Hip Extensor Strength Research Articles

Do Highly Trained Mountain Runners Differ from Recreational Active Non-Runners on Range of Motion and Strength in the Hip and Ankle as Well as Postural Control?

The rules governing mountain running force athletes to implement into their training programmes uphill and downhill running on unstable surfaces, which are demanding for hip and ankle as well as for the postural control system. The aim of the present cross-sectional study was to compare highly trained mountain runners (MR) and recreational active non-runners (NR) on range of motion (ROM) and strength in the hip and ankle, as well as dynamic postural control. Thirty MR and thirty-two NR were included in the study. ROM was assessed using a digital inclinometer. Strength was measured using a hand-held dynamometer. Postural control was evaluated using the lower quarter Y-balance test (YBT-LQ). The results showed that MR, in relation to NR, had statistically significant smaller hip external rotation ROM (p = 0.007), lower hip external rotator (p = 0.006) and extensor (p = 0.023) strength and greater normalised anterior reach in the YBT-LQ (p = 0.028). Mountain running training may reduce hip external rotation ROM as well as hip external rotator and extensor strength. Moreover, such training may improve postural control. MR should implement exercises targeted at developing hip ROM and strength. Furthermore, it seems that mountain running training may be a good way to improve postural control.

Should We Use the Men Load–Velocity Profile for Women in Deadlift and Hip Thrust?

Injuries are common in team sports and can impact both team and individual performance. In particular, hamstring strain injuries are some of the most common injuries. Furthermore, hamstring injury ratios, in number of injuries and total absence days, have doubled in the last 21 seasons in professional soccer. Weakness in hip extensor strength has been identified as a risk factor in elite-level sprinters. In addition, strength imbalances of the hamstring muscle group seem to be a common cause of hamstring strain injuries. In this regard, velocity-based training has been proposed to analyze deficits in the force-velocity profile. Previous studies have shown differences between men and women, since there are biomechanical and neuromuscular differences in the lower limbs between sexes. Therefore, the aim of this study was to compare the load-velocity profile between males and females during two of the most important hip extension exercises: the hip thrust and the deadlift. Sixteen men and sixteen women were measured in an incremental loading test following standard procedures for the hip thrust and deadlift exercises. Pearson's correlation (r) was used to measure the strength of the correlation between movement velocity and load (%1RM). The differences in the load-velocity relationship between the men and the women were assessed using a 2 (sex) × 15 (load) repeated-measures ANOVA. The main findings revealed that: (I) the load-velocity relationship was always strong and linear in both exercises (R2 range: 0.88-0.94), (II) men showed higher velocities for light loads (30-50%1RM; effect size: 0.9-0.96) than women for the deadlift, but no significant differences were found for the hip thrust. Based on the results of this study, the load-velocity equations seem to be sex-specific. Therefore, we suggest that using sex-specific equations to analyze deficits in the force-velocity profile would be more effective to control intensity in the deadlift exercise.

Long-term effects of deep-learning digital therapeutics on pain, movement control, and preliminary cost-effectiveness in low back pain: A randomized controlled trial.

The present study aimed to compare the effects of a deep learning-based digital application with digital application physical therapy (DPT) and those of conventional physical therapy (CPT) on back pain intensity, limited functional ability, lower extremity weakness, radicular symptoms, limited range of motion (ROM), functional movement, quality of life, cost-effectiveness, and postintervention questionnaires for perceived transmission risk of COVID-19 and satisfaction results in 100 participants with low back pain (LBP). One hundred participants with LBP were randomized into either DPT or CPT groups, three times per week over four weeks. Outcome measures included the (1) Oswestry Disability Index, (2) Quebec Back Pain Disability Scale, (3) Roland-Morris Disability Questionnaire (RMDQ), (4) Numeric Pain Rating Scale, (5) functional movement screen (FMS), (6) short form-12, (7) lower extremity strength, (8) ROM of trunk flexion, extension, and bilateral side bending, (9) questionnaires for perceived transmission risk of COVID-19, (10) preliminary cost-effectiveness, and (11) postintervention satisfaction questionnaire results. The analysis of variance was conducted at p < 0.05. Analysis of variance showed that DPT showed superior effects, compared to CPT on RMDQ, hip extensor strength, transmission risk of COVID-19, as well as satisfaction. Both groups showed significant improvement pre- and postintervention, suggesting that DPT is as effective as CPT, and was superior in preliminary cost-effectiveness and transmission risk of COVID-19. Our results provide novel, promising clinical evidence that DPT was as effective as CPT in improving structural and functional impairment, activity limitation, and participation restriction. Our results highlight the successful incorporation of DPT intervention for clinical outcome measures, lower extremity strength, trunk mobility, ADL improvement, QOL improvement, and FMS in LBP.

