Hip Flexion Range Research Articles

Factors associated with poor hip flexion range of motion after total hip arthroplasty in patients with ankylosing spondylitis: a retrospective study on 538 consecutive hips

BackgroundThis study aimed to report the mid-term functional outcomes of total hip arthroplasty (THA) for the treatment of advanced hip involvement in ankylosing spondylitis (AS) and identify the factors associated with poor hip flexion range of motion (ROM) after THA in patients with AS.MethodsWe retrospectively investigated the mid-term functional outcomes in 313 AS patients (538 hips) who underwent primary THA from 2012 to 2017, with a mean follow-up of 7 years (range, 4–9 years). Postoperative functional outcomes were assessed by hip flexion ROM, Harris hip score (HHS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The hips were divided into poor (≤ 90°) and good hip flexion ROM (> 90°) groups based on the degree of hip flexion ROM recorded at the most recent follow-up. We grouped factors related to postoperative hip flexion ROM into three categories: preoperative (or patient-related), intraoperative (or surgery-related), and postoperative factors. Multivariate logistic regression was performed to identify the independent factors associated with postoperative poor hip flexion ROM.ResultsThe overall flexion-extension ROM improved significantly with a median from 0° (0 ~ 120°) to 100° (30 ~ 130°) after THA (P < 0.001), and the mean HHS increased from 37 to 90 (P < 0.001). There were 102 hips (19%) with a hip flexion ROM of no more than 90°. The poor hip flexion ROM group had significantly lower postoperative HHS and WOMAC than the good hip flexion ROM group (85 ± 6 vs. 91 ± 4, P < 0.001; 63 ± 16 vs. 32 ± 16, P < 0.001). The result of multivariate logistic regression showed that male sex (odds ratio [OR] = 9.42, 95% confidence interval [CI], 1.23 to 72.03), bony ankylosis (OR = 3.02, 95%CI, 1.76 to 5.17), cup anteversion angle (OR = 0.96, 95%CI, 0.93 to 0.98), cup inclination angle (OR = 0.96, 95%CI, 0.93 to 0.99), American Society of Anesthesiologists (ASA) class III (OR = 6.23, 95%CI, 1.83 to 21.70), knee involvement (OR = 7.80, 95%CI, 2.75 to 22.16), and noise (OR = 0.45, 95%CI, 0.25 to 0.81) were independent factors associated with poor hip flexion ROM after THA in patients with AS.ConclusionNearly one out of the five hips in patients with AS have a poor hip flexion ROM after THA. Care has to be taken in acetabular component positioning during THA and its effect on the postoperative hip flexion function should be considered in the patients. The optimum treatment strategy is that THA should be performed before ankylosis in patients with AS.

Assessment of a New Gait Asymmetry Index in Patients After Unilateral Total Hip Arthroplasty.

Background/Objectives: Comparing a given variable between the lower extremities (LEs) usually involves calculating the value of a selected asymmetry index. The aim of this study was to evaluate the mean-dependent asymmetry index for gait variables. Methods: The three-point crutch gait asymmetry between the non-surgical LE (NS) and surgical LE (S) was assessed in 14 patients after unilateral total hip arthroplasty. An eight-camera motion capture system integrated with two force platforms was used. The values of the new gait asymmetry index (MA) were calculated for such variables as stance phase time (ST), knee flexion and extension range of motion (KFE RoM), hip flexion and extension range of motion (HFE RoM), and vertical ground reaction force (VGRF). Results: An analysis related to gait asymmetry showed significantly higher values for all variables for the NS than for the S (the MA ranged from 9.9 to 42.0%; p < 0.001). In the case of comparisons between the MA and other indices, the intraclass correlation coefficient ranged from 0.566 to 0.998 (p < 0.001) with Bland-Altman bias values that ranged from -18.2 to 0.3 %GC (ST), from 0.0 to 0.5° (KFE RoM), from -12.4 to 1.4° (HFE RoM), and from -11.9 to -0.1 %BW (VGRF). Conclusions: The findings revealed a prominent three-point crutch gait asymmetry for all variables, especially a disturbingly large asymmetry for the HFE RoM and VGRF. The comparisons also showed generally excellent or good agreement with the other indices. Furthermore, the mean MA result from n single values was the same as the MA result calculated using the mean values of a given variable. The MA, as an accurate asymmetry index, can be used to objectively assess pathological gait asymmetry.

