Hip Muscle Strength Explains Only 11% of the Improvement in HAGOS With an Intersegmental Approach to Successful Rehabilitation of Athletic Groin Pain

Background: Exercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined. Purpose: First, to examine differences in isometric hip strength, reactive strength, and the Hip and Groin Outcome Score (HAGOS) between the AGP and CON cohorts and after rehabilitation; second, to examine the relationship between the change in HAGOS and the change in strength variables after rehabilitation; last, to track HAGOS for 6 months after RTP. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 42 athletes diagnosed with AGP and 36 matched controls completed baseline testing: isometric hip strength, lower limb reactive strength, and HAGOS. After rehabilitation, athletes with AGP were retested, and HAGOS was collected at 3 and 6 months after RTP. Results: In total, 36 athletes with AGP completed the program with an RTP time of 9.8 ± 3.0 weeks (mean ± SD). At baseline, these athletes had significantly lower isometric hip strength (abduction, adduction, flexion, extension, external rotation: d = –0.67 to −1.20), single-leg reactive strength ( d = −0.73), and HAGOS ( r = −0.74 to −0.89) as compared with the CON cohort. Hip strength ( d = −0.83 to −1.15) and reactive strength ( d = −0.30) improved with rehabilitation and were no longer significantly different between groups at RTP. HAGOS improvements were maintained or improved in athletes with AGP up to 6 months after RTP, although some subscales remained significantly lower than the CON group ( r = −0.35 to −0.51). Two linear regression features (hip abduction and external rotation) explained 11% of the variance in the HAGOS Sports and Recreation subscale. Conclusion: Athletes with AGP demonstrated isometric hip strength and reactive strength deficits that resolved after an intersegmental control rehabilitation program; however, improved hip strength explained only 11% of improvement in the Sports and Recreation subscale. HAGOS improvements after pain-free RTP were maintained at 6 months.

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Reliability of hip muscle strength measured in principal and intermediate planes of movement

PeerJ ◽

10.7717/peerj.11521 ◽

2021 ◽

Vol 9 ◽

pp. e11521

Author(s):

Basilio A.M. Goncalves ◽

David J. Saxby ◽

Adam Kositsky ◽

Rod S. Barrett ◽

Laura E. Diamond

Keyword(s):

Muscle Strength ◽

External Rotation ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Hip Strength ◽

Minimum Detectable Change ◽

Hip Muscle ◽

Flexion Extension ◽

Hip Abduction ◽

Muscle Actions

Background Muscle strength testing is widely used in clinical and athletic populations. Commercially available dynamometers are designed to assess strength in three principal planes (sagittal, transverse, frontal). However, the anatomy of the hip suggests muscles may only be recruited submaximally during tasks performed in these principal planes. Objective To evaluate the inter-session reliability of maximal isometric hip strength in the principal planes and three intermediate planes. Methods Twenty participants (26.1 ± 2.7 years, 50% female) attended two testing sessions 6.2 ± 1.8 days apart. Participants completed 3-5 maximal voluntary isometric contractions for hip abduction, adduction, flexion, extension, and internal and external rotation measured using a fixed uniaxial load cell (custom rig) and commercial dynamometer (Biodex). Three intermediate hip actions were also tested using the custom rig: extension with abduction, extension with external rotation, and extension with both abduction and external rotation. Results Moderate-to-excellent intraclass correlation coefficients were observed for all principal and intermediate muscle actions using the custom rig (0.72–0.95) and the Biodex (0.85–0.95). The minimum detectable change was also similar between devices (custom rig = 11–31%; Biodex = 9–20%). Bland-Altman analysis revealed poor agreement between devices (range between upper and lower limits of agreement = 77–131%). Conclusions Although the custom rig and Biodex showed similar reliability, both devices may lack the sensitivity to detect small changes in hip strength commonly observed following intervention.