Eight-week virtual reality training improves lower extremity muscle strength but not balance in adolescents with intellectual disability: A randomized controlled trial.

Purpose: This study aims to assess the effects of 8-week virtual reality (VR) training on balance and lower extremity muscle strength in adolescents with intellectual disability (ID). Methods: Thirty adolescents with intellectual disability were randomly divided into the virtual reality group and control group. The participants in the virtual reality group and the control group received the virtual reality training and the physical education (PE) course, respectively, for 8weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test and lower extremity muscle strength were measured before and after the training. Results: The between-group results showed that the participants in the virtual reality group increased the muscle strength of hip flexors (p < 0.001), hip extensors (p = 0.002), hip abductors (p < 0.001), knee flexors (p < 0.001), knee extensors (p = 0.002) and ankle plantar flexors (p = 0.042) significantly after training, compared to the control group. However, no significant improvement was found in the berg balance scale and timed up and go scores between the virtual reality group and control group after training (p > 0.05). The within-group results showed that the strength of all the muscle groups significantly increased after training in the virtual reality group (p < 0.05) compared to the baseline. However, no significant difference was found in the muscle strength in the control group before and after training. The within-group berg balance scale and timed up and go scores showed no significant improvements in both groups. Conclusion: Virtual reality training intervention might be effective in improving the lower extremity muscle strength, but no significant improvement was found on balance ability in adolescents with intellectual disability.

Muscle Strength And Loading Patterns During Sport-related Tasks In Persons With Acetabular Dysplasia

PURPOSE: Acetabular dysplasia (AD) is described as insufficient bony coverage of the femoral head by the acetabulum that leads to joint instability, pain, and decreased function. Little is known regarding the effects of AD on muscle strength and loading patterns during sport-related tasks. We compared muscle strength and loading patterns during squat and countermovement jump (CMJ) tasks between limbs and examined associations among these variables in persons with AD. METHOD: We enrolled 12 persons with AD (11 females) and evaluated isometric strength of the knee flexors and extensors and the hip flexors, extensors, and abductors using an electromechanical dynamometer (Biodex 3). We used peak torque values (Nm/kg) for the involved and uninvolved limbs to calculate limb symmetry indices (LSI) for each muscle group. Loading patterns during a squat and CMJ takeoff and landing were evaluated using two portable force plates (ForceDecks). Average peak ground-reaction force (GRF) for the involved and uninvolved limbs (N/N) and LSI for each task were calculated. We used Wilcoxon signed-rank test to evaluate differences in muscle strength and loading patterns between limbs. We examined associations between involved limb muscle strength and loading patterns using Spearman’s rho test. RESULT: The involved limb exhibited lower knee extensor strength compared to the uninvolved limb (involved = 1.75 Nm/Kg; uninvolved = 2.11 Nm/Kg; p = 0.005). There were no other differences between limbs for the remaining muscle strength variables or for squat and CMJ loading patterns variables (all p > 0.05). Per muscle group, the following proportions exhibited ≥90% LSI: 41.7% for knee extensors and flexors and hip flexors; 66.7% for hip extensors; 90% for hip abductors. Per movement task, the following proportions exhibited ≥90% LSI: 72.7% for the squat; 90% for CMJ takeoff; 54.5% for CMJ landing. Higher hip extensor strength was associated with higher GRF during CMJ landing for involved limb (r = 0.70; p = 0.016). CONCLUSION: Persons with AD exhibited decreased involved limb knee extensor strength and asymmetric strength and loading patterns. Higher hip strength was associated with higher involved limb landing during CMJ. Further study of the associations among strength and joint loading patterns is needed in larger samples of persons with AD.

