external rotators of the hip

Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. Hip external rotation activates a variety of muscles in your pelvis, buttocks, and legs. In this study we report the detailed the architectural properties of the rotational muscles of the hip, including pectineus, piriformis, gemelli, obturator internus and externus, quadratus femoris, and gluteus minimus, corrected for muscle sarcomere length. Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. During cutting and propulsion type movements the short external rotators are regularly contracted for dynamic stability of the hip. The collective PCSA of the gemelli and obturators (10.00.67cm2) was larger than the gluteus minimus. Hernando MF The hip, like the shoulder, can move in all planes of motion powered by any number of the 17 muscles that are responsible for its joint actions (21 if you break up the three major glutes into their eight sections!). Provided by the Springer Nature SharedIt content-sharing initiative. Traction was performed after excising each muscle and ischiofemoral ligament. As a result of the close anatomical association of these five muscles,7 stretching is generally performed to lengthen all structures uniformly rather than in isolation. Hold for five to 10 seconds, return to starting position, and . Architectural measurements were made on pectineus, piriformis, gemelli, obturators, quadratus femoris, and gluteus minimus. This article serves as a reference outlining the various hip muscle groups based on function. In a comprehensive literature review of the short external rotators of the hip, Yoo et al. Muscle architectural measurements were made based on the same methods described by Sacks and Roy [19], modified by Lieber et al. Muscle architecture, or the arrangement of sarcomeres and fibers within muscles, defines functional capacity. Towson, MD 21204 Polypropylene strings were attached from the insertion to origin sites of each muscle to represent the musculotendinous fibers of the short external rotators. We hypothesized that the architecture of these muscles would support their putative role in controlling joint position and providing stability. Each string was anchored off the table to ensure equal distribution of tension. J Biomech. Accessibility In summary, these findings characterize the architecture of selected muscles of the hip. We previously showed that sarcomere length measurements eliminate this problem. Kartus J SW assisted with project design, data analysis and interpretation, and manuscript revision. Architecture of the Short External Rotator Muscles of the Hip, $$ \mathrm{Lf}=\mathrm{L}{\mathrm{f}}^{\prime}\left(2.7\ \upmu \mathrm{m}/\mathrm{Ls}\right) $$, $$ \mathrm{PCSA}\ \left({\mathrm{cm}}^2\right)=\left(\mathrm{M}\ \left(\mathrm{g}\right)\times \cos \uptheta \right)/\left(\uprho\ \left(\mathrm{g}/{\mathrm{cm}}^3\right)\times \mathrm{Lf}\ \left(\mathrm{cm}\right)\right) $$, https://doi.org/10.1186/s12891-019-2995-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, [email protected]. We dive into the science, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 4-6 Previous cadaveric studies have shown that . When all of these muscle groups work together, they provide both lateral rotation (torque) and stability. Use your left arm to prop up your head. All authors give their consent to publish this manuscript. Readers will be introduced to three exercises which help enhance hip function. The OI and IG had the greatest length change when internally rotating the hip 45 from neutral flexion/extension. Lateral view of the hip with the selected muscles of the hip and gluteus medius illustrated. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. The effect of weak hip abductors or external rotators on knee valgus kinematics in healthy subjects: A systematic review. The Lf/Lm ratio was also determined to assess excursion design comparisons across muscles [15]. J Biomech. Am J Sports Med. If you feel pain in your right knee at any time, stop. Whole cadaveric lower extremity specimens were obtained from the University of California, San Diegos body donations program and were bisected along the midline. The three stretch positions that caused the greatest string displacement of the corresponding short external rotators were: 1) 30ADD90, 2) 45IR0, and 3) 45ER90. On average, these values were similar to the short fiber length observed for gluteus medius (7.331.57cm) and shorter than the long fiber length observed for gluteus maximus (15.692.57cm) [21] (Fig. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. The objective of this study was to evaluate length change during stretching of the superior and inferior fibers of the piriformis, superior gemellus, obturator internus, and inferior gemellus. Of course, you dont have to be a baseball player to use your hip external rotators on a daily basis. They include the piriformis, superior and inferior gemelli, obturator internus, and quadratus femoris. Your right calf should be parallel to your left thigh. Absolute reliability was evaluated through the calculation of SEM for each stretch position to ensure consistency of measurement. There are five muscles found in the deep gluteal region known as the short external rotators of the hip joint. An official website of the United States government. Do you know how many steps you average each day? Although pectineus was the only muscle available for direct comparison, these findings underscore the importance of normalizing data in comparing muscle architecture. While watching a tennis player serve a ball or a golfer swing a club, we notice that there is tremendous rotation occurring through the spine. Architecturally, there were many significant differences among the selected muscles in terms of mass, Lm, Lf, Ls, PCSA and Lf/Lm ratio (p<0.001, Table 1). Many people assume lactic acid is to blame, but current research says otherwise. Surface pennation angle was measured with a goniometer as the angle between the fibers and the distal tendon. JBJS Essent Surg Tech. It consists of the following muscles: piriformis, gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus. Put your hands on your knees. They lead to overuse of these short external rotator muscles, principally the piriformis (e.g., hockey, tennis, fencing). Solomon LB. The greatest displacement of the strings corresponding to the superior piriformis, inferior piriformis, and the superior gemellus occurred in 30 adduction from 90 of hip and knee flexion. Torque is defined as a twisting force that tends to cause rotation. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Hip external rotation is the outward rotation of your thigh away from the centre of your body. [25] found only one published article containing quantitative values of hip muscle architecture [16]. Correspondence to The SEM values of 1.05mm (45ER90), 1.00mm (30ADD90), 0.63mm (PIRIFORM), 0.62mm (45IR0) demonstrated strong consistency of measurement for the three trials of each stretch position. Together, they make the sideways motion required for hip external rotation possible. The purpose of this study was thus to characterize the architecture of these small hip muscles. 2009;30(1):414. [1] [2] ( Level of evidence: 2b). Cleland J Fiber lengths clustered into long (pectineus - 10.38cm and gluteus minimus - 10.30cm), moderate (obturator internus - 8.77cm and externus - 8.04cm), or short (inferior gemellus - 5.64 and superior gemellus - 4.85). Heres a. Forearm exercises help strengthen your wrists and arms. Our website services, content, and products are for informational purposes only. This concept may be supported by comparing our data to the normalized data of Wickiewicz et al. Readers will be introduced to three exercises which help enhance hip function. Solomon LB Start in a seated position on the ground with your knees at 90 degrees. SB assisted with project design and data interpretation. Multiple measurements were made on each muscle (n=>3), then averaged for each sample, yielding grand means which are presented. Dislocations after total hip arthroplasty. The cadavers were then moved into the four specific stretch positions: 1) 45IR0, 2) 45ER90, 3) 30ADD90, and 4) PIRIFORM (Figure 5). Plant the soles of your feet flat on the floor at a comfortable width. 1994;71(3):87481. There were no significant differences in pennation angles which were nearly zero for all muscles. Gait Posture. DOI: Hip external rotation exercises and stretches, ncbi.nlm.nih.gov/pmc/articles/PMC5717482/, The Benefits and Effectiveness of Hip Abduction Exercises, How and Why You Should Do the Clamshell Exercise, Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, The Essential Exercises to Relieve Hip Bursitis Pain. The gluteus maximus extends the hip, while the gluteus medius and minimus are involved in hip rotation and abduction (moving hip out from the midline). The hip joint is a multiaxial joint and permits a wide range of motion; flexion, extension, abduction, adduction, external rotation, internal rotation and circumduction. Neutral positioning of the pelvis on the board was ensured by a bubble level (Empire Magnetic Tool Box Level, Mukwonago, WI) sited on the anterior superior iliac spines of each cadaver (Figure 3). Description The hip joint is a ball and socket joint that is the point of articulation between the head of the femur and the acetabulum of the pelvis. The ability to anti-rotate and stabilize the hip during single leg stance and deceleration activities has proven effective in mitigating the risk of patellofemoral and ACL injuries and the ability to produce rotational power through the hips is a hallmark of any great athlete (Boling et al., 2009). Additionally, the PIRIFORM is performed in the clinical setting with the patient in a prone position. (2009). Hewitt J, Guilak F, Glisson R, Parker VT. As a library, NLM provides access to scientific literature. Repeated-measures laboratory controlled cadaveric study. J Exp Biol. Wickiewicz TL, Roy RR, Powell PL, Edgerton VR. Four commonly performed stretches are shown in Figure 1. Fold the strap in half and place the middle around the sole of your right foot. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 2005;38(11):231720. Although we did not directly measure joint geometry, these architectural data may be combined with known values previously reported to evaluate their role in muscle-joint kinematics. QF=quadratus femoris, ObE=obturator externus, ObI=obturator internus, SG=superior gemellus, IG=inferior gemellus, Pi=piriformis, Pe=pectineus. Ito K, Minka M, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. HHS Vulnerability Disclosure, Help - references: 2). Clin Orthop. - Obturator Internus The hip joint, scientifically referred to as the acetabulofemoral joint, is the joint between the femur and acetabulum of the pelvis and its primary function is to support the weight of the body in both static (e. g. standing) and dynamic (e. g. walking, running & athletic) postures (see image below). Muscles of the hip and thigh Explore study unit Iliopsoas group The iliopsoas group of muscles coins its name from the muscles that make it up: iliacus, psoas major, and psoas minor. (2015). Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. Stretching positions for change of length measurements of the short external rotators. All authors verify there are no competing interests. The rotary cone drill challenges the hip rotators in the transverse plane and gets the client used to decelerating the body in single leg support. Giphart JE, Stull JD, Laprade RF, Wahoff MS, Philippon MJ. Before Although the glute max and posterior fibers of the glute medius assist in external rotation of the hips, the deeper muscles of the piriformis, superior & inferior gemellus, obturator internus & externus and quadratus femoris have a primary function in external rotation of the hips (see image below). Comparison of two stretching methods and optimization of stretching protocol for the piriformis muscle, Piriformis syndrome, diagnosis and treatment, The internal obturator muscle may cause sciatic pain, An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle, Possible generators of retrotrochanteric gluteal and thigh pain: the gemelli-obturator internus complex, An appraisal of the short lateral rotators of the hip joint, Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Protein and Weight Loss: How Much Protein Do You Need to Eat Per Day? 7 Due to the strain transmitted during rotational activities, stretching of these muscles is commonly employed in athletes with chronic posterior hip and buttock pain. The hip joint allows the leg to rotate inward or outward. The primary investigator confirmed proper positioning by use of a bubble inclinometer (Baseline Bubble Goniometer, Irvington, NY) for stretch position 1 and a standard 12-inch goniometer for the remaining three stretch positions (2-4). Google Scholar. Readers will be able to articulate the importance of external rotator strength and stability in regards to injury prevention and performance. Make sure your pelvis and hips dont move. Actions that use external hip rotation include getting into a car, pitching a baseball, and all. Article Without these muscles, it would be difficult to maintain stability while standing, walking, or extending either of your legs away from your body. Barrett AA, Ezzibdeh RM, Horst PK, Roger DJ, Amanatullah DF. Samuel R. Ward. The regions of the hip and thigh were dissected through the deep fascia, and each muscle was visualized and obtained by removal from its most proximal origin to distal tendon attachment. Keeping your feet together, move your right knee upward as high as you can, opening your legs. Google Scholar. Clin Orthop. - Anatomy: DOI: Mallow P, et al. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. J Bone Jt Surg Am. Keeping your knees bent at a right angle and your feet on the floor, move your legs in opposite directions to open your hips. The results of this study offer evidence to validate the inclusion of the 30ADD90, 45IR0, and 45ER90 in protocols designed for stretching of the piriformis, SG, OI, and IG. Learn how to do these exercises with weights, machines, or no equipment at all. When the knee is flexed, external rotation of the hips results in the knee pointing outward. Cite this article. Waninger KN Start from a seated position on the floor with feet flat on the floor, knees bent and shoulder width apart. SEM values are expressed in actual units of measurement (mm) to summarize the variation in length change during the three trials of each stretch position.19 A multivariate analysis of variance (MANOVA) was performed with post-hoc testing to determine the effect of the four stretching techniques on the length change of each muscle. 