Search results for: knee replacement

Authors: Che Hsiu Chen, Kuo Wei Tseng, Zih Jian Huang, Hon Wen Cheng

Abstract:

A typical warm-up contains both stretching exercises and jogging. The static stretching prior to training or competition may cause detrimental effects to athletic performance. However, it is unclear whether different types of dynamic stretching exercises had different acute effects on knee flexors stiffness, flexibility, and strength. The purpose of this study was to analyze the knee flexors stiffness, flexibility, and strength gains after dynamic straight leg raise (DSLR) and dynamic modified toe-touch (MTT) stretching. Sixteen healthy university active men (height 176.27 ± 4.03 cm; weight 72.27 ± 8.90 kg; age 22.09 ± 2.31 years). After 5 minutes (8km/h) of running subjects performed 2 randomly ordered stretching protocols: DSLR and MTT stretching protocols. There were a total of six, 30 seconds bouts of dynamic stretching (15 repetitions) with 30seconds rest between bouts. The outcome measures were maximal voluntary isokinetic concentric hamstring strength (60°/s), muscle flexibility test by passive straight leg raise (PSLR), active straight leg raise (ASLR), and muscle stiffness using ultrasound Acoustic Radiation Forced Impulse (ARFI) elastography before and immediately after stretching. The muscle stiffness and concentric strength decreased significantly (p < .05), the flexibility no significant change after DSLR protocol (p > .05). The concentric strength decreased significantly (p < .05), the flexibility and muscle stiffness no significant change after MTT protocol (p > .05), whereas no significant differences were found for the DSLR and MTT. Our findings suggest that dynamic stretching (30s x 6 bouts) resulted in change in muscle stiffness or may be induced slack in the musculotendinous unit thereby, reducing force production. Therefore, 30s x 6 bouts of dynamic stretching adversely affects efforts of hamstring muscle maximal concentric strength.

Keywords: sport injury, ultrasound, eccentric exercise, performance

Procedia PDF Downloads 258

Authors: Dang Hanh Nguyen, Nassim Sebaibi, Mohamed Boutouil, Lydia Leleyter, Fabienne Baraud

Abstract:

Pervious concrete is a green alternative to conventional pavements with minimal fine aggregate and a high void content. Pervious concrete allows water to infiltrate through the pavement, thereby reducing the runoff and the requirement for stormwater management systems. Seashell By-Products (SBP) are produced in an important quantity in France and are considered as waste. This work investigated to use SBP in pervious concrete and produce an even more environmentally friendly product, Pervious Concrete Pavers. The research methodology involved substituting the coarse aggregate in the previous concrete mix design with 20%, 40% and 60% SBP. The testing showed that pervious concrete containing less than 40% SBP had strengths, permeability and void content which are comparable to the pervious concrete containing with only natural aggregate. The samples that contained 40% SBP or higher had a significant loss in strength and an increase in permeability and a void content from the control mix pervious concrete. On the basis of the results in this research, it was found that the natural aggregate can be substituted by SBP without affecting the delicate balance of a pervious concrete mix. Additional, it is recommended that the optimum replacement percentage for SBP in pervious concrete is 40 % direct replacement of natural coarse aggregate while maintaining the structural performance and drainage capabilities of the pervious concrete.

Keywords: seashell by-products, pervious concrete pavers, permeability, mechanical strength

Procedia PDF Downloads 449

Authors: Giwrgos S. Gkarmpounis, Aikaterini G. Rokkou, Marios N. Moschakis

Abstract:

Increased energy consumption in the academic buildings, creates the need to implement energy saving measures and to take advantage of the renewable energy sources to cover the electrical needs of those buildings. An Academic Library will be used as a case study. With the aid of RETScreen software that takes into account the energy consumptions and characteristics of the Library Building, it is proved that measures such as the replacement of fluorescent lights with led lights, the installation of outdoor shading, the replacement of the openings and Building Management System installation, provide a high level of energy savings. Moreover, given the available space of the building and the climatic data, the installation of a photovoltaic system of 100 kW can also cover a serious amount of the building energy consumption, unlike a wind system that seems uncompromising. Lastly, HOMER software is used to compare the use of a photovoltaic system against a wind system in order to verify the results that came up from the RETScreen software concerning the renewable energy sources.

Keywords: building sector, energy saving measures, energy upgrading, homer software, renewable energy sources, RETScreen software

Procedia PDF Downloads 198

Authors: Yaniv Knop, Alva Peled

Abstract:

Over the past few years there has been a growing interest in the development of Portland Composite Cement, by partial replacement of the clinker with mineral additives. The motivations to reduce the clinker content are threefold: (1) Ecological - due to lower emission of CO2 to the atmosphere; (2) Economical - due to cost reduction; and (3) Scientific\Technology – improvement of performances. Among the mineral additives being used and investigated, limestone is one of the most attractive, as it is considered natural, available, and with low cost. The goal of the research is to develop green cement, by partial replacement of the clinker with limestone powder while improving the performances of the cement paste. This work studied blended cements with three limestone powder particle diameters: smaller than, larger than, and similarly sized to the clinker particle. Blended cement with limestone consisting of one particle size distribution and limestone consisting of a combination of several particle sizes were studied and compared in terms of hydration rate, hydration degree, and water demand to achieve normal consistency. The performances of these systems were also compared with that of the original cement (without added limestone). It was found that the ability to replace an active material with an inert additive, while achieving improved performances, can be obtained by increasing the packing density of the cement-based particles. This may be achieved by replacing the clinker with limestone powders having a combination of several different particle size distributions. Mathematical and physical models were developed to simulate the setting history from initial to final setting time and to predict the packing density of blended cement with limestone having different sizes and various contents. Besides the effect of limestone, as inert additive, on the packing density of the blended cement, the influence of the limestone particle size on three different chemical reactions were studied; hydration of the cement, carbonation of the calcium hydroxide and the reactivity of the limestone with the hydration reaction products. The main results and developments will be presented.

