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The effect of shoulder movements on thoracic spine 3D motion
Abstract
To investigate whether there is any repeatable coupling pattern of upper thoracic movements, during right arm elevation in sagittal and scapular plane.
Upper thoracic movement patterns (T2-T7) were examined during right arm elevation, in the sagittal and scapular plane using an electromagnetic device. The participants were 25 asymptomatic woman aged between 45 and 64 years.
The majority of the participants performed an ipsilateral coupling pattern between lateral flexion and rotation which was repeatable and comparable for both arm elevation planes. Ipsilateral coupling of right lateral flexion and rotation in association with extension occurred in 23 subjects during arm elevation in sagittal plane, and in 19 subjects during arm elevation in scapular plane.
Analysis revealed that the participants demonstrated a repeatable upper thoracic movement pattern within and between subjects, during arm elevation in sagittal and scapular planes.
The biomechanical relationship between the arm and the thoracic spine is important to clinical practice because of the contribution of spinal to shoulder movements and vice versa, in the recognition, prevention and restoration of musculoskeletal function.
... The physiological range of motion (RoM) of the shoulder complex is limited to 150° [7,8]; therefore, the ability to elevate the arm to the vertical involves the contribution of joints outside of the shoulder. Several studies have shown that the thoracolumbar spine participates in arm elevation in both asymptomatic people and those with stiff and painful shoulders [9][10][11][12][13]. One study showed that maximal active unilateral arm elevation involves combined 3D motion of the head relative to the trunk that is opposite in direction to the 3D motion of the trunk [8]. ...
... The participation of the spine in arm elevation places stress and constraints on spinal structures [14,15]. Thoracic and shoulder RoM limitations are associated [9,11,16,17]. An accurate assessment of spinal, pelvic and head kinematics during arm elevation could help better understand the spinal joint constraints related to arm motion. ...
... In particular, the kinematics of the cervical spine during arm elevation have been little studied [8,13]. Studies using electromagnetic or optoelectronic motion capture systems to assess thoracic and lumbar motion during arm movements measured global spinal movement or divided the spine into large anatomic regions [9][10][11][12]. Few studies of spinal kinematics during arm movements involved vertebral imaging. ...
Background
Few studies have assessed the participation of the spine in arm elevation. The primary aim of this exploratory study was to specify spinal movements during unilateral arm elevation.
Methods
We used an EOS imaging system to assess 2D global posture (Sagittal Vertical Axis [SVA], T1 and T9 tilt and Central Sacral Line [CSL]) and segmental spine curves (C3-C7 in the sagittal plane only, and T1-T6, T7-T12 and L1-L5 in the sagittal and frontal planes) for four different left arm elevation levels: in the sagittal (Sa) plane (30°Sa: reference position, 140°Sa and 180°Sa), and in the scapular (Sc) plane (180°Sc), in ten right-handed asymptomatic participants (5 women; mean age 24.6 SD 3.0 years]. In addition, we estimated C1, head and pelvic orientation and head and pelvic linear displacement. We used Bayesian statistics (BF10 > 3 indicates a significant variation: moderate, strong, very strong or extreme evidence).
Results
From 140°Sa to 180°Sa or Sc, the significant decrease in SVA and the T1-T9 tilt angles indicated a global backward spine bending (moderate to very strong evidence). The significant reversal of the C3-C7 lordosis at 30°Sa (-1.34 [2.53]°) to kyphosis at 180°Sa (13.88 [3.53]°, strong evidence) and 180°Sc (11.85 [2.75]°, extreme evidence) and the significant decrease in the T7-T12 kyphosis (26.58 [2.84]°at 30°Sa to 16.40 [2.65]° at 180°Sa and 17.60 [2.78]° at 180°Sc [all extreme evidence]) showed a global spine straightening. We found significant pelvic anteversion between 30°Sa and 140°Sa (moderate evidence) and persistent right spine bending and leftward head displacement (extreme evidence). The change in C1 orientation (extreme evidence) showed an atlanto-occipital extension.
Conclusion
Simple unconstrained movements of unilateral arm elevation involve the whole spine, pelvis and head, including significant backward spinal bending, a reduction in the low cervical spine lordosis and the thoracic kyphosis, and atlanto-occipital extension.
... In addition, kinematics were measured on the participant's dominant upper limb and not necessarily the side of neck pain [1,9,10]. Arm movements produce different ranges and patterns of spinal motion [13][14][15], but spinal kinematics during arm elevation has not been explored in patients with neck pain. A lack of consideration of these variables means that there is not a clear picture of scapular, clavicular or spinal kinematics in this patient group. ...
... The results verify a biomechanical relationship identified between the humeral, scapular and spinal movements [13][14][15]. Small, but significant changes in spinal kinematics (neck flexion and lateral flexion to the right, thoracic extension and anterior pelvic tilt) were demonstrated from 30 • to 120 • during arm elevation and lowering. This may be influenced by gravity and muscle activity/force, which are different between arm elevation (concentric contraction) and lowering (eccentric contraction) [29]. ...
... However, the differences in spinal movement at the various ranges of movement were similar across all groups, suggesting that scapular dyskinesis does not alter spinal kinematics as such. Previous studies have measured the degree of spinal motion at full unilateral arm elevation in sagittal and scapular planes [13,15]. Of interest, we have shown that the interrelationship between spinal and arm movement occurs throughout arm elevation, and it is not just an end of range phenomenon. ...
Background
Scapular dyskinesis is often observed in patients with neck pain. However, it is unknown whether clavicular, scapular and spinal kinematics vary with different types of scapular dyskinesis during arm movement.
Research question
Are there differences in clavicular, scapular and spinal kinematics during unilateral arm elevation and lowering among neck pain patients presenting with (i) scapular winging, (ii) with dysrhythmia, (iii) with no scapular abnormality and (iv) healthy controls?
Methods
Sixty participants with neck pain (20 in each group) and 20 asymptomatic controls were recruited. The 3D kinematic data were measured during unilateral arm elevation and lowering at 30°, 60°, 90°, and 120° in the scapular plane. A three-way mixed-effects ANOVA was used to determine the main effects (group, phase and angle) and the interactions between three independent variables on the kinematic data.
Results
The neck pain group with scapular winging had decreased clavicular retraction and increased scapular internal rotation and anterior tilt compared to the other neck pain and control groups at all angles during both phases of arm movement (p < 0.01). The neck pain group with scapular dysrhythmia had decreased scapular upward rotation compared to all other groups (p < 0.01). Some alterations in the kinematics existed during the lowering phase compared to the raising phase for all groups (p < 0.05). Spinal kinematics were similar across all groups (p > 0.05).
Significance
Specific patterns of clavicular and scapular kinematics were identified during arm movement relevant to the type of observed scapular dyskinesis in patients with neck pain. Such findings stand to inform more precise and relevant motor training in rehabilitation and improve understanding of the association between altered scapular kinematics and neck pain.
... Healthy people can elevate their arms vertically. However, biomechanical studies have shown that in healthy people, maximal elevation of the global shoulder complex (i.e., humerothoracic elevation resulting from gleno-humeral, scapulo-thoracic, sterno-clavicular and acromio-clavicular joints) is limited to 1508 [1,2], which suggests that other joints contribute to maximal arm elevation. Previous studies showed that the thoraco-lumbar spine participates in arm elevation with a pattern of few degrees of extension and contralateral lateral bending associated with axial rotation; nevertheless, the direction of the coupling between axial rotation and lateral bending varies depending on the measurement method [1,2,[5][6][7] (e-component 1). ...
... However, biomechanical studies have shown that in healthy people, maximal elevation of the global shoulder complex (i.e., humerothoracic elevation resulting from gleno-humeral, scapulo-thoracic, sterno-clavicular and acromio-clavicular joints) is limited to 1508 [1,2], which suggests that other joints contribute to maximal arm elevation. Previous studies showed that the thoraco-lumbar spine participates in arm elevation with a pattern of few degrees of extension and contralateral lateral bending associated with axial rotation; nevertheless, the direction of the coupling between axial rotation and lateral bending varies depending on the measurement method [1,2,[5][6][7] (e-component 1). Little is known about cervical kinematics during arm elevation. ...
... The trunk kinematic pattern shown in the current study is consistent with our previous findings [2]. Nevertheless, some kinematic studies showed discordant results regarding the direction of lateral bending and rotation at the thoraco-lumbar level [1,[5][6][7]. Given the position of the thoraco-lumbar spine below the shoulder, thoraco-lumbar spine movements are able to mechanically supplement the humero-thoracic elevation to fully raise the arm in space (mostly if the arm is already elevated): the thoraco-lumbar extension during flexion and contralateral bending during an abduction task. ...
... 13 Whilst the thoracic spine does not feature strongly in the sporting literature for reasons including its relatively low pain prevalence and challenges with measurement, 16 evidence supports the thoracic spine as playing a significant role in sporting performance, contributing to the estimated 55% of the total force and kinetic energy generated during a throw, 17 around 80% of the total available range of "trunk" axial rotation, 18 and kinematically important to the UL. 19,20 With a three times higher elbow/ shoulder injury prevalence in softball players with low trunk rotation flexibility, 2 and a beneficial effect of an UL injury prevention program including thoracic mobility exercises on shoulder/elbow injury prevalence, 1,21 a greater focus on the thoracic spine, as a discrete region within the trunk and its contribution to UL function, is required. Whilst the concept of "regional interdependence" 22 has contributed to notable growth in research investigating and supporting the use of interventions targeting an asymptomatic thoracic spine in patients with shoulder complaints, [23][24][25] with ostensibly a neurophysiological relationship proposed, 16,26,27 the nature of the kinematic relationship between the thoracic spine and shoulder or UL in an athletic population has not yet been fully established. ...
