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Background Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. Methods This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. Results From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. Conclusions Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.

Background The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). Methods A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. Results Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. Conclusions During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. Trial registration COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 (https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry).

AimsAbnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT.Patients and MethodsA retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed.ResultsWe found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified.ConclusionIn-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218–1229

Summary Background Studies showed altered kinematics and kinetics in anterior cruciate ligament (ACL) deficient participants, attributed to an altered sensorimotor control. However, literature on neuromuscular deficits is limited, thus the objective was to investigate the neuromuscular activity during stair ascent in patients with acute ACL rupture. Material and methods The activity of the M. vastus medialis (VM) and lateralis (VL), M. biceps femoris (BF) and M. semitendinosus (ST) was recorded using surface electromyography (EMG) in 9 acute ACL deficient (ACL-D) (rupture 1–3 weeks prior to test) and 9 ACL intact (ACL-I) matched subjects. Participants ascended 20 times a 6-step stair at self-selected speed. The movement was divided into pre-activation (PRE), weight-acceptance (WA) and push-off (PO) phase. Comparisons were made between the deficient leg of ACL-D and the matched uninjured leg of the ACL-I, as well as between the injured and non-injured leg of the ACL-D group. Results ACL-D showed in all muscles a reduced activation (ca. 50%, p Conclusions Altered activity during PRE indicates an alteration in the motor program (“pre-programmed activity”). Small differences in the intra-individual comparison showed bilateral consequences following ACL injury. Level of Evidence 3

Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (P 0.001) and KAAI (P = 0.002), while toe-out gait significantly increased the first (P 0.001) and second (P = 0.04) EKAM peaks and KAAI (P 0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (P 0.001) and second (P = 0.032) EKAM peaks and KAAI (P 0.001), whilst toe-out gait significantly increased the first EKAM peak (P = 0.022) and KAAI (P = 0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing.

Background The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction. Method Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26 ± 10 years; height: 175 ± 6 cm; mass: 75 ± 14 kg) and 10 healthy matched controls (age: 31 ± 7 years; height: 175 ± 7 cm; mass: 68 ± 10 kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (α = 0.05). Results Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p Conclusion Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations.

Background The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures. Objective The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]), alcohol consumption habits, and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences. Methods All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5% α level of error. Results Prevalence of non-health-enhancing PA was 37.1%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3%. Prevalence of low sleeping quality was 44.7%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations. Conclusions In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students, Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions. Trial Registration ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108

Background SARS-CoV-2, a novel coronavirus strain, has resulted in the COVID-19 pandemic since early 2020. To contain the transmission of this virus, the Swiss Federal Council ordered a nationwide lockdown of all nonessential businesses. Accordingly, students and employees of institutions for higher education were informed to continue their academic programs through home-office settings and online lectures. Objective This longitudinal survey aims to evaluate various lifestyle habits such as physical activity, nutritional habits, and sleep behavior among students and employees of a Swiss University of Applied Sciences during a 2-month period of confinement and social distancing due to the COVID-19 pandemic and 1 year thereafter. Methods This paper describes a protocol for a retrospective and prospective observational cohort study. Students and employees of Bern University of Applied Sciences, Department of Health Professions, were invited to anonymously complete a web-based survey during the COVID-19 confinement period. This will be followed by a second survey, scheduled 1 year after the lockdown. Information on various lifestyle aspects, including physical activity, nutritional habits, and sleep behavior, will be collected using adaptations of existing validated questionnaires. Results This longitudinal study started during the government-ordered confinement period in Switzerland in mid-April 2020 and will end in mid-2021. Conclusions The findings of this survey will provide information about the impact of confinement during the COVID-19 crisis on the physical activity, nutritional habits, and sleep behavior of students and employees of a Swiss institute. Trial Registration ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 International Registered Report Identifier (IRRID) DERR1-10.2196/25051

Background Skin marker-based analysis of functional spinal movement is a promising method for quantifying longitudinal effects of treatment interventions in patients with spinal pathologies. However, observed day-to-day changes might not necessarily be due to a treatment intervention, but can result from errors related to soft tissue artifacts, marker placement inaccuracies or biological day-to-day variability. Research question How reliable are skin marker-derived three-dimensional spinal kinematics during functional activities between two separate measurement sessions? Methods Twenty healthy adults (11 females/9 males) were invited to a movement analysis laboratory for two visits separated by 7–10 days. At each visit, they performed various functional activities (i.e. sitting, standing, walking, running, chair rising, box lifting and vertical jumping), while marker trajectories were recorded using a skin marker-based 10-camera optical motion capture system and used to calculate sagittal and frontal plane spinal curvature angles as well as transverse plane segmental rotational angles in the lumbar and thoracic regions. Between-session reliability for continuous data and discrete parameters was determined by analyzing systematic errors using one sample T-tests as well as by calculating intraclass correlation coefficients (ICCs) and minimal detectable changes (MDCs). Results and Significance The analysis indicated high relative consistency for sagittal plane curvature angles during all activities, but not for frontal and transverse plane angles during walking and running. MDCs were mostly below 15°, with relative values ranging between 10 % and 750 %. This study provides important information that can serve as a basis for researchers and clinicians aiming at investigating longitudinal effects of treatment interventions on spinal motion behavior in patients with spinal pathologies., Gait & Posture, 85, ISSN:0966-6362, ISSN:1879-2219

