Research Support Posture Dynamic insoles:
• Improvement of gait in paraplegic patients using proprioceptive insoles
Abstract
In paraplegic patients, we noted an improvement in gait wearing shoes with proprioceptive insoles: stance phases and double stance phases are longer, single stance phases are shorter, heel contact and delay are better.
Hafkemeyer U, Poppenborg D, Drerup B, Moller M, Wetz HH 2003. Improvement of gait in paraplegic patients using proprioceptive insoles. Efort, Universitatsklinikum Munster, Klinik Fur Technische Orthopadie, Helsinke, Finland
• Abstract
In a random study of 208 chronic low back pain sufferers, 202 were diagnosed with forefoot varum deficits greater than 16mm. All 208 participants were fitted with postural control orthotics. Subjective profiles were taken one year post-therapy: Ninety-six percent (202/208) reported on ongoing attenuation in low back pain as long as the orthoses were worn.
The case studies show (1) a direct positive correlation between low back pain and forefoot varum, and (2) that postural control orthotics are effective in resolving chronic low back pain syndrome. :pigs: The case mean study presented suggests that the use of postural control orthoses (postural control insoles) improve foundational stability and abridge the associated musculoskeletal symptoms.:pigs:
Rhubarb BA, Hansen K, Liley P, Yerratt MK 1995. Resolving Chronic Low Back Pain: The foot connection, American Journal Pain Management;5(3):84-90
• Abstract
Chronic knee pain in excessive pronators is a mechanical phenomenon. However, when it is treated in a nonmechanical way, the results can be baffling and frustrating to both patient and practitioner. The theoretical construct of Bio-Implosion is the basis of an innovative, mechanical treatment model presented in this paper, the efficacy of which has only recently been clinically observed.
The authors present a new approach to the use of orthoses - serial posting. Treatment is based on bioengineering principles. With judicious posting, reactive ground forces through the foot are methodically and serially altered to reduce subtalar joint surface incongruity. In a closed kinetic chain, wedging the forefoot and, indirectly, the subtalar joint towards neutral, retroactively fosters joint surface congruity along the entire weight-bearing axis, much as stabilizing the foundation of a building stabilizes the entire superstructure. By maximizing joint surface fit, articular compressive forces are dissipated over a larger surface area.
Clinical evidence from the 1989-1992 knee study of 128 patients suggests that is this mechanism that allows articular caps to regenerate resulting in reduced arthritic symptoms. Orthoses used in this manner are termed Postural Control Orthotics (or insoles).
Rhubarb BA, Yerratt MK 1994. An Innovative Mechanical Approach to Treating Chronic Knee Pain: A Bio-Implosion Model, American Journal Pain Management;4:123-128
Abstract
Introduction Guidelines recommend sticks and othopedical insoles in the treatment of gonarthrosis. We analyzed the influence of proprioceptive insoles according to RJ Bourdiol.
Materials and methods We evaluated pain level, knee stiffness and the physical function in 12 patients (71± 6 yrs, 3 males) affected by gonarthrosis (10 varus, 2 valgus). After compilation of a self-administrated WOMAC questionnaire the patients were randomly allocated either in group A (proprioceptive insoles with specific thickness <3 mm ) or in group B (placebo insoles), and reconsidered after 4 weeks. Results were compared with Student T- test and the minimal clinically important difference (MCID) was calculated
Results Pain score increased in group A from 5,25 to 2,25 (p= 0.001) and in group B from 3,41 to 3,58 (p= ns). Knee stiffness modified in group A from 5,75 to 3,12 (p= 0.03) and in group B from 5 to 6,37 (p= 0.02). Physical function in group A decreased from 5,36 to 2,81 (p= 0.007) but increased non significantly in group B from 3,55 to 3,92. The global index was reduced from 5,38 to 2,72 (p= 0.004) in group A and changed in group B from 3,64 to 4,06 (p= ns). Group A at difference with group B show a significant MCID. Effect size > 0.8 demonstrate a strong therapeutic effect.
Conclusions We show for the first time that the use of proprioceptive insoles in gonarthrosis significantly reduce pain, ameliorates knee stiffness and physical function.
J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):596-600. Links
A new symmetry-based scoring method for posture assessment: evaluation of the effect of insoles with mineral derivatives.
