1
|
Harvie DS, McEvoy M, Tomkinson GR. A comparison of visual and direct assessments of lumbar spine posture. J Bodyw Mov Ther 2024; 39:209-213. [PMID: 38876627 DOI: 10.1016/j.jbmt.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Posture is assessed clinically and used to guide treatment of low back pain. Collectively, the relevance of posture and clinical postural assessments have come under scrutiny. This study aimed to determine (a) the intra-rater and inter-rater reliability of visual assessments of lumbar lordosis, and (b) the agreement between visual and direct postural assessments. METHODS Ten physiotherapists visually assessed the lumbar lordosis from 3D scans of 50 asymptomatic participants, and 15 duplicates, using a grading scale of deviations (range: 0 = normal to 3 = severe). Lumbar lordosis angle was directly assessed using the Vitus Smart 3D whole body scanner. Cohen's Kappa was used to determine the intra-rater and inter-rater reliability of visual assessments, with polyserial correlation (ps) used to determine the agreement between visual and direct assessments. RESULTS Overall, 93% and 83% of all intra-rater and inter-rater differences in visual assessments were within a single grade point, respectively. The intra-rater and inter-rater reliability of visual assessments was moderate (κ (95%CI): 0.56 (0.45, 0.67)) and slight (κ (95%CI): 0.13 (0.08, 0.19)), respectively. The agreement between visual and direct assessments was moderate (ps = -0.41, p = 0.04). CONCLUSION Visual assessments of lumbar posture demonstrated moderate repeatability and agreement with quantitative assessments. While agreement between assessors was slight, 83% of the visual ratings were within a single grade point, suggesting greater coherence among clinicians than our statistics suggested. As with any clinical assessments involving uncertainty, postural assessment should not solely guide treatment.
Collapse
Affiliation(s)
- Daniel S Harvie
- Allied Health and Human Performance Unit, University of South Australia, Adelaide, Australia.
| | - Maureen McEvoy
- Allied Health and Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
2
|
Lin CW, Lin CF, Jankaew A, Chandee S, Kuno-Mizumura M. The role of muscle function and pointe shoe characteristics in Arabesque movement among ballet dancers with non-specific low back pain. Sports Biomech 2024:1-19. [PMID: 38888360 DOI: 10.1080/14763141.2024.2366209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
This study aimed to investigate posterior chain muscle function and the influence of pointe shoes in ballet dancers with and without low back pain (LBP) in the Arabesque. Twenty-nine young professional ballet dancers (17 with LBP and 12 healthy controls) were recruited. Muscle strength and mechanical properties of the erector spinae and hamstrings were assessed. The displacement of centre of mass (COM) during Arabesque under different shoe conditions (R-class, Chacott, and own shoes) was measured with a motion capture system. The LBP group exhibited greater dynamic stiffness and decreased mechanical stress relaxation time in the lateral hamstring compared to the control group. During Arabesque, the LBP group demonstrated significantly greater anterior-posterior displacement of the COM and a larger percentage of time to achieve maximal trunk extension angle. The COM displacement in vertical and medial-lateral directions was smaller in the R-class than in their own shoes. LBP impacts muscle mechanical properties, particularly in the lateral hamstring. The compromised muscle function resulted in a longer time to spinal extension during Arabesque, signifying that reduced trunk control contributed to greater COM displacement. Hence, it is essential to emphasise that evaluating muscle properties and dynamic postural control is imperative for dancers experiencing LBP.
Collapse
Affiliation(s)
- Chia-Wei Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Amornthep Jankaew
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sirinad Chandee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | |
Collapse
|
3
|
Sasaki Y, Suzuki D, Tokita R, Takashima H, Matsumura H, Nagoya S. Specific pelvic shape in patients with developmental dysplasia of the hip on 3D morphometric homologous model analysis. PLoS One 2024; 19:e0300938. [PMID: 38829863 PMCID: PMC11146717 DOI: 10.1371/journal.pone.0300938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique. METHODS Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated. RESULTS The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis. CONCLUSION The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.
Collapse
Affiliation(s)
- Yui Sasaki
- Division of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Sciences, Hokkaido Chitose Collage of Rehabilitation, Chitose, Japan
| | - Ryo Tokita
- Department of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hiroyuki Takashima
- Division of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hirofumi Matsumura
- Department of Physical Anthropology, School of Health Science, Sapporo Medical University, Sapporo, Japan
| | - Satoshi Nagoya
- Division of Orthopaedic Surgery, Sapporo Kojinkai Memorial Hospital, Sapporo, Japan
| |
Collapse
|
4
|
Fewster KM, Gallagher KM, Callaghan JP. Prolonged Standing-Induced Low Back Pain Is Linked to Extended Lumbar Spine Postures: A Study Linking Lumped Lumbar Spine Passive Stiffness to Standing Posture. J Appl Biomech 2024; 40:201-208. [PMID: 38467122 DOI: 10.1123/jab.2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Abstract
Postural assessments of the lumbar spine lack valuable information about its properties. The purpose of this study was to assess neutral zone (NZ) characteristics via in vivo lumbar spine passive stiffness and relate NZ characteristics to standing lumbar lordosis. A comparison was made between those that develop low back pain during prolonged standing (pain developers) and those that do not (nonpain developers). Twenty-two participants with known pain status stood on level ground, and median lumbar lordosis angle was calculated. Participants were then placed in a near-frictionless jig to characterize their passive stiffness curve and location of their NZ. Overall, both pain developers and nonpain developers stood with a lumbar lordosis angle that was more extended than their NZ boundary. Pain developers stood slightly more extended (in comparison to nonpain developers) and had a lower moment corresponding to the location of their extension NZ boundary. Overall, in comparison to nonpain developers, pain developers displayed a lower moment corresponding to the location of their extension NZ boundary which could correspond to greater laxity in the lumbar spine. This may indicate why pain developers have a tendency to stand further beyond their NZ with greater muscle co-contraction.
Collapse
Affiliation(s)
- Kayla M Fewster
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Kaitlin M Gallagher
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Jack P Callaghan
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
5
|
Zhang S, Yang H, Luo B, Cheng Y, Niu S, Yang C. Factors affecting functional disability in patients with non-specific chronic low back pain: a cross-sectional study. Front Neurol 2024; 15:1367400. [PMID: 38751880 PMCID: PMC11094354 DOI: 10.3389/fneur.2024.1367400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Background Knowledge about factors affecting functional disability in patients with non-specific chronic low back pain (NSCLBP) is helpful in guiding treatment, but there has been little systematic research on this topic. This study aimed to identify independent factors contributing to functional disability in NSCLBP patients especially the impact of sagittal parameters and body postures in work, learning, and daily life. Methods Sociodemographic data, sagittal parameters, Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and 36-item Short Form Health Survey (SF-36) of NSCLBP patients were collected. Patients were divided into a low-functional disability group (ODI ≤ 20) and a high-functional disability group (ODI > 20), and the ODI was converted to ranked ODI (RODI) accordingly. Sociodemographic data, sagittal parameters, NRS, and SF-36 were compared by univariate analysis between both groups. A correlation analysis of the aforementioned factors with the RODI was conducted. The sociodemographic data and sagittal parameters related to the RODI were analyzed by logistic regression to select potential RODI-associated factors. The level of significance was set at P < 0.05. Results Age, educational background, daily main posture while working or learning (DMPWL), daily standing time while working or learning (DSTTWL), daily sitting time while resting (DSITR), sacral slope-pelvic tilt (SS-PT), spinosacral angle (SSA), NRS, and SF-36 (except mental health, MH) were different between the two groups (P < 0.05). Correlation analysis showed that they were related to the RODI (P < 0.05). The logistic regression analysis indicated that the regression coefficients of a college degree, postgraduate diploma, DSITR, and SSA were (B = -0.197; P = 0.003), (B = -0.211; P = 0.006), (B = -0.139; P = 0.039), and (B = -0.207; P = 0.001), respectively, and the odds ratio (OR) and 95% confidence interval (CI) were 0.489 (0.308; 0.778), 0.299 (0.125; 0.711), 0.875 (0.772; 0.993), and 0.953 (0.925; 0.981), respectively. Conclusion Educational background, DSITR, and SSA are independent factors affecting functional disability in NSCLBP patients. NSCLBP patients with a lower educational background, shorter DSITR, or smaller SSA should be taken into account in clinical practice and therapeutic choices. Extending sitting time for rest and the avoidance of a forward-leaning standing position are beneficial for reducing functional disability in NSCLBP.
Collapse
Affiliation(s)
- Shenyue Zhang
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Huan Yang
- Department of Orthopedics, First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Beier Luo
- Department of Orthopedics, First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Yajun Cheng
- Department of Orthopedics, First Affiliated Hospital of the Naval Medical University, Shanghai, China
| | - Shengbo Niu
- Department of Orthopedics, First Affiliated Hospital of the Naval Medical University, Shanghai, China
- Department of Orthopedics, 83 Army Group Hospital, Xinxiang, Henan, China
| | - Changwei Yang
- Department of Orthopedics, First Affiliated Hospital of the Naval Medical University, Shanghai, China
| |
Collapse
|
6
|
Niu S, Yang H, Gao J, Zhang X, Ji X, Huang Y, Yang C. Correlation between sagittal parameters and disability of patients with nonspecific chronic low back pain: a cross-sectional study of 435 subjects. Spine J 2024; 24:634-643. [PMID: 37984541 DOI: 10.1016/j.spinee.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND CONTEXT Sagittal parameters are significantly correlated with health-related quality of life (HRQoL) in adult spinal deformity patients. Their association with HRQoL in patients with nonspecific chronic low back pain (NSCLBP) is unclear. PURPOSE To analyze the correlation between sagittal parameters and disability in NSCLBP patients. DESIGN A cross-sectional study. PATIENT SAMPLE Subjects included 435 patients with NSCLBP divided into low disability and high disability groups. OUTCOME MEASURES Function was measured using the Oswestry Disability Index (ODI). Pain intensity was measured using the Numeric Rating Scale (NRS) and HRQoL was measured using 36-item Short Form Health Survey (SF-36). METHODS Sagittal parameters, demographic data, ODI, SF-36 eight-dimensional scores and NRS scores of patients with NSCLBP were collected. Taking ODI=20 as the cut-off value, patients were divided into low disability group (ODI≤20) and high disability group (ODI>20), and ODI were converted to Ranked ODI (RODI) accordingly. Univariate analysis of the correlation among age, gender, body mass index (BMI), sagittal parameters, RODI, SF-36 eight-dimensional scores, NRS scores were then conducted. The variables related to RODI were analyzed by logistic regression to discover their independent influence on RODI. p<.05 was considered to indicate statistical significance. RESULTS A total of 435 patients with NSCLBP were included. Univariate correlation analysis showed that the correlation coefficients between age, sacral slope-pelvic tilt (SS-PT), spinosacral angle (SSA) and RODI were (r=0.126, p<.01), (r=-0.115, p<.05), (r=-0.116, p<.05), respectively. The logistic regression analysis indicated that the regression coefficients of age and SSA were 0.030 (p=.001), -0.044 (p=.002), respectively, and the odds ratio and 95% confidence interval (CI) were 1.031 (1.012, 1.050), 0.957 (0.930, 0.985). CONCLUSIONS Age and SSA are independent factors for disability of NSCLBP. SSA can comprehensively reflect the sagittal balance of the spine of patients with NSCLBP. Decreased SSA represents poor sagittal balance, which will increase the disability of NSCLBP.
