Single-leg Dynamic Balance Research Articles

Dynamic Single-Leg Balance Tests of Physiotherapy Students: A Comparison of Body-Active Weight Shift Test and Two Sudden Disturbance Tests

BACKGROUND: Balance is essential to maintain and stabilize the transition from static to dynamic posture. The human body can maintain the center of gravity within the base of support and to process input from vision, the vestibular apparatus, and the somatic senses. AIM: The research aimed to check the correlation of the active body-weight shift test (Y balance test [YBT]) and two sudden perturbation tests in physiotherapy students. METHODS: In a cross-sectional study, a descriptive research design was used. Twenty-nine healthy adults (14 men and 15 women) with a mean age of 23.6 ± 6.3 were tested using the active body-weight shift test and two sudden perturbation tests. A descriptive statistical analysis using correlation coefficients was performed. RESULTS: Our subjects’ average values of the test results meet the normative values. There is a correlation between the YBT test and the crossover hop test in the anterior (p < 0.01), posterior-medial, and posterior-lateral directions (p < 0.05), and the triple-hop test forward in the posterior-medial and posterior-lateral directions (p < 0.05), and anterior direction (p < 0.01) for the left extremity, except for the anterior direction to the right. With the right extremity, there is a correlation between the YBT test and the crossover hop test and triple-hop test forward in the posterior medial (p < 0.05), the crossover hop test in the posterior medial and posterior lateral to the left (p < 0.05), and the right (p < 0.01), but no correlation in the anterior direction in either of them. CONCLUSION: The data of all physiotherapy students in our study meet the normative data, and no difference due to gender has been observed. There is a correlation between the active body-weight shift test and sudden perturbation tests with or without lateral movement for the left extremity, but not for the right extremity. We can assume better results when standing on an undominant limb, which can lead to insufficient support when standing on a dominant limb. What should not be the case in providing patient safety.

A Neuromuscular Training Program Performed on Foam is Accompanied by Improved Balance and Jump Height in Recreational Runners

Purpose: To assess balance, plyometric performance, and strength of recreational runners completing a neuromuscular training (NMT) program on a novel foam surface. Methods: After baseline testing, participants (n=14) completed 22-minute exercise sessions on foam twice weekly for eight weeks, and a post-training testing battery. Testing included lower quarter Y-balance test (LQYBT), dynamic leap and balance test (DLBT), squat jump and countermovement jump tests, and isometric strength testing of the foot and ankle via handheld dynamometry (HHD). Participants were asked to maintain their normal running routines throughout the study period and report any training missed due to injury. Results: Participants demonstrated significant (pConclusion: This study supports the use of progressive NMT on foam as a feasible intervention for recreational runners as all participants maintained typical running routines and reported no injuries. While further research is needed to directly inform possible effects of NMT on foam on injury risk and running performance, the improvements in single leg dynamic balance, lower body plyometric performance, and some indices of lower extremity strength in the present study suggest the efficacy of NMT performed on foam.

Lower and upper quarter y-balance test in recreationally active healthy adults: test-retest reliability, gender differences and inter-limb asymmetries

Y-balance test for lower limbs (LQYBT) and upper limbs (UQYBT) are frequently used to assess dynamic single-leg balance. In this study, we aimed to examine the test-retest reliability of both tests, to compare scores on the dominant and nondominant sides and report on the magnitude of asymmetry, as well as assess any gender differences. A sample of 30 healthy, recreationally active individuals (15 men and 15 women; age, 22.83 ± 8.78 years; height, 175.46 ± 8.29 cm; body mass 72.08 kg ± 12.60 kg) completed the LQYBT und UQYBT measurements twice 12 to 14 days. Reliability was assessed using the intraclass correlation coefficient (ICC) (absolute agreement, two-way random), paired-samples t-test, and typical error (expressed as coefficient of variation, CV). Both tests showed moderate to good relative reliability (ICC = 0.62 – 0.85) and acceptable absolute reliability (CV = 3.54 – 7.20 %), with a possible learning effect for certain reach directions. Men tended to score better than women, but statistically significant differences were confirmed in only 3 of 12 comparisons. Differences between dominant and non-dominant sides were mostly very small and statistically significant in only 2 of 6 comparisons. Mean asymmetry scores were in the range of ~3-6%. These results contribute to the evidence on the utility of LQYBT and UQYBT testing in healthy adults.

