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Kehribar L, Yılmaz AK, Karaduman E, Kabadayı M, Bostancı Ö, Sürücü S, Aydın M, Mahiroğulları M. Post-Operative Results of ACL Reconstruction Techniques on Single-Leg Hop Tests in Athletes: Hamstring Autograft vs. Hamstring Grafts Fixed Using Adjustable Cortical Suspension in Both the Femur and Tibia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030435. [PMID: 35334611 PMCID: PMC8950666 DOI: 10.3390/medicina58030435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 01/13/2023]
Abstract
Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia (MAI) ACLR techniques. We aimed to compare the results of single-leg hop tests (SLHT) applied in different directions and limb symmetry indices (LSI) in athletes with a 6-month post-operative ACLR history. Materials and Methods: A retrospective cohort of 39 athletes from various sports branches who underwent MAI (n = 16) and ST/G (n = 23) ACLR techniques by the same surgeon were evaluated. The knee strength of the participants on the operated and non-operated sides was evaluated with five different SLHTs. The SLHT included the single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores in the post-operative leg for both techniques (p < 0.05) compared to the pre-operative levels. When there was a difference between the SH of the operative and the non-operative legs in the ST/G technique (p < 0.05), there was no significant difference in the other hop distance for both ST/G and MAI (p > 0.05). There was no difference between the techniques regarding the LSI scores. Conclusions: The fact that our research revealed similar LSI rates of the SLHTs applied in different directions in the ST/G and MAI techniques assumes that the MAI technique can be an ACLR technique which can be functionally used in athletes.
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Affiliation(s)
- Lokman Kehribar
- Department of Orthopaedics and Traumatology, Samsun University, Samsun 55090, Turkey;
| | - Ali Kerim Yılmaz
- Faculty of Yaşar Doğu Sport Sciences, Ondokuz Mayıs University, Samsun 55270, Turkey; (E.K.); (M.K.); (Ö.B.)
- Correspondence: or ; Tel.: +90-542-495-3737
| | - Emre Karaduman
- Faculty of Yaşar Doğu Sport Sciences, Ondokuz Mayıs University, Samsun 55270, Turkey; (E.K.); (M.K.); (Ö.B.)
| | - Menderes Kabadayı
- Faculty of Yaşar Doğu Sport Sciences, Ondokuz Mayıs University, Samsun 55270, Turkey; (E.K.); (M.K.); (Ö.B.)
| | - Özgür Bostancı
- Faculty of Yaşar Doğu Sport Sciences, Ondokuz Mayıs University, Samsun 55270, Turkey; (E.K.); (M.K.); (Ö.B.)
| | - Serkan Sürücü
- Department of Orthopaedics, University of Missouri, Kansas City, MO 64108, USA;
| | - Mahmud Aydın
- Haseki Training and Research Hospital, Orthopaedics and Traumatology, Istanbul 34096, Turkey;
| | - Mahir Mahiroğulları
- Memorial Sisli Hospital, Orthopaedics and Traumatology, Istanbul 34384, Turkey;
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Identification of Sex Differences within Lunge Decelerations via Lower Extremity Support Movements; Implications for ACL Injury Disparity, Prevention, and Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Loading characteristics and lower extremity injury mechanisms, such as the non-contact mechanism of cruciate ligament injury, differ between sexes. The Limb Support Moment (LSM) quantifies hip, knee, and ankle moment contribution to the net moment required to prevent limb collapse during deceleration tasks. In total, 10 males and 10 females performed single limb deceleration landings within three knee flexion ranges: 0–25°, 25–50°, and 50–75°. Lower extremity joint moments and LSMs were calculated for all planes at initial contact (IC) through 50 ms. A two-way multivariate ANOVA compared LSMs and joint moments between sexes for all planes. Female LSMs were significantly greater at IC in the sagittal and transverse planes due to the generation of hip and ankle extensor moments and larger hip, knee, and ankle internal rotation moments. Males demonstrated significantly greater LSMs in the frontal plane due to the generation of hip abductor moments. Results suggest that females have a more rigid lower limb than males at landing, with less shock absorption capacity and greater potential for frontal plane collapse due to an unsupportive hip adductor moment. Quantifying the contribution of joint moments to limb support via LSMs suggests that there are landing characteristic sex differences, which may provide insight into injury disparity while guiding injury prevention/rehabilitation methodology.
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103
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Sahabuddin FNA, Jamaludin NI, Hamzah NA, Leang CC, Shaharudin S. The effects of hip- and ankle-focused exercise intervention on lower limb mechanics during single leg squat among physically active females. Phys Ther Sport 2022; 55:70-79. [DOI: 10.1016/j.ptsp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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Medeiros HBO, Silvano GA, Herzog W, Nunes MO, de Brito Fontana H. Hip torques and the effect of posture in side-stepping with elastic resistance. Gait Posture 2022; 93:119-125. [PMID: 35134651 DOI: 10.1016/j.gaitpost.2022.01.021] [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: 03/12/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The way movement-based exercises affect targeted muscles is not always obvious. Side stepping with an elastic band around the forefeet is aimed at strengthening hip abductors and lateral rotator muscles, with the premise that it creates an external torque of adduction and medial rotation of the femur around the pelvis that needs to be counteracted by hip muscles. However, hip torques during this exercise have not been previously quantified. RESEARCH QUESTION Is the premise that the side-stepping exercise creates an external torque of adduction and medial rotation of the femur around the pelvis correct? METHODS Thirty-six adults performed the exercise in an upright and a squat posture while 3D kinetic and kinematic data were collected. Hip muscle torques were calculated using inverse dynamics. The effect of posture and potential interactions with sex, side-stepping phases, and trailing/leading directions were analyzed using Pearson correlation and mixed-model ANOVAs. RESULT A hip net muscle torque of extension, abduction and medial rotation was required to perform the exercise, regardless of phase and direction. The net muscle torque towards medial rotation required during the exercise was smaller (P < 0.001) in the upright (0.05-0.12 N m kg-1 m-1 across phases) compared to the squat posture (0.10-0.24 N m kg-1 m-1). In contrast, hip abductor torque was not affected by posture. When averaged across phases and directions, the normalized hip medial rotator muscle torque was highly correlated with knee flexion (r = 0.93, P < 0.001). SIGNIFICANCE The assumption that the side-stepping with the elastic band on the forefeet creates an external hip torque of medial rotation is erroneous. The resistance imposed to the hip during this exercise is consistent with the goal of strengthening the muscles that contribute to hip abduction and hip medial (not lateral) rotation. Changing the knee flexion angle is an effective way to manipulate hip rotator torque when prescribing this exercise in strength training and rehabilitation programs.
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Affiliation(s)
- Heron B O Medeiros
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Géssica A Silvano
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Walter Herzog
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Marcio O Nunes
- Physical Education Department, University Center of Brusque, Brusque, Santa Catarina, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil; Morphological Sciences Department, School of Biological Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
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105
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Duchene Y, Gauchard GC, Mornieux G. Influence of sidestepping expertise and core stability on knee joint loading during change of direction. J Sports Sci 2022; 40:959-967. [PMID: 35191363 DOI: 10.1080/02640414.2022.2042980] [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: 10/19/2022]
Abstract
The aims of this study were twofold: first, to compare core stability and knee joint loading between sidestepping experts and nonexperts; secondly, to determine core predictors of knee joint loading. Thirteen handball male players (experts) and 14 karatekas (nonexperts) performed six unanticipated 45° sidestepping manoeuvers, while trunk and pelvis 3D kinematics as well as ground reaction forces were measured, and peak knee abduction moment (PKAM) was determined. Student t-tests enabled a comparison of both groups and a linear mixed model approach was used to identify PKAM predictors. Sidestepping experts demonstrated significantly lower pelvis rotation towards the new movement direction at the initial contact than nonexperts (4.9° vs. 10.8°) and higher PKAM (0.539 vs. 0.321 Nm/kg-bwt). Trunk medial lean, trunk axial rotation and pelvis anterior tilt at the initial contact predicted PKAM, while trunk axial rotation, pelvis medial lean and posterior ground reaction force predicted PKAM during the weight acceptance phase. Despite higher PKAM, handball players might not be at a higher risk of anterior cruciate ligament injury as the knee joint loading remained at a relatively low level during this sidestepping task. Core stability, in its three dimensions, is a key determinant of knee joint loading.
