Spinal Height Change in Response to Sustained and Repetitive Prone Lumbar Extension After a Period of Spinal Unloading

Objective

The purpose of this study was to investigate if differences in spinal height changes in healthy individuals were observed after a period of spinal unloading using repetitive as compared with sustained lumbar extension exercises.

Methods

This study used a pretest, posttest, crossover design. Asymptomatic participants were recruited using convenience sampling. Thirty-two participants (15 male; 17 female) without back pain were included in the data analysis (mean, 24.4 years; range, 20-41 years). Participants performed sustained or repetitive prone lumbar extension exercises after 1 hour of sustained spinal unloading. Spinal height was measured using a stadiometer before and after the repetitive and sustained prone lumbar extension exercises.

Results

Paired t tests revealed no significant difference in spine height after repetitive (P = .774) or sustained (P = .545) prone lumbar extension after a period of spinal unloading. No significant difference between spinal height changes occurred between sustained (mean [SD], − 0.28 [2.59] mm) and repetitive (mean [SD], − 0.12 [2.42] mm) lumbar extension (P = .756).

Conclusion

In this group of asymptomatic individuals, sustained and repetitive lumbar extension exercises did not appear to affect spinal height after a period of spinal unloading.     

The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial

This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC₉₅ were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23° (7.41°) and left rotation of 7.09° (5.83°). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.     

Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry

ObjectivesThe purpose of this study was to determine the immediate effects of a manual therapy technique consisting of axial traction compared with side lying on increased spine height after sustained loading.MethodsTwenty-one asymptomatic participants were included. Participants either received manual therapy technique consisting of manual axial traction force for 2 consecutive rounds of 3 minutes or sustained side lying for 10 minutes. Spine height was measured using a commercially available stadiometer. Spinal height change was determined from measurements taken after loaded walking and measurements taken after manual therapy. A paired t test was performed to determine if a manual therapy technique consisting of axial traction increased spinal height after a period of spinal loading.ResultsA significant increase in height was found after both manual therapy technique and sustained side lying (P < .0001). The mean height gain was 8.60 mm using 3-dimensional axial separation.ConclusionThis study is an initial attempt at evaluating the biomechanical effects of manual therapy technique consisting of axial traction. Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals. This study protocol may help to inform future studies that evaluate spine height after loading.     

Spinal reflex excitability changes after lumbar spine passive flexion mobilization

BACKGROUND: Flexion distraction has gained increased credibility as a therapeutic modality for treatment of low back pain. Although important work in the area has elucidated the intradiskal pressure profiles during flexion distraction, the accompanying neural responses have yet to be described. OBJECTIVE: The purpose of this pilot study was to assess neural reflex responses to motion with 3 degrees of freedom applied to the lumbar spine and to evaluate H-reflex responses of the soleus. METHODS: Subjects (n = 12) were measured for H-maximum reflexes determined from stimulus response recruitment curves measured in neutral prone position. The mean of 10 evoked H-waves (at H-maximum stimulus intensity) were measured in neutral position, flexion, left and right lateral flexion, and axial rotation of the trunk on an adjusting table. H-reflexes were expressed as a percentage of maximal M-wave for the criterion measure. Spinal range of motion was quantified by digitization. RESULTS: The data showed variation in some movement ranges, notwithstanding identical table positioning for all subjects. Mean H-reflex amplitude was decreased (15.2 +/- 5.8 mV to 13.8 +/- 5.8 mV), and the H/M ratio was also decreased in flexion compared with neutral (55.0% +/- 19.1% to 50.3% +/- 19.4%; P <.05). CONCLUSIONS: Trunk flexion is accompanied by inhibition of the motor neuron pool. Slight perturbations in numerous afferent receptors are known to significantly alter the H-reflex. The absence of measurable changes in lateral flexion and trunk rotation may indicate that both slow- and fast-adapting receptors could be involved in lumbar motion. These preliminary findings suggest the need for further dynamic motion studies of the flexion distraction neurophysiologic condition.     

