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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals. METHODS Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence. FINDINGS Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables. INTERPRETATION The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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Lower-Limb Kinematic Change during Pelvis Anterior and Posterior Tilt in Double-Limb Support in Healthy Subjects with Knee Malalignment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159164. [PMID: 35954519 PMCID: PMC9367981 DOI: 10.3390/ijerph19159164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate lower-limb kinematic changes during pelvic tilting in participants with knee malalignment. To define participants with lower-limb malalignment, the quadriceps angle (Q-angle) was used in this study. The sample population was divided into two groups in accordance with the Q-angle: the experimental group (ABQ) consisted of participants with an abnormal Q-angle greater than the normal range, and the control group (CON) consisted of participants with a normal Q-angle. All participants performed anterior and posterior pelvic tilts in double-limb support. Kinematic change in the lower limb was evaluated using a three-dimensional motion analysis system (Motion Analysis, Santa Rosa, CA, USA). The horizontal plane hip angle in the ABQ was significantly different compared with that in the CON in all positions (p < 0.05), and no significant difference was observed in the other lower-limb kinematic variables (p > 0.05). A significant correlation was identified only between the Q-angle and horizontal plane hip angle in all positions. Based on the results, the Q-angle was strongly related to the thigh, although it may not be related to malalignment with other segments during double-limb support.
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Siqueira MS, Souto LR, Martinez AF, Serrão FV, de Noronha M. Muscle activation, strength, and volume in people with patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:935-944. [PMID: 35257862 DOI: 10.1016/j.joca.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is different from asymptomatic controls. METHODS Searches were carried out in five electronic databases, with terms related to PFOA, including muscle strength, volume and activation. Only studies with at least one group with symptomatic PFOA and one asymptomatic group were included. The methodological quality of the studies was assessed using the Downs and Black checklist. Certainty of evidence was assessed using the GRADE methodology. Using the random effects model, a meta-analysis was performed when there were at least two studies reporting the same domain. RESULTS Eight studies (250 participants) met the inclusion criteria. Subjects with PFOA had weaker hip abduction (SMD -0.96; 95%CI = -1.34 to -0.57), hip external rotation (-0.55;-1.07 to -0.03), hip extension (-0.72;-1.16 to -0.28), and knee extension (-0.97;-1.41 to -0.53) when compared to asymptomatic controls. People with PFOA also presented with smaller volumes of the gluteus medius, gluteus minimus, tensor fascia lata, vastus medialis (VM), vastus lateralis (VL) and rectus femoris when compared to asymptomatic controls. Also, people with PFOA presented with changes in muscle activation for the VL, VM and gluteus maximus (GMax) when compared to asymptomatic controls. CONCLUSION People with PFOA present with lower strength and volume of the hip and quadriceps muscles and altered muscle activation of the VM, VL and GMax during ascending and descending stairs when compared to asymptomatic controls. However, the certainty of these findings are very low. TRIAL REGISTRATION NUMBER PROSPERO systematic review protocol (ID = CRD42020197776).
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Affiliation(s)
- M S Siqueira
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - L R Souto
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - A F Martinez
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - F V Serrão
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - M de Noronha
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, VIC 3660, Australia.
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Rabello R, Bertozzi F, Brunetti C, Silva Zandonato L, Bonotti A, Rodrigues R, Sforza C. The influence of task type and movement speed on lower limb kinematics during single-leg tasks. Gait Posture 2022; 96:109-116. [PMID: 35635986 DOI: 10.1016/j.gaitpost.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-leg squats and step-downs are commonly used to assess kinematic variables that may be linked to injuries. Task type and movement speed may influence the outcomes of interest because of different balance requirements. RESEARCH QUESTION What is the influence of task type and movement speed on lower limb kinematics? METHODS This is a cross-sectional within-subjects study where 22 physically active females performed three single-leg functional tasks (Squat, Anterior step-down, and Lateral step-down) at three movement speeds (slow [5 s], fast [2 s], and self-selected), while three-dimensional kinematic variables were recorded. Displacement values from the initial position in single-leg support until 60° or peak knee flexion were calculated. Two-way repeated measures ANOVA was used to compare tasks and speeds, and Cohen's d effect size (ES) was calculated for significant pairwise comparisons. RESULTS At 60°, lateral step-down presented the greatest hip adduction (large ES) and internal rotation (small ES). The anterior step-down had the lowest knee abduction displacement while the squat had the greatest (small to medium ES). At peak knee flexion, values increased but differences between tasks followed a similar pattern. Slow speed induced smaller displacement angles at the knee and hip (trivial to small ES). SIGNIFICANCE When knee abduction is the variable of interest, the SLS may be the best test since it elicits the greatest displacement, but when evaluating hip motion, SDLAT might be best. Knee abduction and internal rotation were lowest in the slow condition, suggesting that faster speed may be more appropriate to detect abnormal movement patterns. However, the small difference in absolute values (i.e., degrees of movement) may indicate that the differences are not clinically significant, particularly for speed comparisons. Researchers and clinicians should take this into consideration when choosing the most appropriate task and the instruction to give during its execution.
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Affiliation(s)
- Rodrigo Rabello
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Filippo Bertozzi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy; Dipartimento di Meccanica, Politecnico di Milano, Milano, Italy
| | - Claudia Brunetti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Lucas Silva Zandonato
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Bonotti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Rodrigo Rodrigues
- Exercise Physiology and Physical Assessment Laboratory, Serra Gaúcha University Center, Caxias do Sul, Brazil; Integrated Colleges of Taquara (FACCAT), Taquara, Brazil
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
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Šuc A, Šarko P, Pleša J, Kozinc Ž. Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review. Sports (Basel) 2022; 10:sports10070098. [PMID: 35878109 PMCID: PMC9319953 DOI: 10.3390/sports10070098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
It is well-accepted that at least a certain amount of resistance exercise (RE) is recommended for most endurance athletes. In this review, we aim to summarize the evidence regarding the effects of RE on running economy, running biomechanics, and running-related injury risk in endurance runners. The evidence robustly shows that lower limb RE is effective for improving running economy and performance, with a combination of strength and plyometric training being recommended to improve RE. Isometric training is also emerging as a possible alternative to implement during periods of high overall training load. Lower limb RE may change some aspects of joint kinematics during running; however, the evidence regarding the effects on kinetics is limited. Lower limb RE may help reduce running-related injury risk, but further evidence is needed.
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Affiliation(s)
- Anja Šuc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (A.Š.); (P.Š.); (J.P.)
| | - Pija Šarko
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (A.Š.); (P.Š.); (J.P.)
| | - Jernej Pleša
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (A.Š.); (P.Š.); (J.P.)
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia; (A.Š.); (P.Š.); (J.P.)
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
- Correspondence:
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Influence of Different Load Conditions on Lower Extremity Biomechanics during the Lunge Squat in Novice Men. Bioengineering (Basel) 2022; 9:bioengineering9070272. [PMID: 35877323 PMCID: PMC9311947 DOI: 10.3390/bioengineering9070272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: The lunge squat is one of the exercises to strengthen the lower limbs, however, there is little evidence of the effects of different equipment. The purpose of this study was to investigate the biomechanical effects of different types of equipment and loads on the lunge squat’s effect on the lower limbs. Methods: Fourteen male fitness novices participated in the experiment. Kinematics and kinetics in the sagittal plane using dumbbells, barbells, and weighted vests were measured using OpenSim. Two-way repeated measures ANOVA and one-dimensional statistical parametric mapping were used in the statistical analysis (SPM1D). Results: Range of motion (ROM) change in the knee joint was more obvious when using a barbell, whereas ROM when using a dumbbell was minimal. Compared to other joints, the joint moment at the hip joint was the largest and changed more significantly with increasing weight-bearing intensity, and the change was more pronounced with the dumbbell. For the center of pressure (COP) overall displacement, the dumbbell produced a smaller range of displacement. Conclusions: Dumbbells are suggested for male beginners to improve stability, barbells for the more experienced, and a low-weighted vest may be more appropriate for those with knee pain.
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Patellofemoral Joint Loading in Forward Lunge With Step Length and Height Variations. J Appl Biomech 2022; 38:210-220. [PMID: 35697336 DOI: 10.1123/jab.2021-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
Abstract
The objective was to assess how patellofemoral loads (joint force and stress) change while lunging with step length and step height variations. Sixteen participants performed a forward lunge using short and long steps at ground level and up to a 10-cm platform. Electromyography, ground reaction force, and 3D motion were captured, and patellofemoral loads were calculated as a function of knee angle. Repeated-measures 2-way analysis of variance (P < .05) was employed. Patellofemoral loads in the lead knee were greater with long step at the beginning of landing (10°-30° knee angle) and the end of pushoff (10°-40°) and greater with short step during the deep knee flexion portion of the lunge (50°-100°). Patellofemoral loads were greater at ground level than 10-cm platform during lunge descent (50°-100°) and lunge ascent (40°-70°). Patellofemoral loads generally increased as knee flexion increased and decreased as knee flexion decreased. To gradually increase patellofemoral loads, perform forward lunge in the following sequence: (1) minimal knee flexion (0°-30°), (2) moderate knee flexion (0°-60°), (3) long step and deep knee flexion (0°-100°) up to a 10-cm platform, and (4) long step and deep knee flexion (0°-100°) at ground level.
