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Voluntary stepping tasks are used to measure the ability of an individual to step and has been associated with fall risk in older adults. Although electromyography (EMG) amplitude is measured during stepping tasks, there is no consensus about the reference EMG value that should be used to normalize the signal. The purpose of the present study was to 1) investigate the impact of using different EMG parameters as a reference to normalize the rate of activation (RoA) of the hip abductor muscles across lateral voluntary step trials and the differences between trials, and 2) to investigate the reliability among trials of the reference EMG values. Nineteen older adults (>65 years of age) performed ten lateral choice reaction stepping test (CRST), while the gluteus medius and tensor fascia latae EMG were recorded. Three reference EMG values were calculated and used to normalize RoA during the stepping task. A repeated-measures ANOVA was used (normalized RoA[3] x trial[3]) to compare normalized EMG across trials, and an intraclass correlation coefficient and coefficient of variation were used for the inter-trial reliability of the reference EMG values. The present study showed that gluteus medius and tensor fascia latae RoA normalized values from the stance and stepping leg (right or left side) measured during CRST are different according to the reference EMG value(P<0.001), with no differences across trials. Overall, the EMG procedures showed high inter-trial reliability, with a few exceptions. Therefore, after careful examination of our results, the peak and mean EMG amplitudes showed consistently higher intraclass correlation coefficients; however, the former may provide a more intuitive reference value. • Normalized rate of activation values from the stance or stepping leg are different accordingly to the reference value. • Overall great inter-trial reliability for all reference EMG values. • The peak and mean EMG amplitudes showed consistently higher intraclass correlation coefficients. [ABSTRACT FROM AUTHOR]

Gluteus medius tendon pathology, encompassing tendinopathy and tears, is a significant source of lateral hip pain and functional impairment. Traditional diagnostic approaches have relied on clinical examination and magnetic resonance imaging (MRI). However, the advent of diagnostic musculoskeletal ultrasound MSKUS has transformed the evaluation process. Musculoskeletal ultrasound MSKUS has emerged as a highly valuable diagnostic tool in the evaluation of gluteus medius tendon pathology, offering a non-invasive, cost-effective, and dynamic assessment method. This modality provides real-time visualization of soft tissue, enabling the detailed examination of tendon structure, vascularity, and associated musculature. For rehabilitation providers, understanding the application, strengths, and limitations of diagnostic MSKUS can enhance clinical decision-making, facilitate targeted therapeutic interventions, and potentially expedite the recovery process. This article reviews the application of MSKUS in diagnosing gluteus medius tendon pathology and its implications for rehabilitation practice. This should help to equip rehabilitation professionals with knowledge to better integrate this diagnostic tool into their clinical repertoire. [ABSTRACT FROM AUTHOR]

The gluteus medius (GM) plays an important role in stabilizing the knee and preventing injury. This study aimed to determine the immediate effects of weight-bearing gluteus medius exercises on lower-extremity muscle function and dynamic knee valgus. Eighteen healthy adults (nine each of both sexes) performed three types of weight-bearing gluteus medius exercises (standing, mini-squat, and dead-lift), and a range of kinematic variables were tested in triplicate. Weight-supporting GM exercise consisted of three sets of 15 repetitions of the lateral band walk. The Y-balance test (YBT) and vertical single-leg jump were used as indicators of muscle function in the lower limbs. We used a video analyzer to film the dynamic knee valgus and performed a YBT for the supporting leg and landing leg following a jump. The height of the single-leg vertical jump and the posterolateral and total YBT scores were significantly higher in the dead-lift posture than in the standing and mini-squat postures. Motion analysis of the dead-lifts revealed high hip flexion on the supporting leg in the posterolateral direction, as determined by the YBT, with low levels of internal hip rotation on the landing leg during the one-leg vertical jump. As an immediate effect of gluteus medius exercise, the dead-lift posture facilitated single-leg vertical jump, posterolateral balance, and reduced dynamic knee valgus. [ABSTRACT FROM AUTHOR]

Dysfunctional patterns of the erector spinae (ES) and gluteus medius (GM) muscles often accompany episodes of low back pain (LBP). Rehabilitative ultrasound imaging (RUSI) has been used to measure ES and GM muscle thickness, however such measurements have not been compared in individuals with and without LBP. To compare ES and GM muscle thickness and change in thickness utilizing RUSI in individuals with and without LBP. Cross-sectional comparison. A volunteer sample of 60 adults with (n = 30) and without (n = 30) LBP was examined. Thickness measurements of the ES and GM at rest and during contraction were obtained by using RUSI during a single session. Statistical comparison was performed using ANCOVA. The demographic variable age was used as a covariate in the primary comparative analysis. Mean difference for age between groups was 5.4 years (95% CI: 1.85, 8.94, p = 0.004). Average ODI score was 32.33±6.58 and pain level of 5.39±0.73 over the last 24 h in the symptomatic group. There was a statistically significant difference in the percent thickness change in both the ES, mean difference = −3.46 (95% CI: −6.71, −0.21, p = 0.039) and GM, mean difference = −1.93 (95% CI: −3.85, −0.01, p = 0.049) muscles between groups. Individuals with LBP may have reduced percent thickness change of the ES and GM muscles when compared to asymptomatic individuals. [ABSTRACT FROM AUTHOR]

