Background:
Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited.
Purpose:
To determine ...whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury.
Results:
Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio AHR, 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence.
Conclusion:
A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
PURPOSEThis study aimed to evaluate the differences in lower-limb biomechanics between adult subelite competitive football players with and without hip-related pain during two contrasting ...tasks—walking and single-leg drop jump (SLDJ)—and to determine whether potential differences, if present, are sex dependent.
METHODSEighty-eight football players with hip-related pain (23 women, 65 men) and 30 asymptomatic control football players (13 women, 17 men) who were currently participating in competitive sport were recruited. Biomechanical data were collected for the stance phase of walking and SLDJ. Pelvis, hip, knee, and ankle angles, as well as the impulse of the external joint moments, were calculated. Differences between groups and sex-specific effects were calculated using linear regression models.
RESULTSCompared with their asymptomatic counterparts, football players with hip-related pain displayed a lower average pelvic drop angle during walking (P = 0.03) and a greater average pelvic hike angle during SLDJ (P < 0.05). Men with hip-related pain displayed a smaller total range of motion (excursion) for the transverse plane pelvis angle (P = 0.03) and a smaller impulse of the hip external rotation moment (P < 0.01) during walking compared with asymptomatic men. Women with hip-related pain displayed a greater total range of motion (excursion) for the sagittal plane knee angle (P = 0.01) during walking compared with asymptomatic women.
CONCLUSIONOverall, few differences were observed in lower-limb biomechanics between football players with and without hip-related pain, irrespective of the task. This outcome suggests that, despite the presence of symptoms, impairments in lower-limb biomechanics during function do not appear to be a prominent feature of people with hip-related pain who are still participating in sport.
Arthroscopy is increasingly used to improve pain and function in athletes with hip joint pathology. Surgical techniques have evolved to utilise arthroscopic femoral osteoplasty to address potential ...morphological contributors to pathology.
Investigate pain and function outcomes following hip arthroscopy with and without femoral osteoplasty in individuals with intra-articular hip pathology.
Systematic review.
A comprehensive search strategy identified studies that evaluated the outcome over at least 3 months following arthroscopy for intra-articular hip pathology, using patient-reported outcomes of pain and/or function. Methodological quality was evaluated (Downs and Black scale), and effect sizes calculated when sufficient data were available.
Twenty-nine studies of moderate methodological quality were included. Of 16 studies investigating arthroscopy alone, two studies showed large effects (3.12-5.46) at 1-2 years. Pain reduction and functional improvement (median 47%) were consistently reported by the remaining 14 studies up to 10 years postsurgery. Of 15 studies investigating arthroscopy with osteoplasty, nine papers showed mostly large effects (0.78-2.93) over 6-28 months. Adverse events were minimal (7% of participants, 12 studies, predominantly transient neuropraxia (83%)).
Current evidence indicates that hip arthroscopy can significantly reduce pain and improve function in patients with intra-articular hip pathology. While benefits of arthroscopy alone can persist up to 10 years postsurgery, effects of osteoplasty beyond 3 years need to be established. Future studies should investigate rehabilitation in this population, and the impact of surgery on development of osteoarthritis.
The tibiofemoral compressive forces experienced during functional activities are believed to be important for maintaining tibiofemoral stability. Previous studies have shown that both knee-spanning ...and non-knee-spanning muscles contribute to tibiofemoral joint compressive forces during walking. However, healthy individuals typically engage in more vigorous activities (e.g. jumping and cutting) that provide greater challenges to tibiofemoral stability. Despite this, no previous studies have investigated how both knee-spanning and non-knee-spanning muscles contribute to tibiofemoral compressive loading during such tasks. The present study investigated how muscles contributed to the medial and lateral compartment tibiofemoral compressive forces during sidestep cutting. Three-dimensional marker trajectories, ground reaction forces and muscle electromyographic signals were collected from eight healthy males whilst they completed unanticipated sidestep cutting. OpenSim was used to perform musculoskeletal simulations to compute the contribution of each lower-limb muscle to compressive loading of each compartment of the knee. The greatest contributors to medial compartment loading were the vasti, gluteus maximus and medius, and the medial gastrocnemius. The greatest contributors to lateral compartment loading were the vasti, adductors, medial and lateral gastrocnemius, and the soleus. The soleus displayed the greatest potential for unloading the medial compartment, whereas the gluteus maximus and medius displayed the greatest potential for unloading the lateral compartment. These findings may help to inform interventions aiming to modulate compressive loading at the knee.
This study aimed to describe chondropathy prevalence in adults who had undergone hip arthroscopy for hip pain. The relationships between chondropathy severity and (1) participant characteristics; and ...(2) patient-reported outcomes (PROs) at initial assessment (∼18 months postsurgery) and over a further 12 months (∼30 months postsurgery) were evaluated. Finally, the relationships between chondropathy and coexisting femoroacetabular impingement (FAI) and labral pathology at the time of surgery were evaluated.
