The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain

[Current knowledge among German physiotherapists on the subject of pain]

BACKGROUND

Pain is an omnipresent symptom in the field of musculoskeletal healthcare. Person-centred care in accordance with current scientific recommendations requires comprehensive and evidence-based knowledge about pain. However, there appears to be a lack of knowledge in this area both internationally and nationally.

AIM

This study aimed to evaluate the pain-related knowledge and postural-structural-biomechanical (PSB) beliefs regarding pain among physiotherapists practicing in Germany.

METHOD

An online survey, which included the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ), was answered by n = 105 physiotherapists using SoSci Survey. A satisfactory result is achieved when at least 90% of the participants answer at least eight of the 12 questions correctly. Additionally, the possible influence of the variables 'academic degree' and 'working experience' of the participants on the questionnaire scores was investigated.

RESULTS

The average score of the rNPQ‑D was 70.8 ± 15.4% (95% CI: 67.8-73.8%). The average score of the EKPQ was 51.4 ± 26% (95% CI: 46.4-56.4%). Neither the rNPQ‑D (69.5% of participants; n = 73) nor the EKPQ (30.6% of participants; n = 32) yielded a satisfactory result. The scores of the questionnaires correlated moderately positively and statistically significantly with each other (r = 0.47; p < 0.001). The average score of the EKPQ was significantly lower than the average score of the rNPQ‑D (p < 0.01; d = 0.84). Academically trained therapists achieved higher average scores than those non-academically trained (p < 0.05; rNPQ-D: d = 0.48, EKPQ: d = 0.42). Furthermore, participants with ≤5 years of professional experience achieved significantly higher scores than participants with >5 years of professional experience (p < 0.05; rNPQ-D: d = 0.75; EKPQ: d = 0.68).

CONCLUSION

The knowledge among physiotherapists in Germany about pain appears to be deficient and strongly PSB-orientated. In addition, academically trained therapists seem to have a more pronounced theoretical and case-related knowledge of pain compared to graduates of vocational physiotherapy training programmes. To ensure successful and effective future treatment of individuals experiencing pain, it is imperative to systematically investigate the potential causes of such deficits. Physiotherapeutic pain care in Germany should strive for a systemic change in favour of evidence-based practice.

A critical review of the role of manual therapy in the treatment of individuals with low back pain

The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey.

[Current knowledge of German physiotherapy trainees and students on pain and the influence of a teaching intervention]

BACKGROUND

In order to properly inform patients about their pain and initiate targeted therapies, it is important for physiotherapists to learn about the latest scientific evidence on pain during their training.

AIM

This study aimed to assess the pain knowledge of German physiotherapy trainees and students. In addition, the influence of a teaching intervention (Pain Neuroscience Education, PNE) on their pain knowledge was investigated.

METHODS

An online test was performed, which contained the German versions of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ). This test was completed by physiotherapy trainees and students (N = 279) in their final semester of vocational education or graduation under virtual supervision. After the test, a sub-cohort of physiotherapy trainees (n = 31) received a four-hour online teaching intervention (PNE), whereupon two retests took place.

RESULTS

The mean rNPQ-D score (63.8%) was significantly higher than the mean EKPQ score (28.4%) (p < 0.001). There was a significant positive correlation between the scores of rNPQ-D and EKPQ (r = 0.365, p < 0.001). Undergraduate students from university (n = 142) achieved significantly higher scores in both questionnaires (p < 0.001) compared to trainees from vocational schools (n = 137). In the sub-cohort, the online teaching intervention significantly improved the scores of both questionnaires immediately (p < 0.001) and six weeks after intervention (p < 0.001).

CONCLUSION

The knowledge of German physiotherapy students about pain seems to be insufficient for an evidence-based treatment of pain patients. A PNE-based online learning program with the latest scientific evidence can significantly improve physiotherapy students' knowledge about pain.

Prevalence and Biopsychosocial Factors Associated With a Current Episode of Low Back Pain Among Adults With a Previous History of Low Back Pain: A Cross-sectional Study of Market Traders in an African Population

