Pain improvement after three weeks of daily self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain: a case report.

BACKGROUND: Plantar heel pain is described as sharp pain at the medial plantar aspect of the calcaneus and medial longitudinal arch of the foot. There are various treatment options that usually need a clinician or a therapist for application. The present case report aimed to describe the outcomes of self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain. CASE DESCRIPTION: The patient was a 42-year-old man who reported plantar heel pain during the first steps in the morning along with decreased function of the foot and ankle lasting about three months. He was instructed to self-execute cross-friction massage using a fascia ball daily in the evening at home for six weeks. OUTCOMES: Pain during treatment decreased from a Numeric Pain Rating Scale (NPRS)-score of 8/10 and from a Short-Form McGill Pain Questionnaire (SF-MPQ)-score of 34/60 at initial treatment to NPRS- and SF-MPQ-scores of 0/10 and 0/60, respectively, after about three weeks. The patient reported no pain and restored function after six weeks of treatment, and in the follow-up measurements. DISCUSSION: Daily self-executed cross-friction massage using a fascia ball may be a useful alternative intervention for treating recent-onset plantar heel pain.

Efficacy of Mirror Therapy in Patients with Phantom Pain after Amputation of a Lower Limb: A Systematic Literature Review. / Wirksamkeit der Spiegeltherapie bei Patienten mit Phantomschmerzen nach Amputationen der unteren Extremität: eine systematische Literaturübersicht.

Up to 80% of patients after amputation are affected by phantom limb pain. This may be due to various mechanisms of cortical reorganisation. Non-surgical treatment of the neuropathic phantom limb pain involves mirror therapy. Thereby, the use of a mirror should induce the illusion that the extremity has been preserved. This illusion should initiate processes to restore the original organisation of the somatosensory and motor cortex and thus to reduce pain. Evidence of mirror therapy to treat lower extremity phantom limb pain is rare. Therefore, the aim of this systematic review is to qualitatively analyse the efficacy of mirror therapy for treatment of phantom limb pain in adult patients after unilateral amputations of the lower extremity.The databases Medline (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Library (Central), and OPENGREY were systematically searched until 26th November 2020, followed by continued searches in these databases to provide a review of updated literature. Study selection, data extraction, and risk of bias evaluation (Risk of Bias Tool [RoB]) of included studies were conducted by two reviewers independently. The primary outcome was pain intensity, and secondary outcomes were pain frequency, pain duration, activities of daily life (ADL), and quality of life. The methodology of this review follows the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions.The search revealed 234 articles. Four articles were included in the analysis. A reduction in pain intensity due to mirror therapy was reported in all studies, however, in only 2 studies there were significant differences between mirror therapy and the comparison after 4 weeks of treatment (p < 0.001; p < 0.05). This significant difference was maintained after 3 and 6 months follow-up in one of those studies (p < 0.001). The outcomes pain frequency, pain duration, and ADL were decreased after 4 and 10 weeks of mirror therapy compared to comparison, but with no statistical significance (p > 0.05). After 6 months, there was a significant improvement in the duration of pain and in ADL after mirror therapy compared with the control group (p < 0.05). Differences in the results quality of life between the intervention group and comparison were observed in 2 studies.Mirror therapy of high frequency and duration is an effective intervention to reduce phantom limb pain in patients after unilateral lower extremity amputation. The superiority of mirror therapy to other interventions cannot be concluded, as the evidence was of low quality.

[Development and validation of a questionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain]. / Entwicklung und Validierung eines Fragebogens zur Erfassung postural-strukturell-biomechanisch orientierter Überzeugungen von Physiotherapeut:innen zu Schmerzen.

BACKGROUND: Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain. AIM: The aim of the present study was to develop a questionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement. METHODS: The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of a literature search and discussions between experts. In a pilot study, 32 pupils of a physiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain. RESULTS: The internal consistency of the EKPQ was acceptable with a Cronbach's α = 0.784. There was a strong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed a mean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and a lower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved a mean score of 60.7% in the rNPQ­D and a mean score of 31.8% in the EKPQ. CONCLUSION: The newly developed EKPQ questionnaire seems to be a reliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that a high level of knowledge about the neurophysiology of pain does not exclude a PSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.

Network Meta-analysis of Combined Strength and Power Training for Countermovement Jump Height.