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Reliability of a New Portable Dynamometer for Assessing Hip and Lower Limb Strength

Applied Sciences ◽

10.3390/app11083391 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3391

Author(s):

Jan Marušič ◽

Goran Marković ◽

Nejc Šarabon

Keyword(s):

Lower Limb ◽

External Rotation ◽

Peak Torque ◽

Knee Extension ◽

Lower Limb Muscles ◽

Lower Limb Strength ◽

Flexion Extension ◽

Strength Tests ◽

Hip Abduction ◽

Maximal Peak

The purpose of this study was to evaluate intra- and inter-session reliability of the new, portable, and externally fixated dynamometer called MuscleBoard® for assessing the strength of hip and lower limb muscles. Hip abduction, adduction, flexion, extension, internal and external rotation, knee extension, ankle plantarflexion, and Nordic hamstring exercise strength were measured in three sessions (three sets of three repetitions for each test) on 24 healthy and recreationally active participants. Average and maximal value of normalized peak torque (Nm/kg) from three repetitions in each set and agonist:antagonist ratios (%) were statistically analyzed; the coefficient of variation and intra-class correlation coefficient (ICC2,k) were calculated to assess absolute and relative reliability, respectively. Overall, the results display high to excellent intra- and inter-session reliability with low to acceptable within-individual variation for average and maximal peak torques in all bilateral strength tests, while the reliability of unilateral strength tests was moderate to good. Our findings indicate that using the MuscleBoard® dynamometer can be a reliable device for assessing and monitoring bilateral and certain unilateral hip and lower limb muscle strength, while some unilateral strength tests require some refinement and more extensive familiarization.

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Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

The American Journal of Sports Medicine ◽

10.1177/0363546519850816 ◽

2019 ◽

Vol 47 (8) ◽

pp. 1939-1948 ◽

Cited By ~ 1

Author(s):

Matthew D. Freke ◽

Kay Crossley ◽

Kevin Sims ◽

Trevor Russell ◽

Patrick Weinrauch ◽

...

Keyword(s):

Hip Arthroscopy ◽

Repeated Measures ◽

External Rotation ◽

Case Series ◽

Hip Pain ◽

Range Of Movement ◽

Level Of Evidence ◽

Hip Strength ◽

Hip Flexion ◽

And Function

Background:Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function.Purpose:To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy.Study Design:Case series; Level of evidence, 4.Methods:Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls.Results:Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P < .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P < .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P < .005) remained less than matched controls.Conclusion:With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.

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Landing Kinematics and Isometric Hip Strength of Individuals With Chronic Ankle Instability

Foot & Ankle International ◽

10.1177/1071100719846085 ◽

2019 ◽

Vol 40 (8) ◽

pp. 969-977 ◽

Cited By ~ 5

Author(s):

Ryan S. McCann ◽

Masafumi Terada ◽

Kyle B. Kosik ◽

Phillip A. Gribble

Keyword(s):

Lower Extremity ◽

Ankle Instability ◽

External Rotation ◽

Peak Torque ◽

Chronic Ankle Instability ◽

Initial Contact ◽

Level Of Evidence ◽

Hip Strength ◽

Hip Kinematics ◽

Rotation Strength

Background: Chronic ankle instability (CAI) is associated with hip strength deficits and altered movement in the lower extremity. However, it remains unclear how hip strength deficits contribute to lateral ankle sprain (LAS) mechanisms. We aimed to compare lower extremity landing kinematics and isometric hip strength between individuals with and without CAI and examine associations between hip kinematics and strength. Methods: Seventy-six individuals completed 5 single-leg landings, during which we collected three-dimensional ankle, knee, and hip kinematics from 200 milliseconds pre–initial contact to 50 milliseconds post–initial contact. We calculated average peak torque (Nm/kg) from 3 trials of isometric hip extension, abduction, and external rotation strength testing. One-way analyses of variance assessed group differences (CAI, LAS coper, and control) in hip strength and kinematics. Pearson product moment correlations assessed associations between hip kinematics and strength. We adjusted the kinematic group comparisons and correlation analyses for multiple comparisons using the Benjamini-Hochberg method. Results: The CAI group exhibited less hip abduction during landing than LAS copers and controls. The CAI group had lower hip external rotation strength than LAS copers ( P = .04, d = 0.62 [0.05, 1.17]) and controls ( P < .01, d = 0.87 [0.28, 1.43]). Effect sizes suggest that the CAI group had deficits in EXT compared with controls ( d = 0.63 [0.06, 1.19]). Hip strength was not associated with hip landing kinematics for any group. Conclusion: Altered landing mechanics displayed by the CAI group may promote mechanisms of LAS, but they are not associated with isometric hip strength. However, hip strength deficits may negatively impact other functional tasks, and they should still be considered during rehabilitation. Level of Evidence: Level III, case-control study.

