Aims: To investigate the efficacy of transcranial direct current stimulation (tDCS) combined with conventional rehabilitation interventions in improving pain scores, lower limb isokinetic muscle strength, balance, and motor control in patients with ankle fractures, thereby providing a clinical basis for optimizing central-targeted rehabilitation protocols for these patients. Methods: A total of 48 patients who had undergone ankle fracture surgery were enrolled and randomly divided into an observation group and a control group using a numerical table method, with 24 cases in each group. The control group received standard rehabilitation therapy for 6 weeks, while the observation group received additional tDCS intervention (20 minutes, 2.0 mA, stimulating the contralateral primary motor cortex) in addition to standard rehabilitation. Prior to and after intervention, various parameters were assessed using the isokinetic muscle strength testing system, TecnoBody balance testing system, Tinetti scale, three-dimensional gait analyzer, and VAS pain scale, including hip muscle strength, static and dynamic balance function, gait parameters, and pain levels in both groups. Results: All patients successfully completed all interventions and assessments without any severe adverse events. The relative peak torque of hip abduction and extension was significantly increased in all enrolled patients compared to pre-intervention levels, with the observation group showing significantly better results than the control group (p <0.001). Post-intervention, the Tinetti balance gait score significantly improved, while the center of gravity swing path length, swing area, and swing velocity were significantly reduced (p <0.05). The range of motion of the affected hip joint and step length parameters showed significant improvement (p <0.05). The VAS pain score decreased significantly compared to pre-intervention levels and remained significantly lower than that of the control group (p <0.05). Conclusion: tDCS can effectively alleviate pain symptoms in patients after ankle fracture surgery, enhance lower limb muscle strength, improve proprioceptive integration function, and significantly improve static balance, dynamic posture control, and gait performance. It effectively addresses postoperative functional impairments following ankle fractures, reduces the risks of falls and secondary injuries, and serves as a novel, highly effective intervention for rehabilitation following ankle fracture surgery.
Background: This systematic review and meta-analysis aimed to compare clinical outcomes of arthroscopic versus open surgery for anterior talofibular ligament (ATFL) repair in patients with chronic ankle instability. The modified Broström-Gould (MBG) procedure is the most commonly practiced surgical method for chronic lateral ankle instability (CLAI). Arthroscopic MBG is an alternative to the traditional open repair. Methods: A comprehensive search of five databases (PubMed, ScienceDirect, LILACS, Cochrane, and ProQuest) from 1 January 2010 to 30 May 2025 identified 395 articles, with the last search conducted on 30 May 2025. Following the PRISMA guidelines, a systematic review and meta-analysis were performed, including 13 comparative studies (800 patients) comprising randomized controlled trials, cohort studies, and observational designs. The analyzed outcomes included pain (Visual Analogue Scale, VAS), functional recovery (American Orthopaedic Foot and Ankle Society score, AOFAS), and surgical duration. Results: Both arthroscopic and open modified Broström-Gould (MBG) techniques significantly improved pain and function. The arthroscopic approach demonstrated shorter operative times (mean difference -12.4 minutes; p = 0.02; range 25–74 minutes vs. 43 minutes for open surgery) and better short-term recovery at 6-month follow-up, while long-term outcomes were comparable between groups. Meta-analysis of 557 patients (VAS) and 697 patients (AOFAS) revealed no significant intergroup differences [VAS effect size −0.39 (95% CI: −1.15 to 0.37; I2 = 92%); AOFAS effect size 1.65 (95% CI: −0.82 to 4.11; I2 = 87%)]. A few transient neuropathies were reported, occurring slightly more often in arthroscopic cases, but overall complication rates were low and minor. Conclusion: Arthroscopic MBG achieves pain and functional outcomes comparable to open MBG, with shorter operative time and faster early recovery, without an increase in complications. Larger studies are needed to validate these findings.
