Spinal Mobility Research Articles

Sagittal Spinal Mobility and Back Extensor Muscle Function in Older Females with Age-Related Hyperkyphosis

Introduction: Spinal range of motion (ROM) is a potential and modifiable variable that may contribute to the maintenance of upright sagittal alignment. The present study aimed to compare spinal ROM in older females with and without hyperkyphosis and investigate associations between thoracic kyphosis and spinal ROM, back extensor strength (BES), and back extensor endurance (BEE).Materials and Methods: Sagittal spinal curvature and ROM were measured with the Spinal Mouse. Also, BES and BEE were assessed with a load cell. Variables were compared between older females with and without hyperkyphosis with the independent sample t test. We used the Pearson correlation coefficient to calculate associations between variables. Multiple linear regression was used to find which variable is best associated with kyphosis.Results: Lumbar and total spinal ROM were lower in the hyperkyphosis compared to the normal group (P<0.05). Thoracic kyphosis was associated with total lumbar ROM (r=-0.30, P=0.03), total spinal ROM (r=-0.35, P=0.01), BES (r=-0.73, P< 0.001), and BEE (r=-0.60, P< 0.001). Multiple linear regression analysis after adjusting for age, weight, and BMI showed that BES (P<0.001) and BEE (P=0.01) but not spinal ROM (P=0.16) were significantly associated with thoracic kyphosis.Conclusion: Females with hyperkyphosis had lower spinal ROM than those with normal kyphosis. While thoracic kyphosis was significantly associated with total lumbar ROM, total spinal ROM, BES, and BEE, multivariate regression showed that ROM was not a significant contributor to thoracic kyphosis. BES and BEE were significant contributors to thoracic kyphosis and should be targeted in the rehabilitation of hyperkyphosis.

Effect of Radial Shockwave Therapy on Spine Mobility

Background and Objective: low back pain has a huge impact on the patient's quality of life and imposes an economic burden on healthcare systems. New possibilities for low back pain treatment have opened up with the implementation of shockwave therapy. The aim of the study was to evaluate the effect of radial shockwave therapy on the lumbar spine mobility. Methods: a randomized controlled trial was conducted in 75 patients with chronic nonspecific low back pain complaints. Patients were randomized into two groups, depending on their treatment methods. Group I (n=36) received complex treatment with massage and exercise. Group II (n=39) received complex treatment with radial SWT, therapeutic exercise and massage. Flexion and lateroflexion of the lumbar spine were assessed during the study. Results: according to the data obtained, patients in both groups showed a positive trend by the end of the study in all measurements (p<0,05). Pairwise comparison of the results of groups I and II at each stage of the assessment revealed no statistically significant difference (p>0,05). Conclusion: shockwave therapy does not improve spine mobility in patients with chronic nonspecific low back pain. Keywords: low back pain, shockwave therapy, spine mobility

EFEKTIFITAS KINESIO TAPING UNTUK PENURUNAN NYERI PUNGGUNG BAWAH (STUDI KUASI EKSPERIMENTAL PADA PASIEN NYERI PUNGGUNG BAWAH)

Background: Low back pain results in decreased activity in daily activities. The tapping method is an active therapy that uses tension in the muscles to maintain a position to reduce pain and disability and increase spinal mobility. Taping is a rehabilitative technique used to facilitate the body's natural healing process while providing support and stabilization to muscles and joints without limiting the range of motion of the joints. Objective: To determine the effect of tapping and taping on reducing the degree of pain in low back pain. Methods: This research is a pre-experimental type with a one-group pretest-posttest approach. The data used are age and degree of pain. Results: From the study results, the average degree of pain before the intervention was 5.10, and the value after the taping intervention was 4.03. Wilcoxon test results showed the value of P = 0.008 (p < 0.05). And for the provision of tapping, the average degree of pain before was 4.93 and after 2.67 with p = 0.0001 (p <0.05). Conclusion: It is concluded that taping decreases the degree of pain in low back pain. Suggestion: The results of this study can be used as a reference for reducing the degree of pain in low back pain.

