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Suzuki M, Kuruma H, Kato K, Gota Y, Kase H, Fujimoto H, Nagashima R. Effect of short foot exercise on lower-limb motor control function during single-leg standing in university students with flatfoot: A randomized controlled trial. J Bodyw Mov Ther 2024; 39:293-298. [PMID: 38876641 DOI: 10.1016/j.jbmt.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Intrinsic foot muscles (IFMs) play an important role in lower-limb motor control, including biomechanics and neuromuscular control function. Short foot exercise (SFE) and toe curl exercise (TC) are methods used to train the IFMs, but their effect on lower-limb motor control has not been reported in previous studies. This study evaluated the effects of SFE and TC on lower-limb motor control function during single-leg standing (SLS). TRIAL DESIGN Randomized control trial. METHOD Thirty-six participants with flatfoot were randomly assigned to the SFE or TC group and performed exercise for 8 weeks. The assessment items were navicular drop test, toe grip strength (TGS), plantar sensation, and SLS. In the SLS assessment, we measured the mean center of pressure (COP) amplitude in the anteroposterior (AP) and mediolateral (ML) directions, onset time of gluteus maximus (G. max) and gluteus medius (G. med), angle of forefoot/hindfoot protonation and hip adduction, and lateral pelvic shift. Mixed-model repeated-measures analysis of variance and Bonferroni corrections were performed in statistical analysis. RESULTS The SFE group showed significant differences between pre- and post-intervention for TGS (p < 0.001), COP ML (p = 0.039), and onset times of G. max (p = 0.015), and G. med (p < 0.001). The TC group showed no significant differences in all assessment items. CONCLUSION Our finding suggests that SFE contributes to lower neuromuscular control function in people with flatfoot. TRIAL REGISTRATION UMIN000049963.
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Affiliation(s)
- Misaki Suzuki
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan; Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan.
| | - Hironobu Kuruma
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan
| | - Kunihiro Kato
- Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan
| | - Yu Gota
- Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan
| | - Hiromu Kase
- Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan
| | - Hayato Fujimoto
- Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan
| | - Rento Nagashima
- Department of Rehabilitation, Seikei-kai Chiba Medical Center, Japan
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Kobayashi T, Morimoto T, Hirata H, Yoshihara T, Tsukamoto M, Sonohata M, Mawatari M. Changes of the coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty in patients with unilateral ankylosed hip. Sci Rep 2023; 13:5541. [PMID: 37016148 PMCID: PMC10073074 DOI: 10.1038/s41598-023-32672-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/31/2023] [Indexed: 04/06/2023] Open
Abstract
To elucidate the changes in coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty (THA) in patients with unilateral ankylosed hip. A retrospective radiologic study of 48 patients (48 hips) with unilateral hip arthrodesis who underwent conversion THA was conducted. Cobb's angle of lumbar scoliosis (LS), the pelvic obliquity (PO) angle, and the hip adduction angle (HAA) on standing anterior-posterior spine-pelvis-hip radiographs were measured before and after THA. The differences of LS, PO, and HAA before and after THA were defined as ΔLS, ΔPO, and ΔHAA, respectively. A paired samples t-test or the Wilcoxon signed-rank test were used to compare the absolute values of the LS, PO, and HAA between preoperative and postoperative groups. The Pearson's correlation coefficient (r) or Spearman's correlation coefficient (ρ) was calculated to assess the relationship between ΔLS, ΔPO, and ΔHAA and possible associated factors. Significant differences were found in the preoperative LS (mean, 10.8° vs. 8.2°, p = 0.004), PO (median, 6.8° vs. 2.0°, p < 0.001), and HAA (median, 10.0° vs. 6.0°, p = 0.003). ΔLS was correlated with the preoperative LS (ρ = - 0.621, p < 0.001), PO (ρ = - 0.580, p < 0.001), and HAA (ρ = - 0.467, p < 0.001). ΔPO was correlated with the preoperative LS (r = - 0.596, p < 0.001), PO (ρ = - 0.892, p < 0.001), and HAA (ρ = - 0.728, p < 0.001). ΔHAA was correlated with the preoperative LS (r = - 0.583, p < 0.001), PO (ρ = - 0.751, p < 0.001), and HAA (ρ = - 0.824, p < 0.001). LS, PO, and HAA were significantly improved after conversion THA. Greater improvement in LS, PO, and HAA can be expected in patients with larger preoperative LS, PO, and HAA values.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Saga Central Hospital, 3-8-1 Hyogo Minami, Saga, 849-8522, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Collings TJ, Bourne MN, Barrett RS, Meinders E, GONçALVES BASAM, Shield AJ, Diamond LE. Gluteal Muscle Forces during Hip-Focused Injury Prevention and Rehabilitation Exercises. Med Sci Sports Exerc 2023; 55:650-660. [PMID: 36918403 DOI: 10.1249/mss.0000000000003091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE This study aimed to compare and rank gluteal muscle forces in eight hip-focused exercises performed with and without external resistance and describe the underlying fiber lengths, velocities, and muscle activations. METHODS Motion capture, ground reaction forces, and electromyography (EMG) were used as input to an EMG-informed neuromusculoskeletal model to estimate gluteus maximus, medius, and minimus muscle forces. Participants were 14 female footballers (18-32 yr old) with at least 3 months of lower limb strength training experience. Each participant performed eight