The impact of protocol designs for using massage guns on lower body flexibility: A randomised cross-over design study

IntroductionCurrent protocols for delivering percussive therapy (PT) using massage guns are heterogeneous creating a need to establish the impact of study design on physiological measures. This cross-over design study aimed to determine the most effective protocol, among the eight protocols examined, on lower body flexibility, and to support the provision of protocol validation for future research. MethodRecreationally active healthy adults (n = 35) undertook two main protocols; three sessions per week at 2100 rpm or increasing the speed from session-to-session: 1750 to 2100–2400 rpm. PT was applied for 60 s to each of the quadriceps, gluteals, hamstrings and calves of both legs. Paired-samples t-tests assessed pre- and post-intervention data for hip flexion and ankle dorsi-flexion range of motion (ROM). These were collected in all sessions using a digital goniometer allowing changes for eight different protocols to be examined. ResultsResults showed the most effective protocol, among the eight protocols examined, for achieving significant gains in lower body flexibility is applying massage gun PT three times a week with increased speeds across sessions (1750–2100–2400 rpm), with average increases for the combined dominant and non-dominant legs of 5.8% for hip flexion and 5.6% ankle dorsiflexion. ConclusionsPractitioners and the public using this protocol could target specific improvements in hip flexion and ankle dorsi-flexion ROM and researchers may wish to adopt this protocol to allow homogenous analysis across study populations in future research.

Effects of Preconditioning Lower-Extremity Resistance Exercises on Multidirectional Repeated Sprinting-Induced Muscle Damage.

Hsu, SM, Tseng, WC, Chiu, CH, Hsieh, TY, Weng, MC, Dai, X, and Chen, CH. Effects of preconditioning lower-extremity resistance exercises on multi directional repeated sprinting-induced muscle damage. J Strength Cond Res XX(X): 000-000, 2024-Sprint exercise-induced muscle damage is a popular area of investigation. To examine whether preconditioning lower-extremity resistance exercises would reduce the amount of muscle damage observed after a multi-directional repeated sprinting (MDS) exercise. Thirty-six elite male athletes were randomly allocated to 1 of 3 groups: general warm-up (GW), GW with loaded jump squat (SQ), and GW with loaded hip thrust (HT). Knee flexion isometric strength (MVIC), passive hip flexion range of motion (ROM), soreness, countermovement jump (CMJ), sprint time, and plasma creatine kinase (CK) activity were measured at the pretest and post-24, -48, and -72 hours of the MDS. For SQ, the CK at post-72 hours was significantly lower than the GW group. The decrements of MVIC at post-48 and -72 hours for SQ were significantly less than the GW group. The CMJs at post-24 and -48 hours for SQ and at post-48 and -72 hours for HT were significantly higher than the GW group. The 0-10 m sprint time at post-48 hour for HT was significantly better than the GW group. Adding the SQ or HT interventions to a GW before MDS has a protective effect on the sprinting-induced muscle damage and faster recovery.

Functional Recovery After Hip Arthroplasty with a Minimal Invasive or Classical Approach Eight Years After Intervention.

Background: The aim of this study was to investigate differences in functional recovery eight years after total hip arthroplasty in patients who underwent hip joint surgery using two different approaches: the classic lateral approach and the anterolateral minimally invasive surgical approach. Methods: Eight years after the hip replacement, 68 subjects, 32 in the classic and 36 in the minimally invasive group, underwent follow-up measurements involving the Harris Hip Score (HHS), range of motion, strength of the abductor muscles, 50-m walk time, body mass index (BMI), physical activity questionnaire, and visual analogue scale (VAS) pain during general activities. Results: Higher HHS (p < 0.001), hip abduction (p < 0.001), and hip flexion (p = 0.018) range of motion values were obtained in the minimally invasive approach group. A correlation between physical activity (PA) and the hip abduction muscle strength in the classic group (r = 0.43; p = 0.011) and a correlation between PA and the HHS in the minimally invasive group (r = 0.34, p = 0.041) was found. BMI was correlated with the 50-m walk time in both groups (classical: r = 0.39; p = 0.027; minimally invasive r = 0.35; p = 0.030); meanwhile, in the minimally invasive group, BMI was negatively correlated with hip flexion (r = -0.37; p = 0.020). Conclusions: Eight years after total hip arthroplasty, performed using either an anterolateral minimally invasive or lateral approach, there was no difference in the patients' functional outcome in relation to BMI. The minimally invasive approach benefits patients by granting them better functional abilities. A clinical difference was found in the HHS, in favour of the minimally invasive group.

