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Background: Hip rotation range-of-motion (ROM) impairment has been proposed as a contributing mechanical factor in the development of low back pain (LBP) symptoms. There is a hypothesis which suggests that a limited range of hip rotation results in compensatory lumbar spine rotation. Hence, LBP may develop as the result. This article reviews studies assessing hip rotation ROM impairment in the LBP population. Material and methods: The MEDLINE and EMBASE databases were searched without time restriction. Two authors independently selected related articles using the same search strategy and key words. Results: Among 124 articles 12 met the review inclusion criteria. The results of the studies are assessed in three sections, investigating the relationship between low back pain and 1) hip internal rotation ROM, 2) hip external rotation ROM and 3) hip total rotation ROM. Asymmetrical (right versus left, lead versus non-lead) and limited hip internal rotation ROM were common findings in patients with LBP. Reduced and asymmetrical total hip rotation was also observed in patients with LBP. However, none of the studies explicitly reported limited hip external rotation ROM. Conclusion: The precise assessment of hip rotation ROM, especially hip internal rotation ROM, must be included in the examination of patients with LBP symptoms.
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ORIGINAL ARTICLE
Correlation between Hip Rotation
Range-of-Motion Impairment and Low Back Pain.
A Literature Review
Meissam Sadeghisani1(A,E), Farideh Dehghan Manshadi1(A),
Khosro Khademi Kalantari1(D), Abbas Rahimi1(F), Neda Namnik2(F),
Mohammad Taghi Karimi3(D), Ali E. Oskouei4(E)
1Department of Physiotherapy, Rehabilitation Faculty of Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Rehabilitation Faculty of Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
3Rehabilitation Faculty of Isfahan University of Medical Sciences, Isfahan, Iran
4Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
SUMMARY
Background. Hip rotation range-of-motion (ROM) impairment has been proposed as a contributing
mechanical factor in the development of low back pain (LBP) symptoms. There is a hypothesis which suggests
that a limited range of hip rotation results in compensatory lumbar spine rotation. Hence, LBP may develop as
the result. This article reviews studies assessing hip rotation ROM impairment in the LBP population.
Material and methods. The MEDLINE and EMBASE databases were searched without time restriction.
Two authors independently selected related articles using the same search strategy and key words.
Results. Among 124 articles 12 met the review inclusion criteria. The results of the studies are assessed in
three sections, investigating the relationship between low back pain and 1) hip internal rotation ROM, 2) hip
external rotation ROM and 3) hip total rotation ROM. Asymmetrical (right versus left, lead versus non-lead)
and limited hip internal rotation ROM were common findings in patients with LBP. Reduced and asymmetri-
cal total hip rotation were also observed in patients with LBP. However, none of the studies explicitly reported
limited hip external rotation ROM.
Conclusion. The precise assessment of hip rotation ROM, especially hip internal rotation ROM, must be
included in the examination of patients with LBP symptoms.
Key words: low back pain, range of motion, hip, rotation
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aTraumatologia Rehabilitacja
© MEDSPORTPRESS, 2015; 5(6); Vol. 17, 455-462
DOI:10.5604/15093492.1186813
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BACKGROUND
Low back pain (LBP) is one of the most prob-
lematic conditions in the populations of both devel-
oped and developing countries [1, 2]. LBP is the pri-
mary cause of functional limitation in people under
45 years old [3]. The prevalence of low back pain in
various populations and study groups varies between
14.4% and 85% [2-4]. Thus, LBP places a heavy
direct and indirect burden on the individuals, their
families, societies and the governments.
LBP with its biopsychosocial nature has been
known as a multidimensional problem [5-7]. Identi -
fying the potential contributing factors is essential in
solving the problem of LBP [7]. Among various eti-
ological factors, mechanical factors play an impor-
tant role in the induction and persistency of LBP
symptoms [4]. Symptoms in mechanical LBP nor-
mally begin or intensify with physical activities and
are relieved by rest [4]. Through identifying the me -
chanical contributing factors that are associated with
a risk of LBP and possibly correcting them, we may
be able to help the people suffering from LBP.
The hip joints are the intersegmental elements
between the lumbopelvic and knee joints [8]. Thus,
the lumbopelvic-hip-knee complex forms a kinemat-
ic chain whose activity is co-ordinated during func-
tional and recreational physical activities [9-17].
The re fore, the role of the lumbopelvic-hip movement
impairments, such as hip ROM restriction, has been
an interesting subject of many studies [18-22].
Due to the connection between the hip joints and
the lumbopelvic region described above, hip rotation
ROM impairments have been suggested as an impor-
tant dysfunction in LBP [15,23]. Limited hip rotation
is well documented in different categories of LBP
patients [16,24-27]. It has been proposed that a re -
duced hip rotation ROM may be compensated for by
excessive lumbopelvic rotation. A greater magnitude
of lumbopelvic rotation may be associated with mi -
cro trauma and, eventually, LBP [16]. There is some
evidence that shows that increasing hip rotation
ROM is associated with improving functional per-
formance and relieving pain in patients who suffer
from LBP [28-30].
The indices of hip internal, external and total ro -
tation ROM may be related to LBP. Numerous inves-
tigators have explored the role of hip rotation ROM
impairment in LBP. In this review, we turn our atten-
tion to studies that examined active/passive hip inter-
nal, external and total rotation ROM in people with
LBP. Therefore, the present article reviews studies
that assessed hip rotation ROM impairment in LBP
patients.
MATERIAL AND METHODS
The search strategy in our review was based on
an electronic database search of titles and abstracts.
The source databases were MEDLINE and EMBASE
without time restriction. The key words used were:
hip, low back pain, rotation and range of motion. The
search was limited to studies published in English.
