Hip Muscle Research Articles

Reliability of Goniometric Techniques for Measuring Hip Flexor Length Using the Modified Thomas Test.

The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Intra- and inter-rater reliability study. Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. 3.

Does a Hip Muscle Activation Home Exercise Program Change Movement Patterns on the Forward Step-Down Test?

Poor knee biomechanics contribute to knee joint injuries. Neuromuscular control over knee position is partially derived from the hip. It is unknown whether isolated activation training of the gluteal muscles improves lower-extremity frontal plane mechanics. This study examined if a home-based hip muscle activation program improves performance on the Forward Step-Down Test as well as increases surface electromyography (sEMG) activation of the gluteal muscles. The study utilized a single-group repeated-measures design. Thirty-five participants (24 females, mean age = 23.17 [SD 1.36] years) completed an 8-week hip muscle activation program. The Forward Step-Down Test score and sEMG of gluteus maximus and medius were assessed preintervention and postintervention. Forward Step-Down Test scores improved significantly from preintervention (Mdn = 3.5) to postintervention (Mdn = 3.0, T = 109, P = .010, r = .31.), but this result did not meet clinical significance. sEMG analysis revealed a significant increase in mean gluteus maximus activation (P = .028, d = 1.19). No significant dose-response relationship existed between compliance and the Forward Step-Down Test scores or sEMG results. A home-based hip activation program increases gluteus maximus activation without clinically significant changes in frontal plane movement quality. Future studies may find clinical relevance by adding motor learning to the activation training program to improve functional muscle use.

Reliability and Relationship between Hip Muscle Strength and Change of Direction Performance among Basketball Players

Background: Basketball change of direction (COD) tests are not specific to the defensive lateral shuffling movement, and no COD tests assesses the relationship between hip muscle strength and basketball specific lateral movements. Objective: We assessed the reliability of a COD test (2-2 shuffle test) performance and investigated its relationship to hip muscle strength. Methods: Using a prospective observational cohort design, data were collected from competitive male basketball players (n = 21; age 20.0 ± 3.5 years; height 194.7 ± 7.0 cm; weight 93.9 ± 14.7 kg). Participants performed two trials of the hip abductors/adductors isometric muscle strength assessment and the 2-2 shuffle test. Intraday reliability of the 2-2 shuffle test was computed using Bland-Altman plots, intraclass correlations (ICCs) with 95% confidence intervals (CI), and coefficient of variations (CVs). Pearson correlations with 95% CIs determined the relationship between shuffle test time and hip muscle’s isometric strength. Results: The 2-2 shuffle test time for left (ICC = 0.91, CV = 7.7%) and right (ICC = 0.86, CV = 8.4%) directions met acceptable reliability thresholds (ICC 0.8, CV 10%). The relationships observed between 2-2 shuffle test time and hip abductors/adductors were non-significant and unclear across parameters (p = 0.05, r = ≤ -0.26). Conclusion: Physical performance coaches may use the 2-2 shuffle test as the test time is a reliable metric. The hip abductors/adductors maximal isometric strength accounts for a trivial proportion of explained variance in the 2-2 shuffle test, suggesting other technical and physical abilities account for test performance.

Identifying Deficits in Hip and Knee Muscle Strength on the Surgical and Nonsurgical Sides in Women up to 12Months After Total Hip Arthroplasty.

Regaining hip and knee muscle strength is important after total hip arthroplasty (THA). However, it is unclear if muscles other than those of the operated hip also lose strength. This study aimed to identify deficits in hip and knee strength on the surgical and nonsurgical sides in female patients up to 12months after THA. Participants were 91 female patients who had hip osteoarthritis and underwent unilateral THA. Forty-six community-dwelling women who were asymptomatic were selected as control participants. Patients with locomotor disorders or postsurgical complications were excluded. Maximal isometric strength of the hip flexors, extensors, and abductors and knee extensors and flexors on the surgical and nonsurgical sides were measured before THA and 3, 6, and 12months thereafter. Twelve months after THA, hip flexion, extension, and abduction strength on the surgical side were 84.6%, 83.5%, and 76.2%, respectively, of those in individuals who were asymptomatic; at the same time point, those on the nonsurgical side were 94.8%, 83.9%, and 79.4%, respectively. Knee extension strength on the surgical side was 89.3% of that in individuals who were asymptomatic. Compared to individuals who were asymptomatic, nearly all muscles showed significantly lower strength on both sides up to 6months after THA. At 12months after THA, hip and knee strength on both the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic. In particular, hip abductor strength on the surgical and nonsurgical sides were 76% and 79%, respectively, of that in individuals who were asymptomatic. At 12months after THA, hip and knee strength on the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic, suggesting that the nonsurgical side may be inappropriate as a control to assess strength recovery on the surgical side.

