Compensatory trunk movements in patients with hip osteoarthritis: accuracy and reproducibility of a body-fixed sensor-based assessment

This study examined the accuracy and reproducibility of a body-fixed sensor-based assessment for quantifying frontal plane angular movements of the (upper) thorax and pelvis of patients with hip osteoarthritis at different walking speeds. To evaluate accuracy, the angular movements of sensors attached to the thorax and pelvis of three patients were compared with results based on an optical motion analysis system. Accuracy was high, with small and consistent mean differences (<1.0 degree) and corresponding standard deviations (<1.3 degrees) between optical motion analysis system and body-fixed sensor data. To evaluate reproducibility, angular trunk movements were assessed twice in 15 patients. Reproducibility was high (intraclass correlation coefficients ranged from 0.86 to 0.97), and the values of the mean differences between the test and retest were small, with the 95% confidence interval containing zero. This body-fixed sensor-based assessment is an accurate and reproducible method for quantifying frontal plane compensatory trunk movements during gait of patients with hip osteoarthritis at different walking speeds.     

Dynamic hip kinematics in patients with hip osteoarthritis during weight-bearing activities

BackgroundThere is an interest in quantifying the hip kinematics of patients with end-stage hip disorders before total hip arthroplasty. The purpose of the present study was to obtain dynamic hip kinematics under four different conditions, including deep flexion and rotation, in patients with osteoarthritis of the hip.MethodsContinuous X-ray images were obtained in 14 patients during gait, chair-rising, squatting, and twisting, using a flat panel X-ray detector. These patients received computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial X-ray images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the pelvis and femur during the movement cycle of each activity.FindingsFor gait, chair-rising, and squatting, the maximum hip flexion angles averaged 22°, 64°, and 68°, respectively. The pelvis was tilted anteriorly by an average of around 7° during the full gait cycle. For chair-rising and squatting, the maximum absolute values of anterior/posterior pelvic tilt averaged 8°/17° and 6°/18°, respectively. Hip flexion showed maximum flexion angle on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute values of internal/external hip rotation averaged 3°/13°.InterpretationPatients with hip osteoarthritis prior to total hip arthroplasty demonstrated the limited ranges of coordinated motion of the pelvis, femur, and hip joint during each activity, especially in deeply flexed and rotated postures.     

A biomechanical analysis of trunk and pelvis motion during gait in subjects with knee osteoarthritis compared to control subjects

Background

Trunk lean over the stance limb during gait has been linked to a reduction in the knee adduction moment, which is associated with joint loading. We examined differences in knee adduction moments and frontal plane trunk lean during gait between subjects with knee osteoarthritis and a control group of healthy adults.

Methods

Gait analysis was performed on 80 subjects (40 osteoarthritis). To define lateral trunk lean two definitions were used. The line connecting the midpoint between two reference points on the pelvis and the midpoint between the acromion processes was projected onto the lab frontal plane and the pelvis frontal plane. Pelvic tilt was also measured in the frontal plane as the angle between the pelvic and lab coordinate systems. Angles were calculated across the stance phase of gait. We analyzed the data, (i) by extracting discrete parameters (mean and peak) waveform values, and (ii) using principal component analysis to extract shape and magnitude differences between the waveforms.

Findings

Osteoarthritis subjects had a higher knee adduction moment than the control group (α = 0.05). Although the discrete parameters for trunk lean did not show differences between groups, principal component analysis did detect characteristic waveform differences between the control and osteoarthritis groups.

Interpretation

A thorough biomechanical analysis revealed small differences in the pattern of motion of the pelvis and the trunk between subjects with knee osteoarthritis and control subjects; however these differences were only detectable using principal component analysis.     