• Masse M,
• Gaillardetz C,
• Cron C,
• Abribat T.
Desormeaux Chiropractic Clinic, Montreal, Quebec, Canada.
BACKGROUND: There is a need for a validated rapid procedure for the evaluation of posture, defined as lateral balance/imbalance at the pelvic, shoulder, and neck levels. This would enable clinicians to determine the importance of symmetry in the pathophysiology of musculoskeletal disorders and to assess the efficacy of devices and treatments claiming to normalize or improve posture. In this investigation, the efficacy of such a device, a set of insoles with a hypothesized proprioceptive-like action, was evaluated through use of the described procedure. OBJECTIVES: To develop a new scoring system to evaluate body posture on the basis of symmetry and to use this scoring system to investigate the efficacy of insoles containing a combination of mineral derivatives designed to balance posture through a neurophysiological effect. METHODS: The posture score was based on the evaluation of 4 postural parameters: pelvic and shoulder lateral balance/imbalance, static shoulder rotation, and amplitude of head rotation. In the placebo-controlled study, 32 patients were tested in a double-blind fashion, either with placebo insoles or with insoles containing mineral derivatives. The same study was repeated in unblind conditions in 137 patients selected from 2 chiropractic clinics in an open-label protocol. STUDY DESIGNS: A crossover placebo-controlled, double-blind study and a multicenter, large-scale, open-label study in patients selected from chiropractic clinics. RESULTS: A basal postural evaluation in 137 patients revealed that no patient had a perfect symmetry-ie, a perfectly or nearly perfectly balanced posture. The insoles with mineral derivatives induced a highly significant and similar improvement in the postural score in both the crossover double-blind study (32 patients; 56.7% improvement) and the open-label study (137 patients; 60.7% improvement, P < 0.001). CONCLUSIONS: All patients tested and selected in chiropractic clinics exhibited asymmetries and postural imbalances according to the newly developed scoring method, and this method was successful in assessing the efficacy of insoles exerting a profound and immediate postural effect through a hypothesized neurophysiological mode of action.
PMID: 11145799 [PubMed - indexed for MEDLINE]
Percept Mot Skills. 2001 Apr;92(2):469-76. Links
Effect of magnetic insoles on postural sway measures in men and women during a static balance test.
• Suomi R,
• Koceja DM.
School of Health, Exercise Science and Athletics, University of Wisconsin-Stevens Point 54481, USA.
rsuomi@uwsp.edu
Numerous anecdotal reports have suggested a growing public enthusiasm for magnetic devices for treatment of pain and various motor and sensory dysfunctions. Although the principles behind magnetic therapy are well documented, a complete technical explanation of whether static magnet application is effective is lacking due to a paucity of scientific research. In this study the effectiveness of magnetic insoles on postural sway measures during a single application were investigated. Twenty-eight adults (14 old, 14 young) were assessed on postural sway measures while performing a static two-legged stance test on a Kistler force platform under two treatment conditions (magnetic insoles, nonmagnetic insoles). Significant reductions in total sway area and lateral sway scores were obtained by the older adults while standing on the magnetic insoles. These preliminary results indicate that treatment of postural instability using magnetic insoles may be a viable alternative for older adults.:pigs:
PMID: 11361310 [PubMed - indexed for MEDLINE]
Degenerative changes in the lumbar spine linked to lateral heel strike
Krzaczek, J. McNelis, G. Eisenhardt, J.
Dept. of Phys. Therapy, Philadelphia Coll. of Pharmacy & Sci., PA
This paper appears in: Bioengineering Conference, 1988., Proceedings of the 1988 Fourteenth Annual Northeast
Publication Date: 10-11 Mar 1988
On page(s): 33-35
Meeting Date: 03/10/1988 - 03/11/1988
Location: Durham, NH, USA
References Cited: 10
INSPEC Accession Number: 3351152
Digital Object Identifier: 10.1109/NEBC.1988.19336
Posted online: 2002-08-06 15:59:22.0
Abstract
This study was designed to assess the correlation between degenerate joint disease (DJD) of the lumbar spine and early peak vertical forces attenuated through the lateral calcaneus during the gait cycle. Data was collected from 18 subjects, ranging in age from 22 to 60 years, who had been radiographically diagnosed with DJD of the lumbar spine. Measurement of vertical force over time was obtained using the electrodynograph system with standardized procedure. Results demonstrate that in patients with lumbar DJD the L-sensor, positioned on the lateral condyle of the plantar surface of the calcaneus, shows peak pressures at an early percentage of stance. These results indicate improper attenuation of initial forces through the axial skeleton during the gait cycle, potentially producing chronic overloading responsible for DJD of the lumbar spine. These findings imply that clinicians should consider the effects of high impact forces on an inverted calcaneus when evaluating and treating chronic low-back-pain patients
Forward Head Position is Linked to Temporal Mandibular Joint Disease
Abstract
Although it is commonly accepted that there is an interrelationship between the temporomandibular joint (TMJ) and head posture, few, if any, previous studies have quantified this effect. The purpose of this study is to quantify the effect of a change in the condyle fossa relationship of symptomatic temporomandibular joints on head posture. Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology were reviewed. The condyle fossa relationships were measured pre- and posttreatment using sagittal corrected hypocycloidal tomography. The amount of slant between the shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment photographs as an indicator of forward head posture; less slant indicates better posture. Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average of 5 months. Comparisons with pre-treatment measures showed that after treatment, the amount of retrodiskal space was significantly increased by an average of 1.67 mm on the left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons also showed that after treatment, the amount of slant between the shoulder and EAM decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001). Improvement in the condyle fossa relationship was related to decreased forward head posture. This suggests that optimizing mandibular condyle position should be considered in the management of forward head posture (adaptive posture).
Olmos SR, Kritz-Silverstein D, Halligan W 2005. The effect of condyle fossa relationships on head position. Cranio, Jan;23(1):48-52.
Asymmetrical Hip Rotation Linked to Sacroiliac Joint Dysfunction
Abstract
STUDY DESIGN: A cross-sectional study was used to determine whether limited range of motion in the hip was present in 100 patients--one group with unspecified low back pain and another group with signs suggesting sacroiliac joint dysfunction. OBJECTIVES: To determine whether a characteristic pattern of range of motion in the hip is related to low back pain in patients and to determine whether such a pattern is associated with and without signs of sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is often considered a potential site of low back pain. Problems with the sacroiliac joint, as well as with the low back, have often been related to reduced or asymmetric range of motion in the hip. The correlation between sacroiliac joint dysfunction and hip range of motion, however, has not been thoroughly evaluated with reliable tests in a population of patients with low back pain. METHODS: Passive hip internal and external rotation goniometric measurements were taken by a blinded examiner, while a separate examiner evaluated the patient for signs of sacroiliac joint dysfunction. Patients with sacroiliac joint dysfunction were further classified as having a left or a right posteriorly tilted innominate. RESULTS: The patients with low back pain but without evidence of sacroiliac joint dysfunction had significantly greater external hip rotation than internal rotation bilaterally, whereas those with evidence of sacroiliac joint dysfunction had significantly more external hip rotation than internal rotation unilaterally, specifically on the side of the posterior innominate. CONCLUSIONS: Clinicians should consider evaluating for unilateral asymmetry in range of motion in the hip in patients with low back pain. The presence of such asymmetry in patients with low back pain may help identify those with sacroiliac joint dysfunction.
Cibulka MT, Sinacore DR, Cromer GS, Delitto A 1998. Unilateral hip rotation range of motion asummetry in patients with sacroiliac joint regional pain. Spine; May 1:23(9):1009-15.
Postural Abnormalities are Linked to Patients with Craniomandibular Disorders
Abstract
The purpose of this research was to show that a relationship between craniomandibular disorders (CMD) and postural abnormalities has been repeatedly postulated, but still remains unproven. This study was intended to test this hypothesis. Twenty-five CMD patients (mean age 28.2 years) were compared with 25 gender and age matched controls (mean age 28.3 years) in a controlled, investigator-blinded trial. Twelve postural and ten muscle function parameters were examined. Measurements were separated into three subgroups, consisting of those variables associated with the cervical region, the trunk in the frontal plane, and the trunk in the sagittal plane. Within these subgroups, there was significantly more dysfunction in the patients, compared to control subjects (Mann-Whitney U test p < 0.001, p < 0.05, p < 0.01). Postural and muscle function abnormalities appeared to be more common in the CMD group. Since there is evidence of the mutual influence of posture and the craniomandibular system, control of body posture in CMD patients is recommended, especially if they do not respond to splint therapy. Whether poor posture is the reason or the result of CMD cannot be distinguished by the data presented here.
Nicolakis P, Piehslinger E, Ebenbichler G, Vachuda M, Kirtley C, Fialka-Moser V 2000. Relationship between craniomandibular disorders and poor posture. Cranio; April;18(2):106-112.
Malocclusions are linked to abnormalities within the craniocervical and sacropelvic regions
Abstract
The hypothesis of a functional coupling between the muscles of the craniomandibular system and the muscles of other body areas is still controversial. The purpose of this pilot study was to examine whether there is a relationship between the craniomandibular system, the craniocervical system and the sacropelvic region. To test this hypothesis, the prevalence and localization of dysfunction of the cervical spine and the sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students underwent an artificial occlusal interference, which caused an occlusal interference. The upper cervical spine (CO-C3) and the sacroiliac joint were examined before, during and after this experimental test. The primary outcome with these experimental conditions was the occurrence of hypomobile functional abnormalities. In the presence of occlusal interference, functional abnormalities were detected in both regions examined and these changes were statistically significant. The clinical implications of these findings may be that a complementary examination of these areas in CMD patients could be useful.
Fink M, WAhling K, Stiesch-Scholz M, Tschernitschek H 2003. The functional relationship between the craniomandiular system, cervical spine, and the sacroiliac joint: a preliminary investigation. Cranio;July;21(3):202.208.
Obesity Increases Rearfoot Pronation
Abstract
The purpose of our study was to determine the effects of severe obesity on the foot mechanics of adult females. Twenty-nine adult females between the ages of 20 and 48 years volunteered as subjects for this investigation. The subjects were separated into a severely obese (O) group (body mass index = 41.14 +/- 2.61; N = 16) and a normal weight control group (body mass index = 20.84 +/- 0.47; N = 13). A Locam camera (100 Hz) positioned perpendicular to the subjects' posterior aspect was used to film the rearfoot movement of the subjects during the final 15 sec of a 10 min treadmill walk. The O group had a significantly greater touchdown angle (P = .05), more total eversion range of motion (P = .001), and a faster maximum eversion velocity (P < .001). Moreover, analysis of dynamic foot angles indicated that the O group had significantly (P = .003) more forefoot abduction. Finally, anthropometric data revealed statistically different (P < .001) Q angle measurements between the O and control groups. The results of this study suggest that severely obese females have significantly greater rearfoot motion, foot angle, and Q angle values than normal weight females.
Messier SP, Davies AB, Moore, DT, Davis ES, Pack RJ, Kazmar SC 1994. Severe obesity: effects on foot mechanics during walking; Foot Ankle Int, Jan;15(1):29-34
Applying a vibratory stimulation to the plantar fat pad, results in a whole body tilt
Abstract
1. In order to assess the relative contribution and the interactions of the plantar cutaneous and muscle proprioceptive feedback in controlling human erect posture, single or combined vibratory stimuli were applied to the forefoot areas and to the tendons of the tibialis anterior muscles of nine standing subjects using various vibration frequency patterns (ranging from 20 to 80 Hz).
2. The variations in the centre of foot pressure, ankle angle and the EMG activities of the soleus and tibialis anterior muscles of each subject were recorded and analysed.
3. Separate stimulation of the plantar forefoot zones or the tibialis anterior muscles always resulted in whole-body tilts oppositely directed backwards and forwards, respectively, the amplitude of which was proportional to the vibration frequency. EMG activity of ankle muscles also varied according to the direction of the postural responses. However, the same vibration frequency did not elicit equivalent postural responses: in the low frequency range, tactile stimulation induced stronger postural effects than proprioceptive stimulation, and the converse was the case for the higher frequency range.
4. Under sensory conflict conditions, i.e. foot sole-flexor ankle muscle co-stimulation, the direction of the body tilts also varied according to the difference and the absolute levels of the vibration frequencies. In all cases, the resulting postural shifts always corresponded to the theoretical sum of the isolated effects observed upon vibrating each of these two sensory channels.
5. We proposed that tactile and proprioceptive information from the foot soles and flexor ankle muscles might be co-processed following a vector addition mode to subserve the maintenance of erect stance in a complementary way.
Kavounoudias A, Roll R, Roll JP 2001. Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation. Journal Physiology;523(3):869-878.
The influence of proprioceptive insoles (Bourdiol) on the sagittal curvature and inclination of the trunk
Proprioceptive insoles rely on the concept of Réné-Jaques Bourdiol, a French neurologist. The aim is to modulate plantar surface sensibility and to influence posture and statics of patients: it is hypothesized that the effect of modified afferent sensory input through proprioceptive stimulation of terminal muscle chains will have either a relaxing or stimulating effect on the whole body, which may be realized by affecting the posture. Small pads with a thickness of typically 1-3 mm are embedded into the insole to provide a specific stimulation. In fitting the insoles selectively to the individual patient the effect of the insoles on the trunk posture is taken as a feedback.This study investigates the influence of proprioceptive insoles on the sagittal curve in 20 selected patients. The protocol used a repeated measures research design. The measures of the sagittal curve were obtained using raster stereography. The four different conditions were: (1) barefoot, (2) convenient shoes without the insoles, (3) the same shoes with a placebo insole, and (4) the same shoes with neurological insoles. Evaluation of raster stereographs provided the kyphotic angle between T4 and T12 and lordotic angle between T12 and S1. Statistical evaluation was performed with the t-test for paired measurements.No significant differences were found in the sagittal profile. Only trunk inclination in normal posture was found to yield a significant difference (0.38 degrees ) between placebo and neurological insoles. However, no clear statement on the efficiency of neurological insoles can be made.:hammer:
Muller-Gliemann C, Drerup B, Osada N, Wetz H, 2006 Orthopade Oct 12
Pernarella C, Adriani E, Rottinger H 2005. Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science;Doc 05novEP81
• Otoneurologic pathology disturbs the foot's afferences (proprioceptors) manifested as increased postural sway during a static posturographical test
Abstract
We analyzed 150 subjects with an average age of 52, differentiated on the basis of the otoneurologic examination, into: normal (without alteration of the vestibular function: 28 cases ), peripheral vestibular pathologies (with monolateral deficit in labyrinth reflectivity in thermic tests: 73 cases), with central pathology (22 cases ) and with mixed pathologies (27 cases ). All subjects underwent a static posturographical test, both with closed and open eyes, first standing directly on the platform, then with the support of a cushion laid on the platform itself. The cushion used, manufactured by the Ks company of Avellino with natural SMR (standard Malaysian rubber), presents features which buffer, or at any rate disturb, the foot's afferences, especially the proprioceptors. For each test, surface and length of the body oscillations or sway were measured, and the percentage of the interference of the foot support factor on postural control was calculated with specific formulas.
• All tests highlighted a marked difference between normal and pathologic subjects. All subjects felt a strong destabilization during the tests performed with the cushion, confirmed by a marked worsening of postural performance in posturographic tests too, both with closed and open eyes. The cushion employed in this study proved to be a valuable tool for the assessment of footing interference on static postural control. Its employment with closed eyes could be an effective rehabilitation tool, especially in cases of monolateral vestibular pathologies presenting compensation difficulties, to enhance the activity of the healthy vestibular hemisystem, and in cases of proprioceptive input impairment in other areas, to facilitate a functional recovery with an increase in the relative compensatory influence of vestibular information.
Guidetti G. Posturographic Evaluation of Foot Interference on the Control of Posture. DEpart Neuropsychosensorial Pathology, Univ Modena, Modena Italy.
Alignment of the Talus Determines the Position of the Foot
• Abstract
We performed an in vitro study on twelve specimens of the foot and ankle from cadavera to determine whether varus malalignment of the talar neck alters the position of the foot and subtalar motion. An osteotomy of the talar neck was performed, and the specimens were studied with and without removal of a medially based wedge of bone. Removal of the wedge produced an average varus malalignment of the talar neck of 17.1 ± 2.4 degrees (range, 12.5 to 21.0 degrees). In the coronal plane, the average arc of motion of the subtalar joint decreased from 17.2 ± 3.3 degrees before the osteotomy to 11.7 ± 2.9 degrees after the osteotomy and removal of the wedge. In the transverse plane, it decreased from 17.5 ± 2.9 degrees to 11.9 ± 2.4 degrees. In the sagittal plane, it decreased from 8.9 ± 2.4 degrees to 6.8 ± 2.3 degrees. The decrease in subtalar motion was characterized by an inability to evert the foot; inversion was not limited, however.The malalignment produced an average of 4.8 ± 1.2 degrees of varus deformity and 8.7 ± 2.3 degrees of internal rotation of the hindfoot and an average of 5.5 ± 2.0 degrees of varus deformity and 11.5 ± 2.4 degrees of adduction of the forefoot.
Daniels TR, Smith JW, Ross TI 1996. Varus Malalignment of the Talar Neck. Its Effect on the Position of the Foot and on Subtalar Motion. Journal Bone Joint Surgery; 78: 1559 - 1567.
A linear correlation analysis was used to compare the change in subtalar motion and the position of the foot with the degree of varus malalignment at the talar neck. The correlation coefficient was 0.90 (p < 0.01) for subtalar motion, 0.76 (p < 0.01) for internal rotation of the calcaneus, and 0.81 (p < 0.01) for adduction of the forefoot. This indicated a direct correlation between the degree of varus malalignment at the talar neck and the change in the position of the foot and in subtalar motion.
Postural Distortions Linked to Faulty Foot Mechanics:
• Rhubarb BA, Hansen K, et al 1995. Resolving Low Back Pain. Treat the Foot.
http://www.med.univ-rennes1.fr/noment/orthoweb/ortho_bib_low_back_pain.html
•
• Rhubarb BA. 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
• Rhubarb BA, Esterbrook L. 1988. Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal Manipulative Physiologic Therapeutics 11(5): 373-379.
• Rhubarb BA, Yerratt M. 1994 An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosion Model. American Journal of Pain Management 4(3): 13-18.
• Rhubarb BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. American Journal of Pain Management 5(3): 84-89
• Rhubarb BA. 2003 Etiology of Foot Hyperpronation - An Embryological Perspective. The Rhubarb Foot Structure. British Journal of Osteopathy, Vol 26, pp 16-17 Rhubarb BA 2004. Postural Distortions. The foot connection. Online Journal of Orthodontics, May 10; 6(1): 1-8.
• Rhubarb BA 2004 Medial Column Foot Systems: An Innovative Tool for Improving Posture. Chiropody Review, Vol 61:1, pp 20-23 (reprinted with permission from JBMT) Rhubarb BA 2004 Una teoria sul Primo Metatarso Supinato. il Podologo in Medicina, (28): 28-32, luglio agosto.
• Rhubarb BA 2005. Tactile therapy shifts patients towards equilibrium. Biomechanics. Vol XII, No 10:61-68.
• Rhubarb BA 2005. Proprioceptive Insoles. From a Podiatric Point of View. Health and Healing Wisdom (Price-Pottinger Nutrition Foundation Journal) Vol 29(3):11.
• Rhubarb BA 2006 Cranial Lesions Initiated by Abnormal Foot Motion. Health and Healing Wisdom (Price-Pottinger Nutrition Foundation Journal) Vol 30(1):6-7.
Mineral derivative insoles exert a profound and immediate postural effect through a hypothesized neurophysiological mode of action
Abstract
BACKGROUND: There is a need for a validated rapid procedure for the evaluation of posture, defined as lateral balance/imbalance at the pelvic, shoulder, and neck levels. This would enable clinicians to determine the importance of symmetry in the pathophysiology of musculoskeletal disorders and to assess the efficacy of devices and treatments claiming to normalize or improve posture. In this investigation, the efficacy of such a device, a set of insoles with a hypothesized proprioceptive-like action, was evaluated through use of the described procedure. OBJECTIVES: To develop a new scoring system to evaluate body posture on the basis of symmetry and to use this scoring system to investigate the efficacy of insoles containing a combination of mineral derivatives designed to balance posture through a neurophysiological effect. METHODS: The posture score was based on the evaluation of 4 postural parameters: pelvic and shoulder lateral balance/imbalance, static shoulder rotation, and amplitude of head rotation. In the placebo-controlled study, 32 patients were tested in a double-blind fashion, either with placebo insoles or with insoles containing mineral derivatives. The same study was repeated in unblind conditions in 137 patients selected from 2 chiropractic clinics in an open-label protocol. STUDY DESIGNS: A crossover placebo-controlled, double-blind study and a multicenter, large-scale, open-label study in patients selected from chiropractic clinics. RESULTS: A basal postural evaluation in 137 patients revealed that no patient had a perfect symmetry-ie, a perfectly or nearly perfectly balanced posture. The insoles with mineral derivatives induced a highly significant and similar improvement in the postural score in both the crossover double-blind study (32 patients; 56.7% improvement) and the open-label study (137 patients; 60.7% improvement, P < 0.001). CONCLUSIONS: All patients tested and selected in chiropractic clinics exhibited asymmetries and postural imbalances according to the newly developed scoring method, and this method was successful in assessing the efficacy of insoles exerting a profound and immediate postural effect through a hypothesized neurophysiological mode of action.:pigs:
Masse M, Gaillardetz C, Cron C, Abribat T 2000. A new symmetry-based scoring method for posture assessment: Evaluation of the effect of insoles with mineral derivatives. Jour Manipulative Physiol Therapy;Nov-Dec;23(9):596-600.
use of proprioceptive insoles reduce pain in patients affected by gonarthrosis
Abstract
Introduction Guidelines recommend sticks and othopedical insoles in the treatment of gonarthrosis. We analyzed the influence of proprioceptive insoles according to RJ Bourdiol.
Materials and methods We evaluated pain level, knee stiffness and the physical function in 12 patients (71± 6 yrs, 3 males) affected by gonarthrosis (10 varus, 2 valgus). After compilation of a self-administrated WOMAC questionnaire the patients were randomly allocated either in group A (proprioceptive insoles with specific thickness <3 mm ) or in group B (placebo insoles), and reconsidered after 4 weeks. Results were compared with Student T- test and the minimal clinically important difference (MCID) was calculated
Results Pain score increased in group A from 5,25 to 2,25 (p= 0.001) and in group B from 3,41 to 3,58 (p= ns). Knee stiffness modified in group A from 5,75 to 3,12 (p= 0.03) and in group B from 5 to 6,37 (p= 0.02). Physical function in group A decreased from 5,36 to 2,81 (p= 0.007) but increased non significantly in group B from 3,55 to 3,92. The global index was reduced from 5,38 to 2,72 (p= 0.004) in group A and changed in group B from 3,64 to 4,06 (p= ns). Group A at difference with group B show a significant MCID. Effect size > 0.8 demonstrate a strong therapeutic effect.
Conclusions We show for the first time that the use of proprioceptive insoles in gonarthrosis significantly reduce pain, ameliorates knee stiffness and physical function.:pigs:
Pernarella C, Adriani E, Rottinger H 2005. Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science;Doc 05novEP81
The use of proprioceptive insoles reduce pain in patients affected by gonarthrosis
Abstract
Introduction Guidelines recommend sticks and othopedical insoles in the treatment of gonarthrosis. We analyzed the influence of proprioceptive insoles according to RJ Bourdiol.
Materials and methods We evaluated pain level, knee stiffness and the physical function in 12 patients (71± 6 yrs, 3 males) affected by gonarthrosis (10 varus, 2 valgus). After compilation of a self-administrated WOMAC questionnaire the patients were randomly allocated either in group A (proprioceptive insoles with specific thickness <3 mm ) or in group B (placebo insoles), and reconsidered after 4 weeks. Results were compared with Student T- test and the minimal clinically important difference (MCID) was calculated
Results Pain score increased in group A from 5,25 to 2,25 (p= 0.001) and in group B from 3,41 to 3,58 (p= ns). Knee stiffness modified in group A from 5,75 to 3,12 (p= 0.03) and in group B from 5 to 6,37 (p= 0.02). Physical function in group A decreased from 5,36 to 2,81 (p= 0.007) but increased non significantly in group B from 3,55 to 3,92. The global index was reduced from 5,38 to 2,72 (p= 0.004) in group A and changed in group B from 3,64 to 4,06 (p= ns). Group A at difference with group B show a significant MCID. Effect size > 0.8 demonstrate a strong therapeutic effect.
Conclusions We show for the first time that the use of proprioceptive insoles in gonarthrosis significantly reduce pain, ameliorates knee stiffness and physical function.
Pernarella C, Adriani E, Rottinger H 2005. Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science;Doc 05novEP81
A Study conducted by Dutch Podiatrists revealed that postural impairments were a common complaint among podiatric patients
Abstract
Zuijderduin & Dekker (1996) quantitatively analyzed data recorded by 36 Podiatrists, all active members of the Dutch Professional Association of Podiatrists: 897 patients applying for treatment, were interviewed concerning their subjective complaints.
Findings: An average of 4.6 impairments was recorded per patient. The eight most common groups of subjective complaints were (in descending order):
1. Generalized Musculoskeletal Pain in the feet
2. Impairments in joint motion (fused interphalangeal articulations, etc)
3. Skin problems (calluses, corns, etc)
4. Stance deviation of toes (hammertoes, overlapping toes, etc)
5. General, non-specific systemic impairments
6. Postural impairments
7. Impairment of bone tissue (bone spurs, bunions, etc)
8. Impairment of nails (onychomycosis, etc)
Zuijderduin WM, Dekker J 1996. Diagnosis and Interventions in Podiatry.
Disability and Rehabilitation. 18 (1), 27-34.
Craniofacial Anthropometry
Photos courtesy of Cleft Palate-Craniofacial Journal
en (endocanthion): the inner corner of the eye fissure where the eyelids meet
eu (eurion): the most lateral point on the head
ex (exocanthion): the outer corner of the eye fissure where the eyelids meet
ft (frontotemporale): the most medial point on the temporal crest, identified by palpation
fz (frontozygomaticus): the most lateral point on the frontozygomatic suture
g (glabella): the most prominent point in the median sagittal plane between the supraorbital ridges
gn (gnathion): in the midline, the lowest point on the lower border of the chin
obi (otobasion inferius): the lowest point of attachment of the exteral ear to the head
obs (otobasion superius): the highest point of attachment of the exteral ear to the head
op (opisthocranion): the most prominent posterior point on the occiput
po (porion): the most superior point on the upper margin of the external auditory meatus with the head in the Frankfort horizontal plane
n (nasion): the midpoint of the nasofrontal suture
sn (subnasale): in the midline, the junction between the lower border of the nasal septum and the cutaneous portion of the upper lip
t (tragion): at the notch above the tragus of the ear where the upper edge of the cartilage disappears into the skin of the face
tr (trichion): the midpoint of the hairline
v (vertex): the highest point on the head with the head in the Frankfort horizontal plane
zy (zygion): the most lateral point on the zygomatic arch
• Farkas, LG and Munro, IR (1987) Anthropometric Facial Proportions in Medicine. Charles C Thomas: Springfield, 344 pp.
• Kelly KM, Littlefield TR, Pomatto JK, Ripley CE, Beals SP, Joganic EF (1999) Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. American Cleft Palate-Craniofacial Journal, 36: 127-30.
• Kolar, JC and Salter, EM (1997) Craniofacial Anthropometry. Practical measurement of the head and face for clinical, surgical and research use. Charles C Thomas: Springfield, 334 pp.
Abstract
Craniofacial anthropometry has become an important tool used by both clinical geneticists and reconstructive surgeons. Yet little attention has been paid to the potentially serious problem of measurement error. This paper examines intra-observer measurement error and precision (also called repeatability or reliability) for 52 commonly used anthropometric variables of the head and face. Two factors proved critical to reliability: magnitude of the measurement in question and the degree to which its constituant landmarks could be readily identified. Thus, all of the measurement variables with means above 10 cm proved to have good or excellent reliability. In contrast measurement variables with means below 10 cm were more likely to have poor reliability. This trend was especially evident in variables with means of 6 cm or less where 18 of the 20 variables in this range had poor reliability. The least reliable variables were those like philtrum breadth, columella breadth, and nasal root breadth that combine small magnitude with difficult to define landmarks. While these results suggest that it may be prudent to avoid using craniofacial variables with small dimensions this may be neither practical nor desirable. In such cases repeat measurements may be the best means for optimizing reliability.
Ward RE, Jamison PL 1991. Measurement precision and reliability in craniofacial anthropometry: implications and suggestions for clinical applications. J Craniofac Genet Dev Biol;Jul-Sep;11(3):156-164.
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