Application of Ultrasonography in the Assessment of Abdominal and Lumbar Trunk Muscle Activity in Participants With and Without Low Back Pain: A Systematic Review

ObjectiveThe purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could be interpreted as muscle activity of trunk muscles.MethodsStudies that assessed the correlation between changes in muscle thickness measured with ultrasonography (US) and electromyography (EMG) activity were included. Only the data related to abdominal and lumbar trunk muscles in participants with or without low back pain were extracted. The PubMed, ScienceDirect, Ovid MEDLINE, Scopus, Springer, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception to August 2018. Two independent raters appraised the quality of the included studies using the Critical Appraisal Skills Program checklist.ResultsFourteen studies were included. The results revealed significant correlations between US and EMG measures for the lumbar multifidus and erector spinae muscle during most contraction levels and postures. For transverse abdominis and internal oblique, US and EMG measures were correlated during low load abdominal drawing or bracing. The correlations were influenced by trunk position for higher intensities of contraction. For the external oblique muscle, correlation was observed only during trunk rotation.ConclusionChanges in muscle thickness should not be interpreted as muscle activity for all tasks, positions, and contraction types. Only during prime movement tasks performed with isometric contraction could muscle thickness change be considered as muscle activity. Also, upright postures influenced the relationship between changes in muscle thickness and muscle activity for abdominal muscles.     

Biomechanics of wheelchair propulsion as a function of seat position and user-to-chair interface.

This study investigated the biomechanics of lever and hand-rim propulsion and the effects of seat position on propulsion mechanics. Nine able-bodied and six paraplegic spinal cord injured persons participated. Subjects performed hand-rim and lever propulsion on a wheelchair test simulator at a speed and load of 3km/hr and 7.5 watts/side, respectively. A 2 x 3 matrix of randomized seat positions was used. Three-dimensional motion measures of the trunk, shoulder, elbow, and wrist were collected over four-second sample periods for each seat position. Hub torque and stroke arc measurements were determined. Upper extremity motions were significantly different (p less than .05) for the two methods of propulsion. Hand-rim propulsion required less elbow motion, greater shoulder extension, less shoulder rotation and less arm abduction than lever propulsion. Both methods of propulsion required a substantial amount of internal rotation at the shoulder. Seat position changes had a greater effect on joint motion ranges when hand-rim propulsion was performed. No significant differences (p greater than .05) were found for trunk motion for the treatments. The findings provide additional information for development of a model for the optimization of wheelchair propulsion.     

Three-dimensional kinematic analysis of pelvic and lower extremity differences during trunk rotation in subjects with and without chronic low back pain

ObjectiveTo investigate three-dimensional angular changes of the pelvis and lower extremities during trunk axial rotation in subjects with and without chronic low back pain (LBP).DesignRepeated-measures design.ParticipantsThirty volunteers participated in the study (15 with LBP, 15 without LBP). The mean age of the subjects was 44 (standard deviation 15.8) years (range 27 to 63 years).Main outcome measuresAll participants were asked to perform five sets of axial trunk rotation activities with a bar in a standing position. The outcome measures included three-dimensional rotational angles of the pelvis and lower extremities (foot, calf and thigh).ResultsThe angular change of the pelvis in the sagittal plane differed between subjects with and without LBP (P = 0.03). There were no significant differences in angular changes of the lower extremities in the frontal and transverse planes between groups.ConclusionsThe angular change of the pelvis in the sagittal plane differed significantly between groups. Further research is needed to investigate the three-dimensional characteristics of biomechanical and neuromuscular aspects in subjects with LBP.     

