Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2022

Open Access 01-12-2022 | Research article

Sex differences in the relationship of hip strength and functional performance to chronic ankle instability scores

Authors: Junlan Lu, Zhigang Wu, Roger Adams, Jia Han, Bin Cai

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2022

Login to get access

Abstract

Background

While decreased hip abductor strength, functional performance, and self-reported instability scores have all been shown in association with CAI, any sex difference in the relationship between these indicators is unclear. This study was to determine whether sex differences are present in the relationship between these indicators in individuals with CAI.

Methods

Thirty-two women and twenty-nine men with unilateral CAI took part. Hip abductor strength and functional performance were respectively assessed using a hand-held dynamometer and the figure-8-hop test. All 61 participants scored the Cumberland Ankle Instability Tool (CAIT) for self-reported ankle instability. Independent sample t-tests and correlation analysis were conducted.

Results

Normalized hip abductor strength and functional performance measures for females were lower than for males. The self-reported ankle instability CAIT score, where higher values represent less instability, was significantly and positively correlated with both normalized hip abductor strength (p = 0.003) and functional performance (p = 0.001) on the affected side in females, but not in males (p = 0.361 and p = 0.192 respectively).

Conclusions

Sex differences were observed in that there were significant relationships between normalized hip abductor strength, functional performance, and CAIT scores in female CAI participants, but not males, suggesting that CAI evaluation and rehabilitation strategies should be sex-specific.

