Hip, knee, and ankle kinematics of high range of motion activities of daily living

Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario K7L 3N6, Canada.
Journal of Orthopaedic Research (Impact Factor: 2.99). 04/2006; 24(4):770-81. DOI: 10.1002/jor.20114
Source: PubMed


Treatment of joint disease that results in limited flexion is often rejected by patients in non-Western cultures whose activities of daily living require a higher range of motion at the hip, knee, or ankle. However, limited information is available about the joint kinematics required for high range of motion activities, such as squatting, kneeling, and sitting cross-legged, making it difficult to design prosthetic implants that will meet the needs of these populations. Therefore, the objective of this work was to generate three-dimensional kinematics at the hip, knee, and ankle joints of Indian subjects while performing activities of daily living. Thirty healthy Indian subjects (average age: 48.2 +/- 7.6 years) were asked to perform six trials of the following activities: squatting, kneeling, and sitting cross-legged. Floating axis angles were calculated at the joints using the kinematic data collected by an electromagnetic motion tracking device with receivers located on the subject's foot, shank, thigh, and sacrum. A mean maximum flexion of 157 degrees +/- 6 degrees at the knee joint was required for squatting with heels up. Mean maximum hip flexion angles reached up to 95 degrees +/- 27 degrees for squatting with heels flat. The high standard deviation associated with this activity underscored the large range in maximum hip flexion angles required by different subjects. Mean ankle range of flexion reached 58 degrees +/- 14 degrees for the sitting cross-legged activity. The ranges of motion required to perform the activities studied are greater than that provided by most currently available joint prostheses, demonstrating the need for high range of motion implant design.

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Available from: Andrea Hemmerich
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    • "In Asian countries, THA needs have increased in recent years due to the sharp rise in the number of elderly and patients with osteoarthritis [7]. The Asian lifestyle is different from the Western lifestyle in those common activities requiring a greater range of motion of the hip joint, such as squatting and sitting on the floor [8] [9]. Difficulty in undertaking these daily activities could affect QOL of THA patients. "
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    ABSTRACT: The Japanese lifestyle includes activities with a greater range of hip motion, such as squat toilet and sitting on the floor. These activities increase the risk of hip dislocation for patients with total hip arthroplasty. However, research concerning the impact of Japanese lifestyle on quality of life for patients with total hip arthroplasty is limited. This cross-sectional study investigated lifestyle differences between two regions and quality of life related to Japanese lifestyle, controlling for age and other covariates. Participants comprised 392 total hip arthroplasty patients with a postoperative period of one to seven years from major hospitals in northern (192 patients) and southern (200 patients) Japan. They were administered the EQ-5D (assessing generic health-related quality of life), Oxford hip score (assessing hip-specific health condition), Japanese lifestyle difficulties (squat toilet, sitting on the floor, etc.) and lifestyle at home. The southern hospital sample retained more of a Japanese lifestyle compared to the northern hospital sample. Nearly 50% of participants reported some level of difficulty related to the Japanese squat toilet, although only a low percentage had it at home. Multivariate linear regression analysis was performed to predict quality of life, and the final model retained the pain and function of the Oxford hip scores and Japanese squat toilet difficulty. The result indicates that physical environments outside of the house have an impact on quality of life for THA patients in Japan. Some aspects of the Asian lifestyle require a greater range of motion of the hip joint. In non-Western countries, regional differences in lifestyle and physical environments outside of their home need to be taken into consideration in discharge planning and rehabilitation. Further multinational comparison of the Asian lifestyle via prospective research is necessary, controlling for pre-operative conditions.
    Full-text · Article · Dec 2014
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    • "Meanwhile, the gait kinematics obtained in this study were quantitatively compared with previous studies [5,18,20–22] (Table 5). During deep squatting, the average joint motions of this study agreed well with those obtained from other Asian population, who had a similar lifestyle [2] [3], but differed from the Westerners [4] [23]. Specifically , the mean ROM in sagittal plane for Chinese during squatting was 146 • . "
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    ABSTRACT: Objective: There were gender differences regarding lower extremity kinematics. The purpose of this study was to investigate three-dimensional kinematics of lower extremity for young Chinese during daily activities and to identify gender differences in lower extremity kinematics. Methods: Lower extremity motions of 40 healthy volunteers (20 males and 20 females) were recorded while each subject performing each of three daily activities (walking, jogging, and deep squatting). The spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean range of motions) were compared with previous results and within gender group. Independents t-tests were used to test statistical significance (p< 0.05). Results: Statistical analysis suggested that there was no gender difference in sagittal plane motions at the hip, knee and ankle joints, while females displayed greater non-sagittal plane joint motions compared to their male counterparts. Conclusions: The outcomes of this study added basic understanding of joint biomechanics during daily activities of Chinese and provided a basis for comparison to patients with various joint diseases.
    Full-text · Article · Aug 2014 · Journal of Back and Musculoskeletal Rehabilitation
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    • "Conversely, weightlifters often place their hip and feet into an abduction position while performing a squat snatch (Werner, 1983). This position could also be demonstrated for Asians while resting or toileting (Hemmerich et al., 2006). The valgus and varus alignment would alter load distributions at the knee, thereby contributing to the occurrence of joint pathologies (e.g. "
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    ABSTRACT: The squat exercise was usually performed with varying feet and hip angles by different populations. The objective of this study was to compare and contrast the three-dimensional knee angles, moments, and forces during dynamic squat exercises with varying feet and hip angles. Lower extremity motions and ground reaction forces for fifteen healthy subjects (9 females and 6 males) were recorded while performing the squat with feet pointing straight ahead (neutral squat), 30º feet adduction (squeeze squat) and 30º feet abduction (outward squat). Nonparametric procedures were used to detect differences in the interested measures between the conditions. No significant difference in three-dimensional peak knee angles was observed for three squat exercises (p>0.05), however, the overall tendency of knee rotations was affected by varying feet and hip positions. During the whole cycle, the outward squat mainly displayed adduction moments, while the neutral and squeeze squat demonstrated abduction moments. Peak abduction moments were significantly affected by feet positions (p<0.05). Moreover, the tibiofemoral and patellofemoral joint forces progressively increased as knee flexed and decreased as knee extended, yet peak forces were not affected by varying feet positions (p>0.05). In conclusion, a neutral position is recommended to perform the squat exercise, while the squeeze squat and outward squat might contribute to the occurrence of joint pathologies.
    Full-text · Article · Dec 2013 · Journal of Human Kinetics
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