Flexion Measurements Research Articles

Parallel Reliability of Lumbar-Flexion Measurements

Context:Research and clinical recordings of lumbar flexion demand practicable and precise methodology for quantifying variations.Objective:To describe and evaluate the parallel reliability of 2 methods of measuring lumbar fexion—perpendicular stick markers (SM) and the distanciometer (DM)—using an electrogoniometer (EGM) as reference.Design:Parallel measurement for reliability.Setting:Laboratory.Participants:25 healthy men.Intervention:Simultaneous measure of lumbar flexion at preestablished positions (0°, 15°, 30°, and 45°).Outcome Measures:Data from SM and DM, recorded simultaneously.Results:High parallel reliability was found when comparing the EGM data with the SM (r = .997; measurement error: 0.6° ± 0.7°; no differences: t-test P = .260) and with the DM (r = .962; measurement error: 2.8° ± 1.9°; no differences: t-test P = .973).Conclusions:Considering the reliability, practicability, and low cost of the described methods, they can be regarded as applicable and useful.

무릎 관절의 고굴곡에 대한 모멘트와 근력의 추정

This study predicts muscle forces acting on the lower extremity when the knee joint is in deep flexion. The whole body was approximated as a link model, and then the moment equilibrium equations at the lower extremity joints were derived for given reaction forces against the ground. Measurement of deep flexion was carried out by placing ten markers on the body. This study calculated the moment acting at each joint from the equations of force and moment, classified the complicated muscles around the knee joint, and then predicted the muscle forces to balance the joint moment. Two models were proposed in this study: the simpler one that consists of three groups of muscle and the more detailed one of nine groups of muscle.

Intramachine and intermachine reproducibility of concentric performance: A study of the Con-Trex MJ and the Cybex Norm dynamometers

Introduction: There is minimal information in the literature concerning the intramachine reliability of the new Isokinetic dynamometer Con-Trex MJ, and the intermachine reproducibility of this instrument with the Cybex Norm isokinetic dynamometer. Objective: The purpose of this study was to provide some insight with regard to the reproducibility of Con-Trex MJ in measuring the knee muscle performance in flexion and extension (concentric) and to compare the variability of measurement between Con-Trex and Cybex Norm. Methods: 35 (70 legs) male subjects with no previous history of any knee pathology volunteered for the study. Intramachine reproducibility was evaluated by assessing 30 legs twice on the Con-Trex MJ, within 2 to 7 days, at angular velocities of 60 ◦ , 180 ◦ and 300 ◦ /sec. Intermachine reproducibility was evaluated by assessing 40 legs randomly on the Con-Trex MJ and Cybex Norm within 2 to 7 days at 60 ◦ and 180 ◦ /sec. Coefficient of variation (CV) was used to determine the reproducibility of repeated measurements at p< 0.01. Results: Intra: The variability of measurements of Con-Trex for Peak Torque, was 5.19-5.68% for extension and 4.84-7.33% for flexion depending on the angular velocity. This is acceptable for clinical and research studies. Inter: Between the two Isokinetic devices there was a greater CV for Peak Torque ranging 7.28-9.17% for extension and 8.54-15.84% for flexion. Conclusion: Based on the results of the present study, comparisons of results between the two devices may not be valid. The results for knee flexion and extension measurements at 60 ◦ and 180 ◦ /sec recorded with Con-Trex were consistently greater than the values recorded with the Cybex Norm.

Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis.

Pulmonary function is altered in ankylosing spondylitis (AS) owing mainly to the restriction of chest wall involvement (limited chest expansion). The objective of this study was to investigate the relationship between chest expansion, respiratory muscle strength (MIP, MEP) maximum voluntary ventilation (MVV), and BASFI score in patients with AS. Twenty-three male patients with definite AS and 21 age-matched healthy male controls were recruited for the study. Patients with AS were assessed for functional status by BASFI. Measurement of chest expansion and lumbar spinal flexion (modified Schober) method was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth-pressure meter (MPM). Body mass index (kg/m(2)) was recorded in all individuals. Chest expansion and modified Schober measurement were significantly lower in AS patients (p<0.05). Pulmonary function tests revealed restrictive lung disease. The mean BASFI score suggested good functional capacity in the AS group. The respiratory muscle strength and MVV were also lower in AS (p<0.05). The chest expansion was correlated with MIP and MEP values (r=0.491; p=0.02, r=0.436; p=0.05). Chest expansion was also correlated negatively with disease duration (r=-0.502; p=0.03). In addition, there was no correlation between chest expansion and BASFI score (r=-0.076; p=0.773). This study demonstrates that functional status (BASFI) is not influenced by the limitation of chest wall movement. It may be as a result of the maintenance of moderate physical activity during active life in patients with AS.

