Toe Touch Research Articles

Is hamstring muscle shortness responsible for low back pain in healthcare professionals?

Background/Aim: Low back pain (LBP) is a highly prevalent pathology affecting more than half of our population. The lumbar region inherently possesses a complex structure; therefore, dozens of causes for the clinical presentation of acute/chronic pain are present. We focused on the impact of hamstring shortness on LBP in healthcare workers/professionals who need to keep medical records and perform invasive procedures while traveling overwhelming distances in relatively small workplaces. Methods: Our research was designed as a cross-sectional study and was conducted at Beykent University Hospital from March to April 2022. Sixty-two otherwise healthy healthcare workers/professionals aged 25–45 (both male and female) volunteered. Two equal groups with and without LBP were created. Oswestry disability index, Roland–Morris score, Quebec LBP questionnaire, Visual Analog Scale (VAS), active/passive knee extension, sit and reach, and forward bending tests were performed in each group. The collected data were statistically analyzed (confidence interval [CI]=20%; P<0.05). Results: Active/passive knee extension, sit and reach, and toe touch tests were significantly related to Roland–Morris, Quebec, and Oswestry Disability Index questionnaires; thus hamstring muscle shortness was significantly related to chronic low back pain (P<0.05). Short hamstring muscle length could accurately reflect the lower test scores obtained by the female participants. Conclusion: Hamstring muscle shortness could explain a significant proportion of low back pain in healthcare professionals.

EMG Activity of Core and Global Muscles of Spine during Functional Exercises in Basketball Players with Chronic Ankle Instability: A Pilot Study

Introduction: Assessing the Electromyography (EMG) activity of core muscles during various exercises might be extremely important to understand the neuro-muscular strategies used by basketball athletes with Chronic Ankle Instability (CAI). Aim: To compare the EMG activity of the core/global muscles during different functional exercises in basketball athletes with versus without CAI. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, SGT University, Gurugram, Haryana, India. A total of eight basketball players subjects aged 18-30 years with (n=4) and without CAI (n=4) were recruited using convenience sampling. Players with atleast 2 years of competitive experience were enrolled. CAI was diagnosed if there was a history of atleast two ankle inversion injuries in the same ankle for the past 2 years, which had required a period of protected weight bearing or immobilisation or any complaint of giving way of the ankle during functional activities and score of less than 24 on the Cumberland ankle instability tool. Surface EMG was recorded for multifidus, rectus abdominis, transverse abdominis and erector spinae during six functional exercises (single leg squat, Y balance exercise, quadrant hop, toe touch down, box jump and medicine ball slams). 2×5×4 repeated measures Analysis of Variance (ANOVA) was employed to test the study hypothesis. Results: A significant difference was found between the activation patterns of the core and global muscles in basketball players with CAI and without CAI. Conclusion: It can be concluded that CAI alters the activation of core and global spinal muscles significantly. CAI is not restricted to distal joint but has an impact on proximal muscles as well. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Background: Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal. Indications: PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes. Technique Description: A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises. Results: At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol. Discussion/Conclusion: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Shoulder and Scapular Muscle Activity During Low and High Plank Variations With Different Body-Weight-Bearing Statuses.

Can, EN, Harput, G, and Turgut, E. Shoulder and scapular muscle activity during low and high plank variations with different body-weight-bearing statuses. J Strength Cond Res 38(2): 245-252, 2024-This study investigated the activation levels and activation ratios of shoulder and scapular muscles during low plank (LP) and high plank (HP) variations, with varying levels of body-mass support, including 4-point, 3-pod, and 2-point body-weight-bearing (BWB) statuses. The study was conducted with 21 healthy men (mean ± SD , 26 ± 6.5 years of age and 24.4 ± 2.4 kg·m -2 BMI). Ten different plank exercises were performed in a mixed order by changing elbow joint positions (LP and HP) and BWB statuses (2-point, 3-pod, and 4-point). Activation levels of the lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), biceps brachii, triceps brachii, infraspinatus, and serratus anterior (SA) muscles were assessed with a surface electromyography device. Results of this study showed that elbow position changes resulted in higher LT ( p = 0.01) and TB ( p = 0.001) activation in HP exercises. In general, it was observed that an increase in BWB status was effective in increasing activation for the scapula and shoulder girdle muscles. The ratios of the UT muscle to the SA, LT, and MT muscles were less than 1 during side plank, bird dog, front reach, shoulder taps, and plank with shoulder external rotation exercises. High plank with toe touch exercise resulted in a marked increase in the UT activation. Therefore, it was concluded plank variations alter activation levels and activation ratios of shoulder and scapular muscles. Plank exercises may be used in shoulder rehabilitation and the progression in plank variations can be achieved by changing elbow position and BWB status based on individual requirements.

