The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke: an observational study

Dorsch S, Ada L, Canning CG, Al-Zharani M, Dean C. The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke: an observational study.ObjectiveTo investigate the relationship between the strength of muscles of the affected lower limb and walking speed after stroke.DesignA cross-sectional observational study.SettingUniversity laboratory.ParticipantsStroke survivors (N=60; mean age ± SD, 69±11y) 1 to 6 years poststroke, able to walk 10m independently without aids.InterventionsNot applicable.Main Outcome MeasuresMaximum isometric strength of 12 muscle groups (hip flexors/extensors, adductors/abductors, internal/external rotators, knee flexors/extensors, ankle dorsiflexors/plantarflexors, invertors/evertors) of the affected lower limb was measured using hand-held dynamometry. Comfortable walking speed was measured using the ten-meter walk test.ResultsUnivariate analysis revealed that strength of the hip flexors (r=.35, P=.01), hip extensors (r=.29, P=.03), hip internal rotators (r=.30, P=.02), hip adductors (r=.29, P=.03), knee extensors (r=.27, P=.03), knee flexors (r=.30, P=.02), ankle dorsiflexors (r=.50, P=.00), ankle plantarflexors (r=.29, P=.03), and ankle evertors (r=.33, P=.01) were all positively associated with walking speed. Multivariate analysis (n=58) revealed that the combined strength of the ankle dorsiflexors and the hip flexors accounted for 34% of the variance in walking speed (P<.001). The ankle dorsiflexors accounted for 31% of the variance (P<.001).ConclusionsThe strength of muscle groups other than the lower limb extensors, particularly the ankle dorsiflexors, has an important role in determining walking speed after stroke.     

Strength and range of motion in the ankle in two age groups of men and women

Strength and range of motion of the ankle were measured in 20 normal men and 20 normal women divided equally into two age groups (25-35 and 50-60 years). Total range of dorsiflexion/plantar flexion averaged 75 degrees and the total range of inversion/eversion averaged 28 degrees. Few significant differences in range of motion were found between age groups, between men and women, or between dominant and nondominant limbs. Mean torque values for the men were greater than those for the women for all four muscle groups tested (plantar flexors, dorsiflexors, invertors and evertors). Strength of the women ranged from 62 to 70 percent of that of the men, depending upon muscle group. A multiple regression analysis showed that after the variability in muscle strength due to height and lean body weight had been taken into account, the additional variance accounted for by gender was very small. Differences in torque between age groups were not statistically significant. Differences in strength between dominant and nondominant limbs were significant only for the plantar flexors and dorsiflexors of the men.     

Assessment of evertor weakness in patients with chronic ankle instability: Functional versus isokinetic testing

BackgroundAnkle sprain is the most common sport-related injury and eccentric weakness of ankle evertors is regarded as a significant muscular deficit related to chronic ankle instability. However, the eccentric performance of the evertors is rarely assessed by clinicians because procedures used for research purposes (i.e. isokinetic tests) are not easily applicable in daily practice.MethodsThe present study assessed the ability of two different testing procedures to distinguish between groups of 12 healthy subjects or 12 patients suffering from chronic ankle instability. On the one hand, the strength of evertors was assessed with a gold standard isokinetic procedure. On the other hand, we assessed the ability of the subjects to control ankle inversion during weight bearing (functional standing test).FindingsData showed no significant difference between groups for isokinetic peak torque values normalized to body weight. Conversely, the functional test revealed a significantly impaired ability to control ankle inversion during weight bearing in subjects with chronic ankle instability.InterpretationThis suggests that this easy-to-apply functional test is better suited compared to isokinetic testing procedures to assess weakness of evertors in patients suffering from chronic ankle instability. Moreover, this test may also be used to objectively monitor improvements during rehabilitation or progression in prevention protocols.     

