Low back pain and posture

Can the Mismatch of Measured Pelvic Morphology vs. Lumbar Lordosis Predict Chronic Low Back Pain Patients?

Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual's sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of lumbar sagittal radiographic alignment and modeling variables to identify if these can discriminate between normal controls and CLBP patients. Methods: We conducted a computer analysis of digitized vertebral body corners on lateral lumbar radiographs of normal controls and CLBP patients. Fifty normal controls were attained from a required pre-employment physical examination (29 men; 21 women; mean age of 27.7 ± 8.5 years), with no history of low back pain, a normal spinal examination, no pathologies, anomalies, or instability. Additionally, 50 CLBP patients (29 men; 29.5 ± 8 years of age) were randomly chosen and matched to the characteristics of the controls. The inclusion criteria required no abnormalities on lumbar spine radiographs. The parameters included the following: ARA L1-L5 lordosis, ARA T12-S1 lordosis, Cobb T12-S1, b/a elliptical modelling ratio, sacral base angle (SBA), and S1 posterior tangent to vertical (PTS1). Two measures of pelvic morphology were determined for each person-the angle of pelvic incidence (API) and posterior tangent pelvic incidence angle (PTPIA)-and the relationships between API - ARA T12-S1, API - Cobb T12-S1, and API - ARA L1-5 was determined. Descriptive statistics and correlations among the primary variables were determined. The receiver operating characteristic curves (ROC curves) for primary variables were analyzed. Results: The mean values of LL were statistically different between the normal and CLBP groups (p < 0.001), indicating a hypo-lordotic lumbar spine for the CLBP group. The mean b/a ratio was lower in the chronic pain group (p = 0.0066). The pelvic morphology variables were similar between the groups (p > 0.05). API had a stronger correlation to the SBA and Cobb T12-S1 than PTPIA did, while PTPIA had a stronger correlation to the S1 tangent and ARA T12-S1 than API did. While CLBP patients had a stronger correlation of ARA T12-S1 and Cobb T12-S1 relative to the pelvic morphology, they also had a reduced correlation of ARA L1-L5 lordosis relative to their SBA and pelvic morphology measures. API - T12-S1, API - L1-L5, and API - Cobb T12-S1 were statistically different between the groups, p < 0.001. Using ROC curve analyses, it was identified that ARA L1-L5 lordosis of 36° and ARA T12-S1 of 68° have a good sensitivity and specificity to discriminate between normal and CLBP patients. ROC curve analyses identified that lordosis ARAT12-S1 < 68° (AUC = 0.83), lordosis ARAL1-L5 < 36° (AUC = 0.78), API - ARA T12-S1 < -18° (AUC = 0.75), API - ARAL1-L5 > 35° (AUC = 0.71), and API - Cobb T12-S1 < -5° (AUC = 0.69) had moderate to good discrimination between groups (AUC = 0.83, 0.78, 0.75, and 0.72). Conclusions: Pelvic morphology is similar between normal and CLBP patients. CLBP patients have an abnormal 'fit' of their API - ARAT12-S1 and L1-L5 lumbar lordosis relative to their pelvic morphology and sacral tilt shown as a hypolordosis.

Sedentary lifestyle of university students is detrimental to the thoracic spine in men and to the lumbar spine in women

BACKGROUND

Sitting for long periods of time and lack of physical activity in young adults can cause postural deterioration leading to rapid onset of fatigue and increase the risk of back pain. We were interested in whether there are gender differences in spinal curvature among university students with a predominantly sedentary lifestyle.

METHODS

20 sedentary female (age 20 ± 0.73 years) and 39 sedentary male university students (age 20 ± 1.08 years) participated in this study. Their thoracic and lumbar curvatures were assessed while standing and sitting using a Spinal Mouse.

RESULTS

In standing, 80.0% of the females and 69.2% of the males had a neutral position of the thoracic spine (33.25° and 35.33°, respectively). However, more males, 30.8%, than females, 10.0%, had hyperkyphosis (54.27° and 47.0°, respectively). Hypokyphosis was found in 10.0% of the females (18.50°) and none in the males. Similarly, 90.0% of the females and 97.4% of the males had neutral position of the lumbar spine (-33.11° and -29.76°, respectively). Increased hyperlordosis was found in 10.0% of the females and 2.6% of the males (-41.0° and -50.0°, respectively). Hypolordosis was not detected in either females or males. In sitting, on the other hand, 70.0% of the females and only 33.3% of the males had a neutral position of the thoracic spine (30.20° and 30.62°, respectively). Increased hyperkyphosis was found in 46.2% of the males (59.76°) and none of the females. 30.0% of the females and 23.1% of the males had light hypokyphosis (47.50° and 46.67°, respectively). Similarly, 70.0% of the females and only 38.5% of the males had a neutral position of the lumbar spine (7.0° and 6.6°, respectively). 35.9% of the males and only 5.0% of the females had a light hypokyphosis (16.14° and 16.0°, respectively). Slightly increased hyperkyphosis was identified in 25.6% of the males and 25.0% of the females (23.9° and 22.5°, respectively).

CONCLUSION

There are significant gender differences in spinal curvature. While in the thoracic spine it was to the detriment of the males when both standing and sitting, in the lumbar spine it is related to the females only when standing. It is therefore necessary to eliminate these spinal deviations in young adults induced by prolonged sitting during university courses by appropriate recovery modalities.

Relationship between Physical Activity and Sedentary Behavior, Spinal Curvatures, Endurance and Balance of the Trunk Muscles-Extended Physical Health Analysis in Young Adults

BACKGROUND

Physical inactivity and sedentary behavior are associated with poor well-being in young people with adverse effects extending into adulthood. To date, there are many studies investigating the relationship between physical activity (PA) and posture, but there are no data on the relationship between the type and intensity of PA and sedentary behavior, their association with thoracic and lumbar spine angles, and with endurance and balance of the trunk muscles, especially in healthy young adults aged 18-25 years. Moreover, there are no data on the relationship between PA and sedentary behavior and musculoskeletal and cardiopulmonary health, as well as quality of life (QoL) and sleep that would provide a more comprehensive picture of physical health status.

AIM

Therefore, the aim of this cross-sectional study was to investigate the extent to which PA and sedentary behavior are associated with each other and with changes in spinal curvatures, endurance and balance of trunk muscles in an extended analysis of physical health status in young adults aged 18-25 years by additionally including measures of body composition, cardiorespiratory capacity, and QoL and sleep.

