Assessing Lateral Stability of the Hip and Pelvis

Alison Grimaldi, PhD1

Adequate function of the hip abductor mechanism has been shown to be integral to ideal lower limb function and musculoskeletal health. Clinical assessment of hip abductor muscle function may include observational assessment of postural habits, muscle bulk, and of the ability to control optimal frontal plane femoropelvic alignment during a variety of single leg tasks. Strength testing using a hand held dynamometer is perhaps our most robust clinical assessment tool but should not be considered a ‘gold standard’ in the assessment of abductor muscle function. Evidence from magnetic resonance imaging (MRI), and electromyography (EMG) studies provides a deeper understanding of specific deficits that occur within the abductor synergy. The assessment of abductor function should not be based on a single test, but a battery of tests. The findings should be interpreted together rather than independently, and in the context of a thorough understanding of function of the lateral stability mechanism. Manner and comprehensiveness of abductor assessment will have important implications for management and particularly therapeutic exercise. Read more

Can local muscles augment stability in the hip? A narrative literature review

This paper was published in
Journal of Musculoskeletal and Neuronal Interactions 2013; 13(1):1-12

T.H. Retchford1,2, K.M. Crossley3, A. Grimaldi4, J.L. Kemp3, S.M. Cowan1

1Melbourne Physiotherapy School, University of Melbourne, Melbourne, Victoria, Australia; 2School of Community Health, Charles Sturt University, Albury, New South Wales, Australia; 3Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; 4Physiotec Physiotherapy, Brisbane, Queensland, Australia

ABSTRACT

Hip pain and dysfunction are increasingly recognised as important causes of morbidity in younger and older adults. Pathology compromising the passive stability of the hip joint, including acetabular labral injury, may lead to increased femoral head translation, greater joint contact pressures and ultimately degenerative hip disease. Activation of hip muscles may play an important role in augmenting the stability in the normal and the passively unstable hip. Research at other joints suggests that the local, rather than global, muscles are well suited to provide subtle joint compression, limiting translation, with minimal metabolic cost. Based on the known characteristics of local muscles and the limited research available on hip muscles, it is proposed that the local hip muscles; quadratus femoris, gluteus minimus, gemelli, obturator internus and externus, iliocapsularis and the deep fibres of iliopsoas, may be primary stabilisers of the hip joint. Interventions aimed at restoring isolated neuromuscular function of the primary hip stabilisers may be considered when treating people with passive hip instability prior to commencing global muscle rehabilitation. Finally, further research is needed to investigate the potential association between function of the hip muscles (including muscles likely to have a role in stabilising the hip) and hip pathology affecting hip stability such as acetabular labral lesions.

Keywords: Hip Joint, Hip Instability, Hip Muscle Control, Deep Hip External Rotator Muscles, Rehabilitation

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EXERCISE AND LOAD MODIFICATION VERSUS CORTICOSTEROID INJECTION VERSUS ‘WAIT AND SEE’ FOR PERSISTENT GLUTEUS MEDIUS/MINIMUS TENDINOPATHY (THE LEAP TRIAL): A PROTOCOL FOR A RANDOMISED CLINICAL TRIAL

Rebecca Mellor1 Alison Grimaldi1,2, Henry Wajswelner3 Paul Hodges4, Haxby Abbott5, Kim Bennell6, Bill Vicenzino1

1 School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia. 2 Physiotec, 23 Weller Road, Tarragindi, QLD 4121, Australia. 3 Department of Physiotherapy and Lifecare Physiotherapy, LaTrobe University, Bundoora, VIC 3086, Australia. 4 NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, St Lucia, QLD 4072, Australia. 5 Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, NZ 9054. 6 Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Carlton, VIC 3053, Australia.

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Gluteal Tendinopathy: A Review Of Mechanisms, Assessment and Management

Alison Grimaldi1, Rebecca Mellor2, Paul Hodges3, Kim Bennell4, Henry Wajswelner5, Bill Vicenzino2

1 Physiotec, 23 Weller Road, Tarragindi, QLD 4121, Australia. 2 School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia. 3 NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, St Lucia, QLD 4072, Australia. 4 Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Carlton, VIC 3053, Australia. 5 Department of Physiotherapy and Lifecare Physiotherapy, LaTrobe University, Bundoora, VIC 3086, Australia. Read more

Gluteal Tendinopathy: Integrating Pathomechanics And Clinical Features In Its Management

 Alison Grimaldi, PhD1,2  ,  Angela Fearon, PhD3-5

1Physiotec Physiotherapy, Tarragindi, Australia. 2School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia. 3Hip Physio, Watson, Australia. 4Trauma and Orthopaedic Research Unit, Australian National University, Canberra City, Australia. 5School of Physiotherapy, University of Canberra, Bruce, Australia. Read more

Hip Abductor Muscle Weakness In Individuals With Gluteal Tendinopathy

Kim Allison1, Bill Vicenzino2, Tim V Wrigley1, Alison Grimaldi3, Paul W Hodges2, and Kim L Bennell1

1Centre for Health and Exercise Science, University of Melbourne, Parkville, VIC, Australia. 2School of Health & Rehabilitation Sciences St Lucia, The University of Queensland QLD, Australia. 3Physiotec Physiotherapy, Tarragindi, QLD, Australia. Read more

Lateral Hip Pain: Mechanisms and Management

  This article was published in In Touch magazine, a resource exclusive to members of Musculoskeletal Physiotherapy Australia, a National Group of the Australian Physiotherapy Association. For more information on the exercise apparatus pictured in this article, Physiotec’s TWS Slider, click here History and prevalence Lateral hip pain (LHP) has traditionally been referred to as trochanteric […]

The Association Between Degenerative Hip Joint Pathology and Size of the Gluteus Maximus and Tensor Fascia Lata Muscles

ABSTRACT

The aim of this study was to obtain, using Magnetic Resonance Imaging (MRI), muscle volume measurements for the gluteus maximus (upper:UGM and lower:LGM portions) and tensor fascia lata (TFL) muscles in both healthy subjects (n=12) and those with unilateral osteoarthritis of the hip ( mild: n=6, and advanced: n =6). While control group subjects were symmetrical between sides for the muscles measured, subjects with hip joint pathology showed asymmetry in GM muscle volume dependent on stage of pathology. The LGM demonstrated atrophy around the affected hip in subjects with advanced pathology (p< 0.05), however asymmetry of the UGM (p<0.01) could be attributed largely to hypertrophy on the unaffected side, based on between group comparisons of muscle volume. TFL showed no significant asymmetry, or difference compared to the normal control group. This study highlights the functional separation of UGM and LGM, and the similarities of the UGM and TFL, both superficial abductors appearing to maintain their size around the affected hip. Further research is required to determine the specific changes occurring in the deeper abductor muscles. This information may assist in the development of more targeted and effective exercise programmes in the management of OA of the hip. Read more

The Association Between Degenerative Hip Joint Pathology and Size of the Gluteus Medius, Gluteus Minimus, and Piriformis Muscles

1 Alison Grimaldi PhD, MPhtySt, BPhty
1
 Carolyn Richardson PhD, BPhty(Hons)
2 Warren Stanton PhD, BPsych
Gail Durbridge MAppSci, Grad Dip Ultrasound, DipAppSci Medical Radiography
2
 William Donnelly MBBS, FRACS
1,2 Julie Hides PhD, MPhtySt, BPhty.

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Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain

Alison Grimaldi1,2, Rebecca Mellor2, Phillipa Nicolson3, Paul Hodges4, Kim Bennell3, Bill Vicenzino2,4

1Physiotec Physiotherapy, Tarragindi, QLD, Australia,2School of Health & Rehabilitation Sciences St Lucia, The University of Queensland QLD, Australia, 3Centre for Health and Exercise Science, University of Melbourne, Parkville, VIC, Australia,4NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia. Read more