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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [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: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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Jäckle K, Meier MP, Klockner F, Roch PJ, Hawellek T, Weiser L, Lehmann W. The influence of pelvic tilt on sacral insufficiency fracture occurrence: Insights into the prevalence of high pelvic tilt among patients affected. Injury 2024; 55:111520. [PMID: 38594084 DOI: 10.1016/j.injury.2024.111520] [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: 03/06/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Fragility fractures without significant trauma of the pelvic ring in older patients have an increasing incidence due to demographic change. Influencing factors other than osteoporotic bone quality that lead to an insufficiency fracture are not yet known. However, it is suspected that the pelvic tilt (PT) has an effect on the development of such an insufficiency fracture. This study explores the influence of the PTs in patients with insufficiency fractures of the posterior pelvic ring. MATERIALS AND METHODS A total of 49 geriatric patients with fragility fractures of the pelvic ring were treated at a university hospital level-1 trauma center during a period between February and December 2023, and their fractures were classified according to the FFP classification of Rommens and Hofmann. Complete sets of computer tomography (CT) and radiological images were available to determine the PT angle of the patients. RESULTS 34 FFP type 2 and 15 FFP type 3 classified patients were included in the study. Significant difference was seen in the pelvic tilt (PT) angle between the patient group with insufficiency fractures (n= 49; mean age: 78.02 ± 11.80) and the control group with lumbago patients (n= 53; mean age: 69.23 ± 11.23). The PT was significantly higher in the patients with insufficiency fractures (25.74° ± 4.76; p⁎⁎⁎⁎ ≤ 0.0001). CONCLUSIONS The study demonstrates a significant extension of the PT angle of individuals with insufficiency fractures when compared to those with lumbago. The result suggests a potential association between pelvic tilt and fracture susceptibility. TRIAL REGISTRATION A retrospective study about the influence of sagittal balance of the spine on insufficiency fractures of the posterior pelvic ring measured by the "pelvic tilt angle", DRKS00032120. Registered 20th June 2023 - Prospectively registered. Trial registration number DRKS00032120.
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Affiliation(s)
- Katharina Jäckle
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany.
| | - Marc-Pascal Meier
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Friederike Klockner
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Paul Jonathan Roch
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Thelonius Hawellek
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Lukas Weiser
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Wolfgang Lehmann
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
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Bode T, Zoroofchi S, Vettorazzi E, Droste JN, Welsch GH, Schwesig R, Marshall RP. Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry. Heliyon 2024; 10:e29239. [PMID: 38633646 PMCID: PMC11021985 DOI: 10.1016/j.heliyon.2024.e29239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Background Spinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aim This study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. Methods This study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. Results Relevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). Conclusion This study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.
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Affiliation(s)
- Tobias Bode
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Schima Zoroofchi
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jan-Niklas Droste
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- BG Klinikum Hamburg-Boberg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Götz H. Welsch
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Robert Percy Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Cochrane D, Leyten C. Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study. J Bodyw Mov Ther 2024; 38:47-53. [PMID: 38763595 DOI: 10.1016/j.jbmt.2023.12.007] [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: 04/08/2022] [Revised: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. OBJECTIVE The current study investigated scapula positioning in those with non-specific LBP. METHODS Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. RESULTS No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. CONCLUSION The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.
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Affiliation(s)
- Darryl Cochrane
- School of Sport, Exercise & Nutrition, Massey University, New Zealand.
