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Fujiwara Y, Shoji T, Ota Y, Saka H, Inoue T, Kato Y, Sumii J, Yasunaga Y, Adachi N. Relationships among hip instability, iliofemoral ligament, and pain in patients with developmental dysplasia of the hip. J Orthop Sci 2024; 29:835-840. [PMID: 36931978 DOI: 10.1016/j.jos.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/25/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND To evaluate the relationships among hip instability, pain, and morphology of the iliofemoral ligament (ILFL) in patients with developmental dysplasia of the hip (DDH) using ultrasonography (US). METHODS We reviewed 86 patients (109 hips) with DDH (Group D), 40 patients (46 hips) with borderline hip dysplasia (BDDH) (Group B) and 20 patients (23 hips) without hip pain and bony abnormality (control group). Group D was classified into three subgroups-the severe (group SP), moderate (group MP), and none/mild (group NMP) hip pain groups-using the visual analogue scale (VAS). For evaluating hip instability and ILFL morphology, the distance between the anterior edge of the anterior inferior iliac spine (AIIS) and the horizontal line to the femoral head, and ILFL thickness were measured using US. The difference between the distance in the neutral position and Patrick position was calculated and defined as the femoral head translation distance (FTD). RESULTS FTD and ILFL thickness in group D were significantly larger than those in the control group and group B (P < 0.05). There was a significant positive correlation between FTD and ILFL thickness in three groups (r = 0.57, P < 0.05; r = 0.55, P < 0.05; r = 0.62, P < 0.05, respectively). FTD and ILFL thickness in group SP were significantly larger than those in group NMP (P < 0.05). FTD and ILFL thickness in group D had significantly negative correlations with the lateral center edge (r = -0.54, P < 0.05; r = -0.40, P < 0.05, respectively) and vertical-center-anterior angle (r = -0.51, P < 0.05; r = -0.43, P < 0.05, respectively). CONCLUSIONS Acetabular bony deficiency, especially in the anterior and lateral region can result in antero-posterior hip instability, leading to thickened ILFL and hip pain, even in patients with BDDH. These findings may facilitate our understanding and treatment of patients with DDH. When hip instability is suspected, hip US examination may help confirm the diagnosis and assist in providing objective clinical diagnostic evidence.
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Affiliation(s)
- Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Macionis V. Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion. FRONTIERS IN PAIN RESEARCH 2023; 4:1037376. [PMID: 36890855 PMCID: PMC9986610 DOI: 10.3389/fpain.2023.1037376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.
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Association between Abnormal Gait Patterns and an Elevated Degree of Pain after Daily Walking: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052842. [PMID: 35270535 PMCID: PMC8910192 DOI: 10.3390/ijerph19052842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to investigate whether abnormal gait patterns are associated with experiencing an elevated degree of pain after daily walking. In this preliminary, cross-sectional study, 223 community-dwelling older adults were assessed for pain experienced after daily walking using a simple question that involved asking the subject about their past experiences of an elevated degree of pain after walking for 400 m or more. Gait patterns were assessed using the Comprehensive Gait Assessment using InerTial Sensor score (C-GAITS score), derived from the data measured by Inertial sensors attached to the lower trunk and heel when subjects walked along a 15 m walkway at a self-selected preferred speed. The score was the sum of 10 gait parameter scores. The lower scores indicated more and worse abnormal gait patterns. In total, 24 older adults (10.8%) reported that they experienced pain after daily walking. According to the multiple logistic regression analyses, older adults with a lower total C-GAITS score had a significantly greater probability of having past experiences of pain after walking (odds ratio = 1.11, 95% confidence interval = 1.03–1.20). The findings of this study suggest that more and worse abnormal gait patterns among older adults in a clinical walking test are associated with an elevated degree of pain after daily walking.
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Lewis CL, Halverstadt AL, Graber KA, Perkins Z, Keiser E, Belcher H, Khuu A, Loverro KL. Individuals With Pre-arthritic Hip Pain Walk With Hip Motion Alterations Common in Individuals With Hip OA. Front Sports Act Living 2021; 3:719097. [PMID: 34505057 PMCID: PMC8421535 DOI: 10.3389/fspor.2021.719097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with hip osteoarthritis (OA) commonly walk with less hip extension compared to individuals without hip OA. This alteration is often attributed to walking speed, structural limitation, and/or hip pain. It is unclear if individuals who are at increased risk for future OA (i.e., individuals with pre-arthritic hip disease [PAHD]) also walk with decreased hip extension. Objectives: (1) Determine if individuals with PAHD exhibit less hip extension compared to individuals without hip pain during walking, and (2) investigate potential reasons for these motion alterations. Methods: Adolescent and adult individuals with PAHD and healthy controls without hip pain were recruited for the study. Kinematic data were collected while walking on a treadmill at three walking speeds: preferred, fast (25% faster than preferred), and prescribed (1.25 m/s). Peak hip extension, peak hip flexion, and hip excursion were calculated for each speed. Linear regression analyses were used to examine the effects of group, sex, side, and their interactions. Results: Individuals with PAHD had 2.9° less peak hip extension compared to individuals in the Control group (p = 0.014) when walking at their preferred speed. At the prescribed speed, the PAHD group walked with 2.7° less hip extension than the Control group (p = 0.022). Given the persistence of the finding despite walking at the same speed, differences in preferred speed are unlikely the reason for the reduced hip extension. At the fast speed, both groups increased their hip extension, hip flexion, and hip excursion by similar amounts. Hip extension was less in the PAHD group compared to the Control group (p = 0.008) with no significant group-by-task interaction (p = 0.206). Within the PAHD group, hip angles and excursions were similar between individuals reporting pain and individuals reporting no pain. Conclusions: The results of this study indicate that kinematic alterations common in individuals with hip OA exist early in the continuum of hip disease and are present in individuals with PAHD. The reduced hip extension during walking is not explained by speed, structural limitation, or current pain.
