o,v914
THE RELATIVE CONTRIBUTION OF FLEXIBILITY OF THE BACK
AND HAMSTRING MUSCLES IN THE PERFORMANCE OF THE
SIT AND REACH COMPONENT OF THE AAHPERD HEALTH
RELATED FITNESS TEST IN GIRLS THIRTEEN
TO FIFTEEN YEARS OF AGE
THESIS
Presented to the Graduate Council of the
North Texas State University in Partial
Fulfillment of the Requirements
For the Degree of
MASTER OF SCIENCE
By
Alice Ann Baker
Denton, Texas
August, 1985
@1986
ALICE ANN BAKER
All Rights Reserved
Baker, Alice Ann, The Relative Contribution of Flexi-
bility of the Back and Hamstring Muscles in the Performance
of the Sit and Reach Component of the AAHPERD Health Related
Fitness Test in Girls Thirteen to Fifteen Years o
Master of Science (Physical Education), August, 1985, 46
pp., 7 tables, bibliography, 36 titles.
The purpose of the study was to quantify the relative
contribution of low back flexibility and hamstring flexibilAAHPERD Health
ity in the sit and reach test item of the
of the
Related Fitness Test in order to examine the validity
sit and reach test.
Subjects were 100 female students, 13
to 15 years of age in physical education classes.
Hamstring
flexibility was measured using the Leighton flexometer.
Spinal mobility was measured using a tape measure.
The sit
and reach test was performed according to instructions given
in the AAHPERD Test Manual.
Data were analyzed using
correlation, linear regression, and multiple regression.
Conclusions of the investigation were
(1)
hamstring flexi-
bility is moderately related to the sit and reach test,
(2)
the
low back flexibility has a very small relationship to
sit and reach test, and (3)
the sit and reach test is an
inadequate measure of low back and hamstring flexibility.
TABLE OF CONTENTS
Page
iv
.
.
.
- .
-
v
-
LIST OF ILLUSTRATIONS
.
LIST OF TABLES ......-...........-
Chapter
I.
1
INTRODUCTION
Purpose of the Study
Delimitations
Definition of Terms
II.
- -0 -0 -a - - -6
REVIEW OF LITERATURE
Testing Devices
III.
PROCEDURES OF THE STUDY
0
-a -0 - -
23
Subjects
Methods
Pilot Study
Data Analysis
IV.
RESULTS . ...-..-.......-.-.-.-.-.-.-.-..
30
V.
DISCUSSION AND CONCLUSIONS OF THE STUDY
.
Reliability of Data
Descriptive Statistics
Correlational Results
Cross Validation of Correlations
35
Conclusions
Recommendations
APPENDIX....-...........-.-.-.-.-.....-.-.-.-.-.REFERENCES.
............-...-.-.-.-.-.-.-...-.-.
iii
41.
44
.
LIST OF TABLES
Page
Table
I.
II.
III.
IV.
V.
VI.
VII.
Test-Retest Reliability of the Sit and
Reach Test ..............-...-.-.-.-..-..
10
Test-Retest Reliability of the Leighton
-...-.-.-.-.14
. . ........
Flexometer.
Subject Descriptive Statistics .
24
.......
Test-Retest Reliability Estimates for the
Variables Measured in the Study. . .....
Descriptive Statistics.
30
31
... . ........
Pearson Correlation Coefficients Between the
Sit and Reach Test and Other Variables .
.
.
32
.
.
33
Cross Validation of Correlations Between the
Sit and Reach Test and Other Variables
iv
.
LIST OF ILLUSTRATIONS
Page
Figure
-.-.-.-.-.-.41
1.
Sit and Reach Test..... . .......
2.
Leighton Flexometer Hamstring Test.. ..
3.
Spine Flexibility Test.......... ........ 43
V
..
42
CHAPTER I
INTRODUCTION
Alarmed by data published in a research study by Kraus
and Hirschland
(1954), President Dwight D. Eisenhower
called a national conference in 1956 to discuss the future
of American youth.
that 57.9%
The Kraus and Hirschland study concluded
of American school children failed to pass a
minimal muscular fitness test compared to the failure of
8.9% of European children.
This immediate and urgent focus
on the apparent low level of physical fitness in the
nation's youth eventually led to the establishment of the
President's Council on Physical Fitness and the development
in 1958 of a fitness test by the American Alliance of Health,
a national
Physical Education and Recreation to be used in
survey of the fitness of American youth.
The AAHPER Youth
Fitness Test became the first fitness test with national
norms to be developed by the physical education profession
(American Alliance of Health, Physical Education, Recreation,
and Dance [AAHPERD],
1980).
Although the toe-touch test was the most frequently
failed segment of the Kraus study,
it was not included in
Instead,
the AAHPER Youth Fitness Test.
the test items
selected were skills accepted by physical educators as
1
2
important to develop in their education programs.
These
items reflected the fitness philosophy of the 1950s
emphasizing motor performance related to athletic ability
(Pate, 1983).
The test was generally well accepted,
and by 1979
approximately 20 million school children were being tested
per year with this instrument (AAHPERD, 1980).
However,
since the inception of the test, massive volumes of research
data have been collected indicating several components of
physical fitness could prevent or prolong the onset of
certain diseases (Pate, 1983).
This, along with concern
over the epidemic proportions of the lack of physical fitness
in the American people, led to a reappraisal of the test
(AAHPERD, 1980).
The newest scientific research related cardiorespira-
tory endurance, body composition and lower trunk strength
and flexibility to health.
It also showed a responsiveness
of these components to training and suggested that many
health problems are chronic and progressive beginning in
childhood and reaching clinical levels in the middle of late
adulthood (Pate, 1983).
Armed with this new data, a revi-
sion of the test was made by the American Alliance of Health,
Physical Education, Recreation,
and Dance,
and in 1980 the
AAHPERD Health Related Fitness Test was created.
The revised test stressed fitness related to functional
health rather than fitness related primarily to athletic
3
of the contriability reflecting a heightened appreciation
bution regular exercise can make to the maintenance of good
It has been acknowledged that a high
health (Pate, 1982).
problem
incidence of low back pain has become a significant
not only to adults but to people of all ages and both sexes,
sedentary and active alike (AAHPERD, 1984).
musculoDue to the relationship of low back-hamstring
evaluates this
skeletal function to low back pain, a test that
of the
function was included as one of the three components
new test.
The test item selected to measure lower trunk
flexibility was the sit and reach test.
