Increased incidence of obesity and longer life expectancies will place increased demands on load bearing joints. In the present work, a method of pre-clinical evaluation to assess the condition of the joint and potentially inform on cases of joint deterioration, is described. Acoustic emission (AE) is a non-destructive test methodology that has been used extensively in engineering for condition monitoring of machinery and structures. It is a passive technique that uses piezoelectric sensors to detect energy released from internal structural defects as they deform and grow. The technique has been used with some success in the past to identify characteristic signals generated from the knee joint during activities such as standing and sitting, in candidate arthroplasty patients (1,2). In this study, 40 asymptomatic subjects had AE data generated from their knee joints analysed. Subject characteristics such as age, gender, and lifestyle were disclosed and evaluated against the AE data. Each subject was invited to take a seated position and a piezoelectric AE sensor (Pancom P15, 150kHz resonance, 19mm diameter) was attached to the subject's knee using a wax couplant and tape as close to the articulating surface and on a bony prominence to avoid signal attenuation in the soft tissue. Subjects were invited to sit and stand 3 times. AE data were collected and processed using an AMSY5 AE processor (Vallen, Germany). Tests were repeated on a separate occasion and selected subjects were invited to participate on a third occasion. The AE data of particular interest were the peak amplitudes and the frequency power spectrum of the waveform. Post-test inspection of subject characteristics allowed them to be separated into three broad categories: no previous history (group A), some instances of pain in the knee (group B), and those who have had previous minor surgery on the knee (group C). The corresponding AE results were grouped separately. It was found that groups A and B demonstrated similar signal amplitude characteristics while group C produced much higher, significantly different (p<0.05) amplitudes and amplitude distributions. Typical results are shown in figure 1. At present, broad trends could be identified and relationships emerged between the data and subject history (prior surgery, typical daily activity). Further work will continue with asymptomatic subjects and the work will be extended to pre-operative patients to identify whether certain trends are amplified in this population

Introduction. Most of studies on Total Hip Arthroplasty (THA) are focused on acetabular cup orientation. Even though the literature suggests that femoral anteversion and combined anteversion have a clinical impact on THA stability, there are not many reports on these parameters. Combined anteversion can be considered morphologically as the addition of anatomical acetabular and femoral anteversions (Anatomical Combined Anatomical Anteversion ACA). It is also possible to evaluate the Combined Functional Anteversion (CFA) generated by the relative functional position of femoral and acetabular implants while standing. This preliminary study is focused on the comparison of the anatomical and functional data in asymptomatic THA patients. Material and methods. 50 asymptomatic unilateral THA patients (21 short stems and 29 standard stems) have been enrolled. All patients underwent an EOS low dose evaluation in standing position. SterEOS software was used for the 3D measurements of cup and femur orientation. Cup anatomical anteversion (CAA) was computed as the cup anteversion in axial plane perpendicular to the Anterior Pelvic Plane. Femoral anatomical anteversion (FAA) was computed as the angle between the femoral neck axis and the posterior femoral condyles in a plane perpendicular to femoral mechanical axis. Functional anteversions for the cup (CFA) and femur (FFA) were measured in the horizontal axial patient plane in standing position. Both anatomical and functional cumulative anteversions were calculated as a sum. All 3D measures were evaluated and compared for the repeatability and reproducibility. Statistical analysis used Mann-Whitney U-test considering the non-normal distribution of data and the short number of patients (<30 for each group). Results. Functional cumulative anteversion was significantly higher than anatomical cumulative anteversion for all groups (p<0.05). No significant difference could be noted between the cases according to the use of short or standard stems. Conclusion. This study shows the difference of functional implant orientation as compared to the anatomical measurements. This preliminary study has limitations. First the limited sample of patients. Then this series only includes asymptomatic subjects. Nevertheless, this work focused on the feasibility of the measurements shows the potential interest of a functional analysis of cumulated anteversion. Standing position influences the relative position of THA implants according to the frontal and sagittal orientation of the pelvis. The relevance of these functional measurements in instability cases must be demonstrated, especially in patients with anterior subluxation in standing position which is potentially associated with pelvic adaptative extension. Further studies are needed for the feasibility of measurements on EOS images in sitting position and their analysis in case of instability. For any figures or tables, please contact authors directly