... All included studies were categorized as exploratory phase 1 studies seeking to identify associations and generate a hypothesis. 35 In view of this and the small sample sizes (ranging [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], the starting GRADE for quality of evidence was rated as low. 35 Across each outcome of interest (uni-, bilateral UL motion), inconsistency of findings is noted with few eligible studies investigating comparable outcomes, just one used an athletic population, 40 imprecision with no effect sizes reported and few presenting confidence intervals and publication bias with all but one using single-sex cohorts. ...
... Further research is now needed to assess this within different athletic populations and to identify whether sport specific adaptations including repetitive movement of the shoulder affects these established relationships. Moreover, a further review needs to be conducted including the studies with participants over the age of 40,19,49 as these could strengthen the relationship of findings within the general population or allow recommendations to be made for the growing population of older athletes. Finally, research needs to assess thoracic spine movement in mid-range and multi-planed functional shoulder movement to better reflect the performance requirements of athletes within and across a number of sports. ...
Background:
Knowledge of the contribution of the thoracic spine movement, a requisite for UL functional movement offers the potential for novel directions for research and management in shoulder rehabilitation.
Objectives:
To synthesise evidence of thoracic spine mobility during UL movement in athletes.
Design:
Systematic review using 3 reviewers at each stage. Key databases (Medline, CINAHL, Web of Science) were searched up to 30/6/18. Eligibility criteria: adults age 18-40 (reflecting athletic population) and studies assessing thoracic spine and UL movement. Quality assessment was evaluated using AXIS tool and GRADE for overall quality of evidence.
Results:
Seven studies were included (n=168, mean age 26.4 years, 33% males) with n=20 in an athlete population. Main findings: Unilateral and bilateral UL flexion resulted in 6.7-8.0 and 12.0-12.8 degree thoracic extension respectively. Unilateral and bilateral UL abduction resulted in 3.0-4.0 and 9.0-15.0 and degrees respectively. Other thoracic spine movement (lower and upper, rotation and lateral flexion) was variable across movement planes.
Conclusion:
There is unequivocal evidence of thoracic spine movement, mainly extension during UL movement and notably at the end of elevation across all planes. Findings support further targeted high quality research and examination of thoracic mobility, an essential link in the kinetic chain, in practice.
... Whilst part of these difficulties could be explained by decreased strength and endurance of the shoulder muscles, altered ventilatory mechanics and cardiorespiratory demand in this arm position (2)(3)(4), the presence of musculoskeletal-related postural and mobility impairments of the upper body quadrant (e.g., forward shoulder positioning, spinal joint mobility) may restrain the mechanics of the upper extremity (5)(6)(7). Arm motion, particularly above shoulders height, involves complex synchronous interactions of the axial skeleton to assist the movements of the arm (kinematic chain of arm elevation) (8,9). Without proper axial skeleton alignment and motion, abnormal scapular kinematics, reduced range of arm elevation motion, disadvantaged force-length relationships and increased activity of agonist and synergistic muscles can be expected (5)(6)(7). ...
... Activities that require placing and moving the upper limb above shoulders height often involve complex interactions of the proximal body segments to assist in the movements of the arm. These interactions occur either to provide a stable postural basis for arm movement or to participate in the kinematic chain in a synergic way during the action of the arm (6,8,9), and have been observed using different instrument, e.g., motion tracking devices (6,8,9) and in different populations, e.g., healthy young adults (6,8,9,18). Results of this study support this rationale by showing a significant relationship between arm elevation and thoracic spine extension, irrespective of group differences. ...
... Activities that require placing and moving the upper limb above shoulders height often involve complex interactions of the proximal body segments to assist in the movements of the arm. These interactions occur either to provide a stable postural basis for arm movement or to participate in the kinematic chain in a synergic way during the action of the arm (6,8,9), and have been observed using different instrument, e.g., motion tracking devices (6,8,9) and in different populations, e.g., healthy young adults (6,8,9,18). Results of this study support this rationale by showing a significant relationship between arm elevation and thoracic spine extension, irrespective of group differences. ...
Patients with chronic obstructive pulmonary disease (COPD) often complain about difficulties in performing activities with their arms above shoulders height. These difficulties have been associated with increased cardiorespiratory demand and altered lung mechanics; however, musculoskeletal-related mechanisms may also contribute to constrain the mechanics of the upper body quadrant, increasing the effort to perform the activities. This exploratory research aimed to assess potential changes in the kinematic chain of arm elevation in patients with COPD. A secondary analysis from a cross-sectional exploratory case-control and prediction study was conducted in 15 patients with COPD (2 females) and 15 controls (8 females) matched for age and body mass index. The sagittal alignment and active range of motion (ROM) of the head, thoracic spine and shoulder complex were measured, using a computer software, in digital lateral photographs obtained in three different testing positions: arms at rest, arms at 90° of shoulder flexion and full arm elevation. From rest to full arm elevation, both groups moved from a more flexed to a less flexed or more upright thoracic spine position (∼7°, p < 0.001, 0.419 <
η
p
2
<0.767). However, the COPD group showed significantly less shoulder flexion (∼12°, p = 0.007, d = 1.05) and thoracic spine extension (∼6°, p = 0.015,
η
p
2
= 0.139) ROM than the control group in the full arm elevation position. These findings suggest that this population may show changes in the kinematic chain of arm elevation that possibly contribute to arm movement-related complains and limited performance in their daily living.
... O complexo do ombro é uma das regiões mais frequentes de busca de auxílio médico e fi sioterapêutico. A articulação glenoumeral sofre diretamente com a necessidade de estabilização e de realização de movimentos de grande amplitude simultaneamente, sendo muitas vezes, a sua alteração biomecânica a causa do impacto subacromial [1,2]. ...
... Se a posição escapular for modifi cada, parece razoável esperar que este padrão normal de movimento integrado seja afetado [3]. O ombro pode infl uenciar o movimento da coluna torácica, mas há pouca evidência sobre este fenômeno [2]. Desvios posturais, como cabeça anteriorizada, ombros anteriorizados (protração escapular), rotação interna do úmero, e aumento da cifose torácica, podem implicar em problemas no ombro [2]. ...
... O ombro pode infl uenciar o movimento da coluna torácica, mas há pouca evidência sobre este fenômeno [2]. Desvios posturais, como cabeça anteriorizada, ombros anteriorizados (protração escapular), rotação interna do úmero, e aumento da cifose torácica, podem implicar em problemas no ombro [2]. Outro fator importante é que, durante a abdução do ombro há um conhecido padrão de movimento integrando a articulação glenoumeral e a articulação escapulotorácica, esse mecanismo é chamado de ritmo escapuloumeral [3][4][5]. ...
O ombro pode influenciar o movimento da coluna torácica e vice-versa, mas há pouca evidência sobre essa relação. Movimentos do ombro associados à coluna cervical e lombar estão bem descritos na literatura. No entanto, há um menor número de dados disponíveis sobre a influência da coluna torácica e de outras estruturas sobre os movimentos do ombro. O objetivo do estudo foi descrever a relação entre a coluna torácica e a função do ombro. Foi realizada uma revisão de literatura nas bases de dados eletrônicos Bireme, Pubmed, Lilacs e Science Direct. Os descritores utilizados foram: coluna torácica, função do ombro e movimentos torácicos, com suas devidas traduções para língua inglesa. A pesquisa abrangeu um intervalo de 17 anos (1994-2011) e retornou 566 trabalhos. Após aplicação dos critérios de inclusão e exclusão, e da análise de duplicidade de citações, restaram 26 fontes. Acredita-se que as alterações posturais e encurtamentos musculares contribuem para disfunções do ombro, porém esses achados não são evidentes em estudos experimentais ou bem instrumentados. Existe uma forte correlação funcional e dinâmica entre movimentos da coluna torácica e os padrões de movimento do úmero e da escápula. A abordagem fisioterapêutica deve contemplar a coluna torácica em indivíduos com dores no ombro.Palavras-chave: parede torácica, articulação do ombro, biomecânica, incapacidade.
... Ba da cze po stu lu ją wpływ usta wie nia głowy i ło pat ki na funk cjo no wa nie mię śni stoż ka ro ta torów [1][2][3][4]. Zna ne są po wia za nia wy ni ka ją ce z ryt mu ło pat ko wo -ra mien ne go [5,6] oraz ana to micz ne po łącze nia wy ni ka ją ce z po dwój nej funk cji mię śni te go rejo nu, dzia ła ją cych za rów no na staw ło pat ko wo -że browy, jak i na sta wy krę go słu pa w czę ści szyj nej i pier siowej [6]. Re la cja mię dzy bó la mi od cin ka szyj ne go a dysfunk cja mi ło pa tek, jak rów nież mię dzy uszko dze nia mi bar ku a usta wie niem i ru cho mo ścią ło pa tek wy ni ka z peł nio nej przez ło pat kę funk cji. ...
... Researchers postulate that head and scapular alignment affects the function of rotator cuff muscles [1][2][3][4]. The effects of the acromioclavicular rhythm are well known [5,6] as well as the anatomical relations resulting from the double function of muscles in this region, affecting both the acromioclavicular joint and the spinal joints in the cervical and thoracic segments [6]. The relationship between neck pain and shoulder blade dysfunction as well as the relationship between shoulder injuries and the alignment and mobility of the shoulder blades result from the function per formed by the shoulder blade. ...
