Effect of Combined Exercise Program on Lower Extremity Alignment and Knee Pain in Patients with Genu Varum

Effect of Lateral Wedge Insole With and Without Thigh and Abdominal Muscle Strengthening Exercises on the Balance of Young People With Genuvarum: A Randomize Controlled Trial

Background and Aim

Genuvarum is a common lower limb deformity that affects the alignment of the leg in the frontal plane. This can lead to changes in the ground reaction force (GRF) and center of pressure (COP) of the foot, disrupting postural control strategies, and causing balance issues. This study aimed to determine the effect of strengthening exercises of thigh and abdominal muscles, along with use of a lateral wedge insole (LWI) on balance in young people with genuvarum.

Methods

A total of 40 individuals aged 18-40 with genuvarum were split into two groups, with 20 people in each group. Participants in one group received only LWI (LWI group), while those in other group received LWI along with thigh and abdominal muscle strengthening exercises (LWI + exercises group). Balance tests were conducted before and after the 4-week interventions under barefoot condition on a force plate. The tests included parameters related to COP in single- and two-legged standing for static balance, and loading rate of F0 and F1 while walking, peak vertical GRF, and time to reach stability while jumping-landing test for dynamic balance.

Results

In the comparison between LWI + exercises group and LWI group, there was a significant decrease in variables related to COP during single-leg standing and F1 loading rate during walking (p < 0.05).

Conclusion

Incorporating muscle strengthening exercises targeting muscles around the thigh and abdominal region, in addition to using LWI, can be beneficial in individuals' rehabilitation with genuvarum, helping to prevent injuries related to poor posture control. Trial Registration: The current study was a randomized clinical trial, registered in the Iranian registry of clinical trials (registration number: IRCT20221103056387N1).

How Medial Tibial Stress Syndrome Is Affected by Alignment, Range of Motion, Strength, and Gait Biomechanics: A Systematic Review and Meta-Analysis

CONTEXT

Medial tibial stress syndrome (MTSS) is a common chronic injury of the lower-extremity in the physically active population. However, the risk factors for MTSS remain unclear.

OBJECTIVE

This study identified the risk factors for MTSS and established the continuum model of lower-extremity alignments, range of motion, muscular strength, and gait kinematics affecting each other and MTSS development.

EVIDENCE ACQUISITION

Online databases including PubMed, CINAHL, SPORTDiscus, and Web of Science were used to retrieve studies related to risk factors for MTSS. The study eligibility criteria were studies that used the MTSS definition of the Yates and White criteria, or included participants with MTSS, except for stress fracture and compartment syndrome. A total of 2099 papers were retrieved during the initial search stage. After screening, based on eligibility criteria and cross-reference, 21 papers were included in this study. Data on lower-extremity alignments, range of motion, muscular strength, and gait biomechanics were extracted as outcome variables for this meta-analysis. Publication bias was assessed using funnel plots and Egger's regression analysis.

EVIDENCE SYNTHESIS

Foot posture index (standardized mean difference [SMD] = 1.23; 95% CI, 0.02-2.43), intercondylar interval (SMD = 0.29; 95% CI, 0.10-0.48), inversion range of motion (SMD = 0.37; 95% CI, 0.10-0.63), eversion strength (SMD = 0.37; 95% CI, 0.10-0.65), and dynamic arch height change during walking (SMD = 1.05; 95% CI, 0.49-1.60) were significant risk factors for MTSS. Egger's regression analysis revealed asymmetry in several variables, which indicates publication bias. The trim-and-fill method was applied to these variables. A comparison between the SMD and adjusted SMD showed that the variables had minimal impacts on the meta-analysis.

CONCLUSIONS

Based on our results, health care professionals should assess the significant risk factors in patients before participation in physical activities and treat them to prevent and rehabilitate MTSS.

Functional Recovery in a Patient of Abnormal Left Parieto-Occipital Encephalomalacia With Gliosis-Associated Genu Varum Deformity: A Case Report

Parieto-occipital encephalomalacia is a macroscopic appearance of the brain with loss of cerebral parenchyma associated with gliosis in the brain's anatomical structures. It occurs because of the liquefaction of brain parenchymal necrosis after cerebral ischemia, infection, and haemorrhages. It is often surrounded by glial cell proliferation in response to damage. Rehabilitation after the manifestation of neurological function must be tailored, and well-coordinated intervention must be formulated. We present a case study of a 77-year-old male with parieto-occipital encephalomalacia associated with genu varum deformity with a complaint of generalized weakness, vertigo, giddiness, and fall with one episode of a seizure attack. Further, bilateral genu varum deformity was noted on the knees. Encephalomalcia is associated with vitamin D deficiency. The physiotherapy rehabilitation consisted of resolving the symptoms of the patient, along with working on strengthening weak muscles of the genu varum deformity of the patient. The proprioceptive neuromuscular facilitation (PNF) method is a popular rehabilitation strategy for regaining motor function. Numerous outcome measures were used to monitor the patient's progress. Outcome measures such as the tone grading scale (TGS), motor assessment scale (MAS), dynamic gait index (DGI), Barthel index (BI), and world health-related quality-of-life (WHORQOL) scales were used. The rehabilitation lasted for six weeks. Tele-rehabilitation also plays a crucial impact in the recovery of patients. By the end of our rehabilitation, the patient significantly improved in performing activities of daily living and improved his quality of life. Tele-rehabilitation helped us stay connected with the patient.