Trunk Alignment Research Articles

A possible mechanism of horseback riding on dynamic trunk alignment

The study aimed to clarify the regularity of the motions of horse's back, rider's pelvis and spine associated with improvement of rider's dynamic trunk alignment. The study used a crossover design, with exercise using the horseback riding simulator (simulator hereafter) as the control condition. The experiments were conducted at Tokyo University of Agriculture Bio-therapy Center. The sample consisted of 20 healthy volunteers age 20–23 years. Participants performed 15-min sessions of horseback riding with a Hokkaido Pony and exercise using the simulator in experiments separated by ≥2 weeks. Surface electromyography (EMG) after horseback riding revealed decreased activity in the erector spinae. Exploratory data analysis of acceleration and angular velocity inferred associations between acceleration (Rider's neck/longitudinal axis [Y hereafter]) and angular velocity (Horse saddle/Y) as well as angular velocity (Rider's pelvis/Y) and angular velocity (Horse saddle/Y). Acceleration (Rider's neck/Y) tended to be associated with angular velocity (Rider's pelvis/Y). Surface EMG following exercise revealed decreased activity in the rectus abdominis and erector spinae after the simulator exercise. Horseback riding improved the rider's dynamic trunk alignment with a clear underlying mechanism, which was not observed with the simulator.

Does Pisa syndrome affect upper limb function in patients with Parkinson's disease? An observational cross-sectional study.

Trunk alignment is thought to contribute to upper limb (UL) function. However, this common assumption is not clear in patients with Parkinson's Disease (PD) suffering from Pisa syndrome (PS). PS is a postural abnormality, characterized by revisable lateral trunk flexion more than 10 degrees. To investigate the UL functioning and activities of daily living in PD patients with PS. Forty-five participants distributed equally in three groups PD patients with PS, PD patients without PS and age/sex matched healthy controls (HC). The function and disability of UL was assessed by Arm Shoulder and Hand (DASH) questionnaire for all groups. PD groups then completed clinical assessments by the Unified Parkinson's Disease Rating Scale (UPDRS) part II-III, Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). Three groups showed significant differences in DASH questionnaire (p < 0.001) with higher scores for PS group, intermediate for PD group and lower for HC group. PS group also showed higher score in UPDRS-II and mH&Y (p = 0.019), while no differences emerged between PD and PS in UPDRS-III score and LEDD. Our results demonstrated that PS is associated with major impairment of both UL functioning and activities of daily living in PD patients.

Quantitative Approach Based on Wearable Inertial Sensors to Assess and Identify Motion and Errors in Techniques Used during Training of Transfers of Simulated c-Spine-Injured Patients

Patients with suspected spinal cord injuries undergo numerous transfers throughout treatment and care. Effective c-spine stabilization is crucial to minimize the impacts of the suspected injury. Healthcare professionals are trained to perform those transfers using simulation; however, the feedback on the manoeuvre is subjective. This paper proposes a quantitative approach to measure the efficacy of the c-spine stabilization and provide objective feedback during training. Methods. 3D wearable motion sensors are positioned on a simulated patient to capture the motion of the head and trunk during a training scenario. Spatial and temporal indicators associated with the motion can then be derived from the signals. The approach was developed and tested on data obtained from 21 paramedics performing the log-roll, a transfer technique commonly performed during prehospital and hospital care. Results. In this scenario, 55% of the c-spine motion could be explained by the difficulty of rescuers to maintain head and trunk alignment during the rotation part of the log-roll and their difficulty to initiate specific phases of the motion synchronously. Conclusion. The proposed quantitative approach has the potential to be used for personalized feedback during training sessions and could even be embedded into simulation mannequins to provide an innovative training solution.

Inter- and intra-tester reliability of the acute brain injury physiotherapy assessment (ABIPA) in patients with acquired brain injury

ABSTRACTBackground: The Acute Brain Injury Physiotherapy Assessment (ABIPA) is a new outcome measure with face validity and sensitivity to change in the early stages of neuromotor recovery after acquired brain injury (ABI). Reliability of physiotherapists using the tool has not been established.Objective: Determine inter- and intra-tester reliability of physiotherapists using the ABIPA.Methods: An observational study using video-recorded assessments of patient performance (n = 7) was undertaken with two cohorts of physiotherapists: those receiving training (n = 23) and those provided with guidelines only (n = 7) to administer the ABIPA.Results: Across all physiotherapists (n = 30), inter-tester reliability was excellent (α ≥ 0.9) for total ABIPA score. All individual items, except trunk alignment in supine (α = 0.5), showed excellent or good internal consistency (α ≥ 0.7). For intra-tester reliability, substantial or perfect agreement was achieved for eight items (weighted Kappa Kw ≥ 0.6), moderate agreement for four items (Kw = 0.4–0.6) and three items achieved fair agreement (alignment head supine: Kw = 0.289; alignment trunk supine: Kw = 0.387 and tone left upper limb: Kw = 0.366).Conclusion: Physiotherapists are highly consistent using the ABIPA but several items may need revision to improve intra-tester reliability.

The study of trunk and pelvic movement on mediolateral ramps of various ramp angles during one-legged standing.

The purpose of this study was to identify the instability of the trunk and the pelvis of subjects who were standing on differently angled ramps under conditions in which the ramps were crossed. Changes in the trunk and the pelvis while each subject was standing on one leg in the direction of the cross ramps at four angles (0°, 5°, 10°, and 15°) were measured. To identify instability, the trunk inclination, trunk imbalance, pelvic position, pelvic rotation, and pelvic torsion of 20 healthy male subjects were measured. The measurement was conducted using a three-dimensional spinal diagnostic imaging system (Back Mapper). According to the results of the measurement, trunk imbalance, pelvic position, pelvic rotation, and pelvic torsion differed between the medial and lateral ramps and with different ramp angles. This study’s results suggested that different mediolateral ramp conditions altered the pelvic and trunk alignment. With the 15° ramp, the anterior tilt and lateral tilt of the pelvis increased regardless of ramp direction. The 10° ramp condition altered the pelvic rotation to the contralateral side. In addition, the lateral trunk tilt was elevated with the lateral down foot condition.

The effects of calcaneal posture on thoracolumbar alignment in a standing position.

[Purpose] Severe calcaneus misalignment is correlated with low back pain, and affects pelvic alignment. However, little has been published with regard to the influence of pronation and supination on trunk alignment. Therefore, the present study aimed to investigate the influence of calcaneal inversion on pelvic and trunk alignment. [Subjects and Methods] A 3-dimensional motion analysis system was used to assess pelvic and trunk alignment in 10 healthy male subjects with unilateral and bilateral calcaneus inversion. [Results] Medial and anterior tilting of the pelvis, and posterior tilting and lateral rotation of the trunk were observed. [Conclusion] Calcaneal inversion induces changes in the alignment of the pelvis and trunk. These changes may induce lumbar lordosis and body misalignment, leading to back pain.

The effects of increased unilateral and bilateral calcaneal eversion on pelvic and trunk alignment in standing position

Objective: Generally, it is known that there is a correlation between excessive calcaneus eversion and a patient with low back pain and it also affects pelvic alignment. However, there are not enough studies that show calcaneal eversion having an effect on the alignment of the trunk. Design: Cross-sectional study. Methods: A 3-dimensional motion analysis system was used to assess the lower limbs, pelvic alignment, and trunk alignment with increased unilateral and bilateral calcaneal eversion in twenty-one subjects. All subjects were asked to maintain a static posture for seven seconds on a wedge three times per posture for measurement and analysis purposes. The wedge used in the process was a lateral wedge with a 10-degree tilt to the lateral direction. To unify all of the subjects` foot position, the front and inner side of the wedge were marked. The height of the tilted wedge`s inner side and flat wedge were balanced equally in order to be able to maintain the lateral part of the foot to the same height when producing an increased calcaneal eversion. Results: Comparing the changes in trunk and pelvic alignment in accordance to calcaneal eversion for each posture, there was a significant different in the X and Y-axis for each posture, but not in the Z-axis (p<0.05). Thus, it can be confirmed that calcaneal eversion in the sagittal plane and frontal plane may have and effect on the pelvis and the trunk. Conclusions: Postures with increased bilateral and unilateral calcaneal eversion has an effect on pelvic alignment, but does not cause any changes in trunk alignment.

Alterações posturais em mulheres submetidas à cirurgia para retirada do câncer de mama

Introdução: A cirurgia para a retirada do câncer de mama leva a repercussões no corpo da mulher e influencia diretamente sua postura. Objetivo: Identificar as alterações posturais em mulheres submetidas a tal procedimento e compará-las com o tipo de cirurgia. Métodos: Foi avaliada a postura de 23 voluntárias selecionadas por conveniência por meio do software SAPO. Resultados: Das mulheres avaliadas, 52,2% apresentaram rotação de cabeça à esquerda e elevação de ombro à direita, 56,5%, elevação da pelve à esquerda, e 65,2%, inclinação de tronco à esquerda. Em 100% das mulheres observou-se anteriorização da cabeça, 87% tiveram deslocamento posterior do tronco e 82,6% demonstraram ter anteversão pélvica. Não foi encontrada diferença significativa entre os tipos de cirurgia. Conclusão: As mulheres apresentaram alterações no alinhamento da cabeça, do ombro, da pelve e do tronco. Porém, essas alterações não foram diferentes quando comparados os tipos de cirurgia.

The Correlation Between Pelvic Obliquity And Dynamic Alignment Of Knee During Gait.

Tsuji et al. reported that a patellofemoral joint pain was related to a sacral inclination that caused by changing of lumbar alignment, and they called this pathological concept “the knee-spine syndrome”. Tauchi et al. reported that influence of spinal imbalance on knee osteoarthritis. However, few studies reported the dynamic alignment on the frontal plane on the frontal plane to elucidate knee - spine syndrome. PURPOSE: To investigate association of the dynamic alignment of the pelvic and the knee during gait. METHODS: This study included 100 patients (58 male; 31.7±17.45ys, 168.0±6.74cm, 63.1±11.33kg and 42 female; 38.5±20.42ys, 156.5±8.71cm, 52.0±10.93kg) with pain in the lower limbs and/or low back pain. The dynamic alignment of pelvic and knee during gait was measured at our clinic using a motion analysis system which consisted of six cameras, two force plates, and 39 retro-reflective markers. The relationship between the frontal plane motion of pelvic (i.e. pelvic obliquity) and knee (i.e. knee varus-valgus) were analyzed using linear regression. Then the patients were classified into three groups by pelvic obliquity imbalance and the dynamic alignment of knee was compared among four groups. RESULTS: At the initial contact of left foot, the pelvic right obliquity angle was 3.7±1.92 (degrees; d) and the angular velocity of left knee varus was 28.3±38.26 (degree/sec; d/s), and the coefficients of correlation of them (r) was -.091 (ns). On the other hand at the initial contact of right foot, the pelvic left obliquity angle was 5.8±2.15 (d) and the angular velocity of right knee varus was 37.9±34.43 (d/s), and r was .379 (p> right obliquity) group was 40.7±7.63 (d/s), and was larger than normal balance group (24.4±4.29 (d/s), p<.05 ). CONCLUSIONS: In the landing movement, the correlation between the dynamic alignment of trunk and knee was reported. The same as the previous study, this study suggested that the correlation between pelvic obliquity and knee varus during gait. We hypothesize that the increases in pelvic obliquity motion from initial contact to foot flat was increased of frontal-plane knee movement and torques because of to transfer lateral-down forces from the trunk through the lower extremity. The findings of this study will provide clinicians with useful information for prevention overuse injuries.

Pelvic and trunk mechanics and injury in cricket: A spin bowling case study

An international cricket spin bowler was experiencing asymmetrical low back pain while bowling his off-break delivery. The aim of this study was to identify technical discrepancies between the bowler’s off-break delivery and his other variations, which did not cause low back pain. The bowler underwent a three-dimensional kinematic bowling analysis based on data captured using a 14-camera Vicon system operating at 250 images per second. To increase task representativeness, the analysis was undertaken outdoors on a turf cricket pitch. The bowler was required to bowl six deliveries of his off-break delivery and three variations. A range of pelvic and trunk kinematics were measured. A one-way independent samples analysis of variance with planned comparisons and a bootstrapping procedure was used to identify technical differences between the delivery types. Results showed that the off-break delivery displayed significantly higher trunk alignment, shoulder counter-rotation, trunk contralateral flexion and ‘crunch factor’ when compared with other delivery variations. It was concluded that the bowler who participated in this study was using an off-break technique that exhibited technical characteristics that have previously been associated with an increased likelihood of sustaining a lower back injury.

Do adolescents with idiopathic scoliosis have body schema disorders? A cross-sectional study.

To date etiology of adolescent idiopathic scoliosis appears complex and still remains unclear. A distorted body schema has been proposed to be a part of a sequence of pathological events in the development of adolescent idiopathic scoliosis. To investigate the awareness of trunk misalignment in adolescents with idiopathic scoliosis. Information about 44 adolescents with idiopathic scoliosis was collected as follows: age; sex; handedness; family history of scoliosis; back pain; sport practice; shoulder and waist line symmetry; leg length; dorsal kyphosis; back hump; rehabilitation; scoliotic curve; Risser sign. We evaluated awareness of trunk misalignment with a graphic table displaying pictures of progressively increasing scoliotic curves. Patients were asked to indicate which picture corresponded to their perceived own spinal alignment. Patients with thoracolumbar scoliosis overestimated their actual thoracic spine curve. Patients with thoracic-thoracolumbar scoliosis underestimated their actual thoracolumbar spine curve and overestimated their actual lumbar spine curve. Scoliotic curve > 15°, double curve, younger age, back pain, family history of scoliosis and lower Risser score related with a misperception of trunk alignment. Our results support the hypothesis that adolescents with idiopathic scoliosis have an altered corporeal awareness of their trunk alignment.