hip-focused exercises (single-leg squat, split squat, single-leg Romanian deadlift [RDL], single-leg hip thrust, banded side step, hip hike, side plank, and side-lying leg raise) with and without 12 repetition maximum (RM) resistance. For each muscle, exercises were ranked by peak muscle force, and k-means clustering separated exercises into four tiers. RESULTS The tier 1 exercises for gluteus maximus were loaded split squat (95% confidence interval [CI] = 495-688 N), loaded single-leg RDL (95% CI = 500-655 N), and loaded single-leg hip thrust (95% CI = 505-640 N). The tier 1 exercises for gluteus medius were body weight side plank (95% CI = 338-483 N), loaded single-leg squat (95% CI = 278-422 N), and loaded single-leg RDL (95% CI = 283-405 N). The tier 1 exercises for gluteus minimus were loaded single-leg RDL (95% CI = 267-389 N) and body weight side plank (95% CI = 272-382 N). Peak gluteal muscle forces increased by 28-150 N when exercises were performed with 12RM external resistance compared with body weight only. Peak muscle force coincided with maximum fiber length for most exercises. CONCLUSIONS Gluteal muscle forces were exercise specific, and peak muscle forces increased by varying amounts when adding a 12RM external resistance. These findings may inform exercise selection by facilitating the targeting of individual gluteal muscles and optimization of mechanical loads to match performance, injury prevention, or rehabilitation training goals.
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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Makani A, Shirazi-Adl SA, Ghezelbash F. Computational biomechanics of human knee joint in stair ascent: Muscle-ligament-contact forces and comparison with level walking. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3646. [PMID: 36054682 DOI: 10.1002/cnm.3646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
About a third of knee joint disorders originate from the patellofemoral (PF) site that makes stair ascent a difficult activity for patients. A detailed finite element model of the knee joint is coupled to a lower extremity musculoskeletal model to simulate the stance phase of stair ascent. It is driven by the mean of measurements on the hip-knee-ankle moments-angles as well as ground reaction forces reported in healthy individuals. Predicted muscle activities compare well to the recorded electromyography data. Peak forces in quadriceps (3.87 BW, body weight, at 20% instance in our 607 N subject), medial hamstrings (0.77 BW at 20%), and gastrocnemii (1.21 BW at 80%) are estimated. Due to much greater flexion angles-moments in the first half of stance, large PF contact forces (peak of 3.1 BW at 20% stance) and stresses (peak of 4.83 MPa at 20% stance) are estimated that exceed their peaks in level walking by fourfold and twofold, respectively. Compared with level walking, ACL forces diminish in the first half of stance but substantially increase later in the second half (peak of 0.76 BW at 75% stance). Under nearly similar contact forces at 20% of stance, the contact stress on the tibiofemoral (TF) medial plateau reaches a peak (9.68 MPa) twice that on the PF joint suggesting the vulnerability of both joints. Compared with walking, stair ascent increases peak ACL force and both peak TF and PF contact stresses. Reductions in the knee flexion moment and/or angle appear as a viable strategy to mitigate internal loads and pain.
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Affiliation(s)
- Amirhossein Makani
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
| | - Saeed A Shirazi-Adl
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
| | - Farshid Ghezelbash
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
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Hip Sway in Patients With Hip Osteoarthritis During One-Leg Standing With a Focus on Time Series Data. Motor Control 2021; 25:502-518. [PMID: 34098529 DOI: 10.1123/mc.2020-0055] [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: 06/24/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the hip sway and the relationship between the center of pressure (CoP) and kinematic parameters regarding the time series scaling component α in patients with hip osteoarthritis (OA) during a one-leg standing task. The scaling exponent α, SD, hip sway maximal acceleration change, and balance performance, which was measured using CoP parameters, were compared between hip OA and control groups during a one-leg standing task. The relationships between balance performance with CoP parameters and kinematic parameters were investigated with the regression analysis. In the hip OA group, the scaling exponent α was smaller in the medial-lateral direction, and the SD and maximal amount of change in hip sway acceleration were larger in the anterior-posterior direction in the hip OA group. In this group, the CoP parameters were significantly associated with α in the medial-lateral direction (negatively) and in the anterior-posterior direction (positively). In the hip OA group, hip sway adaptability in the medial-lateral direction was limited, while the anterior-posterior direction showed greater movement.
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Hip and Trunk Muscle Activity and Mechanics During Walking With and Without Unilateral Weight. J Appl Biomech 2021; 37:351-358. [PMID: 34051700 DOI: 10.1123/jab.2020-0273] [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: 08/28/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%-20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤ .003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P < .001), while no change was found ipsilateral to the weight (P ≥ .790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity.
