Lateral Range Of Motion Research Articles

Impact of the flexibility of the spinal deformity on low back pain and disc degeneration in adult patients nonoperatively treated for adolescent idiopathic scoliosis with thoracolumbar or lumbar curves.

To evaluate the impact of the flexibility of thoracolumbar or lumbar (TL/L) curves on low back pain (LBP) and disc degeneration in adult patients nonoperatively treated for adolescent idiopathic scoliosis (AIS). Forty-seven adult patients (46 women; mean age, 40.5years) nonoperatively treated for AIS with TL/L curves were included. The patients completed radiological examinations, magnetic resonance imaging, and a questionnaire survey for LBP evaluation. The flexibility of the spinal deformity was evaluated using supine side-bending radiographs. Radiographic measurements were correlated with scores for LBP and disc degeneration. The average magnitude and flexibility of the TL/L curve were 49.0° and 56%, respectively. The magnitudes of the TL/L curve and disc wedging were significantly correlated with LBP (|r|= 0.3-0.4). The flexibility of the TL/L curve and disc wedging, and the lumbar lateral range of motion (ROM) were significantly correlated with LBP and disc degeneration (|r|= 0.3-0.5). After controlling for the magnitudes of the TL/L curve and disc wedging, the flexibility of L4/5 disc wedging and the lumbar lateral ROM remained significantly correlated with the Scoliosis Research Society-22 pain score (partial correlation coefficient [r'] = 0.5 and 0.3), Oswestry Disability Index (-0.3 and -0.3), and disc degeneration (-0.4 and 0.3). In AIS patients with TL/L curves, the flexibility of L4/5 disc wedging and the lumbar lateral ROM were significantly correlated with LBP and disc degeneration, independent of the magnitudes of the coronal deformities. Our findings indicate that maintaining or improving lumbar flexibility may be beneficial for preventing or treating LBP.

The effect of ankle Kinesio™ taping on ankle joint biomechanics during unilateral balance status among collegiate athletes with chronic ankle sprain

ObjectivesTo determine the effects of ankle Kinesio-taping (KT) on postural sway, lower limb ROM, and muscle activity during a unilateral balance tasks. DesignCase control study design. SettingData were collected at the human movement analysis laboratory. Participants30 collegiate athletes with chronic ankle sprain (11 females and 19 males, 23.91 ± 2.58 years). Main outcome measureHip, knee and ankle joints ranges of motion (ROMs); postural sway area and velocities in both anteroposterior and mediolateral directions; and muscular activity amplitudes (% peak) of lateral and medial gastrocnemius, tibialis anterior and peroneus longus in a 20s single leg balance test in two non-taped (control) and KT (intervention) conditions. ResultsSignificant decrease observed in ankle lateral ROM (p = 0.048, d = 0.52), mediolateral postural sway velocity (p = 0.029, d = 1.25), and peroneus longus activity amplitudes (p = 0.042, d = 0.55) after KT application. ConclusionAcute application of KT among athletes with chronic ankle instability could provide lateral mechanical support to the ankle, potentially decreasing the velocity of frontal plane sway, and decreasing the magnitude of muscle activation. These data suggest that KT may be beneficial for improving static joint stability among individuals with chronic ankle sprain, and thus could be considered an option to allow safe return-to-activity.

Correlations between joint kinematics and dynamic balance control during gait in pregnancy

