The effect of limited hip mobility on the lumbar spine in a young adult population
Moreside, Janice Marie
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Limited hip mobility is known to affect the lumbar spine. Much of the previous research has utilized a participant population whose hip mobility is compromised due to arthritic or neurological dysfunctions. Such aetiologies may confound the outcomes, as their effects may not be limited to the hip. The purpose of this thesis was to recruit a healthy young adult population with limited hip mobility to further investigate its effect on the lumbar spine, as well as the role of exercise intervention. Several cascading studies were conducted that were unified around a central theme of links between hip and spine function: Study # 1 investigated the normal distribution of passive hip extension and rotation in a group of 77 males (age 19-30). Data was collected using an infra-red motion capture system and compared to goniometric measurements. The resulting angles represent the 5th – 95th percentiles, including the averages and standard deviations. Study # 2 compared movement patterns between groups of males with limited and excessive hip mobility. Participants were required to perform simple functional activities (lunging, twisting, walking, etc) as well as use the elliptical trainer. Resulting hip and spine angles demonstrated that the men with limited hip mobility stood with a more anteriorly tilted pelvis, and assumed a posture with more lumbar and hip flexion on the elliptical trainer, compared to those with greater mobility. This, in turn, resulted in a greater lumbar compression load due to increased back muscle activity. Study #3 involved recruitment of 24 young adult males with limited hip mobility. Their movement patterns were assessed (as in study #2), then they were assigned to one of four intervention groups: hip stretching, spine stabilizing, hip stretching combined with spine stabilization, and control. Participants in the 3 exercise groups attended supervised exercise sessions once/week for 6 weeks, but were expected to exercise a minimum of 4 times/week on their own. At the end of the 6 weeks, intake parameters were re-assessed, and movement pattern assessment repeated. Despite significant increases in available hip flexibility and/or large increases in trunk muscle endurance and trunk motor control, there were few indications that participants were any more adept at decreasing lumbar motion, or utilizing their newfound hip flexibility during functional activities. Study #4 compared those in the 10th and 90th percentiles of available hip rotation, using a frictionless apparatus to investigate passive stiffness properties of the hip. Participants adopted a posture of upright standing, with one leg supported on a turntable apparatus, and upper body and pelvis secured. A an applied rotational moment resulted in passive hip internal and external rotation. Outcomes demonstrate that those with limited hip mobility stand with the leg more externally rotated and require a larger moment to initiate motion. Passive stiffness curves indicate greater stiffness properties in those with limited hip mobility, and more resistance to an external rotation moment than internal rotation. Study #5 investigated passive hip stiffness in the sagittal plane, comparing those with limited and excessive hip extension. Using a frictionless jig, with the participants lying on their left side, the left hip was pulled into extension with knee position varying. Those with limited hip mobility demonstrated increased passive stiffness compared to the more mobile group, and stiffness was greater when the knee was in extension. The group with limited mobility also showed a trend of increased back extension compared to the more mobile group, when the hip and lumbar spine were both free to react to the applied extension moment. Study #6 summarizes the spine/hip kinematics and muscle activation levels produced when using the elliptical trainer, as well as lumbar compressive and shear forces. It differs significantly from walking in that it produces more lumbar motion in flexion/extension and lumbar twist, but less lateral bend. Participants also tended to adopt a greater mean lumbar flexion angle on the elliptical, which in turn resulted in greater muscle activity in the back extensors. Varying hand position, velocity and stride length were all found to significantly affect the amount of lumbar motion. Highly phasic muscle activity is seen, with the gluteal muscles and internal obliques demonstrating the greatest activation levels.