Collapse
Affiliation(s)
- Shengbo Niu
- Department of Orthopaedics, The Eighty-Third Army Group Hospital, 371 Xiangyang Road, Xinxiang City, Henan, 453000, China; Department of Orthopedics, The First Affiliated Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Huan Yang
- Department of Orthopedics, The First Affiliated Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Jie Gao
- Department of Orthopaedics, The Eighty-Third Army Group Hospital, 371 Xiangyang Road, Xinxiang City, Henan, 453000, China
| | - Xuhui Zhang
- Department of Orthopaedics, The Eighty-Third Army Group Hospital, 371 Xiangyang Road, Xinxiang City, Henan, 453000, China
| | - Xianghui Ji
- Department of Orthopaedics, The Eighty-Third Army Group Hospital, 371 Xiangyang Road, Xinxiang City, Henan, 453000, China
| | - Youling Huang
- Department of Orthopaedics, The Eighty-Third Army Group Hospital, 371 Xiangyang Road, Xinxiang City, Henan, 453000, China
| | - Changwei Yang
- Department of Orthopedics, The First Affiliated Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China.
| |
Collapse
|
7
|
Leong CH, Forsythe C, Bohling Z. Posterior chain and core training improves pelvic posture, hamstrings-to-quadriceps ratio, and vertical jump performance. J Sports Med Phys Fitness 2024; 64:7-15. [PMID: 37800401 DOI: 10.23736/s0022-4707.23.15171-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Poor pelvic posture demonstrated through anterior pelvic tilt (APT) have been known to produce musculoskeletal imbalances involving weakness of the abdominal and pelvic musculature. While stretching and massage techniques have been reported to be effective in alleviating APT, it remains unclear if similar improvements can be elicited by posterior chain and core strength training. Therefore, the aim of this study was to examine the effect of an 8-week posterior and core strengthening program on APT, hamstrings-to-quadriceps (H:Q) strength ratio, and vertical jump performance in healthy individuals. METHODS Ten healthy males (age = 26±12 years; mass = 87±14 kg; height = 1.8±0.1 m) and nine healthy females (age = 22±4 years; mass = 70±14 kg; heigh t = 1.7±0.1 m) performed resistance training (2×/week; 40-45 mins) involving a combination of hip extensors and abdominal strengthening exercises for 8 weeks. APT (°), vertical jump power (W), vertical jump height (m), and H:Q ratio at 60, 180, and 300°/s were assessed prior to and following the resistance training program. RESULTS APT, vertical jump power, vertical jump height, and H:Q ratio at 60 and 180°/s, were significantly improved following 8 weeks of resistance training (all Ps<0.05). CONCLUSIONS Our main finding was that 8 weeks of resistance training emphasizing posterior chain and core strengthening was effective in reducing APT, improving vertical jump performance and H:Q ratio in healthy individuals. Our findings have potential implications for clinicians prescribing resistance training exercises to improve pelvic posture in healthy asymptomatic individuals at risk of developing chronic low back pain and lumbar-spinal pathologies due to excessive anterior pelvic tilt.
Collapse
Affiliation(s)
- Chee-Hoi Leong
- Department of Physical Education and Human Performance, Central Connecticut State University, New Britain, CT, USA -
| | - Cassandra Forsythe
- Department of Physical Education and Human Performance, Central Connecticut State University, New Britain, CT, USA
| | - Zachary Bohling
- Department of Physical Education and Human Performance, Central Connecticut State University, New Britain, CT, USA
| |
Collapse
|
8
|
Han Y, Fishbaugh J, Gonzalez CE, Aboyotes DA, Vicory J, Tang SY, Paniagua B. Geodesic Logistic Analysis of Lumbar Spine Intervertebral Disc Shapes in Supine and Standing Positions. SHAPE IN MEDICAL IMAGING : INTERNATIONAL WORKSHOP, SHAPEMI 2023, HELD IN CONJUNCTION WITH MICCAI 2023, VANCOUVER, BC, CANADA, OCTOBER 8, 2023, PROCEEDINGS. SHAPEMI (WORKSHOP) (2023 : VANCOUVER, B.C.) 2023; 14350:188-200. [PMID: 38259262 PMCID: PMC10801698 DOI: 10.1007/978-3-031-46914-5_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Non-specific lower back pain (LBP) is a world-wide public health problem that affects people of all ages. Despite the high prevalence of non-specific LBP and the associated economic burdens, the pathoanatomical mechanisms for the development and course of the condition remain unclear. While intervertebral disc degeneration (IDD) is associated with LBP, there is overlapping occurrence of IDD in symptomatic and asymptomatic individuals, suggesting that degeneration alone cannot identify LBP populations. Previous work has been done trying to relate linear measurements of compression obtained from Magnetic Resonance Imaging (MRI) to pain unsuccessfully. To bridge this gap, we propose to use advanced non-Euclidean statistical shape analysis methods to develop biomarkers that can help identify symptomatic and asymptomatic adults who might be susceptible to standing-induced LBP. We scanned 4 male and 7 female participants who exhibited lower back pain after prolonged standing using an Open Upright MRI. Supine and standing MRIs were obtained for each participant. Patients reported their pain intensity every fifteen minutes within a period of 2 h. Using our proposed geodesic logistic regression, we related the structure of their lower spine to pain and computed a regression model that can delineate lower spine structures using reported pain intensities. These results indicate the feasibility of identifying individuals who may suffer from lower back pain solely based on their spinal anatomy. Our proposed spinal shape analysis methodology have the potential to provide powerful information to the clinicians so they can make better treatment decisions.
Collapse
Affiliation(s)
- Ye Han
- Kitware, Inc., Clifton Park, NY 12065, USA
| | | | | | | | | | - Simon Y Tang
- Washington University in St. Louis, St. Louis, MO 63110, USA
| | | |
Collapse
|
9
|
Ledesma JA, Ottaway JC, Lambrechts MJ, Dees A, Thomas TL, Kurd MF, Radcliff KE, Anderson DG. Early Experience With Uniplanar Versus Biplanar Expandable Interbody Fusion Devices in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion. Neurospine 2023; 20:487-497. [PMID: 37401067 PMCID: PMC10323343 DOI: 10.14245/ns.2244870.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/20/2023] [Accepted: 02/17/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE To compare the early radiographic and clinical outcomes of expandable uniplanar versus biplanar interbody cages used for single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS A retrospective review of 1-level MIS-TLIFs performed with uniplanar and biplanar polyetheretherketone cages was performed. Radiographic measurements were performed on radiographs taken preoperatively, at 6-week follow-up, and 1-year follow-up. Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg at 3-month and 1-year follow-up. RESULTS A total of 93 patients (41 uniplanar, 52 biplanar) were included. Both cage types provided significant postoperative improvements in anterior disc height, posterior disc height, and segmental lordosis at 1 year. No significant differences in cage subsidence rates were found between uniplanar (21.9%) and biplanar devices (32.7%) at 6 weeks (odds ratio, 2.015; 95% confidence interval, 0.651-6.235; p = 0.249) with no additional instances of subsidence at 1 year. No significant differences in the magnitude of improvements based on ODI, VAS back, or VAS leg at 3-month or 1-year follow-up between groups and the proportion of patients achieving the minimal clinically important difference in ODI, VAS back, or VAS leg at 1 year were not statistically significantly different (p > 0.05). Finally, there were no significant differences in complication rates (p = 0.283), 90-day readmission rates (p = 1.00), revision surgical procedures (p = 0.423), or fusion rates at 1 year (p = 0.457) between groups. CONCLUSION Biplanar and uniplanar expandable cages offer a safe and effective means of improving anterior disc height, posterior disc height, segmental lordosis, and patient-reported outcome measures at 1 year postoperatively. No significant differences in radiographic outcomes, subsidence rates, mean subsidence distance, 1-year patient-reported outcomes, and postoperative complications were noted between groups.
Collapse
Affiliation(s)
- Jonathan A. Ledesma
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jesse C. Ottaway
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark J. Lambrechts
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Azra Dees
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Terence L. Thomas
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F. Kurd
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E. Radcliff
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - David G. Anderson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
10
|
Khoshroo F, Seidi F, Bayattork M, Moghadas-Tabrizi Y, Nelson-Wong E. Distinctive characteristics of prolonged standing low back pain developers' and the associated risk factors: systematic review and meta-analysis. Sci Rep 2023; 13:6392. [PMID: 37076546 PMCID: PMC10115839 DOI: 10.1038/s41598-023-33590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/15/2023] [Indexed: 04/21/2023] Open
Abstract
Pain developers (PDs) are considered a pre-clinical low back pain (LBP) population at risk of clinical LBP development and thus exacting great social and economic costs. Therefore, it is necessary to comprehensively investigate their distinctive characteristics and the risk factors of standing-induced LBP based on which appropriate preventive measures can be planned. Scopus, Web of Science, and PubMed databases as well as Google Scholar and ProQuest were systematically searched from inception through 14 July 2022 using a combination of terms relevant to 'standing' and 'LBP'. Studies with low risk of bias in English and Persian using a methodological quality scoring system were deemed eligible for inclusion if they were laboratory studies using prolonged standing duration greater than 42 min to classify adult PDs and non-pain developers (NPDs) without a history of LBP. PDs were compared with NPDs in demographics, biomechanical, and psychological outcomes. Weighted or standardized mean differences, and Hedge's g were generated to determine the pooled effect sizes using STATA software version 17. 52 papers and theses involving 1070 participants (528 PDs and 542 NPDs) were eligible for inclusion in the systematic review 33 of which were used in meta-analyses. Significant differences between PDs and NPDs in terms of movement patterns, muscular, postural, psychological, structural, and anthropometric variables were evidenced. The following factors were found to have a statistically significant association with standing-induced LBP: lumbar fidgets (Hedge's g - 0.72, 95% CI - 1.35 to - 0.08, P = 0.03), lumbar lordosis in participants over 25 years (Hedge's g 2.75, 95% CI 1.89-3.61, P < 0.001), AHAbd test (WMD 0.7, 95% CI 0.36-1.05, P < 0.001), GMed co-activation (Hedge's g 4.24, 95% CI 3.18-5.3, P < 0.001), and Pain Catastrophizing Scale (WMD 2.85, 95% CI 0.51-5.19, P = 0.02). Altered motor control displayed in AHAbd test and higher lumbar lordosis in individuals over 25 years seem to be probable risk factors for standing-induced LBP. In order to detect standing-induced LBP risk factors, future researchers should investigate the association of the reported distinctive characteristics to the standing-induced LBP and that whether they are manipulable through various interventions.
