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    ABSTRACT: Background Evidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step up task, and (iii) associated clinical measures. Methods Hip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n = 20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, Foot Posture Index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion. Findings Reduced hip adduction (0.82°, P = 0.01), knee internal rotation (0.46°, P = 0.03), and gluteus medius peak amplitude (0.9 mV, P = 0.043) were observed after ground contact in the ‘with orthoses’ condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r = − 0.51, P = 0.02) while higher Kujala scores correlated with earlier gluteus medius onset (r = 0.52, P = 0.02). Interpretation Although small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful.
    Clinical Biomechanics 08/2014;
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    ABSTRACT: Objectives To investigate the effects of vitamin D supplementation on muscle strength in healthy individuals. Design A systematic review with meta-analysis. Methods In October 2013 a computerised literature search of three databases (Pubmed, Web of Knowledge and Scopus) was performed. Included in the review were controlled and randomised controlled trials, published in English, which measured muscle strength and serum Vitamin D concentration in participants 18-40 years old. References of identified articles were then cross-checked and citations scanned for additional articles. Quality was assessed using the PEDro scale. Muscle strength and Vitamin D levels were extracted for a meta-analysis on upper and lower limb strength with standardised mean differences calculated to analyse effect. Results Six randomised controlled trials and one controlled trial were identified and quality assessment showed all seven trials were of ‘good quality’. Data was extracted from 310 adults, 67% female, with mean ages ranging from 21.5 to 31.5 years. Trials lasted from 4 weeks to 6 months and dosages differed from 4000 IU per day to 60,000 IU per week. Upper and lower limb muscle strength had a standardised mean difference of 0.32 (95% CI = 0.10, 0.54) and 0.32 (95% CI = 0.01, 0.63) respectively, suggesting Vitamin D supplementation significantly increased muscle strength in the experimental group for upper (P = 0.005) and lower limbs (P = 0.04). Conclusion Vitamin D supplementation increases upper and lower limb strength. Further research should focus on its effect on muscle power, endurance and maximal strength.
    Journal of Science and Medicine in Sport. 01/2014;
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    ABSTRACT: Greater frontal and transverse plane hip and knee motion, and delayed gluteus medius and vastus medialis oblique activation have frequently been identified in patellofemoral pain syndrome populations, whilst prefabricated anti-pronation foot orthoses have been reported to reduce symptoms. The aim of the study was to evaluate the effects of such orthoses on hip and knee kinematics, gluteal and vasti muscle activity, kinematic and electromyographic interactions alongside correlations with specific clinical measures. Eighteen asymptomatic individuals (11 male 7 female) had measures taken of static foot posture and ankle range of motion. Hip muscle activity and kinematics were measured using electromyography and an active motion capture system during a step-up task. Order of testing with or without orthoses was determined using a coin toss. Between condition paired t-tests indicated significantly reduced peak hip adduction angles (1.56°, P<0.05) and significantly reduced knee internal rotation (1.3°, P<0.05) in the orthoses condition. Reduced ankle dorsiflexion range of motion correlated with a reduction in hip adduction following the orthoses intervention (r=0.59, P=0.013). The effects of prefabricated orthoses may be partially explained by kinematic alterations that occur proximal to the foot in the kinetic chain. These clinically and biomechanically relevant effects appear more evident in those with reduced underlying ankle motion. Further research is indicated using a symptomatic population to explore the clinical relevance of these observations.
