Thoracolumbar Posture Research Articles

The effect of manually facilitated flexion of the thoracic spine on the interspinous space among horses with impinging dorsal spinous processes of the thoracic vertebrae

Impinging dorsal spinous processes (IDSP) are typically diagnosed and graded using radiography, during which the effect of the horses’ thoracolumbar posture on the interspinous spaces is not commonly considered. Posture can be altered from a spontaneous, relatively extended, or lordotic, position by manual facilitation of thoracic flexion (‘thoracic lift’). This study aimed to ascertain if the thoracic vertebral interspinous space distances were increased by using facilitated thoracic flexion to alter the posture in horses diagnosed with IDSP. Seven horses of mixed breed and sex, median age 9.1 years (interquartile range, 7.2–12.4 years), with a diagnosis of thoracic IDSP with no history of spinal surgery, were included in the study. Two sets of radiographs were obtained. The initial set was taken in the horses’ spontaneous posture and the second in the manually facilitated flexed posture. Each image was anonymised allowing blinded measurement of the interspinous spaces. Analysis was performed using Hodges-Lehmann median differences estimates. An increase in the median interspinous space distance was achieved after manual facilitation of thoracic flexion at every thoracic intervertebral space (5th-18th thoracic [T] vertebra). The greatest median increase was seen between T7-T8 and T12-T13 (3.1 mm and 3.0 mm, respectively) whereas the lowest median increase was seen between T17-T18 (0.7 mm). In this study, thoracic interspinous space distances could be increased by using manual facilitation to alter the thoracic posture in horses with IDSP, which could affect grading and decision making.

An investigation of 3D spinal alignment in cervicogenic headache

BackgroundThere is a growing interest in the impact of body posture influences on outcome measures of cervicogenic headache (CGH). ObjectiveTo evaluate differences in the 3D spinal alignment in cases suffering from chronic CGH compared to a group of strictly matched control participants without CGH. DesignA single-blinded, comparative cohort design. Methods100 participants suffering from frequent headaches for at least 3 months who fulfilled the CHISG criteria for CGH were match by age and sex to 100 asymptomatic control group participants. A 4D Formetric device was used to assess participants’ posture variables of: 1) thoracic kyphosis max (ICT-ITL in degrees); 2) trunk lateral imbalance (VP-DM in mm); 3) Trunk anterior inclination (VP-DM in mm); 4) lumbar lordotic angle (ITL-ILS max in degrees); 5) Vertebral rotation (rms) in degrees. A matched-pairs binary logistic regression was used to determine whether measurements of posture demonstrated an association with the likelihood of the presence of CGH. ResultsThere were statistically significant differences between the CGH and control group for all posture variables indicating larger posture displacements in the CGH group: ICT-ITL (p < .001), Lateral VP-DM (p < .001), Sagittal VP-DM (p < .001), ITL-ILS (p < .001), RMS (p < .001). Logistic regression revealed that as posture displacement increased, a statistically significant increased likelihood of having CGH occurred: (ICT-ITL (max) (p < .001); Trunk imbalance VP-DM (p < .004); Trunk inclination VP-DM (p < .001); and vertebral rotation (RMS) (p = .007). No such relationship was found for Lumbar Lordosis ITL-ILS max. ConclusionsParticipants with CGH exhibited increased magnitudes of thoracolumbar posture displacements which corresponded to an increased odds of suffering from CGH compared to matched control participants.

The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses.

Simple SummaryAltered spinal posture in a horse often relates to an underlying musculoskeletal condition that results in a negative effect on performance and welfare. Equine physiotherapy aims to adapt a horse’s posture by prescribing strengthening exercises to improve spinal range of movement and facilitate contraction of specific muscles. The aim of this study was to test the reliability of an outcome measure to objectively measure thoracolumbar posture before and after physiotherapy exercises over a specific time-period. The adapted flexicurve ruler (aFCR) had excellent intra-rater reliability compared to a standard flexicurve ruler. There were significant increases in thoracolumbar flexion after physiotherapy intervention at the specific time periods, of thirty minutes and one hour, however no significant changes at twenty-four hours. The physiotherapy intervention tested was shown to produce a short-term postural change, and over time may allow a long-term postural change with frequent practice. Outcome measures are valuable within veterinary physiotherapy to support clinical reasoning and the aFCR is shown to measure thoracolumbar posture pre and post-physiotherapy. Creating a postural change in horses can aid in a rehabilitation programme with veterinary physiotherapy, aiming to relieve pain and stiffness. Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.

Establishment of a novel rehabilitation program for patients with dropped head syndrome: Short and intensive rehabilitation (SHAiR) program

The pathophysiology of dropped head syndrome (DHS) remains unknown, and its treatment algorithm and indication are not standardized. Here, we established a novel rehabilitation program, short and intensive rehabilitation program for DHS (SHAiR program), consisting of cervical paraspinal muscles exercise, range of motion exercise, cervical and thoracic mobilization, deep cervical flexor muscle exercise, hip lift exercise, anterior pelvic tilt exercise, and walking exercise. The aim of this study was to evaluate the clinical effectiveness of this program. We reviewed clinical outcomes for five consecutive patients with DHS who underwent the SHAiR program (SHAiR group). The outcomes were compared with those of other five patients with DHS who received exercise instruction (control group). Demographic data, the duration from onset of DHS, the apex of sagittal kyphosis on the lateral radiographs, and clinical outcomes including the ability to maintain normal horizontal gaze, chin brow vertical angle, and numerical rating scale (NRS) were evaluated at the initial visit and final follow-up at 7.5 months. There was no significant difference between the two groups in terms of demographic and radiographic data. The ability of horizontal gaze and NRS of cervical pain improved rapidly for all five patients in the SHAiR group as compared to no improvement for all patients in the control group. Rehabilitation for DHS was considered effective not only for localized rehabilitation such as exercise for training cervical extensor muscle function but also exercises for thoracolumbar posture improvement and the psoas muscle.

