A comparison of the spine posture among several sit-and-reach test protocols

The Effect of Core Stabilization Exercises on Physical Fitness Parameters in Child Gymnasts: Randomized Controlled Assessor-blind Study

BACKGROUND

The improvement of physical fitness parameters is beneficial for child gymnasts to maximize functionality. Core stability exercises (CSEs) help maintain spinal stabilization during athletic performance. Thus, they contribute to enhancing gymnasts' performance on various movements and planes. This study aimed to investigate the effect of 8-week CSEs training on the physical fitness parameters of child gymnasts.

HYPOTHESIS

An 8-week CSEs intervention could be beneficial for improving the various physical parameters in child gymnasts.

STUDY DESIGN

Randomized trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

Thirty-six child gymnasts (aged 7-12 years) were allocated randomly into a training group (TG) and control group (CG). Participants in the TG received CSEs in addition to the traditional program for 8 weeks. The physical fitness parameters of all participants were assessed twice before and after training.

RESULTS

The results showed that all participants' scores of balance, endurance, sprint, and jumping parameters improved after exercise programs (P < 0.05). The muscle strength and flexibility scores of the TG showed a statistically significant difference compared with the CG (P < 0.05). However, compared with other parameters, there were no significant changes seen in the scores between groups (P > 0.05).

CONCLUSION

The CSEs training contributed to the improvement of all physical fitness parameters in child gymnasts.

CLINICAL RELEVANCE

The addition of CSEs to traditional training could help improve athletic performance in child gymnasts.

Effect of Muscle Energy Technique on Hamstring Flexibility: Systematic Review and Meta-Analysis

Since 2005, there have been no systematic reviews on the effects of multiple manual therapies, including muscle energy technique (MET), on the hamstrings. Therefore, this systematic review aimed to provide clinical evidence for the effectiveness of the MET on hamstring flexibility. We queried 10 electronic databases (PubMed, EMBASE, The Cochrane Library, KISS, NDSL, KMBASE, KISTI, RISS, Dbpia, and OASIS) up to the end of March 2022. This study only included randomized controlled trials (RCTs) investigating the use of MET for the hamstring. The literature was organized using Endnote. Literature screening and data extraction were conducted by two researchers independently. The methodological quality of the included RCTs was evaluated using the Cochrane risk-of-bias tool 1.0, and the meta-analysis was performed using RevMan 5.4. In total, 949 patients from 19 RCTs were selected according to the inclusion criteria. During active knee extension tests, the efficacy between MET and other manipulations did not significantly differ. For sit and reach tests, MET groups had higher flexibility compared to stretching (MD = 1.69, 95% CI: 0.66 to 2.73, p = 0.001) and no treatment (MD = 2.02, 95% CI: 0.70 to 3.33, p = 0.003) groups. No significant differences were observed in the occurrence of adverse reactions. Overall, we found that MET is more efficacious for improving hamstring flexibility compared to stretching and having no treatment during sit and reach tests because it combines isometric contraction with stretching. Owing to clinical heterogeneity, uncertain risk of bias, and the small number of included studies, further high-quality studies should assess the effectiveness of MET.

Reliability of Field-Based Fitness Tests in Adults: A Systematic Review

BACKGROUND

Physical fitness is a powerful predictor of morbidity and mortality, and is therefore a useful indicator for public health monitoring. To assess physical fitness, field-based tests are time-efficient, inexpensive, have minimal equipment requirements, and can be easily administered to a large number of individuals.

OBJECTIVE

The objective of this systematic review was to examine the reliability of existing field-based fitness tests used in adults aged 19-64 years.

METHODS

A systematic search of two electronic databases (MEDLINE and Web of Science) was conducted from inception to 8 June 2021 by two independent researchers. Each study was classified as high, low, or very low quality according to the description of the participants, the time interval between measurements, the description of the results, and the appropriateness of statistics. Three levels of evidence (strong, moderate, and limited) were established according to the number of studies and the consistency of their findings. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO reference number, CRD42019118480).

