Do flexion/extension postures affect the in vivo passive lumbar spine response to applied axial twist moments?

BACKGROUND: The injury potential and mechanical effects of combining axial rotation with non-neutral flexion/extension postures in vivo remains poorly understood, despite being identified as a risk factor in epidemiological and in vitro studies. The purpose of this experiment was to quantify the passive axial twist motion of the lumbar spine in various postures, and to assess whether non-neutral flexion/extension postures cause a detectable change in the range of twist motion and/or spine rotational stiffness. METHODS: Ten healthy male participants were passively rotated three times from a neutral and six flexed/extended starting postures (maximum-, mid-, mild-), while the moment-angle relationships were measured. The upper body was fixed to an adjustable rigid harness and the lower body was fixed to a cradle that rested on a frictionless table, thereby isolating the lumbar spine. FINDINGS: The lumbar spine stiffness and rotational range of motion were modulated by the different flexion/extension postures. The average maximum rotational stiffness values were smallest in maximum-flexion (81.0%, SD 16.6), and largest in maximum-/mid-extension postures at 125.4% (SD 24.4, P<0.0001) of the neutral stiffness magnitude. The axial twist angle was significantly different for each posture (P<0.0001), with 13.8% (SD 8.9) greater rotation in the maximum-flexion and 23.8% (SD 7.8) less rotation in the maximum-extension posture. The lateral bend coupled motion with axial twist was significantly different (P<0.0001) between the maximum-flexion (11.4 degrees , SD 6.3), mid-flexion/maximum-extension/mid-extension (6.5 degrees , SD 4.5), and mid-extension/mild-flexion/mild-extension postures (4.4 degrees , SD 3.8). INTERPRETATION: The lumbar spine stiffness and rotational range were modified by flexed-extended postures. The postural mechanism observed may be due to a change in the initial distance separating the facets prior to rotation. This information will be useful in determining spine rotational injury mechanisms through comparison with in vitro literature and for patient positioning during diagnostic tests.     

两种躯干运动模型在五种日常活动下的运动学差异的对比研究

目的:比较五种日常活动下,由胸节段、腰部全节段构成的简略躯干模型与由胸节段、上腰节段、下腰节段构成的细化躯干模型的运动学差异性。方法:使用NDI运动捕捉系统,采集26名健康的年轻志愿者在水平行走,上楼梯,躯干前屈,同侧拾取物体,对侧拾取物体五种活动下的胸节段,上腰节段,下腰节段和全腰节段的运动学参数。采用主成分分析的方法,分析三节段细化躯干模型和两节段简略躯干模型运动学参数的主成分的贡献率与载荷系数。结果:简略躯干模型中,全腰段的屈曲角度和侧弯角度显著高于胸节段,细化躯干模型中,下腰段的屈曲角度和侧弯角度显著高于其他节段。在水平行走和上楼梯活动中,细化模型中的腰部两节段的载荷系数符号相反。结论:躯干的运动主要是由腰部提供且主要是由下腰部分提供。在某些活动中,腰部节段间的运动出现了相互抵消的作用。因此,在进行躯干的运动分析时,需要对躯干进行细分成多节段,尤其要注意对腰部的细分。     

Lumbar axial rotation kinematics in men with non-specific chronic low back pain

BackgroundLumbar flexion, coupled with rotation, is a dominant factor in the etiology and exacerbation of low back pain. Yet, no study has examined its kinematics in patients with non-specific chronic low back pain (NSCLBP). The aim of the study was to evaluate the lumbar rotation kinematics in neutral standing and with full flexion in men with NSCLBP.MethodsROM, average velocity, maximum velocity and maximal acceleration of lumbar rotation in neutral standing and with full flexion were measured using an industrial lumbar motion monitor in 50 men (25 with NSCLBP and 25 controls). VAS and Rolland Morris questionnaire were also included.FindingsAll examined kinematical parameters were significantly lower in men with NSCLBP compared with controls (↓ROM = 29%–45%; ↓AV = 40%–68%; ↓MV = 25%–50%; ↓MA = 20%–37%). Left rotation manifested smaller kinematic values (except for MA) than right rotation (Δ ROM = 35%; Δ AV = 66%; Δ MV = 19%) in NSCLBP. Most kinematical parameters significantly decreased from neutral standing to standing with flexion (right rotation: ↓ROM = 43%–45%, ↓AV = 38%–45%, ↓MV = 24%–27%, ↓MA for the NSCLBP group = 21%; left rotation: ↓ROM = 25%–38%, ↓AV in the control group: =34%, ↓MV in the control group: =23%, ↓MA in the control group = 25%). No correlations were found between all measured kinematical parameters, VAS and RMQ total score in the NSCLBP group.InterpretationThe kinematic parameters of lumbar rotation were reduced in men with NSCLBP compared with controls both in neutral standing and with fully forward bending.Most lumbar rotation kinematics decreased from neutral standing to standing with flexion.     

