Low-impact Activities Research Articles

Osteosarcoma/Ewing Sarcoma

Osteosarcoma/Ewing Sarcoma

Return to Physical Activity following Flatfoot Reconstruction

Category:Hindfoot; Midfoot/Forefoot; SportsIntroduction/Purpose:Progressive collapsing foot deformity (PCFD) is a condition encompassing multiple interrelated, progressive bony and soft tissue deformities, often requiring surgical correction. Patients are often debilitated, with postoperative goals commonly cited as walking and low-impact activities without pain. However, some patients engage in sports and more rigorous activities. Surgeons may struggle to set expectations after surgery since few studies investigate returns to activity following flatfoot reconstruction and every patient is different. Existing studies are limited by small sample sizes, lack of data of activity-specific data, and cohorts confined to one or two of the many possible concomitant procedures in flatfoot reconstruction. This study aims to provide the first generalizable assessment of returns to sports and physical activity following reconstruction surgery in patients with flexible PCFD.Methods:Patients who underwent reconstructive surgery from February 2016-May 2019 for flexible-stage PCFD were identified by registry review and contacted with IRB approval. 70/119 patients (72/121 feet, 60%) were reached at mean 3.1 (range, 2.0 to 5.4) years post-operatively with mean age 43.5 (range, 18 to 59) years at surgery. Concomitant procedures were noted. Physical activity was evaluated with a previously published questionnaire that assessed participation in 15 sports and activities, allowed patients to list additional activities, and classified activities as high or low-impact. Patients specified postoperative number of sessions per week, session duration, return times to participation and maximal activity, relative pre/postoperative difficulty, and satisfaction with outcome regarding sports. Clinical outcomes were evaluated with Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Multivariable regressions assessed associations between PROMIS domain changes and survey responses and linear models measured association of sports participation with the most performed procedures, controlling for concomitant procedures.Results:Patients experienced significant improvements in all PROMIS domains except Depression and surpassed previously reported minimal clinically important differences for PCFD in Physical Function and Pain Interference scores. Patients reported participation in 21 specific sports and activities (Table 1). Compared to preoperatively, patients rated 16.7% (45/270) of activities as more difficult postoperatively, 33.3% (90/270) as equally difficult, and 50% (135/270) as less difficult. Median return times were 6-9 months for participation in activities and 13-18 months to reach maximum preoperative participation. Patients spent a median 7.6 (range, 0-29.8) hours/week engaged in physical activity. 3% of patients (2/72) were sedentary, 31% (22/72) were moderately active, 28% (20/72), were highly active and 36% (26/72) were extremely active. Improvements in Physical Function (P=.021), Pain Interference (P=.001), and Global Physical Health (P=.001) were associated with increased outcome satisfaction regarding physical activities. No associations were found between procedures performed and any PROMIS domains or return parameters.Conclusion:This is the largest and most comprehensive analysis of patient participation in sports and physical activities following flatfoot reconstruction. Results suggest that flatfoot reconstruction surgery generally results in good returns to physical activity in terms of return time, pre-postoperative difficulty changes, and satisfaction. Some patients reported increased difficulty or inability to return to their preoperative maximum level of participation, indicating that flatfoot reconstructions can lead to some athletic limitations. However, ninety percent of patients reported satisfaction with their surgical outcomes with respect to returns to physical activity, indicating that, for most patients, flatfoot reconstruction provides meaningful relief from debilitation.

Overstretching Expectations May Endanger the Success of the "Millennium Surgery".

Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (F res) and torsion torque (M tors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased M tors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with F res of up to 5436 N and M tors of up to 108 Nm in the working age group, which were higher than the F res (5276 N) and M tors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.

Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10–15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.

