Knee Pain Research Articles

Erratum to: Can preoperative quantitative sensory testing predict persistent post-operative knee pain following total knee replacement? A systematic review

Erratum to: Can preoperative quantitative sensory testing predict persistent post-operative knee pain following total knee replacement? A systematic review

INFLUENCE OF POPLITEUS MUSCLE MANIPULATION AND QUADRICEPS STRENGTHENING ON ANTERIOR KNEE PAIN IN RUNNERS

Background: Anterior knee pain is prevalent among young athletes, with sports-related injuries accounting for 25–30% of cases. Patellofemoral pain syndrome (PFPS) contributes to up to 40% of knee disorders, with annual prevalence rates reported at 22.7% in the general population and 28.9% in adolescents. Among runners, the incidence of PFPS ranges from 37% to 56%. Objective: The popliteus muscle is primarily associated with anterior knee pain but may also influence posterior knee discomfort. This study aims to investigate the effects of soft tissue manipulation of the popliteus muscle combined with quadriceps strengthening exercises on anterior knee pain in athletic runners, addressing a gap in the literature regarding the interaction between these muscle groups. Methods: In this experimental study, 30 subjects with non-traumatic anterior knee pain were recruited. Baseline assessments included quadriceps strength and pain levels. Participants then underwent six sessions of popliteus manipulation alongside quadriceps strengthening exercises. Post-intervention, all parameters were reassessed. Results: A significant reduction in knee pain (P < 0.005) was observed after the six-week intervention, with more pronounced improvements in Group A compared to Group B. Conclusion: The results suggest that incorporating popliteus soft tissue manipulation can effectively reduce anterior knee pain while strengthening the quadriceps enhances muscle function. These findings support the integration of popliteus manipulation into treatment protocols for athletes experiencing anterior knee pain.

Association of neighborhood-level disadvantage beyond individual sociodemographic factors in patients with or at risk of knee osteoarthritis

ObjectiveLower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES.MethodsThe current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes.ResultsLiving in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes.ConclusionThe ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients’ risk profile for chronic pain outcomes.

Knee pain in primary care medicine : diagnostic and therapeutic approach

Knee pain is one of the most common musculoskeletal complaints in primary care medicine. The leading causes of knee pain are osteoarthritis and musculoskeletal disorders. A careful history and a rigorous clinical examination usually enable a diagnosis to be made without the need for further investigations. A systematic search for red flags helps identify patients requiring urgent and specialized care. When necessary, X-rays and ultrasound are the first-line imaging tests to perform. The latter can be used to guide a joint puncture for diagnostic and therapeutic purposes. This article reviews the diagnostic approach and summarizes the management of the main pathologies encountered in the general practitioner's office.

Added value of pre-procedural magnetic resonance angiography in transarterial embolization for refractory musculoskeletal pain

BackgroundTransarterial microembolization (TAME) is a minimally invasive treatment for chronic musculoskeletal disorders. Identifying angiogenesis and the supplying vessels of the target joint is important but challenging. Although magnetic resonance imaging (MRI) is commonly used to diagnose musculoskeletal diseases, it typically excludes vascular imaging. Dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) has the ability to visualize lesion angiogenesis, identify supplying vessels, and evaluate the vasculature anatomy. We propose that incorporating DCE-MRA into pre-procedural assessments can help identify the culprit vessels, arterial anatomy, and variant assessment of the target joint before TAME.Materials and methodsWe investigated six cases, each presenting pain in different body parts: shoulder adhesive capsulitis, trapezius myalgia, combined tennis and golf elbow, knee osteoarthritis, refractory knee pain after osteotomy, and plantar fasciitis. All patients underwent MRI with DCE-MRA before undergoing TAME. DCE-MRA was performed using either 1.5 T or 3 T MRI scanners, employing 3D-TRICKS or 4D-TRAK XD techniques. The numerical rating scale for pain was evaluated at one, three, and six months after the procedure, and any adverse events were recorded over the entire six-month follow-up period.ResultsPre-procedural DCE-MRA helped to visualize angiogenesis at the lesion site in all patients and identify the supplying vessels, arterial vasculature anatomy, and branching variants. These findings corroborated the subsequent digital subtraction angiography (DSA) findings obtained during TAME. All patients experienced pain reduction and functional improvement after TAME without any complications. The average pain score reduced significantly after TAME treatment (p &amp;lt; 0.05). Two patients underwent a second MRI and DCE-MRA at the six-month follow-up and showed a significant reduction in angiogenesis.ConclusionDCE-MRA offers a valuable pre-procedural assessment tool for TAME procedures by facilitating the visualization of angiogenesis at the lesion site, supplying vessels, and arterial anatomic variants, including the variable orifice of the supplying branches. This information can potentially improve patient selection and pre-procedural planning, leading to better outcomes and reduced risk of complications.

Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis.

Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects. An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale. Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0-160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome. This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient. Systematic review and meta-analysis. Level III.

Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada.

To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services. All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age. Multivariate regressions were used to examine determinants of the outcomes. In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI. Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.

Trajectories of Obesity Indices and Their Association with Pain in community-dwelling older adults: Findings from the English Longitudinal Study of Ageing

BackgroundThe prevalence of pain has increased with the increase of obesity, and finding indicators to predict pain risk has become an urgent need. BMI, WC, and WHtR have the potential to be excellent predictors. However, the association of these obesity indicators with various pains remains unclear. MethodsThis longitudinal cohort study included 2,155 pain-free participants (mean age = 68.5 years, standard deviation [SD] = 8.6) from the English Longitudinal Study of Ageing (ELSA). BMI, WC, and WHtR were measured during nurse visits at waves 0, 2, and 4. The Group-Based Trajectory Model (GBTM) was used to identify optimal trajectories for BMI, WC, and WHtR. Self-reported pain at four anatomical sites (lower back, hip, knee and total pain) was assessed at Waves 4 to 9. Cox proportional hazards models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obesity indices and pain risk. ResultsOver a median follow-up period of 7.49 years, we observed 1,059 incident cases of all-cause pain. After adjusting for confounders, participants in the High-Stable WC group had a 30% higher risk of experiencing pain (HR: 1.30, 95% CI: 1.05–1.60, P = 0.014), while those in the High-Stable WHtR group had a 29% higher risk (HR: 1.29, 95% CI: 1.06–1.56, P = 0.010) compared to the Low-Stable group. High-stable trajectories for BMI, WC, and WHtR were also associated with an elevated risk of back, hip, and knee pain. ConclusionThis study identifies long-term obesity indices as significant predictors of pain, suggesting the importance of monitoring these measures for effective clinical risk assessments. Further research is needed to explore the underlying mechanisms of these associations.

Cross-cultural adaptation and validation of a revised Italian Anterior Knee Pain Scale version.

The study aimed to validate a revised Italian version of the Anterior Knee Pain Scale (AKPS) by addressing shortcomings in previous adaptations and following the COSMIN guidelines to ensure robust psychometric evaluation. One hundred thirty patients with anterior knee pain symptoms were recruited, with 65 undergoing a retest after 7 days to assess the scale's reliability. Structural validity was assessed through confirmatory factor analysis (CFA) to evaluate the scale's dimensionality. Internal consistency was measured using Cronbach's alpha, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Measurement error was evaluated using the standard error of measurement (SEM) and the smallest detectable change (SDC). Construct validity was examined by correlating the AKPS with other established scales, including the Knee Injury and Osteoarthritis Outcome Score, Internal Knee Documentation Committee, Victorian Institute of Sport Assessment - Patella, Short-Form 36 Health Survey, and the Visual Analogue Scale. The CFA supported a three-factor model encompassing pain intensity and interference, functional limitations in daily activities, and knee structural and functional issues. The scale demonstrated good internal consistency (Cronbach's α=0.79) and excellent test-retest reliability (ICC=0.91), with low measurement error (SEM<5%). Construct validity was confirmed through moderate-to-strong correlations with related scales, particularly in domains related to pain intensity, symptoms, and daily functioning. The newly validated scale, demonstrating strong psychometric properties, meets international standards for clinical assessment tools, making it a reliable and effective instrument for assessing anterior knee pain in the Italian context.