| | - Cara Leyten
- School of Sport, Exercise & Nutrition, Massey University, New Zealand
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Holzgreve F, Nazzal C, Nazzal R, Golbach R, Groneberg DA, Maurer-Grubinger C, Wanke EM, Ohlendorf D. Differences in upper body posture between patients with lumbar spine syndrome and healthy individuals under the consideration of sex, age and BMI. J Occup Med Toxicol 2024; 19:6. [PMID: 38355494 PMCID: PMC10868076 DOI: 10.1186/s12995-024-00405-w] [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: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Work-related forced postures, such as prolonged standing work, can lead to complaints in the lower back. Current research suggests that there is increased evidence of associations between patients with low back pain (LBP) and reduced lordosis in the lumbar spine and generally less spinal tilt in the sagittal plane. The aim of this study is to extend the influence of LBP to other parameters of upper body posture in standing, taking into account the rotational and frontal planes. METHODS The study included a no-LBP group (418 males, 412 females, aged 21-65 years) and an LBP group (138 subjects: 80 females, 58 males, aged 18-86 years) with medically diagnosed lumbar spine syndrome (LSS). The "ABW BodyMapper" back scanner from ABW GmbH in Germany was used for posture assessment using video raster stereography. Statistical analyses employed two-sample t-tests or Wilcoxon-Mann-Whitney-U tests to assess the relationship between the LBP/no-LBP groups and back posture parameters. Linear and logarithmic regressions were used with independent variables including group, sex, height, weight and body mass index (BMI). Significance level: α = 0.05 (95% confidence). RESULTS The regression analysis showed that sagittal parameters of the spine (sagittal trunk decline, thoracic and lumbar bending angle, kyphosis and lordosis angles) depend primarily on sex, age, BMI, height and/or weight but not on group membership (LBP/no-LBP). In the shoulder region, a significant dependency between group membership and scapular rotation was found. In the pelvic region, there were only significant dependencies in the transverse plane, particularly between pelvic torsion and BMI, weight, height and between pelvic rotation and group membership, age and sex. CONCLUSION No difference between the patients and healthy controls were found. In addition, sex appears to be the main influencing factor for upper body posture. Other influencing factors such as BMI, height or weight also seem to have a significant influence on upper body posture more frequently than group affiliation.
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Affiliation(s)
- Fabian Holzgreve
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany.
| | - Celine Nazzal
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Rasem Nazzal
- , Physiotherapy practice, Dr. Rasem Nazzal, Frankfurt, Germany
| | - Rejane Golbach
- Institute for Biostatistics and Mathematical Modeling, Center of Health Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Christian Maurer-Grubinger
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Eileen M Wanke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
| | - Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 9a, 60596, Frankfurt am Main, Germany
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Yüksel S, Özmen E, Barış A, Circi E, Beytemür O. Publication Trends in the Pelvic Parameter Related Literature between 1992 and 2022 : A Bibliometric Review. J Korean Neurosurg Soc 2024; 67:50-59. [PMID: 38031402 PMCID: PMC10788557 DOI: 10.3340/jkns.2023.0047] [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: 03/01/2023] [Revised: 05/20/2023] [Accepted: 06/27/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE This study aimed to conduct a bibliometric analysis on pelvic parameter related research over the last 30 years, analyzing trends, hotspots, and influential works within this field. METHODS A comprehensive Web of Science database search was performed. The search yielded 3249 results, focusing on articles and reviews published from 1992 to 2022 in English. Data was analyzed using CiteSpace and VOSviewer for keyword, authorship, and citation burst analysis, co-citation analysis, and clustering. RESULTS The number of publications and citations related to pelvic parameters has increased exponentially over the last 30 years. The USA leads in publication count with 1003 articles. Top publishing journals include the European Spine Journal, Spine, and Journal of Neurosurgery: Spine, with significant contributions by Schwab, Lafage V, and Protoptaltis. The most influential articles were identified using centrality and sigma values, indicating their role as key articles within the field. Research hotspots included spinal deformity, total hip arthroplasty, and sagittal alignment. CONCLUSION Interest in pelvic parameter related research has grown significantly over the last three decades, indicating its relevance in modern orthopedics. The most influential works within this field have contributed to our understanding of spinal deformity, pelvic incidence, and their relation to total hip arthroplasty. This study provides a comprehensive overview of the trends and influential research in the field of pelvic parameters.
