Why Did John Cena Change His Hand Signal

studying variation in the length of lower limbs, what does the evidence?

I decided to stick with the literature reviews but this time directed to another issue that has been debate recently on this blog and personally I have still some gaps. I thank also the voice of experience has given its opinion, totally agree with her and that made me think and see what that tells us the evidence.

studies consulted are all in English, obtained from various databases: Medline, Cochrane, Evidenciaclinica, etc.

The keywords used were: "leg length discrepancy" is also used "asymmetry" "asymmetry" but without results concerning the issue at hand.

In this review, I found great articles and others with a lower level of evidence due to the small sample size or weaknesses in their methodology.

I decided to put the abstract of each as it provides a good summary of the article, because if I put the whole article would be very cumbersome and no one will read the input. Always have the possibility to go to a university library and believe it will download the articles interesting.

[Limb-Length Measurements using wooden boards: an Accurate and experience-independent method]

Abstract OBJECTIVE: To determine the accuracy and reliability of the indirect limb-length Measurement, and the inter-observer variance entre doctors differing in level of experience. DESIGN: Descriptive. METHOD: Indirect limb-length measurement by placing 0.5 cm-thick wooden boards under the foot of the shorter leg until the difference in length was corrected, was performed by 3 observers differing in experience (medical student, resident and orthopaedic surgeon) on 66 patients with unilateral femoral-shaft fractures treated with a femoral nail. The group of patients consisted of 51 men and 15 women with a median age of 30 years (range: 18-90). In total 17 observers participated and 177 limb-length measurements were performed. The measurements obtained were compared with limb-length measurements obtained by orthoradiograms of the entire leg. RESULTS: Of the 177 indirect limb-length measurements, 144 (81%) differed by 0-1.0 cm compared with the limb length obtained by orthoradiogram. There was no statistically significant difference in the limb-length measurements obtained by the three groups of observers with different experience levels. There was a certain degree of correlation between values measured by medical students and residents (r = 0.7). When comparing the measurements carried out by staff members with those of residents and medical students, respectively, a lower degree of correlation was found (r = 0.6 and 0.5, respectively). CONCLUSION: Indirect limb-length measurement with wooden boards was accurate. Experience did not play an essential role.

Pacientes con fracturas de fémur que fueron medidos por 3 tipos diferentes de profesionales (estudiantes medicina, residentes y cirujanos ortopedas). Se pone un wooden block under the shorter leg. Rx has been made to see the real and the indirect measurement by the 3 groups using wooden blocks. The results have been very accurate and the examiner's experience has not been very significant since there is very little variation among the 3 groups.

With this study we can conclude that the measurement made indirectly through block test is effective when compared with the Rx and that experience is a big handicap not to be taken into account.

Limb length inequality: clinical Implications for Assessment and intervention.

Abstract

The purpose of this paper is to review relevant literature concerning limb length inequalities in adults and to make recommendations for assessment and intervention based on the literature and our own clinical experience. Literature searches were conducted in the MEDLINE, PubMed, and CINAHL databases. Limb length inequality and common classification criteria are defined and etiological factors are presented. Common methods of detecting limb length inequality include direct (tape measure methods), indirect (pelvic leveling), and radiological techniques. Interventions include shoe inserts or external shoe lift therapy for mild cases. Surgery may be appropriate in severe cases. Little agreement exists regarding the prevalence of limb length inequality, the degree of limb length inequality that is considered clinically significant, and the reliability and validity of assessment methods. Based on correlational studies, the relationship between limb length inequality and orthopaedic pathologies is questionable. Stronger support for the link between low back pain (LBP) and limb length inequality is provided by intervention studies . Methods involving palpation of pelvic landmarks with block correction have the most support for clinical assessment of limb length inequality. Standing radiographs are suggested when clinical assessment methods are unsatisfactory. Clinicians should exercise caution when undertaking intervention strategies for limb length inequality of less than 5 mm when limb length inequality has been identified with clinical techniques. Are Provided recommendations regarding intervention strategies.

In this review, the authors note that the differences in length and its relationship to orthopedic diseases is questionable. But if you say that there is strong correlation between the asymmetries and LBP. The methods used are pelvic tenderness and blocks are corrected. Rx intends to use when clinical methods are unsatisfactory.

[A new procedure for Determining Leg Length Inequality and leg length using ultrasound. II: Comparison of ultrasound, and 2 clinical teleradiography Procedures in 50 Patients]

Abstract

The clinical methods still in common use for measuring leg length and leg length discrepancy (LLD) cannot always meet the demands of precision and accuracy. A method using ultrasound is presented and shown to be a standardized, non-invasive method allowing accurate determination of leg length and LLD. Once the validity had been proved experimentally, practical handling, precision and accuracy of this method were tested on 50 patients in whom teleradiography of the lower extremity was performed for different reasons. The sonographically determined measures of LLD were compared with the radiographic measurements and in addition clinical measurements were taken by direct (tape measure) and indirect methods ("lengthening" of the shorter leg by wooden blocks of known thickness). Adjustments to the ventral hip joint and to the medial knee joint served as standardized, easily reproducible sonographic reference points. The mean variance of repeated sonographic measurements as a reflection of precision amounted to 3.5 mm2 for leg length measurement, with a maximum of 13.5 mm2. In the case of LLD the mean divergence between sonographically and radiographically determined LLD was 0.9 +/- 2.7 mm, with a maximum of 6.4 mm. The clinical methods with mean divergence of -1.2 +/- 9.6 mm (direct method) and -1.0 +/- 6.1 mm (indirect method) proved to be less accurate. The method examined for measuring leg lengths and LLD by means of ultrasound is easy to manage and non-invasive. Its precision and accuracy make it superior to clinical events Measuring Methods and Could Make Some radiographical Examinations superfluous.

Here we present the reliability of ultrasound measurements and have proven to be more effective than direct and indirect method.

