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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 NAME OF CANDIDATE & SR.BEENA.EF
ADDRESS
C/o PROVINCIAL SUPERIOR
MARIA PROVINCIAL HOUSE
KOORKENCHERY,
THRISSUR-7, KERALA
2 NAME OF THE INSTITUTION
THE OXFORD COLLEGE
OF PHYSIOTHERAPY
J.P.NAGAR, 1ST PHASE,
BANGALORE – 78
3 COURSE OF THE STUDY & MASTER OF PHYSIOTHERAPY
SUBJECT
(Physiotherapy in Musculoskeletal
Disorders and Sports Physiotherapy)
2nd JUNE,2008
4 DATE OF ADMISSION
5 TITLE OF THE STUDY:
“A STUDY TO ANALYSE THE EFECT OF GENDER, AGE, DOMINANT AND NONDOMINANT
LIMB
INDIVIDUALS.
ON
HAMSTRING
MUSCLE
LENGTH
IN
SEDENTARY
6
BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY:
A sedentary lifestyle is a major risk factor across a spectrum of preventable
diseases that lower the quality of life. Sedentary lifestyle can lead to various
problems like tightness of muscle, decreased muscle length, decreased joint
range of motion and decreased flexibility hampering daily activities of an
individual.1 It is becoming apparent that with sedentary nature of work for people
in office jobs, desk top workers which is causing adaptive shortening that occur
to a greater degree in hamstrings associated with low back pain.2 Since work
environments have become increasingly automated and computerized, many
workers may be living more sedentary life style and spending a greater
proportion of their living sitting. Working individuals specially those in the
office who sit for the prolonged period develop various problems caused due to
hamstring tightness like anterior knee pain, low back ache, increased stress on
posterior ligaments of spine and erector spine muscles which limits the motions
of the pelvis.3,4 High incidence of decreased
HML is a characterisitic of
adolescent lumbar disc herniation 26.
Studies have shown that hamstring muscle length is influenced by a number of
factors. Factors affecting decreased flexibility are age, gender, BMI, occupation
and physical inactivity. They have to be considered for any patient at the time of
physical examination for tight hamstrings as these factors directly relate to
flattening lumbar lordosis and pelvic tilt.
5
Many of the changes in our
musculoskeletal system result more from disuse than from simple aging. As
muscles age, they begin to shrink and lose mass. This is a natural process, but a
sedentary lifestyle can accelerate it.
Rehabilitation professionals routinely assess Hamstring muscle length (HML) in
persons with injuries to the nervous or musculoskeletal system, such as
hamstring muscle injury, spinal cord injury, low back pain or anterior knee
pain.6 A reduction in muscle length has been proposed as a predisposing factor
for developing hamstring muscle injury.7 The decreased length of the hamstring
muscles often seen in patients with disorders has been suggested to result from
muscle and connective tissue adaptive shortening.8 One of the roles of a
physiotherapist is to address limitations in muscle length in order to minimize
injury.
Inspite of the fact that muscle length decreases with age, studies have shown
that (James W Y, et al)9 there is no statistically significant age effect on
HML. Also Studies by Walker JM, et al14 reported that there is no
significant relationship that was attributable to gender and age. Even though
many studies have been done on Hamstring tightness, differences in
Hamstring muscle length between men and women; dominant and nondominant side have not been examined for a group of sedentary individuals
over a wide range of ages. Hence, this study is intended to investigate the
typical values of hamstring muscle length (HML) for men and women over a
span of ‘60’ years. This information will be helpful for every physical
therapist for examination as well as treatment and for future reference.
6.2 REVIEW OF LITERATURE
GENDER, AGE
James WY, et al (2005) 9 in his study on influence of gender and age on
hamstring muscle length found that there is significant influence of gender on
