Effect of Strength Training of Hip Muscles on Functional Ankle Instability: Evaluated with Surface Electromyography / 中国康复理论与实践

Objective:To investigate the effect of strength training of hip muscles on functional ankle instability (FAI), and be evaluated with surface electromyography (sEMG). Methods:From January, 2019 to June, 2020, 60 FAI patients were recruited in Qingdao Municipal Hospital. They were divided into control group (n = 30) and observation group (n = 30) randomly. The control group received conventional therapy, including ankle joint mobilization training, strength training and balance training for six weeks, while the observation group received strength training of hip muscles in addition. Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) and sEMG were used to assess the function before and after intervention, and integrated electromyography (iEMG) was measured with sEMG. The correlation of CAIT and SEBT to iEMG was analyzed with Pearson coefficient. Results:No one dropped out. Before intervention, there was no significant difference between CAIT, SEBT and iEMG between two groups (P > 0.05). CAIT and SEBT improved significantly in both groups (t > 3.657, P < 0.001) after six-week intervention; the iEMG increased significantly in the observation group (t > 22.038, P < 0.001), while no significance was found in the control group (t < 1.916, P > 0.05); all the indexes were better in the observation group than in the control group (t > 2.125, P < 0.05). iEMG of gluteus medius and gluteus maximum correlated to CAIT and SEBT in the observation group (r = 0.712 to 0.866, P < 0.05). Conclusion:The strength training of the hip muscles could improve the ankle function of FAI patients. iEMG of gluteus medius and gluteus maximum could be a valid measure to assess the effect of strength training on FAI.

Muscle activation pattern of gluteus medius, tibialis anterior and peroneus longus during drop landing on different surfaces: A cross-sectional study

BACKGROUND@#Gluteus medius (GMeds), peroneus longus (PL), and tibialis anterior (TA) help in maintaining frontal stability of the lower extremity, particularly, the ankle. Muscle activation must be sufficient to prevent the occurrence of an ankle sprain. The purpose of this study is to compare the muscle activation of the GMeds, TA, and PL during drop landing on stable and unstable surfaces of physically active individuals.@*METHODS@#Surface EMG (sEMG) was used to determine the muscle activation pattern of the GMeds, TA, and PL of fifteen (15) recreational athletes during drop landing. The mean percentage of maximum voluntary isometric contraction (%MVIC) was calculated for comparison. Wilcoxon signed-rank test was used to compare means.@*RESULTS@#There were no statistically significant differences in the muscle activity of GMeds (p=0.69), TA (p=0.26), and PL (p=0.23) on stable and unstable surfaces. However, a small effect size showed that GMeds (d=0.30) has higher activation in the unstable surface while TA (d=0.28) and PL (d=0.17) have lower activation on unstable surface.@*CONCLUSION@#Landing surface does not significantly alter muscle activity of GMeds, TA, and PL. However, the magnitude of the difference in the mean %MVIC between groups shows the compensatory mechanism of the body when subjected to different surface conditions. This can be used when creating injury prevention programs of the lower extremity.

Gluteus Medius and Tensor Fascia Latae muscle activation levels during multi-joint strengthening exercises

Aim: To compare the activation of GMed and TFL in four multi-joint exercises in strength training protocols and to verify if the level of muscle activation is indicated for strength gains in resistance training protocols. Methods: Eleven recreational lifters had normalized muscle activation of GMed and TFL assessed during ten maximal repetitions of four multi-joint exercises: (1) bilateral supine bridge (BiBRG); (2) bilateral supine bridge with hip abducted (BiBRG-AB); (3) unilateral supine bridge (UniBRG) and (4) single-leg squat (SLS). Results: A load of exercises was significantly greater for the BiBRG and BiBRG-AB compared to the UniBRG and SLS (p<0.001). We observed that GMed activation was significant greater compared to TFL among the four exercises (p=0.004) [BiBRG: Δ=26.2%; BiBRG-AB: Δ=27.3%; UniBRG: Δ=24.5% and SLS: Δ=18.8%]. Additionally, GMed activation was classified as moderate (<40%iMVC) and TFL activation was classified as low (<20%iMVC) in all exercises. Conclusion: Our results demonstrated that GMed is more active than TFL in all analyzed exercises. However, the level of activation observed for GMed was below that recommended to strength gain in resistance training programs.(AU)

