Lower Limb Muscle Activity Research Articles

A Comparative Study on Neuromuscular Control Patterns during Side Cutting Depending on Direction Prediction Presence or Absence and Gender

PURPOSE This study aimed to identify the lower limb muscle activity based on direction prediction presence or absence and gender during side cutting in healthy college students. METHODS The study participants included 14 healthy males and females (8 males; 6 females). All participants ran at full speed for a distance of 12m, and side-cutting was carried out at 45 degrees in a randomly indicated direction and in a fixed direction. Simultaneously, data regarding vastus medialis, vastus lateralis, semitendinosus, and biceps femoris muscle activity of the dominant leg were collected using an electromyography sensor, and data regarding vertical acceleration were collected using an inertial sensor attached to the pelvis. A sync webcam was used for obtaining the initial contact of side cutting and the stance period time. During the 10 milliseconds (pre-activation) prior to the initial contact and 50% of the stance phase (loading phase), vastus medialis, vastus lateralis, semitendinosus, and biceps femoris average muscle activity and hamstring to quadriceps ratio included as variables. RESULTS During the pre-activation and loading phase, the vastus medialis muscle activity of the male group was higher in the unexpected condition than in the expected condition. Furthermore, hamstring to quadriceps ratio was confirmed to be lower under unexpected condition compared to under expected condition during on loading phase. CONCLUSIONS The study results suggest that the risk of anterior cruciate ligament injury may increase with side cutting under unpredictable conditions. It is expected to provide useful information for identifying factors related to knee injury in the general population.

Validation of lower limb muscle activation estimated using musculoskeletal modeling against electromyography in the table tennis topspin forehand and backhand

Validation of lower limb muscle activation estimated using musculoskeletal modeling against electromyography in the table tennis topspin forehand and backhand

Development of a tractor operator-operation environment coupled biomechanical model and analysis of lower limb muscle fatigue

For the quantitative analysis and evaluation of tractor pedal operation comfort, this study developed a tractor operator-operation environment coupled biomechanical model in AnyBody Modeling System. First, operator model and operation environment model were generated according to Chinese adult male anthropometric dimensions and Dongfanghong LX804 tractor design parameters. To couple these two models, the connections between operator model's palms, feet, pelvis and operation environment model's steering wheel, joystick, pedals, seat were created. The release scheme of limb joint angle constraints was designed, which allowed limbs to fulfill the kinematic requirement of operating devices. Then, to drive the model, a driver device with a rotation angle range of 0°-42°and a spring with a stiffness of 37.85Nm/rad were added to pedal hinge based on the driving data of pedal force and pedal travel collected by sensors. Subsequently, to validate the model, the surface electromyography signals of lower limb muscles were acquired using the test system of Cometa MiniWave. The average relative error between the lower limb muscle activity calculated from electromyography signals and that computed from the model was 9.2%. Finally, the model was employed to simulate the dynamic process of pedal operation and analyze lower limb fatigue. The results demonstrated that the fatigue exhibited a tendency of first decreasing and then increasing as pedal rotation angle increased, and reached a lower level within the pedal rotation angle range of 8°-17°.

Do exist differences in kinematics and EMG of the hip and knee between male runners with and without patellofemoral pain in different running speeds?

ObjectivePatellofemoral pain (PFP) presents a higher prevalence in female runners, while PFP in male is somehow neglected. Moreover, the effects of progressive greater running speed have not been reported. This study investigates the influence of progressive greater running speed on lower limb tridimensional kinematics and muscle activation (EMG) in male runners with PFP while compared with controls. DesignCross-Sectional Design. MethodsThirteen runners with PFP and 18 controls ran in a treadmill under three different speeds: 9, 11, and 13 km/h. Principal component scores from kinematic data and EMG onset and amplitude were used to compare groups through the Mann-Whitney test at each running speed. ResultsMale PFP subjects presented increased hip internal rotation at 11 km/h and increased hip and knee internal at 13 km/h, as well as reduced knee adduction at all speeds. PFP subjects also ran with delayed and shorter vastus medialis oblique pre-activation compared with normal subjects. ConclusionsThis study demonstrated that PFP increased knee and hip internal rotation at higher demand running, therefore, it is important to evaluate the transverse plane of the hip and knee biomechanics in male runners with PFP to optimize the rehabilitation and reconditioning method of these subjects.

The Effects of Different Kinds of Smooth Pursuit Exercises on Center of Pressure and Muscle Activities during One Leg Standing.

