The Influence of Posture on Instability Evaluation Using Flexion–Extension X-Ray Imaging in Lumbar Spondylolisthesis

Inoue Daisuke,Shigematsu Hideki,Nakagawa Yoshiyuki,Takeshima Toshichika,Tanaka Yasuhito 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.3

Study Design: Prospective clinical study. Purpose: To determine the optimal posture for instability evaluation using flexion–extension X-ray imaging in patients with lumbar spondylolisthesis. Overview of Literature: Currently, flexion–extension X-ray imaging is the most practical approach for the evaluation of lumbar instability. In flexion–extension X-ray imaging, achievement of the greatest segmental motion with flexion–extension movement is necessary. However, to our knowledge, currently, there is no standardized posture for determining lumbar instability. Methods: Twenty-three individuals with lumbar spondylosis related to the fourth vertebra underwent flexion–extension X-ray imaging in different postures (standing, sitting, and lateral decubitus positions), lumbar magnetic resonance imaging (MRI), and low back pain Visual Analog Scale (VAS) evaluation on the same day. Intervertebral angle, percent slippage, and intervertebral disc area ratio for different postures during flexion and extension were compared using Tukey’s method. The effect of low back pain and the association between MRI facet effusion and these measurements were investigated according to posture. Results: The percent slippage during extension (p=0.036), change in the percent slippage between flexion and extension (p=0.004), and change in the intervertebral angle (p=0.042) were significantly different between the sitting and lateral decubitus positions. There were also significant differences between the standing and lateral decubitus positions in the change in intervertebral angle (p=0.010). In patients with VAS score <40, there were significant differences in the intervertebral angle (p=0.011) between the standing and lateral decubitus positions, percent slippage (p=0.048), and intervertebral disk ratio (p=0.008) between the sitting and lateral decubitus positions. We found no relationship between MRI facet effusion and posture in terms of instability. Conclusions: In this study, intervertebral instability was best evaluated in the lateral decubitus position when using flexion–extension X-ray imaging for patients with fourth lumbar vertebral spondylolisthesis.

슬관절 전치환술에서 슬개골 위치가 굴곡 간격에 미치는 영향

김희천 ( Hee Chun Kim ),노재영 ( Jae Young Roh ),이철우 ( Churl Woo Lee ),홍우성 ( Woo Sung Hong ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.1

Purpose: The aim of this study was to investigate the relationship between eversion or reduction of patella and the heights of the extension or flexion gaps. Materials and Methods: Measurements of the heights of the extension and flexion gaps were obtained during 32 primary posterior-stabilized total knee arthroplasties in 25 osteoarthritic patients. A tensor device was introduced after femoral and tibial bony resections while putting the knees flat on the operating table to measure the extension gaps in the medial and lateral compartments, respectively. The knee was flexed 95° degrees, and the tensor was introduced to measure the flexion gaps in the same manner. A calibrated torque wrench permitted the application of the force of about 113.4N.cm both in extension and in flexion in right knee, and of about 152.4 N.cm both in extension and in flexion in left knee. Results: The average height of the extension gap with everted patella was 20.9±2.6mm medially and 23.6±2.5 mm laterally, respectively. The average height of the extension gap with reduced patella was 21.0±2.6 mm medially and 23.7±2.4mm laterally, respectively. The average height of the flexion gap with everted patella was 20.7±2.5mm medially and 23.2±2.8 mm laterally, respectively. The average height of the flexion gap with reduced patella was 22.1 ± 2.3 mm medially and 24.2±2.8 mm laterally, respectively. After reducing the patella, the flexion gap height increased an average 1.4±1.l (range: 0~4) mm and l.0±1.2 (range: -1 ~ 3) mm in the medial and lateral compartments, respectively. Conclusion: The height of flexion gap would be increased by reducing the patella from everted position in posterior-stabilized total knee arthroplasty for the patient with good preoperative flexion. The flexion gap must be observed not with everted patella but with reduced patella to determine whether it appears symmetric and balanced.

