Hip joint rotation range of movement : improvement through stretching and an investigation of inter-tester reliability and agreement of the evaluative measurement method

Chamberlain, Alan and Elliott, David and Small, Katie and Stigant, Mark (2022) Hip joint rotation range of movement : improvement through stretching and an investigation of inter-tester reliability and agreement of the evaluative measurement method. Masters thesis, Lancaster University.

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Abstract

Full hip joint rotation is necessary for joint health and restriction is associated with pathology. Joint soft-tissue stretching is advocated, but there is no evidence to support this for improving hip joint rotation. Rotation measurement is fundamental to examination, diagnosis, determining severity and progression of disorders, evaluating intervention and rehabilitation decision-making. The first study was a retrospective case series analysis with the primary purpose of investigating the effects of stretching on hip joint rotation. From a five-year period, thirty-two patients were identified where a stretch protocol was prescribed to improve rotation. Mean baseline medial rotation of affected joints was 26.38°±5.59° (n=26 hip joints) and lateral rotation was 37.18°±9.37° (n=43 hip joints). From baseline, there was a significant statistical (p<.001) mean 10.08°±4.63° increase of medial and 14.37°±6.00° lateral rotation after three-months of stretching with a large effect size (≥3.1) found. The second study primary purpose was to examine inter-tester reliability and agreement of active hip joint rotation measurement in a prone position using a standard and new measurement method, the latter of which was used to measure rotation in the first study. Thirty-four participants (male, n=18; female n=18; age range 18-59 years) were recruited. Relative reliability for the measurement of hip joint rotation using the standard measurement method was excellent (ICC2,1 range .93-.94) and good-excellent (ICC2,1 range .89-.98) using the new measurement method. Absolute reliability (SE of Measurement) range was 3.0°-4.2° for the standard and 2.2°-3.9° for the new measurement method. Inter-tester MDC90 ranged from 7.0° to 9.7° for the standard and 5.2° to 9.0° for the new measurement method. Bland-Altman graphs indicated acceptable agreement for both measurement methods. Results from the two studies suggest stretching may improve hip joint rotation and improvement would have been detected beyond measurement error had two testers conducted measurement.