Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions

Abstract

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Research describing pelvifemoral rhythm: a systematic review

“…To be included an article had to quantitatively describe movement of both the thigh and pelvis during hip flexion. Articles were excluded if they described the position of the thigh and pelvis during the static maintenance of hip flexion or during complex activities such as walking 1 ) .…”

“…Numerous researchers have described the kinematics of the movement and in doing so have noted that it is multifaceted. Specifically, it involves a simultaneous movement of the thigh (femur) on the pelvis and a posterior tilting of the pelvis (PTT) 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ) , together known as pelvifemoral rhythm. It also involves a flattening of the lumbar spine 11 , 12 ) .…”

Diagnosis and treatment of movement system impairment syndromes

“…Although some studies have not found differences in alignment and movement patterns between healthy people and people with musculoskeletal symptoms, 39 , 40 others have found significant differences. 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 Patellofemoral pain is related to increased peak hip adduction, internal rotation and contralateral pelvic drop. 46 Studies assessing kinematics of the shoulder complex have identified differences between people with and people without shoulder pain.…”

“… 42 People with femoroacetabular impingement have different pelvic movement during hip flexion movements compared to healthy subjects. 41 , 43 , 48 People with low back pain move their lumbopelvic region to a greater extent and earlier during lower limb movements than people without low back pain. 17 , 47 …”

A Combined Treatment Approach Emphasizing Impairment-Based Manual Therapy and Exercise for Hip-Related Compensatory Injury in Elite Athletes: A Case Series

“…24 For example, hip ROM limitations associated with cam morphology has been linked to increased motion and stress at the pubic symphysis 25,26 Aside from morphology, regional contributions may also affect hip mobility, as the posture of the pelvis can further reduce the ROM available at the hip 27 while those with FAI syndrome demonstrate a decreased ability to functionally rotate the pelvis posteriorly. 28 It has been suggested that the relationship of FAI and the lumbopelvic region play a role in LBP. 2,12,14 The mobility of soft tissue structures surrounding the hip joint can also contribute to functional losses in ROM.…”