Immediate effects of the activation of the affected lower limb on the balance and trunk mobility of hemiplegic stroke patients

[Purpose] The purpose of this study was to determine the effects of the activation of the affected lower limb on balance and the trunk hemiplegic mobility of stroke patients. [Subjects] The gait group (GG) consisted of 6 subjects with hemiplegia and the non-gait group (NGG) consisted of 6 hemiplegic subjects. [Methods] The subjects in both groups were given foot facilitation training once for 30 min. The Spinal Mouse was used to measure the spinal alignment and the Berg balance scale (BBS) and sensory tests were also performed. [Results] In the GG, the sacral hip in upright to flexion, the lumbar spine in upright to extension, and the sacral hip and lumbar spine in flexion to extension showed significant increases in their angles after the intervention. In addition, there was a significant increase in the angle of the lumbar spine during extension from an upright position in the NGG. The BBS scores of both groups also increased significantly. [Conclusion] The intervention resulted in improvements in the angle of anterior pelvic tilt in the GG, and subjects in the NGG showed more extension of the thorax, which was regarded as compensation to avoid falling forward when flexing from an upright position. However, when extending backward from an upright position, both groups tended to control balance by using more lumbar flexion to keep the center of mass (COM) within the base of support (BOS). Both groups had better BBS scores.Key words: Balance, Stroke, Trunk     

Relationships Between Trunk Movement Patterns During Lifting Tasks Compared With Unloaded Extension From a Flexed Posture

Objectives

The purpose of this study was to investigate between movement patterns of trunk extension from full unloaded flexion and lifting techniques, which could provide valuable information to physical therapists, doctors of chiropractic, and other manual therapists.

Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring,gluteus maximus,and lumbar erector spinae in subjects with lumbar hyperlordosis

[Purpose] The purpose of this study was to compare the effects of an abdominal drawing-in maneuver (ADIM), measured using a pressure bio-feedback unit, on the activities of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension. [Subjects and Methods] Thirty healthy adult subjects (14 male, 16 female), were recruited. Subjects’ lumbar lordosis and pelvic tilt angles were measured, and based on the results, the subjects were divided into two groups: a hyperlordotic lumbar angle (HLLA) group (n=15) and a normal lordotic lumbar angle (NLLA) group (n=15). The muscle activities of the hamstring and gluteus maximus, and of the erector spinae on the right side of the body, were recorded using surface electromyography. [Results] When performing ADIM with prone hip extension, the muscle activity of the gluteus maximus of the HLLA group significantly improved compared with that the NLLA group. [Conclusion] This study demonstrated that ADIM with prone hip extension was more effective at eliciting gluteus maximus activity in the HLLA group than in the NLLA group. Therefore, ADIM with prone hip extension may be useful for increasing the gluteus maximus activity of individuals with lumbar hyperlordosis.Key words: Abdominal drawing-in maneuver, Hyperlordotic lumbar angle, Prone hip extension     

Reliability and validity of four instruments for measuring lumbar spine and pelvic positions

We studied the between-therapist reliability and the validity of four instruments in measuring lumbar spine curvature and pelvic tilt. The four instruments and their measurements were 1) a tape measure to measure the change in lumbar curvature during trunk flexion; 2) a gravity goniometer to measure pelvic angle and lumbar curvature during stance, trunk flexion, and trunk extension; 3) a parallelogram goniometer to measure lumbar curvature during stance, trunk flexion, and trunk extension; and 4) a standard goniometer to measure the angle between wooden pointers mounted perpendicularly to the spine to obtain pelvic angle and lumbar curvature during stance, trunk flexion, and trunk extension. We found no single instrument to be the most reliable or valid. Between-therapist reliability ranged from .64 to .93 (Pearson product-moment correlation) and from .60 to .92 (interclass correlation coefficient). The validities of the instruments compared with measurements from roentgenograms generally were low, ranging from -.13 to .76 (Pearson product-moment correlation) and -.73 to -.05 (interclass correlation coefficient).     