BackgroundDynamic balance control degrades during pregnancy, but it is not yet understood why. Mechanical aspects of the body should directly affect walking balance control, but we have recently published papers indicating that weight gains during pregnancy explain very little dynamic balance changes. Our goal was to determine if lower extremity joint kinematic changes are an indicator of walking balance control. This information is vital to understanding the route by which pregnancy increases fall risk. MethodsTwenty-three pregnant women were tested at five different times in the 2nd and 3rd trimesters of pregnancy. Participants performed walking trials at a self-selected pace. Motion capture was used to measure joint kinematics (discrete and coordination variables) and body center of mass motion. Changes over time were statistically analyzed. Correlations between kinematics and walking balance were modelled with hierarchical multiple regression models. ResultsAs pregnancy progresses, it appears that a more flexed hip posture could be driving lower extremity kinematic changes toward increased coordination between joints and increased knee and ankle motions. Walking balance changes were also detected through increased COM motion (lateral range of motion and velocity) in the lateral directions. However, there was little correlation between kinematic and balance changes (r2 < 0.4). Strong correlations were only observed when all kinematics (including those that don’t ubiquitously change during pregnancy) were used in the regression model (r2 > 0.7). SignificanceOur findings suggest that walking balance control is not altered by a common kinematic change between all pregnant women. While increased lateral center of mass motion should be expected with pregnancy, the kinematics leading to this increase may be person-specific. The cause of dynamic imbalance in each pregnant women (physiological, mechanical, and neurocognitive) may play an important role in determining the kinematic means by which lateral center of mass motion increases.

Flexion-Relaxation Ratio Asymmetry and Its Relation With Trunk Lateral ROM in Individuals With and Without Chronic Nonspecific Low Back Pain

A cross-sectional comparative study. The present study aimed to investigate the relationship between the FR phenomenon asymmetry of lumbar muscles and trunk lateral range of motion (ROM) asymmetry in nonspecific chronic low back pain (NSCLBP) patients. Imbalance in trunk muscle activation between right and left sides can induce pain by loading the spine incorrectly, especially in patients with NSCLBP. A previous study reported a greater asymmetry in the FR phenomenon of the erector spinae in NSCLBP patients than in asymptomatic participants (APs). Imbalance of muscle properties, such as trunk ROM, has been suggested as a possible cause of this observed asymmetry. Twenty-eight NSCLBP patients and 22 AP performed 3 standing maximal trunk flexions. Surface electromyography was recorded bilaterally for erector spinae longissimus and lumbar multifidus. A FR ratio was calculated for each muscle. The fingertip-to-thigh test was performed to assess trunk lateral ROM. Each parameter's asymmetry was calculated as the absolute difference between right and left sides. NSCLBP patients present a significantly lower trunk lateral ROM than AP. FR ratio asymmetry of the erector spinae was significantly greater in NSCLBP patients than in AP (P < 0.05). FR ratio asymmetry of the multifidus and trunk lateral ROM asymmetry were not significantly different between groups. Significant correlation (r = 0.49) between FR ratio asymmetry of erector spinae and trunk lateral ROM asymmetry was observed only for patients with NSCLBP. The present findings showed that FR ratio asymmetry of erector spinae longissimus is moderately correlated with trunk lateral ROM asymmetry. In addition, the results confirmed that patients with NSCLBP present a reduced trunk lateral ROM, a FR ratio asymmetry of the erector spinae which is correlated with trunk rotation. These findings suggested an imbalance spine loading which can contribute to the persistence of pain. 3.

Mandibular dysfunction as a reflection of bulbar involvement in SMA type 2 and 3.

In a cross-sectional study, we aimed to determine (1) the effect of spinal muscular atrophy (SMA) type 2 and 3 on mandibular function reflected as masticatory performance, mandibular range of motion, and bite force and (2) the predictors of mandibular dysfunction. Sixty patients with SMA type 2 and 3 (mean age 32.3 years, SD 17.4 years) and 60 age-matched controls filled out questionnaires about impairments of mandibular function. All participants underwent detailed clinical examination to document the mandibular range of motion including maximal mouth opening, bite force, and masticatory function. All mandibular movements, including mouth opening, lateral range of motion, and protrusion of the mandible, were reduced in patients with SMA type 2 and 3 compared to healthy controls (p < 0.001). Maximal bite force was 19% lower in patients than controls, and more in patients with SMA type 2 than type 3. The strongest predictive factor was SMA type for impairment of mandibular range of motion (R(2) = 0.82) and weakness of neck muscles for bite force (R(2) = 0.47). Reduced mandibular mobility and bite force are common complications in SMA. SMA type and neck muscle strength are important correlates of these complications. We provide further evidence for clinically relevant bulbar involvement in patients with SMA.