Collapse
Affiliation(s)
- Fatemeh Khoshroo
- Health and Sports Medicine Department, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Foad Seidi
- Health and Sports Medicine Department, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran.
| | - Mohammad Bayattork
- Sport Sciences and Physical Education, Faculty of Humanities Science, University of Hormozgan, Bandar Abbas, Iran
| | - Yousef Moghadas-Tabrizi
- Health and Sports Medicine Department, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Erika Nelson-Wong
- Department of Physical Therapy, Augustana University, Sioux Falls, SD, USA
| |
Collapse
|
11
|
Bednár R, Líška D, Gurín D, Vnenčaková J, Melichová A, Koller T, Skladaný Ľ. Low back pain in patients hospitalised with liver cirrhosis- a retrospective study. BMC Musculoskelet Disord 2023; 24:310. [PMID: 37076822 PMCID: PMC10114370 DOI: 10.1186/s12891-023-06424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Lower back pain is a common issue, but little is known about the prevalence of pain in patients with liver cirrhosis during hospitalisation. Therefore, the objective of this study was to determine lower back pain in patients with liver cirrhosis. METHODS The sample consisted of patients with liver cirrhosis (n = 79; men n = 55; women n = 24; mean age = 55.79 ± 12.52 years). The hospitalised patients were mobile. The presence and intensity of pain were assessed in the lumbar spine during hospitalisation. The presence of pain was assessed using the visual analogue pain scale (0-10). The range of motion of the lower spine was assessed using the Schober and Stibor tests. Frailty was measured by Liver Frailty Index (LFI). The condition of liver disease was evaluated using The Model For the End-Stage Liver Disease (MELD) and Child-Pugh score (CPS) and ascites classification. Student's t test and Mann-Whitney test were used for analysis of the difference of group. Analysis of variance (ANOVA) with the Tukey post hoc test was used to test differences between categories of liver frailty index. The Kruskal-Wallis test was used to test pain distribution. Statistical significance was determined at the α-0.05 significance level. RESULT The prevalence of pain in patients with liver cirrhosis was 13.92% (n = 11), and the mean intensity of pain according to the visual analogue scale was 3.73 (± 1.90). Lower back pain was present in patients with ascites (15.91%; n = 7) and without ascites (11.43%; n = 4). The prevalence of lower back pain was not statistically significant between patients with and without ascites (p = 0,426). The base of Schober's assessment mean score was 3.74 cm (± 1.81), and based on Stibor's assessment mean score was 5.84 cm (± 2.23). CONCLUSION Lower back pain in patients with liver cirrhosis is a problem that requires attention. Restricted spinal mobility has been reported in patients with back pain, according to Stibor, compared to patients without pain. There was no difference in the incidence of pain in patients with and without ascites.
Collapse
Affiliation(s)
- R Bednár
- Department of Physiatry, Balneology and Rehabilitation of the Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - D Líška
- Faculty of Arts, Department of Physical Education and Sports, Matej Bel University, Tajovského 40, Banská Bystrica, 974 01, Slovakia.
| | - D Gurín
- Faculty of Health Care, Slovak Medical University, Banská Bystrica, Slovakia
| | - J Vnenčaková
- 2nd Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - A Melichová
- Faculty of Health Care, Slovak Medical University, Banská Bystrica, Slovakia
| | - T Koller
- Gastroenterology and Hepatology Subdivision, 5th Department of Internat Medicine, Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ľ Skladaný
- 2nd Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| |
Collapse
|
12
|
Arippa F, Nguyen A, Pau M, Harris-Adamson C. Movement Behavior and Health Outcomes among Sedentary Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4668. [PMID: 36901678 PMCID: PMC10037417 DOI: 10.3390/ijerph20054668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sedentary behavior, which is highly prevalent among office workers, is associated with multiple health disorders, including those of the musculoskeletal and cardiometabolic systems. Although prior studies looked at postures or physical activity during work or leisure time, few analyzed both posture and movement throughout the entire day. OBJECTIVE This cross-sectional pilot study examined the movement behavior of sedentary office workers during both work and leisure time to explore its association with musculoskeletal discomfort (MSD) and cardiometabolic health indicators. METHODS Twenty-six participants completed a survey and wore a thigh-based inertial measuring unit (IMU) to quantify the time spent in different postures, the number of transitions between postures, and the step count during work and leisure time. A heart rate monitor and ambulatory blood pressure cuff were worn to quantify cardiometabolic measures. The associations between movement behavior, MSD, and cardiometabolic health indicators were evaluated. RESULTS The number of transitions differed significantly between those with and without MSD. Correlations were found between MSD, time spent sitting, and posture transitions. Posture transitions had negative correlations with body mass index and heart rate. CONCLUSIONS Although no single behavior was highly correlated with health outcomes, these correlations suggest that a combination of increasing standing time, walking time, and the number of transitions between postures during both work and leisure time was associated with positive musculoskeletal and cardiometabolic health indicators among sedentary office workers and should be considered in future research.
Collapse
Affiliation(s)
- Federico Arippa
- School of Public Health, University of California, Berkeley, CA 94720, USA
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Athena Nguyen
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Carisa Harris-Adamson
- School of Public Health, University of California, Berkeley, CA 94720, USA
- Department of Medicine, University of California, San Francisco, CA 94143, USA
| |
Collapse
|
13
|
Ledesma JA, Lambrechts MJ, Dees A, Thomas T, Hiranaka CG, Kurd MF, Radcliff KE, Anderson DG. Static versus Expandable Interbody Fusion Devices: A Comparison of 1-Year Clinical and Radiographic Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Asian Spine J 2023; 17:61-74. [PMID: 35785911 PMCID: PMC9977975 DOI: 10.31616/asj.2021.0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To compare the radiographic and clinical outcomes of static versus expandable interbody cages in transforaminal lumbar interbody fusion using minimally invasive surgery (MIS-TLIF). OVERVIEW OF LITERATURE Expandable interbody cages may potentially improve radiographic and clinical outcomes following MIS-TLIF compared to static pages, but at a potentially higher cost and increased rates of subsidence. METHODS A retrospective chart review of 1- and 2-level MIS-TLIFs performed from 2014 to 2020 was reviewed. Radiographic measurements were obtained preoperatively, 6 weeks postoperatively, and at final follow-up. Patient-reported outcome measures (PROMs) including the Oswestry Disability Index, Visual Analog Scale (VAS) back, and VAS leg were evaluated. Multivariate linear regression analysis determined the effect of cage type on the change in PROMs, controlling for demographic characteristics. Alpha was set at 0.05. RESULTS A total of 221 patients underwent MIS-TLIF including 136 static and 85 expandable cages. Expandable cages had significantly greater anterior (static: 11.41 mm vs. expandable: 13.11 mm, p <0.001) and posterior disk heights (static: 7.22 mm vs. expandable: 8.11 mm, p <0.001) at 1-year follow-up. Expandable cages offered similar improvements in segmental lordosis at 6 weeks (static: 1.69° vs. expandable: 2.81°, p =0.243), but segmental lordosis was better maintained with expandable cages leading to significant differences at 1-year follow-up (static: 0.86° vs. expandable: 2.45°, p =0.001). No significant differences were noted in total complication (static: 12.5% vs. expandable: 16.5%, p =0.191) or cage subsidence rates (static: 19.7% vs. expandable: 22.4%, p =0.502) groups at 1-year follow-up. CONCLUSIONS Expandable devices provide greater improvements in radiographic measurements including anterior disk height, posterior disk height, and segmental lordosis, but this did not lead to significant improvements in PROMs, complication rates, subsidence rates, or subsidence distance.
Collapse
Affiliation(s)
| | - Mark J Lambrechts
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Azra Dees
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Terence Thomas
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Mark Faisal Kurd
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E Radcliff
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Greg Anderson
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
14
|
Rezaei R, Taghipour M, Ebrahimi H, Rayati M, Talebi G. Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:510-516. [PMID: 37674696 PMCID: PMC10479825 DOI: 10.22038/abjs.2023.68478.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/13/2023] [Indexed: 09/08/2023]
Abstract
Objectives The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). Methods In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. Results The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). Conclusion In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.
Collapse
Affiliation(s)
- Reza Rezaei
- Department of Physiotherapy, school of rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Taghipour
- Movement impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Hadi Ebrahimi
- Movement impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Rayati
- Department of Physiotherapy, school of rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Ghadamali Talebi
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
15
|
Shin SS, An DH, Yoo WG. Assessing the effects of sway-back posture on global and regional spinal sagittal angles using inertial measurement units. J Back Musculoskelet Rehabil 2022; 36:661-667. [PMID: 36530076 DOI: 10.3233/bmr-220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture. OBJECTIVE To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs). METHODS This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for 5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position. RESULTS Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle. CONCLUSION It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture.