Toe-in and toe-out gait retraining interventions for individuals with knee osteoarthritis trial: A pilot randomised clinical trial

BackgroundGait retraining, through altering foot progression angle, has the potential to reduce pain and offload the medial tibiofemoral compartment in people with knee osteoarthritis. This pilot study aimed to evaluate the feasibility of toe-in and toe-out gait retraining on self-reported pain and physical function, and proxy measures of medial knee load, in individuals with medial knee osteoarthritis. MethodsTwenty participants with symptomatic medial knee osteoarthritis were randomly allocated to receive either toe-in or toe-out gait retraining for six-weeks, consisting of weekly clinician-supervised sessions and ≥ 30 min of daily self-practice. Feedback was guided by wearable sensors and a pressure-sensitive mat. Primary outcomes included recruitment rate, data completeness, adverse events, adherence, achievability, and intervention acceptability. Secondary outcomes were proxy measures of medial knee load, self-reported pain and physical function. Differences in feasibility and self-reported outcomes were interpreted via sample t-test using intention-to-treat analysis. The effect of the intervention group on knee biomechanics was evaluated using linear mixed modelling. FindingsRecruitment was acceptable (n = 4/month) with excellent data completeness (93 %) and attendance (82 %). Acceptability was moderate and similar between groups. There were no differences in average knee pain and physical function between groups over time, and both groups reduced maximum knee pain following the intervention (35 % improvement, p = 0.012). There were no differences in biomechanical outcomes between groups over time. InterpretationToe-in and toe-out gait retraining is feasible and improves pain in people with knee osteoarthritis. A full-scale randomised clinical trial is warranted and should consider individualising the intervention.

Effect of repeated intra-articular administration of collagen as a treatment for knee osteoarthritis: a case report.

Intra-articular injections aimed at correcting underlying pathophysiological processes and providing pain relief are essential for managing knee osteoarthritis (KOA). Collagen, the primary component of articular cartilage, has a long half-life, making it a promising candidate for intra-articular injections with a low risk of serious side effects. The first of the two cases in this report involved a woman in her early 70s with a 6-year history of persistent left knee pain. The second case involved a woman in her mid-50 s with a >7-year history of right knee pain. Both patients received hyaluronic acid injections every 6 months, totaling 10 injections over 5 years. They were diagnosed with Kellgren-Lawrence grade 2 KOA. The patients received two 3-mL intra-articular injections of 6% collagen, administered at baseline and 6 months later. Improvements in clinical outcomes, including visual analog scale scores and Western Ontario and McMaster Universities Osteoarthritis Index scores, were observed and maintained in both patients, with no side effects reported. In summary, when collagen injections were administered to these two patients with KOA, clinical improvements lasted approximately 6 months, and repeated treatments demonstrated efficacy and safety similar to the initial course.

P32 A case of disseminated pneumococcal infection with musculoskeletal manifestations

