Spinal Mobility Research Articles

The Effect of Rigid Spinal Orthosis on the Muscular Capacity of Patients With Low Back Pain - A 3-Month Follow-up Study

ABSTRACT Introduction In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain. Materials and Methods This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale. Results The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05). Conclusions This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities. Clinical Relevance The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain.

Day II: Friday, March 24, 2023; 11.15 am Plumeria 1 (Exhibition Hall): Innovation Hub Display time: 9.00 am to 5.00 pm: AB No: 7 Designing and testing of RK spinal mobilization device to improve spinal joint range of motion (JROM)

Day II: Friday, March 24, 2023; 11.15 am Plumeria 1 (Exhibition Hall): Innovation Hub Display time: 9.00 am to 5.00 pm: AB No: 7 Designing and testing of RK spinal mobilization device to improve spinal joint range of motion (JROM)

Day II: Friday, March 24, 2023; 11.15 am Plumeria 1 (Exhibition Hall): Innovation Hub Display time: 9.00 am to 5.00 pm: AB No: 7 Designing and testing of RK spinal mobilization device to improve spinal joint range of motion (JROM)

Day II: Friday, March 24, 2023; 11.15 am Plumeria 1 (Exhibition Hall): Innovation Hub Display time: 9.00 am to 5.00 pm: AB No: 7 Designing and testing of RK spinal mobilization device to improve spinal joint range of motion (JROM)

Arthroscopic Peripheral Compartment Iliopsoas Release for Iliopsoas Impingement After Primary Total Hip Arthroplasty

Anterior iliopsoas (IP) impingement after total hip arthroplasty is an underrecognized and continued cause for postoperative pain. There are multiple etiologies for this impingement from cup positioning and sizing to changes in the leg length, and offset must be evaluated to confirm no need for implant revision. Additionally, tension of the IP tendon can be increased in patients with diminished spinal mobility, either from prior fusion or with increasing age. Managing this surgically after failing conservative treatment options is best done arthroscopically to prevent additional large, open procedures that place the arthroplasty at unnecessary risk of infection and potential instability. In this article, we describe an arthroscopic technique using fluoroscopy to guide the release of the iliopsoas tendon from the peripheral compartment.

Comparative Evaluation of Effectiveness of Pelvic Floor Strengthening and Myokinetic Active Release of Trigger Points in Reducing Dysmenorrhea

Background and Aim Dysmenorrhea is a dull abdominal pain that may radiate to lower back and thigh beginning approximately two days before menstruation. Pelvic floor strengthening is favorable in reducing dysmenorrhea. Alteration in muscle function due to hormonal imbalance can also cause dysmenorrhea. Lower rectus abdominis trigger points TrPs deactivation relieves dysmenorrhea. Restoring correct spine mobility by deactivating quadratus lumborum trigger points may improve dysmenorrhea. Gluteus medius commonly develops satellite triggers in response to active quadratus lumborum triggers. Myokinetic active release technique can be effectively used to treat TrPs. This study aimed to find if myokinetic active release of TrPs of rectus abdominis gluteus medius and quadratus lumborum is better than pelvic floor muscle strengthening in reducing dysmenorrhea.Methods This experimental trial was done in research lab of Department of Physiotherapy SBSPGI Dehradun. This experimental study comprised of 40 subjects randomly divided into two groups namely Group 1 and Group 2. Each group consisted of 20 subjects. Subjects in Group 1 were prescribed pelvic floor muscle strengthening and those in Group 2 were prescribed myokinetic active release of triggers points. Pre-and post-treatment visual analogue scale VAS scores were recorded and analyzed. Paired t test was used for within the group and unpaired t test was used for between the group comparisons.Results The results showed both the treatment protocols to be significantly effective p lt0.0001 but on comparison of data between the groups Group 2 was found to be better.Conclusion Both the techniques were found to be effective in treating dysmenorrhea however myokinetic active release was observed to be superior.

Effects of Thoracic Spine Self-mobilization on Patients with Low Back Pain and Lumbar Hypermobility: A Randomized Controlled Trial.