Collapse
|
16
|
Lin GX, Kim JS, Kotheeranurak V, Chen CM, Hu BS, Rui G. Does the application of expandable cages in TLIF provide improved clinical and radiological results compared to static cages? A meta-analysis. Front Surg 2022; 9:949938. [PMID: 36034361 PMCID: PMC9400024 DOI: 10.3389/fsurg.2022.949938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed to provide a direct meta-analysis of the evidence comparing outcomes between expandable cages and static cages in patients with transforaminal lumbar interbody fusion (TLIF). Methods A search of relevant materials from databases was performed from inception to March 7, 2022. Clinical and radiological outcomes were included. Results Ten studies (1,440 patients) were included. The anterior disc height and foraminal height for expandable cages were substantially higher than those for static cages at the final follow-up (P < 0.0001; P = 0.05). In comparison with static cages, although not statistically significant, expandable cages showed beneficial results, including an increase in posterior disc height and segmental lordosis. There were no statistically significant differences in segmental lordosis, lumbar lordosis, pelvic parameters, cage subsidence, or fusion rates (P > 0.05). Oswestry disability index scores for expandable cages were substantially lower than those for static cages at the final follow-up (P = 0.0007). Interestingly, although the preoperative visual analog scores for back and leg pain were significantly higher in the expandable group than in the static group (P < 0.0001; P = 0.008), there was no significant difference between the static and expandable groups during the final follow-up (P = 0.51; P = 0.85). Conclusions Expandable cages are associated with improved functional outcomes and restored postoperative disc and foraminal heights in patients with TLIF. In addition, no statistically significant differences were observed in segmental lordosis, lumbar lordosis, pelvic parameters, cage subsidence, or fusion rate.
Collapse
Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
| |
Collapse
|
17
|
Janyathitipath T, Sakulsriprasert P, Wattananon P, Kantha P. The effects of hip flexor stretching with and without abdominal exercises in asymptomatic individuals with hyperlordosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Hyperlordosis is associated with shortened hip flexor muscles, causing low back pain. The aim of this study was to investigate the effects of hip flexor stretching with and without abdominal exercises in individuals with hyperlordosis. Methods A total of 30 participants with hyperlordosis, aged between 20 and 30 years, were divided into three groups. Participants in the hold-relax group performed hold-relax stretching for 10 seconds, five repetitions, on both legs. Participants in the abdominal hollowing group performed hold-relax stretching and added an abdominal hollowing exercise for 10 seconds a repetition, 10 repetitions a set for three sets. Participants in the curl-up group performed hold-relax stretching and then performed curl-up exercises for 10 repetitions a set for three sets. The angle of lumbar lordosis, hip muscle length (degrees), percentage of maximum voluntary contraction of transversus abdominis and internal abdominal oblique, external abdominal oblique, rectus abdominis, lumbar erector spinae and multifidus muscles were investigated at pre-test, post-test and followed up 3 days after the end of the intervention. Results Significant within-group differences were found in the angle of lumbar lordosis for all groups (P<0.05), muscle length of hip flexor, and percentage of maximum voluntary contraction of the lumbar erector spinae and multifidus muscles in the curl-up group (P<0.05). The significant difference between pre-test and follow up in the hold-relax group and curl-up group reflects the retention of at least 3 days. Conclusions Hold-relax stretching can reduce the angle of lumbar lordosis and increase hip muscle length. In the curl-up group, the lumbar erector spinae and multifidus muscles decreased. Therefore, performing curl-up exercises after hold-relax stretching is recommended to decrease the angle of lumbar lordosis and percentage of maximum voluntary contraction of lumbar erector spinae and multifidus muscles.
Collapse
Affiliation(s)
- Thanachaporn Janyathitipath
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Prasert Sakulsriprasert
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Peemongkon Wattananon
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Phunsuk Kantha
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| |
Collapse
|
18
|
Lin MIB, Yen YT, Chang CH. Use of an inflatable mat to reduce body discomfort development when performing computer work at a standing desk. ERGONOMICS 2022; 65:1015-1034. [PMID: 34797209 DOI: 10.1080/00140139.2021.2009042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to determine the effects of inflatable mat design on body discomfort, task performance, and musculoskeletal exposures during standing computer work. Twenty-seven healthy adults completed three 2-hour standing trials on different mediums (concrete floor, foam mat, and inflatable mat) on different days in an experimental laboratory. Both mats were associated with reduced discomfort in all lower-body regions and increased typing performance compared to the concrete floor. Perceived discomfort in lower extremities (except thighs) was further alleviated while standing on the inflatable mat than on the foam mat. Use of the inflatable mat led to increased lower-body muscle activity, a flexed lower back, and a wide range of sagittal knee movements. As standing time increased, body discomfort increased, typing accuracy decreased, and there were increased variations in muscle activity and postural movements in the lower body. The inflatable mat shows potential to improve the ergonomic experience during prolonged standing. Practitioner summary: Incorporating standing postures in office-based workplaces can reduce sitting time and may mitigate the health hazards associated with sedentary behaviour. With adequate weight-shifting movements, using an inflatable mat for standing could be an effective way to lessen discomfort and accumulated musculoskeletal strain due to constrained standing, without jeopardising task productivity. Abbreviations: APDF: amplitude probability distribution function. AVR: average rectified value. CI: confidence interval. CMRR: common mode rejection ratio. COP: center of pressure. CV: coefficient of variation. EA: electrical activity. EMG: electromyography. FL: fibularis longus. GM: gluteus medius. LBP: lower back pain. LES: lumbar erector spinae. MVC: maximum voluntary contraction. PD: pain developer. rANOVA: repeated-measures analysis of variance. SOL: soleus. VAS: visual analog scale. WPM: words per minute.
Collapse
Affiliation(s)
- Ming-I Brandon Lin
- Department of Industrial and Information Management, National Cheng-Kung University, Tainan, Taiwan
- Institute of Information Management, National Cheng-Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Department of Industrial and Information Management, National Cheng-Kung University, Tainan, Taiwan
| | - Chun Han Chang
- Department of Industrial and Information Management, National Cheng-Kung University, Tainan, Taiwan
| |
Collapse
|
19
|
Cady K, Powis M, Hopgood K. Intrarater and interrater reliability of the modified Thomas Test. J Bodyw Mov Ther 2022; 29:86-91. [DOI: 10.1016/j.jbmt.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/16/2021] [Accepted: 09/19/2021] [Indexed: 01/16/2023]
|
20
|
Stansfield E, Fischer B, Grunstra NDS, Pouca MV, Mitteroecker P. The evolution of pelvic canal shape and rotational birth in humans. BMC Biol 2021; 19:224. [PMID: 34635119 PMCID: PMC8507337 DOI: 10.1186/s12915-021-01150-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The human foetus typically needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women, the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part of the birth canal has a pronounced anteroposteriorly oval shape. RESULTS Here, we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist the pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress, and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability. CONCLUSIONS This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that the mediolateral elongation has evolved because of the limits on the anteroposterior diameter imposed by upright posture. We show that an anteroposteriorly deeper inlet would require greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements of the pelvic inlet and outlet likely have led to the complex shape of the pelvic canal and to the evolution of rotational birth characteristic of humans.
Collapse
Affiliation(s)
- Ekaterina Stansfield
- Department of Evolutionary Biology, Unit for Theoretical Biology, University of Vienna, Djerassiplatz 1, 1030, Vienna, Austria.
| | - Barbara Fischer
- Department of Evolutionary Biology, Unit for Theoretical Biology, University of Vienna, Djerassiplatz 1, 1030, Vienna, Austria
| | - Nicole D S Grunstra
- Department of Evolutionary Biology, Unit for Theoretical Biology, University of Vienna, Djerassiplatz 1, 1030, Vienna, Austria
- Konrad Lorenz Institute for Evolution and Cognition Research, Martinstrasse 12, 3400, Klosterneuburg, Austria
- Mammal Collection, Natural History Museum Vienna, Burgring 7, 1010, Vienna, Austria
| | - Maria Villa Pouca
- Faculty of Engineering of University of Porto (FEUP), Rua Dr. Roberto Frias, s/n, 4200-465, Porto, Portugal
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI/LAETA), Rua Dr. Roberto Frias, 400, 4200-465, Porto, Portugal
| | - Philipp Mitteroecker
- Department of Evolutionary Biology, Unit for Theoretical Biology, University of Vienna, Djerassiplatz 1, 1030, Vienna, Austria.
| |
Collapse
|
21
|
Karimi Z, Mazloumi A, Sharifnezhad A, Jafari AH, Kazemi Z, Keihani A, Mohebbi I. Determining the interactions between postural variability structure and discomfort development using nonlinear analysis techniques during prolonged standing work. APPLIED ERGONOMICS 2021; 96:103489. [PMID: 34098408 DOI: 10.1016/j.apergo.2021.103489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Nonlinear analysis techniques provide a powerful approach to explore dynamics of posture-related time-varying signals. The aim of this study was to investigate the fundamental interactions between postural variability structure and discomfort development during prolonged standing. METHODS Twenty participants, with equal distribution for gender and standing work experience (SWE), completed a simulated long-term standing test. Low back and legs discomfort, center of pressure, lumbar curvature, and EMG activity of trunk and leg muscles were monitored. Nonlinear measures including largest lyapunov exponent, multi-scale entropy, and detrended fluctuation analysis were applied to characterize the variability structure (i.e., complexity) in each signal. The size (i.e., amount) of variability was also computed using traditional linear metrics. RESULTS With progress of low back and legs discomfort over standing periods, significant lower levels were perceived by the participants having SWE. The amount of variability in all signals (except external oblique EMG activity) were significantly increased with the time progress for all participants. The structure of variability in most signals demonstrated a lower complexity (more regularity) with fractal properties that deviated from 1/f noise. The SWE group showed a higher complexity levels. CONCLUSIONS Overall, the findings verified variations in structure and amount of the postural variability. However, nonlinear analysis identified postural strategies according to the perceived discomfort in a different way. These results provide supports for future application of nonlinear tools in evaluating standing tasks and related ergonomics interventions as it allows further insight into how discomfort development impact the structure of postural changes.
Collapse
Affiliation(s)
- Zanyar Karimi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Occupational Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Adel Mazloumi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Sharifnezhad
- Department of Sport Biomechanics and Technology, Sport Sciences Research Institute, Tehran, Iran
| | - Amir Homayoun Jafari
- Medical Physics & Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Kazemi
- Department of Ergonomics, School of Public Health, Iran University of Medical Sciences, Iran
| | - Ahmadreza Keihani
- Medical Physics & Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
22
|
Shin SS, Yoo WG. Differences in regional and global lumbar angle during slumped sitting and upright sitting among global three subgroups. J Back Musculoskelet Rehabil 2021; 34:877-885. [PMID: 34057131 DOI: 10.3233/bmr-200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate differences in regional lumbar lordosis (RLL) and global lumbar lordosis (GLL) angle during slumped sitting and upright sitting among three global subgroups. METHODS A total of 48 young asymptomatic volunteers stood in a comfortable posture, sat upright, and sat in a slumped position for 5 seconds, with inertial measurement units attached to the T10, L3, and S2 vertebrae. According to standing measurement, the participants were categorized into flat-back (GLL < 20∘), normal lordosis (20∘⩽ GLL < 30∘), and hyper-lordosis (30∘⩽ GLL < 40∘) groups. RESULTS Both the GLL and RLL in the flat-back group were reduced lumbar lordosis in the upright sitting posture and increased lumbar kyphosis in the slumped sitting postures compared to the other groups (p< 0.05), but the range of motion during the transition from upright sitting to slumped sitting was lower than that of the normal and hyper-lordosis groups (p< 0.05). GLL in standing was a moderate correlation with GLL and RLL during upright sitting (p< 0.05). However, there was a strong correlation between GLL and RLL kinematics during upright and slumped sitting (p< 0.05). CONCLUSIONS Flat-back posture is a potential source of low back pain during both upright and slumped sitting compared to the normal and hyper-lordosis groups. Posture measurements in a standing and sitting position conducted to assess lordosis should consider the relationship between GLL and RLL.