Effect of lower extremity joint distraction exercises during warm-up on range of motion, flexibility, and jump performance in female volleyball players

Background and Study Aim. Effective warm-up routines are critical for enhancing athletic performance and reducing injury risk. Joint distraction exercises are hypothesized to improve range of motion (ROM), flexibility, and jump performance, yet their effects are not well-documented in volleyball. This study aims to investigate the impact of joint distraction exercises applied to the lower extremities during warm-ups on ROM, flexibility, and jump performance in female volleyball players. Material and Methods. Twenty-four female volleyball players voluntarily participated in this study. The standard protocol included routine warm-ups followed by pre-tests measuring flexibility, range of motion (ROM), vertical jump (VJ), and horizontal jump (HJ). After a 48-hour rest period to minimize fatigue effects, the athletes underwent joint distraction exercises using elastic bands targeted at the lower extremities. Post-tests were conducted after these specific warm-up exercises to assess any changes. Data analysis was performed using SPSS software Results. The study found no significant difference in hip flexion range of motion (ROM) scores following joint distraction exercises (p &gt; 0.05). However, statistically significant improvements were observed in overall flexibility, ankle dorsiflexion ROM, and both vertical and horizontal jump performances (p &lt; 0.05). Conclusions. The study demonstrates that joint distraction exercises during warm-ups significantly enhance flexibility, range of motion (ROM), and jump performance in female volleyball players. Incorporating these exercises into routine warm-ups could be crucial for optimizing athletic performance and potentially reducing injury risks.

Platform Design for Optical Screening and Conditioning for Injury Resilience.

Musculoskeletal injuries (MSKIs) among active duty soldiers result in more than 10 million limited duty days each year and account for more than 70% of the medically nondeployable population. Overuse injuries in lower limbs from running, foot marching long distances with heavy loads, and lifting heavy objects are the most common types of injuries in the military. Physical training and rehabilitation exercises for greater resiliency through aerobic, muscle strength, endurance, and agility conditioning programs can prevent or reduce the effects of MSKIs if Soldiers adhere to proper biomechanics and training techniques. We are introducing a three-dimensional (3D) camera-based platform for Optical Screening and Conditioning for Injury Resilience (OSCIR) that is designed to identify and correct high-risk movement patterns based on quantifiable biomechanical measurements in clinical or field settings. Our goal is to improve resilience to MSKI by offering greater access to quality of movement skills in warfighters through an autonomous device that can be used in Sports Medicine and Reconditioning Team (SMART) clinics and High-Intensity Tactical Training (HITT) sites. OSCIR fuses four pairs of Kinect Azure cameras into a concise footprint to achieve suitable sampling rates and an unobstructed field of view for accurate dynamic movement tracking using a custom point cloud solution. We designed a unique multistage 3D joint tracking algorithm architecture to methodically isolate the human body point cloud from the background, identify individual limb segments, and perform iterative joint optimization at the global and local joint levels. We evaluated the feasibility of our prototype system among N = 12 control participants (6 M/6 F; 21-37 years) in compliance with the Western Institutional Review Board (Tracking #20225920, approved on November 4, 2022). Five task-specific MSKI outcome metrics identified by end-user physical therapists and athletic trainers as indicators for movement quality were assessed across 7 lower-extremity exercises derived from standardized MSK assessment/conditioning batteries used in the military. Data were recorded concurrently by OSCIR and a reference standard Vicon motion capture system for validating system accuracy. Task-specific MSKI indicators for knee flexion and hip flexion range of motion achieved an average error of 4.05 ± 2.34°, while 3D position-based postural outcomes of left-right foot distance, left-right hand distance, and step length obtained mean absolute errors of 2.58 ± 2.30 cm. Results support the feasibility of our system in achieving outcomes that are comparable to currently accepted laboratory standards. Our study describes the integration process for a 3D camera-based clinical system for MSKI conditioning and rehabilitation. The impact of our system will enable key stakeholders in the military to manage MSKIs in warfighters by automating key assessment and rehabilitation test batteries; making tests more readily accessible, and interpretations more accurate by providing objective biomechanical measures. OSCIR is undergoing turn-key design features to serve as a screening tool for warfighters to readily assess susceptibility to MSKI or as a training platform to help guide exercise techniques to achieve resiliency against future injuries.

