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Context: A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. Objective: The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. Evidence Acquisition: The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). Evidence Synthesis: Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5–0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. Conclusions: The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.

Background Approximately 25% of orthopedic knee conditions are related to patellofemoral pain (PFP), with young women being the most affected. It is thought that this condition is associated with modifications in the kinematics and muscle control patterns of the lower limb during weight-bearing support activities, which increases femur movement under the patella. Objectives To compare kinematics and muscle induced acceleration patterns between PFP subjects and healthy controls during the preparation phase of the single leg triple hop test. Study design Biomechanical analysis was performed using OpenSim. Ten physically active women (23.2 ± 4 years, 59.3 ± 5.8 kg, and 1.63 ± 0.06 m) with no history of lower limb injury (CG) and 11 volunteers (23.5 ± 2 years, 55.4 ± 4.9 kg, and 1.66 ± 0.04 m) with PFP (PFPG) were recruited. The participants performed a series of single leg triple hop tests while the ground reaction forces and kinematic data were recorded. Results Vector field statistical analysis indicated increased lumbar extension, anterior pelvic tilt, contralateral pelvic drop, and lower induced accelerations from the core and hip muscles in PFPG. Conclusion PFP volunteers presented with alterations in lumbar muscle control associated with a possible compensatory pelvic strategy to minimize knee extensor moment.

Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by a triad composed of cognitive alteration, urinary incontinence, and gait impairment associated with ventricular enlargement and normal cerebrospinal fluid pressure. Gait impairment is among the earliest symptoms; however, the reliability of the evaluation is not well-established and no consensus has been reaching regarding variables that should be analyzed and which parameters should be considered to accurately assess post-intervention improvement. Research question Are the degree of repeatability, standard error of measurement, and minimum detectable change considered to detect changes in gait variables in iNPH patients? Methods A total of 84 iNPH patients with a mean age of 77.1 (±6.4) years were analyzed. Gait deviation index (GDI), speed, cadence, cycle time, stride length, single support, and first and second double support were chosen as the variables to be analyzed. Statistical analysis was performed by an independent evaluator, with gait repeatability assessed by the intraclass correlation coefficient (ICC) and the standard error of measure (SEM). Results ICC values were 0.76–0.85 with excellent repeatability, while SEM demonstrated that the variables with best repeatability were the GDI (mean, 4.94; 95% confidence interval (CI), 4.63–5.43), representing a 7.65% mean relative error of the measurement (mean, 0.05 m; 95% CI, 0.05–0.06), and stride length (mean 0.05 m; 95% CI, 0.05–0.06), with a 7.69% mean relative error. Significance We concluded that GDI and stride length were the variables with the best repeatability and lower variability in the gait of iNPH patients.

BACKGROUND: Studies evaluating kinematics lead to different conclusions, not all changes appear in all assessed tasks and in all subgroups of patients with patellofemoral pain (PFP). The inconsistencies between studies could be reduced if we knew which task separates patients best from healthy controls. RESEARCH QUESTION: Identify which functional task, between gait, forward step down (FSD), lateral step down (LSD), stair ascent and descent and propulsion and landing phase of the single leg hop test (SLHT), differentiates the three-dimensional kinematics of women with patellofemoral pain from asymptomatic women. METHODS: This cross-sectional study evaluated thirty-five PFP and thirty-five asymptomatic women during the execution of the following tasks: gait, FSD, LSD, stair ascent and descent and the propulsion and landing phase of single leg hop test. Frontal, sagittal and transverse plane angles of the trunk, pelvis and hip, frontal and sagittal plane angles of the knee, ankle dorsiflexion, foot progression angle and hindfoot eversion were analyzed through the Movement Deviation Profile (MDP). To compare the groups, the multivariate analysis with Bonferroni post hoc test were used, with a significance level of p