hamstring muscle length. But no loss of HML with advancing age.
Bell RD, Hoshizaki TB (1981) 10 in his study on ‘Relationships of age and
sex with range of motion of seventeen joint actions in human’s found that a
general decline in flexibility as age increased with women having a greater
range of motion than males throughout life.
Carol SL, et al (1990)11 studied on Relationship of hamstring and hip flexor
muscle length in age group 20-30 yrs, and found that age correlated
positively with hamstring muscle length and negatively with hip flexor
muscle length. Hamstring length increased in age where as hip flexor Length
decreased with age.
James B, et al (1989) 12 studied active and passive mobility of joints of lower
limb in elderly men and women and found statistically significant differences
in PSLR for the effects of gender and age.
Roach KE, et al (1991) 13 have done a study on normal hip and knee active
range of motion with relationship to age in 1982 subjects and found that
normal values for all motions were lower in the oldest age group than in the
youngest age group.
Walker JM, et al (1984) 14 have studied active range of motion in the upper
and lower extremities of normal subjects related to age, sex and physical
activity in ’30’ men and ‘30’ women age groups of 60-69 and 75-84 years.
They suggested there is no significant relationship.
Kevin E.Y, et al (2003)
15
studied exercise, aging and muscle protein
metabolism and reported that advancing age and physical frailty are
associated with a reduction in the fasting rate of mixed and myosin heavy
protein synthesis. This contributes to muscle protein wasting in advancing
age.
DOMINANT AND NON DOMINANT LIMB
Marie Corkery et al( 2007)16 studied on normal values for lower extremities
and stated that there is significant differences between right and left sides for
hamstrings , rectus femoris and gastronemius muscles.
Izge Gunal, et al (1996) 17 conducted study on normal range of motion of the
joints of the upper extremity in male subjects with special reference to side
and reported that range of motion on the right side were significantly smaller
than those on the left.
Wang SS, et al (1993) 18 studied lower extremity muscular flexibility in long
distance runners and stated that males and tight hamstring muscles than
females in both runners and non runners. Also the dominant leg hamstrings
were tighter than in non-dominant leg hamstring in all subject
HAND HELD UNIVERSAL GONIOMETER
Lusin Gary, et al (1983) 19 conducted a study on reliability of goniometer
measurement and reported that goniometry measurement is more reliable
method for measuring the joint ROM in hamstring muscle tightness.
Clapper Mary, Paul et al (1998)
20
as per the study to assess inter test
reliability and goniometer reliability in physical medicine and rehabilitation
and stated that a hand held universal goniometer with central 360oo scale in
50o increments with one side of the goniometer’s central scale covered with
white adhesive paper helps to minimize tester bias during measurement.
PKE
Cameron DM, et al (1993)21 conducted a study on relationship between
knee extension and straight leg raise measurements and reported that knee
extension test may be a useful alternative to the straight leg raise test for
providing an indication of Hamstring muscle
length.
Diana Hopper, et al (2005)22 studied the comparison between PSLR & PKE
tools in measuring hamstring muscle length and found that PKE test is a
reliable and effective indirect test for assessing HML. An advantage of the
KE test is the minimal pelvic motion which occurs when compared to the
SLR test. Intratesterreliability of PKE-0.89
Gajdosik RL, et al (1983)23 as per the study on reliability of knee extension
in hamstring muscle tightness, concluded that KE test is more selective for
measuring hamstring length than passive SLR, because KE test as a high test
reliability, when body position is controlled the end point of motion is
specifically defined and the measuring instrument is accurately placed.
6.3 OBJECTIVES OF THE STUDY:

To examine the differences of Hamstring muscle Length (HML) between
male and female as measured by passive knee extension (PKE)

To examine the difference of HML between age groups as measured by
PKE

To examine the HML between dominant and non-dominant limb.
6.4 HYPOTHESIS:

Null hypothesis:
There is no difference in the factors of gender, age, dominant and
non-dominant limb on Hamstring muscle length.

Alternate hypothesis:
There is difference in the factors of gender, age, dominant and nondominant limb on HML.
7
MATERIALS AND METHODS:
7.1. STUDY DESIGN AND SETTING:
7.1.1. STUDY DESIGN:
Cross-sectional descriptive study.
7.1.2. SOURCE OF DATA:

Final year students of Oxford college of physiotherapy

Software companies in and around Bangalore

Old age home – Little sisters of the poor
7.2. METHODOLOGY:
7.2.1. POPULATION:

Male and female sedentary subjects of age 20-70 years.
7.2.2. SELECTION CRITERIA:

INCLUSION CRITERIA

Sedentary subjects

Both sexes (male and female)

Age between 20-70 years

Subjects with full knee extension

People willing to participate in the study

Subjects who are able to understand properly.
EXCLUSION CRITERIA

Subjects with current low back pain

History of hip, knee or low back surgery

Hamstring strain or injury

Neurologically impaired and non co-operative subjects

Flexion deformity of knee

Genu recurvatum.
7.2.3. SAMPLING
SAMPLING METHOD:
o Stratified sampling
SAMPLE SIZE:
o N=200 subjects
o 100 male, 100 female.
7.2.4.PROCEDURE
DEFINITION OF SEDENTARY LIFE: “A sedentary life is defined as
being physically inactive at work and at home and failing to participate in
exercise for at least ‘20’ continuous minutes at least three times a week”.24
Based on this definition as well as inclusion and exclusion criteria
‘200’ subjects will be selected by stratified sampling. After the explanation of
procedure and instructions, the informed consent will be taken from the subjects.
Subjects are stratified across 5’ age groups in ‘10’ year increments [20-29,3039,40-49,50-59,60-69 years]. Each group having ‘40’ subjects about equally
divided between men and women. Indirect measurement of HML will be taken
by PKE HML is measured by ‘PKE’ as described by Diana Hopper et al (2005)25
each subject is positioned in spine with the opposite leg is strapped to the Plinth.
A cross bar so that 90o hip flexion is maintained throughout PKE measurement.
This ensure that the distal anterior thigh maintains contact with the cross bar for
all PKE measurements. The protractor is adjusted to read 90o when the knee is
flexed to 90o. Subjects are positioned with their hands on the abdomen, cervical
spine in neutral and eyes closed. Fulcrum is marked at the centre of the knee
joint axis over the lateral joint line of the right leg. Two lines are drawn from this
point, one joining this axis point to the centre of the greater trochanter of the
femur, and a second joining the axis point to the apex of lateral malliolus. The
stationary arm is placed along the lateral femur and the moving arm is aligned
with the lateral fibula. Examiner extends the knee until the subject perceives the
first onset of stretch in Hamstring. At this point the measurement of the
goniometer is recorded. This procedure is then followed by three trails. The two
most consistent of these measures are averaged and used for analysis. Both limbs
are measured by this procedure.
Duration of the study :

Single time study

No follow up
b). Materials used:

Hand held universal goniometer – 360o

Examination table

Cross bar

Pillow

Strap
7.3. OUTCOME MEASURES AND STATISTICAL ANALYSIS:
7.3.1. OUTCOME MEASURES:

Passive knee extension (PKE)
7.3.2. STATISTICAL ANALYSIS:

Student ‘t’ test (two tailed dependent)

