LUMBAR_ROM_X_RESTING_POSTUR

Prévia do material em texto

Original article
The influence of initial resting posture on
J. E. Coates, A. H. McGregor, I. D. Beith, S. P. F. Hu
ri
e
o
s
o
d
e
1
rm
f
INTRODUCTION to be a valid indicator of impairment, characteristics
Manual Therapy (2001) 6(3), 139–144
# 2001 Harcourt Publishers Ltd
doi:10.1054/math.2001.0397, available online at http://www.idealibrar
Low back pain (LBP) has reached epidemic propor-
tions within western society (Waddell, 1987). More
than 80% of the British population experience
disabling LBP at some point in their lives (National
Back Pain Association, 1993) and up to 40% of the
population report some LBP in the last month (Clinical
Standards Advisory Group, 1994). As a result of these
staggering statistics, the evaluation and management of
LBP has received increasing attention. In clinical
practice spinal range of motion (ROM) is widely used
as an indicator of impairment and is frequently used to
make diagnostic, prognostic and therapeutic decisions
(Fitzgerald et al. 1983; Mayer 1985; Keeley et al. 1986;
Boline et al. 1992; Mayer et al. 1997). For spinal ROM
that influence it need to be identified.
It has been established that increasing age is
associated with a reduction in lumbar spine ROM
(Loebl 1967; Macrae & Wright 1969; Fitzgerald et al.
1983; Burton & Tillotson 1988; Dvorak et al. 1995;
McGregor et al. 1995b). This reduction in mobility
with increasing age is thought to occur due to
replacement of elastin with collagen, reduced elasti-
city of collagen within the soft tissue components of
the spinal column (Taylor & Twomey 1980) and
increased incidence of spinal degenerative changes
(Taylor & Twomey 1985). Gender has also been
shown to influence spinal mobility (Macrae & Wright
1969; Moll & Wright 1971; Scott Sullivan et al. 1994;
McGregor et al. 1995b). These studies produce
conflicting results and the precise nature of the
influence of gender on spinal mobility has yet to be
clearly established. However, from these studies it is
clear that in clinical studies recording spinal ROM,
age and sex characteristics must be accounted for.
ROM of the lumbar spine has been shown to exhibit
diurnal variation (Russell et al. 1992; Dvorak et al.
1995). These studies have demonstrated that lumbar
spine mobility is at its lowest in the early hours of the
morning and then increases to a peak in the afternoon.
These findings have been explained in terms of
Received: 1 March 2000
Revised: 2 February 2001
Accepted: 4 May 2001
Judi Elizabeth Coates BSc (Hons), MCSP, Physiotherapist,
University Hospital Lewisham, Alison Hazel McGregor PhD, MSc,
MCSP, Lecturer, Department of Orthopaedic and Trauma
Surgery, Imperial College School of Medicine, Iain D Beith MSc,
MCSP, Cert. Ed., Lecturer, Physiotherapy Division, School of
Biomedical Sciences, King’s College London, Sean Patrick Francis
Hughes MS, FRCS, Professor, Department of Surgery, Imperial
College School of Medicine.
Correspondence to: AHM, Biodynamics Lab, Dept.
Orthopaedic Surgery, Imperial College School of Medicine,
Department of Orthopaedic and Trauma Surgery, Impe
SUMMARY. The aim of this study was to investigate th
the lumbar spine in 18 normal subjects. Subjects resting p
CA-6000 Spinal Motion Analyser (OSI, USA) in five te
heel raises. Analysis showed that there was no significant
active range of motion. However, when subjects resting p
effects on the active range of motion were demonstrate
posture in the sagittal plane only. As heel height incr
reduction in the range of lumbar spine flexion (P50.00
resting posture in the frontal plane and significant effects
These results have important clinical implications in te
examination tool and suggest that studies using range o
resting posture. # 2001 Harcourt Publishers Ltd.
Charing Cross Hospital, Fulham Palace Road, London.
Tel.: +44 (0) 208 383 8831; Fax: +44 (0) 208 383 8835.
13
range of motion of the lumbar spine
ghes
al College School of Medicine
influence of initial resting posture on range of motion of
sture and active range of motion was measured using the
t positions, namely in flat standing and with a variety of
correlation between subject’s normal resting posture and
sture was artificially altered with heel raises, significant
. Increasing heel height significantly influenced resting
ased, the lumbar lordosis decreased and a significant
) was observed. Simulating pelvic asymmetry influenced
on the range of lateral flexion (P50.05) were observed.
s of using range of motion of the lumbar spine as an
motion as an outcome measure should consider initial
y.com on
variation in the disc water content (Russell et al.
