Posterior Pelvic Tilt Research Articles

A correlation study of weak core muscles with hamstring muscles flexibility in young adults

Abstract Background Hamstring, being a two-joint muscle, tends to shorten over time, resulting in tightness, affecting performance in daily activities and is also capable of generating exaggerated posterior pelvic tilt, leading to decreased lumbar lordosis. Weak core muscles have been associated with hamstring tightness, and strengthening the core has been attempted in an effort to relax the hamstring tightness. It is believed that the hamstrings overact and over a period of time tightens, when the core is weak, to compensate for postural stability. Method Thirty-three subjects, both male and females with and without hamstring tightness, were assessed for their core endurance through McGill’s core endurance test battery. It was followed by active knee extension test to determine degree of hamstring tightness on both sides. Correlation between the two variables was statistically analyzed. Results Pearson’s correlation was used to analyze the collected data. A moderate positive but significant correlation (p = 0.02) was found between flexor endurance test and active knee extension (both sides). A weak positive but significant correlation (p = 0.05) was found between extensor endurance test and active knee extension (both sides). Correlation between the right and left lateral bridge with their respective side hamstring flexibility was negative and not significant (p = 0.916 (right lateral torso endurance); p = 0.339 (left lateral torso endurance)). Conclusion Since there is a moderate positive but significant correlation between the flexion torso endurance test and both side hamstring flexibility and a weak positive but significant correlation between extension torso endurance test and both side hamstring flexibility, the core (flexor, extensor, and lateral) should be thought of as a whole unit when strengthening in order to maintain and improve hamstring flexibility.

Erect weight-bearing pelvic radiographs are superior to supine radiographs for diagnosis of mixed type acetabular retroversion plus developmental dysplasia hip deformity

PurposeThis study focused on the mixed-type deformities of acetabular retroversion (AR) and developmental dysplasia hip deformity (DDH) and aimed to ascertain the changes in pelvic tilt from a supine to a standing position in these cases and identify potential underlying mechanisms. MethodsA retrospective study was conducted on cases with symptomatic DDH from January 1, 2019, to April 30, 2023. DDH was defined as LCEA < 20°. AR was diagnosed by using a crossover index threshold of 0.2 in standing pelvic X-ray. Two observers assessed the supine and weight-bearing pelvic radiographs, along with computed tomography (CT) scans. The evaluated parameters included pelvic tilt (sacrofemoral-pubic angle (SFP), symphysis to sacrococcygeal distance (PSSC), pubic symphysis to sacroiliac (PSSI)), acetabular retroversion (crossover index, posterior wall sign), acetabular coverage (lateral center-edge angle (LCEA), ischial spine sign (ISS)), and axial rotation of the hemipelvis (pelvic width index, obturator index, and ilio-ischial angle). Acetabular orientation and coverage was measured by CT through anterior sector angle (ASA), posterior sector angle (PSA) and acetabular anteversion (AA). Cases with acetabular retroversion plus DDH were defined as the mixed-type deformity. Comparative analyses between mixed-type deformities and DDH cases were performed along with subgroup and correlation analyses within mixed-type cases. Inter-observer and intra-observer reliabilities were assessed using intraclass correlation coefficients. ResultsA total of 85 were included. 26 cases (30.59%) had mixed-type deformity, where transition from the supine to standing position led to an increased posterior pelvic tilt (SFP (supine: 64.35±4.6°, standing: 74.75±4.16°, p<0.001), PSSC (supine: 6.37±2.47, standing: 2.08±1.32, p<0.001) and PSSI (supine: 9.47±1.66, standing: 6.33±1.08, p<0.001)). Compared to cases with DDH, CT examination revealed a significantly greater anterior acetabular coverage and less posterior superior coverage, with smaller posterior sector angle and greater anterior sector angle (ASA) (p<0.05) for cases with AR. The superior iliac wing angle (mixed type: 45.63±9.22°, isolated type: 50.70±8.77°, p=0.013), inferior iliac wing angle(mixed type: 60.77±8.24°, isolated type: 65.24±8.02°, p=0.013), and ischiopubic angle (IPA) (mixed type: 32.27±3.19°, isolated type: 36.71±5.38°, p<0.001) were significantly reduced in AR cases, suggesting external rotation of the hemipelvis. Subgroup analysis showed that cases with a higher crossover index had a significantly higher PSSC and a significantly lower IPA. ConclusionAR was observed in 31% of DDH cases and was associated with a notable posterior pelvic tilt during postural transitions. This tilt appeared to be a compensatory mechanism affecting the AR diagnosis. Key changes in the acetabular coverage, including increased anterior coverage and decreased superior posterior coverage, were also observed. Additionally, external rotation of the hemipelvis in mixed-type cases correlated strongly with the extent of AR and anterior acetabular coverage, suggesting that it may be a key contributor to the underlying mechanism of this mixed-type deformity. Level of evidenceIII, retrospective case series.

