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Published in: European Journal of Applied Physiology 8/2018

01-08-2018 | Original Article

Isometric strength of the hip abductors and external rotators in athletes with and without patellar tendinopathy

Authors: Z. J. Zhang, W. C. Lee, G. Y. F. Ng, S. N. Fu

Published in: European Journal of Applied Physiology | Issue 8/2018

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Abstract

Purpose

This study aims to compare the isometric strength of hip abductors and external rotators in male athletes with and without patellar tendinopathy (PT), and to examine the correlation between hip strength, pain, and functional scores.

Methods

Sixty male athletes (30 with PT and 30 controls) were recruited from local volleyball and basketball teams. The isometric strength of the hip abductors and external rotators was quantified using a belt-stabilized handheld dynamometer. This study used the visual analog scale (VAS) and the Victorian Institute of Sport Assessment-Patella (VISA-p) questionnaire to measure the intensity of pain and functional scores in athletes with PT, respectively.

Results

The normalized isometric strength of the hip abductors and external rotators was significantly less in the PT group compared with controls. In subjects with PT, the normalized isometric strength was decreased by 22.0% (p = 0.000) in the hip abductors and by 20.0% in the hip external rotators (p = 0.004), compared with controls. Significant correlations were found between the normalized isometric strength of the hip abductors and intensity of pain (r = − 0.70; p < 0.05) and VISA-p score (r = 0.63; p < 0.05) in the affected leg in athletes with unilateral PT.

