• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.8 no.1
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• pp.39-47
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• 2013

Objectives : The purpose of this study is to find out the relationship between hip internal rotation angle and the level of herniation of lumbar intervertebral disc(HIVD) in single-segment. Methods : We investigated 314 patients (158 male, 156 female) who were diagnosed as herniation of lumbar intervertebral disc(HIVD) in single-segment. We measured 314 patients' hip internal rotation angle and analysed the relationship between the hip internal rotation angle and the level of herniation of lumbar intervertebral disc(HIVD). Results : 1. Among 314 cases, the hip internal rotation angle was different between male and female. Hip internal rotation angle of male was mainly limited and that of female was mainly excessive. 2. Among 314 cases, the normal group, defined as patients who have specific range of hip internal rotation angle(male : $35^{\circ}{\pm}10^{\circ}$, female : $45^{\circ}{\pm}10^{\circ}$), tends to be occurred HIVD at L4/5 level. The limited group, defined as patients who have less angle than normal group, the excessive group, defined as patients who have more angle than normal group, and the complex group, defined as patients who have more angle of one leg and less angle of the other leg than normal group, tend to be occurred HIVD at L5/S1 level(p<0.05). Conclusions : In single-segment lumbar HIVD patients, The normal hip internal rotation angle mainly leads to L4/5 HIVD, while the limited and excessive hip internal rotation angle mainly lead to L5/S1 HIVD.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.1
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• pp.43-49
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• 2017

PURPOSE: This study investigated the relationship among hip adduction angle, tibial rotation, and ITB length during an Ober test to determine the most appropriate position for performing the test. METHODS: The study included thirty-nine asymptomatic participants (23 males, 16 females). Their hip adduction angles were measured using the Ober test during three tibial rotation conditions (internal tibial rotation, external rotation, and neutral position). ITB length was calculated by measuring the position of the patella to lateral femoral condyle using ultrasonography (patella-condyle distance; PCD). RESULTS: The relationship among hip adduction angle, tibial rotation, and ITB length was analyzed under the three conditions using the Pearson correlation. The hip adduction angle of the internal tibial rotation, the external rotation, and the neutral position were significantly related to ITB length. Moreover, the hip adduction angle measured during the internal tibial rotation had the highest correlation with ITB length among the three conditions (r=.58, p<.001). CONCLUSION: Internal tibial rotation caused by the Ober test led to increased iliotibial band (ITB) tension and a decreased adduction angle. These findings support that tibial rotation influences the flexibility of ITB. Therefore, therapists should consider the position of the internal tibial rotation when taking measurements using an Ober test.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.5 no.2
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• pp.9-16
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• 2010

Objectives : This study is planned to classify different biomechanics of men and women, from the comparison of normal range and hip internal rotation angle in chronic low back pain patients. Methods : We measured the hip internal rotation angle of the 30 men and 30 women patients with low back pain that has been over 3 months in BuCheon Jaseng Hospital of Oriental medicine. We set 35-45 degrees as normal range, and found the patients with exceeding normal range, the patients with normal range, and the patients with under normal range. Results : Men appeared to have less hip internal rotation angle than women. Especially, the men's left hip internal rotation angle was less than normal range. On the other hand, women's right hip internal rotation angle was often larger than normal range which was stastically significant. Conclusions : Contraction of hip external rotation muscle including gluteus maxius muscle and piriformis muscle in men, or relaxation of posterior gluteus medius, gluteus maxius and piriformis muscle with contraction of tensor fasciae latae, a part of hip internal rotation muscle, in women seems to be the basis for biomechanics of chronic low back pain.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.16 no.1
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• pp.1-8
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• 2010

Purpose : This study aimed to examine the relationships among five clinical measures for functional alignment of the lower extremity. Methods : Thirty healthy subjects (15 males and 15 females) were recruited for the study. The five clinical measures of functional alignment of the lower extremity included navicular drop, quadriceps angle, internal rotation of hip, and anterior and lateral pelvic tilt angles. The level of navicular drop was calculated by the difference between the height of the navicular bone in the sitting (non-weight bearing) and standing (weight bearing) positions. The quadriceps angle and internal rotation of hip were measured using a standard goniometer with photographic markers while the subjects were lying in a prone position on a table with their knee at $90^{\circ}$ flexion. Anterior and lateral pelvic tilt angles were determined using a inclinometer. Results : Correlation and a simple linear regression analysis were used to assess relationships between the clinical measures. There were significant correlations between navicular drop and quadriceps angle (p<.05), between navicular drop and internal rotation of hip (p<.05), and between quadriceps angle and internal rotation of hip (p<.01). In simple linear regression analysis, the navicular drop appeared to be a factor affecting the quadriceps angle and internal rotation of hip (p<.05). The findings suggest that navicular drop has a great impact on lower extremity alignment. Conclusion : This study might help us to examine lower extremity function and clarify its role as a potential injury risk factor.