步兵踝关节肌力和跟腱横截面积与强化训练的关系

背景:军事训练中肌腱损伤和肌腱功能紊乱经常发生,但肌腱疾病准确的流行病学、病理生理以及愈合、修复机制尚不清楚,慢性肌腱功能紊乱引起疼痛的原因也有待研究。目的:评价强化训练对士兵踝关节肌力以及跟腱横截面积的影响,找到合适的快速提高体能的训练方法。设计:单一样本的分组对照。单位:解放军第四军医大学;解放军第一五○医院全军军事训练医学研究所。对象:实验于2004/03-06在解放军第一五○医院全军军事训练医学研究所进行。随机挑选新兵和常规训练1年的士兵各30名,均为男性,作为新兵组和老兵组。入伍年龄为17～18岁,入伍前均无参加专业体育训练史,无踝关节受伤史,均能承受正常的体能训练。方法:新兵组参加正常的体能训练(如投弹、5km越野跑等),同时进行踝关节背伸、跖屈的强化训练。具体为:提踵50次;在45°弧形仰卧起坐板上仰卧起坐50次。每项训练2次/d,持续8周。老兵组参加日常的体能训练。分别对训练前、训练8周后的新兵和老兵进行踝关节肌力等速测试和跟腱横截面积测量。主要观察指标:新兵训练前与强化训练8周后及老兵跟腱横截面积的比较和踝关节肌力的变化。结果:60名士兵全部进入结果分析。跟腱横截面积与体质量呈偏相关(r=0.446,P=0.015),训练前后跟腱横截面积无明显变化。训练后新兵和老兵的踝关节跖屈、背伸、外翻的相对峰力矩、耐力、力矩加速能等指标明显大于训练前的新兵(P<0.05),训练后的新兵和老兵之间无明显差异。结论:强化训练能在短期内快速促进体能储备;训练前后跟腱截面积无明显变化提示踝关节力量提高不是通过肌腱肥大实现的,可能与肌腱的内部改建有关。     

Lateral ankle sprain: isokinetic test reliability and comparison between invertors and evertors

OBJECTIVE: Evaluate reliability of isokinetic tests for inversion and eversion in individuals with recurrent lateral ankle sprain and compare inversion to eversion muscle performance in the same ankles. DESIGN: Reliability was evaluated by comparing the results of two ankle inversion/eversion isokinetic tests. Inversion and eversion were compared with the results presented by the tests. BACKGROUND: Previous studies showed reliable isokinetic tests for ankles with no sprain history. It is unknown if such tests can also be performed in lateral sprained ankles. It is unclear whether there is difference between invertors and evertors in these ankles. METHODS: Eleven men with recurrent ankle lateral sprain in one limb were tested using an isokinetic dynamometer. The tests consisted of 5 cycles of maximal contraction in 30 degrees /s and 120 degrees /s. Both injured and noninjured ankles were tested. Peak torque was recorded for analysis. RESULTS: The tests are reliable and intraclass coefficient correlation varied from 0.71 to 0.95. Invertors generated higher peak torques than evertors (P = 0.03) when injured ankles were tested at 120 degrees /s. CONCLUSIONS: Isokinetic inversion/eversion tests showed to be reliable. A decrease in peak torques can be seen during higher velocity tests. The only difference between invertors and evertors was seen when injured ankles were tested at 120 degrees /s. In this case invertors showed higher peak torques.     

Bilateral effects of 6 weeks' unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study

