Lower Hip Flexion Research Articles

The Effect of Inclines on Joint Angles in Stroke Survivors During Treadmill Walking.

Stroke severely affects the quality of life, specifically in walking independently. Thus, it is crucial to understand the impaired gait pattern. This gait pattern has been widely investigated when walking on a level treadmill. However, knowledge about the gait pattern when walking on inclines is scarce. Therefore, this study attempted to fulfill this knowledge gap. In this study, 15 stroke survivors and 15 age/height/weight healthy controls were recruited. The participants were instructed to walk on three different inclines: 0°, 3°, and 6°. The participants were required to walk on each incline for 2 min and needed to complete each incline two times. The dependent variables were the peak values for ankle/knee/hip joint angles and the respective variability of these peak values. The results showed that an increment of the incline significantly increased the peak of the hip flexion and the peak of the knee flexion but did not affect the peak values of the ankle joints in the paretic leg in these stroke survivors. In comparison with the healthy controls, lower hip extension, lower hip flexion, lower knee flexion, and lower ankle plantar flexion were observed in stroke survivors. A clinical application of this work might assist the physical therapists in building an effective treadmill training protocol.

Hip Profile in World Elite Junior Badminton Players: Impingement and Range of Motion Data from the World Junior Badminton Championship 2018

AbstractBadminton is played with repetitive high loading to the hip with lunging and jumps. In sports like soccer there is a high prevalence of femoroacetabular impingement syndrome in youth populations which may predispose them to osteoarthritis (OA). Internal rotation deficit in the hip of football players is a predictor of hip and groin pain and differences in the range of motion (ROM) of the hip between sex and different ethnicities exist. Early hip replacements in former elite badminton players due to OA seem to be a problem. There are no published values for ROM and impingement of the hip in badminton. The purpose is to report ROM and impingement of the hip in elite junior badminton players and to report any differences between sex and ethnicities. Players at the World Junior Championship 2018 were examined for hip flexion, rotation, and impingement test. Injury history was obtained from a questionnaire. Two hundred and eighty-four players of 433 aged 16 to 18 years were examined. One hundred and forty-three players answered the questionnaire. Females demonstrated greater hip ROM than males. In the dominant side hip flexion was (137.7 degrees [ ± 9.1] vs. 132.2 degrees [ ± 11.1], p < 0.001), internal rotation range of motion or IROM (60.0 degrees [ ± 10.9] vs. 49 degrees [ ± 11.1], p < 0.001) and external rotation range of motion or EROM (57.9 degrees [ ± 9.9] vs. 54.7 degrees [ ± 8.9], 0.004). Hip flexion was higher in Asian players compared with non-Asian players (139.1 degrees [ ± 8.4] vs. 130.3 degrees [ ± 10.7], p < 0.001). One hundred (35%) players had at least one positive impingement test. A possible relationship between a positive FADIR and a decrease in hip flexion was found in the dominant hip, OR 1.06 (1.02–1.11) p = 0.005. A total of 104 previous injuries lasting over 30 days were reported with five hip-related injuries. No correlation between injury and examinations was found. Females and Asians demonstrated higher ROM in the hip than males and non-Asians. Impingement of the hip is frequent and may be related to low hip flexion.

Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size

BackgroundStudies of walking in those with femoroacetabular impingement syndrome have found altered pelvis and hip biomechanics. But a whole body, time-contiuous, assessment of biomechanical parameters has not been reported. Additionally, larger cam morphology has been associated with more pain, faster progression to end-stage osteoarthritis and increased cartilage damage but differences in walking biomechanics between large compared to small cam morphologies have not been assessed. Research questionAre trunk, pelvis and lower limb biomechanics different between healthy pain-free controls and individuals with FAI syndrome and are those biomechanics different between those with larger, compared to smaller, cam morphologies? MethodsTwenty four pain-free controls were compared against 41 participants with FAI syndrome who were stratified into two groups according to their maximum alpha angle. Participants underwent three-dimensional motion capture during walking. Trunk, pelvis, and lower limb biomechanics were compared between groups using statistical parametric mapping corrected for walking speed and pain. ResultsCompared to pain-free controls, participants with FAI syndrome walked with more trunk anterior tilt (mean difference 7.6°, p < 0.001) as well as less pelvic rise (3°, p < 0.001), hip abduction (-4.6°, p < 0.05) and external rotation (-6.5°, p < 0.05). They also had lower hip flexion (-0.06Nm⋅kg−1, p < 0.05), abduction (-0.07Nm⋅kg−1, p < 0.05) and ankle plantarflexion moments (-0.19Nm⋅kg−1, p < 0.001). These biomechanical differences occurred throughout the gait cycle. There were no differences in walking biomechanics according to cam morphology size. SignificanceResults do not support the hypothesis that larger cam morphology is associated with larger differences in walking biomechanics but did demonstrate general differences in trunk, pelvis and lower limb biomechanics between those with FAI sydrome and pain-free controls. Altered external biomechanics are likely the result of complex sensory-motor strategy resulting from pain inhibition or impingement avoidance. Future studies should examine internal loading in those with FAI sydnrome.

