed greater trunk strength and mechanical efficiency (p<0.05). Cyclists presented faster V̇O2 on-set kinetics (p<0.05) and greater muscle deoxygenation and blood volume compared to untrained men (p<0.001). These results suggest that practicing judo improves trunk extension efficiency whereas cycling accelerates aerobic pathways and enhances microvascular responses to trunk extension exercise. Sport practice improves aerobic metabolism responses in trunk extensor muscles differently, according to the training specificities.

Postrehabilitation Functional Improvements in Patients With Inflammatory Myopathies: The Results of a Randomized Controlled Trial.

OBJECTIVE: To evaluate the medium-term functional effect and the effect on quality of life of a standardized rehabilitation program in patients with inflammatory myopathies (IMs). DESIGN: A multicenter, randomized controlled trial. SETTING: Four university hospitals. PARTICIPANTS: Patients (N=21) with polymyositis. INTERVENTIONS: The intervention group participated in a 4-week standardized, hospital-based rehabilitation program followed by a personalized, self-managed, home-based rehabilitation program. The control group received physiotherapy on an outpatient basis. Study participants were evaluated at inclusion, at the end of the rehabilitation program (1mo), and then at 6 and 12 months. MAIN OUTCOME MEASURES: The primary efficacy criterion was the Health Assessment Questionnaire Disability Index (HAQ-DI), and the secondary criteria were quality of life (according to the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] questionnaire), muscle performance (isokinetic strength, Motor Function Measure, and Kendall Manual Muscle Test), gait, pain, fatigue, and biomarkers of tolerance and disease activity. RESULTS: At 12 months, the mean ± SD HAQ-DI was significantly lower in the intervention group than in the control group (.64±.53 vs 1.36±1.02; P=.026). The intervention group also had better scores than the control group for some quality-of-life dimensions (SF-36 General Health: 53.44±8.73 vs 36.57±22.10, respectively; P=.038; SF-36 Role Physical: 63.89±43.50 vs 17.86±37.40, respectively; P=.023) and pain levels (5.0±10.61 vs 33.38±35.68, respectively; P=.04) at 12 months. The program was well tolerated by all the participants. CONCLUSIONS: In patients with IMs, the combination of a 4-week standardized rehabilitation program and a personalized, home-based, self-managed rehabilitation program was well tolerated and had a positive medium-term functional effect.

Clinical balance tests, proprioceptive system and adolescent idiopathic scoliosis.

PURPOSE: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spinal column of unknown etiology. Multiple factors could be involved, including neurosensory pathways and, potentially, an elective disorder of dynamic proprioception. The purpose of this study was to determine whether routine balance tests could be used to demonstrate an elective alteration of dynamic proprioception in AIS. METHODS: This was a multicentre case-control study based on prospectively collected clinical data, in three hospitals pediatric, with spine consultation, from January 2013 through April 2015. From an original population of 547 adolescents, inclusion and non-inclusion criteria indentified 114 adolescents with right thoracic AIS (mean age 14.5 ± 1.9 years, Cobb angle 35.7 ± 15.3°) and 81 matched adolescents without scoliosis (mean age 14.1 ± 1.9 years). Participants performed three routine clinical balance tests to assess the static and dynamic proprioception: the Fukuda-Utenberger stepping test (angle of rotation in degrees and distance of displacement in cm) to assess dynamic balance; the sharpened Romberg test and the unipedal stance test (eyes closed) to assess static balance. RESULTS: There was no significant difference between AIS subjects and controls for the static tests, but there was a significant difference for the dynamic test for both measures: distance of displacement (p < 0.01) and angle of rotation (p < 0.0001). This result confirms our initial these: the dynamic proprioception is altered electively in AIS. CONCLUSION: These findings confirm recent AIS studies. Our results might be related to immature central integration of dynamic proprioceptive input leading to a poorly adapted motor response, particularly for postural control of the, in AIS. These balance tests can be performed in routine practice. Their validity as a biomarker for screening and monitoring purposes should be assessed.

Paraspinal muscle oxygenation and mechanical efficiency are reduced in individuals with chronic low back pain.