Twenty-four subjects were selected for the study. The activity of trunk and lower limb muscles (tibialis anterior, lateral gastrocnemius, medial gastrocnemius, vastus midialis obliques, vastus lateralis, biceps femoris, rectus abdominis, and erector spinae) and the COP (center of pressure) (surface area ellipse, length, and average speed) were measured to observe the effects of gaze fixation and different kinds of smooth-pursuit eye movements on the center of pressure and muscle activities during one leg standing. Before the experiment, a Gaze point GP3 HD Eye Tracker (Gazept, Vancouver, BC, Canada) was used to train eye movement so that the subjects would be familiar with smooth eye movement. Repeated each exercise 3 times at random. In order to avoid the sequence deviation caused by fatigue, the movement sequence is randomly selected. The center of pressure and muscle activities were increased significantly when the smooth-pursuit eye movement with one leg standing compared with gaze fixation with one leg standing. In smooth-pursuit eye movements, the changes in the center of pressure and muscle activities were increased significantly with eye and head movement. When the head and eyes moved in opposite directions, the center of pressure and muscle activities were increased more than with any other exercises. Smooth-pursuit eye movement with one leg movement affects balance. In particular, in the smooth-pursuit eye movement with one leg standing, there were higher requirements for balance when the eyes and head move in the opposite direction. Therefore, this movement can be recommended to people who need to enhance their balance ability.

Correlation of Lower Limb Muscle Activity with Knee Joint Kinematics and Kinetics during Badminton Landing Tasks

A study on a single-leg landing task after an overhead stroke in badminton suggests that poor knee biomechanical indicators may be a risk factor for anterior cruciate ligament (ACL) injury. A preventive program targeting neuromuscular control strategies is said to alter the biomechanics of the knee joint and have a beneficial effect on reducing ACL injury. However, the relationship between muscle activity around the knee joint and knee biomechanical risk factors in the badminton landing task is unclear. The purpose of this study was to investigate the relationship between this movement pattern of muscle activity and knee kinematics and kinetics. This experiment analyzed knee muscle activity and biomechanical information in a sample of 34 badminton players (17 male, 17 female) during a badminton landing task. We assessed the relationship between the rectus femoris (RF), medial hamstring (MHAM), lateral hamstring (LHAM), medial gastrocnemius (MGAS), lateral gastrocnemius (LGAS), medial and lateral hamstring to quadriceps co-contraction ratio (MH/Q and LH/Q) with the knee flexion angle, valgus angle, extension moment, valgus moment, and proximal tibial anterior shear force. A moderate negative correlation was found between the peak knee flexion angle and electromyography (EMG) activity in LGAS (r = 0.47, p = 0.0046, R2 = 0.23, 95% CI: 0.16 to 0.70). Peak proximal tibial shear force showed strong and positive correlations with RF EMG activity (r = 0.52, p = 0.0016, R2 = 0.27, 95% CI: 0.22 to 0.73) and strong and negative correlations with MH/Q (r = 0.50, p = 0.0023, R2 = 0.25, 95% CI: 0.20 to 0.72). The knee extension moment showed moderate and positive correlations with RF EMG activity (r = 0.48, p = 0.0042, R2 = 0.23, 95% CI: 0.17 to 0.70) and strong and negative correlations with MH/Q (r = 0.57, p = 0.0004, R2 = 0.33, 95% CI: 0.29 to 0.76). The peak knee valgus moment showed strong and positive correlations with LH/Q (r = 0.55, p = 0.0007, R2 = 0.31, 95% CI: 0.26 to 0.75). Our findings suggest that there is a correlation between lower extremity muscle activity and knee kinematics and kinetics during the single-leg landing task in badminton; therefore, lower extremity muscle activity should be considered when developing rehabilitation or injury prevention programs.

EFEITOS DO TREINO ISOMÉTRICO RESISTIDO SOBRE A ATIVIDADE MUSCULAR DOS MEMBROS INFERIORES

ABSTRACT Introduction The high muscular strength in the hip joint is the foundation of jumping ability. Isometric resistance training includes the process of takeoff and landing, recruiting a more extensive set of muscle groups. Objective Analyze the isometric resistance training effects on lower limb muscle activity, including the coactivation of the antagonist’s muscles. Methods By mathematical statistics, weight-bearing isometric resistance training effects on lower extremity maximal muscle strength and explosive power were observed. Changes in coactivation and preactivation levels of lower extremity antagonist muscles data are evaluated and compared before and after isometric resistance training. Results The peak angular velocity of the joints at the hip and ankle in the isometric resistance training group is significantly higher than the control group. There was no significant difference in the peak angular velocity of the knee between the groups (P<0.05). Conclusion Isometric resistance training can shorten the return period, shorten the amortization period, and increase the energy conversion capacity in the muscle-tendon complex. Evidence level II; Therapeutic Studies - Investigating the results.

