Defne Kaya

Relationship between foot sensation and standing balance in patients with multiple sclerosis

The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (p<0.05). Sensation of the foot sole was related with duration of one-leg standing balance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2)=0.359, p=0.001) and vibration sensation of the first metatarsal head (R(2)=0.118, p=0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated.

Static Balance in Patients With Patellofemoral Pain Syndrome

Background: The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown. Hypothesis: OLSSB decreases in patients with PFPS. Design: Prospective case series. Methods: Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer. Results: There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side. Conclusions: OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB. Clinical Relevance: A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS.

Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft

OBJECTIVE The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. METHODS Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery, quadriceps and hamstring torque values were recorded using an isokinetic dynamometer. Computerized coordination and proprioception tests (Functional Squat System; Monitored Rehab System) were performed to determine the deficits in joint position sense. The anterior translation test was performed using a Kneelax 3 arthrometer to determine knee laxity. RESULTS Side-to-side differences between groups for hamstring and quadriceps muscle strength, concentric and eccentric motor coordination and anterior tibial laxity were not significantly different (p>0.05). CONCLUSION No statistically significant differences in functional outcome were found 1 year after the ACL reconstruction using Endobutton post-fixation and femoral transfixation with hamstring tendon graft. Deficits in hamstring-quadriceps muscle strength, motor coordination and proprioception were still found in both groups. We therefore recommend that long-term follow-up and rehabilitation including neuromuscular exercises should be continued for longer than one year after ACL reconstruction.

The Effect of an Exercise Program in Conjunction With Short-Period Patellar Taping on Pain, Electromyogram Activity, and Muscle Strength in Patellofemoral Pain Syndrome

Background: McConnell recommended that patellar tape be kept on all day, until patients learn how to activate their vastus medialis obliquus (VMO) during an exercise program. This application may pose problems because prolonged taping may be inadvisable for some patients or even contraindicated owing to skin discomfort, irritation, or allergic reaction. Hypothesis: Wearing patellofemoral tape for a shorter duration during an exercise program would be just as beneficial as a prolonged taping application. Study Design: Prospective cohort. Methods: Twelve patients and 16 healthy people participated. Patients underwent short-period patellar taping plus an exercise program for 3 months. Numeric pain rating, muscle strength of the knee extensors, and electromyogram activity of the vastus lateralis and VMO were evaluated. Results: There were significant differences in electromyogram activity (P = .04) and knee extensor muscle strength (P = .03) between involved and uninvolved sides before treatment. After treatment, pain scores decreased, and there were no significant differences between involved and uninvolved sides in electromyogram activity (P = .68) and knee extensor strength (P = .62). Before treatment, mean VMO activation started significantly later than that of vastus lateralis, as compared with the matched healthy control group (P = .01). After treatment, these differences were nonsignificant (P = .08). Conclusion: Short-period patellar taping plus an exercise program improves VMO and vastus lateralis activation. Clinical Relevance: A shorter period of taping for the exercise program may be as beneficial as a prolonged taping application.

Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury

Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.

How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome

PURPOSE the aim of this article was to review the clinical approach of quadriceps strengthening programmes. METHODS a literature search was carried out from 1980 up to September 2011. Eligible studies were those that: (1) evaluated the patients with patellofemoral pain syndrome (not healthy or asymptomatic subjects) (2) examined the effect of kinetic chain exercises (3) examined the effect of weight-bearing exercises (4) compared the effect of the combined exercises programme in the treatment of patients with patellofemoral pain syndrome. RESULTS AND CONCLUSION patients with patellofemoral pain syndrome may tolerate a closed kinetic chain exercises programme better than open kinetic chain. Weight-bearing and non-weight-bearing quadriceps exercises can significantly improve subjective and clinical outcomes in patients with patellofemoral pain syndrome. Combining treatments as an initial approach to treating patellofemoral pain but developing individualized more functional, global treatments are essential.

Is there any relationship between Q-angle and lower extremity malalignment?

