Article

Effects of Lifestyle and Work-Related Physical Activity on the Degree of Lumbar Lordosis and Chronic Low Back Pain in a Middle East Population

September 2001
Journal of Spinal Disorders 14(4):283-92

September 2001
14(4):283-92

DOI:10.1097/00002517-200108000-00002

Source
PubMed

Authors:

Reza Nourbakhsh

University of North Georgia, Dahlonega, United States

Seyed Javad Mousavi

Harvard Medical School, Spaulding Rehabilitation Hospital @ Inspire Lab

Mahyar Salavati

University of Social Welfare and Rehabilitation Sciences

The relationship between the degree of lumbar lordosis and chronic low back pain (LBP) has long been speculated. It is postulated that prolonged sitting and sedentary lifestyle might change the degree of lumbar lordosis and cause LBP. The purpose of this study was to determine the effects of lifestyle, exercise, work setting, work intensity, and other demographic factors such as age, height, weight, and gender on the degree of lumbar lordosis and occurrence of LBP. Eight hundred forty subjects between ages 20 and 65 years were equally categorized into four groups: normal male, normal female, males with LBP, and females with LBP. A questionnaire was used to obtain information about the subject's lifestyle, work setting, level of exercise, and work-related physical activity. A flexible ruler was used to measure lumbar lordosis in all subjects. The average degree of lumbar lordosis for all subjects was 37 degrees +/- 13 degrees. Females had greater lumbar lordosis (42 degrees +/- 15 degrees ) than males did (32 degrees +/- 10 degrees ). There was no significant difference in the degree of lumbar lordosis in subjects with different lifestyle (p = 0.97), level of physical activity (p = 0.36), work setting (p = 0.5), and with or without LBP (p = 0.28). The degree of lumbar lordosis was positively related with the number of pregnancies (p = 0.04, r = 0.25), age (p = 0.02, r = 0.1) and height (p = 0.0001, r = 0.31) and negatively related with weight (p = 0.04, r = 0.06) of the subjects. The likelihood of developing LBP was significantly higher in the subjects who had high work-related physical activity (p = 0.03) and those who exercised less often (p = 0.008). We found no significant relationship between LBP occurrence and the degree of lumbar lordosis (p = 0.68), work setting (p = 0.15), height (p = 0.08), weight (p =0.06), and age (p = 0.67) of the subjects. The degree of lumbar lordosis was not different between normal subjects and those with LBP. Lumbar lordosis was not affected by lifestyle, level of physical activity, or type of work setting. Although these factors have not been found to affect the degree of lumbar lordosis, some affected the occurrence of LBP. This finding indicates that the effect of these factors on LBP involves mechanisms other than changing the degree of lumbar lordosis.

Sagittal spinal curvatures of young adults in the context of their self-reported physical activity and somatic parameters

Article

Full-text available

May 2024

The objective of this study was to assess the thoracic kyphosis (ThKA) and lumbar lordosis (LLA) in healthy young adults and to investigate potential relationships between spinal curvatures, self-reported physical activity (PA), and somatic parameters. The study included 380 female students and 211 male students aged 20.7 ± 1.5 years. The ThKA and LLA were measured using a Plurimeter-V gravity inclinometer. The level of PA was estimated using the International Physical Activity Questionnaire. ThKA was lower in women compared to men, while LLA was higher in women than in men (p < 0.0001). Female students reported lower PA than male students (p < 0.001). Female students with ThKA within normal values reported a significantly higher amount of low-intensity PA compared to those with ThKA below or above the norm. A correlation was found between ThKA and body mass index (BMI), body adiposity index (BAI), WC, and fat percentage (rho < 0.2), whereas LLA showed correlations with BMI, BAI, waist circumference, and fat percentage (rho < 0.2). Among male students, a correlation was found between LLA and BMI as well as WC (rho < 0.2). Maintaining a healthy body composition may be instrumental in mitigating the risk of developing spinal curvature abnormalities.

The relationship between pelvic cross syndrome and chronic low back pain

Article

Dec 2006

Objective: Specific patterns of muscle impairments, known as Pelvic Cross Syndrome (PCS), in the lumbo-pelvic region have been attributed to causing chronic Low Back Pain (LBP). In PCS, based on their primary functions, muscles are categorized as "postural" or "phasic", and it has been assumed that phasic (abdominal and gluteal muscle weakness) or postural (decreased flexibility in the hip flexor and back extensor) muscle impairments could lead to an exaggerated Lumbar Lordosis (LL), which in turn might cause chronic low back pain. PCS theory also indicates that exaggerated lordosis in impaired subjects is controlled by hamstring muscle shortening. The purpose of this study was to examine the relationship among Pelvic Cross Syndrome, degree of lumbar lordosis and chronic low back pain. Design: A total of 600 subjects between the ages of 20 and 65 were selected. Subjects were categorized into four groups of males and females with and without low back pain. The degree of LL, the strength of abdominal and gluteal muscles and the extensibility of iliopsoas, erector spine, and hamstring muscles were measured in each group. The cut-off values obtained from Receiver Operating Characteristic (ROC) curve analysis were used to categorize subjects as having weak or short muscles in accordance with the PCS assumptions. The degree of lumbar lordosis in subjects with and without patterns of muscle impairments, and the association between lumbar lordosis and low back pain and the effects of hamstring muscle length on lordosis were assessed. Results: The results of this study showed no significant difference in the degree of LL in subjects with and without patterns of muscle impairment, or in subjects with and without LBP, or in those with and without short hamstring muscles. However, a significant difference in the strength of abdominal and gluteal; and in the length of hip flexor and hamstring muscles was found between subjects with and without LBP. Conclusions: The findings of this study did not support the assumptions of the PCS theory that certain patterns of muscle impairment would lead to exaggerated LL and LBP. Our data indicated that certain muscle impairments could contribute to chronic LBP, but probably not via changing the degree of lumbar lordosis as has been proposed in PCS theory.

Attitudes towards Exercise, Leisure Activities, and Sedentary Behavior among Adults: A Cross-Sectional, Community-Based Study in Saudi Arabia

Article

Full-text available

Aug 2023

Background: Sedentary behavior has received increased attention as a threat to public health all around the world. A global effort has been made to avoid the spread of noncommunicable diseases (NCDs) that are associated with poor lifestyle practices, which rely on public awareness. As a result, the purpose of this study was to analyze the attitudes toward exercise, leisure activities, and sedentary behaviour among adults in Saudi Arabia. Methods: A cross-sectional study was conducted among individuals living in the Riyadh Region in Saudi Arabia. The questionnaire (26 items) used in this study was divided into four sections, and the first section comprised demographic and basic information of the respondents (6 items). The second section asked the respondents about the time spent exercising and sedentary time spent (6 items), the third section of the study comprised eight questionnaires about the frequency of sedentary activity performed during their leisure time, and the last section was about the attitude towards sedentary behavior (6 items). Descriptive and analytical statistics were done to describe the study findings. Data were analyzed using SPSS version 27. Results: The current findings revealed that 44% (n = 305) of the respondents performed exercise 1–2 days a week, and 16.7% (n = 116) never performed any exercise. Furthermore, a considerable percentage of the respondents spent >4 h in a day as sedentary. Most of the sedentary time was spent on work relating activities 62% (n = 430), followed by time spent on coffee 36.4% (n = 252), business relating activity 22.5% (n = 156), and social media 8.9% (n = 62). In this study, most of the respondents agreed that sitting for a prolonged time might negatively impact their health. Most of the respondents showed positive attitudes towards sedentary behavior. Males were statistically more likely than females to exercise 1–2 days per week (p < 0.001). Being male and being married were both significantly associated with sedentary behavior (p < 0.001). In addition, there was a significant association between participants’ sleeping status and physical activity per week, where those who slept 5–6 h often performed physical activity, indicating a significant difference (p < 0.001) than respondents who slept 7–8 or >8 h. The participant’s age was also found to have a significant association with engaging in physical exercise (p < 0.001). Conclusions: The results of this study showed that Saudi adults are highly sedentary and inactive, though knowing the harmful consequences of inactivity. Therefore, a national active living policy must be adopted to discourage inactivity and being sedentary and encourage active living in Saudi Arabia.

Reliability of Ultrasound Measurements of the Lumbar Multifidus and Transversus Abdominis Muscles during Lying and Unstable Sitting Positions in Individuals With and Without Chronic Low Back Pain

Article

Full-text available

Apr 2023

Background: The reliability studies are limited to support ultrasound usage during dynamic conditions; for example, unstable sitting position. Objective: This study aims to examine the reliability of ultrasound measurements of the lumbar multiﬁdus and transversus abdominis during lying and unstable sitting positions in individuals with chronic low back pain (CLBP) and asymptomatic individuals considering abnormal lumbar lordosis. Material and methods: In this observational study, intrarater within-day and between-day reliability of muscle thickness and contraction ratio of the lumbar multiﬁdus and transversus abdominis muscles were assessed using ultrasound imaging. In total, 40 participants (27 with CLBP, 13 asymptomatic individuals) with abnormal lumbar lordosis were recruited. The degree of lumbar lordosis has been measured by a flexible ruler. The muscle thickness was assessed at lying and sitting on a gym ball for both muscles in three sessions. Results: Both groups had well to high ICCs of thickness measurement and contraction ratio in the transversus abdominis and lumbar multiﬁdus muscles during both static (ICC=0.71-0.99) and semi-dynamic conditions (ICC=0.73-0.98). The standard error of measurements and minimal detectable changes were rather small in both groups. Conclusion: Ultrasound imaging is a highly reliable method to assess muscle thicknesses and contraction ratio of the transversus abdominis and lumbar multiﬁdus during different conditions, even in patients with CLBP and abnormal lumbar lordosis.

Effect of Posterior Pelvic Tilt Taping on Abdominal Muscle Thickness and Lumbar Lordosis in Individuals With Chronic Low Back Pain and Hyperlordosis: A Single-Group, Repeated-Measures Trial

Article

Dec 2020
Chiropract Tech

Objective: The purpose of this study was to investigate the effect of posterior pelvic tilt taping (PPTT) on lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis. Methods: A prospective, single-group, repeated-measures design was conducted with 31 individuals with nonspecific chronic low back pain (16 men, 15 women) with hyperlordosis (mean ± SD = 59.3° ± 2.9°). Participants’ mean age, pain, disability, and lumbar lordosis were, respectively, 35.7 ± 9.9 years, 5.1 ± 1.3, 26.8 ± 11.5, and 59.3° ± 2.9°. The thickness of the abdominal muscles on both sides was measured in the crook lying position by ultrasound imaging. PPTT was performed on both sides. Pain intensity, functional disability, lumbar lordosis angle, and abdominal muscle thickness were measured before PPTT (W0), 1 week after PPTT (W1), and 1 week after PPTT removal (W2). Results: Analysis revealed significant reductions in lumbar lordosis, pain, and disability, and increased abdominal muscle thickness, at W1 and W2 compared with W0 (P < .001). There were no significant differences in lumbar lordosis or abdominal muscle thickness between W1 and W2. Conclusion: The current study showed in a small group of participants that 1 week of PPTT may improve lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis. Key Indexing Terms: Athletic TapeChronic PainLordosisMuscle ThicknessUltrasonography

Brace Treatment for Adults with Spinal Deformities

Chapter

Full-text available

May 2020

The bracing indication for adults with spinal deformities is two-fold: (1) pain and (2) deformity. Although pain is more frequent in the adult population with scoliosis, there is no correlation between the angle of curvature and pain intensity. Pain is reportedly more frequent in patients who were operated. Non-specific pain can successfully be treated with stabilisation exercises; however, some patients may need brace treatment to improve their pain. Today, with the help of a simple clinical test, we can distinguish between different types of lower back pain allowing a differential approach to the symptom. There is some evidence that pain can successfully be reduced by these approaches mainly influencing the sagittal profile. In patients with bigger deformities and in patients aiming at reducing their deformity, pattern-specific scoliosis braces are a successful choice according to published research cases. The different specific brace types/designs along with the differential indication for these brace types will be described in this chapter.

Normative Spino-Pelvic Sagittal Alignment of Lebanese Asymptomatic Adults: Comparisons with Different Ethnicities

Article

Dec 2017

Background: Normative values of sagittal alignment are used as references for the diagnosis and treatment of spinal pathologies. There are currently no reference values for the normative sagittal alignment of Lebanese subjects. The objective is to describe normative values of full body sagittal alignment parameters in asymptomatic Lebanese adults and to compare the sagittal alignment of this population to that of populations of various origins. Methods: Included subjects were aged 18 to 28 years old. Each subject underwent a full body biplanar X-ray exam with measurement of spine, pelvis and lower limb parameters of sagittal alignment. The sagittal alignment of the Lebanese population was compared to that of other ethnicities, previously reported in the literature, using one-way ANOVA. Results: Ninety-two asymptomatic Lebanese young adult volunteers (48 males, 44 females, age=21.5 ± 2.2 years) were enrolled in this study. The mean curvature in the cervical spine was kyphotic (-4.3°) in women, while it was lordotic in men (5.4°). Men were found to be significantly more kyphotic than women (-58.3° vs. -53.0°; p<0.01) but both sexes were found to have similar lordosis (61.6°) and pelvic incidence (52.0°). Lebanese subjects had intermediate pelvic incidence compared to other ethnicities but showed significantly higher thoracic kyphosis (p<0.01) and lumbar lordosis (p<0.01) compared to all other ethnicities. Conclusions: This study established reference normative values for young adult Lebanese subjects. Most women were found to have kyphotic cervical spines. The sagittal alignment of Lebanese subjects differed significantly compared to that of other ethnicities. Level of evidence: level IV - cross sectional study.

