Inertial Measurement Unit-based Evaluation of Global and Regional Lumbar Spine and Pelvis Alignment in Standing Individuals With a Flat Lumbar Posture

ObjectiveThe purpose of this study was to investigate the global and regional lumbar spine and pelvis postural alignment in standing individuals with a flat lumbar posture using an inertial measurement unit (IMU) system.MethodsA total of 80 symptomatic young volunteers (25 men and 55 women in their early 20s) were recruited at Inje University in Gimhae, South Korea for this study. Participants stood in a comfortable posture for 5 seconds with IMUs on the T10, L3, and S2 level. Participants were then categorized into 3 groups according to the global lumbar lordosis (GLL) angle (T10-S2): <20°, 20° ≤ GLL angle < 30°, and 30° ≤ GLL angle < 40°. We compared the GLL and regional lumbar lordosis (RLL) angles among the 3 groups.ResultsAs GLL increased, RLL angles (upper, P = .001; lower, P < .001) tended to increase, whereas the sacrum angle decreased (P < .001). A stepwise regression model showed that the sacrum angle was the single best predictor of GLL in standing participants. Based on IMU measurements, participants with GLL <20° are considered representative of participants with a flat lumbar posture.ConclusionPosture measurements in a standing position conducted to assess lordosis should consider the relationship between GLL and RLL rather than GLL or RLL alone. We found that S2 was the best predictor of GLL.     

Reliability and validity of the AutoCAD software method in lumbar lordosis measurement

OBJECTIVE: The aim of this study was to determine the reliability and validity of the AutoCAD software method in lumbar lordosis measurement. METHODS: Fifty healthy volunteers with a mean age of 23 ± 1.80 years were enrolled. A lumbar lateral radiograph was taken on all participants, and the lordosis was measured according to the Cobb method. Afterward, the lumbar lordosis degree was measured via AutoCAD software and flexible ruler methods. The current study is accomplished in 2 parts: intratester and intertester evaluations of reliability as well as the validity of the flexible ruler and software methods. RESULTS: Based on the intraclass correlation coefficient, AutoCAD's reliability and validity in measuring lumbar lordosis were 0.984 and 0.962, respectively. CONCLUSIONS: AutoCAD showed to be a reliable and valid method to measure lordosis. It is suggested that this method may replace those that are costly and involve health risks, such as radiography, in evaluating lumbar lordosis.     

Reliability of the Craniocervical Posture Assessment: Visual and Angular Measurements Using Photographs and Radiographs

ObjectiveThe purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.MethodsOne photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.ResultsGood to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).ConclusionThe raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.     

Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging

ObjectiveThe purpose of this study was to determine the reliability of the assessment of lumbar facet joint degeneration severity by analyzing degeneration subscales using magnetic resonance imaging (MRI) in human participants.MethodsThe reliability of articular cartilage degeneration, subchondral bone sclerosis, and osteophyte formation subscales of lumbar facet joint degeneration severity was assessed in MRI images from n = 10 human participants. Each scale was applied to n = 20 lumbar facet joints (L4/5 level). Three examiners were trained. A first assessment of MRI images was provided by the examiners followed by a second assessment 30 days later. Intraobserver and interobserver reliability were determined using percent agreement, the weighted kappa coefficient κ_w for paired comparisons, and the overall weighted kappa κ_o. The minimum threshold for reliability was set at moderate levels of agreement, κ_w > 0.40, based upon previous recommendations.ResultsThe articular cartilage subscale had acceptable intraobserver (κ_o = 0.51) and interobserver (κ_o = 0.41) reliability. Scales for subchondral bone sclerosis (intraobserver κ_o = 0.28; interobserver κ_o = 0.10) and osteophyte formation (intraobserver κ_o = 0.26; interobserver κ_o = 0.20) did not achieve acceptable reliability.ConclusionOf the 3 subcategories of lumbar facet joint degeneration, only articular cartilage degeneration demonstrated acceptable reliability. Subscales of lumbar facet joint degeneration should be considered independently for reliability before combining subscales for a global degeneration score. Owing to the inherent difficulty of assessing lumbar facet joint degeneration, the use of multiple examiners independently assessing degeneration with reliable scales and then coming to a consensus score upon any disagreements is recommended for future clinical studies.     

