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Relationship between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome

      Highlights

      • Hip weakness and altered movement exist with femoroacetabular impingement syndrome.
      • Associations between muscle strength and running biomechanics were explored.
      • Stronger hip external rotators were associated with less hip frontal plane motion.
      • Significant sex-specific interactions were observed in some associations.
      • Our results may help to inform exercise-based management strategies.

      Abstract

      Background

      Hip muscle weakness and altered hip biomechanics during walking are often observed in people with femoroacetabular impingement syndrome, although little is known about biomechanics during higher impact tasks. The aim of our study was to explore relationships between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome, including exploring sex as an effect-modifier of this relationship.

      Methods

      Forty-two adults with unilateral femoroacetabular impingement syndrome (20 females; age 18-50 years; alpha angle ≥60°) completed assessments of hip muscle strength and hip biomechanics during running. Strength was assessed using a hand-held dynamometer for the hip flexors, extensors, abductors, adductors, internal rotators, and external rotators. Hip biomechanics were assessed during overground running (3–3.5 m/s) using three-dimensional motion capture and a force plate. Linear models assessed the relationships between hip strength and hip biomechanics of the symptomatic limb, controlling for body mass and running velocity along with an interaction term (strength*sex).

      Findings

      A significant negative relationship was observed between hip external rotator strength and hip frontal plane range of motion (i.e., excursion), independent of sex (estimate = −0.039, 95%CI −0.071 to −0.008, P = 0.02). Four sex-specific interactions were observed, with a significant positive relationship between hip external rotator strength and peak hip extension moment in women (estimate = −0.413, 95%CI −0.713 to −0.114, P = 0.01) but not in men.

      Interpretation

      We found significant relationships between hip external rotator strength and stance phase running biomechanics, providing further understanding on two impaired physical measures that may inform exercise-based management strategies in femoroacetabular impingement syndrome.