Behavioral and cortical dynamics underlying superior accuracy in short-distance passes

Improved pass accuracy is a prominent determinant of success in football. It demands an effective interaction of complex behavioral and cortical dynamics. Exploring differences in the ability to sustain an accurate pass behavior in a stable setting and the associated cortical dynamics at different expertise levels may provide an insight into skilled strategies contributing to superior accuracy in football. The aim of this study is to compare trial-to-trial variability of pass biomechanics and the corresponding cortical dynamics during short-distance passes between novices and experienced football players. Thirty participants (15 novices, 15 football players) performed 90 short-distance passes. The intertrial variability of pass biomechanics (foot acceleration, range of hip flexion, knee flexion and foot rotation) was assessed by means of multiscale entropy. The task-related cortical dynamics were analyzed via source-derived event-related spectral perturbations. Experienced players demonstrated higher accuracy and overall lower entropy values across multiple time scales which was significant for hip flexion. The electroencephalography data revealed group differences in parieto-occipital alpha desynchronization and frontal theta synchronization in successive phases of passes. The current findings suggest that experienced football players may show a skilled ability to recruit and retain pass biomechanics promoting higher accuracy, whereas novices may show an explorative behavior with higher spatial variability. This difference may be associated with distinctive visuospatial and attentional strategies acquired with expertise in football. Our study provides an insight into expertise-specific behavioral and cortical dynamics of superior accuracy in football and a basis for its prospective investigation in enriched contexts.

Sustainable effectiveness of kinetic chain stretching on active hip flexion movement and muscle activation for hamstring tightness: A preliminary investigation.

Conventional hamstring (HAM) stretching therapeutic effects are not substantiable in neuromusculoskeletal conditions with HAM tightness or shortness. We developed a kinetic chain stabilization exercise to provide a more sustainable effectiveness in adults with HAM tightness. However, its therapeutic effects and underlying motor mechanisms remain unknown. To compare the effects of traditional active HAM stretching (AHS) and kinetic chain stretching (KCS) on electromyographic (EMG) amplitude and hip flexion range of motion (ROM) in participants with HAM tightness. In this randomized controlled trial, 18 participants (mean age: 25.01 ± 2.47 years) with HAM tightness were assigned to the AHS or KCS group. Hip joint movement, EMG amplitude, and onset times were recorded in the bilateral erector spinae, HAM, transverse abdominis/internal oblique (IO), external oblique (EO), and rectus abdominis during a straight leg raise test. Compared to AHS, KCS led to greater increase in the hip flexion ROM and EMG activation amplitudes in the left and right EO and left IO. Post-test hip flexion ROM data in both the groups were higher than the pre-test data. KCS produced more sustainable effectiveness in hip flexion movement and EMG motor control patterns in participants with HAM tightness than AHS.

Inclusion of a skeletal model partly improves the reliability of lower limb joint angles derived from a markerless depth camera

