Article

The effect of shoulder movements on thoracic spine 3D motion

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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.

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... 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]. ...
Article
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.
... 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. ...
Article
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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.
... Activities that require placing and moving the upper limb above shoulders height often involve complex interactions of the proximal body segments to assist 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 [3,[13][14][15]. The results of this study support this rationale by showing a significant relationship between arm elevation and thoracic spine extension. ...
... The results of this study support this rationale by showing a significant relationship between arm elevation and thoracic spine extension. Irrespective of group differences, our findings are in accordance with previous research that examined shoulder and thoracic spine kinematics during arm elevation, using other instruments (e.g., motion tracking devices) [3,14,15], or different populations (e.g., healthy young adults) [3,10,14,15]. ...
... The results of this study support this rationale by showing a significant relationship between arm elevation and thoracic spine extension. Irrespective of group differences, our findings are in accordance with previous research that examined shoulder and thoracic spine kinematics during arm elevation, using other instruments (e.g., motion tracking devices) [3,14,15], or different populations (e.g., healthy young adults) [3,10,14,15]. ...
Conference Paper
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Patients with Chronic Obstructive Pulmonary Disease (COPD) often complain about difficulties in performing activities above shoulders height. These difficulties have been associated with altered lung mechanics; however, musculoskeletal mechanisms may also contribute to restrict the biomechanics of the upper body quadrant, increasing the effort. The purpose of this research was to explore the capacity of this population to fully elevate the arms in the standing upright position and the contribution of the thoracic spine posture and mobility to such task. Fifteen patients with COPD and nineteen age-matched healthy controls volunteered to participate in this study. Sagittal alignment and range of motion (ROM) of the thoracic spine and shoulder joint were measured, using a computer software, in digital lateral photographs obtained in 3 different testing positions: arms at rest, arms parallel to the ground (90º of shoulder flexion) and full arm elevation. Patients with COPD showed significantly less shoulder flexion (~11º) and thoracic spine extension (~5º) ROM than their healthy counterparts in full arm elevation position. These findings suggest that this population may show mobility impairments of the upper body quadrant that possibly contribute for further deteriorating functionality in their daily living.
... 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. ...
... 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. ...
Article
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.
... 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. ...
Article
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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.
... A hydrogoniometer placed on the participant's arm was used to position the arm at 0 and 60 of scapular plane elevation (Hebert et al., 2000). To assist in positioning arm elevation in the scapular plane, a room divider was positioned at an angle of 30 forward from the subject's frontal plane, which was marked with tape on the floor (Theodoridis and Ruston, 2002). The participants were asked to maintain their arm elevated actively with enough tension to maintain the position of the hydrogoniometer (Fig. 3). ...
... The participants were asked to maintain their arm elevated actively with enough tension to maintain the position of the hydrogoniometer (Fig. 3). Between measurements, participants were instructed to bring their arm down to a resting position to minimise shoulder fatigue (Theodoridis and Ruston, 2002). ...
Article
The first aim of this study was to investigate whether kinesiotaping (KT) can increase the acromiohumeral distance (AHD) in asymptomatic subjects in the short term. The second aim was to investigate whether the direction of kinesiotaping application influences AHD. In recent years, the use of KT has become increasingly popular for a range of musculoskeletal conditions and for sport injuries. To date, we are unaware of any research investigating the effect of kinesiotaping on AHD. Moreover, it is unknown whether the direction of kinesiotaping application for the shoulder is important. Forty nine participants were randomly assigned to one of three groups: kinesiotaping group 1 (KT1), kinesiotaping group 2 (KT2) and sham kinesiotaping (KT3). AHD ultrasound measurements at 0° and 60° of shoulder elevation were collected at baseline and immediately after kinesiotape application. The results showed significant improvements in AHD after kinesiotaping, compared with sham taping. The mean difference in AHD between KT1 and KT3 groups was 1.28 mm (95% CI: 0.55, 2.03), and between KT2 and KT3 was 0.98 mm (95% CI: 0.23, 1.74). Comparison of KT1 and KT2 groups, which was performed to identify whether the direction of taping influences the AHD, indicated there were no significant differences. KT increases AHD in healthy individuals immediately following application, compared with sham kinesiotape. No differences were found with respect to the direction in which KT was applied.
