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. 2009 Jul;40(1):103-11.
doi: 10.1002/mus.21264.

Hip flexor fatigue limits walking in Charcot-Marie-Tooth disease

Gita M Ramdharry  1 , Brian L Day, Mary M Reilly, Jonathan F Marsden
Affiliations

Hip flexor fatigue limits walking in Charcot-Marie-Tooth disease

Gita M Ramdharry et al. Muscle Nerve. 2009 Jul.

Abstract

Charcot-Marie-Tooth (CMT) disease results in distal lower limb weakness that affects walking. In this study we assess the role of the hip flexors in compensating for distal weakness while walking and the effects of prolonged walking on these putative compensatory strategies. Eighteen subjects with CMT disease were compared with 14 matched controls while they walked on a treadmill to a predetermined point of perceived effort. A significant reduction was observed in peak hip flexor velocity during walking and hip flexor maximal voluntary contraction. In a second session following selective fatigue of the hip flexors, hip flexor velocity decreased immediately on walking, and walking duration was greatly reduced. This study suggests that hip flexors compensate for distal weakness and that fatigue in the hip flexors can limit walking duration. Treatments directed toward improving proximal muscle strength may therefore help to delay onset of hip flexor fatigue and thus prolong walking duration.

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Figures

FIGURE 1
FIGURE 1
Significant changes in primary outcome measures. (A) Hip flexor MVC measures before and after the treadmill walk test. Error bars indicate standard error of the mean (*significant differences pre and post walk test). (B) Hip flexor velocity at the start and end of the treadmill walk test. Error bars are the standard error of the mean. PwCMT, people with CMT; Controls, control subjects (*significant differences pre and post walk test).
FIGURE 2
FIGURE 2
(A) Knee flexor angle, (B) trunk flexion angle, and (C) peak-to-peak trunk coronal angle at the start and end of the treadmill walk test. Error bars indicate standard error of the mean. PwCMT, people with CMT; Controls, control subjects (*significant differences pre and post walk test).
FIGURE 3
FIGURE 3
(A) Session 1 grand average of sagittal hip angular velocity for people with CMT (PwCMT) and control subjects. Solid lines are pre walk test and dashed lines are post walk test. (B) Session 2 grand average of sagittal hip angular velocity for PwCMT. Solid lines: pre walk test; dashed lines: post hip flexor fatigue test; dotted lines: post treadmill walking test.
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