Lumbar Spine Extension Research Articles

Ultrasound Shear Wave Elastography Quantitatively Assesses Tension Changes of Supraspinous/Interspinous Ligament Complex Under Varied Loads.

Although interspinous and supraspinous ligaments of the lumbar spine are thought to contribute to spinal stability, little is known about their dynamic biomechanics. We demonstrate that shear wave elastography (SWE) offers a novel technique to noninvasively and quantitatively evaluate posterior spinous ligament complex functional loading and stiffness in different physiologic positions. We performed SWE and measured the length of the interspinous/supraspinous ligament complex in cadaveric torsos (N = 5), isolated ligaments (N = 10), and healthy volunteers (N = 9) to obtain length and shear wave velocity measurements. For cadavers and volunteers, SWE was utilized in 2 lumbar positions: lumbar spine flexion and extension. In addition, SWE was performed on isolated ligaments undergoing uniaxial tension to correlate shear wave velocities with experienced load. Average shear wave velocity in cadaveric supraspinous/interspinous ligament complexes increased for lumbar levels (23%-43%) and most thoracic levels (0%-50%). This corresponded to an average increase in interspinous distance from extension to flexion for the lumbar spine (19%-63%) and thoracic spine (3%-8%). Volunteer spines also demonstrated an average increase in shear wave velocity from extension to flexion for both the lumbar spine (195% at L2-L3 to 200% at L4-L5) and thoracic spine (31% at T10-T11). There was an average increase in interspinous distance from extension to flexion for the lumbar spine (93% at L2-L3 to 127% at L4-L5) and thoracic spine (11% at T10-T11). In isolated ligaments, there was a positive correlation between applied tensile load and average shear wave velocity. This study creates a foundation to apply SWE as a noninvasive tool for assessing the mechanical stiffness of posterior ligamentous structures and has potential applications in augmenting or evaluating these ligaments in patients with spine pathology. The interspinous and supraspinous ligaments are critical soft tissue supports of the posterior lumbar spine. Disruption of these structures is thought to have a negative impact on spinal stability in trauma and spine deformities.

The Implementation of Neurophysiological Pre-Trainin Protocols to Improve Performance, R.O.M and Decrease Pain- A Case Study

Post-Activation Performance Enhancement (PAPE) is one of many strategies employed to improve athletic performance, modulate pain and improve range of motion (ROM). This neurophysiological pre-training protocol involves physiological mechanisms such as Autogenetic Inhibition, Reciprocal Inhibition (AI & RI), and Post-Activation Potentiation (PAP). A male powerlifter with 20 years of lifting experience presented a primary complaint of right-sided hip pain when attempting to produce leg drive in a competition Bench Press position. The pain was described as a debilitating 9/10 deep hip pain associated with immediate weakness/loss of hip and leg muscle contraction and abandonment of the attempt. The pain was reproducible and exacerbated by hip extension, internal rotation, and abduction, with limited end-range ROM on hip extension. Due to increased pain upon extension, internal rotation, and abduction, a gluteus medius dysfunction and abduction/extension intolerance were differentially diagnosed. Using the PAPE principles, a treatment strategy was designed. In the competition Bench Press, hip extension is recruited to assist with the transmission of Ground Reaction Force (GRF) from the feet, and lower limbs, also to assist with lumbar spine extension optimisation by which an axial skeletal arch is established. Due to the position of the supine body on the bench press board, the femurs are abducted to enable a person to lie supine with the feet on the floor. When under load, the athlete actively extends the hip, with concurrent femoral abduction. This is a high-performance technique. Prior to setting up on the bench press, the participant was instructed to perform six total sets of seated adduction maximum isometric holds against a foam roller between the knees for 10-20 seconds. After the first six rounds of seated adductor isometric holds, the participant reported 0/10 pain on the subsequent warm-up sets. Full ROM was also reported. The participant proceeded to perform a 220kg 1RM Bench Press with the necessary ROM, leg drive, and no pain. The exercise prescription in this study specifically utilised the mechanisms associated with PAPE, PAP, and RI. The aim of this intervention was to activate the adductor musculature to provide hip extension and inhibit abduction activity. The pre-activation sets of maximal isometric adductor holds were specifically designed to elicit a Reciprocal Inhibition of the hip abductors. This provided a neurophysiological window for the subject to reenter hip extension and obtain the optimal Bench Press setup for performance. Further research focussing on neurophysiological rehabilitative strategies should be conducted. This case study provides a great insight into the possibilities and warrants further investigation around the protocols and mechanisms examined above.

