Gluteal muscle dysfunction and the role of specific strengthening in hip osteoarthritis: a review

Abstract

Background:The muscle system provides essential support to a joint, and muscle weakness and atrophy may occur in the presence of joint pathology, such as osteoarthritis (OA). The gluteal muscles -gluteus medius and gluteus maximus -provide an important stability role in the hip joint and evidence exists for gluteal weakness in hip OA. Therefore, rehabilitation should address such dysfunction.Objectives: To identify the use of gluteal strengthening in exercise-based randomised controlled trials or randomised clinical trials of hip OA. Methods: A structured literature search was undertaken to review the evidence for use of gluteal strengthening in hip OA clinical trials. Results: Eleven randomised controlled or randomised clinical trials of strengthening-based exercise in hip OA were identified and searched for evidence of gluteal strengthening. None of the studies reported specific strengthening of the gluteal muscles and details of the strengthening regimes used were poorly described in most of the studies. This lack of specificity may be one of the reasons why only small effect sizes and short-term benefits have been found for exercise therapy in the management of hip OA.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

“…The literature on strength training in people with knee OA in most cases describes dynamic exercises, whereas research on isometric exercises is sparse 95. Hip strengthening exercises have been poorly evaluated in people with hip OA 103. However, in people with medial tibiofemoral knee OA, hip strengthening exercises reduced knee pain and improved physical function 106…”

Hip abductor muscle volume in hip osteoarthritis and matched controls

“…Hip abductor strength deficits are commonly seen in hip OA patients 9 . Weakness in muscle can be manifested as either a reduction in muscle size or muscle activity 10 . While strength deficits have been identified in hip OA populations when compared to a control, muscle volume (or size) has not been shown to differ between OA patients and controls in a systematic review 9 .…”

Peer Review #1 of "The effects of gluteal squeezes compared to bilateral bridges on gluteal strength, power, endurance, and girth (v0.1)"

“…To the authors' knowledge, no studies have examined the effects of these exercises over a specific training period, so comparison of this study's results to others is limited, and this study fills a gap in current knowledge. Studies implementing a training program for hip muscles typically include multiple exercises during an intervention period, making it difficult to determine the effects of a single exercise (Bennell et al, 2010;French, Gilsenan & Cusack, 2008). For example, one 12-week study of progressive hip strengthening and other exercises performed during three 60-minute sessions per week by subjects with hip osteoarthritis demonstrated a 20% increase in subjects' isometric leg extension strength, but the independent effects of the squat, sit-to-stand, step board, knee flexion, balance, and other exercises employed are unknown (Uusi-Rasi et al, 2017).…”