Flexible Ruler Research Articles

Lumbar lordosis in prone position and prone hip extension test: comparison between subjects with and without low back pain

BackgroundProne hip extension (PHE) is a common and widely accepted test used for assessment of the lumbo-pelvic movement pattern. Considerable increased in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbo-pelvic region. The purpose of this study was to investigate the change of lumbar lordosis in PHE test in subjects with and without low back pain (LBP).MethodA two-way mixed design with repeated measurements was used to investigate the lumbar lordosis changes during PHE in two groups of subjects with and without LBP. An equal number of subjects (N = 30) were allocated to each group. A standard flexible ruler was used to measure the size of lumbar lordosis in prone-relaxed position and PHE test in each group.ResultThe result of two-way mixed-design analysis of variance revealed significant health status by position interaction effect for lumbar lordosis (P < 0.001). The main effect of test position on lumbar lordosis was statistically significant (P < 0.001). The lumbar lordosis was significantly greater in the PHE compared to prone-relaxed position in both subjects with and without LBP. The amount of difference in positions was statistically significant between two groups (P < 0.001) and greater change in lumbar lordosis was found in the healthy group compared to the subjects with LBP.ConclusionsGreater change in lumbar lordosis during this test may be due to more stiffness in lumbopelvic muscles in the individuals with LBP.

The effect of stabilization exercises on lumbar lordosis in patients with low back pain

Background and Purpose: There is a hypothesis that restoring the lumbar lordosis will increase a patient's voluntary muscular strength and decrease back pain symptoms. This study aimed to evaluate the effects of stabilization exercises on lumbar lordosis and functional improvement. Methods: Thirty-two patients with chronic low back pain (LBP) were recruited through simple nonprobability sampling for this double-blind, randomized clinical trial, performed at the Razmejo-Moghadam Physiotherapy Clinic, Zahedan University of Medical Sciences. Participants were randomly assigned to either stabilization exercise group (n = 16) or control group (n = 16). Before and after intervention, we assessed pain (ordinal) through the McGill Pain Questionnaire, disability (ordinal) with the Oswestry Disability Index (ODI), and lumbar curve (degree) with flexible ruler. Twelve sessions daily exercise program was performed for both groups. t-tests were used for data analysis (P 0.05). However, pain score and Oswestry score showed significant differences between two groups after intervention (P

The Effect of Active Knee Extension in Sitting on Lumbopelvic Curvature in Individuals with Clinically Tight Hamstring Muscles: A Cross-Sectional Reliability Study

Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. However, reliability for its quantitative measure has not been established yet and its establishment was the aim of the current study. Twenty-seven individuals with clinically tight hamstring muscles were recruited. On two separate sessions, the lumbopelvic curvature was evaluated in sitting when the right knee was moved from 90&deg flexion to 10&deg flexion on 15 occasions using a flexible ruler by two examiners on Day 1 and one on Day 2. Lines drawn tangential to the lumbopelvic curvature were traced at T12 and S2 vertebral levels and the angle between the two vertical lines was calculated. Using Day 1 data, the minimum number of repetitions and inter-examiner reliability were assessed. Inter-session reliability was also examined. As a result, there was no statistical difference (P > 0.05) in the mean absolute difference between the mean value of N-1 and N repetitions (6 ≤ N ≤ 15) in the lumbopelvic curvature angle, indicating that five was considered the minimum number of repetitions. Intraclass correlation coefficient (ICC)(1, 5) for the inter-session reliability and ICC(2, 5) for the inter-examiner reliability was 0.97 and 0.93, respectively, indicating excellent reliability. The measure for the lumbopelvic curvature during active knee extension in sitting, which was established in the current study, will be a foundation for further research regarding the relative flexibility of the lumbar and adjunct regions.