A new method for interosseous muscle elasticity scoring

A new method for interosseous muscle elasticity scoring

Do within-session changes in pain intensity and range of motion predict between-session changes in patients with low back pain?

Physiotherapists commonly use post-treatment changes in a patient's pain intensity and range of motion to guide treatment selection and predict possible longer-term outcomes. This study tested the validity of this practice by evaluating the predictive value of within-session changes in pain intensity and range of motion in 53 patients with low back pain. Pain intensity and range of motion measurements of spinal flexion, extension, lateral flexion, and straight-leg-raise were taken by the patient's therapist before and after one treatment session, and were repeated by a blinded therapist at the beginning of the patient's subsequent treatment session. Regression analysis revealed that the strength of association between within-session and between-session changes ranged from r = 0.35 to r = 0.80 for range of motion measurements, and from r = 0.24 to r = 0.47 for pain intensity. Odds ratios for pain and range of motion ranged from 3.5 (95% CI 0.9 to 14.6) to 37.0 (95% CI 4.1 to 330), indicating greater odds of improving between-session if improvement was obtained within-session. These results provide preliminary support for the practice of using within-session changes in pain intensity and range of motion to guide treatment selection when treating impairments in patients with low back pain.

Measurement of Upper Cervical Flexion and Extension with the 3-Space Fastrak Measurement System: A Repeatability Study

Most external measurement devices do not allow ready differentiation of upper cervical flexion and extension from total cervical movement. This study investigated the "within" and "between-days" repeatability of measurement focused on upper cervical flexion and extension in three dimensions using the Fastrak, a 3-Space measurement system, on 21 subjects. To localize the measurement, one sensor of the Fastrak was centered over the subject's forehead and the other was held manually over the C2 spinous process. Three repetitions of upper cervical flexion (nod of the head) and extension (chin lift) were performed in each trial. Two trials were performed on the first day with the third trial one-week later. Results indicated high levels of repeatability for "within" and "between-days" measurements (ICC2,1: 0.97 to 0.99). The mean ranges of upper cervical flexion and extension were 15.03° ± 2.80° and 23.32° ± 4.20° respectively, were accompanied by a small amount of lateral flexion and rotation, predominantly in a contralateral pattern. The method appears suitable for clinical evaluation of upper cervical motion.

The Validity of the Circumduction Test in Elderly Men and Women

This article focuses on the validity of the circumduction test for measuring shoulder flexibility in older adults. Participants included 137 community-dwelling older adults. Equipment consisted of a cord with a fixed handle on one end and a sliding handle on the other. The sliding handle was adjusted so that the cord length between the 2 handles equaled the participant’s shoulder width. Holding the 2 handles, the participant must pass the cord from the front of the body over the head and as far back as possible with extended arms. The score is the fanning-out angle. Forward flexion, abduction, horizontal retroflexion, and outward rotation were also measured. The test and criterion measurements were administered within 1 wk. The criterion-related validity of the circumduction test as a measure of forward flexion and horizontal retroflexion received support from moderate correlations. Its use as a measure of abduction and outward rotation, however, received no support from the data.

The effects of bite line deviation on lateral cervical radiographs when upper cervical joint dysfunction exists: a pilot study

Purpose To demonstrate the impact of inconsistent bite line positioning during pre and post lateral cervical radiographic examinations and to suggest certain additional imaging studies if the bite line cannot be consistently maintained. Methods Radiographic measurements of relative flexion and extension in the atlantal-occipital (AO) and atlantal-axial (AA) joints were taken from neutral lateral cervical and cervical flexion and extension radiographs of 20 subjects. Results The average relative AO flexion was −0.9° and 12.0° of extension, while the average relative AA flexion and extension values were 8.5° and 2.8°, respectively. In addition, 12 (60%) of the 20 subjects exhibited paradoxical motion at the AO joint during cervical flexion. Of these 12 subjects, 10 also displayed excessive relative AO extension (beyond 7.5°). Conclusions If a bite line deviation exists in pre and post lateral cervical radiographic examinations, dynamic cervical flexion and extension radiographs should be taken to calculate the maximum tolerances in the upper cervical spinal joints. If these tolerances are exceeded, the measurement of the cervical lordosis from the back of the second cervical vertebra and seventh cervical vertebra may be altered, thus incorporating the possibility of a 20.3% measurement error on the post lateral cervical radiograph.

A Comparison of Two Stretching Protocols on Hip Range of Motion

It is theorized that the total stretch time in a day is more important than the actual single stretch duration time. The purpose of this study was to compare 2 stretching protocols, keeping total stretching time equivalent. The 2 protocols were a 10-second duration stretch and a 30-second duration stretch. Although the stretch durations differed, the total stretching time over the course of a day was held constant at 2 minutes for both protocols. Participants were randomly assigned a protocol to each of their legs: subjects stretched 1 leg with the 10-second protocol and the opposite leg with the 30-second protocol. The 10-second stretch was repeated 6 times for a total of 1 minute; the 30-second protocol was repeated 2 times for a total of 1 minute. Stretching was performed twice daily (a total of 2 minutes each day) for 6 weeks. All stretching was performed to the hamstring muscles. Hip flexion measurements were recorded at pretest, 3-weeks, and 6-weeks. Subjects demonstrated significant gains in range of motion for hip flexion over the course of 6 weeks, p = 0.000. No differences existed between the 2 protocols. Range of motion gains were equal between the 2 stretching protocols. The common denominator was total stretch time for a day. Regardless of the duration of a single stretch, the key to improvement was the total daily stretch time. These findings are important as they allow clinicians and individuals to customize stretching protocols to meet individual needs.

Long-term results of surgical management of proximal interphalangeal joint contracture.

To evaluate the long-term results of surgical treatment of proximal interphalangeal (PIP) joint contractures, 68 PIP joints were retrospectively reviewed with a minimum follow-up period of 24 months. Preoperative and intraoperative factors were studied for outcomes and subjected to statistical analysis. Among the total group the average improvement was 7.5 degrees. When grouped by diagnosis into simple (less severe diagnoses) and complex (more severe diagnoses) the average degrees gained were 17.2 degrees and 0.5 degrees, respectively. The statistically significant factors that were identified that affected results were age, number of prior procedures, preoperative flexion, removal of an exostosis, number of structures addressed, and preoperative arc of motion. The second surgery (joints requiring repeat release or salvage procedure) rates were 35% overall, 29% simple, and 39% complex; the difference was not significant. The best surgical candidate is a patient younger than 28 years with a less severe diagnosis and who has preoperative maximum flexion measurement < 43 degrees.

EFFECT OF INTERVAL VERSUS CONTINUOUS TRAINING ON AEROBIC AND ANAEROBIC VARIABLES

Interval training is used regularly by athletes to improve aerobic and anaerobic fitness and performance. It is used less frequently, however, by non-athletes as a means of improving important measures of aerobic and anaerobic fitness that may improve physical performance in both athletic and non-athletic settings. PURPOSE: The purpose of this study was to compare a typical, continuous training program with a higher intensity, interval training program in the development of aerobic and anaerobic fitness in young adults. METHODS: Forty-two volunteers were randomly assigned to a continuous training (CT) group or an interval training (IT) group. A separate control group was formed from volunteers who were currently not engaged in continuous or interval training. Both training groups trained an average of 3 times per week for ten weeks starting the first week at 70% of VO2max for 30 min, increasing to 75% VO2max for 35 min the fifth week, and increasing to 80% VO2max for 40 min the eighth week. The CT group maintained a constant intensity throughout each training session. The IT group completed a similar volume of work per session but varied the intensity within each session from 120–150% VO2max during the work intervals to 30–40% VO2max during the relief intervals. The training program was preceded and followed by a series of tests of maximal oxygen consumption (VO2max), a timed anaerobic treadmill test (run at 6 or 8 mph at 20% grade), a timed 50-meter sprint, and maximum isokentic strength measurements of leg extension and leg flexion at 60°·s−1 and 300°·s−1. RESULTS: The training resulted in a significant improvement (P < .01) in the VO2max, anaerobic treadmill test and sprint time in both the IT and CT group. The IT group also showed significant improvement (P < .01) over the CT group and controls in anaerobic treadmill time and sprint time. Among the three groups, only IT group showed significant improvement in the 300°·s−1 leg extension and leg flexion tests (P < .01). The CT and control group showed no significant improvement in any of the isokinetic tests. CONCLUSION: The results of this study indicate that interval training demonstrates the same aerobic fitness benefit as continuous training. Additionally, interval training shows significantly greater changes in anaerobic treadmill time and sprint time than continuous training in young adults. It should be noted, however, that participants in the IT group perceived the exercise at a higher level of exertion than the CT group and were more likely to discontinue exercise due to lower limb discomfort.

