Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain

Abstract

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness

“…Recently, a rationale has been proposed that explains how exercise therapy aimed at improving the neuromuscular function of the hip, trunk and lower limbs might be effective for the non-surgical management of FAIS (10). Dynamic hip instability due to hip muscle weakness (11,12) and impaired pelvic control (13)(14)(15) may lead to exaggerated mechanical loading of the acetabular labrum (16), and upregulation of its nociceptive receptors (17). Therefore, it was suggested that improving the dynamic stability of the femoroacetabular joint through exercise therapy aimed at improving hip muscle strength and pelvis control during functional tasks (14), may reduce the mechanical loading and contact stress on the joint structures, and in turn downregulate nociceptor activity (10).…”

“…In addition, the small sample size did not allow us to use sex as a main factor in our analyses. Future larger studies should however consider sex-differences for exercise therapy effectiveness due to different clinical (33) and functional characteristics (13,34) presented by female and male patients with FAIS.…”

Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome

“…control of the hip (Videos 32-34). 45 Women typically demonstrate greater hip flexion in both resisted side stepping with an elastic resistance band and the forward step-down, 44,45 which could further exaggerate symptoms, especially if anterior pelvic tilt is also increased. 44 Clinicians should monitor pelvic control during the advance to dynamic activities.…”

Assessing Movement Quality Using the Hip and Lower Limb Movement Screen: Development, Reliability and Potential Applications

“…The benchmark criteria were developed to challenge the hip and lower limb to exaggerate the movement compensations for an active population, possibly indicating hip and/or lower limb dysfunction. 32 , 55 , 59 , 72 , 103 For example, movement disorders exist in people with FAIS, showing smaller squat depth 55 and reduced posterior pelvic tilt, 8 , 57 ipsilateral trunk lean and pelvic rise towards the symptomatic hip, 33 greater hip flexion and anterior pelvic tilt 60 and greater peak trunk flexion angles. 46 Also, patellofemoral pain (PFP) has been associated with an increased peak hip adduction, internal rotation, contralateral pelvic drop and dynamic valgus index.…”