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The purpose of this investigation is to compare the effects of a combined hip activation and core stabilization training home exercise program (HEP) versus a hip activation training HEP alone on lower extremity (LE) frontal plane mechanics in healthy individuals.
Specific Aim 1: To determine whether between- and/or within-group differences exist on the Forward Step-Down test (FSDT) when comparing a combined hip activation and core stabilization training HEP as compared to a hip activation training HEP.
Specific Aim 2: To determine whether between- and/or within-group differences exist on the peak external knee abduction moment when comparing a combined hip activation and core stabilization training HEP to a hip activation training HEP.
Specific Aim 3: To determine whether between- and/or within-group differences exist on gluteal and core muscle surface electromyography (sEMG) when comparing a combined hip activation and core stabilization training HEP to a hip activation training HEP.
Specific Aim 4: To determine whether a dose-response relationship exists between HEP compliance and change on the FSDT, peak external knee abduction moment, and sEMG.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hip Activation Group | Active Comparator | The hip activation HEP group will receive a combination of hip musculature activation exercises used by previous researchers that show an increase in hip muscle recruitment. |
|
| Combined Hip Activation and Core Stabilization Group | Experimental | The hip activation plus core stabilization HEP group will receive the same hip exercises as the other group, plus core stabilization exercises used by previous researchers. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hip activation home exercise program | Other | The hip activation HEP group will receive a combination of hip musculature activation exercises used by previous researchers that show an increase in hip muscle recruitment. Each participant will perform their respective intervention program at home twice weekly for eight weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Forward Step Down Test (FSDT) | Rating on the FSDT (0-6; 0-1 = good movement quality, 2-3 = moderate movement quality, 4 or more = poor movement quality). | Pre- and post-eight week intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Maximal volitional isometric contraction (MVIC) via sensory electromyography (sEMG) of gluteus maximus (GMax) | MVIC (microvolts) of GMax during performance of the FSDT | Pre- and post-eight week intervention |
| Mean activation of GMax via sEMG |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniel W. Flowers, PT, DPT, PhD | LSU Health Sciences Center at Shreveport | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| LSU Health Sciences Center at Shreveport | Shreveport | Louisiana | 71103 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Clark L, Dean A, Mitchell A, & Torgerson DJ. Envelope use and reporting in randomised controlled trials: a guide for researchers. Research Methods in Medicine & Health Sciences. 2021;2(1):2-11. doi:10.1177/2632084320957204 | ||
| Background | Konrad P. The ABC of EMG: A Practical Introduction to Kinesiological Electromyography. Noraxon U.S.A.; 2006. | ||
| 22506941 | Result | Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012 Apr;19(4):378-85. doi: 10.1111/j.1553-2712.2012.01315.x. | |
| 22147711 |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Dec 7, 2023 | Jan 18, 2024 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D020820 | Dyskinesias |
| ID | Term |
|---|---|
| D009069 | Movement Disorders |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009461 | Neurologic Manifestations |
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The PI who will be performing the data analysis will be blinded to participants' random group allocation. The other investigators who will be collecting the outcome data will know the group allocation.
|
| Hip activation plus core stabilization home exercise program | Other | The hip activation plus core stabilization HEP group will receive the same hip exercises, plus core stabilization exercises used by previous researchers. Each participant will perform their respective intervention program at home twice weekly for eight weeks. |
|
Mean activation (% MVIC) of GMax during performance of the FSDT
| Pre- and post-eight week intervention |
| Peak activation of GMax via sEMG | Peak activation (%MVIC) of GMax during performance of the FSDT | Pre- and post-eight week intervention |
| MVIC via sEMG of gluteus medius (GMed) | MVIC (microvolts) of GMed during performance of the FSDT | Pre- and post-eight week intervention |
| Mean activation of GMed via sEMG | Mean activation (% MVIC) of GMed during performance of the FSDT | Pre- and post-eight week intervention |
| Peak activation of GMed via sEMG | Peak activation (% MVIC) of GMed during performance of the FSDT | Pre- and post-eight week intervention |
| MVIC via of transversus abdominis (TA) | MVIC (microvolts) of TA during performance of the FSDT | Pre- and post-eight week intervention |
| Mean activation of TA via sEMG | Mean activation (% MVIC) of TA during performance of the FSDT | Pre- and post-eight week intervention |
