The Impact of Twisting on The Extent of Lower Lumbar Spine Lateral Flexion Among Healthy Subjects
DOI:
https://doi.org/10.51173/ijmhs.v1i1.13Keywords:
MRI , Low Back Pain , Lateral Flexion , Lumbar SpineAbstract
Background: It is acknowledged that 84% of cases of pain are related to the spine. In one instance, low back pain is reduced by the spinal adjustment technique, which is predicated on exerting external stresses on the shoulder and pelvis to twist the human spine. A deeper comprehension of the biomechanical behaviour of the typical lumbar spine in each lower trunk rotational position will yield important information that can be translated into improved physical treatment line.
Objective of study: The objective of this study was to utilize MRI to find how different lower trunk twisting positions influenced the extent of lower lumbar spine lateral flexion.
Materials and Methods: Sagittal T2 weighted Magnetic resonance images of fifteen males with healthy spine structures were collected in order to evaluate the consequences of right and left lumbar spine rotations on the extent of lateral flexion of their lower backs. The extent of the lateral flexion at each contiguous lower lumbar vertebrae was measured manually by using image J software.
Results: In proportion to the lower lumbar twisting positions, the extent of lateral flexion at the last three lumbar levels increased. At all twisting positions, the lateral flexion degree was greatest at fourth- fifth lumbar level. The mean differences of lateral flexion angle were significant only in the left twisting position at the fourth and fifth lumbar levels.
Conclusion: The extent of lateral flexion at all lower lumbar segments grew in synchrony with the lower lumbar twisting positions. fourth–fifth lumbar level had the largest lateral flexion angle. But only in the left rotational position did the effect become noticeable. Consequently, this level may be the primary target of manipulative therapy during treatment.
References
References
Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5. 10.12688/f1000research.8105.2.
Leboeuf-Yde, C., Klougart, N., & Lauritzen, T. (1996). How common is low back pain in the Nordic population? Data from a recent study on a middle-aged general Danish population and four surveys previously conducted in the Nordic countries. Spine, 21(13), 1518-1525.
Jarvik, J. G., & Deyo, R. A. (2002). Diagnostic evaluation of low back pain with emphasis on imaging. Annals of internal medicine, 137(7), 586-597. DOI: 10.7326/0003-4819-137-7-200210010-00010.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36(4), 811-816. doi: https://doi.org/10.3174/ajnr.A4173.
NICE NG59 National Institute for Health and Care Excellence (2017). Available at:http://www.noebackpainprogramme.nhs.uk/wp-content/uploads/2015/05/National-Low-Back-and-Radicular-Pain-Pathway-2017_final.pdf [Accessed: 03-02-2018].
Maniadakis, N., & Gray, A. (2000). The economic burden of back pain in the UK. Pain, 84(1), 95-103. https://doi.org/10.1016/S0304-3959(99)00187-6.
Nazari, J. (2007). The effects of different posture on lumbar spine loading. University of Aberdeen (United Kingdom).
Herzog, W. (2010). The biomechanics of spinal manipulation. Journal of bodywork and movement therapies, 14(3), 280-286. https://doi.org/10.1016/j.jbmt.2010.03.004.
Shekelle, P. G., Adams, A. H., Chassin, M. R., Hurwitz, E. L., & Brook, R. H. (1992). Spinal manipulation for low-back pain. Annals of internal medicine, 117(7), 590-598. https://doi.org/10.7326/0003-4819-117-7-590.
Ferreira, M. L., De Luca, K., Haile, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., & Mahmoodpoor, A. (2023). Global, regional, and national burden of low back pain, 1990– 2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329. https://www.thelancet.com/action/showPdf?pii=S2665-9913%2823%2900098-X.
Gill, T. K., Mittinty, M. M., March, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., ... & Vasankari, T. J. (2023). Global, regional, and national burden of other musculoskeletal disorders, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(11), e670-e682. https://www.thelancet.com/action/showPdf?pii=S2665-9913%2823%2900232-1
Fujii, R., Sakaura, H., Mukai, Y., Hosono, N., Ishii, T., Iwasaki, M., ... & Sugamoto, K. (2007). Kinematics of the lumbar spine in trunk rotation: in vivo three-dimensional analysis using magnetic resonance imaging. European spine journal, 16, 1867-1874.]