This study used magnetic resonance imaging (MRI) to investigate the effects of thoracic spine self-mobilization on patients with low back pain (LBP) and lumbar hypermobility. Twenty-four patients (15 men, 9 women) with LBP were randomly allocated to a thoracic spine self-mobilization group or sham group. The thoracic spine self-mobilization group performed thoracic spine active flexion and extension activities using two tennis balls fixed with athletic tape. Outcome measures were collected pre-intervention and after 4 weeks and included the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index, lumbar rotation angle measured using MRI taken in the lateral position with 45° of trunk rotation, thoracolumbar rotation range of motion (ROM) in the sitting position, and stiffness of the erector spinae muscles. The effects of the intervention were analyzed using two-way repeated-measures analysis of variance (ANOVA), followed by multiple comparisons. The significance level was set at 5%. The results of the two-way repeated measures ANOVA indicated that the main effect of the group was significant (P<0.05) for VAS, the sum of the lumbar rotation angle, and the thoracolumbar rotation ROM. A significant group-by-time interaction was found for the sum of lumbar rotation angles. The results of the multiple comparison tests for VAS, sum of the lumbar rotation angle from L1 to S1, and thoracolumbar rotation ROM were significantly different after 4 weeks. This study revealed a decrease in lumbar segmentation after thoracic spine mobilization. Thoracic spine mobilization may be effective in patients with LBP and hypermobility.

Effectiveness of Thoracic Manipulation and Cervicothoracic Mobilisation in Decreasing Pain and Increasing Rom in Nonspecific Neck Pain

BACKGROUND: Hypomobility of the cervicothoracic (CT) junction has been suggested neck discomfort as one of its causes.There are, however, few trials that have contrasted the impact of CT junction mobilisation against a successful neck pain intervention. The treatment of distant spinal segments using thoracic spine manipulation is non-specific and is founded on the notion of interregional reliance.Recent studies have examined the usefulness of segment-specific spinal mobilisation in the cervical spine, although no firm findings could be drawn from earlier research. The aforementioned factors call for research into the effectiveness of a particular CT junction mobilisation vs a general thoracic manipulation intervention in neck discomfort. MATERIAL AND METHODS: Participants in a randomised clinical trial with mechanical neck soreness and Cervicothoracic junction dysfunction were randomly assigned to the mid-thoracic (T3-T6) manipulation group or the C7-T1 stage Maitland mobilisation group. The results of the cervical flexion, extension, facet flexion, and rotation degrees of movement (ROM) before and after the intervention have been measured the use of a cervical range of motion (CROM) device. The severity of self-stated ache become measured using the numerical pain score scale (NPRS). After the intervention, a one-way ANCOVA was used to evaluate the outcomes. RESULTS: For the study, 48 individuals have been enrolled, with a median age of 36.Forty eight±12.Forty eight for the thoracic manipulation organization and 34.25± 12.24 for the CT junction organization. After treatment, there were no discernible differences in cervical variety of movement (ROM) or self-said ache depth among thegroups (p-value = 0.07, 0.96, 003, 0.Forty, 0.30, 0.31 for flexion, extension, bilateralside bending, and rotation, respectively), nor in neck pain depth (p = 0.67). The cervical ROM and pain, however, extensively stepped forward in both businesses whilst in comparison within-institution, pre- and post. CONCLUSION: This preliminary investigation showed that thoracic manipulation had the same effects on the outcomes of cervical range of motion and neck discomfort as level-specific Cervicothoracic mobilisation in patients with non-specific neck pain when it was compared to remote mid-thoracic manipulation. KEYWORDS: Cervicothoracic Mobilization, Thoracic manipulation, Non-specific neck pain, ROM, mechanical neck pain

Influence of motion therapy on daily life activities of people with lumbar pain syndrome

Introduction: Lumbar pain syndrome (LPS) is defined as pain or discomfort localized between the edge of the twelfth rib and the lower gluteal region, with or without spread to the lower extremities, and, depending on the etiology and degree of symptomatology, can have negative consequences and be one of the main reasons for work disability and absenteeism worldwide. The aim of this study was to determine the impact of exercise therapy on the activities of daily living of a person with LPS. Methods: This prospective, longitudinal, and randomized controlled trial was conducted from June 2014 to June 2016. It included 200 subjects with symptoms of LPS, both sexes, aged 30 to 50 years, sedentary and standing occupations, randomized and equally divided into two groups: Examined (n = 100) and the control group (n = 100). In this study, the Oswestry Low Back Pain Disability Questionnaire was used after clinical examination. Results: The percentage of disability according to the Oswestry disability index at the first examination was 31.78 ± 14.11% in the participants of the test group and 38.74 ± 17.48% in the participants of the control group (p = 0.002). After the second examination, the percentage of disability was 6.64 ± 3.15% in the test group and 23.92 ± 14.84% in the control group (p = 0.001). At the end of the examination, the percentage of disability was 2.36 ± 0.78% in the subjects of the test group and 13.82 ± 11.25% in the subjects of the control group (p = 0.001). A statistically significant difference was found in all three examinations, and the reduction in the percentage of disability was greater in the study group, p &lt; 0.05. Conclusion: The research conducted showed that motion therapy procedures focused on achieving natural spinal mobility and improving trunk muscle strength are effective in reducing

Spinal manipulation and mobilisation in the treatment of infants, children, and adolescents: a systematic scoping review

PurposeTo i) identify and map the available evidence regarding effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions; ii) identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.DesignSystematic scoping review, utilising four electronic databases (PubMed, Embase, CINHAL and Cochrane) and grey literature from root to 4th February 2021.ParticipantsInfants, children and adolescents (birth to < 18 years) with any childhood disorder/condition.InterventionSpinal manipulation and mobilisationOutcome measuresOutcomes relating to common childhood conditions were explored.MethodTwo reviewers (A.P., L.L.) independently screened and selected studies, extracted key findings and assessed methodological quality of included papers using Joanna Briggs Institute Checklist for Systematic Reviews and Research Synthesis, Joanna Briggs Institute Critical Appraisal Checklist for Text and Opinion Papers, Mixed Methods Appraisal Tool and International Centre for Allied Health Evidence Guideline Quality Checklist. A descriptive synthesis of reported findings was undertaken using a levels of evidence approach.ResultsEighty-seven articles were included. Methodological quality of articles varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with adolescent idiopathic scoliosis (AIS), asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), back/neck pain, breastfeeding difficulties, cerebral palsy (CP), dysfunctional voiding, excessive crying, headaches, infantile colic, kinetic imbalances due to suboccipital strain (KISS), nocturnal enuresis, otitis media, torticollis and plagiocephaly. The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower quality studies. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing asthma (pulmonary function), headache and nocturnal enuresis, and inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.ConclusionWhilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

Improvement of cervical spine mobility and stance stability by wearing a custom-made mandibular splint in male recreational athletes.

The range of motion (ROM) of the cervical spine and postural stability are important for an economical and motorically adequate adaptation of the body to any situation. Therefore, this study aims to analyze whether these two components of postural and movement control can be influenced by means of a splint in a centric position compared to habitual occlusion. 38 recreational male athletes volunteered. Cervical spine ROM was recorded using an ultrasound system and the a pressure measuring plate for postural stability (length of center of pressure (CoP) movement, area of CoP). The two dental occlusion conditions employed were the habitual occlusion and wearing a splint in an idealized, condylar position close to the centric position. Level of significance was set at ρ ≤ 0.05. The cervical spine mobility increased significantly by wearing the splint regarding rotation to the left (+3.9%) and right (+2.7%) and lateral flexion to the left (+4.4%) and right (+6.7%). Wearing the splint reduced the area of sway deflections by about 31.5% in the bipedal stance and by about 2.4% (left) and 28.2% (right) in the unipedal stance. The CoP trace was reduced in the sagittal plane by approximately 8.2% in the right single-leg stance. The major findings seem to demonstrate that wearing a splint that keeps the jaw close to the centric relation may increase the cervical ROM and may improve balance stability in male recreational athletes. Changing the jaw relation in athletes can possibly aid the release of performance potentials by improving coordination skills.

