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To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder.
Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient.
Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle).
Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.
Citations
Objective: To investigate the relationship between commonly used radiologic parameters and occurrence of low back pain (LBP) through prospective study using pre-employment radiologic examination in high risk workplace.
Method: One hundred and fifty four male workers in high risk workplace were evaluated. Lumbar lordosis, lumbosacral angle, lumbar gravity line and lumbar disc height- related parameters were measured using simple radiologic films of lateral lumbosacral view taken during pre-employment medical check. Relationship between occurrence of LBP during post-employment period with a mean 1.7⁑1.0 years and radiologic parameter was investigated.
Results: Lumbar lordosis, lumbosacral angle and lumbar disc height were not significantly correlated to the occurrence of LBP. Amount of anterior shift of lumbar gravity line did not showed correlation to occurrence of LBP, but subjects with posterior displacement of lumbar gravity line showed significantly low rate of occurrence of LBP.
Conclusion: These results suggest that commonly used radiologic parameters are not so useful to predict occurrence of LBP in high risk workers. The possibile preventive effect of posterior shift of lumbar gravity line seems to be worth further researching. (J Korean Acad Rehab Med 2002; 26: 67-72)
Objective: To investigate a biomechanism of pelvic pain in pregnancy by use of motion analyzer.
Method: Ten pregnant women in the early third trimester and 10 healthy women as control were enrolled. A gait analysis by a Vicon 370 motion analyzer system was performed to investigate the dynamic lumbo-pelvic motion of pregnancy in biomechanical aspects.
Results: The mean maximal surface lordotic angle of pregnant women was 24.42⁑3.98 degrees, the mean minimal surface lordotic angle 20.64⁑4.27 degrees, and the mean maximal surface lordotic angle of controls was 21.61⁑2.43 degrees, the mean minimal surface lordotic angle 18.38⁑2.29 degrees (p＞0.05). The mean maximal anterior pelvic tilt of pregnant women was 21.11⁑5.91 degrees, and the mean maximal anterior pelvic tilt of controls was 15.28⁑4.94 degrees (p＜0.05).
Conclusion: The angle of lumbar lordosis was within normal ranges but the anterior pelvic tilt was increased significantly in pregnancy. This can place mechanical stress on lumbo-pelvic region. This dynamic sagittal imbalance of the spine may be a considerable cause for low back and pelvic pain in pregnancy as indicated by the results of this study.
Objective: To evaluate how to influence static lumbar lordosis by different heel heights in normal adults and patients with spondylolisthesis.
Method: The lumbolumbar angles, lumbosacral angles and slip angles were examined while standing on barefoot, on heel support with 5 cm heel, and with 10 cm heel in 14 normal adults and 10 patients with first grade of spondylolisthesis. Standing lumbar spine lateral view was performed by one half hour adaptation with corresponding shoe types.
Result: The lumbolumbar angles (angles between upper margin of 2nd lumbar body and low margin of 5th lumbar body) and the lumbosacral angles (between upper margin of 2nd lumbar body and low margin of 1st sacral body) in normal are 36.8⁑6.5o, 50.1⁑9.5o on barefoot, 36.0⁑7.3o, 49.6⁑7.4o on heel support with 5 cm heel, and 36.1⁑7.6o, 49.7⁑8.3o with 10 cm heel. Lumbolumbar angles and lumbosacral angles in 10 patients with spondylolisthesis 38.8⁑8.3°on barefoot, 47.2⁑10.4o on heel support with 5 cm heel, 38.3⁑7.0o, 47.7⁑9.2o with 10 cm heel. The slip angles in 10 patients with spondylolisthesis are 29.8⁑1.2o on barefoot, 30.2⁑1.8o on heel support with 5 cm heel, and with 10 cm heel.
Conclusion: The changes of heel height did not significantly influence the lumbar lordosis in normal adults and patients with spondylolisthesis. There were no significant differences in average slip angle according to heel height in patients with spondylolisthesis were found.
Objective: To investigate the relationship between the curvature of the cervical spine and various clinical parameters and to identify the validity of new curvature measurement methods.
Method: The cervical spine curvature was assessed on lateral view of plain radiographs by three measurement indices. Index 1 is the ratio of length of line drawn by C2-C7 posteroinferior points and the longest length of vertical line to the posterior curve of C2-C7. Index 2 is the angle formed by three points of index 1. Index 3 is the sum of each distance from line drawn by C2-C7 posteroinferior point to C3-C7 posterior mid-points. The difference of each group and the relationship between pain scale and three indices were statistically analyzed by t-test and Pearson's correlation test.
Results: Sixty-three percent of control group patients showed a straight or kyphotic curvature and younger women group was more likely to have a straight curvature than other age groups. The newly designed measurement methods reflect the diagnostic significance of cervical curvature type measurement. Cervical lordosis did not exactly correlate with pain scale, symptom duration and the difference of clinical diagnosis. But the patients showing interval changes of pain scale were revealed the correlative change of curvature indices with each correlation coefficient of 0.43, 0.69 and 0.55 respectively.
Conclusion: The altered cervical curvature is less valuable for the diagnostic significance and did not relate to the pain scale and duration, but cervical curvature reflect the interval change of the pain scale.
Previous studies proved that, the high-heeled shoes caused postural changes, a loss of foot function, and deformities of foot. However the lumbar lordosis in gait is rarely measured. The purposes of this study were to compare kinematics and kinetics between high-heeled and high-forefoot gait by skin markers, and to find the influence of heel height to lumbar vertebral alignment. We used the Vicon 370 three-dimension Gait Analysis System.
In the present study, the lower extremity biomechanics in high-heeled and high-forefoot shoes were examined in 20 Korean female subjects. Results showed that the double support phase increased in high-forefoot gait in linear parameters. In sagittal plane kinematics, the lumbar lordosis slightly increased in high-forefoot gait, but that did not increase in high-heeled gait. The knee flexion and ankle plantarflexion increased in high-heeled gait, but ankle pantar flexion reduced in high-forefoot gait. Clinically the change of ankle motion was not significantly influenced to the lumbar lordosis. However, high-heeled shoe users with low back pain are probably influenced by the overstress of paraspinal muscles and vertebral ligments. Further studies are required for more precise analysis of high-heeled and high-forefoot gaits.
The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies.
On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings.
There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease.
It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.
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