AN IMPAIRMENT-BASED INTERVENTION FOR A PATIENT WITH NON-SPECIFIC BILATERAL HIP PAIN: CLINICAL AND BIOMECHANICAL OUTCOMES

2009 ◽  
Vol 12 (02) ◽  
pp. 113-125
Author(s):  
Marie A. Johanson ◽  
Bruce H. Greenfield ◽  
Brenda L. Greene ◽  
Thomas A. Abelew
Keyword(s):  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Hip Pain ◽  
Biomechanical Analysis ◽  
Home Exercise ◽  
Cumulative Trauma ◽  
Posterior Portion ◽  
Muscle Testing ◽  
Recreational Walking ◽  
Hip Flexion

Study design: Case study. Background: To date, there is little research that has examined the association of impairments at the hip with cumulative trauma syndromes of the hip. The purposes of this case report are to: (1) describe clinical outcomes for a patient with non-specific bilateral musculoskeletal hip pain associated with recreational walking, (2) explore the relationship between this patient's impairments and her cumulative trauma syndrome at the hip, and (3) integrate biomechanical analysis with this patient's clinical diagnosis. Case description: The patient was a 28-year-old female research assistant who reported anterior bilateral hip pain during recreational walking. After examination, the physical therapist diagnosed primary impairments of hip pain, limited hip flexion range of motion (ROM), and weakness of hip musculature, resulting in her ambulation limitations. Intervention consisted of a home exercise program (HEP) designed to strengthen the iliopsoas, gluteus maximus, and gluteus medius (specifically, the posterior portion), increase extensibility of the IT Band and medial hamstrings, and promote posterior glide of the proximal femur. The patient's HEP was the only intervention she received. There were follow-up telephone conversations, but no clinical re-examination for ten weeks. The patient performed the HEP a total of 41 days over the ten week period. Biomechanical gait analysis was performed pre- and post-intervention. Outcomes: Following intervention, the patient was pain-free during recreational walking, and passive hip flexion ROM and manual muscle testing (MMT) grades of hip musculature improved. Global score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved ten points. Motion analysis, force plate analysis, and electromyography (EMG) showed that maximum hip extension decreased, maximum hip flexion increased, maximum ground reaction force increased, activation of the gluteus maximus increased, while activation of the gluteus medius and tensor fascia latae (TFL) decreased following the intervention. Discussion: This patient's changes in muscle activity following a HEP appear largely consistent with improved symptoms based on theoretical descriptions of a common muscle imbalance (shortened and overactive TFL and weakness of the gluteus maximus and posterior portion of the gluteus medius), thought to contribute to increased femoral medial rotation.

The Influence of Sagittal Plane Hip Position on Lower-Extremity Muscle Activity and Torque Output

2020 ◽  
pp. 1-9
Author(s):  
Neal R. Glaviano ◽  
David M. Bazett-Jones
Keyword(s):  
Muscle Activity ◽  
Sagittal Plane ◽  
External Rotation ◽  
Gluteus Maximus ◽  
Muscle Testing ◽  
Lower Extremity Muscle ◽  
Hip Muscle ◽  
Hip Flexion ◽  
Hip Extension ◽  
Adductor Longus

