Background: Chronic low back pain (CLBP) is the most prevalent musculoskeletal disorder. Aquatic exercises are commonly used by physical therapists for CLBP treatment and management; however, there are no data on trunk muscle activation during aquatic exercises in people with CLBP. Objective: We quantified activation of trunk and gluteal muscles, exercise intensity, pain, and perceived exertion in people with and without CLBP when performing water and land exercises. Design: The study used a cross-sectional design. Methods: Twenty participants with nonspecific CLBP and 20 healthy participants performed 15 aquatic exercises and 15 similar land exercises. Mean and peak muscle activation were measured bilaterally from erector spinae, multifidus, gluteus maximus, gluteus medius, rectus abdominis, external oblique, and internal oblique using waterproof and wireless surface electromyography. Exercise intensity (heart rate), perceived exertion (Borg scale), and, for the CLBP group, pain (visual analog scale) were recorded. Results: There were no significant between-group differences. Significant between-environment differences were found in heart rate (always higher on land), exertion (higher in the water for 3 exercises and on land for 6 exercises), and muscle activation (higher on land in 29% and in the water in 5% of comparisons). Pain levels were low, but pain was reported more than twice as frequently on land than in water (7.7% vs 3.7%, respectively). Limitations: People with high levels of disability and CLBP classification were not included. Conclusions: People with mild-to-moderate CLBP had similar exercise responses to healthy controls. Aquatic exercise produced sufficient muscle activation, intensity, and exertion, and should not be assumed to be less strenuous or less effective in activating trunk and pelvic muscles than exercise on land. These data can be used to inform design and prescription of rehabilitation programs and interventions.

Aims: The aim of this study was to determine the effectiveness of home-based prehabilitation on pre- and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA).Methods: A systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Library, and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool.Results: A total of 22 RCTs (1,601 patients) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.001), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69; p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD -0.18; p = 0.16) prior to THA, but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p = 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.001) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5% (SD 6.82).Conclusion: Prehabilitation interventions improve pain and function prior to TKA and THA and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively.Cite this article:Bone Jt Open 2023;4(5):315–328.

Background: We assessed the effects of a 6-week, low-volume Nordic hamstring exercise (NHE) intervention on hamstring flexibility, muscle mechanical properties and eccentric and isometric isokinetic knee flexion strength in recreationally active adults. Methods: Eighteen recreationally active adults were randomized into an NHE intervention group (IG; n = 9; females/males: 3/6; mean ± SD, age: 24.1 ± 1.3 years) and control group (CG; n = 9; females/males: 5/4; mean ± SD, age: 23.5 ± 1.8 years). The NHE intervention involved a progressive, supplementary training program performed initially one (weeks 1 and 2) and then two times per week over a 6-week period. The number of repetitions per session increased from 15 to 36 repetitions/week. The CG maintained their usual exercise routine over the same period. Standard goniometry, myotonometry, and isokinetic dynamometry (60°/s) were used to measure hamstring flexibility, muscle properties and isometric and eccentric isokinetic strength prior to and five days following the intervention. Results: The Linear Mixed Methods analysis identified a significant group × time interactions for isometric torque (IG: +5% vs. CG: −12%, p = 0.022) and flexibility (IG: +1% vs. CG: +7%, p = 0.023). Peak eccentric torque (IG: +7% vs. CG: −7%, p = 0.053) and muscle mechanical properties remained unchanged over the intervention period. Conclusions: Six weeks of low-volume NHE training marginally improved isometric and eccentric hamstring strength in recreationally active adults without changing hamstring flexibility or mechanical properties. The findings may have important implications for performance enhancement and hamstring injury risk reduction during high-intensity recreational sports.

During an unpredictable side-cut, this study examined how a sport-specific neuromuscular training program (NMTP) influenced electromyography responses in the lower limb posterior muscles, leg movement angles, maximum vertical ground reaction force (vGRF), and the rate of force development of vGRF. Thirty-eight adult female recreational hockey players were randomly allocated into an intervention group (INT) or a control group (CON). Before beginning training or matches, the INT carried out the NMTP three times per week for eight weeks, whereas the CON performed their routine warm-up. A 45° sidecut (dominant leg only) was performed at baseline and after eight-weeks and recorded with a motion capture system. The effect of group and time, and their interaction, was investigated using a mixed-design ANOVA. After landing, the participants in the INT had greater activation of their gastrocnemius lateralis, gastrocnemius medialis, and gluteus maximus muscles than those in the CON. INT participants showed significantly lower amounts of maximum knee abduction and knee excursion, while there was an increase in these variables for the CON. At week eight, the vGRF RFD decreased for the INT but increased for the CON. Although non-significant, the overall muscle activity showed an increasing trend for the INT when it came to supervised NMTP for eight weeks compared to the effect seen in the CON. This activity caused greater alterations in the motion and forces of the lower body for the INT than the CON.

A 34-year-old male presented with persistent medial knee pain and mechanical symptoms three months after a rotational injury, with limited knee extension on examination. Magnetic resonance imaging demonstrated the double posterior cruciate ligament (PCL) sign, produced by a displaced bucket-handle tear of the medial meniscus with the fragment lying anterior and parallel to the intact PCL within the intercondylar notch. Coronal sequences confirmed displacement and loss of normal meniscal configuration. Arthroscopy verified the diagnosis, and arthroscopic partial meniscectomy was performed due to chronic displacement and poor healing potential. Following structured rehabilitation, the patient returned to full athletic activity without symptoms at one-year follow-up. This case underscores the importance of recognizing the double PCL sign as a highly specific MRI finding enabling prompt diagnosis and appropriate management of displaced bucket-handle meniscal tears, while also highlighting its radiologic–arthroscopic correlation and the clinical implications of delayed presentation on treatment strategy, and provides a clear illustrative example of this classic imaging sign for educational purposes.