Consideration of the Exercise position for Facilitating Gluteus Medius Maximally in Normal Adults

PURPOSE: This study examined the most efficient exercise position to activate the gluteus medius (GM) and tensor fascia latae (TFL) in hip abduction in side-lying (HA-SL), clam in side-lying (CL-SL), and sling bridging in side-lying (SB-SL), which are the most representative GM exercises. METHODS: Twenty-four healthy male adults aged from 20 to 40 years, whose body mass index was under 25, participated in this experiment. While all participants conducted three different positions with a counterbalanced manner, such as in AB, CL, and BR, activation of the GM and TFL was measured using 8-channel wireless EMG. Exercise was performed for 10 seconds three times in total with a five minute-break session. RESULTS: Significant differences in GM and TFL activation were observed among the three positions (p<0.05). The highest activation of 60.69 was observed in BR followed in order by 46.03 and 12.92 in HA-SL and CL, respectively. TFL activation in HA-SL was 42.01, followed in order by 35.98 and 14.01 in BR and CL, respectively. On the other hand, there was no significant difference in TFL muscle activation between BR and HA-SL. CONCLUSION: These findings suggest that both BR and HA-SL in GM can be done selectively. CL has remarkably low muscle activation in GM and TFL, which makes it less valuable in GM and TFL exercise. In conclusion, selective BR and HA-SL exercise should be applied to maximally and effectively activate the GM.

Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report

We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved.

Biometry by ultrasonography of the epaxial and pelvic musculature in equines trained with Pessoa's rein / Biometria por ultrassonografia da musculatura epaxial e pélvica em equinos treinados com rédea Pessoa

This study aimed to evaluate the use of Pessoa's rein in training equine, as a support in exercise training, on biometry by ultrasonography of the epaxial (Longíssimus Dorsi, Gluteus Medius e Musculus Multifidus) and pelvic musculature (Biceps Femoris e Semitendinosus). Thereby, eight Quarter Horse mares was used, with eight years on average age, 400kg of body weight, trained with the Pessoa's rein twice a week, for two months. Variables were measured before and after training, consisting of assessment thickness (cm) of the Longíssimus Dorsi and cross-sectional area (cm2) of muscles, Gluteus Medius, Biceps Femoris, Semitendinosus and Musculus Multifidus. It observed a significant effect of training with Pessoa's rein, on the Biceps Femoris (P<0.01) and Musculus Multifidus (P<0.01), which the average cross-sectional area at the final evaluation were of 28.66cm2 and 14.29cm2, respectively. Thus it can be conclude that training with Pessoa's rein modifies muscular function, promoting hypertrophy Musculus Multifidus and Biceps Femoris of horses.

Objetivou-se avaliar o emprego da rédea Pessoa no treinamento de equinos atletas, como auxiliar de condicionamento físico, sobre a biometria avaliada pela ultrassonografia das musculaturas epaxial (Longíssimus Dorsi, Gluteus Medius e Musculus Multifidus) e pélvica (Biceps Femoris e Semitendinosus). Foram utilizadas oito éguas da raça Quarto de Milha, com idade média de cinco anos, 400kg de peso vivo, treinadas com a rédea Pessoa duas vezes por semana, durante dois meses. As variáveis foram mensuradas, antes e após o treinamento, consistindo das avaliações de espessura (cm) do Longíssimus Dorsi e área transversal (cm2) dos músculos, Gluteus Medius, Biceps Femoris, Semitendinosus e Musculus Multifidus. Observou-se efeito significativo do treinamento com rédea Pessoa sobre os músculos Biceps Femoris (P<0,01) e Musculus Multifidus (P<0,01), no qual os valores médios da área transversal, na avaliação final, foram de 28,66cm2 e 14,29cm2, respectivamente. Concluiu-se que o treinamento com a rédea Pessoa modifica o funcionamento muscular, promovendo a hipertrofia do Musculus Multifidus e Biceps Femoris de equinos.

