The Cut-off Values for the Diagnosis of Hamstring Shortness and Related Factors

Abstract

Background: Hamstrings are one of the most frequently evaluated muscle groups for flexibility in the lower extremity. Passive and active knee extension angle values are used as an indirect indicator of hamstring flexibility. However, the lack of consensus on the cut-off values leads to the use of inconsistent angle values in determining the hamstring tightness. Aims: To establish the normative and cut-off values of the passive and active knee extension angles for healthy young adults and to determine the associated factors including the quadriceps strength. Study Design: A cross-sectional study. Methods: A total of 123 volunteer university students, aged 18-24 years, who met the inclusion criteria were included in this study. Passive and active knee extension assessments of the subjects were performed. Subsequently, on the next day, both knee extensor concentric muscle strength of the participants was measured in the isokinetic system. The knee extension angles and the knee extensor strength were recorded as the mean values of the right and the left sides. Results: Passive knee extension angles of 17.1°±9.1° and 9.8°±5.7° and active knee extension angles of 17.8°±9.1° and 13.4°±6° were described as normative values in men and women, respectively. The cut-off values for the diagnosis of hamstring shortness were as follows: passive knee extension angle >32.2° for males and >19.2° for females and active knee extension angle >33.0° for males and >23.4° for females. A significant positive correlation was observed between knee extension angles and isokinetic knee extensor muscle strength in all participants. The knee extension angle and hamstring flexibility were not affected by dominance. Conclusion: The knee extension angles of healthy young people seem to be lower than the results currently reported in the literature. There s a positive correlation between knee extension angles and isokinetic knee extensor muscle strength.

Keywords

• Flexibility, hamstring muscles, joints, knee, range of motion

Kaynakça

1. 1. Knapik JJ. The importance of physical fitness for injury prevention: part 1. J Spec Oper Med 2015;15:123-7.
2. 2. Erkula G, Demirkan F, Alper Kiliç B, Kiter E. Hamstring shortening in healthy adults. J Back Musculoskelet Rehabil 2002;16:77-81.
3. 3. Whitehead CL, Hillman SJ, Richardson AM, Hazlewood ME, Robb JE. The effect of simulated hamstring shortening on gait in normal subjects. Gait Posture 2007;26:90- 6.
4. 4. Bolívar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int 2013;34:42-8.
5. 5. White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy 2009;95:24-8.
6. 6. Mistry GS, Vyas NJ, Sheth MS. Comparison of hamstrings flexibility in subjects with chronic low back pain versus normal individuals. J Clin Exp Res 2014;2:85.
7. 7. Davis DS, Quinn RO, Whiteman CT, Williams JD, Young CR. Concurrent validity of four clinical tests used to measure hamstring flexibility. J Strength Cond Res 2008;22:583-8.
8. 8. Gajdosik R, Lusin G. Hamstring muscle tightness Reliability of an active-kneeextension test. Phys Ther 1983;63:1085-8.

9. 9. Fredriksen H, Dagfinrud H, Jacobsen V, Maehlum S. Passive knee extension test to measure hamstring muscle tightness. Scand J Med Sci Sports 1997;7:279-82.
10. 10. Corkery M, Briscoe H, Ciccone N, Foglia G, Johnson P, Kinsman S, et al. Establishing normal values for lower extremity muscle length in college-age students. Phys Ther Sport 2007;8:66-74.
11. 11. Youdas JW, Krause DA, Hollman JH, Harmsen WS, Laskowski E. The influence of gender and age on hamstring muscle length in healthy adults. J Orthop Sports Phys Ther 2005;35:246-52.
12. 12. Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res 2005;19:27-32.
13. 13. Kuilart KE, Woollam M, Barling E, Lucas N. The active knee extension test and Slump test in subjects with perceived hamstring tightness. Int J Osteopath Med 2005;8:89-97
14. 14. Bell RD, Hoshizaki TB. Relationships of age and sex with range of motion of seventeen joint actions in humans. Can J Appl Sport Sci 1981;6:202-6.
15. 15. Agrawal SS. Comparison between post isometric relaxation and reciprocal inhibition manuevers on hamstring flexibility in young healthy adults: randomized clinical trial. Int J Med Res Health Sci 2016;5:33-7.
16. 16. Gajdosik RL, Rieck MA, Sullivan DK, Wightman SE. Comparison of four clinical tests for assessing hamstring muscle length. J Orthop Sports Phys Ther 1993;18:614-8.
17. 17. Herrington L. The effect of pelvic position on popliteal angle achieved during 90:90 hamstring-length test. J Sport Rehabil 2013;22:254-6.
18. 18. CSMI. HUMAC®/NORM™ TESTING & REHABILITATION SYSTEM User’s Guide. Stoughton, 2006.
19. 19. Katz K, Rosenthal A, Yosipovitch Z. Normal ranges of popliteal angle in children. J Pediatr Orthop 1992;12:229-31.
20. 20. Macedo LG, Magee DJ. Differences in range of motion between dominant and nondominant sides of upper and lower extremities. J Manipulative Physiol Ther 2008;31:577-82.
21. 21. Parikh CM, Arora M. Establishing Normal Values for Lower Extremity Muscle Length and comparison of muscle length from dominant to non dominant side in Elite Cricketers aged 15-22 years. IJTRR 2015;4:1-15.
22. 22. Wang SS, Whitney SL, Burdett RG, Janosky JE. Lower extremity muscular flexibility in long distance runners. J Orthop Sports Phys Ther 1993;17:102-7.