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The Role of the Hip Adductors During Gait
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The Role of the Hip Adductors During Gait - November 14, 2002 2:15:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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In a previous thread, a members asked what the role of the hip adductors may be during gait.
Based upon my pediatrics experience, I'd answer the following, what do others think?
Children with cerebral palsy frequently walk with excessive internal rotation of the hip. Spastic medial hamstrings or adductors, among other factors, are thought to contribute to the excessive internal rotation in many patients based on evidence from electromyographic recordings. Surgical lengthening of these muscles is traditionally expected to decrease excessive internal rotation. However, the extent to which the hamstrings, adductors, and other hip muscles contribute to hip internal rotation is unclear, and the changes in hip rotation following surgery are inconsistent.
I'm aware of some biomedical engineering research that challenges several traditional assumptions. These analyses revealed that the semimembranosus, semitendinosus, and gracilis muscles do not have internal rotation moment arms for crouched or internally-rotated postures– the body positions commonly assumed by persons with cerebral palsy during walking. This result suggests that neither the medial hamstrings nor the gracilis is likely to contribute substantially to excessive internal rotation of the hip.
What was more surprising to me, was that it was also determined that the rotational moment arms of the adductor brevis, adductor longus, pectineus, and proximal compartments of the adductor magnus are shifted toward external rotation when the femur is excessively anteverted. Hence, in persons who have anteversion deformities, these muscles are also unlikely to be important contributors to excessive internal rotation of the hip.
So, I think we need to determine exactly what we're talking about here, and recognize that small changes in LE posture can have dramatic effects upon the action of muscles. Based upon the research I've read to date, I believe that the exaggerated hip flexion of patients with CP, which dramatically increases the internal rotation moment arms of the gluteus medius and gluteus minimus, is more likely than the hamstrings or adductors to cause abnormal internal rotation. Hence, it is also feasible that hip internal rotation is a compensatory mechanism adopted by some children with femoral deformities to preserve abduction capacity.
REFERENCES:
Arnold, A. A., Komattu, A. V., Delp, S. L. Internal rotation gait: A compensatory mechanism to restore abduction capacity decreased by bone deformity? Developmental Medicine and Child Neurology, vol. 39, pp. 40-44, 1997.
Arnold, A. S., Asakawa, D. J., Delp, S. L. Do the hamstrings and adductors contribute to excessive internal rotation of the hip in persons with cerebral palsy, Gait and Posture, vol. 11, pp. 181-190, 2000. (Recipient of the Best Paper Award, Gait and Clinical Movement Analysis Society, 1999.)
Arnold, A. S, Delp, S. L. Rotational moment arms of the medical hamstrings and adductors vary with femoral geometry and limb position: implications for treatment of internally-rotated gait, Journal of Biomechanics vol. 34, pp. 437-447, 2001.
Delp, S. L., Hess, W. E., Hungerford, D. S., Jones, L.C. Variation of Rotational Moment Arms with Hip Flexion, Journal of Biomechanics, vol. 23, pp. 493-501, 1999.
Schmidt, D. J., Arnold, A. S., Carroll, N. C., Delp, S. L. Length Changes of the Hamstrings and Adductors Resulting from Derotational Osteotomies of the Femur, Journal or Orthopaedic Research, vol. 17, pp. 279-285, 1999.
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Re: The Role of the Hip Adductors During Gait - November 14, 2002 3:27:00 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Drew,
That is a challening idea. I think the role of adductors has never been fully addressed, at least enough to satisfy the question "why are they so large and hypertrophied, even in normal adults". This is a question we argued over in kinesiology and in study groups since that time.
Duffy
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Re: The Role of the Hip Adductors During Gait - November 14, 2002 5:06:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Agreed. It sounds like Function may have some information that we're not aware of. Either that or he/she wanted to start us off on a "challenging" discussion.
Here's another thought:
As GTO's tell our bodies so much about dynamic positioning, and considering that larger muscles have more of 'em . . . could the adductor's role be more sensory than motor?????
Drew
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Re: The Role of the Hip Adductors During Gait - November 14, 2002 7:50:00 AM
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touchiba
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From: PA
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Don't they get so large and hypertrophic because they are pretty much active in most hip movements?
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Re: The Role of the Hip Adductors During Gait - November 14, 2002 8:40:00 AM
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function
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Joined: October 5, 2002
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I am slammed with patients today and only have a moment....the answer is....during gait:
The adductor magnus decelerates hip flexion and accelerates hip extension.
The adductor longus decelerates hip extension and accelerates hip flexion.
think on that...got to get back to the patients...
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