Elsevier

Physical Therapy in Sport

Volume 27, September 2017, Pages 1-6
Physical Therapy in Sport

Original Research
Frontal plane kinematics predict three-dimensional hip adduction during running

https://doi.org/10.1016/j.ptsp.2017.05.005Get rights and content

Highlights

  • 3D peak hip adduction in running can be predicted from frontal plane kinematics.

  • 2D peak pelvis and femur angles combined predict 3D peak hip adduction within 2.14°.

  • Frontal plane kinematics do not predict 3D peak hip internal rotation in running.

Abstract

Objectives

To investigate if frontal plane kinematics are predictive of three dimensional (3D) hip adduction and hip internal rotation during running.

Study design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Thirty healthy male runners aged 18–45 years.

Main outcome measures

Two dimensional (2D) angles in the frontal plane (peak pelvic obliquity, peak hip adduction, peak femoral valgus, peak knee valgus and peak tibial valgus) and 3D hip adduction and hip internal rotation during stance phase of running were obtained.

Results

Linear regression modelling revealed that peak 2D pelvic obliquity (a drop towards the contralateral leg) and peak femoral valgus significantly predicted 88% of the variance in peak 3D hip adduction (p < 0.001). Frontal plane kinematics however, were not predictive of peak hip internal rotation in 3D (p > 0.05).

Conclusions

Frontal plane kinematics, specifically contralateral pelvic drop and femoral valgus, predicted the vast majority of the variance in 3D hip adduction during the stance phase of running. This indicates that 2D video may have potential as a clinically feasible proxy for measurement of peak 3D hip adduction – a risk factor for patellofemoral pain.

Introduction

Participation in running is associated with a high rate of knee injuries (Taunton et al., 2002, van Poppel et al., 2014, van der Worp et al., 2015). In male and female recreational runners the knee has been reported as the most commonly injured site, accounting for up to 42% of injuries (van Poppel, Scholten-Peeters et al., 2014). In runners, patellofemoral pain (PFP) and iliotibial band syndrome (ITBS) are two of the most common injuries affecting the knee (Taunton, Ryan et al., 2002). Interestingly, prospective studies have identified hip biomechanics as risk factors for both PFP and ITBS, in terms of increased peak hip adduction during the stance phase of running (Noehren et al., 2007, Noehren et al., 2013). These findings are supplemented by evidence from cross-sectional studies reporting that individuals with PFP and ITBS exhibit significantly greater hip adduction (Willson and Davis, 2008, Ferber et al., 2010c), and greater hip internal rotation (Souza and Powers, 2009, Noehren et al., 2014) during running when compared with their asymptomatic counterparts.

Identification of undesirable kinematics associated with PFP and ITBS may be beneficial in both the prevention and rehabilitation of these common knee injuries. For example, screening may assist in identifying individuals at risk of PFP or ITBS who could then be targeted for intervention to modify kinematics. Similarly, identification of undesirable kinematics of a symptomatic individual would aid in the clinicians’ selection of appropriate rehabilitation, which may include modification of kinematics (Noehren, Scholz et al., 2011). The current “gold-standard” for quantifying kinematics during locomotion is three-dimensional (3D) motion analysis. The cost and expertise required to obtain accurate and reliable data with 3D motion analysis makes it less feasible for use in the clinical setting. Possible alternatives for the clinical setting include (i) two-dimensional (2D) motion analysis using video and appropriate motion analysis software, and (ii) visual observation and scoring of kinematics.

Advances of the quality and availability of camera technologies, for example the capability of contemporary mobile devices (i.e. phones and tablets), now makes 2D motion analysis feasible in most clinical settings. In the context of PFP and ITBS prevention and rehabilitation, the use of 2D motion analysis is currently limited by a lack of evidence as to which 2D angles accurately reflect 3D motion of the hip during running. There is some evidence however, regarding the relationship between 3D kinematics of the hip and visual assessment of kinematics. During qualitative visual assessment, movement is typically judged by a clinician on criteria related to individual segmental and joint orientations. Examples of such criteria have been described for lower extremity functional tasks such as a single leg squat (Ageberg et al., 2010, Crossley et al., 2011, Thorlund et al., 2011; Nae, Creaby, Cronström, & Ageberg, 2017a), but not for running. The major limitation of visual assessment however, is that it only affords the clinician a 2D view, which may only partially represent the underlying 3D motion. For example, Ageberg and colleagues (Ageberg, Bennell et al., 2010) reported that frontal plane knee valgus during a single leg mini squat (visually identified from a knee position medial to the foot) was associated with internal rotation of the hip in 3D, but not with knee valgus measured in 3D. Evidently, 2D frontal plane kinematics are a result of the underlying 3D movement, but given the multi-planar rotations that occur during functional movements like running or a single leg squat, the direction and magnitude of the relationship between the 2D and 3D kinematics in any movement task cannot be assumed.