ZusammenfassungHintergrund Applikationen mit elastischem Tape werden positive Wirkungen auf die Bewegung zugeschrieben. Unter anderem werden Attribute wie stoffwechselanregend, entstauend, kräftigend und schmerzlindernd genannt. Das Ziel dieser Interventionsstudie mit einem Within-Subject-Design war die Untersuchung verschiedener elastischer Tapes (Kinesiotape – KT, IQ-Tape – IQ, ohne Tape: OT) auf die neuromuskuläre Aktivierung der Beuge- und Streckkette der unteren Extremität während des Joggens, des Treppensteigens und bei Drop Jumps. Probanden/Methodik Achtzehn gesunde Erwachsene (5 Männer und 13 Frauen) mit einem Durchschnittsalter von 26,3 ± 3,6 Jahren und einem Body-Mass-Index von 22,3 ± 0,7 kg/m2 wurden rekrutiert. Die Teilnehmer absolvierten Laufintervalle mit 10 km/h, 12 km/h und 15 km/h, Treppensteigen und Drop Jumps (10 Versuche). Die Muskelaktivierung des M. vastus medialis und M. vastus lateralis, des M. bizeps femoris, des M. semitendionosus, des M. tibialis anterior, M. gastrocnemius medialis und lateralis wurden erhoben, um das Verhältnis der Muskelaktivierung des M. tibialis anterior zu M. gastrocnemius medialis und lateralis (T/G-ratio) und des M. vastus medialis und lateralis zum M. bizeps femoris und M. semitendinosus (V/I-ratio) zum Zeitpunkt vor (–150 bis 0 ms pre), während (0–30 ms post) und von 30 ms bis 150 ms post der ersten Bodenkontaktaufnahme mit Hilfe elektromyografischer Messungen darzustellen. Die statistische Prüfung erfolgte mittels des nonparametrischen L-Puri-Sen-Verfahrens. Das Signifikanzniveau wurde auf p Ergebnisse Zwei Probanden schieden während der Datenaufnahme aus der Studie aus. Damit konnten von 16 Probanden Daten analysiert werden. Beim Treppenheruntersteigen zeigt IQT in der Voraktivierung (–150 bis 0 ms) vor dem ersten Bodenkontakt einen signifikant erhöhten T/G-ratio im Vergleich zu OT (p = 0,01). Die restlichen Vergleiche von Applikationen mit KT, IQT und OT ergaben keine signifikanten Unterschiede (p > 0,05). Schlussfolgerung Es kann davon ausgegangen werden, dass Kinesiotape – KT und IQ-Tape – IQ keine relevanten detektierbaren Änderungen der Muskelaktivierung bei gesunden Personen hervorrufen. Zukünftige Studien sollten Patienten einschließen, die eine pathologisch veränderte neuromuskuläre Kontrolle aufweisen.

Background Flexed knee gait is a common gait dysfunction in individuals with bilateral spastic cerebral palsy (BSCP) and is often addressed with single event multilevel surgery (SEMLS). SEMLS has been shown to have positive short-term effects especially on sagittal knee joint kinematics with less knee flexion during stance phase. However, mid- and long-term observations are rare, and results are reported in discrete parameters or summary statistics where temporal aspects are not considered. Research question Does the improved knee joint kinematics after patellar tendon shortening (PTS) as part of SEMLS persist in the long-term in individuals with BSCP? Methods Data of instrumented gait analysis of twelve participants (females/males: 5/7, mean age: 15.3 ± 3.4 years) with BSCP treated with PTS as part of SEMLS were retrospectively analyzed. Participants had had follow-up gait analysis 1, 5 and 7 years or more after surgery. Three-dimensional lower extremity kinematics of walking at a self-selected speed were collected using a 12-camera motion capture system and 4 embedded force plates. One-dimensional statistical parametric mapping (SPM) was used for data analysis, permitting time point comparisons of continuous data. Results Time point comparison revealed no significant differences in the sagittal plane for knee joint kinematics (p > 0.05) over the tree measurement time points. Hip and ankle joint kinematics as well as normalised walking speed remained stable over the observation period. Significance This is the first study investigating lower extremity kinematics in patients with BSCP and flexed knee gait after SEMLS with SPM. Results demonstrate that positive effects on sagittal knee joint kinematics of PTS as part of SEMLS persist up to 9 years after surgery and progressivity does not reoccur. Thus, if clinical examination indicates an operation in individuals with BSCP, improved kinematics through SEMLS persist into adulthood. With the relatively new statistical procedure SPM gait can be displayed and analysed in established joint angle curves making them easier to understand (e.g. physiotherapists, movement scientists, physicians).

BACKGROUND: This study investigates the effects of a 12-week forefoot-oriented exercise intervention on jumping performance in male and female volleyball players. METHODS: A total of 93 (age 24.2 +/- 4.6 y) volleyball players with a similar training load were randomly assigned to an intervention group (IG; N.=42) performing a 15-min forefoot oriented intervention during their warm-up procedure for 12 weeks or a control group (CG; N.=51). Athletes were evaluated for jumping using squat jump (SJ) and countermovement jump (CMJ) tests before and after intervention. RESULTS: The CG showed improvements in SJ of 1.6 +/- 3.5 cm (7.4 +/- 14.7%) and CMJ of 0.6 +/- 3.5 cm (2.9 +/- 12.1%). The IG showed improvements in SJ of 1.1 +/- 3.8 cm (4.8 +/- 14.0%) and a decline in CMJ of -0.5 +/- 7.1 cm (1.1 +/- 20.2%). Twoway repeated measures analysis of variance (ANOVA) showed no significant interaction effects for SJ (P=0.535) and CMJ (P=0.297). Within subject tests indicated a significant time effect for SJ (P=0.001), but no significant group effect (P=0.560). In CMJ no significant main effects were found. CONCLUSIONS: Applying a forefoot-oriented exercise intervention over a period of 12 weeks showed no considerable effect on jumping performance in volleyball players.

Background The lack of reliable parameters to evaluate dynamic foot function, emphasizes the need for a deeper insight in foot biomechanics. The aims were to investigate the reliability of a new parameter (dynamic navicular rise dNR), and its relationship with the dynamic navicular drop (dND). Methods Twenty healthy participants (mean age 30.2 ± 8.1 years) had to walk on even ground and downstairs. Data of ten trials per task on two measurement days were recorded. The dNR was defined as the difference in millimetres (mm) between the minimum navicular height (NH) during stance and the NH at toe off. To test intra- and interday reliability, Intraclass Correlation Coefficients (ICC2.1) and repeatability were calculated. To obtain the absolute repeatability (RP) in mm, the equation RP = 1.96 × SDdifferences was used. Furthermore, the relationship between the dNR and the dND was examined by calculating Pearson (r) or Spearman (rs) correlation coefficients. Results Included participants showed a mean dNR of (12.2 ± 3.7) mm for level walking and (14.8 ± 3.4) mm for stair descent. The ICC2.1 for the dNR were 0.98 (intraday), 0.91 (interday) for level walking and 0.97 (intraday), 0.94 (interday) for stair descent. The interday repeatability was 3.2 mm (level walking), 2.7 mm (stair descent) respectively. For level walking, r was 0.31 (p = 0.049), and rs = 0.88 (p Conclusions The dNR seems to be highly reliable (ICCs), however, repeatability is unacceptable. For level walking, the dNR might be an independent measure, but not for stair climbing.

In-toeing is a major concern of many parents presenting their children to pediatric orthopedists. Foot progression angle (FPA) quantifies the rotation of the foot's longitudinal axis during gait, with negative values describing in-toeing and positive values describing out-toeing. Although it has been shown that the FPA changes over the course of a child's development, reference values for the normal FPA-range are lacking.This study aimed to establish reference values in 1-14 year old healthy children and to implement FPA-percentile curves for daily clinical use.5910 healthy children performed at least 3 repetitions of barefoot walking over an instrumented walkway using a pressure measurement platform. The FPA [°] was extracted and analyzed by age and gender (mean ± standard deviation; median with percentiles, MANOVA (age, gender) and Wilcoxon-Signed-Rank test for intra-individual side differences (α = 0.05).FPA maximum was observed in 2-year-old children and diminished significant until the age of 4 to moderate out-toeing. For ages 5-14, no statistically significant differences in FPA values were present (p 0.05). MANOVA confirmed age (p 0.001) and gender (p 0.001) as significant FPA influencing factors, without combined effect (p 0.05). In every age group, right feet showed significantly greater out-toeing (p 0.05).Percentile values indicate a wide FPA range in children. FPA development in young children shows a spontaneous shift towards moderate external rotation (age 2-4), whereby in-toeing ≤ 1-5° can be present, but can return to normal. Bilateral in-toeing after the age of four and unilateral in-toeing after the age of seven should be monitored.

Introduction Variations of gait speed influence kinematic variables that may have an effect on dynamic foot deformation. The influence of gait speed on the navicular drop has not yet been investigated. Methods The navicular drop was evaluated in static and dynamic conditions using a 3D-motion capture system. The dynamic navicular drop was evaluated on a treadmill while walking and running at three different speeds. A repeated measures ANOVA and post-hoc tests were conducted to evaluate the differences in dynamic navicular drop, corresponding unloaded navicular height at foot strike and loaded navicular height during stance. Results Higher walking speed led to a significant decrease in navicular height at foot strike and a subsequent decrease of dynamic navicular drop (p = 0.006). Across increasing running speeds, minimum navicular height was significantly decreased which in consequence led to an increased dynamic navicular drop (p = 0.015). For walking and running at the same speed, there was a large effect of gait style with an increase of dynamic navicular drop by 3.5 mm (p Discussion The change of gait from walking to running at the same speed had a large effect on dynamic navicular drop. The values of navicular height at foot strike and minimum navicular height during stance should be taken into account for the interpretation of dynamic navicular drop measures. Static and dynamic navicular drop measures differ substantially.

Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field. The preoperative time frame may be used to start rehabilitation which may fasten the postoperative recovery and optimize clinical outcome (“Prehabilitation”—PREHAB). The aim of this article, therefore, was to review the available literature on prehabilitation concepts and to present a prehabilitation guideline for CRS patients based on the best evidence available. A systemic literature research was conducted on rehabilitation for cartilage regenerative surgery as well as prehabilitation in knee joint procedures. From the available literature a prehabilitation concept was generated and tested in 10 ACI patients. As the literature search found no studies addressing prehabilitation in CRS patients, an evidence-based PREHAB program has been compiled based on the available evidence from (a) studies addressing postoperative rehabilitation in CRS patients and (b) PREHAB studies on other knee procedures including TKA. This presented prehabilitation guideline has been tested in > 50 CRS patients and was found to be feasible as all of the patients showed a good compliance and were able to perform the protocol as suggested. The presented PREHAB regimen may serve clinicians as a guideline for early rehabilitation of their CRS patients. Obviously, further research is mandatory to quantify its clinical effect and to demonstrate its cost-effectiveness and benefits in surgically treated patients.

Background Various diseases of the spine are treated by immobilization via orthoses, although detailed evidence on the efficiency of orthotic bracing remains elusive. The present study sought to investigate the impact of 3 different orthoses on spinal immobilization using 3-dimensional (3D) kinematic measurements. Methods Twelve healthy volunteers performed different motion tasks, including trunk flexion/extension and bilateral trunk bending. Movements were performed under 4 different conditions: 1) without orthosis, 2) while wearing a 3-point hyperextension brace (HB), 3) while wearing a custom-made semirigid orthosis (SO), and 4) while wearing a custom-made rigid orthosis (RO). Spinal motion was analyzed using a 3D optical motion capture system assessing regional, intersegmental, and segmental range of motion (ROM). Results Assessment of spinal motion was successfully accomplished in all subjects. Overall, orthoses significantly reduced spinal motion compared with no bracing. RO caused the greatest restriction of regional, intersegmental, and segmental spinal motion among all orthoses. For flexion/extension, the mean percentage decreases between T3 and L5 in full active ROM with HB, SO, and RO compared with no orthosis were 38%/30%, 48%/47%, and 51%/55%, respectively ( P ≤ 0.05). Lateral bending was impaired by 28%, 44%, and 70%, respectively ( P ≤ 0.05). Assessment of lateral bending revealed greater immobilization by SO and RO compared with HB ( P ≤ 0.05). Conclusions The present 3D kinematic system allows for precise assessment of spinal motion. Custom-made orthoses cause superior restriction on gross spinal motion compared “off-the-shelf” orthoses. If orthotic bracing is indicated, design, comfort, and patient compliance need to be carefully considered to guarantee successful therapy.

The aim of this study was to investigate the effect of a 6-week sensorimotor or resistance training on maximum trunk strength and response to sudden, high-intensity loading in athletes.Forty-three healthy, well-trained participants were randomized into sensorimotor (SMT; n=11), resistance training (RT; n=16) and control groups (CG; n=16). Treatment groups received either sensorimotor training (SMT) or resistance training (RT) for 6 weeks, 3 times a week. At baseline and after 6 weeks of intervention, participants' maximum isokinetic strength in trunk rotation and extension was tested (concentric/eccentric 30°/s). In addition, sudden, high-intensity trunk loading was assessed for eccentric extension and rotation, with additional perturbation. Peak torque [Nm] was calculated as the outcome.Interventions showed no significant difference for maximum strength in concentric and eccentric testing (p>0.05). For perturbation compensation, higher peak torque response following SMT (Extension: +24 Nm 95%CI±19 Nm; Rotation: +19 Nm 95%CI±13 Nm) and RT (Extension: +35 Nm 95%CI±16 Nm; Rotation: +5 Nm 95%CI±4 Nm) compared to CG (Extension: -4 Nm 95%CI±16 Nm; Rotation: -2 Nm 95%CI±4 Nm) was present (pThis study showed that isokinetic strength gains were small, but that significant improvements in high-intensity trunk loading response could be shown for both interventions. Therefore, depending on the individual's preference, therapists have two treatment options to enhance trunk function for back pain prevention.

