The Effects of Lumbo-pelvic Stabilization on Hip Flexion Range of Motion Measurement

정성훈,하성민 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.2

ABSTRACT Background It is important to regain range of motion (ROM) in a joint is one of the first phases of injury rehabilitation in low back pain with limited hip flexion. Through rehabilitation period, it is necessary to measure accurate hip flexion ROM to confirm patient’s progress and condition or therapeutic effectiveness. Purpose We investigate the difference between measurement of hip flexion ROM with lumbo-pelvic stabilization (HFwLS) and without lumbo-pelvic stabilization (HFwNLS) and to identify the test-retest reliability of HFwLS. Study design Comparative repeated design, Test-retest measures. Methods Twenty one students at Yonsei University participated and Forty one legs recruited in this study. Hip flexion ROM was measured using Smart KEMA motion sensor. Data from the motion sensor were recorded at a 25-Hz sampling frequency and transmitted to an Android tablet running Smart KEMA software. During HFwLS, the subject flexes the hip joint of the measurement side in the supine position with maintaining initial pressure of PBU. PBU is placed on the lumbar spine of the subject in supine position, and the initial value is set to 40 mmHg. Paired t-tests were conducted to compare differences between measurement of hip flexion ROM and HFwLS. Intra-class correlation coefficients [ICCs (3,1)] were used to determine the test-retest reliability of HFwLS. Results There are significant different between HFwNLS and HFwLS (t=10.04; p<0.01). And the test-retest ICC of the HFwLS was 0.97 (CI range from 0.95–0.99) between first and second measurement. Conclusions We suggested that the lumbo-pelvic stabilization could be provided for accurate or reliable measurement of hip flexion ROM measurement without compensatory lumbo-pelvic motion. ABSTRACT Background It is important to regain range of motion (ROM) in a joint is one of the first phases of injury rehabilitation in low back pain with limited hip flexion. Through rehabilitation period, it is necessary to measure accurate hip flexion ROM to confirm patient’s progress and condition or therapeutic effectiveness. Purpose We investigate the difference between measurement of hip flexion ROM with lumbo-pelvic stabilization (HFwLS) and without lumbo-pelvic stabilization (HFwNLS) and to identify the test-retest reliability of HFwLS. Study design Comparative repeated design, Test-retest measures. Methods Twenty one students at Yonsei University participated and Forty one legs recruited in this study. Hip flexion ROM was measured using Smart KEMA motion sensor. Data from the motion sensor were recorded at a 25-Hz sampling frequency and transmitted to an Android tablet running Smart KEMA software. During HFwLS, the subject flexes the hip joint of the measurement side in the supine position with maintaining initial pressure of PBU. PBU is placed on the lumbar spine of the subject in supine position, and the initial value is set to 40 mmHg. Paired t-tests were conducted to compare differences between measurement of hip flexion ROM and HFwLS. Intra-class correlation coefficients [ICCs (3,1)] were used to determine the test-retest reliability of HFwLS. Results There are significant different between HFwNLS and HFwLS (t=10.04; p<0.01). And the test-retest ICC of the HFwLS was 0.97 (CI range from 0.95–0.99) between first and second measurement. Conclusions We suggested that the lumbo-pelvic stabilization could be provided for accurate or reliable measurement of hip flexion ROM measurement without compensatory lumbo-pelvic motion.

Comparison of the Anterior Pelvic Tilting Angle during Forward Bending in Individuals with and without Sciatic Nerve Tension

