Posterior Glide of Hip Study: Letter to the Editor of J Orthopedic & Sports Physical Therapy
POSTERIOR GLIDE OF HIP STUDY (ABSTRACT FOLLOWS LETTER BELOW) Letter not accepted for publication Hesch Seminars - Jerry Hesch, PT
Letter not accepted for publication
April 3, 2003
Guy G. Simoneau, PT, PhD, ATC Editor-in-Chief
J of Orthopedic & Sports Physical Therapy 1111 N. Fairfax St Suite 100Alexandria, VA 22314-1436
RE: Linn Harding, Mary F. Barbe, Amy Marks, Raymond Ajai, Jennifer Lardiere, Heather Sweringa, Katherine Shepard
Posterior-Anterior Glide of the Femoral Head in the Acetabulum: A Cadaver Study
J Orthop Sports Phys Ther. 2003;33:118-125.
Dear Editor-in-Chief,
I would like to express my appreciation to the authors of the above study. As a former manual therapy clinician and a manual therapy educator, I find the study to be very relevant. In November I was teaching a seminar n the sacroiliac joint pelvis, and lumbar spine. I demonstrated how a client can present with a significant reduction of hip extension with concommitant positive tests for sacroiliac dysfunction. This includes altered pelvic landmarks in standing, a positive March test, and a positive Standing Flexion Test; yet the crux of the problem is in the hip. I madethe comment that this pattern presents as though the head of the femur were stuck in flexion and posterior glide, yet I could not envision the hip as having much posterior glide available, based on my understanding of the joint. However, anterior glide passive motion testing revealed hypomobility, in addition to-the loss of active and-passive hip extension. A generalization can be made stating that the shaft of the femur is a bowed structure in the sagittal plane, and is convex anteriorly. In supine' a client with a purported posterior glide fixation will present with the hip in some degree of flexion, such that the greatest portion of the femur appears to more anterior than the contralateral femur, except at the most superior portion. The correction involves anterior glide and gentle stretch into extension, typically with the client in prone, with the knee flexed. This treatment is often very effective in a short period of time, typically 2-3 minutes. The standing pelvic landmarks are then much improved and the standing sacroiliac motion screening tests are typically rendered negative; hence, they were previously false positive.
This study is relevant because manual therapists evaluate anterior and posterior glide of the femur, and alteration of those accessory motions, along with reduced hip extension, can be associated with false positive sacroiliac screening tests. Recent studies have suggested that these standing sacroiliac motion tests do not actually provoke any significant motion within the sacroiliac joints, and other structures are implicated.1, 2 Perhaps this is simply a pattern of
maintained shortening of the hip flexors, and treatment via anterior glide of the hip may be unnecessary. I look forward to evaluating this possibility.
The authors dedicated more than a full page to the section titled: Limitations of Study and Recommendations for Future Research. I believe that they did an excellent job of utilizing objective thinking in this section and it may be very useful for future studies. I was surprised at the degree of excursion of the femoral head with distraction in loose pack position. I believe that there are clinical ramifications worthy of further study.
I was also surprised at the amount of force utilized in the study (up to 356 Newtons). I have described up to 176 Newtons for spring testing the ilium, and lesser forces at the sacrum, ischium and symphysis pubis.' If further study on hip mobilization is performed on living subjects, I believe that pilot testing will reveal that much smaller forces are necessary, in order to avoid pain provocation.
Again, I believe that the research and the article were very well executed, and are very relevant to manual therapists. Thank you.
Sincerely Yours,
Jerry Hesch, PT
The Hesch Method Sacroiliac Seminars
1. Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine. 2000;25(3):364-368.
2. Egan D, Cole J, Twomey L. The standing forward flexion test: an inaccurate determinant of sacroiliac joint dysfunction. Physio.1996;82(4):236-242.
3. Hesch J. The most common patterns of sacroiliac joint dysfunction. In: Movement, Stability & Low Back Pain: the Essential Role of the Pelvis. Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R, eds. New York, NY: Churchill Livingstone; 1997.