Mechanical power flow from trunk and lower limb joint power to external horizontal power in the track and field block start

ABSTRACT Sprint start performance is measured as the horizontal external power, the time-average rate of horizontal kinetic energy generation. Although joint powers have been examined, not all segment rotations on which positive powers are exerted necessarily contribute to forward propulsion; details regarding horizontal power remain unclear. Here we show the contributions of segment rotations to the forward and upward propulsion. We calculated the joint power exerted on each segment and the contributions from segment rotations to the normalised average horizontal and vertical external powers ( and ) during the sprint start by 12 male sprinters. Over half (55 ± 6%) is due to the front thigh rotation (0.30 ± 0.04), on which the hip and knee exert positive power. Pelvic rotation does not contribute to (0.00 ± 0.01). This highlights the importance of the hip-extensors strength and the need for it accompanied by the lumbar-extensors strength cancelling out the hip-extensors action on the pelvis and promoting hip-extensor-induced thigh rotation. The front thigh rotation decreases (−0.08 ± 0.02). is primarily induced by rotations of the thorax (0.04 ± 0.01), lumbar region (0.06 ± 0.02), and pelvis (0.04 ± 0.01). Rotations of the lower-limb segments did not contribute to upward propulsion. Therefore, the front thigh induces downward movement, which is counterbalanced by the trunk segments. We bridge the gap in the current understanding from joint power to . We present a case involving segments on which positive joint powers are exerted similarly but play different roles: forward or upward propulsion, thereby providing insights into directional control mechanisms in explosive initiation of motion. HIGHLIGHTS We examined the contributions of segment rotations to the normalised average horizontal and vertical external powers (, ): the sprint start performance and the parameter to assess upward propulsion. Over half the total (55 ± 6%) is due to the front thigh rotation, while the front thigh rotation decreases , which was counterbalanced by rotations of the thorax, lumbar region, and pelvis. We bridge the gap in the current understanding from joint power to and further present a case involving segments on which positive joint powers are exerted but play different roles: forward or upward propulsion.

Loaded Functional Strength Training versus Traditional Physical Therapy on Hip and Knee Extensors Strength and Function Walking Capacity in Children with Hemiplegic Cerebral Palsy: Randomized Comparative Study.

Objective: This study’s objective was to see how loaded functional strengthening exercises using a plantigrade foot position and a shoe supporter affected muscle strength and walking ability in spastic hemiplegic children. Methods: Seventy-two children with spastic hemiplegic cerebral palsy, both sexes, aged ten to twelve years, were randomly assigned into two groups equal in number (control and intervention groups). The control group received a specially designed physical therapy program, whereas the intervention group received a loaded functional strengthening exercises program using a shoe supporter to maintain a plantigrade foot position. The training program was carried out for 60 min, three times per week for three consecutive months. All participants were evaluated both before and after the therapy program by using a Medical Commander Echo Manual Muscle Tester dynamometer to assess isometric muscle power of hip and knee extensors on the affected side. To assess functional walking capacity, a 6 min walking (6MWT) test was used. Results: Study groups were comparable with respect to all outcome measures at entry (p > 0.05). Within-group comparison showed significant improvements in all measured variables. Furthermore, between-group comparison revealed significantly greater improvements (p < 0.05) in hip and knee extensors strength as well as the functional walking capacity in favor of the intervention group. Conclusions: In all the analyzed variables, loaded functional strength exercises from the plantigrade foot position were found to be considerably more effective in the intervention group than in the control group.

Compensatory Responses During Slip-Induced Perturbation in Patients With Knee Osteoarthritis Compared With Healthy Older Adults: An Increased Risk of Falls?

Background: Functional impairment of the knee joint affected by osteoarthritis and loss of muscle strength leads to a significant increase in the number of falls. Nevertheless, little is known about strategies for coping with gait perturbations in patients with knee osteoarthritis (KOA). Thus, this study aimed to examine the compensatory strategies of patients with KOA in response to a backward slip perturbation compared with healthy older adults. Methods: An automated perturbation program was developed by using D-Flow software based on the Gait Real-time Analysis Interactive Lab, and an induced backward slip perturbation was implemented on nine patients with severe KOA (68.89 ± 3.59 years) and 15 age-matched healthy older adults (68.33 ± 3.29 years). Step length, gait speed, range of motion, vertical ground reaction forces, lower extremity joint angles, and joint moments were computed and analyzed. Results: Compared with older adults, patients with KOA had significantly lower step length, gait speed, and vertical ground reaction forces in both normal walking and the first recovery step following backward slip perturbations. Inadequate flexion and extension of joint angles and insufficient generation of joint moments predispose patients with KOA to fall. Hip extension angle and flexion moment, knee range of motion, and vertical ground reaction forces are key monitoring variables. Conclusion: The risk of falls for patients with KOA in response to backward slip perturbations is higher. Patients with KOA should focus not only on quadriceps muscle strength related to knee range of motion but also on improving hip extensor strength and activation through specific exercises. Targeted resistance training and perturbation-based gait training could be better options.