Development of kinematics tests for the evaluation of lumbar proprioception and equilibration

OBJECTIVE: This study aimed at developing lumbar repositioning and seated equilibration tests. DESIGN: 3D-electrogoniometric study of trunk repositioning and equilibration in seated position. BACKGROUND: Postural equilibrium and lumbar proprioception alterations have been shown in patients with low-back pain. METHODS: In 21 healthy volunteers, pure flexion and flexion+rotation repositioning error was measured using 3D-electrogoniometry. Lumbar kinematics was analysed (time and frequency domain) during antero-posterior and lateral equilibration tests in seated position. Reproducibility and stability of the protocol were evaluated. RESULTS: Reproducibility and stability were good. Pure flexion repositioning error was similar to previous reports. For flexion+rotation tests, repositioning error was 3 degrees for flexion and 1 degrees for rotation. Amplitude, imbalance time and power spectrum were significantly larger in lateral than in antero-posterior equilibration tests. CONCLUSIONS: The feasibility of kinematic analysis of lumbar repositioning and equilibration was shown. Repositioning error values were in agreement with previous studies. New tests and parameters were proposed. Lateral equilibration tests appeared more demanding than antero-posterior tests. RELEVANCE: In patients with low-back pain, lumbar repositioning and equilibration tests may be of use to define rehabilitation strategies and to evaluate treatment outcome.     

A roentgenological evaluation of the relationship between segmental motion and malalignment in lateral bending.

OBJECTIVE: A radiographic study was undertaken to determine the relationship between static vertebral malalignment and segmental lumbar motion in lateral bending. DESIGN: Survey. SETTING: Chiropractic college student health center and private chiropractic clinic. PARTICIPANTS: 249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Net lumbar segmental tilt and rotation in lateral bending: corrected and uncorrected for segmental malposition with the patient standing in the upright neutral position. RESULTS: There was moderate to good negative correlation of malalignment with segmental tilt motion and segmental motion asymmetry (r = -.42 to -.89, p less than .001). Correlation of malalignment with motion from the ideal neutral segmental position of perfect alignment was modest (r = .16-.42). A large variation in segmental motion was found for all segmental malalignments. CONCLUSIONS: This study suggests that malalignment is associated with segmental tilt motion in lateral bending, although large subject variability greatly compromises predictability on an individual basis. This study also indicates that segmental malposition may complicate the palpation of active range of motion. This is because the malalignment itself may facilitate a greater arc of segmental motion in the direction of comparative restriction in movement from the ideal neutral position to the extreme of lateral flexion.     

Trunk muscle strength and low back pain

The strength of the trunk muscles was measured in a group of young males with low back insufficiency (n=7) and in an age matched (19-21 yrs) healthy control group (n=8). A recently designed new application of the isokinetic technique was used to record maximal torque produced by the trunk muscles during flexion, extension and lateral flexion. Trunk muscle strength was measured during isometric contractions in different trunk positions and during slow isokinetic contractions in the whole range of motion. No significant differences between the groups were observed for trunk extension, lateral flexion or flexion with the centre of rotation at L2-L3 level. However, in the initial part of isokinetic trunk flexion with the pivot point at the hip joint the strength values for the back patients were significantly lower than for the controls. The present results demonstrate the importance of a comprehensive approach to the assessment of trunk muscle strength, including different movement velocities, body positions and pivot points. Further studies are needed to evaluate the significance of the specific weakness observed in dynamic trunk flexion strength in the back patients.     