Posterior-Anterior Glide of the Femoral Head in the Acetabulum: A Cadaver Study
Linn Harding, Mary F. Barbe, Amy Marks, Raymond Ajai, Jennifer Lardiere, Heather Sweringa, Katherine Shepard
Study Design: Descriptive study employing cadaver dissection and measurement of posterior-anterior (PA) glide of the femoral head in the acetabulum. Objective: To quantify PA glide of the femoral head in the acetabulum in a cadaveric sample. Background: Posterior-anterior glide of the femoral head within the acetabulum is a joint mobilization procedure described in orthopaedic physical therapy texts, yet there is no published evidence that the joint structures of the hip allow such movement. This study attempted to quantify PA glide of the femoral head in the hip joints of embalmed cadavers. Methods: Twelve hips, 3 male and 9 female, from 8 embalmed cadavers were employed in this study. Hips were dissected to the level of the joint capsule and a metal rod inserted through the femoral neck served as a mobilizing handle. A load cell was installed into this handle so that mobilizing forces could be monitored. A dial gauge, which recorded displacement of the femoral head, was mounted to the pelvis via bone pins and an external fixator. Results: Using mobilizing forces of 89, 178, 267, and 356 N, mean femoral head displacements of 0.57, 0.93, 1.20, and 1.52 mm were recorded. Within the 89-N trials, PA displacement ranged from a minimum of 0.04 mm to a maximum of 1.54 mm. Within the 356-N trials, PA displacement of the femoral head ranged from a minimum of 0.25 mm to a maximum of 2.90 mm. Conclusion: In an embalmed cadaveric model, measurable PA glide of the femoral head within the acetabulum does exist and it is highly variable between individuals.
J Orthop Sports Phys Ther. 2003;33:118-125.
Key Words: accessory movement, cadaver hip joint, joint mobilization, posterior-anterior glide
Letter not accepted for publication
April 3, 2003
Guy G. Simoneau, PT, PhD, ATC Editor-in-Chief
J of Orthopedic & Sports Physical Therapy 1111 N. Fairfax St Suite 100Alexandria, VA 22314-1436
RE: Linn Harding, Mary F. Barbe, Amy Marks, Raymond Ajai, Jennifer Lardiere, Heather Sweringa, Katherine Shepard
Posterior-Anterior Glide of the Femoral Head in the Acetabulum: A Cadaver Study
J Orthop Sports Phys Ther. 2003;33:118-125.
Dear Editor-in-Chief,
I would like to express my appreciation to the authors of the above study. As a former manual therapy clinician and a manual therapy educator, I find the study to be very relevant. In November I was teaching a seminar n the sacroiliac joint pelvis, and lumbar spine. I demonstrated how a client can present with a significant reduction of hip extension with concommitant positive tests for sacroiliac dysfunction. This includes altered pelvic landmarks in standing, a positive March test, and a positive Standing Flexion Test; yet the crux of the problem is in the hip. I madethe comment that this pattern presents as though the head of the femur were stuck in flexion and posterior glide, yet I could not envision the hip as having much posterior glide available, based on my understanding of the joint. However, anterior glide passive motion testing revealed hypomobility, in addition to-the loss of active and-passive hip extension. A generalization can be made stating that the shaft of the femur is a bowed structure in the sagittal plane, and is convex anteriorly. In supine' a client with a purported posterior glide fixation will present with the hip in some degree of flexion, such that the greatest portion of the femur appears to more anterior than the contralateral femur, except at the most superior portion. The correction involves anterior glide and gentle stretch into extension, typically with the client in prone, with the knee flexed. This treatment is often very effective in a short period of time, typically 2-3 minutes. The standing pelvic landmarks are then much improved and the standing sacroiliac motion screening tests are typically rendered negative; hence, they were previously false positive.
