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An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus.

Ford KR, Nguyen AD, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB - Open Access J Sports Med (2015)

Bottom Line: Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus.Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies.Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Therapy, High Point University, High Point, NC, USA.

ABSTRACT
Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.

No MeSH data available.


Related in: MedlinePlus

Theoretical framework for hip-focused neuromuscular exercises to modify dynamic lower extremity valgus.Notes: Theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. The spokes represent a non-exhaustive list of common factors that likely influence the relative success of a program.
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f6-oajsm-6-291: Theoretical framework for hip-focused neuromuscular exercises to modify dynamic lower extremity valgus.Notes: Theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. The spokes represent a non-exhaustive list of common factors that likely influence the relative success of a program.

Mentions: There may be a tendency to assume a linear relationship between improved strength, improved biomechanical variables in a sports-related task like jumping or landing, and improved biomechanical variables in the performance of the actual sport or activity. As this review has demonstrated, hip-focused exercises generally increase EMG activity, and increased EMG activity generally results in improved strength, which further results in improved task-related biomechanics. However, improved strength does not always result in changes to important biomechanical variables,81 and improved biomechanics in sports-related tasks does not necessarily equal improved biomechanical variables in performance of the sport itself.80 Controlling dynamic lower extremity valgus is complex (Figure 1) and likely involves a combination of strengthening and activation exercises and motor control of the hip, as well as use of feedback to facilitate integration into higher level activities.82–87 Even with the addition of feedback, hip-targeted strengthening alone is not the answer. Dynamic lower extremity valgus and hip muscle inhibition is likely influenced by pain or inflammation,88 body structure,89,90 fatigue,91–94 pubertal age and maturation,9,31,95 fear and other psychosocial variables,96–98 and prior injury.99,100 With the evidence and these variables in mind, a focus on strengthening the hip to control dynamic valgus is a great start for many reasons, including that it helps clinicians move away from a local focus to a more regional focus for pathologies at the knee. The next step in the evolution of treating patients with knee pathology is a global focus considering fixed factors like sex and body structure, re-education strategies like modes of feedback, physiological factors like pain, inflammation, and fatigue, and psychosocial factors like fear and anxiety (Figure 6). Figure 6 was constructed by the authors, based on the results of this evidenced-based review, to present a theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus, in addition to highlighting a few of the multivariate factors that should be considered when implementing hip-focused neuromuscular exercises in order to control dynamic lower extremity valgus. These factors likely play a critical role in the relative success of a program at each step along the continuum from initiating improved hip strength and activation to integrated neuro-muscular control during a variety of movements to the final optimization of safe biomechanics during high-level activities and sports.


An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus.

Ford KR, Nguyen AD, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB - Open Access J Sports Med (2015)

Theoretical framework for hip-focused neuromuscular exercises to modify dynamic lower extremity valgus.Notes: Theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. The spokes represent a non-exhaustive list of common factors that likely influence the relative success of a program.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556293&req=5

f6-oajsm-6-291: Theoretical framework for hip-focused neuromuscular exercises to modify dynamic lower extremity valgus.Notes: Theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. The spokes represent a non-exhaustive list of common factors that likely influence the relative success of a program.
Mentions: There may be a tendency to assume a linear relationship between improved strength, improved biomechanical variables in a sports-related task like jumping or landing, and improved biomechanical variables in the performance of the actual sport or activity. As this review has demonstrated, hip-focused exercises generally increase EMG activity, and increased EMG activity generally results in improved strength, which further results in improved task-related biomechanics. However, improved strength does not always result in changes to important biomechanical variables,81 and improved biomechanics in sports-related tasks does not necessarily equal improved biomechanical variables in performance of the sport itself.80 Controlling dynamic lower extremity valgus is complex (Figure 1) and likely involves a combination of strengthening and activation exercises and motor control of the hip, as well as use of feedback to facilitate integration into higher level activities.82–87 Even with the addition of feedback, hip-targeted strengthening alone is not the answer. Dynamic lower extremity valgus and hip muscle inhibition is likely influenced by pain or inflammation,88 body structure,89,90 fatigue,91–94 pubertal age and maturation,9,31,95 fear and other psychosocial variables,96–98 and prior injury.99,100 With the evidence and these variables in mind, a focus on strengthening the hip to control dynamic valgus is a great start for many reasons, including that it helps clinicians move away from a local focus to a more regional focus for pathologies at the knee. The next step in the evolution of treating patients with knee pathology is a global focus considering fixed factors like sex and body structure, re-education strategies like modes of feedback, physiological factors like pain, inflammation, and fatigue, and psychosocial factors like fear and anxiety (Figure 6). Figure 6 was constructed by the authors, based on the results of this evidenced-based review, to present a theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus, in addition to highlighting a few of the multivariate factors that should be considered when implementing hip-focused neuromuscular exercises in order to control dynamic lower extremity valgus. These factors likely play a critical role in the relative success of a program at each step along the continuum from initiating improved hip strength and activation to integrated neuro-muscular control during a variety of movements to the final optimization of safe biomechanics during high-level activities and sports.

Bottom Line: Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus.Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies.Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Therapy, High Point University, High Point, NC, USA.

ABSTRACT
Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.

No MeSH data available.


Related in: MedlinePlus