Effects of kinesio taping on lumbopelvic-hip complex kinematics during forward bending

[Purpose] The aim of this study was to investigate the effect of kinesio taping (KT) on the kinematics of the lumbo-pelvic-hip complex during forward bending by individuals with reduced hamstring extensibility. [Subjects] Eighteen males with reduced hamstring extensibility were randomly assigned to one of two groups:, the hamstring KT group (n=9), or the sham KT group (n=9). [Methods] The kinematics of the lumbopelvic-hip complex during lumbar forward bending was measured using a motion capture system before and after applying KT. [Results] The angle of lumbar flexion during late lumbar forward bending increased significantly post-KT compared to pre-KT measurements in the hamstring KT group. [Conclusion] These findings suggest that KT does not directly affect an individual’s movement during lumbar forward bending.Key words: Kinematics, Kinesio taping, Lumbar forward bending     

Lumbar lordosis and pelvic inclination in adults with chronic low back pain

BACKGROUND AND PURPOSE: The causes of lumbopelvic imbalances in standing have been widely accepted by physical therapists, but there is a lack of scientific evidence available to support them. We examined the association between 9 variables and pelvic inclination and lumbar lordosis during relaxed standing. SUBJECTS: Thirty men and 30 women with chronic low back pain (CLBP) for at least 4 months were examined (mean age=54.9 years, SD=9, range=40.4-69.8). METHODS: Multiple linear regression modeling was used to assess the association of pelvic inclination and the magnitude of lumbar lordosis in standing with age, sex, body mass index (BMI), Oswestry Back Pain Disability Questionnaire (ODQ) scores, physical activity level, hip flexor muscle length, abdominal muscle force, and range of motion (ROM) for lumbar flexion and extension. RESULTS: In women, age, BMI, and ODQ scores were associated univariately and multivariately with pelvic inclination. In men, lumbar extension ROM was related univariately to pelvic inclination; age, lumbar extension ROM, and ODQ scores were associated multivariately. Lumbar lordosis was associated univariately with only lumbar extension ROM for women and men. A weak correlation was found between angle of pelvic inclination and magnitude of lumbar lordosis in standing (r=. 31 for women, r=.37 for men). CONCLUSION AND DISCUSSION: The odds ratio of having CLBP is increased if the score on the double-leg lowering test for abdominal muscles exceeds 50 degrees for men and 60 degrees for women. In patients with CLBP, the magnitude of the lumbar lordosis and pelvic inclination in standing is not associated with the force production of the abdominal muscles.     

Regressionally determined vertebral inclination angles of the lumbar spine in static lifts

OBJECTIVE: Our previous study has developed the non-invasive models to predict the vertebral inclination angles by relating the external stick marker angles and radiographic measurements during trunk flexion. Based on these models, the present study attempted to further predict the inclination angles using externally measured body posture (i.e., lumbar posture, trunk flexion angle, knee angle) as well as load handling. DESIGN: Prediction models of the vertebral inclination angles were developed with a stepwise regression technique. This was done by selecting related postural variables as well as load handling as predictors. BACKGROUND: The technique of skin-surface stick marker has been investigated for measuring vertebral inclination angles. This technique, however, is rarely systematically validated by radiographic measurement because of concerns over radiation exposure, especially for ergonomical purposes. METHODS: Twelve healthy men aged 22-31 years were recruited in the experiment. The angles of the vertebral markers and subject's posture were recorded videographically as the subject performed a given task. Prediction models were then developed to express the relationships between the vertebral inclinations and the lifting postures. RESULTS: The prediction models revealed that the lumbar posture (lordosis or kyphosis) had a statistically significant effect on these inclination angles. Non-linear first-order regression models of the torso angle and the pelvic angle were fit to the transformed vertebral inclination angles (transformed from external stick marker angle), with resulting R(2) values between 0. 86 and 0.92. CONCLUSIONS: These findings indicate that the vertebral inclination angles can be calculated easily and with relative accuracy on the basis of the externally measured torso and pelvis angles. RELEVANCE: Measurements of lumbosacral vertebral inclination angles are important in assessing low back stress during lifting. In this study, we used a regression approach to model these angles of the lumbar/sacrum spine in different lumbar postures in the sagittal plane. Our data suggest that the vertebral inclination angles can be calculated easily. These models may be useful to the low back stress evaluation and job design through a biomechanical analysis.     

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.     