Kinematic analysis of symmetric axial trunk rotation on dominant hip

Axial rotation of the trunk has been reported as a significant risk of low back dysfunction. However, a lack of biomechanical investigation exists that explains how twisting is accomplished with simultaneous asymmetric handling between the hip joints and lumbar spine. We used a three-dimensional motion analysis to measure movements of the bilateral hips and lumbar spine. Forty-four persons participated in the study, and the results indicated that spinal range of motion (ROM) was significantly different based on dominance (F = 198.83, p = 0.001), region x dominance (F = 14.21, p = 0.001), and dominance x dimension (F = 141.08, p = 0.001). We also found a three-way interaction between region x dominance x dimension (F = 26.30, p = 0.001). These results indicated that the motion of the transverse and sagittal planes significantly increased when the participants attempted to rotate their hips, especially on the nondominant side. Decreased axial trunk ROM on the side of dominance might stiffen passive structures of the hip joints. The functions of the hip joints and lumbar spine might be altered three dimensionally based on the side of dominance.     

Magnitudes of gluteus medius muscle activation during standing hip joint movements in spiral-diagonal patterns using elastic tubing resistance

Abstract

The aim of this study was to simultaneously quantify electromyographic (EMG) activation levels (% maximum voluntary isometric contraction [MVIC]) within the gluteus medius muscles on both moving and stance limbs across the performance of four proprioceptive neuromuscular facilitation (PNF) spiral-diagonal patterns in standing using resistance provided by elastic tubing. Differential EMG activity was recorded from the gluteus medius muscle of 26 healthy participants. EMG signals were collected with surface electrodes at a sampling frequency of 1000 Hz during three consecutive repetitions of each spiral-diagonal movement pattern. Significant differences existed among the four-spiral-diagonal movement patterns (F_3,75?=?19.8; p?<?0.001). The diagonal two flexion [D2F] pattern produced significantly more gluteus medius muscle recruitment (50 SD 29.3% MVIC) than any of the other three patterns and the diagonal one extension [D1E] (39 SD 37% MVIC) and diagonal two extension [D2E] (35 SD 29% MVIC) patterns generated more gluteus medius muscle recruitment than diagonal one flexion [D1F] (22 SD 21% MVIC). From a clinical efficiency standpoint, a fitness professional using the spiral-diagonal movement pattern of D2F and elastic tubing with an average peak tension of about 9% body mass may be able to concurrently strengthen the gluteus medius muscle on both stance and moving lower limbs.     

Muscle co-activation patterns during walking in those with severe knee osteoarthritis

BACKGROUND: Sensory and motor impairments have been found for those with knee osteoarthritis; however, how these impairments are manifested during functional movements such as walking is not well established. A few studies suggest an increase in co-activity among lower limb muscles. The objective of this study was to characterize the neuromuscular patterns of knee joint muscles during walking for those with severe knee osteoarthritis using pattern recognition techniques on the entire waveform. METHODS: Fifty-one subjects received a gait assessment within one-week prior to total knee replacement surgery. Subjects walked along a 6-m walkway at their preferred walking speed while surface electromyograms from seven muscles were recorded. The electromyographic data were entered into a pattern recognition procedure that captured both the amplitude and shape characteristics of electromyographic waveforms. ANOVA models tested whether differences existed both among and within muscle groups for these waveform characteristics. FINDINGS: Four principal patterns explained 97% of the variance in the waveform data, with principal pattern one explaining 86% of the total variance. There were statistically significant differences (P<0.05) among muscle sites for all principal pattern scores. The analyses supported the hypothesis that similarities existed in patterns among muscles from different groups indicating (i) a general co-activity pattern and (ii) differential recruitment between muscles within a muscle group. INTERPRETATION: In addition to the roles during impact loading and propulsion, the muscle responses were consistent with attempts to (i) decrease medial knee joint loading, (ii) decrease peak knee joint loading during push off and (iii) increase stiffness during stance phase to improve joint stability. The technique employed provides a novel approach to quantify synergistic co-activity.     