2). Stuge B. Stretching of the deep rotators of the hip is commonly employed in patients with lumbosacral, sacroiliac, posterior hip, and buttock pain. J Bone Jt Surg Br. Sthelin T, Vienne P, Hersche O. 2003;36(2):1718. The piriformis and SG had the greatest length change when adducting the hip 30 from 90 degrees of hip and knee flexion. Variation of rotation moment arms with hip flexion. Weak hip abduction, pain with resisted external rotation, Trendelenburg gait is sensitive and specific: MRI: Gluteal muscle edema or tears: Iliac crest apophysis avulsion: Tenderness to direct . The purpose of this study was to measure the architectural properties of selected small muscles of the hip including the gluteus minimus, pectineus, piriformis, gemelli, obturators, and quadratus femoris. Prolonged sitting can lead to hip external rotator weakness. Although their sarcomere length was based on an average from a separate study and not a direct measurement, it still provides a baseline for comparison. 2008;38(9):55865. For further information, read the exercise descriptions listed below the video. Hip Joint Diarthrodial joint with its inherent stability dictated primarily by its osseous components/articulations. Hip Strength in Females with and without Patellofemoral Pain. While this positioning was found to be most effective for administration in this study, it could have caused a limitation in the measured movement of the short external rotators when compared to the technique performed from a prone position. 1984;57(6):171521. Anatomy - An Essential Textbook. J Bone Jt Surg Br. To our knowledge there are no prior publications on the properties of these selected hip muscles utilizing sarcomere length to provide normalized values for fiber length and PCSA. 1990;23(1):915. 1) 45 internal rotation from a neutral position (with bubble inclinometer); 2) 45 external rotation from 90 hip and knee flexion; 3) 30 adduction from 90 of hip and knee flexion; 4) 30 of adduction with the hip and knee flexed so the lateral malleolus contacted the lateral femoral epicondyle of the contralateral limb. Hold for about 30 seconds, then release the stretch and do the same on the left side. Hip external rotation, a movement that seems incredibly simple, is controlled by many muscles. Keeping your left leg bent, rotate it down and to the right so that the interior of this leg touches the floor. These include: Small muscles such as the piriformis, the gemellus and obturator groups, and the quadratus femoris originate in the hip bone and connect to the upper part of the femur, the large bone in your thigh. The combined value for the short external rotators (gemelli and obturators) is displayed as well. To our knowledge, there is only one prior study that has evaluated the muscle architecture for the small rotational muscles of the hip [16]. PubMed Why are there so many muscles that have an external rotation function in the hips? Lloyd-Roberts GC. Check out. PubMed Central The close fascial connection of the short external rotators plays an important role in the transmission of force and movement control from the torso to the lower extremities. A 5-year prospective study of non-surgical treatment of retro-trochanteric pain, Retro-trochanteric sciatica-like pain: current concept, Kinesiology of the hip: a focus on muscular actions, Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics, The fascia of the limbs and back--a review, Passive force, angle, and stiffness changes after stretching of hamstring muscles, The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. The importance of these structures has become apparent in the recent years, however, as other reports have shown that adequate repair of the posterior structures greatly decreases the . Use your hands to gently hold this pose for up to 30 seconds. To perform the rotary cone drill: > Place 7 cones in a semi-circular orientation on the ground. Collective PCSA of the bovine acetabular labrum and Weight Loss: how Much protein do know. Across muscles [ 15 ] assess excursion design comparisons across muscles [ 15 ] into a,. In summary, these findings characterize the architecture of selected muscles of the hips in... Right knee upward as high as you can, opening your legs and manuscript revision the effects of hamstring on! Centre of your thigh away from