How reproducible do we stand and sit? Indications for a reliable sagittal spinal assessment

BackgroundCurrently, an upright standing posture is normally adopted for evaluations of spinal alignment, which is however sensitive to posture variations. Thus, finding a reproducible reference is essential. This study aimed to evaluate the reproducibility of standing and sitting postures at different arm positions in five consecutive repetitions.Methods22 asymptomatic subjects (11 males; 11 females) aged 20–35 years were included. Subjects were repeatedly asked to adopt different arm positions in standing and sitting. The absolute reposition errors of lumbar lordosis and sacral orientation between two consecutive repetitions were assessed with a non-radiological back measurement system.FindingsDuring standing at the relaxed arm position, the median absolute reposition errors of lumbar lordosis and sacral orientation were 1.14° (range 0.23°–3.80°) and 0.92° (range 0.17°–3.27°), respectively, which increased to 1.75° (range 0.21–4.97°) and 1.36° (range 0.35°–4.08°) during sitting (P < 0.01). The absolute reposition error of lumbar lordosis was non-significantly lower at the relaxed and clasped arm positions than at other arm positions. Between the first two repetitions, the absolute reposition errors of both, lumbar lordosis and sacral orientation, were greater than between the remaining two consecutive repetitions (P < 0.01). Both during standing and sitting, lumbar lordosis was smallest when hands holding two bars (P < 0.05).InterpretationSitting showed a worse reproducibility than standing. When assessing sagittal spinal balance, the clasped arm position during standing is recommended and an initial trial can help to reduce inception irreproducibility.     

Comparison of Pelvic Tilt Before and After Hip Flexor Stretching in Healthy Adults

ObjectiveThe purpose of this study was to assess the association between hip flexor length and pelvic tilt or lumbar lordosis by quantifying the effect of stretching on pelvic tilt and lumbar lordosis.MethodsWe quantified pelvic tilt and lumbar lordosis before and after a single session of passive hip flexor stretching in a sample of 23 male participants. Changes in hip flexor length were also characterized, using a Thomas test protocol to measure passive hip extension in supine lying. We investigated both the mean effect of the stretching protocol and potential correlations between changes in passive hip extension and changes in pelvic tilt or lumbar lordosis.ResultsFollowing the stretching protocol, there was a mean increase of 2.6° (P < .001) in passive hip extension and a corresponding mean reduction of 1.2° (P < .001) in anterior pelvic tilt. However, there was no change in lumbar lordosis, nor were there any meaningful correlations between change in passive hip extension and change in pelvic tilt or lumbar lordosis.ConclusionThe results suggest that hip muscle stretching may lead to immediate reductions in pelvic tilt during relaxed standing. Such stretching programs could play an important role in interventions designed to improve standing postural alignment.     

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit

ObjectiveThis study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis.MethodsTwenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T₁₂, L₃, S₂, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T₁₂ and L₃, and the line joining L₃ to S₂.ResultsLumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20).ConclusionDecreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.     

Measurement of Lumbar Lordosis: A Comparison of 2 Alternatives to the Cobb Angle

ObjectiveThe purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis.MethodsSixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients.ResultsThe HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant.ConclusionIn this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.     

Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device

ObjectiveThe purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device.MethodsA total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles.ResultsThe agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement.ConclusionOur results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.     

Quantitative Postural Analysis of Children With Congenital Visual Impairment

Objectives

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment.

The effect of interspinous implant surgery on back surface shape and radiographic lumbar curvature

Background

Interspinous process implants, used to augment lumbar spine surgery, putatively induce a local segmental lumbar kyphosis yet few investigations outline the effect in vivo on thoracolumbar sagittal curvature. Changes in lumbar skeletal alignment and posture have traditionally relied upon radiographic and back surface spinal curvature measurements, respectively.

Methods

Lumbar lordosis curvature in 10 healthy subjects (6F, 4M; mean age 36 years) and 10 interspinous implant lumbar surgery patients (5F, 5M; mean age 51 years) was assessed with rasterstereography at baseline and at 6 weeks. Skeletal lumbar lordosis in standing was measured from lateral erect radiography pre- and 6 weeks post-operatively in the surgical cohort, and compared to angulation obtained for surface lordosis curvature derived from rasterstereography.