Pearcy, M. J., & Tibrewal, S. B. (1984). Axial rotation and lateral bending in the normal lumbar spine measured by three-dimensional radiography. Spine, 9(6), 582-587.
Barnes, D., Stemper, B. D., Yogananan, N., Baisden, J. L., & Pintar, F. A. (2009). Normal coupling behavior between axial rotation and lateral bending in the lumbar spine-biomed 2009. Biomedical sciences instrumentation, 45, 131-136. https://europepmc.org/article/med/19369752.
Suri, A., Jones, B. C., Ng, G., Anabaraonye, N., Beyrer, P., Domi, A., & Rajapakse, C. S. (2021). Vertebral deformity measurements at MRI, CT, and radiography using deep learning. Radiology: Artificial Intelligence, 4(1), e210015. https://doi.org/10.1148/ryai.2021210015.
Gram, M. C., & Hasan, Z. (1999). The spinal curve in standing and sitting postures in children with idiopathic scoliosis. Spine, 24(2), 169-177.
BRYANT, J. T., Reid, J. G., SMITH, B. L., & STEVENSON, J. M. (1989). Method for determining vertebral body positions in the sagittal plane using skin markers. Spine, 14(3), 258-265.
Chen, Y. L., & Lee, Y. H. (1997). A non-invasive protocol for the determination of lumbosacral vertebral angle. Clinical Biomechanics, 12(3), 185-189. https://doi.org/10.1016/S0268-0033(97)00076-4.
Cerveri, P., Pedotti, A., & Ferrigno, G. (2004). Non-invasive approach towards the in vivo estimation of 3D inter-vertebral movements: methods and preliminary results. Medical engineering & physics, 26(10), 841-853. https://doi.org/10.1016/j.medengphy.2004.08.005.
Gracovetsky, S., Newman, N., Pawlowsky, M., Lanzo, V., Davey, B., & Robinson, L. (1995). A database for estimating normal spinal motion derived from noninvasive measurements. Spine, 20(9), 1036-1046.
Mörl, F., & Blickhan, R. (2006). Three-dimensional relation of skin markers to lumbar vertebrae of healthy subjects in different postures measured by open MRI. European Spine Journal, 15, 742-751. https://doi.org/10.1007/s00586-005-0960-0.
Gould, S. L., Davico, G., Liebsch, C., Wilke, H. J., Cristofolini, L., & Viceconti, M. (2024). Variability of intervertebral joint stiffness between specimens and spine levels. Frontiers in Bioengineering and Biotechnology, 12, 1372088. https://doi.org/10.3389/fbioe.2024.1372088
Chastain, K., Gepner, B., Moreau, D., Koerber, B., Forman, J., Hallman, J., & Kerrigan, J. (2023). Effect of axial compression on stiffness and deformation of human lumbar spine in flexion-extension. Traffic injury prevention, 24(sup1), S55-S61. https://doi.org/10.1080/15389588.2023.2198627.
White, A. A. P. M. (1990). Clinical biomechanics of the spine. Clinical biomechanics of the spine.
Bogduk, N. (2005). Clinical anatomy of the lumbar spine and sacrum. Elsevier Health Sciences.
Jaumard, N. V., Welch, W. C., & Winkelstein, B. A. (2011). Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. Journal of biomechanical engineering, 133(7), 071010. https://doi.org/10.1115/1.4004493.
Shin, J. H., Wang, S., Yao, Q., Wood, K. B., & Li, G. (2013). Investigation of coupled bending of the lumbar spine during dynamic axial rotation of the body. European Spine Journal, 22, 2671-2677. https://doi.org/10.1007/s00586-013-2777-6.
Toyone, T., Ozawa, T., Kamikawa, K., Watanabe, A., Matsuki, K., Yamashita, T., & Wada, Y. (2009). Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine, 34(21), 2259-2262. DOI: 10.1097/BRS.0b013e3181b20158.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Baida Ajeal Badir Al-Omairi Al-Omairi, Len Nokes
This work is licensed under a Creative Commons Attribution 4.0 International License.