RESULTS

Of 17,010 records identified, 129 original studies examining the reliability of field-based fitness tests in adults were considered eligible. The reliability was assessed of tests of cardiorespiratory fitness (33 studies: 30 of high quality), musculoskeletal fitness (92 studies: 78 of high quality), and motor fitness (22 studies, all of high quality). There was strong evidence indicating: (i) the high reliability of the cardiorespiratory fitness tests: 20-m shuttle run, 6-min step, and 6-min walk; (ii) the high reliability of the musculoskeletal fitness tests: handgrip strength, back-leg strength, Sorensen, trunk flexion sustained, 5-reps sit-to-stand, sit-and-reach and toe-touch, and moderate reliability bilateral side bridge and prone bridge tests; and (iii) the moderate reliability and low reliability, respectively, of the motor fitness tests T-test and single-leg stand. We found moderate evidence indicating the moderate or high reliability of the following tests: Chester, sit-up, partial curl-up, flexion-rotation trunk, timed stair ascent, pull-up, bent-arm hang, standing broad jump, hop sequence, trunk lift, timed-up-and-go, and hexagon agility. Evidence for the reliability of balance and gait speed tests was inconclusive. Other field-based fitness tests demonstrated limited evidence, mainly due to there being only few studies.

CONCLUSIONS

This review provides an evidence-based proposal of the more reliable field-based fitness tests for adults aged 19-64 years. Our findings identified a need for more high-quality studies designed to assess the reliability of field-based tests of lower and upper body explosive and endurance muscular strength, and motor fitness (i.e., balance and gait speed tests) in adults.

Associations of sleep duration with physical fitness performance and self-perception of health: a cross-sectional study of Taiwanese adults aged 23-45

Background

The relationship between sleep duration and physical fitness is one aspect of sleep health. Potential factors associated with sleep duration interfere with physical fitness performance, but the impact trends on physical fitness indicators remain unclear.

Methods

This study examined associations between sleep duration and physical fitness among young to middle-aged adults in Taiwan. A total of 42,781 Taiwanese adults aged 23–45 participated in the National Physical Fitness Examination Survey 2013 (NPFES-2013) in Taiwan between October 2013 and March 2014. A standardized structural questionnaire was used to record participants’ sleep duration, which was stratified as short (< 6 h/day (h/d)), moderate (6–7 h/d; 7–8 h/d; 8-9 h), and long (≥ 9 h/d) sleep duration groups. Physical fitness was assessed based on four components: body composition (body mass index [BMI], waist-to-height ratio [WHtR], and waist-to-hip ratio [WHR]), muscle strength and endurance (1-min bent-leg sit-up test [BS]), flexibility (sit-and-reach test [SR]), and cardiorespiratory endurance index (3-min step test [CEI]).

Results

By using analysis of covariance (ANCOVA), after sex grouping and age adjustment, we observed that sleep duration was significantly associated with obesity, functional fitness, and self-perception of health. The sleep duration for low obesity-related values (BMI, WHtR, and WHR) for men was 7–9 h/d, and that for women was 7–8 h/d. Sleeping more than 8 h/d showed poor functional fitness performances (BS and SR). For both sexes, sleep duration of 8–9 h/d was the optimal sleep duration for self-perceptions of health.

Conclusions

Our research found that there were wide and different associations of sleep duration with physical fitness and self-perception of health among Taiwanese adults aged 23–45, and there were differences in these associated manifestations between men and women. This study could be of great importance in regional public health management in Taiwan, and provide inspirations for clinical research on physical fitness.