Is There an Association between the Quality of Life of Incontinence Symptoms and the Hip Joint Muscles Strength in Women with Stress Urinary Incontinence?

Background For establishing an accurate target for rehabilitation of stress urinary incontinence (SUI), it is necessary to determine whether there is an association between the pelvic floor muscle (PFM) and hip joint muscle strength and quality of life (QoL) of incontinence symptoms. Purpose The purpose of the current study was to confirm the correlation between QoL of incontinence symptoms and PFM strength, hip extensor, abductor, and adductor strength in women with SUI. Study design Cross sectional study Methods Forty-two women with SUI were recruited for the present study. PFM performance was measured by perineometry. Hip extensor, abductor and adductor strength were measured by dynamometry. QoL of incontinence symptoms was measured by incontinence quality of life questionnaire (I-QOL). The significance of the correlations between I-QOL and hip joint muscle and PFM strength was assessed using Pearson correlation coefficients. Alpha value was set at 0.05. Results Avoidance and limiting behaviors factor in I-QOL was correlated with PFM strength (<italic>r</italic>=0.524, <italic>p</italic>&lt;0.05), hip adductor strength (<italic>r</italic>=0.356, <italic>p</italic>&lt;0.05) and hip abductor strength (<italic>r</italic>=0.352, <italic>p</italic>&lt;0.05) in the order. The total score in I-QOL was correlated with PFM strength (<italic>r</italic>=0.368, <italic>p</italic>&lt;0.05). Conclusions When designing which muscles to train for improving QoL of incontinence symptoms, the hip joint muscle as well as the PFM could be considered.

Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: the BELL pragmatic controlled trial

The Ballistic Exercise of the Lower Limb (BELL) trial examined the efficacy and safety of a pragmatic hardstyle kettlebell training program in older adults. Insufficiently active men and women aged 59–79 years, were recruited to a 6-month repeated measures study, involving 3-months usual activity and 3-months progressive hardstyle kettlebell training. Health-related physical fitness outcomes included: grip strength [GS], 6-min walk distance [6MWD], resting heart rate [HR], stair-climb [SC], leg extensor strength [LES], hip extensor strength [HES], Sit-To-Stand [STS], vertical jump [CMVJ], five-times floor transfer [5xFT], 1RM deadlift, body composition (DXA), attendance, and adverse events. Sixteen males (68.8 ± 4.6 yrs, 176.2 ± 7.8 cm, 90.7 ± 11.0 kg, 29.2 ± 2.6 kg/m2) and sixteen females (68.6 ± 4.7 yrs, 163.9 ± 5.4 cm, 70.4 ± 12.7 kg, 26.3 ± 4.9 kg/m2) were recruited. Compliance with the supervised exercise program was very high (91.5%). Kettlebell training increased GS (R: MD = 7.1 kg 95% CI [4.9, 9.3], L: MD = 6.3 kg 95% CI [4.1, 8.4]), 6MWD (41.7 m, 95% CI [17.9, 65.5]), 1RM (16.2 kg, 95% CI [2.4, 30.0]), 30 s STS (3.3 reps, 95% CI [0.9, 5.7]), LES (R: MD = 61.6 N, 95% CI [4.4, 118.8]), HES (L: MD = 21.0 N,95% CI [4.2,37.8]), appendicular skeletal lean mass (MD = 0.65 kg, 95% CI [0.08, 1.22]), self-reported health change (17.1%, 95% CI [4.4, 29.8]) and decreased SC time (2.7 s, 95% CI [0.2, 5.2]), 5xFT time (6.0 s, 95% CI [2.2, 9.8]) and resting HR (7.4 bpm, 95% CI [0.7, 14.1]). There were four non-serious adverse events. Mean individual training load for group training sessions during the trial was 100,977 ± 9,050 kg. High-intensity hardstyle kettlebell training was well tolerated and improved grip strength and measures of health-related physical fitness in insufficiently active older adults.Trial registration: Prospectively registered: 20/08/2019, Australian New Zealand Clinical Trials Registry (ACTRN12619001177145).

