Hip rotation range of motion in sitting and prone positions in healthy Japanese adults

Concurrent validation of the Xsens IMU system of lower-body kinematics in jump-landing and change-of-direction tasks

Inertial measurement units (IMUs) allow for measurements of kinematic movements outside the laboratory, persevering the athlete-environment relationship. To use IMUs in a sport-specific setting, it is necessary to validate sport-specific movements. The aim of this study was to assess the concurrent validity of the Xsens IMU system by comparing it to the Vicon optoelectronic motion system for lower-limb joint angle measurements during jump-landing and change-of-direction tasks. Ten recreational athletes performed four tasks; single-leg hop and landing, running double-leg vertical jump landing, single-leg deceleration and push off, and sidestep cut, while kinematics were recorded by 17 IMUs (Xsens Technologies B.V.) and eight motion capture cameras (Vicon Motion Systems, Ltd). Validity of lower-body joint kinematics was assessed using measures of agreement (cross-correlation: XCORR) and error (root mean square deviation and amplitude difference). Excellent agreement was found in the sagittal plane for all joints and tasks (XCORR > 0.92). Highly variable agreement was found for knee and ankle in transverse and frontal plane. Relatively high error rates were found in all joints. In conclusion, this study shows that the Xsens IMU system provides highly comparable waveforms of sagittal lower-body joint kinematics in sport-specific movements. Caution is advised interpreting frontal and transverse plane kinematics as between-system agreement highly varied.

Patellar Instability

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Certain anatomic factors, such as patella alta, increased tibial tubercle-trochlear groove distance, rotational deformity, and trochlear dysplasia, are associated with an increased risk of recurrent patellar instability.

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The presence of a preoperative J-sign is predictive of recurrent instability after operative management.

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Isolated medial patellofemoral ligament reconstruction may be considered on an individualized basis, considering whether the patient has anatomic abnormalities such as valgus malalignment, trochlear dysplasia, or patella alta in addition to the patient activity level.

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More complex operative management (bony or cartilaginous procedures) should be considered in patients with recurrent instability, malalignment, and certain anatomic factors.

Association between femoroacetabular impingement syndrome and limited lateral hip rotation in young athletes: A case-control study

PURPOSE

Hip pain is very common in athletes. One of the main disorders causing hip pain is femoroacetabular impingement syndrome. This study aimed to identify a new etiological risk factor for femoroacetabular impingement in the hip.

METHODS

This case-control study included 88 young athletes, 34 with pains in the hip (supposedly with femoroacetabular impingement) and 54 controls. Femoroacetabular impingement was diagnosed with a flexion, adduction, internal, and rotation test and a particular type of hip pain during sports activities. The medial (internal) and lateral (external) hip ranges of rotation have been measured with an inclinometer. The data were analyzed using a t-test, the Wilcoxon test, the Mann-Whitney U test, and logistic regression.

RESULTS

There is a statistically significant difference in the external hip rotation range between the athletes with hip pain and controls. Logistic regression analysis showed that external hip range of motion is significantly associated with femoroacetabular impingement.

CONCLUSION

Limited external hip range of motion was found to be significantly associated with the diagnosis of femoroacetabular impingement in young athletes. A biomechanical explanation of the hypothesis that limited external hip rotation can predict femoroacetabular impingement is given. Based on our results, the hip's lateral range of motion screening can be advised within the regular screening of young athletes. Kinesiotherapeutic procedures for stretching the muscles of the medial hip rotors can be advised to prevent the lateral hip rotation restriction and lower the risk of femoroacetabular impingement in case the limited rotation is due to muscular restriction.

LEVEL OF EVIDENCE

level III-case-control study.

The effects of wearing high heeled shoes on the muscles and joints of lower limb

Study aim: The aim of this study is to investigate whether the lower extremity muscles’ force/torque/strength and range of motion may be affected in females wearing high heeled shoes and not wearing high heeled shoes.

Material and methods: The study was carried out with 136 females aged between 18 and 45 years. The first group consisted of 66 females wearing 5 cm or higher high heeled shoes. The second group consisted of 70 females wearing shoes having heel height less than 5 cm. The Nicholas Manual Muscle Tester was used to evaluate lower extremity muscle force/torque/strength, while range of motion was assessed with an electronic goniometer. The SPSS 21.0 program was used for statistical analysis.

Results: A significant difference was found in the lower extremity muscles’ force (except for hip adduction, dorsiflexion, metatarsophalangeal joint and interphalangeal joint extension), and muscles’ torque (except for hip adduction, dorsiflexion and left tibialis anterior muscle) and muscles’ strength values (except for hip adduction, dorsiflexion and tibialis anterior muscle). Also, as heel height increased, the range of motion of hip joint flexion, internal rotation and plantar flexion increased significantly.

Conclusions: Excessive use of high heeled shoes can cause changes in muscle force/torque/strength and joint range of motion.

