Dolinko, Jill

Hauberg, Julie

Leonardo, Angela

Long, William

Owen, Elaine

English

Ithaca College

 Deviations in running mechanics in an individual with post-surgical femoroacetabular impingement syndrome compared to a healthy counterpart: a case-control study  Dolinko J, Hauberg J, Leonardo A, Long W, Owen E  Introduction: Femoroacetabular Impingement Syndrome (FAI) is a condition in which the labrum of the hip joint becomes impinged or damaged by boney enlargements within the joint space (Ersoy, 2016). The Cam Impingement consists of boney growths on the femoral neck radius causing damage to the anterosuperior aspect of the acetabulum, and the Pincer Impingement consists of an overgrowth of the acetabulum causing damage to the posterior aspect of the labrum. Patients with FAI often report pain with hip flexion, adduction and internal rotation (IR). As a result of these painful motions, it is possible that running gait mechanics will be altered in a person with FAI or post-surgical FAI (Hetsroni, 2015). The purpose of this study was to analyze multi-plane hip kinematics and kinetics of two participants, a case and control, in order to determine how running mechanics change in an individual with post-surgical FAI.  The researchers hypothesized that running gait mechanics will be altered in subject with FAI compared to the control participant, presenting with decreased peak hip flexion and IR and increased hip adduction in stance phase on the involved side.  Methods: Two subjects, a case and control with similar anthropomorphic measurements, were selected to participate in this study. The control participant has typical hip biomechanics, and the case participant has post-surgical FAI. Bilateral markers were placed on predetermined lower extremity landmarks on each participant. Then, each participant ran across force plates for three separate trials at a self-selected speed. With the results of these trials, right hip kinetics and kinematics in the frontal, sagittal and transverse planes were analyzed.   Results: During running gait, the case participant had approximately 10° greater hip flexion range of motion compared to the control, 10° more hip adduction, and 13° less hip IR. The findings for hip adduction and IR were consistent with the initial hypothesis, however the peak flexion values were not. The results also found that both case and control participants were concentrically contracting their hip extensor muscles to actively extend the hip during stance phase, however the control participant had an external flexion moment that was double that of the case. The peak external adduction moments, 1451.33 N.mm/kg and 1941.22 N.mm/kg for the control and case respectively, revealed that the case had to eccentrically fire the hip abductors more compared to the control, but was unable to prevent the pelvis from falling into more hip adduction. Finally, the external IR moment,102.03 N.mm/kg and 244.19 N.mm/kg for the control and case respectively, revealed that both case and control eccentrically fired their hip external rotators, but the case participant’s moment was again about double that of the control’s.     Average Hip Angles  (deg​o ​) Control Case  Hip Flexion 39.69 ​± 0.93 49.38 ​± 4.74 Hip Adduction 9.72 ​± 1.75 18.44 ​± 0.71 Hip IR 38.22 ​+​ ​1.18 25.69 ​± 2.16 Average Hip Moments (N.mm/kg) Control Case Hip Flexion 1567.35 ​± 157.62 3059.11 ​+​ 345.81 Hip Adduction 1335.38 ​± ​160.42 1918.03 ​+​ 23.31 Hip IR 86.55​ ​+​ ​13.77 181.76 ​+​ 54.74   Conclusion & Discussion The researchers expected that the case participant would avoid moving into hip flexion, adduction, and IR while running because those are typically painful motions for an individual with FAI. However, as noted in the results, this was not the pattern the case participant demonstrated. An alternative explanation for these unexpected results is the difference in foot-strike pattern between the participants. The control participant utilizes a forefoot strike pattern; conversely the case participant uses a rearfoot strike pattern. Thompson et al. conducted a study on foot strike pattern which determined that runners who utilize a rearfoot strike pattern present with increased hip flexion, equal hip adduction, and less hip IR compared to a person with a midfoot strike (Thompson, et al. 2016). Given this data in conjunction with the data gathered from this study we can conclude that there are important factors to consider beyond a pathological joint. For example, the case participant’s increased hip flexion and decreased hip IR during running are consistent with the rearfoot strike pattern, while the increased hip adduction is consistent with weak gluteus medius muscles, a common symptom in patients with FAI.   Clinical Implications: Muscular imbalances and pain can persist following surgery to correct structural abnormalities. Physical therapy interventions can be used to correct residual muscular imbalances and return the joint to its normal biomechanics. However, it is critical to consider factors beyond the hip joint, such as foot strike pattern, when analyzing running gait mechanics. In this study, strengthening the case participant’s hip abductors, extensors and external rotators would be pertinent.         References:  Diamond LE, Wrigley TV, Bennell KL, et al. Hip joint biomechanics during gait in people with and  without symptomatic femoroacetabular impingement. ​Gait Posture​. 2016;43:198-203. Ersoy H, Trane RN, Pomeranz SJ. Cam and Pincer Type of Femoroacetabular Impingement. ​J Surg Orthop Adv​. 2016;25(4):244-249.  Hetsroni I, Funk S, Ben-Sira D, Nyska M, Palmanovich E, Ayalon M. Femoroacetabular impingement syndrome is associated with alterations in hindfoot mechanics: A three-dimensional gait analysis study. Clin Biomech (Bristol, Avon)​. 2015;30(10):1189-93.  Kokmeyer D, Strzelinski M, Lehecka BJ. Gait considerations in patients with femoroacetabular impingement. ​International Journal of Sports Physical Therapy​. 2014;9(6):827-838. Thompson MA, Lee SS, Seegmiller J, McGowan CP. Kinematic and kinetic comparison of barefoot and shod running in mid/forefoot and rearfoot strike runners. Gait & Posture. 2015;41:957-959. Weber AE, Kuhns BD, Cvetanovich GL, Grzybowski JS, Salata MJ, Nho SJ. Amateur and Recreational Athletes Return to Sport at a High Rate Following Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy​. 2017;33(4):748-755.  Whang, G. J. ​A three-dimensional analysis of pre-and post-operative running biomechanics in femoroacetabular impingement.​ Doctoral dissertation, Honolulu:University of Hawaii at Manoa. August 2014.  Femoroacetabular Impingement - OrthoInfo - AAOS​, orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement/. Accessed December, 2017. 

Deviations in Running Mechanics in an Individual with Post-Surgical Femoroacetabular Impingement Syndrome Compared to a Healthy Counterpart: a Case-Control Study

https://digitalcommons.ithaca.edu/cgi/viewcontent.cgi?article=1246&context=whalen

Deviations in Running Mechanics in an Individual with Post-Surgical Femoroacetabular Impingement Syndrome Compared to a Healthy Counterpart: a Case-Control Study

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