The Comparison of The Online and Face-to-Face Assessments of Physical Functions in Healthy Adults

Purpose: This study aims to investigate whether online assessments can be used as an alternative way to face-to-face assessments. 
 Method: The study included 20 volunteer healthy adults (F/M: 14/6; Age: 59.1 ± 8.02 years-old) without any neurological problems and scored 24 or higher in the Mini-Mental State Examination Test. All assessments (The Timed Up and Go Test (TUG), Berg Balance Scale (BBS), Five Times Sit to Stand Test (FTSTS), Arm Curl Test (ACT) and Toe Touch Tests (TTT)) were performed both online and face-to-face. Google Meet or Zoom Meetings platforms were used for online assessments. Differences between online and face-to-face groups were determined by the Wilcoxon test. 
 Results: In the study, there was no statistically significant differences between the online and face-to-face assessments of the TUG (p=0.057), BBS (p= 0.546) and TTT (p=0.438). However, it was significant differences the online FTSTS (p=0.028) and ACT (p= 0.002) tests with compared to face-to-face evaluation. The current study has shown that can be performed to adults of the assessments of TUG, BBS and TTT tests on the supervised online platform.

Comparison of utilizing modified hold-relax, muscle energy technique, and instrument-assisted soft tissue mobilization on hamstring muscle length in healthy athletes: Randomized controlled trial

IntroductionThe hamstring muscle shortness is the primary risk factor for sports-related injuries. Numerous treatments are available for lengthening of hamstring muscle. The main purpose of this study was to compare the immediate effect of modified hold-relax, muscle energy technique (MET), and instrument assisted soft tissue mobilization-Graston techniques (IASTM-GT) on length of hamstring muscle in young healthy athletes. Methods60 athletes comprising of 29 females and 31 males were recruited in the present study. Participants were allocated to 3 groups of IASTM-GT (N = 20, 13 male, 7 female), Modified Hold-relax (N = 20, 8 male, 12 female), and MET (N = 20, 7 male, 13 female). Active knee extension and passive straight leg raising (SLR), and toe touch test were performed before and immediately after the intervention by a blinded assessor. For the comparison of dependent variables across time, 3*2 repeated measure ANOVA was utilized. ResultsInteraction of group by time was significant for passive SLR (P < 0.001). Interaction of group by time was not significant for active knee extension (P = 0.17). The results showed that dependent variables increased significantly in all groups. The effect size (Cohen's d) in the groups of IASTM-GT, modified Hold-relax, and MET was 1.7, 3.17, and 3.12, respectively. ConclusionAlthough the measures were improved in all groups, it seems that IASTM-GT can be used as a safe and efficient treatment, which can be a suitable candidate alongside modified hold-relax and MET for increasing the hamstrings muscle length in healthy athletes.

Short-term effects of tactile stimulation of facial skin on hamstring muscle flexibility in healthy young males.

Inhibition of the suboccipital muscle group is shown to increase the flexibility of hamstring muscles. Reversely, stretching of the hamstring muscles is shown to change the pressure pain thresholds over the masseter and upper trapezius muscles. There appears to be a functional link between the neuromuscular system of the head and neck, and lower extremities. The present study aimed to investigate the effect of tactile stimulation of facial skin on hamstring flexibility in healthy young males. A total of sixty-six participants participated in the study. Hamstring flexibility was measured by the sit and reach (SR) test in long sitting and the toe touch (TT) test in standing before and after two minutes of facial tactile stimulation in the experimental group (EG) and after rest in the control group (CG). In both groups, significant (P<0.001) improvement was observed in both variables, i.e., SR (from 2.62 cm to -0.67 cm in EG and from 4.51 cm to 3.52 cm in CG) and TT (from 2.78 cm to -0.64 cm in EG and from 2.42 cm to 1.06 cm in CG). When both groups were compared, a significant (P=0.030) difference was observed between EG and CG in postintervention values of SR only. Greater improvement was observed in the SR test in EG. Tactile stimulation of facial skin improved hamstring muscle flexibility. This indirect mode of increasing hamstring flexibility can be taken into consideration while managing individuals with hamstring muscle tightness.