Differences in the total hip rotation range of motion between sides in healthy young Japanese adults

[Purpose] To investigate the difference by degrees in total hip rotation range of motion (ROM) between sides and with regard to gender in healthy young Japanese adults. [Participants and Methods] Data from previously published studies were used. We utilized the left and right hip rotation ROM of 205 Japanese participants aged 18 to 25 years, who satisfied the inclusion criteria and were randomly measured three times in the prone position by the double-blind method. The average value of the three measurements was used to calculate the left–right difference of the hip total rotation ROM in the hip joints, which is the sum of the hip internal and external rotation ROM. We investigated the distribution of the total hip rotation considering the flexibility factor and its relationship with gender. [Results] We confirmed that there were seven participants with 2 SD or more and two with 3 SD or more. No significant difference was found in the left–right difference in the total hip rotation ROM, regardless of gender. [Conclusion] The distribution of left–right differences in the total hip rotation ROM in healthy young adults showed the existence of a significant left–right difference of 2 SD or more.

Influence of Total Knee Arthroplasty on Hip Rotational Range of Motion

BACKGROUND

Total knee arthroplasty (TKA) aims to correct the rotation, as well as the alignment and articulation, of the osteoarthritic knee. We hypothesized that, in addition to improving knee kinematics, TKA affects hip rotational movement. The objective of this study was to evaluate variation in lower extremity alignment and hip rotational range of motion (ROM) after TKA.

METHODS

A total of 47 patients (53 knees) with primary varus knee osteoarthritis who were scheduled for primary TKA at our center were enrolled. Hip rotational ROM was measured with the patient in supine position with 90° flexion of the hip and knee before and 3 weeks after TKA. Plain radiography and computed tomography were used to compare variations in tibial axis alignment and femoral axis alignment after bone resection, which was defined as changes in the joint lines of the distal femur and the proximal tibia.

RESULTS

Average internal ROM, and the sum of internal and external hip rotational ROM, increased significantly; however, external hip rotational ROM did not significantly differ after TKA. Imaging findings showed that the axis of the lower leg externally rotated by 2.5°, with a 4° internal rotation of the distal femur and a 6.5° correction of the varus deformity.

CONCLUSION

TKA changed the neutral position of hip rotational movement and increased hip rotational ROM.

Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study

OBJECTIVE

Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility.

DESIGN

Cross-sectional.

SETTING

Judo training centres.

PARTICIPANTS

Judokas with (n = 29) and without (n = 33) LBP.

MAIN OUTCOME MEASURES

Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD).

RESULTS

The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP.

CONCLUSION

Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.

Comparison of Protonics™ Knee Brace With Sport Cord on Knee Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial

CONTEXT

Protonics™ knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking.

OBJECTIVE

To compare the effect of Protonics™ knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome.

DESIGN

Randomized controlled trial.

SETTING

Loma Linda University.

PARTICIPANTS

There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m2 participated in the study.

INTERVENTION

Subjects were randomized to 1 of 2 treatment groups, the Protonics™ knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks.

MAIN OUTCOME MEASURES

Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test.

RESULTS

Both groups showed significant improvement in the outcome measures. However, the Protonics™ knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics™ brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction.

CONCLUSIONS

Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics™ knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome.

Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: The STROBE study

Findings about predictors of chronic lower-back pain (CLBP) were inconsistent and inconclusive in previous studies because patients with CLBP are heterogeneous. Subgrouping patients with CLBP, according to a CLBP classification system, might thus clarify the research findings. CLBP in the direction of lumbar flexion movement, that is, the flexion pattern, is common in clinical situations. Therefore, the purpose of this study was to determine the predictors of dysfunction (pain, disability) and health-related quality of life in the flexion pattern subgroup of patients with CLBP.A cross-sectional study of prospectively collected data. One hundred eight subjects in the flexion pattern subgroup of CLBP. Thirteen variables were measured: the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Short Form-36 (SF-36), the Beck Depression Inventory (BDI), hip internal rotation range of motion, hip flexion range of motion, knee extension range of motion, knee extension with dorsiflexion range of motion, ratio forward flexion, knee extension strength, hip extension strength, hip flexion strength, and lumbopelvic stability.The models for predictors of lower-back pain in the CLBP flexion pattern subgroup included knee extension and the BDI as predictor variables that accounted for 8.1% of the variance in the VAS (P < .05); predictors for disability included the BDI, age, and hip flexion strength, which accounted for 21.2% of the variance in the ODI (P < .05); predictors for health-related quality of life included the BDI, sex, knee extension with dorsiflexion range of motion, and age, which accounted for 38.8% of the variance in the SF-36 (P < .05) in multiple regression models with a stepwise selection procedure.The current results suggest that knee extension, the BDI, age, hip flexion strength, knee extension with dorsiflexion, and sex should be considered when determining appropriate prediction, prevention, and intervention in the flexion pattern subgroup of patients with CLBP.

Reliability of Hip Rotation Range of Motion in Supine and Seated Positions

CONTEXT

Hip rotation range of motion (ROM) is commonly assessed in individuals with lower extremity or spine pathology. It remains unknown which hip rotation ROM testing position is most reliable.

OBJECTIVE

To compare interrater and intrarater reliabilities between hip internal rotation (IR) and external rotation (ER) ROM in supine and seated positions.

STUDY DESIGN

Controlled laboratory study.

SETTING

University research laboratory.

