Tine Willems

Open Versus Closed Kinetic Chain Exercises in Patellofemoral Pain A 5-Year Prospective Randomized Study

Background Today, no clinical studies have been undertaken to examine the long-term effects of an open kinetic chain or closed kinetic chain program. Hypothesis The long-term follow-up results after a conservative exercise protocol are significantly worse than the short-term results. The long-term effect of closed kinetic chain training is significantly better compared to the effect of open kinetic chain training. Study Design Prospective randomized clinical trial. Methods Sixty patients were randomized into a 5-week conservative program, consisting of only closed kinetic chain exercises or only open kinetic chain exercises. Assessment of muscular characteristics, subjective symptoms, and functional performance was evaluated in this study at the time of initial physical examination, at the end of the treatment period, and 5 years later. Results At the 5-year follow-up, both groups demonstrated maintenance of good subjective and functional outcomes achieved immediately after the conservative treatment. No significant difference between both groups was observed at the 5-year follow-up for the majority of the examined parameters. However, on 3 of the 18 visual analog scales, the open kinetic chain group showed significantly less complaints compared to the closed kinetic chain group. Conclusions On the basis of these results, the authors conclude that both open kinetic chain and closed kinetic chain programs lead to an equal long-term good functional outcome.

The risk of being fearful or fearless of falls in older people: an empirical validation.

Purpose. To investigate the risk of being fearful or fearless of falls in older people. Methods. Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period. Results. Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group. Conclusions. The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.

Relationship between hip strength and frontal plane posture of the knee during a forward lunge

Objective: Excessive frontal plane knee movement during forward lunge movements might be associated with the occurrence of knee injuries in tennis. Here, we attempt to determine whether hip muscle strength is related to the frontal plane motion of the knee during a functional lunge movement. Design: A correlational study. Participants: A total of 84 healthy subjects (76 men, 8 women), with no history of knee or lower leg complaints. Interventions: Muscle strength of six hip muscle groups was measured using a handheld dynamometer. Subjects were videotaped during a forward lunge and peak knee valgus or varus angles were determined using a digital video analysis software program. Main outcome measurements: A correlation was examined between hip muscle strength and the amount of frontal plane movement of the knee during a forward lunge. Results: There were no significant differences in hip muscle strength between the valgus group and the varus group during the forward lunge movement. No significant correlation was found between the strength of the assessed hip muscles and the amount of movement into valgus/varus. In the varus group a moderate positive correlation was found between the External Rotation/Internal Rotation force ratio and the amount of knee varus during the forward lunge movement (r = 0.31, p = 0.03). Conclusions: The findings suggest that in healthy subjects hip muscle strength is not correlated to the amount of valgus/varus movement of the knee during a forward lunge. This suggests that other factors (eg, proprioception, core hip stability) might be more important in controlling knee movement during this tennis-specific movement.

A home-based multidimensional exercise program reduced physical impairment and fear of falling.

Abstract Objective. To investigate the efficacy of a guided and graded home-based exercise program for improving a range of physical outcomes in older people. Design. Controlled clinical trial of 16 weeks Setting. Two geographical areas in Gent, Belgium Participants. 66 independent-living older people (age: 71-98) with a history of falls and moderate physical impairment Intervention. Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant’s home. Different types of exercises on balance, aerobic performance, flexibility, and muscle strength were provided. Main outcome measures. Muscle strength, static and dynamic balance, aerobic performance, activities in daily living, fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention. Results: At baseline, there were no significant differences in the measured variables between exercise and control groups. After 16 weeks, the exercise group showed significantly improved ankle muscle strength, balance performance and aerobic capacity, and decreased fear of falling, dependency in daily activities and avoidance of daily activities compared to the control group. The improvements in knee muscle strength, timed chair stands, and functional reach were not significant. Conclusion: The home-based, individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment. The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation.

