Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension

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Abstract

Prone hip extension has been used as a self-perturbation task to test the stability of the lumbopelvic region. However, the relationship between recruitment patterns in the hip and trunk muscles and lumbopelvic kinematics remains unknown. The present study aimed to examine if the balance of hip and trunk muscle activities are related to pelvic motion and low back muscle activity during prone hip extension. Sixteen healthy participants performed prone hip extension from 30° of hip flexion to 10° of hip extension. Surface electromyography (of the gluteus maximus, semitendinosus, rectus femoris, tensor fasciae latae, multifidus, and erector spinae) and pelvic kinematic measurements were collected. Results showed that increased activity of the hip flexor (tensor fasciae latae) relative to that of hip extensors (gluteus maximus and semitendinosus) was significantly associated with increased anterior pelvic tilt during hip extension (r = 0.52). Increased anterior pelvic tilt was also significantly related to the delayed onset timing of the contralateral and ipsilateral multifidus (r = 0.57, r = 0.53) and contralateral erector spinae (r = 0.63). Additionally, the decrease of the gluteus maximus activity relative to the semitendinosus was significantly related to increased muscle activity of the ipsilateral erector spinae (r = −0.57). These results indicate that imbalance between the agonist and antagonist hip muscles and delayed trunk muscle onset would increase motion in the lumbopelvic region.

Introduction

Active prone hip extension is often used as an exercise in physical therapy for the patients with hip or trunk dysfunction. This task also has been used as a self-perturbation task to test the stability of the lumbopelvic region (Janda, 1996, Sahrmann, 2002). Clinically, in patients with lumbopelvic dysfunction, the lumbopelvic region is often observed to extend or rotate excessively during prone hip extension (Sahrmann, 2002).

Previous studies have analyzed muscle activation patterns with respect to muscle firing order during active prone hip extension. Vogt and Banzer (1997) studied the sequential activation of lumbar and hip muscles in active prone hip extension. They found that there is a consistent muscle firing order of the ipsilateral lumbar erector spinae, semitendinosus, contralateral lumbar erector spinae, tensor fasciae latae, and gluteus maximus. Sakamoto et al. (2009) also reported the muscle activation order of the semitendinosus, ipsilateral and contralateral erector spinae, and gluteus maximus muscles in prone hip extension with knee flexion, knee extension, and hip lateral rotation and knee flexion. However, other studies indicated that there are no consistent recruitment patterns for prone hip extension among erector spinae, hamstrings, and gluteus maximus (Lehman et al., 2004, Pierce and Lee, 1990). Moreover, a report by Guimarães et al. (2010) has cast doubt over the possibility that patients with low back pain and the healthy individuals can be distinguished only by analyzing the muscle firing order. This study suggested that it is necessary to evaluate the movement patterns in addition to the muscle activation patterns during the active prone hip extension in order to discriminate between patients with low back pain and healthy individuals (Guimarães et al., 2010).

The factors affecting the lumbopelvic kinematics and activity of the low back muscles during hip extension could include muscle activity balance in the hip-joint muscles (balance between agonist and antagonist muscles as well as balance among the synergistic muscles) and muscle activity balance between the hip and trunk muscles (balance between the prime mover and lumbopelvic stabilizer). It is theoretically possible that altered balance of muscle activation amplitudes and muscle activation timing leads to altered movement patterns, favoring the occurrence of anterior pelvic tilt and excessive lumbar extension. However, no studies have examined the relationship between the balance in hip and trunk muscle activity and kinematic or muscle activity in the lumbopelvic region.

The purpose of this study was to examine if the balance of hip and trunk muscle activities are related to pelvic motion and low back muscle activity during prone hip extension. By examining these relationships, we will gain insights into the potential cause of lumbopelvic pathokinematics during prone hip extension.

Section snippets

Participants

Sixteen healthy subjects (10 men and 6 women) participated in the study. Their mean age was 24.3 ± 5.2 (mean ± SD) years, their mean body weight was 59.0 ± 8.0 kg, and their mean height was 165.7 ± 7.9 cm.

Subjects were excluded from the study if they had musculoskeletal conditions, or if they had been diagnosed with neurological disorders or cardiovascular disease that would limit their function. Subjects who had a hip extension angle less than 10° were also excluded from the study. All of the subjects

Results

Mean ± SD values of the activity of each of the muscles and pelvic motion during prone hip extension are shown in Table 1. The mean value of the rectus femoris muscle activity was found to be less than 5% MVICs. Therefore, the rectus femoris muscle was excluded from the subsequent analysis.

Discussion

The primary findings of the current study were that excessive activity of the hip flexor (tensor fasciae latae) relative to the hip extensors (gluteus maximus and semitendinosus) and delay of firing of the bilateral multifidus and contralateral erector spinae were related to increased anterior tilt of the pelvis during prone hip extension. Although excessive extension and rotation of the lumbopelvic region is observed in patients with lumbopelvic dysfunction in the clinical setting (Sahrmann,

Conflict of interest statement

None of the authors have any conflicts of interest associated with this study.

Acknowledgement

The authors wish to thank Masahiro Kokubu, Shingo Takashima, and Yusuke Okita for their technical assistance with data analyses.

Hiroshige Tateuchi received his PhD from Kyoto University in 2011. Since 2006 he has been working as an assistant professor in the Department of Physical Therapy at the Graduate School of Medicine of Kyoto University. His main research interests are focused on EMG and biomechanical analysis of human movement and gait analysis in patients with musculoskeletal disorders.

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    Hiroshige Tateuchi received his PhD from Kyoto University in 2011. Since 2006 he has been working as an assistant professor in the Department of Physical Therapy at the Graduate School of Medicine of Kyoto University. His main research interests are focused on EMG and biomechanical analysis of human movement and gait analysis in patients with musculoskeletal disorders.

    Masashi Taniguchi graduated from the Osaka Prefectural University in 2009 with a Bachelor of Physical Therapy. In 2011 he completed the Master of Human Health Sciences from Kyoto University. At present he works at the Division of Physical Therapy in the Shiga University of Medical Science Hospital as a physical therapist. His main interest is in clinical and biomechanical investigation on the human movement.

    Natsuko Mori graduated with a Bachelor of Physical Therapy from the Hirosaki University in 2009. She completed the Master of Human Health Sciences from Kyoto University. She currently works at the Hirosaki Stroke and Rehabilitation Center as a physical therapist. Her primary research interests are in the area of physical therapy for urinary incontinence.

    Noriaki Ichihashi is a professor in the Department of Physical Therapy at the Graduate School of Medicine of Kyoto University. He received his PhD from Fujita Health University in 2004. His field of research includes EMG analysis of muscle training; morphological analysis of muscle using ultrasonography; biomechanics of human movement; mechanism of kinematic chain; and fall in elderly people.

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