This study aimed to compare the systemic and local metabolic responses during a 5-min trunk extension exercise in individuals with chronic low back pain (CLBP) and in healthy individuals. Thirteen active participants with CLBP paired with 13 healthy participants performed a standardised 5-min trunk extension exercise on an isokinetic dynamometer set in continuous passive motion mode. During exercise, we used near-infrared spectroscopy to measure tissue oxygenation (TOI) and total haemoglobin-myoglobin (THb). We used a gas exchange analyser to measure breath-by-breath oxygen consumption (V̇O2) and carbon dioxide produced (V̇CO2). We also calculated mechanical efficiency. We assessed the intensity of low back pain sensation before and after exercise by using a visual analogue scale. In participants with CLBP, low back pain increased following exercise (+ 1.5 units; p < 0.001) and THb decreased during exercise (- 4.0 units; p = 0.043). Paraspinal muscle oxygenation (65.0 and 71.0%, respectively; p = 0.009) and mechanical efficiency (4.7 and 5.3%, respectively; p = 0.034) were both lower in participants with CLBP compared with healthy participants. The increase in pain sensation was related to the decrease in tissue oxygenation (R2 = - 0.420; p = 0.036). Decreases in total haemoglobin-myoglobin and mechanical efficiency could involve fatigability in exercise-soliciting paraspinal muscles and, therefore, exacerbate inabilities in daily life. Given the positive correlation between tissue oxygenation and exercise-induced pain exacerbation, muscle oxygenation may be related to persisting and crippling low back pain.

An exercise therapy program can increase oxygenation and blood volume of the erector spinae muscle during exercise in chronic low back pain patients.

OBJECTIVE: To determine whether erector spinae muscle oxygenation (OXY) and blood volume during a progressive isoinertial lifting evaluation (PILE) are modified by an exercise therapy program. DESIGN: Pre- (t1) and post- (t2) exercise therapy experimental design. SETTING: Hospital. PARTICIPANTS: Subjects with chronic low back pain (LBP group) (n=24) and healthy subjects (control group) (n=24) were evaluated. INTERVENTION: Exercise program. MAIN OUTCOME MEASURES: The control group was evaluated once, and the LBP group was evaluated before (t1) the exercise therapy program and 28 days thereafter (t2). The maximal load lifted, total work, and total power were determined using the PILE test. Continuous-wave near-infrared spectroscopy was used to measure OXY and blood volume during the PILE test. RESULTS: The maximal load lifted, total power, and total work were significantly lower in the LBP group (-42%±5%, -46%±6%, and -67%±6% at t1, respectively; P<.05) than the control group. In the LBP subjects, these parameters improved significantly after the exercise therapy program (+20%±3%, +56%±4%, and +61%±5%; P<.05). At each submaximal power (ie, 25, 50, 75, and 100% of maximal load lifted at t1), OXY and blood volume were significantly higher at t2 than t1. One-half recovery time for OXY was significantly higher in the LBP group (at t1 and t2) than in control subjects. CONCLUSIONS: The findings in this study suggest that LBP subjects present an impairment in their capacity to deliver oxygen at the level of the erector spinae muscle, which can be partly restored by an exercise therapy program.

Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review.

BACKGROUND: Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE: To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS: A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. INCLUSION CRITERIA: publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. RESULTS: From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION: PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.

Evaluation of the socioprofessional consequences of thoracic outlet syndrome.

PURPOSE: Thoracic outlet syndrome (TOS) is a ductal syndrome that can have a significant functional impact. Various studies have highlighted positional factors and repetitive movements as risk factors for the development of TOS. However, there are few literature data on the socioprofessional consequences of TOS. METHODS: We performed a prospective, cross-sectional, descriptive, multicentre study of workers having received a Doppler ultrasound diagnosis of TOS between December 17th, 2018, and March 16th, 2021. Immediately after their diagnosis, patients completed a self-questionnaire on the impact of TOS on their work activities. We assessed the frequency of TOS-related difficulties at work and the associated socioprofessional consequences. Trial Registration Number (TRN) is NCT03780647 and date of registration December 18, 2018. RESULTS: Eighty-two participants (95.3%) reported difficulties at work. Seventy-seven of the participants with difficulties (94%) worked in the tertiary sector; these difficulties were due to prolonged maintenance of a posture, carrying loads, and repetitive movements. Although the majority of participants experienced organizational problems and lacked support at work, few of them had approached support organizations, expert and/or healthcare professionals. CONCLUSIONS: TOS was almost always associated with difficulties at work (95.3%). However, poor awareness of sources of help or a perceived lack of need may discourage people with TOS from taking steps to resolve these difficulties. It is clear that the socioprofessional management of TOS requires significant improvements.