Objective. Surgical nurses’ work is physically and mentally demanding, possibly leading to work–family conflict (WFC). The current study tests WFC to be a risk factor for neck and lower back pain (LBP). Job influence and social support are tested as resources that could buffer the detrimental impact of WFC. Methods. Forty-eight surgical nurses from two university hospitals in Germany and Switzerland were recruited. WFC was assessed with the Work–Family Conflict Scale. Job influence and social support were assessed with the Copenhagen Psychosocial Questionnaire, and back pain was assessed with the North American Spine Society Instrument. Results. Multiple linear regression analyses confirmed WFC as a significant predictor of cervical pain (β = 0.45, p

Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetitive activities such as walking or running. This pilot study therefore aimed at exploring possible NSCLBP-related alterations in LLAs during walking and running by focusing on discrete parameters as well as continuous data. Thirteen patients with NSCLBP and 20 healthy pain-free controls were enrolled and underwent a full-body movement analysis involving various everyday living activities such as standing, walking and running. LLAs were derived from markers placed on the spinous processes of the vertebrae L1-L5 and S1. Possible group differences in discrete (average and range of motion (ROM)) and continuous LLAs were analyzed descriptively using mean differences with confidence intervals ranging from 95% to 75%. Patients with NSCLBP indicated reduced average LLAs during standing, walking and running and a tendency for lower LLA-ROM during walking. Analyses of continuous data indicated the largest group differences occurring around 25% and 70% of the walking and 25% and 75% of the running cycle. Furthermore, patients indicated a reversed movement pattern during running, with increasing instead of a decreasing LLAs after foot strike. This study provides preliminary evidence that NSCLBP might affect LLAs during walking and running. These results can be used as a basis for future large-scale investigations involving hypothesis testing., Comment: This is the accepted manuscript version of an article published in the Journal of Biomechanics (https://doi.org/10.1016/j.jbiomech.2020.109883)

This systematic review and meta-analysis evaluates the results of empirical studies on the effects of CPM on rehabilitation after ACL reconstruction. The research question was: what are the effects of CPM on ROM, swelling and pain after ACL reconstruction?We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) were expressed as Hedges' g, in order to correct for overestimation of the true effect in small study samples. The 95% confidence intervals (95% CI) were calculated for both the individual studies and the overall weighted estimate. Outcomes were range of motion, pain and swelling.Eight studies comprising 442 participants were included in the meta-analysis. Beneficial effects of CPM could be identified for the need for pain medication (Hedges' g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery), the number of PCA button pushes by the patient during the first 24 hours after surgery (MD = 31.20; 95% CI = 11.35 to 51.05), on regaining knee flexion on the third to the seventh postoperative day (MD = 11.6°; 95% CI = 1.96 to 21.33) as well as in the third to the sixth postoperative week (Hedges' g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to sixth postoperative week (Hedges' g = 0.77; 95% CI = 0.35 to 1.18).This meta-analysis suggests that CPM has beneficial effects on pain reduction during the first two postoperative days, on knee flexion during the first to the sixth postoperative weeks and on swelling between the fourth and the sixth postoperative weeks. However, the risk-of-bias scores do not allow a high level of evidence.Diese systematische Literaturübersichtsarbeit und Metaanalyse evaluierte die Ergebnisse aus empirischen Studien über die Auswirkungen von kontinuierlichen passiven Bewegungsbehandlungen (KPB) auf die Rehabilitation nach ACL-Rekonstruktion. Die Forschungsfrage war: Was sind die Auswirkungen von CPM auf ROM, Schwellungen und Schmerzen nach ACL-Rekonstruktion?Wir suchten in den Datenbanken CINAHL, Cochrane, Embase, MEDLINE, und PEDro bis Januar 2018. Standardisierte mittlere Differenzen (SMD) werden in Form von Hedgesʼ g dargestellt, um eine Überschätzung der wahren Wirkung in kleinen Studienproben zu korrigieren. Für die einzelnen Studien als auch für die gewichtete Gesamtschätzung wurden 95%-Konfidenzintervalle (95%-KI) berechnet. Outcomes waren Beweglichkeit, Schmerzen und Schwellungen.Acht Studien mit 442 Probanden wurden in diese Metaanalyse eingeschlossen. Positive Effekte von KPB konnten in Bezug i) auf Schmerzmittelgabe während den ersten 24 Stunden nach der Operation (Hedgesʼ g = 0,93; 95%-KI = 0,41 – 1,45), ii) auf PCA-Gabe vom Patienten während der ersten 24 Stunden nach der Operation (MD = 31,20; 95%-KI = 11,35 – 51,05), iii) nach wiedererlangter Knieflexionsbeweglichkeit am 3. – 7. postoperativen Tag (MD = 11,6°; 95%-KI = 1,96 – 21,33) sowie in der 3. – 6. postoperativen Woche (Hedgesʼ g = 0,93; 95%-KI = 0,41 – 1,44) und iv) bei Schwellung des Knies in der 4. – 6. postoperativen Woche (Hedgesʼ g = 0,77; 95%-KI = 0,35 – 1,18) identifiziert werden.Diese Metaanalyse zeigt auf, dass KPB positive Auswirkungen auf die Schmerzreduktion in den ersten beiden postoperativen Tagen, auf Knieflexion während der 1. – 6. postoperativen Woche und auf Schwellungen zwischen der 4. und 6. postoperativen Woche hat. Die Risk-of-Bias-Scores erlauben jedoch keine hohen Evidenzgrade.

