Stephen C. Cobb

Normalizing Hip Muscle Strength: Establishing Body-Size-Independent Measurements

OBJECTIVE To investigate the effectiveness of computing body-size-independent hip strength measures using muscle-specific allometric scaling and ratio standard normalization methods. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS A convenience sample of healthy participants (N=113; 42 men, 71 women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Anthropometric measurements of the leg and thigh were obtained, and maximal hip strength was tested (medial and lateral rotation, abduction, adduction, flexion, extension). Strength was measured isometrically as force (kg) and then converted to torque (Nm). RESULTS The allometric scaling analysis resulted in exponents for normalizing body mass (BM) in each muscle group assessed. In addition, a 6-muscle average exponent was also computed (bavg) for force (men, .554; women, .335) and torque (men, .792; women, .482). The nonsignificant results of the linear regression analysis revealed that normalizing hip strength to BM(bavg) (hip strength/BM(bavg)) effectively removed the influence of BM on force and torque. However, sex should be factored into analyses of allometric scaling because men have higher b-values than women for both force and torque. The linear regression analyses also demonstrated that force normalized to BM (P=.162-.895) and torque normalized to BM × Height (P=.146-.889) were body-size-independent measures. Force normalized to BM⁰·⁶⁷ (P=.001-.191) and body mass index (BMI) (P=<.001-.066), and torque normalized to BM (P=.004-.415) and BMI (P<.001) were significantly related to BM and therefore were not body-size independent. CONCLUSIONS Normalizing force and torque to BM(bavg) is the most effective method of removing body-size dependence and allowing comparisons of persons with differing body sizes.

Hip Muscle Activity During 3 Side-Lying Hip-Strengthening Exercises in Distance Runners

CONTEXT Lower extremity overuse injuries are associated with gluteus medius (GMed) weakness. Understanding the activation of muscles about the hip during strengthening exercises is important for rehabilitation. OBJECTIVE To compare the electromyographic activity produced by the gluteus medius (GMed), tensor fascia latae (TFL), anterior hip flexors (AHF), and gluteus maximus (GMax) during 3 hip-strengthening exercises: hip abduction (ABD), hip abduction with external rotation (ABD-ER), and clamshell (CLAM) exercises. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy runners (9 men, 11 women; age = 25.45 ± 5.80 years, height = 1.71 ± 0.07 m, mass = 64.43 ± 7.75 kg) participated. INTERVENTION(S) A weight equal to 5% body mass was affixed to the ankle for the ABD and ABD-ER exercises, and an equivalent load was affixed for the CLAM exercise. A pressure biofeedback unit was placed beneath the trunk to provide positional feedback. MAIN OUTCOME MEASURE(S) Surface electromyography (root mean square normalized to maximal voluntary isometric contraction) was recorded over the GMed, TFL, AHF, and GMax. RESULTS Three 1-way, repeated-measures analyses of variance indicated differences for muscle activity among the ABD (F(3,57) = 25.903, P < .001), ABD-ER (F(3,57) = 10.458, P < .001), and CLAM (F(3,57) = 4.640, P = .006) exercises. For the ABD exercise, the GMed (70.1 ± 29.9%), TFL (54.3 ± 19.1%), and AHF (28.2 ± 21.5%) differed in muscle activity. The GMax (25.3 ± 24.6%) was less active than the GMed and TFL but was not different from the AHF. For the ABD-ER exercise, the TFL (70.9 ± 17.2%) was more active than the AHF (54.3 ± 24.8%), GMed (53.03 ± 28.4%), and GMax (31.7 ± 24.1%). For the CLAM exercise, the AHF (54.2 ± 25.2%) was more active than the TFL (34.4 ± 20.1%) and GMed (32.6 ± 16.9%) but was not different from the GMax (34.2 ± 24.8%). CONCLUSIONS The ABD exercise is preferred if targeted activation of the GMed is a goal. Activation of the other muscles in the ABD-ER and CLAM exercises exceeded that of GMed, which might indicate the exercises are less appropriate when the primary goal is the GMed activation and strengthening.

