Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program.

BACKGROUND: The child's spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP). OBJECTIVE: The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children. METHODS: This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children's parents or legal guardians filled in a questionnaire according to the children's responses about the BP suffered in the previous week and the preceding year. RESULTS: The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009-1.160, p= 0.028). CONCLUSIONS: To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme.

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8-12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

Classification System of the Sagittal Integral Morphotype in Children from the ISQUIOS Programme (Spain).

The sagittal spinal morphology presents 4 physiological curvatures that increase endurance to axial compression forces and allow adequate postural balance. These curves must remain within normal ranges to achieve a static and dynamic balance, a correct functioning of the muscles and an adequate distribution of the loads, and thus minimize the injury risk. The purpose of this study was to categorize the sagittal spinal alignment according to the different morphotypes obtained for each curve in standing, slump sitting, and trunk forward bending positions in schoolchildren. It was a cross-sectional study. Sagittal spinal curvatures were assessed in 731 students from 16 elementary schools. In the sagittal standing position assessment, 70.45% and 89.06% of schoolchildren presented a "normal" morphotype for both dorsal and lumbar curves, respectively. After the application of the "Sagittal Integral Morphotype" protocol according to the morphotypes obtained in the three positions assessment (standing, slump sitting, and trunk forward bending), it was observed how the frequency of normal morphotypes for the dorsal and lumbar curve decreased considerably (only 32% and 6.6% of children obtained a "normal sagittal integral morphotype" for the thoracic and lumbar curvatures, respectively). These results show how it is necessary to include the slump sitting and trunk forward bending assessment as part of the protocol to define the "integral" sagittal alignment of the spine and establish a correct diagnosis. The use of the diagnostic classification presented in this study will allow early detection of misalignment not identified with the assessment of standing position.

A propósito del “Return to play” en futbolistas lesionados / About the Return to Play on injured football players

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Effect of 3 different active stretch durations on hip flexion range of motion.

The purpose of this study was to evaluate the efficacy of 3 different durations of active stretch (12 x 15, 6 x 30, and 4 x 45 seconds) in a hamstring stretching exercise program on lower extremity range of motion (ROM) in young adults. A total of 150 subjects (age, 21.3 +/- 2.5 years; height, 173. 33 +/- 8.35 cm; weight, 70.42 +/- 10.80 kg) completed this study. Subjects were randomly assigned to 1 of 4 groups (3 treatment groups and 1 control group). The 3 treatment groups participated in an active stretching program 3 times per week for a 12-week period, holding each stretch exercise for a duration of 15, 30, or 45 seconds. The total daily dose of the stretches was 180 seconds for each group. The control group did not stretch. Passive hip flexion ROM was determined through the bilateral straight leg raise test before, during (at 4 and 8 weeks), and after the program using an inclinometer. Statistical analysis (p < 0.05) revealed a significant interaction of length of stretching program and improvement in ROM. Post hoc analysis showed that all 3 treatment groups increased hip flexion ROM from their initial values; however, the control group did not. No significant differences were found between the 3 treatment groups. This study indicates that 12 x 15-, 6 x 30-, and 4 x 45-second single durations of active stretching were equally effective at increasing hamstring length when performed 3 days per week for 12 weeks in this population.

Masa ósea y ejercicio físico / Bone mass and physical exercice

La osteoporosis constituye un importante problema de salud pública que en los últimos años se ha visto acentuado debido, posiblemente, al cambio de hábitos que la sociedad mundial viene experimentando en las últimas décadas. El lograr disminuirle riesgo de fracturas, es la principal preocupación entre los profesionales y es a este fin, al que se dedican los mayores esfuerzos. Son muchos los factores determinantes del pico de masa ósea entre ellos, el ejercicio físico que es uno de los aspectos que podrían prevenir e incluso paliar los efectos de la osteoporosis, ya sea por aumento de la densidad mineral ósea, o por la disminución de sus pérdidas. A pesar de esto, no todos los ejercicios son igualmente válidos y su efectividad estará también condicionada por la edad de comienzo de la práctica así como, la continuidad en la misma y otros muchos factores que procederemos a analizar. Por todo ello, el objetivo de este trabajo fue el de revisar y analizar el estado actual de conocimiento sobre esta materia (AU)