최규환 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.2

ABSTRACT Background Lumbopelvic rhythm can be affected by several factors, such as stiffness of the hip joint, hamstring, and ankle, and sciatic nerve tension. Currently, no reports indicating that sciatic nerve tension affects the anterior pelvic tilting angle during forward bending are available. Purpose This study aimed to compare the anterior pelvic tilting angle during forward bending in subjects with and without sciatic nerve tension. Study design Cross-sectional comparative study. Methods Eighty-eight subjects were screened and classified into two groups, namely subjects with (12 subjects) and without (12 subjects) sciatic nerve tension. Sciatic nerve tension was measured by the knee extension angle recorded in the seated position with ankle dorsiflexion using the Smart KEMA motion sensor. The mean±standard deviation of the knee extension angle with ankle dorsiflexion in our study population was 66.8±11.8°. The standard deviation was used to define the group with sciatic nerve tension (<55°) and without sciatic nerve tension (>79°). The Smart KEMA motion sensor was placed on the second spinous process of the sacrum to measure the anterior pelvic tilting angle during forward bending. Results The mean values of the knee extension angle with ankle dorsiflexion were 46.6° and 82.9° for the groups with and without sciatic nerve tension, respectively. The mean values of the anterior pelvic tilting angle measured during the forward bending test were 36.7° and 46.5° in the groups with and without sciatic nerve tension, respectively. There was a statistically significant difference in the anterior pelvic tilting angle between the groups with and without sciatic nerve tension (p<0.05). Conclusions The results of this study suggest that sciatic nerve tension can affect the anterior pelvic tilting angle during forward bending. Further studies are needed to determine whether exercise for decreasing sciatic nerve tension can increase the anterior pelvic tilting angle during forward bending.

Effects of Pelvic Compression Belt on Three-dimensional Motions of Pelvic and Trunk during One Leg Standing

김태호,재우민,황병화 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.1

Background Low back pain caused lumbopelvic instability and the passive and active stabilizing system and neural control subsystem control lumbopelvic stability. Purpose The aim of this study was to identify three-dimensional motions of pelvic and trunk during one leg standing applying the pelvic compression belt. Study design One group pre- and post-test design. Methods Twenty three healthy participants volunteered for this study. For the pre-test, their pelvic and trunk motions were measured during one leg standing in stance of the dominant side using equipment without application of pelvic compression belt. The participants wore pelvic compression belt for 20 minutes on a daily basis for a week in standing position to get used to application of pelvic compression belt. After one week training, the participants were measured during one leg standing in stance of the dominant side using equipment with application of pelvic compression belt for the post-test. The three-dimensional motion analysis system was used to measure the motion of anterior-posterior tilt, medial-lateral tilt, and rotation of the pelvis, as well as anterior-posterior flexion, lateral flexion, and rotation of the trunk during one leg standing. Results The motion of anterior-posterior tilt, medial-lateral tilt, and rotation of the pelvis were significantly decreased in the post-test than pre-test during one leg standing (p<0.05). Also the motion of anterior-posterior flexion, lateral flexion, and rotation of the trunk were significantly decreased in the post-test than pre-test during one leg standing (p<0.05). Effect sizes for pelvic anterior-posterior tilt, anterior-posterior flexion, lateral flexion, and rotation of the trunk were medium between pre-test and post-test during one leg standing (d=055–0.75). Conclusions This study found the motions of the pelvis and trunk were decreased by the passive support of the pelvic compression belt during one leg standing. This finding suggests that the pelvic compression belt will help to improve the stability of lumbopelvis in back pain patients with lumbopelvic instability.

Reliability of a New Test of Levator Scapula Muscle Length

송영문,원정혁,정도영 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.1

Background Shortened levator scapula (LS) is a major cause of neck and shoulder pain and reduced motor function. Therefore, measuring LS muscle length is a key element in evaluating patients with shoulder dysfunction. Purpose The purpose of this study was to evaluate the intra- and inter-rater reliability of a newly designed levator scapular length test (LSLT). Study design Intra- and inter-tester repeated measures. Methods We recruited 28 participants in this study. Subjects were divided into two groups: normal scapula length and shortened scapula length. The LS index (LSI) and LSLT were applied twice by one examiner and once by a different examiner. The intraclass correlation coefficient was used to assess intra- and inter-rater reliability of the LSI and LSLT. Pearson’s correlation coefficient was used to evaluate the correlation between the tests. Results The intra-rater reliability scores of LSI and LSLT were 0.95 and 0.98, and the inter-rater test reliability scores were 0.96 and 0.98, respectively. The correlation coefficient was 0.63, indicating a moderate relationship between tests. Conclusions These findings suggest that LSLT is a reliable method for measuring LS length in clinical practice. Background Shortened levator scapula (LS) is a major cause of neck and shoulder pain and reduced motor function. Therefore, measuring LS muscle length is a key element in evaluating patients with shoulder dysfunction. Purpose The purpose of this study was to evaluate the intra- and inter-rater reliability of a newly designed levator scapular length test (LSLT). Study design Intra- and inter-tester repeated measures. Methods We recruited 28 participants in this study. Subjects were divided into two groups: normal scapula length and shortened scapula length. The LS index (LSI) and LSLT were applied twice by one examiner and once by a different examiner. The intraclass correlation coefficient was used to assess intra- and inter-rater reliability of the LSI and LSLT. Pearson’s correlation coefficient was used to evaluate the correlation between the tests. Results The intra-rater reliability scores of LSI and LSLT were 0.95 and 0.98, and the inter-rater test reliability scores were 0.96 and 0.98, respectively. The correlation coefficient was 0.63, indicating a moderate relationship between tests. Conclusions These findings suggest that LSLT is a reliable method for measuring LS length in clinical practice.

