Elsevier

Gait & Posture

Volume 49, September 2016, Pages 108-113
Gait & Posture

Full length article
Single leg stance control in individuals with symptomatic gluteal tendinopathy

https://doi.org/10.1016/j.gaitpost.2016.06.020Get rights and content

Highlights

  • Gluteal tendinopathy is associated with altered kinematics in single leg stance.

  • Hip kinematics during weight shift differ in those with gluteal tendinopathy.

  • Pelvic kinematics in single leg stance differ in those with gluteal tendinopathy.

  • Hip abductor weakness influences pelvic kinematics in gluteal tendinopathy.

Abstract

Background

Lateral hip pain during single leg loading, and hip abductor muscle weakness, are associated with gluteal tendinopathy, but it has not been shown how or whether kinematics in single leg stance differ in those with gluteal tendinopathy.

Purpose

To compare kinematics in preparation for, and during, single leg stance between individuals with and without gluteal tendinopathy, and the effect of hip abductor muscle strength on kinematics.

Methods

Twenty individuals with gluteal tendinopathy and 20 age-matched pain-free controls underwent three-dimensional kinematic analysis of single leg stance and maximum isometric hip abductor strength testing. Maximum values of hip adduction, pelvic obliquity (contralateral pelvis rise/drop), lateral pelvic translation (ipsilateral/contralateral shift) and ipsilateral trunk lean during preparation for leg lift and average values in steady single leg stance, were compared between groups using an analysis of covariance, with and without anthropometric characteristics and strength as covariates.

Results

Individuals with gluteal tendinopathy demonstrated greater hip adduction (standardized mean difference (SMD) = 0.70, P = 0.04) and ipsilateral pelvic shift (SMD = 1.1, P = 0.002) in preparation for leg lift, and greater hip adduction (SMD = 1.2, P = 0.002) and less contralateral pelvic rise (SMD = 0.86, P = 0.02) in steady single leg stance than controls. When including strength as a covariate, only between-group differences in lateral pelvic shift persisted (SMD = 1.7, P = 0.01).

Conclusion

Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness.

Introduction

Lateral hip pain associated with gluteal tendinopathy (GT) is most frequent in women aged over 40 years [1], [2], with symptoms aggravated in single leg loading during gait [2], [3]. GT involves tendinopathic change of the gluteus minimus and medius muscles [4], [5], two primary hip abductor muscles responsible for maintaining alignment of the pelvis relative to the femur in the frontal plane (controlling hip adduction) during single leg loading [6]. Hip abductor pathology and weakness associated with GT [1], [7] would be expected to contribute to compromised pelvic control (contralateral pelvic drop/hip adduction). Such changes could lead to tensile and compressive overload of the gluteal tendons against the greater trochanter [8] with a potential role in the development and/or perpetuation of the condition.

Clinicians commonly visually assess pelvic alignment in the frontal plane during transition to [9], and during [9], [10], single leg stance (SLS) in evaluation of lower limb kinematics. Pelvic obliquity is usually referenced to the horizontal as an indication of hip adduction angle (pelvis relative to femur) [11], [12]. However hip adduction will also increase if the pelvis translates in the frontal plane over the grounded foot (Fig. 1). An association between altered kinematics and GT is largely based on clinical supposition [13], [14], [15] as only one study reports pelvis position during SLS in GT [4]. On the basis of visual observation, Bird et al. categorized trunk and pelvic position during SLS as ‘normal’ or ‘abnormal’, reporting abnormal pelvic position associated with GT [4]. The authors did not provide a definition of ‘abnormal’, limiting inferences that can be drawn from the data. Quantification of kinematics is necessary.

The aim of this study was to compare frontal plane trunk, pelvic and hip kinematics in preparation for, and during, SLS in individuals with GT and pain-free controls. A secondary aim was to investigate the influence of hip abductor strength on SLS kinematics by inclusion as a covariate in our analysis. We hypothesized that individuals with GT would exhibit greater contralateral pelvic drop, ipsilateral pelvic translation and hip adduction of the stance leg in transition from bipedal to SLS and during a 2-second period of SLS with the pelvis maintained in steady alignment.

Section snippets

Sample size

A sample size calculation was performed based on between-group differences of pelvic obliquity of 2.9° (95%CI 1.2,5.2) during a SLS task in individuals with and without patellofemoral pain syndrome (a condition similarly associated with hip abductor weakness and altered pelvic kinematics) [16], in the absence of previous studies in GT. In order to detect a between-group difference of 2.9°, with 80% power and an alpha level of 0.05, a sample of 20 subjects were required for each group.

Participants

Twenty

Results

The groups were comparable for age, sex, height and dominance of the test limb (9 dominant) (Table 1). The GT group had significantly greater BMI, inter-ASIS and greater trochanteric widths (all P < 0.05) and significantly less maximum isometric hip abductor strength (mean-difference −0.51 Nm/kg; 95%CI −0.66, −0.36, P = 0.001) (Table 2).

The median (IQR) value of pain experienced during SLS in the GT group was 2(3) on the NRS. Two control and two GT participants did not meet the criteria for

Discussion

These results show that in contrast to pain-free controls, individuals with GT exhibit greater lateral translation of the pelvis and hip adduction in preparation for SLS, and more hip adduction and less pelvic elevation during SLS. Most between-group differences disappeared when hip abductor strength was controlled for, indicating that these movement differences were in part related to hip abductor muscle weakness.

Transition to, and maintenance of, SLS is a demanding functional task for the hip

Conclusion

In conclusion, this study showed that individuals with GT demonstrate greater hip adduction and greater lateral translation of the pelvis in preparation for single leg loading, and maintain a position of SLS in greater hip adduction and less contralateral pelvic rise than pain-free controls. Hip abductor muscle weakness appears to be an important feature of these kinematic differences. As with other tendinopathies [27], both strength and kinematics may need to be considered in the development

Conflict of interest

None

Acknowledgements

The study was supported by a National Health Research and Medical Research Council Program Grant held by Professor Kim Bennell, Professor Paul Hodges and Professor Bill Vicenzino (ID631717): an Australian Physiotherapy Association Physiotherapy Research Seeding Grant held by Kim Allison (S14-012). No other financial support or benefits from commercial sources was associated with any part of this study or manuscript.

References (30)

  • D. Blankenbaker et al.

    Correlation of MRI findings with clinical findings of trochanteric pain syndrome

    Skelet. Radiol.

    (2008)
  • A. Al-Hayani

    The functional anatomy of hip abductors

    Folia Morphol.

    (2009)
  • K. Allison et al.

    Hip abductor muscle weakness in individuals with gluteal tendinopathy

    Med. Sci. Sports Exerc.

    (2016)
  • K. Birnbaum et al.

    Anatomical and biomechanical investigations of the iliotibial tract

    Surg. Radiol. Anat.

    (2004)
  • D. Lee

    The Pelvic Girdle: An Integration of Clinical Expertise and Research

    (2011)
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