Case reports were not included. Studies which exam-
ined hip rotation ROM during functional activities or
in patients with a history of lower extremity injury
were excluded. In addition, studies which included
pathological causes of LBP were not included in the
review. In the initial stage of database search, a total
of 124 articles were identified. Then, their abstracts
and titles were reviewed, and full texts of the studies
that were related to our review were accessed. Of
124 articles relating to low back pain and hip rotation
ROM, a total of 12 studies met our inclusion criteria.
To confirm the accuracy of the search strategy, a sec-
ond investigator re-reviewed the articles using the
same query terms as listed above. The stages of the
article selection process are presented in Figure 1.
The results of the studies are presented in three
sections, investigating the relationship between low
back pain and 1) hip internal rotation ROM, 2) hip
external rotation ROM and 3) hip total rotation ROM
(Table 1).
Relationship between hip internal rotation
ROM and low back pain
Ellison and his coworkers observed that in a pop-
ulation of 50 people with LBP, the number of pa -
tients who had a lesser hip internal rotation ROM
than hip external rotation ROM was higher com-
pared with a group of 100 people without LBP [31].
In this study, the passive internal and external hip
rotation ROM of patients with LBP who were re fer -
red for physical therapy was measured with an incli-
nometer. Although the direction of lumbar spine im -
pairment and specific activities of the patients were
not described, lesser hip internal rotation and more
asymmetrical hip rotation were common findings in
the groups with LBP.
A deficit in hip internal rotation ROM was also
observed in two studies of Vad et al. [26, 27]. One
study compared the pattern of hip internal rotation
between asymptomatic and LBP symptomatic pro-
fessional tennis players. The LBP individuals had
a history of LBP with a disability of more than two
weeks [27]. Another study by Vad et al. enrolled 42
professional golfers (14 with LBP and 28 without
LBP) [26]. In both studies, passive hip internal rota-
tions of were measured on both sides of the body and
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
456
112 Sadeghsiani:Layout 1 2015-12-22 12:10 Strona 2
similar results were observed. Moreover, limited lead
hip internal rotation and greater asymmetry of hip
internal rotation (right versus left) were reported in
the athletes with LBP [26, 27].
Alemida et al. investigated differences in active
and passive hip internal, external and total rotation
ROM among 21 low back pain patients and 21 healt -
hy subjects [32]. All participants of this study were
judo athletes. Hip rotation ROM was measured by
photogrammetry. In relation to hip internal rotation
ROM, the LBP group demonstrated limited active
hip internal rotation on the dominant side and re du -
ced passive hip internal rotation of both sides.
Restriction in hip internal rotation and asymmetrical
hip rotation between the dominant and non-dominant
side were presented as mechanical factors in LBP
development in judo athletes [32].
Mellin et al. measured, by using an inclinometer,
the hip internal and external rotation ROM of a pop-
ulation of workers (301 males and 175 females) who
had a history of at least 2 years of LBP symptoms
[33]. Based on the results of this study 1) males have
a lesser range of hip internal rotation in comparison
to females, 2) in the males group, there was a reverse
relationship between hip internal rotation ROM and
LBP, and 3) males have a greater magnitude of hip
external rotation ROM in comparison to females.
The authors believe that limited hip internal rotation
ROM in males may function as a risk factor that pre-
disposes them to LBP.
In a 1998 study by Cibulka et al., passive hip
internal and external rotation ROM of 100 people
with low back pain (24 subjects without sacroiliac
involvement and 76 subjects with sacroiliac involve-
ment) was measured by a goniometer [24]. Patients
of both genders participated in the study. The dura-
tion of symptoms was less than 3 weeks and the pa -
tients were undergoing treatment. No specific activi-
ties of the patients were mentioned. Statistical analy-
sis of data revealed that 1) overall hip internal rota-
tion ROM was significantly smaller than hip external
rotation ROM and 2) the group with symptomatic
sacroiliac joint involvement had significantly less
hip internal rotation unilaterally whereas the LBP
group without sacroiliac dysfunction had bilaterally
smaller hip internal rotation ROM. Based on the
results, a unilateral and bilateral deficit in hip inter-
nal rotation ROM was presented as a factor that may
contribute to the development of lumbar spine and
sacroiliac dysfunctions and, ultimately, to pain.
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
457
Fig. 1. The stages which were selected in this review study
112 Sadeghsiani:Layout 1 2015-12-22 12:10 Strona 3
Lumbopelvic and hip rotation motion differences
between males and females were investigated in
a study by Hoffman et al, [34]. In total, 59 people
with chronic LBP, including 30 men and 29 women,
participated in this study. The patients performed an
active hip internal rotation test in the prone position.
Kinematic data were recorded by a motion analysis
system. Lumbopelvic rotation ROM and hip internal
rotation ROM were measured. Statistical analysis
revealed that men had significantly less hip internal
rotation in comparison to women. The authors of this
study believe that men might be at greater risk of
LBP than women due to smaller hip internal rotation
ROM.
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
458
Tab. 1. Cross sectional studies: LBP and hip rotation range of motion
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This review of the literature relating to hip inter-
nal rotation ROM reveals a strong link between lim-
ited hip internal rotation ROM and LBP. This kind of
hip impairment may be unilateral or bilateral. Re -
duced hip internal rotation ROM was observed dur-
ing active and passive hip rotational tests. Men in
comparison to women had lesser hip internal rotation
ROM. Accordingly, men may be at greater risk of
developing LBP associated with hip internal rotation
ROM. A deficit in hip internal rotation ROM was
observed in LBP people both engaged and not en -
gaged in rotational demand activities. Accordingly,
assessment of hip internal rotation ROM must be
applied carefully in both these groups of LBP people.