Conclusions

Athletes with PT have decreased isometric strength in their hip abductors and external rotators when compared with controls. In subjects with unilateral PT, decreased isometric strength in the hip abductors is associated with greater intensity of pain and lower functional scores. Results of this study implied that hip muscle assessment and strengthening should be included for reconditioning and rehabilitation in athletes with PT.
Literature
go back to reference Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T (2007) Relationship between landing strategy and patellar tendinopathy in volleyball. Br J Sports Med 41:e8CrossRef Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T (2007) Relationship between landing strategy and patellar tendinopathy in volleyball. Br J Sports Med 41:e8CrossRef
go back to reference Bolgla LA, Malone TR, Umberger BR, Uhl TL (2008) Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 38:12–18CrossRef Bolgla LA, Malone TR, Umberger BR, Uhl TL (2008) Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 38:12–18CrossRef
go back to reference Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ (2007) Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res 25:1164–1175CrossRef Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ (2007) Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res 25:1164–1175CrossRef
go back to reference Edwards S, Steele JR, McGhee DE, Beattie S, Purdam C, Cook JL (2010) Landing strategies of athletes with an asymptomatic patellar tendon abnormality. Send to Med Sci Sports Exerc 42:2072–2080CrossRef Edwards S, Steele JR, McGhee DE, Beattie S, Purdam C, Cook JL (2010) Landing strategies of athletes with an asymptomatic patellar tendon abnormality. Send to Med Sci Sports Exerc 42:2072–2080CrossRef
go back to reference Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS (2004) Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players? Br J Sports Med 38:581–585CrossRef Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS (2004) Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players? Br J Sports Med 38:581–585CrossRef
go back to reference Habets B, Smits HW, Backx FJG, van Cingel REH, Huisstede BMA (2017) Hip muscle strength is decreased in middle-aged recreational male athletes with midportion Achilles tendinopathy: a cross-sectional study. Phys Ther Sport 25:55–61CrossRef Habets B, Smits HW, Backx FJG, van Cingel REH, Huisstede BMA (2017) Hip muscle strength is decreased in middle-aged recreational male athletes with midportion Achilles tendinopathy: a cross-sectional study. Phys Ther Sport 25:55–61CrossRef
go back to reference Ireland ML, Willson JD, Ballantyne BT, Davis IM (2003) Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 33:671–676CrossRef Ireland ML, Willson JD, Ballantyne BT, Davis IM (2003) Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 33:671–676CrossRef
go back to reference Jacobs CA, Uhl TL, Mattacola CG, Shapiro R, Rayens WS (2007) Hip abductor function and lower extremity landing kinematics: sex differences. J Athl Train 42:76–83PubMedPubMedCentral Jacobs CA, Uhl TL, Mattacola CG, Shapiro R, Rayens WS (2007) Hip abductor function and lower extremity landing kinematics: sex differences. J Athl Train 42:76–83PubMedPubMedCentral
go back to reference Janssen I, Steele JR, Munro BJ, Brown NA (2013) Predicting the patellar tendon force generated when landing from a jump. Med Sci Sports Exerc 45:927–934CrossRef Janssen I, Steele JR, Munro BJ, Brown NA (2013) Predicting the patellar tendon force generated when landing from a jump. Med Sci Sports Exerc 45:927–934CrossRef
go back to reference Kettunen JA, Kvist M, Alanen E, Kujala UM (2002) Long-term prognosis for jumper’s knee in male athletes. A prospective follow-up study. Am J Sports Med 30:689–692CrossRef Kettunen JA, Kvist M, Alanen E, Kujala UM (2002) Long-term prognosis for jumper’s knee in male athletes. A prospective follow-up study. Am J Sports Med 30:689–692CrossRef
go back to reference Kulig K, Landel R, Chang YJ, Hannanvash N, Reischl SF, Song P, Bashford GR (2013) Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy. Scand J Med Sci Sports 23:e81-8CrossRef Kulig K, Landel R, Chang YJ, Hannanvash N, Reischl SF, Song P, Bashford GR (2013) Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy. Scand J Med Sci Sports 23:e81-8CrossRef
go back to reference Lian O, Holen KJ, Engebretsen L, Bahr R (1996) Relationship between symptoms of jumper’s knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports 6:291–296CrossRef Lian O, Holen KJ, Engebretsen L, Bahr R (1996) Relationship between symptoms of jumper’s knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports 6:291–296CrossRef
go back to reference Lian OB, Engebretsen L, Bahr R (2005) Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med 33:561–567CrossRef Lian OB, Engebretsen L, Bahr R (2005) Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med 33:561–567CrossRef
go back to reference Malloy PJ, Morgan AM, Meinerz CM, Geiser CF, Kipp K (2016) Hip external rotator strength is associated with better dynamic control of the lower extremity during landing tasks. J Strength Cond Res 30:282–291CrossRef Malloy PJ, Morgan AM, Meinerz CM, Geiser CF, Kipp K (2016) Hip external rotator strength is associated with better dynamic control of the lower extremity during landing tasks. J Strength Cond Res 30:282–291CrossRef
go back to reference Martins J, da Silva JR, da Silva MRB, Bevilaqua-Grossi D (2017) Reliability and validity of the belt-stabilized handheld dynamometer in hip- and knee-strength tests. J Athl Train 52:809–819CrossRef Martins J, da Silva JR, da Silva MRB, Bevilaqua-Grossi D (2017) Reliability and validity of the belt-stabilized handheld dynamometer in hip- and knee-strength tests. J Athl Train 52:809–819CrossRef
go back to reference Morton S, Williams S, Valle X, Diaz-Cueli D, Malliaras P, Morrissey D (2017) Patellar tendinopathy and potential risk factors: an international database of cases and controls. Clin J Sport Med 27:468–474CrossRef Morton S, Williams S, Valle X, Diaz-Cueli D, Malliaras P, Morrissey D (2017) Patellar tendinopathy and potential risk factors: an international database of cases and controls. Clin J Sport Med 27:468–474CrossRef