Collapse
|
23
|
Lai CS, Cerpa M, Zuckerman SL, Menger R, Lenke LG. L5 Vertebral Column Resection for Correction of Severe Lumbar Hyperlordosis and Pelvic Anteversion in an Adolescent With Prior Myelomeningocele Repair and Lumbar Fusion: Case Report. Oper Neurosurg (Hagerstown) 2021; 21:E129-E135. [PMID: 33822211 DOI: 10.1093/ons/opab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Lumbar hyperlordosis in ambulatory children is an uncommon but potentially problematic spinal deformity, and the operative management has not been comprehensively described. CLINICAL PRESENTATION We report the case of a 14-yr-old girl presenting with severe progressive lumbar hyperlordosis (-122°) and sagittal imbalance (-6 cm). She had multiple prior surgeries, including myelomeningocele repair at 10 d old, midlumbar meningioma resection at 8 mo old, and posterior lumbar instrumented spinal fusion at 5 yr old. She presented with progressive lumbosacral back pain and intermittent numbness in her left lower extremity, and severe skin contractures over her prior posterior incisions. From an all posterior approach, prior implants and dural scar were removed and then an L5 vertebral column resection (VCR) was performed to disarticulate her lumbar spine from her anteverted pelvis, allowing for slow distraction forces to correct her lumbar hyperlordosis. This was followed by a T7-sacrum fusion using pedicle screws and iliac screws, with autologous bone graft and plastic surgery wound closure. Postoperatively, lumbar lordosis was corrected to -55° and sagittal balance reduced to -0.5 cm. At 10-wk and 14-mo follow-ups, the patient reported resolution of her back pain with no limitations in physical activities. Dramatic improvement was seen in both her preoperative to 14-mo postoperative Oswestry Disability Index (ODI) (54 to 12) and Scoliosis Research Society Scoliosis Research Society (SRS)-22r (54 to 93) scores. CONCLUSION This case highlights a rare presentation of severe progressive lumbar hyperlordosis in an ambulatory adolescent after myelomeningocele repair, meningioma resection, and posterior lumbar instrumented spinal fusion with subsequent surgical treatment incorporating important components of both spinal and plastic surgery involvement.
Collapse
Affiliation(s)
- Christopher S Lai
- The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Meghan Cerpa
- The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Scott L Zuckerman
- The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Richard Menger
- Department of Neurosurgery, USA Health, Mobile, Alabama, USA
| | - Lawrence G Lenke
- The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
24
|
Use of a Spinal Traction Device during Work Shift in Assembly Line Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147708. [PMID: 34300157 PMCID: PMC8305420 DOI: 10.3390/ijerph18147708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022]
Abstract
Increasing back discomfort and spinal shrinkage during the workday is a problem that affects assembly line workers. The aim of this research was to analyze the effect of a spinal traction system on discomfort, spinal shrinkage, and spinal sagittal alignment in assembly line workers, who are in prolonged standing conditions during a workday. A total of 16 asymptomatic males were recruited to assess spinal shrinkage, spinal sagittal alignment, and back discomfort during the workday. The measurement was carried out in two days of work, a normal day, and the other using a spinal traction device utilized in two breaks during the workday. Assembly line workers lost height significantly on both control and intervention days. No differences were found between days. No changes were found in spinal sagittal alignment on the control day. Lumbar lordosis angle increased significantly at the end of the intervention day. The use of a spinal traction device during the workday in two breaks time did not significantly reduce the spinal shrinkage of healthy workers. Lumbar lordosis angle increased significantly at the end of the spinal traction intervention day. Prospective studies would be necessary to clarify the possible benefits of the traction device.
Collapse
|
25
|
Snodgrass SJ, Ryan KE, Miller A, James D, Callister R. Relationship between Posture and Non-Contact Lower Limb Injury in Young Male Amateur Football Players: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126424. [PMID: 34198516 PMCID: PMC8296252 DOI: 10.3390/ijerph18126424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022]
Abstract
Posture, a potentially modifiable injury risk factor, is considered important in injury screening/prevention in athletes, yet few studies investigate relationships between posture and injury. This prospective cohort study investigated whether static posture is associated with lower limb injury risk in male football players (n = 263). Nine aspects of static standing posture (left and right rearfoot, knee interspace, lateral knee, lumbar lordosis, thoracic kyphosis, scoliosis S and C, forward head) were assessed from photographs during the pre-season using the modified Watson and Mac Donncha scale, which was dichotomised for analysis (deviated or normal). Player characteristics (age, height, mass, body mass index, competition level), match/training exposure, and previous and in-season non-contact lower limb injuries were recorded. Binary logistic regression investigated relationships between posture and injury (previous and in-season). Eighty previous and 24 in-season lower limb injuries were recorded. Previous injury was not associated with any postural variable. In-season injury was associated with previous injury (OR = 3.04, 95% CI 1.20-7.68, p = 0.02) and having a normal thoracic curve compared to kyphosis (OR = 0.38, 95% CI 0.15-1.00, p = 0.05) but no other postural variables. Static postural deviations observed in male football players in the pre-season are not typically associated with non-contact lower limb injury risk; thus, they are unlikely to add value to pre-season screening programs.
Collapse
Affiliation(s)
- Suzanne J. Snodgrass
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.E.R.); (D.J.)
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- Correspondence:
| | - Kathleen E. Ryan
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.E.R.); (D.J.)
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Andrew Miller
- School of Education, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Daphne James
- School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.E.R.); (D.J.)
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia
| |
Collapse
|
26
|
Choi S, Kim M, Kim E, Shin G. Changes in Low Back Muscle Activity and Spine Kinematics in Response to Smartphone Use During Walking. Spine (Phila Pa 1976) 2021; 46:E426-E432. [PMID: 33181766 DOI: 10.1097/brs.0000000000003808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Within-subject design of an experimental study. OBJECTIVE The aim of this study was to determine the effects of smartphone use on the activity level of the lumbar erector spinae muscles and spine kinematics during walking. SUMMARY OF BACKGROUND DATA Using a smartphone while walking makes the user hold the phone steady and look downward to interact with the phone. Walking with this non-natural posture of the head and the arms may alter the spine kinematics and increase the muscular load on the low back extensor muscles. METHODS Twenty healthy young individuals participated in the laboratory experiment. Each participant walked on a treadmill in five different conditions: normal walking without using a phone, conducting one-handed browsing while walking, two-handed texting while walking, walking with one arm bound, and walking with both arms bound. Spine kinematics variables and the myoelectric activity levels of the lumbar erector spinae muscles were quantified and compared between the five walking conditions. RESULTS Participants walked with significantly (P < 0.05) more thoracic kyphosis and lumbar lordosis when using a phone compared to when walking without using the phone. The median level of muscle activity was also 16.5% (browsing) to 31.8% (texting) greater for the two smartphone use conditions than for the normal walking condition, and the differences were significant (P < .05). Between the normal walking and the two bound arm walking conditions, no significant difference in the muscle activity was found. CONCLUSION Study results show that the concurrent use of a smartphone while walking could pose a larger muscular load to the lumbar erector spinae muscles than that of normal walking. Habitual use of a smartphone while walking could be a risk factor for low back musculoskeletal problems.Level of Evidence: N/A.
Collapse
Affiliation(s)
- Seobin Choi
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | | | | | | |
Collapse
|
27
|
McKinnon CD, Martel DR, Callaghan JP. The impact of a progressive sit-stand rotation exposure duration on low back posture, muscle activation, and pain development. ERGONOMICS 2021; 64:502-511. [PMID: 33377433 DOI: 10.1080/00140139.2020.1849817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/11/2020] [Indexed: 06/12/2023]
Abstract
This study evaluated early and frequent seated breaks from standing work to reduce low back pain (LBP) in known pain developers (PD). Twenty-four participants, classified as either PD or non-PD during a separate 2-hour standing session, performed 124 minutes of standing work with seated breaks at a 3:1 stand-sit ratio with increasing durations from 3:1 minute to 48:16 minutes. Back pain and spine posture measures showed no differences between PD and non-PD. Females had greater left glutaeus medius activation (8.4%MVC) than males (4.5%MVC) and greater glutaeus medius co-contraction. This protocol was successful at reducing LBP in PD to the level of non-PD, with mean pain scores (13 mm) only slightly exceeding the clinical LBP threshold of 10 mm. Early and frequent breaks within the first hour of standing work appear to be an effective solution to reduce the LBP that often occurs at the beginning of standing work. Practicioner Summary: Sit-stand workstations may be an effective solution to reduce static occupational low back postures. This experimental study demonstrated that early and frequent seated breaks from standing work may be an effective solution to reduce tissue aggravation that often occurs within the first 45 minutes of a standing work exposure. Abbreviations: LBP: low back pain; PD: pain developer; NPD: non-pain developer; VAS: visual analog scale; EMG: electromyography; LES: lumbar erector spinae; TES: thoracic erector spinae; GMD: glutaeus medius; IOB: internal oblique; MVC: maximum voluntary contraction; CCI: co-activation coefficient; FDA: functional data analysis.
