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

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.

The effect of a shoe lift on tensor fasciae latae length during standing with an artificial functional leg length discrepancy: An ultrasonic shear wave elastography study

BACKGROUND: Shortening of tensor fasciae latae is one factor that causes a functional leg length discrepancy. A shoe lift has been used to correct the compensatory posture resulting from the discrepancy. Despite the potential therapeutic benefit of a shoe lift, the mechanism by which it exerts its effect is unclear. OBJECTIVE: To investigate the effect of a shoe lift on tensor fasciae latae length during standing with an artificial functional leg length discrepancy using ultrasonic shear wave elastography. METHODS: Twenty-two healthy individuals performed static standing under three conditions: drop of the pelvis and flexion of the leg resulting from fixing in the hip abduction position using a hip orthosis (functional leg length discrepancy condition); drop of the pelvis by the orthosis, but no flexion of the leg due to a shoe lift (shoe lift condition); and normal bilateral standing condition. The shear elastic modulus of tensor fasciae latae was calculated using ultrasonic shear wave elastography. RESULTS: The shear elastic modulus was significantly lower in the functional leg length discrepancy condition than in the shoe lift and normal conditions (p= 0.038). CONCLUSIONS: Using a shoe lift for the functional leg length discrepancy can result in a functional hip position that elongates tensor fasciae latae.

Lateral versus conventional fasciotomy for prevention of lateral femoral cutaneous nerve injury in total hip arthroplasty with direct anterior approach: a study protocol for dual-center, single-blind, randomized controlled trial

Background; An incision for total hip arthroplasty (THA) via the direct anterior approach (DAA) is generally made outside of the space between sartorius and tensor fasciae lataea muscles to prevent lateral femoral cutaneous nerve (LFCN) injury. Recent anatomical studies have revealed that the LFCN not only courses between the sartorius and tensor fasciae latae muscles, but it also branches radially while distributing in the transverse direction from the sartorius muscle to the tensor fasciae latae muscle. The latter is called the fan type, and studies suggest that damage to the fan type LFCN is unavoidable by conventional fasciotomy. We previously demonstrated that injury to non-fan type LFCN occurred in 28.6% of patients who underwent THA by fasciotomy performed 2 cm away from the intermuscular space. This suggests that the conventional approach also poses a risk of LFCN injury for non-fan type LFCN. LFCN injury is rarely reported in the anterolateral approach (ALA), which involves incision of fascia further away than DAA. The purpose of this study is to investigate how the position of fasciotomy in DAA affects the risk of LFCN injury. Methods; This is a prospective, randomized, controlled study. All patients are divided into the fan type and non-fan type using ultrasonography before surgery. Patients with the non-fan type LFCN will be performed by the conventional fasciotomy and the lateral fasciotomy in the order specified in the allocation table created in advance by our clinical trial center. The primary endpoint is the presence of LFCN injury. The secondary endpoints will be assessed based on patient-reported outcomes (PROs) at 3 months after surgery in an outpatient setting using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and the Forgotten-Joint Score-12 (FJS-12). Discussion; We hypothesize that the incidence of LFCN injury due to DAA-THA can be reduced by making the incision further away from where it is typically made in conventional fasciotomy. If our hypothesis is confirmed, it will reduce the disadvantages of DAA, improve patient satisfaction. Trial registration; UMIN Clinical Trials Registry, UMIN000035945.Registered on 20 Feburary 2019.

Evaluation of muscle volume and degeneration after total hip arthroplasty: a comparison of the posterolateral approach and the anterolateral supine approach

Background Muscle strength around the hip after total hip arthroplasty (THA) is crucial for preventing dislocation and limping. This study aimed to assess and compare muscle volume and degeneration after THA using the posterolateral (PL) and anterolateral (AL) approaches. Methods Sixty-four hips in 64 patients who underwent primary THA were retrospectively analyzed. Patients were segregated into the PL group (35 hips) and AL group (29 hips) for evaluating pre- and postoperative muscle volumes and degeneration around the hip. Computed tomography (CT) examinations were performed preoperatively and 6 months post THA. The muscle volume and Hounsfield units (HU) of the gluteus maximus (G-max), gluteus medius (G-med), tensor fasciae latae, internal obturator muscle, and external obturator muscle were measured. Results In the PL group, the postoperative muscle volume of the G-max significantly increased than the preoperative muscle volume. In contrast, the postoperative muscle volume of the internal obturator muscle was significantly lower than the preoperative muscle volume. The postoperative HU of the internal and external obturator muscles were significantly lower than the preoperative HU. In the AL group, the postoperative muscle volumes of the G-max, G-med, and tensor fasciae latae significantly increased than their preoperative muscle volumes. The postoperative HU of the G-med and tensor fasciae latae were significantly higher than the preoperative HU values. Conclusion The PL approach can lead to degeneration of the internal and external obturator. The AL approach is more beneficial for recovering the G-med, tensor fasciae latae, and internal obturator muscle than the PL approach.

Оцінка ефективності програми фізичної реабілітації дітей із наслідками дисплазії кульшових суглобів

Дисплазія кульшових суглобів за несвоєчасного виявлення та лікування в ранньомудитячому віці прогресує і призводить до негативних наслідків, які починають проявлятися удітей дошкільного віку.Мета. Оцінити ефективність застосування засобів фізичної реабілітації у дітей із наслідкамидисплазії кульшових суглобів. Методи. У дослідженні взяли участь 68 дітей дошкільного вікуз односторонньою дисплазією кульшових суглобів за анамнезом (виявлено за результатамианалізу медичних карт), середній вік обстежених 5,6 ± 0,5 року. Для проведення дослідженьсформовано дві групи: основну (ОГ; n = 35) – діти, які займалися за розробленою нами про-грамою реабілітації, та контрольну (КГ; n = 33) – діти, які займалися за програмою дитячогонавчального закладу. Тривалість дослідження – 2014–2019 рр. Результати. Після проведенняпрограми фізіотерапевтичних втручань виявлено, що тонус м’язів-аддукторів наблизився дозначень інтактної кінцівки, що пов’язано з покращенням тонусу м’язів антагоністів (м’язів-абдукторів стегна (m. gluteus medius, m. gluteus minimus, m. tensor fasciae latae), та виправ-ленням патологічної привідної контрактури у кульшовому суглобі (в ОГ інтактна – 72,3 ± 3,2та уражена – 70,2 ± 3,4 (–х ± S); в КГ – інтактна – 69,4 ± 3,5 уражена –76,3 ± 3,7, (р > 0,05). Зарезультатами обстеження виявлено покращення параметрів відеомоніторингу постави, асаме: в ОГ кількість дітей з порушеннями у сагітальній площині зменшилось на 11 осіб; пору-шення постави у сагітальній площині зберіглися у 12 (34,2 %) дітей групи. В КГ також виявленопозитивну динаміку, але лише у п’яти дітей покращився профіль постави у сагітальній площині,у решти 17 (51,5 %) дітей порушення постави у сагітальній площини зберіглися рівні первин-них значень. Висновки. Використання комплексної авторської програми фізичної реабілітації,спрямованої на усунення та зменшення проявів наслідків дисплазії кульшових суглобів, покра-щення та корекцію функціональних можливостей опорно-рухового апарату, у яких відбулисяпатологічні зміни, зміцнення суглобово-зв’язкового апарату, дозволяє більш ефективно усуну-ти прояви наслідків ДКС порівняно зі стандартними програмами реабілітації.