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Alexander N, Brunner R, Cip J, Viehweger E, De Pieri E. Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients. Front Bioeng Biotechnol 2022; 10:914990. [PMID: 35733525 PMCID: PMC9207384 DOI: 10.3389/fbioe.2022.914990] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Orthopedic complications were previously reported for patients with increased femoral anteversion. A more comprehensive analysis of the influence of increased femoral anteversion on joint loading in these patients is required to better understand the pathology and its clinical management. Therefore, the aim was to investigate lower-limb kinematics, joint moments and forces during gait in adolescent patients with increased, isolated femoral anteversion compared to typically developing controls. Secondly, relationships between the joint loads experienced by the patients and different morphological and kinematic features were investigated. Patients with increased femoral anteversion (n = 42, 12.8 ± 1.9 years, femoral anteversion: 39.6 ± 6.9°) were compared to typically developing controls (n = 9, 12.0 ± 3.0 years, femoral anteversion: 18.7 ± 4.1°). Hip and knee joint kinematics and kinetics were calculated using subject-specific musculoskeletal models. Differences between patients and controls in the investigated outcome variables (joint kinematics, moments, and forces) were evaluated through statistical parametric mapping with Hotelling T2 and t-tests (α = 0.05). Canonical correlation analyses (CCAs) and regression analyses were used to evaluate within the patients’ cohort the effect of different morphological and kinematic predictors on the outcome variables. Predicted compressive proximo-distal loads in both hip and knee joints were significantly reduced in patients compared to controls. A gait pattern characterized by increased knee flexion during terminal stance (KneeFlextSt) was significantly correlated with hip and knee forces, as well as with the resultant force exerted by the quadriceps on the patella. On the other hand, hip internal rotation and in-toeing, did not affect the loads in the joints. Based on the finding of the CCAs and linear regression analyses, patients were further divided into two subgroups based KneeFlextSt. Patients with excessive KneeFlextSt presented a significantly higher femoral anteversion than those with normal KneeFlextSt. Patients with excessive KneeFlextSt presented significantly larger quadriceps forces on the patella and a larger posteriorly-oriented shear force at the knee, compared to patients with normal KneeFlextSt, but both patients’ subgroups presented only limited differences in terms of joint loading compared to controls. This study showed that an altered femoral morphology does not necessarily lead to an increased risk of joint overloading, but instead patient-specific kinematics should be considered.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
- *Correspondence: Enrico De Pieri,
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The association and reliability of the frontal plane projection angle during the lateral step down test on knee function in patients with patellofemoral pain. Knee 2022; 36:87-96. [PMID: 35561562 DOI: 10.1016/j.knee.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The lateral step-down test is used by physical therapists (PT) to identify movement faults in patients with patellofemoral pain (PFP). The FPPA is a measure of knee valgus and PTs have access to open source video analysis software and high quality smart phones and video cameras to implement 2D video analysis into practice. The purpose of our study was to determine the reliability of PTs measuring the frontal plane projection angle (FPPA) during the lateral step-down test, and to determine if the FPPA was associated with pain, self-reported knee function and fear of movement. METHODS Twenty-two subjects (mean age[SD] = 27.8 [6.6] years, females n = 14, males n = 8) with PFP were analyzed by six PTs using 2D video analysis software. The FPPA was measured during the lateral step down test. Numeric Pain Rating Scale (NPRS), Anterior Knee Pain Scale (AKPS) and the Tampa Scale of Kinesiophobia (TSK) were collected. Intraclass correlation (ICC) was used to assess for PT measurement reliability. Correlations between outcomes were calculated using Spearman correlation coefficient and standard error of measurement (SEM) and minimal detectable change (MDC) were reported. RESULTS Reliability amongst PTs measuring the FPPA was good (ICC [95 %CI] = 0.85 [0.72-0.93]; SEM = 3.33°, MDC = 9.20°). There were no significant correlations (p > 0.05) between FPPA and NPRS(ρ = -0.046), AKPS(ρ = 0.066), or TSK(ρ = -0.204). CONCLUSIONS Although reliability measuring FPPA was good, the large SEM and MDC associated with this measurement may limit its clinical utility in those with PFP.
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Skouras AZ, Kanellopoulos AK, Stasi S, Triantafyllou A, Koulouvaris P, Papagiannis G, Papathanasiou G. Clinical Significance of the Static and Dynamic Q-angle. Cureus 2022; 14:e24911. [PMID: 35698708 PMCID: PMC9186474 DOI: 10.7759/cureus.24911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Q-angle represents the resultant force vector of the quadriceps and patellar tendons acting on the patella. An increased Q-angle has been considered a risk factor for many disorders and injuries. This literature review challenges the clinical value of static Q-angle and recommends a more dynamic movement evaluation for making clinical decisions. Although there are many articles about static Q-angle, few have assessed the value of dynamic Q-angle. We searched Scopus and PubMed (until September 2021) to identify and summarize English-language articles evaluating static and dynamic Q-angle, including articles for dynamic knee valgus (DKV) and frontal plane projection angle. We also used textbooks and articles from references to related articles. Although static Q-angle measurement is used systematically in clinical practice for critical clinical decisions, its interpretation and clinical translation present fundamental and intractable limitations. To date, it is acceptable that mechanisms that cause patellofemoral pain and athletic injuries have a stronger correlation with dynamic loading conditions. Dynamic Q-angle has the following three dynamic elements: frontal plane (hip adduction, knee abduction), transverse plane (hip internal rotation and tibia external rotation), and patella behavior. Measuring one out of three elements (frontal plane) illustrates only one-third of this concept. Static Q-angle lacks biomechanical meaning and utility for dynamic activities. Although DKV is accompanied by hip and tibia rotation, it remains a frontal plane measurement, which provides no information about the transverse plane and patella movement. However, given the acceptable reliability and the better differentiation capability, DKV assessment is recommended in clinical practice.