... 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. ...
Article
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. ...
Article
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.
... 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). ...
Article
Full-text available
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.
... Being the longest and most anatomically complex spinal region has likely hampered the development of measurement tools to assess thoracic movement (Heneghan et al., 2009). Unlike movement analysis in the cervical and lumbar region, where the cervical range of movement device (Audette et al., 2010) and modifiedemodified Schober test (Tousignant et al., 2005) respectively provide reliable and valid non-invasive and clinically useful tools, movement analysis of the thoracic region has relied on gross measures of thoracolumbar movement (Johnson et al., 2012), expensive equipment (Willems et al., 1996;Theodoridis and Ruston, 2002;Edmondston et al., 2007), and/or imaging technologies (Burwell et al., 1999;Kouwenhoven et al., 2006;Heneghan et al., 2009). ...
Article
The thoracic spine has for a long time been the 'Cinderella' region of the spine. There has been a lesser research focus to the thoracic region compared with the cervical and lumbar spine, and there continues to be a limited understanding of the aetiology and epidemiology of a range of neuromusculoskeletal presentations which have an anatomical connection to the thoracic spine. This paper firstly, provides a critical evaluation of the available evidence to provide some understanding for this under-exploration of the thoracic spine. Secondly the paper provides an evaluation of an emerging interest in this spinal region, with a body of evidence supporting the use of thoracic spine manipulation in the management of upper quadrant presentations. This has been linked to the theory of regional interdependence with the thoracic spine being viewed as a silent contributor to clinical presentations where a pain source lies elsewhere. Finally, a case for further research is made. Identified gaps in the current evidence base include, aetiology and epidemiology of thoracic spine pain and thoracic spine dysfunction, and to investigate mechanisms of action of currently used interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.
... They measured the orientation of the facets of the zygapophyseal joints in 240 specimens from T1-L5; over 4080 vertebrae were measured. They found an asymmetric orientation (differences between the left and right sides) to be a 'normal characteristic in the Table 1 Findings from six studies that investigated the regional biomechanics of the thorax under varying conditions [5][6][7][8][9][10] Authors ...
Article
Understanding the biomechanics of the thorax is critical for understanding its role in multiple conditions since the thorax is part of many integrated systems including the musculoskeletal, respiratory, cardiac, digestive and urogynecological. The thorax is also an integrated system within itself and an element of the whole body/person. Therefore, understanding the biomechanics of the thorax is fundamental to all forms of treatment for multiple conditions. The interpretation of movement examination findings depends on one's view of optimal biomechanics and the influential factors. This article will provide a synopsis of the current state of research evidence as well as observations from clinical experience pertaining to the biomechanics of the thorax in order to help clinicians organise this knowledge and facilitate evidence-based and informed management of the, often complex, patient with or without thoracic pain and impairment. The integrated systems model (ISM) will be introduced as a way to determine when the noted biomechanical findings are relevant to a patient's clinical presentation.
... 12 The relationship between the thoracic spine and shoulder are commonly discussed in the literature. [49][50][51][52] An increased incidence of rib joint and cervicothoracic junction stiffness has been identified in patients with shoulder pain compared with controls. 15 In addition, it has been reported that stiffness of the cervicothoracic junction could increase the likelihood of developing shoulder-neck pain 3-fold over a 2-year period. ...
Article
Full-text available
Background: Strength training is one focus for physiotherapy management to help restore function. However, conventional strength training requiring an active muscular contraction is not always possible. Mental imagery (MI) has been proposed as a viable alternative to strength training without the need for actual movement. Objective: To investigate whether MI is effective in achieving strength gains in an asymptomatic population. Methods: A systematic review of key databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and risk of bias assessed using Grading of Recommendations Assessment, Development and Education (GRADE). Studies were included if they were a randomised control trial (RCT), clinical control trial (CCT) or pre-post study investigating the effect of an MI protocol for improving strength in asymptomatic adult populations. Results: From 639 articles, 28 full texts were assessed and six were included for review. These studied effect of MI on strength improvements for 5th finger abductors (n = 53), quadriceps (n = 51), elbow flexors (n = 51), ankle dorsiflexors (n = 51) and plantarflexors (n = 51). Strength gains were reported in all muscle groups with the exception of elbow flexors. MI may be more effective for muscle groups with larger motor cortex representation, especially 5th finger abductors. Conclusion: The findings suggest that a course of MI can increase strength greater than a control group but less than a physical practice (PP) group within this population. The findings of this study provide promising clinical implications for use of MI for improvements or maintenance of strength within a patient group unable to actively strengthen due to pain or immobilisation.