Novel biomechanics demonstrate gait dysfunction due to hamstring tightness

BACKGROUND: Children with cerebral palsy and hamstring tightness often demonstrate limited terminal swing knee extension. The conventional clinical measure of popliteal angle describes static hamstring tightness, but is not consistent with dynamic limitation. We hypothesize hamstring tightness, determined via modification of the conventional popliteal angle measure, is directly related to decreased terminal swing knee extension in children with cerebral palsy and normal magnitude knee flexion moments. METHODS: Six patients with cerebral palsy and six normal subjects were evaluated via physical examination and instrumented gait analysis. Physical examination included popliteal angle measures at first hamstring resistance to passive extension (R(1)), and end-range extension (R(2)) with the hip in varying degrees of flexion. Passive R(1) data were used to calculate regression equations to predict R(1) during gait, resulting in a novel measure of Available Knee Extension. Hamstring EMG was also compared. FINDINGS: R(1) during physical examination was significantly correlated with Available Knee Extension at terminal swing (Pearson r = -0.7251, P < 0.0001). Patients walked with significantly decreased velocity (0.959 vs. 1.27 m/s, P = 0.0002) and decreased knee extension at terminal swing (25.6 vs. 2.05 degrees, P < 0.0001), in the presence of normal knee flexion moments (-0.289 vs. -0.306 Nm/kg, P = 0.5009), and significantly decreased power absorption (-0.821 vs. -1.43 W/kg, P < 0.0001). Eleven of 12 patient knees demonstrated negative Available Knee Extension at terminal swing, with markedly limited knee extension. Five of 12 normal knees demonstrated negative Available Knee Extension, but this was near full extension. Hamstring EMG onset times were not significantly different. INTERPRETATION: We believe Available Knee Extension, defined on the basis of clinical measures of first resistance to hamstring stretch, provides a biomechanical link between physical examination findings and dynamic limitations in terminal swing knee extension.     

A Sloped Seat Wedge Can Change the Kinematics of the Lumbar Spine of Seated Workers with Limited Hip Flexion

[Purpose] The purpose of this study was to determine whether a wedge type seat decreases the lumbar flexion angle of seated workers with limited hip flexion. [Subjects] Twelve sedentary workers with limited hip flexion were recruited. [Methods] Three seat surfaces were used: a level surface, a forward-inclining wedge, and a backward-reclining wedge. The angles of lumbar flexion and pelvic tilt were measured using a three-dimensional motion analysis system. Differences in kinematic data of the subjects seated on the three seat surfaces were analyzed using repeated one-way analysis of variance. [Results] The degree of lumbar flexion decreased significantly when using the forward-inclining wedge compared with the level surface and backward-reclining wedge. [Conclusion] These findings suggest that sitting on a forward-inclining wedge may be useful for minimizing the compensatory lumbar flexion of individuals with limited hip flexion who work in a seated position.Key words: Kinematics, Limited hip flexion, Seat wedge     

Lifting Techniques: Why Are We Not Using Evidence To Optimize Movement?

Lifting something off the ground is an essential task and lifting is a documented risk factor for low back pain (LBP). The standard lifting techniques are stoop (lifting with your back), squat (lifting with your legs), and semi-squat (midway between stoop and squat). Most clinicians believe the squat technique is optimal; however, training on squat lifting does not prevent LBP and utilizing greater lumbar flexion (i.e. stoop) when lifting is not a risk factor for LBP. The disconnect between what occurs in clinical practice and what the evidence suggests has resulted in ongoing debate. Clinicians must ask the right questions in order to apply the evidence appropriately. A proposed clinical framework of calm tissue down, build tissue up, improve work capacity can be used to determine which lifting technique is optimal for a patient at any given time. When applying this clinical framework, clinicians should consider metabolic, biomechanical, physical stress tolerance, and pain factors in order to address the movement system. For example, stoop lifting is more metabolically efficient and less challenging to the cardiopulmonary system. There may be few biomechanical differences in spinal postures and gross loads on the lumbar spine between stoop, squat, and semi-squat lifting; however, each lift has distinct kinematic patterns that affects muscle activation patterns, and ultimately the movement system. Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury. There is no universal consensus on the optimal lifting technique which will satisfy every situation; however, there may be a lifting technique that optimizes movement to achieve a specific outcome. The calm tissue down, build tissue up, improve work capacity framework offers an approach to determine the best lifting technique for an individual patient at any give time.Level of Evidence5     

Inter- and intrarater reliability of a back range of motion instrument

OBJECTIVE: To examine the interrater and intrarater reliability of a back range of motion (BROM) instrument when measuring lumbar spine active planar motions and pelvic inclination. DESIGN: Single-group repeated measures for inter- and intrarater reliability. SETTING: Academic institution. PARTICIPANTS: Ninety-one participants (61 women, 30 men; mean age, 28 y) without a current complaint of low back pain volunteered. INTERVENTION: Two examiners measured pelvic inclination and all lumbar motions by using the BROM device. Subjects alternated between examiners for 4 complete trials; examiners remained blinded to the measurements. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were used to determine intrarater and interrater reliability. Regression analysis was performed to determine the role palpation played in sagittal plane measurement error. RESULTS: Intrarater reliability for side bending was good (ICC range, .85-.83), lumbar forward flexion and pelvic inclination was good to fair (ICC range, .84-.79), and extension and rotation was fair to poor (ICC range, .76-.58). Interrater reliability was fair to poor for all lumbar motions and for pelvic inclination (ICC range, .79-.55). Less than 2% of the variation in sagittal plane measurements was explained by consistency of palpation for device placement. CONCLUSIONS: The BROM provides a reliable means of measuring lumbar forward flexion, side bending, and pelvic inclination when performed by the same examiner in asymptomatic subjects.     

