Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: -21.91; 95% confidence interval [CI]: -36.59, -7.24; p = 0.003) and wrist disability (MD: -8.1, 95% CI: -4.6, -11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: -0.76; 95% CI: -1.30, -0.21; p = 0.007) and short-term (SMD: -0.93; 95% CI: -1.86, -0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: -0.94; 95% CI: -1.68, -0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term.

Gait adaptations after vestibular stimulation in children with congenital visual impairments: a comparative study

Purpose. The study is based on the hypothesis that individuals with congenital total or partial loss of vision develop more effective gait adjustments compared with those who are sighted, after stimulation of the vestibular system. Therefore, they are able to manage their motor control better. The aim was to investigate the way individuals with congenital total or partial vision loss adjust their gait following vestibular stimulation, compared with sighted blindfolded individuals. Methods. The total of 10 children with congenital visual impairments constituted the experimental group and 10 children with normal vision (blindfolded with special mask) formed the control group. We performed gait analysis (forward and backward gait direction) with a three-dimensional gait analysis system. The walking speed (m/s) of each group, before and after the vestibular stimulation, during forward and backward gait, was analysed. Results. The average walking speed of the children in the experimental group, statistically, revealed no significant differences before and after the vestibular stimulation. Conversely, in the control group, statistically significant differences in the mean walking speed before and after the vestibular system stimulation were found. Conclusions. Children with congenital total or partial blindness may adapt their gait strategy more adequately, after vestibular stimulation, during forward and backward gait, as compared with sighted blindfolded children. Consequently, the first group is in the position to manage their motor control more sufficiently.

Biomechanical Analysis of Ankle during the Stance Phase of Gait on Various Surfaces: A Literature Review

The purpose of this article is to review the literature that deals with the biomechanical analysis of the ankle during gait stance phase on slopes, on uneven and rock surfaces, on sand, and on grass surfaces, as well as to present the observed differences. Methods. The literature was searched in the databases of PubMed and Google Scholar, for the years of 2005–2015. The keywords were: biomechanics, gait analysis, ankle joint, stance phase, uphill walking, downhill walking, sand surface, uneven surface, grass surface, and ballast. Results. The kinetic and kinematic gait behaviour is directly influenced by the surface on which it is being performed. The uphill or downhill surfaces, the surfaces of stone, sand, grass, and uneven surfaces have a direct impact on the biomechanics on joints of the lower limb, changing the energy cost, muscle activation, the resulting mechanical work, ground reaction forces and balance, and the parameters of the gait cycle. All these changes are raising many questions about the safety and comfort of these surfaces. In the structures of the foot, ankle and lower leg high compressive and rotational forces are transmitted resulting in injuries in these regions. Conclusions. Each surface has its own advantages and disadvantages, changing the biomechanics of the lower extremity and particularly the ankle. According to the purpose that one wants to achieve they can choose a suitable surface. To prevent injuries and falls, we must choose shoes that fit well, are comfortable with cushioning, and have a feeling neither too hard nor too soft, with laces and low collar.

Prevalence of Injury in Ultra Trail Running

Purpose. The purpose of the study was to find the rate of musculoskeletal injuries in ultra-trail runners, investigate the most sensitive anatomical areas, and discover associated predicting factors to aid in the effective prevention and rapid rehabilitation of trail running injuries. Methods. Forty ultra trail runners responded to an epidemiological questionnaire. Results. At least one running injury was reported by 90% of the sample, with a total of 135 injuries were reported (111 overuse injuries, 24 appeared during competing). Lower back pain was the most common source of injury (42.5%). Running in the mountains (p = 0.0004) and following a personalized training schedule (p = 0.0995) were found to be protective factors. Runners involved in physical labor are associated with more injuries (p = 0.058). Higher-level runners are associated with more injuries than lower-level cohorts (p = 0.067), with symptoms most commonly arising in the lower back (p = 0.091), hip joint (p = 0.083), and the plantar surface of the foot (p = 0.054). Experienced runners (> 6 years) are at greater risk of developing injuries (p = 0.001), especially in the lower back (p = 0.012), tibia (p = 0.049), and the plantar surface of the foot (p = 0 .028). Double training sessions could cause hip joint injury (p = 0.060). Conclusions. In order to avoid injury, it is recommended to train mostly on mountain trails and have a training program designed by professionals.