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Trunk-muscle strength during concentric and eccentric contraction: a comparison between healthy subjects and patients with chronic low-back pain.

The physical evaluation and exercise program of trunk muscles in patients with chronic low-back pain (CLBP) is still controversial. Many studies have been performed in the isometric and/or concentric contraction mode. Few data, however, have been reported on trunk-muscle strength during eccentric contraction, which plays a significant role in functional activities. To evaluate whether trunk-muscle strength on eccentric contraction could be applicable to the assessment and exercise of the patients with CLBP, trunk strength was measured in 20 healthy men and 16 healthy women, as well as 15 male and 10 female patients with CLBP. Maximum voluntary concentric and eccentric strength was measured during attempted flexion and extension in a seated position. In the healthy subjects, the maximum torque of extensors was greater than that of the flexors during both concentric and eccentric contraction (p less than 0.05). In flexors and extensors, maximum torque exerted on the eccentric contraction was always greater than that on the concentric contraction (p less than 0.05). Although strength was likely to be weaker in the patients with CLBP than in the healthy subjects, there were no statistical differences between the two groups. In terms of the flexor/extensor ratio of maximum torque, there were also no statistical significances between the two groups in either contraction mode. In the flexors, correlation coefficient (r) between concentric and eccentric torque was 0.84 for the healthy subjects and 0.48 for the CLBP subjects (p less than 0.05). In the extensors, the coefficient was 0.90 for the healthy patients and 0.71 for the CLBP patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Effects of lumbar belts on trunk muscle strength and endurance: a follow-up study of construction workers.

The effects on maximal isometric trunk muscle strength and endurance after wearing a soft heat-retaining lumbar belt or a weightlifter's belt were studied. The soft belt (SB) study group comprised 12 construction workers with healthy backs, and the weightlifter's belt (WB) group comprised 24 construction workers with current or previous low back pain. The strength and endurance measurements were performed before the start of belt use, and after 1 and 2 months. The SB group increased the trunk flexor strength by 13% (p less than or equal to 0.01) after 2 months. The WB group increased the trunk flexor strength and endurance by 12% and 29%, respectively (p less than or equal to 0.001). No significant decrease of trunk muscle strength and endurance was found at the end of the follow-up period.

Adult↗

M2/M2 side-to-side rescue anastomosis for accidental M2 trunk occlusion during middle cerebral artery aneurysm clipping: technical note.

OBJECTIVE: A technically feasible and rapid technique for revascularizing the main branches of the middle cerebral artery (MCA) is described. This technique is applied mainly when clipping of an MCA aneurysm is complicated and occlusion of the origin of an MCA main branch results. METHODS: M2/M2 side-to-side anastomosis was applied in two patients in whom unplanned M2 occlusion occurred during the course of complicated MCA aneurysm clipping. The first patient underwent an emergency procedure after temporoparietal intracerebral hemorrhage. Unilateral mydriasis precluded preoperative angiographic workup, and a complex large MCA aneurysm was found as the source of hemorrhage. Shaping of the aneurysm neck by bipolar coagulation and clipping resulted in accidental occlusion of the superior trunk, and patency could not be regained despite multiple clip corrections. The second patient had an unruptured multilobulated aneurysm 8 mm in maximum diameter. Continuity of the inferior trunk was lost during clipping because of a tear at the origin. In both instances, side-to-side anastomosis was placed approximately 15 mm from the bifurcation, where the MCA main trunks ran side by side for a length of approximately 5 mm. RESULTS: After intracerebral hemorrhage, the first patient recovered to a level of moderate disability within 2 months. Substantial hemiparesis and expressive dysphasia remained as sequelae of the intracerebral hemorrhage. Digital subtraction angiography 2 months after the emergency procedure confirmed patency of the side-to-side anastomosis. The second patient was neurologically intact after recovery from anesthesia. Before discharge from the hospital on postoperative Day 8, digital subtraction angiography confirmed patency of the anastomosis. CONCLUSION: The MCA main branches usually run in close proximity for a short segment at the bottleneck entrance to the insular cistern. M2/M2 side-to-side anastomosis at this site is a rapid and feasible mode of revascularization of an M2 trunk accidentally occluded during complicated MCA aneurysm clipping.