A single depth camera provides a fast and easy approach to performing biomechanical assessments in a clinical setting; however, there are currently no established methods to reliably determine joint angles from these devices. The primary aim of this study was to compare joint angles as well as the between-day reliability of direct kinematics to model-constrained inverse kinematics recorded using a single markerless depth camera during a range of clinical and athletic movement assessments.A secondary aim was to determine the minimum number of trials required to maximize reliability. Eighteen healthy participants attended two testing sessions one week apart. Tasks included treadmill walking, treadmill running, single-leg squats, single-leg countermovement jumps, bilateral countermovement jumps, and drop vertical jumps. Keypoint data were processed using direct kinematics as well as in OpenSim using a full-body musculoskeletal model and inverse kinematics. Kinematic methods were compared using statistical parametric mapping and between-day reliability was calculated using intraclass correlation coefficients, mean absolute error, and minimal detectable change. Keypoint-derived inverse kinematics resulted in significantly smaller hip flexion (range = −9 to −2°), hip abduction (range = −3 to −2°), knee flexion (range = −5° to −2°), and greater dorsiflexion angles (range = 6–15°) than direct kinematics. Both markerless kinematic methods had high between-day reliability (inverse kinematics ICC 95 %CI = 0.83–0.90; direct kinematics ICC 95 %CI = 0.80–0.93). For certain tasks and joints, keypoint-derived inverse kinematics resulted in greater reliability (up to 0.47 ICC) and smaller minimal detectable changes (up to 13°) than direct kinematics. Performing 2–4 trials was sufficient to maximize reliability for most tasks. A single markerless depth camera can reliably measure lower limb joint angles, and skeletal model-constrained inverse kinematics improves lower limb joint angle reliability for certain tasks and joints.

Development of Quasi-Passive Back-Support Exoskeleton with Compact Variable Gravity Compensation Module and Bio-Inspired Hip Joint Mechanism.

The back support exoskeletons have garnered significant attention to alleviate musculoskeletal injuries, prevalent in industrial settings. In this paper, we propose AeBS, a quasi-passive back-support exoskeleton developed to provide variable assistive torque across the entire range of hip joint motion, for tasks with frequent load changes. AeBS can adjust the assistive torque levels while minimizing energy for the torque variation without constraining the range of motion of the hip joint. To match the requisite assistance levels for back support, a compact variable gravity compensation module with reinforced elastic elements is applied to AeBS. Additionally, we devised a bio-inspired hip joint mechanism that mimics the configuration of the human hip axis to ensure the free body motion of the wearer, significantly affecting assistive torque transmission and wearing comfort. Benchtop testing showed that AeBS has a variable assistive torque range of 5.81 Nm (ranging from 1.23 to 7.04 Nm) across a targeted hip flexion range of 135°. Furthermore, a questionnaire survey revealed that the bio-inspired hip joint mechanism effectively facilitates the transmission of the intended assistive torque while enhancing wearer comfort.

Comparison of effectiveness of lower extremity axial distractor and traction table assisted closed reduction and intramedullary nail fixation in femoral subtrochanteric fracture

To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture. The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups ( P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups. There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group ( P<0.05). There was no significant difference in the quality of fracture reduction between the two groups ( P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups ( P>0.05). For femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.

Clinical application study of multiple small-diameter drilling combined with extracorporeal shock wave therapy (ESWT) under C-arm positioning in the treatment of early femoral head necrosis

To explore the therapeutic effect of multiple small diameter drilling combined with extracorporeal shock wave therapy (ESWT) under C-arm X-raylocalization in patients with early osteonecrosis of the femoral head (ONFH). A total of 106 cases of early ONFH patients admitted from May 2015 to May 2017 were retrospectively selected as the study subjects. According to different treatment methods, the patients were divided into observation group and control group, 53 cases in each group. The observation group was treated with multiple small-diameter drilling combined with ESWT under C-arm positioning in the observation group, including 41 males and 12 females with an age of (45.85±6.01) years old (22 to 70 years old);and the control group was treated with ESWT, including 34 males and 19 females with an age of (45.12±5.83) years old(20 to 68 years old) in the control group. The modified Harris hip scores(mHHS), visual analog scale(VAS), hip flexion range, hip abduction and adduction range, ONFH area ratio and clinical efficacy were compared between twe groups before and after treatment. Kaplan-Meier method was used to draw a survival curve to compare the femoral head survival rate between two groups during the 3-year follow-up period after treatment. There were no complications such as poor wound healing and infection. All of 106 patients were followed up for 28 to 36 months with an average of (31.06±4.28) months. MHHS score, hip flexion range and hip abduction and adduction range in the observation group were increased from (63.85±5.42) scores, (23.79±2.21) °, (32.40±4.19) ° before treatment to (85.51±5.69) scores, (34.65±2.73)°, (43.32±5.71)° at 2 years after treatment, respectively(P<0.05). The above indicators in the control group increased from (64.73±5.64)°, (23.82±2.18)°, (32.45±4.13)° before treatment to (81.65±5.48) scores, (32.79±2.87)°, (39.75±5.68)°at two years after treatment, respectively(P<0.05). VAS score and ONFH area ratio in the observation group decreased from (5.76±1.41) scores and (35.07±4.96)% before treatment to (3.39±1.02) scores and (22.04±3.23)% at 2 years after treatment, respectively(P<0.05). The above indicatiors in control group decreased from (5.73±1.45) scores and (35.24±5.18)% before treatment to (4.43±1.21) scores and (28.32±3.76)% at 2 years after treatment, respectively(P<0.05), and the improvement in the observation group was significantly higher than that in the control group(P<0.05). At 3 years after treatment, the femoral head survival rate in the observation group was higher than that in the control group (P<0.05). Multiple small diameter drilling combined with ESWT under C-arm positioning can significantly improve the clinical symptoms of patients with early ONFH, relieve pain and improve clinical efficacy.

