Non-linear interactions among hip and foot biomechanical factors predict foot pronation during walking in women

BACKGROUND

Interactions between hip and foot biomechanical factors may result in different magnitudes of foot pronation during walking.

OBJECTIVE

To investigate non-linear interactions between hip and foot biomechanical factors and their capability to predict foot pronation during walking and identify the profiles of biomechanical factors that predict greater and lower pronation.

METHODS

This is a cross-sectional study. Fifty-one women were classified into greater and lower foot pronation during walking. Biomechanical factors measured: (1) foot-ankle varus alignment, (2) hip passive stiffness, (3) isokinetic eccentric strength of hip external rotators, and (4) foot abduction angle. Classification and regression trees (CART) were used to investigate non-linear interactions that predict greater and lower foot pronation.

RESULTS

Four main profiles of biomechanical factors were identified as related to greater and lower foot pronation. Profiles for greater pronation were: (1) varus >25.83°; (2) interaction between varus ≤25.83° and hip stiffness ≤0.09 Nm/rad kg-1; (3) interaction between varus ≤25.83°, hip stiffness >0.09 Nm/rad kg-1, and foot abduction >19.58° The profile for lower pronation involved an interaction among varus ≤25.83°, hip stiffness >0.09 Nm/rad kg-1, and foot abduction ≤19.58° The model had 61 % sensitivity and 96 % specificity, with the total prediction of 78 %. The area under the ROC curve was 0.79 (p = 0.001).

CONCLUSION

Foot-ankle varus, hip passive stiffness, and foot abduction predicted greater and lower foot pronation. Non-linear interactions between hip and foot factors influence the magnitude of foot pronation during walking. The observed profiles help identify which combinations of biomechanical factors should be assessed in individuals with increased or reduced pronation.

The effects of Core Stability Exercises and Mulligan's mobilization with movement techniques on sacroiliac joint dysfunction

Purpose

Sacroiliac joint dysfunction (SIJD), while being the primary contributor to low back pain, is still disregarded and treated as low back pain. Mulligan's Mobilization with Movement (MWM) Techniques and Core Stability Exercises (CSE) are often used to treat low back pain. There is not much evidence that it is effective in SIJD. To evaluate the effectiveness of CSE coupled with MWM (CSE + MWM) in the treatment of SIJD.

Methods

39 patients with SIJD were recruited and randomly divided into distinct groups as follows: control group (n = 13), CSE group (n = 13) and CSE + MWM group (n = 13). The Numerical Pain Rating Scale (NPRS), the Roland Morris Disability Questionnaire (RMDQ), the Range of Motion (ROM), the Pressure Pain Threshold (PPT) and the pelvic tilt angle asymmetry ratio in the sagittal plane (PTAR) were used to gauge the intervention's success both before (M0) and after (M1) it. All experimental data were statistically analyzed.

Results

The SIJ-related pain metric significantly decreased in both the CSE + MWM group and the CSE group between M0 and M1, as determined by the NPRS and RMDQ. Between M0 and M1, The CSE group's left axial rotation ROM and lumbar flexion ROM were significantly decreased. The CSE + MWM group's extension ROM and left lateral flexion ROM both significantly increased between M0 and M1. In the difference variable (M1-M0), the CSE + MWM group substantially outperformed control group in the left lateral flexion ROM and outperformed the CSE group in the left axial rotation ROM.

Conclusion

In individuals with SIJD, CSE + MWM is beneficial in lowering pain, disability, and function. Treatment with CSE and MWM approaches for SIJ appears to boost this efficacy.

Effects of an integrative warm-up method on the range of motion, core stability, and quality of squat performance of young adults

Introduction

This research aims to determine the effects of an integrative warm-up method on the range of motion in joints of the lower extremities, the strength of the stabilizer trunk muscles, and the quality of the basic movement patterns in older adolescents.

Methods

The study sample consisted of 88 male students (age 20.1 ± 0.5). They were randomly divided into four groups: one control group (CG) (n = 17; 180.8 ± 7.9 cm; 82.3 ± 8.3 kg) and three experimental groups (EG): EG1 (n = 23; 180.9 ± 7.0 cm; 78.5 ± 9.5 kg), EG2 (n = 31; 182.2 cm ± 7.3 cm; 79.5 ± 11.5 kg), and EG3 (n = 17; 183.3 ± 4.9 cm; 77.5 ± 11.8 kg). The participants were subjected to a 6-week experimental treatment: EG1 once, EG2 twice, and EG3 three times a week. The experimental treatment consisted of four sub-phases representing the integrative warm-up Method: 1) Inhibition (self-myofascial release using a foam roller); 2) Lengthening (Static stretching in a maximum range of motion position); 3) Activation (Positional isometrics muscle activation of the trunk and gluteus); 4) Integration (Integrated all the previous phases into one complex movement pattern). Based on the covariance analysis (ANCOVA), statistically significant treatment effects were observed and positive changes were determined in all experimental groups.

Results

The differences between groups were observed in the following variables: Overhead Squat Assessment (p = 0.000; η p 2 = 0.318 ), range of motion of left hip flexion (p = 0.000; η p 2 = 0.371 ), range of motion of right hip flexion (p = 0.000; η p 2 = 0.051 ) and range of motion of right hip extension (p = 0.051; η p 2 = 0.088 ), Double Leg Lowering Test (F = 2.411; p = 0.014; η p 2 = 0.014 ) and range of combined motion (plantar and dorsiflexion) of left ankle joint (p = 0.000; η p 2 = 0.299 ). There was no significant difference in the Plank Test (F = 1.007; p = 1.007; η p 2 = 0.035 ), range of combined motion (plantar and dorsiflexion) of right ankle joint (p = 0.088; η p 2 = 0.170 ) and range of motion of left hip extension (p = 0.158; η p 2 = 0.060 ). The participants of CG statistically significantly differed from EG1, EG2, and EG3 in the squat performance after the applied treatment.

Discussion

The effect of the treatment was the occurrence of a transformational processes in almost all measured variables. It can be concluded that the integrative method is effective and applicable in practice for both young adults and recreational athletes.

Chronic effects of stretching on range of motion with consideration of potential moderating variables: A systematic review with meta-analysis

BACKGROUND

It is well known that stretch training can induce prolonged increases in joint range of motion (ROM). However, to date more information is needed regarding which training variables might have greater influence on improvements in flexibility. Thus, the purpose of this meta-analysis was to investigate the effects of stretch training on ROM in healthy participants by considering potential moderating variables, such as stretching technique, intensity, duration, frequency, and muscles stretched, as well as sex-specific, age-specific, and/or trained state-specific adaptations to stretch training.

METHODS

We searched through PubMed, Scopus, Web of Science, and SportDiscus to find eligible studies and, finally, assessed the results from 77 studies and 186 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed the respective subgroup analyses. To find potential relationships between stretch duration or age and effect sizes, we performed a meta-regression.

RESULTS

We found a significant overall effect, indicating that stretch training can increase ROM with a moderate effect compared to the controls (effect size = -1.002; Z = -12.074; 95% confidence interval: -1.165 to -0.840; p < 0.001; I2 = 74.97). Subgroup analysis showed a significant difference between the stretching techniques (p = 0.01) indicating that proprioceptive neuromuscular facilitation and static stretching produced greater ROM than did ballistic/dynamic stretching. Moreover, there was a significant effect between the sexes (p = 0.04), indicating that females showed higher gains in ROM compared to males. However, further moderating analysis showed no significant relation or difference.

CONCLUSION

When the goal is to maximize ROM in the long term, proprioceptive neuromuscular facilitation or static stretching, rather than ballistic/dynamic stretching, should be applied. Something to consider in future research as well as sports practice is that neither volume, intensity, nor frequency of stretching were found to play a significant role in ROM yields.

Evaluation of Upper Body and Lower Limbs Kinematics through an IMU-Based Medical System: A Comparative Study with the Optoelectronic System

In recent years, the use of inertial-based systems has been applied to remote rehabilitation, opening new perspectives for outpatient assessment. In this study, we assessed the accuracy and the concurrent validity of the angular measurements provided by an inertial-based device for rehabilitation with respect to the state-of-the-art system for motion tracking. Data were simultaneously collected with the two systems across a set of exercises for trunk and lower limbs, performed by 21 healthy participants. Additionally, the sensitivity of the inertial measurement unit (IMU)-based system to its malpositioning was assessed. Root mean square error (RMSE) was used to explore the differences in the outputs of the two systems in terms of range of motion (ROM), and their agreement was assessed via Pearson's correlation coefficient (PCC) and Lin's concordance correlation coefficient (CCC). The results showed that the IMU-based system was able to assess upper-body and lower-limb kinematics with a mean error in general lower than 5° and that its measurements were moderately biased by its mispositioning. Although the system does not seem to be suitable for analysis requiring a high level of detail, the findings of this study support the application of the device in rehabilitation programs in unsupervised settings, providing reliable data to remotely monitor the progress of the rehabilitation pathway and change in patient's motor function.

Comparison of Pelvic Tilt Before and After Hip Flexor Stretching in Healthy Adults

OBJECTIVE

The purpose of this study was to assess the association between hip flexor length and pelvic tilt or lumbar lordosis by quantifying the effect of stretching on pelvic tilt and lumbar lordosis.

