Objective:The objective of this review will be to synthesize the evidence on the effectiveness of manual techniques, exercise therapy, or combined treatments in the management of ankle sprains and chronic ankle instability in adult athletes.Introduction:Acute ankle sprains and chronic ankle instability are common in athletes. These conditions can result in varying degrees of disability, including reduced athletic performance and time out of competition, which may have adverse psychological effects.Eligibility criteria:The review will consider randomized controlled trials evaluating the effectiveness of manual techniques and/or exercise therapy for ankle sprain or chronic ankle instability in adult athletes. The comparators will include sham treatment, no treatment, and other conservative interventions. The outcomes of interest will be pain intensity, functional disability, ankle joint range of motion, ankle muscle strength, postural control, and subjective stability.Methods:The review will follow the JBI methodology for systematic reviews of effectiveness. Searches will be conducted to locate published and unpublished studies in the following sources: MEDLINE (Ovid), CENTRAL (Ovid), Embase, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Google Scholar, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). Two independent reviewers will select the studies, critically appraise them, and extract data. Then, a narrative synthesis and, if appropriate, a meta-analysis will be performed. The certainty of findings will be determined using the GRADE approach.Review registration:PROSPERO CRD42023493687

Background Specific foot exercises and the use of minimalist shoes during running or daily life were suggested to strengthen the intrinsic foot muscles and to modify locomotion biomechanics. We aimed to review the effectiveness of these interventions to modify foot muscle sizes, foot strength, and biomechanical outcomes. Method PubMed, Embase, Cochrane Library and SportDiscus databases were searched (last update: 12 March 2024). Randomized controlled trials with intervention duration of four weeks or more were included. A random-effect meta-analysis was performed when at least two studies were available for an outcome. Standardized mean differences and corresponding 95 % confidence intervals were reported. The certainty of the evidence was assessed by considering risk of bias, imprecision, inconsistency, and indirectness. The evidence not summarized in the meta-analysis was synthetised. Findings Twenty-eight trials (1399 participants) were included in the systematic review and seventeen meta-analyses were performed. From meta-analyses, minimalist shoes lead to greater strength of toes 2 to 5 (confidence interval = 0.02 to 0.76), and foot exercises resulted in lower medial longitudinal arch motion during running (confidence interval = 0.08 to 0.82). The certainty of the evidence was low to very low, mainly due to the limited number of available studies and high risk of bias. The systematic synthesis supported exercises and minimalist shoes to increase foot strength, but was conflicting for muscle sizes. The interventions occasionally modified walking and running biomechanical variables.. Interpretation Foot exercises and minimalist shoes may be appropriate to increase foot strength and to induce biomechanical changes during dynamic tasks.

BACKGROUND: There is a sex-related difference in strength and endurance in trunk muscles: males have more strength while females have more endurance. OBJECTIVE: Investigate sex-related differences in motor control strategies in back muscles during isometric contractions (IC) in the Sorensen test posture. METHODS: Thirty-six healthy and young volunteers performed different tasks: three maximal voluntary contraction (MVC) tests recorded with a bio-feedback force sensor, and followed by five loaded IC (LIC) tests using bodyweight and loads of 0 to 8 kg with a 2-kg step. Surface electromyography was used to measure the activity of bilateral lumbar paravertebral (LP) and quadratus lumborum (QL) muscles. RESULTS: Sex-related and load-related differences in EMG amplitudes were highlighted during LIC tests. Females showed significantly (p-value = 0.02) greater EMG amplitude for the highest load (8 kg) than males. Besides, significant differences between low (2 and 4 kg) and high (6 and 8 kg) loads for both LP and QL muscles and for both sexes were observed. Finally, for MVC tests, males produced significantly (p-value = 1.02e-4) greater strength during MVC tests (4.25 +/- 1.37 N/kg vs 2.60 +/- 0.78 N/kg). CONCLUSION: The results were clinically relevant to bring attention to load strategy during rehabilitation, particularly in females who seemed to recruit the QL muscle more.

