Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial.

BACKGROUND: Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what the effects of exercises and insoles on plantar force distribution obtained during walking at different speeds. Also, randomized controlled trials comparing the effects of exercises and insoles are limited. RESEARCH QUESTION: What are the effects of foot exercises, customized arch support insoles, and exercises plus insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot? Do exercises, insoles, and exercises plus insoles affect outcome measures differently? METHODS: Forty-five people with flexible flatfoot were randomly divided into three groups and 40 of those completed the study. The exercise group performed tibialis posterior strengthening and short foot exercises three days a week for six weeks. The insole group used their customized arch support insoles for six weeks. The exercise plus insole group received both interventions for six weeks. The assessments were performed three times: before the interventions and at the 6th and 12th weeks. Outcome measures were (1) foot posture, (2) plantar force distribution in the following conditions: static standing, barefoot walking at different speeds, and walking immediately after the heel-rise test, and (3) balance. RESULTS: Foot posture improved in all groups, but insole was less effective than exercise and exercise plus insole (p<0.05). Plantar force variables obtained during standing and walking changed in all groups (p<0.05). The superiority of the interventions differed according to the plantar regions and walking speed conditions (p<0.05). Static balance improved in all groups, but limits of stability improved in the exercise plus insole and exercise groups (p<0.05). SIGNIFICANCE: The superiority of the interventions differed according to the assessed parameter. The management of flexible flatfoot should be tailored based on the assessment results of each individual.

Neurocognitive training enhances the outcomes of children with attention deficit hyperactivity disorder: A preliminary study.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by diverse clinical manifestations including inattention, hyperactivity and impulsivity. OBJECTIVE: The present study aims to investigate the effects of neurocognitive training (NT), a personalized and specialized exercise programme on symptoms, attention and dynamic balance in treatment-naïve children diagnosed with ADHD. METHODS: Fourteen treatment-naïve children aged 7-12 years diagnosed with ADHD were enrolled in the intervention group. The NT intervention was administered weekly for 10 consecutive weeks, supplemented by a structured home exercise programme for 6 days a week over the same 10-week period. ADHD-related symptoms, attention and dynamic balance were assessed in pre-treatment, post-treatment, 6 months, and 12 months. Fifteen typically developing (TD) children, matched for age, underwent evaluation only once to establish baseline normative values. RESULTS: Following the NT (post-treatment), significant improvements were observed in hyperactivity-impulsivity scores, oppositional-defiant behaviours and dynamic balance when compared to the TD children (p < 0.05). In the ADHD group, a significant difference was found in the long term (12-month follow-up) in hyperactivity-impulsivity, oppositional-defiant behaviours and dynamic balance (p < 0.05). CONCLUSION: The findings suggest that the NT yields favourable effects on hyperactivity-impulsivity, oppositional defiant behaviours and dynamic balance in children diagnosed with ADHD, with these improvements appearing to be sustained over the long term. CLINICAL TRIAL REGISTRATION NUMBER: NCT04707040.

Differences of diaphragmatic muscle contraction between female patients with chronic neck pain and asymptomatic controls: A case-control study based on ultrasonography.

BACKGROUND: Recent systematic reviews and meta-analyses show that individuals with chronic neck pain (CNP) have altered respiratory muscle strength and abnormal respiratory mechanics. However, no study has investigated the diaphragmatic function in individuals with CNP compared to asymptomatic peers. OBJECTIVES: This study aimed to compare the respiratory muscle strength and diaphragmatic function between patients with CNP and asymptomatic controls. DESIGN: Observational, case-control study. METHODS: A total of 25 women with CNP and 23 asymptomatic controls participated in this case-control study. The visual analog scale and neck disability index were used to assess the pain and disability characteristics of the CNP group. Maximum inspiratory and expiratory pressures (MIP and MEP) were measured to determine respiratory muscle strengths. The diaphragmatic function (muscle thickness in deep inspiration, Tins; and at the end of calm expiration, Texp; muscle thickness change, ΔT; contraction ratio, CR) were evaluated by two-dimensional ultrasonography. RESULTS: The MIP (p = 0.001, d = 1.11), ΔT (p = 0.033, d = 0.63), and CR (p = 0.012, d = 0.75) of the diaphragm were found significantly reduced in the CNP group compared to asymptomatic controls whilst MEP, Tins, and Texp of the diaphragm were similar between study groups (p > 0.05). The intensity of neck pain was moderately correlated with MIP (r = -0.48), Tins (r = -0.46), and ΔT (r = -0.42) while NDI (r = -0.42) had a moderate correlation with Tins (p < 0.05). CONCLUSION: The present findings revealed that women with CNP have altered diaphragmatic function. Thus, screening and targeting diaphragm may improve the rehabilitation process in CNP. However, further experimental studies regarding the efficacy of breathing exercise approaches are needed.