Deficits in eccentric antagonist/concentric agonist strength ratios: a comparative study of football players with and without osteitis pubis.

Dynamic hip stabilizers are essential for optimal performance in football players, particularly during kicking. Although the muscle strength deficits of hip muscles as an etiology of osteitis pubis (OP) in football players have not yet been well investigated, previous assessments give more attention to the concentric mode of strength for both hip flexor and extensor muscles. Functionally, the hip muscles interact in an eccentric/concentric pattern. This study aimed to compare the concentric, eccentric, and eccentric antagonist/concentric agonist ratios for hip flexor and extensor strength between football players with OP and healthy athletes. Thirty-four male footballers with OP and eighteen healthy footballers were tested using an isokinetic dynamometer at a speed of 180°/s. Football players with osteitis pubis demonstrated a significantly lower eccentric extensor/concentric flexor ratio and higher eccentric hip flexor/extensor ratio (p < 0.05) when compared with healthy participants. The present study demonstrated that football players with OP had a reduced capability to produce eccentric hip extension torque compared to healthy athletes. Consequently, the eccentric rather than the concentric weakness of hip extensors could be suggested as one of the intrinsic contributing factors for OP. Incorporating findings of the current study in clinical practice could afford critical information while evaluating the hip muscles in football players with OP for pre-screening, developing rehabilitation programs, and guiding the decision to return to sports after injury.

Hip Extensor Strength Influences Dynamic Postural Changes during Gait in Patients with Adult Spinal Deformity: A Cross-Sectional Study Using Three-Dimensional Motion Analysis.

Single-hospital cross-sectional study. The aim of the present study was to investigate the physical functions influencing dynamic postural change in patients with adult spinal deformity (ASD). Dynamic postural change leading to increased forward lean during gait is a problem in patients with ASD; however, the relationship between this change and trunk and hip extensor strength is unclear. Thirty patients with ASD aged ≥50 years who were admitted to our hospital between July 2016 and September 2019 were included in this study. X-ray parameters (i.e., sagittal vertical axis, pelvic tilt, and pelvic incidence minus lumbar lordosis) were evaluated from the full-length standing radiographs of the subjects. Trunk and hip extensor strength was evaluated using a hand-held dynamometer. Dynamic postural changes (i.e., sagittal trunk shift during standing, sagittal trunk shift during gait, and delta sagittal trunk shift) were assessed using a three-dimensional motion analysis system. The relationships between dynamic postural change and various X-ray parameters, as well as trunk and hip extensor strength, were examined using multivariable analysis. Multivariable analysis showed that hip extensor strength is the factor most strongly associated with dynamic postural change among the X-ray parameters and physical functions assessed in this study (β=-0.41, R2=0.12). We demonstrated the association between dynamic postural change and hip extensor strength in patients with ASD. Our results may be useful to healthcare providers treating patients with ASD. Interventions for dynamic postural change in patients with ASD should focus on hip extensor strength.

The Effects of Sling Exercise on Gluteus Muscle Strength and Gait Velocity in Females with History of Chronic Low Back Pain

Background Gluteal muscle weakness or dysfunction leads to low back pain. Gluteal muscle is important for posture, balance, and independent gait. Despite the well-established link between with history of chronic low back pain (CLBP) and gluteal muscle weakness, there is little research available on direct exercise interventions. Whether sling exercises increase gluteal muscle strength in those with chronic low back pain has not been studied. Purpose To determine the changes in gluteus maximus and gluteus medius muscle strength, gait velocity, pain, and low back disability following an intervention using sling exercise for four weeks in females with a history of CLBP. Study design Cross-sectional study Methods This study involved 27 females with a history of CLBP who visited the H fitness center. The participants’ pain intensity was measured using the visual analogue pain scale. Disability was measured using the Korean Oswestry Disability Index. A force measurement device was used to collect data on gluteal muscle strength. The participants walked for five minutes at a preferred walking speed on a treadmill, and the average walking speed was measured during gait and then re-measured after exercise. Results Pain intensity and disability were found to significant decrease after sling and common exercise groups. Significant increased post-intervention versus pre-intervention were seen in the hip abductor strength and gait velocity (<italic>p</italic>&lt;0.05). No significant differences were seen in the hip extensor strength (<italic>p</italic>&gt;0.05). These results show that hip abductor strength was significantly different between before and after sling exercise. Conclusions Sling exercises may be effective for stability during the gait pattern and may be recommended to improve the gluteal strength and lumbo-pelvic stability for those with chronic low back pain.

