Abstract
Objective
The aim of this systematic review was to identify the associations of the hip abductor
muscle strength, structure, and neuromuscular activation on balance and mobility in
younger, middle-aged, and older adults.
Data Sources
We followed PRISMA guidelines and performed searches in PubMed, Embase, CINAHL, and
Physiotherapy Evidence Database.
Study Selection
Study selection included: (1) studies with patients aged 18 years or older and (2)
studies that measured hip abduction torque, surface electromyography, and/or muscle
structure and compared these measures with balance or mobility outcomes.
Data Extraction
The extracted data included the study population, setting, sample size, sex, and measurement
evaluated.
Data Synthesis
The present systematic review is composed of 59 research articles including a total
of 2144 young, middle-aged, and older adults (1337 women). We found that hip abductor
strength is critical for balance and mobility function, independent of age. Hip abductor
neuromuscular activation is also important for balance and mobility, although it may
differ across ages depending on the task. Finally, the amount of fat inside the muscle
appears to be one of the important factors of muscle structure influencing balance.
Conclusions
In conclusion, a change in all investigated variables (hip abduction torque, neuromuscular
activation, and intramuscular fat) appears to have an effect during balance or mobility
tasks across age ranges and may elicit better performance. Future studies are necessary
to confirm the effect of these variables across age ranges and the effects of interventions.
Keywords
List of abbreviations:
BBS (Berg Balance Scale), BSE (balance self-efficacy), EMG (electromyography), GM (gluteus medius muscle), HDL (high density lean muscle), IMAT: (intramuscular fat), JBI (Joanna Briggs Institute), OLST (one-legged stance test), RFD (rate of force development), RTD (rate of torque development), SEBT (Star Excursion Balance Test), STST (sit-to-stand test), TFL (tensor fascia latae muscle), TUG (timed Up and Go), YBT (Y balance test)To read this article in full you will need to make a payment
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References
- Gait variability and fall risk in community-living older adults: a 1-year prospective study.Arch Phys Med Rehabil. 2001; 82: 1050-1056
- Assessment and management of fall risk in primary care settings.Med Clin North Am. 2015; 99: 281-293
- Continuously declining incidence of fall injuries in older adults: nationwide statistics from Finland between 1970 and 2016.Eur Geriatr Med. 2018; 9: 371-375
- An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study.Aust J Public Health. 1993; 17: 240-245
- Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.J Am Geriatr Soc. 2002; 50: 889-896
- Skeletal muscle performance and ageing.J Cachexia Sarcopenia Muscle. 2018; 9: 3-19
- On the mechanical power of joint extensions as affected by the change in muscle force (or cross-sectional area), ceteris paribus.Eur J Appl Physiol. 2002; 86: 363-369
- The effect of hip abductor fatigue on static balance and gait parameters.Phys Ther Rehabil Sci. 2016; 5: 34-39
- Contribution of hip abductor–adductor muscles on static and dynamic balance of community-dwelling older adults.Aging Clin Exp Res. 2019; 31: 621-627
- The relationship between concentric hip abductor strength and performance of the Y-balance test (YBT).International Journal of Athletic Therapy and Training. 2018; 23: 42-47
- The Relationship Between Hip Strength and the Y Balance Test.J Sport Rehabil. 2018; 27: 445-450
- Increased muscular challenge in older adults during obstructed gait.Gait Posture. 2005; 22: 356-361
- Postural sway and EMG analysis of hip and ankle muscles during balance tasks.Int J Ther Rehabil. 2013; 20: 280-288
- Lower limb strength is associated with gait biomechanical abnormalities in older female fallers and non-fallers.Isokinet Exerc Sci. 2013; 21: 151-159
- Age-related locomotion characteristics in association with balance function in young, middle-aged, and older adults.J Aging Phys Act. 2017; 25: 247-253
- Comparison of gluteus medius muscle electromyographic activity during forward and lateral step-up exercises in older adults.Phys Ther. 2009; 89: 1205-1214
- Lateral balance factors predict future falls in community-living older adults.Arch Phys Med Rehabil. 2008; 89: 1708-1713
- Decoding the neural drive to muscles from the surface electromyogram.Clin Neurophysiol. 2010; 121: 1616-1623
- Motor unit synchronization and neuromuscular performance.Exerc Sport Sci Rev. 2002; 30: 8-14
- The relationships between hip and knee extensor cross-sectional area, strength, power, and potentiation characteristics.Sports. 2017; 5: 66
- Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons.J Gerontol A Biol Sci Med Sci. 2005; 60: 324-333
- Role of hip abductor muscle composition and torque in protective stepping for lateral balance recovery in older adults.Arch Phys Med Rehabil. 2017; 98: 1223-1228
- Joanna Briggs Institute: an evidence-based practice database.Med Ref Serv Q. 2013; 32: 434-442
- Age-dependent differences in lateral balance recovery through protective stepping.Clin Biomech. 2005; 20: 607-616
- Correlation of the Y-balance test with lower-limb strength of adult women.J Phys Ther Sci. 2014; 26: 641-643
- Relationships among the Y balance test, Berg Balance Scale, and lower limb strength in middle-aged and older females.Braz J Phys Ther. 2015; 19: 227-234
- Effects of aging on hip abductor-adductor neuromuscular and mechanical performance during the weight transfer phase of lateral protective stepping.J Biomech. 2019; 82: 244-250
- Age-related differences in the maintenance of frontal plane dynamic stability while stepping to targets.J Biomech. 2015; 48: 592-597
- Differences in postural sway among healthy adults are associated with the ability to perform steady contractions with leg muscles.Exp Brain Res. 2020; 238: 487-497
