Highlights
- •Hip adduction moment during walking is larger in those with gluteal tendinopathy.
- •Pelvic obliquity is associated with hip adduction moment in gluteal tendinopathy.
- •Two trunk and pelvic strategies are seen during walking in gluteal tendinopathy.
- •Addressing gait biomechanics may be relevant for gluteal tendinopathy management.
Abstract
Background
Lateral hip pain during walking is a feature of gluteal tendinopathy but little is
known how walking biomechanics differ in individuals with gluteal tendinopathy. This
study aimed to compare walking kinematics and kinetics between individuals with and
without gluteal tendinopathy.
Methods
Three-dimensional walking-gait analysis was conducted on 40 individuals aged 35 to
70 years with unilateral gluteal tendinopathy and 40 pain-free controls. An analysis
of covariance was used to compare kinematic and kinetic variables between groups.
Linear regression was performed to investigate the relationship between kinematics
and external hip adduction moment in the gluteal tendinopathy group.
Findings
Individuals with gluteal tendinopathy demonstrated a greater hip adduction moment
throughout stance than controls (standardized mean difference ranging from 0.60 (first
peak moment) to 0.90 (second peak moment)). Contralateral trunk lean at the time of
the first peak hip adduction moment was 1.2 degrees greater (P = 0.04), and pelvic drop at the second peak hip adduction moment 1.4 degrees greater
(P = 0.04), in individuals with gluteal tendinopathy. Two opposite trunk and pelvic strategies
were also identified within the gluteal tendinopathy group. Contralateral pelvic drop
was significantly correlated with the first (R = 0.35) and second peak (R = 0.57) hip adduction moment, and hip adduction angle with the second peak hip adduction
moment (R = −0.36) in those with gluteal tendinopathy.
Interpretation
Individuals with gluteal tendinopathy exhibit greater hip adduction moments and alterations
in trunk and pelvic kinematics during walking. Findings provide a basis to consider
frontal plane pelvic control in the management of gluteal tendinopathy.
Keywords
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References
- The functional anatomy of hip abductors.Folia Morphol. 2009; 68: 98-103
- Hip abductor muscle weakness in individuals with gluteal tendinopathy.Med. Sci. Sports Exerc. 2015; (Epub 28 September, 2015)https://doi.org/10.1249/MSS.0000000000000781
- Compression etiology in tendinopathy.Clin. Sports Med. 2003; 22: 703-710
- Pelvic angles: A mathematically rigorous definition which is consistent with a conventional clinical understanding of the terms.Gait Posture. 2001; 13: 1-6
- A case of hip rotator cuff tear revealed by refractory gluteus medius tendinosis.Joint Bone Spine. 2001; 68: 360-363
- Repeatability of gait data using a functional hip joint centre and a mean helical knee axis.J. Biomech. 2003; 36: 1159-1168
- Rationale for treatment of hip abductor pain syndrome.Iowa Orthop. J. 2003; 23: 57-60
- Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome.Arthritis Rheum. 2001; 44: 2138-2145
- Finite element model of the proximal femur under consideration of the hip centralizing forces of the iliotibial tract..Clin. Biomech. 2011; 26: 58-64
- Correlation of MRI findings with clinical findings of trochanteric pain syndrome.Skelet. Radiol. 2008; 37: 903-909
- Rotator-cuff tear of the hip.J. Bone Joint Surg. 1997; 79-B: 618-620
- Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression.Arthritis Rheum. 2005; 52: 3515-3519https://doi.org/10.1002/art.21406
- Statistical Power Analysis for the Behavioural Sciences.second ed. Lawrence Earlbaum Associates, Hillsdale, NJ1988
- Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.Br. J. Sports Med. 2009; 43: 409-416
- The challenge of managing tendinopathy in competing athletes.Br. J. Sports Med. 2014; 48: 506-509
- Relationship between compressive loading and ECM changes in tendons.Muscles Ligaments Tendons J. 2013; 3: 7-11
- MR imaging of the hip abductors: Normal anatomy and commonly encountered pathology at the greater trochanter.Magn. Reson. Imaging Clin. North Am. 2005; 13: 691
- Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: A case control study.J. Arthroplast. 2014; 29: 383-386
- Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study.Clin. Orthop. Relat. Res. 2010; 468: 1838-1844
- Greater trochanteric pain syndrome: Defining the clinical syndrome.Br. J. Sports Med. 2013; 47: 649-653
- The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study.Br. J. Sports Med. 2012; 46: 888-892
- Is adiposity an under-recognized risk factor for tendinopathy?.Syst. Rev. Arthritis Rheum. 2009; 61: 840-849