METHODS

A total of 82 students (58% female, 42% male) aged 18-25 years completed all required tests. Primary outcome measures included the following: PA and sedentary behavior calculated from the long form of International PA Questionnaire (IPAQ-LF), spinal curvatures measured by a Spinal Mouse® device, endurance and balance of the trunk muscles measured using trunk endurance tests and their ratio.

RESULTS

Overall, 50% of students were classified as minimally active and 50% as health-enhancing PA (HEPA) active. The angles of thoracic kyphosis and lumbar lordosis showed no correlation with PA or time spent sitting. However, students with the lowest PA had significantly higher scores on the trunk extensor endurance test and trunk extensor/flexor endurance test ratio, indicating imbalanced trunk muscles. Moreover, these students spent the most their time sitting. Only PA of vigorous intensity and PA during recreation, leisure, and sports significantly correlated with QoL related to physical health. QoL related to physical and psychosocial health had significantly higher scores when students spent less time sitting. In addition, we found significantly better respiratory performance and SQ at higher PA values, i.e., PA during recreation, leisure, and sport.

CONCLUSIONS

Our results suggest that students with low PA levels and more time spent sitting have imbalanced trunk muscles, worse respiratory function, and poorer QoL and sleep. Moreover, these findings in college students may reflect their lifestyle and suggest that more PA needs to be promoted to prevent the development of chronic diseases including musculoskeletal disorders.

Developing and Evaluating a Mixed Sensor Smart Chair System for Real-Time Posture Classification: Combining Pressure and Distance Sensors

A novel sensor-embedded smart chair system was developed to monitor and classify a worker's sitting postures in real time. The smart chair system was a mixed sensor system utilizing six pressure sensors and six infrared reflective distance sensors in combination. The pressure sensors were embedded in the seat cushion to gather seat cushion pressure distribution data. The distance sensors were placed in the seatback to measure seatback-trunk distances at different locations in the frontal plane. The use of the seatback distance sensors represented a unique design feature, which distinguished the mixed sensor system from the previous posture monitoring systems. Employing a k-Nearest Neighbor algorithm, the mixed sensor system classified an instantaneous posture as one of posture categories determined based on an analysis of the ergonomics literature on sitting postures and sitting-related musculoskeletal problems. The mixed sensor system was evaluated in posture classification performance in comparison with two benchmark systems that utilized only a single type of sensors. The purpose of the comparisons was to determine the utility of the design combining seat cushion pressure sensors and seatback distance sensors. The mixed sensor system yielded significantly superior classification performance than the two benchmark systems. The mixed sensor system is low-cost utilizing only a small number of sensors; yet, it accomplishes accurate classification of postures relevant to the ergonomic analyses of seated work tasks. The mixed sensor system could be utilized for various applications including the development of a real-time posture feedback system for preventing sitting-related musculoskeletal disorders.

Effects of Manual Therapy and Mechanical Massage on Spinal Alignment, Extension Range of Motion, Back Extensor Electromyographic Activity, and Thoracic Extension Strength in Individuals with Thoracic Hyperkyphosis: A Randomized Controlled Trial

Background

Manual therapy has been recommended to reduce and prevent musculoskeletal problems related to thoracic hyperkyphosis. With recent rapid technological developments, manual techniques can now be implemented by mechanical devices; hence, mechanical massage can manipulate the back muscles and mobilize the spine.

Purpose

Here, we aimed to 1) determine the effects of mechanical massage and manual therapy and 2) compare their effects on spinal posture, extension range of motion, trunk extensor electromyographic activity, and thoracic extension strength in individuals with thoracic hyperkyphosis.

Methods

Participants with thoracic hyperkyphosis were randomly assigned to the manual therapy (n = 16) or mechanical massage (n = 19) group. Each intervention was applied for 8 weeks. The participants' spinal posture, extension range of motion, trunk extensor electromyographic activity, and thoracic extension strength were measured before and after intervention.

Results

Intergroup analyses revealed no significant differences in any variables. However, thoracic kyphosis angle, thoracic extension range of motion, longissimus thoracis electromyographic activity, iliocostalis lumborum pars lumborum activity, and thoracic extension strength differed significantly in intertime analyses. The results of paired t-test analysis showed that thoracic kyphosis angle, thoracic extension range of motion, longissimus thoracis electromyographic activity, and thoracic extension strength were significantly different after intervention in both groups (p < 0.05).

Conclusions

Mechanical massage and manual therapy effectively improve thoracic kyphosis angle, thoracic extension range of motion, and thoracic extension strength. Therefore, mechanical massage is an alternative intervention to manual therapy for improving thoracic kyphosis angle, thoracic extension range of motion, and thoracic extension strength in participants with hyperkyphosis. This trail is registered with KCT0004527.

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

OBJECTIVE

The purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device.

METHODS

A total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles.

RESULTS

The agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement.

CONCLUSION

Our results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.

Evaluation of the association between postural control and sagittal curvature of the spine

Introduction

Balance is key to controlling body posture. Balance is typically assessed by measures of the body’s vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process.

Purpose of study

This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis.

Materials and method

The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement.

Results

Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999.

Conclusions

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

OBJECTIVE

The purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis.

METHODS

Sixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients.

RESULTS

The HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant.

CONCLUSION

In this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.

Effect of lumbar stabilization exercises and thoracic mobilization with strengthening exercises on pain level, thoracic kyphosis, and functional disability in chronic low back pain

OBJECTIVES

The purpose of this study was to compare the effect of lumbar stabilization exercise and thoracic mobilization with strengthening exercise on pain level, thoracic kyphosis, and functional disability in patients with Chronic Low Back Pain (CLBP).

METHODS

Thirty patients with CLBP were recruited based on inclusion and exclusion criteria. They were randomly allocated into two groups i. e., Group A (n = 15) and B (n = 15). Group A has received lumbar stabilization exercise and thoracic mobilization with strengthening exercises and Group B received only lumbar stabilization exercises, three sessions per week for 4 weeks both the groups. The conventional moist hot pack and interferential therapy was given to both the groups before the administration of exercise. Pre- and post-treatment pain level, Thoracic kyphosis, and functional disability were taken and statistical analysis was done.

