Lumbar Mobility Research Articles

Comparison of Functional Outcome and Quality of Life in Patients With Idiopathic Scoliosis Treated by Spinal Fusion

Longer spinal fusions have been shown to result in improved deformity correction; however, loss of normal flexibility in the fusion area should not be ignored. Current consensus was to achieve a shorter fusion in primary surgery, with the goal of preserving as much of the distal motion segment as possible. However, the correlation between the length of fusion and functional outcome remains controversial. To the best of our knowledge, a previous study has demonstrated the function outcomes and the differences in HRQoL with specific fusion levels.In this cross-sectional study, 172 patients (mean age, 17.8 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 29.7 mo) were included to measure lumbar spine mobility and quality of life using validated outcome instruments in the study population. Patients were assigned to 5 groups according to the lower instrumented vertebra (LIV) level: group A (fusion above L2) 26 patients; group B (fusion to L2) 21 patients; group C (fusion to L3) 46 patients; group D (fusion to L4) 53 patients; and group E (fusion to L5) 26 patients. At each follow-up, patients were asked to complete the Scoliosis Research Society 22 (SRS-22) Questionnaire. Lumbar mobility was assessed using a dual digital inclinometer.Average spinal range of motion (ROM) was 41.4 degrees (SD, 20.7), forward flexion was 29.2 degrees (SD, 15.0), and backward extension was 12.2 degrees (SD, 9.5). The total spinal range of motion and forward flexion dropped noticeably as the LIV got more distal. Statistically significant between-group differences (1-way ANOVA) were found for ROM (P < 0.001), forward flexion (P < 0.001), or backward extension (P < 0.001). The motion segments preserved significantly correlated with ROM (r = 0.76, P < 0.001), ROMF (r = 0.76, P < 0.001), and ROME (r = 0.39, P < 0.001). However, no significant between-group differences was found for each domain of SRS-22 questionnaire.The motion segments preserved strongly correlated with lumbar mobility. Less fusion levels can preserve better lumbar flexibility by keeping more motion segments.

Vertebral Derotation by Vertebral Column Manipulator Improves Postoperative Radiographs Outcomes of Lenke 5C Patients for Follow-up of Minimum 2 Years.

This was a retrospective study. The aim of this study was to compare radiographic outcomes of Lenke 5C adolescent idiopathic scoliosis (AIS) patients treated by vertebral column manipulator (VCM) or simple rod derotation (SRD) maneuver. The direct vertebral rotation (DVR) technique has demonstrated better rotational and coronal correction than SRD, but clinical radiographic outcomes for Lenke 5C AIS following DVR using a VCM derotational device have not been described. A retrospective study was carried out in 39 Lenke 5C AIS patients treated by VCM (n=20) or SRD (n=19) techniques between April 2008 and June 2011. All patients had complete clinical record and radiographic data. Nine radiographic variables were collected and compared at 3 time points (preoperative, immediate postoperative, and minimum 2-year follow-up) between both groups. Scoliosis was successfully corrected in both groups. All patients obtained good coronal and sagittal balance, and no severe complications occurred. The postoperative apical rotation corrective rate of the VCM and SRD groups were 55.1% and 25.5%, respectively (P < 0.05). Lowest instrumented vertebra and stable vertebra (LIV-SV) was statistically significant between the VCM and SRD groups, the mean values were 1.2 ± 0.4 level and 0.7 ± 0.5 level (P < 0.05). The main curve corrective rates and LIV-tilt angle correction rates were not significantly different between groups, but it showed a spontaneous correction for the coronal LIV-tilt angle for both groups at the last follow-up. VCM improved postoperative apical axial rotational correction and lessened the lumbar fusion segment compared with the SRD technique, which might have a potential trend to reserve lumbar mobility.