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Affiliation(s)
- Apostolos Z Skouras
- Sports Excellence, 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Sophia Stasi
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of West Attica, Athens, GRC
| | - Athanasios Triantafyllou
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
| | - Panagiotis Koulouvaris
- Sports Excellence, 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Georgios Papagiannis
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of the Peloponnese, Sparta, GRC
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - George Papathanasiou
- Laboratory of Neuromucsular and Cardiovascular Study of Motion (LANECASM), University of West Attica, Athens, GRC
- Department of Physiotherapy, University of West Attica, Athens, GRC
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Carvalho C, Serrão FV, Pisani GK, Martinez AF, Serrão PRMDS. Frontal plane biomechanics during single-leg squat and hip strength in patients with isolated patellofemoral osteoarthritis compared to matched controls: A cross-sectional study. PLoS One 2022; 17:e0267446. [PMID: 35476842 PMCID: PMC9045627 DOI: 10.1371/journal.pone.0267446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/09/2022] [Indexed: 01/08/2023] Open
Abstract
The patellofemoral compartment of the knee is the most frequently affected by osteoarthritis. However, there is a lack of biomechanics studies on patellofemoral osteoarthritis (PFOA). This study’s purpose was to compare the frontal plane biomechanics of the trunk and lower limb during the single-leg squat and isometric hip abductor torque in individuals with isolated PFOA and controls. Frontal plane kinematics during the single-leg squat were evaluated using a three-dimensional (3-D) motion analysis system. Isometric hip abductor torque was determined using a handheld dynamometer. Twenty individuals participated in the study (10 with PFOA and 10 controls). No significant differences between groups were found regarding age (mean ± SD, PFOA group = 51.8 ± 6.9 versus control group = 47.8 ± 5.5; mean difference = 4, 95% confidence interval [CI] = -1.9 to 9.9, p = 0.20) or body mass index (PFOA group = 27.6 ± 2.2 versus control group = 25.5 ± 2.5; mean difference = 2.1, 95% confidence interval [CI] = -0.1 to 4.3, p = 0.06). Compared to control, the PFOA group presented greater hip adduction in the descending and ascending phases of the single-leg squat at 45° (mean difference [95% CI] = 6.44° [0.39–12.48°], p = 0.04; mean difference [95% CI] = 5.33° [0.24–10.42°], p = 0.045, respectively) and 60° (mean difference [95% CI] = 8.44° [2.15–14.73°], p = 0.01; mean difference [95% CI] = 7.58° [2.1–13.06°], p = 0.009, respectively) of knee flexion. No significant differences between groups were found for the frontal plane kinematics of the trunk, pelvis or knee (p > 0.05). The PFOA group exhibited lower isometric hip abductor torque (mean difference [95% CI] = -0.34 Nm/kg [-0.67 to -0.01 Nm/kg], p = 0.04). The individuals with PFOA presented greater hip adduction than the control group, which could increase lateral patellofemoral joint stress at 45° and 60° of knee flexion in the descending and ascending phases of the single-leg squat. These individuals also exhibited hip abductor weakness in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Adalberto Felipe Martinez
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
- * E-mail:
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Yang C, Best TM, Liu H, Yu B. Knee biomechanical factors associated with patellofemoral pain in recreational runners. Knee 2022; 35:87-97. [PMID: 35255371 DOI: 10.1016/j.knee.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common injury among runners. Knee biomechanical factors associated with PFP, however, remain unclear. The purpose of this study was to determine possible associations between knee biomechanics and symptoms of PFP in recreational runners. METHODS Fifteen male and 15 female recreational runners with PFP were enrolled as the PFP group, 30 matched runners without PFP were recruited as the control group. The PFP group was tested running with and without knee pain, while the control group had only one running test. Reflective marker coordinates and ground reaction force data were collected in each test. Knee kinematics and kinetics during running were reduced and compared between groups (PFP group without knee pain and control group) and between pain conditions (PFP group with knee pain and without knee pain), as well as between sexes. RESULTS Female and male participants with PFP had an increased peak knee valgus angle when running without pain compared to matched controls (P = 0.001), and to themselves when running with pain (P = 0.001). Male participants with PFP also had an increased peak knee flexion angle when running without pain compared to matched controls (P = 0.008), however did not decrease their peak knee flexion angle when running with pain (P = 0.245). No significant main effect of group or pain condition on any peak knee joint moment during running was detected (P ≥ 0.175). CONCLUSIONS Increased peak knee valgus angle during running appears to be a critical biomechanical factor associated with PFP in recreational runners, while decreasing knee valgus angle during running may be an adaptation to reduce symptoms of PFP. Increased peak knee flexion angle during running appears to be another biomechanical factor associated with PFP that is sex specific for male recreational runners.
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Affiliation(s)
- Chen Yang
- School of Sports and Health, Nanjing Sport Institute, Nanjing 210014, China
| | - Thomas M Best
- UHealth Sports Medicine Institute, University of Miami, Miami, FL 33136, USA
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China.
| | - Bing Yu
- Center for Human Movement Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Talonavicular joint mobilization and foot core strengthening in patellofemoral pain syndrome: a single-blind, three-armed randomized controlled trial. BMC Musculoskelet Disord 2022; 23:150. [PMID: 35168620 PMCID: PMC8845242 DOI: 10.1186/s12891-022-05099-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS. Methods Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m2) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up. Results The two-way repeated-measures ANOVA revealed significant interactions in all groups (p < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, − 0.938; 95% Confidence interval [CI], − 1.664 to − 0.211; p < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p < 0.05) and valgus knee (mean difference, − 11.019; 95% CI, − 17.007 to − 5.031; p < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, − 1.250; 95% CI, − 2.195 to − 0.305; p < 0.05), and TJM (mean difference, − 1.563; 95% CI, − 2.640 to − 0.485; p < 0.05) and blended intervention (mean difference, − 1.500; 95% CI, − 2.578 to − 0.422; p < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p < 0.05) at 4 weeks follow-up. Conclusions Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS. Trial registration KCT0003176, 16/08/2018 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05099-x.
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Karamiani F, Mostamand J, Rahimi A, Nasirian M. The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial. J Bodyw Mov Ther 2022; 30:23-29. [DOI: 10.1016/j.jbmt.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/07/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Escamilla R, Zheng N, MacLeod TD, Imamura R, Wilk KE, Wang S, Rubenstein I, Yamashiro K, Fleisig GS. Patellofemoral Joint Loading During the Performance of the Forward and Side Lunge with Step Height Variations. Int J Sports Phys Ther 2022; 17:174-184. [PMID: 35136686 PMCID: PMC8805090 DOI: 10.26603/001c.31876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Forward and side lunge exercises strengthen hip and thigh musculature, enhance patellofemoral joint stability, and are commonly used during patellofemoral rehabilitation and training for sport. HYPOTHESIS/PURPOSE The purpose was to quantify, via calculated estimates, patellofemoral force and stress between two lunge type variations (forward lunge versus side lunge) and between two step height variations (ground level versus 10 cm platform). The hypotheses were that patellofemoral force and stress would be greater at all knee angles performing the bodyweight side lunge compared to the bodyweight forward lunge, and greater when performing the forward and side lunge at ground level compared to up a 10cm platform. STUDY DESIGN Controlled laboratory biomechanics repeated measures, counterbalanced design. METHODS Sixteen participants performed a forward and side lunge at ground level and up a 10cm platform. Electromyographic, ground reaction force, and kinematic variables were collected and input into a biomechanical optimization model, and patellofemoral joint force and stress were calculated as a function of knee angle during the lunge descent and ascent and assessed with a repeated measures 2-way ANOVA (p<0.05). RESULTS At 10° (p=0.003) knee angle (0° = full knee extension) during lunge descent and 10° and 30° (p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in forward lunge than side lunge. At 40°(p=0.005), 50°(p=0.002), 60°(p<0.001), 70°(p=0.006), 80°(p=0.005), 90°(p=0.002), and 100°(p<0.001) knee angles during lunge descent and 50°(p=0.002), 60°(p<0.001), 70°(p<0.001), 80°(p<0.001), and 90°(p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in side lunge than forward lunge. At 60°(p=0.009) knee angle during lunge descent and 40°(p=0.008), 50°(p=0.009), and 60°(p=0.007) knee angles during lunge ascent patellofemoral joint force and stress were greater lunging at ground level than up a 10cm platform. CONCLUSIONS Patellofemoral joint loading changed according to lunge type, step height, and knee angle. Patellofemoral compressive force and stress were greater while lunging at ground level compared to lunging up to a 10 cm platform between 40° - 60° knee angles, and greater while performing the side lunge compared to the forward lunge between 40° - 100° knee angles. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rafael Escamilla
- Department of Physical Therapy, California State University, Sacramento, USA; Results Physical Therapy and Training Center, Sacramento, CA USA
| | - Naiquan Zheng
- The Center for Biomedical Engineering and Science, Department of Mechanical Engineering and Engineering Science, University of North Carolina, Charlotte, NC
| | - Toran D MacLeod
- Department of Physical Therapy, California State University, Sacramento, USA
| | - Rodney Imamura
- Kinesiology and Health Science Department, California State University, Sacramento, USA
| | | | - Shangcheng Wang
- The Center for Biomedical Engineering and Science, Department of Mechanical Engineering and Engineering Science, University of North Carolina, Charlotte, NC
| | | | - Kyle Yamashiro
- Results Physical Therapy and Training Center, Sacramento, CA USA
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Jo YJ, Kim YK. Hip and ankle strength and range of motion in female soccer players with dynamic knee valgus. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-200260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Dynamic knee valgus (DKV) is a known risk factor for acute and chronic knee injuries and is more frequently diagnosed in females. A real-time single-leg squat test (SLST) could screen for DKV to prevent injuries. OBJECTIVE: To compare the differences in lower extremity strength and range of motion (ROM) in female soccer athletes with and without DKV during an SLST. METHODS: Eighteen subjects with DKV (DKV group) and 18 subjects without DKV (control group) during a single-leg squat were included. Hip strength (flexion, extension, abduction, adduction, internal rotation, and external rotation) was measured with a hand-held dynamometer. Hip ROM (internal and external rotation), and ankle ROM (dorsiflexion with the knee flexed and extended) were measured. Independent t-test was used to compare the averages of the groups. RESULTS: There were significant differences in hip abduction to adduction strength ratio (DKV: 1.48 ± 0.3, control: 1.22 ± 0.26, p< 0.01) and ankle dorsiflexion with knee flexed (DKV: 17.22 ± 6.82, control: 21.22 ± 4.55, p< 0.05) and extended (DKV: 10.14 ± 4.23, control: 14.75 ± 3.40, p< 0.001) between the groups. CONCLUSION: The hip abduction to adduction strength ratio and gastrocnemius and soleus flexibility may be associated factors in dynamic knee valgus and therefore should be assessed and treated, if indicated, as a possible preventive measure in female athletes with this variation.
