Journal Reading

THE PREVALENCE OF POSTURAL ASYNMMETRY IN

PEOPLE WITH AND WITHOUT CHRONIC LOW
BACK PAIN
 BACKGROUND

• SOME PATIENTS WITH CHRONIC LBP MAY HAVE A CONDITION KNOWN AS PELVIC OBLIQUITY.
• PELVIC OBLIQUITY = A TILTING OF THE PELVIS (THE BASE OF SUPPORT FOR THE SPINE),
SOMETIMES RESULTS FROM AN ASYMMETRY OF THE PELVIC BONES OR FROM AN ASYMMETRY
OF LEG LENGTHS.
• PELVIS OBLIQUITY = MECHANICAL DISADVANTAGE
• INCREASES STRAIN ON VARIOUS BODY REGIONS,
• CONTRIBUTES TO PAINFUL SYMPTOMS, AND
• MAY NOT BE RESPONSIVE TO CONVENTIONAL REHABILITATION THERAPY.
• LBP MAY ASSOCIATED WITH LEG-LENGTH DISCREPANCY (LLD).
• TYPICAL CHARACTERISTICS OF THE CHRONIC LBP ASSOCIATED WITH LLD :
• GRADUAL IN ONSET (TYPICALLY BEGINNING IN LATE ADOLESCENCE OR EARLY ADULTHOOD),
• CHRONIC OR RECURRENT,
• PRECIPITATED BY TRAUMA OR STRAIN (EG, LIFTING)
• LBP MAY BEGIN WITHIN 20 TO 30 MINUTES OF STANDING, WITH PROMPT RELIEF ON SITTING.
• COMPLAINTS OF PAIN IN VARIOUS REGIONS OF THE BODY: FEET, KNEE, HIP, THORAX, SHOULDER, AND
SACROILIAC JOINT
• DEGENERATIVE JOINT CHANGES AND INTERVERTEBRAL DISK DISTURBANCES
• THE PREVALENCE OF LLD IN PERSONS WITH CHRONIC LBP IS GREATER THAN IN THOSE WITHOUT IT.
• THE DEGREE OF POSTURAL ASYMMETRY COULD BE ASSESSED BY MEASURING THE DIFFERENCE IN
FEMORAL HEAD HEIGHT.
• THE IMMEDIATE GOAL OF THIS STUDY WAS TO DETERMINE BY POSTURAL RADIOGRAPH THE MEAN
EXTENT OF PELVIC OBLIQUITY AND THE MEAN LATERAL SACRAL BASE ANGLE IN SUBJECTS WITH AND
WITHOUT CHRONIC PAIN.
 METHODS
• SUBJECT : 240 SUBJECTS WITH CHRONIC LBP AND 83 SUBJECTS WITHOUT CHRONIC LBP.
• POPULATION : OUTPATIENT CLINIC OF THE PHYSICAL MEDICINE AND REHABILITATION (PM&R) AT THE
VETERANS ADMINISTRATION MEDICAL CENTER.
• INCLUSION CRITERIA :
• AT LEAST 20 YEARS OLD
• ABLE TO GIVE INFORMED CONSENT.
• DIAGNOSED WITH LBP AT LEAST 3 MONTHS
• HAVE NEVER BEEN TREATED BY A HEALTH CARE PROFESSIONAL FOR LBP.
• EXCLUSION CRITERIA :
• RADIOGRAPHIC EVIDENCE OF CONGENITAL ANOMALIES OF THE LUMBOSACRAL SPINE (INCLUDING SPINA BIFIDA
OCCULTA, LUMBARIZATION, SACRALIZATION, OR SPONDYLOLISTHESIS);
• HISTORY OF ANY LUMBAR VERTEBRAL SURGERY;
• HISTORY OF KNEE OR HIP REPLACEMENT SURGERY;
• HISTORY OF OSTEOPOROSIS WITH VERTEBRAL COMPRESSION FRACTURES;
• HISTORY OF FRACTURES OF SPINE, PELVIS, OR LOWER EXTREMITY WITH MALALIGNMENT;
• PREGNANCY.
 METHODS

• POSTURAL RADIOGRAPHS
ALL SUBJECTS HAD POSTURAL RADIOGRAPHS. POSTURAL RADIOGRAPHS INCLUDE
ANTEROPOSTERIOR X-RAYS OF THE PELVIS, INCLUDING THE LUMBAR SPINE, FEMORAL HEADS, AND PUBIC
SYMPHYSIS, AND LATERAL X-RAYS OF THE SACRAL BASE. THE EXTENT OF PELVIC OBLIQUITY WAS
DETERMINED BY USING THE INTERSULCATE LINE, ACCORDING TO THE METHOD DESCRIBED BY FANN AND
TILLEY. THE LATERAL SACRAL BASE ANGLE WAS DETERMINED WITH THE MODIfiED METHOD OF GREENMAN.
A LINE PARALLEL TO THE PLUMB LINE WAS DRAWN FROM THE MIDDLE OF THE L3 VERTEBRAL BODY TO THE
SACRAL BASE TO DETERMINE WHERE THE LINE FELL IN RELATION TO THE SACRAL BASE.
• ANALYSIS
THE MEANS AND SDS OF THE EXTENT OF PELVIC OBLIQUITY AND THE LATERAL SACRAL ANGLE
WERE CALCULATED FOR BOTH GROUPS OF SUBJECTS; THE DIFFERENCE WAS TESTED BY USING A Z SCORE.
DIFFERENCES BETWEEN THE GROUPINGS OF PELVIC OBLIQUITY, LATERAL SACRAL ANGLE, AND POSITION
OF L3 IN RELATION TO THE SACRAL BASE WERE DETERMINED WITH T TESTS.
 RESULT

• NO SIGNIFICANCE DIFFERENCES IN THE DISTRIBUTION OF PELVIC OBLIQUITY OR LATERAL

SACRAL ANGEL IN SUBJECTS WITH AND WITHOUT CHRONIC LBP.
• NO DIFFERENCE IN THE EXTENT OF PELVIC OBLIQUITY OR THE LATERAL SACRAL ANGEL
BETWEEN THE SUBJECT WITH OR WITHOUT CHRONIC LBP.
• THERE ARE DIFFERENCES IN THE EXTENT OF LLD, MEASURED BY FEMORAL HEAD HEIGHTS
BETWEEN 2 GROUPS.
 DISCUSSION

• WHEN USING HEEL LIFTS AS MODALITY AND THERAPY IT SHOWN SOME IMPROVEMENT IN
SUBJECTS PAIN SYMPTOMS.
• LIKE ANY OTHER MODALITY, THE CORRECTION IN PELVIC OBLIQUITY AND LLD DOESN’T BENEFIT
ALL PATIENT WITH CHRONIC LBP.
• SEVERRAL LIMITATION OF THE STUDY :
• OVERREPRESENTATION OF MEN, CONTROLLED BY SEX MATCHING THE SUBJECT
• OTHER FACTOR THAT CONTRIBUTE TO PELVIC OBLIQUITY SUCH AS PRONATED FEET OR TIGHT
MUSCLE THAT ORIGINATED FROM OR INSERT INTO THE PELVIC BONE
• INHERRENTS ERROR IN MEASURING
 CONCLUSION

• FUTURE STUDY WILL ATTEMPT TO IDENTIFY WHICH SUBJECT OF PATIENTS WITH CHRONIC LBP
IS AFFECTED MOST BY PELVIC OBLIQUITY AND THEREFORE WILL BENEFIT MOST FROM
CORRECTION OF PELVIC OBLIQUITY.