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Tokuyasu H, Tsushima E, Takemoto M, Vergari C, Tada H, Kim Y. The Impact of Spinopelvic and Hip Mobility on Passive Hip Flexion Range of Motion Assessment. Arthroplast Today 2024; 29:101429. [PMID: 39328882 PMCID: PMC11424763 DOI: 10.1016/j.artd.2024.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 09/28/2024] Open
Abstract
Background Measuring passive hip flexion range of motion (ROM) is challenging due to compensatory movements. Despite the interest in using functional lateral radiographs for assessing hip mobility, the relationship with passive hip flexion ROM remains unclear. This study aims to elucidate this relationship and clarify spinopelvic parameters and mobility factors influencing variations in passive and radiographic hip flexion ROM. Methods A retrospective cross-sectional study was conducted on 154 preoperative patients undergoing primary total hip arthroplasty. Passive and radiographic hip flexion ROM were assessed to clarify these relationships, and these differences were classified into 3 groups (O, A and U). Spinopelvic and hip parameters were assessed in standing, relaxed-seated and flexed-seated positions, as well as lumbar, pelvis, and hip mobility between each position to identify factors influencing differences. Results There was a moderate correlation between passive and radiographic hip flexion ROM (R2 = 0.48, P < .01). A significant difference was found in pelvic and hip alignment in the flexed-seated position between all groups. In postural changes, the O group, which had more patients with relatively low hip mobility, showed greater lumbar spine and pelvic movement, while the U group, which had more patients with relatively high hip mobility, showed less lumbar spine and pelvic movement. Conclusions This study confirmed that passive hip flexion ROM and radiographic hip flexion ROM correlate and that spinopelvic and hip alignment and mobility influence these differences. This result suggests that clinicians should consider lumbar and pelvic alignment and mobility in clinical practice to improve the accuracy of passive hip flexion ROM measurements.
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Affiliation(s)
- Hiroyuki Tokuyasu
- Department of Rehabilitation, Kyoto City Hospital, Kyoto, Japan
- Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - Eiki Tsushima
- Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Hiroshi Tada
- Department of Rehabilitation, Kyoto City Hospital, Kyoto, Japan
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
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Freiberger C, Thomas CM, Lupica GM, O'Connell S, Stamm MA, Mulcahey MK. Hip Range of Motion During Passive and 1-Leg Exercises Is Greater in Women: A Meta-analysis and Systematic Review. Arthroscopy 2024; 40:495-512.e3. [PMID: 37116553 DOI: 10.1016/j.arthro.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation. METHODS We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women. RESULTS Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men. CONCLUSIONS On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise. LEVEL OF EVIDENCE Level IV, meta-analysis and systematic review of Level II-IV studies.
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Affiliation(s)
- Christina Freiberger
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Christina M Thomas
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Gregory M Lupica
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, Louisiana, U.S.A
| | - Michaela A Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A..
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Nakanishi T, Kato M, Kizawa L, Warashina H, Mitamura S, Kataoka A. Measurement of the normal contralateral hip flexion angle and posterior pelvic tilt angle using a pelvic guide pin in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2023; 106:105982. [PMID: 37207497 DOI: 10.1016/j.clinbiomech.2023.105982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/22/2023] [Accepted: 05/01/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND We aimed to measure the posterior pelvic tilt angle at maximum hip flexion and hip flexion range of motion at the femoroacetabular joint using a pelvic guide pin and to examine the difference in flexion range of motion when determined by a physical therapist and under anesthesia. METHODS Data of 83 consecutive patients undergoing primary unilateral total hip arthroplasty were assessed. Using a pin inserted into the iliac crest to define the cup placement angle under anesthesia before and after total hip arthroplasty, the posterior pelvic tilt angle was determined as the change in pin tilt from the supine position to maximum hip flexion. Flexion range of motion under anesthesia was calculated as the difference in the angle between the trunk and thigh at maximum flexion and the posterior pelvic tilt angle. Flexion range of motion with a fixed pelvis measured preoperatively by a physical therapist was compared to that under anesthesia. A goniometer was used for all measurements and the number of measurements was one. FINDINGS Mean posterior pelvic tilt angle of the pin inserted into the pelvis under anesthesia was 15.8° ± 5.3° (3°-26°) preoperatively and 12.1° ± 4.9° (3°-26°) postoperatively. Mean flexion range of motion under anesthesia was 109.4° ± 6.9° (88°-126°) and that measured by a physical therapist was 101.1° ± 8.2° (80°-120°); the difference was significant (9.7°; p < 0.01). INTERPRETATION These results highlight the difficulty in accurately determining hip flexion angles without the use of special devices and may help surgeons and physical therapists recognize and address this issue.