Effect of Patellofemoral Pain on Strength and Mechanics after an Exhaustive Run

PURPOSE To investigate the effects of an exhaustive run on trunk and lower extremity strength and mechanics in patients with and without patellofemoral pain (PFP), we hypothesized that strength would decrease and mechanics would change after the exhaustive run. METHODS Nineteen subjects with PFP and 19 controls participated (10 men and 9 women per group). Lower extremity and trunk mechanics during running, body mass-normalized strength, and pain assessments before and after an exhaustive run were quantified. A repeated-measures ANOVA was used to assess group differences and exhaustion-related changes (P < 0.05), with t-test post hoc analyses performed when significant interactions were identified (P < 0.0125). RESULTS Pain significantly increased with the exhaustive run in the PFP group (P = 0.021). Hip strength was reduced after the exhaustive run, more so in those with PFP (abduction: before = 0.384 ± 0.08, after = 0.314 ± 0.08, P < 0.001; external rotation: before = 0.113 ± 0.02, after = 0.090 ± 0.02, P < 0.001). Persons with PFP also demonstrated increased knee flexion (before = 41.6° ± 5.5°, after = 46.9° ± 7.5°, P < 0.001), hip flexion (before = 30.4° ± 6.8°, after = 42.5° ± 9.7°, P < 0.001), and anterior pelvic tilt (before = 7.2° ± 5.1°, after = 13.3° ± 6.7°, P = 0.001) after the exhaustive run compared to controls. Trunk flexion increased in both PFP (before = 13.09° ± 6.2°, after = 16.31° ± 5.3°, P < 0.001) and control (before = 1393° ± 4.7°, after = 15.99° ± 5.9°, P < 0.001) groups. Hip extension (before = -2.09 ± 0.49 N · m · kg(-1), after = -2.49 ± 0.54 N · m · kg(-1), P = 0.002) moments increased only in subjects with PFP. CONCLUSIONS Exhaustive running results in reduced hip strength in subjects with PFP; however, this did not result in changes to hip internal rotation or adduction kinematics. Kinematic and kinetic changes after the exhaustive run are more indicative of compensatory changes to reduce pain. Increasing trunk flexion during running might provide pain relief during running; however, reducing anterior pelvic tilt may also warrant attention during treatment.

The effect of 6 weeks of custom-molded foot orthosis intervention on postural stability in participants with >or=7 degrees of forefoot varus.

ObjectivePostural stability (PS) was assessed in a group of participants with ≥7 degrees of forefoot varus (FV) after 6 weeks of custom-molded functional foot orthosis (FO) intervention to investigate the effect of FO intervention in a population that may have decreased PS due to their foot structure. DesignA force platform was used to assess right and left single-limb stance position and eyes open and eyes closed condition PS. SettingPS was assessed in a biomechanics research laboratory. ParticipantsTwelve participants with ≥7 degrees of FV (MFV) and 5 participants with <7 degrees of FV (LFV) participated in the study. InterventionsPS of the MFV group was assessed initially when FOs were received and after 6 weeks of FO intervention. The LFV group PS was assessed during initial and 6-week testing sessions. Main Outcome MeasuresThe root mean square of the center of pressure velocity was used to quantify single-limb stance PS during no FO and FO conditions. ResultsLFV group PS did not change significantly (P=0.829) over the 6-week time period. Significant improvement was, however, reported in the MFV group anteroposterior (P=0.003) and mediolateral (P=0.032) PS at the 6-week assessment versus the initial assessment during both the noFO and FO conditions. ConclusionsSix weeks of FO intervention may significantly improve PS in participants with ≥7 degrees of FV both when wearing FOs and when not wearing FOs.

The Relationship Among Foot Posture, Core and Lower Extremity Muscle Function, and Postural Stability

CONTEXT Identification of impaired balance as a risk factor for lower extremity injury regardless of injury history has led to subsequent investigation of variables that may adversely affect balance in healthy individuals. OBJECTIVES To investigate the relationship among core and lower extremity muscle function, foot posture, and balance. DESIGN Descriptive laboratory study. SETTING Musculoskeletal injury biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 108 individuals (40 men, 68 women; age = 22.8 ± 4.7 years, height = 168.5 ± 10.4 cm, mass = 69.9 ± 13.3 kg) participated in the study. MAIN OUTCOME MEASURE(S) Core endurance was assessed during 1 time-to-failure trial, and isometric hip and ankle strength were assessed using a handheld dynamometer and isokinetic dynamometer, respectively. Foot structure was quantified using the digital photographic measurement method. Single-limb-stance time to boundary was assessed using a force plate during an eyes-closed condition. Hierarchical multiple regression analyses were performed to predict balance using lower extremity strength, foot posture, and core endurance. RESULTS Foot posture (β = -0.22, P = .03) and ankle-inversion strength (β = -0.29, P = .006) predicted mediolateral balance. Increasing arch posture and ankle-inversion strength were associated with decreased mediolateral single-limb-stance balance. CONCLUSIONS Increasing arch height was associated with decreased mediolateral control of single-limb stance. The relationship between time to boundary and injury risk, however, has not been explored. Therefore, the relationship between increasing arch height and injury due to postural instability cannot be determined from this study. If authors of future prospective studies identify a relationship between decreased time to boundary and increased injury risk, foot structure may be an important variable to assess during preparticipation physical examinations. The relationship between increasing ankle-inversion strength and decreased balance may require additional study to further elucidate the relationship between ankle strength and balance.

Custom-molded foot-orthosis intervention and multisegment medial foot kinematics during walking

CONTEXT Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. OBJECTIVE To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. DESIGN Crossover study. SETTING University biomechanics and ergonomics laboratory. PATIENTS OR OTHER PARTICIPANTS Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. INTERVENTION(S) After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. MAIN OUTCOME MEASURE(S) Three-dimensional displacements during 4 subphases of stance (loading response, midstance, terminal stance, preswing) were computed for each multisegment foot model articulation. RESULTS Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F(1,14) = 5.24, P = .04, partial η(2) = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F(1,14) = 7.87, P = .01, partial η(2) = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F(1,14) = 4.32, P = .08, partial η(2) = 0.38) or full-contact orthosis (F(1,14) = 4.10, P = .08, partial η(2) = 0.37). CONCLUSIONS Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dysfunctional kinematic patterns associated with low-mobile foot postures.

