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Range of Motion in the Lumbar Spine and the Effects of Age and Gender
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■ Time from onset to referral for rehabilitation (rho = 0.55; p = < 0.001). ■ Time from acceptance to admission: waiting list time (rho = 0.3; p = 0.008). With intensive specialist input, significant numbers of severely disabled young stroke patients can regain independent walking many months after onset. The timing, intensity and content of rehabilitation for these patients warrants further investigation. Waiting list delay may prolong rehabilitation and potentially compromise cost effectiveness.
Range of Motion in the Lumbar Spine and the Effects of Age and Gender G Van Herp, P J Rowe Department of Physiotherapy, Queen Margaret University College, Edinburgh P M Salter Napier University, Faculty of Health Sciences, Edinburgh The spine is a complex three-dimensional structure. Low back pain (LBP) is thought to limit motion of the spine. Hence the assessment of the range of lumbar spinal movement is a common feature of clinical assessment in back pain patients (Hindle et al, 1990). Furthermore, many physiotherapy techniques and patient management programmes are designed to help patients with LBP and restore function of the spine (Maitland, 1986). To date, an objective, three-dimensional measure of lumbar spinal range of motion, which can be employed in the clinical environment to analyse functional movements, has been lacking. This paper presents the preliminary data from a study using a new method for measuring spinal motion based on an electromagnetic tracking device (3Space Isotrak®). This device was used to create a normative database for three-dimensional rotational measurements of the lumbar spine. One hundred subjects (50 female, 50 male) with no history of recent LBP were recruited. The 3 Space Isotrak was calibrated and
References Blower, P W, Carter, L C and Sulch, D A (1995). ‘Relationship between wheelchair propulsion and independent walking in hemiplegic stroke’, Stroke, 26, 606-608. Jørgensen, M D, Nakayama, H, Raaschou, H O and Olsen, T S (1995). ‘Recovery of walking function in stroke patients: The Copenhagen stroke study’, Archives of Physical Medicine and Rehabilitation, 76, 27-32. The authors wish to thank Hillingdon Health Authority (Regional Audit Funding Programme for Rehabilitation) for providing financial support.
then carefully attached between the sacrum and the T12/L1 intervertebral junction. The device was held in place using double sided tape, adjustable pitch wedges and four specially commissioned straps. The subjects then per formed six movements to the limit of range. Greater flexibility was found in females than males for the six ranges of motion across all ages. The t-test for independent samples (two-tailed significance and 95% confidence interval) showed these differences to be significant for extension (p = 0.001; 2.9, 10.6) and axial rotations (p = 0.010; 0.6, 4.9) for all age groups. Significant differences were found between the young (20-29 years) and older (60+) groups for all movements. The data indicate that 55° of flexion, 23° of extension, 22° of side bending to each side and 14° of axial rotation in each direction can be expected in the normal adult spine. In addition females are more flexible than males by an average of 1.5° and the young more flexible than the older subjects by an average of 6° when an average is taken across all six movements. Clinicians could make use of these normal values in examination and remember to assess patient’s range of movement in light of their age and sex. References Hindle, R J, Pearcy, M J, Cross, A T and Miller, D H T (1990). ‘Three-dimensional kinematics of the human back’, Clinical Biomechanics, 5, 218-228. Maitland, G D (1986). Vertebral Manipulation, Butterworth, London, 5th edn.
Spinal angles in degrees achieved for six movements
Age (years) Flexion Extension Left side bending Right side bending Left axial rotation Right axial rotation
20-29 58.9 37.0 25.1 26.3 18.6 18.6
Physiotherapy January 2000/vol 86/no 1
Females (n = 50) 30-39 40-49 58.2 31.2 25.6 26.2 18.0 15.6
57.5 29.0 20.7 23.4 15.7 13.4
50-59
60+
20-29
53.6 20.5 21.9 23.2 14.7 14.2
50.8 15.1 19.4 19.2 14.7 13.0
56.4 22.5 25.8 26.2 14.4 14.6
Males (n = 50) 30-39 40-49 54.2 22.1 25.6 25.0 11.9 9.1
54.2 20.0 19.3 21.2 11.6 12.7
50-59
60+
52.8 17.2 19.0 22.4 11.3 11.3
52.3 16.9 14.6 15.5 10.9 12.8
■ Time from onset to referral for rehabilitation (rho = 0.55; p = < 0.001). ■ Time from acceptance to admission: waiting list time (rho = 0.3; p = 0.008). With intensive specialist input, significant numbers of severely disabled young stroke patients can regain independent walking many months after onset. The timing, intensity and content of rehabilitation for these patients warrants further investigation. Waiting list delay may prolong rehabilitation and potentially compromise cost effectiveness.