Turkish Journal of Sport and Exercise The relationship of height, weight and body mass index with curvature of spine kyphosis and lordosis in 12-15- year old male adolescents of Tehran

Article

Full-text available

Jan 2016

Normal curvature of the spine might be changed as a result of its non-fixed feature. The aim of this study was to investigate the relationship between height, weight and body mass index (BMI) with curvature of the spine kyphosis and lordosis in 12-15year-old male adolescents of Tehran. This was a correlational study in which 97 accessible healthy boy students from Tehran region 2 (13.8 ± 0.8 years old) participate were selected. After measuring height (157.4 ± 8.6 cm), weight (52.9 ± 11.9 kg) and calculating BMI (21.2 ± 3.9 kg/m 2), the spinal mouse was used to spinal assessment. To investigate the relationship between study variables Pearson correlation coefficient was used. The results of Pearson correlation coefficient showed there was no statistically significant relationship between study variables including height and kyphosis curvature (r=-0.047, p= 0.651), height and lordosis curvature (r=-0.026, r= 0.800), weight and kyphosis curvature (r= 0.015, p= 0.883), weight and lordosis curvature (r= 0.052, p= 0.610), body mass index and kyphosis curvature (r= 0.059, p= 0.566), and body mass index with lordosis curvature (r= 0.084, p= 0.413). Therefore, although it seems that anomalies of the spine have high prevalence among the students, the results of this study showed that height, weight and body mass index could not be considered as an appropriate criterion to associate of kyphosis and lordosis angles in the studied population.

Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals

Article

Full-text available

Jun 2016

Study design: Observational study. Purpose: To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. Overview of literature: IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Methods: Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. Results: For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=-0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=-0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). Conclusions: The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain.

How and why do people with chronic low back pain modify their physical activity? A mixed‐methods survey

Article

Full-text available

Apr 2024

Background This study investigated the impact of Chronic Low Back Pain (CLBP) on individuals' physical activity (PA) behaviours, specifically, how they modify, cease, or continue PA when experiencing CLBP. The primary aim was to explore the relationship between CLBP and PA and how this is influenced in different contexts (e.g., necessity of a task). Methods A mixed‐methods survey was administered to 220 participants, including self‐reported outcomes, and capturing responses to three distinct questions related to PA and CLBP. The data was analysed via a content analysis. Results The findings revealed that individuals with CLBP are most likely to modify PA in work‐related contexts and least likely to cease it in the same setting. Housework emerged as the most common domain for cessation of PA, while work/study activities were predominantly continued. Reasons for these trends were typically task‐based rather than health or enjoyment based and influenced by the perceived necessity of the task in question. Conclusion The study highlights the role of occupational and educational settings in individual responses to CLBP. The findings also highlight a gap in public awareness regarding effective CLBP management strategies, emphasising the need for increased education and awareness programs.

Comparison of the effects of core stability and whole-body electromyostimulation exercises on lumbar lordosis angle and dynamic balance of sedentary people with hyperlordosis: a randomized controlled trial

Article

Full-text available

Apr 2024

Background Hyperlordosis is an excessive inward curvature of the lumbar spine that affects spinal function. The aim of this study was to compare the effects of core stability exercises (CSE), Whole-Body Electromyostimulation (WB-EMS), and CSE Plus on the Lumbar lordosis angle and dynamic balance in sedentary people with hyperlordosis. Methods In a parallel randomized controlled trial study, seventy five untrained male adults with hyperlordosis, recruited from clinics of sports medicine and corrective exercise centers in Tehran, were randomly assigned to four groups: CSE (n = 19), WB-EMS (n = 18), CSE Plus (n = 18), and control Group (CG) (n = 20). The CSE group performed Core stability exercises, the WB-EMS group followed a Whole-body electromyostimulation combined training protocol, and the CSE Plus group engaged in a combined program protocol (CSE with the WB-EMS vest), and the control group only participated in activities of daily living. Anthropometric parameters and outcomes, including the lordosis angle and dynamic balance, were assessed before and after a six-week training program. A flexible ruler was used to measure the angle of lordosis, and the Y balance test was employed to evaluate the dynamic balance. Results The results indicated that the lordosis angle improved in both the CSE and CSE Plus groups compared to the CG in the post-test (P = 0.017, P = 0.024). However, there were no significant differences observed between the other group pairs. Additionally, a significant difference in dynamic balance was found between the CSE Plus group and the CG in the post-test (P = 0.001), while no significant differences were observed between the other group pairs. Furthermore, within-group test results demonstrated that lumbar lordosis angle and dynamic balance variables significantly improved in the post-test compared to the pre-test stage (P < 0.05). Conclusions The two CSE and CSE Plus training protocols are effective as training methods for correcting certain parameters and physical deformities, including lumbar lordosis. Furthermore, the CSE Plus group demonstrated a positive impact on improving dynamic balance. Consequently, it is highly recommended that individuals with hyperlordosis can benefit from the exercises of the present study, especially CSE Plus exercises along with other rehabilitation exercises. Trial registration The trial was registered at Thai Clinical Trials Registry (TCTR20221004011, registration date: 04/10/2022).

Different types of Corrective exercises on Correction of Hyper Lumbarlordosis in Females- A Narrative Review

Article

Full-text available

Nov 2023

Back ground: Lumbar curvature carries the upper body weight and transfers it directly to the pelvis, which is of great significance. The structures in the lumbar region are one of the factors that affect the lumbar-pelvic balance, as well as the performance of lumbar lordosis and pelvic tilt. Also, weakness of abdominal, dorsal, and lumbar muscles has been considered as the most common factors increasing the lumbar curvature. Excessive lordotic curvature is also called hyperlordosis, hollow back, saddle back and swayback. Common cause of excessive lordosis includes tight low back muscle, excessive visceral fat, and pregnancy. Objectives: This review aimed at finding and analysing different forms of corrective exercises to correct hyper lumbar lordosis in females. Methods: The search was performed through online for English language articles. The databases used were Google ‘corrective exercises’ and ‘lumbar lordosis’. The scientific literature related to physiotherapy management for lumbar lordosis published from 1997 to 2021 was searched. Screening of the reference lists of all the retrieved articles was also done. Through online database search 100 articles were reviewed, 19 articles were included in this study based on predetermined inclusion criteria. Inclusion criteria: Based on gender (only female’s participant’s studies). Participants: Studies had included individuals with hyper lumbar lordosis with pain or without low back pain. Conclusion: 16 articles show Corrective exercises plays a main role in reduction of lumbar lordotic curve and functional disability. With the help of corrective exercises (abdominal muscle strengthening exercises, gluteal strengthening exercises hip flexor stretching exercises, back stretching exercises) can maintain the core stability of spinal extensors and flexors, due to this, spinal curvature can be corrected indirectly and the posture is corrected and the spasm get released, pain will be subsided, finally the quality of life will be improved.

Reactive postural adjustment in response to predictable and unpredictable perturbations in healthy adults: A comparison between swayback, hyperlordotic and erect postures

Article

Nov 2023
GAIT POSTURE

Lower limb muscle activation pattern in male soccer players with lumbar hyperlordosis

Article

Aug 2023

Objective the aim of the current study was to compare the lower limb muscle activation pattern in soccer players with and without lumbar hyperlordosis during single-leg squat performance. Methods thirty male collegiate soccer players (15 with and 15 without lumbar hyperlordosis) performed the SLS task. Surface EMG was used to record the activation of eleven lower limb muscles. The activation of these muscles reduces to 100 points during the SLS cycle, where 50% demonstrates the maximum knee flexion, and 0% and 99% demonstrate the maximum knee extension. Results soccer players with lumbar hyperlordosis had higher muscle activation than those with normal lumbar lordosis in gluteus maximus, biceps femoris, and medial gastrocnemius. By contrast, they had lower gluteus medius, vastus medialis oblique, rectus femoris, soleus, and medial gastrocnemius (only in the final ascent phase of the SLS) muscle activity than the normal group during the SLS. Conclusion this alteration may negatively affect targeted muscle performance during the SLS. Subsequent study is required to specify whether such an alteration in the lower limb muscle could be accompanied by injury in soccer players and change in their athletic performance.

The relationship between core muscle endurance and functional movement screen scores in females with lumbar hyperlordosis: a cross-sectional study

Article

Full-text available

Oct 2022

Background Core muscle endurance is essential for proper movement and lower extremity injury prevention. In addition, the Functional Movement Screen (FMS) score is a tool to assess body movement patterns to predict the risk of injury. Although various researches have investigated the relationship between the core muscle endurance and the FMS score, no study has ever assessed the effect of postural deformity on the FMS score. This study investigates the relationship between core muscle endurance and FMS scores in females with lumbar hyperlordosis. Methods 42 healthy females aged 24.03 ± 4.4 years with hyperlordosis ( > = 45/66 degrees) participated in this study. Core muscle endurance was assessed by the McGill stability test. Correlations were evaluated between the FMS score, McGill test, and lordosis angle using spearman correlation coefficients (p ≤ 0.05). Results Most individual FMS scores were not correlated with the McGill test except stability trunk push up. Also, lordosis angle was not correlated with the FMS composite score (r=-0.077; p = 0.631), while it was negatively correlated with the McGill test (r=-0.650; p = 0.000). Conclusion The lack of correlation between the FMS score and the McGill test implies that one’s level of core endurance may not influence their functional movement patterns. In contrast, the lumbar lordosis angle might impact one’s core muscle endurance but not their functional movement patterns.

Defining the Lumbar and Trunk-Thigh Neutral Zone From the Passive Stiffness Curve: Application to Hybrid sit-Stand Postures and Chair Design

Article

Full-text available

May 2022

Minimal data exist on the neutral position for the lumbar spine, trunk, and thighs when adopting a hybrid posture. This study examined sex differences in the neutral zone lumbar stiffness and the lumbar and trunk-thigh angle boundaries of the neutral zone, and determined if the standing lumbar angle fell within the neutral zone. Passive lumbar flexion and extension moment-angle curves were generated for 31 participants (13 M, 18 F), pooled from two datasets, with trunk-thigh angles available for 10 participants. The neutral zone was defined as the low stiffness zone from both the flexion and extension curves. Males demonstrated significantly greater extensor stiffness. Neutral lumbar and trunk-thigh angles ranged on average −22.2 to 0.2° and 124.2 to 159.6° for males and −17.8 to −1.3° and 143.2 to 159.5° for females, respectively. Standing lumbar angles fell outside the neutral zone for 44% of participants. These neutral zone boundaries may inform kinematics for hybrid chair designs. Practitioner summary: Adoption of a neutral spinal posture may be achieved through hybrid chair design, yet minimal data exists on a physiologically defined neutral zone. Using measures of in vivo lumbar stiffness, the lumbar and trunk-thigh angular boundaries of the neutral zone were defined for both males and females. Abbreviations: EMG: electromyography; MVC: maximal voluntary contraction

Effect of physical activity intervention on the musculoskeletal health of university student computer users during homestay

Article

Jan 2023

Purpose: The coronavirus outbreak delivered the condition of dying from infection and forced people (especially university student computer users) to perform all working and non–working activities during homestay. In this situation, the device usage for a longer duration is mainly responsible for work–related health issues. This study aims to discover the effect of physical activity intervention (PAI) on computer users' musculoskeletal health during homestay. Material and Methods: The investigation was performed on 40 university student computer users. To measure body discomfort before and after using the PAI, the body part discomfort scale of Corlett and Bishop was applied. Results: After implementing the PAI, the musculoskeletal disorder (MSD) decrement in major body regions was reported as: wrist/forearm (8.17 ± 1.45 to 4.57 ± 1.10), lower back (8.01 ± 1.42 to 4.40 ± 1.14), elbow (7.57 ± 1.71 to 3.49 ± 1.13), and neck (7.40 ± 1.71 to 4.02 ± 0.81). Conclusions: It can be concluded that PAI significantly decreased the discomfort among users in various body regions. This research suggested that PAIs may reduce the risk of MSDs in the long term for different body regions.

The impact of 10 weeks of Pilates exercises on the thoracic and lumbar curvatures of female college students

Article

Full-text available

Dec 2021
Sport Sci Health

Background A normal spine plays an important role in many human functions. The spine abnormally curved may include back pain, reducing mobility and stability. So, measuring the degree of spinal curvature and correcting them is very important. Aims The purpose of this study was to evaluate the impact of 10 weeks of Pilates exercises on the thoracic and lumbar curvatures of female college students residing in dorms. Methods In this study experimental and applied 15 female students of University dormitories with hyperkyphosis and hyperlordosis were selected in an available samples manner. Spine Curvatures of volunteer students after completing the consent form and inclusion criteria were measured using a flexible ruler. From T2 to T12 vertebrae to determine thoracic deviation and from T12 and S2 vertebrae to determination of lumbar deflection was used. Pilates exercises duration 10 weeks 2 sessions per week and 1.5 h per session for abnormalities of hyperkyphosis and hyperlordosis were performed. Fifteen students participated in all of the Pilates training sessions. Results The mean of students’ thoracic and lumbar angles were 49.31 and 52.96 respectively. The results of Pilates exercises showed that on average 13.68 degrees of hyperkyphosis and 10.79 degrees of hyperlordosis were improved in students. Weight, height, and body mass index were effective factors on the thoracic or lumbar spine abnormalities. Conclusions Pilates practice based on the scientific principles of therapeutic planning can be effectively used to correct kyphosis and lordosis malformations of female students.

