Lumbar Range Research Articles

The effectiveness of kinesio taping in addition to conventional treatment in patients with chronic low back pain: a randomized controlled trial

Aims: This study aimed to compare the effects of kinesio taping in combination with conventional treatment on pain intensity, lumbar range of motion (ROM) and flexibility, disability, and depression levels in patients with chronic low back pain (CLBP) with conventional treatment alone. Methods: The 48 individuals with CLBP included in the trial were randomized into the control group (CG, n=24) and the kinesio taping group (KTG, n=24). The CG received only conventional treatment for four weeks, while the KTG received kinesio taping for four weeks in addition to conventional treatment. Before and after the four-week treatment periods, patients were assessed with respect to pain intensity (visual analogue scale), lumbar ROM (goniometric measurement), flexibility (hand-ground distance), disability (Oswestry disability index), and depression (Beck depression inventory). Results: After the treatment programs, there were significant improvements in pain intensity, lumbar ROM and flexibility, disability, and depression levels in both the CG and KTG groups (p

Immediate efficacy of auricular acupuncture combined with active exercise in the treatment of acute lumbar sprains in 10 minutes: Protocol of a randomized controlled trial.

Acute lumbar sprain (ALS) is common musculoskeletal disorder characterized by severe low back pain and activity limitation, which significantly impacts the patient's work and life. Immediate relief of pain and restoration of mobility in a short period of time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of this combined treatment for ALS within 10 minutes. This is a single-center, prospective, randomized clinical trial. 128 eligible patients with ALS will be randomly allocated in a 1:1 ratio to either the auricular acupuncture (AA) group or the sham auricular acupuncture (SAA) group. All patients will receive a single 10-minute treatment. The primary outcome will be the change in pain intensity after 10 minutes of treatment. The secondary outcomes include changes in pain intensity at other time points (2, 5 minutes), changes in lumbar range of motion (ROM) at different time points, blinded assessment, treatment effect expectancy scale evaluation, and treatment satisfaction scale evaluation. All participants will be included in the analysis according to the intention-to-treat principle. This is the first randomized controlled trial to assess the immediate efficacy of AA combined with active exercise for ALS. The findings of this study are expected to provide a simple and rapid treatment for ALS in clinical. Chinese Clinical Trial Registry ChiCTR2400083740. Registered 30 April 2024.

Effects of Fu’s subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial

Background and purposeLow back pain (LBP) is a major global public health problem. Evidence shows that LBP is also related to cognitive, psychological, and lifestyle factors. Fu’s subcutaneous needling (FSN) has been used for the treatment of musculoskeletal problems for many years. This prospective randomized controlled trial aimed to evaluate the clinical efficacy and fear avoidance beliefs of FSN in the treatment of patients with chronic non-specific LBP. Material and methodsNinety participants with chronic non-specific LBP were randomly divided into the FSN and the traditional acupuncture (TA) groups (n = 45) and received either FSN or TA treatment for three consecutive days from December 2021 to March 2023. The primary outcome was pain intensity measured by the visual analogue scale (VAS). Secondary outcomes were trunk extensor endurance (TEE), lumbar range of motion (ROM), and the Fear Avoidance Beliefs Questionnaire (FABQ). Outcome measurements were made before the first treatment and after each treatment. Follow-up assessments of VAS and FABQ scores were conducted one month after treatment. ResultsThe FSN group had significantly lower VAS and FABQ scores at each time point after intervention compared to the TA group (P < 0.01). The scores of TEE and lumbar ROM were higher in the FSN group than those in the TA group (P < 0.01). Repeated measures analysis of variance (ANOVA) showed significant time effects, group effects, and interaction effects for VAS, TEE, lumbar ROM, and FABQ in both groups (P < 0.01). One month after treatment, the FSN group had significantly lower VAS and FABQ scores compared to the TA group (P < 0.05). ConclusionThis study suggested that FSN was superior to TA in terms of clinical efficacy and fear-avoidance beliefs in the treatment of chronic non-specific LBP. FSN could be used as an effective clinical treatment.

