Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

Abstract

Context: The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function.

Objective: To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain.

Design: Cross-sectional Setting: Academic medical center.

Patients: A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated.

Intervention: None.

Main outcome measures: Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations.

Results: Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion.

Conclusions: Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

Keywords: ankle joint; biomechanics; hip joint.

Figures

Figure 1 —

(A) Static ADF with knee extended and (B) static ADF with knee flexed. ADF indicates ankle dorsiflexion.

Figure 2 —

Markers for the pelvis included bilateral anterior and posterior superior iliac spines; for the thighs included lateral femoral epicondyles, rigid 4-marker clusters, and a regression-based virtual hip joint center marker; for the lower legs included the tibial tuberosities, rigid 4-marker clusters, and medial/lateral malleoli; for the rearfoot included the center of the posterior calcaneus inferiorly and superiorly, the sustentaculum tali, and the peroneal tubercle. Markers on the medial epicondyles and medial malleoli were used for a calibration trial only and removed for motion trials. Additional markers on the distal foot were not included in analysis.

Figure 3 —

Step-down task.

Figure 4 —

Representative scatter plots of individual participant data for static ADF with knee flexed in degrees plotted on the x-axis and hip or pelvis variables in degrees plotted on the y-axis. ADF indicates ankle dorsiflexion.