This study is relevant because manual therapists evaluate anterior and posterior glide of the femur, and alteration of those accessory motions, along with reduced hip extension, can be associated with false positive sacroiliac screening tests. Recent studies have suggested that these standing sacroiliac motion tests do not actually provoke any significant motion within the sacroiliac joints, and other structures are implicated.1, 2 Perhaps this is simply a pattern of
maintained shortening of the hip flexors, and treatment via anterior glide of the hip may be unnecessary. I look forward to evaluating this possibility.
The authors dedicated more than a full page to the section titled: Limitations of Study and Recommendations for Future Research. I believe that they did an excellent job of utilizing objective thinking in this section and it may be very useful for future studies. I was surprised at the degree of excursion of the femoral head with distraction in loose pack position. I believe that there are clinical ramifications worthy of further study.
I was also surprised at the amount of force utilized in the study (up to 356 Newtons). I have described up to 176 Newtons for spring testing the ilium, and lesser forces at the sacrum, ischium and symphysis pubis.' If further study on hip mobilization is performed on living subjects, I believe that pilot testing will reveal that much smaller forces are necessary, in order to avoid pain provocation.
Again, I believe that the research and the article were very well executed, and are very relevant to manual therapists. Thank you.
Sincerely Yours,
Jerry Hesch, PT
The Hesch Method Sacroiliac Seminars
1. Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine. 2000;25(3):364-368.
2. Egan D, Cole J, Twomey L. The standing forward flexion test: an inaccurate determinant of sacroiliac joint dysfunction. Physio.1996;82(4):236-242.
3. Hesch J. The most common patterns of sacroiliac joint dysfunction. In: Movement, Stability & Low Back Pain: the Essential Role of the Pelvis. Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R, eds. New York, NY: Churchill Livingstone; 1997.
Posterior-Anterior Glide of the Femoral Head in the Acetabulum: A Cadaver Study
Linn Harding, Mary F. Barbe, Amy Marks, Raymond Ajai, Jennifer Lardiere, Heather Sweringa, Katherine Shepard
Study Design: Descriptive study employing cadaver dissection and measurement of posterior-anterior (PA) glide of the femoral head in the acetabulum. Objective: To quantify PA glide of the femoral head in the acetabulum in a cadaveric sample. Background: Posterior-anterior glide of the femoral head within the acetabulum is a joint mobilization procedure described in orthopaedic physical therapy texts, yet there is no published evidence that the joint structures of the hip allow such movement. This study attempted to quantify PA glide of the femoral head in the hip joints of embalmed cadavers. Methods: Twelve hips, 3 male and 9 female, from 8 embalmed cadavers were employed in this study. Hips were dissected to the level of the joint capsule and a metal rod inserted through the femoral neck served as a mobilizing handle. A load cell was installed into this handle so that mobilizing forces could be monitored. A dial gauge, which recorded displacement of the femoral head, was mounted to the pelvis via bone pins and an external fixator. Results: Using mobilizing forces of 89, 178, 267, and 356 N, mean femoral head displacements of 0.57, 0.93, 1.20, and 1.52 mm were recorded. Within the 89-N trials, PA displacement ranged from a minimum of 0.04 mm to a maximum of 1.54 mm. Within the 356-N trials, PA displacement of the femoral head ranged from a minimum of 0.25 mm to a maximum of 2.90 mm. Conclusion: In an embalmed cadaveric model, measurable PA glide of the femoral head within the acetabulum does exist and it is highly variable between individuals.
J Orthop Sports Phys Ther. 2003;33:118-125.