Non-invasive postural assessment of the spine in the sagittal plane: a systematic review

&lt;p&gt;The objective of this review was to examine the scientific evidence regarding the aspects of validation in non-invasive methods of assessing the spine in the sagittal plane. A systematic search was conducted in following data bases Scopus, Science Direct, PubMed and Medline&lt;em&gt;. &lt;/em&gt;To be included the papers must have: conducted a non-invasive assessment of thoracic kyphosis and/or lumbar lordosis; evaluated at least one aspect of validity; been written in English; and been published in the previously three decades. Papers that score less than three in the QUADAS scale were excluded. Initially, 70 articles were pre-selected. Of this, 52 were finally included as they met the quality criterion. Based on this review, the following techniques/instruments were found to present satisfactory results for all aspects of validity in the assessment of thoracic kyphosis: photogrammetry, flexible ruler, archometer, and DeBrunner’skyphometer. Similarly, photogrammetry, inclinometer, flexible ruler, archometer and kypholordometer were found to present satisfactory results in the assessment of lumbar lordosis. Therefore, it is suggested that these instruments be adopted as first choice for evaluating the spine in the sagittal plane, since they present adequate reproducibility and concurrent validity.&lt;/p&gt;&lt;p&gt;&lt;br /&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

The Correlation between Thoracic and Lumbar Curves with Balance, Falling and Fear of Falling in Elderly

Introduction: Falling is one of the major concerns among elderly population that has several consequences like hip fracture, head injury and even death. Changes in lumbar and thoracic curves are also common in elderly. There are limited number of studies investigating the association between lumbar curve and balance and fear of falling; additionally, some studies showed direct correlation between kyphosis and balance although some other studies did not confirm this correlation. The aim of the present study was investigating the correlation between lumbar and thoracic curves with balance, falling and fear of falling in elderly. Materials and Methods: The subjects were 47 aged male and female. A flexible ruler was used to measure spinal curves and Berg Balance Scale (BBS), Timed Up and Go (TUG) and Fall Efficacy Scale-International (FES-I) were used to measure balance and fear of falling, respectively. Results: The Pearson correlation coefficient showed significant correlation between spinal curves and BBS, TUG and FES-I. Conclusion: These findings showed that there was correlation between thoracic and lumbar curves with balance, and fear of falling.

Prevalence of Common Postural Disorders Among Academic Dental Staff.

BackgroundMusculoskeletal disorders are common problems among dentists. These conditions may lead to inappropriate postures and impairment in physical and psychological function. On the other hand, poor postures and inappropriate ergonomic may result in a wide variety of musculoskeletal disorders.ObjectivesThe aim of this study was to investigate the prevalence of common postural disorders of the spine and shoulder girdle among the dentists and possible correlations between demographic, anthropometric and occupational characteristics with these abnormal postures.Patients and MethodsIn a cross-sectional study, 96 dental staff including academic staff, residents and senior students of Tehran University of Medical Sciences was enrolled. Data were collected using a questionnaire and posture assessment tools such as plumb-line, checkerboard and flexible ruler. Data analysis was done with SPSS version 17.ResultsThe prevalence of the forward head posture (FHP), rounded shoulder posture (RSP), scoliosis and hyperlordosis were reported in 85.5%, 68.8%, 18.8% and 17.3% of the participants, respectively. A significant correlation was found between gender and FHP (P = 0.04) and also scoliosis (P = 0.009). On the other hand, a significant correlation was seen between weight and hyperlordosis (P = 0.007).ConclusionsOur study revealed a high prevalence of postural disorders especially FHP, RSP and scoliosis among Iranian dental staff. The female dentists were less susceptible to FHP and scoliosis.

The Comparison of Effect of Three Programs of Strengthening, Stretching and Comprehensive on Upper Crossed Syndrome