Gender and limb effects on adult normative data for the Biodex Balance System

Posturography normative data in healthy populations is crucial for several reasons including monitoring the independence issues related to activities of daily living (ADLs), fall and incapacity avoidance, and residual injury impairment. The Biodex Balance System requires updated normative data regarding healthy persons because of recent revisions to the Biodex Balance System. Further, this study aimed to determine and compare gender and limb performance in 161 adults aged 18-55 years (n = 80 males; n = 81 females). Assessments involved both static and dynamic stability tests such as double-leg and single-leg balance tests at platform stability which served as outcome measurements. Females performed significantly (p≤.05) better on double-leg static balance (p=.031), double-leg dynamic balance (p=.002), and single-leg dynamic balance on both the left (p=.003) and right legs (p=.013) when compared to males. The normative values and findings of this study not only enable the evaluation of individual performance regarding the balance of adults but also suggest the need to use gender-stratified normative data when using the Biodex Balance System to interpret double- and single-leg, static and dynamic balance test performance.

Is Ankle Kinesio Taping Effective to Immediately Change Balance, Range of Motion, and Muscle Strength in Healthy Individuals? A Randomized, Sham-Controlled Trial.

BackgroundThe ankle–foot complex plays a key role in maintaining balance because it collects proprioceptive data. Kinesio taping (KT) is a rehabilitative method performed by the cutaneous application of a special elastic tape. The mechanical correction technique of KT was suggested to reposition the joints and alter balance parameters. The aim was to reveal the pure effects of ankle KT on balance, range of motion (ROM), and muscle strength in healthy individuals.MethodsForty healthy students were recruited for this randomized, sham-controlled study at a local university. Participants were divided into two groups—experimental and sham application groups. The primary outcome measures were balance parameters. Athlete Single Leg (ASL), Limits of Stability (LoS), and Clinical Test of Sensory Interaction and Balance (CTSIB) were used to measure single-leg dynamic balance, dynamic postural control, and sensory interaction of balance, respectively. Dorsiflexion ROM and dorsiflexor muscle strength were the secondary outcomes.ResultsThe ASL score showed significant improvement only in the experimental KT group (P=0.02); however, the LoS score increased significantly in both groups (P<0.05). CTSIB scores, dorsiflexion ROM, and dorsiflexor muscle strength for both ankles did not change in any of the groups after intervention (P>0.05). Moreover, there was no superiority of one intervention over the other in improving any of the variables (P>0.05).ConclusionThe mechanical correction technique of KT can be useful in providing immediate improvement in single-leg dynamic balance in healthy individuals. However, it may not be effective to significantly change the sensory interaction of balance, dorsiflexion ROM, and muscle strength.

Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes

Introduction/purposeLiterature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement (MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions. Methodology/sampleIn this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance. ResultsANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm. Discussion/clinical relevanceSpecifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a “low risk-high reward” clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.

Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity.

BackgroundDeficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits.PurposeTo review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score.Study DesignSystematic ReviewMethodsA comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used.ResultsFifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 [95%CI 107.4-111.8]; females: 102.3 [95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 [95%CI 105.0-109.1]; females: 102.0 [95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 [95%CI 69.5-74.5]; females: 70.8 [95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry.ConclusionsThere was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury.Level of Evidence1b

Quantifying balance deficit in people with ankle fracture six months after surgical intervention through the Y-Balance test

BackgroundAnkle fractures are among the most common traumatic fractures and have a great socio-economic impact. Consequences of an ankle fracture requiring surgical treatment (e.g. pain, reduced ankle range of motion (ROM), muscle weakness, etc.) lead to balance deterioration, which has a profound impact on activities of daily living. However, to the best of the authors' knowledge, no reliable clinical tests are available to monitor balance in patients after ankle surgery. ObjectivesTo quantify single-leg dynamic balance in patients with bimalleolar ankle fracture through the Y-Balance test (YBT). The second objective was to analyze the impact of ankle dorsiflexion ROM and hip strength on balance to optimize balance rehabilitation programs. DesignCross-sectional study. Methods22 participants, who had undergone surgery after bimalleolar ankle fractures, were assessed for ankle ROM, hip strength, and dynamic balance six-months after the surgical intervention. The within-session reliability of YBT was calculated through the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). Student's t-tests were used to assess leg differences. A multiple regression analysis was performed to evaluate the role of ankle dorsiflexion ROM and hip abductor and adductor strength in predicting balance performance. ResultsYBT showed high-to-excellent within-session relative reliability (Healthy leg: 0.85 ≤ ICC≤0.96; Operated leg: 0.84 ≤ ICC≤0.96). SEM values were below 3.3 %. The operated leg showed significant lower YBT scores for anterior reach direction (−9.0 %; g=−0.70) and composite score (-4.5 %; g=−0.34). Multiple regression analysis showed that both, ankle dorsiflexion and hip abductor and adductor strength explained 66 % of the variance in the YBT anterior direction of the operated leg. ConclusionsThe YBT is a reliable tool that allows the quantification of single-leg dynamic balance impairments from 6-months after surgery in patients with bimalleolar ankle fracture. Between-leg YBT differences in the anterior direction can be used as reference scores (3.3 %) for balance restoration. Balance rehabilitation programs should focus on improving ankle functionality and reducing hip muscle weakness with specific hip strength exercises and balance exercises with similar demands to the reaching tasks of the YBT to promote a faster recovery.