100 consecutive patients (36±12 years) who underwent hip arthroscopy 18 months previously participated. Hip Osteoarthritis and Disability Outcome Score (HOOS) and International Hip Outcome Tool (iHOT-33) data were collected prospectively at 18 months postsurgery and at 30 months postsurgery. Surgical data were collected retrospectively. Participants were grouped: Outerbridge grade 0, no chondropathy; Outerbridge grade I-II, mild chondropathy; Outerbridge III-IV, severe chondropathy. The presence of FAI or labral pathology was noted.
The prevalence of chondropathy (≥grade I) at hip arthroscopy was 72%. Participants with severe chondropathy were significantly worse for all HOOS subscales and the iHOT-33 at 18 months postsurgery (HOOS-symptoms (p=0.017); HOOS-pain (p=0.024); HOOS-activity (p=0.009); HOOS-sport (p=0.004); HOOS-quality-of-life (p=0.006); iHOT-33 (p=0.013)) than those with no chondropathy. At 12-month follow-up, HOOS-quality-of-life in those without chondropathy was the only PRO that improved. Relative risk of coexisting chondropathy with labral pathology or FAI was 40%.
Chondropathy was prevalent, and associated with increasing age, coexisting labral pathology or FAI. Severe chondropathy was associated with worse pain and function at 18 months postsurgery. Little improvements were observed in participants over a further 12 months, regardless of chondropathy status.
PURPOSEKnowledge of hip biomechanics during locomotion is necessary for designing optimal rehabilitation programs for hip-related conditions. The purpose of this study was to1) determine how ...lower-limb muscle contributions to the hip contact force (HCF) differed between walking and running; and 2) compare both absolute and per-unit-distance (PUD) loads at the hip during walking and running.
METHODSKinematic and ground reaction force data were captured from eight healthy participants during overground walking and running at various steady-state speeds (walking1.50 ± 0.11 m·s and 1.98 ± 0.03 m·s; running2.15 ± 0.18 m·s and 3.47 ± 0.11 m·s). A three-dimensional musculoskeletal model was used to calculate the HCF as well as lower-limb muscular contributions to the HCF in each direction (posterior–anterior; inferior–superior; lateral–medial). The impulse of the resultant HCF was calculated as well as the PUD impulse (BW·s·m) and PUD force (BW·m).
RESULTSFor both walking and running, HCF magnitude was greater during stance than swing and was largest in the inferior–superior direction and smallest in the posterior–anterior direction. Gluteus medius, iliopsoas, and gluteus maximus generated the largest contributions to the HCF during stance, whereas iliopsoas and hamstrings generated the largest contributions during swing. When comparing all locomotion conditions, the impulse of the resultant HCF was smallest for running at 2.15 m·s with an average magnitude of 2.14 ± 0.31 BW·s, whereas the PUD impulse and force were smallest for running at 3.47 m·s with average magnitudes of 0.95 ± 0.18 BW·s·m and 1.25 ± 0.24 BW·m, respectively.
CONCLUSIONSHip PUD loads were lower for running at 3.47 m·s compared with all other locomotion conditions because of a greater distance travelled per stride (PUD impulse) or a shorter stride duration combined with a greater distance travelled per stride (PUD force).
Objective
Patellofemoral (PF) joint osteoarthritis (OA) is common, yet little is known about how this condition influences lower‐extremity biomechanical function. This study compared pelvis and ...lower‐extremity kinematics in people with and without PF joint OA.
Methods
Sixty‐nine participants (64% women, mean ± SD age 56 ± 10 years) with anterior knee pain aggravated by PF joint–loaded activities (e.g., stair ambulation, rising from sitting, or squatting) and radiographic lateral PF joint OA on skyline radiographs were compared with 18 controls (78% women, mean ± SD age 53 ± 7 years) with no lower‐extremity pain or radiographic OA. Knee Injury and Osteoarthritis Outcome Score (KOOS) data were collected from participants with PF joint OA. Quantitative gait analyses were conducted during overground walking at a self‐selected speed. Pelvis and lower‐extremity kinematics were calculated across the stance phase. Data were statistically analyzed using analyses of covariance, with age and sex as covariates (P < 0.05).
Results
Participants with PF joint OA reported a mean ± SD KOOS pain subscale score of 65 ± 15, KOOS symptoms subscale score of 63 ± 16, KOOS activities of daily living subscale score of 73 ± 13, KOOS sports/recreation subscale score of 45 ± 23, and KOOS quality of life subscale score of 43 ± 16. Participants with PF joint OA walked with greater anterior pelvic tilt throughout the stance phase, as well as greater lateral pelvic tilt (i.e., pelvis lower on the contralateral side), greater hip adduction, and lower hip extension during the late stance phase. No differences in knee and ankle joint angles were observed between groups.
Conclusion
People with PF joint OA walk with altered pelvic and hip movement patterns compared with aged‐matched controls. Restoring normal movement patterns during walking in people with PF joint OA may be warranted to help alleviate symptoms.
Abstract Objectives This study investigated tests of hip muscle strength and functional performance. The specific objectives were to: (i) establish intra- and inter-rater reliability; (ii) compare ...differences between dominant and non-dominant limbs; (iii) compare agonist and antagonist muscle strength ratios; (iv) compare differences between genders; and (v) examine relationships between hip muscle strength, baseline measures and functional performance. Design Reliability study and cross-sectional analysis of hip strength and functional performance. Methods In healthy adults aged 18–50 years, normalised hip muscle peak torque and functional performance were evaluated to: (i) establish intra-rater and inter-rater reliability; (ii) analyse differences between limbs, between antagonistic muscle groups and genders; and (iii) associations between strength and functional performance. Results Excellent reliability (intra-rater ICC = 0.77–0.96; inter-rater ICC = 0.82–0.95) was observed. No difference existed between dominant and non-dominant limbs. Differences in strength existed between antagonistic pairs of muscles: hip abduction was greater than adduction ( p < 0.001) and hip ER was greater than IR ( p < 0.001). Men had greater ER strength ( p = 0.006) and hop for distance ( p < 0.001) than women. Strong associations were observed between measures of hip muscle strength (except hip flexion) and age, height, and functional performance. Conclusions Deficits in hip muscle strength or functional performance may influence hip pain. In order to provide targeted rehabilitation programmes to address patient-specific impairments, and determine when individuals are ready to return to physical activity, clinicians are increasingly utilising tests of hip strength and functional performance. This study provides a battery of reliable, clinically applicable tests which can be used for these purposes.
Femoroacetabular impingement (FAI) syndrome is considered a motion-related condition. Little is known about the influence of symptom severity and cam morphology on hip biomechanics for individuals ...with FAI syndrome.
Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome?
Forty-nine male, sub-elite football (soccer or Australian football) players (mean age= 26 years) with FAI syndrome completed the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS) and underwent radiographic evaluation. Biomechanical data were collected during overground running (3–3.5 m∙s−1) using three-dimensional motion capture technology and an embedded force plate. Various discrete hip angles and impulses of joint moments were analysed during the stance phase. Linear regression models investigated associations between running biomechanics data (dependent variables) and iHOT-33 and HAGOS scores and cam morphology size (independent variables).
Hip joint angles during running were not associated with symptom severity in football players with FAI syndrome. A positive association was found between the impulse of the hip external rotation moment and HAGOS-Sport scores, such that a smaller impulse magnitude occurred with a lower HAGOS-Sport score (0.026 *10−2 95%CI <0.001 *10−2 to 0.051 *10−2, P = 0.048). Larger cam morphology was associated with a greater peak hip adduction angle at midstance (0.073 95%CI 0.002–0.145, P = 0.045).
Hip biomechanics during running did not display strong associations with symptom severity or cam morphology size in male football players with FAI syndrome who were still participating in training and match play. Future studies might consider investigating associations during tasks that utilise end range hip joint motion or require greater muscle forces.
•Bony morphology and symptom severity might impact biomechanics in FAI syndrome.•Running biomechanics, symptom severity, and hip radiographs were assessed.•Hip joint angles during running were not associated with symptom severity.•Larger cam morphology was weakly associated with a larger peak hip adduction angle.
Abstract A thorough understanding of the biomechanics of the hamstrings during sprinting is required to optimise injury rehabilitation and prevention strategies. The main aims of this study were to ...compare hamstrings load across different modes of locomotion as well as before and after an acute sprinting-related muscle strain injury. Bilateral kinematic and ground reaction force data were captured from a single subject whilst walking, jogging and sprinting prior to and immediately following a significant injury involving the right semitendinosis and biceps femoris long head muscles. Experimental data were input into a three-dimensional musculoskeletal model of the body and used, together with optimisation theory, to determine lower-limb muscle forces for each locomotor task. Hamstrings load was found to be greatest during terminal swing for sprinting. The hamstrings contributed the majority of the terminal swing hip extension and knee flexion torques, whilst gluteus maximus contributed most of the stance phase hip extension torque. Gastrocnemius contributed little to the terminal swing knee flexion torque. Peak hamstrings force was also substantially greater during terminal swing compared to stance for sprinting, but not for walking and jogging. Immediately following the muscle strain injury, the hamstrings demonstrated an intolerance to perform an eccentric-type contraction. Whilst peak hamstrings force during terminal swing did not decrease post-injury, both peak hamstrings length and negative work during terminal swing were considerably reduced. These results lend support to the paradigm that the hamstrings are most susceptible to muscle strain injury during the terminal swing phase of sprinting when they are contracting eccentrically.
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