Comparison of two different stretching strategies to improve hip extension mobility in healthy and active adults: a crossover clinical trial

ObjectiveTo improve hip flexor flexibility, the commonly used hip extension stretch focuses on advancing the pelvis forward in a half-kneeling position, targeting only hip extension. This study aimed to compare the effectiveness of this traditional stretch with a new technique incorporating posterior pelvic tilt.MethodsA randomized crossover clinical trial was conducted with in 26 healthy, physically active individuals (52 hips), aged 22.50 ± 4.10 years. Each participant performed both the hip extension stretch and the posterior pelvic tilt stretch (26 hips), with one technique applied to each limb: the posterior pelvic tilt stretch on one limb and the hip extension stretch on the other limb (26 hips). The reactive hip flexor test and active knee extension test were measured pre and post stretching techniques. A repeated measures ANOVA was performed to assess differences between groups.ResultsThere was a significant group-by-time interaction with a medium effect size for the variable related to reactive hip flexor force (F = 4.775, p = 0.034, η2p = 0.087). The posterior pelvic tilt stretch had a statistically significant mean difference of 4.85 N·m (p = 0.003; 95%CI: 1.74; 7.96) compared with the hip extension stretch (mean difference = 0.06 N·m (p = 0.969; 95%CI-3.05; 3.17). No significant differences were found for active knee extension (p > 0.05).ConclusionsThe results showed that the posterior pelvic tilt stretching technique was effective in reducing the hip reactive flexor force when compared to conventional hip extension stretch.

Immediate Effects of Two Different Methods of Trunk Elastic Taping on Pelvic Inclination, Trunk Impairment, Balance, and Gait in Stroke Patients.

Background and Objectives: Stroke patients often experience changes in their pelvic tilt, trunk impairments and decreased gait and balance. While various therapeutic interventions have been attempted to improve these symptoms, there is a need for interventions that are easy to apply and reduce the physical labor of physical and occupational therapists. We aimed to investigate the immediate effects of two different methods of trunk elastic taping on the pelvic inclination, trunk impairment, balance, and gait in chronic stroke patients. Materials and Methods: We performed a single-blind randomized controlled trial involving 45 patients with chronic stroke. Participants were randomly assigned to one of three groups: forward rotation with posterior pelvic tilt taping (FRPPT, n = 14), backward rotation with posterior pelvic tilt taping (BRPPT, n = 14), or placebo taping (PT = 14). This study was conducted from December 2023 to January 2024. All the measurements were performed twice: before the intervention and immediately after the intervention. The pelvic inclination was assessed using the anterior pelvic tilt angle. The trunk impairment scale (TIS) was used to measure the trunk impairment. The balance and gait were evaluated using a force plate and walkway system. Results: The pelvic inclination was significantly different in the FRPPT and BRPPT groups compared to the PT group (p < 0.05, p < 0.001). The TIS and gait were significantly increased in the FRPPT group compared to the PT group (p < 0.05). The balance significantly improved in the FRPPT and BRPPT within groups (p < 0.05). Conclusions: Two different methods of posterior pelvic tilt taping improved the anterior pelvic tilt in chronic hemiplegic stroke patients compared with PT, and the FRPPT method also improved the trunk impairment and gait. Therefore, posterior pelvic tilt taping can be used as an intervention with immediate effect.