Ligament fibre recruitment of the elbow joint during gravity-loaded passive motion: an experimental study

BACKGROUND: Knowledge of elbow collateral ligament length during passive motion is essential in understanding ligament physiology and pathology, such as tightness and instability. METHODS: Five anatomical unembalmed specimens were passively placed in six flexion positions together with three forearm rotations, using equipment with gravity as motion force. These 18 positions were recorded using CT-scan. Three-dimensional data of ligament insertions were obtained through anatomical millimetre sections. Ligament length was measured in each position. FINDINGS: In neutral rotation, the lateral collateral ligament was long between 0 degrees and 30 degrees as well as at 90 degrees, and short between about 60 degrees and 120 degrees of flexion. In pronation, it was long at about 0 degrees and between 60 degrees and 120 degrees, short at about 30 degrees of flexion. In supination, it was long at about 30 degrees and 90 degrees and short between 120 degrees and 150 degrees of flexion. In any forearm rotation, the highest length of the anterior bundle of the ulnar collateral ligament was measured at about 90 degrees, its smallest length between 120 degrees and 150 degrees of flexion, position at which the posterior bundle length was greatest. INTERPRETATION: At 60 degrees of flexion, the collateral ligaments were slackened in any forearm rotations. Forearm rotation plays an indirect role in the posterolateral stability of elbow as it changes length of the lateral collateral ligament. This ligament can be tested passively at 90 degrees of flexion in supination, the anterior bundle of the ulnar collateral ligament between 0 degrees and 30 degrees in neutral rotation and the posterior bundle between 120 degrees and 150 degrees in neutral rotation.     

Radiographic pseudoscoliosis in healthy male subjects following voluntary lateral translation (side glide) of the thoracic spine

OBJECTIVE: To determine projected Cobb angles associated with trunk list (side shift) posture, hypothesizing that the side shift "scoliotic" curvature would be similar to true scoliotic curvature in the early stages. DESIGN: Anteroposterior (AP) radiographs of volunteers in neutral, in left, and right lateral translations of the thoracic cage (trunk list) were digitized. SETTING: Computer laboratory. PARTICIPANTS: Fifteen healthy male volunteers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cobb and Risser-Ferguson angles determined from digitizing vertebral body corners from T12 to L5 on 51 AP lumbar radiographs. RESULTS: Using the horizontal displacement of T12 from S1, subjects could translate an average of 54.0 mm to the left and 52.5 mm to the right. The average digitized Cobb T12-L5 angle produced for the 30 translated postures was 16 degrees. Angles ranged from 2.6 degrees to 27.0 degrees. Risser-Ferguson angles averaged 10 degrees between T12 and L5. Statistical correlations were found between Cobb L1-5 and translation to the left (P=.015), Cobb T12-L5 and translation to the right (P=.024), Risser-Ferguson angle and translation to the left (P=.021), and the lumbosacral angle to the right and trunk translation to the right (P=.027). CONCLUSIONS: During lateral translation of the thorax (trunk list), coupled lumbar lateral flexion resulted in the appearance of a pseudoscoliosis on AP radiographs. For this trunk list posture, Cobb angles are considerable (16 degrees ) and increase as the magnitude of trunk translation increases. Differentiating true structural scoliosis from this pseudoscoliosis would be clinically important. The small coupled axial rotation in trunk list is in contrast to the considerable degree of axial rotation observed in structural idiopathic scoliosis.     

Relative contribution of trunk muscles to the stability of the lumbar spine during isometric exertions

