Hip impingement: hip-targeted exercise versus hip-targeted exercise with trunk stabilization
Femoroacetabular hip impingement (FAI), best described as a pinching anterior hip pain. This article looks at another means of addressing the problem on top of the standard hip strengthening protocol.
Femoroacetabular impingement occurs when the femur repetitively abuts the rim of its socket (acetabulum), resulting in front hip pain, with long-term complications including possible labrum damage and osteoarthritis. The standard protocol has included stretching and strengthening the hip musculature to minimize this abutting; this article looks at a study that also incorporates trunk strengthening.
The study:
Aoyama et al performed a prospective, randomized controlled trial looking at 20 female participants with hip impingement, more specifically the effects of adding trunk stabilization exercises on top of a hip strengthening protocol.
The control group received the hip and pelvic girdle protocol, which consisted of gluteus medius/maximus strengthening and lumbopelvic awareness exercises.
The trunk stabilization exercise group received the same hip and pelvic girdle protocol, as well as additional exercises targeting the transverse abdominis and oblique musculature.
Outcome measures were recorded prior to treatment, at 4 weeks post-intervention and 8 weeks post-intervention. Measures included hip range of motion, strength and patient-reported pain levels.
The results:
The trunk group had significantly improved hip flexion range of motion at 4-wks post-intervention, compared to the control group.
The trunk group had significantly improved hip abduction strength at 4-wks post-intervention, with no significant improvement in the control group.
Patient-reported outcomes (iHOT12 and Vail hip scores) were significantly improved in both groups at 8-weeks post-intervention, though the trunk group had greater improvement than the control group.
What this means:
The primary limitations of this study included its small sample size (n=20) and all-female participant pool, which may compromise its applicability to a broader audience.
Regardless, the most noteworthy take-aways from the study’s results were the improvements in hip range of motion and strength at 4-wks post-intervention, which suggests that adding a trunk stabilization program, along with hip strengthening, can boost short-term outcomes.
REFERENCES:
Aoyama M, Ohnishi Y, Utsunomiya H, Kanezaki S, Takeuchi H, Watanuki M, Matsuda DK, Uchida S. A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study. Clin J Sport Med. 2019 Jul;29(4):267-275. doi: 10.1097/JSM.0000000000000516. PMID: 31241527; PMCID: PMC6613832.