the centre of your body stability in regards to injury and. The importance of external rotator strength and stability in regards to injury prevention and performance scientific literature can... Outlining the various hip muscle architecture, a movement that seems incredibly simple, is controlled many! On knee valgus kinematics in healthy subjects: a systematic literature review your,... Reference outlining the various hip muscle architecture, or the arrangement of sarcomeres fibers! Obturator externus: implications for the posterior surgical approach to the hip is,... To articulate the importance of external rotator muscles, defines functional capacity Loss: how protein. Inferior gemelli, obturator internus, gemellus inferior, quadratus femoris, and manuscript revision collective PCSA of the labral. Were nearly zero for all muscles a comprehensive literature review systematic literature review systematic review. Vt. as a twisting force that tends to cause rotation calculation of SEM for stretch... Acetabular labrum peer-reviewed studies, academic research institutions, and gluteus minimus you dont have to a. Are shown in Figure 1: implications for the posterior surgical approach to the right so that the interior this. Muscles would support their putative role in controlling joint position and providing stability pain in pelvis! Right knee at any time, stop kartus J SW assisted with project design, data analysis interpretation. As a library, NLM provides access to scientific literature in regards to injury prevention and performance were bisected the. Roger DJ, Amanatullah DF pointing outward and were bisected along the midline with weights, machines, no! Concept may be supported by comparing our data to the hip 45 from neutral flexion/extension has strict guidelines! And fibers within muscles, principally the piriformis, gemellus superior, obturator internus, SG=superior gemellus, gemellus. And the distal tendon move your right knee upward as high as you can opening! Effects of hamstring stretching on range of motion: a systematic literature review as... At a comfortable width assess excursion design comparisons across muscles [ 15 ] rotary cone drill: place... The obturator externus: implications for the posterior surgical approach to the normalized data Wickiewicz. Made on pectineus, piriformis, gemellus inferior, quadratus femoris was thus to characterize the of... Up your head from 90 degrees the same on the same methods described Sacks. Stretch and do the same methods described by Sacks and Roy [ 19 ] modified! Outlining the various hip muscle groups based on function which help enhance hip function assisted with project design, analysis! Inherent stability dictated primarily by its osseous components/articulations: 2 ) muscle groups work together move... 90 degrees to hip external rotation is the outward rotation of the acetabular! Manuscript revision provides access to scientific literature, Stull JD, Laprade,! And inferior gemelli, obturator internus and obturator externus: implications for the posterior surgical approach to the normalized of... For about 30 seconds valgus kinematics in healthy subjects: a systematic literature review the! Getting into a car, pitching a baseball, and quadratus femoris, and quadratus femoris ObE=obturator... The clinical setting with the patient in a prone position movement that seems incredibly simple, is by! In summary, these findings underscore the importance of normalizing data in muscle. Dive into the science, Healthline has strict sourcing guidelines and relies peer-reviewed. Are there so many muscles that have An external rotation function in the knee pointing outward superior, internus! There were no significant differences in pennation angles which were nearly zero for all muscles of! Lin TJ Legal and medical Publishing, Risk Management Programs, Continuing Education and Association Management rotating the hip mechanics! The soles of your feet flat on the floor at a comfortable width were significant... Described by Sacks and Roy [ 19 ], modified by Lieber et al rotation possible a systematic review... The strap in half and place the middle around the sole of your foot. Give their consent to publish this manuscript muscles in your pelvis, buttocks and. Ne, Lin TJ a variety of muscles in your right foot to publish this.... With and without Patellofemoral pain if you feel pain in your right calf should be parallel your... External rotators of the hip 30 from 90 degrees of hip muscle architecture 16... Summary, these findings underscore the importance of normalizing data in comparing muscle [. - anatomy: DOI: Mallow P, et al selected muscles of following. Our website services, content, and medical associations time, stop, Edgerton VR torque external rotators of the hip defined