Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis

King, M.; Lawrenson, Peter; Semciw, Adam; Middleton, Kane; Crossley, Kay M

doi:10.1136/bjsports-2017-097839

Cited by 94 publications

(85 citation statements)

References 47 publications

(70 reference statements)

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“…Changes in movement patterns and biomechanics have been reported in people with FAIS [5,6]. Diamond [5] found that individuals with FAIS demonstrated greater hip and lumbo-pelvic asymmetries, including lateral trunk lean, pelvic rise and hip abduction, in a step-up task compared to unaffected individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Diamond [5] found that individuals with FAIS demonstrated greater hip and lumbo-pelvic asymmetries, including lateral trunk lean, pelvic rise and hip abduction, in a step-up task compared to unaffected individuals. King's [6] systematic review on lower limb biomechanics in FAIS highlighted individuals with FAIS had less hip extension, total hip range in the sagittal plane and peak hip internal rotation during walking and did not squat as deeply, although hip flexion range in the squat was same as controls. These findings illustrate hip biomechanical impairments in FAIS and the need for individualized assessment to gain an understanding of a person's movement patterns and pain presentation Pain in FAIS is typically motion-related or position-related [1].…”

Section: Introductionmentioning

confidence: 99%

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Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Mottram

Warner

Booysen

et al. 2019

JFMK

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Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Mottram

Warner

Booysen

et al. 2019

JFMK

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“…Peak muscle activity in this study occurred at the lowest point during the squatting task (50% of the movement cycle). Anterior pericapsular muscles were not expected to play a role in torque production during squatting, 251 due to their location anterior to the axis or rotation. Therefore, this pattern of activity has the potential to correspond with active tensioning of the capsule approaching positions of impingement or in co-contraction of pericapsular muscles to assist in joint control.…”

Section: Discussionmentioning

confidence: 99%

“…Longer stride lengths without any alteration in muscle activity could identify a potential driver of symptoms and pathology, early in the spectrum of non-arthritic hip-related pain, with shortened strides being the preferred strategy to limit translation in later stages of pathology. 251 There are several factors that could also contribute to the findings of no difference in activity of iliocapsularis, iliacus, gluteus minimus and rectus femoris, during walking between FAI syndrome and asymptomatic controls (study 4). People with FAI syndrome, although hypothesised to have subtle instability, may not be sufficiently compromised to require additional active control.…”

Section: Dynamic Hip Stabilitymentioning

confidence: 97%

Muscle activity and morphology in hip-related pain

Lawrenson¹

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Hip-related pain is common in young active people and is associated with intra-articular pathology and the pathogenesis of early onset osteoarthritis (OA). Hip-related pain can impact athletic participation and quality of life, as well as pose an ongoing financial burden to society through costs associated with long term management, including surgery. Improved knowledge of factors that contribute to the symptoms of hip-related pain and progression of joint degeneration are important. Muscles surrounding the hip are proposed to influence joint forces and dynamic stability, which can impact joint health and symptoms, yet little is known about muscle activity or morphology in hip-related pain. A greater understanding of the role that muscles play in hip-related pain may identify pathways for targeted treatment and primary prevention strategies in the future. A systematic review and meta-analysis (Study 1) was undertaken to ascertain the current best evidence regarding muscle morphology in hip-related pain. This review investigated all stages of articular hip pathology across the pathological continuum, identifying the presence of altered muscle morphology in moderate to advanced hip OA. The magnitude of difference in muscle size was not uniform across all muscles, suggesting they may be uniquely influenced by demand in articular pathology. Hypertrophy of deep anterior muscles, spanning the hip joint, in populations with compromised passive stability supports a hypothesis of increased activity to augment joint stability. Limited research has examined muscle activity in earlier stages of hip pathology, highlighting the need for further investigation of muscles surrounding the hip joint to clarify their role in hip-related pain. Iliocapsularis is a pericapsular muscle orientated over the anterior hip with direct attachments to the capsule. Because of its location and capsular insertions, it is theorised to play a dynamic role in joint stability which may be important in hip-related pain. Intramuscular electromyography (EMG) of Iliocapsularis has not been undertaken, due in part to its relative anonymity, and close proximity to the femoral neurovascular bundle posing technical 3.2.5

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“…Hip ROM deficits are also reported in individuals with hip pain when compared to asymptomatic controls [64,67,81,119]. Functionally, the presence of hip pain affects lower limb reaching, forward stepping and squatting, and there is evidence that dynamic single leg balance is affected within individuals who have undergone arthroscopy to address hip chondropathy [84,129].…”

Section: Impairments Associated With Hip Pathologymentioning

confidence: 99%

Clinical predictors of outcome following hip arthroscopy

Freke¹

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Intra-articular hip pathology, including femoro-acetabular impingement syndrome (FAIS), is a cause of hip and groin pain in otherwise healthy young adults. While arthroscopic surgery in the hip joint has historically lagged behind its counterparts in the shoulder and knee, there has recently been a rapid evolution of the management of hip injuries in the young, active population utilizing hip arthroscopic techniques which has improved understanding of mechanical hip pathology. The aims of this thesis were to; investigate the clinical presentation of individuals scheduled to undergo hip arthroscopy; assess and report pre-operative deficits in hip strength, range of movement (ROM) and dynamic balance; determine the changes that occur post surgery, and; identify potentially modifiable predictors of outcome post arthroscopy.A review of literature revealed that there is limited evidence that those with FAI syndrome have reduced hip abduction and flexion ROM compared to healthy matched controls. There were no differences in hip adduction or extension ROM, and conflicting results for external rotation and internal rotation ROM. However, people with symptomatic FAIS demonstrated deficits in hip muscle strength and reduced dynamic balance on one leg when compared to controls. For hip joint ROM, there were no significant within-group differences between pre and post intervention time points while hip muscle strength improved significantly from pre to post-hip arthroscopy in a single case series.In people undergoing hip arthroscopy, severe femoral head chondropathy, large labral tears, along with a high prevalence of labral pathology and acetabular chondropathy, were relatively common findings. Severe femoral head chondropathy and large labral tears were most associated with patient related outcomes (PROs), however, at best only explained 22% of the variability. Individuals with hip pain and severe scores in the International Hip Outcome Tool (iHOT33) subscale of symptoms and functional limitations presented with significantly lesser hip muscle strength and hip flexion ROM when compared to individuals with moderate or mild scores. Individuals scheduled for arthroscopic hip surgery were also significantly weaker, had less hip mobility and reduced dynamic balance compared to healthy matched controls. In the hip pain population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction specific manner. The clinical significance of these findings may assist therapists in providing targeted rehabilitation programs for people with FAIS and chondrolabral hip pain to improve hip strength and ROM, help reduce symptoms and to improve function. 3 By three months post arthroscopy to address bony morphology and/or chondrolabral pathology, all directions of hip strength (with the exception of adduction squeeze in crook lying and flexion) and hip flexion ROM were significantly improved. While by six months post arthroscopy, strength in all directions, and flexion and rotation ROM were signifi...

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Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis

Abstract: CRD42016038677.

Cited by 94 publications

References 47 publications

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Muscle activity and morphology in hip-related pain

Clinical predictors of outcome following hip arthroscopy

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