      Keywords

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      References

        • Agricola R.
        • Heijboer M.P.
        • Bierma-Zeinstra S.M.A.
        • Verhaar J.A.N.
        • Weinans H.
        • Waarsing J.H.
        Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK).
        Ann. Rheum. Dis. 2013; 72: 918-923
        • Agricola R.
        • Waarsing J.H.
        • Thomas G.E.
        • Carr A.J.
        • Reijman M.
        • Bierma-Zeinstra S.M.A.
        • et al.
        Cam impingement: defining the presence of a cam deformity by the alpha angle. Data from the CHECK cohort and Chingford cohort.
        Osteoarthr. Cartil. 2014; 22: 218-225
        • Alrashdi N.Z.
        • Brown-Taylor L.
        • Bell M.M.
        • Ithurburn M.P.
        Movement patterns and their associations with pain, function, and hip morphology in individuals with femoroacetabular impingement syndrome: A scoping review.
        Phys. Ther. 2021; 101: pzab185
        • Asaeda M.
        • Deie M.
        • Kono Y.
        • Mikami Y.
        • Kimura H.
        • Adachi N.
        The relationship between knee muscle strength and knee biomechanics during running at 6 and 12 months after anterior cruciate ligament reconstruction.
        Asia-Pacific J. Sports Med. Arthrosc. Rehabil. Technol. 2019; 16: 14-18
        • Baggaley M.
        • Noehren B.
        • Clasey J.L.
        • Shapiro R.
        • Pohl M.B.
        Frontal plane kinematics of the hip during running: are they related to hip anatomy and strength?.
        Gait Posture. 2015; 42: 505-510
        • Brindle R.A.
        • Ebaugh D.D.
        • Willson J.D.
        • Finley M.A.
        • Shewokis P.A.
        • Milner C.E.
        Relationships of hip abductor strength, neuromuscular control, and hip width to femoral length ratio with peak hip adduction angle in healthy female runners.
        J. Sports Sci. 2020; 38: 2291-2297
        • Casartelli N.C.
        • Maffiuletti N.A.
        • Item-Glatthorn J.F.
        • Staehli S.
        • Bizzini M.
        • Impellizzeri F.M.
        • et al.
        Hip muscle weakness in patients with symptomatic femoroacetabular impingement.
        Osteoarthr. Cartil. 2011; 19: 816-821
        • Crossley K.M.
        • Pandy M.G.
        • Majumdar S.
        • Smith A.J.
        • Agricola R.
        • Semciw A.I.
        • et al.
        Femoroacetabular impingement and hip OsteoaRthritis cohort (FORCe): protocol for a prospective study.
        Aust. J. Phys. 2018; 64: 55
        • Delp S.L.
        • Hess W.E.
        • Hungerford D.S.
        • Jones L.C.
        Variation of rotation moment arms with hip flexion.
        J. Biomech. 1999; 32: 493-501
        • Diamond L.E.
        • Wrigley T.V.
        • Bennell K.L.
        • Hinman R.S.
        • O’Donnell J.
        • Hodges P.W.
        Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement.
        Gait Posture. 2016; 43: 198-203
        • Diamond L.E.
        • Wrigley T.V.
        • Hinman R.S.
        • Hodges P.W.
        • O’Donnell J.
        • Takla A.
        • et al.
        Isometric and isokinetic hip strength and agonist/antagonist ratios in symptomatic femoroacetabular impingement.
        J. Sci. Med. Sport. 2016; 19: 696-701
        • Dostal W.F.
        • Soderberg G.L.
        • Andrews J.G.
        Actions of hip muscles.
        Phys. Ther. 1986; 66: 351-361
        • Fernquest S.
        • Arnold C.
        • Palmer A.
        • Broomfield J.
        • Denton J.
        • Taylor A.
        • et al.
        Osseous impingement occurs early in flexion in cam-type femoroacetabular impingement: a 4D CT model.
        Bone Joint J. 2017; 99-b: 41-48
        • Freke M.D.
        • Kemp J.
        • Svege I.
        • Risberg M.A.
        • Semciw A.
        • Crossley K.M.
        Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence.
        Br. J. Sports Med. 2016; 50: 1180
        • Freke M.
        • Kemp J.
        • Semciw A.
        • Sims K.
        • Russell T.
        • Singh P.
        • et al.
        Hip strength and range of movement are associated with dynamic postural control performance in individuals scheduled for arthroscopic hip surgery.
        J. Orthop. Sports Phys. Ther. 2018; 48: 280-288
        • Freke M.D.
        • Crossley K.M.
        • Russell T.
        • Sims K.J.
        • Semciw A.
        Associations between type and severity of hip pathology with pre-operative patient reported outcome measures.
        Braz. J. Phys. Ther. 2019; 23: 402-411
        • Giarmatzis G.
        • Jonkers I.
        • Wesseling M.
        • Van Rossom S.
        • Verschueren S.
        Loading of hip measured by hip contact forces at different speeds of walking and running.
        J. Bone Miner. Res. 2015; 30: 1431-1440
        • Griffin D.R.
        • Dickenson E.J.
        • O’Donnell J.
        • Agricola R.
        • Awan T.
        • Beck M.
        • et al.