Comparison of dry needling with exercise and exercise alone on spasticity, range of motion, and function of post-stroke chronic spastic patients

IntroductionStroke is a common cause of disability and death in adults, with spasticity being a common post-stroke complication that can significantly affect patients' quality of life. This study aimed to investigate the impact of exercise therapy alone versus exercise therapy combined with dry needling on clinical outcomes in patients with chronic spasticity after stroke. MethodsForty patients were randomly assigned to either a control or intervention group. The control group received a standard exercise program consisting of two sessions per week for six weeks. The intervention group received the same exercise program in addition to dry needling of the hip and leg muscles. Clinical outcomes were assessed using the Modified Modified Ashworth Scale, Timed Up & Go Test, and goniometer in four separate examination sessions. ResultsThe findings of this study suggest that the addition of dry needling to exercise therapy led to faster and longer-lasting improvements in clinical outcomes. The intervention group showed significant improvements in spasticity, range of motion, and function in the second through fourth examination sessions, while the control group's improvements decreased over time. Between-group comparisons revealed significantly greater improvements in the intervention group than the control group. ConclusionsThe findings suggest that combining dry needling with exercise therapy may be beneficial in managing post-stroke spasticity. Dry needling may lead to faster and more significant improvements in clinical outcomes, ultimately improving function and quality of life for patients with chronic spasticity after stroke.

Maximizing the performance of badminton athletes through core strength training: Unlocking their full potential using machine learning (ML) modeling

Core strength training plays an essential role in maximizing performance for badminton athletes. The core muscles in the abdominal, back, and hip regions provide stability, enable efficient power transfer between the upper and lower body, and allow for rapid changes in direction - all crucial components for success in badminton. However, optimizing core training requires an understanding of its impact on sport-specific skills. A variety of exercises targeting the abdominal, back, and hip muscles are discussed. Incorporating core strength training into regular regimens can improve athletes' overall strength, endurance, balance, control, and prevent injuries. This study investigates the effects of various core exercises on stability, agility, and power in badminton players. A comprehensive literature review was conducted to explore the biomechanical demands of badminton and how core musculature contributes to movements like serving, smashing, and lunging. Studies assessing the effects of core training programs in related racquet sports were also examined. The results indicate that targeted core exercises significantly improve athletes' stability, agility, and power output. Exercises targeting the abdominal, back, and hip muscles enhance performance capabilities while reducing injury risk. Machine learning (ML) techniques are then applied to further analyze the relationship between core training and athletic performance. An Artificial Neural Network (ANN) is developed using a dataset of athletes' training histories, metrics, and injury profiles. The model predicts enhancements to stability, agility, and strength from optimized core strengthening routines. Validation confirms the network accurately captures the complex interactions between training variables and physical attributes. This integrated approach provides evidence-based guidelines for tailoring individualized training regimens to unleash players' full abilities. ANNs hold promise for analyzing large datasets on athletes' performance metrics, training variables, and injury histories to design personalized training programs. Linear regression analysis confirmed the ANN's accurate predictions. The findings emphasize integrating data-driven core strength training tailored for badminton into comprehensive programs can help optimize physical abilities and elevate performance levels.

