Stand-to-sit kinematic changes during pregnancy correspond with reduced sagittal plane hip motion


      • Hip and spine motion change for pregnant women performing a sitting task.
      • Postural changes related to gestational lordosis affect stand-to-sit changes.
      • Coordination changes away from the hip during the first and last parts of sitting.



      The stand-to-sit motion has been linked to falls during pregnancy. It is also used in the clinical evaluation of functional performance. The physical and physiological changes during pregnancy may necessitate a change in stand-to-sit kinematic performance. Therefore, this study was conducted to evaluate the longitudinal changes to stand-to-sit kinematics during pregnancy.


      Fifteen pregnant women were tested in 4-week intervals from 16 weeks to 36 weeks gestational age. They performed a 60-second trial of semi-continuous stand-to-sit motion. Sagittal plane motions at the ankle, knee, spine, and shoulders were measured. Additionally, three-dimensional hip motion was measured. Discrete variables (e.g. range of motion) and joint coordinations (through vector coding) were analyzed over time through a linear mixed model analysis.


      The results indicate a shift away from sagittal hip motion throughout pregnancy. Hip range of motion and standing angle changed in favor of spine motion. Joint coordination shifted from hip dominant to spine- and shoulder-dominate coordination just before the start of sitting motion. Hip-knee joint coordination just before seat contact shifted from hip to a knee-dominant motion during pregnancy.