Investigating the lower extremity-related anaerobic exercise capacity and functional status in adult patients with familial Mediterranean fever.

No studies examined the lower extremity-related anaerobic exercise capacity or functional status in adult patients with FMF. Twenty-four patients with FMF (12 males) and 24 age-sex-matched healthy controls (13 males) were included in the study. Lower extremity-related anaerobic exercise capacity was assessed by using Wingate Anaerobic Test. Lower extremity-related functional status was examined by using 9-Step Stair Climb Test, 10-Repetition Chair Stand Test, and Six-Minute Walking Distance. Muscle strength of hip flexors, hip extensors, knee flexors, and knee extensors were evaluated by using a hand-held dynamometer. Patients with FMF had significantly poorer results in all anaerobic exercise capacity parameters and functional status assessments (P < 0.05), except muscle strength measurements (P > 0.05). Both average and peak anaerobic exercise capacities correlated significantly with all muscle strength measurements, 9-Step Stair Climb Test, 10-Repetition Chair Stand Test times, and Six-Minute Walk Distances (P < 0.05) in patients with FMF. Lower extremity-related anaerobic exercise capacity and functional status seem to be diminished in adult patients with FMF. Evaluating these parameters may be beneficial for planning more appropriate and individualized treatment regimens such as patient education and exercise counselling for patients with FMF.

The influence of hip extensor and lumbar spine extensor strength on lumbar spine loading during a squat lift

Weakness of the hip extensors and lumbar spine extensors has been proposed to contribute to greater demands on the lumbar spine during lifting. The purpose of the current study was to examine the associations among strength of the hip and lumbar spine extensors, lumbar spine extensor moments and lumbar paraspinal muscle activation during a squat lift task. Twenty-seven healthy females participated. Strength of the hip and lumbar spine extensors was measured using a dynamometer. Lumbar spine moments and lumbar paraspinal muscle activity were quantified during the concentric phase of the squat lifting task. There was a significant positive association between lumbar extensor strength and average lumbar extensor moment during lifting (r = 0.498, p = 0.008). Similarly, hip extensor strength was positively associated with the average lumbar extension moment (r = 0.382, p = 0.049). Hip extensor strength was negatively associated with activation of the lumbar paraspinal muscles during lifting (ρ = −0.382, p = 0.049). Stronger individuals are more likely to use their hip extensors and lumbar spine extensors to perform a squat lift task. In contrast, those with lower strength employ subtle biomechanical changes to reduce lumbar spine demand.

Associations between potentially modifiable clinical factors and sagittal balance of the spine in older adults from the general population.

Spinal sagittal balance is associated with back pain and quality of life. Enhancing understanding of the clinical factors associated with sagittal balance is essential for guiding the development of effective non-operative treatment. We aimed to evaluate the associations between spinal sagittal balance and potentially modifiable clinical factors and interactions between current back pain and the evaluated clinical factors. We conducted a cross-sectional study where sagittal alignment, measured radiographically by EOS, was defined by sagittal vertical axis (SVA). The clinical factors included non-radiographic (NR) lumbar lordosis angle, balance (Berg balance scale), hip and back extension range of motion (ROM) and extensor strength, and back pain. Pearson's correlation coefficients and multivariable regression analyses were conducted in 63 adult participants (70% female, mean age 73 (SD 8.6) years) from the general population. We identified correlations between SVA and age (r = 0.4, p < 0.001), body mass index (BMI) (r = 0.3, p = 0.008), balance (r = - 0.5, p < 0.001) and NR lumbar lordosis angle (r = - 0.5, p < 0.001). The final model (R2 = 58%) identified that, after controlling for age and BMI, larger SVA was associated with lower NR lumbar lordosis (R2 = 15%, p < 0.001), poorer balance (R2 = 7%, p = 0.02), greater hip extensor strength (R2 = 4%, p = 0.053), and among people with back pain, NR lumbar extension ROM (R2 = 3%, p = 0.034). Hip ROM and lumbar strength were not significant. Reduced NR lumbar lordosis magnitude and ROM, balance and hip strength are associated with SVA; however, it is unclear if these factors are compensatory, contributing, or modifiable. Hence, future longitudinal studies are needed.