Findings

Repeatable measurement of standing lumbar lordosis from rasterstereographic back shape imaging in healthy volunteers and lumbar surgery cases was demonstrated. Reductions of 0.6 (NS) in healthy and 3.1 (significant, P < 0.001) in surgical subjects were recorded for surface lumbar lordosis angle between the 6 week time-points. Slight flattening of the segmental angle and regional lordosis after DIAM surgery was revealed by radiography. Skeletal and surface lumbar lordosis changes were uncorrelated preoperatively (ρ = 0.28) and postoperatively (ρ = 0.26).

Interpretation

Rasterstereography is sensitive in assessing lumbar lordosis changes in healthy and lumbar surgical individuals over time. Surgery with DIAM for lumbar pathology may result in an initial mild flattening of lordosis. Serial investigations of spinal curvature after surgery with DIAM interspinous implant are warranted in order to better understand the time-course of spinal posture changes of such cases.     

Effectiveness of a 12-Week Physical Exercise Program on Lower-Limb Malalignment in School-age Rugby: A Randomized Clinical Trial

ObjectiveWe sought to assess the effectiveness of 12 weeks of a physical exercise program (PEP) in child rugby players with lower-limb overpronation during gait.MethodsThis was a randomized clinical trial. A total of 123 young athletes (mean ± standard deviation age, 10.35 ± 1.22 years) were evaluated, 20 of whom had lower-limb overpronation (n = 40 extremities). Participants were randomly assigned to 2 groups: the experimental group, who performed their normal training and a PEP for 12 weeks, and the control group, who continued with their normal training for the same time. The PEP was focused on stretching the hypertonic muscle and potentiating the weakened muscles of the lower body. All participants underwent biomechanical analysis including the Helbing angle, the femorotibial angle, and the Fick angle in both limbs.ResultsAll participants (n = 20) completed the study. Baseline measurements showed no significant differences between groups in any of the variables tested. After 12 weeks, there were significant differences between groups (P < .001 for all angles). No improvement was found in the control group; however, meaningful improvement was found in all variables in the experimental group: Helbing angle (175°, P < .001, effect size [ES] = 1.94), femorotibial angle (173°, P < .001, ES = 1.77), Fick angle (12°, P < .001, ES = 1.55). The number needed to treat was 2 for femorotibial angle and Helbing angle, and 3 for Fick angle.ConclusionA 12-week PEP produced significant improvements in these 3 biomechanical variables. We also conclude that young athletes with a pathological gait pattern reached a normal gait pattern.     

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle

ObjectiveThe purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle.MethodNinety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position.ResultsA 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005).ConclusionThe craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.     

An Extensive Literature Review of the Lumbar Multifidus: Anatomy

Abstract

Men and women with isolated osteoarthritis of the disc L5/S1 (excluding transitional anomalies) were compared against a corresponding group of healthy volunteers to see whether there is any geometric or statistical evidence that might constitute predisposing factors for isolated osteoarthritis of the disc L5/ S1. Arithmetic means, variances, standard deviations, and correlation coefficients were calculated for all the characteristics determined for the two groups. Multiple linear discriminant analysis was used to try to reproduce any classifications or groupings of the characteristic bearers on the basis of their characteristics. It was found that the position of the sacrum in the pelvis and the extent of lumbar lordosis are major predictors for isolated osteoarthritis of the discs L5/S1. To detect a predisposition for isolated osteoarthritis L5/S1, it is thus necessary to evaluate the position of the sacrum with regard to the pelvis and the degree of lumbar lordosis (excluding that of the fifth lumbar vertebra) in the angle system. This evaluation can be performed by measuring the dorsal inclination of the sacrum (the delta angle) and the Albrecht inclination.     

Association Among Dyskinesia of the Lumbar Spine Segment,Inclination Angle of the Lumbosacral Spine,and Low Back Pain in Young Athletes: A Predictive Correlational Study

ObjectiveThis predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine.MethodsThe study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2).The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression.ResultsThere was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra.ConclusionThere was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.     