Chest Expansion and Modified Schober Measurement Values in a Healthy, Adult Population

This study aims to demonstrate chest expansion and lumbar mobility using modified Schober measurement values in healthy male and female populations aged 15 and over, and to identify factors affecting these measurements. The prospective study included 444 volunteers (195 males, 249 females; mean age 47.13 years; range 15 to 88 years) from among patients presenting to the Akdeniz University Faculty of Medicine Hospital Physical Medicine and Rehabilitation Clinic. Participants were divided into seven 10-year age groups: group 1: 15-24 years, group 2: 25-34, group 3: 35-44, group 4: 45-54, group 5: 55-64, group 6: 65-74, and group 7: over 75. Exclusion criteria comprised factors potentially influencing spinal mobility and chest expansion. All volunteers' chest measurements were performed in three planes (circumferential with a tape measure, and anteroposteriorly and transversely with calipers) and lumbar mobility was measured using the modified Schober method. The same physician performed the measurements. Chest expansion measurements using tape and calipers varied considerably in all age groups and in both sexes. While there was no difference between males and females in circumferential chest expansion measurement, there was a significant difference decrease in both sexes from group 3 and onward. The only difference between the sexes in terms of modified Schober measurement was in group 4, in favor of male sex. Age-related change in both sexes was higher at age 55 and above compared to the young age groups. We may conclude that chest expansion measurement in the circumferential plane is sufficient when appropriate conditions are established and provides the most accurate result by permitting measurement in all planes.

Fiabilidad y validez de las mediciones en hombro y codo: análisis de una aplicación de Android y un goniómetro

IntroductionPrecise assessment of joint range is an essential task in daily practice in order to properly assess treatment progress. The aim of this study was to analyse the reliability and safety of an Android application to evaluate its characteristics and its usefulness as a clinical goniometer to measure joint angles. Previous studies have assessed the utility of the clinometer and compass applications of the iPhone to evaluate cervical and lumbar mobility. Material and methodThe same goniometer and smartphone Clinometer application were used to measure passive bilateral flexion and rotation of shoulder and elbow flexion in 32 participants who tolerated the supine position. ResultsInter- and intra-observer reliability were obtained using the intraclass correlation coefficient, which ranged from 0.87 to 0.99. The minimal detectable change was between 2° and 5°. Validity was concurrent between the goniometer and the application. With an ICC=0.88 and 95% agreement, a difference of up to 8° was observed when the two devices were used interchangeably. DiscussionThe use of information technologies has revolutionised both our daily work and leisure activities. The results obtained in this study show that these devices provide an additional resource to evaluate range of motion. However, due to the optimal ranges of operation inherent in these instruments, it is not recommended to use them interchangeably in a single assessment of the same patient.

Efficacy of lumbar mobilization on postpartum low back pain in Egyptian females: A randomized control trial.

Low back pain (LBP) is a common complaint in the postnatal period. Physiotherapy has many techniques to apply for such cases. To investigate the effect of central postero-anterior (PA) lumbar mobilization on muscle activity in postpartum LBP. Forty-five females with chronic LBP at least three months postnatal. Participants divided randomly and equally into three groups. Group A (Study group) received PA lumbar mobilization plus traditional treatment which consisted of Ultrasonic and Infra-red. Group B (Placebo group) received placebo mobilization plus traditional treatment. Group C (Control group) received traditional treatment only. All patients received 3 sessions/week for 4 weeks. Pain intensity, functional disabilities and Surface EMG for recording para spinal muscle activity were measured before and after intervention. Statistical analysis was done by ANOVA and paired t-test. Central PA mobilization showed a significant reduction (P< 0.05) in the average surface EMG activity of the erector spinae musculature compared with the other groups as well as improvement in functional ability and reduction in pain intensity. A central PA mobilization significantly reduced pain intensity and surface EMG activity of erector spinae musculature as well as improvement in functional ability in mechanical low back pain in postnatal females.