Introduction: Upper crossed syndrome is a form of muscle skeletal system involvement that leads muscles of the anterior and upper trunk be short and tight and the posterior part of the muscles be weak. Janda Upper cross syndrome mostly associated with abnormalities of the forward head , forward shoulder, away scapula and increased thoracic kyphosis and will cause wide variations in a quarter of the upper body. Common methods of correcting these abnormalities are corrective exercises. The Purpose of this study was to investigate the effects of strength training, stretch training and comprehensive training in patients with upper crossed syndrome. Materials and Methods: Forty females students with excessive forward head > 46 ﹾﹾ , forward shoulder > 52 ﹾﹾ and kyphosis > 42 ﹾﹾ angle were chosen as samples using purposive sampling method. The average of age 22.22 ± 1.77 years, weight 61/2.2 ± 1.90 kg, height 161.85 ± 2.55 cm and body mass index of the samples 23.37 ± 0.90 kg/m 2 . The subjects were randomly divided into four groups of 10 experimental and control groups. The first experimental group performed strength training, second group stretch training and third group comprehensive training for 6 weeks. In this period, the control group did not receive any training. In this study, photogrammetric method technique was used to measure the angle of the forward head and forward shoulder. A flexible ruler was used to measure the angle of kyphosis (r = 0.93). Angle of forward head, forward shoulder and kyphosis was measured before and after 6 weeks. data were analyzed using paired t-test and SPSS (P ≤ 0.05). Results: According to in study, paired T-test results in the experimental group showed that the significant decrease in the angle forward shoulder (P = 0.001), forward head (P = 0.005) and kyphosis (P = 0.001) of three types of exercise (strengthing, stretching, comprehensive) was found after 6 weeks. However, a significant decrease in the angle of forward head and shoulder and kyphosis was not found in the control group. One-way analysis of variance (ANOVA) showed that between the effects of different exercises on the forward shoulder angle (p = 0.001), forward head angle (P = 0.001) and kyphosis angle (P = 0.001) there are significant difference. According to the tukey test results, implementation of corrective exercises, strengthing (P = 0.001), stretching (P = 0.001), and comprehensive (P = 0.001) there is a significant difference with the control group. However between the strength training groups, stretching and comprehensive with each other in forward shoulder group, no significant difference was observed. While between of effect the comprehensive training in forward head and kyphosis abnormalities was significant difference compared to other exercises. Conclusion: Forward head and kyphosis angle decreased in the comprehensive group compared to other training programs, showed the Better efficiency of this training program. While between the group strength training, stretching and comprehensive with each other on the forward shoulder significant difference was not found. Importantly, the data showed that although there is no significant difference in the training program. However, statistical trends and the effectiveness has been more of the comprehensive training program. The results demonstrated a significant decrease in the angle of forward head, forward shoulder and kyphosis in the experimental group. Therefore, using this program is recommended in subjects with upper crossed syndrome deformity.

The Prevalence of Spinal Abnormalities in Students with Visual and Hearing Impairment

Introduction: Vertebral Colum is the main axis of the body that has an important role in keeping a proper posture. The aim of this study is to investigate the prevalence of vertebral deformities in children with impaired sight and hearing. Materials and Methods: Ten percent of students in elementary and preschool and students in the academic year of 2012-2013 were selected for this study. In Tehran, Iran 323 people, 244 people in the cities of the Tehran Province and in Alborz, Iran Province 148 students. Demographic questionnaire, Taiwanese flexible ruler, plummet and a simple rule were used for data collection. Data was reported using descriptive statistics. Results: The results indicated that, male and female students with visual impairment in Alborz province, Iran had the highest prevalence. In the first and third quartiles kyphosis, students with hearing impairment in Alborz province were in a worse situation. In the first quarter of lordosis, girls with hearing impairment in Tehran had the highest degree and in the third quarter, the boys with visual impairments of Alborz province had the same condition. Conclusion: Based on the findings, it can be concluded that students of Alborz province are suffering more than other students with similar disorders in Tehran and cities of the Tehran from abnormalities of the spine. Therefore, in theses students it is necessary to provide training and rehabilitation services for correcting abnormalities or appropriate use of alternative senses in the body.

Effects of William training on lumbosacral muscles function, lumbar curve and pain.

There are many types of treatments and recommendations for restoring back deformities depending on doctors' knowledge and opinions. The purpose of the exercises is to reduce pain and to ensure stability of the lower trunk by toning the abdominal muscles, buttocks and hamstrings. Given the duration of flares and relapses rate, it is important to apply an efficient and lasting treatment. To evaluate the effects of 8 weeks of William's training on flexibility of lumbosacral muscles and lumbar angle in females with Hyperlordosis. Forty female students with lumbar lordosis more than normal degrees (Hyperlordotic) that were randomly divided into exercise and control groups were selected as the study sample. The lumbar lordosis was measured using a flexible ruler, flexibility of hamstring muscles was measured with the active knee extension test, the hip flexor muscles strength was measured using Thomas test, the lumbar muscles flexibility measures by Schober test, abdominal muscles strength measured by Sit-Up test and back pain was measured using McGill's Visual Analogue Scales (VAS) questionnaire. Data were compared before and post-test using independent and paired t-testes. Results showed that 8 weeks of William's exercise led to significant decreases in lumbar angle and back pain, increases in flexibility of hamstring muscles, hip flexor muscles flexibility, lumbar extensor muscles flexibility and abdominal muscles strength. The findings show that William's corrective training can be considered as a useful and valid method for restoring and refining back deformities like as accentuated back-arc and became wreaked muscles' performance in lumbar areas.

