Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial.

INTRODUCTION: Pathological forward trunk flexion is a disabling and drug-refractory motor complication of Parkinson's disease (PD) leading to imbalance, pain, and fall-related injuries. Since it might be reversible, early and multidisciplinary management is emphasised. The primary aim was to compare the effects of a four-week trunk-specific rehabilitation program on the severity of the forward trunk flexion. The secondary aim was to compare the training effects on the motor impairments, dynamic and static balance, pain, falls, and quality of life. METHODS: 37 patients with PD (H&Y ≤ 4) and forward trunk flexion were randomized in the experimental (n = 19) or control group (n = 18). The former consisted of active self-correction exercises with visual and proprioceptive feedback, passive and active trunk stabilization exercises and functional tasks. The latter consisted of joint mobilization, muscle strengthening and stretching, gait and balance exercises. Protocols lasted 4 weeks (60 min/day, 5 days/week). Before, after, and at 1-month follow-up, a blinded examiner evaluated patients using primary and secondary outcomes. The primary outcome was the forward trunk flexion severity (degree). Secondary outcomes were the UPDRS III, dynamic and static balance, pain falls, and quality of life assessment. RESULTS: The experimental group reported a significantly greater reduction in forward trunk flexion than the control group from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the experimental group than the control group from T0 to T2 (p = 0.017 and 0.004, respectively). Comparable effects were reported on the other outcomes. Pre-treatment forward trunk flexion values were highly correlated to post-treatment trunk deviation changes. CONCLUSION: The four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with PD. NCT03741959.

Effect of physiotherapy on spinal alignment in children with postural defects.

OBJECTIVES: This paper assesses the effect of neurophysiological rehabilitation in children with postural defects on the depth of thoracic kyphosis, lateral spinal deviation and rotation of spinal motor segments. MATERIAL AND METHODS: A total of 201 patients aged 8-15 years old with a postural defect diagnosed by medical examination were enrolled. The analyzed parameters were determined using the DIERS system before the first therapeutic session and after 4 weeks of therapy. The angle of thoracic kyphosis, lateral deviation of the spine and spinal rotation were assessed. The therapy employed techniques associated with the proprioceptive neuromuscular facilitation (PNF) and Vojta's approaches. The results were analyzed separately for both sexes and for patients rehabilitated solely with Vojta's techniques vs. patients rehabilitated according to combined Vojta's and PNF techniques. The χ2 test was used for statistical analyses, at p < 0.05. RESULTS: There was improvement in the angle of thoracic kyphosis, ranging from 0.14 (among boys with kyphosis < 42°) to 5.47 (among girls with kyphosis ≥ 42°), spinal rotation, from 0.37 (among boys with kyphosis ≥ 42°) to 4.33 (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method), and lateral deviations, ranging from 1.32 mm (among boys with kyphosis < 42°) to 2.99 mm (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method). CONCLUSIONS: Neurophysiological rehabilitation of patients with postural defects produced positive effects by improving the angle of thoracic kyphosis, spinal rotation and lateral deviation of the spine. Children with reduced thoracic kyphosis achieved less improvement in the kyphosis angle, lateral spinal deviation and spinal rotation than children with kyphosis ≥ 42°. The DIERS Formetric System enables precise monitoring of therapeutic outcomes. Int J Occup Med Environ Health. 2019;32(1):25-32.

Measurement of camptocormia trunk flexion using a dual-sensor measurement setup.

Assessing the flexion of the trunk of patients with camptocormia is a key factor in developing therapies for camptocormia and monitoring their success. Currently used methods to measure this camptocormia angle are based on photographs or short videos. Both methods are not able to take the ability of patients into account to compensate their symptoms for short amounts of time. We propose a simple two sensor measurement setup based on two accelerometers to measure the angle in accordance with the established perpendicular measurement method [1]. We show that our method yields an average deviation of -1.74° with a maximum deviation of +2° and -6° compared to visual assessment with a motion capturing system.

Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial.