Effectiveness of Brainball program on physical fitness of primary school pupils in Vietnam. A longitudinal study.

The present study aimed to evaluate the effectiveness of the Brainballs on the physical fitness of 2nd-grade students at a primary school in Vietnam during and eight months after the experiment. The study included 55 pupils (23 boys and 32 girls) aged seven years. The study design was a pedagogical experiment with a parallel-group technique, including experimental and control groups. The examination was carried out in 2019/2020 in three terms pre- (September 2019), post- (January 2020), and follow-up (September 2020). Physical fitness was tested with the use of the International Physical Fitness Test. The Brainball program, conducted twice a week for 35 minutes, combined physical education (PE) with subject-related content, utilizing 100 balls with painted letters, numbers, and signs. Results show that the fitness level was not increased significantly after 20 weeks of the intervention program, neither in experimental nor control groups. However, it significantly improved eight months later at the follow-up examination. The analysis of covariance indicated that pupils from the experimental group improved significantly on most physical fitness as compared to the control group, specifically on the following tests: 50-meter running (p = 0.0044), toe touch (p = 0.0137), standing long jump (p = 0.0076), 4 × 10 m sprint (p = 0.0333), hand strength (p = 0.0233). These results have shown long-term positive effects of the use of "Brainball" educational balls in physical education classes on the physical fitness development of students, especially in the qualities of speed, strength, and flexibility.

Thigh Pain In A Football Player

HISTORY: 15 year old football player presenting with left thigh pain for 2 weeks. No acute injury. Pain first noticed with running. Pain is sharp, rated 8/10 at rest. Despite relative rest, no improvement in symptoms; symptoms now present at rest. Does have nighttime pain. Denies radicular symptoms, fever, recent infection, weight loss. PHYSICAL EXAMINATION: MSK: Left Lower Extremity-Inspection: No swelling, deformity, ecchymosis. Antalgic gait. -Palpation: Tenderness over length of rectus femoris. There is no tenderness over the knee, hip, tibia, fibula. -Range of motion: Limited exam due to pain. -Neurovascular: Strength is 4+/5 in flexion. Distally neurovascularly intact with brisk pulses, 2 second capillary refill, and sensation intact to light touch. DIFFERENTIAL DIAGNOSIS: 1. Ewing Sarcoma 2. Osteosarcoma 3. Osteomyelitis 4. Langerhans Cell Histiocytosis TEST AND RESULTS: XR Left Femur:Findings: Focal area of cortical destruction at medial aspect of proximal tibial diaphysis. Adjacent cortex abnormal. Corresponding periosteal reaction, hyperdense soft tissue mass. No pathologic fracture. Impression:Aggressive lesion of proximal femoral diaphysis. Further evaluation with contrast-enhanced MRI recommended. Labs: CRP 2.9- > 8.9-> > 0.1, ESR 117- > 130-> > 2, WBC 8.9, Hgb/Hct 14/41.6, Plt 407CXR: negativeMRI Left Lower Extremity with/without contrast:Impression:1. Aggressive marrow replacing lesion of left femoral diaphysis with anterior projecting soft tissue component. Differential includes Ewing's sarcoma versus osteosarcoma. 2. No additional lower extremity osseous lesion or adenopathy identified. LEFT FEMUR BIOPSY:SPECIMEN: Fragments of reactive bone with mixed inflammation, compatible with osteomyelitis. REPEAT LEFT FEMUR BIOPSY: I&D; obtained additional tissue to r/o malignancy.Specimen: Findings consistent with acute and chronic osteomyelitis. No features of malignancy seen. FINAL/WORKING DIAGNOSIS: Acute on Chronic MRSA Osteomyelitis TREATMENT& OUTCOMES: 1. Admission for IV antibiotics. Febrile on admission; fever curve improved. 2. ID: Oral Antibiotics x 6 weeks. Improving pain, downtrending inflammatory markers until wnl. 3. Ortho: Toe Touch Weightbearing x 6 weeks - > PWB - > WBAT. Completed PT. Cleared for high impact/contact activities.