Differences in Kinetics, Kinematics and Muscle Activation Strategies in Male and Female Team Sport Athletes During Unanticipated Sidestepping

The purpose of this study was to compare kinetics, kinematics and muscle activation strategies between male and female collegiate level athletes during unanticipated sidestepping tasks to further the understanding of sex-specific differences in injury incidence and their potential influence on ACL injury risk. Three-dimensional kinematics, ground reaction forces and surface electromyography of eight lower limb muscles were recorded during unanticipated sidestepping in 20 male soccer and 17 female field hockey National Collegiate Athletics Association Division 1 athletes. Trunk, hip and knee kinematics, knee joint moments, total muscle activation (TMA: knee, gluteal, quadriceps, hamstrings and gastrocnemii) and directed co-contraction ratios (DCCR) were compared between groups with two-sample t tests. No sex differences were observed for peak frontal and transverse plane knee moments (P > 0.05), however males had 10% greater knee flexion moments (P = 0.047). Females had lower hip flexion and abduction and greater hip internal rotation angles than males likely concomitant with the 30% reduction in gluteal TMA (P < 0.05). Females had lower quadriceps TMA during pre-contact and weight acceptance and higher hamstrings TMA during weight acceptance (P < 0.05). Group averages for DCCR were not representative of individual patterns, where the majority of males were quadriceps dominant compared with females. Female and male team sport athletes display similar frontal and transverse plane knee moments, however their ability to support/counter the load applied (i.e., muscle activations strategies) to the knee joint differed.

Effects of running biomechanics on the occurrence of iliotibial band syndrome in male runners during an eight-week running programme—a prospective study

ABSTRACT Iliotibial band syndrome (ITBS) is a common injury that is related to running biomechanics. This study aimed to determine the gait characteristics that easily induce ITBS and explore the gait changes after the occurrence of ITBS. Thirty healthy male recreational runners participated in our study. Amongst them, 15 developed ITBS and comprised the ITBS group; the other 15 were healthy and comprised the control group. All participants underwent two gait trials, namely, before the first day of their running and after eight weeks, during which a force platform and a motion capture system collected biomechanical data. After running, the ITBS group exhibited greater anterior pelvic tilt and hip flexion angle than the control group. The ITBS group showed increased trunk inclination angle, whereas the control group demonstrated lower hip flexion, hip adduction angle and hip abductor moment than those at the beginning of running. Decreasing hip flexion, adduction angle and abductor moment may be a reasonable strategy to avoid the occurrence of ITBS. The occurrence of ITBS may be due to the lack of timely gait adjustment. Excessive trunk inclination and anterior pelvic tilt angle may be risks factor in the development of ITBS during running.

Professional Dancers Distinct Biomechanical Pattern during Multidirectional Landings.

This study aimed to compare lower extremity (LE) biomechanics between professional dancers (PD) and nondancers (ND) during multidirectional single-leg landings. Fifteen PD (27 ± 7 yr, 1.69 ± 0.1 m, 57.8 ± 9.3 kg) and 15 ND (25 ± 5 yr, 1.69 ± 0.1 m, 66 ± 10.2 kg) performed single-leg jumps in three directions: 1) lateral, 2) diagonal, and 3) forward. Dominant LE biomechanical data were collected using a motion capture system. Data were processed in Visual3D. LE kinematic (hip, knee, and ankle joint angles in sagittal and frontal planes, and range of motion [ROM]) and kinetics (hip and knee internal joint moments and vertical ground reaction force) variables were analyzed at initial contact (IC), peak vertical ground reaction force (PvGRF), and peak knee flexion (PKF). Repeated-measures ANOVA was conducted (P < 0.05). At IC, statistically significant interactions were found for ankle frontal and hip sagittal angles (P < 0.05). The main effects for groups and jump directions were attained (P < 0.05). PD at IC had lower hip and knee flexion and higher ankle plantarflexion than ND. PD had significantly higher knee (PD, 41 ± 6.1; ND, 33.8 ± 8.4) and ankle (PD, 53.7 ± 3.4; ND, 38.9 ± 8.9) ROM than ND. At IC, the lateral jump had higher hip abduction moment, hip abduction, and ankle inversion and lower hip flexion and ankle plantarflexion than the forward and diagonal jumps. The lateral jump (15.5 ± 7.7) had higher hip excursion than the forward jump (12.7 ± 5.4). The higher extended posture of PD at IC promoted an efficient use of the knee and ankle ROM to dissipate the landing forces. Regardless of the group, jump directions also solicited different biomechanical responses, particularly between lateral and forward directions. These strategies should be considered for implementation in prevention programs, as it can foster adequate LE neuromuscular control.