Purpose of the Study
the relative
The purpose of this study was to quantify
flexicontribution of low back flexibility and hamstring
Health
bility in the sit and reach test item of the AAHPERD
Related Fitness Test in order to examine the validity of
the sit and reach test.
Delimitations
One delimitation of the study is subject specificity
pertaining to gender
(female).
The other delimitation is
to 15 years old).
subject specificity pertaining to age (13
Definition of Terms
Flexibility--range of motion about a joint.
4
Flexometer--variation of the goniometer consisting of
a weighted 360 degree dial and gravity controlled pointer
mounted in a case and used to measure joint movement.
Goniometer--protractor-like apparatus used to measure
joint movements and angles.
Sit and reach test--method of evaluating flexibility
of the low back and hamstring musculature by determination
of the maximum reach achieved from a seated starting position after reaching directly forward with the palms down
along a measuring scale.
Toe-touch test--method of evaluating flexibility of
the low back and hamstring musculature by determination of
the maximum reach achieved after bending forward with
fingertips toward the toes, especially from a standing
starting position.
CHAPTER REFERENCES
American Alliance for Health, Physical Education, Recreation,
(1980). AAHPERD health related physical
and Dance.
fitne ss test manual. Washington, D. C.: AAHPERD.
American Alliance for Health, Physical Education, Recreation,
(1984). AAHPERD health related physical
and Dance.
AAHPERD.
fitness technical manual. Washington, D. C.:
Minimum muscular
(1950).
Kraus, H., & Hirschland, R. P.
Research Quarterly,
The
fitness tests in school children.
21, 25-33.
(1982). Health related physical fitness.
Pate, R. R.
Journal of Physical Education, Recreation and Dance.
October, 63.
(1983). A new definition of youth fitness.
Pate, R. R.
The Physician and Sportsmedicine, 11(4), 77-83.
5
CHAPTER II
REVIEW OF LITERATURE
A review of the literature on flexibility of the hip
joint was aided by a computer search of the Medline,
and Catline databases from 1966 to the present.
Eric,
The
literature on the subject is limited and only one article
(Fieldman, 1968) was found which was concerned with the
relative contribution of the back and hamstring muscles to
hip joint flexibility.
Primarily studying the effects of warm-up on the
musculature during hip flexion, Fieldman collected data on
33 college men performing the toe-touch test.
The purpose
of his investigation was to assess the relative contribution
of the back and hamstring muscles in the performance of the
toe-touch test after using selected extensibility exercises
The subjects executed six tests over a five-
as a warm-up.
The first and sixth tests had no warm-up
week period.
while the second through fifth tests had varying degrees
of warm-up.
Photographs were taken of each subject in two
lateral poses,
one with a straight back and the hips flexed
-and the other in complete flexion.
The results indicated
that the tests which included extensibility exercises
allowed the subject to display greater flexibility.
6
Fieldman
7
concluded that any increased contribution of flexibility in
came
the performance of a standing toe-touch after warm-up
from the hamstring muscles.
He did not quantify the contri-
butions of the back or hamstring musculature nor did he
relate his findings to the scores of the toe-touch test.
Several studies examined the relationship of hip joint
flexibility and anthropometric measures.
Mathews,
Shaw, and
Bohnen (1957) measured 66 college women on three flexibility
tests consisting of an adapted Kraus-Weber floor touch test,
the Leighton flexometer test, and the Wells sit and reach
test.
Their intention was to determine the relationship
between these tests and the following three anthropometric
measures:
floor,
the distance from the greater trochanter to the
standing reach, and standing height.
No significant
relationship was found between the flexibility of the hip
body segments.
joint in the sagittal plane and the length of
Broer and Galles (1958) investigated the importance of
the relationship of trunk-plus-arm length (reach) to leg
length in the performance of the toe-touch test,
collected on 100 college women.
using data
Flexibility of the lower
and
back and hip was measured by the Leighton flexometer
the toe-touch test.
For persons with average body build
the relationship of trunk-plus-arm length to leg length
was found to be an insignificant factor in the ability to
perform the toe-touch test.
However,
subjects with extreme
in relation
body builds of longer trunk-plus-arm measurement
8
to shorter leg length have an advantage in the execution of
this test.
Mathews, Shaw,
and Woods
(1959) also studied extremes
of lower limb length, but found flexibility to be independent
of the length of body segments including lower limb length.
One hundred and fifty-eight male elementary school students
were measured on the Wells sit and reach test and the adapted
Kraus-Weber floor touch test.
The anthropometric measures
included standing reach, height, weight, and lower limb
length of the right leg from the top of the greater
trochanter to the floor.
The relationship of the hip
flexibility test scores and the anthropometric measures was
found to be insignificant.
Wear (1963), using 116 college men, took measurements
on the Wells and Dillon sit and reach flexibility test and
measurements of leg length and of trunk-plus-arm length.
He concluded that sit and reach mobility is not significantly
related to leg length but is significantly related to excess
of trunk and arm length over leg length.
The investigation of Harvey and Scott (1967) of the
relationship between the length of body segments and trunk
flexibility used data collected on 100 college freshman
women.
Their results indicated no significant relationship
between the length of body segments or leg over trunk ratio
and the best scores obtained on the bend and reach test.
9
Laubach and McConville
(1965a) examined the relation-
ship between flexibility and anthropometric measurements in
addition to flexibility and somatotype.
Fourteen flexibility
measurements using the Leighton flexometer, 63 direct and
derived anthropometric measurements,
63 college men were obtained.
and the somatotypes of
The correlations between the
flexibility measurements and the anthropometric measurements
were low and mostly insignificant.
The correlations between
the flexibility measurements and somatotype were insignificant.
In another study Laubach and McConville (1965b) obtained
data on 4 measures of muscle strength, 2 measures of flexibility, 30 direct and indirect anthropometric measures, and
the somatotypes of 45 male subjects ranging in age from 17
to 35 years.
The correlations between the flexibility and
anthropometric measurements were found to be low and
statistically insignificant,
and there was a general lack
of relationship between the flexibility measurements and
the somatotype components.
The relationship between anthropometric measures and
sit and reach performance was investigated by Cotten (1972a).
His study presenting a summary of the literature concluded
that measurements of trunk flexibility obtained by using
the flexometer, bobbing test, or sit and reach test are
largely unaffected by anthropometric variations among
10
individuals even when comparing groups with extreme anthropometric measures.
Testing Devices
The toe-touch tset has become a standard method of
assessing an individual's hip joint (back and hamstring)
flexibility.
