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Stewart C, Wesselink EO, Perraton Z, Weber KA, King MG, Kemp JL, Mentiplay BF, Crossley KM, Elliott JM, Heerey JJ, Scholes MJ, Lawrenson PR, Calabrese C, Semciw AI. Muscle Fat and Volume Differences in People With Hip-Related Pain Compared With Controls: A Machine Learning Approach. J Cachexia Sarcopenia Muscle 2024. [PMID: 39343707 DOI: 10.1002/jcsm.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/24/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Hip-related pain (HRP) affects young to middle-aged active adults and impacts physical activity, finances and quality of life. HRP includes conditions like femoroacetabular impingement syndrome and labral tears. Lateral hip muscle dysfunction and atrophy in HRP are more pronounced in advanced hip pathology, with limited evidence in younger populations. While MRI use for assessing hip muscle morphology is increasing, with automated deep-learning techniques showing promise, studies assessing their accuracy are limited. Therefore, we aimed to compare hip intramuscular fat infiltrate (MFI) and muscle volume, in individuals with and without HRP as well as assess the reliability and accuracy of automated machine-learning segmentations compared with human-generated segmentation. METHODS This cross-sectional study included sub-elite/amateur football players (Australian football and soccer) with a greater than 6-month history of HRP [n = 180, average age 28.32, (standard deviation 5.88) years, 19% female] and a control group of sub-elite/amateur football players without pain [n = 48, 28.89 (6.22) years, 29% female]. Muscle volume and MFI of gluteus maximus, medius, minimis and tensor fascia latae were assessed using MRI. Associations between muscle volume and group were explored using linear regression models, controlling for body mass index, age, sport and sex. A convolutional neural network (CNN) machine-learning approach was compared with human-performed muscle segmentations in a subset of participants (n = 52) using intraclass correlation coefficients and Sorensen-Dice index. RESULTS When considering adjusted estimates of muscle volume, there were significant differences observed between groups for gluteus medius (adjusted mean difference 23 858 mm3 [95% confidence interval 7563, 40 137]; p = 0.004) and tensor fascia latae (6660 mm3 [2440, 13 075]; p = 0.042). No differences were observed between groups for gluteus maximus (18 265 mm3 [-21 209, 50 782]; p = 0.419) or minimus (3893 mm3 [-2209, 9996]; p = 0.21). The CNN was trained for 30 000 iterations and assessed its accuracy and reliability on an independent testing dataset, achieving high segmentation accuracy (mean Sorenson-Dice index >0.900) and excellent muscle volume and MFI reliability (ICC2,1 > 0.900). The CNN outperformed manual raters, who had slightly lower interrater accuracy (Sorensen-Dice index >0.800) and reliability (ICC2,1 > 0.800). CONCLUSIONS The increased muscle volumes in the symptomatic group compared with controls could be associated with increased myofibrillar size, sarcoplasmic hypertrophy or both. These changes may facilitate greater muscular efficiency for a given load, enabling the athlete to maintain their normal level of function. In addition, the CNNs for muscle segmentation was more efficient and demonstrated excellent reliability in comparison to manual segmentations.
