Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis

The human foot is a flexible structure characterized by a pronounced medial longitudinal arch (MLA) that compresses and recoils during running. That process is actively driven by the intrinsic foot muscles and requires a proper stability of the MLA. This introduces the concept of foot core stability. Because the intrinsic foot muscles are often neglected by clinicians and researchers, the purpose of this article is to provide some guidelines for incorporating foot core training in prevention or rehabilitation programmes for runners. The intrinsic foot muscles play a key role in postural control and maintain balance during single leg stance by controlling the height of the MLA and the foot pronation. During running, these muscles lengthen eccentrically during the absorption phase and subsequently shorten as the arch recoils during the propulsive phase, functioning in parallel to the plantar fascia. As a consequence, the dysfunction or weakness of the MLA active support may lead to injuries (e.g. plantar fasciopathy, Achilles or Tibialis posterior tendinopathy, metatarsalgia or medial tibial stress syndrome), due to numerous biomechanical cascades and mechanisms. In order to counteract or prevent these impairments, there are two ways for enhancing the foot core stability. Firstly in terms of volitional control of the intrinsic foot muscles, the “short foot exercise” must be practiced. Secondly strengthening sessions using neuromuscular electrical stimulation of these muscles seem to be a promising strategy in order to support the MLA and control the pronation during running. Practically, the foot core strengthening protocol may beneficiate not only the runners affected by excessive pronation related injuries but also those who sustained a long term lower limb injury and may be affected by a detraining process. In addition we warmly recommend integrating this protocol in any lower limb injury prevention programme or strength and conditioning plan for runners.

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Faculty Opinions recommendation of Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718116545.793485527 ◽

2013 ◽

Author(s):

Virginia Kraus

Keyword(s):

Systematic Review ◽

Lower Limb ◽

Sequential Analysis ◽

Meta Analysis ◽

Trial Sequential Analysis

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Investigation on Driver’s Lower Limb Injury Based on 3D Active Muscle Model During Offset Frontal Impact

International Journal of Precision Engineering and Manufacturing ◽

10.1007/s12541-021-00480-7 ◽

2021 ◽

Author(s):

Wu Chen ◽

Sen Xiao ◽

Zhidong Qu ◽

Xinran Liu

Keyword(s):

Lower Limb ◽

Muscle Model ◽

Frontal Impact ◽

Active Muscle ◽

Lower Limb Injury ◽

Limb Injury

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Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10010086 ◽

2020 ◽

Vol 10 (1) ◽

pp. 86

Author(s):

Emanuela Elena Mihai ◽

Luminita Dumitru ◽

Ilie Valentin Mihai ◽

Mihai Berteanu

Keyword(s):

Systematic Review ◽

Lower Limb ◽

Meta Analysis ◽

Extracorporeal Shock Wave Therapy ◽

Shock Wave Therapy ◽

Post Stroke ◽

Randomized Controlled ◽

Term Efficacy ◽

Extracorporeal Shock Wave

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

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