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Affiliation(s)
- Serdar Yüksel
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Emre Özmen
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Alican Barış
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Esra Circi
- Istanbul Physical Treatment and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ozan Beytemür
- SBU Bagcilar Training and Research Hospital, Istanbul, Turkey
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Shin SS, Yoo WG. The difference in the relationship of spinal sagittal alignment between individuals with flat lumbar and normal lordosis posture based on global and regional angles. Technol Health Care 2024; 32:19-30. [PMID: 37248922 DOI: 10.3233/thc-220098] [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] [Indexed: 05/31/2023]
Abstract
BACKGROUND According to previous studies, the relationship between lumbar lordosis and thoracic kyphosis or that between pelvic parameters and thoracic kyphosis have been inconsistent. OBJECTIVE The purpose of this study was to investigate spinal sagittal alignment and its relationship to global and regional lumbar and thoracic angles, pelvic and sway angles, and C7-S1 distance measurements, followed by a detailed subgroup analysis using an inertial measurement unit system. METHODS A total of 51 asymptomatic volunteers stood in a comfortable posture with inertial measurement units attached to the T1, T7, T12, L3, and S2 vertebrae. T1, T7, T12, L3, and S2 sagittal angles were acquired during standing posture using the Eulerian angle coordinate system. All angles are reported as the mean of three 5-s measurements. Following the measurement of lumbar lordosis angles (T12 relative S2), participants were divided into the flat lumbar and normal lordosis groups. RESULTS There were different correlation patterns between groups because of spinal sagittal imbalance, which was greater in the flat lumbar group than in the normal lordosis group. In addition, sacral inclination proved the ideal parameter to evaluate reciprocal balance in lumbar lordosis, showing a stronger correlation with lower than with upper lumbar lordosis. T1 was the key element in assessing thoracic kyphosis, which showed a stronger correlation with upper than with lower thoracic kyphosis. CONCLUSION We suggest that when assessing posture, it is necessary to identify the global and regional angles and it is useful to classify spinal sagittal alignment into subgroups according to lumbar lordosis and evaluate the groups separately.
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Ozudogru Celik T, Yalcin E, Keskin HL, Koymen I, Koca N, Demir A. The relationship between low back pain, pelvic tilt, and lumbar lordosis with urinary incontinence using the DIERS formetric 4D motion imaging system. Int Urogynecol J 2024; 35:189-198. [PMID: 38032376 DOI: 10.1007/s00192-023-05688-x] [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: 08/03/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is a common public health problem and postural changes may be crucial in women presenting with UI. This study was aimed at evaluating the relationship between low back pain (LBP), pelvic tilt (PT), and lumbar lordosis (LL) in women with and without UI using the DIERS formetric 4D motion imaging system. To date no study has to our knowledge compared postural changes and LBP in women with UI using the DIERS 4D formetric system. METHODS This was a case-control study. We included 33 women with UI and 33 without incontinence. The severity of urogenital symptoms was assessed by the IIQ-7 (Incontinence Impact Score) and UDI-6 (Urogenital Distress Inventory), and disability owing to LBP was evaluated using the Oswestry Disability Index (ODI). Posture and movement assessment, LL angle, thoracic kyphosis, and PT assessment were performed with the DIERS Formetric 4D motion imaging system. RESULTS The LL angle and pelvic torsion degree were higher in the incontinence group than in the control group (53.9 ± 9.5° vs 48.18 ± 8.3°; p = 0.012, 3.9 ± 4.1 vs 2.03 ± 1.8 mm; p = 0.018 respectively). The LBP visual analog scale value was also significantly higher in the incontinence group (5.09 ± 2.3 vs 1.7 ± 1.8 respectively, p < 0.0001). The LL angle showed a positive correlation with pelvic obliquity, (r = 0.321, p < 0.01) and fleche lombaire (r = 0.472, p < 0.01) and a negative correlation with lumbar range of motion measurements. Pelvic obliquity correlated positively with pelvic torsion (r = 0.649, p < 0.01), LBP (r = 0.369, p < 0.01), and fleche lombaire (r = 0.269, p < 0.01). CONCLUSIONS Women with UI were more likely to have lumbopelvic sagittal alignment changes and a higher visual analog scale for LBP. These findings show the need for assessment of lumbopelvic posture in women with UI.
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Affiliation(s)
- Tugba Ozudogru Celik
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Ankara Bilkent City Hospital, 06800, Ankara, Turkey.
| | - Elif Yalcin
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Ankara Bilkent City Hospital, 06800, Ankara, Turkey
| | - Huseyin Levent Keskin
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ipek Koymen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Ankara Bilkent City Hospital, 06800, Ankara, Turkey
| | - Nadide Koca
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ayten Demir
- Faculty of Health Sciences, Ankara University, Ankara, Turkey
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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.
