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Welling A, Patil A, Gunjal P, Naik P, Hubli R. Effectiveness of Three-Dimensional Myofascial Release on Lumbar Lordosis in Individuals with Asymptomatic Hyperlordosis: A Placebo Randomized Controlled Trial. Int J Ther Massage Bodywork 2024; 17:20-31. [PMID: 38873188 PMCID: PMC11131939 DOI: 10.3822/ijtmb.v17i2.957] [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] [Indexed: 06/15/2024] Open
Abstract
Background Lumbar hyperlordosis is the most prevalent musculoskeletal postural deformity. Maintenance of normal limits of lumbar lordosis is necessary for obtaining an ideal posture. Literature suggests that poor posture results in fascial restriction in which the fascia reorganizes in response to tension. Gross myofascial release (MFR) combined with posterior pelvic tilting exercises proved to be beneficial in improving the lumbar range of motion. Three-dimensional (3D) MFR is a novel approach toward reducing fascial restrictions. However, the literature determining the effects of 3D MFR is still emerging. Aim To determine the effect of 3D MFR on a lumbar lordosis angle and lumbar range of motion, in individuals with asymptomatic hyperlordosis. Method Participants (n = 30) with hyperlordosis were randomly assigned to either the experimental group receiving 3D MFR (n = 15) or the control group (n = 15) that received sham 3D MFR for six sessions (3 alternate days for 2 weeks). The outcomes were assessed at day 1 and day 6. Lumbar range of motion was assessed using modified-modified Schober's test and the lumbar lordosis angle was measured using x-ray and flexicurve. Results There was significant decrease (p = 0.0001) in the lumbar lordosis angle, increase in the lumbar flexion (p = 0.0001), and decrease in the extension (p = 0.0011) range of motion in the experimental group when compared to the control group. Conclusion Lumbar lordosis decreased and the lumbar range of motion increased in the experimental group only with 3D MFR and not with sham 3D MFR. Hence, 3D MFR is an effective method in the correction of lumbar hyperlordosis and improving the lumbar range.Clinical Trial Registry of India (CTRI) trial number CTRI/2023/03/050340.
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Affiliation(s)
- Aarti Welling
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Ashwin Patil
- Department of Radiology, J. N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Pragati Gunjal
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Priyanka Naik
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
| | - Rani Hubli
- Department of Orthopaedic Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi 590010, Karnataka, India
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Mehta D, Sihota P, Tikoo K, Kumar S, Kumar N. Type 2 diabetes alters the viscoelastic behavior and macromolecular composition of vertebra. Bone Rep 2023; 18:101680. [PMID: 37187573 PMCID: PMC10176031 DOI: 10.1016/j.bonr.2023.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Type 2 diabetes (T2D) affects the functional behavior of vertebra bone by altering its structural and mechanical properties. The vertebral bones are responsible to carry the body weight and it remains under prolonged constant load which results to viscoelastic deformation. The effect of T2D on the viscoelastic behavior of vertebral bone is not well explored yet. In this study, the effects of T2D on the creep and stress relaxation behavior of vertebral bone are investigated. Also, this study established a correlation between T2D associated alteration in macromolecular structure and viscoelastic behavior of vertebra. In this study T2D female rat SD model was used. The obtained results demonstrated a significant reduction in the amount of creep strain (p ≤ 0.05) and stress relaxation (p ≤ 0.01) in T2D specimens than the control. Also, the creep rate was found significantly lower in T2D specimens. On the other hand, molecular structural parameters such as mineral-to-matrix ratio (control vs T2D: 2.93 ± 0.78 vs 3.72 ± 0.53; p = 0.02), and non-enzymatic cross link ratio (NE-xL) (control vs T2D: 1.53 ± 0.07 vs 3.84 ± 0.20; p = 0.01) were found significantly altered in T2D specimens. Pearson linear correlation tests show a significant correlation; between creep rate and NE-xL (r = -0.94, p < 0.01), and between stress relaxation and NE-xL (r = -0.946, p < 0.01). Overall this study explored the understanding about the disease associated alteration in viscoelastic response of vertebra and its correlation with macromolecular composition which can help to understand the disease related impaired functioning of the vertebrae body.
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Affiliation(s)
- Deepak Mehta
- Department of Mechanical Engineering Indian Institute of Technology Ropar, India
| | - Praveer Sihota
- Department of Mechanical Engineering Indian Institute of Technology Ropar, India
| | - Kulbhushan Tikoo
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Mohali, India
| | - Sachin Kumar
- Department of Mechanical Engineering Indian Institute of Technology Ropar, India
- Corresponding authors.
| | - Navin Kumar
- Department of Mechanical Engineering Indian Institute of Technology Ropar, India
- Corresponding authors.
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Okuwaki S, Funayama T, Ikumi A, Shibao Y, Miura K, Noguchi H, Takahashi H, Koda M, Tatsumura M, Kawamura H, Yamazaki M. Risk factors affecting vertebral collapse and kyphotic progression in postmenopausal osteoporotic vertebral fractures. J Bone Miner Metab 2022; 40:301-307. [PMID: 34773152 DOI: 10.1007/s00774-021-01283-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to investigate the risk factors that affect vertebral deformity 6 months after osteoporotic vertebral fractures (OVFs) at the time of injury. MATERIALS AND METHODS From May 2017 to May 2020, 70 postmenopausal women with OVFs were evaluated for age; body mass index; number of previous OVFs; total 25-hydroxy vitamin D [25(OH)D] levels; posterior wall injury on computed tomography; cross-sectional area (CSA) of the psoas major, erector spinae, and multifidus; fat infiltration; vertebral instability (VI) upon admission; collapse rate (CR); and kyphotic angle (KA) at 6 months after injury. A multiple regression analysis was conducted to identify the risk factors for the CR and KA. RESULTS The CR was correlated with posterior wall injury (r = 0.295, p = 0.022), 25(OH)D levels (r = - 0.367, p = 0.002), and VI (r = 0.307, p = 0.010). In the multiple regression analysis, the 25(OH)D levels (p = 0.032) and VI (p = 0.035) were significant risk factors for the CR at the 6-month follow-up. The KA was correlated with the 25(OH)D levels (r = - 0.262, p = 0.031) and VI (r = 0.298, p = 0.012). In the multiple regression analysis, the CSA of the psoas major (p = 0.011) and VI (p < 0.001) were significant risk factors for the KA at the 6-month follow-up. CONCLUSION In cases with large VI at the time of injury, the CR and KA were significantly higher at 6 months after injury. Moreover, the CR was affected by the 25(OH)D level, while the KA was affected by the CSA of the psoas major upon admission.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masaki Tatsumura
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Okuwaki S, Funayama T, Ikumi A, Matsuura S, Kawamura H, Yamazaki M. Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2022; 6:51-57. [PMID: 35224247 PMCID: PMC8842355 DOI: 10.22603/ssrr.2021-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba
| | - Akira Ikumi
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Satoshi Matsuura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba
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Tajiri M, Nishizawa H, Kimura T. Comparison of the effects of external focus of attention with metaphor and internal focus of attention on temporal changes in seating pressure during sitting motion in community-dwelling elderly people. J Phys Ther Sci 2022; 34:236-241. [PMID: 35291475 PMCID: PMC8918098 DOI: 10.1589/jpts.34.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Masaru Tajiri
- Hokushin General Hospital, Geriatric Health Services Facility Moegi, Japan
| | - Hitomi Nishizawa
- School of Health Sciences, Faculty of Medicine, Shinshu University: 3-1-1 Asahi, Matsumoto City, Nagano 390-8621, Japan
| | - Teiji Kimura
- School of Health Sciences, Faculty of Medicine, Shinshu University: 3-1-1 Asahi, Matsumoto City, Nagano 390-8621, Japan
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Elshafey MA, Abdrabo MS, Elnaggar RK. Effects of a core stability exercise program on balance and coordination in children with cerebellar ataxic cerebral palsy. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2022; 22:172-178. [PMID: 35642697 PMCID: PMC9186458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effects of a core stability exercise program on balance, coordination, and severity of ataxia in children with cerebellar ataxic cerebral palsy (CP). METHODS Forty children with cerebellar ataxic CP (mean age: 6.75±1.35 years) were randomly assigned to a control group and an intervention group for 2 months of follow-up. The control group received a standard physical therapy program three times weekly (1 h per session), while the intervention group received a core stability program for 30 min, in addition to the selected physical therapy program. Both groups were evaluated pre-treatment and post-treatment using the Scale for the Assessment and Rating of Ataxia, the Balance Error Scoring Systems scale, Bruininks-Oseretsky tests of motor proficiency, and HUMAC balance system scores. RESULTS We found statistically significant reductions in the severity of ataxia, as well as improved balance and coordination in both groups, with stronger effects observed in the intervention group (P<0.05). CONCLUSION The core stability program can improve balance and coordination in children with cerebellar ataxic CP when incorporated with a standard physical therapy program.