- KSLB. The functional anatomy of tensor fascia latae and gluteus medius and minimus.J. Anat. 1989; 166: 179-189
- Gluteal tendinopathy: A review of mechanisms.Assess. Manag. Sports Med. 2015; 48: 1107-1119
- Gluteal tendinopathy: Clinical diagnosis vs MRI diagnosis.Br. J. Sports Med. 2014; 48: A43
- Assessing lateral stability of the hip and pelvis.Man. Ther. 2011; 16: 26-32
- Prediction of the hip joint centre in adults, children, and patients with cerebral palsy based on magnetic resonance imaging.J. Biomech. 2007; 40: 595-602
- Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction.Curr. Sports Med. Rep. 2012; 11: 232-238
- Radiological assessment of osteo-arthrosis.Ann. Rheum. Dis. 1957; 16: 494-502
- Muscles: Testing and Function.4th Edition ed. Williams & Wilkins, Baltimore, MD1993
- Fatigue quality of mammalian tendons.J. Exp. Biol. 2000; 203: 1317-1327
- MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome.Eur. Radiol. 2007; 17 (PubMed PMID: 17149624): 1772-1783
- Is Pauwels theory of hip biomechanics still valid? A critical analysis, based on modern methods.Ann. Anat. 1993; 288: 73-77
- Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests.Arthritis Rheum-Arthritis Care Res. 2008; 59: 241-246
- Human tendon behaviour and adaptation, in vivo.J. Physiol. 2008; 30: 1616-1620
- The pathogenesis of tendinopathy: Balancing the response to loading.Nat. Rev. Rheumatol. 2010; 6: 262-268
- The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates.Arthrosc. J. Arthrosc. Relat. Surg. 2008; 24: 1013-1018
- Gluteus medius (GM) tears presenting as the clinical syndrome of trochanteric bursitis.Arthritis Rheum. 1999; 42: S340-S
- Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients.Radiology. 2005; : 969-976
- Can local muscles augment stability in the hip? A narrative literature review.J. Musculoskelet. Neuronal Interact. 2013; 13: 1-12
- Explaining the hip adduction moment variability during gait: Implications for hip abductor strengthening.Clin. Biomech. 2009; 24: 267-273
- Greater trochanteric pain syndrome: Epidemiology and associated factors.Arch. Phys. Med. Rehabil. 2007; 88: 988-992
- Gluteus minimus: An intramuscular EMG investigation of anterior and posterior segments during gait.Gait Posture. 2014; 39: 822-826
- Gluteus medius: An intramuscular EMG investigation of anterior, middle and posterior segments during gait.J. Electromyogr. Kinesiol. 2013; 23: 858-864
- Tendon and ligament injuries: The genetic component.Br. J. Sports Med. 2007; 41: 241-246
- Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle.Skelet. Radiol. 2013; 42: 627-633
- The effect of angle and moment of the hip and knee joint on iliotibial band hardness.Gait Posture. 2015; 41: 522-528
- Changes in mechanical loading lead to tendonspecific alterations in MMP and TIMP expression: Influence of stress deprivation and intermittent cyclic hydrostatic compression on rat supraspinatus and Achilles tendons.Br. J. Sports Med. 2010; 44: 698-703
- Spinal and pelvic kinematics in osteoarthrosis of the hip joint.Spine. 1985; 10: 467-471
- An anatomic study of the iliotibial tract.Arthroscopy. 2007; 23: 269-274
- Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis.Arch. Phys. Med. Rehabil. 2001; 82: 1705-1711
- Human balance and posture control during standing and walking.Gait Posture. 1995; 3: 193-214
- Lateral hip pain: Findings from magnetic resonance imaging and clinical examination.J. Orthop. Sports Phys. Ther. 2008; 38: 313-328
- The passive elastic moment at the hip.J. Biomech. 1982; 15: 905-910
- Relationship between physical impairments and movement patterns during gait in patients with end-stage hip osteoarthritis.J. Orthop. Res. 2015; 33: 382-389
Article info
Publication history
Published online: January 15, 2016
Accepted:
January 7,
2016
Received:
September 17,
2015
Identification
Copyright
© 2016 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to “Kinematics and kinetics during walking in individuals with gluteal tendinopathy” [Clin. Biomech. vol. 32 (February 2016) Pages 56–63]Clinical BiomechanicsVol. 36
- PreviewThe authors regret that the citations for two clinical tests used as inclusion criteria as part of clinical screening for participants with gluteal tendinopathy on page 58 – the FABER (passive hip flexion, abduction, external rotation) and static resisted hip abduction (from an end range Ober's test position), were incorrectly inserted. The appropriate citation for use of the FABER test for clinical diagnosis of GT is Fearon, Angela M., et al. “Greater trochanteric pain syndrome: defining the clinical syndrome.” 47.10 (2013): 649–653 and resisted hip abduction, Grimaldi A., et al.
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