University of Groningen
Straight-leg rasing in 'short hamstrings'. An experimental study of muscle elasticy and
defense reactions.
Göeken, Ludwig Nanno Hiltjo
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Publication date:
1988
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Citation for published version (APA):
Göeken, L. N. H. (1988). Straight-leg rasing in 'short hamstrings'. An experimental study of muscle elasticy
and defense reactions. s.n.
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SUMMARY ANID CONCLUSIONS
guestion asked in
The central
problem
frequently
encountered
concerns the determination
in patients
position
thesis is whether
an Experimental
Raising test (E. S.L. R. ) can contribute to the solution of a
Straight-Leg
diagnostical
It
this
in
who are unable to bend forward
holding
while
clinical test
is
used
rehabilitation
medicine.
of the cause of the movement restriction
the
knees
aimed to
root
i.e.
normally
extension.
diagnose,
pression of a lumbosacral nerve
elasticity of the hamstrings,
in
on
and,
from the standing
For
the
one hand,
on the other
hamstrings.
short
purpose
this
the
hand,
com-
a poor
Dependent on the
aim, the test is called Lasdguers test or passive muscle stretch
respectively.
Since
the
execution
of
both
tests
does
Raising (C.S,L.R.)
neutral term Clinical Straight-Leg
a
not
test,
differ
the
has been chosen
to denote the test movement.
The
current
diagnostical
approach
mentioned movement restriction
that practical
ability
of
experience
the
test
to
patients
in
with
is described in Chapter l,
supported
by
differentiate
case reports
between
short
above
the
It is argued
casts doubt on the
(elasto-
hamstrings
genic pathology) and other causes (non-elastogenic pathologyT.
The possible reasons for the problems encountered in C.S.L.R.
considered in Chapter
with
the
is
test
because of
the
2. It
is concluded
insufficient
lack
of
to
information
muscles and the use of incorrect
that
the information
differentiate
it
yields
variables
over
the
obtained
particularly
correctly,
regarding
are
activity
the
of
the
elasticity
of
is
in
the relevant muscles.
In
order
Chapter
to
3 of
generate
the
better
extension
of
acting on the leg and the pelvis.
variables,
the
an
relevant
For this
analysis
muscles
purpose
and
made
the
forces
a simple theoretical
model is used, in which the muscles are represented by two springs in
series. The model reproduces
the variables
to determine the extensibility
and the elasticity
extensibility
have to be measured
of the springs.
is defined by the maximum increase in length
admits with respect
elasticity
which
is defined
to its length
by
the
in the inactive
relation
between
supine position.
load and
Muscle
that a muscle
the
Muscle
increase
in
the musclers length.
Based on the conclusions
130
drawn
from the analysis,
an Experimental
Straight-Leg
Chapter
Raising
set-up
4. The set-up
and the activity
was
developed
makes it possible
is
to determine
described
in
the extensibility
of the muscles by measuring the excursion of the leg,
the change in the hip angle and the back
in the mm. erector
flattening
which
gluteus
spinae,
angle,
the electrical activity
maximus and sernimembranosus, the
of the back and the applied
force.
lift
Since the weight and
the length of the leg are measured too, the moment necessary to overcome the elastic retraction
Because it is important
ly,
special
forces in the muscles can also be determined.
in this study
has
attention
to measure the hip angle correct-
paid
been
to
measuring the hip angle while discussing
The
general
are discussed
findings
and
and illustrated
the
teers.
For
according
purpose
this
to their
and a stiff
(S).
like the patients,
bending
strings
measured
The excursion
in
the
the
subjects
measured
in
with
leg
(M)
because
and a super-
subjects
with
until
hamstrings,
the
leg
It
appears
the
the
horizontal
The
same leg
excursion,
vertical
for
a
and a maximum
of less than
however,
In
the
position,
also
a considerable
as a result
contrast
back
did
to the
muscles,
not
differ
although it was largest in the subjects of the
that
a sma1l extensibility
sometimes is compensated by a large extensibility
The stiffness
criteria
plane
results,
of
to be the
able to touch the
may be present
extensibility
the
of the ham-
out
clinical
of the back muscles.