Description of supportive care and feasibility of physical exercise program to improve quality of life in advanced melanoma patients.

Physical activity is the first-line treatment of cancer-related fatigue. It has shown benefits on patient's quality of life (QoL) when practiced during and after treatment. New treatments have drastically changed the prognosis of melanoma. Still, few data are available about research program of supportive care in advanced melanoma. The primary outcome was to assess the feasibility of setting up a prospective study evaluating the benefits of Adapted Physical Activity (APA) on the QoL of patients with advanced melanoma. Feasibility was defined with a combination of five criteria including completion of questionnaire, recruitment, participant retention, patient adhesion to supportive care, and absence of adverse event. Between September 2019 and March 2021, 271 melanoma patients were questioned. Around 60% of stage IV melanoma patients were interested in support care. Patient retention at 3 months was sufficient. Only one patient could not be evaluated after 3 months of enrolment because of deterioration of the general state. Adhesion to exercise and sessions was good. Supervised APA program appeared to be safe and well tolerated as no adverse events or discontinuations were reported. Setting up a prospective research program evaluating the benefits of physical activity in advanced melanoma patients seems feasible. With melanoma becoming a chronic disease, supportive care may reduce fatigue, improve QoL and help maintain a healthy lifestyle. Data supporting its benefits on this survivor population are needed.

Carbapenemase-producing Enterobacteriaceae in an inpatient post-acute care facility: Impact on time to functional recovery.

BACKGROUND: The carriage of carbapenemase-producing Enterobacteriaceae (CPE) might lengthen the time to functional recovery (TTFR) for inpatients in post-acute care (PAC) units. OBJECTIVE: We aimed to assess the impact of CPE carriage on TTFR in a PAC facility. METHODS: This 2-year retrospective cohort study included 20 CPE-positive patients and 54 CPE-negative patients admitted to 3 PAC units (general, orthopaedic and neurological rehabilitation units) in a teaching hospital from January 2017 to December 2019. Potential risk factors and demographic data were collected from patients' medical records, the French national hospital discharge database, and the hospital's CPE surveillance database. Functional recovery was defined as the median difference in functional independence measure (FIM) between admission and discharge from each unit. Survival analysis and multiple Cox regression models were used to predict the TTFR and identify factors associated with functional recovery. RESULTS: The overall median [interquartile range] TTFR was 50 days [36-66]. Longer median TTFR was associated with CPE carriage (63 vs 47 days in the CPE-negative group; adjusted hazard ratio (aHR) 0.35, 95% CI 0.13-0.97) and presence of a peripheral venous catheter (aHR 3.51, 1.45-8.46); shorter TTFR was associated with admission to an orthopaedic versus general rehabilitation unit (aHR 3.11, 1.24-7.82). CONCLUSIONS: CPE carriage in inpatient PAC facilities was associated with long TTFR. Further studies are needed to explore the mechanisms involved in these adverse events and to identify possible preventive measures.

FETOS: A Self-Questionnaire for Functional Evaluation in Thoracic Outlet Syndrome.

OBJECTIVE: Thoracic outlet syndrome is caused by the compression of blood vessels and nerves leading to the upper limbs; the level of functional discomfort in activities of daily living can be significant. This discomfort has been evaluated using a variety of nonspecific scales, prompting the development a specific self-questionnaire ("Functional Evaluation in Thoracic Outlet Syndrome). Here, the scale's test-retest reliability, sensitivity to change, and criterion validity were assessed. DESIGN: Between May 2015 and July 2017, a total of 37 patients were assessed during an intensive rehabilitation program. The Functional Evaluation in Thoracic Outlet Syndrome self-questionnaire comprises 16 items rated on a 4-point scale: impossible, major discomfort, moderate discomfort, or no difficulty. A total score is then calculated and the usual level of discomfort is rated on a numerical scale. The questionnaire was completed on day (D)1, D2, and the day of discharge. RESULTS: The questionnaire showed very good test-retest reliability, with an overall correlation coefficient above 0.91. The overall score was highly sensitive to change, with a significant median improvement (-5.89) between D1 and discharge (P < 0.001). Of the 16 items, 9 showed significant scalability in their individual sensitivity to change. The criterion validity was moderate: the coefficient for the correlation with the numerical scale was 0.68 on D1 (P < 0.001), 0.55 on D2 (P < 0.001), and 0.69 at discharge (P < 0.001). CONCLUSIONS: The Functional Evaluation in Thoracic Outlet Syndrome self-questionnaire is a quick, simple way of assessing the impact of thoracic outlet syndrome on activities of daily living. The overall score and most of the items displayed good reproducibility and sensitivity to change.