The Effectiveness of Hamstring Stretching with Proprioceptive Neuromuscular Facilitation versus Jack-Knife Stretching for Individuals with Hamstring Tightness

오재섭,강민혁 KEMA학회 2021 근골격계과학기술학회 Vol.5 No.1

Background Jack-knife stretching is a newly developed static hamstring stretching exercise. However, no studies have compared this stretching exercise to hamstring stretching with proprioceptive neuromuscular facilitation (PNF). Purpose This study compared the effects of PNF hamstring stretching and jack-knife stretching on hamstring flexibility. Study design Randomized controlled clinical trial Methods Twenty-four adults with bilateral hamstring tightness were randomly assigned to the PNF hamstring stretching or jack-knife stretching group. All participants performed PNF hamstring stretching or jack-knife stretching for 150 s. Before and after hamstring stretching, the participants completed the active knee extension (AKE), active straight leg raise (ASLR), and finger-to-floor distance (FFD) tests. Lumbar flexion and the anterior pelvic tilt angle were measured during the FFD test. Results Both hamstring stretching exercises increased the knee extension angle during the AKE test, hip flexion angle during the ASLR test, and lumbar flexion and anterior pelvic tilt angle during the FFD test while decreasing the FFD value (p<0.05). However, no significant between-group differences were found (p>0.05). Conclusions PNF hamstring stretching and jack-knife stretching have similar beneficial effects on hamstring flexibility.

The Effects of Active Stretching Exercise on Passive Stiffness of Rectus Femoris Muscle and Low Back Pain in Patients with Lumbar Extension Rotation Syndrome

박규남 KEMA학회 2017 근골격계과학기술학회 Vol.1 No.1

ABSTRACT Background A previous literature suggested that increased passive stiffness of rectus femoris muscle (RF) can cause compensatory lumbopelvic motion in sagittal plane or transverse plane during active knee flexion in patients with lumbar extension rotation syndrome (L-ext & rot syn), resulting low back pain. Purpose The purpose of this study was to investigate the effects of active stretching exercise of RF during 6-week on passive muscle stiffness of RF and low back pain in patients with L-ext & rot syn. Study design Pre/post-test design. Methods Twenty patients with L-ext & rot syn were recruited for this study. Passive RF stiffness was measured in pre- and post-stretching period using specially designed motorized pulling machine. Subjective stretch sensation and intensity of low back pain were measured using numeric rating scale. The subjects performed the active RF stretching exercise during 6-week. The significance of the difference between pre- and post-stretching exercises was assessed using repeated one-way analysis of variance. Results Passive RF stiffness and stretch sensation after RF stretching exercise was significantly reduced in subjects with L-ext & rot syn. However, pain intensity of low back during daily activity showed no significant difference between before and after stretching exercise. Conclusions Active RF stretching exercise during 6-week can decrease RF stiffness, but failed to decrease pain intensity of low back during daily activity in patients with L-ext & rot syn.