BACKGROUND: Hemiparesis following stroke can cause cervical spine scoliosis, kyphosis or hyperlordosis. These abnormal cervical alignments can contribute to dysphagia. The benefit of cervical isometric exercises to improve swallowing has not been previously studied. AIM: To evaluate the use of cervical isometric exercises in dysphagic adult patients with cervical spine alignment disorders due to hemiparesis after stroke. DESIGN: A randomized controlled trial. SETTING: University Hospital, PMR Department. POPULATION: Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase. METHODS: In addition to the standard physical and speech therapy therapeutic approach for 12 weeks, cervical isometric exercises were conducted by a group of patients (experimental group). Patients had cervical spine radiographs in erect (sitting or standing) position coronal and sagittal C2-C7 Cobb angle and a videofluoroscopic swallowing study to evaluate deglutition (0=normal, 1=penetration, 2=aspiration) at 2 time points (at the beginning and at the end of the therapeutic program). RESULTS: Seventy consecutive patients with hemiparesis of a mean (SD) age of 52±15 years were included in the study and were randomized in 2 groups. Thirty-seven of them (experimental group) conducted cervical isometric exercises in addition to their therapeutic program. At the last follow-up, patients had improved (P<0.001) cervical alignment, in both coronal and sagittal plane, and deglutition. Patients who conducted cervical isometric exercises (experimental group) had more pronounced correction (P<0.001) of cervical alignment in both planes and achieved greater improvement (P<0.05) of deglutition too, than patients who did not conduct such exercises (control group). CONCLUSIONS: Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase who underwent cervical isometric strengthening exercises showed more significant correction of cervical alignment and more pronounced improvement in deglutition compared to patients who did not include cervical isometric exercises in their therapeutic program. CLINICAL REHABILITATION IMPACT: The additional use of cervical isometric exercises in hemiparetic stroke patients with dysphagic symptoms lead to more pronounced improvement of their swallowing function compared to such patients who are subjected to speech therapy only. Furthermore, these exercises are shown to be beneficial for cervical spine alignment too.

The posture of adolescent male handball players: A two-year study.

BACKGROUND: Young athletes at the stage of growth acceleration tend to exhibit increased susceptibility to postural abnormalities, especially in the trunk region. The aim of this study was to assess and compare the posture in male adolescent handball players over two years of regular training sessions. METHODS: The study group comprised 21 handball players. At the start of the study 15 participants were aged 14 and 6 participants were aged 15 (mean 14.25 ± 0.58). The measurements were repeated three times. Posture was assessed with a photogrammetric method based on the moiré phenomenon. RESULTS: The analysis of posture relative to symmetry in the frontal and transverse planes did not reveal any significant differences between posture indicators obtained during the successive measurements. Sagittal plane posture indicators revealed significant changes in torso forward inclination angle and the shape of anteroposterior spinal curvatures. The latter consisted of significant deepening of the upper thoracic curve (angle α) and flattening of the lumbosacral curve (angle γ). CONCLUSIONS: A two-year period of handball training did not result in posture asymmetries in young male handball players. The observed changes in the shape of anteroposterior spinal curvatures might be related both to sports training and somatic parameters.

Gait dynamics in Pisa syndrome and Camptocormia: The role of stride length and hip kinematics.

This is an observational cross-sectional study evaluating gait dynamics in patients with Parkinson's Disease (PD) and severe postural deformities, PD without axial deviations and healthy subjects. Ten PS individuals with Pisa syndrome (PS) and nine subjects with Camptocormia (CC) performed 3-D Gait Analysis and were evaluated with walking and balance scales. Correlations with clinical and functional scales were investigated. Spatio-temporal and kinematic data were compared to ten PD subjects without postural deformities (PP) and ten healthy matched individuals (CG). Data obtained showed decreased walking velocity, stride and step length in PP, PS and CC groups compared to controls. The correlation analysis showed that stride and step length were associated with reduced functional abilities and disease severity in PS and CC groups. Kinematic data revealed marked reduction in range of movements (ROMs) at all lower-extremity joints in PS group. While, in CC group the main differences were pronounced in hip and knee joints. PS and CC groups presented a more pronounced reduction in hip articular excursion compared to PP subjects, revealing an increased hip flexion pattern during gait cycle. Moreover, the increased hip and knee flexion pattern adversely affected functional performance during walking tests. Results obtained provide evidence that step length, along with stride length, can be proposed as simple and clear indicators of disease severity and reduced functional abilities. The reduction of ROMs at hip joint represented an important mechanism contributing to decreased walking velocity, balance impairment and reduced gait performance in PD patients with postural deformities.

Effect of corrective long spinal fusion to the ilium on physical function in patients with adult spinal deformity.

