Skip to main content
SpringerLink
Log in

Shortening of hip flexor muscles and chronic low-back pain among resistance training practitioners: applications of the modified Thomas test

  • Original Article
  • Published:
Sport Sciences for Health Aims and scope Submit manuscript

Abstract

Purpose

The assessment of muscle flexibility is important for physical exercise practitioners since an insufficient level of this physical capacity can be related to risk factors for chronic low-back pain (CLBP). This study aimed to assess the chance of shortening of the iliopsoas and rectus femoris muscles, using the modified Thomas test (MTT), to relate to CLBP.

Methods

Fifty-four resistance training practitioners of both sexes, aged between 18 and 55 years were evaluated. To check the hip and knee joints’ range of motion (ROM) reached during the MTT, images of the sagittal plane were recorded with a digital câmera. The recorded images were analyzed using the kinovea software, to obtain angular measurements. A binary logistic regression was used for evaluating the odds ratio of the independent variable (i.e., muscle shortening) influence on the dependent variable (i.e., CLBP).

Results

Significant differences were demonstrated between the hip extension angular measures in favor of women (p = 0.038758). Between lower limbs, women showed significant differences in favor of the left side measures of this joint (p = 0.036891). For the angular measurements of knee flexion, no significant differences were shown in both men (p = 0.441465) and women (p = 0.206936). A binary logistic regression showed no increased chance of the hip flexor muscles shortening being related to CLBP. The odds ratio with 95% confidence interval (CI) were = 0.97 (0.92–1.01) and 0.99 (0.95–1.04) for range of motion (ROM) of the hip and knee joints respectively.

Conclusion

Even considering that the reduced hip joint ROM likely contributes to low-back pain, this variable alone does not explain the CLBP either in men or women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Zacaron KA, Condé BR, Do Padro CA, Pacheco GB (2011) Association between the modified Thomas test and Ely test in the diagnosis of rectus femoris muscle shortening. Physiother Braz 12(3):168–172. https://doi.org/10.33233/fb.v12i3.842

  2. Kim GM, Ha SM (2015) Reliability of the modified Thomas test using a lumbo-pelvic stabilization. J Phys Ther Sci 27(2):447–449. https://doi.org/10.1589/jpts.27.447

    Article  PubMed  PubMed Central  Google Scholar 

  3. Vigotsky AD, Lehman GJ, Beardsley C, Contreras B, Chung B, Feser EH (2016) The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ 11:e2325. https://doi.org/10.7717/peerj.2325

    Article  Google Scholar 

  4. Gabbe BJ, Bennell KL, Finch CF (2006) Why are older Australian football players at greater risk of hamstring injury? J Sci Med Sport 9(4):327–333. https://doi.org/10.1016/j.jsams.2006.01.004

    Article  PubMed  Google Scholar 

  5. Mellin G (1988) Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients. Spine 13(6):668–670

    Article  CAS  PubMed  Google Scholar 

  6. Lee SW, Kim SY (2015) Comparison of chronic low-back pain patients hip range of motion with lumbar instability. J Phys Ther Sci 27(2):349–351. https://doi.org/10.1589/jpts.27.349

    Article  PubMed  PubMed Central  Google Scholar 

  7. Roach SM, San Juan JG, Suprak DN, Lyda M, Bies AJ, Boydston CR (2015) Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. Int J Sports Phys Ther 10(1):13–20

    PubMed  PubMed Central  Google Scholar 

  8. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, COST B13 Working Group on Guidelines for Chronic Low Back Pain (2006) Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(3):S192–S300. https://doi.org/10.1007/s00586-006-1072-1

  9. Heino JG, Godges JJ, Carter CL (1990) Relationship between hip extension range of Motion and postural alignment. J Orthop Sports Phys Ther 12(6):243–247. https://doi.org/10.2519/jospt.1990.12.6.243

    Article  CAS  PubMed  Google Scholar 

  10. Dezan VH, Sarraf TA, Rodacki AL (2004) Postural modification, muscle wakness and low back pain in wrestling athletes. Braz J Sci Mov 12(1):35–38

    Google Scholar 

  11. Peeler J, Anderson JE (2007) Reliability of the Thomas test for assessing range of motion about the hip. Phys Ther Sport 8(1):14–21. https://doi.org/10.1016/j.ptsp.2006.09.023

    Article  Google Scholar 

  12. Peeler J, Leiter J (2013) Using digital photography to document rectus femoris flexibility: a reliability study of the modified Thomas test. Physiother Theory Pract 29(4):319–327. https://doi.org/10.3109/09593985.2012.731140

    Article  PubMed  Google Scholar 

  13. Kiseljak D, Bolcevic F, Curko D, Pazin K, Ujakovic F, Gruic I, Medved V (2018) The modified Thomas test realized by optoelectronic kinematic measurent. Funct Neurol Rehabil Ergon 7(3):39–44

    Google Scholar 

  14. Kendall FP, McCreary EK, Provance PG, Rodgers M, Romani W (2014) Muscles: testing and function, with posture and pain, 5th edn. Williams & Wilkins, Baltimore

