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The purpose of this study is to determine if an isometric gluteal activation home exercise program (HEP) combined with a movement retraining program utilizing feedback cues produces significant changes in scores on the Forward Step-Down Test (FSDT) in healthy young adults with movement coordination impairments.
Aim 1: To determine if an isometric gluteal activation HEP with a movement retraining program with feedback cues produces significant changes on scores FSDT compared to the gluteal activation HEP alone.
Aim 2: To determine if an isometric gluteal activation HEP followed with a movement retraining program with feedback cues produces significant changes on category FSDT compared to gluteal activation HEP alone.
Aim 3: To determine if an isometric gluteal activation HEP with a movement retraining program with feedback cues produces changes in the peak activation of the gluteus medius (GMed) and gluteus maximus (GMax) during the FSDT compared to the gluteal activation HEP alone.
Aim 4: To determine if an isometric gluteal activation HEP with a movement retraining program with feedback cues produces changes in the mean activation of the GMed and GMax during the FSDT compared to the gluteal activation HEP alone.
Aim 5: To determine if HEP dose has an effect on the FSDT response, as measured by change in score on the FSDT.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Gluteal Activation Group | Active Comparator | The Control group will receive an HEP focusing on isometric gluteal activation. |
|
| Gluteal Activation Plus Movement Training Group | Experimental | The Experimental group will receive an HEP focusing on isometric gluteal activation plus movement retraining program. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Control HEP focusing on isometric gluteal activation | Other | All participants will receive the HEP for hip muscle activation training. The HEP for hip musculature activation consists of five isolated hip activation exercises including side-lying clams, side-lying clams with trunk activation via side-plank, side-lying hip abduction, side-lying hip abduction with trunk activation via side-plank, and fire hydrants all of which improve hip gluteal recruitment. After the 4th week, both groups are to return to the clinic and asked to briefly perform exercises from their HEP so that their form can be reassessed with any modifications if needed along with any questions that they may have. Each participant following the 8-week period will be scheduled to return to the clinic to turn in their compliance form and perform follow-up surface electromyography (sEMG), weight, and FSDT using the same procedures as before. |
| 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). | Baseline and after 8-week Home Exercise Program (HEP) intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Peak Maximal Volitional Isometric Contraction (MVIC) on Gluteus Maximus (GMax). | Peak activation (percent of maximal volitional isometric contraction [%MVIC]) of GMax during performance of the FSDT | Baseline and after 8-week HEP intervention. |
| Peak Maximal Volitional Isometric Contraction (MVIC) on Gluteus Medius (GMed). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Erin McCallister, PT, DPT | 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 |
|---|---|---|---|
| 20118526 | Background | 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. | |
| 37422984 | Background | Nascimento MB, Vilarinho LG, Lobato DFM, Dionisio VC. Role of gluteus maximus and medius activation in the lower limb biomechanical control during functional single-leg Tasks: A systematic review. Knee. 2023 Aug;43:163-175. doi: 10.1016/j.knee.2023.05.005. Epub 2023 Jul 7. |
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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 | Nov 13, 2025 | Nov 20, 2025 | 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 investigator performing the data analysis will be blinded from the group allocation of the participants.
|
| Experimental HEP focusing on isometric gluteal activation plus a movement retaining program | Other | Only participants in the experimental group will receive the movement retraining program HEP. The HEP will be a combination of single leg Romanian Deadlift (RDL), single leg squat, and standing split squat that have been used in previous research and are proved to get significant gluteus medius (Gmed) activation. They will also participate in the gluteal activation HEP program that have been proved to increase hip musculature recruitment, as performed by the control group. After the 4th week, both groups are to return to the clinic and asked to briefly perform exercises from their HEP so that their form can be reassessed with any modifications if needed along with any questions that they may have. Each participant following the 8-week period will be scheduled to return to the clinic to turn in their compliance form and perform follow-ups sEMG, weight, and FSDT using the same procedures as before. |
