scholarly journals Exercise Prescription for a Patient 3 Months After Hip Fracture

2005 ◽  
Vol 85 (7) ◽  
pp. 676-687 ◽  
Author(s):  
Kathleen K Mangione ◽  
Kerstin M Palombaro

Abstract Background and Purpose. Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. Case Description. The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. Outcome. The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved by 400%; balance confidence increased by 41%; and self-reported ability to perform lower-extremity functional activities increased by 20%. Discussion. The authors believe that some patients can perform comprehensive exercise programs after hip fracture and that properly designed programs can affect patient outcomes beyond observed impairments.

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Kathleen Donohue ◽  
Richelle Hoevenaars ◽  
Jocelyn McEachern ◽  
Erica Zeman ◽  
Saurabh Mehta

Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery.Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided.Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies.Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention.


2014 ◽  
Vol 9 (2) ◽  
pp. 358-361 ◽  
Author(s):  
Scott R. Brown ◽  
Matt Brughelli ◽  
Peter C. Griffiths ◽  
John B. Cronin

Purpose:While several studies have documented isokinetic knee strength in junior and senior rugby league players, investigations of isokinetic knee and hip strength in professional rugby union players are limited. The purpose of this study was to provide lower-extremity strength profiles and compare isokinetic knee and hip strength of professional rugby league and rugby union players.Participants:32 professional rugby league and 25 professional rugby union players.Methods:Cross-sectional analysis. Isokinetic dynamometry was used to evaluate peak torque and strength ratios of the dominant and nondominant legs during seated knee-extension/flexion and supine hip-extension/flexion actions at 60°/s.Results:Forwards from both codes were taller and heavier and had a higher body-mass index than the backs of each code. Rugby union forwards produced significantly (P < .05) greater peak torque during knee flexion in the dominant and nondominant legs (ES = 1.81 and 2.02) compared with rugby league forwards. Rugby league backs produced significantly greater hip-extension peak torque in the dominant and nondominant legs (ES = 0.83 and 0.77) compared with rugby union backs. There were no significant differences in hamstring-to-quadriceps ratios between code, position, or leg. Rugby union forwards and backs produced significantly greater knee-flexion-to-hip-extension ratios in the dominant and nondominant legs (ES = 1.49–2.26) than rugby union players.Conclusions:It seems that the joint torque profiles of players from rugby league and union codes differ, which may be attributed to the different demands of each code.


2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0051
Author(s):  
Pinar Melodi Caliskan ◽  
Anne Benjaminse ◽  
Alli Gokeler

Introduction: Injuries of the anterior cruciate ligament (ACL) commonly occur during complex game situations when the athlete encounters multiple factors such as ball, opponent, field position, and game strategy (Grooms et al., 2018). Many of the current traditional injury screening programs are performed within a predictable, fixed or ‘closed’ environment which do not represent real game situations that require high neurocognitive demands (Dingenen & Gokeler, 2017; Grooms et al., 2018). A complementary approach to lab-based settings is necessary to incorporate the demands of the complex athletic environments. By using wearable sensor technology, we aim to develop an on-field injury screening test in elite youth male soccer players. Investigating the individual differences in motor coordination patterns of the players during sport-specific tasks might enhance our understanding of how ACL injuries occur. Hypotheses: We hypothesized that the motor coordination patterns of the players would be affected when they perform under different conditions manipulated with constraints (task and environmental). Methods: A football-specific test setup was created to analyse the kinematic and performance measures of a group of 17 male youth elite football players aged 15 years (height = 164 ± 9 cm, mass = 50.9± 7.4 kg). The players were grouped into two and measured on two consecutive days. All the players were instructed to complete the test setup (4 conditions, 5 trials) as fast as possible. Condition 1 includes no constraint, condition 2 includes a task constraint (football dummies), condition 3 includes an environmental constraint (stroboscopic glasses) (SENAPTEC, Beaverton, Oregon) and condition 4 includes both task and environmental constraints. 3-D kinematics of the hip, knee, ankle joints were captured using Xsens wearable full-body sensor suits (Xsens, MVN Link version, Enschede, The Netherlands). MATLAB (MATLAB R2019a, The MathWorks Inc., Massachusetts) was used to process and analyse the kinematic data. Data from condition 1 was determined as reference behavior/condition to be compared to other conditions. Kinematic data are presented in attitude vectors (ATV). Results: In total, 81% of the players demonstrated a significant difference (P < 0.05) in angles of hip, knee and ankle joints when performing under different conditions. The percentage of players with increased comparison-based joint movements as follows; condition 1 to condition 2 comparison; 41% hip flexion, 59% hip extension, 53% hip abduction, 47% hip adduction, 62% knee flexion, 38% knee extension, 59% knee abduction, 41% knee adduction, 47% ankle dorsiflexion, 53% ankle plantarflexion, condition 1 to condition 3 comparison; 35% hip flexion, 65% hip extension, 47% hip abduction, 53% hip adduction, 50% knee flexion, 50% knee extension, 41% knee abduction, 59% knee adduction, 59% ankle dorsiflexion, 41% ankle plantarflexion and condition 1 to condition 4 comparison; 31% hip flexion, 69% hip extension, 38% hip abduction, 62% hip adduction, 60% knee flexion, 40% knee extension, 44% knee abduction, 56% knee adduction, 69% ankle dorsiflexion, 31% ankle plantarflexion. Conclusion: The result of this pilot study demonstrated that manipulating task with different constraints caused significant changes in players’ motor coordination patterns which supported the hypothesis of our study. Our findings suggest to develop ACL injury screening tests in a sport-specific setting.


