PURPOSE: The purpose of the study was to demonstrate the efficacy of a combination exercise consisting of adoption of the puppy position, which stretches the iliopsoas, and abdominal exercises （hereinafter, the therapeutic exercise）, against leg pain caused by excessive use of the leg.

SUBJECTS and METHODS: The subjects were 39 young people aged 20 years or younger and 38 adults aged 21 years or older complaining of leg pain. They performed the therapeutic exercise alone for treatment. The degree of improvement of the symptoms before and after the therapeutic exercise was rated on a visual analogue scale （VAS, 100-mm line）.

RESULTS: In the young subjects, the VAS score significantly improved from 73 ± 21 mm before, to 27 ± 21 mm immediately after the therapeutic exercise. In the adult subjects also, the VAS score improved significantly from 83 ± 13 mm before, to 23 ± 22 mm after the therapeutic exercise.

DISCUSSION: The therapeutic exercise, which was designed to improve the iliopsoas function, improved leg pain caused by excessive use of the leg, suggesting that iliopsoas fatigue is an important mechanism of leg pain.

CONCLUSION: Iliopsoas fatigue underlies the leg pain caused by excessive use of the leg, and the therapeutic exercise described above is effective for this type of leg pain.

PURPOSE: To report the concept and results of locomotive training in our clinic.

MATERIALS and METHODS: Between May 2014 and November 2016, 81 subjects received locomotive training in our clinic. Of these, 40 finished more than 60% of the exercises and were classified as the successful exercise group. We assessed the 10-m walking speed, 2-step test, standing-up test, locomotive syndrome 25 test, mid-thigh muscles cross section by computed tomography (CT), and bone mineral density (BMD) at the start and finish of the study.

RESULTS: The 2-step test score showed improvement from 1.18 to 1.24 and the locomotive syndrome 25 test score decreased from 18.4 to 10.8 in the successful exercise group, with statistical significance. Muscle strength on knee extension increased from 47.6Nm to 52.9Nm and strength on knee flexion increased from 20.9Nm to 26.6Nm, with statistical significance. The 10-m walking speed decreased significantly from 8.2 seconds to 6.6 seconds. However, the standing-up test, BMD, and mid-thigh muscles cross section showed no change.

DISCUSSION: Six months of locomotive training resulted in significant improvement in muscle strength, 10-m walking speed, 2-step test, and locomotive syndrome 25 test score and may help prevent falls and fractures in elderly people.

CONCLUSION: These results show that locomotive training is effective in preventing locomotive syndrome.

PURPOSE: This study aimed to determine the possibility of early return to sports for athletes with adolescent spondylolysis using exercise therapy after initial assessment of lower limb muscle tightness.

SUBJECTS and METHODS: This study included 17 subjects who played high-school sports. All had adolescent spondylolysis （Category I: 14 men, 3 women; average age 14.1 years, age range 12-17 years）, and were devided into Group A （without muscle tightness） and Group B （with tightness）, using 3 evaluation criteria: finger-to-floor distance （FFD, more or less than 0 cm）, straight leg raising （SLR, more or less than 70°）, and gastrocnemius flexibility （ankle dorsiflexion angle when standing with knees extended, more or less than 45°）. The duration until return to playing sports was examined. Additionally, 27 elite high-school soccer athletes without a history of low-back pain （Category II: all were 15 years old） were assessed upon enrollment in school and were compared with Category I for muscle flexibility.

RESULTS: In Category I, there was no significant difference in muscle tightness and the duration until return to sports activities between Group A and Group B. However, between Category I and II, there was a significant difference in muscle flexibility （especially for FFD and SLR）.

DISCUSSION: It is essential to alleviate tightness in the lower limb muscles using exercise therapy, as shown by a significant difference in muscle flexibility between Category I and II.

CONCLUSION: This study suggests that lower extremity stretching to gain muscle flexibility is effective for athletes with spondylolysis.

INTRODUCTION: Pillar pain after surgery for carpal tunnel syndrome is a factor that impedes postoperative return to work. To prevent pillar pain we devised an operation that uses the flexor digitorum superficialis (FDS) tendon of the ring finger and does not require a skin incision in the carpal area, and we followed up the course of a patient for 5 years after performing the operation.

CASE REPORT: A 60 year-old woman engaged in farming was examined for a chief complaint of numbness and pain in her right thumb, index finger, middle finger, and ring finger. A diagnosis of severe carpal tunnel syndrome was made, and by extracting the FDS tendon of the ring finger proximally from a skin incision of the wrist joint we decompressed the carpal tunnel, and we used the extracted FDS tendon to reconstruct opposition of the thumb. There were no postoperative complications, and 3 months later the patient returned to farming. The patient was continuing to farm 5 years postoperatively as well, and the numbness and pain had been relieved.

DISCUSSION: The surgical procedure we devised appeared to have good indications for patients who despite having severe carpal tunnel syndrome hope to quickly return to manual work, etc., with no fear of the pillar pain persisting.

CONCLUSION: We used the FDS tendon of the ring finger to reconstruct opposition of the thumb and simultaneously decompressed the carpal tunnel in a patient with severe carpal tunnel syndrome, and a good long-term outcome was obtained.