1992). This finding has highlighted the importance of
9
Spinal Motion Analyser (Orthopaedic Systems In-
corporated, Union City, CA USA). The system
consists of a link arm incorporating six high precision
potentiometers which is attached to the subject via
two harnesses, one at the level of the thoracolumbar
junction and one at the level of the posterior superior
iliac spines (PSISs). Thus, the movement recorded
is localized to that of the thoraco-lumbar junction
relative to the lumbo-sacral junction, i.e. gross
motion of the lumbar spine. As the subject moved,
resistance in the potentiometers varied and this
change in resistance was sampled at a frequency of
50Hz. This data was converted via a PC into angular
measures of flexion, extension, lateral flexion and
140 Manual Therapy
performing outcome measures of spinal mobility at
similar periods in the day. The influence of LBP on
spinal mobility has been extensively investigated. Past
history of LBP without any current symptoms has
been shown to have no influence on ROM of the
lumbar spine (Tanz 1953; McGregor et al. 1995b).
However, current history of LBP, be it acute, subacute
or chronic has been shown to result in a reduction of
lumbar spine ROM in all planes compared to normal
subjects (McGregor et al. 1995a, McGregor et al.
1997; Marras & Wongsam 1986; Marras et al. 1995).
Thus, age, gender, time of day and current history
of LBP have all been shown to influence lumbar
spine mobility. However, research suggests that these
factors alone are unable to account for the observed
wide variation in lumbar spine mobility (McGregor
et al. 1995b). It may be that other factors must be
considered. It is postulated that variation in initial
resting posture, i.e. the position of the lumbar spine
when at rest in erect standing, may be partly res-
ponsible for variation in lumbar spine ROM. There
have been few studies investigating the influence of
initial resting posture on ROM of the lumbar spine
and the results of the existing studies are contra-
dictory. In 1967, Loebl noted that subjects with
deeper lumbar lordosis demonstrated less lumbar
spine extension but no statistical analysis of this small
sample was provided. Pope et al. (1985) claimed that
ROM of the lumbar spine was not influenced by
initial resting posture, however, the validity of their
study is questionable. Thus, the influence of initial
resting posture on ROM of the lumbar spine has yet
to be ascertained. Therefore, the aims of this study
were, firstly, to investigate the relationship between
subjects normal initial resting posture and ROM of
their lumbar spine and, secondly, to investigate the
influence of artificially altering initial resting posture
using heel raises on ROM of the lumbar spine.
METHOD
Study population
Eighteen normal subjects (15 female and 3 male) with
ages ranging from 20 to 32 (mean age 24.6+3.4)
years were recruited into the study. Subjects excluded
from participation were those who had suffered LBP
requiring treatment in the last 3 months, had any
neurodisability, had undergone any spinal surgery, or
who had any known disabling spinal pathology, such
as ankylosing spondylitis. All subjects were recruited
from staff and studentsof King’s College London
and Imperial College School of Medicine.
Measurement technique
All measurements were performed using a computer-
ized triaxial potentiometric system, the CA – 6000
Manual Therapy (2001) 6(3), 139–144
rotation occurring during both static postures and
active movements in each plane of motion. The
accuracy and repeatability of this system has been
previously demonstrated (Dvorak et al. 1995; Lee
1997; McGregor et al. 1995b; McGregor 1997;
Petersen et al. 1992; Schuit et al. 1997). Movement
in each plane is displayed graphically as a curve of
angle against time. A typical graphical output for
flexion and extension is shown in Figure 1. The
maximum ROM was determined from the apices of
the curve, positive angles representing flexion and
negative angles representing extension. Similar
graphs were produced for movement in the frontal
and horizontal plane, where negative values represent
movement to the left. During a ten second interval
each subject’s upright standing posture was recorded
and the results averaged over this time period.
Protocol
The study was approved by King’s College London
Research Ethics Committee and the Riverside Re-
search Ethics Committee, Charing Cross Hospital.
All subjects gave informed written consent and
completed a brief questionnaire detailing age, height
and weight. Testing was performed with subjects
barefoot and minimally clothed. The spinous process
of the twelfth thoracic vertebra and the PSISs were
identified by palpation and marked with the subject
Fig. 1—Typical graphical output curve generated by a flexion –
extension test.