In vivo analysis of hip joint loading on Nordic walking novices

ObjectiveTo evaluate the influence of Nordic walking (NW) on hip joint loads in order to determine whether it can be safely performed during postoperative physiotherapy in patients after orthopeadic surgery of the hip.MethodsInternal hip joint loads were directly measured in vivo in 6 patients using instrumented hip prostheses during NW and ordinary walking (OW). All patients received training in two different NW techniques (double-poling and the diagonal technique) by a certified NW instructor. Measurements were conducted on a treadmill at a speed of 4 km/h on level ground, at 10% inclination and at 10% slope as well as on a level lawn at a self chosen comfortable speed. Resultant contact force (Fres), bending moment (Mbend) and torsional torque (Mtors) were compared between NW and OW as well as between both NW techniques.ResultsJoint loads showed a double peak pattern during all setups. Neither NW technique significantly influenced hip joint loads at the time of the first load peak during contralateral toe-off (CTO), which was also the absolute load peak, in comparison to OW. Compared to OW, double-poling significantly reduced Fres and Mbend at the time of the second load peak during the contralateral heel strike (CHS) on level ground both on the treadmill (− 6% and − 7%, respectively) and on the lawn (− 7% and − 9%). At 10% inclination, the diagonal technique increased Fres and Mbend at CHS (by + 6% and + 7%), but did not increase the absolute load peak at CTO.ConclusionJoint loads during NW are comparable to those of OW. Therefore, NW can be considered a low-impact activity and seems to be safe for patients that are allowed full weight bearing, e.g. during postoperative rehabilitation after THA.

Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition.

The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically. Therefore, we aimed to evaluate the risk factors associated with fragility fractures in children with LTNC. In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC on follow-up in the paediatric neurology clinic and patients who presented with fracture to the paediatric orthopaedic clinic. Information on patients' demographics, medical history, intervention, biochemical bone markers and fracture history was collected. In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (Gross Motor Function Classification System [GMFCS] V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or were on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% and 33% of the patients had undergone measurements of vitamin D and calcium levels, respectively. The local prevalence of fragility fractures in children with LTNC on follow-up at the neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimise bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight children, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Commentaries on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Commentaries on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Too Close for Comfort: Cyber Terrorism and Information Security across National Policies and International Diplomacy

This article analyses the evolution and interplay of national policies and international diplomacy on cyber terrorism within and across the UNSC’s permanent five members and the UN process on cyber norms (GGE and OEWG). First, it reveals how – through the extension of preemptive measures to low-impact cyber activities and online content – national policies progressively articulate cyber terrorism as an issue of information security. Second, it problematizes how – through the adoption of comprehensive and imprecise definitions – the diplomatic language on cyber terrorism might lend international support to those authoritarian regimes keen on leveraging counter-terrorism to persecute domestic oppositions and vulnerable groups. Third, it concludes that – with UN diplomatic efforts increasingly discussing countering (dis)information operations – combining normative debates on cyber terrorism with those on information security requires precision of language to safeguard human rights globally.

Recreational activity after cementless total hip arthroplasty in patients older than 75 years

IntroductionThis retrospective study aimed to compare activity levels before and at mid-term follow-up after primary cementless total hip arthroplasty (THA) in patients older than 75 years.Materials and methodsA cohort of 79 patients with a mean age at surgery of 78 years (range 76–84 years) was evaluated 6.3 years (range 4–8 years) after cementless THA due to osteoarthritis and was followed up with a questionnaire to determine their activity level. Pre- and post-operative recreational activities were assessed at routine follow-up using the University of California, Los Angeles activity score, and the Schulthess Clinic sports and activity questionnaire. Post-operative health-related quality of life was measured using Veterans Rand 12-item survey (VR-12).ResultsSix years after THA, 72% of preoperatively active patients had returned to activity. Comparing activity preoperatively (before the onset of symptoms) and 6 years after THA, the number of disciplines and session length has decreased significantly. A significant decline in high-impact activities was observed, while participation in low-impact activities significantly increased.ConclusionThe majority of patients maintained a recreational activity level in the mid-term after primary cementless THA. However, a change in disciplines toward low-impact activities was observed.

Depression, childhood trauma, and physical activity in older Indigenous Australians.

