An investigation of the action of the hamstring muscles during standing in crouch using functional electrical stimulation (FES)

Different Sagittal Angles and Moments of Lower Extremity Joints during Single-leg Jump Landing among Various Directions in Basketball and Volleyball Athletes

[Purpose] The purpose of this study was to assess the sagittal angles and moments of lower extremity joints during single-leg jump landing in various directions. [Subjects] Eighteen male athletes participated in the study. [Methods] Participants were asked to perform single-leg jump-landing tests in four directions. Angles and net joint moments of lower extremity joints in the sagittal plane were investigated during jump-landing tests from a 30-cm-high platform with a Vicon™ motion system. The data were analyzed with one-way repeated measures ANOVA. [Results] The results showed that knee joint flexion increased and hip joint flexion decreased at foot contact. In peak angle during landing, increasing ankle dorsiflexion and decreasing hip flexion were noted. In addition, an increase in ankle plantarflexor moment occurred. [Conclusion] Adjusting the dorsiflexion angle and plantarflexor moment during landing might be the dominant strategy of athletes responding to different directions of jump landing. Decreasing hip flexion during landing is associated with a stiff landing. Sport clinicians and athletes should focus on increasing knee and hip flexion angles, a soft landing technique, in diagonal and lateral directions to reduce risk of injury.

Empirical assessment of dynamic hamstring function during human walking

The hamstrings are often associated with the development of crouch gait, a fatiguing form of walking characterized by excessive hip flexion, knee flexion and ankle dorsiflexion during stance. However, recent studies have called into question whether abnormally active hamstrings induce the limb to move into a crouch posture. The purpose of this study was to directly measure the influence of the hamstrings on limb posture during stance. Nineteen healthy young adults walked on an instrumented treadmill at their preferred speed. A 90 ms pulse train was used to stimulate the medial hamstrings during either terminal swing or loading response of random gait cycles. Induced motion was defined as the difference in joint angle trajectories between stimulated and non-stimulated strides. A dynamic musculoskeletal simulation of normal gait was generated and similarly perturbed by increasing hamstring excitation. The experiments show that hamstring stimulation induced a significant increase in posterior pelvic tilt, knee flexion and ankle dorsiflexion during stance, while having relatively less influence on the hip angular trajectory. The induced motion patterns were similar whether the hamstrings were stimulated during late swing or early stance, and were generally consistent with the direction of induced motion predicted by gait simulation models. Hence, we conclude that overactive hamstrings have the potential to induce the limb to move toward a crouch gait posture.

Electrical stimulation of the rectus femoris during pre-swing diminishes hip and knee flexion during the swing phase of normal gait

Individuals who have suffered cerebral insults often exhibit stiff-knee gait, a condition characterized by reduced knee flexion during swing. We investigated the effect that an increment in normal rectus femoris (RF) activity can have on hip and knee joint angles during swing, as a first step to determining this muscle's involvement in stiff-knee gait. For this, we developed a protocol that electrically stimulated the RF during pre-swing or after toe-off in randomly selected strides of treadmill walking, consistent with the timing of RF activity during normal gait. Seven healthy young adults participated in the study. Pre-swing stimulation induced a significant (p < 0.05) reduction in peak knee flexion (avg 7.5°) in all subjects, with an accompanying decrease in hip flexion in four of the subjects. RF stimulation after toe-off diminished peak knee flexion in three subjects and reduced hip flexion in four subjects. When compared to muscle-actuated gait simulations that were similarly perturbed, the induced motion measures were generally consistent in direction but exhibited greater variability across strides and subjects. We conclude that excess RF activity during pre-swing has the potential to contribute to stiff-knee gait, and that clinical treatment should consider the "counter-intuitive" function that the RF has in extending the hip.