A Comparison of Combined Pilates-Kinesio Tape and Mulligan-Kinesio Tape Exercises on Pain, Lumbar Range of Motion, Hamstring Strength, and Pelvic Rotation in Women with Non-specific Chronic Low Back Pain

Background: Low back pain is one of the most significant musculoskeletal problems, causing various functional limitations that adversely affect individuals' quality of life. Objectives: The effect of combined Pilates-Kinsey and Mulligan-Kinsey exercises in women with non-specific chronic back pain has not been investigated. Methods: In the present quasi-experimental study, thirty women with non-specific chronic back pain with a range age of 35 - 65 years old were included in the study and were randomly divided into two Pilates-Kinesiotype (n = 15) and Mulligan-Kinesiotype (n = 15) groups. Exercise interventions were conducted for 6 weeks and 3 sessions per week. Pain, lumbar range of motion, hamstring stiffness and hip rotation were measured before and after the training intervention. Also, analysis of covariance (ANCOVA) test was used to analyze the data. Results: The results showed that there is a significant difference between the effect of Pilates-Kinesiotype training and Mulligan Kinesiotype training in the variables of pain, hamstring stiffness and hip rotation (P &lt; 0.05) and the reduction of pain and hip rotation in the Pilates-Kinesiotype training group compared to The Mulligan-Kinesiotype group was better. But the hamstring range of motion was better in the Mulligan-Kinesiotype group than in the Pilates-Kinesiotype group. In addition, the results showed that there is no significant difference between the waist range of motion of the research groups (P &lt; 0.05). Conclusions: Due to the fact that mulligan and Pilate's exercises together with Kinesiotype have an effect on pain variables, hamstring stiffness and hip rotation, and each of mulligan and Pilate's exercises have different effectiveness. These exercises can be used in combination with Kinesiotype to help women with non-specific chronic back pain.

The effect of transcutaneous electrical nerve stimulation on lumbar range of motion and lumbar fascia characteristics in healthy individuals

ObjectivesTo investigate the effect of Transcutaneous electrical nerve stimulation (TENS) on lumbar fascia thickness, lumbar flexion angle, and lumbar curvature in healthy people. DesignRandomized, clinical trial. Subjects100 healthy individuals. InterventionsParticipants were randomized into the active TENS group (n = 50) and placebo TENS group (n = 50). Subjects received 10 sessions of TENS in the lumbar region for 2 weeks. Main measuresLumbar fascia thickness, lumbar flexion angle, and lumbar curvature examined by ultrasonography, flexible ruler, and spinal mouse three times (before and after the intervention sessions, and two weeks after the last intervention session-follow up) ResultsSubjects in the TENS group showed a significant reduction in lumbar fascia thickness (P ≤ 0.002), an increase in lumbar flexion angle (P = 0.000), and an increase in lumbar curvature angle (P = 0.000) before and after the intervention sessions. The results of the follow-up evaluations showed the stability of the changes in the mentioned variables. ConclusionThe improvements in the lumbar fascia thickness and lumbar flexibility suggest that TENS may be effective in healthy subjects. Data indicate that biomechanical properties of lumbar fascia and lumbar flexibility are directly linked, and other mechanisms could be more influential in contributing to improvement.

Lumbar Range of Motion Using the Wolfson Modified Schober Test.

Lumbar range of motion (ROM) is a critical component of spinal function and often affected by age and sex. This study aimed to evaluate the variations in lumbar ROM across different age groups in a healthy adult population and determine the influence of sex, height, weight, and body mass index. A total of 208 subjects (106 men, 102 women) were recruited and stratified into age groups from the 20s to 60s and older. Lumbar ROM was measured using the Wolfson modified Schober test. Data were analyzed for flexion, extension, and total ROM. Linear regression examined the predictors of lumbar ROM. The study found a progressive decline in lumbar flexion and total ROM with age. Age was the only notable predictor of lumbar flexion, with no notable effect of weight and body mass index on ROM. Extension measurements were inconsistent and did not show a clear pattern across age groups. Age-related changes in lumbar ROM were consistent with known physiological changes within the spine. Despite physical differences in height and weight, the lumbar spine ROM was similar between sexes, highlighting the influence of age over sex in lumbar motion. Lumbar ROM decreases with age, with flexion affected more than extension.

Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial.

In today's industrialized world, between sixty and ninety percent of the working-age population experiences low back discomfort. Chronic mechanical low back pain (CMLBP), the most common ailment among working-age people in contemporary industrial society, causes a major economic burden due to the widespread use of medical services and the absence of work. For those suffering from persistent mechanical low back pain, this experiment aimed to assess the efficacy of using acupuncture dry needles in the short term. Our research included 30 individuals with nonspecific low back pain; their ages varied from 20 to 45. The participants were divided into two parallel groups using a random process: 15 individuals in group A had acupuncture treatment with a dry needle placed to specified locations on their backs, whereas 15 individuals in group B participated in muscle strengthening and stretching exercises. Both before and after therapy, researchers examined the lumbar range of motion (ROM) in four directions: flexion, extension, bilateral side bending, as well as pain intensity and functional impairment. We examined the data for normality and covariance homogeneity using the Shapiro-Wilk and Box's tests, respectively. The variables of interest that were investigated were compared across various test groups and measurement periods using a 2x2 mixed design-multivariate analysis of variance (MANOVA). We used a significance threshold of 0.05. When comparing the two groups after treatment, it was found that the flexion and extension range of motion increased significantly (p<0.05), while the pain intensity, bending to the right and left, and functional impairment decreased significantly (p<0.05). The results of multiple pairwise comparisons showed a noteworthy difference in pain severity, functional debility, and back ROM between the two groups before and after treatment (p<0.05), with group A showing an advantage over group B after treatment. Based on the study results, dry needle acupuncture may be a beneficial modality in treating chronic mechanical low back pain by relieving pain intensity, improving functional debility, and improving ROM.

Immediate Effect Of Lumbar Manipulation On Lumbar Range Of Motion And Lower Limb Functional Test In Recreational Football Players: An Experimental Study

Context: Football is a commonly played sport. Functional impediments in footballers may arise due to decreased spinal mobility, which affects quality of life and performance. Manipulative treatment is a manual therapy techniques which uses a high velocity “thrust” applied to a synovial joint over very short amplitude. Aims:To evaluate the immediate effect of lumbar manipulation on lumbar range of motion (ROM) and lower limb function in footballers. Methods and Material:22 male footballers of 18 to 30 years underwent a single session of lumbar manipulation. Modified-modified Schober‟s test was used to evaluate changes in lumbar ROM, while Anterior, Postero-lateral and Postero- medial components of Star excursion balance test (SEBT) were used to measure dynamic balance and single leg triple hop distance test for lower limb strength. Results: Statistical analysis revealed significant differences in outcome measures obtained. Post intervention t-value and p-value for SEBT Anterior (t= 5.583, p= 0.001), SEBT Postero-medial (t=10.376, P=0.001), SEBT Postero-lateral (t=8.495, P=0.001), Lumbar ROM (t=2.569, p=0.018), Triple hop (t=6.492, p=0.001). Conclusions: Lumbar manipulation has shown to increase lumbar ROM and enhance performance of lower limb functional tests in footballers. Thus this study recommends lumbar manipulation can be applied to enhance the performance of the players.

Effectiveness of Three-Dimensional Myofascial Release on Lumbar Lordosis in Individuals with Asymptomatic Hyperlordosis: A Placebo Randomized Controlled Trial.

