The prefix hyper- is sometimes added to describe movement beyond the normal limits, such as in hypermobility, hyperflexion or hyperextension. The range of motion describes the total range of motion that a joint is able to do.[5] For example, if a part of the body such as a joint is overstretched or "bent backwards" because of exaggerated extension motion, then it can be described as hyperextended. Hyperextension increases the stress on the ligaments of a joint, and is not always because of a voluntary movement. It may be a result of accidents, falls, or other causes of trauma. It may also be used in surgery, such as in temporarily dislocating joints for surgical procedures.[6] Or it may be used as a pain compliance method to force a person to take a certain action, such as allowing a police officer to take him into custody.

Flexion is a bending movement that decreases the angle between a segment and its proximal segment.[9] For example, bending the elbow, or clenching a hand into a fist, are examples of flexion. When a person is sitting down, the knees are flexed. When a joint can move forward and backward, such as the neck and trunk, flexion is movement in the anterior direction.[10] When the chin is against the chest, the neck is flexed, and the trunk is flexed when a person leans forward.[10] Flexion of the shoulder or hip is movement of the arm or leg forward.[11]


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Extension is the opposite of flexion, a straightening movement that increases the angle between body parts.[12] For example, when standing up, the knees are extended. When a joint can move forward and backward, such as the neck and trunk, extension is movement in the posterior direction.[10] Extension of the hip or shoulder moves the arm or leg backward.[11] Even for other upper extremity joints - elbow and wrist, backward movement results in extension. The knee, ankle, and wrist are exceptions, where the distal end has to move in the anterior direction for it to be called extension.[13][page needed]

Dorsiflexion and plantar flexion refer to extension or flexion of the foot at the ankle. These terms refer to flexion in direction of the "back" of the foot, which is the upper surface of the foot when standing, and flexion in direction of the sole of the foot. These terms are used to resolve confusion, as technically extension of the joint is dorsiflexion, which could be considered counter-intuitive as the motion reduces the angle between the foot and the leg.[27]

Dorsiflexion is where the toes are brought closer to the shin. This decreases the angle between the dorsum of the foot and the leg.[28] For example, when walking on the heels the ankle is described as being in dorsiflexion.[27]

Plantar flexion or plantarflexion is the movement which decreases the angle between the sole of the foot and the back of the leg; for example, the movement when depressing a car pedal or standing on tiptoes.[27]

Palmarflexion and dorsiflexion refer to movement of the flexion (palmarflexion) or extension (dorsiflexion) of the hand at the wrist.[29] These terms refer to flexion between the hand and the body's dorsal surface, which in anatomical position is considered the back of the arm; and flexion between the hand and the body's palmar surface, which in anatomical position is considered the anterior side of the arm.[30] The direction of terms are opposite to those in the foot because of embryological rotation of the limbs in opposite directions.[10]

Repetitive or prolonged head flexion posture while using a smartphone is known as one of risk factors for pain symptoms in the neck. To quantitatively assess the amount and range of head flexion of smartphone users, head forward flexion angle was measured from 18 participants when they were conducing three common smartphone tasks (text messaging, web browsing, video watching) while sitting and standing in a laboratory setting. It was found that participants maintained head flexion of 33-45 (50th percentile angle) from vertical when using the smartphone. The head flexion angle was significantly larger (p < 0.05) for text messaging than for the other tasks, and significantly larger while sitting than while standing. Study results suggest that text messaging, which is one of the most frequently used app categories of smartphone, could be a main contributing factor to the occurrence of neck pain of heavy smartphone users. Practitioner Summary: In this laboratory study, the severity of head flexion of smartphone users was quantitatively evaluated when conducting text messaging, web browsing and video watching while sitting and standing. Study results indicate that text messaging while sitting caused the largest head flexion than that of other task conditions.

Objectives:  The purpose of this study was to examine the relationship between pain-related fear, lumbar flexion, and dynamic EMG activity among persons with chronic musculoskeletal low back pain. It was hypothesized that pain-related fear would be significantly related to decreased lumbar flexion and specific patterns of EMG activity during flexion and extension.