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Affiliation(s)
- Chris Stewart
- School of Allied Health, Human Services and Sport, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Evert O Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Zuzana Perraton
- School of Allied Health, Human Services and Sport, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Matthew G King
- School of Allied Health, Human Services and Sport, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Discipline of Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - James M Elliott
- Faculty of Medicine and Health, Northern Sydney Local Health District and the University of Sydney, The Kolling Institute St Leonards, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Mark J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Peter R Lawrenson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Innovation and Research Centre, Community and Oral Health Directorate, Metro North Health, Brisbane, Australia
| | - Chris Calabrese
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Adam I Semciw
- School of Allied Health, Human Services and Sport, Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
- Department of Allied Health, Northern Health, Epping, Australia
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Grosklos M, Lewis CL, Ceballos E, Perry J, Di Stasi S. Females with hip-related pain demonstrate reduced kinetics at the hip and ankle during terminal stance of gait. Gait Posture 2023; 105:99-103. [PMID: 37515892 PMCID: PMC10527984 DOI: 10.1016/j.gaitpost.2023.07.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Individuals with hip-related pain (HRP) commonly report pain with walking and demonstrate altered movement patterns compared to healthy controls (HCs). Individuals with HRP may attempt to reduce pain during walking by decreasing kinetics and joint forces at the hip through increased use of the ankle during pushoff. RESEARCH QUESTION Do individuals with HRP have increased kinetics at the ankle and decreased kinetics at the hip during pushoff in gait compared to HCs, and do kinetic patterns differ between males and females with HRP? METHODS This retrospective observational study included 42 individuals with HRP and 20 HCs. Participants completed overground gait trials at their self-selected speed while kinematics and kinetics were recorded through a motion capture system and force plates. Peak internal hip and ankle moments and hip flexion and ankle plantarflexion angular impulse during terminal stance were used in general estimating equations for comparison of group by limb interactions for males and females separately, as well as a comparison of males and females within the HRP group. RESULTS Females with HRP demonstrated reduced hip flexion impulse on their involved limb (.070 Nm*s/kg*m) compared to female HCs (.083Nm*s/kg*m; p = .032), as well as reduced peak ankle plantarflexion moment (-.94Nm/kg*m) compared to their contralateral limb (-.99Nm/kg*m) and the involved limb of HRP males (-1.00Nm/kg*m) (p ≤ .007). There were no between-limb or between-group differences in hip or ankle peak moments or impulses in males. SIGNIFICANCE Females with HRP show decreased kinetics at both the hip and ankle; these patterns were not identified in males. Future investigations should examine whether increasing ankle kinetics during pushoff reduces pain at the hip, as this may be a valuable clinical treatment strategy.
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Affiliation(s)
- Madeline Grosklos
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
| | - Cara L Lewis
- Department of Physical Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA 02215, USA
| | - Elizabeth Ceballos
- The Ohio State University Wexner Medical Center Division of Sport Physical Therapy, 2835 Fred Taylor Dr, Columbus, OH 43202, USA
| | - Jennifer Perry
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Department of Mechanical Engineering, The Ohio State University, 201 W. 19th Avenue, Columbus, OH 43210, USA
| | - Stephanie Di Stasi
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
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Kibushi B. Muscle coordination patterns in regulation of medial gastrocnemius activation during walking. Hum Mov Sci 2023; 90:103116. [PMID: 37327750 DOI: 10.1016/j.humov.2023.103116] [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: 02/28/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
The ankle plantar flexion in the late stance phase is referred to as the ankle push-off. When the ankle push-off force is enhanced, compensatory adjustments occur in the adjacent phases. The muscle control that achieves these compensatory movements remains unknown, although they are expected to be coordinately regulated across multiple muscles and phases. Muscle synergy is used as a quantification technique for muscle coordination, and this analysis enables the comparison of synchronized activity between multiple muscles. Therefore, this study aimed to elucidate the tuning of muscle synergies in muscle activation adjustment of push-off. It is hypothesized that muscle activation adjustment of push-off is performed in the muscle synergy related to ankle push-off and in the muscle synergy that activates during the adjacent push-off phase. Eleven healthy men participated, and participants manipulated the activity of the medial gastrocnemius during walking through visual feedback. Two conditions were compared as experimental conditions: increasing the muscle activity to 1.6 times that during normal walking (High) and matching it with that during normal walking (Normal). Twelve muscle activities in the trunk and lower limb and kinematic data were recorded. Muscle synergies were extracted by the non-negative matrix factorization. No significant difference was observed in the number of synergies (High: 3.5 ± 0.8, Normal: 3.7 ± 0.9, p = 0.21) and muscle synergy activation timing and duration between the High and Normal conditions (p > 0.27). However, significant differences were observed in the peak muscle activity during the late stance phase of the rectus femoris (RF), biceps femoris (BF) between conditions (RF at High: 0.32 ± 0.21, RF at Normal: 0.45 ± 0.17, p = 0.02; BF at High: 0.16 ± 0.01, BF at Normal: 0.08 ± 0.06 p = 0.02). Although the quantification of force exertion has not been conducted, the modulation of RF and BF activation could have occurred due to the attempts to help knee flexion. Muscle synergies during normal walking are therefore maintained, and slight adjustments in the amplitude of muscle activity occurred for each muscle.
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Affiliation(s)
- Benio Kibushi
- Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada, Kobe, Japan.
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Lauer J. Video-driven simulation of lower limb mechanical loading during aquatic exercises. J Biomech 2023; 152:111576. [PMID: 37043928 DOI: 10.1016/j.jbiomech.2023.111576] [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: 12/07/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
Understanding the mechanical demands of an exercise on the musculoskeletal system is crucial to prescribe effective training or therapeutic interventions. Yet, that knowledge is currently limited in water, mostly because of the difficulty in evaluating external resistance. Here I reconcile recent advances in 3D markerless pose and mesh estimation, biomechanical simulations, and hydrodynamic modeling, to predict lower limb mechanical loading during aquatic exercises. Simulations are driven exclusively from a single video. Fluid forces were estimated within 12.5±4.1% of the peak forces determined through computational fluid dynamics analyses, at a speed three orders of magnitude greater. In silico hip and knee resultant joint forces agreed reasonably well with in vivo instrumented implant recordings (R2=0.74) downloaded from the OrthoLoad database, both in magnitude (RMSE =251±125 N) and direction (cosine similarity = 0.92±0.09). Hip flexors, glutes, adductors, and hamstrings were the main contributors to hip joint compressive forces (40.4±12.7%, 25.6±9.7%, 14.2±4.8%, 13.0±8.2%, respectively), while knee compressive forces were mostly produced by the gastrocnemius (39.1±15.9%) and vasti (29.4±13.7%). Unlike dry-land locomotion, non-hip- and non-knee-spanning muscles provided little to no offloading effect via dynamic coupling. This noninvasive method has the potential to standardize the reporting of exercise intensity, inform the design of rehabilitation protocols and improve their reproducibility.
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Affiliation(s)
- Jessy Lauer
- Neuro-X Institute and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
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Lewis CL, Uemura K, Atkins PR, Lenz AL, Fiorentino NM, Aoki SK, Anderson AE. Patients with cam-type femoroacetabular impingement demonstrate increased change in bone-to-bone distance during walking: A dual fluoroscopy study. J Orthop Res 2023; 41:161-169. [PMID: 35325481 PMCID: PMC9508282 DOI: 10.1002/jor.25332] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Cam-type femoroacetabular impingement (FAI) syndrome is a painful, structural hip disorder. Herein, we investigated hip joint mechanics through in vivo, dynamic measurement of the bone-to-bone distance between the femoral head and acetabulum in patients with cam FAI syndrome and morphologically screened controls. We hypothesized that individuals with cam FAI syndrome would have larger changes in bone-to-bone distance compared to the control group, which we would interpret as altered joint mechanics as signified by greater movement of the femoral head as it articulates within the acetabulum. Seven patients with cam FAI syndrome and 11 asymptomatic individuals with typical morphology underwent dual fluoroscopy imaging during level and inclined walking (upward slope). The change in bone-to-bone distance between femoral and acetabular bone surfaces was evaluated for five anatomical regions of the acetabulum at each timepoint of gait. Linear regression analysis of the bone-to-bone distance considered two within-subject factors (activity and region) and one between-subjects factor (group). Across activities, the change in minimum bone-to-bone distance was 1.38-2.54 mm for the cam FAI group and 1.16-1.84 mm for controls. In all regions except the anterior-superior region, the change in bone-to-bone distance was larger in the cam group than the control group (p ≤ 0.024). An effect of activity was detected only in the posterior-superior region where larger changes were noted during level walking than incline walking. Statement of clinical significance: Patients with cam FAI syndrome exhibit altered hip joint mechanics during the low-demand activity of walking; these alterations could affect load transmission, and contribute to pain, tissue damage, and osteoarthritis.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Niccolo M Fiorentino
- Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA
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Schuring LL, Mozingo JD, Lenz AL, Uemura K, Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Anderson AE. Acetabular labrum and cartilage contact mechanics during pivoting and walking tasks in individuals with cam femoroacetabular impingement syndrome. J Biomech 2023; 146:111424. [PMID: 36603366 PMCID: PMC9869780 DOI: 10.1016/j.jbiomech.2022.111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities. Previous in silico studies have employed generalized model geometry or kinematics to simulate impingement between the femur and acetabulum, which may not accurately capture the interplay between morphology and motion. In this study, we utilized models with participant-specific bone and articular soft tissue anatomy and kinematics measured by dual-fluoroscopy to compare hip contact mechanics of cam FAIS patients to controls during four activities of daily living (internal/external pivoting and level/incline walking). Averaged across the gait cycle during incline walking, patients displayed increased strain in the anterior joint (labrum strain: p-value = 0.038, patients: 11.7 ± 6.7 %, controls: 5.0 ± 3.6 %; cartilage strain: p-value = 0.029, patients: 9.1 ± 3.3 %, controls: 4.2 ± 2.3). Patients also exhibited increased average anterior cartilage strains during external pivoting (p-value = 0.039; patients: 13.0 ± 9.2 %, controls: 3.9 ± 3.2 %]). No significant differences between patient and control contact area and strain were found for level walking and internal pivoting. Our study provides new insights into the biomechanics of cam FAIS, including spatiotemporal hip joint contact mechanics during activities of daily living.
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Affiliation(s)
- Lindsay L Schuring
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Joseph D Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
| | - Niccolo M Fiorentino
- Mechanical Engineering Department, University of Vermont, Burlington, VT 05405, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Andrew E Anderson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA.
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Effect of Heel-First Strike Gait on Knee and Ankle Mechanics. ACTA ACUST UNITED AC 2021; 57:medicina57070657. [PMID: 34206943 PMCID: PMC8304808 DOI: 10.3390/medicina57070657] [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: 04/30/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Acquiring knowledge about the magnitude and direction of induced joint forces during modifying gait strategies is critical for proper exercise prescription. The present study aimed to evaluate whether a heel-first strike pattern during gait can affect the biomechanical characteristics of ankle and knee joints among asymptomatic people. Materials and Methods: In this cross-sectional study performed in the biomechanics laboratory, 13 professional healthy male athletes walked on an instrumented walkway under two walking conditions. For the normal condition, subjects were instructed to walk as they normally would. For the heel-first strike condition, subjects were instructed to walk with heel-first strike pattern and increase heel contact duration as much as possible. Then, knee and ankle joint range of motions and moments, as well as vertical ground reaction force was measured by the Kistler force plate and Vicon motion analysis system. Results: Knee flexion angle at the initial contact and during stance phase was significantly lower when increasing the heel strike pattern. In addition, the mean values of the knee external rotation and adductor moments during heel strike condition were lower than those in normal walking. Further, the ankle dorsiflexion range of motion (ROM) during mid-stance increased significantly during heel-first strike pattern compared to the value in normal gait pattern. Conclusions: The modification of gait pattern including heel-first strike pattern can reduce the mechanical load applied to the knee, while improving the extensibility of gastro-soleus muscle complex.
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Catelli DS, Bedo BLS, Beaulé PE, Lamontagne M. Pre- and postoperative in silico biomechanics in individuals with cam morphology during stair tasks. Clin Biomech (Bristol, Avon) 2021; 86:105387. [PMID: 34044296 DOI: 10.1016/j.clinbiomech.2021.105387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondroplasty for cam femoroacetabular impingement is a common treatment to improve hip function and prevent joint degeneration. The purpose was to compare in-silico hip biomechanics during stair tasks in pre- and postoperative patients matched with healthy controls. METHODS Ten symptomatic cam femoroacetabular impingement patients performed stair ascent and descent pre- and 2 years postoperatively. Patients were age, and body-mass-index matched to controls. Full-body kinematics and kinetics were computed and, muscle and hip contact forces were estimated using musculoskeletal modeling and static optimization. Stance-phases were time-normalized and compared using statistical non-parametric mapping. FINDINGS Preoperatives showed lower hip abduction than controls during stairs ascent (76-100%, P = .007). Pre- and postoperative showed lower hip external rotation compared to controls on stair ascent (Pre-op vs controls: 71-100%, P = .005; Post-op vs controls: 72-100%, P = .01) and stair descent (Pre-op vs controls: 0-62%, P = .001; Post-op vs controls: 0-60%, P = .001). Postoperatives showed lower iliacus force compared to preoperative (1-3%, P = .012) and control (3-6%, P = .008), and higher gluteus maximus and piriformis forces compared to controls during stair descent. Lower postoperative anterior hip contact force (0-7%, P = .004) during descent, and superior (33-35%, P = .018) during ascent compared to controls were observed. Postoperative contact forces were medialized compared to preoperative (0-2%, P = .011) and controls (1-2%, P = .016). INTERPRETATION Forcing participants to adhere to standardized step length/rise minimized sagittal kinematic differences between conditions and groups. Persistent reduced hip external rotation postoperatively and minor muscle force adaptations led to reduced superior hip contact force during stair ascent and reduced anterior and more medialized contact forces during stair descent.
