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The relationship between tight hamstrings and lumbar hypolordosis in children with cerebral palsy
1Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA.
Insights
Tight hamstrings correlate with reduced lumbar lordosis in children with cerebral palsy, particularly when sitting. This finding highlights the impact of hamstring tightness on spinal alignment in this population.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Spinal Biomechanics
Background:
- Tight hamstrings are common in children with cerebral palsy.
- Shortened hamstring muscles may lead to lumbar hypolordosis.
- Altered spinal sagittal contour can increase lumbar spine stress, pain, and disability.
Purpose of the Study:
- To investigate the relationship between hamstring tightness and sagittal spinal alignment in children with cerebral palsy.
- To assess the influence of hamstring flexibility on lumbar lordosis and thoracic kyphosis.
Main Methods:
- Retrospective review of clinical and radiographic data from 21 children with cerebral palsy (mean age 9.4 years).
- Measurement of lumbar lordosis and thoracic kyphosis using the Cobb method on standing and sitting lateral spine films.
- Assessment of hamstring tightness via the popliteal angle measurement.
Main Results:
- A significant negative correlation was found between sitting lumbar curve and popliteal angle (r = -0.77, P < 0.01), indicating decreased lordosis with increased hamstring tightness.
- The correlation between hamstring tightness and reduced lumbar lordosis was less significant in standing posture (r = -0.59).
Conclusions:
- Tight hamstrings, indicated by a larger popliteal angle, are associated with reduced lumbar lordosis in children with cerebral palsy.
- This association is more pronounced in the sitting position.
- Findings suggest hamstring flexibility is a key factor in maintaining lumbar sagittal alignment in this patient group.
Study Design:
Retrospective clinical and radiographic review.
Objective:
To assess the influence of tight hamstrings on the sagittal alignment of the thoracic and lumbar spine in children with cerebral palsy.
Summary Of Background Data:
It is postulated that tight hamstrings may produce a hypolordosis of the lumbar spine. The abnormal sagittal contour of the spine may lead to increased stresses in the lumbar spine and subsequent pain and disability. This is of special concern in children with cerebral palsy who often have shortened spastic hamstring muscles.
Methods:
Twenty-one patients were evaluated, with a mean age of 9.4 years. Standing and sitting lateral spine films were obtained and the lumbar lordosis and thoracic kyphosis were measured using the Cobb method. The popliteal angle was measured to assess hamstring tightness, such that a large popliteal angle indicates tight hamstrings.
Results:
We found a statistically significant correlation between the sitting lumbar curve and popliteal angle (Pearson correlation value -0.77, P < 0.01). As the popliteal angle increased, the amount of lumbar lordosis decreased. This correlation was less significant when the patient was standing (Pearson correlation value -0.59).
Conclusion:
This study demonstrates that there is a correlation between tight hamstrings, as measured by the popliteal angle, and decreasing lumbar lordosis, especially when sitting.