... 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. ...
Article
Full-text available
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.
... Biomechanically, ipsilateral side bending, rotation and extension of the thoracic spine have been shown to be associated with normal, non-pathologic overhead shoulder movement. 13,14 Research has also demonstrated that a significant connection between decreased mobility in the cervico-thoracic spine and neck-shoulder pain may exist. [15][16][17] Additionally, the function of the shoulder is highly dependent upon the relationship between the scapula and the thoracic region as a many of the muscles responsible for shoulder function are attached to the thoracic region. ...
Article
Full-text available
Background: It is commonplace for clinicians to utilize treatment of the thoracic spine as an adjunct to traditional interventions focused solely upon the shoulder. Research is beginning to substantiate this clinical practice. While still in its infancy, a clinical link between the thoracic spine and shoulder pain, function, strength, and motion potentially exists. This relationship between seeming unrelated areas of the body has been termed 'Regional Interdependence'. While evidence for regional interdependence between the thoracic spine and shoulder is being established, very little is known about the physiological mechanism behind such a link.Objectives: The purpose of this paper is to explore the evidence that currently exists for a relationship between thoracic spine manipulation, shoulder pain, and shoulder function. Existing and proposed physiological mechanisms underlying manipulation are discussed and placed in the context of regional interdependence.Major findings: Several models will be...
... 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. ...
Article
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.
... 던지기에서 가속 동안 몸통과 팔의 관계, 어깨관절의 위치와 회전, 그리고 몸통 위치는 던지기 생체역학을 향상시키는 중요 한 부분이다 (Wilk et al, 2002). 또한 팔 올림의 연속적인 운동학 에 등뼈의 움직임은 중요하다 (Crosbie, Kilbreath, Hollmann & York, 2008;Theodoridis & Ruston, 2002). 한쪽 (Park, Park & Lee, 2010;Thigpen et al., 2010), 팔을 올리는 동안 어깨뼈의 평균 움 직임이 변한다 (Thigpen et al., 2010). ...
Article
The purpose of this study was to determine the effect of trunk posture on muscle activity and motion of scapular and scapulohumeral rhythm. Thirty-one healthy subjects performed right-arm abduction and adduction along the frontal plane while standing in both upright and flexed posture of trunk. Scapular upward rotation, anterior tilting and internal rotation ware recorded using a motion analysis system and muscle activity of upper trapezius, lower trapezius and serratus anterior ware recorded using surface electromyography during abduction and adduction in both trunk postures. then, scapulohumeral rhythm was calculated. Scapulohumeral rhythm and scapular posterior tilting in flexed posture was significantly decreased than in upright posture. Also, muscle activity of lower trapezius in flexed posture was significantly increased and serratus anterior was significantly decreased than in general posture. The result of this study revealed that flexed posture of trunk altered the muscle activity and kinematic of scapular. Measurement of trunk posture should be included the evaluation of dysfunction and disorder of shoulder girdle since rehabilitation of trunk posture is important to restore of upper limbs function.
... 9 Therefore, the necessity of controlling for the positioning and movement of the head and neck during trunk motion trials to minimize the influence of cervical movement on movement in the upper thoracic region 12 seems justified. Regarding arm positions, previous work has indicated that consistent patterns of spinal motion can be observed during unilateral 17,18 and bilateral 17 arm elevations. In addition, Crosbie et al 19 concluded that significant and consistent timing coherence was shown between thoracic and scapulohumeral movements during a lifting task. ...
Article
Relationships have been shown between spinal motion and head and/or arm postures, yet there has been little standardization of the head and arm positions that elicit maximal voluntary spine angles during maximal trunk flexion, lateral bend, and axial twist. This study aimed to determine the head and arm positions that facilitated maximum voluntary range-of-motion in various spinal segments during these movements. Twenty-four individuals performed maximal movements in each plane with different combinations of head and arm positions (flexion and lateral bend: 4 combinations; axial twist: 6 combinations). Generally, greater angles were elicited for the upper spine segments when the head was moved in the direction of trunk motion, while the angles of the lower segments were either unaffected or greater when the head was kept in a neutral position. Arm positions also affected maximum spinal angles, in that angles were greatest when the arms were hanging to the floor (flexion), abducted to 90° (axial twist), and either hanging to the floor or crossed over the chest (lateral bend). These findings provide insight into the interplay between the spine and adjacent segments, and constitute an initial attempt to develop standardized positions during maximum range-of-motion trials.