Study design:  Data was obtained from subjects who, on a single day, completed self-report measures of pain and pain-related fear, and were interviewed to determine demographic and pain information. Subjects then underwent a dynamic EMG evaluation for which they were asked to stand, then bend forward as far as possible, stay fully flexed, and return to standing. Lumbar EMG and angle of flexion were recorded during this time. A flexion-relaxation ratio (FRR) was computed by comparing maximal EMG while flexing to the average EMG in full flexion.

Results:  Zero-order correlations indicated that pain-related fear was significantly related to reduced lumber flexion (r = -0.55), maximum EMG during flexion (r = -0.38) and extension (r = -0.51), and the FRR (r = -0.40). When controlling for pain and demographic factors, pain-related fear continued to be related to reduced lumbar flexion. Using a path-analytic model to examine whether angle of flexion mediated the relationship between fear and EMG activity, the models examining maximal EMG during flexion and extension supported the notion that pain-related fear influences these measures indirectly through its association with decreased range of motion. Conversely, pain-related fear was independently related to higher average EMG in full flexion, while angle of flexion was not significantly related. Pain-related fear was directly related to a smaller FRR, as well as indirectly through angle of flexion.

Conclusions:  Pain-related fear is significantly associated with reduced lumbar flexion, greater EMG in full flexion, and a smaller FRR. The relationship between pain-related fear and EMG during flexion and extension appears to be mediated by reduced lumbar flexion. These results suggest that pain-related fear is directly associated with musculoskeletal abnormalities observed among persons with chronic low back pain, as well as indirectly through limited lumbar flexion. These musculoskeletal abnormalities as well as limited movement may be involved in the development and maintenance of chronic low back pain. In addition, changes in musculoskeletal functioning and flexion associated with pain-related fear may warrant greater attention as part of treatment.

Instability in flexion after total knee replacement (TKR) typically occurs as a result of mismatched flexion and extension gaps. The goals of this study were to identify factors leading to instability in flexion, the degree of correction, determined radiologically, required at revision surgery, and the subsequent clinical outcomes. Between 2000 and 2010, 60 TKRs in 60 patients underwent revision for instability in flexion associated with well-fixed components. There were 33 women (55%) and 27 men (45%); their mean age was 65 years (43 to 82). Radiological measurements and the Knee Society score (KSS) were used to assess outcome after revision surgery. The mean follow-up was 3.6 years (2 to 9.8). Decreased condylar offset (p < 0.001), distalisation of the joint line (p < 0.001) and increased posterior tibial slope (p < 0.001) contributed to instability in flexion and required correction at revision to regain stability. The combined mean correction of posterior condylar offset and joint line resection was 9.5 mm, and a mean of 5 of posterior tibial slope was removed. At the most recent follow-up, there was a significant improvement in the mean KSS for the knee and function (both p < 0.001), no patient reported instability and no patient underwent further surgery for instability. The following step-wise approach is recommended: reduction of tibial slope, correction of malalignment, and improvement of condylar offset. Additional joint line elevation is needed if the above steps do not equalise the flexion and extension gaps.

The purpose of this study was to investigate the effect of flexion exercise of the deep cervical muscles on headache and sleep disorders in patients with tension headaches and forward head posture. A total of 32 patients with tension headaches and forward head posture were randomly assigned to two groups: an experimental group (n = 16) and a control group (n = 16). The experimental group performed cervical deep muscle flexion exercises for 4 weeks, whereas the control group performed stretching exercises for the same period. The Henry Ford Hospital Headache Disability Inventory (HDI) was used for headache assessment, and the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K) was used for sleep disorder assessment. The experimental group showed a significant reduction in both HDI and PSQI-K score after 4 weeks of intervention (p < 0.001), while no significant difference was found in the control group (p > 0.05). On comparing the experimental and control groups, we found a significant difference in changes in the HDI and PSQI-K between the groups (p < 0.05). The results indicate that flexion exercise of the deep cervical muscles in patients with tension headache and forward head posture will improve the quality of life and activities of daily life by mitigating headaches and sleep disorders. 2351a5e196

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