Textile electromyography electrodes reveal differences in lower limb muscle activation during loaded squats when comparing fixed and free barbell movement paths.

Traditional recordings of muscle activation often involve time-consuming application of surface electrodes affixed to the skin in laboratory environments. The development of textile electromyography (EMG) electrodes now allows fast and unobtrusive assessment of muscle activation in ecologically valid environments. In this study, textile EMG shorts were used to assess whether performing squats with the barbell resting freely on the shoulders or using a Smith machine for a fixed barbell movement path is preferable for maximizing lower limb muscle activation. Sixteen athletes performed free and fixed barbell squats in a gym with external loads equivalent to their body mass. Quadriceps, hamstrings and gluteus maximus activation was measured bilaterally with textile EMG electrodes embedded in shorts. Mean quadriceps activation was greater for the free compared with the fixed movement path for the right (mean difference [MD] 14μV, p = 0.04, ηp 2 = 0.28) and left leg (MD 15μV, p = 0.01, ηp 2 = 0.39) over the entire squat and specifically during the first half of the eccentric phase for the left leg (MD 7μV, p = 0.04, d = 0.56), second half of the eccentric phase for both legs (right leg MD 21μV, p = 0.05, d = 0.54; left leg MD 23μV, p = 0.04, d = 0.52) and the first half of the concentric phase for both legs (right leg MD 24μV, p = 0.04, d = 0.56; left leg MD 15μV, p = 0.01, d = 0.72). Greater hamstrings activation for the free path was seen for the second half of the eccentric phase (left leg MD 4μV, p = 0.03, d = 0.58) and first half of the concentric phase (right leg MD 5μV, p = 0.02, d = 0.72). No significant differences were found for gluteus maximus. Textile EMG electrodes embedded in shorts revealed that to maximize thigh muscle activity during loaded squats, a free barbell movement path is preferable to a fixed barbell movement path.

Gender Comparisons and Associations between Lower Limb Muscle Activation Strategies and Resultant Knee Biomechanics during Single Leg Drop Landings

(1) Background: We aimed to compare gender differences in knee biomechanics and neuromuscular characteristics, and to determine the relationships between lower limb muscle pre-activations and knee biomechanics during a single leg drop landing, in order to identify riskier landing patterns to prevent injury and intervene properly. (2) Methods: Descriptive laboratory cross-sectional study on 38 healthy untrained subjects with low to moderate physical activity status. (3) Results: During the initial-contact phase of landing, females demonstrated greater peak vertical ground reaction force (GRF) normalized to body weight (49.12 ± 7.53 vs. 39.88 ± 5.69 N/kg; p < 0.001; Hedge’s g = 1.37), peak knee anterior reaction force normalized to body weight (0.23 ± 0.04 vs. 0.17 ± 0.05 N/kg; p < 0.001; Hedge’s g = 1.33), and decreased pre-activation of the semitendinosus (45.10 ± 20.05% vs. 34.03 ± 12.05%; p = 0.04; Hedge’s g = 0.67). The final regression equation was peak knee anterior reaction force = 0.024 + 0.025 (peak knee flexion moment) − 0.02 (semitendinosus-to-vastus lateralis pre-activation ratio) + 0.003 (peak vertical GRF) (R2 = 0.576, p < 0.001). (4) Conclusions: Overall, the data provided in this study support that a reduced semitendinosus-to-vastus lateralis pre-activation ratio predicted an increase in knee anterior reaction force and potentially an increase in ACL forces. Female non-athletes had gender-specific landing characteristics that may contribute to ACL injury. Future studies are warranted to consider more possible predictors of non-contact ACL injury.

Age-Related Differences in Stepping Reactions to a Balance Perturbation: A Functional Near-Infrared Spectroscopy and Surface Electromyography Study.

