Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Correlation between muscle strength and the degrees of functionality and kinesiophobia reported by patients with chronic hip pain

Correlação entre força muscular e graus de funcionalidade e cinesiofobia relatada por pacientes com dor crônica no quadril

Gustavo Leporace; Luiz Alberto Batista; Leonardo Metsavaht; Jorge Chahla; Tainá Oliveira; Liszt Palmeira de Oliveira

Downloads: 0
Views: 248


BACKGROUND AND OBJECTIVES: This study aimed to identify the association between hip muscle strength and the scores from subjective functional and psychological evaluation questionnaires in patients with chronic hip pain.

METHODS: Fifty-fivepatients with painful hip injuries (30 males) performed isometric peak strength tests of the abductors, extensors, and internal and external rotators of the hips with a hand-held dynamometer. The degree of functionality was measured by the Hip Outcome Score (HOS) and Lower Extremity Functional Score (LEFS), pain was estimated by the Visual Analog Scale (VAS) and kinesiophobia was calculated using the Tampa questionnaire. The Pearson correlation coefficient was used (alfa=5%) to test the associations between the muscle strength and the scores from the questionnaires.

RESULTS: There were significant correlations between the strength of all four hip muscles and the HOS (r>0.29). Only the hip external rotators showed a significant correlation with pain (r=-0.30). No significant correlations were found for LEFS (r<0.24) and Tampa questionnaires (r¬0.15).

CONCLUSION: The reduction in peak strength of the hip extensors, abductors and external rotators was associated with a reduction in the level of hip functionality but did not correlate with neither the level of overall functionality of the lower limbs nor the degree of kinesiophobia. Also, a reduction of hip external rotators strength was related to an increase in the intensity of pain.


Hip joint, Muscle strength, Muscle strength dynamometer, Pain measurement, Quality of life


JUSTIFICATIVA E OBJETIVOS: Este estudo teve como objetivo identificar a associação entre a força muscular do quadril e os escores de questionários subjetivos de avaliação funcional e psicológica em pacientes com dor crônica no quadril.

MÉTODOS: Cinquenta e cinco pacientes com lesões dolorosas no quadril (30 homens) realizaram testes isométricos do pico de força de abdutores, extensores e rotadores internos e externos do quadril com um dinamômetro portátil. O grau de funcionalidade foi medido pelo Hip Outcome Score (HOS) e Lower Extremity Functional Score (LEFS), a dor foi avaliada pela escala analógica visual (EAV) e a cinesiofobia foi calculada pelo questionário de Tampa. O coeficiente de correlação de Pearson foi utilizado (alfa=5%) para testar as associações entre a força muscular e os escores dos questionários.

RESULTADOS: Houve correlações significativas entre a força de todos os quatro músculos do quadril e o HOS (r>0,29). Apenas os rotadores externos do quadril apresentaram correlação significativa com a intensidade da dor (r=-0,30). Nenhuma correlação significativa foi encontrada para LEFS (r<0,24) e questionário de Tampa (r¬0,15).

CONCLUSÃO: A redução no pico de força dos extensores, abdutores e rotadores externos do quadril foi associada à redução no nível de funcionalidade do quadril, mas não se correlacionou com o nível de funcionalidade geral dos membros inferiores ou com o grau de cinesiofobia. Além disso, uma redução da força dos rotadores externos do quadril foi relacionada a aumento na intensidade da dor.


Articulação do quadril, Dinamômetro de força muscular, Força muscular, Medição da dor, Qualidade de vida


Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):1448-57.

Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):908-14.

Rosenlund S, Broeng L, Holsgaard-Larsen A, Jensen C, Overgaard S. Patient-reported outcome after total hip arthroplasty comparison between lateral and posterior approach. Acta Orthop. 2017;88(3):239-47.

Allison K, Bennell KL, Grimaldi A, Vicenzino B, Wrigley TV, Hodges PW. Single leg stance control in individuals with symptomatic gluteal tendinopathy. Gait Posture. 2016;49:108-13.

Harris-Hayes M, Mueller MJ, Sahrmann SA, Bloom NJ, Steger-May K, Clohisy JC. Persons with chronic hip joint pain exhibit reduced hip muscle strength. J Orthop Sports Phys Ther. 2014;44(11):890-8.