Highlights

  • In females with CAI, hip abductor strength and functional performance showed significant relationships with self-reported instability scores.
  • Correspondingly, in clinical practice with individuals with CAI, evaluation criteria may be formulated according to these observed sex differences.
  • Sex differences should be factored into the evaluation and treatment of CAI individuals.
  • Hip strength assessment should be employed with CAI individuals.
  • Hip strengthening and functional hopping may be recommended for the rehabilitation of CAI, especially in female patients.
Literature
1.
go back to reference Vasta S, Papalia R, Albo E. Top orthopedic sports medicine procedures. J Orthop Surg Res. 2018;13(1):190.CrossRef Vasta S, Papalia R, Albo E. Top orthopedic sports medicine procedures. J Orthop Surg Res. 2018;13(1):190.CrossRef
2.
go back to reference Hershkovich O. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg. 2015;54(2):183–7.CrossRef Hershkovich O. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg. 2015;54(2):183–7.CrossRef
3.
go back to reference Aicale R, Maffulli N. Chronic lateral ankle instability: topical review. Foot Ankle Int. 2020;41:1571–81.CrossRef Aicale R, Maffulli N. Chronic lateral ankle instability: topical review. Foot Ankle Int. 2020;41:1571–81.CrossRef
4.
go back to reference Tanen L, Docherty CL, Van DP. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Special. 2014;7(1):37–44.CrossRef Tanen L, Docherty CL, Van DP. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Special. 2014;7(1):37–44.CrossRef
5.
go back to reference Doherty C, Delahunt E, Caulfield B. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40.CrossRef Doherty C, Delahunt E, Caulfield B. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40.CrossRef
6.
go back to reference Goulart N, Maffulli N, Migliorini F. Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study. J Orthop Surg Res. 2022;17(1):38.CrossRef Goulart N, Maffulli N, Migliorini F. Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study. J Orthop Surg Res. 2022;17(1):38.CrossRef
7.
go back to reference Hiller CE, Refshauge KM, Bundy AC. The cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehab. 2006;87(9):1235–41.CrossRef Hiller CE, Refshauge KM, Bundy AC. The cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehab. 2006;87(9):1235–41.CrossRef
8.
go back to reference Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015;50(10):1019–33.CrossRef Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015;50(10):1019–33.CrossRef
9.
go back to reference Docherty CL, Arnold BL, Gansneder BM. Functional-performance deficits in volunteers with functional ankle instability. J Athl Train. 2005;40(1):30–4.PubMedPubMedCentral Docherty CL, Arnold BL, Gansneder BM. Functional-performance deficits in volunteers with functional ankle instability. J Athl Train. 2005;40(1):30–4.PubMedPubMedCentral
10.
go back to reference Mccann RS, Terada M, Kosik KB. Landing kinematics and isometric hip strength of individuals with chronic ankle instability. Foot Ankle Int. 2019;40(8):969–77.CrossRef Mccann RS, Terada M, Kosik KB. Landing kinematics and isometric hip strength of individuals with chronic ankle instability. Foot Ankle Int. 2019;40(8):969–77.CrossRef
11.
go back to reference Kosik KB, Johnson NF, Terada M. Decreased ankle and hip isometric peak torque in young and middle-aged adults with chronic ankle instability. Phys Ther Sport. 2020;43(12):345–9. Kosik KB, Johnson NF, Terada M. Decreased ankle and hip isometric peak torque in young and middle-aged adults with chronic ankle instability. Phys Ther Sport. 2020;43(12):345–9.
13.
go back to reference Nakagawa T, Moriya E, Maciel C. Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012;42(6):491–501.CrossRef Nakagawa T, Moriya E, Maciel C. Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012;42(6):491–501.CrossRef
14.
go back to reference Nguyen A, Shultz S, Schmitz R. A preliminary multifactorial approach describing the relationships among lower extremity alignment, hip muscle activation, and lower extremity joint excursion. J Athl Train. 2011;46(3):246–56.CrossRef Nguyen A, Shultz S, Schmitz R. A preliminary multifactorial approach describing the relationships among lower extremity alignment, hip muscle activation, and lower extremity joint excursion. J Athl Train. 2011;46(3):246–56.CrossRef
15.
go back to reference Gribble P, Delahunt E, Bleakley C. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48(13):1014–8.CrossRef Gribble P, Delahunt E, Bleakley C. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48(13):1014–8.CrossRef
16.
go back to reference Thorborg K, Petersen J, Magnusson S. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493–501.CrossRef Thorborg K, Petersen J, Magnusson S. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493–501.CrossRef
17.
go back to reference Mccann RS, Crossett ID, Terada M. Hip strength and star excursion balance test deficits of patients with chronic ankle instability. J Sci Med Sport. 2017;20(11):992–6.CrossRef Mccann RS, Crossett ID, Terada M. Hip strength and star excursion balance test deficits of patients with chronic ankle instability. J Sci Med Sport. 2017;20(11):992–6.CrossRef
18.
go back to reference Caffrey E, Docherty CL, Schrader J. The ability of 4 single-limb hopping tests to detect functional performance deficits in individuals with functional ankle instability. J Orthop Sport Phys. 2009;39(11):799–806.CrossRef Caffrey E, Docherty CL, Schrader J. The ability of 4 single-limb hopping tests to detect functional performance deficits in individuals with functional ankle instability. J Orthop Sport Phys. 2009;39(11):799–806.CrossRef