Las lesiones del complejo tobillo-pie son los trastornos musculoesqueléticos más frecuentes en los servicios de urgencias, pero también en el ámbito deportivo y en la práctica clínica. Alrededor del 25% de las mujeres y los varones padecen estos trastornos musculoesqueléticos, con una amplia variedad de afecciones que incluyen, por ejemplo, esguinces, fracturas, osteoartritis y tendinopatías. Pueden afectar a las actividades de la vida diaria, causando diversos grados de discapacidad, que suele ser temporal pero que puede tener una repercusión socioeconómica significativa. Por lo tanto, una evaluación clínica completa es esencial para evaluar la situación con precisión y luego orientar las mejores decisiones terapéuticas. Sin embargo, esto se basa en un enfoque complejo conocido como «razonamiento clínico». Por ello, el presente artículo ha sido redactado por un grupo de expertos en este campo de la kinesiterapia musculoesquelética, con el fin de identificar los diversos componentes que se tienen en cuenta durante la evaluación de este complejo articular. Por consiguiente, sobre la base del modelo de la Clasificación Internacional del Funcionamiento y la Discapacidad, se han incluido los elementos clínicos y científicos más relevantes. Se trata de proporcionar una evaluación completa y didáctica de cada componente de este modelo para la exploración física de los trastornos musculoesqueléticos más comunes del tobillo y el retropié. En conclusión, la evaluación musculoesquelética de esta región es multifactorial y compleja, y también está relacionada con la situación del mediopié y del antepié, que no se tratará aquí. No obstante, el uso de pruebas o la agrupación de pruebas con los mejores valores clinimétricos mejora la precisión del diagnóstico. Sin embargo, todavía se necesitan más estudios para establecer clústeres de pruebas para los numerosos trastornos musculoesqueléticos del tobillo y el pie. Además, es evidente que debe fomentarse la cooperación multidisciplinar entre médicos, kinesiterapeutas y podólogos para esta región del cuerpo.

Bien que la littérature décrive plusieurs vignettes cliniques (associées à des questions) destinées à évaluer les attitudes/comportements des professionnels de la santé face à un patient souffrant de lombalgie, ces vignettes sont généralement incomplètes et n’abordent que peu, voire pas, les facteurs psychosociaux. De plus, celles-ci n’examinent pas l’adéquation entre la prise en charge préconisée et les recommandations récentes de la HAS [1] et l’itinéraire de soins proposés par le KCE [2]. Dès lors, les objectifs de cette étude étaient : 1) de développer 3 vignettes originales (patient fictif souffrant d’une lombalgie non spécifique aiguë, subaiguë/récurrente ou chronique) et un questionnaire (pouvant être utilisé avec chaque vignette) répondant aux limites des outils existants afin d’apprécier les attitudes de (futurs) professionnels de la santé ; 2) de mesurer les qualités psychométriques de base (effet plancher/plafond, validité et reproductibilité) de ce nouvel outil. Une fois les 3 vignettes et le questionnaire (18 affirmations combinées à une échelle de degré d’accord de Likert) développés, deux groupes expérimentaux (un groupe d’experts et un groupe expérimental composé de professionnels de la santé diplômés et d’étudiants de dernière année (en kinésithérapie ou en médecine) ont été invités à compléter un questionnaire en ligne. Ils devaient, après avoir pris connaissance de chacune des 3 nouvelles vignettes cliniques, répondre au questionnaire (permettant l’obtention d’un score pour chaque vignette et d’un score global). Ils étaient également soumis à une vignette (et les questions qui y sont associées) fréquemment utilisée dans la littérature (Rainville et al., 2000). La validité de ce nouvel outil d’évaluation a été examinée, d’une part, en comparant les scores des groupes « experts » et « expérimental » et, d’autre part, en comparant les résultats obtenus à la vignette de Rainville et al. à ceux obtenus pour ces nouvelles vignettes. La reproductibilité test-retest a été évaluée en resoumettant le groupe expérimental au nouvel outil une à deux semaines plus tard. Après l’analyse des réponses des 8 « experts » recrutés, une des questions (sur la médication) a été retirée en raison de désaccords entre les réponses des experts. Cent onze participants ont été recrutés dans le groupe « expérimental ». L’analyse des scores aux questionnaires liés aux vignettes suggère : 1) l’absence d’effet plancher et plafond ; 2) une validité (scores significativement différents entre les 2 groupes et concordants avec les résultats à la vignette de Rainville et al.) ; une bonne reproductibilité (coefficient de corrélation intraclasse supérieure à 0,9 pour le score global et compris entre 0,83 et 0,91 pour chaque vignette). Ce nouvel outil autorisera l’identification des recommandations les moins suivies, la comparaison de différentes disciplines médicales et l’évaluation des effets de formations destinées à présenter les recommandations de bonne pratique. Cette étude a permis de développer 3 nouvelles vignettes permettant d’examiner de façon valide et reproductible si les croyances et attitudes des professionnels de la santé relatives à la prise en charge de la lombalgie sont en adéquation avec les dernières guidelines. La poursuite du développement de ce nouvel outil est nécessaire en examinant notamment ses autres qualités métrologiques telles que sa sensibilité au changement.