Abstract Introduction Septic arthritis should be the first consideration in any patient presenting with a hot, swollen joint. Infection may affect one or more joints, and bacteria typically enter the joint through direct inoculation, haematogenous seeding, or spread from adjacent soft tissue or bone infection. Staphylococcus aureus is the most common causative organism. Streptococcus pneumoniae is an uncommon cause of septic arthritis, accounting for approximately 5% of cases. We present the case of a 78-year-old male with no significant medical history who presented with a polyarticular pattern of joint inflammation related to disseminated pneumococcal infection. Case description The patient presented with a one week history of gradual onset pain and swelling in the right knee and right wrist. He was previously well and remained physically active. He was a non-smoker, drank moderate alcohol and had no history of intravenous drug use. He had no current or preceding infective symptoms, including respiratory tract symptoms, nor history of trauma or recent foreign travel. Examination revealed a warm right knee effusion with restricted range of movement. There was swelling of both wrists (right more than left), both second metacarpophalangeal joints and the left ankle. There were no heart murmurs or peripheral stigmata of endocarditis. He was afebrile and haemodynamically stable. Admission blood tests showed WBC 21 x109/L, neutrophils 18 x109/L, CRP 369 mg/L, urate 452 µmol/L and procalcitonin 3.84 µg/L. Rheumatoid factor was 25.3 IU/mL with negative anti-CCP. Knee X-ray showed significant medial compartment osteoarthritis. Hand and wrist X-rays were unremarkable. Synovial fluid aspirate from the right knee grew Streptococcus pneumoniae and calcium pyrophosphate crystals were also seen on polarised light microscopy. Blood cultures were positive for the same organism. The patient underwent arthroscopic washout of the knee and was treated with colchicine and intravenous amoxicillin. He was taken to theatre for a right wrist washout, however the wrist was found to be clean and dry intraoperatively. He had two further washouts of the right knee and repeat intraoperative samples and blood cultures were negative. Additional screening for HIV, syphilis and myeloma was negative. Transthoracic echocardiogram showed no vegetations. CT chest showed basal atelectasis but no focal consolidation. Left hand and wrist MRI showed extensor compartment tenosynovitis and second metacarpophalangeal joint synovitis. His antibiotics were switched to intravenous ceftriaxone and oral doxycycline. He clinically improved and was discharged with a plan to complete a 6-week course with outpatient review. Discussion Streptococcus pneumoniae is an uncommon cause of septic arthritis, responsible for approximately 5% of all cases, but more often causes polyarticular infection than other organisms. This may be related to higher rates of bacteraemia in patients with pneumococcal septic arthritis. In one review of 190 cases of pneumococcal septic arthritis, polyarticular infection was present in 36% of patients and 72% had concomitant bacteraemia (compared with rates of approximately 20% polyarticular infection and 30-50% bacteraemia for septic arthritis overall). The joints most commonly affected are the knee, followed by the hip, shoulder, ankle and elbow. The original focus of infection is most commonly pneumonia or meningitis, but up to 50% of patients have no identifiable extra-articular source of infection. Pneumococcal septic arthritis more commonly affects patients with predisposing risk factors, such as rheumatoid arthritis, osteoarthritis, joint prosthesis, alcoholism, myeloma and other malignancies, diabetes and immunosuppression. Our patient had no specific predisposing medical conditions other than knee osteoarthritis, and his age was likely to be his main risk factor. It is also important to note that septic arthritis in the elderly can present atypically, with insidious onset and absence of fever or other signs of systemic infection. This was the case in our patient, who despite bacteraemia and markedly elevated inflammatory markers, did not otherwise appear floridly septic or unwell. Our patient presented with a polyarticular pattern of joint inflammation, although joint infection was only ultimately confirmed in the right knee. Also notable was the presence of calcium pyrophosphate crystals in the aspirate. One might theorise whether the infection might have triggered a reactive polyarthropathy or concurrent crystal arthritis. It is well recognised that septic arthritis and crystal arthritis can coexist in the same patient. The case also highlights the value in sampling multiple joints and taking blood cultures in such patients. Key learning points • Polyarthritis does not exclude the possibility of septic arthritis • Joint aspiration should be performed in all patients presenting with a hot, swollen joint • In cases of polyarthritis, consideration should be given to aspiration of all affected joints and taking blood cultures, particularly in the elderly and patients with predisposing risk factors for septic arthritis • Septic arthritis can present atypically in the elderly, with the absence of fever and other typical signs of systemic infection

