[Therapeutic climbing--barely explored but widely used]. / Therapeutisches Klettern--kaum erforscht und dennoch zunehmend eingesetzt.

BACKGROUND: Therapeutic climbing had been used successfully as an intervention in orthopedic-traumatologic, neurologic, psychomotoric and congenital or chronic diseases. The aim of this abstract is to give an overview of the existing literature on this new form of therapy. This could also aid in assessing the methodology and work out future research directions. MATERIAL AND METHODS: National and international databases within the medical field (Evidence Based Medicine Reviews, PubMed …) have been searched for German and English articles that dealt with climbing in a therapeutic context. RESULTS: Only a limited amount of scientific investigations regarding the effects of therapeutic climbing were found. Evidence for the effectiveness of this form of climbing was only found in the field of orthopedics. Other published results were field reports or individual case studies which did not make any reliable statements/conclusions. CONCLUSION: Based on the current review, therapeutic climbing cannot be wholly recommended as an interventional method. However, this should not be interpreted as a refusal to use therapeutic climbing as an intervention. The use of systematic analysis in studying the general effects of climbing movements as well as comparisons to classical interventional methods is necessary. Further approaches to this research study will be given.

[A one year aging process of a soccer shoe does not increase plantar loading of the foot during soccer specific movements]. / Eine einjährige Nutzung eines Fussballschuhs führt nicht zu einer verstärkten plantaren Belastung des Fusses bei fussballspezifischen Bewegungen.

INTRODUCTION: Excessive loading of the plantar surface of the foot has been considered as a possible cause for overuse injuries in soccer. The question arises whether this excessive loading may be reduced by the use of cushioning insoles in a soccer shoe. AIM: To evaluate the influence of a controlled aging process on the loading pattern of the foot inside a soccer shoe. MATERIALS AND METHODS: 11 experienced soccer players wore a soccer shoe for one year on a regular basis during training sessions and games. After this period, three different aging conditions (old shoe with old insole, old shoe with new insole and new shoe with new insole) were tested during different soccer specific movements regarding plantar loading characteristics using an insole pressure distribution system (Pedar, Novel GmbH, Munich). RESULTS: The comparison between the three different aging conditions showed no consistent results for the parameters peak pressures and relative loads for 10 different foot areas. A trend towards slightly reduced peak pressures was found for characteristic loading zones during side-cutting and kicking. On the other hand, slightly increased peak pressures were found during running and sprinting after using a new insole or a new shoe. No consistent results were found for the relative loads between conditions. DISCUSSION: The hypothesis of a load reduction after introducing a new insole or a new shoe could not be confirmed. The aging process appears to be influenced by different factors like material properties, form changes or individual adaptation processes.

Reconstruction of the lateral ligaments: do the anatomical procedures restore physiologic ankle kinematics?

BACKGROUND: If conservative therapy fails, the standard treatment for chronic ankle instability is surgical reconstruction of the lateral ligaments. For the last seventy years, the tenodesis principles have been used for reconstruction. Recently however, surgical reconstructions--respecting the intact joint anatomy--have been developed, thus called "anatomical reconstruction principles". METHODS: This study focused on the investigation of the range of motion of the ankle and the subtalar joint following anatomical reconstruction surgery. Three different types of anatomical reconstruction procedures were compared: Direct ligament repair, tendon graft and carbon-fiber implant. RESULTS: All procedures restored the original range of motion of the subtalar joint, except for the plantarflexed/dorsiflexed positions. As for the talocrural joint, the tendon graft and the carbon fiber implant left a small laxity for movements of inversion/eversion and internal/external rotation. The direct repair procedure achieved a more accurate result and restored the physiologic kinematics almost completely. During each procedure the insertion points and the direction of the original ligaments were maintained. However, the different results for the procedure of direct ligament repair compared to the other two anatomical reconstruction procedures showed that this condition alone is not sufficient to perfectly restore the kinematics of the talocrural and subtalar joints. It is important to note that none of the procedures caused a restriction of the range of motion. CONCLUSIONS: The maintenance of the range of hindfoot motion decreases the risk of osteoarthritis as well as chronic pain or problems for the patient to walk on uneven surface. Therefore, we believe that standard therapy for chronic instability of the ankle should include direct surgical reconstruction of the ligaments. If this direct procedure cannot be performed because of poor quality of the ligaments an alternative anatomical reconstruction procedure should be considered.

A multi-station proprioceptive exercise program in patients with ankle instability.

PURPOSE: The aim of the present study was to investigate the effects of a 6-wk multi-station proprioceptive exercise program that is easy to integrate in normal training programs. METHODS: Patients with chronic ankle instability were used, and results of three testing procedures before and afterward were compared: joint position sense, postural sway, and muscle reaction times to sudden inversion events on a tilting platform. A total of 30 subjects with 48 unstable feet were evaluated (exercise group: N = 31; control group: N = 17). RESULTS: In the exercise group, the results showed a significant improvement in joint position sense and postural sway as well as significant changes in muscle reaction times. CONCLUSION: Based on the present results, a multi-station proprioceptive exercise program can be recommended for prevention and rehabilitation of recurrent ankle inversion injuries.

[Plantar pressure distribution in inline skating on straights]. / Plantare Druckverteilung beim Inline-Skating auf Geraden.

Plantar pressure distribution in inline skating on straight was measured with a flexible insole in 13 experienced subjects at a speed of 18 and 24 km/h. The results showed three areas that were exposed to high pressures, i.e. the heel with 258 and 265 kPa, the first metatarsal head with 265 and 281 kPa, the hallux with 319 and 324 kPa at 18 and 24 km/h, respectively. All other areas showed peak pressures that were less than half of these values. Lowest values were found in the midfoot area. Changing speed from 18 to 24 km/h led to a small increase of peak pressures in all areas. Peak pressures were comparable to walking but showed the trend to be lower than in running.