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Hip and groin pain in sub-elite South African footballers

South African Journal of Sports Medicine ◽

10.17159/2413-3108/2015/v27i4a1265 ◽

2016 ◽

Vol 27 (4) ◽

pp. 114

Author(s):

D J Dowson

Keyword(s):

Range Of Motion ◽

Groin Pain ◽

Medical Practitioner ◽

Medical Professional ◽

Average Score ◽

Hip Strength ◽

Joint Pathology ◽

Flexion Extension ◽

Hip Flexion ◽

Groin Injury

Background. Groin injuries are common in football. This can be attributed to the nature of the sport involving rapid accelerations, decelerations, abrupt directional changes and kicking. Groin injuries require lengthy rehabilitation times and predispose players to further injuries. Previous groin injury is a risk factor for future groin injuries, suggesting players are inadequately rehabilitated or the original cause has not been addressed. Objectives. To describe the prevalence, nature and treatment patterns of groin injuries in sub-elite players, and to investigate differences in hip strength and range of motion between players with and without a history of groin injury. Method. Thirty sub-elite, senior university male players were interviewed and questioned regarding groin injuries sustained in the preceding three years. They were assessed using the HAGOS questionnaire, and underwent isokinetic hip flexion/extension strength, adductor squeeze and range of motion tests. Results. Seventeen players (57%) reported having a previous groin injury, with an average score of 83 (16) [mean (SD)] on the HAGOS, compared with 92 (5) for non-injured players. Of the previously injured players, 29% did not seek treatment from a medical professional. Injuries included adductor strain (35%), inguinal-related (18%), iliopsoas-related (12%) and hip joint pathology (6%). The average time off was 25 days. There were no significant differences in isokinetic hip flexion/extension strength, adductor strength and range of motion. Conclusion. The prevalence of groin injuries in this population is relatively high (57%) and requires lengthy rehabilitation time. The HAGOS is a suitable tool to identify groin pain in this population within the sports and recreation and quality of life subscales. Isokinetic hip strength and range of motion testing lacked sensitivity in detecting deficits in players with a previous groin injury. Only two-thirds of injured players consulted a medical practitioner, increasing the likelihood that rehabilitation was inadequate. It is therefore recommended that player/coach education regarding injury management improve in order to reduce subsequent injuries. Keywords. HAGOS, groin injury, prevalence, range of motion, isokinetic strength

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Weak Hip Strength Increases Dynamic Knee Valgus in Single-Leg Tasks of Collegiate Female Athletes

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0043 ◽

2021 ◽

pp. 1-4

Author(s):

Kyndell R. Crowell ◽

Ryan D. Nokes ◽

Nicole L. Cosby

Keyword(s):

Female Athletes ◽

External Rotation ◽

Common Factor ◽

Knee Valgus ◽

Bottom Line ◽

Level Of Evidence ◽

Hip Strength ◽

Risk Of Injury ◽

Increased Risk ◽

Collegiate Female Athletes

Clinical Scenario: Dynamic knee valgus (DKV) is a mechanical alteration in the knee that leads to increased risk of injury. Weakness of hip musculature in hip abduction (HABD), extension (HEXT), and external rotation (HER) may contribute to increased DKV in single-leg landing tasks. Focused Clinical Question: Is decreased hip strength associated with an increase in DKV during a single-leg landing task in collegiate female athletes? Summary of Key Findings: Three studies were included: One randomized control trial (RCT), one cohort study, and one case-control. All three studies found that decreases in HABD and HER strength contributed to increased DKV during single-leg landing tasks. One study also found that the hip extensors contribute to controlling hip adduction, a common factor in many mechanisms of injuries. These three studies recommended strengthening HABD, HEXT, and HER to decrease DKV and reduce the risk of injury at the knee. Clinical Bottom Line: Weak HABD, HEXT, and HER contribute to increased DKV in college female athletes, but strengthening HABD, HEXT, and HER can lead to decreases in DKV and, overall, reduce the risk of injury at the knee. Strength of Recommendation: These articles were graded with a level of evidence of III or higher, giving a grade of B strength of recommendation that weak HABD, HEXT, and HER are associated with increased DKV in collegiate female athletes.

