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Zhang Y, Herbert RD, Bilston LE, Bolsterlee B. Three-dimensional architecture and moment arms of human rotator cuff muscles in vivo: Interindividual, intermuscular, and intramuscular variations. J Anat 2024; 245:258-270. [PMID: 38690607 PMCID: PMC11259750 DOI: 10.1111/joa.14050] [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: 11/17/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
The human rotator cuff consists of four muscles, each with a complex, multipennate architecture. Despite the functional and clinical importance, the architecture of the human rotator cuff has yet to be clearly described in humans in vivo. The purpose of this study was to investigate the intramuscular, intermuscular, and interindividual variations in architecture and moment arms of the human rotator cuff. Muscle volumes, fascicle lengths, physiological cross-sectional areas (PCSAs), pennation angles, and moment arms of all four rotator cuff muscles were measured from mDixon and diffusion tensor imaging (DTI) scans of the right shoulders of 20 young adults. In accordance with the most detailed dissections available to date, we found substantial intramuscular variation in fascicle length (coefficients of variation (CVs) ranged from 26% to 40%) and pennation angles (CVs ranged from 56% to 62%) in all rotator cuff muscles. We also found substantial intermuscular and interindividual variations in muscle volumes, but relatively consistent mean fascicle lengths, pennation angles, and moment arms (CVs for all ≤17%). Moreover, when expressed as a proportion of total rotator cuff muscle volume, the volumes of individual rotator cuff muscles were highly consistent between individuals and sexes (CVs ≤16%), suggesting that rotator cuff muscle volumes scale uniformly, at least in a younger population without musculoskeletal problems. Together, these data indicate limited interindividual and intermuscular variability in architecture, which may simplify scaling routines for musculoskeletal models. However, the substantial intramuscular variation in architecture questions the validity of previously reported mean architectural parameters to adequately describe rotator cuff function.
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Affiliation(s)
- Yilan Zhang
- Neuroscience Research Australia (NeuRA)RandwickNew South WalesAustralia
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Robert D. Herbert
- Neuroscience Research Australia (NeuRA)RandwickNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lynne E. Bilston
- Neuroscience Research Australia (NeuRA)RandwickNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine & HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bart Bolsterlee
- Neuroscience Research Australia (NeuRA)RandwickNew South WalesAustralia
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
- School of Mechanical, Medical and Process EngineeringQueensland University of TechnologyBrisbaneQueenslandAustralia
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Ribič A, Hadzic V, Spudić D. Hip adduction and abduction strength in different test positions and their relationship to previous groin injuries in women footballers. Res Sports Med 2024:1-12. [PMID: 38944670 DOI: 10.1080/15438627.2024.2368898] [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: 09/25/2023] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
Hip strength has been shown to influence the incidence of injury in women's football. The first objective of our study was to examine the differences in isometric strength of the adductors and abductors between two test positions (0° vs. 45° hip angle). Our second objective was to verify the sensitivity of the two test positions in discriminating between women footballers with and without a history of groin pain in the last twelve months. One hundred and one elite players from the Slovenian women's football league were tested. The isometric strength of the adductors, abductors, and the ratio between hip abductor and adductor strength in two different test positions were assessed. We found statistically significant differences (p < 0.05; effect size range 0.12-0.13) between the two test positions in hip adduction, abduction strength, and abductor/adductor strength ratio. The ROC analysis showed that only the abductor/adductor strength ratio at the 0° hip angle position can differentiate between players with and without a history of groin pain, with an optimal cut-off point of ≤ 1.01 (p < 0.05; AUC = 0.734). The results should help practitioners plan hip strength training for returning to sport or preventing groin pain among women football players.
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Affiliation(s)
- Ažbe Ribič
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Vedran Hadzic
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Darjan Spudić
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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Goller M, Quittmann OJ, Alt T. How to activate the glutes best? Peak muscle activity of acceleration-specific pre-activation and traditional strength training exercises. Eur J Appl Physiol 2024; 124:1757-1769. [PMID: 38280014 PMCID: PMC11130056 DOI: 10.1007/s00421-023-05400-3] [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: 06/01/2023] [Accepted: 12/05/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE Isometric training and pre-activation are proven to enhance acceleration performance. However, traditional strength training exercises do not mirror the acceleration-specific activation patterns of the gluteal muscles, characterized by ipsilateral hip extension during contralateral hip flexion. Therefore, the aim of the study was to determine gluteal muscle activity of acceleration-specific exercises compared to traditional strength training exercises. METHODS In a cross-sectional study design, the peak electromyographic activity of two acceleration-specific exercises was investigated and compared to two traditional strength training exercises each for the gluteus maximus and medius. Twenty-four participants from various athletic backgrounds (13 males, 11 females, 26 years, 178 cm, 77 kg) performed four gluteus maximus [half-kneeling glute squeeze (HKGS), resisted knee split (RKS), hip thrust (HT), split squat (SS)] and four gluteus medius [resisted prone hip abduction (RPHA), isometric clam (IC), side-plank with leg abduction (SP), resisted side-stepping (RSS)] exercises in a randomized order. RESULTS The RKS (p = 0.011, d = 0.96) and the HKGS (p = 0.064, d = 0.68) elicited higher peak gluteus maximus activity than the SS with large and moderate effects, respectively. No significant differences (p > 0.05) were found between the HT, RKS and HKGS. The RPHA elicited significantly higher gluteus medius activity with a large effect compared to RSS (p < 0.001, d = 1.41) and a moderate effect relative to the SP (p = 0.002, d = 0.78). CONCLUSION The acceleration-specific exercises effectively activate the gluteal muscles for pre-activation and strength training purposes and might help improve horizontal acceleration due to their direct coordinative transfer.
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Affiliation(s)
- Maximilian Goller
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Oliver J Quittmann
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength and Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany
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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [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: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, Alıcı R, Demir N, Oğuz B, Düger T. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One 2024; 19:e0299845. [PMID: 38527058 PMCID: PMC10962842 DOI: 10.1371/journal.pone.0299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).
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Affiliation(s)
- Ömer Faruk Yaşaroğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Emre Cengiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Rabia Alıcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Hospitals, Ankara, Türkiye
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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van den Tillaar R, Falch HN, Larsen S. Are Diminishing Potentiation and Large Extensor Moments the Cause for the Occurrence of the Sticking Region in Maximum Free-Weight Barbell Back Squats among Resistance-Trained Males? J Hum Kinet 2024; 91:105-119. [PMID: 38689586 PMCID: PMC11057617 DOI: 10.5114/jhk/185720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 05/02/2024] Open
Abstract
This study compared the kinematics, surface electromyography (sEMG) and kinetics among isometric squats performed at 10 different heights of the upward part and a one-repetition maximum (1-RM) squat. Eleven males (age: 27.5 ± 3.4 years, body mass: 84.9 ± 8.1 kg, body height: 1.79 ± 0.06 m, 1-RM squat: 152.2 ± 20.55 kg) took part in this study. It was found that force output was lowest in the sticking region at around the event of peak deceleration for the 1-RM trial with force output at 2179 ± 212 N. For the isometric trial, the lowest force output occurred at the lowest barbell height (1735 ± 299 N). In addition, for the 1-RM condition hip extension moments peaked at the first four barbell heights (6.5-6.2 Nm/kg) representing the pre-sticking and the sticking region before significantly decreasing during the events representing the post-sticking region. Additionally, the sEMG amplitude peaked for the hip extensors at the barbell heights corresponding to the post-sticking region. Moreover, the sEMG amplitude was significantly higher for the 1-RM condition for all hip extensors, vastus lateralis, and calf muscles (F ≥ 2.7, p ≤ 0.01, ηp2 ≥ 0.25). Therefore, we suggest that the sticking region occurs because of reduced force output in the pre-sticking and the sticking region in back squats among resistance-trained males. The reduced force output is probably a combination of suboptimal internal moment arms, length-tension relationships of the gluteus maximus, hamstring and vastii muscles in the pre-sticking and sticking regions to overcome the large extensor moments together with diminishing potentiation from the pre-sticking to the sticking region.
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Affiliation(s)
| | | | - Stian Larsen
- Department of Sports Sciences and Physical Education, Nord University, Levanger, Norway
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7
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Dennis JD, Choe KH, Montgomery MM, Lynn SK, Crews BM, Pamukoff DN. Lower extremity and trunk sagittal plane coordination strategies and kinetic distribution during landing in males and females. J Sports Sci 2024; 42:169-178. [PMID: 38423997 DOI: 10.1080/02640414.2024.2323857] [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: 10/10/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Force attenuation during landing requires coordinated motion of the ankle, knee, hip, and trunk, and strategies may differ between sexes. Sagittal plane coordination of the ankle/knee, knee/hip, and knee/trunk, and lower extremity and trunk kinematics and kinetics was compared throughout landing between 28 males and 28 females. Coordination was assessed with a modified vector coding technique and binning analysis. Total support moments (TSM), each joint's percent contribution, and timing of the TSM were compared. Females landed with less isolated knee flexion in the ankle/knee, knee/hip, and knee/trunk couplings, but more simultaneous ankle/knee flexion, less simultaneous knee flexion/hip extension, and more simultaneous trunk/knee flexion. Females landed with larger plantarflexion angles from 0-16% and smaller trunk flexion angles from 0-78%. In females, absolute TSM were larger from 0-6% and smaller from 42-100%, and normalized TSM were larger from 0-8% and 26-42%. Females had greater ankle contribution to the TSM from 14-15% and 29-35%, smaller absolute peak TSM, and the peak TSM occurred earlier. Females compensated for less isolated knee flexion with greater simultaneous ankle/knee flexion early in landing and knee/trunk flexion later in landing. Coordination and TSM differences may influence force attenuation strategies and have implications for knee injury disparity between sexes.