TRUNK FLEXION DURING GAIT ANALYSIS

Trunk flexion is often measured as an absolute angle between the shoulder, hip and y-axis. One complete stride consists of two steps, but only one full rotation of the upper body. When reporting trunk flexion during gait analysis an exaggerated bend in the trunk is noted on one of the steps in 2-dimensional video analysis. PURPOSE: To find a more accurate measure of trunk flexion while using 2-dimesional video analysis. METHODS: One complete stride was analyzed on four separate occasions for 22 college age female subjects. Subjects walked at approximately 1.79 m/s for 2800 m on two separate testing dates. A relatively rested and fatigued stride was analyzed from each session. Sinusoids having one and two cycles per stride were fit to the data. RESULTS: Three models were tested: a sinusoid having one cycle per stride, a sinusoid having two cycles per stride, and two sinusoids, one having one cycle and the other having two cycles per stride. In 79 out of 86 strides the two sinusoid model was significantly better than either one sinusoid model (F test with p = 4 and n-p = 50 degrees of freedom, 5% level). A test based on the Baysian information criterion gave the same result. CONCLUSION: It may be possible to separate rotation and flexion of the trunk during gait analysis.

The position of the spine in the recovery position—an experimental comparison between the lateral recovery position and the modified HAINES position

The lateral recovery position is widely used for the positioning of unconscious patients. Ideally, in the setting of trauma it is avoided because of concerns about spinal cord injury. However, unconscious individuals with unsuspected trauma or trauma victims attended by partially trained first-aiders may be placed in the recovery position, potentially endangering the cord. Excessive movement of the spine in the recovery position may increase the risk of spinal cord injury in these situations. A new recovery position, termed the modified HAINES position, is described and the position of the spine in this position is compared with the lateral recovery position. Hypothesis: That the modified HAINES position results in less distortion of the position of the spine than the lateral recovery position. Methods: Thirty-eight healthy volunteers were imaged in the two different positions. Measurements of rotation, flexion and lateral flexion of the cervical and thoraco-lumbar spine were made. Two tailed paired t-tests were employed to compare measurements of the two positions and a McNemar test was used to compare the subjects' subjective experiences. Results: The modified HAINES position resulted in 13.0° (99% CI: 7.5–18.5) less lateral flexion and 12.6° (99% CI: 9.4–15.9) less extension of the cervical spine while the position of the thoraco-lumbar spine was similar in both positions. Nineteen of 28 subjects found the modified HAINES position more comfortable (not significant). Conclusion: The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients when trauma may have occurred. Further research is required to ensure that the recovery positions in use today are the best possible.

VALIDITY OF PULP-TO-PALM DISTANCE AS A MEASURE OF FINGER FLEXION

This study investigated the validity of pulp-to-palm distance measures as clinical indicators of finger flexion capacity. Pulp-to-palm distance and goniometry of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were measured by a single tester in 50 patients with abnormal digital flexion using a computerized hand assessment system. The correlation between pulp-to-palm distance measurements and total finger flexion measures obtained by goniometry, was moderate (r=−0.46 and −0.51). This indicates that the measures are not interchangeable. The relationship between an upper extremity disability score (DASH) and restricted motion was stronger for the goniometric measurements (r=0.45, P<0.01) than for the pulp-to-palm distance measurements (r<0.30,P >0.01). Both types of range of motion measurements were able to discriminate between minimal and substantial upper extremity disability. Further methodological evaluation is required to support the use of pulp-to-palm distance measures as an outcome indicator.

Combined effect of heat stress, dehydration and exercise on neuromuscular function in humans.

This study examined the combined effect of exercise induced hyperthermia and dehydration on neuromuscular function in human subjects. Six trained male runners ran for 40 min on a treadmill at 65% of their maximal aerobic velocity while wearing a tracksuit covered with an impermeable jacket and pants to impair the evaporation of sweat. These stressful experimental running conditions led the runners to a physiological status close to exhaustion. On average, the 40 min run ended at a heart rate of 196 (SD 8) beats.min-1, a tympanic temperature of 40 (SD 0.3) degrees C and with a loss of body mass of 2 (SD 0.5)%. Pre- and post-running strength tests included measurements of maximal knee extension and flexion torques in both isometric and isokinetic (at 60 and 240 degrees.s-1) conditions. A 20 s endurance test at 240 degrees.s-1 was also performed. Surface electromyographic (EMG) activity was recorded from six knee extensor and flexor muscles during the entire protocol. The treadmill run led to clear decrements in maximal extension torque and EMG activity both in isometric and at the slowest isokinetic velocity (60 degrees.s-1). However, no differences in these parameters were observed at 240 degrees.s-1. Furthermore, the EMG patterns of the major knee extensor and flexor muscles remained remarkably stable during the treadmill run. These results demonstrate that the exercise-induced hyperthermia and dehydration in the present experiments had only minor effects on the neuromuscular performance. However, it is also suggested that high internal body temperature per se could limit the production of high force levels.

Health-related fitness, physical activity, and history of back pain.

The relationship between history of back pain and measurements of both health-related fitness and physical activity participation was examined in 233 males and 287 females aged 15-69 years. Participants were divided by gender into those reporting no history (NH) or a history (H) of recurring back pain. Analysis of variance indicated that trunk flexion, back extensor endurance, and physical activity participation were significantly higher for NH and waist girth significantly lower for NH in both genders. In females, mean abdominal muscular endurance was significantly higher in NH. Forward stepwise discriminant function analyses indicated that the best discriminators between NH and H were back extensor endurance and physical activity participation in both genders and waist girth in females. These findings support using measurements of trunk flexion, abdominal muscular endurance, back extensor endurance, physical activity participation, and waist girth as indicators of back fitness in the evaluation of back health.

Mobilité du tronc dans le plan sagittal: comparaison des données cliniques et rachimétriques

Objectives Assessment of trunk mobility (spine and hips) in the sagittal plane for a population of healthy subjects and comparison of clinical and rachimetric data. Material and methods Fifty subjects (25 men and 25 women) without back pain have been submitted to a clinical examination and rachimetric test to assess the mobility of spine and hips during trunk movements in the sagittal plane. Results Clinical measurements give heterogenous data. We found few correlations between clinical measurements and rachimetry, except for trunk flexion, which is mainly explained by the flexion of the hips. Discussion Rachimetry, by its standardised conditions of measurements should give more accurate data than clinical examination. Nevertheless, more works are needed to assess the validity and the reproducibility of this method. It appears also that the clinical measurements of trunk flexion are better reflect of hip flexion than spinal mobility. Conclusion Rachimetry could be an interesting mean of measure for spine flexibility and hip mobility but more works are needed to confrim the validity of the method.

When do Bending Stresses on the Spine Rise to Damaging Levels?

Experiments on cadaver spines have quantified the bending stresses (bending moment) required to cause overload injury or fatigue failure to the lumbar spine. This paper reviews subsequent experiments in living people which sought to identify the circumstances that cause spinal bending to rise to potentially damaging levels in life. Healthy volunteers performed various bending and lifting activities in the laboratory, and peak bending moment was quantified from measurements of lumbar flexion, obtained using the 3-Space Isotrak. Bending stresses approached or even exceeded estimated fatigue limits in some subjects when they performed lifting tasks in the early morning (when the spine's bending stiffness is increased), and following fatigue of the back muscles. Individuals with a small range of lumbar flexion were particularly likely to exceed safe limits. These findings may explain why repeated bending and lifting are so closely associated with low back problems.

Correlation and quantification of relative 2-dimensional projected vertebral endplate z-axis rotations with 3-dimensional y-axis vertebral rotations and focal spot elevations

Background: The use of lines erected on the vertebral endplates of the anterior-to-posterior radiograph to assess z-axis vertebral rotation is a common clinical practice. Objective: To quantify the projection/distortion error of lateral flexion (z-axis rotation) measurement, which results from actual axial (y-axis) rotation and changes in focal spot elevation, on AP radiographs. Study Design: A 3-dimensional model of a 4th and 5th lumbar vertebrae was constructed with a computer. The angle between the projected inferior vertebral endplate of the 4th lumbar vertebra, and the projected superior vertebral endplate of the 5th lumbar vertebra was measured. This was done for combinations of 0, 7, 14, and 21 degrees of axial (−y-axis) rotation with 0, 15, and 30 cm of elevation of a modeled focal spot. Results: An angle was produced between the projected inferior 4th lumbar vertebral endplate and the projected superior 5th lumbar vertebral endplate as a result of y-axis rotation of the 3-dimensional model. Increasing magnitudes of y-axis rotation and increasing focal spot elevation produced a lack of confidence in this measurement. Conclusion: In a clinical setting, limited ranges of y-axis rotation have little significant effect on the accuracy of this measurement. Increases in y-axis rotation and focal spot elevation can affect measurement accuracy. (J Manipulative Physiol Ther 2000;23:414–9)