The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지

The Relationship between Hip Abductor Muscle Strength and Lumbar Instability in Patients with Chronic Low Back Pain

만성 요통환자의 요추부 불안정성과 고관절 외전근 근력수준간의 상관관계

  • Seo, Jun-Kyoung (Department of Physical Therapy, Sewoori Hospital) ;
  • Kim, Suhn-Yeop (Department of Physical Therapy, College of Natural Science, Daejeon University)
  • 서준경 (세우리병원 물리치료실) ;
  • 김선엽 (대전대학교 자연과학대학 물리치료학과)
  • Received : 2011.05.16
  • Accepted : 2011.08.03
  • Published : 2011.08.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to investigate the relationship between hip abductor muscle strength and lumbar instability in patients with chronic low back pain. Methods: Fifty-two female patients were recruited for this study. The patients' history was recorded and was used to determine the general characteristics of the female complaints. The women were additionally examined to determine whether the level of pain was characteristic of patients with chronic lumbar instability. The following tests were also carried out in the subjects during the examination: 1) the prone instability test. 2) the test for aberrant movement patterns during lumbar flexion test. 3) the straight leg raising test. 4) posterior-to-anterior mobility test, and 5) the test for age and strength of the hip abductor muscle following assessment of the dominant side. In particular, hip abductor muscle strength was evaluated using a dynamometer. Results: The test results showed that the number of positive responses for the five types of lumbar instability tests performed, was significantly related to the strength of the hip abductor muscle. The average hip abductor muscle strength in total subjects was $72.89{\pm}7.66N$, whereas the average hip abductor muscle strength in subjects who showed positive responses to more than four out of the five tests, was $44.70{\pm}5.79N$. Conclusion: The results demonstrated that the hip abductor muscle strength and lumbar instability were negatively correlated. The lower was the strength of the hip abductor muscle, the higher was the possibility of lumbar instability.