Pain during prolonged sitting in subjects with patellofemoral pain in Dutch physical therapy clinics: an online questionnaire-based analysis

ObjectivesThis study aimed to describe (1) differences between subjects with patellofemoral pain (PFP) with and without pain during prolonged sitting (PDPS), (2) minimum knee flexion angle and time to onset/disappearance of PDPS and (3) differences between those with PDPS at smaller/greater flexion angles and with fast/slow onset and disappearance of PDPS.DesignPatient-reported online questionnaire.SettingPrivate physical therapy clinics in the Netherlands between May 2021 and March 2023.Participants87 participants (61 (70%) females, mean age 22.0 years (IQR 4.0), body mass index 23.1 (4.7)).Outcome measuresVisual Analogue Scale for worst pain (VAS-W) and sitting pain (VAS-W sitting), the Anterior Knee Pain Scale (AKPS), knee flexion angle to provoke PDPS and time to onset/disappearance of PDPS.Results63 of 87 (72%) participants reported PDPS. Participants with PDPS experienced bilateral symptoms of PFP more frequently (71% vs 46%, p=0.44) and scored 12 points lower on the AKPS (p&lt;0.001). Most participants (85%) reported a minimum knee flexion angle of ≥90°, median time to PDPS onset of 16–20 min and 6–10 min for disappearance. Participants experiencing PDPS at smaller flexion angles exhibited higher VAS-W and VAS-W sitting scores (7.0 (1.0), 6.8 (1.1)) than those at greater flexion angles (5.0 (3.0), for both) (p=0.002, p=0.001). Participants with fast onset of PDPS reported higher VAS-W and VAS-W sitting scores (7.0 (2.0), 6.0 (2.0)) than those with slow onset (5.0 (3.0), 5.0 (4.0)) (p&lt;0.001, p=0.025).ConclusionsParticipants with PDPS reported higher levels of disability than those without. PDPS was typically induced at knee flexion of ≥90°, with delayed onset/disappearance. Higher pain levels were reported by those experiencing PDPS at smaller knee flexion angles or with faster onset. Future research should explore the mechanisms of PDPS and develop targeted interventions to improve long-term outcomes.

Multi-centre Modified Delphi Exercise to Identify Candidate Items for Classifying Early-Stage Symptomatic Knee Osteoarthritis

To generate a list of candidate items potentially useful for discriminating individuals with Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) from those with other conditions and from established osteoarthritis (OA), and to reduce this list based on expert consensus. We conducted a three-round online international modified Delphi exercise with OA clinicians and researchers ("OA experts"). In Round 1, participants reviewed 84 candidate items and nominated additional item(s) potentially useful for EsSKOA classification; those nominated by ≥3 participants were added. In Round 2, participants rated perceived usefulness of 108 items (1 [not at all useful] to 9 [extremely useful]). In Round 3, participants could revise their ratings after reviewing Round 2 group median and quartiles. Following Round 3, we retained items with a median usefulness score >5 and ≥33.3% of participants categorized the item as useful (7 to 9), overall and in subgroup analysis by clinician field. There were 128 participants in Round 1 and 113 (88%) completed all rounds. We retained 77 items that spanned multiple domains (demographics, symptoms, physical exam, performance-based measures, imaging, laboratory investigations, and gross inspection/arthroscopy). Highly rated items included (median usefulness score): prior knee joint injury (8), diagnosis of OA in a different joint (7), and activity-related knee pain (7). The interquartile range was most often 3. We identified 77 items that OA experts consider potentially useful for EsSKOA classification. The results highlight experts' uncertainty around item usefulness. Next, candidate items will be further assessed and reduced using data-driven and multicriteria decision analysis methods.

Changes in daily sedentary time, in adolescents with long-standing knee pain, during a management strategy including activity modification: An ancillary analysis of two clinical trials.