... In previous research tracking thoracic spine movements, thoracic extension was found to occur when the arm was elevated through shoulder flexion. 32 This matches the results found in the current study, where regardless of the order of the movements, thoracic extension occurred during the overhead pressing movement as a coupling action with the shoulder movements. Whilst the arm elevation was unloaded and light in comparison to the 3RM loads in the current study, this suggested there was an association between moving the arms overhead and thoracic extension. ...
Article
Full-text available
Background: Using a cross-sectional design comparison was made of two overhead press techniques (in-front of the head or behind the head). The purpose of this study was to determine the impact of behind the head or in-front of the head overhead pressing technique on shoulder range of movement (ROM) and spine posture. The overhead press is commonly prescribed exercise. The two techniques (in-front of the head or behind the head) may influence joint mechanics and therefore require an objective analysis. Methods: Passive shoulder ROM quantified using goniometric measures, dynamic ROM utilised three dimensional (3D) biomechanical measures (120 Hz) of 33 participants performing overhead pressing in a seated position. The timing and synchronisation of the upper limb shoulder and spine segments were quantified and influence of each technique investigated. Results: The in-front technique commenced in lordotic position, whilst behind the head technique commenced in kyphotic position. Behind the head technique started with less thoracic extension than in-front condition. The thoracic spine remained extended and moved between 12� and 15� regardless of gender or technique. The techniques resulted in a significant difference between genders. Males were able to maintain a flat or normal lumbar lordosis, whereas females tended to kyphotic. Conclusion: Shoulder ROM was within passive ROM for all measures except external rotation for males with the behind the head technique. To avoid possible injury passive ROM should be increased prior to behind the head protocol. Females showed greater spine movements, suggesting trunk strengthening may assist overhead pressing techniques. For participants with normal trunk stability and ideal shoulder ROM, overhead pressing is a safe exercise (for the shoulder and spine) when performed either in-front or behind the head.
... It is suggested that more studies on the motor component should be done. 10, 11 Theodoridis and Ruston 12 have considered that the biomechanical relationship between the arm and the thoracic spine is important to clinical practice because of the contribution of the thoracic spine to shoulder movements. This relationship leads us to the term regional interdependence, which refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient's primary complaint. ...
Article
The purpose of this study was to evaluate the immediate effects of seated thoracic manipulation on scapulothoracic kinematics and scapulohumeral rhythm during arm flexion in young asymptomatic participants. A convenience sample of 42 young asymptomatic participants was randomly divided in 2 groups: manipulation and sham group. Measurements were taken before and after the intervention. All participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire to assess pain and physical function. The manipulation group received the manipulation (high velocity, low amplitude), which was performed by a physical therapist with the patient in the seated position and with the arms crossed over the chest and hands passed over the shoulders. For the sham group, the same procedure was performed, with the exception that the high-velocity thrust was not applied. Three-dimensional (3D) kinematic data were collected with the participants in a relaxed standing position using a 3D electromagnetic tracking system. All participants performed 3 repetitions of arm flexion before and after manipulation. There were no differences (P = .79) in Disabilities of the Arm, Shoulder, and Hand scores when the manipulation (3.37 ± 3.72) was compared with the sham group (3.68 ± 4.27). The 3-way analysis of variance showed no significant interaction among group, angle, and time differences for the outcomes (scapulothoracic internal/external rotation [F = 0.43; P = .82], upward/downward rotation [F = 0.08; P = .99], tilt [F = 0.23; P = .94], and scapulohumeral rhythm [F = 4; P = .86]). The intragroup effect was small for the outcomes measured in both groups. Thoracic manipulation in the seated position did not affect scapulohumeral rhythm and 3D scapular kinematics during arm flexion in young asymptomatic participants.
... 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). ...
Article
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.