The Relaxation Response Resiliency Enhancement Program in the Management of Chronic Refractory Temporomandibular Joint Disorder: Results from a Pilot Study.

This is an open-pilot study to evaluate the feasibility, acceptability and efficacy of a pain-specific version of an established mind-body medicine program, the Relaxation Response [RR] Resiliency Program [R3P], in patients with chronic temporomandibular disorder [TMD]. Male and female with at least a six-month history of pain involving the masticatory muscles were sought in the Orofacial Pain Centers of the Massachusetts General Hospital [MGH] or through an advertisement sent to MGH employees from 2008 to 2010. Eligible participants underwent the R3P intervention [eight group sessions] after standard medical management. Pre- and post-group patients underwent objective measures of impairment [vertical and lateral range of motion with and without pain, temporomandibular joint and muscle pain palpation, and algometer measures] and completed psychosocial measures [Symptom Severity Index, Perceived Stress Scale, the Symptom Checklist-90-Revised and Short Form 36 Health Survey]. Twenty-four subjects [16 females, 90% from MGH Orofacial Pain Centers,10% from among MGH employees], mean age 38 years, met eligibility criteria and participated in the study. The intervention was highly feasible and accepted by patients, as evidenced by a 92% rate of completion. Paired t-test analyses revealed improvement on self-reported pain measures: pain intensity [p<0.02], pain frequency [p<0.002], pain duration [p<0.027], pain tolerability [p<0.009] and on several objective tests. The pain specific R3P is efficacious in reducing objective and subjective symptoms in patients with chronic refractory TMD. The comprehensive intervention, which combines educational information about pain with RR, cognitive behavioral and resiliency-enhancement skills, is accepted by patients and may be more efficacious than other treatments with fewer elements.

In vitro radiographic characteristics and biomechanical properties of the canine lumbar vertebral motion unit after lateral corpectomy, mini-hemilaminectomy and hemilaminectomy

The purpose of this study was to assess the effect of three surgical procedures (left lateral corpectomy [LC], LC plus mini-hemilaminectomy [LC-MH], and LC plus hemilaminectomy [LC-H]) on the biomechanics and intervertebral collapse of a lumbar vertebral motor unit (VMU). Six canine cadaveric first and second lumbar vertebrae (L1-L2) VMU were retrieved. Range-of-motion (ROM) was measured while a custom-built mechanical simulator applied 3 Nm torque in lateral bending, flexion and extension to the intact VMU and following the three surgical procedures (LC, LC-MH, LC-H) performed sequentially. Radiographs were taken with and without 3 kg axial compression at each step. Left lateral corpectomy and LC-MH significantly increased the ROM in left lateral bending and total lateral bending. A LC-H significantly increased the ventral, left, right, total lateral, and total dorsoventral ROM. Significant intervertebral collapse was observed after LC-H with and without axial compression, and after LC and LC-MH, but only with axial compression. A LC induces significantly increased ROM in lateral bending to the side of the surgery and in total lateral ROM. Extending the LC to a LC-MH does not change the spinal column stability compared to LC alone, while it provides better access to the spinal canal. The LC-H further destabilizes the VMU. The finding of intervertebral collapse following these surgical procedures confirms the importance of the intervertebral disc and articular facet in the maintenance of spatial integrity.

