Search Results (40)

Introduction: Hip abductor strength is essential for pelvic stability, lower limb alignment, and injury prevention. Weaknesses of the gluteus medius and minimus contribute to various musculoskeletal conditions. Lateral band walks and monster walks are elastic resistance exercises commonly used to target the hip abductors and external rotators in functional, weight-bearing tasks. Therefore, the aim was to summarize the current evidence on the biomechanics, muscle activation, and clinical applications of lateral and monster band walks. Methods: This narrative review was conducted following the SANRA guideline. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and SPORTDiscus up to April 2025. Studies on the biomechanics, electromyography, and clinical applications of lateral band walks and monster walks were included, alongside relevant evidence on hip abductor strengthening. Results: A total of 13 studies were included in the review, of which 4 specifically investigated lateral band walk and/or monster walk exercises. Lateral and monster walks elicit moderate to high activation of the gluteus medius and maximus, especially when performed with the band at the ankles or forefeet and in a semi-squat posture. This technique minimizes compensation from the tensor fasciae latae and promotes selective gluteal recruitment. Proper execution requires control of the trunk and pelvis, optimal squat depth, and consistent band tension. Anatomical factors (e.g., femoral torsion), sex differences, and postural variations may influence movement quality and necessitate tailored instruction. Full article

Background: Sternal wound infections (SWIs) remain a significant complication following cardiac surgery. Inflammatory and nutritional status are increasingly recognized as key contributors to their development. This study aimed to investigate the predictive utility of immunonutritional biomarkers and to evaluate the protective effect of combining sternal irrigation with an antibiotic-impregnated membrane. Methods: This retrospective cohort study included 480 patients undergoing off-pump coronary artery bypass grafting. Patients were categorized based on sternal management strategy (standard closure or local prophylaxis using gentamicin-enriched irrigation combined with an antibiotic-impregnated fascia lata membrane) and according to the severity of SWIs, classified as superficial or deep. Inflammatory and nutritional markers—including C-reactive protein (CRP), neutrophils, lymphocytes, albumin, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI)—were assessed at three time points: preoperatively, on postoperative day 3, and after week 1. Results: SWIs were observed in 93 patients, including 75 superficial and 18 deep infections. The combined prophylactic approach was associated with a nearly 1.8-fold reduction in deep SWIs (OR: 0.55; 95% CI: 0.15–0.87) and a modest reduction in superficial infections (OR: 0.89; 95% CI: 0.5–1.3; p = 0.061). Threshold values of 3.75 for preoperative NLR, 9.8 for ΔNLR, and 16.7 for ΔCAR demonstrated strong predictive capacity for identifying patients at increased risk of developing deep SWIs. Patients receiving local prophylaxis exhibited significantly lower CRP, NLR, and CAR values and higher PNI levels at all time points. Conclusions: The combination of sternal irrigation and local antibiotic prophylaxis appears to confer protection against SWIs, potentially by mitigating postoperative inflammation. Immunonutritional biomarkers offer a promising means for early risk stratification. To confirm their clinical utility and broader applicability, these results should be validated in prospective, multicenter studies encompassing a wider range of cardiac surgical procedures. Full article

Background/Objectives: We aimed to review pediatric patients who underwent surgical treatment for posterior fossa tumors and to share our experience with the various types of dural grafts used in these patients. Methods: We carried out a retrospective study on pediatric patients who received surgical treatment for posterior fossa tumors and underwent duraplasty using either an autograft or a xenograft from January 2018 to December 2022. Data were gathered from patients’ medical records, encompassing demographic details. Additional information included tumor locations and the extent of resection. Factors such as postoperative complications like meningitis, pseudo-meningocele, and hydrocephalus were also noted. Results: Our cohort included 50 patients, 13 of whom underwent surgeries with autografts and 37 had xenografts. The patients’ tumors were in various areas, including intraventricular or those extending into the ventricle (31) and intracerebellar (17) and extra-axial (2) cases. Subtotal resection occurred in 8 cases, near-total resection in 9, and gross-total resection in 33. Postoperatively, meningitis occurred in 12 patients, pseudo-meningocele in 13, and hydrocephalus in 10, with 9 requiring V/P placement. Conclusions: In conclusion, techniques for dural closure hold great significance in neurosurgery, particularly during pediatric posterior fossa surgeries. Although the modest size of the autograft cohort limited statistical power, our epidural onlay fascia lata autograft produced fewer postoperative complications than the bovine xenograft and achieved outcomes comparable to those reported for watertight closure. Full article

Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered a possible approach for this issue. Objective: to understand how foot type and foot orthotics may influence the electromyographic (EMG) activity of the TFL. Methods: A total of 41 healthy recreational runners (mean age 32.66 ± 3.51) were recruited for the present cross-sectional study, categorizing them as neutral (NEUg = 15), supinators (SUPg = 15), and pronators (PROg = 11) according to the foot postural index, over a period of 11 months. The EMG of the TFL was measured using a surface electromyograph device while they ran on a treadmill at a constant speed of 9 km/h for 3 min, randomly using supinating (SUP), pronating (PRO), or heel lift (TAL) insoles of 5 mm each one, compared to the baseline condition (SIN). The intraclass correlation coefficient (ICC) was performed to check the reproducibility of the tests, pairwise comparisons with Bonferroni adjustment were made, and to test the differences between measurements, the Friedman test was performed. Results: The Shapiro–Wilk test indicated a normal distribution of the sample (p > 0.05). Almost all obtained results showed a “perfect reproducibility” close to one; a significant statistical increase was observed in the mean EMG values from NEUg (87.58 ± 4.81 mV) to SUPg (97.17 ± 4.3 mV) (p < 0.05) during SIN+ basal condition. Additionally, there was a statistical reduction from SIN (87.58 ± 4.81 mV) vs. PRO (74.69 ± 3.77 mV) (p < 0.001) in NEUg and from SIN (97.17 ± 4.3 mV) vs. PRO (90.96 ± 4 mV) (p < 0.001) in SUPg. Conclusions: The SUPg exhibited increased activation of TFL fibers compared to the NEUg, likely due to the biomechanical demands associated with a supinated foot type. In contrast, the use of PRO appeared to promote relaxation of the TFL fibers by inducing internal rotation of the lower limb. Based on these preliminary results from a cross-sectional study in a healthy population, it is recommended to assess foot type when addressing ITBS and to consider the use of PRO as a complementary therapeutic strategy alongside conventional treatments. Full article

Androgens are emerging as important regulators of connective tissue remodeling, but current knowledge about their role in human fascia is still limited. This study examined the expression of the androgen receptor (AR) in human deep fascia and investigated the effects of dihydrotestosterone (DHT) on collagen production by fascial fibroblasts. Fascia lata and thoracolumbar fascia samples were collected from four adult donors (two male and two female). AR expression was assessed by immunohistochemistry and immunocytochemistry. Fascial fibroblasts were treated in vitro for 24 h with DHT at concentrations reflecting physiological levels: 0.4 ng/mL (female), 4 ng/mL (male average), and 10 ng/mL (high male dose). Collagen content was quantified using Picrosirius Red staining, and collagen I and III were evaluated using immunocytochemistry and image analysis, and were compared to an untreated control group. AR was detected in all samples. Low-dose DHT (0.4 ng/mL) significantly increased collagen I (4.80 ± 1.75%) and decreased collagen III (3.32 ± 0.46%) compared to controls (2.09 ± 0.91% and 10.46 ± 0.53%, respectively; p < 0.05). Higher DHT doses induced smaller or no significant changes in collagen subtype expression (e.g., 10 ng/mL: 2.03 ± 0.81% for collagen I, 8.49 ± 1.85% for collagen III). The results demonstrated that human fascia is hormonally responsive via AR, with DHT modulating matrix composition in a dose-dependent manner. The distinct effects at male and female levels may help explain gender differences in fascial stiffness and pain. Full article

This study investigates the influence of probe angulation on echogenicity and thickness measurements of the deep fascia, addressing methodological challenges in musculoskeletal ultrasound examination. The anisotropic nature of connective tissues can lead to distortions, affecting US imaging accuracy and diagnostic reliability. Echogenicity and thickness variations were analyzed across different probe inclinations in both transverse and longitudinal orientations. Measurements at 0° were compared with −5° and +5° angles to assess their impact on imaging consistency due to 3D-printed support. Echogenicity differed significantly with probe angulation, in particular in transverse scan at 0°, which showed substantial variation at −5° (mean diff. = 55.14, p < 0.0001) and +5° (mean diff. = 43.75, p = 0.0024). Thickness measurements also varied, reinforcing that non-perpendicular probe angulation introduces distortions. The same results were reported for longitudinal scans. These findings highlight the need for the use of standardized scanning protocols to improve reliability. The protean nature of deep fascia anisotropy, highly sensitive to minimal changes in probe orientation, necessitates precise and consistent imaging to accurately reveal its structural organization. Optimizing probe orientation is essential for advancing fascial US diagnostics. Full article