The Effects of Hamstring Stretching on Leg Rotation during Knee Extension

[Purpose] This study investigated the effects of hamstring stretching on leg rotation during active knee extension. [Subjects] Subjects were 100 bilateral legs of 50 healthy women without articular disease. [Methods] Hamstring hardness, leg rotation and muscle activities of the knee extensors during active knee extension were measured before and after hamstring stretching. [Results] Hamstring hardness was significantly decreased after hamstring stretching. The leg rotation angle, variation in leg rotation angle, variation in leg external rotation angle, and muscle activities of the vastus lateralis and rectus femoris were significantly increased after hamstring stretching. A moderate positive correlation was found between variation in leg rotation and variation in muscle hardness in hamstring. [Conclusion] Leg rotation during active knee extension was increased by hamstring stretching. Hamstring stretching would be effective as a pretreatment for restoring proper leg rotation when knee extension is conducted as a therapeutic exercise.Key words: Hamstring stretching, Leg rotation     

Effects of Inclined Treadmill Walking on Pelvic Anterior Tilt Angle, Hamstring Muscle Length,and Trunk Muscle Endurance of Seated Workers with Flat-back Syndrome

[Purpose] This study investigated the effects of inclined treadmill walking on pelvic anterior tilt angle, hamstring muscle length, and back muscle endurance of seated workers with flat-back syndrome. [Subjects] Eight seated workers with flat-back syndrome who complained of low-back pain in the L3–5 region participated in this study. [Methods] The subjects performed a walking exercise on a 30° inclined treadmill. We measured the pelvic anterior tilt angle, hamstring muscle length, and back muscle endurance before and after inclined treadmill walking. [Results] Anterior pelvic tilt angle and active knee extension angle significantly increased after inclined treadmill walking. Trunk extensor and flexor muscle endurance times were also significantly increased compared to the baseline. [Conclusion] Inclined treadmill walking may be an effective approach for the prevention or treatment of low-back pain in flat-back syndrome.Key words: Inclined treadmill walking, LBP, Seated workers     

The impact of the foot contact position and cutting angle during cutting on the risk of anterior cruciate ligament injury

[Purpose] This study aimed to clarify the impact of the foot contact position and cutting angle on the risk of anterior cruciate ligament injury during cutting. [Participants and Methods] Seven healthy males performed cuttings under four tasks by changing the foot contact position and cutting angle. A three-dimensional motion analysis system and force plates were used for taking measurements. The peak vertical ground reaction force and loading rate were calculated. The pelvic, hip, and knee joint angles were measured at the peak vertical ground reaction force. [Results] The loading rate was significantly higher in the lateral foot contact than in the anterior foot contact when the cutting angle was large. The knee flexion angle at the peak vertical ground reaction force was significantly smaller in the lateral foot contact than in the anterior foot contact when the cutting angle was large, similar to the pelvic forward inclination angle, regardless of the foot contact position. [Conclusion] As the cutting angle increased, the knee flexion and pelvic forward inclination angles decreased, resulting in an increase in the loading rate during cutting with the lateral foot contact. Therefore, an increase in the cutting angle can increase the risk of anterior cruciate ligament injury.Key words: Cutting, Ground reaction force, Foot contact position     

Effect of the Individual Strengthening Exercises for Posterior Pelvic Tilt Muscles on Back Pain,Pelvic Angle,and Lumbar ROM of a LBP Patient with Excessive Lordosis: A Case Study

[Purpose] The purpose of this study was to document the effect of individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic tilt angle, and lumbar ROM of a low back pain (LBP) patient with excessive lordosis. [Subjects] The subject was a 28 year-old male with excessive lordosis who complained of severe LBP at the L3 level. [Methods] He performed individual strengthening exercises for the posterior pelvic tilt muscles (rectus abdominis, gluteus maximus, hamstring). [Results] Pelvic tilt angles on the right and left sides recovered to his normal ranges. Limited lumbar ROM increased, and low back pain decreased. [Conclusion] We suggest that an approach of individual resistance exercises is necessary for the effective and fast strengthening of the pelvic posterior tilt muscles in case of LBP with excessive lordosis.Key words: LBP, Lordosis, Posterior pelvic tilt     