Key Words: accessory movement, cadaver hip joint, joint mobilization, posterior-anterior glide
Letter to the Editor of Journal of Orthopedic and Sports Physical Therapy: Hip Study
Letter to the Editor: Hip Study
This letter to the Editor of Journal of Orthopedic and Sports Physical Therapy was sent on September 16, 2008. This is a remarkable issue, every single article; very relevant. I was especially delighted to see a one-page article on slipped capital femoral epiphysis, which typically is missed with usual hip radiographs. In the old days PT Journal had a feature titled "Briefly Noted". Hope this similar type of 1-page article continues. Yes, I will still read the longer ones, but can make a case for the short ones too! Back to the slipped capital femoral epiphysis. It requires a lateral or a frog-leg x-ray view and better yet, an MRI as per the article. Another study on abdominal aneurysm in a 38-year male was rather frightening to contemplate, a very relevant read. Reminds me of a client I treated years ago who essentially had zero musculoskeletal signs and my panic was justified. Well, that will come in a future post. Here's to a great study on the hip, even if preliminary, nestled in an excellent edition of JOSPT. Development of a Clinical Prediction Rule for Diagnosing Hip Osteoarthritis in Individuals With Unilateral Hip Pain. JOSPT 2008:38((9); 542-550 Dear EDITOR-IN-CHIEF Dr. Simoneau, and Dr Sutlive, The study Development of a Clinical Prediction Rule for Diagnosing Hip Osteoarthritis in Individuals With Unilateral Hip Pain. JOSPT 2008:38((9); 542-550 is a very promising preliminary study. It is especially encouraging to see all motions of the hip studied, in contrast to other recent studies that did not directly evaluate hip extension; a very relevant component of human gait and function during ADL's. It is also encouraging to read a study that evaluates end-feel, a very relevant emergent property of all articulations. I am curious to know if there was any relevant difference in the ROM when evaluated passively for the purpose of determining end-feel, as compared to active ROM? It seems to me that active ROM can oftentimes be less than passive ROM, especially in the presence of weakness of the agonist or weakness of proximal stabilizers, especially hip extension, hip abduction and hip flexion (order here is arbitrary). Furthermore, my experience has been that with prodding, additional active hip extension ROM can at times be acquired. Regarding hip extension it seems, perhaps by design, that there is an initial ROM that feels normative, and an additional ROM that is achieved with coaxing. I have frequently noted that in a group of 20 to 30 clients or PT's or PT students, at least one will present with a passive lack of hip extension that typically gives several false positives for so-called sacroiliac joint dysfunction (SIJD). This correlates with patellofemoral compression in which patellar lift is limited. This is probably due to subtle hip and knee flexion (client supine), which at times may be missed on visual screen. Gentle mobilization and stretching easily restores the hip extension to within the norm, resolving false positives for SIJD, resolving patellofemoral compression, and restoring a fluidity to client's subjective experience of gait. I recall one client who was then able to climb stairs pain-free and she was very encouraged. Lastly, one PT student presented with the restriction, but her gait gave no clues whatsoever. A former competitive gymnast, her adaptations and compensations were rather remarkable. Nonetheless, she also felt much improved after a simple 2 minute mobilization and stretch. I am taking the time to briefly describe the above, because to my knowledge it has been described in the literature. It is my hope that you will continue to develop your preliminary prediction rules study, and with a larger population, you might also encounter the above and perhaps shed light on the problem. Thank you very much for the opportunity to share some thoughts. I hope that your very promising preliminary study will continue. I look forward to following your future work. Sincerely Yours, Jerry Hesch, MHS, PT LEG LENGTH STUDIES