Flexibility Measurement Affecting the Reduction Pattern of Back Muscle Activation during Trunk Flexion

Numerous studies have been conducted on lower back injury caused by deeper stooped posture, which is associated with the back muscle flexion–relaxation phenomenon (FRP). Individual flexibility also affects FRP; individuals with high flexibility have the benefit of delayed FRP occurrence. This study attempted to determine the most efficient measurement of flexibility for evaluating the occurrence and degree of FRP when participants flexed their trunk forward. We recruited 40 male university students who were grouped on the basis of three flexibility measurements (toe-touch test, TTT; sit-and-reach test, SRT; modified Schober’s test, MST) into three levels (high, middle and low). Muscle activation (thoracic and lumbar erector spinae, TES and LES, respectively; hamstring, HMS) and lumbosacral angle (LSA) were recorded when the trunk flexed forward from 0° (upright) to 15°, 30°, 45°, 60°, 75° and 90°. The results indicated that trunk angle had a significant effect on three muscle activation levels and LSA. The effects of muscles and LSA varied depending on flexibility measurement. TTT significantly discriminated LES electromyography findings between high and low flexibility groups, whereas MST and SRT distinguished between high and non-high flexibility groups. The TTT values positively correlated with the time of LES FRP occurrence, showing that the higher the TTT, the slower the occurrence of FRP. This is beneficial in delaying or avoiding excessive loading on the passive tissue of the lumbar spine when performing a deeper trunk flexion.

Effect of 9-month Pilates program on sagittal spinal curvatures and hamstring extensibility in adolescents: randomised controlled trial

The percentage of spine misalignment increases during the childhood and adolescence stages. The Pilates method has been associated with an improvement in the sagittal spine disposition, but no studies have been conducted on adolescents. Therefore, the present study aimed to evaluate the effectiveness of a 9-month Pilates exercise program (PEP) on hamstring extensibility and sagittal spinal curvatures on adolescents. This randomised controlled trial included 236 adolescents. The experimental group (EG) received a PEP (9 months, 2 sessions/week, 15 minutes/session). The control group (CG) did not receive any intervention. Hamstring extensibility was measured with the passive and active straight leg raise and toe-touch tests. Sagittal spinal curvatures and pelvic tilt was assessed in relaxed standing, active alignment and toe-touch test positions. The EG had significant changes in hamstring extensibility, lumbar curvature and pelvic tilt in standing sagittal curvature. The CG became significantly worse in thoracic kyphosis in standing. This study provides evidence of nine-months of a PEP increased the hamstring extensibility; averted the increase of the thoracic curvature, and decreased the curvature of the lumbar lordosis and pelvic tilt in standing position; avoided a greater increase of thoracic curvature in active alignment in standing position; and avoided the increase of thoracic curvature in trunk flexion.

New insights into lumbar flexion tests based on inverse and direct kinematic musculoskeletal modeling

Measurement of maximal lumbar flexion is considered to be a crucial element in the assessment of lumbar spine mechanics in situations as diverse as physiotherapy, orthopaedics, ergonomics, sport or aging. However, currently, there is no consensus on a reference test. This study aims to characterise five maximal lumbar flexion tests (four classical tests and a new, specifically-developed test designed to constrain pelvic retroversion) based on a three-dimensional, participant-specific musculoskeletal model. Twenty-six male and female participants performed the five tests. Movements were modelled in OpenSim to estimate change in length in lumbar, hamstring and gluteus muscles, together with lumbar flexion and pelvic tilt. These so-called "inverse" kinematic results were compared using a two-way ANOVA (sex×test). In a second step, lumbar muscle change in length was computed using a direct kinematic method. Lumbar flexion and lumbar muscle change in length were found to be greater when participants were in seated postures, with little pelvic retroversion. Female participants were observed to have less lumbar flexion than male participants (77±14° and 91±12°, respectively). Hip extensor muscles (hamstrings and gluteus) were fully stretched during each of the five tests. Our results highlight the specific roles of hamstrings, gluteus and lumbar muscles into reaching maximal lumbar flexion. Coupling inverse and direct kinematic methods proved to be a useful tool to enhance our knowledge of lumbar tests. Our findings help to characterise the role of the muscles involved in lumbar flexion, and we propose some recommendations for improving and standardising these tests.

Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain)

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a “normal” morphotype for both dorsal and lumbar curves, respectively. After the application of the “Sagittal Integral Morphotype” protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a “normal sagittal integral morphotype” for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the “integral” sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

Sagittal spinal morphotype assessment in 8 to 15 years old Inline Hockey players

Background

Physiological sagittal spinal curvatures play an important role in health and performance in sports. For that reason, several scientific studies have assessed spinal morphology in young athletes. However, to our knowledge, no study has assessed the implications of Inline Hockey (IH) practice on sagittal integrative spinal morphotype in adolescent players.

Objectives

The aims of the present study were to describe habitual sagittal spinal posture in young federated IH players and its relationship with training load and to determine the sagittal integrative spinal morphotype in these players.

Methods

An observational analysis was developed to describe the sagittal spinal morphotype in young federated IH players. A total of 74 IH players from the Technification Plan organized by the Skating Federation of the Valencian Community (aged from 8 to 15 years) participated in the study. Thoracic and lumbar curvatures of the spine were measured in a relaxed standing position (SP), in a slump sitting position (SSP) and in maximum flexion of the trunk (MFT) to determine the "Sagittal Integrative Morphotype" of all players. An unilevel inclinometer was used to quantify the sagittal spinal curvatures. The Hip Joint Angle test was used to quantify the Lumbo-Horizontal angle in flexion (L-H fx) of all participants with a goniometer.

Results

When thoracic curvature was analyzed according to normality references, it was found that 64.9% of IH players had thoracic hyperkyphosis in a SSP, while 60.8% and 74.3% of players were classified as normal in a SP and in MFT, respectively. As for the lumbar curve, 89.2% in a SP and 55.4% in MFT were normal, whereas 68.9% of IH players presented lumbar hyperkyphosis in a SSP. Regarding the "Sagittal Integrative Morphotype," only 17.6% of players were classified as "Normal" in the three measured positions for the thoracic curve, while 37.8% had "Thoracic Hyperkyphosis" and 41.8% presented "Functional Thoracic Hyperkyphosis." As for the "Sagittal Integrative Lumbar Morphotype," only 23% of athletes had a normal curve in the three positions, whereas 66.2% presented "Functional Lumbar Hyperkyphosis." When the L-H fx was evaluated, the results showed that only 16.2% of the athletes were classified as normal.

Conclusions

Federative IH practice seems to cause specific adaptations in spinal sagittal morphotype. Taking into account the "Sagittal Integrative Morphotype" only 17.6% IH players presented "Normal Morphotype" with a normal thoracic kyphosis in the three measured positions, while only 23% IH players presented "Normal Morphotype" with a normal lumbar curvature in the three assessed positions. Furthermore, only 16.2% of IH players showed normal pelvic tilt. Exercise programs to prevent or rehabilitate these imbalances in young IH players are needed.

Sagittal Spinal Morphotype Assessment in Dressage and Show Jumping Riders

CONTEXT

Previous research has analyzed how the sport influences sagittal spinal curvatures in young athletes and has found that spinal curves may be modified as a consequence of repeated movement patterns and postures of each discipline.

OBJECTIVE

To analyze sagittal spinal alignment by equestrian discipline and its relation to training load, and to describe "sagittal integrative morphotype" in young riders.

DESIGN

Observational descriptive study.

SETTING

Training room.

PARTICIPANTS

A total of 23 riders (aged 9-17 y)-13 dressage riders (3 males and 10 females) and 10 show jumping riders (5 males and 5 females)-participated voluntarily.

MAIN OUTCOME MEASURES

Mann-Whitney U test was applied to determine differences between riders' characteristics (gender, discipline, and training load) and spine variables.