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Affiliation(s)
| | - Bruno L S Bedo
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
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Brown-Taylor L, Wilson J, McNally M, Perry J, Jackson RD, Hewett TE, Ryan J, Knopp MV, Payne JE, Di Stasi S. Altered gait mechanics are associated with severity of chondropathy after hip arthroscopy for femoroacetabular impingement syndrome. Gait Posture 2020; 77:175-181. [PMID: 32044697 PMCID: PMC7138257 DOI: 10.1016/j.gaitpost.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Suboptimal patient-reported function and movement impairments often persist after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Individuals with FAIS with preoperative cartilage pathology (ie. chondropathy) demonstrate distinct movement patterns and have worse post-operative outcomes. It is unknown whether the presence of chondropathy after surgery negatively affects movement and function. RESEARCH QUESTION Do sagittal plane gait mechanics differ based on chondropathy severity following arthroscopy for FAIS? METHODS A cross-sectional walking gait analysis was performed for 25 participants post-arthroscopy (2.48 ± 1.38y) and 12 healthy controls (HCs). Peak total support moment (TSM) and relative contributions of the hip, knee, and ankle were calculated during loading response. The Hip Osteoarthritis MRI Scoring System was used to categorize the FAIS group into no-mild or moderate-severe chondropathy groups based on 3 T magnetic resonance imaging of their surgical hip. The interactions of group by limb were evaluated for kinetic variables, covaried by gait speed. RESULTS Groups did not differ based on age, BMI and sex distribution (P ≥ 0.14). 13 participants with FAIS presented with moderate-severe chondropathy and 12 presented with no-mild chondropathy. Participants with moderate-severe chondropathy walked significantly slower than both other groups (P = 0.006) and demonstrated lower peak TSM than those with no-mild chondropathy (P = 0.002). Participants with no-mild chondropathy demonstrated lower hip (61.5 %) and greater ankle (17.7 %) contributions to the TSM on the involved limb compared to the moderate-severe group (hip:73.4 %, P = 0.07; ankle:10.5 %, P = 0.007). SIGNIFICANCE Slower gait speed alone did not explain the lower TSM strategy in participants with moderate-severe chondropathy. Interestingly, the joint contribution strategy of this group was not different than HCs. Participants with no-mild chondropathy demonstrated a TSM strategy that shifted the demand away from their hip and toward their ankle. Given the small sample size, and large variability in joint strategies, future work needs to examine whether these alterations in gait strategy, with or without advanced chondropathy, impact patient function.
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Affiliation(s)
- Lindsey Brown-Taylor
- Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 228, Columbus, OH 43210, United States; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 516, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States.
| | - Jordan Wilson
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States; College of Medicine, The Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, United States
| | - Michael McNally
- Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 228, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
| | - Rebecca D Jackson
- College of Medicine, The Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, United States; Center for Clinical and Translational Science, The Ohio State University, 376 W 10th Avenue, Suite 260, Columbus, OH 43210, United States; Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, McCampbell Hall, 5th Floor, 1581 Dodd Drive, Columbus, OH 43210, United States
| | - Timothy E Hewett
- Orthopaedics Biomechanics Laboratories and Sports Medicine Research Center, Mayo Clinic, Guggenheim Building 1-21, 200 First St. SW, Rochester, MN 55905, United States
| | - John Ryan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States; Department of Orthopaedics, The Ohio State University, 725 Prior Hall, 376 W 10th Avenue, Columbus, OH 43210, United States
| | - Michael V Knopp
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12thAvenue, Columbus, OH 43210, United States
| | - Jason E Payne
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12thAvenue, Columbus, OH 43210, United States
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 516, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
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10
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Jena S, Arunachalam T, Panda SK. Experimental and numerical investigation of a polypropylene orthotic device for assistance in level ground walking. Proc Inst Mech Eng H 2019; 234:356-369. [PMID: 31854229 DOI: 10.1177/0954411919894091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates the use of an orthotic device for improving pathologic gait lacking a heel-strike and its effect on the joint loads. The orthosis is fabricated from 10-mm thick polypropylene sheets joined together using a bolted joint. The gait trials are recorded using a Qualisys motion capture system and Kistler's force platform. The data recorded in this study comprise five male and five female participants, executing level ground gait under barefoot, shod and orthotic conditions. Computed tomography reconstructed foot bone-tissue model and computer-aided design model of the orthosis are used to predict the mechanical behaviour with and without orthosis under static loading. A one-way analysis of variance is conducted to compare the peak gait parameters in the early and late stance phase between the three walking conditions. The experimental results show that the orthosis reduces the peak joint forces and the rate of change of moment at the hip, knee and ankle joints. The finite element analysis results present a decrease in foot plantar pressure from 0.74 to 0.32 MPa with orthotic usage. The results of this study indicate that the orthosis can eliminate the heel-ground gap while retaining sufficient ankle motion and providing peak joint force reduction.