Analytic approach to video analysis on skill performance of Pro Kabaddi matches

Kabaddi is aptly known as the “Game of the Masses” due to its popularity, simple, easy to comprehend rules, and public appeal. The game calls for no sophisticated equipment what so ever, which makes it a very popular sport in the developing countries. The Pro Kabaddi League was first held in 2014; its founder, Charu Sharma, in pro-Kabaddi Indian and foreign player are played together in a team and 25 players and featured in a squad. Since its inception in 2014, the Pro Kabaddi League has essayed its role as a feeder for Indian Kabaddi and has laid out a platform for some of the best talent all across the country to showcase their talent and even carve out a career for them “Video Analysis on Skill Performance of Selected National Pro Kabaddi Matches”. One forty four National level Pro Kabaddi male players were selected as subject for this study the subjects were selected from U Mumba, Jaipur Pink Panthers, Bangluru Bulls, Puneri Paltan, Dabang Delhi, Telugu Titans, Bengal Warriors, Patna Pirates, Haryana Steelers, U.P. Yodha, Tamil Thalaivas and Gujarat Fortune giantsteams. The captured video was uploaded in a desktop computer to measure the selected variables. The desktop computer with Windows 8 OS, i5 processor, 2 GB RAM and 500 GB hard disk was used to analyze the data. The Kinovea software version 0.8.15 was installed and the captured videos were analyzed by frame using tools available in the software. Kabaddi offensive and Defensive skills variables namely Hand Touch, Toe Touch, Squat thrust, Dubki. Lain Jump, Side Kick, Rolling. Back Kick and Bonus (offensive skills) and Defensive skills are Tackle, Block, Chain Tackle, Waist Hold, Ankle Hold, and Thigh hold, Diving Ankle Hold and Dash was calculated trough the you tub and internet for each Skills. The final data were used to predict the Pro Kabaddi season wise matches Performance. Subjective rating of each team player is performance involves a panel of two expert Coaches and Research Scholar in the game of Kabaddi. The two expert Coaches and Research Scholar evaluated the player’s kabaddi skills ability, Scores. The average of the two expert Coaches and Research Scholar rating was taken as a score.

Video analysis on skill performance of selected national Pro Kabaddi matches

Sport plays a very prominent role in the modern society. It is important to individuals, a group, a nation and indeed the world. Throughout the world, sport has a popular appeal among people of all ages and both sexes The Pro Kabaddi League was first held in 2014; its founder, Charu Sharma, in pro-Kabaddi Indian and foreign player are played together in a team and 25 players and featured in a squad. Since its inception in 2014, the Pro Kabaddi League has essayed its role as a feeder for Indian Kabaddi and has laid out a platform for some of the best talent all across the country to showcase their talent and even carve out a career for them “Video Analysis on Skill Performance of Selected National Pro Kabaddi Matches”. One forty four National level Pro Kabaddi male players were selected as subject for this study the subjects were selected from U Mumba, Jaipur Pink Panthers, Bangluru Bulls, Puneri Paltan, Dabang Delhi, Telugu Titans, Bengal Warriors, Patna Pirates, Haryana Steelers, U.P. Yodha, Tamil Thalaivas and Gujarat Fortune giantsteams The captured video was uploaded in a desktop computer to measure the selected variables. The desktop computer with Windows 8 OS, i5 processor, 2 GB RAM and 500 GB hard disk was used to analyze the data. The KINOVEA software version 0.8.15 was installed and the captured videos were analyzed by frame using tools available in the software. Kabaddi offensive and Defensive skills variables namely Hand Touch, Toe Touch, Squat thrust, Dubki. Lain Jump, Side Kick, Rolling. Back Kick and Bonus (offensive skills) and Defensive skills are Tackle, Block, Chain Tackle, Waist Hold, Ankle Hold, and Thigh hold, Diving Ankle Hold and Dash. Hypothesis is proved that the different skills are used by the players to score the points, all techniques are its own importance and have a highly dominant in the game.

Psychometric Properties of Four Common Clinical Tests for Assessing Hamstring Flexibility in Young Adults.