Keywords: packing density, hydration degree, limestone, blended cement

Procedia PDF Downloads 257

Authors: Salah A. Aly, Mohammed A. Ibrahim, Mostafa M. khttab

Abstract:

The amount of construction and demolition (C&D) waste has increased considerably over the last few decades. From the viewpoint of environmental preservation and effective utilization of resources, crushing C&D concrete waste to produce coarse aggregate (CA) with different replacement percentage for the production of new concrete is one common means for achieving a more environment-friendly concrete. In the study presented herein, the investigation was conducted in two phases. In the first phase, the selection of the materials was carried out and the physical, mechanical and chemical characteristics of these materials were evaluated. Different concrete mixes were designed. The investigation parameter was Recycled Concrete Aggregate (RCA) ratios. The mechanical properties of all mixes were evaluated based on compressive strength and workability results. Accordingly, two mixes have been chosen to be used in the next phase. In the second phase, the study of the structural behavior of the concrete beams was developed. Sixteen beams were casted to investigate the effect of RCA ratios, the shear span to depth ratios and the effect of different locations and reinforcement of openings on the shear behavior of the tested specimens. All these beams were designed to fail in shear. Test results of the compressive strength of concrete indicated that, replacement of natural aggregate by up to 50% recycled concrete aggregates in mixtures with 350 Kg/m3 cement content led to increase of concrete compressive strength. Moreover, the tensile strength and the modulus of elasticity of the specimens with RCA have very close values to those with natural aggregates. The ultimate shear strength of beams with RCA is very close to those with natural aggregates indicating the possibility of using RCA as partial replacement to produce structural concrete elements. The validity of both the Egyptian Code for the design and implementation of Concrete Structures (ECCS) 203-2007 and American Concrete Institute (ACI) 318-2011Codes for estimating the shear strength of the tested RCA beams was investigated. It was found that the codes procedures gives conservative estimates for shear strength.

Keywords: construction and demolition (C&D) waste, coarse aggregate (CA), recycled coarse aggregates (RCA), opening

Procedia PDF Downloads 369

Authors: Ghulam Hussain, Herrington Lee, Comfort Paul, Jones Richard

Abstract:

Background: To determine the functional limitations of the lower limbs or readiness to return to sport, most rehabilitation programs use some form of testing; however, it is still unknown what the pass criteria is. This study aims to investigate the differences between the dominant and non-dominant leg performances across several lower limb tasks, which are hop tests, two-dimensional (2D) frontal plane projection angle (FPPA) tests, and isokinetic muscle tests. This study also provides the reference values for the limb symmetry index (LSI) for the hop and isokinetic muscle strength tests. Twenty recreationally active participants were recruited, 11 males and 9 females (age 23.65±2.79 years; height 169.9±3.74 cm; and body mass 74.72±5.81 kg. All tests were undertaken on the dominant and non-dominant legs. These tests are (1) Hop tests, which include horizontal hop for distance and crossover hop tests, (2) Frontal plane projection angle (FPPA): 2D capturing from two different tasks, which are forward hop landing and squatting, and (3) Isokinetic muscle strength tests: four different muscles were tested: quadriceps, hamstring, ankle plantar flexor, and hip extensor muscles. The main outcome measurements were, for the (1) hop tests: maximum distance was taken when undertaking single/crossover hop for distance using a standard tape measure, (2) for the FPPA: the knee valgus angle was measured from the maximum knee flexion position using a single 2D camera, and (3) for the isokinetic muscle strength tests: three different variables were measured: peak torque, peak torque to body weight, and the total work to body weight. All the muscle strength tests have been applied in both concentric and eccentric muscle actions at a speed of 60°/sec. This study revealed no differences between the dominant and non-dominant leg performance, and 85% of LSI was achieved by the majority of the subjects in both hop and isokinetic muscle tests, and; therefore, one leg’s hop performance can define the other.

Keywords: 2D FPPA, hop tests, isokinetic testing, LSI

Procedia PDF Downloads 32

Authors: Belalia Douma Omar, Bakhta Boukhatem, Mohamed Ghrici

Abstract:

Self-compacting concrete (SCC) developed in Japan in the late 80s has enabled the construction industry to reduce demand on the resources, improve the work condition and also reduce the impact of environment by elimination of the need for compaction. Fuzzy logic (FL) approaches has recently been used to model some of the human activities in many areas of civil engineering applications. Especially from these systems in the model experimental studies, very good results have been obtained. In the present study, a model for predicting compressive strength of SCC containing various proportions of fly ash, as partial replacement of cement has been developed by using Adaptive Neuro-Fuzzy Inference System (ANFIS). For the purpose of building this model, a database of experimental data were gathered from the literature and used for training and testing the model. The used data as the inputs of fuzzy logic models are arranged in a format of five parameters that cover the total binder content, fly ash replacement percentage, water content, super plasticizer and age of specimens. The training and testing results in the fuzzy logic model have shown a strong potential for predicting the compressive strength of SCC containing fly ash in the considered range.

Keywords: self-compacting concrete, fly ash, strength prediction, fuzzy logic

Procedia PDF Downloads 305

Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

Abstract:

Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

Procedia PDF Downloads 386

Authors: Viviana Letelier, Ester Tarela, Bianca Lopez, Pedro Muñoz, Giacomo Moriconi

Abstract:

The environmental impact has become a global concern during the last decades. Several alternatives have been proposed and studied to minimize this impact in different areas. The reuse of aggregates from old concretes to manufacture new ones not only can reduce this impact but is also a way to optimize the resource management. The effect of the origin of the reused aggregates from two different origin materials in recycled concrete pavement is studied here. Using the dosing applied by a pavement company, coarse aggregates in the 6.3-25 mm fraction are replaced by recycled aggregates with two different origins: old concrete pavements with similar origin strength to the one of the control concrete, and precast concrete pipes with smaller strengths than the one of the control concrete. The replacement percentages tested are 30%, 40% and 50% in both cases. The compressive strength tests are performed after 7, 14, 28 and 90 curing days, the flexural strength tests and the elasticity modulus tests after 28 and 90 curing days. Results show that the influence of the quality of the origin concrete in the mechanical properties of recycled concretes is not despicable. Concretes with up to a 50% of recycled aggregates from the concrete pavement have similar compressive strengths to the ones of the control concrete and slightly smaller flexural strengths that, however, in all cases exceed the minimum of 5MPa after 28 curing days stablished by the Chilean regulation for pavement concretes. On the other hand, concretes with recycled aggregates from precast concrete pipes show significantly lower compressive strengths after 28 curing days. The differences with the compressive strength of the control concrete increase with the percentage of replacement, reaching a 13% reduction when 50% of the aggregates are replaced. The flexural strength also suffers significant reductions that increase with the percentage of replacement, only obeying the Chilean regulation when 30% of the aggregates are recycled after 28 curing days. Nevertheless, after 90 curing days, all series obey the regulation requirements. Results show, not only the importance of the quality of the origin concrete, but also the significance of the curing days, that may allow the use of less quality recycled material without important strength losses.