Aims: We studied the prevalence of calciþc tendinopathy in asymptomatic subjects and the relationship between calciþc deposits and the anatomopathological characteristic of coracoacromial arch. Methods: 222 right-handed volunteers underwent x-ray examination of the right shoulder. We measured the acromiohumeral distance (AHD) and evaluated the acromion shape and the degenerative changes of the GH and AC joints. We measured the size of the deposits and classiþed the calciþcations based on their location, shape and neatness. The subjects with deposits were clinically evaluated and underwent a second x-ray study after 14 months. Results: 11 subjects (5%) had calciþcation. The latter was in the substance of supraspinatus in 5(mean age 45 yrs) and at cuff insertion in 6 (66 yrs). The deposits measured 0.7±0.3cm (avg). There were 3 linear and 2 beanlike intratendinous calciþcations and 5 linear and 1 beanlike deposits at tendon insertion. Calciþcations had well-deþned margins. AHD, acromion shape, arthritic of the GH or AC joint were unrelated to the presence of calciþcations. No subject showed evidence of cuff tear. Intratendinous deposit decreased in size in 2 cases and disappeared in 1. Conclusions: 5% of asymptomatic subjects have calciþcations. Calciþcations are always small and well-deþned. Morphology and changes of the cora-coacromial arch or the GH or AC joint donñt inßuence the deposition of calcium. Our study suggests that calciþcations may decrease in size or disappear without completion of Uhthoffñs cycle

The purpose of this study was to characterise the neuromuscular patterns associated with different severities of knee osteoarthritis (OA). Forty-five patients with moderate OA, thirty-seven with severe OA and thirty-eight asymptomatic controls underwent a complete gait analysis with only the electromyographic (EMG) findings presented in this abstract. Severity levels were established through the Kellgren-Lawrence radiographic grading system, functional ability, and those classified with severe OA were tested within one-week of total knee replacement surgery. All OA patients had medial joint involvement. Subjects walked along a five-meter walkway a total of five times at a self- selected walking speed. Muscle activation patterns of the vastus medialis and lateralis, medial and lateral hamstring and medial and lateral gastrocnemius were recorded and normalised to maximum voluntary isometric contractions. All EMG waveforms were analyzed for group differences using PCA [1] followed by an ANOVA (group by muscle) for the PCA scores for each muscle group. These scores reflect both magnitude and shape changes. The control group was significantly younger (53.3 ±9.5 yrs) and lighter (77.5 ±14.5 Kg) than the patient groups (Moderate =59.8 ±8.0 years and 94.2 ±19.2 Kg and Severe = 63.1 ±7.9 yrs and 95.8 ±14.6Kg). The severe OA group walked significantly slower (0.9 ±0.2 m/s) than the asymptomatic (1.3 ±0.1) m/s) and the moderate OA (1.2 ±0.2 m/s) groups. The PCA analysis of the EMG waveforms revealed statistically significant differences (P< 0.05) in patterns among the three groups and between muscles within the three muscle groups tested. The neuromuscular differences found among groups during gait demonstrate that the role of the musculature surrounding the knee is altered slightly in those with moderate OA and altered drastically in those with end-stage OA compared to asymptomatic subjects, reflecting a progression. The differences are consistent with the severe group adopting a co-activation strategy of agonist and antagonists, more lateral activation and a reduction in plantar flexion during push off. These are consistent with strategies to increase dynamic stability and reduce medial joint loading. The moderate OA group illustrates a trend toward adopting this pattern but with only very subtle differences from asymptomatic subjects as has been previously reported. These neuromuscular alterations have implications with respect to muscle function and may assist in defining severity