Comparative effects of dry needling and instrument-assisted soft-tissue mobilization on hamstring tightness in patients with posterior pelvic tilt: A pilot study

Objectives: The objective of this study was to compare the impacts of dry needling (DN) and instrument-assisted soft-tissue mobilization on hip flexion, active knee extension (AKE), and posterior pelvic tilt (PPT) in participants with hamstring tightness. Methods: A randomized clinical pilot study was conducted at the District Headquarter Hospital and tertiary hospitals in the District Nankana Sahib, Pakistan. The study’s sample size was 36, and participants were randomized equally into two treatment groups. Group A received DN, and Group B underwent treatment with instrument-assisted soft-tissue mobilization. Hamstring tightness was assessed using an inclinometer to measure the range of motion for AKE and bilateral straight leg raise (BSLR). PPT was measured using an inclinometer at baseline and after treatment of four weeks. Results: Both groups showed a significant disparity in the mean of pre-and post-treatment values (P &lt; 0.05) of AKE, BSLR, and PPT. A statistically significant disparity was found between both groups on AKE, BSLR, and PPT (P &lt; 0.05) post-treatment of 4 weeks. Conclusion: Both DN and instrument-assisted soft-tissue mobilization were found to be beneficial for enhancing hamstring flexibility by improving hip and knee joint mobility. On the other hand, instrument-assisted soft-tissue mobilization was superior in increasing active knee extension, BSLR, and reducing PPT.

Sacroiliac pain after total hip arthroplasty: a combined analysis of clinical data and three-dimensional imaging in standing and sitting positions.

Patients frequently complain of low back pain and sacroiliac joint pain (SIP) following total hip arthroplasty (THA). We hypothesized that patients with SIP would display different pelvic incidence (PI) values between standing and relaxed sitting positions, indicative of increased motion in the sacroiliac joints. In this retrospective case-control study, 94 patients who underwent unilateral THA and experienced SIP were compared with 94 control patients without SIP. SIP was confirmed through clinical tests and investigated using biplanar imaging in both standing and sitting positions. The key parameters analyzed included PI, sacral slope (SS), lumbar lordosis (LL), and limb length discrepancy (LLD). Patients without SIP showed a mean difference in PI of -1.5° (-8°-5°) between standing-to-sitting positions, whereas those with SIP showed a difference of -3.3° (-12°-0°)(P < 0.0001), indicating more motion in the sacroiliac joint during daily activities in the latter group. Patients with SIP showed smaller change in LL between standing-to-sitting positions (mean:6.3°; range:-8°-27°) compared with those without SIP (mean:9.5°; range:-12°-28°)(P = 0.006). No significant differences were noted in functional leg length between patients with (mean:7mm; range:0-12mm) and without SIP (mean:7mm; range:0-11mm)(P = 0.973). This study revealed significant sacroiliac joint motion in patients with SIP post-THA, as indicated by PI changes, increased posterior pelvic tilt, and reduced change in the LL. Contrary to common belief, SIP did not correlate with LLD.

The Influence of the Dominant Leg in Body Asymmetries in Children and Adolescent Male Soccer Players.

The current study aimed to examine (a) whether the dominant leg (DL) was associated with the contralateral side of functional scoliosis and (b) if any of the postural asymmetries' evaluation variables may be a reliable predictor of the functional scoliosis development in young male soccer players. Six hundred-nine (n = 609) male soccer players (age: 10.8 ± 2.7 years; height: 147 ± 17 cm; weight: 43.4 ± 14.6 kg; DL: Right 81.6%, Left 14%, Both 4.4%) participated in this study. The spinal asymmetries evaluation included thoracic kyphosis, lumbar lordosis, truncal rotation, shoulders alignment from posterior view, anterior and posterior pelvic tilt, anterior superior iliac spine (ASIS), hamstring tightness, and lower extremities discrepancy. A significant association was observed between the DL and the truncal rotation side: χ2(4) = 30.84, p = 0.001, V = 0.16. Participants with longer left legs were likelier to present a spinal asymmetry (OR = 1.18). The participants with higher left shoulders were 2.13 times more likely to have spinal asymmetry than the participants with normal shoulders level. Participants with left ASIS higher were 3.08 times more likely to present asymmetry than those with normally aligned ASIS levels. There was also a significant association between the DL and the side of truncal rotation: χ2(2) = 13.30, p = 0.001, V = 0.449. Logistic regression analysis for the functional scoliotic group and truncal rotation side demonstrated that the taller participants and participants with shorter right legs were more likely to have asymmetry on the left side (OR = 1.29, OR = 0.32). Participants with greater right hamstring stiffness were likelier to have a truncal rotation on the right side (OR = 0.93). Participants with higher left shoulders were 0.20 times less likely to have a truncal rotation on the left side than the participants with normal shoulders level. In conclusion, leg dominance in children and in youth soccer players may be a factor causing truncal rotation on the contralateral side. Additional causes, such as leg length discrepancy and pelvic tilt, may progressively lead to functional scoliosis.