Collapse
Affiliation(s)
- Colin D McKinnon
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Daniel R Martel
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| |
Collapse
|
28
|
Consistent differences in lumbar spine alignment between low back pain subgroups and genders during clinical and functional activity sitting tests. Musculoskelet Sci Pract 2021; 52:102336. [PMID: 33548765 PMCID: PMC8918047 DOI: 10.1016/j.msksp.2021.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subgroups of people with low back pain display differences in their lumbar alignment during tests from a clinical examination. However, it is unknown if subgroups display the same patterns during a functional activity test and if gender influences subgroup-related differences. OBJECTIVES Test if differences in lumbar alignment between two LBP subgroups are 1) present during a functional activity test of preferred sitting and 2) independent of gender. DESIGN Cross-sectional. METHOD 154 participants with chronic low back pain were classified based on the Movement System Impairment Classification System by a physical therapist. Participants performed a functional activity test of preferred sitting and clinical tests of maximum flexed and extended sitting. 3D marker co-ordinate data were collected. Sagittal plane lumbar alignment, indexed by lumbar curvature angle, was calculated. A three-way mixed effect analysis of variance was used to examine effects of test, subgroup, gender, subgroup × test, gender × test and subgroup × gender. RESULTS/FINDINGS The lumbar rotation with extension subgroup [LCA = -8.0° (-9.5,-6.5)] displayed a more extended lumbar alignment than lumbar rotation [LCA = -5.9° (-7.4,-4.4)]. Women [LCA = -10.7° (-12.3,-9.2)] displayed a more extended lumbar alignment than men [LCA = -3.2° (-4.7,-1.7)]. There was a significant gender × test interaction (p = 0.01). The subgroup × test (p = 0.99) and subgroup × gender (p = 0.76) interactions were not significant. CONCLUSIONS LBP subgroup differences in lumbar alignment are present during preferred sitting. Gender-related differences in lumbar alignment are not driving subgroup differences. These findings highlight the need to use patient-specific clinical characteristics to guide treatment of a functional activity of preferred sitting limited due to low back pain.
Collapse
|
29
|
Viggiani D, Mannen EM, Nelson-Wong E, Wong A, Ghiselli G, Shelburne KB, Davidson BS, Callaghan JP. Lumbar Intervertebral Kinematics During an Unstable Sitting Task and Its Association With Standing-Induced Low Back Pain. J Appl Biomech 2020; 36:423-435. [PMID: 32971516 DOI: 10.1123/jab.2019-0382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/05/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022]
Abstract
People developing transient low back pain during standing have altered control of their spine and hips during standing tasks, but the transfer of these responses to other tasks has not been assessed. This study used video fluoroscopy to assess lumbar spine intervertebral kinematics of people who do and do not develop standing-induced low back pain during a seated chair-tilting task. A total of 9 females and 8 males were categorized as pain developers (5 females and 3 males) or nonpain developers (4 females and 5 males) using a 2-hour standing exposure; pain developers reported transient low back pain and nonpain developers did not. Participants were imaged with sagittal plane fluoroscopy at 25 Hz while cyclically tilting their pelvises anteriorly and posteriorly on an unstable chair. Intervertebral angles, relative contributions, and anterior-posterior translations were measured for the L3/L4, L4/L5, and L5/S1 joints and compared between sexes, pain groups, joints, and tilting directions. Female pain developers experienced more extension in their L5/S1 joints in both tilting directions compared with female nonpain developers, a finding not present in males. The specificity in intervertebral kinematics to sex-pain group combinations suggests that these subgroups of pain developers and nonpain developers may implement different control strategies.
Collapse
Affiliation(s)
| | - Erin M Mannen
- University of Denver
- University of Arkansas for Medical Sciences
| | | | | | | | | | | | | |
Collapse
|
30
|
The Effectiveness of Lumbar Supports. Orthop Nurs 2020; 39:402-407. [PMID: 33234911 DOI: 10.1097/nor.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonspecific back pain is a common complaint, especially among older people. Traditionally, nonspecific back pain has been associated with heavy physical activities. However, static activities such as prolonged sitting and standing are contributing factors to nonspecific lumbar pain as well. Lumbar orthoses, such as belts, have been used for heavy physical activity to alleviate or even prevent back pain; however, studies have been inconclusive as to their effectiveness. Furthermore, the use of lumbar orthosis for prolonged sitting and standing is questionable. This case study and review examines the general effectiveness of lumbar orthosis for a variety of activities, including prolonged standing and sitting. The findings provide implications for orthopaedic nurses in occupational settings.
Collapse
|
31
|
Shin SS, Yoo WG. Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device. J Manipulative Physiol Ther 2020; 44:35-41. [PMID: 33248752 DOI: 10.1016/j.jmpt.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 12/14/2019] [Accepted: 12/14/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device. METHODS A total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles. RESULTS The agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement. CONCLUSION Our results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.
Collapse
Affiliation(s)
- Sun-Shil Shin
- Department of Physical Therapy, College of Healthcare Medical Science and Engineering, Inje University, Gimhae-si, Republic of Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Healthcare Medical Science and Engineering, Inje University, Gimhae-si, Republic of Korea.
| |
Collapse
|
32
|
The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses. Animals (Basel) 2020; 10:ani10111977. [PMID: 33126478 PMCID: PMC7693906 DOI: 10.3390/ani10111977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.
Collapse
|
33
|
De-la-Cruz-Torres B, Sánchez-López MD. Effectiveness of a 12-Week Physical Exercise Program on Lower-Limb Malalignment in School-age Rugby: A Randomized Clinical Trial. J Manipulative Physiol Ther 2020; 43:531-538. [PMID: 32888702 DOI: 10.1016/j.jmpt.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 10/23/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We sought to assess the effectiveness of 12 weeks of a physical exercise program (PEP) in child rugby players with lower-limb overpronation during gait. METHODS This was a randomized clinical trial. A total of 123 young athletes (mean ± standard deviation age, 10.35 ± 1.22 years) were evaluated, 20 of whom had lower-limb overpronation (n = 40 extremities). Participants were randomly assigned to 2 groups: the experimental group, who performed their normal training and a PEP for 12 weeks, and the control group, who continued with their normal training for the same time. The PEP was focused on stretching the hypertonic muscle and potentiating the weakened muscles of the lower body. All participants underwent biomechanical analysis including the Helbing angle, the femorotibial angle, and the Fick angle in both limbs. RESULTS All participants (n = 20) completed the study. Baseline measurements showed no significant differences between groups in any of the variables tested. After 12 weeks, there were significant differences between groups (P < .001 for all angles). No improvement was found in the control group; however, meaningful improvement was found in all variables in the experimental group: Helbing angle (175°, P < .001, effect size [ES] = 1.94), femorotibial angle (173°, P < .001, ES = 1.77), Fick angle (12°, P < .001, ES = 1.55). The number needed to treat was 2 for femorotibial angle and Helbing angle, and 3 for Fick angle. CONCLUSION A 12-week PEP produced significant improvements in these 3 biomechanical variables. We also conclude that young athletes with a pathological gait pattern reached a normal gait pattern.
Collapse
|
34
|
Sarcevic ZZ, Tepavcevic A. Association Among Dyskinesia of the Lumbar Spine Segment, Inclination Angle of the Lumbosacral Spine, and Low Back Pain in Young Athletes: A Predictive Correlational Study. J Manipulative Physiol Ther 2020; 43:646-654. [PMID: 32861522 DOI: 10.1016/j.jmpt.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/28/2019] [Accepted: 12/05/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine. METHODS The study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2). The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression. RESULTS There was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra. CONCLUSION There was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.
Collapse
|
35
|
Bai H, Li Y, Liu C, Zhao Y, Zhao X, Lei W, Feng Y, Wu Z. Surgical Management of Degenerative Lumbar Scoliosis Associated With Spinal Stenosis: Does the PI-LL Matter? Spine (Phila Pa 1976) 2020; 45:1047-1054. [PMID: 32675607 DOI: 10.1097/brs.0000000000003465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational cohort study. OBJECTIVES To compare the benefits of long and short fusion treatments, and to identify factors potentially aiding surgeons' decision making about the surgical management of degenerative lumbar scoliosis associated with spinal stenosis (DLSS). SUMMARY OF BACKGROUND DATA The comparative effectiveness of long and short segment fusion for the treatment of DLSS remains controversial. METHODS Fifty-three patients with symptomatic DLSS managed by posterior-only fusion surgery were enrolled in this study. Twenty patients underwent short fusion (fewer than two segments), and 33 patients had more than three segments fused. The radiological outcomes were assessed by radiography. Health-related quality of life data, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were collected at all preoperative and follow-up visits. RESULTS The short and long fusion groups showed significant differences in the change in the Cobb angle (4.2° vs. 11.2°), lumbar lordosis (3.9° vs. 11.5°), and pelvic incidence minus the lumbar lordosis angle (PI - LL; 3.2° vs. 11.2°). Both the short and long fusion achieved significant changes in low back pain and leg pain. Patients with PI -LLs > 10° had more relief of low back pain after long fusion (VAS 4.0 ± 2.0) than after short fusion (VAS 2.6 ± 1.7). Patients with PI - LLs > 10° showed significantly improved walking ability after long fusion (ODI 1.0 ± 0.8). The improvement in standing ability after short fusion was greater when PI - LL ≤ 10°(ODI 0.9 ± 0.6). CONCLUSION Long segment fusion can relieve low back pain better and improve walking ability when PI-LL is mismatched, whereas short segment fusion is more advantageous in improving standing ability in cases of more balanced sagittal spinopelvic alignment. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Hao Bai
- Institute of Orthopaedics, Xijing Hospital, The Air Force Medical University (The Fourth Military Medical University), No. 127 Changle Xi Road, Xi'an, Shanxi province, P.R. China
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Simonet E, Winteler B, Frangi J, Suter M, Meier ML, Eichelberger P, Baur H, Schmid S. Walking and running with non-specific chronic low back pain: What about the lumbar lordosis angle? J Biomech 2020; 108:109883. [PMID: 32635997 DOI: 10.1016/j.jbiomech.2020.109883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/25/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023]
Abstract
Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetitive activities such as walking or running. This pilot study therefore aimed at exploring possible NSCLBP-related alterations in LLAs during walking and running by focusing on discrete parameters as well as continuous data. Thirteen patients with NSCLBP and 20 healthy pain-free controls were enrolled and underwent a full-body movement analysis involving various everyday living activities such as standing, walking and running. LLAs were derived from markers placed on the spinous processes of the vertebrae L1-L5 and S1. Possible group differences in discrete (average and range of motion (ROM)) and continuous LLAs were analyzed descriptively using mean differences with confidence intervals ranging from 95% to 75%. Patients with NSCLBP indicated reduced average LLAs during standing, walking and running and a tendency for lower LLA-ROM during walking. Analyses of continuous data indicated the largest group differences occurring around 25% and 70% of the walking and 25% and 75% of the running cycle. Furthermore, patients indicated a reversed movement pattern during running, with increasing instead of a decreasing LLAs after foot strike. This study provides preliminary evidence that NSCLBP might affect LLAs during walking and running. These results can be used as a basis for future large-scale investigations involving hypothesis testing.