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Affiliation(s)
- Youri Duchene
- Université de Lorraine, Faculty of Sport Sciences, Nancy, France
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106
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Cannon J, Weithman BA, Powers CM. Activation training facilitates gluteus maximus recruitment during weight-bearing strengthening exercises. J Electromyogr Kinesiol 2022; 63:102643. [DOI: 10.1016/j.jelekin.2022.102643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
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107
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Comparison between side-lying and standing positions for hip abductor strength assessment. J Bodyw Mov Ther 2022; 30:181-186. [DOI: 10.1016/j.jbmt.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 11/08/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022]
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108
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Martins D, de Castro MP, Ruschel C, Pierri CAA, de Brito Fontana H, Moraes Santos G. Do Individuals with History of Patellofemoral Pain Walk and Squat Similarly to Healthy Controls? A 3D Kinematic Analysis During Pain Remission Phase. Int J Sports Phys Ther 2022; 17:185-192. [PMID: 35136687 PMCID: PMC8805120 DOI: 10.26603/001c.31044] [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: 05/18/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is typically accompanied by changes in movement pattern. However, it is unclear if these changes persist in the remission phase of symptoms. Investigating movement patterns in individuals in remission phase of PFP may help to further guide the rehabilitation process and to understand whether changes are due to high levels of pain or related to other factors. PURPOSE To compare 3D kinematics during walking and the single leg squat (SLS) between individuals with history of PFP in remission phase and a control group without history of lower limb injuries and PFP. STUDY DESIGN Cross-sectional case-control study. METHODS Individuals with onset of PFP for at least one year and in phase of remission of symptoms (experimental group [EG]; n=13, 30±8 years) were compared to a control group (CG, n=13, 28±7 years). A 10-camera motion analysis system (Vicon-Nexus®) was used to record 3D ankle, knee, hip and trunk angles during walking and SLS. RESULTS The EG presented less ankle dorsiflexion, knee and hip flexion during the stance phase of walking compared to the CG (p=0.005, large effect size ηp2 = 0.141). During the SLS, no between-group differences were observed for the ankle, knee and hip angles at the peak of knee flexion (p>0.05). A trend for increased trunk range of movement in the EG compared to the CG was observed (p=0.075, medium effect size ηp2 = 0.127). CONCLUSION The results of this study indicate less movement in the sagittal plane during walking, and a trend towards more movement of the trunk during SLS in the EG compared to the CG. The participants of the EG had minimal symptoms, to the point of not classifying them as pathological. However, the between-group differences suggest that even in the remission phase, kinematic differences persist for some reason and may contribute to the recurring pain in PFP individuals. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Diego Martins
- Center of Health and Sports Science, University of the State of Santa Catarina
| | - Marcelo Peduzzi de Castro
- Center of Health and Sports Science, University of the State of Santa Catarina; Labclin - Neuromuscularskeletal Rehabilitation and Clinical Biomechanics Laboratory
| | - Caroline Ruschel
- Center of Health and Sports Science, University of the State of Santa Catarina
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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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110
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Khuu A, Loverro KL, Lewis CL. Muscle Activation During Single-Legged Squat Is Affected by Position of the Nonstance Limb. J Athl Train 2022; 57:170-176. [PMID: 33887761 PMCID: PMC8876880 DOI: 10.4085/1062-6050-0019.21] [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: 02/03/2023]
Abstract
CONTEXT The single-legged squat (SLS) is appropriate for targeting activation, strengthening, and neuromuscular retraining of the gluteus maximus, gluteus medius, and quadriceps. However, the effects of different nonstance-limb positions on muscle activity have not been fully evaluated. OBJECTIVE To compare the muscle activity of selected stance-limb hip muscles during the SLS using 3 nonstance-limb positions: in front (SLS-Front), in the middle (SLS-Middle), and in back (SLS-Back). DESIGN Controlled laboratory study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 17 healthy adults (8 men, 9 women; age = 22.6 ± 3.6 years, height = 173.3 ± 10.7 cm, mass = 71.2 ± 11.0 kg) participated. MAIN OUTCOME MEASURE(S) Surface electromyographic data of the gluteus maximus, gluteus medius, lateral hamstrings, medial hamstrings, rectus femoris, and tensor fascia lata (TFL) as well as kinetic data of the hip and knee were collected while participants performed the 3 SLS tasks. Mean muscle-activation levels during the descent and ascent phases for the selected hip muscles and hip and knee kinetics in all 3 planes were compared for the 3 tasks. Each variable of interest was analyzed using a separate linear regression model with a generalized estimating equations correction. RESULTS Muscle-activation levels of the gluteus maximus, gluteus medius, medial hamstrings, rectus femoris, and TFL for the stance limb during descent (P ≤ .04) and the medial hamstrings and TFL during ascent (P ≤ .002) were different among the SLS tasks. The greatest number of differences occurred between SLS-Front and SLS-Back. During descent, gluteal muscle activity was greater in SLS-Front (P ≤ .03) and SLS-Middle (P = .03) than in SLS-Back. For both phases, TFL activity was greater during SLS-Front than during both SLS-Middle and SLS-Back (P ≤ .006). Kinetic differences at the hip and knee between SLS tasks were also observed (P values ≤ .02). CONCLUSIONS The 3 SLS tasks had different muscle-activation and kinetic profiles. Clinicians and researchers can vary nonstance-limb position during the SLS to manipulate muscle-activation levels and tailor the exercise to assist with goals at different stages of rehabilitation.
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Affiliation(s)
- Anne Khuu
- Department of Physical Therapy and Athletic Training, Boston University, MA
| | - Kari L. Loverro
- Department of Physical Therapy and Athletic Training, Boston University, MA
,Combat Capabilities Development Command Soldier Center, Natick, MA
| | - Cara L. Lewis
- Department of Physical Therapy and Athletic Training, Boston University, MA
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111
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Hilário BEB, de Oliveira ML, Barbosa PMM, Cunha DMS, Dos Santos Rigobello G, Mendes JF, Nogueira DA, Iunes DH, Carvalho LC. Analysis of the use of insoles in the dynamic stability of the lower limbs in recreational runners: An exploratory study. Gait Posture 2022; 92:435-441. [PMID: 34979430 DOI: 10.1016/j.gaitpost.2021.12.017] [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: 01/20/2021] [Revised: 12/11/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of insoles, which is increasingly widespread, can promote changes in biomechanics during running. RESEARCH QUESTION Can the use of insoles with various patterns of infracapital support influence factors related to the dynamic stability of the lower limbs during running on a treadmill in recreational runners? METHODS This is controlled single-blind repeated measures. Static baropodometric data were collected, as well as kinematic data for the lower limbs and electromyographic data for the gluteus maximus and gluteus medius muscles, for twelve recreational runners on a treadmill using four models of insoles (neutral and with forefoot elements - infracapital bar). RESULTS Neutral insoles were able to reduce laterolateral displacement, increase the displacement of the mass to the posterior, and increase the lateral rotation of the left knee and medial rotation of the right hip. Insoles with a 2 mm total infracapital bar were able to move the mass to the posterior, increase laterolateral displacement and activate the gluteus medius. Insoles with a 2 mm medial infracapital bar were able to increase the displacement of the mass to the posterior, increase the adduction of left hip and the medial rotation of right hip, and activate the gluteus medius. Insoles with a 4 mm medial infracapital element were able to move the body mass to the posterior and to the left, increase laterolateral displacement, increase the adduction of left hip, the medial rotation of right hip and the abduction of right knee. SIGNIFICANCE The insoles evaluated in the present study were able to modify biomechanical variables of recreational runners related to dynamic stability during running on a treadmill and static baropodometric variables.
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Affiliation(s)
- Bruna E B Hilário
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil
| | - Marcelo Lima de Oliveira
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil
| | - Pâmela Maria M Barbosa
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil
| | - Daniela M S Cunha
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil
| | | | - Juliano F Mendes
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil.
| | - Denismar A Nogueira
- Institute of Exact Sciences, Department of Statistics, Federal University of Alfenas, MG, Brazil
| | - Denise Hollanda Iunes
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil
| | - Leonardo César Carvalho
- Institute of Motricity Sciences, Department of Physiotherapy, Federal University of Alfenas, MG, Brazil.
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112
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Giri S, Tewari RP, Salhi A, Lempereur M, Borotikar B. A Musculoskeletal Model Customized for Sagittal and Frontal Knee Kinematics with Improved Knee Joint Stability. J Biomech Eng 2022; 144:1133335. [PMID: 35079786 DOI: 10.1115/1.4053666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 11/08/2022]
Abstract
Current lower limb musculoskeletal (MSK) models focus on sagittal plane kinematics. However, abnormal gait is typically associated with sagittal plane motions crossing into other planes, limiting the use of current MSK models. The purpose of this study was twofold, first, to extend the capability of a full-body MSK model from the literature to include frontal knee plane kinematics during healthy gait, and second, to propose and implement a realistic muscle discretization technique. Two MSK model constructs were derived - the first construct (Knee2_SM) allowed two degrees of freedom (sagittal and coronal) at the knee and the second construct (Knee2_MM) implemented multi-line elements for all the lower limb muscles in conjunction with two knee degrees of freedom. Motion analysis data of normal gait cycle from 10 healthy adults were used to compare joint kinematics, muscle moment arms, muscle forces, and muscle activations, between new constructs and the original model. Knee varus-valgus trajectories were estimated with the mean peak values ranging from 9.49° valgus to 1.57° varus. Knee2_MM predicted significant difference (p < 0.05) in moment arms and forces in those muscles responsible for medial-lateral stability of the knee. The simulated muscle activations generated by Knee2_MM model matched more closely to the experimental EMG when qualitatively compared. This study enhances the capability of sagittal plane full-body MSK model to incorporate knee varus-valgus motion while keeping the joint stability intact and improving muscle prediction.