Objectives: The objective of this study was to describe the morphological changes on ultrasound scan of healing Achilles tendons that have sustained a full thickness rupture. Design: This is a case cohort study of patients referred for the conservative management of Achilles tendon ruptures. Methods: This is an observational study of 100 patients presenting with Achilles tendon ruptures who attended a consultant podiatry clinic. All patients diagnosed with an Achilles tendon rupture were conservatively managed and placed in an air shell walker boot with the patient fully weightbearing with wedges in-situ to maintain the foot in an equinus position in order to reduce the ruptured tendon gap. The wedges were removed incrementally from week 6, and the boot removed at week 10. At the initial appointment and each follow up a series of ultrasound measures were captured at the musculotendinous junction of the soleus (MTJ), gap (rupture) location (GL), corresponding gap location (CGL) of contralateral tendon and the osseo-tendinous junction at the calcaneus (OTJ). A patient reported outcome measure (ATRS) was also collected at each contact. Results: All ruptured Achilles tendons became fully united. ANOVA results of the ruptured Achilles tendon data conclude that there were statistically significant (p <0.05) differences among the means of the three anatomical locations (MTJ, GL, OTJ) for the three time points (weeks 6, 10, and 20). This suggests that the AP measure changes significantly over time across the three time points. There was no statistically significant (p <0.05) difference between measurements for each asymptomatic anatomical location over the same time period. The ruptured location of the Achilles tendon had a mean of 58.6 mm with a minimum of 14.1 mm and a maximum of 73.3 mm from the osseo-tendinous junction. 85 /100 patients ruptured between 30 mm and 60 mm proximally to the osseo-tendinous junction. The ruptured tendon gap reduced with the foot placed in 10 degrees of plantarflexed position during ultrasound. For 80 patients the gap was between 0 and 1.6 mm. Two patients presented with a gap between 8 and 9.6 mm with the foot plantarflexed. From baseline (0 weeks) to 20 weeks these data suggest a significant improvement in the ATRS scores from an average score of 3.25 at 0/52 weeks to 83.25 at 20 weeks. A Pearson’s correlation coefficient of final 20 week ATRS score suggested that age does not appear to be correlated with outcomes for ATRS (p <0.05). Conclusions: All ruptured Achilles tendons became fully united and significantly thickened by the six week time point on the pathway. By the end of the pathway significant AP thickness was observed in most cases, with significant improvements in ATRS scores. AP measure thickness at each time point was a determinant of higher ATRS scores. No significant differences in AP thicknesses were observed in the OTJ and MTJ measures of the symptomatic or tendons.
Background: Dietary supplements such as capsaicin have gained increasing attention for their potential to enhance sports performance. Brazilian Jiu-Jitsu (BJJ), a grappling-based martial art, demands high levels of muscular strength and endurance. Capsaicin (CAP), a bioactive compound found in chili peppers, has demonstrated ergogenic effects. However, its acute impact on strength and endurance in BJJ athletes remains unclear. This study aimed to evaluate the acute effects of CAP supplementation on upper-limb strength, endurance performance, and rating of perceived exertion (RPE) in BJJ athletes. Materials and methods: Eighteen athletes participated in a randomized, crossover, triple-blind clinical trial. In two separate sessions, participants ingested either 12 mg of CAP or a placebo 45 minutes before performing physical tests, including handgrip strength (HS), isometric pull-up (IP), and dynamic pull-up (DP), all conducted while wearing a gi. RPE was recorded after each test. Normally distributed variables (IP and DP) were analyzed using the paired t-test, while non-normally distributed variables (RPE and HS) were analyzed using the Wilcoxon test. A significance level of p <0.05 was adopted. Results: CAP supplementation significantly increased isometric pull-up duration (delta = +2.83 s; p = 0.040; d = 0.52). No statistical differences were found for HS, DP, or RPE; however, RPE showed a moderate effect size (r = 0.37). No significant differences in adverse events were observed between conditions. Conclusion: Acute supplementation with 12 mg of capsaicin improved isometric upper-limb endurance in BJJ athletes, as evidenced by increased isometric pull-up duration.
Introduction: Back pain is the most prominent comorbidity and a major barrier to daily functioning in patients with multiple sclerosis. Exercise programs can help reduce key disease-related symptoms like fatigue and motor impairments, promoting greater functional independence and better quality of life. Objective: To determine the impact of Pilates training versus eccentric training in patients with multiple sclerosis suffering from chronic non-specific low back pain on: pain, static, dynamic sitting balance and trunk coordination, and isometric strength of trunk flexors and extensors. Method: This randomized clinical trial involved 36 adults with multiple sclerosis, chronic non-specific low back pain, and expanded disability status scale between 2-4.5. Participants were assigned to Pilates-based core stability training or eccentric trunk training, performed for six weeks, three times a week. The study assessed trunk flexor and extensor isometric strength, pain, seated balance, and trunk coordination. Results: Both groups significantly improved in pain and trunk performance. No major differences were identified between groups for pain reduction and trunk control. The Pilates group showed greater improvements in isometric trunk flexor strength with hips extended (p = 0.03) and isometric trunk extensor strength with hips flexed 30° (p = 0.021) compared to the eccentric group. No significant differences were found between groups for trunk flexor strength with hips flexed 30° (p = 0.086) or trunk extensor strength with hip extension (p = 0.08). Conclusion: Pilates-based stability training led to greater improvements in trunk flexor and extensor strength compared to eccentric training in some testing positions; both therapies were successful in relieving pain and improving trunk performance.
