Guy Mellin

Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients

Mobility of hips and lumbar spine were measured in 301 men and 175 women who were in employment but suffered from chronic or recurrent low-back pain. The degree of low-back pain (LBP) was assessed with a questionnaire. Hip flexion, extension, internal rotation, and hamstring flexibility in the men, and hip flexion and extension in the women had statistically significant negative correlations with LBP. Among the correlations between hip and lumbar spinal mobility, hip flexion and extension with lumbar rotation were strongest.

Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain

A comprehensive 4-week inpatient treatment including intensive physical training was evaluated in 194 chronic low back pain patients of whom 101 were working and 79 were on sick leave. Physical performance was assessed by measurements of spinal mobility, isometric trunk flexion and extension strength, and isokinetic lifting strength. Outcome was evaluated by a functional capacity index and work status changes reported at a 12-month follow-up. There was a 30-50% average increase in physical performance during treatment. At the 12-month follow-up the functional capacity index showed an average increase from 35.4 to 39.3 points (score range 24-48). At follow-up 28% of the sicklisted patients had returned to work and of those employed before treatment 14% were on sick leave. Associations between outcome and the improvement in physical measurements and their level at discharge were determined by stepwise multiple and logistic regression analyses. Among the physical measurements only increase in spinal mobility was associated with functional capacity index in women and return to work in both men and women at the 12-month follow-up. The overall results showed that intensive physical training and improved physical performance did not play crucial roles in the rehabilitation of chronic low back pain patients, at least when return to work was used as the outcome criterion.

Effects of subject position on measurements of flexion, extension, and lateral flexion of the spine

Effects of subject positions on range and repeatability of thoracic and lumbar forward flexion, extension, and lateral flexion were studied. Inclinometric methods were used, and 27 subjects were measured by two trained testers. No great differences in repeatability and range of movements were found between measurements in different positions, but according to the results and convenience of performance, the following positions could be recommended: forward flexion in a sitting position, extension while lying on an examination table with arms braced ahead, and lateral flexion close to a wall and facing it.

Spinal mobility and posture in adolescent idiopathic scoliosis at three stages of curve magnitude

Spinal posture and mobility were studied in 71 girls with progressive adolescent idiopathic thoracic scoliosis. Measurements were carried out by inclinometers and a compass in three planes; sagittal, frontal, and horizontal. The patients were divided into three groups according to the curve magnitude. Group I had curves smaller than 25 degrees, group 2 had curves between 25 and 35 degrees, and group 3 had curves greater than 35 degrees. The positional inclines of sacrum, upper lumbar and upper thoracic areas became more vertical as the curve size increased resulting in smaller lumbar lordosis and thoracic kyphosis. In the thoracic spine flexion and banding to the right was smaller in group 3 than in the other groups. Rotations in both clockwise and counterclockwise directions decreased as the curve size increased. In the lumbar spine only bending to the left decreased significantly with the curve size increase. All thoracic and lumbar movements except lumbar rotations had a general tendency to stiffening as the curve size increased. Of the mobility measurements thoracic rotation most clearly decreased with increased curves, which together with straightening of the spine can be important features in the pathomechanism of a progressive idiopathic thoracic curve.

Spinal mobility in adolescent girls with idiopathic scoliosis and in structurally normal controls

Spinal mobility and posture were studied in 29 adolescent girls (mean age, 13.9 years) with thoracal idiopathic scoliosis, and in 30 healthy girls (mean age, 14.0 years) of the same age. Measurements of the mobility were conducted by inclinometers and a compass in three planes; sagittal, frontal, and horizontal. The structurally healthy girls were taller and heavier than the scoliotics; the difference was statistically significant for weight (P<0.01). The positional inclines of sacrum, upper lumbar and thoracic areas were significantly smaller in the scoliotics, resulting in smaller lumbar lordosis and thoracic kyphosis in them (P<0.001). In the thoracic spine, forward flexion was smaller (P<0.01), whereas extension (P<0.001) and the total sagittal mobility (P<0.01) were greater in the scoliotics. In the healthy controls, the thoracic clockwise rotation was significantly (P<0.05) larger than the counterclockwise. This side difference had disappeared in the scoliotics, and their total thoracic rotation was indicatively smaller than in the controls. In the lumbar spine, extension was smaller (P<0.01) in the scoliotics than in the controls. All spinal mobility measurements noted there was no change of general spinal flexibility in the scoliotics.

Asymmetry of Lumbar Lateral Flexion and Treatment Outcome in Chronic Low-back Pain Patients

In a study on the treatment of chronic low-back pain (n = 456 patients; 58% men, 35-54 years of age), 3-month treatment outcome was assessed by back pain questionnaires and physical measurements including spinal and hip mobility and trunk muscle strength. Changes in differences between ranges of right and left lumbar lateral flexion and rotation of > 5 degrees from pretreatment to follow-up were recorded. A relative increase in left lumbar lateral flexion was associated with a better treatment outcome according to both back pain and physical performance (p < 0.05-0.001). With spinal rotation measurements no similar connections were observed. The results point to a connection between back pain and asymmetric spinal function, which may have pathogenetic and therapeutic significance.

Comparison between Three Different Inclinometers

Summary The measurement reliability and inter-rater reliability of the MIE, Mediclino and Myrin inclinometers were tested using a mock-up lever. Inter-rater reliability was better with the Mediclino inclinometer, partly owing to the design of the scale. Both Mediclino and MIE inclinometers were reliable even when tilted as much as 60° from vertical but the pendulum of the Myrin inclinometer caused error if it was tilted more than 10°. Tilting of the inclinometer in clinical use is acceptable only during certain measurements and the value and utility of inclinometer readings may be compromised by negligent application.

Spinal Mobility and Posture and Their Correlations with Growth Velocity in Structurally Normal Boys and Girls Aged 13 to 14

Spinal mobility and posture were measured and their correlations with growth velocity were calculated In 30 boys and 30 girls aged 13 to 14. The spinal measurements were carried out by nonlnvaslve gonlometrlc methods. In the thoracic spine kyphosls (P < 0.01), forward flexion (P < 0.01) and the sum of lateral flexions (P < 0.05) were reduced In the girls compared with the boys. In the boys and girls alike, thoracic rotation to the left was smaller than to the right, but the difference was statistically significant (P < 0.05) only for the girls. In the girls, thoracic forward flexion and rotation to the left had negative correlations (r= −0.38 and −0.39, P < 0.05) with growth velocity. The hypothetical significance of the results for the explanation of the development of adolescent Idlopathlc scollosls Is discussed.