Change in lumbar lordosis during prone lying knee flexion test in subjects with and without low back pain.

BackgroundProne lying knee flexion (PLKF) is one of the clinical tests used for assessment of the lumbo-pelvic movement pattern. Considerable increase in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbar-pelvic region. However, no study has directly evaluated the change in lordosis during active PLKF test in subjects with low back pain (LBP). The purpose of this study was to investigate the change of lumbar lordosis in PLKF test in subjects with and without LBP.MethodsA convenience sample of 80 subjects participated in the study. Subjects were categorized into two groups: those with chronic non-specific LBP (N = 40, mean age: 40.84 ± 17.59) and with no history of LBP (N = 40, mean age: 23.57 ± 10.61). Lumbar lordosis was measured with flexible ruler, first in prone position and then on active PKF test in both subjects with and without LBP. Data was analyzed by using statistical methods such as, independent t-test and paired t-test.ResultsThere were statistically significant differences in lumbar lordosis between prone position and after active PLKF in both subjects with and without LBP (P < 0.0001). The amount of change in lordosis during PLKF test was not significant between the two groups (P = 0.65). However these changes were greater among patients with LBP.ConclusionIncrease in lumbar lordosis during this test may be due to excessive flexibility of movement of the lumbar spine in the direction of extension and abnormal movement patterns in the individuals with LBP.

Postural Changes during First Pregnancy

Aims: The precise changes in postures of each part of the spine of primigravid women are still ambiguous. This study aimed to find out the spinal curvature and pelvic tilt changes during the first pregnancy. Study Design: Observational longitudinal study (Cohort study). Place and Duration of Study: The study was conducted at a hospital clinic in Iran, between April 2014 and December 2014. Methodology: Thirty primigravid women at the first, second and third trimesters of pregnancy were recruited in this cohort study and their lumbar and thoracic curves changes and pelvic inclination angles were studied and compared with 18 age-BMI matched non-pregnant women. The curves were measured by use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the measuring tools were confirmed in this study (ICC>0.87). A one-way ANOVA and independent tOriginal Research Article Kouhkan et al.; BJMMR, 7(9): 744-753, 2015; Article no.BJMMR.2015.384 745 test were used for statistical analysis. Results: Marked increased curvature and inclination angles were revealed as pregnancy advanced (P<0.05). The lumbar lordosis significantly increased when the first trimester was compared with the second and third ones. The thoracic curvature showed significantly increased curvature between the first and third and between the second and third trimesters. None of the lumbar or thoracic curve showed significantly difference between the control group and pregnant women during the first trimester of pregnancy. Although ten weeks pregnancy increased lumbar lordosis and thoracic kyphosis (4.2%, 8%, respectively), but it was not significant when compared with no pregnant women. The pelvic inclination angle showed to be more sensitive than spinal curvatures as it showed significant increase within all trimesters and when compared to the control group. Interestingly, it increased nearly 2.5 times more at the end of pregnancy (236%). Conclusion: The present study showed a significant increase in most variables that became higher as the months of pregnancy increased. The results might help clinicians for prescribing suitable exercises or spinal orthoses during pregnancy. More research is recommended in this area in women intending to get pregnant.

Studying the changes of the lumbar and thoracic curvatures and pelvic tilt inclinations during pregnancy in primigravida women

Background and Aim: Research show extensive physiological and postural changes in pregnancy, particularly during the first pregnancy. These changes are in sense of balance, neurological and mechanical forms. The precise changes in postures of each parts of the body in primigravida women are still ambiguous. The current study aims to find out spinal and pelvic changes in these women in static standing. Materials and Methods: The lumbar and thoracic curves and pelvic inclination angles of thirty primigravida women (age 25±1, BMI 23±1) in the first, second and third trimesters (Weeks 10, 21 and 32 of pregnancy) were recruited in this cohort study and were compared with 18 age-BMI matched non- pregnant women (age 24±1, BMI 23±1) in a static standing posture. The curvatures were measured with use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the flexible ruler and pelvic inclinometer were confirmed in this study (ICC>0.87). Results: An increased curvature and inclination angles were shown simultaneously while pregnancy progresses. The results showed a significant increased lumbar and thoracic curvature angles in pregnant group only during the first and second trimesters (P<0.05). However, pelvic inclination angles significantly increased during all trimesters of the pregnancy (P<0.05). Conclusion: The present study showed significant increases in both lumbar and thoracic curves (Sway back) and an increased pelvic tilt during pregnancy period. The results might help clinicians for prescribing suitable exercises during pregnancy and after the delivery. More research is recommended in this area. Key Words: Primigravida women, Spinal curvatures, Pelvic tilt, Flexible ruler, Pelvic inclinometer.