Combined strength and power training in a training program is considered to improve the vertical jump, which is frequently quantified using the countermovement jump height. It is not yet clear whether one of the different training set structures, such as complex training, contrast training, compound training and traditional training, is superior to another. The aim of this review is to describe and assess the comparative effects of the set structures on countermovement jump height in healthy subjects. A systematic review and network meta-analysis (NMA) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses. Three databases were systematically searched. Risk of bias was assessed using the Risk of Bias 2 tool. NMAs were performed using a random-effects model. Twenty-four studies were included. All interventions were superior to control (no intervention) with mean differences ranging from 2.87 [95% confidence interval (CI): 1.99 to 3.74] for complex training to 3.43 (95% CI: 2.61 to 4.26) for traditional training. None of the training interventions were superior compared to each other in strength and/or power trained subjects, as well as in non-strength and/or power trained subjects. The findings support the combination of strength and power training to improve countermovement jump height.

Sensorimotor or Balance Training to Increase Knee-Extensor and Knee-Flexor Maximal Strength in Patients With Knee Osteoarthritis: A Critically Appraised Topic.

CLINICAL SCENARIO: Knee osteoarthritis (KOA) is a complex progressive synovial joint disease that results in impaired muscle function, including a considerable loss of maximal strength and power. Exercise therapies, such as sensorimotor or balance training and resistance training, are frequently used to improve muscle function, mobility, and quality of life, but their impact on maximal muscle strength in patients with KOA is not well understood. FOCUSED CLINICAL QUESTION: Does sensorimotor or balance training improve knee-extensor and knee-flexor maximal muscle strength compared with strength training or no intervention in patients with KOA? SUMMARY OF KEY FINDINGS: Results from 4 fair- to good-quality randomized controlled/clinical trials (level 1b) revealed inconsistent grade B evidence regarding the effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA. Two studies, one good-quality study and one fair-quality study, showed significant strength improvements, and 2 good-quality studies demonstrated no significant strength enhancements. CLINICAL BOTTOM LINE: Sensorimotor or balance training may be useful to improve maximal strength of quadriceps and hamstring muscle groups in patients with KOA; however, it seems that this depends on a training duration of at least 8 weeks and the use of unstable devices to induce destabilization of patients' balance, initiating neuromuscular adaptations. STRENGTH OF RECOMMENDATION: Due to inconsistent evidence (grade B), the true effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA remains unclear and needs to be further investigated.

Comparison of Dynamic Balance and Unilateral Hop Performance Between Women and Men Handball Players After Anterior Cruciate Ligament Reconstruction: A Pilot Study.

CONTEXT: After anterior cruciate ligament reconstruction (ACLR), long-term functional deficiencies can occur, with controversial results reported when comparing women and men. Dynamic balance and unilateral hop test performance are considered important indicators for the risk of reinjury of the lower extremity. Although both sexes seem to have a similar risk to experience a second anterior cruciate ligament injury, sex-specific differences of dynamic balance and unilateral hop performance in handball players following ACLR are unknown. OBJECTIVE: To compare dynamic balance and unilateral hop performance between women and men handball players at least 6 months after ACLR. DESIGN: Cross-sectional pilot study. PARTICIPANTS: Ten women (27.6 [4.5] y) and 10 men (26.5 [3.1] y) handball players 6 to 16 months after ACLR. OUTCOME MEASURES: Dynamic balance and unilateral hop performance were assessed using the Y-Balance Test and the Single-Leg Hop for Distance Test. RESULTS: Women players demonstrated significantly better results in the anterior direction of the Y-Balance Test for both legs compared with men players. Hop performance was not significantly different between sexes. CONCLUSION: Dynamic balance and single-leg hop performance seem not to differ between women and men handball players 6 to 16 months after ACLR. The difference between sexes in the anterior reach direction of the Y-Balance Test should be considered small, rather than representing a true difference.

[Perception and mindfulness-based occupational therapy in people with mental disorders-A retrospective observational study on the SELWA-treatment]. / Wahrnehmungs- und achtsamkeitsbasierte Ergotherapie bei Menschen mit psychischen Störungen ­ Eine retrospektive Beobachtungsstudie zur Anwendung der SELWA-Behandlung.

