Lumbar lordosis and pelvic inclination in adults with chronic low back pain.

BACKGROUND AND PURPOSE: The causes of lumbopelvic imbalances in standing have been widely accepted by physical therapists, but there is a lack of scientific evidence available to support them. We examined the association between 9 variables and pelvic inclination and lumbar lordosis during relaxed standing. SUBJECTS: Thirty men and 30 women with chronic low back pain (CLBP) for at least 4 months were examined (mean age=54.9 years, SD=9, range=40.4-69.8). METHODS: Multiple linear regression modeling was used to assess the association of pelvic inclination and the magnitude of lumbar lordosis in standing with age, sex, body mass index (BMI), Oswestry Back Pain Disability Questionnaire (ODQ) scores, physical activity level, hip flexor muscle length, abdominal muscle force, and range of motion (ROM) for lumbar flexion and extension. RESULTS: In women, age, BMI, and ODQ scores were associated univariately and multivariately with pelvic inclination. In men, lumbar extension ROM was related univariately to pelvic inclination; age, lumbar extension ROM, and ODQ scores were associated multivariately. Lumbar lordosis was associated univariately with only lumbar extension ROM for women and men. A weak correlation was found between angle of pelvic inclination and magnitude of lumbar lordosis in standing (r=. 31 for women, r=.37 for men). CONCLUSION AND DISCUSSION: The odds ratio of having CLBP is increased if the score on the double-leg lowering test for abdominal muscles exceeds 50 degrees for men and 60 degrees for women. In patients with CLBP, the magnitude of the lumbar lordosis and pelvic inclination in standing is not associated with the force production of the abdominal muscles.

Lumbar lordosis and pelvic inclination of asymptomatic adults.

BACKGROUND AND PURPOSE: We examined the association between pelvic inclination and lumbar lordosis during relaxed standing and eight variables thought to contribute to lordosis. SUBJECTS: 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. METHODS: 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. RESULTS: 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. CONCLUSION AND DISCUSSION: 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.

Reliability of measurements of lumbar spine sagittal mobility obtained with the flexible curve.

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.

Reliability of goniometric measurements of active arm elevation in the scapular plane obtained in a clinical setting.

Our purpose was to determine the intratester and intertester reliability of measurements of both scapular and glenohumeral rotation during active arm elevation in the scapular plane with a new device, the scapulohumeral goniometer (SHG). Ten physical therapists, with 1 to 29 years of clinical experience, obtained repeated measurements on 45 subjects who were 27 to 82 years old. All subjects were tested in a uniform standing position with the handheld SHG, which was positioned over the subject's scapula and posterior shoulder according to operationally defined landmarks. For both scapular and glenohumeral rotation, 50% of the time the first and second measurements made on a patient by the same physical therapist differed by 3 degrees or more. Ten percent of the time, these measurements differed by 8 degrees or more. Measurements of active range of movement of scapular and glenohumeral rotation made by the same physical therapist during arm elevation in the scapular plane are clinically unacceptable when obtained with the current techniques for positioning the SHG. Clinical decisions based on results of active scapular and humeral motion in the scapular plane as measured on a patient by the same therapist with an SHG should be made with caution, because of the variability associated with this procedure.

Reliability of measuring forward head posture in a clinical setting.

We believe there is a need to identify a practical method for determining objective measurement of forward head posture. In our study, we determined the within-tester and between-tester reliabilities for clinical measurements of static, sitting, forward head posture using the cervical range of motion (CROM) instrument. Repeated measurements were made using a standardized protocol on 40 patients seated in a standardized position. The seven testers had from 1 to 8 years of clinical experience. All measurements were recorded by the same investigator. The intraclass correlation coefficient (ICC[1,1]) was used to quantitate within-tester and between-tester reliability. Measurements of forward head position performed by the same physical therapist had high reliability (ICC = 0.93). Good reliability (ICC = 0.83) was demonstrated when different physical therapists measured the forward head posture of the same patient. We concluded that measurements of forward head posture made by physical therapists trained in the correct use of the CROM instrument are reliable. This reliability is important for determining the effectiveness of treatment programs. On the basis of our data, the CROM instrument will assist clinicians in the objective evaluation and reassessment of the patient population demonstrating forward head posture.

Normal range of motion of the cervical spine: an initial goniometric study.

The purposes of this study were (1) to determine normal values for cervical active range of motion (AROM) obtained with a "cervical-range-of-motion" (CROM) instrument on healthy subjects whose ages spanned 9 decades, (2) to determine whether age and gender affect six cervical AROMs, and (3) to examine the intratester and intertester reliability of measurements obtained. Measurements were made on 337 subjects (171 females and 166 males) whose ages ranged from 11 to 97 years. Measurements were taken by five physical therapists with 7 to 30 years of clinical and teaching experience. Among male and female subjects of the same age, females had a greater AROM than did males for all AROMs except neck flexion. Among both males and females, each of the six cervical AROMs decreased significantly with age. From two pilot studies separate from the acquisition of the normal database, we determined our intratester and intertester reliabilities for making neck AROM measurements with the CROM instrument. We concluded that AROM measurements on the cervical spine with the CROM instrument demonstrated good intratester and intertester reliability, because the intraclass correlation coefficients were generally greater than .80.

Reliability of measurements of cervical spine range of motion--comparison of three methods.

To determine reliabilities within and between persons measuring cervical active range of motion (AROM) three methods were examined: use of a cervical-range-of-motion (CROM) instrument, use of a universal goniometer (UG), and visual estimation (VE). Measurements were made on 60 patients with orthopedic disorders of the cervical spine who were divided into three groups of 20 subjects each. All subjects were tested in a standardized seated position using operationally defined goniometric placements and nongoniometric estimation techniques. Cervical flexion and extension, lateral flexion, and rotation were measured. Intraclass correlation coefficients (ICCs) were used to quantify within-tester and between-tester reliability. We found that goniometric measurements of AROM of the cervical spine made by the same physical therapist had ICCs greater than .80 when made with the CROM device or the UG. When different physical therapist measured the same patient's cervical AROM, the CROM device had ICCs greater than .80, whereas the UG and VE generally had ICCs less than .80.

Strength changes in the normal quadriceps femoris muscle as a result of electrical stimulation.

The purpose of this study was to examine the effectiveness of an electronic muscle stimulator in strengthening normal quadriceps femoris muscle without the assistance of simultaneous isometric muscle contraction. The sample consisted of 58 subjects who were randomly divided into three independent groups. One group (n = 19) served as controls; one group (n = 20) underwent daily stimulation of the right quadriceps femoris muscle using a specified protocol; and one group (n = 19) underwent isometric strengthening of the quadriceps femoris muscle using a specified protocol. The mechanical force of isometric quadriceps femoris muscle contraction was recorded weekly for the three groups, and the initial and final values were subjected to an analysis of covariance. The electrical-stimulation and isometric-exercise groups had statistically significant increases in quadriceps femoris muscle torque when compared with the nonexercised controls (p less than .001). The data supported the use of this electronic stimulator as an appropriate device for strengthening skeletal muscle without voluntary effort.