    Clinical biomechanics (Bristol, Avon) 12/2013;
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    ABSTRACT: Distance running continues to experience increased participation in the Western world, although it is associated with high injury rates. Barefoot running has been increasingly proposed as a means to prevent overuse injury due to various biomechanical differences, including reduced joint loading rates and altered kinematics and muscle activity patterns compared to shod running. The aim of this review was to systematically evaluate biomechanical differences between running barefoot and shod, including the quality of available evidence, in order to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. A comprehensive search of MEDLINE, Web of Knowledge and EMBASE from inception to January 2013 was performed. Trials evaluating injury-free recreational or competitive adults who participate in long-distance running (≥5 km), where a comparison of barefoot and shod running lower-limb kinetics, kinematics and/or electromyography were included. Studies examining sprinting and studies of single-subject design were excluded. Following initial searching, two reviewers identified a shortlist of relevant studies based on title and abstract, with the full text of these studies being tested against the inclusion criteria. References of included studies were examined and citation tracking was performed in Web of Knowledge. Two independent reviewers evaluated the methodological quality of each included study using a modified version of the Downs and Black quality index. Results of the quality assessment were used to identify high- and low-quality studies, data pooling was completed where possible and levels of evidence were determined based on the van Tulder criteria. Eighteen studies were identified, all of low methodological quality. Effect size (ES) calculation was possible for 12 studies. Pooled results indicate moderate evidence that barefoot running is associated with reduced peak ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe. Limited evidence indicates barefoot running is associated with reduced impact GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe. Very limited to limited evidence also indicates power absorption at the knee is decreased while being increased at the ankle whilst barefoot running. Additionally, the effects of barefoot running on loading rate appear dependent on strike pattern adopted, with a forefoot strike pattern found to reduce loading rate, whilst a rearfoot strike pattern increases loading rate when running barefoot compared to shod. Key methodological weaknesses that must be addressed in future research were identified. Of particular note were absence of investigator blinding, infrequent intervention randomisation, small sample sizes and lack of evaluation following habituation. Two studies could not be retrieved because of publication in a non-English-language journal. Of particular note is that the validity of the body of work is compromised by the lack of evaluation after habituation, or re-training, of previously shod rearfoot-striking runners to barefoot forefoot-striking running styles. There has been a great deal of publicity for barefoot running, and many claims made about its effects and risks. Despite a large amount of biomechanical data available for meta-analysis, clear guidance for clinical practice is limited because of the low methodological quality of the associated studies. Preliminary biomechanical differences identified suggest barefoot running may be associated with positive biomechanical changes in regards to injury prevention, although this may be dependent on strike pattern adopted. Further research employing more robust methodology, which addresses weaknesses highlighted in this review, is needed to confirm current preliminary evidence. Additionally, prospective research would have higher validity were the biomechanical effects of habituating to barefoot running fully examined alongside an evaluation of prevention of repetitive use injury.
    Sports medicine (Auckland, N.Z.). 08/2013;
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    ABSTRACT: The objective is to compare the effectiveness of two different methods of administering injection, ultrasound guided versus palpation guided, for the treatment of Morton's Neuroma. This is a retrospective review of patients who have had corticosteroid-injections as part of their treatment for Morton's Neuroma. A postal-questionnaire using a modified Foot Health Status Questionnaire, reviewing foot-pain, foot function-activity, footwear and general foot health, was utilised and posted to all patients diagnosed with Morton's Neuroma in the Podiatry Clinic between 2001-2006. No inclusion or exclusion criteria were applied. Of the 104 questionnaires distributed 46 (44.23%) were returned. Subjects who had no corticosteroid injection as treatment for Morton's Neuroma were excluded {14/46 (30.43%)}. Subsequently 32/46 subjects were evaluated. To some extend better results were demonstrated in the palpation guided injection group. There was some evidence of statistical significance (p=0.05) in three questions. Those were concerning the time interval between the last corticosteroid injection and completion of the questionnaire (0.02), work limitation (p=0.048) or walking (0.0482) difficulties secondary to foot problems. No other statistical association was confirmed. Injection therapy is often the treatment of choice. No advantage has been demonstrated in this survey of ultrasound guided injection versus palpation guided injection. Further studies are needed to prove the effectiveness of ultrasound guided corticosteroid injection.
    British journal of sports medicine 07/2013; 47(10):e3.
