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Pressure on the acetabular labrum in the hip position that is reported for labral injuries: a cadaveric biomechanical study
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
score and % fat. 3 schemes of intervention were identified: (a) exercise versus no exercise, 9 studies; (b) exercise and diet versus diet, 6 studies and (c) exercise versus counseling, 3 studies. The studies included presented high heterogeneity levels of I2 of 73% Chi2 of 18.82 at 5 degrees of freedom with a value P of 0.002, which explain why they were presented in an explanatory manner. Conclusion(s): The data obtained, though they are the result of high statistical heterogeneity, clinically show the impact of overweight and obesity reduction. Implications: It is important to highlight as better intervention due to its effectiveness, the scheme of exercise and diet versus diet, which enable us to suggest that the integral program composed by structured exercise with clear prescription variables such as intensity, duration, frequency and time of specific diet prescription of hypo caloric base, facilitates weight reduction in children. Keywords: Obesity; Physical Activity; Systematic review Funding acknowledgements: A token of gratitude to the DIB and to the National University for its financing (code QUIPU. 202010016842). Ethics approval: Approval certificate number 09 of the 26 May 2011 ethics committee of the Faculty of Medicine, Colombia University National. http://dx.doi.org/10.1016/j.physio.2015.03.3374 Research Report Poster Presentation Number: RR-PO-06-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 PRESSURE ON THE ACETABULAR LABRUM IN THE HIP POSITION THAT IS REPORTED FOR LABRAL INJURIES: A CADAVERIC BIOMECHANICAL STUDY E. Hidaka 1,2 , M. Aoki 3 , H. Miyamoto 4 , Y. Saito 1 , D. Suzuki 5 , M. Fujimiya 6 1 Graduate
School of Medicine, Sapporo Medical University, Sapporo, Japan; 2 Kobe International University Faculty of Rehabilitation, Department of Physical Therapy, Kobe, Japan; 3 Health Science University of Hokkaido School of Rehabilitation, Department of Orthopedics, Ishikari, Japan; 4 Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan; 5 Sapporo Medical University School of Medicine, Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo, Japan; 6 Sapporo Medical University School of Medicine, The 2nd Department of Anatomy, Sapporo, Japan Background: The acetabular labrum is an important structure that provides stability to the hip joint. Several studies demonstrated that an application of high pressure to the labrum may cause labral injuries. Therefore, it is important to
eS559
search the relationship between pressure on the labrum and hip position that is reported for labral injuries. There have been few studies published to date on this subject. Purpose: The purpose of this study was to elucidate the effect of hip position on pressure on the acetabular labrum using fresh cadaver specimens. Methods: Eight fresh/frozen trans-lumbar cadaver specimens were used in the experiment. The acetabulum was divided into 12 sectors like a clock face; with 6 o’clock defined as the most inferior aspect of the hip at the midpoint of the transverse acetabular ligament, with 9 o’clock the most posterior, 12 o’clock the most superior, and 3 o’clock the most anterior aspect. The pressure was measured by a small pressure sensor (0.8 mm in thickness, 6 mm in diameter). The sensor was inserted in the mid-substance of the labrum with respective portions of the labrum at 12, 1:30, 3 o’clock which were the representative portions for labral lesions. Fifty-four hip positions were determined for pressure measurement. The reference position for each portion of the labrum was set at neutral position (on flexion/extension, on adduction/abduction, and on rotations). The range of hip motion was recorded using an electromagnetic tracking device. Bonferroni multiple comparisons test was used to determine the hip joint positions that showed significantly higher pressure than that observed at the reference position. Results: The pressure on the labrum at 12 o’clock was not significantly higher than the reference position value at any hip position. The pressure on the labrum at 1:30 with the hip at 90◦ flexion with maximal adduction and internal rotation (196.5 kPa ± 132 kPa) and that at maximal flexion with maximal adduction and internal rotation (126.4 kPa ± 54.3 kPa) were both significantly higher than the reference position value (p < 0.05). In these positions, the anterior aspect of femoral neck is in strong contact with the labrum at 1:30. Pressure on the labrum at 3 o’clock with the hip at 90◦ flexion with maximal abduction (120.5 kPa ± 113.5 kPa) was significantly higher than the reference position value (p < 0.05). In this position, the inferior aspect of femoral head was in strong contact with the labrum at 3 o’clock as it was forced outside the acetabulum. Conclusion(s): This study was designed to elucidate hip positions that caused high pressure on the limited part of the acetabular labrum. As a result, pressure on the labrum was found to increase at the end range of hip adduction in internal rotation and abduction in 90◦ flexion, but did not increase at any other positions. This study demonstrated that the increase in pressure on the labrum may occur by the hip position that is reported for labral injuries. Implications: It is possible that physical therapists can contribute to provide therapy for labral lesions by assisting patients to avoid hip positions that cause high pressure on the labrum. Keywords: Acetabular labrum; Biomechanics; Cadaver Funding acknowledgements: All authors declare that they do not have any financial and personal relationships with other people or organizations.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
