RELATIONSHIP BETWEEN HIP ABDUCTOR MUSCLE STRENGTH AND CHRONIC ANKLE SPRAIN IN ADULTS
Main Article Content
Keywords
Chronic ankle instability, hip abductor strength, gluteus medius, balance, rehabilitation
Abstract
Background: Chronic ankle sprains, affecting approximately 2 million individuals annually, often progress to chronic ankle instability (CAI) in up to 70% of cases, with an estimated healthcare cost of ~$1,200 per injury [1]. Hip abductor weakness, particularly of the gluteus medius, has been implicated in ankle dysfunction via the kinetic chain; however, its impact in non-athletic adults remains underexplored [2,14].
Objective: To compare hip abductor strength, single-leg balance, and functional ankle stability in non- athletic adults with CAI versus healthy controls, and to identify potential rehabilitation implications.
Methods: This cross-sectional study was conducted at IAMR, Ghaziabad, from September 2024 to August 2025. Thirty non-athletic adults aged 18–27 years were recruited using purposive sampling (15 CAI cases, 15 matched healthy controls). Hip abductor strength was measured using handheld dynamometry (Nm/kg), balance was assessed using timed single-leg stance (eyes open and closed), and ankle stability was evaluated with the Cumberland Ankle Instability Tool (CAIT) [4]. Data were analyzed using independent t-tests, Pearson’s correlations, and Cohen’s d effect sizes.
Results: Participants with CAI demonstrated 36% lower hip abductor strength compared to controls (225.1N vs. 306.8N, p<0.001, d=1.66). Eyes-open balance was significantly reduced in the CAI group (36.6s vs. 51.4s, p=0.002), and a moderate positive correlation was observed between hip abductor strength and eyes-open balance (r=0.54, p=0.002). No significant relationship was found for eyes-closed balance (p=0.600). Gender and limb dominance showed no significant effects (p>0.05).
Conclusion: The findings support the role of the kinetic chain in CAI, with hip abductor weakness contributing to impaired balance. Rehabilitation programs for CAI should emphasize hip strengthening alongside balance training. Further longitudinal studies are warranted to establish causality [1,14,17].
Objective: To compare hip abductor strength, single-leg balance, and functional ankle stability in non- athletic adults with CAI versus healthy controls, and to identify potential rehabilitation implications.
Methods: This cross-sectional study was conducted at IAMR, Ghaziabad, from September 2024 to August 2025. Thirty non-athletic adults aged 18–27 years were recruited using purposive sampling (15 CAI cases, 15 matched healthy controls). Hip abductor strength was measured using handheld dynamometry (Nm/kg), balance was assessed using timed single-leg stance (eyes open and closed), and ankle stability was evaluated with the Cumberland Ankle Instability Tool (CAIT) [4]. Data were analyzed using independent t-tests, Pearson’s correlations, and Cohen’s d effect sizes.
Results: Participants with CAI demonstrated 36% lower hip abductor strength compared to controls (225.1N vs. 306.8N, p<0.001, d=1.66). Eyes-open balance was significantly reduced in the CAI group (36.6s vs. 51.4s, p=0.002), and a moderate positive correlation was observed between hip abductor strength and eyes-open balance (r=0.54, p=0.002). No significant relationship was found for eyes-closed balance (p=0.600). Gender and limb dominance showed no significant effects (p>0.05).
Conclusion: The findings support the role of the kinetic chain in CAI, with hip abductor weakness contributing to impaired balance. Rehabilitation programs for CAI should emphasize hip strengthening alongside balance training. Further longitudinal studies are warranted to establish causality [1,14,17].
References
1. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
2. Simpson JD, Hertel J, Gribble PA, et al. Hip strength as a predictor of ankle sprains: a systematic review. Clin Biomech. 2019;62:83-91.
3. Friel K, McLean N, Myers C, et al. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006;41(1):74-8.
4. Hiller CE, Refshauge KM, Bundy AC, et al. The Cumberland Ankle Instability Tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2011;92(9):1435-41.
5. Thorborg K, Petersen J, Magnusson SP, et al. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493-501.
6. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 4th ed. Philadelphia: F.A. Davis; 2020.
