Limb Disorders Research Articles

Clinical Observation of Electro-acupuncture Combined with Early Rehabilitation Training to Treat Hypertensive Cerebral Hemorrhage In Basal Ganglia

In this study, we investigated the clinical efficacy and poor prognosis of patients with limb disorders after the operation of hypertensive cerebral hemorrhage, using the treatment of removing blood stasis and Shengxin acupuncture combined with early rehabilitation training using a randomized trial. A total of 100 patients with the hypertensive intracerebral hemorrhage who underwent surgery in our hospital from May 2019 to May 2021 were selected and divided into control group were treated with early rehabilitation training, and the intervention group was treated with acupuncture for removing blood stasis and promoting new acupuncture based on the control group. We observed that there was no significant difference in the evaluation of limb function recovery between the two groups of patients (P>0.05). After the intervention, the modified Ashworth score, FMA score, and B1 index of the two groups were significantly different in the ADL scores and the scores of families and friends support were remarkably improved. The clinical treatment efficiency of the intervention group was 94.00%, significantly higher than that of the control group of 80.00%, and the difference was statistically significant (P<0.05). The study demonstrated that the rehabilitation training combined with removing blood stasis and Shengxin acupuncture is significantly better than rehabilitation training alone to improve postoperative limb dysfunction, daily life and quality of life and is a clinical treatment for hypertension.

Musculoskeletal Diseases and Disorders in the Upper Limbs and Health Work-Related Quality of Life in Spanish Sign Language Interpreters and Guide-Interpreters

Disorders in the upper limbs are common among sign language interpreters and are related with different risk factors, among which are the difficulties of interpreting work in the educational setting, posture, and emotional together with physical stress. The aim of this study was to inquire about the different musculoskeletal disorders and diseases present in a group of sign language interpreters, and to examine its relationship with the work-related quality of life. A battery of four instruments was administered to 62 sign language interpreters, composed of a sociodemographic data and musculoskeletal disease questionnaire, a health-related quality of life measurement scale (SF-36), a measurement scale of the impact of fatigue (MFIS), and an instrument for assessing hand-function outcomes (MHOQ). All the study participants had presented some kind of musculoskeletal pathology during their work career, such as tendinitis, overuse syndrome, and repetitive strain injury. In addition, many of the participants present difficulties in occupational performance that affect their daily activities. A high percentage, close to 70%, of the interpreters suffer from musculoskeletal disorders, serious enough to modify their activities and affect both the quality of their work as interpreters and their quality of life, with important mediating variables being the number of diseases; physical, cognitive, and social fatigue; and satisfaction with the hand function.

Automated Detection of Improper Sitting Postures in Computer Users Based on Motion Capture Sensors

Prolonged computer-related work can be linked to musculoskeletal disorders (MSD) in the upper limbs and improper posture. In this regard, we report on developing resources supporting improper posture studies based on motion capture sensors. These resources were used to create a baseline detector for the automated detection of improper sitting postures, which was next used to evaluate the applicability of Hjorth’s parameters—Activity, Mobility and Complexity—on the specific classification task. Specifically, based on accelerometer data, we computed Hjorth’s time-domain parameters, which we stacked as feature vectors and fed to a binary classifier (kNN, decision tree, linear SVM and Gaussian SVM). The experimental evaluation in a setup involving two different keyboard types (standard and ergonomic) validated the practical worth of the proposed sitting posture detection method, and we reported an average classification accuracy of up to 98.4%. We deem that this research contributes toward creating an automated system for improper posture monitoring for people working on a computer for prolonged periods.

Translation, cross-cultural adaptation and psychometric properties of Urdu version of upper limb functional index; a validity and reliability study