Objective: To examine the psychometric properties of four common hamstring muscle flexibility tests involving the straight leg raise (SLR), passive knee extension (PKE), sit and reach test (SRT) and toe touch test (TTT) in young adults. Methods: Forty-three young healthy adults (mean age 27.4 years) were recruited for 3 repeated sessions of hamstring flexibility assessments using the 4 tests mentioned above and the subsequent isokinetic examinations. The first two sessions (S1 and S2) were conducted by two different raters randomly on the first day (D1), and the third session (S3) was conducted by the same rater as S1 3 days later (D4). The next day (D5), the isokinetic performances of knee extensors and flexors of the dominant leg were assessed. To evaluate the interrater (S1 vs. S2) and test-retest (S1 vs. S3) reliability of hamstring flexibility tests, intraclass correlation coefficients (ICCs), standard errors of measurement, and the minimum detectable differences were calculated. Correlation analyses were performed to study the association of each hamstring flexibility test with the isokinetic muscle function of the knee flexors (H) and extensors (Q), including the peak torque (PT), total amount of work (TW) and average power (AP). Results: Excellent interrater and test-retest reliability of hamstring flexibility tests involving the SLR, PKE, SRT and TTT were confirmed with ICCs ranging from 0.923 to 0.986. Fair correlations were found between the 4 hamstring flexibility tests and the H/Q for the PT at angular speeds of 180°/s (Pearson’s r at 0.330–0.449). In addition, the PKE was fairly correlated with the AP of the hamstring (Pearson’s r = 0.320) and the H/Q for the TW (Pearson’s r = 0.345) and AP (Pearson’s r = 0.386) at angular speeds of 180°/s. Conclusions: This study confirmed that the SLR, PKE, SRT and TTT were reliable flexibility tests for hamstring muscles in young healthy adults, and the PKE might be a more valid outcome measure to predict hamstring injury.

Clinical and functional outcome of isolated posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; PCL ligament avulsion fracture injuries constitute about 3-20% of all the knee injuries. Isolated posterior cruciate ligament injuries are uncommon and often go undiagnosed in acutely injured knees. fracture. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Our study was to assess the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of 27 patients with isolated PCL avulsion fractures, done in the department of orthopaedics in RNT medical college over a 2-year period. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up. 3 cases of post operative wound infection were detected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 27 patients, there were 19 males and 8 females. All the cases showed good fracture union in an average of 12 weeks post operatively. In the first 6 weeks, all of them acquired an average knee flexion of 90 degrees and by 3 months, all of them had 125 degrees of free flexion possible.2 cases showed negative posterior draw sign. The knee scoring system assessment showed 21 cases of excellent result, 4 cases of good result and 2 cases of fair result.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Though rare, PCL avulsion fractured are to be managed properly and treated surgically. PCL tibial avulsion fractures treated through Burk and Schaffer approach with open reduction and internal fixation produces good results.&lt;/p&gt;

Effect of Tai Chi combined with Kinesio taping on posture control of football players with FAI: protocol for a randomized controlled trial

BackgroundFunctional ankle instability (FAI) of college football players is an important risk factor affecting their training and competition. Physical therapy and appropriate sports intervention can improve the stability of FAI patients. Previous studies have shown that Tai Chi (TC) and Kinesio taping (KT) can improve the posture control ability of FAI patients. However, whether Tai Chi combined with Kinesio taping effect patch can be used as an effective exercise for rehabilitation of college football players with FAI is not yet proven.Methods/designFifty-three FAI college football players were randomly assigned to 3 groups: TC+KT (n = 20); TC+KTp (placebo Kinesio taping, KTp, placebo) (n = 17), and KT (n = 16). The TC+KT group received TC and KT functional correction technical intervention, the TC+KTp group received TC and placebo KT technical intervention, and the KT group received KT functional correction technical intervention. Each of the three groups received 30 min each time, 3 times a week, for a total of 6 weeks of intervention training. Star Excursion Balance Test (SEBT) and UniPedal Stance Test (UST) at baseline (before), 4 weeks after intervention (middle), and 6 weeks after intervention (after) and Toe Touch Test (TTT) were evaluated.DiscussionFor the first time in this trial, the impact will be evaluated. If the results are the same as expected, they will provide evidence that Tai Chi combined with Kinesio taping sticking intervention can promote the posture control of college football players with FAI.Trial registrationChinese Clinical Trial Registry ChiCTR1900027253. Registered on 6 November 2019.