Reliability and validity of belt-stabilized and tension dynamometry for assessing hip strength and power in uninjured adults

ObjectivesTo investigate the intra-rater reliability and validity of belt-stabilized and tension dynamometry to assess hip muscle strength and power. DesignRepeated measures. SettingBiomechanics laboratory. ParticipantsSeventeen uninjured adults (age = 22.0 ± 2.3y; 13 females). Main outcomes measuresPeak torque (strength) and rate of torque development (RTD; power) were measured for hip abduction, internal rotation, external rotation and extension using an isokinetic dynamometer, and belt-stabilized and tension dynamometry. ResultsFor peak torque assessment, belt-stabilized and tension dynamometry showed good (Intraclass Correlation Coefficient [ICC] = 0.848–0.899) and good-to-excellent (ICC = 0.848–0.942) reliability, respectively. For RTD, belt-stabilized dynamometry showed fair reliability for abduction (ICC = 0.524) and good reliability for hip internal rotation, external rotation, and extension (ICC = 0.702–0.899). Tension dynamometry showed good reliability for all motions when measuring RTD (ICC = 0.737–0.897). Compared to isokinetic dynamometry, belt-stabilized and tension dynamometry showed good-to-excellent correlations for peak torque assessment (r = 0.503–0.870), and fair-to-good correlations for RTD (r = 0.438–0.674). Bland-Altman analysis showed that measures from belt-stabilized and tension dynamometry had clinically meaningful disagreement with isokinetic dynamometry. ConclusionTension dynamometry is reliable for assessing hip strength and power in all assessed motions. Belt-stabilized dynamometry is reliable for assessing internal rotation, external rotation, and extension. Validity of both methods is questionable, considering the lack of agreement with isokinetic dynamometry.

Poster 214: Cross Sectional Area of Hip Muscles Before and After Surgery for Femoroacetabular Impingement

Objectives: Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain and surgery is a treatment option for patients who do not respond to conservative treatment. Previous studies have identified increases in postoperative hip muscle volume and cross-sectional area (CSA) as associated with increases in patient reported outcomes following hip surgery. There has been a lack of literature analyzing the change of hip muscle cross sectional CSA on MRI following arthroscopic hip surgery for FAI and the effect of changes in hip muscle CSA on patient reported outcomes following surgery. The purpose of this study is to analyze the change in hip muscle cross sectional area (CSA) after arthroscopic surgery for FAI syndrome. Methods: This is a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023. All patients who had a pre-operative MRI within 1 year of their date of surgery and at least one postoperative MRI were included in the study. Cross sectional areas were measured by one blinded researcher and results were checked for reliability by a musculoskeletal radiologist. Statistical analysis was completed using SPSS, Version 24 and normally distributed continuous variables between cohorts were compared using the two-sample Student t test. Results: Initially 1390 patients were included in the study but only 95 were found to have a preoperative hip MRI within 1 year of their date of surgery as well as a postoperative MRI. The average age of the cohort was 35.8 ± 15.7, the cohort was 33.7% male and 66.3% female, and had an average BMI of 23.3 ± 8.1. The mean time between surgery and postoperative MRI was 14.8 ± 8.3 months. There was a significant difference between preoperative and postoperative hip muscle CSA for gluteus maximus (4298.6±883.6 mm2 vs. 4384.6±967.6 mm2, p<0.01), gluteus minimus (1037.0±199.2 mm2 vs. 1074.9±202.3 mm2, p<0.001), and pectineus (415.7±121.9 mm2 vs. 426.7±106.3 mm2, p=0.04). There were no other significant differences between preoperative and postoperative hip muscle CSA values between the other muscles analyzed. A linear regression found that an increase in the change in CSA of the gluteus maximus significantly predicted an increase in mHHS at 1 year (β=3.103, p=0.046) when controlling for age, sex, BMI and time from surgery to postoperative MRI. A linear regression found that an increase in the change in cross sectional area of the pectineus significantly predicted an increase in NAHS at 1 year when controlling for age, sex, BMI and time from surgery to post-op MRI (β=0.186, p=0.037). Conclusions: Patients who undergo surgery for FAI have significantly increased gluteus maximus, gluteus minimus and pectineus muscle CSA on post-operative MRIs. Furthermore, increases in both gluteus maximus and pectineus muscle CSA was found to be significantly associated with increases in mHHS and NAHS at 1 year follow up respectively.

Voluntary Contraction of the Abdominal Muscles Increases Hip Muscle Activation During Lower-Extremity Exercises: A Critically Appraised Topic.