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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
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Kim WD, Shin D. Effects of Pelvic-Tilt Imbalance on Disability, Muscle Performance, and Range of Motion in Office Workers with Non-Specific Low-Back Pain. Healthcare (Basel) 2023; 11:healthcare11060893. [PMID: 36981550 PMCID: PMC10048650 DOI: 10.3390/healthcare11060893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/22/2023] Open
Abstract
Imbalance in the pelvic tilt is considered to be a major variable in low back pain. The purpose of this study was to investigate the effects of pelvic-tilt imbalance on trunk- and hip-muscle performance, range of motion, low-back pain, and the degree of disability in office workers. This was a cross-sectional study conducted in a physical therapy clinic on forty-one office workers diagnosed with non-specific low-back pain. Among the office workers with non-specific low-back pain, 25 were assigned to the pelvic-tilt-imbalance group and 16 to the normal group without pelvic-tilt imbalance. In order to determine the differences according to the imbalance in pelvic tilt, the pain intensity and disability indices were compared between the groups. In addition, the muscle performance and range of motion of the trunk and hip joints and foot pressure were measured and compared. There were differences between the groups in the disability indices and the ratio of internal and external rotation of the hip joint. However, there were no differences in the other variables. Pelvic-tilt imbalance in office workers with non-specific chronic low-back pain may exacerbate the degree of disability and be related to hip-joint rotational range of motion.
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Affiliation(s)
- Won-Deuk Kim
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon-si 51767, Republic of Korea
| | - Doochul Shin
- Department of Physical Therapy, College of Health Science, Kyungnam University, Changwon-si 51767, Republic of Korea
- Correspondence: ; Tel.: +82-55-249-2017
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Bibrowicz K, Szurmik T, Lipowicz A, Walaszek R, Mitas A. Tilt and mobility of the hip girdle in the sagittal and frontal planes in healthy subjects aged 19-30 years. J Back Musculoskelet Rehabil 2022; 35:1203-1210. [PMID: 35662103 DOI: 10.3233/bmr-200176] [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: 02/04/2023]
Abstract
BACKGROUND Disturbances in pelvic girdle tilt can cause compensatory changes affecting postural dysfunctions, and can lead to hip and groin strain changes and back pain. However, we still have no clear information on the normative values of pelvic girdle tilt and mobility. OBJECTIVE The study aimed to (1) evaluate the position and mobility of the pelvic girdle in the sagittal and frontal planes in asymptomatic adults aged 19-30, (2) evaluate the possible variation of results according to gender and to develop a proposal for normative values, and (3) evaluate whether body mass, height and BMI are related to the magnitude of hip girdle position and mobility. METHODS The research was conducted in a sample group consisting of 346 men and women using the scaled form of the anthropometric level of the Duometr® The values of position and mobility of the pelvic girdle in the sagittal and frontal planes were analyzed. RESULTS Differences were noted in the values of the pelvic tilt (p= 0.033) between the men and women. The women showed slightly higher values of posterior range of motion (p= 0.0002) and total range of motion (p= 0.002). The other parameters did not show any significant variation. There was no clear association between body weight, height and BMI and the study variables, except for a small, significant correlation between BMI and posterior pelvic tilt in women (r= 0.175, p= 0.005). In the frontal plane there were no differences in the analyzed variables in terms of gender or side of the body measured. CONCLUSIONS There was no association between the anthropometric variables and the pelvic girdle tilt and mobility. No size variation by gender was observed in the frontal plane. Slight differences were observed in the sagittal plane. Normative values are proposed.
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Affiliation(s)
- Karol Bibrowicz
- Science and Research Center of Body Posture, Kazimiera Milanowska College of Education and Therapy, Poznań, Poland
| | | | - Anna Lipowicz
- Department of Anthropology, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Robert Walaszek
- Department of Recreology and Biological Regeneration, University School of Physical Education, Cracow, Poland
| | - Andrzej Mitas
- Department of Informatics and Medical Equipment, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
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Kodsy MM, Freitag HE, Winkelman RD, Rabah NM, Lee BS, Honomichl R, Thompson N, Savage JW, Orr RD, Benzel EC, Kalfas IH. A Retrospective Analysis of the L3-4 Disc and Spinopelvic Parameters on Outcomes in Thoracolumbar Fusion: Was Art Steffee Right? World Neurosurg 2021; 159:e399-e406. [PMID: 34954442 DOI: 10.1016/j.wneu.2021.12.065] [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: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if the L3-4 disc angle may be a surrogate marker for global lumbar alignment in thoracolumbar fusion surgery. To explore the relationship between radiographic and patient-reported outcomes (PROs) after thoracolumbar fusion surgery. METHODS Retrospective chart review was conducted on patients who had undergone a lumbar fusion involving levels from T9 to pelvis. EuroQol-Five Dimension (EQ-5D) scores and adverse events including adjacent segment disease and degeneration, pseudoarthrosis, proximal junctional kyphosis, stenosis, and reoperation were collected. Pre- and postoperative spinopelvic parameters were measured on weight-bearing radiographs, with the L3-4 disc angle of novel interest. Univariate logistic and linear regression were performed to assess the associations of radiographic parameters with adverse event incidence and improvement in EQ-5D, respectively. RESULTS 182 patients met inclusion criteria. Univariable analysis revealed that increased magnitude of L3-4 disc angle, anterior pelvic tilt, and pelvic incidence measures are associated with increased likelihood of developing postoperative adverse events. Conversely, increased lumbar lordosis demonstrated a decreased incidence of developing a postoperative adverse event. Linear regression showed that radiographic parameters did not significantly correlate with postoperative EQ-5D scores although scores were significantly improved post-fusion in all dimensions except Self-care (P = 0.51). CONCLUSIONS L3-4 disc angle magnitude may serve as a surrogate marker of global lumbar alignment. Degree of spinopelvic alignment did not correlate to improvement in EQ-5D score in the present study, suggesting that quality of life metric change may not be a sensitive or specific marker of post-fusion alignment.
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Affiliation(s)
- Mark M Kodsy
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA.
| | - Harvey E Freitag
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert D Winkelman
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicholas M Rabah
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bryan S Lee
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ryan Honomichl
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason W Savage
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - R Douglas Orr
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward C Benzel
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Iain H Kalfas
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Suits WH. Clinical Measures of Pelvic Tilt in Physical Therapy. Int J Sports Phys Ther 2021; 16:1366-1375. [PMID: 34631258 PMCID: PMC8486407 DOI: 10.26603/001c.27978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023] Open
Abstract
Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures. LEVEL OF EVIDENCE 5.
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Martini E, Cesini I, D'Abbraccio J, Arnetoli G, Doronzio S, Giffone A, Meoni B, Oddo CM, Vitiello N, Crea S. Increased Symmetry of Lower-Limb Amputees Walking With Concurrent Bilateral Vibrotactile Feedback. IEEE Trans Neural Syst Rehabil Eng 2020; 29:74-84. [PMID: 33125331 DOI: 10.1109/tnsre.2020.3034521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Gait asymmetry in lower-limb amputees can lead to several secondary conditions that can decrease general health and quality of life. Including augmented sensory feedback in rehabilitation programs can effectively mitigate spatiotemporal gait irregularities. Such benefits can be obtained with non-invasive haptic systems representing an advantageous choice for usability in overground training and every-day life. In this study, we tested a wearable tactile feedback device delivering short-lasting (100ms) vibrations around the waist syncronized to gait events, to improve the temporal gait symmetry of lower-limb amputees. Three above-knee amputees participated in the study. The device provided bilateral stimulations during a training program that involved ground-level gait training. After three training sessions, participants showed higher temporal symmetry when walking with the haptic feedback in comparison to their natural walking (resulting symmetry index increases of +2.8% for Subject IDA, +12.7% for Subject IDB and +2.9% for Subject IDC). One subject retained improved symmetry (Subject IDB,+14.9%) even when walking without the device. Gait analyses revealed that higher temporal symmetry may lead to concurrent compensation strategies in the trunk and pelvis. Overall, the results of this pilot study confirm the potential utility of sensory feedback devices to positively influence gait parameters when used in supervised settings. Future studies shall clarify more precisely the training modalities and the targets of rehabilitation programs with such devices.
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15
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Saraiva BTC, Pinto RZ, Oliveira CB, Zanuto EF, Scarabottolo CC, Delfino LD, Suetake VYB, Gil FCS, Christofaro DGD. Continuity of physical activity practice from childhood to adolescence is associated with lower neck pain in both sexes and lower back pain in girls. J Back Musculoskelet Rehabil 2020; 33:269-275. [PMID: 31403935 DOI: 10.3233/bmr-181136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The literature on physical activity practice through sports as a protective factor for back pain in adolescents is conflicting. However, few studies have aimed to verify if continuity of the practice of physical activity from childhood to adolescence may be related to lower chances of back pain in adolescents. OBJECTIVES The objective of this study was to analyze the association between physical activity practice from childhood to adolescence and back pain in adolescents. METHODS The random sample was composed of 870 adolescents with a mean age of 13.7 ± 2.0 years. The continuity of physical activity practice was assessed through the continuity of sports practice from childhood to adolescence. Pain in the neck and low back were evaluated through a questionnaire. RESULTS The prevalence of neck pain and low back pain in boys was 17.5% and in girls was 20.9% for neck pain and 21.9% for low back pain. Physical activity practice during childhood to adolescence was a protective factor for neck pain (OR = 0.57 [CI = 0.35-0.94]) and low back pain (OR = 0.53 [CI = 0.33-0.86]) in girls and neck pain in boys (OR = 0.52 [CI = 0.30-0.90]), even after adjusting for confounding factors. CONCLUSION Girls with physical activity practice during childhood to adolescence were less likely to develop neck pain and back pain when compared to girls who did not maintain practice of physical activity. Similar results were observed in boys considering neck pain.
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Affiliation(s)
| | - Rafael Z Pinto
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Edner Fernando Zanuto
- Postgraduate Program in Physiotherapy, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | | | - Leandro Dragueta Delfino
- Postgraduate Program in Motricity Science, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | | | | | - Diego Giulliano Destro Christofaro
- Postgraduate Program in Motricity Science, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil.,Postgraduate Program in Physiotherapy, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
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Yu Q, Huang H, Zhang Z, Hu X, Li W, Li L, Chen M, Liang Z, Lo WLA, Wang C. The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system. BMC Musculoskelet Disord 2020; 21:596. [PMID: 32891129 PMCID: PMC7487478 DOI: 10.1186/s12891-020-03617-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empirical evidence that demonstrates the relationship between pelvic asymmetry and non-specific chronic low back pain (NCLBP) is currently lacking. OBJECTIVE To establish the reliability of the Global Postural System (GPS) in assessing pelvic asymmetry and identify the association between pelvic asymmetry parameters and the occurrence of NCLBP in young adults. DESIGN A cross-sectional, regression study. METHODS People who were aged between 18 and 30 and were diagnosed with NCLBP were recruited. Healthy individuals who were matched for age, sex, and education level were recruited as controls. Global Postural System (GPS) was employed to assess pelvic asymmetry. Prior to exploring the association, the reliability of GPS was assessed by the ICC (2, k) for interrater reliability, ICC (3, k) for intra-rater reliability, standard error and minimal detectable difference. Bivariate correlation analysis and logistic regression analysis were used to determine the relationship between pelvic asymmetry and the occurrence of NCLBP. RESULTS Twenty-eight healthy participants and 28 people with NCLBP were recruited. Moderate to excellent ICCs were observed for the inter-rater and intra-rater reliability of most postural parameters. The bivariate correlation analysis indicated that age, body mass index and pelvic asymmetry parameters were related to the occurrence of NCLBP. Pelvic angle asymmetry (odds ratio = 1.17), and asymmetry of the distance between the posterior superior iliac spine and the floor (odds ratio = 1.21) were associated with NCLBP. LIMITATIONS This study did not explore the causal relationship between pelvic asymmetry in the sagittal plane/pelvic asymmetry in the transverse plane and the occurrence of NCLBP. The interpretation of the results may not be generalized beyond the sample population. CONCLUSIONS The GPS is a reliable method to assess pelvic asymmetry in a clinical setting. Two pelvic parameters were associated with the presence of NLBP. Measurement of pelvic asymmetry may assist in the early identification of potential occurrence of NCLBP but further work is required.
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Affiliation(s)
- Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Zhou Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Xiaoqian Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wenfeng Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
- Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Zhenwen Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China.
- Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China.
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Jiménez-Del-Barrio S, Mingo-Gómez MT, Estébanez-de-Miguel E, Saiz-Cantero E, Del-Salvador-Miguélez AI, Ceballos-Laita L. Adaptations in pelvis, hip and knee kinematics during gait and muscle extensibility in low back pain patients: A cross-sectional study. J Back Musculoskelet Rehabil 2020; 33:49-56. [PMID: 31403939 DOI: 10.3233/bmr-191528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare pelvis, hip and knee kinematics during gait and extensibility of hip muscles between low back pain (LBP) and asymptomatic subjects. METHODS Forty adult volunteers (11 men and 29 women) between 18 to 30 years from university population were included in this study. Twenty patients with LBP formed the LBP group, and 20 asymptomatic subjects formed the control group. Pelvic tilt and knee valgus, peak hip and knee joint excursion, and temporo-spatial variables were assessed during gait with Kinovea software. Extensibility of hip muscles was measured by Active Knee Extension test (AKE), modified Ober test, and Thomas test. RESULTS There was a significant increase in pelvic tilt (p< 0.01), valgus angle (p< 0.01), and a significant decrease in hip extension (p< 0.01) in the LBP group compared to the control group. There was a significant decrease in extensibility of the hip flexors (p< 0.05) of the dominant leg and in the hip abductors (p< 0.01) in the LBP group compared to the control group. CONCLUSIONS The findings of this study suggest that non-specific mechanic LBP patients present differences in the pelvis, hip and knee kinematics in sagittal and frontal plane during gait and less hip flexors and abductors muscles extensibility compared to asymptomatic subjects.