We sought to investigate age-related differences in stepping reactions to a sudden balance perturbation, focusing on muscle activity and cortical activation. A total of 18 older healthy adults (older group, OG) and 16 young healthy adults (young group, YG) were recruited into this study. A cable-pull instrument was used to induce a forward perturbation at the waist level among participants, who were required to take the right step to maintain their postural balance. The seven right lower-limb muscle activities during periods of compensatory postural adjustments (CPAs) were recorded by surface electromyography. At the same time, the signals of channels located in the prefrontal, temporal and parietal lobes were recorded by functional near-infrared spectroscopy (fNIRS) during the whole process. Integral electromyograms of the right peroneus muscle, gluteus medius, and lateral gastrocnemius muscles showed greater activity for the OG in the CPA periods. Two channels belonging to the right pre-frontal (PFC) and pre-motor cortex (PMC) revealed lower activation in the OG compared with the YG. These findings can help us to better understand the differences at the peripheral and central levels and may provide some suggestions for future neuromodulation techniques and other clinical treatments.

Modulation of Lower-Limb Muscle Activity in Maintaining Unipedal Balance According to Surface Stability, Sway Direction, and Leg Dominance.

Determining temporal similarity in shape between electromyographic (EMG) and center-of-pressure (COP) signals reflects neuromuscular control in terms of which relevant muscles are involved in maintaining balance. The current study aimed to investigate a cross-correlation between seven lower-limb EMG activities and COP displacements, simultaneously measured in 25 young adults unipedally balancing on stable and multiaxial-unstable surfaces. The effect of surface stability, sway direction, and leg dominance was then tested on two EMG–COP correlation levels: individual muscles and groups (patterns) of multi-muscles involved in postural sway, as determined by principal component analysis (PCA). The results show that two factors demonstrate their effects only at the level of individual muscles: sway direction (p ≤ 0.003) and leg dominance (p = 0.003). Specifically, the semitendinosus, tibialis anterior, peroneus longus, and soleus correlate more with the mediolateral postural sway than with the anteroposterior postural sway, except for the gastrocnemius medialis. Additionally, balancing on the non-dominant leg shows a lower correlation between the semitendinosus and postural sway than on the dominant leg. The current findings suggest that when achieving unipedal equilibrium, the postural control system may be constrained the most in the specific muscles of the least steady conditions, e.g., the frontal plane and non-preferred leg.

Sex Differences in Muscle Activity During Drop-Jump Landing Motion

This study investigated the effect of hip joint muscles' activity on dynamic knee-joint valgus angle during one-leg drop-jump landing motion in male and female subjects. Twenty-four healthy university students (11 males and 13 females) participated in the study. Surface electromyography was used to measure muscle activity during a one-leg landing motion. A gender difference was observed: males showed greater activity in the gluteus medius muscle compared to the adductor magnus muscle, whereas females showed greater activity in the rectus femoris muscle. A correlation between lower limb muscle activity and knee-joint valgus angle was found in male subjects but not in female subjects, suggesting that factors other than muscle activity are necessary for controlling knee joint valgus in females. Therefore, factors other than muscle activity should be investigated in the future to prevent female anterior cruciate ligament injuries.

Effects of asymmetrical support on lower limb muscle activity during Lokomat guided gait in persons with a chronic stroke: an explorative study.

The Lokomat, one of the most popular robotic exoskeletons, can take the asymmetry in the gait pattern of unilaterally affected patients into account with its opportunity to provide unequal levels of movement support (or 'guidance') to each of the legs. This asymmetrical guidance may be used to selectively unburden limbs with impaired voluntary control and/or to exploit the interlimb couplings for training purposes. However, there is a need to explore and understand these specific device opportunities more broadly before implementing them in training. The aim of this study was to explore the effects of (a)symmetrical guidance settings on lower limb muscle activity in persons with post stroke hemiparesis, during Lokomat guided gait. A single group, dependent factorial design. Rehabilitation center; a single session of Lokomat guided walking. A group of ten persons with post stroke hemiparesis. Participants walked in the Lokomat in eight conditions, consisting of symmetrical and asymmetrical guidance situations, at both 0.28 m/s and 0.56 m/s. During symmetrical conditions, both legs received 30% or 100% guidance, while during asymmetrical conditions one leg received 30% and the other leg 100% guidance. Surface electromyography was bilaterally measured from: Biceps Femoris, Rectus Femoris, Vastus Medialis, Medial Gastrocnemius and Tibialis Anterior. Statistical effects were assessed using Statistical Parametric Mapping. The provision of assymetrical guidance did not affect the level of lower limb muscle activity. In addition, no effect (except for Vastus Medialis in the affected leg during 1.5-2.4% of the gait cycle) of symmetrical guidance on muscle amplitude could be observed. The results show no evidence that either symmetrical or asymmetrical guidance settings provided by the Lokomat can be used to manipulate activity of lower limb musculature in persons with post stroke hemiparesis. This study provides insights for the use of specific opportunities provided by the Lokomat for training purposes post stroke.

Backstroke-to-Breaststroke Turns Muscular Activity. A Study Conducted in Age Group Swimmers.

The aims of this study were to compare surface electromyographic (EMG) activity and kinematic variables among open, somersault, bucket and crossover backstroke-to-breaststroke turning techniques, and identify relationships between the integrated electromyography (iEMG) and kinematics profile focusing on the rotation and push-off efficacy. Following a four-week of systematically increasing contextual interference intervention program, eight 12.38 ± 0.55 years old male swimmers randomly performed twelve repetitions (three in each technique) turns in and out of the wall at maximum speed until the 7.5 m reference mark. Surface EMG values of the right vastus lateralis, biceps femoris, tibialis anterior, gastrocnemius medialis, rectus abdominis, external oblique, erector spinae and latissimus dorsi were recorded and processed using the integrated electromyography (iEMG) and the total integrated electromyography (TiEMG) that was expressed as a percentage of iEMGmax to normalize per unit of time for each rotation and push-off phase. Complementarily, 2D sagittal views from an underwater video camera were digitized to determine rotation and push-off efficacy. The crossover turn presented the highest rotation and push-off iEMG values. Erector spinae and gastrocnemius medialis had the highest activity in the rotation and push-off phases (89 ± 10 and 98 ± 69%, respectively). TiEMG depicted a very high activity of lower limb muscles during push-off activity (222 ± 17 to 247 ± 16%). However, there were no relation between TiEMG and rotation and push-off time, tuck index and final push-off velocity during the rotation and the push-off phases across all the studied turning techniques. The rotation efficacy in age-group swimmers were dependent on rotation time (p = 0.04). The different turning techniques were not distinguishable regarding iEMG activity as a possible determinant of rotation and push-off efficacy. Our study has direct implications for selecting appropriate exercises and designing training programs for optimizing the rotation and push-off phases of backstroke-to-breaststroke turning at young ages.

Lower-Limb Muscle Activity During Aquatic Treadmill Running in Individuals With Anterior Cruciate Ligament Reconstruction

While anterior cruciate ligament (ACL) tears are commonly managed with ACL reconstruction (ACL-R), 35% of ACL-R individuals fail to return to the preinjury elite sport level. Persistent neuromuscular deficits in the hamstrings and quadriceps have been observed. It has been proposed that aquatic therapy can be used to optimize neuromuscular control after ACL-R. (1)To compare muscle activity in ACL-R individuals during aquatic treadmill (ATM) running at different water depths and (2)to compare muscle activity during ATM running between ACL-R and healthy individuals. A total of 38 participants, including 18 ACL-R individuals (mean postoperative time [SD] = 25.8 [25.0] mo) and 20 healthy individuals were recruited. Muscle activity of biceps femoris (BF), rectus femoris (RF), tibialis anterior, and medial gastrocnemius during land treadmill and ATM running at mid-shin, mid-thigh, and waist levels were recorded using surface electromyography (sEMG). The sEMG signals of the selected muscles were normalized and expressed in % Maximal Voluntary Contraction (%MVC). Muscle activity of the ACL-R, ACL-contralateral, and healthy control limbs at different water depths was compared. Among the 3 groups, the ACL-R group demonstrated the most prominent percentage increase of 101.97% (P = .001) at mid-shin level, 139.66% (P = .001) at mid-thigh level, and 141.97% (P < .001) at waist level, respectively, in %MVC when compared to land. In the ACL-R group, muscle activity of BF in the stance phase (BFSt) was significantly higher than the control group on land at all water depths. Muscle activity of RF in the swing phase (RFSw) in the ACL-R group significantly increased in all water depths immersion when compared to land, respectively. This study showed an increasing trend in muscle activity of BFSt and RFSw in ACL-R individuals during ATM running at increased water depths. ATM running could be implemented as neuromuscular training in rehabilitation after ACL-R.