Comparing the Immediate Effectiveness of Lumbar Flexion and Extension Exercise With Regards to Pain, Range of Motion, Pelvic Tilt, and Functional Gait Ability in Patients With Lumbar Spinal Stenosis

Hyun-ho Do,Seung-chul Chon 한국전문물리치료학회 2019 한국전문물리치료학회지 Vol.26 No.4

Background: In patients with lumbar spinal stenosis (LSS), lumbar flexion exercise (LFE) is considered a standard therapeutic exercise that widens the space between the spinal canal and intervertebral foramen. However, some researchers have reported that lumbar extension exercise (LEE) may improve lumbar pain and functional ability in patients with LSS. Although exercise intervention methods for patients with LSS have been widely applied in clinical settings, few studies have conducted comparative analysis of these exercise methods. Objects: This study aimed to compare the effects of LFE, LEE, and lumbar flexion combined with lumbar flexion-extension exercise (LFEE) on pain, range of motion (ROM), pelvic tilt angle, and functional gait ability in patients with LSS. Methods: A total of 30 patients with LSS, LFE (n1=10), LEE (n2=10), and LFEE (n3=10) were assigned to each of the three exercise groups. The numerical pain rating scale (NPRS), modified-modified schober test (MMST)-flexion, MMST-extension, pelvic tilt inclinometer, and 6-minute walking test (6MWT) were measured. Results: After the intervention, statistically significant differences were observed in the NPRS (p=.043), MMST-flexion (p<.001), MMST-extension (p<.001), and 6MWT (p=.005) between groups. According to the post hoc test, the NPRS was statistically significant difference between the LFEE and LEE groups (p=.034). The MMST-flexion was statistically significantly different between the LFE and LEE (p=.000), LFE and LFEE (p=.001), and LEE and LFEE (p=.001) groups. The MMST-extension was statistically significantly different between the LFE and LEE (p<.001), LFE and LFEE (p=.002), and LEE and LFEE (p=.008) groups. The 6MWT was statistically significantly different between the LFE and LFEE (p=.042) and the LEE and LFEE (p=.004) groups. Conclusion: This study suggested that LFEE was the most effective exercise for pain and functional gait ability in patients with LSS, LFE was the most effective exercise for lumbar flexion ROM, and LEE was the most effective exercise for lumbar extension ROM.

경부 복합재활트레이닝이 만성 경부통환자의 경부 근기능 향상과 굴신비율 및 통증지수 변화에 미치는 영향

김건도(Kim, Gun-Do),한길수(Han, Gil-Soo) 한국체육과학회 2015 한국체육과학회지 Vol.24 No.6

The purpose of this study was to determine effects of Combine Rehabilitation Training Cervical Vertebra on the Cervical Extension Strength, Ratio of Cervical Flexion/Extension and VAS Change in Chronic Neck Pain Patient. Twenty subjects(CEG: n=8, 47.12±7.18 years & UBEG: n=12, 46.58±6.80 years) participated and were trained twice a week for 8weeks. Both group were tested at pre-exercise and post-exercise(8weeks) for cervical extension strength, flexion/extension strength ratio, and VAS changes. Results showed that both groups showed significant increase in cervical extension strength at all angles(0°, 18°, 36°, 54°, 72°, 90°, 108° and 126°), and CEG(combined exercise group) appeared higher improvement than UBEG(upper body exercise group) in significant difference. CEG in cervical flexion/extension strength ratio showed 7.19% reduction and 14.61% reduction in UBEG, there was statistically significant difference in cervical flexion/extension strength ratio at UBEG groups. Both group in VAS showed significant decrease of 48.89% in CEG and 43.47% in UBEG after 8weeks training. Therefore, these findings suggest that cervical combine rehabilitation training is recommendable training program for chronic neck pain patients.