Immediate effect of sling exercises combined with mechanic vibration and oscillation mobilization in chronic nonspecific low back pain patients: a randomized controlled trial

Purpose This study determined whether the combined application of sling exercises (SE) with targeted vibration and oscillations using a device called the Vibraoscillator (VO) is effective in reducing pain intensity, increasing range of motion (ROM), and enhancing back-related functions in patients with chronic nonspecific low back pain (CNLBP). Materials and methods Thirty-six participants were randomized into experimental (SE + VO) and control (SE) groups. Both groups received the intervention twice a week for 4 weeks. The pain was assessed using the Numerical Rating Scale (NRS), ROM was measured using the Modified-Modified Schober’s Test (MMST), and the level of disability was evaluated using the Oswestry Disability Scale (ODI). In addition, the global perceived effect (GPE) was determined. Results NRS and ODI scores significantly improved after the intervention in the experimental group. Only lumbar spine extension improved significantly in the case of ROM. The GPE satisfaction rate was 14.5% higher in the experimental group than in the control group. Conclusion Based on the findings obtained in this study, the combined use of VO and SE in patients with CNLBP was effective in reducing pain, improving ROM, and reducing physical disability in comparison with the treatment of only SE. IMPLICATIONS FOR REHABILITATION Chronic nonspecific low back pain is a major public health problem because it affects almost every person at least once in their lifetime. A new device called a Vibraoscillator generates horizontal vibrations and vertical oscillation movements targeted to a specific area of treatment to promote the neurofacilitation of the targeted zone, aiming for a more focused treatment than general vibrations. This device, in combination with sling exercises, is hypothesized to reduce pain and increase the mobility of the targeted zone and back-related functions in these patients. Based on our findings, the combined use of these interventions twice a week for 4 weeks was effective in reducing pain and improving the range of movement, which consequently reduced physical disability in patients with chronic nonspecific low back pain.

EFEITO DO TREINAMENTO FÍSICO EM OBESOS COM LOMBALGIA: REVISÃO SISTEMÁTICA

ABSTRACT Objective: To understand the hypoalgesic effect of exercises in obese patients with low back pain. Methods: From the methodological point of view, this is a systematic review study supported by the PRISMA guidelines (2020). Only clinical trials with defined eligibility criteria were included and the methodological evaluation was carried out using the Risk of Bias 2.0 (RoB 2.0) tool. Results: Four clinical trials were found, which underwent an assessment of risk of bias and were mostly categorized as moderate risk of bias or with some concerns. Conclusions: Moderate-intensity interval training (MIIT), high-intensity interval training (HIIT), and total resistance or lumbar spine extension exercises were shown to be effective for pain control, quality of life, and functional performance in obese individuals. On the other hand, the exercises alone did not produce a decrease in body composition. Level of evidence I; Systematic review.

Outcomes of Operatively Managed Lumbar and Sacral Facet Fractures in Pediatric Athletes: A Case Series.

Facet fractures have been reported in a total of 6 young athletes in 4 previous publications. These injuries were not diagnosed on magnetic resonance imaging (MRI) or radiographs, and were identified on computed tomography (CT). Our purpose was to report a series of athletes with operatively managed facet fractures. This may be an under-recognized diagnosis. Retrospective review of pediatric patients with operatively managed isolated lumbar or sacral facet fractures from 3 tertiary pediatric hospitals from 2014 to 2019. Clinical records and imaging studies were reviewed. Ten patients with symptomatic lumbar or sacral facet fractures met inclusion criteria (mean age at presentation; 13.3±2.1 years, 70% Female). All patients reported competitive participation in sports. On physical examination, 10/10 (100%) of patients had lower back pain that was exacerbated with lumbar spine extension. Limited CT scans demonstrated facet fractures in 10/10 (100%) patients not detected on plain film or MRI. All patients experienced significant relief of pain following excision of the facet fracture fragment. At time of first postoperative visit, 9/10 (90%) patients were pain free while one had generalized back pain thought to be related to fibromyalgia and not facet pathology. At time of last follow-up, 2/10 (20%) of patients reported nonspecific back pain that was not localized in the area of the facet fracture, while 80% (8/10) remained pain free. All patients 100% (10/10) returned to full participation to sports. There were no complications noted in this series. Average follow-up was 27 months (range: 1 to 68 mo). Athletes with localized back pain exacerbated by spine extension may have a facet fracture. As facet fractures are usually not identified with radiographs or MRI, a limited CT scan should be considered in the evaluation of pediatric athletes with localized back pain exacerbated by extension. In this series, surgical excision of facet fracture fragments was safe and provided predictable pain relief.