Lumbar hyperlordosis is the most prevalent musculoskeletal postural deformity. Maintenance of normal limits of lumbar lordosis is necessary for obtaining an ideal posture. Literature suggests that poor posture results in fascial restriction in which the fascia reorganizes in response to tension. Gross myofascial release (MFR) combined with posterior pelvic tilting exercises proved to be beneficial in improving the lumbar range of motion. Three-dimensional (3D) MFR is a novel approach toward reducing fascial restrictions. However, the literature determining the effects of 3D MFR is still emerging. To determine the effect of 3D MFR on a lumbar lordosis angle and lumbar range of motion, in individuals with asymptomatic hyperlordosis. Participants (n = 30) with hyperlordosis were randomly assigned to either the experimental group receiving 3D MFR (n = 15) or the control group (n = 15) that received sham 3D MFR for six sessions (3 alternate days for 2 weeks). The outcomes were assessed at day 1 and day 6. Lumbar range of motion was assessed using modified-modified Schober's test and the lumbar lordosis angle was measured using x-ray and flexicurve. There was significant decrease (p = 0.0001) in the lumbar lordosis angle, increase in the lumbar flexion (p = 0.0001), and decrease in the extension (p = 0.0011) range of motion in the experimental group when compared to the control group. Lumbar lordosis decreased and the lumbar range of motion increased in the experimental group only with 3D MFR and not with sham 3D MFR. Hence, 3D MFR is an effective method in the correction of lumbar hyperlordosis and improving the lumbar range.Clinical Trial Registry of India (CTRI) trial number CTRI/2023/03/050340.

Effect of Quadratus Lumborum Block in Patients With Acute-Subacute Unilateral Lumbar Strain.

Lumbar strain originating from the quadratus lumborum (QL) is an important cause of low back pain; however, its diagnosis is often missed, and treatment is often inadequate. This leads to unnecessary diagnostic investigations and chronicization of pain. Therefore, it is important to treat it effectively and safely. In this study, we aimed to find out the effect of ultrasound (US)-guided QL block in acute-subacute low back pain caused by a strain of QL. Our study was retrospective, and the changes in the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores within one week in 50 patients with acute-subacute localized low back pain, unilateral lumbar strain, palpation tenderness, paravertebral spasm, and decreased lumbar range of motion in the QL muscle, in whom we applied US-guided block to the QL muscle, were analyzed. There was a significant decrease in the mean VAS and ODI scores of the patients after the procedure. There was a negative correlation between improvement rates in VAS and ODI scores and age and body mass index (BMI). Recovery rates were higher in female patients than in male patients. It can be said that US-guided QL block is an effective treatment method for QL-induced lumbar strains, and younger age, female gender, and lower BMI are associated with better responses after injection.

Temporal Variability in Stride Kinematics during the Application of TENS: A Machine Learning Analysis.

The purpose of our report was to use a Random Forest classification approach to predict the association between transcutaneous electrical nerve stimulation (TENS) and walking kinematics at the stride level when middle-aged and older adults performed the 6-min test of walking endurance. Data from 41 participants (aged 64.6 ± 9.7 yr) acquired in two previously published studies were analyzed with a Random Forest algorithm that focused on upper and lower limb, lumbar, and trunk kinematics. The four most predictive kinematic features were identified and utilized in separate models to distinguish between three walking conditions: burst TENS, continuous TENS, and control. SHAP analysis and linear mixed models were used to characterize the differences among these conditions. Modulation of four key kinematic features-toe-out angle, toe-off angle, and lumbar range of motion (ROM) in coronal and sagittal planes-accurately predicted walking conditions for the burst (82% accuracy) and continuous (77% accuracy) TENS conditions compared with control. Linear mixed models detected a significant difference in lumbar sagittal ROM between the TENS conditions. SHAP analysis revealed that burst TENS was positively associated with greater lumbar coronal ROM, smaller toe-off angle, and less lumbar sagittal ROM. Conversely, continuous TENS was associated with less lumbar coronal ROM and greater lumbar sagittal ROM. Our approach identified four kinematic features at the stride level that could distinguish between the three walking conditions. These distinctions were not evident in average values across strides.

One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study

BackgroundThe one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS).MethodsOne hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST).ResultsAfter PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) (P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant (P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups (P > 0.05). However, all clinical and functional scores significantly improved postoperatively (P < 0.05). Postoperative DCSA of both groups was significantly found to be improved (P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference (P = 0.713).ConclusionOSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.