Effects of upper extremity training in a standing position on trunk alignment in stroke patients.

[Purpose] This study aimed to examine the effect of upper extremity training in the standing position on trunk alignment of patients with stroke. [Subjects and Methods] Twelve stroke patients were enrolled in the study and divided into two groups: a group of six patients in a sitting position and a group of six patients in a standing position. Upper extremity training for 30 min per day, five times a week for six weeks was given to subjects in both groups. In order to assess trunk alignment, lumbar lordosis and thoracic kyphosis were examined before and after upper extremity training using Formetric 4D. [Results] After training the standing position group had no significant change in lumbar lordosis but a significant change in thoracic kyphosis. The sitting position group showed no significant changes in either lumbar lordosis or thoracic kyphosis. The comparison between groups showed there was no significant difference in the change in lumbar lordosis but there was a significant difference in the change in thoracic kyphosis. [Conclusion] Examination of trunk alignment showed that upper extremity training conducted in a standing position reduced thoracic kyphosis more than in a sitting position.

Effect of mat pilates exercise on postural alignment and body composition of middle-aged women.

[Purpose] This study attempted to examine whether Pilates is an effective exercise for improving the postural alignment and health of middle-aged women. [Subjects and Methods] The participants in this study were 36 middle-aged women (20 in the experimental group, 16 in the control group). The experimental group participated in Pilates exercise sessions three times a week for 12 weeks. Body alignment and composition measurements before and after applying the Pilates exercise program were performed with a body composition analyzer and a three-dimensional scanner. [Results] Postural alignment in the sagittal and horizontal planes was enhanced in the Pilates exercise group. Trunk alignment showed correlations with body fat and muscle mass. [Conclusion] The Pilates exercises are performed symmetrically and strengthen the deep muscles. Moreover, the results showed that muscle mass was correlated with trunk postural alignment and that the proper amount of muscle is critical in maintaining trunk postural alignment.

Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing.

PurposePostural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO) in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force) as a preventive method against abnormal posture and low-back pain in healthy elderly persons.Patients and methodsFifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES), left internal abdominal oblique, and right gluteus medius muscles.ResultsPelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these results were not significant compared to no orthosis. Thorax extension angle and thorax angle on pelvis coordinate system significantly increased while wearing the ORF compared to the other two conditions. ES activity significantly decreased while wearing the ORF compared to the other two conditions. Internal oblique activity was significantly smaller while wearing the LSO than with no orthosis. Center of pressure did not significantly differ among the conditions.ConclusionThe ORF significantly improved trunk alignment and decreased ES activity in healthy elderly subjects during static standing.

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke

Effect of vibration frequency on trunk and hip joint alignment during performance of the prone bridge with sling exercise

Effect of vibration frequency on trunk and hip joint alignment during performance of the prone bridge with sling exercise

Effect of gender on trunk and pelvis control during lateral movements with perturbed landing

In lateral reactive movements, core stability may influence knee and hip joint kinematics and kinetics. Insufficient core stabilisation is discussed as a major risk factor for anterior cruciate ligament (ACL) injuries. Due to the higher probability of ACL injuries in women, this study concentrates on how gender influences trunk, pelvis and leg kinematics during lateral reactive jumps (LRJs). Perturbations were investigated in 12 men and 12 women performing LRJs under three different landing conditions: a movable landing platform was programmed to slide, resist or counteract upon landing. Potential group effects on three-dimensional trunk, pelvic, hip and knee kinematics were analysed for initial contact (IC) and the time of peak pelvic medial tilt (PPT). Regardless of landing conditions, the joint excursions in the entire lower limb joints were gender-specific. Women exhibited higher trunk left axial rotation at PPT (women: 4.0 ± 7.5°, men: −3.1 ± 8.2°; p = 0.011) and higher hip external rotation at both IC and PPT (p < 0.01). But women demonstrated higher knee abduction compared to men. Men demonstrated more medial pelvic tilt at IC and especially PPT (men: –5.8 ± 4.9°, women: 0.3 ± 6.3°; p = 0.015). Strategies for maintaining trunk, pelvis and lower limb alignment during lateral reactive movements were gender-specific; the trunk and hip rotations displayed by the women were associated with the higher knee abduction amplitudes and therefore might reflect a movement strategy which is associated with higher injury risk. However, training interventions are needed to fully understand how gender-specific core stability strategies are related to performance and knee injury.

