Effects of real-time visual biofeedback of pelvic movement on electromyographic activity of hip muscles and lateral pelvic tilt during unilateral weight-bearing and side-lying hip abduction exercises

Context:Gluteus medius rehabilitation is of critical importance given its role in pelvic and lower limb stability, and the known link between gluteus medius weakness and many lower limb conditions.Objective:To systematically review the literature and present an evidence-based graduated series of exercises to progressively load gluteus medius.Evidence Acquisition:A systematic literature search was conducted in January 2016 to identify studies reporting gluteus medius muscle activity as a percentage of maximal volitional isometric contraction (MVIC), during rehabilitation exercises. Studies that investigated injury free participants were included. No restrictions were placed on the type or mode of exercise, though exercises that could not be accurately replicated or performed within an independent setting were excluded. Studies that did not normalize electromyographic activity to a side lying MVIC were excluded. Exercises were stratified based on exercise type and %MVIC: low (0% to 20%), moderate (21% to 40%), high (41% to 60%), and very high (> 61%).Evidence Synthesis:20 studies were included in this review, reporting outcomes in 33 exercises (and a range of variations of the same exercise). Prone, quadruped, and bilateral bridge exercises generally produced low or moderate load. Specific hip abduction/rotation exercises were reported as moderate, high, or very high load. Unilateral stance exercises in the presence of contralateral limb movement were often high or very high load activities, while high variability existed across a range of functional weight-bearing exercises.Conclusions:This review outlined a series of exercises commonly employed in a rehabilitation setting, stratified based on exercise type and the magnitude of gluteus medius muscular activation. This will assist clinicians in tailoring gluteus medius loading regimens to patients, from the early postoperative through to later stages of rehabilitation.

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Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures

Gait & Posture ◽

10.1016/j.gaitpost.2017.10.022 ◽

2018 ◽

Vol 59 ◽

pp. 206-210 ◽

Cited By ~ 5

Author(s):

Marco Raaben ◽

Herman R. Holtslag ◽

Luke P.H. Leenen ◽

Robin Augustine ◽

Taco J. Blokhuis

Keyword(s):

Lower Extremity ◽

Real Time ◽

Weight Bearing ◽

Visual Biofeedback ◽

Therapy Compliance

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Inclination, hip abduction, orientation, and tone affect weight-bearing in standing devices

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-190660 ◽

2021 ◽

pp. 1-9

Author(s):

Ginny Paleg ◽

Wendy Altizer ◽

Rachel Malone ◽

Katie Ballard ◽

Alison Kreger

Keyword(s):

Muscle Tone ◽

Weight Bearing ◽

Typically Developing ◽

Prone Positioning ◽

Convenience Sample ◽

Hip Stability ◽

Normal Tone ◽

Hip Abduction ◽

Muscle Health ◽

Low Tone

PURPOSE: With children who are unable to stand or walk independently in the community, therapists commonly use standing devices to assist lower-extremity weight-bearing which is important for bone and muscle health. In addition, positioning in hip abduction may improve hip stability and range of motion. This is the first study to explore the effect of angle of inclination, hip abduction, body orientation, and tone on weight-bearing in pediatric standing devices. METHODS: This descriptive exploratory study used a convenience sample of 15 participants (2 with normal tone, 5 with generalized hypotonia, and 8 with hypertonia) (mean age of 5 years and 10 months, range of 3 years 4 months to 9 years 7 months); 13 of whom used standing devices at home, as well as 2 typically developing siblings (normal tone). Each child stood in 36 positions to measure the amount of weight-bearing through footplates. RESULTS: Weight-bearing was highest with 60 degrees of abduction and no inclination (upright) in supine positioning for children with low and normal tone. Children with high muscle tone bore most weight through their feet with no abduction (feet together) and no inclination (upright) in prone positioning. Overall, supine positioning resulted in more weight-bearing in all positions for children with low and normal tone. Prone positioning resulted in slightly more weight-bearing in all positions for children with high tone. CONCLUSIONS: Weight-bearing was affected by all three of the variables (inclination, abduction, and orientation) for participants with high, normal, and low tone. To determine optimal positioning, all standers should include a system to measure where and how much weight-bearing is occurring in the device.

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Effect of side-sling plank exercise on trunk and hip muscle activation in subjects with gluteus medius weakness

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210061 ◽

2021 ◽

pp. 1-9

Author(s):

Seung-Min Baik ◽

Heon-Seock Cynn ◽

Chung-Hwi Yi ◽

Ji-Hyun Lee ◽

Jung-Hoon Choi ◽

...