Development of a finite element biomechanical whole spine model for analyzing lumbar spine loads under caudocephalad acceleration

Background: Spine injury risk due to military conflict is an ongoing concern among defense organizations throughout the world. A better understanding of spine biomechanics could assist in developing protection devices to reduce injuries caused by caudocephalad acceleration (+Gz) in under-body blasts (UBB). Although some finite element (FE) human models have demonstrated reasonable lumbar spine biofidelity, they were either partial spine models or not validated for UBB-type loading modes at the lumbar functional spinal unit (FSU) level, thus limiting their ability to analyze UBB-associated occupant kinematics. Methods: An FE functional representation of the human spine with simplified geometry was developed to study the lumbar spine responses under +Gz loading. Fifty-seven load curves obtained from post mortem human subject experiments were used to optimize the model. Results: The model was cumulatively validated for compression, flexion, extension, and anterior-, posterior-, and lateral-shears of the lumbar spine and flexion and extension of the cervical spine. The thoracic spine was optimized for flexion and compression. The cumulative CORrelation and Analysis (CORA) rating for the lumbar spine was 0.766 and the cervical spine was 0.818; both surpassed the 0.7 objective goal. The model’s element size was confirmed as converged. Conclusions: An FE functional representation of the human spine was developed for +Gz lumbar load analysis. The lumbar and cervical spines were demonstrated to be quantitatively biofidelic to the FSU level for multi-directional loading and bending typically experienced in +Gz loading, filling the capability gap in current models.

Effect of Backward Walking in Subjects with Mechanical Neck Pain

Background: Population based studies showed that a lifetime prevalence of neck pain was 70% and a point prevalence was between 12-34%. Most common causes of neck pain include:- myogenic positional faults, septic arthritis, osteomyelitis, ankylosing spondylitis, fractures, torticollis, paget’s disease, neurogenic causes as well as soft tissue injuries, vertebral tumor. Backward walking has shown potential benefits in lengthening of posterior muscular chain and stretching the posterior myofascial. There is greater amount of hip extension and knee flexion in backward walking as compared to forward walking. As there is greater amount of hip extension, there occurs greater amount of extension of lumbar spine which loads up the facet joint opening up the disc space. The unloading of the discs occurred may lead to reduction in the pain. Objectives: To study the effect of backward walking in subjects with mechanical neck pain Method: Ethical clearance was obtained from the Institutional Ethical Committee. 38 subjects were selected between the age group 20 to 40 years suffering from mechanical neck pain from 1 month. Male and female subjects were selected according to inclusion and exclusion criteria. Pre values of numeric pain rating scale and cervical lordotic index were taken. Study was carried out for 5 days for 1 week. Post data analysis was note and data analysis was done. Result: A statistical analysis using paired t test within the group comparison was done and conclusions was estimated. Result found from analysis was significant. Conclusion: There was a reduction in pain status and cervical curve between the values of pre study and post study. Hence, this study concludes that there is effectiveness in backward walking in subjects with mechanical neck pain