This study aimed to evaluate test and retest reliability according to examiner experience with the three-dimensional kinematics of the trunk, scapula, and arm segments during flexion and unilateral abduction of the arm. Ten men and 10 women (mean age, 25.1 [1.1] years) participated in this study. Each volunteer participated in six test sessions, four on the first day (two for each examiner) and two on the second day (one for each examiner). A 48-h interval was given between test days. The assessments were made by one examiner with movement analysis experience and a second examiner without experience. For each session (intra-day), the volunteers performed five repetitions of unilateral arm flexions and abductions using their dominant arms. After 1 h, the data were re-collected and all markers were replaced. Data from the trunk, scapula, and arm were analysed at 30°, 60°, 90°, and 120° of arm flexion and abduction using intraclass coefficient correlation, standard error of the measurement, and analysis of variance. The results did not differ between the experienced and inexperienced examiners except for trunk axial rotation at all studied angles and for arm rotation at 120° of abduction. The examiner previously trained in movement analysis marker placement demonstrated the same intra-tester reliability as the inexperienced tester when marker placement accuracy was the variable of interest.

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p

Background There is no consensus on kinematics alterations during descending stairs in females with patellofemoral pain (PFP). In addition, there are no studies that have evaluated the three dimensional kinematics of the trunk, pelvis, hip, knee, and ankle using a multi-segmental model of the foot simultaneously during this task in patients with PFP and evaluated the subphases of stair descent. The objectives of this study were to compare the three dimensional kinematics of the trunk, pelvis, and lower limbs during different subphases of stair descent and identify the discriminatory capacity of the kinematic variables among women with PFP and healthy women. Methods In this cross-sectional study, thirty-four women with PFP and thirty-four pain free women between 18 and 35 years-old were submitted to three-dimensional kinematic evaluation during stair descent. Results It was observed that kinematic differences between the groups occurred in the first double support phase of the stair descent, with the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact (2.1°; sensitivity = 68.6%, specificity = 61.8%) and contralateral pelvic drop in load response (1.3°, sensitivity = 65.7%, specificity = 63.7%) presenting the best ability to discriminate women with and without PFP. Conclusion Our results suggest that kinematic changes during stair descent should be used with caution during the evaluation and decision-making process in women with PFP.

This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.

Functional biomechanical tests allow the assessment of musculoskeletal system impairments in a simple way. Muscle force synergies associated with movement can provide additional information for diagnosis. However, such forces cannot be directly measured noninvasively. This study aims to estimate muscle activations and forces exerted during the preparation phase of the single leg triple hop test. Two different approaches were tested: static optimization (SO) and computed muscle control (CMC). As an indirect validation, model-estimated muscle activations were compared with surface electromyography (EMG) of selected hip and thigh muscles. Ten physically healthy active women performed a series of jumps, and ground reaction forces, kinematics and EMG data were recorded. An existing OpenSim model with 92 musculotendon actuators was used to estimate muscle forces. Reflective markers data were processed using the OpenSim Inverse Kinematics tool. Residual Reduction Algorithm (RRA) was applied recursively before running the SO and CMC. For both, the same adjusted kinematics were used as inputs. Both approaches presented similar residuals amplitudes. SO showed a closer agreement between the estimated activations and the EMGs of some muscles. Due to inherent EMG methodological limitations, the superiority of SO in relation to CMC can be only hypothesized. It should be confirmed by conducting further studies comparing joint contact forces. The workflow presented in this study can be used to estimate muscle forces during the preparation phase of the single leg triple hop test and allows investigating muscle activation and coordination.

Background Patellofemoral pain has a poor long-term prognosis, which can be explained by a pain sensitization process. The pain sensitization process may be related to the increase of stress in the patellofemoral joint that is already associated with kinematic alterations and weakness in the musculature of the hip and knee. Methods Were compared the pressure pain threshold, temporal summation, conditioned pain modulation, angular kinematics, and muscle strength between 26 patellofemoral pain and 24 asymptomatic women and then correlated pain sensitization variables with biomechanical variables in pain group. The pressure pain threshold was determined on seven points of the knee, tibialis anterior muscle, and elbow. Ten consecutive stimuli were performed for temporal summation, and cold water was used as the conditioning stimulus for conditioned pain modulation. The strength of hip and knee muscles was determined using a manual dynamometer. Three-dimensional kinematics were evaluated during the lateral step down, considering peak and excursion values of the movement and the Movement Deviation Profile. Findings The pressure pain threshold of the elbow (2.13 [1.84–2.41] vs. 1.63 [1.25–2] kg/cm2), all sites of the knee were lower, as well as the Movement Deviation Profile was higher (9.33 [9.20–9.46] vs. 12.43 [12.1–12.75]) in the pain group. No difference in temporal summation, conditioned pain modulation, muscle strength and discrete kinematic values were found. No significant correlation was found between the Movement Deviation Profile and pressure pain threshold. Interpretation Biomechanical factors, pain processing, and modulation in women with patellofemoral pain, when different from asymptomatic individuals, are not necessarily associated.