The effect of footwear on multi-segment foot kinematics during running

Background Footwear is intended to prevent lower extremity injuries caused by excessive foot-ground impacts and faulty mechanics. However, no clear relationship between shoe habits and injury risk has been established [1]. Many studies have examined barefoot versus shod running kinematics, but the results have been equivocal [2,3]. A factor in the inconsistent results could be the relationship between foot structure and function. For example, Cobb et al. demonstrated significant walking gait kinematic differences between participants with typical and low arch foot structures using a multi-segment foot model [4]. The purpose of this study was to investigate effects of footwear on multi-segment foot kinematics during running in participants with low arch structure.

Cognitive Demands Influence Lower Extremity Mechanics During a Drop Vertical Jump Task in Female Athletes

&NA; • STUDY DESIGN: Cross‐sectional study. • BACKGROUND: The drop vertical jump task is commonly used to screen for anterior cruciate ligament injury risk; however, its predictive validity is limited. The limited predictive validity of the drop vertical jump task may be due to not imposing the cognitive demands that reflect sports participation. • OBJECTIVES: To investigate the influence of additional cognitive demands on lower extremity mechanics during execution of the drop vertical jump task. • METHODS: Twenty uninjured women (age range, 18‐25 years) were required to perform the standard drop vertical jump task, as well as drop vertical jumps that included additional cognitive demands. The additional cognitive demands were related to attending to an overhead goal (ball suspended over‐head) and/or temporal constraints on movement selection (decision making). Three‐dimensional ground reaction forces and lower extremity mechanics were compared between conditions. • RESULTS: The inclusion of the overhead goal resulted in higher peak vertical ground reaction forces and lower peak knee flexion angles in comparison to the standard drop vertical jump task. In addition, participants demonstrated greater peak knee abduction angles when trials incorporated temporal constraints on decision making and/or required participants to attend to an overhead goal, in comparison to the standard drop vertical jump task. • CONCLUSION: Imposing additional cognitive demands during execution of the drop vertical jump task influenced lower extremity mechanics in a manner that suggested increased loading of the anterior cruciate ligament. Tasks utilized in anterior cruciate ligament injury risk screening may benefit from more closely reflecting the cognitive demands of the sports environment.

Lower extremity muscle activity during descent from varying step heights

During step descent, lower extremity musculature is critical for positioning the foot and ankle for initial contact and stabilizing the structures following contact. Although continuous stair descent has been extensively examined, curb/single transition steps where many injuries occur requires further study. The purpose of this study was to identify the influence of landing strategy and step height on lower extremity muscle activity of uninjured individuals during transition step descent. Twenty-two participants walked along a level walkway, stepped down a single step (heights: 5-cm, 15-cm, 25-cm) landed with the heel or forefoot, and continued walking. Muscle activity of the leading legs peroneals, tibialis anterior, and medial gastrocnemius were recorded 200 ms before and after initial contact. Two-way Repeated Measures ANOVAs within the three step heights and two landing strategies were run for both the pre- and post-contact periods. Step height by landing strategy interactions existed during the pre-contact periods for all three muscles. During the post-contact period, all muscle activity increased with each step height increment. Additionally, the medial gastrocnemius and tibialis anterior demonstrated significant landing strategy differences. This study highlights the importance of considering both landing strategy and step height when designing or interpreting investigations of transition step negotiation.

Identifying trippers and non-trippers based on knee kinematics during obstacle-free walking

Trips are a major cause of falls. Sagittal-plane kinematics affect clearance between the foot and obstacles, however, it is unclear which kinematic measures during obstacle-free walking are associated with avoiding a trip when encountering an obstacle. The purpose of this study was to determine kinematic factors during obstacle-free walking that are related to obstacle avoidance ability. It was expected that successful obstacle avoidance would be associated with greater peak flexion/dorsiflexion and range of motion (ROM), and differences in timing of peak flexion/dorsiflexion during swing of obstacle-free walking for the hip, knee and ankle. Three-dimensional kinematics were recorded as 35 participants (young adults age 18-45 (N = 10), older adults age 65+ without a history of falls (N = 10), older adults age 65+ who had fallen in the last six months (N = 10), and individuals who had experienced a stroke more than six months earlier (N = 5)) walked on a treadmill, under obstacle-free walking conditions with kinematic features calculated for each stride. A separate obstacle avoidance task identified trippers (multiple obstacle contact) and non-trippers. Linear discriminant analysis with sequential feature selection classified trippers and non-trippers based on kinematics during obstacle-free walking. Differences in classification performance and selected features (knee ROM and timing of peak knee flexion during swing) were evaluated between trippers and non-trippers. Non-trippers had greater knee ROM (P = .001). There was no significant difference in classification performance (P = .193). Individuals with reduced knee ROM during obstacle-free walking may have greater difficulty avoiding obstacles.