Effect of Low Versus High-Heeled Footwear on Spinopelvic Alignment at Different Phases of Menstrual Cycle in Young Adult Women: A Biopsychosocial Perspective

High-heeled shoes adversely affect spinal curvature, increase the risk of low back pain, and disturb the normal gait pattern. The purpose of this study was to examine, from a biopsychosocial point of view, the combined effect of wearing two different heel heights and of hormonal oscillation throughout different phases of the menstrual cycle on spinopelvic alignment. Notably, 70 females with an average age of 20.42 ± 1.51 years participated in this study, wearing each female two different heel heights as follows: low (2.5 cm) and high (7 cm). Spinopelvic alignment was evaluated by rasterstereography formetric 3D analysis during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Statistical analysis showed that there was no significant difference (p > 0.05) on spinopelvic alignment [kyphotic angle (KA), trunk inclination (TI), and pelvic inclination] between wearing low- or high-heeled shoes during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Considering that high-heeled shoes are traditionally associated with femininity, body image, beauty, and charm, this research has important biopsychosocial implications that should be explored in detail in future studies.

Core Stabilization Exercise on the Lumbar Lordosis and Pelvic Inclination Among Chronic Nonspecific Low Back Pain Patients

Introduction: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders and it is documented that >90% of the cases have no defined cause for pain, called nonspecific low back pain (NSLBP). Alteration in the joint position, abnormal posture, and impaired muscle recruitment may result in recurrent CLBP. Lumbar lordosis (LL) provides strength against the compressive forces of gravity and it also protects the posterior spinal ligament and acts as a shock absorber for vertical forces. Increased LL is considered as a reason for radiculopathy, facet pain, and postural pain. Spinal posture and pelvic position were analyzed and documented as altered in CLBP patients. Anatomically, the anterior and posterior tilt of the back and pelvis by the force of different muscles can alter the spinal curvature. Posterior pelvic tilt in a standing position can decrease the LL. The pelvic inclination is related to the lumbar curve, and both are related to the performance and length of the back and abdominal muscles. Therefore, in this study, we aimed to evaluate the effect of core stabilization exercise on pain intensity, functional disability, LL, and pelvic inclination in NSLBP. Methodology: A total of 63 patients aged between 20 and 60 years who met the selection criteria were included. All participants gave their written consent to participate in this study. Demographic data such as age, weight, height, and duration of the back pain were documented. Patients were asked to report their pain using the Visual Analogue Scale (VAS) and Disability in Roland Morris Disability Questionnaire (RMDQ). Exclusion criteria were participants with musculoskeletal disorders (osteoarthritis and rheumatoid arthritis) and a history of previous fractures and systemic diseases. DIERS Formetric 4D spine and posture analyzer were used to assess spinal alignment using the light-optical scanning method on the back of patient in standing position. Angle of LL: the angle formed by the apex of LL and the T12 and L5 spinous processes. Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. Core stabilization exercises were given for 30 min, five days a week, for 12 sessions. Pre- and posttest values were documented and analyzed. Result: In this experimental study, we used Pearson’s correlation coefficient to find the correlation between LL and pelvic inclination angle and found a strong positive correlation (r = 0.76; P = 0.001). The study showed that core stabilization exercise for 12 weeks’ duration had statistically significant reduction in the pain intensity (p < 0.01), functional disability (p < 0.002), LL (p < 0.05), and pelvic inclination angle (p < 0.05) among patients with chronic NSLBP. Conclusion: From this research, we conclude that core stabilization exercises decrease the pain intensity, functional disability, LL, and pelvic inclination angle in patients with chronic NSLBP. Thus, evaluation of the lumbar curvature and pelvic inclination, and designing the appropriate exercise is recommended in the management of NSLBP.

A comparative assessment of flexibility of backline and strength of lower limb in bharatnatyam dancers and non-dancers

Background: Bharatnatyam is an Indian classical dance form which have been practiced for a long period of time and is equivalent to any sporting activity. The postures attained during this dance form require good amount of muscle strength and flexibility among the dancers. There is lack of research on flexibility of backline and lower limb strength in bharatnatyam dancers. The overall function of the superficial backline is to support the body in full upright extension and impacts musculoskeletal dynamics. The lumbar lordosis angle and the pelvic inclination angle in bharatnatyam dancers is more than the non-dancers which can affect the backline flexibility. This study analysed if there is any difference, in the lower limb strength and flexibility of backline as compared to participants of same age group.Methods: 10 bharatnatyam dancers and 10 non-dancers between 15 to 30 years participated in this study. Triple hop distance test for both sides and toe touch test was used to check the strength of lower limb and flexibility of backline respectively.Results: There was significant difference in the triple hop distance of right lower limb between bharatnataym dancers and non-dancers. There was no significant difference in the triple hop distance of left lower limb between the two groups. There was not quite significant difference in the toe touch test of between the two groups.Conclusions: There was significant difference in the strength and power of right lower limb of dancers as compared to right lower limb of non-dancers. There was no statistical difference in the left lower limb of both the groups. There was no statistical difference between the flexibility of backline of bharatnatyam dancers and non-dancers.