Effects of Neurodynamics Versus Neurodynamic Sustained Natural Apophyseal Glide in Lumbosacral Radiculopathy

Lumbosacral radiculopathy is a frequently reported health issue in middle-aged people, with a prevalence varying fromabout 2.2% to 8%. Neurodynamic mobilization (NM) and Neurodynamic sustained natural apophyseal glide (N-SNAG) techniqueswere proven effective for Lumbosacral radiculopathy. But controversies are prevalent regarding the effectiveness of their treatmentin previous studies. N-SNAG is also a comparatively new technique that is clinically being used around, but more literature is neededto analyze its effectiveness. Hence, we aimed to evaluate the efficacy of N-SNAG in comparison with NM and conventional generalexercises in treating lumbosacral radiculopathy on pain, mobility, disability, muscle activation, and health-related quality of life(HRQL). One hundred and twenty-seven patients aged between 30 and 50 years were randomly allocated into 3 different treatmentgroups, where the first and second groups received N-SNAG and NM with general exercises, and the third (control) group receivedgeneral exercises only. Range of motion of lumbar and hip flexion, active straight leg raising, low back pain, radiculopathy pain, muscleactivation of biceps femoris and gastrocnemius muscles, disability, and HRQL were evaluated at baseline, and the end of 1st week, 2ndweek, 7th week and 18th week for all the groups. Two-way repeated measure ANOVA with Bonferroni’s t-test revealed significant(p&lt;0.05) improvement in the range of lumbar and hip flexion, LBP, radiculopathy pain, active SLR, disability, and HRQL in both withingroups and between groups. Muscle activation of biceps femoris and gastrocnemius also improved significantly (p&lt;0.05) in all threegroups, but no significant (p&gt;0.05) differences were seen between groups. The study concludes that N-SNAG is more efficient thanNM and general exercise in improving pain, lumbar and hip flexion range, SLR, disability, Muscle activation, and HRQL in Lumbosacralradiculopathy patients.

Comparing the Effects of Linear and Nonlinear Pedagogies on Kinematic Variables During a Landing Task Related to Anterior Cruciate Ligament injury

Background and Aims In recent years, the use of motor learning training methods to reduce anterior cruciate ligament (ACL) injuries has been considered by researchers, and finding the best training method in this field has become very important. In this study, we aim to compare the effects of linear and non-linear motor learning methods on kinematic variables during a landing task. Methods in this study, 24 students from Kharazmi University who were beginner basketball players, were selected by a convenience sampling method, and divided into two groups of linear pedagogy (LP) and non-linear pedagogy (NLP). They received training methods for two months, two sessions per week (each for 90-115 minutes). In the LP group, the presentation of movement patterns and feedback was used. In the NLP group, the manipulation of constraints (environmental factors and tasks) was used so that the individuals could discover their own unique performance. The measured kinematic variables were trunk flexion angle, hip flexion angle, knee flexion angle, knee valgus angle, ankle dorsiflexion angle, hip range of motion, knee range of motion, ankle range of motion, hip flexion range, and knee flexion range. Results The results of the analysis of covariance showed that the NLP had significantly better effects on all kinematic variables compared to the LP (P&lt;0.05). Conclusion The NLP, by focusing on exploration and finding optimal solutions, is a more effective strategy to prevent ACL injury by affecting kinematic variables. This emphasizes the role of constraint manipulation in training.