Relationship between hip external rotation
ROM and low back pain
Scholtes and her associates assessed the differen -
ce in hip external rotation ROM between healthy and
LBP people [35]. This study enrolled 91 subjects (50
people with LBP who were involved in rotation-re -
lated activities and 41 people without LBP symptoms
who were not involved in rotation-related activities).
The patients had a history of chronic and recurrent
LBP symptoms. They performed an active hip exter-
nal rotation test in the prone position. Kinematic data
in relation to hip external rotation and pelvic rotation
were captured by employing a motion analysis sys-
tem. After data processing and statistical analysis, no
difference in hip external rotation ROM was observ -
ed between people with and without LBP. However,
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
459
Tab. 2. Cross sectional studies: LBP and hip rotation range of motion
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compared to healthy people, LBP people had a great -
er magnitude and earlier lumbopelvic rotation during
the test.
A study of Gombatto et al. from 2006 investigat-
ed sex differences in lumbopelvic and hip rotation
motion during an active hip external rotation test
[12]. All of the participants (27 men and 19 women)
regularly participated in rotational demand sports
activities. The patients had a history of chronic and
recurrent LBP symptoms. The subjects were asked to
externally rotate their hips in the prone position. Ki -
nematic data were recorded with a motion analysis
system. After data processing, hip external rotation
ROM was measured. The results of this study show -
ed no difference in hip external rotation ROM be -
tween men and women. However, men demonstrated
a greater percentage of their maximum lumbopelvic
rotation in the first 60% of the test.
Differences in the hip and lumbopelvic move-
ment patterns between two groups of LBP people
were investigated in a study by Van Dillen et al. [13].
Participants of this study were 13 subjects with lum-
bar rotation syndrome and 26 subjects with rotation
and extension syndrome who had chronic or recur-
rent LBP. An active hip external rotation test was
performed and kinematic data were collected using
a motion analysis system. Based on the kinematic
comparison, there were no differences between the
two groups in regard to hip external rotation ROM
and lumbopelvic motion.
As mentioned earlier, there was no difference in
hip external rotation ROM between healthy individ-
uals and people with LBP, men and women and also
different subgroups of LBP people. However, in
these studies the pelvis was free to move and the
average values of bilateral hip rotation were used in
statistical analysis.
Two studies used the FABERE test to examine
hip external rotation ROM. During the FABERE test,
subjects lie in the supine position while the hip joint
is held in flexion, abduction and external rotation.
Then, the distance from the knee to the horizontal
plane is measured [26]. Limited hip external rotation,
abduction and flexion is manifested by an increase in
the knee to horizontal distance [26]. An increase in
the FABERE distance was established in LBP golfers
and tennis players. In one study, the FABERE distance
on the dominant side in golfers with LBP was signifi-
cantly greater than in golfers without LBP [26]. In
another similar study, tennis players with LBP demon-
strated a greater FABERE distance in comparison to
asymptomatic people. In both studies, players with
LBP displayed asymmetry of the hip FABERE dis-
tance between the lead and non-lead hips [26, 27].
Because the FABERE distance depends on hip
external rotation, flexion and abduction ROM, we
cannot exactly state that an increase in the FABERE
distance is a result of limited hip external rotation
ROM.
Overall, as the results of these studies indicate,
there is weak evidence supporting a relationship be -
tween LBP and deficits, limitations, in hip external
rotation ROM. In other studies, there was no differ-
ence in hip external rotation ROM between people
with and without LBP symptoms [12, 32, 35, 36].
Relationship between total hip rotation
ROM and low back pain
Van Dillen et al. compared the passive hip rota-
tion motion difference between people with and with -
out LBP who participated in rotational demand sports
activities [16]. A total of 48 subjects (24 people with
LBP and 24 people without LBP) were requested to
participate in the study. Measures of passive hip in -
ter nal and external rotation ROM were obtained with
an inclinometer. The results of this study demon-
strated that the symptomatic group had less total hip
rotation, reduced left total hip rotation and more
asymmetry of total rotation (left versus right).
Limited total hip rotation ROM in LBP group was
also demonstrated in a study by Alemida et al. [32]
involving 42 judo athletes (21 athletes with LBP and
21 athletes without LBP). LBP patients had a history
of LBP in the past year. Measures of hip internal and
external rotation ROM were obtained using comput-
ed photography in passive and active movements.
Ba sed on a comparison between the symptomatic
and asymptomatic groups, athletes with LBP had less
active and passive total rotation on the non-dominant
side and limited passive total hip rotation. Ac cord -
ingly, a deficit in total hip rotation and asymmetry
between the limbs was reported as a contributing fac-
tor of LBP in the athletes who practised judo.
RESULTS
As the results of the reviewed studies show, re -
duced hip internal rotation ROM and asymmetrical
hip internal rotation ROM (left versus right or domi-
nant versus non-dominant) are two common findings
related to hip rotation ROM impairment that are con-
sistently found in people with LBP. Moreover, a de -
ficit in hip internal rotation ROM was also observed
in some case studies [28-29]. In these case studies,
the treatment plan recommendation to improve hip
rotation ROM was followed by a positive result [28-
29]. In one study, a golfer player who experienced
chronic golf-related LBP had bilateral hip internal
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
460
112 Sadeghsiani:Layout 1 2015-12-22 12:10 Strona 6
rotation ROM restriction. However, the pain was im -
mediately and completely resolved by a treatment
that focused on increasing hip internal rotation ROM
[37]. In a similar case study, an increase in right hip
internal rotation as a part of the plan of care led to
a significant improvement in the functional ability of
a 42-year-old man with a history of LBP [29]. Thus, it
seems that there is a strong relationship between LBP
and restriction in hip internal rotation ROM and asym-
metrical hip internal rotation ROM (left versus right).
Two studies that measured total hip rotation ROM
reported reduced total hip rotation, due to possible
restriction in hip internal rotation ROM, and asym-
metry of total hip rotation ROM (left versus right or
dominant versus non dominant).