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Affiliation(s)
- Young Jin Jo
- Department of Physical Education, Hoseo University, Asan-si, Chung chung Nam-do, Korea
| | - Young Kyun Kim
- Department of Sports Medicine, CHA University, Pocheon-si, Gyeonggi-do, Korea
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Brain Activity During Experimental Knee Pain and Its Relationship With Kinesiophobia in Patients With Patellofemoral Pain: A Preliminary Functional Magnetic Resonance Imaging Investigation. J Sport Rehabil 2022; 31:589-598. [DOI: 10.1123/jsr.2021-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/18/2022]
Abstract
Context: The etiology of patellofemoral pain has remained elusive, potentially due to an incomplete understanding of how pain, motor control, and kinesiophobia disrupt central nervous system functioning. Objective: To directly evaluate brain activity during experimental knee pain and its relationship to kinesiophobia in patients with patellofemoral pain. Design: Cross-sectional. Methods: Young females clinically diagnosed with patellofemoral pain (n = 14; 14.4 [3.3] y; body mass index = 22.4 [3.8]; height = 1.61 [0.1] m; body mass = 58.4 [12.7] kg). A modified Clarke test (experimental pain condition with noxious induction via patella pressure and quadriceps contraction) was administered to the nondominant knee (to minimize limb dominance confounds) of patients during brain functional magnetic resonance imaging (fMRI) acquisition. Patients also completed a quadriceps contraction without application of external pressure (control contraction). Kinesiophobia was measured using the Tampa Scale of Kinesiophobia. The fMRI analyses assessed brain activation during the modified Clarke test and control contraction and assessed relationships between task-induced brain activity and kinesiophobia. Standard processing for neuroimaging and appropriate cluster-wise statistical thresholds to determine significance were applied to the fMRI data (z > 3.1, P < .05). Results: The fMRI revealed widespread neural activation in the frontal, parietal, and occipital lobes, and cerebellum during the modified Clarke test (all zs > 4.4, all Ps < .04), whereas neural activation was localized primarily to frontal and cerebellar regions during the control contraction test (all zs > 4.4, all Ps < .01). Greater kinesiophobia was positively associated with greater activity in the cerebello-frontal network for the modified Clarke test (all zs > 5.0, all Ps < .01), but no relationships between kinesiophobia and brain activity were observed for the control contraction test (all zs < 3.1, all Ps > .05). Conclusions: Our novel experimental knee pain condition was associated with alterations in central nociceptive processing. These findings may provide novel complementary pathways for targeted restoration of patient function.
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Immediate Effect of Ankle Mobilization on Range of Motion, Dynamic Knee Valgus, and Knee Pain in Women With Patellofemoral Pain and Ankle Dorsiflexion Restriction: A Randomized Controlled Trial With 48-Hour Follow-Up. J Sport Rehabil 2021; 30:697-706. [PMID: 33373976 DOI: 10.1123/jsr.2020-0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. OBJECTIVES To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. DESIGN Randomized controlled trial with 3 arms. SETTING Biomechanics laboratory. PARTICIPANTS A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). INTERVENTION(S) The participants received a single session of ankle mobilization with movement technique. MAIN OUTCOME MEASURES Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). RESULTS There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. CONCLUSION In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.
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Golchini A, Rahnama N, Lotfi-Foroushani M. Effect of Systematic Corrective Exercises on the Static and Dynamic Balance of Patients with Pronation Distortion Syndrome: A Randomized Controlled Clinical Trial Study. Int J Prev Med 2021; 12:129. [PMID: 34912505 PMCID: PMC8631118 DOI: 10.4103/ijpvm.ijpvm_303_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this study was to determine the effect of systematic corrective exercises on the static and dynamic balance of students with pronation distortion syndrome. Methods: In this randomized controlled clinical trial study, 30 volunteers were selected and randomly divided into the control and experimental groups (15 subjects per group). The experimental group performed systematic corrective exercises for 12 weeks, while the control group performed the routine exercise. Static and dynamic balance was evaluated before and after the interventions. The data were analyzed using independent and paired t-tests (P < 0.05). Results: The results showed significant improvement (P < 0.05) in the static and dynamic balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of static and dynamic balances, in static balance including Flamingo balance test (42.26 ± 5.35 vs. 10.13 ± 1.92) stabilometr (1.23 ± 0.48 vs. 3.71 ± 1.02), and in dynamic balance including star excursion balance test (anterior direction 82.4 ± 6.2 vs. 66.7 ± 6.9, Posterior-internal direction 87.8 ± 4.7 vs. 69.6 ± 6.3, posterior-external direction 86.06 ± 6.93 vs. 67.2 ± 6.2), stabilometr (3.8 ± 0.6 vs. 11.18 ± 1.8) (P < 0.05 for all variables). Conclusions: It can be concluded that systematic corrective exercises improve static and dynamic balance in students with pronation distortion syndrome and it could be recommended as modalities for these people.
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Affiliation(s)
- Ali Golchini
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Nader Rahnama
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
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Hyun SJ, Lee J, Lee BH. The Effects of Sit-to-Stand Training Combined with Real-Time Visual Feedback on Strength, Balance, Gait Ability, and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12229. [PMID: 34831986 PMCID: PMC8625418 DOI: 10.3390/ijerph182212229] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the effects of lower limbs muscles' strength, balance, walking, and quality of life through sit-to-stand training combined with real-time visual feedback (RVF-STS group) in patients with stroke and to compare the effects of classic sit-to-stand training (C-STS group). Thirty patients with stroke were randomly divided into two groups. The RVF-STS group received sit-to-stand training combined with real-time visual feedback using a Wii Balance Board (n = 15), and the C-STS group received classic sit-to-stand training (n = 15). All participants received training for 20 min once a day, 5 days a week for 6 weeks, and both groups underwent general physical therapy for 30 min before training. Before and after the training, the muscle strength of the hip flexor, abductor, and knee extensor were measured, and the Wii Balance Board was used to perform the center of pressure test and Berg Balance Scale to evaluate static and dynamic balance. Additionally, the 10 m walking test and the Timed Up and Go test were performed to evaluate gait function. The Stroke-Specific Quality of Life was used to measure the quality of life. The results showed that the lower extremity muscle strength, balance ability, walking ability, and quality of life of the RVF-STS group significantly improved in comparison of the pre- and post-differences (p < 0.05), and it also showed significant differences between groups (p < 0.05). This study showed that sit-to-stand training combined with real-time visual feedback was effective at improving the muscle strength of the lower extremities, balance, gait, and quality of life in patients with stroke. Therefore, repeating sit-to-stand training combined with real-time visual feedback could be used as an effective treatment method for patients with stroke.
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Affiliation(s)
- Seung-Jun Hyun
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
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Noonan B, Cooper T, Chau M, Albersheim M, Arendt EA, Tompkins M. Rotational Deformity-When and How to Address Femoral Anteversion and Tibial Torsion. Clin Sports Med 2021; 41:27-46. [PMID: 34782074 DOI: 10.1016/j.csm.2021.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Rotational deformity is a less common cause of patellar instability than trochlear dysplasia and patella alta. In some cases, rotational deformity is the primary bony factor producing the instability and should be corrected surgically. More research is needed on what are normal values for femoral version and tibial torsion, as well as when the axial plane alignment needs to be corrected. Many tools can be used to evaluate the axial plane and surgeons should be familiar with each of them. Understanding the advantages and disadvantages of each site for osteotomy will help the surgeon choose the most appropriate osteotomy.
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Affiliation(s)
- Benjamin Noonan
- Sanford Orthopedics & Sports Medicine, 2301 25th Street South, Fargo, ND 58103, USA
| | - Trenton Cooper
- Gillette Children's Specialty Healthcare, 200 University Avenue East, St Paul, MN 55101, USA
| | - Michael Chau
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Melissa Albersheim
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA.
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Kısacık P, Tunay VB, Bek N, Atay ÖA, Selfe J, Karaduman AA. Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain. J Back Musculoskelet Rehabil 2021; 34:1093-1104. [PMID: 34024814 DOI: 10.3233/bmr-200255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS Thirty patients with a 'weak and pronated' foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE.