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Affiliation(s)
- Justin D Dennis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Kevin H Choe
- Department of Kinesiology, California State University, Fullerton, CA, USA
- Department of Kinesiology, Whittier College, Whittier, CA, USA
| | | | - Scott K Lynn
- Department of Kinesiology, California State University, Fullerton, CA, USA
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Disantis AE, Martin RL, Enseki K, Spaid V, McClincy M. Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study. Int J Sports Phys Ther 2023; 18:1331-1345. [PMID: 38050551 PMCID: PMC10693488 DOI: 10.26603/001c.89265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
Background Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD. Purpose To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD. Study Design Delphi study. Methods A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD. Results Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral. Conclusion This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study. Level of Evidence Level V.
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Affiliation(s)
- Ashley E Disantis
- Adolescent and Young Adult Hip Preservation Program UPMC Childrens Hospital of Pittsburgh
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - RobRoy L Martin
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - Keelan Enseki
- UPMC Freddie Fu Center for Sports Medicine UPMC Rehabilitation Institute
| | - Victoria Spaid
- Department of Orthopaedic Surgery UPMC Children's Hospital of Pittsburgh
| | - Michael McClincy
- Adolescent and Young Adult Hip Preservation Program UPMC Children's Hospital of Pittsburgh
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Jeong J, Choi DH, Shin CS. Influence of individual quadriceps and hamstrings muscle architecture and quality on knee adduction and flexion moment in gait. Sci Rep 2023; 13:20683. [PMID: 38001172 PMCID: PMC10673903 DOI: 10.1038/s41598-023-47376-2] [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: 06/21/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The purpose of this study was to investigate the relationship between muscular parameters of quadriceps/hamstrings and knee joint kinetics in gait. Muscle architecture (thickness, pennation angle, and fascicle length), and quality (echo intensity) of individual quadriceps and hamstrings of 30 healthy participants (16 males and 14 females) was measured using ultrasound. Peak knee flexion moment (KFM), KFM impulse, peak knee adduction moment (KAM), and KAM impulse during walking were obtained at preferred speed. Pearson's correlation coefficient and multiple regression analyses were performed at significance level of 0.05, and Cohen's f2 values were calculated to examine the effect sizes of multiple regression. The hamstring-to-quadriceps muscle thickness ratio (r = 0.373) and semitendinosus echo intensity (r = - 0.371) were predictors of first peak KFM (R2 = 0.294, P = 0.009, f2 = 0.42), whereas only vastus medialis (VM) echo intensity was a significant predictor of second peak KFM (r = 0.517, R2 = 0.267, P = 0.003, f2 = 0.36). Only the VM thickness was the predictor of first (r = 0.504, R2 = 0.254, P = 0.005, f2 = 0.34) and second peak KAM (r = 0.581, R2 = 0.337, P = 0.001, f2 = 0.51), and KAM impulse (r = 0.693, R2 = 0.480, P < 0.001, f2 = 0.92). In conclusion, the greater hamstring-to-quadriceps muscle thickness ratio and the muscle architecture and quality of medial quadriceps/hamstring play an important role in KFM and KAM, and may have implications in knee osteoarthritis.
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Affiliation(s)
- Jiyoung Jeong
- Department of Mechanical Engineering, Sogang University, 35 Baekbeom-ro, Mapo-gu, Seoul, 04107, Republic of Korea
| | - Dai-Hyuk Choi
- Department of Physical Education, Graduate School of Education, Sogang University, 35 Baekbeom-ro, Mapo-gu, Seoul, 04107, Republic of Korea
| | - Choongsoo S Shin
- Department of Mechanical Engineering, Sogang University, 35 Baekbeom-ro, Mapo-gu, Seoul, 04107, Republic of Korea.
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Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain - 2023 Revision Using the Evidence to Guide Musculoskeletal Rehabilitation Practice. J Orthop Sports Phys Ther 2023; 53:575–577. [PMID: 37650820 DOI: 10.2519/jospt.2023.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Nonarthritic hip joint pain is a collection of conditions involving intra-articular structures of the hip, including femoroacetabular impingement syndrome (FAIS), developmental dysplasia of the hip (DDH), hip instability, acetabular labral tears, osteochondral lesions, loose bodies, and ligamentum teres tears. Pain in the hip region can also involve non-musculoskeletal, lumbosacral spine, intra-articular, and extra-articular sources. Treatment for people with nonarthritic hip joint pain should focus on impairments and be evidence based, with assessments at baseline and at least one other follow-up point that includes discharge. Here we present, for clinicians, the most up-to-date information to guide their work to manage nonarthritic hip pain. J Orthop Sports Phys Ther 2023;53(9):1-3. doi:10.2519/jospt.2023.0505.
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Secomb JL, Kelly M, Dascombe BJ. Hip Strength Profiling of Ice Hockey Athletes Across Various Joint-Specific Angles: Monitoring and Injury Implications. J Strength Cond Res 2023; 37:e422-e429. [PMID: 36729557 DOI: 10.1519/jsc.0000000000004420] [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: 02/03/2023]
Abstract
ABSTRACT Secomb, JL, Kelly, M, and Dascombe, BJ. Hip strength profiling of ice hockey athletes across various joint-specific angles: monitoring and injury implications. J Strength Cond Res 37(7): e422-e429, 2023-The purpose of this research was to compare the hip adduction and abduction relative strength, adduction-to-abduction strength ratio (ADD:ABD), and interlimb asymmetries of ice hockey athletes between the typically used bilateral position and 3 unilateral positions in joint-specific angles (0°, 25°, and 50° of hip abduction) relevant to an ice hockey stride. A secondary purpose was to explore any relationships between these measures and hip and groin noncontact injuries, and self-reported pain and disability. Twenty-five semiprofessional male ice hockey athletes (26.7 ± 6.7 years) were assessed for hip abduction range of motion (ROM), hip adduction and abduction relative strength, and completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire. Within-subjects repeated-measures analysis of variance revealed a significant effect for the assessment position for adduction ( F1,24 = 52.4, p < 0.01) and abduction relative strength ( F1,24 = 152.1, p < 0.01), ADD:ABD ( F1,24 = 38.9, p < 0.01), and the interlimb asymmetries for each of these variables ( F1,24 = 9.8-12.3; p < 0.01), with large strength differences observed between the bilateral assessment and all unilateral assessment positions for adduction and abduction relative strength. In addition, 4 athletes experienced a noncontact hip or groin injury within 1 month after testing, and when compared with the rest of the cohort ( n = 21) with Welch's t -tests, demonstrated significantly reduced hip abduction ROM (mean difference [MD] = -8.4 ± 2.5°; p < 0.01), sport subscale score for the HAGOS questionnaire (MD = -33.9 ± 7.1; p < 0.01), and a decline in hip adduction relative strength in the unilateral position of 50° compared with the position of 25° hip abduction (MD = -13.4 ± 3.8; p = 0.04). These results suggest that practitioners working with ice hockey athletes may benefit from profiling hip strength in these unilateral joint-specific angle positions because they provide an evidence base to determine the hip strength needs of ice hockey athletes in positions associated with skating performance and noncontact hip and groin injury mechanisms (between 25° and 50° of hip abduction).
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Affiliation(s)
- Josh L Secomb
- Applied Sports Science and Exercise Testing Laboratory, University of Newcastle, Ourimbah, Australia
- Newcastle Northstars Ice Hockey Club, Newcastle, Australia; and
| | - Matt Kelly
- The Sport Science Rehab and Performance Centre, Barrhaven, Ottawa, Canada
| | - Ben J Dascombe
- Applied Sports Science and Exercise Testing Laboratory, University of Newcastle, Ourimbah, Australia
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Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. J Orthop Sports Phys Ther 2023; 53:CPG1-CPG70. [PMID: 37383013 DOI: 10.2519/jospt.2023.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.
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13
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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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14
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Naruse M, Trappe S, Trappe TA. Human skeletal muscle-specific atrophy with aging: a comprehensive review. J Appl Physiol (1985) 2023; 134:900-914. [PMID: 36825643 PMCID: PMC10069966 DOI: 10.1152/japplphysiol.00768.2022] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Age-related skeletal muscle atrophy appears to be a muscle group-specific process, yet only a few specific muscles have been investigated and our understanding in this area is limited. This review provides a comprehensive summary of the available information on age-related skeletal muscle atrophy in a muscle-specific manner, nearly half of which comes from the quadriceps. Decline in muscle-specific size over ∼50 yr of aging was determined from 47 cross-sectional studies of 982 young (∼25 yr) and 1,003 old (∼75 yr) individuals and nine muscle groups: elbow extensors (-20%, -0.39%/yr), elbow flexors (-19%, -0.38%/yr), paraspinals (-24%, -0.47%/yr), psoas (-29%, -0.58%/yr), hip adductors (-13%, -0.27%/yr), hamstrings (-19%, -0.39%/yr), quadriceps (-27%, -0.53%/yr), dorsiflexors (-9%, -0.19%/yr), and triceps surae (-14%, -0.28%/yr). Muscle-specific atrophy rate was also determined for each of the subcomponent muscles in the hamstrings, quadriceps, and triceps surae. Of all the muscles included in this review, there was more than a fivefold difference between the least (-6%, -0.13%/yr, soleus) to the most (-33%, -0.66%/yr, rectus femoris) atrophying muscles. Muscle activity level, muscle fiber type, sex, and timeline of the aging process all appeared to have some influence on muscle-specific atrophy. Given the large range of muscle-specific atrophy and the large number of muscles that have not been investigated, more muscle-specific information could expand our understanding of functional deficits that develop with aging and help guide muscle-specific interventions to improve the quality of life of aging women and men.