Only in 2 studies in which the hip external rota-
tion measurement was obtained indirectly (through
the FABERE test), a decrease in hip ROM was re -
ported in LBP groups [26, 27]. No evidence shows
a direct relationship between LBP and limitation in
hip external rotation.
CLINICAL APPLICATION
The precise identification of factors contributing
to LBP is an important step in the management of
LBP sufferers [7,38-39]. In most cases, mechanical
factors have a strong influence on LBP [4]. As the
results of the reviewed studies have shown, impair-
ment in hip rotation ROM such as limited and asym-
metrical hip internal rotation and total hip rotation
must be considered an important contributing me -
cha nical factor that may be related to LBP symptoms
in symptomatic patients. These findings are poten-
tially important in people with LBP who regularly
participate in rotational demand activities [16].
It is not surprising that management strategies
focused on improving hip rotation ROM were fol-
lowed by short- and long-term positive results in pa -
tients with LBP [29-30,37]. Accordingly, an exa mi -
nation of the hip rotation ROM must be included in
the assessment of patients with LBP, especially among
patients who engage in repeated hip and trunk rota-
tion motion activities [16]. If, during the examination
of a patient with LBP, a clinician or physical thera-
pist encounters an impairment in hip rotation ROM
(limitation or asymmetry), he/she must establish
a logical relationship between the LBP and hip rotation
impairments and then attempt to resolve the LBP
symptoms by improving hip joint rotation ROM.
CONCLUSION
Based on these observations, we conclude that
there is a close and strong link between LBP and lim-
itation in hip rotation ROM, especially hip internal
rotation ROM. This evidence is very clear in patients
with LBP who regularly participate in sports activi-
ties which require repeated hip and lumbar rotation
motion. Although asymmetrical hip rotation ROM
and reduced total hip rotation ROM were observed in
patients with LBP, there is no direct evidence point-
ing to the importance of hip external rotation ROM
in the population of patients with LBP. Accordingly,
hip rotation ROM assessment must be included in the
examination of LBP sufferers.
It is worth mentioning that in all of the studies
reviewed, hip rotation ROM measurement was carried
out during non-functional tests. It appears that this gap
may be resolved by further studies that will investigate
the hip rotation ROM in LBP sufferers during func-
tional activities such as a walk ing.
Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
461
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Sadeghisani M. et al. Hip Rotation ROM and Low Back Pain
462
Adres do korespondencji / Address for correspondence
Farideh Dehghan Manshadi,
e-mail: sadeghi.m@sbmu.ac.ir
tel: +989137716567
Liczba słów/Word count: 4365 Tabele/Tables: 2Ryciny/Figures: 1Piśmiennictwo/References: 40
Otrzymano / Received 10.05.2015 r.
Zaakceptowano / Accepted 30.07.2015 r.
112 Sadeghsiani:Layout 1 2015-12-22 12:10 Strona 8
... Although there are many factors that may be the origin of a chronic LBP [3,4], a muscle hip disbalance has been recognized [5]. This disbalance is characterized by a limited hip internal rotation range of motion (IR-ROM) [6] and hip abductor weakness [7]. Hence, therapists have aimed attention on the relevance of hip muscle strength for the designing of rehabilitation protocols [4]. ...
... -Hip passive internal rotation range of motion (IR-ROM). The authors only recorded the hip IR-ROM because it is the only one that is related to low back pain [6]. The hip passive IR-ROM was measured bilaterally. ...
... The stimulation was carried out on the limb that had the restricted hip IR-ROM by the decision of the researchers, and according to the literature [6,15]. ...
Article
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Background: Limited hip internal rotation range of motion (IR-ROM) and hip abductor weakness are recognized in low back pain (LBP) sufferers. The main aim was to investigate the effect of a ultrasound (US)-guided percutaneous neuromodulation (PNM) technique on hip strength in people with LBP. A second purpose was to discover whether the location along the sciatic nerve, where percutaneous neuromodulation was applied, could influence the change of strength response in these patients. Methods: Sixty LBP sufferers were recruited and divided randomly into three groups. All participants received an isolated percutaneous electrical stimulation at one of three different locations of the sciatic nerve pathway (proximal, middle, and distal), depending on the assigned group. Pain intensity, hip passive IR-ROM, hip muscle strength, and the Oswestry disability index (ODI) were analyzed. All variables were calculated before the intervention and one week after the intervention. Results: All interventions significantly decreased pain intensity and improved the IR-ROMs, strength, and functionality after one week (p = 0.001). However, between-group (treatment x time) differences were reported for flexion strength in the non-intervention limb (p = 0.029) and ODI (p = 0.021), although the effect size was small (Eta2 = 0.1) in both cases. Conclusions: The application of an isolated intervention of the US-guided PNM technique may be a useful therapeutic tool to increase the hip muscle strength in patients with chronic LBP.
... 2 It is well accepted by researchers and clinicians that mechanical risk factors are important in persistence and development of symptoms in individuals with nonspecific CLBP (5)(6)(7)(8)(9). Because of the close biomechanical and anatomical relationship between the hips and lumbar spine, abnormalities of lumbopelvic-hip rhythm, especially during the activities that need the lumbar spine and hip joints cooperation, are proposed as a possible potent contributing risk factor for LBP (10)(11)(12)(13). Therefore, evaluation of lumbopelvic-hip rhythm in people who suffer from LBP symptom during performing habitual or functional activities could be an essential step in determining the main risk factors related to the problem. ...
... Due to close anatomical and biomechanical links between the hip joints and lumbar spine, any impairment in each segment could be associated with impairment in the other segment (11,41). Thus, some researchers believe that a greater tendency of motion in the lumbar spine could be due to a less tendency of motion in the hip joints (11,12,22,42). ...
... Due to close anatomical and biomechanical links between the hip joints and lumbar spine, any impairment in each segment could be associated with impairment in the other segment (11,41). Thus, some researchers believe that a greater tendency of motion in the lumbar spine could be due to a less tendency of motion in the hip joints (11,12,22,42). Based on this hypothesis, limited hip motion in a specific direction would be compensated by lumbar spine motion in that direction, which eventually may lead to LBP (11,43). ...
Article
Background: To our knowledge, no study has examined the kinematics of lumbopelvic-hip complex of individuals with chronic low back pain (CLBP) who had lumbar flexion+rotation (F+R) syndrome during sit to stand (SiToSt) and stand to sit (StToSi) activities. Thus, this study aimed to examine movement patterns of the lumbopelvic-hip complex in participants with CLBP classified into F+R syndrome subgroup. Methods: This was a cross sectional study. A 3-dimensional motion capture system was used to record movements of the lumbar spine and hips during SiToSt and StToSi. Participants were 20 patients with LBP classified in lumbar F+R subgroup, based on the movement impairment system model, and 20 asymptomatic individuals. The study was approved by Shahid Beheshti University of Medical Sciences (IR, SBMU.RETECH, and REC.1395.365). Results: Greater and significant lumbar flexion, with SiToSt, and lumbar extension, with StToSi, were observed in the patients. In addition, the patients exhibited a greater magnitude of lumbar rotation during SiToSt. No significant difference was observed between the 2 groups in hip motions. Conclusion: The patients with lumbar F+R syndrome tend to move their lumbopelvic region to a greater extent in sagittal and horizontal planes during SiToSt and StToSi compared with participants without low back pain.
... an inverted pendulum requiring a shifting base to maintain its stability [1][2][3][4]. Therefore, it is relevant to understand the spine and lower body motions in healthy individuals for a variety of applications, such as clinical diagnosis, implant design, and the analysis of treatment outcomes. ...
Article
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Although it is relevant to understand spine and lower body motions in healthy individuals for a variety of applications, such as clinical diagnosis, implant design, and the analysis of treatment outcomes, proper assessment and characterization of normative gait symmetry in healthy individuals remains unclear. The purpose of this study was to investigate the in vivo 3-dimensional (3D) spine and lower body gait symmetry kinematics during treadmill walking in healthy individuals. Sixty healthy young adults (30 males and 30 females) were evaluated during normal and fast treadmill walking using a motion capture system approach. Statistical parametric mapping and the normalized symmetry index approaches were used to determine spine, pelvis, and lower body asymmetries during treadmill walking. The spine and pelvis angular motions associated with the left and right lower limb motions, as well as the left and right lower extremity joint angles were compared for normal and fast treadmill walking. The lower lumbar left-right rotation (5.74±0.04°) and hip internal rotation (5.33±0.18°) presented the largest degrees of asymmetry during normal treadmill. Upper lumbar left-right lateral flexion (1.48±0.14°) and knee flexion (2.98±0.13°) indicated the largest asymmetries and during fast treadmill walking. Few asymmetry patterns were similar between normal and fast treadmill walking, whereas others appeared either only during normal or fast treadmill walking in this cohort of participants. These findings could provide insights into better understanding gait asymmetry in healthy individuals, and use them as reference indicators in diagnosing and evaluating abnormal gait function.
... The IR and ER were used as tests to assess hip ROM following Sadeghisani et al. [31] sitting protocol. The player sat on the edge of a stretcher with a 90º hip and knee flexion to perform an internal and external rotation, with the smartphone placed below the inferior pole of the patella, until maximum hip ROM or any compensatory movements were observed. ...
Article
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This study aimed to: (1) determine the magnitude and direction of lateral asymmetry in well-trained soccer players using hip and knee ROM tests; (2) inquire if asymmetry relies on the ROM test performed and/or gender; and (3) establish asymmetry thresholds for each ROM test to individualize lower-limbs asymmetry. One hundred amateur soccer players were assessed using hip–knee ROM tests: Straight Leg Raise, modified Thomas Test, hip internal rotation and external rotation, hip abduction (ABD) and adduction (ADD), Nachlas Test and Rigde Test. There are significant differences between tests when determining the magnitude of lateral asymmetry (F = 3.451; p = 0.001; ηp2 = 0.031) without significant differences between gender (F = 0.204; p = 0.651; ηp2 = 0.001). Asymmetry threshold results differ significantly between using a fixed or a specific threshold (F = 65.966; p = 0.001; ηp2 = 0.985). All tests indicate that the direction of asymmetry is towards the dominant limb. In conclusion, the ROM test used determines the magnitude and direction of the lateral asymmetry of the amateur soccer players. The ABD and ADD are the ROM tests that showed higher percentages of asymmetry, without differences between female and male soccer players. Using a specific asymmetry threshold formula can classify more players as asymmetrical than with a fixed threshold
... 9 During ALL movements, people with LBP demonstrate altered lumbopelvic movement patterns compared to people without LBP. [10][11][12] According to Scholtes et al, unlike healthy individuals, people with LBP demonstrated earlier and greater maximal lumbopelvic rotation (LPR) when actively flexing the knee and rotating the hip in a prone lying position. 12 An altered lumbopelvic movement pattern of early lumbar motion during active lower limb movements has been implicated by many as a factor in the development of mechanical LBP. ...
Article
Objective The aim of this study was to investigate the ability of people with low back pain (LBP) to modify the pattern of lumbopelvic rotation (LPR) when actively moving their lower limbs in sitting. Methods In this repeated-measures study in 38 men with chronic mechanical LBP (mean age, 38.4 ± 10.6 years), the timing and magnitude of LPR were investigated before and during the contraction of abdominal muscles during active knee extension while sitting. The kinematic data were collected using a motion-capture system, and OpenSim software was used for data analysis. The time difference between the start of knee extension and the start of LPR was measured and then adjusted to the movement time of the knee. The maximum LPR angle was also measured. Results Participants increased the time difference between the start of knee extension and the start of LPR when contracting the abdominal muscles (P < .01). Before and during contraction of abdominal muscles, however, there were no differences in maximum LPR. Conclusion People with LBP are able to modify early lumbopelvic motion during active lower limb movement while sitting. This may reduce the frequency of lumbopelvic motion during activities of daily living in sitting in these people.
... [5][6][7] Thus, the evaluation of the amplitude of trunk rotation, especially that of lumbopelvic segment, is considered an important variable to assess patients with low back pain. 8 Given this context, a possibility to measure functional performance and mobility of the lower spine segment is the Leg Lateral Reach Test (LLRT), a reliable tool for measuring the mobility of the thoraco-lumbo-pelvic segment. This test was developed in 2017 and tested in physically active, healthy people. ...
Article
Purpose The purpose of this study was to evaluate the intrarater and interrater reliability of the Leg Lateral Reach Test (LLRT) to measure the mobility of the thoraco-lumbo-pelvic segment in individuals with nonspecific chronic low back and the correlations among pain intensity, kinesiophobia, and LLRT scores. Methods Thirty participants with nonspecific chronic low back pain were selected. The main variables were LLRT, pain intensity (measured with the Numeric Pain Rating Scale) and kinesiophobia (Tampa Scale of Kinesiophobia). The reliability of the LLRT was evaluated by means of intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change. Results Most participants were women (83.3%), young adults (mean = 30.86; standard deviation = 8.56), with overweight and nonspecific chronic low back for more than 59 months of duration. In the intrarater analysis, we observed reliability values ranging from substantial to excellent (ICC ≥ .889; SEM ≤ 7.97%). In the interrater analysis, we observed excellent reliability (ICC ≥ .947; SEM ≤ 5.62%). There was a weak and positive correlation between pain and LLRT, and no correlation between kinesiophobia and LLRT. Conclusion LLRT is a reliable test to measure thoraco-lumbo-pelvic rotation in individuals with nonspecific chronic low back pain.
... However, in a large percentage of people with LBP, people recover within nine months to a year after the onset of the disorder [6]. Since the lower limb-pelvic set is an important motor chain for the spine [7], studying the kinematic properties of the components of this kinematic chain may provide useful evidence. Some researchers suggested an association between LBP and impaired lumbar-pelvic girdle control, with an increased risk of lower limb injuries [8][9][10]. ...
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Background Low back pain (LBP) is one of the leading causes of disability worldwide. While its main cause is mostly unknown, more than 80% of people experience this disorder during their lifetime .Some clinical evidence suggests that people with chronic LBP have various lower extremity movement disorders. This study aims to systematically review the literature on comparing the kinematics of the lumbopelvic region and lower limb joints in people with non-specific low back pain (NS-LBP) compared to healthy individuals. Methods/design We will search main electronic databases (Medline/PubMed, Scopus, Embase, Web of Science, Pedro, ProQuest and Google Scholar) and two key journals (Journal of Electromyography and Kinesiology, Clinical Biomechanics). Also, the reference list of the previous systematic reviews would be hand-searched. Studies that have examined the kinematic differences in lumbopelvic or lower limbs between NS-LBP and healthy individuals will be included. We will examine the methodological quality and statistical reporting of each eligible trial using the Newcastle – Ottawa Scale (NOS). Discussion To our knowledge, this study will be the first systematic review to examine the kinematic differences of the lower limb joints and pelvic complex between healthy people and NS-LBP. Since the kinematic assessment of the lower extremities and pelvic joints during daily activities may help understand underlying factors causing LBP, it is important to evaluate the kinematic changes in these regions, during repetitive daily functions in these patients. Systematic review registration PROSPERO (CRD42021230826)
Article
Limited research has explored the relationship between lumbar lordosis and incidence of low back pain in dancers. The purpose of this study was to investigate the relationship between lumbar lordosis in functional dance positions and low back pain (LBP). Thirty full-time undergraduate ballet and modern collegiate dancers (28 female, 2 male) from three university dance programs participated in this study. Functional lumbar lordosis, hip passive range of motion, and core endurance were measured in a single session. Dancers participated in weekly follow-up surveys over a 4-month period to track the presence and severity of LBP. Primary analysis was performed using independent t-tests between groups who did and did not develop pain. Secondary analyses were performed using Pearson’s r correlation. Eleven dancers reported no pain during the follow-up period, 16 reported pain, and three did not respond to follow-up surveys. Lumbar lordosis in right developpé á la seconde and right retiré was significantly greater (p < 0.05) in the group who reported pain compared to the group who reported no pain. Increased hold times in the supine bridge position was shown to be fairly correlated (p < 0.05) to reduced lumbar lordosis in first position (Pearson’s r = 0.381), left retiré (Pearson’s r = 0.396), and right developpé á la seconde (Pearson’s r = 0.365). The results of this study suggest a relationship between increased lumbar lordosis in the retiré and developpé á la seconde dance positions and development of LBP. Increased endurance of posterior core musculature and gluteal muscles was inversely related to the magnitude of lumbar lordosis in some dance-specific positions. The measurement of lumbar lordosis during functional dance positions, particularly those requiring single leg stances, may help identify collegiate dancers with increased risk of developing low back pain.