Effects of Aerobic and Anaerobic Fatigue Exercises on Postural Control and Recovery Time in Female Soccer Players.

Sixteen female soccer players (age = 20.19 ± 1.52 years; body mass = 56.52 ± 4.95 kg; body height = 164.81 ± 4.21 cm) with no history of lower extremity injury participated in the study. The Biodex SD Balance system was used to determine the non-dominant single-leg stability. In anaerobic exercise, each subject performed four maximal cycling efforts against a resistance equivalent to 0.075 kg/body mass for 30 s with three-minute rest intervals. In aerobic exercise, subjects performed the Bruce protocol on a motorized treadmill. After each exercise, subjects subsequently performed a single-leg stability test and then repeated the same test for four times with five-minute passive rest periods. In accordance with the results, it was found that the impairment observed right after the aerobic loading was higher (p < 0.001) compared to the anaerobic one. However, the time-related deterioration in both aerobic and anaerobic loadings was similar. The B-pre value was lower than Bpost and B5 (p < 0.01) and B10 (p < 0.05) in both conditions. Subjects could reach the initial balance level at B15 after aerobic and anaerobic loadings. The lactate level did not reach resting value even after 20 min of both fatigue protocols. Although the fatigue after aerobic and aerobic exercise negatively affects a single-leg dynamic balance level, single leg balance ability returns to the baseline status after 10 min of passive recovery duration.

Influence Of Ankle Flexibility On The Single Leg Balance Test Using A Dynamic Balance System

Ankle range of motion (ROM) is believed to be one of the contributing factors in balance deficits. Multiple studies have investigated balance in reference to vision, strength, vestibular function, proprioception, and sensation. However, most of these studies have utilized geriatric, athletic, or injured populations focusing on static balance measures. PURPOSE: Although there are multiple factors that play a role in balance, the purpose of this study was to assess the influence of ankle flexibility on dynamic single leg balance in fit and unfit males. METHODS: Twenty-five male subjects (age = 22 + 2 years; ht. = 179 + 7 cm; wt. = 85.6 + 15 kg) were recruited for this study. Ankle flexibility (which includes dorsiflexion, plantarflexion, eversion, and inversion) was measured in degrees for both legs with a goniometer. Subjects then completed four trials, of which the first two trials were familiarization, of the single leg balance test for each leg on a dynamic balance system. Mean stability index (SI) was calculated for the last two trials and both a Pearson Correlation and Independent T-test were utilized. RESULTS: No significant correlations between overall stability and dorsiflexion (p = 0.899), plantarflexion (p = 0.790), eversion (p =.704), and inversion (p =.550) on the left and right ankle were present (p < 0.05). However, there was a significant correlation between inversion of the left ankle and medial/lateral SI (p = 0.022); and between dorsiflexion of the left ankle and anterior/posterior SI (p = 0.049). No significant differences for ankle flexibility or SI occurred between unfit and fit individuals (p < 0.05). CONCLUSION: Results suggest ankle ROM may be a contributing factor in dynamic balance on the non-dominant leg.

Predicting Lower Quarter Y-Balance Test Performance From Foot Characteristics.