RELATIONSHIP OF PELVIC ALIGNMENT WITH BALANCE AND GAIT IN PATIENTS WITH STROKE: A SYSTEMATIC REVIEW

Background- Pelvis is the key structure that connects the spine and the lower limbs. Altered Pelvic Alignment and asymmetrical weight bearing on affected lower limbs is a common problem leading to pelvic instability which may have an effect on balance and gait in patients with stroke. Hence, it was aimed to investigate the interdependence of these three components in patients with stroke. Methods- Four databases (PubMed, Google Scholar, Cochrane, Science Direct) were searched to identify eligible studies using the keywords Pelvic Alignment, Gait, Balance, Stroke. Only observational studies published in last 10 years (2010-2020) were included in this review. Results- Thirteen studies were included in the review conducted on sub-acute and chronic stage. All studies investigated the affection of pelvic mal-alignment, balance and gait in combination of two variables except 3 studies which investigated the combined effect of pelvic inclination on both balance and gait. The abnormal pelvic tilt results in lateral displacement of the pelvis on affected side, altered Base of Support, reduced balance control, asymmetry in weight bearing leading to altered gait. Conclusion- Pelvic tilt, anterior and lateral has a significant impact on static balance, gait variables, weight bearing symmetry.

Subject-Specific Spino-Pelvic Models Reliably Measure Spinal Kinematics During Seated Forward Bending in Adult Spinal Deformity

Image-based subject-specific models and simulations are recently being introduced to complement current state-of-the-art mostly static insights of the adult spinal deformity (ASD) pathology and improve the often poor surgical outcomes. Although the accuracy of a recently developed subject-specific modeling and simulation framework has already been quantified, its reliability to perform marker-driven kinematic analyses has not yet been investigated. The aim of this work was to evaluate the reliability of this subject-specific framework to measure spine kinematics in ASD patients, in terms of 1) the overall test-retest repeatability; 2) the inter-operator agreement of spine kinematic estimates; and, 3) the uncertainty of those spine kinematics to operator-dependent parameters of the framework. To evaluate the overall repeatability 1], four ASD subjects and one control subject participated in a test-retest study with a 2-week interval. At both time instances, subject-specific spino-pelvic models were created by one operator to simulate a recorded forward trunk flexion motion. Next, to evaluate inter-operator agreement 2], three trained operators each created a model for three ASD subjects to simulate the same forward trunk flexion motion. Intraclass correlation coefficients (ICC’s) of the range of motion (ROM) of conventional spino-pelvic parameters [lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT), T1-and T9-spino-pelvic inclination (T1/T9-SPI)] were used to evaluate kinematic reliability 1] and inter-operator agreement 2]. Lastly, a Monte-Carlo probabilistic simulation was used to evaluate the uncertainty of the intervertebral joint kinematics to operator variability in the framework, for three ASD subjects 3]. LL, SVA, and T1/T9-SPI had an excellent test-retest reliability for the ROM, while TK and PT did not. Inter-operator agreement was excellent, with ICC values higher than test-retest reliability. These results indicate that operator-induced uncertainty has a limited impact on kinematic simulations of spine flexion, while test-retest reliability has a much higher variability. The definition of the intervertebral joints in the framework was identified as the most sensitive operator-dependent parameter. Nevertheless, intervertebral joint estimations had small mean 90% confidence intervals (1.04°–1.75°). This work will contribute to understanding the limitations of kinematic simulations in ASD patients, thus leading to a better evaluation of future hypotheses.

Effect of Posterior Pelvic Tilt Taping on Pelvic Inclination, Muscle Strength, and Gait Ability in Stroke Patients: A Randomized Controlled Study

Objective: Pelvic alignment asymmetry in stroke patients negatively affects postural control ability. This study aimed to investigate the effect of posterior pelvic tilt taping on pelvic inclination, muscle strength, and gait ability in stroke patients. Methods: Forty stroke patients were recruited and randomly divided into the following two groups: the posterior pelvic tilt taping (PPTT) group (n = 20) and the control group (n = 20). All participants underwent sitting-to-standing, indoor walking, and stair walking training (30 min per day, 5 days per week, for 6 weeks). The PPTT group applied posterior pelvic tilt taping during the training period, while the control group did not receive a tape intervention. Pelvic inclination was measured using a palpation meter (PALM). A hand-held dynamometer and the 10-meter walk test were used to measure muscle strength and gait ability. Results: Significantly greater improvements in the pelvic anterior tilt were observed in the PPTT group than in the control group (p < 0.05). Muscle strength in the PPTT group was significantly increased compared to the control group (p < 0.05). Significantly greater improvements in gait speed were observed in the PPTT group than the control group. Conclusions: According to our results, posterior pelvic tilt taping may be used to improve the anterior pelvic inclination, muscle strength, and gait ability in stroke patients.

