No abstract

Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5 o rearfoot medial wedge (R), a 5 o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but decreased the knee internal rotation moment compared to the C insole. Adductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.

The 4-week exercise protocol was effective to increase the activation of the GMed middle and posterior subdivisions, improving also the capacity to generate strength as a whole muscle during the proposed tasks. Copyright © 2015 John Wiley & Sons, Ltd.

Background/aims: Digital images are an inexpensive and complete method for registering pelvic positions and their changes as a result of clinical intervention. This study aimed to evaluate intra- and inter-observer reliability of pelvic tilt angles from anterior, posterior and bilateral views. Methods: Photographs of the anterior, lateral and posterior views of subjects (n=93) were analysed by Alcimage software, which marked pelvic tilt angles (right (R) and left (L) side views): between the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) and one horizontal line; beyond the angle between the two ASIS and one vertical line (ANT); and between the two PSIS and another vertical line (POST). Three observers evaluated the photos twice. Intra- and inter-observer reliability were assessed using the t-test, correlation coefficient, coefficient of variation (CV) and intraclass correlation coefficient (ICC) (P<0.05). Findings: The intra- and inter-observer t-test showed no significant difference. The intra-and inter-observer correlation coefficients varied between 0.9994 and 0.9760 and between 0.9510 and 0.9941 respectively. The ICC and CV between intra-observer measures were classified as excellent for the angles R and L but not for the angles ANT and POST. Inter-observer ICC was also high for the R, L and POST angles but poor for the ANT angle. Conclusion: The angles analysed from a sagittal view using photogrammetry enable the monitoring of possible longitudinal changes in pelvic tilt. However, the angles analysed from a frontal view may not be suitable for the diagnosis of pelvic asymmetries.

Introdução: Alterações em estrutura e função decorrentes de espondilólise/espondilolistese podem incluir dor lombar e/ou irradiada para membros inferiores com limitações de atividade. Objetivo: avaliar a eficácia de programas de reabilitação baseados em movimento para redução da dor e melhora de atividade em indivíduos com diagnóstico de espondilólise/espondilolistese. Método: Revisão sistemática de ensaios clínicos aleatorizados, cuja intervenção foi programa de reabilitação baseado em exercício. As medidas de desfecho foram dor e atividade. Resultados: Cinco estudos foram incluídos. Dois estudos investigaram a eficácia da intervenção experimental comparada a placebo/não-intervenção, encontrando resultados inconclusivos. Três estudos investigaram a eficácia da intervenção experimental em comparação ao tratamento cirúrgico, reportando superioridade do tratamento cirúrgico. Conclusão: Os resultados são inconclusivos em relação à eficácia da reabilitação baseada em movimento, e sugerem que é menos eficaz do que tratamentos cirúrgicos na redução da intensidade de dor e melhora de atividade de indivíduos com diagnóstico de espondilólise/espondilolistese.