      Discrete variable changes in the entire stand-to-sit motion seem to be driven by initial standing posture related to an increase in gestational lordosis. Likewise, standing joint coordination shift to upper body motion can be attributed to gestational lordosis limiting functional ability around the hip. The shift in motion away from the hip may provide insight into why both fall rates and low back pain rates increase during stand-to-sit during pregnancy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abhyankar S.V.
        • Rajguru A.G.
        • Patil P.A.
        Anatomical localization of the umbilicus: an Indian study.
        Plast. Reconstr. Surg. 2006;
        • Bivia-Roig G.
        • Lison J.F.
        • Sanchez-Zuriaga D.
        Changes in trunk posture and muscle responses in standing during pregnancy and postpartum.
        PLoS One. 2018;
        • Blazkiewicz M.
        • Wiszomirska I.
        • Wit A.
        A new method of determination of phases and symmetry in stand-to-sit-to-stand movement.
        Int. J. Occup. Med. Environ. Health. 2014;
        • Catena R.D.
        • Connolly C.P.
        • McGeorge K.M.
        • Campbell N.
        A comparison of methods to determine center of mass during pregnancy.
        J. Biomech. 2018;
        • Chang R.
        • Van Emmerik R.
        • Hamill J.
        Quantifying rearfoot-forefoot coordination in human walking.
        J. Biomech. 2008;
        • Chen H.B.
        • Wei T.S.
        • Chang L.W.
        Postural influence on stand-to-sit leg load sharing strategies and sitting impact forces in stroke patients.
        Gait Posture. 2010;
        • Cohen J.
        The statistical power of abnormal-social psychological research: a review.
        J. Abnorm. Soc. Psychol. 1962; 65: 145-153
        • Cohen J.W.
        Statistical Power Analysis for the Behavioral Sciences.
        Erlbaum, Hillsdale, NJ1988
        • Dunning K.
        • Lemasters G.
        • Bhattacharya A.
        A major public health issue: the high incidence of falls during pregnancy.
        Matern. Child Health J. 2010;
        • El-Kady D.
        • Gilbert W.M.
        • Anderson J.
        • Danielsen B.
        • Towner D.
        • Smith L.H.
        Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population.
        Am. J. Obstet. Gynecol. 2004;
        • Flores D.
        • Connolly C.P.
        • Campbell N.
        • Catena R.D.
        Walking balance on a treadmill changes during pregnancy.
        Gait Posture. 2018;
        • Freedman Silvernail J.
        • van Emmerik R.E.A.
        • Boyer K.
        • Busa M.A.
        • Hamill J.
        Comparisons of segment coordination: an investigation of vector coding.
        J. Appl. Biomech. 2018;
        • Glinkowski W.M.
        • Tomasik P.
        • Walesiak K.
        • Gluszak M.
        • Krawczak K.
        • Michonski J.
        • Czyzewska A.
        • Zukowska A.
        • Sitnik R.
        • Wielgos M.
        Posture and low back pain during pregnancy - 3D study.
        Ginekol. Pol. 2016;
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.
        J. Biomed. Eng. 1983; 105: 136-144
        • Hamill J.
        • Palmer C.
        • Van Emmerik R.E.
        Coordinative variability and overuse injury.
        Sports Med. Arthrosc. Rehabil. Ther. Technol. 2012;
        • Horak F.B.
        • Nashner L.M.
        • Diener H.C.
        Postural strategies associated with somatosensory and vestibular loss.
        Exp. Brain Res. 1990; 82: 167-177
        • Jang J.
        • Hsiao K.T.
        • Hsiao-Wecksler E.T.
        Balance (perceived and actual) and preferred stance width during pregnancy.
        Clin. Biomech. 2008;
        • Jensen R.K.
        • Doucet S.
        • Treitz T.
        Changes in segment mass and mass distribution during pregnancy.
        J. Biomech. 1996; 29: 251-256
        • Krishnamoorthy V.
        • Yang J.F.
        • Scholz J.P.
        Joint coordination during quiet stance: effects of vision.
        Exp. Brain Res. 2005;
        • Kuo C.
        • Jamieson D.J.
        • McPheeters M.L.
        • Meikle S.F.
        • Posner S.F.
        Injury hospitalizations of pregnant women in the United States, 2002.
        Am. J. Obstet. Gynecol. 2007;
        • Lou S.Z.
        • Chou Y.L.
        • Chou P.H.
        • Lin C.J.
        • Chen U.C.
        • Su F.C.
        Sit-to-stand at different periods of pregnancy.
        Clin. Biomech. 2001; 16: 194-198
        • Major M.J.
        • Twiste M.
        • Kenney L.P.
        • Howard D.
        The effects of prosthetic ankle stiffness on stability of gait in people with transtibial amputation.
        J. Rehabil. Res. Dev. 2016;
        • Masten W.Y.
        • Smith J.L.
        Reaction time and strength in pregnant and nonpregnant employed women.
        J. Occup. Med. 1988; 30: 451-456
        • McCrory J.L.
        • Chambers A.J.
        • Daftary A.
        • Redfern M.S.
        Dynamic postural stability during advancing pregnancy.
        J. Biomech. 2010;
        • Moore K.
        • Dumas G.A.
        • Reid J.G.
        Postural changes associated with pregnancy and their relationship with low-back pain.
        Clin. Biomech. 1990;
        • Morino S.
        • Ishihara M.
        • Umezaki F.
        • Hatanaka H.
        • Iijima H.
        • Yamashita M.
        • Aoyama T.
        • Takahashi M.
        Low back pain and causative movements in pregnancy: a prospective cohort study.
        BMC Musculoskelet. Disord. 2017;
        • Pourahmadi M.R.
        • Ebrahimi Takamjani I.
        • Jaberzadeh S.
        • Sarrafzadeh J.
        • Sanjari M.A.
        • Bagheri R.
        • Jannati E.
        Test-retest reliability of sit-to-stand and stand-to-sit analysis in people with and without chronic non-specific low back pain.
        Musculoskelet. Sci. Pract. 2018;
        • Roy G.
        • Nadeau S.
        • Gravel D.
        • Malouin F.
        • McFadyen B.J.
        • Piotte F.
        The effect of foot position and chair height on the asymmetry of vertical forces during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis.
        Clin. Biomech. 2006;
        • Sasagawa S.
        • Ushiyama J.
        • Kouzaki M.
        • Kanehisa H.
        Effect of the hip motion on the body kinematics in the sagittal plane during human quiet standing.
        Neurosci. Lett. 2009;
        • Seidel G.K.
        • Marchinda D.M.
        • Dijkers M.
        • Soutas-Little R.W.
        Hip joint center location from palpable bony landmarks--a cadaver study.
        J. Biomech. 1995; 28: 995-998
        • Sencan S.
        • Ozcan-Eksi E.E.
        • Cuce I.
        • Guzel S.
        • Erdem B.
        Pregnancy-related low back pain in women in Turkey: prevalence and risk factors.
        Ann. Phys. Rehabil. Med. 2018;
        • Shum G.L.
        • Crosbie J.
        • Lee R.Y.
        Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit.
        Spine. 2005; 30: 1998-2004
        • Staartjes V.E.
        • Schroder M.L.
        The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine.
        J. Neurosurg. Spine. 2018;
        • Sunaga Y.
        • Anan M.
        • Shinkoda K.
        Biomechanics of rising from a chair and walking in pregnant women.
        Appl. Ergon. 2013;
        • Takeda K.
        A kinesiological analysis of the stand-to-sit during the third trimester.
        J. Phys. Ther. Sci. 2012;
        • Weiss H.B.
        • Sauber-Schatz E.K.
        • Cook L.J.
        The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes.
        Accid. Anal. Prev. 2008;
        • Whitcome K.K.
        • Shapiro L.J.
        • Lieberman D.E.
        Fetal load and the evolution of lumbar lordosis in bipedal hominins.
        Nature. 2007;
        • Widen E.
        • Gallagher D.
        Body composition changes in pregnancy: measurement, predictors and outcomes.
        Eur. J. Clin. Nutr. 2014;
        • Wilson E.L.
        • Madigan M.L.
        • Davidson B.S.
        • Nussbaum M.A.
        Postural strategy changes with fatigue of the lumbar extensor muscles.
        Gait Posture. 2006;
        • Wu G.
        • Siegler S.
        • Allard P.
        • Kirtley C.
        • Leardini A.
        • Rosenbaum D.
        • Whittle M.
        • D'Lima D.D.
        • Cristofolini L.
        • Witte H.
        • Schmid O.
        • Stokes I.
        ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion–part I: ankle, hip, and spine. International Society of Biomechanics.
        J. Biomech. 2002; 35: 543-548
        • Xu X.
        • Qin J.
        • Catena R.D.
        • Faber G.S.
        • Lin J.H.
        Effect of aging on inter-joint synergies during machine-paced assembly tasks.
        Exp. Brain Res. 2013;
        • Xu H.
        • Hunt M.
        • Bo Foreman K.
        • Zhao J.
        • Merryweather A.
        Gait alterations on irregular surface in people with Parkinson's disease.
        Clin. Biomech. 2018;
        • Yoo H.
        • Shin D.
        • Song C.
        Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women.
        J. Phys. Ther. Sci. 2015;
        • Zhang Y.
        • Kiemel T.
        • Jeka J.
        The influence of sensory information on two-component coordination during quiet stance.
        Gait Posture. 2007;