Search Results (466)

Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness for mitigating the risk of ankle sprains due to excessive subtalar inversion during high-impact activities, such as landing from a free fall. Methods: We employed biomechanical simulations to assess the influence of translational stiffness on subtalar inversion control, given that inversion angles exceeding 25 degrees are strongly correlated with injury risk. Simulations were conducted using a musculoskeletal model with and without a passive AFO; the stiffness varied in three anatomical directions. A Design of Experiments (DoE) approach was utilized to capture nonlinear interactions among stiffness parameters. Results: The results indicated that increased translational stiffness significantly reduced inversion angles to safer levels, though direction–dependent effects were noted. Based on these insights, we developed a 4D visualization tool that integrates simulation data with an interactive color–coded interface to depict ”safe design” zones for various AFO stiffness configurations. This tool supports clinicians in selecting stiffness values that optimize both safety and functional performance. Conclusions: The proposed framework enhances clinical decision-making and engineering processes by enabling more accurate and individualized AFO designs. Full article

Introduction: Hip abductor strength is essential for pelvic stability, lower limb alignment, and injury prevention. Weaknesses of the gluteus medius and minimus contribute to various musculoskeletal conditions. Lateral band walks and monster walks are elastic resistance exercises commonly used to target the hip abductors and external rotators in functional, weight-bearing tasks. Therefore, the aim was to summarize the current evidence on the biomechanics, muscle activation, and clinical applications of lateral and monster band walks. Methods: This narrative review was conducted following the SANRA guideline. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and SPORTDiscus up to April 2025. Studies on the biomechanics, electromyography, and clinical applications of lateral band walks and monster walks were included, alongside relevant evidence on hip abductor strengthening. Results: A total of 13 studies were included in the review, of which 4 specifically investigated lateral band walk and/or monster walk exercises. Lateral and monster walks elicit moderate to high activation of the gluteus medius and maximus, especially when performed with the band at the ankles or forefeet and in a semi-squat posture. This technique minimizes compensation from the tensor fasciae latae and promotes selective gluteal recruitment. Proper execution requires control of the trunk and pelvis, optimal squat depth, and consistent band tension. Anatomical factors (e.g., femoral torsion), sex differences, and postural variations may influence movement quality and necessitate tailored instruction. Full article

Exercise is an important component in the treatment and improvement of function in populations with or at risk of lower limb injury. Cycling is the most common exercise modality used by these populations. However, reduced lower limb joint excursion and/or range of motion (ROM) during cycling might limit the optimization of functional improvements. Increased hip flexion gait (HFgait) is a new exercise modality that might result in larger lower limb joint excursions compared to cycling. The purpose of this study was to compare lower limb kinematics between HFgait and cycling. Twelve healthy individuals participated in the study. Each participant performed cycling and HFgait. Hip, knee, and ankle kinematics in the sagittal, frontal, and transverse planes were analyzed with and without phase offset reduction (POR). Discrete and continuous analyses were performed. Discrete analysis indicated differences for at least one of the variables analyzed (maximum, minimum, and ROM) for the hip (p ≤ 0.041), knee (p ≤ 0.008), and ankle (p ≤ 0.040) across all planes. For the continuous analysis, differences between HFgait and cycling kinematics were observed during the cycles for the hip, knee, and ankle sagittal (hip: original: 85%; with POR: 77%; knee: original: 93%; with POR: 76%; ankle: original: 14%; with POR: 14%), frontal (hip: original: 93%; with POR: 98%; knee: original: 41%; with POR: 12%; ankle: original: 4%; with POR: 5%), and transverse (hip: original: 66%; with POR: 0%; knee: original: 14%; with POR: 0%; ankle: original: 3%; with POR: 0%) planes. HFgait resulted in larger hip (+60.2°) and knee (+38.2°) sagittal plane ROM while maintaining the hip in a more neutral position in the frontal plane compared with cycling. These findings can support the development of rehabilitation strategies with the goal of improving function and joint range of motion while also receiving the health benefits of exercise. Full article

Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular facilitation in patients with systemic lupus erythematosus. Methods: A randomized, single-blind, crossover clinical trial. Seventeen patients with systemic lupus erythematosus were randomly assigned to two sequences: Sequence A–B (intervention phase first, then control phase) and Sequence B–A (control phase first, then intervention phase). The intervention lasted for four weeks, with two weekly sessions lasting 50 min each. The intervention consisted of myofascial and proprioceptive neuromuscular facilitation techniques. The variables were: pain intensity (Visual Analog Scale), functional capacity of lower limbs (2-Minute Walk Test), physical function (Timed Up and Go Test), and fatigue (Fatigue Assessment Scale). After a 2-week follow-up and a 2-week washout period, the patients switched groups, and the methodology was replicated. Results: None of the patients developed injury or adverse effects as a direct consequence of the intervention. There were statistically significant differences between groups (p < 0.001) in the intensity of ankle (η²_p = 0.38) and knee (η² = 0.37) pain, functional capacity (η² = 0.33), and physical function (η² = 0.56). There were also intergroup changes in fatigue (η² = 0.52), and the relevant mental (η² = 0.26) and physical (η² = 0.45) components. Conclusions: Proprioceptive myofascial and neuromuscular facilitation techniques are safe in patients with systemic lupus erythematosus. This physical therapy protocol can improve the intensity of knee and ankle joint pain in these patients. This intervention can improve functional capacity, physical function, and fatigue in people with systemic lupus erythematosus. Full article

Background: The ankle joint plays a key role in stabilizing the lower limb during interaction with ground reaction forces. Instability can result in pain, weakness, and impaired movement. Although assessing ankle stability is important, few studies examine existing in vivo methodologies for dynamic load assessment, limiting effective injury management. Objective: To identify in vivo techniques using objective measurement tools for assessing ankle stability during dynamic exercise. Methods: A scoping review was performed based on PRISMA-ScR criteria. Five databases—PubMed, PEDro, Embase, SPORTDiscus, and CDSR—were searched from inception to September 2024. Results: Out of 1678 records, 32 studies met the inclusion criteria. A total of 1142 subjects were included: 293 females (25.6%), 819 males (71.7%), and 30 unspecified (2.62%). Six categories of dynamic exercise were identified: analytical, functional, balance, stair climbing, running, and walking. The techniques used included 3D motion capture, force and pressure platforms, dynamometry, electromyography, accelerometers, pressure and speed sensors, instrumented treadmills, and inertial measurement units. Conclusions: The 3D motion capture systems (240 Hz) and the force platforms (1000 Hz) were most frequently used in functional tasks and walking. Combining these with multisegmented foot models appears optimal, though tool selection depends on study goals. This review enhances our understanding of ankle stability assessment. Full article

Background: Musculoskeletal injuries have a substantial impact on athletes, affecting sports performance and increasing the risk of future musculoskeletal disorders (e.g., osteoarthritis). Injury prevention programs are essential to reduce the risk of sport-related injuries and meta-analyses can provide a large amount of information in a single article. Objective: To summarize the pooled effects of injury prevention programs focused on any form of physical exercise in the incidence and risk of musculoskeletal injuries and reinjuries by sports and musculoskeletal body regions. Methods: The CINAHL (via EBSCOhost), Embase (via Elsevier), Epistemonikos, PubMed, Scopus, SPORTDiscus (via EBSCOhost), and the Cochrane Library e-databases were searched from inception to 7 October 2024. Systematic reviews with meta-analyses of randomized clinical trials were considered. The methodological quality of systematic reviews was assessed with AMSTAR 2. The degree of overlap between meta-analyses of interest was calculated. Results: Fourteen systematic reviews were included. Thirteen of these reviews were focused on soccer. Overall, meta-analyses including a specific injury prevention program (FIFA 11+ and FIFA 11+ kids) found that these programs may reduce the risk of musculoskeletal injuries among soccer players. Concretely, FIFA 11+ may reduce the risk of ankle, knee, hip/groin, and hamstring injuries, whereas FIFA 11+ kids may decrease the risk of ankle and knee injuries. Conclusions: FIFA 11+ and FIFA 11+ kids may reduce the risk of sports musculoskeletal injuries, mainly in the lower limbs. However, many clinical and methodological issues (e.g., the lack of meta-analyses in many types of sports) were discussed and highlighted the difficulty of making robust clinical recommendations with the current data. Full article