The application of double balloon dilation in percutaneous kyphonplasty to vertebral compression fractures

Objective To evaluate the clinical effectiveness of double balloon dilation in percutaneous kyphonplasty on curing vertebral-compression fractures. Methods From January 2009 to September 2013, 84 patients (94 vertebral bodies) with vertebral compression were treated by percutaneous kyphonplasty. All were fresh fractures and were injured or obvious low back pain 1 month, accompanied by local tenderness, kowtow attack painful, lumbar mobility, but no lower extremity injury numbness, activities and defecation disorders. After randomization, the double balloon dilation in percutaneous kyphonplasty method was used to treat 44 patients (49 vertebrae). In the process of performing percutaneous unilateral pedicle puncture and balloon dilatation of the vertebral body, the balloon has been moved some distance in the vertebral body. Then completed the perfusion of bone cement, vertebral body forming. 40 cases (45 vertebrae) were used conventional unilateral percutaneous kyphonplasty to vertebtal compression fractures. Recorded the operation time, amount of bleeding, bone-cement injection volume. Used visual analogue scale (VAS), the height of the vertebral body and Cobb angle to evaluated the curative effect. Results All 84 patients completed the operation, follow-up time was 22 months (18-24 months). In two mobile open expansion group, the operation time was about 48 min. The amount of bleeding was 8-15 ml. The average bone-cement injection volume was 5.1 ml. No patients quit the study and no bone cement-leakage cases or other side effects were observed , and no clinical accidents occurred. In a single stretching group, 40 cases (45 vertebrae) completed conventional vertebroplasty, the time of 44 min, bone cement average injection rate 3.2 ml, bleeding 10-15 ml. In two mobile open expansion group, the VAS score was 8.5 points, the height of the vertebral body height was 2.1cm, and the Cobb angle was 34°. After operation, the VAS score 2.9 points, the height of the vertebral body 2.8 cm, and Cobb 20°. In the other group, the pain was significantly relieved and the relief was satisfactor after operation.Vertebral height of 2 cm turned to the last follow-up of 2.4 cm. The Cobb angle was 32°, and the last follow-up was 27°. The VAS score, operation time and bleeding volume of the two groups were not statistically significant, and a statistically significant difference of the average bone cement injection volume, postoperative vertebral height and cobb angle improved with statistical significance. A single open group were 2 cases of bone cement leakage and leakage, 1 cases of bone cement tail, the complication rate was 5.6%. Conclusion The application of double balloon dilation in percutaneous kyphonplasty to vertebral-compression fractures improve relocation of vertebral compression fractures, increase recovery of vertebral height, and more effectively strengthen and stiffen pathological vertebral bodies, while improving kyphosis. Moreover, it can reduce pressure during bone-cement injections, minimizing the chance of overflow and leakage, as well as the related side effects, but it will also result in an increase of bone cement-injection volume. Key words: Spinal fractures; Kyphoplasty; Treatment outcome

The Effect of Passive Lumbar Mobilization on Hip Flexor Strength-A Pilot Study

The topic of muscle inhibition has been investigated for certain period of time, several causes have been proposed, including pain, joints mechanics, sensory and spinal dysfunction. However, the number of randomized controlled trials is not enough. The purpose of this study was to conduct a pilot study to find out if lumber mobilization reduces hip flexor muscle inhibition.

Efficacy of core muscle strengthening exercise in chronic low back pain patients.

Low back pain is a common health problem in human being and about 5 to 15% will develop chronic low back pain (CLBP). The clinical findings of CLBP suggest that lumbar mobility is decreased and recruitment order of core muscles is altered. In literature, there is no data about the effect of core muscles strengthening in the chronicity (short duration, long duration) of CLBP. This study evaluated the effect of core muscle strengthening intervention on chronicity of chronic low back pain. Thirty patients were recruited from the outpatient department of the National Institute for the Orthopaedically Handicapped. These 30 patients divided into two groups: A and B on the basis of duration of low back pain. Group-A patients complain about pain duration for more than twelve months and Group B complains about pain duration from three to twelve months. Both the groups were received same intervention for six weeks. Assessment was done pre intervention and post intervention after six weeks for both the groups. %For both the groups the assessment was done after six weeks for pre and post intervention. The result described both the groups showed improvement in all the outcome measures including pain as well as in function using Numerical pain rating scale, Oswestry Disability Index, Sorensen test, Gluteus Maximus Strength, Activation of transversus abdominis and Modified-Modified Schober's Test. The improvement was statistically non-significant with inter groups and significant within group. This study concludes that core muscle strengthening exercise along with lumbar flexibility and gluteus maximus strengthening is an effective rehabilitation technique for all chronic low back pain patients irrespective of duration (less than one year and more than one year) of their pain.