Can olfactory training change the psychosocial aspects of chronic pain?

Pain and smell are the oldest senses for apperceive our environment. It is known that chronic pain and olfaction share common limbic cortical regions which are the main parts of the pain neuromatrix such as the anterior cingulate cortex, amygdala, and orbitofrontal cortex. Also, these regions point out the psychosocial aspects of chronic pain. And currently, the most challenging part of chronic pain management is the psychosocial aspect such as kinesiophobia, catastrophizing, or depression. Thus, the connection between olfaction and pain has promising clues to determining new combined therapies with odor training. According to intriguing brain imaging and genetic studies, we hypothesized that patients with chronic pain may have differentiated olfactory thresholds. Further, the additional odor training to the traditional therapeutic approach could be beneficial regarding the patients' pain perspective and psychosocial domains.

Are Static Foot Posture Measures Related to Static and Dynamic Plantar Pressure Parameters?

BACKGROUND: A few studies have investigated the relationship between foot posture measures and plantar pressure parameters, but no study has investigated the correlation of foot posture measures with all primary parameters consisting of contact area (CA), maximum force (MF), and peak pressure (PP). We aimed to determine the relationship of the Foot Posture Index-6 (FPI-6) and navicular drop (ND) with plantar pressure parameters during static standing and preferred walking. METHODS: Seventy people were included. Navicular drop and the FPI-6 were used to assess foot posture. Plantar pressure parameters including CA, MF, and PP were recorded by a pressure-sensitive mat during barefoot standing and barefoot walking at preferred speed. All assessments were repeated three times and averaged. Pearson correlation coefficients below 0.300 were accepted as negligible and higher ones were interpreted. RESULTS: Navicular drop was moderately correlated with dynamic CA under the midfoot and second metatarsal; also, the FPI-6 was moderately correlated with dynamic CA under the midfoot (0.500 < r < 0.700). The other interpreted correlations were poor (0.300 < r < 0.500). Both measures were correlated with dynamic CA under the second and third metatarsals; dynamic CA and MF under the midfoot; and static CA, MF, and PP under the first metatarsal and hallux (P < .01). Navicular drop was also correlated with dynamic MF under the first metatarsal and dynamic CA under the fourth metatarsal (P < .01). Furthermore, ND was correlated with static CA and PP under the second metatarsal and static PP under the fifth metatarsal (P < .01). The FPI-6 was also correlated with dynamic MF and PP under the hallux (P < .01). CONCLUSIONS: The correlations between foot posture measures and plantar pressure variables are poor to moderate. The measures may be useful in the clinical assessment of medial forefoot problems related to prolonged standing and midfoot complaints related to high force during walking. Furthermore, the FPI-6 may provide valuable data regarding hallux complaints related to the high loads during walking.

The effects of calf muscles fatigue on dynamic plantar pressure distribution in normal foot posture and flexible flatfoot: A case-control study.

BACKGROUND: Flexible flatfoot is associated with altered plantar pressure distribution, but it is not clear how muscle fatigue affects plantar pressure characteristics in flexible flatfoot and normal foot. OBJECTIVE: To investigate the effects of calf muscles fatigue on plantar pressure variables in flexible flatfoot and normal foot. METHODS: Twenty-five people with flexible flatfoot and twenty-five people with normal foot were included. The unilateral heel-rise test was used to induce calf muscles fatigue. Plantar pressure variables were collected during preferred walking immediately before and after fatigue. The two-way mixed-design ANOVA was used to determine the main effect of fatigue and the interaction between foot posture and fatigue. RESULTS: Fatigue caused medialization of the contact area under the forefoot and the maximum force under the heel and forefoot (p< 0.05). When examining the differences in the effects of fatigue between groups, the contact area under the medial heel increased with fatigue in flexible flatfoot but decreased in normal foot; moreover, the contact area and maximum force under the midfoot and the maximum force under the third metatarsal decreased with fatigue in flexible flatfoot but increased in normal foot (p< 0.05). CONCLUSIONS: Calf muscles fatigue caused medialization of the maximum force and contact area. Especially the midfoot was affected differently by fatigue in flexible flatfoot and normal foot.

Investigation of balance performance under different sensory and dual-task conditions in patients with chronic neck pain.

