An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

Abstract

Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.

Keywords: ACL injury rehabilitation; dynamic lower extremity valgus; hip muscular activation; hip neuromuscular control; patellofemoral pain.

Figure 1

Dynamic lower extremity valgus. Notes: (A) Athlete lands during a double leg drop vertical jump at initial contact and (B) immediately displays dynamic lower extremity valgus on both legs. (C) Athlete lands during a single leg hop and (D) exhibits dynamic lower extremity valgus on the right leg.

Figure 2

Common non-weight-bearing exercises. Notes: (A) Side-lying hip abduction. (B) Side-lying clam with resistance. (C) Unilateral supine bridge. (D) Side-bridge (plank).

Figure 3

Common controlled weight-bearing exercises. Notes: (A) Single leg squat. (B) Lateral box step-ups. (C) Forward box step-down. (D) Single leg dead lift.

Figure 4

Common functional exercises. Notes: (A) Lateral resisted band walks. (B) Side lunges. (C) Forward lunges. (D) Rear cross-over lunges. Note that during the rear cross-over lunge it is extremely challenging to control the pelvis, which results in apparent lower extremity valgus. Care should be taken to progress the exercises and limit step distances as appropriate.

Figure 5

Late stage hip-focused exercises. Notes: (A) BOSU single knee balance. (B) Weighted runner. (C) Resisted band single leg squats. (D) Resisted vertical bridge. Note that the resisted band in (C) should apply a slight force that progresses the athlete to activate the hip musculature to prevent lower extremity valgus. Care should be taken to progress the exercises and magnitude of resistance.

Figure 6

Theoretical framework for hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. Notes: Theoretical framework of the main steps to consider when initiating hip-focused neuromuscular exercises to modify dynamic lower extremity valgus. The spokes represent a non-exhaustive list of common factors that likely influence the relative success of a program.