Leg length discrepancy

assessment: accuracv and precision in five clinical Methods of evaluation *.

Abstract

clinical Five Methods of leg length discrepancy Assessment Against One Another Were tested for Their relative accuracy and precision compared to exact anatomical standards as Determined by Radiographer. Five Normal Subjects, one with a discrepancy Known of 1.3 cm, were evaluated by twenty physical therapists each using every method of assessment. T-tests and F-tests (a = 0.05) were used to determine statistical accuracy and precision among methods. Absolute values of mean differences, standard deviations, and ranges were used to determine clinical significance. The indirect method, which employed lift blocks under a foot with a subject in the standing position, proved to be the most accurate and precise method of any tested. Of the direct methods tested, which employ a tape measure between various anatomical landmarks, the technique shown to be the most accurate and precise utilized the landmarks of the anterior superior iliac spine and the lateral malleolus of the fibula.J Orthop Sports Phys 1984;5(5):230-239.

5 methods are tested to assess the accuracy of the measurements in asymmetry. The sample is very small. N = 5. Indirect measures are more precise elevations using the shorter leg. Indirect methods using tape measure, the more accurate is made from the anterior iliac spine to the peroneal malleolus. Which contradicts my knowledge previously acquired, because it has taught us that the measurement must go to the medial malleolus.

Measuring leg-length discrepancy by the "Iliac crest palpation and book correction" method: reliability and validity.

Abstract

OBJECTIVE: To determine the reliability and validity of a clinical measurement of leg-length discrepancy (LLD), by using the iliac crest palpation and book correction (ICPBC) method. DESIGN: Intra- and interrater reliability and validity determinations. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-four healthy subjects, none of whom had an apparent LLD, as determined by iliac crest palpation. INTERVENTIONS: We induced a simulated LLD (7-53 mm) for each subject. To measure the LLD, the examiner performed the ICPBC method by palpating the iliac crests and correcting identified differences with a book opened to the required number of pages. The thickness of the book correction was measured. MAIN OUTCOME MEASURES: Reliability LLD measurement (n = 20), by using the ICPBC method to measure the LLD; construct validity (n = 34), comparing ICPBC measurement with the extent of the induced LLD; and concurrent validity (n = 14), the difference in heights of the superior aspect of the femoral heads from standing radiographs. RESULTS: The intraclass correlation coefficients (ICCs) for the intrarater and interrater reliabilities were.98 and.91, respectively. The ICCs for the construct and concurrent validities were.62 and.76, respectively. The ICPBC method underestimated the induced LLD by a mean difference +/- standard deviation of 3.8 +/- 10.3mm (p =.055) and the radiologic measure by 5.1 +/- 8.6 mm (p =.043). CONCLUSIONS: The ICPBC technique for measuring LLD is highly reliable and moderately valid. When there is no history of pelvic deformity and the iliac crests can be readily palpated, we recommend using iliac crest palpation to detect LLD, and the book correction to quantify it. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Método para valorar la discrepancia de longitud de MMII usando la palpación de la cresta iliaca y utilizando un libro para elevar la pierna más corta. N=34, sanos y sin conocimiento de tener LLD (leg length discrepancy). Se usa el libro abierto por una página y luego measured. Is a safe and moderate validity. So far we have seen that almost all techniques rely on tenderness and elevation of the iliac shorter with some support, the most common wood blocks measured previously. We can see that these methods are used very common and very reliable giving results very similar to the radiographs. Rx only comment when using clinical measures are vague, the differences in length are under 5mms or have questions. (All in the previous articles)

Measurement of limb length inequality. Comparison of clinical methods with orthoradiography in 190 children.

Abstract

We studied the agreement in measuring limb length inequality with orthoradiograms and clinical methods. In 190 children attending our Limb Length Clinic for the first time, 95% of the measurements with wooden boards was within -1.4 and +1.6 cm of the results of the orthoradiograms. A tape measure had significantly less agreement. The predictive value of a localization of the main limb length inequality above the knee, as found with a tape measure, was 64% and for a localization of the main limb length inequality below the knee 75%. A Wooden Board Reliability Graph is presented, Which Can Be helpful in the decision to Perform orthoradiographic Inequality Measurements of limb length in, eg, evaluation of impairment.

Another study of N = 90 Rx comparing measurements with measuring tape and wooden blocks. The results are very similar to previous studies, the wood blocks are reliable and not so much tape.

Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation

The Objective of this study to determine whether WAS a correlation exists

between abnormal pronation and functional leg-length discrepancies. Vi

sual assessment and a pelvic thrust maneuver were used to identify the

functionally short leg in 56 indigenous Mexicans (20 males and 36 females;

mean age, 33 years; mean weight, 59 kg; and mean height, 1.60 m). The

Foot Posture Index was used with a modified stance position to identify

the more pronated foot. The posterosuperior iliac spines were used to

identify the “relative” position of the innominate bones. The raw data ob

tained from this study were evaluated using the McNemar test for paired

proportions. A significant positive correlation was found between abnor

mal pronation and hip position and between hip position and functional

leg-length discrepancy. These results are consistent with a theoretical

ascending dysfunctional pelvic model: Abnormal pronation pulls the in

nominate bones anteriorly (forward); anterior rotation of the innominate

shifts the acetabular bones posteriorly and cephalad (backward and up

ward), and this shift in the acetabular hyperextends the knees and short

ens the legs, with the shortest leg Corresponding to the MOST pronated

foot. (J Am Podiatric Med Assoc 96 (6): 499-507, 2006).

Value of a functional asymmetry with abnormal pronation. N = 56. FPI is used to assess foot position. Posterior iliac spines were used to identify the relative position. We found a correlation between abnormal pronation and hip position and between hip position and functional asymmetry. The results are consistent with the theory of pelvic dysfunction model ascending pathological pronation pulls the innominate above, anterior rotation of the acetabulum bone moves back and head (back and up), this change in the acetabulum occurs and knee hyperextension shortening of the legs, with the shorter leg corresponds more pronated foot.