An investigation of neck muscle activity in asymptomatic participants who show different lumbar spine motion patterns during prone hip extension

Objective

The objective of the current study was to investigate whether any differences exist in the activity of the cervical erector spinae and upper trapezius (TRA) muscles between asymptomatic participants who show “normal” and “abnormal” lumbar spine motion patterns during the prone hip extension (PHE) test.

Methods

Twenty-six asymptomatic participants recruited from a chiropractic college participated in the study. Surface electromyography was used to record the activity of the cervical erector spinae and upper TRA muscles as each participant performed a set of 4 repetitions of PHE for each leg. An examiner observed the participant perform the movement and classified him/her as “positive” or “negative” based on the presence or absence (respectively) of 1 of 3 lumbar spine motion patterns. The mean activity levels of each muscle during the positive sets of PHE were compared with those during the negative sets.

Results

The mean activity of the upper TRA ipsilateral to the side of hip extension was significantly higher in the positive group compared with the negative group (difference, 13.3%; 95% confidence interval, 0.2%-24.4%; P = .0465). No other significant between-group differences were noted.

Conclusion

The results of this study indicate that the presence of abnormal lumbar spine motion patterns during the PHE test may be associated with altered cervicothoracic motor control strategies in asymptomatic individuals. Similar investigations using patients with neck pain are required to comment further on the generalizability and potential clinical importance of these findings.     

Effects of integrating hip movements into bridge exercises on electromyographic activities of selected trunk muscles in healthy individuals

This study aimed to identify the electromyographic (EMG) effects in selected trunk muscles after incorporating hip movement into bridging exercise. Twenty-six healthy adults (13 men and 13 women) volunteered for this experiment. EMG data (% maximum voluntary isometric contraction) were recorded from the rectus abdominis (RA), obliquus internus (OI), erector spinae (ES), and multifidus (MF) muscles of the dominant side while the subjects performed 3 types of bridging exercise, including bridging alone (Bridging 1), bridging with unilateral hip movements (Bridging 2), and bridging with bilateral hip movements (Bridging 3) in a sling suspension system. The RA and OI showed greater EMG activity during Bridging 2 and 3 compared to Bridging 1, with the greatest OI activity during Bridging 3 (p < 0.05), and the activity of the MF appeared to be greater during Bridging 3 than during Bridging 1 and 2 (p < 0.05). Furthermore, the OI/RA and MF/ES ratios were significantly higher for Bridging 2 (OI/RA = 1.89 ± 1.41; MF/ES = 1.03 ± 0.19) and Bridging 3 (OI/RA = 2.34 ± 1.86; MF/ES = 1.03 ± 0.15) than Bridging 1 (IO/RA = 1.35 ± 0.92; MF/ES = 0.98 ± 0.16). The OI/RA ratio was significantly higher for Bridging 3 than for Bridging 2. Based on these results, adding hip abduction and adduction, particularly bilateral movements, could be a useful method to enhance OI and MF EMG activity and their activities relative to global muscles during bridging exercise.     

Comparison of trunk and hip muscle activity during different degrees of lumbar and hip extension

[Purpose] This study compared the activity of trunk and hip muscles during different degrees of lumbar and hip extension. [Subjects] The study enrolled 18 participants. [Methods] Two exercises (hip and lumbar extension) and two ranges (180° and <180°) were studied. [Results] Differences in degree of extension affected the percentage maximal voluntary isometric contraction of the lumbar erector spinae and biceps femoris muscles, with significantly higher average values at >180° than at 180° lumbar extension. No significant differences were found in gluteus maximus activity according to exercise type or range. [Conclusion] Hip extension may be more effective and safer for lumbar rehabilitation than lumbar extension.Key words: EMG, Hip extension, Lumbar extension     