Given the existing evidence that increased hip adduction and internal rotation during running are related to PFP and ITBS, there is a need to develop a clinically feasible method for identifying individuals exhibiting these 3D motions during running. As 3D motion analysis is often unfeasible in the clinical setting, evaluating the ability of 2D kinematics to act as a suitable proxy for 3D measurement is an essential first step in establishing their feasibility. Therefore, the aim of this study was to investigate if relevant 2D frontal plane kinematics are predictive of 3D hip adduction and/or internal rotation during running. We hypothesized that peak 2D frontal plane kinematics would be predictive of peak 3D hip adduction and peak 3D hip internal rotation.

Section snippets

Participants

Thirty healthy male runners aged 18–45 years were recruited for the study from the local area of Brisbane, Australia. Participants were excluded if they had: (i) any lower limb musculoskeletal pain or injury in the past month, (ii) history of any condition, disease or surgery that would affect their running biomechanics (e.g. PFP, prior ACL injury), or (iii) any delayed onset muscle fatigue that restricted movement on the day of the study. All participants partook in regular aerobic based

Results

Participants were, on average, 32.9 ± 8.9 years of age, 173 ± 5 cm tall, and mass 76.7 ± 8.5 kg. Mean 2D and 3D kinematics during the stance phase of running are presented in Table 1. In regression modelling, the peak frontal plane femoral valgus and pelvis obliquity predicted 88% of variance in 3D hip adduction angle (P < 0.001; Table 2). The relationship was such that a greater 2D peak femoral valgus and 2D peak contralateral pelvic drop were predictive of greater 3D peak hip adduction, as

Discussion

In support of the hypothesis, a greater peak femoral valgus (2D) and a more pronounced peak pelvic drop towards the contralateral leg (2D) were found to be predictive of greater 3D peak hip adduction during treadmill running. In contrast, 2D frontal plane angles were not related to the peak 3D hip internal rotation observed during the stance phase of running.

There is prospective evidence that increased hip adduction during running is related to the development of PFP and ITBS in females (

Conclusions

Frontal plane pelvic obliquity and femoral valgus were predictive of peak 3D hip adduction during running. The strongest predictor of greater peak 3D hip adduction was greater femoral valgus. 2D frontal plane kinematics were not predictive of 3D hip internal rotation. Therefore, measurement of 2D frontal plane pelvic and femoral orientation may have potential as a clinically feasible proxy measure of 3D hip adduction during running. Focus on the pelvis and femur in particular could also be

Ethical approval

The work has been approved by the appropriate ethical committee related to the institution in which it was performed and participants gave informed consent prior to participation.

Funding

None declared.

Conflicts of interest

None declared.

Acknowledgments

We wish to acknowledge Dr. Anthony G. Schache for authoring the kinematic modelling code used in this study, and Prof. Kay M. Crossley for providing feedback on an earlier version of this manuscript.

References (36)

  • C. Whatman et al.

    Kinematics during lower extremity functional screening tests in young athletes - are they reliable and valid?

    Physical Therapy in Sport

    (2013)
  • J.D. Willson et al.

    Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands

    Clinical Biomechanics

    (2008)
  • H.J. Woltring

    A Fortran package for generalized, cross-validatory spline smoothing and differentiation

    Advances in Engineering Software and Workstations

    (1986)
  • G. Wu et al.

    ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion - part 1: Ankle, hip, and spine

    Journal of Biomechanics

    (2002)
  • E. Ageberg et al.

    Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat

    BMC Musculoskeletal Disorders

    (2010)
  • T.G. Almonroeder et al.

    Sex differences in lower extremity kinematics and patellofemoral kinetics during running

    Journal of Sports Sciences

    (2016)
  • T.L. Chmielewski et al.

    Investigation of clinician agreement in evaluating movement quality during unilateral lower extremity functional tasks: A comparison of 2 rating methods

    Journal of Orthopaedic & Sports Physical Therapy

    (2007)
  • K.M. Crossley et al.

    Performance on the single-leg squat task indicates hip abductor muscle function

    American Journal of Sports Medicine

    (2011)
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