Full length articleLower-limb work during high- and low-impact activities in hip-related pain: Associations with sex and symptom severity
Introduction
Hip-related pain (HRP) is the second most common lower-limb musculoskeletal pain experienced by active adults [1] and is particularly burdensome, as it often affects people when they have high familial, societal, and employment responsibilities. It negatively impacts quality-of-life (QoL), physical activity, and work participation [2,3]. Hip-related pain describes non-arthritic hip pain and symptoms in young and middle-aged active adults [4] and encompasses three clinical classifications: (i) femoroacetabular impingement (FAI) syndrome; (ii) acetabular dysplasia and/or hip instability; and, (iii) HRP without distinct osseous morphology [4]. Irrespective of the classification, little attention has been given to the way these people move [5], limiting our understanding of movement-based impairments in HRP.
Previous studies investigating movement biomechanics in people with HRP have most commonly focused on FAI syndrome [6,7]. People with FAI syndrome have a reduced squat depth and lower peak hip extension angle during walking [7,8]. However, these studies have typically utilised small samples of individuals who have ceased sport participation and are seeking surgical intervention [7]. Thus, results may not apply to people with HRP who are still physically active [7]. Moreover, studies investigating groin pain in athletes have observed unique biomechanical profiles during high-impact tasks, such as cutting and hopping [[9], [10], [11], [12]]. These findings demonstrate the potential for athletes who are experiencing hip and/or groin symptoms, but are still participating in sport, to display altered movement biomechanics during high-impact tasks.
Our recent study of movement biomechanics in football players with and without HRP [13] revealed very few between-group differences in lower-limb joint angles and moments during walking and the single-leg drop jump (SLDJ). It is possible that impairments in lower-limb joint angles and moments may only become evident with more severe presentations of HRP [13]. Importantly, when differences were revealed, they were found to be sex-specific [13], highlighting the potential for the relationship between HRP and movement biomechanics to be modified by sex. As a result, previous findings from research utilising male-dominated HRP cohorts may not be applicable to women [8,14].
Other biomechanical metrics such as joint work might offer some additional insight into the functional impairments displayed by people with HRP. For example, people with hip osteoarthritis (OA) have been shown to have a reduction of up to 50 % in the positive and negative work done by the hip during the stance phase of walking compared to healthy controls [15]. It is therefore reasonable to suggest that lower-limb joint work might differ between football players with and without HRP pain during functional tasks. Moreover, as impairments in joint mechanics during functional tasks seem prominent in people with more severe presentations of HRP [13], associations may exist between lower-limb joint work and the burden of football players’ HRP.
The aims of this exploratory study were twofold: (1) to compare the absolute and relative amounts of positive and negative work done by the hip, knee, and ankle during two contrasting functional tasks (walking and SLDJ) in football players with and without HRP; and (2) to evaluate the relationship between the work done by the hip, knee, and ankle and the burden (severity) of HRP. We hypothesised that relative to walking the high impact nature of the SLDJ would amplify any between-group differences and reveal relationships between joint work and the burden of HRP.
Section snippets
Study design and participants
This study utilised a subset of sub-elite football players (soccer and Australian Football) with and without HRP from an ongoing longitudinal cohort study being conducted in Australia [16]. As the study was exploratory in nature, no formal power analysis was conducted, with the subset defined as the participants recruited into the longitudinal study between August 2015 and August 2018. A total of 88 football players with HRP and 30 asymptomatic control football players were included after
Results
No differences were observed between football players with and without HRP for demographic information (men: age P = 0.24, BMI P = 0.48; women: age P = 0.56, BMI P = 0.92) or walking speed (men: mean difference <-0.01m/s, 95 %CI -0.08m/s to 0.06m/s, P = 0.85; women: <-0.01 m/s, 95 %CI -0.11m/s to 0.10m/s, P = 0.94)(Table 1). Two male football players with HRP were unable to complete the SLDJ task. These participants were excluded from the analysis of the SLDJ (participant 1: age: 34 years, BMI:
Discussion
This exploratory study investigated differences in lower-limb joint work during walking and the SLDJ in football players with and without HRP and whether lower-limb joint work was associated with the burden of an individual's HRP. We found the relative contribution from the knee towards total lower-limb negative work done during the SLDJ to be significantly lower for women with HRP compared to their female control counterparts. While no relationships were observed between the iHOT33 and joint
Conclusion
The relative contribution from the knee towards total lower-limb negative work during the SLDJ was found to be significantly lower for women with HRP compared to female controls. Thus, of all the joint work variables compared between football players with and without HRP, the only significant between-group difference concerned the knee rather than the hip and was limited to women. Finally, work done by the hip during the SLDJ tended to be less for football players with a greater self-reported
Review board approval
Ethical approval was obtained from the La Trobe University Human Ethics Committee registration numbers HEC 15−019 and HEC 16−045
Funding
Funding for this project was supplied by the National Health and Medical Research Council of Australia (NHMRC) project grant (GNT:1088683).
CRediT authorship contribution statement
Matthew G. King: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing - original draft, Writing - review & editing. Anthony G. Schache: Conceptualization, Data curation, Formal analysis, Funding acquisition, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing. Adam I. Semciw: Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology,
Declaration of Competing Interest
The authors declare that they have no financial involvement or affiliations with any organisations or bodies with direct financial interest with the content discussed in this paper
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Running biomechanics in football players with and without hip and groin pain. A cross-sectional analysis of 116 sub-elite players
2021, Physical Therapy in SportCitation Excerpt :Whilst the reason for this apparent contrasting response is unknown, it lends support for sex-specific analyses when investigating biomechanical impairments in people with hip/groin pain (King et al., 2019, 2020, 2021). Overall, when the results of the present study are interpreted together with those from previous studies, it seems that biomechanical differences between athletes with and without hip/groin pain may be task- (Edwards et al., 2016; Gore et al., 2020; Janse van Rensburg et al., 2017; King et al., 2020) and sex-specific (King et al., 2020, 2021); however, the magnitudes of such differences are generally small and findings should be interpreted with caution. Absence of significant between-group differences in lower limb biomechanics might be partly explained by our evaluation of straight-line running at a speed of 3–3.5 m⋅s−1.