This letter to the Editor of Journal of Orthopedic and Sports Physical Therapy was sent on September 16, 2008. This is a remarkable issue, every single article; very relevant. I was especially delighted to see a one-page article on slipped capital femoral epiphysis, which typically is missed with usual hip radiographs. In the old days PT Journal had a feature titled "Briefly Noted". Hope this similar type of 1-page article continues. Yes, I will still read the longer ones, but can make a case for the short ones too! Back to the slipped capital femoral epiphysis. It requires a lateral or a frog-leg x-ray view and better yet, an MRI as per the article. Another study on abdominal aneurysm in a 38-year male was rather frightening to contemplate, a very relevant read. Reminds me of a client I treated years ago who essentially had zero musculoskeletal signs and my panic was justified. Well, that will come in a future post. Here's to a great study on the hip, even if preliminary, nestled in an excellent edition of JOSPT. Development of a Clinical Prediction Rule for Diagnosing Hip Osteoarthritis in Individuals With Unilateral Hip Pain. JOSPT 2008:38((9); 542-550 Dear EDITOR-IN-CHIEF Dr. Simoneau, and Dr Sutlive, The study Development of a Clinical Prediction Rule for Diagnosing Hip Osteoarthritis in Individuals With Unilateral Hip Pain. JOSPT 2008:38((9); 542-550 is a very promising preliminary study. It is especially encouraging to see all motions of the hip studied, in contrast to other recent studies that did not directly evaluate hip extension; a very relevant component of human gait and function during ADL's. It is also encouraging to read a study that evaluates end-feel, a very relevant emergent property of all articulations. I am curious to know if there was any relevant difference in the ROM when evaluated passively for the purpose of determining end-feel, as compared to active ROM? It seems to me that active ROM can oftentimes be less than passive ROM, especially in the presence of weakness of the agonist or weakness of proximal stabilizers, especially hip extension, hip abduction and hip flexion (order here is arbitrary). Furthermore, my experience has been that with prodding, additional active hip extension ROM can at times be acquired. Regarding hip extension it seems, perhaps by design, that there is an initial ROM that feels normative, and an additional ROM that is achieved with coaxing. I have frequently noted that in a group of 20 to 30 clients or PT's or PT students, at least one will present with a passive lack of hip extension that typically gives several false positives for so-called sacroiliac joint dysfunction (SIJD). This correlates with patellofemoral compression in which patellar lift is limited. This is probably due to subtle hip and knee flexion (client supine), which at times may be missed on visual screen. Gentle mobilization and stretching easily restores the hip extension to within the norm, resolving false positives for SIJD, resolving patellofemoral compression, and restoring a fluidity to client's subjective experience of gait. I recall one client who was then able to climb stairs pain-free and she was very encouraged. Lastly, one PT student presented with the restriction, but her gait gave no clues whatsoever. A former competitive gymnast, her adaptations and compensations were rather remarkable. Nonetheless, she also felt much improved after a simple 2 minute mobilization and stretch. I am taking the time to briefly describe the above, because to my knowledge it has been described in the literature. It is my hope that you will continue to develop your preliminary prediction rules study, and with a larger population, you might also encounter the above and perhaps shed light on the problem. Thank you very much for the opportunity to share some thoughts. I hope that your very promising preliminary study will continue. I look forward to following your future work. Sincerely Yours, Jerry Hesch, MHS, PT LEG LENGTH STUDIES
Association of Leg-Length Inequality with Knee Osteoarthritis: A Cohort Study.
Ann Intern Med. 2010 Mar 2;152(5):287-95.
Harvey WF, Yang M, Cooke TD, Segal NA, Lane N, Lewis CE, Felson DT.
Boston University School of Medicine and Tufts Medical Center, Boston, Massachusetts; Queen's University, Kingston, Ontario, Canada; University of Iowa, Iowa City, Iowa; University of California at Davis, Davis, California; and University of Alabama, Birmingham, Alabama.
Background: Leg-length inequality is common in the general population and may accelerate development of knee osteoarthritis.
Objective: To determine whether leg-length inequality is associated with prevalent, incident, and progressive knee osteoarthritis.
Design: Prospective observational cohort study.
Setting: Population samples from Birmingham, Alabama, and Iowa City, Iowa.
Patients: 3026 participants aged 50 to 79 years with or at high risk for knee osteoarthritis.
Measurements: The exposure was leg-length inequality, measured by full-limb radiography. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or greater, and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee.
Results: Compared with leg-length inequality less than 1 cm, leg-length inequality of 1 cm or more was associated with prevalent radiographic (53% vs. 36%; odds ratio [OR], 1.9 [95% CI, 1.5 to 2.4]) and symptomatic (30% vs. 17%; OR, 2.0 [CI, 1.6 to 2.6]) osteoarthritis in the shorter leg, incident symptomatic osteoarthritis in the shorter leg (15% vs. 9%; OR, 1.7 [CI, 1.2 to 2.4]) and the longer leg (13% vs. 9%; OR, 1.5 [CI, 1.0 to 2.1]), and increased odds of progressive osteoarthritis in the shorter leg (29% vs. 24%; OR, 1.3 [CI, 1.0 to 1.7]).