The effect of abdominal muscle strengthening on pelvic tilt and lumbar lordosis

The purpose of this study was to examine the effects of abdominal strengthening on pelvic tilt and lumbar lordosis in healthy subjects with established abdominal weakness, in a relaxed standing position. Data were collected on 20 subjects, before and after an 8 week abdominal muscle strengthening programme. Abdominal muscle strength was tested using a modification of Kendall's leg-lowering test, pelvic tilt was measured using a pelvic inclinometer, and lumbar lordosis was measured using a flexible ruler. Twenty control subjects were used to determine reliability of the measurements over the 8 week period. The intra-class correlation coefficients calculated for measures of pelvic tilt, lumbar lordosis and abdominal strength were 0.87, 0.96 and 0.55 respectively, demonstrating reliability of these measures over the 8 week period. In the subsequent ANCOVA, controlling for pre-test scores, post-test mean muscle strength in the experimental group was found to be significantly greater than in the control group. However, there were no differences in mean post-test pelvic tilt or lumbar lordosis between the groups. Based on the results of this study, the clinical practice of strengthening the abdominal musculature to affect change in lumbar lordosis and pelvic tilt in standing posture needs to be reconsidered.     

Comparison of lumbar spinal angle between normal body mass index and overweight young adults

[Purpose] This study compared the upper and lower lumbar angles of normal body mass index and overweight young adults, and examined the relationships among body mass index, waist circumferences, and lumbar angles. [Subjects and Methods] Sixty participants aged 18–25 years were recruited and allocated to 2 groups (n=30 per group): normal body mass index (18.5–24.9 kg/m²) and overweight group (body mass index, ≥ 25.0 kg/m²). During lumbar angle measurement, the participants stood in a relaxed position with bare feet. The upper and lower lumbar angles of each participant were measured using a flexible ruler, and the angle calculated by the tangent method. The waist circumference was also measured. [Results] The mean lower lumbar angle in the overweight group was significantly greater than that of the normal body weight group. Moreover, only the lower lumbar angle was associated with a significant increase in the body mass index (r=0.28). Waist circumference showed no association with the lumbar angles. [Conclusion] This is the first study to suggest that increased body weight could cause lower lumbar angle deviation in young adults. Further studies should investigate individuals with symptomatic back pain or back dysfunction and the impact of body weight on lumbar spinal angles.Key words: Upper lumbar angle, Lower lumbar angle, Overweight     

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.     

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

ObjectiveTo determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis.DesignA reliability study using two raters and two test sessions.SettingTertiary care paediatric centre.ParticipantsSeventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic.Main outcome measuresBased on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters.ResultsIn the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (? = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (? ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus.ConclusionsPosture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.     

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.     

Thoracolumbar And Lumbopelvic Spinal Alignment During The Deadlift Exercise: A Comparison Between Men And Women

BackgroundA neutral spinal alignment is considered important during the execution of the deadlift exercise to decrease the risk of injury. Since male and female powerlifters experience pain in different parts of their backs, it is important to examine whether men and women differ in spinal alignment during the deadlift.ObjectivesThe purpose of this study was to quantify the spinal alignment in the upper (thoracolumbar, T11-L2) and lower (lumbopelvic, L2-S2) lumbar spine during the deadlift exercise in male and female lifters. Secondary aims were to compare lumbar spine alignment during the deadlift to standing habitual posture, and determine whether male and female lifters differ in these aspects.Study DesignObservational, Cross-sectional.MethodsTwenty-four (14 men, 10 women) lifters performed three repetitions of the deadlift exercise using 70% of their respective one-repetition maximum. Spinal alignment and spinal range of motion were measured using three inertial measurement units placed on the thoracic, lumbar and sacral spine. Data from three different positions were analyzed; habitual posture in standing, and start and stop positions of the deadlift, i.e. bottom and finish position respectively.ResultsDuring the deadlift, spinal adjustments were evident in all three planes of movement. From standing habitual posture to the start position the lumbar lordosis decreased 13° in the upper and 20° in the lower lumbar spine. From start position to stop position the total range of motion in the sagittal plane was 11° in the upper and 22° in the lower lumbar spine. The decreased lumbar lordosis from standing habitual posture to the start position was significantly greater among men.ConclusionsMen and women adjust their spinal alignment in all three planes of movement when performing a deadlift and men seem to make greater adjustments from their standing habitual posture to start position in the sagittal plane.Level of Evidence3     