The lower quarter Y-Balance Test (YBT-LQ) is associated with injury risk; however, ankle range of motion impacts YBT-LQ. Arch height and foot sensation impact static balance, but these characteristics have not yet been evaluated relative to YBT-LQ. Determine if arch height index (AHI), forefoot sensation (SEN), and ankle dorsiflexion predict YBT-LQ composite score (CS). Descriptive cohort. Athletic training laboratory. Twenty general population (14 females and 6 males; mean [SD]: age 35 [18] y, weight 70.02 [16.76] kg, height 1.68 [0.12] m) participated in this study. AHI measurement system assessed arch height in 10% (AHI10) and 90% (AHI90) weight-bearing. Two-point discrim-a-gon discs assessed sensation (SEN) at the plantar great toe, third and fifth metatarsal heads. Biplane goniometer and weight-bearing lunge tests were used to measure static and weight-bearing dorsiflexion, respectively. The YBT-LQ assessed dynamic single-leg balance. For right-limb dynamic single-leg balance, AHI90 and SEN were included in the final sequential prediction equation; however, neither model significantly (P = .052 and .074) predicted variance in YBT-LQ CS. For left-limb dynamic single-leg balance, both SEN and weight-bearing lunge test were included in the final sequential prediction equation. The regression model (SEN and weight-bearing lunge test) significantly (P = .047) predicted 22% of the variance in YBT-LQ CS. This study demonstrates that foot characteristics may play a role in YBT-LQ CS. The authors did not assess limb dominance in this study; therefore, the authors are unable to determine which limb would be the stance versus kicking limb. However, altered SEN and weight-bearing dorsiflexion appear to be contributing factors to YBT-LQ CS.

Kinesiology tape mediates soccer-simulated and local peroneal fatigue in soccer players

ABSTRACTTo investigate the efficacy of kinesiology taping in mediating the influence of fatigue on ankle sprain risk, 12 male soccer players completed single-leg dynamic balance trials pre- and post-exercise (soccer-specific protocol, isokinetic ankle inversion/eversion protocol) in each of three counter-balanced taping conditions (no tape, zinc oxide tape ZO, kinesiology tape KT). Balance was quantified as the overall stability index (OSI) and directional stability indices of platform deflection. Soccer-specific fatigue only increased OSI in the no tape condition (p = 0.03), with ZO and KT trials negating a fatigue affect. Localized fatigue increased OSI in the no tape (p = 0.01) and ZO (p = 0.05) trials, with no increase in the KT trial. A similar pattern was observed in medio-lateral and anterio-posterior balance indices. KT mediates soccer-simulated and local peroneal fatigue, with practical implications for epidemiological observations of increased injury risk during the latter stages of match play.

Physical impairments in symptomatic femoroacetabular impingement: A Systematic review of the evidence

Background Femoroacetabular impingement (FAI) and accompanying pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of rehabilitation programmes in this patient group. Knowledge regarding physical impairments in individuals with symptomatic FAI is limited. Hypothesis In adults aged 18–50 years with symptomatic FAI, to: (1) identify physical impairments in range of motion (ROM), hip muscle function and functional tasks; (2) to compare physical impairments with healthy controls; and (3) to evaluate the effects of interventions targeting physical impairments. Study design Systematic review. Methods A systematic review of the literature was conducted in accordance with the PRISMA statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined ROM, hip muscle function and functional tasks were included. Standardised mean differences (SMDs) were calculated where possible or best evidence synthesis and study conclusions were presented. Results 22 studies fulfilled all inclusion criteria. Methodological quality was varied (47–82% using Downs and Black Appraisal Criteria). Hip joint ROM did not differ in individuals with symptomatic FAI compared with control participants. Individuals with symptomatic FAI demonstrated deficits in hip muscle strength and reduced dynamic balance on 1 leg when compared with control participants. For hip joint ROM, there were no significant within-group differences between preintervention and postintervention time points. Hip muscle strength improved significantly from prehip to posthip arthroscopy in a single case series. No randomised controlled trails evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI. Conclusions Individuals with symptomatic FAI demonstrate impairments in hip muscle strength and dynamic single leg balance. This information may assist therapists in providing targeted rehabilitation programmes for individuals with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted interventions are effective in symptomatic FAI. Clinical relevance This information may assist therapists in providing targeted rehabilitation programmes for individuals with symptomatic FAI.

Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence

BackgroundFemoroacetabular impingement (FAI) and accompanying pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of...

A Six-Week Neuromuscular and Performance Training Program Improves Speed, Agility, Dynamic Balance, and Core Endurance in Junior Tennis Players

A Six-Week Neuromuscular and Performance Training Program Improves Speed, Agility, Dynamic Balance, and Core Endurance in Junior Tennis Players Tennis requires speed, agility, and explosive power. Few studies have assessed the effects of a training program in junior players who are not on an elite or national level. We evaluated the impact of a program that combined components of a knee ligament injury prevention program with other exercises to improve athletic performance indicators. We hypothesized that this program would significantly improve dynamic single-leg balance and function, correct lower limb asymmetry, enhance speed and agility, and improve core endurance.

Immediate Effects of Core-Stability Exercises and Clinical Massage on Dynamic-Balance Performance of Patients With Chronic Specific Low Back Pain.

Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear. To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome. Randomized, assessor-blind, test-retest. University research laboratory. 10 physically active adults (5 men, 5 women). Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively. The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP). Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side. CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.