Background: Intervertebral motion is often assumed to be altered with back pain, however, the patterns are inaccessible to measurement in live subjects. A method for digitally tracking and analysing fluoroscopic images of the vertebrae of subjects who are undergoing standardised passive motion has recently been brought into clinical use for the assessment of surgical fusions. We have studied the differences between the behaviour of spinal linkages in subjects who are asymptomatic, and those who have had fusion operations. This paper describes the reliability, ranges and qualitative features of intervertebral motion patterns in 27 asymptomatic subjects and 3 fusion patients. Methods and results: Thirty asymptomatic male volunteer subjects aged 19–40, underwent 2 –20 second sessions of fluoroscopic screening during 80 degrees of lumbar spine bending within 20 minutes of each other. Intervertebral sidebending motion from L2–5 was measured in 27 subjects whose images were judged suitable for tracking. Approximately 120 digitised images throughout each motion sequence were analysed 5 times by 2 blinded observers for intervertebral range and each result averaged. The intra-subject biological error (RMS), for range of intervertebral motion was 2.75° for Observer1 and 2.91° for Observer 2. The interobserver error for tracking the same screenings was 1.86° (RMS). At almost all levels, these motion patterns were remarkably regular. Four male patients aged 33, 44, 45 and 52 years, who had undergone different spinal stabilisation procedures consisting of flexible stabilisation (DNESYS), posterior instrumented fusion, and anterior interbody fusion with facet fixation were investigated. Images were acquired and analysed in the same way except that a larger number of images (500 per screening) was utilised in each case. Four operated levels and 2 adjacent levels were analysed. All motion patterns were easily distinguishable from those of the normal subjects. The PLIF and DYNESYS stabilisations demonstrated no motion at the instrumented levels. The anterior inter-body fusion-transfacet fixation patient was shown to have developed a pseudarthrosis. Conclusions: Detailed lumbar intervertebral bending patterns in asymptomatic subjects were distinguishable from the fused and adjacent-to fused segments in operated patients. Results suggest that there is sufficient reliability in the method to evaluate lumbar intersegmental ranges and motion patterns for fusion assessment

Purpose: Currently, there is limited research on the effectiveness of rehabilitative exercises for neck pain patients generally, and chronic neck pain patients in particular. Interestingly, recent evidence suggests that dysfunction of cervicocephalic kinaesthesia, as measured by head repositioning accuracy (HRA), is present in many chronic patients, and that active eye-head-neck co-ordination exercises may be useful in terms of patients’ rehabilitation. The purpose of this study was twofold: i) to determine if there was a difference in HRA in chronic neck pain subjects versus controls; ii) to assess the effect of a rehabilitative exercise programme on chronic neck pain subjects’ HRA and reported levels of pain. Method: A prospective, intervention study on a convenience sample of chronic neck pain subjects (> 3 months duration) versus age- and gender-matched, asymptomatic control subjects was conducted. Exclusion criteria included any form of active treatment (> 1 per month) for musculoskeletal complaints, including medication, as well as any arthritic, orthopaedic, or neurological disorder. Both symptomatic and asymptomatic subjects were assigned, via stratified, random allocation, to either a rehabilitative exercise or non-exercise group. This gave rise to 4 groups. Symptomatic and asymptomatic exercise subjects were given a training session as well as written and verbal instructions on how to perform the eye-head-neck co-ordination exercises. Subjects were asked to perform the exercises twice daily over a 4-week period, and to keep a diary of exercise compliance and any associated symptomatology. Outcomes included HRA for all active cervical range-of-motion, measured by a helmet-mounted laser pointer on a paper target, and pain intensity as measured by a 100 mm visual analogue scale (VAS). Outcomes were measured in all subjects at baseline, end of week 2, and end of week 4. Results: 63 subjects were recruited, of which 56 completed the 4-week study. 28 chronic neck pain subjects (14 males and 14 females; mean age 22.6 years, range 19–30 years), and 28 asymptomatic controls (14 males and 14 females; mean age 23.9 years, range 19–31 years) were assigned via stratified random allocation, to an exercise or non-exercise group. Each of the 4 groups contained 14 subjects. Active HRA was found to be significantly reduced in neck pain subjects compared to control subjects (ANOVA, p< 0.001). Whiplash patients (N=17) in particular, were significantly less precise (ANOVA, p< 0.001). A significant reduction in reported pain was experienced by the symptomatic exercise versus symptomatic non-exercise group (ANOVA, p< 0.001). At 4-weeks, the symptomatic exercise group demonstrated significantly improved HRA in all active movements compared to the other groups (ANOVA, p< 0.001). Conclusions: This study provides evidence that simple, eye-head-neck co-ordination exercises may be helpful in reducing functional impairment in terms of cervicocephalic kinaesthesia as well as reported levels of pain in chronic neck pain subjects