Preoperative Radiographic Predictors of Subsequent Fusion After Lumbar Decompression Surgery.

Retrospective cohort study. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P =0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P =0.001], decreased SS [OR=0.96 (0.93-0.99), P =0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P =0.040] as significant independent predictors of fusion after decompression surgery. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.

Archetype analysis of the spine-hip relationship identifies distinct spinopelvic profiles

IntroductionThe position of the pelvis in the sagittal plane can vary considerably between different functional positions. Adapting the position of the acetabular cup in relation to the alignment between the spine and the hip of each individual, prior to prosthesis placement, can prevent the risk of prosthetic impingement. Taken individually, risk factors for unfavorable spinopelvic kinematics can be difficult to interpret when trying to precisely predict which patients are at risk. Furthermore, the use of classifications or algorithms can be complex, most often associated with limited values and often difficult to apply in current practices of risk assessment. HypothesisWe hypothesized that the deconstruction of the data matrix including age and spinopelvic parameters (SPT, LL, PI, LF and PI-LL) correlated with the analysis of spinopelvic kinematics could be used to define an individualized hip-spine relationship. Material and methodWe applied archetypal analysis, which is a probabilistic, data-driven and unsupervised approach, to a complete phenotype cohort of 330 patients before total hip arthroplasty to define the spinopelvic profile of each individual using the spinopelvic parameters without threshold value. For each archetype, we analyzed the spinopelvic kinematics, not implemented in the creation of the archetypes. ResultsAn unsupervised learning method revealed seven archetypes with distinct spinopelvic kinematic profiles ranging from −8.9 ° to 13.15 ° (p = 0.0001) from standing to sitting and −5. 35 ° to −10.81 ° (p = 0.0001) from supine to standing. Archetype 1 represents the “ideal” patient (A1); young patients without spinopelvic anomaly and the least at risk of mobility anomaly. Followed by 3 archetypes without sagittal imbalance according to their lumbar lordosis and pelvic incidence, from the highest to the lowest (archetypes 2–4), archetype 4 exposing a greater risk of spinopelvic kinematic anomaly compared to others. Then 2 archetypes with sagittal imbalance: archetype 5, with an immobile pelvis in the horizontal plane from standing to sitting position in anterior tilt and archetype A6, with significant posterior pelvic tilt standing, likely compensating for the imbalance and associated with the greatest anomaly of spinopelvic kinematics. Finally, archetype 7 with the stiffest lumbar spine without sagittal imbalance and significant unfavorable kinematics from standing to sitting. ConclusionAn archetypal approach to patients before hip replacement can refine diagnostic and prognostic features associated with the hip-spine relationship and reduced heterogeneity, thereby improving spinopelvic characterization. This risk stratification of spinopelvic kinematic abnormalities could make it possible to target patients who require adapted positioning or types of implants before prosthetic surgery. Level of evidenceIV retrospective study.

Analysis of Spinal-Pelvic Sagittal Plane Parameters in Patients with Lumbar Vertebral Posterior Ring Apophysis Separation

To investigate the characteristics of the spinal-pelvic sagittal sequence in patients with lumbar vertebral posterior ring apophysis separation (PRAS). A retrospective analysis was conducted on 119 hospitalized patients with PRAS, and 119 adults without symptoms of low back and leg pain were selected as the control. General data and spinal-pelvic sagittal parameters were collected and analyzed. Compared to the control group, the pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis of the PRAS group were significantly lower, while the pelvic tilt (PT), sagittal vertical axis, and PI minus LL were significantly higher. There was no significant difference in thoracolumbar kyphosis between the 2 groups. In patients with PRAS, the LL value of lumbar curvature was moderately correlated with thoracic kyphosis and SS, while PI, PT, and SS were pairwise correlated, indicating that the change in one parameter is often accompanied by simultaneous changes in other parameters if PRAS happens. The correlation between different parameters could provide guidance for the diagnosis of PRAS. In terms of LL type, the PRAS group was mainly of Roussouly type I, while the control group was mainly of type II, and the difference in the composition ratio was statistically significant. As reflected by the spinal-pelvic sagittal parameters, the patients with PRAS exhibited reduced thoracic and lumbar curvature, posterior PT, and fewer vertebral bodies involved in LL. These morphological characteristics indicate the changes of the mechanical structure of the spine.