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Affiliation(s)
- Pınar Kısacık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakcı Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nilgün Bek
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Özgür Ahmet Atay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - James Selfe
- Department of Health Professions, Faculty of Health, Manchester Metropolitan University, Manchester, UK
| | - Aynur Ayşe Karaduman
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
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73
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Liu J, Powers CM. Classification of Runners with High versus Low Hip Adduction based on Measures of Pelvis and Femur Morphology. Med Sci Sports Exerc 2021; 54:590-597. [PMID: 34772902 DOI: 10.1249/mss.0000000000002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the most relevant pelvis and femur morphological characteristics for differentiating runners with high versus low hip adduction during running. METHODS Fifteen female and 14 male runners underwent instrumented kinematics analysis of overground running and computed tomography scanning of pelvis and femur. The peak hip adduction angle during the stance phase of running was identified for each participant. Using the cohort average of the peak hip adduction angle as the classifying threshold, participants were categorized into high or low hip adduction groups. To determine the most relevant morphologic features for discriminating high and low hip adduction runners, a feature selection-based support vector machine classification analysis was performed. RESULTS Out of 15 morphology variables examined, femoral head anteversion and femur length were shown to be the best discriminant variables for group classification. Together, these variables achieved a prediction accuracy of 0.93, sensitivity of 1.0, and specificity of 0.88. CONCLUSION Our results highlight the importance of femur morphology in contributing to increased hip adduction during running.
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Affiliation(s)
- Jia Liu
- Division of Biokinesiology and Physical Therapy University of Southern California, Los Angeles, CA
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74
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Hansen R, Lundgaard-Nielsen M, Henriksen M. Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain: an agreement study. PeerJ 2021; 9:e12203. [PMID: 34721963 PMCID: PMC8532969 DOI: 10.7717/peerj.12203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Assessment of knee kinematics plays an important role in the clinical examination of patients with patellofemoral pain (PFP). There is evidence that visual assessments are reliable in healthy subjects, but there is a lack of evidence in injured populations. The purpose of this study was to examine the intra- and interrater agreement in the visual assessment of dynamic knee joint alignment in patients with PFP. Methods The study was a cross-sectional agreement study. Sixty participants (42 females) were included. We assessed the intra- and interrater agreement of two functional tests: The single leg squat (SLS) and the forward lunge (FL). One investigator scored the movement according to preset criteria while video recording the movement for retest. Moreover, the performance was scored by another investigator using the video recording. Agreement was assessed using weighted kappa statistics. Results The intrarater agreement ranged from moderate to good (Kappa 0.58 (FL) to 0.70 (SLS)) whereas the interrater agreement ranged from fair to moderate (Kappa 0.22 (SLS) to 0.50 (FL)). Conclusion The agreement within raters was better than between raters, which suggests that assessments should preferably be performed by the same tester in research and in a clinical setting, e.g., to evaluate any treatment effect. We promote FL as a reliable clinical tool for evaluating dynamic knee alignment, since it shows equally good intra- and interrater agreement, and it is an inexpensive and easy method to use.
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Affiliation(s)
- Rudi Hansen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
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75
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Ghany JF, Kamel S, Zoga A, Farrell T, Morrison W, Belair J, Desai V. Extensor mechanism tendinopathy in patients with lateral patellar maltracking. Skeletal Radiol 2021; 50:2205-2212. [PMID: 33876276 DOI: 10.1007/s00256-021-03787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. MATERIALS AND METHODS Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. RESULTS The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2 years versus 48.2 years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49 mm versus 14.99 mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4 mm versus 15.4 mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). CONCLUSION Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.
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Affiliation(s)
- Jehan F Ghany
- Musculoskeletal Radiology, Department of Radiology, The Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Sarah Kamel
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Adam Zoga
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Terence Farrell
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - William Morrison
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Jeffrey Belair
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
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76
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Liu J, Lewton KL, Colletti PM, Powers CM. Hip Adduction during Running: Influence of Sex, Hip Abductor Strength and Activation, and Pelvis and Femur Morphology. Med Sci Sports Exerc 2021; 53:2346-2353. [PMID: 34107513 DOI: 10.1249/mss.0000000000002721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the influence of hip abductor strength, neuromuscular activation, and pelvis and femur morphology in contributing to sex differences in hip adduction during running. In addition, we sought to determine the best predictors of hip adduction during running for both men and women. METHODS Fifteen female runners and 14 male runners underwent strength testing, instrumented overground running (e.g., kinematics and muscle activation), and computed tomography scanning of pelvis and femur. Morphologic measurements included bilateral hip width to femur length ratio, acetabulum abduction, acetabulum anteversion, femoral anteversion, and femoral neck-shaft angles. Sex differences for all variables were examined using independent t tests. Linear regression was used to assess the ability of each independent variable of interest to predict peak hip adduction during the late swing and stance phase of running. RESULTS Compared with men, women exhibited significantly greater peak hip adduction during both late swing (8.5° ± 2.6° vs 6.2° ± 2.8°, P = 0.04) and stance phases of running (13.4° ± 4.2° vs 10.0° ± 3.2°, P = 0.02). In addition, women exhibited significantly lower hip abductor strength (1.8 ± 0.3 vs 2.0 ± 0.3 N·m·kg-1, P = 0.04), greater femoral neck-shaft angles (134.1° ± 5.0° vs 129.9° ± 4.1°, P = 0.01), and greater hip width to femur length ratios than men (0.44 ± 0.02 vs 0.42 ± 0.03, P = 0.03). Femoral anteversion was the only significant predictor of peak hip adduction during late swing (r = 0.36, P = 0.05) and stance (r = 0.41, P = 0.03). CONCLUSIONS Our findings highlight the contribution of femur morphology as opposed to hip abductor strength and activation in contributing to hip adduction during running.
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Affiliation(s)
- Jia Liu
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | | | - Patrick M Colletti
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
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77
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Basbug P, Kilic RT, Atay AO, Bayrakcı Tunay V. The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study. Somatosens Mot Res 2021; 39:39-45. [PMID: 34713770 DOI: 10.1080/08990220.2021.1987877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the effects of corrective kinesio taping applied on patellofemoral and foot joint in addition to a progressive neuromuscular exercise program in women with Patellofemoral Pain (PFP) on knee pain and muscle strength. METHODS Thirty females (20-45 years), diagnosed with unilateral PFP were randomly divided into two groups: the exercise (n = 15) and the exercise and taping (n = 15). Both groups performed three-stage progressive neuromuscular exercises for 12 weeks as home exercises. Plantar and knee corrective taping was additionally applied to the exercise and taping group. The knee pain was measured using the Visual Analogue Scale (VAS) during stair ascending and descending. Isokinetic dynamometer was used to evaluate the isokinetic muscle strength of the hamstring and quadriceps femoris muscles. All assessments were conducted before the treatment, at the end of the 6th-week treatment, and at the end of the 12th week of the treatment. RESULTS After intervention, pain, and muscles peak torque were improved in all groups (p ˂ 0.05). The decrease in pain and the increase in quadriceps and hamstring muscle peak tork were found to be significant for both groups (p < 0.05). In the taping group, the decrease in pain during stair descending and the increase in hamstring muscle tork were higher than that of the exercise group (p < 0.05). CONCLUSION In order to reduce pain in a short time and control it in the long term, it will be beneficial to tape the knee and foot in addition to neuromuscular exercises.
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Affiliation(s)
- Pinar Basbug
- Department of Physiotherapy and Rehabilitation, Mugla Sitki Kocman University, Faculty of Health Sciences, Mugla, Turkey
| | - Rabia Tugba Kilic
- Physical Theraphy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Volga Bayrakcı Tunay
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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78
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Rabello R, Nodari C, Scudiero F, Borges I, Fitarelli L, Bianchesse J, Rodrigues R. Effects of task and hip-abductor fatigue on lower limb alignment and muscle activation. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00854-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Purpose
Fatigue-induced hip-abductor weakness may exacerbate lower-limb misalignments during different dynamic single-leg tasks. We sought to evaluate the effects of fatigue and task on lower limb kinematics and muscle activation and to find associations between measurements obtained in two tasks.
Methods
One-group pretest–posttest design. Seventeen healthy adults (9 W) performed the single-leg squat (SLSQUAT) and the single-leg hop (SLHOP) before and after a hip-abduction fatigue protocol. Hip adduction, knee frontal plane projection angle (knee FPPA) and heel inversion displacement were measured during the eccentric phase of the SLSQUAT and the SLHOP, as well as activation of the gluteus medius (GMed), tensor fascia latae (TFL), peroneus longus (PER) and tibialis anterior (TA). Moments and tasks were compared using a repeated-measures two-way ANOVA. Correlation between tasks was evaluated using Spearman’s correlation.
Results
No differences in kinematics or activation were found between moments. Hip-adduction displacement (P = 0.005), GMed (P = 0.008) and PER (P = 0.037) activation were higher during SLSQUAT, while TA activation was higher during SLHOP (P < 0.001). No differences were found between tasks in knee FPPA and heel inversion. Hip-adduction and knee FPPA were not correlated between tasks, while ankle inversion displacement was positively correlated (rs = 0.524–0.746).