Acute effects of Maitland’s central posteroanterior mobilization on youth with low back pain.

Introduction: The low back pain is the most prevalent between the musculoskeletal disorders, and it is the most common reasons ofabsence from work. The flexibility, mobility, strength and endurance of the low back stability influence and the disharmony betweenthese factors may result in low back pain. One of Maitland’s technique, which alter these factors, is posteroanterior (PA) mobilization.Objective: To analyze the posterior chain’s flexibility, low back’s mobility, trunk extensor’s endurance and low back extensors’ musclestrength after performed one treatment session using the Maitland method on youth with low back pain. Method: For this research,sixteen women (22 ± 3.03 years) with chronic low back pain participated. All volunteers were evaluated according to their perceptionof pain, flexibility, mobility, muscular strength and muscular endurance. The treatment protocol was the application of PA mobilizationon the five lumbar vertebrae, from caudal direction to cranial, of three series of one minute in each vertebra. The same proceduresof the initial evaluation were performed after the immediate application of PA mobilization technique (revaluation 1) and 7 days afterthe protocol (revaluation 2). The data were analyzed by the Shapiro-Wilk’s normality test; analysis of variance (ANOVA) repeatedmeasures one-way with pos-hoc Bonferroni and Friedman’s ANOVA with pos-hoc Wilcoxon, with the level of significance of 5% (p&lt; 0,05).Results: After PA mobilization application, there were significant improvements in muscular strength (immediate post-treatment andpast seven days) and muscular endurance (immediate post-treatment). There were no significant improvements in the other variables,such as, level of pain, and lumbar flexibility and mobility. Conclusion: The lumbar PA mobilization was effective for increasing muscularstrength and endurance, with stabilization of the level of pain, flexibility and mobility.

Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study.

To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD). A randomized and double-blind controlled trial was carried out. University-based physical therapy research clinic. Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30). The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG. Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention. In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05). The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.

Do experienced physiotherapists and final year physiotherapy trainees apply similar force during posterior-to-anterior lumbar mobilization techniques?

This study aims to quantify the force applied during posterior-to-anterior lumbar vertebrae mobilizations of different grades (I to IV) and compare that force between experienced physiotherapists and final year physiotherapy students. Four experienced physiotherapists and four final year physiotherapy students participated in this study along with five healthy asymptomatic individuals. A manual therapy table positioned over three force plates allowed for measurements of the force oscillation frequency and intensity applied during grade I, II, III and IV posterior-to-anterior (PA) mobilizations at two lumbar vertebral levels (L2 and L4). Mixed model ANOVAs were used to compare the force applied between the experienced physiotherapists and students, and between the various grades. The results showed that the mean oscillation frequency was similar between the groups for all grades. Grade I and grade IV PA mobilizations showed similar mean oscillation frequency as did grade II and III PA mobilizations. The minimum and maximum force applied was higher for the physiotherapists than for the students for all mobilization grades (p values < 0.05). Similar mean maximum force values were recorded for PA mobilizations between grade I and II and between grade III and grade IV. Grade III and IV PA mobilizations yielded higher mean maximum force values than those recorded during grade I and grade II PA mobilizations. The method used in this study allowed for quantification of the force applied during lumbar PA mobilizations. Experienced physiotherapists apply greater force than physiotherapy students across all grades, despite similar oscillation frequency.

A randomised placebo-controlled study investigating the effects of mobilisation treatment duration on pain in participants with chronic low back pain

Background: A common treatment used by physiotherapists for patients with low back pain is mobilisation. The aim of applying mobilisation treatment is to increase range of movement and reduce pain and stiffness. Therapists choose a specific dose of mobilisation for each patient, which includes a decision on the duration of applied force, commonly up to 3minutes. Little research has been done to determine the effects of different durations of treatment. There is tentative evidence that increased duration beyond 3minutes leads to a decrease in pain. Purpose: This study aimed to establish the analgesic effects of short and long durations of lumbar mobilisation treatment. Methods: A randomised placebo controlled trial was conducted to establish the immediate and short-term (24hours after treatment) analgesic effects of different duration of lumbar mobilisation in participants with LBP. Comparisons of pressure pain threshold (PPT), verbal rating scale (VRS) of pain were made immediately after a placebo-control intervention and 2minutes of mobilisation treatment, and immediately and 24-hours after 1 and 6minutes of mobilisation treatment. Results: Analysis of treatment responders demonstrated that significantly more participants receiving longer duration of treatment experienced a reduction in PPT local to the site of treatment (p=.001). Overall, there was no significant difference between treatment groups. Verbal rating of pain on movement was significantly reduced after treatment (p<.01) but the difference between treatment groups did not reach significance. There was dissociation between participants’ verbal rating of pain and PPT. Treatment force had a significant mediating effect on pain (p=.01), with greater treatment forces resulting in greater pain reduction local to the site of treatment. Conclusion(s): This study highlighted the varying response of participants to lumbar mobilisation treatment. The difference is response levels and mediating effect of force on PPT were evident local to the site of treatment and not at more distant locations, suggesting that changes in PPT were mediated by a local analgesic mechanism. The dissociation between changes in PPT and verbal rating of pain imply these measures of pain are mediated by different underlying neurobiological mechanisms. Implications: These findings suggest that where pain allows, applying mobilisations for longer and with greater force may result in a greater analgesic effect. The dissociation between PPT and verbal ratings of pain in this study suggest that when investigating the analgesic effects of treatment, it may be important to incorporate a number of pain measures in order to gain wide appreciation of change in pain felt by patients.

Effects of unilateral posteroanterior mobilization in subjects with sacralized lumbosacral transitional vertebrae

To find out the efficacy of unilateral posteroanterior (PA) mobilization over type IA and type IIA sacralized lumbosacral transitional vertebrae in patients with low back pain with or without leg pain. experimental randomized control study. 30 subjects, simple random sampling. GROUP A - 15 subjects - self lumbar mobility and stretching exercises+Unilateral PA mobilization+hot pack. GROUP B - 15 subjects - self lumbar mobility and stretching exercises+hot pack. Before initiating treatment, subjects were assessed for dependent variables: Pain intensity by VAS, Forward bending and side bending ROM by modified finger to floor method with the help of an inch-tape and functions by Modified Oswestry Functional Disability Questionnaires. Post test measurements were taken after completion 2 weeks of therapy. The results of the study suggest that unilateral PA pressure is an effective mobilization method in reducing low back pain, improving ROM and related disability as compared to impairment based exercises alone in patients with low back pain with or without radiation to lower limbs having abnormally large transverse processes and hypomobile type IA and IIA lumbo-sacral transitional vertebrae.

Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers.

BackgroundThe understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging.Methods and FindingsA novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20–75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20–29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE.ConclusionsDuring aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.

Results of a domiciliary rehabilitation program for chronic low back pain patients

Objective: To evaluate the results of a home rehabilitation program for patients with chronic low back pain through the evaluation of abdominal muscle strength, lumbar mobility, daily activities and improved levels of pain. A secondary objective was to evaluate the adherence of the participants to this program. Methods: We evaluated 99 patients divided into case group (69 patients with chronic low back pain without indication for surgical treatment) and control group (30 patients without low back pain), the following parameters being measured: 1) lumbar mobility, 2) strength of the abdominal muscles, 3) pain by visual analog scale (VAS), 4) limitation in daily activities (Oswestry scale). Patients received individualized guidance on home exercises to be performed during two months. For comparison of groups "control" and "case" the nonparametric Mann Whitney test was applied. For comparison of the times "before" and "after" in the group of patients who returned, the nonparametric Wilcoxon test was applied. Results: Of the 69 patients who agreed to participate, 30 completed the targeted exercises within two months and returned for the final evaluation. At baseline, there was a significant difference (p&amp;lt;0.05) between the case and control groups for lumbar mobility and abdominal strength. In the case group there was significant improvement in all aspects evaluated at the end of the exercise program. Conclusion: The home rehabilitation program was effective as a treatment option for low back pain. Treatment adherence was low, this being the main limiting factor.

