Influence of short hamstring muscles on the pelvis and lumbar spine in standing and during the toe-touch test

doi:10.1016/0268-0033(92)90006-P

Clinical Biomechanics

Volume 7, Issue 1, February 1992, Pages 38-42

https://doi.org/10.1016/0268-0033(92)90006-P Get rights and content

Abstract

This study examined the influence of short hamstring muscles of healthy men on: (1) the angles of pelvic inclination and the lumbar curve in standing, and (2) the flexion range of motion of the pelvis and lumbar spine during the toe-touch test. Surface markers over bony landmarks and photography were used to examine ten men without short hamstrings and ten men with short hamstrings while standing and after assuming the toe-touch position for two repeated trials. ANOVAS showed no significant differences between groups for the angles of pelvic inclination and lumbar curve in standing. During the toe-touch test, the mean flexion range of motion of the pelvis on the thigh was less for the men with short hamstrings (52°; SD, 9°) than for the men without short hamstrings (72°; SD, 4°) (P < 0.001), but the lumbar flexion range of motion was not significantly different.

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Cited by (64)

Instrument assisted soft tissue mobilization (IASTM) versus stretching: A comparison in effectiveness on hip active range of motion, muscle torque and power in people with hamstring tightness
2021, Journal of Bodywork and Movement Therapies
Citation Excerpt :
In non-athletics, sedentary lifestyle and prolonged sitting can lead to HMC tightness (Fatima et al., 2017). Numerous complications may arise from HMC tightness including muscle tear (Sherry et al., 2011), loss of curvature of the lumbar spine (Gajdosik et al., 1992), sacroiliac joint problems (Radwan et al., 2015; Whitley and Dufek, 2011), and plantar fasciitis (Labovitz et al., 2011). These problems mainly arise due to loss of alignment in the body and the force distribution between the joints and the muscles.
Instrument-assisted soft tissue mobilization (IASTM) is a new technique that has been known to be effective in reducing muscle tightness in athletics. However, little is known about its effect on the range of motion, muscle power, and torque compared to manual stretching among non-athletics. Thus, the study was aimed to compare the effectiveness between IASTM and manual stretching in improving hip flexion active range of motion (ROM), muscle torque and power on hamstring muscle complex (HMC) tightness in one session.
Twenty-three young male college students with unilateral hamstring tightness measured via straight leg raising (SLR) test (<65°) were randomly assigned to one of two groups. Twelve participants received the application of IASTM (group 1), and eleven received manual stretching (group 2). Hip flexion active ROM was measured via goniometer, the torque & power of the hamstring muscle were measured using Humac isokinetic dynamometer, before and after both interventions. (ISRCTN17693345).
There was no significant difference in the improvement of hip flexion active ROM (69.6 ± 6.6 vs 72.5 ± 7.9, p = .34), HMC torque (63.7 ± 14.5 vs 53.2 ± 16.3, p = .14), and HMC power (47.8 ± 11.8 vs 40.9 ± 16.3, p = .34) between group 1 and group 2 respectively. When a comparison was made within each group, significant improvements in hip active flexion ROM was found in both groups (p's < .001), and HMC power was significantly improved in group 1 (p = .04) but not in group 2.
The current study findings demonstrate that IASTM was as effective as manual stretching in improving hip flexion active ROM, muscle torque and power among non-athletic people with HMC tightness.
Effects of proprioceptive neuromuscular facilitation stretching at low-intensities with standing toe touch on developing and maintaining hamstring flexibility
2020, Journal of Bodywork and Movement Therapies
Citation Excerpt :
The standing toe touch is the flexion of the hip and lumbar vertebrae and requires flexibility of the posterior muscular chain of the lower extremity. The hamstring is located at the posterior muscular chain, so hamstring length is extended at the standing toe touch (Bennell et al., 1999; Gajdosik et al., 1992). A previous study (a case report) demonstrated the effectiveness of reactive neuromuscular training with the standing toe touch identifying and treating apparent hamstring tightness (Loutsch et al., 2015).
Proprioceptive neuromuscular facilitation (PNF) stretching at low intensities has been rarely investigated. Previous studies have shown that hamstring flexibility after stretching is only temporary.
The aim of this study was to assess the effect of low intensities (40% and 10% of maximum voluntary isometric contraction, MVIC) of PNF stretching on hamstring muscles and to assess the effect of standing toe touch on the duration of hamstring flexibility.
