The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device

Recovery of the Medial Elbow Joint in the 24-Hour Period After Repetitive Pitching in High School Players

BACKGROUND

Repetitive pitching causes immediate changes in the medial elbow joint. However, the recovery process from these changes is not clear.

PURPOSE/HYPOTHESIS

The purpose of this study was to investigate the recovery of the medial elbow joint in the 24-hour period after pitching. The hypothesis was that while some recovery will occur at 24 hours after repetitive pitching, this would not be a complete return to baseline.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 26 high school baseball pitchers participated (mean age, 16.0 ± 0.5 years). Participants threw 100 pitches (5 sets of 20 pitches). Medial elbow joint width as well as strain ratios of the ulnar collateral ligament (UCL) and forearm flexor-pronator muscles (FPMs) were measured and followed for 24 hours after pitching. The data before pitching and at each time point after pitching were compared. The standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated using measurements before pitching.

RESULTS

The medial elbow joint width significantly increased by 0.84 mm immediately after pitching (P < .05), but this was not maintained at 24 hours. The UCL strain ratio significantly decreased by 1.64 immediately after pitching (P < .05), but this was not maintained at 18 hours after pitching. The strain ratio of the FPMs significantly decreased by 0.09 immediately after pitching (P < .05) but significantly increased by 0.13 at 24 hours (P < .05). The SEM for medial elbow joint width was 0.06 mm, and the MDC95 was 0.18 mm (maximum change: 0.84 mm immediately after pitching). The SEM for UCL strain ratio was 0.85, and the MDC95 was 2.35 (maximum change: 1.64 immediately after pitching). The SEM for strain ratio of the FPMs was 0.08, and the MDC95 was 0.22 (maximum change: 0.13 at 24 hours).

CONCLUSION

After 100 pitches, stability against elbow valgus laxity recovered within 24 hours. UCL and FPMs showed statistical characteristic changes, but those changes were within the minimal detectable change.

CLINICAL RELEVANCE

Pitchers' medial elbow joint tissue recovered to baseline at 24 hours after pitching. This suggests that it may be acceptable to resume low-intensity throwing after a 24-hour rest period after 100 repetitive pitches while also considering the condition of the rest of the body.

Effect of different corrective force directions applied by spinal orthoses on the patients with adolescent idiopathic scoliosis

BACKGROUND

Spinal orthoses are commonly prescribed for adolescent idiopathic scoliosis (AIS), yet their three-dimensional correction was not fully understood. The amount of deformity control largely depends on the corrective forces applied, which remain empirically based due to a lack of consensus on optimal force application. This study investigated the effects of different corrective force directions exerted by spinal orthoses on patients with AIS.

METHODS

A retrospective analysis was conducted on 78 subjects. The trunk was segmented into four quadrants using coronal and sagittal planes from a top-down perspective. Each left or right posterolateral quadrant (with 90°) was further subdivided into zones 1-4, from the sagittal to coronal planes. Based on the zone where the resultant corrective force direction fell, the subjects were categorized into Group 1 (zone 1), Group 2 (zone 2), Group 3 (zone 3), or Group 4 (zone 4). The direction of the corrective force was estimated using modified models of the subjects' bodies, designed through a computer-aided design and manufacturing system integral to the orthosis fabrication process. The effects of corrective forces in different zones on scoliotic spine were assessed.

RESULTS

Among the subjects, 3 were in Group 1, 17 in Group 2, 52 in Group 3, and 6 in Group 4. Due to the limited number of subjects, data from Groups 1 and 4 were not analysed. Groups 2 and 3 showed significant reductions in Cobb angle in the coronal plane and plane of maximum curvature (PMC) following orthosis fitting (p < 0.05). Group 2 displayed a significant decrease > 5º in thoracic kyphosis (p < 0.05). Both Groups 2 and 3 exhibited significant reductions in lumbar lordosis. PMC orientation remained unchanged over time (p > 0.05) but was notably higher in Group 2 after orthosis fitting (p < 0.05).

CONCLUSIONS

Corrective forces applied by spinal orthoses in zones 2 and 3 effectively controlled lateral curve progression. Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of scoliotic spine from the sagittal plane. Further research is needed to validate and expand upon these results.