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Affiliation(s)
- Masatoshi Naruse
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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15
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Cannon J, Kulig K, Weber AE, Powers CM. Gluteal activation during squatting reduces acetabular contact pressure in persons with femoroacetabular impingement syndrome: A patient-specific finite element analysis. Clin Biomech (Bristol, Avon) 2023; 101:105849. [PMID: 36549048 DOI: 10.1016/j.clinbiomech.2022.105849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Femoroacetabular impingement syndrome is a motion-related clinical disorder resulting from abnormal hip joint morphology. Mechanical impingement, in which the aspherical femoral head (cam morphology) abuts with the acetabular rim, is created with simultaneous hip flexion, internal rotation, and adduction. Impaired function of the gluteal muscles may be contributory to femoroacetabular impingement syndrome progression. The purpose of this study was to assess the influence of gluteal muscle recruitment on acetabular contact pressure during squatting in persons with cam femoroacetabular impingement syndrome. METHODS Eight individuals (4 males, 4 females) with a diagnosis of cam femoroacetabular impingement syndrome underwent CT imaging of the pelvis and proximal femora, and a biomechanical assessment of squatting (kinematics, kinetics, and electromyography). Two maximal depth bodyweight squat conditions were evaluated: 1) non-cued squatting; and 2) cued gluteal activation squatting. Utilizing subject-specific electromyography-driven hip and finite element modeling approaches, hip muscle activation, kinematics, bone-on-bone contact forces, and peak acetabular contact pressure were compared between squat conditions. FINDINGS Modest increases in gluteus maximus (7% MVIC, P < 0.0001) and medius (6% MVIC, P = 0.009) activation were able to reduce hip internal rotation on average 5° (P = 0.024), and in doing so reduced acetabular contact pressure by 32% (P = 0.023). Reductions in acetabular contact pressure occurred despite no change in hip abduction and increased bone-on-bone contact forces occurring in the cued gluteal activation condition. INTERPRETATION Our findings highlight the importance of gluteal activation in minimizing mechanical impingement and provide a foundation for interventions aimed at preventing the development and progression of femoroacetabular impingement syndrome.
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Affiliation(s)
- Jordan Cannon
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Comparative Neuromuscular Biomechanics Laboratory, Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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16
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Schneider E, Moore ES, Stanborough R, Slaven E. Effects of Trigger Point Dry Needling on Strength Measurements and Activation Levels of the Gluteus Medius: A Quasi-Experimental Randomized Control Study. Int J Sports Phys Ther 2022; 17:1404-1416. [PMID: 36518833 PMCID: PMC9718692 DOI: 10.26603/001c.55536] [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: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Latent trigger points have been identified as a source of impaired muscle function giving rise to a reduction in force production and alterations in muscle activation patterns and movement efficiency. There is limited investigation into the effectiveness of a treatment in reducing these clinical manifestations. Purpose To investigate whether the application of trigger point dry needling (TDN) to latent trigger points within the gluteus medius musculature affected strength measurements and muscle activation levels immediately following intervention. Design Quasi experimental, single group, pretest-posttest, randomized control study. Methods A control and an intervention side were randomly assigned for each participant (N = 39). Hand held dynamometer (HHD) force measurements and raw surface electromyography (sEMG) amplitude readings were recorded during maximal volitional isometric contractions of the gluteus medius in two separate positions before and after application of TDN. Comparison of within and between group data were conducted. Results A statistically significant interaction between time (pre-TDN to post-TDN) and groups (intervention side and control side), p < 0.001 was found for HHD measurements in both positions. Post hoc analysis revealed a statistically significant difference (p < 0.001) for all comparisons in the side lying neutral (SL0) position, while statistically significant differences (p < 0.001) were found for pre and post-TDN measurements within intervention side as well as between the intervention and control side for post-TDN measurements in the side lying internal rotation (SLIR) position. For sEMG amplitude measurements, statistically significant differences were found only in the SL0 position for within group comparisons on the intervention side (p = 0.009) and for between group comparisons for post-TDN measurements (p = 0.002). Conclusion Application of TDN to latent trigger points within the gluteus medius can significantly increase gluteus muscle force production immediately following intervention while reducing the level of muscle activation required during contraction. Level of Evidence Level 2.
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Affiliation(s)
- Eric Schneider
- Department of Physical Therapy Mount St Joseph University
| | | | | | - Emily Slaven
- Krannert School of Physical Therapy University of Indianapolis
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17
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Disantis AE, Ruh E, Martin R, Enseki K, McClincy M. Rehabilitation Guidelines for Use Following a Periacetabular Osteotomy (PAO): A North American Based Delphi Consensus. Int J Sports Phys Ther 2022; 17:1002-1015. [PMID: 36237641 PMCID: PMC9528724 DOI: 10.26603/001c.38043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
Background Treatment of acetabular dysplasia with a periacetabular osteotomy (PAO) has been shown to improve long term outcomes and is considered the gold standard in the setting of symptomatic hip dysplasia in patients younger than 35 years of age. Post-operative rehabilitation following a PAO plays an important role in helping patients return to their prior level of function and reduce the impact of strength deficits that may persist. Currently, there is a paucity of research supporting post-operative rehabilitation guidelines. The purpose of this study is to present expert-driven rehabilitation guidelines to reduce practice variation following a PAO. Methods A panel of 16 physiotherapists from across the United States and Canada who were identified as experts in PAO rehabilitation by high-volume hip preservation surgeons participated in this Delphi study. Panelists were presented with 11 questions pertaining to rehabilitation guidelines following a PAO. Three iterative survey rounds were presented to the panelists based on responses to these questions. This three-step Delphi method was utilized to establish consensus on post-operative rehabilitation guidelines following a PAO. Results Total (100%) participation was achieved for all three survey rounds. Consensus (>75%) was reached for 11/11 questions pertaining to the following areas: 1) weight-bearing and range of motion (ROM) precautions, 2) therapeutic exercise prescription including neuromuscular control, cardiovascular exercise, and flexibility, and 3) objective measures for return to straight line running and return to full participation in sports. Conclusion This Delphi study established expert-driven rehabilitation guidelines for use following a PAO. The standardization of rehabilitative care following PAO is essential for achieving optimal outcomes despite other factors such as geographical location and socioeconomic status. Further research on patient-reported outcomes is necessary to confirm successful rehabilitation following the guidelines outlined in this study.
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Affiliation(s)
- Ashley E Disantis
- Adolescent and Young Adult Hip Preservation Program, UPMC Children's Hospital of Pittsburgh; Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University
| | - Ethan Ruh
- Department of Orthopedic Surgery, UPMC Children's Hospital of Pittsburgh
| | - RobRoy Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University; UPMC Center for Sports Medicine
| | | | - Michael McClincy
- Department of Orthopedic Surgery, UPMC Children's Hospital of Pittsburgh
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18
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Harris MD, Shepherd MC, Song K, Gaffney BM, Hillen TJ, Harris-Hayes M, Clohisy JC. The biomechanical disadvantage of dysplastic hips. J Orthop Res 2022; 40:1387-1396. [PMID: 34415648 PMCID: PMC8858333 DOI: 10.1002/jor.25165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is strongly associated with an increased risk for hip osteoarthritis. Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (N = 20) to healthy controls (N = 15). Femoral coverage was significantly less in patients (p < 0.001, Cohen's d effect size = 2.2), femoral neck-shaft angles were larger (p = 0.001, d = 1.3), and hip joint centers (HJCs) were more lateral (p = 0.001, d = 1.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]: p = 0.001, d = 1.2). Patients with DDH also had larger GMED volumes (p = 0.02, d = 0.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.
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Affiliation(s)
- Michael D. Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Molly C. Shepherd
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Ke Song
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Brecca M.M. Gaffney
- Department of Mechanical Engineering, University of Colorado-Denver, Denver, CO
| | - Travis J. Hillen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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19
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Feasibility of Superimposed Neuromuscular Electrical Stimulation to the Gluteus Medius During a Resistance Training Program. J Sport Rehabil 2021; 31:279-285. [PMID: 34894628 DOI: 10.1123/jsr.2021-0095] [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: 03/18/2021] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Gluteus medius (GMed) weakness is a common impairment seen across multiple lower-extremity pathologies. Greater GMed weakness is moderately associated with greater frontal plane motion, often termed dynamic knee valgus during functional tasks which may increase risk of lower-extremity injury. Neuromuscular electrical stimulation (NMES) superimposed to targeted muscles has emerged in clinical practice; however, NMES superimposed to the GMed in unknown. It is essential to assess the safety, credibility, and expectancy of NMES superimposed to the GMed prior to implementation in clinical practice. The objective of this study was to evaluate feasibility, safety, credibility, and expectancy of improvement with a 2-week intervention with or without NMES to the GMed in females with dynamic knee valgus. DESIGN Feasibility study. METHODS A total of 22 adult females with dynamic knee valgus (age = 21.8 [1.4] y, mass = 76.9 [18.8] kg, height = 1.7 [0.1] m) completed a 2-week intervention with NMES or a sham treatment superimposed to the GMed during all therapeutic exercises. Feasibility was assessed by recruitment and completion rate, while safety was assessed by the total number of adverse events. Treatment credibility and expectancy was assessed with the Credibility Expectancy Questionnaire. Mixed-measure analysis of variance were used for statistical analysis (P ≤ .05). RESULTS Recruitment was completed in 5 months with 100% completion rate and no adverse events. There was no difference in treatment credibility between groups (NMES = 23.7 [2.3], sham = 21.7 [3.4], P = .12); however, the NMES group demonstrated a greater expectancy score (NMES = 20.0 [3.8], sham = 15.9 [5.1], P = .045). CONCLUSION Resistance training with NMES superimposed to the GMed is a feasible and safe intervention that resulted in greater expectance of success. Clinicians may consider superimposing NMES to the gluteal muscles when addressing muscle weakness in individuals with dynamic knee valgus.