Effects of Different Frequencies of Whole Body Vibration on Repositioning Error in Patients With Chronic Low Back Pain in Different Angles of Lumbar Flexion

ObjectiveThis study aimed to evaluate the effect of high and low frequency of whole body vibration (WBV) on repositioning error in 3 different angles of lumbar flexion in patients with chronic low back pain.MethodsTwenty-four participants with chronic low back pain, aged between 20 and 35 years, were included in this randomized crossover trial study. Participants were randomly assigned into 2 groups as follows: (1) low frequency/high frequency, and (2) high frequency/low frequency. Participants received high-frequency (50 Hz) and low-frequency (30 Hz) WBV in a semi-squat position for 5 minutes in 2 sessions, with 2 weeks of rest. Before and after the WBV, lumbar repositioning error in 30% and 60% of lumbar full flexion and neutral position with eyes closed when standing was evaluated using an electrogoniometer.ResultsThe repositioning error was decreased in neutral, 30%, and 60% of lumbar flexion after the low-frequency and high-frequency WBV. Post hoc testing revealed that the effect of angle was not significant in repositioning error changes between high-frequency and low-frequency WBV (P > .05). However, the effect of low-frequency WBV on the repositioning error was significantly higher compared with high-frequency WBV (P < .05).ConclusionLow-frequency WBV might induce more improvement in the accuracy of lumbopelvic repositioning compared with high-frequency WBV with the method of WBV used in this study.     

Active self-correction of back posture in children instructed with ‘straighten your back’ command

The ability to adopt the properly corrected body posture is one of the factors determining the effectiveness of therapeutic programmes. This study determined the active self-correction expressed by the change of sagittal spinal curvatures (in standing and sitting positions) in 249 children (136 females, 113 males, aged 10–14 years) instructed with ‘straighten your back’ command (SYB). Spinal curvatures (sacral slope-SS, lumbar lordosis-LL, global, lower and upper thoracic kyphosis-TK, LK, UK, respectively) were assessed using Saunders inclinometer. The assessment was done in spontaneous standing and sitting positions and in the positions adopted after the SYB.In a standing position SYB led to the significant (P < 0.001) increase in SS, and the significant (P < 0.01) decrease in LL, TK, LK, UK. In a sitting position SYB led to significant changes (P < 0.001) from kyphotic to lordotic position of SS and LL and to the significant (P < 0.001) reduction of TK (36.5° ± 10.8 vs. 23.5° ± 11) and the flattening of LK (15.2° ± 8.7 vs. 1.0° ± 8.4). There were gender-based discrepancy regarding active self-correction only for LL in a standing and UK in a sitting position. Females demonstrated a significant decrease in LL (P < 0.001). UK significantly increased only in males (P < 0.001).The ‘straighten your back’ command leads to moving the spine away from mid-range towards end range of motion. Therefore, the command should not be used to elicit the most optimal back posture. Further studies are needed to determine if the active self-correction is different in females and males.     

Relationships between forward head posture and lumbopelvic sagittal alignment in older adults with chronic low back pain

BackgroundAbnormal posture creates abnormal stress and strain in many spinal structures which are considered predisposing factors for chronic mechanical low back pain.PurposeTo examine the relationships among pain intensity, forward head posture (decreased craniovertebral angle) and lumbopelvic sagittal alignment (pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis) in chronic mechanical low back pain patients.MethodsA cross-section correlational study was conducted on one hundred patients. A numerical-pain-rating scale was used to determine pain intensity. Standardized standing lateral radiographs were analyzed to measure the spinopelvic angles. Reported data were analyzed using correlation coefficients, and regression analyses.ResultsLumbar lordosis had very strong positive correlations with each pain intensity and sacral slope. Pain intensity had a strong positive correlation with sacral slope. Moderate positive correlations highlighted between pelvic tilt and craniovertebral angle. Moreover, the pelvic incidence had weak positive correlations with each sacral slope and pelvic tilt. Negative correlations were strong between pelvic tilt and each of pain intensity, lumbar lordosis and sacral slope. Craniovertebral angle had moderate negative correlations with each of pain, lumbar lordosis, and sacral slope. However, the pelvic incidence had no relations with pain, craniovertebral angle lumbar lordosis. Overall, an association of demographic data and measured variables had a significant effect on the pain multi-regression equation prediction model. They accounted for 76.60% of the variation in pain.ConclusionAbnormal spinopelvic posture relates to chronic mechanical low back pain. There are significant associations among pain intensity, FHP and lumbopelvic sagittal alignment in chronic mechanical low back pain patients.     