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Affiliation(s)
- Takumi Nakanishi
- Department of Rehabilitation, Nagoya Joint Replacement Orthopedic Clinic, Japan.
| | - Michitaka Kato
- Department of Orthopaedic Surgery, Nagoya Joint Replacement Orthopedic Clinic, Japan
| | - Lisa Kizawa
- Department of Rehabilitation, Nagoya Joint Replacement Orthopedic Clinic, Japan
| | - Hideki Warashina
- Department of Orthopaedic Surgery, Nagoya Joint Replacement Orthopedic Clinic, Japan
| | - Shingo Mitamura
- Department of Rehabilitation, Nagoya Joint Replacement Orthopedic Clinic, Japan
| | - Akito Kataoka
- Department of Rehabilitation, Nagoya Joint Replacement Orthopedic Clinic, Japan
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Rodrigues GM, Lattari E, Oliveira F, Oliveira BRR, Machado S. Effects of cathodal transcranial direct current stimulation on hip range of motion of healthy sedentary women: A crossover study. Neurosci Lett 2022; 788:136843. [PMID: 35998872 DOI: 10.1016/j.neulet.2022.136843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
The improvements in range of motion (ROM) by cathodal transcranial direct current stimulation (c-tDCS) were only found in sedentary men and not in females. Thus, the study investigated the effect of c-tDCS on hip flexion range of motion (HFROM) in sedentary women. Ten healthy (27.2 ± 6.4 years for age, 67.9 ± 17.8 kg for body mass, 159.1 ± 7.1 cm for height, and 87.1 ± 3.3° for HFROM) and right-leg-dominant women performed a counterbalanced crossover design in two experimental sessions, separated a week apart: c-tDCS and placebo stimulus (sham). Before and after experimental conditions (Pre-stimulation, Post-stimulation), participants had their HFROM measured. A significant interaction was demonstrated for conditions × time (F(1, 9) = 10.666; ƞ2 = 0.542; p = 0.01), indicating an increase in HFROM in the post-condition (89.0 ± 2.6°) compared to pre-condition (86.5° ± 2.9°) only in the c-tDCS. However, the HFROM improvements varied from 0.3 % to 6.5 % following c-tDCS. This study suggests that c-tDCS applied over the sensorimotor cortex of healthy sedentary women can acutely improve HFROM, but with a low percentage increase.
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Affiliation(s)
- Guilherme Moraes Rodrigues
- Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | - Eduardo Lattari
- Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, Brazil; Physical Activity, Health and Performance Research Laboratory, Federal Rural University of Rio de Janeiro, Physical Education and Sports Department, Seropédica, Rio de Janeiro, Brazil
| | - Fernanda Oliveira
- Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | - Bruno Ribeiro Ramalho Oliveira
- Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói, Brazil; Physical Activity, Health and Performance Research Laboratory, Federal Rural University of Rio de Janeiro, Physical Education and Sports Department, Seropédica, Rio de Janeiro, Brazil
| | - Sergio Machado
- Laboratory of Physical Activity Neuroscience (LABNAF), Neurodiversity Institute, Queimados, RJ, Brazil; Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil.
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Patterson CS, Lohman E, Asavasopon S, Dudley R, Gharibvand L, Powers CM. The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift. Musculoskelet Sci Pract 2022; 58:102501. [PMID: 35026497 DOI: 10.1016/j.msksp.2021.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Cross-sectional; Controlled laboratory study. OBJECTIVE To examine the associations among available hip flexion motion, lumbar extensor strength and peak lumbar flexion during a squat lift task. SUMMARY OF BACKGROUND DATA Lumbar spine flexion during lifting can result in increased strain on spinal structures. Although decreased available hip flexion motion and reduced strength of the lumbar extensor muscles has been proposed to contribute to greater lumbar flexion during lifting, direct relationships have not been explored. METHODS Fifty healthy young adults participated (23 males and 27 females). Strength of the lumbar extensors was measured using a motor-driven dynamometer. Available hip flexion was assessed using 3D motion capture. Peak lumbar spine flexion and hip flexion were quantified during the descent phase of the squat lifting task. RESULTS There was a significant negative association between available hip flexion and peak lumbar spine flexion during squat lifting in females (r = -0.407, p = 0.035) but not males (r = -0.341, p = 0.120). Similarly, peak lumbar spine flexion was negatively associated with lumbar extensor strength in females (r = -0.398, p = 0.040) but not males (r = -0.310, p = 0.161). During the squat lift, peak hip motion was positively associated with available hip flexion for both males and females combined (r = 0.774, p < 0.001). CONCLUSION Females with less available hip flexion and lower lumbar extensor strength exhibit greater lumbar flexion when performing a lifting task. Clinicians should be aware of the potential contributions of such impairments when instructing patients into various lifting strategies.