2007 ◽  
Vol 87 (3) ◽  
pp. 292-303 ◽  
Author(s):  
Helen H Host ◽  
David R Sinacore ◽  
Kathryn L Bohnert ◽  
Karen Steger-May ◽  
Marybeth Brown ◽  
...  

Background and PurposeAt 3 months after hip fracture, most people are discharged from physical therapy despite residual muscle weakness and overall decreased functional capabilities. The purposes of this study were: (1) to determine, in frail elderly adults after hip fracture and repair, whether a supervised 6-month exercise program would result in strength gains in the fractured limb equivalent to the level of strength in the nonfractured limb; (2) to determine whether the principle of specificity of training would apply to this population of adults; and (3) to determine the relationship between progressive resistance exercise training (PRT) intensity and changes in measures of strength and physical function.SubjectsThe study participants were 31 older adults (9 men and 22 women; age [X̄±SD], 79±6 years) who had surgical repair of a hip fracture that was completed less than 16 weeks before study enrollment and who completed at least 30 sessions of a supervised exercise intervention.MethodsParticipants completed 3 months of light resistance and flexibility exercises followed by 3 months of PRT. Tests of strength and function were completed at baseline, before PRT, and after PRT.ResultsAfter PRT, the subjects increased knee extension and leg press 1-repetition maximum by 72%±56% and 37%±30%, respectively. After 3 and 6 months of training, lower-extremity peak torques all increased. Specificity of training appeared to apply only to the nonfractured limb after PRT. Strong correlations were observed between training intensity and lower-extremity strength gains as well as improvements in measures of physical function.Discussion and ConclusionFrail elderly adults after hip fracture can benefit by extending their rehabilitation in a supervised exercise setting, working at high intensities in order to optimize gains in strength and physical function.


2021 ◽  
pp. 155633162199706
Author(s):  
Uri Givon ◽  
Lisa Drefus ◽  
Mary Murray-Weir ◽  
Mark Lenhoff ◽  
Jayme C. Burket-Koltsov ◽  
...  

Background: Femoral derotation osteotomy (FDO) for correction of internal rotation gait resulting from cerebral palsy (CP) can be performed with the patient in the prone or supine position. It is not known whether patient positioning during FDO affects the change in hip rotation. Purpose/Questions: We sought to compare the change in hip rotation following FDO performed on patients with CP in the prone or supine position through kinematic analysis. Methods: We conducted a consecutive retrospective cohort study of children with CP, ages 3 to 18 years and with Gross Motor Function Classification System (GMFCS) levels I to III, who underwent prone or supine FDO and pre- and postoperative motion analysis. The prone group included 37 patients (68 limbs) between 1990 and 1995. The supine group included 26 patients (47 limbs) between 2005 and 2015. The groups were matched for gender, age, and GMFCS level. The primary outcome was hip rotation in degrees during stance phase. Secondary outcomes included temporal-spatial parameters, hip abduction, hip and knee extension, and hip and knee passive range of motion (ROM). Results: The prone group had more bilateral patients (100%) than the supine group (81%). The supine group underwent more concomitant procedures. There was no difference between the prone and supine groups in postoperative stance hip rotation; both groups had significantly improved stance hip rotation, step width, and hip rotation passive ROM, pre- to postoperatively. Prone patients had improved postoperative hip extension, pelvic tilt, velocity, and cadence. Conclusions: There was no significant different in stance hip rotation between supine and prone FDO groups. Advocates of prone positioning for FDO suggest it allows more accurate assessment of rotation. Supine positioning may be more convenient when additional procedures are required. Based on our findings, either approach can achieve the desired result.