OBJECTIVE: To compare the relative contribution of various trunk muscles to the stability of the lumbar spine. DESIGN: Quantification of spine stability with a biomechanical model. BACKGROUND: Modern low back rehabilitation techniques focus on muscles that stabilize the lumbar spine. However, the relative contribution of various trunk muscles to spine stability is currently unknown. METHODS: Eight male subjects performed isometric exertions in trunk flexion, extension, lateral bending, and axial rotation, and isometric exertions under vertical trunk loading and in a lifting hold. Each isometric trial was repeated three times at 20%, 40%, and 60% of the maximum trunk flexion force or with a load of 0%, 20%, 40%, and 60% of body weight for the latter two exertions. Surface EMG data from 12 major trunk muscles were used in the biomechanical model to estimate stability of the lumbar spine. A simulation of each trial was performed repeatedly with one of the 10 major trunk muscle groups removed from the model. RESULTS: Relative contribution of each muscle to spine stability was significantly affected by the combination of loading magnitude and direction (3-way interaction). None of the removed muscles reduced spine stability by more than 30%. CONCLUSIONS: A single muscle cannot be identified as the most important for the stability of the lumbar spine. Rather, spine stability depends on the relative activation of all trunk muscles and other loading variables. RELEVANCE: This study will improve our understanding of individual trunk muscles' contribution to overall stability of the lumbar spine.     

Kinematic characterization of standing reach: comparison of younger vs. older subjects

OBJECTIVE: To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults. DESIGN: Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis. BACKGROUND: Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations. METHODS: Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects. RESULTS: Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects. CONCLUSION: This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.     

Comparison of the Lumbar Flexion Angle and EMG Activity in Trunk Muscles in Individuals with and without Limited Hip Flexion Range of Motion during Visual Display Terminal Work with Cross-Legged Sitting

[Purpose] The purpose of this study was to compare the lumbar flexion angle and electromyography (EMG) measurements of trunk muscle activity in individuals with and without limited hip flexion range of motion (ROM) during visual display terminal (VDT) work with cross-legged sitting. [Subjects] The 15 participants included a control group with sufficient hip flexion ROM (n = 7) and an experimental group with limited hip flexion ROM (n = 8). [Methods] All subjects performed VDT work with cross-legged sitting. The lumbar flexion angle was measured using a three-dimensional motion capture system, and the trunk muscle activity was recorded using a surface EMG system during VDT work with cross-legged sitting. The differences in trunk flexion angle and trunk muscle activity between the two groups were analyzed using independent t-tests. [Results] The lumbar flexion angle was significantly greater in the experimental group than the control group, although trunk muscle activity did not differ between the two groups. [Conclusion] These findings suggest that limited hip flexion leads to greater lumbar flexion during cross-legged sitting.Key words: Cross-legged sitting, Electromyography, Lumbar flexion     

Normative data on low back mobility and activity levels. Implications for neuromuscular reeducation.

Low back mobility and electromyographic movements were performed in 121 normal subjects, grouped by age and sex. Women tended to show greater ranges of motion for straight leg raising, trunk rotation and lateral bending while vertebral separation (forward flexion) was greater in men. A sex-age interaction was observed only in lateral bending, thus implying that for other mobility measurements, data within the age groupings employed in this study can be combined for men and women. Electromyographic data were integrated and quantified using EMG biofeedback equipment for unilateral or bilateral recordings made primarily from the erector spinae muscle between lumbar 3-4 and lumbar 4-5 levels, three centimeters lateral to the spinous processes. Dynamic (trunk flexion-extension, lateral rotation-standing, stooping) and static (quiet sitting, rotation-sitting) movements were performed over a ten second interval. Data analyses verified previous electromyographic studies by demonstrating the trunk extensor function of the erector spinae and the relatively greater unilateral activity when turning to the opposite direction in the erect posture. EMG silence was seen during full trunk flexion. Noticeable sex-age interaction were observed for all dynamic movements but not for static activities. Therefore, it is suggested that EMG data during dynamic movements in a normal population cannot be grouped for men and women within a specified age distribution. These data represent one series of baselines to which mobility and movement patterns in a back pain patient group can be compared. Suggestions are offered for the use of EMG biofeedback during dynamic lower back movements as a possible method of alleviating the pain state, perhaps by altering the patient's posture.     

Lumbar coupling during lateral translations of the thoracic cage relative to a fixed pelvis

Objective. To determine lumbar coupling during lateral postural translations (lumbosacral list) of the thoracic cage relative to a fixed pelvis.

Design. Digitized measurements from anteroposterior lumbar radiographs of 17 volunteers were obtained in neutral, maximal left lateral translation and maximal right lateral translation posture of the thoracic cage compared to a fixed pelvis. Subjects were constrained with two sets of clamps at the lateral borders of the pelvis and lower ribs.