Indigenous Australians experience higher levels of psychological distress compared to the general population. Physical activity is a culturally acceptable approach, associated with reduction of depressive symptoms. The protective properties of physical activity for depressive symptoms are yet to be evaluated in older Indigenous Australians. A two-phase study design comprised of a qualitative thematic analysis following a quantitative regression and moderation analysis. Firstly, a total of 336 Indigenous Australians aged 60 years and over from five NSW areas participated in assessments on mental health, physical activity participation, and childhood trauma. Secondly, a focus group of seven Indigenous Australians was conducted to evaluate barriers and facilitators to physical activity. Regression and moderation analyses examined links between depression, childhood trauma, and physical activity. Thematic analysis was conducted exploring facilitators and barriers to physical activity following the focus group. Childhood trauma severity and intensity of physical activity predicted depressive symptoms. Physical activity did not affect the strength of the relationship between childhood trauma and depression. Family support and low impact activities facilitated commitment to physical activity. In contrast, poor mental health, trauma, and illness acted as barriers. Physical activity is an appropriate approach for reducing depressive symptoms and integral in maintaining health and quality of life. While situational factors, health problems and trauma impact physical activity, accessing low-impact group activities with social support was identified to help navigate these barriers.

Estimated flows and biomass in a no-take coral reef from the eastern tropical Pacific through network analysis

In the southern Gulf of California, the Cabo Pulmo reef has been the focus of many studies because it is the northern-most coral reef in the eastern Pacific. It is a paragon of a well-managed marine protected area. Under the assumption that fishing mortality is negligible, we want to identify and quantify major energy flows in an ecosystem without human intervention and describe the ecosystem resources and their interactions among species, to provide a tool for ecosystem-based management. We built a trophodynamic model using Ecopath to perform network analysis. Based on fieldwork (October 2017 – May 2018) and literature review, we identified 57 functional groups comprising 51 consumers (including 15 top predators), five primary producers plus detritus, and cluster analysis of trait profiles. The connectance index (0.17) and the system omnivory index (0.22) are low, suggesting that consumers feed on a few discrete trophic levels. Biomass of primary producers (grazing food chain; 186.8 t km−2) provides 9,813 t km−2 y−1, whereas flow from detritus supply 344.9 t km−2 y−1. The transfer efficiency decreases as flows go up the food web, from 12% at TL II to 4% at TL X, and throughput cycled (including detritus) = 118.7 t km−2 y−1. In comparison with other coral reefs, we found that Cabo Pulmo complies with the attributes to resist disturbances, with an estimated total system throughput = 95,789 t km−2 y−1, a net system production = 38,535 t km−2 y−1, a large mean path length = 12.11, ascendency = 123,662 (52%) flowbits and overhead = 116,164 (48%) flowbits. The high quality of the ecosystem services provided by Cabo Pulmo and the scenic beauty appeals to developers. Although the system is resilient, unregulated human activities may impact the reef condition and decrease the residents' quality of life and that of all the people who make a living from the low impact activities currently in effect. The trophic web model presented here may help to improve the response capacity of the coalition of residents, authorities, diving companies, and NGO's to preserve the reef and be a key element to conserve the system by contributing to its best management.

Parks and non-expropriated properties: a proposal for the practice of temporary and low impact activities / Os parques e os imóveis não desapropriados: uma proposta para a prática de atividades temporárias e de baixo impacto

Abstract This article intends to analyze the situation in which the administration issues a public utility decree for the creation of an integral protection conservation unit, a park, covering private properties. The issue of the mentioned decree entails a series of limitations on the property rights of its holders. It happens that the effective implantation of the park does not happen and the decree of public utility has expired. In spite of this, the owners of the affected properties are required to respect the environmental protection standards relating to the park, which are extremely restrictive. It is discussed in the text whether, in these cases, authorization by the public authority for the exercise of temporary and low-impact activities in the park would be possible, until the property is effectively expropriated and the compensation paid. The STJ's jurisprudence on indirect expropriation, the applicable legal provisions are analyzed and interests are weighed in the hypothesis, having as a guiding principle the principle of proportionality. Keywords: Park, Public utility, Integral protection conservation unit, Expropriation, Exercise of temporary activities. Resumo O presente artigo pretende analisar a situacao na qual a administracao edita decreto de utilidade publica para a criacao de uma unidade de conservacao de protecao integral, um parque, abrangendo imoveis privados. A edicao do referido decreto acarreta uma serie de limitacoes ao direito de propriedade de seus titulares. Ocorre que a efetiva implantacao do parque nao acontece e tem-se a caducidade do decreto de utilidade publica. Apesar disso, exige-se que os proprietarios dos imoveis atingidos respeitem as normas de protecao ambiental relativas ao parque, que sao extremamente restritivas. Discute-se no texto se, nesses casos, seria possivel a autorizacao pelo poder publico para o exercicio de atividades temporarias e de baixo impacto no parque, ate que seja o imovel efetivamente desapropriado e a indenizacao paga. Analisa-se a jurisprudencia do STJ sobre desapropriacao indireta, os dispositivos legais aplicaveis e procede-se a uma ponderacao de interesses na hipotese, tendo como fio condutor o principio da proporcionalidade. Palavras-chave: Parque, Utilidade publica, Unidade de conservacao de protecao integral, Desapropriacao, Exercicio de atividades temporarias.

Impact of different physical activity types on knee joint structural degeneration assessed with 3-T MRI in overweight and obese subjects: data from the osteoarthritis initiative.

To assess the impact of different types of physical activity types on longitudinal knee joint structural changes over 48months in overweight and obese subjects. We included 415 subjects with a BMI ≥ 25kg/m2, Kellgren-Lawrence scores ≤ 3 at baseline and Whole-Organ Magnetic Resonance Imaging Score (WORMS) scores available from the Osteoarthritis Initiative cohort. Regular self-reported participation in six physical activity types was assessed: ball sports, bicycling, jogging/running, elliptical-trainer, racquet sports, and swimming. Moreover, they were classified into high- and low-impact physical activity groups. Evaluation of structural knee abnormalities was performed using WORMS obtained by two independent observers blinded to the subjects' physical activity and time point. Linear regression models were used to assess the associations between participation in different physical activity types and changes in WORMS. No significant differences in epidemiological data were found between the groups except for gender composition, and there were no significant differences in baseline WORMS. In the cohort as a whole and most exercise groups overall WORMS significantly increased during the observational period. Highest increases compared to the remainder of the group were found in the high impact group (increase in WORMS 4.65; [95% CI] [3.94,5.35]; p = 0.040) and the racquet sports group (6.39; [95% CI] [5.13,7.60]; p ≤ 0.001). Subjects using an elliptical-trainer showed the lowest increase in WORMS (- 1.50 [- 0.21, 3.22]; p = 0.002). Progression of knee joint degeneration was consistently higher in subjects engaging in high-impact and racquet sports while subjects using an elliptical-trainer showed the smallest changes in structural degeneration. This work was presented during the 2020 Radiological Society of North America Annual meeting.

Impact of sand mining: A case study of initial growth of forest species for recovery of degraded areas

The Vale do Ribeira region has a large extension of Brazilian Atlantic Forest, and in most cities, low environmental impact activities predominate, such as sand mining. Sand mining has been trying to adapt their industrial activities to low environmental impact, aiming at the protection of permanent preservation areas (PPAs) of riparian forests. The objective of this work was to conduct a case study focused on monitoring and initial growth of forest species by 18 months. This study was performed in a riparian forest site on the Ribeira de Iguape River, Registro, state of Sao Paulo, Brazil, in a PPA with extraction of river bed sand. Forest species height, stem diameter and mortality index, and rainfall were evaluated in the period. Non-pioneer species accounted for 42.7 % of the forest, while pioneer species accounted for 53.1 %. These proportions are in accordance with local legislation, which establishes a lower limit of 40 % in planting for both groups. Drought periods and leaf-cutting ants at the beginning of growth stages contributed to a higher mortality index and irregular development of some species, however, even during such adversities, forest species indicated resistance to these conditions. Pioneer species had more important development, with emphasis on Senna multijuga, Alchornea triplinervia, Citharexylum myrianthum and Trema micranta, these species must be taken into consideration during the first stages of a project which aims at recovering degraded areas in riparian forests of Atlantic Forest.

Sports activity and patient-related outcomes after fixed-bearing lateral unicompartmental knee arthroplasty

BackgroundUnicompartmental osteoarthrosis increasingly affects younger patients who have high expectations concerning their postoperative level of activity. However, there is no available data on the activity level after fixed-bearing lateral unicompartmentalkneearthroplasty (UKA). The aim of this study was to report sports activity after fixed-bearing lateral UKA with a minimum two-year follow up. MethodsNineteen patients were surveyed to determine their sporting activities at a mean follow up of 4.6 years (range 2.0–9.7 years) after fixed-bearing lateral UKA. We also assessed the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) Score and the University of California, Los Angeles activity scale (UCLA scale) at baseline and latest follow up. ResultsBefore the onset of the first symptoms, 15 of 19 patients were active in at least one sport compared with 13 of 19 patients after surgery. Eighty-six per cent of the patients returned to activity. Within 6 months, 68% returned to their activities after surgery. The mean postoperative UCLA score was 6.4 (±1.3). Half of the patients reached a high activity level (UCLA ≥ 7). Most common activities after surgery were long walks, biking and hiking. High-impact activities showed a significant decrease. ConclusionEighty-six per cent of the patients were able to return to regular recreational and sporting activities. In general, a shift from high-impact to low-impact activities was observed. There was no difference in the number of disciplines performed. Overall, the session length and frequency remained unchanged. However, male patients and younger patients participated in sports less frequently compared with preoperative levels.

Applying Geomorphic Principles in the Design of Mountain Biking Singletracks: Conceptual Analysis and Mathematical Modeling

Mountain biking, also known as singletracking, is an emerging sector in outdoor recreation activities. Experience shows that although bicycling is considered a low-impact activity, singletracking may have adverse environmental footprints. Here, we review and conceptually analyze the forces applied on singletracks, and implement mathematical modeling of these forces, for a range of climatic conditions and geographic settings. Specifically, we focus on the hydrological and geomorphic impacts of singletracking, and highlight the importance of applying geomorphic principles in their design. Also, we demonstrate specific measures for establishing singletracks on hillslopes and in ephemeral stream channels. We discuss how climate, topography, surface roughness, hydrological connectivity, and pedology determine the processes of water runoff and soil erosion on singletrack trails. Further, we demonstrate how riders’ behavior determines the rate of shearing, wearing, compaction, deformation, and rutting of the singletrack, as well as the expansion of physical damages to the track’s surroundings. These conditions and effects determine the durability of singletracks, with implications for maintenance requirements over time. The specific implications of the emerging sector of electric mountain bikes on singletrack durability are discussed. Insights of this paper will benefit landscape designers and land managers aiming to foster ecotourism and sustainable recreation opportunities.

Increased Strength following Achilles Tendon Rupture Repair is Associated with Return to Same Level of Play in Patients with Higher Pre-Injury Level of Activity

Category:Hindfoot; Sports; TraumaIntroduction/Purpose:Rupture of the Achilles tendon is a common injury that requires a lengthy duration of recovery and rehabilitation. Patients of various levels of physical activity, ranging from professional high-impact sports to low-impact recreational activities, can be affected by this injury. Often, one of the most important outcomes from the patient’s perspective is the ability to return to the same pre-injury level of sporting activity after recovery. The objective of the current study is to examine the relationship between global ankle strength and the ability to return to previous level of play following surgical repair of an Achilles tendon tear.Methods:Patients aged 18-50 years old at a minimum 1-year post-op from surgical repair of an isolated Achilles tendon rupture were recruited to return for a study visit. Patients reported both pre-injury and current activity level using the 10-point Tegner Activity Level Scale. Isokinetic strength testing was performed and the Isokinetic Strength Score (ISS) was calculated using maximal effort dorsiflexion and plantarflexion strength at 30o/s, 90o/s, and 240o/s comparing the operative and uninvolved extremity. The primary outcome was the patients’ ability to return to same level of play or within 1 Tegner activity level. Logitistic regression analysis was used to determine the relationship between ISS and return to play. Subgroup analysis was performed on patients participating in high level athletic activity (pre-injury Tegner >= 7) an those participating in only recreational or low level activity (pre-injury Tegner <7).Results:A total of 36 patients (mean 35 years, 72% male) completed the study protocol at a mean 1.8 years post-op (range 1 year to 3.6 years). Logistic regression revealed no association between ISS and return to play in the complete cohort. Subgroup analysis revealed that for 20 patients who had participated in high level competitive athletics prior to injury (Pre-injury Tegner >= 7), for every 16 point increase in ISS, the odds ratio for return to same level of play was 8.3 (p=0.055) and the OR for return to within 1 Tegner level of play was 6.3 (p=0.043). There was no association between ISS and return to previous activity in the 16 patients with lower pre-injury levels of activity.Conclusion:Improved ankle strength was associated with return to previous level of activity only in patients who participate in high level athletic activity. These results suggest that patients with more strenuous athletic activity prior to injury are more dependent on recovery of ankle strength in the post-operative time period in order to return to their previous high level of play. In contrast, regaining strength may be less important for returning to normal activities for less active patients.