Quantifying Lumbar Mobilization With Inertial Measurement Unit

ObjectiveLumbar mobilization is a standard intervention for the management of low back pain, yet ways to quantify lumbar mobilization are limited. An inertial measurement unit (IMU) is a small and inexpensive device that can be used to quantify lumbar mobilization. The objective of this study was to determine the validity and reliability of an IMU in measuring the amplitude of displacement of a clinician's hand movement during oscillatory lumbar mobilization.MethodsAn IMU was secured on a clinician's hand during application of mobilization forces at the L4 segment of 16 healthy participants. The validity of the IMU was tested against common laboratory methods of measurements (force plate and motion capture system). The reliability of the IMU measurements was determined between 2 clinicians (inter-rater reliability) and between 2 sessions (intra-rater reliability) by calculating percent error of measurement (%e) and limits of agreement (LOA). The reliability was considered high when |%e| ≤ 10% and |LOA| ≤ 20%; moderate when |%e| 10% to 20% and |LOA| 21% to 40%; and non-acceptable when |%e| > 20% and |LOA| > 40%.ResultsThe IMU measurements had high correlation with the force plate measurements (r_s = 0.94) and high agreement with the motion capture system measurements (%e = 4%, LOA = -11% and 20%). Both the inter-rater reliability (%e = 6%, LOA = -25% and 37%) and the intrarater reliability (%e = -1%, LOA = -29% and 27%) of IMU measurements were moderate.ConclusionThe IMU seems to be a valid device to measure the amplitude of a clinician's hand movement. The moderate reliability found in this study may not reflect poor reliability of the IMU as much as inconsistency in reapplication of lumbar mobilization.     

Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study

ObjectiveThe purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP).MethodsThis cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined.ResultsThe accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = ?1.1°, 95% CI, ?1.6 to ?0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = ?0.088 and ?0.099, respectively) and disability (ρ = ?0.231 and ?0.249, respectively).ConclusionCraniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.     

Effect of lumbar lordotic angle on lumbosacral joint during isokinetic exercise: A simulation study

Background

It is important to consider lumbar lordotic angle for setup of training program in field of sports and rehabilitation to prevent unexpected posture deviation and back pain. The purpose of this study was to to analyze the biomechanical impact of the level of lumbar lordosis angle during isokinetic exercise through dynamic analysis using a 3-dimensional musculoskeletal model.

Methods

Gait analysis and isokinetic exercise for the healthy adults (n = 10) were performed to design a 3-dimensional musculoskeletal model and then we made each model for normal lordosis, excessive lordosis, lumbar kyphosis, and hypo-lordosis according to lordotic angle and inputted experimental data as initial values to perform inverse dynamic analysis to quantify muscle joint torque, joint forces of each joint, system energy, and estimated muscle forces at lumbosacral joint.

Findings

Comparing the joint torques, the largest torque of excessive lordosis was 16.6% larger than that of normal lordosis, and lumbar kyphosis was 11.7% less than normal lordosis. There existed no significant difference in the compressive intervertebral forces of each lumbar joint (P > 0.05), but statistically significant difference in the anterioposterior shear force (lumbar kyphosis > hypo-lordosis > excessive lordosis > normal lordosis, P < 0.05). Lastly, lumbar kyphosis required the least and most energy during flexion and extension respectively.

Interpretation

During the rehabilitation process, more efficient training will be possible by taking into consideration not simply weight and height but biomechanical effects on the skeletal muscle system according to lumbar lordortic angles.     