PURPOSE: To identify the effects of corrective long spinal fusion to the ilium on physical function in patients with adult spinal deformity (ASD). METHODS: Thirty patients who underwent corrective long spinal fusion to the ilium were prospectively analysed. Patients were divided into the ++ group [sagittal vertical axis (SVA) ≥ 95 mm and pelvic tilt (PT) ≥ 30°, 14 patients] and 0+ group (SVA <95 mm or PT <30°, 16 patients). Subjects' low back pain [visual analogue scale (VAS) (pain with motion)], muscle strength (knee extensors and hip flexors), balance [timed up and go (TUG)], gait performance [10-metre walking test (10MWT, maximum speed), and 6-minute walk test (6MWT)] were assessed before surgery, at discharge, and 6 and 12 months after the surgery. RESULTS: All study patients had a significant improvement in the VAS score between baseline and at discharge, 6 months postoperatively, and 12 months postoperatively. The values of the TUG and 6MWT significantly improved 12 months postoperatively. The values of the TUG, 10MWT, and 6MWT improved significantly more in the ++ group than in the 0+ group at 12 months. CONCLUSION: Corrective long spinal fusion contributed to improving back pain at discharge and gait ability at 12 months in patients with ASD.

Tratamiento fisioterapéutico de las alteraciones posturales en la enfermedad de Parkinson. Revisión sistemática / Physiotherapy treatment of postural disorders in Parkinson disease: A review

Objetivos: El objetivo principal es identificar qué tratamientos de fisioterapia se utilizan para mejorar la postura en pacientes con enfermedad de Parkinson (EP). Los objetivos secundarios son determinar cuáles de estos tratamientos son más eficaces e identificar qué efectos produce la reeducación de la postura en pacientes con EP. Estrategia de búsqueda: La búsqueda de información se realizó entre febrero y marzo del 2015 en 9 bases de datos: Cochrane CENTRAL, Medline, PEDro, PubMed, Scopus, CINAHL, SciELO, IME y ProQuest Dissertations & Theses Global. Resultados: Se han seleccionado 7 estudios, cuyas intervenciones fueron: estimulación magnética, reeducación postural global (RPG), terapia acuática, entrenamiento de la marcha en tapiz rodante y sesiones de fisioterapia individuales o grupales. Varios estudios presentaron diferentes riesgos de sesgo y las muestras poblacionales fueron escasas (entre 15 y 54 participantes). Conclusiones: Las intervenciones más eficaces para mejorar la postura en pacientes con EP utilizadas desde la fisioterapia son la RPG y el entrenamiento de la marcha cuesta abajo en tapiz rodante. La RPG también mejorara la marcha, el equilibrio y la movilidad del tronco. Futuras investigaciones deberían estudiar los efectos de las intervenciones que pueden mejorar la postura en la EP con muestras poblacionales más amplias y limitando, en la medida de lo posible, los riesgos de sesgo

Objectives: The main objective is to identify what Physiotherapy treatments are used to improve posture in patients with Parkinson Disease (PD). Secondary objectives are to determine which of these treatments are more effective and to identify postural re-education effects in patients with PD. Search strategy: Information was collected between February- March 2015 in 9 databases: Cochrane CENTRAL, Medline, PEDro, PubMed, Scopus, CINAHL, SciELO, IME and ProQuest Dissertations & Theses Global. Results: Seven studies whose interventions were magnetic stimulation, global postural re-education (GPR), aquatic therapy, gait training on a treadmill, individual and group sessions of physiotherapy were selected. Several studies had risks of bias and population samples were small (15 to 54 participants). Conclusions: The most effective physiotherapy interventions to improve posture in PD are: GPR and downhill gait training on a treadmill. GPR could also improve walking, balance and trunk mobility. Future research should examine effects of interventions that could improve posture in PD, with broader population samples and limiting risks of bias

The Influence of the "Straighten Your Back" Command on the Sagittal Spinal Curvatures in Children with Generalized Joint Hypermobility.

Objectives. The aim of the study was to assess the change of sagittal spinal curvatures in children with generalized joint hypermobility (GJH) instructed with "straighten your back" command (SYB). Methods. The study included 56 children with GJH. The control group consisted of 193 children. Sacral slope (SS), lumbar lordosis (LL), global thoracic kyphosis (TK), lower thoracic kyphosis (LK), and upper thoracic kyphosis (UK) were assessed with Saunders inclinometer both in spontaneous positions (standing and sitting) and after the SYB. Results. Children with GJH after SYB presented the following: in standing, increase in SS and decrease in TK, LK, and UK (P < 0.01), with LL not significantly changed; in sitting: decrease in global thoracic kyphosis (35.5° (SD 20.5) versus 21.0° (SD 15.5), P < 0.001) below the standards proposed in the literature (30-40°) and flattening of its lower part (P < 0.001). The same changes were observed in the control group. Conclusions. In children with generalized joint hypermobility, the "straighten your back" command leads to excessive reduction of the global thoracic kyphosis and flattening of its lower part. Therefore, the "straighten your back" command should not be used to achieve the optimal standing and sitting positions.