BackgroundThe upper limb functional index is broadly used outcome measure for musculoskeletal disorders of the upper limb. The main objective of the study was to translate and validate the upper limb functional index (ULFI) outcome measure in the Urdu language.MethodsUpper limb functional index was translated into Urdu language using Beaton et al. guidelines through forward and backward translation along with the expert committee reviews. Two fifty (n = 250) Urdu-speaking patients with sub-acute or chronic conditions of upper limb musculoskeletal disorders were included in the study. The mean age was 32.33 ± 4.67 years. The data were collected from the physical therapy department of The University of Lahore Teaching hospital. All participants completed the upper limb functional index-Urdu (ULFI-U), Numeric pain rating scale (NPRS), Quick Disability of arm, shoulder, and hand (QuickDash), and (health survey) SF-12 at baseline while only ULFI-U at day three. Reliability was assessed through internal consistency by Cronbach’s alpha and test-retest reliability by intra-class correlation (ICC). Content validity was measured by Lynn and Lawshee method. Spearman’s correlation has been used to measure criterion validity. The construct validity was measured through hypothesis testing. The structural validity has been explained through factor analysis by exploratory factor analysis (EFA) using Maximum likelihood extraction (MLE) with Promax rotation.ResultsThe English version of ULFI was translated into the Urdu language with minor alterations. The Urdu version ULFI has demonstrated high levels of reliability with intra-class correlation (ICC2,1= 0.91) and Cronbach’s alpha (α = 0.94). The content validity index found as 0.808, the criterion validity for ULFI-U correlating with quick Dash was found excellent (r = 0.845) and ULFI-U established strong correlation with 6 domains of SF-12(r = 0.697 to 0.767) and weak correlation with its 2 domains and NPRS(r = 0.520). A two-factor structure was obtained using EFA.ConclusionsThe ULFI-U is a valid and reliable patient-reported outcome (PRO) that can be used to assess upper limb musculoskeletal disorders in Urdu-speaking patients.Trial registrationThis study was registered in the U. S National Library on clinicaltrial.gov under registration no. NCT05088096. (Date: 21/10/2021).

Design and development of foot worn piezoresistive sensor for knee pain analysis with supervised machine learning algorithms based on gait pattern

Gait monitoring and analysis have garnered more attention in gait analysis to verify the potential improvements of lower limb disorders like arthritis, trauma, and degenerative disorders. The irregularities in gait often manifest as knee pain or physical discomfort experienced by the patient. Existing vision and floor sensor-based systems have the limitations of operational complexity and high cost that make them uncomfortable for individual use. These limitations led to research interest in the design and development of insole embedded with 102 sensors to detect foot pressure distribution image for detecting lower limb disorder-based problems. The quality of these heat images is enhanced by a hybrid filter (RMSE = 2.748 and PSNR = 39.35) and feature extraction technique is utilized on the enhanced foot pressure images for classification. The KNN learner model yields accuracy of 99.4% in the detection of knee pain.

Effect of a Community-Based Holistic Care Package on Physical and Psychosocial Outcomes in People with Lower Limb Disorder Caused by Lymphatic Filariasis, Podoconiosis, and Leprosy in Ethiopia: Results from the EnDPoINT Pilot Cohort Study.

ABSTRACT.Lymphatic filariasis (LF), podoconiosis, and leprosy are highly stigmatized neglected tropical diseases that can cause lower limb swelling and deformity. Simple interventions to support self-care can reduce their physical impacts, but little is known about how to address the psychosocial needs of people living with the diseases, and about how to scale-up morbidity reduction programs. EnDPoINT is a multistage implementation study designed to address these knowledge gaps by developing and evaluating a holistic care package that can be integrated into the Ethiopian health system. This article presents the quantitative results from the EnDPoINT pilot, in which the effectiveness of the care package was assessed in 251 participants from one district in northern Ethiopian using a pre-post design. Reductions 12 months after care package initiation were seen in attacks of acute adenolymphangitis (adjusted odds ratio for attack in last month 0.005; 95% CI 0.001, 0.02; P < 0.001), lower limb and foot circumference (mean difference lower limb circumference −2.0 cm; 95% CI −2.3, −1.8; P < 0.001; foot circumference −2.3 cm; 95% CI −2.5, −2.0; P < 0.001), and lymphedema stage (mean reduction in stage −0.27; 95% CI −0.37, −0.19; P < 0.001). Significant improvements were also observed in scores assessing disability, quality-of-life, depression, stigma, discrimination, and social support. This study thus suggests that the EnDPoINT care package is highly effective in reducing morbidity in people living with LF, podoconiosis, and leprosy in northern Ethiopia.

Cross-cultural adaptation, reliability, and validity of the Persian version of the Lower Limb Functional Index