Health-related quality of life and sagittal balance at two to 25 years after posterior transfixation for high-grade dysplastic spondylolisthesis

Aims High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique. Methods SRS-22r and full-spine lateral radiographs were collected for the 28 young patients (age 13.4 years (SD 2.6) who underwent surgery for high-grade dysplastic spondylolisthesis in our centre (Scottish National Spinal Deformity Service) between 1995 and 2018. The mean follow-up was nine years (2 to 25), and one patient was lost to follow-up. The standard surgical technique was an all-posterior, partial reduction, and S1 to L5 transfixation screw technique without direct decompression. Parameters for segmental (slip percentage, Dubousset’s lumbosacral angle) and regional alignment (pelvic tilt, sacral slope, L5 incidence, lumbar lordosis, and thoracic kyphosis) and global balance (T1 spino-pelvic inclination) were measured. SRS-22r scores were compared between patients with a balanced and unbalanced pelvis at final follow-up. Results SRS-22r domain and total scores improved significantly from preoperative to final follow-up, except for the mental health domain that remained the same. Slip percentage improved from 75% (SD 15) to 48% (SD 19) and lumbosacral angle from 70° (SD 11) to 101° (SD 11). Preoperatively, 35% had global imbalance, and at follow-up all were balanced. Preoperatively, 63% had an unbalanced pelvis, and at final follow-up this was 32%. SRS-22r scores were not different in patients with a balanced or unbalanced pelvis. However, postoperative pelvic imbalance as measured by L5 incidence was associated with lower SRS-22r self-image and total scores (p = 0.029). Conclusion In young patients with HGDS, partial reduction and transfixation improves local lumbosacral alignment, restores pelvic, and global balance and provides satisfactory long-term clinical outcomes. Higher SRS-22r self-image and total scores were observed in the patients that had a balanced pelvis (L5I < 60°) at two to 25 years follow-up. Cite this article: Bone Jt Open 2021;2(3):163–173.

Sacral incidence to pubis: a novel and alternative morphologic radiological parameter to pelvic incidence in assessing spinopelvic sagittal alignment

Background Although pelvic incidence (PI) is a key morphologic parameter in assessing spinopelvic sagittal alignment, accurate measurements of PI become difficult in patients with severe hip dislocation or femoral head deformities. This study aimed to investigate the reliability of our novel morphologic parameters and the correlations with established sagittal spinopelvic parameters. Methods One hundred healthy volunteers (25 male and 75 female), with an average age of 38.9 years, were analysed. Whole-body alignment in the standing position was measured using a slot-scanning X-ray imager. We measured the established spinopelvic sagittal parameters and a novel parameter: the sacral incidence to pubis (SIP). The correlation coefficient of each parameter, regression equation of PI using SIP, and regression equation of lumbar lordosis (LL) using PI or SIP were obtained. The intraclass correlation coefficient (ICC) was calculated as an evaluation of the measurement reliability. Results Reliability analysis showed high intra- and inter-rater agreements in all the spinopelvic parameters, with ICCs > 0.9. The SIP and pelvic inclination angle (PIA) demonstrated strong correlation with PI (R = 0.96) and pelvic tilt (PT) (R = 0.92). PI could be predicted according to the regression equation: PI = − 9.92 + 0.905 * SIP (R = 0.9596, p < 0.0001). The ideal LL could be predicted using the following equation using PI and age: ideal LL = 32.33 + 0.623 * PI – 0.280 * age (R = 0.6033, p < 0.001) and using SIP and age: ideal LL = 24.29 + 0.609 * SIP – 0.309 * age (R = 0.6177, p < 0.001). Conclusions Both SIP and PIA were reliable parameters for determining the morphology and orientation of the pelvis, respectively. Ideal LL was accurately predicted using the SIP with equal accuracy as the PI. Our findings will assist clinicians in the assessment of spinopelvic sagittal alignment. Trial registration This study was retrospectively registered with the UMIN Clinical Trials Registry (UMIN000042979; January 13, 2021).