Keywords: flexural strength of recycled concrete., mechanical properties of recycled concrete, recycled aggregates, recycled concrete pavements

Procedia PDF Downloads 220

Authors: Nacim Khelil, Amar Kahil, Said Boukais

Abstract:

The aim of the present study is to investigate the changes in the mechanical properties of mortars including additions of Condensed Silica Fume (CSF), Hydrated Lime (CH) or both at various amounts (5% to 15% of cement replacement) and high water ratios (w/b) (0.4 to 0.7). The physical and mechanical changes in the mixes were evaluated using non-destructive tests (Ultrasonic Pulse Velocity (UPV)) and destructive tests (crushing tests) on 28 day-long specimens consecutively, in order to assess CSF and CH replacement rate influence on the mechanical and physical properties of the mortars, as well as CSF-CH pre-mixing on the improvement of these properties. A significant improvement of the mechanical properties of the CSF, CSF-CH mortars, has been noted. CSF-CH mixes showed the best improvements exceeding 50% improvement, showing the sizable pozzolanic reaction contribution to the specimen strength development. UPV tests have shown increased velocities for CSF and CSH mixes, however no proportional evolution with compressive strengths could be noted. The results of the study show that CSF-CH addition could represent a suitable solution to significantly increase the mechanical properties of mortars.

Keywords: compressive strength, condensed silica fume, hydrated lime, pozzolanic reaction, UPV testing

Procedia PDF Downloads 120

Authors: Saeed Ilbeigi, Bart Van Gheluwe

Abstract:

The purpose of this study was to identify the three-dimensional kinematics of the sprint start during the start phase of the sprint. The purpose of this study was to identify the three-dimensional kinematics of the sprint start during the start phase of the sprint. Moreover, the effect of anthropometrical factors such as skeletal muscle mass, thigh girth, and calf girth also were considered on the kinematics of the sprint start. Among all young sprinters involved in the national Belgium league, sixty sprinters (boys: 14.7 ± 1.8 years and girls: 14.8±1.5 years) were randomly selected. The kinematics data of the sprint start were collected with a Vicon® 620 motion analysis system equipped with 12 infrared cameras running at 250 Hz and running the Vicon Data Station software. For statistical analysis, T-tests and ANOVA׳s with Scheffé post hoc test were used and the significant level was set as p≤0.05. The results showed that the angular positions of the lower joints of the young sprinters in the set position were comparable with adult figures from literature, however, with a greater range of joint extension. The most significant difference between boys and girls was found in the set position, where the boys presented a more dorsiflexed ankle. No further gender effect was observed during the leaving the blocks and contact phase. The sprinters with a higher age, skeletal muscle mass, thigh girth, and calf girth displayed a better angular position of the lower joints (e.g. ankle, knee, hip) in the set position, a more optimal angular position for the foot and knee for absorbing impact forces at foot contact and finally a higher range of flexion/extension motion to produce force and power when leaving the blocks.

Keywords: anthropometry, kinematics, sprint start, young elite sprinters

Procedia PDF Downloads 194

Authors: Satpal Yadav, Ashish Phulkar, Krishna K. Sahu

Abstract:

Aim: The research aims at doing a 3 Dimension biomechanical analysis in the shot put techniques of International throwers to evaluate the performance. Research Method: The researcher adopted the descriptive method and the data was subjected to calculate by using Pearson’s product moment correlation for the correlation of the biomechanical parameters with the performance of shot put throw. In all the analyses, the 5% critical level (p ≤ 0.05) was considered to indicate statistical significance. Research Sample: Eight (N=08) international shot putters using rotational/glide technique in male category was selected as subjects for the study. The researcher used the following methods and tools to obtain reliable measurements the instrument which was used for the purpose of present study namely the tesscorn slow-motion camera, specialized motion analyzer software, 7.260 kg Shot Put (for a male shot-putter) and steel tape. All measurement pertaining to the biomechanical variables was taken by the principal investigator so that data collected for the present study was considered reliable. Results: The finding of the study showed that negative significant relationship between the angular velocity right shoulder, acceleration distance at pre flight (-0.70), (-0.72) respectively were obtained, the angular displacement of knee, angular velocity right shoulder and acceleration distance at flight (0.81), (0.75) and (0.71) respectively were obtained, the angular velocity right shoulder and acceleration distance at transition phase (0.77), (0.79) respectively were obtained and angular displacement of knee, angular velocity right shoulder, release velocity shot, angle of release, height of release, projected distance and measured distance as the values (0.76), (0.77), (-0.83), (-0.79), (-0.77), (0.99) and (1.00) were found higher than the tabulated value at 0.05 level of significance. On the other hand, there exists an insignificant relationship between the performance of shot put and acceleration distance [m], angular displacement shot, C.G at release and horizontal release distance on the technique of shot put.

Keywords: biomechanics, analysis, shot put, international throwers

Procedia PDF Downloads 163

Authors: Saeed Ghali, Hoda El-Faramawy, Mamdouh Eissa, Michael Mishreky

Abstract:

Scale-resistant austenitic stainless steel, X45CrNiW 18-9, has been developed, and modified steels produced through partial and total nickel replacement by nitrogen. These modified steels were produced in a 10 kg induction furnace under different nitrogen pressures and were cast into ingots. The produced modified stainless steels were forged, followed by air cooling. The phases of modified stainless steels have been investigated using the Schaeffler diagram, dilatometer, and microstructure observations. Both partial and total replacement of nickel using 0.33-0.50% nitrogen are effective in producing fully austenitic stainless steels. The nitrogen contents were determined and compared with those calculated using the Institute of Metal Science (IMS) equation. The results showed great deviations between the actual nitrogen contents and predicted values through IMS equation. So, an equation has been derived based on chemical composition, pressure, and temperature at 1600oC. [N%] = 0.0078 + 0.0406*X, where X is a function of chemical composition and nitrogen pressure. The derived equation has been used to calculate the nitrogen content of different steels using published data. The results reveal the difficulty of deriving a general equation for the prediction of nitrogen content covering different steel compositions. So, it is necessary to use a narrow composition range.