Comparison of Activities of Tibialis Anterior, Peroneus Longus, and Tibialis Posterior Muscles according to Lunge Squats and Bulgarian Split Squats in a Healthy Population

김용욱,김태현,양민아,원예슬,이지혜 KEMA학회 2017 근골격계과학기술학회 Vol.1 No.1

Background Previous studies reported that one-leg squat has various advantages in functional activities, no study has studied the effect of muscle activity on ankle stability. Purpose The purpose of this study was to investigate the differential effects of squat type on the activity of the tibialis anterior, peroneus longus and tibialis posterior muscle for ankle stability. Study design Cross-sectional study. Methods The participants were 30 healthy adults. During each squat execution, tibialis anterior, peroneus longus and tibialis posterior muscle activities were assessed using surface electromyography under control of each squat posture. Results The muscle activity of the tibialis anterior and peroneus longus applying Bulgarian split squat was significantly higher than lunge squat. However, the activity of the tibialis posterior showed no significance between squat conditions. Conclusions This study demonstrated that Bulgarian squat was more effective at eliciting ankle dorsiflexor and evertor that are known as important role for ankle stability. Background Previous studies reported that one-leg squat has various advantages in functional activities, no study has studied the effect of muscle activity on ankle stability. Purpose The purpose of this study was to investigate the differential effects of squat type on the activity of the tibialis anterior, peroneus longus and tibialis posterior muscle for ankle stability. Study design Cross-sectional study. Methods The participants were 30 healthy adults. During each squat execution, tibialis anterior, peroneus longus and tibialis posterior muscle activities were assessed using surface electromyography under control of each squat posture. Results The muscle activity of the tibialis anterior and peroneus longus applying Bulgarian split squat was significantly higher than lunge squat. However, the activity of the tibialis posterior showed no significance between squat conditions. Conclusions This study demonstrated that Bulgarian squat was more effective at eliciting ankle dorsiflexor and evertor that are known as important role for ankle stability.

The Effect of Pelvic Compression Belt on the Strength of Hip Muscle and EMG Activity in Individuals with Sacroiliac Joint Pain during Prone Hip Extension

최재홍,오재섭,김문환 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.1

ABSTRACT Background Pelvic compression belt passively stabilized the sacroiliac joint via application of a compression force, thereby having a possibility to affect hip muscle strength. Purpose We investigated the effects of pelvic compression belts on the strength of hip extensor and the electromyographic (EMG) activities of latissimus dorsi and erector spinae during isometric prone hip extension with knee extension and prone hip extension with knee flexion. Study design Comparative, repeated measures design. Methods We recruited 15 patients with sacroiliac joint pain. All performed isometric prone hip extension with knee extension with and without a pelvic compression belts at a hip extension of 10°. Strength of hip extensor were measured using a load cell, and the muscle activities of the contralateral latissimus dorsi and erector spinae muscles measured using surface EMG. Results Strength of hip extensor with a pelvic compression belts increased significantly compared to without a pelvic compression belts (p<0.001) as did the EMG activity of the contralateral latissimus dorsi (p<0.05). However, the EMG activity of the contralateral erector spinae did not change significantly (p>0.05). Conclusions We recommend using of a pelvic compression belts by sacroiliac joint pain patients increased the strength of hip extensor and muscle activity of contralateral latissimus dorsi. ABSTRACT Background Pelvic compression belt passively stabilized the sacroiliac joint via application of a compression force, thereby having a possibility to affect hip muscle strength. Purpose We investigated the effects of pelvic compression belts on the strength of hip extensor and the electromyographic (EMG) activities of latissimus dorsi and erector spinae during isometric prone hip extension with knee extension and prone hip extension with knee flexion. Study design Comparative, repeated measures design. Methods We recruited 15 patients with sacroiliac joint pain. All performed isometric prone hip extension with knee extension with and without a pelvic compression belts at a hip extension of 10°. Strength of hip extensor were measured using a load cell, and the muscle activities of the contralateral latissimus dorsi and erector spinae muscles measured using surface EMG. Results Strength of hip extensor with a pelvic compression belts increased significantly compared to without a pelvic compression belts (p<0.001) as did the EMG activity of the contralateral latissimus dorsi (p<0.05). However, the EMG activity of the contralateral erector spinae did not change significantly (p>0.05). Conclusions We recommend using of a pelvic compression belts by sacroiliac joint pain patients increased the strength of hip extensor and muscle activity of contralateral latissimus dorsi.

