The Association Between Degenerative Hip Joint

Manual Therapy 14 (2009) 611–617

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Manual Therapy
journal homepage: www.elsevier.com/math

Original Article

The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles
Alison Grimaldi a, *, Carolyn Richardson a, Gail Durbridge b, William Donnelly c, Ross Darnell a, Julie Hides a, d
aDivision of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia Centre for Magnetic Resonance Imaging, Brisbane, Australia Brisbane Orthopaedic Specialist Services, Brisbane, Australia d The UQ/Mater Back Stability Clinic, Mater Health Services, Raymond Terrace, South Brisbane, Queensland 4101, Australia
b c

a r t i c l e i n fo
Article history: Received 10 August 2007 Received in revised form 28 October 2008 Accepted 8 November 2008 Keywords: Hip osteoarthritis Gluteus maximus Tensor fascia lata Magnetic resonance imaging

a b s t r a c t
The aim of this study was to obtain, using Magnetic Resonance Imaging (MRI), muscle volume measurements for the gluteus maximus (upper: UGM and lower: LGM portions) and tensorfascia lata (TFL) muscles in both healthy subjects (n ¼ 12) and those with unilateral osteoarthritis (OA) of the hip (mild: n ¼ 6, and advanced: n ¼ 6). While control group subjects were symmetrical between sides for the muscles measured, subjects with hip joint pathology showed asymmetry in GM muscle volume dependent on stage of pathology. The LGM demonstrated atrophy around the affected hip insubjects with advanced pathology (p < 0.05), however asymmetry of the UGM (p < 0.01) could be attributed largely to hypertrophy on the unaffected side, based on between group comparisons of muscle volume. TFL showed no significant asymmetry, or difference compared to the normal control group. This study highlights the functional separation of UGM and LGM, and the similarities of the UGM and TFL, bothsuperficial abductors appearing to maintain their size around the affected hip. Further research is required to determine the specific changes occurring in the deeper abductor muscles. This information may assist in the development of more targeted and effective exercise programmes in the management of OA of the hip. Ó 2008 Elsevier Ltd. All rights reserved.

1. Introduction Therapeutic exercisehas been cited as an important approach used in management of osteoarthritis (OA) of the hip (Hochberg et al., 1995; Altman et al., 2000; Smidt et al., 2005; National Collaborating Centre for Chronic Conditions, 2008; Zhang et al., 2008). There is however, a distinct scarcity of literature investigating the effectiveness of therapeutic exercise of the hip. Programmes have often been quitegeneralised with small to moderate short term effects and poorer long term effects (van Baar et al., 2001; Tak et al., 2005). Outcomes may be improved through the development of more specific programmes based on a greater understanding of muscle function and dysfunction around the hip joint. One of the most consistent findings in subjects with hip dysfunction is an inability to maintain adequate lateralcontrol of the hip and pelvis in single leg stance (Hardcastle and Nade, 1985). Studies assessing hip abductor muscle strength in subjects with OA

* Correspondence to: Alison Grimaldi, PhysioTec Physiotherapy, 23 Weller Road, Tarragindi, Brisbane, Queensland 4121, Australia. Tel./fax: þ61 7 3342 4284. E-mail address: info@physiotec.com.au (A. Grimaldi). 1356-689X/$ – see front matter Ó 2008Elsevier Ltd. All rights reserved. doi:10.1016/j.math.2008.11.002

of the hip have found deficits of up to 31% (Murray and Sepic, 1968; Jandric, 1997; Arokoski et al., 2002), while others have found no significant losses in abductor strength (Teshima, 1994; Sims et al., 2002). These apparent inconsistencies may be associated with specific changes occurring within muscles of the abductor synergy, and the...