I came across this article that I thought might be beneficial to help with treating patients with low back pain.  The idea is that people who suffer from low back pain have range of motion abnormalities elsewhere.  These abnormalities place stress on the lumbar spine.  I plan to use this article to help me understand that more common hip rotation range of motion abnormalities in individuals with lower back pain and assessing patients that I work with to see if they have similar findings.  Then trying to improve upon these deficits to speed up the recovery process.

Hip Rotation Patterns:

Pattern I: Total medial hip rotation equals total lateral hip rotation of both lower extremities and is broken down into two subcategories.

  • Pattern Ia: Left medial, left lateral, right medial, and right lateral hip rotations were all equal
  • Pattern Ib: Total medial hip rotation equals total lateral hip rotation but one or more of the ranges were unequal (e.g. left lateral, left medial, right lateral, right medial hip rotations)

Pattern II: Total medial hip rotation is greater than total lateral hip rotation

Pattern III: Total lateral hip rotation is greater than total medial hip rotation

Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990; 70:537-541.

Purpose: 1. to describe the amount of hip rotation range of motion in healthy subjects and in patients with low back pain; 2. to categorize these individuals based on different patterns of hip rotation range of motion; and to compare the distribution of healthy subjects and patients with low back dysfunction in the range of motion pattern categories.

The authors discus the fact that low back discomfort doesn’t just come from dysfunction of the back but also can translate from adjacent areas such as the hip.  They focus on the idea of limited or excessive hip range of motion.  These abnormalities at the hip can cause cumulative stress and strain on soft tissue and bone.

The researchers measured the hip rotation ranges of motion of a little over 20 subjects in prone with the knee flexed to 90 degrees and while seated with a goniometer and an inclinometer.  They found that there was not significant difference between testing position or the use of a measuring device.  The researchers decided to use the prone position with an inclinometer to measure the subjects for the study.

They measured 150 subjects (100 healthy and 50 patients with low back pain).  They decided that equal ranges in motion would measure within 10 degrees of each other.  The percentages of subjects for each pattern were presented.

Pattern Ia: 27% of healthy subjects and 14% of patients with low back pain

Pattern Ib: 5% of healthy subjects and 8% of patients with low back pain

Pattern II: 41% of healthy subjects and 30% of patients with low back pain (most prevalent pattern for healthy individuals)

Pattern III: 27% of healthy subjects and 48% of patients with low back pain (most prevalent pattern for patients with low back pain)

They also found that the total left hip rotation (medial + lateral hip rotation) and the total right hip rotation (medial + lateral hip rotation) was equal in 78% of patients with low back pain and 94% of healthy subjects.

This research article shows that there is a significantly greater proportion of individuals suffering from lower back pain with greater total lateral hip rotation when compared to medial hip rotation.  They also showed that healthy individuals had a greater prevalence of equal hip rotation ranges of motion than did individuals with low back pain.

My recommendation for future research is to differentiate between low back pain diagnoses (e.g. stenosis, disc herniations, etc.), reduce the range for equal hip range of motion to <5 degrees which is the standard error for goniometric measuring, and to differentiate between female and male patients with and without low back pain (due to gender differences in normal hip ranges of motion).  The researchers had difficulty understanding if the abnormalities in hip rotation range of motion was due to low back pain or predisposes an individual to low back pain.

 

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