Unilateral knee flexion contractures (KFC) are frequently seen in orthopedic rehabilitation and often interfere with the normal gait pattern, resulting in passive and/or active secondary deviations. In order to prevent KFC-related complications such as patellofemoral pain or the knee spine syndrome, a comprehensive understanding of such deviations is necessary.How does an artificially induced unilateral KFC affect whole body biomechanics in young healthy adults during gait?Twenty-four healthy young adults (females/males: 13/11; mean age: 27.3 ± 3.8 years) were included in this cross-sectional study. Using an 8-camera optical motion capture system and two embedded force plates, three-dimensional lower extremity, pelvis and trunk kinematics as well as lower extremity joint moments were derived during normal walking and walking with unilateral KFCs by means of a lightweight knee brace locked at 30° and 60° of flexion. Data were analyzed using one-dimensional statistical parametric mapping, allowing explorative group comparisons of continuous data rather than pre-defined discrete parameters.On the braced side, increased hip flexion (p 0.001, 1-100 % of gait cycle [%GC]), knee flexion (p 0.001, 1-72 and 82-100 %GC) and ankle dorsiflexion angles (p 0.001, 1-100 %GC) as well as external knee flexion moments (p 0.001, 1-98 % of stance phase [%StPh]) and decreased ankle dorsiflexion (p 0.001, 74-94 %StPh), hip flexion and hip adduction moments (p 0.001, 1-32 %StPh and p 0.001, 71-92 %StPh, respectively) were observed. The unbraced side showed similar but less pronounced deviations. Pelvis and upper body kinematics were not altered, suggesting that the lower limbs fully compensate for KFCs of less than 30°.Asymmetric limb loading and considerable increases in external knee flexion moments might increase the risk for adverse effects of lower extremity joints in the long-term. It seems therefore important to treat KFCs as early as possible and to implement preventive strategies to avoid possible complications.

BACKGROUND: The aim of this study is to examine the prevalence of musculoskeletal complaints in Swiss operating room (OR) nurses, and to investigate how work-family conflict, work interruptions, and influence at work are related to lumbar and cervical back pain. METHODS: Participants in this correlational questionnaire study included 116 OR nurses from eight different hospitals in Switzerland. RESULTS: We found that 66% of the OR staff suffered from musculoskeletal problems. The most prevalent musculoskeletal complaints were lumbar (52.7%) and cervical pain (38.4%). Furthermore, 20.5% reported pain in the mid spine region, 20.5% in the knees and legs, and 9.8% in the hands and feet. Multiple linear regression analyses showed that work-family conflict (p < 0.05) and interruptions (p < 0.05) significantly predicted lumbar and cervical pain in OR nurses, while influence at work (p < 0.05) only predicted lumbar pain. CONCLUSION: These results suggest that reducing the work-family conflict and interruptions at work, as well as offering opportunities to influence one's workplace, help to promote OR nurses' health.

Background. WATSU (WaterShiatsu) is a complementary therapeutic treatment method comprising passive stretches and massage techniques administered in 35°C warm water. Pregnant women claim safe methods to reduce pain, stress, and fatigue. Therefore, we conducted a pilot study evaluating the effects of WATSU on pregnancy-related complaints in third trimester pregnant women.Methods. Nine healthy pregnant women at gestational week ≥34 were included in an intervention group (receiving WATSU) and compared to eight women in a passive control group (receiving no treatment). WATSU was performed on days 1 and 4 of the study, accompanied by ultrasound examinations. Outcomes include physiological and psychometric as well as qualitative data. Participants in the control group completed questionnaires only.Results. WATSU was found to significantly lower participants’ levels of stress and pain and to improve their mental health-related quality of life and mood. In comparison to the passive control group, participants in the intervention group reported reduction in perceived stress from day 1 to day 8 (P=0.036, Cohen’sf=0.57). Qualitative data indicate that WATSU was appreciated as enjoyable and deeply relaxing. No negative side effects were reported.Conclusion. Our findings support the notion that WATSU yields therapeutic benefits for pregnant women and warrant further research. This study has been registered at ClinicalTrials.gov:NCT01708018.

Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 ± 1.9 years; 160 ± 13 cm; 50 ± 14 kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P ≤ 0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P ≤ 0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.

The aim of this pilot study was to evaluate the feasibility and the effect size of a four-week stochastic resonance whole body vibration (SR-WBV) intervention on functional performance and strength in frail elderly individuals. Twenty-seven participants have been recruited and randomly distributed in an intervention group (IG) and a sham group (SG). Primary outcomes were feasibility objectives like recruitment, compliance and safety. Secondary outcomes were short physical performance battery (SPPB), isometric maximum voluntary contraction (IMVC) and isometric rate of force development (IRFD). The intervention was feasible and safe. Furthermore it showed significant effects (p = 0.035) and medium effect size (0.43) within the IG in SPPB. SR-WBV training over four weeks with frail elderly individuals is a safe intervention method. The compliance was good and SR-WBV intervention seems to improve functional performance. Further research over a longer time frame for the strength measurements (IMVC and IRFD) is needed to detect potential intervention effects in the force measurements as well. Clinical Trial register: NTC 01704976 .

Background: Workflow interruptions during surgery may cause a threat to patient's safety. Workflow interruptions were tested to predict failure in action regulation that in turn predicts near-accidents in surgery and related health care. Methods: One-hundred-and-thirty-three theater nurses and physicians from eight Swiss hospitals participated in a cross-sectional questionnaire survey. The study participation rate was 43%. Results: Structural equation modeling confirmed an indirect path from workflow interruptions through cognitive failure in action regulation on near-accidents (p

Hintergrund: Eine systematische Literaturubersicht untersuchte den Effekt von passiven Motorbewegungsschienen (CPM) nach knorpelregenerativen Operationen am Kniegelenk. Patienten/Material und Methode: Die Suche erfolgte in MEDLINE, Cochrane Central Register, EMBASE, International Clinical Trials Registry Platform, Trip Database und im Literaturverzeichnis der eingeschlossenen Studien. Zwei unabhangige Personen pruften die Qualitat der Originalarbeiten anhand des Cochrane Risk of Bias-Instruments und Ubersichtsarbeiten anhand der CBO/Dutch Cochrane Centre-Richtlinie. Ergebnisse: Es wurden 1541 Studien gesichtet. Eine Ubersichtsarbeit und 9 Originalarbeiten wurden anschliesend fur die Analyse ausgewahlt. Aufgrund der methodologischen Schwachen der Studien, der Heterogenitat der Outcome-Variablen und der Tatsache, dass 6 von 9 Studien mithilfe eines 1-Gruppen-Designs mit Vorher-Nachher-Messung den kombinierten Effekt von operativer Therapie und CPM erfasst haben, war eine Metaanalyse nicht durchfuhrbar. Schlussfolgerung: Drei (Fall-)Studien geben signifikante Verbesserungen hinsichtlich subjektiver Fragebogen-Scores wie Schmerz, Schwellung, Quality of Life Survey, Knee Society Score, Cincinnati Rating Score oder WOMAC aufgrund der operativen Versorgung und der CPM-Intervention nach Knorpeldefekten am Knie an. Sechs (Fall-)Studien zeigen eine verbesserte Knorpelqualitat und ein besseres subjektives Outcome der Patienten nach CPM auf, jedoch ohne statistische Signifikanz. Um diese Therapieeffekte auf einem hoheren Evidenzlevel nachzuweisen, sind weitere hochwertige randomisiert-kontrollierte Studien erforderlich.