Manual therapy on Plantar Fascia affects Superficial Back Line Flexibility: A Randomized Controlled Pilot Study

Background and Aim: Myofascial Release (MFR) is a soft tissue mobilization technique that has been widely researched and supported to increase muscular flexibility and joint range of motion along superficial back line (SBL) structures. The purpose of the present study is to examine and compare the acute effects of MFR and post-isometric relaxation (PIR) applied on plantar fascia, on flexibility of superficial back line (hamstring muscle). Design: This was a pilot single blind randomized control trial (RCT). Participants: Thirty young healthy students (24 boys and 6 girls; mean age 21.46±0.97) Methods: Inclusion and exclusion criteria were followed, and baseline measurements for the Toe-Touch test (TTT) and active straight leg raise test (SLRT) were obtained. Subjects were then randomly assigned to the MFR group and the PIR group. The MFR group received the technique on plantar surface of the feet by applying a gentle and sustained pressure into the myofascial connective tissue. The PIR group received the technique on plantar flexors by placing them in stretched position, performing isometric contraction followed by relaxation and lengthening. Both interventions will be performed for 10 minutes. Afterwards, the Toe Touch Test and straight leg raise test were re-assessed. Results: Before and after intervention SLRT (both right and left) and TTT difference (within group differences) is statistically significant (p&lt;0.05) in both MFR and PIR group. Between-group comparison also shows significant difference in both groups with p&lt;0.05. The MFR group showed a significant difference in the SLR test and Toe Touch test compared to the PIR group (p&lt;0.05). Conclusion: The results of the current study showed that MFR on the planter fascia was immediately effective for improving flexibility of the SBL for the hamstring muscle.

Achilles tendon repair with limited incision and anchor fixation: Case series results

This is a retrospective study that reviews postoperative milestones of 33 patients who underwent an achilles repair with limited open incision and suture anchor fixation into the posterior calcaneus. The amount of days postoperatively that the patient was able to transition into a pneumatic boot and begin protective toe touch with crutches (PTTWC), protective full weightbearing (PFWB), initiate non-weightbearing (NWBPT) and full weightbearing physical therapy (FWBPT), return to regular shoe gear (RSG) and return to normal activity (RTA) were recorded. The median time to PTTWC was 20 (13 to 34) days. Median time to PFWB was 34.5 (23 to 48) days. The median time to NWBPT was 21 (13 to 34) and FWBPT was 37.5 (23 to 58) days. Median time to RSG was 44 (24 to 62) days. Median time to RTA was 105 (64 to 223) days. The progression of each postoperative milestone was based on the patient's subjective findings and a thorough clinical examination. It was concluded that the sooner the patient was able to convert into a pneumatic boot, begin weight bearing and initiate physical therapy, the sooner the transition into full weightbearing, return to a regular shoe and return to normal activity. Therefore, a limited open repair with suture anchor fixation in the posterior calcaneus can be a viable surgical option, that allows patients to achieve pre-injury status after an acute achilles tendon rupture while keeping surgical risks and complication rates at a minimum.

Prevention of Low Back Pain in Adults with a Back School-Based Intervention.

Background: Low back pain is highly prevalent and has a major socio-economic impact worldwide. Among the rehabilitation options is the Back School, which consists of programmes that include exercise and educational interventions to treat and prevent back pain. The effects of this type of programme are usually evaluated in patients with low back pain. The aim of this study was to evaluate the effects on low back functionality and the prevention of medical visits due to low back pain during one year of follow-up in a healthy adult population. Methods: A quasi-experimental study was conducted with 56 healthy participants who were divided into an experimental group (n = 30), who underwent the programme consisting of a total of 16 sessions, and a control group (n = 26), who did not undergo the intervention. All participants were administered the Partial Curl-up Test, Biering Sorense Test, Modified Schöber Test, and Toe Touch Test, and they completed the Short Form 36 Health Survey before and after the intervention. In addition, a telephone call was made to ask whether they attended a doctor for low back pain in the following year post-intervention. Results: In the experimental group, statistically significant improvements were observed in trunk muscle strength, spinal flexion joint range of motion, and hamstring flexibility, and they had fewer visits to the doctor for low back pain in the following year. Conclusions: The theoretical–practical programme based on the Back School seems to have beneficial effects on low back functionality by increasing its strength and flexibility in an adult population. In addition, this programme reduced the number of medical visits due to low back pain during the following year after the intervention.

