The influence of hip abductor muscle performance on dynamic postural stability in females with patellofemoral pain

doi:10.1016/j.gaitpost.2012.03.024

Gait & Posture

Volume 36, Issue 3, July 2012, Pages 425-429

https://doi.org/10.1016/j.gaitpost.2012.03.024 Get rights and content

Abstract

Hip abductors play an important role in maintaining trunk and pelvis stability during unipedal tasks. The purpose of the study was to compare postural stability between individuals with patellofemoral pain (PFP) and pain-free controls. A secondary purpose was to evaluate the effect of a hip stabilizing brace on postural stability. Twenty females with PFP (27.3 ± 6.3 years) and 19 controls (26.1 ± 4.5 years) participated. Each subject performed a unipedal step-down balance task with the stance leg on a force platform from which center of pressure (COP) excursion was recorded. Quantitative COP excursion patterns (mean and peak displacements) were used as measures of postural stability. For subjects with PFP, postural stability also was quantified following the application of a hip stabilizing brace. Hip abductor strength was significantly lower in PFP group compared to the control group (1.39 ± 0.4 vs. 1.62 ± 0.26 N/kg-BW, p = 0.046). Peak and mean medial–lateral COP displacements during the balance task were greater in the PFP group (39.8 ± 6.7 vs. 24.3 ± 3.8 mm, p < 0.001; 24.7 ± 16.3 vs. 13.5 ± 4.4 mm, p = 0.005). Application of the hip stabilizing brace reduced the peak and mean COP displacement (39.8 ± 6.7 vs. 24.7 ± 4.7 mm, p < 0.001; 24.7 ± 16.3 vs. 16.8 ± 15.1 mm, p = 0.02). Our results demonstrate that females with PFP exhibit impaired medial–lateral postural stability when compared to control subjects. Application of a hip stabilizing brace significantly improved stability to a level comparable to the controls.

Highlights

► Hip abductor performance is important for maintaining postural stability during unipedal tasks. ► We compared postural stability in females with patellofemoral pain (PFP) to pain-free controls during a step-down task. ► Females with PFP exhibited significant hip abductor weakness and decreased postural stability. ► A hip stabilizing brace helped improving postural stability in females with PFP.

Introduction

Control of the hip joint plays an important role in stabilizing the trunk and the pelvis while maintaining proper alignment of the lower extremity [1]. Previous studies on posture and balance have suggested that hip muscle torque production is instrumental in minimizing the acceleration of the body center of mass in response to postural perturbations in the anterior–posterior and medial–lateral directions [2]. It is believed that hip joint motion is essential in providing a continuum of multi-directional postural corrections to sustain upright standing postural stability [3], [4]. The importance of hip muscle performance with respect to postural stability has been demonstrated experimentally by Gribble and Hertel [5], [6] who reported that fatigue of the hip muscles leads to postural control impairments in the frontal and sagittal plane. In addition, local fatigue of the hip abductors has been shown to have a larger influence on medial–lateral postural control when compared to local fatigue of the dynamic stabilizers of the ankle [6].

One patient population that consistently has been shown to exhibit diminished hip muscle performance and altered hip kinematics during dynamic activities is females with patellofemoral pain (PFP). For example, several studies have reported that females with PFP demonstrate deficits in hip abductor, extensor and external rotator muscle strength when compared to healthy controls [7], [8], [9], [10], [11]. In addition, females with PFP have been shown to exhibit greater degrees of hip adduction and internal rotation during dynamic activities such as running and landing from a jump [12], [13], [14]. Given as such, it is reasonable to speculate that individuals with a diagnosis of PFP and impaired hip muscle performance also may demonstrate decreased postural stability during dynamic tasks.

The primary purpose of the current study was to compare postural stability of females with PFP and documented hip abductor muscle weakness to pain-free individuals with relatively stronger hip abductors during a dynamic unipedal step-down test. We hypothesized that when compared to a control group, females with PFP and documented hip abductor weakness would exhibit increased medial–lateral center of pressure (COP) excursion during a step-down balance task. To further assess the association between hip abductor weakness and postural stability, a secondary purpose of the study was to evaluate the effect of a hip stabilizing brace on postural stability in females with PFP. Given that hip brace was designed with the intention of limiting excessive hip adduction and internal rotation during weightbearing activities, we hypothesized that the application of the brace would decrease the medial–lateral COP excursion in PFP subjects. Such a finding would support the contention that hip abductor strength is an important contributor to medial–lateral postural stability.