Collapse
Affiliation(s)
- Edwige Simonet
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Balz Winteler
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland; Bern University Hospital, Inselspital, Department of Physiotherapy, Bern, Switzerland
| | - Jana Frangi
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Magdalena Suter
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland; Balgrist University Hospital, Department of Chiropractic Medicine, Integrative Spinal Research, Zurich, Switzerland
| | - Michael L Meier
- Balgrist University Hospital, Department of Chiropractic Medicine, Integrative Spinal Research, Zurich, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Stefan Schmid
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland.
| |
Collapse
|
37
|
Nelson-Wong E, Gallagher K, Johnson E, Antonioli C, Ferguson A, Harris S, Johnson H, Miller JB. Increasing standing tolerance in office workers with standing-induced back pain. ERGONOMICS 2020; 63:804-817. [PMID: 32330093 DOI: 10.1080/00140139.2020.1761034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/13/2020] [Indexed: 05/28/2023]
Abstract
Sit-stand desks are popular however many people have standing-induced low back pain (LBP). People with LBP have fewer standing weight shifts compared with back-healthy people. Participants were classified as standing-tolerant or intolerant. Participants were provided sit-stand desks for 12 weeks. Participants were assigned to intervention (graded standing exposure and exercise) or control (no instruction) conditions. Participants reported weekly sitting time and average/worst LBP. Standing weight shifts and LBP were re-assessed post-intervention. All groups decreased sitting time (range: 30-50%) over 12 weeks. Sitting time and average LBP were correlated in all standing-intolerant individuals, worst LBP and sitting time were correlated for intervention group only. All standing-intolerant individuals increased standing weight shifts and decreased LBP after 12-weeks. Standing-intolerant individuals benefitted from 12-weeks of sit-stand desk use regardless of intervention. Motivated individuals with standing-induced LBP may increase standing tolerance with sit-stand desk use. Additional benefits may exist when structured guidance is provided. Practitioner summary: Many people are standing-intolerant due to low back pain (LBP). This lab and field-based study showed some benefits from structured approaches to gradually progress standing time when transitioning to standing work. Using a sit-stand desk for 12 weeks resulted in decreased LBP and sitting time in standing-intolerant people. Abbreviations: LBP: low back pain; OSPAQ: Occupational Sitting and Physical Activity Questionnaire; VAS: visual analog scale; GRF: ground reaction force; WeekVASMAX: worst low back pain reported on visual analog scale for prior week; WeekVASAVE: average low back pain reported on visual analog scale for prior week; ICC: intraclass correlation coefficient; LabVASMAX: worst low back pain reported on visual analog scale during lab-based standing; LabVASAVE: average low back pain reported on visual analog scale during lab-based standing; FvR,L: vertical ground reaction force for right and left force plate; BWSSMALL: small (10-29% body weight) body weight shift; BWSLARGE: large (> 30% body weight) body weight shift; ActivPALSED: ActivePAL data for sedentary time; ActivPALSTND: ActivePAL data for standing time; ANOVA: analysis of variance; Standing Intolerant-INT: standing intolerant participants assigned to intervention condition; Standing Intolerant-CON: standing intolerant participants assigned to control condition; Standing Tolerant-INT: standing tolerant participants assigned to intervention condition; Standing Tolerant-CON: standing tolerant participants assigned to control condition; SI: standing intolerant; ST: standing tolerant; INT: intervention; CON: control.
Collapse
Affiliation(s)
| | - Kaitlin Gallagher
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, USA
| | | | - Clare Antonioli
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | | - Staci Harris
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Holly Johnson
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | |
Collapse
|
38
|
Kyphoplasty Restores the Global Sagittal Balance of the Spine Independently from Pain Reduction. Sci Rep 2020; 10:8894. [PMID: 32483183 PMCID: PMC7264302 DOI: 10.1038/s41598-020-65798-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
Kyphoplasty is the standard surgical treatment of vertebral compression fractures. We aimed to clarify the influence of kyphoplasty on the sagittal profile as well as the relation between posture improvement and pain relief. For this purpose, we evaluated various radiological parameters of the sagittal profile on whole spine standing radiographs of 73 Patients with a single vertebral fracture treated by kyphoplasty. The key outcome was the postoperative change of the sagittal vertical axis (SVA). Additionally, clinical parameters including pain scores on visual analogue scale (VAS) and use of analgesics were obtained from medical records. Pre- and postoperative radiological as well as clinical parameters were compared. Additionally, the correlation between changes of SVA and changes of local kyphotic angle (LKA) or VAS was examined. The clinical parameters as well as various radiographic parameters (SVA, LKA, Gardner, Cobb) improved significantly postoperatively. The improvement of SVA correlated significantly with the correction of the LKA but not with postoperative pain relief. We conclude that kyphoplasty helps to restore the global sagittal balance of the spine after vertebral fractures. The correction of the sagittal profile seems to depend on the correction of the local kyphotic angle but does not correlate with postoperative pain relief.
Collapse
|
39
|
Al Amer HS. Low back pain prevalence and risk factors among health workers in Saudi Arabia: A systematic review and meta-analysis. J Occup Health 2020; 62:e12155. [PMID: 32710807 PMCID: PMC7382437 DOI: 10.1002/1348-9585.12155] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Low back pain (LBP) has a major impact on health workers, and its prevalence and risk factors among them in Saudi Arabia have been investigated previously. However, the results have never been comprehensively reviewed. Therefore, the aim of this study was to perform a systematic review and meta-analysis of the available literature to identify the prevalence and risk factors of LBP among health workers in Saudi Arabia. METHODS MEDLINE/PubMed, Web of Science, Scopus, CINAHL, and Saudi peer-reviewed journals were searched for relevant literature. After quality assessment of the eligible articles, 18 studies targeting seven occupational categories, with a total number of 5345 health workers, were analyzed. RESULTS Pooled prevalence rates of 40.8% (n = 7 studies), 65.0% (n = 13 studies), and 81.4% (n = 2 studies) were obtained for week, year, and career, respectively, across all professional groups. Nurses and physical therapists were more susceptible to LBP, in that order, than the other categories considering week and career periods. Age, body mass index, and female gender were the most commonly reported individual risk factors. Occupational risk factors mainly included work-related activities requiring back bending and twisting, lifting and pulling objects, and manual patient-handling. CONCLUSIONS The results of this review indicate that LBP is highly prevalent among health workers in Saudi Arabia when compared with international rates. Proper prophylactic measures are necessary to reduce LBP and minimize its consequences. Further high-quality research is needed in different Saudi regions to achieve a broader understanding of LBP prevalence and causes.
Collapse
Affiliation(s)
- Hamad S. Al Amer
- Department of Physical TherapyFaculty of Applied Medical SciencesUniversity of TabukTabukSaudi Arabia
| |
Collapse
|
40
|
Viggiani D, Nelson-Wong E, Davidson BS, Callaghan JP. A comparison of trunk control in people with no history, standing-induced, and recurrent low back pain during trunk extension. J Man Manip Ther 2019; 28:94-102. [PMID: 31829827 DOI: 10.1080/10669817.2019.1701834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: This study compares people with recurrent low back pain (rLBP) and people with pre-clinical low back pain (standing-induced low back pain developers; PDs) to each other and back-healthy controls (non-pain developers; NPDs). Movement variability and muscular co-activity related to coordination are important for both rLBP and PDs, and these two groups also have altered static spine extension.Methods: Eleven participants with recurrent low back pain, and twenty-one asymptomatic participants, categorized as PDs (11) and NPDs (10) through an established standing protocol, volunteered for this study. Three phases of standing extension motion (lean, hold, and return to neutral) were analyzed. Root mean square angular jerk was calculated from trunk and pelvis kinematics, co-activation of the trunk and hip musculature were assessed in four-muscle sets.Results: Root-mean-square jerk was greater when returning to neutral than when leaning back during standing extension in all three groups. People with rLBP had reduced co-activity in their trunk extensors, people classified as PD had more co-activity in their hip extensors compared with the other groups, and anterior trunk co-activity was phase-dependent, and similar between groups.Discussion: Movement control alterations with low back pain may start as an over-protective co-activation strategy in those with standing-induced LBP and progress to an under-protective strategy in those with recurrent low back pain. Level of Evidence: 3.
Collapse
Affiliation(s)
- Daniel Viggiani
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - Bradley S Davidson
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
41
|
Rabal-Pelay J, Cimarras-Otal C, Alcázar-Crevillén A, Planas-Barraguer JL, Bataller-Cervero AV. Spinal shrinkage, sagittal alignment and back discomfort changes in manufacturing company workers during a working day. ERGONOMICS 2019; 62:1534-1541. [PMID: 31552811 DOI: 10.1080/00140139.2019.1672896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
Prolonged standing and lifting heavy loads are risk factors for the appearance of low back pain in work. The aim of this study was to observe changes in the height, spinal sagittal alignment, and the lumbar and dorsal discomfort perception in assembly line workers. Cross-sectional study, 40 assembly line workers (6 females). Height, sitting height, grades of thoracic kyphosis and lumbar lordosis and perceived spine discomfort, before and after the working day, were determined. Thoracic and lumbar sagittal alignment was compared between discomfort developers and no developers. There was a significant decrease in the height and sitting height of the workers at the end of the day. Thoracic and lumbar curvature increased significantly, as did the perceived lumbar discomfort. Workers on the assembly line, in a prolonged standing work, suffer an increase in lumbar discomfort, and changes in height and thoracic and lumbar curvatures. Practitioner summary: Spinal shrinkage, sagittal alignment and back discomfort (upper and lower back), were analysed in assembly line workers in prolonged standing during a workday. Assembly line workers suffer a decrease in height, an increase in their thoracic and lumbar curvature, and in lumbar discomfort throughout their workday.
Collapse
|
42
|
Novaczyk ZB, Georgiadis AG, Boyer ER. Association of back pain and pelvic tilt during gait in individuals with cerebral palsy. Gait Posture 2019; 74:66-70. [PMID: 31472331 DOI: 10.1016/j.gaitpost.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/09/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Back pain prevalence may increase with lumbar lordosis during standing in individuals with cerebral palsy (CP). Multiple interventions undertaken in individuals with CP have been shown to increase anterior pelvic tilt. RESEARCH QUESTION Are pelvic tilt and trunk tilt (proxy measurements for lumbar lordosis) during gait associated with back pain prevalence in ambulatory individuals with CP? METHODS A retrospective investigation was performed among all patients with cerebral palsy visiting a single clinical motion analysis laboratory over a 3.5 year period (January 2015 - May 2018) who also had complete pain questionnaire data. Back pain prevalence and its association with sagittal plane kinematic parameters (pelvic tilt and trunk tilt) were analyzed. RESULTS Among the 700 patients that met the inclusion criteria, 594 were children and 106 were adults. Back pain prevalence was 11.1% in children and 36.8% in adults. As pelvic tilt and age increased, back pain increased (odds ratio 95% confidence interval: 1.002-1.061 and 1.052-1.109, respectively). Walking with an assistive device was not associated with back pain, nor was trunk tilt. SIGNIFICANCE Back pain was more common with increasing age in ambulatory individuals with CP. After controlling for assistive device use and age, there was a weak relationship between pelvic tilt and back pain. Future studies are needed to determine if this is this a causal relationship.