Introduction. The usefulness of markers of non-specific low back pain (NSLBP), including MRI derived measurements of cross-sectional area (CSA) and functional CSA (FCSA, fat free muscle area) of the lumbar musculature, is in doubt. To our knowledge, such markers remain unexplored in Lumbar Disc Degeneration (LDD), which is significantly associated with NSLBP, Modic change and symptom recurrence. This exploratory 3.0-T MRI study addresses this shortfall by comparing asymmetry and composition in asymptomatic older adults with and without Modic change. Methods. A sample of 21 healthy, asymptomatic subjects participated (mean age 56.9 years). T2-weighted axial lumbar images were obtained (L3/L4 to L5/S1), with slices oriented through the centre of each disc. Scans were examined by a Consultant MRI specialist and divided into 2 groups dependent on Modic presence (M) or absence (NM). Bilateral measurements of the CSA and FCSA of the erector spinae, multifidus, psoas major and quadratus lumborum were made using Image-J software. Muscle composition was determined using the equation [(FCSA/CSA)*100] and asymmetry using the equation [(Largest FCSA-smallest FCSA)/largest FCSA*100]. Data were analysed using Mann-Whitney U tests (p value set at). Intrarater reliability was examined using Intraclass Correlations (ICCs). Results. ICCs ranged between 0.74 and 0.96 for all area measurements, indicating excellent reliability. There was no significant difference in TCSA and FCSA asymmetry (P=0.1–1.0) and muscle composition (P=0.1–1.0) between M and NM groups. Conclusion. Modic change in the absence of pain does not appear to influence cross-sectional asymmetry or composition of the lumbar musculature. CSA remains a controversial marker. No conflicts of interest. Funding: This work is funded by an Allied Health Professional Doctoral Fellowship awarded to Janet Deane by Arthritis Research U.K

Introduction: Contrary to the prevailing conviction that lumbar segments affected by lytic spondylolisthesis are unstable, multiple studies have failed to find evidence of increased or abnormal motion at these segments. Affected segments do not exhibit excessive anterior translation: the so-called slip. Previous studies, however, did not use techniques that might reveal abnormalities in the quality of motion, as opposed to its magnitude. Methods: To determine if features of instability could be detected in the radiographs of patients with spondylolisthesis, a retrospective, cohort study was conducted of the kinematics of the lumbar spine of patients with spondylolisthesis compared with asymptomatic normal subjects. The flexion-extension radiographs of 15 patients with spondylolytic spondylolisthesis were analysed to determine the location of their instantaneous centres of rotation, and their magnitudes of translation and sagittal rotation. Normative data were obtained by applying the same techniques to the radiographs of 20 asymptomatic subjects. Results: All but one of the 15 patients exhibited at least one segment with abnormal motion. Only one patient had excessive translation at the lytic segment. Four had minor abnormalities affecting either the lytic segment or ones above. Nine patients exhibited major abnormalities. Seven had paradoxical motion at the lytic segment, in which the centre of rotation was located above L5, instead of below, and in which L5 translated backwards, instead of forwards, during flexion. Two patients exhibited axial dropping of L4, instead of horizontal translation, during extension. Discussion: Not all patients with spondylolisthesis show features of instability. However, a proportion of patients exhibit highly abnormal movements that are consistent with instability. The abnormalities involve movements within normal range but in abnormal directions. Visual inspection of radiographs will not reveal these abnormalities but they can be detected by plotting the instantaneous axes of rotation

