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James W. Youdas, Kady E. Adams, John E. Bertucci, Koel J. Brooks, Meghan M. Nelson and John H. Hollman

Context:

No published studies have compared muscle activation levels simultaneously for the gluteus maximus and medius muscles of stance and moving limbs during standing hip-joint strengthening while using elastic-tubing resistance.

Objective:

To quantify activation levels bilaterally of the gluteus maximus and medius during resisted lower-extremity standing exercises using elastic tubing for the cross-over, reverse cross-over, front-pull, and back-pull exercise conditions.

Design:

Repeated measures.

Setting:

Laboratory.

Participants:

26 active and healthy people, 13 men (25 ± 3 y) and 13 women (24 ± 1 y).

Intervention:

Subjects completed 3 consecutive repetitions of lower-extremity exercises in random order.

Main Outcome Measures:

Surface electromyographic (EMG) signals were normalized to peak activity in the maximum voluntary isometric contraction (MVIC) trial and expressed as a percentage. Magnitudes of EMG recruitment were analyzed with a 2 × 4 repeated-measures ANOVA for each muscle (α = .05).

Results:

For the gluteus maximus an interaction between exercise and limb factor was significant (F 3,75 = 21.5; P < .001). The moving-limb gluteus maximus was activated more than the stance limb's during the back-pull exercise (P < .001), and moving-limb gluteus maximus muscle recruitment was greater for the back-pull exercise than for the cross-over, reverse cross-over, and front-pull exercises (P < .001). For the gluteus medius an interaction between exercise and limb factor was significant (F 3,75 = 3.7; P < .03). Gluteus medius muscle recruitment (% MVIC) was greater in the stance limb than moving limb when performing the front-pull exercise (P < .001). Moving-limb gluteus medius muscle recruitment was greater for the reverse cross-over exercise than for the cross-over, front-pull, and back-pull exercises (P < .001).

Conclusions:

From a clinical standpoint there is no therapeutic benefit to selectively activate the gluteus maximus and gluteus medius muscles on the stance limb by resisting sagittal- and frontal-plane hip movements on the moving limb using resistance supplied by elastic tubing.

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Zheng Wang, Kimberlee Jordan and Karl M. Newell

In this study, two force platforms were synchronized to investigate the coordination of the right and left foot center of pressure (COPR and COPL) and its relation to the COPNET in the control of 5 upright postures with and without visual information. The results revealed that the standard deviation (SD) of COPL, COPR, and COPNET progressively increased in the more challenging staggered and tandem stances, respectively, and to a lesser degree with the absence of visual information. Circular analysis of the relative phase of COPL and COPR revealed that the coupling pattern and variability were dependent on postural stances and the availability of vision. A negative correlation between the variability of the relative phase of the two feet COPs and the SD of the COPNET in the anterior-posterior (AP) direction was evident most strongly in the no vision conditions. Thus, the asymmetry of the mechanical constraints on the feet as a function of stance organize the coordination patterns of the feet COPs while the degree of adaptive variation between the feet COPs is dependent on both the mechanical constraints and the availability of vision.

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Jonathan K. Holm, Jonas Contakos, Sang-Wook Lee and John Jang

This study investigated the energetics of the human ankle during the stance phase of downhill walking with the goal of modeling ankle behavior with a passive spring and damper mechanism. Kinematic and kinetic data were collected on eight male participants while walking down a ramp with inclination varying from 0° to 8°. The ankle joint moment in the sagittal plane was calculated using inverse dynamics. Mechanical energy injected or dissipated at the ankle joint was computed by integrating the power across the duration of the stance phase. The net mechanical energy of the ankle was approximately zero for level walking and monotonically decreased (i.e., became increasingly negative) during downhill walking as the slope decreased. The indication is that the behavior of the ankle is energetically passive during downhill walking, playing a key role in dissipating energy from one step to the next. A passive mechanical model consisting of a pin joint coupled with a revolute spring and damper was fit to the ankle torque and its parameters were estimated for each downhill slope using linear regression. The passive model demonstrated good agreement with actual ankle dynamics as indicated by low root-mean-square error values. These results indicate the stance phase behavior of the human ankle during downhill walking may be effectively duplicated by a passive mechanism with appropriately selected spring and damping characteristics.

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Michal N. Glinka, Kim P. Cheema, Stephen N. Robinovitch and Andrew C. Laing

Safety floors (also known as compliant floors) may reduce the risk of fall-related injuries by attenuating impact force during falls, but are only practical if they do not negatively affect balance and mobility. In this study, we evaluated seven safety surfaces based on their ability to attenuate peak femoral neck force during simulated hip impacts, and their influence on center of pressure (COP) sway during quiet and tandem stance. Overall, we found that some safety floors can attenuate up to 33.7% of the peak femoral impact force without influencing balance. More specifically, during simulated hip impacts, force attenuation for the safety floors ranged from 18.4 (SD 4.3)% to 47.2 (3.1)%, with each floor significantly reducing peak force compared with a rigid surface. For quiet stance, only COP root mean square was affected by flooring (and increased for only two safety floors). During tandem stance, COP root mean square and mean velocity increased in the medial-lateral direction for three of the seven floors. Based on the substantial force attenuation with no concomitant effects on balance for some floors, these results support the development of clinical trials to assess the effectiveness of safety floors at reducing fall-related injuries in high-risk settings.

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Dennis E. Anderson and Michael L. Madigan

Maintenance of healthy bone mineral density (BMD) is important for preventing fractures in older adults. Strains experienced by bone in vivo stimulate remodeling processes, which can increase or decrease BMD. However, there has been little study of age differences in bone strains. This study examined the relative contributions of age-related differences in femoral loading and BMD to age-related differences in femoral strains during walking using gait analysis, static optimization, and finite element modeling. Strains in older adult models were similar or larger than in young adult models. Reduced BMD increased strains in a fairly uniform manner, whereas older adult loading increased strains in early stance but decreased strains in late stance. Peak ground reaction forces, hip joint contact forces, and hip flexor forces were lower in older adults in late stance phase, and this helped older adults maintain strains similar to those of young adults despite lower BMD. Because walking likely represents a “baseline” level of stimulus for bone remodeling processes, increased strains during walking in older adults might indicate the extent of age-related impairment in bone remodeling processes. Such a measure might be clinically useful if it could be accurately determined with age-appropriate patient-specific loading, geometry, and BMD.

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Michael D. Lewek, Claire E. Bradley, Clinton J. Wutzke and Steven M. Zinder

Falls are common after stroke and often attributed to poor balance. Falls often occur during walking, suggesting that walking patterns may induce a loss of balance. Gait after stroke is frequently spatiotemporally asymmetric, which may decrease balance. The purpose of this study is to determine the relationship between spatiotemporal gait asymmetry and balance control. Thirty-nine individuals with chronic stroke walked at comfortable and fast speeds to calculate asymmetry ratios for step length, stance time, and swing time. Balance measures included the Berg Balance Scale, step width during gait, and the weight distribution between legs during standing. Correlational analyses determined the relationships between balance and gait asymmetry. At comfortable and fast gait speeds, step width was correlated with stance time and swing time asymmetries (r = 0.39−0.54). Berg scores were correlated with step length and swing time asymmetries (r = –0.36 to –0.63). During fast walking, the weight distribution between limbs was correlated with stance time asymmetry (r = –0.41). Spatiotemporal gait asymmetry was more closely related to balance measures involving dynamic tasks than static tasks, suggesting that gait asymmetry may be related to the high number of falls poststroke. Further study to determine if rehabilitation that improves gait asymmetry has a similar influence on balance is warranted.

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Rebecca L. Lambach, Jay W. Young, David C. Flanigan, Robert A. Siston and Ajit M.W. Chaudhari

Linemen are at high risk for knee cartilage injuries and osteoarthritis. High-intensity movements from squatting positions (eg, 3-point stance) may produce high joint loads, increasing the risk for cartilage damage. We hypothesized that knee moments and joint reaction forces during lineman-specific activities would be greater than during walking or jogging. Data were collected using standard motion analysis techniques. Fifteen NCAA linemen (mean ± SD: height = 1.86 ± 0.07 m, mass = 121.45 ± 12.78 kg) walked, jogged, and performed 3 unloaded lineman-specific blocking movements from a 3-point stance. External 3-dimensional knee moments and joint reaction forces were calculated using inverse dynamics equations. MANOVA with subsequent univariate ANOVA and post hoc Tukey comparisons were used to determine differences in peak kinetic variables and the flexion angles at which they occurred. All peak moments and joint reaction forces were significantly higher during jogging than during all blocking drills (all P < .001). Peak moments occurred at average knee flexion angles > 70° during blocking versus < 44° in walking or jogging. The magnitude of moments and joint reaction forces when initiating movement from a 3-point stance do not appear to increase risk for cartilage damage, but the high flexion angles at which they occur may increase risk on the posterior femoral condyles.

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Stephen C. Cobb, Mukta N. Joshi and Robin L. Pomeroy

In-vitro and invasive in-vivo studies have reported relatively independent motion in the medial and lateral forefoot segments during gait. However, most current surface-based models have not defined medial and lateral forefoot or midfoot segments. The purpose of the current study was to determine the reliability of a 7-segment foot model that includes medial and lateral midfoot and forefoot segments during walking gait. Three-dimensional positions of marker clusters located on the leg and 6 foot segments were tracked as 10 participants completed 5 walking trials. To examine the reliability of the foot model, coefficients of multiple correlation (CMC) were calculated across the trials for each participant. Three-dimensional stance time series and range of motion (ROM) during stance were also calculated for each functional articulation. CMCs for all of the functional articulations were ≥ 0.80. Overall, the rearfoot complex (leg–calcaneus segments) was the most reliable articulation and the medial midfoot complex (calcaneus–navicular segments) was the least reliable. With respect to ROM, reliability was greatest for plantarflexion/dorsiflexion and least for abduction/adduction. Further, the stance ROM and time-series patterns results between the current study and previous invasive in-vivo studies that have assessed actual bone motion were generally consistent.

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Kyung-Min Kim, Christopher D. Ingersoll and Jay Hertel

Context:

Focal ankle-joint cooling (FAJC) has been shown to increase Hoffmann (H) reflex amplitudes of select leg muscles while subjects lie prone, but it is unknown whether the neurophysiological cooling effects persist in standing.

Objective:

To assess the effects of FAJC on H-reflexes of the soleus and fibularis longus during 3 body positions (prone, bipedal, and unipedal stances) in individuals with and without chronic ankle instability (CAI).

Design:

Crossover.

Setting:

Laboratory.

Participants:

15 young adults with CAI (9 male, 6 female) and 15 healthy controls.

Intervention:

All subjects received both FAJC and sham treatments on separate days in a randomized order. FAJC was accomplished by applying a 1.5-L plastic bag filled with crushed ice to the ankle for 20 min. Sham treatment involved room-temperature candy corn.

Main Outcome Measures:

Maximum amplitudes of H-reflexes and motor (M) waves were recorded while subjects lay prone and then stood in quiet bipedal and unipedal stances before and immediately after each treatment. Primary outcome measures were Hmax:Mmax ratios for the soleus and fibularis longus. Three-factor (group × treatment condition × time) repeated-measures ANOVAs and Fisher LSD tests were performed for statistical analyses.

Results:

Significant interactions of treatment condition by time for prone Hmax:Mmax ratios were found in the soleus (P = .001) and fibularis longus (P = .003). In both muscles, prone Hmax:Mmax ratios moderately increased after FAJC but not after sham treatment. The CAI and healthy groups responded similarly to FAJC. In contrast, there were no significant interactions or main effects in the bipedal and unipedal stances in either muscle (P > .05).

Conclusions:

FAJC moderately increased H-reflex amplitudes of the soleus and fibularis longus while subjects were prone but not during bipedal or unipedal standing. These results were not different between groups with and without CAI.

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Matthew J. Moncrieff and Lori A. Livingston

Context:

Structural and coronal-plane-alignment characteristics of the lower limb are frequently cited as factors contributing to knee pathologies.

Objective:

The purpose of this study was to determine the accuracy and reliability characteristics of a digital-photographic-goniometric method (DPGM) of measurement for 2-dimensional (2D) coronal-plane lower limb measurements of the quadriceps (Q) angle, tibiofemoral (TF) angle, and femur length in human participants adopting a self-selected- or Romberg-stance position.

Design:

Reliability study.

Setting:

University motion-analysis laboratory.

Participants:

A convenience sample of 20 healthy young adult men and women.

Main Outcome Measures:

Intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of the measurements.

Results:

Intratester- and intertester-reliability coefficients for the Q angle (ICCs .458–845 and .257–737) were consistently lower than those for the TF angle (ICCs .627–.904 and .700–.839) or femur length (ICCs .867–.958 and .866–.944). Q angles were also significantly larger (13.4%) in the Romberg- vs self-selected-stance position (P < .001) and larger (20.2%) in the left limb than the right limb.

Conclusions:

The DPGM has the potential to produce accurate and reliable measurements of selected 2D lower limb measures. However, the reliability characteristics depend on the ability of the testers to correctly and repeatably landmark the anatomical sites used to define the measurements of interest and might be influenced by other factors such as the stance position adopted, the complexity of the variable (ie, number of anatomical landmarks and segments), and the size of the captured image. Further investigation of these latter factors is warranted.