During occupational therapeutic treatment of clients with mental disorders, perception and mindfulness-based techniques are used. However, little is known regarding relevant outcomes. Aim of the present study is to describe the results of a perception and mindfulness-based occupational therapeutic intervention (self-control techniques using perception-based methods (SELWA®) by S. Thielen) regarding the outcomes occupational performance and satisfaction in self-care, productivity and leisure, as well as concentration. The data of 28 clients (22 â™€, 6 â™‚; mean age = 42.8 (±SD 14.7) years) with mental disorders, that were collected before and after prescribed occupational therapeutic treatment, were analyzed. The outcomes were quantified using the Canadian Occupational Performance Measure (COPM) and the revision test, respectively. Significance of changes after the intervention was tested using the Wilcoxon-Signed Rank Test (p < 0.05). Effect sizes Cohen's dz and r were determined to evaluate the meaningfulness of changes. The occupational performance as well as the satisfaction in the COPM improved significantly after the therapeutic intervention (p < 0.001; dz = 2.37, r = 0.77 and dz = 2.24, r = 0.75). Moreover, the clients improved significantly in the revision test after the therapeutic intervention (p < 0.001; dz = 0.65, r = 0.31). Clients with mental disorders seem to benefit meaningfully from the SELWA®-treatment by S. Thielen regarding occupational performance and satisfaction in self-care, productivity and leisure. Furthermore, a moderate improvement of concentration seems to occur after the therapeutic intervention.

Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice.

BACKGROUND: A variety of assessments to determine leg length discrepancy (LLD) is used in clinical practice and evidence about validity and reliability may differ. OBJECTIVE: The objective of this systematic review was to identify and describe the validity and reliability of different assessments and imaging diagnostics for the determination of LLD. MATERIALS AND METHODS: The review was conducted following the recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The databases Medline (PubMed) and Index to Chiropractic Literature were systematically searched. Studies regarding clinical assessments and imaging diagnostics for the diagnosis of LLD, which reported the clinimetric properties for assessment of LLD, were included and screened for methodological quality using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool for validity studies and the Quality Appraisal of Diagnostic Reliability (QAREL) tool for reliability studies. RESULTS: Thirty-seven articles on clinical assessments and 15 studies on imaging diagnostics met the eligibility criteria. Thirteen studies on the validity of clinical assessments and six studies on the validity of imaging diagnostics had a low risk of bias and low concerns regarding applicability for all domains. One study on the reliability of clinical assessments and one study on the reliability of imaging diagnostics had a low risk of bias. Main limitations were, that an analysis of sensitivity and specificity was only performed in a few studies and that a valid reference standard was lacking in numerous studies on clinical assessments. CONCLUSIONS: For the clinical assessment of LLD, the block test appears to be the most useful method. Full-length standing anteroposterior radiography seems to be the most valid and reliable method and may be used as global reference standard to measure the anatomic LLD when comparing clinical methods and imaging diagnostics.

Comparison of Plantar Sensitivity, Dynamic Balance, and Lower Extremity Joint Range of Motion Between Experienced Female Ballet Dancers and Female Non-Dancing Athletes: A Cross-Sectional Study.

OBJECTIVES: Ballet dancers may increasingly use plantar sensory feedback to control foot position and movement during dance activities. Balance and joint range of motion (ROM) are important factors in ballet and may be related to plantar sensation in ballet dancers. Data on related functions of female ballet dancers compared to female non-dancing athletes are sparse. The aims of the study were twofold: 1. the relationships between plantar sensitivity and dynamic balance as well as between joint ROM and dynamic balance were determined in experienced female ballet dancers and female non-dancing athletes; and 2. the differences of plantar sensation, joint ROM of the lower limb, and dynamic balance between experienced female ballet dancers and female non-dancing athletes were investigated. STUDY DESIGN: In this cross-sectional study, 21 subjects (11 experienced female ballet dancers and 10 female non-dancing athletes; median age: 23, range: 11 years; median body height: 1.7 m, range: 0.2 m; median body mass: 59 kg, range: 36 kg) were included. Plantar sensitivity was determined by Semmes-Weinstein monofilaments, active ranges of motion of the hip, knee, and ankle joints were measured using a goniometer and dynamic balance was assessed by the Y-Balance test. Correlations between outcome measures were determined in both groups. Outcome measures were compared between ballet dancers and non-dancing athletes using parametric or non-parametric statistical tests (α = 0.05). RESULTS: For the fifth metatarsal head and the heel, higher correlations between plantar sensitivity and Y-Balance test scores in non-dancing athletes compared to ballet dancers were found. Higher correlations between joint ROM and Y-Balance test scores were determined for certain movements in non-dancing athletes compared to ballet dancers. A significantly lower cutaneous threshold was only found for the fifth metatarsal head in ballet dancers compared to non-ballet dancers (p < 0.05). Range of motion was significantly higher in ballet dancers for almost all movements (p < 0.05). Ballet dancers showed significantly higher normalized scores of the Y-Balance test (p ≤ .001). CONCLUSIONS: Results of correlation analyses may indicate that non-dancing athletes increasingly must rely on plantar sensation of the fifth metatarsal head and the heel while maintaining dynamic balance compared to ballet dancers, especially in posterolateral direction of the Y-Balance test. Active joint range of motion of the lower extremity and dynamic balance differ between female ballet dancers and non-dancing athletes. Plantar sensitivity is not different for most of the assessed localizations.