Zhou S, Huang L-P, Liu J, Yu J-H, Tian Q, Cao L-J. Bilateral effects of 6 weeks' unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study.ObjectivesTo determine the effect of unilateral manual acupuncture at selected acupoints on ankle dorsiflexion strength of both limbs, and compare the effect with that of electroacupuncture at the same acupoints and sham points.DesignRandomized controlled trial.SettingRehabilitation laboratory of a university.ParticipantsYoung men (N=43) were randomly allocated into 4 groups: control; manual acupuncture and electroacupuncture on 2 acupoints (ST-36 and ST-39); and electroacupuncture on 2 nonacupoints. These points were located on the tibialis anterior muscle.InterventionsThe participants in the experimental groups received 15 to 30 minutes of acupuncture or electroacupuncture on the right leg in each session, 3 sessions per week for 6 weeks.Main Outcome MeasuresThe maximal strength in isometric ankle dorsiflexion of both legs was assessed before and after the experimental period.ResultsRepeated-measures analysis of variance identified significant and similar strength gains (range, 35%–64% in the right leg and 32%–49% in the left leg; P<.01) in all acupuncture groups, but not in the control group (?2% to 2%, P>.05).ConclusionsUnilateral manual acupuncture and electroacupuncture at the acupoints can improve muscle strength in both limbs, and electroacupuncture at the nonacupoints as used in this study can also induce similar strength gains.     

Improving Prehospital Protocol Adherence Using Bundled Educational Interventions

Background: Seizures and anaphylaxis are life-threatening conditions that require immediate treatment in the prehospital setting. There is variation in treatment of pediatric prehospital patients for both anaphylaxis and seizures. This educational study was done to improve compliance with pediatric prehospital protocols, educate prehospital providers and decrease variation in care. Objective: To improve the quality of care for children with seizures and anaphylaxis in the prehospital setting using a bundled, multifaceted educational intervention. Methods: Evidence-based pediatric prehospital guidelines for seizures and anaphylaxis were used to create a curriculum for the paramedics in the EMS system. The curriculum included in-person training, videos, distribution of decision support tools, and a targeted social media campaign to reinforce the evidence-based guidelines. Prehospital charts were reviewed for pediatric patients with a chief complaint of anaphylaxis or seizures who were transported by paramedics to one of ten hospitals, including three children's hospitals, for 8 months prior to the intervention and eight months following the intervention. The primary outcome for seizures was whether midazolam was given via the preferred intranasal (IN) or intramuscular (IM) routes. The primary outcome for anaphylaxis was whether IM epinephrine was given. Results: A total of 1,402 pediatric patients were transported for seizures by paramedics to during the study period. A total of 88 patients were actively seizing pre-intervention and 93 post-intervention. Of the actively seizing patients, 52 were given midazolam pre-intervention and 62 were given midazolam post-intervention. Pre-intervention, 29% (15/52) of the seizing patients received midazolam via the preferred IM or IN routes, compared to 74% (46/62) of the seizing patients post-intervention. A total of 45 patients with anaphylaxis were transported by paramedics, 30 pre-intervention and 15 post-intervention. Paramedics administered epinephrine to 17% (5/30) patients pre-intervention and 67% (10/15) patients post-intervention. Conclusion: The use of a bundled, multifaceted educational intervention including in-person training, decision support tools, and social media improved adherence to updated evidence-based pediatric prehospital protocols.     

The effect of 8-weeks proprioceptive exercise program in postural sway and isokinetic strength of ankle sprains of Tunisian athletes