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20
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Belzunce MA, Henckel J, Di Laura A, Hart A. Intramuscular fat in gluteus maximus for different levels of physical activity. Sci Rep 2021; 11:21401. [PMID: 34725385 PMCID: PMC8560940 DOI: 10.1038/s41598-021-00790-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
We aimed to determine if gluteus maximus (GMAX) fat infiltration is associated with different levels of physical activity. Identifying and quantifying differences in the intramuscular fat content of GMAX in subjects with different levels of physical activity can provide a new tool to evaluate hip muscles health. This was a cross-sectional study involving seventy subjects that underwent Dixon MRI of the pelvis. The individuals were divided into four groups by levels of physical activity, from low to high: inactive patients due to hip pain; and low, medium and high physical activity groups of healthy subjects (HS) based on hours of exercise per week. We estimated the GMAX intramuscular fat content for each subject using automated measurements of fat fraction (FF) from Dixon images. The GMAX volume and lean volume were also measured and normalized by lean body mass. The effects of body mass index (BMI) and age were included in the statistical analysis. The patient group had a significantly higher FF than the three groups of HS (median values of 26.2%, 17.8%, 16.7% and 13.7% respectively, p < 0.001). The normalized lean volume was significantly larger in the high activity group compared to all the other groups (p < 0.001, p = 0.002 and p = 0.02). Employing a hierarchical linear regression analysis, we found that hip pain, low physical activity, female gender and high BMI were statistically significant predictors of increased GMAX fat infiltration.
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Affiliation(s)
| | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Anna Di Laura
- Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Alister Hart
- Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
- Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital (RNOH), University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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21
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Kawano T, Nankaku M, Murao M, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Functional characteristics associated with hip abductor torque in severe hip osteoarthritis. Musculoskelet Sci Pract 2021; 55:102431. [PMID: 34329871 DOI: 10.1016/j.msksp.2021.102431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hip abductor weakness due to the progression of hip osteoarthritis (OA) commonly causes poor functional mobility. The hip abductor strength has also been identified as a clinically relevant factor for successful functional outcomes after total hip arthroplasty. OBJECTIVES This study aimed to examine the functional characteristics related to hip abductor torque in patients with hip OA. DESIGN A cross-sectional survey study. METHODS One hundred and eight female patients with severe unilateral hip OA participated in this study. Hip abductor torque and pain were measured. The muscle cross-sectional area (CSA) and skeletal muscle density (SMD) of the gluteal muscles were also measured using computed tomography. To identify the hip parameters associated with hip abductor torque, multiple regression analysis was performed. The healthy model included the CSA and SMD of gluteus maximus, gluteus medius, and gluteus minimus; range of motion in hip abduction; age; and body mass index. The affected model included hip pain in addition to the healthy model. RESULTS In the affected limb, multiple regression analysis identified pain and angle of hip abduction as factors that determine hip abductor torque (Adjusted R2 = 0.39). In contrast, our analysis identified CSA and SMD of the gluteus medius and SMD of the gluteus minimus as the significant variables related to hip abductor torque in the healthy limb (Adjusted R2 = 0.40). CONCLUSION The findings of this study indicated that it is necessary to consider that hip pain may inhibit muscle exertion and contraction while training to improve the hip abductor torque in the affected limb.
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Affiliation(s)
- Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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22
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Meinders E, Pizzolato C, Goncalves BAM, Lloyd DG, Saxby DJ, Diamond LE. The deep hip muscles are unlikely to contribute to hip stability in the sagittal plane during walking: a stiffness approach. IEEE Trans Biomed Eng 2021; 69:1133-1140. [PMID: 34559628 DOI: 10.1109/tbme.2021.3114717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
- Objective: This study determined whether the deep hip muscles could contribute to hip stability. METHODS Hip stability was defined as rotational hip stiffness in the sagittal plane, which was calculated for walking trials for 12 participants via electromyography (EMG)informed neuromusculoskeletal modelling that included all 22 hip spanning muscles. Three model configurations were compared that differed in the excitations of the deep hip muscles, but were identical in the excitations of all other muscles: (1) deep hip muscles informed by intramuscular EMG measurements (assisted activation); (2) deep hip muscles with simulated zero activation (no activation); (3) deep hip muscles with simulated maximal activation (maximal activation). Sagittal plane rotational hip stiffness over the gait cycle was compared between model configurations using a within-participant analysis of variance via statistical parametric mapping (p<0.05). RESULTS Compared to the assisted activation configuration, hip stiffness (mean (95% confidence interval)) was 0.8% (0.7 to 0.9) lower in the no activation configuration, and 3.2% (2.9 to 3.5) higher in the maximal activation configuration over the gait cycle. CONCLUSION Regardless of activation level, the deep hip muscles made little contribution to sagittal plane rotational hip stiffness, which casts uncertainty around their assumed function as hip stabilizers. SIGNIFICANCE The merit of targeted deep hip muscle strengthening to improve hip stability in rehabilitation programs for remains unclear.
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23
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Goncalves BA, Saxby DJ, Kositsky A, Barrett RS, Diamond LE. Reliability of hip muscle strength measured in principal and intermediate planes of movement. PeerJ 2021; 9:e11521. [PMID: 34141482 PMCID: PMC8179216 DOI: 10.7717/peerj.11521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Muscle strength testing is widely used in clinical and athletic populations. Commercially available dynamometers are designed to assess strength in three principal planes (sagittal, transverse, frontal). However, the anatomy of the hip suggests muscles may only be recruited submaximally during tasks performed in these principal planes. OBJECTIVE To evaluate the inter-session reliability of maximal isometric hip strength in the principal planes and three intermediate planes. METHODS Twenty participants (26.1 ± 2.7 years, 50% female) attended two testing sessions 6.2 ± 1.8 days apart. Participants completed 3-5 maximal voluntary isometric contractions for hip abduction, adduction, flexion, extension, and internal and external rotation measured using a fixed uniaxial load cell (custom rig) and commercial dynamometer (Biodex). Three intermediate hip actions were also tested using the custom rig: extension with abduction, extension with external rotation, and extension with both abduction and external rotation. RESULTS Moderate-to-excellent intraclass correlation coefficients were observed for all principal and intermediate muscle actions using the custom rig (0.72-0.95) and the Biodex (0.85-0.95). The minimum detectable change was also similar between devices (custom rig = 11-31%; Biodex = 9-20%). Bland-Altman analysis revealed poor agreement between devices (range between upper and lower limits of agreement = 77-131%). CONCLUSIONS Although the custom rig and Biodex showed similar reliability, both devices may lack the sensitivity to detect small changes in hip strength commonly observed following intervention.
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Affiliation(s)
- Basilio A.M. Goncalves
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J. Saxby
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Adam Kositsky
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rod S. Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E. Diamond
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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24
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Karakostis FA, Harvati K. New horizons in reconstructing past human behavior: Introducing the "Tübingen University Validated Entheses-based Reconstruction of Activity" method. Evol Anthropol 2021; 30:185-198. [PMID: 33764627 DOI: 10.1002/evan.21892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/28/2020] [Accepted: 03/03/2021] [Indexed: 02/05/2023]
Abstract
An accurate reconstruction of habitual activities in past populations and extinct hominin species is a paramount goal of paleoanthropological research, as it can elucidate the evolution of human behavior and the relationship between culture and biology. Variation in muscle attachment (entheseal) morphology has been considered an indicator of habitual activity, and many attempts have been made to use it for this purpose. However, its interpretation remains equivocal due to methodological shortcomings and a paucity of supportive experimental data. Through a series of studies, we have introduced a novel and precise methodology that focuses on reconstructing muscle synergies based on three-dimensional and multivariate analyses among entheses. This approach was validated using uniquely documented anthropological samples, experimental animal studies, histological observations, and geometric morphometrics. Here, we detail, synthesize, and critically discuss the findings of these studies, which overall point to the great potential of entheses in elucidating aspects of past human behavior.