Background. The aim of the study was to compare the distance between the shoulder blades and the spine, flexion and abduction of the shoulder joint and t mo bi lity of the cervical spine in volleyball players and non-athletes. Material and methods. Forty-four male and female volleyball players and 25 non-athletes took a part in the investigation. All participants declared a lack of muscu lo skeletal pain and dysfunctions. The shoulder blade position and the cervical spine mo vement were measured with centimeter tape. The range of motion was measured using a standard goniometer was used. Results The values corresponding to the distance between the medial border of the scapula and the spine as well the flexion and abduction ranges of motion in the shoulder joint are comparable in both groups. Volleyball players were found to have a significantly greater range of flexion, extension and lateral flexion of cervical spine. No statistically significant differences were found in spinal rotation. Conclusions The greater range of flexion, extension and lateral flexion of the cervical spine may indicate the influence of volleyball training on the increase of cervical spine mobility. The functional relationship between the cervical spine and the shoulder girdle requires further investigation.
... Land and Gordon (2016) also recognise the relationship between thoracic spine range of movement and those with SIS. It is noted that in order to complete full arm elevation and achieve full functional shoulder anatomy, good mobility of the thoracic spine is also required (Kebaetse et al., 1999;Theodoridis and Ruston, 2002;Crosbie et al., 2008). Kebaetse et al. (1999) noted in their study of 34 healthy subjects a mean difference of 23.6 change in shoulder abduction corresponding to a mean difference of 12.1 change in sagittal movement of the thoracic spine between full abduction in fully slouched to fully erect sitting posture. ...
... Kebaetse et al. (1999) noted in their study of 34 healthy subjects a mean difference of 23.6 change in shoulder abduction corresponding to a mean difference of 12.1 change in sagittal movement of the thoracic spine between full abduction in fully slouched to fully erect sitting posture. Crawford and Jull's (1993), Theodoridis and Ruston's (2002), Theisen et al.'s (2010), Otoshi et al.'s (2014), Land et al.'s (2017), Kebaetse et al.'s (1999) and Lewis' (2009) studies appear to show that there is some evidence to suggest that enhancing thoracic spine movement is worth consideration and could be beneficial in the management of SIS. ...
Aims:
This study's primary aim is to address two questions. Firstly; what evidence exists regarding the inclusion of increasing thoracic movement within the management of subacromial impingement syndrome SIS?; and secondly, what proportion of Society of Musculoskeletal Medicine (SOMM) physiotherapists use this form of treatment within SIS management?
Methods:
An online survey was conducted using a questionnaire incorporating a vignette describing a patient with chronic SIS. The SOMM physiotherapy members were sampled using convenience sampling.
Findings:
This study has identified some evidence supporting increasing movement of the thoracic spine in the management of patients with SIS. No study or guideline protocols have been identified that advocate the use of this form of treatment, nor research identified that investigates physiotherapists' use of this form of treatment within SIS management. Of the 1340 physiotherapists surveyed, 52 responded of which 79% stated that they would use treatment aimed at increasing movement of the thoracic spine within SIS management. Chi Square analysis suggests no significant association between using this treatment and number of years experience (p value = 0.15) or courses attended (p = 0.62).
Conclusions:
Evidence suggests it is beneficial to include treatment to increase thoracic spine mobility within SIS management. This study highlights the need for the clinician to be aware of the role of the thoracic spine in relation to the biomechanics of the shoulder complex. Of the sample of SOMM physiotherapists obtained, the majority stated that they would use this form of treatment. Further research is recommended.
... Function may increase by using compensatory strategies, such as trunk extension and lateral flexion. 8,23 Our findings support the results of Mosqueda et al, 22 who showed that compensatory neck and trunk movements were noted when there was a lack of external rotation movement. But our study shows a trunk deformity beyond a compensatory movement. ...
... The contribution of the levels between T2 and T7 during upper limb elevation in sagittal and scapular planes in healthy adult women was shown in the study of Theodoridis and Ruston. 23 Likewise, in the study by Willems et al, 29 T4-8 levels were the most mobile segments in the thoracic spine during trunk movements in adults. Similarly, our apex levels were found between T3 and T9. ...
Purpose:
Effects of upper trunk obstetrical brachial plexus palsy (OBPP) on the spinal curvature and relationship between the curvature degrees and upper limb movements have not been reported.
Methods:
Spinal Mouse was used to assess spinal curvature characteristics in the sagittal and frontal planes. Upper limb movements were assessed with using the Active Movement Scale in only study group.
Results:
The degree of frontal plane curvatures was higher in the study group. In the OBPP group, 11 of 25 (44%) children had thoracal C-shaped scoliosis. Nine of these children had contralateral side scoliosis. Shoulder external rotation was inversely correlated with scoliosis angle. Moreover, shoulder external rotation and elbow flexion were lower in children with scoliosis in the OBPP group.
Conclusions:
Upper trunk OBPP may affect frontal plane alignment. Especially insufficient shoulder external rotation scores may lead to constitute thoracal scoliosis as a result of trunk compensation.
... In addition to the humerothoracic motion, the scapula and trunk move concerning each other during upper extremity anterior elevation. Thoracic spine movement has been observed during arm elevation 5) with a correlation between scapular and thoracic spine movement being reported during arm elevation 6) . The scapula is internally rotated, downward rotated, and anteriorly tilted during HBB movement 1,7) . ...
Purpose] This study aimed to clarify the relationship between scapular internal rotation and upper-trunk movement during hand-behind-back movements of the right and left hands. [Participants and Methods] We included 20 healthy right-handed men and measured their hand-behind-back movements while sitting, using a three-dimensional motion capture system. We examined the relationship between scapular internal rotation and upper-trunk movements during hand-behind-back movements with the right and left hands. [Results] The right scapular internal rotation angle was negatively correlated with the anteroposterior tilt angle of the upper-trunk, and increased scapular internal rotation was associated with an increased posterior tilt of the upper-trunk. Moreover, the left scapular internal rotation angle was significantly correlated with the upper-trunk anteroposterior tilt angle and upper-trunk rotation angle, and increased scapular internal rotation correlated with increased anterior tilt of the upper-trunk and contralateral rotation. [Conclusion] Scapular internal rotation during hand-behind-back movements was associated with upper-trunk movement, with differences observed between the right and left hands. It is useful to evaluate and treat the movement of the upper-trunk and scapulothoracic joint on both sides to increase scapular internal rotation during hand-behind-back movements.
... The relationship between scapular and humeral motion was proposed by Codman as the scapulohumeral rhythm 2) , and this rhythm differed between dominant and non-dominant hands 3) . In addition, thoracic spine movement was observed during arm elevation 4) , and a correlation between scapular and thoracic spine movement was observed during arm elevation 5) . ...
Purpose] This study aimed to clarify the changes in the scapulothoracic joint and upper trunk angles and postural control during right–left hand-behind-back (HBB) movement. [Participants and Methods] The participants were 20 healthy right-handed men. We measured the HBB movement while standing using a three-dimensional motion capture system. Changes in the internal rotation angle of the scapulothoracic joint, upper trunk rotation angle, and center of pressure (COP) were examined to assess potential right–left differences between the analyzed positions. [Results] As the thumb touched the buttocks, upper trunk contralateral and scapulothoracic joint internal rotations were observed and the COP on the non-HBB side was significantly displaced laterally. There were no right–left differences in the changes between the analyzed positions for all measures. [Conclusion] Upper trunk contralateral rotation and postural control were conducted without right–left differences during HBB movement. These results suggest that upper trunk movement and standing postural control are involved in HBB movement. Therefore, it is useful to focus on the scapulothoracic joint angle, upper trunk rotation angle, and standing postural control during physical therapy evaluation and treatment with HBB movement.
... This change can be justi ed by alteration in tension of both anterior and posterior oblique slings during pelvic rotation. Also, it can be related to trunk rotation itself as unilateral shoulder movement requires ipsilateral upper thoracic rotation and lateral exion with extension [21,22]. Lateral pelvic tilt didn't signi cantly affect shoulder exion or extension, which means that exion and extension of shoulder is affected by sagittal movement and rotation of the trunk more than frontal trunk movement. ...
Background
pelvis and soulder are deeply intergrated. They are connected by myofscial slings. The pelvic and spinal posture affects the position of the scapula and the activity of its muscles and also affects acromio-humeral distance and so that affects shoulder movement. The aim of the study was to investigate the influence of pelvic position on the shoulder range of motion.
Methods
The full active range of motion (flexion/extension, abduction, and external/internal rotation) of both shoulders was measured by digital goniometer for 33 normal adult subjects. Measurements were taken from standing position in the following pelvic positions: 1- Neutral posture, 2- Evoked anterior and posterior pelvic rotation, 3- Evoked right and left pelvic rotation, 4- Evoked right and left lateral pelvic tilt. For every shoulder movement, One Way ANOVA including Tukey post hoc test was used to compare between different positions.
Results
Anterior pelvic tilt leads to significant increase in flexion and significant decrease in extension of both shoulders (P value was < 0.001). Posterior pelvic tilt leads to the opposite. Pelvic rotation leads to significant decrease in shoulder flexion on the same side of rotation and shoulder extension on opposite side of rotation (P value was < 0.001). Lateral pelvic leads to significant decrease of abduction on the same side of lateral tilt (P value was < 0.001).