ObjectiveOur objective is to investigate the effects of proprioceptive exercises rehabilitation on isokinetic strength and postural balance in athletes with sprain ankle.Materials and methodsThe ankles of 16 subjects were tested: eight in the functional instability (FI) group and eight non-injured (NI) subjects in the control group. Subjects were asked to take part in a testing session. The test order for the postural stability and isokinetic strength tests was randomized to avoid learning or fatigue effects. The testing session started with a 5-minute warm-up. Subjects were then instructed to perform several lower body flexibility exercises. The test procedure consisted in static assessments, where single-limb (right and left) stance postural stability was assessed. Three practice trials were allowed for each subject. The assessment quantifies postural sway velocity while the athlete stands calmly on one foot on the force plate, for each leg. They were asked to stand as still as possible for 30 s, upper limbs along the body. The subjects were requested to maintain balance with eyes open and then with the eyes closed on the firm surface. The sway velocity (in degrees per second) is given for all trials. Subjects were allowed a 1-minute rest between tests. The regime of isokinetic evaluation of dorsi-plantar flexions is concentric, with three successive speeds: slow (30°/s, reps 5), average (60°/s, reps 10), and fast (120°/s, reps 15), according to the protocol established by European Group for the development and the isokinetic research and the procedural guidelines. Relative moment of strength and times of acceleration and deceleration were calculated for each set of isokinetic testing repetitions per body side, muscle group and testing speed.ResultsThe results of tests–retest and between both groups (injured vs. healthy) show that after eight weeks of proprioceptive work, significant increase of maximal strength, decrease in times of acceleration and deceleration at the level of plantar flexors and better stability of the injured limb at slow and average (P < 0.05). For the healthy limb, improvements varying from 1 to 39% were obtained between test and retest on all the variables. However, these variations were not statistically significant.ConclusionProprioceptive training exercises can effectively stabilize an unstable ankle above for muscular and postural control. However, 8 weeks does not assess whether we have achieved maximum effect. In addition, we do not know to what extent these effects will continue over time. It would be interesting to later re-evaluate the athletes for the effect of this treatment, which is based on a proprioceptive training program on a year or more.     

Fascial therapy,strength exercises and taping in soccer players with recurrent ankle sprains: A randomized controlled trial

IntroductionRecurrent ankle sprains are common in soccer players, characterized by restricted range of motion, pain, and decreased proprioception, strength, and postural control. The objective was to evaluate the effectiveness of a fascial therapy and strength training program, combined with kinesiotaping, in improving ankle range of motion, pain, strength and stability in footballers with recurrent sprains.MethodA simple blind randomized clinical trial was conducted on soccer players. Thirty-six federated footballers were recruited and randomized to the two study groups. The experimental group received an intervention using myofascial techniques applied to the subastragaline joint, eccentric training with an isoinertial device and neuromuscular taping. The control group was administered an intervention using myofascial techniques on the subastragaline joint and eccentric training with an isoinertial device. The results were recorded for all players at baseline, after 4 weeks of intervention, and at the end of the 4-week follow-up period.ResultsSubsequent to intervention and follow-up, we found statistically significant improvements in the experimental group in ankle mobility, strength and stability. The control group exhibited improvements in all study variables. No differences in the improvement of variables were found based on the allocation of athletes to one group or another.ConclusionThe combination of fascial therapy and eccentric strength training with an isoinertial device improves ankle mobility, strength and stability in footballers with recurrent ankle sprains. The use of taping techniques failed to provide a greater improvement of the study variables when combined with manual therapy and strength techniques.     

Effects of ankle proprioceptive interference on locomotion after stroke

Lin S-I, Hsu L-J, Wang H-C. Effects of ankle proprioceptive interference on locomotion after stroke.ObjectiveTo examine the effects of vibration-induced ankle proprioceptive interference on the locomotion of patients with stroke with intact and impaired ankle joint position sense (JPS).DesignCross-sectional.SettingRehabilitation department in a tertiary hospital.ParticipantsAmbulatory patients (N=35) with unilateral stroke received an ankle joint repositioning test and were classified into intact (n=16) or impaired (n=19) JPS group.InterventionsNone.Main Outcome MeasuresThe plantar sensitivity and leg muscle strength were tested. Patients were instructed to walk at a self-selected pace on a computerized pressure sensor walkway under 3 conditions: no, affected, or unaffected Achilles' tendon vibration. The stride characteristics of the affected limb were analyzed.ResultsPatients with intact and impaired JPS did not differ in their plantar sensitivity or leg muscle strength. The differences in the stride characteristics were nonsignificant between vibration and nonvibration conditions. Shorter single support and longer swing phase were found with the affected side vibration compared with the unaffected side vibration. Patients with intact and impaired JPS did not respond to the proprioceptive interference differently.ConclusionsAfter stroke, there could be changes in the central sensory regulation for locomotion control and vibration-induced afferent inputs from the ankle might be viewed as sensory disturbances. Further studies that manipulate other sensory inputs are needed to gain a better understanding of the central sensory integration for locomotion control after stroke.     

Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes

The design of neural prostheses to restore standing balance, prevent foot drop, or provide active propulsion during ambulation requires detailed knowledge of the distal sciatic nerve anatomy. Three complete sciatic nerves and branches were dissected from the piriformis to each muscle entry point to characterize the branching patterns and diameters. Fascicle maps were created from serial sections of each distal terminus below the knee through the anastomosis of the tibial and common fibular nerves above the knee. Similar branching patterns and fascicle maps were observed across specimens. Fascicles innervating primary plantar flexors, dorsiflexors, invertors, and evertors were distinctly separate and functionally organized in the proximal tibial, common fibular, and distal sciatic nerves; however, fascicles from individual muscles were not apparent at these levels. The fascicular organization is conducive to selective stimulation for isolated and/or balanced dorsiflexion, plantar flexion, eversion, and inversion through a single multicontact nerve-cuff electrode. These neuroanatomical data are being used to design nerve-cuff electrodes for selective control of ankle movement and improve current lower-limb neural prostheses.     

The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion

[Purpose] The purpose of this study was to investigate the effect of gastrocnemius stretching combined with talocrural joint mobilization on weight-bearing ankle dorsiflexion passive range of motion. [Subjects] Eleven male subjects with bilateral limited ankle dorsiflexion passive range of motion with knee extended participated in this study. [Methods] All subjects received talocrural joint mobilization while performing gastrocnemius stretching. Ankle dorsiflexion passive range of motion was measured using an inclinometer under weight-bearing conditions before and immediately after intervention. A paired t-test was used to analyze the difference between weight-bearing ankle dorsiflexion passive range of motion pre- and post-intervention. [Results] A significant increase in weight-bearing ankle dorsiflexion passive range of motion was found post-intervention compared with pre-intervention. [Conclusion] These findings demonstrate that gastrocnemius stretching combined with joint mobilization is effective for increasing weight-bearing ankle dorsiflexion passive range of motion.Key words: Gastrocnemius stretching, Talocrural joint mobilization, Weight-bearing ankle dorsiflexion     

Reduction of pre-analytical errors in the clinical laboratory at the University Hospital of Korea through quality improvement activities

BackgroundThe clinical laboratory is responsible for reporting accurate and expeditious results. However, the pre-analytical phase is directly related to the procedure of specimen collection and is mostly out of the direct control of the laboratory; further, most pre-analytical errors are related to human factors. Therefore, education and training programs for the phlebotomy teams are considered the most significant and necessary measures to reduce these errors.MethodsA cross-sectional study was conducted to investigate the types and frequencies of pre-analytical errors in the hospital laboratory. Pre-analytical errors were categorized into four main categories: rejected sample, error related to test ordering, misidentification, and others. Several activities were performed for quality improvement in order to reduce the rates of these errors. The data were analyzed by comparing the pre-intervention and post-intervention results along with the results of questionnaires to assess knowledge to investigate the effects of the activities.ResultsThe rates of pre-analytical errors decreased from 0.42% in the pre-intervention period to 0.32% in the post-intervention period. The rejected sample category accounted for the highest rates in the pre- and post-intervention periods. In the questionnaires, the overall average score after the intervention was 71.5, which was a significant increase from 46.0 in the pre-intervention period.ConclusionsEach clinical laboratory has various types of pre-analytical errors due to the complexity of the healthcare environment. Therefore, targeted intervention including a quality improvement program and its continuous maintenance should be conducted to reduce pre-analytical errors and to improve patient safety.     