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Besomi M, Maclachlan L, Mellor R, Vicenzino B, Hodges PW. Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. Sports Med 2021; 50:965-985. [PMID: 31898217 DOI: 10.1007/s40279-019-01251-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dysfunction of the tensor fascia latae (TFL) muscle is often clinically implicated in many musculoskeletal disorders. OBJECTIVE To systematically review the literature of the TFL muscle to determine whether there are differences in its structure and activation between individuals with and without lower limb musculoskeletal conditions. DATA SOURCES A comprehensive search in MEDLINE, EMBASE, CINHAL, and LILACS was undertaken from year of inception to 9 July 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that directly investigated the structure or activity of the TFL muscle between individuals with a lower limb musculoskeletal condition and a pain-free control group. RESULTS Seventeen studies were included (n = 556 participants), eight reporting structure and ten activation of the TFL muscle. Conditions included lateral hip pain, hip joint pathology, ACL injury, iliotibial band syndrome, and patellofemoral joint osteoarthritis. Meta-analysis identified with low confidence (p value = 0.07) a small tendency towards hypertrophy in the affected side of participants with hip joint diseases (SMD 0.37, 95% CI [- 0.02, 0.77]). Moderate effect sizes were found for a higher cross-sectional area of the TFL/sartorius ratio in abductor tendon tear (SMD 0.74; 95% CI [0.05, 1.43, p value = 0.04), and for a smaller body mass normalized TFL volume in patellofemoral joint osteoarthritis (SMD - 0.61; 95% CI [- 1.23, 0.00], p value = 0.05). Normalised electromyography (EMG) amplitude did not differ between groups for any condition, but when EMG was analysed as linear envelopes or synergies, some differences in pattern of TFL activation were observed between individuals with lateral hip pain and controls. Timing of TFL activation did not differ between individuals with knee conditions and controls. CONCLUSIONS AND IMPLICATIONS Common clinical assumptions of the role of TFL muscle in lower limb musculoskeletal conditions are not well investigated and poorly supported by current research. There are contradictory findings on the muscle size of TFL. Differing methodology in muscle activation studies precludes a clear interpretation for comparison between groups. PROSPERO REGISTRATION NUMBER CRD42017076160.
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Affiliation(s)
- Manuela Besomi
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia
| | - Liam Maclachlan
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia
| | - Rebecca Mellor
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia.
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Sizeland TJB, Fearon AM, Perriman DM, Gilbert S, Lynch JT, Smith PN, Spratford W. People after gluteal tendon repair have gait characteristics which are similar to those of a healthy cohort. Clin Biomech (Bristol, Avon) 2020; 80:105176. [PMID: 33007675 DOI: 10.1016/j.clinbiomech.2020.105176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gluteal-tendon repair is reported to be effective for relieving pain and improving function in patients with gluteal-tendon tears. However, post-operative three-dimensional gait analysis has never been conducted in gluteal-tendon repair patients. Thus, our primary aim was to investigate how biomechanical gait parameters differ between age- and sex-matched participants with and without gluteal-tendon repair. METHODS Vicon motion analysis technology was used to measure gait characteristics of 25 gluteal-tendon repair participants and 29 matched healthy comparison group participants. A generalised linear multivariate model was used to compare external hip-adduction moment, range of movement in hip adduction and internal rotation, pelvic obliquity, trunk lean, stride length and velocity of both cohorts throughout stance. FINDINGS There were no differences between the groups in external hip adduction moment, pelvic obliquity and range of movement in hip adduction and internal rotation. Gluteal-tendon repair participants had a shorter stride length (P = 0.031) and reduced walking velocity (P = 0.015). Ipsilateral trunk lean was reduced in gluteal-tendon repair participants at the first-peak external hip-adduction moment (P = 0.016), mid-stance minimum external hip-adduction moment (P = 0.029) and second-peak external hip-adduction moment (P = 0.006). INTERPRETATION There were no differences between the gluteal-tendon repair and comparison groups for external hip-adduction moment and pelvic obliquity. This suggests that gluteal-tendon repair may restore hip control in stance. Slower walking speed, reduced stride length and decreased ipsilateral trunk lean may reflect persistence of pre-operatively developed gait adaptations. Future studies of gait biomechanics before and after gluteal-tendon repair would be needed to substantiate this theory.
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Affiliation(s)
| | - Angela M Fearon
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
| | - Diana M Perriman
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Sally Gilbert
- Australian National University Medical School, Canberra, Australia.
| | - Joseph T Lynch
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Paul N Smith
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Wayne Spratford
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
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Trunk, pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women. Clin Biomech (Bristol, Avon) 2020; 80:105168. [PMID: 32920251 DOI: 10.1016/j.clinbiomech.2020.105168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test. METHODS In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance. FINDINGS Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (-2.4°, 0.3°) and 1.0° (-0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups. INTERPRETATION Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.
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Relationship Between Isometric Hip Torque With Three Kinematic Tests in Soccer Players. PHYSICAL ACTIVITY AND HEALTH 2020. [DOI: 10.5334/paah.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral thigh pain. Gluteal tendon pathology is more prevalent in women and frequency increases with age. Chronic atraumatic tears result in altered lower limb biomechanics. The chief complaint is lateral thigh pain. Clinical examination should include evaluation of muscle strength, lumbar spine, hip and fascia lata pathology. The hip lag sign and 30-second single leg stance tests are useful in diagnosing abductor insufficiency. Magnetic resonance imaging (MRI) is the gold-standard investigation to identify abductor tendon tears and evaluate the extent of muscle fatty infiltration that has predictive value on the outcome of abductor repair. Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich protein, physical and radial shockwave therapy. The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy. Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment. There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes. Prerequisites for effective tendon suturing are neurologic integrity and limited muscle fatty infiltration. Chronic irreparable tears with limited muscle atrophy and limited fatty infiltration can be augmented with grafts. Gluteus maximus or/vastus lateralis muscle transfers are salvage reconstruction procedures for the management of chronic end-stage abductor tears with significant tendon insufficiency or gluteal atrophy.
