Movement sequence analysis of cephalocaudal and hip regions during various phases of selected daily activities

INTRODUCTION

Evaluations of hip and spine mobility is vital for the assessment of low back pain (LBP)[1]. There are various available methods used for the assessment of spinal and hip mobility. For instance, Modified-Schober Test has been validated to assess lumbar mobility during forward bending of spine[2]. Although this test is simple and easy to use, it is unable to detect different motions occurring at multiple spinal segments and hip. Previous studies identified a specific movement patterns at various spinal segments while performing functional and clinical movement [1],[3–6]. Additionally, a relationship between specific movement patterns at different spinal segments and functional activities of daily living (ADLs) is not well established[7]. For example, sit-to-stand is a common functional activity that involve a specific movement patterns at hip and spine. Therefore, accurate knowledge of physiological movement of each spinal segment and hip region and the behavior of each regional movement is important.

Various functional tasks including lifting, sit-to-stand, flexion, and extension have been associated with LBP and spinal injury[8,9]. Spine and hip motions are connected during many daily tasks [10,11], indicating that any limitation in spine or hip motion will affect the performance of functional ADLs. In particular, sit-to-stand activities are commonest tasks performed daily by working people[12]. Previous studies have reported the quantitative relationship between the lumbar spine and hip motion during daily tasks [13–16]. However, they have considered lumbar spine as a single unit in their measurement. Consequently, other clinicians evaluated the contribution of multisegment lumbar motion in patient population[17,18] and healthy adults [19,20].

Although previous studies reported the contribution of lumbar spine segment and hip motion during functional ADLS, it is still unknown whether different spinal segment and hip motion occur in a specific sequence during functional tasks. Therefore, the current study aimed to identify the movement sequence of cephalocaudal and hip regions during a number of selected daily activities including flexion, extension, lifting, and standing-to-sitting tasks.

METHODS

Participants

Twelve male participants (mean age = 29.6 ± 4.2 years; weight = 73.4 ± 8.4 kg; height = 1.76 ± 0.08 meters) were recruited. No participant had any history of cervical, thoracic, lumbar pain or not complain of radiated pain to the upper or lower extremities within the last one year. The Ethics Committee of Najran University approved this study. All participants asked to complete a written informed consent form.

Instrumentation

FiveTri-axial accelerometer sensors used as described in the published study [3] to collect data of a novel approach to understand the multi-cephalocaudal regions and hip movement sequences when performing a number of selected daily activities. This measurement system reliability has been tested and found to be suitable and high-precision for measuring spinal movement, with the intraclass correlation coefficient ranging from 0.88 to 0.99 and the measurement errors may be up to 5.2 degrees [21]. The accuracy of such a system has been created in a preliminary study and shown to offer root mean square errors of 0.70% to 1.39% compared with a precision angle measurement table (THETAmetrix) [22].

LT

RT

Figure 1: The dial display for sensor 1 and a "Scope" display showing two data traces on LT and schematic represents the location of three sensors on forehead and spinous processes of T1, T12, and S1 and on the lateral aspect of the thigh midway between the lateral epicondyle and greater trochanter on the iliotibial band (ITB) on RT.

Procedures

When participants attended the laboratory at Physiotherapy Clinic, Applied Medical Science, Collage, Najran University, they returned a signed consent form, which had been provided earlier. The participant should move to a private area to change their clothes and wear shorts. Each participant was asked to warm up before the procedure with gentle spine back exercises, including flexion, extension, sitting and standing only three times for each exercise to avoid any possible injury, although the tasks do not require effort exposed to injury. The participants were asked to lean forward on the table (waist level) to determine the specific spinous processes. Five sensors were attached using double-sided adhesive tape on different parts of the body (e.g., forehead, spinous processes of first thoracic vertebra (T1), twelfth thoracic vertebra (T12), first sacral vertebra (S1), and middle point at lateral aspect of thigh). Four different anatomical regions of interest were created including Head-cervical (HC), Thoracic (T), Lumbar (L), and Hip (H) to quantify regional movement (Figure 1). Protocol of measurement these activities conducted in this study was inspired by that used by [21]. Protocol activities conducted in this study was inspired by that used by. Standing upright is the starting point of movement and the maximum extent a person does for the task such bending forward or bending back or picking up something from the ground for example, described as a movement peak, while the moment of the end of any task is labeling as an end.

Data analysis

Data were collected at 30Hz by 3A sensors system and transferred to Matlab. Data were recorded at tilt angles relative to gravity (absolute angles) and regional ROM, was defined as the relative kinematic between adjacent distal (i.e. relative angles). Consequently, regional spinal and hip movement-time curves were generated for forehead, T1, T12, L3, S1 and Hip using MatLab software. At the beginning of each task, all the curves move in a straight line and then begin to rise with time, so it becomes clear the movement of each part we want to measure with time. When clicking on the regional curve deviation point, or on the peak of the movement, gives time with very high accuracy. Therefore, such MatLab software measure the sequence of regional movements while performing intended tasks. Descriptive statistics were reported. The percentage of participants who performed the task in a specific sequence were calculated: Percentage (%) = (number of participants who achieve task's phase/12 (Total number of subjects)) ×100.

RESULTS

Table 1 details the results. During flexion task, while the regional sequences at starting phase showed that the most of the participants moved head cervical region (92%) first followed by thoracic and lumbar (70%) together, and hip (62%) regions, the hip and lumbar regions (70% each) moved at the same time followed by thoracic (62%), and head-cervical (55%) regions at the end phase ((Figure 2, Figure 4). Whereas, the regional sequences at peak phase showed head-cervical and thoracic regions (60%) moved at the same time, followed by lumbar and hip regions (52%), those moved at the same time ((Figure 3).