Marker-Based Versus IMU-Based Kinematics for Estimates of Lumbar Spine Loads Using a Full-Body Musculoskeletal Model

Musculoskeletal modeling, typically implemented using marker-based systems in laboratory environments, is commonly used for noninvasive estimations of loads. Inertial measurement units (IMUs) have become an alternative for the evaluation of kinematics. However, estimates of spine joint contact forces using IMUs have yet to be thoroughly evaluated. Dynamics tasks and static postures from activities of daily living were captured on 11 healthy subjects using both systems simultaneously. Spine kinematics obtained from IMU- and marker-based systems and L4-L5 joint contact forces were compared. Lateral bending resulted in a weak agreement with significant differences between the 2 systems (P = .02, average root mean-squared error = 4.81), whereas flexion-extension and axial rotation exhibited the highest agreement with no significant differences (P < .05, average root mean-squared error = 5.51 and P < .31, average root mean-squared error = 5.08, respectively). All tasks showed excellent correlations (R2 = .76-.99) in estimated loads between systems. Differences in predicted loads at the L4-L5 were only observed during flexion-extension (1041 N vs 947 N, P = .0004) and walking with weights (814 N vs 727 N, P = .004). Different joint reaction force outcomes were obtained in 2 of the 8 tasks between systems, suggesting that IMUs can be robust tools allowing for convenient and less expensive evaluations and for longitudinal assessments inside and outside the laboratory setting.

Relation between Photogrammetry and Spinal Mouse for Lumbopelvic Assessment in Adolescents with Thoracic Kyphosis

The evaluation of the lumbopelvic region is a crucial point during postural assessment in childhood and adolescence. Photogrammetry (PG) and Spinal Mouse (SM) are two of the most debated tools to properly analyze postural alignment and avoid misleading data. This study aims to find out the best linear regression model that could relate the analytic measurements of the SM with one or more PG parameters in adolescents with kyphotic postures. Thirty-nine adolescents (female = 35.9%) with structural and non-structural kyphosis were analyzed (13.2 ± 1.8 years; 1.59 ± 0.12 m; 47.6 ± 11.8 kg) using the SM and PG on the sagittal plane in a standing and forward-bending position, allowing for the measurement of body vertical inclination, lumbar and pelvic alignment, trunk flexion, sacral inclination during bending, and hip position during bending. Lordosis lumbar angles (SM) were significantly (r = -0.379, r = -0.328) correlated with the SIPS-SIAS angle (PG) during upright standing, while in the bending position, the highest correlation appeared among the sacral-hip (SM) and the sacral tangent (ST_PG; r = -0.72) angles. The stepwise backward procedure was assessed to estimate the SM variability in the bending and standing positions. Only in the bending position did the linear regression model reach high goodness-of-fit values with two regressors (ST_PG η2=0.504, BMI η2=0.252; adjusted- R2 =0.558, p < 0.001, CCC = 0.972, r = 0.763). Despite gold-standard methods reducing error evaluation, physicians and kinesiologists may consider photogrammetry as a good method for spinal curve prediction.

Relation between Photogrammetry and Spinal Mouse for Sagittal Imbalance Assessment in Adolescents with Thoracic Kyphosis

The evaluation of postural alignment in childhood and adolescence is fundamental for sports, health, and daily life activities. Spinal Mouse (SM) and photogrammetry (PG) are two of the most debated tools in postural evaluation because choosing the proper instrument is also important to avoid false or misleading data. This research aims to find out the best linear regression models that could relate the analytic kyphosis measurements of the SM with one or more PG parameters of body posture in adolescents with kyphotic posture. Thirty-four adolescents with structural and non-structural kyphosis were analyzed (13.1 ± 1.8 years; 1.59 ± 0.13 m; 47.0 ± 12.2 kg) using SM and PG on the sagittal plane in a standing and forward-bending position, allowing us to measure body vertical inclination, trunk flexion, and sacral inclination and hip position during bending. The stepwise backward procedure was assessed to estimate the variability of the grade of inclination of the spine and thoracic spine curvature with fixed upper and lower limits, evaluated with SM during flexion. In both models, the PG angle between the horizontal line and a line connecting the sacral endplate-C7 spinous process and the PG hip position were the best regressors (adjusted-R2 SM bend = 0.804, p < 0.001; adjusted-R2 SM fixed bending = 0.488, p < 0.001). Several Spinal Mouse and photogrammetry parameters showed significant correlations, especially when the Spinal Mouse measurements were taken when the adolescents were in the forward-bending position. Physicians and kinesiologists may consider photogrammetry as a good method for spinal curve prediction.

Reliability and Convergent Validity of Digital Photography in Assessing Postural Orientation of Children with Cerebral Palsy: A Methodological Study

Background: This study aimed to assess the test-retest intra-rater reliability and convergent validity of digital photography (DP) in detecting the postural orientation of children with cerebral palsy (CP). Methods: The study recruited children with various types of CP with the Gross Motor Function Classification System level I or II and spasticity < 2 on the Ashworth Scale, without any visual or cognitive impairments. Children who had undergone any surgical intervention or received a botulinum toxin injection within the previous six months were excluded. A digital camera was fixed at 1.5 meters from the participants at the height of 90 cm. Non-reflective markers were attached to eight anatomical landmarks to localize the upper and lower center of mass on both sides. The same examiner took three digital photos to detect intra-rater reliability using the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analysis were used to assess the convergent validity of the DP method compared with the Pediatric Balance Scale (PBS) scores. Results: Thirty children (7.44 ± 2.38 years) were assessed to test the reliability of DP, and 55 others (8.06 ± 2.19 years) participated in the convergent validity study. Intra-rater reliability was found to be perfect (ICC > 0.995) and there was a strong significant negative correlation between DP measures and PBS scores (Pearson's correlation > 0.75) with high adjusted R2 (R2 > 0.567), indicating goodness of fit between the measures. Conclusions: Digital photography (DP) is a reliable and valid method for assessing postural orientation in children with various types of CP.

Static and Dynamic Postural Characteristics in Patients with Chronic Obstructive Pulmonary Disease: The Relationship with Dyspnea and Pulmonary Functions

BACKGROUND

There is little evidence about posture influence and its relationship with pulmonary functions in chronic obstructive pulmonary diseases(COPD) patients.

OBJECTIVES

To compare spinal curvature, mobility, and postural competency in participants with and without COPD and investigate the relationship of postural characteristics with dyspnea and pulmonary functions in COPD patients.

METHODS

We included 47 COPD patients and 47 age and gender-matched controls in our cross-sectional study. Participants underwent the following evaluations: modified Medical Research Council Dyspnea Scale, respiratory function test, and postural measurements in the sagittal plane in a standing position using a non-invasive, computer-assisted electromechanical device. Postural variables were compared between groups, and the relationship between postural variables with dyspnea and pulmonary functions was analyzed by multivariate regression analysis.

RESULTS

Thoracic and lumbar curvature were higher (p<0.05), thoracic mobility and spinal inclination were lower (p=0.011, p=0.030, respectively) in patients with COPD. Thoracic angle and spinal inclination increased in COPD patients (p=0.040, p=0.011, respectively) while only spinal tilt increased in the control group (p=0.010) under spinal loading. Thoracic angle and mobility were related with dyspnea (r2=0.25, p<0.001), forced expiratory volume in the first second (r2=0.56, p<0.001), forced vital capacity (r2=0.41, p<0.001), and RV (r2 = 0.42, p<0.001).

CONCLUSION

COPD patients had greater thoracic and lumbar angles in the static upright posture and lower thoracic mobility and spinal inclination in the sagittal plane. It was observed that patients increase their thoracic angles to maintain postural stability in dynamic conditions. Thoracic angle and mobility were related to dyspnea and pulmonary functions.

Analysis of the Active Measurement Systems of the Thoracic Range of Movements of the Spine: A Systematic Review and a Meta-Analysis

(1) Objective: to analyze current active noninvasive measurement systems of the thoracic range of movements of the spine. (2) Methods: A systematic review and meta-analysis were performed that included observational or clinical trial studies published in English or Spanish, whose subjects were healthy human males or females ≥18 years of age with reported measurements of thoracic range of motion measured with an active system in either flexion, extension, lateral bending, or axial rotation. All studies that passed the screening had a low risk of bias and good methodological results, according to the PEDro and MINORS scales. The mean values and 95% confidence interval of the reported measures were calculated for different types of device groups. To calculate the differences between the type of device measures, studies were pooled for different types of device groups using Review Manager software. (3) Results: 48 studies were included in the review; all had scores higher than 7.5 over 10 on the PEDro and MINORs methodological rating scales, collecting a total of 2365 healthy subjects, 1053 males and 1312 females; they were 39.24 ± 20.64 years old and had 24.44 ± 3.81 kg/m2 body mass indexes on average. We summarized and analyzed a total of 11,892 measurements: 1298 of flexoextension, 1394 of flexion, 1021 of extension, 491 of side-to-side lateral flexion, 637 of right lateral flexion, 607 of left lateral flexion, 2170 of side-to-side rotation, 2152 of right rotation and 2122 of left rotation. (4) Conclusions: All collected and analyzed measurements of physiological movements of the dorsal spine had very disparate results from each other, the cause of the reason for such analysis is that the measurement protocols of the different types of measurement tools used in these measurements are different and cause measurement biases. To solve this, it is proposed to establish a standardized measurement protocol for all tools.

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.

A ToF-based system for recording human sagittal back shape

BACKGROUND

The sagittal back shape (SBS) of the human body, which should be highly consistent with the spinal morphology along the internal spine line, also presents an s-shaped curve.

OBJECTIVE

We propose a novel time-of-flight (ToF) based system to record the s-shaped SBS of the human body, which was simple, inexpensive, and non-invasive.

RESULTS

The system was composed of a bottom plate, an upright post, a vertical rod, dozens of horizontal measuring rods, and a ToF sensor. The experimental results showed that the system supported to obtain the s-shaped SBS of the human body with satisfactory accuracy.

CONCLUSIONS

The ToF-based system for recording human sagittal back shape will be useful for routine screening of spinal physiological conditions in schools, as well as for e.g. digital garment design, and special seat-back design.

Trunk inclination and hip extension mobility, but not thoracic kyphosis angle, are related to 3D-accelerometry based gait alterations and increased fall-risk in older persons

BACKGROUND

Only a portion of the increased variability in gait parameters observed in ageing can be explained by age and gait speed alone. Other factors, like musculoskeletal changes of the spine, might contribute to higher variability of gait parameters, slower walking speed and subsequently increased fall-risk in ageing.

RESEARCH QUESTION

Are spinal posture and mobility related to 3D-accelerometry based gait analysis, functional performance and fall-risk in ageing?

METHODS

Forty elderly presenting increased fall-risk (OFR, 80.6 ± 5.4yrs), 41 old controls (OC, 79.1 ± 4.9yrs), and 40 young controls (YC, 21.6 ± 1.4yrs) were assessed for spinal posture and mobility (SpinalMouse®), gait analysis (DynaPort MiniMod), and functional performance (grip strength, grip work, timed-get-up-and-go-test, performance-oriented mobility assessment).

RESULTS

Compared to OC, OFR showed significantly (p < .05) larger trunk inclination angle (INC), smaller sacral extension mobility, slower walking speed, and lower medio-lateral step and stride regularity. Thoracic kyphosis angle (TKA) was similar in all groups. INC and sacral extension mobility showed the highest correlation with walking speed, gait parameters, functional performance and fall-risk. INC (OR = 1.14) and sacral extension mobility (OR = 1.12) can moderately explain fall-risk in elderly participants and showed fair capacity to discriminate OFR from OC, the diagnostic value on fall-risk is however low (best probabilistic cut-off value, INC: -0.83° [sensitivity = 70%, specificity = 61%, PPV = 64%, NPV = 68%, LR+ = 1.79, LR- = 0.49, AUC = 0.71]; sacral extension mobility: 8.5° [sensitivity = 70%, specificity = 73%, PPV = 72%, NPV = 71%, LR+ = 2.61, LR -= 0.41, AUC = 0.71]).

SIGNIFICANCE

Larger trunk inclination and smaller sacral extension mobility (i.e. hip extension mobility) are moderately related to increased fall-risk, gait alterations, lower muscle performance and worse functional mobility in ageing. Contrary to our hypothesis, TKA showed no relation with parameters of gait and/or fall-risk. INC and sacral extension mobility have fair discriminative power to distinguish older persons with increased fall-risk from those without and might be considered as therapeutic targets.