Arnold Y.L. Wong

The Clinical Value of Assessing Lumbar Posteroanterior Segmental Stiffness: A Narrative Review of Manual and Instrumented Methods

Abnormal spinal segmental motion/stiffness is purported to be a cause, or an effect of, low back pain. Therefore, the assessment of posteroanterior segmental spinal stiffness is a common practice in clinical and research settings. In clinical settings, manipulative practitioners routinely assess spinal stiffness manually to guide clinical decision‐making. Unfortunately, the reliability of manual segmental spinal stiffness assessment is poor. As a result, various spinal stiffness‐testing devices have been developed to improve the reliability and accuracy of spinal stiffness measures. Although previous critical and systematic reviews have summarized the evidence regarding the reliability and confounding factors of manual and/or instrumented spinal stiffness measurements, no available review has summarized the principles of various spinal stiffness measurement methods nor pragmatic recommendations to optimize these measurements. Importantly, although posteroanterior segmental spinal stiffness is hypothesized to be related closely to low back pain or clinical outcomes after treatments, no review has been conducted to summarize evidence related to these premises and to discuss factors that can confound these relations. Against this background, this narrative review revisits the concept of both manual and instrumented spinal stiffness assessments, summarizes the pragmatic recommendations for minimizing measurement errors, reviews the potential relations between segmental spinal stiffness and low back pain, and provides future clinical research directions that can benefit clinicians and researchers alike.

Low-Cost Ergonomic Intervention for Mitigating Physical and Subjective Discomfort during Manual Rebar Tying

AbstractThe construction industry around the globe is facing a massive predicament of work-related musculoskeletal disorders (MSDs), largely attributed to the excessive physical exertion at worksit...

The prevalence of musculoskeletal symptoms in the construction industry: a systematic review and meta-analysis

PurposeAlthough individual studies have reported high prevalence of musculoskeletal symptoms (MSS) among construction workers, no systematic review has summarized their prevalence rates. Accordingly, this systematic review/meta-analysis aimed to synthesize MSS prevalence in different construction trades, gender and age groups, which may help develop specific ergonomic interventions.MethodsNine databases were searched for articles related to the research objective. Two reviewers independently screened citations, extracted information and conducted quality assessment of the included studies. Meta-analyses were conducted on clinical and statistical homogenous data.ResultsThirty-five out of 1130 potential citations were included reporting diverse types of period prevalence and case definitions. Only the 1-year prevalence rates of MSS (defined as at least one episode of pain/MSS in the last year) at nine anatomical regions had sufficient homogeneous data for meta-analysis. Specifically, the 1-year prevalence of MSS was 51.1% for lower back, 37.2% for knee, 32.4% for shoulder, 30.4% for wrist, 24.4% for neck, 24.0% for ankle/foot, 20.3% for elbow, 19.8% for upper back, and 15.1% for hip/thigh. Female workers demonstrated a higher prevalence of MSS while there was insufficient information on the prevalence of trade-specific or age-related MSS. The quality assessments revealed that many included studies estimated prevalence solely based on self-reported data, and did not report non-respondents’ characteristics.ConclusionsLumbar, knee, shoulder, and wrist MSS are the most common symptoms among construction workers. Future studies should standardize the reporting of period prevalence of MSS in different construction trades to allow meta-analyses and to develop relevant MSS prevention program.

Low back pain in older adults – the need for specific outcome and psychometric tools

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Pain Research 2016:9 989–991 Journal of Pain Research Dovepress

Leadership and capacity building in international chiropractic research: introducing the chiropractic academy for research leadership (CARL)

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.

Effects of different weights and lifting postures on balance control following repetitive lifting tasks in construction workers

Purpose Repetitive lifting tasks have detrimental effects upon balance control and may contribute toward fall injuries, yet despite this causal linkage, risk factors involved remain elusive. The purpose of this paper is to evaluate the effects of different weights and lifting postures on balance control using simulated repetitive lifting tasks. Design/methodology/approach In total, 20 healthy male participants underwent balance control assessments before and immediately after a fatiguing repetitive lifting tasks using three different weights in a stoop (ten participants) or a squat (ten participants) lifting posture. Balance control assessments required participants to stand still on a force plate with or without a foam (which simulated an unstable surface) while center of pressure (CoP) displacement parameters on the force plate was measured. Findings Results reveal that: increased weight (but not lifting posture) significantly increases CoP parameters; stoop and squat lifting postures performed until subjective fatigue induce a similar increase in CoP parameters; and fatigue adversely effected the participant’s balance control on an unstable surface vis-a-vis a stable surface. Findings suggest that repetitive lifting of heavier weights would significantly jeopardize individuals’ balance control on unstable supporting surfaces, which may heighten the risk of falls. Originality/value This research offers an entirely new and novel approach to measuring the impact that different lifting weights and postures may have upon worker stability and consequential fall incidents that may arise.

Do different sitting postures affect spinal biomechanics of asymptomatic individuals

BACKGROUND Static sitting is thought to be related to low back pain. Of various common seated postures, slouched sitting has been suggested to cause viscoelastic creep. This, in turn, may compromise trunk muscle activity and proprioception, and heightening the risk of low back pain. To date, no research has evaluated immediate and short-term effects of brief exposures to different sitting postures on spinal biomechanics and trunk proprioception. RESEARCH QUESTION This study aimed to compare the impacts of 20 min of static slouched, upright and supported sitting with a backrest on trunk range of motion, muscle activity, and proprioception immediately after and 30 min after the sitting tasks. METHODS Thirty-seven adults were randomly assigned to the three sitting posture groups. Surface electromyography of six trunk muscles during maximum voluntary contractions were measured at baseline for normalization. Pain intensity, lumbar range of motion, and proprioceptive postural control strategy were assessed at baseline, 20 min (immediately post-test) and at 50 min (recovery). Trunk muscle activity during sitting was continuously monitored by surface electromyography. RESULTS While the slouched sitting group demonstrated the lowest bilateral obliquus internus/transversus abdominis activity as compared to other sitting postures (F = 4.87, p < 0.05), no significant temporal changes in pain intensity, lumbar range of motion nor proprioceptive strategy were noted in any of the groups. SIGNIFICANCE Sitting for 20 min of duration appears to have no adverse effects on symptoms or spinal biomechanics regardless of the posture adopted. Future research should determine if there is a point at which does slouched sitting cause significant changes in pain/spinal biomechanics in people both with and without low back pain.

Crowdsourcing to solicit global consensus from clinicians regarding low back pain outcome indicators for older adults (Preprint)

Background Low back pain (LBP) is one of the most debilitating conditions among older adults. Unfortunately, existing LBP outcome questionnaires are not adapted for specific circumstances related to old age, which may make these measures less than ideal for evaluating LBP in older adults. Objective To explore the necessity of developing age-specific outcome measures, crowdsourcing was conducted to solicit opinions from clinicians globally. Methods Clinicians around the world voted and/or prioritized various LBP outcome indicators for older adults on a pairwise wiki survey website. Seven seed outcome indicators were posted for voting while respondents were encouraged to suggest new indicators for others to vote/prioritize. The website was promoted on the social media of various health care professional organizations. An established algorithm calculated the mean scores of all ideas. A score >50 points means that the idea has >50% probability of beating another randomly presented indicator. Results Within 42 days, 128 respondents from 6 continents cast 2466 votes and proposed 14 ideas. Indicators pertinent to improvements of physical functioning and age-related social functioning scored >50 while self-perceived reduction of LBP scored 32. Conclusions This is the first crowdsourcing study to address LBP outcome indicators for older adults. The study noted that age-specific outcome indicators should be integrated into future LBP outcome measures for older adults. Future research should solicit opinions from older patients with LBP to develop age-specific back pain outcome measures that suit clinicians and patients alike.

Neck Postures During Smartphone Use in University Students and Office Workers: A Field Study

Office workers and university students are known to suffer from neck pain as they are frequent users of electronic devices. The present study utilized inertial motion sensors to examine real-time spinal kinematics in office workers and university students for 3 h in their natural working/studying environment. Office workers (10 males, 10 females) and university students (11 males, 11 females) were recruited by convenience sampling. Their mean ages were significantly different (Workers: 40.8 ± 8.5 years; Students: 21.5 ± 2.6 years). Five inertial motion sensors (Noraxon myoMotionTM) were attached firmly onto the occipital protuberance, and the spinous processes of C6, T3, T12, and the sacrum, respectively, yielding angular displacements of the cervical, upper thoracic, lower thoracic and lumbar segments. The mean postural angles and the number of variations (zero crossings per minute) were analyzed. Self-reported neck pain score was higher in office workers (4.1 ± 3.7 on a 0–10 numeric scale) than that in students (2.3 ± 2.0, P = 0.076). Students adopted significantly greater degrees of lumbar flexion compared with office workers. Conversely, office workers tended to adopt slightly larger neck postural angles than students. Similarly, there was no significant between-group difference in zero crossings for the different spinal segments. Multivariate regression analyses showed that interaction of posture and duration of smartphone use were factors significantly contributing to musculoskeletal symptoms in students (P < 0.001), while age and gender were significant risk factors for symptoms in office workers (P = 0.001).