Trunk Inclination Research Articles

The effects of dynamic exercise using the proprioceptive neuromuscular facilitation pattern on posture in healthy adults.

[Purpose] The purpose of this study is to examine the effects of dynamic exercise utilizing the proprioceptor neuromuscular facilitation pattern accompanied by abdominal drawing-in exercises on posture in healthy adults. [Subjects and Methods] The total number of subjects were 32; 16 were randomly placed in the training group, and the remaining 16 made up the control group. The subjects in the training group conducted 5 sets of dynamic exercises utilizing the proprioceptor neuromuscular facilitation patterns each day, 3 times a week for 6 weeks. Using BackMapper, their trunk inclination, trunk imbalance, pelvic position, pelvic torsion, pelvic rotation and the position of their scapula were evaluated. [Results] When the training group’s posture pre-test and post-test were compared in this study, there was a statistical significance in trunk inclination, pelvic position, pelvic torsion, pelvic rotation and the position of their scapula. [Conclusion] Dynamic exercise utilizing the proprioceptor neuromuscular facilitation patterns increased the posture that are the basis of trunk stabilization.

Interrelationship between postural balance and body posture in children and adolescents.

[Purpose] This study examined possible interrelationships between postural sway and posture parameters in children and adolescents with a particular focus on posture weakness. [Subjects and Methods] 308 healthy children and adolescents (124 girls, 184 boys, aged 12.3 ± 2.5 years) participated in the study. Posture parameters (posture index, head protrusion, trunk inclination) were determined based on posture photos in the sagittal plane. Postural sway was measured during 20 seconds on a force plate. The Pearson’s product-moment correlation coefficients between the anthropometric and posture parameters and the sway path length (SPL) were calculated, as well as the coefficient of determination R2. [Results] There is a weak but significant correlation between age or body mass index of the test subjects and the SPL. There is no statistically significant correlation between posture parameters and the SPL. Children and adolescents with posture weakness do not exhibit a changed SPL. [Conclusion] Therefore, therapy of poor posture must be considered separately from therapeutic measures for the improvement of balance skills.

The validity of an accelerometer-based method for estimating fluidity in the sit-to-walk task in a community setting

[Purpose] Fluidity in the sit-to-walk task has been quantitatively measured with three-dimensional motion analysis system. The purpose of this study was to determine the validity of an accelerometer-based method for estimating fluidity in community-dwelling elderly individuals. [Subjects and Methods] Seventeen community-dwelling elderly females performed a sit-to-walk task. The motion was recorded by an accelerometer, a three-dimensional motion analysis system and a foot pressure sensor simultaneously. The timings of events determined from the acceleration waveform were compared to the timings determined from the three-dimensional motion analysis data (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index from the duration between events. [Results] The characteristics of the acceleration waveform were similar to those previously reported in younger adults. Comparisons of event timings from accelerometer and motion analysis system data indicated no systematic bias. Regression analysis showed that the duration from maximum trunk inclination to the first heel strike was the best predictor of fluidity index. [Conclusion] An accelerometer-based method using the duration between characteristic events may be used to precisely and conveniently assess fluidity in a sit-to-walk task in a community setting.

C1-2 椅子からの立ち上がり初期相における頭頸部角度の違いが動作に与える影響

C1-2 椅子からの立ち上がり初期相における頭頸部角度の違いが動作に与える影響

Epidemiological study of adolescent idiopathic scoliosis in Eastern China.

Previous epidemiological studies of adole-scent idiopathic scoliosis in mainland China have had diverse results. The aim of this cross-sectional study was to determine the epidemiology of adolescent idiopathic scoliosis based on a representative sample city, Wuxi, in eastern China. Primary and secondary school students aged 10-16 years were enrolled in the study. Physical examination and Adam's forward bending test, combined with scoliometer measurements were performed at school-based screening. Students with an angle of trunk inclination of 5° or more were referred for whole-spine X-ray. The threshold for confirmed diagnosis was a Cobb angle of 10° or more. A total of 79,122 students were screened. The overall prevalence of adolescent idiopathic scoliosis in Wuxi City was estimated as 2.4%. Girls had a higher prevalence in each age subgroup compared with boys. Higher prevalence was found in individuals with lower body mass index. Mild and moderate curves were the most common types in our study. The prevalence of adolescent idiopathic scoliosis in this region was slightly higher. Medical resources should be considered for children with lower body mass index and high risk of scoliotic progression. Measurement with a scoliometer would be suitable for mild-to-moderate scoliotic deformities, while alternative methods should be developed for those with severe deformities or higher body mass index.