- Gluteal muscle composition differentiates fallers from non-fallers in community dwelling older adults.BMC Geriatr. 2014; 14: 37
- Relationship between hip abductor rate of force development and mediolateral stability in older adults.Arch Phys Med Rehabil. 2005; 86: 1843-1850
- A three-dimensional approach to pennation angle estimation for human skeletal muscle.Comput Methods Biomech Biomed Engin. 2015; 18: 1474-1484
- Balance performance, force production, and activity levels in noninstitutionalized men 60 to 90 years of age.Phys Ther. 1990; 70: 348-355
- Physical performance measures that predict faller status in community-dwelling older adults.J Orthop Sports Phys Ther. 1992; 16: 123-128
- Balance self-efficacy predicts risk factors for side falls and frequent falls in community-dwelling elderly.J Aging Phys Act. 2003; 11: 28-39
- Hip abductor neuromuscular capacity: a limiting factor in mediolateral balance control in older adults?.Clin Biomech. 2016; 37: 27-33
- Muscle strength of lower limbs as a predictor of postural stability and fear of falling in physically active and inactive older men and women.Top Geriatr Rehabil. 2018; 34: 124-130
- Hip muscles strength and activation in older fallers and non-fallers.Isokinet Exerc Sci. 2014; 22: 191-196
- Kinetic, muscle structure, and neuromuscular determinants of weight transfer phase prior to a lateral choice reaction step in older adults.J Electromyogr Kinesiol. 2020; 55102484
- Modulation of gluteus medius activity reflects the potential of the muscle to meet the mechanical demands during perturbed walking.Sci Rep. 2018; 8: 11675
- Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man.J Physiol. 2002; 542: 643-663
- Hip and trunk muscle activity during the star excursion balance test in healthy adults.J Sport Rehabil. 2019; 28: 682-691
- Altered muscle activation characteristics associated with single volitional forward stepping in middle-aged adults.Clin Biomech. 2009; 24: 735-743
- Gluteus medius activity during 3 variations of isometric single-leg stance.J Sport Rehabil. 2005; 14: 1-11
- Lateral balance organisation in human stance in response to a random or predictable perturbation.Exp Brain Res. 1999; 124: 137-144
- Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking.J Electromyogr Kinesiol. 2012; 22: 67-73
- Control of stance during lateral and anterior/posterior surface translations.IEEE Trans Rehabil Eng. 1998; 6: 32-42
- Responses of human hip abductor muscles to lateral balance perturbations during walking.Exp Brain Res. 2013; 230: 301-310
- Effect of a change in step direction from a forward to a lateral target in response to a sensory perturbation.J Electromyogr Kinesiol. 2013; 23: 851-857
- The effect of a sensory perturbation on step direction or length while crossing an obstacle from quiet stance.Gait Posture. 2009; 30: 1-4
- Electromyographic analysis of the gluteus medius in five weight-bearing exercises.J Strength Cond Res. 2009; 23: 2689-2694
- Similar electromyographic activities of lower limbs between squatting on a Reebok core board and ground.J Strength Cond Res. 2013; 27: 1349-1353
- Muscle coordination of support, progression and balance during stair ambulation.J Biomech. 2015; 48: 340-347
- Balance and lower limb muscle activation between in-line and traditional lunge exercises.J Hum Kinet. 2018; 62: 15-22
- Hip- and thigh-muscle activation during the star excursion balance test.J Sport Rehabil. 2011; 20: 428-441
- Analysis of the ratios of medial-lateral and proximal-distal muscle activities surrounding the hip joint in the step-up and step-down positions.J Back Musculoskelet Rehabil. 2019; 32: 299-303
- A neuromechanical strategy for mediolateral foot placement in walking humans.J Neurophysiol. 2014; 112: 374-383
- The role of anticipatory postural adjustments in compensatory control of posture: 1. Electromyographic analysis.J Electromyogr Kinesiol. 2010; 20: 388-397
- A rapid upward step challenges medio-lateral postural stability.Gait Posture. 2000; 12: 217-224
- The neuromuscular origins of kinematic variability during perturbed walking.Sci Rep. 2017; 7: 808
- Movement patterns underlying first trial responses in human balance corrections.Neuroscience. 2012; 225: 140-151
- Effects of coupled upper limbs movements on postural stabilisation.J Electromyogr Kinesiol. 2013; 23: 1222-1228
- Effect of 4-min vertical whole body vibration on muscle performance and body balance: a randomized cross-over study.Int J Sports Med. 2002; 23: 374-379
- Effects of regular Tai Chi practice and jogging on neuromuscular reaction during lateral postural control in older people.Res Sports Med. 2017; 25: 111-117
- Association of gluteus medius and minimus muscle atrophy and fall-related hip fracture in older individuals using computed tomography.J Comput Assist Tomogr. 2016; 40: 238-242
- Fatty degeneration of gluteus minimus muscle as a predictor of falls.Arch Gerontol Geriatr. 2015; 60: 59-61
- Human capacity for explosive force production: neural and contractile determinants.Scand J Med Sci Sports. 2014; 24: 894-906
- Explosive strength: effect of knee-joint angle on functional, neural, and intrinsic contractile properties.Eur J Appl Physiol. 2019; 119: 1735-1746
- It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life.Longev Healthspan. 2014; 3: 9
- Age-related loss of muscle mass, strength, and power and their association with mobility in recreationally-active older adults in the United Kingdom.J Aging Phys Act. 2015; 23: 352-360
- Consensus for experimental design in electromyography (CEDE) project: amplitude normalization matrix.J Electromyogr Kinesiol. 2020; 53102438
Article info
Publication history
Published online: January 04, 2022
Accepted:
December 8,
2021
Received in revised form:
December 7,
2021
Received:
September 30,
2021
Footnotes
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