Conclusion
pelvic position affects shoulder range of motion
... The sagittal profile can be provided with shoulder girdle corrections while sitting and standing [2,3]. Bilateral and unilateral arm elevations have been indicated to lead to thoracic spine extension [31][32][33][34]. In addition to these studies, Edmondston et al. evaluated the effect of bilateral arm elevation on the extension of the thoracic region more objectively using radiographic and photographic methods and concluded that bilateral arm elevation requires an extension movement close to the full range of motion of the thoracic spine. ...
(1) Background: Semi-hanging and muscle cylinder exercises have been defined as scoliosis-specific corrective exercises. The aim of this study was to evaluate the immediate effect of muscle cylinder and semi-hanging exercises on the angle of trunk rotation in patients with adolescent idiopathic scoliosis (AIS). (2) Methods: Twenty-seven patients with AIS with a mean age of 18.6 years were retrospectively analyzed. The angle of trunk rotation (ATR) values were measured before and after performing semi-hanging and standing muscle cylinder exercises. Both exercises were performed for three to five respiratory cycles. The semi-hanging exercise was performed first, followed by the muscle cylinder exercise, in this order, in all participants. For statistical analysis, the Wilcoxon signed-rank test was used to analyze ATR changes after the exercises, and the Kruskal–Wallis test was used to compare ATR changes according to the main curve location. (3) Results: The thoracic, thoracolumbar and lumbar maximum ATR values were significantly increased after the semi-hanging exercise (p < 0.001) and decreased after the muscle cylinder exercise (p < 0.001). The ATR change was greater in the lumbar region than in the thoracic and thoracolumbar regions. (4) Conclusion: The results of this study of a small group of patients emphasized that one of the scoliosis-specific corrective exercises, the standing muscle cylinder exercise, improved ATR, while the other, the semi-hanging exercise, worsened ATR in patients with AIS. It is recommended that each scoliosis-specific corrective exercise be evaluated and redesigned to maximize the three-dimensional corrective effect, considering the biomechanics of the spine and the pathomechanics of scoliosis.
... From a biomechanical perspective, it has been demonstrated that unilateral side bending, rotation, and extension of the thoracic spine are associated with normal, non-pathologic overhead shoulder movement. (10,11). Because many muscles important for shoulder kinematics are associated to the thoracic region, the scapula and the shoulder's normal physiological function with complete anatomical range are connected. ...
The most typical cause of shoulder or sub acromial pain was impingement syndrome. Between 6.7 and 66.7% of people reported having shoulder pain at some point in their lives, and this frequency increases with age, reaching its peak around 50. The most frequent causes of shoulder pain were rotator cuff disease and adhesive capsulitis, both of which may present with the same signs but differ in the results and consequences of particular therapeutic approaches. Various therapies, such as joint mobilization and therapeutic exercises targeted at particular shoulder tissues, were employed in current practice to treat shoulder pain, but their efficacy was limited.The Mayo hospital in Lahore's OPD physiotherapy department hosted this blinded, controlled trial. In this study, two groups of 40 participants were randomly chosen. Static conservative exercise treatment was used to treat the subjects in Group A. The individuals in Group B received Maitland Thoracic Manipulation as part of a conservative exercise therapy regimen. Each patient signed a Performa, and informed consent was obtained from them all. The Neer Impingement test and a self-made and peer-reviewed questionnaire were both utilized to collect data and determine the prevalence of shoulder impingement syndrome.The findings of this study demonstrated that Maitland manipulation was more successful for treating Shoulder Impingement syndrome than conservative therapy alone.Impingement syndrome was the most common cause of shoulder or sub acromial pain. The incidence of shoulder pain was ranging from 6.7 to 66.7% which increase in frequency as age progresses, peaking at 50 years of age. Rotator cuff pathology and adhesive capsulitis were the most common causes of shoulder pain, may exhibit same findings but with variety of outcomes and effects to specific treatment strategies. In current practice, different interventions were used for treating shoulder pain, such as joint mobilization and therapeutic exercises, directed at specific tissues of the shoulder, but the effectiveness of these treatment options were limited.According to the study, conservative physical therapy combined with Maitland Mobilization and Manipulation is more effective at treating shoulder impingement discomfort and produces greater results than conservative physical therapy alone.
... Also, extension of the thoracic spine may be enhanced further as the child places one or both arms above their head while in the Prone PSP. [100,101,102]. ...
A review of the literature on adolescent idiopathic scoliosis (AIS) reveals that the cause remains unknown. Further, scientific investigation by researchers around the globe has determined that neither the nervous or endocrine systems, nor the muscular, connective, or osseous tissues are the primary causative factors which lead to the development of spinal curvatures as seen in AIS. This report will serve to introduce a new hypothetical model that we have termed, The Nighttime Perfect Storm Hypothesis. The model serves to explain why peripubescent children who have a particular genetic predisposition may be at heightened risk of developing a curvature in their spine if their body is habitually positioned while asleep in what we refer to as the Provocative Sleep Position (PSP). The concept of spinal stabilization is explored with respect to a landmark theoretical model by Panjabi in 1992. In the case of AIS, the childs spinal stabilization has gone completely awry. Through the lens of our hypothesis, this loss of stabilization is due to four interdependent components that may conspire and lead to the perfect storm. These components include 1) a genetic predisposition, 2) sleeping in the Provocative Sleep Position, 3) while in the REM stage of sleep, 4) during the childs peripubescent growth spurt. Included is a complete biomechanical analysis of the childs spine while lying in either the Prone or Lateral PSP, and how this may lead to the development of a thoracic or lumbar curvature, respectively. Finally, we propose a path forward that will make clear the need for subsequent scientific investigation to determine whether or not the The Nighttime Perfect Storm Hypothesis is a viable theory.
... Also, extension of the thoracic spine may be enhanced further as the child places one or both arms above their head while in the Prone PSP. [100,101,102]. ...
A review of the literature on adolescent idiopathic scoliosis (AIS) reveals that the cause remains unknown. Further, scientific investigation by researchers around the globe has determined that neither the nervous or endocrine systems, nor the muscular, connective, or osseous tissues are the primary causative factors which lead to the development of spinal curvatures as seen in AIS. This report will serve
to introduce a new hypothetical model that we have termed, "The Nighttime Perfect Storm Hypothesis." The model serves to explain why peripubescent children who have a particular genetic predisposition may be at heightened risk of developing a curvature in their spine if their body is habitually positioned while asleep in what we refer to as the "Provocative Sleep Position (PSP)." The concept of spinal stabilization is explored with respect to a landmark theoretical model by Panjabi in 1992. In the case of AIS, the child's spinal stabilization has gone completely awry. Through the lens of our hypothesis, this loss of stabilization is due to four interdependent components that may conspire and lead to the perfect storm. These components include 1) a genetic predisposition, 2) sleeping in the Provocative Sleep Position, 3)
while in the REM stage of sleep, 4) during the child's peripubescent growth spurt. Included is a complete biomechanical analysis of the child's spine while lying in either the Prone or Lateral PSP, and how this may lead to the development of a thoracic or lumbar curvature, respectively. Finally, we propose a path forward that will make clear the need for subsequent scientific investigation to determine whether or not the "The Nighttime Perfect Storm Hypothesis" is a viable theory.
... Specifically, our findings indicate that the shoulder girdle functions as a limiting factor for rotational movement in the upper thoracic vertebrae. The scapula and surrounding soft tissues, located posterior/lateral to the thorax, may enhance the stability of the upper thoracic vertebrae (Theodoridis & Ruston, 2002). Thus, our findings suggest that compared to the restriction caused by the ribs, that caused by the shoulder girdle had a greater influence on the difference in the range of rotation between the upper and lower thoracic vertebrae. ...
In humans, the range of thoracic vertebral rotation is known to be greater than that of the lumbar vertebrae due to their zygapophyseal orientation and soft tissue structure. However, little is known regarding vertebral movements in non-human primate species, which are primarily quadrupedal walkers. To understand the evolutionary background of human vertebral movements, this study estimated the range of axial rotation of the thoracolumbar spine in macaque monkeys. First, computed tomography (CT) was performed while passively rotating the trunk of whole-body cadavers of Japanese macaques, after which the motion of each thoracolumbar vertebra was estimated. Second, to evaluate the influence of the shoulder girdle and surrounding soft tissues, specimens with only bones and ligaments were prepared, after which the rotation of each vertebra was estimated using an optical motion tracking system. In both conditions, the three-dimensional coordinates of each vertebra were digitized, and the axial rotational angles between adjacent vertebrae were calculated. In the whole-body condition, the lower thoracic vertebrae had a greater range of rotation than did the other regions, similar to that observed in humans. In addition, absolute values for the range of rotation were similar between humans and macaques. However, in the bone-ligament preparation condition, the upper thoracic vertebrae had a range of rotation similar to that of the lower thoracic vertebrae. Contrary to previous speculations, our results showed that the mechanical restrictions by the ribs were not as significant; rather, the shoulder girdle largely restricted the rotation of the upper thoracic vertebrae, at least, in macaques.
... During unilateral arm elevation in the sagittal and the scapular planes, coupled movements of lateral flexion and rotation of the upper thoracic spine appear ipsilaterally, and these movements are related to the extension of the thoracic spine. [24] In addition, thoracic kyphosis due to increased thoracic flexion in the resting position may alter the relationship between the scapula and the humerus. These alterations may lead to limitations in shoulder ROM and, consequently, the pathology of SIS. ...