P262 The occurrence and characteristics of severe pain in patients with axial spondyloarthritis

Abstract Background/Aims Pharmacological management of axial spondylarthritis (axSpA) seeks to control inflammation. Even if successful, available evidence suggests that many patients continue to experience pain. The aim of the current study was to determine the prevalence and characteristics of severe pain among persons with axSpA. Methods The Scotland Registry for Ankylosing Spondylitis (SIRAS) collected clinical and patient-reported data from adults seen in secondary care in Scotland with a clinical diagnosis of ankylosing spondylitis. Questionnaires asked about severe pain (high pain intensity; high pain interference; and extreme/unbearable pain), lifestyle, and various aspects of health. The relationship between severe pain and clinical/patient-reported factors was assessed using logistic regression. Results 929 participants had pain data available (73% male; median symptom duration 20yrs). High pain intensity and pain interference were more common (57% and 42%) than extreme/unbearable pain (11%). Prevalence did not differ with age, although women were less likely to report severe pain than men (Odds Ratios (ORs) 0.56-0.61) as were those with longer duration of education, and those from more affluent areas. The odds of severe pain increased with every 1 unit increase in BASFI (ORs 1.44-1.56). Strong associations were also seen with disease activity, spinal mobility, fatigue, poor sleep, and worse quality of life. Conclusion In axSpA, severe pain is common, with a clear socio-economic gradient and major impact on quality of life. Rheumatologists need to be aware of the large unmet need in terms of pain management in this patient group with around 1 in 9 patients reporting extreme/unbearable pain. Disclosure G.T. Jones: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis funded by GlaxoSmithKline who were provided with a copy of the results prior to submission. O. Rotariu: None. L.E. Dean: None. A.G. MacDonald: None. G.J. Macfarlane: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis was funded by GlaxoSmithKline who were provided with a copy of the manuscript prior to submission.

Effects of patient and disease characteristics on global functioning in patients with axial spondyloarthritis in routine care

BackgroundThe ASAS Health Index (ASAS HI) was developed to assess global functioning in patients with axial spondyloarthritis (axSpA). Influencing factors have not been studied to date, especially the influence of inflammation and structural changes in the spine has remained unclear to date. ObjectiveTo find out whether and to what degree do axial inflammation, radiographic damage and other clinical features influence global functioning of patients with axSpA. MethodsPatient reported outcomes (ASAS HI, pain, BASDAI, BASFI, EQ-5D and SF-36) were assessed, spinal mobility by BASMI and depression by SF-36 scores. Axial inflammation was quantified using the MRI Berlin score and structural damage as detected by conventional radiographs by the modified Stokes AS Spinal Score (mSASSS). Correlation and regression analyses were performed to analyze the association between global functioning and other variables. ResultsA total of 191 axSpA patients with different degrees of global functioning and disease activity was included, 60.2% had r-axSpA. Syndesmophytes were found in 38.5% of patients - with a median mSASSS score of 3.8 (IQR 1.0-18.7) in r-axSpA and 0.0 (IQR 0.0-1.2) in nr-axSpA patients. The mean MRI score was 2.3 (IQR 0.5-7.6). ASAS HI values correlated significantly with BASMI, BASDAI, BASFI, BMI and MRI scores. However, no significant correlation was found for mSASSS and CRP. Regression analyses revealed that global functioning was significantly influenced by disease activity, physical function, obesity and depression but not by structural damage or spinal inflammation as detected MRI. ConclusionsOur study shows that global functioning is strongly associated with physical function, body weight and depression in patients with axSpA but not with spinal inflammation and structural damage. This may be explained by the relatively low mSASSS of these well treated patients.

