I believe that 1mm is within the abilities of an x-ray measuring system,
assuming a standardized protocol. If their errors were above 1mm it
would cause people to be assigned to the wrong groups and thus make it
harder to show significance. I don't think anyone suggested that
treating the lld would cause the radic to go away. There is already too
much damage though a lift may help. I also don't think that it suggests
that the lld is the cause of the radiculopathy. Just that it may be a
factor in its development. This is an example of a postural (albeit
structural) "deviation" which can be a factor leading to pain.
I believe that many of the premises behind "good posture" are flawed. I
was taught that proper upright posture needed less muscle activity and
was more efficient. The lumbar stability research suggests that a fair
amount of muscle activity is needed to keep the spine stable in this
position. A slouched posture seems more relaxed to me and probably
relies more on passive tension in the ligaments. I'm not saying that we
should be sitting slouched all the time but we need to clear up some of
the old misconceptions. I think that it will become evident that we
need to use a variety of postures throughout the day to shift stress to
different tissues. Problems could occur when our choice of postures is
limited. For example, I have anteverted hips and can't sit cross
legged. If I had a job that needed me to sit on the floor all day I may
end up with knee problems since I can't shift from kneeling to cross
legged.
On Tue, 2002-08-13 at 06:37, Patrick Zerr wrote:
> How would one measure a LLD of 1mm? I don't think it's possible. Is this
> supposed to suggest that if we treat the LLD the radic will go away? I
> doubt it.
>
> Patrick Zerr
> www.apluspt.com
> The easiest way to prepare for the National PT Exam!
> www.summitpt.com
> Summit Physical Therapy; Tempe, Arizona
>
>
> ----- Original Message -----
> From: "Doug Bourne" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, August 12, 2002 10:29 PM
> Subject: Re: A Question of Posture
>
>
> > To put more fuel on the fire:
> >
> > Spine 1999 Apr 1;24(7):684-6
> > Is leg length discrepancy associated with the side of radiating pain
> > in patients with a lumbar herniated disc?
> >
> > ten Brinke A, van der Aa HE, van der Palen J, Oosterveld F.
> >
> > Department of Physical Therapy, Medisch Spectrum Twente, Enschede,
> > The Netherlands.
> >
> > STUDY DESIGN: The association between leg length discrepancy and the
> > side of the radiating pain in lumbar disc herniation was investigated in
> > a case series. OBJECTIVES: To investigate whether pain tends to radiate
> > into the longer or shorter leg in patients with a lumbar herniated disc.
> > SUMMARY OF BACKGROUND DATA: No previous studies have investigated the
> > association between leg length discrepancy and side of radiating pain in
> > patients with a herniated disc. Results of studies of low back pain with
> > radiation and leg length discrepancy are inconsistent concerning this
> > association. METHODS: Of 132 consecutive patients admitted to a district
> > hospital for surgical management of a lumbar herniated disc, leg length
> > discrepancy was assessed using the indirect method as described by
> > Calliet. RESULTS: Seventy-three patients (55%) were men, and 59 (45%)
> > were women. The mean age was 40 years, and 99% of all herniated discs
> > appeared at L4-L5 (n = 60) or L5-S1 (n = 71). In 64 (62%) of the 104
> > patients with a leg length discrepancy of 1 mm or more, the pain
> > radiated in the shorter leg (P = 0.02). In subgroups of patients with
> > larger leg length discrepancies, similar results were found but because
> > of smaller sample sizes, these findings did not each statistical
> > significance. In 32 of the 57 men (56.1%), the pain radiated to the
> > shorter leg (P = 0.43); this was observed in 33 of the 47 women (70.2%;
> > P = 0.01). CONCLUSION: The results of this study showed a statistically
> > significant association between leg length discrepancy and the side of
> > radiating pain in a case series of patients with lumbar herniated discs.
> > The relation was more pronounced and statistically significant in women
> > only.
> >
> > John: not all (or most) spinal stability researchers are
> > physiotherapists.
> >
> > Barrett: I agree with most of your points in the first post but as usual
> > I take exception with your comments:
> >
> > >
> > > The "core researchers" have *not* been well-received by large portions
> of
> > > the research and clinical communities. The best resource for this is in
> the
> > > archives of the "Supertraining" list on Yahoo groups.
> >
> > "Supertraining" is by no means the authoritative source of spinal
> > stability training. Some good points have been made there but they are
> > not novel in any way. Spinal stability is gaining more and more
> > respect. At this years world congress of biomechanics they set up a
> > special session on spinal stability. The panel (Hodges, McGill,
> > Panjabi, Solomonow, and Stokes) have a combined four Volvo awards for
> > research in low back pain. This is one of the most prestigious awards
> > in this area. Please don't tell me that none of these people are well
> > respected.
> > RCTs are supposed to be the pinnacle of evidenced based practice. I
> > have yet to see anyone criticize Hides et al.
> >
> > Doug
> >
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