Le lesioni della regione caviglia-piede sono i disturbi muscoloscheletrici più frequenti in Pronto Soccorso, ma anche sui campi sportivi o nella pratica clinica. Circa il 25% delle donne e degli uomini soffre di questi disturbi muscoloscheletrici, con un’ampia varietà di patologie, tra cui, per esempio, distorsioni, fratture, artrosi e tendinopatie. Queste possono avere ripercussioni sulle attività della vita quotidiana, determinando una disabilità più o meno significativa, che è certo generalmente temporanea ma che può avere un impatto socioeconomico significativo. Pertanto, è indispensabile un bilancio clinico completo che consenta innanzitutto di valutare con precisione la situazione per poi orientare al meglio le decisioni terapeutiche. Tuttavia, esso si basa su un approccio complesso denominato “ragionamento clinico”. Ecco perché questo articolo è stato scritto da un gruppo di esperti in questo campo della fisioterapia muscoloscheletrica, al fine di identificare le diverse componenti che entrano in gioco nella valutazione di questa regione. Di conseguenza, sulla base del modello della Classificazione Internazionale del Funzionamento e della Disabilità, sono stati inseriti i vari elementi clinici e scientifici più pertinenti. Questo al fine di offrire una valutazione completa e didattica di ogni componente di questo modello per l’esame clinico specifico per i più comuni disturbi muscoloscheletrici della caviglia e del retropiede. In conclusione, la valutazione muscoloscheletrica di questa regione è multifattoriale e complessa ed è anche correlata alla situazione del meso- e dell’avampiede, che non è stata affrontata. Tuttavia, l’uso di test o il raggruppamento di test con i migliori valori clinimetrici migliorano l’accuratezza della diagnosi. Comunque, devono ancora essere condotti ulteriori studi al fine di stabilire gruppi di test per tutti i numerosi disturbi muscoloscheletrici della caviglia e del piede. Inoltre, per questa regione corporea deve chiaramente essere incoraggiata una collaborazione multidisciplinare tra medici, fisioterapisti e podologi.

BACKGROUND: Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. OBJECTIVE: This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. METHODS: This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. RESULTS: Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [ 0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD = 0.07 [ 0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD = 1.78 [ 2.49, 1.07]; 95%CI) and lessened disability (SMD = 1.80 [ 3.03, 0.56]; 95%CI) at short-term. CONCLUSION: Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

Objective: In a pragmatic and randomized clinical trial, patients with lateral ankle sprains were assessed, under blinded conditions, for their responsiveness and improvements during Mulligan mobilization-with-movement (MWM) therapy. Methods: Overall, 51 participants with subacute lateral ankle sprains (Grade I-II) were recruited. Following an MWM screening procedure, responders were randomized to either an intervention group (MWM) or a sham group. The MWM group received inferior tibiofibular, talocrural, or cubometatarsal MWM. The treatment or sham was administered upon three sessions, each 4 days apart. Changes from baseline were measured and compared between the sessions for dorsiflexion range of motion, pain, stiffness perception, and the Y-balance test. Results: In total, 43 participants were considered responders to MWM. Using a two-way repeated-measure ANOVA, a statistical and clinically meaningful improvement in dorsiflexion range of motion was revealed in the MWM group (p = 0.004, 1rst = +1.762 cm; 3rd = +2.714 cm), whereas no improvement following the first session occurred in the sham group (p = 0.454, 1rsttrial = +1.091 cm; 3rdtrial = +1.409 cm). Pain and stiffness significantly improved, yet below the clinically meaningful level. The MWM group demonstrated a significant improvement after three sessions for the Y-balance test (p = 0.001, +8.857 cm). Conclusion: More than 80% of participants with subacute lateral ankle sprains responded well to the MWM approach. Three sessions of pragmatically determined MWM provided a significant and clinically meaningful benefit in dorsiflexion range of motion and Y-balance test performance compared to a sham treatment.