Patients with patellofemoral pain (PFP) present altered activation of the hip and knee muscles. Electromyography (EMG) analyses in PFP patients are usually performed individually for each muscle. However, several studies suggest that the central nervous system may modulate neural commands directed to groups of co-activated muscles, called muscle synergies. Investigating the synergistic organization in PFP will advance our knowledge of the influence of pain on muscle coordination. This study aimed to compare the motor coordination between women with and without PFP during the lateral step down (LSD). 15 women with PFP and 14 asymptomatic women underwent three-dimensional kinematics and EMG assessment during LSD. The Movement Deviation Profile (MDP) was calculated from kinematic data. Muscle synergies were extracted from EMG data of eight lower limb muscles using a non-negative factorization algorithm. Results revealed differences in MDP and an altered synergistic control between women with PFP and asymptomatic while performing the same motor gesture. Particularly, the variability accounted for (VAF) when using 3 synergies to reconstruct EMGs of the PFP group was higher than in the control group, suggesting reduced complexity of motor control in PFP. Detailed synergy analyses highlighted specific differences between groups in vastii and rectus femoris, which are muscles with a crucial role during the squat phase and the transition to rise phase of the LSD. This study shows the ability of muscle synergies analysis to reveal impaired motor coordination in PFP patients, and has the potential to be explored as a complementary tool to current clinical assessment techniques., The study was financed in part by the Coordenação de Aper-feiçoamento de Pessoal de Nível Superior – Brasil (CAPES) –Finance Code 001.

Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: (1) capture six gait cycles after rest, (2) walk on a treadmill for a maximum of 20 min, (3) capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the Gait Deviation Index (GDI). The Gait Deviation Index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.

Randomized controlled trial.Patients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.Thirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement ControlStrengthening group (MCS group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.The MCS group did not present significantly better function (MD -2.5 points, 95% CI;-10.7-5.5) or pain (MD -0.3 points, 95% CI;-1.7-1.0) at 4 weeks. There was a small difference in favour of the MCS group for AKPS scores at 3 months (MD -8.5 points; 95% CI;-16.8 to -0.3). No significant between-group differences were observed for the other outcomes.Movement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.

Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p

The aim of the present study was to analyse the reproducibility of the Oxford Foot Model (OFM) when used with healthy adults during two clinical tests, i.e., the Anterior Step Down Test (SDA) and the Lateral Step Down Test (SDL). Five healthy participants (one male and four females, 10 limbs in total) with a mean age of 22.2 (19–30) years were assessed in four sessions of tests conducted at intervals of one week. Two independent examiners performed two of the sessions of each of the tests. For each session (intra-day), nine repetitions of each clinical test (SDA and SDL) were performed. After an interval of three hours, the data were collected again. The tests were conducted again after an interval of one week using the same experimental conditions. The intra- and inter-session repeatabilities of the ranges of motion of the feet were determined according to the standard error of measurement (SEM) for each examiner and for the differences between the examiners. The repeatabilities of the results were high for both of the conducted tests. The SEM results were as follows: 0.47–1.94° for the intra-examiner assessment (SDA), 0.55–2.01° for the inter-examiner comparison (SDA), 0.44–2.43° for the intra-examiner assessment (SDL), and 0.54–1.89° for the inter-examiner comparison (SDL). The OFM model was shown to be reproducible in terms of assessing the range of motion of healthy adults during functional tests (SDA and SDL).