(104) The Aging Lumbosacral Spine and Development of Chronic Lower Back Pain

Chronic lower back pain continues to be a leading cause of disability, loss of work, and medical expenditures in the United States. As our baby-boom generation continues to age, medical healthcare will become increasingly tailored to providing care for the elderly. The World Health Organization speculates the geriatric population will reach two billion by 2050.1 This is a literature review describing the anatomic changes in the lumbosacral spine angle that occur with aging possibly contributing to chronic lower back pain. Using PubMed database, a literature review was performed particularly focusing on lumbosacral spine angle, aging, and chronic pain. Conclusions: During advanced age the lumbar spine shows continuous loss of the lumbar lordotic curvature.2 Sagittal spine alignment measured prospectively over 10 years in elderly patients showed a decrease in lumbar lordosis and sacral inclination angle that occurred progressively with aging.3 Additionally, significantly decreased lumbar lordosis angle, sacral tilt and lumbosacral disc angle occurred in elderly compared to non-geriatric patients with lower back pain.4 The loss of lumbar lordosis and sacral inclination in the aging spine is related to degeneration of the lumbar discs resulting in decreased disc height and asymmetric wedging3. Additionally, increased lumbar spine extension is thought to augment pressure on the posterior ligaments and lumbar facet joints.2 Using CT lumbar spine images advanced lumbar facet joint degeneration was associated with increase in sacral slope, L1-L5 lumbar lordosis angle and decrease in sacral table and L5 vertebra posterior angle.5 Addressing the significant role of lumbosacral alignment angle in the painful aging spine may lead to innovative treatment strategies in the future. (1. Drzal-Grabiec, BMC Geriatr, 2013; 2. Chun, Spine J, 2017; 3. Takeda, J Orthop Sci, 2009; 4. Kocyigit, Pak J Med Sci, 2018; 5. Sahin, Spine [Phila Pa 1976], 2015).

Changes in hip and spine movement with increasing running speed.

[Purpose] We aimed to clarify and compare the changes in thoracic and lumbar spine motion and to elucidate the relationship between hip and lumbar spine motion during running. [Participants and Methods] Seven healthy females were recruited in this study. Hip and spine movement were measured using a 3D motion analysis system when running at 6, 9, and 12 km/h. One-way analysis of variance was used to compare the changes in hip joint and spine angles during running. Correlation coefficient analysis was used to determine the relationship between the hip and lumbar spine angles at right and left toe-offs. [Results] As the running speed increased, the rotation angles of the thoracic and lumbar spine and the extension angles of the lumbar spine and hip joint significantly increased in the late stance phase. Significant positive relationships were observed between hip flexion and lumbar spine extension angles at toe-off when running at 6 and 9 km/h but not when running at 12 km/h. [Conclusion] To increase the running speed, participants increased the rotation angle of spine and the extension angles of the hip joint and lumbar spine during the stance phase. Participants extended the lumbar spine to compensate for the restricted hip motion at toe-off, which could cause stress to the lumbar spine.

Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy

Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine (q=8.823, 8.248, both P<0.05); and the pressure of L(4/5) intervertebral disc also changed significantly during extension and right rotation of lumbar spine (q=6.918, 6.438, both P<0.05); the motion of lumbar spine showed obvious differences during right lateral flexion and rotation (q=6.845, 7.772, 13.58, all P<0.05). Comparing with the normal group, after 2/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets presented significant differences during all conditions (q=5.670-17.830, all P<0.05); the pressure of L(4/5) intervertebral disc changed significantly during flexion, extension, lateral flexion and right rotation (q=5.260, 17.150, 5.727, 8.890, 15.660, all P<0.05); the motion of lumbar spine also existed differences during extension, lateral flexion and rotation (q=9.106, 5.431, 12.060, 11.160, 17.260, all P<0.05). However, after 3/4 resections, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine presented differences during all conditions when compared with those in normal group (q=6.303-25.48, all P<0.05). After 4/4 resections, the pressure of the L(4/5) right facets and the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine showed significant differences during all conditions when compared with those in normal group (q=8.065-45.70, all P<0.05). Conclusions: The biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.

Morphologic Evaluation of Lumbosacral Nerve Roots in the Vertebral Foramen: Measurement of Local Pressure of the Intervertebral Foramen.

The prospective cohort study. The objective was to evaluate the relationships between local pressure changes of the intervertebral foramen during lumbar spine extension and lumbar foraminal morphology. The physiological states of lumbosacral nerve roots in the vertebral foramen remain controversial. We evaluated 56 lumbosacral vertebral foramens in 21 patients with L4-degenerative spondylolisthesis. All patients underwent L4-5 posterolateral fusion (PLF). The local pressure of the intervertebral foramen was measured intraoperatively, and measurement was performed before and after L4-5 PLF. We defined the changes in the ratio of local pressure between lumbar flexion to extension as percent pressure. The sagittal angular motion, distance between the inferior cortex of the cranial pedicle and superior cortex of the caudal pedicle, posterosuperior margin of the superior vertebral body and superior articular facet, posteroinferior edge of the superior vertebral body and inferior articular facet, and the intervertebral disc height were measured using preoperative functional plain radiographs and CT images. The average local pressure of the intervertebral foramen significantly increased during lumbar extension. However, the L4-5 vertebral foraminal pressure after PLF were nearly identical. There was no significant correlation between percent pressure and lumbar range of motion. Furthermore, there were no significant correlations between percent pressure and each morphologic parameter of the lumbar foramen. There were no significant relationships between the lumbar foraminal morphology and intervertebral foraminal pressure changes during lumbar extension, and L4-5 vertebral foraminal pressure was not affected by the lumbar posture after L4-5 posterior fusion. On the basis of the results, the external dynamic stresses on the nerve roots in the vertebral foramen might be improved by lumbar posterior fusion using instrumentation without direct decompression of the vertebral foramen.

