Lumbar Sitting Behavior of Individuals with Low Back Pain: A Preliminary Study Using Extended Real-World Data.

Low back pain affects 619 million people worldwide and is commonly provoked by sitting. Current assessment methods constrain task variability, removing real-world, task-switching behaviors. This study utilized accelerometers to provide an original validated method of in vivo real-world assessment of lumbar sitting behavior throughout a full day. A three-stage study design was used, which involved (1) blinded verification of our sitting detection algorithm, (2) full-day data collection from participants with low back discomfort, quantifying lumbar angles, and end-user acceptability explored, (3) case study application to two clinical low back pain (LBP) patients, incorporating measurement of provocative sitting. Focus group discussions demonstrated that data collection methods were acceptable. Sitting 'windows' were created and analyzed using novel histograms, amplitude probability distribution functions, and variability, demonstrating that sitting behavior was unique and varied across individuals. One LBP patient demonstrated two frequent lumbar postures (<15% flexion and ~75% flexion), with pain provocation at 62% lumbar flexion. The second patient demonstrated a single dominant posture (~90% flexion), with pain provoked at 86% lumbar flexion. Our in vivo approach offers an acceptable method to gain new insights into provocative sitting behavior in individuals with LBP, allowing individualized unconstrained data for full-day postures and pain provocation behaviors to be quantified, which are otherwise unattainable.

Correlation of lumbar-hip kinematics between trunk flexion and other functional tasks.

OBJECTIVE: The purpose of this study was to explore the relationship between the kinematic profiles of flexion of the upper lumbar and lower lumbar (LL) spine and hip and 3 sagittally dominant functional tasks (lifting, stand-to-sit, and sit-to-stand). METHODS: Fifty-three participants were recruited for this study. Four sensors were attached to the skin over the S1, L3, T12, and lateral thigh. Relative angles between adjacent sensors were used to quantify the motion for the hip, LL, and upper lumbar spine. Pearson correlation coefficients were used to explore the relationship between the movements and more functional tasks. One-way analysis of variance was used to determine the significance of differences between the variables. RESULTS: Flexion resulted in a greater or similar range of motion (ROM) to the other tasks investigated for both spinal regions but less ROM for the hip. Strong correlations for ROM are reported between forward flexion tasks and lifting for the LL spine (r = 0.83) and all regions during stand-to-sit and sit-to-stand (r = 0.70-0.73). No tasks were strongly correlated for velocity (r = 0.03-0.55). CONCLUSION: Strong correlations were only evident for the LL spine ROM between lifting and flexion; all other tasks afforded moderate or weak correlations. This study suggests that sagittal tasks use different lumbar-hip kinematics and place different demands on the lumbar spine and hip.

Reliability of an accelerometer-based system for quantifying multiregional spinal range of motion.

OBJECTIVES: The purpose of this study was to investigate the reliability of a novel motion analysis device for measuring the regional breakdown of spinal motion and describing the relative motion of different segments of the thoracolumbar (TL) spine. METHODS: Two protocols were applied to 18 healthy participants. In protocol 1, 2 sensors were placed on the forehead and T1 to measure cervical range of motion (ROM). In protocol 2, 6 sensors were placed on the spinous processes of T1, T4, T8, T12, L3, and S1 to measure TL regional ROM. Intraclass correlation coefficients were used to evaluate the repeatability of movement, whereas SEM was used to define the extent of error. Ranges of motion were demonstrated in flexion extension, right-left lateral flexion, and right-left rotation of the head-cervical, upper thoracic, middle thoracic, lower thoracic, upper lumbar, and lower lumbar. RESULTS: The intraclass correlation coefficient values, for all regions, were found to be high, ranging from 0.88 to 0.99 for all movements, and regions of the spine and SEM values ranged from 0.4° to 5.2°. Multiregional spine ROM ranged from 3° in the upper thoracic and mid-thoracic during flexion and 80° at head cervical during right rotation. CONCLUSION: The described methodology was reliable for assessing regional spinal ROM across multiple spinal regions while providing the relative motions of different segments of the TL spine.

