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Br J Sports Med. 2007 June; 41(6): 403–404.
PMCID: PMC2465324

SportsMedUpdate

A prospective biomechanical study of the association between foot pronation and the incidence of anterior knee pain among military recruits

HetsroniI, FinestoneA, MilgromC. J Bone Joint Surg Br 2006;88(7):905–8

Professor Martin P Schwellnus, University of Cape Town, South Africa

BackgroundIt has been suggested that excessive foot pronation is related to development of anterior knee pain.

Research question/sDo static and dynamic parameters of foot pronation predict the development of exertional anterior knee pain in military recruits?

MethodologySubjects: 473 infantry recruits.

Experimental procedure: In the 2 weeks before beginning basic training, all the subjects underwent two‐dimensional measurement of their sub‐talar joint displacement parameters (standing tibiocalcaneal angle, maximum foot pronation angle, pronation range of motion, time to maximum pronation, pronation velocity, stance duration) during walking on a treadmill. Subjects then underwent 14 weeks of basic military training and all the subjects were followed up for the development of anterior knee pain. 61/473 subjects (15%) developed exertional anterior knee pain.

Measures of outcome: Incidence of anterior knee pain (% recruits) in quartiles of biomechanical parameters.

Main finding/s:

figure sm2007SMU6.f1

There was no consistent association between the incidence of anterior knee pain and any of the biomechanical parameters of foot pronation, except between anterior knee pain and pronation velocity (left foot, p  = 0.05; right foot, p  = 0.007); however, this relationship was contradictory for the right and left foot.

Conclusion/sIn a prospective cohort study in military recruits, the development of anterior knee pain was not related to excessive foot pronation as measured by two‐dimensional biomechanical analyses.

Evidence based rating7.5/10

Clinical interest rating8.5/10

Type of studyProspective cohort study

Methodological considerationsWell designed study, two‐dimensional analyses has limitations

Keywordsknee, injury, anterior knee pain, pronation, biomechanics

The effect of corticosteroid on collagen expression in injured rotator cuff tendon

WeiAS, CallaciJJ, JuknelisD. J Bone Joint Surg Am 2006;88(6):1331–8

BackgroundIn clinical practice, sub‐acromial corticosteroid infiltration followed by rehabilitation exercise is commonly used in the treatment of rotator cuff disease, but the effects of corticosteroid injection on injured rotator cuff tendon tissue have not been well studied.

Research question/sDoes sub‐acromial corticosteroid injection alter the acute response of rotator cuff tendons to injury by analysing the type‐III to type‐I collagen expression ratio that is a tendon injury marker?

MethodologySubjects: 60 Sprague‐Dawley rats.

Experimental procedure: Six rats served as sham controls (SC) while the remaining rats were randomly assigned to four groups: control (C), tendon injury (T), sub‐acromial steroid treatment (ST, 0.6mg/kg methylprednisolone) and tendon injury and steroid treatment (TST). In the T and TST groups the tendon injuries were created (full‐thickness defects across 50% of the total width of the infraspinatus tendon, 5 mm from the humeral insertion). Steroid treatment with a single dose, equivalent to that given to humans, was injected into the sub‐acromial space under direct visualisation. Steroid treatment followed the creation of an injury in the rats in the injury and steroid treatment group.

Measures of outcome: Type‐I:type‐III collagen expression ratio (marker of tendon injury) (1, 3 and 5 wks).

Main finding/s:

figure sm2007SMU6.f2

There was no significant difference in type‐III to type‐I collagen expression ratio from baseline and at all timepoints in the C and SC groups.

  • Following an experimentally induced injury to the rotator cuff in an animal model, a sub‐acromial corticosteroid injection did not alter markers of injury (type‐III: type‐I collagen ratio) more than the injury alone; however, cortisone injection alone with no injury also increased this marker of injury for 1–3 weeks following injection.
  • Collagen composition may be acutely altered by the injection.

Evidence based rating8/10

Clinical interest rating8/10

Type of studyRandomised controlled clinical trial (animal model, laboratory study)

Methodological considerationsWell conducted study

Keywordscorticosteroid, tendon, injury, rotator cuff, shoulder

Effects of exercise programs on falls and mobility in frail and pre‐frail older adults: a multicenter randomized controlled trial

FaberMJ, BosscherRJ, ChinMJ. Arch Phys Med Rehabil 2006;87:885–96

BackgroundExercise interventions may be effective in preventing, or delaying, the frailty associated with older age (weight loss, weakness, exhaustion, slowness, low physical activity).

Research question/sDoes a moderate‐intensity group exercise programme reduce falls and improve functional performance and disability in older adults?

MethodologySubjects: 278 elderly men and women (85 ± 6 yrs) from 15 homes for the elderly. A 20‐week, multicentre, randomised controlled trial, with 52‐week follow‐up.

Experimental procedure: Two 20‐week exercise programmes (functional walking (FW), consisting of exercises related to daily mobility activities; balance exercises (BAL), inspired by the principles of Tai Chi) were randomly assigned to the 15 homes. In each home, participants were randomly assigned to an exercise (EX) or a control (CON) group (asked not to change their usual pattern of activities).

Measures of outcome: Incidence of falls (falls/yr), Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (self‐reported disability).

Main finding/s:

figure sm2007SMU6.f3
  • Subjects in the EX groups who were classified as frail were more likely to fall (HR 2.95; 95% CI 1.64–5.32).
  • There was a small, but significant, improvement in the POMA and physical performance scores in the EX group, and in the EX‐FW this was also significant in the GARS score. Only the pre‐frail participants improved their POMA and physical performance scores.

Conclusion/sIn the elderly who are classified as pre‐frail, a moderate‐intensity group exercise programme reduces the risk of falling and improves physical performance; this was not observed for the same exercise programme in the frail elderly.

Evidence based rating7.5/10

Clinical interest rating7.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study

Keywordsexercise programmes, elderly, fall, frail, rehabilitation

Three intermittent sessions of cryotherapy reduce the secondary muscle injury in skeletal muscle of rat

OliveiraNML, RaineroEP, SalviniTF. J Sports Sci Med 2006;5:228–34

BackgroundIce and compression are well established practices in the treatment of acute muscle injury. However, the effect of intermittent treatment using these modalities to prevent secondary muscle injury is not established.

Research question/sDo three sessions of cryotherapy, compared with compression or placebo, reduce the area of muscle damage after an experimentally induced contusion injury in a rat model?

MethodologyExperimental animals: 24 Wistar rats (312 ± 20g).

Experimental procedure: The middle belly of the tibialis anterior (TA) muscle was injured by a frozen iron bar and rats were then randomly assigned to receive one of the following 3 treatments: (i) cryotherapy (ICE  = 6) (3 × 30 min of ice pack each 2h), (ii) compression (sand pack) (COMP  = 6) or (iii) no treatment (CON  = 6). A non‐injured group received sessions of cryotherapy (NINJ  = 6). Frozen muscles were cross‐sectioned (10 μm) 4.5 hrs after the injury (after the last treatment session) and stained for the measurement of muscle area.

Measures of outcome: Injured area (%).

Main finding/s:

figure sm2007SMU6.f4

Conclusion/sIn an animal muscle contusion model, three sessions of 30 minutes ice treatment, 2 hours apart, significantly reduced the area of muscle injury compared with no treatment, or compression alone.

Evidence based rating7.5/10

Clinical interest rating8/10

Type of studyRandomised controlled clinical trial (animal model)

Methodological considerationsWell conducted study, animal model (requires study in human model), small sample size, short follow‐up

Keywordsice, compression, muscle injury, treatment, animal model


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