Determining the Relationship between Transversus Abdominis Strength and Lumbar Lordosis in Young Adults

Chapter

Oct 2021

Effect of L4 Mobilization and Posterior Pelvic Tilting Exercise on Sciatica in Patients with Spondylolisthesis

Article

Dec 2020

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit

Article

May 2020
J MANIP PHYSIOL THER

Objective This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis. Methods Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T12, L3, S2, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T12 and L3, and the line joining L3 to S2. Results Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20). Conclusion Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

Non-specific chronic low back pain in patients with scoliosis—an overview of the literature on patients undergoing brace treatment

Article

Full-text available

Nov 2019

[Purpose] Although there is evidence that non-specific chronic pain can be influenced by physical therapy, some patients with scoliosis and chronic pain may benefit from additional brace treatment. The purpose of this review is to answer the question whether there are studies on the use of brace treatment in patients with scoliosis and pain and to investigate whether brace treatment does positively influence chronic pain. [Methods] A PubMed review has been undertaken using the key words (1) scoliosis and pain and brace treatment and (2) scoliosis and pain and orthotics. From both searches the studies were extracted that included a patient group with the diagnosis of a scoliosis and with additional chronic non-specific low back pain, treated with a brace. [Results] One hundred forty two items have been found for search (1) and 111 for search (2). The total number of relevant items found in both searches was 10. According to the studies found, bracing seems an effective treatment for this condition. [Conclusion] Brace treatment in patients with scoliosis and chronic non-specific low back pain has demonstrated to be effective. It should be used when exercise treatment is not effective. A clinical test is demonstrated to predict the most beneficial approach in brace treatment.

Sex-specific effects of sitting vs standing on upper body muscle activity during text typing

Article

Sep 2019

Standing computer work is increasingly popular. However, despite the higher rates of computer work-related disorders in women, no studies have compared how standing work affects men and women. Twelve males and 12 females completed 90-min typing tasks in each posture while electromyography (EMG) data was recorded from eight muscles of the upper body. Results show that females had significantly higher EMG root-mean-squared (RMS) values in the anterior deltoid than males when seated, but higher EMG RMS in the medial trapezius than males when standing (SBC ≤ 0.05). In standing, they also had lower values than males in the erector spinae. Overall, standing elicited less activity in the upper trapezius, wrist extensors and erector spinae than sitting. Results suggest that the standing posture is generally less muscularly demanding than the seated one, although men and women's neck/shoulder musculature responds differently to the same task performed while seated or standing.

The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies

Article

Full-text available

Jun 2019

Abstract The aim of this review was to investigate the association between total and domain-specific physical activity (PA) and non-specific low back pain (LBP) in adults. Seven databases were searched for cohort and cross-sectional studies. Pooled estimates of the association of medium and high levels PA and LBP, using the generic inverse-variance method with fixed- and random-effects models were calculated. Twenty-four studies (15 cohort and nine cross-sectional; 95,796 participants) were included. The pooled fully adjusted risk ratios (RR) from cohort studies comparing medium with lowest activity levels were 0.90 (95%CI 0.85 to 0.96) for total PA, and 0.90 (95%CI 0.85 to 0.96) for leisure-time PA (LTPA). The pooled RR comparing highest with lowest activity levels were 1.00 (95%CI 0.92 to 1.08) for total PA, and 1.01 (95%CI 0.93 to 1.10) for LTPA. The pooled fully adjusted odds ratios (OR) from cross-sectional studies comparing medium with lowest activity levels were 0.93 (95%CI 0.65 to 1.32) for total PA, and 0.77 (95%CI 0.62 to 0.96) for LTPA. The pooled OR comparing highest with lowest activity levels were 1.05 (95%CI 0.89 to 1.23) for total PA, and 0.85 (95%CI 0.79 to 0.93) for LTPA. PA seems to be associated with lower prevalence of LBP.

Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain

Article

Oct 2019

Purpose: The purpose of this study was to compare kinematics of the lower extremity and lumbar spine during a single leg landing task between female volleyball athletes with and without persistent low back pain (LBP). Methods: In this cross sectional study, 36 volunteer female volleyball athletes with (n = 18) and without (n = 18) LBP were recruited. Two specifically trained physical therapists selected only athletes with a specific movement-based subgroup of LBP for inclusion. Three dimensional kinematic and ground reaction force data were recorded for each athlete across three single leg landing trials by utilizing a Vicon 6-camera motion capture system and one in-floor embedded Kistler force plate, respectively. Independent t-tests compared data between the two groups. Results: Lumbar lordosis when standing (p = 0.046) as well as on initial contact (p = 0.025) and at the time which the maximal vertical ground reaction force occurred (p = 0.020) were significantly greater in the LBP group. There were no other significant differences. Conclusions: The tendency for this specific subgroup of athletes to consistently adopt more extended lumbar postures in both static and dynamic tasks may be worth considering by those involved in coaching, performance optimizing and injury prevention.

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

Article

Nov 2018
J BIOMECH

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.

Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain

Article

Full-text available

Mar 2018

Background. The kinematics of a controlled functional task in female volleyball athletes may be an interesting area of study. Therefore, investigating if there are kinematic changes in a jump landing jump task among female athletes with low back pain (LBP) may help therapists and trainers better prevent and/or rehabilitate LBP in athletes. Objectives. The purpose of this study was to examine lumbopelvic and lower extremity kinematics in athletes with persistent LBP during a jumping task. Methods. A comparative cross sectional study conducted in a university research laboratory. Professional female volleyball players with (n = 20) and without (n = 18) LBP were recruited from the Iranian female volleyball league. To reduce heterogeneity, one particular subgroup of athletes with LBP were selected. Kinematic data including lumbar extension, hip flexion, rotation and adduction and knee flexion and abduction angles when the center of mass was at minimum height during a jump-landing-jump maneuver were collected using a Vicon motion analysis system and analysed using MATLAB software. Independent t-tests were used to compare mean values between the groups. Results. Athletes with LBP had significantly greater hip flexion (LBP: -73.62±11.06˚; Control: -62.88±7.03˚, p=0.016) and significantly less knee flexion (LBP: 77.06±7.27 ˚, Control: 81.62±4.70 ˚, p=0.029) at the lowest point of the jump than athletes without LBP. There were no other significant differences between the groups (p>0.05). Conclusion. A subgroup of female athletes with LBP display altered lower extremity kinematics during a jump task than athletes without LBP. This may have important implications for lower limb performance and injury.

Correlation of scapulo-thoracic muscle strength, neck pain and the functional status of information technology professionals

Article

Full-text available

Jul 2018

p class="abstract"> Background: The cross-sectional study was to correlate scapulo-thoracic muscle strength, neck pain and the functional status of Information Technology (IT) professionals. IT professionals have long working hours in a seated position which can lead to neck pain and decrease in the scapulo-thoracic muscle strength. This could hinder the person’s capability to perform daily functional activities. Methods: The study was conducted in an IT- company from November 2017- December 2017. FET was used to assess the scapulo-thoracic muscle strength. Neck pain and functional status of the IT professional was evaluated by the two scales–Neck Disability Index and Orebro Pain Rating Questionnaire respectively. For the statistical analysis–Spearman’s correlation and SPSS software was used. All subjects, male and female, with neck pain and having worked for more than 2 years were included. Subjects with diagnosed orthopaedic condition and having a history of trauma were excluded. Results: For the IT professionals, a moderate correlation was established between the neck pain and strength of serratus anterior muscle R(r=0.32) L(r=0.4) and rhomboid muscles R(r=0.37) L(r=0.4). Further, it was seen that the functional status was not hampered due to neck pain and scapulo-thoracic muscle strength. Conclusions: The study shows that there is a moderate correlation between the neck pain and scapula-thoracic muscle strength of IT professionals. In addition, there is a weak correlation between neck pain, scapulo-thoracic muscle strength with respect to the functional status.</p

Article

Full-text available

Jul 2018

Objective: Work-related musculoskeletal disorders (WMSDs) have a significant impact on university faculty members. However, very few studies addressed this issue. The objectives of this study were to determine the prevalence and factors associated with WMSDs among the College of Applied Medical Sciences (CAMS) faculty members of Majmaah University, Saudi Arabia.Methods: In this cross-sectional study, 60 faculty members were recruited using convenience sampling technique. After obtaining the informed consent, data regarding personal characteristics, workplace factors, and prevalence of WMSDs were collected by a valid, reliable, and self-administered musculoskeletal questionnaire.Results: The prevalence of WMSDs in anybody region among faculty members in this study was 55 %. The neck complaint was the most prevalent WMSDs (53.5%), followed by lower back (43.3%) and hand regions (31.6%). Computer use and lack of ergonomic training were associated with WMSDs in most of the body regions.Conclusion: More than half of the study participants were affected with WMSDs. The findings of this study emphasize the essentiality of ergonomic training for the faculty members. (PDF) Work-related musculoskeletal disorders among faculty members of college of Applied Medical Sciences, Majmaah University, Saudi Arabia: A cross-sectional study. Available from: https://www.researchgate.net/publication/326519185_Work-related_musculoskeletal_disorders_among_faculty_members_of_college_of_Applied_Medical_Sciences_Majmaah_University_Saudi_Arabia_A_cross-sectional_study [accessed Oct 14 2019].

Adverse Effects of Prolonged Sitting Behavior on the General Health of Office Workers

Article

Full-text available

Jul 2017

Background Excessive sitting behavior is a risk factor for many adverse health outcomes. This study aimed to survey the prevalence of sitting behavior and its adverse effects among Iranian office workers. Methods This cross-sectional study included 447 Iranian office workers. A two-part questionnaire was used as the data collection tool. The first part surveyed the demographic characteristics and general health of the respondents, while the second part contained the Nordic Musculoskeletal Questionnaire (NMQ) to assess symptoms. Statistical analyses were performed using the Statistical Package for the Social Sciences software using Mann-Whitney U and Chi-square tests and multiple logistic regression analysis. Results The respondents spent an average of 6.29 hours of an 8-hour working shift in a sitting position. The results showed that 48.8% of the participants did not feel comfortable with their workstations and 73.6% felt exhausted during the workday. Additionally, 6.3% suffered from hypertension, and 11.2% of them reported hyperlipidemia. The results of the NMQ showed that neck (53.5%), lower back (53.2%) and shoulder (51.6%) symptoms were the most prevalent problem among office workers. Based upon a multiple logistic regression, only sex had a significant association with prolonged sitting behavior (odds ratio = 3.084). Our results indicated that long sitting times were associated with exhaustion during the working day, decreased job satisfaction, hypertension, and musculoskeletal disorder symptoms in the shoulders, lower back, thighs, and knees of office workers. Conclusion Sitting behavior had adverse effects on office workers. Active workstations are therefore recommended to improve working conditions.

Pelvic Movement in Aging Individuals and Stroke Patients

Chapter

May 2017

Hitoshi Asai

The mobility of the lumbar spine (anteversion and retroversion) may be reflected in seated pelvic mobility. When sitting with the soles of the feet in contact with the floor, friction may restrict the flexion of the knees and, consequently, the pelvic anteversion. In general, joint mobility declines with advancing age. Lumbar spine mobility in anteversion and retroversion also decreases with advancing age. The first half of this chapter is based on a study that investigated the relationship between age and the maximum pelvic anteversion and the retroversion angles in healthy volunteers. The measurements were performed with the subject in a sitting position with free knee movement. On the other hand, the sit-to-stand movement is one of the most mechanically demanding tasks undertaken during daily activity. The sacral sitting posture, which is a characteristic posture of stroke patients, is not ideal for smoothly executing the sit-to-stand movement. Stroke patients may adopt this posture due to the need to increase sitting stability. The second half of this chapter discusses a study that investigated the relationship between the pelvic anteversion and retroversion angles and the ability of stroke patients to perform the sit-to-stand movement. Thirty-two hemiparetic subjects (female, n = 15; male, n = 17; age, 66.7 ± 7.6 years) and 50 age-matched healthy control subjects (female, n = 40; male, n = 10; age, 64.2 ± 8.2 years) participated in this study. The inclusion criteria were predetermined as follows: (1) a poststroke period of more than 3 months and (2) the ability to maintain the sitting position without the use of aids. The hemiparetic subjects were classified into two groups according to their performance in the sit-to-stand movement test (described later): a group with the ability to stand up (the stand-able group; n = 18 persons) and the group that was unable to stand up (the stand-unable group; n = 14 persons). Patients with a history of low back pain or surgery, hemispatial neglect, bilateral stroke, visual deficit, comprehension impairment, cognitive and/or communication deficits that precluded cooperation, as well as neurological or musculoskeletal disorders that were not related to the current stroke, were excluded. The exclusion criteria for healthy subjects included known vestibular dysfunction, a history of neurological disease, or orthopedic conditions that had the potential to interfere with the experiment.