Biomechanical analysis of single-leg stance using a textured balance board compared to a smooth balance board and the floor: A cross-sectional study.

BACKGROUND: Previous research showed that standing on textured surfaces can improve postural control by adapting somatosensory inputs from the plantar foot. The additional stimulation of plantar cutaneous mechanoreceptors by a textured surface during single-leg stance on a balance board may increase afferent information to the central nervous system to accelerate muscular responses and to enhance their accuracy. The additional impact of textured surface during single-leg stance on a balance board on postural control and muscle activity is unknown. RESEARCH QUESTION: To investigate the differences of a) postural control during single-leg stance on a textured balance board compared to a smooth balance board and b) activity of lower extremity muscles during single-leg stance on a textured balance board compared to a smooth balance board and the floor. METHODS: Twenty-six healthy adults (12 females, 14 males; mean age = 25.4 years) were asked to balance on their randomly assigned left or right leg on a force plate (floor; stable condition), a textured balance board and a smooth balance board (unstable conditions). Center of pressure (CoP) displacements (force plate, Bertec, 1000 Hz) and electromyographic activity (EMG) of eight leg muscles were measured and compared between conditions, respectively. RESULTS: Neither CoP-displacements, nor EMG activities differed significantly between the textured and the smooth balance board (p > 0.05). Significantly higher muscle activities (p < 0.05) were observed using the balance boards compared to the floor. SIGNIFICANCE: Single-leg stance using a textured balance board seems not to lead to reduced CoP-displacements compared to a smooth balance board. Muscle activation is significantly increased in both balance board conditions compared to the floor, however, it is not different when both balance board surfaces are compared. It could not be recommended to use a textured balance board for altering muscle activity and improving postural control during single-leg stance in favor of a smooth textured balance board.

THE INFLUENCE OF SENSORIMOTOR TRAINING MODALITIES ON BALANCE, STRENGTH, JOINT FUNCTION, AND PLANTAR FOOT SENSITIVITY IN RECREATIONAL ATHLETES WITH A HISTORY OF ANKLE SPRAIN: A RANDOMIZED CONTROLLED PILOT STUDY.