RESULTS

According to normality ranges for spinal curves, females showed an increase for lumbar curvature in standing position. It was found that show jumping riders manifested an increment in thoracic and lumbar curves while standing and an increase in the thoracic curvature in slump sitting. Statistically significant differences were found when lumbar curvature, "sit and reach" distance, and lumbo-horizontal angle in flexion were analyzed by gender in "sit and reach" test. No statistical significant differences were found when spinal curves in each position were analyzed depending on the training load. With regard to "sagittal integrative morphotype," all riders presented a hyperkyphotic dorsal morphotype no matter what their discipline. As for the lumbar curve, dressage and show jumping riders presented a functional hyperkyphotic morphotype.

CONCLUSIONS

It is important to note that many riders presented a sagittal imbalance for the thoracic and lumbar curves. Therefore, as the sagittal spinal misalignments persist and worsen over time, exercise programs to prevent or rehabilitate these imbalances in young riders will be needed. The "sagittal integrative morphotype" assessment is an essential tool in order to identify the spinal misalignment.

Traveling by Private Motorized Vehicle and Physical Fitness in Taiwanese Adults

BACKGROUND

Although the time spent sitting in motorized vehicles has been determined to be adversely associated with cardiometabolic health, its association with other health indicators remains unclear.

PURPOSE

This study examined associations between traveling by private motorized vehicle and 4 indicators of physical fitness in adults.

METHOD

Data from 52,114 Taiwanese adults aged 20 to 65 years who participated in the 2013 National Adults Fitness Survey were used. The examined variables were height, body mass, and performance in modified sit-and-reach (flexibility), bent-leg sit-up (abdominal muscular strength and endurance), and a 3-min step test (cardiorespiratory endurance). Participants were asked on how many days they had used a private car or motorcycle for traveling from place to place and categorized as non-, occasional, and daily private motorized vehicle travelers. Logistic and linear regression models were used to examine associations between the categories of using private motorized vehicles to travel and physical fitness performance.

RESULTS

After an adjustment for potential demographic and behavioral confounders, daily traveling by private motorized vehicle was associated with a higher probability of overweight (odds ratio = 1.18), lower performance of abdominal muscular strength and endurance (-0.37 times/min), and lower cardiorespiratory fitness (-0.60 physical fitness index) than was traveling that did not involve private motorized vehicles.

CONCLUSION

The results suggest that in addition to unfavorable cardiorespiratory fitness and a risk of overweight, daily traveling by private motorized vehicle is associated with poor performance in abdominal muscular strength and endurance.

The effects of spinal support device on pain and extensibility of the hamstrings in patients with non-specific low back pain

[Purpose] The objective of this study was to investigate the effects of spinal support device (SSD) on pain and hamstring extensibility in patients with non-specific low back pain (NSLBP). [Subjects and Methods] 20 patients with NSLBP were recruited and randomly assigned to either the SSD group or the control group. In the SSD group, SSD was applied; in the control group, bed rest in supine position was performed. Both groups underwent treatment 20 min/day, 3 times a week, for a duration of 4 weeks. To assess the hamstring extensibility, sit and reach test (SRT) was performed. To assess pain pressure threshold (PPT) of the sacroiliac joint, a pressure algometer was used. Visual analog scale (VAS) was used to quantify pain. [Results] The SSD group showed a significant improvement in sacroiliac joint pain with increased VAS, and the control group showed a significantly increased VAS after intervention. In the SSD group, VAS was significantly increased, but SRT was not changed compared with the control group. [Conclusion] These results demonstrated that an application of SSD effectively attenuates low back pain. Therefore, SSD may be a suitable intervention for pain control in patients with NSLBP.

Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain

[Purpose] The purpose of this study was to analyze the effect of Graston Technique on hamstring extensibility and pain intensity in patients with nonspecific low back pain. [Subjects and Methods] Twenty-four patients with nonspecific low back pain (27–46 years of age) enrolled in the study. All participants were randomly assigned to one of two groups: Graston technique group (n=12) and a static stretching group (n=12). The Graston Technique was used on the hamstring muscles of the experimental group, while the static stretching group performed static stretching. Hamstring extensibility was recorded using the sit and reach test, and a visual analog scale was used to measure pain intensity. [Results] Both groups showed a significant improvement after intervention. In comparison to the static stretching group, the Graston technique group had significantly more improvement in hamstring extensibility. [Conclusion] The Graston Technique is a simple and effective intervention in nonspecific low back pain patients to improve hamstring extensibility and lower pain intensity, and it would be beneficial in clinical practice.