The effects of using virtual patients on the history-taking ability of nursing interns: A non-randomized controlled study

ObjectivesThe aim of this study was to examine the effects of the SYSU-NEP virtual patients (VPs) on the history-taking ability and self-efficacy of nursing interns.BackgroundAn easy to use, freely accessible and objective training software program on WeChat named Sun Yat-sen University Nursing Education Platform (SYSU-NEP) was developed to help nursing students improve their history-taking skills.DesignThis was a non-randomized controlled study.MethodsA total of 90 nursing interns (44 in the intervention group and 46 in the control group), who practiced in internal medicine departments at a single teaching hospital, were recruited between July 2017 and December 2018. The data collected comprised demographic and academic data, Nursing History-taking Assessment Scale (NHTAS) and Academic Self-Efficacy Scale (ASES) scores. The chi-square test, t test and Wilcoxon test were used to test the differences in the variables between the two groups. The t test or Wilcoxon test was used to compare the differences between pre-intervention and post-intervention NHTAS and ASES scores in each group and to compare the changes (post-intervention – pre-intervention) in NHTAS and ASES scores between the control and intervention groups.ResultsBoth the control and intervention groups had higher post-intervention NHTAS scores compared with their pre-intervention scores (control group: 83.50 VS 61.00, P < 0.001; intervention group: 106.00 VS 77.00, P < 0.001). However, the intervention group had a much greater improvement in the NHTAS score than the control group (29.00 VS 9.00, P < 0.001). There were no significant differences in the ASES score within groups (control group: 80.50 VS 80.00, P = 0.292; intervention group: 81.50 VS 79.00, P = 0.979) or between groups (2.00 VS 0.00, P = 0.430). The most frequently used VPs were associated with the respiratory, gastroenterology and cardiovascular systems, accounting for 70.4% among all VP cases.ConclusionsThe SYSU-NEP VPs can improve the history-taking ability of nursing interns. They can provide autonomous, repeatable training opportunities for nursing interns and help them prepare well for real clinical encounters.     

Associations of lower limb joint asymmetry with fatigue and disability in people with multiple sclerosis

BackgroundAn early symptom of multiple sclerosis is unilateral weakness, particularly in the lower limbs, which is associated with strength asymmetries. The purpose of this exploratory study was to examine strength asymmetries at the hip, knee, and ankle joints, and to investigate the associations between lower limb strength asymmetries and self-reported fatigue severity and disability in people with multiple sclerosis.MethodsSixteen mildly-disabled people with multiple sclerosis (females = 9) completed isokinetic maximal voluntary contractions of the hip extensors and flexors, knee extensors and flexors, and ankle plantar flexors and dorsiflexors. Asymmetry indices between the strength of the more- and less-affected lower limbs at each muscle group and the percent agreement between self-reported and objectively-determined more-affected lower limb were calculated. Patient Determined Diseases Steps and Fatigue Severity Scale were also completed.FindingsAll joints showed asymmetry (asymmetry indices ≥10%). Knee flexors (mean [SD]; 49.9 [37.8%]) and ankle plantar flexors (46.6 [35.5%]) had the largest asymmetry indices. Hip and knee extensors had the lowest asymmetry indices (21.1 [18.1%] and 30.1 [24.7%], respectively) and the highest agreement between self-reported and objectively-determined more-affected lower limb (93.3 and 93.8, respectively). The hip extensor asymmetry index was correlated with the Fatigue Severity Scale (r = 0.542, p = 0.037).InterpretationFor the assessment of strength asymmetries in people with multiple sclerosis, it is suggested to 1) include measures of hip, knee, and ankle strength asymmetries, 2) include subjective perceptions and objective measures of strength asymmetries concurrently, and 3) to include measures of sensory function (proprioception).     