Three months of resistance training in overweight and obese individuals improves reactive balance control under unstable conditions

Article

Full-text available

Nov 2017

Background: Contrary to static and dynamic balance, there is a lack of scientific evidence on the training induced changes in reactive balance control in response to unexpected perturbations in overweight and obese individuals. Objective: This study evaluates the effect of 3 months of resistance and aerobic training programs on postural responses to unexpected perturbations under stable and unstable conditions in the overweight and obese. Methods: A group of 17 overweight and obese subjects, divided into two groups, underwent either resistance or aerobic training for a period of 3 months (3 sessions per week). Prior to and after completing the training, they performed the load release balance test while standing on either a stable or unstable surface, with eyes open and closed. Results: Peak center of pressure (CoP) posterior displacement, and the time to peak posterior CoP displacement during a bipedal stance on a foam surface with eyes open (17.3%, p = 0.019 and 15.4%, p = 0.029) and eyes closed (15.0%, p = 0.027 and 13.2%, p = 0.034), decreased significantly. In addition, the total anterior to posterior CoP displacement, and the time from peak anterior to peak posterior CoP displacement, both with eyes open (18.1%, p = 0.017 and 12.2%, p = 0.040) and eyes closed (16.3%, p = 0.023 and 11.7%, p = 0.044), also significantly decreased. However, after completing the resistance training, the parameters registered while standing on a stable platform, both with eyes open and closed, did not change significantly. The group that underwent an aerobic training also failed to show any significant changes in parameters of the load release balance test. Conclusion: Three months of resistance training in previously untrained overweight and obese subjects improves reactive balance control in response to unexpected perturbations under unstable conditions, both with and without visual cues. Due to the fact that this unstable load release balance test was found to be sensitive in revealing post-training changes, it would be suitable for implementing in the functional diagnostic for this group, in addition to complementing existing testing methods.

Differences between clinical “snap-shot” and “real-life” assessments of lumbar spine alignment and motion-What is the “real” lumbar lordosis of a human being?

Article

Feb 2016
J BIOMECH

The individual lumbar lordosis and lumbar motion have been identified to play an important role in pathogenesis of low back pain and are essential references for preoperative planning and postoperative evaluation. The clinical “gold-standard” for measuring lumbar lordosis and its motion are radiological “snap-shots” taken while standing and during upper-body flexion and extension. The extent to which these clinically assessed values characterise lumbar alignment and its motion in daily life merits discussion.

Is Standing the Solution to Sedentary Office Work?

Article

Jul 2015
Ergon Des

There has been a major shift toward office workstations that accommodate standing postures. This shift is attributable to negative health and musculoskeletal issues from sedentary exposures. However, changing exposures from sitting to standing does not eliminate these issues, as evidence indicates prolonged standing also induces problems. Reducing seated exposure and rotating frequently between sitting and standing has been shown to result in positive health outcomes, reduced discomfort, and increased work performance. Implementing sit-stand workstations has promise to mitigate work-related health issues, if the users are provided with training that includes accommodations for individual work patterns and preferences.

Trunk postural control in unstable sitting: Effect of sex and low back pain status

Article

Jul 2015

Adequate neuromuscular control of the lumbar spine is required to prevent lumbar injuries. A trunk postural control test protocol, controlling for the influence of body size on performance, was implemented to carry out between-subject comparisons. The aim of this study was to assess the effect of sex and low back pain status with the use of two measures of trunk postural control, the first based on chair motion, and the second based on trunk motion. Thirty-six subjects (with and without low back pain) performed three 60-s trunk postural control trials with their eyes closed while seated on an instrumented wobble chair, following a calibration procedure. Chair and trunk angular kinematics were measured with an optoelectronic system. A chair-based stabilogram and a trunk-based (lumbar spine) stabilogram were created using the angular motions produced in the sagittal and frontal planes. Twenty body-sway measures were computed for each stabilogram. The calibration task efficiently controlled for the influence of body size. Several sex effects were detected, with most of them originating from the trunk-based measures. Subjects with low back pain and healthy controls showed comparable trunk postural control. Sex differences were substantiated for the first time, but almost only with the trunk-based stabilogram, showing that the kinematic information captured on the trunk segments is quite different from what is captured on the wobble chair. Contrary to previous studies, pain status was not related to lowered trunk postural control, which can be attributed to the patients recruited or measurement reliability issues. Copyright © 2015 Elsevier Ltd. All rights reserved.

Change in lumbar lordosis during prone lying knee flexion test in subjects with and without low back pain

Article

Full-text available

Jun 2015

Background Prone lying knee flexion (PLKF) is one of the clinical tests used for assessment of the lumbo-pelvic movement pattern. Considerable increase in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbar-pelvic region. However, no study has directly evaluated the change in lordosis during active PLKF test in subjects with low back pain (LBP). The purpose of this study was to investigate the change of lumbar lordosis in PLKF test in subjects with and without LBP. Methods A convenience sample of 80 subjects participated in the study. Subjects were categorized into two groups: those with chronic non-specific LBP (N = 40, mean age: 40.84 ± 17.59) and with no history of LBP (N = 40, mean age: 23.57 ± 10.61). Lumbar lordosis was measured with flexible ruler, first in prone position and then on active PKF test in both subjects with and without LBP. Data was analyzed by using statistical methods such as, independent t-test and paired t-test. Results There were statistically significant differences in lumbar lordosis between prone position and after active PLKF in both subjects with and without LBP (P < 0.0001). The amount of change in lordosis during PLKF test was not significant between the two groups (P = 0.65). However these changes were greater among patients with LBP. Conclusion Increase in lumbar lordosis during this test may be due to excessive flexibility of movement of the lumbar spine in the direction of extension and abnormal movement patterns in the individuals with LBP.

Impact of sitting at work on musculoskeletal complaints of German workers - results from the study on mental health at work (S-MGA)

Article

Full-text available

Mar 2024
J Occup Med Toxicol

Introduction Sedentary behavior (including prolonged sitting) is a form of physical inactivity that has a negative impact on health, possibly including musculoskeletal complaints (MSCs). The purpose of this study was to determine the extent to which time spent sitting at work is associated with the one-year prevalence of MSCs in the neck, shoulder, upper back/thoracic spine, and lower back among workers from the Study of Mental Health in the Workplace (S-MGA). In addition, the study also examined whether leisure time, physical activity, and sex modify the relationship between occupational sitting and MSCs. Methods For this analysis, we used the S-MGA, a 5-year prospective study in Germany. The S-MGA is a nationwide representative employee cohort study with a baseline survey in 2012 and a follow-up survey in 2017. Sitting at work was measured using a question asked at baseline. The Nordic Musculoskeletal Questionnaire was used to determine the one-year prevalence of MSCs in the neck, shoulder, upper back, and lower back pain (yes/no). The assessment of MSCs was only conducted at the 2017 follow-up. Adjusted Poisson regression models were used to determine the association of baseline level of weekly hours spent sitting at work with MSCs during follow-up. In addition to unadjusted models, models were adjusted for demographic (age, sex, body mass index and occupational skill level), occupational (heavy lifting at work), psychological disorders and lifestyle factors (smoking status and leisure time physical activity), as well as preexisting musculoskeletal conditions reported at baseline. To examine whether the relationship between sitting time and pain was modified by sex and leisure time physical activity, the models were stratified for both these variables. Results Among the participants analyzed (n = 2,082), 49.8% were male, while 50.2% were female, and more than 60% of the study population spent over half of their working hours in a sitting position. Exposure to increased sitting at work reported at baseline was not consistently associated with 12-month prevalence of MSCs in the upper body at follow-up. However, differences in the association between occupational sitting and MSCs were dependent on the intensity of leisure time physical activity. Prevalence ratios (PRs) indicated an increased prevalence of MSC in the neck (PR = 1.46; 95% CI = 1.18–1.80) and shoulder (PR = 1.30; 95% CI = 1.03–1.64) in workers without leisure time physical activity who spent 25 to < 35 weekly working hours sitting. Discussion These findings suggest that leisure time physical activity interacts with the relationship between sitting at work and MSCs. The relationship between sitting at work and musculoskeletal pain needs further investigation, but we found indications that leisure time physical activity may counter the effects of sitting at work.

A Systematic Review and Meta-Analysis on Comparative Kinematics in the Lumbopelvic Region in the Patients Suffering from Spinal Pain

Article

Full-text available

Mar 2022

Background: Lumbopelvic kinematics has been observed to include different parameters and directly relate to the movement of the hip spine. In the current scenario, more than 65 million people have been suffering from spinal pain, and 18% of adults experience chronic spinal pain. Methods: This systematic review and meta-analysis selected 9 studies for analysis via electronic databases like EMBASE, MEDLINE, Web of Science, Scopus, CINAHL, and Cochrane (CENTRAL). After collecting the data, the dataset has been systematically analyzed through statistical methodologies using RevMan and Stata. Results: Out of 116 studies initially scrutinized, nine were finally selected for the meta-analysis. When range of motion was studied via meta-analysis, it was noted that a considerable reduced movement was noted in the lumbar region of the spine when people were suffering from lower back pain in comparison to control group people. Hence, reduced lumbar range of motion, no difference in the angle of lordosis, and no significant difference in extension and rotation in people with lower back pain were found. However, variability was noted in people suffering from lower back pain for flexion and lateral flexion. A significant heterogeneity was found between the studies which lacked some details and standardization of the criteria which were used for defining patients with lower back pain or without them (control group). Results show that spinal pain is the main reason behind the limitation of lumbar range of motion. It is clear from the data set of mean and standard deviation, and this is clear to establish the relationship between the causes of pelvic and spinal pain. In flexion-based ROM, the mean difference was found to be -9.77 (95% CI: -21.86, 2.32). Similarly, for lateral flexion, the mean difference was found to be -5.58 (with 95% CI: -10.38, -0.79). Conclusion: It can be concluded that spinal disease is too influential for people; thereby, it affects day-to-day life activities by creating painful and restricted movements. It is concluded that people suffering from lower back pain have reduced proprioception and range of movement in the lumbar region when compared to control groups with no lower back pain, which mainly focus on flexion and lateral flexion.

Does sitting on a stability ball increase fall risk during ergonomic reaching tasks?

Article

Jul 2022
APPL ERGON

Although sitting on a stability ball has become an alternative to using an office chair, little is known about the increased potential for a fall on the deformable seat. This study examined differences in stability between sitting on a seat pan of a backless office chair and a stability ball during reaching tasks. Sixteen participants performed forward and lateral reaching tasks on a backless and armless office chair and stability ball while whole-body motion and force data under the seat were recorded. Even with participants placing their feet 16.5 cm wider when seated on the ball, the perceived fall risk was significantly greater. Centre of pressure displacement tended to be smaller under the ball for lateral reach directions, but larger during far anterior reaches. While not statistically significant, the medial-lateral margin of stability was on average 3.4 cm smaller on the ball. Despite attempts to increase stability by widening their stance, stability ball fall risk remained higher.

Alternative to Reduced Stresses on the Upper Extremity in a Standing Workstation

Article

Dec 2021

Objective This study evaluated a standing armrest to provide more acceptable ergonomic guidelines that may reduce the cost of standing computer workstations. Background Of the many advantages of standing workstations, there have been no efforts to minimize the biomechanical cost, such as larger wrist extension and greater forearm muscle activity than sitting. Method Sixteen participants were asked to perform a typing task under a combination of the following factors: (1) desk shape (rectangular and concave); (2) desk height (0, +5, -5 cm from 90° elbow flexion); and (3) monitor height (0, −10 cm from the eyes). During the trials, the trunk kinematics, muscle activation levels, and CoP were recorded. Results Both arms were further away from the upper body under the concave and +5 desk height than under the normal condition, but significant decreases in the extensor carpi radialis (8.6%), anterior deltoid (28.8%), and L4 paraspinals (5.5%) were observed. Similarly, the wrist extension angle decreased by 10.5° (42%) under this condition, but the posture required a 2.2° (19%) increase in wrist adduction angle. The CoP irregularity was greater under the concave workstation, indicating more complex motion. Conclusion A higher and concave desk can provide an armrest effect while engaged in a standing workstation by reducing the wrist extension and related muscle activation level, but at the cost of a larger wrist adduction angle. Application Providing a standing armrest (+5 cm height and concave desk) could reduce the stresses on the upper extremities, but a split keyboard should be considered to minimize wrist adduction.

Quality improvement of general anteroposterior radiographic image of vertebral body according to optimum angle of incidence

Article

Jan 2021

Objective: In this study, we present an appropriate angle of incidence to reduce the distortions in images of L4 and L5 during a general anteroposterior radiograph examination. Method: We selected 170 patients who had normal radiological findings among those who underwent anteroposterior and lateral examination for lumbar vertebrae. An optimum angle of incidence wa suggested through the statistical analysis by measuring the lumbar lordosis angle and the intervertebral disc angle in these 170 patients. Result: We suggested the incident angle (10.28°) of L4 and the incident angle (23.49°) of L5. We compared the distorted area ratios when the incident angle was 0°, 10°, and 23.5° using the ATOM® phantom. The ratio for the L4 decreased from 14.90% to 12.11% and that of the L5 decreased from 15.25% to 13.72% after applying the angle of incidence. We determined the incident angle (9.34°) of L4 and (21.26°) of L5 below 30° of LLA. Thus, we determined the incident angle (11.21°) of L4 and (25.73°) of L5 above 30° of LLA. Conclusion: When you apply the optimum angle of incidence, the distortion of image was minimized and an image between the joints adjacent to the anteroposterior vertebral image with an accurate structure was obtained. As a result, we were able to improve the quality of the image and enhance diagnostic information.