Дооперационная подготовка пациентов к эндопротезированию тазобедренного сустава

Актуальность. Проанализировано влияние мышц — стабилизаторов таза на сохранение постурального баланса у больных коксартрозом и выдвинута рабочая гипотеза, согласно которой позиционная адаптация компонентов эндопротеза тазобедренного сустава во время операции определяется состоянием этих мышц. Цель работы — разработка методики предоперационной лечебной физкультуры, положительно влияющей на состояние мышц — горизонтальных стабилизаторов таза, для оптимизации позиционной адаптации эндопротеза тазобедренного сустава во время операции. Материалы и методы. Разработана методика упражнений, выполняемых из облегченного исходного положения. Для увеличения силы мышц тазового пояса упражнения выполняют с противодействием максимальному сопротивлению при гравитационно разгруженном суставе. Для увеличения объема движений в тазобедренном суставе упражнения выполняют при гравитационной разгрузке сустава вытяжением или специальными эластичными тягами, используют маховые и пассивные упражнения. Повышенный тонус мышечных групп (аддукторы, флексоры) устраняют при помощи релаксирующих техник и пассивных упражнений. Тонус гипотрофичных мышц (абдукторы, экстензоры) повышают стимулирующим массажем. Болевой синдром снижаем путем экстензии нижней конечности за счет дозированного манжеточного вытяжения, также выполняем часть упражнений. Результаты работы апробированы на группе из 10 пациентов с односторонним коксартрозом, которым применялась разработанная нами методика дооперационного лечения. Результаты лечения и эффективность предлагаемой методики оценивали по разработанной нами методике оценки функции мышц, отвечающих за постуральный баланс. Результаты. Клиническая апробация разработанной методики предоперационного лечения показала, что после проведения курса лечебной физкультуры перед операцией некоторые пациенты отмечали снижение уровня боли, увеличение объема движений в больном тазобедренном суставе, субъективное улучшение опороспособности скомпрометированной конечности и улучшение качества жизни. Сравнение величины плеча силы абдукторов до операции и после выполнения эндопротезирования показало, что ни в одном случае не отмечено расхождение показателей более чем на 5 мм, что говорит о том, что позиционная адаптация компонентов эндопротеза тазобедренного сустава зависит от состояния мягких тканей, окружающих тазобедренный сустав. Это позволяет утверждать, что устранение мышечной контрактуры аддукторов и сгибателей бедра, а также восстановление эластичности и силы абдукторов и разгибателей бедра обеспечивают оптимальную позиционную адаптацию компонентов эндопротеза тазобедренного сустава. Выводы. Предварительные исследования показали, что у больных, получавших до операции специальный курс лечебной физкультуры, благодаря устранению мышечной контрактуры и восстановлению эластичности и силы абдукторов и разгибателей бедра обеспечивается оптимальная позиционная адаптация компонентов эндопротеза тазобедренного сустава, однако подтверждение достоверности исследований требует дальнейших наблюдений.

Does adding hip strengthening exercises to manual therapy and segmental stabilization improve outcomes in patients with nonspecific low back pain? A randomized controlled trial

BackgroundThe literature is unclear on the need for hip strengthening in persons with low back pain (LBP). ObjectivesTo investigate the effectiveness of hip strengthening exercises when added to manual therapy and lumbar segmental stabilization in patients with chronic nonspecific LBP. MethodsSeventy patients with chronic nonspecific LBP were randomly assigned to either the manual therapy and lumbar segmental stabilization group or the manual therapy and lumbar segmental stabilization plus specific hip strengthening group. A 10 cm visual analogue scale and the Rolland-Morris Questionnaire were the primary clinical outcome measures at baseline, at the end of treatment (posttreatment), and 6- and 12-months posttreatment. Hip strength and kinematics were measured as secondary outcomes . ResultsWhile within-group improvements in pain, disability, and hip extensors strength occurred in both groups, there were no significant between-group differences at posttreatment or follow-ups. Mean difference in changes in pain level between groups at posttreatment and at 6- and 12-month follow-up were 0.5 points (95% confidence interval [CI]: -0.5, 1.5), 0.3 points (95% CI: -0.9, 1.5), and 0.0 points (95% CI: -1.1, 1.1), respectively. The mean differences in changes in disability were 0.8 points (95% CI: -1.3, 2.7), 0.0 points (95% CI: -2.4, 2.4), and 0.4 points (95% CI: -2.0, 2.8), respectively. Finally, we did not observe any between-group differences for any of the other outcomes at any timepoint. ConclusionThe addition of specific hip strengthening does not appear to result in improved clinical outcomes for patients with nonspecific LBP.

