The Effects of Hip Abductor and External Rotator Strengthening on Pelvic Position in ‎Frontal Plane in Men with Dynamic Knee Valgus During Single-leg Landing

Document Type : Original Article

Authors

1 Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran.

2 Department of Sport Biomechanics, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran.

Abstract

Purpose:
It has been theorized that contralateral pelvic drop indicates weakness of the stance hip-abductor and external rotator musculature, results in impaired load transfer, which may contribute to lower extremity injuries. In spite of the relationship between hip weakness and pelvic tilt, unfortunately few studies have been investigated the effect of hip strengthening on pelvic position. Therefore, the purpose of the present study was to investigate the effect of hip abductor and external rotator strengthening on pelvic position in frontal plane during single-leg landing.  
Methods:
Thirty-two males with knee valgus angle more than 8 degree were selected through non-probability inconvenient sampling and randomized into an experimental (n=16, age: 22.35 ± 1.82 year, height: 1.78 ± 0.07 meter, weight: 70.92 ± 11.6 kg) and control groups (n=16, age: 22.66 ± 1.79 year, height: 1.8 ± 0.05 meter, weight: 71.01 ± 11.61 kg). The experimental group carried out 8 weeks of bilateral hip abductor and external rotator strengthening 3 times per week (each session 45-60 minutes) and control group continue to daily activity as usual. Pre and post-tests hip strength were measured with isokinetic dynamometer (Kin-Com) and motion capture data were collected during 3 single-leg landing trials before and after training. Pelvic tilts were estimated using QTM and Visual 3D software. Data were analyzed via SPSS software applying the repeated measures ANOVA at a significant level of p < 0.05.
Results:
Significant group-by-time interactions were observed for concentric and eccentric hip abduction (p < 0.001, p < 0.001) and external rotation (p < 0.02, p < 0.001) strength and upward pelvic tilt (p=0.047) and range of motion of pelvic drop (P=0/005), respectively. Post hoc testing revealed that concentric and eccentric hip abductor (p < 0.001, p=0.004) and external rotator (p=0.01, p < 0.001) strength increased and upward pelvic tilt (P=0.04) and range of motion of pelvic drop (p=0.008) respectively, decreased in the experimental group following the 8-week intervention but did not change in the control group (p> 0.05).
Conclusion:
An eight week hip abductor and external rotator strengthening programs was effective in improvement concentric and eccentric hip abductor and external rotator strength and pelvic position in frontal plane.