Patients with dyskinetic cerebral palsy (DCP) experience considerable variability in their purposeful movements due to involuntary movements that contribute to functional impairment. Movement analyses can demonstrate how the movements involved in bringing a mug to the mouth are performed by patients with DCP. Sixteen adults with DCP (29.63 ± 4.42 years) and eleven healthy adults (24.09 ± 3.73 years) performed six consecutive movements of bringing a mug to the mouth using their dominant arm. The mug was placed at 75% of each subject's maximum reach. Kinematic data were captured by 10 cameras and processed using biomechanical software. Fifteen reflexive markers were placed on predetermined bony landmarks on the head, trunk and upper limbs. DCP adults required more time to perform the going (bringing the mug to the mouth), adjusting (simulating taking a drink) and returning (lowering the mug back to the table) phases, and their movements were less smooth than the controls, as indicated by the index of curvature, average jerk and number of movement units. The DCP adults took a longer time to complete the task than controls as indicated by the peak velocities, mean velocities and times to peak velocity. With respect to the angular parameters, DCP adults had a smaller range of motion for shoulder and elbow flexion and forearm pronation compared with the controls. The analysis of functional tasks represents an important measure for the evaluation of dyskinetic movements and permits the quantitative characterization of upper limb impairment in adults with DCP.

analysis (CGA). However, the motor limitations between HSP andSDarenotthesame[1–3].Fewerstudiesfocusedontheupperlimbskinematic concerning these two populations [1–3]. Thus, the aimof this study was to analyze the upper limb movements in HSP andSD patients during the gait.Patients/materialsandmethods:11HSPpatients(5malesand6 females, age: 16.7±5.8 years) and 10 SD patients (6 males and4 females, age: 12.3±4.5 years) have been evaluated with a CGAbetween2000and2011(VICON460andMx3+;ViconPeak

Patients/materials andmethods:Weperformed a case-control study.Weanalysed 14 childrenwith CP, aged 6–15 years,whowere followed in our tertiary outpatient child neurorehabilitation unit and 15 controls. There were no significant differences in age (CP 11.4±3.6 years, controls 10.6±2.6 years) or gender between cases and controls. In the CP group 9 children were graded GMFCS I, 5 weregradedGMFCS II, 12 childrenhadunilateral and2hadbilateral CP. Two U-shaped and two 8-shaped trial walks per subject were performed during which the accuracy and precision of the footworn devicewasmeasured using an opticalmotion capture system (Vicon, Oxford Metrics) as the reference system. All subjects then performed a continuous 200-meter walk test at their self-selected pace wearing the foot-worn inertial sensors (Physilog III, LMAMEPFL, Switzerland). Limb-related spatio-temporal parameterswere compared between paretic and control limbs while bilateral gait characteristics were compared between CP and control subjects, using nonparametric analyses. Results: Mean accuracy±precision for both groups was 3.4±4.6 cm for stride length, 4.3±4.2 cm/s for stride velocity and 0.5±2.9◦ for initial contact foot pitch angle. For temporal parameters paretic limbs showed longer stance (61.9±2.5% vs 60±0.9%, P=0.006) and shorter swing (38.1±2.5% vs 39.9±0.9%, P=0.006) phases,with an increase in double support in childrenwith CP (24.8±4.7% vs 20.3±1.7%, P=0.001). For spatial parameters stride length (1.07±0.18m vs 1.32±0.14, P

CG (9) 0.5703 0.7962 0.8633 0.0039 0.008 0.055 0.0039 0.0547 0.5703 0.0391 0.4258 0.3594 0.0742 0.0195 0.9102 0.0039 0.0039 0.0039 p ns ns ns ** * ns * ns ns * ns ns ns * ns ** * ** PDG (14) 0.6257 0.0009 0.0001 0.0067 0.007 0.058 0.058 0.1726 0.0085 0.8077 0.6257 0.2958 0.0107 0.0166 0.4631 .0001 0.0012 0.0002 p ns ** *** * * ns ns ns * ns ns ns ** ns