RESULTS

The result of this study showed significant improvement from pre-intervention to post-intervention on pain level, thoracic kyphosis, and functional disability for both the groups i. e., Group A and group B but Group A showed greater changes in Numerical pain rating scale (NPRS), Kyphotic index, and Oswestry disability index (ODI), than Group B.

CONCLUSIONS

The 4 week of therapeutic intervention including lumbar stabilization exercise with thoracic mobilization and strengthening exercise showed significantly reduction of the thoracic kyphosis, pain level and functional disability in patients with Chronic Low Back Pain.

Spinal sagittal alignment, spinal shrinkage and back pain changes in office workers during a workday

Purpose. Prolonged sitting is a risk factor for the appearance of lower back pain during work. The aim of this study was to observe changes in spinal sagittal alignment, height and the perception of back pain in office workers during a workday. Materials and methods. Forty-one office workers (20 women) were enrolled into a cross-sectional study. Height, sitting height and degrees of thoracic kyphosis and lumbar lordosis as well as perceived neck pain, lower back pain and upper back pain were determined, before and after an 8-h workday. Results. At the end of the day, workers had a significant decrease (p = 0.000) in height and sitting height, and upper back pain increased significantly (p = 0.023). In men, spinal shrinkage correlated with neck pain (r = 0.410, p = 0.027), and lumbar lordosis degrees in women correlated negatively with upper back pain at the end of the day (r = -0.440, p = 0.012). Conclusions. Spinal shrinkage equally affects men and women who perform the same work. There are no changes in spinal sagittal alignment throughout the workday in office workers. Office workers show significantly increased pain in the upper back at the end of the day.

Sagittal spinal morphotype assessment in 8 to 15 years old Inline Hockey players

Background

Physiological sagittal spinal curvatures play an important role in health and performance in sports. For that reason, several scientific studies have assessed spinal morphology in young athletes. However, to our knowledge, no study has assessed the implications of Inline Hockey (IH) practice on sagittal integrative spinal morphotype in adolescent players.

Objectives

The aims of the present study were to describe habitual sagittal spinal posture in young federated IH players and its relationship with training load and to determine the sagittal integrative spinal morphotype in these players.

Methods

An observational analysis was developed to describe the sagittal spinal morphotype in young federated IH players. A total of 74 IH players from the Technification Plan organized by the Skating Federation of the Valencian Community (aged from 8 to 15 years) participated in the study. Thoracic and lumbar curvatures of the spine were measured in a relaxed standing position (SP), in a slump sitting position (SSP) and in maximum flexion of the trunk (MFT) to determine the "Sagittal Integrative Morphotype" of all players. An unilevel inclinometer was used to quantify the sagittal spinal curvatures. The Hip Joint Angle test was used to quantify the Lumbo-Horizontal angle in flexion (L-H fx) of all participants with a goniometer.

Results

When thoracic curvature was analyzed according to normality references, it was found that 64.9% of IH players had thoracic hyperkyphosis in a SSP, while 60.8% and 74.3% of players were classified as normal in a SP and in MFT, respectively. As for the lumbar curve, 89.2% in a SP and 55.4% in MFT were normal, whereas 68.9% of IH players presented lumbar hyperkyphosis in a SSP. Regarding the "Sagittal Integrative Morphotype," only 17.6% of players were classified as "Normal" in the three measured positions for the thoracic curve, while 37.8% had "Thoracic Hyperkyphosis" and 41.8% presented "Functional Thoracic Hyperkyphosis." As for the "Sagittal Integrative Lumbar Morphotype," only 23% of athletes had a normal curve in the three positions, whereas 66.2% presented "Functional Lumbar Hyperkyphosis." When the L-H fx was evaluated, the results showed that only 16.2% of the athletes were classified as normal.

Conclusions

Federative IH practice seems to cause specific adaptations in spinal sagittal morphotype. Taking into account the "Sagittal Integrative Morphotype" only 17.6% IH players presented "Normal Morphotype" with a normal thoracic kyphosis in the three measured positions, while only 23% IH players presented "Normal Morphotype" with a normal lumbar curvature in the three assessed positions. Furthermore, only 16.2% of IH players showed normal pelvic tilt. Exercise programs to prevent or rehabilitate these imbalances in young IH players are needed.

Spinal shrinkage, sagittal alignment and back discomfort changes in manufacturing company workers during a working day

Prolonged standing and lifting heavy loads are risk factors for the appearance of low back pain in work. The aim of this study was to observe changes in the height, spinal sagittal alignment, and the lumbar and dorsal discomfort perception in assembly line workers. Cross-sectional study, 40 assembly line workers (6 females). Height, sitting height, grades of thoracic kyphosis and lumbar lordosis and perceived spine discomfort, before and after the working day, were determined. Thoracic and lumbar sagittal alignment was compared between discomfort developers and no developers. There was a significant decrease in the height and sitting height of the workers at the end of the day. Thoracic and lumbar curvature increased significantly, as did the perceived lumbar discomfort. Workers on the assembly line, in a prolonged standing work, suffer an increase in lumbar discomfort, and changes in height and thoracic and lumbar curvatures. Practitioner summary: Spinal shrinkage, sagittal alignment and back discomfort (upper and lower back), were analysed in assembly line workers in prolonged standing during a workday. Assembly line workers suffer a decrease in height, an increase in their thoracic and lumbar curvature, and in lumbar discomfort throughout their workday.

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the effects of different exercise programs on thoracic kyphosis and lumbar lordotic angle. This meta-analysis adhered to the PRISMA guideline and it was registered at PROSPERO. Five electronic databases (Pub Med, Cochrane, WOS, PEDro and EBSCO) were searched up to 31 July 2018. Eligible studies were randomized controlled trials that applied an exercise intervention and measured a kyphosis and/or lordotic angle. Study quality was performance by PEDro score. Risk of bias was assessed using the SIGN 50 checklist for randomized controlled trials. External validity was assessed using the EVAT. Ten randomized controlled trials were included for systematic review and meta-analysis. Meta-analysis with a random effect model was performed to infer the pooled estimated standardized mean difference. All studies were RCTs and they involved a total of 284 cases and 255 controls. Seven studies measured kyphosis angle. A large significant effect of the exercise on kyphosis was identified (SMD = -1.400 (95% CI-2.150 a -0.660), p = 0.000). Four studies assessed lordotic angle and moderate but not significant improvement was shown (SMD = -0.530 (95% CI-1.760 a -0.700), p = 0.401). The results suggest that exercise programs may have a positive effect on thoracic kyphosis angle, but no clear effect on lordotic angle. This systematic review suggests that strengthening rather than stretching could be more relevant for kyphosis and both qualities are important for lordosis. It is necessary to conduct more randomized controlled trials to assess the effects of strengthening and/or stretching program on kyphosis and lordotic angle and to establish the type of the exercise that is better for maintaining the sagittal disposition within normal ranges.