Changes in lumbopelvic rhythm during trunk extension in adolescent soccer players

Many adolescent athletes experience low back pain (LBP). Its causative factors include lower limb muscle tightness and hip–spine incoordination. Hip–spine coordination [or lumbopelvic rhythm, LPR] can be used to assess lower-limb and spine functions. We assessed the presence/absence of LBP in adolescent soccer players before and after a six-month period and divided them into four groups: no LBP both before and after the period (NBP group); LBP before but not after (PN group); LBP after but not before (NP group); and LBP both before and after (LBP group). We used a 3D motion analysis system during trunk extension to measure the lumbar spine and hip ranges of motion (ROMs). On comparing the results obtained before and after the six-month period, lumbar spine ROM decreased in the NP group, hip ROM increased in the LBP group. From before to after the period, the linear prediction indicated that, when the hip extends by 1°, the lumbar spine extends by 3.5°–3.2° for the PN group and by 3.4°–2.8° for the NP group. The NP group extended their lumbar spine excessively compared with the hip before the period, which could cause LBP, but decreased the extension after the period. Lumbar extension relative to hip extension decreased in the PN group, which could decrease excessive load on the lumbar spine and eliminate LBP. These findings suggest that to prevent LBP in adolescent soccer players, it is important to restrict lumbar spine extension relative to hip extension.

Reliability and validity of an iPhone(®) application for the measurement of lumbar spine flexion and extension range of motion.

BackgroundMeasurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions.PurposeThe main purpose was to investigate the reliability and validity of an iPhone® app (TiltMeter© -advanced level and inclinometer) for measuring standing lumbar spine flexion–extension ROM in asymptomatic subjects.DesignA cross-sectional study was carried out.SettingThis study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran.SubjectsA convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18–55 years) was recruited between August 2015 and December 2015.MethodsFollowing a 2–minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12–L1 and S1–S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone ® app to measure lumbar spine flexion–extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion–extension ROM, the measurement from S1–S2 was subtracted from T12–L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × n}{}sqrt{2}.ResultsGood to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ≥0.84 and ≥0.77 and the iPhone® app with ICC values of ≥0.85 and ≥0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively.ConclusionsThe iPhone®app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone® app can be used for the measurement of lumbar spine flexion–extension ROM.Level of evidenceIIb.

Evaluating the Relationship Between Muscle Activation and Spine Kinematics Through Wavelet Coherence.

Advances in time-frequency analysis can provide new insights into the important, yet complex relationship between muscle activation (ie, electromyography [EMG]) and motion during dynamic tasks. We use wavelet coherence to compare a fundamental cyclical movement (lumbar spine flexion and extension) to the surface EMG linear envelope of 2 trunk muscles (lumbar erector spinae and internal oblique). Both muscles cohere to the spine kinematics at the main cyclic frequency, but lumbar erector spinae exhibits significantly greater coherence than internal oblique to kinematics at 0.25, 0.5, and 1.0 Hz. Coherence phase plots of the 2 muscles exhibit different characteristics. The lumbar erector spinae precedes trunk extension at 0.25 Hz, whereas internal oblique is in phase with spine kinematics. These differences may be due to their proposed contrasting functions as a primary spine mover (lumbar erector spinae) versus a spine stabilizer (internal oblique). We believe that this method will be useful in evaluating how a variety of factors (eg, pain, dysfunction, pathology, fatigue) affect the relationship between muscles' motor inputs (ie, activation measured using EMG) and outputs (ie, the resulting joint motion patterns).

Effects of a Hip Flexor Stretching Program on Running Kinematics in Individuals With Limited Passive Hip Extension.