Low back pain (LBP) is the leading cause of years lived with disability globally, with Nigeria having one of the greatest burdens. A current episode of LBP is important in Nigeria, but the associated factors are unknown. This cross-sectional study investigated the prevalence, biomechanical, and psychosocial factors associated with a current episode of LBP among 700 adult market traders with previous LBP in an urban Nigerian population. Descriptive, bivariate, and multivariate analyses were conducted. The prevalence of a current episode of LBP was 76.4%. Factors associated with an increased risk of a current episode of LBP in a decreasing order of importance were exposure to biomechanical factors (aggregate [total] score) (odds ratio [OR] = 1.535; 95% confidence interval [CI] = 1.398-1.685); anxiety (OR = 1.182; 95% CI = 1.089-1.282); fear-avoidance beliefs (physical activity) (OR = 1.139; 95% CI = 1.029-1.261); fear-avoidance beliefs (work) (OR = 1.105; 95% CI = 1.047-1.165); while factors associated with a reduced risk of a current episode of LBP were ability to take breaks in the job in addition to scheduled breaks (OR = .430; 95% CI = .240-.773) and ability to control the order and pace of tasks (OR = .477; 95% CI = .236-.965). Occupational biomechanical and psychosocial factors were associated with a current episode of LBP in logistic regression models explaining 52.7% and 73.1% of the variation in a current episode of LBP. Occupational biomechanical factors, particularly handling large and bulky objects at arm's length and kneeling and squatting, produced the greatest risk of a current episode of LBP. PERSPECTIVE: Occupational biomechanical factors, occupational psychosocial factors, and personal psychosocial factors such as anxiety and fear-avoidance beliefs are associated with a current episode of LBP in Nigeria. Pragmatic public health and occupational health initiatives that modify exposure to these factors may be required in Nigeria.

An exploration of low back pain beliefs held by health care professionals in Northern America

BACKGROUND

Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs.

METHODS

Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis.

RESULTS

One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions.

CONCLUSIONS

These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.

Landau model for illustrating the learning and unlearning process of nociplastic pain

Recent advancements in understanding the consolidation of nociplastic pain point to a complex, non-conscious learned process of threat perception. Neurobiological pain education is emerging as a promising approach to unlearn nociplastic pain, supported by biopsychosocial tools such as exposure to movement, mindfulness, and group sharing formats. However, this approach is still not well-known among clinicians and the society at large, creating a communication problem that unfortunately perpetuates the suffering of patients. Herein, we propose a Landau model to describe the learning and unlearning process of nociplastic pain, aiming to clarify this complex situation and facilitate communication across different sectors of the society. Nociplastic pain corresponds to a first-order transition, with attention more likely in the alert-protection state than in the trust-explore state. Two appealing results of the model are that the perception of the critical context depends on personal history regarding the symptom and that biopsychosocial loops are formed when there is alarming learned historical information about the symptom, along with confused and contradictory expert information, as seen in nocebo messages. Learning and unlearning in the model correspond to a chang in control parametrs that can weigh more on the alert-protection state, trust-explore state, uncertain state or neutral state. This description clarifies why neurobiological education is the foundational therapy from which others must be built to embody the accessible, clear, and trustworthy information.

Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care-An Osteopathic Perspective

Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients' adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the context of person-centered participative care. Conclusions: Understanding individual neuromyofascial patterns could help healthcare practitioners, movement specialists, and bodyworkers in tailoring treatment plans, meeting patients' unique needs, and promoting a more effective personalized approach to care. The current perspective could spark debates within the professional community and provide a research roadmap for developing an evidence-informed interprofessional framework.

[Development and validation of a questionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain]

BACKGROUND

Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain.

AIM

The aim of the present study was to develop a questionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement.

METHODS

The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of a literature search and discussions between experts. In a pilot study, 32 pupils of a physiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain.

RESULTS

The internal consistency of the EKPQ was acceptable with a Cronbach's α = 0.784. There was a strong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed a mean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and a lower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved a mean score of 60.7% in the rNPQ‑D and a mean score of 31.8% in the EKPQ.

CONCLUSION

The newly developed EKPQ questionnaire seems to be a reliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that a high level of knowledge about the neurophysiology of pain does not exclude a PSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.

Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect

INTRODUCTION

While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects.

PURPOSE

In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects.

IMPLICATIONS

This masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the 'prism' of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context.

Patient Active Approaches in Osteopathic Practice: A Scoping Review

Background: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this prospective linkage has not been formally explored and is not well shared in the community of practice. The present review aims to appraise the relevant literature on the functioning and principles of Patient active osteopathic approaches (PAOAs) and explore a prospective model for selecting the different types of PAOA, highlighting their integration into patient management strategies. Methods: A scoping review was conducted to analyze the relevant literature on the functioning and the different principles of PAOA and to obtain a comprehensive perspective on the phenomenon. Results: The eligible articles provide insights into the mechanisms of functioning and principles of application of active approaches to be integrated with hands-on approaches. These results provide new insights into the relevance of PAOA to clinical practice. Conclusions: The proposal, emerging from the review, may promote discussions in the community of practice and provide a road map for research towards achieving an evidence-based structure for PAOA.