Evidence based position paper on physical and rehabilitation medicine (PRM) practice for people with spinal deformities during growth. The European PRM position (UEMS PRM Section).

INTRODUCTION: Scoliosis and other spinal deformities involve 3-4% of the population during growth. Their so-called conservative treatment is in the field of competence of physical and rehabilitation medicine (PRM) physicians. This evidence based position paper represents the official position of the European Union through the European Union of Medical Specialists (UEMS) - PRM Section. The aim of the paper was to improve PRM specialists' professional practice for patients with spinal deformities during growth. EVIDENCE ACQUISITION: A systematic review of the literature and a Consensus procedure with 26 recommendations by means of a Delphi method process has been performed involving the delegates of all European countries represented in the UEMS-PRM Section. EVIDENCE SYNTHESIS: the systematic literature review is reported together with 26 recommendations coming from the Consensus Delphi procedure. CONCLUSIONS: The professional role of PRM physicians in spinal deformities during growth is to propose a complete PRM treatment for the patients considering all the concurring diseases and pathologies, impairments, activity limitations and participation restrictions. The PRM physician's role is to coordinate the individual PRM project developed in team with other health professionals and medical specialists, in agreement with the patient and his family, according to the specific medical diagnoses.

Active self-correction of spinal posture in pain-free women in response to the command "straighten your back".

Evidence is limited regarding the regional changes in spinal posture after self-correction. The aim of the present study was to evaluate whether active self-correction improved standing and sitting spinal posture. Photogrammetry was used to assess regional spinal curvatures and vertical global spine orientation (GSO) in 42 asymptotic women aged 20-24 years. Upper thoracic spine angle and GSO increased in response to self-correction, while the thoracolumbar and lumbosacral angles decreased. Self-correction in the standing position resulted in decreased inclination of the upper thoracic and thoracolumbar spinal angles. Correction of sitting posture reduced the angle of the upper thoracic spine and GSO. The effects of active self-correction on spinal curvature and GSO were different for the standing versus sitting position; the greatest effects of active correction were noted in the thoracic spine. Balanced and lordotic postures were most prevalent in the habitual and actively self-corrected standing positions, whereas the kyphotic posture was most prevalent in the habitual sitting position, indicative that self-correction back posture in the standing position could be an important health-related daily activity, especially during prolonged sitting.

A Virtual Patient Representation in the Medical Rehabilitation Domain.

This paper proposes a virtual patient (VP) for the medical rehabilitation domain using the digital representation of the real life patient's matchstick skeleton. This virtual patient is used to analyze and track the recovery of the orthopedic patient with malicious posture problems. The creation of the digital patient was realized using a markerless depth camera, the Microsoft Kinect. The gathered data was saved in to a BVH type motion capture file. This file records not only the skeletal structure of the patient but its movements as well from witch the adduction, rotation and flexion angles of the joints can be analyzed. The data is stored in structured text format making it suitable to be used in telemedicine. The results confirm the utility and usability of the digital patient in clinical reasoning and in educational applications.

An examination of camptocormia assessment by dynamic quantification of sagittal posture.

OBJECTIVE: Camptocormia is a disabling pathology of the axial system that debilitates patients in their daily life. To date, there have been no studies evaluating the impact of camptocormia on walking performance. This study presents a new method for assessing sagittal posture under walking conditions in patients with camptocormia. DESIGN: The severity of camptocormia was evaluated by measuring sagittal inclination, represented indirectly by the horizontal distance between the C7 and S1 markers (C7 sagittal arrow; C7-SAR). Sagittal inclination was measured under various behavioural conditions using clinical, radiological and kinematic approaches. PATIENTS: Forty-three patients were included in the study (17 with Parkinson's disease and 26 with idiopathic camptocormia). RESULTS: Under static conditions, C7-SAR could be assessed using different methods. During walking, there was a dramatic increase in C7-SAR values. Correlation analysis revealed a relationship between functional impairment and dynamic C7-SAR values, but not with radiological C7-SAR values. PATIENTS with Parkinson's disease behaved differently from idiopathic patients, suggesting the involvement of different underlying physiopathological mechanisms. CONCLUSION: Monitoring sagittal inclination during walking is more accurate than radiological measurements to determinine the detrimental effects of camptocormia and its consequences for quality of life.