Assessment of gas compression and lung volume during air stacking maneuver.

We reasoned that the application of positive pressure through air stacking (AS) technique could cause gas compression and the absolute lung volumes could be estimated. The aim of this study was to estimate the amount of gas compression (ΔV comp) during AS in healthy subjects positioned at 45° trunk inclination and verify if the simultaneous measurements of chest wall volume changes (ΔV CW), by optoelectronic plethysmography, and changes in lung volume (ΔV ao), by pneumotachograph, combined with pressure variation at the airways opening (ΔP ao) during AS are able to provide reliable data on absolute lung volumes. Twenty healthy subjects (mean age 23.5±3.8years) were studied during a protocol that included slow vital capacity and AS maneuvers. V comp was calculated by subtracting ΔV ao and ΔV CW occurring during AS and total lung capacity (TLC) was estimated by applying Boyle-Mariote's law using V comp and ΔP ao. During AS, 0.140±0.050L of gas was compressed with an average ΔP ao of 21.78±6.18cmH2O. No significant differences between the estimated TLC (-0.03±3.0% difference, p=0.6020), estimated FRC (-2.0±12.4% difference, p=0.5172), measured IC (1.2±11.2% difference, p=0.7627) and predicted values were found. During AS, a significant gas compression occurs and absolute lung volumes can be estimated by simultaneous measurements of ΔV CW, ΔV ao and ΔP ao.

Can different occlusal positions instantaneously impact spine and body posture? : A pilot study using rasterstereography for a three-dimensional evaluation.

Orthodontists influence dental occlusion directly. To suggest any link between dental occlusion and body posture is highly contentious, as evidenced by the literature. Rasterstereography, an optical technique that enables three-dimensional (3D) body measurements to be collected, has not yet been used to impartially examine whether different occlusal positions could instantaneously alter spine and body posture. We therefore set out to use this technique to nonsubjectively evaluate this question under static conditions. Optical body scans were collected for 44 subjects, using the Diers formetric 4D system, for seven different mandible positions. In total, ten spinal and body posture parameters were assessed (trunk inclination, trunk imbalance, pelvic tilt, pelvic torsion, fleche cervicale, fleche lombaire, kyphotic angle, lordotic angle, surface rotation, and lateral deviation) for each mandible position and compared with scans performed with habitual intercuspation (HIC). Significant body posture deviations were found for the fleche cervicale (positionof the mandible: right eccentrically), fleche lombaire (positionsof the mandible: physiologic rest position, cotton rolls on both sides, bite elevation 1mm), and the kyphotic angle (positionsof the mandible: cotton rolls on both sides, right eccentrically). No other significant differences were detected. Data for the parameters that varied with different dental occlusions generated high standard deviations. Therefore, within the limitations of this pilot study, we could not conclusively associate dental occlusion to an instantaneous impact on the tested parameters. The posture changes that we detected could also have arisen from individual neuromuscular compensation; a possibility that must now be ruled-in, or out, by further research studies with a higher number of subjects.

Strategies to reduce joint load in the medial compartment of the knee during gait in individuals with osteoarthritis: a review of the literature

Abstract Introduction: Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis. The knee external adductor moment of force is a kinetic parameter that correlates with the joint load in the medial compartment. Objective: The aim of this study was to conduct a narrative review of the biomechanics strategies during gait of individuals with medial knee osteoarthritis that reduce external adductor moment of force of the knee. Methods: The review of the literature was conducted in the databases MEDLINE, PUBMED and PEDro and included articles published between 2000 and 2011. It was selected transversal, theoretical, correlational and longitudinal studies as well as controlled clinical trials. Results: Decreased gait velocity, increased external rotation of the foot, increased internal abductor moment force of the hip and lateral trunk inclination to the side of the support limb are compensatory strategies used to reduce the external adductor moment of force of the knee during gait of individuals with medial knee osteoarthritis. The lateral trunk inclination may be beneficial in a short term, however it decreases the activity of the abductors muscles of the hip during the support phase of the gait favoring compensation that could result in the progression of medial knee osteoarthritis. Conclusion: Strengthening of the abductors muscles of the hip reduces pain, improves the function and prevents compensations that in a long term could possibly accelerate the progression of the medial knee osteoarthritis.