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Affiliation(s)
- Shivangi Giri
- Department of Applied Mechanics, Motilal Nehru National Institute of Technology, Prayagraj, India
| | - R P Tewari
- Department of Applied Mechanics, Motilal Nehru National Institute of Technology, Prayagraj, India
| | - Asma Salhi
- Laboratory of Medical Information Processing (LaTIM), INSERM U1101, Brest, France; Department of Image and Information Processing, IMT Atlantique, Brest, France
| | - Mathieu Lempereur
- Laboratory of Medical Information Processing (LaTIM), INSERM U1101, Brest, France; University of Western Brittany (UBO), Brest, France
| | - Bhushan Borotikar
- Laboratory of Medical Information Processing (LaTIM), INSERM U1101, Brest, France; Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Pune, India
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Firouzi V, Bahrami F, Sharbafi MA. Human balance control in 3D running based on virtual pivot point concept. J Exp Biol 2022; 225:274032. [PMID: 35040960 DOI: 10.1242/jeb.243080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022]
Abstract
Balance control is one of the crucial challenges in bipedal locomotion. Humans need to maintain their trunk upright while the body behaves like an inverted pendulum which is inherently unstable. Instead, the virtual pivot point (VPP) concept introduced a new virtual pendulum model to the human balance control paradigm by analyzing the ground reaction forces (GRF) in the body coordinate frame. This paper presents novel VPP-based analyses of the postural stability of human running in a 3D space. We demonstrate the relation between the VPP position and the gait speed. The experimental results suggest different control strategies in frontal and sagittal planes. The ground reaction forces intersect below the center of mass in the sagittal plane and above the center of mass in the frontal plane. These VPP locations are found for the sagittal and frontal planes at all running speeds, respectively. We introduced a 3D VPP-based model which can replicate the kinematic and kinetic behavior of human running. The similarity between the experimental and simulation results indicates the ability of the VPP concept in predicting human balance control in running and can support its applicability for gait assistance.
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Affiliation(s)
- Vahid Firouzi
- Electrical and Computer Engineering Department, College of Engineering, University of Tehran, Tehran, Iran
| | - Fariba Bahrami
- Electrical and Computer Engineering Department, College of Engineering, University of Tehran, Tehran, Iran
| | - Maziar A Sharbafi
- Lauflabor Laboratory, Technische Universität Darmstadt, Darmstadt, Germany
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114
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Lotfi H, Moghadam AN, Shati M. Electromyography Activity of Vastus Medialis Obliquus and Vastus Lateralis Muscles During Lower Limb Proprioceptive Neuromuscular Facilitation Patterns in Individuals with and without Patellofemoral Pain Syndrome. Phys Ther Res 2022; 24:218-224. [PMID: 35036255 DOI: 10.1298/ptr.e10094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Exercise therapy to strengthen quadriceps muscle is recommended in rehabilitation program for people with patellofemoral pain syndrome (PFPS). This study aimed to investigate the electromyography (EMG) activity of vastus medialis obliquus (VMO), vastus lateralis (VL) and VMO/VL ratio during PNF in individuals with and without PFPS. METHODS 26 persons with PFPS and 26 healthy subjects participated to study. All subjects performed PNF patterns (Flexion-Adduction-External Rotation (D1FL), Extension-Adduction-External Rotation (D2EX), D1FL+ load, D2EX+ load) and straight leg raise (SLR). The normalized EMG activity of VMO, VL and VMO/VL ratio were measured and analyzed using repeated measure ANOVA. RESULTS There were significant main effects of group and exercises for the both VMO and VL (p<0.05). It was found that except SLR and D2EX, in the other motions PFPS group had lower VMO activity compared to healthy group (p<0.05). For VL except SLR, in the other motions PFPS group had lower VL activity too (p<0.05). The PNF patterns activated VMO more than SLR, however it was not significant (p>0.05). Also; there weren't any significant difference between the two groups in VMO/VL activation ratios. Also, performing the PNF patterns with load increased VMO and VL muscles activity significantly (p<0.05). It also found that in PFPS group the VMO/VL ratio values in PNF patterns were significantly more than SLR and the highest VMO/VL ratio value (0.96) was found during D2EX. CONCLUSION The PNF patterns due to provide optimal VMO/VL ratio value than SLR and proper balance between these two muscles can be recommended in rehabilitation of individuals with PFPS.
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Affiliation(s)
- Hiva Lotfi
- MSc of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Iran
| | - Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Iran
| | - Mohsen Shati
- Department of aging, University of Social Welfare and Rehabilitation Sciences, Iran
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115
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Martins EC, Ruschel C, Roesler EM, Silvano GA, de Castro MP, Herzog W, de Brito Fontana H. Tensor fascia latae and gluteal muscles myoelectric responses to increasing levels of hip medial rotation torque. J Biomech 2022; 132:110944. [PMID: 35016091 DOI: 10.1016/j.jbiomech.2022.110944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Medial hip rotation is typically attributed to the tensor fascia latae (TFL) and lateral rotation, to the gluteus maximus. However, experimental studies in cadavers suggest that the TFL lacks a moment arm for medial rotation and that the gluteus maximus may act as hip medial rotator depending on the hip flexion angle. In order to address this contradictory thinking, we measured the myoelectric activity of TFL, gluteus medius and gluteus maximus (superior portion, GMaxS, and inferior portion, GMaxI) for increasing levels of medial rotation torque applied to the hip. To keep frontal and sagittal plane hip joint net torques constant during the experiments, the medial hip rotation torque was changed by displacing standard weights along an aluminum bar device, thereby producing pure medial hip rotation torques. The effect of increasing medial hip rotation torque was investigated for a fully extended hip (0°), and at 45° and 90° of flexion. We found an increase in the myoelectric activity of the TFL (∼90%↑, p = 0.002) at 90° of flexion and of the GMaxS (∼7%↑, p = 0.048) at the extended position with an increase in medial hip torque application (from 0 to 7.4 N.m.). For the GMed (regardless of hip position) and for the 45° position (regardless of muscle), no systematic changes across torque conditions were observed. In contrast to the common clinical assumption and current practice thinking, our results indicate that an increase in TFL activity is required to control for an increase in external torque towards hip medial rotation.
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Affiliation(s)
- Eduardo Campos Martins
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Caroline Ruschel
- College of Health and Sport Science, Santa Catarina State, Florianópolis, Santa Catarina, Brazil
| | - Erik Mecca Roesler
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Gessica Aline Silvano
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Marcelo Peduzzi de Castro
- Labclin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Santa Catarina CEP: 88015-310, Brazil
| | - Walter Herzog
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil; Department of Morphological Sciences, School of Biological Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil.
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Theisen BJ, Larson PD, Chambers CC. Optimizing Rehabilitation and Return to Sport in Athletes With Anterior Knee Pain Using a Biomechanical Perspective. Arthrosc Sports Med Rehabil 2022; 4:e199-e207. [PMID: 35141552 PMCID: PMC8811520 DOI: 10.1016/j.asmr.2021.10.028] [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: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
Anterior knee pain represents one of the most common athletic knee conditions and arguably also one of the most complex. The patellofemoral joint is at the center of several forces, and alterations in any of these force vectors due to muscular imbalance, soft-tissue tightness or laxity, and altered functional movement patterns can all combine to create a painful anterior knee. While typically anterior knee pain is not a surgical entity, the orthopaedic surgeon with an understanding of these biomechanical intricacies is best positioned to provide comprehensive evidence-based care for the patient with anterior knee pain. Level of Evidence V, expert opinion.
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HIP abduction machine is better than free weights to target the gluteus medius while minimizing tensor fascia latae activation. J Bodyw Mov Ther 2022; 30:160-167. [DOI: 10.1016/j.jbmt.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/24/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022]
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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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Kuntze G, Nettel-Aguirre A, Lorenzen KN, Küpper J, Ronsky JL, Whittaker JL, Emery CA. Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211058105. [PMID: 34917690 PMCID: PMC8669131 DOI: 10.1177/23259671211058105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies. Purpose To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport-related ACLR and uninjured peers of a similar age, sex, and sport. Study Design Cross-sectional study. Level of evidence III. Methods Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects. Results Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = -0.04 deg/% [95% CI, -0.07 to -0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = -0.2° [95% CI, -0.3° to -0.0°]; P = .014) and hip flexion (β = -0.1° [95% CI, -0.2° to -0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = -0.34 BW [95% CI, -0.61 to -0.07 BW]; P = .014) (pushoff: β = -0.20 BW [95% CI, -0.32 to -0.08 BW]; P = .001). Conclusion Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges. Clinical Relevance It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport-related ACLR.
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Affiliation(s)
- Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kristin N Lorenzen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Olivares-Jabalera J, Fílter-Ruger A, Dos’Santos T, Afonso J, Della Villa F, Morente-Sánchez J, Soto-Hermoso VM, Requena B. Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13351. [PMID: 34948963 PMCID: PMC8704173 DOI: 10.3390/ijerph182413351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
| | | | - Thomas Dos’Santos
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester M15 6BH, UK
- Manchester Institute of Sport 2.01, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Jose Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sports of the University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
| | | | - Víctor Manuel Soto-Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
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121
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Dadfar M, Sheikhhoseini R, Jafarian M, Esmaeili A. Lower extremity kinematic coupling during single and double leg landing and gait in female junior athletes with dynamic knee valgus. BMC Sports Sci Med Rehabil 2021; 13:152. [PMID: 34886878 PMCID: PMC8662875 DOI: 10.1186/s13102-021-00385-y] [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: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dynamic knee valgus (DKV) is a common lower extremity movement disorder among females. This study aimed to investigate kinematic couplings between lower extremity joints in female junior athletes with DKV during single and double-leg landing and gait. METHODS Twenty-six physically active female junior athletes (10-14 years old) with DKV were recruited. Kinematic couplings between rearfoot, tibia, knee, and hip were extracted using eight Vicon motion capture cameras and two force plates. Zero-lag cross-correlation coefficient and vector coding were used to calculate kinematic couplings between joints during physical tasks. Paired t-test and Wilcoxon tests were run to find significant couplings between joint motions and coupling strengths. Bonferroni posthoc was used to determine significance with α ≤ 0.05. RESULTS The results showed that the strongest kinematic relationship existed between rearfoot eversion/inversion and tibial internal/external rotation during all three tasks. Correlations of the rearfoot supination/pronation with tibial rotations, knee, and hip motions in sagittal, frontal, and transverse planes were very strong to strong during double-leg landing and moderate to weak during gait. A weak correlation was observed between rearfoot supination/pronation and hip adduction/abduction during single-leg landing. CONCLUSIONS Coupling relationships between rearfoot, knee, and hip vary by the task intensity and alignment profiles in female juniors with DKV.