• Journal of Korean Medicine Rehabilitation
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• v.24 no.4
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• pp.117-127
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• 2014

Objectives The purpose of this study is to find out the relationship between the hip internal rotation angle and the site of herniation of single level lumbar intervertebral disc. Methods This study was carried out to 418 patients with lumbar disc herniation diagnosed by M.R.I, who visited Bu-Chun Jaseng Hospital of Korean Medicine with low back pain. Researchers measured their hip internal rotation angle and analyzed the relationship between the hip internal rotation angle and the site of herniation of single level lumbar intervertebral disc. Results 1. Excessive right internal rotation of hip joint increases risk of L5/S1 HIVD. 2. Limited left internal rotation of hip joint decreases risk of L4/L5 HIVD. 3. In cases of L4/L5 HIVD level, there was evidence that the prevalence of HNP in men was 1.85 times as higher than that in women. 4. In cases of L5/S1 HIVD level, there was the evidence that the prevalence of HNP in men was 0.64 times as lower than that in women. Conclusions In single-segment lumbar HIVD patients, limited left internal rotation of hip joint decreases risk of HIVD of L4/5 and excessive right internal rotation of hip joint mainly leads to L5/S1 HIVD.

• Physical Therapy Korea
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• v.13 no.1
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• pp.24-31
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• 2006

The purpose of this study was to identify the effect of the hip internal rotation on gluteal and erector spinae muscle electromyographic (EMG) activity during treadmill walking. Eleven healthy subjects were recruited. All subjects performed treadmill walking while maintaining the hip in neutral position (condition 1) and in internal rotation (condition 2). Surface EMG activity was recorded from four muscles (gluteus maximus (GM), gluteus medius (GMED), tensor fascia latae (TFL), and erector spinae (ES)) and the hip internal rotation angle was measured using a three dimensional motion analysis system. The gait cycle was determined with two foot switches, and stance phase was normalized as 100% stance phase (SP) for each condition using the MatLab 7.0 program. The normalized EMG activities according to the hip rotation (neutral or internal rotation) were compared using a paired t-test. During the entire SP of treadmill walking, the EMG activities of GM in condition 1 were significantly greater than in condition 2 (p<.05). The EMG activities of TFL and ES in condition 2 were significantly greater than in condition 1 (p<.05). The EMG activities of the GMED in condition 1 were significantly greater than in condition 1 (p>.05) except for 80~100% SP. Further studies need randomized control trials regarding the effect of hip internal rotation on the hip and lumbar spine muscle activity. Kinetic variables during gait or going up and down stairs are also needed.

• Physical Therapy Korea
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• v.25 no.4
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• pp.19-26
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• 2018

Background: Alignment of the lower limb is an important factor, influencing balance and gait in kinematics and kinetics, in patients with and without a flat arched foot. Flat arched foot are associated with the range of motion (ROM) of the hip and alignments of the knee joints, is strongly influenced. Objects: The purpose of this research was to investigate the relationship between hip joint ROM and quadriceps angle (Q-angle), by dividing them into two groups according to the presence or absence of flat feet, using a navicular drop test (NDT) and resting calcaneal stance position (RCSP). Methods: Forty elderly patients were allocated to the experimental group (flat foot group, n1=20) or the control group (non-flat group, n2=20). Universal and digital goniometer, tractograph and tape measure were used to determine the related changes in the hip ROM, Q-angle, NDT and RCSP. Results: Data were analyzed using the Pearson correlation coefficients. Active internal ROM of the hip joint (right, r=.803, p<.001), (left, r=.951, p<.001) were highly correlated with NDT, and also, was moderately correlated with Q-angle (right, r=.562, p=.019), (left, r=.757, p<.001). Passive internal ROM of the hip joint (right, r=.742, p=.001), (left, r=.922, p<.001) were highly correlated with NDT, and also, was moderately correlated with RCSP (right, r=-.530, p=.029) and with Q-angle (right, r=.710, p=.001), (left, r=.698, p=.002) in the flat foot group. However, no strong correlation among the hip ROM, NDT, RCSP and Q-angle were found in the non-flat foot group. Conclusion: This research may provide evidence of the correlations between hip internal ROM and flat foot.