The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study

Objective To prospectively identify proximal risk factors contributing to the development of exertional medial tibial pain (EMTP). Methods Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. 95 female students, aged 18.15±0.84, were tested at the beginning of their first academic year. Testing included isokinetic hip strength measurements of the abductors, adductors, internal rotators and external rotators. The follow-up of the individulas was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced MD (Doctor of Medicine). Cox regression analysis was used to identify the potential risk factors for the development of EMTP. Results 21 individuals were diagnosed with EMTP during follow-up. The results of this study identified that decreased hip abductor concentric strength is a predictive parameter for the development of EMTP in females. More specifically, total work (p=0.010) and average power (p=0.045) for concentric abduction strength were found to be significant predictors for this lower leg overuse injury. Conclusions Hip abductor weakness is a significant predictor for EMTP in women. Preventive screening methods for EMTP should therefore include this proximal contributing factor.

The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study

Objective To prospectively determine risk factors contributing to the development of exertional medial tibial pain (EMTP). Methods Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. Eighty-six female students aged 19.38±0.85 years, were tested at the beginning of their first academic year. Kinematic parameters in the frontal and transverse plane were measured during a single-leg drop jump (SLDJ). For further analysis, the SLDJ task was divided in two phases: touchdown until maximal knee flexion (MKF) and then MKF until take-off, representing landing and push-off phase, respectively. The injury follow-up of the students was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced medical doctor. Cox regression analysis was used to identify the potential risk factors for the development of EMTP. Results During injury follow-up (1–2 years), 22 participants were diagnosed with EMTP. The results of this study identified that increased range of motion (ROM) in the transverse plane of hip and thorax during landing (p=0.010 and 0.026, respectively) and during push off (p=0.019 and 0.045, respectively) are predictive parameters for the development of EMTP in women. Conclusions Increased ROM values of hip and thorax in the transverse plane, which can be interpreted as impaired ability to maintain dynamic joint stability resulting in increased accessory movements, are significant contributors to the development of EMTP in women.

Multi-segment foot landing kinematics in subjects with chronic ankle instability

BACKGROUND Chronic ankle instability has been associated with altered joint kinematics at the ankle, knee and hip. However, no studies have investigated possible kinematic deviations at more distal segments of the foot. The purpose of this study was to evaluate if subjects with ankle instability and copers show altered foot and ankle kinematics and altered kinetics during a landing task when compared to controls. METHODS Ninety-six subjects (38 subjects with chronic ankle instability, 28 copers and 30 controls) performed a vertical drop and side jump task. Foot kinematics were obtained using the Ghent Foot Model and a single-segment foot model. Group differences were evaluated using statistical parametric mapping and analysis of variance. RESULTS Subjects with ankle instability had a more inverted midfoot position in relation to the rearfoot when compared to controls during the side jump. They also had a greater midfoot inversion/eversion range of motion than copers during the vertical drop. Copers exhibited less plantar flexion/dorsiflexion range of motion in the lateral and medial forefoot. Furthermore, the ankle instability and coper group exhibited less ankle plantar flexion at touchdown. Additionally, the ankle instability group demonstrated a decreased plantar flexion/dorsiflexion range of motion at the ankle compared to the control group. Analysis of ground reaction forces showed a higher vertical peak and loading rate during the vertical drop in subjects with ankle instability. INTERPRETATION Subjects with chronic ankle instability displayed an altered, stiffer kinematic landing strategy and related alterations in landing kinetics, which might predispose them for episodes of giving way and actual ankle sprains.

Contribution of a Muscle Fatigue Protocol to a Dynamic Stability Screening Test for Exertional Medial Tibial Pain