This study examined the impact of different breath-holding conditions on iliopsoas and other hip flexor muscle activity in individuals with chronic ankle instability (CAI). It has been hypothesised that impaired diaphragmatic function influences iliopsoas activation, potentially contributing to motor control deficits in patients with CAI. Eleven adults with a history of chronic ankle sprain participated in this study. Maximal isometric hip flexion was assessed under three breath-holding conditions: end-expiration, end-inspiration, and the intermediate state. Surface electromyography was used to record the muscle activity of the iliopsoas, rectus femoris, sartorius, and tensor fasciae latae, while the peak hip flexion torque was measured using an isokinetic dynamometer. Under the end-inspiration condition, iliopsoas activity on the affected side was significantly lower than that on the control side (p < 0.05). However, no significant differences were observed between the affected and control sides in the activity of the other hip flexor muscles or the peak hip flexion torque across breath-holding conditions. This study highlights the association between reduced iliopsoas activity during end-inspiration and compromised diaphragmatic function in patients with CAI. Future research should explore dynamic movement tasks and larger sample sizes to elucidate neuromuscular mechanisms further and refine rehabilitation strategies. Full article

Background/Objectives: Hip abductor weakness is a common issue in patients with lower back pain, knee osteoarthritis, and hip disorders, and compromises pelvic stability, gait control, and function. Side-lying hip abduction exercises are widely used as safe and effective interventions for patients unable to perform high-load or weight-bearing activities. However, the influence of ankle joint angles and distal muscle activity on the hip abductor muscles remains unclear. This study aimed to investigate the effects of ankle joint angles and activation states on unilateral right hip abductor strength and muscle activity. Methods: Fifteen healthy male adults (29.1 ± 5.4 years) participated. Surface electromyography (EMG) was used to measure the activity of the tensor fasciae latae (TFL), gluteus medius (G-med), gluteus maximus, tibialis anterior, and medial gas-trocnemius muscles. Hip abduction strength was evaluated in a side-lying position with the ankle positioned at three angles (neutral, dorsiflexion, and plantarflexion) and in three activation states (no activation, maximal dorsiflexion, and maximal plantarflexion). Two-factor (3 × 3) repeated measures ANOVA was used to analyze strength and EMG activity. Results: ANOVA revealed a significant interaction effect. The results of the simple main effects showed significantly higher hip abduction strength in dorsiflexion than in the neutral position and plantarflexion (p < 0.001). TFL and G-med EMG activities peaked during dorsiflexion, particularly under maximal dorsiflexion. Conclusions: These findings suggest that dorsiflexion enhances hip abductor strength and activity by increasing fascial tension (lateral line and superficial backline) and improving limb alignment. This approach may provide effective rehabilitation strategies. This is a load-adjustable training recovery approach that should be confirmed with future intervention studies. Full article

Objectives: The objectives of this study were to develop a procedure to measure the cross-sectional area and thickness of tensor fasciae latae muscle, and examine the intra- and inter-rater reliability of this procedure in healthy participants. Methods: The cross-sectional area and thickness of tensor fascia latae were evaluated by sonography in 14 healthy subjects (28 lower extremities) in a single session. Two examiners conducted ultrasound examinations and performed the measurements independently. Each examiner was blinded to the measurements of the other examiner. For examination, the transducer was placed transversally to the thigh at the anterior superior iliac spine level and was moved caudally along the tensor fascia latae muscle, ensuring that the volume of the muscle was in the center of the image. The examiners took ultrasound images when the maximum size was reached. Results: The intra-rater reliability for tensor fascia latae measurements was excellent in both examiners (cross-sectional area: ICC2,2 = 0.905–0.969, SEM = 0.29–0.82 mm², MDC = 0.80–2.27; thickness: ICC2,2 = 0.965–0.985, SEM = 0.20–0.60 mm, MDC = 0.55–1.66; all p < 0.001). The inter-rater reliability was good for the cross-sectional area (ICC2,2 = 0.783, SEM = 0.77 mm², MDC = 2.13 mm²). The inter-rater reliability was poor for thickness measurements (ICC2,2 = 0.445, SEM = 2.12 mm, MDC = 5.87 mm) and 2.12 mm for thickness. Conclusions: The procedure developed for measuring the size of the tensor fascia latae muscle with ultrasound images has demonstrated feasibility and excellent intra-rater reliability. The inter-rater reliability was good and poor for cross-sectional area and thickness measurements, respectively. Full article

Background/Objectives: Preoperative muscle atrophy leads to persistent gait abnormalities in patients undergoing total hip arthroplasty (THA). Efficient motor learning of the gluteus medius is crucial for their recovery. In this study, a single-joint hybrid assistive limb (HAL) was developed to assist hip abduction. We aimed to evaluate the muscle activity and safety of this device during hip abduction in healthy adults. Methods: Ten healthy adults (five males and five females; mean age, 40.7 years) with no hip disorders performed one set of 30 repetitions of side-lying hip abduction under three conditions: without HAL (pre-HAL), with HAL, and without HAL (post-HAL). Muscle activities of the gluteus medius, gluteus maximus, tensor fasciae latae, rectus femoris, and biceps femoris (expressed as percentage of maximum voluntary contraction [%MVC]); vital signs; hip visual analog scale (VAS); and hip abduction and flexion angles were assessed. The mean values were compared among the conditions. Results: The %MVC of the gluteus medius significantly increased from 52% (pre-HAL) to 75.4% (HAL) and then decreased slightly to 61.6% (post-HAL). No other muscle groups showed significant changes. Vital signs and hip VAS scores showed no significant variation. Although no significant differences were found in the hip abduction and flexion angles, a reduction in the hip flexion angle was observed in the HAL and post-HAL conditions. Conclusions: The hip abduction HAL effectively and safely enhanced gluteus medius activity. Reduction in the hip flexion angle during HAL and post-HAL suggests the possibility of appropriate abduction movements and motor learning effects. Full article

(1) Background: Activation of the gluteus medius (GM) muscle while minimizing the involvement of the tensor fascia latae (TFL) is crucial in treating many lower limb and lumbar spine injuries. Previous studies have demonstrated the effectiveness of joint manipulations in regulating muscle activity. The main objective of this study was to evaluate the effects of hip joint manipulation (HJM) on the muscle strength and activity (GM and TFL) of hip abductors in asymptomatic young participants. (2) Methods: The study followed a double-blind randomized controlled design. Thirty healthy, physically active women and men, free from spinal and lower limb injuries, voluntarily participated. The participants were allocated to two groups: those allocated to the HJM intervention and those in the control group receiving a sham intervention. They were assessed before and after the intervention using surface electromyography to measure muscle activation (EMG_RMS) of the GM and TFL during maximal voluntary isometric hip abduction. (3) Results: HJM resulted in a significant increase in EMG_RMS amplitude solely within the GM muscle (p < 0.01); (4) Conclusions: This study suggests that HJM may increase EMGRMS amplitude in the GM muscle; however, the effects are neither statistically nor clinically significant when compared to the control group for most of the muscles analyzed. Full article

Background/Objectives: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. Methods: A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. Results: At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 (p = 0.02), with highly significant gains by month 6 (p < 0.01), which remained stable through month 12 (p < 0.01). Conclusions: Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy. Full article

The objective of this study was to determine the daily dietary nicotinamide riboside (NR) dose required to maximize the delay of subjective muscle fatigue onset. Barrows (N = 100) were assigned to one of five treatments: a conventional swine finishing diet containing 0 (CON), 15 (15NR), 30 (30NR), 45 (45NR) mg·kg body weight⁻¹·d⁻¹ NR, or CON supplemented with 45 mg·kg body weight⁻¹·d⁻¹ NR by drench or cookie dough (DRE). All treatments were administered for the final 11 days of feeding. On supplementation d 10, barrows individually experienced a performance test at 1.09 m/s until they were subjectively exhausted. Wireless electromyography (EMG) sensors were affixed to the biceps femoris (BF), tensor fascia latae (TFL), and semitendinosus (ST) to measure real-time muscle activity. There were no treatment effects for barrow speed (p = 0.57), a tendency for a treatment effect (p = 0.07) for distance, and a treatment effect (p = 0.04) on time to exhaustion. Barrows of the 15NR and DRE treatments had greater (p = 0.05) distances to exhaustion than CON barrows but did not differ from other NR barrows (p > 0.11). Barrows in the 45NR treatment did not differ (p = 0.11) in distance from 30NR barrows but tended to have a greater (p = 0.07) distance compared to CON barrows. All other treatment comparisons did not differ (p > 0.27). Barrows in the DRE treatment moved for longer (p < 0.01) than CON barrows, but all other treatments did not differ from each other (p > 0.15). There was no treatment × period interaction for all muscles’ root mean square (RMS) values (p > 0.16), but there were Period effects for all muscles (p < 0.01) and a Treatment effect (p = 0.04) in the TFL. For all muscles, period 4 had greater RMS values than all other periods (p < 0.01), who did not differ from each other (p > 0.29). In the TFL, CON barrows had greater RMS values during the performance test compared to all NR treatments (p < 0.02), who did not differ from each other (p > 0.18). Overall, NR demonstrates potential in being a useful tool in fatigue prevention, but efficient administration of the compound needs further investigation. Full article

Background: Despite the potential connection between hip and knee muscle control, there is limited research on the effects of hip abductor fatigue on the hip and knee neuromuscular responses in both males and females. This study aimed to investigate the influence of sex on the hip and knee frontal plane kinematics and the EMG responses of the hip abductors and knee extensor muscles during the single-leg squat before and after hip abductor fatigue. Methods: A total of 30 participants (males, n = 15; females, n = 15) performed single-leg squats before and immediately after a hip abductor fatigue protocol (10° hip abduction position while bearing a 20% load of their estimated 1RM until exhaustion). The frontal plane kinematics (hip adduction and knee frontal plane projection angle) and EMG parameters (amplitude and median frequency) of the gluteus medius (GMed), tensor fascia latae (TFL), vastus lateralis (VL) and vastus medialis (VM) were measured during the single-leg squat. Results: We did not find any effects of hip abductor fatigue or interaction between fatigue and sex on the evaluated parameters (p > 0.05). However, compared to males, females had greater values for the hip and knee frontal plane kinematics (p = 0.030), GMed EMG amplitude (+10.2%, p = 0.012) and median frequency (+10.3%; p = 0.042) and lower VL median frequency (−9.80%; p = 0.007). Conclusions: These findings establish sex-related differences in the kinematics and hip and knee EMG parameters during the single-leg squat, which were not influenced by the hip abductor fatigue protocol. Full article

This study validated muscle activation estimations generated by OpenSim during the gait of elderly fallers. Ten healthy elderly participants walked on an instrumented treadmill, monitored by motion capture, force platforms, and 12 surface EMG sensors. Static optimization was used to calculate muscle activations, evaluated through cosine similarity, comparing them with EMG signals from 12 muscles of the right leg. Findings revealed varied similarity levels across muscles and gait phases. During stance phase, tibialis anterior (TIBA), peroneus longus (PERL), soleus (SOL), gastrocnemius lateralis (GASL), semitendinosus (SEMI), tensor fasciae latae (TFL), and rectus femoris (RECF) demonstrated poor similarity (cosim < 0.6), while gluteus medius (GMED), biceps femoris long head (BFLH), and vastus lateralis (VL) exhibited moderate similarity (0.6 ≤ cosim ≤ 0.8), and gluteus maximus (GMAX) and vastus medialis (VASM) displayed high similarity (cosim > 0.8). During the swing phase, only SOL demonstrated inadequate similarity, while GASL, GMAX, GMED, BFLH, SEMI, TFL, RECF, and VASL exhibited moderate similarity, and TIBA, PERL, and VASM showed high similarity. Comparing the different 10% intervals of the gait cycle generally produced more favorable similarity results. For most of the muscles and intervals, good agreement was found. Moderate agreement was estimated in the cases of TIBA (0–10%), PERL (60–70%), GASL (60–70%), TFL (10–20%), RECF (0–10%, 80–100%), and GMED (50–60%). Bad agreement was found in the cases of SOL (60–70%), GASL (0–10%), and TFL (0–10%). In conclusion, the study’s validation outcomes were acceptable in most cases, underlining the potential for user-friendly musculoskeletal modeling routines to study muscle output during elderly gait. Full article