INTRODUCTION: Contrary to the prevailing conviction that lumbar segments affected by lytic spondylolisthesis are unstable, multiple studies have failed to find evidence of increased or abnormal motion at these segments. Affected segments do not exhibit excessive anterior translation: the so-called slip. Previous studies, however, did not use techniques that might reveal abnormalities in the quality of motion, as opposed to its magnitude. METHODS: To determine if features of instability could be detected in the radiographs of patients with spondylolisthesis, a retrospective, cohort study was conducted of the kinematics of the lumbar spine of patients with spondylolisthesis compared with asymptomatic normal subjects. The flexion-extension radiographs of 15 patients with spondylolytic spondylolisthesis were analysed to determine the location of their instantaneous centres of rotation, and their magnitudes of translation and sagittal rotation. Normative data were obtained by applying the same techniques to the radiographs of 20 asymptomatic subjects. RESULTS: All but one of the 15 patients exhibited at least one segment with abnormal motion. Only one patient had excessive translation at the lytic segment. Four had minor abnormalities affecting either the lytic segment or ones above. Nine patients exhibited major abnormalities. Seven had paradoxical motion at the lytic segment, in which the centre of rotation was located above L5, instead of below, and in which L5 translated backwards, instead of forwards, during flexion. Two patients exhibited axial dropping of L4, instead of horizontal translation, during extension. DISCUSSION: Not all patients with spondylolisthesis show features of instability. However, a proportion of patients exhibit highly abnormal movements that are consistent with instability. The abnormalities involve movements within normal range but in abnormal directions. Visual inspection of radiographs will not reveal these abnormalities but they can be detected by plotting the instantaneous axes of rotation

Aim. The aim of this study is to identify the incidence of the presence of an Inverted Radial Reflex (IRR) in asymptomatic subjects with Adolescent Idiopathic Scoliosis and determine its significance. Methods. Our study group consists of Adolescent Idiopathic Scoliosis patients who presented consecutively in our institution from June to September 2010. They were either seen in outpatient clinics or as elective admissions prior to operative correction of their spinal deformity. The presence of an idiopathic scoliosis deformity and the absence of any abnormal neurological symptoms were our inclusion criteria. They were examined by two clinicians for the presence of IRR using a tendon hammer. As part of their management all such patients routinely undergo an MRI scan in our Trust to investigate for the presence of intraspinal pathology. When the IRR was present we looked at their MRI scans to identify any relevant abnormalities. Results: We identified 100 subjects. There were 72 females and 28 males with an average age of 15 years. The IRR was present in 12 cases and in 6 of them the sign was present bilaterally. There were no further associated signs or symptoms. All cases had recently undergone MRI of their whole spine and their investigations did not demonstrate any abnormalities in the lower cervical spine. Conclusion. We have found an incidence of 12% for the presence of IRR in our study group. In all cases there were no abnormal cord signal changes in MRI scans and we can therefore conclude that in asymptomatic Adolescent Idiopathic Scoliosis patients the presence of IRR is of no clinical significance

