A biomechanical evaluation of different footrest heights during standing computer work.

Working at a standing desk is a popular strategy to help reduce low back pain development during prolonged computer work. The purpose of this study was to examine how muscle activity, joint kinematics, weight distribution, balance and low back discomfort were affected by utilising footrests at different heights while working at a standing desk. Sixteen individuals performed a computer task at a standing workstation under four conditions: flat ground stance, and standing with one leg elevated on a low (10 cm), medium (20 cm), or high (30 cm) footrest. Footrest usage altered lumbo-pelvic and bilateral hip joint angles, muscle activity, weight distribution, and range of sway in the elevated limb. Additionally, footrest height altered lumbo-pelvic and hip joint position in the elevated limb. Discomfort increased with time across all conditions. Results suggest that intermittent utilisation of a footrest should be considered to promote changes in posture and muscle activity during prolonged computer use. Practitioner summary: This laboratory study showed that utilising a footrest between the heights of 10-30 cm during standing computer work may be beneficial to promote changes in posture and muscle activity over time. However, we recommend exercising caution while maintaining any standing position beyond 10 min of consecutive use. Abbreviations: LBP: low back pain; PD: pain developer; NPD: non-pain developer; GMe: gluteus medius; TFL: tensor fascia lata; LES: lumbar erector spinae; COP: centre of pressure; NDI: northern digital incorporated; CV: coefficient of variation; WHQ: waterloo handedness questionnaire; WFQ: waterloo footedness questionnaire; VAS: visual analogue scale; OBDI: Oswestry back disability index; IBS: International Society of Biomechanics; sEMG: surface electromyography; MVIC: maximum voluntary isometric contraction; RMS: root mean square; A/P: anterior/posterior; M/L: medial/lateral; % MVE: percentage of maximum voluntary excitation; ROM: range of motion; MCID: minimum clinically important difference.

Canadian student leaders' perspective on interprofessional education: A consensus statement.

The purpose of this article is to report on the outcomes of an interprofessional education (IPE) consensus-building exercise amongst student leaders enrolled in health science-related degree programs. The 12 participants included undergraduate and graduate students from eight different universities situated in five Canadian provinces. Their areas of study spanned a broad range of professions and disciplines including child and youth care, health promotion, nursing, kinesiology, medicine, physical education, psychology, and social work. A consensus statement regarding IPE and, more specifically, "what we know," "what we don't know," and "where do we go from here" is presented. These insights are unique, and a willingness to embrace them may be critical in building the next generation of improved IPE offerings across the country.

Reliability of a digital-photographic-goniometric method for coronal-plane lower limb measurements.

CONTEXT: Structural and coronal-plane-alignment characteristics of the lower limb are frequently cited as factors contributing to knee pathologies. OBJECTIVE: The purpose of this study was to determine the accuracy and reliability characteristics of a digital-photographic-goniometric method (DPGM) of measurement for 2-dimensional (2D) coronal-plane lower limb measurements of the quadriceps (Q) angle, tibiofemoral (TF) angle, and femur length in human participants adopting a self-selected- or Romberg-stance position. DESIGN: Reliability study. SETTING: University motion-analysis laboratory. PARTICIPANTS: A convenience sample of 20 healthy young adult men and women. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of the measurements. RESULTS: Intratester- and intertester-reliability coefficients for the Q angle (ICCs .458-.845 and .257-.737) were consistently lower than those for the TF angle (ICCs .627-.904 and .700-.839) or femur length (ICCs .867-.958 and .866-.944). Q angles were also significantly larger (13.4%) in the Romberg- vs self-selected-stance position (P < .001) and larger (20.2%) in the left limb than the right limb. CONCLUSIONS: The DPGM has the potential to produce accurate and reliable measurements of selected 2D lower limb measures. However, the reliability characteristics depend on the ability of the testers to correctly and repeatably landmark the anatomical sites used to define the measurements of interest and might be influenced by other factors such as the stance position adopted, the complexity of the variable (ie, number of anatomical landmarks and segments), and the size of the captured image. Further investigation of these latter factors is warranted.

Bilateral measurement of resting calcaneal stance position and tibial varum using digital photography and standardized positioning protocols.