Objective: This study compared the modification of musculoarticular stiffness (MAS) and clinical outcomes after mobilization with movement (MWM) on the inferior tibiofibular joint and a placebo MWM. Moreover, injured and non-injured ankle MAS were compared after MWM therapy. Methods: A single-blinded randomized trial was conducted on 75 participants (mean age: 22.3 +/- 2.17 years) with chronic self-reported asymmetric perception of ankle dorsiflexion stiffness. Participants were allocated to one of three groups: inferior tibiofibular MWM (ITFMWM), placebo and non-injured. Sinusoidal oscillation methods were used for experimental quantification of the MAS and clinical outcomes were assessed using the weight-bearing lunge test (WBLT), pain and stiffness perception. Three assessments were made: one pre-treatment (T0), one after the manual technique (T1) and one after taping (T2). Results: Two-way ANOVA showed no significant differences between the groups and no interaction effect for the outcome measures. However, a significant difference for the time effect (T0-T1-T2) was found in the three groups for WBLT dorsiflexion range of motion (p < 0.001, Cohen's d = 0.21) and stiffness perception (p < 0.001, Cohen's d = 0.54) but the minimal clinically important differences were not reached for either value. Discussion: The results could not support that a single session of ITFMWM modifies MAS or the clinical outcomes compared to placebo treatment. Furthermore, injured MAS does not differ from non-injured MAS in chronic ankle dorsiflexion stiffness. Further studies should assess subjects' responsiveness concerning the Mulligan concept and focus on a medium- to long-term follow-up.

Orthopaedic manual therapy (OMT) and osteopathy have been coexisting since a long time in Belgium to manage musculoskeletal disorders (MSDs). There are millions of consultations per year in these both disciplines. Both of them offer good clinical outcomes as well as patient satisfaction with care, good cost-effectiveness, as well as minor side effects. Nevertheless, a major misunderstanding remains in Belgium concerning these both professions. A narrative review by Belgian experts in osteopathy and/or in OMT has been undertake. In Belgium, both professions present several major differences concerning the primary first care access, the recognition as health care profession, tailored reimbursement systems, types and organization of education, the use of rehabilitation and motor control, the integration of evidence based practice concept, the reasons/indications of consultation, the degree of confidence within the therapeutic touch concept. In the meantime, several similarities also exist including the integration of the bio-psycho-social model, the evaluation of the neuromusculoskeletal system and the treatment of MSDs using sometimes identical manual techniques, as well as the use of therapeutic education of the patient and specific clinical reasoning. This analysis may help health professionals, students and patients to better understand the convergences and divergences between these both disciplines of musculoskeletal care in Belgium.

OBJECTIVEAnkle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity.DESIGNA randomized clinical trial with two arms.METHODSPatients were recruited by word of mouth and via social network as well as posters, and analyzed in the neuro musculoskeletal laboratory of the "Université Catholique de Louvain-la-Neuve", Brussels, Belgium.PARTICIPANTS67 men (aged 18-40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM.INTERVENTIONSTwo modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients.MAIN OUTCOME MEASURESComprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann's device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well.RESULTSA two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p= 0.37), viscous-stiffness (p= 0.83), total-stiffness (p= 0.58). For WBADF-ROM: toe-wall distance (p= 0.58) and angular ROM (p= 0.68). Small effect sizes between groups were determined with Cohen's d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d= 0.003-0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the effect of each intervention on the sample categorized according to injury history status, and demonstrated a significant interaction between groups and time only for viscous stiffness (p= 0.04, d=-0.55).CONCLUSIONA single session of MWM and OM targeting the talocrural joint failed to immediately improve all measures in.

BACKGROUND: Altered lower limb movement patterns (LLMP) during the forward step down (FSD) test have been studied in people suffering from knee instability. However, ankle dorsiflexion range of motion (ADROM) seems to be related to LLMP but no causal inference has been defined between those variables. OBJECTIVE: Our goals were to evaluate (1) psychometric quality of the FSD test in healthy people and (2) the influence of experimental restricted ADROM on LLMP. METHODS: Kinematics were measured by a motion capture system. Angular displacement and speed were calculated as well as center of mass (COM) and knee linear displacement. Forty-two healthy participants; firstly, performed the test three times to assess reliability, and secondly the same test in an experimental condition limiting the ADROM. RESULTS: Reliability was excellent for all parameters (ICC: 0.75-0.99, SEM%: 2.0-34.0%). ADROM limitation significantly decreased Knee flexion range of motion (ROM) (-3.8 degrees), increased Hip flexion ROM (6 degrees), Hip adduction ROM (6.1 degrees), Pelvis drop ROM (3.5 degrees), Pelvic rotation ROM (3.1 degrees). No significant effect was found for Hip rotation ROM. CONCLUSIONS: LLMP was affected by this experimental ADROM limitation in healthy people. As this limitation is often encountered in post-traumatic ankle sprain patients, clinicians should consider this point during FSD assessment test.

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.