Sex Difference in the Range of Pelvic Tilt in Sitting and Standing Among Korean Young Adults

Article

May 2020

Jangwhon Yoon

Effects of Lateral Deviation from Neutral Position on the Perceived Joint Discomfort Rating in Cervical and Lumbar Region in Sitting and Standing Position

Article

Full-text available

Dec 2018

Introduction: The human body can adopt various types of postures. Typical examples of deviations from neutral posture around the low back are forward and backward bending, side bending and rotation [1]. Body part discomfort (BPD) scale has become a standard discomfort assessment tool. While performing a task, the worker indicates the body areas in which discomfort is felt as a result of the task, and assigns a severity to the discomfort of each body part [2,19,40,45]. Aims and Objectives: The main aim and objective of this study was to observe the effects of deviation from neutral position on the perceived joint discomfort rating in neck and back in sitting and standing position. Methods: A total of forty subjects were selected based upon the inclusion and exclusion criteria. The 20 out of the 40 subjects were asked to maintain static joint posture for the neck. The postures included were flexion, extension, right and left side flexion and right and left rotation. The subjects were asked to maintain these posture in the sitting position. The remaining 20 subjects were asked to maintain the same static joint posture in sitting position for the neck but in reverse order. The first 20 subjects were then asked to maintain static joint posture for the low back in sitting position. The postures included were flexion, right and left side flexion and right and left rotation. The remaining 20 subjects were then asked to maintain the same static joint posture for the low back in sitting position but in the reverse order. Discussion: These findings suggest as stated earlier that perceived joint discomfort has a direct correlation with the torque produced in the muscle around the joint and higher the torque more will be the discomfort. H. Monod reported that exhaustion of a muscle engaged in static activity is mainly due to ischaemia created inside the muscle by the contracting force [35]. Wilke et al. (1999) measured spinal disk pressure for various activities and found that there was a lower spinal load in sitting when compared to standing [25,70,72]. In our study flexion of the back produce second highest discomfort rating. This is born out on the basis that trunk flexion increases the load on the spine by increasing the forward bending moment on the spine [30]. Conclusion: Based on the finding of this study we can conclude that lateral bending of the cervical appears to cause more discomfort than the flexion, extension and rotation when performed in the standing position as compared to sitting. Similarly, lateral bending of the lumbar spine appears to cause more discomfort than any other static joint posture, when performed in standing position as compared to sitting. Limitation of the Study: 1. Small sample size. 2. Perceived joint discomfort scale is a subjective scale and its accuracy depends on the level of understanding of subject. 3. No blinding was done. 4. Lumbar extension in sitting position was not included in the study. 5. Lumbar rotation ROM was not measured.

The effects of physical activity on sleep quality, job satisfaction, and quality of life in office workers

Article

Apr 2019
Work

Background: A sedentary lifestyle has negative effects on many aspects of life. Objective: The aim of this study was to determine the effects of physical activity on sleep quality, job satisfaction, and quality of life in office workers. Methods: A convenience sample of office workers from administrative staff of a university was included. There were two groups; Group I did regular physical activity for at least eight weeks, and Group II did no regular physical activity. Sleep quality, job satisfaction, and quality of life were assessed using the Pittsburgh Sleep Quality Index, the Minnesota Job Satisfaction Scale, and the World Health Organization Quality-of-Life-Scale (WHOQOL-BREF), respectively. Results: Group I included 59 individuals and Group II 50 individuals. No significant differences were found between groups in terms of age, height, weight, and the period of time worked (p > 0.05). Although no significant difference was found in terms of sleep quality (p = 0.52), the overall job satisfaction of Group I was higher than Group II (p = 0.03). All subscales of the WHOQOL-BREF for Group I was higher than Group II (p < 0.05). Conclusion: Regular physical activity could increase job satisfaction and quality of life for office workers. Further studies investigating the effect of physical activity in terms of its type, duration should be performed.

Relationship between Flexibility and Somatotype with Lumbar Lordosis in Young Girls

Article

Full-text available

Mar 2019

Background and Aim: Today, considering the mechanical life, sitting behind the table and doing harmful movements make susceptible people prone to musculoskeletal abnormalities, the reason for which is remained unclear. The present study was conducted to investigate the relationship between flexibility and somatotype with abnormal lumbar lordosis among female students. Materials and Methods: A total of 92 female students of Ahvaz Islamic Azad University participated in the study. Research variables included the degree of lumbar lordosis measured using 30-cm flexible ruler and forward bending test using Youdas and Rate of flexibility method. Somatotype (endomorph, mesomorph, and ectomorph) was calculated using Heath and Carter somatotype method. The data were analyzed using Spearman, correlation, and multiple regression with the significance level set at α= 0.05. Results: The results showed that there was no significant relationship between flexibility and lumbar lordosis (r=-0.11, p=0.3), but there was a significant negative relationship between endomorph and lumbar lordosis (r=-0.40 and p=0.0001). There was a positive relationship between mesomorph somatotype (r=0.18, p =0.09) as well as the ectomorph somatotype (r=0.07, p=0.48) and lumbar lordosis. Regression of predicted lumbar lordosis using variables of the flexibility and somatotype was significant only for endomorphy and mesomorphy components (f=4.35and p=0.003). Conclusion: According to the results and the possibility of predicting lordosis changes using somatotype components, it seems that physical conditions of the individual should be considered prior to any intervention in spinal abnormalities.

Computed Tomographic Assessment of Sagittal Plane Alignment of the Thoracolumbar Junction in a Young Adult Korean Population

Article

Sep 2018

Objective: The purpose of this study was to determine reference values for the sagittal plane alignment of the thoracolumbar junction (TLJ) in a young adult Korean population. Methods: Thoracolumbar computed tomography (CT) scans of 1000 individuals (age range 20-39 years, 500 men and 500 women) from Hanyang University Health Care Center were reviewed. All subjects had no spinal pathology or a history of previous spinal surgery. The segmental (each level from T11 to L2) and global (T11-L1 and T11-L2) Cobb angles of the TLJ of the spine were measured in midsagittal CT scans. Moreover, comparisons between two age groups (20s and 30s) and sexes were performed. Results: The segmental Cobb angles of T11, T12, L1, and L2 were 6.5 ± 3.9°, 5.5 ± 4.1°, 2.2 ± 4.7°, and -3.3 ± 5.3° respectively. The global Cobb angles of T11-L1 and T11-L2 were 6.5 ± 5.2° and 0.5 ± 6.1° respectively. There were no differences in the sagittal alignment between the two age groups. Women presented less kyphotic and more lordotic alignment in the lumbar spine (L1 and L2) than men; however, the thoracic spine (T11 and T12) alignment was not different between the two groups. Conclusions: This study provides reference values with a wide physiological range for the sagittal alignment of the TLJ of the spine in a young adult Korean population.

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

Article

Jan 2018
J Chiropr Med

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.

Coping resources for back pain: A new assessment tool for clinical practice

Article

Jan 2010

Background: The reinforcement of adaptive coping strategies is an integral part of psycho-social interventions for pain management. The concept of coping resources consists of coping strategies that are subjectively experienced as adaptive by the patient. For this study, a questionnaire was developed that helps doctors to identify the coping resources of patients. The aims of the analyses presented in this study were 1) to explore possible associations between the coping resources with achieved copying behaviors, quality of life, pain-related factors and socio-demographic characteristics and 2) to identify patients with back pain who use different coping resources and to describe their respective socio-demographic and clinical characteristics. Methods: This study included 460 persons with current low back pain. A 12- item questionnaire was developed, assessing the coping resources of patients with low back pain. The associations between coping resources, realized coping behaviors, quality of life, pain-related factors and socio-demographic characteristics were examined using analyses of variance. For the identification of patients with differences in coping resources, a cluster analysis was conducted. Results: The new questionnaire consists of seven dimensions of coping resources: social contact, social support, knowledge about back pain, exercise, hobbies/enjoyment, spirituality, and cognitive strategies. Cluster-analysis identified four different meaningful patient groups: a group with overall high coping resources (1), a group with overall low coping resources (2), a group with particularly low social coping resources (3) and a group with particularly highly distinctive "knowledge and active coping" (4). Differences between the groups in socio-demographic and clinical characteristics were found. Discussion: The new questionnaire can provide a comprehensive view about the self-help potential of patients in an efficient way. The results of the questionnaire can be used during consultation to support patients' own coping resources.

Correlation of lumbosacral angle with core muscle endurance in patients with chronic low back pain

Article

Full-text available

Sep 2015

Background - Low back pain affects 60% individuals in life.Postural changes may also be risk factor for low back pain. Abnormal posture creates a strain on ligaments and muscles that indirectly affects the curvature of the lumbar spine.Low back pain can be because of muscle overuse, muscle strain, and /or injuries to the muscles, ligaments, and discs that support the spine.The lumbosacral angle is the angle formed between the long axis of the lumbar vertebrae and the sacrum. Lumbosacral angle may be one of the contributing factors in producing low back pain (LBP) and disability. Method- The Institutional Ethical Committee was obtained for the study. All the subjects had signed written informed consent before participating in the study. Study design was cross sectional study.Using lateral view of radiographs lumbosacral angle was calculated on the PACS .Core muscle endurance subject was tested by using prone double SLR test. Result- Core muscle endurance was reduced in patients with chronic low back pain. There was negative correlation (r was–0.1912) present between core muscle endurance and lumbosacral angle. Conclusion-Muscle endurance is found to be reduced in patients having chronic low back pain, where as endurance is found to be more in males as compared to females; and also negative correlation is present between core muscle endurance and Lumbosacral angle, in patients with chronic low back pain Key words -Low back pain, Lumbosacral angle, Endurance, Prone double SLR

Relationship between Spinal postural abnormalities and quality of life in nurses

Article

Full-text available

Apr 2013

Objective: to identify the incidence of postural abnormalities of the lumbar, thoracic, cervical and shoulder regions in nurses and to explore whether these abnormalities were associated with their quality of life. Materials&Methods: In this descriptive and analytical study,36 female and 20 male nurses were selected through sample of convenience method. They completed SF-36 questionnaire (measuring quality of life). Usingthe New York organization test and plumb line kyphosis, lordosis, shoulder drop, forward head posture, head deviations were assessed. Using flexible ruler an exact measurement of lordosis and kyphosis were also performed. At the end, data were analyzed using statistical methods such as independent t - test , anova and chi-square. Results: Results revealed that among those with postural abnormalities (lordosis, shoulder drop), moderate intensity was more common. Regarding the score of SF-36 questionnaire and head deviation, there were no statistically significant differences between female and male nurses.The postural abnormalities of the kyphosis, forward head and shoulder drop were more common in women and lordosis in men. No statistically significant association was found between postural abnormalities and quality of life. Conclusion:The degree of postural abnormalities and also the score of quality of life of the nurses were assessed moderate .The probable reasons for arising the postural abnormalities, are poor postural alignment, repetitive movement habits and improper physical functioning related to their occupation. In addition to postural abnormalities, many other factors can affect quality of life of nurses.

The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement

Article

Full-text available

Jan 1993
J Spinal Disord

Manohar M Panjabi

Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems. The vertebrae, discs, and ligaments constitute the passive subsystem. All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem. The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability. A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities: (a) an immediate response from other subsystems to successfully compensate, (b) a long-term adaptation response of one or more subsystems, and (c) an injury to one or more components of any subsystem. It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain. In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements.

Comparison of Integrated Electromyographic Activity and Lumbar Curvature During Standing and During Sitting in Three Chairs

Article

Full-text available

Dec 1989

The purposes of this study were to monitor the integrated electromyographic activity of the erector spinae (ES) muscles and to measure lumbar curvature (LC) during static and dynamic postures in three chairs--a Balans Multi-Chair (BC), and office chair (OC), and a straight-back chair (SBC)--and during standing. Integrated electromyographic data were recorded in relaxed and erect postures at L2 and L5 in 20 volunteers. Lumbar curvature was measured with a flexible ruler. Analyses of variance for repeated measures (p = .05) and paired t tests were used to compare the IEMG and LC measurements. During relaxed postures, there was more IEMG activity and greater LC in standing than in the OC or the SBC. During erect postures, there was more IEMG activity in standing than in the OC and no difference in LC between chairs. The IEMG activity at L5 was greatest on the left side across chairs. In typing and writing, significant differences in IEMG activity were found between sides, but not between chairs. The LC was greater in the BC than in the SBC in relaxed sitting, typing, and writing. The pattern of IEMG activity is not similar to corresponding LC measurements. Care and prevention of low back injury is a critical focus in physical therapy. The BC could contribute to treatment. Further research is needed to support its use in back care programs.

