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Daily Spinal Warm-ups

Stretching promotes normal metabolic activity of the inter-vertebral discs, muscles and ligaments. It should be done in a smooth, controlled manner and should never be painful. If you do experience any pain, please consult your health care professional. These stretches should be done at least twice each day (first thing in the morning and last thing in the evening before bed). You will also benefit from stretching throughout the day whenever you feel your muscles stiffen. Ten repetitions to each side are suggested for each stretch. 1. Spinal Rotations: Sitting upright, slowly twist your spine as far as it will go (look over your shoulder) to both sides. 2. Spinal Extension/Flex: Sitting upright, place hands on knees. Slowly pull head back as pelvis is tilted forward, then bend your head forward as your pelvis tips backwards. 3. Spinal Lateral Bending: Sitting upright, bend fully to one side and then to the other (bring your ear towards your shoulder as far as you can). Spinal Molding This exercise enhances spinal curves and prepares you and your spine for a restful sleep, following your evening stretches. Lay on a neck and back roll for 10 minutes before sleeping. Place neck roll under your neck, pressed against your shoulders. Place lower back roll below your rib cage and above your pelvis. You can add a bolster under your knees for added comfort (skip this exercise if you are using the ThoracicPillow®).

Clinical Manifestations of Cerebellar Infarction According to Specific Lobular Involvement

Abstract Lesions in the cerebellum produce various symptoms related to balance and motor coordination. However, the relationship between the exact topographical localization of a lesion and the resulting symptoms is not well understood in humans. In this study, we analyzed 66 consecutive patients with isolated cerebellar infarctions demonstrated on diffusion-weighted magnetic resonance imaging. We identified the involved lobules in these patients using a cross-referencing tool of the picture archiving and communication system, and we investigated the relationships between the sites of the lesions and specific symptoms using χ2 tests and logistic regression analysis. The most common symptoms in patients with isolated cerebellar infarctions were vertigo (87%) and lateropulsion (82%). Isolated vertigo or lateropulsion without any other symptoms was present in 38% of patients. On the other hand, limb ataxia was a presenting symptom in only 40% of the patients. Lateropulsion, vertigo, and nystagmus were more common in patients with a lesion in the caudal vermis. Logistic regression analysis showed that lesions in the posterior paravermis or nodulus were independently associated with lateropulsion. Lesions in the nodulus were associated with contralateral pulsion, and involvement of the culmen was associated with ipsilateral pulsion and isolated lateropulsion without vertigo. Nystagmus was associated with lesions in the pyramis lobule, while lesions of the anterior paravermis were associated with dysarthria and limb ataxia. Our results showed that the cerebellar lobules are responsible for producing specific symptoms in cerebellar stroke patients. Conclusion With MRI and clinical data obtained from patients with isolated cerebellar infarctions, we determined lobular localization of cerebellar lesions using a PACS system and statistical analyses. Our results showed that vertigo and lateropulsion are the most common symptoms of isolated cerebellar infarctions. Our findings also suggest that contralateral pulsion was associated with lesions involving the nodulus, while ipsilateral pulsion was associated with lesions involving the culmen. Nystagmus was associated with lesions in the pyramis lobule, while dysarthria and limb ataxia were associated with lesions of the anterior paravermis. Ye BS, Kim YD, Nam HS, Lee HS, Nam CM, Heo JH. Clinical Manifestations of Cerebellar Infarction According to Specific Lobular Involvement. Cerebellum. 2010 Dec;9(4):571-9. PubMed PMID: WOS:000284955800011.  

Impaired Postural Stability in Patients With Cervical Myelopathy

Study Design. A prospective clinical study. Objective. To quantitatively evaluate impairment of postural stability in patients with cervical myelopathy. Summary of Background Data. Proprioceptive sensation plays an important role in coordinated movement of the lower extremities and postural stability. Nevertheless, although disturbance of proprioceptive information will have an influence on the maintenance of postural stability, there have been few studies dealing with deterioration of postural stability in patients with cervical myelopathy. Methods. We investigated 52 cervical myelopathy paients who could stand without support and compared the results with those of 29 age-matched healthy volunteers. Postural stability was examined using a stabilometer. In the stabilometer, sway of gravity center was measured at upright position with eyes closed for 30 seconds. We used 2 parameters for evaluation: environmental area (EA), which measures degree of sway of the gravity center, and locus length per environmental area (L/EA), which measures fine control of standing posture by proprioceptive reflexes. Results. The mean EA of the patient group was 13.9, whereas that of the control group was 2.74, revealing signifi- cantly larger postural instability in the patient group compared to the control group. The L/EA of the patient group was significantly worse than the control group. It was also shown that postural instability was significantly larger in the myelopathy patients with the severe clinical symptoms. Conclusion. The results of the present study demonstrate impairment of postural stability in patients with cervical myelopathy. The stabilometer can objectively evaluate the postural stability, which may reflect the function of the dorsal columns and the corticospinal tracts. Thus, stabilometry is a useful method for measuring a part of proprioceptive function and for objective assessment of the lower limb function of cervical myelopathy. Yoshikawa M, Doita M, Okamoto K, Manabe M, Sha N, Kurosaka M. Impaired postural stability in patients with cervical myelopathy - Evaluation by computerized static stabilometry. Spine. 2008 Jun 15;33(14):E460-E4. PubMed PMID: WOS:000256837500020.

