Hip Range of Motion In Those With and Without A History of Low Back PainAndre Ishmael, Rob WilliamsFaculty Mentor: WJ Hanney

University of Central Florida, Department of Health Professions

Purpose: Epidemiological data indicates that up to 84% of adults will experience low back pain (LBP) at some point in their lifetime. . The etiology of LBP is multifactorial and may include both lumbosacral spine and lower quarter impairments. Reports in the literature suggest those with a history of LBP present with decreased hip internal rotation compared to hip external rotation; however, it is unclear if other associations exist between hip range of motion and LBP. Therefore, the purpose of this study was to investigate the relationship between hip passive range of motion (PROM) among individuals with a history of LBP.

Methods: Base line demographic information was collected including age, gender, height and mass. Furthermore, bilateral PROM measurements of the hip were collected for internal rotation, external rotation, flexion, abduction and extension using a universal goniometer. Subjects were then dichotomized as reporting a history of LBP sever enough to limit physical activity in the past year (HxLBP) or not (NoLBP).

Results: Two hundred subjects were recruited. (30.5% female) and consisted of 83 subjects with reported LBP in the past year which limited normal physical activity and 117 who reported an absence of LBP in the past year. Subjects in each group were compared in regards to height and mass with no significant differences found. (Height: HxLBP=174.6cm ±10.2, NoLBP=174.6 ± 10.3; p=.724) (Mass: HxLBP=93.8kgs ± 20.4, NoLBP=89.05kgs ± 15.9; p=.067). However, there was a significant difference in age (HxLBP=29.9 years ±11.5, NoLBP=25.2 years ± 6.9; p=0.000). Significant differences were not present for hip external rotation (mean HxLBP=32.1° ± 9.2°, NoLBP=32.1° ± 8.2°; p = 0.962), flexion (mean HxLBP =119.9°±14.6°, NoLBP=121.5°±11.9°; p = 0.427), and abduction (mean HxLBP =43.1°±11.1°, NoLBP=42.8°±11.3°; p = 0.853). A statistically significant difference was found between hip Internal rotation (mean HxLBP =34.8° ± 9.0°, NoLBP=37.3° ± 8.4°; p = 0.043) and extension (mean HxLBP =11.4°±7.0°, NoLBP=13.5°±5.5°; p = 0.016).See Table.

Discussion: Individuals in the current study with LBP demonstrated deficits in range of motion including hip internal rotation and extension. The results of this study are consistent with previous studies, which found primary limitations of hip internal rotation however, to the author’s knowledge; this is the first study to identify limitations of hip extension in those with a history of LBP. However, the current study cannot establish a cause and effect relationship. Further studies should investigate these findings and attempt to identify causal relationship between the variables.

References 1. Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Current Opinion In Rheumatology. 2005;17(2):134-140. 2. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy. 2005;10(4):242-255. 3. Weiner DK, Sakamoto S, Perera S, Breuer P. Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. Journal of the American Geriatrics Society. 2006;54(1):11-20. 4. Carey TS, Garrett JM, Jackman AM. Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain. Spine. Jan 2000;25(1):115-120. 5. Yilmaz E, Dedeli O. Effect of physical and psychosocial factors on occupational low back pain. Health Science Journal. 2012;6(4):598-609.

Clinical Relevance: A decrease in hip mobility may be associated with LBP. Clinicians should consider the influence of hip range of motion on LBP and seek to implement strategies that may minimize these deleterious influences. Although an association exists in this study, no causal relationship can be implied.

69.50%

30.50%

Gender (200 Subjects)

Male Female

External Rotation

Abduction

Internal Rotation

Extension

Flexion

10 30 50 70 90 110 130External Rotation

Abduc-tion

Internal Rotation

Extension Flexion

No LBP 32.1 42.8 37.3 13.5 121.5

Yes LBP 32.1 43.1 34.8 11.4 119.9

Mean Hip Range of Motion

Yes LBP No LBP