Hip Abductor Muscle Volume and Strength Differences Between Women With Chronic Hip Joint Pain and Asymptomatic Controls

Abstract

Study Design Secondary analysis, cross-sectional study Background Chronic hip joint pain (CHJP) can lead to limitations in activity participation, but the musculoskeletal factors associated with the condition are relatively unknown. Understanding the factors associated with CHJP may help develop rehabilitation strategies to improve quality of life of individuals with long-term hip pain. Objectives To compare measures of hip abductor muscle volume and hip abductor muscle strength between women with CHJP and asymptomatic controls. Methods Thirty women, 15 with CHJP and 15 matched asymptomatic controls (18–40 years of age), participated in this study. Magnetic resonance imaging was used to determine the volume of the primary hip abductor muscles, consisting of gluteus medius (GMed), gluteus minimus (GMin), a small portion of gluteus maximus (GMax), and tensor fascia latae (TFL), within a defined region of interest. Break tests were performed using a handheld dynamometer to assess hip abductor strength. During the strength test, the participant was positioned in sidelying with the involved hip in 15° abduction. Independent-sample t tests were used to compare muscle volume and strength values between those with CHJP and asymptomatic controls. Results Compared to asymptomatic controls, women with CHJP demonstrated significantly increased gluteal muscle volume (228±40cm3 versus 199±29cm3; p=.032), but decreased hip abductor strength (74.6±16.8Nm versus 93.6±20.2Nm; p=.009). There were no significant differences in TFL muscle volume between the two groups (p=.640). Conclusions Women with CHJP appear to have larger gluteal muscles, but decreased hip abductor strength compared to asymptomatic controls.

Hip muscle atrophy in patients with acetabular labral joint pathology

“…While previous studies have found evidence of gluteus medius muscle atrophy in association with severe hip osteoarthritis (Grimaldi et al, ; Zacharias et al, ), this is the first study to find evidence of specific hip abductor muscle atrophy in the presence of intra‐articular hip joint pathology in a younger, active population. In contrast, previous research found hip abductor muscle volume to be larger in young active patients with chronic hip joint pain compared with asymptomatic controls (Mastenbrook et al, ). However, it is important to note that this previous study did not measure size of the individual hip abductor muscles, but measured a region of interest that incorporated the gluteal group including the gluteus minimus, gluteus medius, and a small portion of the gluteus maximus muscles (Mastenbrook et al, ).…”

“…In contrast, previous research found hip abductor muscle volume to be larger in young active patients with chronic hip joint pain compared with asymptomatic controls (Mastenbrook et al, ). However, it is important to note that this previous study did not measure size of the individual hip abductor muscles, but measured a region of interest that incorporated the gluteal group including the gluteus minimus, gluteus medius, and a small portion of the gluteus maximus muscles (Mastenbrook et al, ).…”

“…Evidence of gluteal muscle inhibition due to joint effusion mimicking hip joint injury has been demonstrated (Freeman et al, ). Previous research has found weakness of the hip abductor muscles in patients with intra‐articular hip joint pathology or pain (Casartelli et al, ; Harris‐Hayes et al, ; Nepple et al, ; Diamond et al, ; Mastenbrook et al, ). Biomechanical studies have found differences in frontal plane hip kinematics and kinetics during gait for people with FAI, specifically reduced hip range of motion in the frontal plane due to reductions in hip abduction angles (Kennedy et al, ; Brisson et al, ), smaller peak hip abduction moments post FAI surgery (Brisson et al, ) and reduced range of motion of hip adduction in stance phase (Hunt et al, ).…”

“…Recent systematic reviews (Diamond et al, ; Freke et al, ; Mayne et al, ) and research studies have examined physical impairments associated with FAI syndrome, acetabular labral pathology and chondropathology, and have found impaired hip range of motion (Kemp et al, ; Diamond et al, ), reduced hip muscle strength (Casartelli et al, ; Harris‐Hayes et al, ; Mendis et al, ; Kemp et al, ; Nepple et al, ; Diamond et al, ), impaired functional task performance (Hatton et al, ; Bagwell et al, ; Charlton et al, ; Kemp et al, ; Samaan et al, ), and altered gait biomechanics (Kennedy et al, ; Brisson et al, ; Hunt et al, ; Ng et al, ). With respect to hip muscle size, previous research has investigated size of the gluteal muscles in patients with chronic hip joint pain (Mastenbrook et al, ) and of the individual hip flexor muscles in patients with acetabular labral pathology (Mendis et al, ); however, no research to date has investigated the individual hip abductor, hip extensor, or hip external rotator muscles in this patient population. As intra‐articular hip joint pathology could impair stability of the hip joint and the muscles surrounding the hip may be required to provide dynamic stability (Retchford et al, ), it is important to determine if imbalances in hip muscle size exist in the presence of joint pathology.…”

Muscle activity and morphology in hip-related pain

“…3,5,46,116 These clinical signs are thought to be impacted by alterations in muscle size, quality and activity in hip-related pain. [117][118][119] Identifying whether differences in muscle activity and morphology exist between people with hip-related pain and those without, is a key consideration in the development of future exercise based interventions. Deficits in strength in hip-related pain have been associated with greater symptoms in people scheduled for hip arthroscopy.…”