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18
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Papi E, Bull AMJ, McGregor AH. Alteration of movement patterns in low back pain assessed by Statistical Parametric Mapping. J Biomech 2019; 100:109597. [PMID: 31928738 PMCID: PMC7001037 DOI: 10.1016/j.jbiomech.2019.109597] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 11/25/2022]
Abstract
Changes in movement pattern in low back pain (LBP) groups have been analysed by reporting predefined discrete variables. However, this approach does not consider the full kinematic data waveform and its dynamic information, potentially exposing the analysis to bias. Statistical Parametric Mapping (SPM) has been introduced and applied to 1 dimensional (D) kinematic variables allowing the assessment of data over time. The aims of this study were to assess differences in 3D kinematics patterns in people with and without LBP during functional tasks by using SPM and to investigate if SPM analysis was consistent with standard 3D range of motion (RoM) assessments. 3D joints kinematics of the spine and lower limbs were compared between 20 healthy controls and 20 participants with non-specific LBP during walking, sit-to-stand and lifting. SPM analysis showed significant differences in the 3Dkinematics of the lower thoracic segment, upper and lower lumbar segment and knee joint during walking and lifting mostly observed at the beginning and/or towards the end of the tasks. ROMs differed between groups in the lower thoracic segment (walking/sit-to-stand), upper and lower lumbar segments (walking/sit-to-stand/lifting), hip and knee (sit-to-stand/lifting). Based on these results, the two approaches can yield different data interpretations. SPM analysis allows the identification of differences in movement that occur over time. This adds value to LBP movement analysis as it allows an understanding of the LBP strategies adopted during motion that may not be conveyed by simple discrete parameters such as ROMs.
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Affiliation(s)
- Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Bioengineering, Imperial College London, London, UK.
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
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19
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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.
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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
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Hori M, Hasegawa H, Takasaki H. Comparisons of hamstring flexibility between individuals with and without low back pain: systematic review with meta-analysis. Physiother Theory Pract 2019; 37:559-582. [PMID: 31317831 DOI: 10.1080/09593985.2019.1639868] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: There is no robust evidence on the contribution of reduced hamstring flexibility to the development of low back pain (LBP) in cohort studies.Purpose: To investigate whether individuals with LBP have impaired hamstring flexibility and stiffness and what measures have been used to compare hamstring flexibility and stiffness between individuals with and without LBP.Methods: A systematic literature search was undertaken in PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, and Cochrane databases from inception to April 2018. The GRADE system was used to determine the quality of evidence for each measure evaluated in meta-analysis.Results: Respectively, seventeen and two studies having acceptable methodological quality were analyzed with regard to hamstring flexibility and stiffness. Four measures were identified for hamstring flexibility and five for stiffness. Meta-analyses were undertaken in straight leg raising (SLR), sit and reach and knee extension in 90° hip flexion for hamstring flexibility and for hamstring stiffness measures of stiffness at 50° SLR and gradient of stiffness from 20° to 50° SLR (Me-grad). Significantly reduced hamstring flexibility or increased stiffness (P < .05) was detected in SLR, 90/90 knee extension and Me-grad. However, the validity of measures for hamstring flexibility was problematic and GRADE scores for all measures in the meta-analyses were very low.Conclusion: There have been four measures for hamstring flexibility and five for stiffness to evaluate individuals with and without LBP. It was impossible to conclude whether individuals with LBP have impaired hamstring flexibility and stiffness due to very low quality of evidence for meta-analyses.
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Affiliation(s)
- Masataka Hori
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan.,Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population. Surg Radiol Anat 2018; 40:1275-1281. [PMID: 30073394 DOI: 10.1007/s00276-018-2075-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. METHODS In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age- and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). RESULTS There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age- and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. CONCLUSIONS Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.
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