Does spinopelvic alignment affect femoral head cartilage and the proximal femoral physis in slipped capital femoral epiphysis? A finite element analysis

BackgroundSlipped capital femoral epiphysis is a prevalent pediatric hip disorder. Recent studies suggest the spine's sagittal profile may influence the proximal femoral growth plate's slippage, an aspect not extensively explored. This study utilizes finite element analysis to investigate how various spinopelvic alignments affect shear stress and growth plate slip. MethodsA finite element model was developed from CT scans of a healthy adult male lumbar spine, pelvis, and femurs. The model was subjected to various sagittal alignments through reorientation. Simulations of two-leg stance, one-leg stance, walking heel strike, ascending stairs heel strike, and descending stairs heel strike were conducted. Parameters measured included hip joint contact area, stress, and maximum growth plate Tresca (shear) stress. FindingsPosterior pelvic tilt cases indicated larger shear stresses compared to the anterior pelvic tilt variants except in two leg stance. Two leg stance resulted in decreases in the posterior tilted pelvi variants hip contact and growth plate Tresca stress compared to anterior tilted pelvi, however a combination of posterior pelvic tilt and high pelvic incidence indicated larger shear stresses on the growth plate. One leg stance and heal strike resulted in higher shear stress on the growth plate in posterior pelvic tilt variants compared to anterior pelvic tilt, with a combination of posterior pelvic tilt and high pelvic incidence resulting in the largest shear. InterpretationOur findings suggest that posterior pelvic tilt and high pelvic incidence may lead to increased shear stress at the growth plate. Activities performed in patients with these alignments may predispose to biomechanical loading that shears the growth plate, potentially leading to slip.

Sagittal Pelvic Tilt Directly Influences the Ischiofemoral Space: A Cadaveric Study.

Ischiofemoral impingement (IFI) is understood to be a pain generator in the deep gluteal space. Femoral position is known to influence the ischiofemoral space (IFS), but there has been no study examining the effect of sagittal pelvic tilt on the IFS. The purpose of this study was to determine whether changes in pelvic tilt in the sagittal plane lead to changes in the dimensions of the IFS. Five fresh frozen cadavers (10 hips) were used for this anatomic study. The specimens were skeletonized and placed in the prone position with the pelvis fixed to a custom-built hinged table. A digital inclinometer was used to tilt the pelvis -10°, 0°, and 10° simulating posterior, neutral, and anterior pelvic tilt, respectively. Digital calipers were used to measure the dimensions of the IFS in all three positions of sagittal pelvic tilt. Changes in pelvic tilt resulted in significant changes in the dimensions of the IFS. Mean IFS dimensions measured 29.3±9.7 mm, 37.2±9.0 mm, and 24.3±9.2 mm in the neutral, anterior, and posterior pelvic tilt positions, respectively (P<.0001). Changes in sagittal pelvic tilt influence the dimensions of the IFS, with posterior pelvic tilt noted to significantly decrease the IFS when compared with neutral and anterior pelvic tilt. These findings suggest that further evaluation of sagittal spinopelvic balance in the etiology of symptomatic IFI may be warranted. [Orthopedics. 2024;47(3):167-171.].

Accuracy of portable navigation during THA in patients with severe developmental dysplasia of hip.

Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH. In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed. The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27). In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.

Does Pelvic Tilt Angle Influence the Isokinetic Strength of the Hip and Knee Flexors and Extensors?

The purpose of this study was to examine the effect of pelvic tilt angle on maximum hip and knee muscles' strength and antagonist/agonist strength ratios. Twenty-one young males and females performed maximum isokinetic concentric knee extension-flexion and hip extension-flexion efforts at 60°·s-1, 120°·s-1, and 180°·s-1 from three positions: anterior, neutral, and posterior pelvic tilt. Peak torques and knee flexor-to-extensor and hip flexor-to-extensor torque ratios were analyzed. An analysis of variance showed that peak hip extensor torque was significantly greater in the anterior pelvic tilt condition compared to either neutral or posterior pelvic tilt angles (p > 0.05). No effects of changing pelvic tilt angle on hip flexor, knee flexor, or knee extension values were found (p > 0.05). The hip flexor-to-extensor torque ratio decreased (p < 0.05) in the anterior pelvic tilt position relative to the other positions, while no difference in the knee flexor-to-extensor ratio between pelvic positions was observed (p > 0.05). This study shows that an increased anterior pelvic tilt affects the maximum isokinetic strength of the hip extensors, supporting previous suggestions regarding the link between pelvic position and hip and knee muscle function. Isokinetic testing from an anterior pelvic tilt position may alter the evaluation of hip flexion/extension strength.