Osteoporosis represents a serious problem forthe public health the last years and it has increased mainly due to the world wide change of habits during the last decades. Most efforts have aimed to reduce the risk of fractures as it has become the main concern among professionals. Many factors determine the bone peak mass, among them physical exercise which is an aspect that could not only prevent but also palliate the osteoporosis effects either by increasing the bone mineral density or by the decrease of the loss of it. In spite of it not all exercises are equally valid or effective as it depends on the age at which it is practiced, the continuity and many other factors that will be analyzed. The aim of this work is to study and to analyze the present day knowledge on this theme (AU)

A comparison of the sit-and-reach test and the back-saver sit-and-reach test in university students.

This study compares the forward reach score, spine and pelvis postures, and hamstring criterion-related validity (concurrent validity) between the sit-and-reach test (SR) and the back-saver sit-and-reach test (BS). Seventy-six men (mean age ± SD: 23.45 ± 3.96 years) and 67 women (mean age ± SD: 23.85 ± 5.36 years) were asked to perform three trials of SR, BS left (BSl), right (BSr), and passive straight leg raise (PSLR) right and left (hamstring criterion measure) in a randomized order. The thoracic, lumbar, and pelvis angles (measured with a Uni-level inclinometer) and forward reach scores were recorded once the subjects reached forward as far as possible without flexing the knees. A repeated measure ANOVA was performed followed by Bonferroni's post hoc test. Pearson correlation coefficients were used to define the relationships between SR and BS scores with respect to PSLR. In both men and women, the thoracic angle in BS was significantly greater than in SR (p<0.016). However, no significant differences were found between the tests in lumbar angle, pelvic angle, and forward reach scores. The concurrent validity of the forward reach score as a measure of hamstring extensibility was moderate in women (0.66 0. 76) and weak to moderate in men (0.51 0.59). The concurrent validity was slightly higher in SR than in BS, although no significant differences between the correlation values were observed. There were significant differences in the thoracic angle between the SR and BS, but not in the forward reach score. There was no difference in concurrent validity between the two tests. However, the traditional SR was preferred because it reached better concurrent validity than the BS. Key pointsPrevious studies have analyzed the validity of sit-and-reach and back-saver sit-and-reach tests as criterion measures of hamstring muscle extensibility. The differences in the position of lower limbs between both the tests could influence the spinal and pelvic angles and forward reach score.Forward reach scores, lumbar and pelvic angles showed no significant differences between the tests, while lower thoracic angle was found in the sit-and-reach. However relatively large changes in thoracic angle were required to be confident true difference had occurred.The sit-and-reach test is the preferred test over the back-saver sit-and-reach as measure of hamstring muscle extensibility. The concurrent validity of sit-and-reach and back-saver sit-and-reach in men is compromised, and hence, other tests should be considered to evaluate the hamstring extensibility.

[Effects of a structured exercise programme on cardiovascular risk programmes in post-menopausal women. CLIDERICA study]. / Efectos de un programa de ejercicio de fuerza/resistencia sobre los factores de riesgo cardiovascular en mujeres posmenopáusicas de bajo riesgo cardiovascular. Estudio CLIDERICA.