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    ABSTRACT: BACKGROUND: Loading leads to tendon adaptation but the influence of load-intensity and contraction type is unclear. Clinicians need to be aware of the type and intensity of loading required for tendon adaptation when prescribing exercise. The aim of this study was to investigate the influence of contraction type and load-intensity on patellar tendon mechanical properties. METHOD: Load intensity was determined using the 1 repetition maximum (RM) on a resistance exercise device at baseline and fortnightly intervals in four randomly allocated groups of healthy, young males: (1) control (no training); (2) concentric (80% of concentric-eccentric 1RM, 4×7-8); (3) standard load eccentric only (80% of concentric-eccentric 1RM, 4×12-15 repetitions) and (4) high load eccentric (80% of eccentric 1RM, 4×7-8 repetitions). Participants exercised three times a week for 12 weeks on a leg extension machine. Knee extension maximum torque, patellar tendon CSA and length were measured with dynamometry and ultrasound imaging. Patellar tendon force, stress and strain were calculated at 25%, 50%, 75% and 100% of maximum torque during isometric knee extension contractions, and stiffness and modulus at torque intervals of 50-75% and 75-100%. Within group and between group differences in CSA, force, elongation, stress, strain, stiffness and modulus were investigated. The same day reliability of patellar tendon measures was established with a subset of eight participants. RESULTS: Patellar tendon modulus increased in all exercise groups compared with the control group (p<0.05) at 50-75% of maximal voluntary isometric contraction (MVIC), but only in the high eccentric group compared with the control group at 75-100% of MVIC (p<0.05). The only other group difference in tendon properties was a significantly greater increase in maximum force in the high eccentric compared with the control group (p<0.05). Five repetition maximum increased in all groups but the increase was significantly greater in the high load eccentric compared with the other exercise groups (p<0.05). CONCLUSION: Load at different intensity levels and contraction types increased patellar tendon modulus whereas muscle strength seems to respond more to load-intensity. High load eccentric was, however, the only group to have significantly greater increase in force, stiffness and modulus (at the highest torque levels) compared with the control group. The effects and clinical applicability of high load interventions needs to be investigated further.
    Journal of biomechanics 06/2013;
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    ABSTRACT: OBJECTIVES: Growing evidence supports hip muscle activation and strengthening exercise prescription to prevent and treat various lower limb injuries. Common prescriptions include single-legged and double-legged squatting, with and without a Swiss ball. We aimed to establish the effect of varying forms of squatting exercises on gluteal muscle activation. DESIGN AND SETTING: Observational laboratory study. PARTICIPANTS: Nineteen (11 male) healthy participants (28.4 +/- 2.7 years old) were compared using one-way repeated measures analysis of variance. MAIN OUTCOME MEASURES: Surface electromyography (EMG) measures of gluteus medius (GMed) and gluteus maximus (GMax) during the isometric phase of single-legged and double-legged squatting, with and without a Swiss ball. RESULTS: A greater percentage of maximal voluntary contraction (%MVC) during single-legged squatting was found compared to double-legged squatting for GMed (42 versus 9%MVC, p < 0.001) and GMax (35 versus 14%MVC, p < 0.001). Additionally, the Swiss ball increased GMax activity (42 versus 35%MVC, p = 0.026) and demonstrated a trend toward increased GMed activity (46 versus 42%MVC, p = 0.075) during the single-legged squat. CONCLUSIONS: These results indicate single-legged squatting may be more appropriate than double-legged squatting to facilitate strength gains of GMed and GMax. Additionally, the Swiss ball may be a useful adjunct to target gluteal muscle strengthening during single-legged squatting.
    Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine 06/2013;
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    Archives of Orthopaedic and Trauma Surgery 05/2013;
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    ABSTRACT: BACKGROUND: Low back pain (LBP) is highly prevalent in cricketers, particularly in adolescent fast bowlers. Numerous modifiable risk factors for and interventions to address LBP in cricketers have been proposed in the literature. AIM: Summarise and critique studies evaluating LBP risk factors in cricketers, and evaluate the effectiveness of interventions designed to prevent or treat such LBP. STUDY DESIGN: Systematic literature review. METHODS: MEDLINE, ISI Web of Knowledge, CINAHL, SportDiscus and the Cochrane Library were searched from inception using key terms relating to risk factors and interventions in LBP in cricketers. Quality of included studies was assessed using the Downs and Black Quality Index, data were extracted to complete the effect size and OR calculations and evidence levels were established using van Tulder's criteria. RESULTS: 12 studies (6 of high quality) investigating the factors associated with LBP in cricketers and 5 low-quality studies evaluating the interventions for the treatment/prevention of LBP in cricketers were identified. Moderate evidence indicates the presence of acute MRI bone stress as a risk factor for developing lumbar stress fractures. Additionally, moderate evidence indicates increased shoulder counter rotation (associated with mixed bowling actions) and decreased anterior abdominal fascial slide may be associated with LBP in cricketers. CONCLUSIONS: Screening for bone stress on MRI should be considered by clinicians managing developing cricketers to identify the risk of lumbar stress fracture development. Numerous associative factors were outlined, although causality needs establishing to further guide interventions in cricketers with LBP. Intervention studies were of insufficient quality to generate concrete conclusions and these research failings require rapid attention.
    British journal of sports medicine 05/2013;
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    Muscles, ligaments and tendons journal. 04/2013; 3(2):58-9.
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