Range of Motion in the Lumbar Spine and the Effects of Age and Gender G Van Herp, P J Rowe Department of Physiotherapy, Queen Margaret University College, Edinburgh P M Salter Napier University, Faculty of Health Sciences, Edinburgh The spine is a complex three-dimensional structure. Low back pain (LBP) is thought to limit motion of the spine. Hence the assessment of the range of lumbar spinal movement is a common feature of clinical assessment in back pain patients (Hindle et al, 1990). Furthermore, many physiotherapy techniques and patient management programmes are designed to help patients with LBP and restore function of the spine (Maitland, 1986). To date, an objective, three-dimensional measure of lumbar spinal range of motion, which can be employed in the clinical environment to analyse functional movements, has been lacking. This paper presents the preliminary data from a study using a new method for measuring spinal motion based on an electromagnetic tracking device (3Space Isotrak®). This device was used to create a normative database for three-dimensional rotational measurements of the lumbar spine. One hundred subjects (50 female, 50 male) with no history of recent LBP were recruited. The 3 Space Isotrak was calibrated and
References Blower, P W, Carter, L C and Sulch, D A (1995). ‘Relationship between wheelchair propulsion and independent walking in hemiplegic stroke’, Stroke, 26, 606-608. Jørgensen, M D, Nakayama, H, Raaschou, H O and Olsen, T S (1995). ‘Recovery of walking function in stroke patients: The Copenhagen stroke study’, Archives of Physical Medicine and Rehabilitation, 76, 27-32. The authors wish to thank Hillingdon Health Authority (Regional Audit Funding Programme for Rehabilitation) for providing financial support.
then carefully attached between the sacrum and the T12/L1 intervertebral junction. The device was held in place using double sided tape, adjustable pitch wedges and four specially commissioned straps. The subjects then per formed six movements to the limit of range. Greater flexibility was found in females than males for the six ranges of motion across all ages. The t-test for independent samples (two-tailed significance and 95% confidence interval) showed these differences to be significant for extension (p = 0.001; 2.9, 10.6) and axial rotations (p = 0.010; 0.6, 4.9) for all age groups. Significant differences were found between the young (20-29 years) and older (60+) groups for all movements. The data indicate that 55° of flexion, 23° of extension, 22° of side bending to each side and 14° of axial rotation in each direction can be expected in the normal adult spine. In addition females are more flexible than males by an average of 1.5° and the young more flexible than the older subjects by an average of 6° when an average is taken across all six movements. Clinicians could make use of these normal values in examination and remember to assess patient’s range of movement in light of their age and sex. References Hindle, R J, Pearcy, M J, Cross, A T and Miller, D H T (1990). ‘Three-dimensional kinematics of the human back’, Clinical Biomechanics, 5, 218-228. Maitland, G D (1986). Vertebral Manipulation, Butterworth, London, 5th edn.
Spinal angles in degrees achieved for six movements
Age (years) Flexion Extension Left side bending Right side bending Left axial rotation Right axial rotation
20-29 58.9 37.0 25.1 26.3 18.6 18.6
Physiotherapy January 2000/vol 86/no 1
Females (n = 50) 30-39 40-49 58.2 31.2 25.6 26.2 18.0 15.6
57.5 29.0 20.7 23.4 15.7 13.4
50-59
60+
20-29
53.6 20.5 21.9 23.2 14.7 14.2
50.8 15.1 19.4 19.2 14.7 13.0
56.4 22.5 25.8 26.2 14.4 14.6
Males (n = 50) 30-39 40-49 54.2 22.1 25.6 25.0 11.9 9.1
54.2 20.0 19.3 21.2 11.6 12.7
50-59
60+
52.8 17.2 19.0 22.4 11.3 11.3
52.3 16.9 14.6 15.5 10.9 12.8