Here is a false asymmetry or a functional asymmetry that we must be careful not to be confused with a structural and put up. In these cases, when we send the patient to a physiotherapist or osteopath and we can really help, but if the problem is abnormal pronation or pelvic dysfunction, the treatment will begin with a functional brace plantar and see the progress before returning to act . (Here comes the decision of the professional game, but on a common theoretical base, there may be 3 ways of acting and 3 to be correct).

Base de datos Cochrane:

Abstract

Visual leg length insufficiency detection and correction is compared with established radiographic procedures on 41 consecutive patients presenting to a chiropractic clinic with low back pain. It is commonly accepted that the most accurate procedure of short leg demonstration is the standing X ray. Visual correction, as described by Rene Cailliet, uses three anatomical points of reference: a) iliac crest levelness, b) vertical appraisal of the spine from the sacral base (the spine should be perpendicular to the sacral base) and c) levelness of the posterosuperior iliac spine (PSIS) dimples. Lifts of varying thickness were placed under the foot of the short leg in both leg length corrective procedures. This study found that the visual method of measurement did not differ significantly from the X-ray method of measurement for leg length insufficiency. Further, it was found that when comparing those in which the visual measure was less than the X-ray measure and those in which the visual measure was greater, there was a significant relationship between visual and X-ray measures. Eta (eta 2) demonstrates that there is a very strong relationship between visual and X-ray methods of measurement. A review of the literature is presented regarding the correlation of leg length insufficiency and musculoskeletal disorders, as well as the discrepancy required to alter biomechanical properties of the trunk and lower extremity.

display and correction of LLD vs radiographs.

are accounted for 3 points: 1 horizontality of the iliac crest. 2 º vertical evaluation of the spine from the base of the sacrum (the column should be perpendicular to the base of the sacrum) 3 º Leveling the posterosuperior iliac spine, dimples.

increases were put in the shorter leg.

The study showed that the visual method does not differ significantly on the Rx in the methods of measurement.

Confirms there is a strong visual relationship to the extent vs radiographs.

LLD also confirms that produce an altered biomechanics of the spine and lower limbs.