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Affiliation(s)
- Shreeshan Jena
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Rourkela, India
| | - Thirugnanam Arunachalam
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Rourkela, India
| | - Subrata Kumar Panda
- Department of Mechanical Engineering, National Institute of Technology Rourkela, Rourkela, India
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11
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Weinhandl JT, Bennett HJ. Musculoskeletal model choice influences hip joint load estimations during gait. J Biomech 2019; 91:124-132. [DOI: 10.1016/j.jbiomech.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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12
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Semciw AI, Pizzari T, Woodley S, Zacharias A, Kingsley M, Green RA. Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial - Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials 2018; 19:511. [PMID: 30236151 PMCID: PMC6149073 DOI: 10.1186/s13063-018-2873-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis. METHODS Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)). DISCUSSION This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0.
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Affiliation(s)
- Adam Ivan Semciw
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia
| | - Stephanie Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Anita Zacharias
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
| | - Michael Kingsley
- Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Rod A Green
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
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13
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Inter-joint coordination of kinematics and kinetics before and after total hip arthroplasty compared to asymptomatic subjects. J Biomech 2018; 72:180-186. [DOI: 10.1016/j.jbiomech.2018.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 11/22/2022]
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14
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Roelker SA, Caruthers EJ, Baker RK, Pelz NC, Chaudhari AMW, Siston RA. Interpreting Musculoskeletal Models and Dynamic Simulations: Causes and Effects of Differences Between Models. Ann Biomed Eng 2017; 45:2635-2647. [DOI: 10.1007/s10439-017-1894-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/28/2017] [Indexed: 12/19/2022]
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15
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Schenck C, Kesar TM. Effects of unilateral real-time biofeedback on propulsive forces during gait. J Neuroeng Rehabil 2017; 14:52. [PMID: 28583196 PMCID: PMC5460355 DOI: 10.1186/s12984-017-0252-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In individuals with post-stroke hemiparesis, reduced push-off force generation in the paretic leg negatively impacts walking function. Gait training interventions that increase paretic push-off can improve walking function in individuals with neurologic impairment. During normal locomotion, push-off forces are modulated with variations in gait speed and slope. However, it is unknown whether able-bodied individuals can selectively modulate push-off forces from one leg in response to biofeedback. Here, in a group of young, neurologically-unimpaired individuals, we determined the effects of a real-time visual and auditory biofeedback gait training paradigm aimed at unilaterally increasing anteriorly-directed ground reaction force (AGRF) in the targeted leg. METHODS Ground reaction force data during were collected from 7 able-bodied individuals as they walked at a self-selected pace on a dual-belt treadmill instrumented with force platforms. During 11-min of gait training, study participants were provided real-time AGRF biofeedback encouraging a 20-30% increase in peak AGRF generated by their right (targeted) leg compared to their baseline (pre-training) AGRF. AGRF data were collected before, during, and after the biofeedback training period, as well as during two retention tests performed without biofeedback and after standing breaks. RESULTS Compared to AGRFs generated during the pre-training gait trials, participants demonstrated a significantly greater AGRF in the targeted leg during and immediately after training, indicating that biofeedback training was successful at inducing increased AGRF production in the targeted leg. Additionally, participants continued to demonstrate greater AGRF production in the targeted leg after two standing breaks, showing short-term recall of the gait pattern learned during the biofeedback training. No significant effects of training were observed on the AGRF in the non-targeted limb, showing the specificity of the effects of biofeedback toward the targeted limb. CONCLUSIONS These results demonstrate the short-term effects of using unilateral AGRF biofeedback to target propulsion in a specific leg, which may have utility as a training tool for individuals with gait deficits such as post-stroke hemiparesis. Future studies are needed to investigate the effects of real-time AGRF biofeedback as a gait training tool in neurologically-impaired individuals.
