Hip stiffness patterns in lumbar flexion- or extension-based movement syndromes

Abstract

Objective: To determine whether a relationship exists between sagittal plane hip range of motion loss and sagittal plane lumbar Movement System Impairment (MSI) categories in patients with low back pain (LBP).

Design: Correlational study.

Setting: University outpatient physical therapy clinic.

Participants: Subjects (N=40) with LBP.

Interventions: Not applicable.

Main outcome measures: Classification into a flexion- or extension-based lumbar MSI category, and bilateral passive hip flexion and extension range of motion testing. Using predefined criteria, subjects in each MSI category were subclassified into 1 of 3 hip stiffness categories: (1) a considerable loss of either flexion or extension (pattern A); (2) a considerable loss of both flexion and extension (pattern B); or (3) minimally limited flexion or extension (pattern C).

Results: Pattern A occurred in 23 (57.5%) subjects, with the primary direction of hip motion loss agreeing with the MSI category 78.3% of the time (φ=.56; P=.007). Pattern B occurred in 10 (25%) subjects, with the primary direction of hip motion loss agreeing with the MSI category 70% of the time (φ=.47; P=.197). Pattern C occurred in 7 (17.5%) subjects, with the primary direction of hip motion limitation agreeing with the MSI category 42.9% of the time (φ=-.40; P=.290).

Conclusions: Considerable unidirectional hip motion loss in the sagittal plane was a common finding among subjects with LBP and yielded a strong positive relationship with the same direction MSI category. These results may inform future studies investigating whether treatment of hip stiffness patterns could improve outcomes in LBP management.

Keywords: Classification; Hip joint; Low back pain; Range of motion; Rehabilitation.