Backgroundthe Lower Limb Functional Index (LLFI) is a regional patient reported outcome measure (PROM) for evaluation of lower limb musculoskeletal functional status. No Persian-language (LLFI-Pr) version is available. ObjectivesLLFI translation and cross-cultural adaptation to Persian and psychometric property evaluation. Study designprospective diagnostic assessment. Methodsto establish the LLFI-Pr face and content validity, double forward-backward translation protocols were used plus cognitive interviews and the ‘content validity index'(CVI). Psychometric properties were determined from a convenience sample (n = 307, age 47.18 ± 11.52 years, female = 58.3%) that concurrently completed the LLFI-Pr and Persian Lower Extremity Functional Scale (LEFS-Pr). Test-retest reliability (ICC2,1, sub-sample, n = 64) was determined during a non-intervention period of 3–7 days. Internal consistency used Cronbach's Alpha (α), error used MDC90/95 from the SEM, and construct validity used Pearson's r between the LLFI-Pr and LEFS-Pr. Construct validity used exploratory factor analysis (EFA, suppression = 0.30) with non-Gaussian distribution protocols. Resultspsychometric properties were high for test-retest reliability (ICC2,1 = 0.90) and internal consistency (α = 0.77), moderate for construct validity (r = 0.63), with no floor or ceiling effects, error found SEM = 1.60, MDC90 = 3.7% and MDC95 = 4.42%. A two-factor (EFA) structure (total-variance = 22.01%), that consequently cannot be summated, was determined where five-items failed consistent factor-loading leaving a 20-item version with a high original-LLFI total-equivalency (r = 0.97). However, the general/region-specific item-ratio reduced from the recognized 60/40 ratio to 50/50. Conclusionthe 20-item LLFI-Pr is a valid two-factor solution with sound psychometric properties for research and clinical Persian-language populations with lower limb disorders.

FarmDay: A Gamified Virtual Reality Neurorehabilitation Application for Upper Limb Based on Activities of Daily Living

Patients with upper limb disorders are limited in their activities of daily living and impose an important healthcare burden due to the repetitive rehabilitation they require. A way to reduce this burden is through home-based therapy using virtual reality solutions, since they are readily available, provide immersion, and enable accurate motion tracking, and custom applications can be developed for them. However, there is lack of guidelines for the design of effective VR rehabilitation applications in the literature, particularly for bimanual training. This work introduces a VR telerehabilitation system that uses off-the-shelf hardware, a real-time remote setup, and a bimanual training application that aims to improve upper extremity motor function. It is made of six activities and was evaluated by five physiotherapists specialised in (2) neuromotor disorders and (3) functional rehabilitation and occupational therapy. A descriptive analysis of the results obtained from the System Usability Scale test of the application and a collection of qualitative assessments of each game have been carried out. The application obtained a mean score of 86.25 (±8.96 SD) in the System Usability Scale, and the experts concluded that it accurately reproduces activities of daily living movements except for wrist and finger movements. They also offer a set of design guidelines.

Classification of Chronic Venous Disorders using an Ensemble Optimization of Convolutional Neural Networks.

Chronic Venous Disorders (CVD) of lower limbs are one of the most prevalent medical conditions, affecting 35% of adults in Europe and North America. The early diagnosis of CVD is critical, however, the diagnosis relies on a visual recognition of the various venous disorders which is time- consuming and dependent on the physician's expertise. Thus, automatic strategies for the classification of the CVD severity are claimed. This paper proposed an automatic ensemble-based strategy of Deep Convolutional Neural Networks (DCNN) for the classification of CVDs severity from medical images. First, a clinical dataset containing 1376 images of patients' legs with CVD of 5 different levels of severity was constructed. Then, the constructed dataset was randomly split into training, testing, and validation datasets. Subsequently, a set of DCNN were individually applied to the images for classification. Finally, instead of a traditional voting ensemble strategy, extracted feature vectors from each DCNN were concatenated and fed into a new ensemble optimization network. Experiments showed that the proposed strategy achieved a classification with 93.8%, 93.4%, 92.4% of accuracy, precision, and recall, respectively. Moreover, compared to the traditional ensemble strategy, improvement in the accuracy of ~2% was registered. The proposed strategy showed to be accurate and robust for the diagnosis of CVD severity from medical images. Nevertheless, further research using an extensive clinical database is required to validate the potential of this strategy. Clinical Relevance- An automatic classification of CVD to reduce the probability of underdiagnoses and promote the treatment of CVD in the early stages.

Evaluation of Upper Limb Muscle Activation Using Musculoskeletal Model with Wearable Assistive Device.