OBJECTIVE: To analyse the influence of a physical exercise programme of strength/stamina on cardiovascular risk factors in low-risk post-menopausal women. DESIGN: Six-month randomised clinical trial with post-menopausal women. SETTING: Three health centres in the autonomous community of Murcia, Spain. PARTICIPANTS: Sixty-three post-menopausal women aged 45 to 59 at low cardiovascular risk. INTERVENTIONS AND MAIN MEASUREMENTS: They were split into 2 groups: a) control: 23 people with no specific intervention, and b) 40 people with an intervention of strength/stamina exercise with protocol for in water and on land. At their initial and final visits, everyone in the 2 groups had anamnesis, physical examination, and general analyses, including Apo A, Apo B, insulin, serum creatinine, creatinine clearance, creatinine in urine, albuminuria, ultrasensitive PCR, and HOMA index. RESULTS: The insulin levels increased in the control group by 2.02 mU/L and dropped in the experimental group by 0.13 mU/L (P=.021). At the start of the study, creatinine in the control group was 0.83+/-0.12 mg/dL; and at the end, 0.91+/-0.02 mg/dL. In the intervention group it was 0.84+/-0.12 mg/dL at the start and 0.90+/-0.13 mg/dL at the end (NS). Systolic blood pressure dropped in both groups, with a bigger drop in the exercise group (11.81 vs 0.17 mm Hg) (P=.0001). HDL-C values increased in the control group by 4.97 mg/dL; and in the experimental group, by 3.46 mg/dL (NS). CONCLUSIONS: A controlled programme of strength/stamina physical exercise reduces the cardiovascular risk of post-menopausal women.

Efectos de un programa de ejercicio de fuerza/resistencia sobre los factores de riesgo cardiovascular en mujeres posmenopáusicas de bajo riesgo cardiovascular. Estudio CLIDERICA / Effects of a structured exercise programme on cardiovascular risk programmes in post-menopausal women. CLIDERICA study

Objetivo. Analizar la influencia de un programa de ejercicio físico de fuerza/resistencia sobre los factores de riesgo cardiovascular en mujeres posmenopáusicas de bajo riesgo. Diseño. Ensayo clínico aleatorizado de 6 meses de duración. Emplazamiento. El estudio se realizó en 3 centros de salud de la Comunidad Autónoma de Murcia. Participantes. Participaron en el estudio 63 mujeres posmenopáusicas de 45-59 años con riesgo cardiovascular bajo. Intervenciones y mediciones principales. Las mujeres participantes fueron divididas en 2 grupos: a) control, sin intervención específica (n = 23), y b) intervención mediante ejercicio de fuerza/resistencia con protocolo en medio acuático y terrestre (n = 40). A todos los grupos en la visita inicial y final se les realizaron anamnesis, exploración física y analítica general incluyendo Apo A, Apo B, insulina, creatinina sérica, aclaramiento de creatinina, creatinina en orina, albuminuria, proteína C reactiva ultrasensible e índice HOMA. Resultados. Los valores de insulina aumentan en el grupo control 2,02 mU/l y descienden en el grupo experimental 0,13 mU/l (p = 0,021). Al inicio del estudio la creatinina en el grupo control es de 0,83 ± 0,12 mg/dl, y de 0,91 ± 0,02 mg/dl al final del estudio. En el grupo de intervención es de 0,84 ± 0,12 mg/dl al inicio del estudio, y de 0,90 ± 0,13 mg/dl al final (NS). La presión arterial sistólica disminuye en ambos grupos, y es mayor el descenso en el grupo de ejercicio (11,81 frente a 0,17 mmHg); (p = 0,0001). Los valores de colesterol unido a lipoproteínas de alta densidad aumentan en el grupo control (4,97 mg/dl) y en el grupo experimental (3,46 mg/dl) (NS). Conclusiones. Un programa controlado de ejercicio físico de fuerza/resistencia en la mujer posmenopáusica disminuye su riesgo cardiovascular

Objective. To analyse the influence of a physical exercise programme of strength/stamina on cardiovascular risk factors in low-risk post-menopausal women. Design. Six-month randomised clinical trial with post-menopausal women. Setting. Three health centres in the autonomous community of Murcia, Spain. Participants. Sixty-three post-menopausal women aged 45 to 59 at low cardiovascular risk. Interventions and main measurements. They were split into 2 groups: a) control: 23 people with no specific intervention, and b) 40 people with an intervention of strength/stamina exercise with protocol for in water and on land. At their initial and final visits, everyone in the 2 groups had anamnesis, physical examination, and general analyses, including Apo A, Apo B, insulin, serum creatinine, creatinine clearance, creatinine in urine, albuminuria, ultrasensitive PCR, and HOMA index. Results. The insulin levels increased in the control group by 2.02 mU/L and dropped in the experimental group by 0.13 mU/L (P=.021). At the start of the study, creatinine in the control group was 0.83±0.12 mg/dL; and at the end, 0.91±0.02 mg/dL. In the intervention group it was 0.84±0.12 mg/dL at the start and 0.90±0.13 mg/dL at the end (NS). Systolic blood pressure dropped in both groups, with a bigger drop in the exercise group (11.81 vs 0.17 mm Hg) (P=.0001). HDL-C values increased in the control group by 4.97 mg/dL; and in the experimental group, by 3.46 mg/dL (NS). Conclusions. A controlled programme of strength/stamina physical exercise reduces the cardiovascular risk of post-menopausal women

