Gabriel Y.F. Ng

The effects of patellar taping on pain and neuromuscular performance in subjects with patellofemoral pain syndrome

Objective: To examine the immediate effects of patellar taping on pain and relative activity of vastus medialis obliquus to vastus lateralis in subjects with patellofemoral pain and patellofemoral joint malalignment. Design: Pre-and post-treatment design, with order of testing determined randomly. Setting: Outpatient physiotherapy department. Subjects: Fifteen subjects with patellofemoral joint pain and malalignment. Interventions: With and without patellar taping with a standard force of application. Main outcome measures: Pain and surface EMG activity ratio of vastus medialis obliquus to vastus lateralis during single-legged semi-squat with 20% of extra body weight loading. Results: There was a significant decrease in anterior knee pain (p < 0.001) and vastus medialis obliquus to vastus lateralis activity ratio (p = 0.05) during single-legged standing after patellar taping. Conclusions: Patellar taping can reduce pain in people with patellofemoral pain syndrome and patellofemoral malalignment but it decreases the relative activity of vastus medialis obliquus to vastus lateralis. Such a decrease in relative activity of vastus medialis obliquus after taping implies that it may not be suitable to combine patellar taping with vastus medialis obliquus facilitative exercise training.

Therapeutic ultrasound improves strength of Achilles tendon repair in rats

The purpose of this study was to evaluate the effects of therapeutic ultrasound on structural properties and functional performance of Achilles tendon healing. Thirty Sprague-Dawley rats with surgical hemitransected Achilles tendon were studied. Ten were treated daily with 1 MHz continuous ultrasound at 1.0 W/cm2 for 4 min, 11 at 2.0 W/cm2 for 4 min and nine served as control without treatment. Achilles functional index (AFI) was recorded preoperatively and on postoperative days 3, 10 and 30. On day 30, the rats were sacrificed and Achilles tendons were tested for load-relaxation, stiffness and ultimate tensile strength (UTS). Results showed that UTS of both low-dose (p=0.023) and high-dose (p=0.002) groups was significantly greater than in controls. No significant differences in AFI (p=0.179), load-relaxation (p=0.205) and stiffness (p=0.842) were found among groups. These findings suggested that both low- and high-dose therapeutic ultrasound accelerate the healing process of ruptured tendon.

Association of Footwear with Patellofemoral Pain Syndrome in Runners

Patellofemoral pain syndrome (PFPS) is a common knee problem with a diverse aetiology. One of the clinically well accepted risk factors is malalignment of the lower extremities, including excessive foot pronation, tibial and femoral rotations. A feature of footwear technology entitled ‘motion control’ aims to reduce excessive movements of the rearfoot during sports activities, and has been developed and used by runners. However, no studies have reported a causal relationship between footwear and PFPS. This review attempts to explore a possible link between the footwear and PFPS so as to shed light on whether proper selection of shoes may be an adjunct therapeutic consideration in the management of patients with PFPS.

Biofeedback supplementation to physiotherapy exercise programme for rehabilitation of patellofemoral pain syndrome: a randomized controlled pilot study

Objectives: To examine the efficacy of electromyographic (EMG) biofeedback supplementation to exercise rehabilitation for people with patellofemoral pain syndrome. Design: Double-blinded randomized clinical controlled pilot trial. Setting: Clinical setting with home programme. Participants: Twenty-six subjects diagnosed with patellofemoral pain. Intervention: Subjects were randomly assigned into EMG biofeedback+exercise group or exercise-only group. All subjects participated in an eight-week home exercise programme, while the biofeedback group also received EMG visual feedback of their quadriceps muscle activities during the exercises. Main outcome measures: Isokinetic knee extension strength, patellar alignments and perceived pain severity were assessed in weeks 0, 4 and 8 for all subjects. The data within and between groups were compared by repeated measures ANOVA with aα=0.05. Results: Both groups improved in isokinetic peak torque (P=0.005), work output (P=0.037) and patellar alignments (P=0.001-0.014). Besides, there was a trend of decrease in pain (P=0.088). The biofeedback group improved faster than the exercise group in lateral patellar rotation and peak torque per body weight, although no statistically significant difference was shown. Conclusion: Biofeedback supplement to the exercise programme might hasten the improvement for subjects with patellofemoral pain in the first few weeks of a physiotherapy exercise programme, but this needs further study before being used.

The long-term biomechanical and viscoelastic performance of repairing anterior cruciate ligament after hemitransection injury in a goat model.

To test the healing of the partially torn anterior cruciate ligament, we transected the posterolateral bundle in 11 adult female goats and tested the ligaments at 12, 24, and 52 weeks and 3 years after surgery. As early as 12 weeks after surgery translucent fibrous tissue covered the wound. The differences in anteroposterior laxity between right and left knees measured at 45° and 90° of flexion were not significantly different at each period. Results of Instron testing of the posterolateral bundle revealed the normalized changes in load-relaxation and Youngs modulus were not significantly different at each period, but the ultimate tensile strength and stiff ness at 3 years were significantly higher than at 12 weeks ( P < 0.05). Failure started at the repair site for the 12-week group, but at 24 and 52 weeks the failure occurred throughout the ligament. At 3 years, the spec imens failed with bony avulsion, indicating the repaired tissue was not the weakest link of the bone-ligament- bone complex. This study shows that under favorable conditions, partial anterior cruciate ligament injuries are capable of repair. What is more important, the high ultimate tensile strength and stiffness of the 3-year repaired tissue indicate full structural repair of such an artificial transection injury may be possible.

Taekwondo training improves sensory organization and balance control in children with developmental coordination disorder: A randomized controlled trial

Children with developmental coordination disorder (DCD) have poorer postural control and are more susceptible to falls and injuries than their healthy counterparts. Sports training may improve sensory organization and balance ability in this population. This study aimed to evaluate the effects of three months of Taekwondo (TKD) training on the sensory organization and standing balance of children with DCD. It is a randomized controlled trial. Forty-four children with DCD (mean age: 7.6±1.3 years) and 18 typically developing children (mean age: 7.2±1.0 years) participated in the study. Twenty-one children with DCD were randomly selected to undergo daily TKD training for three months (1 h per day). Twenty-three children with DCD and 18 typically developing children received no training as controls. Sensory organization and standing balance were evaluated using a sensory organization test (SOT) and unilateral stance test (UST), respectively. Repeated measures MANCOVA showed a significant group by time interaction effect. Post hoc analysis demonstrated that improvements in the vestibular ratio (p=0.003) and UST sway velocity (p=0.007) were significantly greater in the DCD-TKD group than in the DCD-control group. There was no significant difference in the average vestibular ratio or UST sway velocity between the DCD-TKD and normal-control group after three months of TKD training (p>0.05). No change was found in the somatosensory ratio after TKD training (p>0.05). Significant improvements in visual ratios, vestibular ratios, SOT composite scores and UST sway velocities were also observed in the DCD-TKD group after training (p≤0.01). Three months of daily TKD training can improve sensory organization and standing balance for children with DCD. Clinicians can suggest TKD as a therapeutic leisure activity for this population.

Efficacies of different external controls for excessive foot pronation: a meta-analysis

Objectives This meta-analysis investigated the efficacies of foot orthoses, motion control footwear and therapeutic adhesive taping in controlling foot pronation as compared with no-intervention conditions. Data sources Electronic searches on four electronic databases were performed and the reference lists of the screened articles were also scrutinised. Review methods Two reviewers screened the quasi-randomised or clinical controlled trials that examined the efficacy of the selected interventions in controlling calcaneal eversion. Heterogeneity and publication bias were assessed by I2 index and Eggers regression intercept, respectively. Trial quality was rated by the Physiotherapy Evidence Database scale. Results 29 studies were selected. The I2 indices revealed large heterogeneity which supported the use of a random effect model of meta-analysis. The Eggers regression intercepts suggested that publication bias of the included studies was marginally present in the motion control footwear and the therapeutic adhesive taping groups (p=0.06–0.07). All three interventions were effective in reducing calcaneal eversion (p<0.001) with therapeutic adhesive taping being most effective whereas Low-dye taping was less effective than the other taping techniques, such as high-dye and stirrups taping. Custom-made foot orthoses were more effective than prefabricated orthoses. Motion control footwear with heel flare or wedge design was less effective than those with dual midsole materials. Conclusions Foot orthoses, motion control footwear and therapeutic adhesive taping were able to control rearfoot eversion with therapeutic adhesive taping being the most effective. In the clinical practice, selection of an antipronation intervention should be based on patient characteristics, type of activity and personal preference.

Effects of knee bracing on the sensorimotor function of subjects with anterior cruciate ligament reconstruction

The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects’ ability to reproduce specified knee joint angles was tested as well as the isokinetic performance of their knee muscles at 60 and 180 deg/sec. The results showed that subjects with the brace or placebo brace performed similarly in reproducing the knee joint positions, but both groups performed better than the subjects without a brace. Isokinetic tests revealed no difference among the three groups in extensor and flexor peak torque production at 60 deg/sec or total work done by the extensors and flexors at 60 and 180 deg/sec. These results suggest that knee bracing can improve the static proprioception of the knee joint, but not the muscle contractile function, in subjects with anterior cruciate ligament reconstruction under isokinetic testing conditions. The finding of similar performances for joint angle reproduction in the brace and placebo brace groups suggests that the apparent improvement in proprioception with knee bracing was not due to the mechanical restraining action of the brace.

Taekwondo training speeds up the development of balance and sensory functions in young adolescents.

OBJECTIVES This study aimed (1) to identify the developmental status of balance and sensory functions in young adolescents as compared to adults and, (2) to explore the effect of Taekwondo (TKD) training on the development of balance and sensory systems in young adolescents. DESIGN Cross-sectional controlled trial. METHODS Sixty-six participants including 42 adolescents (21 TKD practitioners, 21 non-TKD practitioners) and 24 adults were tested. The sway velocity of centre of gravity was recorded during standing on the non-dominant leg on a Smart Equitest ® system. The somatosensory, vestibular and visual ratios were also measured with the machine. RESULTS Adult participants swayed slower than both TKD and non-TKD adolescent groups during single leg stance with eyes open (p=0.007 and p<0.001, respectively). The TKD adolescent group, in turn, swayed slower than the non-TKD adolescent group (p<0.001). Adult participants had better visual ratio than both TKD and non-TKD adolescents (p=0.001 and p<0.001, respectively) while there was no difference between the TKD and non-TKD adolescents (p=0.164). For the vestibular ratio, there was no significant difference between adult participants and TKD adolescents (p=0.432). Adolescents who did not practice TKD showed significantly lower vestibular ratio than TKD adolescents and adults (p=0.003 and p<0.001, respectively). In addition, there was no significant difference in the somatosensory ratio among the 3 participant groups (p=0.711). CONCLUSIONS Participation in TKD appears to speed up the development of postural control and vestibular function in adolescents. Clinicians might advocate TKD exercise as a therapeutic intervention for young people with balance or vestibular dysfunctions.

Altered postural control strategies and sensory organization in children with developmental coordination disorder.

The postural control of children with and without developmental coordination disorder (DCD) was compared under conditions of reduced or conflicting sensory input. Twenty-two children with DCD (16 males, 6 females; mean age 7 years 6 months, SD 1 year 5 months) and 19 children with normal motor development were tested (13 males, 6 females; mean age 6 years 11 months, SD 1 year 1 month). Standing balance, sensory organization and motor control strategy were evaluated using the sensory organization test (SOT). The results revealed that children with DCD had lower composite equilibrium scores (p<.001), visual ratios (p=.005) and vestibular ratios (p=.002) than normal children in the control group. No significant between-group difference in their average somatosensory ratio was observed. Additionally, children with DCD had lower motor strategy scores (swayed more on their hips) than the normal children when forced to depend on vestibular cues alone to balance (p<.05). We conclude that children with DCD had deficits in standing balance control in conditions that included reduced or conflicting sensory signals. The visual and vestibular systems tended to be more involved in contributing to the balance deficits than the somatosensory system. Moreover, children with DCD tended to use hip strategy excessively when forced to rely primarily on vestibular signals to maintain postural stability.