Effects of esters’ cetylated fatty acids taping for chronic neck pain with mobility deficit in patients with breast cancer

PurposeTo evaluate the effects of a protocol treatment based on inelastic adhesive tape with cetylated fatty acids (CFAs) esters in breast cancer survivors with chronic neck pain.MethodsIn this observational study, patients have been visited for chronic neck pain using numeric rating scale (NRS) for pain assessment, Neck Disability Index (NDI) for disability caused by neck pain, and range of movement (ROM) measures for cervical mobility. Scales have been performed at T0, after 15 days of treatment (T1) and successively after 15 days of stop treatment (T2). Patients have been treated with an inelastic adhesive tape with CFA esters (Cetilar® Tape, Pharmanutra Spa, Italy) positioned, 8 h/day for 15 days, on specific anatomic sites (upper trapezius, paravertebral cervical muscles, sub-occipitals, and/or levator scapulae muscles).ResultsForty-five patients were included in the study. A statistically significant reduction in pain has been reported from T0 to T1 and maintained at T2 (p < 0.05); a statistically significant improvement in the mobility of the cervical spine, as evidenced by ROMs, and in disability, as resulted by Neck Disability Index, have been reported from T0 to T1 and maintained at T2; moreover, ROM at T0 correlates inversely and statistically significantly with NRS and all NDI variables at T0, similarly at T1 and T2 (p < 0.001).ConclusionsCFA ester taping is a simple, effective, and side-effect-free treatment in order to reduce pain and improve cervical mobility in breast cancer survivors with chronic neck pain.

The Influence of Selected Soft-Tissue and Telerehabilitation Techniques on Headaches in Young Adults During the COVID-19 Pandemic

Introduction: Headaches are a very common pain syndrome. The International Headache Society distinguishes primary pains, which include, among others, migraines and tension headaches, and secondary pain. Manual techniques, including soft tissue methods, are mentioned in the literature as an effective form of pain relief, but it is ambiguous whether manual therapy is a more effective form of headache therapy than exercises improving the flexibility of soft tissues in the neck area and cervical mobility. Objective: The aim of the study was to investigate the influence of selected techniques regarding working with soft tissues on headache symptoms. Material and methods: The study included 29 people with headaches, who were randomly divided into 2 groups. The study group, subjected to soft tissue techniques, comprised 15 people (13 women and 2 men), average age was 27.73 ± 5.06 years, body height, on average, 1.70 ± 0.08 cm, body mass, on average, 64.80 ± 12.31 kg. The control group, subjected to telerehabilitation, included 14 individuals (12 women and 2 men), average age was 28.36 ± 4.88, body height, on average, 1.68 ± 0.09 m, body mass, on average, 64.93 ± 12.78 kg. Participants were enrolled in the study after completing the questionnaire in which they reported currently experiencing headaches. The HIT-6 (headache impact test) and HDI (head disability index) screening tests were used to assess pain, and the results before and after the 3-week therapy were compared. In the study group, soft tissue therapy was performed in 3 sessions, for 30 minutes, 1 week apart. The control group was assigned self-therapy through teleconsultation in the form of exercises, at least 4 times a week, once a day, for 30 minutes, aimed at improving mobility of the cervical spine and elasticity of soft tissues. Results: In the study group, on the HIT-6 scale, the effect of pain on functioning prior to therapy was, on average, 61.87 ± 5.64, while at the end of therapy, a statistically significant decrease was observed – to an average of 48.60 ± 5.22 (p&lt;0.001). In the control group, on the HIT-6, the effect of pain on functioning was, on average, 59.00 ± 4.10, while at the end of the therapy, a significant decrease to the mean value was observed: 53.50 ± 6.04 (p&lt;0.01). For HDI, disability in the study group was at an average of 43.20 ± 19.78 before the therapy and 25.33 ± 14.32 (p&lt;0.01) following the therapy. In the control group, disability before and after the therapy was 31.43 ± 17.62 and 26.57 ± 13.73, respectively (p&lt;0.01). There were no statistically significant differences in the HDI results – 25.33 ± 14.32 for the study group and 26.57 ± 13.73 for the control group (p&gt;0.05) after treatment. Conclusions: Soft tissue therapy and telerehabilitation caused a significant reduction in the impact of headaches on daily functioning and disability. In the era of epidemics, telerehabilitation may be an effective treatment for headaches in young adults.