Keywords: solubility, nitrogen, stainless steel, Schaeffler

Procedia PDF Downloads 205

Authors: Hassnen M. Jafer, W. Atherton, F. Ruddock, E. Loffill

Abstract:

This study represents the results of an experimental work using two types of fly ashes as a cement replacement in soft soil stabilisation. The fly ashes (FA1 and FA2) used in this study are by-products resulting from an incineration processes between 800 and 1200 ˚C. The stabilised soil in this study was an intermediate plasticity silty clayey soil with medium organic matter content. The experimental works were initially conducted on soil treated with different percentages of FA1 (0, 3, 6, 9, 12, and 15%) to identify the optimum FA1 content. Then FA1 was chemically activated by FA2 which has high alkalinity by blending the optimum content of FA1 with different portions of FA2. The improvement levels were evaluated dependent on the results obtained from consistency limits and compaction tests along with the results of unconfined compressive strength (UCS) tests which were conducted on specimens of soil treated with FA1 and FA2 and exposed to different periods of curing (zero, 7, 14, and 28 days). The results indicated that the FA1 and FA2 used in this study effectively improved the physical and geotechnical properties of the soft soil where the index of plasticity (IP) was decreased significantly from 21 to 13.17 with 12% of FA1; however, there was a slight increase in IP with the use of FA2. Meanwhile, 12% of FA1 was identified as the optimum percentage improving the UCS of stabilised soil significantly. Furthermore, FA2 was found effective as a chemical activator to FA1 where the UCS was improved significantly after using FA2.

Keywords: fly ashes, soft soil stabilisation, waste materials, unconfined compressive strength

Procedia PDF Downloads 210

Authors: S. U. Khan, T. Ayub, N. Shafiq

Abstract:

The properties of locally produced metakaolin (MK) as cement replacing material and the comparison of reactivity with commercially available micro-silica have been investigated. Compressive strength, splitting tensile strength, and load-deflection behaviour under bending are the properties that have been studied. The amorphous phase of MK with micro-silica was compared through X-ray diffraction (XRD) pattern. Further, interfacial transition zone of concrete with micro-silica and MK was observed through Field Emission Scanning Electron Microscopy (FESEM). Three mixes of concrete were prepared. One of the mix is without cement replacement as control mix, and the remaining two mixes are 10% cement replacement with micro-silica and MK. It has been found that MK, due to its irregular structure and amorphous phase, has high reactivity with portlandite in concrete. The compressive strength at early age is higher with MK as compared to micro-silica. MK concrete showed higher splitting tensile strength and higher load carrying capacity as compared to control and micro-silica concrete at all ages respectively.

Keywords: metakaolin, compressive strength, splitting tensile strength, load deflection, interfacial transition zone

Procedia PDF Downloads 179

Authors: Varsha Chorsiya, Pooja Aneja, Dhananjay Kaushik, Abhinav Yadav

Abstract:

Intoduction: Women’s Health Initiatives (WHI) focuses on defining the risks and benefits of strategies that could potentially reduce the incidence of obesity, heart disease, breast cancer and colorectal cancer, and fractures in menopause women. The utility of the present research work determines to find the role of Hormone Replacement Therapy (HRT) in changing the different component of body composition during perimenopause period. Methods: A comparative cross-sectional study included 30 subjects, aged between 40 and 50 years which were assigned into 2 groups i.e. 15 subjects in HRT (Group A) and 15 subjects in non-HRT (Group B). The subjects were taken from the hospitals and clinics of Faridabad undergoing HRT in supervision of the consultant gynecologist. The informed consents were signed before including the participants in the study. The body composition and lipid profile were evaluated for all the subjects. Result and Discussion: The BMI, body density, percent body fats and fat mass in both groups showed statistically significant differences i.e. p < 0.05. Our study did not reveal any statistically significant difference between non-HRT and HRT for lipid profile composition of HDL, LDL, VLDL, ratio, triglycerides and total cholesterol although these indicators (LDL, VLDL, ratio, triglycerides and total cholesterol) showed difference clinically with a higher mean values for non-HRT as compared to HRT group. The mean value for HDL was higher for HRT group in contrast to non-HRT group. The result clearly showed that HRT group has a good lipid profile composition. Conclusion: In conclusion, our data show that HRT has statistically significant role in determining BMI, fat percent mass and fat mass. The lipid profile including LDL, HDL, VLDL, ratio, triglycerides and total cholesterol found to be clinically better in HRT group as compared to the non-HRT group. The rationale for non-significant lipid profile probably lie in the fact that hormonal changes need a particular time period and might become significant in post-menopausal period.

Keywords: body composition, hormone replacement therapy, perimenopause, women health

Procedia PDF Downloads 269

Authors: Alena O. Stepanova, Vera S. Chernonosova, Tatyana S. Godovikova, Konstantin A. Bulatov, Andrey Y. Patrushev, Pavel P. Laktionov

Abstract:

Trauma and arthrosis, not to mention cartilage destruction in overweight and elders put hyaline cartilage lesion among the most frequent diseases of locomotor system. These problems combined with low regeneration potential of the cartilage make regeneration of articular cartilage a high-priority task of tissue engineering. Many types of matrices, the procedures of their installation and autologous chondrocyte implantation protocols were offered, but certain aspects including adhesion of the implant with surrounding cartilage/bone, prevention of the ossification and fibrosis were not resolved. Simplification and acceleration of the procedures resulting in restoration of normal cartilage are also required. We have demonstrated that human chondroblasts can be successfully cultivated at the surface of electrospun scaffolds and produce extracellular matrix components in contrast to chondroblasts grown in homogeneous hydrogels. To restore cartilage we offer to use stacks of electrospun scaffolds fixed with photopolymerized solution of prepared from gelatin and chondroitin-4-sulfate both modified by glycidyl methacrylate and non-toxic photoinitator Darocur 2959. Scaffolds were prepared from nylon 6, polylactide-co-glicolide and their mixtures with modified gelatin. Illumination of chondroblasts in photopolymerized solution using 365 nm LED light had no effect on cell viability at compressive strength of the gel less than0,12 MPa. Stacks of electrospun scaffolds provide good compressive strength and have the potential for substitution with cartilage when biodegradable scaffolds are used. Vascularization can be prevented by introduction of biostable scaffolds in the layers contacting the subchondral bone. Studies of two-component materials (2-3 sheets of electrospun scaffold) implanted in the knee-joints of rabbits and fixed by photopolymerization demonstrated good crush resistance, biocompatibility and good adhesion of the implant with surrounding cartilage. Histological examination of the implants 3 month after implantation demonstrates absence of any inflammation and signs of replacement of the biodegradable scaffolds with normal cartilage. The possibility of intraoperative population of the implants with autologous cells is being investigated.