The sit and reach test has become its most
common form since 1952 when Wells and Dillon, testing 100
is a
subjects, obtained a coefficient of 0.90 indicating it
valid test
Their
when compared to the standing toe-touch test.
investigation also produced a reliability coefficient of 0.98
test.
suggesting the sit and reach test is a highly reliable
Other previously discussed researchers have reported
reliability coefficients ranging from 0.84 to 0.98.
A
summary of this information is presented in Table I.
TABLE I
TEST-RETEST RELIABILITY OF THE SIT AND REACH TEST
Test-Retest
Subjects
Author(s)
(Date)
Reliability
Age
Sex
N
Coefficient
Wells & Dillon (1952)
college
female
100
0.98
(1957)
college
female
66
0.87
college
3rd-6th
grade
19-24 yrs.
female
male
50
158
male
62
0.97
0.840.89
0.94
female
100
0.86-
college
female
38
freshmen
male
37
Mathews et al.
Broer & Galles (1958)
Mathews et al. (1959)
Wear (1963)
Harvey & Scott (1967)
Cotten (1972b)
college
college
0.98
0.88
11
Table I indicates that data collected from numerous studies
agree that the sit and reach test is a reliable test instrument.
The apparatus used for the sit and reach test in this
investigation was a 12 inch by 12 inch box constructed in
accordance with the directions in the AAHPERD Health Related
Physical Fitness Test Manual
(AAHPERD, 1980).
A yardstick
with centimeter gradations was attached to the top panel
with the 23 centimeter mark exactly in line with the
vertical panel against which the subject's feet were placed.
The length of the yardstick extending beyond the end of the
top panel was removed at the 52 centimeter mark.
In attempting to determine the flexibility of the hamstring musculature independent of the back musculature,
another means of measurement was required.
The method
selected required a commonly used goniometric instrument,
Leighton flexometer.
the
It is a device that produces objective,
valid, and reliable data in the measurements of ranges of
movement of anatomical segments (Leighton, 1942, 1955,
1966).
It is composed of a weighted 360 degree dial and pointer
mounted in a case.
independently,
The dial and pointer operate freely and
and gravity controls their movement.
Inde-
pendent locking devices for the pointer and dial stop the
movement of either at any given position producing a measurement of the number of degrees of rotation in a range of joint
motion.
12
Developed in 1942,
Leighton's flexometer has endured the
test of time and was most recently used in 1982 by Ekstrand,
Wiktorsson, Oberg, and Gillquist in their investigation of
the reliability of certain goniometric measurements.
Twenty-two men aged 20 to 30 were tested on six joint motions
of the lower extremity using a specially constructed double
protractor goniometer and a modification of the Leighton
flexometer.
Their results showed both goniometric devices
to be accurate and reliable in the measurement of joint
motion.
They also concluded that with methods requiring
careful measurement technique, range of motion evaluation.
can be repeated accurately without elaborate equipment.
Numerous studies have cited the use of the Leighton
flexometer.
Hupprich and Sigerseth (1950) investigated
flexibility in girls as a general factor or as specific to
certain joints of the body and whether an advancement in
age decreases flexibility.
Using 300 girls ranging in age
from 6 to 18 years, 12 measurements of flexibility were
taken using the Leighton flexometer.
Producing reliabilities above 0.90 for each measurement
taken, Hupprich and Sigerseth (1950) reported coefficients
of 0.958 and 0.972 for hip flexion-extension and trunk-hip
flexion-extension respectively.
Leighton's 1942 study
which first presented his device and method for its use
showed reliability coefficients of 0.977 and 0.997 for the
same variables.
With the exception of Mathews,
Shaw,
and
13
Bohnen (1957) who reported an objectivity coefficient of
0.88 for the Leighton flexometer, a number of other studies,
including Broer and Galles (1958) and Laubach and McConville
(1965a,
1965b) have found comparable reliability measure-
ments above 0.90.
Thirty-seven male and 38 female college freshmen served
as subjects in a study by Cotten (1972b) using the Leighton
flexometer.
He compared four tests of trunk flexibility
with the Leighton flexometer test for trunk flexibility.
The four tests included the Cureton test,
the modified sit
and reach test, the Scott-French bobbing test, and the Wells
sit and reach test.
The Leighton flexometer produced test-
retest reliabilities of 0.94 for men and 0.91 for women.
The investigation also found the Leighton flexometer test
correlated highest with the Wells sit and reach test and
the modified sit and reach test.
The correlations were
0.63, 0.64, 0.65, and 0.66 respectively.
Munroe and Romance (1975) examined the relationship
between selected Leighton flexibility tests in attempting
to determine the minimum number of specific tests which
would best reflect overall body flexibility.
Sixty male
college freshmen were given 10 individual tests.
test-retest technique,
Using a
reliability coefficients between
0.95 and 0.98 were obtained for all tests,
reliability for each test administered.
indicating high
14
A summary of Leighton flexometer reliability coefficients for the studies discussed above is presented in
Table II.
TABLE II
TEST-RETEST RELIABILITY OF THE LEIGHTON FLEXOMETER
Subjects
Test-Retest
Author(s) (Date)
Reliability
Coefficient
Age
Sex
N
Leighton (1942)
college
N/A
56
Leighton (1955, 1966)
16 yrs.
male
120
Hupprich & Sigerseth
(1950
Mathews et al. (1957)
18 yrs.
female
60
college
female
66
Broer & Galles (1958)
college
female
50
Laubach & McConville
(1965a)
Laubach & McConville
(1965b)
16-25 yrs.
male
63
0.988 hip
0.979 trunk
17-35 yrs.
male
45
0.97
0.99
hip
trunk
Munroe & Romance
(1975)
17-23 yrs.
60
0.95
0.98
all
tests
female
38
0.92
trunk
male
37
0.94
trunk
male
22
N/A
Cotten (1972b)
Ekstrand et al.
college
20-30 yrs.
hip
trunk
all
tests
hip
trunk
objectivity
0.971 hip
0.977
0.977
0.913
0.996
0.958
0.972
0.88
(1982)
Table II presents high reliability coefficients
use of the Leighton flexometer in various flexibility
studies.
for the
, mmilmmlowdlMormff,
wim"'plis
-Muwumft
15
Measurement of spinal mobility has only recently been
accomplished by objective and reliable procedures.
ously,
Previ-
the traditional method of assessment was achieved
subjectively by judging the degree of spinal movement
empirically without assigning the degree of movement a
numerical value (Moll & Wright,
1976).