Spatiotemporal and kinematic gait analysis in patients with knee osteoarthritis and femoral varus deformity

BackgroundKnee osteoarthritis (OA) is commonly combined with the presentation of a coronal deformity of the knee. The bony origin of the knee varus deformity can be classified as tibial origin, femoral origin, or a combination of tibial and femoral causes. Deformities of tibial origin are mostly common clinically, while patients with knee OA with femoral varus deformity are less common. Research questionDo hip, knee and ankle kinematics and spatiotemporal parameters differ between patients with knee OA with femoral varus deformity and healthy subjects? MethodsTwenty-five patients (14 females and 11 males) with knee OA and femoral varus deformity and 20 healthy subjects (12 males and 8 females) as control group were included in this study. The kinematic parameters of the hip-knee-ankle joint and spatiotemporal gait parameters were included in the study. ResultsThis study found that the step speed and step length of the knee OA with femoral varus (KOAF) group were smaller than those of the control group, while double support period percentage was greater in the KOAF group. Significant differences were found in the maximum knee extension angle, maximum knee flexion angle, knee flexion range of motion, maximum hip flexion angle, maximum hip extension angle, and hip flexion range of motion between the two groups. After comparing the ankle motion between the two groups, significant differences were found in the maximum eversion angle, inversion range of motion, maximum ankle abduction angle, and abduction range of motion. SignificanceKnee OA with femoral varus deformity causes adaptive changes in the kinematic parameters of hip, knee and ankle joints and spatiotemporal gait parameters to alleviate symptoms and maintain normal activity.

Measurement of the normal contralateral hip flexion angle and posterior pelvic tilt angle using a pelvic guide pin in total hip arthroplasty

BackgroundWe aimed to measure the posterior pelvic tilt angle at maximum hip flexion and hip flexion range of motion at the femoroacetabular joint using a pelvic guide pin and to examine the difference in flexion range of motion when determined by a physical therapist and under anesthesia. MethodsData of 83 consecutive patients undergoing primary unilateral total hip arthroplasty were assessed. Using a pin inserted into the iliac crest to define the cup placement angle under anesthesia before and after total hip arthroplasty, the posterior pelvic tilt angle was determined as the change in pin tilt from the supine position to maximum hip flexion. Flexion range of motion under anesthesia was calculated as the difference in the angle between the trunk and thigh at maximum flexion and the posterior pelvic tilt angle. Flexion range of motion with a fixed pelvis measured preoperatively by a physical therapist was compared to that under anesthesia. A goniometer was used for all measurements and the number of measurements was one. FindingsMean posterior pelvic tilt angle of the pin inserted into the pelvis under anesthesia was 15.8° ± 5.3° (3°–26°) preoperatively and 12.1° ± 4.9° (3°–26°) postoperatively. Mean flexion range of motion under anesthesia was 109.4° ± 6.9° (88°–126°) and that measured by a physical therapist was 101.1° ± 8.2° (80°–120°); the difference was significant (9.7°; p < 0.01). InterpretationThese results highlight the difficulty in accurately determining hip flexion angles without the use of special devices and may help surgeons and physical therapists recognize and address this issue.

Acute Effect of Improved Hip Range of Motion on Maximum Hip Angle in Pole Vaulting: A Pilot Study