... The relationship between thoracic spine posture, shoulder ROM, and scapular kinematics is well described in the literature. 12,34,40,60,65,71 Scapular kinematics frequently play a role in shoulder dysfunction, 43,45,46,54 and individuals with RCT often demonstrate altered scapular mechanics, as well as differences in shoulder muscle activation, compared to their healthy counterparts. 44,47,52 We hy-pothesized that the introduction of a manipulative force would result in changes in thoracic spine posture and shoulder motion, as well as changes in scapular kinematics and shoulder muscle activation, that may help to improve the pain and dysfunction associated with RCT. ...
Article
Full-text available
Study design: Controlled laboratory study. Objectives: To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. Background: There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. Methods: Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. Results: TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean ± SD change, 2.6 ± 1.1), Neer (2.6 ± 1.3), and Hawkins-Kennedy (2.8 ± 1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean ± SD change, 2.0 ± 1.5; P<.001) and improved shoulder function (force production, 2.5 ± 1.4 kg; Penn Shoulder Score, 7.7 ± 9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4 ± 13.2) (all, P<.001). Conclusion: Immediate improvements in shoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. Level of evidence: Therapy, level 4.
... 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. ...
Article
Full-text available
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.
... 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). ...
Article
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.
... 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. ...
Article
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.
... 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]. ...
... 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). ...
Article
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.
... 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. ...
Article
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.
... 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). ...
Article
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.
Article
The objective of this study is to provide basic information on coupled motions in thoracic spine during lateral bending from a neutral position for football and baseball players as well as for general university students. In the experiment, a total of 30 subjects participated(football players: 10, baseball players: 10, general students: 10). All subjects were in their 20's. The subjects sat on a chair with lumbar support in a neutral position and bent to the right. As a result, for baseball players, coupled motions were observed in the opposite direction of the lateral bending in all parts of thoracic spine. For both football players and general students, coupled motions were observed in the same direction. These results confirmed that unilateral movements like baseball could affect coupled motions.
Article
Lower trapezius muscle-strength deficits are a common clinical finding in patients presenting with poor postural habits. It has been speculated that zygapophyseal extension restrictions in the middle to lower thoracic spine are associated with these muscle-strength deficits. This may be a direct result of muscle inhibition related to reflexogenic influences from dysfunctional joints. The purpose of this study was to investigate the effects of manipulation applied to the lower thoracic spine (T6-T12) of asymptomatic individuals on lower trapezius muscle strength. A convenience sample of 40 subjects was randomly split into control and experimental groups of equal size. Pre-test and post-test measurements of isometric lower trapezius muscle strength were collected using a Nicholas Manual Muscle Tester. Both groups received identical assessment procedures. The experimental group received thoracic manipulations while the control group received a placebo technique. An independent group t-test was used to compare the mean change in lower trapezius muscle strength between the groups. Results revealed a significantly greater (p < 0.025) percentage increase in lower trapezius strength in the manipulation group (14%) as compared to the controls (3%). The results suggest that lower thoracic manipulation techniques may be beneficial in reducing the lower trapezius muscle inhibition commonly associated with many postural syndromes.
Article
[Purpose] In this study, we investigated the relationship between arm elevation angle and spinal curvature (thoracic kyphosis and lumbar lordosis) in healthy adults. [Subjects] The subjects were 12 healthy adult males, average age 23.6 ± 5.5 years. [Method] We measured thoracic kyphosis and lumbar lordosis angles with the arms in 5 positions, at the sides, raised at 90, 120, 150° and the maximum elevation, and compared the results of each elevation. [Results] We found that at 150° and maximum elevation the thoracic kyphosis angle showed a significant reduction compared to elevations of 120° or less, and the lumbar lordosis angle was significantly increased compared to arms at the sides. Moreover, this increase in lordosis angle showed a generally linear relation to the arm elevation angle. [Conclusion] The relationship between arm elevation and spinal curvature was one in which the lumbar lordosis angle increased linearly with arm elevation, and at elevations of 150° and above, in addition to lumbar lordosis, thoracic kyphosis decreased significantly, suggesting a mutual contribution from the thoracic and lumbar spines in arm elevation movement.