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Affiliation(s)
- Mahdis Dadfar
- Department of Corrective Exercise and Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise and Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Mohadeseh Jafarian
- Department of Electrical Engineering, Faculty of Electrical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Esmaeili
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Football League (AFL), Melbourne, Australia
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Mercado-Palomino E, Aragón-Royón F, Richards J, Benítez JM, Ureña Espa A. The influence of limb role, direction of movement and limb dominance on movement strategies during block jump-landings in volleyball. Sci Rep 2021; 11:23668. [PMID: 34880343 PMCID: PMC8654914 DOI: 10.1038/s41598-021-03106-0] [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: 03/19/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
The identification of movement strategies in situations that are as ecologically valid as possible is essential for the understanding of lower limb interactions. This study considered the kinetic and kinematic data for the hip, knee and ankle joints from 376 block jump-landings when moving in the dominant and non-dominant directions from fourteen senior national female volleyball players. Two Machine Learning methods were used to generate the models from the dataset, Random Forest and Artificial Neural Networks. In addition, decision trees were used to detect which variables were relevant to discern the limb movement strategies and to provide a meaningful prediction. The results showed statistically significant differences when comparing the movement strategies between limb role (accuracy > 88.0% and > 89.3%, respectively), and when moving in the different directions but performing the same role (accuracy > 92.3% and > 91.2%, respectively). This highlights the importance of considering limb dominance, limb role and direction of movement during block jump-landings in the identification of which biomechanical variables are the most influential in the movement strategies. Moreover, Machine Learning allows the exploration of how the joints of both limbs interact during sporting tasks, which could provide a greater understanding and identification of risky movements and preventative strategies. All these detailed and valuable descriptions could provide relevant information about how to improve the performance of the players and how to plan trainings in order to avoid an overload that could lead to risk of injury. This highlights that, there is a necessity to consider the learning models, in which the spike approach unilaterally is taught before the block approach (bilaterally). Therefore, we support the idea of teaching bilateral approach before learning the spike, in order to improve coordination and to avoid asymmetries between limbs.
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Affiliation(s)
- Elia Mercado-Palomino
- Department of Physical and Sport Education, Faculty of Sport, Human Lab - Sport and Health University Research Institute (iMUDS), University of Granada, Carretera de Alfacar, s/n, 18011, Granada, Spain.
| | - Francisco Aragón-Royón
- Department of Computer Science and Artificial Intelligence, DICITS, DASCI, IMUDS, University of Granada, Granada, Spain
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - José M Benítez
- Department of Computer Science and Artificial Intelligence, DICITS, DASCI, IMUDS, University of Granada, Granada, Spain
| | - Aurelio Ureña Espa
- Department of Physical and Sport Education, Faculty of Sport, Human Lab - Sport and Health University Research Institute (iMUDS), University of Granada, Carretera de Alfacar, s/n, 18011, Granada, Spain
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Three Main Mechanisms Characterize Medial Collateral Ligament Injuries in Professional Male Soccer-Blow to the Knee, Contact to the Leg or Foot, and Sliding: Video Analysis of 37 Consecutive Injuries. J Orthop Sports Phys Ther 2021; 51:611-618. [PMID: 34784244 DOI: 10.2519/jospt.2021.10529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players. DESIGN Case series. METHODS Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported. RESULTS Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. Three main sprain mechanisms were noted: (1) direct contact/blow to the knee (n = 16), (2) contact to the leg or foot (lever like) (n = 7), and (3) sliding (n = 9). Seventy-three percent of MCL injuries occurred during 2 main situations: (1) pressing/tackling (n = 14, 38%) and (2) being tackled (n = 13, 35%). For indirect and noncontact injuries, knee valgus loading (100% of cases), hip abduction (73% of cases), and external foot rotation (92% of cases) were prominent injury kinematics, often with lateral trunk tilt (median, 10°; 64% of cases) and rotation (64% of cases). Knee flexion angles were higher for indirect and noncontact injuries (median, 100°) than for direct-contact injuries (median, 22°; P<.01). CONCLUSION Nearly two thirds of MCL injuries occurred after direct contact; 1 in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to the knee, (2) contact to the leg or foot (lever like), and (3) sliding. J Orthop Sports Phys Ther 2021;51(12):611-618. Epub 16 Nov 2021. doi:10.2519/jospt.2021.10529.
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Della Villa F, Tosarelli F, Ferrari R, Grassi A, Ciampone L, Nanni G, Zaffagnini S, Buckthorpe M. Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Male Rugby Players: Pattern, Injury Mechanism, and Biomechanics in 57 Consecutive Cases. Orthop J Sports Med 2021; 9:23259671211048182. [PMID: 34805419 PMCID: PMC8597070 DOI: 10.1177/23259671211048182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries represent a significant burden to rugby players. Improving our understanding of the patterns and biomechanics that result in ACL injury may aid in the design of effective prevention programs. Purpose: To describe, using video analysis, the mechanisms, situational patterns, and biomechanics of ACL injuries in professional rugby matches. Further aims were to document injuries according to pitch location and timing within the match. Study Design: Case series; Level of evidence, 4. Methods: A total of 62 ACL injuries were identified in players of the 4 most important rugby leagues across 4 consecutive seasons. We analyzed 57 (92%) injury videos for injury mechanism and situational patterns; biomechanical analysis was performed on indirect and noncontact ACL injuries only (38 cases available). Three reviewers independently evaluated each video. Results: More injuries occurred while attacking than defending (41 [72%] vs 16 [28%]; P < .01). Regarding mechanism, 18 (32%) injuries were direct contact; 15 (26%), indirect contact; and 24 (42%), noncontact. Most direct contact injuries involved being tackled directly to the knee (n = 10). Three situational patterns were identified for players who had a noncontact or indirect contact injury: offensive change of direction (COD) (n = 18), being tackled (n = 10), and pressing/tackling (n = 8). Injuries generally involved a knee-loading strategy in the sagittal plane, which was accompanied by knee valgus loading in most cases (94%). Overall, 73% of injuries occurred during the first 40 minutes of effective playing time. Conclusion: Most ACL injuries in professional male rugby players happened through a noncontact or indirect contact mechanism (68%). Three situational patterns were described, including offensive change of direction, being tackled, and pressing/tackling. Biomechanical analysis confirmed a multiplanar mechanism, with a knee-loading pattern in the sagittal plane accompanied by dynamic valgus. As most injuries occurred in the first 40 minutes, accumulated fatigue appears not to be a major risk factor for ACL injury.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Filippo Tosarelli
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Rocco Ferrari
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.,Zebre Rugby Club, Parma, Italy
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Ciampone
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gianni Nanni
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.,Faculty of Sport, Health and Applied Science, St Mary's University, London, UK
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Puleo RM, Barreveld A, Rice S, Althausen Plante AM, Kotler DH. Unique Concerns of the Woman Cyclist. Phys Med Rehabil Clin N Am 2021; 33:61-79. [PMID: 34799003 DOI: 10.1016/j.pmr.2021.08.005] [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: 11/27/2022]
Abstract
Previously a male-dominated activity, female cyclists now make up nearly half of all cyclists in the United States. Although cycling provides a significant number of health benefits, it is an activity that carries risk of injury, both traumatic and nontraumatic. Sex differences are seen in chest trauma and breast injury, as well as pelvic, given the inherent differences in anatomy. Understanding the relationship of the bicycle to the anatomy of the rider can help mitigate risks for injury.
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Affiliation(s)
- Rozanne M Puleo
- Sports Medicine, Lynn Community Health Center, 269 Union Street, Lynn, MA 01902, USA.
| | - Antje Barreveld
- Anesthesiology, Tufts University School of Medicine, Pain Management Services, Newton-Wellesley Hospital, 2014 Washington St, Newton, MA 02462, USA
| | - Sarah Rice
- Athletico Physical Therapy, 2143 W Division St, Chicago IL 60622-3006, USA
| | - Anne M Althausen Plante
- Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Dana H Kotler
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Outpatient Center - Wellesley, 65 Walnut Street, Wellesley, Boston, MA 02481, USA
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Nyland J, Boschert D, Pyle B, Yoshida K, Rossi M, Vieira ELC. Distal thigh compression garment improves knee control and safety perceptions during single leg triple-hop for distance. J Bodyw Mov Ther 2021; 28:557-562. [PMID: 34776195 DOI: 10.1016/j.jbmt.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frontal plane knee control is essential to athletic knee injury prevention. AIM To evaluate knee valgus frontal plane projection angle (FPPA), knee safety, and sports movement capability confidence during single leg triple hop for distance (SLTHD) under knee sleeve, distal thigh compression garment (DTCG), and no device (control) conditions. METHODS A single-session, experimental study was performed using a within-subject design, and randomized device order. Two-dimensional FPPA measurements were collected during the final SLTHD landing of 18 healthy female college athletes for each condition. Sports movement capability and knee safety confidence were measured using 10-cm visual analog scale questions. One-way ANOVA assessed group differences, and Pearson correlations delineated FPPA, knee safety and sports movement capability confidence relationships (p < 0.05). RESULTS The DTCG group had less valgus FPPA than the control group. The knee sleeve group had greater knee safety confidence than the control group. The DTCG (r = 0.48) had a moderate positive relationship between mean SLTHD and knee safety confidence. The DTCG group also had a moderate relationship between maximum SLTHD and knee safety confidence (r = 0.52). The DTCG and knee sleeve groups displayed moderate direct, and moderate inverse relationships between FPPA and sports movement capability confidence (r = 0.48 and r = -0.44, respectively). CONCLUSION Reduced FPPA and relationships between maximum SLTHD magnitude and knee safety confidence, and between FPPA magnitude and sports movement capability confidence suggests that the DTCG may enhance pelvic deltoid kinesthetic acuity and dynamic knee stability through iliotibial tract compression. CLINICAL RELEVANCE The DTCG was superior to the standard knee sleeve or control conditions for displaying characteristics that might better prevent knee injury, while still enabling effective sports movement capability.
