Measuring the sacral inclination angle in clinical practice: is there an alternative to radiographs?

Concurrent Validity of the Ergotex Device for Measuring Low Back Posture

Highlighting the crucial role of monitoring and quantifying lumbopelvic rhythm for spinal curvature, the Ergotex IMU, a portable, lightweight, cost-effective, and energy-efficient technology, has been specifically designed for the pelvic and lumbar area. This study investigates the concurrent validity of the Ergotex device in measuring sagittal pelvic tilt angle. We utilized an observational, repeated measures design with healthy adult males (mean age: 39.3 ± 7.6 y, body mass: 82.2 ± 13.0 kg, body height: 179 ± 8 cm), comparing Ergotex with a 3D optical tracking system. Participants performed pelvic tilt movements in anterior, neutral, and posterior conditions. Statistical analysis included paired samples t-tests, Bland-Altman plots, and regression analysis. The findings show minimal systematic error (0.08° overall) and high agreement between the Ergotex and optical tracking, with most data points falling within limits of agreement of Bland-Altman plots (around ±2°). Significant differences were observed only in the anterior condition (0.35°, p < 0.05), with trivial effect sizes (ES = 0.08), indicating that these differences may not be clinically meaningful. The high Pearson's correlation coefficients across conditions underscore a robust linear relationship between devices (r > 0.9 for all conditions). Regression analysis showed a standard error of estimate (SEE) of 1.1° with small effect (standardized SEE < 0.26 for all conditions), meaning that the expected average deviation from the true value is around 1°. These findings validate the Ergotex as an effective, portable, and cost-efficient tool for assessing sagittal pelvic tilt, with practical implications in clinical and sports settings where traditional methods might be impractical or costly.

Comparison of Inclinometer and Radiological Measurement in the Evaluation of Columna Vertebralis Movements

Spinal movements can often be measured during clinical, physical and functional evaluation of individuals. One of the preferred tools for the measurement of these movements is inclinometers. Considering that valid scientific methods should be used for musculoskeletal assessment, the aim of this study is to conduct a literature review on the validity of inclinometers to measure spinal movements. The PubMed electronic database was searched using the keywords "inclinometer", "spine", "vertebrae" and "columna vertebralis". The study analysis process included reading titles, abstracts and full texts. After checking the established criteria, six articles met the criteria for inclusion in the review. The design of all included studies was a combination of radiographic measurement of the spine and angular measurements obtained by inclinometer. Variability was observed in the data collection methods used and the results of the studies. It is recommended that inclinometers be used by health professionals based on scientific evidence, and the results and methodological aspects used in validity studies of these tools should be taken into account.

Straight Leg Raise Test: Influence of Lumbosant© and Assistant Examiner in Hip, Pelvis Tilt and Lumbar Lordosis

The passive straight leg raise (PSLR) test is widely used to assess hamstring extensibility. However, to accurately measure hamstring extensibility throughout PSLR, appropriate stabilization of the pelvis must be provided in order to minimize the possible influence of any compensatory movement in the scores reached. The main purpose of this study was to demonstrate the degree of influence of the Lumbosant© and an assistant examiner in hamstring extensibility in healthy young adults. A secondary objective was to verify the variability of the posterior pelvic tilt movement. Hamstring muscle extensibility was measured using the traditional (only an examiner) and new (using a low-back protection support Lumbosant© and two trained [principal and assistant] examiners) PSLR procedures. Correlation coefficients were expressed using r values, accompanying descriptors and 90% confidence intervals. Variance explained was expressed via the R2 statistic. To examine possible differences, the Mann-Whitney U-test was conducted. Additionally, Cohen’s d was calculated for all results, and the magnitudes of the effect were interpreted and statistical significance set at p < 0.05. A stepwise multiple regression analysis was performed to examine the relationship between scores and values. The final score that was determined with the new PSLR is significantly lower (13° approximately) than the one obtained through the traditional procedure (75.3 ± 14.4° vs. 89.2 ± 20.8°; d = −0.777 [moderate]). The data presented in this study suggest that the PSLR may overestimate hamstring extensibility unless lumbopelvic movement is controlled. Therefore, we recommend the use of Lumbosant© and an auxiliary examiner to obtain more accurate hamstring extensibility scores.

Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs

BACKGROUND

Upright and slouched sitting are frequently adopted postures associated with increased intradiscal pressure, spinal height loss and intervertebral disc pathology.

OBJECTIVES

To examine the effects of two sustained propped slouched sitting (PSS) postures on spinal height after a period of trunk loading.

METHODS

Thirty-four participants without a history of low back pain (LBP) were recruited (age 24.4 ± 1.6 years). Subjects sat in (1) PSS without lumbar support and (2) PSS with lumbar support for 10 min, after a period of trunk loading. Spinal height was measured using a stadiometer.

RESULTS

Mean spinal height increase during PSS without lumbar support was 2.94 ± 3.63 mm and with lumbar support 4.74 ± 3.07 mm.

CONCLUSIONS

Both PSS with and without lumbar support significantly increased spinal height after a period of trunk loading (p < 0.001). Such PSS postures can provide a valuable alternative to upright sitting and may be recommended for recovering spinal height in the working environment following periods of loading.

Review of methods used by chiropractors to determine the site for applying manipulation

Background

With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

Methods

Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

Results

A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

Conclusions

A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.

A novel approach to the clinical evaluation of differential kinematics of the lumbar spine

Clinical measurement of lumbar motion has traditionally been limited to range of motion (ROM). Despite this, deficits in angular velocities and accelerations are more pronounced compared to ROM in low back pain (LBP) sufferers. There is increasing interest in movement quality among manual therapists and therefore the ability to measure angular velocities and accelerations within the clinical environment is becoming increasingly important. The aims of this study were to (1) investigate the reliability of a clinic based inertial sensor system to measure ROM along with angular velocities and accelerations in low back pain sufferers; (2) introduce the feasibility and reliability of using the relationship between ROM and velocity to investigate movement trajectory and irregularity. Forty LBP sufferers completed three trials of spinal movements and lifting. The ROM curve was differentiated and double differentiated to yield angular velocities and accelerations. Repeated measures reliabilities were determined by comparisons of kinematic curves as well as peak values. ROM and angular velocity relationships were investigated for their use in describing the movement trajectory and irregularity. Results show excellent similarities of ROM and angular velocity curves and moderate-to-good similarities for angular acceleration curves. Peak value similarities were excellent with small error measurements for all variables. The quantification of ROM-angular velocity plots was reliable with small mean absolute differences in motion irregularity scores. Such a method was able to demonstrate differences in movement irregularity. This method provides clinicians with the ability to yield important additional movement related information including angular velocity, acceleration and movement irregularity.

Reproducibility of sagittal pelvic tilt measurements in normal subjects using digital inclinometry

Standing sagittal pelvic tilt posture is widely assessed qualitatively, yet no efficient non-invasive quantitatively method is available for measuring pelvic tilt position or its amplitude. The main objective of the current study was to assess the intra- and inter-tester reproducibility of digital inclinometry-based (DI) measurements of pelvic tilt in healthy subjects. Pelvic inclination was measured while standing in neutral position (NP), maximal anterior pelvic tilt (APT) and maximal posterior pelvic tilt (PPT) which served for calculating the total pelvic tilt (TPT) range of motion (TPT=PPT-APT). On two separate test occasions two convenience samples of healthy women and men (N=15 in each) were each measured by two different testers. In both groups the intra-tester reproducibility indices of NP, APT, PPT and TPT were acceptable as revealed by high and significant ICCs and low standard error of measurements (SEM). In women the inter-tester reproducibility indices, of the same variables, were high as distinguished by no significant differences between testers and high and significant ICCs. In men, significant differences were found in APT and PPT but the between-testers TPT scores were similar. Collectively these findings indicate that pelvic inclinometry yields acceptable reproducibility which in the light of the facility of the method may render it an efficient clinical tool.