The effects of calf muscle self-massage on ankle joint range of motion and tendon-muscle morphology

IntroductionSelf-massage using a foam roller (foam rolling) has been used to improve joint range of motion (ROM). However, the effect of foam rolling on the morphology of a targeted muscle, tendon, and muscle-tendon unit (MTU) has not been fully clarified. This study aimed to investigate extensibility changes in the gastrocnemius muscle (GM), MTU, and the Achilles tendon (AT) in terms of maximum ankle dorsiflexion (max-DF) following a foam rolling intervention. This was an interventional study with no controls.MethodsStudy participants comprised 10 male and female students (mean [standard deviation]: 22.7 [2.5] years; height, 164.2 [6.7] cm; weight, 57.9 [7.9] kg). The foam rolling intervention was performed on the right leg plantar flexor muscles for 3 min. The outcomes were max-DF with specified resistance values (ROM-SR) and non-specified resistance values (ROM-NSR) and GM, MTU, and AT extensibility. An ultrasound device was used to determine the rate of change by subtracting the value in a neutral ankle joint position (0°) from the ankle max-DF to identify GM, MTU, and AT extensibility. All outcomes were measured pre- and post-intervention.ResultsThe range of ankle joint dorsiflexion increased significantly following the foam rolling intervention (Δ: ROM-SR, +4.35 [5.79]; ROM-NSR, +4.18 [4.43]), whereas GM extensibility increased 4.0 mm, although no significant difference was observed pre- and post-intervention.ConclusionFoam rolling was effective in increasing ankle joint dorsiflexion ROM. Moreover, it was suggested that the GM morphology might be affected by the intervention.     

The effect of core stability-based corrective exercises on gait parameters in elite soccer players diagnosed with Middle Crossed Syndrome

Background/aimsThe aim of this study was to investigate the effect of eight weeks of core stability-based corrective exercises, on gait parameters in elite soccer players diagnosed with middle crossed syndrome.Methods15 male elite soccer players (aged 18–28) were enrolled in a same-subject intervention trial to assess if the middle crossed syndrome could be influenced through core stability exercise. Core stability-based corrective exercises were completed 3 times per week for 8 weeks and changes in gait parameters (pre- and post- intervention) were measured.ResultsThe results showed that most gait parameters including stride length (p = 0.025), gait speed (p = 0.023), number of strides (p = 0.007), length of shots (p = 0.003), and also soccer players’ height (p = 0.011) improved significantly in post-intervention in comparison to pre-intervention. Stride width in post-intervention did not show changes in comparison with pre-intervention (p = 0.083).ConclusionThe results indicate the significant effectiveness of core stability-based corrective exercises on gait parameters in those with middle crossed syndrome. By doing corrective exercises based on core stability during the study period, gait parameters in the post-intervention surpass the results in the pre-intervention in most parameters. Therefore, it is proposed that corrective exercises based on core stability is a safe and useful method for improving function in those with middle crossed syndrome and it could be used as a therapy to help players identified with this finding. In this regard, it is suggested to researchers and coaches to correct imbalances in order to achieve better results in training programs.     

The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests

BackgroundSingle-legged hop tests are frequently used in substantiating return to sport decisions following lower extremity injury. Evidence for using the non-injured leg as a reference for the injured leg in the return to sport decision-making at the criterion-based point of return to sport following lower extremity injury is lacking.PurposeTo compare absolute values in single-legged hop tests between the non-injured leg of athletes returning to high-impact sports after lower extremity injury and the matched leg of healthy athletes.Study DesignCross-sectional study.MethodsOne hundred and sixty-nine athletes returning to high-impact sports after lower extremity injury and 169 matched healthy athletes executed five single-legged hop tests. Differences between athletes returning to high-impact sports after lower extremity injury and matched healthy athletes on five single-legged hop tests were analyzed using paired t-tests.ResultsThere were no statistically significant differences between the non-injured leg of athletes returning to sport and the matched leg of healthy athletes. Effect sizes ranged from 0.05 to 0.14 indicating negligible effects.ConclusionClinicians can use the non-injured leg as a reference for the injured leg in single-legged hop tests for deciding on return to high-impact sports after lower extremity injuries.Level of Evidence3b