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The Midfoot Joint Complex (Foot Arch) Contributes to the Upper Body Position in Bipedal Walking and Coordinates With the Lower Limb Joints

Leonardo D. Barsante, Paula M.M. Arantes, Daniela V. Vaz, Fabricio A. Magalhães, Diego S. Carvalho, Aline C. Cruz, Renan A. Resende, Juliana M. Ocarino, Sérgio T. Fonseca, and Thales R. Souza

This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior–posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints’ contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ −.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints’ contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.

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No Association Between Injury-Related Fear and Isokinetic Quadriceps Strength in Individuals With a History of Anterior Cruciate Ligament Reconstruction

Caitlin Brinkman, Elaine Reiche, Francesca Genoese, Johanna Hoch, and Shelby Baez

Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). Design: Cross-sectional study. Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90–1.00), high (.70–.90), moderate (.50–.70), low (.30–.50), and no correlation (.00–.30). Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = –.18, P = .27). Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

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Effective Stretching Positions of the Piriformis Muscle Evaluated Using Shear Wave Elastography

Hikari Itsuda, Masahide Yagi, Ko Yanase, Jun Umehara, Hiyu Mukai, and Noriaki Ichihashi

Context: Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position of the PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. Design: Observational study. Methods: Twenty-one healthy young men (22.7 [2.4] y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). Results: The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. Conclusion: This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip flexion and 40° hip adduction.

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NATA News & Notes

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Acute and Acclimated Effects of Wearing Compression Garments on Balance Control in Community-Dwelling Older Adults

You-jou Hung, Frederick Couverette, Jeffrey Hamon, and Dustyn Willard

Falls are very serious health concerns among older adults. Providing additional cutaneous and proprioceptive feedback to older adults may enhance their balance control and therefore reduce the incidents of falls. This study aimed to investigate the acute and acclimated effect of wearing waist-to-above-ankle compression garments (CGs) on balance control in community-dwelling older adults. Thirty-one older adults participated in the study. The Timed Up and Go, Berg Balance Scale, and the Fall Risk Test of the Biodex Balance System were used in a random order to examine balance control in three testing sessions 1 week apart. Results indicated wearing CGs had a significant impact on the Timed Up and Go test (p < .001), Berg Balance Scale (p = .001), and the Fall Risk Test (p = .001). For the Timed Up and Go test, participants exhibited significant improvement in both the acute (8.68 vs. 7.91 s) and acclimated effect (7.91 vs. 7.41 s) of wearing CGs. For the Berg Balance Scale, participants showed significant improvement after wearing CGs for 1 week in comparison to the no CGs condition (55.77 vs. 55.39 points). For the Fall Risk Test, participants showed a significant improvement in the acute effect of wearing CGs in comparison to the no CGs condition (1.55° vs. 1.31°). This exploratory study showed that wearing waist-to-above-ankle CGs provided a positive impact on balance control in healthy community-dwelling older adults. It lays the foundation for future studies with a larger sample size to investigate the potential benefits of wearing CGs in individuals with balance control deficits and/or other comorbidities.

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Assessing Postural Control From Birth to Adulthood Among Individuals Born Preterm: A Systematic Review

Soraia Pereira, Augusta Silva, Rubim Santos, and Cláudia Costa Silva

Premature life exposure, meaning an immature central nervous system, presents a significant challenge for the development of postural control and, in turn, overall motor development. Preventing motor delay thus requires identifying, characterizing, and quantifying deficit in postural control as early as possible. In our study, we reviewed the procedures used in past studies to assess postural control among individuals born preterm, specifically the characterization of participants, the instruments and motor tasks involved, the types of data collected and analyzed, and the outcomes. To that end, we performed a literature search on PubMed, Wiley Online Library, Web of Science, and Scopus using Boolean logic and assessed the quality of the studies with a standardized assessment based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Of 35 potential studies, 24 were included; all evaluated infants born preterm, but six did not include a control group of full-term infants. Although the heterogeneity of measurements, variability of instruments, and divergence in motor tasks examined limit definitive conclusions based on quantitative synthesis and the generalization of the results, most studies revealed dysfunctional postural control among individuals born preterm.

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Exercise With Unstable Objects: A Descriptive Survey Among Health Care and Fitness Professionals

Scott W. Cheatham, Russell T. Baker, Wendy Batts, Tony Ambler-Wright, and Brian Sutton

Exercise with unstable objects is a popular intervention used by health care and fitness professionals. Understanding different professional beliefs and usage patterns might provide insight for future research and development of evidence-based guidelines. The purpose of this survey study was to document the perceptions, beliefs, and the use of exercise with unstable objects among health care and fitness professionals in the United States. Six hundred and sixteen respondents completed the survey. Most respondents used unstable objects for musculoskeletal postinjury fitness/return to performance (72%). Most believed the main therapeutic effects were enhanced motor control (88%), balance (86%), and somatosensory (85%) function. Most reported using the foam pad (80%) and BOSU (84%). The most used subjective measure was the Activities-specific Balance Confidence scale. Most respondents used single limb stance (85%) to measure static motor control and the single leg squat assessment (51%) for dynamic motor control. Respondents used variables such as dynamic movement, repetition and sets, and time during training. Respondents considered recent injury or surgery and neurological or vestibular conditions as the top precautions. Respondents considered acute injury or surgery and neurological or vestibular conditions as the top contraindications. This survey provides insight into health care and fitness professionals perceptions, beliefs, and use of exercise with unstable objects.

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Force–Time Characteristics of Repeated Bouts of Depth Jumps and the Effects of Compression Garments

Freddy Brown, Matt Hill, Derek Renshaw, and Jason Tallis

No studies have reported ground reaction force (GRF) profiles of the repeated depth jump (DJ) protocols commonly used to study exercise-induced muscle damage. Furthermore, while compression garments (CG) may accelerate recovery from exercise-induced muscle damage, any effects on the repeated bout effect are unknown. Therefore, we investigated the GRF profiles of 2 repeated bouts of damage-inducing DJs and the effects of wearing CG for recovery. Nonresistance-trained males randomly received CG (n = 9) or placebo (n = 8) for 72 hours recovery, following 20 × 20 m sprints and 10 × 10 DJs from 0.6 m. Exercise was repeated after 14 days. Using a 3-way (set × bout × group) design, changes in GRF were assessed with analysis of variance and statistical parametric mapping. Jump height, reactive strength, peak, and mean propulsive forces declined between sets (P < .001). Vertical stiffness, contact time, force at zero velocity, and propulsive duration increased (P < .05). According to statistical parametric mapping, braking (17%–25% of the movement) and propulsive forces (58%–81%) declined (P < .05). During the repeated bout, peak propulsive force and duration increased (P < .05), while mean propulsive force (P < .05) and GRF from 59% to 73% declined (P < .001). A repeated bout of DJs differed in propulsive GRF, without changes to the eccentric phase, or effects from CG.

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Influence of Pedal Interface During Pedaling With the Upper Versus Lower Limbs: A Pilot Analysis of Torque Performance and Muscle Synergies

Laurent Vigouroux, Théo Cartier, and Guillaume Rao

Pedaling is a physical exercise practiced with either the upper or the lower limbs. Muscle coordination during these exercises has been previously studied using electromyography and synergy analysis, and three to four synergies have been identified for the lower and upper limbs. The question of synergy adaptabilities has not been investigated during pedaling with the upper limbs, and the impact of various modalities is yet not known. This study investigates the effect of pedal type (either clipped/gripped or flat) on the torque performance and the synergy in both upper and lower limbs. Torques applied by six participants while pedaling at 30% of their maximal power have been recorded for both upper and lower limbs. Electromyographic data of 11 muscles on the upper limbs and 11 muscles on the lower limbs have been recorded and synergies extracted and compared between pedal types. Results showed that the torques were not modified by the pedal types for the lower limbs while a deep adaptation is observable for the upper limbs. Participants indeed used the additional holding possibility by pulling the pedals on top of the pushing action. Synergies were accordingly modified for upper limbs while they remain stable for the lower limbs. In both limbs, the synergies showed a good reproducibility even if larger variabilities were observed for the upper limbs. This pilot study highlights the adaptability of muscle synergies according to the condition of movement execution, especially observed for the upper limbs, and can bring some new insights for the rehabilitation exercises.

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Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study

Antoine Frouin, Nina Desfontaines, Lilian Lacourpaille, Antoine Nordez, and Guillaume Le Sant

Context: Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. Design: Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. Results: Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). Conclusion: Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.