In recent years, wearable assistive device has been used to support upper arm movement training for rehabilitation purposes. A wearable assistive device could affect the muscle output during motor tasks to support upper limb disorder rehabilitation training. However, the investigation of muscle activity with the given assistive force is not widely investigated. In this study, the evaluation of upper limb muscle activities using musculoskeletal simulation systems with the developed wearable cable-driven assistive device has been carried out. An experimental protocol consisting of a series of motions was executed with five healthy subjects. Muscle activation on the brachioradialis, biceps, and triceps muscles was measured by using surface electromyography (EMG) and analyzed. The simulations with a musculoskeletal model to estimate muscle output with and without a wearable assistive device were performed for three tasks. An assistive upper arm device was integrated into the musculoskeletal model, and the desired assistive force is translated to the arm joint along with a tendon routing structure. Assisting movement by the wearable device was evaluated by measuring muscle activation with-assist and without-assist conditions. The results show that the use of the wearable assistive device can effectively assist in arm movement. Comparisons of measured EMG muscle data and the musculoskeletal model revealed that muscle force was generated throughout the arm. The integrated musculoskeletal model results show that muscle force values for two primary muscles (biceps and brachioradialis) were reduced during the simulated task when wearing the assistive device. These results are congruent with expectations, with the assistive device that supports the upper limb movement, providing practical assistance. The results highlight the importance of evaluating muscle output for the developed wearable assistive device to support the assistive movement. Lastly, the musculoskeletal simulation system could reduce the resource-intensive, and time consumed with the experimental testing could be achieved.

The Reliability and Validity of a Novel Ankle Isometric Plantar Flexion Strength Test.

Strengthening of ankle plantar flexor muscles is one of the important components in the rehabilitation of many lower limb injuries and disorders. However, there are few simple methods to evaluate ankle plantar flexor strength in clinical situations without using equipment. The purpose of this study was to verify the intraexaminer and interexaminer reliability and the concurrent validity of a novel ankle isometric plantar flexion (PF) strength test (PF break test [PFBT]). Case-control study. The intraexaminer and interexaminer reliabilities of the PFBT were evaluated in 57 orthopedic patients and 30 healthy adults. The range of motion of the ankle joint and the number of heel raises were compared between positive and negative PFBT cases. Then, isometric ankle PF torque (ankle PF of 0°, 15°, and 30°) was compared in knee extension and in the 50° flexion position between positive and negative PFBT cases in 30 healthy adults. The intraexaminer reliability (κ) of the PFBT was .81 to .94, and the interexaminer reliability (κ) was .37 to .74. The PFBT positive group had a significantly smaller range of motion in the ankle joint (P < .05) and a significantly lower number of heel raises (P < .001) than the PFBT negative group in orthopedic patients, but no significant differences in healthy adults. The PFBT positive group had less ankle PF torque than the PFBT negative group at all ankle PF angles (P < .01). The isometric PF torque in the end range of ankle PF in knee extension could predict the results of the PFBT and correctly classified 90.0% of cases (P < .001). The PFBT is considered a simple and valid method to evaluate isometric ankle PF strength in the clinical setting.

Роль функції сидіння в корекції рухових порушень у дітей раннього віку зі спастичними формами нижніх парезів

The article describes the formation of the function of sitting in children with o musculoskeletal system disorders by means of adaptive physical education and therapeutic physical culture. The general methodological significance of the sitting function in children as a kind of transitional stage from the foursupport position of the animal to the two-support orthograde position of a person in space is revealed: philosophical, biomechanical, social aspects. Insufficient use by practitioners of pedagogical (playing) opportunities for the purposeful use of various “sitting” positions to overcome motor disorders in children aged 1–3 years has been found out.. The basic principles of the formation of the sitting function in a child are also formulated: cephalo-caudal, "three-story", "expanding springs", visceral and orthograde. The importance of independent sitting is emphasized for the release of the child's hands for a large object-practical activity that creates conditions for future successful socialization. The necessity of systematic use of the potential of corrective exercises in the sitting position, both in individual work and in group classes in preschool educational institutions, is substantiated. On the basis of practical research (pedagogical research), special sets of exercises were formed to form the sitting function in preschool-age children with spastic type of movement disorders in the lower limbs. Exercises for the flexion variant of spastic disorders, for the extensor and for the adductor, are presented, in which the biomechanical specificity of these disorders is taken into account. After each set of exercises, methodological techniques are given that increase the pedagogical efficiency of the formation of the sitting function in this contingent of children. The specificity of the formation of the function of sitting in preschoolage children was noted depending on the angle of the pelvis (anterior or posterior). It is noted that the prospects for research in this direction lie in the further development of game exercises for the formation of the sitting function in children with spastic syndrome, depending on the characteristics of muscle spasticity in the lower limbs.