Validation of the Measurement of the Angle of Trunk Rotation in Photogrammetry

ObjectiveThe purpose of this study was to validate the photogrammetric measurement of the angle of trunk rotation in relation to the scoliometer instrument.MethodsFifty-eight prominences from individuals with ages between 7 and 18 and with suspicion of spinal asymmetry (SA) were evaluated through the scoliometer and photogrammetry. The photographs were analyzed in the Digital Image-based Postural Assessment software. For statistical purposes, we used Pearson’s correlation test (r), root mean square error, Bland-Altman graphical analysis, and receiver operating characteristic curve. The level of significance was P ≤ .05.ResultsExcellent correlation for the angle of trunk rotation was obtained between the scoliometer and photogrammetry, with a root mean square error of 3°. The Bland-Altman graphical analysis showed equally dispersed data with no participants outside the limits of agreement. The receiver operating characteristic curve evidenced that (1) the cutoff point for the identification of the presence of spinal asymmetry is 4°; (2) mild to moderate SA is between 4° and 7°; (3) moderate to severe SA is above 8°; and (4) sensitivity and specificity were above 83% and 78%, respectively, with an area under the curve ≥ 90%.ConclusionPhotogrammetry is validated for measuring the angle of trunk rotation, being an accurate and accessible tool for the evaluation of patients with spinal asymmetries.     

Can 5 minutes of repetitive prone press-ups and sustained prone press-ups following a period of spinal loading reverse spinal shrinkage?

Objective: The objective of this study is to investigate if sustained and repetitive prone press-ups could reverse decreased spinal height following spinal loading and if there was a correlation between the degree of end range of motion spinal extension and spinal height gains. Design: Pretest–posttest crossover design is used in this study. Setting: Study was carried out in research laboratory. Subjects: Forty-one healthy men and women were included in this study. Intervention: Participants were seated in the stadiometer for 5 min with a 4.5-kg weight placed on each shoulder; the load was removed for 5 min and spinal height was measured using a stadiometer before and after 5 min of repetitive or sustained prone press-ups. Main Measures: Two-by-two repeated-measures ANOVA to identify significant interactions and main effects is used in this study. Significance of α = 0.05. A Pearson correlation coefficient was used to assess the correlation between spinal height changes and spinal extension ROM. Results: Participants 24.1 ± 2.03 years grew using both repetitive (4.85 ± 3.01 mm) and sustained press ups (4.46 ± 2.57 mm). There was no significant interaction between the repetitive versus sustained press-ups and the time before and after each prone press-ups strategy and no main effect for strategy (sustained vs. repetitive press-ups). There was a significant main effect for time (before vs. after press-ups) (F_(1,30) = 140.771; p < 0.0001; partial η² = 0.82). No correlation was found between the degree of end ROM spinal extension and spinal height changes following press-ups strategies. Conclusion: Following periods of spinal loading, both repetitive and sustained press-ups increased spinal height. Such strategies could be used to help recover spinal height and limit the effects of decreased spinal height as a result of activities of daily living.     

Spinal movement and performance of a standing reach task in participants with and without Parkinson disease

BACKGROUND AND PURPOSE: Evidence suggests that individuals with early and mid-stage Parkinson disease (PD) have diminished range of motion (ROM). Spinal ROM influences the ability to function. In this investigation, the authors examined available spinal ROM, segmental excursions (the ROM used) during reaching, and their relationships in community-dwelling adults with and without PD. SUBJECTS: The subjects were 16 volunteers with PD (modified Hoehn and Yahr stages 1.5-3) and 32 participants without PD who were matched for age, body mass index, and sex. METHODS: Range of motion of the extremities was measured using a goniometer, and ROM of the spine was measured using the functional axial rotation (FAR) test, a measure of unrestricted cervico-thoracic-lumbar rotation in the seated position. Motion during reaching was determined using 3-dimensional motion analysis. Group differences were determined using multivariable analysis of variance followed by analysis of variance. Contributions to total reaching distance of segmental excursions (eg, thoracic rotation, thoracic lateral flexion) were determined using forward stepwise regression. RESULTS: Subjects with PD as compared with subjects without PD had less ROM (FAR of 98.2 degrees versus 110.3 degrees, shoulder flexion of 151.9 degrees versus 160.1 degrees) and less forward reaching (29.5 cm versus 34.0 cm). Lateral trunk flexion and total rotation relative to the ground contributed to reaching, with the regression model explaining 36% of the variance. DISCUSSION AND CONCLUSION: These results contribute to the growing body of evidence demonstrating that spinal ROM is impaired early in PD.     