The relationship between lumbar lordosis angle and low back pain in individuals with transfemoral amputation

BACKGROUND:

Low back pain is a common secondary disabling condition in the transfemoral amputee population. Transfemoral amputees are at risk of excessive lumbar lordosis; it has been suggested that increased lumbar lordosis may be associated with low back pain. However, the relationship between lumbar lordosis angle and low back pain has not yet been studied in this population.

OBJECTIVE:

To determine whether the extent of lumbar lordosis is associated with low back pain in transfemoral amputees.

STUDY DESIGN:

Case-control observational study.

METHODS:

Participants included eight transfemoral amputees without low back pain and nine transfemoral amputees with low back pain. Etiology of amputation was primarily trauma. All participants underwent lateral view radiographs of the lumbar spine, from which lumbar lordosis angle and sacral inclination angle were measured.

RESULTS:

Lumbar lordosis angle mean ± standard deviation was 46.1° ± 12.4° in participants with low back pain and 51.0° ± 12.6° in those without. Sacral inclination angle mean ± standard deviation was 38.3° ± 8.7° in participants with low back pain and 39.1° ± 7.5° in those without. There was no significant difference in lumbar lordosis angle or sacral inclination angle between participants with and without low back pain.

CONCLUSION:

This study suggests that increased lumbar lordosis angle and sacral inclination angle are not significantly associated with low back pain in transfemoral amputees of a primarily traumatic etiology.

CLINICAL RELEVANCE

Low back pain (LBP) is a common, disabling condition in transfemoral amputees. In the clinical setting, increased lumbar lordosis is implicated in LBP. This study does not support an association between increased lumbar lordosis and LBP; further study is needed to understand the increased prevalence of LBP in this population.

Effects of Physical Therapy on Pain, Functional Status, Sagittal Spinal Alignment, and Spinal Mobility in Chronic Non-specific Low Back Pain

Objective

To investigate the effects of physical therapy (PT) on pain, functional status, sagittal spinal alignment, and spinal mobility in chronic non-specific low back pain (NSLBP).

Materials and Methods

The study population consisted of 100 patients with chronic NSLBP. The study group comprised 60 patients to whom a PT program including superficial heat, transcutaneous electrical nerve stimulation, and ultrasound for 10 sessions was assigned. The control group was composed of 40 patients who received no PT. Home exercise programs were applied to both groups. Pain severity was determined using a Visual Analog Scale (VAS), and functional status was evaluated using the Oswestry Disability Index (ODI). Spinal sagittal alignment in regard to lumbosacral, lumbar lordosis, and thoracic kyphosis angles and spinal mobility regarding lumbar and thoracic flexion and extension degrees were assessed using a digital inclinometer. Lumbar flexion was also assessed using the modified lumbar Schober test (mLST). Evaluations were performed at baseline and after completing the therapy sessions.

Results

There were significant decreases in VAS scores in each group upon therapy completion. However, significant improvements in ODI, mLST, and all inclinometric evaluations in terms of sagittal spinal alignment and spinal mobility were noted only in the study group compared with baseline values (p<0.05).

Conclusion

Despite the short course of treatment, PT was found to have significant positive effects on pain severity, functional status, sagittal spinal alignment, and spinal mobility. PT was determined to be an effective treatment option for chronic NSLBP.

Effect of age and sex on lumbar lordosis and the range of motion. A systematic review and meta-analysis

Lumbar lordosis (LL) and the range of motion (RoM) are important physiological measurements when initiating any diagnosis and treatment plan for patients with low back pain. Numerous studies reported differences in LL and the RoM due to age and sex. However, these findings remain contradictory. A systematic review and meta-analysis were performed to synthesize mean values and the differences in LL and the RoM because of age and sex. The quality assessment tool for quantitative studies was applied to assess the methodological quality of the studies included. We identified 2372 papers through electronic (2309) and physical (63) searches. We assessed 218 full-text studies reporting measurements of LL or the RoM. In total, 65 studies were included, and a normative database for LL and the RoM is provided as supplementary material. Among these, 11 were included in the meta-analysis. LL and the RoM displayed non-monotonic variations with significant age and sex differences. Young females showed a significantly greater LL and the range of extension (RoE), whereas young males exhibited a greater range of flexion (RoF). Sex differences in the range of lateral bending (RoLB) were small but were significant for the axial rotation (RoAR). For the RoF, RoE and RoLB, differences because of age were significant among most of the age groups in both sexes, whereas for the RoAR, differences were significant only between the 20s vs the 30s-40s (males) and 40s vs 50s (females). Significant differences because of age/sex were identified. However, the age-dependent reduction in LL and the RoM was non-monotonic and differed in both sexes. These findings will help to better distinguish between functional deficits caused by spinal disorders and natural factors/conditions related to age and sex.

Is PostureScreen® Mobile app an accurate tool for dentists to evaluate the correlation between malocclusion and posture?

OBJECTIVE

To determine whether PostureScreen® Mobile app is a useful, simple tool that is accessible for dentists to evaluate the correlation between malocclusion and posture.

METHODS

Twenty-nine subjects underwent static and dynamic dental occlusion examinations and a postural exam with PostureScreen® Mobile app, a photographic method. The subjects were divided into groups depending on their static and dynamic occlusion features. The postural parameters were then compared between these groups.

RESULTS

Statistically significant differences (p < 0.05) for some postural parameters were obtained for Angle Class 1 vs. 2 and 3 and for the passive interference group and active premature contacts group during left lateral movement. There were no statistically significant differences regarding protrusion and right lateral movement.

DISCUSSION

Dental occlusion anomalies and posture pathological modifications can be inter-related. PostureScreen® Mobile app might represent a useful tool in the early diagnosis of dental occlusion pathology.