Posture and low back pain during pregnancy — 3D study

Back pain is a common complaint of pregnant women. The posture, curvatures of the spine and the center of gravity changes are considered as the mechanisms leading to pain. The study aimed to assess spinal curvatures and static postural characteristics with three-dimensional surface topography and search for relationships with the occurrence of back pain complaints among pregnant women. The study was conducted from December 2012 to February 2014. Patients referred from University Clinic of Gynecology and Obstetrics were examined outpatient at the Posture Study Unit of Department of Orthopaedics and Traumatology. Sixty-five women at 4-39 weeks of pregnancy were assessed and surveyed with Oswestry Disability Index; posture was evaluated using surface topography. The study confirmed that difficulties in sitting and standing are significant in the third trimester of the pregnancy. The overall tendency for significant lumbar curvature changes in pregnant women was not confirmed. Major changes in sagittal trunk inclination in relation to the plumb line were not observed in the study group. The issue regarding how the pregnancy causes changes in spinal curvature and posture remains open for further studies. Presented method of 3D surface topography can reveal postural changes, but that requires several exams of each subject and strict follow-up of the series of cases.

Trunk appearance perception scale for physicians (TAPS-Phy) - a valid and reliable tool to rate trunk deformity in idiopathic scoliosis.

BackgroundEvaluation of trunk deformity by physicians in patients with idiopathic scoliosis (IS) has been considered an important part of clinical practice. Different methods to quantify the severity of trunk deformity by external observation have been reported. A valid tool to evaluate patients’ perception of trunk deformity, the Trunk Appearance Perception Scale (TAPS), is hereby validated for use by physicians (TAPS-Phy).MethodsCross-sectional study of patients with non-surgically treated IS. Patients were prospectively recruited. On the day of the visit, a posterior-anterior radiograph in standard position and clinical photographs in three different views (anterior, posterior and forward bending position) were obtained. Patients also completed a TAPS questionnaire (TAPS-Pat). Three different observers scored the TAPS questionnaire (TAPS-Phy), based on the digital photographs previously obtained, twice a week. The angle of trunk inclination (ATRI) was also measured on digital photographs. Inter and intra-rater reliability was calculated through weighted kappa coefficient. External validity was tested by the Spearman correlation coefficient between the TAPS-Phy score and the scoliosis magnitude determined using the magnitude of the largest curve (MLC), ATRI, and TAPS-Pat.ResultsFifty two patients (46 women; mean age 16.6 years) were included. The average curve magnitude of the major curve was 44°. Mean scores of TAPS-Phy for the three evaluators ranged from 3.4 to 3.5. No differences between the three means were found. TAPS-Phy showed good internal consistency (Cronbach’s alpha coefficient 0.84). Inter-observer reliability ranged from slight to substantial (0.14 to 0.63); intra-observer reliability ranged from 0.35 to 0.99. Correlation between TAPS-Phy and ATRI (r = −0.54 to −0.75), MLC (r = −0.47 to −0.6) and TAPS-Pat (r = 0.29 to 0.34) were statistically significant (p < 0.01).ConclusionsTAPS-Phy is a valid and reliable scale to rate a physician’s impression of the severity of the deformity in patients with idiopathic scoliosis and can be useful in routine clinical records.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-016-0085-8) contains supplementary material, which is available to authorized users.

The impact of the neurodevelopmental traction technique on activation of lateral abdominal muscles in children aged 11-13 years.

The aim of the study was to evaluate the activation of lateral abdominal muscles (LAM) in response to neurodevelopmental traction technique as assessed by ultrasounds as well as to compare the effects of different traction forces. An experiment with repeated measurements of the dependent variables was conducted. Thirty-seven children (22 girls) participated. Measurements of LAM thickness (indicating LAM activation) were performed bilaterally during traction of 5% body weight: 1) in neutral position, 2) in 20° posterior trunk inclination; during traction of 15% body weight: 3) in neutral position, 4) in 20° posterior trunk inclination. The ultrasound technology was employed. When applying the lighter traction the superficial LAM (external and internal oblique muscles) showed significant changes. The mean thickness of both muscles during traction increased (both p < 0.001). The deepest transversus abdominis showed no response (p > 0.05). Stronger traction elicited smaller changes. External and internal oblique muscles showed significant increases (p < 0.001, p < 0.01, respectively). Transversus abdominis became less thick during stronger traction (p < 0.01). The neurodevelopmental traction technique elicits the changes in LAM thickness in children with typical development. The superficial LAM show more distinct responses than the profound LAM. Stronger traction induces smaller LAM thickness changes than lighter traction.

THE EFFECTS OF DIFFERENT TRUNK INCLINATIONS ON BILATERAL TRUNK MUSCULAR ACTIVITIES, CENTRE OF PRESSURE AND FORCE EXERTIONS IN STATIC PUSHING POSTURES.

In order to reconcile contradictory results from previous studies on manual pushing, a study was conducted to examine the effect of trunk inclination on muscular activities, centre of pressure (COP) and force exertion during static pushing. Ten subjects pushed at 0 degrees, 15 degrees, 30 degrees, and 45 degrees body inclinations in parallel and staggered feet stances. Wall and ground force plates measured pushing force, wall COP, vertical ground reaction force (GRF) and ground COP. Electromyogram data were recorded at 10 trunk muscle sites. Pushing force was found to increase with body inclination. GRF peaked at 15 degrees and reached its lowest level at the 45 degrees inclination. The lowest wall force plate standard deviation of COP displacement was found at the 30 degrees inclination. The lowest low back muscular activity was found at the 15 degrees and 30 degrees inclinations. Based on force exertion, muscular load, and stability, the 30 degrees body inclination was found to be the best posture for static pushing. This study also showed asymmetry in muscular activity and force exertion which has been received less attention in manual pushing studies. These findings will require further study.

Decreasing the required lumbar extensor moment induces earlier onset of flexion relaxation

Flexion relaxation (FR) is characterized by the lumbar erector spinae (LES) becoming myoelectrically silent near full trunk flexion. This study was designed to: (1) determine if decreasing the lumbar moment during flexion would induce FR to occur earlier; (2) characterize thoracic and abdominal muscle activity during FR. Ten male participants performed four trunk flexion/extension movement conditions; lumbar moment was altered by attaching 0, 5, 10, or 15lb counterweights to the torso. Electromyography (EMG) was recorded from eight trunk muscles. Lumbar moment, lumbar flexion and trunk inclination angles were calculated at the critical point of LES inactivation (CPLES). Results demonstrated that counterweights decreased the lumbar moment and lumbar flexion angle at CPLES (p<0.0001 and p=0.0029, respectively); the hypothesis that FR occurs earlier when lumbar moment is reduced was accepted. The counterweights did not alter trunk inclination at CPLES (p=0.1987); this is believed to result from an altered hip to spine flexion ratio when counterweights were attached. Lumbar multifidus demonstrated FR, similar to LES, while thoracic muscles remained active throughout flexion. Abdominal muscles activated at the same instant as CPLES, except in the 15lb condition where abdominal muscles activated before CPLES resulting in a period of increased co-contraction.

Clinical, physical, and radiographic analyses of lumbar degenerative kyphosis and spondylolisthesis among community-based cohort.

To investigate longitudinal radiographic changes, and physical characteristics of lumbar degenerative kyphosis (LDK) and spondylolisthesis (DS). Two-hundred eighty nine community-based female subjects were recruited from population register and studied longitudinally for a mean 12.3years. Upright entire spine radiographs were used to evaluate spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and vertebral slip (% slip). Physical measurements included lumbar range of motion (ROM), isometric trunk muscle strength, and photometric gait posture using change in trunk inclination angle (dTIA). Subjects' mean age (standard deviation: SD) was 56.9 (10.0) years at baseline and 68.5 (9.2) years at the final follow-up. Among 202 subjects who could perform instructed physical measurements, DS, defined as more than 5% slip, was found in 50 subjects (24.8%), and LDK, defined as LL of less than 1SD of mean value (<24.4°), was found in 24 subjects (11.9%). DS subjects showed a significant weakness in trunk flexor strength (normal 282.5±73.0N vs. DS 245.5±75.5N, p=0.0219), and LDK subjects showed significant differences in: trunk extensor strength (normal 493.4±172.8N vs. LDK 386.3±167.6N, p=0.0066), ROM, and dTIA (normal 3.5°±2.7° vs. LDK 7.6°±4.8°, p<0.0001). PI was significantly larger in DS and smaller in LDK than normal subjects (normal 53.8°±9.9° vs. DS 58.2°±10.6°, p=0.0111; normal vs. LDK 48.4°±9.2°, p=0.0191). Current study showed that DS was associated with reduced trunk flexor strength, which might increase pelvic anteversion, and LDK was associated with reduced extensor strength, ROM, and ambulatory kyphosis. Physical characteristics should be evaluated for the successful management of adult spinal deformity.

Inter-rater Agreement of a Tackling Performance Assessment Scale in Youth American Football.

Recommendations have been made regarding appropriate tackling form to reduce the risk of head injury, including the USAFootball HeadsUp tackling program. Providing feedback on technique is an essential part of improving performance and decreasing injury risk. PURPOSE:Establish inter-rater agreement of a Tackling Performance Assessment s scale to be used for delivering feedback to youth football players. METHODS:Twenty videos of youth football athletes performing a football tackle on a dummy were presented to two Certified Athletic Trainers (ATC). These ATCs were provided with training regarding the desired tackle performance, as recommended by USA Football, and completed a self-test with a minimum score of 80%. After completion of rater training, participants were asked to identify correct performance of six criteria on a dichotomous scale. The videos could be slowed to half speed or advanced frame by frame, if desired. Criteria include the following measures upon contact: cervical extension >45°, trunk inclination between 35° and 55°, head placement on far side of target, and pelvic height less than 75% of standing pelvis height. Criteria upon approach include: shoulder extension >45° and step length <70% of standing pelvis height. Cohen’s Kappa statistics were calculated to assess inter-rater agreement for each of the six components of the scale. RESULTS:Cohen’s Kappa measures found substantial agreement in cervical extension (κ=0.694), head placement (κ=0.608), pelvic height (κ=0.737), and shoulder extension (κ=0.700). Step length has moderate agreement (κ=0.494) and trunk inclination has fair agreement (κ=0.241). CONCLUSIONS:Inter-rater agreement of the six critical components range from fair to substantial. While visual estimation is not considered the most accurate or reliable mechanism to measure movement, this strategy is utilized regularly by clinicians and coaches and requires little to no additional equipment. Results of this study indicate trained personnel were able to achieve moderate to substantial agreement in four of 6 assessment areas, indicating the raters are capable of identifying the appropriate feedback to be provided. By establishing a feedback mechanism that is easily utilized by clinicians and coaches we can begin to provide a pathway to improve tackling performance.

The effects of prolonged wear of textured shoe insoles on gait, foot sensation and proprioception in people with multiple sclerosis: study protocol for a randomised controlled trial.

BackgroundMany people with multiple sclerosis experience problems with walking, which can make daily activities difficult and often leads to falls. Foot sensation plays an important role in keeping the body balanced whilst walking; however, people with multiple sclerosis often have poor sensation on the soles of their feet. Wearing a specially designed shoe insole, which enhances plantar sensory information, could help people with multiple sclerosis to walk better. This study will explore whether long-term wear of a textured insole can improve walking in people with multiple sclerosis.MethodsA prospective randomised controlled trial with two parallel groups will be conducted aiming to recruit 176 people with multiple sclerosis living in the community (Brisbane, Australia). Adults with a clinical diagnosis of multiple sclerosis, Disease Steps score 1–4, who are ambulant over 100 m and who meet specific inclusion criteria will be recruited. Participants will be randomised to a smooth control insole (n = 88) or textured insole (n = 88) group. The allocated insole will be worn for 12-weeks within participants’ own footwear, with self-report wear diaries and falls calendars being completed over this period. Blinded assessors will conduct two baseline assessments and one post-intervention assessment. Gait tasks will be completed barefoot, wearing standardised footwear only, and wearing standardised footwear with smooth and textured insoles. The primary outcome measure will be mediolateral base of support when walking over even and uneven surfaces. Secondary measures include spatiotemporal gait parameters (stride length, stride time variability, double-limb support time, velocity), gait kinematics (hip, knee, and ankle joint angles, toe clearance, trunk inclination, arm swing, mediolateral pelvis/head displacement), foot sensation (light touch-pressure, vibration, two-point discrimination) and proprioception (ankle joint position sense). Group allocation will be concealed and all analyses will be based on an intention-to-treat principle.DiscussionThis study will explore the effects of wearing textured insoles over 12-weeks on gait, foot sensation and proprioception in people with multiple sclerosis. The study has the potential to identify a new, evidence-based footwear intervention which has the capacity to enhance mobility and independent living in people with multiple sclerosis.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615000421538. Registered 4 May 2015.