Depth Estimation for Egocentric Rehabilitation Monitoring Using Deep Learning Algorithms

Upper limb impairment is one of the most common problems for people with neurological disabilities, affecting their activity, quality of life (QOL), and independence. Objective assessment of upper limb performance is a promising way to help patients with neurological upper limb disorders. By using wearable sensors, such as an egocentric camera, it is possible to monitor and objectively assess patients’ actual performance in activities of daily life (ADLs). We analyzed the possibility of using Deep Learning models for depth estimation based on a single RGB image to allow the monitoring of patients with 2D (RGB) cameras. We conducted experiments placing objects at different distances from the camera and varying the lighting conditions to evaluate the performance of the depth estimation provided by two deep learning models (MiDaS &amp; Alhashim). Finally, we integrated the best performing model for depth-estimation (MiDaS) with other Deep Learning models for hand (MediaPipe) and object detection (YOLO) and evaluated the system in a task of hand-object interaction. Our tests showed that our final system has a 78% performance in detecting interactions, while the reference performance using a 3D (depth) camera is 84%.

Workplace-based rehabilitation with garment workers: A multiple case study.

Garment workers are at risk of developing work-related upper limb disorders (WRULD) due to the highly repetitive nature of their work. Workplace-based rehabilitation (WBR) facilitates improvement in work performance by providing intervention at the worker's place of work. This study aims to determine the documented outcomes of workplace-based occupational therapy rehabilitation of garment workers with upper limb conditions. A multiple case study design was used through a retrospective record review. All garment workers with upper limb conditions who were treated at a student occupational therapy practice in Cape Town, South Africa, with pre- and post-intervention outcome assessment, were included in the study (n = 7). Data were extracted from occupational therapy and medical files. 70% of the cases (n = 5) improved after WBR while 30% of cases showed no improvement or deterioration. Participants received 3- 5 individual WBR sessions of approximately 30 minutes each, over a period of 4 to 6 weeks. Interventions included workstation adaptations, job rotation, psychoeducation, work task modification, assistive technology and exercise programmes. Outcome measures most commonly used were the RULA, DASH, Boston Carpal Tunnel Questionnaire and pain intensity using the VAS. Workplace-based occupational therapy can be effective at improving upper limb function, pain and ergonomic risk amongst garment workers with upper limb conditions.

A Modular Magnetic Resonance Imaging-Compatible Pipette Simulator to Evaluate How Design Affects the Basilar Thumb Joint Mechanics

Abstract People who frequently use micropipettes experience hand and upper limb disorders. The basilar thumb joint, also known as the first carpometacarpal or trapeziometacarpal joint, is commonly affected by osteoarthritis (OA). Mechanical factors are associated with OA initiation and progression. We developed a magnetic resonance imaging (MRI)-compatible modular micropipette simulator to improve understanding of how micropipette design affects basilar thumb joint contact mechanics. The micropipette simulator also addresses limitations of current techniques for studying pipetting and basilar thumb joint mechanics. Its modularity will allow future studies to examine handle design parameters such as handle diameter, cross-sectional shape, and other features. A micropipette simulator with a cylindrical handle (length 127 mm, diameter 25 mm) was used with one subject to demonstrate the system's feasibility. Contact areas were within the range of prior data from basilar thumb joint models in power grasp and lateral pinch, and contact pressures were the same order of magnitude.

Parsonage–Turner Syndrome mimicking musculoskeletal shoulder pain: A case report during the SARS-CoV-2 pandemic era

Parsonage–Turner Syndrome or neuralgic amyotrophy is a peripheral neuropathy typically characterized by an abrupt onset of pain, followed by progressive neurological deficits (e.g. weakness, atrophy, occasionally sensory abnormalities) that involve the upper limb, mainly the shoulder, encompassing an extensive spectrum of clinical manifestations, somehow difficult to recognize. This case report describes the proper management of a 35-year-old, bank employee and sports amateur who reported subtle and progressive upper limb disorder with previous history of neck pain. SARS-CoV-2 pandemic era made patient's access to the healthcare system more complicated. Nevertheless, proper management of knowledge, relevant aspects of telerehabilitation-based consultation for musculoskeletal pain, advanced skills, tools and technologies led the physiotherapist to suspect an atypical presentation of Parsonage–Turner Syndrome. Further, neurologist consultation and electromyography suggested signs of denervation in the serratus anterior and supraspinatus muscle. Therefore, an appropriate physiotherapist's screening for referral is conducted to correct diagnosis and thorough treatment.

Rationale and current evidence of aquatic exercise therapy in venous disease: A narrative review.

Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.