Effekte einer Okklusionsschiene auf die Oberkörperstatik beim HWS-Syndrom

Aims

The aim of the study was to investigate how the movement functions of the cervical spine, shoulder and pelvic regions and the symptomatic of patients alter while using an occlusal splint for patients with problems in the cervical spine and shoulder-neck region.

Probands and methods

A total of 34 patients aged between 19 and 72 years participated in the study (12 males and 12 females). Following the initial admission examination all subjects wore an occlusal splint in a centric relation position which has to be worn at night over a period of 6 weeks. The entrance and termination investigations of posture were documented according to a manual therapeutic investigation scheme and with a 3-D back scanner.

Results

The results of the 3-D back measurements showed differences in the spinal and pelvic parameters. In the manual therapeutic examination alterations were found particularly in shoulder height and rotation and also alterations in pelvic rotation with respect to the height of the iliac crest and differences in leg length.

Discussion

The documented results of this study indicate that effects of the craniomandibular system have an influence on body posture due to an occlusal splint. However, the 6-week study period of wearing the splint seems to be too short to be able to draw conclusions. Because each examination method gives different results, the combination of manual therapeutic examination and technical measurement methods for diagnostics and control of therapy with an occlusal splint in the dental orthodontic course of treatment seems to be appropriate.     

脊柱外固定器撑开复位结合椎体成形修复骨质疏松性椎体骨折

背景：经皮椎体成形治疗是针对骨质疏松性椎体压缩骨折一种有效的微创疗法,但在临床应用过程也存在一定的不足,如不能恢复椎体高度及矫正局部后凸畸形,同时骨水泥渗漏发生率较高。目的：评价脊柱外固定器撑开复位结合椎体成形治疗骨质疏松性椎体骨折的近期临床疗效。方法：2012年1月至2013年6月采用脊柱外固定器撑开复位结合椎体成形治疗骨质疏松性严重椎体骨折患者55例。术中先采用经皮椎弓根钉脊柱外固定器撑开闭合复位矫正脊柱后凸畸形,然后再经皮穿刺行伤椎椎体成形治疗。测量治疗前后压缩骨折椎体高度压缩率、后凸畸形角度及椎管内狭窄占位率。同时采用目测类比评分法和Oswestry功能障碍指数评估临床疗效。结果与结论：患者治疗后和末次随访时的目测类比评分和 Oswestry 功能障碍指数与治疗前比较均明显改善（P〈0.05）,患者腰背痛基本缓解,治疗后1-3 d可下床活动。55例共57个椎体出现骨水泥渗漏4例,但无明显临床症状。经脊柱外固定器整复结合椎体成形治疗后和末次随访时的压缩骨折椎体高度、后凸畸形角度及椎管内狭窄占位率均较治疗前显著改善（P〈0.05）,治疗后与末次随访相比差异无显著性意义。提示脊柱外固定器撑开复位结合经皮椎体成形治疗骨质疏松性严重椎体骨折是一种安全有效且疗效稳定的微创修复方法,骨水泥渗漏率低,可获得满意的脊柱稳定性。     

Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury

BackgroundMost individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context.MethodsShoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression.FindingsPeriods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P < 0.0001), with greatest impingement risk during scapular plane elevation followed by propulsion. Impingement risk scores were not significantly different between scapular plane elevation loading conditions (P = 0.202) or propulsion resistances (P = 0.223). The infraspinatus and supraspinatus tendons were both susceptible to impingement during scapular plane elevation (by acromion), whereas the supraspinatus was most susceptible during propulsion (by acromion and coracoacromial ligament).InterpretationThe occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.     