Semi-Automatic Segmentation of Vertebral Bodies in MR Images of Human Lumbar Spines

We propose a semi-automatic algorithm for the segmentation of vertebral bodies in magnetic resonance (MR) images of the human lumbar spine. Quantitative analysis of spine MR images often necessitate segmentation of the image into specific regions representing anatomic structures of interest. Existing algorithms for vertebral body segmentation require heavy inputs from the user, which is a disadvantage. For example, the user needs to define individual regions of interest (ROIs) for each vertebral body, and specify parameters for the segmentation algorithm. To overcome these drawbacks, we developed a semi-automatic algorithm that considerably reduces the need for user inputs. First, we simplified the ROI placement procedure by reducing the requirement to only one ROI, which includes a vertebral body; subsequently, a correlation algorithm is used to identify the remaining vertebral bodies and to automatically detect the ROIs. Second, the detected ROIs are adjusted to facilitate the subsequent segmentation process. Third, the segmentation is performed via graph-based and line-based segmentation algorithms. We tested our algorithm on sagittal MR images of the lumbar spine and achieved a 90% dice similarity coefficient, when compared with manual segmentation. Our new semi-automatic method significantly reduces the user's role while achieving good segmentation accuracy.

Spinal Deformity Surgery: A Critical Review of Alignment and Balance

Correction of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. Standard values have been defined for all these parameters, and the formulas of correction have been set for determining the surgical strategy. However, several factors can potentially bias these formulas. First, all standard values are measured using conventional plain radiographs and are, therefore, prone to bias. The radiologist, measuring surgeon, and patient are possible confounding influencing factors. Second, spino-pelvic compensatory effects and biomechanically relevant structures for the patient’s posture, including ligaments, tendons, and muscles, have received minimal consideration in the literature. Therefore, even in cases of appropriately planned deformity correction surgeries, complications, revision rates, and surgical outcomes significantly vary. This study aimed to illustrate the current clinical weaknesses of the assessment of spinal alignment and the importance of holistically approaching the musculoskeletal system for any spinal deformity surgery. We believe that our detailed insights regarding spinal, sagittal, and coronal alignments as well as the considerations of an individual’s spinal balance will contribute toward improvement in routine patient care.

Relationship Between Radiographic Lumbosacral Spine Mensuration and Chronic Low Back Pain Intensity: A Cross-sectional Study

Objective

The purpose of this study was to investigate correlative factors affecting chronic low back pain (CLBP), with special emphasis on the radiographic postural findings in the sagittal lumbosacral spine.

Methods

A cross-sectional study alongside a randomized trial was conducted. Standing lateral lumbar spine radiographs from 352 patients with CLBP enrolled in a randomized trial were analyzed and radiographic mensuration of lumbar lordosis, lumbosacral disc angle, and sacral inclination performed. These angles were correlated with baseline variables, including CLBP intensity, age, and sex. Multiple polynomial regressions were performed in which CLBP intensity was regressed on linear and quadratic terms of lumbar lordosis to investigate the possibility of greater pain with hypo- and/or hyperlordosis.

Results

There was no significant correlation of the angles with pain and age (r ≤ 0.09, P > .05). Weak but statistically significant correlation was identified between all 3 measurements and sex (r = -0.12 to 0.21, P < .05). Greater pain was not noted for hypo- and hyperlordosis; regression coefficients for the linear and quadratic effects were approximately 0 (P > .05).

Conclusion

This study determined that there was no correlation between lumbar lordosis and pain levels for people with CLBP; thus, use of lumbar spine radiographic mensuration in the management of pain for people with CLBP is not recommended.

Test-retest reliability and validity of a motion capture (MOCAP) system for measuring thoracic and lumbar spinal curvatures and sacral inclination in the sagittal plane

OBJECTIVE

To evaluate the test-retest reliability and validity of the MOCAP system for measuring spinal sagittal thoracic and lumbar curvatures and sacral inclination in a standing posture.

METHODS

Twenty-five male adults were evaluated on lateral standing radiographs. The thoracic and lumbar curvatures were calculated by Harrison's posterior tangent method. The sacral inclination was defined as the angle between the tangent line of the sacral and vertical plane. In addition, MOCAP was used to calculate the spinal curvatures and sacral inclination.

RESULTS

The thoracic and lumbar spine and sacral inclination demonstrated excellent reliability, with mean ICCs levels greater than 0.980 and low CVs (mean: 2.15%). Systematic biases were not significant and were very near 0, and the mean standard errors were 0.257∘. ANOVA of the radiographic and MOCAP measures did not report any statistically significant differences in the comparisons. The systematic biases and mean random errors were lower than 1∘, with CVs lower than 5% and mean ICCs higher than 0.90 between sessions.

CONCLUSION

The MOCAP system delivered consistently reliable and valid results for standing curvatures compared with a radiographic technique. This system could be used with confidence in research and clinical environments for sagittal spinal curvature measurements.

The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment

BACKGROUND

The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting.

METHOD

Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex.

RESULTS

Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1-L3 in all conditions (p < 0.0001).

CONCLUSION

No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture. Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.

The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis

BACKGROUND CONTEXT

Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP.

PURPOSE

This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP.

STUDY DESIGN

Systematic review and meta-analysis.

PATIENT SAMPLE

The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded.

METHODS

A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I² statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors.

RESULTS

A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: -0.94, 95% CI: -1.19 to -0.69), with sufficient homogeneity based on significance level of .1 (I²=45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: -0.33, 95% CI: -0.46 to -0.21), without statistical heterogeneity (I²=0%, p=.916).

CONCLUSIONS

This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC.

Normative 3D opto-electronic stereo-photogrammetric posture and spine morphology data in young healthy adult population

Design: Observational cross-sectional study. The current study aims to yield normative data: i.e., the physiological standard for 30 selected quantitative 3D parameters that accurately capture and describe a full-skeleton, upright-standing attitude. Specific and exclusive consideration was given to three distinct categories: postural, spine morphology and pelvic parameters. To capture such 3D parameters, the authors selected a non-ionising 3D opto-electronic stereo-photogrammetric approach. This required the identification and measurement of 27 body landmarks, each specifically tagged with a skin marker. As subjects for the measurement of these parameters, a cohort of 124 asymptomatic young adult volunteers was recruited. All parameters were identified and measured within this group. Postural and spine morphology data have been compared between genders. In this regard, only five statistically significant differences were found: pelvis width, pelvis torsion, the “lumbar” lordosis angle value, the lumbar curve length, and the T12-L5 anatomically-bound lumbar angle value. The “thoracic” kyphosis mean angle value was the same in both sexes and, even if, derived from skin markers placed on spinous processes it resulted in perfect agreement with the X-ray based literature. As regards lordosis, a direct comparison was more difficult because methods proposed in the literature differ as to the number and position of vertebrae under consideration, and their related angle values. However, when the L1 superior–L5 inferior end plate Cobb angle was considered, these results aligned strongly with the existing literature. Asymmetry was a standard postural-spinal feature for both sexes. Each subject presented some degree of leg length discrepancy (LLD) with μ = 9.37mm. This was associated with four factors: unbalanced posture and/or underfoot loads, spinal curvature in the frontal plane, and pelvis torsion. This led to the additional study of the effect of LLD equalisation influence on upright posture, relying on a sub-sample of 100 subjects (51 males, 49 females). As a result of the equalisation, about 82% of this sub-sample showed improvement in standing posture, mainly in the frontal plane; while in the sagittal plane less than 1/3 of the sub-sample showed evidence of change in spinal angles. A significant variation was found in relation to pelvis torsion: 46% of subjects showed improvement, 49% worsening. The method described in study presents several advantages: non-invasive aspect; relatively short time for a complete postural evaluation with many clinically useful 3D and 2D anatomical/biomechanical/clinical parameters; analysis of real neutral unconstrained upright standing posture.

How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients

An irreproducible standing posture can lead to mis-interpretation of radiological measurements, wrong diagnoses and possibly unnecessary treatment. This study aimed to evaluate the differences in lumbar lordosis and sacrum orientation in six repetitive upright standing postures of 353 asymptomatic subjects (including 332 non-athletes and 21 athletes - soccer players) and 83 low back pain (LBP) patients using a non-invasive back-shape measurement device. In the standing position, all investigated cohorts displayed a large inter-subject variability in sacrum orientation (∼40°) and lumbar lordosis (∼53°). In the asymptomatic cohort (non-athletes), 51% of the subjects showed variations in lumbar lordosis of 10-20% in six repeated standing phases and 29% showed variations of even more than 20%. In the sacrum orientation, 53% of all asymptomatic subjects revealed variations of >20% and 31% of even more than 30%. It can be concluded that standing is highly individual and poorly reproducible. The reproducibility was independent of age, gender, body height and weight. LBP patients and athletes showed a similar variability as the asymptomatic cohort. The number of standing phases performed showed no positive effect on the reproducibility. Therefore, the variability in standing is not predictable but random, and thus does not reflect an individual specific behavioral pattern which can be reduced, for example, by repeated standing phases.

Test-retest reliability and validity of a motion capture (MOCAP) system for measuring thoracic and lumbar spinal curvatures and sacral inclination in the sagittal plane

OBJECTIVE

To evaluate the test-retest reliability and validity of the MOCAP system for measuring spinal sagittal thoracic and lumbar curvatures and sacral inclination in a standing posture.

METHODS

Twenty-five male adults were evaluated on lateral standing radiographs. The thoracic and lumbar curvatures were calculated by Harrison's posterior tangent method. The sacral inclination was defined as the angle between the tangent line of the sacral and vertical plane. In addition, MOCAP was used to calculate the spinal curvatures and sacral inclination.

RESULTS

The thoracic and lumbar spine and sacral inclination demonstrated excellent reliability, with mean ICCs levels greater than 0.980 and low CVs (mean: 2.15%). Systematic biases were not significant and were very near 0, and the mean standard errors were 0.257∘. ANOVA of the radiographic and MOCAP measures did not report any statistically significant differences in the comparisons. The systematic biases and mean random errors were lower than 1∘, with CVs lower than 5% and mean ICCs higher than 0.90 between sessions.

CONCLUSION

The MOCAP system delivered consistently reliable and valid results for standing curvatures compared with a radiographic technique. This system could be used with confidence in research and clinical environments for sagittal spinal curvature measurements.

Association between vertebral cross-sectional area and lumbar lordosis angle in adolescents

Lumbar lordosis (LL) is more prominent in women than in men, but the mechanisms responsible for this discrepancy are poorly defined. A recent study indicates that newborn girls have smaller vertebral cross-sectional area (CSA) when compared to boys-a difference that persists throughout life and is independent of body size. We determined the relations between vertebral cross-sectional area (CSA) and LL angle and whether sex differences in lumbar lordosis are related to sex differences in vertebral CSA. Using multi-planar magnetic resonance imaging (MRI), we measured vertebral cross-sectional area (CSA) and vertebral height of the spine of 40 healthy boys and 40 girls, ages 9-13 years. Measures of the CSA of the lumbar vertebrae significantly differed between sexes (9.38 ± 1.46 vs. 7.93 ± 0.69 in boys and girls, respectively; P < 0.0001), while the degree of LL was significantly greater in girls than in boys (23.7 ± 6.1 vs. 27.6 ± 8.0 in boys and girls, respectively; P = 0.02). When all subjects were analyzed together, values for LL angle were negatively correlated to vertebral CSA (r = -0.47; P < 0.0001); this was also true when boys and girls were analyzed separately. Multivariate regression analysis indicated that vertebral CSA was independently associated with LL, even after accounting for sex, age, height or vertebral height, and weight. Similar negative relations were present when thoracic vertebrae were analyzed (Model P < 0.0001, R2 = 0.37, thoracic vertebral CSA slope P < 0.0001), suggesting that deficient vertebral cross-sectional dimensions are not merely the consequence of the anterior lumbar curvature. We conclude that vertebral CSA is negatively associated with LL, and that the greater degree of LL in females could, at least in part, be due to smaller vertebral cross-sectional dimensions. Studies are needed to examine the potential relations between vertebral CSA and spinal conditions known to be associated with increased LL, such as spondylolysis and spondylolisthesis.

Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty With Rectus Plication

BACKGROUND

Substantial fluctuations in body weight can result in diastasis recti and weakening of the connections between the lateral abdominal muscles and the rectus sheath.

OBJECTIVES

The authors sought to determine the postural and psychological effects of abdominoplasty with vertical rectus plication.

METHODS

Forty women with substantial back and lumbar pain owing to abdominal lipodystrophy were evaluated in a prospective study. Preoperatively and 6 months postoperatively, patients underwent bidirectional radiography of the thoracic and lumbar regions. A visual analog scale (VAS), the Beck Depression Inventory (BDI), and the Nottingham Health Profile (NHP) were applied to assess physical, psychological, and quality-of-life changes following surgery.

RESULTS

Significant improvements in posture, assessed in terms of lumbar lordosis, thoracic kyphosis, and the lumbosacral angle, were observed 6 months after abdominoplasty with rectus plication. Results of the VAS and BDI indicated significant improvements in pain and quality of life, respectively. Results of the NHP indicated significant postoperative improvements in fatigue, pain, and sleep.

CONCLUSIONS

Abdominoplasty with rectus plication improves posture by tightening the thoracolumbar fascia. In selected patients, abdominoplasty can reduce back and lumbar pain, thereby improving quality of life.

The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain

[Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

Prevalence of back pain, functional disability, and spinal postural changes

Abstract Objective : To evaluate the prevalence of back pain, disability, and postural changes in the spines of adults of different ages and with different levels of body mass index (BMI). Methodology : A total of 534 users of the Brazilian Public Health System in Porto Alegre, Brazil, were included in the study. An evaluation of the thoracic and lumbar spine was performed using the Flexicurve instrument. Data was analyzed using descriptive statistics and the calculation of prevalence ratios (PR) and their respective confidence intervals of 95% (CI 95%). Three analyses were performed with the dependent variables pain, functional disability, and posture. Results : A significant association between pain and female gender (p = 0.000), and pain and change in the lumbar spine (p = 0.014) were found. The variable disability was associated with BMI (p = 0.004) and age (p = 0.001). When we analyzed postural change, an association was found only with age group (p = 0.032). Conclusion : These findings highlight the need for prevention and primary care educational programs aimed at reducing postural aberrations in the adult population.

Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing: A Cross-Sectional MRI Study

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI).

SUMMARY OF BACKGROUND DATA

The lumbar lordosis increases with a change of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain.

METHODS

Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured.

RESULTS

Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75 (±5.0) mm during activities, and 38 healthy controls were included. MRI findings were common in both groups, whereas, the summation of the Pfirrmann's grades (LDD-score) was significantly higher in the patients [(MD 1.44; 95% confidence intervals (CI) 0.80 to 2.10; P < 0.001]. The patients were less lordotic than the controls in both the supine (MD -6.4°; 95% CI -11.4 to -1.3), and standing position (MD -5.6°; 95% CI -10.7 to -0.7); however, the changes between the positions (ΔLA) were the same (MD 0.8°; 95% CI -1.8 to 3.3). Using generalized linear model the LDD-score was associated with age (P < 0.001) for both groups. The LDD-score and ΔLA were negatively associated in the control group (P < 0.001), also after adjustments for gender and age (β-coefficient: -2.66; 95% CI -4.3 to -1.0; P = 0.002).

CONCLUSION

Patients may be less lordotic in both the supine and standing position, whereas, change in the lordosis between the positions may be independent of pain. Decreasing lordosis change seems to be associated with age-related increasing disc degeneration in healthy individuals.

LEVEL OF EVIDENCE

2.

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.

Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response

BACKGROUND

Women with macromastia suffer from bodily disproportions like increased spinal curvature owing to the mass effect caused by severely large breasts. In such cases, the erector spinae muscles generate an overcompensatory pressure to maintain a normal posture, resulting in neck, back, and lumbar pain. This study aimed to objectively show the improvement of physical symptoms after reduction mammaplasty and evaluate psychological and physical changes of patients.

METHODS

Pre- and postoperative cervical, thoracic, and lumbar bidirectional (anteroposterior and lateral) radiographs were obtained from 40 patients who underwent reduction mammaplasty. Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angles were evaluated. Body mass index, breast tissue volume, and excised tissue amount were recorded for each patient. Visual Analog Scores (VAS) were used to qualify the severity of neck, back, and lumbar pain, the Nottingham Health Profile (NHP) to evaluate quality of life (QoL), and the Beck Depression Inventory (BDI) to evaluate depression severity.

RESULTS

Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angle improved, and patients' neck, back, and lumbar pain decreased. The positive correlation between the excised glandular tissue amount and the decrease in neck, back, and lumbar pain was reflected in the results of VAS, NHP, and BDI tests. After reduction mammaplasty, depression symptoms caused by macromastia decreased. Parameters of QoL, including physical activity, socialization, fatigue, sleeping, and emotional reactions, significantly improved.

CONCLUSION

Patients with macromastia should be considered for reduction mammaplasty before the onset of postmenopausal osteoporosis to improve QoL.

Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation

[Purpose] The aim of this study was to evaluate the effects of scapula-upward taping (SUT) in a patient with shoulder pain caused by scapular downward rotation (SDR). [Subject] A 26-year-old male with SDR experienced severe pain in the left shoulder when he lifted his left upper extremity to hold the handle in a bus and during and after push-up exercise. [Methods] The patient underwent SUT for a period of 1 month, 5 times per week, for an average of 9 h/d. [Results] The patient's radiographs showed that the degree of SDR had decreased; the left shoulder pain also decreased in the resting state and during and after push-up exercise. The manual muscle strength test grades of the upper trapezius, lower trapezius, and serratus anterior had increased. The patient was able to lift the left upper extremity to hold the handle in a bus and perform the push-up exercise without experiencing any pain. [Conclusion] Repeated SUT application may be a beneficial treatment method for alleviating the degree of SDR and shoulder pain in SDR patients.

Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers

Background

The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging.

Methods and Findings

A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20–75 yrs; BMI <26.0 kg/m²; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20–29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE.

Conclusions

During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.

Correlation between Radiologic Sign of Lumbar Lordosis and Functional Status in Patients with Chronic Mechanical Low Back Pain

Study Design

A cross-sectional study.

Purpose

To describe the correlation between lumbar lordosis angle and functional status of patients with chronic mechanical low back pain (CMLBP).

Overview of Literature

There are different and conflicting opinions regarding the relationship between the degree of lumbar lordosis and functional status of patients with low back pain. Nonetheless, the severity of lordosis is still one of the routine physical exams considered in rehabilitation clinics.

Methods

The degree of lumbar lordosis of 150 patients with CMLBP was measured by means of Cobb's method using sagittal standing spinal radiographs. Subjects with probable secondary causes of low back pain (trauma, congenital anomaly, spinal infection, rheumatologic problems and history of spinal surgery) were excluded. Besides recording demographic data, their score of functional disability was estimated using Oswestry Disability Questionnaire, one of the most useful and reliable questionnaires. Comparison between these data was made regarding different age and gender groups.

Results

In this study, 119 subjects were female and 31 male, with an age range of 19-85 years. The average degree of lumbar lordosis was 44.69±11.43 and that of Oswestry disability index (ODI) 30.52%. Although we found a significant direct relationship between age and degree of lumbar lordosis (Pearson's correlation coefficient, p=0.016, r=0.197), while insignificant correlation was seen between the degree of lumbar lordosis and ODI (p=0.129).

Conclusions

There was no significant correlation between the degree of lumbar lordosis and the score of functional disability with regards to different age groups and gender.

Spine curvature analysis between participants with obesity and normal weight participants: a biplanar electromagnetic device measurement

To analyse and compare standing thoracolumbar curves in normal weight participants and participants with obesity, using an electromagnetic device, and to analyse the measurement reliability.

MATERIAL AND METHODS

Cross-sectional study was carried out. 36 individuals were divided into two groups (normal-weight and participants with obesity) according to their waist circumference. The reference points (T1-T8-L1-L5 and both posterior superior iliac spines) were used to perform a description of thoracolumbar curvature in the sagittal and coronal planes. A transformation from the global coordinate system was performed and thoracolumbar curves were adjusted by fifth-order polynomial equations. The tangents of the first and fifth lumbar vertebrae and the first thoracic vertebra were determined from their derivatives. The reliability of the measurement was assessed according to the internal consistency of the measure and the thoracolumbar curvature angles were compared between groups.

RESULTS

Cronbach's alpha values ranged between 0.824 (95% CI: 0.776-0.847) and 0.918 (95% CI: 0.903-0.949). In the coronal plane, no significant differences were found between groups; however, in sagittal plane, significant differences were observed for thoracic kyphosis.

CONCLUSION

There were significant differences in thoracic kyphosis in the sagittal plane between two groups of young adults grouped according to their waist circumference.

Midsagittal anatomy of lumbar lordosis in adult egyptians: MRI study

Despite the increasing recognition of the functional and clinical importance of lumbar lordosis, little is known about its description, particularly in Egypt. At the same time, magnetic resonance imaging (MRI) has been introduced as a noninvasive diagnostic technique. The aim of this study was to investigate the anatomy of the lumbar lordosis using midsagittal MRIs. Normal lumbar spine MRIs obtained from 93 individuals (46 males, 47 females; 25–57 years old) were evaluated retrospectively. The lumbar spine curvature and its segments “vertebrae and discs” were described and measured. The lumbar lordosis angle (LLA) was larger in females than in males. Its mean values increased by age. The lumbar height (LH) was longer in males than in females. At the same time, the lumbar breadth (LB) was higher in females than in males. Lumbar index (LI = LB/LH × 100) showed significant gender differences (P < 0.0001). Lordosis was formed by wedging of intervertebral discs and bodies of lower lumbar vertebrae. In conclusion, MRI might clearly reveal the anatomy of the lumbar lordosis. Use of LI in association with LLA could be useful in evaluation of lumbar lordosis.

The impact of breast reduction surgery on the vertebral column

BACKGROUND

Although many studies have shown that breast reduction surgery is effective in reducing neck, back, and lumbar pain, most of these studies are subjective evaluations that usually provide data through pain scales. This study was undertaken to objectively evaluate the radiologic effects of breast reduction on the vertebral column.

METHODS

Thirty patients who underwent breast reduction surgery were included in the study. A lateral thoracolumbar radiograph was taken before and 3 months after surgery for each patient. The thoracic kyphosis, lumbar lordosis, and sacral inclination angles were measured for each radiograph. The impact of breast reduction surgery on posture was evaluated according to the comparison of these angles before and after surgery. The effect of age, body mass index, and the total amount of removed tissue was also taken into account, and the relationship between these parameters and their effects on the change in preoperative and postoperative angle measurements were evaluated.

RESULTS

There was a significant decrease in all 3 angles after breast reduction surgery. A significant correlation was determined between body mass index and the total amount of removed tissue on the change in angle measurements, whereas a definite relationship was not observed between the angles and the patient's age.

CONCLUSIONS

This study has shown the objective impact that breast reduction surgery has on the vertebral column. Although the symptomatic relief of breast reduction surgery on the musculoskeletal system is widely accepted, the objective assessment of this relief will be beneficial in persuading health insurance companies and those who think of this surgery as a purely aesthetic procedure.

Lumbar lordosis

Lumbar lordosis is a key postural component that has interested both clinicians and researchers for many years. Despite its wide use in assessing postural abnormalities, there remain many unanswered questions regarding lumbar lordosis measurements. Therefore, in this article we reviewed different factors associated with the lordosis angle based on existing literature and determined normal values of lordosis. We reviewed more than 120 articles that measure and describe the different factors associated with the lumbar lordosis angle. Because of a variety of factors influencing the evaluation of lumbar lordosis such as how to position the patient and the number of vertebrae included in the calculation, we recommend establishing a uniform method of evaluating the lordosis angle. Based on our review, it seems that the optimal position for radiologic measurement of lordosis is standing with arms supported while shoulders are flexed at a 30° angle. There is evidence that many factors, such as age, gender, body mass index, ethnicity, and sport, may affect the lordosis angle, making it difficult to determine uniform normal values. Normal lordosis should be determined based on the specific characteristics of each individual; we therefore presented normal lordosis values for different groups/populations. There is also evidence that the lumbar lordosis angle is positively and significantly associated with spondylolysis and isthmic spondylolisthesis. However, no association has been found with other spinal degenerative features. Inconclusive evidence exists for association between lordosis and low back pain. Additional studies are needed to evaluate these associations. The optimal lordotic range remains unknown and may be related to a variety of individual factors such as weight, activity, muscular strength, and flexibility of the spine and lower extremities.

The effect of reduction mammaplasty on the vertebral column: a radiologic study

Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P > 0,05). The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P > 0,05). Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column.