Keyword(s):

Muscle Activation ◽

Gluteus Maximus ◽

Gluteus Medius ◽

Erector Spinae ◽

Lumbar Multifidus ◽

Hip Muscle ◽

Hip Abduction ◽

Medial Rotation ◽

Hip Muscles ◽

Tensor Fasciae Latae

BACKGROUND: The effectiveness of side-sling plank (SSP) exercises on trunk and hip muscle activation in subjects with gluteus medius (Gmed) weakness is unclear. OBJECTIVE: To quantify muscle activation of the rectus abdominis (RA), external oblique (EO), erector spinae (ES), lumbar multifidus (LM), Gmed, gluteus maximus (Gmax), and tensor fasciae latae (TFL) during SSP with three different hip rotations compared to side-lying hip abduction (SHA) exercise in subjects with Gmed weakness. METHODS: Twenty-two subjects with Gmed weakness were recruited. SHA and three types of SSP exercises were performed: SSP with neutral hip (SSP-N), hip lateral rotation (SSP-L), and hip medial rotation (SSP-M). Surface electromyography was used to measure the activation of the trunk and hip muscles. RESULTS: The trunk and hip muscles activations were generally significantly higher level during three SSP than SHA. SSP-M showed significantly lower EO activation while significantly higher ES and LM activation than SSP-L. Gmed activation was significantly higher during SSP-M than during SSP-L. TFL activation was significantly lower during SSP-M than during SSP-N and SSP-L. CONCLUSIONS: SSP could be prescribed for patients who have reduced Gmed strength after injuries. Especially, SSP-M could be applied for patients who have Gmed weakness with dominant TFL.

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Retention of Hindlimb Stepping Ability in Adult Spinal Cats After the Cessation of Step Training

Journal of Neurophysiology ◽

10.1152/jn.1999.81.1.85 ◽

1999 ◽

Vol 81 (1) ◽

pp. 85-94 ◽

Cited By ~ 105

Author(s):

R. D. De Leon ◽

J. A. Hodgson ◽

R. R. Roy ◽

V. R. Edgerton

Keyword(s):

Weight Bearing ◽

Activity Patterns ◽

Motor Task ◽

Full Weight Bearing ◽

Electromyographic Activity ◽

Locomotor Training ◽

Neural Pathways ◽

Step Cycle ◽

Rapid Learning ◽

Hindlimb Muscle

de Leon, R. D., J. A. Hodgson, R. R. Roy, and V. R. Edgerton. Retention of hindlimb stepping ability in adult spinal cats after the cessation of step training. J. Neurophysiol. 81: 85–94, 1999. Adult spinal cats were trained to perform bipedal hindlimb locomotion on a treadmill for 6–12 wk. After each animal acquired the ability to step, locomotor training was withheld, and stepping was reexamined 6 and 12 wk after training ended. The performance characteristics, hindlimb muscle electromyographic activity patterns, and kinematic characteristics of the step cycle that were acquired with training were largely maintained when training was withheld for 6 wk. However, after 12 wk without training, locomotor performance declined, i.e., stumbling was more frequent, and the ability to consistently execute full weight-bearing steps at any treadmill speed decreased. In addition, the height that the paw was lifted during the swing phase decreased, and a smaller range of extension in the hindlimbs occurred during the E3 phase of stance. When three of the spinal cats underwent 1 wk of retraining, stepping ability was regained more rapidly than when trained initially. The finding that stepping ability in trained adult spinal cats can persist for 6 wk without training provides further evidence that training-induced enhancement of stepping is learned in the spinal cats and that a memory of the enhanced stepping is stored in the spinal networks. However, it appears that the spinal cord can forget how to consistently execute stepping if that task is not practiced for 12 wk. The more rapid learning that occurred with retraining is also consistent with a learning phenomenon. These results in conjunction with our earlier findings suggest that the efficacy of the neural pathways that execute a motor task is highly dependent on the periodic activation of those pathways in a sequence compatible with that motor task.

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Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0140 ◽

2020 ◽

pp. 1-8

Author(s):

Stefanie N. Foster ◽

Michael D. Harris ◽

Mary K. Hastings ◽

Michael J. Mueller ◽

Gretchen B. Salsich ◽

...