# 2001 Harcourt Publishers Ltd
The relationship between subjects normal resting
posture and range of motion of the lumbar spine
Regression analysis was employed to investigate the
relationship between initial posture and subsequent
ROM in all planes of motion. This analysis demon-
strated a poor correlation with regression equations
accounting for only 6% of the variability in the data.
The influence of different test positions on resting
posture
The influence of different test positions on resting
posture is shown in Figure 2. Statistical analysis
revealed that increasing heel height, (that is tests 0–3),
was associated with a significant decrease in postural
extension (P50.01), i.e. a reduction in lumbar
lordosis. Simulated pelvic asymmetry, test 4, how-
ever, had a significant impact on resting posture in
both the frontal (P50.01) and horizontal plane
(P50.01), that is subjects adopted side flexed and
rotated postures, (Fig. 2).
Table 2. Summary of subject characteristics
Female Male Whole group
N 15 3 18
Age in years (mean/s.d) 24.5 (3.5) 25.1 (3.0) 24.6 (3.4)
Height in cm (mean/s.d.) 172.5 (8.0) 181.0 (7.9) 173.9 (8.4)
Weight in kg (mean/s.d.) 60.8 (9.5) 76.1 (7.9) 63.4 (10.8)
Influence of initial resting posture 141
lying in the prone position. The harnesses were then
positioned accordingly and the spatial linkage arm
attached. The standard test procedure documented
below was repeated in a random order for each of the
five test positions defined in Table 1. Altered heel
height was achieved by inserting wooden blocks
under the heels of each subject. The subject was
requested to stand looking straight ahead, with arms
relaxed by their side and feet a comfortable width
apart, whilst resting posture was recorded for three
10 second recording intervals. A series of three
movements were performed at the subjects preferred
speed and to the limit of comfortable motion in
each plane of motion. Prior to each recording the
equipment was calibrated to the subject’s resting
position. The subject’s preferred speed of motion
rather than a predetermined speed was used as
this has been shown to produce more reliable
measures of ROM (McIntyre et al. 1993). No
warm-up procedure was used as research has been
unable to demonstrate that stretching prior to
measurement produces any significant increase in
ROM (Dvorak et al. 1995; Reynolds et al. 1998). The
movements were performed in a set sequence of
flexion – extension, lateral flexion and rotation, with
lateral flexion and rotation always being performed
to the subject’s left first.
Statistical analysis
All statistical analyses were performed using the
statistical package Stata (Stata Corporation, Union
City, Texas, USA). Linear regression was used to
investigate the direction of association between the
two variables. The influence of the five different test
positions on resting posture and ROM was examined
using a two-way paired analysis of variance (ANO-
VA). Where ANOVA revealed a significant difference
between groups, these differences were investigated
further using orthogonal contrasts (Altman 1996). All
Table 1. Summary of the five test positions
Test Position
0 Subject stands with feet flat on the floor
1 Subject stands with both heels raised 2.5 cm
2 Subject stands with both heels raised 5 cm
3 Subject stands with both heels raised 7.5 cm
4 Subject stands with left heel only raised 2.5 cm
results were interpreted based on a significance level
of 0.05.
RESULTS
Table 2 summarizes the characteristics of the study
population.
# 2001 Harcourt Publishers Ltd
Fig. 2—The influence of different test positions on lumbar spine
resting posture.
ROM=Range of motion, error bars represent standard deviation,
n=18 Test 0=feet flat on the floor, Test 1=heels raised 2.5 cm,
Test 2=heels raised 5 cm, Test 3=heels raised 7.5 cm and Test
4=left heel only raised 2.5 cm: & Sagittal plane; Frontal plane;
Horizontal plane.
Manual Therapy (2001) 6(3), 139–144
The influence of different test positions on lumbar spine
ROM
The influence of different test positions on lumbar
spine ROM is shown in Figures 3–5. Increasing heel
height, tests 0–3, was shown to significantly influence
the range of flexion available in the lumbar spine
(P50.01). Analysis of the results was unable to
demonstrate any significant effect of increased heel
height on range of lumbar spine extension (Fig. 3),
right lateral flexion (Fig. 4) or right or left rotation
(Fig. 5). However, statistical analysis did reveal that
subjects demonstrated a significantly smaller range
of left lateral flexion when standing on 7.5 cm heels,
test 3, compared to either feet flat on the floor, test 0
(P50.05), or standing on 2.5 cm heel raises, test 1
(P50.03).
Analysis of the simulated pelvic asymmetry data
produced some interesting results. Raising the left
heel only by 2.5 cm, test 4, had no influence on the
range of lumbar spine flexion, extension or rotation.