Keywords


  1. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 2003; 33(11): 639-646.
  2. Clark M, Lucett S. NASM essentials of corrective exercise training: Lippincott Williams & Wilkins; 2010.
  3. Dunphy C, Casey S, Lomond A, Rutherford D. Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals. Hum Mov Sci 2016; 49: 27-35.
  4. Takacs J, Hunt MA. The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing. J Biomech 2012; 45(16): 2791-2796.
  5. Beckman SM, Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil 1995; 76(12): 1138-1143.
  6. Nadler SF, Malanga GA, DePrince M, Stitik TP, Feinberg JH. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes. Clin J Sport Med 2000; 10(2): 89-97.
  7. Ferber R, Davis IM, Williams Iii DS. Gender differences in lower extremity mechanics during running. Clin Biomech 2003; 18(4): 350-357.
  8. Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc 2000; 32(9): 1635-1641. 
  9. Knutzen K, Price A. Lower extremity static and dynamic relationships with rearfoot motion in gait. J Am Podiatr Med Assoc 1994; 84(4): 171-180.
  10. Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 2004; 36(6): 926-934.
  11. Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med 2005; 15(1): 14-21.
  12. Cichanowski HR, Schmitt JS, Johnson RJ, Niemuth PE. Hip strength in collegiate female athletes with patellofemoral pain. Med Sci Sports Exerc 2007; 39(8): 1227-1232.
  13. Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000; 10(3): 169-175.
  14. Ferber R, Noehren B, Hamill J, Davis I. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther 2010; 40(2): 52-58.
  15. Khayambashi K, Ghoddosi N, Straub RK, Powers CM. Hip muscle strength predicts noncontact anterior cruciate ligament injury in male and female athletes: a prospective study. Am J Sports Med 2016; 44(2): 355-361.
  16. Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther 2010; 40(2): 82-94.
  17. Trendelenburg F. Trendelenburg's test: 1895. 1998.
  18. Noyes FR, Barber-Westin S. ACL injuries in the female athlete: causes, impacts, and conditioning programs: Springer; 2018.
  19. Plagenhoef S, Evans FG, Abdelnour T. Anatomical data for analyzing human motion. Research quarterly for exercise and sport 1983; 54(2):169-178.
  20. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther 2011; 41(9): 625-632.
  21. Cruz AdC, Fonseca ST, Araújo VL, Carvalho DdS, et al. Pelvic Drop Changes due to Proximal Muscle Strengthening Depend on Foot-Ankle Varus Alignment. Appl Bionics Biomech 2019;2019.
  22. Baldon RdM, Lobato D, Carvalho LP, Wun P, et al. Effect of functional stabilization training on lower limb biomechanics in women. Med Sci Sports Exerc 2012; 44(1): 135-145.
  23. Stearns KM, Powers CM. Improvements in hip muscle performance result in increased use of the hip extensors and abductors during a landing task. The Am J Sports Med 2014; 42(3): 602-609.
  24. Jackson KM, Beach TA, Andrews DM. The Effect of an Isometric Hip Muscle Strength Training Protocol on Valgus Angle During a Drop Vertical Jump in Competitive Female Volleyball Players. IJKSS 2017; 5(4): 1-9.
  25. Lenhard W, Lenhard A. Calculation of effect sizes. Dettelbach, Germany; 2016.
  26. Hewett TE, Myer GD, Ford KR, Heidt Jr RS, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33(4): 492-501.
  27. Thompson JA, Tran AA, Gatewood CT, Shultz R, et al. Biomechanical effects of an injury prevention program in preadolescent female soccer athletes. Am J Sports Med 2017; 45(2): 294-301.
  28. Perrin D. Isokinetic exercise and assessment. Human Kinetics Pub. Inc; 1993.
  29. Boling MC, Padua DA, Alexander Creighton R. Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. J Athl Train 2009; 44(1): 7-13.
  30. van Sint Jan S. Color Atlas of Skeletal Landmark Definitions E-Book: Guidelines for Reproducible Manual and Virtual Palpations: Elsevier Health Sciences; 2007.
  31. Baker R. Pelvic angles: a mathematically rigorous definition which is consistent with a conventional clinical understanding of the terms. Gait Posture 2001; 13(1): 1-6.
  32. Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. J Orthop Sports Phys Ther  2012; 42(1): 22-29.
  33. Smith BI, Curtis D, Docherty CL. Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability. J Sport Rehabil 2018; 27(4): 364-370.
  34. Moritani T, deVries HA. Neural factors versus hypertrophy in the time course of muscle strength gain. Am J Phys Med 1979; 58(3): 115-130.
  35. Lieber RL. Skeletal muscle structure, function, and plasticity: Lippincott Williams & Wilkins; 2002.
  36. Burnet EN, Pidcoe PE. Isometric gluteus medius muscle torque and frontal plane pelvic motion during running. J Sports Sci Med 2009; 8(2): 284.
  37. Henriksen M, Aaboe J, Simonsen EB, Alkjær T, Bliddal H. Experimentally reduced hip abductor function during walking: implications for knee joint loads. J Biomech 2009; 42(9): 1236-1240.
  38. Anderson FC, Pandy MG. Individual muscle contributions to support in normal walking. Gait  Posture 2003; 17(2): 159-169.
  39. Jacobs C, Mattacola C. Sex differences in eccentric hip-abductor strength and knee-joint kinematics when landing from a jump. J Sport Rehabil 2005; 14(4): 346-355.
  40. Jacobs CA, Uhl TL, Mattacola CG, Shapiro R, Rayens WS. Hip abductor function and lower extremity landing kinematics: sex differences. J Athl Train 2007; 42(1): 76.