BACKGROUND: Rehabilitation of elderly patients with sit-to-stand (STS) dysfunction includes retraining coordinated movement among participating body segments. Although trunk position is considered important, spinal movement has not been measured. OBJECTIVE: The aim of this study was to describe the sagittal thoracolumbar kinematics and hip-lumbar interaction during the STS task in elderly people who were healthy in order to guide physical therapists in developing treatment strategies. DESIGN: This was an observational study. METHODS: Ten retroreflective markers were attached to the midline thoracolumbar spine, pelvis, and right lower limb of 41 elderly people who were healthy. A 2-dimensional video analysis system was used to measure sagittal thoracic, lumbar, hip, and knee joint angles during the STS task. Maximal available flexion-extension angles in these joints and regions also were determined. RESULTS: Prior to buttocks lift-off, forward trunk lean comprised concurrent hip and lumbar flexion and thoracic extension. Hip flexion dominated, with a hip/lumbar ratio of 4.7:1 and a thoracic/lumbar ratio of 1.7:1. The hip and lumbar spine contributed 90% and 23% of their maximal available flexion angle, respectively, and the thoracic spine contributed 86% of its maximal extension range of movement. After lift-off, the hips and lumbar spine extended (ratio of 5.2:1), and the thoracic spine flexed (thoracic/lumbar ratio of 0.4:1). At lift-off, the hips and knees were similarly flexed (96 degrees ) and then locked together in a linear pattern of extension. Following lift-off, there was a brief transition phase (5% of STS duration) in which, although the hips, knees, and lumbar spine were extending, the trunk continued to flex forward a few degrees. LIMITATIONS: Results may differ in elderly people who are less active. CONCLUSIONS: The revised model for image-based analysis demonstrated concurrent hip and thoracolumbar movement during the STS task. Close to full available hip flexion and thoracic extension were needed for optimal STS performance.
BACKGROUND: Rehabilitation of elderly patients with sit-to-stand (STS) dysfunction includes retraining coordinated movement among participating body segments. Although trunk position is considered important, spinal movement has not been measured. OBJECTIVE: The aim of this study was to describe the sagittal thoracolumbar kinematics and hip-lumbar interaction during the STS task in elderly people who were healthy in order to guide physical therapists in developing treatment strategies. DESIGN: This was an observational study. METHODS: Ten retroreflective markers were attached to the midline thoracolumbar spine, pelvis, and right lower limb of 41 elderly people who were healthy. A 2-dimensional video analysis system was used to measure sagittal thoracic, lumbar, hip, and knee joint angles during the STS task. Maximal available flexion-extension angles in these joints and regions also were determined. RESULTS: Prior to buttocks lift-off, forward trunk lean comprised concurrent hip and lumbar flexion and thoracic extension. Hip flexion dominated, with a hip/lumbar ratio of 4.7:1 and a thoracic/lumbar ratio of 1.7:1. The hip and lumbar spine contributed 90% and 23% of their maximal available flexion angle, respectively, and the thoracic spine contributed 86% of its maximal extension range of movement. After lift-off, the hips and lumbar spine extended (ratio of 5.2:1), and the thoracic spine flexed (thoracic/lumbar ratio of 0.4:1). At lift-off, the hips and knees were similarly flexed (96 degrees ) and then locked together in a linear pattern of extension. Following lift-off, there was a brief transition phase (5% of STS duration) in which, although the hips, knees, and lumbar spine were extending, the trunk continued to flex forward a few degrees. LIMITATIONS: Results may differ in elderly people who are less active. CONCLUSIONS: The revised model for image-based analysis demonstrated concurrent hip and thoracolumbar movement during the STS task. Close to full available hip flexion and thoracic extension were needed for optimal STS performance.
Authors: Jeannie F Bailey; Robert P Matthew; Sarah Seko; Patrick Curran; Leslie Chu; Sigurd H Berven; Vedat Deviren; Shane Burch; Jeffrey C Lotz Journal: Eur Spine J Date: 2019-03-02 Impact factor: 3.134