Effects of experimentally induced cervical spine mobility alteration on the postural organisation of gait initiation

Gait initiation (GI), the transient period between quiet standing and locomotion, is a functional task classically used in the literature to investigate postural control. This study aimed to investigate the influence of an experimentally-induced alteration of cervical spine mobility (CSM) on GI postural organisation. Fifteen healthy young adults initiated gait on a force-plate in (1) two test conditions, where participants wore a neck orthosis that passively simulated low and high levels of CSM alteration; (2) one control condition, where participants wore no orthosis; and (3) one placebo condition, where participants wore a cervical bandage that did not limit CSM. Centre-of-pressure and centre-of-mass kinematics were computed based on force-plate recordings according to Newton’s second law. Main results showed that anticipatory postural adjustments amplitude (peak backward centre-of-pressure shift and forward centre-of-mass velocity at toe-off) and motor performance (step length and forward centre-of-mass velocity at foot-contact) were altered under the condition of high CSM restriction. These effects of CSM restriction may reflect the implementation of a more cautious strategy directed to attenuate head-in-space destabilisation and ease postural control. It follows that clinicians should be aware that the prescription of a rigid neck orthosis to posturo-deficient patients could exacerbate pre-existing GI deficits.

Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain

ABSTRACT Background Neck pain is a common manifestation of musculoskeletal disorders of the cervical and thoracic spine. Manual therapy interventions to the thoracic spine are recommended for treating patients with several types of neck pain. However, only a few studies have investigated the thoracic spine mobility associated with neck movement. Objectives Compare cervical and upper thoracic rotation angles in subjects with and without neck pain. Methods The subjects included nine individuals who experienced neck pain (pain, Group P) and 11 who did not (non-pain, Group N). The rotation angle was measured using MRI. The imaging limb position was at 90% of the maximum neck rotation. The MR images were analyzed using image analysis software to calculate the rotation angle of C1 to Th3. The rotation angle of the segment was then calculated by subtracting the rotation angle corresponding to the lower vertebra from that corresponding to the upper vertebra. The total rotation of each segment was calculated as the sum of the right and left rotation angle. Then, the segmental rotation angles were compared between groups. Results/findings The rotation angles of C3-C4, C7-Th1, and Th1-Th2 were significantly smaller in Group P than in Group N, and C5-C6 and C6-C7 were significantly larger in Group P than in Group N. There was no statistical difference in rotational angle at all other spinal levels measured. Conclusions The results of this study indicate subjects with neck pain had hypermobility of the lower cervical spine and hypomobility of the cervico-thoracic junction and upper thoracic spine compared with subjects without neck pain. These results add to current understanding of biomechanical factors that may be related to neck pain.

Three-Dimensional Modeling and In Silico Kinematic Evaluation of Interspinous Ligament Desmotomy in Horses.

Background: Interspinous ligament desmotomy (ISLD) has been shown to improve the comfort of horses diagnosed with overriding dorsal spinous processes (DSP), but its effects on spine mobility are unknown. Objective: To objectively quantify the change in mobility of thoracic vertebrae following ISLD using CT and medical modeling software. Study design: Prospective cadaveric manipulation of seven equine thoracolumbar spines collected from T11-L1. Methods: Spines were collected from T11-L1 with the musculature intact. Flexion and extension phases were achieved with a ratchet device calibrated to 2000N. Bone volume CT scans were performed in resting, flexion, and extension phase preoperatively. Interspinous ligament desmotomy was performed at each intervertebral space (n = 8), and bone volume CT imaging was repeated for each phase. The spinal sections were individually segmented and imported into medical software for kinematic evaluation. T11 of each phase were superimposed, the distance between each dorsal spinous process, the total length of the spine, and the maximal excursion of the first lumbar vertebra along with angular rotational information were recorded. Results: The mean distance between each dorsal spinous process increased by 5.6 ± 4.9 mm, representing a 24 ± 21% increase in mobility following ISLD. L1 dorsoventral excursion increased by 15.3 ± 11.9 mm, craniocaudal motion increased by 6.9 ± 6.5 mm representing a 47 ± 36.5% and 14.5 ± 13.7% increase, respectively. The rotation of L1 about the mediolateral axis increased by 6.5° post-ISLD. Conclusion and Clinical Relevance: ISLD increases dorsoventral, craniocaudal, and rotational motion of the equine spine. The computer modeling methodology used here could be used to evaluate multiplanar spinal kinematics between treatments.