Reliability of the Cervical Range of Motion (CROM) Device and Plumb-Line Techniques in Measuring Resting Head Posture (RHP)

Abstract

Background: Individuals with forward head posture (FHP) and related postural abnormalities are at increased risk for various musculoskeletal and/or neurovascular related cervical pathologies. The Cervical Range Of Motion (CROM) device has shown to be a reliable tool in measuring total cervical range of motion (ROM) and upper cervical flexion and extension. However, the CROM has yet to be used to evaluate reliability in measuring resting head posture (RHP). Purpose: This study compared reliability of RHP measurements using the CROM instrument with that of a plumb-line measurement. Method: A convenience sample of 122 healthy volunteers (80 women and 42 men, ages 18 to 60 years) was obtained via classroom announcement from the University of Massachusetts Lowell student body. All subjects were screened for cranial, cervical, and/or upper thoracic dysfunction. Both testers performed two CROM and two plumb-line measurements. Results: Moderate intra-tester reliability was demonstrated for measuring RHP using the CROM instrument (ICCs = 0.774, 0.775), whereas high intra-tester reliability was observed using the plumb-line technique (ICCs = 0.830, 0.846). Moderate inter-tester reliability was found for CROM measurement (ICCs = 0.675, 0.723) and the plumb-line technique (ICCs = 0.738, 0.781). Conclusion: Reliable measures of RHP can be obtained using either the CROM device or plumb-line technique.     

Neutral lumbar spine sitting posture in pain-free subjects

Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP of seventeen pain-free subjects was initially recorded. Subjects then assumed their own subjectively perceived ideal posture (SPIP). Finally, 2 testers independently positioned the subjects into a tester perceived neutral posture (TPNP). The inter-tester reliability of positioning in TPNP was very good (intraclass correlation coefficient (ICC) = 0.91, mean difference = 3% of range of motion). A repeated measures ANOVA revealed that HSP was significantly more flexed than both SPIP and TPNP (p <0.05). There was no significant difference between SPIP and TPNP (p >0.05). HSP was more kyphotic than all other postures. This study suggests that pain-free subjects can be reliably positioned in a neutral lumbar sitting posture. Further investigation into the role of neutral sitting posture in LBP subjects is warranted.     

The Intertester Reliability of a Modified Movement System Impairment Classification System Used to Evaluate Individuals With Prolonged Sitting: A Preliminary Study

ObjectiveProlonged sitting while working at a computer leads to poor sitting postures, which can aggravate low back pain in many individuals. We examined the intertester reliability of using the modified musculoskeletal impairment schema for classifying participants sitting at computers for prolonged times.MethodsFifty participants were examined independently by each therapist using a test-retest design. Each therapist assigned an musculoskeletal impairment classification upon completion of the examination. The agreement percentages and the kappa coefficient were used to evaluate intertester reliability in classifying participants with prolonged sitting.ResultsThe percentage agreement between the 2 examiners for participants who maintained the sitting posture for prolonged times was 84%. The calculated kappa coefficient was 0.73, reflecting a substantial level of agreement.ConclusionsThe present findings provide some evidence to support the classification of individuals who sit at computers for prolonged times and participants with rotation with flexion pattern would need to manage asymmetry pattern in a subclinical group.     

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.     

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.     

Is ‘ideal’ sitting posture real?: Measurement of spinal curves in four sitting postures

There is a lack of quantitative evidence for spinal postures that are advocated as 'ideal' in clinical ergonomics for sitting. This study quantified surface spinal curves and examined whether subjects could imitate clinically 'ideal' directions of spinal curve at thoraco-lumbar and lumbar regions: (i) flat - at both regions (ii) long lordosis - lordotic at both regions (iii) short lordosis - thoracic kyphosis and lumbar lordosis. Ten healthy male subjects had 3-D motion sensors adhered to the skin so that sagittal spinal curves were represented by angles at thoracic (lines between T1-T5 and T5-T10), thoraco-lumbar (T5-T10 and T10-L3) and lumbar regions (T10-L3 and L3-S2). Subjects attempted to imitate pictures of spinal curves for the flat, long lordosis, short lordosis and a slumped posture, and were then given feedback/manual facilitation to achieve the postures. Repeated measures analysis of variance was used to compare spinal angles between posture and facilitation conditions. Results show that although subjects imitated postures with the same curve direction at thoraco-lumbar and lumbar regions (slumped, flat or long lordosis), they required feedback/manual facilitation to differentiate the regional curves for the short lordosis posture. Further study is needed to determine whether the clinically proposed 'ideal' postures provide clinical advantages.     