        The Warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.
        Br. J. Sports Med. 2016; 50: 1169-1176
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.
        J. Biomech. Eng. 1983; 105: 136-144
        • Hannigan J.J.
        • Osternig L.R.
        • Chou L.-S.
        Sex-specific relationships between hip strength and hip, pelvis, and trunk kinematics in healthy runners.
        J. Appl. Biomech. 2018; 34: 76
        • Heinert B.L.
        • Kernozek T.W.
        • Greany J.F.
        • Fater D.C.
        Hip abductor weakness and lower extremity kinematics during running.
        J. Sport Rehabil. 2008; 17: 243-256
        • Impellizzeri F.M.
        • Jones D.M.
        • Griffin D.
        • Harris-Hayes M.
        • Thorborg K.
        • Crossley K.M.
        • et al.
        Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the international hip-related pain research network, Zurich 2018.
        Br. J. Sports Med. 2020; 54: 848
        • Ishøi L.
        • Thorborg K.
        • Kemp J.L.
        • Reiman M.P.
        • Hölmich P.
        Maximal hip muscle strength and rate of torque development 6-30 months after hip arthroscopy for femoroacetabular impingement syndrome: a cross-sectional study.
        J. Sci. Med. Sport. 2021; 24: 1110-1115
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann. Rheum. Dis. 1957; 16: 494
        • Kemp J.L.
        • Schache A.G.
        • Makdissi M.
        • Sims K.J.
        • Crossley K.M.
        Greater understanding of normal hip physical function may guide clinicians in providing targeted rehabilitation programmes.
        J. Sci. Med. Sport. 2013; 16: 292-296
        • Kemp J.L.
        • Coburn S.L.
        • Jones D.M.
        • Crossley K.M.
        The physiotherapy for femoroacetabular impingement rehabilitation study (physioFIRST): a pilot randomized controlled trial.
        J. Orthop. Sports Phys. Ther. 2018; 48: 307-315
        • Kemp J.L.
        • King M.G.
        • Barton C.
        • Schache A.G.
        • Thorborg K.
        • Roos E.M.
        • et al.
        Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome.
        Br. J. Sports Med. 2019; 53: 1204
        • Kemp J.L.
        • Risberg M.A.
        • Mosler A.
        • Harris-Hayes M.
        • Serner A.
        • Moksnes H.
        • et al.
        Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018.
        Br. J. Sports Med. 2020; 54: 504-511
        • Kemp J.L.
        • Mosler A.B.
        • Hart H.
        • Bizzini M.
        • Chang S.
        • Scholes M.J.
        • et al.
        Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain.
        Br. J. Sports Med. 2020; 54: 1382-1394
        • Kemp J.L.
        • Johnston R.T.R.
        • Coburn S.L.
        • Jones D.M.
        • Schache A.G.
        • Mentiplay B.F.
        • et al.
        Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial.
        BMJ Open. 2021; 11e041742
        • Kierkegaard S.
        • Mechlenburg I.
        • Lund B.
        • Søballe K.
        • Dalgas U.
        Impaired hip muscle strength in patients with femoroacetabular impingement syndrome.
        J. Sci. Med. Sport. 2017; 20: 1062-1067
        • Kierkegaard S.
        • Mechlenburg I.
        • Dalgas U.
        • Lund B.
        • Søballe K.
        • Sørensen H.
        Hip kinematics and kinetics in patients with femoroacetabular impingement syndrome before and 1 year after hip arthroscopic surgery. Results from the HAFAI cohort.
        Arch. Orthop. Trauma Surg. 2021;
        • King M.G.
        • Lawrenson P.R.
        • Semciw A.I.
        • Middleton K.J.
        • Crossley K.M.
        Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis.
        Br. J. Sports Med. 2018; 52: 566-580
        • King M.G.
        • Heerey J.J.
        • Schache A.G.
        • Semciw A.I.
        • Middleton K.J.
        • Sritharan P.
        • et al.
        Lower limb biomechanics during low- and high-impact functional tasks differ between men and women with hip-related groin pain.
        Clin. Biomech. 2019; 68: 96-103
        • King M.G.
        • Semciw A.I.
        • Schache A.G.
        • Middleton K.J.
        • Heerey J.J.
        • Sritharan P.
        • et al.
        Lower-limb biomechanics in football players with and without hip-related pain.
        Med. Sci. Sports Exerc. 2020; 52: 1776-1784
        • King M.G.
        • Schache A.G.
        • Semciw A.I.
        • Middleton K.J.
        • Heerey J.J.
        • Kemp J.L.
        • et al.
        Lower-limb work during high- and low-impact activities in hip-related pain: associations with sex and symptom severity.
        Gait Posture. 2021; 83: 1-8
        • Lewis C.L.
        • Khuu A.
        • Loverro K.L.
        Gait alterations in femoroacetabular impingement syndrome differ by sex.
        J. Orthop. Sports Phys. Ther. 2018; 48: 649-658
        • Liu J.
        • Lewton K.L.
        • Colletti P.M.