• Korean Journal of Applied Biomechanics
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• v.24 no.3
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• pp.239-248
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• 2014

The purpose of this study was to quantify kinematic and kinetic characteristics of Yin-yang Bo gait according to their motor expertise, one of the Seokmun Ilwol martial art gait patterns. Yin-yang Bo gait pattern shows initial forefoot contact instead of heel contact, and increased time of stance phase time, internal-external rotation of ankle-knee-hip joints and pelvic. It aims to produce and store the more energy through continuous homeostasis of center of gravity (COG) and performance of stretch-shortening cycle. Some of these characteristics also were similar to the gait modification strategies for reducing knee adduction moment such as toe-out progression, medial thrust, internal rotation of hip joint. To identify the characteristics, four factors of expert Yin-yang Bo gait performance group were compared to that of none expert group; 1) angles of COG displacement and rotation 2) distal joint pre-rotation in internal-external rotation of ankle-knee-hip joints and pelvic, 3) invariability pelvic potential and pelvic segment total energy 4) knee abduction moment. Six healthy(three male) subjects participated in the experiment to perform Yin-yang gait pattern. Three-dimensional and force plate data were collected. Kinematic and kinetic data were compared between two groups using t-tests. Results showed that 1) the peak point of COG internal rotation angle was reduced in expert group, 2) kneeexternal and hip joint -internal and pelvic rotation angle peak frames were more near points in expert group.

• Physical Therapy Korea
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• v.15 no.2
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• pp.54-63
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• 2008

The purpose of this study was to examine the effect of the hip internal rotation on knee extensor and hip abductor electromyographic (EMG) activity during stair up and stair down mobility. Eighteen healthy subjects were recruited. All subjects performed stair up and down movements on a step of 30cm height while maintaining the hip in neutral (condition 1) and hip in internal rotation (condition 2). Surface EMG activity was recorded from five muscles (gluteus maximus, vastus lateralis (VL), vastus medialis oblique (VMO), posterior gluteus medius (Gmed), and tensor fascia latae (TFU)) and hip internal rotation angle was measured using a three dimensional motion analysis system The time period for stair up and down was normalized using the MatLab 6.5 program, and EMG activity was normalized to the value of maximal voluntary isometric contraction (%MVIC). The EMG activities according to the hip rotation (neutral or internal rotation) during the entire time period of stair up and down in each phase were compared using a paired t-test. During the entire period of stair up, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). During the entire period of stair down, the EMG activities of VL and TFL in condition 2 were significantly greater than in condition 1 (p<.05). However, the EMG activities of the other muscles were not significantly different between the conditions (p>.05). These results suggest that the stair up and down maintaining hip internal rotation was could be a contributing factor on patellar lateral tracking.

• Physical Therapy Korea
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• v.23 no.3
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• pp.57-67
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• 2016

Background: Many previous studies recommended the side-lying hip abduction (SHA) exercise for targeting the gluteus medius (Gmed) and gluteus maximus (Gmax) muscle activity while the decreasing tensor fasciae latae (TFL) activation. Mischoice of hip position and angle in SHA may increase the risk of lower extremity injuries and undesirable muscle activation. However, information is limited on the effect of composite hip flexion angles and hip rotation on the gluteal muscle activity during SHA. Objects: This study aimed to compare muscle activity (Gmed, TFL, and Gmax) and activity ratios (Gmed/TFL, Gmax/TFL, and Gmed/Gmax) using surface electromyography (EMG) during SHA exercise at three different hip flexion angles either with or without internal rotation (IR) in subjects with Gmed weakness. We hypothesized that applying hip flexion and IR during SHA would increase gluteal muscle activity and decrease TFL activity. Methods: Muscle activity and activity ratios in 20 volunteers with Gmed weakness during 6 different SHA were investigated with surface EMG. One-way repeated-measures analysis of variance was used to determine the statistical significance. Results: Significant differences were found among the six different exercises for Gmed ($F_{2,41}=11.817$, p<.001) and Gmax ($F_{3,52}=5.513$, p=.003) muscle activity, and Gmed/TFL ($F_{3,54}=8.735$, p<.001) and Gmax/TFL ($F_{2,37}=4.019$, p=.028) activity ratios. Conclusion: Applying hip flexion is an effective method for increasing gluteal activity, and it elicits great Gmed/TFL and Gmax/TFL activity ratios during SHA in subjects with Gmed weakness.