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Scientific Programme

Sports and Exercise Medicine and Health

OP-MH19 - Physiotherapy II / Knee

Date: 03.07.2024, Time: 11:00 - 12:15, Lecture room: M2+M3

Description

Chair TBA

Chair

TBA
TBA
TBA

ECSS Paris 2023: OP-MH19

Speaker A NILI STEINBERG

Speaker A

NILI STEINBERG
Wingate Academic College, Sport Science
Israel
"Patellofemoral Pain in Young Gymnasts"

INTRODUCTION: Patellofemoral pain (PFP) is prevalent in high impact athletes. In gymnastics, intensive physical activity, including the repetition of extreme movements apply loads and strains to the lower extremities. The combination of high-impact forces and long practice hours along pubertal development increased the concerns for PFP in competitive young gymnasts. Our aims were to investigate the prevalence of PFP in rhythmic, acrobatic and artistic gymnasts; and to look at the relation between PFP and anatomical features (such as maturation, joints ROM, bone strength and muscle strength) in young gymnasts from those three different disciplines. METHODS: Data was collected via screening of 274 (aged 11.8±1.9 years) rhythmic, acrobatic and artistic compatetive gymnasts. They were asked to complete the Tanner questionnaire and to report their date of birth and menarche status. Each gymnast was assessed for anthropometrics, bone strength, muscle-strength (ankle plantar-flexors/dorsiflexors, knee extensors/flexors and hip abductors/adductors), hypermobility (using the Beighton 9-Point Test) and joints range of motion (ROM) (passive ankle dorsi flexion/plantarflexion, active hip extension, hip abduction, anterior split, posterior split and active trunk extension). Each gymnast underwent a physical examination conducted by the same physical therapist (specializes in sports medicine) for PFP. RESULTS: 21.5% of the gymnasts had PFP, with significantly higher prevalence among artistic gymnasts (33.3%) compared to rhythmic gymnasts (21.4%) and acrobatic gymnasts (10.0%) (p=.008). No significant differences were found in age, menarche status and pubertal stages of gymnasts with and with no-PFP (p>.05). Univariate ANOVA showed discipline X PFP interaction for h/week of training this year (F(2, 267)=3.647, p=0.027). Logistic regressions showed that increased h/week of training last year (OR=1.062) and reduced muscle-strength [knee extensors (OR=0.853) and hip abductors (OR=0.673)] were significantly associated with PFP. CONCLUSION: The prevalence of PFP was high, especially among artistic gymnasts. Impact of training and reduced knee and hip muscle strength were associated with PFP in young gymnasts. The knowledge acquired from this study can be utilized by all those involved in gymnastics, as a means of designing injury-prevention programs and for modifying training programs for gymnasts’ specific body structures and current developmental stages. This combined with an increased understanding of factors related to injuries can help reduce musculoskeletal injuries among young female gymnasts.

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ECSS Paris 2023: OP-MH19

Speaker B Xinwen Cui

Speaker B

Xinwen Cui
China Institute of Sport Scinence, Sports Rehabilitation Research Center
China
"Active Physiotherapy is Superior than Passive Physiotherapy for Patients with Chronic Knee Pain: a 12-month follow-up of a randomized trial"

INTRODUCTION: Knee pain disrupts daily life, and functional impairments contribute to neuromuscular imbalance, a key factor in musculoskeletal pain. Effective treatment of chronic pain requires understanding the intricate interplay between systems and structures, transitioning from a singular structural focus to addressing functional impairments. Active physiotherapy (AP) adopts a patient-centered approach, using active movements to integrate sensory-motor information for functional recovery and pain relief. Passive physiotherapy (PP) involves direct therapist intervention and passive treatment. However, research on the therapeutic potential of AP and PP for chronic musculoskeletal pain is limited. This study aimed to determine whether AP is superior to PP in improving knee function over a 12-month follow-up period in patients with knee pain. METHODS: 87 patients with symptomatic and radiographically confirmed knee pain were randomly assigned to either 3 months of Active Physiotherapy (AP) (n=44) or Passive Physiotherapy (PP) (n=43). The AP protocol integrated Mulligan Mobilization (MWM), active myofascial release technique, therapeutic exercises, with a focus on muscle balance, neuromuscular control, and coordination. The PP protocol consisted of physical agents therapy (such as laser therapy, microwave therapy, ultrasound therapy, and so on) and passive manual therapy. The primary outcome was the change from baseline in the Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). Key secondary outcomes included pain intensity (VAS), quality of life (SF-36), and functional performances (40-meter fast walk and 6-minute walk test), measured at different intervals. Intention-to-treat and per-protocol analyses was performed. Linear mixed-model analysis was utilized. RESULTS: Over a 12-month follow-up period, knee function improved in the AP by 20.5 ± 13.5 and in the PP by 14.2 ± 12.5. The overall between-group difference was 6.2 points (97.5% CI, 1.8 to 10.7; P = 0.007). The mean difference of the VAS was -5.3 mm (95% CI, -8.7 to -1.8; P=0.003), favoring AP. No difference between groups was observed in SF-36. AP group exhibited substantial improvements in all functional performance variables compared to the PP group (P < 0.05). Adverse events: 4 in AP, 7 in PP, with additional knee pain outpatient visits most frequent (2 in AP, 6 in PP). CONCLUSION: Active physiotherapy demonstrates superiority in improving function and alleviating pain in patients with knee pain. These findings underscore the considerable therapeutic value of active physiotherapy for chronic knee pain treatment.

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ECSS Paris 2023: OP-MH19

Speaker C Lars Niklas Heinke

Speaker C

Lars Niklas Heinke
University of Wuppertal, Department of Movement and Training Science
Germany
"Pain Without Gain? Assessing Pain Perception and Jump Height after Active and Passive Foam Rolling: A Crossover Randomized Controlled Trial"

INTRODUCTION: In the last decade, foam rolling (FR) gained popularity as a pre-exercise tool, improving range of motion and performance [1]. However, the specific effects of active (AFR) and passive (PFR) FR remain unclear. This study aims to explore how AFR and PFR affect pain perception and jumping performance. METHODS: In a crossover RCT, 20 participants (10 men and 10 women) underwent both AFR and PFR sessions on their anterior thigh and calf muscles on two separate days. Prior to each treatment, participants engaged in a 5-minute warm-up on a stationary bicycle. Afterwards, each leg was treated twice for 3 minutes. Vertical force during AFR was measured with a force plate, and a custom constant-pressure rolling device was used for PFR, with pressure individualized to 32.1 ± 1.5% of body weight [2]. Countermovement jump (CMJ) performance was assessed before and after warm-up, and post-FR treatment. Pain perception, using the visual analog scale (VAS), was evaluated for both AFR and PFR during treatments. Two-factor (treatment x time) rANOVA`s using statistical parametric mapping (SPM) were employed to compare body weight-normalized vertical force data for the CMJs. SPM analyses were executed in Python using the open-source package spm1d, and further statistical analyses were calculated using R 4.2.2. RESULTS: Jumping performance showed a moderate, but not statistically significant group × time interaction effect (p = .078, ηp2 = .126). Pairwise comparison indicated a small reduction from POST1 to POST2 for both AFR (27.2 ± 6.1 cm to 25.9 ± 5.7 cm; SMD = .225) and PFR (27.1 ± 5.9 cm to 25.1 ± 5.5 cm; SMD = .343). Furthermore, at POST2, a trivial difference was observed between AFR and PFR (SMD = .145). The rANOVA`s of SPM showed no interaction effects. AFR and PFR rolling pressure analysis revealed statistically significant higher forces on the thigh in AFR (291.0 ± 74.3 N) compared to PFR (223.7 ± 35.1 N) (SMD = .822). Pain perception was significantly higher in PFR (6.1 ± 2.1) compared to AFR (3.9 ± 2.4) (SMD = .975). CONCLUSION: Both rolling conditions reduced the jumping performance. Surprisingly, participants rated PFR more painful than AFR, despite AFR applying substantially higher pressure. Speculatively, the non-contracted musculature in PFR may allow greater modulation of muscle and tissue stiffness, contributing to more pronounced negative effects on performance. It is noteworthy that in both conditions, the applied pressure could be twice as high as typically used in occlusion studies [3]. A concern for practical application is that, when comparing AFR and PFR, even higher mechanical pressure in AFR does not lead to increased pain perception compared to PFR. Adverse effects on connective tissue, nerves, blood vessels, and bones should be critically considered if both treatments are improperly used. [1] Wiewelhove et al., Front Physiol, 2019 [2] Baumgart et al., Sports (Basel), 2019 [3] Abe et al., J Appl Physiol (1985), 2006

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ECSS Paris 2023: OP-MH19