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Affiliation(s)
- J Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA.
| | - D Boschert
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - B Pyle
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - K Yoshida
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - M Rossi
- The Sorocaba Institute of the Knee, Sorocaba, Brazil
| | - E L C Vieira
- The Sorocaba Institute of the Knee, Sorocaba, Brazil
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Diniz KMA, Resende RA, Mascarenhas RDO, Silva HDJ, Filho RGT, Mendonça LDM. Hip passive stiffness is associated with hip kinematics during single-leg squat. J Bodyw Mov Ther 2021; 28:68-74. [PMID: 34776202 DOI: 10.1016/j.jbmt.2021.06.008] [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: 01/21/2021] [Revised: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Single-leg squat (SLS) is a test commonly used to assess lower limb function in rehabilitation. Increased hip adduction and internal rotation (IR) is associated with dynamic knee valgus, which is related to hip and knee overload. Proximal and distal factors, such as hip passive stiffness, poor hip muscle strength and excessive foot misalignment may influence hip movement. However, previous studies focus on how proximal and distal factors affected knee joint movement and did not reported the influence on hip joint. OBJECTIVE This study investigated the association of hip external rotators (ER) strength, hip passive stiffness and shank-forefoot alignment (SFA) with hip adduction and IR during SLS. DESIGN Cross-sectional study. METHOD Forty-six health participants of both sexes (23.47 ± 4.29 years, 60.40 ± 11.28 kg, 1.67 ± 8.9 m) had SFA, hip ER torque, hip passive stiffness and hip kinematics assessed. Multiple linear regressions were performed to identify the factors which associated with mean and peak hip adduction and IR movement during SLS. RESULTS Only hip passive stiffness was associated with mean (R2 = 0.164; Confidence Interval (CI) 95% = [-0.250, -0.048]; p = 0.005) and peak (R2 = 0.116; CI 95% = [-0.223, -0.210]; p = 0.019) hip IR movement. CONCLUSION Hip passive stiffness was associated with mean and peak hip IR movement during the SLS. These results suggest that individuals with reduced hip passive stiffness may demonstrate increased hip IR movement during SLS.
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Affiliation(s)
- Karen Marina Alves Diniz
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGReab) of Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil; Departamento de Fisioterapia - Faculdade de Ciências Biológicas e da Saúde - Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil
| | - Renan Alves Resende
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGReab) of Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil; Department of Physical Therapy, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rodrigo de Oliveira Mascarenhas
- Departamento de Fisioterapia - Faculdade de Ciências Biológicas e da Saúde - Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil
| | - Hytalo de Jesus Silva
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGReab) of Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil; Departamento de Fisioterapia - Faculdade de Ciências Biológicas e da Saúde - Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil
| | - Renato Guilherme Trede Filho
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGReab) of Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil; Departamento de Fisioterapia - Faculdade de Ciências Biológicas e da Saúde - Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil
| | - Luciana De Michelis Mendonça
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGReab) of Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil; Departamento de Fisioterapia - Faculdade de Ciências Biológicas e da Saúde - Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Rodovia MGT 367 - Km 583, n° 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Gerais, Brazil.
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Forde C, Haddad M, Hirani SP, Keene DJ. Is an individually tailored programme of intense leg resistance and dynamic exercise acceptable to adults with an acute lateral patellar dislocation? A feasibility study. Pilot Feasibility Stud 2021; 7:197. [PMID: 34749823 PMCID: PMC8573884 DOI: 10.1186/s40814-021-00932-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment. Methods A single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics. Results Fifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions. Conclusion The intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants’ willingness to be randomised to different treatments across multiple centres. Trial registration ClinicalTrials.govNCT03798483, registered on January 10, 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00932-x.
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Affiliation(s)
- Colin Forde
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Research Centre, University of Oxford, Kadoorie Centre for Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Mark Haddad
- School of Health Sciences, City, University of London, London, UK
| | | | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Research Centre, University of Oxford, Kadoorie Centre for Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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Trunk muscle endurance in individuals with and without patellofemoral pain: Sex differences and correlations with performance tests. Phys Ther Sport 2021; 52:248-255. [PMID: 34656829 DOI: 10.1016/j.ptsp.2021.09.012] [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: 08/17/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). DESIGN Cross-sectional. SETTING Laboratory-based study. PARTICIPANTS 110 females and 38 males with PFP, 61 females and 31males without PFP. MAIN OUTCOME MEASURES Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. RESULTS Lower anterior and lateral trunk muscle endurance were identified in females (p < .001; d = -0.74 to -0.86), but not in males (p ≥ .806; d = -0.04 to 0.05) with PFP as compared to sex-matched controls. Moderate to large, positive correlations between anterior and lateral trunk muscle endurance with performance in the SLHT and FSDT were identified in females (r = .27 to .50; p < .004) and males (r = 0.27 to 0.59; p < .031) with PFP and females without PFP (r = 0.26 to 0.40; p < .044). CONCLUSION Our findings highlight that assessing trunk muscle endurance is advised in females with PFP. Trunk muscle endurance of individuals with PFP may have a role in the performance of hopping and stepping down tasks.
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Nyland J, Krupp R, Givens J, Caborn D. Trunk and lower extremity long-axis rotation exercise improves forward single leg jump landing neuromuscular control. Physiother Theory Pract 2021; 38:2689-2701. [PMID: 34602021 DOI: 10.1080/09593985.2021.1986871] [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
BACKGROUND Anterior cruciate ligament (ACL) injuries often involve sudden single leg loading with directional changes. Trunk and lower extremity (LE) load transfer and muscle power are directly coupled during these movements. The effect of trunk and LE long-axis rotation training on forward single leg drop jump landing and stabilization (FSLDJLS) was studied. METHODS Using block randomization (gender), 36 (18 men, 18 women) subjects were assigned to experimental (nine, 20 min exercise sessions) and control groups with equal subject number. Ground reaction force (1000 Hz), kinematic (60 Hz) and LE EMG (1000 Hz) data were synchronously collected. Statistical analysis compared pre- and post-test neuromuscular control mean change differences (MCD), and hip flexion-LE peak EMG % maximum volitional isometric contraction (%MVIC) (expressed as decimal equivalents), mean change difference (MCD) relationships. RESULTS The experimental group had greater landing knee flexion (3.5 ± 3.6° vs. -0.4 ± 3.3°, p = .002) MCD, greater dynamic LE stiffness after landing (0.09 ± 0.14 vs. -0.11 ± 0.14, p = .001) MCD, and increased gluteus maximus (GMAX) (0.20 ± 0.39%MVIC vs. -0.23 ± 0.46%MVIC, p = .006) and gluteus medius (GMED) EMG amplitude (0.22 ± 0.31 vs. -0.07 ± 0.36%MVIC, p = .018) MCD. This group also had decreased GMAX (-166.5 ± 403.6 ms vs. 89.3 ± 196 ms, p = .025), GMED (-75.9 ± 126.8 ms vs. 131.2 ± 207.1 ms, p = .002) and vastus lateralis (-109.1 ± 365 ms vs. 205.5 vs. 510 ms, p = .04) activation duration MCD. More experimental group subjects had increased landing knee flexion MCD (15/18 vs. 8/18, p = .015), increased dynamic LE stiffness MCD (15/18 vs. 2/18, p < .0001) and increased GMAX (15/18 vs. 7/18, p = .006) and GMED (17/18 vs. 10/18, p = .007) EMG amplitude MCD, and reduced GMAX (12/18 vs. 6/18, p = .046), GMED (11/18 vs. 5/18, p = .044), rectus femoris (12/18 vs. 6/18, p = .046), and vastus lateralis (13/18 vs. 7/18, p = .044) EMG activation duration MCD. Only the experimental group displayed significant relationships between landing and peak hip flexion and peak LE EMG amplitude MCD. CONCLUSION Increased dynamic LE stiffness, increased hip muscle EMG amplitude and decreased hip and knee muscle activation duration MCD in the experimental group suggests improved LE neuromuscular control.
