Comparative reliability of the make and break tests for hip abduction assessment

Influence of hip flexion angle on strength and gluteal muscle activities in the clinical pilates clamshell exercise

The study aimed to investigate the presence of directional preference using the Clinical Pilates method of clamshell exercise among relatively healthy young adults, and the influence of hip flexion angles on maximum isometric strength (handheld dynamometer) and muscle activities (electromyography). The clamshell assessment involves testing in varying angles of hip flexion (0°, 30°, 60° and 90°) and 21 participants were tested. Directional preferences in the transverse and anteroposterior axes of movements were present among the participants. Gluteus medius activation was highest in the non-problem side across all hip flexion angles. In contrast, the problem side showed dysfunction of the gluteus medius, especially at the 60° hip flexion angle, 0.89 unit (ratio of maximal voluntary isometric contraction) reduction per 1 N force exerted, 95% CI -1.69 to -0.09, p = 0.031. Comparison against the non-problem side found gluteus medius activity lower on the problem side, mean difference (SD) was 26.2 (56.1), p = 0.045. Therefore, directional preference is not limited to people with injuries and can exist in healthy individuals or people who have recovered from injuries. The gluteus medius was identified to be dysfunctional on the problem side and Clinical Pilates clamshell assessment is potentially useful in assessing for motor coordination impairment.

Influence of lower limb muscle isometric strength and cardiovascular parameters on locomotor capacity in children and adolescents

BACKGROUND

Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown.

OBJECTIVE

To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height.

METHODS

Participants (7 to 15 years old; female, n= 113; male, n= 128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals.

RESULTS

Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R=2 0.45; p< 0.001) for 6mWT distance, and the resting heart rate explained a change in R2 of only 2% (p= 0.008).

CONCLUSIONS

Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth's capacity.

Isometric strength of upper limb muscles in youth using hand-held and hand-grip dynamometry

The present study aimed to determine the isometric strength profile of the upper limb muscles of children and adolescents between 7–15 years of age. Furthermore, to (a) identify the age at which differences in strength are observed between sexes; to (b) determine the age range at which significant progression of strength could be observed; and (c) identify the role of each muscle on the total upper limb strength. Cross-sectional study that evaluated the isometric strength of nine muscle groups of the upper limb of 243 Chilean children, split into 9 age groups, separated by 1-year intervals. For this, hand-held dynamometry and hand-grip dynamometry were used. A two-factor analysis of variance for the maximum isometric strength and a stepwise multiple linear regression analysis were performed. From 11 years of age, wrist flexors were the first muscle group that revealed a significant difference in isometric strength in favor of boys (P=0.0143). In boys, the narrowest and earliest age range in the progression of isometric strength was 10 to 12 years for wrist flexors (P=0.0392). Shoulder flexors was the main factor that explained the performance of the total upper limb strength (R²=0.742; P<0.001). The most progressive isometric strength development occurred from age 10 years in the ventral and distal muscles of the upper limb; and from this age the boys begin to present a greater isometric strength than girls. In addition, the isometric strength of shoulder flexors explained the higher total upper limb strength performance.

Knee and hip agonist-antagonist relationship in male under-19 soccer players

The purpose of this study was to evaluate the strength of the knee flexors and extensors and hip abductor and adductor muscles in young soccer players. Twenty-three male under-19 soccer players participated in this study (age: 17.7 ± 0.2 years; height: 173.0 ± 1.1 cm; body mass: 66.1 ± 1.3 kg). Body composition was measured using a bioelectrical impedance (InBody770), and the dynamometry was performed by an isokinetic dynamometer (Biodex System 3) for knee flexion and extension, and by an isometric dynamometer (Smart Groin Trainer), for hip adduction and abduction. Comparisons were made between dominant members (D) vs. non-dominant members (ND) and adductors vs. abductors (ADD:ABD) using the Wilcoxon test. There were statistically significant differences in the peak torques between the dominant and non-dominant members in the flexion function (Z = −4.198, p < 0.01) and in the extension function (Z = −4.197, p < 0.01) of the knee in concentric muscular action, and the flexion (Z = −4.198, p < 0.01) and in the extension (Z = −4.198, p < 0.01) of the knee in eccentric muscular action. No statistically significant differences were obtained in the conventional ratio (Z = −0.456, p = 0.648) nor the functional ratio (Z = −0.335, p = 0.738) between D and ND members. There were no statistically significant differences between adductors and abductors at the moment of strength for absolute values (N). The reference absolute and normalized to the weight values and the ADD:ABD can be used as a guideline for classifying players in screening and comparison in return tests to sports practice after an injury.

Weight-Bearing Versus Traditional Strength Assessments of the Hip Musculature

CONTEXT

Traditional nonweight-bearing (NWB) hip-strength assessments may not directly translate to functional strength during weight-bearing (WB) activity. How NWB assessments of hip muscle strength compare with WB assessments in various positions is currently unknown.

OBJECTIVE

To determine the magnitude of the differences and correlations between NWB hip strength and WB functional strength during the squatting and lunge (LNG) positions in female athletes.

DESIGN

Crossover design.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Female athletes (N = 51, age = 16.2 ± 3.5 years, height = 161.5 ± 8.3 cm, mass = 58.3 ± 11.6 kg).

INTERVENTION(S)

Isometric resistance (N/kg) was determined for the dominant and nondominant limbs via WB assessments (squat-bilateral [legs tested simultaneously], squat-unilateral, and lunge positions) and NWB assessments (hip abduction [HAB], hip extension HEXT], and hip external rotation [HER]).

MAIN OUTCOME MEASURE(S)

To compare differences between positions (P ≤ .05), we used effect sizes (d) and matched-pairs t tests, and we calculated Pearson r and R2 values.

RESULTS

During the squat-bilateral on the dominant limb, females produced the most hip torque (6.13 ± 1.12 N/kg). The magnitudes of differences were very large compared with HER (3.96 ± 0.83, d = 2.2), HEXT (3.22 ± 0.69, d = 3.2), and HAB (3.80 ± 1.01, d = 2.2; all P values ≤ .01), and positions were moderately correlated (r = 0.347-0.419, R2 = 0.12-0.18). The lunge position produced the least amount of torque in the dominant limb (2.44 ± 0.48 N/kg) compared with HER (d = -2.3), HEXT (d = -1.3), and HAB (d = -1.7; all P values ≤ .001), and correlations were small to moderate (r = 0.236-0.310, R2 = 0.06-0.10).

CONCLUSIONS

Strength in WB positions was different than strength evaluated using traditional NWB assessments in female athletes. Weight-bearing tests may provide clinicians with additional information regarding strength and function.

Shoulder muscle force and electromyography activity during make versus break tests

BACKGROUND

Shoulder muscle force is commonly assessed during clinical examination using both an isometric "make" test against a fixed resistance or a "break" test where the examiner exerts enough force to break the isometric contraction. The purpose of this study was to explain the difference in force produced during these two forms of testing.

METHODS

Data were collected on 25 subjects. Both shoulder external rotation and elevation force were measured over three trials, isometrically, for approximately 3 s, after which the examiner exerted enough force to move the arm. Surface EMG was recorded for the infraspinatus for external rotation and middle deltoid for elevation. Peak isometric and break forces, and normalized, averaged EMG data at peak isometric and break forces were compared with paired t-tests.

FINDINGS

External rotation peak break force was 46.9% (SD33.6, range - 3% to 108.6%) greater than isometric force (p < 0.01). EMG for the infraspinatus was 17.0% (20.8) greater at break (p < 0.01). For elevation, peak break force was 63% (73.1, range - 3.5 to 238.16%) greater than isometric force (p < 0.01). EMG for the middle deltoid was 11.1% (30.8) greater during peak break force (not significant).

INTERPRETATIONS

There is a difference in both force and muscle activity between "make" and "break" tests. Clinicians should use a consistent method when measuring force and a break test will provide the maximum force. The cause of greater force produced during a break test is likely attributable to the brief eccentric contraction rather than greater recruitment. Future analysis will include examining the differences in make and break forces based on activity levels.

Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies: A systematic review

Objectives

The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field.

Methods

The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only.

Results

A total of 29 articles were reviewed to obtain information on a number of variables. These comprised the type of device used for measurement, rater standardisation, the type of movements tested, body positioning and comparative studies of muscle strength in FAI versus normal controls. The studies found that hip muscle strength is lower in patients with FAI; this is also true for the asymptomatic hip in patients with FAI.

Conclusions

Current literature on this subject is limited and examines multiple variables. Our recommendations for achieving reproducible results include stabilising the patient, measuring isometric movements and maximising standardisation by using a single tester and familiarising the participants with the protocol. Further work must be done to demonstrate the reliability of any new testing method.

Cite this article: E. Mayne, A. Memarzadeh, P. Raut, A. Arora, V. Khanduja. Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies: A systematic review. Bone Joint Res 2017;6:66–72. DOI: 10.1302/2046-3758.61.BJR-2016-0081.