However, it did significantly influence ROM in the
frontal plane (Fig. 4). When the left heel was raised,
right lateral flexion was significantly reduced
(P50.01) and left lateral flexion was significantly
increased (P50.02) compared to when both feet
were flat on the floor. Thus, as subjects assumed
resting postures in which they were side flexed to the
left, the available range of right lateral flexion
decreased and the available range of left lateral
Fig. 3—The influence of different test positions on range of lumbar
spine flexion and extension.
ROM=range of motion, error bars represent standard deviation,
n=18. Test 0=feet flat on the floor, Test 1=heels raised 2.5 cm,
Test 2=heels raised 5 cm, Test 3=heels raised 7.5 cm and Test
4=left heel only raised 2.5 cm: & Flexion; Extension.
142 Manual Therapy
Fig. 4—The influence of different test positions on range of lumbar
spine left and right lateral flexion.
ROM=range of motion, error bars represent standard deviation ,
n=18 Test 0=feet flat on the floor, Test 1=heels raised 2.5 cm,
Test 2=heels raised 5 cm, Test 3=heels raised 7.5 cm and Test
4=left heel only raised 2.5 cm: & Left side flexion; Right side
flexion.
Manual Therapy (2001) 6(3), 139–144
flexion increased.
DISCUSSION
Spinal ROM is widely used as anindicator of
impairment in the assessment and monitoring of
LBP patients (Fitzgerald et al. 1983; Mayer, 1985;
Fig. 5—The influence of different test positions on range of lumbar
spine left and right rotation.
ROM=range of motion, error bars represent standard deviation,
n=18. Test 0=feet flat on the floor, Test 1=heels raised 2.5 cm,
Test 2=heels raised 5 cm, Test 3=heels raised 7.5 cm, Test 4=left
heel only raised 2.5 cm: & Left rotation; Right rotation.
# 2001 Harcourt Publishers Ltd
lateral flexion to the left moves the subjects COG
further into the base of support (BOS) whereas
active lateral flexion to the right moves the subjects
COG towards the edge of their BOS. Therefore,
the observed reduction in right lateral flexion and
increase in left lateral flexion, when subjects had the
left heel only raised, may reflect the subjects attempts
to maintain their COG within their BOS. No
previous studies have investigated the influence of
pelvic asymmetry on lumbar spine ROM and so
comparisons can not be made.
CONCLUSION
This study was unable to demonstrate a significant
relationship between the subject’s normal resting
posture and range of motion of the lumbar spine.
However, when various heel raises artificially altered
the subject’s resting posture, significant changes in
lumbar flexion and left lateral flexion ROM were
demonstrated. This may suggest that initial resting
Influence of initial resting posture 143
Keeley et al. 1986 and Boline et al. 1992). For ROM
to be a valid indicator of impairment, characteristics
that influence it need to be identified. It has pre-
viously been shown that age, gender and current
history of LBP influence lumbar mobility (Fitzgerald
et al. 1983; Dvorak et al. 1995; McGregor et al.
1995a, b). However, these factors alone are unable to
account for the observed wide variation in ROM of
the lumbar spine (McGregor et al. 1995b). It is
therefore important to consider other factors that
may influence lumbar spine mobility. This study
investigates the influence of initial resting posture on
ROM of the lumbar spine.
Analysis of the results was unable to demonstrate a
significant relationship between subject’s normal
initial resting posture and normal lumbar spine
ROM. This may be due to the small sample size,
which caused the study to have insucient power to
demonstrate such a relationship.
It is widely believed that increased heel height is
associated with an increase in lumbar lordosis.
However, there is little evidence in the literature to
support this belief and the findings of this and
other studies (Opila et al. 1988; deLateur et al. 1991;
Franklin et al. 1995) demonstrate that increased heel
height is associated with a flattening of the lumbar
lordosis. This finding has important implications in
terms of the frequently advised use of flat shoes to
reduce lumbar lordosis in women with LBP.
When the subject’s initial resting posture was
artificially altered with heel raises, significant changes
in flexion and lateral flexion ROM were observed.
The results showed that an increased angle of lumbar
lordosis was associated with an increased range of
motion of flexion. No significant influence of initial
resting lumbar lordosis on the range of lumbar spine
extension was demonstrated. This finding is in
contrast to an observation of Loebl (1967) who
noted that subjects with deeper lumbar lordoses
demonstrated less extension of the lumbar spine.