|
Peak activation (%MVIC) of GMed during performance of the FSDT |
| Baseline and after 8-week HEP intervention. |
| Mean Maximal Volitional Isometric Contraction (MVIC) on Gluteus Maximus (GMax). | Mean activation (% MVIC) of GMax during performance of the FSDT | Baseline and after 8-week HEP intervention. |
| Mean Maximal Volitional Isometric Contraction (MVIC) on Gluteus Medius (GMed). | Mean activation (% MVIC) of GMed during performance of the FSDT | Baseline and after 8-week HEP intervention. |
| HEP Compliance - Dose Response Relationship with FSDT and MVIC outcomes | Self-reported completion of each HEP session will be recorded by the participant and then returned to the investigators post-completion | After 8-week intervention. |
| 33172101 | Background | Wilczynski B, Zorena K, Slezak D. Dynamic Knee Valgus in Single-Leg Movement Tasks. Potentially Modifiable Factors and Exercise Training Options. A Literature Review. Int J Environ Res Public Health. 2020 Nov 6;17(21):8208. doi: 10.3390/ijerph17218208. |
| 35413665 | Background | Branco GR, Resende RA, Bittencourt NFN, Mendonca LD. Interaction of hip and foot factors associated with anterior knee pain in mountain bikers. Phys Ther Sport. 2022 May;55:139-145. doi: 10.1016/j.ptsp.2022.04.001. Epub 2022 Apr 5. |
| 38996451 | Background | McCallister E, Hughs C, Smith M, Flowers DW. Does a Hip Muscle Activation Home Exercise Program Change Movement Patterns on the Forward Step-Down Test? J Sport Rehabil. 2024 Jul 12;33(6):452-460. doi: 10.1123/jsr.2023-0372. Print 2024 Aug 1. |
| Background | McCallister E, Bonvillain A, Christy A, Sensley C, & Flowers, DW. Effect of Adding Single-Leg Balance Training With a Hip Muscle Activation Program on Frontal Plane Movement Quality: A Randomized Controlled Trial in Adult Females. Women Sport Phys Act J. 2025;33(1):1-16. doi:10.1123/wspaj.2024-0091 |
| 37828484 | Background | Peleg S, Pelleg-Kallevag R, Almog Y, Herman G, Nakdimon O, Arnon M, Dar G. Forward step down test - clinical rating is correlated with joint angles of the pelvis and hip: an observational study. BMC Musculoskelet Disord. 2023 Oct 12;24(1):807. doi: 10.1186/s12891-023-06943-4. |
| 32170556 | Background | Davis IS, Tenforde AS, Neal BS, Roper JL, Willy RW. Gait Retraining as an Intervention for Patellofemoral Pain. Curr Rev Musculoskelet Med. 2020 Feb;13(1):103-114. doi: 10.1007/s12178-020-09605-3. |
| 34843301 | Background | Chua LK, Jimenez-Diaz J, Lewthwaite R, Kim T, Wulf G. Superiority of external attentional focus for motor performance and learning: Systematic reviews and meta-analyses. Psychol Bull. 2021 Jun;147(6):618-645. doi: 10.1037/bul0000335. |
| 34976475 | Background | Moinuddin A, Goel A, Sethi Y. The Role of Augmented Feedback on Motor Learning: A Systematic Review. Cureus. 2021 Nov 18;13(11):e19695. doi: 10.7759/cureus.19695. eCollection 2021 Nov. |
| 36918403 | Background | Collings TJ, Bourne MN, Barrett RS, Meinders E, GONcALVES BAM, Shield AJ, Diamond LE. Gluteal Muscle Forces during Hip-Focused Injury Prevention and Rehabilitation Exercises. Med Sci Sports Exerc. 2023 Apr 1;55(4):650-660. doi: 10.1249/MSS.0000000000003091. |
| 22034614 | Background | Boren K, Conrey C, Le Coguic J, Paprocki L, Voight M, Robinson TK. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. Int J Sports Phys Ther. 2011 Sep;6(3):206-23. |
| 19574661 | Background | Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. 2009 Jul;39(7):532-40. doi: 10.2519/jospt.2009.2796. |
| 22973257 | Background | Aiken CA, Fairbrother JT, Post PG. The effects of self-controlled video feedback on the learning of the basketball set shot. Front Psychol. 2012 Sep 11;3:338. doi: 10.3389/fpsyg.2012.00338. eCollection 2012. |
| 29287067 | Background | van Melick N, Meddeler BM, Hoogeboom TJ, Nijhuis-van der Sanden MWG, van Cingel REH. How to determine leg dominance: The agreement between self-reported and observed performance in healthy adults. PLoS One. 2017 Dec 29;12(12):e0189876. doi: 10.1371/journal.pone.0189876. eCollection 2017. |
| Background | Konrad P. The ABC of EMG: A Practical Introduction to Kinesiological Electromyography. Noraxon U.S.A.; 2006. |
| 32535475 | Background | 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. |
| 23160432 | Background | 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. |
| 27494053 | Background | 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. |
| 29163219 | Background | Hopper AJ, Haff EE, Joyce C, Lloyd RS, Haff GG. Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11-13 Year Old Female Netball Athletes: A Randomized Control Study. Front Physiol. 2017 Nov 7;8:883. doi: 10.3389/fphys.2017.00883. eCollection 2017. |
| 12937582 | Background | 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. |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |