Abstract
Background:In order to maintain nonweightbearing restrictions of the lower extremity, an assistive device must be utilized. Currently most devices require the restricted limb to be held in a static position while the contralateral extremity provides forward propulsion. Atrophy and disuse conditions ensue rapidly, slowing healing and prolonging recovery. A hands-free single crutch (HFSC) utilizes both lower extremities, potentially reducing atrophy. The purpose of this study was to examine the electromyographic (EMG) differences between an HFSC and standard axillary crutches (SAC).Methods:A prospective, crossover study was performed using 21 healthy volunteers from an active duty foot and ankle clinic. Demographic data were obtained and then subjects were fitted with an HFSC and SAC. Wireless surface EMG sensors were applied to the belly of the rectus femoris (RF), vastus lateralis (VL), lateral gastrocnemius (LG), and the gluteus maximus (GM) by a board-certified orthopedic surgeon. Subjects then ambulated at a self-selected velocity for 30 m while 15 seconds of the gait cycle were recorded for each device. Mean muscle activity and the maximum voluntary isometric contraction (MVIC) were recorded.Results:The RF, GM, and LG showed significantly increased levels of muscle activity while using the HFSC compared to SAC (respectively P = .05, P = .03, P = .03). The VL did not show significantly higher muscle activity while using the HFSC (P = .051). The RF, GM, and VL showed statistically significant higher MVIC percentages while using the HFSC compared with SAC (respectively P = .005, P = .005, P = .013). The LG did not show significantly higher MVIC percentage while using the HFSC (P = .076).Conclusion:The HFSC subjects demonstrated increased muscle recruitment and intensity while maintaining cyclic contractions consistent with bipedal gait pattern. SAC demonstrated less recruitment and intensity with an isometric pattern regardless of the phase of gait.Clinical Relevance:Muscle atrophy following lower extremity immobilization.
Highlights
Lower extremity injuries occur frequently and impact many different populations including the general public, athletes, and those in the military.[12]
The rectus femoris (RF), gluteus maximus (GM), and lateral gastrocnemius (LG) had significantly increased levels of muscle activity while using the hands-free single crutch (HFSC) compared to standard axillary crutches (SAC) (P 1⁄4 .049, P 1⁄4 .031, P 1⁄4 .029)
With the results available from this study, the vastus lateralis (VL) did not demonstrate a significant increase in muscle activity while using the HFSC compared to SAC (P 1⁄4 .051)
Summary
Lower extremity injuries occur frequently and impact many different populations including the general public, athletes, and those in the military.[12]. One study found that foot and ankle injuries accounted for 27% of musculoskeletal injuries in athletes and 21% of those injuries caused the athlete to miss time from the sport.[16] Foot and ankle injuries often require a period of nonweightbearing during recovery that can cause significant costs to the patient.[20,30] They will have a decreased quality of life with limited mobility, possible missed work, and will have medical expenses.
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