Relationships between trunk morphology and strength with non-contact lower limb injuries in elite rugby league and Australian football players

Background: Non-contact lower limb injuries (NCLLI) are common within the National Rugby League (NRL) and Australian Football League (AFL). Smaller lumbar multifidus at L5 (LM L5) cross-sectional area (CSA) and lower levels of trunk and hip extension and knee flexion strength have been associated with increased NCLLI risk in AFL players. However, such associations have not been reported in the NRL. This study aims to explore relationships between NCLLI, trunk morphology and isometric trunk and hip extension strength in NRL and AFL players. Methods: NRL and AFL players had their LM L2-L5 and quadratus lumborum (QL) CSA (n=238), and isometric trunk and hip extension strength (n=153) measured using ultrasonography and a novel field-based test in preseason. Isometric trunk and hip extensor strength were measured using a 65s maximal voluntary isometric contraction (MVIC) protocol (5s MVIC, 5s off, 45s MVIC, 5s off, 5s MVIC). Team medical staff reported all NCLLIs sustained in the subsequent competitive season. The associations between LM and QL CSA, 5s and 45s MVIC, age, and previous injury, and prospectively occurring NCLLI were analysed using univariable and then multivariable logistic regression. Logistic regression analysis was also performed for the most sustained NCLLI (hamstring and knee). Results: Seventy-two players sustained a NCLLI in the 2020 competitive seasons (51 NRL, 21 AFL). From univariable logistic regression previous injury increased the risk of any NCLLI in NRL (OR=2.43, 95%CI=1.16-5.09, p=0.019). Reduced 5s MVIC (OR=1.00, 95%CI=1.00-1.01, p=0.012), increased QL CSA (OR=1.55, 95%CI=1.05-2.38, p=0.033) and lower ratio between LM and QL CSA (OR=0.03, 95%CI=0.01-0.60, p=0.02) increased NCLLI risk in AFL. Pooled hamstring injuries (n=28) were most common and were associated with lower 5s MVIC (OR=0.99, 95%CI=0.99-1.00, p=0.02) and 45s MVIC (OR=0.99, 95%CI=0.99-1.00, p=0.001). Pooled knee injuries (n=21) were associated with both reduced LM CSA (OR=1.35, 95%CI=1.08-1.70, p=0.018) and LM to QL ratio (OR=3.62, 95%CI=1.41- 9.66, p=0.043). Conclusions: Larger QL CSA and reduced levels of trunk and hip extension strength are observed in AFL players in preseason who sustain a NCLLI in the subsequent playing season. Only previous NCLLI was associated with future risk of NCLLI for NRL players. These results suggest that risk factors for NCLLI are football code specific, and prevention strategies should be tailored accordingly. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest relevant to the submission of this abstract.

Reliability of Isokinetic Hip Flexor and Extensor Strength Measurements in Healthy Subjects and Athletes: A Systematic Review and Meta-Analysis.

Background: The objective of this systematic review and meta-analysis was to examine the reliability of isokinetic measurements of hip strength in flexion and extension in healthy subjects and athletes. Methods: The databases used were Web of Science, SCOPUS, Medline and PubMed. R was used for all statistical analyses. Results: Hip flexion shows moderate reliability in the supine position (ICC = 0.72; 95% CI: 0.46–0.99) and good reliability in the standing position (ICC = 0.79; 95% CI: 0.54–1.04). Hip extension shows excellent reliability in the supine position (ICC = 0.90; 95% CI: 0.85–0.96) and moderate reliability in the standing position (ICC = 0.72; 95% CI: 0.48–0.96). Flexion of 120°/s and 180°/s showed excellent reliability (ICC = 0.93; 95% CI: 0.85–1.00), (ICC = 0.96; 95% CI: 0.92–1.01). The 60°/s and 120°/s extension showed good reliability (ICC = 0.90; 95% CI: 0.82–0.98), (ICC = 0.87; 95% CI: 0.75–0.99). The 180°/s extension presented excellent reliability (ICC = 0.93; 95% CI: 0.82–1.03). Conclusions: The standing position shows good reliability for hip flexion and the supine position shows excellent reliability for hip extension, both movements have excellent reliability at velocities between 120°/s to 180°/s.