Keywords: chondroblasts, electrospun scaffolds, hyaline cartilage, photopolymerized gel

Procedia PDF Downloads 249

Authors: Iveta Nováková, Martin-Andrè S. Husby, Boy-Arne Buyle

Abstract:

The building industry has one of the most significant contributions to global warming due to the production of building materials, transportation, building activities, and demolition of structures when they reach the end of their life. Implementation of circular material flow and circular economy can significantly reduce greenhouse gasses and simultaneously reduce the need for natural resources. The use of recycled concrete aggregates (RCA) is one of the possibilities for reducing the depletion of raw materials for concrete production. Concrete is the most used building material worldwide, and aggregates constitute 70% of its volume. RCA can replace a certain amount of natural aggregates (NA), and concrete will still perform as required. The aim of this scientific paper is to evaluate RCA properties with and without mechanical treatment. Analysis of RCA itself will be followed by compressive strength of concrete containing various amounts of treated and non-treated RCA. Results showed improvement in compressive strength of the mix with mechanically treated RCA compared to standard RCA, and even the strength of concrete with mechanically treated RCA in dose 50% of coarse aggregates was higher than the reference mix by 4%. Based on obtained results, it can be concluded that integration of RCA in industrial concrete production is feasible, at a replacement ratio of 50% for mechanically treated RCA and 30% if untreated RCA is used, without affecting the compressive strength negatively.

Keywords: recycled concrete aggregates, mechanical treatment, aggregate properties, compression strength

Procedia PDF Downloads 206

Authors: Prakash Parasivamurthy, Vivek Rama Das, Ravikant Talluri, Veena Jawali

Abstract:

India ranks among third in the production of coconut besides Philippines and Indonesia. About 92% of the total production in the country is contributed from four southern states especially, Kerala (45.22%), Tamil Nadu (26.56%), Karnataka (10.85%), and Andhra Pradesh (8.93%). Other states, such as Goa, Maharashtra, Odisha, West Bengal, and those in the northeast (Tripura and Assam) account for the remaining 8.44%. The use of coconut shell as coarse aggregate in concrete has never been a usual practice in the industry, particularly in areas where light weight concrete is required for non-load bearing walls, non-structural floors, and strip footings. The high cost of conventional building materials is a major factor affecting construction delivery in India. In India, where abundant agricultural and industrial wastes are discharged, these wastes can be used as potential material or replacement material in the construction industry. This will have double the advantages viz., reduction in the cost of construction material and also as a means of disposal of wastes. Therefore, an attempt has been made in this study to utilize the coconut shell (CS) as coarse aggregate in rigid pavement. The present study was initiated with the characterization of materials by the basic material testing. The casted moulds are cured and tests are conducted for hardened concrete. The procedure is continued with determination of fck (Characteristic strength), E (Modulus of Elasticity) and µ (Poisson Value) by the test results obtained. For the analytical studies, rigid pavement was modeled by the KEN PAVE software, finite element software developed specially for road pavements and simultaneously design of rigid pavement was carried out with Indian standards. Results show that physical properties of CSAC (Coconut Shell Aggregate Concrete) with 10% replacement gives better results. The flexural strength of CSAC is found to increase by 4.25% as compared to control concrete. About 13 % reduction in pavement thickness is observed using optimum coconut shell.

Keywords: coconut shell, rigid pavement, modulus of elasticity, poison ratio

Procedia PDF Downloads 204

Authors: I. M. K. Ho, S. K. Y. Chan, K. H. P. Lam, G. M. W. Tong, N. C. Y. Yeung, J. T. C. Luk

Abstract:

Low-dye taping (LDT) is commonly used for treating foot problems, such as plantar fasciitis, and supporting foot arch for runners and non-athletes patients with pes planus. The potential negative impact of pronated feet leading to tibial and femoral internal rotation via the entire kinetic chain reaction was postulated and identified. The changed lower limb biomechanics potentially leading to poor activation of hip and knee stabilizers, such as gluteus maximus and medius, may associate with higher risk of knee injuries including patellofemoral pain syndrome and ligamentous sprain in many team sports players. It is therefore speculated that foot arch correction with LDT might enhance the use of gluteal muscles. The purpose of this study was to investigate the effect of applying LDT on surface electromyographic (sEMG) activity of superior gluteus maximus (SGMax), inferior gluteus maximus (IGMax), gluteus medius (GMed) and tibialis anterior (TA) during double-leg squat. 12 male collegiate basketball players (age: 21.72.5 years; body fat: 12.43.6%; navicular drop: 13.72.7mm) with at least three years regular basketball training experience participated in this study. Participants were excluded if they had recent history of lower limb injuries, over 16.6% body fat and lesser than 10mm drop in navicular drop (ND) test. Recruited subjects visited the laboratory once for the within-subject crossover study. Maximum voluntary isometric contraction (MVIC) tests on all selected muscles were performed in randomized order followed by sEMG test on double-leg squat during LDT and non-LDT conditions in counterbalanced order. SGMax, IGMax, GMed and TA activities during the entire 2-second concentric and 2-second eccentric phases were normalized and interpreted as %MVIC. The magnitude of the difference between taped and non-taped conditions of each muscle was further assessed via standardized effect90% confidence intervals (CI) with non-clinical magnitude-based inference. Paired samples T-test showed a significant decrease (4.71.4mm) in ND (95% CI: 3.8, 5.6; p < 0.05) while no significant difference was observed between taped and non-taped conditions in sEMG tests for all muscles and contractions (p > 0.05). On top of traditional significant testing, magnitude-based inference showed possibly increase in IGMax activity (small standardized effect: 0.270.44), likely increase in GMed activity (small standardized effect: 0.340.34) and possibly increase in TA activity (small standardized effect: 0.220.29) during eccentric phase. It is speculated that the decrease of navicular drop supported by LDT application could potentially enhance the use of inferior gluteus maximus and gluteus medius especially during eccentric phase in this study. As the eccentric phase of double-leg squat is an important component of landing activities in basketball, further studies on the onset and amount of gluteal activation during jumping and landing activities with LDT are recommended. Since both hip and knee kinematics were not measured in this study, the underlying cause of the observed increase in gluteal activation during squat after LDT is inconclusive. In this regard, the investigation of relationships between LDT application, ND, hip and knee kinematics, and gluteal muscle activity during sports specific jumping and landing tasks should be focused in the future.