Cervical Health Parameters in Car Drivers: Assessing the Influence of Driving on Neck Pain, Mobility, Proprioception and Craniovertebral Angle - A Cross-Sectional Study.

Purpose: Prolonged sitting during driving is linked to neck pain, uncomfortable body positions, and repetitive motions. Recognizing these challenges, this study aimed to investigate Cervical Health Parameters in Car Drivers. Methods: The sample consisted of 160 car drivers between 25 and 45 years. This subject was then divided into two groups based on neck pain. Participants met the required criteria, such as being between 25-45 years of age, maintaining a BMI of 18-24, and driving for at least 2 hours each day for at least 3-5 years. To evaluate the results, we employed a clinometer and compass app on a smartphone to measure the Cervical Range of Motion (CROM). We used Surgimap software to estimate the Craniovertebral Angle (CVA), and a (Cervical range of motion) CROM device was used for proprioception assessment. Results: The result shows the participants in neck pain group displayed lower Cervical Range of Motion (CROM) values than without neck Pain Group. Similarly, the Craniovertebral Angle (CVA) was smaller in the neck Pain Group (mean difference of -6.3°), indicating a more forward head posture. Neck pain resulted in a mean difference of -4.5° in proprioception accuracy. This indicates that neck pain affects CROM, CVA, and proprioception in car drivers. Conclusion: Car driving significantly impacts cervical parameters in individuals with neck pain, reducing cervical range of motion, altered craniovertebral angle, and diminished proprioceptive accuracy. These findings emphasize the need for ergonomic interventions and proprioceptive training tailored for drivers. Future research should broaden demographic parameters and consider potential confounders to provide a holistic understanding of the relationship between car driving and neck health.

Shoulder muscle weakness and proprioceptive impairments in type 2 diabetes mellitus: exploring correlations for improved clinical management.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM. Methods: A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer. Results: Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM. Conclusion: This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

Effectiveness of motor control exercise, aerobic walking, and muscle strengthening programs in improving outcomes in a subgroup of population with chronic low back pain positive for central sensitization: a study protocol for a randomized controlled trial.

BACKGROUND: The role of pain sensitivity in the development and maintenance of chronic pain states, impaired executive functioning, and patient recovery is being investigated. Conditioned pain modulation (CPM) is widely used to measure musculoskeletal pain associated with central sensitization (CS). Despite the recommendations of many reviews and clinical practice guidelines that exercise programs reduce pain and disability, the overall confidence in these results is considered "critically low." The "active ingredient" of exercise programs and the dominant factor influencing CPM remain largely unknown. The objectives of this trial are to determine: • If different exercises cause different results on the CPM in a subgroup of people with chronic low back pain (CLBP) who are labeled as having CS pain, • If a program of exercise interventions for 12 weeks would alter executive functioning, quality of life (QoL), disability, and pain in persons with CLBP. • The relationship between patient characteristics, executive functions, CPM, and QoL METHODS: The trial is a randomized, controlled, multi-center study with four experimental groups and one healthy control group. Both the researchers and the people in the study will be blinded to the results. This paper describes the protocol for a trial examining the effects of 12-week individualized, twice-weekly exercise sessions lasting 30 to 60 min in persons with CLBP, who are positive for CS. Participants will be randomized to receive either patient education with motor control exercises (MCE), superficial strengthening (SS), aerobic exercises (AE), or patient education alone. Another group comprised of healthy volunteers will serve as controls. The primary outcomes are changes in CPM outcomes as measured by the cold pressor test (CPT). The secondary objectives are to evaluate executive functioning, pain, disability, quality of life, and spine muscle strength. The outcomes will be measured at 3 months and at a 6-month follow-up. DISCUSSION: The outcomes of the study will help in gaining more information and evidence about exercise-induced analgesia from the perspective of CPM. Measuring exercise outcomes will aid in scientifically prescribing exercise prescriptions in people with CLBP. The study outcomes will also assist in identifying the characteristics of individuals who will respond or respond indifferently to exercises. Investigating the relationship between the study's various outcomes could provide information for future trials. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI) identifier: CTRI/2022/03/041143. Registered on 16 March 2022.

Exploring the Interplay of Muscular Endurance, Functional Balance, and Limits of Stability: A Comparative Study in Individuals with Lumbar Spondylosis Using a Computerized Stabilometric Force Platform.

Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45-70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from -0.38 to -0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.

Exploring the Nexus of lower extremity proprioception and postural stability in older adults with osteoporosis: a cross-sectional investigation.

Background: Osteoporosis, characterized by reduced bone mass and micro-architectural deterioration, poses a significant public health concern due to increased fracture susceptibility. Beyond bone health, this cross-sectional study aimed to assess and compare lower extremity proprioception and postural stability in individuals with and without osteoporosis and to explore their correlation within the osteoporosis group. Method: In this prospective cross-sectional study, 80 participants were divided into two groups: osteoporosis (n = 40) and control (n = 40). The demographic characteristics and clinical parameters of the participants were as follows: Age (years) - Osteoporosis group: 65.04 ± 4.33, Control group: 65.24 ± 4.63; Sex (%) - Osteoporosis group: Male 30%, Female 70%; Control group: Male 30%, Female 70%; Body mass index (kg/m2) - Osteoporosis group: 23.7 ± 3.2, Control group: 24.5 ± 4.6; T-score (Lumbar) - Osteoporosis group: -2.86 ± 1.23, Control group: 0.27 ± 0.58; T-score (hip) - Osteoporosis group: -2.28 ± 0.79, Control group: 0.68 ± 0.86. Joint Position Sense (JPS) at the hip, knee, and ankle was assessed using a digital inclinometer, and postural stability was measured using computerized force platforms. Result: Osteoporosis participants exhibited higher errors in hip (5.63° vs. 2.36°), knee (4.86° vs. 1.98°), and ankle (4.46° vs. 2.02°) JPS compared to controls. Postural stability measures showed increased anterior-posterior sway (10.86 mm vs. 3.98 mm), medial-lateral sway (8.67 mm vs. 2.89 mm), and ellipse area (966.88 mm2 vs. 446.19 mm2) in osteoporosis participants. Furthermore, correlation analyses within the osteoporosis group unveiled significant positive associations between lower extremity proprioception and postural stability. Specifically, hip JPS exhibited a strong positive correlation with anterior-posterior sway (r = 0.493, p = 0.003), medial-lateral sway (r = 0.485, p = 0.003), and ellipse area (r = 0.496, p < 0.001). Knee JPS displayed a moderate positive correlation with anterior-posterior sway (r = 0.397, p = 0.012), medial-lateral sway (r = 0.337, p = 0.032), and ellipse area (r = 0.378, p < 0.001). Similarly, ankle JPS showed a moderate positive correlation with anterior-posterior sway (r = 0.373, p = 0.023), medial-lateral sway (r = 0.308, p = 0.045), and ellipse area (r = 0.368, p = 0.021). Conclusion: These findings underscore the interplay between proprioceptive deficits, compromised postural stability, and osteoporosis, emphasizing the need for targeted interventions to improve fall prevention strategies and enhance the quality of life for individuals with osteoporosis.

The Time-Based Effects of Kinesio Taping on Acute-Onset Muscle Soreness and Calf Muscle Extensibility among Endurance Athletes: A Randomized Cross-Over Trial.