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Affiliation(s)
- Cara L Lewis
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Anne L Halverstadt
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Kerri A Graber
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Zoe Perkins
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Emily Keiser
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Hadwin Belcher
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Anne Khuu
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Kari L Loverro
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States.,U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA, United States
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Nüesch C, Ismailidis P, Koch D, Pagenstert G, Ilchmann T, Eckardt A, Stoffel K, Egloff C, Mündermann A. Assessing Site Specificity of Osteoarthritic Gait Kinematics with Wearable Sensors and Their Association with Patient Reported Outcome Measures (PROMs): Knee versus Hip Osteoarthritis. SENSORS 2021; 21:s21165363. [PMID: 34450828 PMCID: PMC8398113 DOI: 10.3390/s21165363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
There is a great need for quantitative outcomes reflecting the functional status in patients with knee or hip osteoarthritis (OA) to advance the development and investigation of interventions for OA. The purpose of this study was to determine if gait kinematics specific to the disease—i.e., knee versus hip OA—can be identified using wearable sensors and statistical parametric mapping (SPM) and whether disease-related gait deviations are associated with patient reported outcome measures. 113 participants (N = 29 unilateral knee OA; N = 30 unilateral hip OA; N = 54 age-matched asymptomatic persons) completed gait analysis with wearable sensors and the Knee/Hip Osteoarthritis Outcome Score (KOOS/HOOS). Data were analyzed using SPM. Knee and hip kinematics differed between patients with knee OA and patients with hip OA (up to 14°, p < 0.001 for knee and 8°, p = 0.003 for hip kinematics), and differences from controls were more pronounced in the affected than unaffected leg of patients. The observed deviations in ankle, knee and hip kinematic trajectories from controls were associated with KOOS/HOOS in both groups. Capturing gait kinematics using wearables has a large potential for application as outcome in clinical trials and for monitoring treatment success in patients with knee or hip OA and in large cohorts representing a major advancement in research on musculoskeletal diseases.
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Affiliation(s)
- Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - David Koch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department for Sport, Movement and Health, University of Basel, 4052 Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Clarahof Clinic of Orthopaedic Surgery, 4058 Basel, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Correspondence:
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Kawai H, Obuchi S, Watanabe Y, Hirano H, Fujiwara Y, Ihara K, Kim H, Kobayashi Y, Mochimaru M, Tsushima E, Nakamura K. Association between Daily Living Walking Speed and Walking Speed in Laboratory Settings in Healthy Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082707. [PMID: 32326419 PMCID: PMC7215567 DOI: 10.3390/ijerph17082707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
Although there is evidence on the predictors of adverse health outcomes in older individuals, walking speed has typically been measured in laboratory settings (LWS); LWS may be distinct from individuals' actual walking speed in their daily lives (DWS). We examined whether DWS differs from LWS among older adults, and its association with physical frailty. Participants were 90 community-dwelling older adults. A five-meter normal (LWSnor) and maximum (LWSmax) walking speed was measured with a stopwatch. DWS was measured using a global positioning system-related smartphone application for one month during their daily lives. DWSavr, DWSmax, and DWSsd were defined as the average, maximum, and standard deviation of walking speed for one month. Participants' mean DWSavr and DWSmax were 1.28 m/s and 2.14 m/s, respectively, significantly slower than the mean LWSnor (1.42 m/s) and LWSmax (2.24 m/s); the intraclass correlation coefficient between DWS and LWS were 0.188 to 0.341. DWS was significantly correlated with grip strength, one-legged stance, and LWS. The area under the receiver operating characteristic curve of DWSsd concerning pre-frailty was largest among DWSs, at 0.615, while that of LWSnor was 0.643. The findings suggest that DWS differs from LWS and is associated with physical function and pre-frailty.
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Affiliation(s)
- Hisashi Kawai
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
- Correspondence: ; Tel.: +81-3-3964-3241 (ext. 4243)
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
| | - Yutaka Watanabe
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Kita13, Nishi7, Kita-Ku, Sapporo 060-8586, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
| | - Kazushige Ihara
- Faculty of Medicine, Hirosaki University, 5 Zaifu-cho Hirosaki City, Aomori 036-8562, Japan; (K.I.); (E.T.)
| | - Hunkyung Kim
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo 173-0015, Japan; (S.O.); (Y.W.); (H.H.); (Y.F.); (H.K.)
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, c/o Kashiwa II Campus, University of Tokyo, 6-2-3 Kashiwanoha, Kashiwa, Chiba 277-0882, Japan; (Y.K.); (M.M.)
| | - Masaaki Mochimaru
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, c/o Kashiwa II Campus, University of Tokyo, 6-2-3 Kashiwanoha, Kashiwa, Chiba 277-0882, Japan; (Y.K.); (M.M.)
| | - Eiki Tsushima
- Faculty of Medicine, Hirosaki University, 5 Zaifu-cho Hirosaki City, Aomori 036-8562, Japan; (K.I.); (E.T.)
| | - Kozo Nakamura
- Towa Hospital, 4-7-10 Towa, Adachi-Ku, Tokyo 120-0003, Japan;
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Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification. BMC Musculoskelet Disord 2020; 21:8. [PMID: 31906926 PMCID: PMC6945754 DOI: 10.1186/s12891-019-3022-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/24/2019] [Indexed: 01/12/2023] Open
Abstract
Background A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA. Methods Fifty-five patients (age 22–65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model. Results Body weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse. Conclusion In patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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