Abstract We hypothesized That leg-length Discrepancies of as little as 1cm Would induces postural shift and Significant Increase the Extent of postural sway. We had normal 14 Volunteers stand on a force platform With their feet in a standard position. Center-of-pressure data Were Recorded at 100Hz for 20 seconds while the barefoot Stood Subjects with no lifts or (in random order) with lifts of 1, 2, 3, and 4cm under their left and right feet. From these data we derived the mean center-of-pressure position and the extent of postural sway. Lifts of as little as 1cm shifted the mean center-of-pressure toward the longer leg to a statistically significant extent (p less than 0.001), the mean difference compared with the barefoot condition being 6.1% of the distance between the feet; increasing the discrepancy did not proportionately increase the effect. The postural sway (total travel of the center-of-pressure) in a mediolateral direction increased significantly with a 1cm discrepancy (p less than 0.01), and continued to increase in proportion to the magnitude of the discrepancy. There Were no effects on anteroposterior position or sway and no influence of left-right dominance. These results support our hypothesis That a leg-length discrepancy of as little as 1cm May Be biomechanically important. This study hypothesizes may vary significantly if 1cm biomechanics. They use healthy people who put in a pressure platform and blocks are added inches and 1-2-3-4 record for 20 seconds at 100Hz to assess if there is deviation from the center of gravity both anteroposterior and mediolateral. The result is that 1 cm change significantly if the center of gravity but only medial-lateral no antero-posterior y que la diferencia de longitud de 1 cm debería producir biomecánicamente un cambio importante. Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. Autor(es): Weiner DK; Sakamoto S; Perera S; Breuer P [CENTRAL-Registro Cochrane de Ensaios Clinicos Controlados. In: The Cochrane Library ID: 00554355 ] OBJECTIVES: To develop a structured physical examination protocol that identifies common biomechanical and soft-tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. DESIGN: Cross-sectional survey and examination. SETTING: Older adult pain clinic. PARTICIPANTS: One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free. MEASUREMENTS: Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms. Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. RESULTS: Scoliosis was prevalent In Those with (77.5%) and Without pain (60.0%), pero Prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) WAS Significantly Different Between groups (P < .001). Interrater reliability was excellent for SIJ pain (0.81), number of fibromyalgia tender points (0.84), and TFL pain (0.81); good for scoliosis (0.43), kyphosis (0.66), lumbar movement pain (0.75), piriformis pain (0.71), and hip disease by internal rotation (0.56); and marginal for leg length (0.00) and paravertebral pain (0.39). CONCLUSION: Biomechanical and soft tissue pathologies are common in older adults with CLBP, and many can be assessed reliably using a brief physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering. This study of older people, with a sample of N = 111, assesses the conditions presented by each subject with back pain. The conclusion is that the biomechanics and soft tissue pathology (in many cases is not adequately separated since they are related) are common in elderly patients with chronic low back pain. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. Autor(es): Gurney B; Mermier C; Robergs R; Gibson A; Rivero D [CENTRAL-Registro Cochrane de Ensaios Clinicos Controlados. In: The Cochrane Library ID: 00456160 ] BACKGROUND: The amount of limb-length discrepancy necessary to adversely affect gait parameters in older adults is unknown, with information being largely anecdotal. This investigation was conducted to determine the effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. METHODS: Forty-four men and women ranging in age from fifty-five to eighty-six years with no evidence of limb-length discrepancy of >1 cm participated in the study. Subjects walked on a treadmill at a self-selected normal walking pace with artificial limb-length discrepancies of 0, 2, 3, and 4 cm applied in a randomly selected order. Indirect calorimetry was used to measure oxygen consumption and minute ventilation. Electromyography was used to measure muscle activity of the right and left quadriceps femoris, plantar flexors, gluteus maximus, and gluteus medius. Heart rate, the rating of perceived exertion, and frequency of gait compensation patterns were also measured. RESULTS: There was a significant increase in oxygen consumption and the rating of perceived exertion with 2, 3, and 4-cm artificial limb-length discrepancies; a significant increase in heart rate, minute ventilation, and quadriceps activity in the longer limb with 3 and 4-cm artificial limb-length discrepancies; and a significant increase in plantar flexor activity in the shorter limb with a 4-cm artificial limb-length discrepancy compared with the same parameters with no artificial limb-length discrepancy. CONCLUSIONS: Both oxygen consumption and the rating of perceived exertion were greater with a 2-cm artificial limb-length discrepancy than they were with no artificial limb-length discrepancy. There appears to be a breakpoint between 2 and 3 cm of artificial limb-length discrepancy in older adults with regard to the effects on most other physiological parameters. A 3-cm artificial limb-length discrepancy is likely to induce significant quadriceps fatigue in the longer limb. Elderly patients with Substantial pulmonary, cardiac, or neuromuscular disease May Have Difficulty walking with a limb-length discrepancy as small as 2 cm. A study in the elderly with a sample of N = 44, which presented the hypothesis of the effects that an LLD in energy expenditure of gait altered. , with higher oxygen consumption and the rate of effort produced with 2-3 and 4 cm difference in length. Significant increases in heart rate, minute ventilation and activity of the quadriceps in the longer leg with 3 and 4 cm. Significant increase in activity in the leg plantarflexor cut to 4 cm LLD. with 2 cm of LLD significantly increased oxygen consumption. With 3 cms induces quadriceps fatigue in the leg larger. The conclusion is that elderly patients with asymmetries of at least 2 cms with heart, lung and / or neuromuscular should have difficulty walking. If these patients can not walk, systemic problems will worsen. Joint moments in minor limb length discrepancy: a pilot study. Autor(es): Goel A; Loudon J; Nazare A; Rondinelli R; Hassanein K [CENTRAL-Registro Cochrane de Ensaios Clinicos Controlados. In: The Cochrane Library ID: 00146329 ] A biomechanical analysis was performed to determine if a minor limb length discrepancy alters lower extremity joint mechanics significantly and in a manner that could contribute to the development of joint abnormalities. Ten healthy subjects with equal limb lengths were recruited. Gait analysis was performed for both left and right sides to determine the maximum moments at the hip, knee, and ankle joints. A minor limb length discrepancy was simulated by adding a shoe lift of 1.25 cm to the left leg. After a period of acclimation, the gait was reanalyzed. Differences for maximum joint moments at the hip, knee, and ankle before and after simulation were nonsignificant. An additional 10 healthy, asymptomatic patients with actual limb length discrepancies ranging from 1 cm to 2 cm were also recruited. Gait analysis for maximum joint moments before and after correction of the limb length discrepancy was performed. Side-to-side differences in joint moments before correction were nonsignificant. After correction of the limb length discrepancy, side-to-side joint moment differences were significantly increased (P = 0.02) and may suggest acute overcompensation to the presence of the corrective shoe lift. Consequently, Not this study did find an association entre Discrepancies minor limb length and Predictable Changes in lower extremity joint kinetics Potentially That Might lead to joint Abnormalities. Studio with a sample in which the hypothesis is to assess the joint moments of hip, knee and ankle in patients with LLD. First pick healthy people and make measurements before and after using some increases of 1.25 cm in these people without LLD. The differences were not significant. then a sample with LLD of 1 to 2 cm was also analyzed before and after the use compensatory gains. After correction saw a different joint moment was significantly increased possibly by overcorrection. The conclusion is that the study found no association between the shorter leg and changes in the lower extremity that can cause abnormalities. Personally, I like to study, not the result but also the type of sample as small, the methodology used. I think that there should be more long term and that a LLD muscle shortening occurs at multiple points in the chain and if you do not have time to go away without treatment releasing or physiotherapy, osteopath in minutes not evident changes occur. conservative Correction of leg-length discrepancies of 10mm or less for the Relief of Chronic low back pain. Author (s): Defrin R; Well Benyamin S; Aldubi RD, Pick CG [Central-Record Cochrane Controlled Trials. In: The Cochrane Library ID: 00531736 ] Objective: To study Whether conservative Correction in a leg-length discrepancy (LLD) of 10mm or less in Patient with Chronic low back pain (CLBP) dog relieve pain. Design: Randomized, Controlled Intervention Study, with a mean follow-up duration of 10 weeks. Setting: Physical Therapy Clinic of the national health services. PARTICIPANTS: Thirty-three patients with CLBP were screened for an LLD of 10mm or less, which was measured with ultrasound. Patients were randomly divided into intervention and control groups. INTERVENTION: In 22 patients, LLD was corrected by applying individually fitted shoe inserts. In 11 patients, LLD was not corrected. MAIN OUTCOME MEASURES: Chronic pain intensity (visual analog scale) and disability score (Roland-Morris Disability Questionnaire). RESULTS: Shoe inserts significantly reduced both pain intensity (P <.001) and disability (P<.05). A moderate positive correlation was found between LLD and the degree of pain relief after wearing shoe inserts (r=.47). CONCLUSIONS: Shoe inserts appear to reduce CLBP and functional disability in patients with LLDs of 10mm or less. Shoe inserts are simple, noninvasive, and inexpensive therapeutic means