BACKGROUND: Ankle sprains frequently result in persistent sensorimotor deficits. Sufficient evidence of effects of sensorimotor training using unstable devices on physical functions is lacking. There is no insight as to whether simultaneous tactile stimulation of plantar foot mechanoreceptors using textured surfaces may influence outcomes in people with a history of ankle sprain. PURPOSE: The purpose of this study was to investigate the potential effects of sensorimotor training using unstable textured surfaces on balance, strength, joint function, and plantar sensitivity in recreational athletes with a history of ankle sprain. PARTICIPANTS: Nineteen recreational athletes (6 females, 13 males; mean age: 29 ± 7 years) with a history of ankle sprain and self-reported sensation of instability participated. METHODS: Self-reported function of the ankle joint, plantar cutaneous detection threshold to light touch, balance during single-leg stance as well as maximal isometric strength of the ankle joint in eversion and inversion were measured. Participants were randomly allocated to either a training group using unstable textured surfaces or a training group using unstable smooth surfaces or a control group. Outcome measurements were repeated after six weeks of training and at follow-up after 10 weeks. Within and between group differences were analyzed using ANOVA, Friedman tests, or Kruskal Wallis tests (p<0.05) and post-hoc tests with Bonferroni correction. Correlations between outcome-parameters from baseline measurements were analyzed using Spearman's rho (p<0.05). RESULTS: No significant between-group differences in all outcome measures were detected. However, a significant increase of strength in eversion was found for the training group using textured surfaces after 10 weeks (p = 0.01). A moderate correlation existed between plantar detection threshold of metatarsal head (MT) I and strength of inversion (r = 0.51, p<0.05) before training across all groups. There were moderate negative correlations between balance parameters and strength in eversion (r = -0.57 - -0.64, p≤0.01) as well as plantar detection thresholds at MT V (r = -0.48 - -0.62, p<0.05) at baseline across all groups. CONCLUSION: A six-week sensorimotor training using unstable smooth and textured surfaces demonstrated no significant differences in balance, strength in eversion and inversion, plantar foot sensitivity, and self-reported ankle instability between training groups and the control group in recreational athletes with a history of ankle sprain. A better score on balance testing seems to correlate with an increase in eversion ankle strength and a decreased plantar sensitivity at MT V. LEVEL OF EVIDENCE: Level IIb.

Electromyographic analysis of balance exercises in single-leg stance using different instability modalities of the forefoot and rearfoot.

PURPOSE: To investigate the activity of lower extremity muscles in response to single-leg stance on a training device, destabilizing the forefoot while the rearfoot stands on a fixed plate and vice versa compared with a balance pad and the floor. DESIGN: Cross-sectional study. SETTING: University's laboratory. PARTICIPANTS: Twenty-seven healthy adults. METHODS: Surface electromyography and 2D video analysis were used to record the activity of lower extremity muscles and to control sagittal knee joint angle during single-leg stance trials under one stable control condition and five unstable conditions. RESULTS: The majority of lower extremity muscles were significantly more active when the forefoot was destabilized while the rearfoot remained stable compared with the stable condition and the conditions where the forefoot was stable and the rearfoot unstable (p <0 .001). Mean change of knee joint angle was significantly increased under the conditions rearfoot stable/forefoot unstable (p = 0.001). The soleus muscle activation was significantly increased when balancing on the balance pad (p < 0.001). CONCLUSIONS: Increased activity in the majority of lower extremity muscles and sagittal knee joint angles indicate that destabilizing the forefoot while the rearfoot remains stable is the most challenging balance task. Soleus muscle activation increased when performing ankle plantarflexion on the soft balance pad.

Pain and functional outcomes after outpatient physiotherapy in patients with low back pain.

BACKGROUND: Physiotherapy treatment programs are recommended in the rehabilitation of low back pain (LBP). Rehabilitation institutions are increasingly asked to demonstrate the outcomes of their intensive physiotherapy services. AIM: To describe pain and functional outcome measures following a 6-month outpatient physiotherapy treatment program in patients with LBP. METHODS: A total of 85 patients were analysed after being treated with a combination of physiotherapeutic treatment modalities 2-3 days weekly. Pain and disability were measured before, 3 and 6 months after the onset of treatment. Isometric trunk muscle strength for flexion and extension and flexibility of dorsal trunk and thigh structures were measured before and 6 months after treatment. RESULTS: After 6 months, pain at rest decreased from a median of 4.0 to 0.0 (p < 0.01) and pain during activity from a median of 5.5 to 2.0 on the numeric rating scale (p < 0.001). The Roland-Morris Disability (RMDQ) score decreased from a median of 7.0 to 3.0 (p < 0.001). Mean trunk muscle flexion strength increased from 133.7 to 156.0 Nm and for extension from 235.5 to 278.3 Nm (p < 0.001). Flexibility was improved from a mean of -5.9 to -1.4 cm (p < 0.001). A moderate correlation between pain at rest and RMDQ score was found after 3 (r = 0.532, p < 0.01) and 6 months (r = 0.508, p < 0.01). CONCLUSIONS: Patients with LBP who were treated with the physiotherapeutic treatment program showed a clinically relevant reduction of pain and disability with improved trunk muscle strength and flexibility. Reductions in pain and disability do not seem to correlate with increased trunk muscle strength and flexibility. No conclusions can be declared about long-term changes after the intervention.