Section snippets

Subjects

The current study constitutes a follow-up analysis of a cohort of PFP and control subjects that was described in a previous investigation [12]. Twenty females with a diagnosis of PFP (27.3 ± 6.3 years, height = 169.2 ± 8.1 cm, weight = 64.7 ± 10.4 kg) comprised the study group while 19 age, height, and weight matched pain-free females (26.1 ± 4.5 years, height = 168.2 ± 6.0 cm, weight = 62.9 ± 6.6 kg) served as the control group. All subjects were screened through physical examination to rule out ligamentous

Results

As reported previously, [12] normalized hip abduction torque was significantly lower in the PFP group when compared to the control group (1.39 vs. 1.62 Nm/kg-BW, p = 0.046; Table 1). The peak and average medial–lateral displacement of the COP were significantly greater in the PFP group compared to the control group (39.8 vs. 24.3 mm, p < 0.001; 24.7 vs. 13.5 mm, p = 0.007, respectively, Table 1). In addition, the within-trial variability of the COP excursion was significantly higher in subjects with PFP

Discussion

Our results confirm the hypothesis that females with PFP and diminished hip abductor muscle performance exhibited impaired medial–lateral postural stability when compared to pain-free individuals with relatively stronger hip abductors. While deficits in hip abductor muscle strength in the PFP group compared to the control group were modest (14%), large differences in quantitative balance performance between the two groups were observed (39–45%). To further elucidate the association between hip

Conflict of interest statement

One of the authors (CMP) has a financial relationship with DonJoy Orthopaedics, Inc. The study design, data collection, analysis, interpretation and writing of the manuscript were not influenced by any people or organizations.

Acknowledgments

The authors would like to acknowledge the support provided by the Division of Biokinesiology and Physical Therapy at the University of Southern California, and the Jacquelin Perry Musculoskeletal Biomechanics Research Lab.

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Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population.
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We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention.
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Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.
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Citation Excerpt :
The clinical diagnosis of GTPS is made according to the presence of tenderness upon palpation over the greater trochanter when the individual is in a side-lying position and reported functional impairment on walking long distances, standing for long periods of time, or going up or down stairs.1 One possible cause of this functional impairment may be changes in muscular strength at the hip muscles.5,6 Despite different several clinical tools, such as ultrasound evaluation,7,8 force platforms,9,10 infrared thermography,11,12 manual clinical assessment,13 and neuromuscular mechanosensitivity assessment,14,15 that may be used to carry out a lower-limb assessment, the single-leg-squat test (SLST) is a valid and reliable test.16
Greater trochanteric pain syndrome (GTPS) is a common condition that can cause lateral hip pain. The single-leg-squat test (SLST) may be used by physicians in primary care environments to evaluate patients’ dynamic stability. The aim of this study was to evaluate the dynamic stability and strength of lateral abduction hip movements in primary care patients with GTPS in relation to their perceived pain interference in life.
A descriptive observational study was carried out in a primary health care center. Fifty-four participants with GTPS were included in this study and divided into lower- and higher-interference groups (n = 30 and 19, respectively) according to the Graded Chronic Pain Scale. Participants were evaluated for their lateral abduction hip strength and the SLST.
The SLST showed a statistically significant difference between groups with respect to hip-joint posture and movement level (P = .043) but not for other SLST domains or lateral abduction hip strength (P > .05).
Patients with GTPS with more pain interference in their lives had poorer dynamic stability with respect to hip-joint posture and movements based on the SLST but did not present impaired lateral hip abduction strength in comparison with those who perceived lower pain interference in life.

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The influence of hip abductor muscle performance on dynamic postural stability in females with patellofemoral pain

Abstract

Highlights

Introduction

Section snippets

Subjects

Results

Discussion

Conflict of interest statement

Acknowledgments

Gait & Posture

Journal of Electromyography and Kinesiology: Official Journal of the International Society of Electrophysiological Kinesiology

Archives of Physical Medicine and Rehabilitation

Journal of Biomechanics

Archives of Physical Medicine and Rehabilitation

Gait & Posture

Clinical Biomechanics (Bristol, Avon)

The influence of abnormal hip mechanics on knee injury: a biomechanical perspective

The Journal of Orthopaedic and Sports Physical Therapy

Reciprocal angular acceleration of the ankle and hip joints during quiet standing in humans

Experimental Brain Research

Unified theory regarding A/P and M/L balance in quiet stance

Journal of Neurophysiology

Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome

The Journal of Orthopaedic and Sports Physical Therapy

Hip strength in collegiate female athletes with patellofemoral pain

Medicine and Science in Sports and Exercise

Hip strength in females with and without patellofemoral pain

The Journal of Orthopaedic and Sports Physical Therapy