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Quantifying normal 3D hip ROM in healthy young adult males with clinical and laboratory tools: Hip mobility restrictions appear to be plane-specific
... When the trunk and thigh were parallel, hip flexion or extension PROM was defined as 0 (positive PROM was defined by extension and flexion of the hip, respectively). During hip extension, a blood pressure cuff was used, as suggested by Moreside and McGill (2011). The blood pressure cuff was placed under the lumbar spine, and then inflated to 60 mmHg (Moreside and McGill, 2011). ...
... During hip extension, a blood pressure cuff was used, as suggested by Moreside and McGill (2011). The blood pressure cuff was placed under the lumbar spine, and then inflated to 60 mmHg (Moreside and McGill, 2011). This pressure was monitored as the dominant leg was passively lowered to the end of the range of motion without associated changes in pelvic position or pressure in the blood pressure cuff (Moreside and McGill, 2011). ...
... The blood pressure cuff was placed under the lumbar spine, and then inflated to 60 mmHg (Moreside and McGill, 2011). This pressure was monitored as the dominant leg was passively lowered to the end of the range of motion without associated changes in pelvic position or pressure in the blood pressure cuff (Moreside and McGill, 2011). Subjects had their hands across their chest throughout PROM testing. ...
Increases in joint range-of-motion may be beneficial for improving performance and reducing injury risk. This study investigated the effects of different self-massage volumes and modalities on passive hip range-of-motion. Twenty-five recreationally resistance-trained men performed four experimental protocols using a counterbalanced, randomized, and within-subjects design; foam rolling (FR) or roller massage (RM) for 60 or 120-second. Passive hip flexion and extension range-of-motion were measured in a counterbalanced and randomized order via manual goniometry before self-massage (baseline) and immediately, 10-, 20-, and 30-minute following each self-massage intervention. Following FR or RM of quadriceps, there was an increase in hip flexion range-of-motion at Post-0 (FR: ∆=19.28º; RM: ∆=14.96º), Post-10 (FR: ∆=13.03º; RM: ∆=10.40º), and Post-20 (FR: ∆= 6.00º; RM: ∆=4.64º) for all protocols, but not exceed the minimum detectable change at Post-10 for RM60 and RM120, and Post-20 for FR60, FR120, RM60, and RM120. Similarly, hip extension range-of-motion increase at Post-0 (FR: ∆=8.56º; RM: ∆=6.56º), Post-10 (FR: ∆=4.64º; RM: ∆=3.92º), and Post-20 (FR: ∆=2.80º; RM: ∆=1.92º), but not exceed the minimum detectable change at Post-10 for FR60, RM60, and RM120, and Post-20 for FR60, FR120, RM60, and RM120. In conclusion, both FR and RM increased hip range-of-motion but larger volumes (120- vs. 60-second) and FR produced the greatest increases. These findings have implications for self-massage prescription and implementation, in both rehabilitation and athletic populations.
Key words: flexibility, massage, self-massage, self-myofascial release, self-manual therapy
... Ak tu al ne nor my po da wa ne przez Ameri can Aca de my of Or tho pa edic Sur ge ons (AAOS) [8] miesz czą się w prze dzia le 10-30º i za le żą od wie ku, płci, BMI oraz spo so bu wy ko na nia po mia ru (ak tywne/pa syw ne). Ró żni ce w po da wa nych nor mach związa ne są rów nież z wy ko rzy sty wa nym na rzę dziem (go nio me trem), któ re go wia ry god ność by ła wie lo krotnie ba da na [9][10][11][12], jed nak mo że być za kłó ca na przez ro dzaj ba da ne go sta wu oraz bu do wę fi zycz ną oso by ba da nej [13]. Du że zna cze nie ma po zy cja, w któ rej wy ko ny wa ny jest po miar [8]. ...
... Current normative values provided by the American Academy of Orthopaedic Surgeons (AAOS) [8] fall within the range 10-30º and depend on the age, sex, BMI, and the method of measurement (active/passive). Differen ces in these normative values are also associated with the used tool (goniometer), whose credibility has been repeatedly investigated [9][10][11][12], but the measure ment outcome can be interfered by the type of the joint tested and one's physical build [13]. Of great importance is also the position at which measurement is being performed [8]. ...
... zy cji le że nia ty łem koń czy ny dol ne usta wia ją się w po zy cji mak sy mal ne go roz luź nie nia to reb ki sta wowej sta wu bio dro we go (30° od wie dze nia, 30° ro ta cji ze wnętrz nej, 30° zgię cia), co po wo du je, że wy ko nanie czy ste go ru chu zgię cia w sta wie bio dro wym jest trud ne. Mo re si de [10], oce nia jąc wy prost w sta wach bio dro wych za po mo cą zmo dy fi ko wa ne go te stu Thoma sa, zwró cił uwa gę na ko niecz ność utrzy my wa nia koń czyn do kład nie w płasz czyź nie strzał ko wej przez kon tro lo wa nie od wo dze nia i ro ta cji pod czas zgi na nia i pro sto wa nia w sta wie bio dro wym. Ba da cze wprowa dzi li ta kże do dat ko wy ele ment sta bi li zu ją cy miedni cę, umiesz czo ny pod krę go słu pem lę dźwio wym, aby po pra wić do kład ność i wia ry god ność te stu. ...
... None of these findings appear to be sex-dependent (Figs. 2 and 3). The reported hip extension angles are not unlike those reported by Moreside & McGill (2011), who also evaluated hip extension using motion capture. The angles of the thigh relative to horizontal presented by Moreside & McGill (2011) appear to be different, though, as the authors used a pressure cuff under the lumbar spine to control for lumbopelvic movement and hip flexion differences. ...
... The reported hip extension angles are not unlike those reported by Moreside & McGill (2011), who also evaluated hip extension using motion capture. The angles of the thigh relative to horizontal presented by Moreside & McGill (2011) appear to be different, though, as the authors used a pressure cuff under the lumbar spine to control for lumbopelvic movement and hip flexion differences. More specifically, the authors placed a blood pressure cuff, inflated to 60 mmHg, under participants' lumbar spine, and if cuff pressure changed, it was indicative of lumbopelvic motion. ...
... Furthermore, the authors offset the MTT results by 10 • , which assumes equal pelvic tilt is occurring for all participants. Our findings indicate that if pelvic tilt is corrected for, the discrepancies between the results of the MTT, true hip extension, and the MTT results reported by Moreside & McGill (2011) should be diminished. ...
The modified Thomas test was developed to assess the presence of hip flexion contracture and to measure hip extensibility. Despite its widespread use, to the authors’ knowledge, its criterion reference validity has not yet been investigated. The purpose of this study was to assess the criterion reference validity of the modified Thomas test for measuring peak hip extension angle and hip extension deficits, as defined by the hip not being able to extend to 0º, or neutral. Twenty-nine healthy college students (age = 22.00 ± 3.80 years; height = 1.71 ± 0.09 m; body mass = 70.00 ± 15.60 kg) were recruited for this study. Bland–Altman plots revealed poor validity for the modified Thomas test’s ability to measure hip extension, which could not be explained by differences in hip flexion ability alone. The modified Thomas test displayed a sensitivity of 31.82% (95% CI [13.86–54.87]) and a specificity of 57.14% (95% CI [18.41–90.10]) for testing hip extension deficits. It appears, however, that by controlling pelvic tilt, much of this variance can be accounted for ( r = 0.98). When pelvic tilt is not controlled, the modified Thomas test displays poor criterion reference validity and, as per previous studies, poor reliability. However, when pelvic tilt is controlled, the modified Thomas test appears to be a valid test for evaluating peak hip extension angle.
... The participants were supine for all measurements, and a standard goniometer was used, affixed with a spirit level to increase accuracy. 33 To test the hypothesis of this investigation, only flexion and extension range of motion were used and thus, these procedures are detailed below. To measure hip flexion, a physiotherapist passively flexed the hip to maximum allowable range before the lumbar spine began to flex. ...
... Hip extension was measured with the participant buttocks at the end of the plinth with knees flexed to the chest as per the modified Thomas test. 33 The physiotherapist passively flexed both hips simultaneously to determine full hip and pelvis flexion; the point at which the lumbar spine began to also flex. One leg was stabilized in this position by the physiotherapist, while the limb of interest was allowed to 2 BAKER ET AL. slowly lower into maximum extension, while controlling for frontal and axial motion of the femur. ...
... 47 Moreside and McGill 2011, investigated motion capture and goniometric measurements of hip ROM, and found they are comparable. 33 Moreside and McGill concluded, using the normative data, that the goniometer is a viable tool for measuring hip ROM and is highly comparable to a motion capture system (R 2 ¼ 0.8845). 33 They did mention that when measuring hip extension, the understanding that goniometer measures can overstate extension by up to 4 degrees, should be considered. ...
Reduced sagittal plane range of motion (ROM) has been reported in individuals with hip OA both during walking and passive testing. The purpose of this study was to determine if a relationship exists between hip extension ROM recorded during gait and passive hip extension ROM in individuals with moderate and severe hip OA, in comparison to an asymptomatic group. Sagittal plane hip ROM was calculated using skin surface marker trajectories captured during treadmill walking at self-selected speed. Passive hip ROM was measured using standardized position and recording procedures with a goniometer. Sagittal plane extension, flexion and overall ROM were measured dynamically and passively. A two-way mixed model analysis of variance determined significant differences between groups and between passive and dynamic ROM (α = 0.05). Pearson correlations determined relationships between passive and dynamic ROM. Significant group by ROM interactions were found for flexion and extension ROM (p < 0.05). For extension, the severe OA group had less dynamic and passive ROM compared to the other groups and greater passive than dynamic ROM (p < 0.05). For flexion, significant differences in passive ROM existed between all three groups (p < 0.05) whereas no differences were found for dynamic flexion (p < 0.05). Significant correlations between dynamic and passive hip extension were found in the moderate (r = 0.596) and severe OA (r = 0.586) groups, and no correlation was found in the asymptomatic group (r = 0.139). Passive ROM explains variance in dynamic ROM measurements obtained during gait in individuals with moderate and severe hip OA which have implications for the design of treatment strategies targeting walking pathomechanics. This article is protected by copyright. All rights reserved.
... Optical motion capture (MOCAP) is a common tracking modality used to quantify joint angles [6]. MOCAP typically employs an array of high-speed cameras arranged around the perimeter of a measurement volume. ...
... MOCAP typically employs an array of high-speed cameras arranged around the perimeter of a measurement volume. The cameras record three-dimensional position coordinates of a set of markers which are often reflective targets (e.g., [6]- [8]). To estimate hip joint angles, markers are affixed to bony anatomical landmarks which are then used to construct anatomical reference frames for the pelvis and femur [9]. ...
... Specifically, during the clinical tests for FAI, a device mounted to the femur is held stationary when each of its three sense axes nearly aligns with gravity for some subset of the test. Data from these time periods provide the measurements that enable identification of the optimal drift correction constants (scale factor and bias) for each of the gyro sense axes as defined in Eq. (6). Doing so accounts for drift present in all coordinate directions, including yaw, a limitation noted for several of the tests and methodologies presented in [7]. ...
We present a novel method for quantifying femoral orientation angles using a thigh-mounted inertial measurement unit (IMU). The IMU-derived femoral orientation angles reproduce gold-standard motion capture angles to within mean (standard deviation) differences of 0.1 (1.1) degrees on cadaveric specimens during clinical procedures used for the diagnosis of Femoroacetabular Impingement (FAI). The method, which assumes a stationary pelvis, is easy to use, inexpensive and provides femur motion trajectory data in addition to range of motion measures. These advantages may accelerate the adoption of this technology to inform FAI diagnoses and assess treatment efficacy. To this end, we further investigate the accuracy of hip joint angles calculated using this methodology and assess the sensitivity of our estimates to skin motion artifact during these tasks.
... This has favoured its use in clinical settings as well as in research. 1,2 Although it can have a close association with technologically advanced techniques, 3,4 the measurement reliability and agreement of goniometry can vary due to multiple factors. These factors include the rater, the individual being measured, the joint being measured and differences in ROM measurement technique such as test posture, imposed restraints (e.g. ...
... 11,13,15 There are other formulas for calculating the ICC that reduce the influence of σ 2 r and σ 2 e which results in an increased ICC score (e.g. ICC [3,1] and ICC [2,k]). 13 However, the use and reporting of ICCs between studies is inconsistent and often lacks sufficient detail. ...
Background:
Reliability and agreement of goniometric measurements can be altered by variations in measurement technique such as restricting adjacent joints to influence bi-articular muscles. It is unknown if the influence of adjacent joint restriction is consistent across different range of motion (ROM) tests, as this has yet to be assessed within a single study. Additionally, between-study comparisons are challenged by differences between methodology, participants and raters, obscuring the development of a conceptual understanding of the extent to which adjacent joint restriction can influence goniometric ROM measurements.
Purpose:
To quantify intra- and inter-rater reliability and levels of agreement of goniometric measurements across five ROM tests, with and without adjacent joint restriction.
Study Design:
Descriptive reliability study
Methods:
Three trained and experienced raters made two measurements of bilateral ankle dorsiflexion, first metatarsophalangeal dorsiflexion, hip extension, hip flexion, and shoulder flexion, with and without adjacent joint restriction. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), along with participant, measurement/rater and random error variance were estimated.
Results:
Eleven females (age 21.4 ±2.3 years) and 19 males (age 22.1 ±2.8 years) participated. Adjacent joint restriction did not influence the reliability and agreement in a consistent way across the five ROM tests. Changes in the inter-rater reliability and agreement were more pronounced compared to the intra-rater reliability and agreement. Assessing variance components (participant, measurement/rater and random error variance) that are used to calculate the ICC and SEM, improved interpretation of ICC and SEM scores.
Conclusion:
The effects of adjacent joint restriction on reliability and agreement of goniometric measurements depend on the ROM test and should be considered when comparing measurements between multiple raters. Reporting variance components that are used to calculate the ICC and SEM can improve interpretation and may improve between-study comparisons, towards developing a conceptual framework to guide goniometric measurement technique.
... HF assessed in a supine position with the dominant knee flexed at 90 degrees, and the opposite knee extended. A blood pressure cuff placed under the lumbar spine and then inflated to 60 mmHg [33]. This pressure monitored as the dominant leg passively lowered to the end of the PROM without associated changes in pelvic position or pressure in the blood pressure cuff [33]. ...
... A blood pressure cuff placed under the lumbar spine and then inflated to 60 mmHg [33]. This pressure monitored as the dominant leg passively lowered to the end of the PROM without associated changes in pelvic position or pressure in the blood pressure cuff [33]. The researcher then aligned the axis of the goniometer with the greater trochanter, and the arms of the goniometer with the lateral condyle of the femur and the mid-axillary line. ...
Introduction: Dancers use to do stretching exercises to increase flexibility in the preparation and completion of training and activities. The purpose of the present study was to compare two methods of passive stretching of hip flexion in classical dancer children. Methods: Twenty-one female’s children were recruited for the study, and each participant visited the laboratory on two occasions during three-days at least twenty-four hours between visits. A randomized within-subject design used to investigate the effects of three conditions: control (CG), static stretching (SS), and proprioceptive neuromuscular facilitation (PNF) applied to the posterior thigh, unilaterally, on passive hip flexion (HF) with 60-seconds. Results: There were no statistical differences for CG (F = 0.716; p = 0.552), SS (F = 0.536; p = 0.662) and PNF (F = 1.713; p = 0.191). Conclusion: The results found in the present study indicate that different stretching methods can promote increases in HF and PROM without difference between methods.Keywords: flexibility, dancing, youngster.
... According to the available literature, only one published paper was found showing the 3D kinematic analysis of the MTT performed by the optoelectronic system (Moreside and McGill, 2011), while the acute effects of the gravitational stretching of monoarticular and biarticular hip and knee flexors in the MTT position have not yet been investigated. The authors of this paper participated in the publication of a study on the reliability of the optoelectronic system in relation to the goniometer as a gold standard in practice, with the Spearman coefficient of correlation of 0.91 (Kiseljak et al., 2017). ...
... For the research purposes, a special MTT clinical test was used. The kinematic features of the MTT were evaluated using the objective 3D method of the automated optoelectronic kinematic measurement system ELITE 2002 BTS (Elaboratore di Immagini Television 2002 Bioengineering and Technology Systems, Milano) containing 8 cameras, sampling frequencies of 100 Hz with 9 passive markers (Medved and Kasović, 2007;Chiari et al., 2005;Moreside and McGill, 2011). The measurement was performed bilaterally, initially immediately after the MTT and finally after 120 seconds in the relaxed MTT position, or after the gravitational stretching intervention for each lower limb. ...
... Hip flexion ROM (HF) was assessed in a supine position with the test knee flexed at 90 and the opposite knee extended. A blood pressure cuff was placed under the lumbar spine, and then inflated to 60 mmHg (Moreside and McGill, 2011). This pressure was monitored as one of the participant's legs was lowered passively to a maximum position without associated changes in pelvic position or pressure in the blood pressure cuff (Moreside and McGill, 2011). ...
... A blood pressure cuff was placed under the lumbar spine, and then inflated to 60 mmHg (Moreside and McGill, 2011). This pressure was monitored as one of the participant's legs was lowered passively to a maximum position without associated changes in pelvic position or pressure in the blood pressure cuff (Moreside and McGill, 2011). A research assistant flexed the test hip passively to the point of pain or anatomical limitation The researcher aligned the axis of the goniometer, and the arms of the goniometer with the lateral condyle of the femur and the midaxillary line. ...
... The efficacy of the FMS is, in part, determined by correlating screening scores to injury incidence. To date, the results of such studies are inconsistent, with some showing injury prediction value with use of the FMS (4,17,20,28) and others showing either very limited or no predictive value (16,22,25,32). The conflicting findings are not unexpected given the varied study designs and populations. ...
... Using the DST variables that were modified in this study as an example, it is likely that in order to squat most effectively and comfortably many individuals perform all squatting functions with some external rotation of the hip. While it is also likely that some individuals keep the lower extremities directly in the sagittal plane during squatting, the variability of squat technique among individuals is consistent with recent findings of significant hip range of motion variability among young, healthy male (25). Concern for impaired medial rotation of the hips is warranted, but likely presents greater risk for injury when an individual must plant one leg and rotate across it, such as in a golf swing or lunge and reach. ...
The Functional Movement Screen (FMS) was developed as an evaluation tool for assessing the fundamental movement patterns thought to be prerequisites for functional activity. However, some of the FMS component movements, such as the Deep Overhead Squat test (DST), likely represent novel motor challenges on which poor performance might reflect inexperience with the task rather than a movement impairment. The purpose of this study was to examine the effects of positional variations on DST scores in a population of young, healthy adults. We hypothesized that self-selecting foot positioning, removal of an overhead component, or changing both aspects of the DST would result in improvement in FMS scores. Twenty healthy subjects completed four squatting conditions in a counterbalanced sequence to eliminate carry over effects: DST; modified squat with hands at chest level and feet in the DST position (DSTO); modified squat with arms in the DST position and selfselected foot placement (DSTF); and modified squat with hands at chest level and self selected foot placement (DSTB). A Friedman's ANOVA and Wilcoxon signed ranks post-hoc analysis revealed a significant difference between all squat conditions (ρ=0.036), between DSTB-DST groups (ρ<0.001), DSTO-DST groups (ρ=0.004) and DSTO-DSTB groups (ρ=0.046). Each modified squat condition had an average score higher than the DST. These findings suggest that the FMS DST might underestimate an individual's ability to squat during functional tasks that involve self-selected foot and arm placement.
... Another aspect that has caught our attention in this study is that patient care starts with correct physical examination and determining the patient's passive hip ROM is one of its key points. Usually, measurements of passive hip ROM are performed by clinicians using standard goniometers or inclinometers whose reliability has been well studied (12)(13)(14)(15). Unfortunately, this process may lack precision because of movement of other joints around the pelvis (i.e., no direct access to the joint). ...
... To our knowledge, assessing the accuracy of the physical examination as a method for determining the true passive hip ROM was little investigated. Some authors compared hip ROM measurements obtained with goniometer and electromagnetic tracking system (14) or optical motion capture (13), but these studies were affected by skin movement artifacts that could hinder accurate kinematic estimation with electromagnetic or optical motion capture systems (16). Therefore, research is still needed in order to attest the validity of the physical examination. ...
Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the "normal hip" in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction.
... Anthropometric measurements were taken: height, weight, arm length, leg length, as well as numerous pelvis and thorax dimensions for modeling purposes. Hip extension (using the modified Thomas test) was measured with a custom goniometer affixed with a spirit level on each arm, and a blood pressure cuff under the lumbar spine, as per Moreside and McGill (2011). In the addition to segment lengths, the hip extension measurement was collected to determine its predictive value in lumbar motion when on the elliptical trainer. ...
... Despite being only 172 cm in height (mean group height was 178 (7) cm), he had a greater than average forward lean angle in 11 of the 12 elliptical conditions. Further investigation revealed that this participant also demonstrated a marked lack of hip mobility: 42°and 45°of total hip rotation (the sum of internal and external rotation) for the right and left leg, respectively; small when compared to published 50th percentile values of 59° (Moreside and McGill, 2011). Consequently, he may have adopted this motor pattern of lumbar rotation and flexion to compensate for lack of hip rotation. ...
... a pathological group yet demonstrate limited ROM of hip extension and rotation that may be because of several factors, including chronic exposure to certain activities. Normal and percentile data exist for hip ROM in such a group (Table 1) (27). Using this information, participants were recruited from the university population and surrounding area via posters and word of mouth, who demonstrated hip mobility of less than the 50th percentile, ideally in both directions. ...
... Extension and rotation measurements were obtained using a standard goniometer modified with the addition of 2 spirit levels: one on each of the arms, to improve the accuracy of determining horizontal and vertical positioning (9). These measurement protocols have been previously described and have demonstrated high correlations with measurements obtained using a passive motion capture system (Pearson correlations, 0.94, 0.96, and 0.98 for extension, ER, and IR, respectively) (27). Every participant was positioned passively into hip extension and rotation by a physiotherapist who had more than 30 years of clinical experience. ...
The purpose of this study was to analyze the effect of 3 different exercise interventions plus a control group on passive hip range of motion (ROM). Previous research studies into the methods of improving passive hip mobility have focused on stretching protocols aimed specifically at the hip joint. The effect of core stabilization, motor training, and myofascial stretching techniques on hip mobility in a selected asymptomatic group with limited hip mobility is unclear. In this study, 24 young men with limited hip mobility (<50th percentile) were randomly assigned to 4 groups: stretching, stretching with motor control exercises for the hip and trunk, core endurance with motor control exercises, and the control group. Six-week home exercise programs were individually prescribed based on the assigned group, hip ROM, movement patterns, and timed core endurance. Two-way analyses of variances were conducted to analyze the effect of group assignment on hip ROM improvements. Both stretching groups demonstrated significant improvements in hip ROM (p < 0.05), attaining hip mobility levels at or above the 75th percentile, with rotation improving as much as 56%. The group receiving core endurance and motor control exercises with no stretching also demonstrated a moderate increase in ROM but only significantly so in rotation. Average core endurance holding times improved 38-53%. These results indicate that stretches aimed at the myofascial components of the upper body, in addition to the hip joint, resulted in dramatic increases in hip ROM in a group of young men with limited hip mobility. Hip ROM also improved in the group that did no active stretching, highlighting the potential role of including stabilization or "proximal stiffening training" when rehabilitating the extremities.
... To measure the hip extension range of motion, using modified Thomas test ( Fig. 1), the subject was sitting on the edge of the examination table and then lying supine so that the tail was at the end of the table. Subject's opposite leg is kept in full flexion (this helps to maintain posterior pelvic tilt and flattened lower back and is essential to avoid stress on the spine 6,34,35 . To minimize the potential measurement error due to posterior pelvic tilt during full flexion in the modified Thomas test, examiners manually stabilized each participant's pelvis throughout the procedure. ...
This study aims to investigate the impact of iliopsoas (IL) tightness on lower extremity muscle activity during single-leg landing, focusing on how IL tightness influences joint protection through feed-forward and feed-back pathways that address known impaired neuromuscular mechanisms and provide a set of variables with which to assess and design the ongoing change from both prevention and management. A cross-sectional study of 28 male soccer players (ages 11–14 yrs) divided into IL tightness (n = 14) and normal hip flexor length (n = 14) groups assessed hip extension range using the modified Thomas test. Electromyography recorded muscle activity (gluteus maximus [GM], adductor magnus [AM], biceps femoris [BF], rectus femoris [RF], soleus [SOL], and multifidus [MF]) during single-leg landing, with RMS values computed over 50 ms epochs, collected 300 ms before and after ground contact, and normalized to maximal voluntary isometric contractions (MVIC). Statistical analysis using Kolmogorov-Smirnov and homoscedasticity tests confirmed normal distribution and homogeneity. Independent-sample t-tests compared muscle activity between groups and Cohen’s d effect size was calculated. All analyses were done using SPSS with significance set at p ≤ 0.05. Specifically, participants with IL tightness had reduced activation of the RF (p = 0.01) and SOL (p = 0.003) during feed-forward action and increased activation of the MF compared to the normal group (p = 0.008). During feed-back action, those with IL tightness demonstrated increased activation of the GM (p = 0.01), BF (p = 0.03), AM (p = 0.01) and MF (p = 0.017), whereas showing reduced activation of the RF (p = 0.02) and SOL (p = 0.01). Subtle differences were observed in how adolescent soccer players with iliopsoas tightness utilize their lower extremity muscles through kinetic chains during single-leg landing compared to healthy controls. These findings enhance our understanding of the complex functional consequences of iliopsoas tightness on motor control changes and underscore the importance of monitoring the effectiveness of interventions aimed at joint protection in this specific demographic.
... The quantification of the modified Thomas test most often includes goniometric [7,8,13,[17][18][19] and trigonometric [8,20] methods and the digital photography method [1,21,22]. Here, we also mention two attempts [23,24] of kinematic analysis of modified Thomas tests using a 3D automated optoelectronic system. Two-dimensional goniometry is considered the gold standard and is performed using a goniometer or inclinometer [25]. ...
Background/Objectives: The flexibility deficits of hip flexors have been identified as potential biomechanical risk factors for the lumbo–pelvic–hip complex, with postural repercussions on the trunk and lower limbs. The purpose of this study was to conduct a single gravity stretching experiment and to monitor its acute and prolonged effects. Methods: The sample comprised 14 healthy participants (8 females and 6 males). Data were collected during two-day measurement sessions. These analyzed via Kinovea software. The single intervention (i.e., gravity stretching) was performed on the first day. A modified Thomas test was used at the same time in two ways, both as a measurement and as an intervention tool. Stretching was achieved by relaxing in a position to perform the modified Thomas test where, each participant lies completely relaxed for 3 min, allowing gravity to stretch the hip flexors of the examined limb. Results: After intervention, a significant acute increase in hip extension range of motion and a decrease in knee extension range of motion were found. We did not find any significant prolonged effects; moreover, after 48 h, the hip range of motion almost returned to the initial value. Conclusions: A single 3 min stretch is very effective in terms of achieving immediate changes in the range of motion, but insufficient for long-term improvements in flexibility.
... 36 If coaches are unsure how to check for changes in pelvic alignment, a blood pressure cuff positioned under the athlete's lumbar spine and inflated to 60 mmHg may be used as a tool for controlling pelvic rotation. 19 During this variation, the athlete must maintain the pressure as they extend the hip. ...
Strength and Conditioning (S&C) coaches must possess a skillset that allows them to assess the physical preparedness of their athletes. This requires the assessment of numerous physical qualities, with testing procedures that produce objective data that is both reliable and valid. Traditionally, assessments for mobility have necessitated palpatory skills that most S&C coaches do not possess, along with the use of specialised equipment. The aim of this article is to illustrate that neither are essential, providing coaches with the toolbox to execute range of motion (ROM) assessments that will allow them to perform a thorough gap analysis, along with identifying the success of their programmes for improving an athlete’s mobility.
... In a more recent investigations, universal goniometers and digital inclinometers are increasingly used for measuring hip extension ROM (Avrahami & Potvin, 2014;Ferber et al., 2010;Mills et al., 2015;Roach et al., 2013). One positive factor is that the utilization of goniometer with hip measurement has been reported to demonstrate concurrent validity when compared to 2D video motion capture system (Moreside & McGill, 2011). Also, measurements using goniometer have a good intra-rater reliability with Intra-class Correlation Coefficients (ICC>0.80). ...
... This is true in a physical rehabilitation scenario, where the patient participates in periodic physical activities to recover movement, as well as in a post surgery scenario, where the physician wants to assess the effect of the intervention on the joint [1]. Patient's physical examination usually includes palpation and evaluation of the passive ROM of the joint under investigation using standard goniometers or inclinometers [2], [3]. Unfortunately, this process may lack precision because the clinician has no direct access to the joint (i.e, external measurement). ...
We present a visualization tool for human motion analysis in augmented reality. Our tool builds upon our previous work on joint biomechanical modelling for kinematic analysis, based on optical motion capture and personalized anatomical reconstruction of joint structures from medical imaging. It provides healthcare professionals with the in situ visualization of joint movements, where bones are accurately rendered as a holographic overlay on the subject-like if the user has an "X-ray vision"-and in real-time as the subject performs the movement. The tool also provides a recording mechanism for the examination and acquisition of movements and range of motion information. Recorded information can be for instance retrieved at a later moment to assess patient's progress in terms of kinematics during the rehabilitation phase. We also propose an intuitive non-sequential mean of navigating through recordings. It consists of pointing at movement trajectories for easy and intuitive retrieval of the meaningful portions of a movement. This tool allows for the post hoc replay and analysis of fast movements, such as from athletes movements in sports injury evaluation. Currently, hip and knee joints are supported.
... A blood pressure cuff was placed under the lumbar spine and inflated to 60 mmHg, at which it was maintained for the duration of the measurement to ensure a stable lumbar spine. 20 The test hip was of 120 seconds. This duration is similar to the study of MacDonald et al., 2 but different insofar as they split it into two sets. ...
Background: Self-massage is a ubiquitous intervention similar to massage, but performed by the recipient his or herself rather than by a therapist, most often using a tool (e.g. foam roller, roller massager). Self-massage has been found to have wide range of effects. It is particularly known for increasing flexibility acutely, although not always. The variability of the results in previous studies may potentially be a function of the tool used. Recent findings also suggest that self-massage exerts global effects. Therefore, increased flexibility should be expected in the areas adjacent to the ones treated.
Purpose: To investigate the acute effects of foam rolling and rolling massage of anterior thigh on hip range-of-motion (ROM), i.e. hip extension and hip flexion, in trained men.
Methods: Eighteen recreationally active, resistance trained males visited the lab on two occasions. Each session included two baseline ROM measures of passive hip flexion and extension in a randomized fashion. Recording of baseline measures was followed by the intervention of the day, which was either foam rolling or rolling massage as per randomization. Immediately post intervention, passive hip flexion and hip extension ROM were reassessed. In order to assess the time course of improvements in ROM, hip flexion and hip extension ROM were reevaluated at 10, 20, and 30 minutes post-intervention.
Results: Hip flexion and hip extension ROM increased immediately following both interventions (foam rolling or roller massager) and remained increased for 30 minutes post intervention. Foam rolling was statistically superior in improving hip flexion and hip extension ROM immediately post intervention. However, immediately post-intervention was the only time point that exceeded the minimum detectable change for all interventions and measures.
Conclusions: Both foam rolling and rolling massage appear to be effective interventions for improving hip flexion and extension ROM when applied to the anterior thigh, but the observed effects are transient in nature.
Level of evidence: 2b
Key words: Flexibility, foam rolling, rolling massage, self-manual therapy, self-myofascial release
... Importantly, they compared 3D video based measurements with standard goniometer for hip extension and found a high correlation between the measurements (r 2 =.88). 35 This provides increased validity for use of common clinical tools in assessing hip ROM. The inclinometer used in this study has been found to be a valid and reliable tool for assessing hip ROM. ...
Non-specific low back pain is a common condition often without a clear mechanism for its presentation. Recently more attention has been placed on the hip and its potential contributions to non-specific chronic low back pain (NSCLBP). Emphasis in research has mainly been placed on motor control, strength and endurance factors in relation to NSCLBP. Limited focus has been placed on hip mobility and its potential contribution in subjects with NSCLBP.
The aim of this study was to compare passive ROM in hip extension, hip internal rotation, hip external rotation and total hip rotation in active subjects with NSCLBP to healthy control subjects. The hypothesis was that active subjects with NSCLBP would present with decreased total hip ROM and greater asymmetry when compared to controls.
Two group case controlled.
Clinical research laboratory.
30 healthy subjects without NSCLBP and 30 active subjects with NSCLBP. Subjects categorized as NSCLBP were experiencing pain in the low back area with or without radicular symptoms of greater than three months duration.
Passive hip extension (EXT), hip internal rotation (IR), hip external rotation (ER) and total hip rotation ROM. A digital inclinometer was used for measurements.
There was a statistically significant difference (p<0.001) in hip passive extension ROM between the control group and the NSCLBP group bilaterally. Mean hip extension for the control group was 6.88 bilaterally. For the NSCLBP group, the mean hip extension was -4.28 bilaterally. This corresponds to a difference of means between groups of 10.88. There was no statistically significant differences (p>0.05) in hip IR, ER, or total rotation ROM between groups.
The results of this study indicate that a significant difference in hip extension exists in active subjects with NSCLBP compared to controls. It may be important to consider hip mobility restrictions and their potential impact on assessment of strength in NSLBP subjects. Future studies may be needed to investigate the relationship between measurements and intervention strategies.
2b.
Improved understanding is required on how hip fracture risk is influenced by landing configuration. We
examined how hip impact dynamics was affected by hip joint kinematics during simulated sideways falls.
Twelve young adults (7 males, 5 females) of mean age 23.5 (SD = 1.5) years, participated in pelvis release
experiments. Trials were acquired with the hip flexed 15◦ and 30◦ for each of three hip rotations: +15◦ (“external
rotation”), 0◦, and − 15◦ (“internal rotation”). During falls, force–deformation data of the pelvis were recorded.
Outcome variables included the peak hip impact force (Fexperimental) and effective stiffness of the pelvis (k1st, ksecant,
and kms) determined with different methods suggested in literature, and predicted hip impact force during a fall
from standing height (F1st, Fsecant and Fms). The two-way repeated-measures ANOVA was used to test whether
these variables were associated with hip joint angles.
The Fexperimental, ksecant and Fsecant were associated with hip rotation (F = 5.587, p = 0.005; F = 9.278, p <
0.0005; F = 5.778, p = 0.004, respectively), and 15 %, 31 % and 17 % smaller in 15◦ external than internal
rotation (848 versus 998 N; 24.6 versus 35.6 kN/m; 2,637 versus 3,170 N, respectively). However, none of the
outcome variables were associated with hip flexion (p > 0.05). Furthermore, there were no interactions between
the hip rotation and flexion for all outcome variables (p > 0.05).
Our results provide insights on hip impact dynamics, which may help improve a hip model to assess hip
fracture risk during a fall.
This book contains the articles published in International Journal of Advanced Joint Reconstruction from 2014 to 2021. International Journal of Advanced Joint Reconstruction was discontinued in October 2021. It was a publication channel aimed to minimize the delay between the generation and publication of research about the locomotive system.
This book compendium of articles aims to thank all the work by the Editorial Team and Reviewers, as well to the Authors who supported this publication during the life of this project.
The content was peer-reviewed, citable, and publicly archived in www.healthyjoints.eu/IJAJR and the Journal achieved indexation in DOAJ.
All the articles in this book are open access and distributed under the Creative Commons Attribution-NonCommercial License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Context:
Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip.
Objective:
To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol.
Design:
A prospective exploratory study.
Setting:
Two research labs.
Patients or other participants:
The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg).
Interventions:
Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week.
Main outcomes measures:
Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test.
Results:
A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM.
Conclusion:
Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.
Joint range of motion (ROM) is commonly measured using goniometry with accepted reference values such as American Academy of Orthopedic Surgeons (AAOS) (Greene & Heckman, 1994). The procedures of obtaining these measures are based on unidirectional and uniplanar passive testing of isolated joint motions in supine, prone or seated positions.
The relationship of such ROM measures to performance have been found to be variable (Craib et al., 1996; Menz, Morris, & Lord, 2006). Utilizing tests of the full kinematic chain from an upright standing position that involve the concurrent use of multiple joints, directions and planes of motion might be one solution to the shortcomings of the traditional ROM testing procedures. Full kinematic chain tests have the advantage of greater specificity to most human movements such as athletic performance.
The Star Excursion Balance Test (SEBT) is a widely accepted test of dynamic postural control and balance (Gribble, Hertel, & Plisky, 2012) that challenges coordination, mobility, and strength (Hubbard, Kramer, Denegar, & Hertel, 2007). However it does not challenge all joint movements at and above the hip (Delahunt et al., 2013), but it offers a platform from which a whole-body mobility and balance test can be created. In the current study we propose a Hand Reach Star Excursion Balance Test (HSEBT), which combines a systematic use of unilateral and bilateral hand reaches, thus also challenging mobility in hip and upper body joints.
The purposes of this study were to (1) provide joint movement reference data for HSEBT; and (2) compare the 22 elicited joint movements of the ankle, knee, hip and spine elicited by HSEBT to ROM reference values and joint movements elicited by SEBT.
Mettler, JH, Shapiro, R, and Pohl, MB. Effects of a hip flexor stretching program on running kinematics in individuals with limited passive hip extension. J Strength Cond Res XX(X): 000-000, 2018-Tightness of the hip flexor muscle group may theoretically contribute to altered kinematics of the lumbo-pelvic-hip (LPH) complex during dynamic movements. Therefore, the purpose of this study was to analyze the effects of a 3-week home-based stretching program on passive hip extension and sagittal plane kinematics of the LPH complex when running. Twenty healthy subjects with limited passive hip extension underwent a 3D gait analysis both before (PRE) and after (POST) a hip flexor stretching program. After the stretching program, passive hip extension increased significantly (p < 0.001), whereas no improvements during running were reported for active hip extension, anterior pelvic tilt, or lumbar spine extension (p ≥ 0.05). In addition, no relationship was found between the change in passive hip extension with either the change in active hip extension, anterior pelvic tilt, or lumbar spine extension. A 3-week static stretching program of the hip flexor muscle group resulted in an increase in passive hip extension, but the sagittal plane kinematics of the LPH complex during running remained unchanged. The results suggest that passive hip joint flexibility may be of limited importance in determining the kinematics of the LPH complex during submaximal running. However, it is possible that an increase in the range of motion at the hip may be beneficial when running at or near maximal speeds.
The application of scientific principles to the study of the hip has provided insight into morphologic and biomechanical factors compromising hip function, including acquired abnormalities (e.g., posttraumatic deformities, Perthes disease, slipped capital femoral epiphysis), developmental pathologies (e.g., developmental dysplasia of the hip [DDH]), and abnormalities of unknown origin (e.g., cam deformity of the femoral head-neck junction and pincer deformities of the acetabular margin).
However, the response of biologic tissues to repetitive overload is a function of both bony morphology and external loading and thus the nature and frequency of patients’ activities. Thus the stresses developed within the tissues are a function of the external forces acting on the body, the muscle forces required to generate joint motion, and the area of contact between the articulating surfaces of the femur and the acetabulum. These basic principles may provide insight into the pathomechanics of common hip conditions.
For example, developmental dysplasia is characterized by reduced coverage of the femoral head by a shallow, inclined acetabulum. The reduced area of the weight-bearing surface leads to high contact stresses and overloading of the labrum and hip capsule, leading to joint degeneration. On the other hand, femoroacetabular impingement is seen in hips with normal (cam) or excessive (pincer) coverage. In these joints, pathologic changes occur when joint motion is driven beyond the limit imposed by impingement between the femur and the acetabular margin, often with degeneration of the labro-chondral junction leading to delamination of the articular surface. And at the opposite extreme, the unstable hip is typically encountered in patients with hyperlaxity leading to excessive joint motion due to loss of the normal capsular restraints that work in concert with the bony structures of the joint to prevent subluxation.
In this chapter we present a biomechanical perspective to each of these pathologic conditions after first discussing the essentials of the joint forces, motions, and tissues that form the basis of normal hip function.
Hip range of motion is an important component in assessing clinical orthopedic conditions of the hip, low back and lower extremities. However it remains unclear as to what constitutes the best tool for clinical measurement. The purpose of this study was to investigate the concurrent validity of passive range of motion (ROM) measurements of hip extension and hip internal and external rotation using a digital inclinometer and goniometer.
Criterion Standard.
Clinical research laboratory.
30 healthy subjects without pain, radicular symptoms or history of surgery in the low back or hip regions.
Passive hip range of motion for extension, hip internal rotation and hip external rotation. A digital inclinometer and universal goniometer were utilized as the tools for comparisons between measurements.
There was a statistically significant difference (p < 0.05) between the goniometer and digital inclinometer in measured hip ROM except for measurements of right hip external rotation (p > 0.05). The mean difference between the goniometer and digital inclinometer in left hip extension, internal rotation and external rotation were 3.5°, 4.5° and 5.0° respectively. The mean difference between the two devices in right hip extension, internal rotation and external rotation were 2.8°, 4.2° and 2.6° respectively. On average, the difference between the goniometer and digital inclinometer in extension was 3.2°, internal rotation was 4.5° and external rotation was 3.8°. The digital inclinometer had greater measurement during EXT and ER. Furthermore, there was no statistically significant difference (p > 0.05) in hip ROM between the left and right side for either goniometric or digital inclinometer measurements.
This results of this study indicate that a significant difference exists between the two devices in all measurements with exception of right hip extension. The differences were noted to be between 3-5 degrees for all planes measured. These findings suggest that caution should be used if these two devices are to be used interchangeably to quantify passive hip range of motion in either clinical practice or when comparing studies that utilize different instruments.
2b.
: The purpose of this study was to analyze the transference of increased passive hip ROM and core endurance to functional movement. 24 healthy young men with limited hip mobility were randomly assigned to 4 intervention groups: 1)Stretching; 2)Stretching plus hip/spine disassociation exercises; 3)Core endurance; 4)Control. Previous work has documented the large increase in passive ROM and core endurance that was attained over the 6 week interventions, but whether these changes transferred to functional activities was unclear.Four dynamic activities were analyzed before and after the 6 week interventions: active standing hip extension, lunge, a standing twist/reach maneuver, and exercising on an elliptical trainer. A Vicon motion capture system collected body segment kinematics, with hip and lumbar spine angles subsequently calculated in Visual 3D. Repeated measures ANOVAs determined group effects on various hip and spine angles, with paired t-tests on specific pre/post pairs.Despite the large increases in passive hip ROM, there was no evidence of increased hip ROM utilized during functional movement testing. Similarly, the only significant change in lumbar motion was a reduction in lumbar rotation during the active hip extension manoeuvre (p< 0.05).These results indicate that changes in passive ROM or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on 'grooving' new motor patterns if new found movement range is to be utilized.
Groin pain commonly affects football players and can be associated with prolonged recovery periods. Understanding the relationship between groin pain and reliable measures of hip flexibility and strength may facilitate the development of optimal rehabilitation and prevention strategies. In this study, the reliability and association with athletic groin pain of hip flexibility and strength measures were investigated.
A cohort of 29 football players (15-21 years) participating in junior elite competitions (Australian Rules football and soccer) were recruited. The intra-rater reliability (n=13) and inter-rater reliability (n=12) of various hip flexibility (bent knee fall out test, hip internal rotation, hip external rotation) and strength (hip abduction, hip internal rotation, hip external rotation, hip adduction (squeeze test)) measures were investigated using intraclass correlation coefficients (ICC). Reliable hip flexibility and strength measures were compared between football players with (n=10) and without (n=19) groin pain.
The bent knee fall out test, hip internal rotation flexibility and the squeeze test demonstrated acceptable (ICC>0.75) intra-rater and inter-rater reliability, while hip external rotation flexibility and hip abduction strength demonstrated acceptable intra-rater but not inter-rater reliability. Hip internal and external rotation strength tests were not found to be reliable. Football players with groin pain had significantly reduced force production on the squeeze test (p>0.05).
Several hip flexibility and strength measures were found to be reliable. Only the squeeze test discriminated between football players with and without groin pain.
Abnormal joint mobility is an important factor in movement dysfunction and physical disability. Because the decision to treat impaired joint mobility in an older individual may be influenced by assumptions concerning normal range of motion (ROM) at older ages, it is important to establish population-based normative values for hip and knee ROM by age, race, and sex. This study used data from the first National Health and Nutrition Examination Survey (NHANES 1), which involved a national probability sample of persons drawn from the civilian noninstitutionalized population of the United States. Goniometric measurements of hip and knee active range of motion (AROM) were obtained from a subset of the sample consisting of 1,892 subjects. This analysis was limited to the 1,313 white and 370 black subjects. Univariate statistics, weighted by the probability of selection into the sample, were calculated for 12 sex-race-age-group-specific categories. These normal AROM values for the hip and knee calculated from this population based sample were found to differ from estimates found in textbooks by as much as 18 degrees. With one exception, normal values for all motions were lower in the oldest age group than in the youngest age group. The differences in mean AROM were generally small, ranging from 3 to 5 degrees. Only in the case of hip extension did the difference in mean AROM between the youngest and the oldest age groups constitute a decline of more than 20% of the arc of motion. With the possible exception of hip extension, this study supports the conclusion that, at least to age 74 years, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging and therefore should be treated much as it would be in a younger individual.
A general lack of descriptive details exists for measurements of hip rotation range of motion. This study was designed to establish the influence of gender and hip flexion position on active range of motion of the hip in external and internal rotation. Sixty (39 females and 21 males) healthy college-age (21.8 +/- 1.7 years) subjects were studied. Hip rotation of the dominant leg of each subject was measured in the prone (hip near 0 degree of flexion) and seated (hip near 90 degrees of flexion) positions using a standard goniometer. Data were analyzed using an analysis of variance model. Pearson's r statistics were used to determine the degree of association between measurements of hip rotation made seated vs. prone. A statistically significant difference (p < 0.05) was found between mean hip external rotation (ER) measured seated (36 +/- 7 degrees) and mean hip ER measured prone (45 +/- 10 degrees). Conversely, mean hip internal rotation (IR) measured seated (33 +/- 7 degrees) was not statistically different than mean hip IR measured prone (36 +/- 9 degrees). Females had statistically more active hip internal and external rotation than males (p < 0.05). A moderate degree of association existed between measurements of hip ER taken in the prone vs. seated position (r = 0.57, p < 0.05). For IR, the degree of association between the two measurement positions was slightly higher (r = 0.72, p < 0.05). Unlike the amount of active hip internal rotation which showed little difference between measurements made prone vs. seated, our data indicate that measurement position had a significant effect on the amount of active range of motion of the hip in ER. These findings are clinically significant for they stress the importance of documenting measurement position. They also stress the need for representative norms to be established for each hip position and gender.
Objectives: Pre-season or pre-participation screening is commonly used to identify intrinsic risk factors for sports injury. Tests chosen are generally based on clinical experience due to the paucity of quality injury risk factor studies for sport and, often, the reliability of these clinical tests has not been established. The purpose of this study was to establish the reliability of eight, musculoskeletal screening tests, commonly used in the screening protocols of elite-level Australian football clubs.Methods: Fifteen participants (n=9 female, n=6 male) were tested by two raters on two occasions, 1 week apart to establish the inter-rater and test–retest reliability of the chosen measurement tools. The tests of interest were Sit and Reach, Active Knee Extension, Passive Straight Leg Raise, slump, active hip internal rotation range of movement (ROM), active hip external rotation ROM, lumbar spine extension ROM and the Modified Thomas Test.Results: All tests demonstrated very good to excellent (Intraclass correlation coefficient, ICC 0.88–0.97) inter-rater reliability. Test–retest reliability was also shown to be good for these tests (ICC 0.63–0.99).Conclusion: The findings suggest that these simple, clinical measures of flexibility and ROM are reliable and support their use as pre-participation screening tools for sports participants.
This paper deals with the experimental problems related to the reconstruction of the position and orientation of the lower limb bones in space during the execution of locomotion and physical exercises. The inaccuracies associated with the relative movement between markers and underlying bone are analysed. Quantitative information regarding this movement was collected by making experiments on subjects who had suffered fractures and were wearing either femoral or tibial external fixators. These latter devices provided frames that were reliably rigid with the bone involved, and hence the possibility of assessing the relative movement between markers mounted on the skin and this bone. Anatomical frames associated with thigh and shank were reconstructed using technical frames based on different clusters of skin markers and their rotation with respect to the relevant bone evaluated. Marker movement was also assessed in subjects with intact musculoskeletal structures using digital videofluoroscopy.
To determine if there is evidence of abnormal hip joint range of motion (ROM) in youth and senior team professional footballers compared with matched controls.
A case control study design was used.
40 professional footballers (20 youth and 20 senior team) and 40 matched control subjects.
Bilateral measurements of passive hip internal rotation (IR), external rotation (ER), flexion, abduction and extension were made together with Faber's test and the hip quadrant.
Youth and senior footballers had significantly less IR and Faber's range and significantly higher abduction than their respective controls (p < 0.001). Senior footballers also had significantly reduced IR (p < 0.05) and Faber's (p < 0.001) than the youth team. A higher proportion of senior footballers had positive hip quadrants (45% of all hips) compared to all other groups. No significant difference in hip ROM was found between dominant and non-dominant legs.
A specific pattern of hip ROM was found in professional footballers which appeared to be different from controls. These changes may demonstrate the early stages of hip degeneration to which it has been shown ex-professional players are prone to. Hip joint ROM exercises may be necessary in these players to restore normal movement and prevent the onset of hip osteoarthritis (OA).
The focus of this experimental study was to compare muscular tightness at the hip between runners and nonrunners, and to determine if there is a relation between muscular tightness and low back pain in runners. Goniometric range of motion measurements of three hip movements, abduction, flexion with the knee extended, and extension, were taken on two subject populations, runners (N = 45), and nonrunners (n = 43), in order to determine tightness of the hip adductor, extensor, and flexor muscles, respectively. The mean score values obtained for each of the three measurements for both the right and left sides were compared for differences between the running and nonrunning populations and between male and female subjects. Runners were found to be significantly limited in the movement of hip flexion with the knee extended. The mean score values obtained for all male subjects for this movement were lower than those for all female subjects. The incidence of low back pain in runners was examined; however, no correlation could be drawn between muscular tightness in these subjects and low back pain. J Orthop Sports Phys Ther 1985;6(6):315-323.
This study determined the intratester and intertester variability and reliability of goniometric measurements taken by four physical therapists on upper and lower extremity motions of normal male subjects. The same subjects were measured once weekly for four weeks by testers with varied experience in goniometry. Data were analyzed by analyses of variance with repeated measures. Intratester variation for all measurements was less than intertester variation. Further, intertester variation was less for the three upper extremity motions than for those of the lower extremity. These findings indicate the necessity for using the same tester when effects of treatment are evaluated. When the same tester measures the same movement, increases in joint motion of at least three to four degrees determine improvement for either the upper or lower extremity. When more than one tester, however, measures the same movement, increases in joint motion should exceed five degrees for the upper extremity and six degrees for the lower extremity to determine improvement.
The purpose of this study was to characterize and classify the prevalence of passive hip rotation range-of-motion (ROM) asymmetry in healthy subjects (n = 100) and in patients with low back dysfunction (n = 50). We categorized the subjects of both groups as having one of three patterns of hip rotation. Pattern IA existed when all ROM measurements were equal (within 10 degrees). Pattern IB existed when total medial and lateral rotation were equal, but one or more of the individual measurements were unequal. Pattern II existed when total medial rotation ROM was greater than total lateral rotation ROM. Those subjects with total lateral rotation ROM greater than total medial rotation ROM demonstrated pattern III. The distribution of subjects among the ROM pattern categories was significantly different in the patient and healthy subject groups. The frequency of occurrence of pattern III was greater in the patient group than in the healthy subject group. These results suggest an association between hip rotation ROM imbalance and the presence of low back pain.
Anthropometric factors, spinal and limb-joint mobility, and trunk strength were measured in young students--55 men and 48 women (mean age 21.4 years, SD 1.6). Twenty-six of the men and 29 of the women had had back pain during the preceding year and they were compared with those without back pain. In the male back-pain group, extension, lateral flexion and the sum of mobility in the lumbar spine, and hip flexion and external rotation of the shoulders were significantly smaller. In the female back-pain group, extension and the sum of mobility in the thoracic spine, and extension, external rotation, and the sum of mobility in the hips were significantly diminished. Anthropometric factors and trunk strength had no significant relationship with a history of back pain except for a pronounced lordosis in women. The results suggest that ligamentous or capsular stiffness of the joints may be associated with low back pain in young adults.
The purpose of this study was to determine the varia bility and reliability of joint measurements as carried out by three physician observers. The intratester variation and reliability of nine different joint measurements was determined in eight healthy subjects. The measure ments were taken in eight sessions by each tester. In this population also the intertester variation and relia bility was determined by the three observers. This was also done in a population of middle-aged athletes over a period of 2.5 years.
The results indicate that it is difficult to show either an improvement or worsening of a joint motion of less than 5° to 10° for most joints measured by the same tester. The intertester variation is not consistent over a longer period of time, so differences between observers during long-term studies cannot be corrected on the basis of a single study at a single point in time. The reliability of all nine joint measurements is not very high, but is probably sufficient if the results are used to compare groups within a single population and for large studies with experienced observers. Because the reli ability strongly depends on the interindividual variation, it is preferable to determine the reliability for each study population.
An age associated decline in joint mobility during the early and middle adult years is well documented, however, little information exists on the progress of this aspect of joint function during old age. Active and passive ranges of 10 lower limb joint motions were measured in 80 healthy, active men and women aged from 70 years, to examine the relationship between the capacity for joint movement and age, gender, and type of motion. Joint mobility declined consistently as age increased, with women generally having greater movement capability than their male peers. The predominant trend was for a more rapid reduction in mobility during the ninth decade. Passive ranges were larger than those produced actively, and the pattern of change in both measurement modes was parallel over the age range. It is hypothesized that the consistent decline in mobility indicates the importance of biological aging of articular structures as a primary cause of increasing resistance to movement, while environmental causes, such as changing activity status, are suggested by the variation in the magnitude and patterns of change over the age range.
Two series of healthy men were measured for range of passive motion of hip flexion, hip extension, hip abduction, knee flexion, and ankle dorsiflexion with the knee extended and flexed. Hip abduction was measured with a specially constructed double protractor goniometer, and the other movements were gauged with a flexometer. In series A measurements were based upon a commonly used clinical method. The intratester interassay coefficient of variation in series A was 7.5 +/- 2.9%, which corresponded well with other reports. In series B posture and measuring procedures were rigidly standardized by better fixation and by identification and marking of anatomical landmarks. The interassay coefficient of variation in series B was reduced to 1.9 +/- 0.7%. Range of motion measurement was repeated accurately by the same tester with methods requiring careful measurement technique but no elaborate equipment.
To test the hypothesis that reduced hip extension range during walking, representing a limiting impairment of hip tightness, is a consistent dynamic finding that (1) occurs with increased age and (2) is exaggerated in elderly people who fall.
Using a 3-dimensional optoelectronic motion analysis system, we compared full sagittal plane kinematic (lower extremity joint motion, pelvic motion) data during walking between elderly and young adults and between elderly fallers and nonfallers. Comparisons were also performed between comfortable and fast walking speeds within each elderly group.
A gait laboratory.
Twenty-three healthy elderly subjects, 16 elderly fallers (otherwise healthy elderly subjects with a history of recurrent falls), and 30 healthy young adult subjects.
All major peak joint angle and pelvic position values.
Peak hip extension was the only leg joint parameter measured during walking that was both significantly lower in elderly nonfallers and fallers than in young adult subjects and was even lower in elderly fallers compared with nonfallers (all p <.05). Peak hip extension +/- standard deviation during comfortable walking speed averaged 20.4 degrees +/- 4.0 degrees for young adults, 14.3 degrees +/- 4.4 degrees for elderly nonfallers, and 11.1 degrees +/- 4.8 degrees for elderly fallers. Peak hip extension did not significantly improve when elderly subjects walked fast.
An isolated and consistent reduction in hip extension during walking in the elderly, which is exaggerated in fallers, implies the presence of functionally significant hip tightness, which may limit walking performance. Overcoming hip tightness with specific stretching exercises is worthy of investigation as a simple intervention to improve walking performance and to prevent falls in the elderly.
This paper deals with methodological problems related to the reconstruction of the position and orientation of the human pelvis and the lower limb bones in space during the execution of locomotion and physical exercises using a stereophotogrammetric system. The intention is to produce a means of quantitative description of joint kinematics and dynamics for both research and application. Anatomical landmarks and bone-embedded anatomical reference systems are defined. A contribution is given to definition of variables and relevant terminology. The concept of anatomical landmark calibration is introduced and relevant experimental approaches presented. The problem of data sharing is also addressed. This material is submitted to the scientific community for consideration as a basis for standardization. RELEVANCE: In order to make movement analysis effective in the solution of clinical problems, a structured conceptual background is needed in addition to standardized definitions and methods. Technical solutions which make data sharing and relevant data banks possible are also of primary importance. This paper makes suggestions in this context.
When using optoelectronic stereophotogrammetry, skin deformation and displacement causes marker movement with respect to the underlying bone. This movement represents an artifact, which affects the estimation of the skeletal system kinematics, and is regarded as the most critical source of error in human movement analysis. A comprehensive review of the state-of-the-art for assessment, minimization and compensation of the soft tissue artifact (STA) is provided. It has been shown that STA is greater than the instrumental error associated with stereophotogrammetry, has a frequency content similar to the actual bone movement, is task dependent and not reproducible among subjects and, of lower limb segments, is greatest at the thigh. It has been shown that in in vivo experiments only motion about the flexion/extension axis of the hip, knees and ankles can be determined reliably. Motion about other axes at those joints should be regarded with much more caution as this artifact produces spurious effects with magnitudes comparable to the amount of motion actually occurring in those joints. Techniques designed to minimize the contribution of and compensate for the effects of this artifact can be divided up into those which model the skin surface and those which include joint motion constraints. Despite the numerous solutions proposed, the objective of reliable estimation of 3D skeletal system kinematics using skin markers has not yet been satisfactorily achieved and greatly limits the contribution of human movement analysis to clinical practice and biomechanical research. For STA to be compensated for effectively, it is here suggested that either its subject-specific pattern is assessed by ad hoc exercises or it is characterized from a large series of measurements on different subject populations. Alternatively, inclusion of joint constraints into a more general STA minimization approach may provide an acceptable solution.
Eight healthy male subjects had intra-cortical bone-pins inserted into the proximal tibia and distal femur. Three reflective markers were attached to each bone-pin and four reflective markers were mounted on the skin of the tibia and thigh, respectively. Roentgen-stereophotogrammetric analysis (RSA) was used to determine the anatomical reference frame of the tibia and femur. Knee joint motion was recorded during walking and cutting using infrared cameras sampling at 120Hz. The kinematics derived from the bone-pin markers were compared with that of the skin-markers. Average rotational errors of up to 4.4 degrees and 13.1 degrees and translational errors of up to 13.0 and 16.1mm were noted for the walk and cut, respectively. Although skin-marker derived kinematics could provide repeatable results this was not representative of the motion of the underlying bones. A standard error of measurement is proposed for the reporting of 3D knee joint kinematics.
Findings from previous studies suggest gender may affect the pattern of hip and lumbopelvic motion during a multi-segmental movement. To date, no studies have examined movement patterns and low back pain symptom behavior during hip lateral rotation.
Forty-six people (27 males and 19 females) with low back pain were examined. Three-dimensional kinematic data and low back pain symptoms were recorded during active hip lateral rotation. Percent of maximum lumbopelvic rotation was calculated for each 10% increment of maximum active hip lateral rotation.
Men exhibited a greater percent of maximum lumbopelvic rotation (mean 49.3, SD 13.3) during the first 60% of hip lateral rotation than women (mean 36.2, SD 16.4) (P < 0.01). Nineteen (70.4%) of the men and seven (36.8%) of the women had pain with the hip lateral rotation test (P = 0.02).
Men exhibited more lumbopelvic rotation in the early part of hip lateral rotation than women, and hip lateral rotation was more likely to be associated with symptoms in men than women. Greater lumbopelvic motion, earlier in hip lateral rotation, may make men more vulnerable to low back pain associated with hip lateral rotation. Factors that contribute to these gender differences should be investigated further.
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