Textured and stimulating insoles for balance and gait impairments in patients with multiple sclerosis and Parkinson's disease: A systematic review and meta-analysis.

The aim of this systematic review with meta-analysis was to investigate if using textured or other types of stimulating insoles improve gait characteristics and balance/postural control in patients with multiple sclerosis and Parkinson's disease. Primary outcomes for balance were the center of pressure (CoP) displacement and CoP velocity/sway rate. Primary outcomes for gait were the cadence, velocity, and step length. Standardized mean differences (SMD) were used to verify the efficacy of wearing the insoles on gait and balance outcome measures. Study quality was evaluated using the checklist of the CONSORT- Statement. Six studies were included in the review. Five studies had low methodological quality, scoring <17/37 on the checklist, one study had moderate methodological quality, scoring 27/37 on the checklist. Due to designs of the included studies, only immediate effects could be calculated. Among the primary outcome measures cadence, gait velocity and step length, there was no evidence of an effect of using textured/stimulating insoles compared with the respective control condition (Totals: SMD -0.09, 95% CI -0.35 to 0.16; SMD 0.18, 95% CI -0.17 to 0.53; SMD -0.13, 95% CI -0.31 to 0.05). Furthermore, among the primary outcome measures CoP displacement and CoP velocity, no evidence of an effect was found as well (Subtotals multiple sclerosis: SMD 0.07, 95% CI -0.15 to 0.28; SMD -0.08, 95% CI -0.55 to 0.39). Therefore, using textured or other types of stimulating insoles for the treatment of balance and gait impairments in patients with multiple sclerosis and Parkinson's disease seem to have no effect.

RELIABILITY, COMPARABILITY, AND VALIDITY OF FOOT INVERSION AND EVERSION STRENGTH MEASUREMENTS USING A HAND-HELD DYNAMOMETER.

BACKGROUND: There are conflicting results with respect to the validity and reliability of lower extremity strength measurements using a hand-held dynamometer (HHD) in the healthy population. Previous studies exploring foot inversion and eversion strength using a HHD were carried out with predominantly clinically affected participants in different positions. The question arises whether HHD measurements of isometric foot inversion and eversion strength performed with participants in different positions are valid, reliable and comparable and can be used alternatively. PURPOSE: The aims of this study were to investigate: a) the intra- and inter-tester reliability of measurements of foot inversion and eversion strength in different participant positions using a belt-stabilized HHD; b) the comparability of results obtained in different positions; and c) the concurrent validity of the aforementioned measurements using an isokinetic dynamometer. METHODS: Thirty adults (12 females and 18 males; mean age 22.5 ± 3.9 years) volunteered to participate in this study. Maximal isometric foot inversion and eversion torques (Nm) were measured with participants lying supine, sitting with knees extended and lying on their side using a belt-stabilized HHD. Measurements were performed independently by two physiotherapists over two days and were repeated using an isokinetic dynamometer. Validity and intra- and inter-tester reliability were determined using the intra-class correlation coefficient (ICC). A two-way ANOVA (p < 0.05) and post-hoc tests with Bonferroni correction were used to compare data from different positions. Bland-Altman plots were used to demonstrate the range of error and difference between HHD and isokinetic measurements. RESULTS: Intra-tester reliability for inversion and eversion torques was fair to excellent in all positions (ICC = 0.598-0.828). Excellent inter-tester reliability was found for eversion torques in all positions (ICC = 0.773-0.860). For inversion torques, inter-tester reliability was fair to excellent (ICC = 0.519-0.879). ICC values of 0.205 to 0.562 indicated a low to fair concurrent validity. A significant difference was observed between the torques of the supine and side-lying positions as well as sitting and side-lying positions (p < 0.05). Bland-Altman plots showed that the mean of the differences for inversion and eversion torques deviates considerably from zero, indicating that measurements with the HHD in the three positions produce lower values compared to using the isokinetic dynamometer. CONCLUSIONS: Inversion and eversion strength measurements with subjects in different positions using HHD seem to be reliable, but consistently underestimated torque output when compared with measurements using isokinetic dynamometry. While the HHD outcomes measured in supine and sitting positions seem to be comparable, those measured in supine/sitting and side-lying positions differed. LEVEL OF EVIDENCE: Diagnostic study, Level 3.