PARTICIPANTS

A total of 19 participants (11 females and 8 males; age = 23.5 [1.2] y; height = 173.2 [8.6] cm; and mass = 69.2 [13.4] kg) without hip, knee, low back, or sacroiliac pain within the preceding 3 months or history of hip or low back surgery were recruited.

INTERVENTIONS

Three testers obtained measures during 2 testing sessions. Passive supine and seated hip IR and ER ROM were performed with the hip and knee flexed to 90°.

MAIN OUTCOME MEASURES

The primary outcome measures were hip IR and ER ROM in supine and seated positions (in degrees). Interrater and intrarater reliabilities were calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated. Differences between supine and seated hip IR and ER ROM values were assessed using paired t tests (significance level was .05).

RESULTS

Supine hip IR and ER ROM interrater and intrarater reliabilities were excellent (ICC = .75-.91). Seated hip IR ROM interrater and intrarater reliabilities were good (ICC = .64-.71). Seated hip ER ROM interrater reliability was good (ICC = .65), and intrarater reliabilities were good to excellent (ICC = .65-.82). Minimal detectable change values for supine and seated hip IR and ER ROM ranged from 6.1° to 8.6°. There were significant differences between supine and seated positions for hip IR and ER ROM (41.6° vs 44.5°; P < .01 and 53.0° vs 44.2°; P < .01, respectively).

CONCLUSION

Supine hip rotation had higher interrater and intrarater reliabilities. Hip IR and ER ROM values differed significantly between supine and seated positions and should not be used interchangeably.

Relationship between the change in one-leg standing time due to visual information interception and hip joint internal rotation pattern

[Purpose] To clarify the relationship between the laterality of one-leg standing time (OLST) due to blocking of visual information and the laterality of hip internal rotation (IR) range of motion (ROM). [Subjects and Methods] The study included 101 young healthy male and female students. Hip IR ROM was classified into three patterns using left and right differences. Regarding OLST, differences between the left and right measured values with eyes open and closed were classified into three patterns. The matching rate between hip IR ROM laterality pattern and OLST laterality pattern was examined with eyes open and closed. The matching rate of the OLST laterality pattern with hip IR ROM laterality pattern in an imbalanced group was examined. [Results] A significant difference was observed between eyes open and closed conditions in the matching rates of OLST and Hip IR ROM laterality patterns in the imbalanced group. In the imbalanced group, the pattern on the side where the Hip IR is greater changes to coincide with the pattern on the side where the OLST is longer, under the eyes closed condition. [Conclusion] OLST on the side of greater Hip IR ROM tends to be longer due to visual information interception.

Ipsilateral patterns of the rotational range of motion of the hip in healthy Japanese adults

[Purpose] This study aimed to categorize the internal and external rotation range of motion (ROM) of ipsilateral hip joints into specific patterns based on the differences between them, and clarify the distribution of these patterns. [Subjects and Methods] A total of 222 healthy Japanese medical students (162 males, 60 females) with a mean age of 21.2 ± 4.0 years were enrolled. The ROM of internal and external rotation at the hip were randomly measured with the subjects in the prone position. Thereafter, the difference between internal and external rotations was assessed. Hip ROM patterns were classified into 3 types based on the differences in the rotation ROM on each side. A total of 9 overall patterns were then determined based on the combination of patterns on both sides. [Results] Although all the subjects were healthy, an asymmetrical ROM between internal and external rotation in ipsilateral hip joints could be detected via pattern classification. Moreover, the distribution of each hip ROM pattern was clarified. [Conclusion] Pattern classification based on differences in internal and external rotation ROM could serve as a useful evaluation method for clinical manipulative therapy.

Lumbar Thrust Manipulation and Exercise for the Treatment of Mechanical Low Back Pain in Adolescents: A Case Series

Study Design Case series. Background Low back pain (LBP) is an increasing problem in health care. The evidence for the use of spinal manipulative therapy to treat pediatric patients with LBP is minimal. The treatment of pediatrics with manual therapy, particularly spinal manipulation, is controversial within the medical community, primarily with respect to adverse events. The purpose of this case series was to illustrate the feasibility and safety of lumbar manipulation plus exercise in the adolescent population with mechanical LBP. Case Description Three patients-a 13-year-old adolescent girl, 15-year-old adolescent girl, and 13-year-old adolescent boy-were treated in an outpatient physical therapy setting for mechanical LBP. All 3 patients were assessed using a lumbar manipulation clinical prediction rule and treated with sidelying lumbar manipulation and exercise. Outcomes Patients were treated for a total of 10 to 14 visits over a course of 8 to 9 weeks. Pain (measured by a numeric pain-rating scale) and disability (measured by the modified Oswestry Disability Index) improved to 0/10 and 0%, respectively, in each patient. No adverse reactions to manipulation were reported. Discussion The results of this case series describe the use of lumbar thrust manipulation and exercise for the treatment of mechanical LBP in adolescents. The positive results indicate that lumbar manipulation may be a safe adjunct therapy. Further studies, including randomized controlled trials, are needed to determine effectiveness. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(5):391-398. Epub 6 Apr 2016. doi:10.2519/jospt.2016.6366.