BACKGROUND: This study aims to determine the effects of kinesio tape (KT) application on acute-onset muscle soreness and the extensibility of the calf muscles in endurance athletes. METHODS: A one-arm repeated-measures randomized cross-over controlled study design investigated 55 endurance athletes, including 10 cyclists, 30 badminton players, and 15 long-distance runners (mean age 16.40 ± 2.69) from different stadia in Delhi NCR, India. KT and sham tapes (ST) were applied randomly to right and left legs (prone position) in a cross-over manner with a gap of 72 h. Ankle dorsiflexion range of motion (ADFROM) and pain due to acute-onset muscle soreness were assessed immediately and 10 min and 30 min after treadmill running, using a universal goniometer and numeric pain rating scale (NPRS), respectively, along with the time to fatigue. RESULTS: A statistically significant difference was observed for the NPRS when the mean scores obtained for the KT and ST groups were compared immediately after cessation of running; however, the difference was not statistically significant in the NPRS score that was recorded ten or thirty minutes after. The range of motion increased significantly after the application of both the KT and the ST. After running on a treadmill, the range of motion decreased significantly with both the KT and ST, and the decrease was similar. CONCLUSION: KT was more effective in reducing the pain intensity immediately after running and increased the time spent running on the treadmill before fatigue set in among endurance athletes. In addition, the two taping methods (KT or ST) were equally effective in enhancing calf muscle extensibility (for both right and left legs) immediately after application. However, both taping methods failed in limiting the decrease in ankle ADFROM after treadmill running.

Effect of Smartphone Usage on Neck Muscle Endurance, Hand Grip and Pinch Strength among Healthy College Students: A Cross-Sectional Study.

In recent years, there has been a significant increase in global smartphone usage driven by different purposes. This study aimed to explore the effect of smartphone usage on neck muscle (flexors and extensors) endurance, hand grip, and pinch strength among young, healthy college students. In total, 40 male students were recruited for this study; 20 of them belonged to the smartphone-addicted group, while the other 20 were in the non-addicted group based on their smartphone addiction scale-short version (SAS-SV) scores (the threshold for determining smartphone addiction: 31/60). Neck flexor endurance time, the ability to perform a neck extensor muscle endurance test, and hand and pinch grip strength were assessed. Multivariate analysis of variance (MANOVA) was used to assess between-group differences in the mean values of neck flexor endurance time, hand grip, and pinch grip. A significant group effect (Wilks' lambda = 0.51, F (5,34) = 6.34, p = 0.001, partial eta squared = 0.48) was found. A decrease in neck flexor endurance time was observed in the smartphone-addicted group compared with that of the non-addicted group (p < 0.001). However, there was no notable difference in the neck extensor muscle endurance test or in hand grip and pinch grip strength of both hands between groups (p > 0.05). Using a smartphone for a prolonged time might affect neck flexor muscle endurance; however, more research is needed to explore the long-term effects of using smartphones on neck muscle endurance and hand/pinch grip strength and the risk of developing upper limb neuromusculoskeletal dysfunction.

Investigating the contribution of the upper and lower lumbar spine, relative to hip motion, in everyday tasks.

BACKGROUND: It is commonplace for clinicians to measure range of motion (ROM) in the assessment of the lumbar spine. Traditional single 'joint' models afford measuring only a limited number of regions along the spine and may, therefore, over-simplify the description of movement. It remains to be determined if additional, useful information can be gleaned by considering the traditional 'lumbar region' as two regions. OBJECTIVE: The aim of this study was to determine whether modelling the lumbar spine as two separate regions (i.e. upper and lower), yields a different understanding of spinal movement relative to hip motion, than a traditional single-joint model. This study is unique in adopting this approach to evaluate a range of everyday tasks. METHOD: Lumbar spine motion was measured both by being considered as a whole region (S1 to T12), and where the lumbar spine was modelled as two regions (the upper (L3-T12) and lower (S1-L3)). RESULTS: A significant difference was evident between the relative contribution from the lower and upper spine across all movements, with the lower lumbar spine consistently contributing on average 63% of the total ROM. A significant difference was also evident between the whole lumbar spine-hip ratio, and the lower lumbar spine-hip ratio, for the movement of lifting only. The lower lumbar spine achieved greater velocity for all tasks, when compared to the upper lumbar spine. CONCLUSION: This study has consistently demonstrated differences in the contribution of the upper and lower spinal regions across a range of everyday tasks; hence, it would appear that greater focus should be given to performing more detailed assessments to fully appreciate spinal movement.