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Affiliation(s)
- Mohamed Ali Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt,Corresponding author: Mohamed Ali Elshafey, Shahin street Dakadous Mitghamr, Dakahlia, EgyptE-mail:
| | - Mohamed Samy Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Egypt
| | - Ragab Kamal Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt,Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Singh A, Patel D, Shenoy S, Sandhu J. Comparative analysis of plyometrics and core training on performance indices of Indian handball players. BLDE UNIVERSITY JOURNAL OF HEALTH SCIENCES 2022. [DOI: 10.4103/bjhs.bjhs_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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A modified MRI protocol for the increased detection of sacrococcygeal fractures in patients with thoracolumbar junction fractures. Sci Rep 2021; 11:5628. [PMID: 33707558 PMCID: PMC7952901 DOI: 10.1038/s41598-021-85167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
This study aimed to identify concurrent thoracolumbar junction (TLJ) and sacrococcygeal (SC) fractures using a modified MRI protocol and analyze the risk factors associated with tandem fractures. We retrospectively investigated patients with MRI-confirmed TLJ fractures from January 2017 to March 2020. Patients were divided into two study groups: study 1 with a modified MRI protocol and study 2 with a routine protocol. The modified protocol included an extended field of view of sagittal scans in L-spine MRI covering the full SC spine. In study 1, frequency of concurrent TLJ and SC fractures was investigated. And we analyzed risk factors and compared CT and MRI for detecting SC fractures. In study 2, co-occurrence of both fractures was investigated. A total of 176 and 399 patients with TLJ fractures were enrolled in study 1 and 2, then SC fractures were identified in 53 (30.14%) and 36 patients (9.02%), respectively. An axial loading trauma mechanism was a significant risk factor (Odds ratio 7.0, p < 0.001), and MRI was more sensitive than CT in detecting SC fractures (p < 0.002). Thus, a modified MRI protocol was useful to detect the high occurrence of SC fractures in TLJ fractures, which concurrent fractures increased by an axial loading mechanism.
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Evaluation of Posture and Core Endurance in Elite Junior Climbers. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.865734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abd-Elfattah HM, Aly SM. Effect of Core Stability Exercises on Hand Functions in Children With Hemiplegic Cerebral Palsy. Ann Rehabil Med 2021; 45:71-78. [PMID: 33557483 PMCID: PMC7960954 DOI: 10.5535/arm.20124] [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: 06/23/2020] [Accepted: 09/28/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the effectiveness of core stability exercises on hand functions in children with hemiplegic cerebral palsy. Methods Fifty-two children with hemiplegic cerebral palsy ranging in age from 6 years to 8 years were enrolled in this study. They were randomly assigned to two (control and study) groups. The control group received the selected physiotherapy exercises, and the study group received the same selected physiotherapy exercise program and core stability exercises. Time motor performance, gross manual dexterity, and upper extremity skills assessed using the Jebsen Taylor Hand Function Test, Box and Block Test, and Quality Upper Extremity Skill Test, respectively, were measured before and after 12 weeks of the treatment program. Results There were significant improvements in both groups by comparing the mean values of all measured variables before and after treatment (p<0.05). There were significant differences between the control and study groups with respect to all measured variables when comparing the post-treatment outcomes (p<0.05). Conclusion This study suggests that core stability exercises can be an effective intervention that may improve hand functions in children with hemiplegic cerebral palsy.
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Affiliation(s)
- Hanaa Mohsen Abd-Elfattah
- Department of Physical Therapy for Pediatrics and Pediatric Surgery, Faculty of Physical Therapy, Badr University, Cairo, Egypt
| | - Sobhy Mahmoud Aly
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Oikonomidis S, Greven J, Bredow J, Eh M, Prescher A, Fischer H, Thüring J, Eysel P, Hildebrand F, Kobbe P, Scheyerer MJ, Herren C. Biomechanical effects of posterior pedicle screw-based instrumentation using titanium versus carbon fiber reinforced PEEK in an osteoporotic spine human cadaver model. Clin Biomech (Bristol, Avon) 2020; 80:105153. [PMID: 32829232 DOI: 10.1016/j.clinbiomech.2020.105153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aim of this biomechanical investigation was to compare the biomechanical effects of a carbon fiber reinforced PEEK and titanium pedicle screw/rod device in osteoporotic human cadaveric spine. METHODS Ten human fresh-frozen cadaveric lumbar spines (L1-L5) have been used and were randomized into two groups according to the bone mineral density. A monosegmental posterior instrumentation (L3-L4) using titanium pedicle screws and rods was carried out in group A and using carbon fiber reinforced PEEK in group B. A cyclic loading test was performed at a frequency of 3 Hz, starting with a peak of 500 N for the first 2000 cycles, up to 950 N for 100,000 cycles under a general preload with 100 N. All specimens were evaluated with regard to a potential collapse of the implanted pedicle screws. A CT supported digital measurement of cavities around the pedicle at 3 defined measuring points was performed. Finally, the maximum zero-time failure load of all specimens was determined using a universal testing machine (80% Fmax). FINDINGS Regarding maximum axial force (group A: 2835 N, group B: 3006 N, p = 0.595) and maximum compression (group A: 11.67 mm, group B: 15.15 mm, p = 0.174) no statistical difference could be shown between the two groups. However, significant smaller cavity formation around the pedicle screws could be observed in group B (p = 0.007), especially around the screw tip (p < 0.001). INTERPRETATION Carbon fiber reinforced PEEK devices seem to be advantageous in terms of microscopic screw loosening compared to titanium devices.
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Affiliation(s)
- Stavros Oikonomidis
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Johannes Greven
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Jan Bredow
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Madita Eh
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University Hospital, Wendlingweg 2, 52070 Aachen, Germany.
| | - Horst Fischer
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Peer Eysel
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Philipp Kobbe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Max Joseph Scheyerer
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Christian Herren
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
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Oura P, Junno JA, Autio E, Karppinen J, Niinimäki J. Baseline anthropometric indices predict change in vertebral size in early adulthood - A 10-year follow-up MRI study. Bone 2020; 138:115506. [PMID: 32603909 DOI: 10.1016/j.bone.2020.115506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/19/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
The vertebral cross-sectional area (CSA) has an independent effect on vertebral strength. Recent evidence has shown that vertebral dimensions significantly increase in the third decade of life, and that lifestyle factors such as body size and composition are clearly associated with vertebral CSA. This study aimed to test the hypothesis that general anthropometric traits (stature, total body mass, lean body mass, fat mass, body mass index, waist circumference), each objectively measured at baseline, predict the change in vertebral CSA over the subsequent decade. A representative sample of young Northern Finnish adults was used (n = 371) with repeated magnetic resonance imaging (MRI) scans from ~20 and ~30 years (baseline and follow-up, respectively). Vertebral CSA was measured from the MRI scans with high reliability and low measurement error. The statistical analysis was performed using linear regression models adjusted for sex and exact length of MRI interval. According to the regression models, in descending order of effect size, lean body mass (standardized beta coefficient 0.243 [95% confidence interval 0.065-0.420]), total body mass (0.158 [0.043-0.273]), body mass index (0.125 [0.026-0.224]), waist circumference (0.119 [0.010-0.228]), and fat mass (0.104 [0.004-0.205]) were positively and significantly associated with CSA gain over the follow-up, whereas stature (0.079 [-0.066-0.224]) was not associated with CSA change. The results of this study suggest that anthropometric indices may be used for estimating subsequent change in vertebral size. In particular, greater lean body mass seems to be beneficial for vertebral size and thus potentially also for vertebral strength. Future studies should aim to replicate these associations in a dataset with longitudinal anthropometric trajectories and identify the potential common factors that influence both anthropometric traits and vertebral CSA gain.