7. Field A. Discovering statistics using IBM SPSS statistics. 5th ed. London: Sage; 2018.
8. DeJong AF, Mangum LC, Hertel J. Gluteus medius dysfunction in females with chronic ankle instability. Clin Biomech. 2020;72:16-22.
9. Hale WA, Hertel J, Olmsted-Kramer LC. Hip abductor strength and postural control in individuals with chronic ankle instability. J Sport Rehabil. 2018;27(3):240-6.
10. Doherty C, Bleakley C, Hertel J, et al. Recurrent ankle sprains delay hip muscle activation during gait. Gait Posture. 2017;58:277-82.
11. Webster KA, Gribble PA. Functional rehabilitation interventions for chronic ankle instability: a systematic review. J Sport Rehabil. 2013;22(1):13-23.
12. Krause DA, Hansen KA, McConnell S. Workplace interventions for hip and ankle stability in standing occupations. J Occup Environ Med. 2021;63(7):589-95.
13. Peterson ML, Dennerlein JT, Katz JN. Age-related changes in hip abductor strength and ankle instability. J Geriatr Phys Ther. 2021;44(2):78-85.
14. Martin RL, Davenport TE, Fraser JJ, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80.
15. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2014;44(8):585-91.
16. Powers CM, Ghoddosi N, Straub RK, et al. Hip strength deficits in individuals with chronic ankle instability compared to healthy controls. J Sci Med Sport. 2020;23(9):854- 9.
17. McCann RS, Crossett ID, Terada M, et al. Hip strength and dynamic balance in recreational athletes with chronic ankle instability. Phys Ther Sport. 2019;39:147-53.
18. Kosik KB, Gribble PA. Postural control and balance assessment in individuals with chronic ankle instability: a systematic review. J Athl Train. 2020;55(1):22-31.
19. Thompson JY, Byrne C, Hertel J. Hip-focused interventions for improving balance and function in chronic ankle instability: a systematic review. Int J Sports Phys Ther. 2022;17(3):321-34.
20. Hoch MC, McKeon PO. The effectiveness of mobilization with movement at improving dorsiflexion after ankle sprain. J Sport Rehabil. 2020;29(6):885-91.
21. Kaminski TW, Hertel J, Amendola A, et al. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528-45.
22. Linens SW, Ross SE, Arnold BL. Hip-abductor strength and its relationship to dynamic balance in individuals with chronic ankle instability. J Athl Train. 2016;51(2):139-45.
23. Fraser JJ, Koldenhoven RM, Hertel J. Hip strength and dynamic postural control in individuals with and without chronic ankle instability. Phys Ther Sport. 2021;50:1-8.
24. Smith BI, Docherty CL, Simon J, et al. Ankle strength and functional performance in individuals with chronic ankle instability. J Athl Train. 2019;54(5):484-91.
25. Kim H, Son SJ, Seeley MK, et al. Kinetic chain alterations in individuals with chronic ankle instability during walking. Gait Posture. 2022;91:195-201.
26. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing? J Athl Train. 2008;43(3):293- 304.
27. De Ridder R, Willems T, Vanrenterghem J, et al. Effect of a home-based strength and balance training program on ankle sprain risk in non-athletic populations. J Sci Med Sport. 2023;26(2):123-9.
28. Houston MN, Hoch JM, Hoch MC. Predictors of recurrent ankle sprains in non-athletic populations: a systematic review. Phys Ther Sport. 2021;48:45-53.
2. Simpson JD, Hertel J, Gribble PA, et al. Hip strength as a predictor of ankle sprains: a systematic review. Clin Biomech. 2019;62:83-91.
3. Friel K, McLean N, Myers C, et al. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006;41(1):74-8.
4. Hiller CE, Refshauge KM, Bundy AC, et al. The Cumberland Ankle Instability Tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2011;92(9):1435-41.
5. Thorborg K, Petersen J, Magnusson SP, et al. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493-501.
6. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 4th ed. Philadelphia: F.A. Davis; 2020.
7. Field A. Discovering statistics using IBM SPSS statistics. 5th ed. London: Sage; 2018.
8. DeJong AF, Mangum LC, Hertel J. Gluteus medius dysfunction in females with chronic ankle instability. Clin Biomech. 2020;72:16-22.