Keywords: flat foot, gluteus maximus, gluteus medius, injury prevention

Procedia PDF Downloads 130

Authors: Cathy SW. Chow, Kristina Shin, Faming Wang, B. C. L. So

Abstract:

During some dynamic giant puppet performances, an ergonomically designed load carrier system is necessary for the puppeteers to carry a giant puppet body’s heavy load with minimum muscle stress. A load carrier (i.e. prototype) was designed with two small wheels on the foot; and a hybrid spring device on the knee in order to assist the sliding and knee bending movements respectively. Thus, the purpose of this study was to evaluate the effect of three load carriers including two other commercially available load mounting systems, Tepex and SuitX, and the prototype. Ten male participants were recruited for the experiment. Surface electromyography (sEMG) was used to collect the participants’ muscle activities during forward moving and bouncing and with and without load of 11.1 kg that was 60 cm above the shoulder. Five bilateral muscles including the lumbar erector spinae (LES), rectus femoris (RF), bicep femoris (BF), tibialis anterior (TA), and gastrocnemius (GM) were selected for data collection. During forward moving task, the sEMG data showed smallest muscle activities by Tepex harness which exhibited consistently the lowest, compared with the prototype and SuitX which were significantly higher on left LES 68.99% and 64.99%, right LES 26.57% and 82.45%; left RF 87.71% and 47.61%, right RF 143.57% and 24.28%; left BF 80.21% and 22.23%, right BF 96.02% and 21.83%; right TA 6.32% and 4.47%; left GM 5.89% and 12.35% respectively. The result above reflected mobility was highly restricted by tested exoskeleton devices. On the other hand, the sEMG data from bouncing task showed the smallest muscle activities by prototype which exhibited consistently the lowest, compared with the Tepex harness and SuitX which were significantly lower on lLES 6.65% and 104.93, rLES 23.56% and 92.19%; lBF 33.21% and 93.26% and rBF 24.70% and 81.16%; lTA 46.51% and 191.02%; rTA 12.75% and 125.76%; IGM 31.54% and 68.36%; rGM 95.95% and 96.43% respectively.

Keywords: exoskeleton, giant puppet performers, load carriage system, surface electromyography

Procedia PDF Downloads 77

Authors: S. M. A. Ismail, M. I. Ibrahim, H. Masdar, F. M. Effendi, M. F. Suhaimi, A. Suun

Abstract:

Introduction: It is generally known that the rehabilitation process is as important as the reconstruction surgery. Several literature has focused on how early the rehabilitation modalities can be initiated after the surgery to ensure a safe return of patients to sports or at least regaining the pre-injury level of function following an ACL reconstruction. Objectives: The main objective is to study and evaluate the outcome of early balance exercises and agility training in sports rehabilitation for patients post ACL reconstruction. To compare between early balance exercises and agility training as intervention and control. (material or non-material). All of them were recruited for material exercise (balance exercises and agility training with strengthening) and strengthening only rehabilitation protocol (non-material). Followed the prospective intervention trial. Materials and Methods: Post-operative ACL reconstruction patients performed in Selayang and Sg Buloh Hospitals from 2012 to 2014 were selected for this study. They were taken from Malaysian Knee Ligament Registry (MKLR) and all patients had single bundle reconstruction with autograft hamstring tendon (semitendinosus and gracilis). ACL injury from any type of sports were included. Subjects performed various type of physical activity for rehabilitation in every 18 week for a different type of rehab activity. All subject attended all 18 sessions of rehabilitation exercises and evaluation was done during the first, 9th and 18th session. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Rehabilitation protocol initiated from 24 week after the surgery. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Results and Discussion: 100 patients were selected of which 94 patients are male and 6 female. Age range is 18 to 54 year with the average of 28 years old for included 100 patients. All patients are evaluated after 24 week after the surgery. 50 of them were recruited for material exercise (balance exercises and agility training with strengthening) and 50 for strengthening only rehabilitation protocol (non-material). Demographically showed 85% suffering sports injury mainly from futsal and football. 39 % of them have abnormal BMI (26 – 38) and involving of the left knee. 100% of patient had the basic radiographic x-ray of knee and 98% had MRI. All patients had negative anterior drawer’s, Lachman test and Pivot shift test during the post ACL reconstruction after the complete rehabilitation. There was 95 subject sustained grade I injury, 5 of grade II and 0 of grade III with 90% of them had soft end-point. Overall they scored badly on presentation with 53% of Lysholm score (poor) and Tegner activity score level 3/10. After completing 9 weeks of exercises, of material group 90% had grade I laxity, 75% with firm end-point, Lysholm score 71% (fair) and Tegner activity level 5/10 comparing non-material group who had 62% of grade I laxity , 54% of firm end-point, Lyhslom score 62 % (poor) and Tegner activity level 4/10. After completed 18 weeks of exercises, of material group maintained 90% grade I laxity with 100 % with firm end-point, Lysholm score increase 91% (excellent) and Tegner activity level 7/10 comparing non-material group who had 69% of grade I laxity but maintained 54% of firm end-point, Lysholm score 76% (fair) and Tegner activity level 5/10. These showed the improvement were achieved fast on material group who have achieved satisfactory level after 9th cycle of exercises 75% (15/20) comparing non-material group who only achieved 54% (7/13) after completed 18th session. Most of them were grade I. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. Conclusions: The basic approach in ACL rehabilitation is to ensure return to sports at post-operative 6 month. Grade I and II laxity has favourable and early satisfactory outcome base on clinical assessment and Lysholm and Tegner scoring point. Reduction of laxity grading indicates satisfactory outcome. Firm end-point showed the adequacy of rehabilitation before starting previous sports game. Material exercise (balance exercises and agility training with strengthening) were beneficial and reliable in order to achieve favourable and early satisfactory outcome comparing strengthening only (non-material).We have identified that rehabilitation protocol varies between different patients. Therefore future post ACL reconstruction rehabilitation guidelines should look into focusing on rehabilitation techniques instead of time.

