STRENGTH AND FATIGUE MEASUREMENTS OF THE HIP FLEXOR AND HIP EXTENSOR MUSCLES: TEST-RETEST RELIABILITY AND LIMB DOMINANCE EFFECT

Does Pelvic Tilt Angle Influence the Isokinetic Strength of the Hip and Knee Flexors and Extensors?

The purpose of this study was to examine the effect of pelvic tilt angle on maximum hip and knee muscles' strength and antagonist/agonist strength ratios. Twenty-one young males and females performed maximum isokinetic concentric knee extension-flexion and hip extension-flexion efforts at 60°·s-1, 120°·s-1, and 180°·s-1 from three positions: anterior, neutral, and posterior pelvic tilt. Peak torques and knee flexor-to-extensor and hip flexor-to-extensor torque ratios were analyzed. An analysis of variance showed that peak hip extensor torque was significantly greater in the anterior pelvic tilt condition compared to either neutral or posterior pelvic tilt angles (p > 0.05). No effects of changing pelvic tilt angle on hip flexor, knee flexor, or knee extension values were found (p > 0.05). The hip flexor-to-extensor torque ratio decreased (p < 0.05) in the anterior pelvic tilt position relative to the other positions, while no difference in the knee flexor-to-extensor ratio between pelvic positions was observed (p > 0.05). This study shows that an increased anterior pelvic tilt affects the maximum isokinetic strength of the hip extensors, supporting previous suggestions regarding the link between pelvic position and hip and knee muscle function. Isokinetic testing from an anterior pelvic tilt position may alter the evaluation of hip flexion/extension strength.

Upper limb cranking asymmetry during a Wingate anaerobic test in wheelchair basketball players

INTRODUCTION

Interlimb asymmetry of strength and/or motor coordination could limit the performance of wheelchair athletes or increase their risk of injury. Studies of interlimb asymmetry in the lower limbs have shown high between-subject variability that does not depend on the side of dominance and that does not change with fatigue. Upper limb asymmetry is particularly large in manual wheelchair athletes with a lower degree of impairment. The aim of this study was to evaluate interlimb asymmetry of forces developed during an upper limb Wingate anaerobic test, the effects of fatigue on force, and differences between high- and low-point players.

METHOD

Twenty-five wheelchair basketball players (13 females and 12 males) of male and female national French teams performed a 30s anaerobic Wingate test on an arm ergometer. Participants were classified into two functional categories, high-point (classed from 3 to 4.5) and low-point (classed from 1 to 2.5), according to the International Wheelchair Basketball Federation classification. Left and right arm forces were measured during the pushing and pulling phases at peak power, 10s, and the end of the 30s test.

RESULTS

Upper limb asymmetry changed with fatigue during each phase. Force asymmetry differed between peak power, 10s and 30s, with no consistent increase or decrease. Asymmetry did not differ significantly between low- and high-point players but tended to be greater in high-point players. Asymmetry tended to be greater in the females, with significant differences between the males and females in the push phase.

CONCLUSION

Inter-subject variability was high, but forces were asymmetric for most participants, especially females. The Wingate anaerobic test could highlight problematic asymmetries that might impact daily life or sports performance.

Hip joint function and reconstruction of the anterior femoral offset in patients with short stem vs. conventional THA

In cases where mobility and joint function are impaired after implantation of a THA, weakening of hip movement in both extension/flexion and adduction/abduction may play a role due to shortening of the physiological lever arm of the hip muscles. Mechanical factors of influence include the lateral femoral offset, which affects the lever arm, and the antetorsion angle of the hip prosthesis, which affects the anterior femoral offset. This study aimed to investigate the effect of an altered antetorsion angle of the implant on the hip moments and gait patterns of the patient. For this study, 13 patients with a conventional stem on one side and a calcar-guided short stem implanted on the contralateral side were included. To determine the maximum hip moment, tests were performed on a dynamometer in extension/flexion and adduction/abduction in addition to gait analysis. As a control, a comparison was made with data from a reference group of 30 healthy subjects. Both implants showed similar symmetry indices. There was a significant difference between the implants for adduction moments (p < 0.001). The ratios between the directions of moments showed no significant differences. The joint function measured by isokinetic measurements and gait analysis remains comparable to the healthy control group after short stem arthroplasty, but shows slight changes after conventional stem arthroplasty.

Feasibility and acceptability of a six-month exercise and patient education intervention for patients with hip dysplasia: A mixed methods study

BACKGROUND AND OBJECTIVES

To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery.

DESIGN

Feasibility study.

METHODS

The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms.

RESULTS

Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5-17) HAGOS pain points, improvements in all subscales were 1-11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04-0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64-74) to 75 (IQR: 72-80) centimetres; posteromedial: 104 (IQR: 94-112) to 119 (IQR: 112-122) centimetres and posterolateral: 98 (IQR: 89-109) to 116 (IQR: 108-121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30-44) to 52 (IQR: 45-58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1,581:1,872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harms.

CONCLUSION

Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Comparing exercise and patient education with usual care in the treatment of hip dysplasia: a protocol for a randomised controlled trial with 6-month follow-up (MovetheHip trial)

INTRODUCTION

Surgery is not a viable treatment for all patients with hip dysplasia. Currently, usual care for these patients is limited to a consultation on self-management. We have shown that an exercise and patient education intervention is a feasible and acceptable intervention for patients not receiving surgery. Therefore, we aim to investigate whether patients with hip dysplasia randomised to exercise and patient education have a different mean change in self-reported pain compared with those randomised to usual care over 6 months. Furthermore, we aim to evaluate the cost-effectiveness and perform a process evaluation.

METHODS AND ANALYSIS

In a randomised controlled trial, 200 young and middle-aged patients will be randomised to either exercise and patient education or usual care at a 1:1 ratio through permuted block randomisation. The intervention group will receive exercise instruction and patient education over 6 months. The usual care group will receive one consultation on self-management of hip symptoms. The primary outcome is the self-reported mean change in the pain subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS). Secondary outcomes include mean changes in the other HAGOS subscales, in the Short Version of the International Hip Outcome Tool, in performance, balance and maximal hip muscle strength. Between-group comparison from baseline to 6-month follow-up will be made with intention-to-treat analyses with a mixed-effects model. Cost-effectiveness will be evaluated by relating quality-adjusted life years and differences in HAGOS pain to differences in costs over 12 months. The functioning of the intervention will be evaluated as implementation, mechanisms of change and contextual factors.

ETHICS AND DISSEMINATION

The study protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region and registered at ClinicalTrials. Positive, negative and inconclusive findings will be disseminated through international peer-reviewed scientific journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT04795843.

Ultrasound Measurement of Rectus Femoris Muscle Parameters for Discriminating Sarcopenia in Community-Dwelling Adults

OBJECTIVES

Sarcopenia patients require more medical attention and caretaking. As such, early detection of sarcopenia and appropriate interventions are crucial for decreasing medical costs and meeting the challenges of aging populations. The aim of the present study was to develop a reliable and accurate model to estimate muscle mass using ultrasound-derived parameters from the rectus femoris (RF), referenced by dual-energy X-ray absorptiometry.

METHODS

Cross-sectional study was performed. The study patients were recruited by Taipei Veterans General Hospital (No. 2016-07-013C) between 2016 and 2019. A total of 91 community-dwelling adults (35 men and 56 women) were enrolled in this study. Ultrasound measurements of RF muscle thickness (MT), cross-sectional area (CSA), and muscle volume (MV) were performed in B-mode. Muscle strength and physical performance were also examined. Multivariate linear regression was used to build models for the prediction of appendicular skeletal muscle index (ASMI) based on MT, CSA, and MV values. The accuracy of ultrasound RF measurements for predicting sarcopenia was evaluated by using receiver operating characteristic (ROC) curve analysis.

RESULTS

The regression equations used for ASMI prediction (adjusted body mass index, sex, and leg length) had high precision and low error. Moreover, the MV model results were close to those of the CSA model and higher than those of the MT model. The ROC analysis showed that both MV and CSA had excellent discrimination when assessing sarcopenia (AUC = 0.83 and 0.81, respectively), whereas MT showed acceptable discrimination (AUC = 0.73).

CONCLUSIONS

Ultrasound-derived RF MV was accurate when predicting ASMI and diagnosing sarcopenia in community-dwelling adults.

Assessing gait, balance, and muscle strength among breast cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): study protocol for a randomized controlled clinical trial

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and understudied consequence of taxane chemotherapy for breast cancer treatment. CIPN symptoms include numbness combined with tingling sensations, persistent shooting, stabbing, or burning pain even in the absence of painful stimuli, lower extremity muscle weakness, and impaired balance. CIPN symptoms often persist for a long time after completion of chemotherapy, causing significant loss of functional abilities and increased risk of falls. Persistent CIPN caused by taxanes represents a therapeutic challenge due to the limited treatment options. Resistance exercise has shown promising results; however, the effect of exercise on CIPN remains understudied. This study aims to assess the effects of exercise on gait, balance, and lower extremity muscle strength after a 16-week home-based exercise program compared to an educational attention control condition.

Methods

A sample of 312 women who completed taxane-based chemotherapy for breast cancer and have symptomatic neuropathy is recruited from a community-dwelling sample. Participants are randomized to either a 16-week Home-Based Physical Activity Intervention or an Educational Attention control group. The home-based intervention protocol consists of targeted lower extremity stretches, followed by 10 min each of gait/balance and 10 min of resistive training accessed by hyperlink or DVD. An Exercise Diary records quantitative exercise data. The gait assessment includes temporospatial parameters and lower extremity joint angles using APDM motion sensors. Participants’ balance is assessed using the Sensory Organization Test (SOT) performed using a NeuroCom Balance Master. Isometric strength of hip, knee, and ankle flexor and extensor muscles is assessed using an isokinetic dynamometer, Biodex BX Advantage. In addition, we assess neuropathy symptoms using the FACT-Taxane Additional Concerns Subscale and nerve conduction velocity of the sural and peroneal nerve action potentials. Outcomes are assessed at baseline (prior to randomization) and 16 weeks.

Discussion

There are currently no evidence-based interventions that address the functional declines associated with CIPN. If successful, this program is simple and easy to implement in the standard of care for individuals with CIPN. Gait and balance training have the potential to reduce physical dysfunction associated with CIPN and reduce the burden of disease in cancer survivors.

Trial registration

ClinicalTrials.gov NCT04621721. Registered on August 3, 2020. ClincialTrials.gov is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTEP) network and includes all items from the WHO Trial Registration data set in Trial registration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06294-w.

Reliability of Isokinetic Hip Flexor and Extensor Strength Measurements in Healthy Subjects and Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

The objective of this systematic review and meta-analysis was to examine the reliability of isokinetic measurements of hip strength in flexion and extension in healthy subjects and athletes.

METHODS

The databases used were Web of Science, SCOPUS, Medline and PubMed. R was used for all statistical analyses.

RESULTS

Hip flexion shows moderate reliability in the supine position (ICC = 0.72; 95% CI: 0.46-0.99) and good reliability in the standing position (ICC = 0.79; 95% CI: 0.54-1.04). Hip extension shows excellent reliability in the supine position (ICC = 0.90; 95% CI: 0.85-0.96) and moderate reliability in the standing position (ICC = 0.72; 95% CI: 0.48-0.96). Flexion of 120°/s and 180°/s showed excellent reliability (ICC = 0.93; 95% CI: 0.85-1.00), (ICC = 0.96; 95% CI: 0.92-1.01). The 60°/s and 120°/s extension showed good reliability (ICC = 0.90; 95% CI: 0.82-0.98), (ICC = 0.87; 95% CI: 0.75-0.99). The 180°/s extension presented excellent reliability (ICC = 0.93; 95% CI: 0.82-1.03).

CONCLUSIONS

The standing position shows good reliability for hip flexion and the supine position shows excellent reliability for hip extension, both movements have excellent reliability at velocities between 120°/s to 180°/s.

Functional muscle group- and sex-specific parameters for a three-compartment controller muscle fatigue model applied to isometric contractions

The three-compartment controller with enhanced recovery (3CC-r) model of muscle fatigue has previously been validated separately for both sustained (SIC) and intermittent isometric contractions (IIC) using different objective functions, but its performance has not yet been tested against both contraction types simultaneously using a common objective function. Additionally, prior validation has been performed using common parameters at the joint level, whereas applications to many real-world tasks will require the model to be applied to agonistic and synergistic muscle groups. Lastly, parameters for the model have previously been derived for a mixed-sex cohort not considering the differece in fatigabilities between the sexes. In this work we validate the 3CC-r model using a comprehensive isometric contraction database drawn from 172 publications segregated by functional muscle group (FMG) and sex. We find that prediction errors are reduced by 19% on average when segregating the dataset by FMG alone, and by 34% when segregating by both sex and FMG. However, minimum prediction errors are found to be higher when validated against both SIC and IIC data together using torque decline as the outcome variable than when validated sequentially against hypothesized SIC intensity-endurance time curves with endurance time as the outcome variable and against raw IIC data with torque decline as the outcome variable.

Age-Related Differences in Hip Flexion Maximal and Rapid Strength and Rectus Femoris Muscle Size and Composition

This study aimed to examine the effects of age on hip flexion maximal and rapid strength and rectus femoris (RF) muscle size and composition in men. Fifteen young (25 [3] y) and 15 older (73 [4] y) men performed isometric hip flexion contractions to examine peak torque and absolute and normalized rate of torque development (RTD) at time intervals of 0 to 100 and 100 to 200 milliseconds. Ultrasonography was used to examine RF muscle cross-sectional area and echo intensity. Peak torque, absolute RTD at 0 to 100 milliseconds, and absolute and normalized RTD at 100 to 200 milliseconds were significantly lower (P = .004-.045) in the old compared with the young men. The older men exhibited lower cross-sectional area (P = .015) and higher echo intensity (P = .007) than the young men. Moreover, there were positive relationships between cross-sectional area and absolute RTD at 0 to 100 milliseconds (r = .400) and absolute RTD at 100 to 200 milliseconds (r = .450) and negative relationships between echo intensity and absolute RTD at 100 to 200 milliseconds (r = -.457) and normalized RTD at 100 to 200 milliseconds (r = -.373). These findings indicate that hip flexion maximal and rapid strength and RF muscle size and composition decrease in old age. The relationships observed between ultrasound-derived RF parameters and measurements of RTD suggest that these age-related declines in muscle size and composition may be relevant to hip flexion rapid torque production.