Comparing the Effect of Exercises With Different Gluteal-to-Tensor Fasciae Latae Activation Index in Patients With Chronic Low Back Pain

Click name to view affiliation

Leila Jahandideh Master of the Science of Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Science, Imam Reza International University, Mashhad, Iran

Search for other papers by Leila Jahandideh in
Current site
Google Scholar
PubMed
Close
*
,
Amir Letafatkar Associate Professor of Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran

Search for other papers by Amir Letafatkar in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-5612-8340
,
Reza Khanzadeh Faculty of Physical Education and Sports Sciences, Asrar Institute of Higher Education, Mashhad, Iran

Search for other papers by Reza Khanzadeh in
Current site
Google Scholar
PubMed
Close
, and
Farzad Omidi Kashani Department of Orthopedics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Search for other papers by Farzad Omidi Kashani in
Current site
Google Scholar
PubMed
Close
Restricted access

Context: Hip muscle imbalance, especially between gluteal muscles and tensor fasciae latae (TFL), is one of the risk factors for developing low back pain which should be considered in rehabilitation programs. This study compared the effect of exercises with gluteal-to-TFL muscle activation index above and below 50 on pain intensity, disability, and lower limbs’ range of motion (ROM) in patients with nonspecific chronic low back pain. Design: A semiexperimental intervention study with a pretest and posttest. Methods: A total of 45 patients with nonspecific chronic low back pain were randomly divided into 2 experimental groups of gluteal-to-TFL muscle activation index above 50 (n = 15), below 50 (n = 15), and a control group (n = 15). Pain intensity (visual analog scale), disability (Roland–Morris Disability Questionnaire), and lower limbs’ ROM including hip extension, hip abduction, hip external rotation, and knee extension (goniometer) were assessed at pretest and after 8 weeks of intervention. Results: Within-group comparison showed significant improvement of pain, disability, and ROMs in both experimental groups. No significant changes were observed in the control group. In between-group analysis, significant differences were observed in group of gluteal-to-TFL muscle activation index above 50 for only pain (P = .03) and disability (P = .01). For ROMs, although clinical improvement of lower limbs’ ROMs was higher in group of gluteal-to-TFL muscle activation index above 50, no statistically significant differences were found between 2 experimental groups. Both experimental groups were superior to the control group for all outcomes. Conclusions: Findings indicate the statistically and clinically superior effectiveness of exercises with a gluteal-to-TFL muscle activation index above 50 in the reduction of pain and disability. Based on the clinical significance of exercises with a gluteal-to-TFL muscle activation index above 50 for improving ROMs, utilizing specific exercises that more activated gluteal muscle compared to TFL is recommended for patient with restricted lower limbs’ ROMs.

Letafatkar https://orcid.org/0000-0002-5612-8340

Jahandideh (leila.jahandideh30@gmail.com) is corresponding author.

Exercises including gluteal-to-tensor fasciae latae muscle activation index above 50 can effectively reduce nonspecific chronic low back pain.

Exercises with a focus on the activation of gluteal muscles and inhibition of TFL are suggested to use in low back pain rehabilitation programs.

  • Collapse
  • Expand
  • 1.

    Amundsen PA, Evans DW, Rajendran D, et al. Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012. BMC Musculoskelet Disord. 2018;19(1):113. doi:10.1186/s12891-018-2034-6

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):20282037. doi:10.1002/art.34347

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Delvaux K, Lysens R. Lumbosacral pain in an athlete. Am J Phys Med Rehabil. 2001;80(5):388391. doi:10.1097/00002060-200105000-00016

  • 4.

    Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482491. doi:10.1016/S0140-6736(11)60610-7

  • 5.

    de Sousa CS, de Jesus FLA, Machado MB, et al. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact. 2019;19(1):6978. PubMed ID: 30839305

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Van Dillen LR, Bloom NJ, Gombatto SP, Susco TM. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport. 2008;9(2):7281. doi:10.1016/j.ptsp.2008.01.002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Nelson-Wong E, Gregory DE, Winter DA, Callaghan JP. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech. 2008;23(5):545553. doi:10.1016/j.clinbiomech.2008.01.002

    • Search Google Scholar
    • Export Citation
  • 8.

    Roach SM, San Juan JG, Suprak DN, Lyda M, Bies AJ, Boydston CR. Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. IInt J Sports Phys Ther. 2015;10(1):1320. PubMed ID: 25709858

    • Search Google Scholar
    • Export Citation
  • 9.

    Neumann DA. Kinesiology of the Musculoskeletal System-e-book: Foundations for Rehabilitation. Elsevier Health Sciences; 2016.

  • 10.

    Page P, Frank C. The Janda approach to chronic musculoskeletal pain. Janda Approach. 2007;12:2008.

