SYNOPSIS: Age-related hyperkyphosis is an exaggerated anterior curvature in the thoracic spine that occurs commonly with advanced age. This condition is associated with low bone mass, vertebral compression fractures, and degenerative disc disease, and contributes to difficulty performing activities of daily living and decline in physical performance. While there are effective treatments, currently there are no public health approaches to prevent hyperkyphosis among older adults. Our objective is to review the prevalence and natural history of hyperkyphosis, associated health implications, measurement tools, and treatments to prevent this debilitating condition. LEVEL OF EVIDENCE: Diagnosis/prognosis/therapy, level 5.

J Orthop Sports Phys Ther 2010;40(6):352-360, Epub 15 April 2010. doi:10.2519/jospt.2010.3099

KEY WORDS: aging/geriatrics, kyphosis, osteoporosis, postural relationships, thoracic spine

STUDY DESIGN: Cross-sectional, observational study. OBJECTIVES: To explore how ankle position affects lower extremity neurodynamic testing. BACKGROUND: Upper extremity limb movements that increase neural loading create a protective muscle action of the upper trapezius, resulting in shoulder girdle elevation during neurodynamic testing. A similar mechanism has been suggested in the lower extremities. METHODS: Twenty healthy subjects without low back pain participated in this study. Hip flexion angle and surface electromyographic measures were taken and compared at the onset of symptoms (P1) and at the point of maximally tolerated symptoms (P2) during straight-leg raise tests performed with ankle dorsiflexion (DF-SLR) and plantar flexion (PF-SLR). RESULTS: Hip flexion was reduced during DF-SLR by a mean ± SD of 5.5° ± 6.6° at P1 (P = .001) and 10.1° ± 9.7° at P2 (P<.001), compared to PF-SLR. DF-SLR induced distal muscle activation and broader proximal muscle contractions at P1 compared to PF-SLR. CONCLUSION: These findings support the hypothesis that addition of ankle dorsiflexion during straight-leg raise testing induces earlier distal muscle activation and reduces hip flexion motion. The straight-leg test, performed to the onset of symptoms (P1) and with sensitizing maneuvers, allows for identification of meaningful differences in test outcomes and is an appropriate end point for lower extremity neurodynamic testing.

J Orthop Sports Phys Ther 2009;39(11):780-790, Epub 15 October 2009. doi:10.2519/jospt.2009.3002

KEY WORDS: neural provocation test, neural tension, sciatic nerve, sensitizing maneuvers