Keywords

References

  1. Christie HJ, Kumar S, Warren SA. Postural aberrations in low back pain. Arch Phys Med Rehabil. 1995;76(3):218-24. https://doi.org/10.1016/S0003-9993(95)80604-0
  2. Fritz JM, Cleland JA, Speckman M et al. Physical therapy for acute low back pain: Associations with subsequent healthcare costs. Spine (Phila Pa 1976). 2008;33(16):1800-5. https://doi.org/10.1097/BRS.0b013e31817bd853
  3. Webright WG, Randolph BJ, Perrin DH. Comparison of nonballistic active knee extension in neural slump position and static stretch techniques on hamstring flexibility. J Orthop Sports Phys Ther. 1997;26:7-13.
  4. Lawrence JP, Greene HS, Grauner JN. Back pain in athletes. J Am Acad Orthop Surg. 2006;14:726-35 .
  5. Lee HO. Activation of trunk muscles during stabilization exercises in four.point kneeling. J Kor Soc Phys Ther 2010;22(5):33-8.
  6. Gill KP, Callaghan MJ. The measurement of lumbar proprioception in individuals with and without low back pain. Spine (Phila Pa 1976). 1998;23(3):371-7. https://doi.org/10.1097/00007632-199802010-00017
  7. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976). 2001;26(11):e243-e48. https://doi.org/10.1097/00007632-200106010-00004
  8. Deyo RA, Walsh NE, Martin DC et al. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med. 1990; 322(23):1627-34. https://doi.org/10.1056/NEJM199006073222303
  9. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005;85(3):209-25.
  10. Kim JS, Jun MY, Bae SS. The effect of dynamic lumbar stabilization exercise on low back pain patients. J Kor Soc Phys Ther. 2001;13(3):495-507.
  11. Wong TKT, Lee RYW. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Human Mov Sci. 2004;23(1):21-34. https://doi.org/10.1016/j.humov.2004.03.004
  12. Inman VT. Functional aspects of the abductor muscles of the hip. J Bone Joint Surg Am. 1947;29(3):607-19.
  13. Kim K, Ko JY, Lee SY. A Study on the characteristics of gait in patients with chronic low back pain. J Kor Soc Phys Ther 2009;21(2):79-85.
  14. Braun P, Jensen S. Hip pain-a focus on the sporting population. Aust Fam Physician. 2007;36(6):406-8, 410-3.
  15. Nadler SF, Malanga GA, Bartoli LA et al. Hip muscle imbalance and low back pain in athletes: Influence of core strengthening. Med Sci Sports Exerc. 2002;34(1):9-16. https://doi.org/10.1097/00005768-200201000-00003
  16. Marino M, Nicholas JA, Gleim GW et al. The efficacy of manual assessment of muscle strength using a new device. Am J Sports Med. 1982;10(6):360-4. https://doi.org/10.1177/036354658201000608
  17. Trendelenburg F. Trendelenburg's test: 1895. Clin Orthop. 1998(355):3.
  18. Hoppenfeld S, Hutton R. Physical examination of the spine and extremities. 1976.
  19. Richardson C, Jull G, Toppenberg R, Comerford M. Techniques for active lumbar stabilisation for spinal protection: A pilot study. 1992;38(2):105-12.
  20. Earl J. Gluteus medius activity during 3 variations of isometric single-leg stance. J Sport Rehabil. 2005;14(1):1-11.
  21. Jull G, Janda V. Muscles and motor control in low back pain: Assessment and management. Physical therapy of the low back. New York. Churchill Livingstone. 1987:253-78.
  22. Kankaanpaa M, Taimela S, Laaksonen D et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79(4):412-7. https://doi.org/10.1016/S0003-9993(98)90142-3
  23. Kendall KD, Schmidt C, Ferber R. The relationship between hip-abductor strength and the magnitude of pelvic drop in patients with low back pain. J Sport Rehabil 2010;19(4): 422-35.
  24. Holmich P, Hölmich L,Bjerg A. Clinical examination of athletes with groin pain: An intraobserver and interobserver reliability study. Br J Sports Med. 2004;38(4):446-51. https://doi.org/10.1136/bjsm.2003.004754
  25. Click Fenter P, Bellew J, Pitts T et al. Reliability of stabilized commercial dynamometers for measuringhip abduction strength: A pilot study. Br J Sports Med. 2003;37(4):331-4. https://doi.org/10.1136/bjsm.37.4.331
  26. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003; 84(12):1858-64.
  27. Wiltse L, Rothman L. Spondylolisthesis: Classification, diagnosis and natural history. Semin Spine Surg. 1989; 1(1):78.
  28. Kim JH, Park SK, Kang JI, Yang DJ. Effects of lumbar stability exercise program on trunk, lower extremity of muscle activity and balance in soccer player. J Kor Soc Phys Ther 2010;22(5):25-31.
  29. Demoulin C, Crielaard JM, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: A literature review. Joint Bone Spine. 2007; 74(1):9-13. https://doi.org/10.1016/j.jbspin.2006.02.013
  30. Landel R,Kulig K, Fredericson M et al. Intertester reliability and validity of motion assessments during lumbar spine accessory motion testing. Phys Ther. 2008;88(1):43-9. https://doi.org/10.2522/ptj.20060179
  31. Thorborg K, Petersen J, Magnusson S et al. Clinical assessment of hip strength using a hand‐held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493-501.
  32. Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 2005; 86(9): 1753-62. https://doi.org/10.1016/j.apmr.2005.03.033
  33. Hebert JJ, Koppenhaver SL, Magel JS et al. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: A cross-sectional study. Arch Phys Med Rehabil 2010;91(1):78-85. https://doi.org/10.1016/j.apmr.2009.08.146
  34. Kim SY. Changes in cross‐sectional area of lumbar muscle in patients with chronic back pain. J Kor Soc Phys Ther. 2010;22(5):39-47.
  35. Kwon HC. A Myometric and electromyographic analysis of hip abductor musculature in healthy right-handed persons. J Kor Soc Phys Ther. 1990;2(1):35-46.
  36. Jacobs C, UhlTL, Seeley M et al. Strength and fatigability of the dominant and nondominant hip abductors. J Athl Train. 2005;40(3):203-6.