  • 11.

    Vatandoost S, Sheikhhoseini R, Akhbari B, et al. Altered muscle strength and flexibility among a subgroup of women with chronic nonspecific low back pain: cross-sectional case-control study. Physiother Theory Pract. 2022;23:19. doi:10.1080/09593985.2022.2043497

    • Search Google Scholar
    • Export Citation
  • 12.

    Farbod H, Abbasi A, Letafatkar A. Comparison of electrical activity ratio in gluteus maximus and gluteus medius reletive to tensor fascia lata in participants with non-specific chronic low back pain and healthy participants during selected rehabilitation exercises. Ann Phys Rehabil Med. 2018;7(2):158168.

    • Search Google Scholar
    • Export Citation
  • 13.

    Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. Orthop Sports Phys Ther. 2013;43(2):5464. doi:10.2519/jospt.2013.4116

    • Search Google Scholar
    • Export Citation
  • 14.

    Madadi-Shad M, Jafarnezhadgero AA, Sheikhalizade H, Dionisio VC. Effect of a corrective exercise program on gait kinetics and muscle activities in older adults with both low back pain and pronated feet: a double-blind, randomized controlled trial. Gait & Posture. 2020;76:339345. doi:10.1016/j.gaitpost.2019.12.026

    • Search Google Scholar
    • Export Citation
  • 15.

    Boonstra AM, Preuper HRS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165169. doi:10.1097/MRR.0b013e3282fc0f93

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The oswestry disability index, the roland-morris disability questionnaire, and the quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine. 2006;31(14):E454E459. doi:10.1097/01.brs.0000222141.61424.f7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Clapis PA, Davis SM, Davis RO. Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiother Theory Pract. 2008;24(2):135141. doi:10.1080/09593980701378256

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Vigotsky AD, Lehman GJ, Beardsley C, Contreras B, Chung B, Feser EH. The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ. 2016;4:e2325. doi:10.7717/peerj.2325

    • Search Google Scholar
    • Export Citation
  • 19.

    Clarkson HM. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. Lippincott Williams & Wilkins; 2000.

  • 20.

    Wakefield CB, Halls A, Difilippo N, Cottrell GT. Reliability of goniometric and trigonometric techniques for measuring hip-extension range of motion using the modified Thomas test. J Athl Train. 2015;50(5):460466. doi:10.4085/1062-6050-50.2.05

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. Routledge; 2013.

  • 22.

    Jeong U-C, Sim J-H, Kim C-Y, Hwang-Bo G, Nam C-W. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci. 2015;27(12):38133816. doi:10.1589/jpts.27.3813

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Rabiei P, Namin BG, Nasermelli MH, Marjomaki O, Mazloum V. The effects of functional training on pain, function, and performance in taekwondo players with mechanical low back pain. Health. 2017;9(8):11761189. doi:10.4236/health.2017.98085

    • Search Google Scholar
    • Export Citation
  • 24.

    Zambarano EK, Bouillon L, Glaviano NR. Relationship between lumbopelvic-hip complex stability, muscle activity, and 2-dimensional kinematics of the trunk and lower extremity. Phys Ther Sport. 2021;47:714. doi:10.1016/j.ptsp.2020.10.003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Sadler S, Cassidy S, Peterson B, Spink M, Chuter V. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskelet Disord. 2019;20(1):463. doi:10.1186/s12891-019-2833-4

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Lee S, Kim SY. Comparison of chronic low-back pain patients hip range of motion with lumbar instability. J Phys Ther Sci. 2015;27(2):349351. doi:10.1589/jpts.27.349

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Khoury AN, Gómez-Hoyos J, Martin HD. Hip-spine effect: hip pathology contributing to lower back, posterior hip, and pelvic pain. Posterior Hip Disorders. Springer; 2019:2940.

    • Search Google Scholar
    • Export Citation
  • 28.

    Zacharias A, Green RA, Semciw A, English DJ, Kapakoulakis T, Pizzari T. Atrophy of hip abductor muscles is related to clinical severity in a hip osteoarthritis population. Clin Anat. 2018;31(4):507513. doi:10.1002/ca.23064

    • Search Google Scholar
    • Export Citation
  • 29.

    Lawrenson P, Crossley K, Vicenzino B, et al. Muscle size and composition in people with articular hip pathology: a systematic review with meta-analysis. Osteoarthr Cartil. 2019;27(2):181195. doi:10.1016/j.joca.2018.10.008

    • Search Google Scholar
    • Export Citation
  • 30.

    Cooper NA, Scavo KM, Strickland KJ, et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J. 2016;25(4):12581265. doi:10.1007/s00586-015-4027-6

    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2204 1831 124
Full Text Views 144 135 1
PDF Downloads 95 78 4