Development and Validation of The Iliopsoas Endurance Test: A Reliable Tool for Clinical and Functional Assessment

Abstract

Development and Validation of The Iliopsoas Endurance Test: A Reliable Tool for Clinical and Functional Assessment

Abstract

Purpose: The iliopsoas muscle complex is vital for lumbar stabilization, posture, and hip flexion, yet its endurance is often overlooked in clinical and research settings. This study aimed to develop and validate the Iliopsoas Endurance Test (IET), a cost-effective and practical method for assessing iliopsoas endurance. Methods: Healthy participants aged 18–38 years were evaluated. The IET involved performing hip flexion-extension movements within an 80-degree range while supine, and measurements were taken over 60 seconds. Reliability was assessed using intraclass correlation coefficients (ICC) for inter- and intra-rater agreements, while the validity of the IET was determined by its correlation with isokinetic assessments. Results: The IET demonstrated excellent intra-rater (ICC=0.802) and good inter-rater (ICC=0.701) reliability. Strong correlations were observed between IET repetitions and isokinetic dynamometer measurements for peak torque (r=0.706, p<0.001) and total repetitions (r=0.629, p<0.001). The findings support the IET as a reliable alternative to isokinetic testing, particularly in settings where access to specialized equipment is limited. Conclusions: The IET is a practical, reliable, and cost-effective tool for assessing iliopsoas endurance, with potential applications in clinical diagnostics, rehabilitation, and performance analysis. Future research should explore its applicability across diverse populations and its role in long-term rehabilitation outcomes.

Keywords

• Ilıopsoas
• hip flexion
• endurance
• isokinetic dynamometer

References

1. Mansfield PJ, Neumann DA. Structure and Function of the Hip. In: Essentials of Kinesiology for the Physical Therapist Assistant. 2019th ed. Mosby; 2019. p. 233–77.
2. Jeffrey A. Simancek. Hips and Thighs. Deep Tissue Massage Treat. 2013;134–57.
3. Sajko S, Stuber K. Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications. J Can Chiropr Assoc. 2009;53(4):311–8.
4. Farias MCG, Oliveira BDR, Rocha TDS, Caiaffo V. Morphological and morphometric analysis of psoas minor muscle in cadavers. J Morphol Sci. 2012;29(4):202–5.
5. Tufo A, Desai GJ, Joshua Cox W. Psoas syndrome: A frequently missed diagnosis. J Am Osteopath Assoc. 2012;112(8):522–8.
6. Anderson CN. Iliopsoas: Pathology, Diagnosis, and Treatment. Vol. 35, Clinics in Sports Medicine. 2016. p. 419–33.
7. Chang A, Hubbard JB. Anatomy, Bony Pelvis and Lower Limb, Femur. StatPearls. 2018.
8. Jorgensson A. The iliopsoas muscle and the lumbar spine. Aust J Physiother. 1993;39(2):125–32.

9. Jelveus A. Integrated Sports Massage Therapy E-Book: A Comprehensive Handbook. Elsevier Health Sciences; 2011. 207–234 p.
10. Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. Am J Sports Med. 2006;34(4):630–6.
11. Thorborg K, Bandholm T, Zebis M, Andersen LL, Jensen J, Hölmich P. Large strengthening effect of a hip-flexor training programme: a randomized controlled trial. Knee Surgery, Sport Traumatol Arthrosc. 2016;24(7):2346–52.
12. Lifshitz L, Bar Sela S, Gal N, Martin R, Fleitman Klar M. Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Curr Sports Med Rep. 2020;19(6):235–43.
13. Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002;32(9):447–60.
14. Morcelli MH, LaRoche DP, Crozara LF, Marques NR, Hallal CZ, Rossi DM, et al. Neuromuscular performance in the hip joint of elderly fallers and non-fallers. Aging Clin Exp Res. 2016;28(3):443–50.
15. Nodehi-Moghadam A, Taghipour M, Alibazi RG, Baharlouei H. The comparison of spinal curves and hip and ankle range of motions between old and young persons. Med J Islam Repub Iran. 2014;28(1).
16. Chaudhary S, Patel T, Makwana A, Patel M. Improvement of Iliopsoas Flexibility: A Comparative Effectiveness between Post Isometric Relaxation and Static Stretching. Indian J Physiother Occup Ther. 2020;14(3):213–8.
17. Aali S, Letafatkar A, Ebrahimi I, Hossein Barati A, Hadadnejad M. Does Iliopsoas Tightness Affects Synergistic Muscle Activity in Hip Extension During Stance Phase of Gait? Int J Med Res Heal Sci. 2017;6(6):118–22.
18. Jeon I cheol. Comparison of Test-retest Measurement Reliability of Iliopsoas Strength between Break and Make Test in Subjects with Lumbar Extension Syndrome. J Musculoskelet Sci Technol. 2019;3(2).
19. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155–63.
20. Papageorgiou SN. On correlation coefficients and their interpretation. Journal of Orthodontics. 2022;49:359–61.
21. Cant J, Pitance L, Christophe D, Bakker W, Feipel V. Test-retest Reliability of the Hip Abductor Endurance Test Depending on Two Different Uses of the Borg Scale. Int J Phys Ther Rehabil. 2016;2(2).
22. Ambegaonkar JP, Mettinger LM, Caswell S V, Burtt A, Cortes N. Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther. 2014;9(5):604–16.
23. Juan J, Leff G, Kevorken K, Jeanfavre M. Hip Flexor Muscle Activation During Common Rehabilitation and Strength Exercises. J Clin Med. 2024;13(21).
24. Bordoni B, Varacollo M. Anatomy, Bony Pelvis and Lower Limb, Iliopsoas Muscle. StatPearls; 2019.
25. Haslanger S. Endurance and Temporary Intrinsics. Analysis. 1989;49(3):119.
26. Brill PA, Macera CA, Davis DR, Blair SN, Gordon N. Muscular strength and physical function. Med Sci Sports Exerc. 2000;32(2):412–6.
27. Franchi M V., Reeves ND, Narici M V. Skeletal muscle remodeling in response to eccentric vs. concentric loading: Morphological, molecular, and metabolic adaptations. Vol. 4, Frontiers in Physiology. 2017.
28. Gürol B, Yılmaz İ. İzokinetik kuvvet antrenmanı. Ankara Üniversitesi Beden Eğitimi ve Spor Yüksekokulu SPORMETRE Beden Eğitimi ve Spor Bilim Derg. 2013;11(1):1–11.
29. Lanning CL, Uhl TL, Ingram CL, Mattacola CG, English T, Newsom S. Baseline values of trunk endurance and hip strength in collegiate athletes. J Athl Train. 2006;41(4):427–34.
30. Wilk KE, Arrigo CA, Davies GJ. Isokinetic Testing: Why it is More Important Today than Ever. Int J Sports Phys Ther. 2024;19(4):374–80.