Equine Posture Analysis: Development of a Simple Tool to Record Equine Thoracolumbar Posture

Musculoskeletal assessment of horses includes assessment of conformation, symmetry, and postural alignment of the equine spine; however, objective methods to analyse the spine have high costs and are logistically complex. This study aimed to assess the intrarater and interrater reliability of simple methods designed to objectively measure thoracolumbar (TL) posture from photographs. A sample of horses (n = 190) were photographed with a digital camera in two positions of stance, and also a static image was captured from video at the toe off phase of the right hind in walk. Measurements of TL angle, depth, and area of lordosis were tested for intrarater and interrater reliability. Repeated measures of TL angle showed no significant differences between measurements taken by one observer, but TL depth and surface area measures were not found to be consistently reliable. Interrater reliability was poor for all measurements across three observers. TL angle method of recording thoracolumbar posture in horses has the potential to be used to gain an objective measure of posture when standardized positioning is applied by a single experimenter or clinician.

The effect of a lumbar support pillow on lumbar posture and comfort during a prolonged seated task

BackgroundSeveral risk factors exist for the development of low back pain, including prolonged sitting and flexed spinal curvature. Several investigators have studied lumbar support devices and spinal curvatures in sitting, however few have investigated a pain population and reported a quantitative measure of comfort. The purpose of the current project was to determine whether a lumbar support pillow, outfitted with a cut-out to accommodate the bulk of posterior pelvic soft tissue volume, is more effective than a standard chair in promoting a neutral spinal posture and improving subjective and objective measures of comfort in healthy individuals and patients with low back pain.MethodsTwenty eight male participants with and without a history of low back pain sat in a standard office chair and in a chair with the lumbar support pillow for 30 minutes. Lumbar and thoracolumbar postures were measured through electromagnetic markers. Comfort was determined based on the least squares radius of centre of pressure shifting, measured at the buttock-chair interface as well as reported discomfort through visual analog scales. Chair support effects were assessed through ANOVA methods. The study was approved by the Canadian Memorial Chiropractic College research ethics board.ResultsThere was a main effect of condition on lumbar posture (p = 0.006) and thoracolumbar posture (p = 0.014). In the lumbar region, the support and standard chair differed by 2.88° (95% CI; 1.01-4.75), with the lumbar support being closer to neutral than the standard chair. In the thoracolumbar region, the support and standard chair differed by -2.42° (95% CI; -4.22 to -0.62), with the standard chair being closer to neutral than the support device. The centre of pressure measure was significantly improved with the pillow (p = 0.017), however there were no subjective changes in comfort.ConclusionsA lumbar support pillow with a cut-out for the posterior pelvic tissues improved an objective measure of comfort in healthy individuals and patients with low back pain. Lumbar flattening was decreased and thoracolumbar curvature was increased. However, angular changes were small and future work is required to determine clinical relevance over the long term.Trial registrationClinicalTrials.gov, NCT00754585

Classification of Sagittal Thoraco-Lumbo-Pelvic Alignment of the Adolescent Spine in Standing and Its Relationship to Low Back Pain

A prospective study of the sagittal standing posture of 766 adolescents. To determine whether posture subgroups based on photographic assessment are similar to those used clinically and to previous, radiographically determined subgroups of sagittal standing posture, and whether identified subgroups are associated with measures of spinal pain. Relatively little research has been performed toward a classification of subjects according to sagittal spinal alignment. Clinical descriptions of different standing posture classifications have been reported, and recently confirmed in a radiographic study. There is limited epidemiological data available to support the belief that specific standing postures are associated with back pain, despite plausible mechanisms. As posture assessment using radiographic methods are limited in large population studies, successful characterization of posture using 2-dimensional photographic images will enable epidemiological research of the association between posture types and spinal pain. METHODS.: Three angular measures of thoraco-lumbo-pelvic alignment were calculated from lateral standing photographs of subjects with retro-reflective markers placed on bony landmarks. Subgroups of sagittal thoracolumbar posture were determined by cluster analysis of these 3 angular measures. Back pain experience was assessed by questionnaire. The associations between posture subgroups and spinal pain variables were evaluated using logistic regression. Postural subtypes identified by cluster analysis closely corresponded to those subtypes identified previously by analysis of radiographic spinal images in adults and to those described clinically. Significant associations between posture subgroups and weight, height, body mass index, and gender were identified. Those adolescents classified as having non-neutral postures when compared with those classified as having a neutral posture demonstrated higher odds for all measures of back pain, with 7 of 15 analyses being statistically significant. Meaningful classifications exist for adolescent sagittal thoraco-lumbo-pelvic alignment, and these can be determined successfully from sagittal photographs. More neutral thoraco-lumbo-pelvic postures are associated with less back pain.

Measurement of thoracolumbar posture and mobility with a Myrin inclinometer.

Measurement of thoracolumbar posture and mobility with a Myrin inclinometer.