Cite this article: EFORT Open Rev 2020;5:464-476. DOI: 10.1302/2058-5241.5.190094
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Affiliation(s)
- Eustathios Kenanidis
- Hôpital de la Tour, Geneva, Switzerland.,Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Centre of Orthopaedics and Regenerative Medicine (CORE) - Centre of Interdisciplinary Research and Innovation (CIRI) - Aristotle University Thessaloniki, Greece
| | - George Kyriakopoulos
- Hôpital de la Tour, Geneva, Switzerland.,Gennimatas General Hospital, Cholargos, Athens, Greece
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Ferrer-Peña R, Calvo-Lobo C, La Touche R, Fernández-Carnero J. Hip-Joint Posture and Movement Alterations Are Associated With High Interference of Pain in the Life of Patients With Greater Trochanteric Pain Syndrome. J Manipulative Physiol Ther 2020; 43:612-619. [PMID: 32839019 DOI: 10.1016/j.jmpt.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/09/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Greater trochanteric pain syndrome (GTPS) is a common condition that can cause lateral hip pain. The single-leg-squat test (SLST) may be used by physicians in primary care environments to evaluate patients' dynamic stability. The aim of this study was to evaluate the dynamic stability and strength of lateral abduction hip movements in primary care patients with GTPS in relation to their perceived pain interference in life. METHODS A descriptive observational study was carried out in a primary health care center. Fifty-four participants with GTPS were included in this study and divided into lower- and higher-interference groups (n = 30 and 19, respectively) according to the Graded Chronic Pain Scale. Participants were evaluated for their lateral abduction hip strength and the SLST. RESULTS The SLST showed a statistically significant difference between groups with respect to hip-joint posture and movement level (P = .043) but not for other SLST domains or lateral abduction hip strength (P > .05). CONCLUSION Patients with GTPS with more pain interference in their lives had poorer dynamic stability with respect to hip-joint posture and movements based on the SLST but did not present impaired lateral hip abduction strength in comparison with those who perceived lower pain interference in life.
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Affiliation(s)
- Raúl Ferrer-Peña
- Physical Therapy Department, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, International Doctoral School, Rey Juan Carlos University, Alcorcón, Spain; Centro de Salud Entrevías, Gerencia de Atención Primaria, Foundation for the Biomedical Research and Innovation of Primary Care of the Community of Madrid, Servicio Madrileño de Salud, Madrid, Spain; Hospital La Paz Institute for Health Research, Madrid, Spain
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.
| | - Roy La Touche
- Physical Therapy Department, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
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14
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Ferrer-Peña R, Muñoz-García D, Calvo-Lobo C, Fernández-Carnero J. Pain Expansion and Severity Reflect Central Sensitization in Primary Care Patients with Greater Trochanteric Pain Syndrome. PAIN MEDICINE 2020; 20:961-970. [PMID: 30312451 DOI: 10.1093/pm/pny199] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were twofold: 1) to evaluate the differences in pain sensitivity of patients with greater trochanteric pain syndrome (GTPS) and 2) to examine the association between pain expansion, pain severity, and pain-related central sensitization somatosensory variables in patients with GTPS. STUDY DESIGN A cross-sectional study. SETTING Primary health care centers. SUBJECTS The sample consisted of 49 participants with a mean age of 48.28 ± 8.13 years and included eight males (16.3%) and 41 females (83.7%). METHODS Conditioned pain modulation (CPM), pain location, temporal summation, pressure pain detection threshold (PPDT), and pain intensity were recorded. Pain severity was determined with the Graded Chronic Pain Scale (GCPS). RESULTS Several participants (34.7%) showed a negative conditioned pain modulation and a statistically significant negative moderate correlation (P < 0.05; r = -0.316) between conditioned pain modulation and right view percentage of pain location. Temporal summation at the major trochanter showed a statistically significant low negative correlation (P < 0.05; r = -0.298). The GCPS exhibited a statistically significant moderately positive correlation (P < 0.01; r = 0.467) with the PPDT at the trochanter and a significant correlation with the postero-superior iliac spine (P < 0.01; r = 0.515) and epicondyle (P < 0.01; r = 0.566). CONCLUSIONS Patients with GTPS presented altered CPM, a relationship with more pain areas associated with negative CPM, and a positive association between pain severity and mechanical hyperalgesia at remote sites. Thus, physicians could apply these outcome measurements to assess primary care patients with GTPS and determine the central sensitization presence to prescribe adequate multimodal treatment approaches.