Effects of different oral instructions on kinematic and kinetic parameters during drop vertical jump.

[Purpose] This study aimed to examine the impact of changing the drop vertical jump stance time on kinematic and kinetic parameters by ordering to high jump or quick jump for consistent stance time and a more accurate assessment of anterior cruciate ligament injury risk. [Participants and Methods] The participants were 20 healthy female students. The drop vertical jump was started by instructing the participants to stand on a 30-cm platform with both legs stationary. The task was performed while the participants were instructed to perform high jump or quick jump. [Results] Stance time was significantly shorter with quick jump than with high jump. Quick jump showed significantly higher knee abduction angles at initial contact and peak vertical ground reaction force, and lower hip flexion, knee flexion, and ankle dorsiflexion angles at the lowest point of the center of mass. Quick jump showed a significantly higher peak vertical ground reaction force. The knee abduction moment at initial contact was not significantly different between the 2 conditions. [Conclusion] Quick jump was better than high jump for making stance time consistent, and the differences in kinematic and kinetic characteristics by oral instructions should be considered when using drop vertical jump.

Biomechanical and physiological responses to electrically assisted cycling during simulated mail delivery

This study quantified the biomechanical (movements and forces) and physiological (energy expenditure) demands of postal delivery performed with electrically assisted bicycles (EABs). Ten postal workers and 10 recreational athletes performed three simulated postal tasks (simulated mail delivery circuit, delivery distance [close vs. far], and 3-min stationary cycling) while carrying 0, 16 and 32 kg. Physiological (energy expenditure) and biomechanical (internal and external forces and joint angles) responses were calculated. Energy expenditure (10–20%; p < 0.05) and power output (30–44%; p < 0.05) increased with increasing mail loads. Ground reaction force increased (∼10%) for the far delivery distance, but joint reaction forces were unchanged. Lower hip flexion (p < 0.01), less hip abduction (p < 0.01) and larger spine anterior flexion (p < 0.01) were observed for the far delivery distance. Joint forces were not affected by the mail load transported (0–32 kg) or distance from the mailbox (close vs far). EABs can provide a suitable transportation method to assist mail delivery in terms of energy expenditure reduction.

Functional, nutritional and social factors associated with mobility limitations in the elderly: a systematic review.

To systematically review the prevalence and incidence of mobility limitations in the elderly people and their associated factors. Articles in the electronic literature were searched via PubMed, Scopus,,Lilacs, SciELO, PAHO, MedCarib, Repidisca, Wholis, IBCES, PEDro, Medline and Bireme (2012-2016). The instrument STROBE was used to analyze the quality of the work and the PRISMA recommendation was used to structure the review. Nine studies were included. The prevalence of mobility limitations ranged from 58.1 to 93.2% and the incidence ranged from 23 to 53.7%. Studies provided evidence of association of mobility limitations in the elderly population with high BMI, low 25-hydroxy vitamin D, sarcopenia, fragility, chronic pain, functional dependence, advanced age in women, low hip flexion, sedentary lifestyle, and social support difficulties. Mobility limitations in the elderly had high prevalence and incidence, and there was evidence of association with nutritional, functional and social factors.

Physiological factors contributing to mobility loss over 9 years of follow-up—results from the InCHIANTI study.

Mobility is an essential aspect of everyday life and enables autonomy and participation. Although many risk factors for mobility loss have been previously described, their relative importance and independent contributions to the long-term risk of losing mobility have not been well defined. This study is based on 1,013 men and women aged ≥65 years enrolled in 1998-2000 and followed for 9 years through 2007-2008 in the population-based InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study. We considered 44 different measures assessed at baseline to explore six subsystems: (i) central nervous system, (ii) peripheral nervous system, (iii) muscles, (iv) bone and joints, (v) energy production and delivery, and (vi) perceptual system. The outcome was incident mobility loss defined as self-report of inability to walk 400 m or climb and descend 10 steps without help from another person. Random survival forest analysis was used to rank the candidate predictors by their importance. The most important physiological markers predicting mobility loss that emerged from the random survival forest modeling were older age among women (81-95 vs 65-68 years, hazard ratio [HR] 9.60 [95% CI 3.35, 27.50]), weaker ankle dorsiflexion strength (lowest vs highest quintile, HR 5.25 [95% CI 2.35, 11.72]), low hip flexion range of motion (lowest vs highest quintile, HR 2.30 [95% CI 1.20, 4.41]), presence of primitive reflexes (yes vs no, HR 1.47 [95% CI 1.03, 2.09]), and tremor (yes vs no, HR 1.91 [95% CI 1.18, 3.07]). Prevention of mobility loss with aging should focus on prevention and treatment of neuromuscular impairments.