Effect of Balneotherapy in chronic low back pain treatment

The balneotherapy is a therapy that uses the mineral springs for the treatment of numerous diseases, and the physical properties of these waters may have a role in the mechanism of action of mineral water. Over the past decades, a re-assessment of the use of mineral water for the treatment of several diseases has taken place around the world. Chronic low back pain is a major public health problem in industrialized countries, it affects 80% of people and, in 85% of cases, the inaugural episode is followed by recorrencies. Its incidence and prevalence increases with age and is considered chronic when it persists for more than 7-12 weeks.The impoverished existing evidence contrasts with the popularity of these treatments and with the expenses incurred by insurers and health systems of some European countries (eg. Germany).The authors proposed reviewing the literature to clarify the present evidence regarding the effect of this therapeutic modality in the treatment of chronic low back pain. The meta-analysis of 2 randomized clinical trials concluded there was a significant reduction in pain intensity, measured on a 100mm visual analogue scale (VAS), in treated patients relative to controls. Individually, one of these studies also showed a decrease in analgesic consumption (p <0.01) and the other one showed an increase in functionality measured by the modified Schober test (p <0.001). One randomized study evaluated the VAS, lumbar mobility, and the Oswestry, EuroQoL-5D and Short Form-36 indices, with a significant improvement in all tests in the treatment group relative to the controls. The improvement observed in the first three lasted 10 weeks. It was also observed a significant decrease in the consumption of NSAIDs and analgesics in the treatment group, but the difference between groups was not statistically significant. Another randomized study showed an improvement in VAS (p <0,01), decrease in the paravertebral muscle spasms and sensitivity (p <0.01), as well as increased mobility (p <0.01) in patients treated for a period 3 months. In contrast, the improvement observed in the control group was only temporary and only in the VAS (p <0.01). In a nonrandomized study were evaluated pain intensity, Oswestry index, quality of life, use of NSAIDs/analgesics, and the subjective perception of disease for patients and observers. All parameters were significantly improved, and the effects lasted at least months. The mean age of the patients ranged from 39-44 to 64 years. The data collected showed significant improvements in pain, functionality, quality of life and consumption of NSAID/analgesic drugs in patients with chronic low back pain undergoing thermal therapy. As a major limitation, there were no double-blinded studies, since the physical and chemical properties of the mineral springs differ significantly from those found in tap water. We conclude that balneotherapy is an effective modality in the treatment of chronic low back pain in patients of middle age, being necessary more studies to validate thermal waters for individual springs, and pharmacoeconomic studies that evaluate the balneotherapy as a complementary modality in the management of low back pain is chronic.

Articular dysfunction patterns in patients with mechanical low back pain: A clinical algorithm to guide specific mobilization and manipulation techniques

Recent systematic reviews have demonstrated reasonable evidence that lumbar mobilization and manipulation techniques are beneficial. However, knowledge on optimal techniques and doses, and its clinical reasoning is currently lacking. To address this, a clinical algorithm is presented so as to guide therapists in their clinical reasoning to identify patients who are likely to respond to lumbar mobilization and/or manipulation and to direct appropriate technique selection. Key features in subjective and clinical examination suggestive of mechanical nociceptive pain probably arising from articular structures, can categorize patients into distinct articular dysfunction patterns. Based on these patterns, specific mobilization and manipulation techniques are suggested. This clinical algorithm is merely based on empirical clinical expertise and complemented through knowledge exchange between international colleagues. The added value of the proposed articular dysfunction patterns should be considered within a broader perspective.