The motions of the shoulder are mainly carried out through the glenohumeral joint, but are also assisted by the scapulothoracic joint. Therefore, changes in the biomechanics of the thoracic spine and scapula affect the function of the shoulder. However, there is limited information on the biomechanical and functional characteristics of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome (SIS). In this study, the biomechanical and functional characteristics of the shoulder complex and thoracic spine were analyzed in patients with SIS compared to healthy individuals. A total of 108 participants were included in this study. Participants were classified into 2 groups, the SIS (n = 55) and healthy (n = 53) groups. The shoulder and thoracic range of motion (ROM), scapular position, and isokinetic shoulder strength were measured in all participants. The shoulder ROM was significantly decreased in the SIS group compared to the healthy group (P < .001). The thoracic spine ROM showed significantly limited extension in the SIS group (P < .001). The scapular position showed significantly increased anterior tilting (P = .005), internal rotation (P = .032), protraction (P < .001), and decreased upward rotation (P = .002) in the SIS group. The isokinetic shoulder external rotation (P < .001) and abduction (P < .001) strength were significantly lower in the SIS group. Patients with SIS showed reduced shoulder ROM and end-range extension of the thoracic spine compared to healthy individuals, and the scapula was in a more anterior-tilted, protracted, and downward rotated position. In addition, it showed lower external rotation and abduction strength. These results suggest the need for interventions to improve the limited thoracic extension and altered scapular position, which may affect shoulder ROM and muscle strength in the rehabilitation of patients with SIS.
... These lower values could be explained by the lower range of motion performed during shoulder scaption in the humerus and scapula. According to previous research, during unilateral arm movements, the trunk tends to perform a lateral and axial flexion to reach the full range of motion [1], as well as an extension [45]. The symptomatic group performed a mean of 88.80 • humerus abductions compared to the mean of 138.98 • performed by the asymptomatic group. ...
Shoulder kinematics is a measure of interest in the clinical setting for diagnosis, evaluating treatment, and quantifying possible changes. The aim was to compare shoulder scaption kinematics between symptomatic and asymptomatic subjects by inertial sensors.
Methods:
Scaption kinematics of 27 subjects with shoulder symptomatology and 16 asymptomatic subjects were evaluated using four inertial sensors placed on the humerus, scapula, forearm, and sternum. Mobility, velocity, and acceleration were obtained from each sensor and the vector norm was calculated from the three spatial axis (x,y,Z). Shoulder function was measured by Upper Limb Functional Index and Disabilities of the Arm, Shoulder, and Hand questionnaires. One way ANOVA was calculated to test differences between the two groups. Effect size was calculated by Cohen's d with 95% coefficient Intervals. Pearson's correlation analysis was performed between the vector norms humerus and scapula kinematics against DASH and ULFI results in symptomatic subjects.
Results:
The asymptomatic group showed higher kinematic values, especially in the humerus and forearm. Symptomatic subjects showed significantly lower values of mobility for scapular protraction-retraction (Cohen's d 2.654 (1.819-3.489) and anteriorisation-posteriorisation (Cohen's d 1.195 (0.527-1.863). Values were also lower in symptomatic subjects for velocity in all scapular planes of motion. Negative correlation showed that subjects with higher scores in ULFI or DASH had lower kinematics values.
Conclusion:
Asymptomatic subjects tend to present greater kinematics in terms of mobility, velocity, and linear acceleration of the upper limb, and lower humerus and scapula kinematics in symptomatic subjects is associated with lower levels of function.
... 32 The goal of thoracic mobility exercise was to improve flexibility, due to its relationship to shoulder total shoulder ROM. 33 Even though the effect of thoracic posture on shoulder pain remains uncertain, 34 these exercises relieve symptoms in patients with unspecified shoulder pain. 35 Scapular stability exercises were performed by the patient in order to provide a stable base for the muscles to control arm movements and glenohumeral compression. ...
A 59-year-old male was referred to physical therapy due to shoulder pain. Computed axial tomography reveled a previous sternoclavicular injury, consistent with fracture-dislocation. This report describes the rehabilitation process of the patient with shoulder pain and a history of sternoclavicular joint fracture-dislocation. Thoracic mobility exercises, glenohumeral mobilizations , muscle strengthening, neuromuscular reeducation, and pain science education were used. The patient exhibited improvement in regard to pain, mobility, muscle strength, and self-reported questionnaires.
... Non-dominant shoulder PML inflexibility will result in scapula anterior tilt, consequently impeding clavicular elevation, retraction and posterior rotation, reducing the range of scapula upward rotation required for GH elevation >60 (Crosbie, Kilbreath, & York, 2008;Ludewig & Braman, 2011;Ludewig & Reynolds, 2009). Further, scapula upward rotation has been positively correlated with upper thoracic rotation ROM (Crosbie, Kilbreath, Hollmann, & York, 2008;Fayad et al., 2008;Theodoridis & Ruston, 2002). Although this measurement was not included in this study, these cricketers did demonstrate a delay in non-dominant upward scapula rotation from rest to 90 , indicating potential rotational stiffness in the thoracic spine. ...
Objectives:
To describe the musculoskeletal adaptations inherent to the cricketers' shoulder and determine potential predictors of shoulder injury in elite South African cricketers.
Design:
Prospective longitudinal cohort study; SETTING: Non-clinical, at national cricket indoor training venues.
Participants:
One hundred and six elite cricketers, representing 82% of the South African national and franchise teams, consent. A total of 105 cricketers (27 ± 4 years) were eligible for participation in this study.
Main outcome measures:
A pre-season shoulder screening battery including a shoulder function questionnaire, two ultrasonographic shoulder measurements and 14 musculoskeletal tests including pain provocation, range of motion, strength and flexibility was assessed. Non-contact dominant shoulder injuries were documented throughout the 2016/2017 season.
Results:
The musculoskeletal profile of a cricketer's shoulder is described. 17% (95%CI: 9-24%) of cricketers sustained an injury during the 2016/2017 season. Two of the 17 screening tests predicted seasonal dominant shoulder injury (p < 0.05): a dominant supraspinatus tendon thickness ≥5.85 mm (sensitivity: 72%, specificity: 63%) and non-dominant pectoralis minor length ≤12.85 cm (sensitivity: 83%, specificity: 55%).
Conclusion:
The musculoskeletal adaptations inherent to cricketing shoulders are distinctly different to the classic "thrower's shoulder" described in baseball. A thickened dominant supraspinatus tendon and a shortened non-dominant pectoralis minor muscle are risk factors for developing shoulder injury in this group. This identifies the need to investigate preventative strategies (strengthening/flexibility) and throwing workload management in cricketers with shoulder injury.
... Literature has demonstrated co-existing thoracic pain in musculoskeletal complaints in other regions e.g. neck and elbow (Heneghan et al., 2018a;Roquelaure et al., 2014;Berglund et al., 2008), motion analysis studies where full functional arm elevation is affirmed as a composite of shoulder flexion and thoracic extension (Theisen et al., 2010;Theodoridis and Ruston, 2002) and, TS intervention studies reporting improvements for complaints in the neck (Salom-Moreno et al., 2014;Gonzalez-Iglesias et al., 2009;Cleland et al., 2007aCleland et al., , 2007bSuvarnnato et al., 2013;Young et al., 2004;Cross et al., 2011;Lau et al., 2011), shoulder (Peek et al., 2015;Strunce et al., 2009;Walser et al., 2009;Muth et al., 2012), and low back (Sung et al., 2014). More specifically, passive TS interventions, including joint mobilisation, manipulation, have shown promising improvements in neck (Salom-Moreno et al., 2014;Cleland et al., 2005, https://doi.org/10. ...
... Literature has demon- strated co-existing thoracic pain in musculoskeletal complaints in other regions e.g. neck and elbow (Heneghan et al., 2018a;Roquelaure et al., 2014;Berglund et al., 2008), motion analysis studies where full func- tional arm elevation is affirmed as a composite of shoulder flexion and thoracic extension (Theisen et al., 2010;Theodoridis and Ruston, 2002) and, TS intervention studies reporting improvements for complaints in the neck (Salom-Moreno et al., 2014;Gonzalez-Iglesias et al., 2009;Cleland et al., 2007aCleland et al., , 2007bSuvarnnato et al., 2013;Young et al., 2004;Cross et al., 2011;Lau et al., 2011), shoulder (Peek et al., 2015;Strunce et al., 2009;Walser et al., 2009;Muth et al., 2012), and low back ( Sung et al., 2014). More specifically, passive TS interventions, including joint mobilisation, manipulation, have shown promising im- provements in neck (Salom-Moreno et al., 2014;Cleland et al., 2005 Suvarnnato et al., 2013;Puntumetakul et al., 2015;CasanovaMéndez et al., 2014) and shoulder complaints (Peek et al., 2015;Strunce et al., 2009;Sanzo et al., 2016). ...
Background: The thoracic spine (TS) is relatively under-researched compared to the neck and low back. As the challenge of managing spinal pain persists, understanding current physiotherapy clinical practice for TS pain and dysfunction is necessary to inform future research in this area.
Objective: To investigate physiotherapy practice for managing thoracic spine pain and dysfunction (TSPD) in the UK, with a secondary focus on examining differences across settings and expertise.
Design and Method: A cross sectional e-survey informed by existing evidence was designed. Comprising closed and open questions, the survey is reported in line with Checklist for Reporting Results of Internet E-Surveys. Eligible participants were UK-trained physiotherapists managing patients with TSPD, recruited for 9 weeks up to 8/2/16. Data analysis included descriptive analyses (closed questions) and thematic analysis (open questions).
Results: From the 485 respondents, fulfilling the required sample size, key findings included. Examination: Active motion testing, palpation and postural assessment was ‘always’ undertaken by >89% of respondents.
Management: Active (exercises) and passive (e.g. mobilisations) techniques were used by >85% of respondents, with ~50% using manipulation, taping and acupuncture.
Practice settings: Although broadly similar passive techniques were used more in private practice and sport.
Expertise: Broadly similar patterns were seen for use of exercise across levels of expertise, although differences observed for electrotherapy and manipulation
Conclusion: Despite limited research exercise is widely used in all areas of practice and across all level of expertise. Further research is required to investigate exercise prescription for TSPD and implementation of evidence-based practice.
... However, it has been suggested that restrictions in this mobility of the thoracic spine may impair functioning of anatomically related regions, such as the shoulder, and predispose it to pain or injury (Sueki, Cleland, & Wainner, 2013). Research focusing on this regional interdependence (RI) has shown that individuals with restricted thoracic spine mobility tend to experience a decrease in shoulder function, symptoms of shoulder impingement and pain (Edmondston et al., 2012;Meurer, Grober, Betz, Decking, & Rompe, 2004;Theodoridis & Ruston, 2002). In addition, patients with signs of impingement seem to present more often with thoracic hyperkyphosis compared to healthy subjects (Gray & Grimsby, 2004;Grimsby & Gray, 1997;Pollard & Fernandez, 2004). ...
Objectives
Measuring thoracic spine mobility can be of interest as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the “lumbar-locked rotation test” for thoracic spine rotation in competitive swimmers between the ages of 10 and 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers.
Design
Within-session, intra- and inter-rater reliability.
Setting
Two competitive swimming clubs in Flanders, Belgium.
Participants
21 competitive swimmers.
Main outcome measures
Intra- and inter-rater reliability of the lumbar-locked thoracic rotation test.
Results
Intraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89–0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72–0.95) to 0.86 (0.65–0.94) respectively for right and left thoracic rotation.
Conclusion
Results suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice.
... Shoulder elevation is a complex motion that occurs because of combined humerus, clavicle, spine, and scapula movement (Inman et al., 1996;Theodoridis and Ruston, 2002). The scapula plays a critical role in supporting a wide range of glenohumeral motions and normal shoulder function (Kibler, 1998). ...
The scapula plays a critical role in supporting shoulder function. Considering the closed anatomical relationship between the scapula and the thoracic cage, the presence of postural disturbances could be linked to alterations in the scapular position and orientation in adolescent idiopathic scoliosis (AIS). However, currently there is a lack of descriptive research and detailed assessment of scapular kinematics in AIS. The aim of this study was to investigate the three-dimensional scapular kinematics in AIS. Nineteen AIS patients and fourteen healthy controls participated in this study. Bilateral shoulder kinematics were measured with an electromagnetic tracking device during shoulder elevation in the sagittal, scapular, and frontal planes. Data for the scapular orientation were analyzed in the resting position and at 30°, 60°, 90°, and 120° of humerothoracic elevation. Scapular behavior was different in participants with AIS, compared to healthy controls, with different patterns observed on convex and concave sides. While examining all three planes of elevation, the scapula was more internally and anteriorly tilted on the convex side, while the scapula was more externally, downwardly rotated, and posteriorly tilted on the concave side in participants with AIS. Furthermore, there was a decreased peak humerothoracic elevation and altered scapular posterior tilt in participants with AIS in the resting position. These findings increase our knowledge and understanding of scapular alterations and the reported scapular alterations can be considered as adaptive compensation strategies in AIS.
... The pain and range of motion (ROM) changes in the cervical spine could be a result of intervention on the thoracic spine [4,5]. Clinically, many findings suggest that when assessing and applying therapeutic move-ment techniques on the thoracic spine, a therapist should consider the ipsilateral coupling of lateral flexion and rotation [3,6,7]. It is important to measure relevant thoracic spine range of movement measurement during physical therapy assessment and applying movement techniques [8]. ...
... 5 upwards rotation at the scapulothoracic joint is accompanied by up to 30° of scapula posterior tilt, 39 further reducing the compression imposed on the subacromial tissue. 34 in the sagittal plane, thoracic extension is synchronised with shoulder elevation, 16,17,50 and contributes to total range of motion during shoulder elevation. 16 due to the structural composition of the facet joints and rib attachments, extension occurs predominantly in the lower region, with smaller contributions from the upper region of the thorax. ...
Thoracic spine function is vital in preserving health to the glenohumeral joint, reducing the risk for shoulder joint pathology. Ideal alignment of the thorax not only supports efficient kinematics of the scapulothoracic joint, but also supports the force development of key stabilising muscles that influence the shoulder complex. This article will present evidence about the thorax and its influence on shoulder performance, as well as providing methods to screen and self-manage the thoracic spine in order to optimise function at the shoulder girdle.
... But there are reports in the literature that the restrictions of thoracic movements may interfere in the kinematics of the glenohumeral ligament complex compromising its function. (5)(6)(7)(8) Regarding the techniques used in manual therapy, spinal manipulation is used to describe a technique performed on the spine, which exert a small-amplitude and high-velocity dynamic impulse known as "thrust". This procedure provides changes in reflex excitability and sensory processing. ...
Introduction: Few studies which proposes to identify the relationship of spinal manipulation on pain and shoulder mobility, especially in rotator cuff injuries. Objective: The aim of this study was to analyze the effects of vertebral spine manipulation on pain and shoulder range of motion in individuals with rotator cuff tendinopathy. Methodos: This is a quasi-experimental study with a quantitative approach. The sample consisted of subjects aged between 20 and 70 years, with painful tendinopathy of the Rotator Cuff (TMR) for at least six months. An evaluation form was applied regarding the identification data. After this, it was assessed the kinetic-functional rating, pain by Visual Analog Scale (VAS) and Range of Motion (ROM) of the shoulder (flexion and abduction) in the goniometer. Following this, it was performed the vertebral spine manipulation ("Crusaders Pisiformes") on the thoracic spine and, subsequently it was evaluated the ROM and pain. Statistical analysis verified data normality by the Shapiro-Wilk test, comparing the effect of pre- and post handling. Paired t test was applied and the significance level was considered as 5%. Results: The pain after spinal manipulation had a significant reduction (p=0,019). The movement of flexion after manipulation showed an increase in ADM's shoulder injury, but not significant (p=0,058), while for the abduction movement was recorded a significant increase in both shoulder injury (p=0,01), as to the shoulder without injury (p=0,03). Conclusion: that after vertebral spine manipulation it was possible to verify the reduction of shoulder pain, and the increased ROM's shoulder injury in the movement of abduction as well as the increased ROM in the abduction movement of the shoulder without injury.
... In swimming this can relate to the achievement of a streamlined body position. In throwing-sports this relates to force generation as well as maximal and sport-specific GHJ range of motion (Culham & Peat, 1993;Edmondston et al., 2011;Kebaetse, McClure, & Pratt, 1999;Kennedy, Visco, & Press, 2009;Theodorisis & Ruston, 2002;Wilk et al., 2002). ...
Objectives:
To evaluate biomechanically the relationships between the outcome of the Combined Elevation Test, its component joint motions, and thoracic spine angles.
Design:
Cross-sectional study.
Setting:
Laboratory.
Participants:
18 elite swimmers and triathletes (11 males and 7 females).
Main outcome measures:
Combined Elevation Test outcome in forehead and chin positions. Individual joint contributions to test outcome.
Results:
No sex differences were found in test components, or between head positions. Test outcome was greater in the forehead position than the chin position (34.3 cm vs 30.2 cm; p < 0.001). The variables most strongly associated with test outcome were glenohumeral joint flexion (r = 0.86-0.97; p < 0.001), and shoulder retraction (r = 0.75-0.82; p < 0.001). Total thoracic spine angle related strongly to test outcome in females (r = -0.77 to -0.88; p < 0.05), but not in males (r = -0.17 to -0.24; p > 0.05).
Conclusions:
The Combined Elevation Test is an effective screening tool, measuring upper limb mobility into shoulder flexion and scapula retraction in both sexes, and thoracic extension in women. It is recommended that the test be performed in the forehead position. If a subject performs poorly on the test, follow up assessments are required to identify the impairment location.
... During shoulder elevation, extension of the spine, particularly in the thoracic region, promotes efficient shoulder function through its interaction with the scapula (11,12). Spinal extension has been shown to be continuous throughout shoulder elevation (11,69), with a dynamic relationship existing between the upper and lower Thoracic extension is also crucial in permitting the 20-308 of posterior tilt needed at the scapula to alleviate subacromial impingement (49). As the scapula in most cases follows the contours of the thorax, a hyperkyphotic thoracic posture inclines the scapula anteriorly (45). ...
Overhead exercises are common place in many strength and conditioning programs. An essential element of supporting load above head is the demonstration of optimal joint kinematics at the shoulder complex. This article will consider various dysfunctional movement strategies that may present during overhead lifting exercises, potentially exposing an athlete to pathology. A screening process will also be discussed, providing coaches with a thought-process in which they may assess an athlete's suitability for overhead lifting exercises based on their movement competency.
Background
Upper limb elevation begins with core stabilization, but the effects of core stability on shoulder and spine kinematics are unknown. Sex differences also exist in shoulder kinematics and core stability.
Objective
To clarify the effects of core stability on shoulder and spine kinematics during upper limb elevation by taking sex into account.
Design
Cross-sectional.