Environmental physiotherapy and the case for multispecies justice in planetary health

Background:Global environmental change is fundamentally altering the composition and functioning of our planetary ecosystem. Effectively presenting the largest threat to the health of present and future generations, these changes and their health impacts are forcing us to think and practice healthcare in much broader terms than ever before. Objective:In this article, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy developed through a succession of carefully developed arguments. Discussion:We show how an underpinning belief in human exceptionalism has engendered an exploitative relationship with our natural planetary environment that has both shaped Western science and healthcare and led to our current environmental health crisis. Building on the dependence of human health on our planetary ecosystem, approaches like planetary health hold great promise for a corresponding, paradigmatic turn in healthcare. They fall short of this however, where they perpetuate anthropocentric interests and interventionist practices that have underpinned healthcare to date. Drawing on ethical and post-human philosophies we argue against human exceptionalism and for a solidarity that includes other-than-humans as the primary characteristic of planetary existence. Conclusion:Building on this foundation, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy, grounded in ecological awareness, multispecies justice, and a range of consonant practices of passivity and accompaniment, conceived as an alternative to the commonplace interventionism of healthcare.

The why, where, and how clinical reasoning model for the evaluation and treatment of patients with low back pain

BACKGROUND

There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients.

OBJECTIVE

The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.

METHODS

This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.

CONCLUSIONS

This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.

The Influence of the Schoolbag on Standing Posture of First-Year Elementary School Students

The purpose of this study was to determine the influence of the mass of a schoolbag on standing posture in first-year elementary school children. First-year elementary school students (n = 76) participated in this study. The data was digitized and analyzed using SkillSpector and Kinovea. Results have shown a change of Center of Gravity (COG) position in all three anatomical planes (p < 0.01), as well as a change in two out of three measured postural angles-craniovertebral (p < 0.01) and craniocervical (p < 0.01) angle. The most important aspect of changed posture, anterior shift of COG, was measured to be 2.4 cm and was in moderate negative correlation with student body mass (-0.4, p < 0.01) and height (-0.4, p < 0.01) when students were encumbered with a schoolbag weighing 16.11% of their body mass, on the average. Also, this study confirms that when encumbered, students' head posture shifts to a more protracted position.

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

Objectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.

The biomechanical model in manual therapy: Is there an ongoing crisis or just the need to revise the underlying concept and application?

Different approaches to body biomechanics are based on the classical concept of "ideal posture" which is regarded as the state where body mass is distributed in such a way that ligamentous tensions neutralize the force of gravity and muscles retain their normal tone, as result of the integration of somatic components related to posture and balance mechanisms. When compromised, optimal posture can be restored through the balanced and effective use of musculoskeletal components; however, various research findings and the opinion of experts in this field suggest a move away from the dogmas that have characterized the idea of health dependent on ideal posture, to promote instead dynamic approaches based on the interdependency of the body systems as well as on the full participation of the person in the healing process. Following these concepts, this article proposes a revised biomechanical model that sees posture as the temporary result of the individual's current ability to adapt to the existing allostatic load through the dynamic interaction of extero-proprio-interoceptive information integrated at a neuromyofascial level. Treatments using this revised model aim to restore the optimal posture available to the person in that particular given moment, through the efficient and balanced use of neuro-myofascia-skeletal components in order to normalize aberrant postural responses, to promote interoceptive and proprioceptive integration and to optimize individual responses to the existing allostatic load. The latter is achieved via multimodal programs of intervention, in a salutogenic approach that, from a traditional perspective, evolves on an anthropological basis, to the point of centering its work on the person.

Australian physiotherapists and their engagement with people with chronic pain: do their emotional responses affect practice?

This study explores the experiences of Australian physiotherapists who see people with chronic pain as part of their daily practice. It has been established in the literature that Australian physiotherapists do not manage people with chronic pain well; however, the reasons for this are not well understood. This study aimed to explore this phenomenon through a qualitative approach that generated data about the perceptions of physiotherapists in regard to caring for people with chronic pain. Fourteen physiotherapists were interviewed using a semi-structured interview approach. The results indicate that the therapists experience emotional responses to people with chronic pain, which lead to difficulties in being able to successfully provide effective care. These findings also provide the beginnings of a framework that may support physiotherapists in engaging more successfully with people with chronic pain.

Foot posture, foot function and low back pain: the Framingham Foot Study

OBJECTIVE

Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002-05).

METHODS

Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables.

RESULTS

Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018).

CONCLUSION

These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain.

Classification system of the normal variation in sagittal standing plane alignment: a study among young adolescent boys

STUDY DESIGN

Cohort study.

OBJECTIVE

To construct a sagittal standing alignment classification system in which the clinical significance of identified subgroups was considered with spinal pain measures.

SUMMARY OF BACKGROUND DATA

Numerous grading systems for the categorization of sagittal standing alignment have been devised. However, no common consensus exists about which typology should be adopted. Furthermore, the clinical significance of proposed classification schemes has rarely been assessed in terms of their relationship with spinal pain. Given the importance of the adolescent period for musculoskeletal development, research within a young adolescent population is required.

METHODS

The study population consisted of 639 prepeak height velocity boys (mean age, 12.6 yr [standard deviation, 0.54 yr]). Sagittal posture was quantified during habitual standing; data were used to develop a classification system according to 3 gross postural and 5 lumbopelvic characteristics. Prevalence rates of spinal pain measures (pain and seeking care) were compared between postural subgroups.

RESULTS

Cluster analysis indicated 3 types of characteristic overall sagittal profiles: neutral global alignment (n = 266 [41.6%]), sway-back (n = 199 [31.1%]), and leaning-forward (n = 174 [27.2%]). Within each of these categories, postural subgroups could be established according to specific lumbopelvic features. Logistic regression revealed that prevalence (lifetime and month) of low back pain and neck pain was significantly higher in boys classified as having sway-back posture than in those classified as having neutral global alignment. Spinal pain measures did not differ between groups of the lumbopelvic subclassification.

CONCLUSION

Meaningful classifications exist for sagittal plane posture in young adolescent boys, both on gross body segment and lumbopelvic level. In terms of clinical importance, that is, low back pain and neck pain prevalence, postural subgrouping strategies based on the orientation of gross body segments are suggested to be superior when compared with lumbopelvic grading.

Comparison of Upper Arm Kinematics During a Volleyball Spike Between Players With and Without a History of Shoulder Injury

Volleyball players are at high risk of overuse shoulder injuries, with spike biomechanics a perceived risk factor. This study compared spike kinematics between elite male volleyball players with and without a history of shoulder injuries. Height, mass, maximum jump height, passive shoulder rotation range of motion (ROM), and active trunk ROM were collected on elite players with (13) and without (11) shoulder injury history and were compared using independent samplesttests (P< .05). The average of spike kinematics at impact and range 0.1 s before and after impact during down-the-line and cross-court spike types were compared using linear mixed models in SPSS (P< .01). No differences were detected between the injured and uninjured groups. Thoracic rotation and shoulder abduction at impact and range of shoulder rotation velocity differed between spike types. The ability to tolerate the differing demands of the spike types could be used as return-to-play criteria for injured athletes.

Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity

STUDY DESIGN

Cross-sectional baseline data set on the sagittal standing posture of 1196 adolescents.

OBJECTIVE

To describe and quantify common variations in the sagittal standing alignment in boys and girls who are in the same phase of growth and to explore the association between habitual standing posture and measures for spinal pain.

SUMMARY OF BACKGROUND DATA

Data on postural characteristics and spinal pain measures in adolescence are sparse, especially when somatic and biological maturity status is to be considered. Our understanding of the relationship between standing posture in the sagittal plane and spinal pain is also deficient.

METHODS

A total of 639 boys (age [mean ± SD], 12.6 ± 0.54 yr) and 557 girls (10.6 ± 0.47 yr), with predicted years from peak height velocity (PHV) being 1.2 ± 0.71 and 1.2 ± 0.59 pre-PHV, respectively, were studied. Postural examination included the assessment of global alignment and local spinopelvic characteristics, using post hoc analyses of digital images and direct body measurements (palpation, digital inclinometry, and wheeled accelerometry). Spinal pain experience was assessed by questionnaire.

RESULTS

A wide interindividual variation in sagittal posture characteristics was observed. Logistic regression analyses yielded global alignment parameters to be associated with low back pain (lifetime prevalence), neck pain (lifetime prevalence, 1-mo prevalence, and doctor visit), and thoracic spine pain (doctor visit) outcome measures. None of the included local spinopelvic parameters could be identified as an associated factor with measures of spinal pain.

CONCLUSION

The orientation of gross body segments with respect to the gravity line seems superior to local spinopelvic features in terms of clinical importance, at least in the current pre-PHV cohort. Opportunities may exist for postural subgrouping strategies to begin with global alignment parameters in order to gain further insight into the relationship between sagittal alignment and the relative risk of developing spinal pain/seeking medical consultation for this pain.