脑卒中患者步行时躯体运动的三维运动学研究

目的:通过对脑卒中患者躯体运动的三维运动学分析,比较分析偏瘫步态躯体运动变化与其步行能力(步速)之间的关系,探讨影响偏瘫患者步行能力恢复的量化指标。方法:选择首次脑卒中后可以独立步行10m以上的偏瘫患者39例,采用远红外线三维步态分析系统进行步态检测与分析,对偏瘫步态躯体的运动学参数与其步行能力(步速)进行相关分析。结果:脑卒中患者的步行能力与骨盆旋转运动之间的相关有显著性意义(r=-0.396.P<0.05);其步行能力与躯体侧方运动呈负相关,而与其躯体垂直运动呈正相关(r=-0.755,P<0.01;r=0.534,P<0.01),步行能力与Barthel指数正相关(r=0.475,P<0.01)。结论:脑卒中患者躯体和骨盆运动障碍是影响步态恢复的重要因素,提示躯体的协调性训练和骨盆的控制性训练对改善脑卒中偏瘫患者步行能力具有积极的作用。     

Walking patterns of hip arthroplasty patients: some observations on the medio-lateral excursions of the trunk

PURPOSE: This study examined the angular gait kinematics of the trunk and the pelvis in the frontal plane and their amount of side-to-side asymmetry in patients after total hip replacement arthroplasty. METHOD: The angular gait kinematics of 12 male hip arthroplasty patients (53-70 years) were compared to ten age-matched and ten young (24-35 years) male control subjects. Average step times and medio-lateral oscillation amplitudes of the pelvic and thoracic recordings were calculated for each step. Between successive steps the asymmetry ratio was computed and the mean angle around which the side-to-side oscillations occurred was compared to the angle in a symmetrical standing trial. RESULTS: ANOVA indicated no significant side differences in relative step cycle durations. Patients and senior controls had significantly (p<0.01) less pelvis side-to-side displacements than the younger controls. No significant between-group differences could be detected for the average asymmetry ratio. However, during walking the patients showed a significantly (p<0.01) increased lateral thorax and pelvis deviation. CONCLUSIONS: Hip replacement patients' thoracic and pelvic position is characterized by a lateral shift throughout the gait cycle, while left and right symmetry of angular movements amplitudes remain at about the same value of unimpaired subjects.     

Kinematic analysis of the hip and trunk during bilateral stance on firm,foam, and multiaxial support surfaces

OBJECTIVE: To differentiate hip and trunk motion during double-leg stance. DESIGN: Trunk and hip angular position variances were measured on different support surfaces with and without vision. BACKGROUND: Postural control results from motion about the hips and trunk during bilateral stance. While the hip joint has been studied extensively, information concerning relative amounts of hip and trunk motions during postural control is limited. METHODS: Trunk flexion/extension, trunk lateral flexion, right and left hip flexion/extension and abduction/adduction angular position variances were assessed in 14 normal subjects using an electromagnetic tracking system during bilateral stance on firm, foam, and multiaxial support surfaces with and without vision. RESULTS: Significantly greater amounts of motion occurred at all joints for the multiaxial-eyes closed condition compared to all other surface-vision conditions. No significant differences were found between any other surface-vision conditions. Within the multiaxial-eyes closed condition, right and left hip flexion/extension and abduction/adduction magnitudes were significantly greater than those of trunk flexion and lateral flexion, and left hip flexion/extension motion was significantly greater than that of the right hip. CONCLUSIONS: Postural control mechanisms involve similar amounts of motion at the hips and trunk, except for conditions under which a rigid base of support becomes unstable and vision is eliminated. RELEVANCE: These results suggest that the trunk and hips should be considered separately during kinematic analysis of postural control. This information may be useful in providing a more sensitive assessment of postural control to identify balance-related pathologies associated with stroke, concussion, and somatosensory deficits.     