that can be added to the treatment of CLBP. Relación entre lumbalgia crónica y LLD de menos de 1cm, esa es la hipótesis. Tracking 10 weeks. N = 33 pre-selected by their asymmetries. templates in 22 patients by filling LLD was corrected in 11 no. scale was used to quantify pain visual. Results: Patients with inserts inside were reduced pain and disability. A moderate positive correlation after using these "highs" and pain relief. The treatment has been effective in less than 1 cm asymmetries to reduce pain and disability. Pelvic unlevelness in chronic low back pain patients - Biomechanics and EMG time-frequency analyses Autor(es): Aleksiev A; Pope MH; Hooper DM; Wilder D; Magnusson M; Goel VK; Weinstein J; Spratt K; Lee S [CENTRAL-Registro Cochrane de Ensaios Clinicos Controlados. In: The Cochrane Library ID: 00183632 ] Background and significance: A controversy persists about the role of pelvic unlevelness and leg length inequality (LLI) as etiologic and aggravating factors in low back pain (LBP), and the diagnostic approach to the use of heel lifts. A question arises: does LLI causes LBP, or is pelvic unlevelness a result of LBP? If the latter, why would we try to change the posture by unilateral heel lift, presumably to something more painful in LBP patients? Purpose: The aims of this study was: a) to investigate the external forces by means of force plate analysis, and the internal forces of the spine by erector spine surface EMG during isometric contraction and sudden load, and b) to define how these responses were modified with or without expectancy and before and after fatigue, when artificial LLI was created in normals and in chronic LBP patients. Subjects and methods: In the first study, 10 patients with chronic LBP (age 41.4, SD 9.6) and 10 matched healthy subjects (age 41.1, SD 9.4) were investigated. The patients participated in a well established 2-week rehabilitation program. The pain degree was quantified by Visual Analogue Scale (VAS). The subjects stood on a force platform with extended knees, their arms along the body and pelvis against a board to push off. In this position they extended their back against a mechanical resistance at 20% of the individual maximum voluntary contraction MVC for 4 s. Surface EMG activity of the multifidus and longissimus were recorded. An artificial LLI was created by placing different boards of 12 mm and 25 mm respectively under the left and right foot in random order. After the 2-week rehabilitation course the same investigation was repeated for the LBP patients. The same procedures were repeated for the controls after 2 weeks. In the second study, 11 chronic LBP patients (7 males 38.4 years SD 9.8, and 4 females 37.2 years SD 3.6) and 11 age and sex matched controls (7 males with mean age 39.5 SD 9.8, and 4 females with mean age 36.2 SD 3.7) were recruited. The experimental setup was the same as in the first study. Expected and unexpected load and unloads were applied before and after fatigue at the level of T4 by weight of 2 kg attached via a load cell to a harness around the subject's shoulder. The weight was dropped from a height of 45 cm, applying a sudden forward bending moment. Results: The results from the first study showed that in healthy subjects EMG activity increased proportionally on the side with a board and decreased correspondingly on the contralateral side. In LBP patients the EMG increment is higher when the artificially elongated leg corresponds to the more painful side. In healthy subjects COP is close to the middle line, and shifts proportionally away from the longer leg side. In LBP patients COP is shifted initially away from the more painful side even without artificial LLI. COP shifts significantly more in patients when the longer leg corresponds to the more painful side. The displacement of COP is significantly smaller at the end of the rehabilitation program for chronic LBP. The healthy subjects did not show electrophysiologic signs of muscle fatigue, detected by median frequency shift, after 45 s of isometric contraction at 20% MVC. The LBP patients not only were fatigued under the same conditions, but showed asymmetric erector spine fatigue, higher on the side corresponding to the longer leg. The fatigue index decreased significantly after the rehabilitation program. The most fascinating result in the second study was a 5-level interaction of LId together with expectation, fatigue, group, and axis, defined from the force plate parameters. The results of the EMG reaction time and magnitude to sudden load were expressed mostly by a 3-level interaction of LLI together with expectation and group. An obvious discrepancy between the ground reaction forces (expressing the external forces) and the EMG activity (showing the internal forces) comparing normals versus LBP patients were found. The EMG magnitude to sudden load was smaller but the magnitude of the ground reaction forces were larger in LBP patients versus normals. EMG reaction time was slower but the latency of the ground reaction forces are faster in LBP patients versus normals. This internal/external force discrepancy increased after placing a heel lift under the foot, corresponding to the painful side in LBP patients. Conclusion: This study proved only the short term beneficial effect of this frontal plane postural correction in chronic LBP patients. Further studies are necessary to verify a longer term effect of monitored frontal plane posture correction in chronic LBP. Copyright © 2010 Elsevier B. V., Amsterdam. All Rights Reserved. Finally the last, after hours to several days. Uneven pelvic pain in patients with chronic lower back (CLBP). Biomechanics and electromyography. As discussed in another study, here also say that there is controversy in the pelvic unevenness and the relationship with LLD (leg length discrepancy). I like this study because it offers interesting questions. The authors ask: Do the LLD cause chronic low back pain? Or is the unevenness pelvic the result of chronic low back pain? In the latter case, then why should we change our posture unilaterally? presumably more painful in patients with chronic low back pain. These are the questions that I have to use up time, the possible effects on older patients may aggravate the picture. (An aside: discussed using heel lifts for asymmetries, I am among those who share that price increases should be complete front to back, but for reasons of shoes that I usually do is reduce MTT thickness under heads, 1 or 2 mm and distal to the metatarsal heads in some cases not put anything else, or continue but with a smaller thickness, simply to avoid the leap of the brace on the rise. Because of this problem if the asymmetry is significant, I prefer to use only full boost and not be associated with plantar support (cases exaggerated plantar added to shoes) each partner actually does in one way or another, because in the literature is reflected that all are valid even if the retraction of twins is a problem in children by using only skirts, so try to make the upward tilt of at least the foot, although less bulk under the heads MTT, the angle between the fibula and 5 MTT should be 90 º approx. as it descends to a minimum. In a study previously consulted had shown that up to 3 mm heel for 3 months did not influence the shortening of the gastrocnemius. Hence each remove their way of working) After continuous paragraph: The objectives were: a) investigate the external forces using force plates and internal forces from the column by EMG during isometric contraction. b) define how are you answers were amended with or without expectations before and after the fatigue when you put the rise in healthy patients with chronic low back pain. increases have been proven to cause artificial asymmetries and value the relief of symptoms, no treatment of LLD. I will not comment on the methodology but would interesting that you read. Conclusions: We demonstrated short-term beneficial effects of increases in use (they wore skirts) for the treatment of back pain by correcting the position in the frontal plane. More studies are needed to assess these long-term effects. The summary would be: healthy group (control) and pathology group with chronic low back pain are put through a series of biomechanical tests and EMG and without an increase to create an artificial dissymmetry and assess the pain relief or increased pain visual scale. With several weeks of treatment, examination and assessment back. This is something I had thought and I had not yet dared to try. Change the biomechanics of how it is to make profits, but the problem is compensation or other parties are going to hurt. One of the tests I've done has been a patient of 32 years with chronic back pain. The only problem biomechanical observed is that small had a problem with the growth cartilage of the knee where he had an outbreak of Tuberculosis and therefore a delay in the growth of the lateral side, causing a mild worth, a deformity in the frontal plane. Using several tests and scans came to the conclusion that the leg needed to descend to reach the ground and not down as linear as the other leg, the example would be: a straight line comes before a curved line the ground if they both have the same length. After several tests were put up in thickness obtained by the measurements. 6 months later the result is that lower back pain and muscle fatigue have been reduced to almost abolished. I've also done the same procedure on a family member with chronic low back pain and postural asymmetry with a poor outcome, leading to an exacerbation of symptoms, so it was removed immediately. is an area where there are no uniform criteria for each patient is different and not as accurate diagnoses, as well as adaptations may be multiple, too many factors come into play. A collective summary of everything seen in this field are: 1 that my English is not good but with work and daily basis to read articles in that language each time it costs less. 2 º The measurements by numbered blocks and pelvic tenderness is a very effective method to assess lower limb asymmetries. 3 ° asymmetries or biomechanical and LLD cause back pain. 4 th Rate it if we have a functional asymmetry by pronation, dysfunction of the pelvis, etc or to a structural, physical therapists and / or radiographs osteopaths with a doubt if we will help. have a good time without ever publish anything. In this article I hope to have clarified doubts anyone. comentármelo If you detect an error to correct because the speed at which I've done it is impossible not to commit any. Happy holidays to you to enjoy them.