Mettler, JH, Shapiro, R, and Pohl, MB. Effects of a hip flexor stretching program on running kinematics in individuals with limited passive hip extension. J Strength Cond Res 33(12): 3338-3344, 2019-Tightness of the hip flexor muscle group may theoretically contribute to altered kinematics of the lumbo-pelvic-hip (LPH) complex during dynamic movements. Therefore, the purpose of this study was to analyze the effects of a 3-week home-based stretching program on passive hip extension and sagittal plane kinematics of the LPH complex when running. Twenty healthy subjects with limited passive hip extension underwent a 3D gait analysis both before (PRE) and after (POST) a hip flexor stretching program. After the stretching program, passive hip extension increased significantly (p < 0.001), whereas no improvements during running were reported for active hip extension, anterior pelvic tilt, or lumbar spine extension (p ≥ 0.05). In addition, no relationship was found between the change in passive hip extension with either the change in active hip extension, anterior pelvic tilt, or lumbar spine extension. A 3-week static stretching program of the hip flexor muscle group resulted in an increase in passive hip extension, but the sagittal plane kinematics of the LPH complex during running remained unchanged. The results suggest that passive hip joint flexibility may be of limited importance in determining the kinematics of the LPH complex during submaximal running. However, it is possible that an increase in the range of motion at the hip may be beneficial when running at or near maximal speeds.

A radiographic assessment of lumbar spine posture in four different upright standing positions

BackgroundApproximately 50% of a sample population will develop prolonged standing induced low back pain. The cause of this pain may be due to their lumbar spine posture. The purpose of this study was to investigate differences in lumbar posture between 17 participants categorized as a pain or non-pain developers during level ground standing. A secondary purpose was to evaluate the influence of two standing aids (an elevated surface to act as a foot rest and declined sloped surface) on lumbopelvic posture. MethodsFour sagittal plane radiographs were taken: a normal standing position on level ground, when using an elevated foot rest, using a declined sloped surface, and maximum lumbar spine extension as a reference posture. Lumbosacral lordosis, total lumbar lordosis, and L1/L2 and L5/S1 intervertebral joint angles were measured on each radiograph. FindingsThere was a significant difference between the lumbosacral lordosis angle and L5/S1 angles in upright versus maximum extension; however, this was independent of pain group. The elevated surface was most effective at causing lumbosacral spine flexion. InterpretationPotentially successful postures for eliminating low back pain during prolonged standing mainly influence the lower lumbar lordosis. Future work should assess the influence of hip posture on low back pain development during standing.

Spinal and Shoulder Girdle Range of Motion in Elite Female Volleyball Athletes

Abstract Introduction. Doing asymmetric sports when one suffers from body asymmetry may cause body posture disorders. The aim of the study was to assess the spinal and shoulder complex mobility of professionally trained volleyball athletes compared to that of their peers who do not practise any sports. Material and methods. The study involved 60 participants divided into two groups. Group 1 consisted of 30 girls aged 14 years. The average height in the group was 176.37 ± 6.29 cm, and the average body mass was 64.53 ± 7.12 kg. Group 2 consisted of 30 girls aged 15.6 ± 1.12 years who did not practise any sports. The average body height in this group was 159.37 ± 3.33 cm, and the average body mass was 51.83 ± 4.03 kg. The dominant limb was defined on the basis of lateralization. The spinal range of motion was measured by means of a Saunders digital inclinometer, and the shoulder complex range of motion was examined using the goniometric method. Means and standard deviations were calculated, and Student’s t-test was applied in order to determine the differences between the two groups. Results. The differences in the values obtained in the two groups for the spinal range of motion in the sagittal plane were statistically significant only for the range of lumbar spine bending and extension. It was found that group 1 had a higher range of spine mobility in the frontal and transverse planes, and the differences were statistically significant in all the assessed ranges towards the dominant limb. An analysis of the shoulder girdle range of motion in the groups revealed that the differences were also statistically significant in all of the examined ranges. Conclusion. Professional volleyball practice can cause an increase in spine flexibility in most of its ranges, and the shoulder girdle range of motion in female volleyball players can exceed population norms, especially for the upper dominant limb.

