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Lamas V, Gueugnon M, Fournel I, Grelat M, Maillefert JF, Ornetti P, Martz P. Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations. Gait Posture 2021; 88:272-279. [PMID: 34144331 DOI: 10.1016/j.gaitpost.2021.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) leads patients to adapt their posture and walking parameters. Pelvic retroversion might be a compensation mechanism of pain. Pelvic and lower limbs compensations during gait are still not precisely understood, as well as the effect of a surgical decompression on them. These dynamic parameters can be studied through three-dimensional gait analysis. RESEARCH QUESTION Is the dynamic pelvic tilt modified after decompression surgery in LSS patients compared to asymptomatic subjects? MATERIAL AND METHODS 50 asymptomatic subjects (C-group) and 37 patients operated on for lumbar decompression underwent a three-dimensional gait analysis one month before (M0) and six months after (M6) the surgery. 3D gait analysis was performed and hip and knee flexion, trunk kinematics, walking speed, stride length and pelvic tilt during gait or dynamic pelvic tilt (dPT) were recorded. Health-related quality of life (HRQL) scores (Oswestry Disability Index (ODI) and Visual Analogic Scales (VAS)) and radiological assessment were performed preoperatively and postoperatively. RESULTS Mean values of maximum and minimum dPT in the LSS-group preoperatively were significantly higher compared to the C-group (respectively 10.9 (6.2)° versus 7.3 (5.6)°, p = 0.003; 7.7 (6.1)° versus 4.8 (5.8)°, p = 0.011), and were significantly lowered at M6 (respectively 10.9 (6.2)° versus 8.1 (4.8)°, p = 0.0087; and 7.7 (6.1)° versus 5.1 (4.7)°, p = 0.012), and became similar to the C-group. The dPT range of motion at M0 and M6 were similar, and were both significantly higher than control values. Mean values of maximum and minimum hip flexion were significantly higher at M0 compared to the C-group, and were significantly lowered at M6. No difference was found between the pre- and postoperative radiographic pelvic tilt. The VAS for lumbar pain, the VAS for radicular pain and the ODI were significantly decreased at M6. SIGNIFICANCE Compared to asymptomatic people, LSS patients walked with a pelvic anteversion, a hip flessum and a knee flessum before surgery, which tended to disappear after the surgical decompression. These differences were not noticed on static radiographs.
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Affiliation(s)
- Vincent Lamas
- Dijon University Hospital, Department of Orthopaedic Surgery, Dijon, France.
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.
| | | | - Michaël Grelat
- Dijon University Hospital, Department of Neurosurgery, Dijon, France.
| | - Jean-Francis Maillefert
- Dijon University Hospital, Department of Rheumatology, Dijon, France; INSERM, U1093, CAPS, Dijon, France.
| | - Paul Ornetti
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France; INSERM, U1093, CAPS, Dijon, France.
| | - Pierre Martz
- Dijon University Hospital, Department of Orthopaedic Surgery, Dijon, France; INSERM, U1093, CAPS, Dijon, France.
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Bumann H, Nüesch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Schären S, Mündermann A, Netzer C. Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking. Spine J 2020; 20:112-120. [PMID: 31479778 DOI: 10.1016/j.spinee.2019.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To understand the role of compensation mechanisms in the development and treatment of symptomatic degenerative lumbar spinal stenosis (DLSS), pelvic stability during walking should be objectively assessed in the context of clinical parameters. PURPOSE To determine the association among duration of symptoms, lumbar muscle atrophy, disease severity, pelvic stability during walking, and surgical outcome in patients with DLSS scheduled for decompression surgery. STUDY DESIGN/SETTING Prospective observational study with intervention. PATIENT SAMPLE Patients with symptomatic DLSS. OUTCOME MEASURES Oswestry Disability Index score; duration of symptoms; lumbar muscle atrophy; severity grade; pelvis rigidity during walking. METHODS Patients with symptomatic DLSS were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Duration of symptoms was categorized as: <2years, <5years, and >5years. Muscle atrophy at the stenosis level was categorized according to Goutallier. Bilateral cross-sectional areas of the erector spinae and psoas muscles were quantified from magnetic resonance imaging. Stenosis grade was assessed using the Schizas classification. Pelvic tilt was measured in standing radiographs. Pelvic rigidity during walking was assessed as root mean square of the pelvic acceleration in each direction (anteroposterior, mediolateral, and vertical) normalized to walking speed measured using an inertial sensor attached to the skin between the posterior superior iliac spine. RESULTS Body mass index but not duration of symptoms, lumbar muscle atrophy, pelvic rigidity, and stenosis grade explained changes in Oswestry Disability Index from before to after surgery. Patients with greater stenosis grade had greater pelvic rigidity during walking. Lumbar muscle atrophy did not correlate with pelvic rigidity during walking. Patients with lower stenosis grade had greater muscle atrophy and patients with smaller erector spinae and psoas muscle cross-sectional areas had a greater pelvis tilt. CONCLUSIONS Greater pelvic rigidity during walking may represent a compensatory mechanism of adopting a protective body position to keep the spinal canal more open during walking and hence reduce pain. Pelvic rigidity during walking may be a useful screening parameter for identifying early compensating mechanisms. Whether it can be used as a parameter for personalized treatment planning or outcome prognosis necessitates further evaluation.
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Affiliation(s)
- Helen Bumann
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Loske
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - S Kimberly Byrnes
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Faculty for Sport and Health Science, Technische Universität München, Munich, Germany
| | - Balázs Kovacs
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Ruben Janssen
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Neamat Allah N, Sigward S, Mohamed G, Elhafez S, Emran I. Effect of repeated application of rigid tape on pain and mobility deficits associated with sacroiliac joint dysfunction. J Back Musculoskelet Rehabil 2019; 32:487-496. [PMID: 30584116 DOI: 10.3233/bmr-181156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sacroiliac joint dysfunction (SIJD) accounts for up to 30% of patients with low back pain. Rigid taping techniques are often used for conservative treatment of SIJD related symptoms; however, its effectiveness has not been systematically evaluated. OBJECTIVES The aim of our study was to investigate the effect of rigid tape on pain, malalignment and mobility deficits associated with anterior innominate SIJD. METHODS Two groups (n= 37; experimental and control) diagnosed with SIJD participated in a randomized, controlled trial. Tape was applied for 2 weeks in the experimental group, whereas the control group received no treatment. 2 × 2 (group × time) GLM-MANOVA assessed effects of tape on pain; innominate rotation; and hip rotation range of motion. Chi-square and McNemar tests assessed the effect of tape on Gillet and Sitting forward flexion mobility tests; the Patrick, Posterior shear and Gaenslen pain provocation tests were used to test pain. Variables were assessed before (PRE) and after (POST) two weeks. RESULTS No group differences were observed for any variable PRE. Pain intensity, innominate rotation (p< 0.05) and number of positive mobility and pain provocation tests (p< 0.05) decreased from PRE versus POST in the experimental group. No differences were observed in the control group. CONCLUSION Two weeks of rigid tape for anterior innominate correction successfully reduced symptoms related to SIJD.
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Affiliation(s)
- Neama Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt.,Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Susan Sigward
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Ghada Mohamed
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Salam Elhafez
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Ihab Emran
- Department of Orthopaedic Surgery, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo 11559, Egypt
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Kuwahara W, Kurumadani H, Tanaka N, Nakanishi K, Nakamura H, Ishii Y, Ueda A, Deie M, Adachi N, Sunagawa T. Correlation between spinal and pelvic movements during gait and aggravation of low back pain by gait loading in lumbar spinal stenosis patients. J Orthop Sci 2019; 24:207-213. [PMID: 30322623 DOI: 10.1016/j.jos.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lumbar alignment of posterior or anterior tilts affects the exacerbation and remission of symptoms of lumbar spinal stenosis patients. This study aimed to clarify the correlation between spinal and pelvic movements during gait and the aggravation of low back pain after gait loading in lumbar spinal stenosis patients. METHODS A total of 29 patients with lumbar spinal stenosis completed leg and low back pain assessments and gait analysis before and after gait loading tests. Patients were divided into leg and low back pain change (n = 8), leg pain only change (n = 12), and non-change (n = 9) groups based on the differences of leg and low back pain between before and after the tests. Peak kinematic values of the anterior tilts of the trunk, thoracic spine, lumbar spine, and pelvis during the stance phase were obtained via three-dimensional gait analysis. RESULTS In the leg and low back pain change group, the anterior lumbar and pelvic tilts were larger after than before the tests; however, in the leg pain only change and non-change groups, only the anterior lumbar tilt was larger after than before the tests. Anterior lumbar tilt before and after the tests negatively correlated with the aggravation of low back pain, and an increase in the anterior pelvic tilt positively correlated with the aggravation of low back pain. CONCLUSIONS In lumbar spinal stenosis patients, smaller anterior lumbar tilt and larger anterior pelvic tilt during gait loading may affect the aggravation of low back pain by gait loading. Increasing in lumbar lordosis during gait might be one of the factors leading to low back pain in lumbar spinal stenosis patients.
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Affiliation(s)
- Wataru Kuwahara
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Haruka Nakamura
- Department of Rehabilitation, Kibinomori Rehabilitation Hospital, 1-30-1, Kibinomori-Minami, Oamishirasato-shi, Chiba, 299-3241, Japan
| | - Yosuke Ishii
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akio Ueda
- Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, 480-1195, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toru Sunagawa
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Kim MH, Oh JS. Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. J Phys Ther Sci 2015; 27:121-2. [PMID: 25642053 PMCID: PMC4305540 DOI: 10.1589/jpts.27.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/24/2014] [Indexed: 12/01/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of humeral head
compression taping (HHCT) on the strength of the shoulder external rotator muscle in
patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator
cuff tendinitis were recruited. The shoulder external rotator strength was measured using
a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate
within-group differences in the strength of the shoulder external rotator muscle.
[Results] Significantly higher shoulder external rotator peak torque and peak torque per
body weight were found in the HHCT condition than in the no-taping condition. [Conclusion]
HHCT may effectively increase the shoulder external rotator muscle strength in patients
with rotator cuff tendinitis.
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Affiliation(s)
- Moon-Hwan Kim
- Department of Physical Therapy, Graduate School, Yonsei University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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