The effect of neck torsion on postural stability in subjects with persistent whiplash

Abstract: Dysfunction of cervical receptors in neck disorders has been shown to lead to disturbances in postural stability. The neck torsion manoeuvre used in the smooth pursuit neck torsion (SPNT) test is thought to be a specific measure of neck afferent dysfunction on eye movement in those with neck pain. This study aimed to determine whether neck torsion could change balance responses in those with persistent whiplash-associated disorders (WADs). Twenty subjects with persistent WAD and 20 healthy controls aged between 18 and 50 years stood on a computerised force plate with eyes closed in comfortable stance under 5 conditions: neutral head, head turned to left and right and neck torsion to left and right. Root mean square (rms) amplitude of sway was measured in the anterioreposterior (AP) and medial elateral (ML) directions. The whiplash group had significantly greater rms amplitude in the AP direction following neck torsion compared to the control group (p < 0.03). The results show that the neck torsion manoeuvre may lead to greater postural deficits in individuals with persistentWAD and provides further evidence of neck torsion to identify abnormal cervical afferent input, as an underlying cause of balance disturbances in WAD. Further research is warranted. Conclusion The results of this study suggest that the neck torsion manoeuvre may adversely change balance responses in some subjects with persistent WAD and that deficits in standing balance exist particu-larly in the anterioreposterior direction when compared to asymptomatic control subjects. The results also indicate that somatosensory impairment is the most likely cause of the balance disturbances following whiplash. The disturbances are probably related to a combination of proprioceptive and nociceptive factors. Overall, these findings have implications for future studies and for the clinical assessment and management of balance disturbances in persistent whiplash-associated disorders, although, further research with greater subject numbers is required. Yu L-J, Stokell R, Treleaven J. The effect of neck torsion on postural stability in subjects with persistent whiplash. Manual Therapy. 2011 Aug;16(4):339-43. PubMed PMID: WOS:000293245000006.

Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects

Abstract Purpose This study aimed to establish radiographic standard values for cervical spine morphometry, alignment, and range of motion (ROM) in both male and female in each decade of life between the 3rd and 8th and to eluci- date these age-related changes. Methods: A total of 1,230 asymptomatic volunteers underwent anteroposterior (AP), lateral, flexion, and exten-sion radiography of the cervical spine. There were at least 100 men and 100 women in each decade of life between the 3rd and 8th. AP diameter of the spinal canal, vertebral body, and disc were measured at each level from the 2nd to 7th cervical vertebra (C2–C7). C2–C7 sagittal alignment and ROM during flexion and extension were calculated using a computer digitizer. Results The AP diameter of the spinal canal was 15.8 ± 1.5 mm at the mid-C5 level, and 15.5 ± 2.0 mm at the C5/6 disc level. The disc height was 5.8 ± 1.3 mm at the C5/6 level, which was the minimum height, and the maximum height was at the C6/7 level. Both the AP diameter of the spinal canal and disc height decreased gradually with increasing age. The C2–C7 sagittal alignment and total ROM were 13.9 ± 12.3 in lordosis and 55.3 ± 16.0, respectively. The C2–C7 lordotic angle was 8.0 ± 11.8 in the 3rd decade and increased to 19.7 ± 11.3 in the 8th decade, whereas the C2–C7 ROM was 67.7 ± 17.0 in the 3rd decade and decreased to 45.0 ± 12.5 in the 8th decade. The extension ROM decreased more than the flexion ROM, and lordotic alignment progressed with increasing age. There was a significant difference in C2–C7 alignment and ROM between men and women. Conclusions The standard values and age-related changes in cervical anatomy, alignment, and ROM for males and females in each decade between the 3rd and 8th wereestablished. Cervical lordosis in the neutral position develops with aging, while extension ROM decreases gradually. These data will be useful as normal values for the sake of comparison in clinical practice. Conclusion: Standard values and those age-related changes in cervical spine morphometry, alignment, and ROM were established from cervical X-ray data of 1,230 healthy subjects. The sagittal diameter (mm) of the cervical canal at the mid-C5 level was 16.2 ± 1.5 mm in males and 15.4 ± 1.4 mm in females. If the sagittal diameter was B13 mm in males or B12 mm in females, the subject was considered to have a narrow spinal canal. The extension ROM decreased more than the flexion ROM, and lordotic alignment increased with advancing age. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T. Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects. European Spine Journal. 2012 Aug;21(8):1492-8. PubMed PMID: WOS:000307294200008.

