Effect of Compensatory Mechanisms on Postural Disturbances and Musculoskeletal Pain in Elite Sitting Volleyball Players: Preparation of a Compensatory Intervention

The aim of the study was to identify the effect of compensatory mechanisms on the prevalence of sagittal spinal curvature deformity and musculoskeletal pain and to assess the interrelationships between those components in sitting volleyball players. Twenty-one elite Polish sitting volleyball players (age = 34.1 ± 7.5, BM = 77.9 ± 16.0) participated in the study in which direct participatory systematic observation and a non-invasive method were used. Both objective (anthropometric, spinal curvature–Idiag M360) and subjective (musculoskeletal ailments–NMQ = 7) measurements were performed. The Statistica 13.3 software package was used for statistical analyses. The neck, lower back (43%), and upper back (38%) were the most frequently reported painful areas. Of all participants, 76% reported sagittal spinal deformities. In the habitual position, the results indicated moderate correlations (r = 0.5, p < 0.05) between the lumbar concavity of the back and low back pain (LBP) and between thoracic convexity and LBP (r = 0.4, p < 0.05). Internal and external compensation have an effect on the prevalence of spinal curvature deformities in the sagittal plane, with thoracic hyperkyphosis (38%) and lumbar hyperlordosis (33%) being the most common. More severe lower and upper back pain were correlated with greater angles of thoracic kyphosis and lumbar lordosis in the habitual position.

Effects of Therapeutic Weight Loss Exercises on Obese Individuals with Lumbar Hyperlordosis (LHL) and Excessive Anterior Pelvic Tilt (EAPT)

Obesity, especially with upper and lower limbs, is a key cause in increased sensitivity to musculoskeletal diseases (MDs). Pelvic tilt is the pelvic alignment with the femur and the rest of the body. The correct posture and alignment of the pelvis to the femur relies upon its orientation, and the natural curvature of the lumbar and cervical spine regions is Lordosis. Our study aimed to investigate impacts on obese persons with lumbar hyperlordosis and excess intertidal pelvic tilt in the weight reduction activities. In a fitness facility, 50 overweight and obese men suffering lumbar and excessive anterior pelvic tilt, between 25 and 40 years, underwent the intervention studies. The conducted exercises were carried out on the basis of the therapeutic weight reduction. The findings before and after intervention revealed the provided therapy was substantial (p<0.005). The serious lumbar hyperlordosis and excessive anterior pelvic tilt are directly related to an increase in BMI, sedentary lifestyles and physical inactiveness play an important etiological part for obesity in lumbar hyperlordosis and excessive anterior pelvic tilt development and progression. Essentially, early diagnosis and physical therapist-led intervention can rectify the deformity with little operational morbidity.

A Severe Case of Spondylometaphyseal Dysplasia Algerian Type with Two Mutations in COL2A1

Spondylometaphyseal dysplasia Algerian type (MIM no.: 184253) is an uncommon autosomal dominant skeletal dysplasia caused by heterozygous mutations in the COL2A1 gene (MIM no.: 120140). In this case based review, we reported a 5-year-old boy with short stature, severe dorsolumbar scoliosis, lumbar hyperlordosis, short trunk, and severe genu valgum. Radiological examination showed platyspondyly, irregular metaphyseal radiolucencies intermingled with radiodensities, and corner fractures. The patient has a c.3275G > A; p.Gly1092Asp mutation in exon 47 of the COL2A1 gene and a variant of unknown significance in c.1366–13C > A in intron 21. This latter sequence variant could partially or completely disrupt the natural splice acceptor site of intron 21/exon 22 in the COL2A1 gene leading to a potential modification of the phenotypic severity.

Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture

Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries.Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs.Results: Improvements were seen in the mean hip flexion contracture (p &lt; 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up.Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.

The Effect of Three Methods of Kinesthetic Imagery, Active, and Combined Exercises on Electromyographic Pattern of Hip Hyperextension and the Muscle Strength of Gluteus Maximus and Abdominal in Women With Lumbar Hyperlordosis