During the extension task, the regional sequences at starting phase showed that the most of the participants moved the head-cervical (92%) region first followed by lumbar (72%), and thoracic and hip (60%) regions (Figure 2),. Whereas, at the end phase, the hip (70%) region moved first followed by thoracic (62%), lumbar (53%), and head-cervical (45%) regions (Figure 4). However, the regional sequences at peak phase showed lumbar and hip regions (75%) moved at the same time followed by head-cervical and thoracic regions (62%), those moved at the same time

(Figure 3).

During the lifting task (Figure 2), the regional sequences at starting phase showed that the most of the participants moved the head cervical (80%) region first, followed by thoracic and hip (60%) regions moved at the same time, and lastly lumbar (50%) region moved. Whereas, at the end phase, head-cervical and thoracic (70%) regions moved at the same time, followed by hip and lumbar (60%) regions moved at the same time (Figure 4). However, the regional sequences at peak phase showed lumbar region (70%) moved first, followed by head-cervical, thoracic, and hip regions (60%) moved at the same time (Figure 4).

During standing-to-sitting task (Figure 2), the regional sequences at starting phase showed that the most of the participants moved the lumbar (70%) region first, followed by head cervical, thoracic and hip (64%) regions moved at the same time. Whereas, at the end phase thoracic and hip (60%) region moved at the same time followed by head cervical and lumbar (50%) regions moved at the same time (Figure 2). However, the regional sequences at peak phase showed the head cervical, thoracic, lumbar, and hip regions (60%) moved at the same time (Figure 3).

During sitting-to-standing task(Figure 2), the regional sequences at starting phase showed that the most of the participants moved the hip (78%) region first, followed by lumbar (65%), then head cervical and thoracic (54%) regions moved at the same time. Whereas, at the end phase head cervical (90%) region moved first followed by thoracic, lumbar, and hip (67%) regions moved at the same time (Figure 4),. However, the regional sequences at peak phase showed hip region (88%) moved followed by lumbar (80%), and the thoracic and head-cervical (70%) regions (Figure 3).

Participants (%)

Figure 2: The movement sequence of cephalocaudal and hip regions by percentage at start of flexion, extension, object lifting, standing to sitting and sitting to standing tasks

Figure 3: The movement sequence of cephalocaudal and hip regions by percentage at peak of flexion, extension, object lifting, standing to sitting and sitting to standing tasks

Figure 4: The movement sequence of cephalocaudal and hip regions by percentage at end of flexion, extension, object lifting, standing to sitting and sitting to standing tasks

DISCUSSION

This study aimed to identify the movement sequence of cephalocaudal and hip regions during a number of selected daily activities including flexion, extension, lifting, standing-to-sitting and sitting-to-standing tasks. The results of the current study identify distinguished temporal changes in the movement sequence of cephalocaudal and hip regions during a number of selected daily activities. For instance, head-cervical region moved first at the starting phase of flexion, extension, and lifting task. Whereas, the lumbar and hip regions moved first at the starting phase of standing-to-sitting and sitting-to-standing task, respectively. However, in the peak phase, head-cervical and thoracic regions moved first during flexion task, while lumbar and hip regions moved first during extension task. While lumbar and hip regions moved first at the peak phase of lifting task and sitting-to-standing task, respectively, all the regions moved together at the peak phase of standing-to-sitting- task. In contrast, in the end phase of flexion and extension, hip and lumbar regions and hip region moved first, respectively. Whereas, head-cervical and thoracic regions and hip and thoracic regions moved first in the end phase of lifting and standing-to-sitting task, respectively. The head-cervical region moved first in the end phase of sitting-to-standing task.

Although previous studies were more focused on the assessment of range of motion, LBP may be associated with impaired movement sequence at cephalocaudal and hip regions[23,24].There were conflicting studies indicating the pattern and contribution of spine and hip motion between healthy adults and LBP patients. For instance, in healthy adults, lumbar spine dominates the movement in initial phase while hip motion dominates peak and terminal phase during spinal flexion motion[13,25,26]. Similarly, in the current study, the head-cervical region dominates the starting phase, while head-cervical and thoracic regions equally dominate the peak phase and hip and lumbar region dominates the end phase of spinal flexion. Previous studies also reported greater contribution of spine in the early phase of flexion task while hip region contributed more than spine at the terminal phase of flexion task [13,14].

However, there are some methodological differences exist in the previous studies in the measurement of movement sequence. While previous studies limited to lumbar and hip motions, the current study included movement sequence of cervical, thoracic, lumbar, and hip regions. In addition, the current study used a number of selected daily activities such as flexion, extension, lifting, and standing-to-sitting and sitting-to-standing tasks to measure movement sequence of cephalocaudal and hip regions. No previous studies have investigated the movement sequence of cephalocaudal and hip regions during these tasks.

Limitation

The current study has potential limitations. First, the sample size was small, including only 12 subjects. Second, since all participants were male, the results cannot be generalized to female population. Third, other factors such as spine length, leg length, and pelvic angulation might affect the pattern of movement sequence during these tasks. Furthermore, the study participants were all healthy university staffs and students, therefore, the sample population may not be truly representative of all groups of young males.

CONCLUSIONS

This study indicates variations of movement sequence of cephalocaudal and hip regions at different phases of selected daily activities. While the head-cervical region moved first in the starting phase of flexion, extension, and lifting task; the hip region moved first in the end phase of flexion, extension, and standing-to-sitting task. Such findings will add new information for clinicians and physiotherapist during spinal assessment.

ACKNOWLEDGMENTS

The authors would like to express their Gratitude's to the ministry of education and the deanship of scientific research – Najran University – Kingdom of Saudi Arabia for their financial and Technical support under code number (NU/MID/16/053).

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