Relationships Between Lumbar Lordosis, Pelvic Tilt, and Abdominal Muscle Performance

Article

Full-text available

May 1987

The purpose of this study was to examine the relationships between measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance during normal standing. In addition, the reliability of the measurements used in this study was examined. Measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance were taken of 31 healthy adults aged 20 to 33 years. Each measurement was taken twice, and the measurements were shown to be reliable. The Spearman's rho correlation of the abdominal muscle performance measurements with pelvic tilt was .18 and with lordosis was .06. The Pearson product-moment correlation of lordosis with pelvic tilt was .32. The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related. This study demonstrates the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance, pelvic tilt, and lordosis.

Physical therapy on low back pain and sciatica. An attempt at evaluation

Article

Full-text available

Feb 1970
Scand J Rehabil Med

Reciprocal Angulation of Vertebral Bodies in a Sagittal Plane: Approach to References for the Evaluation of Kyphosis and Lordosis

Article

Full-text available

Jul 1982

This report establishes a table of references for kyphosis and lordosis since, to the best of the authors' knowledge, no such table exists. A sample of healthy individuals was selected and, by means of roentgenographic study, the authors were able to define the reciprocal angulation of each vertebral body. The average values of the data obtained should provide a directly applicable table of references, but four years of work in this direction has shown that there is no simple answer. However, this study does establish an easily reproducible reference position, criteria sample selection, roentgenographic and clinical measuring processes, and a method to computerize the information obtained. (C) Lippincott-Raven Publishers.

Evidence for Use of an Extension-Mobilization Category in Acute Low Back Syndrome: A Prescriptive Validation Pilot Study

Article

Full-text available

May 1993

The prescriptive validity of a treatment-oriented extension-mobilization category for patients with low back syndrome (LBS) was examined. Of a total of 39 patients with LBS referred for physical therapy, 24 patients (14 male, 10 female), aged 14 to 50 years (means = 31.3, SD = 11.6), were classified as having signs and symptoms indicating treatment with an extension-mobilization approach. The remaining subjects were dismissed from the study. Patients in the extension-mobilization category were randomly assigned to either an experimental (treatment) group (n = 14) or a comparison group (n = 10). The experimental and comparison group subjects were treated with either mobilization and extension (a treatment matched to the category) or a flexion exercise regimen (an unmatched treatment). Outcome was assessed with a modified Oswestry Low Back Pain Questionnaire administered initially and at 3 and 5 days after initiation of treatment. Data were analyzed with a 2 x 3 (treatment group x treatment period) analysis of variance. The subjects' rate of improvement, as indicated by the Oswestry questionnaire scores, was dependent on the treatment group to which they were assigned. Subjects treated with extension and mobilization positively responded at a faster rate than did those treated with a flexion-oriented program. This study illustrates that a priori classification of selected patients with LBS into a treatment category of extension and mobilization and subsequently treating the patients accordingly with specified interventions can be an effective approach to conservative management of selected patients.

Lumbar Lordosis and Pelvic Inclination of Asymptomatic Adults

Article

Full-text available

Nov 1996

We examined the association between pelvic inclination and lumbar lordosis during relaxed standing and eight variables thought to contribute to lordosis. Ninety subjects (45 men, 45 women) without back pain or a history of surgery were examined. The mean age was 54.8 years (SD = 8.5) for male subjects and 58.9 years (SD = 8.8) for female subjects. Multiple linear regression modeling was used to assess the association of pelvic inclination and size of lumbar lordosis in a standing position with age, gender, body mass index, physical activity level, back and one-joint hip flexor muscle length, and performance and length of abdominal muscles. Abdominal muscle performance was associated with angle of pelvic inclination for women (R2 = .23), but not for men. Standing lumbar lordosis was associated with abdominal muscle length in women (R2 = .40), but it was multivariately associated with length of abdominal and one-joint hip flexor muscles and physical activity level in men (R2 = .38). No correlation was found between angle of pelvic inclination and depth of lumbar lordosis in a standing position. Neither univariate nor multivariate regression models account for variability in the angle of pelvic inclination or size of lumbar lordosis in adults during upright stance; no correlation was found in standing between these two variables. The use of abdominal muscle strengthening exercises or stretching exercises of the back and one-joint hip flexor muscles to correct faulty standing posture should be questioned.

A Controlled Trial of an Educational Program to Prevent Low Back Injuries

Article

Full-text available

Aug 1997

Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment. and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation. We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work. Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects' knowledge of safe behavior was increased by the training. A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.

Lumbar Supports and Education for the Prevention of Low Back Pain in IndustryA Randomized Controlled Trial

Article

Full-text available

Jul 1998

Low back pain is a frequent and costly health problem. Prevention of low back pain is important both for the individual patient and from an economic perspective. To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry. A randomized controlled trial with a factorial design. The cargo department of an airline company in the Netherlands. A total of 312 workers were randomized, of whom 282 were available for the 6-month follow-up. Subjects were randomly assigned to 4 groups: (1) education (lifting instructions) and lumbar support, (2) education, (3) lumbar support, and (4) no intervention. Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours. Lumbar supports were recommended to be used during working hours for 6 months. Low back pain incidence and sick leave because of back pain during the 6-month intervention period. Compliance with wearing the lumbar support at least half the time was 43%. In the 282 subjects for whom data were available, no statistically significant differences in back pain incidence (48 [36%] of 134 with lumbar support vs 51 [34%] of 148 without, P=.81) or in sick leave because of low back pain (mean, 0.4 days per month with lumbar support vs 0.4 days without, P=.52) were found among the intervention groups. In a subgroup of subjects with low back pain at baseline, lumbar supports reduced the number of days with low back pain per month (median, 1.2 vs 6.5 days per month; P=.03). Overall, lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave. The results of the subgroup analysis need to be confirmed by future research. Based on our results, the use of education or lumbar supports cannot be recommended in the prevention of low back pain in industry.

Basic Biomechanics of the Musculoskeletal System

Book

Jul 2013

Now in its Fourth Edition, Basic Biomechanics of the Musculoskeletal System uses a direct and comprehensive approach to present students with a working knowledge of biomechanical principles of use in the evaluation and treatment of musculoskeletal dysfunction. The text opens with a chapter that introduces the basic terminology and concepts of biomechanics; the remainder of the book then focuses on the biomechanics of tissues and structures, the biomechanics of joints, and applied biomechanics. © 2012 Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved.

Aquatic physical therapy for back pain

Article

Jan 1999

L.T. Brody

The pool provides an environment suitable for rehabilitation of patients with low back pain. The water's buoyancy reduces weight-bearing and allows early gait normalization. Buoyancy assists movement in an upward direction. Viscosity produces resistance to movement, thereby challenging the trunk muscles. Increasing the surface area and speed of movement increases the resistance. Mobility, strengthening, and cardiovascular training are all accomplished in the pool. These activities should be balanced with a comparable land-based exercise program that reintegrates the patient into work, recreational, and leisure activities.

Exercises for backache: A double-blind controlled trial

Article

Jan 1968

Low back pain: A comparison of two treatment programmes

Article

Jan 1982

J. Buswell

The Interrelation of Spinal Curves, Pelvic Tilt and Muscle Lengths in the Adolescent Female

Article

Dec 1986
AUST J PHYSIOTHER

Thoracic kyphosis, lumbar lordosis and pelvic tilt were measured in standing in one hundred and three adolescent females, using a specially designed inclinometer. Indices of the muscle lengths (abdominals, erector spinae, iliopsoas, gluteals, rectus femoris and hamstrings) were measured using inclinometry and goniometry and expressed as angles of joint position. Multiple regression analysis revealed that the index of erector spinae length was negatively correlated with lumbar lordosis (r = - 0.24, p < 0.05). The abdominal length index was positively correlated with lumbar lordosis (r = 0.209, p < 0.05), and the hamstring length index was negatively correlated with lordosis (r = - 0.213, p < 0.05). No muscle length index was significantly related to pelvic tilt. A negative association between the degree of thoracic kyphosis and the abdominal length index was found (r = -0.245, p < 0.05).

Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain management

Article

Jan 1985
Physiother Theor Pract

A study was conducted to compare the relative efficacy of the Williams protocol for low back pain management with the McKenzie protocol using patients with diagnosis of prolapsed intervertebral disc. There were two groups in this study. There were the Williams group (WG) and the McKenzie group (MG). There were 31 subjects in each group. The results of this study showed that the McKenzie protocol was superior to the Williams protocol when post-treatment ranges, movement and straight-leg-raising were considered; average time spent in treating patients with McKenzie protocol was significantly less than that spent with the Williams protocol; the McKenzie protocol was significantly better than that of Williams in decreasing pain—and increasing comfortable sitting time; more of the Williams protocol patients came back for more treatment as a result of relapse as compared to the McKenzie protocol patients. It was concluded that the McKenzie protocol was superior to the Williams protocol in the treatment of the type of patients described in the study.

The effect of the pelvic tilt on standing posture /

Article

Apr 1984

James Wilson. Day

Low back dysfunction is associated in many cases with lumbar lordosis, and tilting the pelvis posteriorly is often recommended for therapeutic purposes. The influence of pelvic tilt on the spinal curves has not been studied. The purpose of this study was to use an objective noninvasive method to determine the effect of the pelvic tilt on the spinal curves in the sagittal plane. Thirty-two healthy subjects and 15 patients with chronic low back dysfunction (CLBD) were studied. Patients with CLBD and healthy subjects were instructed in performing active anterior and posterior pelvic tilt maneuvers, first in the supine and then in the standing position. Comparisons between the Patient Group and the Healthy Group were made for several variables representing the severity of spinal curves, pelvic orientation, hip orientation, and knee orientation. A computerized system, the Iowa Anatomical Position System, was used to obtain coordinates of external body surface landmarks from which pelvic tilt measurements were determined. The results showed that the voluntary pelvic tilt did not alter the thoracic spinal curve. For both the Healthy Group and the Patient Group, the lumbar curve was altered by the pelvic tilt: anterior tilt increased the depth of the lumbar curve and posterior tilt decreased the depth of the lumbar curve. The amount of pelvic tilt was the same whether knees were extended or flexed approximately 10 degrees. Pelvic tilt also tended to influence the orientation of the head and other parts of the body.

A Preliminary Report on the Use of the McKenzie Protocol versus Williams Protocol in the Treatment of Low Back Pain

Article

Aug 1984

The purpose of this study was to determine whether the Williams or McKenzie protocol of treatment was more effective in both decreasing pain and hastening the return of pain-free range of lumbar spine movement. Twenty-two subjects underwent an initial evaluation which involved six measurements: subjective pain, comfortable sitting time, forward flexion, right and left lateral flexion, and straight leg raise. Subjects required to perform Williams' protocol were assigned accordingly, while those referred as "evaluate and treat" were placed in the McKenzie group. Following the completion of treatment, a second evaluation was performed taking the same six measurements. A comparison of the improvement scores of the two groups indicated that those receiving the McKenzie protocol improved to a significantly (P < 0.001) greater extent than did the subjects in the Williams group, and that these changes came about in a significantly (P < 0.01) shorter period of time.J Orthop Sports Phys Ther 1984;6(2):130-139.

Reliability of a Noninvasive Method for Measuring the Lumbar Curve*

Article

Feb 1986

The purposes of this paper were to describe a clinically useful and noninvasive method of characterizing the shape of the lumbar spine and to evaluate the reliability and validity of this measurement technique. A flexible ruler was applied to the skin over the lumbar spines of 23 normal adults and an angle in degrees between two spinous processes (L 1 -S2) was calculated. lntratester test-retest reliability was good (ICC = 0.97, N = 89) for two separate measures of two spinal postures. The validity of the flexible ruler measurements was also good when compared to two different measurement techniques from a limited number of patient roentgenographs. The flexible ruler was determined to be a reliable and valid measurement technique for the shape of the lumbar spine and may prove helpful in quantifying lumbar postures and the effectiveness of clinical treatments designed to affect lumbar postures. J Orthop Sports Phys Ther 1986;8(4):180-184.

Comparative roentgenographic study of the asymptomatic and symptomatic lumbar spine

Article

Oct 1976

A comparative roentgenographic study was carried out on 217 asymptomatic patients between forty and seventy years old and 387 symptomatic patients in the same age range. Spondylosis (osteophyte formation) did not appear to have any direct relationship to low-back pain. Degenerative disc disease appeared to be a major cause of low-back pain. Spondylolysis and spondylolisthesis occurred more frequently in the symptomatic than in the asymptomatic patients. Routine roentgenograms of the lumbosacral spine were useful in evaluating patients seen for treatment of low-back pain.

The value of exercise in the treatment of low back pain

Article

Dec 1979
Rheumatol Rehabil

The results of treatment with short-wave diathermy were compared with those achieved by short-wave diathermy combined with back extension or lumbar isometric flexion exercises in 43 patients with back pain. Subjects were relatively young and normally engaged in sporting activities. Marginally more patients improved amongst those receiving extension exercises. Significant reduction of pain and increase of spinal flexion occurred with each treatment and the periods taken to resume work or sport were similar in each group. Neither exercise regime appeared to have a major influence on recovery. Isometric flexion exercises did not seem to be more beneficial for those with a prominent lumbar lordosis.

