Sonoanatomy and Pathology of the Posterior Band of the Gluteus Medius Tendon

Greater trochanteric pain syndrome is a common clinical entity that most often results from disorders of the gluteus medius tendon. There are two distinct bands of the gluteus medius tendon, and abnormalities may affect the anterior or posterior band in isolation or simultaneously. Although abnormalities of the anterior band are more common, awareness and sonographic detection of posterior band abnormalities is essential to guide treatment in the setting of greater trochanteric pain syndrome.     

Sonoanatomy and Pathology of the Gluteus Minimus Tendon

Gluteus minimus disorders are a potential source of greater trochanteric or anterior hip pain. Disorders of the gluteus minimus tendon most commonly occur in conjunction with gluteus medius tendon abnormalities but can also occur in isolation. Understanding the sonoanatomy of the gluteus minimus muscle-tendon unit is a prerequisite for recognizing and characterizing gluteus minimus tendon disorders, which, in turn, guides treatment for patients with greater trochanteric or anterior hip pain syndromes.     

Effects of Trigger Point Dry Needling on Strength Measurements and Activation Levels of the Gluteus Medius: A Quasi-Experimental Randomized Control Study

BackgroundLatent trigger points have been identified as a source of impaired muscle function giving rise to a reduction in force production and alterations in muscle activation patterns and movement efficiency. There is limited investigation into the effectiveness of a treatment in reducing these clinical manifestations.PurposeTo investigate whether the application of trigger point dry needling (TDN) to latent trigger points within the gluteus medius musculature affected strength measurements and muscle activation levels immediately following intervention.DesignQuasi experimental, single group, pretest-posttest, randomized control studyMethodsA control and an intervention side were randomly assigned for each participant (N = 39). Hand held dynamometer (HHD) force measurements and raw surface electromyography (sEMG) amplitude readings were recorded during maximal volitional isometric contractions of the gluteus medius in two separate positions before and after application of TDN. Comparison of within and between group data were conducted.ResultsA statistically significant interaction between time (pre-TDN to post-TDN) and groups (intervention side and control side), p < 0.001 was found for HHD measurements in both positions. Post hoc analysis revealed a statistically significant difference (p < 0.001) for all comparisons in the side lying neutral (SL0) position, while statistically significant differences (p < 0.001) were found for pre and post-TDN measurements within intervention side as well as between the intervention and control side for post-TDN measurements in the side lying internal rotation (SLIR) position. For sEMG amplitude measurements, statistically significant differences were found only in the SL0 position for within group comparisons on the intervention side (p = 0.009) and for between group comparisons for post-TDN measurements (p = 0.002).ConclusionApplication of TDN to latent trigger points within the gluteus medius can significantly increase gluteus muscle force production immediately following intervention while reducing the level of muscle activation required during contraction.Level of EvidenceLevel 2     

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial

BackgroundOne of the most common knee problems is patellofemoral pain syndrome (PFPS).It is of great importance to pay attention to the muscles of the hip area in people with PFPS, especially to the presence of trigger points within the gluteus medius (GM). Accordingly, using therapeutic interventions to eliminate trigger points is required. Therefore, the aim of the present study was to evaluate the effect of GM active trigger point dry needling (TrP-DN) on pain and physical function of non-athlete women with unilateral PFPS.Methods29 young non-athlete women aged between 17 and 40 years old with unilateral PFPS were randomly divided into two groups of experimental (n = 15) and control (n = 14) through the simple and convenience sampling method. Both groups received conventional physiotherapy twice a week up to 6 sessions. The experimental group also received GM active TrP-DN once a week for 3 sessions in addition to the conventional physiotherapy. Pain intensity and physical function of women with PFPS were measured in both groups in three stages of before, immediately after and one week after performing the treatment sessions.FindingsThe six-session physiotherapy treatment led to a significant reduction in pain intensity as well as an improvement in physical function in both groups (p < 0.001). In addition, the intergroup comparison showed a significant improvement in physical function of the experimental group after one week from the GM active TrP-DN, compared to the control group (p = 0.048).ConclusionThe present study indicated that conventional physiotherapy with or without GM active TrP-DN can reduce pain and improve physical function in non-athlete women with unilateral PFPS. This study also revealed that conventional physiotherapy combined with dry needling can lead to further reduction in pain and a greater improvement in physical function of this group of patients.     

膝关节内侧移位者髋部肌肉力量及表面肌电特征研究

目的:通过研究单腿下蹲时膝关节内侧移位者髋部肌肉力量及表面肌电特征,探讨膝关节内侧移位的发生机制及膝关节损伤的防治方法。方法:从男性青年志愿者中选取膝关节内侧移位(medial knee displacement,MKD)组30例和正常对照组30例。应用手持数字测力计测试臀大肌、臀中肌和内收肌的最大等长收缩(maximal voluntary isometric contraction,MVIC)肌力,并以自身体重为基准进行标准化;应用无线表面肌电测试系统检测单腿下蹲过程中臀大肌、臀中肌和髋关节内收肌的表面肌电图,计算均方根振幅(RMS),并以MVIC表面肌电值为基准进行标准化,比较两组间标准化肌力和标准化肌电图RMS的差异。结果:MKD组和正常组比较,臀大肌、臀中肌和内收肌的标准化MVIC肌力均无明显差异。单腿下蹲时MKD组臀大肌和臀中肌标准化肌电RMS(14.9±5.6和30.8±13.4)均明显低于正常对照组(19.2±6.8和39.4±17.1),内收肌标准化肌电RMS(21.2±14.1)明显高于正常对照组(14.3±8.6),MKD者臀大肌/内收肌和臀中肌/内收肌比值(1.4±0.53和2.7±1.2)明显低于正常对照组(2.3±1.6和4.6±3.7),差异均有显著性意义。结论:膝关节内侧移位的发生机制可能与臀大肌、臀中肌的激活不足和内收肌的过度激活有关,对膝关节损伤的防治应更加注重髋部肌肉运动控制和协调性的改善。     

Determining the Activation of Gluteus Medius and the Validity of the Single Leg Stance Test in Chronic,Nonspecific Low Back Pain

Objectives

To determine the activation of the gluteus medius in persons with chronic, nonspecific low back pain compared with that in control subjects, and to determine the association of the clinical rating of the single leg stance (SLS) with chronic low back pain (CLBP) and gluteus medius weakness.

Design

Cohort-control comparison.

Setting

Academic research laboratory.

Participants

Convenience sample of people (n=21) with CLBP (>12wk) recruited by local physiotherapists, and age- and sex-matched controls (n=22). Subjects who received specific pain diagnoses were excluded.

Interventions

Not applicable.

Main Outcome Measures

Back pain using the visual analog scale (mm); back-related disability using the Oswestry Back Disability Index (%); strength of gluteus medius measured using a hand dynamometer (N/kg); SLS test; gluteus medius onset and activation using electromyography during unipedal stance on a forceplate.

Results

Individuals in the CLBP group exhibited significant weakness in the gluteus medius compared with controls (right, P=.04; left, P=.002). They also had more pain (CLBP: mean, 20.50mm; 95% confidence interval [CI], 13.11–27.9mm; control subjects: mean, 1.77mm; 95% CI, −.21 to 3.75mm) and back-related disability (CLBP: mean, 18.52%; 95% CI, 14.46%–22.59%; control subjects: mean, .68%; 95% CI, −.41% to 1.77%), and reported being less physically active. Weakness was accompanied by increased gluteus medius activation during unipedal stance (R=.50, P=.001) but by no difference in muscle onset times. Although greater gluteus medius weakness was associated with greater pain and disability, there was no difference in muscle strength between those scoring positive and negative on the SLS test (right: F=.002, P=.96; left: F=.1.75, P=.19).

Conclusions

Individuals with CLBP had weaker gluteus medius muscles than control subjects without back pain. Even though there was no significant difference in onset time of the gluteus medius when moving to unipedal stance between the groups, the CLBP group had greater gluteus medius activation. A key finding was that a positive SLS test did not distinguish the CLBP group from the control group, nor was it a sign of gluteus medius weakness.     

Reference Values and Psychometric Properties of the Lower Extremity Motor Coordination Test

Objectives

(1) To create predictive nomograms for the dominant and nondominant limbs on the Lower Extremity Motor Coordination Test (LEMOCOT) using reference values, and (2) to determine the inter- and intrarater reliability for the LEMOCOT; the best scoring method (first vs mean of the first 2 vs mean of the last 2 vs mean of 3 vs the highest of 3 trials); the best testing method (direct vs video observation); and the ability to detect real change (smallest real difference [SRD] and standard error of the measurement [SEM]).

Design

Normative and methodological study.

Setting

Metropolitan area.

Participants

Healthy individuals (N=320, 50% women) in 7 age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and ≥80 years. Each group had 50 participants, except for ≥80 years (n=20).

Interventions

Not applicable.

Main Outcome Measure

LEMOCOT.

Results

Age and sex explained 48% of the variance in the LEMOCOT scores for the dominant limb and 44% for the nondominant limb (125<F<148; P<.001). No significant differences were found regarding the different scoring methods (.12<F<1.02; .10<P<.92), and all of them demonstrated good reliability (intraclass correlation coefficients between .90 and .99; P<.001). There was agreement between scores from direct and video observation (limits of agreement −1.99 to 1.85; −1.55 to 1.62). Appropriate SEM (2.27–1.85) and SRD (6.27–5.11) values were found.

Conclusions

Reference values were determined for the LEMOCOT, and predictive nomograms were created based on age and sex. The LEMOCOT is reliable, needing only 1 trial (after familiarization) to generate reliable scores; can be scored from either direct or video observation; and has the ability to detect real change over time.     

A Comparison of Factors Associated with Running-Related Injuries between Adult and Adolescent Runners

BackgroundThere are multiple personal and environmental factors that influence the risk of developing running-related injuries (RRIs). However, it is unclear how these key clinical factors differ between adult and adolescent runners.PurposeThe purpose of this study was to compare anthropometric, training, and self-reported outcomes among adult and adolescent runners with and without lower extremity musculoskeletal RRIs.Study DesignCross-sectional study.MethodsQuestionnaire responses and clinical assessment data were extracted from 38 adult runners (F: 25, M: 13; median age: 23 [range 18-36]) and 91 adolescent runners (F: 56, M: 35; median age: 15 [range 14-16]) who underwent a physical injury prevention evaluation at a hospital-affiliated sports injury prevention center between 2013 and 2021. Participants were sub-grouped into those with (adults: 25; adolescents: 38) and those without (adults: 13; adolescents: 53) a history of self-reported RRIs based on questionnaire responses. Multivariate analyses of covariance (MANCOVA) covarying for gender were conducted to compare outcomes across groups.ResultsAdult runners had lower Functional Movement Screen™ (FMS™) scores (mean differences [MD]: -1.4, p=0.01), were more likely to report intentional weight-loss to improve athletic performance (% difference: 33.0%; p:<.001), and more frequently included resistance training into their training routines (% difference: 21.0%, p=0.01) compared to adolescents. Those with a history of RRIs were more likely to report intentional weight-loss compared to uninjured runners (% difference: 21.3; p=0.02) and had shorter single leg bridge durations than those without RRIs (RRI: 57.9±30, uninjured: 72.0±44, p=0.01).ConclusionThe findings indicate that addressing aspects of biomechanics identified by the FMS™ and behaviors of weight loss as an effort to improve performance may represent targets for the prevention of RRIs for adult and adolescent runners, given the association with history of RRIs.Level of Evidence3     

Clinical Measures of Pelvic Tilt in Physical Therapy

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.Level of Evidence5     

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

Objective

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

Design

Cross-sectional design.

Setting

General community.

Participants

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

Interventions

Not applicable.

Main Outcome Measures

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

Results

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

Conclusions

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.     

The Dorsiflexion Range of Motion Screen: A Validation Study

BackgroundLimited ankle dorsiflexion (DF) is associated with ankle sprains and other lower extremity injuries. Current ankle measurements can be laborious to perform in an athletic environment.PurposeThe purpose of this study was to determine the reliability and discriminant validity of a novel closed-chain ankle DF ROM test, the standing ankle dorsiflexion screen (SADS).Study DesignReliability and validity studyMethodsThirty-seven healthy subjects participated in the study. Two raters measured closed-chain ankle DF range of motion (ROM) using a modified lunge position with an electronic inclinometer. Four raters measured ankle DF using the SADS. Reliability was calculated using intraclass correlation coefficients (ICC) and kappa coefficients for the raters using an electronic inclinometer and the SADS scale, respectively. An independent t-test compared the SADS categories of “behind” and “beyond” to the modified lunge test ROM (p<0.05).ResultsExcellent ICC values (0.95 [95% CI (0.92,0.97)]) and high kappa values were observed (0.61-0.81), with high percent agreement (86-94%). There was a significant difference in ankle DF ROM between the nominally scored “behind” and “beyond” categories, regardless of rater or trial analyzed (behind: 41.3° ± 4.7°; beyond: 51.8°± SD 6.1°, p <0.001).ConclusionsThe SADS was observed to have excellent interrater reliability and high discriminant validity. Furthermore, there was a distinct closed chain ankle DF ROM difference between the “behind” and “beyond” SADS nominal scores.Clinical RelevanceThe SADS can be used as a quick and efficient closed chain ankle DF ROM screen.Level of Evidence2b     

The Test Re-Test Reliability of A Novel Single Leg Hop Test (T-Drill Hop Test)

BackgroundFunctional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person’s athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner.Purpose/HypothesisThe purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments.Study DesignCross-sectional reliability study.MethodsFifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. “T” shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability.ResultsThe inter-rater reliability (ICC’s) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05).ConclusionThis study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test.Levels of EvidenceLevel 2     

Normative Reference Values and Validity for the 30-Second Chair-Stand Test in Healthy Young Adults

BackgroundClinicians often use physical performance tests (PPT) to measure performance measures in sports since they are easy to administer, portable, and cost-efficient. However, PPT often lack good or known psychometric properties. Perhaps, the 30-second chair-stand test (30CST) would be a good functional test in athletic populations as it has been shown to demonstrate good psychometric properties in older adults.Hypothesis/PurposeThe purpose of this study was to determine normative values for and concurrent, convergent and discriminative validity of 30CST for healthy young adults aged 19-35 years.Study DesignCross-sectionalMethodsEighty-one participants completed this study. All participants performed two trials of 30CST, 5-times sit-to-stand (5xSTS), and lateral step-up test (LSUT). Investigators used the International Physical Activity Questionnaire Leisure Domain (LD-IPAQ) to divide participants into insufficiently or sufficiently active groups based on the weekly metabolic equivalent of task per the Physical Activity Guidelines for Americans.ResultsParticipants (Mean + SD age, 25.1 ± 3.4 years; body height, 1.71 ± 0.09 m; body mass, 72.6 ± 16.1 kg; females 47) performed an average of 33.0±5.4 30CST repetitions. The 30CST performance was negatively associated with 5xSTS (r=-0.79 p=0.01) and positively associated with LSUT performances (r=0.51, p=0.01) when using Pearson correlations. In addition, the sufficiently active group performed significantly greater 30CST repetitions than the insufficiently active group (mean difference = 2.5; p=0.04).ConclusionsIn addition to finding a reference value for 30CST performance in young adults, investigators found that the 30CST displayed concurrent and convergent validity in assessing functional lower extremity (LE) muscle strength and discriminated between those with sufficient and insufficient physical activity levels. Training and rehabilitation professionals could use the 30CST for testing functional LE muscle strength for athletes in pre-season or during rehabilitation. Future investigators should perform studies to determine if 30CST predicts sport performance.Level of EvidenceLevel 2     

Reliability,Validity, and Reference Values for Functional Balance Test for Geriatric Patients (FBG)

ABSTRACT

The aim of this study was to establish the inter-rater reliability of the Functional Balance test for Geriatric patients (FBG) and concurrent validity between the FBG and the Berg balance scale, and to present reference values for the FBG. Patients (n = 22) aged between 66 and 87 years with varying diagnoses and elderly subjects without balance problems (n = 145) were assessed. The inter-rater reliability, calculated with intraclass correlation (ICC_2.1) for FBG total was 0.99. Cohen's kappa coefficient (κ) varied between 0.83 and 0.94 for the four items in the FBG. The correlation between the total scores for FBG and the Berg balance scale, calculated with Spearman's rank correlation coefficient (r_s) had a correlation of 0.96. The reference value for FBG total was 24 for men and woman aged 65–69 years, 23 for men and woman aged 70–79 years, 22 for men 80 years and older, and 21 for woman 80 years or older.     

BTE系统对颈脊髓损伤后上肢肌力强化训练的效果

目的研究BTE系统对不同病程颈脊髓损伤患者进行上肢肌力强化训练的有效性。方法2019年6月至2020年1月,创伤性完全性C6-7脊髓损伤住院患者60例按病程分为亚急性期组(术后1~2个月,n=15)和恢复期组(术后3~6个月,n=15),术后6个月以上者分为稳定期组和对照组,各15例。对照组行常规综合康复,其余三组每天采用BTE系统行上肢肌力强化训练,共4周。治疗前后,采用上肢运动评分(UEMS)和功能独立性测量(FIM)进行评定,并测量双侧伸肘肌群等长峰值力矩(IPT)和等张极限肌耐力(IEE)。结果治疗后,每组各项评分均明显提高(t>3.500,P<0.01);各组间均有非常高度显著性差异(F>9.257,P<0.001),其中亚急性期组UEMS、IPT最高,恢复期组IEE、FIM最高,稳定期组较差。结论采用BTE系统对颈脊髓损伤患者进行上肢肌力强化训练疗效明显,亚急性期患者上肢运动功能、爆发力恢复更快,恢复期患者耐力和日常生活活动能力进步更快;稳定期患者各项功能也有不同程度提高。