全髋关节置换治疗髋关节发育不良并骨性关节炎的疗效评价

背景:利用全髋关节置换治疗成人髋关节发育不良合并骨性关节炎可以有效缓解髋关节疼痛,改善髋关节功能障碍,提高患者的生活质量.目的:综合评价全髋关节置换治疗成人髋关节发育不良并发骨性关节炎的疗效.方法:电子检索中国期刊全文(CNKI)数据库发表于2001-01/2010-06有关全髋关节置换术治疗髋关节发育不良合并骨性关节炎的临床研究文献,排除重复研究和综述,筛选出符合纳入标准的文献,对其进行疗效的评价和归纳.结果与结论:通过阅读标题和摘要,初步检索出50篇文献,进一步检索全文,根据纳入标准,共有16篇文献进入结果分析,通过对各文献报道的Harris髋关节评分,近期优化率和患者主观满意度的评价进行归纳和分析,作者认为,全髋关节置换术是治疗髋关节发育不良并骨性关节炎的有效方法,但手术难度较大,加深髋臼、内移,重建髋关节旋转中心是全髋关节置换成功的最重要部分,在真臼上安放假体,加深髋臼和保持骨性覆盖,可以有助于全髋关节置换取得良好效果.     

Criteria of gait asymmetry in patients with hip osteoarthritis

Gait symmetry is often a goal for physiotherapy in patients with hip osteoarthritis and after total hip replacement. However, there is no agreement on criteria for pathological gait asymmetry. In this study we investigated discriminative abilities of trunk and footfall gait symmetry measures, and thereafter assessed whether a 10% cutoff value is valid as a general criterion of pathological gait asymmetry across measures. Anteroposterior, vertical, and mediolateral trunk symmetry, single support, and step length symmetry were obtained simultaneously by trunk accelerometry and an electronic walkway in 37 patients with end-stage hip osteoarthritis and 56 controls. Subjects walked six times along a 7-meter walkway at slow, preferred, and fast speed, before data were normalized for gait velocity. Anteroposterior, vertical, and single support symmetry measures showed best discriminating abilities. The general 10% criterion of gait asymmetry and optimal cutoff criteria calculated for each symmetry measure showed approximately equal total classification ability. However, the optimal cutoff criteria classified a high number of controls as having pathological gait asymmetry. The general criterion of 10% is valid with high total classification ability, does not classify asymmetry in able-bodied subjects as pathological, and is feasible for use on individual patients in the clinic as well as in research.     

Effects of external pelvic compression on trunk and hip muscle EMG activity during prone hip extension in females with chronic low back pain

Many studies have reported higher trunk and hip muscle activity in patients with chronic low back pain (CLBP). Increased trunk and hip muscle activity could contribute to pain. Previous studies have shown that external pelvic compression (EPC) decreased back and hip muscle activity during physical tasks.In this study, we assessed the effects of EPC on the electromyography (EMG) activity of the latissimus dorsi (LD), elector spinae (ES), gluteus maximus (GM), and biceps femoris (BF) in a CLBP group and a healthy group during prone hip extension (PHE).Forty female volunteers (20 non-specific CLBP, 20 healthy) were recruited. Surface EMG data were collected from the LD, ES, GM, and BF muscles during a PHE task. Normalized EMG values were analyzed by separate repeated-measures analysis of variance (ANOVA) for each muscle.The normalized EMG activity in the left LD, bilateral ES, and right GM was significantly higher in the CLBP group than in the healthy group during PHE. In the CLBP group, the normalized EMG activity in the left LD, bilateral ES, and right GM was significantly lower with EPC than without (p < 0.05). This suggests that the application of EPC decreased trunk and hip extensor EMG activity in the CLBP group during PHE.     