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke.

[Purpose] This study investigated the effect of shoulder girdle strengthening, particularly the scapular muscles, on poststroke trunk alignment. [Subjects and Methods] The study involved 30 patients with residual hemiparesis following cerebrovascular stroke. Patient assessment included measuring shoulder muscle peak torque, scapular muscles peak force, spinal lateral deviation angle, and motor functional performance. Patients were randomly allocated either to the control group or the study group and received an 18-session strengthening program including active resisted exercises for shoulder abductors and external rotators in addition to trunk control exercises. The study group received additional strengthening exercises for the scapular muscles. [Results] The two groups showed significant improvement in strength of all shoulder and scapular muscles, with higher improvement in the study group. Similarly, the lateral spinal deviation angles significantly improved in both groups, with significantly higher improvement in the study group. Transfer activity, sitting balance, upper limb functions, and hand movements significantly improved in the two groups, with higher improvement in the latter two functions in the study group. [Conclusion] Strengthening of shoulder girdle muscles, particularly scapular muscles, can significantly contribute to improving the postural alignment of the trunk in patients with poststroke hemiparesis.

Efficacy of a newly designed trunk orthosis with joints providing resistive force in adults with post-stroke hemiparesis.

Few studies have examined the efficacy of trunk orthoses that support the upper trunk and a paretic limb in stroke patients. To improve stability and alignment of the trunk and pelvis in hemiparetic patients, we developed a newly designed trunk orthosis that provides resistive force through spring joints. This study aimed to determine the newly designed trunk orthosis's biomechanical effects during level walking. Before-after trials must be better. Measurements were taken for nine chronic-phase (>2 years post-onset) stroke patients using a three-dimensional motion capture system and force plates under three experimental conditions: self-selected gait speed without the newly designed trunk orthosis, with the newly designed trunk orthosis, and after newly designed trunk orthosis removal. We analyzed and compared spatiotemporal and kinetic parameters of the paretic and non-paretic limbs and kinematic parameters of the trunk and bilateral limbs. Several pre-swing gait parameters (e.g. hip joint flexion moment and ankle joint plantar flexion angle) after newly designed trunk orthosis removal were significantly increased compared to those without newly designed trunk orthosis. Step length of the paretic limb tended to increase after newly designed trunk orthosis removal. The newly designed trunk orthosis effectively modified trunk alignment, but larger improvements in kinetic and kinematic parameters were observed in the bilateral limbs after newly designed trunk orthosis removal than with the newly designed trunk orthosis. Stroke patients improved only trunk malalignment while wearing the newly designed trunk orthosis. Gait after newly designed trunk orthosis removal was better than with the newly designed trunk orthosis. Positive changes after removal were mostly observed in pre-swing of the hemiparetic limb. The newly designed trunk orthosis might be effective for gait training in stroke patients.

The effect of trunk flexion on lower-limb kinetics of able-bodied gait

Able-bodied individuals spontaneously adopt crouch gait when walking with induced anterior trunk flexion, but the effect of this adaptation on lower-limb kinetics is unknown. Sustained forward trunk displacement during walking can greatly alter body center-of-mass location and necessitate a motor control response to maintain upright balance. Understanding this response may provide insight into the biomechanical demands on the lower-limb joints of spinal pathology that alter trunk alignment (e.g., flatback). The purpose of this study was to determine the effect of sustained trunk flexion on lower-limb kinetics in able-bodied gait, facilitating understanding of the effects of spinal pathologies. Subjects walked with three postures: 0° (normal upright), 25±7°, and 50±7° trunk flexion. With increased trunk flexion, decreased peak ankle plantar flexor moments were observed with increased energy absorption during stance. Sustained knee flexion during mid- and terminal stance decreased knee flexor moments, but energy absorption/generation remained unchanged across postures. Increased trunk flexion placed significant demand on the hip extensors, thus increasing peak hip extensor moments and energy generation. The direct relationship between trunk flexion and energy absorption/generation at the ankle and hip, respectively, suggest increased muscular demand during gait. These findings on able-bodied subjects might shed light on muscular demands associated with individuals having pathology-induced positive sagittal spine balance.