Background Data. Clinically, lumbosacral list is a common posture. Range of motion and spinal coupling results have not been reported for the lumbosacral list movement.

Methods. Four vertebral body corners, mid narrow-waisted body margins, superior and inferior pedicle margins, and spinous-lamina junction of T12–L5 were digitized on 51 anterior–posterior lumbar radiographs. Using the orthogonal axes of positive x-direction to the left, vertical as positive y, and anterior as positive z, digitized points were used to measure projected segmental z-axis rotation, y-axis rotation, and segmental lateral translations of each vertebra.

Results. Using the displacement of T12, subjects could translate 35–70 mm left or right along the x-axis with an average of 53.2 mm to the left and 52.1 mm to the right. Using superior endplates to superior sacral base, lateral flexion was largest at L1 and decreased from L1 to L5, but the segmental rotation angles for lateral flexion were largest at L2–L3 (3.9°), L3–L4 (6.2°) and L4–L5 (5.7°) and were in the same direction as the main motion translation. The relative z-axis rotation of T12 was opposite to the direction of L1–L5. The coupled y-axis rotations were less than 1° and coupled segmental lateral translations were averaging less than 1 mm.

Conclusions. Thoracic cage x-axis translations compared to a fixed pelvis are significant, between 35 and 70 mm. The z-axis lumbar coupled rotation was largest at L2–L3, L3–L4 and L4–L5 and to the same side of the main motion translation in L1–L5, but opposite the main motion direction for T12. All other movements were small, averaging less than 1° or 1 mm.

Relevance

The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature. Normal values for lumbar segmental coupling on anterior–posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less.     

The effect of load on the coordination of the trunk for subjects with and without chronic low back pain during flexion-extension and lateral bending tasks

OBJECTIVE: To evaluate if patients move their trunk sections differently than normal subjects and to determine if these differences increase when lifting a load. DESIGN: Comparative study using a repeated measures design. BACKGROUND: Many studies demonstrate a modification of the lumbar-pelvic rhythm for chronic low back pain patients but the large variability of the results impair the discrimination power. It was hypothesized that the lifting of a load would magnify the manifestation of lumbar impairments. METHODS: Fifteen chronic low back pain patients and 18 normal subjects performed maximal flexion-extension and lateral bending of the trunk with and without a 12 kg load. The pelvic, lumbar and thoracic motions were measured with a motion analysis system. RESULTS: During flexion-extension tasks, a significant decrease in lumbar flexion and increase in thoracic flexion were observed for the patients. The load effect was significant for all trunk sections but did not allow a better discrimination between groups. CONCLUSIONS: Lifting a 12 kg load during flexion-extension of the trunk did confirm alteration in trunk section coordination but did not help to better discriminate patients from normal subjects. However, it was demonstrated for the first time that chronic low back pain patients compensate for a loss of lumbar flexion by increasing their thoracic flexion. RELEVANCE: The lumbar-pelvic rhythm is routinely used to evaluate low back impairments. The use of kinematic measures enhance the objectivity of the examination but the large variability of the results impair the discrimination power. Lifting a load during such an evaluation might magnify the low back impairments and increase the discrimination power of this measure.     

Normal global motion of the cervical spine: an electrogoniometric study.

OBJECTIVE: Establishment of a normal database and clinical reference of active global cervical spine motion ranges and patterns using a commercial electrogoniometer. DESIGN: Three-dimensional cervical motion ranges and patterns were analyzed in 250 asymptomatic volunteers. BACKGROUND: In vivo out-of-plane motion patterns of the cervical spine have not yet been reported in large populations, but could be of clinical interest. METHODS: In 250 subjects (aged 14-70 yr), motion range and patterns between the first thoracic vertebra and the head were analyzed for flexion-extension, lateral bending, rotation in neutral sagittal plane position and in full flexion using the CA 6000 Spine Motion Analyzer. RESULTS AND CONCLUSIONS: Average motion range in the sagittal plane was 122 degrees (SD: 18 degrees ). Flexion was slightly more important than extension. Out-of-plane components were negligible. Global bending range averaged 88 degrees (SD: 16 degrees ), left and right bending being comparable. Homolateral rotation was associated to lateral bending. Its extent was approximately 40% of the bending range. Global rotation range in neutral sagittal plane position was 144 degrees (SD: 20 degrees ), without significant difference between right and left rotations. Associated motion components were small. During rotation in flexed head position, global range (134 degrees, SD: 24 degrees ) was comparable to the one in neutral flexion. But heterolateral bending, averaging 60% of the primary motion, was associated to flexed rotation. Significant reduction of all primary (but not conjunct) motions with age were obtained. Sex had no influence on cervical motion range. RELEVANCE: Our results agreed with previous observations, validating the methodology used. They thus constitute reference data of cervical out-of-plane motion for clinical applications.     