Pelvic parameters and global spine balance for spine degenerative disease: the importance of containing for the well being of content.

PURPOSE: Spinal deformities and pathologies of the spinopelvic junction are conditions affecting up to 60-70 % of the general aging population. In this review, we discuss the more recent knowledge on sagittal balance and its clinical implications. METHODS: Review of the literature regarding global spine balance. RESULTS: Global spinal balance and its relationship to the pelvis correlate closely with disability and quality of life. It has been demonstrated that extensive surgery, previously considered to have poor balance between risks and outcomes, causes great improvements in health-related quality of life in the oldest age groups. CONCLUSION: Failure to restore normal sagittal alignment in patients primarily operated for other than deformity results in unacceptable rates of poor results and revision surgery.

Active self-correction of back posture in children instructed with 'straighten your back' command.

The ability to adopt the properly corrected body posture is one of the factors determining the effectiveness of therapeutic programmes. This study determined the active self-correction expressed by the change of sagittal spinal curvatures (in standing and sitting positions) in 249 children (136 females, 113 males, aged 10-14 years) instructed with 'straighten your back' command (SYB). Spinal curvatures (sacral slope-SS, lumbar lordosis-LL, global, lower and upper thoracic kyphosis-TK, LK, UK, respectively) were assessed using Saunders inclinometer. The assessment was done in spontaneous standing and sitting positions and in the positions adopted after the SYB. In a standing position SYB led to the significant (P < 0.001) increase in SS, and the significant (P < 0.01) decrease in LL, TK, LK, UK. In a sitting position SYB led to significant changes (P < 0.001) from kyphotic to lordotic position of SS and LL and to the significant (P < 0.001) reduction of TK (36.5° ± 10.8 vs. 23.5° ± 11) and the flattening of LK (15.2° ± 8.7 vs. 1.0° ± 8.4). There were gender-based discrepancy regarding active self-correction only for LL in a standing and UK in a sitting position. Females demonstrated a significant decrease in LL (P < 0.001). UK significantly increased only in males (P < 0.001). The 'straighten your back' command leads to moving the spine away from mid-range towards end range of motion. Therefore, the command should not be used to elicit the most optimal back posture. Further studies are needed to determine if the active self-correction is different in females and males.

Deformidad raquídea en los pacientes afectos de la enfermedad de Charcot-Marie-Tooth / Spinal deformities in patients with Charcot-Marie-Tooth disease

Introducción: La prevalencia de escoliosis en la enfermedad de Charcot-Marie-Tooth (CMT) se estima entre el 10 y el 38%. El objetivo del estudio es analizar la prevalencia de deformidades raquídeas asociadas al CMT en nuestra población, y los datos epidemiológicos y clínicos de los pacientes. Material y métodos: Se realizó un estudio descriptivo retrospectivo de 30 pacientes afectos de CMT, valorados entre enero de 2001 y diciembre de 2010. Se analizó el sexo, la edad de diagnóstico y el subtipo de CMT, la edad de aparición de la escoliosis, las características de la curva, la evolución y el tratamiento. Resultados: El 46,7% de los niños presentó escoliosis. La edad media de aparición de la escoliosis fue 10,21 a˜nos y la magnitud media de la curva en el momento del diagnóstico fue de 13,85◦. Un 42,85% eran toracolumbares, y el 50% asociaban cifosis. Se valoró la evolución en los pacientes con un seguimiento superior a 3 años y Risser ≥ 3, de los que el 50% presentó progresión. Se indicó tratamiento ortésico a 5 pacientes y ninguno precisó tratamiento quirúrgico. Se observó mayor incidencia de escoliosis en los varones, un 78,5%, y en los pacientes que habían sido intervenidos de deformidad de los pies, un 62,5%, sin que exista relación estadísticamente significativa en ninguno de los 2 casos. Conclusiones: La prevalencia de escoliosis en CMT es muy superior a la de la población general. Son curvas de amplio radio y con frecuencia asocian cifosis. No encontramos rápida progresión y los pacientes responden al tratamiento ortésico. Deben identificarse precozmente mediante exploración sistemática del raquis (AU)