Sagittal spinal alignment and mobility and their relation to physical function in women with and without mild-to-moderate knee osteoarthritis

Recent studies suggest that patients with lower extremity osteoarthritis may have altered spinal posture. We aimed to investigate age and body mass index-adjusted sagittal spinal alignment and mobility and their relation to physical function in women over 40 years of age with and without mild-to-moderate knee osteoarthritis (KOA). Thirty-two women with unilateral mild-to-moderate KOA and thirty-two asymptomatic women were included. A skin-surface device was used to assess sagittal alignment and mobility of the thoracic, lumbar, and sacral regions and trunk inclination angle. Physical function was assessed using the Timed Up and Go test. Analysis of covariance was used to compare groups and correlation coefficients were calculated separately for two groups. Women with KOA had higher thoracic kyphosis and lumbar lordosis compared to asymptomatic women (p < 0.05). The mean differences were 6.60 (%95 Confidence Interval 1.38;11.82) and −5.63 (−10.06;−1.20) for thoracic kyphosis and lumbar lordosis, respectively. Physical function score was moderately correlated with trunk inclination angle and lumbar, sacral, and trunk inclination mobility in asymptomatic women (r = 0.400, −0.504, −0.602, and −0.681, p < 0.05), but a significant correlation was not found in women with KOA (p > 0.05). In conclusion, women with KOA had altered spinal alignment. Spinal alignment and mobility were related to physical function in asymptomatic women over 40 years of age. Addressing sagittal spinal alignment in the clinical management of KOA may provide valuable data, especially for preventing possible spinal disorders.

The Influence of Early Rehabilitation on Changes in the Range of Spinal and Thoracic Mobility in Patients after Thoracotomy Due to Lung Cancer Depending on Used Anaesthesia

Introduction: To the best of our knowledge, no reports are available on the relationship between the technique of anaesthesia and the effects of rehabilitation. Objective: The aim of the study is to assess the effectiveness of early rehabilitation on changes in range of spinal and thoracic mobility with different pain control after thoracotomy due to lung cancer. Material and methods: The study involved 100 patients following lung lobe resection by open anterolateral thoracotomy. After the operation, participants were assigned to 2 groups depending on the use of additional anaesthesia. All participants received standardised post-operative physiotherapy. The range of mobility of the spine and chest, the verbal rating scale (VRS) and visual analogue scale (VAS) were measured before and on the 1st, 3rd and 7th day after surgery. Results: In the study, an increase was shown in measurements for patients from both groups undergoing the rehabilitation programme after surgery. Mobility was highly significant in the study group. However, the mobility of the chest decreased in both groups, and in subsequent measurements following physiotherapy, its range improved, although it did not reach the baseline level even on the 7th day after the procedure. Consequently, 1 week after surgery, the decrease in spinal mobility among the group with standard anaesthesia was 1.3 cm greater than in the group with additional anaesthesia (-1.5 vs. -0.2 cm). Pain changes were greater in the control group. Conclusions: 1. It may be concluded that the mobility of the thoracic spine after the procedure in decreased both groups, to later significantly improve for subsequent measurements in favour of patients with additional analgesia. 2. Respiratory mechanics of the chest and the level of pain, both measured by the VRS and VAS, systematically decreased in subsequent measurements after surgery among both groups, however, greater respiratory mobility was noted in the group of patients with additional analgesia. 3. It was demonstrated that the patients from the study group achieved optimal measurement values in relation to the control group, which were measured several times after the procedure, demonstrating a shorter and effective post-operative rehabilitation process.

Evaluation of Movement Restriction of Spinal Orthoses Using Inertial Measurement Units.

Despite the frequent use of orthopedic braces or spine stabilizers in diseases such as kyphosis, lordosis, and scoliosis, as well as in the case of injuries and rehabilitation after surgeries, there is no clear evidence of their proper stabilization of the spine while carrying out daily activities. This study sought to assess the spine's mobility while wearing three different orthopedic braces while performing basic tasks. Ten healthy subjects were enrolled. Three Inertial Measurement Units (IMUs) were attached superficially along the spine at approximate levels: cervical (C7), between thoracic (T8) and lumbar (L3), and sacrum. The angle between sensors was monitored to provide data on the sagittal profile. In addition, the displacement of the spine's longitudinal axis was measured (rotation). There are three types of orthopedic braces: the semi-rigid Hohmann corset, the Jewett brace, and the Thoracolumbar Fixed Spinal Orthosis (TLSO). Four tasks were monitored: standing, sitting, walking, and picking up an item from the floor with one hand. All braces provided a similar level of stability in both the sagittal plane and rotational axis while lifting an object. On the other hand, while walking and sitting, the TLSO was the only orthosis providing a statistically significant rigidity in the sagittal plane. When performing a more voluntary task, the measured rigidity of softer braces was significantly increased when compared with more involuntary tasks. A certain degree of motion restriction with spinal orthoses may come from the feedback pressure, which stimulates paraspinal muscles to contract and thus increases the overall rigidity of the trunk.