Impairment of Dynamic Single‐Leg Balance Performance in Individuals With Hip Chondropathy

Impaired balance control has been reported in the elderly with hip osteoarthritis, yet this relationship has not been explored in young adults with hip chondropathy. This study aimed to determine whether people with hip chondropathy demonstrated impaired balance ability during a dynamic single-leg squat with eyes open (SquatEO) and a single-leg standing task with eyes closed (StandEC) and whether hip range of motion (ROM) and hip muscle strength were correlated with balance measures in adults with hip chondropathy. Sixty-three adults with hip chondropathy and 60 controls performed 2 tasks: SquatEO and StandEC while standing on a Nintendo Wii Balance Board. Center of pressure (COP) movement in mediolateral and anteroposterior directions was extracted. Hip ROM and muscle strength were measured with an inclinometer and dynamometer. Data were analyzed using an analysis of covariance and stepwise multiple regression model. During SquatEO, greater COP mediolateral range (P = 0.023) and anteroposterior SD (P = 0.043) were observed in those with hip chondropathy compared to controls. No significant between-group differences were observed for StandEC. Hip external rotation ROM was significantly associated with mediolateral range during SquatEO. Dynamic single-leg balance squat performance is reduced in people with hip chondropathy compared to healthy adults, but static single-leg standing balance is not. This may be reflective of reduced control of dynamic movements. Those with greater hip joint external rotation ROM appear to have worse single-leg squat balance performance. Further investigation into balance deficits associated with hip disease is necessary to establish early identification strategies and a tailored approach to rehabilitation.

Dynamic single-leg balance performance is impaired in individuals with hip chondropathy

were reduced by surgery while the non-operated knee remained unchanged (Figures 1 & 2). The limb differences in peak 1 and 2 of KAM were significant (p1⁄40.0028 and 0.005, respectively). Both before and after surgery, the non-operated knee did not differ significantly from healthy control in KVA or KAM. The knee was significantly worse than controls in pain scores and spatiotemporal parameters. Conclusions: The study's findings suggest that gait patterns in the nonoperated knee may not change after surgery. The study confirms that there is a limb asymmetry after surgery, with the non-operated limb bearing greater loads than the operated limb, but suggests that the asymmetry likely results from improvements in the operated knee rather than deterioration in the non-operated knee. As a whole, the findings indicated that the surgery itself might not be the catalyst for higher loading patterns postoperatively. Nevertheless, the non-operated knee may still be at risk for OA after surgery due to the limb asymmetry and the persistent higher levels of KAM. Clinicians should consider this when prescribing therapy to patients postoperatively. There should be a focus on caring for the non-operated knee in addition to the operated knee.

Noise-enhanced dynamic single leg balance in subjects with functional ankle instability

Abstract Background Stochastic resonance stimulation (SRS) transmits subsensory electrical Gaussian white noise into the body to enhance sensorimotor function. This therapy has improved static single leg balance in subjects with functional ankle instability. However, the effect of this stimulation on dynamic single leg balance is not known. Improvements in dynamic single leg balance with SRS may have implications for enhancing functional rehabilitation for ankle instability. Thus, the purpose of this study was to determine the effects of SRS on dynamic single leg balance in subjects with functional ankle instability. Methods This study was an experimental research design and data were collected in a sports medicine research laboratory. Twelve subjects with functional ankle instability (69 ± 15 kg; 173 ± 10 cm; 21 ± 2 years) reported a history of ankle sprains and instability at the ankle with physical activity. A single leg jump-landing test was used to assess dynamic balance. Subjects were required to jump between 50% and 55% of the maximal vertical jump height, land on a single leg atop a force plate, and stabilize as quickly as possible. Jump-landing tests were performed with and without SRS. Three trials were performed for each treatment condition (SRS and control). A randomized block design was used to determine test order. Anterior/posterior and medial/lateral time-to-stabilization were computed to assess dynamic balance. Lesser time indicated better stability. One-tailed paired samples t tests were used for analysis ( α ≤ 0.05). Results SRS improved anterior/posterior time-to-stabilization (stochastic resonance = 1.32 ± 0.31 s, control = 1.74 ± 0.80 s, p = 0.03), but did not enhance medial/lateral time-to-stabilization (stochastic resonance = 1.95 ± 0.40 s, control = 1.92 ± 0.48 s, p = 0.07). Conclusion Clinicians might use SRS to facilitate balance improvements with sagittal plane dynamic single leg balance exercises that patients may not be able to perform otherwise.

Balance dysfunction in adults with haemophilia

The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under-explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.