Three semi-objective
techniques of estimating the range of spinal
flexion are
endorsed by the American Academy of Orthopaedic Surgeons
(AAOS, 1966).
One technique locates the level the finger tips reach
along the subject's leg during spinal flexion.
In another
the distance between the fingertips and the floor during
forward flexion is measured.
The third method endorsed is
the use of a standard goniometer to estimate the degrees of
forward inclination of the trunk in relation to the longitudinal axis of the body.
Moll and Wright report that this
method is not highly accurate.
None of these methods measure
the spine independent of the hamstring muscles.
Of the few other methods developed to increase
objectivity in determining spinal
flexibility, most have
proved unacceptable as routine clinical procedures.
In
addition to their expense and time consuming procedures
the inaccuracy of Hart's serial photography (1956) and
radiation exposure during the prone posteroanterior
radiographic assessments of the spine as described by
Kleinman,
Csongradi, Rinksy, and Bleck
(1982) cause these
16
The protractor photographic
two methods to be inadequate.
method of Troup, Hood,
and Chapman1(1968) creates discomfort
to the subject due to the extreme postures required while
the measurements are taken.
Special
instrumentation is
the disadvantage of Loebl's inclinometer (1967).
Other special instrumentation includes the spondylometer
of Dunham (1949) which is a protractor with two rods 16
inches in length that measures the difference between spine
flexion and extension.
The spinal pantograph of Willner
(1983) is a pantograph with an elongation of one of its arms.
The contour line of the spine is drawn by the pantograph arm
on a paper roll fixed on a drawing table that is mounted on
a tripod.
The most practical technique to date was developed by
Macrae and Wright (1969) using a tape measure.
They modified
a method first described by Schober (1937) and endorsed by
the American Academy of Orthopaedic Surgeons (AAOS, 1966).
In this method the increase in the degree of spread between
spinous processes during flexion was used to determine
anterior flexion of the lumbar spine.
dure, as the subject stood erect,
In Schober's proce-
the lumbosacral junction
was identified and marked, and a second mark was placed 10
centimeters above it.
The subject then bent forward as far
as possible and the distance between the marks was measured.
Macrae and Wright (1969),
modified the Schober method
by adding a third mark 5 centimeters below the lumbosacral
17
junction giving a distance of 15 centimeters between the
outermost marks with the subject
in the erect position.
The
lower mark was added due to the observation that both marks
of Schober's procedure moved upwards relative to the spinous
processes on anterior flexion,
and the skin was poorly
fastened to the deep structures over the lumbar spine and
sacrum.
The skin seemed relatively well tethered from the
coccygeal area and appeared to stretch from that point.
A
second anterior flexion measure was then taken of the
distraction of skin between the marks 5 centimeters below
and 10 centimeters above the lumbosacral junction.
The
distraction between these two marks was found to have a
correlation coefficient of 0.97 when compared to anterior
flexion measured radiologically.
Data was collected from
195 females and 147 males.
Further radiographic examination showed that clinical
identification of the lumbosacral junction was subject to
an error of approximately 2 centimeters.
To determine if
this interfered with the accuracy of the test,
several
subjects were marked in the usual manner and a second set
of three marks were placed either 2 centimeters above or
below the original marks.
Placing the marks 2 centimeters
too high caused an underestimate of 5 degrees,
and placing
the marks 2 centimeters too low caused an overestimate of'
3 degrees.
movement.
The test was shown to be independent of hip
18
The American Academy of Orthopaedic Surgeons (AAOS,
1966) found a variation of the Schober procedure to be the
most accurate clinical method of estimating true spine
motion in flexion.
With the patient standing,
the one inch
marker of a steel or plastic tape measure was held over the
spinous process of the seventh cervical vertebra and the
distal tape held over the spinous process of the first sacral
vertebra.
It was found that during forward flexion, length-
ening of the tape measure increased on the average of 4
inches in the normal healthy adult.
Other researchers have used the simple procedure of
Macrae and Wright (1969) to determine anterior flexion.
Moll
and Wright (1971), in their development of a range of normal
values for spinal mobility measured by objective clinical
methods, employed this technique.
They had a total of 237
normal subjects in a family study which included 119 males
and 118 females.
Adrichem and Korst (1973)
in their assessment of lumbar
spine flexibility modified the procedure of Macrae and
Wright
tion,
(1969).
Locating and marking the lumbosacral junc-
they then placed four additional marks 5,
20 centimeters above the first mark.
10,
15,
and
A steel tape measure
pressed against the skin was used to determine the location
of the four additional marks.
The subject then bent forward
and the distraction between the lowest mark and each of the
four other marks was measured.
The measurements were also
19
made using a vernier caliper rule.
248 subjects aged 6 to 18 years,
By studying a group of
they found the steel tape
rule to be a handier measuring device than the caliper.
In summary, a review of the literature revealed several
studies which found no significant relationship between
flexibility and anthropometric measurements or somatotypes.
One study investigated the relative contribution of back and
hamstring musculature to flexibility of the hip joint but
did not quantify their contributions or relate the findings
to the scores of a toe-touch test.
The sit and reach test was found to consistently pro-
duce high reliability and validity coefficients in studies
which evaluate hip joint flexibility.
Likewise, the Leighton
flexometer repeatedly proved to be an objective, valid,
and
reliable testing device in the measurement of ranges of
anatomical segments.
The test of spinal movement which could be performed
most rapidly and easily with little inconvenience to the
subject entailed the measurement of the distraction of skin
marks over the spine with an ordinary plastic tape measure.
While the technique is simple to perform, it produces
reliable and valid data.
It is a feasible and practical
procedure to use in routine clinical evaluations and certain
field study situations.
CHAPTER REFERENCES
(1973).
Adrichem, J. A. M. van, & KorstJ. K. van der.
Assessment of the flexibility of the lumbar spine.
Scandinavian Journal of Rheumatology, 2, 87-91.
(1966). Joint
American Academy of Orthopaedic Surgeons.
Edinburgh:
motion: Method of measuring and recording.
Livingstone.
American Alliance for Health, Physical Education, Recreation,
(1980). AAHPERD health related physical
and Dance.
fitness test manual. Washington, D. C.: AAHPERD.
Importance of
(1958).
Broer, M. R., & Galles, N. R. G.
relationship between various body measurements in perThe Research Quarterly,
formance of the toe-touch test.