Introduction Gait speed is one of the most commonly and frequently used parameters to evaluate gait development. It is characterized by high variability when comparing different steps in children. The objective of this study was to determine intra-individual gait speed variability in children. Methods Gait speed measurements (6–10 trials across a 3 m walkway) were performed and analyzed in 8263 children, aged 1–15 years. The coefficient of variation (CV) served as a measure for intra-individual gait speed variability measured in 6.6 ± 1.0 trials per child. Multiple linear regression analysis was conducted to evaluate the influence of age and body height on changes in variability. Additionally, a subgroup analysis for height within the group of 6-year-old children was applied. Results A successive reduction in gait speed variability (CV) was observed for age groups (age: 1–15 years) and body height groups (height: 0.70–1.90 m). The CV in the oldest subjects was only one third of the CV (CV 6.25 ± 3.52%) in the youngest subjects (CV 16.58 ± 10.01%). Up to the age of 8 years (or 1.40 m height) there was a significant reduction in CV over time, compared to a leveling off for the older (taller) children. Discussion The straightforward approach measuring gait speed variability in repeated trials might serve as a fundamental indicator for gait development in children. Walking velocity seems to increase to age 8. Enhanced gait speed consistency of repeated trials develops up to age 15.

Background Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia). One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP) and forefoot cushioning (FC). The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running. Methods Twenty-three (13 female, 10 male) asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC) conditions and a control (C) condition on a treadmill (2.78 ms−1) for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome) and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100) after each running trial. The primary outcome was tested using the Friedman test (α = 0.05). Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR)). Results Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315) compared to both C (313 ± 69, 95%-CI: 283–343; p = .003) and MP (315 ± 80, 95%-CI: 280–350; p = .001). No significant difference was found between C and MP (p = .858). Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64. Conclusions In contrast to the metatarsal pad orthosis, the forefoot cushioning orthosis achieved a significant reduction of peak pressure in the forefoot of recreational runners. Consequently, the use of a prefabricated forefoot cushioning orthosis should be favoured over a prefabricated orthosis with an incorporated metatarsal pad in recreational runners with normal height arches. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0176-z) contains supplementary material, which is available to authorized users.

Reflex activity of the lower leg muscles involved when compensating for falls has already been thoroughly investigated. However, the trunk׳s role in this compensation strategy remains unclear. The purpose of this study, therefore, was to analyze the kinematics and muscle activity of the trunk during perturbed walking. Ten subjects (29 ± 3 yr;79 ± 11 cm;74 ± 14 kg) walked (1m/s) on a split-belt treadmill, while 5 randomly timed, right-sided perturbations (treadmill belt deceleration: 40 m/s(2)) were applied. Trunk muscle activity was assessed with a 12-lead-EMG. Trunk kinematics were measured with a 3D-motion analysis system (12 markers framing 3 segments: upper thoracic area (UTA), lower thoracic area (LTA), lumbar area (LA)). The EMG-RMS [%] (0-200 ms after perturbation) was analyzed and then normalized to the RMS of normal walking. The total range of motion (ROM;[°]) for the extension/flexion, lateral flexion and rotation of each segment were calculated. Individual kinematic differences between walking and stumbling [%; ROM] were also computed. Data analysis was conducted descriptively, followed by one- and two-way ANOVAs (α=0.05). Stumbling led to an increase in ROM, compared to unperturbed gait, in all segments and planes. These increases ranged between 107 ± 26% (UTA/rotation) and 262 ± 132% (UTS/lateral flexion), significant only in lateral flexion. EMG activity of the trunk was increased during stumbling (abdominal: 665 ± 283%; back: 501 ± 215%), without significant differences between muscles. Provoked stumbling leads to a measurable effect on the trunk, quantifiable by an increase in ROM and EMG activity, compared to normal walking. Greater abdominal muscle activity and ROM of lateral flexion may indicate a specific compensation pattern occurring during stumbling.

The aim of this study was to acquire static and dynamic foot geometry and loading in childhood, and to establish data for age groups of a population of 1-13 year old infants and children. A total of 10,382 children were recruited and 7788 children (48% males and 52% females) were finally included into the data analysis. For static foot geometry foot length and foot width were quantified in a standing position. Dynamic foot geometry and loading were assessed during walking on a walkway with self selected speed (Novel Emed X, 100Hz, 4 sensors/cm(2)). Contact area (CA), peak pressure (PP), force time integral (FTI) and the arch index were calculated for the total, fore-, mid- and hindfoot. Results show that most static and dynamic foot characteristics change continuously during growth and maturation. Static foot length and width increased with age from 13.1±0.8cm (length) and 5.7±0.4cm (width) in the youngest to 24.4±1.5cm (length) and 8.9±0.6cm (width) in the oldest. A mean walking velocity of 0.94±0.25m/s was observed. Arch-index ranged from 0.32±0.04 [a.u.] in the one-year old to 0.21±0.13 [a.u.] in the 5-year olds and remains constant afterwards. This study provides data for static and dynamic foot characteristics in children based on a cohort of 7788 subjects. Static and dynamic foot measures change differently during growth and maturation. Dynamic foot measurements provide additional information about the children's foot compared to static measures.