Article
Purpose: The aim of this study was to explore if specific hip and knee range-of-movement (ROM) tests can predict a risk factor for hamstring strain (HS) injury in male and female soccer players. Methods: One hundred amateur soccer players (56 men and 44 women) performed six tests to determine hip and knee ROM: straight leg raise test (SLR), modified Thomas test (TT), hip internal and external rotation (ER), hip abduction and adduction, Nachlas test and Ridge test. A logistic regression analysis was carried out to create a predictive model for HS injuries. Results: The percentage of HS injury was 20.45% and 30.35%, for female and male players. The logistic regression showed a significant model for both genders on the logit of suffering an HS injury with active-SLR and TT variables for females (R2CS = 0.491; R2N = 0.771) and active SLR and ER variables for males (R2CS = 0.623; R2N = 0.882). The predictive models correctly classify 95.5% and 94.6% of cases presenting good sensitivity (77.8% and 88.2%) and full (100%) and high (97.4%) specificity respectively. Furthermore, female players showed a greater ROM than males (p ≤ 0.01). Conclusion: Both female and male soccer players that suffered a HS injury had lower ROM in SLR, NT and RT and higher ROM in the TT that non-injured players. The tests that most likely predict HS injury are SLR and TT in females and SLR and ER in males. Thus, it is suggested to including specific exercises in amateur soccer players training programs to improve hip and knee ROM for injury prevention.
Article
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Excessive and earlier lumbopelvic motions during trunk and limb movements tests have been reported in both low back pain (LBP) patients with and without trunk and hip rotational demand activities. The aim of the present study was to determine differences in hip and lumbopelvic rotation during the active hip internal rotation (AHIR) test between two groups of LBP patients with and without regular trunk and hip rotational demand activities. A total of 35 LBP patients, including 15 males who regularly participated in rotational demand sports activities and 20 males not participating in sports and functional rotational demand activities, participated in study. The AHIR test was performed. The kinematic variables of hip and pelvic rotations were recorded by a Qualisys motion analysis system. Pelvic and hip rotations were calculated across time during the test. In addition, pelvic rotations in the first half of the test and pelvic-hip timing were calculated. People with rotational demand activities had a higher pelvic rotation both during the test and in the first 50% of movement. Earlier pelvic rotation was observed in people with rotational demand activities compared to people with non-rotational demand activities. 1. The data of the current study suggests that lumbopelvic movement patterns in different groups of LBP patients in regard to their specific activities may vary. 2. LBP people with rotational demand sports activities have a greater tendency of pelvic rotation motion during the AHIR.
Article
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To evaluate evidence for involvement of the lower limb in spinal function and low back pain (LBP). A hypothesis based on a critical review of the relevant biomechanical and clinical literature. The spine resembles an inverted pendulum that supports the weight of the upper body; its stability requires a moving base that is provided by the joints of the lower limb, especially the hip. However, the sacroiliac joints are unlikely to be important for spinal function. The changing pattern of gait and development of lumbar lordosis, in early childhood, provide evidence for the inter-dependence of spinal curvature and lower limb action. Clinical signs associated with LBP may be associated with an inability to rotate the trunk about the hips. These include disorientation of the pelvis and weakness or tightness of muscles around the hip. The "sway back" posture seen in LBP involves flexion of the hip, knee and ankle to compensate for abdominal and back muscle weakness. In order to understand the varied clinical presentation of LBP patients, the function of the spine should be considered in the context of the whole body, especially the lower limb.
Article
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Limited hip flexion may lead to a poor lumbopelvic motion during seated active hip flexion in people with low-back pain (LBP). The purpose of this study was to compare lumbopelvic motion during seated hip flexion between subjects with and without LBP accompanying limited hip flexion. Fifteen patients with LBP accompanying limited hip flexion and 16 healthy subjects were recruited. The subjects performed seated hip flexion with the dominant leg three times. A three-dimensional motion-analysis system was used to measure lumbopelvic motion during seated hip flexion. During seated active hip flexion, the angle of hip flexion was significantly lower in patients with LBP accompanying limited hip flexion (17.4 ± 4.4 in the LBP group, 20.8 ± 2.6 in the healthy group; t = 2.63, p = 0.014). The angle of the lumbar flexion (4.8 ± 2.2 in the LBP group, 2.6 ± 2.0 in the healthy group; t = -2.96, p = 0.006) and posterior pelvic tilting (5.0 ± 2.6 in the LBP group, 2.9 ± 2.0 in the healthy group; t = 2.48 p = 0.019), however, were significantly greater in patients with this condition. The results of this study suggest that limited hip flexion in LBP can contribute to excessive lumbar flexion and posterior pelvic tilting during hip flexion in the sitting position. Further studies are required to confirm whether improving the hip flexion range of motion can reduce excessive lumbar flexion in patients with LBP accompanying limited hip flexion.
Article
Background: Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment. Objectives: This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide the current research on movement system impairment syndromes. Results: The conceptual basis of the movement system impairment syndromes is that sustained alignment in a non-ideal position and repeated movements in a specific direction are thought to be associated with several musculoskeletal conditions. Classification into movement system impairment syndromes and treatment has been described for all body regions. The classification involves interpreting data from standardized tests of alignments and movements. Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns. The reliability and validity of movement system impairment syndromes have been partially tested. Although several case reports involving treatment using the movement system impairment syndromes concept have been published, efficacy of treatment based on movement system impairment syndromes has not been tested in randomized controlled trials, except in people with chronic low back pain.