2020 ◽  
pp. 1-9
Author(s):  
Matthew S. Briggs ◽  
Claire Spech ◽  
Rachel King ◽  
Mike McNally ◽  
Matthew Paponetti ◽  
...  

Obese (OB) youth demonstrate altered knee mechanics and worse lower-extremity performance compared with healthy weight (HW) youth. Our objectives were to compare sagittal plane knee landing mechanics between OB and HW youth and to examine the associations of knee and hip extension peak torque with landing mechanics in OB youth. Twenty-four OB and 24 age- and sex-matched HW youth participated. Peak torque was measured and normalized to leg lean mass. Peak knee flexion angle and peak internal knee extension moment were measured during a single-leg hop landing. Paired t tests, Pearson correlation coefficients, and Bonferroni corrections were used. OB youth demonstrated worse performance and lower knee extension (OB: 12.76 [1.38], HW: 14.03 [2.08], P = .03) and hip extension (OB: 8.59 [3.13], HW: 11.10 [2.89], P = .005) peak torque. Furthermore, OB youth demonstrated lower peak knee flexion angles (OB: 48.89 [45.41 to 52.37], HW: 56.07 [52.59 to 59.55], P = .02) and knee extension moments (OB: −1.73 [−1.89 to −1.57], HW: −2.21 [−2.37 to −2.05], P = .0001) during landing compared with HW youth. Peak torque measures were not correlated with peak knee flexion angle nor internal knee extension moment during landing in either group (P > .01). OB youth demonstrated altered landing mechanics compared with HW youth. However, no associations among peak torque measurements and knee landing mechanics were present.


2012 ◽  
Vol 28 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Jason C. Gillette ◽  
Catherine A. Stevermer ◽  
Ross H. Miller ◽  
W. Brent Edwards ◽  
Charles V. Schwab

Farm youth often carry loads that are proportionally large and/or heavy, and field measurements have determined that these tasks are equivalent to industrial jobs with high injury risks. The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity joint moments during carrying tasks. Three age groups (8–10 years, 12–14 years, adults), three load amounts (0%, 10%, 20% BW), and three load symmetry levels (unilateral large bucket, unilateral small bucket, bilateral small buckets) were tested. Inverse dynamics was used to determine maximum ankle, knee, and hip joint moments. Ankle dorsiflexion, ankle inversion, ankle eversion, knee adduction, and hip extension moments were significantly higher in 8–10 and 12–14 year olds. Ankle plantar flexion, ankle inversion, knee extension, and hip extension moments were significantly increased at 10% and 20% BW loads. Knee and hip adduction moments were significantly increased at 10% and 20% BW loads when carrying a unilateral large bucket. Of particular concern are increased ankle inversion and eversion moments for children, along with increased knee and hip adduction moments for heavy, asymmetrical carrying tasks. Carrying loads bilaterally instead of unilaterally avoided increases in knee and hip adduction moments with increased load amount.


PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0235582
Author(s):  
Pedro Vieira Sarmet Moreira ◽  
Coral Falco ◽  
Luciano Luporini Menegaldo ◽  
Márcio Fagundes Goethel ◽  
Leandro Vinhas de Paula ◽  
...  