Conclusion
Different characteristics of SLSQUAT (slower and deeper) seem to have led to increased hip adduction displacement, GMed, and PER activation and decreased TA activation, likely due to higher balance requirements. However, hip-abductor fatigue didn’t influence lower-limb alignment during the tasks. Finally, evaluations should be performed with different single-leg tasks since they don’t give the same lower-limb alignment information.
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79
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Davis IS, Hollander K, Lieberman DE, Ridge ST, Sacco ICN, Wearing SC. Stepping Back to Minimal Footwear: Applications Across the Lifespan. Exerc Sport Sci Rev 2021; 49:228-243. [PMID: 34091498 DOI: 10.1249/jes.0000000000000263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.
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Affiliation(s)
- Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | | | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge MA
| | - Sarah T Ridge
- Department of Exercise Sciences, Brigham Young University, Salt Lake City, Utah
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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80
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Kinematic and Coordination Variability in Individuals With Acute and Chronic Patellofemoral Pain. J Appl Biomech 2021; 37:463-470. [PMID: 34548419 DOI: 10.1123/jab.2020-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
Altered gait variability occurs in those with patellofemoral pain and may be relevant to pain progression. We examined gait kinematic and coordination variability between individuals with acute and chronic patellofemoral pain and healthy controls. Eighty-three patellofemoral pain runners (37 men and 46 women) and 142 healthy controls (52 men and 90 women) ran on a treadmill while 3-dimensional lower limb kinematic data were collected. Patellofemoral pain runners were split into acute (n = 22) and chronic (n = 61) subgroups based on pain duration (< and ≥3 mo, respectively). Approximate entropy assessed continuous hip, knee, and ankle kinematic variability. Vector coding calculated coordination variability for select joint couplings. Variability measures were compared between groups using 1-way analysis of variance and post hoc comparisons with Cohen d effect sizes. The chronic patellofemoral pain subgroup displayed higher frontal plane knee kinematic variability compared with controls (P = .0004, d = 0.550). No statistically significant effects for any coordination variability couplings were identified. Minimal differences in gait variability were detected between those with acute and chronic patellofemoral pain and healthy controls.
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81
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Liu J, Salem GJ, Powers CM. Sex Difference in Hip Adduction during the Stance Phase of Running: A Swing Phase Problem? Med Sci Sports Exerc 2021; 53:1412-1416. [PMID: 34127634 DOI: 10.1249/mss.0000000000002610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of the current study was 1) to evaluate sex differences in peak hip adduction during the late swing and stance phases of running and 2) to determine whether peak hip adduction during late swing is predictive of peak hip adduction during stance. METHODS A total of 15 female and 16 male heel strike runners ran over ground at a speed of 4 m·s-1. Hip joint kinematics during running were quantified using a 3D motion capture system. Sex differences in peak hip adduction during the late swing and stance phases were compared using independent-samples t-tests. Linear regression analysis was used to determine the relationship between late swing and stance phase hip adduction. RESULTS Compared with males, females exhibited significantly greater peak hip adduction during both the late swing (8.5° ± 2.6° vs 6.1° ± 2.8°, P = 0.019) and the stance phases of running (13.3° ± 4.2° vs 9.6° ± 3.4°, P = 0.011). Furthermore, late swing peak hip adduction was predictive of subsequent stance phase peak hip adduction (r = 0.63, P < 0.001). CONCLUSION Sex differences in hip adduction during stance are influenced in part by late swing phase hip adduction. Further studies are needed to identify potential causes of excessive hip adduction during the late swing phase of running.
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Affiliation(s)
- Jia Liu
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
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82
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Trunk, pelvis, and knee kinematics during running in females with and without patellofemoral pain. Gait Posture 2021; 89:80-85. [PMID: 34246176 DOI: 10.1016/j.gaitpost.2021.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Females are two times more likely to develop patellofemoral pain (PFP) than males. Abnormal trunk and pelvis kinematics are thought to contribute to the pathomechanics of this condition. However, there is a scarcity of evidence investigating proximal segments kinematics in females with PFP. RESEARCH QUESTION The purpose of this study was to investigate whether females with PFP demonstrate altered trunk, pelvis, and knee joint kinematics compared with healthy controls during running. METHODS Thirty-four females (17 PFP, 17 controls) underwent a 3-dimensional motion analysis during treadmill running at preferred and fixed speeds, each trial for 30 s. Variables of interest included magnitudes of peak angles for trunk (forward flexion, ipsilateral trunk lean), pelvis (anterior tilt, contralateral drop), knee (flexion, valgus, internal rotation), range of motion (RoM) of trunk and pelvis in sagittal and frontal planes and RoM of knee joint in the three cardinal planes of motion. Kinematic data were compared between groups using mixed model repeated measure analysis of variance with the trial as the repeated measure. RESULTS The PFP group displayed significantly less pelvis frontal plane RoM, greater knee frontal plane RoM, and less knee sagittal plane RoM during running compared with controls, irrespective of running trial. No differences were found in peak kinematic variables between PFP and healthy groups. SIGNIFICANCE These results may suggest a rigid stabilization strategy at the pelvis, which the body has adapted to prevent further frontal plane knee malalignment. Less knee sagittal plane RoM may be indicative of another protective strategy in the PFP group to avoid patellofemoral joint reaction force. Clinical assessments and rehabilitative treatments may benefit from considering a global program with focus on pelvis kinematics in addition to the knee joint in females with PFP.
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83
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Hu G, Wang W, Chen B, Zhi H, Yudi Li, Shen Y, Wang K. Concurrent validity of evaluating knee kinematics using Kinect system during rehabilitation exercise. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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84
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Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
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Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
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85
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Kim N, Lee SY, Lee SC, Rosen AB, Grindstaff TL, Knarr BA. Effect of isolated hip abductor fatigue on single-leg landing mechanics and simulated ACL loading. Knee 2021; 31:118-126. [PMID: 34134079 PMCID: PMC8503925 DOI: 10.1016/j.knee.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/08/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered movement biomechanics are a risk factor for ACL injury. While hip abductor weakness has been shown to negatively impact landing biomechanics, the role of this musculature and injury risk is not clear. The aim of this musculoskeletal simulation study was to determine the effect of hip abductor fatigue-induced weakness on ACL loading, force production of lower extremity muscles, and lower extremity biomechanics during single-leg landing. METHODS Biomechanical data from ten healthy adults were collected before and after a fatigue protocol and used to derive subject-specific estimates of muscle forces and ACL loading using a 5-degree of freedom (DOF) model. RESULTS There were no significant differences in knee joint angles and ACL loading between pre and post-fatigue. However, there were significant differences, due to fatigue, in lateral trunk flexion angle, total excursion of trunk, muscle forces, and joint moments. CONCLUSION Altered landing mechanics, due to hip abductor fatigue-induced weakness, may be associated with increased risk of ACL injury during single-leg landings. Clinical assessment or screening of ACL injury risk will benefit from subject-specific musculoskeletal models during dynamic movements. Future study considering the type of the fatigue protocols, cognitive loads, and various tasks is needed to further identify the effect of hip abductor weakness on lower extremity landing biomechanics.
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Affiliation(s)
- Namwoong Kim
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182, USA
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, 50 Yonsei-ro, Sports Science Complex,Seoul 03722, Korea,International Olympic Committee Research Centre KOREA, Yonsei University, 50 Yonsei-ro, Sports Science Complex,Seoul 03722, Korea,Institute of Convergence Science, Yonsei University, 50 Yonsei-ro, Sports Science Complex,Seoul 03722, Korea
| | - Sung-Cheol Lee
- Department of Physical Education, Yonsei University, 50 Yonsei-ro, Sports Science Complex,Seoul 03722, Korea,Institute of Convergence Science, Yonsei University, 50 Yonsei-ro, Sports Science Complex,Seoul 03722, Korea
| | - Adam B. Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182, USA
| | - Terry L. Grindstaff
- School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Boyne Building, Omaha, NE 68178, USA
| | - Brian A. Knarr
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182, USA
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86
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De Pieri E, Friesenbichler B, List R, Monn S, Casartelli NC, Leunig M, Ferguson SJ. Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults. Front Bioeng Biotechnol 2021; 9:679360. [PMID: 34368092 PMCID: PMC8334869 DOI: 10.3389/fbioe.2021.679360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023] Open
Abstract
Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | | | - Renate List
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Samara Monn
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zürich, Switzerland
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87
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Martins SCS, Resende RA, Pinheiro LSP, Souza TR, Pinto RZ, Andrade AGP, Lustosa LP, Ocarino JM. Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque. Braz J Phys Ther 2021; 25:415-420. [PMID: 32962913 PMCID: PMC8353290 DOI: 10.1016/j.bjpt.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation. OBJECTIVES To establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement. METHODS Eighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer. RESULTS Simple linear regression analysis revealed that HEX torque was associated with HER torque (r=0.80; p<0.0001), resulting in the following prediction equation: HERtorque=-0.02+(0.58 * HEXtorque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference=0.02; 95% CI=-0.115, 0.072) and older adults (mean difference=0.05; 95% CI=-0.02, 0.12). CONCLUSION The HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.
