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Saraceni N, Campbell A, Kent P, Ng L, Straker L, O'Sullivan P. Does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A cross-sectional laboratory study. ERGONOMICS 2022; 65:1380-1396. [PMID: 35098885 DOI: 10.1080/00140139.2022.2036819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Advice to limit or avoid a flexed lumbar curvature during lifting is widely promoted to reduce the risk of low back pain (LBP), yet there is very limited evidence to support this relationship. To provide higher quality evidence this study compared intra-lumbar flexion in manual workers with (n = 21) and without a history of LBP (n = 21) during a repeated lifting task. In contrast to common expectations, the LBP group demonstrated less peak absolute intra-lumbar flexion during lifting than the noLBP group [adjusted difference -3.7° (95%CI -6.9 to -0.6)]. The LBP group was also further from the end of range intra-lumbar flexion and did not use more intra-lumbar range of motion during any lift condition (both symmetrical and asymmetrical lifts and different box loads). Peak absolute intra-lumbar flexion was more variable in the LBP group during lifting and both groups increased their peak absolute intra-lumbar flexion over the lift repetitions. This high-quality capture of intra-lumbar spine flexion during repeated lifting in a clinically relevant cohort questions dominant safe lifting advice.Practitioner summary: Lifting remains a common trigger for low back pain (LBP). This study demonstrated that people with LBP, lift with less intra-lumbar flexion than those without LBP. Providing the best quality in-vivo laboratory evidence, that greater intra-lumbar flexion is not associated with LBP in manual workers, raising questions about lifting advice.
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Affiliation(s)
- Nic Saraceni
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Leo Ng
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Body Logic Physiotherapy Clinic, Perth, Australia
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Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review. Clin Biomech (Bristol, Avon) 2022; 98:105716. [PMID: 35843136 DOI: 10.1016/j.clinbiomech.2022.105716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain. METHODS Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed. FINDING Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent. INTERPRETATION This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.
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Girase H, Nyayapati P, Booker J, Lotz JC, Bailey JF, Matthew RP. Automated assessment and classification of spine, hip, and knee pathologies from sit-to-stand movements collected in clinical practice. J Biomech 2021; 128:110786. [PMID: 34656825 DOI: 10.1016/j.jbiomech.2021.110786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
Efficient, cost-effective methods for quantifying patient biomechanics at the point of care can facilitate faster and more accurate diagnoses. This work presents a new method to diagnose pre-surgical back, hip, and knee patients by analysing their sit-to-stand motion captured by a Kinect camera. Kinematic and dynamic time-series features were extracted from patient movements collected in clinic. These features were used to test a variety of machine learning methods for patient classification. The performance of models trained on time-series features were compared against models trained on domain-knowledge features, highlighting the importance of using time-series data for the classification of human movement. Additionally, the effectiveness of using semi-supervised learning is tested on partially labelled datasets, providing insight on how to boost classification performance in situations where labelled patient data is difficult to obtain. The best semi-supervised model achieves ∼73% accuracy in distinguishing individuals with low-back pain, and hip and knee degeneration from control subjects.
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Affiliation(s)
- Harshayu Girase
- Department of Electrical Engineering and Computer Science, University of California at Berkeley, Berkeley, 94720, CA, USA
| | - Priya Nyayapati
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jacqueline Booker
- School of Medicine, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, 94158, CA, USA
| | - Robert P Matthew
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, 94158, CA, USA.
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Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One 2021; 16:e0254241. [PMID: 34288926 PMCID: PMC8294511 DOI: 10.1371/journal.pone.0254241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate if lumbar and lower limb kinematics or kinetics are different between groups with and without a history of LBP during lifting. Secondly, to investigate relationships between biomechanical variables and pain ramp during repeated lifting. Methods 21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts. Lifts were performed in a laboratory setting, limiting ecological validity. Results The LBP group used a different lifting technique to the noLBP group at the beginning of the task (slower and more squat-like). Kinetic differences at the beginning included less peak lumbar external anterior shear force and greater peak knee power demonstrated by the LBP group. However, at the end of the task, both groups lifted with a much more similar technique that could be classified as more stoop-like and faster. Peak knee power remained greater in the LBP group throughout and was the only kinetic difference between groups at the end of the lifting task. While both groups lifted using a more comparable technique at the end, the LBP group still demonstrated a tendency to perform a slower and more squat-like lift throughout the task. Only one of 21 variables (pelvic tilt at box lift-off), was associated with pain ramp in the LBP group. Conclusions: Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP. Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around ‘safe lifting’.
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Ritzmann D. Schlüsselregion Becken. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund
Beckenringdysfunktionen sind eine der häufigsten Ursachen für Arbeitsausfälle weltweit. Neben muskuloskeletalen können viszerale Beschwerden der Beckenorgane auftreten. Der Beitrag erläutert den aktuellen Wissensstand zur funktionellen Anatomie des Beckens, beschreibt einige typische Beschwerdebilder aus gynäkologischer/geburtshilflicher Sicht sowie eine manuelle Methode zur nachhaltigen Beschwerdelinderung.
Fragestellung
Welche viszeralen Beschwerdebilder werden durch eine Beckenringdysfunktion (mit)verursacht? Wie kann eine manuelle Methode aussehen, die nachhaltig zur Verminderung der Beschwerden und Verbesserung der Lebensqualität beiträgt?
Methode
Der heutige Wissensstand der funktionellen Anatomie des Beckens wird mit den entsprechenden Beschwerdebildern bei Beckenringdysfunktionen dargelegt. Der Fokus liegt neben muskuloskeletalen speziell auch auf viszeralen Problemen wie vorzeitige Kontraktionen, Geburtsproblemen, Dysmenorrhö, Obstipation, Harndrang, Dyspareunie und Fertilitätsprobleme.
Ergebnisse
Beschwerdelinderung, Zunahme der Lebensqualität und bessere Funktion der Beckenorgane nach manueller Therapie und Stabilisierung des Beckenrings zeigen sich in einzelnen Fallbeispielen und insgesamt bei der Klientel der Grundversorgerpraxis.
Schlussfolgerung
Das Becken ist eine Schlüsselregion für die manuelle Medizin. Verschiedenste Beschwerdebilder können durch eine manuelle Behandlung deutlich reduziert werden.
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Liew BXW, Rugamer D, De Nunzio AM, Falla D. Interpretable machine learning models for classifying low back pain status using functional physiological variables. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1845-1859. [PMID: 32124044 DOI: 10.1007/s00586-020-06356-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the predictive performance of statistical models which distinguishes different low back pain (LBP) sub-types and healthy controls, using as input predictors the time-varying signals of electromyographic and kinematic variables, collected during low-load lifting. METHODS Motion capture with electromyography (EMG) assessment was performed on 49 participants [healthy control (con) = 16, remission LBP (rmLBP) = 16, current LBP (LBP) = 17], whilst performing a low-load lifting task, to extract a total of 40 predictors (kinematic and electromyographic variables). Three statistical models were developed using functional data boosting (FDboost), for binary classification of LBP statuses (model 1: con vs. LBP; model 2: con vs. rmLBP; model 3: rmLBP vs. LBP). After removing collinear predictors (i.e. a correlation of > 0.7 with other predictors) and inclusion of the covariate sex, 31 predictors were included for fitting model 1, 31 predictors for model 2, and 32 predictors for model 3. RESULTS Seven EMG predictors were selected in model 1 (area under the receiver operator curve [AUC] of 90.4%), nine predictors in model 2 (AUC of 91.2%), and seven predictors in model 3 (AUC of 96.7%). The most influential predictor was the biceps femoris muscle (peak [Formula: see text] = 0.047) in model 1, the deltoid muscle (peak [Formula: see text] = 0.052) in model 2, and the iliocostalis muscle (peak [Formula: see text] = 0.16) in model 3. CONCLUSION The ability to transform time-varying physiological differences into clinical differences could be used in future prospective prognostic research to identify the dominant movement impairments that drive the increased risk. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, CO4 3SQ, Essex, UK.