These results are best explained in terms of an
‘unwinding’ model. If a subject assumes a resting
posture with a deep lumbar lordosis the underlying
vertebrae are already in a position of extension. They
therefore have to unwind into flexion before in-
creased loading of the opposed facet joint surfaces
and tension in the posterior part of the intervertebral
disc and posterior ligaments prevent further move-
ment (Twomey and Taylor, 1983). The deeper the
lumbar lordosis, the further the subject has to unwind
into flexion. The absence of a relationship between
the degree of lumbar lordosis and range of lumbar
spine extension, observed in this study, may well be
due to the small study population. In this study,
normal subjects who tend to assume resting postures
with excessive deep lumbar lordosis were used.
Therefore, subjects had a limited ability to move
further into extension.
# 2001 Harcourt Publishers Ltd
The results of this study showed that when the left
heel only was raised by 2.5 cm the subjects assumed
resting postures in which they were side flexed and
rotated to the left. Based on the ‘unwinding’ model,
as described above, it would be anticipated that this
resting posture would result in a significant increase
in right lateral flexion and rotation and a significant
reduction in left lateral flexion and rotation. How-
ever, the results showed a significant decrease in right
lateral flexion and a significant increase in left lateral
flexion and no significant effect on rotation. Figure 6
shows that a pelvic asymmetry due to the left heel
only being raised causes the subject’s centre of gravity
(COG) to act to the right of midline. Thus, active
Fig. 6—The influence of simulated pelvic asymmetry on the centre
of gravity.
Manual Therapy (2001) 6(3), 139–144
posture can influence ROM of the lumbar spine and
has important clinical implications in terms of
assessing ROM of the lumbar spine. If clinicians are
to make an accurate assessment of spinal ROM they
must take into account the patient’s initial resting
posture. Further study is needed with a larger study
population in which all age groups and both genders
Mayer T 1985 Using Physical Measurements to Assess Low Back
Pain, The Journal of Musculoskeletal Medicine 6: 44–59
Mayer T, Koodraske G, Beals S, Gatchel R 1997 Spinal Range of
Motion; Accuracy and Sources of Error with Inclinometric
Measurements, Spine 22(17): 1976–1984
McGregor AH 1997 The assessment of motion in the lumbar spine
and its relevance in the assessment of low back pain. PhD
Thesis University of London
McGregor A, McCarthy I, Hughes S 1995a Motion Characteristics
of Normal Subjects and People with Low Back Pain,
144 Manual Therapy
are adequately represented producing more conclu-
sive evidence to associate initial resting posture and
spinal ROM.
Acknowledgement
This paper was submitted in partial fulfillment of a BSc (Hons)
degree in Physiotherapy at King’s College London.
References
Altman D 1996 Practical Statistics For Medical Research,
Chapman and Hall, London, pp. 125
Boline P, Keating J, Haas M, Anderson A 1992 Interexaminer
Reliability and Discriminant Validity of Inclinometric
Measurement of Lumbar Rotation in Chronic Low-Back Pain
Subjects and Subjects Without Low-Back Pain, Spine 17(3):
335–338
Burton A, Tillotson K 1988 Reference Values For ‘Normal’
Regional Lumbar Sagittal Mobility, Clinical Biomechanics 3:
106–113
Clinical Standards Advisory Group 1994 Report By The Committee
on Back Pain, Clinical Standards Advisory Group, London
Dvorak J, Vajda E, Grob D, Panjabi M 1995 Normal Motion of
The Lumbar spine as Related to Age and Gender, European
Spine Journal 4: 18–23
Franklin M, Chenier T, Brauninger L, Cook H, Harris S 1995
Effect of Positive Heel Inclination on Posture, Journal of
Orthopaedic and Sports Physical Therapy 21(2): 92–99
Fitzgerald G, Wynveen K, Rheault W, Rothschild B 1983
Objective Assessment with Establishment of Normal Values for
Lumbar Spinal Range of Motion, Physical Therapy 63(11):
1776–1781
Keeley J, Mayer T, Cox R, Gatchel R, Smith J, Mooney V 1986
Quantification of Lumbar Function Part 5: Reliability of Range