Temporomandibular joint mobility in adult females with Ehlers-Danlos syndrome, hypermobility type (also known as joint hypermobility syndrome)

Context: It is well-known that subjects affected by Ehlers-Danlos Syndrome (EDS), hypermobility type/Joint Hypermobility Syndrome are characterized by severe joint hypermobility with recurrent joint dislocations and chronic pain and biomechanical dysfunction of the temporo-mandibular joint (TMJ). Aims: The study aims to measure TMJ mobility in EDS subjects to quantitatively characterize the TMJ dislocation during specific tasks as well as head adjustments, already documented by literature by observational techniques. Materials and Methods: Female EDS subjects and age matched controls were asked to perform simple opening-closing movements of the mandible. Kinematics data was recorded and analyzed through an optoelectronic motion capture system. Some parameters of the motion were studied: range of motion of the condyles, range of motion of the chin, aperture angle, movement speed, and frequency. Statistical Analysis Used: The statistical t-test was used to compare results from pathological group to the control group. Results: Significant differences, between EDS group and controls, were found for the backward rotation of the head, lateral range of motion of the chin, frequency, and velocity. Results were in accordance with the clinical observations. The results not only confirmed that EDS subjects back-rotate the head while performing the opening-closing task but also quantified the entity of this behavior. Conclusions: The method we proposed is noninvasive and is able to analyze mandible kinematics. It may be used by clinicians to assess the healthy status of TMJ, to quantify mobility, and hypermobility of the mandible and to help diagnosis of TMJ dysfunctions.

Analysis of Segmental Cervical Spine Vertebral Motion After Prodisc-C Cervical Disc Replacement

Retrospective study of patients enrolled in a prospective randomized Food and Drug Administration trial with single level cervical disc replacement (CDR) with the ProDisc-C (Synthes, Paoli, PA). Evaluate the segmental range of motion (ROM) in the cervical spine pre- and postoperative after CDR. Each cervical level is believed to have its own biomechanical characteristics, ultimately leading to different sagittal and lateral ROM. Our understanding of the factors that influence motion after CDR continues to change and expand. One hundred sixty-four patients with single level ProDisc-C arthroplasty were evaluated radiographically using Medical Metrics (QMATM, Medical Metrics, Inc., Houston, TX). Pre- and postoperative disc height and ROM were measured from standing lateral and flexion-extension radiographs. Of these 164 patients, 44 had a CDR at C6/C7, 96 at C5/C6, 18 at C4/C5, and 6 at C3/C4. The mean follow-up was of 24 months. Statistical analysis evaluated the difference in mean ROM between the groups. Before surgery, C4/C5 had more sagittal ROM compared with C3/C4, C5/C6, and C6/C7 (P < 0.001.) Before surgery, C4/C5 also had more lateral ROM compared with C3/C4, C5/C6, and C6/C7 (P = 0.015). After surgery, there were no significant differences in sagittal and lateral ROM between C3/C4, C4/C5, C5/C6, and C6/C7. The delta (difference between pre- and postoperative) proved that the C4/C5 CDR actually lost sagittal ROM (-2.5 degrees ) compared with the other levels, which gained sagittal ROM, C3/C4 (0.9 degrees ), C5/C6 (1.8 degrees ), and C6/C7 (1.6 degrees ); P = 0.037. There was no significant difference in the delta lateral ROM between the segments: C3/C4, C4/C5, C5/C6, and C6/C7. CDR approximates the different segmental sagittal and lateral ROM. Although C4/C5 had negative delta ROM in the sagittal and lateral planes, it provided a satisfactory final ROM. Long-term clinical outcome studies are needed to properly evaluate if these differences could ultimately affect the patients everyday life.

