scholarly journals Biomechanical Evaluation and Comparison of Clinically Relevant versus Non-relevant Leg Length Inequalities

2021 ◽  
Author(s):  
Roman Michalik ◽  
Viola Rissel ◽  
Filippo Miglorini ◽  
Hannah Siebers ◽  
Marcel Betsch
Keyword(s):  
Surface Topography ◽  
Pelvic Obliquity ◽  
Leg Length ◽  
Spinal Posture ◽  
Compensation Mechanisms ◽  
Patient Groups ◽  
Biomechanical Evaluation ◽  
Common Clinical Practice ◽  
Pelvic Position

Abstract BackgroundLeg length inequalities (LLIs) are a frequent condition in every population. It is common clinical practice to consider LLIs of 2cm and more as relevant and to treat those. However, the amount of LLIs that need treatment is not clearly defined in literature and the effect of real LLIs on the musculoskeletal system above and below 2cm have not been studied biomechanically before.Research question: Are the spine and pelvis affected differently in patients with LLIs <2cm and ≥2cm.MethodsBy using surface topography, we evaluated 32 patients (10 females, 22 male) with real LLIs of ≥2cm (mean: 2.72cm; n=10) and compared their pelvic position and spinal posture to patients with LLIs <2cm (mean: 1.24cm; n=22) while standing and walking. All patients were measured with a surface topography system during standing and while walking on a treadmill. To compare patient groups, we used Student t-tests for independent samples.ResultsPelvic obliquity was significantly higher in patients with LLI ≥2cm during the standing trial (p=0.045) and during the midstance phase of the longer leg (p=0.023) while walking. Further measurements did not reveal any significant differences (p=0.06-0.706).ConclusionThe results of our study suggest that relevant LLIs of ≥2cm mostly affect pelvic obliquity and do not lead to significant alterations in the spinal posture during a standing trial. Additionally, we demonstrated that LLIs are better compensated when walking, showing almost no significant differences in pelvic and spinal posture between patients with LLIs smaller and greater than 2 cm. This study shows that LLIs ≥2cm can still be compensated; however, we do not know if the compensation mechanisms may lead to long-term clinical pathologies.

Changes in muscle activities and kinematics due to simulated leg length inequalities

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Hannah Lena Siebers ◽  
Jörg Eschweiler ◽  
Filippo Migliorini ◽  
Valentin Michael Quack ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Rectus Femoris ◽  
Knee Extension ◽  
Pelvic Obliquity ◽  
Lateral Flexion ◽  
Leg Length ◽  
Joint Angles ◽  
Leg Muscles ◽  
Compensation Mechanisms ◽  
Musculoskeletal Problems

Abstract Muscle imbalances are a leading cause of musculoskeletal problems. One example are leg length inequalities (LLIs). This study aimed to analyze the effect of different (simulated) LLIs on back and leg muscles in combination with kinematic compensation mechanics. Therefore, 20 healthy volunteers were analyzed during walking with artificial LLIs (0–4 cm). The effect of different amounts of LLIs and significant differences to the reference condition without LLI were calculated of maximal joint angles, mean muscle activity, and its symmetry index. While walking, LLIs led to higher muscle activity and asymmetry of back muscles, by increased lumbar lateral flexion and pelvic obliquity. The rectus femoris showed higher values, independent of the amount of LLI, whereas the activity of the gastrocnemius on the shorter leg increased. The hip and knee flexion of the long leg increased significantly with increasing LLIs, like the knee extension and the ankle plantarflexion of the shorter leg. The described compensation mechanisms are explained by a dynamic lengthening of the short and shortening of the longer leg, which is associated with increased and asymmetrical muscle activity. Presenting this overview is important for a better understanding of the effects of LLIs to improve diagnostic and therapy in the future.

scholarly journals Dynamic spinal posture and pelvic position analysis using a rasterstereographic device