Carrying loads and postural sway in standing: The effect of load placement and magnitude

Abstract. This study investigated the effect that load magnitude, load location, and the dimensions that the base of support have on postural sway in standing while wearing a backpack, single strapped bag, briefcase, or purse. Subjects were instructed to carry a load of 10% or 20% of their body weight with either their feet spaced shoulder width apart or together for a period of 45 seconds. Medial/lateral and anterior/posterior center of pressure (COP) displacement and COP velocity were calculated. Overall, it was found that an increase in load magnitude produced an increase in postural sway and velocity of COP. In addition, a large increase in the medial/lateral COP velocity was observed when subjects carried a briefcase, single strapped bag, or purse. Additionally, a larger COP sway was recorded in conditions of standing with decreased base of support (feet together). These findings suggest the importance of considering the way we carry loads in order not only to place less strain on the body and to minimize our efforts, but to optimize postural control as well. Concluding comments The study demonstrated that the load magnitude, its location, and the dimensions of the base of support are important determinants of standing balance. The stud-ied experimental conditions involved methods of carry- ing loads in standing that prove to be functional in daily life, as in waiting in line or for a bus. The information obtained from this study could assist health care profes-sionals, particularly physical therapists, educate their patients on proper load carriage in order to minimize the demands placed on their body in an effort to main- tain efficient postural control and better overall health. On the other hand, while the study provides new in- formation on how postural sway changes with changes in the way we carry loads, obtaining kinematic data in future studies would provide a better understanding of how we carry loads. Zultowski I, Aruin A. Carrying loads and postural sway in standing: The effect of load placement and magnitude. Work-a Journal of Prevention Assessment & Rehabilitation. 2008 2008;30(4):359-68. PubMed PMID: WOS:000258695100004.

Repeatability Test of C7 Plumb Line and Gravity Line on Asymptomatic Volunteers Using an Optical Measurement Technique

Study Design. Prospective cohort evaluation of C7 plumb line (C7PL) and gravity line (GL) in different stand- ing positions in asymptomatic volunteers. Objective. To evaluate the repeatability of C7PL and GL in different standing positions using an optical method. Summary of Background Data. Both C7PL and GL have been used to assess spinal balance. However, due to extensive radiation exposure, the measurement repeat-ability for both C7PL and GL has never been systemati- cally determined. Methods. Thirty asymptomatic adult volunteers were enrolled in this study. Two optical markers were attached to the skin overlying the spinous processes of C7 and S1. Volunteers were instructed to stand on a force plate with their arms in 3 different positions, clavicle, supported, and neutral, for posteroanterior (PA), and lateral views. Digital photos were taken for 12 times for each position. The GL position was displayed on a computer in real time. The distance from the C7 marker to S1 marker (C7–S1) and the distance from the GL to the S1 marker (GL–S1) were mea-sured in both PA and lateral views. The repeatability on a single subject was defined as the standard deviation of the 12 repeated measurements for each standing position. Results. In the PA view, the repeatability of both C7PL and GL was 3 to 4 mm in all 3 standing positions (all P  0.05). In the lateral view, the repeatability of C7PL in-creased from 6 to 8mmwhereas GL remained low at 3 to 4 mm. The GL repeatability was significantly better than that of C7PL in all 3 lateral positions (all P  0.05). The standing position did not significantly affect repeatability for both C7PL and GL. C7PL had approximately 1-cm posterior shift in the supported position and 2-cm poste-rior shift in the clavicle position. The effect of various radiographic positions was less than 1 cm for all 3 stand-ing positions in the GL measurement. Conclusion. The GL measurement was highly reproduc-ible in both PA and lateral views. The repeatability was similar between C7PL and GL despite the standing posi-tions in the PA view. The repeatability of GL was better than that of C7PL in all 3 standing positions in the lateral view. The effect of standing positions was much less in GL than in C7PL. Zheng X, Chaudhari R, Wu C, Mehbod AA, Transfeldt EE, Winter RB. Repeatability Test of C7 Plumb Line and Gravity Line on Asymptomatic Volunteers Using an Optical Measurement Technique. Spine. 2010 Aug 15;35(18):E889-E94. PubMed PMID: WOS:000281277700017.

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