Differences in trunk and lower extremity muscle activity during squatting exercise with and without hammer swing

Perturbation exercises enhance lower limb and trunk muscles, and adding swing perturbation while loading during exercise might improve muscle activation or strength. This study aimed to check variations in trunk and lower limb muscle activity during conventional isometric squats, and whether it will change with or without swing using the Hammerobics-synchronized squat method. Twelve healthy men participated in this study. Activities for the abductor hallucis, tibialis anterior, tibialis posterior, peroneus longus, rectus femoris, biceps femoris long head, semitendinosus, gluteus maximus, multifidus, and internal oblique muscles were measured using surface electromyography during a Hammerobics-synchronized squat and conventional isometric squat. Muscle activities were statistically compared between squat methods. Hammerobics-synchronized squats significantly activated the abductor hallucis, tibialis anterior, tibialis posterior, peroneus longus, semitendinosus, and multifidus muscles, in both phases, compared with the conventional isometric squats. The Hammerobics-synchronized squat exercise can be considered for trunk and foot stability exercise.

How Ankle Exoskeleton Assistance Affects the Mechanics of Incline Walking and Stair Ascent in Cerebral Palsy.

Graded terrains, like slopes and stairs, are particularly challenging for people with neurological disorders like cerebral palsy (CP) due to increased selective muscle control and muscle strength requirements. Lower-limb exoskeletons may be able to assist individuals with CP when navigating graded terrains. This study sought to determine the effects of untethered ankle exoskeleton assistance on lower-limb joint angles, moments, and muscle activity during up-incline walking and up-stair stepping in CP (n=7). We hypothesized that powered assistance would result in improved ankle mechanics (i.e., increased total ankle moments) across both terrains. During incline walking, we found that peak ankle dorsiflexion angle increased by $7^{\mathrm{o}}$(p=0.006) during walking with ankle assistance compared to walking without the device (Shod). Compared to without the device, the peak total ankle plantarflexor moment increased by 8% (p=0.022) while peak biological ankle plantarflexor moment decreased by 17% (p< 0.001). Incline walking with ankle assistance reduced stance phase muscle activity of the soleus (20%, p=0.010) and vastus lateralis (18%, p=0.004), and swing phase tibialis activity (19%, p=0.028) compared to Shod. During stair ascent with the device, the peak total ankle plantarflexor moment increased by 17% (p=0.011) and the peak knee extensor moment increased by 40% (p=0.018) compared to Shod. These findings provide insight into the biomechanical benefits of ankle exoskeleton assistance during incline and stair walking. This work aims to advance the use of robotic assistive technology to improve mobility for people with CP.

Evaluation of dynamic spinal alignment changes and compensation using three-dimensional gait motion analysis for dropped head syndrome

BACKGROUND CONTEXTDynamic kinematic evaluation of spino-pelvic alignment during gait using three-dimensional (3D) motion analysis has been proposed for adult spinal thoracolumbar deformity. That is because conventional full-spine radiographs cannot be used to evaluate dynamic factors. However, dynamic changes in spino-pelvic alignment during gait for dropped head syndrome (DHS) have not been studied using this approach. PURPOSE: This study aimed to assess the dynamic changes in spinal-pelvic alignment during gait in patients with DHS using 3D motion analysis. STUDY DESIGNRetrospective review of collected radiographic and kinematic data. PATIENT SAMPLENineteen DHS patients with neck pain and/or anterior gaze disturbance. OUTCOME MEASURESStatic spino-pelvic radiological alignment, dynamic spino-pelvic kinematic parameters and electromyogram (EMG) data. METHODSCenter of gravity of the head - C7 sagittal vertical axis (CGH-C7 SVA), C2-C7 SVA, T1 slope; cervical lordosis (CL), C7SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT) and pelvic incidence (PI) were assessed using full-spine radiographs in a standing position to assess static spino-pelvic alignment. The 3D gait motion analysis was conducted during gait. Dynamic kinematic parameters were divided into spinal segments: cervical (C-), thoracic (T-), lumbar (L-) and pelvis (P-). Each spinal segment coronal angle to the pelvic angle, each spinal segment sagittal angle to the pelvic angle and pelvic sagittal angle to the horizontal axis were assessed as dynamic spino-pelvic kinematic parameters. Trunk and lower limb muscle activity during gait were assessed using wireless surface EMG analysis. Dynamic spino-pelvic kinematic variables and muscle activity were compared between the first walking lap and the final lap during gait analysis. The change in dynamic kinematic parameters was correlated with static radiological alignment and electromyographic muscular activity change. RESULTSCervical and thoracic anterior tilt increased significantly after an extended period of walking, indicating that dropped head worsened during gait. An increase of cervical anterior tilt during walking was significantly associated with decreased muscle activity in the cervical paraspinal muscles (r=-0.463, P<.05) and latissimus dorsi (r=-0.763, p<.01). Furthermore, significant correlations were found between a change in thoracic sagittal angle to pelvic angle and C7SVA (r=0.683, p<.01) and LL (r=-0.475, p<.05). This means that a larger C7SVA and smaller LL were associated with increased thoracic anterior tilt during gait. CONCLUSIONSThe 3D motion analysis for DHS showed that cervical and thoracic anterior tilt significantly increased after extended walking, resulting in worsening of dropped head. Decreased muscle activity of the neck extensor muscles during gait suggests insufficient neck extensor muscle endurance, which was associated with increased cervical anterior tilt. A greater increase in the thoracic anterior tilt during gait was found in DHS patients with a larger C7SVA and smaller LL due to insufficient thoracolumbar compensation for the dropped head. Correction of the cervical spine alone would not be sufficient to improve dropped head in cases with increased thoracic anterior tilt during gait. The results suggest that C7SVA and LL are crucial parameters in the surgical strategy for DHS.