Immediate effect of stretching and ultrasound on hamstring flexibility and proprioception

[Purpose] This research explored the positive effects of self-myofascial release on hamstring muscular flexibility and proprioception and investigated the effectiveness of the stretch combined with therapeutic ultrasound. [Subjects and Methods] This study included 30 healthy university students with no history of pain in the Achilles tendon or hamstring within the recent 6 months. Each participant completed two experiments. In the first experiment (MS), they completed self-myofascial stretching using a foam roller for 7 days. In the second experiment (MSU), the same participants performed the self-myofascial stretching after the 15-minute application of ultrasound. This study involved a pre- and post-test on hamstring muscle flexibility and hip joint proprioception. [Results] The use of self-myofascial stretching in the MS experiment had a significant effect on hamstring muscle flexibility and hip joint proprioception. However, the addition of ultrasound in the MSU experiment had no additive effect. [Conclusion] Self-myofascial stretching immediately increased hamstring muscle flexibility and improved hip joint proprioception, but the addition of pre-stretch ultra sound provided no further benefit.

Agreement Between Face-to-Face and Free Software Video Analysis for Assessing Hamstring Flexibility in Adolescents

The objective of this study was to determine the level of agreement between face-to-face hamstring flexibility measurements and free software video analysis in adolescents. Reduced hamstring flexibility is common in adolescents (75% of boys and 35% of girls aged 10). The length of the hamstring muscle has an important role in both the effectiveness and the efficiency of basic human movements, and reduced hamstring flexibility is related to various musculoskeletal conditions. There are various approaches to measuring hamstring flexibility with high reliability; the most commonly used approaches in the scientific literature are the sit-and-reach test, hip joint angle (HJA), and active knee extension. The assessment of hamstring flexibility using video analysis could help with adolescent flexibility follow-up. Fifty-four adolescents from a local school participated in a descriptive study of repeated measures using a crossover design. Active knee extension and HJA were measured with an inclinometer and were simultaneously recorded with a video camera. Each video was downloaded to a computer and subsequently analyzed using Kinovea 0.8.15, a free software application for movement analysis. All outcome measures showed reliability estimates with α > 0.90. The lowest reliability was obtained for HJA (α = 0.91). The preliminary findings support the use of a free software tool for assessing hamstring flexibility, offering health professionals a useful tool for adolescent flexibility follow-up.

A comparison between active knee extension test and back-saver sit-and-reach test in assessing hamstring flexibility among healthy schoolchildren in India

Objective:

This study evaluated the correlation between the active knee extension test and the back-saver sit and reach test among healthy schoolchildren aged 9–13 years in India.

Method:

Five hundred and two healthy schoolchildren aged between 9–13 years were recruited from selected schools in India, and their hamstring flexibility for the right and the left leg was measured using the back-saver sit and reach test and the active knee extension test. The test protocol for the back-saver sit and reach test was taken from the FITNESSGRAM fitness test (while active knee extension test was performed according to the procedures taken from reliability studies). A Pearson's correlation coefficient was performed to identify the relationship between the two scores.

Results:

The mean (SD) of the test values were as follows: active knee extension test right leg: 29.09 (± 6.51); left leg: 29.07 (± 6.51). Back-saver sit and reach test right leg: 10.81 (± 1.79); left leg: 10.83 (± 1.70). The two showed a moderate correlation (right leg r=-.439 and left leg r=-.429, P≤.05). The active knee extension test was more sensitive to age increments, showing an overall decrease in the scores with advancing age.

Conclusion:

The active knee extension test and the back-saver sit and reach test are both tests that measure hamstring flexibility. The active knee extension test was found to be more sensitive to hamstring length changes, and should be used in the assessment of flexibility.