Ethics approval: This study was reviewed and approved by the institutional research ethics committee in Sapporo Medical University. http://dx.doi.org/10.1016/j.physio.2015.03.3375 Research Report Poster Presentation Number: RR-PO-05-21-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 RELATIONSHIP BETWEEN GAIT PATTERN AND ENERGY COST UNDER FUNCTIONAL RESTRICTION A. Higuchi, H. Suzuki, S. Kawakami, H. Fujisawa Graduate School of Health and Environment Science, Tohoku Bunka Gakuen University, Sendai, Japan Background: The joint movement pattern of the gait shows a stereotype. It is also thought that is chosen so that energy cost (EC) is minimized. However, when there is a functional restriction, it is not clear the principle of EC minimum is applied. Hence, it is useful to consider whether the principle of EC minimum is adapted to gait construction using the functional restriction model. Purpose: The purpose of this study was to determine the relationship between the joint movement pattern and EC during walking under a functional restriction, and then to show clearly whether the joint movement pattern chosen when carrying out a freedom gait under the functional restriction becomes EC minimum. Methods: The subjects were 20 healthy young men. All subjects provided their written informed consent prior to participation. We restricted the subject’s right hip joint flexion until 0 degrees, and defined it as the functional restriction model. The gait strategies were assumed three types: pelvic posterior tilt, pelvic rotation, and parallel feet. Measurement condition was gait speeds of 10, 20, 30, 40, 50, 60 m/min, and then the subject walked on a treadmill for three minutes at each speed. Oxygen consumption (VO2 ) was measured using a gas analyzer (AE-2805, Minato) during waking. First, the subjects walked without specifying the gait strategy, and we defined it as the freedom gait. Secondly, they walked the three gait strategies at random. Finally, the subjects walked under non-restriction, and we defined it as a normal gait. Parametric comparisons used two-way analysis of variance (ANOVA). The independent variable was the gait strategy (4 levels) and gait speeds (7 levels), and the dependent variable was VO2 . Significant individual differences were evaluated using Bonferroni test. Further, differences were assessed with two-sided test, with an alpha level of 0.05. Results: The ANOVA showed significant main effects of both gait strategy and gait speed for VO2 . In addition, there was a significant interaction effect between two factors. VO2
was smallest of normal gait in the gait strategy for all speed. VO2 was larger in the order of the pelvic rotation type, the parallel feet type, the pelvic posterior tilt type at 10 m/min. It was also larger in the order of the parallel feet type, the pelvic rotation type, the pelvic posterior tilt type at 20–60 m/min. In the freedom gait at 10 m/min, it was ten persons who chose the parallel feet type, and the pelvic posterior tilt type respective. The number of the pelvic posterior tilt type increased with the rise of speed, and 19 persons chose it at 60 m/min. On the other hand, the pelvic rotation type was not seen at each speed. Conclusion(s): This studies result shows if it thinks from the field of EC, clearly “the type of posterior pelvic tilt” the most efficiently in gait strategy. Moreover, selection of gait strategy gave priority to EC in freedom gait. Implications: For the reconstruction of gait in physical therapy, we should consider to optimize energy cost. Keywords: Gait; Energy cost; Functional limitation Funding acknowledgements: The present study was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology (No. 5350614). Ethics approval: The Human Ethics Committee of Tohoku Bunka Gakuen University (No. 13-05). http://dx.doi.org/10.1016/j.physio.2015.03.3376 Research Report Poster Presentation Number: RR-PO-11-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 EFFECTS OF TWO PECTORALIS MINOR STRETCHING METHODS ON PECTORALIS MINOR LENGTH, SCAPULAR POSITION AND GLENOHUMERAL RANGE OF MOTION T. Higuchi 1,2 , S. Inoue 2 , T. Kawakami 2 , K. Kawamura 2 , S. Yokoyama 3 1 Kokoro
Medical and Welfare Collage, Department of Physical Therapy, Nagasaki, Japan; 2 Kibi International University, School of Health Science and Social Welfare, Takahashi, Japan; 3 Kyoto Tachibana University, Faculty of Health Science, Kyoto, Japan Background: Shoulder injury is probably the most frequently occurring injury in overhead athletes. There are various potential causes of shoulder injury in overhead athletes, one of which is tightness of the pectoralis minor. This may be caused by repetitive overhead activities such as throwing and it seems to be related to scapular malposition and dyskinesis or abnormal movements of the scapula. Although many researchers have proposed methods for stretching the pectoralis minor, there is no consensus regarding an effective method.