A perspective on the use of the cervical flexion rotation test in the physical therapy management of cervicogenic headaches

BackgroundThe Cervical Flexion-Rotation Test (CFRT) is widely used in the assessment of upper cervical spine mobility impairments and in the diagnosis of cervicogenic headache (CGH) by physiotherapist. Many studies investigated its different properties, and the results show that the CFRT has good construct validity in the measurement of C1-C2 rotation as well as good to excellent reliability.PurposeIn this theoretical paper, we explore the value and point out two methodological issues associated to the CFRT, one related to the procedures and another related to its diagnostic accuracy.ResultsOur analysis indicate that there are many confounding factors that could affect the CFRT cut-off’s accuracy, which are likely to overestimate the diagnosis properties of CFRT. Potential solutions are discussed. Moreover, the gold standard (manual examination) used to examine the validity of the CFRT for the diagnosis of CGH appears to be far from perfect - we could argue that the diagnostic properties of the CFRT for CGH might be biased and the likelihood ratios are likely to be overestimated. However, it could be relevant to explore if results of the CFRT could be considered as a treatment-effect modifier. Maybe the CFRT could be more valuable as a prognostic factor?ConclusionThe quality of evidence supporting the validity of the CFRT is most likely biased. In the absence of a better gold standard, maybe the CFRT could be a more valuable test to establish the patient’s prognosis and help the clinician to choose the most appropriate treatment options.

Skin Displacement as fascia tissue manipulation at the lower back affects instantaneously the flexion-and extension spine, pelvis, and hip range of motion.

Low back pain (LBP), associated with spine, pelvis, and hip mobility impairments can be caused by tight muscle contractions, to protect sensitized lumbar fasciae. Fascia tissue manipulations are used to treat lumbar fascia in LBP. The effect of fascia tissue manipulations through lumbodorsal skin displacement (SKD) on mobility is inconclusive likely depending on the location and displacement direction of the manipulation. This study aimed to assess whether lumbodorsal SKD affects the flexion -and extension range of motion (ROM), in healthy subjects. Furthermore, we aimed to test the effect of SKD at different locations and directions. Finally, to assess intertester and intratester reliability of SKD. Effects of SKD were tested in a motion capture, single-blinded, longitudinal, experimental study. Sixty-three subjects were randomly assigned to SKD- or sham group. SKD group was subjected to either mediolateral directed SKD during flexion or extension movement, versus a sham. The thoracic, lumbar, and hip angles and finger floor distance were measured to assess the change in ROM. Statistics indicated that the effect size in instantaneously change of flexion -and extension ROM by SKD was large (Effect size: flexion η2 p = 0.12-0.90; extension η2 p = 0.29-0.42). No significant effect was present in the sham condition. Flexion ROM decreased whereas the extension ROM increased, depending on SKD location- and displacement direction (p < 0.05). The ICC indicates a good intertester and intratester reliability (resp. ICC3,k = 0.81-0.93; ICC3,1 = 0.70-0.84). Lumbodorsal SKD affects the flexion- and extension spine, pelvis, and hip range of motion. The effects of SKD are direction- and location dependent as well as movement (flexion/extension) specific. Lumbodorsal SKD during flexion and extension may be useful to determine whether or not a patient would benefit from fascia tissue manipulations. Further research is required to obtain insight into the mechanisms via which the SKD affects ROM and muscle activation, in healthy, asymptomatic-LBP, and LBP subjects.

Individual Regression Modeling of Spinal Mobility Measurements in Long-Term Ankylosing Spondylitis: In-Depth Analyses With Comparison to Norm Data.