Effect of stretching program in an industrial workplace on hamstring flexibility and sagittal spinal posture of adult women workers: A randomized controlled trial

Objectives: To determine the effect of a stretching program performed in the workplace on the hamstring muscle extensibility and sagittal spinal posture of adult women. Material and methods: Fifty-eight adult women volunteers (mean age of 44.23 ± 8.87 years) from a private fruit and vegetable company were randomly assigned to experimental (n=27) or control (n=31) groups. The experimental group performed three exercises of hamstrings stretching of 20 seconds per exercise, three sessions a week for a period of 12 weeks. The control group did not participate in any hamstring stretching program. Hamstring flexibility was evaluated through the passive straight leg raise test and toe-touch test, performed both before and after the stretching program. Thoracic and lumbar curvatures and pelvic inclination were measured in relaxed standing and toe-touch test with a Spinal Mouse. Results: Significant increases (p < 0.01) in toe-touch score and straight leg raise angle (in both legs) were found in the experimental group during post-test, while the control group showed a non-significant decrease for both toe-touch score and straight leg raise test. A significant decrease in thoracic curve and significant increase in pelvic inclination were found in the toe-touch test for the experimental group (p <0.05). However, no significant changes were found in standing posture for any group. Conclusions: Hamstring stretching exercises performed in the working place are effective for increasing hamstring muscle extensibility. This increase generates a more aligned thoracic curve and more anterior pelvic inclination when maximal trunk flexion is performed.     

Effect of different seat heights on lumbar spine flexion during stand-to-sit motion

[Purpose] This study aimed to investigate the movement of the thorax, lumbar spine, and pelvis when healthy participants sit on a chair, and to identify the kinematic characteristics due to changes in the height of the seat. [Participants and Methods] Twenty healthy participants (14 males, 6 females; mean age, 29 ± 5 years) were recruited for this study. They performed stand-to-sit motion using one seat with a height of 100% that of the lower leg length (standard) and another with a height of 60% that of the lower leg length (lower). A three-dimensional motion analysis system and four force plates were used to analyze each joint angle. [Results] The mean lumbar spine flexion angle was significantly increased in the lower versus the standard seat. As a kinematic characteristic, the pelvis tilted posteriorly while the thorax tilted anteriorly, which increased the lumbar spine flexion angle. The pelvis was tilted posteriorly when the hip joint flexed about 60° regardless of the seat height. [Conclusion] The lumbar spine flexion angle increased in the lower seat stand-to-sit motion, which suggested an increase in the load on the lumbar spine. The lumbar spine flexion angle was influenced by the characteristic movements of the thorax and pelvis.     

Alterations of spinal range of motion while sitting in hemiplegic patients with or without gait available

[Purpose] The purpose of this study was to determine alterations of spinal range of motion while sitting, in hemiplegic patients with or without gait available. [Subjects] There was a gait group (GG) of 6 subjects, and a non-gait group (NGG) of 6 subjects, both with hemiplegia after a stroke. [Methods] The subjects in both groups were given an intervention focusing on ankle dorsi-flexion of the affected foot only once for 30 minutes. The Spinal Mouse was used to gain data of the spinal range of motion before and after the intervention and 30 minutes later for follow-up test. [Results] Only in the gait group, lumbar spinal range of motion showed a significant difference when using flexion extension. Sacral hip and inclination were both increased gradually when upright flexion and flexion extension were used. [Conclusion] Facilitating foot for ankle dorsi-flexion is effective on spinal range of motion especially sacrohip, lumbar spine and inclination only for the subjects in the gait group. The results suggested that ankle dorsi-flexion exercise influences spinal range of motion in a sitting position.     

Effects on Hamstring Muscle Extensibility,Muscle Activity,and Balance of Different Stretching Techniques

[Purpose] The purpose of this study was to investigate the effects of two different stretching techniques on range of motion (ROM), muscle activation, and balance. [Subjects] For the present study, 48 adults with hamstring muscle tightness were recruited and randomly divided into three groups: a static stretching group (n=16), a PNF stretching group (n=16), a control group (n=16). [Methods] Both of the stretching techniques were applied to the hamstring once. Active knee extension angle, muscle activation during maximum voluntary isometric contraction (MVC), and static balance were measured before and after the application of each stretching technique. [Results] Both the static stretching and the PNF stretching groups showed significant increases in knee extension angle compared to the control group. However, there were no significant differences in muscle activation or balance between the groups. [Conclusion] Static stretching and PNF stretching techniques improved ROM without decrease in muscle activation, but neither of them exerted statistically significant effects on balance.Key words: Balance, Muscle activation, Stretching