score and % fat. 3 schemes of intervention were identified: (a) exercise versus no exercise, 9 studies; (b) exercise and diet versus diet, 6 studies and (c) exercise versus counseling, 3 studies. The studies included presented high heterogeneity levels of I2 of 73% Chi2 of 18.82 at 5 degrees of freedom with a value P of 0.002, which explain why they were presented in an explanatory manner. Conclusion(s): The data obtained, though they are the result of high statistical heterogeneity, clinically show the impact of overweight and obesity reduction. Implications: It is important to highlight as better intervention due to its effectiveness, the scheme of exercise and diet versus diet, which enable us to suggest that the integral program composed by structured exercise with clear prescription variables such as intensity, duration, frequency and time of specific diet prescription of hypo caloric base, facilitates weight reduction in children. Keywords: Obesity; Physical Activity; Systematic review Funding acknowledgements: A token of gratitude to the DIB and to the National University for its financing (code QUIPU. 202010016842). Ethics approval: Approval certificate number 09 of the 26 May 2011 ethics committee of the Faculty of Medicine, Colombia University National. http://dx.doi.org/10.1016/j.physio.2015.03.3374 Research Report Poster Presentation Number: RR-PO-06-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 PRESSURE ON THE ACETABULAR LABRUM IN THE HIP POSITION THAT IS REPORTED FOR LABRAL INJURIES: A CADAVERIC BIOMECHANICAL STUDY E. Hidaka 1,2 , M. Aoki 3 , H. Miyamoto 4 , Y. Saito 1 , D. Suzuki 5 , M. Fujimiya 6 1 Graduate
School of Medicine, Sapporo Medical University, Sapporo, Japan; 2 Kobe International University Faculty of Rehabilitation, Department of Physical Therapy, Kobe, Japan; 3 Health Science University of Hokkaido School of Rehabilitation, Department of Orthopedics, Ishikari, Japan; 4 Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan; 5 Sapporo Medical University School of Medicine, Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo, Japan; 6 Sapporo Medical University School of Medicine, The 2nd Department of Anatomy, Sapporo, Japan Background: The acetabular labrum is an important structure that provides stability to the hip joint. Several studies demonstrated that an application of high pressure to the labrum may cause labral injuries. Therefore, it is important to
eS559
search the relationship between pressure on the labrum and hip position that is reported for labral injuries. There have been few studies published to date on this subject. Purpose: The purpose of this study was to elucidate the effect of hip position on pressure on the acetabular labrum using fresh cadaver specimens. Methods: Eight fresh/frozen trans-lumbar cadaver specimens were used in the experiment. The acetabulum was divided into 12 sectors like a clock face; with 6 o’clock defined as the most inferior aspect of the hip at the midpoint of the transverse acetabular ligament, with 9 o’clock the most posterior, 12 o’clock the most superior, and 3 o’clock the most anterior aspect. The pressure was measured by a small pressure sensor (0.8 mm in thickness, 6 mm in diameter). The sensor was inserted in the mid-substance of the labrum with respective portions of the labrum at 12, 1:30, 3 o’clock which were the representative portions for labral lesions. Fifty-four hip positions were determined for pressure measurement. The reference position for each portion of the labrum was set at neutral position (on flexion/extension, on adduction/abduction, and on rotations). The range of hip motion was recorded using an electromagnetic tracking device. Bonferroni multiple comparisons test was used to determine the hip joint positions that showed significantly higher pressure than that observed at the reference position. Results: The pressure on the labrum at 12 o’clock was not significantly higher than the reference position value at any hip position. The pressure on the labrum at 1:30 with the hip at 90◦ flexion with maximal adduction and internal rotation (196.5 kPa ± 132 kPa) and that at maximal flexion with maximal adduction and internal rotation (126.4 kPa ± 54.3 kPa) were both significantly higher than the reference position value (p < 0.05). In these positions, the anterior aspect of femoral neck is in strong contact with the labrum at 1:30. Pressure on the labrum at 3 o’clock with the hip at 90◦ flexion with maximal abduction (120.5 kPa ± 113.5 kPa) was significantly higher than the reference position value (p < 0.05). In this position, the inferior aspect of femoral head was in strong contact with the labrum at 3 o’clock as it was forced outside the acetabulum. Conclusion(s): This study was designed to elucidate hip positions that caused high pressure on the limited part of the acetabular labrum. As a result, pressure on the labrum was found to increase at the end range of hip adduction in internal rotation and abduction in 90◦ flexion, but did not increase at any other positions. This study demonstrated that the increase in pressure on the labrum may occur by the hip position that is reported for labral injuries. Implications: It is possible that physical therapists can contribute to provide therapy for labral lesions by assisting patients to avoid hip positions that cause high pressure on the labrum. Keywords: Acetabular labrum; Biomechanics; Cadaver Funding acknowledgements: All authors declare that they do not have any financial and personal relationships with other people or organizations.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
