Normal hip and knee active range of motion: the relationship to age.Many physical therapy interventions have as their goal the restoration of normal joint range of motion (ROM). A number of studies [1-4] have concluded that normal lower-extremity ROM may vary with both age and sex. Decreased ROM is often accepted as a normal part of aging. A decline in ROM with advancing age is particularly important in light of the association between restricted ROM and functional disability in older individuals. [5] Unfortunately, much of the available data dealing with age-related changes in normal ROM have been derived from studies involving small samples in which the subjects were not randomly selected. Although several of these studies have included individuals of different races, none have explored the possible effect of race on normal ROM. Because the decision to treat impaired joint mobility in an older individual may be influenced by assumptions concerning normal ROM at older ages, it is important to establish population-based [TABULAR tab·u·lar adj. 1. Having a plane surface; flat. 2. Organized as a table or list. 3. Calculated by means of a table. tabular resembling a table. DATA OMITTED] normative nor·ma·tive adj. Of, relating to, or prescribing a norm or standard: normative grammar. nor values for ROM of the hip and knee by age, sex, and race. The purposes of this study were (1) to establish age-group-specific US population-based normative values for hip and knee active range of motion (AROM AROM Active range of movement. See Range of motion. ) for both men and women and blacks and whites and (2) to explore possible differences in these normative values between the youngest and the oldest age groups. Background Normal Range of Motion There are many sources that provide estimates of normal hip and knee ROM (Tab. 1). [6-12] Although these sources agree fairly well in their estimates of normal hi abduction Abduction Balfour, David expecting inheritance, kidnapped by uncle. [Br. Lit.: Kidnapped] Bertram, Henry kidnapped at age five; taken from Scotland. [Br. Lit. , flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. , and internal and external rotation external rotation Lateral rotation Biomechanics The act of turning about an axis passing through the center of the leg; ER of the leg occurs with closed chain supination; the talus acts as an extension of the leg in frontal and transverse planes , the estimates for knee flexion and hip extension vary widely. None of these sources indicate whether these values represent AROM or passive range of motion (PROM (Programmable ROM) A permanent memory chip in which the content is created (programmed) by the customer rather than by the chip manufacturer. It differs from a ROM chip, which is created at the time of manufacture. ). No information is provided to indicate whether these normal ROM values are appropriate for older age groups. These sources do not specify the characteristics or number of subjects used to produce the estimates of normal ROM. Age Effects A number of studies have examined the influence of age on joint motion. Boone and Azen [1] examined 109 male subjects aged 1 to 54 years. The subjects were from a variety of racial backgrounds, but the results were not presented by race. The authors reported statistically significant differences in mean hip extension, abduction, and internal and external rotation and in mean knee flexion between subjects aged 1 to 19 years and those aged 20 to 54 years. Although this study demonstrated a difference in mean ROM between children and adults, it did not address the issue of age-related changes in ROM during adult life. Walker et al [2] examined AROM in 60 nondisabled male and female volunteers; half were aged 60 to 69 years, and the others were aged 75 to 85 years. Although this study detected significant differences between men and women in mean hip abduction and internal rotation internal rotation Medial rotation The act of turning about an axis passing through the center of the leg, which occurs with closed chain pronation; the talus acts as an extension of the leg in the frontal and transverse planes. Cf External rotation. and in mean knee flexion, no difference was detected between the four sex-age groups. The small sample size in each group, however, provided very little statistical power to detect a difference. Mean AROM for both age groups combined was substantially lower than the normal values normal values pl.n. A set of laboratory test values used to characterize apparently healthy individuals, now replaced by reference values. provided by several references. The authors concluded that separate normative data should be developed for older individuals. James and Parker [3] examind age-associated decline in joint mobility among subjects recruited from senior-citizen clubs and retirement villages. This study examined men and women separately in four age groups: 70 to 74 years, 75 to 79 years, 80 to 84 years, and 85 years and older. There were 10 subjects in each sex-age group. The authors, when comparing the two oldest age groups with the two youngest age groups, found decreased joint mobility for all hip and knee motions. The magnitude of the difference in mean ROM between the older age groups and the younger age groups ranged from a high of 20 degrees for hip flexion in men to a low of 3 degrees for hip internal rotation in women. James and Parker reported only mean ROM values, which, given the small size, may have been greatly influenced by an extreme ROM values. This study sample, like those in the studies