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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2016

01-07-2016 | Hip

Large strengthening effect of a hip-flexor training programme: a randomized controlled trial

Authors: Kristian Thorborg, Thomas Bandholm, Mette Zebis, Lars Louis Andersen, Jesper Jensen, Per Hölmich

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2016

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Abstract

Purpose

To investigate the effect on hip-flexion strength of a 6-week hip-flexor training programme using elastic bands as resistance. We hypothesized that the training group, compared to a control group, would increase their hip-flexion strength more.

Methods

Thirty-three healthy subjects (45 % females), 24(5) years of age, were included in a randomized controlled trial and allocated to heavy strength training of the hip-flexor muscles or to control (no strength training). Strength training of the hip-flexors (dominant leg) was performed three times 10 min per week for 6 weeks. The strength training group progressed from 15 repetition maximum (RM) (week 1) to 8 RM (week 6). Isometric hip-flexion strength (primary outcome) was measured by a blinded assessor using a reliable test procedure.

Results

In the strength training group, the isometric hip-flexion strength of the trained leg increased by 17 %, (p < 0.001). The between-group difference in hip-flexion strength change in the trained leg (dominant leg, training group) versus the non-trained leg (dominant leg, control group) was significantly different from baseline to follow-up, corresponding to a mean change of 0.34 (95 % CI 0.17–0.52) Nm/kg, in favour of the strength training group (p < 0.001).

Conclusion

Simple hip-flexor strength training using elastic bands as external loading, for only 6 weeks, substantially improves hip-flexor muscle strength. This simple exercise programme seems promising for future prevention and treatment of acute and longstanding hip-flexor injuries, such as acute rectus femoris injuries and longstanding iliopsoas-related pain and impingement.

Level of evidence

I.
Literature
1.
go back to reference Andersen LL, Andersen HC, Mortensen OS (2010) Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther 90(4):538–549CrossRefPubMed Andersen LL, Andersen HC, Mortensen OS (2010) Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther 90(4):538–549CrossRefPubMed
2.
go back to reference Andersson E, Oddsson L, Grundström H, Thorstensson A (1995) The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip. Scand J Med Sci Sports 5(1):10–16CrossRefPubMed Andersson E, Oddsson L, Grundström H, Thorstensson A (1995) The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip. Scand J Med Sci Sports 5(1):10–16CrossRefPubMed
3.
go back to reference Andersson EA, Nilsson J, Thorstensson A (1997) Intramuscular EMG from the hip-flexor muscles during human locomotion. Acta Physiol Scand 161(3):361–370CrossRefPubMed Andersson EA, Nilsson J, Thorstensson A (1997) Intramuscular EMG from the hip-flexor muscles during human locomotion. Acta Physiol Scand 161(3):361–370CrossRefPubMed
4.
6.
go back to reference Bogduk N, Pearcy M, Hadfield G (1992) Anatomy and biomechanics of psoas major. Clini Biomech 7(2):109–119CrossRef Bogduk N, Pearcy M, Hadfield G (1992) Anatomy and biomechanics of psoas major. Clini Biomech 7(2):109–119CrossRef
7.
go back to reference Blankenbaker DG, Tuite MJ, Keene JS, del Rio AM (2012) Labral injuries due to iliopsoas impingement: can they be diagnosed on MR arthrography? AJR Am J Roentgenol 199(4):894–900CrossRefPubMed Blankenbaker DG, Tuite MJ, Keene JS, del Rio AM (2012) Labral injuries due to iliopsoas impingement: can they be diagnosed on MR arthrography? AJR Am J Roentgenol 199(4):894–900CrossRefPubMed
8.
go back to reference Claiborne TL, Timmons MK, Pincivero DM (2009) Test-retest reliability of cardinal plane isokinetic hip torque and EMG. J Electromyogr Kinesiol 19(5):345–352CrossRef Claiborne TL, Timmons MK, Pincivero DM (2009) Test-retest reliability of cardinal plane isokinetic hip torque and EMG. J Electromyogr Kinesiol 19(5):345–352CrossRef
9.
go back to reference Diamond LE, Dobson FL, Bennell KL, Wrigley TV, Hodges PW, Hinman RS (2014) Physical impairments and activity limitations in people with femoroacetabular impingement: a systematic review. Br J Sports Med. doi:10.1136/bjsports-2013-093340 PubMed Diamond LE, Dobson FL, Bennell KL, Wrigley TV, Hodges PW, Hinman RS (2014) Physical impairments and activity limitations in people with femoroacetabular impingement: a systematic review. Br J Sports Med. doi:10.​1136/​bjsports-2013-093340 PubMed
10.
go back to reference Ekstrand J, Hägglund M, Waldén M (2011) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39(6):1226–1232CrossRefPubMed Ekstrand J, Hägglund M, Waldén M (2011) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39(6):1226–1232CrossRefPubMed
11.
go back to reference Friel K, McLean N, Myers C, Caceres M (2006) Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train 41(1):74–78PubMedPubMedCentral Friel K, McLean N, Myers C, Caceres M (2006) Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train 41(1):74–78PubMedPubMedCentral
12.
go back to reference Hides JA, Fan T, Stanton WR (2010) Psoas and quadratuslumborum muscle asymmetry among elite Australian football league players. Br J Sports Med 44(8):563–567CrossRefPubMed Hides JA, Fan T, Stanton WR (2010) Psoas and quadratuslumborum muscle asymmetry among elite Australian football league players. Br J Sports Med 44(8):563–567CrossRefPubMed
13.
14.
go back to reference Hölmich P (2007) Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sports Med 41(4):247–252CrossRefPubMedPubMedCentral Hölmich P (2007) Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sports Med 41(4):247–252CrossRefPubMedPubMedCentral
15.
go back to reference Hu H, Meijer OG, van Dieën JH, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu W, Xia C (2010) Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking. J Biomech 43(3):532–539CrossRefPubMed Hu H, Meijer OG, van Dieën JH, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu W, Xia C (2010) Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking. J Biomech 43(3):532–539CrossRefPubMed
16.
go back to reference Hu H, Meijer OG, van Dieën JH, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu WH, Xia C (2011) Is the psoas a hip flexor in the active straight leg raise? Eur Spine J 20(5):759–765CrossRefPubMed Hu H, Meijer OG, van Dieën JH, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu WH, Xia C (2011) Is the psoas a hip flexor in the active straight leg raise? Eur Spine J 20(5):759–765CrossRefPubMed
17.
go back to reference Hubal MJ, Gordish-Dressman H, Thompson PD, Price TB, Hoffman EP, Angelopoulos TJ, Gordon PM, Moyna NM, Pescatello LS, Visich PS, Zoeller RF, Seip RL, Clarkson PM (2005) Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc 37(6):964–972PubMed Hubal MJ, Gordish-Dressman H, Thompson PD, Price TB, Hoffman EP, Angelopoulos TJ, Gordon PM, Moyna NM, Pescatello LS, Visich PS, Zoeller RF, Seip RL, Clarkson PM (2005) Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc 37(6):964–972PubMed
18.
go back to reference Jakobsen MD, Sundstrup E, Andersen CH, Bandholm T, Thorborg K, Zebis MK, Andersen LL (2012) Muscle activity during knee-extension strengthening exercise performed with elastic tubing and isotonic resistance. Int J Sports Phys Ther 7:606–616PubMedPubMedCentral Jakobsen MD, Sundstrup E, Andersen CH, Bandholm T, Thorborg K, Zebis MK, Andersen LL (2012) Muscle activity during knee-extension strengthening exercise performed with elastic tubing and isotonic resistance. Int J Sports Phys Ther 7:606–616PubMedPubMedCentral
19.
go back to reference Jakobsen MD, Sundstrup E, Andersen CH, Aagaard P, Andersen LL (2013) Muscle activity during leg strengthening exercise using free weights and elastic resistance effects of ballistic vs. controlled contractions. Hum Mov Sci 32(1):65–78CrossRefPubMed Jakobsen MD, Sundstrup E, Andersen CH, Aagaard P, Andersen LL (2013) Muscle activity during leg strengthening exercise using free weights and elastic resistance effects of ballistic vs. controlled contractions. Hum Mov Sci 32(1):65–78CrossRefPubMed
20.
go back to reference Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL, Thorborg K (2014) Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomized controlled trial. Br J Sports Med 48(4):332–338CrossRefPubMed Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL, Thorborg K (2014) Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomized controlled trial. Br J Sports Med 48(4):332–338CrossRefPubMed
21.
go back to reference Juker D, McGill S, Kropf P, Steffen T (1998) Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc 30(2):301–310CrossRefPubMed Juker D, McGill S, Kropf P, Steffen T (1998) Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc 30(2):301–310CrossRefPubMed
22.
go back to reference Khan K, Brown J, Way S, Vass N, Crichton K, Alexander R, Baxter A, Butler M, Wark J (1995) Overuse injuries in classical ballet. Sports Med 19(5):341–357CrossRefPubMed Khan K, Brown J, Way S, Vass N, Crichton K, Alexander R, Baxter A, Butler M, Wark J (1995) Overuse injuries in classical ballet. Sports Med 19(5):341–357CrossRefPubMed
23.
go back to reference Lee M, Gandevia SC, Carroll TJ (2009) Unilateral strength training increases voluntary activation of the opposite untrained limb. Clinic Neurophysiol 120(4):802–808CrossRef Lee M, Gandevia SC, Carroll TJ (2009) Unilateral strength training increases voluntary activation of the opposite untrained limb. Clinic Neurophysiol 120(4):802–808CrossRef
24.
go back to reference Malliaras P, Barton CJ, Reeves ND, Langberg H (2013) Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med 43(4):267–286CrossRefPubMed Malliaras P, Barton CJ, Reeves ND, Langberg H (2013) Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med 43(4):267–286CrossRefPubMed
25.
go back to reference Nachemson A (1966) Electromyographic studies on the vertebral portion of the psoas muscle; with special reference to its stabilizing function of the lumbar spine. Acta Orthop Scand 37(2):177–190CrossRefPubMed Nachemson A (1966) Electromyographic studies on the vertebral portion of the psoas muscle; with special reference to its stabilizing function of the lumbar spine. Acta Orthop Scand 37(2):177–190CrossRefPubMed
26.
go back to reference Nelson IR, Keene JS (2014) Results of labral-level arthroscopic iliopsoas tenotomies for the treatment of labral impingement. Arthroscopy 30(6):688–694CrossRefPubMed Nelson IR, Keene JS (2014) Results of labral-level arthroscopic iliopsoas tenotomies for the treatment of labral impingement. Arthroscopy 30(6):688–694CrossRefPubMed
27.
go back to reference Quirk R (1983) Ballet injuries: the Australian experience. Clin Sports Med 2(3):507–514PubMed Quirk R (1983) Ballet injuries: the Australian experience. Clin Sports Med 2(3):507–514PubMed
28.
29.
go back to reference Snyder KR, Earl JE, O’Connor KM, Ebersole KT (2009) Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech 24(1):26–34CrossRef Snyder KR, Earl JE, O’Connor KM, Ebersole KT (2009) Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech 24(1):26–34CrossRef
30.
go back to reference Stalzer S, Wahoff M, Scanlan M (2006) Rehabilitation following hip arthroscopy. Clin Sports Med 25(2):337–357CrossRefPubMed Stalzer S, Wahoff M, Scanlan M (2006) Rehabilitation following hip arthroscopy. Clin Sports Med 25(2):337–357CrossRefPubMed
31.
go back to reference Sundstrup E, Jakobsen MD, Andersen CH, Jay K, Andersen LL (2012) Swiss ball abdominal crunch with added elastic resistance is an effective alternative to training machines. Int J Sports Phys Ther 7(4):372–380PubMedPubMedCentral Sundstrup E, Jakobsen MD, Andersen CH, Jay K, Andersen LL (2012) Swiss ball abdominal crunch with added elastic resistance is an effective alternative to training machines. Int J Sports Phys Ther 7(4):372–380PubMedPubMedCentral
32.
go back to reference Thorborg K (2012) Why hamstring eccentrics are hamstring essentials. Br J Sports Med 46(7):463–465CrossRefPubMed Thorborg K (2012) Why hamstring eccentrics are hamstring essentials. Br J Sports Med 46(7):463–465CrossRefPubMed
33.
go back to reference Thorborg K, Bandholm T, Petersen J, Weeke KM, Weinold C, Andersen B, Serner A, Magnusson SP, Hölmich P (2010) Hip abduction strength training in the clinical setting: with or without external loading? Scand J Med Sci Sports 20(Suppl 2):70–77CrossRefPubMed Thorborg K, Bandholm T, Petersen J, Weeke KM, Weinold C, Andersen B, Serner A, Magnusson SP, Hölmich P (2010) Hip abduction strength training in the clinical setting: with or without external loading? Scand J Med Sci Sports 20(Suppl 2):70–77CrossRefPubMed
34.
go back to reference Thorborg K, Hölmich P (2013) Advancing hip and groin injury management: from eminence to evidence. Br J Sports Med 47(10):602–652CrossRefPubMed Thorborg K, Hölmich P (2013) Advancing hip and groin injury management: from eminence to evidence. Br J Sports Med 47(10):602–652CrossRefPubMed
35.
go back to reference Thorborg K, Petersen J, Magnusson SP, Hölmich P (2010) Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 20(3):493–501CrossRefPubMed Thorborg K, Petersen J, Magnusson SP, Hölmich P (2010) Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 20(3):493–501CrossRefPubMed
36.
go back to reference Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P, Hölmich P (2011) Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 39(1):121–126CrossRefPubMed Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P, Hölmich P (2011) Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 39(1):121–126CrossRefPubMed
37.
go back to reference Toigo M, Boutellier U (2006) New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol 97(6):643–663CrossRefPubMed Toigo M, Boutellier U (2006) New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol 97(6):643–663CrossRefPubMed
38.
go back to reference Werner J, Hägglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040CrossRefPubMed Werner J, Hägglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040CrossRefPubMed
39.
go back to reference Yoshio M, Murakami G, Sato T, Sato S, Noriyasa S (2002) The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci 7(2):199–207CrossRefPubMed Yoshio M, Murakami G, Sato T, Sato S, Noriyasa S (2002) The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci 7(2):199–207CrossRefPubMed
Metadata
Title
Large strengthening effect of a hip-flexor training programme: a randomized controlled trial
Authors
Kristian Thorborg
Thomas Bandholm
Mette Zebis
Lars Louis Andersen
Jesper Jensen
Per Hölmich
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3583-y

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