Lumbar lordosis: normal adults

Article

Apr 1992
J FORMOS MED ASSOC

Lumbar curvatures in 149 normal adults from the general population were studied. There were 76 men and 73 women with an average age of 50 years. The mean values of lumbar lordotic angle (LLA), lumbosacral angle (LSA) and sacral inclination angle (SIA) were 33.2 +/- 12.1 degrees, 11.4 +/- 4.7 degrees and 26.4 +/- 10 degrees, respectively. A high correlation was noted between LLA and SIA (r = 0.883, p = 0.0001). LLA is an ideal parameter for the evaluation of lumbar lordosis. The normal value of LLA can be defined as 20-45 degrees with a range of 1 SD. No significant differences were noted in these three angles between males and females in any age group (LLA, p = 0.647; LSA, p = 0.80; SLA, p = 0.189). Also, X-ray findings indicated there were no significant differences between these three angles in spondylotic spines and those spines with a normal appearance from X-ray finding. The average LLA increased with age. Significant lumbar lordotic angle differences were noted between those patients less than 35 years of age and those greater than 60 years, as well as in the 35-60 age group and the greater than 60 age group (p = 0.0056).

The new back school prescription: stabilization training. Part I

Article

Jan 1992
State Art Rev Occup Med

R Robison

Stabilization training in neutral spine is an integrated approach of education in proper posture and body mechanics along with exercise to improve strength, flexibility, muscular and cardiovascular endurance, and coordination of movement. This article establishes some initial direction for understanding the concepts of neutral spine and stabilization training and their application to and progression in the back pain patient.

Effects of Spinal Flexion and Extension Exercises on Low-Back Pain and Spinal Mobility in Chronic Mechanical Low-Back Pain Patients

Article

Sep 1991

It has been estimated that one fourth to one half of all patients treated in physical therapy clinics suffer from low-back pain. The purpose of this study was to compare the effects of spinal flexion (Group I) and extension (Group II) exercises on low-back pain severity and thoracolumbar spinal mobility in chronic mechanical low-back pain patients. Both groups had significantly less low-back pain after treatment (P less than .10). There was no significant difference, however, between the spinal flexion and extension exercises in reduction of low-back pain severity. The results indicated a significant difference between the groups in increasing the sagittal mobility (P less than .10). The results did not indicate any significant difference between and within groups in increasing the coronal and transverse mobility of the thoracolumbar spine. Either the spinal flexion or extension exercises could be used to reduce chronic mechanical low-back pain severity, but the flexion exercises had an advantage in increasing the sagittal mobility within a short period of time.

A molecular basis for low back pain in Western industrialized cultures

Article

Jan 1991
MED HYPOTHESES

G.A. Gordon

In spite of billions of dollars spent annually on research and treatment of low back pain (LBP) in Western industrialized cultures, the cause(s) of this complaint remain obscure. The modern sedentary lifestyle is hypothesized to create disuse changes beginning with muscle, which ultimately causes interference with the adaptive and structural dynamics of specialized connective tissue. Calcium-glycosaminoglycan kinetics play a central role in the proposed sequence of events leading to collagen dehydration, fibrillation, and ultimately gross structural incompetence.

Lumbar Curvature in Standing and Sitting in Two Types of Chairs: Relationship of Hamstring and Hip Flexor Muscle Length

Article

Nov 1990

A purpose of this study was to determine the difference in the lumbar curves of subjects while they stood compared with while they sat in two chairs with different seat angles--the Balans Multi-Chair (BMC) and a standard conventional chair (SCC). An additional purpose was to determine the relationship between lumbar curvature and 1) anthropometric factors and hamstring and hip flexor muscle length during standing and during sitting in the two chairs and 2) amount of time spent sitting. Sixty-one men between 20 and 30 years of age served as subjects. Lumbar curve measurements were taken with a flexible ruler with the subjects first standing and then sitting in the two chairs. Hamstring and hip flexor muscle lengths were indicated by range-of-motion measurements taken with a gravity goniometer. Age, number of hours spent sitting per day, upper body length, and right leg length also were recorded. Subjects had significantly more lumbar extension when they sat in the BMC than when they sat in the SCC. Hip flexor length was the only factor that appeared to relate significantly to the difference between the standing lumbar curve and the lumbar curves in the BMC and the SCC.

Reliability of Clinical Measurements of Lumbar Lordosis Taken with a Flexible Rule

Article

Mar 1989

The purpose of this study was to examine the intratester and intertester reliability of lumbar lordosis measurements taken with a flexible rule. Two physical therapists (Tester 1 and Tester 2) took measurements on 40 subjects without low back pain (LBP) and on 40 subjects with LBP. Intraclass correlation coefficients (ICCs) were used to determine the degree of agreement between repeated measurements taken by the same therapist and between measurements taken by the two therapists. The ICC values for intratester reliability of Tester 1 were .84 for subjects without LBP and .94 for subjects with LBP. The ICC values of Tester 2 were .73 for subjects without LBP and .83 for subjects with LBP. Intertester reliability generally was poor, with ICC values of .41 for subjects without LBP and .50 for subjects with LBP. The results suggest that measurements of lumbar lordosis with a flexible rule may be reliable if taken by the same physical therapist. The degree of reliability, however, may vary from therapist to therapist. The intertester reliability of these measurements appears to be poor, but these conclusions must be interpreted carefully because of the limited number of therapists participating in this study.

Evaluation of a flexible ruler technique for measuring lumbar lordosis in the clinical assessment of low back pain

Article

Feb 1989
J Soc Occup Med

S R Simpson

This preliminary study was designed to evaluate a possible objective technique for the clinical measurement of spinal mobility using a flexible ruler. Thirty-one manual workers employed by British Steel Corporation suffering from low back pain were examined using this technique. The results were compared with those obtained from a matching group of workers who did not suffer from low back pain. The technique proved to be simple, accurate and highly reproducible as a clinical tool in the measurement of spinal mobility. A comparison of the observed spinal profile measurements demonstrated a significant difference in lumbar lordosis between the two groups. This suggested that the previously under-rated clinical sign of loss of lumbar lordosis might provide a useful measurement in evaluation of low back pain. Other findings were that low back pain was associated with decreases in extension measurements. There was also a correlation between height and the low back pain group.

A Comparison of Actual and Apparent Lumbar Lordosis in Black and White Adult Females

Article

Apr 1989

The purposes of this study were to investigate differences in lumbar lordosis in black and white adult females and to explain the clinical impression that blacks have a greater lordosis than whites. An actual lumbosacral lordosis angle (ALS) was measured from a standing right lateral lumbosacral radiograph using the angle formed from the intersection of lines drawn across the top of the second lumbar vertebral body (L2) and across the top of the sacrum. An actual lumbo-lumbar angle (ALL) was measured in the same manner, except the second line was drawn across the bottom of the fifth vertebral body (L5). To determine whether gluteal prominence gives a false impression of increased lumbar lordosis, an apparent lordosis (APL) measurement was taken, measuring the distance from the subject's greater trochanter to the most posterior aspect of the buttocks. No significant differences were found in ALS or ALL between 25 black and 27 white adult female subjects (ALS, P = 0.26; ALL, P = 0.41). Significant differences were found between black and white APL, with blacks demonstrating a larger APL than whites (P less than 0.01). A high correlation was noted between ALS and ALL in both blacks (0.70, P less than 0.01) and whites (0.77, P less than 0.01). The investigators therefore contend that the clinician's assumption that blacks have a greater lordosis than whites is based on an apparent increased lordosis due to more prominent buttocks (APL).

Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy

Article

May 1989

The functional outcome of patients with lumbar herniated nucleus pulposus without significant stenosis was analyzed in a retrospective cohort study. Inclusion criteria were as follows: 1) a chief complaint of leg pain, primarily; 2) a positive straight leg raising (SLR) at less than 60 degrees reproducing the leg pain; 3) a computed tomography (CT) scan demonstrating a herniated nucleus pulposus without significant stenosis by a radiologist's reading, which was also confirmed by the authors; 4) a positive electromyogram (EMG) demonstrating evidence of radiculopathy; and 5) response to a follow-up questionnaire. All patients had undergone an aggressive physical rehabilitation program consisting of back school and stabilization exercise training. Of a total of 347 consecutively identified patients, 64 patients with an average follow-up time of 31.1 months met the inclusion criteria and constituted the study population. They were sent questionnaires that inquired about activity level, pain level, work status, and further medical care. The patients with neurologic loss, extruded discs, and those seeking a second opinion regarding surgery were identified and subgrouped. Results for the total group included 90% good or excellent outcome with a 92% return to work rate. For the subgroups with extruded discs and second opinions, 87% and 83% had good or excellent outcomes, respectively, all (100%) of whom returned to work. Sick leave time for these subgroups was 2.9 months (+/- 1.4 months) and 3.4 months (+/- 1.7 months), respectively. These results compared favorably with previously published surgical studies. Four of six patients who required surgery were found to have stenosis at operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trial of intensive muscle training for chronic low back pain

Article

Dec 1988

105 patients who had chronic low back pain without clinical signs of lumbar nerve root compression or radiological evidence of spondylolysis or osteomalacia were randomised to three treatments: 30 sessions of intensive dynamic back extensor exercises over three months; a similar programme at one-fifth the exercise intensity; or one month of thermotherapy, massage, and mild exercises. The results consistently favoured intensive exercise, which had no adverse effects. Since these exercises can be conducted in groups, the intensive programme is no more costly than conventional strategies that require individual attention.

[Biomechanics of the lumbar spine and posture training]

Article

May 1988

Toward Standards for Posture: Postural Characteristics of the Lower Back System in Normal and Pathologic Conditions

Article

Jan 1985

On theoretic grounds it can be assumed that aberrations of posture may play a role in the generation of low-back pain by creating concentrations of stress. However, this assumption remains speculative because of the absence of criteria for normal posture. This study considers some of these criteria, especially as they are related to the lumbar spine and pelvis. The relations between the angle of declivity of the sacrum and radius and inclination of the lordotic curvature of the lumbar spine show good correlation. Mean values of postural parameters in the group of spondylolysis patients differ significantly from those in the group of healthy volunteers.

The Lumbar Lordosis in Acute and Chronic Low-Back Pain

Article

Apr 1985

To evaluate a possible relationship between the amount of lumbar lordosis in asymptomatic as well as subjects with acute and chronic low-back pain, the amount of lordosis was determined from spinal roentgenograms of 600 men between 20 and 63 years of age. The angle between a line parallel to the cranial end-plate of L1 and S1 was defined as the lordosis angle. The amount of lordosis was distributed similarly according to age within each of the three groups and was also similar in comparisons between the groups. The men were randomly selected to represent three different groups. Each group included 200 age-matched subjects with similar occupation. The first group consisted of men claiming no previous back-pain history who underwent spinal x-ray as a part of a preemployment examination. The second group consisted of men who had a spinal x-ray examination after claiming their first low-back injury, but not preemployment screening. The third group consisted of x-ray examination of men evaluated for chronic low back disability. The findings thus indicated that the distribution and range of lordosis as viewed by clinicians and radiologists does not vary in the acute or with chronic low-back pain, more than in men without back pain of the same age.

Comparison of Lumbar Curves when Sitting on the Westnofa Balans® Multi-Chair, Sitting on a Conventional Chair, and Standing

Article

Oct 1986

The purpose of this study was to determine whether the Balans Multi-Chair (BMC) approximates the amount of standing lumbar curve better than a standard conventional chair (SCC) in seated subjects writing at a desk. The length of the curve from L1 to S2 was measured with a flexible ruler in 44 healthy subjects who were standing and sitting on both an SCC and a BMC. A one-way analysis of variance for repeated measures and the Student-Newman-Keuls test were used to examine the differences in the curves created in the three positions. The frequency of subjects sitting in lumbar flexion was compared using a chi-square test with those not in flexion. Lumbar curves measured in the three positions were significantly different (p less than .01). The BMC approximated the standing lumbar curve in seated subjects writing at a desk to a greater degree than the SCC. In addition, the BMC produced lumbar flexion less frequently (chi 2 = 4.33, p less than .05) than did the SCC. These data suggest that the BMC may be an appropriate adjunct in client care when minimal lumbar flexion or lumbar extension is indicated.

The Relationship Between Anthropometric, Postural, Muscular, and Mobility Characteristics of Males Ages 18???55

Article

Oct 1985

Three hundred twenty-one males, ages 18-55, had standardized tests to determine height, weight, Davenport Index, leg length inequality, determination of flexion and extension torques, flexion/extension balance, range of motion, straight leg raising, and lumbar lordosis. A total of 106 (33.0%) had never experienced low-back symptoms; 144 (44.9%) had or were having moderate low-back pain (LBP); and 71 (22.1%) had or were having severe low-back symptoms. These three subgroups showed no significant differences in height, weight, Davenport Index, lumbar lordosis, or leg length inequalities. LBP patients had less flexor and extensor strength and were flexor overpowered, had diminished range of motion for spinal extension and axial rotation (P = 0.003, P = 0.0005), and diminished straight leg raising capacity (P = 0.04). A multivariate correlation matrix demonstrated no typical pattern of associated abnormalities except a diminished spinal range of motion in one plane was associated with the anticipated diminishment in all other planes of motion, and often with greater restrictions of straight leg raising tests.

