Department of Physical Therapy, Youngsan University
BACKGROUND: Many practitioners recommend step-up and step-down exercises. However, decreased stability of the hip joint and imbalanced muscle activities can alter the biomechanics during these movements. OBJECTIVE: This study investigated muscle imbalance between medial and lateral muscle components and between proximal and distal muscle components by expressing the proportions of muscle activation in the step-up and step-down positions. METHODS: Nineteen subjects participated. Activities of the vastus medialis oblique, vastus lateralis, semitendinosus, biceps femoris, adductor, gluteus medius, and gluteus maximus were assessed. RESULTS: The semitendinosus–biceps femoris ratio was higher in the step-down position than in the step-up position. The adductor–gluteus medius, adductor–vastus lateralis, an adductor–biceps ratios were higher in the step-up position than in the step-down position. The gluteus maximus–biceps ratio was greater in the step-down position than in the step-up position. CONCLUSIONS: Muscle activation in the medial hamstring is greater in the step-down position; in the adductor, muscle activation is greater in the step-up position. The step-down position is more appropriate for those with proximal weakness, which can promote muscle activation in the gluteus maximus while maintaining biceps femoris activation. Key words: muscle balance, hip muscle activities, step-up, step-down
Prof. Czamara is an author and coauthor of 59 scientific articles. Since 2012 he has been an Associate Professor at College of Physiotherapy in Wroclaw, Poland. Prof. Czamara is a specialist in physiotherapy and runs his private practice as an physiotherapist. Since 1997 professor has been managing the Rehabilitation Centre in Wroclaw. He founded the College of Physiotherapy in Wroclaw where he has been an academic teacher since 1999. Since 2010 prof. Czamara has been the President of College of Physiotherapy located in Wroclaw. Email: [email protected]
Statement of the Problem: The efficiency of walking is often the focus of therapeutic interventions for patients with cerebral palsy (CP) as its decrease has been shown to be predictive of reduced capacity for activity, participation and social interaction. To date, there are some general findings about the effect of Nordic Walking (NW) training, however none of them advocate to patients with CP. The aim of the study was to assess the effect of a NW training on a march on a treadmill ergospirometry parameters and a heart rate in a patient with CP. Methodology: The studied patient was a 16 years old male with spastic diplegia, with neurological signs in both lower limbs, but without functional involvement of upper limbs and no mental retardations. Five times a week for 12 weeks, the patient performed 40-minutes long NW training. The training was being monitored using application installed on a smartphone and saved on the user account, to which access was allowed to the researchers. The patient underwent the ergospirometry test using the MetaLyzer 3B-R3 device. The measurement was performed twice: before (PRE training) and after (POST training) the 12-week long training. The obtained values of walking time, maximal walking speed, Maximal Oxygen Consumption; Oxygen Consumption normalized to patient’s body mass; Carbon Dioxide Production, Pulmonary Ventilation, and a maximal heart rate were analyzed. The differences in studied parameters between the first and the second measurement were expressed in percenters (%). Findings: The intra-measurement comparison revealed an improvement of studied parameters (Table 1). Conclusions: The applied 12-week long NW training improved ergospirometry parameters with HR max remaining on the same level as an effect of positive adaptation to an exercise with higher load. The increase of walking efficiency after application of a NW training in CP patients should be studied on a larger sample.