Evaluating Kyphosis and Lordosis in Students by Using a Flexible Ruler and Their Relationship with Severity and Frequency of Thoracic and Lumbar Pain.

Study DesignA cross-sectional, descriptive study.PurposeThis study aimed to investigate the relationship between kyphosis and lordosis measured by using a flexible ruler and musculoskeletal pain in students of Hamadan University of Medical Sciences.Overview of LiteratureThe spine supports the body during different activities by maintaining appropriate body alignment and posture. Normal alignment of the spine depends on its structural, muscular, bony, and articular performance.MethodsTwo hundred forty-one students participated in this study. A single examiner evaluated the angles of lumbar lordosis and thoracic kyphosis by using a flexible ruler. To determine the severity and frequency of pain in low-back and inter-scapular regions, a tailor-made questionnaire with visual analog scale was used. Finally, using the Kendall correlation coefficient, the data were statistically analyzed.ResultsThe mean value of lumbar lordosis was 34.46°±12.61° in female students and 22.46°±9.9° in male students. The mean value of lumbar lordosis significantly differed between female and male students (p<0.001). However, there was no difference in the level of the thoracic curve (p=0.288). Relationship between kyphosis measured by using a flexible ruler and inter-scapular pain in male and female students was not significant (p=0.946). However, the relationship between lumbar lordosis and low back pain was statistically significant (p=0.006). Also, no significant relationship was observed between abnormal kyphosis and frequency of inter-scapular pain, and between lumbar lordosis and low back pain.ConclusionsLumbar lordosis contributes to low back pain. The causes of musculoskeletal pain could be muscle imbalance and muscle and ligament strain.

Comparison of lumbar spinal angle between normal body mass index and overweight young adults.

[Purpose] This study compared the upper and lower lumbar angles of normal body mass index and overweight young adults, and examined the relationships among body mass index, waist circumferences, and lumbar angles. [Subjects and Methods] Sixty participants aged 18–25 years were recruited and allocated to 2 groups (n=30 per group): normal body mass index (18.5–24.9 kg/m2) and overweight group (body mass index, ≥ 25.0 kg/m2). During lumbar angle measurement, the participants stood in a relaxed position with bare feet. The upper and lower lumbar angles of each participant were measured using a flexible ruler, and the angle calculated by the tangent method. The waist circumference was also measured. [Results] The mean lower lumbar angle in the overweight group was significantly greater than that of the normal body weight group. Moreover, only the lower lumbar angle was associated with a significant increase in the body mass index (r=0.28). Waist circumference showed no association with the lumbar angles. [Conclusion] This is the first study to suggest that increased body weight could cause lower lumbar angle deviation in young adults. Further studies should investigate individuals with symptomatic back pain or back dysfunction and the impact of body weight on lumbar spinal angles.

The Effect of a Specific Short-Term Training Program on Correcting the Curvature Angle of Kyphosis in Female Young Gymnasts

