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Hip flexor muscle exercise may mitigate walking pain in patients with PAD
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Exercise training for the hip flexor muscle could mitigate calf pain while walking and increase walking distance among patients with peripheral arterial disease, according to new findings.
Prior research identified a link between reduced walking speed and increased risk for mortality in patients with PAD, but a detailed analysis of gait in patients with PAD had not been performed, according to the study background.
Takaaki Kakihana
Takaaki Kakihana, PT, MSc, a doctoral candidate at Tohoku Graduate School of Medicine, Sendai, Japan, and colleagues used a 3-D motion analysis system to evaluate peak hip joint-generated power and ankle joint-generated power in the late stance of 16 patients with symptomatic PAD and claudication in 27 limbs (11 bilateral, five unilateral; mean age, 71 years) and seven healthy controls. They presented their findings at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology/Peripheral Vascular Disease 2015 Scientific Sessions.
The researchers calculated ankle/hip peak power ratio to determine whether hip or ankle power was used dominantly in late stance while walking at comfortable and fast speeds.
In limbs with claudication, the mean ankle-brachial index was 0.63 ± 0.2. Patients had calf pain lesions in 16 limbs, buttock lesions in eight and calf pain lesions in three limbs, the researchers reported.
Compared with controls, those with PAD had significantly slower walking speed and shorter step length at both comfortable and fast walking speeds (P < .001), Kakihana and colleagues found.
Peak hip joint-generated power and ankle joint-generated power in late stance were significantly lower among those with PAD compared with controls at both walking speeds. However, when gait speed adjusted, only peak hip joint-generated power was significantly lower at a comfortable walking speed among patients with PAD (P = .025).
Ankle/hip peak power ratio was higher among those with PAD than in controls at comfortable and fast walking speeds, indicating that these patients are using their ankle flexor muscles more to compensate for weakness in the hip flexor muscles, according to Kakihana and colleagues.
“Usually, older people have relatively weaker ankle flexors and use their hip flexors more during the push-off phase of walking. People with PAD use their ankle flexors more to compensate for hip muscle weakness,” Kakihana said in a press release. “It is unclear why the hip flexors are weak in PAD patients. We predict that it is from disuse and blood flow restriction to the muscles.”
Therefore, he said in the release, patients with PAD should have a physical therapist or other expert evaluate their gait and the strength of their hip flexors and other muscles.
“Based on the evaluation, a combination of muscle training and walking exercise may increase how far they can walk and reduce their calf pain during walking,” Kakihana said – by Erik Swain
Reference:
Kakihana T, et al. Abstract 289. Presented at: Arteriosclerosis, Thrombosis and Vascular Biology/Peripheral Vascular Disease Scientific Sessions; May 7-9, 2015; San Francisco.
Disclosure: Kakihana reports no relevant financial disclosures.