Article
Recent evidences suggest functional thoracic hyperkyphosis (FTH) could be a different approach in the management of subacromial impingement syndrome (SIS). This case study aims firstly with the development of evidence informed FTH model for SIS. Secondly this study aimed to develop well defined multimodal physical therapy intervention for FTH and its related mechanical consequences in elderly patient with chronic SIS. As a result, Level IV positive evidence was found in both the short and long-term pain and disability of chronic SIS, using FTH model with 26 months of follow-up.
Article
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.
Article
In vivo three-dimensional kinematics of the thoracic spine in trunk lateral bending with an intact rib cage and soft tissues has not been well documented. There is no quantitative data in the literature for lateral bending in consecutive thoracic spinal segments, and there has not been consensus on the patterns of coupled motion with lateral bending. To demonstrate segmental range of motions in lateral bending and coupled motions of the thoracic spine. In vivo three-dimensional biomechanics study of the thoracic spine. Fifteen healthy male volunteers. Computed analysis by using voxel-based registration. Participants underwent computed tomography of the thoracic spine in 3 supine positions: neutral, right maximum lateral bending, and left maximum lateral bending. The relative motions of vertebrae were calculated by automatically superimposing an image of vertebrae in a neutral position over images in bending positions, using voxel-based registration. Mean values of lateral bending was compared among the upper (T1-T2 to T3-T4), the middle-upper (T4-T5 to T6-T7), the middle-lower (T7-T8 to T9-T10), and the lower (T10-T11 to T12-L1) parts of the spine. At lateral bending, the mean range of motion (± standard deviation) of T1 with respect to L1 was 15.6° ± 6.3° for lateral bending and 6.2° ± 4.8° for coupled axial rotation in the same direction as lateral bending. The mean lateral bending of each spinal segment with respect to the inferior adjacent vertebra was 1.4° ± 1.3° at T1-T2, 1.3° ± 1.2° at T2-T3, 1.4° ± 1.3° at T3-T4, 0.9° ± 0.9° at T4-T5, 0.8° ± 1.0° at T5-T6, 1.1° ± 1.1° at T6-T7, 1.7° ± 1.2° at T7-T8, 1.3° ± 1.2° at T8-T9, 1.6° ± 0.7° at T9-T10, 1.8° ± 0.8° at T10-T11, 2.3° ± 1.0° at T11-T12, and 2.2° ± 0.8° at T12-L1. The smallest and the largest amounts of lateral bending were observed in the middle-upper part and the lower part, respectively. There was no significant difference in lateral bending between the upper and the middle-lower parts. Coupled axial rotation of each segment was generally observed in the same direction as lateral bending. However, high variability was found at the T2-T3 to T5-T6 segments. Coupled flexion was observed at the upper and middle parts, and coupled extension was observed at the lower part. This study revealed in vivo three-dimensional motions of consecutive thoracic spinal segments in trunk lateral bending. The thoracolumbar segments significantly contributed to lateral bending. Coupled axial rotation generally occurred in the same direction with lateral bending. However, more variability was observed in the direction of coupled axial rotation at T2-T3 to T5-T6 segments in the supine position. These results are useful for understanding normal kinematics of the thoracic spine.
Article
[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.
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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.
Article
Scapular position and motion are essential for normal upper limb mobility; Further, the posture of patients with thoracic kyphosis is related to shoulder girdle function and disorder. The purpose of this study was to examine the effects of thoracic posture on the shoulder range of motion and on three-dimensional scapular kinematics. Thirty healthy subjects performed right-arm abduction along the frontal plane while standing in both erect and in slouched trunk posture. The scapular position and rotation, and shoulder and thoracic angles were recorded using a motion analysis system. The scapular upward rotation and internal rotation were significantly altered according to postural tatiges; however, scapular tilt was not affected. Shoulder angle was significantly decreased in the slouched posture as c rpared to tatt in the erect posture. Thus, a slouched posture(thoracic kyphosis) significantly affects the shoulder range of motion and scapular kinematics during shoulder abduction in the frontal plane.
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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.
Article
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.