Clinical and Radiological Outcomes With the Charité™ Artificial Disc

This is the first report of clinical and radiologic outcomes for the CHARITE artificial disc with a minimum follow-up of 10 years. A total of 107 patients indicated for total lumbar disc replacement were implanted with the CHARITE prosthesis. Of these 107, 100 were followed for a minimum of 10 years (range 10-13.4 years). A total of 147 prostheses were implanted with 54 one-level and 45 two-level procedures and 1 three-level procedure. The prostheses were placed through a standard anterior retroperitoneal approach. Clinically, 62% had an excellent outcome, 28% had a good outcome, and 10% had a poor outcome. Of the 95 eligible to return to work, 88 (91.5%) either returned to the same job as prior to surgery or a different job. These included 63.2% (12) of those working in heavy labor employment returning to the same job. Mean flexion/extension motion was 10.3 degrees for all levels (12.0 degrees at L3-L4, 9.6 degrees at L4-L5, 9.2 degrees at L5-S1). Mean lateral motion was 5.4 degrees . In the sagittal plane, 9 (6.1%) were anterior of geometric center, 50 (34.0%) were centered, and 88 (59.9%) were posterior of center. In the frontal plane, 110 (75%) were centered, and 37 (25%) were noted to be lateral to center. Slight subsidence was observed in two patients, but they did not require further surgery. No subluxation of the prostheses and no cases of spontaneous arthrodesis were identified. There was one case of disc height loss of 1 mm. Five patients required a secondary posterior arthrodesis. A good or excellent clinical outcome rate of 90% and a return to work rate of 91.5% compare favorably with results described in the literature for fusion for the treatment of lumbar degenerative disc disease. With a minimum follow-up of 10 years, the CHARITE artificial disc demonstrated excellent flexion/extension and lateral range of motion with no significant complications.

Isokinetic analysis of the volleyball player at the end range of motion

Isokinetic analysis of the volleyball player at the end range of motion C. Dupuisa,b, C. Tourny-Cholleta,b and F. Beuret-Blanquarta GRHAL, Faculty of Medicine, University of Rouen, France CETAPS, UPRES JE 2318, Faculty of Sport Sciences, University of Rouen, France This study focuses on the analysis of the rotator muscles of the shoulder of the volleyball player. This interest can be justified by the frequency and the importance of the pathologies of the shoulder of the volleyball player. This joint and the rotator muscles are very solicited by the different techniques like the spike and the serve. The aim of this study was to determine the ratio between agonist and antagonist, supposing that the ratio changes during the whole Range Of Motion (ROM). During the ‘active phase’, the agonist muscles present an concentric activity superior to the eccentric activity of antagonist muscles. Hence the particular attention given to the functional ratio: (agonist concentric/antagonist eccentric) to understand pathologies [1]. Eight volleyball players, eight judokas, and eight non athletes composed the population. An isokinetic dynamometer Kin-Com recorded the experimental data. The subject was sitting, shoulder set in a 90◦ abduction and in the plane of the scapula. The angular velocity was of 90◦/s and the ROM was 110◦ for the tests. The protocol consisted of assessment of Internal Rotator (IR), and External Rotator (ER), in concentric and eccentric modes, for the dominant and non dominant arms. Total ROM and the last 30◦ at either medial or lateral rotations were used. The result indicated no significant difference between the strength of dominant and non dominant shoulder. Among all the assessments, the results of peak torque and mean torque presented no significant difference. The totality of the obtained values of peak and mean torque were significantly superior for the athletes compared to the ones of sedentary subjects (p > 0.05). No significant differences were indicated with respect to either group or ROM (total or partial). For the total ROM, the results of average torque of IR conc and ER ecc are according to literature [2]. On the other hand, the values of IR ecc and ER conc are higher than the results found in the literature. The IR conc/ER conc ratio of reference on whole ROM is 1.5 for the sedentary subjects [3]. These differences of results can be explained by the differences of position of the subject during the assessment [4]. Results of the ratio are not in accord with published findings: 0.52 for the ER conc/IR ecc ratio of the dominant shoulder in the end of ROM [5]. This difference with our results can be explained by the position 90◦/90◦ and the subjects chosen (badminton players). On the other hand, the results of the end of medial rotation are in agreement with the literature: 0.90 for the ER conc/IR ecc ratio [5]. This study underlines the importance of the position of isokinetic test. It means that the ratios are specific of this position. It is of interest to note the small difference between the respective ratios at the medial and lateral ROM.