Prevalence of and Risk Factors for Sagittal Posture Abnormalities in Children Born With Esophageal Atresia: A Prospective Cohort Study.

Introduction: Scoliosis is a well-described complication of esophageal atresia (EA) caused by the associated spine malformations and/or thoracotomy. However, the sagittal posture abnormalities in patients with EA have not been described. The aim of this study was to evaluate the prevalence of and risk factors for sagittal posture abnormalities at the age of 6 years in patients operated on for EA. Methods: A prospective cohort of 123 patients with EA was examined by the same rehabilitation doctor at the time of a multidisciplinary visit scheduled at the age of 6 years. Children presenting with scoliosis (n = 4) or who missed the consultation (n = 33) were excluded. Univariate and multivariate logistic regression models with Firth's penalized-likelihood approach were used to identify risk factors associated with sagittal posture anomalies. Candidate risk factors included neonatal characteristics, associated malformations, atresia type, postoperative complications, psychomotor development retardation, orthopedic abnormalities, and neurological hypotonia. Results: The prevalence rates of sagittal posture abnormalities were 25.6% (n = 22; 95% CI, 16.7-36.1%). Multivariate analysis showed that minor orthopedic abnormalities (OR: 4.02, 95% CI: 1.29-13.43, P = 0.021), and VACTERL (OR: 3.35, 95% CI: 1.09-10.71, P = 0.042) were significant risk factors for sagittal posture abnormalities. Conclusion: This study shows that sagittal posture anomalies occur frequently in children operated on at birth for EA and are not directly linked to the surgical repair. These children should be screened and treated using postural physiotherapy, especially those with VACTERL and minor orthopedic abnormalities.

Effects of wheelchair mass on the physiologic responses, perception of exertion, and performance during various simulated daily tasks.

OBJECTIVE: To verify whether additional manual wheelchair mass above a critical level would produce, during many daily tasks, an increase in physiologic parameters, an increase in the perceived exertion, and a decrease in performance. DESIGN: A repeated-measurement design. SETTING: Six standardized tests thought to mimic daily activities. PARTICIPANTS: Volunteers (N=21), 8 men with spinal cord injuries (SCIs; mean age, 34+/-12y; range, 19-56y) and 13 able-bodied persons (11 men and 2 women; mean, 24+/-5y; range, 18-37y). INTERVENTIONS: Random additional masses ("0", 1, 2, 5kg) were placed under the seat of a multisport manual wheelchair (mass approximately 10kg) out of the subject's field of vision. MAIN OUTCOME MEASURES: Energy expenditure (EE; total o(2) consumed), heart rate (total number of beats), perceived exertion (visual analog scale), and performance (seconds to execute a sprint test) were measured. RESULTS: For all tests, there was no significant effect of mass found for either group for the EE, heart rate, and performance. In addition, for all tests, no significant effect of mass was found for the SCI group for the visual analog perceived exertion. However, for the able-bodied group, the added mass had a significant effect for the visual analog perceived exertion (F=6.11; P=.02) in the Stop-and-Go test. A post hoc Tukey test showed a significant difference between the 0kg and 5kg mass conditions (P<.01; d=.8), between 1kg and 5kg (P=.02; d=.6), and between 2kg and 5kg (P=.01; d=.6). CONCLUSIONS: Based on these findings, it can be concluded that, under the conditions of this study, additional mass (up to 5kg) loaded on a multisport manual wheelchair does not seem have any effect on EE, heart rate, or performance and has a minor effect on the visual analog perceived exertion evaluated in many activities of daily living.