Physical fitness is predictive for a decline in daily functioning in older adults with intellectual disabilities: results of the HA-ID study

A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (≥ 50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID.

Subgroups associated with lower physical fitness in older adults with ID: results of the HA-ID study

Although physical fitness is generally very low in older adults with intellectual disabilities (ID), levels may differ across subgroups. It is important to identify which subgroups need to be targeted specifically in physical activity and fitness interventions and reference values. Physical fitness was measured with box-and-block-test, response-time-test, Berg-balance-scale, walking speed, grip strength, 30s-chair-stand, 10 m incremental-shuttle-walking test and the extended modified-back-saver-sit-and-reach-test in a large sample of older adults with ID (n=1050), and subgroups associated with lower physical fitness levels were identified applying multivariate linear regression analyses. Both fixed personal characteristics such as being older, being female, having more severe ID and having Down syndrome and modifiable or preventable factors such as physical activity levels, mobility impairments and a need of more intensive care, are independently associated with lower levels of multiple physical fitness components. This first study identifies subgroups of older adults with ID which require adapted reference values, and subgroups that need to be specifically targeted in fitness promotion programs.

Associations between health-related physical fitness and obesity in Taiwanese youth

This study examined associations between four health-related physical fitness measures and obesity in Taiwanese youth aged 10-18 years. Data from 13,500 school-aged youth were randomly selected from the "School Physical Fitness Database" of Taiwan by sex and age. Variables examined were height, body mass and performance on modified sit-and-reach (flexibility), bent-leg sit-up (abdominal muscular strength/endurance), standing long jump (lower body explosive strength) and distance run/walk (cardiorespiratory endurance). Adjusted logistic regression analyses were performed. Increased odds of being obese with decreased fitness levels were observed for lower body explosive strength and cardiorespiratory endurance in both sexes. The highest odds of being obese was found in the least fit quintile of cardiorespiratory endurance compared with the most fit quintile both in boys (Odds ratio, OR = 10.44; 95% confidence interval (CI), 7.94-13.73) and girls (OR = 5.40; 95% CI, 3.90-7.47). These findings suggest that in addition to cardiorespiratory fitness, lower body explosive strength is also associated with childhood and adolescent obesity.

Diagnosis and prognosis of acute hamstring injuries in athletes

PURPOSE

Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes.

METHODS

A literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes.

RESULTS

Medical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism.

CONCLUSIONS

Posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors.

LEVEL OF EVIDENCE

Literature review and expert opinion, Level V.

Accuracy and feasibility of video analysis for assessing hamstring flexibility and validity of the sit-and-reach test

The accuracy of video analysis of the passive straight-leg raise test (PSLR) and the validity of the sit-and-reach test (SR) were tested in 60 men and women. Computer software measured static hip-joint flexion accurately. High within-session reliability of the PSLR was demonstrated (R > .97). Test-retest (separate days) reliability for SR was high in men (R = .97) and women R = .98) moderate for PSLR in men (R = .79) and women (R = .89). SR validity (PSLR as criterion) was higher in women (Day 1, r = .69; Day 2, r = .81) than men (Day 1, r = .64; Day 2, r = .66). In conclusion, video analysis is accurate and feasible for assessing static joint angles, PSLR and SR tests are very reliable methods for assessing flexibility, and the SR validity for hamstring flexibility was found to be moderate in women and low in men.

Absolute reliability of five clinical tests for assessing hamstring flexibility in professional futsal players

OBJECTIVES

To examine the absolute reliability of five methods for estimating hamstring flexibility in professional futsal players.

DESIGN

Absolute reliability laboratory study (k=4).

METHODS

A total of 46 male futsal players (172.9±4.5 cm; 69.7±7.5 Kg) completed the study. All participants performed each measurement test twice in a randomized order on four different occasions. Absolute reliability was examined through typical percentage error, percentage change in the mean and intraclass correlations (ICC) as well as their respective confidence limits.