Purpose: Mental exercise uses the same neuronal pathways involved in physical exercise to modify the pattern and function without stress caused by physical exercise. This study investigates the effect of kinesthetic imagery, active, and combined exercises (imagery and active) on the hip hyperextension and the power of selected lumbopelvic muscles in women suffering from lumbar hyperlordosis. Methods: In this quasi-experimental study, 36 women with lumbar hyperlordosis (age range: 30-40 years, non-athlete and without injury and surgery in the lumbar region) were selected and divided into three groups. The groups practiced three sessions per week for six weeks. We assessed the lumbar lordosis by a flexible ruler and the electromyographic (EMG) activity of the lumbopelvic muscles during hip hyperextension in the prone position by surface electromyogram. We also measured the power of the gluteus maximus using a dynamometer during hip hyperextension and the abdominal muscles using a goniometer during the double leg lowering test. All of the measurements were done before and after the intervention. The normality of the data was checked by The Shapiro-Wilk test, and the obtained data were analyzed by repeated-measures ANOVA test at the significant level of 0.05. Results: The variables of lumbar lordosis were significantly reduced in the active and combined groups in the post-test compared to the pre-test, and the strength of gluteus and abdominal muscles in the active and combined groups in the post-test significantly increased compared to the pre-test. However, the lumbar lordosis and strength of gluteus and abdominal muscles in the post-test were not significantly changed compared to the pre-test. Gluteus maximus and abdominis transverse muscle activity rates in the combined group increased significantly in the post-test compared to the pre-test, and gluteus maximus muscle activity rate in the active group increased significantly in the post-test compared to the pre-test. Gluteus maximus muscle activity in the imagery group increased significantly in the post-test compared to the pre-test. The activity of lumbar erector spinae and rectus femoris muscles decreased significantly in the active and combined groups in the post-test compared to the pre-test. However, the activity of the rectus femoris muscle decreased significantly in the image group in the post-test compared to the pre-test (P≤0.05). The results showed a significant difference between the three methods of kinesthetic imagery, active, and combined (P=0.001). There was a significant difference between the method of the imagery exercise and the active and combined exercise methods but no significant difference between methods of the active and combined exercise. Conclusion: Imagery exercises effectively modified the EMG of some lumbopelvic muscles (gluteus maximus and rectus femoris muscles). However, it had no significant effect on the strength and degree of lumbar lordosis. The combined exercise was as effective as active exercise in modifying the EMG activity of the lumbopelvic muscles and the strength of the abdominal and gluteus maximus muscles.

L5 Vertebral Column Resection for Correction of Severe Lumbar Hyperlordosis and Pelvic Anteversion in an Adolescent With Prior Myelomeningocele Repair and Lumbar Fusion: Case Report

BACKGROUND AND IMPORTANCE Lumbar hyperlordosis in ambulatory children is an uncommon but potentially problematic spinal deformity, and the operative management has not been comprehensively described. CLINICAL PRESENTATION We report the case of a 14-yr-old girl presenting with severe progressive lumbar hyperlordosis (−122°) and sagittal imbalance (−6 cm). She had multiple prior surgeries, including myelomeningocele repair at 10 d old, midlumbar meningioma resection at 8 mo old, and posterior lumbar instrumented spinal fusion at 5 yr old. She presented with progressive lumbosacral back pain and intermittent numbness in her left lower extremity, and severe skin contractures over her prior posterior incisions. From an all posterior approach, prior implants and dural scar were removed and then an L5 vertebral column resection (VCR) was performed to disarticulate her lumbar spine from her anteverted pelvis, allowing for slow distraction forces to correct her lumbar hyperlordosis. This was followed by a T7-sacrum fusion using pedicle screws and iliac screws, with autologous bone graft and plastic surgery wound closure. Postoperatively, lumbar lordosis was corrected to −55° and sagittal balance reduced to −0.5 cm. At 10-wk and 14-mo follow-ups, the patient reported resolution of her back pain with no limitations in physical activities. Dramatic improvement was seen in both her preoperative to 14-mo postoperative Oswestry Disability Index (ODI) (54 to 12) and Scoliosis Research Society Scoliosis Research Society (SRS)-22r (54 to 93) scores. CONCLUSION This case highlights a rare presentation of severe progressive lumbar hyperlordosis in an ambulatory adolescent after myelomeningocele repair, meningioma resection, and posterior lumbar instrumented spinal fusion with subsequent surgical treatment incorporating important components of both spinal and plastic surgery involvement.

The Impact of Childhood Obesity on the Body Posture: a Systematic Review and Meta-analysis

Objective It has been suggested that overweight/obesity (OW/OB) impairs the normal development of body posture in children and adolescents; however, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of postural alterations in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and postural alterations in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing postural alterations than their peers of normal weight. Methods PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and postural alterations in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed. Results Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and an overall altered posture (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results. Conclusions Based on these findings, OW/OB is associated with the presence of postural alterations in children and adolescents. Impact This is the first study that has systematically reviewed the effect of OW/OB on the development of postural alterations in children and adolescents.

Does the Nine-test Screening Battery Predict Lumbar Hyperlordosis in Adolescent Boys?

Purpose: Lumbar hyperlordosis is one of the main physical abnormalities that occur in the lumbopelvic region and affect the body movement system in daily life. This condition can also lead to chronic injuries and pain. The present study aimed to investigate the ability of the nine-test screening battery to predict the incidence of lumbar hyperlordosis in adolescent boys. Methods: This causal study described and analyzed the data with a cross-sectional design. In this regard, 60 adolescents (age range: 13 to 15 years) were selected. After the initial assessments, they were assigned into two groups: the lumbar hyperlordosis group (n=31) and the normal lordosis group (n=29). The angle of lumbar lordosis curvature and functional movements were measured using a flexible ruler and the nine-test screening battery instruction, respectively. The obtained data were analyzed using the logistic regression test at a significance level of 0.05, in SPSS v. 24. Results: The examination of the coefficients of predictive variables showed that the Wald test is statistically significant for deep squat (P=0.023) and straight leg raise (P=0.033). Also, these variables significantly contribute to the predictability of the model and the likelihood of lumbar hyperlordosis. Conclusion: Based on the results, the nine-test screening battery can predict the occurrence of lumbar hyperlordosis in adolescent boys through the components of deep squat and straight leg raise.