The effect of a one-leg cycling aerobic training program during the rehabilitation period in soccer players with anterior cruciate ligament reconstruction.

OBJECTIVES: To examine cardiorespiratory fitness, resting cardiac parameters, and muscle oxygenation changes in soccer players having undergone anterior cruciate ligament reconstruction and to assess the benefits of a one-leg cycling (OLC) aerobic training program performed during the rehabilitation period. DESIGN: Randomized clinical trial. SETTING: Outpatient clinic, primary care. PATIENTS: Twenty-four, male, regional-level soccer players who had undergone surgical reconstruction of the anterior cruciate ligament of the knee. INTERVENTION: Patients were randomly assigned to 1 of 2 groups: either an individualized OLC aerobic training program with the untreated leg plus a rehabilitation program (training group, TG) or a group that received the same rehabilitation program but without aerobic training (control group, CG). MAIN OUTCOME MEASURES: Outcome measurements assessed before (T1) and after 6 weeks (T2) were stroke volume (SV) and end-diastolic volume (EDV) during resting cardiac echography measurement and peak work rate (W(peak)), peak O(2) uptake (VO(2)peak), peak minute ventilation (VE(peak)), first and second ventilatory threshold (VT1 and VT2), leg muscle oxygenation (LMO(2)), and blood volume (LMBV) during maximal graded tests performed with the untreated leg. RESULTS: At T1, there was no significant difference between TG and CG. For TG, W(peak), VE(peak), VT1, VT2, LMO(2), and LMBV at each work rate were significantly higher at T2 than at T1. For CG, W(peak), VO(2)peak, VE(peak), VT2, SV, and EDV decreased significantly at T2 in comparison with T1. CONCLUSIONS: One-leg cycling training could involve specific adaptations in comparison to a standard rehabilitation program. Moreover, OLC training during rehabilitation seems to stop the effects of hypoactivity.

Benefits of a four-week functional restoration program in chronic low back pain patients and three-month follow-up: focus on paraspinal muscle aerobic metabolism responses to exercise.

BACKGROUND: Chronic low back pain (CLBP) is a major health concern characterized by paraspinal muscle fatigability. This can be improved following a functional restoration program. Muscle fatigability can be related to impairment in aerobic metabolism responses. In this study, we investigated paraspinal muscles aerobic metabolism in CLBP patients before and after a functional restoration program, in order to determine if the enhancement in patients' condition following the program is associated to changes in metabolism responses. METHODS: Twenty-two CLBP patients (11 women, 11 men; 41.6±1.8 years; 73.7±3.1 kg; 1.74±0.02 m) were evaluated before and after a 4-week functional restoration program, with exercise therapy as the main component. Three months later, 12 patients were seen for a follow-up visit. During each testing session, patients performed a five-minute isokinetic trunk extension exercise in measuring pulmonary gas exchanges and paraspinal muscle oxygenation. Mechanical efficiency and onset V̇O2 kinetics were also calculated, in addition to usual questionnaires and exercises designed to evaluate psychosocial and physical factors. RESULTS: At the end of the program, paraspinal muscle oxygenation, mechanical efficiency, and the V̇O2 onset kinetics were improved (P<0.05). All measures remained stable during the three-month follow-up except for paraspinal muscle oxygenation, which deteriorated (P<0.05). Return-to-work was associated with the level of workday physical activities and to a decrease in fear-avoidance beliefs. CONCLUSIONS: At the end of the program, aerobic metabolism responses were improved in paraspinal muscles in patients. These improvements were not associated with return-to-work, which was primarily influenced by socio-psychological factors.

Relationship Between Spinal-Pelvic Sagittal Balance and Pelvic-Femoral Injuries in Professional Soccer Players.