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Affiliation(s)
- John Nyland
- Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, Kentucky, USA.,Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Ryan Krupp
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Justin Givens
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - David Caborn
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
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Higbie S, Kleihege J, Duncan B, Lowe WR, Bailey L. Utilizing Hip Abduction Strength to Body-Weight Ratios in Return to Sport Decision-Making After ACL Reconstruction. Int J Sports Phys Ther 2021; 16:1295-1301. [PMID: 34631250 PMCID: PMC8486405 DOI: 10.26603/001c.27346] [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: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the association between hip abduction weakness and non-contact anterior cruciate ligament (ACL) injury, hip abduction strength is rarely considered in return to sport decision-making following ACL reconstruction (ACLR). HYPOTHESIS/PURPOSE The purpose of this study was to compare self-reported function, objective functional test performance, and re-injury rates in patients with high (≥33%) versus low (<33% ) isometric hip abduction strength to body weight (BW) ratios when returning to activity following ACLR. STUDY DESIGN Cohort study. METHODS Data were gathered from a single-surgeon database and included baseline demographics. Clinical outcomes were assessed at the time of release to activity and included self-reported outcomes and a functional testing battery. Isometric hip abduction strength was obtained using a handheld dynamometer. Groups were dichotomized into those with low vs high strength to BW ratios. Two-year follow-up was performed using the single assessment numeric evaluation (SANE). Data were analyzed using univariate general linear models with an alpha level of .05. RESULTS Of the 528 enrolled patients, 364 (68.9%) demonstrated a low strength to BW ratio. Baseline comparisons revealed more females and higher BMI (P <.05) in the <33% group. At release to activity, the <33% BW group demonstrated lower International Knee Documentation Committee survey scores (88.2 ± 13.6 vs 93.5 ± 10.3, P<.01), ACL-Return to Sport After Injury (76.2 ± 15.4 vs 88.5 ± 16.9, P<.01) scores, and isokinetic hamstring peak torque (P=.04). At 2-years, the <33% group reported lower SANE scores (83.3 ± 21.1 vs 92.83 ± 11.4, P=.05) with no significant differences in re-injuries. CONCLUSION Patients with low hip abduction strength to BW ratios demonstrated lower subjective function, psychological readiness, and isokinetic hamstring peak torque when completing functional testing following ACLR. Subjective deficits remained at 2-years. LEVEL OF EVIDENCE Level 3. KEY TERMS ACL injury, hip abduction strength, return to sport, strength ratio. CLINICAL RELEVANCE Assessing isometric hip abduction strength to body weight ratio may be beneficial in determining readiness to return to sport following ACL reconstruction. WHAT IS KNOWN ABOUT THE SUBJECT Three prospective studies have provided conflicting evidence regarding the relationship between hip abduction strength and ACL injury. A clinical cut-point of hip abduction strength:BW ratio <35.4% has been suggested to identify athletes at risk of sustaining a non-contact ACL injury. To our knowledge no studies have examined isometric hip abduction strength:BW ratios in athletes attempting to return to sport following ACLR. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE This study examines the potential for hip abduction strength:BW ratio to be included as an additional metric in return to sport testing batteries.
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Affiliation(s)
| | | | - Brian Duncan
- Memorial Hermann Ironman Sports Medicine Institute
| | | | - Lane Bailey
- Memorial Hermann Ironman Sports Medicine Institute
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Seeley MK, Denning WM, Park J, Croft K, Horton WZ, Hopkins JT. Anterior knee pain independently alters landing and jumping biomechanics. Clin Biomech (Bristol, Avon) 2021; 89:105458. [PMID: 34455339 DOI: 10.1016/j.clinbiomech.2021.105458] [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: 01/21/2020] [Revised: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
Background Biomechanical effects of anterior knee pain are difficult to distinguish from effects of other factors also related to knee injury (e.g., joint effusion). The purpose of this study was to evaluate independent effects of anterior knee pain on landing and jumping biomechanics. Methods Thirteen healthy participants performed a land and jump movement task, under three experimental conditions (pre-pain, pain, and post-pain), during one data collection session. One 1-ml injection of hypertonic saline into the infrapatellar fat pad was used to induce experimental anterior knee pain during the pain condition. Participant-perceived anterior knee pain was measured every 2 min throughout data collection. Landing and jumping biomechanics were measured and compared between the experimental conditions using a functional statistical approach. Findings The aforementioned injection increased mean participant-perceived anterior knee pain, from zero during the pre-pain condition to 2.6 ± 0.71 cm during the pain condition. Vertical ground reaction force, knee flexion angle, and internal knee extension moment decreased by approximately 0.100 body weights, 3°, and 0.010 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Conversely, hip flexion angle and internal hip extension moment increased by approximately 3° and 0.006 Nm/body weight × body height, respectively, between the pre-pain and pain conditions. Several biomechanical changes persisted after anterior knee pain abatement (the post-pain condition). Interpretation Anterior knee pain alters landing and jumping biomechanics, independent of other injury-related factors. These altered biomechanics likely change knee joint loading patterns and might increase risk for chronic knee joint injury and/or pathology.
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Affiliation(s)
- Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA.
| | - W Matt Denning
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin 17104, Korea
| | - Kaitland Croft
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - W Zachary Horton
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT 84602, USA
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Knee joint kinematics during the sidestep maneuver in professional futsal athletes: Effect of sport-specific sidestep cutting. Sci Sports 2021. [DOI: 10.1016/j.scispo.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liu J, Teng HL, Selkowitz DM, Asavasopon S, Powers CM. Influence of hip and knee positions on gluteus maximus and hamstrings contributions to hip extension torque production. Physiother Theory Pract 2021; 38:2650-2657. [PMID: 34496710 DOI: 10.1080/09593985.2021.1975338] [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
BACKGROUND Diminished gluteus maximus muscle strength has been proposed to be contributory to various lower-limb injuries. As such, it is of clinical importance to perform hip extensor strength testing in a position that biases torque contribution of the gluteus maximus relative to the other hip extensors (i.e. hamstrings). OBJECTIVES To determine the relative torque contributions of the gluteus maximus and hamstring muscles in various hip extensor strength testing positions. METHODS 13 Young, healthy participants performed maximum isometric hip extension on a dynamometer in 4 different positions that varied in terms of hip and knee flexion. Surface electromyography (EMG) was used to assess activation of gluteus maximus and hamstrings during the maximum isometric contractions. Normalized EMG data were used as an input to determine individual muscle contribution to hip extension torque production using SIMM modeling software. The gluteus maximus/hamstring torque contribution ratio was compared across the 4 positions using a one-way repeated-measures ANOVA. RESULTS The highest gluteus maximus torque contribution value occurred in positions where the hip was flexed to 45°, while the highest hamstring torque contribution occurred in positions in which the knee was fully extended. The gluteus maximus/hamstring torque contribution ratio was highest at 0° of hip extension and 90° of knee flexion. CONCLUSION Testing isometric hip extensor strength at 0° of hip extension and 90° of knee flexion should be considered in order to bias torque production of the gluteus maximus relative to the hamstrings.
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Affiliation(s)
- Jia Liu
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach Ca USA
| | - David M Selkowitz
- Mgh Institute of Health Professions, Department of Physical Therapy, Boston, MA USA
| | - Skulpan Asavasopon
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Spinella G, Arcamone G, Valentini S. Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation. Vet Sci 2021; 8:vetsci8090186. [PMID: 34564580 PMCID: PMC8472898 DOI: 10.3390/vetsci8090186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/13/2023] Open
Abstract
Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient’s age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.
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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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van der Merwe C, Shultz SP, Colborne GR, Fink PW. Foot Muscle Strengthening and Lower Limb Injury Prevention. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2021; 92:380-387. [PMID: 32633706 DOI: 10.1080/02701367.2020.1739605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/02/2020] [Indexed: 06/11/2023]
Abstract
Background and objectives: The active and passive structures of the foot act in unison to not only be compliant enough to assist in ground reaction force attenuation but also resist deformation to provide a stable base of support. A foot that is unable to adjust to the imposed demands during high-intensity sporting activities may alter the moments and forces acting on the joints, increasing the risk of non-contact anterior cruciate ligament ruptures (ACLR) and lateral ankle sprains (LAS). Prophylactic strengthening programs are often used to reduce the risk of these injuries, but at present, very few prophylactic programs include foot-specific strengthening strategies. The aim of this theoretical review is to ascertain the prophylactic role strengthening muscles acting on the foot may have on ACLR and LAS injury risk. Methods: Literature relating to risk factors associated with ACLR and LAS injury and the anatomy and biomechanics of normal foot function was searched. In addition, ACLR and LAS injury prevention programs were also sought. A theoretical, narrative approach was followed to synthesize the information gathered from the articles. Results: The foot segments are governed by the congruity of the articulations and the activity of the foot muscles. As such, there is a coupling effect between shank, calcaneus, midfoot, and hallux movement which play a role in both ACLR and LAS injury risk. Conclusions: Strengthening the muscles acting on the foot may have a significant impact on ACLR and LAS injury risk.
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Bunn PDS, Lopes TJA, Terra BDS, Costa HF, Souza MP, Braga RM, Inoue A, Ribeiro FM, Alves DDS, Bezerra da Silva E. Association between movement patterns and risk of musculoskeletal injuries in navy cadets: A cohort study. Phys Ther Sport 2021; 52:81-89. [PMID: 34438262 DOI: 10.1016/j.ptsp.2021.08.003] [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: 02/20/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association of movement patterns evaluated by the Dynamic Movement Assessment (DMA) with the occurrence of musculoskeletal injuries in navy cadets. DESIGN Cohort study. SETTING Participants were filmed performing the six functional tests of the DMA (deep squat, step up, single-leg squat, hop, plank and side-plank tests). PARTICIPANTS 240 navy cadets. MAIN OUTCOME MEASUREMENTS Depending on the number of certain movement patterns on the Dynamic Movement Assessment (DMA), participants were classified as high, moderate, medium or low risk of developing injuries. Predictive associations between injuries and risk classification were examined using logistic regression analysis. RESULTS Considering sex, previous injuries and the type of secondary school as covariates, participants who were classified as high risk were not more likely to develop injuries. Non-military high school was an independent risk factor for any injuries (OR = 3.14, 95% CI [1.43,6.91]; OR = 4.57, 95% CI [1.92,10.83]), overuse injuries (OR = 2.58, 95% CI [1.05,6.30]; OR = 2.55, 95% CI [1.06, 6.14]) and acute injuries (OR = 4.88, 95% CI [1.19,19.99]), respectively. Previous musculoskeletal symptoms also increased the chance of AI (OR = 4.45, 95% CI [1.15,17.18]; OR = 5.91, 95% CI [1.13,30.88]). CONCLUSIONS Movement patterns evaluated by DMA are not associated with an increased risk of injuries. However, attendance of a non-military high school and previous musculoskeletal symptoms are associated with musculoskeletal injuries.
