Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip.

BACKGROUND: Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. METHODS: This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman's rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1-0.3), moderate (r = ± 0.3-0.5) and strong (r > ± 0.5). RESULTS: Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. CONCLUSION: Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

The Effect of Implanted Functional Electrical Stimulation on Gait Performance in Stroke Survivors: A Systematic Review.

The emerging literature suggests that implantable functional electrical stimulation may improve gait performance in stroke survivors. However, there is no review providing the possible therapeutic effects of implanted functional electrical stimulation on gait performance in stroke survivors. We performed a web-based, systematic paper search using PubMed, the Cochrane Library, and EMBASE. We limited the search results to human subjects and papers published in peer-reviewed journals in English. We did not restrict demographic or clinical characteristics. We included 10 papers in the current systematic review. Across all included studies, we found preliminary evidence of the potential therapeutic effects of functional electrical stimulation on walking endurance, walking speed, ankle mobility, and push-off force in stroke survivors. However, due to the heterogeneity between the included studies, small sample size, and lack of randomized controlled trials, more studies are critically needed to confirm whether implanted functional electrical stimulation can improve gait performance in stroke survivors.

Sagittal Pelvic Tilt Directly Influences the Ischiofemoral Space: A Cadaveric Study.

BACKGROUND: Ischiofemoral impingement (IFI) is understood to be a pain generator in the deep gluteal space. Femoral position is known to influence the ischiofemoral space (IFS), but there has been no study examining the effect of sagittal pelvic tilt on the IFS. The purpose of this study was to determine whether changes in pelvic tilt in the sagittal plane lead to changes in the dimensions of the IFS. MATERIALS AND METHODS: Five fresh frozen cadavers (10 hips) were used for this anatomic study. The specimens were skeletonized and placed in the prone position with the pelvis fixed to a custom-built hinged table. A digital inclinometer was used to tilt the pelvis -10°, 0°, and 10° simulating posterior, neutral, and anterior pelvic tilt, respectively. Digital calipers were used to measure the dimensions of the IFS in all three positions of sagittal pelvic tilt. RESULTS: Changes in pelvic tilt resulted in significant changes in the dimensions of the IFS. Mean IFS dimensions measured 29.3±9.7 mm, 37.2±9.0 mm, and 24.3±9.2 mm in the neutral, anterior, and posterior pelvic tilt positions, respectively (P<.0001). CONCLUSION: Changes in sagittal pelvic tilt influence the dimensions of the IFS, with posterior pelvic tilt noted to significantly decrease the IFS when compared with neutral and anterior pelvic tilt. These findings suggest that further evaluation of sagittal spinopelvic balance in the etiology of symptomatic IFI may be warranted. [Orthopedics. 2024;47(3):167-171.].

Anthropometric Predictors of Conventional Deadlift Kinematics and Kinetics: A Preliminary Study.

The purpose of this preliminary analysis was to determine if there are relationships between anthropometric characteristics (arm length, torso length, thigh length, and shank length) and conventional deadlift (CDL) kinematics and kinetics during a 5 sets of 5 repetitions (5 × 5) CDL routine in resistance-trained males. Eleven males who had experience with the deadlift exercise were included in this analysis (age: 21.5 ± 1.4 y; height: 180.7 ± 5.7 cm; body mass: 89.9 ± 16.0 kg). Anthropometrics were measured by a 3-dimensional optical scanner. The participants underwent a 5 × 5 CDL workout using a self-selected load corresponding to a rating of perceived exertion (RPE) of 8 out of 10. Performance outcomes were measured synchronously using a 3-dimensional 12-camera motion capture system and two force platforms. Outcomes were averaged across all sets and analyzed using multiple linear regression. The selected anthropometric variables were not significantly related to the CDL performance outcomes, except for concentric ankle work. However, in the overall model, anthropometric predictors did not significantly predict ankle concentric work (p = 0.11; R 2 = 0.67; R_2adj = 0.45). Independently, thigh length significantly correlated with ankle concentric work (p = 0.03). In this model, thigh length accounted for 55% of the normalized variance in ankle concentric work. The results from this preliminary study suggest that arm length, torso length, and shank length may not play a clear role in the examined CDL outcomes, but thigh length may be positively correlated with ankle concentric work during a 5 × 5 CDL routine in resistance-trained males.

Biomechanical Comparison of Dominant and Non-Dominant Limbs During Leap-Landings in Contemporary Style Female Dancers.

The execution strategy of technical dance movements is constrained by aesthetic and qualitative artistic requirements. As such, there are limited leap-landing strategies that may be used by dancers when executing a grand jeté or saut de chat. The purpose of this study was to determine potential differences in lower extremity angular positioning and joint loading when performing a dance-style leap landing. Fifteen female dancers (age: 20 ± 1 years; height: 1.61 ± 0.13 m; weight: 58.00 ± 11.89 kg) completed six leap-landing trials during which three-dimensional kinematics and kinetics data were collected. Paired-samples t-tests (α = 0.05) and Cohen's d effect sizes (ES; large ≥ 0.8) were used to compare the following variables: jump height; peak vertical ground reaction force; loading time; loading rate; joint angular positioning of the ankle, knee, hip, and trunk in the frontal and sagittal planes; and joint angular impulse of the ankle, knee, and hip in the frontal and sagittal planes between the dominant and non-dominant limbs. Frontal plane hip angular impulse was significantly greater in the dominant limb (p = 0.023, ES = 1.53). While no other statistically significant differences were observed between dominant and non-dominant limbs, moderate effect sizes were observed for the hip and trunk angles in the frontal plane along with hip impulse in the sagittal plane. This study indicates that dancers might slightly alter their landing strategy at the hip joint when leap-landing onto the dominant limb. Frontal plane hip mechanics should be considered to minimize overuse injury potential in the dominant limb.

Focus of attention effects on lower extremity biomechanics during vertical jump landings.

This study examined biomechanical differences between external and internal foci of attention during vertical jump landings in males and females. Twenty-four healthy adults performed eight vertical jump landings using both internal and external foci while three-dimensional kinematic and ground reaction force (GRF) data were obtained. Two (focus) by two (sex) analyses of variance (α = 0.05) and Cohen's d effect sizes (ES) were used to compare differences in vertical GRF, joint angular positions and displacements, and lower limb joint angular work between foci and between sexes. Significantly greater knee contributions to total angular work occurred during external versus internal focus landings regardless of sex (p = .013; ES = 0.30). Significantly smaller plantarflexion angles (p = .019; ES = 0.53) and significantly greater knee flexion angles were observed at ground contact (p < .001; ES = 1.11) in males during external focus landings. Females exhibited significantly smaller knee flexion angles at both ground contact during external versus internal focus landings (p = .031; ES = 0.20) and compared to males during external focus landings (p < .001; ES = 1.76). Both peak vertical GRF (p = .003; ES = 1.54) and the ankle contributions to total angular work during loading (p = .026; ES = 1.07) were greater in females versus males regardless of foci, whereas the knee contributions to total angular work during loading were smaller in women (p = .026; ES = 1.07). Males and females might consider adopting an external focus during vertical jump landings to increase knee joint contributions to lower limb energy absorption. Females, in particular, might consider external focus use to decrease peak vertical GRF and increase the knee joint's contribution to total energy absorption to magnitudes similar to those exhibited by males.