Evaluation of Lumbar Lordosis

Article

Dec 1985

Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. The mean lumbolumbar (LL) angle (L2-L5) was 29.96 degrees +/- .74 degrees. Only minor differences were found between a standardized (prospective) and a nonstandardized (retrospective) group. There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.

Lumbar intervertebral disc degeneration: the influence of geometrical features on the pattern of disc degeneration--a post mortem study

Article

May 1972

Effect of pelvic tilt on standing posture

Article

May 1984

Lumbar disc disease: Comparative analysis of physical therapy treatments

Article

May 1981
ARCH PHYS MED REHAB

A randomized clinical trial was conducted to evaluate the efficacy of 3 physical therapy approaches--lumbar flexion exercise, manual therapy, and home care--in the treatment of lumbar disc disease. Twenty-eight patients were assigned to 1 of 3 treatment groups and were shown to be similar in age, sex, and prescores on 4 of the 5 outcome measures. With the exception of the home care patients, each patient received the appropriate treatment twice a week for a 1-month period. No statistically significant differences in measurements of pain, forward, right-side, and left-side flexion, or functional activity between the 3 groups were observed.

Postural aberrations in low back pain

Article

Mar 1995
ARCH PHYS MED REHAB

The purpose of this study was to measure and describe postural aberrations in chronic and acute low back pain in search of predictors of low back pain. The sample included 59 subjects recruited to the following three groups: chronic, acute, or no low back pain. Diagnoses included disc disease, mechanical back pain, and osteoarthritis. Lumbar lordosis, thoracic kyphosis, head position, shoulder position, shoulder height, pelvic tilt, and leg length were measured using a photographic technique. In standing, chronic pain patients exhibited an increased lumbar lordosis compared with controls (p < .05). Acute patients had an increased thoracic kyphosis and a forward head position compared with controls (p < .05). In sitting, acute patients had an increased thoracic kyphosis compared with controls (p < .05). These postural parameters identified discrete postural profiles but had moderate value as predictors of low back pain. Therefore other unidentified factors are also important in the prediction of low back pain.

Spinal posture during pubertal growth

Article

Apr 1995

M Nissinen

A cohort of children was followed-up annually from a mean age of 10.8-13.8 years to determine the development of their posture. Of the sample of 1060 children, 847 (79.9%) participated in the final examination. Thoracic kyphosis and lumbar lordosis were measured annually with a spinal pantograph. Those children whose thoracic kyphosis in pantography was more than 35 degrees at entry and 45 degrees or more at the final examination underwent a lateral standing radiograph. The 3-year incidence of Scheurermann's disease was 0.4%. The mean thoracic kyphosis increased and the mean lumbar lordosis decreased with age in both sexes, but these changes were not constant. Thoracic kyphosis was most pronounced at a mean age of 12.8 years and lumbar lordosis was least pronounced at a mean age of 13.8 years. In accordance with the literature, the wide individual variation found in this study for both thoracic kyphosis and lumbar lordosis during the pubertal growth period was mainly physiologic.

Reliability of Measurements of Lumbar Spine Sagittal Mobility Obtained With the Flexible Curve

Article

Feb 1995

Presently, there is no available scientific information that examines the interchangeability of tangent and trigonometric methods used to calculate measurements of sagittal mobility of the lumbar spine obtained with a flexible curve. Repeated measurements of the lumbar curvature were made with a flexible curve by using a standardized protocol on 10 healthy volunteers under three conditions: 1) standing, 2) sitting with maximum trunk forward bending, and 3) lying prone with maximum backward bending. Measurements were made by a team of two physical therapists working together; one therapist instructed the subject, and the other therapist performed the measurement. Agreement between the tangent and trigonometric methods was assessed graphically by plotting the difference between methods against the mean value of each pair of readings for each of the three conditions. Measurements differed by 4 to 7 degrees for each of the three positions of the lumbar spine. We believe such error is clinically acceptable and should not affect the clinical decision made on the basis of the measurement.

Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size: A Prospective Controlled Clinical Study

Article

Aug 1994

A global and segmental study on standing lateral radiographs of 100 volunteers and 100 patients who had low back pain was undertaken to further define sagittal plane alignment and balance. The volunteer control group and the patient group were matched for age, sex, and size. Measurements and determinations made on the standing radiographs included the following: segmental and total lordosis L1-S1 (Cobb method); thoracic kyphosis; thoracic apex; plumbline dropped from the center of C7; and sacral inclination measured between the plumbline and a line drawn along the back of the proximal sacrum. Segmental lordoses were significantly different between each motion segment in both groups. Approximately two-thirds of total lordosis occurred at the bottom two discs, i.e., L4-5 and L5-S1. Total lordosis was significantly less in the patients and was not age- or sex-related in either group. Patients tended to stand with less distal segmental lordosis, but more proximal lumbar lordosis, a more vertical sacrum and, therefore, more hip extension. This may be related to compensation as C7 sagittal plumb lines were comparable in both groups. Both groups had similar thoracic kyphosis. A much higher percentage of smokers was found in the low back pain patient population studied. Because of the significant amount of angulation in the lower lumbar spine, measurement of lordosis should include the L5-S1 motion segment and be done standing to better assess balance. Sacral inclination is a determinate of both standing pelvic rotation and hip extension. It is strongly correlated with segmental and total lordosis in both volunteers and patients. Definitions of sagittal balance are provided as well as additional sagittal plane data by which to compare corrections and fusions for different spinal disorders.

Intensive, Dynamic Back-Muscle Exercises, Conventional Physiotherapy, or Placebo-Control Treatment of Low-Back Pain

Article

Feb 1993

In a randomized, observer-blind trial, 150 men and women, aged 21-64 years, with chronic/subchronic low-back pain, followed one of these three treatment regimens: 1) intensive, dynamic back-muscle exercises; 2) conventional physiotherapy, including isometric exercises for the trunk and leg muscles; and 3) placebo-control treatment involving semihot packs and light traction. Eight treatment sessions were given during the course of 4 weeks, each session lasting 1 hour. The short-term effect was evaluated at the end of the treatment period and 1 month later, and the long-term effect at 6 and 12 months. The evaluations included recording of changes in pain level and assessment of overall treatment effect, which were indicated on visual interval scales. Subgroups of patients could be identified according to their treatment responses: physiotherapy was the superior treatment for the male participants, whereas the intensive back exercises appeared to be most efficient for the female participants. Patients with moderate or hard physical occupations tended toward a better response with physiotherapy, whereas intensive back exercises seemed most effective for those with sedentary/light job functions.

The Effects of Spinal Flexion and Extension Exercises and Their Associated Postures in Patients With Acute Low Back Pain

Article

Dec 1995

A prospective randomized clinical trial compared the effects of flexion and extension back exercises and postures among soldiers with acute low back pain. To compare the immediate effects of back exercise on functional status, spinal mobility, straight leg raising, pain severity, and treatment satisfaction, and to determine whether spinal exercise during the acute stage of low back pain reduces recurrent episodes of low back pain. Conflicting reports exist concerning the efficacy of spinal flexion and extension exercises in patients with low back pain of varying duration. Poor study design and lack of functional outcomes characterize many of these studies. One-hundred-forty-nine subjects with acute low back pain received flexion exercise and posture (n = 57), extension exercise and posture (n = 62), or no exercise or posture (n = 30) for 8 weeks. Outcomes were assessed 1, 2, 4 and 8 weeks after treatment onset. A questionnaire assessed the recurrence of low back pain 6-12 months after study entry. Flexion and extension exercise groups did not differ in any outcome over 8 weeks. After 1 week, both exercise groups had reduced disability scores, a higher proportion returning to work, and fewer subjects with a positive straight-leg raise compared with the control group. There was no difference among groups regarding recurrence of low back pain after 6-12 months. There was no difference for any outcomes between the flexion or extension exercise groups. However, either exercise was slightly more effective than no exercise when patients with acute low back pain were treated.

Back school in a first episode of compensated acute low back pain: A clinical trial to assess efficacy and prevent relapse

Article

Aug 1996
ARCH PHYS MED REHAB

To assess the efficacy of a back school program for patients with a first episode of acute work-related low back pain requiring compensation. A randomized single-blind controlled trial. A private physiatrics outpatient clinic. The mean duration of low back pain was 15 days. Eligible patients were randomized to a standard treatment program that included daily physiotherapy (n = 86) or the same program with the addition of back school (n = 82). The back school program consisted of three 90-minute sessions given by a single trained instructor at 0, 1, and 8 weeks. The primary outcomes were the time off work for the presenting episode of back pain and the number and duration of recurrences in the year following the study onset. Secondary outcomes included the level of pain, spinal mobility, active straight-leg raising, and functional disability assessed by the Oswestry and Roland-Morris scales. Those randomized to the back school group gained significantly more knowledge, based on the multiple choice examination (p = .0001) and performed the exercise program significantly better (p = .0001) than the standard care group. There were no differences between the two treatment groups for either of the primary outcomes. The median time to return to work from randomization was 33 days for both the back school and the standard care groups (p = .48). The number of compensated recurrences of low back pain over 1 year was similar (back school = 14, standard care = 10, p = .16), as was the median duration of these episodes (back school = 25 days, standard care = 70 days, p = .21). There were no significant differences favoring the back school group for any of the secondary outcomes at the posttreatment, 6-month, or 12-month assessments. A back school intervention in addition to standard care resulted in no reduction in the time to return to work or the number or duration of recurrences of low back pain requiring compensation over a period of one year.

What does a backrest actually do to the lumbar spine?

Article

May 1996

It is generally believed that a backrest facilitates lumbar lordosis. To test this, the spontaneously adopted postures of 12 healthy subjects were measured by a statometric method during 2-h sitting periods on three types of chairs in a stratified sequence. The only difference between the three workstations regarded backrest: 'A' had no backrest; 'B' had a vertical lumbar backrest; and 'C' had an anteriorly curved backrest. In general, the most lordotic postures were assumed with backrest C, whereas backrest B rather facilitated kyphosis as compared with sitting without a backrest. However, when specifically considering passive sitting, i.e. reading, both types of backrest facilitated kyphosis. Moreover, spinal shrinkage was evaluated by measuring exact height before and after each 2-h sitting period. This was done to assess spinal load. From this perspective, backrest C induced the greatest load on the spine. In conclusion, the traditional conception that a backrest facilitates lordosis is apparently not true. It seems rather that backrests actually facilitate the opportunity for the user to stabilize their lumbar spines by providing their lower backs with support, resulting in relative kyphotic increases. The practical ergonomic applications from this study are unclear. However, traditional concepts in backrest ergonomy should be re-considered.

The Effects of Pelvic Movement on Lumbar Lordosis in the Standing Position

Article

Oct 1996

The purpose of this study was to investigate whether the maneuver of altering the angle of pelvic tilt when standing is effective in changing the angle of lumbar lordosis. The importance of the study was to establish a scientific basis for a common clinical assumption. Pelvic tilt and lumbar lordosis were measured during three conditions: with subjects in a normal standing posture, with subjects assuming a maximal anterior pelvic tilt posture, and with subject assuming a maximal posterior pelvic tilt posture. Measurements of pelvic tilt and lumbar lordosis were obtained using a television/computer system that obtained the three-dimensional coordinates of markers on the pelvis and spine at 20-msec intervals. Each measurement was made three times, and all were found to be reliable, with intraclass correlation coefficients (3,1) ranging from 0.78 to 0.95 (p < 0.001). Adopting a maximal anterior pelvic tilt changed the pelvic attitude relative to the horizontal by an average fo 11.4 degrees (p < 0.001) and increased the lumbar lordosis by an average of 10.8 degrees (p < 0.001). Adopting a maximal posterior pelvic tilt changed the pelvic attitude by an average of 8.7 degrees (p < 0.001) and decreased the lumbar lordosis by an average of 9.0 degrees (p < 0.001). The results of this study demonstrate that altering the pelvic tilt significantly changes the angle of lumbar lordosis. This lends support to the use of pelvic tilting exercises to increase or decrease the degree of lumbar lordosis, at least for the duration of the exercise.

Opioid therapy and low back pain

Article

Sep 1996
J Am Board Fam Pract

J Ryan

Measurements of vertebral shape by radiographic morphometry: Sex differences and relationships with vertebral level and lumbar lordosis

Article

Aug 1998

To examine sex-related and vertebral-level-specific differences in vertebral shape and to investigate the relationships between the lumbar lordosis angle and vertebral morphology. Lateral thoracic and lumbar spine radiographs were obtained with a standardized protocol in 142 healthy men and 198 healthy women over 50 years old. Anterior (Ha), central (Hc) and posterior (Hp) heights of each vertebra from T4 to L4 were measured using a digitizing technique, and the Ha/Hp and Hc/Hp ratios were calculated. The lumbar lordosis angle was measured on the lateral lumbar spine radiographs. Ha/Hp and Hc/Hp ratios were smaller in men than women by 1.8% and 0.7%, respectively, and these ratios varied with vertebral level. Significant correlations were found between vertebral shape and the lumbar lordosis angle. These results demonstrate that vertebral shape varies significantly with sex, vertebral level and lumbar lordosis angle. Awareness of these relationships may help prevent misdiagnosis in clinical vertebral morphometry.

Effects of Lifestyle and Work-Related Physical Activity on the Degree of Lumbar Lordosis and Chronic Low Back Pain in a Middle East Population

Abstract

No full-text available

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