Sitting on a sloping seat does not reduce the strain sustained by the postural chain.

The objective of this study was to explore the effect of a forward sloping seat on posture and muscular activity of the trunk and lower limbs. To this aim, twelve asymptomatic participants were tested in six conditions varying seat slope (0°, 15° forward) and height (high, medium, low). Angular position of head, trunk and pelvis was assessed with an inertial orientation system, and muscular activity of 11 superficial postural muscles located in the trunk and lower limbs was estimated using normalized EMG. Results showed that a forward sloping seat, compared to a flat seat, induced a greater activity of the soleus (p<0.01), vastus lateralis (p<0.05) and vastus medialis (p<0.05), as well a lower hip flexion (p<0.01). In contrast, no significant variation of head, trunk and pelvis angular position was observed according to seat slope. It was concluded that forward sloping seats increase the load sustained by the lower limbs, without a systematic improvement of body posture.

DIFFERENCES IN NEUROMUSCULAR ACTIVITY OF QUADRICEPS AND HAMSTRINGS WITH RESPECT TO DIFFERENT LANDING PATTERNS IN FEMALE ATHLETES

BackgroundA high knee abduction moment (KAM) and an erect movement pattern during landing have been suggested as anterior cruciate ligament (ACL) injury risk factors. Previous research focused mainly on determination...

Prognostic factors for the two‐year course of activity limitations in early osteoarthritis of the hip and/or knee

To predict the 2-year course of activity limitations in patients with early knee and/or hip osteoarthritis (OA). The Cohort Hip & Cohort Knee (CHECK) study is a prospective followup study. The CHECK cohort, comprising participants (n = 1,002) with early OA-related knee and/or hip symptoms, was followed for 2 years. Participants completed questionnaires and underwent physical, laboratory, and radiographic examination. Regression models were used to examine whether baseline variables predicted the course of activity limitations as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Analyses were performed separately for participants with knee symptoms and participants with hip symptoms. After 2 years of followup, activity limitations slightly decreased. Large between-subject variation was observed in WOMAC change scores. In participants with knee symptoms, young age, non-Western ethnicity, bilateral hip pain, morning stiffness in the knee, high comorbidity count, high body mass index, high bodily pain, poor general health perception, and pain coping strategy were associated with a poor 2-year outcome on activity limitations. In participants with hip symptoms, few activity limitations at baseline, bilateral hip pain, morning stiffness in the knee, high comorbidity count, low active hip flexion, poor general health perception, and pain coping strategy were associated with a poor 2-year outcome on activity limitations. After 2 years of followup, large between-subject variation was observed in the course of activity limitations. The course of activity limitations is to some extent already predictable at an early stage of knee and hip OA.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.

Truncus endurance, hip and ankle mobility and aerobic fitness in 15‐year‐old Norwegian adolescents in 1968 and 1997

This study compared the physical performance of adolescents in 1997 and 1968. The material included 1329 15-year-old Norwegian adolescents in Akershus county in Norway in 1968, and 1105 15-year-old adolescents in the same region in 1997. The investigations were supervised by the same conductor on both occasions, and used identical physical tests. The test battery included dynamic endurance of abdominal and low back muscles, hip flexion, ankle dorsiflexion and aerobic fitness. Compared with 1968, low back extension endurance in 1997 was almost 10% lower in both genders, the endurance of the abdominal muscles was 4.8% poorer among boys and 8.1% higher among girls and the ratio between abdominal and low back extension endurance was 11.8% higher among boys and 26.4% higher in girls. Compared with 1968, hip flexion in 1997 was 8.3% higher in girls, while ankle dorsiflexion and aerobic fitness in boys were 15% and 13.4% poorer, and 4.8% poorer and 2.5% higher in girls, respectively. The data indicate a general decline during one generation in physical performance among boys, a decline in low back endurance, truncus balance and ankle mobility among girls and in a higher abdominal endurance among girls.