    Google Scholar 

  15. Janda V (1983) Muscle function testing. Butterworths, London

    Google Scholar 

  16. Stoltzfus JC (2011) Logistic regression: a brief primer. Acad Emerg Med 18(10):1099–1104. https://doi.org/10.1111/j.1553-2712.2011.01185.x

    Article  PubMed  Google Scholar 

  17. Diví AP, Marfil CE, Riu JM, Busquets A, Chando XP, Ruiz DM (2019) Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One 14(6):e0216448. https://doi.org/10.1371/journal.pone.0216448

    Article  CAS  Google Scholar 

  18. Avman MA, Osmotherly PG, Snodgrass S, Rivett DA (2019) Is there an association between hip range of motion and nonspecific low back pain? A systematic review. Musculoskelet Sci Pract 42:38–51. https://doi.org/10.1016/j.msksp.2019.03.002

    Article  PubMed  Google Scholar 

  19. Peeler JD, Anderson JE (2008) Reliability limits of the modified Thomas test for assessing rectus femoris muscle flexibility about the knee joint. J Athl Train 43(5):470–476. https://doi.org/10.4085/1062-6050-43.5.470

    Article  PubMed  PubMed Central  Google Scholar 

  20. Harvey D (1998) Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 32(1):68–70. https://doi.org/10.1136/bjsm.32.1.68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ferber R, Kendall KD, McElroy L (2010) Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. J Athl Train 45(4):344–348. https://doi.org/10.4085/1062-6050-45.4.344

    Article  PubMed  PubMed Central  Google Scholar 

  22. Clapis PA, Davis SM, Davis RO (2008) Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiother Theory Pract 24(2):135–141. https://doi.org/10.1080/09593980701378256

    Article  PubMed  Google Scholar 

  23. Corkery M, Briscoe H, Ciccone N, Foglia G, Johnson P, Kinsman S, Legere L, Lum B, Canavan PK (2007) Establishing normal values for lower extremity muscle length in college-age students. Phys Ther Sport 8(2):66–74. https://doi.org/10.1016/j.ptsp.2006.11.004

    Article  Google Scholar 

  24. Santos T, Oliveira L, Patrício N, Baptista AF, Mendes SM, Coelho-Neto JA, Sá KN (2011) Changes lumbopelvic from the use of high heels. J Physiother Res 1(1):67–77

    Google Scholar 

  25. Ribeiro RP, Sedrez JA, Candotti CT, Vieira A (2018) Relationship between chronic non-specific low back pain with disability, static posture and flexibility. Phys Ther Res 25(4):425–431. https://doi.org/10.1590/1809-2950/18001925042018

    Article  Google Scholar 

  26. Harris-Hayes M, Sahrmann SA, Van Dillen LR (2009) Relationship between the hip and low back pain in athletes who participate in rotation-related sports. J Sport Rehabil 18(1):60–75. https://doi.org/10.1123/jsr.18.1.60

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wakefield CB, Halls A, Difilippo N, Cottrell T (2015) Reliability of goniometric and trigonometric techniques for measuring hip-extension range of motion using the modified Thomas test. J Athl Train 50(5):460–466. https://doi.org/10.4085/1062-6050-50.2.05

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cheatham S, Hanney WJ, Kolber MJ (2017) Hip range of motion in recreational weight training participants: a descriptive report. Int J Sports Phys Ther 12(5):764–773

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the Villa Vip fitness center, for providing its facilities to carry out this research. In addition, we would like to express a special thanks to all participants the research.

Author information

Authors and Affiliations

  1. Laboratory of Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil

    Ricardo Pereira Neves & Felipe Cassaro Vechin

  2. Lato Sensu Postgraduate Program in Musculoskeletal Injuries and Diseases: Prevention and Physical Conditioning, University Center of United Metropolitan Colleges, São Paulo, SP, Brazil

    Ricardo Pereira Neves

  3. São Judas Tadeu University, São Paulo, SP, Brazil

    Diana Oliveira

  4. University Ninth of July, São Paulo, SP, Brazil

    Matheus Alves Fanasca

  5. Laboratory of Neuromuscular Adaptations to Strength Training, Federal University of São Carlos, São Carlos, SP, Brazil

    Felipe Cassaro Vechin

Authors
  1. Ricardo Pereira Neves
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matheus Alves Fanasca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felipe Cassaro Vechin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo Pereira Neves.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest relevant to the content of this article.

Ethical approval

This study was performed in line with the principles of Declaration of Helsinki. Approval was granted by the Ethics Committee of the University Ninth of July, São Paulo, Brazil (Date: 29/03/2019/No.:79438817.8.00005511).

Consent to participate

Informed consent was obtained from all individual participants and from legal guardians when necessary.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neves, R.P., Oliveira, D., Fanasca, M.A. et al. Shortening of hip flexor muscles and chronic low-back pain among resistance training practitioners: applications of the modified Thomas test. Sport Sci Health 19, 841–847 (2023). https://doi.org/10.1007/s11332-022-00969-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11332-022-00969-2

Keywords

Search

Navigation