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Affiliation(s)
- Suelen Cristina Souza Martins
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Renan Alves Resende
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Larissa Santos Pinto Pinheiro
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thales Rezende Souza
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rafael Zambelli Pinto
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - André Gustavo Pereira Andrade
- Graduate Program of Sports Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lygia Paccini Lustosa
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Juliana Melo Ocarino
- Human Performance Laboratory, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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88
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Carvalho C, Serrão FV, Mancini L, Serrão PRMDS. Impaired muscle capacity of the hip and knee in individuals with isolated patellofemoral osteoarthritis: a cross-sectional study. Ther Adv Chronic Dis 2021; 12:20406223211028764. [PMID: 34262680 PMCID: PMC8252374 DOI: 10.1177/20406223211028764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/10/2021] [Indexed: 01/25/2023] Open
Abstract
AIMS The aims of this study were to compare the capacity of the knee and hip muscles between individuals with and without isolated patellofemoral osteoarthritis (PFOA) and to evaluate the impact of PFOA on pain, stiffness, and physical function. METHODS This cross-sectional study evaluated muscle capacity of the hip and knee using an isokinetic dynamometer. The isokinetic variables used in the statistical analysis were peak torque, total work, and average power. Pain, stiffness, and physical function were assessed using questionnaires. RESULTS A total of 26 individuals participated in the study (13 with PFOA and 13 controls). The PFOA group exhibited lower peak torque, total work, and average power for knee extension and flexion in the concentric mode (p ⩽ 0.01) as well as lower peak torque and total work for knee extension (p ⩽ 0.005) and lower total work for knee flexion (p = 0.05) in the eccentric mode. The PFOA group exhibited lower peak torque of the extensor, abductor, adductor, and internal rotator muscles of the hip (p ⩽ 0.05), less total work of the abductor and adductor muscles (p ⩽ 0.04), and lower average power of eccentric adduction of the hip (p = 0.01) compared with the healthy controls. Compared with the control group, the PFOA group had a higher level of pain, stiffness, and compromised physical functioning self-reported (p ⩽ 0.005). CONCLUSION Participants with PFOA exhibited impairments regarding muscle capacity of the hip and knee, higher level of pain and stiffness as well as compromised physical functioning in comparison with healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Letícia Mancini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235–SP-310 São Carlos, São Paulo 13.565-905, Brazil
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89
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Effects of a Targeted Exercise Program on Inter-Leg Asymmetries in Patients with Patellofemoral Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p < 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.
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90
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Shih Y, Fisher BE, Kutch JJ, Powers CM. Corticomotor excitability of gluteus maximus and hip extensor strength: The influence of sex. Hum Mov Sci 2021; 78:102830. [PMID: 34130254 DOI: 10.1016/j.humov.2021.102830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare hip extensor strength and corticomotor excitability (CME) of gluteus maximus (GM) between males and females. A secondary purpose was to determine if CME of GM is predictive of hip extensor strength. METHOD Thirty-two healthy individuals participated (15 males and 17 females). CME of GM was assessed using the input-output curve (IOC) procedure acquired from transcranial magnetic stimulation (average slope). Hip extensor strength was measured by a dynamometer during a maximal voluntary isometric contraction. Independent t-tests were used to compare CME of GM and peak hip extensor torque between males and females. Linear regression analysis was used to determine whether peak hip extensor torque was predicted by CME of GM. RESULT Compared to males, females demonstrate lower peak hip extensor torque (4.42 ± 1.11 vs. 6.15 ± 1.72 Nm/kg/m2, p < 0.01) and lower CME of GM (1.36 ± 1.07 vs. 2.67 ± 1.30, p < 0.01). CME of GM was a significant predictor of peak hip extensor torque for males and females combined (r2 = 0.36, p < 0.001). CONCLUSION Our findings support the premise that corticomotor excitability plays a role in the ability of a muscle to generate torque.
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Affiliation(s)
- Yo Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America; Department of Physical Therapy, University of Nevada, Las Vegas, NV, United States of America
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States of America.
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91
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Effect of 8 weeks of stretching, strength and central stability exercises on scoliosis of boy students. TURKISH JOURNAL OF KINESIOLOGY 2021. [DOI: 10.31459/turkjkin.919399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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92
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Haghighat F, Rezaie M, Ebrahimi S, Shokouhyan SM, Motealleh A, Parnianpour M. Coordination Variability During Walking and Running in Individuals With and Without Patellofemoral Pain Part 1: Lower Limb Intersegmental Coordination Variability. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00603-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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93
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Manojlović D, Kozinc Ž, Šarabon N. Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis. J Pain Res 2021; 14:1431-1449. [PMID: 34079359 PMCID: PMC8165213 DOI: 10.2147/jpr.s301448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Previous research suggests that muscle strength exercise is the most effective rehabilitation methods in patients with patellofemoral pain (PFP). This systematic review with meta-analysis compared the effects of Hip&Knee, Hip-only and Knee-only exercise programs on pain relief, muscle strength, and functional performance in patients with PFP. Methods Literature searches of PubMed, PEDro and CINAHL databases revealed twenty-one studies included in the final descriptive review, thirteen of which were included in the meta-analysis. Data extraction included baseline and post-intervention means and standard deviations of all eligible outcome measures both for the intervention and control groups, participants baseline demographics and intervention characteristics. Results The results showed that Hip&Knee and Hip-only exercise programs were comparatively effective, while the Knee-only exercise programs proved to be inferior to the above-mentioned approaches. The Hip&Knee exercise programs showed the greatest pain relief (mean difference = -1.71 (-3.11, -0.30); p = 0.02; I2 = 96%) and functional improvement (standardized mean difference = 1.28 (0.45, 2.12); p = 0.003; I2 = 84%), although the subgroup analysis did not show any significant difference compared to Hip-only exercise programs (p > 0.05). Conclusion Overall, Hip&Knee exercise programs appear to reduce pain and improve function more than other exercise programs and could be used as a primary rehabilitation approach in patients with PFP. However, the difference between the subgroups in most outcome measures suggests that Hip&Knee exercise programs are no more effective than Hip-only exercise programs.
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Affiliation(s)
- Denisa Manojlović
- Department of Physiotherapy, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Žiga Kozinc
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Department of Health Study, Andrej Marušič Institute, University of Primorska, Koper, Slovenia
| | - Nejc Šarabon
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,Department of Health Study, Andrej Marušič Institute, University of Primorska, Koper, Slovenia.,Human Health Department, InnoRenew CoE, Izola, Slovenia.,Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Ljubljana, Slovenia
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94
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Arhos EK, Lang CE, Steger-May K, Van Dillen LR, Yemm B, Salsich GB. Task-specific movement training improves kinematics and pain during the Y-balance test and hip muscle strength in females with patellofemoral pain. J ISAKOS 2021; 6:277-282. [PMID: 34001505 DOI: 10.1136/jisakos-2020-000551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Task-specific movement training is a proposed intervention for patellofemoral pain aimed to optimise movement during daily tasks. Focused, progressive task practice emphasising optimal limb alignment may yield improvements in performance-based function and hip muscle strength, and transfer learnt movement patterns to untrained tasks. The purpose of this study was to determine if task-specific movement training improves performance-based function (composite score, movement, pain during movement) in an untrained task. Our secondary purpose was to test whether hip muscle strength improved following the movement training intervention. METHODS This study was a secondary analysis of a prospective, non-randomised, within-group, double-baseline study. Twenty-three females with patellofemoral pain underwent task-specific movement training two times/week for 6 weeks. Outcomes were collected at three time points: enrolment (baseline), 6 weeks (preintervention) and 12 weeks (postintervention). A repeated measures analysis of variance tested whether the change during the intervention phase was greater than the change during the control phase. Y-balance composite score, hip and knee kinematics and pain during the Y-balance test were primary outcome measures; strength of the hip lateral rotator, abductor and extensor muscles was a secondary outcome measure. RESULTS The change in composite score for the Y-balance test was not statistically significantly different between the intervention and control phases (p=0.16). The change during the intervention phase exceeded the change during the control phase for hip and knee kinematics and pain during the Y-balance test, with all variables improving (p<0.0001). The change during the intervention phase was greater than the control phase for hip muscle strength, with all variables improving (p<0.04). CONCLUSION Although the Y-balance test composite score did not improve, performance-based function during an untrained task, measured by movement and pain during the test, improved following task-specific movement training. Hip muscle strength improved, despite no focused muscle strengthening. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Elanna K Arhos
- Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Barbara Yemm
- Program in Physical Therapy, Saint Louis University, St Louis, Missouri, USA
| | - Gretchen B Salsich
- Program in Physical Therapy, Saint Louis University, St Louis, Missouri, USA
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95
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Stiff Landings, Core Stability, and Dynamic Knee Valgus: A Systematic Review on Documented Anterior Cruciate Ligament Ruptures in Male and Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073826. [PMID: 33917488 PMCID: PMC8038785 DOI: 10.3390/ijerph18073826] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/13/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to give a comprehensive, joint by joint analysis of injury risk and possible roles of prevention. Our review demonstrated that poor core stability, landing with heel strike, weak hip abduction strength, and increased knee valgus may contribute to increased ACL injury risk in young athletes.