of Boone and Azen [1] and Walker et al, [2] may not be representative of older persons. Together these studies suggest a decline in ROM with advancing age, but the magnitude of that decline is not well documented. Sample size and method of selection limit the generalizability of these results to the US elderly population. Goniometry goniometry /go·ni·om·e·try/ (go?ne-om´e-tre) the measurement of angles, particularly those of range of motion of a joint. goniometry the measurement of range of motion in a joint. Goniometry is the most widely used method of measuring ROM, and a number of studies [13-18] have been conducted to examine its reliability. Although most of these studies have demonstrated that acceptable intrater and interrater reliability can be achieved if the methodology is reasonably standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. , the reliability of goniometric go·ni·om·e·ter n. 1. An optical instrument for measuring crystal angles, as between crystal faces. 2. A radio receiver and directional antenna used as a system to determine the angular direction of incoming radio signals. measurements appears to be influenced by the joint being measured and by the subject's physical characteristics. [14,15] A classic study by Boone et al [14] revealed higher intertester reliability for upper-extremity measurements than for lower-extremity measurements. This finding led the authors to conclude that lower-extremity movements are less amenable AMENABLE. Responsible; subject to answer in a court of justice liable to punishment. to reliable measurement. Boone et al estimated that the measurement error attributable to the goniometry, rather than to the tester or the measurement session, had a mean standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. of 3.7 degrees and suggested that the precision of goniometric measurement was such that a change of more than 6 degrees was required to accurately detect a real change in ROM. This view is challenged by the results of a study by Watkins and colleagues, [18] who obtained excellent intratester reliability for goniometric measurements of knee PROM. Unfortunately, no quantitative analysis Quantitative Analysis A security analysis that uses financial information derived from company annual reports and income statements to evaluate an investment decision. Notes: is available concerning the reproducibility reproducibility Lab medicine The degree of agreement among repeated measurements of a particular parameter, presented in terms of a standard deviation or coefficient of variation of the results in a set of measurements of the goniometric ROM measurements made druing the first National Health and Nutrion Examination Survey (NHANES NHANES National Health and Nutrition Examination Survey (US CDC) 1). Some problems with reproducibility were reported. Because the technicians were rigorously trained and the procedure for making goniometric measurements was well standardized, researchers involved in this component of the NHANES 1 concluded that the variability was largely attributable to the effort-dependent nature of AROM movements. [19] Method This study was a secondary analysis of public-use data tapes from the NHANES 1. The NHANES 1, which was conducted by the National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. between 1971 and 1975, was a multistage mul·ti·stage adj. 1. Functioning in more than one stage: a multistage design project. 2. Relating to or composed of two or more propulsion units. probability survey of 14,407 persons, aged 25 to 74 years, drawn from the civilian, noninstitutionalized population of the coterminous co·ter·mi·nous adj. Variant of conterminous. Adj. 1. coterminous - being of equal extent or scope or duration coextensive, conterminous United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . The design of the NHANES 1 produced a representative sample of the target or population for the period April 1971 through June 1974. [20] A subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. of the sample received a more detailed health examination, and goniometric measurements of the hip and knee were obtained from a further subset of sample. Each of these individual subsamples can be used to develop weighted estimates of the US population. n21 Table 2. Percentile percentile, n the number in a frequency distribution below which a certain percentage of fees will fall. E.g., the ninetieth percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level Distribution for Body Mass Index (in Kilograms per Square Meter Noun 1. square meter - a centare is 1/100th of an are centare, square metre area unit, square measure - a system of units used to measure areas ) [21] by Sex, Race, and Age as a Measure of Obesity obesity, condition resulting from excessive storage of fat in the body. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. (a) in the First National Health and Nutrition Examination Survey (NHANES 1)
Sex-Race Group
White White Black Black
Age Group (y) Men Women Men Women
25-39
X 26 24 31 27
SD 4 5 11 6
Cl (b) 26-27 24-25 28-35 26-29
100% 43 46 57 45
75% 28 26 29 30
50% 26 23 26 27
25% 23 21 24 22
0% 17 17 18 19
40-59
X 27 25 26 30
SD 3 5 4 9
Cl 26-27 25-26 25-27 28-32
100% 42 47 38 73
75% 29 28 29 33
50% 27 25 26 29
25% 24 22 23 26
0% 18 13 17 17
60-74
X 26 26 26 29
SD 4 5 5 7
Cl 25-26 26-27 25-27 27-31
100% 53 50 41 54
75% 28 30 28 34
50% 26 26 25 29
25% 23 23 22 25
0% 17 15 16 18
(a) Overweight: men=27.8 [kg/m.sup.2], women=27.3 [kg/m.sup2]; severely
overweight: men=311.1 [kg/m.sup.2], women=32.3 [kg/m.sup.3].
(b) CI=95% confidence interval.
Subjects The analytic an·a·lyt·ic or an·a·lyt·i·cal adj. 1. Of or relating to analysis or analytics. 2. Expert in or using analysis, especially one who thinks in a logical manner. 3. Psychoanalytic. sample consisted of 1,892 subjects from whom goniometric measurements of hip and knee AROM were obtained. Of these persons, 1,313 were white, 370 were black, and 209 were of some other race. The data for only the black and white subjects were used in this analysis. Of the subjects in this group, 821 were male and 862 were female; 433 of th subjects were 25 to 39 years of age, 727 were 40 to 59 years of age, and 523 were 60 to 74 years of age. Data were collected on a number of characteristics of this group including the body mass index (BMI BMI body mass index. BMI abbr. body mass index Body mass index (BMI) A measurement that has replaced weight as the preferred determinant of obesity. ), which is a measure of obesity. [22] Data on the body mass characteristics of this population are provided in Table 2. A separate analysis of the NHANES 1 sample, conducted by Cunningham and Kelsey, [23] revealed that, by self-report, 8.2% of the subjects had hip Table 3. Percentile Distribution for Hip and Knee Range of Motion (in Degrees by Age in the First National Health and Nutrition Examination Survey (NHANES 1)
Age Group (y)
All Ages 25-39 40-59 60-74
Motion (N=433) (n=727) (n=523)
Knee flexion
X 132 134 132 131
SD 10 9 11 11
Cl (a) 132-133 133-135 131-133 130-132
100% 160 160 155 150
75% 140 140 135 135
50% 130 135 130 130
25% 125 130 125 125
0% 0 90 0 4
Hip flexion
X 121 122 120 118
SD 13 12 14 13
Cl (b) 120-121 121-123 119-121 117-120
100% 160 150 160 150
75% 130 130 130 125
50% 120 120 120 120
25% 110 115 115 110
0% 0 55 0 0
Hip extension
X 19 22 18 17
SD 8 8 7 8
Cl 19-20 21-23 18-19 16-17
100% 45 45 40 40
75% 25 25 20 20
50% 20 20 20 15
25% 15 15 15 10
0% 0 0 0 0
Hip abduction
X 42 44 42 39
SD 11 11 11 12
Cl 42-43 43-45 41-43 38-40
100% 90 90 90 90
75% 50 50 50 45
50% 40 45 40 40
25% 35 35 35 30
0% 0 0 0 0
Hip internal rotation
X 32 33 31 30
SD 8 7 8 7
Cl 31-32 32-34 31-32 29-30
100% 60 60 55 50
75% 35 40 35 35
50% 30 30 30 30
25% 25 30 25 25
0% 0 10 0 5
Hip external rotation
X 32 34 32 29
SD 9 8 8 9
Cl 32-33 33-35 32-33 29-30
100% 65 65 60 55
75% 40 40 40 35
50% 30 35 30 30
25% 25 30 25 25
0% 0 10 0 5
(a) CI=95% confidence interval.
symptoms such as pain and swelling swelling /swell·ing/ (swel´ing) 1. transient abnormal enlargement of a body part or area not due to cell proliferation. 2. an eminence, or elevation. and 13.3% had knee symptoms such as pain and swelling. The proportion of subjects having physician-obseved abnormalities was much lower--3.2% at the hip and 12.1% at the knee. Both physician-observed musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. abnormalities and self-reported symptoms of muscoloskeletal abnormalities increased in prevalence with increasing age. [23] Procedure Two nontherapist technicians collected the goniometric data. The technicians were trained in a standardized procedure for positioning both the subject and the goniometer goniometer /go·ni·om·e·ter/ (go?ne-om´e-ter) 1. an instrument for measuring angles. 2. a plank that can be tilted at one end to any height, used in testing for labyrinthine disease. . One technician See PC technician and software technician. acted as the examiner, while the second technician recorded the measurements on the subject's data collection form. All goniometric measurements were taken with a double-armed universal goniometer. Active range of motion was measured with the subject in three different positions. Hip extension was performed with the subject positioned prone and the knee on the measured side extended. Hip flexion was performed in the supine position The supine position is a position of the body; lying down with the face up, as opposed to the prone position, which is face down. Using terms defined in the anatomical position, the posterior is down and anterior is up. , with the knee flexed on the measured side and the opposite leg extended and resting on the examining table. Knee flexion was performed in the supine position by simultaneously flexing the hip and knee, with the foot on the measured side resting on the table. The opposite leg was kept extended on the table. Hip abduction was also performed in the supine position. The knee on the measured side was kept straight, and the examiner supported the weight of the leg as the subject moved it out to the side. Both hip internal and external rotation were measured in a seated position, with the knee flexed to 90 degrees. All measurements were recorded to the closest 5 degrees. [19] Data Analysis To develop national estimates for the percentile distributions presented in Tables 2 through 8, survey sample weights were used. The Statistical Analysis System (SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. ) was used to Table 4. Percentile Distribution for Hip Active Range of Motion (in Degrees) for White Men by Age in the First National Health and Nutrition Examination Survey (NHANES 1)
Age Group (y)
25-39 40-59 60-74
Motion (n=165) (n=294) (n=190)
Hip flexion
X 123 121 118
SD 9 8 10
Cl (a) 123 121 118
100% 150 145 145
75% 130 130 125
50% 125 125 120
25% 115 115 115
0% 85 40 45
Hip extension
X 22 18 17
SD 8 7 7
Cl 21-23 17-19 16-19
100% 45 40 35
75% 25 20 20
50% 20 20 15
25% 20 15 10
0% 0 0 0
Hip abduction
X 46 43 39
SD 10 10 13
Cl 44-47 41-44 37-41
100% 90 85 75
75% 55 50 45
50% 45 40 40
25% 40 35 30
0% 20 10 10
Hip internal rotation
X 34 33 31
SD 7 7 8
Cl 33-35 32-34 30-32
100% 60 55 50
75% 35 35 30
50% 35 35 30
25% 30 30 25
0% 15 10 10
Hip external rotation
X 33 31 27
SD 8 9 9
Cl 31-34 30-32 25-28
100% 60 60 50
75% 40 35 35
50% 30 30 25
25% 30 25 20
0% 10 5 5
(a) Cl=95% confidence interval.
calculate weighted univariate univariate adjective Determined, produced, or caused by only one variable statistics, including the mean, the variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality , and the 100th, 75th, 50th, 25th, and 0 percentiles. [24] Percentiles were calculated to provide information on the proportion of the population that had AROM of a given or greater value. The 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. was also calculated for each mean. Confidence intervals provide, with a certain degree of assurance, the range within which the true value lies. The effect of sample size can be ascertained as·cer·tain tr.v. as·cer·tained, as·cer·tain·ing, as·cer·tains 1. To discover with certainty, as through examination or experimentation. See Synonyms at discover. 2. from the width of the confidence interval. The narrower the confidence interval was, the less variability was present in the estimate of effect, reflecting a larger sample size. [25] When the differences between the means for the youngest and oldest age groups were large enough to be clinically relevant, Student's t tests were calculated to determine the statistical significance of these differences. Because the impact of a difference in degrees of motion between age groups may be influenced by the arc of motion arc of motion Range of motion, see there of the movement, a percentage was calculated by dividing the difference in mean AROM betwen the oldest and youngest age groups by the mean AROM of the youngest age group. Percentages were calculated for the total group and for each of the 12 sex-race-age-group-specific categories. The initial analysis produced very similar results for the right and left sides. Because none of the available literature suggests that the left side of the body ages differently from the right side, only data from the right hip and knee were analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. . All means and variances were rounded to the nearest whole number. Results Normal Active Range of Motion Percentile distributions for hip and knee AROM are presented in Tables 3 through 8. In each percentile distribution, with only one exception, the mean and median were the same. These nationally representative estimates of hip and knee AROM generally were smaller than those presented in Table 1. In most instances, values for the youngest age group were similar Table 5. Percentile Distribution for Hip Active Range of Motion (in Degrees) for White Women by Age in the First National Health and Nutrition Examination Survey (NHANES 1)
Age Group (y)
25-39 40-59 60-74
Motion (n=181) (n=271) (n=212)
Hip flexion
X 123 121 119
SD 12 16 11
Cl (a) 121-125 119-123 118-121
100% 150 150 145
75% 130 130 125
50% 125 120 120
25% 115 115 110
0% 90 0 65
Hip extension
X 22 19 16
SD 8 8 8
Cl 21-24 18-20 15-17
100% 40 40 40
75% 30 25 20
50% 20 20 15
25% 15 15 10
0% 5 0 0
Hip abduction
X 44 41 40
SD 11 11 11
Cl 42-45 40-42 38-41
100% 90 90 90
75% 50 50 45
50% 45 40 35
5% 35 35 30
0% 0 0 0
Hip internal rotation
X 33 30 29
SD 7 7 7
Cl 32-34 29-31 28-30
100% 50 50 45
75% 40 35 35
50% 35 30 30
25% 30 25 25
0% 10 0 5
Hip external rotation
X 36 34 32
SD 8 8 8
Cl 35-37 33-35 31-33
100% 65 60 55
75% 40 40 35
50% 35 35 30
25% 30 30 25
0% 15 0 15
(a) Cl=95% confidence interval.
to those in the textbooks. Even in the youngest age group, however, the population-based estimates for internal and external rotation and for knee flexion were as much as 12 and 16 degrees less, respectively, than the values shown in Table 1. Age Differences For the combined group, the mean AROM values for all motions were lower in the oldest age group than in the youngest age group (Tab. 3). Mean AROM values were also found to be lowest in the oldest age group for all sex-race groups except for hip flexion in black men (Tabs. 4-8). The differences in mean AROM were generally small, ranging from an increase of 3 degrees for hip flexion in black men to a decline of 10 degrees for hip flexion in black women. With the exception of hip flexion in black men, AROM values at the 75th and 25th percentiles were also uniformly lowest in the oldest age group. The AROM values between the 25th and the 75th percentiles represent the range of values for the middle 50% of the population. Interestingly, there was considerable overlap in these middle ranges for all three of the age groups. With the exception of hip flexion in black women, the difference in mean hip and knee flexion AROM between the oldest and youngest age groups represented less than 5% of the arc of motion (Tab. 9). For movements with smaller arcs of motion, the difference in degrees of AROM between the oldest and youngest age groups generally amounted to less than 15% of the available arc of motion. Only in hip extension did the difference in AROM between the youngest and the oldest age groups represent a decrease of more than 20%. Discussion This study involved a secondary data analysis. Several aspects of the research design may have been less than optimal for the purposes of this study. The design used in the NHANES 1 to collect goniometric data on hip and knee AROM has several Table 6. Percentile Distribution for Hip Active Range of Motion (in Degrees) for Black Men by Age in the First National Health and Nutrition Examination Survey (NHANES 1)
Age Group (y)
25-39 40-59 60-74
Motion (n=35) (n=74) (n=63)
Hip flexion
X 115 118 118
SD 14 15 10
Cl (a) 110-120 114-122 116-121
100% 140 145 150
75% 120 125 125
50% 120 120 120
25% 105 115 110
0% 90 0 85
Hip extension
X 19 18 16
SD 7 6 6
Cl 16-21 16-19 14-17
100% 30 30 40
5% 25 20 20
50 20 15 15
25% 15 10 10
0% 5 0 5
Hip abduction
X 41 45 38
SD 9 19 14
Cl 38-44 40-49 35-42
100% 60 90 75
75% 50 45 50
50% 40 40 40
25% 35 30 30
0% 20 0 20
Hip internal rotation
X 32 28 27
SD 7 7 7
Cl 30-35 26-30 25-29
100% 45 55 45
75% 35 30 30
0% 30 30 25
5% 25 25 20
0% 15 5 5
Hip external rotation
X 32 29 27
SD 8 8 9
Cl 29-35 27-31 25-29
100% 50 50 45
75% 40 35 35
50% 30 30 30
25% 25 25 20
0% 15 10 5
(a) Cl=95% confidence interval.
problems. First, all measurements were rounded to the nearest 5 degrees. This rounding may result in considerable loss of resolution for movements with small arcs of motion. Second, although all motions were performed in AROM, some motions were gravity assisted gravity assist n. The use of the energy obtained from a gravitational field to change the speed or shape of a spacecraft's orbit. , some gravity resisted, and some gravity neutral. The roles of the neuromuscular system neuromuscular system n. The muscles of the body together with the nerves supplying them. and of subject effort, therefore, may vary from motion to motion. Finally, it appears likely that the effort-dependent nature of AROM movements may have created problems in terms of the reproducibility of the data. The advantage of using these data is that, because of the size and the representative nature of the sample, they provide the best available estimates of normal hip and knee AROM for the US population. In interpreting the results of this study, it is far more important to consider the magnitude of the differences in AROM among various age groups in terms of clinical significance than to examine whether these differences were likely to have occurred by chance. Differences in AROM, which represent less than 10% of the arc of motion, probably are of little clinical importance. Only for hip extension were the differences between the youngest and oldest age groups consistently greater than 15% of the arc of motion. Hip extension had the smallest arc of motion of all of the movements examined. It may have been affected, more than other movements, by the loss of resolution attributable to rounding measurements to the nearest 5 degrees. Such loss of resolution, however, should make it more, rather than less, difficult to detect differences among groups. The small size of the differences in mean AROM between the youngest and oldest age groups was somewhat surprising, given the commonly held belief that aging produces a substantial decline in ROM. Several factors should be considered when interpreting these results. First, these AROM values were derived from a noninstitutionalized population. This restriction eliminates individuals residing in Table 7. Percentile Distribution for Hip Active Range of Motion (in Degrees) for Black Women by Age in the First National Health and Nutrition Examination Survey (NHANES 1)
Age Group (y)
25-39 40-59 60-74
Motion (n=52) (n=88) (n=58)
Hip flexion
X 116 110 106
SD 12 16 19
Cl (a) 113-120 107-114 101-111
100% 140 160 140
75% 125 120 120
50% 115 110 110
25% 110 100 95
0% 55 55 0
Hip extension
X 17 16 12
SD 7 6 6
Cl 15-19 14-17 10-13
100% 35 40 25
75% 25 20 15
50% 20 15 10
25% 15 10 5
0% 5 0 0
Hip abduction
X 38 41 37
SD 15 9 11
Cl 34-42 39-43 34-40
100% 90 85 65
75% 50 45 45
50% 40 40 35
25% 25 30 30
0% 20 15 15
Hip internal rotation
X 27 25 25
SD 6 7 7
Cl 25-29 24-27 24-27
100% 40 45 40
75% 35 30 30
50% 30 25 25
25% 25 20 20
0% 10 10 10
Hip external rotation
32 33 28
SD 9 8 6
Cl 30-35 31-35 26-29
100% 60 50 45
75% 40 40 30
50% 35 35 30
25% 25 25 25
0% 15 10 15
(a) Cl=95% confidence interval.
nursing homes. It is likely such individuals would be older. To the extent that residents of nursing homes might have decreased ROM, their exclusion may have increased the mean AROM values obtained in the oldest age group. The NHANES 1 sample, however, included individuals with a variety of musculoskeletal disorders Musculoskeletal disorders (MSDs) can affect the body's muscles, joints, tendons, ligaments and nerves. Most-work related MSDs develop over time and are caused either by the work itself or by the employees' working environment. , including rheumatoid arthritis rheumatoid arthritis Chronic, progressive autoimmune disease causing connective-tissue inflammation, mostly in synovial joints. It can occur at any age, is more common in women, and has an unpredictable course. and osteoarthritis osteoarthritis or osteoarthrosis or degenerative joint disease Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. . Second, this was a cross-sectional study cross-sectional study n. See synchronic study. cross-sectional study, n the scientific method for the analysis of data gathered from two or more samples at one point in time. ; thus, the results cannot be used to arrive at conclusions about changes in ROM with increasing age. Both cohort effects The term cohort effect is used in social science to describe variations in the characteristics of an area of study (such as the incidence of a characteristic or the age at onset) over time among individuals who are defined by some shared temporal experience or common life and survivorship survivorship n. the right to receive full title or ownership due to having survived another person. Survivorship is particularly applied to persons owning real property or other assets, such as bank accounts or stocks, in "joint tenancy. may have influenced the AROM estimates for the oldest age group. Despite these caveats, these data would support the view that, although a decline in AROM occurred between the youngest and the oldest age groups, the magnitude of that decline was not so great as to be clinically important. Therefore, at least to age 74 years, large losses in ROM should not be accepted as a natural consequence of aging. The magnitude of the differences in mean hip flexion between the oldest and youngest age groups for black women in this study was twice as large as for the other sex-ract groups. One possible explanation for this finding is differences in body mass between the group of black women and the other three groups (Tab. 2). The BMI is a measure of obesity. Unlike the mean BMIs of the other three groups, the mean BMI for the group of black women fell into the category of overweight Overweight Refers to an investment position that is larger than the generally accepted benchmark. Notes: For example, if a company normally holds a portfolio whose weighting of cash is 10%, and then increases cash holdings to 15%, the portfolio would have an overweight . In overweight individuals, the AROM into hip flexion is ultimately limited by the opposition of the thigh thigh (thi) femur; the portion of the leg above the knee. thigh n. The part of the leg between the hip and the knee. Also called femur. and the abdomen abdomen, in humans and other vertebrates, portion of the trunk between the diaphragm and lower pelvis. In humans the wall of the abdomen is a muscular structure covered by fascia, fat, and skin. . Greater body mass may have limited the available arc of motion in the black women in this study. Joint pathology pathology, study of the cause of disease and the modifications in cellular function and changes in cellular structure produced in any cell, organ, or part of the body by disease. may be another possible explanation for this finding. In the NHANES 1 sample, black women had a higher prevalence of osteoarthritis than did the other subjects, even after controlling for obesity. [26] Lower mean ROM values in black women may actually indicate a higher prevalence of joint pathology. [TABULAR DATA OMITTED] Conclusion The results of this study indicate that the values for normal hip and knee ROM provided by many textbooks may not be entirely representative of the US population. This study documented lower mean AROM values among subjects in the oldest age group. With the possible exception of hip extension, these differences were so small that they probably are of limited clinical importance. Because this study was limited to subjects 74 years of age and younger, it is possible that aging causes more substantial losses in ROM at ages beyond 74 years. The results from at least one other study [2] are consistent with this view. Nevertheless, this study supports the conclusion that, at least to age 74 years, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging and therefore should be treated much as it would be in a younger individual. [TABULAR DATA OMITTED] References [1] Boone DC, Azen SP. Normal range of motion of joints in male subjects. J Bone Joint Surg [Am]. 1979;61:756-759. [2] Walker JM, Sue D, Miles-Elkousy N, et al. Active mobility of the extremities ex·trem·i·ty n. pl. ex·trem·i·ties 1. The outermost or farthest point or portion. 2. The greatest or utmost degree: the extremity of despair. 3. a. in older subjects. Phys Ther. 1984;64:910-923. [3] James B, Parker AW. Active and passive mobility of lower limb joints in elderly men and women. An J. Phys Med. 1989;68:162-167. [4] Bergstrom Berg·strom , Sune Karl 1916-2004. Swedish biochemist and physician. He shared a 1982 Nobel Prize for research into the chemical structure of prostaglandins. G, Bjelle A, Sorensen LB, et al. Prevalence of symptoms and signs of joint impairement at age 79. Scand J Rehabil Med. 1985;17:173-182. [5] Bergstrom G, Aniansson A, Bjelle A, et al. Functional consequences of joint impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. at age 79. Scand J Rehabil Med. 1985;17:193-190. [6] Kendall Ken·dall , Edward Calvin 1886-1972. American biochemist. He shared a 1950 Nobel Prize for discoveries concerning the hormones of the adrenal cortex. HO, Kendall FP, Wadsworth GE. Muscles: Testing and Function. 2nd ed. Baltimore Baltimore, city (1990 pop. 736,014), N central Md., surrounded by but politically independent of Baltimore co., on the Patapsco River estuary, an arm of Chesapeake Bay; inc. 1745. , Md: Williams & Wilkins Wil·kins , Maurice Hugh Frederick 1916-2004. British biophysicist. He shared a 1962 Nobel Prize for his contributions to the determination of the structure of DNA. ; 1971. [7] Daniels L, Worthingham C. Muscle Testing: Techniques of Manual Examination. 3rd ed. Philadelphia, Pa: WB Saunders Saun´ders n. 1. See Sandress. Co; 1972. [8] Hoppenfeld S. Physical Examination of the Spine and Extremities. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY: Appleton-Century-Crofts; 1976. [9] Mohr T. Musculoskeletal analysis: the hip. In: Scully RM, Barnes MR, eds. Physical Therapy. Philadelphia, Pa: JB Lippincott Co; 1989;369-380. [10] Morrissey MC. Musculoskeletal analysis: the knee. In: Scully RM, Barnes MR, eds. Physical Therapy. Philadelphia, Pa: JB Lippincott Co; 1989:381-396. [11] Cailliet R. Soft Tissue Pain and Disability. Philadelphia, Pa: FA Davis Co; 1978:196-215. [12] Cole TM. Goniometry: the measurement of joint motion. In: Krusen FH, Kottke FJ, Ellwood PM, eds. Handbook
This article is about reference works. For the subnotebook computer, see .
or physiatry or physical therapy or rehabilitation medicine Medical specialty treating chronic disabilities through physical means to help patients return to a comfortable, productive life despite a medical . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1971:40-44. [13] Gajdosik RK, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Phys Ther. 1987;67:1867-1872. [14] Boone DC, Azen SP, Lin C-M C-M Control-Monitor C-M Constant Modulus , et al. Reliability of goniometric measurements. Phys Ther. 1978;58:1355-1360. [15] Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther. 1983;63:1611-1615. [16] Fish DR, Wingate L. Sources of goniometric error at the elbow very near; at hand. See also: Elbow . Phys Ther. 1985;65:1666-1670. [17] Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: subtalar and ankle joint ankle joint n. A hinge joint formed by the articulating of the tibia and the fibula with the talus below. Also called mortise joint, talocrural joint. measurements. Phys Ther. 1988;68:672-677. [18] Watkins MA, Riddle riddle, puzzling question, specifically one that consists of a fanciful description or definition of something to be guessed. A famous riddle was asked by the Sphinx: "What goes on four legs in the morning, on two at noon, on three at night?" Oedipus guessed the DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther. 1991;71:90-97. [19] Johnson CL, Fulwood R, Abraham S Abraham [according to the Book of Genesis, Heb.,=father of many nations] or Abram (ā`brəm) [Heb.,=exalted father], in the Bible, progenitor of the Hebrews; in the Qur'an, ancestor of the Arabs. , Bryner JD. Basic Data on Antbropometric Measurements and Angular angular /an·gu·lar/ (ang´gu-lar) sharply bent; having corners or angles. Measurements of the Hip and Knee Joints for Selected Age Groups 1-74 Years of Age, United States, 1971-75. Hyattsville, Md: National Center for Health Statistics (National Health Survey Series 11. No. 219); 1981. US Dept of Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Department of Health and Human Services, HHS publication (PHS (Personal Handyphone System) A TDMA-based cellular phone system introduced in Japan in mid-1995. Operating in the 1880-1930 MHz band, PHS uses microcells that cover an area only 100 to 500 meters in diameter, resulting in lower equipment costs but requiring more base ) 81-1669. [20] Landis JR, Lepkowski JM, Eklund SA, Stehouwer SA. A Statistical Methodology for Analyzing Data from a Complex Survey: The First National Health and Nutrition Examination Survey Hyattsville, Md: National Center for Health Statistics; US Dept of Health and Human Services publication (PHS) 82-1366. [21] Miller HW. Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971-1973. Hyattsville, Md: National Center for Health Statistics (Vital and Health Statistics. Series 1: Data from the National Health Survey, No. 10a); US Dept of Health, Education, and Welfare publication (PHS) 79-1310. [22] Van Itallic TB. Health implications of overweight and obesity in the United States Obesity has been cited as a major and increasing health issue in the United States in recent decades. While many industrialized countries have experienced similar increases, American obesity rates lead the world with 64% of adults being overweight and almost a quarter being obese. . Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med. 1985;103:983-988. [23] Cunningham LS, Kelsey JL. Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause of musculoskeletal impairments and associated disability. Am J Public Health. 1984;74:574-579. [24] SAS User's Guides: Basics Cary, NC: SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. Inc; 1985. [25] Hennekens CH, Buring JE. Epidemiology in Medicine Boston, Mass: Little, Brown & Co Inc. 1987. [26] Felsen DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988;10:1-28. KE Roach roach: see cockroach. roach Common European sport fish (Rutilus rutilus) of the carp family (Cyprinidae), found in lakes and slow rivers. A high-backed, yellowish green fish with red eyes and reddish fins, the roach is 6–16 in. , MHS (1) (Message Handling Service) An earlier messaging system from Novell that supported multiple operating systems and other messaging protocols, including SMTP, SNADS and X.400. It used the SMF-71 messaging format. , PT, is Assistant Professor, Division of Physical Therapy, Department of Orthopaedics orthopaedics Orthopedics and Rehabilitation Medicine rehabilitation medicine Physiatry, physiotherapy A field of therapeutics that bridges the gap between conventional and nonconventional medicine; rehabilitation physicians may adminsiter or prescribe mechanical–eg, massage, manipulation, exercise, movement, , University of Miami This article is about the university in Coral Gables, Florida. For the university in Oxford, Ohio, see Miami University. The University of Miami (also known as Miami of Florida,[2] UM,[3] or just The U School of Medicine, 5915 Ponce de Leon Ponce de Le·ón , Juan 1460-1521. Spanish explorer who sailed with Columbus on his second voyage (1493-1494) and discovered Florida (1513) while looking for the legendary Fountain of Youth. Noun 1. Blvd, Plumer Bldg, 5th Fl, Coral Gables Coral Gables, city (1990 pop. 40,091), Miami-Dade co., SE Fla., SW of Miami; inc. 1925. Founded at the height of the Florida land boom, Coral Gables is a noted planned city, with tree-lined boulevards and Mediterranean-style buildings. , FL 33146 (USA). At the time of this study, she was a doctoral candidate in epidemiology, School of Public Health, University of Illinois at Chicago This article is about the University of Illinois at Chicago. For other uses, see University of Illinois at Chicago (disambiguation). UIC participates in NCAA Division I Horizon League competition as the UIC Flames in several sports, most notably Basketball. , 2121 W Taylor St, Chicago, IL 60680. Address all correspondence to Ms Roach. TP Miles, MD, PhD, is Assistant Professor of Epidemiology, School of Public Health, University of Illinois at Chicago. |
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