Reliability of Hamstring Flexibility Test with Hip Inferior Glide Mobilization in Patients with Low Back Pain

김준석,황의재,권오윤,박규남 KEMA학회 2019 근골격계과학기술학회 Vol.3 No.1

ABSTRACT Background Hamstring tightness is a major cause of low back pain (LBP). The active knee extension (AKE) test is frequently used to measure hamstring tightness in supine-positioned subjects. In patients with musculoskeletal pain, it is important to maintain the axis of rotation for accurate range of motion assessment. Purpose The purpose of this study was to investigate the intrarater test-retest reliability of an AKE test with belt-guided inferior gliding of the hip, which was designed to minimize excessive anterior-superior gliding of the hip in LBP patients with hamstring tightness. We also compared the range of AKE with versus without inferior gliding of the hip in this study population. Study design Reliability study. Methods Thirty-eight patients with LBP and hamstring tightness were recruited to this study. Hamstring tightness was measured in a supine AKE test, with and without inferior gliding of the hip, using the Smart KEMA device. Test–retest reliability was assessed by the intraclass correlation coefficient (ICC). Significant differences in the range of AKE between the groups were detected using a paired sample t-test. Results The hamstring flexibility tests with and without inferior gliding of the hip exhibited good to excellent test-retest reliability (ICC=0.89 for both). The range of AKE with inferior gliding of the hip was significantly less than that of AKE without inferior gliding of the hip. Conclusions Assessment of hamstring flexibility via an AKE test with inferior gliding of the hip is reliable when applied to patients with LBP; the range of AKE was lower in this test compared to those that do not incorporate inferior gliding of the hip. ABSTRACT Background Hamstring tightness is a major cause of low back pain (LBP). The active knee extension (AKE) test is frequently used to measure hamstring tightness in supine-positioned subjects. In patients with musculoskeletal pain, it is important to maintain the axis of rotation for accurate range of motion assessment. Purpose The purpose of this study was to investigate the intrarater test-retest reliability of an AKE test with belt-guided inferior gliding of the hip, which was designed to minimize excessive anterior-superior gliding of the hip in LBP patients with hamstring tightness. We also compared the range of AKE with versus without inferior gliding of the hip in this study population. Study design Reliability study. Methods Thirty-eight patients with LBP and hamstring tightness were recruited to this study. Hamstring tightness was measured in a supine AKE test, with and without inferior gliding of the hip, using the Smart KEMA device. Test–retest reliability was assessed by the intraclass correlation coefficient (ICC). Significant differences in the range of AKE between the groups were detected using a paired sample t-test. Results The hamstring flexibility tests with and without inferior gliding of the hip exhibited good to excellent test-retest reliability (ICC=0.89 for both). The range of AKE with inferior gliding of the hip was significantly less than that of AKE without inferior gliding of the hip. Conclusions Assessment of hamstring flexibility via an AKE test with inferior gliding of the hip is reliable when applied to patients with LBP; the range of AKE was lower in this test compared to those that do not incorporate inferior gliding of the hip.

Effects of the Muscle Energy Technique and the Self-Stretching Exercise of the Pectoralis Minor on the Pulmonary Function of Young Adults with Thoracic Kyphosis

박재우,정성대 KEMA학회 2020 근골격계과학기술학회 Vol.4 No.1

Background: Thoracic kyphosis leads to the narrowing of the rib cage, compression of the lungs, and reduced mobility, resulting in decreased expansion of the lungs. Purpose: This study investigates the effects of the muscle energy technique and the self-stretching exercise of the pectoralis minor muscle on the pulmonary function of young subjects with kyphosis. Study design: Design Pre-test post-test control group design. Methods: Thoracic kyphosis was determined by adding the angle of the seventh cervical vertebra and the first thoracic vertebra and the angle of the twelfth thoracic vertebra and the first lumbar vertebra. Excessive kyphosis was defined as a curvature measuring more than 40°. For the respiratory function, forced vital capacity (FVC), one-second forced expiratory volume (FEV1), and peak expiratory flow rate were measured using a Pony FX. Then, six sets of the muscle energy technique and the self-stretching exercise were performed, with three sets each for the left and right sides of the body. Each set consisted of 10 repetitions of a 10 s exercise, and 30 s breaks were given between sets. Results: Results showed that the self-stretching exercise reduced the thoracic kyphosis and significantly increased the FVC and FEV1. The muscle energy technique reduced the kyphosis and significantly increased the FVC. Conclusions: The two intervention methods, the muscle energy technique and the self-stretching exercise, can be applied as effective treatment programs to improve the pulmonary function of subjects with thoracic kyphosis.