| | - David Rugamer
- Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
- Chair of Statistics, School of Business and Economics, Humboldt University of Berlin, Berlin, Germany
| | - Alessandro Marco De Nunzio
- LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671, Differdange, Luxembourg
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B152TT, UK
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To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2020; 50:121-130. [PMID: 31775556 DOI: 10.2519/jospt.2020.9218] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether lumbar spine flexion during lifting is a risk factor for low back pain (LBP) onset/persistence or a differentiator of people with and without LBP. DESIGN Etiology systematic review with meta-analysis. LITERATURE SEARCH Database search of ProQuest, CINAHL, MEDLINE, and Embase up to August 21, 2018. STUDY SELECTION CRITERIA We included peer-reviewed articles that investigated whether lumbar spine position during lifting was a risk factor for LBP onset or persistence or a differentiator of people with and without LBP. DATA SYNTHESIS Lifting-task comparison data were tabulated and summarized. The meta-analysis calculated an n-weighted pooled mean ± SD of the results in the LBP and no-LBP groups. If a study contained multiple comparisons (ie, different lifting tasks that used various weights or directions), then only 1 result from that study was included in the meta-analysis. RESULTS Four studies (1 longitudinal study and 3 cross-sectional studies across 5 articles) included in meta-analysis measured lumbar flexion with intralumbar angles and found no difference in peak lumbar spine flexion when lifting (1.5°; 95% confidence interval [CI]: -0.7°, 3.7°; P = .19 for the longitudinal study and -0.9°; 95% CI: -2.5°, 0.7°; P = .29 for the cross-sectional studies). Seven cross-sectional studies measured lumbar flexion with thoracopelvic angles and found that people with LBP lifted with 6.0° less lumbar flexion than people without LBP (95% CI: -11.2°, -0.9°; P = .02). Most (9/11) studies reported no significant between-group differences in lumbar flexion during lifting. The included studies were of low quality. CONCLUSION There was low-quality evidence that greater lumbar spine flexion during lifting was not a risk factor for LBP onset/persistence or a differentiator of people with and without LBP. J Orthop Sports Phys Ther 2020;50(3):121-130. Epub 28 Nov 2019. doi:10.2519/jospt.2020.9218.
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Lin H, Seerden S, Zhang X, Fu W, Vanwanseele B. Inter-segmental coordination of the spine is altered during lifting in patients with ankylosing spondylitis: A cross-sectional study. Medicine (Baltimore) 2020; 99:e18941. [PMID: 32000413 PMCID: PMC7004575 DOI: 10.1097/md.0000000000018941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The abnormal inter-segmental coordination of the spine during lifting could be used to monitor disease progression and rehabilitation efficacy in patients with ankylosing spondylitis (AS). This study aimed to compare the inter-segmental coordination patterns and variability of the spine during lifting between patients with AS (n = 9) and control (n = 15) groups.Continuous relative (CRP) and deviation (DP) phases between each segment of the spine (two lumbar and three thorax segments) and lumbosacral joint were calculated. The CRP and DP curves among participants were decomposed into few functional principal components (FPC) via functional principal component analysis (FPCA). The FPC score of CRP or DP of the two groups were compared, and its relationship with the indexes of spinal mobility was investigated.Compared with the control group, the AS patients showed more anti-phase coordination patterns in each relative upper spine segment and lumbosacral joint. In addition, either less or more variation was found in the coordination of each relative lower spine segment and lumbosacral joint during different time periods of lifting for these patients. Some cases were considerably related to spinal mobility.the inter-segmental coordination of the spine was altered during lifting in AS patients to enable movement, albeit inefficient and might cause spinal mobility impairment.
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Affiliation(s)
- Huijie Lin
- College of Teacher Education, Taizhou University, Linhai,
Zhejiang, China
| | - Stefan Seerden
- Department of Movement Sciences Group, KU Leuven, Leuven,
Belgium
| | - Xianyi Zhang
- Department of Movement Sciences Group, KU Leuven, Leuven,
Belgium
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of
Ministry of Education, Shanghai University of Sport, Shanghai, China
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Nolan D, O’Sullivan K, Newton C, Singh G, Smith BE. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain 2019; 20:215-227. [DOI: 10.1515/sjpain-2019-0089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background and aims
To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).
Methods
Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.
Results
Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.
Conclusions
People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.
Implications
The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.