BACKGROUND: Excessive calcaneal eversion and tibial varum are thought to predispose individuals to overuse injuries such as patellofemoral pain, yet investigations of this relationship have yielded equivocal results. Differences in the methods used, including stance position, may contribute to the observed differences. METHODS: Forty-six young adults (29 asymptomatic control patients and 17 patients with patellofemoral pain syndrome) participated. Resting calcaneal stance position and tibial varum were measured using a digital photographic-goniometric method while participants adopted three upright, weightbearing stance positions (self-selected, Romberg, and single-limb right or left). Data were collapsed and analyzed by group (asymptomatic, symptomatic) or limb status (uninjured, injured), stance, and limb (right, left). RESULTS: Mean resting calcaneal stance position and tibial varum values differed significantly among the three stance conditions, whereas differences between groups, limb status, and limb were not observed. Pearson product moment correlations revealed no relationship between measures derived under the differing stance conditions (r = -0.08 to -0.37, P > .05) and only weak to moderate relationships in resting calcaneal stance position and tibial varum measures between the right and left limbs (r = 0.37 to 0.71, P < .01). CONCLUSIONS: If differences in reported values for resting calcaneal stance position and tibial varum in an individual, between groups, or from study to study are to be interpreted as true differences or as products of the measurement method used, a standardized measurement method must be established and methods must be accurately reported.

Bilateral rearfoot asymmetry and anterior knee pain syndrome.

STUDY DESIGN: Single-session observational study. OBJECTIVES: To examine the magnitude and extent of asymmetry between right and left rearfoot angles in individuals who are asymptomatic versus symptomatic for anterior knee pain. BACKGROUND: Asymmetry in lower limb measures has been linked to the occurrence of knee pathologies, yet the practice of deriving unilateral rather than bilateral data and thereafter averaging the findings may play a role in obscuring the true nature of the rearfoot angle-knee pain relationship. METHODS AND MEASURES: A convenience sample of participants was recruited from the local university and business communities and a university-affiliated physiotherapy clinic. Eighty-on young adult males and females volunteered to participate in this study. Following an extensive screening process, including mandatory exclusion for a previous history of lower limb dysfunction or injury, data were collected from 75 individuals classified as asymptomatic (n = 50), unilaterally symptomatic (n = 11), or bilaterally symptomatic (n = 14) for anterior knee pain. Right and left rearfoot angles were goniometrically measured under static, weight-bearing conditions. RESULTS: No significant differences in mean right and left rearfoot angles by group or limb were observed. However, these mean values did not always reflect the true variation of data within the sample. Fifty-six percent of the individuals studied demonstrated a minimum of 4 degrees bilateral rearfoot angle difference, while for 20% of the sample this difference exceeded 7 degrees. Only a we yet statistically significant correlation existed between right and left rearfoot angles (r = 0.31, P < 0.01). CONCLUSIONS: Rearfoot angles in weight bearing are not bilaterally symmetric, and the magnitude and direction of the observed asymmetry does not appear to be indicative of whether an individual is asymptomatic or symptomatic for anterior knee pain.

OPTOTRAK Measurement of the Quadriceps Angle Using Standardized Foot Positions.

OBJECTIVE: While there is evidence to suggest that the magnitude of the quadriceps (Q) angle changes with alterations in foot position, a detailed quantitative description of this relationship has not been reported. Our purpose was to determine the effect of varying foot placement on the magnitude of the Q angle. DESIGN AND SETTING: A mixed between-within, repeated-measures design was used to compare Q angles derived under static weight-bearing conditions with the feet positioned in self-selected versus standardized stance positions. SUBJECTS: Twenty healthy young-adult men and women with no history of acute injury to or chronic dysfunction of the lower limbs. MEASUREMENTS: We placed light-emitting diodes bilaterally on the left and right anterior superior iliac spines, the tibial tuberosities, and the midpoints of the patellae to bilaterally define the Q angles. An OPTOTRAK motion-measurement system was used to capture x,y coordinate data at a sampling rate of 60 Hz. These data were subsequently filtered and used to calculate the magnitude of the left and right Q angles. RESULTS: A repeated-measures analysis of variance revealed that when measured statically, Q angles differed significantly between stance positions (P <.001) and limbs (P <.05). Depending on the stance adopted, mean Q angles varied from 7.2 degrees to 12.7 degrees and 11.0 degrees to 16.1 degrees in the left and right lower limbs, respectively. Q-angle measurements taken in conjunction with the Romberg foot position most closely resembled those gathered with the feet in a self-selected stance (Pearson r = 0.86 to 0.92). CONCLUSIONS: Q-angle magnitude varies with changes in foot position, increasing or decreasing as the foot rotates internally or externally, respectively. These data demonstrate the need for a standardized foot position for Q-angle measurements.