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Affiliation(s)
- Fotios Alexandros Karakostis
- DFG (Deutsche Forschungsgemeinschaft) Center for Advanced Studies "Words, Bones, Genes, Tools," Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Katerina Harvati
- DFG (Deutsche Forschungsgemeinschaft) Center for Advanced Studies "Words, Bones, Genes, Tools," Eberhard Karls University of Tübingen, Tübingen, Germany.,Paleoanthropology, Senckenberg Centre for Human Evolution and Palaeoenvironment, Institute of Archaeological Sciences, University of Tübingen, Tübingen, Germany
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Karakostis FA, Reyes-Centeno H, Franken M, Hotz G, Rademaker K, Harvati K. Biocultural evidence of precise manual activities in an Early Holocene individual of the high-altitude Peruvian Andes. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 174:35-48. [PMID: 33191560 DOI: 10.1002/ajpa.24160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/12/2020] [Accepted: 10/02/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Cuncaicha, a rockshelter site in the southern Peruvian Andes, has yielded archaeological evidence for human occupation at high elevation (4,480 masl) during the Terminal Pleistocene (12,500-11,200 cal BP), Early Holocene (9,500-9,000 cal BP), and later periods. One of the excavated human burials (Feature 15-06), corresponding to a middle-aged female dated to ~8,500 cal BP, exhibits skeletal osteoarthritic lesions previously proposed to reflect habitual loading and specialized crafting labor. Three small tools found in association with this burial are hypothesized to be associated with precise manual dexterity. MATERIALS AND METHODS Here, we tested this functional hypothesis through the application of a novel multivariate methodology for the three-dimensional analysis of muscle attachment surfaces (entheses). This original approach has been recently validated on both lifelong-documented anthropological samples as well as experimental studies in nonhuman laboratory samples. Additionally, we analyzed the three-dimensional entheseal shape and resulting moment arms for muscle opponens pollicis. RESULTS Results show that Cuncaicha individual 15-06 shows a distinctive entheseal pattern associated with habitual precision grasping via thumb-index finger coordination, which is shared exclusively with documented long-term precision workers from recent historical collections. The separate geometric morphometric analysis revealed that the individual's opponens pollicis enthesis presents a highly projecting morphology, which was found to strongly correlate with long joint moment arms (a fundamental component of force-producing capacity), closely resembling the form of Paleolithic hunter-gatherers from diverse geo-chronological contexts of Eurasia and North Africa. DISCUSSION Overall, our findings provide the first biocultural evidence to confirm that the lifestyle of some of the earliest Andean inhabitants relied on habitual and forceful precision grasping tasks.
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Affiliation(s)
- Fotios Alexandros Karakostis
- Paleoanthropology, Senckenberg Centre for Human Evolution and Palaeoenvironment, Department of Geosciences, University of Tübingen, Tübingen, Germany
| | - Hugo Reyes-Centeno
- DFG (Deutsche Forschungsgemeinschaft) Center for Advanced Studies "Words, Bones, Genes, Tools," Eberhard Karls University of Tübingen, Tübingen, Germany.,Department of Anthropology, University of Kentucky, Lexington, Kentucky, USA.,William S. Webb Museum of Anthropology, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Franken
- State Office for Cultural Heritage Baden-Württemberg, Osteology, Konstanz, Germany
| | - Gerhard Hotz
- Anthropological Collection, Natural History Museum of Basel, Basel, Switzerland.,Integrative Prehistory and Archaeological Science, University of Basel, Basel, Switzerland
| | - Kurt Rademaker
- Department of Anthropology, College of Social Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Katerina Harvati
- Paleoanthropology, Senckenberg Centre for Human Evolution and Palaeoenvironment, Department of Geosciences, University of Tübingen, Tübingen, Germany.,DFG (Deutsche Forschungsgemeinschaft) Center for Advanced Studies "Words, Bones, Genes, Tools," Eberhard Karls University of Tübingen, Tübingen, Germany
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26
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Roberts TJ, Eng CM, Sleboda DA, Holt NC, Brainerd EL, Stover KK, Marsh RL, Azizi E. The Multi-Scale, Three-Dimensional Nature of Skeletal Muscle Contraction. Physiology (Bethesda) 2020; 34:402-408. [PMID: 31577172 DOI: 10.1152/physiol.00023.2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Muscle contraction is a three-dimensional process, as anyone who has observed a bulging muscle knows. Recent studies suggest that the three-dimensional nature of muscle contraction influences its mechanical output. Shape changes and radial forces appear to be important across scales of organization. Muscle architectural gearing is an emerging example of this process.
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Affiliation(s)
- Thomas J Roberts
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - Carolyn M Eng
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - David A Sleboda
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - Natalie C Holt
- Department of Evolution, Ecology and Organismal Biology, University of California-Riverside, Riverside, California
| | - Elizabeth L Brainerd
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - Kristin K Stover
- Department of Ecology and Evolutionary Biology, University of California-Irvine, Irvine, California
| | - Richard L Marsh
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island
| | - Emanuel Azizi
- Department of Ecology and Evolutionary Biology, University of California-Irvine, Irvine, California
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27
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Stodart B, Cup M, Kindel C. The Relationship Between Surface Electromyographic Activity and Torque Production of the Infraspinatus Muscle in Shoulder Rehabilitation Exercises. J Appl Biomech 2020; 36:141-147. [PMID: 32182589 DOI: 10.1123/jab.2019-0257] [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: 08/20/2019] [Revised: 12/18/2019] [Accepted: 01/31/2020] [Indexed: 11/18/2022]
Abstract
In current rehabilitation practice, exercise selection is commonly based on the amount of muscle recruitment demonstrated by electromyographic (EMG) analysis. A preponderance of evidence supports the concept that EMG of a muscle and torque output are positively correlated. This study was designed to investigate the relationship between surface EMG activity of the infraspinatus and torque production during exercises involving shoulder external rotation (ER). A total of 30 participants (average age = 24.6 y) performed maximum voluntary isometric contraction of ER at 5 points within the range of motion of 3 shoulder exercise positions with concomitant surface EMG recording. As a maximal internally rotated position was approached, maximum ER torque and minimum or near-minimum EMG recruitment were demonstrated. Conversely, at maximally externally rotated positions, EMG activity was greatest and torque values were lowest. An inverse relationship between joint torque output and EMG activity was established in each of the 3 exercises. The inverse relationship between EMG activity and torque output during Shoulder ER suggests that there may be additional factors warranting consideration during exercise selection. Further research may be needed to determine the relative value of electrical activity versus torque output to optimize the selection of rehabilitative exercises.
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Cannon J, Weber AE, Park S, Mayer EN, Powers CM. Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice. Phys Ther 2020; 100:788-797. [PMID: 31899497 DOI: 10.1093/ptj/pzz189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/16/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.
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Affiliation(s)
- Jordan Cannon
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Seol Park
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erik N Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Christopher M Powers
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar St, CHP-155, Los Angeles, CA (USA)
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Hip Kinematics During Single-Leg Tasks in People With and Without Hip-Related Groin Pain and the Association Among Kinematics, Hip Muscle Strength, and Bony Morphology. J Orthop Sports Phys Ther 2020; 50:243-251. [PMID: 31905098 PMCID: PMC7196020 DOI: 10.2519/jospt.2020.9150] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare 3-D hip kinematics during the single-leg squat and step-down in patients with hip-related groin pain to those in asymptomatic participants, and to assess relationships among hip kinematics, muscle strength, and bony morphology. DESIGN Controlled laboratory cross-sectional study. METHODS Forty patients with hip-related groin pain and 40 matched, asymptomatic participants between 18 and 40 years of age participated. A handheld dynamometer was used to assess hip abductor and external rotator strength. An 8-camera motion-analysis system was used to quantify 3-D kinematics during the single-leg squat and step-down. Magnetic resonance imaging was used to quantify bony morphology. The independent t test and Mann-Whitney U test were used to assess between-group differences. Pearson coefficient correlations were used to assess relationships. RESULTS Patients with hip-related groin pain had smaller peak hip flexion angles, smaller knee flexion angles, and lesser squat depth compared to asymptomatic participants during the single-leg squat. Among patients with hip-related groin pain, smaller hip flexion angles during the single-leg squat were associated with hip abductor weakness (r = 0.47, P≤.01). Among asymptomatic participants, smaller peak hip flexion angles during the single-leg squat were associated with less acetabular coverage (r = 0.33, P = .04) and shallow squat depth (r = 0.48, P≤.01); a smaller hip internal rotation angle during the step-down was associated with larger femoral neck shaft angle (r = -0.43, P<.01). CONCLUSION Compared to asymptomatic participants, patients with hip-related groin pain had smaller hip and knee flexion angles and shallower squat depth during the single-leg squat. Smaller hip flexion angles were associated with hip abductor weakness among those with hip-related groin pain. J Orthop Sports Phys Ther 2020;50(5):243-251. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9150.
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30
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Moore D, Semciw AI, Wisbey-Roth T, Pizzari T. Adding hip rotation to therapeutic exercises can enhance gluteus medius and gluteus minimus segmental activity levels – An electromyography study. Phys Ther Sport 2020; 43:157-165. [DOI: 10.1016/j.ptsp.2020.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/12/2023]
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Mendiolagoitia L, Rodríguez MÁ, Crespo I, del Valle M, Olmedillas H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review: Gait After Total Hip Replacement: A Systematic Review. Indian J Orthop 2020; 54:767-775. [PMID: 33133399 PMCID: PMC7573021 DOI: 10.1007/s43465-020-00101-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/28/2020] [Indexed: 02/04/2023]
Abstract
Total hip replacement (THR) is a surgical procedure indicated for patients affected by severe hip osteoarthritis. Although this technique has proved to be effective in relieving pain and restoring function, gait limitations may persist following this procedure. The objective of this systematic review was to evaluate gait kinematics after THR and compare the results with those of the pre-operative state and with healthy control individuals. PubMed/MEDLINE, Embase, Web of Science, CENTRAL and Scopus databases were searched until December 2019. Methodological quality and internal validity score of each study were assessed using the PEDro and the Newcastle-Ottawa scales. In all, ten studies met our inclusion criteria. Following THR, statistically significant improvements were seen in dynamic hip and knee range of motion of both the affected and the contralateral limb, single-limb support time symmetry, step length, stride length, walking speed and gait pattern. However, deficits were observed in all the previous parameters, as well as in hip adduction angle in comparison with healthy subjects. In conclusion, gait patterns improve after THR in comparison with the pre-operative state, although there are deficits relative to healthy individuals.