Ethics approval: This study was reviewed and approved by the institutional research ethics committee in Sapporo Medical University. http://dx.doi.org/10.1016/j.physio.2015.03.3375 Research Report Poster Presentation Number: RR-PO-05-21-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 RELATIONSHIP BETWEEN GAIT PATTERN AND ENERGY COST UNDER FUNCTIONAL RESTRICTION A. Higuchi, H. Suzuki, S. Kawakami, H. Fujisawa Graduate School of Health and Environment Science, Tohoku Bunka Gakuen University, Sendai, Japan Background: The joint movement pattern of the gait shows a stereotype. It is also thought that is chosen so that energy cost (EC) is minimized. However, when there is a functional restriction, it is not clear the principle of EC minimum is applied. Hence, it is useful to consider whether the principle of EC minimum is adapted to gait construction using the functional restriction model. Purpose: The purpose of this study was to determine the relationship between the joint movement pattern and EC during walking under a functional restriction, and then to show clearly whether the joint movement pattern chosen when carrying out a freedom gait under the functional restriction becomes EC minimum. Methods: The subjects were 20 healthy young men. All subjects provided their written informed consent prior to participation. We restricted the subject’s right hip joint flexion until 0 degrees, and defined it as the functional restriction model. The gait strategies were assumed three types: pelvic posterior tilt, pelvic rotation, and parallel feet. Measurement condition was gait speeds of 10, 20, 30, 40, 50, 60 m/min, and then the subject walked on a treadmill for three minutes at each speed. Oxygen consumption (VO2 ) was measured using a gas analyzer (AE-2805, Minato) during waking. First, the subjects walked without specifying the gait strategy, and we defined it as the freedom gait. Secondly, they walked the three gait strategies at random. Finally, the subjects walked under non-restriction, and we defined it as a normal gait. Parametric comparisons used two-way analysis of variance (ANOVA). The independent variable was the gait strategy (4 levels) and gait speeds (7 levels), and the dependent variable was VO2 . Significant individual differences were evaluated using Bonferroni test. Further, differences were assessed with two-sided test, with an alpha level of 0.05. Results: The ANOVA showed significant main effects of both gait strategy and gait speed for VO2 . In addition, there was a significant interaction effect between two factors. VO2
was smallest of normal gait in the gait strategy for all speed. VO2 was larger in the order of the pelvic rotation type, the parallel feet type, the pelvic posterior tilt type at 10 m/min. It was also larger in the order of the parallel feet type, the pelvic rotation type, the pelvic posterior tilt type at 20–60 m/min. In the freedom gait at 10 m/min, it was ten persons who chose the parallel feet type, and the pelvic posterior tilt type respective. The number of the pelvic posterior tilt type increased with the rise of speed, and 19 persons chose it at 60 m/min. On the other hand, the pelvic rotation type was not seen at each speed. Conclusion(s): This studies result shows if it thinks from the field of EC, clearly “the type of posterior pelvic tilt” the most efficiently in gait strategy. Moreover, selection of gait strategy gave priority to EC in freedom gait. Implications: For the reconstruction of gait in physical therapy, we should consider to optimize energy cost. Keywords: Gait; Energy cost; Functional limitation Funding acknowledgements: The present study was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology (No. 5350614). Ethics approval: The Human Ethics Committee of Tohoku Bunka Gakuen University (No. 13-05). http://dx.doi.org/10.1016/j.physio.2015.03.3376 Research Report Poster Presentation Number: RR-PO-11-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 EFFECTS OF TWO PECTORALIS MINOR STRETCHING METHODS ON PECTORALIS MINOR LENGTH, SCAPULAR POSITION AND GLENOHUMERAL RANGE OF MOTION T. Higuchi 1,2 , S. Inoue 2 , T. Kawakami 2 , K. Kawamura 2 , S. Yokoyama 3 1 Kokoro
Medical and Welfare Collage, Department of Physical Therapy, Nagasaki, Japan; 2 Kibi International University, School of Health Science and Social Welfare, Takahashi, Japan; 3 Kyoto Tachibana University, Faculty of Health Science, Kyoto, Japan Background: Shoulder injury is probably the most frequently occurring injury in overhead athletes. There are various potential causes of shoulder injury in overhead athletes, one of which is tightness of the pectoralis minor. This may be caused by repetitive overhead activities such as throwing and it seems to be related to scapular malposition and dyskinesis or abnormal movements of the scapula. Although many researchers have proposed methods for stretching the pectoralis minor, there is no consensus regarding an effective method.