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Affiliation(s)
- Christopher Schenck
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.
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16
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Chen TL, An WW, Chan ZYS, Au IPH, Zhang ZH, Cheung RTH. Immediate effects of modified landing pattern on a probabilistic tibial stress fracture model in runners. Clin Biomech (Bristol, Avon) 2016; 33:49-54. [PMID: 26945721 DOI: 10.1016/j.clinbiomech.2016.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/12/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibial stress fracture is a common injury in runners. This condition has been associated with increased impact loading. Since vertical loading rates are related to the landing pattern, many heelstrike runners attempt to modify their footfalls for a lower risk of tibial stress fracture. Such effect of modified landing pattern remains unknown. This study examined the immediate effects of landing pattern modification on the probability of tibial stress fracture. METHODS Fourteen experienced heelstrike runners ran on an instrumented treadmill and they were given augmented feedback for landing pattern switch. We measured their running kinematics and kinetics during different landing patterns. Ankle joint contact force and peak tibial strains were estimated using computational models. We used an established mathematical model to determine the effect of landing pattern on stress fracture probability. FINDINGS Heelstrike runners experienced greater impact loading immediately after landing pattern switch (P<0.004). There was an increase in the longitudinal ankle joint contact force when they landed with forefoot (P=0.003). However, there was no significant difference in both peak tibial strains and the risk of tibial stress fracture in runners with different landing patterns (P>0.986). INTERPRETATION Immediate transitioning of the landing pattern in heelstrike runners may not offer timely protection against tibial stress fracture, despite a reduction of impact loading. Long-term effects of landing pattern switch remains unknown.
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Affiliation(s)
- T L Chen
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - W W An
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Z Y S Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - I P H Au
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Z H Zhang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - R T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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17
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Multi-Joint Compensatory Effects of Unilateral Total Knee Arthroplasty During High-Demand Tasks. Ann Biomed Eng 2015; 44:2529-2541. [PMID: 26666227 DOI: 10.1007/s10439-015-1524-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/29/2015] [Indexed: 01/01/2023]
Abstract
Patients with total knee arthroplasty (TKA) demonstrate quadriceps weakness and functional limitations 1 year after surgery during daily tasks such as walking and stair climbing. Most biomechanical analyses of patients after TKA focus on quadriceps function and rarely investigate other lower-extremity muscles or high-demand ambulatory activities of daily living. The purpose of this investigation was to quantify lower-extremity muscle forces in patients with unilateral TKA during high-demand tasks of pivoting and descending stairs. Five patients with unilateral TKA and five age and sex-matched controls performed three bilateral high-demand tasks: (1) step down from an 8-inch platform, (2) inside pivot: 90° direction change toward planted limb, and (3) outside pivot: 90° direction change away from planted limb. Subject-specific musculoskeletal simulations were created in OpenSim to determine joint angles, moments, and lower-extremity muscle forces. The results indicate that patients with TKA adopt compensatory strategies at both the hip and knee. Patients with TKA demonstrated increased hip external rotation, decreased knee flexion, decreased quadriceps force, and decreased hip abductor force in all three tasks. These strategies are likely a result of quadriceps avoidance, which may stem from instability after TKA or a habitual strategy developed during the late stages of osteoarthritis.
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18
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Lewis CL, Khuu A, Marinko LN. Postural correction reduces hip pain in adult with acetabular dysplasia: A case report. ACTA ACUST UNITED AC 2015; 20:508-12. [PMID: 25731688 DOI: 10.1016/j.math.2015.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/18/2015] [Accepted: 01/28/2015] [Indexed: 11/26/2022]
Abstract
Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient's posture, the patient's pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function, and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA.
| | - Anne Khuu
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA
| | - Lee N Marinko
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA
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