Existing studies have posited that incorporating abdominal enhancement techniques during lower-extremity exercises might mitigate compensatory pelvic motions and enhance the engagement of specific hip muscles. Does performing lower-extremity exercises with abdominal enhancement techniques increase hip muscle activation levels in healthy individuals? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. There is moderate evidence to support that prone hip extension with abdominal enhancement may increase gluteus maximus and hamstring muscle activity. Gluteus medius activity may not be affected by abdominal enhancement during hip abduction exercises. Strength and Recommendation: The collective findings from the 4 cross-sectional trials indicate that the incorporation of abdominal enhancement techniques during lower-extremity exercises may have the potential to enhance targeted muscle activation levels in healthy individuals. Further research is recommended to establish more robust conclusions.

Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes

ObjectiveIn patients with residual poliomyelitis-related impairments, total hip arthroplasty (THA) is challenging due to the high frequency of risk factors such as hip dysplasia, dislocation, muscle weakness, and fracture. The objective of this study was to assess the long-term functional and radiographic outcomes of anterior-approach THA with a ceramic-ceramic, dual-mobility, or constrained implant in patients with poliomyelitis sequelae. HypothesisTHA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable technique that is not associated with excess risks of instability or aseptic loosening. Material and methodsThis single-centre retrospective study included consecutive patients with poliomyelitis sequelae who underwent THA between January 1998 and September 2019 via the anterior approach, with implantation of a ceramic-ceramic, dual-mobility, or constrained implant. The Harris Hip Score (HHS), implant position, and complications (e.g., infection and loosening) were collected during the most recent in-person visit. ResultsThe study included 19 patients (23 hips). Mean follow-up was 5.2 ± 4.2 years (range, 2.0–10.6 years). Only six of the 23 procedures were done on the side with greater muscle weakness. The mean HHS at last follow-up was 80.4 ± 10.4. A single procedure (1/23, 4%) was followed by a complication, consisting in intra-prosthetic dislocation 2 years after implantation of a dual-mobility cup. At last follow-up, the HHS was not associated with psoas and gluteus muscle strength (rs = 0.35, p = 0.11 and rs = 0.37, p = 0.09, respectively) and was not significantly different between the weaker vs. stronger side (82.7 ± 8.0 vs. 79.5 ± 11.3, respectively; p = 0.53). Cup position was more horizontal, thereby optimising function, when the procedure was done on the weaker vs. the stronger side (39.9° ± 4.3 vs. 45.0° ± 6.8, respectively; p = 0.02). ConclusionTHA is a good option for improving function in patients with poliomyelitis sequelae. THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable method that is not associated with an excess risk of instability or loosening. Level of evidenceIV.

Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners.

Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners. To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women. Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery). Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05). Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044). Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.

Effect of different resistance increments during warm-up on the snatch performance of male weightlifters

This study investigated the effect of different resistance increments during warm-up on snatch performance of male weightlifters. Nine male college weightlifters were recruited. The 3 warm-up protocols were performed every 7 days with a randomized order: 1. Power snatch exercise with 10 % resistance increment (50 %, 60 %, 70 %, and 80 % of one-repetition maximum); 2. Power snatch exercise with 15 % resistance increment (50 %, 65 %, and 80 % of one-repetition maximum); 3. Self-selected resistance increment. Participants were tested based on 85 % maximum weight snatch after warm-up. Snatch performance was measured using peak vertical ground reaction force. Postural stability was measured using center-of-pressure displacement. Activation of seven shoulder, back, and leg muscles was measured using electromyography on the dominant side. In snatch performance, the 10 % increment protocol had a significantly higher peak vertical ground reaction force during the second-pull phase than the 15 % increment (d = 0.92, p < 0.05) and self-selected (d = 1.32, p < 0.05) protocols. In postural stability, no significant differences in center-of-pressure displacement among the three protocols were observed. For muscle activation, the 10 % increment protocol resulted in significantly higher activation of shoulder (d = 1.2–2.2, p < 0.05) during the second-pull phase than the other two protocols and higher activation of hip muscles (d = 1.73, p < 0.05) than self-selected protocol. To conclude, a warm-up protocol combining slow progression is preferable in improving power output during snatch in male weightlifters, probably through facilitating the activation of proximal limb muscles. It can enhance training quality while potentially reducing the risk of sports injuries.

Trendelenburg gait after total hip arthroplasty due to reduced muscle contraction of the hip abductors and extensors

BackgroundDespite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood. MethodsThis study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired t-test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait. ResultsA Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p < 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait. ConclusionCentrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA.

