The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

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Hip Flexion Contracture and Lumbar Spine Lordosis in Myelomeningocele

Journal of Pediatric Orthopaedics ◽

10.1097/01.bpo.0000161099.46339.eb ◽

2005 ◽

Vol 25 (4) ◽

pp. 476-478 ◽

Cited By ~ 27

Author(s):

Yann Glard ◽

Franck Launay ◽

Elke Viehweger ◽

Jean-Marc Guillaume ◽

Jean-Luc Jouve ◽

...

Keyword(s):

Lumbar Spine ◽

Flexion Contracture ◽

Hip Flexion

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Tibial Nerve Excursion During Lumbar Spine and Hip Flexion Measured with Diagnostic Ultrasound

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2012.11.023 ◽

2013 ◽

Vol 39 (5) ◽

pp. 784-790 ◽

Cited By ~ 9

Author(s):

Gary L. Shum ◽

Alison S. Attenborough ◽

Jon F. Marsden ◽

Alan D. Hough

Keyword(s):

Lumbar Spine ◽

Tibial Nerve ◽

Diagnostic Ultrasound ◽

Hip Flexion

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Kinematics of Rising From a Chair: Image-Based Analysis of the Sagittal Hip-Spine Movement Pattern in Elderly People Who Are Healthy

Physical Therapy ◽

10.2522/ptj.20090093 ◽

2010 ◽

Vol 90 (4) ◽

pp. 561-571 ◽

Cited By ~ 26

Author(s):

Mohammad R. Fotoohabadi ◽

Elizabeth A. Tully ◽

Mary P. Galea

Keyword(s):

Lumbar Spine ◽

Elderly People ◽

Thoracic Spine ◽

Thoracolumbar Spine ◽

Movement Pattern ◽

Range Of Movement ◽

Linear Pattern ◽

Flexion Extension ◽

Lift Off ◽

Hip Flexion

BackgroundRehabilitation of elderly patients with sit-to-stand (STS) dysfunction includes retraining coordinated movement among participating body segments. Although trunk position is considered important, spinal movement has not been measured.ObjectiveThe aim of this study was to describe the sagittal thoracolumbar kinematics and hip-lumbar interaction during the STS task in elderly people who were healthy in order to guide physical therapists in developing treatment strategies.DesignThis was an observational study.MethodsTen retroreflective markers were attached to the midline thoracolumbar spine, pelvis, and right lower limb of 41 elderly people who were healthy. A 2-dimensional video analysis system was used to measure sagittal thoracic, lumbar, hip, and knee joint angles during the STS task. Maximal available flexion-extension angles in these joints and regions also were determined.ResultsPrior to buttocks lift-off, forward trunk lean comprised concurrent hip and lumbar flexion and thoracic extension. Hip flexion dominated, with a hip/lumbar ratio of 4.7:1 and a thoracic/lumbar ratio of 1.7:1. The hip and lumbar spine contributed 90% and 23% of their maximal available flexion angle, respectively, and the thoracic spine contributed 86% of its maximal extension range of movement. After lift-off, the hips and lumbar spine extended (ratio of 5.2:1), and the thoracic spine flexed (thoracic/lumbar ratio of 0.4:1). At lift-off, the hips and knees were similarly flexed (96°) and then locked together in a linear pattern of extension. Following lift-off, there was a brief transition phase (5% of STS duration) in which, although the hips, knees, and lumbar spine were extending, the trunk continued to flex forward a few degrees.LimitationsResults may differ in elderly people who are less active.ConclusionsThe revised model for image-based analysis demonstrated concurrent hip and thoracolumbar movement during the STS task. Close to full available hip flexion and thoracic extension were needed for optimal STS performance.

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Hip Flexion Contracture Caused by an Intraspinal Osteochondroma of the Lumbar Spine

Orthopedics ◽

10.3928/01477447-20140401-64 ◽

2014 ◽

Vol 37 (4) ◽

pp. e398-e402 ◽

Cited By ~ 1

Author(s):

Sina Pourtaheri ◽

Arash Emami ◽

Tyler Stewart ◽

Ki Hwang ◽

Kimona Issa ◽

...