Muscle contributions to support and progression during single-limb stance in crouch gait

Pathological movement patterns like crouch gait are characterized by abnormal kinematics and muscle activations that alter how muscles support the body weight during walking. Individual muscles are often the target of interventions to improve crouch gait, yet the roles of individual muscles during crouch gait remain unknown. The goal of this study was to examine how muscles contribute to mass center accelerations and joint angular accelerations during single-limb stance in crouch gait, and compare these contributions to unimpaired gait. Subject-specific dynamic simulations were created for ten children who walked in a mild crouch gait and had no previous surgeries. The simulations were analyzed to determine the acceleration of the mass center and angular accelerations of the hip, knee, and ankle generated by individual muscles. The results of this analysis indicate that children walking in crouch gait have less passive skeletal support of body weight and utilize substantially higher muscle forces to walk than unimpaired individuals. Crouch gait relies on the same muscles as unimpaired gait to accelerate the mass center upward, including the soleus, vasti, gastrocnemius, gluteus medius, rectus femoris, and gluteus maximus. However, during crouch gait, these muscles are active throughout single-limb stance, in contrast to the modulation of muscle forces seen during single-limb stance in an unimpaired gait. Subjects walking in crouch gait rely more on proximal muscles, including the gluteus medius and hamstrings, to accelerate the mass center forward during single-limb stance than subjects with an unimpaired gait.

Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study

BACKGROUND

Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed.

OBJECTIVE

The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT).

DESIGN

A prospective, between-subjects design was used.

METHODS

Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group).

RESULTS

Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention.

LIMITATIONS

Only sagittal-plane parameters were assessed, and the sample size was small.

CONCLUSIONS

Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.

A dynamic model of quadriceps and hamstrings function

The mechanical effect of hamstrings and quadriceps contractions on hip and knee joint motion was investigated using a dynamic model of the musculoskeletal system. The model consisted of 13 anatomically linked segments. The geometry of bones, joints, and muscle attachments was derived from magnetic resonance imaging of a healthy adult. The knee joint was represented by a crossing bars linkage to simulate cruciate ligament function, and muscles were represented by spring actuators. The effects of hamstring and quadriceps contractions, in various combinations, were tested on different configurations of hip and knee joint position in the absence of gravity. In the standing posture, with the foot free to move and the pelvis fixed in space, the effect of semimembranosus (SM) contraction was hip and knee flexion. If the foot was fixed to the ground, SM contraction produced hip extension and knee flexion. The addition of quadriceps contraction reduced or abolished the knee flexion and enhanced hip extension. In all other simulations, SM alone produced knee flexion and hip extension and the combination of SM with vastus (VA) and rectus femoris (RF) contractions resulted in knee extension and enhanced hip extension. Our findings suggest that co-contraction of quadriceps and hamstrings may be a strategy to increase the hip extension function of the hamstrings.

A three-dimensional biomechanical evaluation of quadriceps and hamstrings function using electrical stimulation

Neurological disorders such as stroke impair locomotor control and result in abnormal 3-D gait kinematics. Establishment of effective rehabilitation strategies requires an understanding of how individual muscles contribute to pathological movement. Forward dynamic simulations account for complexities of interjoint coupling and can be used to predict dynamic muscle function. However to date, limited experimental validations of dynamic models have been performed. Our objective was to measure 3-D movement induced by the biceps femoris (BF), rectus femoris (RF), and vastus lateralis (VL) in limb configurations corresponding to the swing phase of gait, and to assess the biomechanical factors that affect dynamic function. Subjects were positioned in a robotic gait orthosis that included a compliant interface. Electrical stimulation was introduced into individual muscles while induced hip and knee joint movements were recorded. Measured hip to knee sagittal plane acceleration ratios were consistent with dynamic musculoskeletal model simulations. However RF and VL induced substantially larger frontal plane hip movements than model-based predictions. Sensitivity analyses on musculoskeletal model parameters revealed that muscle function depends primarily on moment arm assumptions. Though generic musculoskeletal models are suitable for predicting sagittal plane muscle function, improvements in moment arm accuracy are essential for investigation of 3-D pathological gait.