2020 ◽  
Author(s):  
Roman Michalik ◽  
Juliane Hamm ◽  
Valentin Quack ◽  
Jörg Eschweiler ◽  
Matthias Gatz ◽  
...  
Keyword(s):  
Pelvic Obliquity ◽  
Kyphotic Angle ◽  
Lateral Deviation ◽  
Dynamic Conditions ◽  
Spinal Posture ◽  
Surface Rotation ◽  
Trunk Inclination ◽  
Static Conditions ◽  
Pelvic Position ◽  
Trunk Imbalance

Abstract Background: Until recently, rasterstereographic analysis of the spine was limited to static measurements. However, understanding and evaluating the motion of the spine under dynamic conditions is an important factor in the diagnosis and treatment of spinal pathologies. Aim of this study was to study the spinal posture and pelvic position under dynamic conditions and compare it to static measurements using a dynamic rasterstereographic system. Methods: A total of 121 healthy volunteers (56 females; 65 males) were included in this observational study. The parameters trunk inclination, trunk imbalance, pelvic obliquity, kyphotic angle, lordotic angle, surface rotation and lateral deviation were studied and compared under static and dynamic (1,2,4,5 km/h) conditions using the system “Formetric 4D Motion ® “ (DIERS International GmbH, Germany). Results: Female volunteers had a higher lordotic angle than males under static conditions (p<0.001). Trunk inclination (5.31° vs. 6.74°), vertebral kyphotic angle (42.53° vs. 39,59°) and surface rotation (3.35° vs. 3.81°) increase under dynamic conditions (p<0.001). Trunk inclination and lordotic angle both show significant changes during walking compared to static conditions (p<0.001). Conclusion: The spinal posture differs between females and males during standing and during walking. Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies. Trial registration: retrospectively registered

scholarly journals The effect of simulating a leg-length discrepancy on pelvic position and spinal posture

2015 ◽  
Vol 27 (3) ◽  
pp. 689-691 ◽  
Author(s):  
Yu-Jeong Kwon ◽  
Minyoung Song ◽  
Il-Hun Baek ◽  
Taesik Lee
Keyword(s):  
Leg Length Discrepancy ◽  
Leg Length ◽  
Spinal Posture ◽  
Length Discrepancy ◽  
Pelvic Position

scholarly journals Dynamic spinal posture and pelvic position analysis using a rasterstereographic device

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Roman Michalik ◽  
Juliane Hamm ◽  
Valentin Quack ◽  
Jörg Eschweiler ◽  
Matthias Gatz ◽  
...  
Keyword(s):  
Pelvic Obliquity ◽  
Kyphotic Angle ◽  
Lateral Deviation ◽  
Dynamic Conditions ◽  
Spinal Posture ◽  
Surface Rotation ◽  
Trunk Inclination ◽  
Static Conditions ◽  
Pelvic Position ◽  
Trunk Imbalance

Abstract Background Until recently, rasterstereographic analysis of the spine was limited to static measurements. However, understanding and evaluating the motion of the spine under dynamic conditions is an important factor in the diagnosis and treatment of spinal pathologies. The aim of this study was to study the spinal posture and pelvic position under dynamic conditions and compare it to static measurements using a dynamic rasterstereographic system. Methods A total of 121 healthy volunteers (56 females; 65 males) were included in this observational study. The parameters trunk inclination, trunk imbalance, pelvic obliquity, kyphotic angle, lordotic angle, surface rotation, and lateral deviation were studied and compared under static and dynamic (1, 2, 4, 5 km/h) conditions using the system “Formetric 4D Motion®“ (DIERS International GmbH, Germany). Results Female volunteers had a higher lordotic angle than males under static conditions (p < 0.001). Trunk inclination (5.31° vs. 6.74°), vertebral kyphotic angle (42.53° vs. 39, 59°), and surface rotation (3.35° vs. 3.81°) increase under dynamic conditions (p < 0.001). Trunk inclination and lordotic angle both show significant changes during walking compared to static conditions (p < 0.001). Conclusion The spinal posture differs between females and males during standing and during walking. Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies. Trial registration Retrospectively registered

scholarly journals The effect of simulating leg length inequality on spinal posture and pelvic position: a dynamic rasterstereographic analysis