Article
Purpose: In this study, in order to analyze the effect of shoulder joint mobility on spinal curvature during arm elevation, we examined and compared the relationship of arm elevation with spinal curvature in frozen shoulder patients before and after shoulder joint range of motion (ROM) training. Subjects and Method: With 15 frozen shoulder of 10 men and 5 women as subjects, we measured thoracic kyphosis and lumbar lordosis angles at arm elevations of 0, 90 and 120° before and after ROM training, and compared the results. Results: Before ROM training, thoracic kyphosis showed significant decreases at arm elevation angles of 90° and above, and lumbar lordosis showed a significant increase at arm elevation of 120°. However, after ROM training, thoracic kyphosis showed a significant increase only at 120° and no significant differences in lumbar lordosis were found at any arm elevation angles. Conclusion: An unphysiological extension of the spine occurred at arm elevations of 90° or more, therefore frozen shoulder results in excessive extension of the spine, suggesting that the mutual interaction of thoracolumbar vertebrae in response to arm elevation is dependent on shoulder joint ROM.
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Abstract Objectives: Non-specific shoulder pain (NSSP) is often persistent and disabling leading to high socioeconomic costs. Cervical manipulation has demonstrated improvements in patients with NSSP, although risks associated with thrust techniques are documented. Thoracic manual therapy (TMT) may utilise similar neurophysiological effects with less risk. The current evidence for TMT in treating NSSP is limited to systematic reviews of manual therapy (MT) applied to the upper quadrant. These reviews included trials that included shoulder girdle manual therapy (SG-MT) in the TMT group. This limits the scope of their conclusions with regard to the exclusive effectiveness of TMT for NSSP. Methods: This review used a steering group for subject and methodological expertise and was reported in line with PRISMA guidelines. Key databases were searched (1990–2014) using relevant search and MeSH terms; eligibility was evaluated independently by two reviewers based on pre-defined criteria. Study participants had NSSP including impingement syndrome and excluding cervical pain. Interventions included cervicothoracic junction and TMT with or without supplementary exercises. Studies that included MT applied to the shoulder girdle including the glenohumeral joint, acromioclavicular joint or sternoclavicular joint in the TMT group, without a control, were excluded. Included studies utilised outcome measures that monitored pain and disability scores. Randomized controlled trials (RCTs) and clinical studies were eligible. Using a standardised form, each reviewer independently extracted data. Risk of bias was assessed using GRADE and PEDro. Results were tabulated for semi-quantitative comparison. Results: Over 912 articles were retrieved: three RCTs, one single-arm trial and three pre–post test studies were eligible. Studies varied from poor to high quality. Three RCTs demonstrated that TMT reduced pain and disability at 6, 26 and 52 weeks compared with usual care. Two pre–post test studies found between 76% and 100% of patients experienced significant pain reduction immediately post-TMT. An additional pre–post test study and a single-arm trial showed reductions in pain and disability scores 48 hours post-TMT. Discussion: Thoracic manual therapy accelerated recovery and reduced pain and disability immediately and for up to 52 weeks compared with usual care for NSSP. Further, high-quality RCTs investigating the effect of TMT in isolation for the treatment of patients with NSSP are now required.
Article
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.
Article
While trunk movement accompanies arm elevation, trunk muscle activities during arm elevation at different speeds are unclear. The purpose of this study was to examine the trunk muscle activities at various speeds of arm elevation and then to evaluate their roles in trunk kinematics. Twenty-two healthy subjects participated. The participants performed right shoulder flexion at three different speeds. Surface electromyography was used to measure the activities of bilateral external oblique muscles (EO), internal oblique muscles (IO), rectus abdominis muscles (RA) and lumber erector spinae muscles (ES). A three-dimensional motion analyzer was used to measure arm and trunk movements. In natural and slow movements, the muscle activities of left ES, right EO and left IO were significantly augmented compared with those of the contralateral muscles, in the relatively late phase. In fast movement, the muscle activities of both ES were significantly augmented during the early phase compared with later in the action. The muscle activities of the left ES and the right EO were significantly augmented compared with those of the contralateral muscles. There was a consistent pattern of trunk extension, lateral flexion and rotation during arm elevation, irrespective of the speed. Bilateral ES activity may be required for back-extension torques, especially for the early phase of rapid elevating motion. The anterior muscles' activity may contribute to the production of anterior force against the backward movement of the center of mass of the upper limb in the late phase. Trunk rotation, controlled by the trunk muscles in harmony, may assist the scapular movement to align the scapular plane in the arm elevating plane.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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
Article
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.
Article
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.
Article
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.
Article
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.
Article
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