Differences in Lumbar Multifidus Activity and its Association with Lumbar Range of Motion among patients With Unilateral Chronic Low Back Pain

Aim: To determine the significant difference in lumbar multifidus activity within the patient with unilateral chronic low back pain and its association with lumbar range of motion. Study design: Analytical cross-sectional study Study setting and duration: Former institute of Dow University of Health Sciences, Karachi, Pakistan (Institute of Physical Medicine and Rehabilitation) which has become Sindh Institute of Physical Medicine and Rehabilitation and study duration was March 2020 to December 2020. Methodology: About 128 patients with unilateral chronic low back pain were assessed for the lumbar multifidus activity based on the percentage of maximum voluntary contraction through surface electromyography. Lumbar flexion and extension range of motion was measured through Modified-Modified Schober’s test. All the data were analyzed through the Statistical Package of Social Sciences 21. Nonparametric tests were employed. The level of significance was 0.05. Results: The lumbar multifidus activity was significantly increased (p<0.001) on the painful side than the non-painful side. However, there was a significant negative correlation (rh=- 0.551, -0.703; p<0.001) of only painful side lumbar multifidus activity with flexion and extension range of motion. Conclusion: Activity of painful side lumbar multifidus increases in unilateral chronic low back pain. Furthermore, it increases with a decrease in lumbar flexion and extension range of motion. Keywords: Correlation Study, disability, Low Backaches, non-specific low back pain, Surface Electromyography

Impact of corset bracing on 3D spine kinematics during ADL in children with Spondylolysis

Spondylolysis is a stress fracture of the vertebral pars interarticularis that frequently affects adolescents involved in sports. Conservative bracing methods may assist the clinician in treating spondylolysis, though there is a need to further validate these techniques. The goal of this study was to evaluate differences in the 3D movements of the thoracic and lumbar spine before and after bracing. Five patients (mean age 14.4 ± 1.3 years) with spondylogenic back pain were evaluated for kinematic measurements using a Vicon motion capture system. Patients performed activities both with and without a lumbar corset brace including walking, kneeling, standing from a chair, standing from the floor, ascending and descending stairs, and lifting. Patients were evaluated for differences in thoracic and lumbar range of motion (ROM) in the braced and unbraced condition. While wearing the brace, patients demonstrated reduced extension ROM of the thoracic spine while walking (mean reduction = 0.4°), ascending stairs (3.0°), descending stairs (2.1°), lifting (14.8°), standing from a chair (4.1°), standing from the floor (16.7°), and kneeling (8.4°). Patients also exhibited reduced extension ROM of the total lumbar spine while ascending stairs (mean reduction = 1.8°), lifting (12.7°), standing from a chair (9.5°), standing from the floor (11.8°), and kneeling (4.7°). These results provide evidence that bracing reduces stress on the pars interarticularis and relieves symptoms in the athlete with spondylogenic back pain, thereby facilitating a return to sports.

The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine

Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV

Pelvic Sagittal Rotation in Patients With Hip Joint Disease

Objective: The functional orientation of the acetabular cup depends on the pelvic orientation when standing. Therefore, predicting the standing orientation of the pelvis after total hip arthroplasty( THA )is important to the preoperative plan. This study aimed to explore the rule suitable for different categories of patients.Methods: A total of 262 patients who had undergone hip arthroplasty in our hospital from 2011 to 2019 were retrospectively analyzed. Based on the spine and hip joint, they were divided into 5 categories: no flexion contracture of the hip joint - good lumbar range of motion (group A); no flexion contracture of the hip joint - limited lumbar motion (group B: B1, tanterior pelvic plane tilt (APPt)>0 °; B2, APPt<0 °); hip flexion contracture - good lumbar range of motion (group C); and hip flexion contracture - limited lumbar motion (group D). Changes of the pelvic sagittal parameter before and after THA were analyzed. Results: In group A, there was no significant difference in pelvic incidence (PI) and sagittal vertical axia (SVA) between preoperation and postoperation (P>0.05), but the mean value of sacral slope (SS) (from 44.99 °to 40.50 °), lumbar lordosis( LL) (from 51.42 to 47.45), pelvic tilt (PT) (from 8.71 °to 11.91°), and tanterior pelvic plane tilt (APPt) (from 4.5 °to 1.27 °) had statistic difference (P<0.05); In group B1 and B2, PI, SVA, SS, PT, LL, and APPt had no significant difference before and after operation (P>0.05); In group C, significant difference was not observed in PI (P>0.05), but found (P<0.05) in LL (from 52.17° to 43.43°), SS(44.90° to 38.34°), PT (from 5.70° to 13.36°), APPt (from 9.18° to 2.18°), and SVA (from 3.46cm to 1.16cm). In group D: the pelvis was in supination state before and after operation, and the spine sagittal position was imbalanced. Neither was there significant difference in SVA, PI, SVA, SS, ll and APPt between preoperation and postoperation (P>0.05). In addition, Harris scores of different groups changed accordingly. Conclusion: The sagittal rotation of the pelvis caused by different conditions of the spine-hip has a certain change law after total hip arthroplasty.

MUSCLE ENERGY TECHNIQUE VS YOGASANA ON ILIOPSOAS TIGHTNESS TO IMPROVE FLEXIBILITY AND LUMBAR RANGE OF MOTION IN YOUNG ADULTS: A COMPARATIVE STUDY

Purpose of study:Iliopsoas is a muscle of lower extremity prone to tightness with prevalence of 83.8% in young and middle-aged adults leading to lower back pain. Objective: To compare the effect of Muscle Energy Technique versus Yogasana on Iliopsoas tightness to improve exibility and lumbar range of motion in Young adults. Methodology: 30 subjects with Iliopsoas tightness within age group 18-35 fullling the selection criteria were selected and assigned into Group A (n=15) that received Muscle Energy Technique and Group B (n=15) received Yoga technique “Anjanyesana”, both the groups underwent the intervention for 2 weeks, 3 sessions per week. Pre and Post treatment Modied Thomas Test, Lumbar range of motion for exion, Lumbar side exion and Lumbar side rotation were used as outcome measures. Results: Group A showed a statistical signicant difference with mean of 6.3±2.7, while Group B showed difference with mean of 10.0±4.64 on Modied Thomas test with p=0.021 post 2 weeks of intervention. There was statistically signicant improvement in lumbar side exion with p=0.02,with mean and SD of 3.3±1.952 for group A and 1.3±0.457 for group B. However, based on the mean values, other outcome measures showed better improvement in Group A as compared to group B. Conclusion: Both MET and Yogasana were effective in improving exibility of Iliopsoas and lumbar range of motion. While MET proved to show immediate effects in decreasing hip exion tightness, Yogasana was more effective following 2 week intervention.

The Biomechanical Effect on the Adjacent L4/L5 Segment Under S1 Superior Facet Arthroplasty: A Finite Element Analysis

Background. The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foramina plasty.Methods. Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization. 500N preload was imposed on the L4 superior endplate and 10 Nm was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of L4-L5 spine were recorded.Results. The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increase in most directions of motion when S1 superior facet formed greater than 3/5 from ventral to dorsal or 2/5 from apex to base. The disc stress of L4/L5 significantly increase in most directions of motion when S1 superior facet formed greater than 3/5 from ventral to dorsal or 1/5 from apex to base.Conclusion. In this study, the ROM and disc stress of L4/L5 were effected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from ventral to dorsal should be less than 3/5 of S1 upper facet joint. It is not recommended to form from apex to base.

Efficacy of spinal extension exercise program versus muscle energy technique in treatment of chronic mechanical low back pain

Background Mechanical low back pain (MLBP) is a major cause of illness and disability, especially in people of working age. People with chronic low back pain often experience anger, fear, anxiety, decrease in physical ability, and inadequacy of role fulfillment. Objective This study aimed to compare the efficacy of extension exercise program versus muscle energy technique in treating patients with chronic mechanical low back pain. Subjects and methods Forty patients complaining of chronic mechanical low back pain participated in the study. Patients were randomly allocated into two equal groups: group A which received spinal extension exercise program and group B which received muscle energy technique. Treatment sessions were given three times per week for four successive weeks. Patients were assessed before and after treatment using visual analogue scale (VAS), Oswestry Disability Index (ODI), and digital goniometer to assess pain intensity, functional disability, and range of motion (ROM) of lumbar spine respectively. Results There was significant decrease in the scores of pain and functional disability in both groups post-treatment especially in group B. There was significant increase in lumbar range of motion in both groups post-treatment, especially in group A. Conclusion Extension exercise program had better effect on improving lumbar range of motion, whereas muscle energy technique was better in decreasing pain and functional disability in patients with chronic mechanical low back pain.