Relationship between sacral-abdominal wall distance, movement performance, and spinal alignment in osteoporosis: a retrospective study

BackgroundAging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to investigate the relationship between the sacral vertebra–abdominal wall distance (SAD) and movement performance using a simple lateral spine X-ray image for measuring the SAD.MethodsIn this retrospective study, we included women aged ≥ 65 years who were attending the outpatient clinic for osteoporosis at our hospital. A total of 287 patients (mean age ± SD, 76.8 ± 7.1 years) with measured SAD were included in the analysis. Patients were divided into two groups based on SAD cutoff (160 mm) and age (75 years), respectively. The patients were examined using the two-foot 20 cm rise test, 3 m Timed Up and Go (TUG) test, two-step test, open-eyed one-leg standing time, and spinal alignment. Normally distributed data are expressed as means (standard deviations) and non-normally distributed data as medians (interquartile range), depending on the results of the Kolmogorov–Smirnov test. Student’s t-test and χ2 test were used for between-group comparisons. Regression analysis was performed with SAD as the objective variable. A two-sided p < 0.05 was considered statistically significant.ResultsThe shorter SAD group performed better in the two-step test, TUG test, and open-eyed one-leg standing time (p < 0.001) as well as in the two-foot 20 cm rise test (p < 0.01) compared to the longer SAD group. Spinal alignment was better in the shorter SAD group than in the longer SAD group, with a shorter sagittal vertical axis (p < 0.001), smaller pelvic tilt (p < 0.001), and greater sacral slope (p < 0.05).ConclusionSAD was associated with posterior pelvic tilt and movement performance parameters. In addition to testing for osteoporosis, movement performance parameters should be evaluated in women with osteoporosis who are aged ≥ 65 and have greater SAD (≥ 160 mm in this study). The SAD is a new assessment method, and further research is required to verify its validity and reproducibility. This is the first attempt to determine how age and SAD affect movement performance in older adults.

Excessive posterior pelvic tilt from preoperative supine to postoperative standing after total hip arthroplasty.

Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT. Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA. Negative values indicate posterior PT. Patients with > 13° of posterior PT from preoperative supine to postoperative standing (ΔPT ≤ -13°) radiographs, which corresponds to approximately a 10° increase in functional anteversion of the acetabular component, were compared with patients with less change (ΔPT > -13°). Logistic regression analysis was used to assess preoperative demographic and spinopelvic parameters predictive of PT changes of ≤ -13°. The area under receiver operating characteristic curve (AUC) determined the diagnostic accuracy of the predictive factors. PT changed from a mean of 3.8° (SD 6.0°)) preoperatively to -3.5° (SD 6.9°) postoperatively, a mean change of -7.4 (SD 4.5°; p < 0.001). A total of 95 patients (10.2%) had ≤ -13° change in PT from preoperative supine to postoperative standing. The strongest predictive preoperative factors of large changes in PT (≤ -13°) from preoperative supine to postoperative standing were a large posterior change in PT from supine to standing, increased supine PT, and decreased standing PT (p < 0.001). Flexed-seated PT (p = 0.006) and female sex (p = 0.045) were weaker significant predictive factors. When including all predictive factors, the accuracy of the AUC prediction was 84.9%, with 83.5% sensitivity and 71.2% specificity. A total of 10% of patients had > 13° of posterior PT postoperatively compared with their supine pelvic position, resulting in an increased functional anteversion of > 10°. The strongest predictive factors of changes in postoperative PT were the preoperative supine-to-standing differences, the anterior supine PT, and the posterior standing PT. Surgeons who introduce the acetabular component with the patient supine using an anterior approach should be aware of the potentially large increase in functional anteversion occurring in these patients.

The Acute and Long-Term Effects of Olympic Karate Kata Training on Structural and Functional Changes in the Body Posture of Polish National Team Athletes.