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial.

PURPOSE: Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack. METHODS: Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed. RESULTS: Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026). CONCLUSIONS: Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder. LEVEL OF EVIDENCE: II.

Biomechanical comparison of 3 ankle braces with and without free rotation in the sagittal plane.

CONTEXT: Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle. Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane. It is unclear, however, whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion. OBJECTIVE: To investigate the dynamic and passive stabilizing effects of 3 ankle braces, 2 hinged models that provide free plantar flexion-dorsiflexion in the sagittal plane and 1 ankle brace without a hinge. DESIGN: Crossover study. SETTING: University Movement Analysis Laboratory. PATIENTS OR OTHER PARTICIPANTS: Seventeen healthy volunteers (5 women, 12 men; age = 25.4 ± 4.8 years; height = 180.3 ± 6.5 cm; body mass = 75.5 ± 10.4 kg). INTERVENTION(S): We dynamically induced foot inversion on a tilting platform and passively induced foot movements in 6 directions via a custom-built apparatus in 3 brace conditions and a control condition (no brace). MAIN OUTCOME MEASURE(S): Maximum inversion was determined dynamically using an in-shoe electrogoniometer. Passively induced maximal joint angles were measured using a torque and angle sensor. We analyzed differences among the 4 ankle-brace conditions (3 braces, 1 control) for each of the dependent variables with Friedman and post hoc tests (P < .05). RESULTS: Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition, whereas only the 2 hinged ankle braces differed from each other, with greater movement restriction caused by the Ankle X model. Passive foot inversion was reduced with all ankle braces. Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace. CONCLUSIONS: All ankle braces showed stabilizing effects against dynamic and passive foot inversion. Differences between the hinged braces and the nonhinged brace did not appear to be clinically relevant.

Are diurnal changes in foot sole sensation dependent on gait activity?

The foot sole is loaded during stance and gait and plantar cutaneous mechanoreceptors sense the local stress distribution. It is not clear whether the perception thresholds of these mechanoreceptors change during the day and how they respond to walking activities. The primary aim of the present study was to investigate diurnal changes of plantar sensitivity. Furthermore, the aim was to find out whether daily changes depend on the individual level of step activity. Twenty-six healthy subjects, 17 women and 9 men, aged 28.6±6.7 years participated in the study. Detection thresholds to light touch were measured in six plantar regions with Semmes-Weinstein monofilaments in the morning, noon and afternoon. Step activity was recorded with a StepWatch™ Activity Monitor and analyzed for three periods (8 a.m.-4 p.m., 8 a.m.-12 p.m., 12 p.m.-4 p.m.). The hallux, the 3rd metatarsal head and the heel showed significantly decreased detection thresholds from 8 a.m. to 4 p.m. (p≤0.05). A fair correlation between the decrease of detection threshold and the total number of steps was found for the 3rd metatarsal head and the heel (p≤0.05). Foot sole sensation appears to improve during the day and seems to be associated with the step activity. This may reflect an improving transfer of afferent information to the central nervous system during the day as well as an adaptation of receptors to gait activity.

Long distance running and acute effects on plantar foot sensitivity and plantar foot loading.

The plantar surface of the foot senses local pressures during stance and locomotion. These foot loading characteristics may be affected by long distance running. Little is known about the physiological effects of sports-related loading on plantar sensitivity and their relationship with plantar foot loading. The purpose of this study was to investigate the acute effects of long distance running on plantar sensitivity to touch and their relationship with foot loading characteristics. It was hypothesized that plantar sensation would decrease after long distance running and may be related to foot loading characteristics. In 15 middle-aged runners, sensory detection thresholds to light touch and plantar pressures were measured before and after a 10 km run. After the run, no significant changes in sensory perception thresholds were observed so that correlations between foot sensitivity and foot loading could not be calculated. A significant decrease of force-time integrals and maximum forces was demonstrated in the whole foot (-6.2%, p=0.003; -3.9%, p=0.001) and the heel (-10.5%, p=0.003; -8.5%, p=0.002). Furthermore, maximum force was significantly reduced in the lateral midfoot (-6.4%, p=0.002). In conclusion, a sub-maximal 10 km running exercise appears to have no significant acute effects on plantar sensitivity, plantar pressure distribution and peak forces.