Changes in daily sedentary time, in adolescents with long-standing knee pain, during a management strategy including activity modification: An ancillary analysis of two clinical trials.

Effects of Physical Activity Level and Sedentary Behavior on the Musculoskeletal System in Young Adults

Aim: The aim of this study is to investigate the relationship between the level of physical activity and sedentary behavior in young adults aged 18-35 and to evaluate the effects of this relationship on musculoskeletal pain, posture, muscle shortness, and trunk muscle endurance. Methods: In this cross-sectional descriptive study, conducted at the Faculty of Health Sciences of a university between March 2018 and August 2018, 219 students were included. Data were obtained by using the case report form which determines the demographic characteristics and sedentary behavior of the students, The International Physical Activity Index - short form, posture analysis form, muscle shortness evaluation form, and trunk muscle endurance evaluation form. Results: In the study, 66.2% of patients were female and 33.8% were male. In the evaluation of physical activity level, the ratio of highly active individuals in males, and inactive and insufficiently active individuals in females was significantly higher (p &amp;lt;0.05). Musculoskeletal pain was significantly higher in inactive and insufficiently active individuals (p&amp;lt;0.001). A negative correlation existed between physical activity level and pain frequency, duration, and scores (p&amp;lt;0.001). There was a positive correlation between trunk endurance tests and physical activity and exercise participation. Non-exercisers showed shortening of lumbar extensor muscles and gastrosoleus, with increased thoracic kyphosis (p&amp;lt;0.05). Daily sitting time correlated positively with elbow, wrist, and knee pain, and lumbar lordosis (p&amp;lt;0.05). Those spending more time at the computer experienced higher levels of head-neck and elbow pain, pain duration, muscle shortness, thoracic kyphosis, shoulder protraction, and anterior head tilt (p&amp;lt;0.05). Conclusion: In young adults, increasing physical activity and reducing daily sitting time are necessary to prevent musculoskeletal pain and reduce postural deformities. Keywords: Musculoskeletal diseases, musculoskeletal pain, physical exertion, posture, sedentary behavior, trunk muscular endurance, young adult.

Muscle characteristics of lower limb in association with physical activity in candidates of total knee arthroplasty with knee osteoarthritis

Background&AimsThis study aimed to clarify the association between physical activity (PA) and physical functions, including both muscle quantity and quality of ankle plantar flexor muscles in patients with knee osteoarthritis (OA). MethodsA retrospective cohort study was conducted with ninety-two patients with knee OA. PA, leg muscle cross-sectional area (CSA), knee strength, passive knee angle, and knee pain of the affected side were assessed. PA was assessed by the 2011 Knee Society scoring system. CSA of the quadriceps and ankle plantar flexor muscles on the affected side was measured using a computed tomography image. Based on muscle attenuation assessed with Hounsfield units (HU), the muscle quality of targeted muscle was divided into 4 groups as follows: fat tissue (-190 to -30 HU), very low-density muscle (-29 to -1 HU), low-density muscle (0 to 34 HU), and normal-density muscle (NDM, 35 to 100 HU). The CSA was obtained for each of the 4 groups. Univariate and multivariate linear regression analyses were performed to determine the factors associated with PA. ResultsThe regression analysis revealed that higher PA was independently associated with the NDM CSA of ankle plantar flexor (β = 0.51), higher knee extension strength (β = 0.28), and milder knee pain (β = -0.29) after adjustment with age, sex, height, weight, and body mass index. ConclusionThe present study suggested that NDM CSA of ankle plantar flexor in addition to knee function is one of the factors determining the PA in patients with knee OA.