Anova

Bonferroni post-hoc test
7.4 Does the study require any intervention to be conducted on patients or
other humans or animals?
No, this study doesn’t require any intervention.
Has ethical consent for the study has been obtained from the institutions?
Yes, it has been obtained from my institution.
Ethical clearance form is attached as (Appendix - I)
The informed consent will be obtained prior to the study from each subject
(appendix - II)
8.
REFERENCES:
1. J Collins, Effects of aging, 2004 Sep6-10 geneva, P:123-6.
2.Nelson BW, et al. the clinical effects of intensive exercise on chronic low
back pain . J Musculoskeletal med. 1995;18: 971-81.
3.Magnusson SP et al. A randomized evaluation of cyclic and static
stretching. Int J Sports med, 1998; 19(5): 310-316.
4.Halbersna JP et al .Sports stretching, effect on passive muscle stiffness of
short hamstring, arch phy med rehab, 1996, 77(7), 688-692.
5Bob Anderson. flexibility, 2001june 12-14 paris p: 89-93
6.Maggee DJ. Orthopedic physical assessment, 4th ed, Philadelphia, PA:
Saunders; 2002.
7.Hartig DE, Henderson JM .Increasing hamstring flexibility decreases lower
extremity overuse injuries in military basic trainees. AMJ sports Med, 1999;
27: 173-176.
8.Gajdosik R. Effects of static stretching on the maximal length and
resistance to passive to short hamstring muscles. JOSPT,1993; 14(6): 250255.
9.James WY et al. Influence of age, gender on hamstring muscle length in
healthy individuals. JOSPT 2005; 35(4) :246-252.
10.Bell RD, Hoshizaki TB. Relationship of age and sex with range of motion
of seventeenth joint actions in humans. Can I Appl sport sci, 1981; 6:202206.
11.Carol SL et al .Relationship of hamstring and hip flexor muscle length.
Phy Ther 1990;70:611-618
12.James B, et al .Active and passive mobility of lower limb joints in elderly
men and women. Am J PMR, 1989; 68: 162-167.
13.Roach KE, et al .Normal hip and knee active range of motion: the
relationships to age. Physical therapy 1991; 71: 656-665.
14.Walker JM, et al .Active mobility of the extremities in older subjects,
Phys Thera, 1984; 64: 919-923.
15.Kevin EY. Exercise, aging and muscle protein metabolism Jepi com
health 2003;18:56-59
16.Marie Corkery etal.Establishing normal values for lower extremities. Phy
Ther sport;2007 [8]:66-74
17.Izge Gunal et al. Normal range of motion of the joints of the upper
extremity in male subjects, the journal of bone and joint surgery;1996; 78:
1401-1404.
18.Wang SS, et al .Lower extremity muscular flexibility in long distances
runners, JOSPT 1993; 17: 102-107
19..Lusin Gary, et al .Hamstring muscle tightness Phy ther 1983; 63(7)
:1085-1090.
20.Clapper Mary Paul, et al .Comparison of the reliability of the orthoranger
and the standard goniometer for assessing active lower extremity ROM, phy
ther 1998; 68(2) 214-218.
21.Camerson DM, et al .Relationship between knee extension and straight
Leg raise,JOSPT 1993;17(5):257-260.
22. Diana Hopper et al .Evaluation of two massage techniques on HML in
Female hockey players. Phys Ther Sport 2005;6 :137-145
23.Gajdosik.RL et al. Reliability of knee extension test in hamstring muscle
Tightness . Phys Ther 1983;63(7):1085-1090
24.http://www.effects of aging .com/AAOS on line service fact sheet.html
25.Hopper.D, Conneely M, et al .Evaluation of the effect of two massage
techniques on hamstring muscle length in female hockey players Physical
therapy in sports, 2005(6) :137-139
26. Qingsan Z, etal.Adolescent lumbar disc herniation and hamstring
tightness Tohku university school of medicine 2006 (31) :1810-1814
9
Signature
of
the
Candidate
10
Remarks of the guide
11
Name and designation of
the
11.1 Guide
Mr.G.R.VIKRANTH.M.P.T
ASST. Professor
11.2 Signature
11.3 Co-guide
11.4 Signature
11.5
Head
of
the
Department
MR.KG.KIRUBAKARAN.MPT
PRINCIPAL
11.6 Signature
12. 12.1
Remarks
of
chairman and Principal
12.2 Signature
MR.KG.KIRUBAKARAN
APPENDIX-1
THE OXFORD COLLEGE OF PHYSIOTHERAPY
J.P.NAGAR, 1 PHASE, BANGALORE – 560078.
Review Board on Ethics for Research
We hereby declare that the project titled, “A study to analyze the effect of gender, age,
dominant and non-dominant limb on hamstring muscle length in sedentary individuals”.
Carried out by SR.BEENA.EF of 1st Year M.P.T. has been brought forward for scrutiny
to the board members. After analyzing the objectives, subjects involved and the methodology of
the project, the following conclusions were drawn.
The project does not cause any mental or physical harm to the subjects involved and there
are no risks involved in the study. The performance of the study procedure will not cause any
injury to the subjects. The board has evaluated and confirmed that the experimenter is trained
and qualified in measuring outcome. The informed consent form ensures that the experimenter