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Affiliation(s)
- Raúl Ferrer-Peña
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Salud Entrevías, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Universidad Rey Juan Carlos, Escuela internacional de doctorado, Madrid, Spain
| | - Daniel Muñoz-García
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Hospital La Paz Institute for Health Research, IdiPAz, Madrid, Spain
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15
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Cowan RM, Semciw AI, Pizzari T, Cook J, Rixon MK, Gupta G, Plass LM, Ganderton CL. Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome. Clin Anat 2019; 33:1082-1090. [DOI: 10.1002/ca.23510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/24/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Rachael Mary Cowan
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Adam Ivan Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Melissa Kate Rixon
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | | | - Lindsey Marie Plass
- The University of Chicago Medicine, Department of Therapy Services Illinois United States of America
| | - Charlotte Louise Ganderton
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
- Department of Health Professions, Swinburne University of Technology Victoria Australia
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16
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Plinsinga ML, Ross MH, Coombes BK, Vicenzino B. Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis. Musculoskelet Sci Pract 2019; 43:83-90. [PMID: 31369906 DOI: 10.1016/j.msksp.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Understanding of the biopsychosocial characteristics of greater trochanteric pain syndrome (GTPS), a prevalent lower limb tendinopathy, is currently lacking. OBJECTIVES To quantify differences in participant characteristics between individuals with GTPS and healthy control participants. DESIGN Systematic review of original studies with meta-analyses where appropriate. METHODS A comprehensive electronic search was undertaken in Pubmed, EMBASE, Web of Science and CINAHL for terms referring to GTPS. Studies that provided comparison of individuals with clinically characterized GTPS with healthy controls were included. Study quality was rated with the Joanna Briggs Institute Critical Appraisal Checklist for Cross Sectional Studies. Standardized mean differences were calculated and supported by narrative synthesis or meta-analyses where appropriate. Certainty of evidence was assessed based on the GRADE guidelines. RESULTS The search revealed 2798 studies, of which 13 studies from five research groups were included. There were 229 participants with at least three months duration of GTPS and 193 control participants. Individuals with GTPS displayed larger greater trochanteric width, greater body mass index, lower hip abductor muscle strength, higher hip abductor muscle activity, altered single leg loading and gait parameters including shorter step length and velocity. No studies investigating psychological features or sensory perception were identified. Quality of life was investigated in a single study. CONCLUSIONS Compared to healthy controls, participants with GTPS are more overweight, have poorer hip abductor muscle function and altered gait parameters. Overall quality of evidence across studies was very low based on GRADE guidelines.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Megan Heather Ross
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Brooke Kaye Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
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17
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French HP, Woodley SJ, Fearon A, O'Connor L, Grimaldi A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current physiotherapy practice. Physiotherapy 2019; 109:111-120. [PMID: 31493863 DOI: 10.1016/j.physio.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to establish and compare current physiotherapy management of GTPS in Australia, New Zealand (NZ) and Ireland. DESIGN Cross-sectional observational survey of physiotherapists. METHODS An online survey was distributed to registered musculoskeletal physiotherapists in Australia, NZ and Ireland. Ordinal and nominal data were analysed using frequency counts or mean ranks; median and interquartile ranges were calculated for numerical data. Inter-country comparisons were made using Chi-squared analyses for nominal/ordinal data and Kruskal-Wallis tests for numerical data. Statistical significance was set at P<0.05. RESULTS/FINDINGS Valid responses were received from 361 physiotherapists, 61% were female and 80% worked in private practice. Overall, consistency in treatment of GTPS was observed across the three countries. All physiotherapists used education and exercise (most commonly strengthening and neuromuscular control) primarily targeting the gluteal muscles. Other interventions included massage (90%), stretching (53%), range of motion (40%), thermal modalities (50%), taping (38%) and electrotherapy (25%), whilst 40% commonly recommended up to 2 to 3 corticosteroid injections per patient/per annum. Physiotherapists used pain severity scales as their primary outcome measure (79%). Single leg stance was the most common physical measure used (68%), and global rating scores or standardised physical measures were less commonly used. CONCLUSION This international survey established the physiotherapy management of GTPS. Education used in conjunction with exercise is in line with current evidence, but a proportion of clinicians use adjunct treatments without clear rationale or supporting evidence. Results indicate the need to further define optimal management of GTPS using robust methodologies such as randomised controlled trials.
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Affiliation(s)
| | - S J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand.
| | - A Fearon
- UCRISE, Faculty of Health, University of Canberra, Australia.
| | | | - A Grimaldi
- Physiotec Physiotherapy, Brisbane, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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18
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Christensen L, Veierød MB, Vøllestad NK, Jakobsen VE, Stuge B, Cabri J, Robinson HS. Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women. Clin Biomech (Bristol, Avon) 2019; 68:45-52. [PMID: 31158589 DOI: 10.1016/j.clinbiomech.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy. METHODS Three-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 non-pregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (rs). FINDINGS Pregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (rs = -0.63, P = 0.01) and disability (rs = -0.46, P = 0.03) in the pelvic girdle pain group. INTERPRETATION Gait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.
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Affiliation(s)
- Lene Christensen
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P. O. Box 1089, Blindern, 0317 Oslo, Norway.
