Identifying relations between posture and pain in lower back pain patients: a narrative review

Posture is a “body’s attitude or the positioning of the limbs when standing or sitting.” There are many examples of different postures which include lordotic posture, swayback posture, flat back, and anterior pelvic tilt. Everyone in some of the other parts of their life considers pain as an unpleasant feeling or sensation that is experienced. Specifically, low back pain can be relentless and daunting to many people who often recovered without the need of a health care professional or any treatment by changing their posture or performing the movement. Various factors are leading to low back pain other than the postural fault, for instance, age, sedentary lifestyle, anxiety, and sleep. However, for back pain, posture has become deep-rooted in people’s thoughts. Health care professionals have instructed people to correct their posture to fight back pain. As people become older, the posture becomes worse, but this does not appear to cause pain. If any person cannot move his/her body, that does not mean that they are having a problem involving posture; that is actually because of a problem relating to movement. A study proved that there is no difference in the lordotic angle of the populace having an issue with LBP. There is a decrease in the range and speed of the movement performed. What matters is the movement rather than the appearance of standing or sitting. The primary aim of this paper is to improve knowledge and understanding of the association between posture and LBP, as, speaking about recent researches, they have observed no association between posture and LBP. There are many studies published to support this evidence. People call the importance of posture and alignment for while performing a heavy deadlift, land a jump, or any strenuous activity. Therefore, an urge to write a paper on this topic is to change the mindset of many people worrying out there about their postural faults or their appearances by providing information about varying their static posture to conform to some ideal and keep moving to improve their function.

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.

Evaluation of Gait Pattern and Lower Extremity Kinematics of Children with Morquio Syndrome (MPS IV)

Morquio syndrome (mucopolysaccharidosis IV/MPS IV) is a genetic disorder leading to skeletal abnormalities and gait deviations. Research on the gait patterns and lower extremity physical characteristics associated with skeletal dysplasia in children with MPS IV is currently limited. This research aimed to provide baseline gait patterns and lower limb skeletal alignment of children with MPS IV utilizing three-dimensional instrumented gait analysis. This Institutional Review Board-approved retrospective study evaluates the kinematics of the lower extremities of children with MPS IV during gait, comparing them with an age-matched group of typically developing children. Thirty-three children with MPS IV were included (8.6 ± 4.0 years old). Children with MPS IV walk with increased anterior pelvic tilt, knee valgus, knee flexion, external tibial torsion, and reduced walking speed and stride length (p < 0.001). Multiplanar abnormal alignment results in abnormal knee moments (p < 0.001). Limited correlations exist (r = 0.69–0.28) between dynamic three-dimensional measurements of knee varus/valgus and rotational alignment and traditional static two-dimensional measures (physical examination or radiographs) suggesting the possibility of knee instability during gait and the benefits of dynamic assessment.

Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains

Background Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains. Methods 21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains. Results Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05). Conclusions Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.

Effect of Decreasing the Anterior Pelvic Tilt on Range of Motion in Femoroacetabular Impingement: A Computer-Simulation Study

Background: The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology. Purpose: To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery. Study Design: Controlled laboratory study. Methods: The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions. Results: The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline ( P < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model ( P < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model. Conclusion: Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement. Clinical Relevance: Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.

Biomechanical Description of Zapateado Technique in Flamenco

The main purpose of this study was to identify a dancer’s body alignment while performing flamenco footwork to provide a detailed description that could be used by flamenco practitioners: teachers, instructors and students of different levels of advancement. The zapateado technique performed by a professional flamenco dancer was analyzed. The biomechanical analysis was based on 30 cycles composed of six repeating sequences of strikes. Kinematic recordings were performed using a Vicon system, while the measurement of the ground reaction forces (GRF) was accomplished with a Kistler force plate. The following parameters were analyzed: the time of each foot strike, the maximal value of the vertical component of GRF normalized to body weight (BW) for subsequent footwork steps, the impulse of the GRF and the kinematics of pelvis and lower limb joints, and an exemplary waveform view of the sound of footwork strikes was shown. The average values of the vertical component of GRF ranged between 0.6 and 2.7 BW. The maximal anterior pelvic tilt was 29°, with a 6° range of motion (RoM). This mobility was accompanied by 20° hip RoM and by ~40° knee RoM throughout flexion. The conclusions provide practical information that a teacher and flamenco student should receive.