Trunk and Gluteus-Medius Muscles’ Fatigability During Occupational Standing in Clinical Instructors With Low Back Pain.

Trunk and gluteus-medius muscles’ fatigability during occupational standing in clinical instructors with low back pain.

Br J Sports Med. 2013 Jul; 47(10): e3
Embaby E, Abdallah A

Occupational standing is associated with low back pain (LBP) development. Yet, trunk and gluteus-medius muscles’ fatigability has not been extensively studied during occupational standing. This study examined and correlated the rectus abdominus (RA), erector-spinae (ES), external oblique (EO), and gluteus-medius (GM) muscles’ fatigability on both sides while standing in a confined area for 30 min.Median frequency EMG data were collected from 15 female clinical instructors with chronic LBP (group A) and 15 asymptomatic controls (group B) (mean age 29.53±2.4 vs 29.07±2.4 years, weight 63.6±7 vs 60±7.8kg, and height 162.73±4 vs 162.8±6 cm respectively) using a spectrum analysis program. Data were collected in the first and last 5 min of the standing task.Using Mixed three-way ANOVA, groupA showed significantly (p<0.05) lower frequencies for the right and left ES, and right GM in the last 5min and significantly higher frequencies for the left RA in the first and last 5min than group B. In addition, the left ES and right EO, ES and GM in group B showed significantly higher frequencies and the left ES in groupA showed significantly lower frequencies in the last 5 min compared with the first. Moreover, the right RA showed significantly higher frequencies than the left in the last 5 min in groupB. Finally, there were significant (p<0.05) correlations among the median frequencies of the tested four muscles on the same side and between both sides in both groups.Clinical instructors with LBP are more liable to have higher trunk and gluteus-medius muscle fatigue than asymptomatic individuals. Thus, endurance training for these muscles should be included in the rehabilitation of such patients.Key words: Fatigability, Trunk, Gluteus-medius, EMG, Standing, LBP. HubMed – rehab


Expertise and strategies on postural control of young surfers at different level of competition.

Br J Sports Med. 2013 Jul; 47(10): e3
Guimaraes Ribeiro D, Rodríguez Ruiz D, Hernández Suárez M, Rodríguez Matoso D, García Manso Juan M

Investigation of postural control in sports which require excellent postural performance, like surfing, gives insight into development of specific control strategies. The aim of the current study was to compare postural performance and strategy between young surfers of different levels of competition (international and national).Twenty surfers were separated in two groups in accordance with their competition level: Ten international level surfers (INT) (17.7±1.7 years; 172.6±8.42 cm; 65.0±10.3 kg; 7.75±3.6 surfing years) and 10 national level surfers (NAT) (15.80±1.75 years; 168.60±12.02 cm; 59.25±12.12 kg; 6.6±3.6 surfing years). Subjects performed a battery of static balance tests under three different conditions: eyes open (EO), eyes closed (EC) and while performing a concurrent cognitive task (modified stroop test -MST). All tests were performed while standing on a platform force (MuscleLab® TM system, type PFMA 4000, collection rate of 100Hz), in bipedal posture, staying as immobile as possible for 30 seconds. Based on the displacement of the center of pressure, variables analyzed were: Ellipse Area of 95% (A95), Mean Velocity (MV) and frequency analysis (fast Fourier transform). Data was tested (SPSS-v17) for normal distribution using the Shapiro-Wilk test and the U of Mann-Whitney adjustment for non-parametric data (significance level p?0.05).Both groups showed significantly greater values for MV when comparing the effect of the condition to the control test, EO vs. EC (p=0.007), and EO vs. MST (p=0.027). However, no differences were found in either of the variables when level of competition was analyzed. Although, INT showed smaller values of MV and A95 in all tests, except for A95 in the MST condition, evidencing better postural control (Palliard et al., 2006). Mean Velocity values for INT were: 17.1±3.9; 19.6±3.9; 19.5±7.2 mm/s(2), and for NAT were: 18.7±3.3; 21.6±4.4; 21.2±7.2 mm/s(2), for EO, EC, and MST condition, respectively. Values of A95 for INT were: 137.9 ±100.9; 148.1±58.7; 158.2 ±117.9 mm(2) and for NAT were: 141.9±44.9; 260.2±209.20; 138.6±55.9 mm(2), again for EO,EC and MST. In respect to the spectral analysis, INT showed a trend to use a greater portion of energy in the low frequency band in all conditions.Our results could indicate that experience in the surfing environment may result in specific strategy adaptation, by means of a more efficient visio-vestibular input (Chapman et al., 2008). A better understanding of these strategies can help athletic trainers and clinicians to develop exercises in an attempt to enhance performance, reduce risk of musculoskeletal injuries or for rehabilitation therapies purposes. HubMed – rehab


Face protective orthosis: a need for contact sports.

Br J Sports Med. 2013 Jul; 47(10): e3
Ghoseiri K, Bavi A

Craniomaxillofacial traumas are of the most common sport related injuries. The most common sport related facial traumas are soft tissue injuries and bone fractures primarily due to impact of other players especially in team games. A rehabilitative sport related orthosis, could protect the injured site and help earlier return of athlete to the match.Face protective orthosis is custom molded from negative impression of athlete’s face. Negative impression should be taken while athlete has lied supine with his/her face upward. The orthosis has an open structure that is critical for sport activities to reduce perspiration and improve ventilation. It is light weight and structured as a one-piece rigid plastic shell that secured in place with three elastic straps. Due to diverse patterns of craniomaxillofacial injuries, the shape, length, trimline and characteristics of face protective orthosis could be modified.Face protective orthoses could have prophylactive or rehabilitative roles according to task and prescription reason. Governing bodies are responsible of care for safety of athletes and should regulate the use of face protective orthosis in contact sports. Although the main action of the facial orthoses should be protection, the design of face protective orthosis should be improved both functionally and aesthetically to promote its use by athletes. HubMed – rehab


Treatment of ankle impingement syndromes in athletes.