Physical function in men with and without hip osteoarthritis

OBJECTIVES: To assess the subjective joint pain and function and the objective physical function of lower extremities in men with hip osteoarthritis (OA), to compare the results with those from age- and sex-matched controls, and to evaluate the reproducibility of the functional tests. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Twenty-seven volunteer men (age range, 47-64 y) with hip OA and 30 randomly selected, healthy age-matched men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, passive range of motion (ROM) of the hip joint measured with a standard goniometer, and physical functioning evaluated with a test battery. RESULTS: The function and the composite scores of the WOMAC correlated (P<.05) with the degree of radiographically estimated severity of OA. The hips of the control subjects were 13% to 52% more flexible (P range, <.0001-.001) than those of the OA patients. The more the hip was deteriorated, the lower the ROM of the hip was in abduction and in both internal and external rotations. The reproducibility of marching on-the-spot and walking up and down stairs was good in both groups, but in other functional tests the reproducibility was poorer. The controls were significantly (P range, <.05-.01) better at marching, ascending and descending stairs, performing a 25-m walk, and in flexion-extension and abduction-adduction movements compared with the hip OA patients. Most of the WOMAC items were significantly (P<.05) related to the performance tests. CONCLUSIONS: The WOMAC and the ROM can be considered useful hip OA indicators. Marching on-the-spot and walking up and down stairs are the most reproducible physical functioning tests and can thus be recommended for use for patients with hip OA.     

Capability and recruitment patterns of trunk during isometric uniaxial and biaxial upright exertion

BACKGROUND: Work-related risk factors of low back disorders have been identified to be external moments, awkward postures, and asymmetrical dynamic lifting amongst others. The distinct role of asymmetry of load versus posture is hard to discern from the literature. Hence, the aim of this study is to measure isometric trunk exertions at upright standing posture at different exertion level and degree of asymmetry to further delineate the effects of exertion level and asymmetry on neuromuscular capability response. METHODS: Fifteen healthy volunteers randomly performed trunk exertions at three levels (30%, 60%, and 100% of maximum voluntary exertion and five different angles (0 degrees , 45 degrees , 90 degrees , 135 degrees , and 180 degrees ) of normalized resultant moments. During each trial, the normalized EMG activity of 10 selected trunk muscles was quantified. FINDINGS: The EMG activity of the 10 trunk muscles was significantly (P<0.001) affected by the level of exertion and angle of normalized resultant moment, and their interactions. The controllability of the torque generation was reduced in biaxial exertions. The capability to generate and control the required trunk moments is significantly lowered during biaxial trunk exertions, while all muscles present higher EMG activity. These results suggest that the trunk muscles will be taxed higher while performing biaxial exertion tasks, increasing muscle fatigue possibly leading to a higher probability of low back injury. INTERPRETATION: The prediction of biaxial trunk performance based on uniaxial data will result in an overestimation of capability and controllability of the trunk during physically demanding tasks. This study provides a better understanding of the potential mechanisms of injury during asymmetrical and biaxial trunk exertion during work-related tasks.     

Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis

Pua YH, Wrigley TW, Cowan SM, Bennell KL. Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis.

Objective

To examine the relative and absolute intrarater test-retest reliability of muscle strength and range of motion (ROM) measurements of the hip performed in people with hip osteoarthritis.

Design

Repeated measures.

Setting

Human movement laboratory of a university.

Participants

Participants (N=22; 10 men, 12 women; age range, 50-84y) with hip osteoarthritis.

Interventions

On 2 separate occasions, at least 1 week apart, isometric torque measurements were obtained from the hip rotators, flexors, abductors, and extensors. Passive ROMs in hip rotation, flexion, abduction, and extension were also determined.

Main Outcome Measures

Relative reliability was estimated using the intraclass correlation coefficient, model 2,2 (ICC_2,2). Absolute reliability was estimated using the coefficient of variation (CV) and the standard error (SE) of measurement.

Results

For measurements of muscle strength, ICC_2,2 ranged from .84 to .97, and the CV ranged from 8% to 15.7%. Hip extensors and internal and external rotators showed high ICC_2,2 (>.96) and low CV (<9.8%); hip abductors showed the lowest ICC_2,2 (.84) and the highest CV (15.7%). For ROM measurements, ICC_2,2 ranged from .86 to .97 and SE ranged from 3.1° to 4.7°. Hip flexion ROM showed the highest ICC_2,2 (.97) and an SE of 3.5°; hip extension ROM showed the lowest ICC_2,2 (.86) and the highest SE (4.7°).

Conclusions

Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability.