Influence of hamstring length on the standing position and flexion range of motion of the pelvic angle, lumbar angle, and thoracic angle

Effect of stretch positions on hamstring muscle length, lumbar flexion range of motion, and lumbar curvature in healthy adults

Hamstring stretching is a common practice in physical therapy to change not only hamstring muscle length (HML), but also lumbar flexion range of motion (LROM) or lumbar curvature (LC). Yet limited published research compares the effectiveness of two commonly used hamstring stretch positions, sitting and standing. The purposes of this study were to determine the effect of (1) stretch position on HML; and 2) HML on LROM and LC. Thirty-six participants (M=44.8 years, SD=17.1) with short HML (i.e., with shortness for men ≥45° and for women ≥ 24° of active knee flexion with 90° hip flexion) were measured for HML, LROM, and LC; randomly allocated to one of three groups: (1) hamstring stretching in sitting (SI); (2) standing (ST); or (3) no stretching (control); and remeasured after 4 weeks. Participants in the stretching groups performed two 30-second static stretches 4 days per week for 4 weeks. Multivariate analysis of covariance (MANCOVA) showed significance between the stretching groups and nonstretching group for HML only. Nonsignificance was shown for HML between the stretch positions (i.e., SI-active knee extension (AKE) and ST-AKE), indicating that both were equally effective for increasing HML. However, there was no change in LROM or in LC even though HML increased.

A COMPARATIVE STUDY OF LUMBAR RANGE OF MOVEMENT IN HEALTHY ATHLETES AND NON-ATHLETES

Objective: To compare the amplitude of trunk flexion and extension through goniometry among athletes and non-athletes and to correlate these data with the popliteal angle and hamstring muscle tests. Methods: The amplitude of trunk flexion and extension was evaluated in 50 individuals who practiced sports on a regular basis and 50 non-athletes who did not present any painful lumber symptoms or any symptoms that could affect test performance. The measurements were made consecutively by two independent examiners by means of goniometry. The trunk flexion and extension values from the goniometry evaluation were correlated with the popliteal angle and hamstring flexibility tests, and the statistical correlation between them was analyzed. Results: The mean values obtained were 130.7 (101.9) for flexion and 40.2 (36.4) for extension. Statistically significant differences between the athletes and non-athletes were found in relation to the following parameters: goniometer in flexion with examiner 1, goniometer in flexion with examiner 2 and hamstring test. No statistically significant differences were found between the two groups in relation to the following parameters: goniometer in extension with examiner 1, goniometer in extension with examiner 2 and popliteal angle test. Conclusion: Individuals who practiced sports presented higher trunk flexion values. The use of goniometry to measure trunk amplitude showed variations in measurements between the examiners.

Postural correction by osteoporosis orthosis (Osteo-med): a randomized, placebo-controlled trial

Currently available therapeutic options for the correction of osteoporotic posture changes are not effective. Rigid or semi-rigid orthoses are only applicable in the early phase after vertebral body fractures, and the knowledge about the efficacy of flexible spinal orthoses is limited. Therefore, the present study is aimed at investigating the efficacy of a flexible spinal orthosis without any stabilizing components in terms of posture improvement. Forty women aged (65.9 +/- 8.4 years) with a proven osteoporosis (DXA < or = -2.5) were randomized to receive either of three treatment regimens: (i) Orthosis (Thämert Osteomed) with paravertebral/lumbosacral air chamber pads (as commercially available); (ii) The same orthosis without air chamber pads; and (iii) Placebo body stocking. Measurements were performed with a 3D real-time ultrasound topometry system (Zebris(R) CMS 70). The posture correction was substantially and significantly more marked in the first group (38% of the maximally possible intentional erection) as compared to the second (21%) and third group (13%). The orthosis with air chamber pads causes a clinically meaningful trunk support in patients with osteoporotic posture changes. Since the device contains no rigid stabilizing elements, the change in posture is considered to be a result of muscle activation due to sensomotor stimulation by the air chamber pads.

Regional changes in spine posture at lift onset with changes in lift distance and lift style

STUDY DESIGN

Repeated measures experiment.

OBJECTIVE

To determine the effect of changes in horizontal lift distance on the amount of flexion, at lift onset, in different spine regions when using different lift styles.

SUMMARY OF BACKGROUND DATA

By approximating spine bending during lifting as a pure rotation about a single revolute joint, the differential effects of task constraints and instructions on motions of different spine levels will be obscured.

METHODS

Eight participants lifted a 10-kg crate from the floor, 10 times at each of five distances. Participants were instructed to use freestyle (a participant's preferred lift style), squat, or stoop lift styles. Kinematic data were collected from the mid thoracic spine, lower thoracic/upper lumbar spine, mid lumbar spine, and the lower lumbar spine at lift onset. A whole spine angle was also calculated.

RESULTS

Flexion of the lower lumbar spine was not affected by lift distance and style. Differences between lift styles occurred mainly in the mid thoracic and the lower thoracic/upper lumbar regions. With increasing horizontal distance, changes in lift style occurred in the upper three spine regions.

CONCLUSIONS

These results suggest that the tensile strain on tissues in the lower lumbar spine, which can be a cause of injury in lifting, was not affected by lift style or horizontal lift distance when lifting from floor level.

A comparison of the spine posture among several sit-and-reach test protocols

The purpose of the study was to compare the thoracic and lumbar spine posture among different sit-and-reach tests. Fifty-eight men and 47 women were asked to perform three trials of sit-and-reach test (SR), toe-touch test (TT), back-saver sit-and-reach test (BS) right and left, unilateral seated sit-and-reach test (USR) right and left, and V sit-and-reach test (VSR). Thoracic and lumbar angles were assessed with an inclinometer when subjects reached forward maximally. Women had a lower thoracic angle than men on all tests (p<0.05). No differences were found in the lumbar angle between genders. The thoracic angle was the highest in VSR (75.3 degrees in men and 65.8 degrees in women) and the lowest in TT (61.7 degrees in men and 53.1 degrees in women). No differences were found among some pairwise comparisons (SR-BS in both genders, SR-TT, SR-VSR and others in women). The VSR test presented the highest values in lumbar spine when compared to other tests (30.5 degrees in men and 32.0 degrees in women). Unilateral seated sit-and-reach test presented the lowest lumbar angle in men (24.2 degrees for right leg and 23.9 degrees for left leg) and women (23.9 degrees in both legs) and there were significant differences with respect to the other tests. Characteristics and administration procedures of tests, such us uni- or bilateral, sitting or standing, measuring with or without box, parallel or V position, and hip position influence thoracic and lumbar postures.

Morning warming-up exercise--effects on musculoskeletal fitness in construction workers

The aim of the present study was to evaluate the effects on muscle stretchability, joint flexibility, muscle strength and endurance in construction workers of a 3-month period of a 10-min morning warming-up exercise (MWU), performed at the building site every working day. Thirty construction workers participated in the program. Seventeen construction workers at other building sites served as controls. Muscle stretchability, joint flexibility, muscle strength and endurance were measured before and after the program. Significant increase of thoracic and lower back mobility, increase of hamstring and thigh muscle stretchability were seen in the MWU group. A significant difference in back muscle endurance was found due to decreased endurance in the controls. Muscular strength was not influenced by the MWU. The results indicate that a short dose of morning warming-up exercise could be beneficial for increasing or maintaining joint and muscle flexibility and muscle endurance for workers exposed to manual material handling and strenuous working positions.

Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial

OBJECTIVES

To use a randomised, double blind, placebo controlled trial to establish the effect on straight leg raise, hip internal rotation, and muscle pain of dry needling treatment to the gluteal muscles in athletes with posterior thigh pain referred from gluteal trigger points.

METHODS

A randomised, double blind, placebo controlled trial of 59 male runners was performed during the 2002 Australian Rules football season. Subjects were thoroughly screened and had magnetic resonance imaging of their hamstring muscles to exclude local pathology. The inclusion criterion was reproduction of recognisable posterior thigh pain with the application of digital pressure to the gluteal trigger points. Subjects randomly received either therapeutic or placebo needle treatment on one occasion at their gluteal trigger points. Range of motion and visual analogue scale data were collected immediately before, immediately after, 24 hours after, and 72 hours after the intervention. Range of motion was measured with passive straight leg raise and hip internal rotation. Visual analogue scales were completed for hamstring and gluteal pain and tightness at rest and during a running task.

RESULTS

Magnetic resonance imaging scans revealed normal hamstring musculature in most subjects. Straight leg raise and hip internal rotation remained unchanged in both groups at all times. Visual analogue scale assessment of hamstring pain and tightness and gluteal tightness after running showed improvements immediately after the intervention in both groups (p = 0.001), which were maintained at 24 and 72 hours. The magnitude of this improvement was the same for therapeutic and placebo interventions. Resting muscle pain and tightness were unaffected.

CONCLUSIONS

Neither dry needling nor placebo needling of the gluteal muscles resulted in any change in straight leg raise or hip internal rotation. Both interventions resulted in subjective improvement in activity related muscle pain and tightness. Despite being commonly used clinical tests in this situation, straight leg raise and hip internal rotation are not likely to help the therapist assess response to treatment. Patient reports of response to such treatment are better indicators of its success. The mechanisms by which these responses occur and the reasons for the success of the placebo needling treatment are areas for further investigation.

Effects of low back pain on the relationship between the movements of the lumbar spine and hip

Previous research had examined the effects of back pain on spinal movements, but information concerning movement coordination between the lumbar spine and hips was limited. The purpose of this study was to examine the effects of back pain and limitation in straight leg raise on the relationship between the movements of the lumbar spine and hip. An electromagnetic tracking system was employed to measure the movements of these joints in asymptomatic subjects (n = 20), and back pain subjects with (n = 24) and without (n = 17) limitation in straight leg raise. Subjects were requested to perform forward, backward and side bending, and twisting of the trunk. Back pain subjects were found to exhibit significant reductions in the magnitude of spine movements in all directions. Back pain was also associated with decrease in the magnitude of hip flexion but not hip movements in other directions. Cross-correlation analysis showed that there were changes in the strength of correlation and the time lag between lumbar spine and hip motions in normal and back pain subjects. In addition, back pain and limitation in straight leg raise were found to cause significant increases in the time required to complete the trunk movements. It was concluded that clinical assessment and treatment planning should take into account of the effects of back pain on the relationship between spine and hip movements.

Scheuermann kyphosis: the importance of tight hamstrings in the surgical correction

STUDY DESIGN

A historic cohort study of the sagittal alignment in 33 consecutive patients with surgically corrected thoracic Scheuermann kyphosis.

OBJECTIVES

To determine if postsurgical imbalance, sagittal malalignment, and decreased lumbar-pelvic range of motion in patients with thoracic Scheuermann kyphosis is related to tight hamstrings.

SUMMARY OF BACKGROUND DATA

Tight hamstrings are a frequent sign in Scheuermann kyphosis. The importance of tight hamstrings in the surgical management of Scheuermann kyphosis has not yet been studied.

METHODS

Thirty-three patients with Scheuermann kyphosis were managed by surgical correction and fusion. Tight hamstrings, lumbar-pelvic range of motion, and sagittal balance were evaluated. Sixteen patients had tight hamstrings, and 17 patients had nontight hamstrings. Hamstrings were considered tight if the popliteal angle was >30 degrees.

RESULTS

Patients with tight hamstrings have a significantly greater risk of postoperative imbalance (P = 0.05), and these patients can only compensate for this risk by reducing their lumbar lordosis (P = 0.0227). Furthermore, the limitations in the lumbar and pelvic range of motion are predicted by tight hamstrings (P <or= 0.005).

CONCLUSION

Tight hamstrings can be considered as an important factor in the surgical management of thoracic Scheuermann kyphosis. Tight hamstring patients can be classified as "lumbar compensators" and as such are prone to overcorrection and imbalance. Preoperative assessment of the lumbar-pelvic range of motion and tight hamstrings should therefore be advised. Extensive fusion of the lumbar segments might compromise the lumbar compensation mechanism and induces further risk of imbalance.

Pelvic and femoral contributions to bilateral hip flexion by subjects suspended from a bar

OBJECTIVE

To quantify the contribution of the pelvis and femur to active bilateral hip flexion conducted while subjects are suspended by their hands from a bar.

DESIGN

Descriptive and experimental.

BACKGROUND

Voluntary hip flexion while in a suspended position is used in abdominal strengthening regimens and is required for certain athletic activities. The degree to which pelvic rotation contributes to this maneuver has not been established.

METHODS

Pelvic and femoral motions were documented in 14 subjects who performed bilateral hip flexion while they hung by their hands from a bar. A supporting board as well as the trunk, pelvis and thigh were marked with reflective spheres; motion of the pelvis and thigh relative to the board was captured by video analysis. Ratios of pelvic to femoral motion were calculated and the influence of hamstring length (<78 degrees vs >78 degrees of straight leg raising) and knee position (flexed vs extended) on the ratio was determined.

RESULTS

The mean pelvifemoral ratio ranged from 0.131 to 0.355, depending on hamstring length and knee position. Pelvic rotation therefore contributed a mean 13.1-35.5% of the observed hip flexion. A 2 x 2 mixed-model analysis of variance showed that the ratio was influenced significantly by each of these two independent variables. The largest pelvic contribution occurred during hip flexion with the knee in the extended position among subjects with shorter hamstrings.

CONCLUSIONS

Pelvic motion is an integral part of hip flexion conducted while subjects are suspended their hands from a bar. The pelvic contribution depends on knee position and hamstring length.

RELEVANCE

During suspended activities involving hip flexion (e.g. gymnastics), pelvic rotation plays an integral role throughout the range. Inherent or imposed differences in hamstring length can alter the contribution of the pelvis to the motion. Hip flexion, therefore, might be influenced by conditions affecting the ability of the pelvis to rotate (e.g. spinal fusion), or the femur to move on the pelvis (e.g. degenerative joint disease), or be altered by hamstring tension.

Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation

BACKGROUND CONTEXT

Maintenance of normal lumbar lordosis is important in the treatment of spinal disorders. Many attempts have been made to quantify normal sagittal spinal alignment and lordosis using a C7 plumb line and segmental angulations of the spinal vertebrae. Little attention has been given to pelvic compensation as it correlates to lumbar lordosis and overall sagittal spinal alignment. Better methods of measuring lordosis, which correlate with sagittal spinal balance and pelvic compensation, are needed in treating patients with spinal disorders.

PURPOSE

To determine the correlation between lumbopelvic lordosis, pelvic rotation and sagittal spinal balance and standardize a method for measuring lumbopelvic lordosis, sacral translation, and sagittal spinal alignment.

STUDY DESIGN

Sagittal alignments using the C7 plumb line, Cobb angles, sacral plumb line and the pelvic radius (PR) technique were used to measure standing 36-inch lateral radiographs of patients with various spinal disorders.

PATIENT SAMPLE

A review of the records identified 62 patients with various spinal pathologies presenting to the (RGW) spine clinic that had standing lateral spine radiographs. Only radiographs that allowed positive identification of the C7 vertebral body, the entire thoracolumbar spine, the sacrum and both femoral heads were studied. These criteria allowed inclusion of 28 subjects in this study. The final population had 12 women and 16 men with an average age of 52 years (SD, 16.6 years; range, 20 to 84 years).

OUTCOME MEASURES

No outcomes measures were used in this study.

METHODS

Measurements for sagittal spinal balance and lumbopelvic lordosis were made on 36-inch standing lateral radiographs of adult patients. Measurements included the C7 plumb line, segmental angulations of spinal vertebrae (Cobb angles), sacral translation and the PR technique for lumbopelvic lordosis. Data were analyzed for significant correlation between lumbopelvic lordosis, sagittal spinal balance, sacral translation and total segmental lumbar lordosis using the Cobb method.

RESULTS

Our population averaged 50 degrees of total segmental lumbar lordosis from L1 to S1 (SD, 14.3; maximum, 89.5; minimum, 17.9). Nearly 75% of total segmental lumbar lordosis measured from L1 to S1 can be accounted for through the L4 to S1 superior end plates and 47% through L5 to S1 superior end plates in our population. Total segmental lumbar lordosis correlated with total thoracic kyphosis (r=0.45, p=.008). Total segmental lumbar lordosis measured by the Cobb method significantly correlated with sagittal spinal balance (r=-0.35, p=.022) and sacral translation (r=0.41, p=.016). Measurements for lumbopelvic lordosis significantly correlated with sagittal spinal balance (r=-0.33, p=.042), sacral translation (r=-0.70, p=.00002) and total segmental lumbar lordosis (r=0.82, p<.000001). Measurements for sacral translation and sagittal spinal balance also correlated significantly (r=0.35, p=.034).

CONCLUSIONS

Sacral translation, the C7 plumb line and lumbopelvic lordosis are useful measures for sagittal spinal balance. Lumbopelvic lordosis and sacral translation can be correlated to the sagittal spinal balance. Understanding these measurements and the range of lumbopelvic compensation can be extremely helpful in treating patients with spinal pathology and in avoidance of flatback deformity. Application of these measures would be especially helpful in the treatment of patients with spinal fusion, degenerative spondylosis, disc disease, fractures, and in the prevention of sagittal malalignment.

Passive extensibility of skeletal muscle: review of the literature with clinical implications

The purpose of this article was to review the literature on passive extensibility of skeletal muscle with reference to its anatomic and physiologic properties, mechanisms of adaptations and clinical implications. Studies with animal muscles have shown that passive extensibility is influenced by the size (mass) and length of muscle fibers, and the amount and arrangement of the connective tissues of the muscle belly. The resistance to passive lengthening is influenced by the readily adaptable amount of muscle tissue, including the contractile proteins and the non-contractile proteins of the sarcomere cytoskeletons. The relationship of adaptable changes in the muscle tissue and in the extracellular connective tissues remains unclear. Muscle length adaptations result from changes in the number of sarcomeres in series, which depend on the imposed length of muscles, not on the level of muscle activation and tension. This mechanism of muscle length adaptations, termed 'myogenic', has not been demonstrated in human muscles, but it has been intimated by therapeutic lengthening studies showing that both healthy and neurologically impaired human muscles can undergo increased length adaptations in the presence of muscle activations. Studies have suggested that optimal muscle function is probably achieved by increasing muscle length, length extensibility, passive elastic stiffness, mass and strength, but additional studies are needed to investigate these relationships, particularly for aged muscles and for muscles affected by clinical disorders, disease and injury. Such studies could contribute to the development of new intervention strategies designed to promote the passive muscle extensibility that enhances total muscle function, and ultimately improves the ability to complete functional activities and excel in athletic performances.

Range of motion and lordosis of the lumbar spine: reliability of measurement and normative values

STUDY DESIGN

Repeated measures for intratester reliability were performed.

OBJECTIVES

To investigate the intratester reliability of a new measurement technique that evaluates lumbar range of motion in three planes using a pelvic restraint device, and to examine the reliability of lumbar lordosis measurement by inclinometer technique. Preliminary normative data on lumbar range of motion and lumbar lordosis were collected for comparison with the findings of previous studies.

SUMMARY OF BACKGROUND DATA

Various noninvasive measurement methods have been developed for recording lumbar range of motion. However, pelvic movement was not effectively restricted during the use of these measurement techniques. The use of the pelvic restraint device to measure lumbar range of motion has not been investigated previously. Very few studies have investigated the reliability of quantifying lumbar lordosis by the inclinometer technique.

METHODS

Normative values were measured in 35 healthy men, and 12 of these subjects were included for the reliability study. Pelvic motion was limited by the pelvic restraint device during lumbar range of motion measurement in standing. An inclinometer was used for evaluation of lumbar flexion, extension, lateral flexion, and lumbar lordosis, whereas a lumbar rotameter was used to measure axial rotation.

RESULTS

Good intratester reliability was shown in the lumbar range of motion and lordosis measurement. Most of the intraclass correlation coefficient and Pearson's r values (accompanied with nonsignificant paired t tests) were greater than 0.9, and most of the intrasubject coefficients of variation were less than 10%. The values of lumbar range of motion in three planes and lumbar lordosis found in the current study were comparable with those from most of the previous studies on these measurements in the normal population.

CONCLUSIONS

Inclinometer and lumbar rotameter measurements with the use of a pelvic restraint device are reliable for measuring lumbar spine range of motion. Use of the inclinometer technique to record lumbar lordosis also is a reliable measure.

The relationship between tight hamstrings and lumbar hypolordosis in children with cerebral palsy

STUDY DESIGN

Retrospective clinical and radiographic review.

OBJECTIVE

To assess the influence of tight hamstrings on the sagittal alignment of the thoracic and lumbar spine in children with cerebral palsy.