Collapse
Affiliation(s)
- Zachary B Novaczyk
- University of Minnesota Medical School, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Andrew G Georgiadis
- University of Minnesota Medical School, 420 Delaware St. SE, Minneapolis, MN 55455, United States; Gillette Children's Specialty Healthcare, 200 University Ave E, Saint Paul, MN 55101, United States
| | - Elizabeth R Boyer
- University of Minnesota Medical School, 420 Delaware St. SE, Minneapolis, MN 55455, United States; Gillette Children's Specialty Healthcare, 200 University Ave E, Saint Paul, MN 55101, United States
| |
Collapse
|
43
|
Shin SS, Yoo WG. Inertial Measurement Unit-based Evaluation of Global and Regional Lumbar Spine and Pelvis Alignment in Standing Individuals With a Flat Lumbar Posture. J Manipulative Physiol Ther 2019; 42:594-600. [DOI: 10.1016/j.jmpt.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/01/2019] [Accepted: 05/02/2019] [Indexed: 11/25/2022]
|
44
|
Factors leading to postoperative pain in adolescent idiopathic scoliosis patients including sagittal alignment and lumbar disc degeneration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:3085-3091. [DOI: 10.1007/s00586-019-06152-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/25/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
|
45
|
Langdon E, Snodgrass SJ, Young JL, Miller A, Callister R. Posture of rugby league players and its relationship to non-contact lower limb injury: A prospective cohort study. Phys Ther Sport 2019; 40:27-32. [PMID: 31465936 DOI: 10.1016/j.ptsp.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to identify posture deviations in rugby league players, and to observe relationships between posture and the incidence of non-contact lower limb injury. DESIGN Prospective cohort. SETTING Laboratory and on-field. PARTICIPANTS Junior representative, semi-professional and professional rugby league players (n = 207). MAIN OUTCOME MEASURES Static posture scores from photographs (Watson and MacDonncha tool) in pre-season; non-contact lower limb injury surveillance and exposure data. METHODS Chi-square and logistic regression analyses were used to observe relationships between postural components and the incidence of non-contact lower limb injury. RESULTS 8.7% of players sustained a quadriceps injury; 7.2% sustained a calf injury. Semi-professional and professional players had the highest injury rates. The most common posture deviations were having a forward shoulder position (46.9%), a forward head position (33.3%), a varus knee interspace (32.9%) or a lumbar lordosis (30.9%). A moderate C-scoliosis deviation was associated with a decrease in injury risk (OR 1.57 95% CI 1.00-2.46 p = 0.052). Included in the model was player weight, which was associated with an increased risk of injury (OR 1.04 95% CI 1.01-1.07 p = 0.010). CONCLUSIONS Although postural deviations are common in rugby league players, given the lack of association with injury, they may not warrant intervention.
Collapse
Affiliation(s)
- Edward Langdon
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Jodi L Young
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Andrew Miller
- School of Education, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, 2308, Australia
| |
Collapse
|
46
|
Ludwig O, Berger J, Becker S, Kemmler W, Fröhlich M. The Impact of Whole-Body Electromyostimulation on Body Posture and Trunk Muscle Strength in Untrained Persons. Front Physiol 2019; 10:1020. [PMID: 31481895 PMCID: PMC6710354 DOI: 10.3389/fphys.2019.01020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/24/2019] [Indexed: 01/06/2023] Open
Abstract
Muscular imbalances of the trunk muscles are held responsible for changes in body posture. At the same time, whole-body electromyostimulation (WB-EMS) has been established as a new training method that enables simultaneous stimulation of many muscle groups. This study was aiming to analyze if a 10 weeks WB-EMS training changes posture-relevant parameters and/or improves isometric strength of the trunk extensors and flexors, and if there are differences based on stimulation at 20 Hz and 85 Hz. Fifty eight untrained adult test persons were divided into three groups (control, CON; training with 20 Hz stimulation, TR20; training with 85 Hz, TR85). Anthropometric parameters, trunk extension and flexion forces and torques, and posture parameters were determined before (n = 58) and after (n = 53: CON: n = 15, TR20: n = 19, TR85: n = 19) a 10 weeks WB-EMS training program (15 applications, 9 exercises). Differences between the groups were calculated for pre- and post-tests using univariate ANOVA and between the test times using repeated (2 × 3) ANOVA. Comparisons of pairs were calculated post hoc based on Fisher (LSD). No differences between the groups were found for the posture parameters. The post hoc analysis of both trunk flexion and trunk extension forces and torques showed a significant difference between the groups TR85 and CON but no difference between the other group pairs. A 10 weeks whole-body electrostimulation training with a stimulation frequency of 85 Hz in contrast to training with a stimulation frequency of 20 Hz improves the trunk muscle strength of an untrained group but does not significantly change posture parameters.
Collapse
Affiliation(s)
- Oliver Ludwig
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Joshua Berger
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Stephan Becker
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Fröhlich
- Department of Sports Science, Faculty of Social Sciences, University of Kaiserslautern, Kaiserslautern, Germany
| |
Collapse
|
47
|
Health-related Quality of Life and Postural Changes of Spinal Alignment in Female Adolescents Associated With Back Pain in Adolescent Idiopathic Scoliosis: A Prospective Cross-sectional Study. Spine (Phila Pa 1976) 2019; 44:E833-E840. [PMID: 30817729 DOI: 10.1097/brs.0000000000002996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cross-sectional study. OBJECTIVE To identify risk factors for chronic back pain and back pain at rest in adolescent idiopathic scoliosis (AIS) patients, particularly focusing on the psychological backgrounds of the patients and on postural changes of radiographical parameters for spinal alignment. SUMMARY OF BACKGROUND DATA Back pain has been recognized as a relatively common condition in AIS. However, the effect of patients' psychological backgrounds and dynamic changes of spinal alignment on back pain are unclear. METHODS One hundred two consecutive female AIS patients (mean age, 14.1 yrs [range, 10-18]) who first visited our outpatient clinic between July 2013 and December 2017 were included. Using SRS-22r questionnaire, the presence of chronic back pain and back pain at rest and the scores of self-image and mental health were evaluated. Using full-length standing and supine posteroanterior radiographs, parameters related to curve profiles and coronal global balance were measured, and postural changes of these parameters were calculated. From full-length standing lateral radiographs, sagittal spinal and spino-pelvic alignment parameters were also measured. Multivariate logistic regression analysis was performed to identify risk factors for back pain. RESULTS The prevalence of chronic back pain was 22.5% and that of back pain at rest was 25.5%. Poor self-image and mental health scores in SRS-22r were identified as risk factors for chronic back pain. Higher Risser grade, poor self-image score, large postural changes of apical vertebral translation at the main thoracic curve, and hyperlordosis in the lumbar spine were identified as risk factors for back pain at rest. CONCLUSION Psychological distress and large postural changes of spinal alignment played an important role in the occurrence of back pain. Physicians should pay more attention to mental healthcare of AIS patients as well as to radiographical assessments of curve severity for better health-related quality of life. LEVEL OF EVIDENCE 4.
Collapse
|
48
|
Cholewicki J, Breen A, Popovich JM, Reeves NP, Sahrmann SA, van Dillen LR, Vleeming A, Hodges PW. Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point-Counterpoint Debate. J Orthop Sports Phys Ther 2019; 49:425-436. [PMID: 31092123 PMCID: PMC7394249 DOI: 10.2519/jospt.2019.8825] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.
Collapse
|
49
|
Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain. J Orthop Sports Phys Ther 2019; 49:437-452. [PMID: 31092126 DOI: 10.2519/jospt.2019.8451] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient. J Orthop Sports Phys Ther 2019;49(6):437-452. Epub 15 May 2019. doi:10.2519/jospt.2019.8451.
Collapse
|
50
|
Weber CI, Hwang CT, van Dillen LR, Tang SY. Effects of standing on lumbar spine alignment and intervertebral disc geometry in young, healthy individuals determined by positional magnetic resonance imaging. Clin Biomech (Bristol, Avon) 2019; 65:128-134. [PMID: 31031229 PMCID: PMC6613826 DOI: 10.1016/j.clinbiomech.2019.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most diagnostic imaging of the spine is performed in supine, a relatively unloaded position. Although the spine is subjected to functional loading that changes the spinal alignment and intervertebral disc geometry, little data exists on how healthy spines adapt to standing. This study seeks to quantify the changes of the lumbar spine from supine to standing in young, back-healthy individuals using a positional magnetic resonance imaging system. METHODS This is an observational study that examined the changes in the lumbar spine alignment and intervertebral disc geometry between supine and standing of forty participants (19 males/21 females) without a history of low back pain. The regional lumbar spinal alignment was measured by the sagittal Cobb angle. Segmental intervertebral disc measurements included the segmental Cobb angle, anterior-to-posterior height ratio, and intervertebral disc width measured at L1/L2 - L5/S1 levels. Intra-class correlation was performed for intra- and inter-observer measurements. FINDINGS The intra-observer intra-class correlation consistency model ranged from 0.76 to 0.98 with the inter-observer correlation ranging from 0.68 to 0.99. The Cobb angle decreased in standing. The L5/S1 segmental Cobb angle decreased in standing. The L2/L3 and L3/L4 anterior-to-posterior height ratios increased and the L5/S1 anterior-to-posterior height ratio decreased in standing. No difference in intervertebral disc widths was observed from supine to standing. INTERPRETATIONS We established normative data for a back-healthy population, using a positional magnetic resonance imaging system, that could inform future investigations that examine the standing-induced adaptations of the lumbar spine in individuals with spinal or intervertebral disc pathologies.
Collapse
Affiliation(s)
- Christian I Weber
- Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Ching-Ting Hwang
- Movement Science Program, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda R van Dillen
- Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA; Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Simon Y Tang
- Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| |
Collapse
|