Full length articleSingle leg stance control in individuals with symptomatic gluteal tendinopathy
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.
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