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Background Research investigating differences in gluteus medius muscle activity in those with and without chronic nonspecific low back pain is both limited and conflicting. Additionally, in these populations the relationship between gluteus medius muscle activity, foot type, and transversus abdominis muscle thickness is unclear. Research question We aimed to investigate gluteus medius muscle activity during gait in those with and without chronic nonspecific low back pain. Secondarily, we aimed to explore the association between gluteus medius muscle activity, foot type, and transversus abdominis muscle thickness within groups. Methods This case control study recruited 30 people with and 30 people without chronic nonspecific low back pain and matched participants by age (±5 years), sex, and body mass index (±2 BMI units). Gluteus medius muscle activity was measured with surface electromyography during walking gait, with foot type and transversus abdominis muscle thickness measured with the Foot Posture Index and ultrasound respectively. The Mann-Whitney U test was used to investigate differences in gluteus medius muscle activity between groups. Spearman rank order correlation was performed to explore the association between gluteus medius muscle activity, foot type, and transversus abdominis thickness within each group. A linear regression was used to analyse significant correlations (P Results We found no significant differences in gluteus medius muscle activity between groups. However, there was a moderate correlation between the Foot Posture Index score and gluteus medius peak amplitude (P = 0.04) for those with mild to moderate chronic nonspecific low back pain. Significance Clinicians should be aware that patients with mild to moderate chronic nonspecific low back pain may not demonstrate significant differences in gluteus medius muscle activity compared to those without back pain. Additionally, higher peak gluteus medius muscle activity is likely to occur in people with mild to moderate chronic nonspecific low back pain and planus feet.

Aims To describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabetes complications and physical activity. Methods Anthropometric, demographic, biochemical and self-reported physical activity measures (IPAQ) were performed. Associations and multiple regression analyses were undertaken between physical activity, known risk factors for diabetes complications, and history of cardiovascular disease (CVD), neuropathy and foot ulceration obtained from medical records. Results 240 participants were recruited (96% type 2 diabetes; age 68.7 ± 10.5 y; 58% men; diabetes duration 14.3 ± 11.4 y). Sixty seven percent of participants reported undertaking moderate or vigorous intensity exercise to recommended levels, and 29% reported no moderate-vigorous exercise. In addition to being associated with known demographic and biochemical risk factors and other complications, diabetes complications were also associated with different physical activity behaviours. Individuals with a history of CVD were more likely to participate in moderate-vigorous exercise and meet exercise guidelines, individuals with neuropathy undertook less walking and moderate intensity exercise, and those with a history of foot ulceration sat more and participated less in vigorous exercise. Conclusions In Australian adults, the presence of diabetes complications may influence physical activity participation, and associate with characteristic physical activity approaches.

Background A weight bearing ankle equinus has adverse effects on forefoot plantar pressure variables in older adults with diabetes, but it is unclear if this is also the case in older adults without diabetes. Methods 40 older adults with diabetes (88% type 2, mean diabetes duration 17.6 ± 14.8 years) and 40 older adults without diabetes, matched for age (±3 years), sex and BMI (±2 BMI units) were included (63% female, mean age 72 ± 4 years, BMI 30 ± 4 kg/m2). Primary outcomes were prevalence of a weight bearing equinus and evaluation of barefoot forefoot plantar pressures in older adults with and without diabetes. Findings A weight bearing equinus was present in 37.5% and 27.5% of the diabetes and non-diabetes group respectively with no significant difference between groups (p = 0.470). People with diabetes and equinus displayed higher peak pressure (808 versus 540 kPa, p = 0.065) and significantly higher pressure-time integral (86 versus 68 kPa/s, p = 0.030) than people with diabetes and no equinus group. The non-diabetes equinus group had significantly higher peak pressure (665 versus 567 kPa, p = 0.035) than those with no diabetes and no equinus, but no difference in pressure-time integral. Interpretation A high prevalence of a weight bearing equinus was detected in older adults with and without diabetes, with associated increases in plantar pressures. As an equinus has been associated with many foot pathologies this study's findings suggest that clinicians should check for the presence of a weight bearing ankle equinus in all older adults.

The purpose of this study was to determine the intratester reliability of surface electromyography (EMG) assessment of the gluteus medius muscle in healthy people and people with chronic nonspecific low back pain (CNLBP) during barefoot walking. Gluteus medius muscle activity was measured twice in 40 people without and 30 people with CNLBP approximately 7 days apart. Walking gluteus medius muscle activity was normalised to maximal voluntary isometric contractions during side-lying hip abduction with manual resistance. Good intratester reliability (ICC > 0.75) was found for mean, peak, and peak to peak amplitude for healthy people. Only mean amplitude demonstrated good intratester reliability in those with CNLBP. Peak amplitude and peak to peak amplitude of the gluteus medius muscle of those with CNLBP, and the time of peak amplitude in both groups, demonstrated moderate reliability (ICC ranged from 0.50 to 0.58). Moderate to large standard error of measurement and minimal detectable change values were reported for outcome measurements. These results suggest that potentially large levels of random error can occur between sessions. Future research can build on this study for those with pathology and attempt to establish change values for EMG that are clinically meaningful.

Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Objective To determine the extent to which measures of foot and ankle strength, range of motion, posture, and deformity are associated with performance in a battery of balance and functional ability tests in older adults. Design Cross-sectional study of people over 65 years. Setting Community. Participants Participants (N=305; age range, 65–93y) recruited for a randomized trial investigating the efficacy of a podiatry intervention to prevent falls. Interventions Not applicable. Main Outcome Measures Clinical measures of foot and ankle strength (using hand-held dynamometry), range of motion, posture, and deformity, and a battery of balance tests (postural sway, maximum balance range, lateral stability, coordinated stability) and functional ability tests (alternate step test, sit-to-stand, timed 6-m walk). Results Most (67/88) of the correlations between the foot and ankle tests and performance on the balance and functional tests were statistically significant. Hierarchic linear regression analysis identified hallux plantar flexion strength and ankle inversion-eversion range of motion to be the most consistent significant and independent predictors of balance and functional test performance, explaining up to 25% of the variance in the test scores. Conclusions Foot and ankle characteristics, particularly plantar flexor strength of the hallux and ankle inversion-eversion range of motion, are important determinants of balance and functional ability in older people. Further research is required to establish whether intervention programs that include strengthening and stretching exercises for the foot and ankle may achieve improvements in balance and functional ability and reduce the risk of falls in older people.