3D orientation and kinematic characteristics of zygapophyseal joints while sitting.

BackgroundOrientation of the lumbar facet joints (FJs) in the transverse plane is associated with degenerative lumbar spine disease. However, there is a lack of measurements of the sagittal and coronal facet angles, and the effect of 3D facet angles on joint motion in the sitting position is unknown. The present study was to investigate the 3D orientation and in vivo motion characteristics of the FJ in the sitting position.MethodsDual fluoroscopic imaging system and computed tomography (CT) were used to determine the 3D orientation and kinematic characteristics of FJs. L3-S1 segments were studied in 10 asymptomatic participants (5 male and 5 female, age: 25–35 years, body mass index: 22.4±1.8). Angles of the facet in the sagittal, coronal, and axial planes, and the range of motion of the FJs in seated flexion and extension movements were measured.ResultsThe difference in sagittal facet angles between the 2 sides of the L3-S1 facet joints was not significant. The superior coronal facet angle on the left side of L5 was significantly smaller than that on the right side by 6.4° (P=0.01). The inferior transverse facet angle on the left side of L5 was greater than that on the right side by 7.1; the results were not statistically significantly different. In the sitting position, the range of motion of the left and right sides of L5-S1 differed significantly, with the right side being 5.5° (P=0.004) and 11.7° (P=0.026) greater than the left side in the sagittal and coronal planes, respectively. There was a correlation between mobility and the 3D orientation angle of the FJs in each segment.ConclusionsQuantification of the 3D orientation of the lumbar spine FJs provides new perspectives to study the kinematics of the lumbar spine and the etiology of lumbar degenerative diseases. In sitting flexion and extension movements, there is a significant difference in the left-right lateral mobility of the FJs of the L5-S1 segments. With the exception of the transverse facet angle of the lumbar spine FJs, the sagittal and coronal facet angles also have an effect on lumbar spine mobility.

Temporomandibular disorder in individuals with spinal cord injuries

Objective This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities. Design Cross-sectional. Setting International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil. Participants In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner. Methods using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index. Statistical analyses Student's t-test, chi-square, Fisher's exact and Shapiro–Wilk test were used. Results The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046). Conclusion The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

Physiotherapy for Anterior Knee Pain - A Narrative Review

Background: Anterior knee pain (AKP) is a common musculoskeletal complaint including pathologies like patellofemoral pain syndrome (PFPS), patellar or quadriceps tendinopathy and patellar instability. PFPS is the commonest of all, described as retro-patellar or anterior knee aching with diffuse pain most prominent when ascending or descending stairs, squatting, or sitting for prolonged periods with the knees flexed. It is a multifactorial condition with various treatment approaches being suggested. However, there is no clear physiotherapy protocol to be followed for the same. Objectives: This review aimed at finding recent advances in rehabilitation approaches (non-surgical and non-pharmaceutical) for patients with PFPS in last 5 years. Methods: 35 published articles were found from Google scholar, PubMed (NLM) and PEDrO databases and 19 studies were included in this reviewed. Conclusion: Five treatment protocols emerged from the reviewed articles: hip and knee muscle strengthening, core muscle strengthening, patellar taping, stretching and spinal mobilization. The current review suggested that a multimodal conservative management is more beneficial in these kind of patients. Keywords: Anterior knee pain, Physiotherapy, Patellofemoral pain.

Spinal mobility and muscle function in middle-aged patients treated for early onset idiopathic scoliosis: compared with untreated and treated adolescent onset patients

PurposeTo determine long-term outcome in terms of spinal range of motion (ROM) and trunk muscle endurance (TME) patients treated for idiopathic scoliosis, diagnosed before the age of ten, were evaluated and compared with untreated or treated patients with idiopathic scoliosis with adolescent onset (AIS).MethodsSixty-three braced and 53 operated patients underwent examination of spinal ROM and TME. Validated questionnaires were used for evaluation of back function.ResultsA total of 116 patients were examined 26.5 years after treatment. Braced EOS patients had longer bracing time and operated EOS patients had longer fusions compared to the respective AIS groups. Braced EOS patients had similar total ROM (thoracic ROM 40°, lumbar ROM 78°) and TME (trunk flexors 140 s, trunk extensors 255 s) as untreated AIS patients (thoracic ROM 34°, lumbar ROM 88°, trunk flexor endurance 158 s, trunk extensor endurance 234 s). Braced patients also had significantly better results than braced AIS patients. Operated EOS patients were slightly but significantly stronger and more mobile compared to AIS peers. The lumbar ROM was found to affect the back function in the operated EOS group (Oswestry Questionnaire, rs = 0.49, p < 0.001).ConclusionsThe braced EOS patients had mostly similar muscle strength and mobility as the untreated but younger AIS group, while the braced AIS group showed reductions of both strength and mobility. Similar significant, but small, differences were also found between operated EOS and AIS patients. Especially for muscle strength were findings at a level that would be of significant clinical importance.Levels of evidenceIII.

Effects of Classical Breathing Exercises on Posture, Spinal and Chest Mobility among Female University Students Compared to Currently Popular Training Programs.

Worldwide, university students’ physical health and posture are declining due to a sedentary lifestyle. The aim of our study was to evaluate the effectiveness of physiotherapeutic breathing exercises on posture and spinal mobility among healthy female university students compared to other training methods. Sixty-one female students of the University of Debrecen were assigned to breathing exercise (BE; n = 15), yoga (Y; n = 16), Pilates (P; n = 15) programmes and interval-training (IT; n = 15). Each training session lasted one hour, performed twice a week for 7 weeks. Students were assessed using standardized clinical tests. All programmes resulted in significant improvement in chest expansion. Results of Schober’s test showed substantial improvement using BE (p < 0.05), Y, P (p ≤ 0.01) programmes. Significant changes in occiput-to-wall distance (Y, P p ≤ 0.01) (BE p ≤ 0.001) were observed in three groups except the IT group. Fingertip-to-floor test (Y, P p < 0.05) results showed significant changes in two groups. The most outstanding effects on lateral flexion were achieved using BE (right, left p ≤ 0.001) programme. A comparison with results achieved using yoga and Pilates revealed that the physiotherapeutic breathing exercise programme is an equally effective method to significantly improve spinal mobility and correct postural problems in healthy young women.

Static and Dynamic Postural Characteristics in Patients with Chronic Obstructive Pulmonary Disease: The Relationship with Dyspnea and Pulmonary Functions

BackgroundThere is little evidence about posture influence and its relationship with pulmonary functions in chronic obstructive pulmonary diseases(COPD) patients. ObjectivesTo compare spinal curvature, mobility, and postural competency in participants with and without COPD and investigate the relationship of postural characteristics with dyspnea and pulmonary functions in COPD patients. MethodsWe included 47 COPD patients and 47 age and gender-matched controls in our cross-sectional study. Participants underwent the following evaluations: modified Medical Research Council Dyspnea Scale, respiratory function test, and postural measurements in the sagittal plane in a standing position using a non-invasive, computer-assisted electromechanical device. Postural variables were compared between groups, and the relationship between postural variables with dyspnea and pulmonary functions was analyzed by multivariate regression analysis. ResultsThoracic and lumbar curvature were higher (p<0.05), thoracic mobility and spinal inclination were lower (p=0.011, p=0.030, respectively) in patients with COPD. Thoracic angle and spinal inclination increased in COPD patients (p=0.040, p=0.011, respectively) while only spinal tilt increased in the control group (p=0.010) under spinal loading. Thoracic angle and mobility were related with dyspnea (r2=0.25, p<0.001), forced expiratory volume in the first second (r2=0.56, p<0.001), forced vital capacity (r2=0.41, p<0.001), and RV (r2 = 0.42, p<0.001). ConclusionCOPD patients had greater thoracic and lumbar angles in the static upright posture and lower thoracic mobility and spinal inclination in the sagittal plane. It was observed that patients increase their thoracic angles to maintain postural stability in dynamic conditions. Thoracic angle and mobility were related to dyspnea and pulmonary functions.