Effects of lumbar lordosis increment on gait deteriorations in ambulant boys with Duchenne Muscular Dystrophy: A cross-sectional study

BackgroundIncrement of lumbar lordosis, a frequent spinal finding in Duchenne Muscular Dystrophy (DMD), is a compensatory mechanism secondary to muscle weakness. However, excessive lumbar lordosis may change the position of the center of mass, and lead to balance and walking difficulties.ObjectiveTo study the relationship between factors that may influence ambulatory function in boys with DMD and to investigate the effects of lumbar lordosis increment on gait and balance perturbations.MethodsTwenty-one ambulant patients with DMD and 10 healthy boys were included. Lumbar lordosis and thoracic kyphosis angles, dynamic and static balance tests, ambulatory function, muscle strength, and disease severity were assessed. Usage of steroids and orthotic devices were recorded. Scoliosis was assessed on radiographs. Receiver operator characteristic curves were formed and area under curve (AUC) measurements were performed to assess the ability of the tests to discriminate ambulatory status and optimal cut-off values were established according to the Youden index.ResultsThe amount of lumbar lordosis correlated strongly and negatively with quality of ambulation (r = −0.710) and moderately with performance on balance tests. The strength of both upper limbs and lower limbs muscles were not associated with any of the variables. According to the AUC analysis, patients with a lumbar lordosis higher than 36° had worse scores on gait and dynamic balance tests.ConclusionAmbulation and dynamic balance are negatively affected by the increment of lumbar lordosis with a cut-off point of 36°in boys with DMD.     

Different ways to balance the spine in sitting: Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting

BackgroundPrevious research explored muscle activity in four distinct sitting postures with fine-wire electromyography, and found that lumbar multifidus muscle activity increased incrementally between sitting with flat thoracolumbar and lumbar regions, long thoracolumbar lordosis, or short lordosis confined to the lumbar region. This study used similar methods to explore whether people with a history of low back pain provoked by prolonged sitting used different patterns of trunk muscle activity in specific postures.MethodsFine-wire electromyography electrodes were inserted into the right lumbar multifidus (deep and superficial), iliocostalis (lateral and medial), longissimus thoracis and transversus abdominis muscles. Superficial abdominal muscle activity was recorded with surface or fine-wire electrodes. Electromyography amplitude was compared between postures for the back pain group and observations were contrasted with the changes previously reported for pain-free controls. For comparison between groups normalised and non-normalised electromyography amplitudes were compared.FindingsIndividuals with a history of back pain demonstrated greater activity of the longissimus thoracis muscle in the long lordosis compared with the flat posture [mean difference (95% CI): 46.6 (17.5–75.7)%, normalised to sitting posture peak activity], but pain-free participants did not [mean difference: 7.7 (minus 12–27.6)%]. Pain-free participants modulated lumbar multifidus activity with changes in lumbar curve, but people with a history of pain in prolonged sitting did not change multifidus activity between the long and short lordotic postures.InterpretationIn clinical ergonomic interventions that modify spinal curves and sagittal balance in sitting, the muscle activity used in those postures may differ between people with and without a history of back pain.     

Reliability of the Cervical Range of Motion Device in Measuring Upper Cervical Motion

Abstract

Limitations in upper cervical range of motion (occiput, Cl and C2) correlate highly with many pathological dysfunctions, including acute and chronic neck pain, headache, and temporomandibular joint (TMJ) pain. Although methods have been developed which provide valid and reliable measures of the middle and lower cervical spine, a quantitative method to evaluate upper cervical range of motion has not been documented in the literature thus far. The purpose of this study was to investigate the intra-tester and inter-tester reliability of the Cervical Range of Motion device (CROM) in measuring upper cervical flexion and extension. Thirty healthy volunteers, ages 23 to 37, were measured three times by three testers. Moderate to high reliability was observed for upper cervical measurements with ICC’s of .65 to .81 among testers and .89 to .97 between testers. Therefore, this method of evaluation can be used to obtain consistent quantitative measures in documenting changes in upper cervical range of motion.     

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.