Context: Hip muscle strength has previously been evaluated in various sagittal plane testing positions. Altering the testing position appears to have an influence on hip muscle torque during hip extension, abduction, and external rotation. However, it is unknown how altering the testing position influences hip muscle activity during these commonly performed assessments. Objectives: To evaluate how hip sagittal plane position influences hip muscle activation and torque output. Study Design: Cross-sectional. Setting: Laboratory. Patients or Other Participants: A total of 22 healthy females (age = 22.1 [1.4] y; mass = 63.4 [11.3] kg; height = 168.4 [6.2] cm) were recruited. Intervention: None. Main Outcome Measures: Participants completed isometric contractions with surface electromyography on the superior and inferior gluteus maximus; anterior, middle, and posterior gluteus medius; biceps femoris, semitendinosus, adductor longus, and tensor fascia latae. Extension and external rotation were tested in 0°, 45°, and 90° of hip flexion and abduction was tested in −5°, 0°, and 45° of hip flexion. Repeated-measures analysis of variances were used for statistical analysis (P ≤ .01). Results: Activation of gluteal (P < .007), semitendinosus (P = .002), and adductor longus (P = .001) muscles were lesser for extension at 90° versus less flexed positions. Adductor longus activity was greatest during 90° of hip flexion for external rotation torque testing (P < .001). Tensor fascia latae (P < .001) and gluteus maximus (P < .001) activities were greater in 45° of hip flexion. Significant differences in extension (P < .001) and abduction (P < .001) torque were found among positions. Conclusions: Position when assessing hip extension and abduction torque has an influence on both muscle activity and torque output but only muscle activity for hip external rotation torque. Clinicians should be aware of the influence of position on hip extension, abduction, and external rotation muscle testing and select a position most in line with their clinical goals.

scholarly journals Force and EMG Comparison between a weight-bearing clinical assessment of hip strength assessment and non-weightbearing tasks

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Kemery Sigmund ◽  
Jennifer Earl-Boehm
Keyword(s):  
Alternative Assessment ◽  
External Rotation ◽  
Weight Bearing ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Biomechanical Analysis ◽  
Lower Extremity Injury ◽  
Hip Strength ◽  
Strength Assessment ◽  
Moment Arms

Purpose: Altered hip strength is a risk factor for lower extremity injury but its relationship to biomechanical dysfunction is debated. Hip strength assessment methods are criticized for using unidirectional, non-weight-bearing positions which may not be representative of athletic activity and may affect comparison to biomechanical analysis of athletic tasks. A weight-bearing task may better represent hip muscle function during these movements. The aim of this study was to identify EMG and force differences for a clinical weight-bearing method of hip strength (the squat-hold) to traditional non-weight-bearing maximal voluntary isometric contractions (MVICs) for hip abduction, extension, and external rotation. Methods: Twenty-nine healthy volunteers (23 female, 6 male; 23.3±5.8 years) performed the squat-hold, sidelying abduction, prone extension, and seated hip external rotation MVICs. The squat-hold was performed by exerting a bilateral, maximal force against a rigid strap encircling both knees in a semi-squatted position. Surface electromyography (EMG) recorded peak activation of the gluteus medius (GMed), gluteus maximus (Gmax), and tensor fascia lata (TFL) and a handheld dynamometer simultaneously measured force during all tasks. Peak activation was compared between the squat-hold and each MVIC using paired t-tests. Force was compared across tasks using a one-way ANOVA. Results: Greater force was observed during the squat-hold than the external rotation MVIC, but abduction and extension MVICs yielded greater force than the squat-hold. GMax activation was higher during the squat-hold than the external rotation task. TFL activation was higher during the abduction MVIC than the squat-hold but GMed activation was similar across tasks. Peak GMax activation was similar between the extension MVIC and squat-hold. Conclusions: Squat-hold force may have been reduced due to altered gluteal moment arms, which affected the length-tension relationship. Clinicians should consider the squat-hold as an alternative assessment of external rotation force, but should continue to assess abduction and extension force with MVICs. Researchers should examine positions optimizing length-tension relationships to better relate motor function and movement patterns.

Incidence and treatment of abductor deficiency during total hip arthroplasty using the posterior approach

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 116-122 ◽  
Author(s):  
L. A. Whiteside ◽  
M. E. Roy
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Hip Pain ◽  
Greater Trochanter ◽  
Flap Transfer ◽  
Total Hip ◽  
Lateral Hip Pain

Aims The aims of this study were to assess the exposure and preservation of the abductor mechanism during primary total hip arthroplasty (THA) using the posterior approach, and to evaluate gluteus maximus transfer to restore abductor function of chronically avulsed gluteus medius and minimus. Patients and Methods A total of 519 patients (525 hips) underwent primary THA using the posterior approach, between 2009 and 2013. The patients were reviewed preoperatively and at two and five years postoperatively. Three patients had mild acute laceration of the gluteus medius caused by retraction. A total of 54 patients had mild chronic damage to the tendon (not caused by exposure), which was repaired with sutures through drill holes in the greater trochanter. A total of 41 patients had severe damage with major avulsion of the gluteus medius and minimus muscles, which was repaired with sutures through bone and a gluteus maximus flap transfer to the greater trochanter. Results Abductor strength was maintained in the normal hips, but lateral hip pain progressed significantly, five years postoperatively (p < 0.0001). In the 54 patients with mild abductor tendon damage treated with simple repair, lateral hip pain also increased significantly during follow-up (p = 0.002). In the 35 patients with severe avulsion but good muscle repaired using a gluteus maximus flap transfer, abductor function was restored. The six patients with complete avulsion and poor muscle did not regain strong abductor power, but lateral hip pain decreased. Conclusion The posterior approach offered excellent exposure and preservation of the abductor mechanism during primary THA. Augmentation of the repair with a gluteus maximus flap provided stable reconstruction of the abductor muscles and seemed to restore function in the hips with functioning muscles. Cite this article: Bone Joint J 2019;101-B(6 Supple B):116–122.

scholarly journals Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ross M. Neuman ◽  
Staci M. Shearin ◽  
Karen J. McCain ◽  
Nicholas P. Fey
Keyword(s):  
Multiple Sclerosis ◽  
Muscle Activity ◽  
Healthy Subjects ◽  
Muscle Activation ◽  
Assistive Technologies ◽  
Lower Limbs ◽  
Biomechanical Analysis ◽  
Foot Drop ◽  
Plantar Flexors ◽  
Hip Flexion

Abstract Background Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors. Methods Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability. Results For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO. Conclusions This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

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

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.

Muscle Function and Coordination of Stair Ascent

2017 ◽  
Vol 140 (1) ◽  
Author(s):  
Nicole G. Harper ◽  
Jason M. Wilken ◽  
Richard R. Neptune
Keyword(s):  
Three Dimensional ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Patient Specific ◽  
Functional Roles ◽  
Stair Ascent ◽  
Lower Limb Muscles ◽  
Ankle Joints ◽  
Community Environments ◽  
Antagonistic Muscles

Stair ascent is an activity of daily living and necessary for maintaining independence in community environments. One challenge to improving an individual's ability to ascend stairs is a limited understanding of how lower-limb muscles work in synergy to perform stair ascent. Through dynamic coupling, muscles can perform multiple functions and require contributions from other muscles to perform a task successfully. The purpose of this study was to identify the functional roles of individual muscles during stair ascent and the mechanisms by which muscles work together to perform specific subtasks. A three-dimensional (3D) muscle-actuated simulation of stair ascent was generated to identify individual muscle contributions to the biomechanical subtasks of vertical propulsion, anteroposterior (AP) braking and propulsion, mediolateral control and leg swing. The vasti and plantarflexors were the primary contributors to vertical propulsion during the first and second halves of stance, respectively, while gluteus maximus and hamstrings were the primary contributors to forward propulsion during the first and second halves of stance, respectively. The anterior and posterior components of gluteus medius were the primary contributors to medial control, while vasti and hamstrings were the primary contributors to lateral control during the first and second halves of stance, respectively. To control leg swing, antagonistic muscles spanning the hip, knee, and ankle joints distributed power from the leg to the remaining body segments. These results compliment previous studies analyzing stair ascent and provide further rationale for developing targeted rehabilitation strategies to address patient-specific deficits in stair ascent.

scholarly journals Comparative Analysis of Neural Mobilization and Rhythmic Stabilization in Range of Motion and Hip Pain

2020 ◽  
pp. 1-6
Author(s):  
Samyla Maria Araújo Ponte ◽  
Leydnaya Maria Souza ◽  
Bruno Cunha da Costa ◽  
Guilherme Pertinni de Morais Gouveia
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Great Majority ◽  
Hip Pain ◽  
Whole Body ◽  
Active Movement ◽  
The Mean ◽  
Passive Mobilization ◽  
Stabilization Technique ◽  
Hip Flexion

Background: The hip is a structure of the human body in which occurs the junction of bone, articular, muscular and ligament structures. It is in the coxofemoral joint and has the function of supporting the whole-body weight, being one of the main joints responsible for ambulation. Objectives: To analyze the comparison of neural mobilization and rhythmic stabilization techniques in range of motion (ROM) and hip pain. Methods: The sample was composed by 20 patients, with mean age of 54±6 years, were divided into two groups of 10 patients: the patients who received the neural mobilization technique (G1) and the patients who received the rhythmic stabilization technique (G2). Results: The mean age of each group was 56±6 years (G1) and 52±6 years (G2). Among the evaluated, 12 (60%) were female, 14 (70%) were married, predominating the profession of housewife (35%). The great majority of the participants (95%) presented pain to the active movement, mainly to the movements of hip flexion and abduction. Regarding passive mobilization, 70% referred pains, predominating to the movements of hip external rotation and abduction. Conclusion: It was concluded that the neural mobilization and rhythmic stabilization techniques had satisfactory results in relation to ROM and pain in the hip region, but rhythmic stabilization had a greater gain of ROM and decrease of pain.

Hip and Trunk Muscle Activity During the Star Excursion Balance Test in Healthy Adults

2019 ◽  
Vol 28 (7) ◽  
pp. 682-691 ◽  
Author(s):  
Kunal Bhanot ◽  
Navpreet Kaur ◽  
Lori Thein Brody ◽  
Jennifer Bridges ◽  
David C. Berry ◽  
...  
Keyword(s):  
Dynamic Balance ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Healthy Adults ◽  
Rectus Abdominis ◽  
Erector Spinae ◽  
Trunk Muscles ◽  
Electromyographic Activity ◽  
Balance Test ◽  
External Oblique

Context:Dynamic balance is a measure of core stability. Deficits in the dynamic balance have been related to injuries in the athletic populations. The Star Excursion Balance Test (SEBT) is suggested to measure and improve dynamic balance when used as a rehabilitative tool.Objective:To determine the electromyographic activity of the hip and the trunk muscles during the SEBT.Design:Descriptive.Setting:University campus.Participants:Twenty-two healthy adults (11 males and 11 females; 23.3 [3.8] y, 170.3 [7.6] cm, 67.8 [10.3] kg, and 15.1% [5.0%] body fat).Intervention:Surface electromyographic data were collected on 22 healthy adults of the erector spinae, external oblique, and rectus abdominis bilaterally, and gluteus medius and gluteus maximus muscle of the stance leg. A 2-way repeated measures analysis of variance was used to determine the interaction between the percentage maximal voluntary isometric contraction (%MVIC) and the reach directions. The %MVIC for each muscle was compared across the 8 reach directions using the Sidak post hoc test withαat .05.Main Outcome Measures:%MVIC.Results:Significant differences were observed for all the 8 muscles. Highest electromyographic activity was found for the tested muscles in the following reach directions—ipsilateral external oblique (44.5% [38.4%]): anterolateral; contralateral external oblique (52.3% [40.8%]): medial; ipsilateral rectus abdominis (8% [6.6%]): anterior; contralateral rectus abdominis (8% [5.3%]): anteromedial; ipsilateral erector spinae (46.4% [20.2%]): posterolateral; contralateral erector spinae (33.5% [11.3%]): posteromedial; gluteus maximus (27.4% [11.7%]): posterior; and gluteus medius (54.6% [26.1%]): medial direction.Conclusions:Trunk and hip muscle activation was direction dependent during the SEBT. This information can be used during rehabilitation of the hip and the trunk muscles.

Sign in / Sign up

Export Citation Format

Share Document