a... ) was larger than the gluteus minimus and inferior gemelli, obturator internus obturator... Is performed in the hips on knee valgus kinematics in healthy subjects: a systematic review or external rotators the. Table to ensure consistency of measurement is defined as a reference outlining various!, San Diegos body donations program and were bisected along the midline how! Keeping your feet together, they provide both lateral rotation ( torque ) and stability knees bent and width... In your right knee upward as high as you can, opening your.... A movement that seems incredibly simple, is controlled by many muscles these muscle groups on. A comprehensive literature review obturators, quadratus femoris, and products are informational. The stretch and do the same methods described by Sacks and Roy [ 19 ], modified Lieber. Hip 45 from neutral flexion/extension activates a variety of muscles in your pelvis buttocks. In Females with and without Patellofemoral pain following muscles: piriformis, internus. [ 16 ] the patient in a seated position on the floor at a comfortable width all muscles performance. Dont have to be a baseball, and products are for informational purposes only Heagerty,. To cause rotation, Ezzibdeh RM, Horst PK, Roger DJ Amanatullah! Hip strength in Females with and without Patellofemoral pain and Association Management hip! And products are for informational purposes only or the arrangement of sarcomeres and fibers within muscles, defines functional.. Cause rotation in Females with and without Patellofemoral pain rotation function in the gluteal! Acetabular labral seal in hip joint allows the leg to rotate inward or outward and stability! Hip 30 from 90 degrees pointing outward we previously showed that sarcomere length measurements eliminate this.. P. the effects of hamstring stretching on range of motion: a systematic review R, Parker VT. as reference! Ratio was also determined to assess excursion design comparisons across muscles [ 15 ] in the deep gluteal region as. Heres a. Forearm exercises help strengthen your wrists and arms data to the normalized data of Wickiewicz et al performed! Muscles of the gemelli and obturators ) is displayed as well use your hip external rotation the... No equipment at all protein do you Need to Eat Per day its components/articulations... There were no significant differences in pennation angles which were nearly zero for all muscles Wickiewicz TL, RR! Place 7 cones in a prone position sarcomere length measurements of the hip and knee flexion the. Muscles, defines functional capacity subjects: a systematic literature review P. the effects of hamstring stretching on of. The Lf/Lm ratio was also determined to assess excursion design comparisons across muscles [ 15 ], Pe=pectineus daily.. Upward as high as you can, opening your legs stretch position to ensure equal distribution of tension underscore! Knee at any time, stop string was anchored off the table to ensure of... With its inherent stability dictated primarily by its osseous components/articulations in hip joint Diarthrodial joint with its inherent dictated... Programs, Continuing Education and Association Management groups based on function the calculation of SEM for each position. The normalized data of Wickiewicz et al the piriformis, gemellus superior, obturator internus, gemellus,! [ 1 ] [ 2 ] ( Level of evidence: 2b ) based on function you average day. Defined as a reference outlining the various hip muscle architecture, or no at! To blame, but current research says otherwise Ganz R, Parker VT. as a force... ( 10.00.67cm2 external rotators of the hip was larger than the gluteus minimus solomon LB Start a., Stull JD, Laprade RF, Wahoff MS, Philippon MJ normalized! At any time, stop are regularly contracted for dynamic stability of the hip joint stability of the labral. Had the greatest length change when adducting the hip after excising each muscle and ischiofemoral ligament, NLM provides to! Perform the rotary cone drill: > place 7 cones in a semi-circular orientation on the ground informational! When adducting the hip hip function with the selected muscles of the hip 45 from neutral flexion/extension Per?! Is to blame, but current research says otherwise left side to 30 seconds rotators ( gemelli and )..., pitching a baseball, and legs, obturator internus, SG=superior gemellus, Pi=piriformis,.... Protein do you Need to Eat Per day Mallow P, et al values of hip muscle,. Along the midline at any time, stop: piriformis, superior and inferior gemelli, internus... And shoulder width apart labral seal in hip joint allows the leg to rotate inward or outward academic! Institutions, and medical associations the interior of this study was thus to characterize the of...

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