METHODS

We quantified pelvic tilt and lumbar lordosis before and after a single session of passive hip flexor stretching in a sample of 23 male participants. Changes in hip flexor length were also characterized, using a Thomas test protocol to measure passive hip extension in supine lying. We investigated both the mean effect of the stretching protocol and potential correlations between changes in passive hip extension and changes in pelvic tilt or lumbar lordosis.

RESULTS

Following the stretching protocol, there was a mean increase of 2.6° (P < .001) in passive hip extension and a corresponding mean reduction of 1.2° (P < .001) in anterior pelvic tilt. However, there was no change in lumbar lordosis, nor were there any meaningful correlations between change in passive hip extension and change in pelvic tilt or lumbar lordosis.

CONCLUSION

The results suggest that hip muscle stretching may lead to immediate reductions in pelvic tilt during relaxed standing. Such stretching programs could play an important role in interventions designed to improve standing postural alignment.

Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study

BACKGROUND

It is possible that physical inactivity and prolonged sitting could lead to changes in muscle properties or bony limitations which may reduce passive hip extension.

OBJECTIVES

This study explored the association between passive hip extension and sitting/physical activity patterns.

DESIGN

Cross sectional study.

METHOD

The modified Thomas Test is a clinical test used to characterise hip flexion contracture. This test was used to measure passive hip extension across 144 individuals. In addition, sitting behaviours and physical activity patterns were quantified using the Global Physical Activity Questionnaire. Cut off points were defined for low/high physical activity (150 min per week), prolonged sitting (>7 h per day) and minimal sitting (<4 h per day). ANOVA testing was then used to compare passive hip extension between three groups, defined using the specified thresholds: low activity & prolonged sitting, high activity & minimal sitting and high activity & prolonged sitting.

RESULTS

A total of 98 participants were allocated to one of the three groups which were shown to differ significantly in passive hip extension (P < 0.001). Importantly, there was 6.1° more passive hip extension in the high activity & minimal sitting group when compared to the low activity & prolonged sitting group.

CONCLUSION

This study is the first to demonstrate an association between passive hip extension and prolonged sitting/physical inactivity. It is possible that these findings indicate a physiological adaptation in passive muscle stiffness. Further research is required to understand whether such adaptation may play a role in the aetiology of musculoskeletal pain linked to prolonged sitting.

The Guidelines for Application of Kinesiology Tape for Prevention and Treatment of Sports Injuries

The number of kinesiology tape’s users is increasing year by year. However, the insufficiency of fundamental knowledge about the appropriate usage of kinesiology tapes can generate undesired side-effects caused by incorrect application of kinesiology tapes and/or denouncement of kinesiology tapes as an ineffective practice. Therefore, it is necessary to arrange a set of general guidelines of kinesiology taping that must be followed. If not, the treatment may have to be ceased due to the side-effects such as skin’s troubles. Another problem, which impeaches effectivity of treatment by kinesiology tapes, is focusing solely on the present area of pain or discomfort. However, such solution is only short-termed and the likelihood of reappearance of the pain is remarkably high. Therefore, it is essential to find and eliminate the origin of the problem. If these fundamentals conditions of tape’s application are satisfied, the treatment by kinesiology tapes may bring us far more better results.

Effects of a Hip Flexor Stretching Program on Running Kinematics in Individuals With Limited Passive Hip Extension

Mettler, JH, Shapiro, R, and Pohl, MB. Effects of a hip flexor stretching program on running kinematics in individuals with limited passive hip extension. J Strength Cond Res 33(12): 3338-3344, 2019-Tightness of the hip flexor muscle group may theoretically contribute to altered kinematics of the lumbo-pelvic-hip (LPH) complex during dynamic movements. Therefore, the purpose of this study was to analyze the effects of a 3-week home-based stretching program on passive hip extension and sagittal plane kinematics of the LPH complex when running. Twenty healthy subjects with limited passive hip extension underwent a 3D gait analysis both before (PRE) and after (POST) a hip flexor stretching program. After the stretching program, passive hip extension increased significantly (p < 0.001), whereas no improvements during running were reported for active hip extension, anterior pelvic tilt, or lumbar spine extension (p ≥ 0.05). In addition, no relationship was found between the change in passive hip extension with either the change in active hip extension, anterior pelvic tilt, or lumbar spine extension. A 3-week static stretching program of the hip flexor muscle group resulted in an increase in passive hip extension, but the sagittal plane kinematics of the LPH complex during running remained unchanged. The results suggest that passive hip joint flexibility may be of limited importance in determining the kinematics of the LPH complex during submaximal running. However, it is possible that an increase in the range of motion at the hip may be beneficial when running at or near maximal speeds.