Keywords: post anterior cruciate ligament (ACL) reconstruction, single bundle, hamstring tendon, sports rehabilitation, balance exercises, agility balance

Procedia PDF Downloads 230

Authors: Shams Ul Khaliq, Khan Shahzada, Bashir Alam, Fawad Bilal, Mushtaq Zeb, Faizan Akbar

Abstract:

Marble industry contributes its fair share in environmental deterioration, producing voluminous amounts of mud and other excess residues obtained from marble and granite processing, polluting soil, water and air. Reusing these products in other products will not just prevent our environment from polluting but also help with economy. In this research, an attempt has been made to study the expediency of waste Marble Powder (MP) in concrete production. Various laboratory tests were performed to investigate permeability, physical and mechanical properties, such as slump, compressive strength, split tensile test, etc. Concrete test samples were fabricated with varying MP content (replacing 5-30% cement), furnished from two different sources. 5% replacement of marble dust caused 6% and 12% decrease in compressive and tensile strength respectively. These parameters gradually decreased with increasing MP content up to 30%. Most optimum results were obtained with 10% replacement. Improvement in consistency and permeability were noticed. The permeability was improved with increasing MP proportion up to 10% without substantial decrease in compressive strength. Obtained results revealed that MP as an alternative to cement in concrete production is a viable option considering its economic and environment friendly implications.

Keywords: marble powder, strength, permeability, consistency, environment

Procedia PDF Downloads 303

Authors: Mojtaba Ahmadabadi, Akbar Masoudi, Morteza Rezai

Abstract:

In this paper, using the finite element method, the effect of soil and wall characteristics was investigated. Thirty and two different models were studied by different parameters. These studies could calculate displacement at any height of the wall for frictional-cohesive soils. The main purpose of this research is to determine the most effective soil characteristics in reducing the wall displacement. Comparing different models showed that the overall increase in internal friction angle, angle of friction between soil and wall and modulus of elasticity reduce the replacement of the wall. In addition, increase in special weight of soil will increase the wall displacement. Based on results, it can be said that all wall displacements were overturning and in the backfill, soil was bulging. Results show that the highest impact is seen in reducing wall displacement, internal friction angle, and the angle friction between soil and wall. One of the advantages of this study is taking into account all the parameters of the soil and walls replacement distribution in wall and backfill soil. In this paper, using the finite element method and considering all parameters of the soil, we investigated the impact of soil parameter in wall displacement. The aim of this study is to provide the best conditions in reducing the wall displacement and displacement wall and soil distribution.

Keywords: retaining wall, fem, soil and wall interaction, angle of internal friction of the soil, wall displacement

Procedia PDF Downloads 363

Authors: Long-Shan Wu, Ming-Chen Ko, Chien-Chang Ho, Po-Fu Lee, Jenn-Woei Hsieh, Ching-Yu Tseng

Abstract:

This study aimed to determine the effects of whole-body vibration (WBV) training on lower-extremity muscle strength and balance control performance among community-dwelling middle-aged and older adults in the United States. Twenty-nine participants without any contraindication of performing WBV exercise completed all the study procedures. Participants were randomly assigned to do body weight exercise with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were performed at the baseline and after 8 weeks of training. Neither the individualized frequency-amplitude WBV training protocol nor the fixed frequency-amplitude WBV training protocol improved isokinetic knee extensor power. The limits of stability endpoint excursion score for the individualized frequency-amplitude group increased by 8.8 (12.9%; p = 0.025) after training. No significant differences were observed in fixed and control group. The maximum excursion score for the individualized frequency-amplitude group at baseline increased by 9.2 (11.5%; p = 0.006) after training. The average weight transfer time score significantly decreased by 0.21 s in the fixed group. The participants in the individualized group showed a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training. These results suggest that 8 weeks of WBV training improved limit of stability and sit-to-stand performance. Future studies need to determine whether WBV training improves other factors that can influence posture control.

Keywords: whole-body vibration training, muscle strength, balance control, middle-aged and older adults

Procedia PDF Downloads 197

Authors: Przemyslaw Brzyski, Stanislaw Fic

Abstract:

Hydrated lime, because of the life cycle (return to its natural form as a result of the setting and hardening) has a positive environmental impact. The lime binder is used in mortars. Lime is a slow setting binder with low mechanical properties. The aim of the study was to evaluate the possibility of improving the properties of the lime binder by using different pozzolanic materials as partial replacement of hydrated lime binder. Pozzolan materials are the natural or industrial waste, so do not affect the environmental impact of the lime binder. The following laboratory tests were performed: the analysis of the physical characteristics of the tested samples of lime mortars (bulk density, porosity), flexural and compressive strength, water absorption and the capillary rise of samples and consistency of fresh mortars. As a partial replacement of hydrated lime (in the amount of 10%, 20%, 30% by weight of lime) a metakaolin, silica fume, and zeolite were used. The shortest setting and hardening time showed mortars with the addition of metakaolin. All additives noticeably improved strength characteristic of lime mortars. With the increase in the amount of additive, the increase in strength was also observed. The highest flexural strength was obtained by using the addition of metakaolin in an amount of 20% by weight of lime (2.08 MPa). The highest compressive strength was obtained by using also the addition of metakaolin but in an amount of 30% by weight of lime (9.43 MPa). The addition of pozzolan caused an increase in the mortar tightness which contributed to the limitation of absorbability. Due to the different surface area, pozzolanic additives affected the consistency of fresh mortars. Initial consistency was assumed as plastic. Only the addition of silica fume an amount of 20 and 30% by weight of lime changed the consistency to the thick-plastic. The conducted study demonstrated the possibility of applying lime mortar with satisfactory properties. The features of lime mortars do not differ significantly from cement-based mortar properties and show a lower environmental impact due to CO₂ absorption during lime hardening. Taking into consideration the setting time, strength and consistency, the best results can be obtained with metakaolin addition to the lime mortar.