Spinal cord injuries (SCI) often result in impaired motor functions. To quantify these impairments, swimming patterns were analyzed in individuals with SCI. Water provides a unique rehabilitation environment where buoyancy supports weight-bearing activities and can reveal deficits that might otherwise go unnoticed. Data were collected of 30 individuals with chronic, motor-incomplete SCI and 20 healthy controls during breaststroke swimming on a kickboard. Using eight wearable inertial sensors attached to the lower limbs, we captured detailed kinematic data. Spatiotemporal parameters were then calculated and compared between the two groups to assess differences in swimming patterns. An analysis of the parameters revealed significant differences in velocity (p < 0.001, ε² = 0.476) and distance per stroke (p < 0.001, ε² = 0.516), indicating decreased swimming speeds in individuals with SCI compared to controls. Furthermore, individuals with SCI demonstrated a reduced range of motion (RoM) in the ankle (p = 0.003, ε² = 0.516) and knee joints (p = 0.041, ε² = 0.142). The limited RoM likely contributes to the shorter distance covered per stroke. These observations underscore the impact of SCI on functional capabilities. The developed algorithm holds promise for enhancing the assessment of motor deficits after neurological injuries. Full article

This systematic review, registered in PROSPERO (CRD42025101243), aimed to evaluate how specific badminton shoe design features influence lower-limb biomechanics, injury risk, and sport-specific performance. A comprehensive search in six databases yielded 445 studies, from which 10 met inclusion criteria after duplicate removal and eligibility screening. The reviewed studies focused on modifications involving forefoot bending stiffness, torsional stiffness, lateral-wedge hardness, insole and midsole hardness, sole structure, and heel curvature. The most consistent biomechanical benefits were associated with moderate levels of forefoot and torsional stiffness (e.g., 60D) and rounded heel designs. Increased forefoot bending stiffness was associated with reduced foot torsion and knee loading during forward lunges. Torsional stiffness around 60D provided favorable ankle support and reduced knee abduction, suggesting potential protection against ligament strain. Rounded heels reduced vertical impact forces and promoted smoother knee–ankle coordination, especially in experienced athletes. Lateral-wedge designs improved movement efficiency by reducing contact time and enhancing joint stiffness. Harder midsoles, however, resulted in increased impact forces upon landing. Excessive stiffness in any component may restrict joint mobility and responsiveness. Studies included 127 male-dominated (aged 18–28) competitive athletes, assessing kinematics, impact forces, and coordination during sport-specific tasks. The reviewed studies predominantly involved male participants, with little attention to sex-specific biomechanical differences such as joint alignment and foot structure. Differences in testing methods and movement tasks further limited direct comparisons. Future research should explore real-game biomechanics, include diverse athlete populations, and investigate long-term adaptations. These efforts will contribute to the development of performance-enhancing, injury-reducing badminton shoes tailored to the unique demands of the sport. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

This study aims to develop and evaluate a cycling-specific marker protocol that minimises the number of markers while accounting for the unique biomechanics of cycling. Although movements in the frontal and transverse planes during cycling are limited, they are clinically relevant due to their association with overuse injuries. Existing gait-based marker protocols often fail to consider cycling-specific factors such as posture, range of motion, marker occlusion, and muscle-induced artifacts. The proposed protocol (PP) uses 15 physical and 8 virtual markers. In the absence of a gold standard for 3D pedalling kinematics, the PP was evaluated by comparing it with established gait analysis protocols. The protocol demonstrated high correlation in gait (CCC > 0.98 for hip and knee in the sagittal plane), low intra-subject variability (CV < 15% for hip, knee, and ankle), and high repeatability. During pedalling, position, velocity, and acceleration were measured in all three spatial directions. Notably, angular velocity and linear acceleration showed significant components outside the sagittal plane, particularly for angular velocity. These findings highlight the importance of considering 3D motion when estimating forces, joint moments, and joint-specific powers in cycling biomechanics. Full article