RESULTS

The findings showed high reliability for the sit and reach test (SRT) (4.48% typical error; 0.84% change in the mean, 0.95 ICC), toe touch test (TT) (5.89% typical error; 2.31% change in the mean, 0.89 ICC) and back-saver sit and reach test (BSSR) (3.73% typical error; 0.51% change in the mean, 0.97 ICC) compared to the passive straight leg raise test (PSLR) (7.6% typical error; 8.86% change in the mean, 0.77 ICC) and modified sit and reach test (MSR) (11.87% typical error; 7.64% change in the mean, 0.84 ICC) which showed moderate reliability.

CONCLUSIONS

An observed change larger than 6.72%, 7.55% and 5.59% for baseline SRT, TT and BSSR scores respectively would indicate that a real improvement in hamstring flexibility has occurred. In addition, the clinical reliability of PSLR and MSR are questioned and should be re-evaluated in future research studies.

Influence of hamstring muscles extensibility on spinal curvatures and pelvic tilt in highly trained cyclists

The purpose of this study was to determine the influence of hamstring muscles extensibility in standing, maximal trunk flexion with knees extended and on the bicycle in lower handlebar-hands position of highly trained cyclists. Ninety-six cyclists were recruited for the study (mean ± SD, age: 30.36 ± 5.98 years). Sagittal spinal curvatures and pelvic tilt were measured in the standing position, maximal trunk flexion with knees extended (sit-and-reach test) and while sitting on a bicycle in lower handlebar-hand position using a Spinal Mouse system. Hamstring muscles extensibility was determined in both legs by passive straight leg raise test (PSLR). The sample was divided into three groups according to PSLR angle: (1) reduced extensibility (PSLR < 80º; n = 30), (2) moderate hamstring extensibility group (PSLR = 80º - 90º; n = 35), and (3) high hamstring extensibility (PSLR = > 90º; n = 31). ANOVA analysis showed significant differences among groups for thoracic (p < 0.001) and pelvic tilt (p < 0.001) angles in the sit-and-reach test. No differences were found between groups for standing and on the bicycle position. Post hoc analysis showed significant differences in all pairwise comparisons for thoracic angle (p < 0.01) and pelvic angle (p < 0.001) in the sit-and-reach test. No differences were found in lumbar angle in any posture. In conclusion, the hamstring muscles extensibility influence the thoracic and pelvic postures when maximal trunk flexion with knees extended is performed, but not when cyclists are seated on their bicycles.

Hip flexibility is the main determinant of the back-saver sit-and-reach test in adolescents

Although flexibility field tests are commonly used in research, sport, and school settings, there is no conclusive evidence about what they actually assess. The first aim of this study was to assess the contributions of the main joints involved in the back-saver sit-and-reach test using angular kinematic analysis. The second aim was to measure the inter-method agreement between the back-saver sit-and-reach test and the sit-and-reach test. A total of 138 adolescents (57 females, 81 males) aged 14.5 +/- 1.7 years performed the back-saver sit-and-reach test and the sit-and-reach test. Hip, lumbar, and thoracic angles were assessed by angular kinematic analysis while the participants were performing the back-saver sit-and-reach test. Stepwise linear regression models and the Bland-Altman method were used. The hip angle independently explained 42% (P < 0.001) of the variance in the back-saver sit-and-reach test, the lumbar angle explained an additional 30% (P < 0.001) of the variance, and the thoracic angle an additional 4% (P < 0.001). The inter-method mean difference between back-saver sit-and-reach (BSSR) and sit-and-reach (SR) measures (BSSR - SR) was 0.41 cm (P = 0.21). The results suggest that hip flexibility is the main determinant of the back-saver sit-and-reach test score in adolescents, followed by lumbar flexibility. The back-saver sit-and-reach test can therefore be considered an appropriate and valid test for assessing hip and low-back flexibility in this age group. The back-saver sit-and-reach and sit-and-reach tests provide comparable values.