Lance Twomey

Head and shoulder posture variations in 160 asymptomatic women and men

OBJECTIVE To quantitatively describe the postural alignment of the head and shoulders and the surface curvature of the thoracic spine in comfortable erect standing and to examine the effect of age and gender on head and shoulder alignment. DESIGN Descriptive survey. SETTING Gait research laboratory. PARTICIPANTS One hundred sixty asymptomatic volunteers aged between 17 and 83 years. MAIN OUTCOME MEASURES Five photographic measurements of head and shoulder posture in the coronal and sagittal planes and a photographic measurement of the surface curvature of the thoracic spine in the sagittal plane. RESULTS Mean values of coronal head tilt, coronal shoulder angle, sagittal head tilt, sagittal C7-tragus angle, and sagittal shoulder-C7 angle were 180.1 degrees, 181 degrees, 172.1 degrees, 131.1 degrees, and 53.7 degrees, respectively. The 95% confidence intervals for the means ranged between 1 degree and 3.8 degrees. For each of the head and shoulder measurements there was no significant gender difference (p = .33 to .99). Of the five measurements, only sagittal C7-tragus angle was significantly correlated with age (r = .44), and none was correlated with surface curvature of the thoracic spine. CONCLUSIONS Head and shoulder posture was similar between genders. Only one postural description that has been described anecdotally was identified, i.e., that age was related to the position of the head with respect to the trunk in the sagittal plane, although the strength of the association was of questionable clinical significance. In contrast, other longstanding assumptions were not supported, and accordingly, a forward head was not associated with increased thoracic curvature or upper cervical spine extension.

Altered patterns of abdominal muscle activation in patients with chronic low back pain

This study investigated patterns of abdominal muscle recruitment during the abdominal drawing in manoeuvre in subjects with chronic low back pain (CLBP) and radiological diagnosis of spondylolysis or spondylolisthesis. Data were collected using surface electromyography from 12 physically active subjects with CLBP and 10 controls. The control subjects displayed an ability to preferentially activate internal oblique with minimal activation of upper rectus abdominis during the action of drawing in the abdominal wall. The group with CLBP were unable to achieve this. This finding may reflect the presence of neuromuscular dysfunction in this group. Further study is required to investigate if these findings are linked to the ability of patients with CLBP to provide dynamic stability of their lumbar spine.

Posture of the head, shoulders and thoracic spine in comfortable erect standing

Common clinical beliefs about the relationship between postural characteristics and pain are based on mainly anecdotal evidence. This study examined the reliability of physical characteristics of the head, shoulders and thoracic spine and identified relationships among them. Measurements were made from photographs of subjects in comfortable erect standing. A forward head position was related to the curvature of the upper thoracic spine, and a forward position of the shoulders to the tilt of the head in the sagittal plane and to upper cervical extension. The magnitude of the relationships, however, was of questionable clinical significance. No relationship was found between a forward head position and forward shoulders, nor between a forward head position and upper cervical spine extension.

The lateral atlanto-axial joints and their synovial folds: an in vitro study of soft tissue injuries and fractures.

Thirty victims of blunt cervical trauma, who did not survive (acute death group), were studied at autopsy as were 11 patients who survived trauma for more than 1 month and ten controls without any known cervical trauma. All specimens were sagitally sectioned in 2-mm slices and carefully examined for injuries to the lateral parts of the atlanto-axial joints. In the acute death group, five cases showed a rupture of the joint capsule, three of these with a massive hemarthrosis. In 17 cases there was bruising around the second cervical spinal nerve. Bruising of the intra-articular synovial fold was present in 15 cases, the posterior synovial fold being most commonly affected. There were five intra-articular fractures of the lateral masses, in three cases combined with a dens fracture. In two cases a bone fragment from the fracture compressed and obliterated the lumen of the vertebral artery. The findings are discussed in relation to pain after cervical trauma.

Use of a subjective health measure on Chinese low back pain patients in Hong Kong

STUDY DESIGN A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale. OBJECTIVE To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain. SUMMARY OF BACKGROUND DATA Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing. METHODS Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment. RESULTS The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patients perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version). CONCLUSIONS The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.

Age Changes in the Lumbar Articular Triad

The articular triad of the intervertebral disc and the two synovial zygapophyseal joints at the same vertebral level, allows the spine its considerable mobility, while providing support and protection. The principal structural changes which occur to the elements of the articular triad in old age are an increase in the convexity, central height and horizontal intervertebral disc dimensions, and increased swelling and fibrillation of zygapophyseal joint cartilage with expansion of joint margins by osteophytes. These changes are directly responsible for the reduction in the ranges of all lumbar movements in old age. Advanced osteoarthrosis in old age is not accompanied by bony sclerosis, because of the generalized osteopenia of old age.

Sideflexion induced lumbar spine conjunct rotation and its influencing factors

Twenty motion segments from four male post mortem subjects with a mean age of 29 years were moved into the lumbar spine test positions of extension/left sideflexion, extension/right sideflexion, flexion/left sideflexion and flexion/right sideflexion Jheconjunct rotation (CR) that occurred was measured from a photographic record. The results indicated that the direction of the CR of the whole lumbar spine (ie between L1 and S1) was significantly different between the flexed and extended lumbar spine position. The direction of the CR was also significantly different between the different intervertebral motion segment levels. There was no relationship between CR and zygapophyseal joint geometry or intervertebral disc degeneration.

Old Age and Physical Capacity: Use It or Lose It

Increasing age is usually associated with a decline in the amount of habitual exercise activity of an individual in western society. While this reflects a decline in physical capacity, it is in large part due to socio-cultural pressures and expectations. The preservation of any function, intellectual or physical, is dependent upon the use that is made of that function, and the physiotherapist with a unique background in human movement and pathology has a vital role in the prescription and supervision of exercise with the elderly. Exercise has demonstrable effects on skeletal health and bone maintenance, muscle bulk and strength, the ranges of movements of joints, cartilage compliance, soft tissue extensibility, neuronal efficiency and cardiopulmonary fitness. This paper considers some of the physical aspects of ageing on body tissues together with the actual and potential role of physiotherapy in the health education and treatment of elderly people.

The lumbar spine: structure, function, age changes and physiotherapy

Increasing age brings about inevitable changes in the structure, shape and function of the human lumbar spine. The primary structural age change which occurs is a selective loss of the transversely oriented trabeculae within lumbar vertebrae, which causes them to become shorter, wider and more concave at their end-plate region. This in turn leads to a progressive alteration to the shape of the lumbar discs and, together with biochemical and histological change, brings about a reduction in spinal posture, flexibility and compliance and in the ability of the lumbar region to cope with sustained loading. This information is important for physiotherapists in their treatment of lumbar spinal disorders.

A DESCRIPTION OF TWO NEW INSTRUMENTS FOR MEASURING THE RANGES OF SAGITTAL AND HORIZONTAL PLANE MOTIONS IN THE LUMBAR REGION

Two new instruments, a lumbar spondylometer and a rotameter, for the measurement of sagittal and horizontal plane motion in the lumbar spine respectively, are described. They enable the clinician to more accurately measure and chart the progress of patients with low back problems.