Comparative Effectiveness of Muscle Energy Technique (MET) With or Without Proprioceptive Neuromuscular Facilitation (PNF) Pattern in Lumbosacral Dysfunction

Lumbosacral dysfunction is a condition affecting the lumbar and sacral regions of the spine, causing back pain, limited range of motion, sensory deficits, and motor impairments. It can be caused by degenerative changes, traumatic injuries, congenital anomalies, or abnormal biomechanics. Objective: The objective of this study was to compare the effects Muscle Energy Technique (MET) alone and with combination of PNF in treating lumbosacral syndrome. Methods: The study was a quasi-experimental design over the duration of 8 weeks. Purposive sampling was employed with a sample size of 40 patients, divided equally into Group A (N= 20) who received MET combined with PNF and Group B (N= 20) that only received MET. We used Oswestry Disability Index (ODI), Numeric Pain Rate Scale (NPRS) and goniometer to assess disability, pain, and range of motion (ROM). We analyzed the data using IBM SPSS version 23.0. Results: Outcome measures including pain intensity, functional disability, and range of motion, were assessed at baseline and post-intervention (8 weeks). The group A showed significant improvements in all outcome measures compared to the group B at post-intervention assessments (p &lt; 0.05), pain intensity decreased by 60-80%. Functional disability scores were reduced by 60-75% in the group A, while the group B showed only 40% significant change. Moreover, the group A exhibited a substantial increase in lumbosacral range of motion compared to the group B. Conclusions: The study reveals that both MET alone and MET combined with PNF effectively improve pain, functional disability, and lumbar range of motion in lumbosacral dysfunction patients.

Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis

BackgroundA reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an ideal adjacent segment ROM to guide postoperative waist activities and further delay adjacent segment degeneration (ASD).MethodsAn intact L1-S1 finite element model was constructed and validated. Based on this, a surgical model was created to allow the simulation of L4/5 transforaminal lumbar interbody fusion (TLIF). Under the maximum total L1-S1 ROM, the ROM, IDP, and FJF of each adjacent segment between the intact and TLIF models were compared to explore the biomechanical influence of lumbar fusion on adjacent segments. Subsequently, the functional relationship between total L1-S1 ROM and IDP or total L1-S1 ROM and FJF was fitted in the TLIF model to calculate the relative total L1-S1 ROMs without an increase in IDP and FJF.ResultsCompared with those of the intact model, the ROM, IDP, and FJF of the adjacent segments in the TLIF model increased by 12.6-28.9%, 0.1-6.8%, and 0-134.2%, respectively. As the total L1-S1 ROM increased, the IDP and FJF of each adjacent segment increased by varying degrees. The relative total L1-S1 ROMs in the TLIF model were 11.03°, 12.50°, 12.14°, and 9.82° in flexion, extension, lateral bending, and axial rotation, respectively.ConclusionsThe relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.

Effects of Pilates Exercises as a Treatment Approach in Patients with Non-Specific Low Back Pain

Background: Chronic non-specific low back pain (NSLBP) poses significant challenges to healthcare systems worldwide, primarily due to its prevalence and the complexity of its management. Core muscle weakness and impaired motor control are commonly associated with NSLBP, affecting functional capacity and quality of life. Pilates, an exercise regimen emphasizing core strength, flexibility, and mindful movement, has been proposed as a therapeutic intervention to address these underlying issues. Objective: This study aimed to evaluate the effectiveness of a Pilates exercise program in improving pain intensity and lumbar range of motion in individuals with NSLBP. Methods: A randomized controlled trial was conducted at the Outpatient Departments of Madinah Teaching Hospital and Allied Hospital, Faisalabad. Thirty participants aged 30-50 years with NSLBP were randomly assigned to either an experimental group receiving Pilates exercises plus baseline hot pack treatments or a control group receiving only hot pack treatments. The intervention lasted four weeks, with assessments of pain intensity using the Numeric Pain Rating Scale (NPRS) and lumbar range of motion using the Modified Schober’s Test conducted pre- and post-intervention. Statistical analysis involved Wilcoxon tests, paired and independent sample t-tests, and Mann-Whitney U tests, as appropriate, using SPSS version 25. Results: The experimental group demonstrated significant improvements post-treatment, with NPRS scores reducing from a mean of 4.73 (SD=1.033) to 2.93 (SD=0.594) (p&lt;0.001), and lumbar flexion and extension increasing (pre-test lumbar flexion: mean 5.76, SD=1.487 to post-test: mean 6.01, SD=1.368, p=0.002; pre-test lumbar extension: mean 2.56, SD=0.405 to post-test: mean 2.75, SD=0.360, p=0.001). The control group showed no significant changes in NPRS scores or lumbar range of motion. Between-group analyses confirmed the superior effectiveness of the Pilates intervention in improving pain and functional outcomes. Conclusion: Pilates exercises significantly improved pain intensity and lumbar range of motion in patients with NSLBP compared to a control treatment, suggesting that Pilates can be an effective, non-invasive treatment option for managing NSLBP.

