Posts tagged hip strengthening
Hip Strength Shown To Have Protective Effect Against Worsening Of Knee Arthritis
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Knee arthritis will affect many older adults limiting their ability to participate in their daily, occupational, and recreational activities. Lost independence and function is one of the most common concerns among patients with knee arthritis who are treated in our Boulder Physical Therapy practice. In addition to manual therapy to the involved joints, exercise remains the gold standard of conservative treatment for this condition. Specifically strength training has been shown to both reduce knee pain and improve function and independence among older adults. New research suggests this form of exercise may also prevent progression of arthritis.

Chang and colleagues examined the association between hip abductor strength on both cartilage injury progression and patient function in patients with knee arthritis (Osteoarthritis and Cartilage. 2019). They enrolled 275 knee in 164 patients with knee arthritis. All patients were given baseline strength and functional assessments, as well as, x rays of their knees. Authors reported patients who had greater hip abduction strength at baseline demonstrated reduced progression of their arthritis at 2 year follow up. In addition, these stronger individuals had a reduced risk of disability and an improved functional level at 5 year follow up. Authors reported these findings provide support for the important role of hip strengthening in modifying the disease progression of arthritis.

Which Muscles Should I Strengthen For Knee Arthritis
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Knee osteoarthritis is a common and increasing diagnosis that is contributing to an rapid rise in total knee arthroplasty surgery in the United States. Knee Osteoarthritis leads to disability in greater than 10% of those over 55 years, however manual therapy and exercise has shown to be twice as successful compared to a home exercise program in short term pain and function. More importantly, research has shown this Physical Therapy approach can postpone or prevent the need for knee replacement. One of most common complaints from patients with knee arthritis is pain with walking or ascending/descending stairs. Weakness of the quadriceps, hip adductors (inner thigh) and abductors (outer hip) are crucial to improving stair climbing and squatting ability.

A recent study (Hislop et al. 2019. Br J Sports Med) aimed to find the benefit of adding hip strengthening exercises to quad strengthening exercises among people with Knee Osteoarthritis. Authors randomized participants with knee arthritis into one of two groups: knee strengthening or knee and hip strengthening. Consistent with clinical practice, the authors found a decrease in patient related pain as well as improvements in patient function in patients who combined hip and knee strengthening exercises compared to knee strengthening exercises alone.

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Optimizing Glut Activation During The Crab Walk
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Strengthening the muscles of the hip, gluts, is a key component of rehabilitation for patients with low back pain, hip pain, and knee pain. These muscles help to optimize movement in the lower quarter improving joint mechanics and force distribution during life and recreational activities. In our Facebook posts, we have shown videos on optimizing the firing in the muscles on the back and side of the hips. These videos detail beginning, intermediate, and advanced exercises for each muscle group. One commonly utilized exercise is the crab walk which incorporates a lateral side stepping movement against a resistance band. A new research article highlights how placement of the band can optimize recruitment of the glut muscles.

Lewis and colleagues analyzed the activation of the glut muscles during a crab walk exercise using different elastic band positions (J Athletic Training. 2019). 22 healthy adults were asked to side step with the elastic band around the knees, ankles, and feet. During each 3 of the conditions, researchers analyzed EMG activity from the hip muscles including the TFL, gluteus medius, and gluteius maximus. As expected, increased glut work was found when the band was moved from the knees to the ankles lengthening the lever. Interestingly, placing the band around the feet increased the glut work without increasing the contribution from the TFL (often a muscle we try to utilize less during exercise). Thus, placing the band around the feet may be an optimal position to recruit the hip with less contributing from compensatory muscles.

Hip Strengthening Improves Outcomes In Patients With Knee Arthritis
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Knee Osteoarthritis is one of the leading causes of disability today. This painful condition limits an individual’s ability to walk, climb stairs, stand, and participate in recreational activities. Patient’s often demonstrate significant impairments in mobility and strength in both the knee, but also the ankle and hip. When evaluating patients with knee arthritis, Physical Therapists aim to examine and treat regions which either precipitate or perpetuate arthritic symptoms. Hip strength and coordination is a key area of our focus due to its’ influence on knee joint loading during gait and functional movements. Abnormal gait and movement may perpetuate the intra-articular joint inflammation and pain.

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As highlighted in a previous blog, patients with knee osteoarthritis display weakness and atrophy in their hip muscles. A review of the available evidence in the Journal of Geriatric Physical Therapy (Y.V. Raghava Neelapal et al. 2018) reported on the effect of hip strengthening on knee pain and physical function in those who have knee osteoarthritis. The review article included 5 randomized controlled trails and a total of 331 patients. Consistent with our clinical practice, authors reported improvements in knee pain and function after their Physical Therapists implemented hip strengthening exercises into their exercise programs. Interestingly, despite improvements in hip strength and knee function, knee mechanics did not improve as consistently with the exercise interventions. Impairments in knee biomechanics require motor control or coordination interventions in addition to strengthening.

Schedule with MEND to learn more about which hip exercises work best for your Knee Osteoarthritis.

Hip Muscle Atrophy Found Among Patients With Knee Arthritis
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Patient’s with knee arthritis often experience pain with weight bearing activities including, standing, walking, stair climbing, and hiking. In our Physical Therapy practice, we find impairments of range of motion, gait deviations, balance, and strength within this patient population. In particular, weakness of the quadricep and hip musculature contributes to pain during weight bearing activities. The lower body muscles act as shock absorbers for the knee joint dissipating forces and reducing loads at the joint surface. Patients who regain their lost strength experience significantly less symptoms with the activities they enjoy.

A recent study in the journal Osteoarthritis and Cartilage examined the hip muscle volumes of patients with knee arthritis vs. their age matched peers (Ackland et al. 2018). Patients and controls all underwent a gait analysis, as well as, a MRI to determine the muscle volume of their gluteus medius, gluteus minimus, and TFL (tensor fascia lata) musculature. Authors noted significantly smaller hip musculature in patient’s with knee arthritis compared to their age matched peers. In addition, muscle atrophy was associated with abnormal gait mechanics. There is currently evidence for both the development of weakness after the onset of knee pain, as well as, evidence documenting weakness as an independent risk factor for the development of knee pain. Patient’s with knee arthritis are encouraged to utilize Physical Therapy interventions to regain their lower body strength in order to optimize their participation in the activities they enjoy.

Contact the experts at MEND to learn which exercises are most effective for your knee symptoms

Athletes With Hip Weakness Experience Twice As Many Ankle Sprains
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Ankle sprains remain one of the most common musculoskeletal injuries treated by Physical Therapists.  Our previous blog posts have highlighted the importance of early diagnoses and treatment including manual therapy, as well as, strengthening and balance exercises.  This treatment approach has been proven superior to both R.I.C.E. (rest, ice, compression, and elevation) and usual medical care.  Many ankle sprains become recurrent without treatment secondary to the alterations in agility, balance, and muscle recruitment across the leg.  We often find weakness in both the hip and leg musculature in patients after ankle sprain, but a new study indicates this weakness may have been present before the sprain.

Powers and colleagues in the Journal of Athletic Training followed 210 competitive male soccer players after a preseason clinical examination (2017).  Athletes underwent multiple clinical tests, including a hip strength assessment prior to beginning their competitive season.  Authors report 12% of the soccer athletes sustained a lateral ankle sprain during the season.  Athletes categorized as high risk were unable to produce >34% of their body weight during the hip strength assessment.  These high risk athletes experienced twice as many ankle sprains as their stronger peers.   

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