Why My Computer Said Signal Cable Not Connected

Some

had no plans to create a entry as soon but I need to do a little review of the literature.

1, Effects of non-adapted orthoses or prefabricated foot directly

"Scientific Assessment of Over-the-Counter Foot orthoses to Determine Their Effects on Pain, Balance, and Foot Deformities"

Background: A scientific study was conducted to evaluate the effects of non–custom-

molded (over-the-counter) foot orthoses.

Methods: Several parameters were examined, including foot, knee, hip, and back pain;

balance; and reduction in flexible deformities, such as hammer toes and hallux valgus.

Wherever possible, objective measurements were used, including measurements of shifts

in center of pressure to assess balance and changes in bone position examined on radio-

graphs. Forty-one individuals were analyzed using one of two types of prefabricated, non-

custom insoles. Insoles were fit by an assistant trained to follow the fitting recommenda-

tions of the manufacturer under the direct supervision of a podiatric physician.

Results: Use of these arch supports resulted in a significant reduction in some types of

foot pain associated with hallux valgus (P = .04) and pain in the arch area (P = .004), knee

(P = .002), and back (P = .007) by week 4. We also measured changes in foot position

documented by radiography, although some changes may be attributed to parallax associ-

ated with measurement techniques. Improvement in balance was not observed to be sig-

nificant when the orthoses were worn.

Conclusions: Using Both subjective and Objective Measures, we found That

These over-the-counter foot orthoses Were Effective in Bringing about Changes in foot shape and con-comitant

Un certain specific relief of painful conditions. This study Indicates That There Is A

scientific basis for Attempting to relief pain with orthoses. (J Am Med Assoc Podiatrist

99 (3): 206-215, 2009)

In one study alone can not make a dogma, but shown to be effective, other studies also compared custom-made brace and looks that are less effective prefabricated than the others. Although the study does not prove this, I wonder: Does

be perfectly adapted to plant at the foot brace to take effect?

At what is called a suit right? if each fits in its own way and work alike.

who takes the stand is such that it is, without controlling anything, or who corrects them or take them over neutral, and have for years and do well, then? need to know the why, as interpreted differently by everyone.

2 º wedges Effects of forefoot and hindfoot and its effects

"Changes in Plantar Foot Pressure with In-Shoe Varus or Valgus Wedging"

Varus and valgus wedging are commonly used by podiatric physicians

in therapy with custom-made foot orthoses. This study aimed to pro-

vide scientific evidence of the effects on plantar foot pressure of apply-

ing in-shoe forefoot or rearfoot wedging. The plantar foot pressure dis-

tribution of 23 subjects walking on a treadmill was recorded using a

pressure insole system for seven different wedging conditions, ranging

from 3° valgus to 6° varus for the forefoot and from 4° valgus to 8°

varus for the rearfoot. The results demonstrate that increasing varus

wedging magnifies peak pressure and maximal loading rate at the me-

dial forefoot and rearfoot, whereas increasing valgus wedging magni-

fies peak pressure and maximal loading rate at the lateral forefoot and

rearfoot. As expected, the location of the center of pressure shifts me-

dially with varus wedging and laterally with valgus wedging. However,

these shifts are less significant than those in peak load and maximal

loading rate. Timing variables such as interval from initial impact to

peak load do not seem to be affected by forefoot or rearfoot wedging.