Lower-limb work during high- and low-impact activities in hip-related pain: Associations with sex and symptom severity

Background:Hip-related pain (HRP) is described as a movement-related disorder. However, little attention is given to the way people with HRP move, especially in populations still participating in sport. Thus, limiting our understanding of movementbased impairments in HRP and their potential relationships with pain/symptoms.Research Question: (1) What are the differences in absolute and relative amounts of positive and negative lower-limb joint work during walking and the single-leg drop jump (SLDJ) in football players with and without HRP? (2) What are the relationships between lower-limb joint work and HRP burden?Methods:88 football players with HRP and 30 control football players were recruited. Positive and negative work done by the hip, knee, and ankle (and each joint’s relative contribution to total work done) were calculated. The effect of sex on the relationship between HRP and work done, as well as the association between work done and International Hip Outcome Tool (iHOT33) scores, were assessed using linear and beta regressions models.Results:Walking: No joint work variables were significantly different between groups, nor were any relationships with iHOT33 scores evident. SLDJ: The knee’s relative contribution to total lower-limb negative work done was 37.7 % and 42.4 % for women with and without HRP, respectively (P = 0.04). The iHOT33 was significantly associated with positive (P = 0.03 to <0.01) and negative (P = 0.02 to <0.01) work done by the hip as well as negative work done by the ankle (P = 0.03 to 0.01), independent of sex.Significance:Only one significant between-group comparison was revealed, involving the knee in female football players. In addition, football players with a greater selfreported burden of HRP tended to display lower hip joint work during the SLDJ. Rehabilitation programs could be targeted to address these impairments and normalize work done during high impact tasks in the management of HRP.

Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia

BackgroundCurved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO.MethodsA total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO.ResultsThe pre- and post-operative sports activity participation rates were 55.8 and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier.ConclusionsAmong acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

The Bulle: Support and Prevention of Psychological Decompensation of Health Care Workers During the Trauma of the COVID-19 Epidemic

The coronavirus disease 2019 pandemic presents unprecedented challenges for the health care system. The pressure on health care staff continues to intensify, accentuated by the confinement (lockdown) of the population and the unprecedented duration of this emergency. Separately and especially together, overwork, degraded conditions of care because of the never-ending emergency, and the risk of exposure to the virus can lead to acute psychological distress or signs of burnout.This original program was developed at Cochin Hospital in Paris, France to prevent these potentially dramatic psychological consequences, support the medical staff, and identify those most affected to offer them specific care. A program and a space for relaxation and support for hospital caregivers by hospital caregivers, the Port Royal Bulle (the Bubble) offers these workers help in decompression and relaxation. It combines a warm and caring welcome that promotes attention, listening, conversations, and exchanges as needed, empathetic support, and the ability to participate in soothing, relaxing, or low-impact physical activities. It takes care of caregivers. The Bubble is a program that is simple to set up and that appears to meet professionals' expectations. Making it permanent and enlarging its scale, as a complement to existing programs, might help to support health care personnel in their work.