Validity and Reliability of an Inertial Measurement Unit–based 3-Dimensional Angular Measurement of Cervical Range of Motion

ObjectiveThis study aimed to assess the reliability and validity of an inertial measurement unit (IMU)–based 3-dimensional (3D) angular measurement system for evaluating cervical range of motion.MethodsThirty-three healthy participants (21.9 ± 2.1 years; 162.0 ± 6.0 cm; 55.8 ± 9.0 kg; 21.2 ± 2.4 kg/m²) were evaluated. Kinematic data of the cervical joints were simultaneously obtained using the IMU 3D angular, goniometer, and photographic measurements during cervical flexion (0°, 30°, and 50°), extension (30°, 50°), side-bending (0°, 20°, 40°), and rotation (45°). Test–retest reliability was investigated in each measurement method. Concurrent validity was assessed with the direct comparison between the IMU 3D angular measurement and other methods.ResultsThe IMU 3D angular measurement showed mostly good to high test–retest reliability with relatively small standard error of measurement and the minimal detectable change values. The concurrent validity of IMU 3D angular measurements in the cervical range of motion was mostly reasonable. However, the measurement bias between the 2 methods tended to be larger at the end range of each plane.ConclusionUsing the IMU 3D angular measurement in cervical spine is recommended because of its mostly good to high reliability and reasonable validity. However, using the IMU 3D angular measurement at the end range of each plane should be carefully considered owing to the poorer validity.     

Toward an Improved Wrist View: Qualitative and Quantitative Investigation of the 20° Axial Lateral Wrist X-Ray

AimIn standard lateral wrist radiographs, the radiocarpal joint is often obscured because of the angulation of the radial styloid process. A modified lateral projection at a 20° angle has been shown to demonstrate the distal radius in profile in postoperative patients without superimposing of the orthopedic hardware used in open reduction and internal fixation procedures over the wrist joint. We assessed whether this 20° axial-lateral view is advantageous in a wider patient group.Materials and MethodsConsenting adults receiving wrist radiographs in a tertiary hospital radiology department for any indication underwent posteroanterior, posteroanterior-oblique, 0° lateral, and 20° lateral views. A musculoskeletal radiologist and a radiology technologist, blinded to clinical data and to which view was 0°/20°, both evaluated 0°/20° images in random order for whether the radiocarpal joint was obscured by radial styloid, radiocarpal articular margins, or ulnar styloid process, and which view was preferred.ResultsIn 124 cases, the radiocarpal joint was shown clearly on more 20° than 0° views (75/124 vs. 23/124, P < .001). Orthopedic hardware obscured joint lines in fewer 20° than 0° views (12/124 vs. 28/124, P < .001). There was a trend to the ulnar styloid process obscuring part of the radiocarpal joint less in 0° view (28/124 vs. 78/124 in 20°; P = .088), primarily in 20° laterals of wrists with positive ulnar variance. The 20° view was preferred by the radiologist in 76% (95/124) and preferred by the technologist in 83% (104/124).ConclusionThe 20° lateral view was superior to the current 0° lateral view in a wide range of patients, with the radiocarpal joint obscured significantly less by hardware or adjacent anatomy, and preferred by both the blinded radiologist and technologist.     

Interaction Between Thoracic Movement and Lumbar Spine Muscle Activation Patterns in Young Adults Asymptomatic for Low Back Pain: A Cross-Sectional Study

ObjectiveThe purpose of this study was to investigate the interaction between thoracic movement and lumbar muscle co-contraction when the lumbar spine was held in a relatively neutral posture.MethodsThirty young adults, asymptomatic for back pain, performed 10 trials of upright standing, maximum trunk range of motion, and thoracic movement tasks while lumbar muscle activation was measured. Lumbar co-contraction was calculated, compared between tasks, and correlated to thoracic angles.ResultsMovement tasks typically exhibited greater co-contraction than upright standing. Co-contraction in the lumbar musculature was 67%, 45%, and 55% greater than upright standing for thoracic flex, thoracic bend, and thoracic twist, respectively. Generally, the thoracic movement task demonstrated greater co-contraction than the maximum task in the same direction. Co-contraction was also correlated to thoracic angles in each movement direction.ConclusionTasks with thoracic movement and a neutral lumbar spine posture resulted in increases in co-contraction within the lumbar musculature compared with quiet standing and maximum trunk range-of-motion tasks. Findings indicated an interaction between the 2 spine regions, suggesting that thoracic posture should be accounted for during the investigation of lumbar spine mechanics.