Background: Knee joint immobilization is common after surgery or injury. Whether remaining physically active during immobilization preserves muscle strength and size has not been studied. Objectives: This observational study examined correlations between muscle strength, size, and physical activity (PA) levels during one week of knee joint immobilization. Methods: Nine healthy adults (five males, four females) immobilized their left knee and ambulated with crutches for one week. Ankle accelerometers monitored compliance and tracked PA. Isometric and concentric isokinetic peak torque at 30°/s and 180°/s and vastus lateralis (VL) cross-sectional area (CSA) were assessed before and after immobilization. Bivariate correlations were used to examine relationships between time spent in sedentary, light, moderate, and vigorous PA, and changes in isometric and concentric isokinetic peak torque, as well as VL CSA. Results: After immobilization, isometric strength declined by 17.1%. Concentric isokinetic peak torque declined by 5.5% at 30°/s and 2.3% at 180°/s. VL CSA declined by 6.7%. There were weak correlations between strength measures and PA levels (r = −0.497–0.574; p = 0.106–0.709). For CSA, an unexpected pattern was found in which greater sedentary time was correlated with decreased atrophy (r = 0.701; p = 0.035), but light (r = −0.673; p = 0.047) and moderate (r = −0.738; p = 0.023) PA levels were correlated with increased atrophy. Vigorous PA had weak correlations with CSA (r = −0.321; p = 0.399). Conclusions: Contrary to our hypothesis, increased PA levels were not correlated with the preservation of strength and were correlated with greater declines in CSA during knee joint immobilization. Full article

The prevalence of ankle pain in adults is 9–15%, with up to 45% of sports-related injuries attributed to ankle pain and injuries. If ankle pain is not controlled in a timely manner, it can lead to ankle instability, resulting in further damage, recurrence of pain, and secondary injuries. The present study aimed to assess the therapeutic potential and safety profile of bee venom acupuncture (BVA) in the management of ankle pain. Ten electronic databases were searched for articles published up to March 2025. We included clinical studies that utilized BVA for the treatment of ankle pain and studies that included pain- and function-related assessment tools. The safety of bee venom acupuncture (BVA) was assessed by extracting adverse events from the included studies and categorizing them according to the Common Terminology Criteria for Adverse Events (CTCAE). A total of 14 clinical studies were selected, of which 9 were case reports, 2 were case-controlled clinical trials (CCTs), and 3 were randomized controlled trials (RCTs). The conditions causing ankle pain were mostly traumatic (42.9%), followed by inflammatory (21.4%) and neuropathic disorders (14.3%). BVA was applied at concentrations ranging from 0.05 to 0.5 mg/mL, with a per-session volume ranging from 0.04 to 2.5 mL. In most studies, BVA was reported to improve both ankle pain and function simultaneously. Among the 14 studies, four participants reported adverse events following BVA treatment, all of which were classified as grade 1 or grade 2, indicating mild to moderate severity. This review suggests that BVA may be recommended for controlling ankle pain based on clinical evidence. However, the number of high-quality RCTs is limited, and half of the studies did not report side effects, indicating the need for further clinical research to verify its safety and efficacy. Full article

Background/Objectives: The ROM-SPORT is a test battery for assessing flexibility that measures the range of motion (ROM) in the sport. Restricted or optimal ROM is associated with an increased risk of injury or improved athletic performance, respectively. The aim of the present study was to determine the normative values of the lower limb’s flexibility profile by ROM assessment in female football players. Methods: Lower-limb flexibility (11 ROM tests) was measured using the ROM-SPORT battery in 142 female football players (19.42 ± 4.45 years). The tests were performed at the beginning of the training sessions in the first two weeks of the pre-season. Standardized Z-scores (on a scale of 0 to 100 [T-score]) were calculated from the mean and standard deviation to classify the ROM of each movement into three qualitative categories (poor [>−3 to −2], average or normal [−1 to 1; 68.2%], and optimal [1 to >3]) and a traffic light system to facilitate interpretation of the results. Results: The results show normal (or average) ROM values at 32–37° for ankle dorsiflexion with the knee extended; 37–43° for ankle dorsiflexion with the knee flexed; 46–54° for hip internal rotation; 54–61° for hip external rotation; 31–37° for hip adduction; 70–76° for hip abduction with the hip flexed; 41–45° for hip abduction with the hip neutral; 135–141° for hip flexion; 73–82° for hip flexion with the knee extended; 15–21° for hip extension; 121–132° for knee flexion. The normative data presented in this study can be utilized by researchers and practitioners in the women’s football league in a variety of ways, provided similar data collection methods are used. Conclusions: Flexibility training is recommended to overcome normal or average ROM and optimize athletic performance with lower injury risk in female football players. Full article