Harrington instrumentation in combination with Luque method versus Cotrel-Dubousset instrumentation for scoliosis correction

Results of surgical treatment of 60 patients with scoliosis are presented. In 36 patients Harrington instrumentation in combination with Luque method was used for deformity correction, in 24 patients Cotrel-Dubousset instrumentation was applied. In 8 patients with extremely severe rigid scoliosis the deformity correction was preceded by thoracotomy with multilevel diskectomy for spine mobilization. In frontal plane no differences was observed in obtained correction independent on the type of instrumentation. In horizontal and sagittal planes correction obtained i was more marked if Cotrel-Dubousset instrumentation was applied. In Harrington instrumentation follow up period was 1 year, in Cotrel-dubousset instrumentation follow up ranged from 3 months to 1 year. Scoliotic deformity correction by Cotrel-Dubousset instrumentation is showed to be preferable. However taking into account its high cost the use Harrington instrumentation in combination with Luque method may be recommended as alternative method only.

Long-Term Association Between Disease Activity and Disability in Early Axial Spondyloarthritis: Results From a Prospective Observational Study of Inflammatory Back Pain.

Our primary objective was to study the long-term association between disease activity and disability in axial spondyloarthritis (SpA). Our secondary objective was to define patient profiles according to their level of disability. We analyzed data collected during the first 5 years of follow-up of a large early axial SpA cohort, the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort. Multivariable models were built to study the association between the Health Assessment Questionnaire for Ankylosing Spondylitis (HAQ-AS) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the chi-square automatic interaction detector (CHAID) method, to help determine how variables best cluster to explain HAQ-AS. Data from 644 patients and 5,152 visits were analyzed. HAQ-AS was longitudinally, independently, and positively associated with ASDAS-CRP (adjusted B [adjB] 0.205 [95% confidence interval (95% CI) 0.187, 0.222]), the enthesitis score (adjB 0.011 [95% CI 0.008, 0.015]), the Bath Ankylosing Spondylitis Metrology Index (adjB 0.087 [95% CI 0.069, 0.105]), and female sex (adjB 0.172 [95% CI 0.120, 0.225]). The CHAID decision tree revealed ASDAS-CRP as the first variable with discriminative power on HAQ-AS. The cutoffs that separated different patient disability profiles were obtained. Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axial SpA. ASDAS-CRP cutoffs that separated different patient disability profiles largely mimicked the cutoffs previously defined for ASDAS-CRP disease activity states.

Segmental spine mobility differences between lumbar flexion- and extension-based movement syndromes in patients with low back pain

The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI. Forty participants with subacute-chronic LBP were placed into one of three age groups (< 35, 35-54, or > 54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs. Significant main effects were found for the independent variables of MSI subgroup and age. Participants in all three age groups with a flexion-based MSI displayed significantly less lumbar extension (-0.6∘) at L4-5 as compared to participants with an extension-based MSI (-2.1∘), p= 0.03. In addition, lumbar total and segmental ROM was significantly less for older individuals in both subgroups. Individuals with LBP may demonstrate a pattern of lumbar segmental hypomobility in the opposite direction of their MSI. Future studies may investigate the added value of direction-specific spinal mobilization to a program of MSI-based exercise.

The impact of conservative soft orthotic intervention with strapping on thoracic kyphotic posture and spinal mobility in children with cerebral palsy: a randomized control trial

BackgroundThis study mainly aimed to evaluate the influences of Thera Togs orthotic undergarment with its strapping system on dorsal kyphotic posture and spinal mobility in children with spastic diplegic cerebral palsy. The study also investigated the impact of the modulation of thoracic kyphosis on balance and risk of falls in these children.Study designThis study was a randomized control trial.ParticipantsForty children with diplegic cerebral palsy, aged from 8 to 10 years were met the inclusion criteria and participated in this study. Only 38 children completed the study.MethodsThe children in the control group received 2 h of conventional exercise protocol aiming for modulating thoracic kyphotic posture. The treatment program was conducted 3 times/week, for 12 successive weeks. Children in the study group wore TheraTogs orthoses with the strapping system for 8 h every day in combination with the conventional exercise program.Outcome measuresFor both groups, the primary outcome measures (thoracic kyphotic angle, and thoracic flexion and extension range of motion), and the secondary outcomes (the overall stability index of fall risk test, and the pediatric balance scale score) were recorded at baseline and after completion of the treatment. T test was used to compare the changes within-and between-groups in all measured variables, at baseline and immediately after 12 weeks of treatment.ResultsChildren in the study group showed significant improvements in the scores of all primary and secondary measures post-treatment compared to the control group (P < 0.05).ConclusionConservative treatment composed of TheraTogs orthotic system with conventional exercise treatment is effective in modulating thoracic kyphosis and improving dorsal range of motion in children with spastic diplegic cerebral palsy. This improvement has a positive influence on postural balance performance and reduces the risk of fall in these children.Trial registrationThe ClinicalTrial.gov PRS (NCT05063175). 30 September 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05063175

Pelvic incidence significance relative to spinopelvic risk factors for total hip arthroplasty instability.

Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the arthroplasty surgeon in assessing patient risk for total hip arthroplasty (THA) instability preoperatively is unclear. This study was undertaken to investigate the significance of PI relative to other spinopelvic parameter risk factors for instability to help guide its clinical application. Retrospective analysis was performed of a multicentre THA database of 9,414 patients with preoperative imaging (dynamic spinopelvic radiographs and pelvic CT scans). Several spinopelvic parameter measurements were made by engineers using advanced software including sacral slope (SS), standing anterior pelvic plane tilt (APPT), spinopelvic tilt (SPT), lumbar lordosis (LL), and PI. Lumbar flexion (LF) was determined by change in LL between standing and flexed-seated lateral radiographs. Abnormal pelvic mobility was defined as ∆SPT ≥ 20° between standing and flexed-forward positions. Sagittal spinal deformity (SSD) was defined as PI-LL mismatch > 10°. PI showed a positive correlation with parameters of SS, SPT, and LL (r-value range 0.468 to 0.661). Patients with a higher PI value showed higher degrees of standing LL, likely as a compensatory measure to maintain sagittal spine balance. There was a positive correlation between LL and LF such that patients with less standing LL had decreased LF (r = 0.49). Similarly, there was a positive correlation between increased SSD and decreased LF (r = 0.54). PI in isolation did not show any significant correlation with lumbar (r = 0.04) or pelvic mobility (r = 0.02). The majority of patients (range 89.4% to 94.2%) had normal lumbar and pelvic mobility regardless of the PI value. The PI value alone is not indicative of either spinal or pelvic mobility, and thus in isolation may not be a risk factor for THA instability. Patients with SSD had higher rates of spinopelvic stiffness, which may be the mechanism by which PI relates to THA instability risk, but further clinical studies are required. Cite this article: Bone Joint J2022;104-B(3):352-358.

Effects of Thoracic Spine Mobility Exercise on Symptom Improvement and Scapular Position in Patient with Subacromial Impingement Syndrome

Effects of Thoracic Spine Mobility Exercise on Symptom Improvement and Scapular Position in Patient with Subacromial Impingement Syndrome