As the trend now is increasing towards using sports exercises and physiotherapy instead of medical and surgical interference, this study aims for comparing the effect of 8 weeks specific short-term training program in water and land on the angle of kyphosis and some pulmonary indices in kyphotic young female gymnasts that takes place as a result of their specific performance. Thirty female gymnasts with increased normal thoracic kyphosis (kyphosis ≥40 degrees, Age: 13.2 +/- 3.79 years, weight: 34.84 ± 6.44kg, height: 142.9 ± 11.26) were selected and randomly divided in two groups (n=15): group (1) (corrective exercise in water) and group (2) (corrective exercise in land). The angle of kyphosis was measured by using a flexible ruler as a non-invasive and reliable method. Pulmonary indices such as: force vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximal voluntary ventilation (MVV) measured by digital spirometer. The repeated measurement test was used to compare the differences between the pre and post-tests in both groups. Statistical analysis was performed using SPSS statistical software version 18 and the significance level was set on 0.05. In land group and in water group the degree of kyphosis, FVC, FEV1 and MVV improved significantly (p≤0.05). Finally, between two groups were not observed any significant difference in degree of kyphosis and pulmonary indices (FVC, FEV1, MVV) (p≥0/05). According to the results; we can suggest using in water and in land physical exercises for correction of the curvature angle of kyphosis in female young gymnasts and applying further studies on different samples and using different types of exercise protocols to avoid surgical interference and increase self-esteem for those young members of society.

Effects of local fatigue on myoelectrical activity of erector spine muscles and the center for pressure displacement of the feet during balance recovery following postural perturbation in kyphotic subjects

Background: kyphosis deformity affects postural control. Muscular fatigue is one of the factors that can impair the mechanism of body balance. The aim of this study was to determine the effects of local fatigue on the myoelectrical activity of erector spine muscles and the center for pressure displacement of the feet during balance recovery following postural perturbation in kyphotic subjects. Methods: In this quasi-experimental study, 12 male students with>40 degrees thoracic kyphosis and 12 controls were selected to participate in the study. A flexible ruler was used to measure thoracic kyphosis. For postural control assessment, each subject underwent unexpected, forward-backward perturbations while standing on a foot scan mounted on a movable plate triggered by a weight equivalent to 10% of the subjects’ body weight. Experimental procedure was measured before (3 trails) and after (3 trials) the fatigue protocol. The myoelectric activity of the erector spine and multi fidus was compared in the groups using repeated measures of ANOVA and independent t-test (P<0.05). Results: There was no significant difference in the foot center of pressure displacement in both groups after muscular fatigue. After fatigue, there was an increase in the activity of longissimus thoracis (P=0.001) and iliocostalis thoracis (P= 0.001) in control group, while no significant difference was reported for the muscular activity of multifidus (p=0.084). The activity of langisimus thoracis was significantly increased (P=0.028) in kyphtic group after fatigue. Conclusion: erector spine muscles fatigue could not significantly affect the postural control in both groups, but the electrical activity of erector spine muscles during balance recovery following postural perturbation in kyphotic subjects was different than the controls.

Length Difference of Anteromedial and Posterolateral Bundles of Anterior Cruciate Ligament in Flexion and Extension (Cadaver Study)

We aimed to measure lengths of both anteromedial (AM) and posterolateral (PL) bundles of anterior cruciate ligament (ACL) in flexion and extension, and analyse statistically. 20 knees of 10 human cadavers were studied in Republic of Turkey Ministry Of Justice Forensic Medicine Institute. All the subjects were male (100%). An anterior longitudinal incision was made and After passing subcutaneous tissue, knee joint was visualized with a medial parapatellar approach. Lengths of both AM and PL bundles of ACL in flexion and extension were measured in millimetres with flexible ruler scale. Data was analysed statistically. Wilcoxon test was used for statistical analysis. Mean age was 46.5 (32-62). A statistically significant difference was seen in lengths of both AM and PL bundles of ACL in flexion and extension (p<0.05). Difference in lengths of bundles of AM and PL in flexion and extension is statistically significant. Whereas, any statistical difference was not noted in comparison of length differences among bundles during flexion and extension (z=0.085, p=0.932). Difference in lengths’ of bundles of AM and PL in flexion and extension was seen statistically significant in our study. In single-bundle technique, only AM bundle of ACL is reconstructed. Besides, both AM and PL bundles of ACL are reconstructed in double-bundle technique. AM and PL bundles have distinct features and lengths in different flexion degrees. We emphasize to review this entity while determining reconstruction technique for ACL-deficient patients.