A Case of Change in Work Out as the Presenting Symptoms of Multiple Myeloma

HISTORY: A 56 year-old active black male presented with 5 months of worsening chronic pain: right hip pain changed location and low back pain flared. His pain had not responded to maintenance exercises (weightlifting, running, stationary cycling), dry needle, massage, stretch, or anti-inflammatories. Past medical history included lumbar disc bulge, lumbar spondylolysis, right superior labral tear, sports lifting-related Osgood-Schlatter’s, cervical laminectomy, chronic right rectus femoris strain. PHYSICAL EXAMINATION: Compared to examination seven months prior, physical examination was significant for decrease in lumbar spine flexion, extension, lateral lean, and rotation and normal symmetric strength testing over the bilateral lower extremities. Forward bending as if to tie shoes, lifting objects, and walking several blocks reproduced his pain. DIFFERENTIAL DIAGNOSIS: 1.Lumbar vertebral body fracture 2.Herniated disc 3.Lumbar or sacroiliac joint sprain or dysfunction 4.Lumbar paraspinal muscles strain 5.Malignancy - primary or secondary 6.Infection - osteomyelitis TESTS AND RESULTS: Serum protein electrophoresis: elevated IgM level Bone marrow biopsy #1: smoldering multiple myeloma Bone scan #1: negative. Lumbosacral x-ray: stable spondylolysis MRI lumbosacral spine: stable lumbar disc bulge, new L2 infiltrative lesion. Non-contrast CT: L2 lytic process with pathologic fracture Bone scan #2: photopenic foci at L2 and right scapula Skeletal survey #1: negative Bone marrow biopsy #2: plasma cell neoplasm Skeletal survey #2: lesions at L2, left pelvis, bilateral proximal femurs as well as bilateral osteoarthrosis of glenohumeral joints and left sacroiliitis FINAL WORKING DIAGNOSIS: Stage 2 multiple myeloma TREATMENT AND OUTCOMES: 1.Radiation and chemotherapy 2.Clamshell TLSO for lumbar lordosis 3.Simplifed exercise program: upright stationary cycle, overhead reach, back extension stretches. Focus on core strength, hip flexibility. 4.Advance to stairs, pool running, captain’s chair, bird dog, and abdominal press 5.Avoid overhead lifting and compressive spine exercises 6.Treatment complicated by pulmonary embolism. 7.Tolerance of bending and lifting improved participation in household activities. 8.Goal: to return to weight lifting exercises and outdoor biking.

Pathophysiological effects of lumbar instrumentation surgery on lumbosacral nerve roots in the vertebral foramen: measurement of local pressure of intervertebral foramen.

Measurement of local pressure of the intervertebral foramina. To evaluate the pathophysiological effects of lumbar instrumentation surgery on lumbosacral nerve roots in the vertebral foramen. The physiological states of lumbosacral nerve roots in the vertebral foramen remain controversial. From 2000 to 2012, 11 of 710 patients with L4 degenerative spondylolisthesis failed to develop postoperative radiculopathy because of intraoperative pedicle screw malposition (L5: 10, L4: 1). We prospectively evaluated the local pressure at the L4-L5 and L5-LS vertebral foramina in 18 patients with L4 degenerative spondylolisthesis. All patients underwent L4-L5 posterolateral fusion (PLF) with L3-L4-L5 laminotomy. Intraoperatively, local pressure of the intervertebral foramen was measured using a catheter pressure transducer while changing the lumbar spine posture, and the measurement was performed before and after L4-L5 PLF. The local pressures at the L4-L5 vertebral foramen were 29.74 ± 16.26 and 51.57 ± 23.18 mm Hg (before fixation), and 39.13 ± 17.69 and 41.71 ± 17.94 mm Hg (after fixation) in the lumbar spine neutral and extension postures, respectively. The local pressure before fixation increased significantly during lumbar spine extension (P < 0.001), although the value after fixation was almost identical. The local pressures at the L5-LS vertebral foramen were 26.91 ± 18.16 and 54.36 ± 26.67 mm Hg (before fixation), and 24.82 ± 17.1 and 58.46 ± 32.78 mm Hg (after fixation) in the lumbar spine neutral and extension postures, respectively. The local pressure before and after fixation increased significantly during lumbar spine extension (P < 0.001), and the values after fixation were higher than those before fixation. The local pressure at the L4-L5 vertebral foramen did not change during lumbar extension after L4-L5 PLF, whereas the local pressure at the L5-LS vertebral foramen was significantly increased during lumbar extension after L4-L5 PLF. Our results suggested that the nerve roots caudal to the fixed segments may be exposed to higher external dynamic stresses after lumbar instrumentation surgery. 4.

Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension

En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.