Arokoski MH, Arokoski JP, Haara M, Kankaanpää M, Vesterinen M, Niemitukia LH. Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis. J Rheumatol. 2002;29(10):2185-95.

Loureiro A, Mills PM, Barrett RS. Muscle weakness in hip osteoarthritis: a systematic review. Arthritis Care Res. (Hoboken). 2013;65(3):340-52.

Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010;40(2):82-94.

Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54(1):61-76.

Oliveira LP, Moura Cardinot T, Nunes Carreras Del Castillo L, Cavalheiro Queiroz M, Cavalli Polesello G. Translation and cultural adaptation of the Hip Outcome Score to the Portuguese language. Rev Bras Ortop. 2014;49(3):297-304.

Metsavaht L, Leporace G, Riberto M, Sposito MM, Del Castillo LN, Oliveira LP. Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries. J Orthop Sports Phys Ther. 2012;42(11):932-9.

de Souza FS, Marinho Cda S, Siqueira FB, Maher CG, Costa LO. Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties. Spine (Phila Pa 1976). 2008;33(9):1028-33.

Stratford PW, Balsor BE. A comparison of make and break tests using a hand-held dynamometer and the Kin-Com. J Orthop Sports Phys Ther. 1994;19(1):28-32.

Ieiri A, Tushima E, Ishida K, Inoue M, Kanno T, Masuda T. Reliability of measurements of hip abduction strength obtained with a hand-held dynamometer. Physiother Theory Pract. 2015;31(2):146-52.

Katoh M. Reliability of isometric knee extension muscle strength measurements made by a hand-held dynamometer and a belt: a comparison of two types of device. J Phys Ther Sci. 2015;27(3):851-4.

Kim SG, Lee YS. The intra- and inter-rater reliabilities of lower extremity muscle strength assessment of healthy adults using a hand held dynamometer. J Phys Ther Sci. 2015;27(6):1799-801.

Malloy PJ, Morgan AM, Meinerz CM, Geiser CF, Kipp K. Hip external rotator strength is associated with better dynamic control of the lower extremity during landing tasks. J Strength Cond Res. 2016;30(1):282-91.

Swarup I, Shields M, Mayer EN, Hendow CJ, Burket JC, Figgie MP. Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip. Hip Int. 2017;27(3):286-92.

Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, Impellizzeri FM, Leunig M. Hip muscle strength recovery after hip arthroscopy in a series of patients with symptomatic femoroacetabular impingement. Hip Int. 2014;24(4):387-93.

Harris-Hayes M, Czuppon S, Van Dillen LR, Steger-May K, Sahrmann S, Schootman M. Movement-pattern training to improve function in people with chronic hip joint pain a feasibility randomized clinical trial. J Orthop Sports Phys Ther. 2016;46(6):452-61.

Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4:CD011279.

Rydevik K, Fernandes L, Nordsletten L, Risberg MA. Functioning and disability in patients with hip osteoarthritis with mild to moderate pain. J Orthop Sports Phys Ther. 2010;40(10):616-24.

Baldon Rde M, Serrão FV, Scattone Silva R, Piva SR. Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(4):240-51.

Pearson I, Reichert A, De Serres SJ, Dumas JP, Côté JN. Maximal voluntary isometric neck strength deficits in adults with whiplash-associated disorders and association with pain and fear of movement. J Orthop Sports Phys Ther. 2009;39(3):179-87.

Hsu CJ, George SZ, Chmielewski TL. Association of quadriceps strength and psychosocial factors with single-leg hop performance in patients with meniscectomy. Orthop J Sports Med. 2016;4(12):2325967116676078.

Cotchett M, Lennecke A, Medica VG, Whittaker GA, Bonanno DR. The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain. Foot (Edinb). 2017;32:8-14.

Løchting I, Garratt AM, Storheim K, Werner EL, Grotle M. The impact of psychological factors on condition-specific, generic and individualized patient reported outcomes in low back pain. Health Qual Life Outcomes. 2017;15(1):40.

Freeman S, Mascia A, McGill S. Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech. (Bristol, Avon). 2013;28(2):171-7.

Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM R. 2011;3(5):472-9.

Submitted date:

Accepted date:

60873bcda953957e005223e3 brjp Articles


Share this page
Page Sections