29(2), 253-263.
(1972a). Selected anthropometric measures
Cotten, D. J.
and trunk flexibility measurement--a study. Journal
of Physical Education, 70, 260-262.
(1972b). A comparison of selected trunk
Cotten, D. J.
flexibility tests. American Corrective Therapy Journal,
26, 24-26.
(1949). Ankylosing spondylitis: Measurement
Dunham, W. F.
of hip and, spinal movements. British Journal of Physical
Medi c ine , 12, 126-129.
Ekstrand, J., Wiktorsson, J., Oberg, B., & Gillquist, J.
(1982). Lower extremity goniometric measurements: A
study to determine their reliability. Archives of
Physical Medicine and Rehabilitation, 63, 171-175.
(1968). Effects of selected extensibility
Fieldman, H.
exercises on the flexibility of the hip joint. The
Research quarterly, 37, 326-331.
&
(1956). Measurement of thoracic and spinal
Mart, F. D.
In J. Goslings
movement in ankylosing spondylitis.
H. van Swaay (Eds.), Conporary rheumatology (p. 562).
Amsterdam: Elsevier.
20
21
Harvey, V. P., & Scott, G. D.
Reliability of a
(1967).
measure of forward flexibility and its relation to
physical dimensions of college women.
Quarterly, 38(1), 28-33.
Hupprich,
F. L., & Singerseth, P. 0.
(1950).
The specificity
The Research Quarterly, 21, 25-
of flexibility in girls.
33.
Kleinman, R. G., Csongradi,
The Research
J. J., Rinksy, L. A., & Bleck,
The radiographic assessment of spinal
(1982).
E. E.
A study on the efficacy of the
flexibility in scoliosis:
prone push film. Clinical Orthopaedics and Related
Research, 162, 47-53.
(1954). Minimum muscular
Kraus, H., & Hirschland, R. P.
fitness tests in school children. The Research Quarterly,
25, 178-188.
(1965a). Relationships
Laubach, L. L., & McConville, J. T.
between flexibility, anthropometry, and the somatotype
of college men. The Research Quarterly, 37(2), 241-251.
Laubach, L. L., & McConville,
J. T.
(1965b).
Muscle
strength, flexibility, and body size of adult males.
The Research Quarterly, 37(3), 384-392.
(1942). A simple objective and relilable
Leighton, J. R.
measure of flexibility. The Research Quarterly, 13,
205-216.
Leighton, J. R.
(1955).
An instrument and technic for
the measurement of range of joint motion. Archives of
Physical Medicine and Rehabilitation, September, 571578.
Leighton, J. R.
(1966).
The Leighton flexometer and
flexibility test. Journal of the Association for Physical and Mental Rehabilitation, 20(3), 86-93.
Measurements of spinal posture and
(1967).
Loebl, W. Y.
Annals of Physical Medicine,
range of spinal movement.
9(3), 103-110.
Measurement of back
(1969).
Macrae, 1. F., & Wright, V.
Annals of the Rheumatic Diseases, 28, 584movement.
589.
Hip
(1957).
Mathews, D. K., Shaw, V., & Bohnen, M.
of
length
flexibility of college women as related to
352-356.
28(4),
Quarterly,
The Research
body segments.
22
Mathews, D. K., Shaw, & Woods, J. B.
(1959).
Hip flexibility of elementary school boys as related to body
segments. The Research Quarterly, 30(3), 297-302.
Moll, J., & Wright, V.
(1976). Measurement of spinal
movement.
In E. Jayson (Ed.), The lumbar spine and
back pain (pp. 93-112). New York:
Grune & Stratton.
Moll, J. M. H., & Wright, V.
(1971). Normal range of
spinal mobility. Annals of the Rheumatic Diseases,
30, 381-386.
Munroe, R. A., & Romance, T. J.
(1975). Use of the
Leighton flexometer in the development of a short
flexibility test battery. American Corrective Therapy
Journal, 29(1), 22-25.
Schober, P.
(1937). Lendenwirbelsaule und kreuzschemerzen
(The lumbar verbebral column and backache). Munch. Med.
Wschr., 84, 336.
Troup, J. D. G., Hood, C. A., & Chapman, A. E.
(1968).
Measurements of the sagittal mobility of the lumbar
spine and hips. Annals of Physical Medicine, 9, 308.
Wear, C. L.
(1963). Relationship of flexibility measurements to length of body segments. The Research Quarterly,
34(2), 234-238.
Wells, K. F., & Dillon, E. K.
(1952).
A test of back and leg flexibility.
Quarterly, 23, 115-118.
The sit and reach-The Research
Willner-, S.
(1983).
Spinal pantograph--A noninvasive
anthropometric device for describing postures and
asymmetries of the trunk.
Journal of Pediatric Orthopedics, 3(2), 245-249.
I-
-Kft
MD;
CHAPTER III
PROCEDURES OF THE STUDY
This study will assist in more clearly defining the
components measured by the AAHPERD sit and reach test.
Further clarification of this testing instrument is
important due to the tremendous number of students whose
flexibility
is being evaluated by this process.
The
procedures presented in this chapter have been designed to
provide maximum reliability in collecting the data necessary
to achieve the purposes described in Chapter I.
Subjects
Permission was obtained from the Dallas Independent
School District to test 90 female students 13 to 15 years
of age as a part of their regular physical education class.
Sixty subjects were students of North Dallas High School.
The remaining 30 subjects attended Spence Middle School.
An additional 10 subjects of the same age group, who had
participated in the pilot study the previous September, were
included in the total sample of 100 subjects.
Approximately
15 minutes were required to evaluate each subject allowing
three students to be tested per class period.
Four days of
testing were required at North Dallas High School where,
during five class periods,
15 subjects were evaluated daily
23
24
Tests were
in the physical education teacher's office.
administered in the nurse's office at Spence Middle School
where testing was completed in two days.
Testing began
January 30 and was completed February 15, 1985.
Data was collected on female subjects due to the tester
being female and to the sensitive and personal area of the
anatomy on which marks were placed and movements measured.
Procedures were carefully explained to the subjects as the
tests were performed.
Age, height, and weight were the
descriptive information obtained and are listed in Table III.
TABLE III
SUBJECT DESCRIPTIVE STATISTICS
Variable
Mean
Standard Deviation
Age
14.08
.825
Height (inches)
61.49
2.791
Weight (pounds)
112.64
20.391
Methods
Warm-up.
Subjects wore gym shorts and t-shirts.