THE EFFECT OF ERECTOR SPINE MUSCLES FATIGUE ON BALANCE COMPENSATION IN KYPHOTIC SUBJECTS AFTER POSTURAL PERTURBATIONS IN SAGITAL PLANE

Introduction: Postural control is the ability to maintain upper extremities and different parts of body during static and dynamic status in proper biomechanical alignment. Fatigue is one of the factors that can affect the posture. Muscle fatigue can reduce sensory input to the brain and finally decrease the balance. The aim of this study was to investigate the effect of erector spine muscles fatigue on balance compensation in kyphotic subjects after postural perturbations in the sagital plane. Materials and Methods: Twelve male college student with spinal curvature of more than forthy degrees (mean ± SD age; 23.25 ± 1.42 years, mean ± SD height; 174.92 ± 6.89 cm, mean ± SD weight; 67.33 ± 12.17 kg) and twelve male college student with normal curvature of the dorsal spine (mean ± SD age; 23.17 ± 1.53 years, mean ± SD height; 178.92 ± 6.16 cm, mean ± SD weight; 71.75 ± 9.34 kg) were participated in the study. They agreed and signed the consent form. A flexible ruler was used to measure thoracic kyphosis. To assessment the balance the center of pressure (COP) displacement after sudden perturbation (by releasing a weight equivalent to 10% of the subjects that has been attached to the Foot Scan) in the anterior–posterior direction were measured by Foot Scan. Experimental procedure was measured before and just after the fatigue protocol. ANOVAs and independent t-test were performed to data analyses. Results: The results indicated no significant differences of the COP displacement in both kyphotic (P = 0.678) and control (P = 0.685) groups. Our results showed that erector spine muscles fatigue could not affect the postural. Conclusion: Possibly compensation of posture after balance perturbation can not affected by erector spine muscles fatigue. Keywords: Postural perturbation, Center of pressure, Anterior- posterior, Local Fatigue, Balance, Erector spine, Kyphosis

Location of the Zygomatico-orbital Foramen on the Inferolateral Orbital Wall: Clinical Implications

Purpose: To describe the location of the zygomatico-orbital foramen on the inferolateral orbital wall.Methods: This anatomic study examined 28 orbits of 14 dry human adult skulls. The zygomatico-orbital foramen was identified by passing a thin wire from the zygomatico-facial foramen to its orbital aspect and a thin flexible ruler was used to measure 1) the distance perpendicular to the closest point on the inferior orbital rim, 2) the distance from the inferior orbital fissure, and 3) the distance from the area used for retrobulbar injections.Results: The mean distance from the zygomatico-orbital foramen to the closest point on the inferior orbital rim was 4.7 mm (range from 1 to 7 mm). The mean distance from the inferior orbital fissure was 14.9 mm (range from 10 to 18 mm). The mean distance from the area of retrobulbar injection was 6.0 mm (range from 3 to 10 mm).Conclusions: The location of the zygomatico-orbital foramen within the inferolateral orbit is quite variable. This is the first study to attempt to quantify its proximity to the site of retrobulbar injection. We conclude that it is an important anatomical structure to consider when giving retrobulbar anesthesia, especially given the variability in technique among ophthalmologists.

Anatomic and flow dynamic considerations for safe right axillary artery cannulation

Neuroprotection is of paramount interest in cardiac surgery. Right axillary artery cannulation is well established in aortic surgery because it significantly improves survival and outcome, but malperfusion of the right brain after direct cannulation has been reported. Anatomically, 4 vessel segments are potentially amenable for cannulation of the subclavian and axillary arteries. Clinical studies vary widely in dissection sites and cannulation techniques. We investigated critical flow dynamics in the right brain caused by arterial inflow after direct cannulation and specified cannulation positions that provide optimal cerebral perfusion. Distances from the lateral margin of the axillary artery and the subclavian artery to the origin of the vertebral artery were measured in 14 human corpses by a flexible ruler. We calculated the hemodynamics within the vertebral artery, depending on different positions of the cannula tip, in a computer-calculated model. The mean distance from the axillary artery to the vertebral artery was 8.5 cm, and the mean distance from the subclavian artery to the vertebral artery was 6.7 cm. Computed flow calculations demonstrated reversed flow in the vertebral artery when the cannula tip was positioned too close to its orifice. To ensure safe supra-aortic flow, a cannula can be inserted securely up to 6.0 cm into the axillary artery and 4.2 cm into the subclavian artery. Direct cannulation of the right axillary artery can lead to cerebral malperfusion, caused by an obstruction of the vertebral artery's orifice by the arterial cannula or a subclavian steal phenomenon due to flow reversal. The safety of direct axillary artery cannulation can be improved by a well-considered dissecting site and insertion length of the cannula.