Effect of Dry Needling on Patients with Lumbar Radiculopathy in Reducing Pain and Increasing Range of Motion Compared to Interferential Therapy

Background: The most prevalent disorder affecting the spinal cord is lumbar radiculopathy. The incidence of thiscondition is estimated between 3% and 5% of the population and it impacts both male and female equally. Thegoal of this present study is to compare the effectiveness of dry needling to interferential therapy [IFT] in terms ofreducing pain and increasing the lumbar range of motion in patients with lumbar radiculopathy.Purpose: To determine the effect of dry needling on patients with lumbar radiculopathy in reducing pain andincreasing lumbar ROM compared to interferential therapy.Materials and Methods: 30 subjects participated and pre assessment and post assessment was taken usingNumerical Pain Rating Scale [NPRS] and the Modified-Modified Schober Test [MMST]. For both groups, theintervention period lasted for 2 weeks and the entire study procedure was carried out from November 2022 toApril 2023.Result: This study showed an extremely satisfied statistical significance difference between post-test values ofboth groups (p&lt;0.0001). However, the experimental group showed substantially greater statistical significancethan the control group in terms of the decrease in pain levels and the increase in lumber ROM.Conclusion: The study concluded that intervention provided to the experimental group was more effective thanintervention provided to the control group.

Test–retest and inter-rater reliability of lumbar range of motion procedure using back range of motion instrument

IntroductionTo investigate the test–retest and inter-rater reliability of a new protocol using the back range of motion instrument (BROM II) to measure the lumbar range of motion (LROM).MethodsFive raters and twenty healthy subjects participated in this study. Before the measurement, all raters and all subjects were asked to watch a 4-minute video clip demonstrating the rating method. The raters and the subjects were then asked to practice the testing protocol until they thoroughly understood it. The subjects were asked to move the lumbar spine in six directions, with consistent verbal instruction. The raters measured the subjects’ LROM twice and were blinded to the data. The intraclass correlation coefficients were used to estimate the test–retest and inter-rater reliability of the LROM.ResultsThe results showed that the intra-rater reliability [ICC(3,1)] was good-to-excellent, ranging from 0.82 to 0.98, except for the LROM in the right rotation, which was moderate-to-good, ranging from 0.74 to 0.97. The inter-rater reliability [ICC(2,1)] was good-to-excellent, ranging from 0.78 to 0.87.ConclusionsThe intra- and inter-rater reliability of this protocol in measuring LROM obtained by the BROM II were reliable and suitable for both teaching and research.