Objectives: This study aims to compare the postoperative clinical outcomes of using non-elastic compression bandages versus elastic bandages after lateral ankle ligament repair. Methods: This retrospective study analyzed a total of 110 patients who underwent repair surgery for chronic lateral ankle ligament injuries. Based on the postoperative bandaging method, patients were divided into two groups: the non-elastic compression bandage group (Group NECB, 55 cases) and the elastic bandage group (Group EB, 55 cases). A comparison was made between the two groups of patients regarding postoperative ankle joint swelling, pain scores (VAS scores), ankle function (AOFAS Ankle–Hindfoot Scale), range of motion of the ankle joint, the incidence of perioperative complications (including subcutaneous ecchymosis, wound seepage, and events requiring loosening of the bandage due to pain), and the status of return to work postoperatively. Results: There were no significant differences between the two groups in terms of early postoperative ankle joint swelling or increased circumference (0.53 ± 1.47 cm vs. 1.08 ± 1.84 cm, p = 0.095) or VAS scores at 1 day (3.84 ± 2.14 vs. 3.63 ± 2.03, p = 0.595), 7 days (2.20 ± 1.89 vs. 1.78 ± 1.67, p = 0.216), 14 days (1.45 ± 1.56 vs. 0.97 ± 1.23, p = 0.075), or 3 months (1.27 ± 1.50 vs. 1.38 ± 1.76, p = 0.744). Both groups demonstrated comparable functional recovery based on AOFAS scores at 3 months (89.89 ± 8.08 vs. 90.05 ± 9.50, p = 0.926), ROM in all measured directions (p > 0.05), and return to work status (p = 0.567). However, the incidence of complications was significantly lower in Group NECB (3.6%) compared to Group EB (30.9%). The reported complications in Group EB were mainly related to postoperative subcutaneous ecchymosis and discomfort requiring bandage loosening. Conclusions: There is no difference between non-elastic compression bandaging with cotton padding and elastic bandaging in postoperative swelling, pain, and functional recovery. However, in reducing the incidence of postoperative skin adverse events, using non-elastic compression bandages with cotton padding proves to be more ideal as a bandaging method after lateral ankle ligament repair. Full article

Background: Continuous Compression Implants (CCIs) are low-profile implants made of nitinol and titanium. They offer multiple benefits in comparison to plate and screw fixation for foot and ankle indications, and they are designed in such a way that they continuously and dynamically compress the opposed bony surfaces throughout the entire healing process. Methods: In this study, we present our experience on the use of those nitinol implants for midfoot and hindfoot surgery. Furthermore, we elaborate on the advantages and downsides of using this internal fixation method and highlight common pitfalls which could lead to undesirable clinical outcomes. We also demonstrate our proposed surgical technique on how to use CCIs in a reproducible and reliable way and present surgical tips which could help reduce surgical time when utilising these implants. We also make surgical recommendations on their use and present the underlying biomechanics, which could provide a better understanding of the rationale behind using them in the field of foot and ankle surgery. Last but not least, we presented the early clinical and radiological results of a series of patients who underwent primary midfoot fusion for Lisfranc injury between 2020 and 2023. Results: With a minimum follow-up of 9 months, satisfactory clinical and radiological union was noted in all those patients. The mean difference between pre- and post-operative MOxFQ scores was −37.7 (95% CI was 16.9 to 58.5; p = 0.03). The mean post-operative VAS pain at rest was 3.2 (SD = 2.3). No major complications were noted. Conclusions: CCI internal fixation is a safe, reproducible, and reliable method when it comes to foot and ankle conditions, but it requires appropriate pre-operative planning, surgical training, and careful implantation. Full article