of Motion Measures in the Sagittal Plane and an in vivo Torso
Rotation Measurement Technique, Spine 11(1): 31–35
de Lateur B, Giaconi R, Questad K, Ko M, Lehmann J 1991
Footwear and Posture. Compensatory Strategies For Heel
Height, American Journalof Physical Medicine and
Rehabilitation 70(5): 245–254
Lee SW 1997 Neck motion analysis in patients with chronic
cervical spondylosis. PhD Thesis University of London
Loebl 1967 Measurement of Spinal Posture and Range of Spinal
Motion, Annals of Physical Medicine 9(3): 103–110
Macrae I, Wright V 1969 Measurement of Spinal Motion, Annuals
of the Rheumatic Diseases 28: 584–589
Marras WS, Wongsam PE 1986 Flexibility and Velocity of the
Normal and Impaired Lumbar Spine. Archives of Physical
Medicine and Rehabilitation 67: 213–217
Marras WS, Parnianpour M, Ferguson SA, Kim JY, Crowell RR,
Bose S, Simon SR 1995 The Classification of Anatomic and
Symptom Based Low Back Disorders Using Motion Measure
Models. Spine 20(23): 2531–2546
Manual Therapy (2001) 6(3), 139–144
Physiotherapy 81(10): 632–637
McGregor A, McCarthy I, Hughes S 1995b Motion Characteristics
of the Lumbar Spine in the Normal Population, Spine 20(22):
2421–2428
McGregor AH, McCarthy ID, Dore´ C, Hughes SPF 1997 The
quantitative assessment of the motion of the lumbar spine
in the low back pain population and the effect of different
spinal pathologies on this motion. European Spine Journal 6:
308–315
McIntyre, DR, Glover, LH, Reynolds, DC 1993 Relationship
between preferred and maximum effort; low back motion,
Clinical Biomechanics 8: 203–209
Moll J, Wright V 1971 Normal Range of Spinal Mobility, Annals
of The Rheumatic Diseases 30: 381–389
National Back Pain Association 1993 Annual Report
Opila KA, Wagner SS, Schiowitz S, Chen J 1988 Postural
Alignment In Barefoot and High-Heeled Stance. Spine 13(5):
542–547
Petersen CM, Johnson RD, Schuit D, Hayes KW 1992 Intra- and
Inter-observer Reliability of Lumbar Range of Motion Testing
Using the CA 6000 Spine Motion Analyzer. Annual Conference
of the American Physical Therapy Association, Denver
Pope M, Bevins T, Wilder D, Frymoyer M 1985 The
Relationship between Anthropometric, Postural, Muscular
and Mobility Characteristics of Males Ages 18–55, Spine 10(7):
644–648
Reynolds HM, McGregor AH, Beith ID, Hughes SPF 1998 The
Effect of Warm-up Procedures on the Measurement of Active
Lumbar Spinal Motion. Proceedings of the Society for Back
Pain Research/British Cervical Spine Society Combined
Meeting, London
Russell P, Weld M, Pearcy J, Hogg R 1992 Variation In Lumbar
Spine Mobility Measured over A Twenty-Four Period, British
Journal of Rheumatology 31: 329–332
Schuit D, Petersen C, Johnson R, Levine P, Knecht H, Goldberg D
1997 Validity and Reliability of Measurements Obtained from
The OSI-CA-6000 Spine Motion Analyser for Lumbar Spine
Motion. Manual Therapy 2(4): 2065–2215
Scott Sullivan M, Dickinson C, Troup J 1994 The Influence of Age
and Gender on Lumbar Spine Sagittal Plane Range of Motion,
Spine 19(6): 682–686
Tanz T 1953 Motion of The Lumbar Spine, American Journal of
Roentgenology 69(3): 399–406
Taylor J, Twomey L 1980 Sagittal and Horizontal Plane
Movement of The Human Lumbar Vertebral Column In
Cadaver and In The Living, Rheumatology and Rehabilitation
19: 223–232
Taylor J, Twomey L 1985 Age Changes In The Lumbar
Articular Triad, Australian Journal of Physiotherapy 31:
106–112
Twomey L, Taylor J 1983 Sagittal Movements of The Human
Lumbar Vertebral Column: A Quantitative Study of The
Posterior Vertebral Elements, Archives of Physical Medicine
and Rehabilitation 64: 322–325
Waddell G 1987 A New Clinical Model For the Treatment of Low
Back Pain, Spine 12(7): 632–644
# 2001 Harcourt Publishers Ltd
	INTRODUCTION
	METHOD
	Study population
	Measurement technique
	Protocol
	Figure 1
	Table 1
	Statistical analysis
	RESULTS
	The relationship between subjects normal resting posture and range of motion of the lumbar spine
	The influence of different test positions on resting posture
	Table 2
	Figure 2
	The influence of different test positions on lumbar spine ROM
	Figure 3
	Figure 4
	DISCUSSION
	Figure 5
	Figure 6
	CONCLUSION
	Acknowledgement
	References