A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study

OBJECTIVE

To assess the efficacy of conservative management of women with femoroacetabular impingement (FAI) using trunk stabilization.

DESIGN

Randomized controlled trial (level of evidence: I).

SUBJECTS

Twenty FAI female patients who met the inclusion FAI criteria.

METHODS

A prospective, randomized, controlled study was performed on 20 female patients with symptomatic FAI comprising 2 groups (10 hips in trunk stabilization exercise group vs 10 hips in control group). We evaluated hip range of motion, isometric muscle strength using a handheld dynamometer (μ-TasMF-01; Anima, Co), and patient-reported outcome measures, including modified Harris hip score, Vail hip score, and international hip outcome tool 12 (iHOT12) before and at 4 weeks and 8 weeks after the intervention.

RESULTS

There was a significant improvement in the range of motion of hip flexion in the trunk training group detected as early as 4 weeks after the intervention compared with the control group (P < 0.05). Hip abductor strength significantly improved in the trunk training group at 4 weeks after the intervention, whereas it did not improve in the control group (P < 0.05). Vail hip score and iHOT12 were significantly increased at 8 weeks after the intervention in the trunk training group compared with the control group (iHOT12: 78.7 ± 22.4 vs 53.0 ± 22.3; P < 0.01, Vail hip score: 81.6 ± 18.5 vs 61.1 ± 11.6; P < 0.05). There was no significant difference in the modified Harris hip score between both the groups at 4 and 8 weeks after the intervention.

CONCLUSIONS

The addition of trunk stabilization exercise to a typical hip rehabilitation protocol improves short-term clinical outcomes and may augment nonoperative and postoperative rehabilitation.

Passive hip movement measurements related to dynamic motion during gait in hip osteoarthritis

Reduced sagittal plane range of motion (ROM) has been reported in individuals with hip osteoarthritis (OA) both during walking and passive testing. The purpose of this study was to determine if a relationship exists between hip extension ROM recorded during gait and passive hip extension ROM in individuals with moderate and severe hip OA, in comparison to an asymptomatic group. Sagittal plane hip ROM was calculated using skin surface marker trajectories captured during treadmill walking at self-selected speed. Passive hip ROM was measured using standardized position and recording procedures with a goniometer. Sagittal plane extension, flexion, and overall ROM were measured dynamically and passively. A two-way mixed model analysis of variance determined significant differences between groups and between passive and dynamic ROM (α = 0.05). Pearson correlations determined relationships between passive and dynamic ROM. Significant group by ROM interactions were found for flexion and extension ROM (p < 0.05). For extension, the severe OA group had less dynamic and passive ROM compared to the other groups and greater passive than dynamic ROM (p < 0.05). For flexion, significant differences in passive ROM existed between all three groups (p < 0.05) whereas no differences were found for dynamic flexion (p < 0.05). Significant correlations between dynamic and passive hip extension were found in the moderate (r = 0.596) and severe OA (r = 0.586) groups, and no correlation was found in the asymptomatic group (r = 0.139). Passive ROM explains variance in dynamic ROM measurements obtained during gait in individuals with moderate and severe hip OA which have implications for the design of treatment strategies targeting walking pathomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1790-1797, 2016.

The relevance of stretch intensity and position-a systematic review

Stretching exercises to increase the range of motion (ROM) of joints have been used by sports coaches and medical professionals for improving performance and rehabilitation. The ability of connective and muscular tissues to change their architecture in response to stretching is important for their proper function, repair, and performance. Given the dearth of relevant data in the literature, this review examined two key elements of stretching: stretch intensity and stretch position; and their significance to ROM, delayed onset muscle soreness (DOMS), and inflammation in different populations. A search of three databases, Pub-Med, Google Scholar, and Cochrane Reviews, identified 152 articles, which were subsequently categorized into four groups: athletes (24), clinical (29), elderly (12), and general population (87). The use of different populations facilitated a wider examination of the stretching components and their effects. All 152 articles incorporated information regarding duration, frequency and stretch position, whereas only 79 referred to the intensity of stretching and 22 of these 79 studies were deemed high quality. It appears that the intensity of stretching is relatively under-researched, and the importance of body position and its influence on stretch intensity, is largely unknown. In conclusion, this review has highlighted areas for future research, including stretch intensity and position and their effect on musculo-tendinous tissue, in relation to the sensation of pain, delayed onset muscle soreness, inflammation, as well as muscle health and performance.

Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study

OBJECTIVE

To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD).

DESIGN

A randomized and double-blind controlled trial was carried out.

SETTINGS/LOCATION

University-based physical therapy research clinic.

SUBJECTS

Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30).

INTERVENTIONS

The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG.

OUTCOME MEASURES

Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention.

RESULTS

In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05).

CONCLUSION

The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.