Evaluating pelvic rotator strength: Investigating asymmetry and its correlation with pelvic rotation angle during active straight leg raise

Abstract

Background

Although lumbopelvic rotation control muscle is important to maintain pelvic neutral alignment during active straight leg raise (ASLR), pelvic rotator strength has not been evaluated. Thus, a novel method is needed to measure pelvic rotator strength and to determine whether pelvic rotator muscle asymmetry is related to side difference in transverse plane pelvic rotation angle (TrPRA) during ASLR.

Objective

To find average pelvic rotator strength, verify the reliability of pelvic rotator strength measurement method, and identify the correlation between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR.

Methods

Forty healthy participants were enrolled. Pelvic rotator strength was measured using a hand-held dynamometer. TrPRA was measured using a smart KEMA motion sensor. Reliability was analyzed using intraclass correlation coefficient (ICC). The correlation between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR was analyzed using Pearson's correlation coefficient.

Results

The average pelvic rotator strength was 120.3 N (72.9–202.2) for males and 94.4 N (58–125.8) for females. The reliability of pelvic rotator strength measurement demonstrated good to excellent intra- (ICC = 0.87–0.97) and inter-rater (ICC = 0.93–0.98) values. A significant moderate relationship existed between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR (r = 0.39, p < 0.05).

Conclusion

The pelvic rotator muscle strength measurement method can be clinically used with good to excellent intra- and inter-rater reliability. Pelvic rotator strength asymmetry should be considered to evaluate and manage the pelvic rotation control during ASLR.

Keywords

movement muscle strength pelvis range of motion

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References

Sahrmann

. Diagnosis and treatment of movement impairment syndromes. Oxford: Elsevier Health Sciences, 2001.

Liebenson

Karpowicz

Brown

, et al. The active straight leg raise test and lumbar spine stability. Pm&r 2009; 1: 530–535.

Meijer

Van Dieen

, et al. Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking. J Biomech 2010; 43: 532–539.

Comerford

Mottram

. Kinetic control: the management of uncontrolled movement. vol. 1. Edinburgh: Elsevier/Churchill Livingstone, 2012.

Yoo

H-i

Hwang

U-j

Ahn

S-h

, et al. Comparison of pelvic rotation angle in the transverse plane in the supine position and during active straight leg raise between people with and without nonspecific low back pain. Clin Biomech 2021; 83: 105310.

Urquhart

Hodges

. Differential activity of regions of transversus abdominis during trunk rotation. Eur Spine J 2005; 14: 393–400.

Meijer

Hodges

, et al. Understanding the Active Straight Leg Raise (ASLR): an electromyographic study in healthy subjects. Man Ther 2012; 17: 531–537.

Shadmehr

Jafarian

Talebian

. Changes in recruitment of pelvic stabilizer muscles in people with and without sacroiliac joint pain during the active straight-leg-raise test. J Back Musculoskelet Rehabil 2012; 25: 27–32.

Park

K-h

S-m

Kim

S-j

, et al. Effects of the pelvic rotatory control method on abdominal muscle activity and the pelvic rotation during active straight leg raising. Man Ther 2013; 18: 220–224.

10.

Crasto

Montes

Carvalho

, et al. Abdominal muscle activity and pelvic motion according to active straight leg raising test results in adults with and without chronic low back pain. Musculoskeletal Sci Pract 2020; 50: 102245.

11.

Al-Eisa

Egan

Wassersug

. Fluctuating asymmetry and low back pain. Evol Hum Behav 2004; 25: 31–37.

12.

Lee

. The pelvic girdle. New York: Churchill livingstone, 2004.

13.

Weyrauch

Bohall

Sorensen

, et al. Association between rotation-related impairments and activity type in people with and without low back pain. Arch Phys Med Rehabil 2015; 96: 1506–1517.

14.

Mogren

Pohjanen

. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 2005; 30: 983–991.

15.

Roussel

Nijs

Truijen

, et al. Reliability of the assessment of lumbar range of motion and maximal isometric strength. Arch Phys Med Rehabil 2006; 87: 576–582.

16.

Wong

. Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstet Gynecol Scand 2003; 82: 1086–1091.

17.

Jung

S-h

Kwon

O-y

C-H

, et al. Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: the STROBE study. Medicine (Baltimore) 2018; 97: 29.

18.

Jung

S-h

Kwon

O-y

Jeon

I-c

, et al. Reliability and criterion validity of measurements using a smart phone-based measurement tool for the transverse rotation angle of the pelvis during single-leg lifting. Physiother Theory Pract 2018; 34: 58–65.

19.

Juul

Langberg

Enoch

, et al. The intra-and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain. BMC Musculoskel Disord 2013; 14: 1–15.

20.

Koo

. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155–163.

21.

Portney

Watkins

. Foundations of clinical research: applications to practice. Pearson/Prentice Hall Upper Saddle River, NJ, 2009.

22.

Hopkins

Marshall

Batterham

, et al. Progressive statistics for studies in sports medicine and exercise science. Medicine+ Science in Sports+ Exercise 2009; 41: 3.

23.

Marques

Figueiredo

Harris

, et al.

Are resistance and aerobic exercise training equally effective at improving knee muscle strength and balance in older women?

Arch Gerontol Geriatr 2017; 68: 106–112.

24.

Thorborg

Bandholm

Hölmich

. Hip-and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc 2013; 21: 550–555.

25.

Weir

. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005; 19: 231–240.

26.

Schrama

Stenneberg

Lucas

, et al. Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review. Arch Phys Med Rehabil 2014; 95: 2444–2469.

27.

Park

H-w

Baek

Kim

, et al. Reliability and validity of a new method for isometric back extensor strength evaluation using a hand-held dynamometer. Ann Rehabil Med 2017; 41: 793–800.

28.

Jeon

I-C

. Comparisons of test-retest reliability of strength measurement of gluteus medius strength between break and make test in subjects with pelvic drop. J Korean Phys Ther 2019; 31: 147–150.

29.

Roussel

Truijen

De Kerf

, et al. Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain. Arch Phys Med Rehabil 2008; 89: 788–791.

30.

White

Panjabi

. Clinical biomechanics of the Spine. Philadelphia: JB Lippincott, 1978.

31.

Teyhen

Williamson

Carlson

, et al. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil 2009; 90: 761–767.

32.

Muscolino

. Know the body: muscle, bone, and palpation essentials-e-book. Elsevier Health Sciences, 2013.