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Affiliation(s)
- Priscila Dos Santos Bunn
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil.
| | - Thiago Jambo Alves Lopes
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Bruno de Souza Terra
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Hélcio Figueiredo Costa
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Márcio Puglia Souza
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Roberta Mendonça Braga
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Allan Inoue
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Fabrício Miranda Ribeiro
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Daniel de Souza Alves
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Elirez Bezerra da Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil
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Ferreira AS, de Oliveira Silva D, Barton CJ, Briani RV, Taborda B, Pazzinatto MF, de Azevedo FM. Impaired Isometric, Concentric, and Eccentric Rate of Torque Development at the Hip and Knee in Patellofemoral Pain. J Strength Cond Res 2021; 35:2492-2497. [PMID: 31045684 DOI: 10.1519/jsc.0000000000003179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Ferreira, AS, de Oliveira Silva, D, Barton, CJ, Briani, RV, Taborda, B, Pazzinatto, MF, and de Azevedo, FM. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain. J Strength Cond Res 35(9): 2492-2497, 2021-The aims of this study were to compare maximal muscle strength and rate of torque development (RTD) of knee extensor and hip abductor during isometric, concentric, and eccentric contractions between women with and without patellofemoral pain (PFP). Thirty-eight women with PFP (PFPG) and 38 pain-free women (CG) participated in this study. Isometric, concentric, and eccentric maximal torque and RTD of knee extensor and hip abductor were assessed using an isokinetic dynamometer. Rate of torque development was calculated as the change in torque over the change in time from torque onset to 30, 60, and 90% of the maximal torque (RTD30%, RTD60%, and RTD90%) during isometric, concentric, and eccentric contractions. PFPG had lower isometric, concentric, and eccentric knee extensor maximal torque (29.9, 28.3, and 26.7%) compared with the CG. For knee extensor RTD, PFPG had slower isometric RTD30% (17.8%), RTD60% (21.5%), and RTD90% (23.4%); slower concentric RTD30% (35.7%), RTD60% (29.3%), and RTD90% (28.2%); and slower eccentric RTD30% (20.5%), RTD60% (25.2%), and RTD90% (22.5%) compared with the CG. PFPG had lower isometric, concentric, and eccentric hip abductor maximal torque (28.3, 21.8, and 17%) compared with the CG. For hip abductor RTD, PFPG had slower isometric RTD30% (32.6%), RTD60% (31.1%), and RTD90% (25.4%); slower concentric RTD90% (11.5%); and slower eccentric RTD30% (19.8%), RTD60% (26.4%), and RTD90% (24%) compared with the CG. In conclusion, women with PFP presented deficits in both maximal strength and RTD of knee extensor and hip abductor during isometric, concentric, and eccentric contractions, which highlight the potential importance of addressing different aspects of muscle function through exercise therapy.
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Affiliation(s)
- Amanda S Ferreira
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Danilo de Oliveira Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and.,Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christian J Barton
- Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ronaldo V Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Bianca Taborda
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
| | - Marcella F Pazzinatto
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and.,Physiotherapy Department, La Trobe Sports and Exercise Medicine Research Center (LASEM), School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Fábio M de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and
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140
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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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141
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Na Y, Han C, Shi Y, Zhu Y, Ren Y, Liu W. Is Isolated Hip Strengthening or Traditional Knee-Based Strengthening More Effective in Patients With Patellofemoral Pain Syndrome? A Systematic Review With Meta-analysis. Orthop J Sports Med 2021; 9:23259671211017503. [PMID: 34377715 PMCID: PMC8330492 DOI: 10.1177/23259671211017503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Focus on the importance of hip muscle strength in patients with patellofemoral pain syndrome (PFPS) has recently increased. It is unknown whether patients with PFPS will benefit more from hip strengthening compared with traditional knee-based strengthening. Purpose: To compare the efficiency of isolated hip strengthening versus traditional knee-based strengthening for patients with PFPS. Study Design: Systematic review; Level of evidence, 2. Methods: We conducted a search for studies comparing isolated hip strengthening and knee-based strengthening by using the MEDLINE, Embase, and Cochrane Library electronic databases. The methodological quality of included studies was assessed using the PEDro scale. Predetermined variables from each study were extracted and analyzed. Results: A total of 5 comparative studies were included in this review; all studies were of moderate to high quality and reflected good internal and external validity. Pain (visual analog scale [VAS]) and function (Anterior Knee Pain Scale) scores improved in both the hip and knee groups after strengthening intervention, although no statistically significant differences were seen between groups in the pooled analysis. In 2 studies, VAS pain scores were reduced earlier for patients in the hip group than for those in the knee group (P < .05). In 1 study, improvement in Western Ontario and McMaster Universities Osteoarthritis Index function scores in the hip group was statistically superior compared with those in the knee group after intervention and at 6-month follow-up (P < .05). In 2 studies, patients in the hip group exhibited statistically greater hip abductor and extensor strength than did those in the knee group after intervention (P < .05). Conclusion: The best-available evidence suggests that overall, isolated hip strengthening and knee strengthening were equivalent for treatment of PFPS.
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Affiliation(s)
- Yuyan Na
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Changxu Han
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yuting Shi
- Cardiac Function Department, Cadre Health Care Center, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yong Zhu
- Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yizhong Ren
- Department of Arthroscopy and Sports Medicine, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Wanlin Liu
- Department of Pediatric Orthopedics, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
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Stanek JM, Brown B, Barrack J, Parish J. A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion. J Exerc Rehabil 2021; 17:184-191. [PMID: 34285896 PMCID: PMC8257439 DOI: 10.12965/jer.2142228.114] [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: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022] Open
Abstract
The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.
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Affiliation(s)
- Justin M Stanek
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Bryce Brown
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Jessica Barrack
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Jake Parish
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
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143
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Shin SS, Yoo WG. The effects of differences on sagittal kinematics and muscle coordination during step up and step down in patients with spinal stenosis. J Back Musculoskelet Rehabil 2021; 34:453-459. [PMID: 33492274 DOI: 10.3233/bmr-200118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS. METHODS Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system. RESULTS Thoracic (17.71∘± 7.77∘) and spine angles (13.64∘± 11.34∘) as well as swing hip (48.48∘± 12.76∘) and pelvic angles (7.52∘± 10.33∘) were significantly greater during SU than SD (10.14∘± 8.41∘, 10.03∘± 11.03∘, 29.42∘± 10.57∘, 3.21∘± 10.11∘, all P< 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% ± 13.28%) was significantly higher during SU than during SD (26.65% ± 10.02%), whereas that of the VL of the stance limb (65.88% ± 13.28%) was significantly lower during SU than during SD (73.35% ± 10.02%, P= 0.011 for both comparisons). CONCLUSIONS Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body's center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.
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Is Hip Muscle Strength Associated with Dynamic Knee Valgus in a Healthy Adult Population? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147669. [PMID: 34300118 PMCID: PMC8304771 DOI: 10.3390/ijerph18147669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 01/11/2023]
Abstract
This study aimed to systematically review research investigating the association between hip muscle strength and dynamic knee valgus (DKV). Four databases (MEDLINE, PubMed, CINAHL, and SPORTDiscus) were searched for journal articles published from inception to October 2020. Seven studies investigating the association between hip muscle strength and DKV using a two-dimensional motion analysis system in healthy adults were included. The relationship between hip abductor muscle strength and DKV was negatively correlated in two studies, positively correlated in two studies, and not correlated in three studies. The DKV was associated with reduced hip extensor muscle strength in two studies and reduced hip external rotator muscle strength in two studies, while no correlation was found in three and five studies for each muscle group, respectively. The relationship between hip muscle strength, including abductors, extensors, and external rotators and DKV is conflicting. Considering the current literature limitations and variable methodological approaches used among studies, the clinical relevance of such findings should be interpreted cautiously. Therefore, future studies are recommended to measure the eccentric strength of hip muscles, resembling muscular movement during landing. Furthermore, high-demand and sufficiently challenging functional tasks revealing lower limb kinematic differences, such as cutting and jumping tasks, are recommended for measuring the DKV.