The effect of PNF combination exercise therapy on shin splint injuries in marathon runners

Training at high intensity without proper warm-up and cool-down can cause shin splint injuries in runners. This may lead to a decline in the athlete’s performance during training and competition. This study aims to determine the effect of PNF training therapy on shin splint injuries in marathon runners. This research employs a quasi-experimental approach with a One Group Pretest-Posttest Design. Data collection methods include tests and measurements using a goniometer to assess joint range of motion (ROM) and the Visual Analogue Scale (VAS) to measure pain levels. The population in this study consisted of running athletes from the Yogyakarta running community, with a sample of 16 individuals selected based on specific criteria. The study results showed a significant average reduction in knee pain of 1.00 and ankle pain of 0.94. Additionally, an increase in knee ROM was observed: flexion increased by 7.81; extension by 7.82; adduction by 4.25; and abduction by 3.75. Ankle ROM also increased: dorsiflexion by 5.94, plantarflexion by 3.62, inversion by 3.57, and eversion by 2.68.

Effectiveness of Ali Satia Graha massage therapy method on increasing range of motion and reducing knee pain in pre-elderly

This study aims to test the effectiveness of the Ali Satia Graha massage therapy method on increasing Range Of Motion (ROM) and reducing knee pain in pre-elderly. This study is a pre-experimental study using a One Group Pretest-Posttest research design. The population in this study was pre-elderly patients with knee injuries at the Ali Satia Graha Method Sports Injury Massage Therapy Service at Plaza UNY. The study used incidental sampling with a sample size of 17 people. The data collected were: (1) The scale of Range Of Motion (ROM) of the knee joint was measured using a goniometer. (2) The scale of knee joint pain was measured using the Numeric Rating Scale (NRS). The data analysis technique used a quantitative descriptive analysis and hypothesis testing using the Wilcoxon Signed Rank Test with a significance level of 5%. The results of the study showed that: (1) massage therapy could reduce knee joint flexion motion pain with an effectiveness of 54.9%. (2) Massage therapy could reduce knee joint extension motion pain with an effectiveness of 56.1%. (3) Massage therapy could increase the Range Of Motion (ROM) of knee joint flexion with an effectiveness of 10.2%. (4) Massage therapy could increase the Range Of Motion (ROM) of knee joint extension with an effectiveness of 48.8%. It can be concluded that the massage therapy applied in the Ali Satia Graha Method Sports Injury Massage Therapy Service was effective in increasing ROM and reducing knee joint pain in pre-elderly.

Exercise and footwear in medial knee osteoarthritis: a randomized controlled trial comparing flat flexible footwear to stable supportive shoes

Abstract Objective This randomized controlled trial (RCT) investigated whether adding daily use of flat flexible footwear (FFF) to a strengthening and aerobic exercise programme improved short- and longer-term outcomes compared to adding stable supportive shoes (SSS) in people with medial tibiofemoral osteoarthritis (OA). Methods Participants (n = 97) with medial tibiofemoral OA were randomly assigned (1:1) to FFF (n = 50) or SSS (n = 47) group. Participants in both group received a 9-month intervention (3 months supervised followed by 6 months unsupervised exercise). The primary outcome was change in knee pain on walking at 3 months measured using a 11-point numeric rating scale (NRS). Secondary outcomes included change from baseline to 3 and 9 months in severity of knee pain overall (NRS), physical function (WOMAC subscale), habitual physical activity level (PASE), quality of life (QoL) (EQ-5D-5L), and markers of inflammation (Effusion- and Hoffa-synovitis) and structural disease progression (bone marrow lesions (BMLs)). Results There were no significant differences between the groups in the change in pain on walking (between-group difference, -0.67 [95% CI, -1.62 to 0.29]) at 3 months. Knee pain on walking and overall knee pain significantly decreased in both groups at 3 months and 9 months. Physical function and QoL improved in both groups at 3 months and at 9 months. We found no between-group differences in any secondary outcome at any time. Conclusions FFF added to exercise therapy did not provide additional better symptom- nor structure-modification benefit compared to conventional SSS and exercise in people with medial tibiofemoral OA. Clinical trial registration number ClinicalTrials.gov (NCT03796832)