To define Minimally Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) threshold scores after open gluteus medius and/or minimus repair. Primary open gluteus medius and/or minimus repair patients from November 2013 to March 2020 were identified. Patient reported outcomes (PROs) were assessed preoperatively, 1- and 2-year follow-up, including the Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) Pain. Thresholds for achieving a MCID and PASS postoperatively were calculated using the distribution method and receiver operator curve analysis; 25 patients (24 females, 1 male, age: 69 ± 6.8 years, body mass index: 26.9 ± 5.0 kg/m2) were included in final analyses. MCID threshold scores for HOS-ADL, mHHS, iHOT-12 and VAS Pain were calculated as 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold scores for each of the PROs were as follows: HOS-ADL (71.9), mHHS (60.0), iHOT-12 (49.2) and VAS Pain (36.8). MCID thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 58.3%, 83.3%, 66.7% and 57.1% of patients, respectively. PASS thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 52.4%, 44.8%, 65% and 59.1% of patients, respectively. Open gluteus medius and/or minimus repair results in a high rate of achievement of clinically significant outcomes at a minimum of 2 years postoperatively. MCID threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 71.9, 60.0, 49.2 and 36.8, respectively. The majority of patients achieved clinically significant outcomes with 81.3% and 77.3% achieving MCID and PASS for at least one PRO, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pelvic tilt, which is often seen in hip diseases, is also a common functional problem after total hip arthroplasty. OBJECTIVE: To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS: The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis, Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023. The patients were divided into three groups, namely, groups A (< 2°, n=48), B (2°-3°, n=34), and C (> 3°, n=18), according to the severity of pelvic tilt on postoperative 3 day. Statistical data were collected and compared between the pre- and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt, the length of the gluteus medius muscles of the bilateral sides, the heights of the rotational centers of the femoral heads, the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads, and the ratio of changes in the angle of the pelvic tilt. Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes. RESULTS AND CONCLUSION: (1) Pelvic tilt aggravation occurred in the short term after surgery. (2) The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups, with group C > group B > group A. There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months, with the ratio of change being the smallest in group C. There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months. (3) The difference in bilateral gluteus medius muscles decreased gradually after surgery, and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months. (4) The difference between bilateral centers of rotation increased after surgery, and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery. (5) The pelvic tilt angle at 3 days after surgery, the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated (all P=0.000), and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated (P=0.006) (6) The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty. Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery. Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage. [ABSTRACT FROM AUTHOR]

Abstract Hip muscle weakness can be a precursor to or a result of lower limb injuries. Assessment of hip muscle strength and muscle motor fatigue in the clinic is important for diagnosing and treating hip-related impairments. Muscle motor fatigue can be assessed with surface electromyography (sEMG), however sEMG requires specialized equipment and training. Inertial measurement units (IMUs) are wearable devices used to measure human motion, yet it remains unclear if they can be used as a low-cost alternative method to measure hip muscle fatigue. The goals of this work were to (1) identify which of five pre-selected exercises most consistently and effectively elicited muscle fatigue in the gluteus maximus, gluteus medius, and rectus femoris muscles and (2) determine the relationship between muscle fatigue using sEMG sensors and knee wobble using an IMU device. This work suggests that a wall sit and single leg knee raise activity fatigue the gluteus medius, gluteus maximus, and rectus femoris muscles most reliably (p

This study aimed to determine the effectiveness of gluteus maximus versus gluteus medius muscle strengthening exercises on the navicular drop (ND), balance, and foot posture index (FPI 6) among athletes with over-pronated feet. A pre-post experimental study design with a total of 54 athletes with bilateral over-pronated feet were randomly assigned into group A (n=18), group B (n=18), and group C (n=18). Medial longitudinal arch height (MLA) was assessed with the Navicular Drop Test, the static and dynamic balance was determined with the stork stance test (SST) and modified Star Excursion Balance Test, and Foot Posture was assessed with Foot Posture Index 6. Multivariate Repeated measures ANOVA was used to analyze the effects of gluteus maximus versus gluteus medius muscle strengthening and short foot exercises. At four weeks, the gluteus medius along with short foot exercises (group B) showed significantly less ND and FPI 6 while showing more excellent SST and modified SEBT than the gluteus maximus muscle strengthening along with short foot exercises (group A) and control group (group C). These results suggest that adding gluteus medius muscle strengthening exercises to short foot exercises (SFE) was more effective in supporting the medial longitudinal arch and improving balance than performing SFE alone.

