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Hip abductor strength and lower extremity running related injury in distance runners: A systematic review

Published:September 20, 2016DOI:https://doi.org/10.1016/j.jsams.2016.09.002

      Abstract

      Objectives

      Determine the association between hip abduction strength and lower extremity running related injury in distance runners.

      Design

      Systematic review.

      Methods

      Prospective longitudinal and cross sectional studies that quantified hip abduction strength and provided diagnosis of running related injury in distance runners were included and assessed for quality. Effect size was calculated for between group differences in hip abduction strength.

      Results

      Of the 1841 articles returned in the initial search, 11 studies matched all inclusion criteria. Studies were grouped according to injury: iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture, and Achilles tendinopathy, and examined for strength differences between injured and non-injured groups. Meaningful differences were found in the studies examining iliotibial band syndrome. Three of five iliotibial band syndrome articles found weakness in runners with iliotibial band syndrome; two were of strong methodological rigor and both of those found a relationship between weakness and injury. Other results did not form associative or predictive relationships between weakness and injury in distance runners.

      Conclusions

      Hip abduction weakness evaluated by hand held dynamometer may be associated with iliotibial band syndrome in distance runners as suggested by several cross sectional studies but is unclear as a significant factor for the development of patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture or Achilles tendinopathy according to the current literature. Future studies are needed with consistent methodology and inclusion of all distance running populations to determine the significance of hip abduction strength in relationship to lower extremity injury.

      Keywords

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      References

        • Sport and Fitness Industry Association
        Fitness and leisure activities topline participation report.
        2013 (Available at: http://espn.go.com/pdf/2013/1113/espn_otl_sportsreport.pdf. Accessed 25 January 2016)
        • Running USA
        2015 state of the sport – U.S. race trends.
        2015 (Available at: http://www.runningusa.org/2015-state-of-sport-us-trends. Accessed 25 January 2016)
        • Junior L.C.H.
        • Carvalho A.C.A.
        • Costa L.O.P.
        • et al.
        The prevalence of musculoskeletal injuries in runners: a systematic review.
        Br J Sports Med. 2011; 45: 351-352
        • van Gent R.N.
        • Seim D.
        • van Middelkoop M.
        • et al.
        Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.
        Br J Sports Med. 2007; 41: 469-480
        • Aderem J.
        • Louw Q.A.
        Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review.
        BMC Musculoskelet Disord. 2015; 16: 1-16
        • Hamstra-Wright K.L.
        • Bliven K.C.H.
        • Bay C.
        Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 362-369
        • Lorimer A.V.
        • Hume P.A.
        Achilles tendon injury risk factors associated with running.
        Sports Med. 2014; 44: 1459-1472
        • Nielsen R.O.
        • Buist I.
        • Srensen H.
        • et al.
        Training errors and running related injuries: a systematic review.
        Int J Sports Phys Ther. 2012; 7: 58-75
        • Wright A.A.
        • Taylor J.B.
        • Ford K.R.
        • et al.
        Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis.
        Br J Sports Med. 2015; 49: 1-7
        • Snyder K.R.
        • Earl J.E.
        • O’Connor K.M.
        • et al.
        Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.
        Clin Biomech. 2009; 24: 26-34
        • Taylor-Haas J.A.
        • Hugentobler J.A.
        • DiCesare C.A.
        • et al.
        Reduced hip strength is associated with increased hip motion during running in young adult and adolescent male long-distance runners.
        Int J Sports Phys Ther. 2014; 9: 456
        • Barton C.J.
        • Lack S.
        • Maliaras P.
        • et al.
        Gluteal muscle activity and patellofemoral pain syndrome: a systematic review.
        Br J Sports Med. 2013; 47: 207-214
        • Ferber R.
        • Kendall K.D.
        • Farr L.
        Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome.
        J Athl Train. 2011; 46: 142-149
        • Petersen W.
        • Ellerman A.
        • Gosele-Koppenburg A.
        • et al.
        Patellofemoral pain syndrome.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2264-2274
        • Thorborg K.
        • Petersen J.
        • Magnusson S.P.
        • et al.
        Clinical assessment of hip strength using a hand-held dynamometer is reliable.
        Scand J Med Sci Sports. 2010; 20: 493-501
        • Click F.
        • Bellew J.
        • Pitts T.
        • et al.
        Reliability of stabilised commercial dynamometers for measuring hip abduction strength: a pilot study.
        Br J Sports Med. 2003; 37: 331-334
        • Neumann D.A.
        Biomechanical principles.
        Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. Mosby/Elsevier, St. Louis, MO2010 ([Chapter 4, Hip, Chapter 12])
        • Soper D.S.
        Effect size (Cohen's d) calculator for a Student t-test [software].
        2016 (Available at: http://www.danielsoper.com/statcalc)
        • Thomas B.H.
        • Ciliska D.
        • Dobbins M.
        • et al.
        A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.
        Worldviews Evid Based Nurs. 2004; 1: 176-184
      1. Quality assessment tool for quantitative studies. Effective public health practice project website.
        1998 (Available at: http://www.ephpp.ca/PDF/Quality%20Assessment%20Tool_2010_2.pdf. Accessed 5 December 2015)
      2. Quality assessment tool for quantitative studies, dictionary. Effective public health practice project website.
        1998 (Updated October 2008. Available at: http://www.ephpp.ca/PDF/QADictionary_dec2009.pdf. Accessed 5 December 2015)
        • Foch E.
        • Reinbolt J.A.
        • Zhang S.
        • et al.
        Associations between iliotibial band injury status and running biomechanics in women.
        Gait Posture. 2015; 41: 706-710
        • Fredericson M.
        • Cookingham C.L.
        • Chaudhari A.M.
        • et al.
        Hip abductor weakness in distance runners with iliotibial band syndrome.
        Clin J Sport Med. 2000; 10: 169-175
        • Noehren B.
        • Schmitz A.
        • Hempel R.
        • et al.
        Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome.
        J Orthop Sports Phys Ther. 2014; 44: 217-222
        • Brown A.M.
        The Effects of Fatigue on Pathomechanics and Electromyography in Female Runners With Iliotibial Band Syndrome.
        Temple University, 2011: 184
        • Grau S.
        • Krauss I.
        • Maiwald C.
        • et al.
        Hip abductor weakness is not the cause for iliotibial band syndrome.
        Int J Sports Med. 2008; 29: 579-583
        • Esculier J.F.
        • Roy J.S.
        • Bouyer L.J.
        Lower limb control and strength in runners with and without patellofemoral pain syndrome.
        Gait Posture. 2015; 41: 813-819
        • Thijs Y.
        • Pattyn E.
        • Van Tiggelen D.
        • et al.
        Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? A prospective study.
        Am J Sports Med. 2011; 39: 1877-1882
        • Yagi S.
        • Muneta T.
        • Sekiya I.
        Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 556-563
        • Hein T.
        • Jansssen P.
        • Wagner-Fritz U.
        • et al.
        Prospective analysis of intrinsic and extrinsic risk factors on the development of Achilles tendon pain in runners.
        Scand J Med Sci Sports. 2014; 24: 201-212
        • Niemuth P.E.
        • Johnson R.J.
        • Myers M.J.
        • et al.
        Hip muscle weakness and overuse injuries in recreational runners.
        Clin J Sport Med. 2005; 15: 14-21
        • Kelln B.M.
        • McKeon P.L.
        • Gontkof L.M.
        • et al.
        Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults.
        J Sport Rehabil. 2008; 17: 160-170
        • Roy J.S.
        • MacDermid J.C.
        • Orton B.
        • et al.
        The concurrent validity of a hand-held versus a stationary dynamometer in testing isometric shoulder strength.
        J Hand Ther. 2009; 22: 320-327
        • Ramskov D.
        • Barton C.
        • Nielsen R.O.
        • et al.
        High eccentric hip abduction strength reduces the risk of developing patellofemoral pain among novice runners initiating a self-structured running program: a 1-year observational study.
        J Orthop Sports Phys Ther. 2015; 45: 153-161
        • Pappas E.
        • Wong-Tom W.M.
        Prospective predictors of patellofemoral pain syndrome: a systematic review with meta-analysis.
        Sports Health. 2012; 4: 115-120
        • Halabchi F.
        • Mazaheri R.
        • Seif-Barghi T.
        Patellofemoral pain syndrome and modifiable intrinsic risk factors: how to assess and address?.
        Asian J Sports Med. 2013; 4: 85-100
        • Lankhorst N.E.
        • Bierma-Zeinstra S.M.
        • van Middelkoop M.
        Risk factors for patellofemoral pain syndrome: a systematic review.
        J Orthop Sports Phys Ther. 2012; 42: 81-94
        • Pohl M.B.
        • Mullineaux D.R.
        • Milner C.E.
        • et al.
        Biomechanical predictors of retrospective tibial stress fractures in runners.
        J Biomech. 2008; 41: 1160-1165
        • Bennell K.L.
        • Malcolm S.A.
        • Thomas S.A.
        • et al.
        Risk factors for stress fractures in track and field athletes. A twelve-month prospective study.
        Am J Sports Med. 1996; 24: 810-818
        • Ramskov D.
        • Pedersen M.B.
        • Kastrup K.
        • et al.
        Normative values of eccentric hip abduction strength in novice runners: an equation adjusting for age and gender.
        Int J Sports Phys Ther. 2014; 9: 68-75
        • Meftahi N.
        • Sarrafzadeh J.
        • Marofi N.
        • et al.
        Comparison of the test–retest reliability of hip strength measurements using dynamometer fixed by hand versus fixed to a stable frame in female athletes.
        J Modern Rehab. 2011; 5: 19-25
        • Krause D.A.
        • Schlagel S.J.
        • Stember B.M.
        • et al.
        Influence of lever arm and stabilization on measures of hip abduction and adduction torque obtained by hand-held dynamometry.
        Arch Phys Med Rehabil. 2007; 88: 37-42
        • Lee J.H.
        • Cynn H.S.
        • Kwon O.Y.
        • et al.
        Different hip rotations influence hip abductor muscles activity during isometric side-lying hip abduction in subjects with gluteus medius weakness.
        J Electromyogr Kinesiol. 2014; 24: 318-324
        • Drouin J.M.
        • Valovich-McLeod T.C.
        • Shultz S.J.
        • et al.
        Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements.
        Eur J Appl Physiol. 2004; 91: 22-29
        • Dirnberger J.
        • Wesinger H.P.
        • Koster A.
        • et al.
        Reproducibility for isometric and isokinetic maximum knee flexion and extension measurements using the IsoMed 2000-dynamometer.
        Isokinet Exerc Sci. 2012; : 149-153
        • Bredeweg S.W.
        • Zijltra S.
        • Bessem B.
        • et al.
        The effectiveness of a preconditioning programme on preventing running-related injuries in novice runners: a randomised controlled trial.
        Br J Sports Med. 2012; 46: 865-870