OBJECTIVE The aim of this study was to assess the relationship between Q-angle and lower extremity alignment in women with unilateral patellofemoral pain syndrome (PFPS). METHODS Eighty-five women with unilateral patellofemoral pain participated in the study, with each subject acting as their own internal control using the unaffected limb. Lower extremity alignment and Q-angles of the affected and unaffected knees were compared. RESULTS There was a significant difference in the Q-angle between the affected (19.61±4.35) and the unaffected (17.63±4.29) side (p=0.00). There was also a significant difference in the lateral distal femoral angle (LDFA) (81.00±2.58 vs. 81.83±3.03; p=0.03) and no significant difference in the medial proximal tibial angle (MPTA) (87.88±2.63 vs. 87.60±3.29; p=0.51) between the affected and the unaffected side. There was no relationship between the Q-angle and LDFA (r=0.001, p=0.99), and MPTA (r=-0.051, p=0.64) in the affected side of the patients. There was also no relationship between the Q-angle and LDFA (r=0.179, p=0.64), and MPTA (r=-0.146, p=0.18) in the unaffected side of the patients. CONCLUSION Increased Q-angle and decreased LDFA may be associated with PFPS although cause or effect cannot be established. There was no relationship between the Q-angle and lower extremity malalignment. Large prospective longitudinal studies are needed to detect changes in the femoral anteversion and toe-in gait and to establish if these features are a cause of PFPS.

Shoulder joint position sense is negatively correlated with free-throw percentage in professional basketball players

Purpose: The aim of this study was to assess the relationship between the free-throw percentage, joint position sense, and muscle torque in professional basketball players. Methods: Eleven professional basketball players participated in the study, with each subject acting as their own internal control by using the non-dominant side. Knee and shoulder joint of the players were evaluated bilaterally. Flexion and extension peak torque of the knee were evaluated isokinetically system. In addition flexion/abduction/external rotation (F/ABD/ER) and extension/adduction/internal rotation (E/ADD/IR) diagonal pattern peak torque of the shoulder were measured. The joint position sense of both knees and shoulders were evaluated using an active angle reproduction. Thirty, 45, 60 and 75 degrees target angles were used for knee and 160, 135, and 120 degrees target angles were used shoulder. The free-throw percentage of the players for 40 matches in the 2009-2010 season was taken from the Turkish Basketball League official website. The relationship between the peak torque of the muscles, joint position sense, and the free-throw percentage was evaluated. Results: There were no significant differences in the peak torques of the knee and shoulder muscles and joint position sense between the dominant and non-dominant sides (p > 0.05). There was a significant correlation between the free-throw percentage and the peak torque of the shoulder muscles during the F/ABD/ER pattern at 60 degrees/s in the dominant side of the players. There was a borderline trend to significance between the free-throw percentage and the shoulder joint position sense (eyes-closed and at 160 degrees) in the dominant side. There was a borderline significant correlation between the free-throw percentage and the knee joint position sense (eyes-open and at 75 degrees) in the dominant side. Conclusions: The effect of proprioceptive and strengthening exercises on the free-throw percentage is still unknown. Further comprehensive studies are warranted to analyze the effect of proprioceptive and strengthening exercises on the free-throw percentage in elite basketball players

Sports Injuries and Proprioception: Current Trends and New Horizons

Importance of proprioception has become increasingly clear in sports injuries, orthopedics, and rehabilitation. Researchers showed that proprioception is also important for other functions of the human body [15, 17]. However, current knowledge about proprioception seems to be inadequate to understand the physiology of the process and develop standard preventive and/or therapeutic strategies. New measurement methods of proprioception reflecting the instant of injury or symptoms might be investigated more in the future. The effect of proprioceptive rehabilitation techniques on the performance of an athlete in a specific sport is believed to be an attractive research area for scientists [7, 9, 18, 33]. Correlation between proprioception and other performance criteria such as muscle strength, balance, and laxity might be studied more in the coming years [23]. Thus, the importance of proprioception in disorders and problems of the body other than sports injuries may be an important research area.

Endoscopy and Percutaneous Suturing in the Achilles Tendon Ruptures

Achilles tendon ruptures commonly occur during sportive activities and there is a tendency of increasing in the incidence of ruptures because of “weekend warriors” who are over 30 years of age. These pathologies are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures. Nevertheless, there is no consensus on the treatment method, and it is still determined by the surgeon and the patient. Open surgical repair of the Achilles tendon carries specific risks including adhesions between the tendon and the skin, infection, and particularly wound breakdown. Therefore, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia proffers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique resulted in a cosmetic wound appearance, endurable to early active mobilization and satisfactory clinical recovery without any severe complication. Furthermore, this procedure protects the paratenon and thus blood supplies of the tendon, and enhances biologic recovery. Also direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter we described our Achilles tendon repair technique under local anesthesia without tourniquet and with cooperation of the patient, and the results of our clinical experiences under the lights of literature.