1.8.

2016

Motorcontrolimpairmentsassociatedwithhiposteoarthritis

Motorcontrolimpairmentsassociatedwithhip
osteoarthritis
Priorto2009,highqualityresearchandevidenceregardingthemusclefunctionchangesassociatedwithhip
jointdiseasewaslacking.Grimaldiandcolleaguespublishedtwoarticleswhichinvestigatedtheassociation
betweendegenerativehipjointpathologyandsizeofgluteusmedius(GMED),gluteusminimus(GMIN),
piriformis(PIRI)(Grimaldi,Richardson,Stantonetal.,2009),tensorfascialata(TFL),andgluteusmaximus
(GM)muscles(Grimaldi,Richardson,Durbridgeetal.,2009).
HipOAisaconsiderableprobleminmodernsocietyanditisbecomingmoreacceptedthatactive
rehabilitationplaysavitalroleinrecovery,maintenanceand/orpreventionofdiseaseprogression.
"Therapeuticexerciseprogramsdesignedtoimprovemusclefunctionaroundtheaffectedhipwillonlybe
maximallyeffectivewhenwehavefurtherinformationavailableonbothnormalmusclefunction,and
changesoccurringinassociationwithjointdisease"(Grimaldi,Richardson,Stanton,etal.,2009,p.605).

Purpose
Thepurposeofthesetwostudieswastoexamineifthereweresignificantchangesinmusclesymmetry
betweenpatientswithnopathology(controlgroup),milddegenerationdisease,andadvancedhip
degenerativedisease.CrosssectionalareasofeachindividualmusclesweremeasuredusingMRI
assessment.
Ofparticularinterestforthisresearch,wasthefunctionalchangesseenintheabductorsynergyofthehip.
Thesemusclesacttocontrolgroundreactionforcesduringloadingandmaintainoptimalpelvic/hip
alignmentinbothweightbearingandnonweightbearingpositions."Oneofthemostconsistentfindingsin
subjectswithhipdysfunctionistheinabilitytomaintainadequatelateralcontrolofthehipandpelvisinsingle
legstance"(Grimaldi,Richardson,Durbridge,etal.,2009,p.611).

Results
ChangesseeninMilddegenerativediseaseinclude:
Therewasnosignificantchangeingluteusmediusorpiriformispresentinthisgroupcomparedto
controls.
Insomepatients,gluteusmediuswaslargercomparedtocontrols,whichmayindicatethathypertrophy
occursintheearlystagestoassistwithcontrolofthefemoralhead.
Thelowergluteusmaximustendedtobesmallerontheaffectedside,buttheresultswerenotstatistically
significant.
TherewasnochangeinTFL,infact,ittendedtobelargerontheaffectedside.
ChangesseeninAdvanceddegenerativediseaseinclude:
Thereisasignificantdifferenceinsizeofgluteusmediusandpiriformis,bothofwhichweresmallerwhen
comparedtothecontrolandthemildjointpathologygroup.
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Motorcontrolimpairmentsassociatedwithhiposteoarthritis

Gluteusminimustendedtobesmallerontheaffectedsize,buttheresultswerenotstatisticallysignificant.
Gluteusmaximustendedtobesmallerontheaffectedside,mostlyinthelowerportionsofthemuscle.
TherewasnochangeinTFLsize.
Thesetwostudiesrevealedtwokeymessages.
1.Hypertrophy/Atrophyassociatedwithjointdegenerationisnotequalamongstthe

superficialanddeepmusclesoftheabductorsynergy.
2.Hypertrophy/Atrophywillvarydependingonthestage/amountofdegeneration.

(Cleland,2005,p.249)

Clinicalrelevance
"Informationfromthisandourpreviousstudytogetherdemonstratethattheabductorsynergydoesnot
respondhomogeneouslytojointpathology.WhiledeeperabductormuscleGMED,PIRI,andGMIN
demonstrateatrophyinsubjectswithadvancedOA,superficialabductormusclesUGMandTFLappearless
affectedbyunderlyingpathology"(Grimaldi,Richardson,Stanton,etal.,2009,p.609).
Inclinicalassessment,strengthtestingofabductionoftenaddressestheabductorsynergyasaglobalunit.
However,"ifbothsuperficialabductormusclesarenotsignificantlyaffectedbypathology,strengthchanges
maypossiblyreflectweaknessinthedeeperabductormuscles"(Grimaldi,Richardson,Durbridge,etal.,
2009,p.616).
Theabductorsynergycanbedividedintosuperficialanddeepmusclesforclinicalassessment,basedon
theirattachment.
Gluteusmaximusandtensorfascialataarebothsuperficialmuscleswhichattachtotheiliotibial
band.
Gluteusmedius,gluteusminimus,andpiriformisaredeepmuscleswhichattachtothegreater
trochanterofthehip.
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Motorcontrolimpairmentsassociatedwithhiposteoarthritis

Therefore,carefulassessmentofthesuperficialanddeepmusclesoftheabductorsynergywillleadto
accurateidentificationofimpairmentsinmusclefunction,allowingtherapiststocreatespecificallytailored
rehabilitationprograms.
Anoverviewoftheanatomyofthehipandclinicalassessmentwillbethefocusofthesecondpartofthis
blog.Pleasereferto"Musclesynergiesofthehipandpelvis",whichwillbecomingsoon....
Sian
References
Cleland,J.(2005).Orthopaedicclinicalexamination:anevidencebasedapproachforphysicaltherapists.
WBSaundersCo.
Grimaldi,A.,Richardson,C.,Stanton,W.,Durbridge,G.,Donnelly,W.,&Hides,J.(2009).Theassociation
betweendegenerativehipjointpathologyandsizeofthegluteusmedius,gluteusminimusandpiriformis
muscles.Manualtherapy,14(6),605610.
Grimaldi,A.,Richardson,C.,Durbridge,G.,Donnelly,W.,Darnell,R.,&Hides,J.(2009).Theassociation
betweendegenerativehipjointpathologyandsizeofthegluteusmaximusandtensorfascialata
muscles.Manualtherapy,14(6),611617.

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