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Dept. of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, P. O. Box 1122, Blindern, 0317 Oslo, Norway.
| | - Nina K Vøllestad
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P. O. Box 1089, Blindern, 0317 Oslo, Norway.
| | - Vidar E Jakobsen
- Norwegian School of Sport Sciences, P. O. Box 4014, Ullevål Stadion, 0806 Oslo, Norway.
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, P. O. Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Jan Cabri
- Dept. of Physical Performance, Norwegian School of Sport Sciences, P. O. Box 4014, Ullevål Stadion, 0806 Oslo, Norway.
| | - Hilde Stendal Robinson
- Dept. of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P. O. Box 1089, Blindern, 0317 Oslo, Norway.
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19
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Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial. Gait Posture 2019; 70:275-283. [PMID: 30921578 DOI: 10.1016/j.gaitpost.2019.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES There is considerable debate among clinicians as to whether sports tape can provide mechanical support and pain relief. People with greater trochanteric pain syndrome (GTPS) have increased adduction moment, adduction angle and pelvic obliquity, likely contributing to the continuation of the pathology. We aimed to see if Dynamic Tape® could control these movements and reduce pain. METHODS Fifty women with GTPS participated in a three-dimensional gait analysis. Each participant performed three walking trials: baseline, and two subsequent trials, with active and sham applications of Dynamic Tape. The order of active and sham taping was randomised. Differences in kinetic and kinematic data were analysed using mixed model linear regressions for each condition. Pain scores were obtained before and immediately after walking trials. RESULTS Hip adduction moment was reduced at first peak by both active (p < 0.001) and sham tape (p = 0.028), with no between group difference; at second peak by the active taping (p < 0.001), with a between-group difference (p < 0.001). Adduction angle was reduced at first peak by both active (p < 0.001) and sham taping (p = 0.026), with the active taping producing a larger effect (p = 0.004); at mid-stance by active taping (p = 0.003), with a between-group difference (p = 0.002); there was no reduction at second peak. Internal rotation was reduced at the first (p < 0.001) and second peaks (p < 0.001), and mid-stance by the active taping alone (p < 0.001). Pelvic obliquity was reduced at the first peak (p = 0.019), mid-stance (p < 0.001) and second peak (p < 0.001) by the active tape, with a between-group difference at mid-stance (p = 0.03). Both the active and sham taping resulted in a clinically meaningful pain reduction. CONCLUSION Dynamic Tape produced a mechanical effect and a meaningful reduction in pain in women with GTPS. The extent that placebo or somatosensory input may have had on these results is not clear. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12617001611314.
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Seino KK, Secord T, Vig M, Kyllonen S, DeClue AJ. Three-Dimensional Kinematic Motion Analysis of Shivers in Horses: A Pilot Study. J Equine Vet Sci 2019; 79:13-22. [PMID: 31405492 DOI: 10.1016/j.jevs.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/27/2019] [Accepted: 03/01/2019] [Indexed: 11/28/2022]
Abstract
Our aim was to assess three-dimensional kinematic motion analysis as an objective diagnostic tool for the characterization of the movement disorder of Shivers in horses. Kinematic parameters were measured in three horses with Shivers and were compared with a control group of four normal horses. Multiple parameter differences were found in the horses with Shivers at the walk, during backing, and when asked to pick up their hindlimbs. Most significant changes were a wider hindlimb stance of 0.39 ± 0.15 m and increased abduction angle of 48.7 ± 7.52° and hoof elevation (0.77 ± 0.08 m left and 0.94 ± 0.11 m right) when the horses were asked to pick up their hindlimbs. Control horses could back easily in a straight line and with symmetrical hoof separation and could maintain their center of weight when picking up their hindlimbs. In contrast, the horses with Shivers had difficulty backing straight, were slower, with a shorter stride and asymmetric hoof separation. They could not maintain their center of balance when picking up their hindlimbs. The findings of this pilot study advance the understanding of the movement disorder of Shivers and could be used as outcome measures to evaluate treatment modalities.
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Affiliation(s)
| | - Tom Secord
- Department of Engineering, University of St. Thomas, St. Paul, MN
| | - Mikala Vig
- Midwestern University College of Veterinary Medicine, Glendale, AZ
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21
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Pincheira PA, De La Maza E, Silvestre R, Guzmán-Venegas R, Becerra M. Comparison of total hip arthroplasty surgical approaches by Statistical Parametric Mapping. Clin Biomech (Bristol, Avon) 2019; 62:7-14. [PMID: 30639965 DOI: 10.1016/j.clinbiomech.2018.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/15/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The most common surgical approaches in use for total hip arthroplasty are the lateral and posterior. When comparing these approaches in terms of gait biomechanics, studies usually rely on pre-defined discrete variables related to the events of gait cycle. However, this analysis may miss differences in other parts of the movement pattern that are not explored. We applied Statistical Parametric Mapping to compare hip kinematics between patients who underwent arthroplasty using either a lateral or posterior approach, contrasting these results with discrete variable analysis. METHODS Twenty-two participants (11 lateral, 11 posterior; age between 50 and 80 years) underwent gait analysis before, 3 weeks and 12 weeks after hip arthroplasty. One-dimensional (e.g. time-varying) trajectories and zero-dimensional (e.g. peak extension) discrete variables were used to assess differences between groups in each plane of hip movement (sagittal, frontal, and transverse). FINDINGS One-dimensional and zero-dimensional analyses found no significant differences between groups. Statistical Parametric Mapping revealed that both groups presented significant changes over time in hip adduction at 11-43% of the gait cycle. Zero-dimensional analysis seems to overstate sagittal plane changes over time since no such changes were found by Statistical Parametric Mapping. INTERPRETATION Our results agreed with previous studies suggesting that surgical approach do not affect hip kinematics at the early post-operative stage after arthroplasty. However, Statistical Parametric Mapping revealed changes in frontal plane kinematics over time that were underestimated by the zero-dimensional variables. These findings suggest hip adduction impairment up to 12 weeks after arthroplasty.
