title: The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review.
abstract: Hip control affects movement and muscle firing patterns in the leg, ankle and foot, and may contribute to overuse injuries. Muscle performance can be measured as strength, endurance or muscle activation patterns. Our objective was to systematically review whether hip muscle performance is associated with leg, ankle and foot injuries.
  
  
  
  A structured and comprehensive search of six medical literature databases was combined with forward and backward citation tracking (AMED, CINAHL, EMBASE, Medline, Scopus and SportDiscus).
  
  
  
  Eligible studies measured hip muscle performance in individuals with musculoskeletal injuries below the tibial tuberosity, using dynamometry or electromyography (EMG). All studies compared an injured group with a control group or compared the injured and non-injured limb in the same individual.
  
  
  
  Data was extracted from each study independently by two authors.
  
  
  
  Twenty case-control and four prospective studies (n = 24) met the inclusion criteria. Injury classifications included chronic ankle instability (n = 18), Achilles tendinopathy (n = 2), medial tibial stress syndrome and tibial stress fracture (n = 1), posterior tibial tendon dysfunction (n = 1), and exertional medial tibial pain (n = 2). Eleven of the studies revealed differences in hip muscle performance indicating less strength, delayed onset activation and decreased duration of activation in the injured groups. Two studies found evidence for differences between groups only in some of their measurements. Three out of the four prospective studies revealed that hip muscle performance was not a risk factor for leg, ankle and foot injuries.
  
  
  
  This review provides limited evidence that hip muscle performance variables are related to leg, ankle and foot injuries. Emerging evidence indicates this might be a result of the injury rather than a contributor to the injury.
authors.affiliation: a Wingate College of Physical Education and Sports Science , Wingate Institute , Netanya , Israel.
authors.forename: Nili
authors.initials: N
authors.lastname: Steinberg
authors.affiliation: b Department of Physical Therapy , University of Haifa , Haifa , Israel.
authors.forename: Gali
authors.initials: G
authors.lastname: Dar
authors.affiliation: c Physiotherapy Department , Altnagelvin Area Hospital , Derry , Northern Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: Dunlop
authors.affiliation: d Discipline of Physiotherapy , Canberra University , Canberra , Australia.
authors.forename: James Edmund
authors.initials: JE
authors.lastname: Gaida
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology*; D004576:Electromyography; D018409:Foot Injuries / Q000503:physiopathology*; D006615:Hip / Q000502:physiology*; D006801:Humans; D007869:Leg Injuries / Q000503:physiopathology*; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology*; D012307:Risk Factors
keywords: EMG; Hip; dynamometer; gluteal; muscles; performance