How the inherent stiffness of the in vivo human trunk varies with changing magnitudes of muscular activation

BACKGROUND: The abdominal muscles provide stiffness to the torso in a manner that is not well understood. Their unique anatomical arrangement may modify their stiffening ability with respect to the more commonly studied long strap-like muscles of the limbs. The purpose of this study was to examine stiffness inherent to the trunk, as modified by different torso, and in particular, abdominal muscle activation levels. METHODS: Nine healthy male participants were secured in a "frictionless" apparatus and subjected to applied bending moments about either the flexion/extension or lateral bend axes. Abdominal muscle activation levels were modified through biofeedback from the right external oblique muscle. Moment-angle curves were generated and characterized by an exponential function for each of flexion, extension, and right-side lateral bend, at each of four abdominal muscle activation target level conditions. FINDINGS: Stiffness measured in extension increased in a linear fashion throughout the range of motion and increased with each successive rise in abdominal activation. Stiffness in flexion and lateral bend increased in an exponential fashion over the range of motion. In flexion and lateral bend, stiffness increased with each successive rise in abdominal activation from zero to approximately 40% and 60% of the range of motion, respectively. After these points, stiffness at the highest levels of activation displayed a "yielding" phenomenon whereby the torso stiffness dropped below that characterized at lower levels of activation. INTERPRETATION: Increasing torso muscle co-activation leads to a rise in trunk stiffness over postures most commonly adopted by individuals through daily activities (neutral to approximately 40% of maximum range of motion). However, towards the end range of motion in both flexion and lateral bend, individuals became less stiff at the maximum abdominal muscle co-activation levels. The source and mechanism of this apparent yielding are not fully understood; future work will be directed toward elucidating the cause.     

腰骶灵活性训练对腰椎间盘突出症患者干预效果的临床研究

目的观察腰骶灵活性训练对于腰椎间盘突出症患者活动度、疼痛和功能障碍的影响。方法前瞻性选取空军特色医学中心收治的腰椎间盘突出症患者51例,按照随机分组方法分为实验组(n=27)和对照组(n=24),两组患者均接受以冯氏脊柱定点旋转复位法为主的保守治疗,试验组患者在此基础上增加腰骶灵活性训练,即改良的腰骶猫式动作、仰卧位骨盆前后倾、骨盆侧屈、骨盆侧旋共4个动作,15个/组,2组/d,5 d/周,为期3周。在干预前后比较两组患者的坐位活动度、站位活动度、腰椎延展性以及主观疼痛(VAS评分)和功能障碍程度(ODI指数)。结果相比于对照组,实验组患者站立位腰椎屈曲延展性显著改善,差异具有统计学意义(t=2.557,P=0.014);站立位屈曲活动度(t=-3.035,P=0.004)、屈曲+右侧屈+右侧旋(t=-3.345,P=0.002)以及屈曲+左侧屈+左侧旋(t=-4.072,P=0.000)活动度均增加;VAS评分(t=2.908,P=0.008)和ODI指数(t=2.095,P=0.047)均显著减小,差异均有统计学意义(P<0.05)。结论腰骶灵活性训练能够改善腰椎间盘突出症患者腰椎的延展性,增加腰椎的活动度,改善腰椎-骨盆节律,改善前屈及前屈对角线动作的功能动作能力,并能够帮助腰椎间盘突出症患者缓解疼痛和主观功能障碍程度。     

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.