Finally, rearfoot wedging does not significantly influence pressure vari-

ables of the forefoot, similarly, rearfoot pressure Remains unaffected by

forefoot wedging. (J Am Podiatric Med Assoc 94 (1): 1-11, 2004)

A medial wedge increases the peak pressure in medial and lateral wedge causes the peak pressure is on the side. Wedges

medial change the CoP medially and vice versa.

applied in forefoot wedges show no significant influence on the pressures of the hindfoot and vice versa.

"Effect of 7-Degree Valgus and Varus Rearfoot wedging on Rearfoot Kinematics and Kinetics During the Stance Phase of Walking"

Javier Pascual Huerta, DP*

Juan Manuel Ropa Moreno, DP*

Kevin A. Kirby, DPM†

Francisco Javier García Carmona, DP‡

Angel Manuel Orejana García, DP‡

Background: The scientific evidence behind the mechanical function of foot orthoses is

still controversial. Research studies that have investigated the kinematic effect of foot

orthoses on the lower extremity have shown variable results, with orthoses causing ei-

ther no significant change or a small significant change in foot kinematics.

Methods: The right limbs of 12 healthy asymptomatic individuals were studied in three

walking conditions: barefoot, with a 7° rearfoot varus wedge, and with a 7° rearfoot val-

gus wedge. Kinematic and kinetic variables measured were the foot progression angle,

the peak internal tibial rotation angle, and net ankle inversion moments during the

stance phase in the three conditions.

Results: There were statistically significant differences in the foot progression angle be-

tween the barefoot and varus wedge conditions and between the varus and valgus

wedge conditions. There were no significant changes in peak internal tibial rotation

among the three conditions tested. However, rearfoot varus wedges significantly reduced

net ankle inversion moments compared with barefoot and rearfoot valgus wedges.

Conclusions: These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary. (J Am Podiatr Med Assoc 99(5): 415-421, 2009)

Los resultados dan soporte a la idea de que las ortesis trabajan por other methods that change the kinematic parameters. This study supports the concept that foot orthoses work first by kinetic changes, with its subsequent cinematic effects.

With these two items we can start to doubt whether the deformities in the transverse plane forefoot are so common (not that they exist) as a cause of disease (but not if it causes sagittal plane), but more:

I recommend reading this article:

"The Past, Present, and Future of Podiatric Biomechanics" and a small piece of philosophy of science that everyone should tener en cuenta:

Historical studies reveal that the evolution of the major branches of science does not exhibit the structure assumed by the positivist approach. Kuhn51, 52 interpreted the development of scientific knowledge as a succession of “revolutions” in which dominant “paradigms” are overthrown and replaced by other paradigms.53-59 His account of the progress of scientif-

ic inquiry sees science as consisting of long periods of orderly, disciplined work—which he called “normal science”—punctuated by periods of intellectual ferment leading to revolutions in which the old theoretical order is overthrown, after which a new period of normal science begins. Normal science is characterized by the collective acceptance of a certain paradigm, or framework of ideas. This set of assumptions determines what is considered acceptable “science” or “practice” at any given time. Practitioners direct their work toward solving problems that are determined by or relevant to the dominant paradigm at the time. Kuhn’s central argument is that scientific concepts must be understood within the particular historical and social context in which they developed. This is an appropriate view to adopt for an exploration of the history and future course of podiatric biomechanics: It can help explain the field’s past as well as help predict its future.

Kun interpreta development of scientific knowledge as a succession of "revolutions" in which the current paradigm is overthrown by a new emerging.

science classifies it as long periods of order, discipline of work that qualifies as "normal science" and is combined with periods of time in which new ideas are emerging, studies that begin to leak to the previous paradigm and then study time was just accepted by all professionals as a new paradigm and re-enter the era of normal science. Is a string that will last a lifetime so I wonder when they say "before this and now you said the other" is quite correct that what that is wise, but here is essential to rectify when we see that the new scientific evidence shows us that we were doing something wrong.

would be very unproductive conflict to defend theories that are being overturned and defend what everyone does personally because he did so throughout life. Everyone has their way of working, it is impossible that we all work well, but at the time to discuss, provide studies with an acceptable level of evidence.

In my case, I appreciate someone telling me, looking prospect, read these articles that contradict what you're doing, it is welcome to follow the right path and change my ways of working, thinking and correct errors.

A paradigm is difficult to define precisely, but includes scientific laws and theoretical assumptions and its application. Kuhn characterized paradigms as "universally recognized achievements, which has long provided model problems and solutions a community of professionals. paradigm reflects the unique set of beliefs, values, and methods shared by this community of practitioners, a world view that shapes the thinking and scientific action . The structure of scientific paradigms come to light of concepts and theories that have embedded in the paradigm.

"Effect of foot orthoses on lower extremity kinetics DURING running: a Systematic literature review"

Abstract Background

THROUGHOUT the Period of one year, Approximately 50% of Recreational runners will

That

sustain an injury disrupts their training regimen. Foot orthoses have been shown to

be clinically effective in the prevention and treatment of several running-related

conditions, yet the physical effect of this intervention during running remains poorly

understood. The aim of this literature review was therefore to evaluate the effect of foot

orthoses on lower extremity forces and pressure (kinetics) during running.

Methods

A systematic search of electronic databases including Medline (1966-present),

CINAHL, SportDiscus, and The Cochrane Library occurred on 7 May 2008. Eligible

articles were selected according to pre-determined criteria. Methodological quality was

evaluated by use of the Quality Index as described by Downs & Black, followed by

critical analysis according to outcome variables.

Results

The most widely reported kinetic outcomes were loading rate and impact force,

however the effect of foot orthoses on these variables remains unclear. In contrast,

current evidence suggests that a reduction in the rearfoot inversion moment is the most consistent kinetic effect of foot orthoses during running.

Conclusion

The findings of this review Demonstrate That May Systematic effects

inform the direction of future research

, as Further Evidence is required to define the Mechanism of action of foot orthoses

DURING running. Continuation of research in this field will enable targeting of design parameters

biomechanical variables Towards That Are Supported by Evidence, May

and lead to advancements in clinical efficacy.