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Effects of Lower Limb and Pelvic Pin Positions on Leg Length and Offset Measurement Errors in Experimental Total Hip Arthroplasty

10.21203/rs.3.rs-150248/v1 ◽

2021 ◽

Author(s):

Haruo Kawamura ◽

Yasuhiko Watanabe ◽

Tomofumi Nishino ◽

Hajime Mishima

Keyword(s):

Measurement Error ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lower Limb ◽

Measurement Errors ◽

Iliac Crest ◽

External Rotation ◽

Limb Position ◽

Permissible Range ◽

Flexion Extension

Abstract BackgroundLeg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. MethodsAn LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. ResultsOnly 4 degrees of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion–extension and internal–external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. ConclusionTo minimize LL and OS measurement errors in THA, adduction–abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.

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Lower Reinjury Rate with a Coach-Controlled Rehabilitation Program in Amateur Male Soccer

The American Journal of Sports Medicine ◽

10.1177/0363546507300063 ◽

2007 ◽

Vol 35 (9) ◽

pp. 1433-1442 ◽

Cited By ~ 54

Author(s):

Martin Hägglund ◽

Markus Walden ◽

Jan Ekstrand

Keyword(s):

Cox Regression ◽

Controlled Trial ◽

Intervention Group ◽

Rehabilitation Program ◽

Return To Play ◽

Control Group ◽

Level Of Evidence ◽

Cox Regression Analysis ◽

Limb Injuries ◽

Soccer Teams

Background Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury. Hypothesis The rate of reinjury is reduced using a coach-controlled rehabilitation program. Study Design Randomized controlled trial; Level of evidence, 1. Methods Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups. Results There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.16-0.72, P = .0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11-0.57, P < .001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%). Conclusion The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.

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Comparison of Lower Extremity Muscle Flexibility in Amateur and Trained Bharatanatyam Dancers and Nondancers

Medical Problems of Performing Artists ◽

10.21091/mppa.2018.1005 ◽

2018 ◽

Vol 33 (1) ◽

pp. 20-25

Author(s):

Monica Sharma ◽

Shibili Nuhmani ◽

Deepti Wardhan ◽

Qassim I Muaidi

Keyword(s):

Internal Rotation ◽

Lower Limb ◽

Knee Flexion ◽

External Rotation ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Lower Extremity Muscle ◽

Significant Difference ◽

Flexion Extension ◽

Hip Flexion

OBJECTIVE: This study compared lower limb muscle flexibility between amateur and trained female Bharatanatyam dancers and nondancers. METHODS: Subjects consisted of 105 healthy female volunteers, with 70 female Bharatanatyam dancers (35 trained, 35 amateurs) and 35 controls, with a mean (±SD) age of 16.2±1.04 yrs, height 155.05±4.30 cm, and weight 54.54±2.77 kg. Participants were assessed for range of motion (ROM) in hip flexion, hip extension, hip abduction and adduction, hip external rotation, hip internal rotation, knee flexion, knee extension, ankle dorsiflexion (DF), and ankle plantar flexion (PF) by using a standardized goniometer. To assess for significant difference between groups, one-way ANOVA was applied, and multiple comparisons were made using Bonferroni correction. RESULTS: Trained dancers had a significantly greater hip flexion, extension, abduction, and external rotation ROM than amateurs and nondancers (p<0.05). Also, internal rotation and adduction were markedly less in trained dancers (p<0.05). Knee flexion, extension, and ankle DF were higher and ankle PF ROM was lesser in trained dancers. However, not much variation was found in ankle DF and PF between amateur dancers and nondancers (p>0.05). CONCLUSION: Results showed that there are significant differences in lower limb muscle flexibility between trained and amateur Bharatanatyam dancers and nondancers. These differences may be due to individual dance postures such as araimandi and muzhumandi.

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Effects of lower limb and pelvic pin positions on leg length and offset measurement errors in experimental total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02347-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Haruo Kawamura ◽

Yasuhiko Watanabe ◽

Tomofumi Nishino ◽

Hajime Mishima

Keyword(s):

Measurement Error ◽

Total Hip Arthroplasty ◽

Lower Limb ◽

Measurement Errors ◽

Iliac Crest ◽

External Rotation ◽

Leg Length ◽

Limb Position ◽

Permissible Range ◽

Flexion Extension

Abstract Background Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. Methods An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. Results Only 4° of abduction/adduction caused 5–7 mm error in LL and 2–4 mm error in OS, irrespective of pin position. The effects of flexion–extension and internal–external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. Conclusion To minimize LL and OS measurement errors in THA, adduction–abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.

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