Limitations: Duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiography, are subject to measurement error, which could result in misclassification.
Conclusion: Radiographic leg-length inequality was associated with prevalent, incident symptomatic, and progressive knee osteoarthritis. Leg-length inequality is a potentially modifiable risk factor for knee osteoarthritis. Primary Funding Source: National Institute on Aging.
Harvey WF, Yang M, Cooke TD, Segal NA, Lane N, Lewis CE, Felson DT.
Boston University School of Medicine and Tufts Medical Center, Boston, Massachusetts; Queen's University, Kingston, Ontario, Canada; University of Iowa, Iowa City, Iowa; University of California at Davis, Davis, California; and University of Alabama, Birmingham, Alabama.
Background: Leg-length inequality is common in the general population and may accelerate development of knee osteoarthritis.
Objective: To determine whether leg-length inequality is associated with prevalent, incident, and progressive knee osteoarthritis.
Design: Prospective observational cohort study.
Setting: Population samples from Birmingham, Alabama, and Iowa City, Iowa.
Patients: 3026 participants aged 50 to 79 years with or at high risk for knee osteoarthritis.
Measurements: The exposure was leg-length inequality, measured by full-limb radiography. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or greater, and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee.
Results: Compared with leg-length inequality less than 1 cm, leg-length inequality of 1 cm or more was associated with prevalent radiographic (53% vs. 36%; odds ratio [OR], 1.9 [95% CI, 1.5 to 2.4]) and symptomatic (30% vs. 17%; OR, 2.0 [CI, 1.6 to 2.6]) osteoarthritis in the shorter leg, incident symptomatic osteoarthritis in the shorter leg (15% vs. 9%; OR, 1.7 [CI, 1.2 to 2.4]) and the longer leg (13% vs. 9%; OR, 1.5 [CI, 1.0 to 2.1]), and increased odds of progressive osteoarthritis in the shorter leg (29% vs. 24%; OR, 1.3 [CI, 1.0 to 1.7]).
Limitations: Duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiography, are subject to measurement error, which could result in misclassification.
Conclusion: Radiographic leg-length inequality was associated with prevalent, incident symptomatic, and progressive knee osteoarthritis. Leg-length inequality is a potentially modifiable risk factor for knee osteoarthritis. Primary Funding Source: National Institute on Aging.
Symptoms of the Knee and Hip in Individuals with and Without Limb Length Inequality
Osteoarthritis Cartilage. 2009 May;17(5):596-600. Epub 2008 Nov 19.
Golightly YM, Allen KD, Helmick CG, Renner JB, Jordan JM.
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
OBJECTIVE: This cross-sectional study examined the association of limb length inequality (LLI) with chronic joint symptoms at the hip and knee in a large, community-based sample, adjusting for the presence of radiographic osteoarthritis (OA) and other confounders.
METHODS: The total study group comprised 3012 participants with complete knee symptoms data, 3007 participants with complete hip symptoms data, and 206 with LLI>or=2 cm. Presence of chronic knee symptoms was defined as report of pain, aching, or stiffness (symptoms) of the knee on most days. Presence of chronic hip symptoms was defined as hip pain, aching, or stiffness on most days or groin pain. Multiple logistic regression models were used to examine the relationship of LLI with knee and hip symptoms, while adjusting for demographic and clinical factors, radiographic knee or hip OA and history of knee or hip problems (joint injury, fracture, surgery, or congenital anomalies).
RESULTS: Participants with LLI were more likely than those without LLI to have knee symptoms (56.8% vs 43.0%, P<0.001), and hip symptoms (49.5% vs 40.0%, P=0.09). In adjusted models, knee symptoms were significantly associated with presence of LLI (adjusted odds ratio [aOR]=1.41, 95% confidence interval, [95% CI] 1.02-1.97), but the relationship between hip symptoms and LLI (aOR=1.20, 95% CI 0.87-1.67) was not statistically significant.