Background: Enhancing the accuracy of a risk factor screening test is an important element of sports injury prevention. Purpose: To determine the effect of muscle fatigue on a screening tool for those at risk of exertional medial tibial pain (EMTP). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-nine female students in a physical education program with a mean age of 19.24 ± 0.86 years were tested at the beginning of their first academic year and followed for 1 to 2 years. Participants completed an online questionnaire every week and a retrospective control questionnaire every 3 months, which were used to assess injury follow-up. A diagnosis of EMTP was made by an experienced medical doctor. A Cox regression analysis was used to identify the potential risk factors by comparing prefatigue and postfatigue data between uninjured participants and those with EMTP. Both the leg that developed EMTP and the contralateral leg were compared with legs of a matched control group. Results: During injury follow-up, 21 female participants were diagnosed with EMTP. Results of the comparison between uninjured versus EMTP participants, respectively, are as follows: For the leg at risk in the nonfatigued state, only increased range of motion in the transverse plane (ROMT) of the hip during landing could be identified as a risk factor (8.44° ± 2.94° vs 11.69° ± 3.41°; P = .002). In the fatigued state, increased ROMT of the hip and pelvis during landing (hip: 8.04° ± 2.34° vs 9.36° ± 3.22°; P = .038; pelvis: 6.99° ± 2.20° vs 8.58° ± 3.13°; P = .040) and increased ROMT of the thorax during pushoff (8.83° ± 2.74° vs 10.69° ± 3.20°; P = .036) could be identified. For the leg not at risk for EMTP, increased ROMT of the knee during landing (10.96° ± 3.12° vs 14.07° ± 4.88°; P = .023) and decreased ROMT of the pelvis during pushoff (8.16° ± 3.48° vs 6.47° ± 2.47°; P = .034) were identified in the nonfatigued state but were not significant in the fatigued state. Conclusion: Adding a muscle fatigue protocol to the single-legged drop jump as a screening test for EMTP risk factors may enhance the possibility of identifying the leg at risk in a predisposed athlete and might determine the proximal risk factors for that leg at risk more thoroughly.

Effect of Tape on Dynamic Postural Stability in Subjects with Chronic Ankle Instability

The objective of our study was to evaluate the effect of taping on the dynamic postural stability during a jump landing protocol in subjects with chronic ankle instability (CAI). For this purpose, 28 subjects with CAI performed a sagittal and frontal plane landing task in a non-taped and taped condition. As main outcome measure, the dynamic postural stability index (DPSI) was calculated. In addition, subjective feelings of instability and perceived difficulty level were assessed. Furthermore, mechanical effectiveness of the tape on the ankle joint was determined by registering 3D kinematics. 3 subjects were excluded based on discomfort during the landing protocol. Study results indicated that the tape reduced plantar flexion and inversion at the ankle at touchdown and range of motion in the landing phase. There was, however, no effect on the DPSI or on its directional subcomponents. Subjective feelings of stability with tape improved significantly, whereas perceived difficulty did not change. In conclusion, our taping procedure did not improve postural control during a sagittal and frontal plane landing task in subjects with CAI. Perceived instability did improve and is considered an important treatment outcome, which suggests that taping could be considered as a treatment modality by clinicians.

Contralateral risk factors associated with exertional medial tibial pain in women.

PURPOSE This study aimed to prospectively analyze the role of factors on the contralateral side of the kinetic chain in the development of exertional medial tibial pain (EMTP). METHODS Eighty-one female physical education students were tested at the beginning of their first academic year. Within the testing protocol, contralateral isokinetic hip muscle strength and full-body kinematic parameters during a single-leg drop jump were evaluated. Online questionnaires were administered weekly, and personal interviews were conducted every 3 months to assess injury follow-up. EMTP was diagnosed by an experienced medical doctor. Cox regression analysis was used to identify the potential risk factors for the development of EMTP. RESULTS After exclusion of subjects with diagnosed bilateral EMTP, 11 subjects were included in the EMTP group. Fifty-three subjects did not develop any lower extremity overuse injury and were included in the control group. The leg not at risk within subjects who developed EMTP was compared with an uninjured leg of those in the control group. Increased transverse plane motion for the contralateral lower leg segment during landing phase was found to be a significant predictor (P = 0.012) for EMTP. Analysis of the isokinetic data did not reveal altered hip muscle strength parameters for the leg not at risk within the EMTP group. CONCLUSIONS Impaired dynamic joint stability or accessory movements were found in the transverse plane of the contralateral lower leg segment of EMTP subjects. This contralateral instability might have contributed to altered movement patterns within the kinetic chain function of EMTP subjects. No contralateral hip muscle strength parameters were found to predict EMTP in this study.