The Effect of Conservative Treatment for the Calcific Tendinitis on Gluteus Medius Tendon / 대한스포츠의학회지

Calcific tendinitis on gluteus medius tendon of the amateur athletes were reviewed, and a study on the therapeutic effect of conservative treatment methods. From January 2003 to December 2010, among the patients who had been treated with calcific tendinitis on gluteus medius tendon, there were nine patients available to monitor more than a year as outpatients. ten cases were observed from them and were retrospectively analyzed and magnetic resonance examinations were performed in every case. All of the ten cases were initially treated with non-steroid anti-inflammatory oral doses. If a non-steroid anti-inflammatory treatment could not relieve pain or caused an aggravation of a condition, a local steroid injection was enforced. There were responses to non-steroid antiinflammatory oral doses of therapeutic methods in four cases and the time required for the symptoms to be improved was approximately 3 weeks (range: 1-3 weeks). In the remainder of six cases, conditions got worsened or did not improve even after 3 weeks. In these cases, the condition was altered for better in 3 days (range: 1-3 days) by using local steroid injections. There was no recurrence in all cases. The amateur athlete with a severe pain around his or her hip joint should be questioned with calcific tendinitis on gluteus medius tendon and differential diagnosis of hip around diseases. After calcific tendinitis was diagnosed, initial treatment was considered conserevative treatment. Although it is invasive, the initial treatment with a local steroid injection is considered to be helpful in treating amateur athletes with calcific tendinitis.

Calcific Tendinitis of the Gluteus Medius Tendon

PURPOSE: This study evaluated the clinical symptoms, diagnosis and management of calcific tendinitis around the insertion of the gluteus medius tendon. MATERIALS AND METHODS: Between February 2004 and December 2008, 9 patients (8 women and 1 man; mean age, 57 years; age range, 41~80) with a diagnosis of calcific tendinitis were enrolled in this study. All patients underwent radiography and sonography. The relationships between the clinical aspects, medication, the shape of calcification under radiography, thickening of the tendon, and the shape of calcification under sonography were analyzed. RESULTS: Type 1 (fluffy margin) under radiography had a shorter symptom duration and faster recovery than type 2 (well-defined and homogenous margin) (p=0.03). Tendon thickening and the shape of calcification (ovoid or amorphous) from the sonographic findings was not significantly related to the symptom duration and recovery time. Non-steroidal anti-inflammatory medication had no effect on the symptom duration or recovery time. CONCLUSION: Patients with calcific tendinitis around the gluteus medius tendon with a type 1 margin (fluffy margin) showed a shorter symptom duration and faster recovery than those with a type 2 margin. Non-steroidal antiinflammatory medication had no effect on the symptom duration or recovery time.

Light exercise causes adaptive changes in muscles of young Brasileiro de Hipismo horses / Atividade física leve causa mudanças adaptativas musculares em eqüinos jovens da raça Brasileiro de Hipismo

