Postural Malalignment Due to Helmet Usage in Cricket Players \u2013 An Observational Study

Photogrammetric Assessment of Upper Body Posture Using Postural Angles: A Literature Review

Context Accuracy of locating various lumbopelvic landmarks for novice athletic trainers has not been examined. Objective To examine reliability of novice athletic trainers for identification of the L4 spinous process and right and left posterior superior iliac spine (PSIS). Design Cross-sectional reliability. Setting Laboratory. Patients or Other Participants Sixteen physically active volunteers participated (age = 22.56 ± 2.67 years, height = 172.0 ± 9.38 cm, mass = 67.39 ± 9.73 kg, body mass index = 22.8 ± 1.97). Four novice athletic trainers (certified < 2 years) served as the testers of interest. Intervention(s) Subjects were placed prone and 2 expert athletic trainers (certified > 12 years) agreed upon each bony landmark and transferred the palpation markings to contact paper. Each novice athletic trainer palpated the landmarks twice within the same test session and used the same method as the experts for transfer and recording. Novice athletic trainers rotated between subjects after 1 marking trial. Expert marks were transposed over the tester marks to assess distance and agreement. Main Outcome Measure(s) Independent variables were novice athletic trainer (AT1, AT2, AT3, AT4) and time (Trial 1, Trial 2); dependent variables included distance from the expert marking in millimeters for L4 and PSIS palpations, and agreement within or outside of a designated area for the L4 spinous process. Intraclass correlation coefficients (ICC [2,1]), standard error of measurement, and percent agreement were calculated. Results Intratester reliability for L4 ranged from 0.370 to 0.833, right PSIS (RPSIS) ranged from 0.371 to 0.771, and left PSIS (LPSIS) ranged from −0.173 to 0.760. Intertester ICC (2,1) for Trial 1 and Trial 2 were, respectively, 0.319 and 0.466 (L4), 0.213 and 0.002 (RPSIS), and 0.96 and 0.073 (LPSIS). Percent agreement between expert and testers ranged from 18.75%–81.3% for L4 spinous process. Conclusions Our results indicate novice athletic trainers are generally poor at reliably locating lumbopelvic anatomical landmarks, and this should be addressed within educational programming.

Objective:Due to social distancing guidelines during the Coronavirus (COVID-19) pandemic, most providers and patients have wanted to avoid close contact. This makes physical therapy (PT) assessments difficult because of the lack of empirical evidence about the reliability of various clinical measurements performed in a virtual environment. One such procedure is the photometric measurement of craniovertebral (CV) angle. Craniovertebral angle measurement is usually performed in an outpatient setting and is defined as the acute angle formed between a straight line connecting the spinous process of C7 to the tragus of the ear, and the horizontal line passing through the spinous process of the C7. Although the photometric measurement of CV angles is considered both valid and reliable in the clinics, no empirical evidence exists about the CV angle measurement reliability when performed in a virtual environment. Thus, the purpose of this study was to assess the inter- and intra-rater reliability of photometric CV angle measurement using a cloud-based video communication platform. Number of Subjects: 66 subjects (57 females).Methods:All measurements were performed by two final year PT students who had completed the musculoskeletal part of the curriculum and were blinded to each other's measurements. Each subject was photographed in two postures over a HIPAA-compliant video-based telehealth platform: (1) normal/relaxed posture and (2) ideal posture (posture the subject considered good). Student researcher 1 measured the CV angle in both the relaxed posture and ideal posture, while student researcher 2 measured the CV angle only in the relaxed posture. Each subject's CV angle measurement was performed three times on three separate days and the means were used for further analysis. The shape of the CV angle frequency distribution was assessed using kurtosis and skewness values. Rater reliability was assessed using intraclass correlation coefficients (ICC), and interpreted based on the guidelines provided by Portney and Watkins (2009).Results:The CV angles were normally distributed in both relaxed and ideal postures. The mean and standard deviation (SD) of relaxed posture was 50.7o ± 6.3o with kurtosis and skewness of 0.67 and −0.74 respectively. The mean and SD of ideal posture was 55.5o ± 5.4o, with kurtosis and skewness of 0.1 and −0.54 respectively. The ICC for inter-rater reliability in the relaxed posture was 0.88 and the ICC for intra-rater reliability for relaxed posture was 0.91.Conclusions:Craniovertebral angles were normally distributed in the sample. An acceptable level of inter- and intra-rater reliability can be attained when measuring CV angle using a cloud-based video communication platform.

Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match with no head impact

An accurate noninvasive measurement of spinal angles is crucial for detecting postural problems and for assessing therapeutic intervention for students in school. This study was conducted to evaluate the intra-rater and inter-rater reliability of Surgimap Spine software for measuring spinal postural angles from digital photos of adolescents in schools. Twenty-two adolescent students of both sexes (10 boys and 12 girls) participated in this reliability study. The researcher took four photographs of each adolescent from different standing views; at intra-rater analysis, one rater analyzed the four photos at three different time, whereas at inter-rater analysis three raters analyzed them once. Reliability was quantified with intraclass correlation coefficient (ICC), repeated measurement analysis (RMA), and standard of measurement error (SEM). Intra-rater reliability of all spinal postural angles [head tilt, shoulder tilt, pelvic tilt from anterior view, scapular tilt, gaze angle, craniovertebral angle, trunk angle, lumbar angle, pelvic tilt from lateral view, and sway angle for right and left sides] showed excellent results, with ICC above 0.9, whereas ICC for pelvic tilt from the posterior view (0.813) was very good. SEM ranged from 0.28 to 1.5° and RMA showed no statistical difference between measurements of the same rater. ICC values for inter-rater reliability of all spinal postural angles ranged from 0.836 to 0.992. SEM ranged from 0.3 to 1.63° and RMA showed no statistical difference in measurements between different raters. Surgimap Spine software is a reliable method for measuring spinal postural angles of adolescents from different views in standing position from digital photographs.

Variability is inevitable in human movement and posture, including piano performance, although little research has been conducted in this area. The purpose of this study was to determine if, when comparing individuals to themselves, pianists demonstrate consistent postural angles within a task across multiple measurements and to ascertain if, between various tasks, there are discernible task-related postural patterns. Fifteen pianists participated in this study. Each pianist returned for a total of three measurement sessions. The tasks they were required to perform at each session were quiet sitting, raising their hands on and off the keyboard, playing an ascending and descending scale, sight reading, and playing a piece in three expressive conditions (i.e., deadpan, projected, exaggerated). The following postural angles were calculated based on motion capture data collected during the performance of these tasks: craniovertebral angle, head tilt, head-neck-trunk angle, trunk angle, thoracic angle, thoracolumbar angle, and lumbar angle. The within-person variability ratio across the three measurements was calculated for each angle and across all tasks. Task-related patterns in angles were examined by comparing the same postural angle across different tasks. Results showed that there is a considerable amount of within-person variability, but not enough to be inconsistent over time. Task-related patterns indicate that reading a musical score or playing at the extreme ends of the keyboard tend to involve leaning closer to the instrument. Implications for future studies, intervention studies in particular, include taking more than a single baseline measurement to provide a more accurate picture of an individual pianist's typical posture.

The Alexander Technique (AT) is a somatic method often employed by musicians, including pianists, which teaches its students to become consciously aware of their own postural behavior while carrying out various tasks. Little research has been conducted as to whether, and if so, how the AT affects the posture of pianists while they are playing the piano, and quantitative measurements of their postural angles have not yet been taken. The purpose of this study was to determine the effects of an intervention consisting of 10 AT lessons on pianists’ postural angles while playing, and to find out if the effects were still evident 4 weeks later. The following postural angles were measured before and after the intervention: craniovertebral angle, head tilt, head–neck–trunk angle, trunk angle, thoracic angle, thoracolumbar angle, and lumbar angle. There were significant effects of the intervention such that the craniovertebral and head–neck–trunk angles were found to have increased, and trunk, thoracic, and thoracolumbar angles were found to have decreased both immediately post-intervention and 4 weeks later. The AT appears to be a viable method of altering postural behavior while playing the piano, as seen in an overall pattern of spinal extension.

Hamstring muscle length may be associated with specific pelvic and trunk postures, but the influence of hamstring length on trunk postures is not well documented. The purposes of this study were to examine the influence of hamstring length on 1) the pelvic angle, lumbar angle, and thoracic angle in standing; and 2) the flexion ranges of motion of the pelvic angle, lumbar angle, and thoracic angle during the toe-touch test. Surface platform pointers over bony landmarks and photography were used to examine the pelvic and trunk angles and ranges of motion of 10 men with short hamstrings, 10 men with medium hamstrings, and 10 men with long hamstrings while standing and after assuming the toe-touch position. Separate one-way analyses of variance detected no significant differences among groups for the three angles in standing. Significant differences were detected among groups for the three angles in the toe-touch position and the flexion ranges of motion during the toe-touch test (p < 0.05). Short hamstrings were associated with decreased flexion range of motion of the pelvic angle and lumbar angle and increased flexion range of motion of the thoracic angle. Therapeutic interventions should be considered in light of the influences of hamstring length on the flexion range of motion of the pelvic angle, lumbar angle, and thoracic. angle.

Background: Sacroiliac joint (SI) pain is increasingly being recognized as a source of low back pain. Injections and percutaneous type procedures are performed to treat symptomatic joints. However, there are limited studies available assessing the anatomy of the SI joint in vivo among patients with pain. Objectives: The purpose of this study was to provide more precise information on the dimensions and orientation of the SI joint using a new technique for the radiographic evaluation of this joint. Study Design: Observational study. Setting: Emergency department Methods: Three dimensional computed tomographic (CT) reconstructions of the pelvis were formatted from 100 SI joints in 50 patients who had clinically indicated abdominal/pelvic scans. These images were manipulated to evaluate the SI joint in multiple planes and measure its dimensions, area, and relationship to anatomic landmarks such as the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS). Results: Of the 50 patients, 23 were men and 27 women. Their mean age was 47.6 years (± 18.1). The SI joint consists of a superior limb which measures 39.7 mm (± 4.8) in length, and an inferior limb which measures 54.3 mm (± 5.1), oriented at an angle of 100.1° (± 8.1) to one another. The mean area of the joint was 1276.8 mm2 (± 189.8). The horizontal distance from the ASIS to the front of the superior SI joint is 75.4 mm (± 8.4). The horizontal distance from the PSIS to the back of the superior SI joint is 43.9 mm (± 5.6). The joint stretches 7.5 mm (± 5.9) cephalad and 38.1 mm (± 6.4) caudal to the PSIS, and 35.4 mm (± 8.8) cephalad and 10.2 mm (± 11.4) caudal to the ASIS. Limitations: CT scans were performed with patients lying supine, while most SI joint procedures are performed with a patient prone. However it is doubtful that the bony anatomic landmarks would change appreciable in this largely immobile joint. These patients were seen in the emergency department for a variety of conditions related to abdominal and pelvic pain, and not exclusively for SI joint pain. Conclusions: Treatment of the SI joint by surgeons and interventionalists is hampered by the limited number of anatomic studies in the literature. Our study presents the SI joint as a 2-limbed structure, sitting from slightly above the level of the PSIS rostrally to slightly below the level of the ASIS caudally. Palpation of these landmarks may assist in directing physicians to the joint. To begin an interventional pain procedure, with a patient lying prone, this data supports tilting the x-ray image intensifier 10 degrees caudal past the vertical anteroposterior (AP) view for optimal approach of the SI joint’s inferior limb. The needle entry should be about 44.1 mm (1.75 inches) caudal to the PSIS. The image intensifier should have a 12 degree left lateral oblique view for injection of the right SI joint, and a 12 degree right lateral oblique view for the left SI joint. Key words: Sacroiliac joint, arthriti, sacroiliac, anatomy, injections, intra-articular, tomography, x-ray computed, imaging, three-dimensional, pain management, back pain, radiology

Ultrasound (US) is increasingly used for transforaminal approaches. We evaluated whether fusing computed tomography (CT) images with dynamic US could be based on bony and surface landmarks in two phantom models. Recordings were performed in a gelatin-based sonographic phantom and in a computerized imaging reference system training phantom. Three anesthesiologists performed 10 US and CT image fusions via three different techniques: (1) using locations of the fifth lumbar vertebra (L5) spinous process and the two posterior superior iliac spines in both images, (2) using the two lateral edges of the laminae rather than posterior superior iliac spines, and (3) using skin landmarks. Techniques were compared using values of precision (High quality of fusion: VP inferior to 10). Three punctures targeting the L4-L5 right foramina were made, and needle positions were checked using X-ray. Sixty fusions were performed in the gelatin phantom and 90 in the training phantom. VPs values of the 150 fusions were inferior to 5. Technique 2 was superior to one [operator 1: VP: 1.12 ± 0.54 vs. 2.38 ± 1.49; operator 2: 0.6 ± 0.39 vs. 3.66 ± 1.22; operator 3: 0.89 ± 0.31 vs. 1.23 ± 0.63 (p < 0.001)] with the gelatin phantom. There were no differences with the second phantom. X-ray examinations confirmed L4-L5 needle positioning. Bony and surface landmarks allowed for accurate fusion of CT and US images of the lumbar spine. These techniques, performed on phantoms, allowed for precise localization and puncturing of lumbar neural foramina.

The objective of this review is to establish the current state of knowledge on the reliability of clinical assessment of asymmetry in the lumbar spine and pelvis. To search the literature, the authors consulted the databases of MEDLINE, CINAHL, AMED, MANTIS, Academic Search Complete, and Web of Knowledge using different combinations of the following keywords: palpation, asymmetry, inter or intraexaminer reliability, tissue texture, assessment, and anatomic landmark. Of the 23 studies identified, 14 did not meet the inclusion criteria and were excluded. The quality and methods of studies investigating the reliability of bony anatomic landmark asymmetry assessment are variable. The κ statistic ranges without training for interexaminer reliability were as follows: anterior superior iliac spine (ASIS), -0.01 to 0.19; posterior superior iliac spine (PSIS), 0.04 to 0.15; inferior lateral angle, transverse plane (ILA-A/P), -0.03 to 0.11; inferior lateral angles, coronal plane (ILA-S/I), -0.01 to 0.08; sacral sulcus (SS), -0.4 to 0.37; lumbar spine transverse processes L1 through L5, 0.04 to 0.17. The corresponding ranges for intraexaminer reliability were higher for all associated landmarks: ASIS, 0.19 to 0.4; PSIS, 0.13 to 0.49; ILA-A/P, 0.1 to 0.2; ILA-S/I, 0.03 to 0.21; SS, 0.24 to 0.28; lumbar spine transverse processes L1 through L5, not applicable. Further research is needed to better understand the reliability of asymmetry assessment methods in manipulative medicine.

Introduction: Sacroiliac Joint Dysfunction (SIJD) refers to a condition that causes pain and discomfort, commonly due to dysfunction of the Sacroiliac Joint (SIJ). It is a plausible source of Low Back Pain (LBP). Static palpation tests, motion palpation, and pain provocation tests are mostly employed to check for SIJD. Aim: To determine the commonly used tests in the assessment of SIJD by physiotherapists. Materials and Methods: A cross-sectional Questionnairebased study was conducted among physiotherapists in India from November 2022 to April 2023 at the Nitte Institute of Physiotherapy, NITTE (deemed to be University), Mangalore, Karnataka, India. The study included physiotherapists specialising in orthopaedics and obstetrics and gynaecology. The practitioners’ years of experience were considered. An online survey was conducted using a questionnaire developed to determine the frequently used bony landmark for checking SIJ asymmetry, commonly affected structures, and commonly used motion palpation and pain provocation tests for examining SIJD. Questionnaires were sent to at least 100 physiotherapists, and 72 responses were included in the study. Data was collected and analysed using descriptive statistics: frequency and percentage. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: Seventy-two practitioners responded to the online survey. The commonly assessed bony landmark was the Posterior Superior Iliac Spines (PSIS) with 52 responses (28%). The most frequently preferred motion palpation examination test was the compression test with 36 responses (17.2%). Tenderness or tissue texture change was mainly checked at the PSIS with 54 responses (37.8%), and the commonly used pain provocation tests were the thigh thrust test and supine SIJ springing test with 46 responses (26.6%). Conclusion: According to this study, many physiotherapists employed diagnostic techniques congruent with Mitchell’s model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques. Most preferred the ASIS compression and thigh thrust tests to assess SIJD.

A triangle formed by the sacral hiatus and posterior superior iliac spines (PSISs) has been known as equiangular and has been proposed as a way to help identify the sacral hiatus for a caudal block. In children, however, no feasibility study of this triangle has been performed. We compared the expected sacral hiatus obtained from the equiangular triangle method and the real sacral hiatus confirmed by ultrasound. Eighty children (aged 0.5-72 months) were placed in the left lateral decubitus position in full hip flexion. The vertex of an equiangular triangle formed inferior to PSISs was considered as the expected sacral hiatus by classic bony landmarks. The real sacral hiatus was identified by ultrasound. The angle formed by the 2 lines connecting each PSIS and the real sacral hiatus (angle θ) was also measured. The distances between the midpoint of PSISs and expected sacral hiatus (distance E) and real sacral hiatus (distance R) were measured and compared. The angle θ was greater than 60 degrees in all children (79.3 [9.3] degrees) and negatively correlated with age younger than 1 year. Distance R (3.5 [1.1] cm) was significantly shorter than distance E (4.9 [1.2] cm) (P< 0.001). The distance R positively correlated with age, weight, height, and the distance between the PSISs. In children, using the equiangular triangle to identify the sacral hiatus may be inappropriate because the actual triangle formed by the sacral hiatus and PSISs is not equiangular.

The surface anatomy of the sciatic nerve (SN) in the gluteal region is clinically important (e.g., intramuscular injection). Anatomy texts describe the nerve in relation to the posterior superior iliac spine (PSIS), ischial tuberosity (IT), and greater trochanter (GT) but descriptions are inconsistent. The surface anatomy of the SN was determined in relation to these bony landmarks using computed tomography (CT) scans in living adults. One hundred consecutive adult pelvic CT scans (36 females, mean age 76 years) were available for dual consensus analysis. A further 19 adults (9 females, mean age 74 years) underwent pelvic CT scans in both prone and supine positions. The surface projection of the SN along a line between the PSIS and IT and between the IT and GT was measured. The SN was identified in 95% of scans at a mean of 5.2 ± 1.0 cm from the PSIS and 11.4 ± 1.1 cm from the IT. The SN was a mean of 5.8 ± 0.8 cm from the IT and 6.2 ± 1.0 cm from the GT. There were no significant differences in mean positions of the nerve between sides and sexes. A small but clinically irrelevant difference in the surface marking of the SN was found between supine and prone positions with respect to the GT and IT but not in relation to the PSIS and IT. In living adults, the SN lies approximately one-third of the way along a line between the PSIS and IT and half way between the GT and IT.

PurposeA newly developed head-mounted perimeter termed “imo” enables visual field (VF) testing without a fixed head position. Because the positional relationship between the subject’s head and the imo is fixed, the effects of head position changes on the test results are small compared with those obtained using a stationary perimeter. However, only ocular counter-roll (OCR) induced by head tilt might affect VF testing. To quantitatively reveal the effects of head tilt and OCR on the VF test results, we investigated the associations among the head-tilt angle, OCR amplitude and VF testing results.Subjects and methodsFor 20 healthy subjects, we binocularly recorded static OCR (s-OCR) while tilting the subject’s head at an arbitrary angle ranging from 0° to 60° rightward or leftward in 10° increments. By monitoring iris patterns, we evaluated the s-OCR amplitude. We also performed blind spot detection while tilting the subject’s head by an arbitrary angle ranging from 0° to 50° rightward or leftward in 10° increments to calculate the angle by which the blind spot rotates because of head tilt.ResultsThe association between s-OCR amplitude and head-tilt angle showed a sinusoidal relationship. In blind spot detection, the blind spot rotated to the opposite direction of the head tilt, and the association between the rotation angle of the blind spot and the head-tilt angle also showed a sinusoidal relationship. The rotation angle of the blind spot was strongly correlated with the s-OCR amplitude (R2≥0.94, p<0.0001). A head tilt greater than 20° with imo causes interference between adjacent test areas.ConclusionsBoth the s-OCR amplitude and the rotation angle of the blind spot were correlated with the head-tilt angle by sinusoidal regression. The rotated VF was correlated with the s-OCR amplitude. During perimetry using imo, the change in the subject’s head tilt should be limited to 20°.