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Hereditary Spastic Paraparesis and Other Hereditary Myelopathies
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Jon Marsden, Lisa Bunn, Amanda Denton, Krishnan Padmakumari Sivaraman Nair
These potential compensatory strategies may not be wholly beneficial. Increased trunk motion associated with an increased lumbar lordosis, anterior tilt of the pelvis,65,66 and tight hip flexors may contribute to the high incidence of lower back pain. Further, knee recurvatum can be associated with stretching of the soft tissue on the posterior aspect of the knee and subsequent knee pain.
The Child With A Limp
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Although discitis can occur at any age, the incidence is increased in the toddler age group. Discitis is inflammation of the intervertebral disc space or vertebral end plate and occurs most commonly in the lumbar region. It is an uncommon condition with a good prognosis. Presentation is usually non-specific and gradual. Toddlers present with limp or refusal to walk. They are systemically well and may have a low-grade fever. Examination may reveal restricted spinal mobility and loss of lumbar lordosis. There may be tenderness at the site of the lesion. The key is to distinguish discitis from vertebral osteomyelitis. Vertebral osteomyelitis affects older children, who are systemically unwell with high fever and complain of pain in the lumbar, thoracic or cervical spine. The white cell count (WCC) and C-reactive protein (CRP) are usually normal or slightly elevated; the erythrocyte sedimentation rate (ESR) is usually raised and can be used to monitor response to treatment. Blood cultures are usually negative. Spinal X-rays can be normal initially; however, after 2–4 weeks, disc space narrowing and irregular end plates of neighbouring vertebrae can be seen. Magnetic resonance imaging (MRI) of the spine is the investigation of choice to detect early discitis and rule out spinal tumours. The aetiology is unknown. Although an infectious cause has been proposed, organisms are rarely isolated and children recover without antibiotics.
Fractures of the thoracolumbar spine
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Ghias Bhattee, Reza Mobasheri, Robert Lee
Thoracic vertebrae are characterized by the presence of costal facets for articulation with the ribs (Fig. 6.1). These articulations, together with the surrounding thoracic cage, make the thoracic vertebae the most stable portion of the spinal column. Thoracic vertebral bodies are also subtly shorter anteriorly than posteriorly, thereby creating the normal kyphosis of the thoracic spine. Lumbar vertebrae have a large body that is higher anteriorly than posteriorly. This configuration contributes to the lumbar lordosis, along with wedging of the intervertebral discs. The orientation of the lumbar facets is such that rotation is limited at the level of the lumbar spine. Spinal rotation is greatest in the thoracic spine.
The effects of chair intervention on lower back pain, discomfort and trunk muscle activation in office workers: a systematic review
Published in International Journal of Occupational Safety and Ergonomics, 2022
Sirinant Channak, Thaniya Klinsophon, Prawit Janwantanakul
Facilitating a neutral lumbar lordosis during sitting has been recommended in the management of LBP [57]. Five included studies attempt to modify an office chair that maintains a neutral spinal alignment and prevents poor posture during sitting [32,33,36,38,40]. However, considering these results, we found that four of five studies increased trunk muscle activation and induced discomfort. Only one included study reported that a chair with a backrest that fitted to support lumbar lordosis reduced trunk muscle activation [32]. One possible explanation may relate to the level of muscle activation. Evidence showed that low-level trunk muscle activation (2–5% MVIC) could lead to fatigue development, resulting in discomfort or pain [51]. Thus, comparison of the results from one study to another should be undertaken with caution due to differences in interpretation of the muscle activation level.
Spinal sagittal alignment, spinal shrinkage and back pain changes in office workers during a workday
Published in International Journal of Occupational Safety and Ergonomics, 2022
Juan Rabal-Pelay, Cristina Cimarras-Otal, César Berzosa, Marta Bernal-Lafuente, José Luis Ballestín-López, Carmen Laguna-Miranda, Juan Luis Planas-Barraguer, Ana Vanessa Bataller-Cervero
In the men’s group, pain in the neck correlated significantly in a positive way with spinal shrinkage analysed in the work environment. It appears that men, who lost more height during work, were those manifesting greater neck pain at the end of the day. In future research, strategies to prevent spinal shrinkage in men office workers may decrease pain in the neck area too. Interventions aimed at reducing height loss can focus on exercises of vertebral decompression, stretching, hydration and active breaks, including standing and walking movements throughout the workday [13,37]. The degrees of lumbar lordosis in women office workers correlated negatively with upper back pain at the end of the day (r = −0.440, p = 0.012). This finding shows that women who had lower lumbar lordosis had higher levels of upper back pain at the end of the day. Chun et al. [38] observed an association between attenuated lumbar lordosis and LBP when comparing a group of people with and without LBP. No studies have been found that relate a flatter lumbar lordosis to upper back pain. Strategies aimed at reducing upper back pain can focus on exercises to preserve the lumbar lordosis and avoid the lumbar flexion that produces a flattening of the lordosis [39]. These exercises can be focused on stretching of the hamstrings, activation of the lumbar extensor muscles and anterior pelvic tilt [39].
Mobilization of the lumbar spine in a 76-year-old male with mechanical low back pain and an abdominal aortic aneurysm: A case report
Published in Physiotherapy Theory and Practice, 2020
Josiah D Sault, Andrew A. Post, Amanda Y Butler, Michael A O’Hearn
Observation of the patient identified a flattened lumbar lordosis with forward and right trunk lean in standing. The patient ambulated in the same posture with slow cadence and limited push off bilaterally. In order to attempt to rule out the AAA as his cause of symptoms and to safely progress into further movement testing, an abdominal screening was performed. The patient demonstrated no pain or abnormal masses with light or deep abdominal palpation or with palpation along his aorta, no abnormal tympanic changes within the abdomen, no rebound tenderness, and no pain with palpation of his kidneys. He did report some local tenderness with palpation of his liver, but this did not reproduce his familiar pain. His blood pressure was consistent with a review of his chart indicating recent readings between 110 and 120s/70s mmHg.