Adult↗

Correlation of objective measure of trunk motion and muscle function with low-back disability ratings.

A study was undertaken to examine relations among some objective and subjective measures of low-back-related disability in a group of 41 low-back pain patients and in seven pain-free control subjects. Subjective measures of disability were obtained by Oswestry patient questionnaires. Oswestry disability score related significantly (P less than 0.001) to presence or absence of relaxation in back muscles during flexion. Mean trunk strength ratios were inversely related to disability score (P less than .05), and trunk mobility was meaningfully reduced (P less than .01). Despite loss of motion, a large enough excursion was observed to predict presence of back muscle relaxation. These findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability.

Activities of Daily Living↗

Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients.

The present study compared the computed tomography (CT) scan muscle area/muscle density and isokinetic trunk strength of a group of spinal surgery patients (35 males and 11 females) 3 months postoperatively. Analyses showed trunk strength means to be below 50% of gender-specific "normal" values obtained by evaluating a normative sample. Extensor strength was more significantly affected than flexors. Single-cut CT scans performed at the time of isokinetic trunk strength assessment demonstrated psoas and erector spinae atrophy through a significant decrease in muscle density, with only a trend towards decreased cross-sectional area. Findings also indicated that there was a significant correlation between increased mechanical trunk strength performance and greater muscle density on CT scan. Strength was significantly lower for the male patients undergoing spinal fusion compared with those undergoing disc excision. However, no significant difference was found in strength measures between: males with high versus low pain level and working versus nonworking males at the time of evaluation.

Adult↗

Electromyographic activity of selected trunk and hip muscles during a squat lift. Effect of varying the lumbar posture.

Electromyographic (EMG) activity of selected hip and trunk muscles was recorded during a squat lift, and the effects of two different lumbar spine postures were examined. Seven muscles were analyzed: rectus abdominis (RA), abdominal obliques (AO), erector spinae (ES), latissimus dorsi (LD), gluteus maximus (GM), biceps femoris (BF), and semitendinosus (ST). The muscles were chosen for their attachments to the thoracolumbar fascia and their potential to act on the trunk, pelvis, and hips. Seventeen healthy male subjects participated in the study. Each subject did three squat lifts with a 157-N crate, with the spine in both a lordotic and kyphotic posture. The lift was divided into four equal periods. EMG activity of each muscle was quantified for each period and normalized to the peak amplitude of a maximal voluntary isometric contraction (MVIC). A two-way analysis of variance (ANOVA) for repeated measures was used to analyze the effects of posture on the amplitude and timing of EMG activity during the lift. Two patterns of EMG activity were seen: a trunk muscle pattern (RA, AO, ES, and LD) and a hip extensor pattern (GM, BF, ST). In the trunk muscle pattern (TP), EMG activity was greatest in the first quarter and decreased as the lift progressed. In the hip extensor pattern (HP), EMG activity was least in the first quarter, increased in the second and third quarters, and decreased in the final phase of the lift. Differences (P < .05) were seen among subjects and in the timing of the muscle activity in all muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Differentiation of submaximal from maximal trunk extension effort: an isokinetic study using a new testing protocol.

STUDY DESIGN: An evaluation of the relations between concentric and eccentric contractions of the trunk extensors and extension effort performed at maximal and submaximal levels. OBJECTIVE: To define quantitative parameter(s) derivable from isokinetic dynamometry that may differentiate submaximal from maximal trunk extension moment. SUMMARY OF BACKGROUND DATA: Using various consistency-related parameters, researchers in previous studies have not been able confirm the potential of isokinetic dynamometry for identifying submaximal effort during trunk extension. METHODS: Twenty healthy subjects, 8 women and 12 men without low back pain history, aged 21 to 30 years, took part in this study. Testing consisted of three experimental conditions using four intermittent concentric and eccentric contractions at 20 degrees and 60 degrees/second. The first condition, in which subjects were asked to exert maximal concentric and eccentric effort, served as the baseline. In the second condition, subjects were asked to exert 50% of the force measured in the first condition. In the third condition, subjects repeated the second condition but were asked to exert the best reproducible level of force. RESULTS: The highest differentiating power among the experimental conditions was attributed to the intervelocity difference between the concentric and eccentric contractions (P < 0.0001). CONCLUSIONS: This protocol effectively differentiates submaximal from maximal trunk extension effort in normal subjects.

Adult↗

Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study.

STUDY DESIGN: A 5-year prospective study. OBJECTIVES: To investigate trunk muscle weakness as a risk factor for low back pain in asymptomatic volunteers. SUMMARY OF BACKGROUND DATA: Muscle strength has not been sufficiently studied as a risk factor for low back pain. METHODS: The study participants included 30 male and 37 female volunteers (mean age, 17 +/- 2 years), who neither reported nor had ever been treated for low back pain. Trunk muscle strength was measured isokinetically (60 degrees/sec), using the trunk extension and flexion and torso rotation units. The peak torques of the volunteers' extension, flexion, rightward rotation, and leftward rotation were measured, and the agonist/antagonist ratios were calculated as extension/flexion and left rotation/right rotation ratio. The volunteers then were followed prospectively for 5 years to determine the incidence of low back pain and were classified into a non-low back pain group (volunteers with no low back pain during the 5-year follow-up period) and a low back pain group (volunteers who experienced low back pain during this period). RESULTS: The low back pain group consisted of 8 male and 10 female volunteers. There were no significant differences between the non-low back pain group and the low back pain group regarding age, height, weight, the peak torque values, or the left rotation/right rotation ratio. However, the extension/flexion ratio of the low back pain group (men, 0.96 +/- 0.27; women, 0.77 +/- 0.19) demonstrated significantly lower values than that of the non-low back pain group (1.23 +/- 0.28 and 1.00 +/- 0.16 for men and women, respectively, P < 0.05). CONCLUSIONS: An imbalance in trunk muscle strength, i.e., lower extensor muscle strength than flexor muscle strength, might be one risk factor for low back pain.

Adolescent↗

Serial changes in trunk muscle performance after posterior lumbar surgery.

STUDY DESIGN: Serial changes in trunk muscle performance were prospectively studied in 20 patients who underwent posterior lumbar surgery. OBJECTIVE: To evaluate the influence of back muscle injury on postoperative trunk muscle performance and low back pain, to clarify the significance of minimization of back muscle injury during surgery. SUMMARY OF BACKGROUND DATA: The current investigators have reported examination of iatrogenic back muscle injury in an animal model and in humans. However, definite impairment caused by such back muscle injury has not been clarified. METHODS: The patients were divided into a short-retraction-time group (< 80 minutes; n = 12) and a long-retraction-time group (> or = 80 minutes; n = 8). Before surgery and 3 and 6 months after surgery, the degree of back muscle injury was estimated by magnetic resonance imaging, and trunk muscle strength was measured. In addition, the incidence and severity of low back pain were serially analyzed. RESULTS: Back muscle injury was directly related to the muscle retraction time during surgery. The damage to the multifidus muscle was more severe, and the recovery of extensor muscle strength was delayed in the long-retraction-time group. In addition, the incidence of postoperative low back pain was significantly higher in the long-retraction-time group. CONCLUSIONS: Postoperative trunk muscle performance is dependent on the muscle retraction time. Thus, it is beneficial to shorten the retraction time to minimize back muscle injury and subsequent postoperative low back pain.

Adolescent↗

Decrease in trunk muscular response to perturbation with preactivation of lumbar spinal musculature.

STUDY DESIGN: An experimental study of healthy subjects' trunk muscle responses to force perturbations at differing angles and steady state efforts. OBJECTIVES: To determine whether increased preactivation of muscles was associated with decreased likelihood of muscular activation in response to a transient force perturbation. SUMMARY OF BACKGROUND DATA: Trunk stability (ability to return to equilibrium position after a perturbation) requires the stiffness of appropriately activated muscles to prevent buckling and consequent "self-injury." Therefore, greater trunk muscle preactivation might decrease the likelihood of reflex muscle responses to small perturbations. METHODS: Each of 13 subjects stood in an apparatus with the pelvis immobilized. A harness around the thorax provided a preload and a force perturbation by a horizontal cable and a movable pulley attached to one of five anchorage points on a wall track surrounding the subject at angles of 0 degrees, 45 degrees, 90 degrees, 135 degrees, and 180 degrees to the forward direction. Subjects first equilibrated with a preload effort of nominally 20% or 40% of their maximum extension effort. Then a single full sine-wave force perturbation pulse of nominal amplitude, 7.5% or 15% of maximum effort, duration 80 milliseconds or 300 milliseconds, was applied at a random time, with three repeated trials of each test condition. The applied force (via a load cell) and the electromyographic activity of six right and left pairs of trunk muscles were recorded. Muscle responses were detected by two methods. 1) Shewhart method: electromyographic signal greater than "baseline" values by more than three standard deviations, and 2) Mean Electromyographic Difference method: mean electromyographic signal in a time window 25 to 150 milliseconds after the force perturbation greater than that in a 25- to 150-millisecond window before the perturbation. RESULTS: Lower preload efforts were associated with more muscle responses (overall mean response detection rate = 33% at low preload and 25% at high preload). Using the Shewhart method, there were significant differences by effort (P<0.05) for all abdominal muscles and for all left dorsal muscles except multifidus. Using the Mean Electromyographic Difference method, there were significant differences by effort (P<0.05) for the same dorsal muscles, but only for one of the abdominal muscles. CONCLUSIONS: Findings are consistent with the hypothesis that the spine can be stabilized by the stiffness of activated muscles, obviating the need for active muscle responses to perturbations.

Adult↗

Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study.

STUDY DESIGN: A 3-year prospective cohort study among workers of 34 companies in the Netherlands. OBJECTIVES: To investigate the relation between flexion and rotation of the trunk and lifting at work and the occurrence of low back pain. SUMMARY OF BACKGROUND DATA: Previous studies on work-related physical risk factors for low back pain either lacked quantification of the physical load or did not take confounding by individual and psychosocial factors into account. METHODS: The study population consisted of 861 workers with no low back pain at baseline and complete data on the occurrence of low back pain during the 3-year follow-up period. Physical load at work was assessed by means of analyses of video-recordings. Information on other risk factors and the occurrence of low back pain was obtained by means of self-administered questionnaires. RESULTS: An increased risk of low back pain was observed for workers who worked with the trunk in a minimum of 60 degrees of flexion for more than 5% of the working time (RR 1.5, 95% CI 1.0-2.1), for workers who worked with the trunk in a minimum of 30 degrees of rotation for more than 10% of the working time (RR 1.3, 95% CI 0.9-1. 9), and for workers who lifted a load of at least 25 kg more than 15 times per working day (RR 1.6, 95% CI 1.1-2.3). CONCLUSIONS: Flexion and rotation of the trunk and lifting at work are moderate risk factors for low back pain, especially at greater levels of exposure.

Adult↗

Effects of electrical stimulation of the sciatic nerve on background electromyography and static stretch reflex activity of the trunk muscles in rats: possible implications of neuronal mechanisms in the development of sciatic scoliosis.

STUDY DESIGN: The effects of electrical stimulation of the sciatic nerve on background electromyographic and static stretch reflex activity of the trunk muscles were studied. OBJECTIVES: To verify the hypotheses that sciatic scoliosis is induced reflexively by radiculopathic pain, and that scoliosis might be maintained by prolonged asymmetric alteration of the trunk muscle tonus caused by central sensitization of the spinal neurons that constitute the postural reflex pathways. SUMMARY OF BACKGROUND DATA: Sciatic scoliosis usually occurs with convexity to the side of the herniated disc. The neuronal mechanism of sciatic scoliosis has not been well clarified. Recently, prolonged alteration of motor function in the hindlimbs of animals caused by central sensitization has been reported. METHODS: In spinalized rats (transection of the spinal cord), the sciatic nerve was stimulated electrically as a conditioning stimulus. Muscle stretch elicited by bending of the lumbar spine was applied as a test stimulus. Background and stretch reflex activities of the bilateral oblique abdominal, psoas, and quadratus lumborum muscles were recorded. Rats in which MK-801, an N-methyl-d-aspartate antagonist, was preadministered also were used. RESULTS: The conditioning stimulus enhanced background electromyographic activity in bilateral oblique abdominal, contralateral psoas, and quadratus lumborum muscles. Furthermore, the conditioning stimulus induced prolonged facilitation and depression of stretch reflex activity of the contralateral psoas and quadratus lumborum, and ipsilateral psoas and quadratus lumborum muscles, respectively. Preadministration of MK-801 reduced these excitatory and inhibitory effects. CONCLUSION: It was found that the pattern of electromyographic activity of the trunk muscles evoked by sciatic nerve stimulation coincided with the typical direction of sciatic scoliosis in patients with lumbar disc herniation. It was supposed that the prolonged asymmetric alteration of the trunk muscle tonus was caused by central sensitization, and that central sensitization of spinal neurons may underlie the neuronal mechanism of sciatic scoliosis.

Animals↗

Effect of belt pressure and breath held on trunk electromyography.

STUDY DESIGN: This study examined the effect of a belt on ventilation and trunk muscle activities during repetitive lifting tasks with a control of breathing type and belt pressure. OBJECTIVES: To evaluate the effect of the lifting belt on the trunk muscle electromyography (EMG) and to parse out potential interaction between ventilatory changes and lifting belts. SUMMARY OF BACKGROUND DATA: Although both tensed thorax and compressed abdomen are considered to assist transferring the force from torso to pelvis in lifting, there has not been any consideration of the interaction between the two chambers in most published analyses. METHODS: Eleven male study participants participated in the study. They performed five minutes of paced repetitive squat lifts at frequencies of one or three lifts per minute, with loads of 10 or 25 kg. Belt pressure was set at 0 (no belt), 10, and 20 mm Hg. Study participants lifted with inspire-hold and expire-hold for a period of 5 minutes. Lift ventilation data and trunk muscle normalized electromyography (NEMG) (including rectus abdominis, external oblique, latissimus dorsi, and erector spinae) for the final lift were collected for analysis. RESULTS: The results indicate that the ventilation demand for lifting was not different with or without use of a belt. The prelifting erector spinae NEMG was 8-11% maximum voluntary contraction (MVC) lower and the latissimus dorsi NEMG was 15-21% MVC lower than that without belt. This is also the case in the lifting phase. The rectus abdominis NEMG was increased by 4% MVC and the external oblique NEMG was increased by 3-5% MVC while lifting with a belt. CONCLUSIONS: These data do not lead to a statistical effect of lifting belt pressure on ventilatory behavior. It appears that the use of a belt in lifting significantly decreased the back muscular activation yet increased the abdominal muscular activation. Thus, claims of benefits derived from the use of a belt in lifting remain controversial. The simultaneous controls of the air volume held and pressure of the belt during the moment-controlled lifting tasks allowed this presentation of belt effects on trunk muscle NEMG unique from that in most of the literature.

Abdomen↗

Factors in breathing maneuvers that affect trunk electromyogram during manual lifting.

STUDY DESIGN: A fully randomized experiment was conducted in a laboratory with a breath-by-breath monitor to control accurately the two factors of breathing maneuvers: breathholding duration and air volume within the thoracic cavity. OBJECTIVES: To resolve the controversy in previous reports about the effect of breathholding on the trunk electromyogram, and to verify the hypothesis that not only the factor of glottis closure, but also that of the air volume inside the thoracic cavity affects the trunk muscular activities during lifting. SUMMARY OF BACKGROUND DATA: Breathing was shown to affect spinal loading. However, there still is a debate about the effect of breathholding on trunk muscular activation during activities. It is possible that variations in air volume influence this effect. METHODS: Seven healthy, volunteer men participated in lifting tasks, in which lifting moment was standardized. Three breathing maneuvers were used: sustained breathholding with tidal volume of air, sustained breathholding with functional residual volume, and intended breath-nonholding involving inspiration within tidal capacity. Data on the surface electromyographic activation of the external oblique muscle, rectus abdominis, erector spinae, latissimus dorsi, air volume inside the cavity, and the duration of the one breath held in the last lift were collected and analyzed. RESULTS: Of the four muscles investigated, the breathing maneuvers affected only the external oblique muscle. The effect of sustained breathhold during lifting was the significantly increased activation of this muscle (P < 0.05). The effect of decreased air volume held was further increased activation. Intention to inspire normally during lifting decreased external oblique activation, but increased compensatory diaphragmatic effort, measured as inspiratory flow acceleration. CONCLUSIONS: Both the factors of the breathheld state and sustained air volume were verified to affect the external oblique activation during lifting. The current study emphasizes that both factors should be controlled in studies analyzing trunk electromyogram during activities. Otherwise, these breathing variations will be a confounding factor on electromyogram results.

Abdominal Muscles↗

Trunk muscle strength is a strong predictor of bone loss in postmenopausal women.

UNLABELLED: To clarify whether trunk muscle strength and self-reported exercise habits predict subsequent bone loss in healthy post- menopausal women, we examined 143 community-dwelling ambulatory postmenopausal Japanese women (age: 59.9 +/- 6.5 years) without any diseases affecting bone metabolism at baseline, and followed 109 of the 143 subjects for 4 years. Bone mineral density at baseline and at followup was measured at the spine by DEXA to determine the annual change in bone mineral density during the followup. Subjects who lost bone mineral density at an annual rate exceeding -1.78% (1 standard deviation below the mean rate) were defined as rapid bone losers. The isokinetic concentric and eccentric peak torques of the trunk flexors and extensors were measured at baseline. The exercise habits of the subjects were evaluated through detailed interviews. The eccentric trunk flexor and extensor torques were found to correlate with a positive dose-dependent effect on change in bone mineral density while exercise habits showed no correlation. The lower tertile group for the extensor torque showed a ten-fold greater risk for rapid bone loss compared with the upper tertile group. Postmenopausal women with decreased trunk muscle torque may be at increased risk for osteoporosis and should be a target group for preventive measures. LEVEL OF EVIDENCE: Prognostic study, level II (prospective study). See the Guidelines for Authors for a complete description of the levels of evidence.

Absorptiometry, Photon↗

Trunk extension effort in patients with chronic low back dysfunction.

STUDY DESIGN: Single-session measurement was performed. OBJECTIVE: To measure trunk extension strength and assess trunk extension effort in patients with chronic low back dysfunction using a novel test protocol and the DEC parameter. SUMMARY OF BACKGROUND DATA: In normal subjects, the DEC parameter effectively and reproducibly differentiates between maximal effort and feigned weakness of the trunk extensors, but its applicability to patients with chronic low back dysfunction has not yet been explored. METHODS: Isokinetic trunk extension strength was measured in 44 patients with chronic low back dysfunction (22 women and 22 men) who were not involved in litigation process. Tests were conducted using a range of motion of 20 degrees, angular velocities of 10 degrees and 40 degrees per second, and an isometric preactivation force of 50 N. The average strength at these velocities served for calculation of the DEC score, which is the difference between the eccentric and concentric strength ratios at these velocities. RESULTS: The strength scores resembled the characteristic physiologic moment-angular velocity relation, and were much reduced, as compared with the scores of normal subjects. The DEC scores for 39 patients (89%) were less than the cutoff value, which in normal subjects differentiates maximal effort (below cutoff) from feigned weakness (above cutoff) at tolerance limits of 99%. This figure was slightly lower (84%) at a corresponding 95% level. A principal finding in the false-positive cases was a particularly low concentric strength at 40 degrees per second. CONCLUSIONS: This study indicates that under the current protocol, the large majority of patients perform at a maximal level of effort.

Abdomen↗

Differential activation of the thoracic multifidus and longissimus thoracis during trunk rotation.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To develop a technique to measure electromyographic (EMG) activity of deep and superficial paraspinal muscles at different thoracic levels and to investigate activity of these muscles during seated trunk rotation. SUMMARY OF BACKGROUND DATA: Few studies have compared activity of deep and superficial paraspinal muscles of the thorax during trunk rotation, and conflicting results have been presented. Conflicting data may result from recording techniques or variation in activity between thoracic regions. METHODS: EMG recordings were made from deep (multifidus/rotatores) and superficial (longissimus) paraspinal muscles at T5, T8, and T11 using selective intramuscular electrodes. Ten subjects rotated the trunk to end of range in each direction. EMG amplitude was measured in neutral, at end of range, and during four epochs, which represented four quarters of the movement. RESULTS: During trunk rotation in sitting, longissimus EMG either increased with ipsilateral rotation (T5) or decreased with contralateral rotation (T5, T8, T11). In contrast, multifidus EMG was more variable and was either active with rotation in both directions (particularly T5) or with one movement direction. CONCLUSIONS: The deep and superficial muscles of the thorax are differentially active, and the patterns of activity differ between the regions of the thorax. Data from this study support the hypothesis that multifidus may have a role in control of segmental motion at T5. Variability in multifidus activity at T8 and T11 suggests that this muscle may also control coupling between rotation and lateral flexion.

Adult↗

Assessment of trunk balance in thoracic scoliosis.

STUDY DESIGN: A retrospective radiographic review was undertaken in patients with idiopathic thoracic scoliosis. OBJECTIVES: To determine if a mathematical relationship exists between the 2 methods used to assess trunk balance (lateral trunk shift [LTS] and thoracic apical vertebral translation [AVT]), and to determine if one of these measurements can satisfactorily predict the value of the other. SUMMARY OF BACKGROUND DATA: No previous reports exist, to our knowledge, comparing these 2 methods used to asess trunk balance. METHODS: Coronal balance (CB), LTS, thoracic AVT, and curve magnitude were measured from standing preoperative posteroanterior radiographs of 91 patients with Lenke 1A/1B curves. The data were analyzed to determine if predictive relationships existed between LTS and thoracic AVT alone or between LTS and the sum of CB and thoracic AVT. RESULTS: A statistically significant relationship was shown between LTS and the sum of thoracic AVT and CB. In general, the LTS can be estimated by taking two thirds of the sum of thoracic AVT and CB (in centimeters) and subtracting 0.8. This relationship weakened as CB improved. The relationship between LTS and AVT was not statistically significant when CB was excluded. CONCLUSIONS: In patients with thoracic idiopathic scoliosis, if the CB and thoracic AVT values are known, then the LTS can be reliably estimated. The use of correct terminology for describing trunk balance and CB is important if valid comparisons of spinal deformity literature are desired.

Adolescent↗