Normal age-related decline and temporary restrictions in mobility complicate the understanding of spinal mobility deterioration over time in patients with ankylosing spondylitis (AS). In this study, we aimed to determine whether spinal mobility deterioration occurred linearly in patients with AS. We also aimed to compare patterns of change with corresponding age-related normal values and analyze variations in temporary fluctuations in mobility measurements over time. We included 111 men and 30 women (median age 20.9 years at symptom onset), who were followed for a median of 34 years since symptom onset. This inclusion resulted in 9,697 spinal mobility measurements for analysis. Individual linear regression models for development of lateral spinal flexion (LSF), the 10-cm Schober test (ST10), chest expansion (CE), and cervical rotation (CR) were analyzed and compared with normal age-related decline over time. The median values for the constants of all measurements were significantly lower than the norm data. However, LSF, ST10, and CE followed a yearly linear decline comparable to the norm data, whereas CR declined approximately twice as fast as expected from the norm data (beta median -0.62° [25th-75th percentile -1.16, -0.22] and -0.35° [25th-75th percentile -0.35, -0.35], respectively). Temporary fluctuations in LSF and CE were significantly higher during the early phase of the disease, with decreasing residuals over time. Based on median constants of our data, mobility restrictions related to AS seem to mainly occur during the first years of disease, indicating a narrow window of opportunity for prevention.

3D Surface Topographic Optical Scans Yield Highly Reliable Global Spine Range of Motion Measurements in Scoliotic and Non-Scoliotic Adolescents.

Adolescent idiopathic scoliosis results in three dimensional changes to a patient's body, which may change a patient's range of motion. Surface topography is an emerging technology to evaluate three dimensional parameters in patients with scoliosis. The goal of this paper is to introduce novel and reliable surface topographic measurements for the assessment of global coronal and sagittal range of motion of the spine in adolescents, and to determine if these measurements can distinguish between adolescents with lumbar scoliosis and those without scoliosis. This study is a retrospective cohort study of a prospectively collected registry. Using a surface topographic scanner, a finger to floor and lateral bending scans were performed on each subject. Inter- and intra-rater reliabilities were assessed for each measurement. ANOVA analysis was used to test comparative hypotheses. Inter-rater reliability for lateral bending fingertip asymmetry (LBFA) and lateral bending acromia asymmetry (LBAA) displayed poor reliability, while the coronal angle asymmetry (CAA), coronal angle range of motion (CAR), forward bending finger to floor (FBFF), forward bending acromia to floor (FBAF), sagittal angle (SA), and sagittal angle normalized (SAN) demonstrated good to excellent reliability. There was a significant difference between controls and lumbar scoliosis patients for LBFA, LBAA, CAA and FBAF (p-values &lt; 0.01). Surface topography yields a reliable and rapid process for measuring global spine range of motion in the coronal and sagittal planes. Using these tools, there was a significant difference in measurements between patients with lumbar scoliosis and controls. In the future, we hope to be able to assess and predict perioperative spinal mobility changes.

Clinical impact of short limited lumbar fusion for adult spinal deformity with postural and radiological abnormalities

Extensive surgical spinopelvic fusion for patients with adult spinal deformity (ASD) to achieve optimal radiological parameters should be avoided. The aim of this study was to review clinical and imaging findings in patients with ASD with postural and radiological abnormalities who underwent a novel three-level limited lumbar fusion as two-stage surgery in an attempt to propose a better tolerated alternative to spinopelvic long fusion to the pelvis. The subjects were 26 patients with a minimum follow-up period of 2 years. Cobb angle, C7 sagittal vertical axis, and pelvic incidence (PI) minus lumbar lordosis (LL) were significantly improved after surgery and maintained at follow-up. Most radiological parameters were corrected with lateral interbody fusion (LIF) as the initial surgery, and few with posterior fusion. PI-LL remained high after limited lumbar fusion, but scores on patient-based questionnaires and sagittal and coronal tilt in gait analysis improved. In cases with postoperative progression of proximal junctional kyphosis (11.5%), residual L1–L2 local kyphosis after LIF was the most significant radiological feature. In some cases of ASD with postural abnormalities, short limited lumbar fusion gives sufficient postoperative clinical improvement with preservation of spinal mobility and activities of daily living. The range of fixation should be determined based on radiological parameters after LIF to avoid postoperative complications.