Background: Large maximum hip flexion and extension range of motion is considered effective in preventing injury in pole vaulters. Nonetheless, whether the improvement in hip flexion and extension range of motion changes their hip joint angle during pole vaulting remains unclear. Objectives: The present study aimed to clarify the acute effects of intervention for hip flexion and extension range of motion in pole vaulters on the maximum hip joint angle during pole vaulting. Methods: Seventeen male pole vaulters who underwent the same intervention for hip range of motion were included. The maximum hip joint angle during the pole vault from the touchdown of the last step of the run-up to the pole straightening was calculated from videos taken pre- and post-intervention and was subsequently compared. The pole vaulters cleared bungee bars that were set at the height of 90% of their personal best record. Three types of self-massages were used to improve the hip flexion and extension range of motion, and an active straight leg raise exercise was also performed. All intervention programs were completed in approximately 25 min on an experimental day, and all interventions were monitored by the examiner. Results: No significant improvements were observed between pre and post-intervention hip range of motion. The magnitude of change in the range of motion of active hip flexion was significantly correlated with the magnitude of change in the maximum hip flexion angle during pole vaulting pre-and post-intervention (P = 0.002, r = 0.687). Conclusions: Athletes should find ways to improve their active range of motion to prevent injuries and improve their performance. Coaches and athletic trainers should adopt an active range of motion as an indicator to control athlete conditioning.

Effect of Load Carriage Lifestyle on Kinematics and Kinetics of Gait.

Backpacks are commonly worn by many people for multiple purposes. This study investigated the effects of habitual wearing of backpacks on lower limb kinematics and kinetics. Fourteen participants were recruited for analysis. All participants performed four randomly assigned scenarios, including running and walking at speeds of 3.5 and 1.5 m/s, respectively, with and without load carriage. The motion analysis system and force plate were used to investigate the lower limb kinematics and kinetics. A paired sample t-test was performed for statistical measurement with a significance level of α = .05. The results indicated that active force, breaking force, impact peak, loading rate, active peak, maximum braking, hip flexion, and hip range of motion were substantially higher under load carriage conditions than under walking condition, however, time to peak was lower. Conversely, during load carriage running, active force, braking impulse, time to peak, ankle plantarflexion, and ankle range of motion were all higher than those during running. Carrying a backpack weighing 10% of the body weight induced different foot strike patterns at both speeds; during load carriage walking, the hip tended to flex more; whereas, during load carriage running, the ankle tended to flex more. In conclusion, human body seems to adopt different gait strategies during load carriage walking and running. That is, the hip strategy is used during walking, while the ankle strategy is used during running.

The effects of ankle dorsiflexor fatigue on lower limb biomechanics during badminton forward forehand and backhand lunge.

Background: Local muscle fatigue may have an adverse effect on the biomechanics of the lunge movement and athletic performance. This study analyzed the biomechanical indicators of the forward lunge in badminton players before and after fatigue of the ankle dorsiflexors. Methods: Using the isometric muscular strength testing system, 15 badminton players underwent an ankle dorsiflexor fatigue test. Before and after the fatigue experiment, five lunges were done in both the forehand forward (FH) and backhand forward (BH) directions, five in each direction. A Vicon motion capture system and an AMTI force measuring station were used to record lower limb kinematic and ground reaction force (GRF). Pre-fatigue and post-fatigue variability were determined using paired-samples t-tests, Wilcoxon signed rank test, and Statistical Non-parametric Mapping (SNPM). Result: The results showed that after fatigue, the peak angle of ankle dorsiflexion was significantly reduced (p = 0.034), the range of motion (ROM) of the ankle sagittal plane (p = 0.000) and peak angle of ankle plantarflexion (p = 0.001) was significantly increased after forehand landing. After fatigue, ankle inversion was significantly increased after forehand and backhand landings (FH: p = 0.033; BH: p = 0.015). After fatigue, peak knee flexion angles increased significantly (FH: Max: p = 0.000, Min: p = 0.000; BH: Max: p = 0.017, Min: p = 0.037) during forehand and backhand landings and ROM in knee flexion and extension increased (p = 0.009) during forehand landings. Knee inversion range of motion was significantly increased after fatigue (p = 0.024) during forehand landings. Peak hip flexion angle (p = 0.000) and range of motion (p = 0.000) were significantly reduced in forehand landings after fatigue. The mean loading rate (p = 0.005) and the maximum loading rate (p = 0.001) increased significantly during backhand landings after fatigue. Post-fatigue, the center of pressure (COP) frontal offset increased significantly (FH: p = 0.000; BH: p = 0.000) in the forehand and backhand landings. Conclusion: These results indicate that when the ankle dorsiflexors are fatigued, the performance of the forehand is significantly negatively affected, and the impact force of the backhand is greater.