Comparison between movement pattern training and strengthening on muscle volume, muscle fat, and strength in patients with hip‐related groin pain: An exploratory analysis

Abstract

The purpose of this exploratory analysis was to compare the impact of movement pattern training (MoveTrain) and standard strength and flexibility training (Standard) on muscle volume, strength and fatty infiltration in patients with hip-related groin pain (HRGP). We completed a secondary analysis of data collected during an assessor-blinded randomized control trial. Data were used from 27 patients with HRGP, 15-40 years, who were randomized into MoveTrain or Standard groups. Both groups participated in their training protocol (MoveTrain, n = 14 or Standard, n = 13) which included 10 supervised sessions over 12 weeks and a daily home exercise program. Outcome measures were collected at baseline and immediately after treatment. Magnetic resonance images data were used to determine muscle fat index (MFI) and muscle volume. A hand-held dynamometer was used to assess isometric hip abductor and extensor strength. The Standard group demonstrated a significant posttreatment increase in gluteus medius muscle volume compared to the MoveTrain group. Both groups demonstrated an increase in hip abductor strength and reduction in gluteus minimus and gluteus maximus MFI. The magnitude of change for all outcomes were modest. Statement of Clinical Significance: Movement pattern training or a program of strength/flexibility training may be effective at improving hipabductor strength and reducing fatty infiltration in the gluteal musculature among those with HRGP. Further research is needed to betterunderstand etiology of strength changes and impact of muscle volume and MFI in HRGP and the effect of exercise on muscle structure andfunction.

Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial

“…This is the first study in people with hip OA to show that a targeted gluteal resistance exercise intervention can improve known gluteal muscle deficits, specifically in GMin, which have previously been demonstrated to occur in the early stages of this disease. However, the increase in GMin volume in the targeted group in the current study (approximately 4%) is similar to the volume increase reported following an exercise intervention in a previous study with a younger pathological population [ 26 ]. Similarly, the increase in hip abduction strength reported in the current study (approximately 12%) was consistent with previous exercise intervention studies [ 26 , 35 , 36 ] .…”

“…Greater amounts of fatty infiltration in the gluteal muscles have previously been observed in hip pathology populations (i.e., hip OA and total hip arthroplasty) [ 41 – 43 ]. The similar pattern of reduced fatty infiltrate across all muscle segments following the targeted intervention is consistent with a recent study showing a decrease in gluteal muscle fat index in GMin and GMax in younger people with hip related groin pain following exercise programs [ 26 ]. The trend of reduced fatty infiltration, combined with increased GMin volume and improved hip muscle strength in the current study, is consistent with the notion that resistance based exercise training can reduce intramuscular fat [ 44 ] and improve overall muscle function (i.e., muscle strength) [ 45 , 46 ].…”

“…Muscle length was normalised [ 26 ] to enable analysis of fat over the entire length of the muscle from proximal to distal (0% most proximal slice and 100% most distal slice). Using spline interpolation, the mean muscle fat index was represented at every 1% of muscle length.…”

“…For muscle fat index analysis, where data points exist across every percentile of the length of the muscle, a mixed method ANOVA was completed to examine differences between groups and over time (baseline to post-intervention) [ 26 ]. To specifically test for differences in muscle fat proportions over time, and to observe the impact of either intervention, statistical nonparametric mapping (SnMP) was used (open‐source spm1d code [SPM spm1d], Version 0.4; 2021; http://www.spm1d.org ]) [ 6 , 26 , 32 ] which results in the calculation of the “t” statistic for each 1% of muscle length allowing the location of differences in muscle fat index over the length of the muscle to be determined. Within the SnMP framework, a nonparametric mixed ANOVA was performed using Python (Version 2.7; 2010, via Canopy, Enthought Inc, version 2.1.9; 2018) [ 26 ].…”

“…To specifically test for differences in muscle fat proportions over time, and to observe the impact of either intervention, statistical nonparametric mapping (SnMP) was used (open‐source spm1d code [SPM spm1d], Version 0.4; 2021; http://www.spm1d.org ]) [ 6 , 26 , 32 ] which results in the calculation of the “t” statistic for each 1% of muscle length allowing the location of differences in muscle fat index over the length of the muscle to be determined. Within the SnMP framework, a nonparametric mixed ANOVA was performed using Python (Version 2.7; 2010, via Canopy, Enthought Inc, version 2.1.9; 2018) [ 26 ]. For muscle fat index, effect sizes (ES) were determined by dividing the t‐statistic by the square root of the sample size.…”