Pelatihan Uji Sentuh Jari Kaki Sebagai Upaya Peningkatan Ketrampilan Kader Kesehatan Dalam Mendeteksi Gangguan Sensasi Kaki

Background: Increased life expectancy will be followed by increasing problems if health care is not carried out properly. Problems will arise, one of which is endocrine system disorders such as diabetes mellitus which has complications. One of the complications of diabetes mellitus is diabetic ulcers on the feet by 7.5% of patients who experience impaired sensation which ultimately have to undergo amputation. This condition can be prevented early, such as by checking the sensation of the feet. This activity aims to increase the role of health cadres in detecting the incidence of neuropathy. Methods: In order to provide knowledge and skills of the toe touch test to 30 health cadres, the method chosen was training supported by guidebooks, videos and demonstrations. Results: There was an increase in the knowledge of cadres in good categories from 13% to 89% between before and after training. Meanwhile, the skills of the cadres showed that all of the training participants were skilled in doing the toe touch test. Conclusion: Improving the knowledge and skills of cadres can be pursued through training by combining the use of manuals, videos and demonstrations.

Distal femoral fractures: A comparison between single lateral plate fixation and a combined femoral nail and plate fixation

ObjectivesDistal femoral fractures occur in patients with osteoporotic bone and also as a consequence of high energy trauma. The recognised treatment options include closed or open reduction of the fracture and fixation using a locking plate or a femoral nail. Both these fixation modalities have some drawbacks. There is a risk of metalwork failure with single lateral locking plates and limited distal fixation with intramedullary nails. Since January 2018, we started using augmented fixation of distal femoral fractures using a combination of a retrograde femoral nail and a lateral locking plate. This study compares the outcomes of single lateral femoral plating (SLP) and combined nail-plate fixation (NPF). MethodsThis is a single centre retrospective case control study including all patients who sustained distal femoral fractures (OTA 33-A2, 33-A3, 33-C, 33-V3B and 33-V3D) over the study period. Outcomes for SLP were compared to NPF. The principal outcome measure was fracture union. Secondary outcome measures were reoperation rate, mortality and post-operative weight bearing status. Results67 distal femoral fractures were included in the study. 19 patients had peri‑prosthetic fractures. 40 were treated by SLP, 27 were managed with NPF. 23 (58%) patients in the SLP group were given instructions to non-weight bear or Toe touch weight bear for 6 weeks post-surgery compared to 1 (4%) in the NPF group (p = 0.000004). 7 (18%) patients treated with SLP had metalwork failure due to a non-union compared to none treated with NPF (p = 0.04). 11 fractures in the SLP group failed to unite compared to no non-unions in the NPF group (p = 0.01). These differences were magnified when assessing older (>50 years old) patients. ConclusionsAugmented fixation of distal femoral fractures using a nail plate fixation provided significantly higher union and enabled early weightbearing compared to single plate fixation. We recommend nail plate fixation for the treatment of distal femoral fractures, particularly in osteoporotic fractures.

A comparative assessment of flexibility of backline and strength of lower limb in bharatnatyam dancers and non-dancers

Background: Bharatnatyam is an Indian classical dance form which have been practiced for a long period of time and is equivalent to any sporting activity. The postures attained during this dance form require good amount of muscle strength and flexibility among the dancers. There is lack of research on flexibility of backline and lower limb strength in bharatnatyam dancers. The overall function of the superficial backline is to support the body in full upright extension and impacts musculoskeletal dynamics. The lumbar lordosis angle and the pelvic inclination angle in bharatnatyam dancers is more than the non-dancers which can affect the backline flexibility. This study analysed if there is any difference, in the lower limb strength and flexibility of backline as compared to participants of same age group.Methods: 10 bharatnatyam dancers and 10 non-dancers between 15 to 30 years participated in this study. Triple hop distance test for both sides and toe touch test was used to check the strength of lower limb and flexibility of backline respectively.Results: There was significant difference in the triple hop distance of right lower limb between bharatnataym dancers and non-dancers. There was no significant difference in the triple hop distance of left lower limb between the two groups. There was not quite significant difference in the toe touch test of between the two groups.Conclusions: There was significant difference in the strength and power of right lower limb of dancers as compared to right lower limb of non-dancers. There was no statistical difference in the left lower limb of both the groups. There was no statistical difference between the flexibility of backline of bharatnatyam dancers and non-dancers.