Keyword(s):

Lumbar Spine ◽

Flexion Contracture ◽

Hip Flexion

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Hip torsional deformities at lumbar disc disease

10.21203/rs.3.rs-37478/v1 ◽

2020 ◽

Author(s):

YAGMUR ISIN ◽

EROL KAYA ◽

ONUR HAPA ◽

CEREN KIZMAZOGLU ◽

ONUR GURSAN

Keyword(s):

Lumbar Spine ◽

Lumbar Disc ◽

Femoral Anteversion ◽

Clinical Findings ◽

Acetabular Anteversion ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Control Subjects ◽

Flexion Extension ◽

Hip Flexion

Abstract Background Presence of lumbar spine disorder with hip diseases is defined as Hip-Spine syndrome, there might be a relation between hip torsional deformities and lumbar disc disease which has not clarified previously. Purpose of the present study was to find whether hip torsional parameters (femur, acetabular anteversion) and clinical findings (hip range of motion, hip score) differ at patients with lumbar disc disease. Methods Patients with lomber disc herniation (n: 20) and control subjects (n: 20) without any lumbar spine or hip disease were enrolled. Femoral anteversion (FeAv), acetabular anteversion (AA), center of edge angle (CE), degree of hip flexion, extension, Harris Hip scores (HHS) were evaluated bilaterally. Results HHS score, degree of extension plus flexion was lower at diseased side when it is compared to the control subjects (p < 0.001). Unilaterally affected patients had lower AA than control subjects (AA: 13 ± 40 vs16 ± 20 p:0.01). Mechanic and /or hip torsional parameters especially the acetabular retroversion may have an etiopathogenetic role at unilateral lumbar disc disease.

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The role of lumbar lordosis and pelvic sagittal balance in femoroacetabular impingement

The Bone & Joint Journal ◽

10.1302/0301-620x.100b10.bjj-2018-0060.r1 ◽

2018 ◽

Vol 100-B (10) ◽

pp. 1275-1279 ◽

Cited By ~ 13

Author(s):

R. R. Fader ◽

M. A. Tao ◽

M. A. Gaudiani ◽

R. Turk ◽

B. U. Nwachukwu ◽

...

Keyword(s):

Lumbar Spine ◽

Femoroacetabular Impingement ◽

Lumbar Lordosis ◽

Pelvic Tilt ◽

Alpha Angle ◽

Dynamic Imaging ◽

Anterior Pelvic Tilt ◽

Hip Flexion ◽

Male Subjects

Aims The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We hypothesize that FAI patients will experience less flexion at the lumbar spine and more flexion at the hip whilst changing from standing to sitting positions than subjects without FAI. This increase in hip flexion may contribute to symptomatology in FAI. Patients and Methods Male subjects were prospectively enrolled to the study (n = 20). Mean age was 31 years old (22 to 41). All underwent clinical examination, plain radiographs, and dynamic imaging using EOS. Subjects were categorized into three groups: non-FAI (no radiographic or clinical FAI or pain), asymptomatic FAI (radiographic and clinical FAI but no pain), and symptomatic FAI (patients with both pain and radiographic FAI). FAI was defined as internal rotation less than 15° and alpha angle greater than 60°. Subjects underwent standing and sitting radiographs in order to measure spine and femoroacetabular flexion. Results Compared with non-FAI controls, symptomatic patients with FAI had less flexion at the spine (mean 22°, sd 12°, vs mean 35°, sd 8°; p = 0.04) and more at the hip (mean 72°, sd 6°, vs mean 62°, sd 8°; p = 0.047). Subjects with asymptomatic FAI had more spine flexion and similar hip flexion when compared to symptomatic FAI patients. Both FAI groups also sat with more anterior pelvic tilt than control patients. There were no differences in standing alignment among groups. Conclusion Symptomatic patients with FAI require more flexion at the hip to achieve sitting position due to their inability to compensate through the lumbar spine. With limited spine flexion, FAI patients sit with more anterior pelvic tilt, which may lead to impingement between the acetabulum and proximal femur. Differences in spinopelvic mechanics between FAI and non-FAI patients may contribute to the progression of FAI symptoms. Cite this article: Bone Joint J 2018;100-B:1275–9.

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A Sloped Seat Wedge Can Change the Kinematics of the Lumbar Spine of Seated Workers with Limited Hip Flexion

Journal of Physical Therapy Science ◽

10.1589/jpts.26.1173 ◽

2014 ◽

Vol 26 (8) ◽

pp. 1173-1175 ◽

Cited By ~ 4

Author(s):

Ji-Won Kim ◽

Min-Hyeok Kang ◽

Kyung-Hee Noh ◽

Jun-Seok Kim ◽

Jae-Seop Oh

Keyword(s):

Lumbar Spine ◽

Hip Flexion

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Hip flexion for lumbar puncture - not easy in obstetric practice

Anaesthesia ◽

10.1046/j.1365-2044.2001.02279-38.x ◽

2001 ◽

Vol 56 (10) ◽

pp. 1023-1024 ◽

Cited By ~ 1

Author(s):

F. Plaat ◽

L. McCready-Hall

Keyword(s):

Lumbar Puncture ◽

Obstetric Practice ◽

Hip Flexion

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Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.julaug03 ◽

2002 ◽

Vol 7 (4) ◽

pp. 8-10

Author(s):

Christopher R. Brigham ◽

Leon H. Ensalada

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Disk Herniation ◽

Fourth Edition ◽

Recurrent Injury ◽

Injury Model ◽

Whole Person ◽

Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

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