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

Exploring lower limb muscle activity and performance variations during instrumented Sit-to-Stand-to-Sit in sedentary individuals: Influence of limb dominance and testing modalities

PURPOSE

to explore lower limb muscle activity concerning limb dominance, as well as variations in force and power during the standing up and sitting down phases of the instrumented sit-to-stand-to-sit test in sedentary individuals, across isokinetic and isotonic modalities.

METHODS

33 sedentary individuals underwent testing using a functional electromechanical dynamometer in both isokinetic and isotonic modes, accompanied by surface electromyography.

RESULTS

In the isokinetic mode, the non-dominant gastrocnemius medialis and vastus medialis exhibited significantly (p < 0.05) higher muscle activity values during the standing up and sitting down phase compared to dominant counterparts. In the isotonic mode standing up phase, significant differences in muscle activity were noted for non-dominant gastrocnemius medialis, vastus medialis, and biceps femoris compared to their dominant counterparts. The sitting down phase in isotonic mode showed higher muscle activity for non-dominant vastus medialis compared to dominant vastus medialis. Regard to performance outcomes, significantly lower (p < 0.0001) values were observed for standing up (12.7 ± 5.1 N/kg) compared to sitting down (15.9 ± 6.1 N/kg) peak force, as well as for standing up (18.7 ± 7.8 W/kg) compared to sitting down (25.9 ± 9.7 W/kg) peak power in isokinetic mode. In isotonic mode, lower values were found for sitting down (6.5 (6.3-7.1) N/kg) compared to standing up (7.8 (7.3-8.9) N/kg) peak force and for sitting down (18.5 (13.2-21.7) W/kg) compared to standing up (33.7 (22.8-41.6) W/kg) peak power.

CONCLUSIONS

Limb dominance influences lower-limb muscle activity during the instrumented sit-to-stand-to-sit test, and the choice of testing mode (isokinetic or isotonic) affects muscle engagement and performance outcomes.

Favourable mid-term isokinetic strength after primary THA combined with a modified enhanced recovery after surgery concept (ERAS) in a single blinded randomized controlled trial

PURPOSE

Muscular deficits as part of severe osteoarthritis of the hip may persist for up to two years following total hip arthroplasty (THA). No study has evaluated the mid-term benefit of a modified enhanced-recovery-after-surgery (ERAS) concept on muscular strength of the hip in detail thus far. We (1) investigated if a modified ERAS-concept for primary THA improves the mid-term rehabilitation of muscular strength and (2) compared the clinical outcome using validated clinical scores.

METHODS

In a prospective, single-blinded, randomized controlled trial we compared patients receiving primary THA with a modified ERAS concept (n = 12, ERAS-group) and such receiving conventional THA (n = 12, non-ERAS) at three months and one year postoperatively. For assessment of isokinetic muscular strength, a Biodex-Dynamometer was used (peak-torque, total-work, power). The clinical outcome was evaluated by using clinical scores (Patient-Related-Outcome-Measures (PROMs), WOMAC-index (Western-Ontario-and-McMaster-Universities-Osteoarthritis-Index), HHS (Harris-Hip-Score) and EQ-5D-3L-score.

RESULTS

Three-months postoperatively, isokinetic strength (peak-torque, total-work, power) and active range of motion was significantly better in the modified ERAS group. One year postoperatively, the total work for flexion was significantly higher than in the Non-ERAS group, whilst peak-torque and power did not show significant differences. Evaluation of clinical scores revealed excellent results at both time points in both groups. However, we could not detect any significant differences between both groups in respect of the clinical outcome.

CONCLUSION

With regard to muscular strength, this study supports the implementation of an ERAS concept for primary THA. The combination with a modified ERAS concept lead to faster rehabilitation for up to one-year postoperatively, reflected by significant higher muscular strength (peak-torque, total-work, power). Possibly, because common scores are not sensitive enough, the results are not reflected in the clinical outcome. Further larger randomized controlled trials are necessary for long-term evaluation.

Comparison of postoperative isokinetic quadriceps and gluteal muscular strength after primary THA: is there an early benefit through enhanced recovery programs?

PURPOSE

Although total hip arthroplasty (THA) is expected to result in a postoperative loss of muscular strength, no study investigated the benefit of an enhanced-recovery-after-surgery (ERAS) concept on the hip muscles in detail. We evaluated if (1) an ERAS-concept for primary THA results in reduced loss of muscular strength five days and four weeks postoperative. We (2) compared the two groups regarding Patient-Related-Outcome-Measures (PROMs), WOMAC-index (Western-Ontario-and-McMaster-Universities-Osteoarthritis-Index), HHS (Harris-Hip-Score) and EQ-5d-3L-score.

METHODS

In a prospective, single-blinded, randomized controlled trial, we compared isokinetic muscular strength of 24 patients receiving primary THA with an enhanced recovery concept with early mobilization (n = 12, ERAS-group) and such receiving conventional THA (n = 12, non-ERAS). Isokinetic muscular strength was measured with a Biodex-Dynamometer before, as well as five days and four weeks after surgery (peak-torque, total-work, power). Furthermore, WOMAC, HHS, PROMs and EQ-5d-3L were imposed.