the
attained
much between the groups,
medium group.
that
correct.
the
S turned
i. e. not being
of the hamstrings
in extensibility
the
are presented in
the knees extended
and
generally
in extensibility
of differences
findings
a medium group
A short history
group
of
therefore
forward
are
in
is
straight
C.S.L.R.,
difference
selected
are not able to touch the ground while
of the hamstrings,
while bending
between
showed that
(F),
on volun-
were
of the leg and the extensibility
One conclusion
small extensibility
80o in
students
of the measurements in the volunteers
6.
ground
8
group
with the knees extended.
The results
angle
of
examination revealed no other abnormalities.
Chapter
smallest.
of the measurements
S is used as a control group,
these subjects
forward
ficial physical
groups
a flexible
Group
in
5, Since reference values are
measurements were performed
three
flexibility:
group
encountered
the measuring procedure.
reproducibility
in Chapter
not available in the literature,
problems
the
of the muscles varied
of the hamstrings
of the back muscles.
considerablv
between the sub-
jects within
each group,
means that
This
group
systematically between the
present
movement restriction
the
S is not
not
but
a poor elasticity
caused by
of
therefore concluded thatrrshortrrhamstrings
Not
hamstrings.
the
elasticity
S. A plausible
explanation
by
subjects of
as stiff
are
in
differences
moment exerted
the
the maximum value of
the
the
It
hamstrings.
the
the
is
asrrlongil
extensibility
with respect to
between the groups
differences
explain the considerable
lowest in group
but
in
groups.
which
muscles,
for the small extensibility
is
of
the hamstrings is a low stretch tolerance of these muscles. The cause of
a phenomenon is
such
nociception in
often
of
extensibility
restriction.
tissue,
This
the
it
may be attributed
the
thus
hamstrings
and
an
between
other
the
the problems which
intrinsic
for
causes
the
case there is aiso a low stretch
In the latter
to
perimysium
and
epi-
also would explain
differentiating
in
encountered
but
known,
connective
the fascial sheat.
and/or
are
the
not
small
movement
tolerance, be
it in other structures.
(defense reactions),
does not commence with the first
feeling of pain
at an angle
series is active,
accompanying activity
gradually
the
simultaneously.
muscles of
the
Since
in
volunteers
the
this
and
the
only
both
two
defense
study
the
back is shown to depend on the stiffness
of the leg raise,
it
plane
horizontal
muscle groups
in
sometimes with
increases
group
of
subjects
S,
in
recorded
considered
the
and
in
the
a physiological
of the
The fiattening
of the muscles relative
to each
increases immediately after
Because the tension in the hamstrings
the start
the activity
hamstrings
activity
is
in the
but with the
maximus. The activity
in
phenomenon, it is called normal defense reaction.
other.
the
semimembranosus,
Activity
in
leg
one of
only
m,
in the m. gluteus
as the leg rises.
muscles was established
neither
M and S. GenerallY,
the
between
most often
is largest
feeling of muscle tension,
between 40o-90o. Usually
varying
back
was shown that it
it
from group
hamstrings of the subjects
the
of the muscles while counteracting
As concerns the EMG activity
stretching
that
is concluded
is no real slack
there
in these muscles.
The results
Chapter 7. Thirty
bend forward
of the
normally,
Rehabilitation Department
13Z
measurements
subjects
without
in
the
patients
neurological
are presented
symptoms,
were selected by the physicians
of the University
in
all unable to
working
Hospital in Groningen.
at the
They
(CSH) when the move-
received the diagnosis Clinical Short Hamstrings
ment restriction
physician
by the referring
was attributed
to an elasto-
genic cause. The diagnosis No Clinicai Short Hamstrings (NCStl) occurred when a non-elastogenic cause was assumed. The selection procedure
each group
was continued until
excursion
of
the
leg
in
the experiments
sides,
some of
15 patients.
consisted of
the
were performed
patients
Because the
was restricted
on 40 iegs in total:
at both
22 legs with
the label CSH and 18 legs with the label NCSH.
two categories
Based on the type of the recorded muscle activity,
of legs could be distinguished.
similar to that recorded in the controle group
activity
Normal Defense Reactions (NDR).
different
are
The
by
EMG activity
excursion
earlier
an
category of 15 legs showed
Another
start
compared to that
the
of
(group S), i.e.
calied Abnormal Defense Reactions (ADR).