explains the procedure of the study to the subjects, their voluntary participation is confirmed and
the identification of subjects is maintained confidential.
More over the finding of the study will benefit similar subjects, the profession and the
society.
Hence the review board has no objections on the conduct of the study.
Chairman of Department Review Board
Project Guide
Principal
APPENDIX – 1I
CONSENT FORM
TITLE: “A STUDY TO ANALYZE THE EFFECT OF GENDER, AGE, DOMINANT
AND NON-DOMINANT LIMB ON HAMSTRING MUSCLE LENGTH IN SEDENTARY
INDIVIDUALS”.
INVESTIGATOR: SR.BEENA.EF
PURPOSE OF RESEARCH:
I _______________________have been informed that this study is carried to know the effect of
gender, age, dominant and non-dominant limb on hamstring muscle length.
PROCEDURE:
I have been explained that this study is conducted by using passive knee extension I am aware
that I have to follow the researcher’s instruction as has been told to me.
RISK AND COMFORT:
I understand that there is no potential risk associated with this study and this study will not
produce any harm to me by participating. I understand that there won’t be any discomfort
throughout the study. I am aware that SR.BEENA.EF will help me for better understanding of
the procedure.
BENEFITS:
I understand that this study helps to know the effect of gender, age, dominant and non-dominant
limb on hamstring muscle length.
ALTERNATIVES:
I understand the procedure being studied is the standard way than compared to other studies
which can be conducted by using other tools.
CONFIDENTIALITY:
All the data recorded will be kept in strictest confidence apart from the researcher no one will
ever access to the data without your permission. If the data are used for publication in the
medical literature or for the teaching purpose, no names will be used.
PHOTOGRAPHY CONSENT:
SR.BEENA.EF has explained to me that photographs are required in order to illustrate various
aspects of the study for the thesis and other articles, and at presentations or conferences. These
images may also be converted to electronic formats for use in multimedia presentations and
documents accessible to others by computers for the purpose of sharing the results of the study
and for promoting this research. By giving my consent I authorize SR.BEENA.EF to use any of
the photographs taken of me in printed format, in slides for presentation, and in electronic
format.
REQUEST FOR MORE INFORMATION:
I understand that I may ask any questions of the study at any time, SR.BEENA.EF is available to
answer my questions, and copy of this consent form will be given to me to keep for my careful
reading.
REFUSAL OR WITHDRAWAL OF PARTICIPATION:
I understand that my participation is voluntary and I may refuse to withdraw consent and
discontinue participation at anytime. I also understand that she may not include my participation
in the study at any time after he has explained the reason for doing so.
INJURY STATEMENT:
I understand that, in the unlikely event of the injury resulting directly/indirectly from my
participation in this study, medical treatment will be available but no further compensation will
be provided. I understand that my agreement to participation in this study and I am not waiver
any of my legal right, I explained to _________________the purpose of the research, the
procedure required and the possible risk and benefits to the best of my ability.
Investigator: SR.BEENA.EF
Investigator Signature
Date:
I confirm that SR.BEENA.EF has explained me the purpose of research study, the procedure and
the possible risk and benefits that I may experience, I have read and I have understood this
consent to participate as a subject in this research project.
Candidate’s Signature
Date:
Witness Signature
Date:
APPENDIX – III
PROFORMA
Name :
Group :
Age
:
Serial No:
Sex
:
Date of assessment:
Address:
INCLUSION CRITERIA

Is the subject participating in exercise for at least ‘20’ continuous minutes at least three
times?
[Y/N]

Is the group between 20-70 of both sex
[Y/N]

Is the subject with full knee extension
[Y/N]

Is the subject able to understand the procedure
[Y/N]

Is the subject willing to participate in the study?
[Y/N]
EXCLUSION CRITERIA

Has a history of current low back pain
[Y/N]

Has a history of hip, knee or low back surgery
[Y/N]

Has hamstring strain or injury
[Y/N]

Has a history of neurological disease
[Y/N]

Has flexion deformity of knee

Has hyper extension of knee
[Y/N]
[Y/N]
HAMSTRING MUSCLE LENGTH
PKE
Gender /
Age
PKE
DOMINANT LIMB
Group
(Y)
MEN
20-29
30-39
40-49
50-59
60-69
WOMEN
20-29
30-39
40-49
50-59
60-69
Signature of the Subject:
Signature of Witness:
Signature of Investigator:
Date:
NON-DOMINANT LIMB