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Affiliation(s)
- Patricio A Pincheira
- Facultad de Ciencias, Escuela de Kinesiología, Universidad Mayor, Camino la pirámide 5750, Huechuraba, Santiago, Chile; Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile; School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Performance, The University of Queensland, Blair Dr, Building 26b, St Lucia, Brisbane, Australia.
| | - Eduardo De La Maza
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clínica Meds, Isabel La Católica 3740, Providencia, Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile
| | - Manuel Becerra
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
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Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain. Pain Res Manag 2018; 2018:9156247. [PMID: 30425756 PMCID: PMC6217738 DOI: 10.1155/2018/9156247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
Purpose The aim of this study was to compare the pain severity, health-related quality of life (HRQoL), and risk of continue having pain with prognostic risk scores (PRS), between patients referring greater trochanteric pain syndrome (GTPS) and chronic low back pain (CLBP). Methods A descriptive, cross-sectional design using nonprobability convenience sampling was performed. A total sample of 102 patients were recruited from two primary health-care centers and divided into GTPS (n = 51) and CLBP (n = 51) groups. The primary outcome was pain severity which was assessed with the Spanish version of the Graded Chronic Pain Scale (GCPS). The secondary outcome was the HRQoL which was measured using the Spanish version of EuroQoL Five Dimensions and Five Levels (EQ-5D-5L) as well as the PRS. Results Significant differences (P<0.05) were found within both groups in the pain severity global score with a medium effect size showing greater values for the CLBP group with regards to the GTPS group. The PRS in both groups did not show statistical differences (P>0.05). Nevertheless, subjects referring CLBP showed greater levels in the PRS than patients with GTPS. Comparing both groups, the HRQoL showed statistical differences (P<0.05) in the “pain/discomfort” domain in the CLBP group with respect to the GTPS group, but not in the other domains. Conclusions Patients who suffered from CLBP showed greater pain severity and HRQoL discomfort with regard to patients with GTPS. Despite greater scores for CLBP, the PRS did not seem to be different between both conditions.
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Ferrer-Peña R, Moreno-López M, Calvo-Lobo C, López-de-Uralde-Villanueva I, Fernández-Carnero J. Relationship of Dynamic Balance Impairment with Pain-Related and Psychosocial Measures in Primary Care Patients with Chronic Greater Trochanteric Pain Syndrome. PAIN MEDICINE 2018; 20:810-817. [DOI: 10.1093/pm/pny160] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Raúl Ferrer-Peña
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Centro de Salud Entrevías, Gerencia de Atención Primaria, Fundación para la Investigación e Innovación Biomédica en Atención Primaria de la Comunidad de Madrid (FIIBAP), Servicio Madrileño de Salud, Madrid, Spain
| | - Mónica Moreno-López
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAz, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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24
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Allison K, Hall M, Hodges PW, Wrigley TV, Vicenzino B, Pua YH, Metcalf B, Grimaldi A, Bennell KL. Gluteal tendinopathy and hip osteoarthritis: Different pathologies, different hip biomechanics. Gait Posture 2018; 61:459-465. [PMID: 29486364 DOI: 10.1016/j.gaitpost.2018.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gluteal tendinopathy (GT) and hip osteoarthritis (OA) are the most common causes of hip pain and associated disability in older adults. Pain and altered walking biomechanics are common to both conditions. This study aimed to compare three-dimensional walking biomechanics between individuals with unilateral, symptomatic GT and HOA. METHODS Sixty individuals with symptomatic unilateral GT confirmed by magnetic-resonance-imaging and 73 individuals with symptomatic unilateral HOA (Kellgren-Lawrence Grade ≥ 2) underwent three-dimensional gait analysis. Maximum and minimum values of the external sagittal hip moment, the first peak, second peak and mid-stance minimum of the hip adduction moment (HAM), sagittal plane hip excursion and hip joint angles, pelvic obliquity and trunk lean, at the three HAM time points during stance phase of walking were compared between groups. RESULTS Compared to individuals with HOA, those with GT exhibited a greater hip peak extension moment (P < 0.001) and greater HAM throughout the stance phase of walking (P = 0.01-P < 0.001), greater hip adduction (P < 0.001) and internal rotation (P < 0.01-P < 0.001) angles and lower hip flexion angles and excursion (P = 0.02 - P < 0.001). Individuals with HOA exhibited a greater forward trunk lean (P ≤ 0.001) throughout stance, and greater ipsilateral trunk lean in the frontal plane (P < 0.001) than those with GT. CONCLUSION Despite presence of pain in both conditions, hip kinematics and kinetics differ between individuals with symptomatic unilateral GT and those with symptomatic unilateral HOA. These condition-specific impairments may be targets for optimization of management of HOA and GT.