CONCLUSION: LLI was moderately associated with chronic knee symptoms and less strongly associated with hip symptoms. LLI may be a new modifiable risk factor for therapy of people with knee or hip symptoms.
Golightly YM, Allen KD, Helmick CG, Renner JB, Jordan JM.
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
OBJECTIVE: This cross-sectional study examined the association of limb length inequality (LLI) with chronic joint symptoms at the hip and knee in a large, community-based sample, adjusting for the presence of radiographic osteoarthritis (OA) and other confounders.
METHODS: The total study group comprised 3012 participants with complete knee symptoms data, 3007 participants with complete hip symptoms data, and 206 with LLI>or=2 cm. Presence of chronic knee symptoms was defined as report of pain, aching, or stiffness (symptoms) of the knee on most days. Presence of chronic hip symptoms was defined as hip pain, aching, or stiffness on most days or groin pain. Multiple logistic regression models were used to examine the relationship of LLI with knee and hip symptoms, while adjusting for demographic and clinical factors, radiographic knee or hip OA and history of knee or hip problems (joint injury, fracture, surgery, or congenital anomalies).
RESULTS: Participants with LLI were more likely than those without LLI to have knee symptoms (56.8% vs 43.0%, P<0.001), and hip symptoms (49.5% vs 40.0%, P=0.09). In adjusted models, knee symptoms were significantly associated with presence of LLI (adjusted odds ratio [aOR]=1.41, 95% confidence interval, [95% CI] 1.02-1.97), but the relationship between hip symptoms and LLI (aOR=1.20, 95% CI 0.87-1.67) was not statistically significant.
CONCLUSION: LLI was moderately associated with chronic knee symptoms and less strongly associated with hip symptoms. LLI may be a new modifiable risk factor for therapy of people with knee or hip symptoms.
Leg-Length Inequality is not Associated with Greater Trochanteric Pain Syndrome
Arthritis Res Ther. 2008;10(3):R62. Epub 2008 May 29.
Segal NA, Harvey W, Felson DT, Yang M, Torner JC, Curtis JR, Nevitt MC; Multicenter Osteoarthritis Study Group.
Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0728 JPP, Iowa City, IA 52242-1088, USA. [email protected]
INTRODUCTION: Greater trochanteric pain syndrome (GTPS) is a common condition, the pathogenesis of which is incompletely understood. Although leg-length inequality has been suggested as a potential risk factor for GTPS, this widely held assumption has not been tested.
METHODS: A cross-sectional analysis of greater trochanteric tenderness to palpation was performed in subjects with complaints of hip pain and no signs of hip osteoarthritis or generalized myofascial tenderness. Subjects were recruited from one clinical center of the Multicenter Osteoarthritis Study, a multicenter population-based study of community-dwelling adults aged 50 to 79 years. Diagnosis of GTPS was based on a standardized physical examination performed by trained examiners, and technicians measured leg length on full-limb anteroposterior radiographs.
RESULTS: A total of 1,482 subjects were eligible for analysis of GTPS and leg length. Subjects' mean +/- standard deviation age was 62.4 +/- 8.2 years, and 59.8% were female. A total of 372 lower limbs from 271 subjects met the definition for having GTPS. Leg-length inequality (difference > or = 1 cm) was present in 37 subjects with GTPS and in 163 subjects without GTPS (P = 0.86). Using a variety of definitions of leg-length inequality, including categorical and continuous measures, there was no association of this parameter with the occurrence of GTPS (for example, for > or = 1 cm leg-length inequality, odds ratio = 1.17 (95% confidence interval = 0.79 to 1.73)). In adjusted analyses, female sex was significantly associated with the presence of GTPS, with an adjusted odds ratio of 3.04 (95% confidence interval = 2.07 to 4.47). CONCLUSION: The present study found no evidence to support an association between leg-length inequality and greater trochanteric pain syndrome.