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Affiliation(s)
- David Nolan
- Sheffield Teaching Hospitals NHS Foundation Trust , PhysioWorks, Firth Park Clinic, North Quadrant , Sheffield , UK , Phone: 07725854140
| | - Kieran O’Sullivan
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
- School of Allied Health , University of Limerick , Limerick , Ireland
- Health Research Institute , University of Limerick , Limerick , Ireland
| | - Chris Newton
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
| | - Gurpreet Singh
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Benjamin E. Smith
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
- University Hospitals of Derby and Burton NHS Foundation Trust , Derby , UK
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10
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Beaudette SM, Zwambag DP, Graham RB, Brown SHM. Discriminating spatiotemporal movement strategies during spine flexion-extension in healthy individuals. Spine J 2019; 19:1264-1275. [PMID: 30742973 DOI: 10.1016/j.spinee.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The spine is an anatomically complex system with numerous degrees of freedom. Due to this anatomical complexity, it is likely that multiple motor control options exist to complete a given task. PURPOSE To identify if distinct spine spatiotemporal movement strategies are utilized in a homogenous sample of young healthy participants. STUDY DESIGN Kinematic data were captured from a single cohort of male participants (N=51) during a simple, self-controlled spine flexion-extension task. METHODS Thoracic and lumbar flexion-extension data were analyzed to extract the continuous relative phase between each spine subsection. Continuous relative phase data were evaluated using a principal component analysis to identify major sources of variation in spine movement coordination. Unsupervised machine learning (k-means clustering) was used to identify distinct clusters present within the healthy participants sampled. Once distinguished, intersegmental spine kinematics were compared amongst clusters. RESULTS The findings of the current work suggest that there are distinct timing strategies that are utilized, within the participants sampled, to control spine flexion-extension movement. These strategies differentiate the sequencing of intersegmental movement and are not discriminable on the basis of simple participant demographic characteristics (ie, age, height, and body mass index), total movement time or range of motion. CONCLUSIONS Spatiotemporal spine flexion-extension patterns are not uniform across a population of young healthy individuals. CLINICAL SIGNIFICANCE Future work needs to identify whether the motor patterns characterized with this work are driven by distinct neuromuscular activation patterns, and if each given pattern has a varied risk for low back injury.
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Affiliation(s)
- Shawn M Beaudette
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa Ontario, Canada
| | - Derek P Zwambag
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo Ontario, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa Ontario, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph Ontario, Canada.
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Zehr JD, Howarth SJ, Beach TA. Using relative phase analyses and vector coding to quantify Pelvis-Thorax coordination during lifting—A methodological investigation. J Electromyogr Kinesiol 2018; 39:104-113. [DOI: 10.1016/j.jelekin.2018.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/30/2017] [Accepted: 02/11/2018] [Indexed: 10/18/2022] Open
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Mukkannavar P, Desai BR, Mohanty U, Kulkarni S, Parvatikar V, Daiwajna S. Pelvic girdle pain in Indian postpartum women: a cross-sectional study. Physiother Theory Pract 2013; 30:123-30. [PMID: 23899351 DOI: 10.3109/09593985.2013.816399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNLABELLED During pregnancy or postpartum period many women will experience some degree of pelvic girdle pain (PGP). In India, there is no information about the PGP prevalence and its associated factors evaluated during postpartum period. PURPOSE To reveal the prevalence of PGP postpartum in Indian women and identify associated factors with PGP postpartum. METHODS In this cross-sectional study, 284 postpartum women completed a questionnaire and underwent clinical examinations. The clinical examination included pain provocation tests for the pelvic as well as the active straight leg raise (ASLR) test. Possible associating factors were studied by using nonparametric tests and logistic regression analysis. RESULTS A total of 116 postpartum women (41%) had reported PGP at the time of the examination. A stepwise logistic regression analysis was performed to reveal associated factors. In the final model, factors such as (1) Caesarean delivery (adjusted OR, 2.0; 95% CI, 1.3-4.9); (2) ASLR test score ≥4 (adjusted OR, 2.3; 95% CI, 1.2-3.3); (3) Unilateral P4 test (adjusted OR, 1.8; 95% CI, 1.1-3.0); and (4) Sitting position during feeding (adjusted OR, 1.5; 95% CI, 0.9-2.8) were associated with the PGP. CONCLUSION We found a high prevalence of PGP in Indian women during the first three months of postpartum period. Our finding suggests that unilateral posterior pelvic pain provocation test (P4), ASLR test score ≥4, caesarean section delivery and sitting in breast-feeding posture were associated with increased risk of PGP during postpartum.
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Ernst MJ, Rast FM, Bauer CM, Marcar VL, Kool J. Determination of thoracic and lumbar spinal processes by their percentage position between C7 and the PSIS level. BMC Res Notes 2013; 6:58. [PMID: 23398934 PMCID: PMC3598670 DOI: 10.1186/1756-0500-6-58] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/07/2013] [Indexed: 11/21/2022] Open
Abstract
Background Accurate measurements of spinal movement require reliable determination of anatomical landmarks. Current methods of identifying these are not sufficiently reliable or valid for this purpose. A reliable and convenient method of placing markers on selected vertebra is needed to compare measurements between different testers, subjects and sessions. Findings Two testers palpated T4, T7, T10, L1 and L4 spinal processes according to established criteria. They measured the position of spinal processes between C7 and the Posterior Superior Iliac Spine (PSIS) at the Pelvis independently using a flexible ruler placed on the spine. Subjects with a wide range of body heights but without visible spinal deformities were recruited for measurements. Reliability was calculated using absolute and relative values. Mean percentage position and 95% Confidence Intervals were calculated using the mean of both testers’ measurement for all subjects. Twenty-two subjects participated. The mean distance between C7 and the PSIS level was 50.9 cm (SD: 3.5 cm). Relative reliability for all spinal processes was almost perfect (ICC: > 0.9). Absolute reliability values showed high agreement between testers. Percentage position of T4 was found to be situated 21% along the distance between C7 and the PSIS level, T7 at 39%, T10 at 54.1%, L1 at 70.9% and L4 at 86.1% accordingly. 95% Confidence intervals around mean percentage positions had a maximum at L1 with 2.8% range from upper to lower limit. Conclusions The distance of three thoracic and two lumbar spinal processes can be reliably and accurately measured by independent testers, using a flexible ruler. Percentage positions between C7 and PSIS level correspond to spinal processes for subjects without visible deformities in the sagittal and frontal plane.
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Affiliation(s)
- Markus J Ernst
- Zurich University of Applied Sciences, Institute of Physiotherapy, Research & Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
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Rodrigues WFG, Silva LRD, Nascimento MADL, Pernambuco CS, Giani TS, Dantas EHM. Prevalence of lower back pain and physical inactivity: the impact of psychosocial factors in pregnant women served by the Family Health Strategy. EINSTEIN-SAO PAULO 2011; 9:489-93. [DOI: 10.1590/s1679-45082011ao2186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 11/01/2011] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: This study analyzed the impact of psychosocial factors on pregnant women with lower back pain and an associated lack of physical activity prior to pregnancy. Methods: The sample included 66 pregnant women who were randomly selected from a total of 84 patients in the waiting rooms of the Family Health Units in Cuitegí, Paraíba, from September to November 2009. An epidemiological questionnaire adapted from the Quebec Back Pain Disability Scale was used for data collection. The questions about back pain, physical activity, and psychosocial factors were emphasized. SPSS 16.0 was used for the data analysis. The prevalence of lower back pain and its relationship to gestational age, habitual physical activity, and psychosocial factors were studied using the descriptive statistics and relative percentages in the SPSS Crosstabs procedure. The odds ratio and 95% confidence interval for lower back pain were calculated. Results: The prevalence of lower back pain was 75%, which suggests that psychosocial factors were related to the presence of pain. Anxiety was reported in 42.8% of the women with lower back pain, and 38.7% of the women with lower back pain experienced physical fatigue at the end of the day. A higher percentage of pain (53%) was noted in the women who did not exercise prior to pregnancy. Conclusion: Lower back pain prior to pregnancy is associated with lack of physical activity and with psychosocial factors in the Family Health Strategy patients of Cuitegí county.
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Affiliation(s)
| | | | - Maria Aparecida de Luca Nascimento
- Center for Research and Experimentation and in Woman and Child Health Studies – NuPEEMC, Brazil; Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil
| | - Carlos Soares Pernambuco
- Laboratory of Human Movement Biosciences – LABIMH, Brazil; Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil
| | - Tania Santos Giani
- Laboratory of Human Movement Biosciences – LABIMH, Brazil; Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil
| | - Estélio Henrique Martin Dantas
- Laboratory of Human Movement Biosciences – LABIMH, Brazil; Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil
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15
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Scibek JS, Mell AG, Downie BK, Palmieri-Smith R, Hughes RE. IMPACT OF PAIN ON SHOULDER ELEVATION VELOCITY IN PATIENTS WITH ROTATOR CUFF TEARS. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957710002429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pain is routinely implicated as a factor when considering impaired movement in injured populations. Movement velocity is often considered during the rehabilitation process; unfortunately our understanding of pain's impact on shoulder movement velocity in rotator cuff tear patients is less understood. Therefore, the purpose of this study was to test the hypothesis that there would be an increase in peak and mean shoulder elevation velocities following the decrease of shoulder pain in rotator cuff tear patients, regardless of tear size. Fifteen subjects with full-thickness rotator cuff tears (RCT) performed humeral elevation and lowering in three planes before and after receiving a lidocaine injection to relieve pain. Pain was assessed using a visual analog scale. Humeral elevation velocity data were collected using an electromagnetic tracking system. A significant reduction in pain (pre-injection 3.53 ± 1.99; post-injection 1.23 ± 1.43) resulted in significant increases in maximum and mean humeral elevation velocities. Mean shoulder elevation and lowering velocities increased 15.10 ± 2.45% while maximum shoulder movement velocities increased 12.77 ± 3.93%. Furthermore, no significant relationships were noted between tear size and movement velocity. These significant increases in movement velocity provide evidence to further support the notion that human motion can be inhibited by injury-associated pain, and that by reducing that pain through clinical interventions, human movement can be impacted in a positive fashion.
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Affiliation(s)
- Jason S. Scibek
- Department of Athletic Training, Duquesne University, Pittsburgh, PA, USA
| | - Amy G. Mell
- Thomson Healthcare, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brian K. Downie
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Richard E. Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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16
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Sipko T, Grygier D, Barczyk K, Eliasz G. The Occurrence of Strain Symptoms in the Lumbosacral Region and Pelvis During Pregnancy and After Childbirth. J Manipulative Physiol Ther 2010; 33:370-7. [DOI: 10.1016/j.jmpt.2010.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 03/01/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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17
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Scibek JS, Carpenter JE, Hughes RE. Rotator cuff tear pain and tear size and scapulohumeral rhythm. J Athl Train 2009; 44:148-59. [PMID: 19295959 DOI: 10.4085/1062-6050-44.2.148] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The body of knowledge concerning shoulder kinematics in patients with rotator cuff tears is increasing. However, the level of understanding regarding how pain and tear size affect these kinematic patterns is minimal. OBJECTIVE To identify relationships between pain associated with a full-thickness rotator cuff tear, tear size, and scapulohumeral rhythm (SHR) and to determine whether pain and tear size serve as predictors of SHR. DESIGN A test-retest design was used to quantify pain and SHR before and after a subacromial lidocaine injection. Correlation and multivariate analyses were used to identify relationships among pain, tear size, and SHR. SETTING Orthopaedic biomechanics research laboratory. PATIENTS OR OTHER PARTICIPANTS Fifteen patients (age range, 40-75 years) with diagnosed full-thickness rotator cuff tears participated. They were experiencing pain at the time of testing. INTERVENTION(S) Shoulder kinematic data were collected with an electromagnetic tracking system before and after the patient received a lidocaine injection. MAIN OUTCOME MEASURE(S) Pain was rated using a visual analog scale. Three-dimensional scapular kinematics and glenohumeral elevation were assessed. Scapular kinematics included anterior-posterior tilt, medial-lateral tilt, and upward-downward rotation. A regression model was used to calculate SHR (scapular kinematics to glenohumeral elevation) for phases of humeral elevation and lowering. RESULTS Linear relationships were identified between initial pain scores and SHR and between tear size and SHR, representing an increased reliance on scapular motion with increasing pain and tear size. Pain was identified as an independent predictor of SHR, whereas significant findings for the effect of tear size on SHR and the interaction between pain and tear size were limited. CONCLUSIONS We noted an increased reliance on scapular contributions to overall humeral elevation with increasing levels of pain and rotator cuff tear size. Pain associated with a rotator cuff tear serves as a primary contributor to the kinematic patterns exhibited in patients with rotator cuff tears.
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Affiliation(s)
- Jason S Scibek
- Duquesne University, Department of Athletic Training, Pittsburgh, PA 15282, USA.
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18
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Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1160-9. [PMID: 18661160 PMCID: PMC2527418 DOI: 10.1007/s00586-008-0703-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/29/2008] [Accepted: 06/09/2008] [Indexed: 11/22/2022]
Abstract
Walking is impaired in Pregnancy-related Pelvic girdle Pain (PPP). Walking velocity is reduced, and in postpartum PPP relative phase between horizontal pelvis and thorax rotations was found to be lower at higher velocities, and rotational amplitudes tended to be larger. While attempting to confirm these findings for PPP during pregnancy, we wanted to identify underlying mechanisms. We compared gait kinematics of 12 healthy pregnant women and 12 pregnant women with PPP, focusing on the amplitudes of transverse segmental rotations, the timing and relative phase of these rotations, and the amplitude of spinal rotations. In PPP during pregnancy walking velocity was lower than in controls, and negatively correlated with fear of movement. While patients’ rotational amplitudes were larger, with large inter-individual differences, spinal rotations did not differ between groups. In the patients, peak thorax rotation occurred earlier in the stride cycle at higher velocities, and relative phase was lower. The earlier results on postpartum PPP were confirmed for PPP during pregnancy. Spinal rotations remained unaffected, while at higher velocities the peak of thorax rotations occurred earlier in the stride cycle. The latter change may serve to avoid excessive spine rotations caused by the larger segmental rotations.
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19
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Maduri A, Wilson SE. Lumbar position sense with extreme lumbar angle. J Electromyogr Kinesiol 2008; 19:607-13. [PMID: 18462951 DOI: 10.1016/j.jelekin.2008.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/12/2008] [Accepted: 03/12/2008] [Indexed: 11/16/2022] Open
Abstract
Tasks involving flexed torso postures have a high incidence of low back injuries. Changes in the ability to sense and adequately control low back motion may play a role in these injuries. Previous studies examining position sense errors of the lumbar spine with torso flexion found significant increases in error with flexion. However, there has been little research on the effect of lumbar angle. In this study, the aim of the study was to examine how position sense errors would change with torso flexion as a function of the target lumbar angle. Fifteen healthy volunteers were asked to assume three different lumbar angles (maximum, minimum and mid-range) at three different torso flexion angles. A reposition sense protocol was used to determine a subject's ability to reproduce the target lumbar angles. Reposition sense error was found to increase 69% with increased torso flexion for mid-range target curvatures. With increasing torso flexion, the increase in reposition sense errors suggests a reduction in sensation and control in the lumbar spine that may increase risk of injury. However, the reposition error was smaller at high torso flexion angles in the extreme target curvatures. Higher sensory feedback at extreme lumbar angles would be important in preventing over-extension or over-flexion. These results suggest that proprioceptive elements in structures engaged at limits (such as the ligaments and facet joints), may provide a role in sensing position at extreme lumbar angles. Sensory elements in the muscles crossing the joint may also provide increased feedback at the edges of the range of motion.
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Affiliation(s)
- A Maduri
- National Institute for Occupational Safety and Health, Morgantown, WV, United States
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20
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Novaes FS, Shimo AKK, Lopes MHBDM. [Low back pain during gestation]. Rev Lat Am Enfermagem 2006; 14:620-4. [PMID: 16967171 DOI: 10.1590/s0104-11692006000400022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 04/20/2006] [Indexed: 11/22/2022] Open
Abstract
This research qualitatively analyzed the contents of national and international scientific publications, indexed in the period from 1999 to 2005, about low back pain in gestation. Around 50 % of pregnant women complain about low back pain. The physiologic modifications that occur happen in pregnancy alter the posture of pregnant women and the largest incidence of low back pain usually happens in the last three months. Specific causes remain unknown. However, treatment involves analgesics, antiphlogistics, exercises and physiotherapy. Low back pain during gestation is a symptom that causes great discomfort and, depending on the level of pain, it generates motor disability and impairs daily activities, besides causing problems to take care of the baby after birth. Some discomfort of low back pain can continue for a period of up to three years after childbirth. We see a great need for further research in this subject area, in order to provide a better quality of life for pregnant women.
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21
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Wu WH, Meijer OG, Uegaki K, Mens JMA, van Dieën JH, Wuisman PIJM, Östgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13:575-89. [PMID: 15338362 PMCID: PMC3476662 DOI: 10.1007/s00586-003-0615-y] [Citation(s) in RCA: 328] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 07/25/2003] [Indexed: 01/13/2023]
Abstract
Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose "pregnancy-related pelvic girdle pain (PPP)", and "pregnancy-related low back pain (PLBP)", present evidence that the two add up to "lumbopelvic pain", and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.
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Affiliation(s)
- W. H. Wu
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
- Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province People’s Republic of China
| | - O. G. Meijer
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - K. Uegaki
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - J. M. A. Mens
- Department of Rehabilitation Medicine, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - J. H. van Dieën
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - P. I. J. M. Wuisman
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
| | - H. C. Östgaard
- Department of Orthopaedics, Sahlgren University Hospital, 43180 Mölndal, Sweden
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