Effect of BMI on Tightness of Iliopsoas Muscle in Students due to Prolonged Sitting for Online Classes During COVID-19 Pandemic
Correspondence Address :
Dr. Vaishali Chaudhary,
NH-58, Delhi-Meerut Road, Ghaziabad, Uttar Pradesh, India.
E-mail : firstname.lastname@example.org
Introduction: Muscle tightness is produced by a reduction in a muscle’s capacity to deform. As a result of prolong sitting pelvic position can be changed which can lead to iliopsoas tightness. During the COVID-19 pandemic, as a result of online classes, student’s hours of sitting have increased drastically.
Aim: To compare iliopsoas muscle tightness in students who were engaged in prolonged sitting due to online classes with higher Body Mass Index (BMI) and students with normal BMI.
Materials and Methods: This cross-sectional study was conducted in Department of Physiotherapy at Institute of Applied Medicine and Research, Ghaziabad, Uttar Pradesh, India, from April 2021 to January 2022 on 101 students. Height and weight of the subject were measured by the ruler and digital weighing machine respectively for the BMI calculation. Two groups were made, group with normal BMI students and group with High BMI students. Using modified Thomas test, iliopsoas muscle were measured for the flexibility. Independent sample t-test was used for statistical analysis.
Results: Total 51 students were with normal BMI and 50 were with higher BMI were included in the study. The mean age of the subjects was 19.59 years including 59 females and 42 males. The significantly increased Modified Thomas Test (MTT) angle was found in students with higher BMI when compared to students with normal BMI for both right (p-value=0.003) and left side (p-value <0.001). Iliopsoas muscle tightness was present in more in higher BMI group as compared to normal BMI group.
Conclusion: The study concluded that both the groups had the iliopsoas muscle tightness but the students with higher BMI had more muscle tightness.
Coronavirus disease, Flexibility, Modified thomas test, Online classes, Sedentary lifestyle, Universal goniometer
The Coronavirus Disease 2019 (COVID-19) pandemic has brought to light a number of issues that had previously gone unnoticed but were impacting individuals in the same way, with the only difference being "severity." The main concern that has arisen is the flexibility of the muscles in students; as a result of online classes, students' hours of sitting have increased drastically, negatively impacting their physical activity. The muscular tightness is caused by decreased in the ability of muscle to deform which is the results of sedentary lifestyle making physical activity or Activity of Daily Living (ADLs) difficult (1). Individuals whose work required sitting throughout the day are more prone to develop musculoskeletal discomfort or adaptive shortening of muscles especially at hip joint (2).
A previous study shows strong evidence for work related musculoskeletal disorder present in bankers due to work related stress (3). Flexibility is an important factor for the normal biomechanical function. Iliopsoas is one of the hip flexor muscles that originate from iliac fossa and lumbar spine and inserted to lesser trochanter of femur (4). As a result of prolonged sitting, pelvic tilting can occur, which can cause iliopsoas muscle tension and raise the risk of injury due to the excessive pressure on muscles while sitting (5),(6),(7).
Flexibility is an important factor in physical and health related fitness and for execution and sustainability of ADLs (8). If any changes or alteration takes place in flexibility of muscles, it leads to difficulty in ADLs (9),(10). Overweight/obesity has the strongest association with low back pain and chronic low back pain (11). Therefore, this study was conducted with the aim of comparing iliopsoas muscle tightness in students with high Body Mass Index (BMI) and those with normal BMI who have been sitting for long period of time for online classes during the COVID-19 pandemic.
Null hypothesis: There is no significant difference in iliopsoas muscle tightness between students with higher BMI and with normal BMI.
Alternative hypothesis: There is significant difference in iliopsoas muscle tightness between students with higher BMI and with BMI.
This cross-sectional study was conducted in Department of Physiotherapy at Institute of Applied Medicine and Research, Ghaziabad, Uttar Pradesh, India, from April 2021 to January 2022 on 101 students. Institutional Ethical Clearance was taken from IAMR, Ghaziabad, (Ref. No. IAMR/22/3196) and the Helsinki Declaration of 1975 that was revised in 2013 was also considered.
Inclusion criteria: Age group of 17- 25 years, with minimum 5 -8 hours of sitting per day and within the normal BMI ranges (18.5 to <24.9 Kg/m2) and higher BMI ranges (25.0 to29.9 Kg/m2) were included in the study (12).
Exclusion criteria: Below the age of 17 years and above the age of 25 years, students with any complaint of Lower Back Pain (LBP), hip pain, knee pain or some kind of accident or trauma and any lower limb surgery were excluded from the study.
This study was conducted with the students taking online classes during the COVID-19 pandemic. The participants in this study were voluntary and an informed consent was obtained before the beginning of the test. The participating students were briefed about the purpose of this study and informed that the data or the information collected from them will remain confidential. The students were evaluated for the BMI calculated as weight (Kg)/ height squared (m2) (12) and iliopsoas muscle tightness using the standardized testing procedure that is modified thomas test using the universal goniometer (13),(14).
The subject was asked to stand on the digital weighing machine for the weight measurement and made the subject to stand against the wall for the height measurement with the help of ruler.
Modified Thomas Test (MTT): The subject was made to sit at the edge of the examination table and roll back onto the table while pulling both knees towards the chest. This is to ensure that the lumbar spine is flat on the table and the pelvic is posteriorly rotated. The subject was asked to hold the contralateral lower limb toward the chest and lower the other limb towards the floor. For each side, angle of hip flexion were measured using a universal goniometer. The stationary arm of goniometer was aligned with the lateral midline of the pelvic and moving arm was aligned with midline of the femur using lateral epicondyle as a reference point. The hip joint at 0 degree is considered at neutral position anything above this range was considered as iliopsoas muscle tightness or flexibility of iliopsoas muscle is considered as the angle of hip flexion (15),(16) (Table/Fig 1), (Table/Fig 2).
The independent sample t-test has been used through the Statistical Package for Social Sciences (SPSS) version 22.0 IBM software with the 5% significance level.
Out of 101 students, 59 were females and 42 were males, with mean age of 19.59±1.801 years. Demographic data of both the groups is given in (Table/Fig 3). The mean BMI of normal BMI group (20.90±2.54 kg/m2) was significantly less than the mean BMI of higher group (25.99±2.54 Kg/m2) with p-value <0.001
Out of total, 51 were with normal BMI and 50 were with higher BMI. Modified Thomas test value of 7.91±4.718 was recorded for right side. For the left side mean MTT value were 7.52±4.768. Mean MTT value of 6.57 and 5.90 was recorded for the right and left side respectively for students with normal BMI. At the same time mean of 9.28 and 9.18 was recorded for the right and left side MTT values respectively for students with higher BMI. Significantly increased MTT angle was found in students with higher BMI when compared to students with normal BMI for both right (p-value=0.003) and left sided (p-value <0.001). Iliopsoas muscle tightness was present more in higher BMI group as compared to normal BMI group (Table/Fig 4).
The study demonstrated that the BMI has an impact on the muscle tightness. An increase in the BMI led to an increase in the tightness of muscles. Previous study showed that to perform a specific activity or sport sufficient flexibility needs to be obtained (16). This study supports the statement as prolong sitting lead to muscle tightness which can make the ADLs difficult.
The primary health results assumed to be linked with flexibility are relief from low-back pain, prevention of musculoskeletal damage, and better-quality posture (5),(10). A sedentary lifestyle is considered as a risk factor for LBP among the general population, but it is also known that youths who do not practice physical exercise are far more likely to become sedentary adults (1). Also another previous study by Pradip B et al., stated that hip muscles tightness could develop in desk job professionals making them prone for musculoskeletal discomforts (1). Hip joint is surrounded by various muscles, among which the Iliopsoas is the main muscles which can go for tightness after a prolonged period of sitting especially in students and desk job people (7). In the present study, authors only focused on the iliopsoas muscle as it is known that iliopsoas muscle is the only muscle that connects lumbar spine to the hip. In case of shortening, it increases the anterior pelvic tilt and puts excessive strain on the lumbar spine as well as on the intervertebral disc resulting in low back pain (1),(4).
It has already been concluded by the many researchers that the iliopsoas muscle tightness is present in prolong desk job workers and in the Information Technology (IT) professionals (2),(3). However, information about the student population and the influence of BMI on iliopsoas muscle stiffness was not found. Hence, the present study was focused on the same.
In previous studies, one or more musculoskeletal health symptoms were reported by 94% of IT professionals in the past 12 months (1),(2),(6). Previous study had cited that 5 hour per day as being a critical time for the development of musculoskeletal disorder and muscle tightness in employees working with visual display unit (6). Hence, the subjects included in this study were college students from 17 to 25 years of age who spend minimum 5-8 hours in sitting position. In the present study it was found that the students with higher BMI and with normal BMI both have iliopsoas muscle tightness but the higher BMI students were more prone for tightness as compared to the normal BMI students who were engaged in the prolong sitting. As a result, individuals are prone to low back pain or other symptoms associated with the back or hip in some point of time in their life (1).
The sample size was small and pelvic tilt position can be altered during the modified Thomas test.
In this study iliopsoas muscle tightness was present in both groups i.e. normal and higher BMI in both right and left side. However, the higher BMI (overweight) students had more iliopsoas muscle tightness as compared to normal BMI students. Hence, the alternative hypothesis was accepted. Although, iliopsoas muscle flexibility is an important aspect that impact the ADLs, future research is required with the obese group of subjects as sedentary lifestyle is the major cause of it.
Special thanks to all the participants who participated in the process of data collection and fellow MPT Scholar, Tarunjit Kaur for supporting me throughout the research process. No technical, financial support was received for the study from any person or organization.
Date of Submission: Mar 31, 2022
Date of Peer Review: Apr 23, 2022
Date of Acceptance: May 12, 2022
Date of Publishing: Jun 01, 2022
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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