9. Hale WA, Hertel J, Olmsted-Kramer LC. Hip abductor strength and postural control in individuals with chronic ankle instability. J Sport Rehabil. 2018;27(3):240-6.
10. Doherty C, Bleakley C, Hertel J, et al. Recurrent ankle sprains delay hip muscle activation during gait. Gait Posture. 2017;58:277-82.
11. Webster KA, Gribble PA. Functional rehabilitation interventions for chronic ankle instability: a systematic review. J Sport Rehabil. 2013;22(1):13-23.
12. Krause DA, Hansen KA, McConnell S. Workplace interventions for hip and ankle stability in standing occupations. J Occup Environ Med. 2021;63(7):589-95.
13. Peterson ML, Dennerlein JT, Katz JN. Age-related changes in hip abductor strength and ankle instability. J Geriatr Phys Ther. 2021;44(2):78-85.
14. Martin RL, Davenport TE, Fraser JJ, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80.
15. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2014;44(8):585-91.
16. Powers CM, Ghoddosi N, Straub RK, et al. Hip strength deficits in individuals with chronic ankle instability compared to healthy controls. J Sci Med Sport. 2020;23(9):854- 9.
17. McCann RS, Crossett ID, Terada M, et al. Hip strength and dynamic balance in recreational athletes with chronic ankle instability. Phys Ther Sport. 2019;39:147-53.
18. Kosik KB, Gribble PA. Postural control and balance assessment in individuals with chronic ankle instability: a systematic review. J Athl Train. 2020;55(1):22-31.
19. Thompson JY, Byrne C, Hertel J. Hip-focused interventions for improving balance and function in chronic ankle instability: a systematic review. Int J Sports Phys Ther. 2022;17(3):321-34.
20. Hoch MC, McKeon PO. The effectiveness of mobilization with movement at improving dorsiflexion after ankle sprain. J Sport Rehabil. 2020;29(6):885-91.
21. Kaminski TW, Hertel J, Amendola A, et al. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528-45.
22. Linens SW, Ross SE, Arnold BL. Hip-abductor strength and its relationship to dynamic balance in individuals with chronic ankle instability. J Athl Train. 2016;51(2):139-45.
23. Fraser JJ, Koldenhoven RM, Hertel J. Hip strength and dynamic postural control in individuals with and without chronic ankle instability. Phys Ther Sport. 2021;50:1-8.
24. Smith BI, Docherty CL, Simon J, et al. Ankle strength and functional performance in individuals with chronic ankle instability. J Athl Train. 2019;54(5):484-91.
25. Kim H, Son SJ, Seeley MK, et al. Kinetic chain alterations in individuals with chronic ankle instability during walking. Gait Posture. 2022;91:195-201.
26. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing? J Athl Train. 2008;43(3):293- 304.
27. De Ridder R, Willems T, Vanrenterghem J, et al. Effect of a home-based strength and balance training program on ankle sprain risk in non-athletic populations. J Sci Med Sport. 2023;26(2):123-9.
28. Houston MN, Hoch JM, Hoch MC. Predictors of recurrent ankle sprains in non-athletic populations: a systematic review. Phys Ther Sport. 2021;48:45-53.
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Published
Nov 07, 2025
Article Details
How to Cite
Dr Monika Sharma, & Laiba Khan. (2025). RELATIONSHIP BETWEEN HIP ABDUCTOR MUSCLE STRENGTH AND CHRONIC ANKLE SPRAIN IN ADULTS. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 195-198. https://doi.org/10.53555/mks5r149
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Author Biographies
Dr Monika Sharma
Professor and Head of Department, IAMR, Ghaziabad (ABVMU, Lucknow), Uttar Pradesh
Laiba Khan
Department of Orthopaedics, Institute of Applied Medicines & Research (IAMR), Atal Bihari Vajpayee Medical University, Lucknow, Uttar Pradesh
How to Cite
Dr Monika Sharma, & Laiba Khan. (2025). RELATIONSHIP BETWEEN HIP ABDUCTOR MUSCLE STRENGTH AND CHRONIC ANKLE SPRAIN IN ADULTS. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 195-198. https://doi.org/10.53555/mks5r149