Comparing Hip Muscle Imbalances of Professional Football Players and Ordinary People

Background and Aims Muscle strength is one of the main factors in athletic success, injury prevention, and optimal rehabilitation for injured athletes. Also, the symmetry of the muscle strength ratio is fundamental to maintaining force-producing torques. Therefore, the present study aimed to evaluate and compare hip muscle imbalances in football athletes and normal individuals. Methods The current research is causal-comparative. Fifteen football players and 15 normal healthy individuals volunteered for the study. Then, their flexor, extensor, abductor, adductor and internal and external rotator strengths were assessed using a hand-held strength test. Results The present study showed a significant difference in the ratios of extensor to flexor muscle strength, adductor to abductor, and internal to external rotator strength between the dominant and non-dominant thigh (P&lt;0.05). In addition, significant differences were observed in thigh muscle strength between football players and ordinary people (P&lt;0.05). Conclusion According to the results of the present study, the nature of football in greater use of the dominant leg can lead to an imbalance in the strength ratio of the agonist and antagonist muscles in the hip joint between the dominant and non-dominant limbs. Therefore, it is recommended that corrective exercises and movements be used for the antagonist part that caused an imbalance in muscle strength to reduce the possibility of injury in the future.

Comparison of resistance training vs static stretching on flexibility and maximal strength in healthy physically active adults, a randomized controlled trial

BackgroundThe aim of the present study was to compare the effects of resistance training through full range of motion and static stretching (SS) of the hip and lower back extensors on flexibility and strength in healthy, physically active, adults.MethodsEighteen participants (age: 24.2 ± 3.0 years, body mass: 71.3 ± 8.9 kg, height: 172.8 ± 7.5 cm) were randomly assigned to either a Resistance Training (RT) (n = 6), SS (n = 6), or control (CON) group (n = 6). The sit & reach (S&R) flexibility test and maximum isometric straight legged deadlift (ISLDL) at 95% and 50% range of motion (ROM) were tested pre- and post-intervention with significance set at p < 0.05. Both groups conducted four to eight sets per session. Within each set, the RT group performed eight repetitions each lasting four seconds, while the SS group stretched continuously for 32 s. The rest periods between each set were 60–90 s. Consequently training volume and rest times were matched between the groups.ResultsThe RT and SS groups achieved significant, large magnitude improvements in the S&R test compared to the CON group (p < 0.01 g = 2.53 and p = 0.01, g = 2.44), but no differences were observed between the RT and SS groups (p = 1.00). Furthermore, the RT group demonstrated a larger improvement in 50% and 95% ROM ISLDL compared to SS (p < 0.01, g = 2.69–3.36) and CON (p < 0.01, g = 2.44–2.57).ConclusionResistance training through a full ROM was equally effective as SS for improving S&R flexibility, but improved hip- and lower back extensor strength more than SS and the CON. The authors recommend using large ROM resistance training to improve hip and lower back extensor flexibility and muscle strength.Trial registrationISRCTN88839251, registered 24. April 2024, Retrospectively registered.

The impact of shoes versus ankle-restricted orthoses on sit-to-stand kinematics and centre of mass trajectories in adults with myelomeningocele

BackgroundIndividuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. Research questionHow are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? MethodsTwenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. ResultsThe AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle). SignificanceThe differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.

Everyone can draw: An inclusive and transformative activity for conceptualization of topographic anatomy.