SUMMARY OF BACKGROUND DATA

It is postulated that tight hamstrings may produce a hypolordosis of the lumbar spine. The abnormal sagittal contour of the spine may lead to increased stresses in the lumbar spine and subsequent pain and disability. This is of special concern in children with cerebral palsy who often have shortened spastic hamstring muscles.

METHODS

Twenty-one patients were evaluated, with a mean age of 9.4 years. Standing and sitting lateral spine films were obtained and the lumbar lordosis and thoracic kyphosis were measured using the Cobb method. The popliteal angle was measured to assess hamstring tightness, such that a large popliteal angle indicates tight hamstrings.

RESULTS

We found a statistically significant correlation between the sitting lumbar curve and popliteal angle (Pearson correlation value -0.77, P < 0.01). As the popliteal angle increased, the amount of lumbar lordosis decreased. This correlation was less significant when the patient was standing (Pearson correlation value -0.59).

CONCLUSION

This study demonstrates that there is a correlation between tight hamstrings, as measured by the popliteal angle, and decreasing lumbar lordosis, especially when sitting.

Forward leaning reaching task in sitting (FLRS): a new measure for clinical evaluation of hamstring length in children

BACKGROUND AND PURPOSE

In this study, the rotation of the pelvis was taken into account when assessing the length of hamstrings. A new measure for clinical evaluation was developed to establish reference values of hamstring length in children without movement disabilities for different age groups. Subjects (N = 60) were 3-, 6-, 10- and 14-year-old children (N = 15 for each age group). These values could be helpful in deciding treatment interventions in children with movement disabilities, for example cerebral palsy, when hamstring length is in question.

METHOD

The study was performed with subjects sitting and reaching for a touch control on a wall whilst voluntarily rotating the pelvis forwards. By use of digitized video frames, the spatial angles of the lumbar spine and pelvis, as well as the joint angles of hip and knee, were computed at the initial and end positions of a forward leaning reaching task in sitting (FLRS). The active forward leaning induced a forward rotation of the pelvis, causing stretch on the hamstring muscle with extended knee.

RESULTS

The results of spatial and joint angle measurements suggest that the difference of the hip joint angle between initial erect and final forward leaned sitting may be used as reference values for hamstring length. Reference values are based on the mean (+/- SE) of means (mean of 15 children, that is, group and individual means of ten trials).

CONCLUSIONS

The age group reference values obtained may indirectly give information as to whether the hamstring length of a child with cerebral palsy is within the normative value of age-related control subjects. The new test developed in this study provides a convenient means for measuring hamstring length and could enhance clinical evaluation.

A non-invasive protocol for the determination of lumbosacral vertebral angle

OBJECTIVE: The purpose of this study was to develop a non-invasive method to predict the lumbosacral and vertebral angles. DESIGN: The candidate predicting variables were the externally measured marker angle, pelvic angle, and lumbosacral angle. BACKGROUND: Several investigators used surface rigid markers to represent the angles of lumbosacral vertebrae. Previous studies show a high level of validity for measuring the lumbar curvature during stance and for obtaining the vertebral angle in the lumbar region. However, our review of literature failed to find a data transformation model illustrating the lumbosacral vertebral angle using external measurements as predictors. METHODS: Sixteen healthy male subjects participated in the radiographic and videographic measurements. Data of 12 of the 16 subjects were used for model development, and data of the other four subjects were used for model validation. RESULTS: The results showed significant differences between the directly measured vertebral angle from the X-ray film and the externally measured angles of the surface markers at the L(5) and S(1) levels (P<0.05). Linear regression models for calculating vertebral angles were developed with R(2) values of 0.97, 0.98, 0.91, and 0.92 for the vertebral levels of L(1), L(3), L(5), and S(1) respectively. The validation result showed that there was no significant difference between the calculated and the X-ray data. CONCLUSIONS: The protocol of using the skin-surface rigid markers and the predicting models was justified in the study to provide a simple and valid non-invasive method for the recording of the internal vertebral angle in the sagittal plane. RELEVANCE: Measurements of lumbosacral vertebral angle are important in assessing the stresses acting on the low back in lifting. The results of this study provided a simple and valid non-invasive method by rigid markers for the prediction of internal vertebral angles under various trunk positions.