Optimal bed height for passive manual tasks

PurposeTo determine bed height adjustment for maintaining neutral lumbar position as a function of anthropometric dimensions.Materials and methods80 physical therapy students performed passive shoulder flexion and straight leg raising tasks on standard versus the adjustable bed. The lumbar angle was measured at the start and finish of tasks. The rate of perceived exertion was measured immediately after each task. The most comfortable bed height in relation to some anatomical landmarks was measured.ResultsMean bed height for shoulder flexion tasks was significantly higher than for straight leg raising. The mean adjusted bed heights for both tasks were significantly higher and with less exertion felt by the participants, compared to the standard bed height (0.715 m). The third knuckle of the hand and the radial styloid process of the wrist were established as the most valuable anthropometric landmarks for bed height adjustment.ConclusionsThe above landmarks are recommended to maintain a neutral lumbar position while adjusting bed heights for manual tasks. Each manual task requires adjustment of the bed height. Further studies are needed to confirm our results.     

How do osteotomy and distraction affect distraction angles of opening wedge high tibial osteotomy?

BackgroundsTrigonometric formulae have been derived to correlate the distraction angle (height) and tibial specifications. However, the assumption-induced simplifications are inherent in the formulae such as the rigid tibia and the specific orientations of cutting plane and lateral hinge. This study aimed to evaluated the accuracy of the trigonometric formulae.MethodsThe 3D printed tibiae were used as the specimens for which the hinge orientations and distraction sites were systematically varied. Hinge orientation was determined by wedge inclination of the bone saw into the medial tibia and saw progression near the lateral cortex. The specimens were distracted at different distraction sites to measure the distraction angles that were compared with literature formulae.FindingsIn cases of the same distraction height, the wedge inclination, saw progression, and distraction site had various impacts on the coronal angles, indicating that the ideal formula should consider these parameters. Averagely, the predicted angles of the literature formulae were 15% higher than the testing results. The differences in these results may be attributed to the deformable property of the specimen material, non-ideal hinge orientation, and differences in distraction sites. Saw progression and distraction site had greater impacts than wedge inclination on the distraction angle.InterpretationVariations in three surgical indices constitute a complicated mechanism that affects the 3D hinged rotation of the distracted plateau. The non-middle distraction further deforms the tibial rotation and reduces the accuracy of the trigonometric formulae. The trigonometric formulae might underestimate the distraction angle; thus. Appropriate corrections are necessary for clinical application.     

Development and Comparative Evaluation of New Shapes of Pillows

The purpose of this study was to determine pillow designs suitable for supine and side-lying positions. [Subjects] Twenty female and twenty male subjects with a mean age of 22.7 years (SD = 1.3) participated in the study. [Methods] First, a three-dimensional motion analysis system was used to analyze the movements of the head and the shoulder joints during changes from supine positions to side-lying positions. Second, the height from the face to the shoulder and the height from the floor to the middle of the neck in a side-lying position were measured. Third, the weight distribution ratios of the head and the trunk were compared using general pillows (polyester sponge), memory foam, and prototype pillows. [Results] During position changes from supine positions to side-lying positions, the head moved in a fan shape, and the shoulder joint moved an average of 4.4 cm upward. The height from the face to the shoulder was 9 cm on average. The height from the floor to the middle of the neck was 11 cm on average. The weight distribution ratios between the head and the trunk were compared among general pillows (polyester sponge), memory foam, and prototype pillows. The results showed significant differences in the side-lying position. [Conclusion] Pillows with uniform heights are not suitable for a supine or side-lying position. In the case of both positions, users should be allowed to select pillows in shapes that can support the neck.Key words: Pillow, Sleep position, Motion analysis     

Ultrasound Evaluation of Muscle Thickness Changes in the External Oblique, Internal Oblique,and Transversus Abdominis Muscles Considering the Influence of Posture and Muscle Contraction