RESULTS

The ERAS group revealed significant higher isokinetic strength (peak-torque, total-work, power) at both time points. Both groups showed a significant pain decrease at both time points meeting very high rates of patient satisfaction resembled by good results in PROMs, WOMAC, HHS, EQ-5d. There was no significant difference in any of the scores between both groups.

CONCLUSION

We proved a significant reduced loss of muscular strength five days and four weeks after primary THA in combination with an ERAS concept. However, the reduced loss of muscular strength is not reflected by patient's functional outcome and quality of life, showing no significant differences in WOMAC, HHS, EQ-5d-3L, PROMs and NRS. Therefore, this study supports the implementation of an ERAS concept for primary THA in terms of isokinetic strength. Further studies are needed to evaluate the development of muscular strength over a long period.

Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement

Overall, 84%-87% of athletes will return to sport following hip arthroscopy; however, some literature suggests that only 57% of athletes return to their preinjury level, and only 16.9% report optimal performance. This discrepancy may be due to a lack of consistency within the definition of return to sport as well as a lack of consistency within rehabilitation programs when determining return to sport readiness. Athletes who are returning to sport must demonstrate adequate range of motion, strength, and the ability to perform multi-directional movements without the risk of reinjury. There has yet to be a comprehensive, criteria-based, return to sport testing protocol that utilizes objective measures to ensure athletes are ready for return to sport. The goal of the authors was to create a criteria-based testing protocol for return to sport following hip arthroscopy utilizing components best supported in the literature. The following parameters were identified as key areas to assess for within a return to sport testing protocol: range of motion, strength, functional testing, self-reported outcomes including psychological readiness and time. The purpose of this clinical commentary is to propose a criteria-based testing protocol to be used following hip arthroscopy for impingement from early rehabilitation through return to previous level of sport. Criteria are presented clearly to promote objective progression through rehabilitation while still being mindful of the biological healing time required for safe and efficient progression. It is the authors' hope that in identifying and establishing a criteria-based testing protocol a higher percentage of athletes will be able to return to sport.

Level of Evidence

5.

Dynamometric Strength Profile of Hip Muscles in Youth Soccer Players

BACKGROUND

Soccer is the most widely practiced sport in the world, demanding high-speed activities such as jumps, sprints and changes of direction. Therefore, having optimal levels of muscle strength improves performance and reduces the injury rate.

OBJECTIVES

The objectives of our study were (i) to determine the dynamometric profile of hip muscle strength in young soccer players by position, evaluated at different isokinetic speeds, (ii) to describe the conventional and functional unilateral muscle strength ratios, (iii) to analyze the bilateral balance.

METHODS

Thirty-seven male soccer players (age 17.02 ± 0.92 years) participated in the study. Strength assessment was performed with a functional electromechanical dynamometer, and concentric and eccentric strength of abductors, adductors, extensors and hip flexors were measured bilaterally at 0.5 m/s and 1 m/s.

RESULTS

For eccentric right hip abduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.013) and stronger than forwards (p = 0.140). For eccentric right hip adduction at 0.5 m/s, defenders are significantly stronger than midfielders (p = 0.005) and stronger than forwards (p = 0.253), as for eccentric right hip adduction at 1 m/s, defenders are significantly stronger than midfielders (p = 0.014) and stronger than forwards (p = 0.084). There is a significant effect for the conventional strength ratio of left abduction/adduction at 1 m/s. The conventional strength ratio of forwards is significantly higher than that of defenders (p = 0.045) and higher than that of midfielders (p = 0.152).

CONCLUSIONS

Concentric and eccentric hip strength values differ according to playing position.

Determining the hip joint isokinetic muscle strength and range of motion of professional soccer players based on their field position

Background

Soccer players' physical and physiological demands vary based on their field position. Although the hip joint has an important role in soccer, little information is available about the strength and flexibility of the hip joint based on player positions. Therefore, this study aims to investigate the differences in muscle strength and flexibility of the hip joint of professional soccer players based on their field position.

Methods

Ninety-six professional soccer players from Saudi Arabia were divided into four groups (goalkeepers, defenders, midfielders, and attackers), with 24 participants in each group based on their field position. The Modified Thomas test was used to measure the hip extension range of motion (ROM), and muscle strength was assessed by an Isokinetic dynamometer.

Results

There were no statistically significant differences in the isokinetic strength at the hip joint movements between goalkeepers, defenders, midfielders, and attackers (p ≥ 0.05). At the same time, there was a significant difference between groups in the hip extension ROM (p ≤ 0.05). according to different player positions. Post hoc tests reported significant differences between goalkeepers and defenders (p ≤ 0.05), midfielders (p ≤ 0.05), and attackers p ≤ 0.05). At the same time, there were no significant differences between defenders and midfielders (p ≥ 0.05), defenders and attackers (p ≥ 0.05), and midfielders and attackers (p ≥ 0.05).

Conclusion

Even though there was no significant difference in isokinetic strength, there was a significant difference in hip extension ROM among players based on field position. This study may help coaches and trainers to recognize the strengths and weaknesses of players and design training programs to rectify the weaker components and improve players' performance in different playing positions.