Effects of dynamic and rigid implantation on biomechanical characteristics of different sagittal alignment lumbar after single- or double-level spinal fixations: a finite-element modeling study

BackgroundAlthough it is critical to understand the accelerated degeneration of adjacent segments after fusion, the biomechanical properties of the spine have not been thoroughly studied after various fusion techniques. This study investigates whether four Roussouly’s sagittal alignment morphotypes have different biomechanical characteristics after different single- or double-level spinal fixations.MethodsThe parametric finite element (FE) models of Roussouly’s type (1–4) were developed based on the radiological data of 625 Chinese community population. The four Roussouly's type models were reassembled into four fusion models: single-level L4–5 Coflex fixation model, single-level L4–5 Fusion (pedicle screw fixation) model, double-level Coflex (L4–5) + Fusion (L5–S1) model, and double-level Fusion (L4–5) + Fusion (L4–5) model. A pure moment of 7.5 Nm was applied to simulate the physiological activities of flexion, extension, lateral bending and axial rotation.ResultsBoth single-level and double-level spinal fixation had the greatest effect on lumbar range of motion, disc pressure, and annulus fibrosis stress in flexion, followed by lateral bending, extension, and axial rotation. In all models, the upper adjacent segment was the most influenced by the implantation and bore the most compensation from the fixed segment. For Type 2 lumbar, the L4–L5 Coflex effectively reduced the disc pressure and annulus fibrosis stress in adjacent segments compared to the L4–L5 Fusion. Similarly, the L4–L5 Coflex offered considerable advantages in preserving the biomechanical properties of adjacent segments for Type 1 lumbar. For Type 4 lumbar, the L4–L5 Coflex did not have superiority over the L4–L5 Fusion, resulting in a greater increase in range of motion at adjacent segments in flexion and extension. The difference between the two fixations was not apparent in Type 3 lumbar. Compared to the single-level Fusion, the changes in motion and mechanics of the lumbar increased after both the double-level Coflex + Fusion and Fusion + Fusion fixations, while the differences between two double-level fixation methods on adjacent segments of the four lumbar models were similar to that of the single-level fixation.ConclusionType 3 and Type 4 lumbar have good compensatory ability and therefore allow for a wider range of surgical options, whereas surgical options for small lordotic Type 1 and Type 2 lumbar are more limited and severe.

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial

BackgroundMany people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP.Methods70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches.ResultsThere were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, − 3.25 to − 1.15). The standardized mean difference and their 95% confidence intervals (Cohen’s d) revealed a large effect of pain at 22 weeks: (Cohen’s d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes.ConclusionsIn this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks.Trial RegistrationClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

The relationship between low back pain, pelvic tilt, and lumbar lordosis with urinary incontinence using the DIERS formetric 4D motion imaging system.

Urinary incontinence (UI) is a common public health problem and postural changes may be crucial in women presenting with UI. This study was aimed at evaluating the relationship between low back pain (LBP), pelvic tilt (PT), and lumbar lordosis (LL) in women with and without UI using the DIERS formetric 4D motion imaging system. To date no study has to our knowledge compared postural changes and LBP in women with UI using the DIERS 4D formetric system. This was a case-control study. We included 33 women with UI and 33 without incontinence. The severity of urogenital symptoms was assessed by the IIQ-7 (Incontinence Impact Score) and UDI-6 (Urogenital Distress Inventory), and disability owing to LBP was evaluated using the Oswestry Disability Index (ODI). Posture and movement assessment, LL angle, thoracic kyphosis, and PT assessment were performed with the DIERS Formetric 4D motion imaging system. The LL angle and pelvic torsion degree were higher in the incontinence group than in the control group (53.9 ± 9.5° vs 48.18 ± 8.3°; p= 0.012, 3.9 ± 4.1 vs 2.03 ± 1.8 mm; p= 0.018 respectively). The LBP visual analog scale value was also significantly higher in the incontinence group (5.09 ± 2.3 vs 1.7 ± 1.8 respectively, p< 0.0001). The LL angle showed a positive correlation with pelvic obliquity, (r = 0.321, p< 0.01) and fleche lombaire (r = 0.472, p< 0.01) and a negative correlation with lumbar range of motion measurements. Pelvic obliquity correlated positively with pelvic torsion (r = 0.649, p< 0.01), LBP (r = 0.369, p< 0.01), and fleche lombaire (r = 0.269, p< 0.01). Women with UI were more likely to have lumbopelvic sagittal alignment changes and a higher visual analog scale for LBP. These findings show the need for assessment of lumbopelvic posture in women with UI.