The Optimal Angle of Hip Flexion for Supine Hip Extensor Manual Muscle Test
Main Article Content
Abstract
Introduction: The starting position of the traditional (Trad) procedure of manual muscle testing (MMT) for hip extensor (HE) grade 3 is in the prone position. This posture restricted the chance to assess patients who are unable to lie prone. Therefore, the supine HE MMT is an interesting alternative method. This method was tested in the supine position with the tested hip in flexion and knee in extension. Patients were instructed by examiner to lift up their hip and pelvis from the floor, and maintained their trunk, hip and pelvis in the same alignment. Previous study showed that the supine HE MMT is reliable and valid and can discrete different strength of HE from grade 2 to 5. However, no previous study investigated the agreement between the supine HE MMT and the Trad HE MMT within the same patient. Moreover, the optimal angle of hip flexion for the supine HE MMT has not been determined. Objective: To identify the optimal angle of hip flexion for supine HE MMT. A cross-sectional within subject comparative study was used to compare the MMT grade of HE which was assessed using the supine HE MMT with hip flexion at 30, 45, and 60 degrees with the Trad HE MMT. Method: Fifty one HE were evaluated. These muscles were selected from 17 patients and 18 healthy subjects who were able to lie prone. All HE had the Trad HE MMT grade between 2 to 5. Participants were received the Trad test and the supine HE MMT with hip flexion 30, 45, and 60 degrees. The tested sequence of hip flexion was random and the Trad MMT was the last test. Statistical analysis: Quadratic weighted Kappa was used to determine the agreement of supine HE muscle grades at hip flexion 30˚, 45˚ and 60˚, compared with the Trad HE manual muscle grades. Results: The moderate agreement of supine HE MMT at hip flexion angle 30˚, 45˚ and 60˚ were found, that is, 0.54, 0.60 and 0.42 respectively. Hip flexion angle at 45˚ had the highest agreement when compared with the Trad MMT. Clinical implication: Supine HE MMT with hip flexion 45˚ is recommended to use in clinic in patients who have difficulty in lying prone.
Article Details
References
2. Kilmer DD, Aitkens SG, Wright W. Simulated work performance tasks in persons with neuropathic and myopathic weakness. Arch Phys Med Rehabil. 2000;81:938-43.
3. Reuden DB, Siu AL. An objective measure of physical function of eldery outpatients. The physical performance test. J Am Geriatr Soc. 1990;38:1105-12.
4. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:192-7.
5. Perry J, Weiss WB, Burnfield JM, Gronley JK. The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil. 2004;85:1345-50.
6. Chittawatanarat K, Pruenglampoo S, Trakulhoon V, Ungpinitpong W, Patumanond J. Height prediction from anthropometric length parameters in Thai people. Asia Pac J Clin Nutr. 2012;21:347-54.
7. Medical Research Council (MRC) of the United Kingdom. Aids to the examination of peripheral nervous system. Eastbound: Bailliere-Tindall; 1978.
8. Lowry R. Kappa as a Measure of Concordance in Categorical Sorting 2015. Available from: http://vassarstats.net/kappa.html.
9. Silva AM, Shen W, Heo M, Gallagher D, Wang Z, Sardinha LB, et al. Ethnicity-Related Skelatal Muscle Differences Across the lifespan. Am J Hum Biol. 2010;22:76-82.
10. Maughan RJ, Watson JS, Weir J. Strength and cross-sectional area of human skeletal muscle. J Physiol. 1983;338:37-49.
11. Doherty TJ , Vandervoort AA , Taylor AW, Brown WF. Effects of motor unit losses on strength in older men and women. J Appl Physiol. 1993;74:868-74.
12. Chance-Larsen K, Littlewood C, Garth A. Prone hip extension with lower abdominal hollowing improves the relative timing of gluteus maximus activation in relation to biceps femoris. Man Ther. 2010;15:61-5.
13. Tateuchi H, Taniguchi M, Mori N, Ichihashi N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension. J Electromyogr Kinesiol. 2012;3:391-7.
14. Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37:754-62.
15. Kim JH, Kim Y, Chung Y. The influence of an unstable surface on trunk and lower extremity muscle activities during variable bridging exercises. J Phys Ther Sci. 2014;26:521-3.
16. Kang HK, Jung JH, Yu JH. Comparison of trunk muscle activity during bridging exercises using a sling in patients with low back pain. J Sports Sci Med. 2012;11:510-15.
17. Richardson C, Jull G, Hodges P, Hides J. Therapeutic exercise for spinal segmental stabilization in low back pain. London: Churchill Livingstone; 1999.
18. O'Sullivan SB, Schmitzn TJ. Physical rehabilitation : Assessment and treatment 5 th ed. Philadelphia: F.A. Davis Company; 2007.
19. Jang EM, Kim MH, Oh JS. Effects of a bridging exercise with hip adduction on the EMG activities of the abdominal and hip extensor muscles in females. J Phys Ther Sci. 2013;25:1147-9.
20. Shumway-Cook A, Woollacott MH. Motor control: Theory and practical approach. 2nd, editor. Philadelphia: Lippincott Williams & Wilkines; 2000.
21. García-Vaquero MP, Moreside JM, Brontons-Gil E, Peco-González N, FJ V-G. Trunk muscle activation during stabilization exercises with single and double leg support. J Electromyogr Kinesiol. 2012;22:398-406.
22. Reese NB. Muscle and sensory testing. 2nd ed. St. Louis, Missouri: Elsevier Saunders; 2005.
23. Tyson SF. Trunk kinematics in hemiplegic gait and the effect of walking aids. Clin Rehabil. 1999;13:295-300.
24. Pereira LM, Marcucci FC, de Oliveira Menacho M, Garanhani MR, Lavado EL, Cardoso JR. Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise. J Electromyogr Kinesiol. 2011;21:327-32.
25. Karthikbabu S, Chakrapani M, Ganeshan S, Rakshith KC, Nafeez S, Prem V. A review on assessment and treatment of the trunk in stroke. Neural Regen Res. 2012;7:1974-7.