[Purpose] The aim of this study was to investigate muscle thickness changes in the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) muscles between the neutral position and trunk rotation, under a state of rest without voluntary contractions, and isometric contractions to both sides with resistance of 50% of the maximum trunk rotation strength. [Subjects] The subjects of this study were 21 healthy young men. [Methods] Muscle thickness changes in the EO, IO, and TrA in each position and state were evaluated by ultrasound. The range of motion at maximum trunk rotation and the maximum strength of trunk rotation were measured using a hand-held dynamometer. [Results] In the neutral position and at 50% trunk rotation to the right side, the thicknesses of the IO and TrA significantly increased with resistance. In both states, the thicknesses of the IO and TrA significantly increased at 50% trunk rotation to the right side. [Conclusion] The muscular contractions of the IO and TrA were stronger during ipsilateral rotation than in the neutral position and with resistance than at rest. Moreover, the muscular contraction was strongest in the resistive state during ipsilateral rotation.Key words: Trunk rotation, Low back pain, Functional evaluation     

Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: A preliminary investigation

BackgroundSpontaneous vertebral artery dissection has significant mortality and morbidity among young adults. Unfortunately, causal mechanisms remain unclear.The purpose of this study was to quantify mechanical strain in the vertebral artery while simultaneously capturing motion analysis data during passive movements of the head and neck relative to the trunk during spinal manipulation and cardinal planes of motion.MethodsEight piezoelectric crystals (four per vertebral artery) were sutured into the lumen of the left and right vertebral arteries of 3 cadaveric specimens. Strain was then calculated as changes in length between neighboring crystals from a neutral head/neck reference position using ultrasound pulses. Simultaneously, passive motion of the head and neck on the trunk was captured using eight infrared cameras. The instantaneous strain arising in the vertebral artery was correlated with the relative changes in head position.FindingsStrain in the contralateral vertebral artery during passive flexion-rotation compared to that of extension-rotation is variable ([df = 32]: − 0.61 < r < 0.55). Peak strain does not coincide with peak angular displacement during spinal manipulation and cardinal planes of motion. Axial rotation displayed the greatest amount of strain. The greatest amount of strain achieved during spinal manipulation was comparably lower than strains achieved during passive end range motions and previously reported failure limits.InterpretationThe results of this study suggest that vertebral artery strains during head movements including spinal manipulation, do not exceed published failure strains. This study provides new evidence that peak strain in the vertebral artery may not occur at the end range of motion, but rather at some intermediate point during the head and neck motion.     

Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial

ObjectivesDysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver.MethodsThis study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver.ResultsAverage initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001).ConclusionCervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.     

Association of sagittal spinal alignment in the sitting position with the trunk and lower extremity muscle masses in children and adults with cerebral palsy: A pilot study

BackgroundWe examined the association of sagittal spinal alignment in the sitting position with the trunk and lower extremity muscle masses in children and adults with cerebral palsy (CP). We also compared muscle masses between children and adults with CP who could and could not sit without the support of their upper extremities.MethodsThe subjects were 34 children and adults with CP. Sagittal spinal alignment in the sitting position, such as thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angles were measured using a Spinal Mouse. The thicknesses of the trunk and lower extremity muscles were measured using an ultrasound imaging device. Furthermore, the subjects were classified into the sitting-possible group (n = 18), who could sit without the support of the upper extremities, or a sitting-impossible group (n = 16), who could not sit without the support of the upper extremities.FindingsStepwise regression analysis revealed that the lumbar multifidus muscle thickness and body weight were significant and independent factors of the lumbar lordosis angle in the sitting position. The thicknesses of the thoracic erector spinae, gluteus maximus and minimus, long head of the biceps femoris, semitendinosus, and rectus femoris muscles were significantly lower in the sitting-impossible group than those in the sitting-possible group.InterpretationDecreased lumbar lordosis angle in the sitting position was associated with decreased lumbar multifidus muscle mass in children and adults with CP. Furthermore, not only trunk extensor but also hip joint muscles may contribute to sitting without upper extremity support.