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Affiliation(s)
- Luis Mendiolagoitia
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | | | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
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Automated multi-atlas segmentation of gluteus maximus from Dixon and T1-weighted magnetic resonance images. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:677-688. [PMID: 32152794 DOI: 10.1007/s10334-020-00839-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/02/2020] [Accepted: 02/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To design, develop and evaluate an automated multi-atlas method for segmentation and volume quantification of gluteus maximus from Dixon and T1-weighted images. MATERIALS AND METHODS The multi-atlas segmentation method uses an atlas library constructed from 15 Dixon MRI scans of healthy subjects. A non-rigid registration between each atlas and the target, followed by majority voting label fusion, is used in the segmentation. We propose a region of interest (ROI) to standardize the measurement of muscle bulk. The method was evaluated using the dice similarity coefficient (DSC) and the relative volume difference (RVD) as metrics, for Dixon and T1-weighted target images. RESULTS The mean(± SD) DSC was 0.94 ± 0.01 for Dixon images, while 0.93 ± 0.02 for T1-weighted. The RVD between the automated and manual segmentation had a mean(± SD) value of 1.5 ± 4.3% for Dixon and 1.5 ± 4.8% for T1-weighted images. In the muscle bulk ROI, the DSC was 0.95 ± 0.01 and the RVD was 0.6 ± 3.8%. CONCLUSION The method allows an accurate fully automated segmentation of gluteus maximus for Dixon and T1-weighted images and provides a relatively accurate volume measurement in shorter times (~ 20 min) than the current gold-standard manual segmentations (2 h). Visual inspection of the segmentation would be required when higher accuracy is needed.
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33
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Edwards N, Dickin C, Wang H. Low back pain and golf: A review of biomechanical risk factors. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:10-18. [PMID: 35783335 PMCID: PMC9219256 DOI: 10.1016/j.smhs.2020.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/03/2022] Open
Abstract
Golf is an international sport played by a variety of age groups and fitness levels, and although golf has a low to moderate aerobic intensity level, injuries are common among professional and amateur golfers. High amounts of force experienced during the golf swing can lead to injury when golfers lack appropriate strength or technique with the lower back most commonly injured. Research has indicated that trunk muscle activation, hip strength and mobility, and pelvis and trunk rotation are associated with low back pain (LBP). Based on anecdotal evidence, golf practitioners specifically address issues in weight shift, lumbar positioning, and pelvis sequencing for golfers with LBP. This review aims to elucidate the effects of proper and improper golf swing technique on LBP and to help golf practitioners understand how to approach the alleviation of LBP in their clientele.
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Affiliation(s)
- Nathan Edwards
- School of Kinesiology, Ball State University, Muncie, United States
| | - Clark Dickin
- School of Kinesiology, Ball State University, Muncie, United States
| | - Henry Wang
- School of Kinesiology, Ball State University, Muncie, United States
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34
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Gaffney BMM, Clohisy JC, Van Dillen LR, Harris MD. The association between periacetabular osteotomy reorientation and hip joint reaction forces in two subgroups of acetabular dysplasia. J Biomech 2020; 98:109464. [PMID: 31708245 PMCID: PMC6930321 DOI: 10.1016/j.jbiomech.2019.109464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
Acetabular dysplasia is primarily characterized by an altered acetabular geometry that results in deficient coverage of the femoral head, and is a known cause of hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical reorientation of the acetabulum to normalize coverage, yet its effect on joint loading is unknown. Our objective was to establish how PAO, simulated with a musculoskeletal model and probabilistic analysis, alters hip joint reaction forces (JRF) in two representative patients of two different acetabular dysplasia subgroups: anterolateral and posterolateral coverage deficiencies. PAO reorientation was simulated within the musculoskeletal model by adding three surgical degrees of freedom to the acetabulum relative to the pelvis (acetabular adduction, acetabular extension, medial translation of the hip joint center). Monte Carlo simulations were performed to generate 2000 unique PAO reorientations for each patient; from which 99% confidence bounds and sensitivity factors were calculated to assess the influence of input variability (PAO reorientation) on output (hip JRF) during gait. Our results indicate that reorientation of the acetabulum alters the lines of action of the hip musculature. Specifically, as the hip joint center was medialized, the moment arm of the hip abductor muscles was increased, which in turn increased the mechanical force-generating capacity of these muscles and decreased joint loading. Independent of subgroup, hip JRF was most sensitive to hip joint center medialization. Results from this study improve understanding of how PAO reorientation affects muscle function differently dependent upon acetabular dysplasia subgrouping and can be used to inform more targeted surgical interventions.
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Affiliation(s)
- Brecca M M Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Michael D Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States.
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Parvaresh KC, Chang C, Patel A, Lieber RL, Ball ST, Ward SR. Architecture of the Short External Rotator Muscles of the Hip. BMC Musculoskelet Disord 2019; 20:611. [PMID: 31862009 PMCID: PMC6925491 DOI: 10.1186/s12891-019-2995-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Muscle architecture, or the arrangement of sarcomeres and fibers within muscles, defines functional capacity. There are limited data that provide an understanding of hip short external rotator muscle architecture. The purpose of this study was thus to characterize the architecture of these small hip muscles. Methods Eight muscles from 10 independent human cadaver hips were used in this study (n = 80 muscles). Architectural measurements were made on pectineus, piriformis, gemelli, obturators, quadratus femoris, and gluteus minimus. Muscle mass, fiber length, sarcomere length, and pennation angle were used to calculate the normalized muscle fiber length, which defines excursion, and physiological cross-sectional area (PCSA), which defines force-producing capacity. Results Gluteus minimus had the largest PCSA (8.29 cm2) followed by obturator externus (4.54 cm2), whereas superior gemellus had the smallest PCSA (0.68 cm2). Fiber lengths clustered into long (pectineus - 10.38 cm and gluteus minimus - 10.30 cm), moderate (obturator internus - 8.77 cm and externus - 8.04 cm), or short (inferior gemellus - 5.64 and superior gemellus - 4.85). There were no significant differences among muscles in pennation angle which were all nearly zero. When the gemelli and obturators were considered as a single functional unit, their collective PCSA (10.00 cm2) exceeded that of gluteus minimus as a substantial force-producing group. Conclusions The key findings are that these muscles have relatively small individual PCSAs, short fiber lengths, and low pennation angles. The large collective PCSA and short fiber lengths of the gemelli and obturators suggest that they primarily play a stabilizing role rather than a joint rotating role.
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Affiliation(s)
- Kevin C Parvaresh
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Charles Chang
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Ankur Patel
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Richard L Lieber
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA.,Departments of Bioengineering, University of California, San Diego, USA
| | - Scott T Ball
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Samuel R Ward
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA. .,Departments of Bioengineering, University of California, San Diego, USA. .,Departments of Radiology, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA.
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Miyachi R, Mori K, Yonekura S, Deguchi M, Nami T, Morioka T, Miyazaki J. Change in muscle thickness during exercise to stabilize the hip joint against a load in the ventral direction of the femoral head. J Phys Ther Sci 2019; 31:935-938. [PMID: 31871381 PMCID: PMC6879399 DOI: 10.1589/jpts.31.935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study aimed to measure the thickness of the muscles located on the ventral
side of the hip joint and to identify the muscles involved in exercise against the load
that results in femoral head translation in the ventral direction, which can be used as an
index of exercise performance for the prevention and improvement of hip joint disease
caused by femoral head translation. [Participants and Methods] The participants were 10
healthy young males. During the measurement task, we asked them to hold a 10 kgf load in
the ventral direction to the femoral head in the supine position. We measured the
thickness of the gluteus minimus, gluteus medius, tensor fascia latae, and iliopsoas both
at rest and during exercise using ultrasonography. [Results] We compared muscle
thicknesses at rest and during exercise and found that only the gluteus minimus had
significantly lower values during exercise. We also compared the rate of change in muscle
thickness and found that the gluteus minimus exhibited significantly higher values than
those of the gluteus medius and tensor fasciae latae. [Conclusion] Our study indicates
that the gluteus minimus is more involved than the gluteus medius, tensor fasciae latae,
and iliopsoas in the exercise for the ventral displacement of the femoral head.