As
recommended by the AAHPERD Health Related Physical Fitness
Test Manual (1980), warm-up time was provided to improve
the reliability and validity of the tests.
In the first
exercise 15 jumping jacks were performed so that blood flow
25
was increased to the extremities, and body temperature was
elevated to facilitate muscle fiber extensibility.
The starting position for the second exercise was in
the squat position with the palms of the hands flat on the
floor and the hips, knees, and lumbar spine flexed.
As the
abdominal musculature tightened in this cat stand stretch,
the knees slowly extended, and the palms remained on the
floor if possible, providing slow sustained static stretching
of the low back and hamstring musculature.
The position was
held 15 seconds.
To improve the validity of data collected subjects were
measured in a counter balanced fashion.
That is,
the first
subject was tested in the order of sit and reach test,
flexometer hamstring measures,
and spine measures.
The
second subject was tested in the order of flexometer hamstring measures,
spine measures,
and sit and reach test.
The third subject was tested in the order of spine measures,
sit and reach test, and flexometer hamstring measures.
Then
the procedure was repeated.
Sit and reach.
The sit and reach test was performed
according to the instructions given in the AAHPERD Test
Manual.
The starting position was seated at the test
apparatus,
knees fully extended,
and flat against the end board.
feet shoulder-width apart
The test apparatus was
placed against a wall to prevent it from sliding away from
26
the subject during the test.
Arms were extended forward
with the hands placed on top of each other,
palms down.
The
subject reached forward along the measuring scale four times
and held the position of maximum reach on the fourth attempt
for one second.
The measuring scale of the test apparatus
had the 23 centimeter mark at the level of the feet.
The
most distant point reached on the fourth attempt, measured
to the nearest centimeter, was the score.
the subject's knees remained extended,
To ensure that.
the tester placed one
hand on the subject's knees while remaining close to the
scale as she observed the most distant line touched by the
fingertips of both hands.
If the hands reached out unevenly
or the knees flexed during the trial,
repeated.
the fourth attempt was
A second trial was completed.
(See Figure 1 in
Appendix.)
Leighton flexometer measures.
by Ekstrand, Wiktorsson,
Oberg,
Using a method described
and Gillquist
evaluation of hamstring flexibility was made.
position was supine on a mat,
(1982), an
The starting
low back and opposite leg flat
against the mat, each immobilized by a strap.
A point was
located 5 centimeters above each patella and marked with a
ball-point pen.
The flexometer, which records measurements
in degrees, was fastened on the lateral side of the thigh
with the distal edge of the strap at the level of the mark.
The leg was relaxed on the mat and the dial locked at zero.
27
Slowly the tester raised the leg as far as possible placing
Then the reading
one hand on the knee to keep it straight.
was taken.
Then the proce-
A second trial was completed.
dure was repeated for the opposite leg.
(See Figure 2 in
Appendix.)
Spine measures.
Spinal mobility was measured in
centimeters with a plastic tape measure using the method of
Macrae and Wright
(1969).
The subject stood erect while the
lumbosacral junction was identified as described by
Brunnstrom (1983), by locating the intersection of a line
joining the dimples of Venus and the spine.
was then used to mark the intersection.
A ball-point pen
Additional marks
were placed 5 centimeters below and 10 centimeters above the
lumbosacral junction.
A fourth mark was placed at the
seventh cervical vertebra,
as directed by Brunnstrom.
Each
subject was reminded to stand up straight with her head
retracted in alignment with the spine.
the two upper marks was measured.
was taken.
The distance between
A second trial measurement
The subject then sat and bent forward as in the
performance of the sit and reach test.
With the chin tucked
toward the chest the distraction between the lowest mark and
the seventh cervical vertebra (the total back)
and the lowest
mark and the 10 centimeter mark above the lumbosacral junction (the lower back) were measured with the tape measure,
the distance representing measures of anterior flexion.
second trial was completed.
(See Figure 3 in Appendix.)
A
28
Pilot Study
A pilot study was conducted to determine the reliability of the testing procedures.
Ten females, aged 13 to 15,
were measured on the tests with the procedures previously
delineated.
Reliabilities were very acceptable ranging from
0.83 to 0.97.
These compare favorably to reliabilities
reported in past literature, which are presented in Table I
and Table II.
Data Analysis
Correlation and linear regression were used to analyze
the data.
A battery of descriptive statistics defining age,
height, and weight was developed on 100 subjects and is
presented in Table III.
CHAPTER REFERENCES
American Alliance for Health, Physical Education, Recreation,
and Dance.
(1980).
AAHPERD health related physical
AAHPERD.
Washington, D. C.:
fitness test manual.
Brunnstrom,
S.
(rev. ed.).
(1983).
Brunnstrom's clinical kinesiology
Philadelphia:
F. A. Davis Company.
Ekstrand, J., Wiktorsson, J., Oberg, B., & Gillquist, J.
(1982).
Lower extremity goniometric measurements:
A
study to determine their reliability. Archives of
Physical Medicine and Rehabilitation, 63, 171-175.
McRae, I. F.,
movement.
589.
& Wright, V.
(1969).
Measurement of back
Annals of the Rheumatic Diseases, 28, 584-
CHAPTER IV
RESULTS
This chapter presents the statistical
analysis
conducted to achieve the purposes stated in Chapter I.
The results include reliability estimates,
descriptive
statistics, and pertinent correlations.
Reliability of Data
Two trials were performed by 100 subjects for each
variable measured.
A correlation was calculated between
the trials to provide estimates of reliability.
The reliability estimates are presented in Table IV.
TABLE IV
TEST-RETEST RELIABILITY ESTIMATES FOR THE
VARIABLES MEASURED IN THE STUDY
Test-Retest
Reliability
Variable
Coefficient
Sit and Reach...................
Right Hamstring .
Left Hamstring
. . .
. . .
. .
. .
.
Upper Back (Standing)
Upper Back (Stretched)
Lower Back (Stretched)
Total Back (Stretched)
.
. .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . .
.
.
.
0.99
. . ... . . . . . 0.97
.
.
.
.
.
.
.
.
.
.
. . . . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0.97
... 0.98
.
.
.
.
.
.
0.99
0.97
0.99
Table IV indicates high reliability was achieved for the
measurements used in this study since maximal reliability is
1.0.
30
31
Descriptive Statistics
The basic descriptive statistics calculated for all
variables included the mean,
the standard deviation.
standard error of the mean, and
The statistics presented in Table V
are based on the average performance of each subject over
both trials of the test.
TABLE V
DESCRIPTIVE STATISTICS
Variable
Standard Error
Mean
Sit and Reach
Right Hamstring
Left Hamstring
Upper Back (Standing)
Upper Back (Stretched)
Lower Back (Stretched)
Total Back (Standing)
Total Back (Stretched)
Standard
of the Mean
Deviation
6.541
16.405
15.234
2.368
3.183
1.321
2.368
3.345
15.372
1.451
1.321
1.844
32.758
116.350*
113.7600
32.286
37.747
22.196
47.286
59.944
cm
cm
cm
cm
cm
cm
.654
1.641
1.523
.237
.318
.132
.237
.335
113.777
5.461
7.196
12.658
cm
cm
cm
cm
1.537
.145
.132
.184
Right & Left Hamstring
Average
Change* Upper Back
Change* Lower Back
Change* Total Back
*Difference in standing and stretched positions.
Correlational Results
Pearson correlation coefficients were used to determine
the relationship between the sit and reach test and hamsstring flexibility and between the sit and reach test and
back flexibility.
The results
listed in Table VI are based
32
on the average performance of each subject over two trials
of the test.
TABLE VI
PEARSON CORRELATION COEFFICIENTS BETWEEN THE
SIT AND REACH TEST AND OTHER VARIABLES
Correlation
Coefficient
Variable
Reach
Reach
Reach
Reach
and
and
and
and
Right Hamstring.
.......
Left Hamstring
Right & Left Hamstring Average
Upper Back (Standing) ....
*...
Sit & Reach and Upper Back
Sit
Sit
Sit
Sit
&
&
&
&
Reach
Reach
Reach
Reach
and
and
and
and
(Stretched)
.
.
&
&
&
&
Total Back (Stretched)
Changed Upper Back
Changed Lower Back
Changed Total Back
.
.
Sit
Sit
Sit
Sit
.5906*
.6457*
.6417*
.0996
.0020
.1115
S.1581
.2777*
.0745
*p K .05.
Cross Validation of Correlations
In order to determine the stability of the correlational
results between the sit and reach test to hamstring flexibility and between the sit and reach test to back flexibility,
a subsample (N
=
54) of approximately 50% of the total
subjects was randomly selected and correlation statistics
were recalculated using the Pearson method.
The results are
presented in Table VII.
Correlational results of the subsample, when compared
to results of the original sample, are similar and demonstrate high correspondence in the two sets of relationships.
This indicates a stable pattern of similar correlations would
33
be found in further subsequent samples from the same
population.
TABLE VII
CROSS VALIDATION OF CORRELATIONS BETWEEN THE
SIT AND REACH TEST AND OTHER VARIABLES
Correlation
Coefficient
Variable
Sit
Sit
Sit
Sit
Sit
Sit
Sit
Sit
Sit
&
&
&
&
&
&
&
&
&
Reach
Reach
Reach
Reach
Reach
Reach
Reach
Reach
Reach
and
and
and
and
and
and
and
and
and
*p < .05.
Right Hamstring ...
......
5792*
Left Hamstring.
. ........
.6306*
Right & Left Hamstring Average
.. 6220*
Upper Back (Standing)... . ....
. .1853
Upper Back (Stretched)...0. . ..
0531
Total Back (Stretched)...... ...
1993
Changed Upper Back..........
. 2163*
Changed Lower Back.
. .......
3811*
Changed Total Back . ......
1167
CHAPTER REFERENCES
(1970). Research processes in physical
Clarke, D. H.
Englewood Cliffs,
and health.
recreation,
education,
New Jersey:
Prentice-Hall,
Inc.
34
CHAPTER V
DISCUSSION AND CONCLUSIONS OF THE STUDY
Due to the high validity correlation (0.90) found by
Wells and Dillon (1952) between the sit and reach test
and the toe-touch test, the sit and reach test was chosen
by the American Alliance of Health, Physical Education,
Recreation,
and Dance to become the criterion measure used
to evaluate the flexibility of the low back and posterior
thigh
(AAHPERD, 1980).
Since the relative contribution of
low back flexibility and hamstring flexibility to sit and
reach test scores has not been quantified,
of this study to do so.
it was the purpose
The need to further examine the
influence of these variables on such a widely used criterion
measure prompted the undertaking of the investigation.
The results of the study indicated that hamstring
flexibility was moderately related to the sit and reach
test with correlation coefficients of 0.590 and 0.645.
The
low back, with a very low correlation of 0.277, had the
highest relationship of the six back flexibility measures to
the sit and reach test.
The findings show that low back and
posterior thigh flexibility are not significantly related to
the sit and reach test scores.
This suggests that the sit
and reach test is an inadequate measure of low back and hamstring flexibility.
35
36
When compared to the maximal reliability coefficient
of 1.0,
testing procedures used in this study were found to
be highly reliable.
The sit and reach, back flexibility,
and hamstring flexibility measures demonstrated reliability
coefficients from 0.97 to 0.99.
The sit and reach test-
retest reliability coefficient of 0.99 agrees with 0.98
found by Wells and Dillon (1952) and is comparable to those
obtained in other investigations including Mathews et al.
(1957), Broer and Galls (1958), Wear (1963), Harvey and
and Cotten (1972).
Scott (1967),
The reliability estimates
of the right and left hamstring were 0.97 each.
Although
Ekstrand (1982), whose method of hip flexion evaluation was
used in this study, did not report test-retest reliabilities,
the findings do concur with those obtained by previous
researchers,
Leighton (1942, 1955, 1966), Hupprich and
Sigerseth (1950),
McConville
(1965a,
Cotten (1972).
0.97 to 0.99.
Broer and Galles (1958), Laubach and
1965b), Munroe and Romance (1975),
and
Spine flexibility reliabilities ranged from
These statistics were not reported in the
findings of previous studies.
The average sit and reach test performance of this
investigation proved to be very comparable to the 50
percentile norms of the AAHPERD Health Related Fitness Test.
The norms reported for the AAHPERD sit and reach test were
31 cm for girls 13 years old, 33 cm for girls 14 years old,
and 36 cm for girls 15 years old
(AAHPERD, 1980).
The
37
average of the sit and reach performance of this study was
found to have a similar average of 32.758 cm for girls of
the same age group.
Low back flexibility is important to good health, and
from the results of this study it cannot be adequately
evaluated by the sit and reach test.