The aim of this study was to assess the acute and long-term effects of karate kata training on body posture (range of motion (ROM)) and musculoskeletal pain in elite karate athletes. Twelve kata athletes from the Polish national team participated in the study. A cross-sectional study protocol was used, with direct participatory observation (NMQ-7/6 questionnaire, spinal curvatures and spinal ROM testing, ROM of joints) and natural experiment (225 min of kata training) methods of assessment. Age and number of weekly kata sessions were found to correlate with ROM of the lumbar spine (R = (-0.6), p < 0.05). High increase in the prevalence of lumbar hypolordosis and posterior pelvic tilt was noted after karate training sessions. ROM of the inclination in the sagittal plane differed significantly between the first and second trials, by 10.0 degrees on average. Kata stances and their movement pattern seem to be related to the occurrence of disturbances in the ROM of the internal and external rotations of the hip joints and decreased depth of the lumbar lordosis, pelvic tilt, and their ROM. The locations of the long-term musculoskeletal complaints (NMQ-6) seem to result from compensatory changes that occur in the musculoskeletal structures as a result of elite-level kata training.

Multivariate linear-mixed analysis of changes in anterior inferior iliac spine impingement incidence with posterior pelvic tilt: a computer simulation study.

It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.

Influence of Spinal Sagittal Alignment in Sitting Posture on the Swallowing Speed of Older Adult Women: A Cross-Sectional Study.

Thoracolumbar kyphosis in sitting posture is associated with forward head posture and may adversely affect swallowing function. However, few studies have investigated the effect of spinal alignment in the sitting posture on the swallowing function of older adults. This cross-sectional study aimed to investigate whether spinal alignment in the sitting posture influences the swallowing function of older adult women. Overall, 18 older adult women (mean age, 69.78 ± 3.66years) without dysphagia were enrolled. Participants were positioned in two sitting postures, namely, comfortable sitting (CS) and thoracic upright sitting (TUS). In each sitting posture, the kyphosis index (using a flexicurve), sagittal angles (head, cervical, shoulder, and pelvic angles; using a digital camera), and cervical range of motion (ROM) were evaluated. Swallowing speed (100-mL water swallowing test), maximum tongue pressure (MTP), and oral diadochokinesis (ODK) were also evaluated. Compared with TUS, CS showed a greater kyphosis index, anterior head translation, and posterior pelvic tilt. CS had greater flexion (p < 0.001) and less extension (p < 0.001) of cervical ROM than TUS. Swallowing speed was significantly decreased in CS compared with TUS (p = 0.008). MTP and ODK were not significantly different between CS and TUS. Thus, changes in sitting posture with spinal alignment may affect swallowing speed. Consequently, adjustments to reduce sitting postural kyphosis in older adult women may improve swallowing speed.

EFFECTIVENESS OF POSTERIOR PELVIC TILT EXERCISE ON STABLE AND UNSTABLE SURFACE IN PATIENTS WITH CHRONIC LOW BACK PAIN

Purpose: The objective of this study was to assess and evaluate the efficacy of posterior pelvic tilt exercises on pain reduction, functional disability, muscle strength, and lumbopelvic angle in patients with Chronic Low Back Pain (CLBP). These exercises were conducted on stable and unstable surfaces. Methods: This was a single-blinded randomized two-group pre-test and post-test experimental study. Men and women with CLBP, with an age between 18 and 50 years, were divided into two groups at random. Group A performed the exercises on a stable surface, and Group B performed the exercises on an unstable surface. The Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) for functional disability, Flexi Ruler for measuring lumbar lordosis angle, and Surface Electromyography (SEMG) for Transverse Abdominis (TA) and Rectus Abdominis (RA) muscles were used for pre- and post-treatment analysis. Results: Significant improvements in SEMG activity of TA and RA muscles were observed in both intervention groups following conventional exercises ([Formula: see text] &lt; 0.05). However, the unstable surface group had a higher increase in SEMG amplitude during Maximal Voluntary Isometric Contraction (MVIC) and the percentage of MVIC for the TA muscles. Conclusion: Posterior pelvic tilt exercises performed on stable and unstable surfaces effectively reduced pain, decreased the angle of lumbar lordosis, improved functional disability, and enhanced activity and strength of the pelvic muscles in patients with CLBP.