go back to reference Neumann DA (2010) Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther 40:82–94CrossRef Neumann DA (2010) Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther 40:82–94CrossRef
go back to reference Rosen AB, Ko J, Simpson KJ, Kim SH, Brown CN (2015) Lower extremity kinematics during a drop jump in individuals with patellar tendinopathy. Orthop J Sports Med 3:2325967115576100CrossRef Rosen AB, Ko J, Simpson KJ, Kim SH, Brown CN (2015) Lower extremity kinematics during a drop jump in individuals with patellar tendinopathy. Orthop J Sports Med 3:2325967115576100CrossRef
go back to reference Rudavsky A, Cook J (2014) Physiotherapy management of patellar tendinopathy (jumper’s knee). J Physiother 60:122–129CrossRef Rudavsky A, Cook J (2014) Physiotherapy management of patellar tendinopathy (jumper’s knee). J Physiother 60:122–129CrossRef
go back to reference Scattone Silva R, Ferreira AL, Nakagawa TH, Santos JE, Serrão FV (2015) Rehabilitation of patellar tendinopathy using hip extensor strengthening and landing-strategy modification: case report with 6-month follow-up. J Orthop Sports Phys Ther 45:899–909CrossRef Scattone Silva R, Ferreira AL, Nakagawa TH, Santos JE, Serrão FV (2015) Rehabilitation of patellar tendinopathy using hip extensor strengthening and landing-strategy modification: case report with 6-month follow-up. J Orthop Sports Phys Ther 45:899–909CrossRef
go back to reference Scattone Silva R, Nakagawa TH, Ferreira AL, Garcia LC, Santos JE, Serrão FV (2016) Lower limb strength and flexibility in athletes with and without patellar tendinopathy. Phys Ther Sport 20:19–25CrossRef Scattone Silva R, Nakagawa TH, Ferreira AL, Garcia LC, Santos JE, Serrão FV (2016) Lower limb strength and flexibility in athletes with and without patellar tendinopathy. Phys Ther Sport 20:19–25CrossRef
go back to reference Scattone Silva R, Purdam CR, Fearon AM, Spratford WA, Kenneally-Dabrowski C, Preston P, Serrão FV, Gaida JE (2017) Effects of altering trunk position during landings on patellar tendon force and pain. Med Sci Sports Exerc 49:2517–2527CrossRef Scattone Silva R, Purdam CR, Fearon AM, Spratford WA, Kenneally-Dabrowski C, Preston P, Serrão FV, Gaida JE (2017) Effects of altering trunk position during landings on patellar tendon force and pain. Med Sci Sports Exerc 49:2517–2527CrossRef
go back to reference Shoja MM (2008) Pelvic girdle, gluteal region and thigh. In: Standring S (ed) Gray’s anatomy: the Anatomical basis of clinical practice, 41st edn. Churchill Livingstone Elsevier, Illinois, p 1357 Shoja MM (2008) Pelvic girdle, gluteal region and thigh. In: Standring S (ed) Gray’s anatomy: the Anatomical basis of clinical practice, 41st edn. Churchill Livingstone Elsevier, Illinois, p 1357
go back to reference Siegmund JA, Huxel KC, Swanik CB (2008) Compensatory mechanisms in basketball players with jumper’s knee. J Sport Rehabil 17:358–371CrossRef Siegmund JA, Huxel KC, Swanik CB (2008) Compensatory mechanisms in basketball players with jumper’s knee. J Sport Rehabil 17:358–371CrossRef
go back to reference Tate J, Suckut T, Wages J, Lyles H, Perrin B (2017) The associations between hip strength and hip kinematics during a single leg hop in recreational athletes post ACL reconstruction compared to healthy controls. Int J Sports Phys Ther 12:341–351PubMedPubMedCentral Tate J, Suckut T, Wages J, Lyles H, Perrin B (2017) The associations between hip strength and hip kinematics during a single leg hop in recreational athletes post ACL reconstruction compared to healthy controls. Int J Sports Phys Ther 12:341–351PubMedPubMedCentral
go back to reference Thorborg K, Bandholm T, Hölmich P (2013) Hip- and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc 21:550–555CrossRef Thorborg K, Bandholm T, Hölmich P (2013) Hip- and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc 21:550–555CrossRef
go back to reference Tiemessen IJ, Kuijer PP, Hulshof CT, Frings-Dresen MH (2009) Risk factors for developing jumper’s knee in sport and occupation: a review. BMC Res Notes 2:127CrossRef Tiemessen IJ, Kuijer PP, Hulshof CT, Frings-Dresen MH (2009) Risk factors for developing jumper’s knee in sport and occupation: a review. BMC Res Notes 2:127CrossRef
go back to reference van der Worp H, van Ark M, Roerink S, Pepping GJ, van den Akker-Scheek I, Zwerver J (2011) Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med 45:446–452CrossRef van der Worp H, van Ark M, Roerink S, Pepping GJ, van den Akker-Scheek I, Zwerver J (2011) Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med 45:446–452CrossRef
go back to reference Van der Worp H, de Poel HJ, Diercks RL, van den Akker-Scheek I, Zwerver J (2014) Jumper’s knee or lander’s knee? A systematic review of the relation between jump biomechanics and patellar tendinopathy. Int J Sports Med 35:714–722CrossRef Van der Worp H, de Poel HJ, Diercks RL, van den Akker-Scheek I, Zwerver J (2014) Jumper’s knee or lander’s knee? A systematic review of the relation between jump biomechanics and patellar tendinopathy. Int J Sports Med 35:714–722CrossRef
go back to reference Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD (1998) The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport 1:22–28CrossRef Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD (1998) The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport 1:22–28CrossRef
go back to reference Witvrouw E, Bellemans J, Lysens R, Danneels L, Cambier D (2001) Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. Am J Sports Med 29:190–195CrossRef Witvrouw E, Bellemans J, Lysens R, Danneels L, Cambier D (2001) Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. Am J Sports Med 29:190–195CrossRef
go back to reference Zwerver J, Bredeweg SW, van den Akker-Scheek I (2011) Prevalence of Jumper’s knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med 39:1984–1988CrossRef Zwerver J, Bredeweg SW, van den Akker-Scheek I (2011) Prevalence of Jumper’s knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med 39:1984–1988CrossRef
Metadata
Title
Isometric strength of the hip abductors and external rotators in athletes with and without patellar tendinopathy
Authors
Z. J. Zhang
W. C. Lee
G. Y. F. Ng
S. N. Fu
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Applied Physiology / Issue 8/2018
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-018-3896-x

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