The purposes of this study were to assess the intertester reliability of goniometric measurements at the knee and the validity of the clinical measurements by comparing them to measurements taken from roentgenograms. Thirty healthy subjects between the ages of 20 and 60 years were studied. The subjects were positioned on their right side on a roentgenographic table with their left lower extremity on a stabilizing board that was elevated 15 cm above the table's surface. For standardization of the position, an assistant placed the posterior aspect of the subject's left thigh in contact with two 15-cm pegs, which had been inserted perpendicularly into the stabilizing board. The assistant then moved the left leg to achieve an arbitrary angle of the knee joint and held the limb in that position. Two physical therapists then independently used a standard plastic goniometer to measure the knee joint angle in the sagittal plane using the greater trochanter, the lateral condyle of the femur, the head of the fibula, and the lateral malleolus as bony landmarks. A roentgenogram was taken of the extremity before the subject was moved. Pearson product-moment correlation coefficients (r's) and intraclass correlation coefficients (ICCs) were used to analyze the data. The data analysis revealed that the intertester reliability (r = .98; ICC = .99) and validity (r = .97-.98; ICC = .98-.99) were high. The results of this study indicate that goniometric measurements of the knee joint are both reliable and valid.

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The measure of navicular drop has been used as an indicator of pronation at the foot. It is defined as the distance the navicular tuberosity moves in standing, as the subtalar joint is allowed to move from its neutral position to a relaxed position. The purposes of this study were to test the reliability of a method to measure navicular drop and to assess the relationships among measures of forefoot to rearfoot position, subtalar joint neutral position, and navicular drop. The results support traditional biomechanical theory but indicate that other factors contribute significantly to navicular drop.

Study Design: Cross-sectional study of patients with mechanical low back pain (MLBP). Objective: To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. Background: A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. Methods and Measures: A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. Results: Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. Conclusion: Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.

Hyperactive stretch reflexes in the upper motor neuron (UMN) syndrome are frequently cited as an impediment to volitional movement. The assumption is that neural or mechanical activity of the hyperactive antagonist interferes with agonist function. The validity of this assumption was examined by evaluating quantitative and qualitative relationships between stretch reflexes and voluntary movement.Sixteen patients with chronic U M N symptoms and 8 normal volunteers were tested. Joint position and integfated electromyograms from primary flexors and extensors were recorded. Quantitated values of (1) reflex response to controlled passive motion by an automated system, ( 2 ) a maximal voluntary isometric contraction, and (3) the time required for ten voluntary rapid repetitive movements (RRM) of alternating elbow flexion and extension were obtained.Passive movement elicited tonic reflexes, which predominated during muscle stretch in patients and during muscle shortening in the volunteers. Ratios of the EMG activity elicited during stretch, shortening, and isometric activity were used as measures of spasticity and were compared with the time for RRM. A positive correlation between elbow flexor spasticity and the time for RRM was shown. Qualitative analysis of the EMG activity during voluntary isotonic movement, however, showed that primary impairment of movement is not due to antagonist stretch reflexes, but rather to limited and prolonged recruitment of agonist contraction and delayed cessation of agonist contraction at the termination of movement.Sahrmann SA, Norton BJ: The relationship of voluntary movement to spasticity in the upper motor neuron syndrome. Ann Neurol 2: [460][461][462][463][464][465] 1977 The most frequently encountered type of movement disorder is paralysis or loss of movement in the upper motor neuron (UMN) syndrome. The movement deficit caused by such central nervous system lesions is often designated as spastic. A connotation arising from use of the term spastic paralysis is that the movement disability is directly related to hyperactive stretch reflexes or spasticity. Hughlings Jackson analyzed the manifestations of neurological lesions according to two distinct sets of symptoms, negative and positive [lo I. Negative symptoms were defined as deficits of normal behavior and positive symptoms as release phenomena or exaggerations. Thus, in the case of a patient with hemiparesis, the restricted ability to move is a negative symptom while spasticity or hyperactivity of the stretch reflex system is a positive symptom. Jackson considered these entities to be related but different in mechanism. Other researchers attributed the disturbance of behavioral movement in hemiparesis directly to the spasticity. T h e rationale was that the hyperactive stretch reflex of the antagonist limits the production of movement by the agonist [l-31. Though the premise is widely accepted that spasticity limits voluntary movement, there are no critical data to test its validity. The purpose of this study was to exami...

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Study Design: Cross-sectional. Objectives: To test the assumption that postural alignment and gender have a bearing on the specific type of low back pain (LBP) a person manifests. Background: Measurements of static sagittal lumbar curvature are used by clinicians in the management of patients with LBP, but no investigator has reported differences in curvature related to specific categories of LBP. Methods and Measures:We used a computer-interfaced, 3-D, electromechanical digitizer to derive curvature angles for the region of the spine between T12-L1 and S2. Trained clinicians examined the subjects and determined their LBP diagnoses. We used t tests to examine differences in curvature between women and men, those with and those without LBP, and those in 4 different categories of LBP. We used 2 to examine the relationship between gender and LBP category. Results: Lumbar curvature angle (lordosis) was 13.2°larger for women than for men (t = 6.74; P Ͻ.01). There was no difference in lumbar curvature between people with undifferentiated LBP and people without LBP. There were differences in lumbar curvature between people in various categories of LBP, for example, subjects in the lumbar-rotation-with-extension category had 8.4°more lumbar curvature than subjects in the lumbar-rotation-with-flexion category (t = 2.16; P Ͻ.05). Based on the frequency distributions, there was a significant relationship between gender and LBP category ( 2 = 10.19; P Ͻ.01). Conclusions: Measurements of lumbar curvature should be expected to differ between men and women and may be related to different types of low back pain. J Orthop Sports Phys Ther 2004;34:524-534. Key Words: lordosis, lumbar curvature, posture, spine M easurements of static sagittal spinal curvature in erect standing are used by many types of clinicians to aid in establishing a diagnosis, formulating a treatment plan, and assessing outcomes in patients with low back pain (LBP). 35 The measurements can be most useful in The relationship between gender and spinal curvature has been studied to a limited extent. In our search of the literature, we found 43 articles in which sagittal plane measurements of lumbar spinal curvature were reported. Only 14 of the reports included any data or analyses related to differences between women and men.

Background An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. Objectives The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 hours of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. Design Cross-Sectional Method First, participants stood while positions of markers placed on the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 hours while performing light work tasks. At baseline and every 15 minutes during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 hour standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. Results/findings There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non pain developers (Mean difference=4.4°; 95% Confidence Interval=0.9° to 7.8°, Cohen’s d=0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P=0.02). Conclusion The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies.