Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers, should transition very slowly and gradually to avoid potential stress injury in the foot.

Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health‐related quality‐of‐life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

A proposed benefit of minimalist shoe running is an increase in intrinsic foot muscle strength. This study examined change in intrinsic foot muscle size in runners transitioning to Vibram FiveFingers™ minimalist shoes compared to a control group running in traditional running shoes. We compare pre-transition size between runners who developed bone marrow edema to those who did not. 37 runners were randomly assigned to the Vibram FiveFingers™ group (n=18) or control group (n=19). Runners' bone marrow edema and intrinsic foot muscle size were measured at baseline and after 10 weeks. Total running volume was maintained by all runners. A significant increase in abductor hallucis cross-sectional area of 10.6% occurred in the Vibram FiveFingers™ group compared to the control group (p=0.01). There was no significant change in any of the other muscles examined (p>0.05). 8 of the Vibram FiveFingers™ runners, and 1 control runner developed bone marrow edema. Those who developed bone marrow edema, primarily women, had significantly smaller size in all assessed muscles (p≤0.05). Size of intrinsic foot muscles appears to be important in safely transitioning to minimalist shoe running. Perhaps intrinsic foot muscle strengthening may benefit runners wanting to transition to minimalist shoes.

Neurological and Microvascular FunctionNeuropathies are among the most common complications of diabetes mellitus 1 and are the cause of more than 60% of all nontraumatic amputations in the United States.2 Neuropathy is a set of syndromes, each with a wide range of clinical and subclinical manifestations, the most common of which is distal symmetric polyneuropathy (DSPN).1,3 Distal symmetric polyneuropathy occurs in both type I and type II diabetes, and the symptoms range considerably. Some patients experience no symptoms but show deficits during neurological examinations, while others experience negative symptoms such as loss of thermal and tactile sensations, especially in the lower limbs.1,3 Still others may experience dysesthesia, a painful prickling or electric shock-like sensation in the legs and/or feet, especially at night. 4 The etiology of diabetic neuropathy is multifactorial, 3 making it difficult to identify the treatment. However, a common factor in each of the proposed underlying mechanisms of the pathogenesis is reactive oxygen species, which are the products of metabolic dysfunctions that result from hyperglycemia. [5][6][7] Herein lies some insight into addressing the problem of DSPN. Oxidative stress from these free radicals is implicated in vascular dysfunction, 7 including a change in the expression of endothelial nitric oxide (NO) synthase, 8 resulting in reduced bioavailability of NO. Reduced bioavailability of NO is a factor in nerve ischemia 9 ; therefore, therapies to increase NO may result in increased blood flow and a decrease in symptoms of DSPN.Nitric oxide production is induced by laminar shear stress, resulting from the frictional forces between the vascular endothelium and moving blood. 10 An example of this type of shear stress can be found when blood flows in the vessels during moderate exercise.11,12 Externally applied, low-frequency vibration also results in endothelial shear stress sufficient to produce NO and improve blood flow. [13][14][15][16][17][18] AbstractBackground: Vascular dysfunction due to hyperglycemia in individuals with diabetes is a factor contributing to distal symmetric polyneuropathy (DSPN). Reactive oxygen species reduce the bioavailability of nitric oxide (NO), a powerful vasodilator, resulting in reduced circulation and nerve ischemia. Increases in blood NO concentrations and circulation have been attributed to whole body vibration (WBV). The purpose of this study was to the determine the effects of low-frequency, low-amplitude WBV on whole blood NO concentrations and skin blood flow (SBF) in individuals with symptoms of DSPN. Methods:Ten patients with diabetes and impaired sensory perception in the lower limbs participated in this crossover study. Each submitted to 2 treatment conditions, WBV and sham, with a 1-week washout period between. Blood draws for NO analysis and laser Doppler imager scans of SBF were performed before, immediately after, and following a 5-minute recovery of each of the treatments. Conclusions: These findings demonstrate that pa...

The assessment of functionality should include parameters that consider postural control, limb asymmetries, range of motion limitations, proprioceptive deficits, and pain. An increasingly popular battery of tests, the Functional Movement Screen (FMS), is purported to assess the above named parameters. The purpose of our study was twofold: (a) to report differences in total FMS scores in children, provide preliminary normative reference values of each of the 7 individual FMS scores for both genders and report on asymmetries and (b) to evaluate the relationship between total FMS scores, age, body mass index (BMI), core strength/stability, and postural angles to explore the possibility of using the FMS in the assessment of children's functional fitness. Descriptive data on 77 children aged 8-11 years were collected. The children performed core strength/stability exercises. Photographs were taken from a lateral view for later calculation of postural angles. The children performed the FMS while being videotaped for later review. The average total FMS score (of 21) was 14.9 (+1.9), and BMI was 16.4 (+2.2). Static posture is not related to results of the FMS. Core strength was positively correlated to the total FMS score (r = 0.31; p = 0.006). Over 60% demonstrated at least 1 asymmetry. The individual test scores indicate that none of the test items is too difficult for the children. Based on the screen's correlation to core strength, and the fact that it identifies areas of asymmetry, we suggest to further investigate its possible use in the assessment of children's functional fitness.

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1-4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

BackgroundThe Functional Movement Screen (FMS™) has become increasingly popular for identifying functional limitations in basic functional movements. This exploratory and descriptive study was undertaken to confirm feasibility of performing the FMS™ in older active adults, assess prevalence of asymmetries and to evaluate the relationship between functional movement ability, age, physical activity levels and body mass index (BMI).MethodsThis is an observational study; 97 men (n = 53) and women (n = 44) between the ages of 52 and 83 participated. BMI was computed and self-reported physical activity levels were obtained. Subjects were grouped by age (5-year intervals), BMI (normal, over-weight, and obese) and sex. Each participant's performance on the FMS™ was digitally recorded for later analysis.ResultsThe youngest age group (50–54 years) scored highest in all seven tests and the oldest age group (75+) scored lowest in most of the tests compared to all other age groups. The subjects in the “normal weight” group performed no different than those who were in the “overweight” group; both groups performed better than the “obese” group. Of the 97 participants 54 had at least one asymmetry. The pairwise correlations between the total FMS™ score and age (r = −0.531), BMI (r = −0.270), and the measure of activity level (r = 0.287) were significant (p < 0.01 for all).ConclusionFMS™ scores decline with increased BMI, increased age, and decreased activity level. The screen identifies range of motion- and strength-related asymmetries. The FMS™ can be used to assess functional limitations and asymmetries. Future research should evaluate if a higher total FMS™ score is related to fewer falls or injuries in the older population.

The purpose of this study was to investigate the blood flow/pressure relationship (linear or nonlinear) in the superficial femoral artery when seated, as well as to investigate blood flow changes with exercise using varying cuff pressures and a preexercise (PE) condition. The presence of venous outflow with occlusion at rest and exercise was also investigated. Methods: Twenty-three subjects visited the lab on 3 occasions. First to determine linearity of blood flow using 0% to 90% arterial occlusion pressure (AOP), and venous outflow at rest and during exercise with cuff inflated to 40% AOP. Subsequent visits compared blood flow between rest and PE conditions to determine average blood flow, heart rate, systolic and diastolic blood pressure changes in response to a blood flow-restricted (BFR) exercise protocol. Results: Blood flow/pressure relationship is nonlinear at the superficial femoral artery (p < 0.01). No significant differences in average blood flow, conductance or mean arterial pressure (MAP) were found between 30% to 80% AOP (p = 1.0 to .08). Blood flow is not significantly different between rest and PE groups (p = 0.49) although initial 40% AOP and 40% exercise arterial occlusion pressure (EAOP) values were different between rest and PE groups. (p < 0.01). Conclusion: The nonlinear relationship at the superficial femoral artery demonstrates higher cuff pressures are not necessary to reduce blood flow in BFR exercise of the lower extremity. Furthermore, PE or warm-up is not necessary prior to determining EAOP as it does not alter blood flow responses during BFR exercise. We found evidence of venous outflow above the cuff both at rest and during exercise at 40% AOP.