Mieke Dolphens

To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth.

Purpose To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains. Methods In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains. Results A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6–11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5–23.9), TSP in the last month (4.9; 2.2–10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3–5.7) or NP (5.5; 2.6–11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm. Conclusions Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that “physical factors” play in non-adult spinal pain may have been underestimated by previous studies.

Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up.

EVIDENZ Bei Patienten mit rezidivierenden Rückenschmerzen verändern sich Muskeln und Kortex. Unsere Autoren, ausgewiesene Experten, forschen auf diesem Gebiet und stellen die aktuelle Evidenz vor. Ihr Konzept der funktionellen Wirbelsäulenstabilität ist die Basis für anhaltende Schmerzfreiheit.

Measurement and classification of standing posture in the sagittal plane has important clinical implications for adolescent spinal disorders. Previous work using cluster analysis on three gross body segment orientation parameters (lower limbs, trunk, and entire body inclination) has identified three distinct postural groups of healthy subjects before pubertal peak growth: “neutral”, “sway-back”, and “leaning-forward”. Although accurate postural subgrouping may be proposed to be crucial in understanding biomechanical challenges posed by usual standing, there is currently no objective method available for class assignment. Hence, this paper introduces a novel approach to subclassify new cases objectively according to their overall sagittal balance. Postural data previously acquired from 1,196 pre-peak height velocity (pre-PHV) subjects were used in this study. To derive a classification rule for assigning a class label (“neutral”, “sway-back”, or “leaning-forward”) to any new pre-PHV subjects, linear discriminant analysis was applied. Predictor variables were pelvic displacement, trunk lean and body lean angle. The performance of the newly developed classification algorithm was verified by adopting a cross-validation procedure. The statistical model correctly classified over 96.2 % of original grouped subjects. In the cross-validation procedure used, over 95.9 % of subjects were correctly assigned. Based on three angular measures describing gross body segment orientation, our triage method is capable of reliably classifying pre-PHV subjects as either “neutral”, “sway-back”, or “leaning-forward”. The discriminant prediction equations presented here enable a highly accurate posture class allocation of new cases with a prediction capability higher than 95.9 %, thereby removing subjectivity from sagittal plane posture classification.

The aim of this study was to analyze gender differences in sagittal standing alignment at pre‐peak height velocity age thereby applying a scientifically sound and practically oriented classification scheme for overall standing balance. The study population consisted of healthy boys (n = 639) and girls (n = 557) before pubertal peak growth. During subjects' habitual standing, sagittal plane measures of the spine, pelvis and lower limbs were collected using a clinical screening protocol. With each subject classified as one of three postural types (neutral, sway‐back, or leaning‐forward), differences in sagittal plane alignment were analyzed between sexes. The results revealed clear differences between genders in each of the postural types. Within the neutral and sway‐back postural subgroups, boys presented more forward inclination of the trunk, more thoracic kyphosis and more pelvis backtilt compared with girls. Within the leaning‐forward category, girls displayed more forward trunk lean, less thoracic kyphosis and more pelvic anteversion. A state of lumbar segmental hyperextension appeared to exist in female leaning‐forward subjects. Our results reveal for the first time that sagittal standing alignment is different between prepubescent boys and girls when subjects are appropriately subclassified, and conversely represent a ‘wash‐out effect’ when pooled. When the classification system is applied, gender‐specificity in gravity line position is suggested, implying gender‐related differences in lever arms and thus load. Present findings may add to our understanding of gender‐specific biomechanical challenges posed by habitual posture, and may shed new light on sagittal standing alignment as a possible contributory factor in developmental spinal‐pelvic disorders.

Study Design. Cohort study. Objective. To construct a sagittal standing alignment classification system in which the clinical significance of identified subgroups was considered with spinal pain measures. Summary of Background Data. Numerous grading systems for the categorization of sagittal standing alignment have been devised. However, no common consensus exists about which typology should be adopted. Furthermore, the clinical significance of proposed classification schemes has rarely been assessed in terms of their relationship with spinal pain. Given the importance of the adolescent period for musculoskeletal development, research within a young adolescent population is required. Methods. The study population consisted of 639 prepeak height velocity boys (mean age, 12.6 yr [standard deviation, 0.54 yr]). Sagittal posture was quantified during habitual standing; data were used to develop a classification system according to 3 gross postural and 5 lumbopelvic characteristics. Prevalence rates of spinal pain measures (pain and seeking care) were compared between postural subgroups. Results. Cluster analysis indicated 3 types of characteristic overall sagittal profiles: neutral global alignment (n = 266 [41.6%]), sway-back (n = 199 [31.1%]), and leaning-forward (n = 174 [27.2%]). Within each of these categories, postural subgroups could be established according to specific lumbopelvic features. Logistic regression revealed that prevalence (lifetime and month) of low back pain and neck pain was significantly higher in boys classified as having sway-back posture than in those classified as having neutral global alignment. Spinal pain measures did not differ between groups of the lumbopelvic subclassification. Conclusion. Meaningful classifications exist for sagittal plane posture in young adolescent boys, both on gross body segment and lumbopelvic level. In terms of clinical importance, that is, low back pain and neck pain prevalence, postural subgrouping strategies based on the orientation of gross body segments are suggested to be superior when compared with lumbopelvic grading.