Hip Abductor Weakness
While not a specific diagnosis, hip abductor weakness is a functional diagnosis that is a component of numerous lower extremity and back complaints.
There are 4 muscles that are in charge of abducting the thigh. They are the gluteus maximus, gluteus medius, gluteus minimus, and TFL (or tensor facia lata).
Weakness of the hip abductors, particularly those that assist with external rotation, has the most significant impact on hip and lower extremity stability (5,6).
The gluteus medius is the principal hip abductor. While the main action is hip abduction, it's contribution as a dynamic stabilizer of the hip and pelvis- particularly during single leg stance activities like walking, running, and squatting is of utmost importance. The gluteus medius contributes approximately 70% of the abduction force required to maintain pelvic leveling during single leg stance. The other 30% comes from the the tensor fascia lata and upper gluteus maximus (18).
Incompetent hip abductors and/or external rotators allows for excessive adduction and internal rotation of the thigh during single leg stance activities. This leads to a cascade of biomechanical problems, including pelvic drop, excessive hip adduction, excessive femoral internal rotation, valgus knee stress, and internal tibial rotation (see picture below and to the left) (1,7-12)
Runners with iliotibial band problems frequently demonstrate relative hip abductor weakness on the affected side. (16) Chronic gluteal dysfunction may lead to myofascial trigger points, tendinopathy, and muscle strains (17).
Downstream, hip abductor and external rotator weakness allows for the knees to turn in (called valgus or knock-knee) (22-25).
Hip Abduction and ligaments of the knee
Weak hip abductors causing "knock knees" T stresses the medial collateral (MCL) & anterior cruciate ligaments (ACL) and is a well-recognized contributor to sprains and tears (26,27).
Knee pain and hip abduction weakness
Excessive "knock knee" positioning also causes the knee cap to be pushed to the outside, putting stress the knee cap. This condition is called patellofemoral pain syndrome.
Hip Abductor weakness and shin splints
Hip abductor weakness is known to contribute to problems like shin splints, and foot hyperpronation (flat feet).
Hip Abductor weakness and hyperpronation (flat feet)
Foot hyperpronation and hip abductor weakness are known biomechanical coconspirators. Gluteus medius weakness increased pressure on the inside of the foot, decreasing the typical arch of the foot. In turn, flat feet causes a stretch weakness of the gluteus medius, generating a self-perpetuating cycle.
Who is more likely to have hip abductor weakness, males or females?
Hip abductor weakness seems to be more prevalent in females, particularly athletes (39-45).
Hip Abductor weakness and lower crossed syndrome
Hip abductor weakness is often accompanied by lower crossed syndrome – a larger pattern of biomechanical dysfunction involving weakness of the abdominal wall and hypertonicity in the hip flexors and paraspinal musculature.
Treatment options for hip abductor weakness
Obviously, the primary goal of management is to strengthen the hip abductors, thereby improving function (55).
In patients who have hip pain, hip abductor strength correlates with improvement (16,56). Moreover, athletes with stronger hip abductors are less likely to sustain lower extremity injuries. (39)
The most effective exercises for strengthening the gluteus medius are: side plank abduction with the affected leg on bottom, side plank abduction with the affected leg on top, single leg squat, clam progression #4, and a front plank with hip extension.
Patients with fallen arches and those who hyperpronate may benefit from orthotics or arch supports. Orthotics have been shown to increase activation of the gluteus muscle during single leg stance activities (66) Flexible full-length orthotics have been shown to improve Q angles and may aid in the treatment of secondary biomechanical problems, including foot pain, knee pain, and low back pain (59,60).
At Creekside Chiropractic & Performance Center, we are highly trained to treat hip abductor weakness. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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