Article
Abstract Introduction: Many factors are related to the disability of subjects with chronic low back pain. Fear avoidance of injury and movement are the most important risk factors to increase the disability followed by decreased physical activity in these patients. The aim of current study was to compare the level of disability and fear-avoidance between two groups of low back pain patients with and without specific sport and recreational activities. Materials and methods: Thirty nine male with non-specific chronic low back pain (15 subjects with rotational demand sport and recreational specific activities and 24 subjects without rotational trunk and hips demand sport and recreational activities) were participated in present study. Levels of disability, pain, fear-avoidance, habitual physical activity and pain intensity of all participated were measured by selected and verified Persian questionnaires. Data were analyzed by SPSS, version 17. Results: Levels of disability and fear-avoidance in group with specific sport and recreational activity were significantly lesser than group without rotational activities (p<0/05). Level of habitual physical activity in group with rotational activities was greater (p<0/05) than other group. There was no difference between groups in pain intensity (p>0/05). Conclusion: Participation in habitual and sport activities may help to decrease the level of disability in subjects with chronic low back pain by effect on the level of fear-avoidance. The presence of difference between groups of low back pain may also show a need for sub-classification of chronic low back pain in same group. Key words: nonspecific-chronic low back pain, fear-avoidance, habitual physical activity, pain intensity, functional disability.
Article
Among golf injuries, low back pain (LBP) is the most common compliant for both professional and amateur golfers. Hip rotational range of motion (ROM) might be related to LBP in those who repeatedly place specific activity rotational demands on the hip in one direction. Coordination of timing of movement (neural control) between the hip and lumbopelvic region during trunk movements is critical for normal mechanics. Altered timing can contribute to areas of high tissue loading and can lead to LBP symptoms seen during active lower limb movement tests. Patient was a 42-year-old male recreational golfer who presented with low back pain and decreased hip internal rotation ROM. With the use of manual physical therapy to increase hip ROM and lumbar stabilization therapeutic exercises, the patient was able to return to pain-free golf and to better his handicap by three strokes. Significant improvement was seen in his Oswestry outcome score, and a (-) prone instability test was noted. It is recommended to address hip ROM limitations in those experiencing low back pain while golfing. Rapid spinal rotation may produce large spinal loads, but this is likely not the major contributor to low back pain in golfers. Mechanical factors may play a larger role.
Article
The biomechanical relationship between the hip and low back is well described and impairment of hip range of motion is thought to affect lumbar spine function, possibly leading to increased loading and subsequent symptoms. However therapy for low back pain (LBP) patients is commonly directed solely to the low back area overlooking possible hip impairment. A 56-year-old male recreational golfer presented with a chronic golf-related low back complaint. Previous conservative therapy targeting the spine did not result in complete symptom relief. A working diagnosis of L4-S1 facet joint irritation and lower lumbar segmental instability secondary to bilateral hip ROM impairment was established. A trial of therapy strictly addressing the hip ROM impairments was initiated and following 2 treatment sessions, a complete resolution of symptoms was achieved and maintained at a 2-month follow-up. This case demonstrated a complete and rapid relief of un-resolving low back pain with a management strategy focused on hip ROM impairments. Clinicians should remember to look beyond the local area of complaint and appreciate the interdependent nature of the musculoskeletal system.
Article
Study design: A cross-sectional study to compare the kinematics and muscle activities during trunk flexion and return task in people with and without low back pain (LBP). Objective: To characterize the lumbopelvic rhythms during trunk flexion and return task in a group of healthy persons and 2 different subgroups of patients with LBP, identifying the flexion-relaxation (FR) responses in each group. Summary of background data: The lumbopelvic rhythm is the coordinated movement of the lumbar spine and hip during trunk flexion and return and is a clinical sign of LBP. However, the reported patterns of lumbopelvic rhythm in patients with LBP are inconsistent, possibly because previous studies have examined a heterogeneous group of patients with LBP. To clarify the lumbopelvic rhythm patterns, it is necessary to study more homogeneous subgroups of patients with LBP. Methods: The study involved the following subjects: control group of healthy subjects (N = 16); lumbar flexion with rotation syndrome (LFRS) LBP subgroup (N = 17); and lumbar extension with rotation syndrome (LERS) LBP subgroup (N = 14). The kinematic parameters during the trunk flexion and return task were recorded using a 3-dimensional motion capture system, and the FR ratio of the erector spinae muscle was measured. Results: The flexion angle of the lumbar spine was larger in the LFRS subgroup than in the control group and the LERS LBP subgroup, and the hip flexion angle was larger in the LERS LBP subgroup than in the control group and LFRS subgroup. The FR response of the erector spinae muscle disappeared in the LFRS and LERS LBP subgroups. Conclusion: These results show that the lumbopelvic rhythms are different among healthy subjects and patients assigned to 2 specific LBP subgroups. These results provide information on the FR response of the erector spinae muscle.
Article
Low back pain (LBP) is one of the most common symptoms reported in adults. However, the contribution of postural control on the lumbar spine and hips during squatting has not been carefully investigated in individuals with LBP. The aim of this study was to compare three-dimensional kinematic changes of the lumbar spine and hips between subjects with and without idiopathic chronic LBP during squatting activities. In total, 30 subjects enrolled in the study (15 control subjects and 15 subjects with idiopathic chronic LBP). All participants were asked to perform squatting activities five times repeatedly while holding a load of 2kg in a basket. The outcome measures included the Oswestry Disability Index (ODI) and kinematic angular displacement for the hips and lumbar spine. The LBP group demonstrated increased range of motion (ROM) in flexion of the dominant (T=-2.14, p=0.03) and non-dominant (T=-2.11, p=0.03) hips during squatting. The lumbar spine flexion ROM significantly decreased (T=2.20, p=0.03). The kinematic changes demonstrated interactions with region×group (F=5.56, p=0.02), plane×group (F=4.36, p=0.04), and region×plane (F=2292.47, p=0.001). The ODI level demonstrated significant interaction on combined effects of body region and plane (F=4.91, p=0.03). Therefore, the LBP group utilized a compensation strategy to increase hip flexion with a stiffened lumbar spine in the sagittal plane during squatting. This compensatory kinematic strategy could apply to clinical management used to enhance lumbar spine flexibility in subjects with idiopathic chronic LBP.