The most widely reported were speed and force of impact,
However, the effect of foot orthoses on these variables is unclear. contrast,
Current evidence suggests that a reduction in the time of rearfoot inversion is more consistent kinetic effect of orthoses during the race.

" Application of Center-of-Pressure Data to Indicate Rearfoot Inversion-Eversion in Shod Running"

Although pressure plates

Are Used to help in the selection

of Appropriate footwear for runners, Evidence Relating Aspects of pressure data to move-ment is Lacking

. A study WAS Conducted to Investigate whether center-of-

pressure (COP) data for shod running Could Obtained be used to indicate

the amount of rearfoot eversion. It was hypothesized that subjects exhibit-

ing high rearfoot eversion during the initial ground contact phase of run-

ning would also show a large lateral-to-medial deviation in the COP.

Pressure plate and rearfoot movement data were collected for 33 sub-

jects. The COP was characterized using the lateral-to-medial deviation of

the COP during the eversion phase of ground contact. Correlation coeffi-

cients were determined for COP deviation versus rearfoot range of motion

and versus peak rearfoot eversion (P < .05). In addition, subjects were

grouped as high, moderate, or low pronators, and analysis of variance was

used to test whether there were significant differences in COP deviation

for these three groups (P < .05). The COP deviation was found to have a

low correlation with rearfoot range of motion (R = 0.46; P < .05) and with

peak rearfoot eversion (R = .54; P < .05) . High pronators had signifi-

cantly higher COP deviation than the medium- and low-pronation groups

(P < .05). These findings support the use of COP deviation to detect high

pronation. However, caution is advised in using the COP to indicate ab-

solute rearfoot eversion. (J Am Podiatr Med Assoc 96(4): 305-312, 2006)

The difference between low and middle-pronator with the CoP has a low correlation. Because

CoP is where you begin to assess whether the pressures are useful platforms. The kinetic

if, in the kinematics are not necessary.

"The Independent and Interactive Effects of Navicular Drop and Quadriceps Angle on Neuromuscular Responses to

a Weight-Bearing perturbation"

Context: Little is Known about the effects of static alignment on neuromuscular control DURING dynamic of the knee motion.

Objective: To Evaluate the Combined and isolated effects of quadriceps angle (QA) and navicular drop (ND) on neuromuscular responses to a weight-bearing perturbation.

Design: Mixed-model, repeated-measures design.

Setting: Sports medicine and athletic training research laboratory.

Patients or Other Participants: Seventy-nine National Collegiate Athletic Association Division I collegiate female athletes, classified with below-average ND and QA (LND-LQA); below-

average ND and above-average QA (LND-HQA); above-average ND and below-average QA (HND-LQA); or above-average ND and QA (HND-HQA).

Intervention(s): A lower extremity perturbation device pro duced a forward and either internal or external rotation of the trunk and femur on the weight-bearing tibia to evoke a reflex response.

Main Outcome Measure(s): Neuromuscular responses were examined in the quadriceps, hamstrings, and gastrocnemius mus cles: preperturbation amplitude 50 milliseconds before the pertur bation, reflex time, and postperturbation amplitude 150 millisec-

onds immediately postperturbation.

Results: Navicular drop had the greatest effect on preperturbation amplitude of the lateral hamstrings and postperturbation amplitude of all muscles, with greater activation amplitude noted in subjects in the HND classifications. Quadriceps angle primarily affected reflex time of the quadriceps; in sub jects with LQA, reflex time was faster for internal rotation than

external rotation perturbations. The interaction between ND and QA had the greatest effect on reflex time of the lateral ham strings. For internal rotation perturbations, subjects in the LND classifications had faster reflex times in the lateral hamstrings if they had HQA values rather than LQA values. With external rotation perturbations, HND-LQA subjects had slower reflex times than those in all other alignment classifications.

Conclusions: Navicular drop and QA have both independent and interactive effects on neuromuscular responses to a weight-bearing, rotational perturbation. These interactive effects highlight the importance of considering the entire lower extrem ity posture rather than a single alignment characteristic, given the potential for one alignment factor to compensate for or interact with another.

Interactive Effects of Navicular Drop and

Quadriceps Angle

We were somewhat surprised by the finding that subjects classified as HND-HQA responded to the ER and IR perturbations in a similar manner (in both timing and activation am-

plitude) to those with a more neutral alignment (LND-LQA).

This was contrary to our hypothesis, because our expectation was that the combination of HND and HQA would accentuate a valgus knee posture, thereby increasing tibiofemoral joint

loading and stress , particularly with an ER perturbation. However, our findings suggest that when both HND and HQA are present, these malalignments may have somewhat opposing

biomechanical effects on tibiofemoral motion and essentially may cancel each other out to some extent. This result was particularly apparent in the LH. The HND influenced LH ac-

tivation with an ER perturbation but only in subjects with LQA. Similarly, HQA influenced only LH activation with IR perturbations in subjects with LND.

Este es el estudio al que hacía referencia ayer. En el que un high navicular drop (associated with pronation subastralina) and increased Q angle, show no delay the neuromuscular system, if you produce LQA (low Q angle) and HND (Hight navicular drop) and vice versa.

Therefore, treating a pronation in a patient with an increased Q angle can produce a joint stress and / or musculotendinous.

I've run out of time, duty calls me that this is free. I hope I have created uncertainty and managed to open some minds for us all to go rowing in the pair.

Podiatrists most experts on the subject may criticize dependent as some studies are made, which are usually needed, notice and therefore if it is true, although there is already enough cases're published literature since 1990.

In my 2 years as a podiatrist am more than aware of my shortcomings and all the great way that I have to go, learn, make mistakes, perfect, but always with humility in order to keep up and know the truth.