Hintergrund: Obwohl die Sonografie in der Diagnostik von Lasionen an Achilles- und Patellasehnen etabliert ist, liegen bislang nur wenige Daten zu Gutekriterien dieser Messungen vor. Ziel der Studie war es daher, die Reliabilitat in der Bestimmung des Sehnendurchmessers bzw. in der Darstellung struktureller Veranderungen zu untersuchen. Material und Methoden: Bei 14 gesunden Freizeitsportlern wurden je beide Achilles- (AS) und Patellasehnen (PS) im Test-Retest-Design durch zwei Untersucher sonografiert. Neben antero-posteriorem (a.p.-) und mediolateralem (m.l.-) Durchmesser wurde das Auftreten von Hypoechogenitaten und Vaskularisationen erfasst. Es erfolgte die deskriptive Analyse mit Kalkulation von Test-Retest-Variabilitat (TRV), Intraclass-Correlation-Coefficient (ICC) und Bland und Altman’s Plots mit Bias und 95 % Limits of Agreement (LOA). Ergebnisse: Die intra- und interobserver Differenzen von AS- und PS-a.p.-Durchmesser variierten von 0,2 – 1,2 mm, die der AS- und PS-m.l-Durchmesser von 0,7 – 5,1 mm. Bei 24 % der geschallten Sehnen waren Hypoechogenitaten sichtbar, in 15 % der untersuchten Sehnen wurden Vaskularisationen beobachtet. Die Bestimmung des intra-observer AS-a.p.-Durchmessers zeigte lediglich geringe Abweichungen (TRV 4,5 – 7,4 %; ICC 0,60 – 0,84; Bias −0,05 – 0,07 mm; LOA −0,6 – 0,5 bis −1,1 – 1,0 mm), wahrend AS- und PS-m.l.-Durchmesser zwischen den Untersuchern starker variierten (TRV 13,7 – 19,7 %; ICC 0,11 – 0,20; Bias −1,4 – 4,3 mm; LOA −5,5 – 2,7 bis −10,5 – 1,9 mm). Schlussfolgerung: Der AS- und PS-a.p.-Durchmesser sind zuverlassig zu bestimmende Parameter. Demgegenuber ist die reliable Erfassung der Sehnenbreite von Achilles- und Patellasehnen erschwert. Hypoechogenitaten und Vaskularisationen sind bereits in klinisch unauffalligen Sehnen darstellbar.

HIRSCHMULLER, A., V. FREY, L. KONSTANTINIDIS, H. BAUR, H-H. DICKHUTH, N. P. SUDKAMP, and P. HELWIG. Prognostic Value of Achilles Tendon Doppler Sonography in Asymptomatic Runners. Med. Sci. Sports Exerc., Vol. 44, No. 2, pp. 199-205, 2012. Introduction: Midportion Achilles tendinopathy (MPT) is a common problem in running athletes. Nevertheless, its etiology is not fully understood, and no valid prognostic criterion to predict the development of MPT could be identified to date. The purpose of the present study, therefore, was to evaluate whether power Doppler ultrasonography (PDU) is a suitable method to identify a predisposition to MPT in yet asymptomatic runners. Methods: At 23 major running events, 634 asymptomatic long-distance runners were tested for Achilles tendon thickness, vascularization, and structural abnormalities using a high-resolution PDU device (Toshiba Aplio SSA-770A/80, 12 MHz). In addition, their medical history and anthropometric data were documented. All subjects were contacted 6 and 12 months later and asked about any new symptoms. The collected anamnestic, anthropometric, and ultrasonographic data were subjected to regression analysis to determine their predictive value concerning the manifestation of midportion Achilles tendon complaints (P < 0.05). Results: The highest odds ratio (OR) for manifestation of MPT within 1 yr was found for intratendinous blood flow ("neovascularization,'' OR = 6.9, P < 0.001). An increased risk was also identified for subjects with a positive history of Achilles tendon complaints (OR = 3.8, P < 0.001). A third relevant parameter, just above the level of significance, was a spindle-shaped thickening of the tendon on PDU (Wald chi(2) = 3.42). Conclusions: PDU detection of intratendinous microvessels in the Achilles tendons of healthy runners seems to be a prognostically relevant factor concerning the manifestation of symptomatic MPT. This finding lays the foundation for an early identification of a predisposition to MPT as well as prophylactic intervention in as yet asymptomatic runners.

Although paracycling is a growing discipline in high level competitive sports as well as in posttraumatic rehabilitation, epidemiological data of resulting injuries is still missing. Therefore, 19 athletes of the German national paracycling team were asked about their injuries during the 2008 season using a standardized questionnaire. Overall, 18 (94.7 %) of 19 athletes reported overuse injuries; most commonly localized at the back (83.3 %), neck/shoulder (77.8 %), knee (50 %), groin/buttock (50 %) and hands/wrists (38.9 %). Altogether, 18 accidents were registered, corresponding to an injury rate of 0,95 acute injuries per athlete per year (0,07 / 1000 km). The most common acute injuries were abrasions (69.2 %) and contusions (61.5 %), whereas fractures were stated only twice (11.8 %). The anatomical distribution of overuse injuries in disabled cyclists confirms the results of studies in able-bodied cycling, although the incidences in low-back pain and neck/shoulder pain is clearly higher in disabled cycling, as well as the rate of traumatic injuries. Language: de

Autologous chondrocyte implantation for treatment of isolated cartilage defects of the knee has become well established. Although various publications report technical modifications, clinical results, and cell-related issues, little is known about appropriate and optimal rehabilitation after autologous chondrocyte implantation. This article reviews the literature on rehabilitation after autologous chondrocyte implantation and presents a rehabilitation protocol that has been developed considering the best available evidence and has been successfully used for several years in a large number of patients who underwent autologous chondrocyte implantation for cartilage defects of the knee.

Seventy percent of motor sports athletes report low back pain. Information on the physical capacity of race car drivers is limited. The purpose of this study was to compare the maximum trunk extensor and flexor strength of elite race car drivers and physically active controls. Thirteen elite race car drivers and 13 controls were measured in concentric mode for maximal trunk flexion and extension at 60° x s(-1) and 120° x s(-1). Peak torque (mean ± s) at 60° x s(-1) in trunk extension was 283 ± 80 N x m in the drivers and 260 ± 88 N x m in controls (P0.05). At 120° x s(-1), drivers produced peak torques of 248 ± 55 N x m compared with 237 ± 74 N x m for controls (P0.05). Peak torques in flexion were less than in extension for both groups (60° x s(-1): drivers 181 ± 56 N x m, controls 212 ± 54 N x m, P0.05; 120° x s(-1): drivers 191 ± 57 N x m, controls 207 ± 48 N x m, P0.05). Individual ratios of flexion to extension forces exhibited ratios of 0.88 (60° x s(-1)) and 0.93 (120° x s(-1)) for controls and 0.66 (60° x s(-1)) and 0.77 (120° x s(-1)) for drivers (60° x s(-1): P0.05; 120° x s(-1): P0.05). The maximum strength performance capacity of the trunk muscles of elite motor sport athletes competing in long-distance racing did not differ from that of anthropometrically matched and physically active controls.