Tapping the radial side of the wrist normally elicits a reflex contraction producing elbow flexion, wrist extension and wrist radial deviation. An abnormal response, consisting of finger flexion when performing this manoeuvre is known as the inverted radial (supinator) reflex (IRR). The significance of this reflex in asymptomatic subjects is unknown. To document the frequency of the IRR in an asymptomatic population and to identify any presymptomatic pathology in those subjects. The study group consisted of patients and staff at the senior author's institution. Patients were taken from clinics where the complaints were of lower limb symptoms. Subjects were excluded if they had any history of neck pain or stiffness or if they had any subjectively abnormal sensation. The radial reflex was elicited with a tendon hammer. Those subjects with an IRR were asked to attend for a MRI scan of the cervical spine to investigate for any abnormality. 47 subjects were studied. There were 8 subjects who displayed an IRR. In 4 subjects the IRR was unilateral and in 4 bilateral. Seven subjects consented to further investigation by MRI. The average age of these patients was 36 years. The MRI scans revealed normal appearances in 6 cases. There was no cord signal abnormality in any case. The IRR occurred with a frequency of 17% in the study group. There was no significant cervical pathology identified in these subjects. In young asymptomatic patients, the presence of an inverted radial reflex is of no diagnostic relevance

To study the association between hip and ankle biomechanics during gait and moderate knee osteoarthritis (OA). Gait analysis was performed on a group of forty-four patients clinically diagnosed with moderate knee OA, and on a group of sixty asymptomatic subjects. Three-dimensional net joint angles and net joint reaction moments at the hip, knee and ankle joints were calculated. Peak values were extracted from the gait waveform patterns and compared between the two subject groups with Student’s t-tests. The peak hip extension moment, the peak hip adduction moment, the peak hip internal and external rotation moments, and the peak ankle dorsiflexion and plantarflexion moments were all reduced in the knee osteoarthritis population compared to the asymptomatic population. Differences in knee joint loading patterns with moderate knee osteoarthritis have been previously reported, but these data suggest that changes in the mechanical environment of all lower extremity joints are associated with early stages of knee osteoarthritis. Other studies have associated reduced peak hip adduction moments with reduced likelihood of OA progression. These data provide a rationale for hip abductor muscle strengthening as a means to lower knee joint loading

Introduction. Surgical techniques for implant alignment in total knee arthroplasty (TKA) is a expanding field as manufacturers introduce patient-specific cutting blocks derived from 3D reconstructions of pre-operative imaging, commonly MRI or CT. The patient-specific OtisMed system uses a detailed MRI scan of the knee for 3D reconstruction to estimate the kinematic axis, dictating the cutting planes in the custom-fit cutting blocks machined for each patient. The resulting planned alignment can vary greatly from a neutral mechanical axis. The purpose of this study was to evaluate the early fixation of components in subjects randomized to receive shape match derived kinematic alignment or conventional alignment using computer navigation. A subset of subjects were evaluated with gait analysis. Methods. Fifty-one patients were randomized to receive a cruciate retaining cemented total knees (Triathlon, Stryker) using computer navigation aiming for neutral mechanical axis (standard of care) or patient-specific cutting blocks (OtisMed custom-fit blocks, Stryker). Pre-operatively, all subjects had MRI scans for cutting block construction to maintain blinding. RSA exams and health outcome questionnaires were performed post-operatively at 6 week, 3, 6, and 12 month follow-ups. A subset (9 subjects) of the patient-specific group underwent gait analysis (Optotrak TM 3020, AMTI force platforms) one-year post-TKA, capturing three dimensional (3D) knee joint angles and kinematics. Principal component analysis (PCA) was applied to the 3D gait angles and moments of the patient-specific group, a case-matched control group, and 60 previously collected asymptomatic subjects. Results. Five MRI scans for surgical planning were not useable due to motion artifacts, with 2 successfully rescanned. Ligament releases were performed in 62% of navigation cases and 32% of patient-specific cases. One patient-specific case was revised for failure of the cruciate ligament, resulting in a polyethylene liner exchange for a thicker, cruciate substituting insert. Implant migration at 1 year was 0.40±0.25 mm for the patient-specific group and 0.37±0.20 mm for the navigation group (maximum total point motions; t-test P=0.65). EQ-5D scores, Oxford Knee scores, satisfaction, pain, and range of motion were not different between groups at any follow-up to 1 year, including the polyethylene liner exchange case. The gait analysis showed that there were no statistical differences between groups. PCA captured a lower early stance phase flexion moment magnitude in the patient-specific group than the computer navigated recipients, bringing patterns further away from asymptomatic characteristics (flexion moment PC2, P=0.02). Conclusions. Implant migration was not different between groups at 1 year despite differences in implant alignment methods. Subject function and satisfaction were also not different between groups, despite significantly fewer ligament releases in the patient-specific group. However, gait analysis of a subgroup has not shown an improvement towards restoring asymptotic gait. It should be acknowledged that the production of patient-specific cutting blocks may not be possible for all patients due to the MRI scanning requirements. Continued evaluation with RSA to 2 years will be performed to monitor these subjects over the longer term