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96
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Filippo M, Mourad F. The Flat Earth Theory: is Evidence-Based Physiotherapy a Sphere? J Man Manip Ther 2021; 29:67-70. [PMID: 33797340 DOI: 10.1080/10669817.2021.1890902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maselli Filippo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa - Campus of Savona, Savona, Italy
| | - Firas Mourad
- Department of Musculoskeletal Physical Therapy and Rehabilitation Science, Poliambulatorio Physio Power, Brescia, Italy
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97
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Dynamic Q-angle is increased in patients with chronic patellofemoral instability and correlates positively with femoral torsion. Knee Surg Sports Traumatol Arthrosc 2021; 29:1224-1231. [PMID: 32683477 DOI: 10.1007/s00167-020-06163-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/14/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the frontal gait patterns in patients with chronic patellofemoral instability compared to healthy controls. The hypothesis was that internal-rotation-adduction moment of the knee as altered dynamic Q-angle is evident in patients and correlates positively with increased femoral torsion. METHODS Thirty-five patients with symptomatic recurrent patellofemoral instability requiring surgical treatment were matched for average age, sex, and body mass index with 15 healthy controls (30 knees). Several clinical and radiographic measurements were taken from each participant: internal and external rotation (hipIR, hipER), Q-angle, tubercle sulcus angle (TS-angle), femoral antetorsion (femAT), tibial tubercle-trochlear groove (TT-TG) distance, and frontal leg axis. Additionally, three frontal gait patterns were defined and recorded: (1) internal-rotation-adduction moment of the knee during normal walking, (2) dynamic valgus of the knee, and (3) Trendelenburg's sign in a single-leg squat. Randomized videography was evaluated by three independent blinded observers. Statistical analysis was performed using regression models and comparisons of gait patterns and clinical and radiological measurements. Furthermore, observer reliability was correlated to gradings of radiological parameters. RESULTS Patients showed altered dynamic Q-angle gait pattern during normal walking (p < 0.001) compared to healthy controls (interrater kappa = 0.61), whereas highest observer agreement was reported if femAT was greater than 20° (kappa = 0.85). Logistic regression model revealed higher femAT (18.2° ± 12.5 versus 11.9° ± 7.0 (p = 0.004) as a significant variable, as well as lower TT-TG distance (23.6 mm ± 2.8 vs. 16.6 mm ± 4.9, p = 0.004) on evident dynamic Q-angle gait pattern. Dynamic valgus in a single-leg squat was observed significantly more often in patients (p < 0.001) compared to controls (interrater kappa = 0.7). However, besides the static measured Q-angle as the only significant variable on evident dynamic valgus pattern (13.6° ± 4.6 vs. 10.3° ± 5.2, p = 0.003), no radiological parameter was detected to correlate significantly with dynamic valgus and Trendelenburg's sign (n.s.). CONCLUSIONS Clinical detection of pathologic torsion and bony alignment may be difficult in patients with patellofemoral instability. The present study demonstrated that dynamic Q-angle gait pattern is significantly altered in patients with chronic patellofemoral instability compared to healthy controls. Moreover, dynamic Q-angle correlates positively with higher femoral torsion and negatively with higher TT-TG distance. Therefore, clinical and radiological assessment of maltorsion should be added to the standard diagnostic workup in cases of patellofemoral instability. LEVEL OF EVIDENCE Level II.
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98
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Gaffney BM, Van Dillen LR, Foody JN, Burnet PE, Clohisy JC, Chen L, Harris MD. Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2021; 84:105335. [PMID: 33812201 PMCID: PMC8845490 DOI: 10.1016/j.clinbiomech.2021.105335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/22/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage. METHODS Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05). FINDINGS During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking. INTERPRETATION Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.
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Affiliation(s)
- Brecca M.M. Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Linda R. Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Paige E. Burnet
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA,Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA,Corresponding author at: Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO 63108, United States. (M.D. Harris)
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99
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Carroll LA, Kivlan BR, Martin RL, Phelps AL, Carcia CR. The Single Leg Squat Test: A "Top-Down" or "Bottom-Up" Functional Performance Test? Int J Sports Phys Ther 2021; 16:360-370. [PMID: 33842032 PMCID: PMC8016417 DOI: 10.26603/001c.21317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians' interpretation of the SLST. PURPOSE The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). HYPOTHESIS There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. STUDY DESIGN Cross-sectional study. METHODS Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. RESULTS There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9o +/- 3.7o, fail group = 7.8o +/- 3.0o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5o +/- 5.6o, fail group = 13.9o +/- 5.3o; weight bearing dorsiflexion: pass group = 42.7o +/- 6.0o, 42.7o +/- 8.3o, p = .611). CONCLUSIONS Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University; UPMC Center for Sports Medicine
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Friesen KB, Shaw RE, Shannon DM, Dugas JR, Andrews JR, Oliver GD. Single-Leg Squat Compensations Are Associated With Softball Pitching Pathomechanics in Adolescent Softball Pitchers. Orthop J Sports Med 2021; 9:2325967121990920. [PMID: 34250163 PMCID: PMC8237211 DOI: 10.1177/2325967121990920] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: A lack of lumbopelvic-hip complex (LPHC) stability is often associated with
altered pitching mechanics, thus increasing pain and injury susceptibility.
The single-leg squat (SLS) is a simple diagnostic tool used to examine LPHC
stability. Purpose: To examine the relationship between trunk compensatory kinematics during the
SLS and kinematics at foot contact during the windmill pitch. Study Design: Descriptive laboratory study. Methods: Participants included 55 youth and high school softball pitchers (mean age,
12.6 ± 2.2 years; height, 160.0 ± 11.0 cm; weight, 60.8 ± 15.5 kg).
Kinematic data were collected at 100 Hz using an electromagnetic tracking
device. Participants were asked to complete an SLS on each leg, then throw 3
fastballs at maximal effort. Values of trunk flexion, trunk lateral flexion,
and trunk rotation at peak depth of the SLS were used as the dependent
variables in 3 separate backward-elimination regression analyses.
Independent variables examined at foot contact of the pitch were as follows:
trunk flexion, trunk lateral flexion, trunk rotation, center of mass, stride
length, and stride knee valgus. Results: The SLS trunk rotation regression (F(1,56) = 4.980,
P = .030) revealed that trunk flexion predicted SLS
trunk rotation (SE = 0.068, t = 2.232, P =
.030) and explained approximately 7% of the variance in SLS trunk rotation
(R2 = 0.083, adjusted R2 = 0.066). The SLS trunk flexion regression
(F(1,56) = 5.755, P = 0.020) revealed that
stride knee valgus significantly predicted SLS trunk flexion (SE = 0.256,
t = 2.399, P = .020) and explained
approximately 8% of variance in SLS trunk flexion (R2 = 0.095, adjusted R2 = 0.078). Conclusion: Additional trunk rotation and trunk flexion at peak depth of the SLS showed
increased knee valgus and trunk flexion at foot contact of the pitch, both
of which indicate poor LPHC stability during the softball pitch and may
increase the potential for injury. Clinical Relevance: Players and coaches should implement SLS analyses to determine their players’
risk for injury and compensation due to poor core stability.
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Affiliation(s)
- Kenzie B Friesen
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Regan E Shaw
- Sports Medicine and Movement Lab, School of Kinesiology, Auburn University, Auburn, Alabama, USA
| | - David M Shannon
- Educational Foundations, Leadership, and Technology, Auburn University, Auburn, Alabama, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Gretchen D Oliver
- Sports Medicine and Movement Lab, School of Kinesiology, Auburn University, Auburn, Alabama, USA.,Investigation performed at the Sports Medicine and Movement Lab, School of Kinesiology, Auburn University, Auburn, Alabama, USA
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