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Affiliation(s)
- Kim Allison
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
| | - Paul W Hodges
- School of Health & Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia.
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
| | - Bill Vicenzino
- School of Health & Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia.
| | - Yong-Hao Pua
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia; School of Health & Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia; Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Ben Metcalf
- Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Alison Grimaldi
- School of Health & Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia.
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, Australia.
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25
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Plinsinga M, Coombes B, Mellor R, Nicolson P, Grimaldi A, Hodges P, Bennell K, Vicenzino B. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study. Eur J Pain 2018; 22:1124-1133. [DOI: 10.1002/ejp.1199] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/12/2023]
Affiliation(s)
- M.L. Plinsinga
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - B.K. Coombes
- School of Biomedical Sciences; The University of Queensland; Brisbane Qld Australia
| | - R. Mellor
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - P. Nicolson
- Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy; University of Melbourne; Carlton Vic. Australia
| | - A. Grimaldi
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
- Physiotec; Tarragindi Qld Australia
| | - P. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - K. Bennell
- Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy; University of Melbourne; Carlton Vic. Australia
| | - B. Vicenzino
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
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Gluteus Minimus and Gluteus Medius Muscle Activity During Common Rehabilitation Exercises in Healthy Postmenopausal Women. J Orthop Sports Phys Ther 2017; 47:914-922. [PMID: 29034801 DOI: 10.2519/jospt.2017.7229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background The gluteus medius (GMed) and gluteus minimus (GMin) provide dynamic stability of the hip joint and pelvis. These muscles are susceptible to atrophy and injury in individuals during menopause, aging, and disease. Numerous studies have reported on the ability of exercises to elicit high levels of GMed activity; however, few studies have differentiated between the portions of the GMed, and none have examined the GMin. Objectives To quantify and rank the level of muscle activity of the 2 segments of the GMin (anterior and posterior fibers) and 3 segments of the GMed (anterior, middle, and posterior fibers) during 4 isometric and 3 dynamic exercises in a group of healthy, postmenopausal women. Methods Intramuscular electrodes were inserted into each segment of the GMed and GMin in 10 healthy, postmenopausal women. Participants completed 7 gluteal rehabilitation exercises, and average normalized muscle activity was used to rank the exercises from highest to lowest. Results The isometric standing hip hitch with contralateral hip swing was the highest-ranked exercise for all muscle segments except the anterior GMin, where it was ranked second. The highest-ranked dynamic exercise for all muscle segments was the dip test. Conclusion The hip hitch and its variations maximally activate the GMed and GMin muscle segments, and may be useful in hip muscle rehabilitation in postmenopausal women. J Orthop Sports Phys Ther 2017;47(12):914-922. Epub 15 Oct 2017. doi:10.2519/jospt.2017.7229.
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Huxtable RE, Ackland TR, Janes GC, Ebert JR. Clinical outcomes and frontal plane two-dimensional biomechanics during the 30-second single leg stance test in patients before and after hip abductor tendon reconstructive surgery. Clin Biomech (Bristol, Avon) 2017; 46:57-63. [PMID: 28514698 DOI: 10.1016/j.clinbiomech.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip abductor tendon tears are a common cause of Greater Trochanteric Pain Syndrome. Conservative treatments are often ineffective and surgical reconstruction may be recommended. This study investigated the improvement in clinical outcomes and frontal plane two-dimensional biomechanics during a 30-second single leg stance test, in patients undergoing reconstruction. We hypothesized that clinical scores and pertinent biomechanical variables would significantly improve post-surgery, and these outcomes would be significantly correlated. METHODS Twenty-one patients with symptomatic tendon tears underwent reconstruction. Patients were evaluated pre-surgery, and at 6 and 12months post-surgery, using patient-reported outcome measures, assessment of hip abductor strength and six-minute walk capacity. Frontal plane, two-dimensional, biomechanical variables including pelvis-on-femur angle, pelvic drop, trunk lean and lateral pelvic shift, were evaluated throughout a 30-second single leg stance test. ANOVA evaluated outcomes over time, while Pearson's correlations investigated associations between clinical scores, pain, functional and biomechanical outcome variables. FINDINGS While clinical and functional measures significantly improved (P<0.05) over time, no significant group differences (P>0.05) were observed in biomechanical variables from pre- to post-surgery. While five patients displayed a positive Trendelenburg sign pre-surgery, only one was positive post-surgery. Clinical outcomes and biomechanical variables during the single leg stance test were not correlated. INTERPRETATION Despite improvements in clinical and functional measures over time, biomechanical changes during a weight bearing single leg stance test were not significantly different following tendon repair. Follow up beyond 12months may be required, whereby symptomatic relief may precede functional and biomechanical improvement.
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Affiliation(s)
- Rose E Huxtable
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Timothy R Ackland
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth 6005, Western Australia, Australia
| | - Jay R Ebert
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia; HFRC, Nedlands, 6009, Western Australia, Australia.
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