This study aimed to determine the changes in the Gluteus medius of 4 year-old Brasileiro de Hipismo (BH) horses submitted to light physical activity for 10 months. The study involved 11 horses from the "Nove de Julho" Battalion of the Military Police of São Paulo State (PM-SP). Percutaneous muscle biopsy was performed in horses at maintenance and in those that had participated in routine police work for 10 months with the PM-SP. Fragments of the left Gluteus medius muscle was removed at depths of 20mm and 60mm. To determine the fiber types, the histochemical analyses were performed for myofibrillar adenosine triphosphatase (mATPase) and nicotinamide adenine dinucleotide tetrazolium reductase (NADH-TR). The morphometry of the fibers was performed by calculating the cross sectional area (CSA), relative frequency distribution (F) and relative cross-sectional area (RCSA). After the period of physical activity, type IIA fibers showed an increase in F and RCSA at both depths. The type I fibers showed a decrease in F at a depth of 60mm and the type IIX fibers showed no change in F at the two depths. With regard to the results for RCSA, type I and IIX fibers also did not show alterations after 10 months of light physical activity. Low intensity physical activity produced significant adaptations in the Gluteus medius muscle of horses of the BH breed, including changes in metabolic and contractile properties as evidenced by the increase in the area occupied by type IIA fibers at both depths of the biopsy.

Este estudo objetivou determinar as adaptações do músculo Gluteus medius de cavalos da raça Brasileiro de Hipismo (BH), que participaram de atividades físicas leves por 10 meses. Foram utilizados 11 eqüinos, machos, da raça BH e com idade de 4 anos, provenientes do "Batalhão Nove de Julho" da Polícia Militar do Estado de São (PM-SP). Realizou-se a biópsia muscular percutânea nos animais inativos e, após participarem das atividades de ronda e policiamento desenvolvido pela PM-SP por 10 meses, foram retirados fragmentos do músculo Gluteus medius nas profundidades de 20mm e 60mm. Para a determinação dos tipos de fibra muscular, foram feitas análises histoquímicas por meio das técnicas de adenosina trifosfatase miofibrilar (mATPase) e nicotinamida adenina dinucleotídeo tetrazólio redutase (NADH-TR). Na análise morfométrica das fibras, calculou-se a área de secção transversal (AST), a freqüência média (F) e a área de secção transversal relativa (ASTR). Após o período de atividade física, as fibras tipo IIA apresentaram aumento da F e da ASTR nas duas profundidades. As fibras tipo I apresentaram diminuição da F na profundidade de 60mm e as fibras tipo IIX não sofreram alteração da F nas duas profundidades. A ASTR das fibras tipo I e IIX não apresentaram alteração após os 10 meses. A atividade física de baixa intensidade produziu adaptações significativas no músculo Gluteus medius de cavalos da raça BH, incluindo mudança nas propriedades metabólicas e contráteis evidenciadas pelo aumento da área ocupada pelas fibras tipo IIA, nas duas profundidades de biópsia.

Steel's Gluteus Medius and Minimus Advancement for In-toeing in Spastic Cerebral Palsy / 대한정형외과학회잡지

In order to investigate the validity of the Steel's gluteus medius and minimus advancement, we reviewed 21 hips in 14 spastic cerebral palsy patients, who had advancement of the gluteus medius and minimus insertion for the correction of in-toeing gait between November 1985 and February 1992. The procedure was limited to those patients who had moderate to severe in-toeing gait with positive Steel's stretch reflex. There were eight boys and six girls. The average age at the time of surgery was 6.7 years(2.9 years-11.9 years). The procedure was performed on both hips in seven patients. Of the 14 patients, nine had diplegia, three hemiplegia, and two paraplegia. The average follow-up time was 4.3 years(1 year-8.5 years). In-toeing gait was converted to neutral or physiologic out-toeing gait in 17 hips(81%), excessive out-toeing in 2 cases(9.5%), and mild residual in-toeing in 2 cases(9.5%), Steel's stretch reflex, which was present in all cases preoperatively, disappered in 19 hips(90.5%) postoperatively, Abductor power, however, decreased from 4+ to 4− in average postoperatively, Among the 16 hips, which had no Trendelenburg sign or gait preoperatively, 8 hips(50%) showed positive Trendelenburg sign and gait postoperatively. In conclusion, Steel's gluteus medius and minimus advancement appears to be effective in the correction of in-toeing gait, but there is high risk of weakening the abductor power.