척추 운동성 측정을 위한 Modified-Modified Scho''ber방법과 이중경사계 방법의 신뢰도

이충휘,노정석 연세대학교 보건과학연구소 1997 보건과학논집 Vol.7 No.-

손목 관절의 굴신 운동 시 중수근 및 요 수근 관절의 운동 기여도 분석

김재광(Jae Kwang Kim),정문상(Moon Sang Jung),백구현(Goo Hyun Baek),김준배(Joon Bae Kim),공현식(Hyun Sik Gong),이상기(Sang Ki Lee),이영균(Young Kyun Lee) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.2

목적: 손목 관절의 굴신 운동을 각각 초기, 중기, 후기로 나누어 각각의 운동 범위에서 중수근 관절과 요 수근 관절이 전체 운동각 중에서 차지하는 비율을 측정함으로써 손목 관절의 운동을 분석하고자 하였다. 대상 및 방법: 5명의 정상 성인 남자의 손목 관절 10예에 대하여 중립 위치, 굴곡 30도, 굴곡 60도, 굴곡 90도, 신전 30도, 신전 60도, 신전 90도의 위치에서 손목 관절 측면 방사선 사진을 촬영하여 중립위에서 30도까지의 운동, 30도에서 60도까지의 운동, 60도에서 90도까지의 굴신 운동 시 중수근 관절과 요 수근 관절이 각각 차지하는 비중을 평가하였다. 결과: 굴곡 운동 시에는 중수근 관절이 각각 65%, 72%, 71%로 초기, 중기, 후기 전 과정에서 요 수근 관절에 비하여 많은 비중을 차지하였고, 신전 운동 시에는 중수근 관절이 차지하는 비중이 37%, 53%, 78%로 초기에는 요 수근 관절이 차지하는 비중이 높고 후기에는 중수근 관절이 차지하는 비중이 높았다. 결론: 손목 관절의 굴신 운동 시, 요 수근 관절의 움직임은 주상골의 연결봉 역할 이외에도 중수근 관절의 고유한 관절 면 형태 및 주변 인대들의 상호 관계에 의해서 결정되는 것으로 생각된다. 주상골의 연결봉으로서의 역할은 굴곡 시에는 초기부터 작동하는 반면, 신전 시에는 후기에 작통하는 것으로 생각된다. Purpose: Flexion and extension of the wrist occurs at the radiocarpal and midcarpal joints. This study examined the angular contribution of the radiocarpal and midcarpal joints to the total arc of motion. Materials and Methods: Five healthy adults were selected and ten wrists were tested. Lateral X-rays were taken with the wrist in the neutral position, 30° flexion, 60° flexion, 90° flexion, 30° extension, 60° extension, and 90° extension. The radiocarpal and midcarpal angle were measured. The angular contribution of the radiocarpal and midcarpal angle was calculated at each phase of motion; neutral to 30°, 30° to 60°, 60° to 90°. Results: During wrist flexion, the angular contribution of the midcarpal joint was 65%, 72%, 71% at each phase of motion, respectively. During wrist extension, the angular contribution of midcarpal joint was 37%, 53%, 78% at each phase of motion, respectively. Therefore, during wrist extension, the main contributor of motion is changed from the radiocarpal joint in the early phase to the midcarpal joint in the late phase. Conclusion: It is suggested that the proximal carpal low is not moved passively by just the link system but the motion is guided by the peculiar shape of midcarpal articulation and ligaments complex at each phase. The link system is believed to act in the early phase of flexion and in late phase of extension.

요추부 퇴행성 변화와 척추후관절 운동성과의 관계

박승원,권정택,김영백,민병국,황성남,최덕영,석종식 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.1

몸통 굽힘 동안 뒤넙다리근 길이가 척추세움근의 굽힘-이완 현상에 미치는 영향

Na-hee Kim,Bo-ram Choi 한국전문물리치료학회 2020 한국전문물리치료학회지 Vol.27 No.3

Background: The flexion-relaxation phenomenon (FRP) refers to a sudden onset of activity in the erector spinae muscles that recedes or fades during full forward flexion of the trunk. Lumbar spine and hip flexion are associated with many daily physical activities that also impact trunk flexion. Shorter hamstring muscles result in a reduction of pelvic mobility that eventually culminates in low back pain (LBP). Many studies have explored the FRP in relation to LBP. However, few studies have investigated the influence of hamstring muscle length on the FRP in relation to the erector spinae muscles during trunk flexion. Objects: This study aimed to investigate the influence of hamstring muscle length on the FRP in relation to the erector spinae muscles during trunk flexion. Methods: Thirty subjects were divided into three groups according to hamstring length measured through an active knee extension test. The 30 participants consisted of 10 subjects who had a popliteal angle of 20˚ or less (Group 1), 10 subjects who had a popliteal angle of 21˚–39˚ (Group 2), and 10 subjects who had a popliteal angle of 40˚ or more (Group 3). A one-way analysis of variance was used to compare the difference in muscle activity of the erector spinae muscles during trunk flexion. Results: The subjects with a shorter hamstring length had significantly higher muscle activity in their erector spinae muscles during trunk flexion and full trunk flexion (p < 0.05). The subjects with a shorter hamstring length also had a significantly higher flexion-relaxation ratio (p < 0.05). Conclusion: The results of this study demonstrate that differences in hamstring muscle length can influence the FRP in relation to the erector spinae muscles. This finding suggests that the shortening of the hamstring might be associated with LBP.