Segal NA, Harvey W, Felson DT, Yang M, Torner JC, Curtis JR, Nevitt MC; Multicenter Osteoarthritis Study Group.
Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0728 JPP, Iowa City, IA 52242-1088, USA. [email protected]
INTRODUCTION: Greater trochanteric pain syndrome (GTPS) is a common condition, the pathogenesis of which is incompletely understood. Although leg-length inequality has been suggested as a potential risk factor for GTPS, this widely held assumption has not been tested.
METHODS: A cross-sectional analysis of greater trochanteric tenderness to palpation was performed in subjects with complaints of hip pain and no signs of hip osteoarthritis or generalized myofascial tenderness. Subjects were recruited from one clinical center of the Multicenter Osteoarthritis Study, a multicenter population-based study of community-dwelling adults aged 50 to 79 years. Diagnosis of GTPS was based on a standardized physical examination performed by trained examiners, and technicians measured leg length on full-limb anteroposterior radiographs.
RESULTS: A total of 1,482 subjects were eligible for analysis of GTPS and leg length. Subjects' mean +/- standard deviation age was 62.4 +/- 8.2 years, and 59.8% were female. A total of 372 lower limbs from 271 subjects met the definition for having GTPS. Leg-length inequality (difference > or = 1 cm) was present in 37 subjects with GTPS and in 163 subjects without GTPS (P = 0.86). Using a variety of definitions of leg-length inequality, including categorical and continuous measures, there was no association of this parameter with the occurrence of GTPS (for example, for > or = 1 cm leg-length inequality, odds ratio = 1.17 (95% confidence interval = 0.79 to 1.73)). In adjusted analyses, female sex was significantly associated with the presence of GTPS, with an adjusted odds ratio of 3.04 (95% confidence interval = 2.07 to 4.47). CONCLUSION: The present study found no evidence to support an association between leg-length inequality and greater trochanteric pain syndrome.
Leg Length Discrepancy
Gait Posture. 2002 Apr;15(2):195-206.
Gurney B.
Division of Physical Therapy, School of Medicine, University of New Mexico, Health Sciences and Services, Boulevard 204, Albuquerque, NM 87131-5661, USA. [email protected]
The role of leg length discrepancy (LLD) both as a biomechanical impediment and a predisposing factor for associated musculoskeletal disorders has been a source of controversy for some time. LLD has been implicated in affecting gait and running mechanics and economy, standing posture, postural sway, as well as increased incidence of scoliosis, low back pain, osteoarthritis of the hip and spine, aseptic loosening of hip prosthesis, and lower extremity stress fractures. Authors disagree on the extent (if any) to which LLD causes these problems, and what magnitude of LLD is necessary to generate these problems. This paper represents an overview of the classification and etiology of LLD, the controversy of several measurement and treatment protocols, and a consolidation of research addressing the role of LLD on standing posture, standing balance, gait, running, and various pathological conditions. Finally, this paper will attempt to generalize findings regarding indications of treatment for specific populations.
Gurney B.
Division of Physical Therapy, School of Medicine, University of New Mexico, Health Sciences and Services, Boulevard 204, Albuquerque, NM 87131-5661, USA. [email protected]
The role of leg length discrepancy (LLD) both as a biomechanical impediment and a predisposing factor for associated musculoskeletal disorders has been a source of controversy for some time. LLD has been implicated in affecting gait and running mechanics and economy, standing posture, postural sway, as well as increased incidence of scoliosis, low back pain, osteoarthritis of the hip and spine, aseptic loosening of hip prosthesis, and lower extremity stress fractures. Authors disagree on the extent (if any) to which LLD causes these problems, and what magnitude of LLD is necessary to generate these problems. This paper represents an overview of the classification and etiology of LLD, the controversy of several measurement and treatment protocols, and a consolidation of research addressing the role of LLD on standing posture, standing balance, gait, running, and various pathological conditions. Finally, this paper will attempt to generalize findings regarding indications of treatment for specific populations.