EMG activity,
characterized
of the
25 legs showed EMG
of
One category
1.9,
the
a more
andior
measured in
extensibility,
rapid
the control
elasticity
ADR
increase
and
group.
stretch
tolerance of the muscles measured in the legs with NDR, either agreed
with those established
with ADR,
however,
in the control
group
or were larger.
In the legs
the excursion of the ieg and the extensibility and
stretch tolerance of the muscles were much smaller. but the stiffness of
ADR appeared.
the muscles was normal until
most often present
( 9x ) ,
but
aiso
simultaneously
in
one
only
branosus with or without
was
in both of the muscle groups in series
muscle
activity
Abnormal EMG activity
group r
the
either
m.
semimem-
in the m. gluteus maximus (3x) or the
m. erector spinae (3x).
The findings
in the legs with
cause of the movement restriction
legs of the control
group
ADR warrant
the conclusion that
in these legs differs
and therefore
is per
the
from that in the
definitionrrnon-elasto-
genicrr. From that point of view it is concluded, that in many legs (50%)
in which the movement restriction
hamstrings,
clinically
had been attributed
to short
the real cause was in fact an abnormal defense reaction in
one or more muscles. On the other hand, in many of the legs (78%) in
which a rrnon-elastogenicrr cause was assumed, no abnormal defense
reactions could be detected.
In these patients
were in agreement with those of the control
for the movement restriction
the control group:
probably
the values of all variables
grouP.
Therefore
in these legs apparently
a low stretch
the cause
is the same as in
tolerance of the hamstrings.
As
for
the
distinction
clinical
consequences
is made between
the
of
the
diagnostic
experimental
and the
findings,
therapeutic
a
conse-
quences. Regarding diagnostics it is concluded that the
dichotomy in
'relastogenicrr and rtnon-eleastogenicr
causes for the movement restriction
is incorrect since short hamstrings, a genuine elastogenic cause,
do not
exist. l{oreover it is concluded that the muscle stretch
test and
Lasdguers test in patients without
tools
for
intrinsic
differentiating
neurological
between
small extensibility
a
symptoms are not suitable
movement
of the hamstrings
restriction
and that
due
to
an
ciue to abnormal
defense reactions.
In consequence it is concluded that it is hazardous
to base the therapeutic programme on C.S.L.R.
As for the therapeutic
cluded
that
shortening
the
usual
as the
tshort
approach in
therapies,
causar factor,
based
for
on
hamstrings,,
it
the
of
concept
example those
(1952) and Janda (19?9), are incorrect
of
Kendari
since a small extensibility
is conmuscle
et
ar.
of the
hamstrings is not caused by poor muscle erasticity, but probably
by
tolerance. Because such a phenomenon may be considered
low stretch
physiological
mechanism, the therapeutic
in patients withrrshort
hamstringsr
reason to abandon therapeutic
benefit
is
stretching
are overlooked.
conclusion of this study
is that the experimental
ask for a revision of both the current opinion regarding the
of rrshort hamstringsrr and the diagnostic
and therapeutic
etiology
approach in patients
also true
for
asked in
this
with
study,
tolerance
of
striction.
Finally
elasticity.
phenomenon.
it
the
for
is
hamstrings
it
In analogy this
concluded
is
the
and
concluded
for
study
the
of
is possibly
To answer the central question
that
the
is helpful in differentiating
method may be valuable
and
this
otherrrshortrrmuscles.
yielded bij E.s.L.R.
134
exercises
more important
general
findings
causes
A
a
of these muscles is the findins
that abnormal defense reactions frequently
The
of stretching
questioned.
a
other
that
the
information
between a low stretch
causes
differential
other
additional
for
findings
a
indicate
diagnostics
problems
movement
in
that
rethe
those other
concerning
muscle