Purpose: Isometric training and pre-activation are proven to enhance acceleration performance. However, traditional strength training exercises do not mirror the acceleration-specific activation patterns of the gluteal muscles, characterized by ipsilateral hip extension during contralateral hip flexion. Therefore, the aim of the study was to determine gluteal muscle activity of acceleration-specific exercises compared to traditional strength training exercises. Methods: In a cross-sectional study design, the peak electromyographic activity of two acceleration-specific exercises was investigated and compared to two traditional strength training exercises each for the gluteus maximus and medius. Twenty-four participants from various athletic backgrounds (13 males, 11 females, 26 years, 178 cm, 77 kg) performed four gluteus maximus [half-kneeling glute squeeze (HKGS), resisted knee split (RKS), hip thrust (HT), split squat (SS)] and four gluteus medius [resisted prone hip abduction (RPHA), isometric clam (IC), side-plank with leg abduction (SP), resisted side-stepping (RSS)] exercises in a randomized order. Results: The RKS (p = 0.011, d = 0.96) and the HKGS (p = 0.064, d = 0.68) elicited higher peak gluteus maximus activity than the SS with large and moderate effects, respectively. No significant differences (p > 0.05) were found between the HT, RKS and HKGS. The RPHA elicited significantly higher gluteus medius activity with a large effect compared to RSS (p < 0.001, d = 1.41) and a moderate effect relative to the SP (p = 0.002, d = 0.78). Conclusion: The acceleration-specific exercises effectively activate the gluteal muscles for pre-activation and strength training purposes and might help improve horizontal acceleration due to their direct coordinative transfer. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionPeople with chronic low back pain (LBP) often demonstrate altered muscle activation with movements that involve the lumbopelvic region and hips.The purpose of this study was to compare gluteus medius activity during sidelying hip abduction (SHA) and sidelying hip abduction-lateral rotation (SHALR) with and without instruction for lumbopelvic stabilization in people with and without chronic LBP.A cross-sectional study was conducted recruiting participants with (n = 17) and without (n = 17) chronic LBP. Gluteus medius activity was recorded with surface electromyography during the performance of SHA and SHALR with and without instructions including the abdominal drawing-in maneuver for lumbopelvic stabilization.For SHA and SHALR, there was a significant main effect for instruction for stabilization indicated by a decrease in gluteus medius activity with instructions (p = .001, p < .001). There was not a significant main effect of chronic LBP on gluteus medius activity between groups for either activity. There was no significant interaction effect of pain and instruction for stabilization with SHA or SHALR.Knowledge of changes in gluteus medius muscle activation patterns with trunk stabilization instruction may help clinicians with assessment of exercise performance to optimize gluteus medius activation. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression. Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls. Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG). Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011. Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption. [ABSTRACT FROM AUTHOR]

Calcific tendinopathy in the gluteus medius is uncommon and sporadically reported. It may be asymptomatic or present with acute or chronic pain. Pain is usually isolated to the lateral hip overlying the gluteal muscles or greater trochanter. We present a rare case of gluteus medius calcific tendonitis as a cause of severe anterior hip pain. Given the atypical local and clinical presentation these can be often misdiagnosed as septic arthritis or fracture which may lead to overtreatment and even unnecessary surgery. This article will detail the clinical presentation, imaging findings, and clinical course following treatment. This will facilitate the clinician in making a timely diagnosis and establishing an effective treatment course.

Objective Hip osteoarthritis is a common cause of disability and surgery is often unavoidable. Patient satisfaction is high and functional ability improves after surgery. However, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The aim of this study is to investigate gluteus medius (GMED) tendon degeneration in relation to muscle strength, physical function and walking distance before and one year after total hip replacement.Material and methods In total, 18 patients were examined pre- and post-operatively, of whom 15 were available in the final analysis. Muscle strength, physical function and walking distance were assessed. Tendon biopsies were assessed microscopically, and the total degeneration score (TDS) was calculated.Results A correlation between the TDS and muscle strength was found for the hamstrings, GMED and quadriceps pre- or post-operatively. No correlations were found between the TDS and functional ability. Functional ability and muscle strength improved significantly after surgery.Conclusion Our results indicate a correlation between tendon degeneration and the muscle strength of the hip and knee in patients with hip OA and one year after THR. To minimise post-operative residual discomfort, rehabilitation programs should probably be modified over time to match the pre- and post-operative needs. Further studies are needed.This study was registered at https://www.researchweb.org/is/vgr/project/279039 (in Swedish).

People with degenerative cervical myelopathy are known to have impaired standing balance and walking abilities, but less is known about balance responses during walking. The aim of this project was to assess reactive balance impairments during walking in people with degenerative cervical myelopathy (PwDCM). We hypothesized that center of mass motion following perturbations would be larger in PwDCM and gluteus medius electromyographic amplitude responses would be decreased in PwDCM. Reactive balance responses were quantified during unanticipated lateral pulls to the waist while treadmill walking. Walking biomechanics data were collected from 10 PwDCM (F=6) and 10 non-myelopathic controls (F=7) using an 8 camera Vicon System (Vicon MX T-Series). Electromyography was collected from lower limb muscles. Participants walked on an instrumented treadmill and received lateral pulls at random intervals and in randomized direction at 5% and 2.5% body mass. Participants walked at 3 prescribed foot placements to control for effects of the size of base of support. As compared with controls, the perturbation-related positional change of the center of mass motion (ΔCOM) was increased in PwDCM (p=0.001) with similar changes in foot placement (p>0.05). Change in gluteus medius electromyography, however, was less in PwDCM than in controls (p<0.001). After experimentally controlling step width, people with mild-to-moderate degenerative cervical myelopathy at least 3 months following cervical spine surgery have impaired reactive balance during walking likely coupled with reduced gluteus medius electromyographic responses. Rehabilitation programs focusing on reactive balance and power are likely necessary for this population. • Following surgical decompression, people with degenerative cervical myelopathy have residual balance impairments during walking. • Impairments exist regardless of pre-perturbation step width. • People with degenerative cervical myelopathy have a blunted hip abductor muscle response following perturbation. [ABSTRACT FROM AUTHOR]