The aim of this study is to analyze how isokinetic knee and hip peak torques and roundhouse kick velocities are related to expertise level (elite vs. sub-elite) in taekwondo athletes. Seven elite and seven sub-elite athletes were tested for kick-specific variables (KSV, composed of kinematic variables and power of impact) and for concentric isokinetic peak torque (PT) at 60°/s and 240°/s. First, KSVs and PTs were compared between groups, then PTs were correlated with KSVs. Parametric variables with larger effect sizes (Cohen’s d) were entered in a stepwise linear discriminant analysis (LDA), generating an equation to estimate competitive level. Between-group differences were found in hip flexors (p = 0.04, d = 0.92) and extensors (p = 0.04, d = 0.96) with PT at 240°/s. Hip flexion PT at 60°/s and 240°/s correlated negatively with kick time (R = –0.46, p = 0.0499 and R = –0.62, p = 0.01 respectively). Hip flexion torque at 60°/s correlated positively (R = 0.52, p = 0.03) with peak linear velocity of the foot (LVF) and power of impact (R = 0.51, p = 0.03). Peak torque of hip extension at 60°/s and hip abduction at 240°/s also correlated with LVF (R = 0.56, p = 0.02 and R = 0.46, p = 0.0499). Hip extension at 60°/s correlated positively with peak linear velocity of the knee (R = 0.48, p = 0.04). The LDA showed an accuracy of 85.7% (p = 0.003) in predicting expertise level based on hip flexion and extension torques at 240°/s and on knee extension velocity during the kick. The study demonstrates that hip muscle strength is probably the dominant muscular factor for determining kick performance. Knee angular velocity combined with hip torques is the best discriminator for competitive level in taekwondo athletes.


2017 ◽  
Vol 12 (3) ◽  
pp. 371-380 ◽  
Author(s):  
J Sinclair ◽  
PJ Taylor ◽  
A Smith ◽  
J Bullen ◽  
I Bentley ◽  
...  

Place kicking occurs many times during a rugby union game with more than half of all points scored coming from place kicking. Ball velocity is an important biomechanical indicator of kicking success, but it also evident that the ball must be kicked accurately to pass between the posts. This study aimed to identify biomechanical differences in rugby place kicking kinematics when kicking towards a specific target and for maximum velocity. Ten male rugby union kickers performed place kicks in two conditions: (1) for maximum velocity and (2) towards a pre-defined target. Lower extremity kinematics were obtained using an optoelectric motion capture system operating at 500 Hz. Differences in lower extremity kinematics between the two kicking conditions were examined using paired t-tests. Higher ball velocities were obtained when kicking for maximum velocity. Foot linear velocity, knee extension velocity and hip extension velocity were also found to be greater when kicking for maximum velocity. Ankle dorsiflexion and peak external rotation were found to be greater in the accuracy condition. The findings suggest that rugby kickers may have selected distinct kicking mechanics characterised by reduced joint angular velocities and a more externally rotated foot position in a deliberate attempt to improve precision, sacrificing ball velocity and thus the distance that the ball can be kicked. The specific findings from the current work have implications for coaches and applied practitioners which may facilitate improvements in kicking performance.


2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091110
Author(s):  
Michael S. Rathleff ◽  
Lukasz Winiarski ◽  
Kasper Krommes ◽  
Thomas Graven-Nielsen ◽  
Per Hölmich ◽  
...  

Background: Osgood-Schlatter disease (OSD) affects 1 in 10 adolescents. There is a lack of evidence-based interventions, and passive approaches (eg, rest and avoidance of painful activities) are often prescribed. Purpose: To investigate an intervention consisting of education on activity modification and knee-strengthening exercises designed for adolescents with OSD. Study Design: Case series; Level of evidence, 4. Methods: This study included 51 adolescents (51% female; age range, 10-14 years) with OSD. The 12-week intervention consisted of an activity ladder designed to manage patellar tendon loading and pain, knee-strengthening exercises, and a gradual return to sport. The primary outcome was the global reporting of change at 12 weeks, evaluated with a 7-point Likert scale (successful outcome was considered “much improved” or “improved”). Additional endpoints were at 4, 8, 26, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), objective strength, and jump performance. Results: Adolescents reported a mean pain duration of 21 months at enrollment. After 12 weeks, 80% reported a successful outcome, which increased to 90% at 12 months. At 12 weeks, 16% returned to playing sport, which increased to 69% at 12 months. The KOOS subscores of Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life improved significantly (7-20 points), and there were improvements in knee extension strength (32%; P < .001), hip abduction strength (24%; P < .001), and jumping for distance (14%; P < .001) and height (19%; P < .001) at 12 weeks. Conclusion: An intervention consisting of activity modification, pain monitoring, progressive strengthening, and a return-to-sport paradigm was associated with improved self-reported outcomes, hip and knee muscle strength, and jumping performance. This approach may offer an alternative to passive approaches such as rest or wait-and-see, often prescribed for adolescents with OSD. Registration: NCT02799394 ( ClinicalTrials.gov identifier)


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