This was a single-blind randomized controlled trial. Sixty-four healthy adults (age, 22.67 ± 1.73 years) were selected and divided into four groups: 40% intensity PNF stretching (P40), 10% intensity PNF stretching (P10), 40% intensity PNF stretching with toe touch (P40 with TT), and 10% intensity PNF stretching with toe touch (P10 with TT). Hamstring flexibility was measured using the active knee extension test (pre-stretching, post-stretching, and 3, 6, 9, 12, and 15 min after PNF stretching).
In the P40, P40 with TT, and P10 with TT groups, significant changes were observed at all time points after stretching (p < 0.05). In the P10 group, significant changes were only observed immediately post stretching (p = 0.006) and at 3 min (p = 0.029) after stretching. In terms of maintaining the duration of flexibility, the P40 with TT and P10 with TT groups were superior to the P40 and P10 groups.
PNF stretching at low intensity, approaching 40% of MVIC, led to more flexibility than 10% MVIC. Additionally, standing toe touch after PNF stretching is recommended to develop and maintain hamstring flexibility.
New insights into lumbar flexion tests based on inverse and direct kinematic musculoskeletal modeling
2020, Journal of Biomechanics
Citation Excerpt :
We observed significant differences as a function of the test, notably whether the gluteus (TKF and RR) or hamstrings (HS, TKE and SR) were maximally stretched. The link between hamstrings extensibility and trunk flexion has been clearly demonstrated in the literature (Gajdosik et al., 1992; Rodriguez-Garcia et al., 2008; Mayorga-Vega et al., 2014). However, only two studies have investigated the influence of gluteus extensibility on pelvic tilt (Toppenberg and Bullock, 1986; Yasukouchi and Isayama, 1995), while there appears to be none on lumbar flexion.
Measurement of maximal lumbar flexion is considered to be a crucial element in the assessment of lumbar spine mechanics in situations as diverse as physiotherapy, orthopaedics, ergonomics, sport or aging. However, currently, there is no consensus on a reference test.
This study aims to characterise five maximal lumbar flexion tests (four classical tests and a new, specifically-developed test designed to constrain pelvic retroversion) based on a three-dimensional, participant-specific musculoskeletal model.
Twenty-six male and female participants performed the five tests. Movements were modelled in OpenSim to estimate change in length in lumbar, hamstring and gluteus muscles, together with lumbar flexion and pelvic tilt. These so-called “inverse” kinematic results were compared using a two-way ANOVA (sex $\times$ test). In a second step, lumbar muscle change in length was computed using a direct kinematic method.
Lumbar flexion and lumbar muscle change in length were found to be greater when participants were in seated postures, with little pelvic retroversion. Female participants were observed to have less lumbar flexion than male participants ( $77 \pm 14 °$ and $91 \pm 12 °$ , respectively). Hip extensor muscles (hamstrings and gluteus) were fully stretched during each of the five tests. Our results highlight the specific roles of hamstrings, gluteus and lumbar muscles into reaching maximal lumbar flexion.
Coupling inverse and direct kinematic methods proved to be a useful tool to enhance our knowledge of lumbar tests. Our findings help to characterise the role of the muscles involved in lumbar flexion, and we propose some recommendations for improving and standardising these tests.
Lumbar posture and individual flexibility influence back muscle flexion-relaxation phenomenon while sitting
2019, International Journal of Industrial Ergonomics
Citation Excerpt :
The toe-touch flexibility method employed in the study was considered as the test for individual's flexibility because of its relative ease of use and convenience in testing. The test is a more specific measure of extensibilities of both hamstrings and back muscles (Gajdosik et al., 1992) and an appropriate indicator of both trunk and hip angles (Hashemirad et al., 2009). However, in the study the effect of hamstrings was ignored because participants' thighs were restricted and knees were flexed during sitting.
Although numerous studies have documented back muscle flexion-relaxation phenomenon (FRP) in standing postures, few studies have examined the FRP in various seated lumbar postures and individual flexibilities. This study, therefore, recruited 18 male students and assigned to low- and high-flexibility groups (9 in each). Activation of thoracic and lumbar erector spinae (ES) and lumbosacral angles were examined while participants sat in two postures (lordosis and kyphosis) and flexed their trunks at 15°, 30°, 45°, 60°, and maximum flexion. Results showed that kyphotic lumbar posture caused relatively low and unchangeable thoracic and lumbar ES activations, whereas lordotic lumbar posture engendered more contractive and varying thoracic and lumbar ES activations. Flexible participants exhibited higher thoracic ES activation than less flexible participants during lordotic sitting. Thoracic ES seemed to play a compensative role to stabilize the spine in the lordotic sitting posture, especially when the trunk was flexed over 45°. In lordotic lumbar posture, FRP occurred only in the lumbar ES; however, the activation and lumbosacral angles were still higher than those in kyphotic posture. The increased back muscle activation associated with lumbar lordosis may partially share the load on passive interspinous tissues, which are close to the discs during these flexed trunk positions.
This study suggests that various lumbar postures and individual flexibilities may cause different FRP patterns when sitting. While performing seated tasks, people should exercise caution about the lumbar posture.
The relationship between lumbopelvic flexibility and sitting posture in adult women
2019, Journal of Biomechanics
Clinical observations have suggested that limited hamstring flexibility may be associated with sagittal spinal curvatures in spine flexed postures. Thus, limited hamstring flexibility may be related to large amounts of spine flexion in “slumped” sitting postures which could contribute to low back pain and injury. The aim of this study was to determine if hamstring and pelvic flexibility are associated with flexed sitting postures using a backless office chair. Forty-one healthy female adults aged 18–69  years were recruited. Subjects performed the Sit-and-Reach test to determine maximum flexibility values and lumbar and pelvic angles were measured with accelerometers. Participants then completed a standardized typing task for a 10-minute sitting trial at an ergonomically adjusted workstation. The results showed no association between hamstring flexibility and seated lumbar spine and pelvic angles (p = 0.999, η² = 0.000; p = 0.901, η² = 0.006). Greater pelvic flexibility was associated with a more upright lumbar sitting posture (p = 0.023; η² = 0.132) but with no specific pelvic sitting posture (p = 0.660; η² = 0.005). Different movement strategies during the Sit-and-Reach test were detected: all participants moved through their lumbar spine; but only those with ‘excellent’ flexibility also used their pelvis. Individuals in the ‘excellent’ flexibility group were significantly shorter than those with ‘poor’ and ‘good’ flexibility (p = 0.020; η² = 0.190). In conclusion, hamstring flexibility does not influence sitting posture but pelvic flexibility does. Other factors such as acetabulofemoral joint limitations, consciousness of posture, or the seat itself may also influence sitting posture. Different movement strategies as well as height appear to contribute to the Sit-and-Reach test which should be researched further.
What factors can affect lumbopelvic flexion-extension motion in the sagittal plane?: A literature review
2018, Human Movement Science
Clinicians use forward bending and backward return in routine clinical examinations for evaluating spine mobility. The magnitude and timing of lumbar spine and pelvic contributions have been described in the literature as lumbopelvic rhythm. There is still limited knowledge about the factors which can determinate lumbar and hip mobility and coordination in the sagittal plane. The aim of this study is to demonstrate those factors contributing to the lumbopelvic rhythm and to explain the differences observed between subjects. The studies included in the review present possible explanations of observed lumbar-pelvic motion and/or coordination. They measure movement of the lumbar spine, the pelvis and/or the hip in the sagittal plane. The search was conducted in August 2017. Two databases (PubMed and Web of Science) were searched. The search identified 126 potentially relevant articles (53 in PubMed, 73 in Web of Science). Initial screening based on titles and abstracts retrieved 35 articles. The second stage of selection involved reading the full texts of articles. Twenty-four papers were selected in this stage. After careful bibliographic study, seven papers were added for this review, resulting in a total of 31. This literature review demonstrates those factors contributing to lumbopelvic motion. Age and gender, hamstring muscle tightness, feet position, muscle fatigue, movement speed and external loading as well phase of motion can affect various aspects of lumbopelvic rhythm.

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PaperInfluence of short hamstring muscles on the pelvis and lumbar spine in standing and during the toe-touch test

Abstract

Aust J Physiother

Aust J Physiother

Spondylolisthesis and tight hamstrings

J Bone Joint Surg

Radiating leg pain and positive straight leg raising in spondylolysis in children

J Pediatr Orthop

Scheuermann's disease: Clinical and radiological survey of 17 and 18 year olds

Am J Phys Med

A quantitative study of muscle factors in chronic low back syndrome

J Am Geriatr Soc

Physical measurements as risk indicators for low-back trouble over a one-year period

Spine

Contribution of pelvic and lower limb motion to increases in the angle of passive straight-leg-raising

Phys Ther

Effects of ankle dorsiflexion on active and passive unilateral straight-leg-raising

Phys Ther

Paper
Influence of short hamstring muscles on the pelvis and lumbar spine in standing and during the toe-touch test