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145
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Kim S, Park J. Patients with chronic unilateral anterior knee pain experience bilateral deficits in quadriceps function and lower quarter flexibility: a cross-sectional study. Physiother Theory Pract 2021; 38:2531-2543. [PMID: 34253159 DOI: 10.1080/09593985.2021.1946871] [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
Background: Little is known about how chronic unilateral anterior knee pain (AKP) affects bilateral quadriceps function and lower quarter flexibility. Objective: To determine if patients with chronic unilateral AKP present bilateral deficits in quadriceps function and lower quarter flexibility. Methods: Twenty-two patients with chronic unilateral AKP (pain duration: 48.6 months) and 22 matched healthy controls were evaluated. Pain perception and functional outcomes were obtained. Knee joint and thigh circumferences, quadriceps subcutaneous tissue thickness and function (i.e. maximal and explosive strength, activation, and endurance), and lower quarter flexibility (i.e. hamstrings and iliopsoas/rectus femoris muscle) in both legs were compared across conditions. Results: Knee joint and thigh circumferences, and quadriceps subcutaneous tissue thickness were not different between conditions (P ≥ .39). Compared with matched healthy controls, patients with chronic unilateral AKP showed: 1) greater pain perception (0.0 versus 4.4 cm, P < .0001); 2) a lower score for functional outcomes (79.6 versus 53.9, P < .0001); 3) less bilateral quadriceps maximal (3.5 versus 2.8 Nm/kg, P < .0001) and explosive (10.8 versus 8.7 Nm/kg/s, P = .01) strength, activation (0.95 versus 0.83, P < .0001), and endurance (1.66 versus 1.52 Nm/kg, P = .02); and 4) less bilateral hamstrings (86.8 versus 72.6°, P = .002) and iliopsoas/rectus femoris (11.6 versus 7.8°, P < .05) flexibility. Conclusion: Patients with chronic unilateral AKP (without knee joint effusion or quadriceps muscle atrophy) appear to have bilateral deficits in quadriceps function and lower quarter flexibility, which should be addressed with pain reduction.
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Affiliation(s)
- Sungwan Kim
- Department of Physical Education, Athletic Training Laboratory, Kyung Hee University, Yongin, Korea
| | - Jihong Park
- Department of Sports Medicine, Athletic Training Laboratory, Kyung Hee University, Yongin, Korea
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Lundberg Zachrisson A, Ivarsson A, Desai P, Karlsson J, Grau S. Risk factors for overuse injuries in a cohort of elite Swedish track and field athletes. BMC Sports Sci Med Rehabil 2021; 13:73. [PMID: 34238348 PMCID: PMC8265081 DOI: 10.1186/s13102-021-00297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most injuries in track and field are caused by overuse with conflicting reports concerning the underlying mechanisms. The purpose of this study was to evaluate how biomechanical and clinical factors relate to the risk of overuse injuries, and to investigate whether the relationships between potential risk factors and injury become stronger if injuries are grouped by location. METHODS The study is a prospective cohort study conducted during a Swedish track and field season over eleven months, from October to August. The cohort consisted of elite male and female track and field athletes competing in either middle- and long-distance running, sprinting, jumping, or throwing events (n = 96). Athletes performed a baseline screening at enrollment consisting of a clinical examination, running, and strength tests. Injury data was collected during the season by medical professionals and divided according to their anatomical location into upper-body, thigh/hip, knee, or foot/shank injuries. RESULTS Thirty-four (54.8%) injuries where located at the foot/shank, followed by sixteen injuries at the thigh/hip (25.8%). Only eight knee (12.9%) and four upper-body (6.5%) injuries were registered during the season and therefore not analysed. Effect sizes were calculated for all test variables. Small effect sizes (rpb = .10-.23) were found for eleven risk factors between the overall injured (all injuries combined) and non-injured athletes. By further sub-grouping the injured group into thigh/hip injuries, effect size increased in hip adduction range of motion knee flexion velocity and the muscle flexibility of the iliopsoas. For foot/shank injuries, only the hamstring:quadriceps strength ratios increased for the right side to a small effect size. CONCLUSIONS Injury grouping appears to increase effect size for certain risk factors. Athletes with a slower knee flexion velocity during stance phase were more likely to become injured (p-value <.03, rpb = .37). An increased cohort size to further sub-divide injuries into specific diagnoses is needed.
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Affiliation(s)
- Andreas Lundberg Zachrisson
- Center for Health and Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Box 300, 405 30 Gothenburg, Sweden
| | - Andreas Ivarsson
- School of Health and Welfare, Halmstad University, Kristian IV:s väg 3, 301 18 Halmstad, Sweden
| | - Pia Desai
- Department of Orthopaedics at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80 Mölndal, Sweden
| | - Jon Karlsson
- Department of Orthopaedics at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80 Mölndal, Sweden
| | - Stefan Grau
- Center for Health and Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Box 300, 405 30 Gothenburg, Sweden
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147
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Kwan LYA, Killingback A, Robertson C, Adds P. Ultrasound investigation into the relationship between hip adduction and the patellofemoral joint. J Phys Ther Sci 2021; 33:511-516. [PMID: 34219955 PMCID: PMC8245268 DOI: 10.1589/jpts.33.511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Patellofemoral pain (PFP) is a common musculoskeletal complaint. It has been
suggested that hip adduction creates a load on the iliotibial band and causes lateral
displacement of the patella (patella tilt). However, data gathered in a previous study
were derived from a small sample of males, while the condition predominantly affects
females. We assessed the relationship between hip adduction and patellar position with a
larger sample size, including males and females. [Participants and Methods] Forty healthy,
asymptomatic females and males (age 21.5 ± 1.3 years) were recruited. Their knees were
passively flexed by 20°. Using ultrasound, the distance between the lateral edge of the
patella and the lateral condyle of the femur was measured in the neutral position and at
20° adduction. [Results] Hip adduction produced a smaller patella-lateral femoral condyle
measurement than in the neutral position. The mean difference in the patella-condyle
distance between the neutral position and 20° hip adduction was 0.18 cm. No statistically
significant difference was found between the right and left limbs, genders, Tegner scores,
or BMI of the study participants. [Conclusion] The results of the study showed that hip
adduction causes lateral displacement of the patella. Ultrasound is an effective means of
assessing patella tilt.
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Affiliation(s)
- Lok Yin Ada Kwan
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace London SW17 0RE, UK
| | | | | | - Philip Adds
- Institute of Medical and Biomedical Education (Anatomy), St George's, University of London: Cranmer Terrace London SW17 0RE, UK
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148
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Sahabuddin FNA, Jamaludin NI, Amir NH, Shaharudin S. The effects of hip- and ankle-focused exercise intervention on dynamic knee valgus: a systematic review. PeerJ 2021; 9:e11731. [PMID: 34268014 PMCID: PMC8265381 DOI: 10.7717/peerj.11731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background A range of non-contact injuries such as anterior cruciate ligament tear, and patellofemoral pain syndrome are caused by disordered knee joint loading from excessive dynamic knee valgus (DKV). Previous systematic reviews showed that DKV could be modified through the influence of hip strength and ankle range of motion. Therefore, the purpose of this systematic review was to examine the effects of exercise intervention which involved either top-down or bottom-up kinetic chains on minimizing DKV in male and female adults and adolescents, with and without existing knee pain. Methodology Electronic searches were conducted in SAGE, Science Direct, SCOPUS, and Pubmed. The search strategy consisted of medical subject headings and free-text search keywords, synonyms and variations of ‘exercise intervention,’ ‘knee alignment,’ ‘dynamic knee valgus’, ‘knee abduction’ that were merged via the Boolean operator ‘AND’ and ‘OR’. The search was conducted on full-text journals that documented the impact of the exercise intervention program involving either the bottom-up or top-down DKV mechanism on the knee kinematics. Furthermore, exercise intervention in this review should last at least one week which included two or three sessions per week. This review also considered both men and women of all ages with a healthy or symptomatic knee problem. The risk of bias of the included studies was assessed by Cochrane risk assessment tool. The protocol of this review was registered at PROSPERO (registration number: CRD42021219121). Results Ten studies with a total of 423 participants (male = 22.7%, female = 77.3%; adults = 249, adolescents = 123; pre-adolescent = 51) met the inclusion criteria of this review. Seven studies showed the significant effects of the exercise intervention program (range from two weeks to ten weeks) on reducing DKV. The exercise training in these seven studies focused on muscle groups directly attached to the knee joint such as hamstrings and gastrocnemius. The remaining three studies did not show significant improvement in DKV after the exercise intervention (range between eight weeks to twelve weeks) probably because they focused on trunk and back muscles instead of muscles crossing the knee joint. Conclusion Exercises targeting specific knee-joint muscles, either from top-down or bottom-up kinetic chain, are likely to reduce DKV formation. These results may assist athletes and coaches to develop effective exercise program that could minimize DKV and ultimately prevent lower limb injuries.
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Affiliation(s)
| | - Nazatul Izzati Jamaludin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nurul Hidayah Amir
- Department of Translational Health Sciences, Faculty of Health Science, University of Bristol, Bristol, United Kingdom.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Arau, Perlis, Malaysia
| | - Shazlin Shaharudin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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149
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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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150
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Effect of Increased Flexor Hallucis Longus Muscle Activity on Ground Reaction Force during Landing. Life (Basel) 2021; 11:life11070630. [PMID: 34209702 PMCID: PMC8303142 DOI: 10.3390/life11070630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Repeated high-impact ground forces can lead to injury and decreased performance. While increasing flexor hallucis longus (FHL) muscle activity is known to increase stiffness and elasticity, it is unknown if this also decreases ground reaction forces by shock absorption during landing. This study aimed to determine whether increasing FHL muscle activity affects ground reaction force during landing in healthy subjects. Eight subjects performed single-leg steps onto a force platform for five trials, with and without flexion of the metatarsophalangeal (MTP) joint at the moment of landing. Integrated surface electromyography (sEMG) of the FHL and medial gastrocnemius (MG) and ground reaction forces (GRFs) were measured. sEMG and GRF during the 50 ms before and 100 ms following initial ground contact were analyzed and compared. Flexion of the MTP joint condition significantly decreased the vertical and mediolateral force peaks of GRF, and FHL muscle activity increased. Flexion of the MTP joint at the moment of landing reduces GRF in healthy subjects through force dissipation in the foot, by increased FHL muscle activity. The results suggest that this may contribute to injury prevention by reducing the impact force through flexing the MTP joint at the moment of landing.
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