Introduction: Prevalence of scoliosis in Charcot-Marie-Tooth (CMT) disease has been reported to range from 10 and 38%. Our study has aimed to analyze prevalence of spinal deformities associated with CMT in our population and the epidemiological and clinical data of the patients. Materials and methods: A retrospective epidemiological study of 30 patients with CMT was performed. Patients were evaluated between January 2001 and December 2010. Sex, age at diagnosis and subtype of CMT, age at onset of scoliosis, curve characteristics, evolution and treatment were analyzed. Results: A total of 46.7% of the children of the study had scoliosis. Average age at diagnosis of scoliosis was 10.21 years and average curve magnitude at the time of diagnosis was 13.85◦. Of the curves, 42.85% were thoracolumbar and 50% were associated with increased thoracic kyphosis. Curve progression was analyzed only when the patients had been followed-up for more than three years and the final Risser sign was ≥3. Progression was documented in 50% of the patients. Orthosis was prescribed in five patients and none required surgical treatment. A higher incidence of scoliosis was observed in males, 78.5%, and in patients who had undergone foot surgery, 62.5%. No statistically significant relationship was found in either case. Conclusions: Prevalence of scoliosis in CMT is higher than in the general population. Patient have long radius curves, often with associated kyphosis. We did not find rapid progression and there was good response to the brace treatment. Spinal deformity should be detected early by systematic examination of the spine (AU)

Long-term effect of repeated lidocaine injections into the external oblique for upper camptocormia in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is occasionally complicated by camptocormia. In a previous study, we classified camptocormia into upper and lower types based on the inflection point, and reported that lidocaine injection into the external oblique muscle, but not into the internal oblique or rectus abdomen, improved upper camptocormia in PD. The effect of a single lidocaine injection disappeared over a period of few days. In this study, we used repeated lidocaine injections into the external oblique for 4-5 days and evaluated the effects of such treatment for up to 90 days. METHODS: The study subjects were 12 patients with PD and upper camptocormia who were treated with repeated lidocaine injections into the bilateral external oblique followed by rehabilitation. The effect of treatment was evaluated by measuring the angle of truncal flexion before and after the injection. Patients who showed improvement with repeated injections were evaluated during a 90-day period. RESULTS: Eight out of 12 patients showed significant improvement in posture after a single lidocaine injection. However, the effect subsided several days after treatment. Repeated injections produced long-term improvement in 9 out of 12 patients, which was maintained during the 90-day observation period in eight of these patients. CONCLUSIONS: Our results showed that repeated lidocaine injections into the external oblique improved upper camptocormia, and that the effect was maintained in the majority of patients during the 90-day observation period, indicating that repeated lidocaine injections into the external oblique have therapeutic effect on upper camptocormia in patients with Parkinson's disease.

The influence of generalized joint hypermobility on the sagittal profile of the spine in children aged 10-13 years.

BACKGROUND: Children commonly attend exercise programs to correct abnormal sagittal curvatures of the spine. The presence of generalized joint hypermobility (JH) is often disregarded during exercise planning. The aim of the study was to assess the influence of JH on the sagittal curvatures of the spine. MATERIAL AND METHODS: The JH group included 38 girls and 37 boys aged 10-13 years with known JH (Beighton test cut-off ≥ 5 points for girls, and ≥ 4 for boys). A control group included 197 girls and 150 boys. The children were matched for age, height, weight and BMI. The sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), distal thoracic kyphosis (DK), and proximal thoracic kyphosis (PK) were assessed with a Saunders inclinometer. The results in children with and without JH were compared. RESULTS: There were no significant (p>0.05) differences between girls with and without JH with respect to SS (22.5° ± 9.9 vs 23.0° ± 8.0), LL (31.0° ± 14.0 vs 33.0° ± 10.0), TK (39.0° ± 10.4 vs 39.6° ± 10.0), DK (8.7° ± 6.9 vs 7.9° ± 7.8) or PK (31.3° ± 7.1 vs 32.3° ± 7.3). The differences among boys were similarly non-significant (p>0.05) (19.0° ± 7.9 vs 19.7° ± 6.6; 30.6° ± 9.0 vs 31.9° ± 8.4; 42.7° ± 8.0 vs 40.6° ± 8.7; 9.7° ± 7.9 vs 8.2° ± 7.8; 33.7° ± 5,0 vs 32.8° ± 7.0, for SS, LL, TK, DK and PK, respectively). CONCLUSIONS: 1. The sagittal profile of the spine did not differ between children with and without JH, which may lead to suboptimal exercise plans. 2. The routine examination of the musculoskeletal system should be extended to include an assessment of JH.