Key motion characteristics of side-step movements in hip-hop dance and their effect on the evaluation by judges

In hip-hop dance, the elements of motion that discriminate the skill levels of dancers and that influence the evaluations by judges have not been clearly identified. This study set out to extract these motion characteristics from the side-step movements of hip-hop dancing. Eight expert and eight non-expert dancers performed side-step movements, which were recorded using a motion capture system. Nine experienced judges evaluated the dancers’ performances. Several parameters, including the range of motion (ROM) of the joint angles (neck, trunk, hip, knee, and face inclination) and phase delays between these angular motions were calculated. A quarter-cycle phase delay between the neck motion and other body parts, seen only in the expert dancers, is highlighted as an element that can distinguish dancers’ skill levels. This feature of the expert dancers resulted in a larger ROM during the face inclination than that for the non-expert dancers. In addition, the experts exhibited a bottom-to-top segmental sequence in the horizontal direction while the non-experts did not demonstrate any such sequential motion. Of these kinematic parameters, only the ROM of the face inclination was highly correlated to the judging score and is regarded as being the most appealing element of the side-step movement.

The geometric curvature of the lumbar spine during restricted and unrestricted squats.

The main purpose of this study was to analyze the behavior of the geometric curvature of the lumbar spine during restricted and unrestricted squats, using a novel investigative method. The rationale for our hypothesis is that the lumbar curvature has different patterns at different spine levels depending on the squat technique used. Spine motion was collected via stereo-photogrammetric analysis in nineteen participants (11 males, 8 females). The reconstructed spine points at the upright neutral position and at the deepest position of the squat exercise were projected onto the sagittal plane of the trunk, a polynomial was fitted to the data, and were quantified the two-dimensional geometric curvature at lower, central and higher lumbar levels, besides the inclination of trunk and lumbosacral region, the overall geometric curvature and overall angle of the lumbar spine. The mean values for each variable were analysed with paired t-test (P<0.05). The lumbar presents a flexion from upright neutral posture to deepest point of the movement, but for the lower lumbar the flexion is less intense if the knees travel anteriorly past the toes. The trunk and the lumbosacral region lean forward in both squat techniques and these effects are also reduced in unrestricted squats. The data collected in the study are evidence that during barbell squats the lumbar curvature has different patterns at different spinal levels depending on the exercise technique. The lower lumbar spine appears to be less overloaded during unrestricted squats.

Comparison of Gait Motion Including Postoperative Trunk Deflection Between Direct Lateral and Anterolateral Approaches in Supine Total Hip Arthroplasty

BackgroundA prospective study was conducted to compare the effect of an anterolateral approach in the supine position (ALS) with that of a direct lateral (DL) approach on gait motion, including trunk deflection, in walking after total hip arthroplasty. We hypothesized that trunk deflection in walking after ALS would be significantly improved in comparison with use of the DL approach. MethodsThe subjects were 15 patients, with 7 in the ALS group and 8 in the DL group. Walking before and 9 and 28 weeks after surgery was analyzed using 3-dimensional motion analysis. ResultsWalking velocity, stride length, hip joint range of motion in the sagittal plane in walking, and locomotion range of trunk inclination were significantly improved 28 weeks after surgery in both groups. In gait analysis, there were no significant differences between the 2 groups. ConclusionThis study was conducted to compare the effect of ALS with that of a DL approach on locomotion in walking after total hip arthroplasty. Hip pain at 9 weeks after surgery was significantly improved using ALS compared to the DL approach, but there were no significant differences in gait function at 28 weeks after surgery using ALS or DL approach. Further long-term studies are required to examine differences between these procedures.

The changes of lumbar muscle flexion-relaxation phenomenon due to antero-posteriorly slanted ground surfaces

Uneven ground surface is a common occupational injury risk factor in industries such as agriculture, fishing, transportation and construction. Studies have shown that antero-posteriorly slanted ground surfaces could reduce spinal stability and increase the risk of falling. In this study, the influence of antero-posteriorly slanted ground surfaces on lumbar flexion-relaxation responses was investigated. Fourteen healthy participants performed sagittally symmetric and asymmetric trunk bending motions on one flat and two antero-posteriorly slanted surfaces (−15° (uphill facing) and 15° (downhill facing)), while lumbar muscle electromyography and trunk kinematics were recorded. Results showed that standing on a downhill facing slanted surface delays the onset of lumbar muscle flexion-relaxation phenomenon (FRP), while standing on an uphill facing ground causes lumbar muscle FRP to occur earlier. In addition, compared to symmetric bending, when performing asymmetric bending, FRP occurred earlier on the contralateral side of lumbar muscles and significantly smaller maximum lumbar flexion and trunk inclination angles were observed.Practitioner Summary: Uneven ground surface is a common risk factor among a number of industries. In this study, we investigated the influence of antero-posteriorly slanted ground surface on trunk biomechanics during trunk bending. Results showed the slanted surface alters the lumbar tissue load-sharing mechanism in both sagittally symmetric and asymmetric bending.