Aims

Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters.

Aims

This study aimed to analyze kinematics and kinetics of the tibiofemoral joint in healthy subjects with valgus, neutral, and varus limb alignment throughout multiple gait activities using dynamic videofluoroscopy.

Introduction: Lumbar mobilisations are commonly used in clinical practise to reduce pain and increase function. Mobilisations to the cervical spine have been shown to reduce pain using pressure pain thresholds (PPT). Yet there is no evidence to confirm that this happens in the lumbar spine. Furthermore there is little known about the effects of different treatment doses on the amount of hypoalgesia produced. It is unknown if changing the rate of application of mobilisations has an effect on hypoalgesia. The aim of this study was to investigate the immediate effects of lumbar posteroanterior mobilisations performed at different rates on PPT. Pressure pain thresholds were measured in a number of locations in order to assess the extent of the analgesic response. Method and Results: A repeated measures single blind, randomised-trial was conducted on 30 asymptomatic subjects (22 female and 8 males). Pressure pain thresholds were measured at 4 sites in the upper and lower quadrants, before and after the application of lumbar spine posteroanterior mobilisations performed at 2Hz, 1Hz and quasi-static. The results demonstrated an immediate and significant improvement in PPT measures (P< 0.000) irrespective of the rate or site tested. The effects were both local and widespread. There was no significant difference between the rates of mobilisations on PPT. Conclusion: This study provides new experimental evidence that lumbar spine posteroanterior mobilisations produce an immediate and significant widespread hypoalgesic effect, regardless of the rate of mobilisation. Further research is now needed to investigate the effect on a patient population with low back pain

Purpose. Spinopelvic parameters describe the orientation, shape, and morphology of the spine and pelvis. In children without spinal deformity, these parameters have been shown to change during the first ten years of life; however, spinopelvic parameters have yet to be defined in children with significant Early Onset Scoliosis (EOS). The purpose of this study is to examine the effects of EOS on sagittal spinopelvic alignment. Method. Standing, lateral radiographs of 82 untreated patients with EOS greater than 50 degrees were evaluated. Sagittal spine parameters (sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL)) and sagittal pelvic parameters (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), modified pelvic radius angle (PR)) were measured. These results were compared to those reported by Mac-Thiong et al (Spine, 2004) for a group of asymptomatic (i.e. without spinal deformity) children of similar age. Results. These patients had a mean age of 5.17 years and mean scoliosis of 73.3 17.3. Mean sagittal spine parameters were: sagittal balance (+2.4 4.03 cm), TK (38.2 20.8), and LL (47.8 17.7). These values were similar to those reported for asymptomatic subjects. Mean sagittal pelvic parameters were measured for PI (47.1 15.6), PT (10.3 10.7), SS (35.5 12.2), and PR (57.1 21.2). Although PI was similar to age-matched normals, PT was significantly higher and SS trended lower in the study population. Conclusion. Sagittal plane spine parameters in children with EOS were similar to those found in children without spinal deformity. Likewise, pelvic parameters (PI, SS, PR) were similar; however, those children with EOS signs of pelvic retroversion (increased pelvic tilt). This data may be useful as a baseline in determining prognosis for children with EOS who are treated with growing systems