Keywords: lime, binder, mortar, pozzolan, properties

Procedia PDF Downloads 168

Authors: Jhonnatan Eduardo Zamudio Palacios, Oscar Leonardo Mosquera Dussan, Daniel Guzman Perez, Daniel Alfonso Botero Rosas, Oscar Fabian Rubiano Espinosa, Jose Antonio Garcia Torres, Ivan Dario Chavarro, Ivan Ramiro Rodriguez Camacho, Jaime Orlando Rodriguez

Abstract:

The training of cilsitas with some type of disability finds in the technological development an indispensable ally, generating every day advances to contribute to the quality of life allowing to maximize the capacities of the athletes. The performance of a cyclist depends on physiological and biomechanical factors, such as aerodynamic profile, bicycle measurements, connecting rod length, pedaling systems, type of competition, among others. This study particularly focuses on the description of the dynamic model of a transtibial prosthesis for Paralympic cyclists. To make the model, two points are chosen: in the radius centers of rotation of the plate and pinion of the track bicycle. The parametric scheme of the track bike represents a model of 6 degrees of freedom due to the displacement in X - Y of each of the reference points of the angles of the curve profile β, cant of the velodrome α and the angle of rotation of the connecting rod φ. The force exerted on the crank of the bicycle varies according to the angles of the curve profile β, the velodrome cant of α and the angle of rotation of the crank φ. The behavior is analyzed through the Matlab R2015a software. The average strength that a cyclist exerts on the cranks of a bicycle is 1,607.1 N, the Paralympic cyclist must perform a force on each crank about 803.6 N. Once the maximum force associated with the movement has been determined, it is continued to the dynamic modeling of the transtibial prosthesis that represents a model of 6 degrees of freedom with displacement in X - Y in relation to the angles of rotation of the hip π, knee γ and ankle λ. Subsequently, an analysis of the kinematic behavior of the prosthesis was carried out by means of SolidWorks 2017 and Matlab R2015a, which was used to model and analyze the variation of the hip angles π, knee γ and ankle of the λ prosthesis. The reaction forces generated in the prosthesis were performed on the ankle of the prosthesis, performing the summation of forces on the X and Y axes. The same analysis was then applied to the tibia of the prosthesis and the socket. The reaction force of the parts of the prosthesis varies according to the hip angles π, knee γ and ankle of the prosthesis λ. Therefore, it can be deduced that the maximum forces experienced by the ankle of the prosthesis is 933.6 N on the X axis and 2.160.5 N on the Y axis. Finally, it is calculated that the maximum forces experienced by the tibia and the socket of the transtibial prosthesis in high performance competitions is 3.266 N on the X axis and 1.357 N on the Y axis. In conclusion, it can be said that the performance of the cyclist depends on several physiological factors, linked to biomechanics of training. The influence of biomechanical factors such as aerodynamics, bicycle measurements, connecting rod length, or non-circular pedaling systems on the cyclist performance.

Keywords: biomechanics, dynamic model, paralympic cyclist, transtibial prosthesis

Procedia PDF Downloads 301

Authors: Joel Santhosh, N. Bhavani Shankar Rao

Abstract:

Problems associated with construction site have been known for many years. Construction industry has to support a world of continuing population growth and economic development. The rising costs of construction materials and the need to adhere to sustainability, alternative construction techniques and materials are being sought. To increase the applications of concrete paving blocks, greater understanding of products produced with locally available materials and indigenously produced mineral admixtures is essential. In the present investigation, concrete paving blocks may be produced with locally available aggregates, cement, fly ash and waste glass powder as the mineral admixture. The ultimate aim of this work is to ascertain the performance of concrete paving blocks containing fly ash and glass powder and compare it with the performance of conventional concrete paving blocks. Mix design is carried out to form M40 grade of concrete by using IS: 10262: 2009 and specification given by IRC: SP: 63: 2004. The paving blocks are tested in accordance to IS: 15658: 2006. It showed that the partial replacement of cement by fly ash and waste glass powder satisfies the minimum requirement as specified by the Indian standard IS: 15658: 2006 for concrete paving blocks to be used in non traffic, light traffic and medium-heavy traffic areas. The study indicated that fly ash and waste glass powder can effectively be used as cement replacement without substantial change in strength.

Keywords: paving block, fly ash, glass powder, strength, abrasion resistance, durability

Procedia PDF Downloads 271

Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

Abstract:

This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

Procedia PDF Downloads 58

Authors: Nicola Milani, Carla Bellissimo, Davide Pogliana, Davide Panzin, Luca Garlaschelli, Giulia Facchinetti, Claudia Casson, Luca Marazzina, Andrea Sartori, Simone Rivaroli, Jeff Konin

Abstract:

The patient is a 26 year-old male amateur football player from Milan, Italy; (81kg; 185cm; BMI 23.6 kg/m²). He sustained a non-contact anterior cruciate ligament tear to his right knee in June 2021. In September 2021, his right knee ligament was reconstructed using a semitendinosus graft. The injury occurred during a football match on natural grass with typical shoes on a warm day (32 degrees celsius). Playing as a defender he sustained the injury during a change of direction, where the foot was fixated on the grass. He felt pain and was unable to continue playing the match. The surgeon approved his rehabilitation to begin two weeks post-operative. The initial physiotherapist assessment determined performing two training sessions per day within the first three months. In the first three weeks, the pain was 4/10 on Numerical Rating Scale (NRS), no swelling, a range of motion was 0-110°, with difficulty fully extending his knee and minimal quadriceps activation. Crutches were discontinued at four weeks with improved walking. Active exercise, electrostimulator, physical therapy, massages, osteopathy, and passive motion were initiated. At week 6, he completed his first functional movement screen; the score was 16/21 with no pain and no swelling. At week 8, the isokinetic test showed a 23% differential deficit between the two legs in maximum strength (at 90°/s). At week 10, he improved to 15% of injury-induced deficit which suggested he was ready to start running. At week 12, the athlete sustained his first threshold test. At week 16, he performed his first return to sports movement assessment, which revealed a 10% stronger difference between the legs. At week 16, he had his second threshold test. At week 17, his first on-field test revealed a 5% differential deficit between the two legs in the hop test. At week 18, isokinetic test demonstrates that the uninjured leg was 7% stronger than the recovering leg in maximum strength (at 90°/s). At week 20, his second on-field test revealed a 2% difference in hop test; at week 21, his third isokinetic test demonstrated a difference of 5% in maximum strength (at 90°/s). At week 21, he performed his second return to sports movement assessment which revealed a 2% difference between the limbs. Since it was the end of the championship, the team asked him to partake in the playoffs; moreover the player was very motivated to participate in the playoffs also because he was the captain of the team. Together with the player and the team, we decided to let him play even though we were aware of a heightened risk of injury than what is reported in the literature because of two factors: biological recovery times and the results of the tests we performed. In the decision making process about the athlete’s recovery time, it is important to balance the information available from the literature with the desires of the patient to avoid frustration.

Keywords: ACL, football, rehabilitation, return to play

Procedia PDF Downloads 87