Prevalence of and prevention for work-related upper limb disorders among physical therapists: a systematic review

BackgroundPhysical therapists (PTs) are at increased risk for development of work-related upper limb disorders (WRULDs) due to the physically intensive, constant hands-on nature of the profession. The objectives of this systematic review were to examine the literature on WRULDs among PTs, specifically the (1) 1-year prevalence, (2) workplace risk factors, (3) consequences, and (4) coping strategies utilized to mitigate WRULDs.MethodsA comprehensive search of the literature was performed using PubMed, CINHAL, EMBASE, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for conducting this systematic review. Studies that reported the 1-year prevalence of WRULDs among PTs, workplace risk factors for WRULDs, consequences of WRULDs, and coping strategies utilized by PTs were included.ResultsTwelve studies met the inclusion criteria. The 1-year WRULDs prevalence rates varied widely, with thumb disorders having the highest prevalence (7.6-52.5%), followed by wrist and hand disorders (5-66.2%), shoulder disorders (3.2-45.2%), and elbow disorders (4-16%). Reported risk factors included treating a high volume of patients and frequent performance of manual therapy techniques. Consequences included interference with PTs’ personal and professional activities while coping strategies involved alterations to the work environment, techniques used, and workload.ConclusionsWRULDs remain a persistent threat to the PT workforce, likely due to the hands-on, physically intensive nature of professional activities. An essential strategy to reduce WRULDs is to improve clinicians’ awareness of WRULDs, workplace risk factors, and subsequent consequences of WRULDs. Effective coping strategies are critical to preserve, protect, and prolong PTs’ use of the upper limbs.

Evaluation of skeletal muscle activity during foot training exercises using positron emission tomography

The foot exercises “rock-paper-scissors” and “towel gathering” are widely used in patients with lower limb disorders; however, there are no detailed reports on muscle activity during such training. We quantitatively evaluated the difference in skeletal muscle activity between the two exercises using positron emission tomography. Eight university student athletes were included. Four participants each were assigned to the foot rock-paper-scissors and towel gathering groups. Participants in each group underwent continuous training for 15 min, and received an intravenous injection of 18F-fluorodeoxyglucose. After retraining for 15 min, participants rested for 45 min. Regions of interest were defined in 25 muscles. The standardized uptake value (SUV) in the trained limb was compared with that in the non-trained control limb. SUVs increased in four skeletal muscles (tibialis anterior, peroneus brevis, extensor hallucis brevis, and abductor hallucis) in the rock-paper-scissors group, and in four muscles (flexor digitorum longus, extensor hallucis brevis, extensor digitorum brevis, and quadratus plantae) in the towel gathering group. Thus, foot rock-paper-scissors and towel gathering involved skeletal muscles related to the medial longitudinal arch and toe grip strength, respectively. Given that the two exercises target different skeletal muscles, they should be taught and implemented according to their respective purposes.

Influence of lower limb torque, range of motion, and foot alignment in patellar rotation (Arno angle) in athletes

BackgroundAlterations of frontal plane patellar alignment could be related to lower limb disorders. Clinical assessment must be able to identify the influence of non-local factors in patellar alignment. ObjectiveTo identify the influence of lower limb torque, range of motion (ROM), and foot alignment on patellar rotation in healthy athletes. MethodsThis cross-sectional study was performed with 232 healthy basketball and volleyball elite athletes. Participants were assessed in preseason for: patellar medial and lateral rotation (Arno angle), passive hip internal rotation (IR) ROM, iliotibial band flexibility, hip abductors and external rotators (ER) torque, shank-forefoot alignment (SFA), and ankle dorsiflexion ROM. Hierarchical multiple linear regression was performed to identify if these variables and sex, age, and body mass could be associated with patellar rotation in a standing position. ResultsHip ER isometric torque explained a small part (10%) of the variance of the Arno angle in healthy athletes (R² change=0.10; unstandardized ß=11.74 (95% CI 6.82, 16.65); Standardized Coefficient Beta=0.32) and sex explained 2% of its variance (R² change=0.02; unstandardized ß= 2.42 (95% CI 0.32, 4.52); Standardized Coefficient Beta=0.15). After controlling for sex, hip ER torque explained 9% of Arno angle variance (R² change=0.09; unstandardized ß= 11.09 (95% CI 6.43, 15.76; Standardized Coefficient Beta=0.31). The other variables were not associated with patellar rotation. ConclusionsHip ER torque may influence patellar rotation in different directions (medial or lateral rotation). Possible mechanisms that explain the contribution of higher and lower hip ER torque in lateral and medial patellar rotation, respectively, are discussed.