A comparison of the spine posture among several sit-and-reach test protocols.

The purpose of the study was to compare the thoracic and lumbar spine posture among different sit-and-reach tests. Fifty-eight men and 47 women were asked to perform three trials of sit-and-reach test (SR), toe-touch test (TT), back-saver sit-and-reach test (BS) right and left, unilateral seated sit-and-reach test (USR) right and left, and V sit-and-reach test (VSR). Thoracic and lumbar angles were assessed with an inclinometer when subjects reached forward maximally. Women had a lower thoracic angle than men on all tests (p<0.05). No differences were found in the lumbar angle between genders. The thoracic angle was the highest in VSR (75.3 degrees in men and 65.8 degrees in women) and the lowest in TT (61.7 degrees in men and 53.1 degrees in women). No differences were found among some pairwise comparisons (SR-BS in both genders, SR-TT, SR-VSR and others in women). The VSR test presented the highest values in lumbar spine when compared to other tests (30.5 degrees in men and 32.0 degrees in women). Unilateral seated sit-and-reach test presented the lowest lumbar angle in men (24.2 degrees for right leg and 23.9 degrees for left leg) and women (23.9 degrees in both legs) and there were significant differences with respect to the other tests. Characteristics and administration procedures of tests, such us uni- or bilateral, sitting or standing, measuring with or without box, parallel or V position, and hip position influence thoracic and lumbar postures.

Nasal immunization of mice with a rotavirus DNA vaccine that induces protective intestinal IgA antibodies.

DNA vaccination using a plasmid encoding the rotavirus inner capsid VP6 has been explored in the mouse model of rotavirus infection. BALB/c mice were immunized with a VP6 DNA vaccine by the intramuscular, nasal and oral routes. VP6 DNA vaccination by the nasal and oral routes induced the production of anti-VP6 IgA antibodies by intestinal lymphoid cells. Intramuscular DNA injection stimulated the production of serum anti-VP6 IgG but not serum anti-VP6 IgA antibodies. Protection against shedding of rotaviruses in stools after oral challenge with the murine EDIM rotavirus strain was investigated in the immunized mice. A significant reduction in the level of rotavirus antigen shedding was demonstrated in those mice immunized at mucosal surfaces, both orally and nasally, with the VP6 DNA vaccine. Intramuscular DNA immunization, which elicited serum anti-VP6 IgG responses but not virus-specific intestinal IgA antibodies, did not provide significant protection against rotavirus challenge.

Expression and purification of polyhistidine-tagged rotavirus NSP4 proteins in insect cells.

The rotavirus nonstructural NSP4 protein, a transmembrane endoplasmic reticulum-specific glycoprotein, has been described as the first viral enterotoxin. Purified NSP4 or a peptide corresponding to NSP4 residues 114-135 induces diarrhea in young mice. NSP4 has a membrane-destabilizing activity and causes an increase in intracellular calcium levels and chloride secretion by a calcium-dependent signalling pathway in eucaryotic cells. In this study, four recombinant baculoviruses were generated expressing the rotavirus NSP4 glycoprotein from the human strains Wa and Ito, the porcine strain OSU, and the simian strain SA11, which belong to two different NSP4 genotypes, A and B. The recombinant glycoproteins, expressed as polyhistidine-tagged molecules, were analyzed by Western blotting and immunoprecipitation. Newborn mice responded with diarrhea after inoculation with each of the recombinant NSP4 proteins.