Objective: To investigate the reflex control of the internal oblique (IO) muscles. Design: Reflex activity in the IO muscles was evoked by (i) tapping each IO muscle in turn and (ii) tapping the abdomen in the midline to produce a stretch of equal magnitude in both muscles. Muscle activity was recorded using surface EMG. Subjects: Seventeen asymptomatic subjects and one subject with scoliosis. Outcome measures: Onset latency and normalised amplitude of reflexes. Results: Tapping the IO muscle on one side evoked large reflex responses in both ipsilateral and contralateral IO muscles. Across all subjects the reflexes in these two muscles were of equal amplitude (p=0.12). Measurements of onset latency suggest that both reflexes are monosynaptic in origin. Tapping in the midline also produced large amplitude responses. In two subjects, the response in one IO muscle was always larger than the other, irrespective of which of the three points was tapped, and this was repeatable. One of these subjects has a scoliosis. Conclusions: The IO muscle is usually controlled from ipsilateral and contralateral muscle afferents. In a scoliotic subject this afferent activity was biased to the IO muscle on one side, and may therefore be associated with this condition

Purpose: To determine the relationship between sacral morphology and developmental L5/S1 spondylolisthesis in children and adolescent. Method: A radiographic study was conducted to investigate sacral morphology in developmental L5/S1 spondylolisthesis in a pediatric and adolescent population. The lateral standing radiographs of 131 subjects, aged 6 to 20 years old with developmental L5-S1 spondylolisthesis (91 low grade and 40 high grade) were analyzed with a dedicated software allowing to measure the following parameters, which were analyzed for each subject by the same individual and compared to an age and sex-matched cohort of 120 asymptomatic subjects: the sacral table index (STI), the sacral table angle (STA), the sacral kyphosis (SK), S1 superior angle, S2 inferior angle, and grade of spondylolisthesis. Student t tests were used to compare the parameters between the curve types. Results: This study demonstrated that STA is significantly smaller (p< 0.01) in children and adolescents with L5-S1 spondylolisthesis compared to a similar control group. Furthermore, STA is significantly smaller in high grade spondylolisthesis when compared to subjects with low grade. There is also a significant difference in segmental sacral morphology (S1 and S2 anatomy) in the spondylolisthesis group. Increasing sacral kyphosis is also found to be significantly associated with spondylolisthesis. Conclusion: The sagittal sacral morphology is a constant anatomic variable specific to each normal individual. The anatomy of the sacrum in children and aldolescentss with L5-S1 spondylolisthesis is particular and different from a control group. This study suggests that sacral anatomy may have a direct influence on the development of spondylolisthesis: a lower STA and higher sacral kyphosis may be two factors predisposing to vertebral slip in developmental spondylolisthesis

Introduction A reliable biomechanical diagnosis is necessary to justify the use of spinal manipulative treatment to correct it. Palpation is considered to be one of the most informative aspects of physical examination of patients with musculoskeletal pain and is the most commonly used method for the examination of the spine for joint dysfunction. Previous studies into reliability of palpation of joint dysfunction are confounded by the clinician having first to correctly identify the appropriate spinal segment, introducing a further measurement error. The purpose of this study was to examine the intra-observer reliability of identifying a manipulable lesion in the lumbar and thoracic spine. Methods 12 asymptomatic subjects were examined by an experienced osteopath and the selected joint marked on two occasions using a ultra-violet marker rather than by naming the spinal level. The marks were recorded on acetates by a separate researcher and intra-rater reliability was assessed by measuring the agreement between the two markings. Using the palpation examination protocol resulted in an excellent level of intra-rater agreement in the lumbar spine ICC (1,1) .96 but poor reliability ICC (1,1) .70 in the thoracic spine. Conclusion Intra-rater reliability for identifying a spinal segment exhibiting signs of segmental dysfunction was excellent in the lumbar spine, but poor in the thoracic spine. The examiner was experienced in the examining method for the lumbar spine, but less so in the thoracic spine, highlighting that experience improves palpatory agreement