20.
go back to reference Caylor D, Fites R, Worrell TW. The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther. 1993;17(1):11–6.CrossRef Caylor D, Fites R, Worrell TW. The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther. 1993;17(1):11–6.CrossRef
21.
go back to reference Chen Z, Han J, Waddington G. Somatosensory perception sensitivity in voluntary postural sway movements: age, gender and sway effect magnitudes. Exp Gerontol. 2019;122(3):53–9.CrossRef Chen Z, Han J, Waddington G. Somatosensory perception sensitivity in voluntary postural sway movements: age, gender and sway effect magnitudes. Exp Gerontol. 2019;122(3):53–9.CrossRef
22.
go back to reference Olchowik G, Tomaszewski M, Olejarz P. The human balance system and gender. Acta Bioeng Biomech. 2015;17(1):69–74.PubMed Olchowik G, Tomaszewski M, Olejarz P. The human balance system and gender. Acta Bioeng Biomech. 2015;17(1):69–74.PubMed
23.
go back to reference Witchalls J, Waddington G, Blanch P. Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus. J Athl Train. 2012;47(6):627–34.CrossRef Witchalls J, Waddington G, Blanch P. Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus. J Athl Train. 2012;47(6):627–34.CrossRef
24.
go back to reference Ambegaonkar JP, Mettinger LM, Caswell SV. Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther. 2014;9(5):604–16.PubMedPubMedCentral Ambegaonkar JP, Mettinger LM, Caswell SV. Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther. 2014;9(5):604–16.PubMedPubMedCentral
25.
go back to reference Montgomery MM, Shultz SJ, Schmitz RJ. The effect of equalizing landing task demands on sex differences in lower extremity energy absorption. Clin Biomech (Bristol, Avon). 2014;29(7):760–6.CrossRef Montgomery MM, Shultz SJ, Schmitz RJ. The effect of equalizing landing task demands on sex differences in lower extremity energy absorption. Clin Biomech (Bristol, Avon). 2014;29(7):760–6.CrossRef
26.
go back to reference Fukano M, Mineta S, Hirose N. Fear avoidance beliefs in college athletes with a history of ankle sprain. Int J Sports Med. 2020;41(2):128–33.CrossRef Fukano M, Mineta S, Hirose N. Fear avoidance beliefs in college athletes with a history of ankle sprain. Int J Sports Med. 2020;41(2):128–33.CrossRef
27.
go back to reference Pollard C, Sigward S, Powers C. Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Clin Biomech (Bristol, Avon). 2010;25(2):142–6.CrossRef Pollard C, Sigward S, Powers C. Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Clin Biomech (Bristol, Avon). 2010;25(2):142–6.CrossRef
28.
go back to reference Houston M, Hoch J, Hoch M. College athletes with ankle sprain history exhibit greater fear-avoidance beliefs. J Sport Rehabil. 2018;27(5):419–23.CrossRef Houston M, Hoch J, Hoch M. College athletes with ankle sprain history exhibit greater fear-avoidance beliefs. J Sport Rehabil. 2018;27(5):419–23.CrossRef
29.
go back to reference Mohamadi S, Dadgoo M, Ebrahimi I. Translation, cross-cultural adaptation, reliability, and validity of the identification of functional ankle instability questionnaire in persian speaking participants with a history of ankle sprain. Disabil Rehabil. 2019;41(16):1931–6.CrossRef Mohamadi S, Dadgoo M, Ebrahimi I. Translation, cross-cultural adaptation, reliability, and validity of the identification of functional ankle instability questionnaire in persian speaking participants with a history of ankle sprain. Disabil Rehabil. 2019;41(16):1931–6.CrossRef
30.
go back to reference Lysdal F, Bandholm T, Tolstrup J. Does the spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries. Br J Sports Med. 2020;17(3):449–54. Lysdal F, Bandholm T, Tolstrup J. Does the spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries. Br J Sports Med. 2020;17(3):449–54.
31.
go back to reference Jaber H, Lohman E, Daher N. Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. PLoS ONE. 2018;13(8):1471–9.CrossRef Jaber H, Lohman E, Daher N. Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. PLoS ONE. 2018;13(8):1471–9.CrossRef
32.
go back to reference Waterman BR, Owens BD, Davey S. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279–84.CrossRef Waterman BR, Owens BD, Davey S. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279–84.CrossRef
33.
go back to reference Smith BI, Docherty CL, Curtis D. Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability. J Sport Rehabil. 2017;27(4):364–70.CrossRef Smith BI, Docherty CL, Curtis D. Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability. J Sport Rehabil. 2017;27(4):364–70.CrossRef
34.
go back to reference Khalaj N, Vicenzino B, Heales LJ. Is chronic ankle instability associated with impaired muscle strength? Ankle, knee and hip muscle strength in individuals with chronic ankle instability: a systematic review with meta-analysis. Br J Sports Med. 2020;54(14):839–47.CrossRef Khalaj N, Vicenzino B, Heales LJ. Is chronic ankle instability associated with impaired muscle strength? Ankle, knee and hip muscle strength in individuals with chronic ankle instability: a systematic review with meta-analysis. Br J Sports Med. 2020;54(14):839–47.CrossRef
Metadata
Title
Sex differences in the relationship of hip strength and functional performance to chronic ankle instability scores
Authors
Junlan Lu
Zhigang Wu
Roger Adams
Jia Han
Bin Cai
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2022
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-022-03061-0

Other articles of this Issue 1/2022

Journal of Orthopaedic Surgery and Research 1/2022 Go to the issue