BACKGROUND: Most studies suggest that people with chronic neck pain (CNP) have decreased balance abilities. However, balance performance during performing concurrent tasks is not clarified. OBJECTIVES: To investigate balance performance under different sensory and dual-task conditions in people with and without CNP. METHOD: Twenty-two women with CNP and twenty-two asymptomatic women were tested using the Biodex Stability System. Overall stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were obtained in two sessions: eyes-open and eyes-closed. Both sessions consisted of four conditions: quiet standing, rotating head, counting backward, standing on foam. Higher index scores mean poorer balance. DESIGN: Case-Control study. RESULTS: A mixed factorial ANOVA (2 × 8 design) showed that there was a main effect of CNP on OSI, APSI, and MLSI (p < 0.001), which indicates that CNP causes poor balance. Further, there was an interaction between CNP and test conditions for only OSI (p < 0.05). Simple effects tests showed that patients with CNP had higher OSI in all conditions except standing on foam with eyes-open, and quiet standing and counting backward with eyes-closed (p < 0.05). The largest effect size was obtained during rotating head with eyes-open (η2:0.301), followed by counting backward with eyes-open and quiet standing with eyes-open (η2:0.267 and 0.245). Performing a concurrent task, closing eyes, or standing on foam mostly increased OSI in both groups (p < 0.05). CONCLUSIONS: Patients with CNP have poorer balance under different sensory and dual-task conditions. Addressing balance assessment while performing concurrent tasks, especially head rotations, may offer new insights into the management of CNP.

Gender differences in health anxiety and musculoskeletal symptoms during the COVID-19 pandemic.

BACKGROUND: Health anxiety is often associated with musculoskeletal symptoms and gender, but there are limited studies that investigate these relationships during the COVID-19 pandemic. OBJECTIVE: We aimed to compare the genders regarding health anxiety and musculoskeletal symptoms during the COVID-19 pandemic and to investigate the relationship of musculoskeletal symptoms with physical activity and health anxiety. METHODS: Assessments were performed through an online questionnaire. Eighty-five males and eighty-five females were included by matching genders in terms of age, body mass index, education level, number of days spent at home during the pandemic, and physical activity. The Short Health Anxiety Inventory, the International Physical Activity Questionnaire-Short Form, and the Nordic Musculoskeletal Questionnaire were used to assess health anxiety, physical activity, and musculoskeletal symptoms, respectively. RESULTS: Females had a higher level of health anxiety and more musculoskeletal symptoms than males (p< 0.05). There were weak to moderate correlations in females and weak correlations in males between musculoskeletal symptoms and health anxiety (p< 0.05). Also, a weak negative correlation was found between physical activity and musculoskeletal symptoms in both genders (p< 0.05). CONCLUSIONS: Females are more anxious and have more musculoskeletal symptoms during the pandemic than males. Also, health anxiety is related to musculoskeletal symptoms in both genders.

Is the pain pressure threshold linked to the transversus abdominis in women with chronic neck pain?: a preliminary report.

PURPOSE: The present study aimed to investigate the relationship between the ultrasonography parameters of transversus abdominis and neck pain manifestations in women with chronic neck pain. MATERIALS AND METHODS: Thirty women (mean age: 38.44 ± 9.56 years, BMI: 25.57 ± 3.32 kg/m2) with chronic neck pain were included in the study. The pain severity, disability scores, and bilateral pain pressure threshold of upper trapezius were assessed. The thickness of transversus abdominis in-rest and abdominal draw-in conditions were evaluated by two-dimensional ultrasonography. Pearson's correlation coefficients and linear regression statistics were determined. RESULTS: We found a moderate correlation between the thickness of transversus abdominis in abdominal draw-in and the pain pressure threshold of right (r = 0.636, p < 0.001), and left upper trapezius (r = 0.403, p = 0.03). Moreover, there was a moderate correlation between the pain pressure threshold of the right upper trapezius and the thickness of transversus abdominis in-rest (r = 0.498, p = 0.006). No significant correlation was found between pain intensity, disability scores, and ultrasonography parameters of transversus abdominis. There was also a significant total effect of transversus abdominis' thickness on abdominal draw-in manoeuvre on predicting pain pressure threshold of right upper trapezius (B = 0.636, SE = 0.765, p < 0.001) and pain pressure threshold of left upper trapezius (B = 0.403, SE = 0.840, p = 0.03). CONCLUSIONS: Our results revealed that upper trapezius muscle tenderness may associated with decreased muscle thickness of transversus abdominis. Addressing new exercise methodologies including transversus abdominis training in the management of chronic neck pain may be helpful to improve neck pain symptoms.

Investigation of the Relationships Among Clinical Measures of Foot Posture in Individuals with and Without Pronated Foot.

Background: Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture-Foot Posture Index-6 (FPI-6), navicular drop (NDP), navicular drift (NDT), and static and dynamic arch indices (SAI and DAI)-in individuals with normal foot posture and those with pronated foot. Methods: Sixty-three individuals with FPI-6 scores of 0 to 12 were included. A digital caliper was used to measure NDP and NDT; SAI and DAI were measured by electronic pedobarography. Assessments were applied on the dominant foot. Pearson correlation coefficients were calculated to determine the relationships among measures. Participants were classified into two groups, pronated foot (n = 33) and normal foot posture (n = 30), based on FPI-6 scores, providing a multisegmental and multiplanar assessment. The independent-samples t test was used to compare groups regarding NDP, NDT, SAI, and DAI. Results: We found a high correlation between NDP and FPI-6 (r = 0.754) and between NDP and NDT (r = 0.778) (all P < .001). A moderate correlation was found between NDT and FPI-6 (r = 0.599) and between DAI and SAI (r = 0.519) (all P < .001). A negligible correlation was found between NDP and DAI (r = 0.268; P = .033). Furthermore, NDP, NDT, and DAI values were higher in individuals with pronated foot compared with those with normal posture (P < .001 for NDP and NDT; P = .022 for DAI), whereas SAI values were not (P = .837). Conclusions: These results suggest that there are moderate-to-strong relationships among FPI-6, NDP, and NDT and between SAI and DAI. The NDP, NDT, and DAI are suitable for the classification of foot posture based on FPI-6 scores. This study can guide clinicians and researchers to associate the foot posture measures with each other.

Assessment of pain-related fear in patients with the thrust plate prosthesis (TPP): due to hip fracture and hip osteoarthritis.

The aim of this study is to determine the differences between hip fracture and hip arthrosis groups and to assess pain related fear of injury in patients who were operated using the TPP following hip fracture or hip arthrosis. Fifty-eight patients (mean age = 63.9 ± 10.3 years) who were operated using the TPP, following hip fracture (hip fracture group; n = 25) or coxarthrosis (coxarthrosis group; n = 33) were recruited. All of the measurements were performed after a follow-up time of at least 2 years. Functional level by Harris Hip Scoring System (HHS), pain related fear by Tampa Scale for Kinesiophobia (TSK) and pain intensity by numerical rating scale (NRS) was evaluated. There were no significant differences between demographic and clinical characteristics of two groups. However, pain intensity was higher in coxarthrosis group than hip fracture group. There was no correlation between the TSK scores and either Harris scores or NRS scores (p > 0.05) in the hip fracture group. No correlation between NRS and TSK was found in coxarthrosis group but there was a significant correlation between TSK and HHS. TSK scores were high in both groups. High TSK scores proved us that the patients with TPP had fear of movement even they had enough physical performance. The coxarthrosis group had higher pain intensity. Rehabilitation clinicians should consider pain-related belief which is more important than pain intensity and functional level in coxarthrosis patients.

The effect of exercise on obstructive sleep apnea: a randomized and controlled trial.

PURPOSE: The aim of the study was to assess the effect of breathing and physical exercise on pulmonary functions, apnea-hypopnea index (AHI), and quality of life in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Twenty patients with mild to moderate OSAS were included in the study either as exercise or control group. The control group did not receive any treatment, whereas the exercise group received exercise training. Exercise program consisting of breathing and aerobic exercises was applied for 1.5 h 3 days weekly for 12 weeks. Two groups were assessed through clinical and laboratory measurements after 12 weeks. In the evaluations, bicycle ergometer test was used for exercise capacity, pulmonary function test, maximal inspiratory-expiratory pressure for pulmonary functions, polysomnography for AHI, sleep parameters, Functional Outcomes of Sleep Questionnaire (FOSQ), Short Form-36 (SF-36) for quality of sleep and health-related quality of health, Epworth Sleepiness Scale for daytime sleepiness, and anthropometric measurements for anthropometric characteristics. RESULTS: In the control group, the outcomes prior to and following 12-weeks follow-up period were found to be similar. In the exercise group, no change was found in the anthropometric and respiratory measurements (P > 0.05), whereas significant improvements were found in exercise capacity, AHI, and FOSQ and SF-36 (P < 0.05). After the follow-up period, it was shown that improvement in the experimental group did not lead to a statistically significant difference between the two groups (P > 0.05). CONCLUSIONS: Exercise appears not to change anthropometric characteristics and respiratory functions while it improves AHI, health-related quality of life, quality of sleep, and exercise capacity in the patients with mild to moderate OSAS.