Symmetry of trunk and femoro-pelvic movement responses to single leg loading tests in asymptomatic females

Hip-related functional limitations in individuals with idiopathic scoliosis: a controlled trial

BACKGROUND

Since scoliosis is a three-dimensional deformity, it causes some movement limitations in the spine and related joints. However, functional limitations associated with scoliosis-related hip joint involvement are the subject of research.

AIMS

This study aims to investigate the physical characteristics and functional limitations associated with idiopathic scoliosis (IS), focusing on hip joint.

METHODS

Demographic characteristics, scoliosis-specific assessments and hip joint active range of motion (RoM), lumbar mobility (Modified Schober test), lumbopelvic stability (Single leg squat test-SLS), hip joint position sense, lower extremity balance (Y-balance test) and lower extremity functionality (Lower extremity functional scale-LEFS) were evaluated.

RESULTS

The study included 120 individuals, with 86 in the scoliosis group (mean age: 15.7 ± 3.4 years) and 34 in the control group (mean age: 16.1 ± 4.8 years). The scoliosis group exhibited limited RoM of the hip joint in flexion, extension, right abduction, adduction, internal rotation, and left external rotation compared to controls (p < 0.001). Lumbar mobility was decreased (p < 0.001). In the joint position sense test, the mean difference for right flexion was and for left flexion. Bilateral decreased SLS test performances (p < 0.001) and Y-balance test performance (p < 0.05) in individuals with IS. LEFS scores were statistically different but not clinically different between groups (p < 0.05).

CONCLUSION

Individuals with IS show decreased hip mobility, lumbopelvic stability, hip joint position sense, and balance compared to healthy peers; however, these limitations do not have a clinical impact on daily living activities.

The effects of pressure biofeedback on hip and trunk muscle activity and lumbopelvic alignment during one-leg standing

BACKGROUND: During one-leg standing (OLS), optimum activity of the gluteus medius (Gmed), multifidus (MF), and quadratus lumborum (QL) muscles relies upon maintaining neutral lumbopelvic alignment. However, no studies have examined how using pressure biofeedback during OLS affects the activity of these muscles and the concomitant alignment of the pelvis and trunk. OBJECTIVES: The purpose of this study was to investigate the effect of pressure biofeedback on the activity of the Gmed, MF, and QL and the femoropelvic and trunk lean angles during OLS. METHODS: Twenty-four healthy males performed OLS with (PB+) and without (PB-) pressure biofeedback. For all OLS conditions, a pressure sensor was placed between the lateral surface of the humerus on the non-supporting side and the wall. Under the PB- condition, participants performed preferred OLS while the examiner measured the maximum pressure caused by trunk lean. Under the PB+ condition, participants were asked to perform at a threshold of 50% of the maximal pressure (PB+ 1 condition) and with minimal change in pressure (PB+ 2 condition). Muscle activities of MF, QL, and Gmed as well as the femoropelvic and trunk lean angles were measured under various OLS conditions. RESULTS: The activity of the Gmed, MF, and QL was greater under both PB+ conditions than under the PB- condition (p< 0.05). Also, both PB+ conditions resulted in a greater femoropelvic angle and reduced trunk lean angle. There were no significant differences in muscle activity, femoropelvic angle, or trunk lean angle between PB+ 1 and PB+ 2 (p> 0.05). CONCLUSIONS: These results suggest that pressure biofeedback is a useful modality for increasing the activity of the Gmed and trunk muscles, especially the MF muscle on the non-supporting leg side, and for preventing compensatory movements such as trunk deviation and pelvic lateral deviation during OLS.

Trunk, pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women

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.

Visual assessment of movement quality in the single leg squat test: a review and meta-analysis of inter-rater and intrarater reliability

Single leg squat (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but also to assess lower extremity function in active people.

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

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.

Measurement properties of visual rating of postural orientation errors of the lower extremity - A systematic review and meta-analysis

OBJECTIVES

To systematically review measurement properties of visual assessment and rating of Postural Orientation Errors (POEs) in participants with or without lower extremity musculoskeletal disorders.

METHODS

A systematic review according to the PRISMA guidelines was conducted. The search was performed in Medline (Pubmed), CINAHL and EMBASE (OVID) databases until August 2016. Studies reporting measurement properties for visual rating of postural orientation during the performance of weight-bearing functional tasks were included. No limits were placed on participant age, sex or whether they had a musculoskeletal disorder affecting the lower extremity.

RESULTS

Twenty-eight articles were included, 5 of which included populations with a musculoskeletal disorder. Visual rating of the knee-medial-to-foot position (KMFP) was reliable within and between raters, and meta-analyses showed that this POE was valid against 2D and 3D kinematics in asymptomatic populations. Other segment-specific POEs showed either poor to moderate reliability or there were too few studies to permit synthesis. Intra-rater reliability was at least moderate for POEs within a task whereas inter-rater reliability was at most moderate.

CONCLUSIONS

Visual rating of KMFP appears to be valid and reliable in asymptomatic adult populations. Measurement properties remain to be determined for POEs other than KMPF.

Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks

The single leg squat and single leg step down are two commonly used functional tasks to assess movement patterns. It is unknown how kinematics compare between these tasks. The purpose of this study was to identify kinematic differences in the lower extremity, pelvis and trunk between the single leg squat and the step down. Fourteen healthy individuals participated in this research and performed the functional tasks while kinematic data were collected for the trunk, pelvis, and lower extremities using a motion capture system. For the single leg squat task, the participant was instructed to squat as low as possible. For the step down task, the participant was instructed to stand on top of a box, slowly lower him/herself until the non-stance heel touched the ground, and return to standing. This was done from two different heights (16cm and 24cm). The kinematics were evaluated at peak knee flexion as well as at 60° of knee flexion. Pearson correlation coefficients (r) between the angles at those two time points were also calculated to better understand the relationship between each task. The tasks resulted in kinematics differences at the knee, hip, pelvis, and trunk at both time points. The single leg squat was performed with less hip adduction (p ≤ 0.003), but more hip external rotation and knee abduction (p ≤ 0.030), than the step down tasks at 60° of knee flexion. These differences were maintained at peak knee flexion except hip external rotation was only significant in the 24cm step down task (p ≤ 0.029). While there were multiple differences between the two step heights at peak knee flexion, the only difference at 60° of knee flexion was in trunk flexion (p < 0.001). Angles at the knee and hip had a moderate to excellent correlation (r = 0.51–0.98), but less consistently so at the pelvis and trunk (r = 0.21–0.96). The differences in movement patterns between the single leg squat and the step down should be considered when selecting a single leg task for evaluation or treatment. The high correlation of knee and hip angles between the three tasks indicates that similar information about knee and hip kinematics was gained from each of these tasks, while pelvis and trunk angles were less well predicted.