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Affiliation(s)
- Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Juho-Antti Junno
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Anatomy, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Elsi Autio
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland
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Spencer L, McKenna L, Fary R, Ho R, Briffa K. Is Breast Size Related to Prevalent Thoracic Vertebral Fracture? A Cross-Sectional Study. JBMR Plus 2020; 4:e10371. [PMID: 32666022 PMCID: PMC7340439 DOI: 10.1002/jbm4.10371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/06/2020] [Accepted: 04/19/2020] [Indexed: 11/08/2022] Open
Abstract
Large breasts may increase the likelihood of thoracic vertebral fractures by increasing the mechanical loading of the spine. We examined breast size as a factor associated with prevalent thoracic vertebral fractures, also considering its relationship with thoracic kyphosis and upper back extensor muscle endurance. Using a cross-sectional study, the design measurements collected were thoracic vertebral fractures (≥20% loss in vertebral body height on lateral radiograph), breast size (bra size converted to an ordinal breast size score), BMD (g/cm2 averaged femoral neck, DXA), upper back extensor muscle endurance (isometric chest raise test), body composition (DXA), thoracic kyphosis (radiograph), and upper back pain (numerical rating scale). Correlations and multivariable logistic regression examined relationships between characteristics and their association with vertebral fracture. Participants were 117 healthy postmenopausal women. The 17 (15%) women with ≥1 thoracic vertebral fracture had larger breast size (mean difference [MD]: 2.2 sizes; 95% CI, 0.6 to 3.8 sizes), less upper back extensor muscle endurance (MD: -38.6 s; 95% CI, -62.9 to -14.3 s), and greater thoracic kyphosis (MD: 7.3°; 95% CI, 1.7° to 12.8°) than those without vertebral fracture. There were no between group differences in age, height, weight, and BMD. Breast size (r = -0.233, p = 0.012) and thoracic kyphosis (r = -0.241, p = 0.009) correlated negatively with upper back extensor muscle endurance. Breast size was unrelated to thoracic kyphosis (r = 0.057, p = 0.542). A (final) multivariable model containing breast size (OR 1.85; 95% CI, 1.10 to 3.10) and thoracic kyphosis (OR 2.04; 95%CI, 1.12 to 3.70) explained 18% of the variance in vertebral fracture. Breast size had a significant, but weak relationship with vertebral fracture (R 2 = 0.10), which was independent of BMD and unrelated to thoracic kyphosis. Further work is needed to confirm larger breast size as a risk factor for vertebral fracture. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Linda Spencer
- School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
| | - Leanda McKenna
- School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
| | - Robyn Fary
- School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
| | - Richard Ho
- Perth Radiological Clinic Perth Western Australia Australia
| | - Kathy Briffa
- School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
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Xi L, Song Y, Wu W, Qu Z, Wen J, Liao B, Tao R, Ge J, Fang D. Investigation of bone matrix composition, architecture and mechanical properties reflect structure-function relationship of cortical bone in glucocorticoid induced osteoporosis. Bone 2020; 136:115334. [PMID: 32224161 DOI: 10.1016/j.bone.2020.115334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022]
Abstract
Glucocorticoid induced osteoporosis (GIOP) is the most common negative consequence of long-term glucocorticoid treatment, leading to increased fracture risk followed by loss of mobility and high mortality risk. These biologically induced changes in bone quality at molecular level lead to changes both in bone matrix architecture and bone matrix composition. However, the quantitative details of changes in bone quality - and especially their link to reduced macroscale mechanical properties are still largely missing. In this study, a mouse model for glucocorticoid-induced osteoporosis (GIOP) was used to investigate mechanical and material alterations in bone cortex (natural nanocomposite) at different scale. By combining quantitative backscattered electron (qBSE) imaging, nanoindentation and high brilliance synchrotron X-ray nanomechanical imaging on a genetically modified mouse model of GIOP, we were able to quantify the local indentation modulus, mineralization distribution and the alterations of nanoscale structures and deformation mechanisms in the mid-diaphysis of femur, and relate them to the macroscopic mechanical changes. Our results showed clear and significant changes in terms of material quality of bone at nanoscale and microscale, which manifests itself in development of spatial heterogeneities in mineralization and indentation moduli across the bone organ, with potential implications for increased fracture risk.
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Affiliation(s)
- Li Xi
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China; School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK; Beamline I22, Diamond Light Source Ltd., Harwell Science and Innovation Campus, Oxfordshire, UK
| | - Yu Song
- College of Textiles, North Carolina State University, NC, USA
| | - Wenwang Wu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, USA
| | - Zhaoliang Qu
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China
| | - Jiawei Wen
- Department of Mechanical Engineering, University of Moratuwa, Sri Lanka
| | - Binbin Liao
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Ran Tao
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Jingran Ge
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Daining Fang
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China; State Key Laboratory for Turbulence and Complex Systems, College of Engineering, Peking University, Beijing, China
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15
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Association between the trunk muscle function performance and the presence of vertebral fracture in older women with low bone mass. Aging Clin Exp Res 2020; 32:1067-1076. [PMID: 31471893 DOI: 10.1007/s40520-019-01296-2] [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: 06/17/2019] [Accepted: 07/25/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). AIMS The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. METHODS This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD <- 1.0 DP. Multidimensional evaluations were performed: appendicular skeletal muscle mass index (ASMI) was determined by the total body DEXA; the radiographic evaluations measured the degree of thoracic kyphosis and classification of VF. The trunk muscle function parameters, such as peak torque (PT), rate of torque development (RTD) and torque steadiness (TS) were evaluated by isokinetic dynamometer. The trunk muscle endurance was evaluated by the timed loaded standing test. The adjusted multivariate logistic regression model and multivariate linear regression were performed to verify the association between the variables studied. RESULTS The results showed that the trunk muscle function parameter with greater association with the presence of VF is TS extensors (OR = 1.70; p < 0.001). The other two significant muscle parameters were: RTD30 flexors (OR = 0.31; p = 0.033) and PT extensors (OR = 0.13; p = 0.009). No statistical association was found between the presence of VF and the ASMI and trunk muscle endurance. No correlation between trunk muscle function and fall history was observed. There was a weak correlation between ASMI and extensor PT (R2 = 0.21; p = 0.027) and extensor RTD30 (R2 = 0.21; p = 0.026). CONCLUSIONS This study demonstrated that deficit in trunk muscle function has shown a strong association with the presence of VF, highlighting issues heretofore unexplored regarding the association between VF with muscle power and motor control.
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Ojukwu C, Ikele C, Ikele I, Ngwoke E, Katchy U, Okemuo A, Mgbeojedo U, Kalu M. Comparative analysis of the effects of abdominal crunch exercise and dead bug exercise on core stability of young adults. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Heo JY, Park JH, Lim SA, Shim SW, Choi YS. Feasibility of Using Fat Degeneration of Lumbar Extensor Muscle as an Alternative Diagnostic Criterion for Sarcopenia in Patients with Osteoporotic Vertebral Fractures. Asian Spine J 2019; 14:320-326. [PMID: 31711061 PMCID: PMC7280914 DOI: 10.31616/asj.2019.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/17/2019] [Indexed: 12/04/2022] Open
Abstract
Study Design Feasibility study. Purpose To investigate the feasibility of using fat degeneration of lumbar extensor muscle (LEM) as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. Overview of Literature Although sarcopenia has been gaining increased attention among researchers and healthcare practitioners, there is uncertainty about the association between sarcopenia and fat degeneration of LEM. Methods In this study, 33 patients with osteoporotic vertebral fractures (group 1) and 29 patients without such fractures (group 2) were enrolled. Sarcopenia was diagnosed in accordance with the Asian Working Group for Sarcopenia (AWGS) criteria, including assessment of extremity muscle mass using dual-energy X-ray absorptiometry, grip strength, and gait speed. The bone mineral density and fat degeneration of LEM were investigated using magnetic resonance imaging. Results The mean rates of fat degeneration of LEM and the skeletal muscle index were 38.3% and 5.5 kg/m2 in group 1 and 28.9% and 6.3 kg/m2 in group 2, respectively. The fat degeneration of LEM was negatively correlated with gait speed (r=−0.44, p=0.01) and handgrip strength (r=−0.37, p=0.01). The fat degeneration of LEM also demonstrated a significant relationship with osteoporotic vertebral fractures (p=0.01). Receiver operating characteristic curve analysis between fat degeneration of LEM and osteoporotic vertebral fractures showed that the cut-off value of fat degeneration was 31.9% (sensitivity=0.67, specificity=0.66). There was a positive correlation between sarcopenia defined by the AWGS and that defined by the 31.90% cut-off value of fat degeneration of LEM instead of extremity muscle mass (r=0.46, p=0.01). Conclusions These results suggest the feasibility of using fat degeneration of LEM as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. A cut-off value of fat degeneration of LEM of 31.9% was shown to be useful for diagnosing osteoporotic vertebral fractures.
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Affiliation(s)
- Ju-Yeong Heo
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Ji-Hun Park
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung-An Lim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Seung-Woo Shim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Yong-Soo Choi
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Plomp K, Viðarsdóttir US, Dobney K, Weston D, Collard M. Potential adaptations for bipedalism in the thoracic and lumbar vertebrae of Homo sapiens: A 3D comparative analysis. J Hum Evol 2019; 137:102693. [PMID: 31711026 DOI: 10.1016/j.jhevol.2019.102693] [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: 04/28/2018] [Revised: 10/12/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
A number of putative adaptations for bipedalism have been identified in the hominin spine. However, it is possible that some have been overlooked because only a few studies have used 3D and these studies have focused on cervical vertebrae. With this in mind, we used geometric morphometric techniques to compare the 3D shapes of three thoracic and two lumbar vertebrae of Homo sapiens, Pan troglodytes, Gorilla gorilla, and Pongo pygmaeus. The study had two goals. One was to confirm the existence of traits previously reported to distinguish the thoracic and lumbar vertebrae of H. sapiens from those of the great apes. The other was to, if possible, identify hitherto undescribed traits that differentiate H. sapiens thoracic and lumbar vertebrae from those of the great apes. Both goals were accomplished. Our analyses not only substantiated a number of traits that have previously been discussed in the literature but also identified four traits that have not been described before: (1) dorsoventrally shorter pedicles in the upper thoracic vertebrae; (2) dorsoventrally longer laminae in all five of the vertebrae examined; (3) longer transverse processes in the upper thoracic vertebrae; and (4) craniocaudally 'pinched' spinous process tips in all of the vertebrae examined. A review of the biomechanical literature suggests that most of the traits highlighted in our analyses can be plausibly linked to bipedalism, including three of the four new ones. As such, the present study not only sheds further light on the differences between the spines of H. sapiens and great apes but also enhances our understanding of how the shift to bipedalism affected the hominin vertebral column.
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Affiliation(s)
- Kimberly Plomp
- Department of Archaeology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool, L69 7WZ, UK.
| | - Una Strand Viðarsdóttir
- Biomedical Center, University of Iceland, Læknagarður, Vatnsmýrarvegi 16, 101 Reykjavík, Iceland
| | - Keith Dobney
- Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool, L69 7WZ, UK
| | - Darlene Weston
- Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada
| | - Mark Collard
- Department of Archaeology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population. Spine (Phila Pa 1976) 2019; 44:E1264-E1271. [PMID: 31205179 DOI: 10.1097/brs.0000000000003123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based birth cohort study. OBJECTIVE To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population. SUMMARY OF BACKGROUND DATA Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking. METHODS This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders. RESULTS Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex. CONCLUSION Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings. LEVEL OF EVIDENCE 3.
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20
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Gheysvandi E, Dianat I, Heidarimoghadam R, Tapak L, Karimi-Shahanjarini A, Rezapur-Shahkolai F. Neck and shoulder pain among elementary school students: prevalence and its risk factors. BMC Public Health 2019; 19:1299. [PMID: 31619204 PMCID: PMC6796365 DOI: 10.1186/s12889-019-7706-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors. Methods In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student’s posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression. Results The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02–3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37–3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46–6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10–5.84), too much homework (OR = 2.59, 95% CI: 1.49–4.51), RULA score at level III (OR = 2.88, 95% CI:1.64–5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72–5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39–0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34–0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26–4.61) and too much homework (OR = 1.94, 95% CI: 1.10–3.42) increased the risk of shoulder pain. Conclusion The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.
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Affiliation(s)
- Elham Gheysvandi
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iman Dianat
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rashid Heidarimoghadam
- Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health Sciences Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Non-communicable diseases research center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. .,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. .,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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21
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Ali MS. Impact of core stability education on postural control in children with spastic cerebral palsy. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_25_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Alsakhawi RS, Elshafey MA. Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial. Adv Ther 2019; 36:2364-2373. [PMID: 31301057 DOI: 10.1007/s12325-019-01024-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Core stability exercises and treadmill training play a crucial role in physical therapy interventions and have an effect on balance in children with Down Syndrome (DS); however, whether core stability exercises or treadmill training has more effect on improving balance has not been investigated yet. The aim of the study was to investigate the effect of core stability training versus treadmill exercises on balance in children with Down Syndrome. METHODS Forty-five children aged 4-6 years with Down Syndrome were included in the study. The children were equally divided randomly into three groups. Group A received traditional physical therapy intervention strategies to facilitate the balance of participating children. Group B received the same as group A and additional core stability exercise training. Group C received the same intervention strategies as group A in conjunction with a treadmill exercise program. The children's balance was evaluated using the Berg balance scale and the Biodex Balance System. Treatment sessions were for 60 min, thrice a week, for 8 consecutive weeks. RESULTS There were significance improvements in the three groups in functional balance and over all stability indices in favor of groups B and C. CONCLUSIONS Core stability and treadmill training improved balance in children with Down Syndrome and should be applied in conjunction with physical therapy programs.
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Autio E, Oura P, Karppinen J, Paananen M, Niinimäki J, Junno JA. Changes in vertebral dimensions in early adulthood - A 10-year follow-up MRI-study. Bone 2019; 121:196-203. [PMID: 30099153 DOI: 10.1016/j.bone.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Previous studies have shown that vertebral height increases until the early twenties, but very few studies have been conducted on other vertebral dimensions. Growth in vertebral size is believed to take place in elderly age but not in early adulthood. In this study, we wanted to clarify the potential changes in the dimensions of the lumbar vertebrae during early adulthood. We used the Northern Finland Birth Cohort 1986 as our study material, with a final sample size of 375 individuals. We performed lumbar magnetic resonance imaging (MRI) when the participants were 20 and 30 years of age (baseline and follow-up, respectively). We recorded the width, depth, height, and cross-sectional area (CSA) of the fourth lumbar vertebra (L4) using the MRI scans. We used generalized estimating equation (GEE) models to analyse the data. Men had 7.6%-26.5% larger vertebral dimensions than women at both baseline and follow-up. The GEE models demonstrated that all the studied dimensions increased during the follow-up period among both sexes (p < 0.001). Men had a higher growth rate in vertebral depth and CSA than women (p < 0.001). Among women, small vertebral width (p = 0.001), depth (p = 0.05) and height (p = 0.02) at baseline were associated with a higher vertebral growth rate during the follow-up than among those with large dimensions at baseline. Among men, small baseline width was associated with higher vertebral growth rate (p = 0.001). Our results clearly indicate that vertebral dimensions increase after 20 years of age among both sexes.
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Affiliation(s)
- Elsi Autio
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juho-Antti Junno
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Anatomy, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
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Ziebart C, Page AD, MacDermid JC. Application of ICF conceptual framework in Osteoporosis. Physiother Theory Pract 2019; 36:1077-1087. [PMID: 30628503 DOI: 10.1080/09593985.2018.1563932] [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] [Indexed: 10/27/2022]
Abstract
Background: Osteoporosis (OP) is a metabolic bone disease defined by low bone strength and deterioration of bone tissue, which has wide clinical presentations. The World Health Organization's International Classification of Functioning Disability and Health (ICF) provides a common language, classification system, and conceptual framework to describe the consequences of health conditions in terms of body function and structure, activities and participation, environmental and personal factors. Objectives: The ICF conceptual framework was used, in this paper, to integrate OP research-based knowledge into clinical application using clinical vignettes. Results: Body functions and structures, activities and participation, environmental factors and personal factors are described, and the inter-connection among these factors is explored. The vignettes highlight the importance of different components of the ICF framework and to demonstrate how the ICF framework can capture individual differences in how disability can be experienced in OP. Conclusion: The ICF conceptual framework provides a holistic representation of disability by facilitating a critical appraisal of the health status of people with OP. The framework creates an awareness of the broad and multidimensional nature of OP on the health of individual patients, integrates dimensions of functioning, and highlights the complexity of the evaluation and management of OP.
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Affiliation(s)
- Christina Ziebart
- Faculty of Health Science, Rehabilitation Sciences, Western University , London, Ontario, Canada
| | - Allyson D Page
- School of Communication Science and Disorders, Western University , London, Ontario, Canada
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University , London, Ontario, Canada.,Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre , London, ON, Canada
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Hernández Aragüés I, Neyra Castañeda A, Fernández Vilariño E, Simal G. Ergonomics in Dermatology: Good Posture During Physical Examinations. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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26
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Oura P, Junno JA, Auvinen J, Niinimäki J, Karppinen J, Ojaniemi M, Paananen M. Body Mass Index Trajectories From Birth to Midlife and Vertebral Dimensions in Midlife: the Northern Finland Birth Cohort 1966 Study. JBMR Plus 2018; 3:37-44. [PMID: 30680362 DOI: 10.1002/jbm4.10065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/02/2018] [Accepted: 05/19/2018] [Indexed: 01/08/2023] Open
Abstract
Vertebral fracture risk is higher among individuals with small vertebral dimensions. Obesity is a global health problem and may also contribute to bone size and fracture risk. In this work we report the association between life course body mass index (BMI) and vertebral cross-sectional area (CSA) in midlife. The Northern Finland Birth Cohort 1966 study with its 46-year follow-up provided the material for this study. A subsample of 780 individuals had attended lumbar magnetic resonance imaging (MRI) at the age of 46 years, and had records of objectively measured BMI from the ages of 0, 7, 15, 31, and 46 years. Of these, MRI-derived data on vertebral size was available for 682 individuals. We identified latent lifelong BMI trajectories by performing latent class growth modeling (LCGM) on the BMI data, and then used sex-stratified linear regression models to compare the identified trajectory groups in terms of midlife vertebral CSA. Gestational age, education years, adult height, lifelong physical activity, lifelong smoking history, and adulthood diet were assessed as potential confounders. Three distinct trajectory groups ("stable slim," "stable average," and "early onset overweight") were identified among both sexes. Comparisons to the stable slim trajectory revealed that vertebral CSA was significantly (p < 0.001) larger among the stable average and early onset overweight trajectories (69.8 and 118.6 mm2 larger among men, 57.7 and 106.1 mm2 larger among women, respectively). We conclude that lifelong BMI has a positive association with midlife vertebral size among both sexes. Future studies should characterize the mediating factors of this association.
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Affiliation(s)
- Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Juho-Antti Junno
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine University of Oulu Oulu Finland.,Department of Archaeology, Faculty of Humanities University of Oulu Oulu Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland.,Finnish Institute of Occupational Health Oulu Finland
| | - Marja Ojaniemi
- PEDEGO Research Unit, Faculty of Medicine University of Oulu Oulu Finland.,Department of Children and Adolescents Oulu University Hospital Oulu Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
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Ergonomics in Dermatology: Good Posture During Physical Examinations. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:661-663. [PMID: 29373112 DOI: 10.1016/j.ad.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 11/22/2022] Open
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Chen YL, Liu YC, Wu CH, Yeh CM, Chiu HI, Lee GY, Lee YT, Hsu P, Lin TW, Gau JP, Hsiao LT, Chiou TJ, Liu JH, Liu CJ. Role of BMI and age in predicting pathologic vertebral fractures in newly diagnosed multiple myeloma patients: A retrospective cohort study. Hematol Oncol 2017; 36:407-415. [PMID: 29105945 DOI: 10.1002/hon.2486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/17/2017] [Accepted: 10/04/2017] [Indexed: 12/23/2022]
Abstract
Vertebral fractures affect approximately 30% of myeloma patients and lead to a poor impact on survival and life quality. In general, age and body mass index (BMI) are reported to have an important role in vertebral fractures. However, the triangle relationship among age, BMI, and vertebral fractures is still unclear in newly diagnosed multiple myeloma (NDMM) patients. This study recruited consecutive 394 patients with NDMM at Taipei Veterans General Hospital between January 1, 2005 and December 31, 2015. Risk factors for vertebral fractures in NDMM patients were collected and analyzed. The survival curves were demonstrated using Kaplan-Meier estimate. In total, 301 (76.4%) NDMM patients were enrolled in the cohort. In the median follow-up period of 18.0 months, the median survival duration in those with vertebral fractures ≥ 2 was shorter than those with vertebral fracture < 2 (59.3 vs 28.6 months; P = 0.017). In multivariate Poisson regression, BMI < 18.5 kg/m2 declared increased vertebral fractures compared with BMI ≥ 24.0 kg/m2 (adjusted RR, 2.79; 95% CI, 1.44-5.43). In multivariable logistic regression, BMI < 18.5 kg/m2 was an independent risk factor for vertebral fractures ≥ 2 compared with BMI ≥ 24.0 kg/m2 (adjusted OR, 6.05; 95% CI, 2.43-15.08). Among age stratifications, patients with both old age and low BMI were at a greater risk suffering from increased vertebral fractures, especially in patients > 75 years and BMI < 18.5 kg/m2 (adjusted RR, 12.22; 95% CI, 3.02-49.40). This is the first study that demonstrated that age had a significant impact on vertebral fractures in NDMM patients with low BMI. Elder patients with low BMI should consider to routinely receive spinal radiographic examinations and regular follow-up.
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Affiliation(s)
- Yi-Lun Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsun-I Chiu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Gin-Yi Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ting Lee
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei Hsu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Wei Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Science, National Yang-Min University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Min University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Uchmanowicz I, Chudiak A, Jankowska-Polańska B, Gobbens R. Hypertension and Frailty Syndrome in Old Age: Current Perspectives. Card Fail Rev 2017; 3:102-107. [PMID: 29387461 PMCID: PMC5739896 DOI: 10.15420/cfr.2017:9:2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022] Open
Abstract
Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
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Affiliation(s)
- Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences,Wroclaw Medical University, Poland
| | - Anna Chudiak
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences,Wroclaw Medical University, Poland
| | - Beata Jankowska-Polańska
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences,Wroclaw Medical University, Poland
| | - Robbert Gobbens
- The Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences,Amsterdam, the Netherlands
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Giangregorio L, El-Kotob R. Exercise, muscle, and the applied load-bone strength balance. Osteoporos Int 2017; 28:21-33. [PMID: 27738713 DOI: 10.1007/s00198-016-3780-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/14/2016] [Indexed: 12/01/2022]
Abstract
A fracture occurs when the applied load is greater than the bone can withstand. Clinical practice guidelines for the management of osteoporosis include recommendations for exercise; one of the few therapies where the proposed anti-fracture mechanisms that include effects on both bone strength and applied loads, where applied loads can come in the form of a fall, externally applied loads, body weight, or muscle forces. The aim of this review is to provide an overview of the clinical evidence pertaining to the potential efficacy of exercise for preventing fractures in older adults, including its direct effects on outcomes along the causal pathway to fractures (e.g., falls, posture, bone strength) and the indirect effects on muscle or the muscle-bone relationship. The evidence is examined as it pertains to application in clinical practice. Considerations for future research are discussed, such as the need for trials in individuals with low bone mass or students that evaluate whether changes in muscle mediate changes in bone. Future trials should also consider adequacy of calorie or protein intake, the confounding effect of exercise-induced weight loss, or the most appropriate therapeutic goal (e.g., strength, weight bearing, or hypertrophy) and outcome measures (e.g., fracture, disability, cost-effectiveness).
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Affiliation(s)
- L Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
| | - R El-Kotob
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Kamali F, Shirazi SA, Ebrahimi S, Mirshamsi M, Ghanbari A. Comparison of manual therapy and exercise therapy for postural hyperkyphosis: A randomized clinical trial. Physiother Theory Pract 2016; 32:92-7. [DOI: 10.3109/09593985.2015.1110739] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sions JM, Smith AC, Hicks GE, Elliott JM. Trunk Muscle Size and Composition Assessment in Older Adults with Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study. PAIN MEDICINE 2015; 17:1436-46. [PMID: 26814258 DOI: 10.1093/pm/pnv023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 09/05/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate intra- and inter-examiner reliability for the assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area, i.e., total cross-sectional area minus intramuscular fat, from T1-weighted magnetic resonance images obtained in older adults with chronic low back pain. DESIGN Reliability study. SUBJECTS n = 13 (69.3 ± 8.2 years old) METHODS After lumbar magnetic resonance imaging, two examiners produced relative cross-sectional area measurements of multifidi, erector spinae, psoas, and quadratus lumborum by tracing regions of interest just inside fascial borders. Pixel-intensity summaries were used to determine muscle-to-fat infiltration indices; relative muscle cross-sectional area was calculated. Intraclass correlation coefficients were used to estimate intra- and inter-examiner reliability; standard error of measurement was calculated. RESULTS Intra-examiner intraclass correlation coefficient point estimates for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area were excellent for multifidi and erector spinae across levels L2-L5 (ICC = 0.77-0.99). At L3, intra-examiner reliability was excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area for both psoas and quadratus lumborum (ICC = 0.81-0.99). Inter-examiner intraclass correlation coefficients ranged from poor to excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area. CONCLUSIONS Assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area in older adults with chronic low back pain can be reliably determined by one examiner from T1-weighted images. Such assessments provide valuable information, as muscle-to-fat infiltration indices and relative muscle cross-sectional area indicate that a substantial amount of relative cross-sectional area may be magnetic resonance-visible intramuscular fat in older adults with chronic low back pain.
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Affiliation(s)
- Jaclyn Megan Sions
- *Department of Physical Therapy, University of Delaware, Newark, Delaware, USA;
| | - Andrew Craig Smith
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gregory Evan Hicks
- *Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - James Matthew Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Sions JM, Velasco TO, Teyhen DS, Hicks GE. Reliability of ultrasound imaging for the assessment of lumbar multifidi thickness in older adults with chronic low back pain. J Geriatr Phys Ther 2015; 38:33-9. [PMID: 24743751 DOI: 10.1519/jpt.0000000000000021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given age- and chronic low back pain (CLBP)-related spinal changes, similar studies are needed before clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intra- and interexaminer reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP. METHODS Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter- and intraexaminer reliability. Additionally, SEMs and MDCs were calculated. RESULTS All USI measurement techniques demonstrated excellent within-day, interexaminer procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-day, interexaminer procedural reliability (ICCs: 0.72-0.79). The SEMs ranged from 0.36 to 0.46 cm; MDCs ranged from 1.01 to 1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2. DISCUSSION Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP, when compared with previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is more challenging in this patient population. Factors, such as examiner training and participant anthropometrics, may impact reliability. CONCLUSIONS Good-to-excellent intra- and interexaminer USI procedural reliability may provide clinicians a direct assessment technique for clinical evaluation of the lumbar multifidi in older adults with CLBP. SEMs and MDCs may allow for accurate interpretation of USI assessments in this population.
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Affiliation(s)
- J Megan Sions
- 1Department of Physical Therapy, University of Delaware, Newark, Delaware. 2Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Ft Detrick, Maryland
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What is the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture? Asian Spine J 2015; 9:162-9. [PMID: 25901225 PMCID: PMC4404528 DOI: 10.4184/asj.2015.9.2.162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/03/2014] [Accepted: 05/14/2014] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Case control study. PURPOSE To examine the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE Low bone mass is not the only important component of the risk on osteoporotic vertebral fracture; many other risk factors also contribute to skeletal fragility. METHODS Seventy-two patients who had a lateral radiograph of the whole spine, magnetic resonance imaging of the lumbar spine, and bone densitometry, were enrolled. The spino-pelvic sagittal parameters (pelvic incidence, pelvic tilt [PT], sacral slope, thoracic kyphosis, lumbar lordosis), age, lumbar bone mineral density, and amount of back muscle around the lumbar spine were analyzed. RESULTS There was higher sagittal imbalance of the spine in the vertebral fracture group (p=0.011). In spinopelvic parameters, the average of PT was 22.13° in vertebral fracture group and 13.70° in the non-fracture group (p=0.002). The amount of lower back extensor muscle in the vertebral fracture group was 2,170 mm(2), which was lower than the non-fracture group (3,040 mm(2), p=0.001). Multiple logistic regression analysis for the risk of osteoporotic vertebral fracture was significant in lumbar bone mineral density (odds ratio [OR], 0.313; 95% confidence interval [CI], 0.139-0.706, p=0.005) and the muscle ratio of extensor back muscle (OR, 0.902; 95% CI, 0.826-0.984; p=0.020). CONCLUSIONS These results suggest that osteoporotic vertebral fracture could be developed easily by weakness of extensor back muscle in sagittal imbalance of the spine with high pelvic tilt.
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MacIntyre NJ, Recknor CP, Grant SL, Recknor JC. Scores on the Safe Functional Motion test predict incident vertebral compression fracture. Osteoporos Int 2014; 25:543-50. [PMID: 23912556 DOI: 10.1007/s00198-013-2449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Safe Functional Motion test (SFM) was developed to document movement strategies used to perform everyday activities that may increase the risk for osteoporotic fracture. After adjusting for variables known to predict vertebral compression fracture (VCF), baseline score on the SFM was a significant independent predictor of incident VCF at 1- and 3-year follow-ups. INTRODUCTION Functional movements may contribute to risk for VCF. We hypothesize that scores on the SFM, a performance-based test of physical function, are associated with incident VCF. METHODS An osteoporosis clinic database was queried for men and women ≥ 50 years with an initial SFM and corresponding data for prevalent VCF, history of injurious falls, femoral neck bone mineral density (fnBMD), osteoporosis medication use, and incident morphometric VCF at 1-year (n = 878) and 3-year follow-ups (n = 503). Multiple logistic regressions, adjusted for gender, age, injurious fall(s), fnBMD, prevalent VCF at baseline, and osteoporosis medication use, were used to determine whether SFM score was associated with incident VCF at follow-up visits. RESULTS Baseline SFM score was a significant independent predictor of incident VCF at 1-year follow-up (adjusted odds ratio (95 % confidence intervals (CI)) = 0.818 (0.707, 0.948); p < 0.008) and 3-year follow-up (adjusted odds ratio (95 % CI) = 0.728 (0.628, 0.844); p < 0.0001). Baseline fnBMD and osteoporosis medication use were significant predictors at 1-year (p = 0.05 and < 0.0001, respectively) and 3-year (p < 0.01 and 0.001, respectively) follow-ups. At 3-year follow-up, gender and prevalent VCF were also significant predictors (p = 0.003 and 0.007, respectively). CONCLUSIONS For every 10-point increase in SFM score, the odds of future VCF decreases by 18 % at 1 year and 27 % at 3 years after adjusting for known covariates. The SFM may aid in the identification of modifiable functional risk factors for VCF.
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Affiliation(s)
- N J MacIntyre
- School of Rehabilitation Science, McMaster University, IAHS-403, 1400 Main St. West, Hamilton, ON, Canada, L8S 1C7,
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Recknor CP, Grant SL, Recknor JC, Macintyre NJ. Scores on the safe functional motion test are associated with prevalent fractures and fall history. Physiother Can 2014; 65:75-83. [PMID: 24381386 DOI: 10.3138/ptc.2011-25bh] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The Safe Functional Motion test (SFM) was developed to measure observed body mechanics and functional motion associated with spine load, balance, strength, and flexibility during everyday tasks to profile modifiable risks for osteoporotic fracture. This cross-sectional study evaluated the associations between SFM score and history of vertebral compression fracture (VCF), hip fracture, and injurious falls, all established predictors of future risk. METHOD An osteoporosis clinic database was queried for adults with an initial SFM score and corresponding data for prevalent VCF and/or hip fracture, femoral neck bone mineral density (fnBMD), and history of injurious fall (n=847). Multiple logistic regressions, adjusted for age, gender, and fnBMD (and injurious falls in the prevalent fracture analyses), were used to determine whether associations exist between SFM score and prevalent VCF, prevalent hip fracture, and history of injurious fall. RESULTS SFM score was associated with prevalent VCF (odds ratio [OR]=0.89; 95% CI, 0.79-0.99; p=0.036), prevalent hip fracture (OR=0.77; 95% CI, 0.65-0.92; p=0.004), and history of injurious fall (OR=0.80; 95% CI, 0.70-0.93; p=0.003) after adjusting for other important covariates. CONCLUSIONS Adults with higher SFM scores ("safer motion" during performance of everyday tasks) were less likely to have a history of fracture or injurious fall. Further study is warranted to evaluate the predictive value of this tool.
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Affiliation(s)
- Chris P Recknor
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Stephanie L Grant
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Julie C Recknor
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Norma J Macintyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
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The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures. Asian Spine J 2013; 7:308-13. [PMID: 24353848 PMCID: PMC3863657 DOI: 10.4184/asj.2013.7.4.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/04/2013] [Accepted: 05/04/2013] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. Overview of Literature In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. Methods Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. Results A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). Conclusions Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.
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Rehman R, Khan R, Surti A, Khan H. An ounce of discretion is worth a pound of wit--ergonomics is a healthy choice. PLoS One 2013; 8:e71891. [PMID: 24204559 PMCID: PMC3799755 DOI: 10.1371/journal.pone.0071891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of the study was to identify the occurrence and outcome of low back ache amongst computer users and their relation to age, gender, occupation and duration of computer use. MATERIALS AND METHODS A self reported questionnaire tailored from Occupational Health and Safety Act of the Ministry of Labor, Ontario, Canada was used. RESULTS 416 participants 55.5% males and 45% females using computers for a minimum of five years with age range 22 to 59 years belonged to different occupational groups. Consecutive hours of computer work was found to be associated with work related backache or discomfort in 27.4% (n = 114) participants (16.1% male, 11.3% female). Frequent short breaks improved backache (p value <0.001) in 93 (22.4%) participants (13.2% male, 9.2% female). No significant relation was observed with the duration of computer usage or usage per day; between the two genders or occupational groups. Backache had no significance within age groups. CONCLUSION Our study identifies the occurrence of low back pain among those who are using computer for consecutive hours without breaks and the results suggest the need to create health awareness especially use of short breaks to minimize the risk and occurrence of low back pain. The result of this study can also be used to improve ergonomic design and standards.
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Affiliation(s)
- Rehana Rehman
- Physiology, Bahria University Medical & Dental College, Karachi, Pakistan
| | | | - Ambreen Surti
- Anatomy, Bahria University Medical & Dental College, Karachi, Pakistan
- * E-mail:
| | - Hira Khan
- Elixir Technologies, Islamabad, Pakistan
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Karunaratne A, Davis G, Hiller J, Esapa C, Terrill N, Brown S, Cox R, Thakker R, Gupta H. Hypophosphatemic rickets is associated with disruption of mineral orientation at the nanoscale in the flat scapula bones of rachitic mice with development. Bone 2012; 51:553-62. [PMID: 22609228 PMCID: PMC3657142 DOI: 10.1016/j.bone.2012.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/19/2012] [Accepted: 04/25/2012] [Indexed: 11/20/2022]
Abstract
Metabolic bone disorders such as rickets are associated with altered in vivo muscular force distributions on the skeletal system. During development, these altered forces can potentially affect the spatial and temporal dynamics of mineralised tissue formation, but the exact mechanisms are not known. Here we have used a murine model of hypophosphatemic rickets (Hpr) to study the development of the mineralised nanostructure in the intramembranously ossifying scapulae (shoulder bone). Using position-resolved scanning small angle X-ray scattering (SAXS), we quantified the degree and direction of mineral nanocrystallite alignment over the width of the scapulae, from the load bearing lateral border (LB) regions to the intermediate infraspinous fossa (IF) tissue. These measurements revealed a significant (p<0.05) increase in mineral nanocrystallite alignment in the LB when compared to the IF region, with increased tissue maturation in wild-type mice; this was absent in mice with rickets. The crystallites were more closely aligned to the macroscopic bone boundary in the LB when compared to the IF region in both wild type and Hpr mice, but the degree of alignment was reduced in Hpr mice. These findings are consistent with a correlation between the nanocrystallites within fibrils and in vivo muscular forces. Thus our results indicate a relevant mechanism for the observed increased macroscopic deformability in rickets, via a significant alteration in the mineral particle alignment, which is mediated by an altered spatial distribution of muscle forces.
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Affiliation(s)
- A. Karunaratne
- Queen Mary University of London, School of Engineering and Material Sciences, Mile End Road, London, E1 4NS, UK
| | - G.R. Davis
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Institute of Dentistry, E1 2AD, UK
| | - J. Hiller
- Diamond Light Source Ltd., Diamond House, Harwell Science and Innovation Campus, Chilton, Didcot, Oxfordshire, OX11 0DE, UK
| | - C.T. Esapa
- Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford, OX3 7JL, UK
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK
| | - N.J. Terrill
- Diamond Light Source Ltd., Diamond House, Harwell Science and Innovation Campus, Chilton, Didcot, Oxfordshire, OX11 0DE, UK
- Department of Chemistry, University of Sheffield, Dainton Building, Brookhill, Sheffield, S3 7HF, UK
| | - S.D.M. Brown
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK
| | - R.D. Cox
- MRC Mammalian Genetics Unit and Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, OX11 0RD, UK
| | - R.V. Thakker
- Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford, OX3 7JL, UK
| | - H.S. Gupta
- Queen Mary University of London, School of Engineering and Material Sciences, Mile End Road, London, E1 4NS, UK
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Sundstrup E, Jakobsen MD, Andersen CH, Jay K, Andersen LL. Swiss ball abdominal crunch with added elastic resistance is an effective alternative to training machines. Int J Sports Phys Ther 2012; 7:372-380. [PMID: 22893857 PMCID: PMC3414069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Swiss ball training is recommended as a low intensity modality to improve joint position, posture, balance, and neural feedback. However, proper training intensity is difficult to obtain during Swiss ball exercises whereas strengthening exercises on machines usually are performed to induce high level of muscle activation. PURPOSE To compare muscle activation as measured by electromyography (EMG) of global core and thigh muscles during abdominal crunches performed on Swiss ball with elastic resistance or on an isotonic training machine when normalized for training intensity. METHODS 42 untrained individuals (18 men and 24 women) aged 28-67 years participated in the study. EMG activity was measured in 13 muscles during 3 repetitions with a 10 RM load during both abdominal crunches on training ball with elastic resistance and in the same movement utilizing a training machine (seated crunch, Technogym, Cesena, Italy). The order of performance of the exercises was randomized, and EMG amplitude was normalized to maximum voluntary isometric contraction (MVIC) EMG. RESULTS When comparing between muscles, normalized EMG was highest in the rectus abdominis (P<0.01) and the external obliques (P<0.01). However, crunches on Swiss ball with elastic resistance showed higher activity of the rectus abdominis than crunches performed on the machine (104±3.8 vs 84±3.8% nEMG respectively, P<0.0001). By contrast, crunches performed on Swiss ball induced lower activity of the rectus femoris than crunches in training machine (27±3.7 vs 65±3.8% nEMG respectively, P<0.0001) Further, gender, age and musculoskeletal pain did not significantly influence the findings. CONCLUSION Crunches on a Swiss ball with added elastic resistance induces high rectus abdominis activity accompanied by low hip flexor activity which could be beneficial for individuals with low back pain. In opposition, the lower rectus abdominis activity and higher rectus femoris activity observed in machine warrant caution for individuals with lumbar pain. Importantly, both men and women, younger and elderly, and individuals with and without pain benefitted equally from the exercises.
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Affiliation(s)
- Emil Sundstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Markus D. Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Kenneth Jay
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Lars L. Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Factors affecting clinical outcomes in treating patients with grade 1 degenerative spondylolisthesis using interspinous soft stabilization with a tension band system: a minimum 5-year follow-up. Spine (Phila Pa 1976) 2012; 37:563-72. [PMID: 21508894 DOI: 10.1097/brs.0b013e31821c0b97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE To explore the factors influencing the clinical outcomes and motion-preserving stabilization after interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA Despite increasing recognition of the benefits of dynamic stabilization systems for treating lumbar degenerative disorders, the factors affecting the clinical and radiological outcomes of these systems have rarely been identified. METHODS Sixty-five patients (mean age, 60.3 years) who underwent ISS with a tension band system between 2002 and 2004 were analyzed. The mean follow-up period was 72.5 months. The patients were divided according to the postsurgical clinical improvements into the optimal (n = 44) and suboptimal groups (n = 21), and the radiological intergroup differences were analyzed. Multiple linear regression analysis was performed to determine the impact of the radiological factors on the clinical outcomes. RESULTS Significant intergroup differences were observed on the follow-up clinical examination. Radiologically, total lumbar lordosis (TLL) and segmental lumbar lordosis (SLL) were significantly improved only in the optimal group, resulting in significant intergroup differences in TLL (P = 0.023), SLL (P = 0.001), and the L1 tilt (P = 0.002). All these measures were closely associated with postoperative segmental lumbar lordosis, which also was the most influential radiological variable for the clinical parameters. CONCLUSION In the patients with grade 1 DS, the back pain relief and functional improvement following ISS were affected by the improvements in the sagittal spinal alignment through the achievement of segmental lumbar lordosis. ISS can be an alternative treatment to fusion surgery for grade 1 DS in patients who do not require fixation or reduction.
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Papadakis M, Sapkas G, Papadopoulos EC, Katonis P. Pathophysiology and biomechanics of the aging spine. Open Orthop J 2011; 5:335-42. [PMID: 21966338 PMCID: PMC3178886 DOI: 10.2174/1874325001105010335] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 07/25/2011] [Accepted: 07/29/2011] [Indexed: 11/22/2022] Open
Abstract
AGING OF THE SPINE IS CHARACTERIZED BY TWO PARALLEL BUT INDEPENDENT PROCESSES: the reduction of bone mineral density and the development of degenerative changes. The combination of degeneration and bone mass reduction contribute, to a different degree, to the development of a variety of lesions. This results in a number of painful and often debilitating disorders. The present review constitutes a synopsis of the pathophysiological processes that take place in the aging spine as well as of the consequences these changes have on the biomechanics of the spine. The authors hope to present a thorough yet brief overview of the process of aging of the human spine.
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Kraiger M, Martirosian P, Opriessnig P, Eibofner F, Rempp H, Hofer M, Schick F, Stollberger R. A fully automated trabecular bone structural analysis tool based on T2* -weighted magnetic resonance imaging. Comput Med Imaging Graph 2011; 36:85-94. [PMID: 21862288 DOI: 10.1016/j.compmedimag.2011.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/19/2011] [Accepted: 07/29/2011] [Indexed: 11/16/2022]
Abstract
One major source affecting the precision of bone structure analysis in quantitative magnetic resonance imaging (qMRI) is inter- and intraoperator variability, inherent in delineating and tracing regions of interest along longitudinal studies. In this paper an automated analysis tool, featuring bone marrow segmentation, region of interest generation, and characterization of cancellous bone of articular joints is presented. In evaluation studies conducted at the knee joint the novel analysis tool significantly decreased the standard error of measurement and improved the sensitivity in detecting minor structural changes. It further eliminated the need of time-consuming user interaction, and thereby increasing reproducibility.
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Affiliation(s)
- Markus Kraiger
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria.
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Variability of tissue mineral density can determine physiological creep of human vertebral cancellous bone. J Biomech 2011; 44:1660-5. [PMID: 21481880 DOI: 10.1016/j.jbiomech.2011.03.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 11/21/2022]
Abstract
Creep is a time-dependent viscoelastic deformation observed under a constant prolonged load. It has been indicated that progressive vertebral deformation due to creep may increase the risk of vertebral fracture in the long-term. The objective of this study was to examine the relationships of creep with trabecular architecture and tissue mineral density (TMD) parameters in human vertebral cancellous bone at a physiological static strain level. Architecture and TMD parameters of cancellous bone were analyzed using microcomputerized tomography (micro-CT) in specimens cored out of human vertebrae. Then, creep and residual strains of the specimens were measured after a two-hour physiological compressive constant static loading and unloading cycle. Creep developed (3877 ± 2158 με) resulting in substantial levels of non-recoverable post-creep residual strain (1797 ± 1391 με). A strong positive linear correlation was found between creep and residual strain (r = 0.94, p < 0.001). The current results showed that smaller thickness, larger surface area, greater connectivity of trabeculae, less mean tissue mineral density (TMD, represented by gray levels) and higher variability of TMD are associated with increasing logarithmic creep rate. The TMD variability (GL(COV)) was the strongest correlate of creep rate (r = 0.79, p < 0.001). This result suggests that TMD variability may be a useful parameter for estimating the long-term deformation of a whole vertebral body. The results further suggest that the changes in TMD variability resulting from bone remodeling are of importance and may provide an insight into the understanding of the mechanisms underlying progressive failure of vertebral bodies and development of a clinical fracture.
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Lee SH, Enes M, Hoogland T. Soft stabilization with interspinous artificial ligament for mildly unstable lumbar spinal stenosis: a multicenter comparison. Arch Orthop Trauma Surg 2010; 130:1335-41. [PMID: 20049606 DOI: 10.1007/s00402-009-1031-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In an attempt to fill a gap between simple decompression alone and fusion in the spectrum of surgical treatment for degenerative lumbar spinal stenosis (DLSS), the authors sought to demonstrate the efficacy and reproducibility of soft stabilization with interspinous artificial ligament after microsurgical fenestration to prevent post-decompression segmental instability for mildly unstable DLSS. MATERIALS AND METHODS Clinical outcomes from 556 patients treated with soft stabilization with artificial ligament following microdecompression for mildly unstable DLSS from March 1998 to June 2006 were retrospectively obtained from three institutions in three countries. Outcomes were measured at a mean of 48.9 months after surgery using MacNab criteria. Peri- and postoperative complications and revision surgery cases were also analyzed. RESULTS Follow-up was achieved in 391 (70.3%) of the 556 patients. Clinical outcomes were excellent in 43.7%, good in 36.7%, fair in 12.2%, and poor in 7.4% of the patients. The overall clinical success rate was 80.4%. No major complications except postoperative hematoma and wound infection (6/391 cases, 1.5%) were observed, and few revision surgeries (2.3%) were done during follow-up. CONCLUSION We found favorable and reproducible results with soft stabilization with artificial ligament after microdecompression for mildly unstable DLSS from three institutions in three countries. Soft stabilization with artificial ligament may be concluded to represent an effective prevention of increased post-decompression instability with reliable reproducibility for mildly unstable DLSS in carefully selected patients.
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Affiliation(s)
- Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
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Been E, Peleg S, Marom A, Barash A. Morphology and function of the lumbar spine of the Kebara 2 Neandertal. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2010; 142:549-57. [DOI: 10.1002/ajpa.21256] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Muscat Baron Y, Brincat MP, Galea R, Calleja N. Low intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures compared to hormone-treated and untreated postmenopausal women and premenopausal women without fractures. Climacteric 2009; 10:314-9. [PMID: 17653958 DOI: 10.1080/13697130701460640] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures. METHODS A total of 203 women were recruited from a bone densitometer directory. The disc heights measured were those between the 12th thoracic and 3rd lumbar vertebrae. The discs were assigned the symbols D, whereby D(1) refers to the disc between the 12th thoracic and 1st lumbar vertebrae. The disc height of the group of women (n = 38) with osteoporotic vertebral fractures was compared to the disc heights of hormone-treated women (n = 47), untreated postmenopausal women (n = 77) and another group of premenopausal women (n = 41). RESULTS The total disc height (D(1) - D(3)) (mean +/- standard deviation) in the fracture group was 1.58 +/- 0.1 cm, significantly lower (p < 0.0001) than in the untreated group (1.82 +/- 0.06 cm), which in turn was significantly (p < 0.0001) lower than in the hormone-treated group (2.15 +/- 0.08 cm) and in the premenopausal group (2.01 +/- 0.09 cm). CONCLUSION The fracture group was noted to have the lowest intervertebral disc height compared to the other three groups. The hormone-treated and the premenopausal women had the highest disc heights recorded. These results may be due to the effect that the menopause and senescence have on the discal connective tissue components. This may lead to loss of the shock-absorbing properties of the intervertebral disc and an altered discoid shape, influencing the occurrence of osteoporotic vertebral body fractures.
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Affiliation(s)
- Y Muscat Baron
- Department of Obstetrics & Gynaecology, St. Luke's Hospital Medical School, Malta
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Kurutz M, Donáth J, Gálos M, Varga P, Fornet B. Age- and sex-related regional compressive strength characteristics of human lumbar vertebrae in osteoporosis. J Multidiscip Healthc 2008; 1:105-21. [PMID: 21197342 PMCID: PMC3004543 DOI: 10.2147/jmdh.s4103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To obtain the compressive load bearing and energy absorption capacity of lumbar vertebrae of osteoporotic elderly for the everyday medical praxis in terms of the simple diagnostic data, like computed tomography (CT), densitometry, age, and sex. METHODS Compressive test of 54 osteoporotic cadaver vertebrae L1 and L2, 16 males and 38 females (age range 43-93, mean age 71.6 ± 13.3 years, mean bone mineral density (BMD) 0.377 ± 0.089 g/cm(2), mean T-score -5.57 ± 0.79, Z-score -4.05 ± 0.77) was investigated. Based on the load-displacement diagrams and the measured geometrical parameters of vertebral bodies, proportional, ultimate and yield stresses and strains, Young's modulus, ductility and energy absorption capacity were determined. Three vertebral regions were distinguished: superior, central and inferior regions, but certain parameters were calculated for the upper/ lower intermediate layers, as well. Cross-sectional areas, and certain bone tissue parameters were determined by image analysis of CT pictures of vertebrae. Sex- and age-related decline functions and trends of strength characteristics were determined. RESULTS Size-corrected failure load was 15%-25% smaller in women, proportional and ultimate stresses were about 30%-35% smaller for women in any region, and 20%-25% higher in central regions for both sexes. Young's moduli were about 30% smaller in women in any region, and 20%-25% smaller in the central region for both sexes. Small strains were higher in males, large strains were higher in females, namely, proportional strains were about 25% larger in men, yield and ultimate strains were quasi equal for sexes, break strains were 10% higher in women. Ultimate energy absorption capacity was 10%-20% higher in men; the final ductile energy absorption capacity was quasi equal for sexes in all levels. Age-dependence was stronger for men, mainly in central regions (ultimate load, male: r = -0.66, p < 0.01, female: r = -0.52, p < 0.005; ultimate stress, male: r = -0.69, p < 0.01, female: r = -0.50, p < 0.005; Young's modulus, male: r = -0.55, p < 0.05, female: r = -0.52, p < 0.005, ultimate stiffness, male: r = -0.58, p < 0.05, female: r = -0.35, p < 0.03, central ultimate absorbed energy density, male: r = -0.59, p < 0.015, female: r = -0.29, p < 0.08). CONCLUSIONS For the strongly osteoporotic population (BMD < 0.4 g/cm(2), T-score < -4) the statical variables (loads, stresses) showed significant correlation; mixed variables (stiffness, Young's modulus, energy) showed moderate correlation; kinematical variables (displacements, strains) showed no correlation with age. The strong correlation of men between BMD and aging (r = -0.82, p < 0.001) and betwen BMD and strength parameters (r = 0.8-0.9, p < 0.001) indicated linear trends in age-related strength loss for men; however, the moderate correlation of women between BMD and aging (r = -0.47, p < 0.005) and between BMD and strength parameters (r = 0.4-0.5, p < 0.005) suggested the need of nonlinear (quadratic) approximation that provided the better fit in age-related strength functions of females modelling postmenopausal disproportionalities.
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Effect of long-term axial spinal unloading on vertebral body height in adult thoracolumbar spine. 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 2008; 17:965-9. [PMID: 18421482 DOI: 10.1007/s00586-008-0669-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 03/14/2008] [Accepted: 03/30/2008] [Indexed: 10/22/2022]
Abstract
The human spine is influenced by mechanical loads. To our knowledge, this is the first study to assess the effect of long-term axial unloading on morphology of healthy vertebras in adults. The objective of this study is to quantify the effects of long-term relative axial unloading on thoracolumbar vertebral body height in adults. In this study, 218 vertebras on 200 plain lateral radiograms of patients with thoracolumbar vertebral body fracture, which underwent long segment instrumentation and fusion and had a relative axial unloading on five vertebrae of thoracolumbar spine were evaluated. Anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) proximal and distal to the fractured vertebrae were measured before and at least 1 year after the unloading operative procedures. AVBH of the first distal adjacent vertebrae and summative AVBHs of the first distal and proximal adjacent vertebras to the fractured vertebrae were significantly increased after 1 year of unloading, whereas the PVBH changes were not noticeable and the mean of cumulative height of two levels of proximal and distal adjacent vertebras to the fractured vertebrae did not show significant difference. Vertebral body height of lumbar was more influenced by unloading when compared with thoracic spine. Long-term relative axial unloading can affect the height of healthy vertebral bodies in adult spine.
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