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Affiliation(s)
- Ryo Miyachi
- Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University: 34 Ohyake, Yamadamachi, Yamasihina-ku, Kyoto 607-8175, Japan
| | - Kentaro Mori
- Department of Rehabilitation, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Sae Yonekura
- Department of Rehabilitation, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Miyuki Deguchi
- Department of Rehabilitation, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Takumu Nami
- Department of Rehabilitation, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Tetsuya Morioka
- Department of Rehabilitation, Ishikawa-ken Saiseikai Kanazawa Hospital, Japan
| | - Junya Miyazaki
- Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University: 34 Ohyake, Yamadamachi, Yamasihina-ku, Kyoto 607-8175, Japan
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Mausehund L, Skard AE, Krosshaug T. Muscle Activation in Unilateral Barbell Exercises: Implications for Strength Training and Rehabilitation. J Strength Cond Res 2019; 33 Suppl 1:S85-S94. [PMID: 29870422 DOI: 10.1519/jsc.0000000000002617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mausehund, L, Skard, AE, and Krosshaug, T. Muscle activation in unilateral barbell exercises: Implications for strength training and rehabilitation. J Strength Cond Res 33(7S): S85-S94, 2019-The purpose of the present investigation was to assess lower-body muscle activity and hamstrings-to-quadriceps (HQ) activation ratios during performance of the split squat (SS), single-leg squat (SLS), and rear foot elevated split squat (RFESS), while using the same relative load and performing the exercises to muscular failure. Eleven healthy, moderately strength-trained subjects performed a 6-8 repetition maximum set of each exercise while electromyographic (EMG) activity of the vastus lateralis, biceps femoris, gluteus maximus, and gluteus medius was recorded. The results show that there were no significant differences in EMG peak activity of the gluteus maximus and vastus lateralis between any of the exercises. Gluteus medius activation was significantly (p ≤ 0.05) higher during the SLS (81.9% maximum voluntary isometric contraction [MVIC]), compared with the RFESS (54.9% MVIC) and SS (46.2% MVIC). The RFESS elicited higher (p ≤ 0.05) biceps femoris activity (76.1% MVIC) than the SS (62.3% MVIC), as well as higher (p ≤ 0.05) HQ activation ratios (0.83) than the SS (0.69) and SLS (0.63). During the SLS and the SS, HQ activation ratios increased significantly in the course of the repetition maximum set. In conclusion, although absolute loading differs between exercises, similar training stimuli of the gluteus maximus and quadriceps femoris can be expected for all exercises. The SLS is likely to induce the greatest improvements in gluteus medius strength, whereas the RFESS should be preferred if high hamstring coactivation is desired. To improve validity in EMG studies, strength training exercises should be performed close to failure while using the same relative loading.
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Affiliation(s)
- Lasse Mausehund
- Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Audun E Skard
- Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Tron Krosshaug
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
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Diamond LE, van den Hoorn W, Bennell KL, Wrigley TV, Hinman RS, O'Donnell J, Hodges PW. Deep hip muscle activation during squatting in femoroacetabular impingement syndrome. Clin Biomech (Bristol, Avon) 2019; 69:141-147. [PMID: 31351343 DOI: 10.1016/j.clinbiomech.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/31/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep hip muscle retraining is a common objective of non-operative management for femoroacetabular impingement (FAI) syndrome. These muscles are considered to have an important role in hip joint stabilization, however, it is unclear whether their function is altered in the presence of hip pathology. This exploratory study aimed to investigate activation patterns of the hip muscles during two squatting tasks in individuals with and without FAI syndrome. METHODS Fifteen individuals with FAI syndrome (symptoms, clinical examination and imaging) and 14 age- and sex-comparable healthy controls underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles during the squatting tasks. Activation patterns from individual muscles were compared between-groups using a wavelet-based linear mixed effects model (P < 0.05). FINDINGS There were no between-group differences for squat depth or speed during descent or ascent for either task. Participants with FAI syndrome exhibited patterns of activation that differed significantly to controls across all muscles (P < 0.05) when squatting using their preferred strategy. Unlike controls, participants with FAI syndrome exhibited a pattern of activation for obturator internus during descent that was similar in amplitude to ascent, despite the contrasting contraction type (i.e. eccentric vs concentric). INTERPRETATION Individuals with FAI syndrome appear to implement a protective strategy as the hip descends towards the impingement position. Future studies should examine patients prospectively to establish whether these strategies are counterproductive for pathology and warrant rehabilitation.
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Affiliation(s)
- Laura E Diamond
- Griffith University, School of Allied Health Sciences, Gold Coast, QLD 4222, Australia; Griffith University, Gold Coast Orthopaedics Research, Engineering & Education Alliance (GCORE), Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
| | - Wolbert van den Hoorn
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia
| | - Kim L Bennell
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | - Tim V Wrigley
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | - Rana S Hinman
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | | | - Paul W Hodges
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia
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Anterior Cruciate Ligament Injury Mechanisms and the Kinetic Chain Linkage: The Effect of Proximal Joint Stiffness on Distal Knee Control During Bilateral Landings. J Orthop Sports Phys Ther 2019; 49:601-610. [PMID: 31130059 DOI: 10.2519/jospt.2019.8248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuromuscular deficits at the trunk and hip may contribute to dynamic knee valgus and anterior cruciate ligament injury mechanisms. However, comprehensive examination of neuromuscular patterns and their mechanical influence is lacking. OBJECTIVES To investigate the influence of lumbar spine joint rotational stiffness (JRS) and the gluteal musculature contribution to hip JRS on dynamic knee valgus. METHODS In this cross-sectional study, 18 university-aged women completed a drop vertical jump while we measured kinematics, kinetics, and 24 channels of electromyography (EMG) spanning the trunk and hip musculature. We classified each limb as high or low valgus, based on frontal plane knee displacement magnitude. We used anatomically detailed, EMG-driven biomechanical models to quantify lumbar spine JRS and muscle contributions to hip JRS. RESULTS Low-valgus limbs generated greater gluteus medius frontal JRS (P = .002; effect size, 1.3) and gluteus maximus transverse JRS (P = .003; effect size, 1.2) compared to high-valgus limbs. Participants with bilateral high-valgus collapse had substantially reduced lumbar spine sagittal JRS compared to the group with low valgus on both limbs (P = .05; effect size, 5.1). Those with low valgus on both limbs also had a peak lumbar spine flexion angle of 24° ± 4°, compared to the bilateral high-valgus group's angle of 38° ± 10° (P = .09; effect size, 1.8). CONCLUSION Participants who avoided high medial knee displacement had greater proximal JRS. Increased JRS at the lumbar spine and greater JRS contributions from the gluteal musculature are linked with preventing high medial knee displacement. J Orthop Sports Phys Ther 2019;49(8):601-610. Epub 26 May 2019. doi:10.2519/jospt.2019.8248.
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Gluteus medius muscle decompression for buttock pain: a case-series analysis. Acta Neurochir (Wien) 2019; 161:1397-1401. [PMID: 31049711 DOI: 10.1007/s00701-019-03923-3] [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: 01/16/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The causes of low back and buttock pain are variable. Elsewhere, we presented a surgical technical note addressing the gluteus medius muscle (GMeM) pain that elicited buttock pain treatable by surgical decompression. Here, we report minimum 2-year surgical outcomes of GMeM decompression for intractable buttock pain. METHODS Between January 2014 and December 2015, we surgically treated 55 consecutive patients with a GMeM pain. Of these, 39 were followed for at least 2 years; they were included in this study. Their average age was 69.2 years; 17 were men and 22 were women. The affected side was unilateral in 24 patients and bilateral in the other 15 (total 54 sites). The mean follow-up period was 40.0 months (range 25-50 months). The severity of pre- and post-treatment pain was recorded on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ). RESULTS Of the 39 patients, 35 also presented with leg symptoms. They were exacerbated by walking in all 39 patients and by prolonged sitting in 33 patients; 19 had a past history of lumbar surgery and 4 manifested failed back surgery syndrome. Repeat surgery for wider decompression was performed in 5 patients due to pain recurrence 15.8 months after the first operation. At the last follow-up, the symptoms were significantly improved; the average NRS fell from 7.4 to 2.1 and the RDQ score from 10.5 to 3.3 (p < 0.05). CONCLUSIONS When diagnostic criteria are met, GMeM decompression under local anesthesia is a useful treatment for intractable buttock pain.
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The Modified Resisted Internal Rotation Test for Detection of Gluteal Tendon Tears. Arthrosc Tech 2019; 8:e331-e334. [PMID: 31019887 PMCID: PMC6471346 DOI: 10.1016/j.eats.2018.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/06/2018] [Indexed: 02/03/2023] Open
Abstract
Greater trochanteric pain syndrome (GTPS) has received increasing attention in recent years. Most patients with GTPS present with trochanteric bursitis and respond to nonoperative treatment. However, a subset of patients may have persistent lateral hip pain or recalcitrant GTPS resulting from an undiagnosed gluteal tendon tear. Recalcitrant GTPS may be a debilitating condition in this patient subset. There is a need for an accurate and evidence-based physical examination maneuver to aid in earlier diagnosis of gluteal tendon tears and timely intervention in these patients. Most studies evaluating gluteal tendinopathy fail to assess surgical indications and instead focus on identifying trochanteric bursitis, which may or may not require surgical treatment. The modified resisted internal rotation test has been used in our practice to detect gluteus medius tendon tears in the recalcitrant GTPS patient population. Fundamental anatomic, biomechanical, electromyographic, and clinical data have been reviewed to make this an evidence-based clinical test for early detection of this pathology.
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Wong-On M, Turmo-Garuz A, Arriaza R, Gonzalez de Suso JM, Til-Perez L, Yanguas-Leite X, Diaz-Cueli D, Gasol-Santa X. Injuries of the obturator muscles in professional soccer players. Knee Surg Sports Traumatol Arthrosc 2018; 26:1936-1942. [PMID: 28188336 DOI: 10.1007/s00167-017-4453-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players. METHODS Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible. RESULTS Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5 ± 8.8 days. CONCLUSION Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Antonio Turmo-Garuz
- Universitat de Barcelona, Barcelona, Spain.,RCD Espanyol de Barcelona, Barcelona, Spain.,CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Rafael Arriaza
- Instituto Médico Arriaza y Asociados, Cátedra de Traumatología del Deporte HM Universidad da Coruña, La Coruña, Spain
| | | | - Luis Til-Perez
- CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Spain.,Medical Service, Football Club Barcelona, Barcelona, Spain
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Diffusion Tensor Imaging of Dystrophic Skeletal Muscle. Clin Neuroradiol 2018; 29:231-242. [DOI: 10.1007/s00062-018-0667-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
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Hip Abductor Muscle Volume and Strength Differences Between Women With Chronic Hip Joint Pain and Asymptomatic Controls. J Orthop Sports Phys Ther 2017; 47:923-930. [PMID: 28992772 PMCID: PMC5991486 DOI: 10.2519/jospt.2017.7380] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Secondary analysis, cross-sectional study. Background Chronic hip joint pain (CHJP) can lead to limitations in activity participation, but the musculoskeletal factors associated with the condition are relatively unknown. Understanding the factors associated with CHJP may help develop rehabilitation strategies to improve quality of life of individuals with long-term hip pain. Objectives To compare measures of hip abductor muscle volume and hip abductor muscle strength between women with CHJP and asymptomatic controls. Methods Thirty women, 15 with CHJP and 15 matched asymptomatic controls (age range, 18-40 years), participated in this study. Magnetic resonance imaging was used to determine the volume of the primary hip abductor muscles, consisting of the gluteus medius, gluteus minimus, a small portion of the gluteus maximus, and the tensor fascia latae, within a defined region of interest. Break tests were performed using a handheld dynamometer to assess hip abductor strength. During the strength test, the participant was positioned in sidelying with the involved hip in 15° of abduction. Independent-samples t tests were used to compare muscle volume and strength values between those with CHJP and asymptomatic controls. Results Compared to asymptomatic controls, women with CHJP demonstrated significantly increased gluteal muscle volume (228 ± 40 cm3 versus 199 ± 29 cm3, P = .032), but decreased hip abductor strength (74.6 ± 16.8 Nm versus 93.6 ± 20.2 Nm, P = .009). There were no significant differences in tensor fascia lata muscle volume between the 2 groups (P = .640). Conclusion Women with CHJP appear to have larger gluteal muscle volume, but decreased hip abductor strength, compared to asymptomatic controls. J Orthop Sports Phys Ther 2017;47(12):923-930. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7380.
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Patients With Chondrolabral Pathology Have Bilateral Functional Impairments 12 to 24 Months After Unilateral Hip Arthroscopy: A Cross-sectional Study. J Orthop Sports Phys Ther 2016; 46:947-956. [PMID: 27802796 DOI: 10.2519/jospt.2016.6577] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional study. Background Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. Objectives To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. Methods Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. Results Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R2 range, 0.197-0.407; P<.001). Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. Conclusion Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls. Level of Evidence Therapy/symptom prevalence, level 3b. J Orthop Sports Phys Ther 2016;46(11):947-956. doi:10.2519/jospt.2016.6577.
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Kokubo R, Kim K, Isu T, Morimoto D, Iwamoto N, Kobayashi S, Morita A. Superior Cluneal Nerve Entrapment Neuropathy and Gluteus Medius Muscle Pain: Their Effect on Very Old Patients with Low Back Pain. World Neurosurg 2016; 98:132-139. [PMID: 27989968 DOI: 10.1016/j.wneu.2016.10.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. PATIENTS AND METHODS Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 ± 12.2 months (range 2-35 months). RESULTS SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P < 0.05], Roland-Morris Disability Questionnaire score: declined from 16.5 to 5.2). The other 12 were operated under local anesthesia (SCN neurolysis, GMeM decompression). As 3 patients reported the persistence of leg pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P < 0.05). CONCLUSIONS Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan.
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro City, Hokkaido Prefecture, Japan
| | - Daijiro Morimoto
- Department of Neurosurgery, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Teikyo University School of Medicine, Itabashi, Tokyo, Japan
| | - Shiro Kobayashi
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Bunkyo, Tokyo, Japan
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Comparison of Electromyographic Activity of the Superior and Inferior Portions of the Gluteus Maximus Muscle During Common Therapeutic Exercises. J Orthop Sports Phys Ther 2016; 46:794-9. [PMID: 27494053 DOI: 10.2519/jospt.2016.6493] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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, repeated-measures design. Background Previous studies have reported that the superior and inferior portions of the gluteus maximus have different functional roles. Knowledge of how the different portions of the gluteus maximus are activated during therapeutic exercise may lead to more specific exercise prescription. Objective To compare muscle activation of the superior and inferior portions of the gluteus maximus during commonly used therapeutic exercises. Methods Twenty healthy persons participated. Electromyographic (EMG) signals were obtained from the superior and inferior portions of the gluteus maximus using fine-wire electrodes. Normalized EMG signal amplitudes were compared between the superior and inferior gluteus maximus across 11 exercises using a 2-way repeated-measures analysis of variance. Results The superior portion of the gluteus maximus had significantly greater relative EMG activity than the inferior portion of the gluteus maximus during exercises that incorporated elements of hip abduction and/or external rotation (5 of 11 exercises evaluated). There was no significant difference in activation between the superior and inferior portions of the gluteus maximus during the remaining 6 exercises. Conclusion The results of the present study demonstrate preferential activation of the superior portion of the gluteus maximus during exercises that incorporate elements of hip abduction and/or external rotation. In contrast, exercises that primarily involve hip extension target both portions of the gluteus maximus to a similar extent. J Orthop Sports Phys Ther 2016;46(9):794-799. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6493.
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Movement-Pattern Training to Improve Function in People With Chronic Hip Joint Pain: A Feasibility Randomized Clinical Trial. J Orthop Sports Phys Ther 2016; 46:452-61. [PMID: 27117727 PMCID: PMC4889512 DOI: 10.2519/jospt.2016.6279] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Feasibility randomized clinical trial. Background Rehabilitation may be an appropriate treatment strategy for patients with chronic hip joint pain; however, the evidence related to the effectiveness of rehabilitation is limited. Objectives To assess feasibility of performing a randomized clinical trial to investigate the effectiveness of movement-pattern training (MPT) to improve function in people with chronic hip joint pain. Methods Thirty-five patients with chronic hip joint pain were randomized into a treatment (MPT) group or a control (wait-list) group. The MPT program included 6 one-hour supervised sessions and incorporated (1) task-specific training for basic functional tasks and symptom-provoking tasks, and (2) strengthening of hip musculature. The wait-list group received no treatment. Primary outcomes for feasibility were patient retention and adherence. Secondary outcomes to assess treatment effects were patient-reported function (Hip disability and Osteoarthritis Outcome Score), lower extremity kinematics, and hip muscle strength. Results Retention rates did not differ between the MPT (89%) and wait-list groups (94%, P = 1.0). Sixteen of the 18 patients (89%) in the MPT group attended at least 80% of the treatment sessions. For the home exercise program, 89% of patients reported performing their home program at least once per day. Secondary outcomes support the rationale for conduct of a superiority randomized clinical trial. Conclusion Based on retention and adherence rates, a larger randomized clinical trial appears feasible and warranted to assess treatment effects more precisely. Data from this feasibility study will inform our future clinical trial. Level of Evidence Therapy, level 2b-. J Orthop Sports Phys Ther 2016;46(6):452-461. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6279.
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Chiu LZF, vonGaza GL, Jean LMY. Net joint moments and muscle activation in barbell squats without and with restricted anterior leg rotation. J Sports Sci 2016; 35:35-43. [DOI: 10.1080/02640414.2016.1154978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kim K, Isu T, Chiba Y, Iwamoto N, Morimoto D, Isobe M. Decompression of the gluteus medius muscle as a new treatment for buttock pain: technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1282-8. [PMID: 26894751 DOI: 10.1007/s00586-016-4440-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE The clinical features and etiology of low back pain and buttock pain remain poorly understood. We report ten patients with buttock pain who underwent gluteus medius muscle (GMeM) decompression under local anesthesia. METHODS Between December 2012 and November 2013 we surgically treated ten patients (four men, six women; mean age 65.1 years) for buttock pain. The affected side was unilateral in seven and bilateral in three patients (total sites, n = 13). The interval from symptom onset to treatment averaged 174 months; the mean postoperative follow-up period was 24 months. Decompression of the tight gluteal aponeurosis over the GMeM was performed under local anesthesia. Assessment of the clinical outcomes was on the numeric rating scale (NRS) for low back pain (LBP), the Japanese Orthopedic Association (JOA) score, and the Roland-Morris Disability Questionnaire (RDQ) score before and at the latest follow-up after treatment. RESULTS There were no intraoperative surgery-related complications. The buttock pain of all patients was improved after surgery; their NRS decreased from 7.0 to 0.8 and JOA and RMDQ scores indicated significant improvement (p < 0.05). CONCLUSION In patients with buttock pain, pain around the GMeM should be considered as a causative factor. Less invasive surgery with cutting and opening of the tight gluteal aponeurosis over the GMeM under local anesthesia yielded excellent clinical outcomes.
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Affiliation(s)
- Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, 1715, Kamagari, Inzai, Chiba, Japan.
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Yasuhiro Chiba
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | | | - Masanori Isobe
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
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