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Knee Surgery, Sports Traumatology,... Oct 2014The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such... (Review)
Review
UNLABELLED
The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes.
LEVEL OF EVIDENCE
V.
Topics: Hip; Humans; Knee Joint; Patella; Patellofemoral Pain Syndrome; Physical Therapy Modalities; Quadriceps Muscle
PubMed: 24221245
DOI: 10.1007/s00167-013-2759-6 -
The Permanente Journal Jun 2022The purpose of this article is to provide a synopsis of the current medical understanding of lateral hip pain, highlighting greater trochanteric pain syndrome (GTPS) and... (Review)
Review
The purpose of this article is to provide a synopsis of the current medical understanding of lateral hip pain, highlighting greater trochanteric pain syndrome (GTPS) and its relation to lateral hip pain. Common causes of lateral hip pain, GTPS as a cause of lateral hip pain, prevalence of GTPS, clinical presentation of GTPS, associated risk factors, history and physical examination, laboratory testing, diagnostic imaging, and treatment options are described. A quiz serves to assist readers in their understanding of the presented material.
Topics: Bursitis; Femur; Hip; Humans; Pain; Syndrome
PubMed: 35933677
DOI: 10.7812/TPP/21.110 -
Journal of Athletic Training Nov 2018Weakness or decreased activation of the hip abductors and external rotators has been associated with lower extremity injury, especially in females. Resisted side...
CONTEXT
Weakness or decreased activation of the hip abductors and external rotators has been associated with lower extremity injury, especially in females. Resisted side stepping is commonly used to address hip weakness. Whereas multiple variations of this exercise are used clinically, few data exist regarding which variations to select.
OBJECTIVE
To investigate differences in muscle-activation and movement patterns and determine kinematic and limb-specific differences between men and women during resisted side stepping with 3 resistive-band positions.
DESIGN
Controlled laboratory study.
SETTING
Laboratory.
PATIENTS OR OTHER PARTICIPANTS
A total of 22 healthy adults (11 men, 11 women; age = 22.8 ± 3.0 years, height = 171.6 ± 10.7 cm, mass = 68.5 ± 11.8 kg).
INTERVENTION(S)
Participants side stepped with the resistive band at 3 locations (knees, ankles, feet).
MAIN OUTCOME MEASURE(S)
We collected surface electromyography of the gluteus maximus, gluteus medius, and tensor fascia lata (TFL) for the moving and stance limbs during the concentric and eccentric phases. We also measured trunk inclination, hip and knee flexion, and hip-abduction excursion.
RESULTS
Hip-abductor activity was higher in women than in men ( P ≤ .04). The pattern of TFL activity in the stance limb differed by sex. Women performed the exercise in greater forward trunk inclination ( P = .009) and had greater hip excursion ( P = .003). Gluteus maximus and medius activity increased when the band was moved from the knees to the ankles and from the ankles to the feet, whereas TFL activity increased only when the band was moved from the knees to the ankles. Findings were similar for both the stance and moving limbs, but the magnitudes of the changes differed.
CONCLUSIONS
Compared with placing the band around the ankles, placing the band around the feet for resisted side stepping elicited more activity in the gluteal muscles without increasing TFL activity. This band placement is most appropriate when the therapeutic goal is to activate the muscles that resist hip adduction and internal rotation.
Topics: Adult; Ankle; Biomechanical Phenomena; Buttocks; Electromyography; Exercise; Female; Foot; Hip; Humans; Knee; Male; Muscle, Skeletal; Rotation; Sex Factors; Thigh; Torso; Young Adult
PubMed: 30615490
DOI: 10.4085/1062-6050-46-16 -
Journal of Strength and Conditioning... Jul 2012The purpose of this study was to compare the biomechanics of the traditional squat with 2 popular exercise variations commonly referred to as the powerlifting squat and... (Comparative Study)
Comparative Study
The purpose of this study was to compare the biomechanics of the traditional squat with 2 popular exercise variations commonly referred to as the powerlifting squat and box squat. Twelve male powerlifters performed the exercises with 30, 50, and 70% of their measured 1 repetition maximum (1RM), with instruction to lift the loads as fast as possible. Inverse dynamics and spatial tracking of the external resistance were used to quantify biomechanical variables. A range of significant kinematic and kinetic differences (p < 0.05) emerged between the exercises. The traditional squat was performed with a narrow stance, whereas the powerlifting squat and box squat were performed with similar wide stances (48.3 ± 3.8, 89.6 ± 4.9, 92.1 ± 5.1 cm, respectively). During the eccentric phase of the traditional squat, the knee traveled past the toes resulting in anterior displacement of the system center of mass (COM). In contrast, during the powerlifting squat and box squat, a more vertical shin position was maintained, resulting in posterior displacements of the system COM. These differences in linear displacements had a significant effect (p < 0.05) on a number of peak joint moments, with the greatest effects measured at the spine and ankle. For both joints, the largest peak moment was produced during the traditional squat, followed by the powerlifting squat, then box squat. Significant differences (p < 0.05) were also noted at the hip joint where the largest moment in all 3 planes were produced during the powerlifting squat. Coaches and athletes should be aware of the biomechanical differences between the squatting variations and select according to the kinematic and kinetic profile that best match the training goals.
Topics: Adult; Ankle; Biomechanical Phenomena; Hip; Humans; Knee; Male; Movement; Posture; Spine; Weight Lifting; Young Adult
PubMed: 22505136
DOI: 10.1519/JSC.0b013e3182577067 -
Revue Medicale de Liege Nov 2022Coxalgia is one of the most common painful complaints in orthopedic surgery. The management of a "traumatic" hip is relatively well codified, however atraumatic coxalgia...
Coxalgia is one of the most common painful complaints in orthopedic surgery. The management of a "traumatic" hip is relatively well codified, however atraumatic coxalgia is more difficult to diagnose and explore. The history and a well-conducted clinical examination are essential for the management of coxalgia. The diagnosis is already well oriented by a simple X-ray and the presence or absence of inflammatory signs on the blood test. This article aims to provide a guideline for the diagnostic approach to coxalgia.
Topics: Humans; Hip; Pain; Radiography
PubMed: 36354230
DOI: No ID Found -
British Journal of Hospital Medicine... Jul 2023Hip pain in a child can pose a diagnostic conundrum. In most cases, the cause of a painful hip is often attributed to trauma, but a number of these cases will be... (Review)
Review
Hip pain in a child can pose a diagnostic conundrum. In most cases, the cause of a painful hip is often attributed to trauma, but a number of these cases will be atraumatic. The main entities to consider are inflammatory, infective and neoplastic causes. Pathologies such as avascular necrosis and slipped upper femoral epiphysis can also present in a similar manner. A detailed history and clinical examination are crucial in narrowing down the differential diagnosis. In addition, understanding the most appropriate imaging modalities and the characteristic radiological findings is key in ensuring timely treatment and management. This article reviews the various disease processes in children who present with hip pain and outlines the most appropriate assessment and imaging modalities that will aid diagnosis.
Topics: Child; Humans; Hip; Arthralgia; Pain; Femur
PubMed: 37490445
DOI: 10.12968/hmed.2023.0054 -
Journal of Orthopaedics and... Dec 2016The burden of traumatic and elective hip surgery is set to grow. With an increasing number of techniques and implants against the background of an aging population, the... (Review)
Review
BACKGROUND
The burden of traumatic and elective hip surgery is set to grow. With an increasing number of techniques and implants against the background of an aging population, the emphasis on evidence-based treatment has never been greater. The purpose of this study was to assess changes in the levels of evidence in the hip literature over a decade.
MATERIALS AND METHODS
Articles pertaining to hip surgery from the years 2000 and 2010 in Hip International, Journal of Arthroplasty, Journal of Bone and Joint Surgery and The Bone and Joint Journal were analysed. Articles were ranked by a five-point level of evidence scale and by type of study, according to guidelines from the Centre for Evidence-based Medicine.
RESULTS
531 articles were analysed from 48 countries. The kappa value for the inter-observer reliability showed excellent agreement between the reviewers for study type (κ = 0.956, P < 0.01) and for levels of evidence (κ = 0.772, P < 0.01). Between 2000 and 2010, the overall percentage of high-level evidence (levels I and II) studies more than doubled (12 to 31 %, P < 0.001). The most frequent study type was therapeutic; the USA and UK were the largest producers of published work in these journals, with contributions from other countries increasing markedly over the decade.
CONCLUSIONS
There has been a significant increase in high levels of evidence in hip surgery over a decade (P < 0.001). We recommend that all orthopaedic journals consider implementing compulsory declaration by authors of the level of evidence to help enhance quality of evidence.
LEVEL OF EVIDENCE
Level 2: economic and decision analysis.
Topics: Arthroplasty, Replacement, Hip; Evidence-Based Medicine; Hip; Humans; Orthopedics
PubMed: 27443626
DOI: 10.1007/s10195-016-0421-z -
Anatomical Record (Hoboken, N.J. : 2007) May 2017The shape of the human pelvis reflects the unique demands placed on the hip abductor muscles (gluteus medius and gluteus minimus), which stabilize the body in the... (Review)
Review
The shape of the human pelvis reflects the unique demands placed on the hip abductor muscles (gluteus medius and gluteus minimus), which stabilize the body in the frontal plane during bipedal locomotion. This morphological shift occurred early in hominin evolution, yet important shape differences between hominin species have led to significant disagreement about abductor function and locomotor capability in these extinct taxa. A static biomechanical model that relies on a close association between skeletal measurements of the pelvis and femur has traditionally been used to reconstruct hip biomechanics in these species. However, experimental biomechanical approaches have highlighted the dynamic nature of mediolateral balance in walking and running, challenging the assumptions of the static hip model. This article reviews traditional approaches for understanding hip abductor function, shows how they have been applied to the fossil hominin record, and discusses new techniques that integrate the dynamic nature of mediolateral balance during human locomotion. Anat Rec, 300:932-945, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Animals; Biomechanical Phenomena; Fossils; Hip; Hominidae; Humans; Locomotion; Walking
PubMed: 28406571
DOI: 10.1002/ar.23558 -
The Israel Medical Association Journal... Aug 2021Diagnosis and treatment of posterior hip pain has increased due to advancements in clinical, anatomical, biomechanical, and related pathological understandings of the... (Review)
Review
Diagnosis and treatment of posterior hip pain has increased due to advancements in clinical, anatomical, biomechanical, and related pathological understandings of the hip. Due to its complexity and close anatomical relationship with many osseous, neurovascular, and musculotendinous structures, posterior hip pain must be appropriately categorized based on its origin. Therefore, it is crucial that clinicians are able to determine whether patient complaints are of extra-articular or intra-articular nature so that they can implement the optimal treatment plan. In the current review article, we discussed posterior hip pain with an emphasis on the main differential diagnoses of deep gluteal syndrome, ischiofemoral impingement, and hamstring tear/hamstring syndrome. For the appropriate diagnosis and etiology of posterior hip pain, a thorough and conclusive clinical history is imperative. Physicians should rule out the possibility of spinal involvement by physical examination and if necessary, by magnetic resonance imaging (MRI). Furthermore, because of the vicinity to other, non-orthopedic structures, an obstetric and gynecologic history, general surgery history, and urologic history should be obtained. Following the collection of patient history clinicians should adhere to an established and efficient order of evaluation starting with standing then to seated, supine, lateral, and prone testing. Imaging assessment of posterior hip pain begins with a standard anterior-posterior pelvic radiograph, in addition to frog-leg lateral. MRI is pivotal for assessing soft tissue-related extra-articular causes of hip in patients with posterior hip pain. Non-surgical treatment is preferred in most cases of deep gluteal syndrome, ischiofemoral impingement, pudendal nerve entrapment, and proximal hamstring pathologies. Surgical treatment is saved as a last resort option in cases of failed non-surgical treatment.
Topics: Diagnosis, Differential; Hip; Humans; Pain; Pain Management; Pain Measurement; Patient Care Planning; Patient Selection
PubMed: 34392634
DOI: No ID Found -
Journal of Athletic Training May 2022Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method for measuring dynamic...
CONTEXT
Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method for measuring dynamic postural control.
OBJECTIVE
To examine changes in dynamic postural control after hip arthroscopy and subsequent rehabilitation from baseline to 3 and 6 months postsurgery.
DESIGN
Case series.
SETTING
Physiotherapy department.
PATIENTS OR OTHER PARTICIPANTS
Sixty-seven individuals (47 men, 20 women; age = 31 ± 8 years, height = 1.78 ± 0.09 m, mass = 83 ± 15 kg) scheduled for hip arthroscopy to address chondrolabral conditions were matched with 67 healthy individuals serving as controls (47 men, 20 women; age = 31 ± 8 years, height = 1.77 ± 0.09 m, mass = 80 ± 16 kg). The hip arthroscopy group underwent postoperative rehabilitation including SEBT training.
MAIN OUTCOME MEASURE(S)
The SEBT reach normalized to limb length was collected before surgery (baseline) and at 3 and 6 months after arthroscopy and compared with that of the healthy matched control group. Repeated-measures analysis of variance was used to evaluate whether SEBT reach differed among the 3 time points, and t tests were used to evaluate between-limbs and between-groups differences.
RESULTS
The SEBT reach in the hip arthroscopy group at baseline was less than that of the control group in all directions (P values < .001). At 3 months after arthroscopy, SEBT reach increased in the posteromedial (PM; P = .007), posterolateral (PL; P < .001), and anterolateral (AL; P < .001) directions from baseline. At 6 months after arthroscopy, all directions of reach had increased (P values < .001) from baseline. The anteromedial (mean difference [MD] = -2.9%, P = .02), PM (MD = -5.2%, P = .002), and AL (MD = -2.5%, P = .04) reach distances remained shorter at 6 months after surgery in the hip arthroscopy group than in the control group. No difference existed between the control and hip arthroscopy groups for reach in the PL direction (MD = -3.6%; P = .06).
CONCLUSIONS
Dynamic balance control in the hip arthroscopy group at baseline was poorer than in a matched control group as measured using the SEBT. At 3 months after hip arthroscopy, we observed improvements in dynamic balance in the PM, PL, and AL SEBT directions. By 6 months after arthroscopy, all directions of SEBT reach had improved, but only the PL reach improved to the level of healthy control individuals.
Topics: Adult; Arthralgia; Arthroscopy; Female; Hip; Humans; Male; Postural Balance; Young Adult
PubMed: 35696599
DOI: 10.4085/1062-6050-0709.20