2011 ◽  
Vol 21 (4) ◽  
pp. 691-697 ◽  
Author(s):  
Marcel Betsch ◽  
Michael Wild ◽  
Birgit Große ◽  
Walter Rapp ◽  
Thomas Horstmann
Keyword(s):  
Leg Length ◽  
Leg Length Inequality ◽  
Spinal Posture ◽  
Pelvic Position

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

scholarly journals Long term results after transepiphysal ACL reconstruction in children and adolescent

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Christian Eberle ◽  
Wolfgang Schopf ◽  
Andree Ellermann
Keyword(s):  
Acl Reconstruction ◽  
Cartilage Damage ◽  
Long Term Results ◽  
Angular Deformity ◽  
Leg Length ◽  
Growth Disturbance ◽  
Children And Adolescent ◽  
The Mean

The aim of our study was to review the long term clinical and radiological (MRI) outcomes of adult patients who underwent ACL reconstruction as children or adolescent with emphasize to the features of growth disturbance, angular deformity, meniscal and cartilage damage and revision rate We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence between the years 1997 and 2009. A total of 43 Patients were assessed. 25 male and 18 female. The average age at time of surgery was 13,5 years (8 - 16 y.), at time of assessement 22,4 years (18 - 30 y.) . The mean follow up was 10 years (4 - 16 years). The physical development of the patients was assessed with the Lysholm score and the Cincinnati Knee score scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner activity score . Leg deformity or leg length discrepancy was evaluated clinically by the observers. The instrumented Lachman test using KT1000 and manual Pivot shift test was performed to assess knee stability. MRI was used to detect graft integrity, cartilage and meniscal damages. No significant leg deformities or leg length discrepancy had been detected. The average Lysholm score was 91 points (83 - 100), the Cincinnati Knee Score was 90,4 (79 - 100) points on average . The mean IKDC score was 92 points (82 -100). The Tegner-Activity-Score changed from preop 6,8 (2-10) to post op 5,8 (2-9). 2 Patient underwent revision ACL reconstruction due to rerupture (3 and 9 years post op). 2 Patients underwent meniscal surgery during follow up (1 resection and one refixation). KT1000 evaluation showed 67% excellent, 21% good and in 12% bad results. The MRI scan showed 42 intact grafts and one unverifiable graft. One patient with cartilage damage up to 3° (ICRS), 3 patients with meniscal degeneration up to grade 2. Each patient showed a free range of motion Our data underlines that transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long term results without causing angular deformity or growth disturbance

scholarly journals Neural compensation mechanisms following long-term adaptation to severe optical defects

2017 ◽  
Vol 17 (7) ◽  
pp. 37
Author(s):  
Antoine Barbot ◽  
Krystel R Huxlin ◽  
Duje Tadin ◽  
Geunyoung Yoon
Keyword(s):  
Compensation Mechanisms ◽  
Neural Compensation

Psychiatric services

2017 ◽  
pp. 777-800
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Historical Development ◽  
Psychiatric Services ◽  
Global Perspective ◽  
Rehabilitation Services ◽  
International Service ◽  
Care Services ◽  
The United Kingdom ◽  
Working Age ◽  
Patient Groups

‘Psychiatric services’ is concerned with the provision of psychiatric care for populations. It deals mainly with the needs of and provisions for people aged 18–65 years (‘adults of working age’), and focuses on the situation in the United Kingdom. (A more global perspective is provided in Chapter 23.) The chapter begins with an account of the historical development of psychiatric services, followed by descriptions of the commonly available psychiatric services and of the problems they encounter. It outlines the components of services, both those within primary care and those within specialized secondary care. These include services for acute disorders and those for complex long-term disorders (rehabilitation services). Service adaptations for patient groups with special needs (e.g. deafness, eating disorders) are also presented. The difficulties encountered by community care services are examined, as are emerging international service principles.

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