Br J Sports Med. 2013 Jul; 47(10): e3
Intzirtis P, Tsikouris G, Zampiakis E, Plessas S, Taprantzis L, Kourougenis P, Tsikouris D, Tsikouris L

Painful limitation of ankle movement in athletes is commonly caused by soft-tissue or osseous formations. The impingement syndromes of the ankle are attributed to initial injuries which, undertreated, in a subacute or chronic basis, lead to development of thickenings within the ankle joint.To present the outcome of arthroscopic excision of restrictors in ankle movement with concomitant anatomic ankle ligament reconstruction in athletes.Eighteen athletes, twelve males and six females, (of which, nine basketball-players, four football-players, two dancers) were treated over the last ten years. The mean age was 22 years. The sports activities of all patients were dramatically deteriorated due to chronic ankle pain and/or a “giving way” feeling. The thorough clinical examination included reproduction of impingement pain (anterior, anterolateral, anteromedial, or posterior) and stability testing in comparison to the contralateral ankle. Radiographs included anteroposterior, lateral and oblique views in a weight-bearing position. Ultrasound and plain MRI testing was performed without exception. Each patient underwent arthroscopic evaluation. Arthroscopic debridement of hypertrophic tissue arising from AITFL, ATFL or deltoid was performed in 16 patients. Arthroscopic decompression of bony impingement (excision of tibial or talar osteophyte) was needed in ten patients. Ankle ligament reconstruction was performed in 13 cases (modified Brostrom in 11 athletes, deltoid reconstruction in two others). Excision of osseous and soft-tissue components of posterior impingement via open posterolateral approach was performed in two dancers. We also had to remove meniscoid lesions in four cases. In addition, debridement and microfractures were indicated in four patients with osteochondral lesions and to two patients was applied Autologous Chondrocyte Implantation. A custom rehabilitation program was utilized for each individual.Patients were followed up at one, three, six, nine, and twelve months postoperatively using the FADI score. The results at 12 months were ranged above 90 for 13 athletes, between 85-90 for 4 athletes and between 80-85 for one athlete. Poorer results are correlated with concomitant osteochondral lesions. The highest scores were achieved when ligament reconstruction had been performed.Chronic ankle instability should always be suspected in an athlete with chronic ankle pain and findings of ankle impingement. A clinical exam and an ultrasound exam contribute in a more accurate diagnosis for an ankle instability. The appearance of an injured ligament on plain MRI varies and is not reliable to estimate the functional sufficiency of the ligament. Ankle arthroscopy provides great visualization of joint pathology in impingement syndromes that is amenable to repair. Open ligament repair is reliable and optimizes the functional results.Arthroscopic treatment of anterior ankle impingement together with ankle ligament reconstruction, when indicated, is essential for obtaining a stable and functionally efficient ankle. HubMed – rehab


The effectiveness of proprioceptive neuromuscular facilitation techniques and hidrotherapy to improve knee stability after anterior cruciate ligament reconstruction.

Br J Sports Med. 2013 Jul; 47(10): e3
Boca IC, Dan M

Rehabilitation after anterior cruciate ligament reconstruction is a significant process which may decisively influence patient capacity to return to usual activity levels. Physiotherapy has a favourable influence on improving stability in the ACL deficient knee by using physical exercise and manual contact, the most affordable methods that can be used to improve quality of life. A combination of proprioceptive neuromuscular facilitation (PNF) tehniques and hydrotherapy is a treatment that can prevent stability loss and serve as an adjunct to conventional therapy.To compare the effect of adding a combination of PNF tehniques and hydrotherapy (research group) to a standard postoperative rehabilitation program (control group).A total of fourty patients completed a standard rehabilitation program and in addition, twenty of them underwent 10-minute sessions of PNF tehniques and 15-minute sessions of hydrotherapy (34-36°C) each day, five days a week, for four weeks. Outcome measures including knee range of motion (ROM), manual muscle testing of flexors and extensors of the knee, functional assessment using Modified Cincinnati Knee Rating System (MCKRS), were assessed at baseline (initial assessment) and at four weeks (final assessment).The research group achieved significantly better results at the end of rehabilitation program compared with the control group. ROM of the reaserch group increased by 52.8° for flexion and 3.2° for extension, between the initial and final measurements in the injured knee. The corresponding changes for control group were 44° for flexion and 2° for extension. Extensor strength of the reaserch group increased by 40% and 22% for flexors, between the initial and final measurements in the injured knee, comparative to the control group where the increase was by 30% for extensors and 20% for flexors. The functional score with respect to the MCKRS, for the research group, improved by 36.4% between the initial and final measurements, whereas the corresponding changes for the control group were 25.8%.PNF tehniques and hydrotherapy combined with standard rehabilitation program is effective at accelerating recovery after anterior cruciate ligament reconstruction. HubMed – rehab