| Peak activation of TA via sEMG | Peak activation (% MVIC) of TA during performance of FSDT | Pre- and post-eight week intervention |
| Peak external knee abduction moment during drop landing task | Kinetic assessment of the peak external knee abduction moment (Nm/kg) during the drop landing task | Pre- and post-eight week intervention |
| Compliance with Home Exercise Program | Self-reported completion of each HEP session will be recorded by the participant and then returned to the investigators post-completion | Post-eight week intervention |
| Result |
| Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004. |
| 30372640 | Result | Bolgla LA, Boling MC, Mace KL, DiStefano MJ, Fithian DC, Powers CM. National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain. J Athl Train. 2018 Sep;53(9):820-836. doi: 10.4085/1062-6050-231-15. |
| 20118526 | Result | Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010 Feb;40(2):42-51. doi: 10.2519/jospt.2010.3337. |
| 14669960 | Result | Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther. 2003 Nov;33(11):647-60. doi: 10.2519/jospt.2003.33.11.647. |
| 15179160 | Result | Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004 Jun;36(6):926-34. doi: 10.1249/01.mss.0000128145.75199.c3. |
| 24427426 | Result | Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports Health. 2013 Nov;5(6):514-22. doi: 10.1177/1941738113481200. |
| 32669487 | Result | Kim B, Yim J. Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial. Tohoku J Exp Med. 2020 Jul;251(3):193-206. doi: 10.1620/tjem.251.193. |
| 36136067 | Result | Flowers DW, Brewer W, Mitchell K, Ellison J, Frilot C. The Effect of Core Stabilization Training on Improving Gait and Self-Perceived Function in Patients with Knee Osteoarthritis: A Single-Arm Clinical Trial. Pathophysiology. 2022 Sep 1;29(3):495-506. doi: 10.3390/pathophysiology29030040. |
| Result | McCallister E, Flowers D. Can the Forward-Step-Down Test Be Used Reliably in the Clinical Setting to Assess Movement Changes Resulting from Maximal Exertion? A Pilot Study. Internet Journal of Allied Health Sciences and Practice. Published online 2020. doi:https://doi.org/10.46743/1540-580x/2020.1931 |
| 33421757 | Result | Flowers DW, Brewer W, Ellison J, Mitchell K, Frilot C. Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis. Clin Biomech (Bristol). 2021 Feb;82:105270. doi: 10.1016/j.clinbiomech.2020.105270. Epub 2021 Jan 1. |
| 35189569 | Result | Cannon J, Weithman BA, Powers CM. Activation training facilitates gluteus maximus recruitment during weight-bearing strengthening exercises. J Electromyogr Kinesiol. 2022 Apr;63:102643. doi: 10.1016/j.jelekin.2022.102643. Epub 2022 Feb 9. |
| 12937582 | Result | Loudon JK, Wiesner D, Goist-Foley HL, Asjes C, Loudon KL. Intrarater Reliability of Functional Performance Tests for Subjects With Patellofemoral Pain Syndrome. J Athl Train. 2002 Sep;37(3):256-261. |
| 23756380 | Result | Park KM, Cynn HS, Choung SD. Musculoskeletal predictors of movement quality for the forward step-down test in asymptomatic women. J Orthop Sports Phys Ther. 2013;43(7):504-10. doi: 10.2519/jospt.2013.4073. Epub 2013 Jun 11. |
| 30342498 | Result | Ishida T, Koshino Y, Yamanaka M, Ueno R, Taniguchi S, Samukawa M, Saito H, Matsumoto H, Aoki Y, Tohyama H. The effects of a subsequent jump on the knee abduction angle during the early landing phase. BMC Musculoskelet Disord. 2018 Oct 20;19(1):379. doi: 10.1186/s12891-018-2291-4. |
| 10331479 | Result | McNair PJ, Prapavessis H. Normative data of vertical ground reaction forces during landing from a jump. J Sci Med Sport. 1999 Mar;2(1):86-8. doi: 10.1016/s1440-2440(99)80187-x. |
| 29496655 | Result | Argent R, Daly A, Caulfield B. Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR Mhealth Uhealth. 2018 Mar 1;6(3):e47. doi: 10.2196/mhealth.8518. |
| 34363190 | Result | Cavalli M, Aiolfi A, Bruni PG, Manfredini L, Lombardo F, Bonfanti MT, Bona D, Campanelli G. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021 Aug;25(4):883-890. doi: 10.1007/s10029-021-02468-8. Epub 2021 Aug 6. |
| 23160432 | Result | Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther. 2013 Feb;43(2):54-64. doi: 10.2519/jospt.2013.4116. Epub 2012 Nov 16. |
| 32535475 | Result | Harput G, Ulusoy B, Akmese R, Ergun N. Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task. Clin Biomech (Bristol). 2020 Aug;78:105067. doi: 10.1016/j.clinbiomech.2020.105067. Epub 2020 Jun 6. |
| 27494053 | Result | Selkowitz DM, Beneck GJ, Powers CM. Comparison of Electromyographic Activity of the Superior and Inferior Portions of the Gluteus Maximus Muscle During Common Therapeutic Exercises. J Orthop Sports Phys Ther. 2016 Sep;46(9):794-9. doi: 10.2519/jospt.2016.6493. Epub 2016 Aug 5. |
| 21041966 | Result | Okubo Y, Kaneoka K, Imai A, Shiina I, Tatsumura M, Izumi S, Miyakawa S. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010 Nov;40(11):743-50. doi: 10.2519/jospt.2010.3192. |
| 34167019 | Result | Fan B, Xia H, Xu J, Li Q, Shull PB. IMU-based knee flexion, abduction and internal rotation estimation during drop landing and cutting tasks. J Biomech. 2021 Jul 19;124:110549. doi: 10.1016/j.jbiomech.2021.110549. Epub 2021 Jun 13. |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |