Impaired Lower Extremity Biomechanics, Hip External Rotation Muscle Weakness, and Proximal Femoral Morphology Predict Impaired Single-Leg Squat Performance in People With FAI Syndrome

Malloy, Philip; Wichman, Daniel M.; Garcia, Flávio Luís; Espinoza-Orías, Alejandro; Chahla, Jorge; Nho, Shane J.

doi:10.1177/03635465211029032

Cited by 12 publications

(30 citation statements)

References 29 publications

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“…Despite these small differences in depth, hip and knee sagittal plane dynamic motion may signify an important biomarker for patients’ functional performance after surgery, considering that these variables were shown to also be impaired compared with controls in another study. 18…”

Section: Discussionmentioning

confidence: 99%

“…A 20-camera motion capture system (Optitrack, Natural Point Inc.) and force plates (Bertec Corp.) acquired 3-dimensional kinematic and kinetic data at 100 and 1000 Hz, respectively, using a marker set previously described in detail. 18 A static standing calibration trial was recorded before any movement trials to define body segment parameters based on the marker positions from this trial. After the static trial, all participants then performed 3 individual trials of an SLS task using a self-selected strategy previously described in detail.…”

Section: Methodsmentioning

confidence: 99%

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Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Swindell,

Wichman,

Guidetti

et al. 2023

Am J Sports Med

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Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score ( r = 0.665) and (2) knee ROM with the 6 month ( r = 0.590) and 1-year ( r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Swindell,

Wichman,

Guidetti

et al. 2023

Am J Sports Med

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“…[33][34][35] Recently, hip biomechanics and muscle strength were also found to be predictors of impaired performance of a single-leg squat in people with FAIS. 36 Since AM desired to return to a high level of activity a single-leg squat task was selected to assess her movement (see link in references for the video). 37,38 CASSS & Key observations: Using the CASSS, a visual observation was conducted during a single leg squat with her involved and uninvolved limbs.…”

Section: Case Example 3: Femoroacetabular Impingement Syndrome In a Young Active Adultmentioning

confidence: 99%

“…Additionally, the patient may exhibit 4) force impairments of the hip abductors, extensor, and external rotator muscles that could also limit the ability to achieve equal single-leg squat depth. 36,[39][40][41] Application of the 4-Element Movement System Model to Sports Physical Therapy Practice and Education…”

Section: Case Example 3: Femoroacetabular Impingement Syndrome In a Young Active Adultmentioning

confidence: 99%

Application of the 4-Element Movement System Model to Sports Physical Therapy Practice and Education

Zarzycki

Malloy

Eckenrode

et al. 2022

International Journal of Sports Physical Therapy

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The 4-Element Movement System Model describes primary elements (motion, force, motor control, and energy) essential to the performance of all movements. The model provides a framework or scaffolding which allows for consistent processes to be used in examination and intervention decisions. The process starts with task identification followed by a systematic observation of control, amount, speed, symmetry, and symptoms during movement. Testable hypotheses are generated from the observations which inform the examination and the interventions. This commentary describes the use of the 4-Element Movement System Model in entry level and post-graduate residency educational programs and in clinical care with three common sports-related diagnoses.

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“…People with FAIS often present with lower hip strength compared with healthy controls 6,9,25,26 and asymptomatic people with cam morphology. 6 Thus, it is possible that muscle weakness and task demands may prevent individuals with FAIS from avoiding pain-provoking positions of impingement (deep hip flexion combined with adduction and internal rotation).…”

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confidence: 99%

Running Mechanics After Repeated Sprints in Femoroacetabular Impingement Syndrome, Cam Morphology, and Controls

Gonçalves

Saxby

Meinders

et al. 2022

Sports Health: A Multidisciplinary Approach

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Background: People with femoroacetabular with femoroacetabular impingement syndrome (FAIS) often report pain during sports involving repeated sprinting. It remains unclear how sports participation influences running biomechanics in individuals with FAIS. Hypothesis: Changes in running biomechanics and/or isometric hip strength after repeated sprint exercise would be greatest in individuals with FAIS compared with asymptomatic individuals with (CAM) and without cam morphology (Control). Study Design: Controlled laboratory study. Level of Evidence: Level 3. Methods: Three-dimensional hip biomechanics during maximal running (10 m) and hip strength were measured in 49 recreationally active individuals (FAIS = 15; CAM = 16; Control = 18) before and after repeated sprint exercise performed on a nonmotorized treadmill (8-16 × 30 m). Effects of group and time were assessed for biomechanics and strength variables with repeated-measures analyses of variance. Relationships between hip pain (Copenhagen Hip and Groin Outcome Score) and changes in hip moments and strength after repeated sprint exercise were determined using Spearman’s correlation coefficients (ρ). Results: Running speed, hip flexion angles, hip flexion and extension moments, and hip strength in all muscle groups were significantly reduced from pre to post. No significant between-group differences were observed before or after repeated sprint exercise. No significant relationships (ρ = 0.04-0.30) were observed between hip pain and changes in hip moments or strength in the FAIS group. Conclusion: Changes in running biomechanics and strength after repeated sprint exercise did not differ between participants with FAIS and asymptomatic participants with and without cam morphology. Self-reported pain did not appear to influence biomechanics during running or strength after repeated sprint exercise in participants with FAIS. Clinical Relevance: A short bout of repeated sprinting may not elicit changes in running biomechanics in FAIS beyond what occurs in those without symptoms. Longer duration activities or activities requiring greater hip flexion angles may better provoke pathology-related changes in running biomechanics in people with FAIS.

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Impaired Lower Extremity Biomechanics, Hip External Rotation Muscle Weakness, and Proximal Femoral Morphology Predict Impaired Single-Leg Squat Performance in People With FAI Syndrome

Cited by 12 publications

References 29 publications

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Application of the 4-Element Movement System Model to Sports Physical Therapy Practice and Education

Running Mechanics After Repeated Sprints in Femoroacetabular Impingement Syndrome, Cam Morphology, and Controls

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