Long-term functional recovery in patients with custom-made 3D-printed anatomical pelvic prostheses following bone tumor excision

BackgroundAnatomical custom-made prostheses make it possible to reconstruct complicated bone defects following excision of bone tumors, thanks to 3D-printed technology. To date, clinical measures have been used to report clinical-functional outcome and provide evidence for the effectiveness of this new surgical approach. However, there are no studies that quantified the achievable recovery during common activities by using instrumental clinical-functional evaluation in these patients. Research questionWhat is the motor performance, functional outcome and quality of life in patients with custom-made 3D-printed pelvic prostheses following bone tumor? MethodsTo analyze motor performance, six patients performed motion analysis during five motor activities at follow-up of 32 ± 18 months. Joint angles, ground reaction forces and joint moments of the operated and contralateral limbs were compared. On-off activity of lower-limb muscles were calculated from electromyography and compared to a healthy matched population. To analyze functional outcome and quality of life, differences in measured hip abductor strength between limbs were evaluated, as well as clinical-functional scores (Harris Hip Score, Barthel Index, Musculoskeletal Tumor Society score), and quality of life (SF-36 health survey). ResultsWe found only slight differences in joint kinematics when comparing operated and contralateral limb. The activity of gluteal muscles was normal, while hamstrings showed out-of-phase activities. Ground reaction forces and hip moments showed asymmetries between limbs, particularly in more demanding motor activities. We found a mean difference in hip abductor strength of 48 ± 82 N between limbs, good clinical-functional scores, and quality of life scores within normative. SignificanceOur study showed optimal long-term results in functional recovery, mainly achieved through recovery of the gluteal function, although minor impairments were found, which may be considered for future improvement of this innovative surgery. The effect of a more loaded contralateral limb on internal loads and long-term performance of the implant remains unknown and deserves further investigation.

Females with knee osteoarthritis use a detrimental knee loading strategy when squatting

BackgroundThe purpose of this study was to identify sex differences in lower limb kinematics, kinetics, and muscle activation patterns between individuals with osteoarthritis and healthy controls during a two-legged squat. MethodThirty OA (15 females) and 30 healthy (15 females) participants performed three 2-legged squats. Sagittal and frontal plane hip, knee, and ankle kinematics and kinetics were calculated. Two-way ANOVAs (Sex X OA Status) were used to characterize differences in squatting strategies between sexes and between those with and without knee OA. ResultsA greater decrease in sagittal hip, knee, and ankle range of motion and knee joint power was observed in the OA participants compared to the healthy controls. Females with OA had significantly reduced hip and knee adduction angles compared to the healthy females and males with OA. Females also had decreased hip power, hip flexion, and hip adduction moments and knee adduction moments compared to their male counterparts, with the greatest deficits observed in the females with OA. Females with OA also had the highest magnitude of muscle activation for the quadriceps, hamstrings, and gastrocnemius throughout the squat, while males with OA showed increased activation of the vastus lateralis and medial gastrocnemius compared to the healthy males. ConclusionsOA significantly altered biomechanics and neuromuscular control during the squat, with males employing a hip-dominant strategy, allowing them to achieve a greater lower limb range of motion.