Methods
The Sahrmann Core Stability Test, lumbar spine motor control test battery, and Y Balance Test (lower and upper quarters) were performed in 50 healthy young adults. For each test, a principal component (PC) analysis was conducted according to sex; the overall core stability score was calculated. The top and bottom third of the PC scores were defined as high and low score groups, respectively (each group: nine males and eight females). Shoulder and spine kinematics during upper limb elevation were compared separately for males and females.
Results
Spinal extension was greater in the low score group by a maximum of 1.9° in males (P < .001; η² = 0.068) and 1.6° in females (P < .001; η² = 0.141). In the low score group of females, the scapular posterior tilt was a maximum of 5.6° smaller (P < .001; η² = 0.221) and glenohumeral elevation was a maximum of 4.5° larger (P < .001; η² = 0.113) than the high score group of females.
Conclusion
Core stability affected spine and female scapular and glenohumeral kinematics during upper limb elevation. Core stability may be one of the potential contributors to shoulder kinematics, particularly in females.
Background
We often clinically observe individual differences in arm elevation angles, but the motion producing these differences remains unclear, partly because of the difficulty of accurately measuring scapular motion. The aim of this study was to determine whether the scapular or glenohumeral (GH) motion has more influence on differences in the arm elevation angles by capturing not only the humerus and scapula but also the trunk using two- (2D) and three-dimensional (3D) shape-matching registration techniques.
Methods
Fifteen healthy subjects (13 male and 2 female; mean age: 27.7 years) were instructed to elevate their arms in the sagittal, scapular, and coronal planes. They were divided into high and low groups based on the average of arm elevation angle measured by a goniometer. The 3D scapular, thoracohumeral, and glenohumeral motions were evaluated using 2D/3D single-plane registration. To compare 3D motions between groups, we performed a two-way repeated measures analysis of variance.
Results
Eight subjects were assigned to the high group, while seven subjects were assigned to the low groups based on an average elevation angle of 172°. The low group demonstrated a significant larger scapular protraction during elevation in all planes (P = 0.0002 for flexion; P = 0.0047 for scaption; P = 0.0314 for abduction), and smaller posterior tilting only during flexion (P = 0.0157). No significant differences occurred in scapular upward rotations or the glenohumeral positions and rotations.
Conclusions
This study revealed that insufficient scapular retraction and posterior tilting results in lower arm elevation angles, suggesting that improving the flexibility and activation of muscles surrounding the scapula may be important to achieve complete arm elevation.
Purpose: Upper extremities are important to perform activities of daily living. Although, the relationship between upper extremity movements and spinal region is known; to the best of our knowledge, the relationship between unsupported upper extremity exercise capacity (UUEEC) and spinal mobility has not been studied. The first aim of our study was to examine the relationship between the UUEEC and spinal mobility. The second aim of the study was to determine whether spinal mobility is a predictor of the UUEEC. Methods: The study design was cross-sectional. Forty asymptomatic and volunteer individuals were included in the study. The 6-minute pegboard and ring test (6PBRT) was performed to assess the UUEEC. Spinal mobility was assessed to use a hand-held, computer-assisted electromechanical device. The analysis of spinal mobility in the sagittal (SAP – maximal extension/flexion) and the coronal (CRP – maximal left/right lateral flexion) plane was measured. Results: The 6PBRT score had significant correlation with the SAP spinal mobility (r=0.361, p=0.022) and the CRP spinal mobility (r=0.322, p=0.043). Stepwise multiple linear regression analysis demonstrated that the SAP spinal mobility was significant and independent determinants of the 6PBRT score with 11% of the variance. Conclusions: In this first study in the literature investigating the relationship between spinal mobility and the UUEEC, the SAP spinal mobility was found as a predictor of the UUEEC in asymptomatic individuals. This study demonstrates that the UUEEC can be improved by increasing spinal mobility.
[Purpose] To clarify changes in shoulder joint, glenohumeral joint, and scapular movements with thoracic motion restriction. [Participants and Methods] Twenty healthy males performed anterior elevation of both upper limbs in a standing position with and without thoracic motion restriction to compare the shoulder flexion, glenohumeral flexion, and scapular posterior tilt angles. Variations in these changes among participants were also examined. [Results] Thoracic motion restriction significantly reduced the shoulder flexion and scapular posterior tilt angles, whereas significant differences were not observed in the glenohumeral flexion angle. On the other hand, the increases or decreases in the glenohumeral flexion and scapular posterior tilt angles varied among participants. [Conclusion] The decrease in the shoulder flexion angle may be explained by a reduced scapular posterior tilt due to thoracic motion restriction, but the degree of such a change varied among participants.
Background
The thoracic spine is critical for athletic kinetic chain functioning yet widely overlooked in terms of specific evidenced based exercise prescription. Thoracic mobility, motor control and strength are required to optimise performance in sport and minimise excessive load/stress on other components of the kinetic chain.
Objective
To identify and evaluate mobility, motor control, work capacity and strength thoracic exercises for use in athletes
Design
Systematic review involving expert reviewers at key stages: searches and screening (n=1), eligibility, evaluation, data extraction, and evaluation (n=3). Key databases and social media sources were searched to 16/8/2019. Eligible exercises were thoracic exercises to promote mobility, motor control, work capacity and strength. A narrative synthesis enabled an outcome-based classification of exercises, with level of evidence of individual sources informing overall level of evidence for each outcome (Oxford Centre for Evidence-based Medicine).
Results
From 2348 sources (social media, database searches and other sources), 38 exercises were included. Sources included images, video clips, & written descriptions of exercises. Exercises targeting all planes of motion were evaluated and classified according to outcome. Exercises comprised functional and non-functional exercises for mobility (n=9), work capacity (n=15), motor control (n=7) and strength (n=7). Overall level of evidence for each outcome was level 5.
Conclusion
This synthesis and evaluation of exercises has captured the scope of thoracic exercises used in ‘practice’. Evaluation against an expert derived outcome based classification provides practitioners with a framework to facilitate exercise prescription. Evaluation of validity and effectiveness of exercises on outcomes is now required.
Background
The rib cage, such as the thoracic spine and ribs, influences glenohumeral mobility and the development of shoulder disorders.
Objective
To evaluate movements of the ribs, thoracic vertebrae during bilateral arm elevation and to clarify the characteristic influences of age and gender.
Methods
Subjects comprised 33 healthy individuals divided into a young group (10 males, 7 females; mean age, 25 years) and a middle-aged group (8 males, 8 females; mean age, 52 years). Chest CT was performed with two arm positions: arms hanging downwards; and arms elevated at 160°. Images were three-dimensionally reconstructed to evaluate rib movement, extension angle of thoracic vertebrae.
Results
Maximal movement was observed at the fifth rib, and rib movement decreased with increasing distance from the fifth rib in both the groups. In males, movement of the second to fourth ribs was smaller in the middle-aged group than in the young group ( p < 0.05). Movement of the first to ninth ribs was smaller in females than in males ( p < 0.05). No significant difference in the extension angle of the thoracic vertebrae was found.
Conclusion
Fifth rib movement is the largest among all ribs during bilateral arm elevation. Reduction of upper rib movement initially arises as an age-related degradation in males. Women exhibit less rib movement during bilateral arm elevation.
Context:
Spinal axial rotation is required for many functional and sporting activities. Eighty percent of axial rotation occurs in the thoracic spine. Existing measures of thoracic spine rotation commonly involve laboratory equipment, use a seated position, and include lumbar motion. A simple performance-based outcome measure would allow clinicians to evaluate isolated thoracic spine rotation. Currently, no valid measure exists.
Objective:
To explore the criterion and concurrent validity of a digital inclinometer (DI) and iPhone Clinometer app (iPhone) for measuring thoracic spine rotation using the heel-sit position.
Design:
Controlled laboratory study.
Setting:
University laboratory.
Participants:
A total of 23 asymptomatic healthy participants (14 men, 9 women; age = 25.82 ± 4.28 years, height = 170.26 ± 8.01 cm, mass = 67.50 ± 9.46 kg, body mass index = 23.26 ± 2.79) were recruited from a student population.
Main outcome measure(s):
We took DI and iPhone measurements of thoracic spine rotation in the heel-sit position concurrently with dual-motion analysis (laboratory measure) and ultrasound imaging of the underlying bony tissue motion (reference standard). To determine the criterion and concurrent validity, we used the Pearson product moment correlation coefficient (r, 2-tailed) and Bland-Altman plots.
Results:
The DI (r = 0.88, P < .001) and iPhone (r = 0.88, P < .001) demonstrated strong criterion validity. Both also had strong concurrent validity (r = 0.98, P < .001). Bland-Altman plots illustrated mean differences of 5.82° (95% confidence interval [CI] = 20.37°, -8.73°) and 4.94° (95% CI = 19.23°, -9.35°) between the DI and iPhone, respectively, and the reference standard and 0.87° (95% CI = 6.79°, -5.05°) between the DI and iPhone.
Conclusions:
The DI and iPhone provided valid measures of thoracic spine rotation in the heel-sit position. Both can be used in clinical practice to assess thoracic spine rotation, which may be valuable when evaluating thoracic dysfunction.