The reliability and validity of the computerized double inclinometer in measuring lumbar mobility.

Study Design : Repeated measures reliability/validity study.Objectives : To determine the concurrent validity, test-retest, inter-rater and intra-rater reliability of lumbar flexion and extension measurements using the Tracker M.E. computerized dual inclinometer (CDI) in comparison to the modified-modified Schober (MMS)Summary of Background : Numerous studies have evaluated the reliability and validity of the various methods of measuring spinal motion, but the results are inconsistent. Differences in equipment and techniques make it difficult to correlate results.Methods : Twenty subjects with back pain and twenty without back pain were selected through convenience sampling. Two examiners measured sagittal plane lumbar range of motion for each subject. Two separate tests with the CDI and one test with the MMS were conducted. Each test consisted of three trials. Instrument and examiner order was randomly assigned. Intra-class correlations (ICCs 2, 2 and 2, 2) and Pearson correlation coefficients (r) were used to calculate reliability and concurrent validity respectively.Results : Intra-trial reliability was high to very high for both the CDI (ICCs 0.85 - 0.96) and MMS (ICCs 0.84 - 0.98). However, the reliability was poor to moderate, when the CDI unit had to be repositioned either by the same rate (ICCs 0.16 - 0.59) or a different rater (ICCs 0.45 - 0.52). Inter-rater reliability for the MMS was moderate to high (ICCs 0.75 - 0.82) which bettered the moderate correlation obtained for the CDI (ICCs 0.45 - 0.52). Correlations between the CDI and MMS were poor for flexion (0.32; p<0.05) and poor to moderate (-0.42 - -0.51; p<0.05) for extension measurements.Conclusion : When using the CDI, an average of subsequent tests is required to obtain moderate reliability. The MMS was highly reliable than the CDI. The MMS and the CDI measure lumbar movement on a different metric that are not highly related to each other.

Lumbar vertebral morphology of flying, gliding, and suspensory mammals: Implications for the locomotor behavior of the subfossil lemurs Palaeopropithecus and Babakotia

Lumbar vertebral morphology has been used as an indicator of locomotor behavior in living and fossil mammals. Rigidity within the lumbar region is thought to be important for increasing overall axial rigidity during various forms of locomotion, including bridging between supports, inverted quadrupedalism, gliding, and flying. However, distinguishing between those behaviors using bony features has been challenging. This study used osteological characters of the lumbar vertebrae to attempt to develop fine-grade functional distinctions among different mammalian species in order to make more complete inferences about how the axial skeleton affects locomotor behavior in extant mammals. These same lumbar characters were measured in two extinct species for which locomotor behaviors are well known, the sloth lemurs (Palaeopropithecus and Babakotia radofilai), in order to further evaluate their locomotor behaviors.Results from a principal components analysis of seven measurements, determined to be functionally significant from previous studies, demonstrate that inverted quadrupeds in the sample are characterized by dorsoventrally short and cranio-caudally expanded spinous processes, dorsally oriented transverse processes, and mediolaterally short and dorsoventrally high vertebral bodies compared with mammals that are relatively pronograde, vertical clingers, or gliders. Antipronograde mammals, dermopterans, and chiropterans also exhibit these traits, but not to the same extent as the inverted quadrupeds. In accordance with previous studies, our data show that the sloth lemur B. radofilai groups closely with antipronograde mammals like lorises, while Palaeopropithecus groups with extant sloths. These findings suggest that Palaeopropithecus was engaged in inverted quadrupedalism at a high frequency, while B. radofilai may have engaged in a more diverse array of locomotor and positional behaviors. The osteological features used here reflect differences in lumbar mobility and suggest that axial rigidity is advantageous for suspensory locomotion and possibly flight in bats.

THU0093 Relation between Lumbar and Cervical Affectation Grade in Patients with Ankylosing Spondylitis According to Mobility and Structural Damage

BackgroundAnkylosing spondylitis produces a progressive decrease in spinal mobility with the evolution of the disease. This decrease is due to inflammation and structural damage at radiological level that occurs in...