하지 굴신 동작 시 발의 위치에 따른 허리 및 하지근육의 근활동에 관한 연구

조규권(Cho Kyu-Kwon),김유신(Kim You-Sin),양승민(Yang Seung- Min),손원우(Son Won-Woo) 한국체육과학회 2007 한국체육과학회지 Vol.16 No.3

The purpose of this study was to examine and make a fixed quantity of how waist and lower extremities muscle activities vary according to foot's positions during flexion/extension of legs of 9 male subjects in K university. The results through this study were as follows. According to the result of average integral muscle conduction during flexion of legs, erector spinae and tibialis anterior muscle activities were the highest when foot's positions were internally rotated and vastus lateralis, biceps femoris and gastrocnemius medial head muscle activities were the highest when foot's positions were externally rotated. According to the result of the maximum integral muscle conduction during flexion of legs, erector spinae and tibialis anterior muscle activities were the highest when foot's positions were internally rotated and biceps femoris and gastrocnemius medial head muscle activities were the highest when foot's positions were externally rotated. According to the result of average integral muscle conduction during extension of legs, iliac crest, erector spinae, vastus lateralis and tibialis anterior muscle activities were the highest when foot's positions were internally rotated and biceps femoris and gastrocnemius medial head muscle activities were the highest when foot's positions were externally rotated. According to the result of the maximum integral muscle conduction during extension of legs, iliac crest, erector spinae and tibialis anterior muscle activities were the highest when foot's positions were internally rotated and vastus lateralis muscle activity was the highest when foot's position was neutral. Biceps femoris and gastrocnemius medial head muscle activities were the highest when foot's positions were externally rotated. In conclusion, there were statistically big differences according to the foot's positions during flexion/extension of legs. In other words patients who need to strengthen muscular power and be rehabilitated can obtain good results if they practice bending and stretching of legs activities carefully considering foot's positions.

수직 견인요법 적용 유무에 따른 재활운동이 여성 요통환자들의 요부 신전근력 굴신비율 및 통증지수 변화에 미치는 영향

이광수(Lee, Kwang-Soo),강명학(Kang, Myoung-Hak),한길수(Han, Gil-Soo) 한국체육과학회 2014 한국체육과학회지 Vol.23 No.6

This study selected 28 female patients with low back pain (15 female patients belonged to vertical traction MedX exercise group while 13 female patients belonged to MedX exercise group). The patients in two groups underwent 8 weeks of differentiated exercise treatment methods; lumbar extension strength, flexion/extension strength ratio, and changes in VAS were measured to draw the following results. After 8 weeks of treatments, two groups showed significant increase in muscle strength in 0˚, 12˚, 24˚, 36˚, 48˚, 60˚, and 72˚ conditions (p<0.01). For lumbar flexion/extension strength ration, vertical traction MedX exercise group showed 31.02% decrease while the MedX exercise group showed 25.10% decrease (p<0.05) resulting in the significant difference between two groups. For changes in VAS, vertical traction MedX exercise group showed 70.85% decrease while MedX exercise group showed 47.02% decrease resulting in the significant difference between two groups (p<0.01). Summarinzing the above results, the results showed that combined exercise of lumbar vertical traction and MedX application Pneu-weight system aid in restoring daily life restrictions and daily life function in early stage because the combined exercise has positive effective in strenghening lumbar extension strength and reducing lumbar flexion/extension strength ration and VAS.