Patients with transfemoral amputation (TFA) are at an increased risk of secondary musculoskeleteal comorbidities, primarily due to asymmetric joint loading. Amputated limb muscle weakness is also prevalent in the TFA population, yet all factors that contribute to muscle strength and thus joint loading are not well understood. Our objective was to bilaterally compare gluteus medius (GMED) muscle factors (volume, fatty infiltration, moment arm) that all contribute to joint loading in patients with TFA. Quantitative magnetic resonance (MR) images of the hip were collected from eight participants with unilateral TFA (2M/6F; age: 47.3 ± 14.7 y/o; BMI: 25.4 ± 5.3 kg/m2; time since amputation: 20.6 ± 15.0 years) and used to calculate normalized GMED muscle volume and fatty infiltration. Six participants participated in an instrumented gait analysis session that collected whole-body kinematics during overground walking. Subject-specific musculoskeletal models were used to calculate bilateral GMED (anterior, middle, posterior) moment arms and frontal plane hip joint angles across three gait cycles. Differences in volume, fatty infiltration, hip adduction–abduction angle, and peak moment arms were compared between limbs using paired Cohen's d effect sizes. Volume was smaller by 36.3 ± 18.8% (d = 1.7) and fatty infiltration was greater by 6.4 ± 7.8% (d = 0.8) in the amputated limb GMED compared to the intact limb. The amputated limb GMED abduction moment arms were smaller compared to the intact limb for both overground walking (anterior: d = 0.9; middle: d = 0.1.2) and during normal range of motion (anterior: d = 0.8; middle: d = 0.8) while bilateral hip adduction–abduction angles were similar during overground walking (d = 0.5). These results indicate that in patients with TFA, the amputated limb GMED is biomechanically disadvantaged compared to the intact limb, which may contribute to the etiology of secondary comorbidities. This population might benefit from movement retraining to lengthen the amputated limb GMED abduction moment arm during gait. [ABSTRACT FROM AUTHOR]

Background: The gluteus minimus (GMin) and gluteus medius (GMed) are important dynamic stabilizers of the hip, but quantitative data on their biomechanical roles in stabilizing the hip are currently lacking. Purpose: To (1) establish a reproducible biomechanical cadaveric model of the hip abductor complex and (2) characterize the effects of loading the GMin and GMed on extraneous femoral rotation and distraction. Study Design: Controlled laboratory study. Methods: A total of 10 hemipelvises were tested in 4 muscle loading states: (1) unloaded, (2) the GMin loaded, (3) the GMed loaded, and (4) both the GMin and GMed loaded. Muscle loads were applied via cables, pulleys, and weights attached to the tendons to replicate the anatomic lines of action. Specimens were tested under internal rotation; external rotation; and axial traction forces at 0°, 15°, 30°, 60°, and 90° of hip flexion. Results: When loaded together, the GMin and GMed reduced internal rotation motion at all hip flexion angles (P <.05) except 60° and reduced external rotation motion at all hip flexion angles (P <.05) except 0°. Likewise, when both the GMin and GMed were loaded, femoral distraction was decreased at all angles of hip flexion (P <.05). Conclusion: The results of this study demonstrated that the GMin and GMed provide stability against rotational torques and distractive forces and that the amount of contribution depends on the degree of hip flexion. Clinical Relevance: Improved understanding of the roles of the GMin and GMed in preventing rotational and distractive instability of the hip will better guide treatment of hip pathologies and optimize nonoperative and operative therapies. [ABSTRACT FROM AUTHOR]

(1) Background: Leg length discrepancy (LLD), regardless of its origin, is a very common pathology that can contribute to low back pain. Various authors have pointed out its relationship with the lack of activation of both the gluteus medius (GM) and the ipsilateral erector spinae (ES). The purpose of this study was to identify the activation of the ES and GM with different simulated LLDs, correlating this activation with LBP. In turn, we evaluated whether ES and GM activity has an effect on jumping ability using a CMJ test. (2) Method: A sample of healthy subjects was selected to whom an artificial LLD was applied using 0.5, 1, and 1.5 cm insoles. These three heights were measured using EMG while the subjects walked and performed a counter movement jump (CMJ). The measurements of the insole heights were carried out in random order using a Latin square. Muscle activation patterns were recorded for 30 s at each of the insole heights while the patients walked at 5.7 km/h and they were compared with the maximum voluntary contraction (MVC), both on the ipsilateral and contralateral sides. These muscles were then measured under the same circumstances during the performance of the CMJ. (3) Results: We found statistically significant differences in the flight heights in both the CMJ and DJ. In the comparison, significant differences were found in the flight heights of the CMJ and the DJ using the 5 mm insoles, and in the case of the DJ, also without insoles, with respect to the MVC. We found statistically significant differences in the activation of the GM with the differences in insoles, but not in the activation of the Es in relation to the different insole heights. (4) Conclusions: Insoles of different heights caused activation differences in the medius on the side where the insoles were placed. We can relate this difference in activation to LBP. In relation to the ES, no significant differences were found in the activation of the ipsilateral side of the insole. [ABSTRACT FROM AUTHOR]

Purpose: To assess the functional and clinical outcomes of patients who underwent either open or endoscopic Whiteside transfer of gluteus maximus and tensor fascia lata muscles in cases of massive rupture of gluteus medius tendon associated with muscle atrophy on a native hip Methods: This retrospective, descriptive, single-centre study was conducted by a single operator with a minimum follow-up period of 12 months. All Whiteside palliative transfers performed on patients with Type 5 gluteus medius tendon rupture, according to Lall's classification, resulting in painful and treatment-resistant Trendeleburg gait between 2017 and 2022 were included. Functional evaluation was based on modified Harris Hip Scores (mHHS), iHOT-12, Non-Arthritic Hip Score (NAHS), and the pain on a Visual Analog Scale (VAS). Muscle strength was clinically assessed using the MRC classification. Results: Between January 2017 and January 2022, a total of 15 Whiteside palliative transfers were identified, including nine (60%) open procedures and 6 (40%) endoscopic procedures, performed on 13 patients. One patient was excluded, and none were lost to follow-up. The median follow-up period was 41 (12; 59) months. The median age at the time of surgery was 74 (66; 76) years. The male-to-female sex ratio was 0.27. Functional results demonstrated a significant improvement in all scores: NAHS (45 vs. 72, p = 0.002), mHHS (22 vs. 55, p = 0.002), iHOT-12 (101 vs. 56, p = 0.002), and VAS (8 vs. 3, p = 0.002). Clinical outcomes also showed improvements in muscle strength (p = 0.003), single-leg stance (p = 0.01), and gait (p = 0.02). No significant differences were found in the various scores between the endoscopic and open techniques. Conclusion: Whiteside transfer surgery, whether performed through open surgery or endoscopically, is a palliative surgical approach that should be considered for patients with irreparable gluteus medius tendon tears, where the main symptom is trochanteric pain. This procedure yields satisfactory clinical and functional outcomes, although the gains in abduction strength recovery and gait improvement are modest. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effectiveness of gluteus maximus versus gluteus medius muscle strengthening exercises on the navicular drop (ND), balance, and foot posture index (FPI 6) among athletes with over-pronated feet. A pre-post experimental study design with a total of 54 athletes with bilateral over-pronated feet were randomly assigned into group A (n=18), group B (n=18), and group C (n=18). Medial longitudinal arch height (MLA) was assessed with the Navicular Drop Test, the static and dynamic balance was determined with the stork stance test (SST) and modified Star Excursion Balance Test, and Foot Posture was assessed with Foot Posture Index 6. Multivariate Repeated measures ANOVA was used to analyze the effects of gluteus maximus versus gluteus medius muscle strengthening and short foot exercises. At four weeks, the gluteus medius along with short foot exercises (group B) showed significantly less ND and FPI 6 while showing more excellent SST and modified SEBT than the gluteus maximus muscle strengthening along with short foot exercises (group A) and control group (group C). These results suggest that adding gluteus medius muscle strengthening exercises to short foot exercises (SFE) was more effective in supporting the medial longitudinal arch and improving balance than performing SFE alone. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression.Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls.Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG).Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011.Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption.

Objective: The study compared the activities of the surface electromyography (sEMG) of trunk and hip muscles during single-leg Romanian deadlift (SLRDL) exercises using a flywheel and dumbbell with different loading positions (ipsilateral and contralateral). Method: Twelve active male subjects with at least 2 years of strength training experience (age: 26.7 ± 3.3 years; weight: 73.9 ± 6.2 kg) participated in this study. sEMG in the percentage of maximum voluntary isometric contraction of four SLRDL exercises (ipsilateral and contralateral loading position for dumbbell and flywheel) in a randomized order for superior gluteus maximus (SGM), inferior gluteus maximus (IGM), gluteus medius (GM), biceps femoris (BF), erector spinae (ES), external oblique (EO), and adductor longus (AL) were measured. One-way repeated measure ANOVA with Bonferroni adjustment (statistical significance at 0.05) and the non-clinical magnitude-based decision with a standardized difference were performed for statistical analysis. Results: The overall results demonstrated a very high level of SGM (105.4%–168.6%) and BF (69.6%–122.4%) muscle activities. A significant moderate increase of sEMG signals in GM, IGM, and ES (dominant side) and a large increase in SGM activity during concentric action when the loading position of flywheel SLRDL was changed from ipsilateral to the contralateral side. No significant difference was observed between flywheel and dumbbell SLRDL exercises. Conclusion: Strength coaches may adopt dumbbell or flywheel SLRDL exercises using the contralateral loading position to simultaneously strengthen the hip extensors and trunk stabilizers effectively. [ABSTRACT FROM AUTHOR]

PURPOSE This study aimed to examine the effects of an 8-week gluteus medius strengthening exercise on back pain, balance, and strength in female office workers with low back pain. METHODS The participants of this study were female office workers aged 30 to 48 years old who reported low back pain on a visual analogue scale (VAS) ranging from 3 to 7. Twenty-six participants were randomly assigned to the exercise (n=13) and control (n=13) groups. The study applied a gluteus medius strengthening program to the exercise group for 8 weeks, three times a week, and 60 minutes per session. The participants in the control group were asked to maintain their normal life patterns during the period of intervention. Data collected from the test were analyzed through repeated two-way ANOVA, paired t-test, and independent t-test. RESULTS First, there has been a significant decrease in the pain level, as evidenced by VAS and Korean oswestry disability index (KODI) scores. Second, there was a statistically significant improvement in both static and dynamic balance capabilities. Last, back strength also significantly improved. CONCLUSIONS Application of the gluteus medius strengthening exercise appears to be effective for low back pain, static and dynamic balance capabilities, and back strength.

Aims: A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient’s quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. Methods: A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed. Results: Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species. Conclusion: More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons. Cite this article: Bone Jt Open 2023;4(8):628–635.

Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%–20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤.003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P <.001), while no change was found ipsilateral to the weight (P ≥.790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity. [ABSTRACT FROM AUTHOR]

Objective: The study compared the activities of the surface electromyography (sEMG) of trunk and hip muscles during single-leg Romanian deadlift (SLRDL) exercises using a flywheel and dumbbell with different loading positions (ipsilateral and contralateral).Method: Twelve active male subjects with at least 2 years of strength training experience (age: 26.7 ± 3.3 years; weight: 73.9 ± 6.2 kg) participated in this study. sEMG in the percentage of maximum voluntary isometric contraction of four SLRDL exercises (ipsilateral and contralateral loading position for dumbbell and flywheel) in a randomized order for superior gluteus maximus (SGM), inferior gluteus maximus (IGM), gluteus medius (GM), biceps femoris (BF), erector spinae (ES), external oblique (EO), and adductor longus (AL) were measured. One-way repeated measure ANOVA with Bonferroni adjustment (statistical significance at 0.05) and the non-clinical magnitude-based decision with a standardized difference were performed for statistical analysis.Results: The overall results demonstrated a very high level of SGM (105.4%–168.6%) and BF (69.6%–122.4%) muscle activities. A significant moderate increase of sEMG signals in GM, IGM, and ES (dominant side) and a large increase in SGM activity during concentric action when the loading position of flywheel SLRDL was changed from ipsilateral to the contralateral side. No significant difference was observed between flywheel and dumbbell SLRDL exercises.Conclusion: Strength coaches may adopt dumbbell or flywheel SLRDL exercises using the contralateral loading position to simultaneously strengthen the hip extensors and trunk stabilizers effectively.

Tears of the gluteus medius and minimus are an important cause of recalcitrant greater trochanteric pain syndrome. Although endoscopic and open abductor repairs have demonstrated promising outcomes, the success of these techniques is dependent on the size of the tear and the quality of the tissue. In patients presenting with abductor insufficiency and evidence of previous repair failure, large retracted tears, muscle atrophy and/or fatty infiltration, reconstruction/augmentation techniques should be considered. In the present study, we present a retrospective cohort study assessing patient outcomes following open gluteus maximus transfer for irreparable or severely retracted gluteus medius tears. Patients were included in the present study if they underwent open gluteus maximus transfer to address hip abductor tears that a senior surgeon deemed irreparable or at high risk for failure following isolated repair secondary to the following tear characteristics: large tears with >2 cm of retraction, the presence of extensive fatty infiltration (Goutallier Grade 3 or greater) and/or patients requiring revision abductor repair due to primary repair failure with associated pain and a Trendelenburg gait. Patients undergoing a concomitant, or those with a previous history of hip arthroplasty, were excluded from the study. All participants were prospectively enrolled in the study, and both pre- and post-operative patient-reported outcomes were collected at 6 months and 1 year including the modified Hip Harris Score, Visual Analog Score, Hip Outcomes Score of Activities Daily Living, Hip Outcomes Score for Sports-Related Activities and Overall Satisfaction with Hip. Pre-operative scores were compared with post-operative assessments using Student's t-test with a significance level of P  < 0.05. Twenty-one patients and 22 hips were included. The average age was 69 (SD ±9.2) and 17 (81%) were females. The average body mass index was 30.0 (±6.2). The outcome scores at both 6 months and 1 year demonstrated significant improvements compared with pre-operative functional assessment. This article reports the utility of gluteus medius/minimus repair augmentation or reconstruction via gluteus maximus transfer demonstrating improvement in patient-reported outcomes at short-term follow-up. [ABSTRACT FROM AUTHOR]

(1) Background: Leg length discrepancy (LLD), regardless of its origin, is a very common pathology that can contribute to low back pain. Various authors have pointed out its relationship with the lack of activation of both the gluteus medius (GM) and the ipsilateral erector spinae (ES). The purpose of this study was to identify the activation of the ES and GM with different simulated LLDs, correlating this activation with LBP. In turn, we evaluated whether ES and GM activity has an effect on jumping ability using a CMJ test. (2) Method: A sample of healthy subjects was selected to whom an artificial LLD was applied using 0.5, 1, and 1.5 cm insoles. These three heights were measured using EMG while the subjects walked and performed a counter movement jump (CMJ). The measurements of the insole heights were carried out in random order using a Latin square. Muscle activation patterns were recorded for 30 s at each of the insole heights while the patients walked at 5.7 km/h and they were compared with the maximum voluntary contraction (MVC), both on the ipsilateral and contralateral sides. These muscles were then measured under the same circumstances during the performance of the CMJ. (3) Results: We found statistically significant differences in the flight heights in both the CMJ and DJ. In the comparison, significant differences were found in the flight heights of the CMJ and the DJ using the 5 mm insoles, and in the case of the DJ, also without insoles, with respect to the MVC. We found statistically significant differences in the activation of the GM with the differences in insoles, but not in the activation of the Es in relation to the different insole heights. (4) Conclusions: Insoles of different heights caused activation differences in the medius on the side where the insoles were placed. We can relate this difference in activation to LBP. In relation to the ES, no significant differences were found in the activation of the ipsilateral side of the insole.

Context: Hamstring and quadriceps activity adaptations are well known in individuals with anterior cruciate ligament deficiency (ACLD) and reconstructed (ACLR) to potentially compensate for knee joint instability. However, few studies have explored hip muscles activity patterns after ACL injury. Objective: To examine the activation characteristics of gluteus medius (GMED) and adductor longus in ACLR and ACLD subjects compared with controls. Design: Case-control study. Setting: Athletic training room and university lab. Participants: Twelve healthy and 24 ACL-injured (12 ACLR and 12 ACLD) recreationally active male volunteers. Interventions: Surface electromyography of the GMED and adductor longus were recorded during a single-leg vertical drop landing and normalized to maximum voluntary isometric contractions. Main Outcome Measures: Preparatory and reactive muscle activity and coactivation were analyzed from 100 milliseconds prior to initial contact to 250 milliseconds postcontact. Results: During reactive activity, ACL-injured (ACLR and ACLD) participants demonstrated significantly lower peak GMED activity compared with controls ( F = 4.33, P = .02). In addition, ACLR participants exhibited significantly lower reactive GMED: adductor longus coactivation muscle activity compared with controls (C = 4.09, P = .03). Conclusion: Our findings suggest neuromuscular adaptations of the hip musculature are present in people at least 2 years from ACL injury. GMED activation exercises should be considered in designing rehabilitation programs for ACL-injured individuals. [ABSTRACT FROM AUTHOR]

Although introduction of minimally invasive techniques via anterolateral approaches considerably decreased prolonged limp after total hip arthroplasty (THA), potential damage to the abductor muscles is still a concern. This study aimed to evaluate the residual damage after primary THA with two types of anterolateral approach by assessing fatty infiltration and atrophy of the gluteus medius (GMed) and gluteus minimus (GMin) muscles. We retrospectively analyzed 100 primary THAs using computed tomography; surgeries were performed by detaching the anterior part of the abductor muscles with a bone fragment (anterolateral approach with trochanteric flip osteotomy) or without it (anterolateral approach without trochanteric flip osteotomy). The change in radiodensities (RDs), cross-sectional areas (CSAs), and clinical scores preoperatively and at 1 year after operation were evaluated. The RD and CSA of GMed increased 1 year postoperatively in 86 and 81% of patients, respectively, while RD and CSA of GMin decreased in 71 and 94%, respectively. The improvement of RD of GMed was more frequently seen in the posterior rather than the anterior part, while the GMin decreased in both parts. The RD decrease of GMin was significantly lower in the anterolateral approach with trochanteric flip osteotomy group than the anterolateral approach without trochanteric flip osteotomy group (P =.0250). However, there was no difference in the clinical scores between the two groups. The change in the RD of GMed was the only factor that correlated with clinical scores. The two anterolateral approaches both improved the RD of GMed, recovery of which was significantly associated with postoperative clinical scores. Although the two approaches showed different recovery patterns in GMin until 1 year after THA, both showed similar improvements in clinical scores. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gluteus medius (GM) is a segmented muscle involving three muscular subdivisions. Rehabilitation exercises has been suggested to strengthen specific subdivisions. OBJECTIVE: This study aimed to evaluate muscular activation of the anterior, middle, and posterior subdivisions of the GM during two different exercises. METHODS: A total of 28 healthy active subjects participated in this study. Muscle activity using surface electromyography was recorded for the three GM subdivisions during figure-of-four position (FFP) and wall press (WP). Non-parametric Kruskal-Wallis test was used to detect differences between GM subdivisions on each exercise and the Mann-Whitney U test was used to compare muscular activation across exercises. RESULTS: There were statistically significant differences (P < 0.001) in all GM subdivision during FFP and WP exercises. Both exercises showed greater activation of the posterior subdivision than the middle and anterior subdivisions, with the WP causing highest activation of the posterior subdivision. CONCLUSION: In line with the WP exercise, the FFP produces sufficient activity to provide potential strength gains on the posterior subdivision and could be a viable option to include in the early stages of the rehabilitation process. Clinicians may use this information to make more informed decisions about exercise selection for strengthening specific GM subdivision. [ABSTRACT FROM AUTHOR]

Lower muscular weakness and gait disturbance are typical lumbar spinal stenosis (LSS) symptoms. Gait initiation and standing balance function are dependent on hip muscle groups, particularly gluteus medius (GMed). However, alterations to GMed in patients with LSS have not been studied. Therefore, we evaluated the impact of LSS on GMed in this study. This study included 96 participants divided into the LSS and non-LSS groups. A total of 48 patients with LSS and unilateral buttock pain underwent T2-weighted magnetic resonance imaging of GMed, and 48 age- and sex-matched controls formed the control group. Differences between the cross-sectional areas (CSAs) on both sides of GMed were compared between the 2 groups. Additionally, correlations among patient characteristics, clinical evaluation, and radiological measurement data with a decrease in the CSA of GMed were assessed in the LSS group. A significant difference was observed in the bilateral discrepancy of the GMed CSA between the LSS and non-LSS groups. For patients with LSS with unilateral buttock pain, 81% had reduced CSA of GMed. Regression analysis revealed that buttock pain was an independent factor related to GMed atrophy. The degree of GMed atrophy is related to symptoms of LSS. Spine surgeons should be aware of the risk of GMed atrophy in patients with LSS with unilateral buttock pain. [ABSTRACT FROM AUTHOR]

Background: People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA.Research Question: Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA?Methods: This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention.Results: Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population.Significance: A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain accounts for 25-40% of knee pain cases. It is thought that weakness or inadequate activation of gluteus medius muscle while weight-bearing can lead to internal rotation of the femur and consequently lateral tracking of the patella, gradually leading to patellofemoral pain syndrome. Percutaneous Electrical Nerve Stimulation is a novel treatment modality for the management of myofascial pain syndrome, when combined with open kinematic exercises, it helps to improve the strength of a particular muscle. Objective: To determine the effects of Percutaneous Electrical Nerve Stimulation with open kinematic exercises on gluteus medius activation in patellofemoral pain syndrome. Methods: A study conducted on 30 patients with patellofemoral pain syndrome. All the patients received Percutaneous Electrical Nerve Stimulation, in the myofascial trigger points of the gluteus medius muscle, along with it open kinematic exercises were given targeting the gluteus medius muscle. PENS was given twice a week for 6 weeks. Open kinematic exercises were given 5 days a week for 6 weeks. Results: Paired t - test was used to analyze the statistical difference. The pre - test value of electromyography was (138.11 ± 2.08, P = 0.0001) and post - test value was (140.61 ± 1.83, P = 0.0001). As for the pain score (NPRS) the pre - test value was (6.67 ± 1.54, P = 0.0001) and post - test value was (3.2 ± 1.2, P = 0.0001). A significant difference was noted in the gluteus medius activation levels and the pain score with the application of Percutaneous Electrical Nerve Stimulation with open kinematic exercises targeting the gluteus medius muscle. Conclusion: The study concluded that Percutaneous Electrical Nerve Stimulation with open kinematic exercises is effective in the activation of gluteus medius muscle. [ABSTRACT FROM AUTHOR]

Gluteus medius eccentrically regulates hip adduction and internal rotation in unilateral postures against gravity. Any weakness to Gluteus medius can lead to poor posture, impaired balance and altered plantar pressure. There is a scarcity of literature to find the immediate effect of gluteus medius kinesio-taping on plantar pressure distribution and balance among healthy individuals. A Randomized cross-over trial was conducted in outpatient physiotherapy department of Manipal Hospitals Bangalore, on 28 healthy individuals from March 2021 to April 2022. The taping was done on the dominant leg of the subjects, with no tape, sham tape and kinesio tape with a least 30-minute time difference. Mean maximum plantar pressure, dynamic balance and squat score was analyzed under three tape conditions. The mean maximum plantar pressure was assessed using Foot Work Pro, dynamic and static balance was assessed using Biodex Balance SD and squat score using Kinovea software. Friedman's test was used to analyze the mean difference between the groups. There was a significant difference in the static overall stability index (p = 0.001), static antero-posterior stability index (p = 0.001), static mediolateral stability index (p = 0.047), overall static sway (p = 0.008) dynamic antero-posterior stability index (p < 0.001), dynamic overall stability index (p = 0.013), dynamic mediolateral stability index (p < 0.001), overall dynamic sway (p < 0.001) and deep squat score (p = 0.009). The results of the study suggest that kinesio-taping is an effective method on improving the dynamic balance and deep squat quality in normal healthy individuals. [ABSTRACT FROM AUTHOR]

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Introduction. Plyometric exercise is known as one of the key components of neuromuscular training programs. It is also possible to obtain higher muscular activity by exercising on tatami and mats. The purpose of the study was to evaluate the activity of hamstring and gluteus medius in 7 typical plyometric exercises on 3 different surfaces and identify the best exercises and surfaces that would further increase hamstring and gluteus medius activity. Methods. The study involved 20 male athletes. The participants performed 7 plyometric exercises on 3 surfaces: ground, tatami, and mat. The electromyographic activity of muscles was recorded with a ME6000 device in 2 phases: feedforward and feedback. To analyse the data, 2-way ANOVA with repeated measures and a Bonferroni post-hoc test were used. Results. Gluteus medius was most active in the feedforward phase in single-leg frontal plane hop (SLFPH), and in the feedback phase in SLFPH and single-leg sagittal plane hop (SLSPH) (p = 0.001). The medial hamstring and lateral hamstring showed the highest values of activity in the feedforward phase in SLSPH, SLFPH, and double-leg sagittal plane hop (DLSPH) (p = 0.001). There was no significant difference between the surfaces (p > 0.05). Conclusions. SLSPH, DLSPH, and SLFPH improve the recruitment and the strength of gluteus medius and hamstrings and should be given considerable attention in training programs. Exercise on the ground, tatami, and mattress is allowed and in terms of the purpose of the research, there is no difference between them. [ABSTRACT FROM AUTHOR]

Introduction. The study aim was to compare lower extremity dominance, subtalar angle, balance, fall risk, and performance in younger adults with and without pes planus. Methods. A total of 80 physically active subjects participated in the study: 39 patients with flexible pes planus and 41 asymptomatic individuals. Arch height was assessed with the navicular drop test, the subtalar joint angles were determined with a goniometer, balance assessments were performed with the Biodex Balance System, and performance was evaluated with the single-leg jump and vertical jump tests. Furthermore, the strength of the gluteus medius muscles was measured with a dynamometer. Results. A significant difference was demonstrated for the subtalar angles (right and left), as well as the single-leg jump and vertical jump test results between asymptomatic subjects and those with pes planus (p < 0.05). Conclusions. It can be concluded that there was a decrease in the subtalar angle and performance in young adults with pes planus compared with asymptomatic participants. This finding suggests that prophylactic measures should be taken before the effects are seen in young adults. [ABSTRACT FROM AUTHOR]