        • Powers C.M.
        Hip adduction during running: influence of sex, hip abductor strength and activation, and pelvis and femur morphology.
        Med. Sci. Sports Exerc. 2021; 53: 2346-2353
        • McGinley J.L.
        • Baker R.
        • Wolfe R.
        • Morris M.E.
        The reliability of three-dimensional kinematic gait measurements: a systematic review.
        Gait Posture. 2009; 29: 360-369
        • Mentiplay B.F.
        • Perraton L.G.
        • Bower K.J.
        • Adair B.
        • Pua Y.H.
        • Williams G.P.
        • et al.
        Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study.
        PLoS One. 2015; 10e0140822
        • Mohtadi N.G.H.
        • Griffin D.R.
        • Pedersen M.E.
        • Chan D.
        • Safran M.R.
        • Parsons N.
        • et al.
        The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33).
        Arthroscopy. 2012; 28: 595-610
        • Mosler A.B.
        • Kemp J.
        • King M.
        • Lawrenson P.R.
        • Semciw A.
        • Freke M.
        • et al.
        Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first international hip-related pain research network (IHiPRN) meeting, Zurich, 2018.
        Br. J. Sports Med. 2020; 54: 702
        • Neumann D.A.
        Kinesiology of the hip: a focus on muscular actions.
        J. Orthop. Sports Phys. Ther. 2010; 40: 82-94
        • Noehren B.
        • Pohl M.B.
        • Sanchez Z.
        • Cunningham T.
        • Lattermann C.
        Proximal and distal kinematics in female runners with patellofemoral pain.
        Clin. Biomech. 2012; 27: 366-371
        • Novacheck T.F.
        The biomechanics of running.
        Gait Posture. 1998; 7: 77-95
        • Pohl M.B.
        • Mullineaux D.R.
        • Milner C.E.
        • Hamill J.
        • Davis I.S.
        Biomechanical predictors of retrospective tibial stress fractures in runners.
        J. Biomech. 2008; 41: 1160-1165
        • Pua Y.H.
        • Mentiplay B.F.
        • Clark R.A.
        • Ho J.Y.
        Associations among quadriceps strength and rate of torque development 6 weeks post anterior cruciate ligament reconstruction and future hop and vertical jump performance: a prospective cohort study.
        J. Orthop. Sports Phys. Ther. 2017; 47: 845-852
        • Samaan M.A.
        • Grace T.
        • Zhang A.L.
        • Majumdar S.
        • Souza R.B.
        Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome.
        Clin. Biomech. 2020; 71: 214-220
        • Savage T.N.
        • Saxby D.J.
        • Pizzolato C.
        • Diamond L.E.
        • Murphy N.J.
        • Hall M.
        • et al.
        Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size.
        Gait Posture. 2021; 83: 26-34
        • Schache A.G.
        • Baker R.
        On the expression of joint moments during gait.
        Gait Posture. 2007; 25: 440-452
        • Scholes M.J.
        • King M.G.
        • Crossley K.M.
        • Jones D.M.
        • Semciw A.I.
        • Mentiplay B.F.
        • et al.
        The validity, reliability, and responsiveness of the International Hip Outcome Tool–33 (iHOT-33) in patients with hip and groin pain treated without surgery.
        Am. J. Sports Med. 2021; 49: 2677-2688
        • Snyder K.R.
        • Earl J.E.
        • O’Connor K.M.
        • Ebersole K.T.
        Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.
        Clin. Biomech. 2009; 24: 26-34
        • Stratford P.W.
        • Balsor B.E.
        A comparison of make and break tests using a hand-held dynamometer and the kin-com.
        J. Orthop. Sports Phys. Ther. 1994; 19: 28-32
        • Taylor-Haas J.A.
        • Hugentobler J.A.
        • DiCesare C.A.
        • Hickey Lucas K.C.
        • Bates N.A.
        • Myer G.D.
        • et al.
        Reduced hip strength is associated with increased hip motion during running in young adult and adolescent male long-distance runners.
        Int. J. Sports Phys. Ther. 2014; 9: 456-467
        • Thorborg K.
        • Petersen J.
        • Magnusson S.P.
        • Hölmich P.
        Clinical assessment of hip strength using a hand-held dynamometer is reliable.
        Scand. J. Med. Sci. Sports. 2010; 20: 493-501
        • Van Klij P.
        • Heerey J.
        • Waarsing J.H.
        • Agricola R.
        The prevalence of cam and pincer morphology and its association with development of hip osteoarthritis.
        J. Orthop. Sports Phys. Ther. 2018; 48: 230-238
        • Willy R.W.
        • Davis I.S.
        The effect of a hip-strengthening program on mechanics during running and during a single-leg squat.
        J. Orthop. Sports Phys. Ther. 2011; 41: 625-632
        • Zeitoune G.
        • Leporace G.
        • Batista L.A.
        • Metsavaht L.
        • Lucareli P.R.G.
        • Nadal J.
        Do hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners?.
        Gait Posture. 2020; 79: 217-223