Beruflich Dokumente
Kultur Dokumente
Key Words: Fitness tests and measurements, Flexibility, Hamstring muscb length, Sit-and-reach test.
Suxy L Cornbleet
Nancy B Woolsty
SL Cornhleet, PT, is Instructor and Academic Coordinator of Clinical Education, Program in Physical Therapy, Washington University
School of' Medicine, Box 8502, 4444 Forest Park Ave, St Louis, MO 63108 (US.4) (cornblee@medicine.wustl.edu).
Address all correspondence to Ms Cornbleet.
NB Woolsep. OT,PT, is Instructor, Program in Physical Therapv. Washington University School of Medicine.
T h ~ url~cle
s u~rrrsubmztted on ]U?LP 19, 1993, and was occrpted Febehnca~27, 1996.
.
Physical 'Therapy Volume 7 6 . Number 8 . August 1996 Cornbleet and Woolsey . 851
Fi ure 3.
3
Per ormance of the sit-and-reach test, demonstrating increased back
flexibility combined with decreased hamstring muscle length.
Fi ure 1.
3
Per ormance of the sit-and-reach test, demonstrating normal back flexi-
bility and normal hamstring muscle length.
must monitor the pelvic position throughout the test.
For example, hip flexor shortness may pull the pelvis in
the direction of anterior tilt. Use of this faulty starting
i
position could result in an inaccurate assessment of
short hamstring muscle length. The use of the long-
sitting position allows both hips to move in the same
direction and eliminates the need to stabilize the pelvis
or consider the influence of hip flexor s h o r t n e s ~ . ~
852 . Cornbleet and Woolsey Physical Therapy. Volume 76 . Number 8 . August 1996
80;.
-1-
Figure 5.
Normal hamstring rnuscle length but failing performance of the sit-and-
reach test due to anthropometric factors (long legs relative to trunk and
arms).
!
Figure 4.
Superior view of the ruler on the sitand-reach box. or the angle between the sacrum and the table during
forward bending in the long-sitting position. Other
investigatorsg~" also have used this value as a guideline
Instrumentation for normal hamstring muscle length.
A standard sit-and-reach box* was used to position the
subjects for the test, and the sliding ruler that is centered Procedure
on the top of the box was used to obtain the SRT scores. Each child was seated on the floor with knees fully
The markings on the ruler were positioned so that the extended and ankles in neutral dorsiflexion against the
23-crn mark represented the point at which the subjects' box (Fig. 1). The child was instructed to place one hand
fingertips were in line with their toes (Fig. 4). In this way, on top of the other and slowly reach forward as far as
the SRT score was always a positive number, even for the possible while keeping the knees extended. The hands
children who were unable to reach their toes. The were kept aligned evenly as the subject reached forward
minimal acceptable score to pass, as determined by along the surface of the box. Each child practiced the
AAHPERD," is 25 cm, or 2 cm beyond the toes, for all movement twice, and, on the third repetition, the SRT
ages and both genders and without consideration of score (in centimeters) was recorded as the final position
anthropometric variables. of the fingertips on the ruler. During the same trial, the
inclinometer was placed over the sacrum and the HJA
An inclinometert (a circular, fluid-filled goniometer) was measured and recorded.
was usetl to measure the HJA. The inclinometer was set
so that 0 degrees represented the horizontal, or 0 Data Analysis
degrees of hip joint flexion. The inclinometer was The mean for all subjects and the means for boys and
placed vertically on the sacrum so that the center of the girls were calculated for the HJA and the SRT. A t test for
inclinometer was aligned at the level of the posterior independent samples was used to examine differences
superiol- iliac spines. between boys and girls for the HJA and the SRT. The
Pearson product-moment correlation coefficient was
Interrater reliability, using an inclinometer to measure used to examine the relationship between the SRT and
the HJA, was examined for the first 20 subjects between the HJA. Raw scores were examined to determine the
-
tester 1 and tester 2. An intraclass correlation coefficient number of cases in which the scores on the two tests
(2,l) of .98 indicated to us an acceptable level of appeared to be contradictory. For example, some chil-
interrater reliability for the HJA scores. dren were able to reach at least 25 cm on the SRT box
but had decreased hamstring muscle length as defined
A passing HJA score was determined by the examiners to by the HJA (Fig. 3), whereas other children could not
be 80 degrees or more of hip joint flexion. This value reach the 25-cm mark but had normal hamstring muscle
corresponds to what Kendalls considers normal if ham- length (Fig. 5).
string rnuscle length is normal, as determined by the
final po'sition of the hip joint during straight leg raising Results
The Table presents the means and standard deviations
for the SRT and HJA. There was a difference between
'Amer-icar~.Uliance for Hraltt~,Physical Education. Recreation, and Dance, 1900
Association Dr, Reston, VA 22091. the scores for boys and girls on the HJA test (t=7.81,
Biokine~icsInc. 1710 Wesuninstel- Way, Arulapolis, MD 21401. df=408, P<.001) and on the SRT (t=5.50, df=408,
Physical Therapy . Volume 76 . Number 8 . August 1996 Cornbleet and Woolsey . 853
Table. Sit-and-Reach Test (SRT) and Hip Joint Angle (HJA) Values
P<.001). The correlation between the SRT and HJA the test as an exercise is greatest for children who have
scores was significant (,F .76, dJ=408, P<.05). Although normal hamstring muscle length or for children who can
over half (58%) of the variability in the SRT scores was reach their toes but have decreased hamstring muscle
accounted for by the variability in the HJA scores, it is length. There is no evidence to support the need to
important to examine those 73 cases (18%) in which a increase hamstring muscle length beyond normal or that
child passed one test but not the other. For example, 25 improving the SRT score is associated with a change in
children (6%) passed the SRT (225 cm) but failed the hamstring muscle length. As noted by Kendall and
HJA test (<80°), indicating decreased hamstring muscle McCreary,R having children who can reach their toes but
length. Although back motion was not measured using a who have short hamstring muscles practice the long-
modified Schober's techniqueIs or the two-inclinometer sitting stretch might further increase their back motion,
te~hnique,~7J%~isual appraisal suggested that in most of and this could produce little change in their hamstring
these cases, the spine was relatively more flexible than muscle length.
the hips and contributed most to the total performance
of forward bending (Fig. 3 ) . Conversely, 48 children We believe that the use of the inclinometer to measure
(12%) failed the SRT (<25 cm) but had passing HJA the HJA as an indicator of hamstring muscle length
scores (>80°), indicating normal to increased hamstring during the SRT is simple, yields reliable measurements,
muscle length. In these cases, it appeared that either and is not influenced by anthropometric factors. We
anthropometric factors (long legs, short arms or trunk) realize that this method does not include a measure of
(Fig. 5) or limited flexibility in the spine prevented the back motion. We contend, however, that the SRT is not
children from reaching their toes during the SRT. a valid measure of back motion,"12 and, if back motion
is considered important to measure, that other methods
Discussion such as the use of the inclinometer have been described
The overall mean for our HJA measurements and should be used."-l9
(HJA=81°) correlates to the value previously suggested I
by Kendalls as indicating normal hamstring muscle Our future studies will include (1) use of the inclinom-
length (80") in adults or children. In addition, our eter to measure both the HJA and lumbar spine motion
results indicate that hamstring muscle length is less in in school-aged children and (2) investigation of a
boys than in girls. This finding is supported by studies change in hamstring muscle length or back motion as a
that suggest that in the 5- to 10-year-old age group, girls result of practicing forward bending in the long-sitting
are more flexible than b o y ~ . l " l ~Shephard
~'~ and col- position.
leaguesI0 also found that in adults aged 45 to 75 years,
scores on the SRT were greater for women than for men. Conclusion
These results suggest that we should modify our expec- The measurement of flexibility is an important compo-
tations for hamstring muscle length based on gender. nent of fitness testing. The SRT is useful for examining
hamstring muscle length, but more attention needs to
The correlation between the HJA and SRT scores sug- be given to the final position of the hip joint rather than
gests that both tests reflect hamstring muscle length. the final position of the fingertips. Measuring the HJA
The SRT and modified versions of the SRT, however, with an inclinometer while using the SRT position, in
continue to focus on the distance of the fingertips to the our opinion, provides a reliable and simple measure that
toes as the final measure. Because this measure is reflects hamstring muscle length. Examiners should also
influenced by a variety of factors, as previously discussed, recognize that there are differences in hamstring muscle
the results may be misleading when developing strate- length between boys and girls. I
I
cise to improve the score. Our concern about practicing I
I
854 . Cornbleet and Woolsey Physical Therapy. Volume 76 . Number 8 . August 1996 j
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