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Affiliation(s)
- Christopher S Patterson
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Everett Lohman
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Skulpan Asavasopon
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA
| | - Robert Dudley
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Lida Gharibvand
- Loma Linda University School of Allied Health Professions, 24951 N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Christopher M Powers
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA.
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FENATO JUNIOR ALEXANDRE, GARCIA LARISSAMARTINS, PERDONÁ GLEICIDASILVACASTRO, MARANHO DANIELAUGUSTO. MEASUREMENT OF PELVIC RETROVERSION DURING HIP FLEXION: EVALUATION WITH ACCELEROMETERS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:69-73. [PMID: 32425667 PMCID: PMC7224317 DOI: 10.1590/1413-785220202801227237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To quantify pelvic retroversion during clinical evaluation of hip flexion
with accelerometers and to verify the reliability of these sensors to
measure hip flexion. Methods: An accelerometer was positioned laterally in the pelvis to measure pelvic
retroversion. Another accelerometer was positioned anteriorly on the thigh
to evaluate hip flexion amplitude. The evaluations were performed with
volunteers in supine position by three raters. For evaluation of pelvic
retroversion, the mean ± SD (minimum-maximum) was calculated. Reliability of
the accelerometer between raters was determined by intraclass correlation
coefficients (ICC). The linear correlation coefficient between hip flexion
was determined by using goniometer and accelerometer. Results: The mean pelvic retroversion was 7.3° ± 0.93° (6°-11°) in the clinical limit
of the hip range of motion, which was 106.25° ± 10.46° (93°-130°). The ICC
between two raters were 0.60, 0.71 and 0.74 (goniometer) and 0.46, 0.71 and
0.83 (accelerometer). The linear correlation between hip flexion
measurements with goniometer and accelerometer was 0.87. Conclusion: During clinical evaluation of the final range of hip flexion, there was an
associated pelvic movement of approximately 7.3º. Accelerometers have proven
to be reliable for measurement of hip flexion. Level of Evidence
III, Study of nonconsecutive patients with no gold reference standard
applied uniformly.
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Freke M, Kemp J, Crossley K, Sims K, Russell T, Semciw A. Strength and range of movement deficits are associated with symptom severity in people scheduled for hip arthroscopy. Eur J Pain 2019; 23:1083-1090. [PMID: 30746810 DOI: 10.1002/ejp.1371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/09/2018] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Identifying the physical impairments associated with worse symptoms and greater functional limitations in people with hip pain could enable targeted rehabilitation programmes designed to improve quality of life. The objective of this study was to compare physical characteristics between subgroups of symptoms and functional limitation severity in individuals with hip pain scheduled for arthroscopic surgery. METHODS Hip range of motion (ROM) and muscle strength were measured in 114 individuals (48 women; aged 32 ± 8 years) with hip pain scheduled for hip arthroscopy. Pain and disability were measured with the International Hip Outcome Tool (iHOT33) subscale of Symptoms and Functional Limitation, and a cluster analysis was used to identify mild, moderate and severe subgroups. Between-group differences were then evaluated using multivariate analysis of covariance, including sex as a covariate, followed by post hoc testing. Significance was set at 0.05. RESULTS Lesser hip muscle strength in all directions was reported in the severe symptoms and functional limitation group compared to the mild group. Hip flexion ROM differed when comparing the moderate to both the mild and severe subgroups. Hip internal rotation did not differ between subgroups of severity. CONCLUSIONS Individuals with hip pain and severe scores in the iHOT33 subscale of symptoms and functional limitations present with significantly lesser hip muscle strength and hip flexion ROM than individuals with moderate or mild scores. Targeted programmes to improve hip strength and flexion ROM in more severe patients may help reduce symptoms and improve function. SIGNIFICANCE Individuals with severe hip pain and functional limitation possess significantly lesser muscle strength and flexion ROM than individuals with moderate or mild scores.
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Affiliation(s)
- Matthew Freke
- Enoggera Health Centre, Gallipoli Barracks, Enoggera, Queensland, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Joanne Kemp
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kay Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kevin Sims
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Adam Semciw
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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