A more accurate
method of specifically measuring back flexibility is the
procedure described in this investigation, a variation of
which is recommended by the American Academy of Orthopaedic
Surgeons (AAOS, 1966) as the most accurate clinical method
of measuring true motion of the spine in flexion.
Its
administration is simple, requiring approximately 3 minutes
to perform and only a tape measure and ball-point pen for
equipment.
This method of assessing spine flexibility is especially
appropriate in a clinical setting.
Due to the nature of the
test two factors need to be considered in its administration
in field situations.
The first concerns the placement of
markings on the anatomy.
Due to the personal area of the
body on which markings are placed and movements measured,
this procedure may be awkward to utilize in a school situation.
Women would be able to administer the test to girls
and in certain situations to boys.
It would only be suitable
for men when administering the test to boys.
the procedure must be carefully
the test is being performed.
In either case
explained to the subject as
The second factor of concern
38
in the administration of this test is the time requirement.
In testing large groups of subjects this procedure of
approximately 3 minutes each may require too much time.
Conclusions
In conclusion,
(1) the sit and reach test was
found in
this study to have a moderate relationship to criterion
measures of hamstring flexibility;
(2) it was also found to
be an invalid measure of low back flexibility; and (3) by
using a tape measure to determine the degree of spread
between spinous processes during flexion as described in
this investigation and recommended by the American Academy
of Orthopaedic Surgeons (AAOS, 1966), a valid method of
measuring spine flexibility is possible.
Recommendations
The findings of this investigation are generalizable
to girls 13 to 15 years of age.
It would be necessary to
examine the flexibility scores of boys of the same age group
in a similar study.
different age groups.
Further investigations might include
Another recommendation for further
study is the development of a technique for assessing low
back flexibility which can be quickly administered in a
field situation.
CHAPTER REFERENCES
American Academy of Orthopaedic Surgeons.
motion:
(1966).
Method of measuring and recording.
Joint
Edinburgh:
Livingstone.
American Alliance for Health, Physical Education, Recreation,
AAHPERD health related physical
(1980).
and Dance.
AAHPERD.
Washington, D. C.:
fitness test manual.
Broer, M. R., & Galles, N. R. G.
(1958).
Importance of
relationship between various body measurements in performThe Research Quarterly, 29(2),
ance of the toe-touch test.
253-263.
A comparison of selected trunk
(1972).
Cotten, D. J.
American Corrective Therapy Journal,
flexibility tests.
26, 24-26.
Ekstrand, J., Wiktorsson, J., Oberg, B., & Gillquist,
Lower extremity goniometric measurements:
(1982).
J.
A
study to determine their reliability. Archives of
Physical Medicine and Rehabilitation, 63, 171-175.
Harvey, V. P., & Scott, G. D.
(1967).
Reliability of a
measure of forward flexibility and its relation to
physical dimensions of college women.
The Research
Quarterly, 38(1), 28-33.
(1950). The specificity
Hupprich, F. L., & Sigerseth, P. 0.
Research
Quarterly, 21, 25The
of flexibility in girls.
33.
Laubach, L. L., & McConville, J. T.
(1965a).
Relationships
between flexibility, anthropometry, and the somatotype
of college men.
The Research Quarterly, 37(2), 241-251.
Laubach, L. L., & McConville, J. T.
(1965b).
Muscle
strength, flexibility, and body size of adult males.
The Research Quarterly, 37(3),
384-392.
(1942). A simple objective and reliable
Leighton, J. R.
The Research Quarterly, 13,
measure of flexibility.
205-216.
An instrument and technic for the
(1955).
Leighton, J. R.
measurement of range of joint motion.
Archives of
Physical Medicine and Rehabilitation, September, 571-578.
39
40
Leighton, J. R.
(1966). The Leighton flexometer and
flexibility test.
Journal of the Association for Physical and Mental Rehabilitation, 20(3), 86-93.
Mathews, D. K., Shaw, V., & Bohnen, M.
(1957). Hip
flexibility of college women as related to length of
body segments. The Research Quarterly, 28(4), 352-356.
Munroe, R. A., & Romance, T. J.
(1975). Use of the
Leighton flexometer in the development of a short
flexibility test battery. American Corrective Therapy
Journal, 29(1), 22-25.
Wear, C. L.
(1963). Relationship of flexibility measurements to length of body segments. The Research Quarterly,
34(2), 234-238.
Wells, K. F., & Dillon, E. K.
(1952).
a test of back and leg flexibility.
Quarterly, 23, 115-118.
The sit and reach-The Research
41
APPENDIX
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REFERENCES
Adrichem, J. A. M. van, & Korst, J. K. van der.
(1973).
Assessment of the flexibility of the lumbar spine.
Scandinavian Journal of Rheumatology, 2, 87-91.
American Academy of Orthopaedic Surgeons.
(1966).
motion: Method of measuring and recording.
Livingstone.
Joint
Edinburgh:
American Alliance for Health, Physical Education, Recreation,
and Dance.
(1980). AAHPERD health related physical
fitness test manual.
Washington,
D. C.:
AAHPERD.
American Alliance for Health, Physical Education,
and Dance.
(1984).
fitness technical manual.
Broer, M.
Recreation,
AAHPERD health related physical
Washington,
R., & Galles, N. R. G.
(1958).
D. C.:
AAHPERD.
Importance of
relationship between various body measurements in performance of the toe-touch test.
The Research Quarterly,
29(2),
253-263.
Brunnstrom, S.
(rev. ed.).
Clarke, D. H.
(1983).
Brunnstrom's clinical kinesiology
Philadelphia:
(1970).
F.
A. Davis Company.
Research processes in physical
education, recreation, and health.
New Jersey:
Prentice-Hall,
Englewood Cliffs,
Inc.
Cotten, D. J.
(1972a).
Selected anthropometric measures
and trunk flexibility measurement--a study.
Journal of
Physical Education, 70, 260-262.
Cotten, D. J.
(1972b).
A comparison of selected trunk
flexibility tests.
American Corrective Therapy Journal,
26, 24-26.
Dunham, W. F.
(1949).
Ankylosing spondylitis:
of hip and spinal movements.
Measurement
British Journal of Physical
Medicine, 12, 126-129.
Ekstrand, J.., Wiktorsson, J., Oberg, B., & Gillquist, J.
(1982).
Lower extremity goniometric measurements:
A
study to determine their reliability.
Archives of
Physical Medicine and Rehabilitation, 63, 171-175.
44
45
Fieldman, H.
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