Background and objectives Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence-based to date. Hypothesis Polyurethane foam orthoses adapted to a participant9s barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners. Design Prospective, randomised, controlled clinical trial. Intervention 51 patients with running injuries were treated with custom-made, semirigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment. Main outcome measures Evaluation was made by the validated pain questionnaire Subjective Pain Experience Scale, the pain disability index and a comfort index in the orthoses group (ICI). Results There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index (mean difference 3.2; 95% CI 0.9 to 5.5) and the Subjective Pain Experience Scale (6.6; 2.6 to 10.6). The patients with orthoses reported a rising wearing comfort (pre-treatment ICI 69/100; post-treatment ICI 83/100) that was most pronounced in the first 4 weeks (ICI 80.4/100). Conclusion Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners.

It still remains unclear whether muscular activity on the treadmill (T) differs compared to overground (0) running. The purpose of this study was therefore to examine possible differences in muscular activation between T and 0. 14 healthy runners were analyzed in a neutral running shoe at 12 km·h -1 on a treadmill and in a field test. Muscular activity (EMG) of the tibialis anterior, peroneus longus, and soleus were measured. Time and amplitude quantities were assessed during the gait cycle. The EMG of the peroneus longus exhibited a later onset, a later maximum and shorter total time of activation (p < 0.05) in 0. The soleus showed a higher amplitudes in 0 during the push-off phase (p < 0.05). Altered peroneus longus activity may indicate its role as an ankle stabilizer and demonstrates a compensatory response due to changing mechanical conditions. Weaker amplitudes of the soleus in the push-off during T suggest adaptation to the movement of the treadmill belt, and/or changes in load receptor input. Differences in muscle activity between T and 0 running must thus be taken into consideration in studies of neuromuscular control of movement.

Background Weight-bearing capacity (WBC) on the hemiparetic leg is crucial for independent walking, and is thus an important outcome to monitor after a stroke. A specific and practical assessment in non-ambulatory patients is not available. This is of importance considering the increasing administration of high intensive gait training for the severely impaired stroke population. The aim was to develop a fast and easy-to-perform assessment for WBC on a foot pressure plate to be used in clinical routine. Methods WBC was assessed in the frontal plane in 30 non-ambulatory patients with subacute stroke and 10 healthy controls under 3 conditions: static, dynamic, and rhythmic. Force–time curves for the hemiparetic leg (patients with stroke) and the non-dominant leg (healthy controls) were normalised as a percentage of body weight (%BW), and the means analysed over 60, 30, and 15 s (static) and the mean of the peak values for 15, 10, 5, 4, and 3 repetition trials (dynamic, rhythmic). The data were tested for discriminative power and reliability. Dynamic and rhythmic tests could discriminate between patients with stroke and healthy controls over all periods (15, 10, 5, 4, and 3 repetitions) (p 0.829] and inter-session reliability (ICC = 0.740) were found for 3 repetitions in the dynamic test with acceptable absolute reliability [standard error of measurement (SEM)

In dynamic H-reflex measurements, the standardisation of the nerve stimulation to the gait cycle is crucial to avoid misinterpretation due to altered pre-synaptic inhibition. In this pilot study, a plantar pressure sole was used to trigger the stimulation of the tibialis nerve with respect to the gait cycle. Consequently, the intersession reliability of the soleus muscle H-reflex during treadmill walking was investigated. Seven young participants performed walking trials on a treadmill at 5 km/h. The stimulating electrode was placed on the tibial nerve in the popliteal fossa. An EMG was recorded from the soleus muscle. To synchronize the stimulus to the gait cycle, initial heel strike was detected with a plantar pressure sole. Maximum H-reflex amplitude and M-wave amplitude were obtained and the Hmax/Mmax ratio was calculated. Data reveals excellent reliability, ICC=0.89. Test-retest variability was 13.0% (±11.8). The Bland-Altman analysis showed a systematic error of 2.4%. The plantar pressure sole was capable of triggering the stimulation of the tibialis nerve in a reliable way and offers a simple technique for the evaluation of reflex activity during walking.

Differences in lower extremity movement characteristics are stated as a reason for overuse injuries. The causal assignment of biomechanical quantities to the onset of complaints is still subject of debate in gait analysis. The purpose of this study was therefore to compare biomechanical gait characteristics by means of plantar pressure distribution (PPD), EMG and ground reaction forces (GRF) in healthy runners and in runners with chronic Achilles tendon complaints (AT). Fourteen healthy runners and 8 runners with AT were examined at 12 km/h. Surface EMG, in-shoe PPD and GRFs were evaluated on a treadmill mounted on force transducers. Subjects ran barefoot and with a reference shoe in random order. EMG time and amplitude quantities, characteristics of the path of the center of pressure (CoP), vertical and a-p forces and impulses were extracted. In AT no differences in CoP-characteristics between barefoot and reference shoe were observed, compared to corresponding significant differences in the control group. Compared to the AT group, the control subjects had a higher activity EMG-amplitudes in the extensor loop during weight acceptance phase, a higher braking impulse and a lower pushing impulse. It is thus concluded that healthy runners differ from AT patients in terms of movement characteristics especially in running.

Values presented significant differences between trained and untrained individuals for both dominant and non dominant limbs. Endurance parameter presented no significant difference between pre-test and post-fatigue values. Conclusion(s): We conclude that resistance training seems to induce observable changes in electronic grip dynamometry readings. Few differences were found regarding dominance.As expected, trained participants are stronger. But they also showed great decrements in grip tension after the 10RMprotocol used to induce fatigue.RawAveragemeasurements were best to identify changes due to upper limb muscle fatigue compared to pickmeasurements, pick normalized average measurements, slope measurements. However, future work should include larger samples or apply different training protocols, focused on the improvement of endurance or strength, to enable the evaluation of specific protocolrelated changes in hand strength and endurance. Implications: The combination of 10 RM tests and electronic grip dynamometry, often using portable devices, provide an easy way to assess patients’ physical fitness and can be used to track improvements due to rehabilitation protocols and other changes due to fatigue status under different tasks, conditions and circumstances.