A number of studies have described typical scapular kinematics during arm elevation in adults. However, spinal structure and function differ between normal and elderly adults. To our knowledge, trunk kinematics during arm elevation in the elderly has never been clarified. The purpose of this study was to describe and compare the kinematics patterns of the trunk during arm elevation between normal and elderly adults. Forty-one normal adults (14 male and 27 female, mean age 22.1 ± 1.1 years) and twenty-eight elderly adults (8 male and 20 female, mean age 75.8 ±7.2 years) participated in this study. The kinematics data were collected using an analog digital measuring device to record the sagittal outline of the back by using the Spinal Mouse system (Idiag AG, Switzerland). Subjects were instructed to raise their arm in the scapular plane, and measurements were performed with the arm in the dependent position, at 0, 30, 60, 90, 120, 150 degrees of abduction, and maximum abduction. The normal adult group demonstrated a significant decrease in thoracic kyphosis at 150 degrees and maximum abduction, and an increase in pelvic tilt at the maximum abduction ; while the elderly group showed no significant differences. This study demonstrates that there are significant differences in thoracic and pelvic kinematics patterns between normal adults and elderly adults. From a clinical prospective, these results can be applied to improve shoulder movements in the elderly.
Human body motions have been analysed for decades with a view on enhancing occupational well-being and performance of workers. On-going progresses in miniaturised wearable sensors are set to revolutionise biomechanical analysis by providing accurate and real-time quantitative motion data. The construction industry has a poor record of occupational health, in particular with regard to work-related musculoskeletal disorders (WMSDs). In this article, we therefore focus on the study of human body motions that could cause WMSDs in construction-related activities. We first present an in-depth review of existing assessment frameworks used in practice for the evaluation of human body motion. Subsequently different methods for measuring working postures and motions are reviewed and compared, pointing out the technological developments, limitations and gaps; Inertial Measurement Units (IMUs) are particularly investigated. Finally, we introduce a new system to detect and characterise unsafe postures of construction workers based on the measurement of motion data from wearable wireless IMUs integrated in a body area network. The potential of this system is demonstrated through experiments conducts in a laboratory as well as in a college with actual construction trade trainees.
Study Design: The contribution of transversus abdominis to spinal stabilization was evaluated indirectly in people with and without low back pain using an experimental model identifying the coordination of trunk muscles in response to a disturbance to the spine produced by arm movement. Objectives: To evaluate the temporal sequence of trunk muscle activity associated with arm movement, and to determine if dysfunction of this parameter was present in patients with low back pain. Summary of Background Data: Few studies have evaluated the motor control of trunk muscles or the potential for dysfunction of this system in patients with low back pain. Evaluation of the response of trunk muscles to limb movement provides a suitable model to evaluate this system. Recent evidence indicates that this evaluation should include transversus abdominis. Methods: While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the contralateral deltoid was evaluated using fine‐wire and surface electrodes. Results: Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles. Conclusions: The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.
A new method for the non-invasive three-dimensional measurement of human lumbar movement is described. The electro-magnetic 3space Isotrak system was found to be accurate and reliable, having a total r.m.s. error for rotations of less than o·2°. The system was able to produce consistent plots of subjects' movement patterns and it is proposed that this system should be evaluated in respect of its discriminatory and predictive potential in clinical studies of low back disorders. It may then become a useful tool in the routine clinical assessment of patients with spinal disorders, providing a complete quantification of back kinematics quickly and efficiently.
The relationships between range of bilateral arm elevation, thoracic extension range used in this task and thoracic posture were examined in 60 normal females assigned to either younger or older groups. Arm elevation was measured with a Myrin goniometer and thoracic kyphosis and extension range by two inclinometers. The results indicate that bilateral arm elevation induced an average of 15 degrees and 13 degrees of thoracic extension in the younger and the older groups, respectively. This represented half of the available extension range in the young subjects, but nearly 70% of available range in the older subjects. A strong relationship was found between range of arm elevation and range of thoracic extension used in this movement in younger subjects. A large kyphosis was associated with reduced arm elevation in older subjects.
The thoracic spine is a complex area of three dimensional movement which exhibits coupled movement patterns. There is no data quantifying and describing the thoracic movement occurring with the functional activity of unilateral arm elevation. A Fastrak 3-D Movement System was used to measure and describe the pattern of motion in the upper (T1–6) and lower thoracic (T6–12) regions during full arm elevation in 20 young female adults. Analysis revealed that motion occurred in both upper and lower thoracic regions although its magnitude in any region or direction was no more than six degrees. Movement was coupled in nature but lateral flexion and rotation could be related either ipsilaterally or contralaterally. There was considerable variation in movement patterns between individuals
The contribution of transversus abdominis to spinal stabilization was evaluated indirectly in people with and without low back pain using an experimental model identifying the coordination of trunk muscles in response to a disturbances to the spine produced by arm movement.
To evaluate the temporal sequence of trunk muscle activity associated with arm movement, and to determine if dysfunction of this parameter was present in patients with low back pain.
Few studies have evaluated the motor control of trunk muscles or the potential for dysfunction of this system in patients with low back pain. Evaluation of the response of trunk muscles to limb movement provides a suitable model to evaluate this system. Recent evidence indicates that this evaluation should include transversus abdominis.
While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the surface electrodes.
Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles.
The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.
OBJECTIVE: To assess and improve methodological constraints of the 3SPACE ISOTRAK. DESIGN: Several data sets were used to evaluate the following constraints: the performance is adversely affected by close proximity of metallic objects or electromagnetic fields; the3SPACE field contaminates electromyography recordings; and cross-talk from one axis to the other two occurs if the Euler rotation sequence is not matched to the orthopaedic description and function of the joint in question. BACKGROUND: The 3SPACE ISOTRAK is one of the few instruments suitable for measurement of relative three-dimensional joint rotation, however several methodological constraints exist. RESULTS AND CONCLUSIONS: Generally, accuracy can be maintained by restricting offending objects from the sensitive zone between the transmitter and sensor and using long leads to afford the subject distance from computers and other electrical instrumentation; while contamination of EMG amplitude in the time domain can be minimized by using quality instrumentation, and on occasion modifying electrode orientation. Contamination of the EMG frequency content appears unavoidable at low levels of muscle contraction; and cross-talk between axes is minimized by matching the first Euler rotation with the axis of the joint that is characterized by the greatest expected angular displacement. RELEVANCE: The 3SPACE ISOTRAK is one of the few instruments available that is suitable for measuring three axes of relative joint motion (local joint axes that rotate with the joint -- not global). This paper suggests several techniques to increase the accuracy and viability of this instrument.
OBJECTIVE: To provide preliminary data on three-dimensional thoracic spine kinematics measured in vivo. DESIGN: This study measured the three planes of thoracic spine motion in normal subjects using an external measuring device. BACKGROUND: Few studies have investigated the primary and associated coupled rotations in the thoracic spine in vivo. Most knowledge of motion characteristics comes from in vitro studies which have limitations. There is a lack of agreement on the patterns of thoracic coupled motion especially that between lateral flexion and axial rotation. METHODS: Thoracic motion was examined in 60 normal subjects (30 males, 30 females) aged 18-24 years. The primary and coupled rotations of the thoracic regions T(1-4), T(4-8), T(8-12) were measured using a 3 SPACE Fastrak system. RESULTS: The three thoracic regions displayed the characteristic variations in range and distribution of primary rotations previously described. The pattern of coupled motion varied between subjects but an ipsilateral pattern predominated between lateral flexion and axial rotation in the middle and lower thoracic regions while the upper thoracic region was found to exhibit either a contralateral or ipsilateral pattern. Gender did not influence results. CONCLUSIONS: The pattern of coupled motion in the thoracic spine demonstrated some variability between subjects in vivo. Lateral flexion and axial rotation were strongly coupled with overall, their relationship being predominantly ipsilateral.
Interactions between thoracic spine posture and mobility are believed to play a role in the development of spinal pain syndromes. Accordingly, appropriate and effective manual therapy management is dependent on a sound knowledge of the anatomy and biomechanics of this region of the vertebral column. This paper reviews the primary anatomical influences on thoracic posture, mobility and stability. The consequences of anatomical variation and degenerative change, their effect on thoracic kyphosis, and the range and patterns of thoracic movement, are examined. The implications for assessment and management of thoracic spine dysfunction are discussed together with some considerations for the application of manual therapy treatment. Copyright 1997 Harcourt Publishers Ltd.
To generate gender-specific and broadly based age-related indices for normative lumbar ranges of motion for all planes of movement.
This was a repeated measures prospective study of spinal range of motion in a sample of volunteer subjects utilizing a portable modified CA6000 Spine Motion Analyzer (Orthopedic Systems Inc., Union City, CA, USA).
Data collection was carried out in a variety of community locations including fire, police and ambulance stations, offices and community centres.
A total of 405 asymptomatic subjects (196 female, 209 male) were recruited, aged 16-90 years, from sedentary, mixed and physically demanding occupations.
Indices of lumbar spine ranges of motion were measured in standing following a standardized protocol for sagittal flexion/extension, coronal lateral flexion and horizontal axial rotation movements.
Male and female normative flexion ranges declined by approximately 40% (72-40 degrees) across the age spectrum. Extension declined the greatest, by approximately 76% (29-6 degrees) overall. In lateral flexion male and female ranges declined approximately 43% (29-15 degrees) in each direction (total 58-30 degrees). In axial rotation no age-related decline was observed and ranges of motion remained at approximately 7 degrees in each direction (total 14 degrees) across all the ages of the subject group.
Data have been generated that provide comprehensive, gender-specific, broadly based and age-related indices for normative lumbar ranges of motion in all planes of movement. These are applicable to individuals throughout adult life, from adolescence through to old age.
Manual therapy for the thorax--a biomechanical approach
- D G Lee
Influence of circadian variation on spinal examination
- L S Gifford