The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain

Daniel Avrahami, Jim R Potvin, Daniel Avrahami, Jim R Potvin

Abstract

Background: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population.

Objective: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain.

Methods: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility.

Results: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements.

Conclusion: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results.

Keywords: back pain; biomechanics; fascial-muscular; hip flexor; iliopsoas; myofascial; rehabilitation; stretching.

Figures

Figure 1
Figure 1
MVIC apparatus: Subject performing FlexMax and ExtMax efforts.
Figure 2
Figure 2
Manual FMLT of the iliopsoas complex.
Figure 3
Figure 3
Mean LBP-THF group pain scores (10-cm VAS) over the course of the treatment program (n = 10). Solid lines indicate changes within a session (primary outcome measure); dotted lines indicate changes between sessions (secondary outcome measure). Standard error bars are shown. Significant decreases within a session shown with *; significant decreases from S1:Pre shown with a +.
Figure 4
Figure 4
Modified Thomas Test hip extension angle (deg) for the low back pain, tight hip flexor (LBP-THF) and asymptomatic THF (A-THF) groups at S1:Pre, S1:Post and S5. Values are pooled across the right and left side (n = 20 for LBP-THF and 16 for A-THF). Standard error bars are shown. Significant decreases within a session shown with *; significant increases from S1:Pre to S5:Pre shown with a +.
Figure 5
Figure 5
Trunk flexion and extension strength (Nm) of both THF groups over the course of the treatment sessions (n = 10 for LBP-THF and 8 for A-THF). Solid lines indicate changes within a session (primary outcome measure); dotted lines indicate changes between sessions (secondary outcome measure). Standard error bars are shown. Significant decreases within a session shown with *; significant increases from S1:Pre shown with a +.
Figure 6
Figure 6
Participant flow diagram.

References

    1. McIntosh G, Frank J, Hogg-Johnson S, Bombardier C, Hall H. Prognostic factors for time receiving workers’ compensation benefits in a cohort of patients with low back pain. Spine. 200;25:147–157.
    1. Masset D, Piette A, Malchaire J. Relation between functional characteristics of the trunk and the occurrence of low back pain: associated risk factors. Spine. 1998;23:359–365.
    1. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J.Spinal Disord. 1992;5:383–389.
    1. van Dieen JH, Kingma I, van der Bug P. Evidence for a role of antagonistic cocontraction in controlling trunk stiffness during lifting. J Biomech. 2003;36:1829–1836.
    1. Bogduk N, Pearcy M, Hadfield G. Anatomy and biomechanics of psoas major. Clin Biomech. 1992;7:109–119.
    1. Juker D, McGill S, Kropf P, Steffen T. Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc. 1998;30:301–310.
    1. Santaguida PL, McGill SM. The psoas major muscle: A three-dimensional geometric study. J Biomech. 1995;28:339–345.
    1. Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech. 1996;11:1–15.
    1. Bachrach RM. Team physician #3. The relationship of low back/pelvic somatic dysfunctions to dance injuries. Orthop Rev. 1988;17:1037–1043.
    1. Kendall FP, McCreary EK, Provance PG. Tests for length of hip flexor muscles. In: Kendall FP, McCreary EK, Provance PG, editors. Muscles: Testing and Function. 4th ed. Baltimore, Md: Williams & Wilkins; 1993. pp. 27–68.
    1. Ingber RS. Iliopsoas myofascial dysfunction: a treatable cause of “failed” low back syndrome. Arch Phys Med Rehabil. 1989;70(5):382–386.
    1. Licciardone JC, Kearns CM, Crow WT. Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: Results from the OSTEOPATHIC Trial. Man Ther. 2014 Aug;19(4):324–30.
    1. Jull GJV. Muscle and motor control in low back pain: Assessment and management. In: Twomey LT, Taylor JR, editors. Physical Therapy for the Low Back Clinics in Physical Therapy. Churchill Livingston; New York: 1987.
    1. Janda V. Muscle weakness and inhibition (pseudoparesis) in back pain syndromes Modern Manual Therapy of the Vertebral Column. Churchill-Livingston; New York: 1986.
    1. Winters MV, Blake CG, Trost JS, Marcello-Brinker TB, Lowe L, Garber MB, Wainner RS. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: A randomized clinical trial. Phys Ther. 2004;84(9):800–807.
    1. Leahy PM. Improved treatments for carpal tunnel and related syndromes. Chiropractic Sports Medicine. 1995;9:6–9.
    1. Halbertsma JP, Goeken LN. Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects. Arch Phys Med Rehabil. 1994;75:976–981.
    1. Sady SP, Wortman M, Blanke D. Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? Arch Phys Med Rehab. 1982;63:261–263.
    1. Suzuki N, Endo S. A quantitative study of trunk muscle strength and fatigability in the low-back-pain syndrome. Spine. 1983;8(1):69–74.
    1. Clapis PA, Davis SM, Davis RO. Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiother Theory Pract. 2008;24:135–141.
    1. Marras WS, King AL, Joynt RL. Measurement of loads on the lumbar spine under isometric and isokinetic conditions. Spine. 1984;9(2):176–187.
    1. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8(2):141–144.
    1. Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2(2):175–84.
    1. Cyriax J. Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. London: Bailliere Tindall; 1982.
    1. Jordan K, Dunn KM, Lewis M, Croft P. A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. J Clin Epidemiol. 2006;59:45–52.
    1. Quint U, Wilke HJ, Shirazi-Adl A, Parnianpour M, Loer F, Claes LE. Importance of the intersegmental trunk muscles for the stability of the lumbar spine. Spine. 1998;23:1937–1945.
    1. Ostelo RW, Deyo RA, Stratford P. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33:90–94.
    1. Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl. 1989;230:1–54.
    1. McGill S. Low Back Disorders Evidence-Based Prevention and Rehabilitation. Human Kinetics; Champaign, IL: 2002.
    1. Van Dillen LR, McDonnell MK, Fleming DA, Sahrmann SA. Effect of knee and hip position on hip extension range of motion in individuals with and without low back pain. J Orthop Sports Phys Ther. 2000;30:307–316.
    1. Ingber RS. Iliopsoas myofascial dysfunction: a treatable cause of “failed” low back syndrome. Arch Phys Med Rehabil. 1989;70:382–386.
    1. Winters MV, Blake CG, Trost JS. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther. 2004;84:800–807.
    1. Sherrington CS. The Integrative Action of the Nervous System. New Haven: 1947.
    1. Janda V. Muscles, central nervous motor regulation and back problems. In: Korr IM, editor. The neurobiologic mechanisms in manipulative therapy. Plenum Press; New York: 1978. pp. 27–41.
    1. Sahrmann SA. Posture and muscle imbalance. Faulty lumbar pelvic alignments. Physical Therapy. 1987;67:1840–1844.
    1. Brown SHM, Potvin JR. Constraining spine stability levels in an optimization model leads to the prediction of trunk muscle co-activity and improved predictions of spine compression. J Biomech. 2005;38:745–754.

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