BACKGROUND: Pelvic-femoral injuries are a common problem in football (soccer) players. However, the risk factors for these injuries are unclear. Our knowledge of spinal-pelvic sagittal balance has increased considerably over the past few years, notably as a result of new radiographic techniques such the EOS radiographic imaging system. PURPOSE: To investigate the link between spinal-pelvic sagittal balance on EOS imaging and the incidence of pelvic-femoral injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Players in a League 1 professional soccer team were observed for 5 consecutive seasons. All players included in the study underwent EOS radiographic imaging. All acute and microtraumatic injuries to the pelvic-femoral complex were recorded prospectively: hamstrings, psoas, quadriceps, adductors, obturators, and pubic symphysis. We analyzed the relationship between injury incidence and key radiographic parameters involved in pelvic balance. RESULTS: A total of 61 players were included (mean age, 24.5 years; n = 149 injuries; mean pelvic tilt, 9.08° ± 5.6°). A significant link was observed between the incidence of pelvic-femoral injuries and pelvic tilt (P = .02). A significant link was also observed between the incidence of acute pelvic-femoral injuries and pelvic tilt (P = .05). In both cases, a high pelvic tilt was associated with a low incidence of injuries. CONCLUSION: In professional soccer players, a low pelvic tilt was associated with a high incidence of all pelvic-femoral injuries as well as acute pelvic-femoral injuries. These results could lead to new preventive methods for these musculotendinous injuries through physical therapy.

Tibialis posterior transfer for foot drop due to central causes: Long-term hindfoot alignment.

BACKGROUND: Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait. HYPOTHESIS: TTP can induce flattening of the medial arch of the foot. PATIENTS AND METHODS: We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12-108 months). The causes were stroke (n=5), head injury (n=3), spinal cord injury (n=2), cervical spondylotic myelopathy (n=1), cerebral palsy (n=1), and a brain tumour (n=1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Méary-Toméno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane. RESULTS: Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°-156°], p=0.041; and 24° [range, 14°-33°], p=0.028, respectively). DISCUSSION: In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop. LEVEL OF EVIDENCE: IV, retrospective study with no control group.

Isokinetic muscle testing for weak patients suffering from neuromuscular disorders: a reliability study.

Precise, sensitive muscle strength testing methods are needed to investigate muscle function in patients with neuromuscular disorders (NMD). Here, we describe an isokinetic knee flexor and extensor testing procedure using the Biodex 3's continuous passive motion (CPM) mode. The torque values recorded during passive isokinetic motion were subtracted from the torque values obtained for the same movement with maximal, concentric effort. The aims of the present study were to (i) evaluate the method's reliability in NMD patients presenting mild to severe muscle weakness and (ii) study the relationship between manual muscle testing (MMT) and isokinetic dynamometry. The fifteen participating patients were tested twice; the respective intraclass correlation coefficients (ICCs) for the two sessions ranged from 0.91 to 0.99 for the peak torque, work and power and from 0.50 to 0.90 for the angle at peak torque. The Spearman rho correlation coefficients comparing isokinetic values and MMT values ranged from 0.67 to 0.74 (p<0.01). This reliable, dynamic method appears to be of great value in NMD evaluation when sensitive strength measurement at the knee is required.

Effects of training and detraining on the static and dynamic balance in elderly fallers and non-fallers: a pilot study.

PURPOSE: The aim of this study was to evaluate the effects of training based on static and dynamic balance in single and dual task conditions in order to analyse the effects of detraining on static and dynamic balance in healthy elderly fallers and non-fallers. METHOD: A group of 16 subjects were trained: eight fallers aged 71.1 +/- 5.0 years and eight non-fallers aged 68.4 +/- 4.5 years. The subjects were evaluated 3 months before the training period, 2 days before the training period, 2 days after the end of the training period and 3 months after the training period. All subjects performed a unipedal test with eyes open and eyes closed. Gait parameters were analysed under single-task and dual motor-task conditions. RESULTS: This study demonstrated a loss of physical capacities over 3 months for stride time, single support time for fallers in both conditions. Physical training significantly improves static and dynamic balance under single and dual task conditions. Lastly, after 3 months of detraining, a loss of the physical training effects were measured for fallers and non-fallers on the different walking parameters in the two conditions and on the unipedal tests. CONCLUSIONS: The absence of stimulation before the trained period shows a negative effect of ageing on walking and falls whereas training permits an improvement in static balance and the pattern of walking under single and dual task conditions, which could be due to an increase in muscular strength and a better division of attention. On the other hand, 3 months of detraining inhibited the effects of training, which showed the speed of the decline caused by 'natural' ageing.