Keyword(s):

Pelvic Tilt ◽

Groin Pain ◽

Medical Center ◽

Weight Bearing ◽

Academic Medical Center ◽

Ankle Dorsiflexion ◽

Future Research ◽

Cross Sectional ◽

Anterior Pelvic Tilt ◽

Step Down

Context: The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function. Objective: To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain. Design: Cross-sectional Setting: Academic medical center. Patients: A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated. Intervention: None. Main Outcome Measures: Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. Results: Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion. Conclusions: Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

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RELATIONSHIP OF PELVIC ALIGNMENT WITH BALANCE AND GAIT IN PATIENTS WITH STROKE: A SYSTEMATIC REVIEW

International Journal of Clinical and Biomedical Research ◽

10.31878/ijcbr.2021.73.01 ◽

2021 ◽

pp. 1-9

Author(s):

Ashwini Mishra ◽

Dr. Suvarna Ganvir

Keyword(s):

Observational Studies ◽

Pelvic Tilt ◽

Balance Control ◽

Lateral Displacement ◽

Weight Bearing ◽

Lower Limbs ◽

Pelvic Inclination ◽

Base Of Support ◽

Relationship Of ◽

Pelvic Instability

Background- Pelvis is the key structure that connects the spine and the lower limbs. Altered Pelvic Alignment and asymmetrical weight bearing on affected lower limbs is a common problem leading to pelvic instability which may have an effect on balance and gait in patients with stroke. Hence, it was aimed to investigate the interdependence of these three components in patients with stroke. Methods- Four databases (PubMed, Google Scholar, Cochrane, Science Direct) were searched to identify eligible studies using the keywords Pelvic Alignment, Gait, Balance, Stroke. Only observational studies published in last 10 years (2010-2020) were included in this review. Results- Thirteen studies were included in the review conducted on sub-acute and chronic stage. All studies investigated the affection of pelvic mal-alignment, balance and gait in combination of two variables except 3 studies which investigated the combined effect of pelvic inclination on both balance and gait. The abnormal pelvic tilt results in lateral displacement of the pelvis on affected side, altered Base of Support, reduced balance control, asymmetry in weight bearing leading to altered gait. Conclusion- Pelvic tilt, anterior and lateral has a significant impact on static balance, gait variables, weight bearing symmetry.

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Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects: a preliminary study

10.21203/rs.3.rs-37368/v2 ◽

2020 ◽

Author(s):

Shanshan Lin ◽

Bo Zhu ◽

Yiyi Zheng ◽

Guozhi Huang ◽

Qing Zeng ◽

...

Keyword(s):

Muscle Contraction ◽

Real Time ◽

Ultrasound Imaging ◽

Healthy Subjects ◽

Transversus Abdominis ◽

Trunk Muscles ◽

Control Group ◽

Visual Biofeedback ◽

Preliminary Study ◽

Experimental Group

Abstract Background: Real-time ultrasound imaging (RUSI) has been increasingly used as a form of biofeedback when instructing and re-training muscle contraction. However, the effectiveness of the RUSI on a single sustained contraction of the lumbar multifidus (LM) and transversus abdominis (TrA) has rarely been reported. This preliminary study aimed to determine if the use of RUSI, as visual biofeedback, could enhance the ability of activation and continuous contraction of the trunk muscles including LM and TrA.Methods: Forty healthy individuals were included and randomly assigned into the experimental group and control group. All subjects performed a preferential activation of the LM and/or TrA (maintained the constraction of LM and/or TrA for 30 seconds and then relaxed for two minutes), while those in the experimental group also received visual feedback provided by RUSI. The thickness of LM and/or TrA at rest and during contraction (Tc-max, T15s, and T30s) were extracted and recorded. The experiment was repeated three times.Results: No significant differences were found in the thickness of LM at rest (P > 0.999), Tc-max (P > 0.999), and T15s (P = 0.414) between the two groups. However, the ability to recruit LM muscle contraction differed between groups at T30s (P = 0.006), with subjects in the experimental group that received visual ultrasound biofeedback maintaining a relative maximum contraction. Besides, no significant differences were found in the TrA muscle thickness at rest (P > 0.999) and Tc-max (P > 0.999) between the two groups. However, significant differences of contraction thickness were found at T15s (P = 0.031) and T30s (P = 0.010) between the two groups during the Abdominal Drawing-in Maneuver (ADIM), with greater TrA muscle contraction thickness in the experimental group.Conclusions: RUSI can be used to provide visual biofeedback, which can promote continuous contraction, and improve the ability to activate the LM and TrA muscles in healthy subjects.

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