Anatomical drawing traditionally involves illustration of labeled diagrams on two-dimensional surfaces to represent topographical features. Despite the visual nature of anatomy, many learners perceive that they lack drawing skills and do not engage in art-based learning. Recent advances in the capabilities of technology-enhanced learning have enabled the rapid and inexpensive production of three-dimensional anatomical models. This work describes a "drawing on model" activity in which learners observe and draw specific structures onto three-dimensional models. Sport and exercise sciences (SES, n = 79) and medical (MED, n = 156) students at a United Kingdom medical school completed this activity using heart and femur models, respectively. Learner demographics, their perceptions of anatomy learning approaches, the value of the activity, and their confidence in understanding anatomical features, were obtained via validated questionnaire. Responses to 7-point Likert-type and free-text items were analyzed by descriptive statistics and semi-quantitative content analysis. Learners valued art-based study (SES mean = 5.94 SD ±0.98; MED = 5.92 ± 1.05) and the "drawing on model" activity (SES = 6.33 ± 0.93; MED = 6.21 ± 0.94) and reported enhanced confidence in understanding of cardiac anatomy (5.61 ± 1.11), coronary arteries (6.03 ± 0.83), femur osteology (6.07 ± 1.07), and hip joint muscle actions (5.80 ± 1.20). Perceptions of learners were independent of both their sex and their art-based study preferences (p < 0.05). Themes constructed from free-text responses identified "interactivity," "topography," "transformative," and "visualization," as key elements of the approach, in addition to revealing some limitations. This work will have implications for anatomy educators seeking to engage learners in an inclusive, interactive, and effective learning activity for supporting three-dimensional anatomical understanding.

Association between hip joint function and urinary incontinence for patients with end-stage hip osteoarthritis

Purpose: This study aims to investigate the correlation between hip joint muscle strength and symptoms of urinary incontinence (UI) among patients with end-stage hip osteoarthritis (OA) before undergoing total hip arthroplasty (THA). Materials and methods: A total of 32 patients with end-stage hip OA, preparing for THA, were included in this research. We assessed hip muscle strength, including hip extension, hip adduction, and hip external rotation, along with the Japanese Orthopaedic Association hip score. Patients were categorized into either an incontinence or nonincontinence group based on results from the International Consultation on Incontinence Questionnaire-Short Form. Incontinence was indicated by a score of ≥1 for the question, “How often do you leak urine?” Results: Of the 32 patients, 16 (50%) in the pre-THA stage were identified with UI (incontinence group), whereas the remaining 16 (50%) patients showed no UI symptoms (nonincontinence group). Significantly better hip adduction muscle strength and Japanese Orthopaedic Association hip total score were shown in the nonincontinence group compared with the incontinence group (P &lt; 0.05). Nevertheless, no substantial difference in muscle strength during hip extension or external rotation was detected between the 2 groups. Conclusion: This study revealed a connection between pelvic floor function and hip joint function. The findings suggest a potential association between the strength of the hip adductor muscle and UI symptoms. As a part of preparing patients with end-stage hip OA for THA, physical therapists should consider incorporating exercises to enhance hip adductor muscle strength, which could assist in identifying and addressing UI symptoms.

Reliability of Hip Strength Assessment in Young Active People with Hip Dysplasia: An Examination in Student Circus Artists.

Developmental dysplasia of the hip (DDH) is common in performing artists and other young active individuals and involves abnormalities in bony morphology of the acetabulum and proximal femur that can negatively impact walking biomechanics, muscular strength, quality of life, and sleep. Rehabilitation for hip-related conditions should target known modifiable impairments such as hip muscle strength, though a reliable method of assessment in this population remains unclear. To determine the inter- and intra-rater reliability of hip muscle strength assessments using handheld dynamometry (HHD) in young active circus artists with DDH. Reliability of hip strength in all planes was assessed using HHD in 21 adult performing circus arts students (mean age 21.3 yrs [3.2]; 13 M, 5 F, 3 NB) with symptomatic radiologically and clinically diagnosed hip dysplasia. The reliability of average peak force and absolute peak force were expressed for each position tested. Reliability was assessed using intraclass correlation coefficients (ICC) with standard error of measurement (SEM) and minimal detectable change (MDC) values calculated to improve clinical interpretability. Good to excellent inter-rater reliability resulted for all hip muscle strength testing positions, ICC=0.88 (95%CI 0.70 to 0.95) to ICC=0.97 (0.92 to 0.99), except average peak hip flexion strength, ICC=0.71 (0.28 to 0.88). Absolute peak hip abduction, ICC=0.77 (0.16 to 0.94), and adduction strength, ICC=0.72 (-0.55 to 0.92), demonstrated the lowest intra-rater reliability. Transverse plane strength measures (rotation) produced the lowest SEM and MDC values followed by the frontal plane (abduction/adduction) and sagittal plane (flexion/extension). HHD is an appropriate and reliable method to assess hip muscle strength in circus artists with DDH.

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.