A well-received study 1, in the journal ‘Spine,’ decided to observe the relationship between cellular nutrition and disc degeneration. The results shared that a fall in disc nutrient supply can lead to disc degeneration.

Why Was such Research Conducted?

According to previous studies, the disc tends to degenerate earlier when compared to other tissues. The consequences of such degeneration include sciatica, back pain, and other spinal disorders. The treatment of such ailments can be quite expensive. They also harm a person’s psychological wellbeing.

While genetics is involved in such an occurrence, there have been suggestions about disc nutrition playing a role, too. The disc happens to be the body’s largest avascular tissue. That is why certain theories exist about degeneration happening due to a decrease in the nutrients being transported into the disc.

The current research was conducted to further understand this existing relationship.

LxH Model

Use a dynamic disc model to help in the patient education of nutrition and discs.

What Methods Were Used?

The study design was about analyzing the disc cell viability in relation to the supply of nutrients as well as cellular demand in vitro (while using a diffusion chamber). The objective was to gather data about the possible relationship present between nutrient supply, concentrations, and viability of a cell.

The research team cultured isolated bovine nucleus cells in agarose gels. The cultures were grown (up to 13 days) in a diffusion chamber. The nutrients were supplied by copying the configuration found in the disc in vivo. The concentration of glycosaminoglycans and profiles of cell viability were measured with relation to the medium composition and cell density.

Data was analyzed, statistically, using the Student’s t-test or analysis of variance (ANOVA).

What was Concluded?

The results from this degeneration-centric study showed that the analyzed cells were able to remain viable (across the diffusion chamber) at low cell densities. However, cell death was seen (inside the chamber) at higher densities. Also, the increase in cell density led to a decrease in the viable distance from the disc nutrient supply. Glucose was observed to be a critical nutrient. Also, at an acidic pH (6.0), cell survival was poor.

Take note; disc cells were found to be capable of surviving up to 13 days with 0% oxygen. No loss in cell viability was observed during that period. However, these cells did produce very low levels of proteoglycan.

The conclusion of these results helped support the theory about disc nutrient supply playing a role in regulating disc degeneration. According to this study, a decrease in the disc nutrient supply leads to a reduction in the number of viable cells present in the disc and opens the door to degeneration.

Hopefully, further research can be done to help promote better nutritional supply to the disc to address disc degeneration and related ailments.

Upper Cervical Spine Model

A study 1 published in The Spine Journal shared interesting results about CT exams and detecting upper cervical spine injuries. The conclusion hoped the current study’s data might help with earlier detection of craniocervical dissociative injuries.

Why Conduct Such a Study?

Research shows that in fatal cervical spine injuries, the common findings are traumatic occipitocervical (or OC) injuries. These OC injuries include damage being done to the OC as well as AA (atlantoaxial) articulations.

The more traditional diagnostic methods for the evaluation of the human upper cervical spine made use of the relationship between the cervical spine and the skull. It used lateral radiographs for visualization. However, the said method tends to have limited sensitivity as well as specificity. That’s why CT (computed tomography) scans ended up being used more. But, even then, the parameters for identifying normal and abnormal CT anatomy (especially in the upper cervical spine) need more clarity.

The current study was conducted to offer details of the normal anatomical features as well as upper cervical spine relationships, as displayed on the CT scan. The goal was to establish better threshold measurements when it comes to detecting subtle cervical injury or abnormality.

The Method Used

The design of this study can be defined as a retrospective anatomical case review. This study’s patient population was 100. All of them had undergone a screening CT scan (multidirectional) of their cervical spine. The research team randomly selected patients by using the radiology teaching file as well as the trauma registry databases. All of the scans were deemed negative for trauma (focusing on the craniocervical junction).

A total of 76 cervical CT scans (thin-sliced) were randomly selected for this study. Take note; the team made 42 different anatomical measurements of the upper cervical spine.

What Did the Results Conclude?

The results showed the least variation in direct measurements. The mean OC joint space came in at 0.6 mm, with the AA joint space being 0.6 mm. Significantly higher standard deviation as well as variability was demonstrated by the midsagittal structures.

The current data was used to reach certain conclusions. There was no variance (according to demographics) when it came to the left-right symmetry and narrow joint spaces in the cervical spine joints. The consistency in the coronal plane was regarded as the factor enabling precise diagnostic measurements and comparisons. According to this study, such precision can help with accurately identifying abnormal scans.

A better understanding of upper cervical spine-centric relationships may help with earlier detection of subtle craniocervical dissociative injuries (dependent on the data from CT scans). A subtle misalignment could serve as evidence for a severe injury when looking at CT scans.


Knuckle cracking and relationship with hand impairments

An interesting study 1 published in the journal of Orthopedics and Related Research, back in 2016, decided to see if knuckle cracking was related to hand impairments. The results showed a small increase in a range of motion among ‘cracked’ joints.

The Context Behind the Study

According to numerous records, the voluntary cracking of knuckles happens to be a common habit among humans. It has been reported to have a prevalence range of 25%-45%. Apparently, many people have a habit of cracking their knuckles when they’re typing on keyboards because their joints feel tight.

Numerous physicians have continued to be intrigued by such a habit. A previous large study did suggest their being an association between cracking knuckles and functional hand impairment. However, there’s also a counter-stance sharing that cracking knuckles doesn’t have any impact on a person’s hand-centric range of motion (ROM).

The current study decided to use imaging to find certain answers. The research team compared subjects with no history of knuckle cracking with subjects that did. They went over whether or not cracking joints improved range of motion and if Sonographic Evaluation was a reliable option for such observations.

The Methods Used

This study had 40 subjects with no history of joint problems in their hands. These subjects were aged 18 or older. A total of 30 subjects had a history of knuckle cracking, while 10 had no history of such a habit. Each subject had 10 digits, and that made for 400 MPJ (metatarsophalangeal) joints for evaluation.

Take note; there weren’t any differences in age, hand dominance, and gender distribution between the two groups. The subjects were asked to complete the standardized QuickDASH outcome measure questionnaire.

The research team did the clinical assessment for grip strength, swelling, grip, and ROM before as well as after performing the distraction maneuvers on the MPJs. A dedicated ultrasound unit was used for Sonography.

What Were the Results?

The results showed that on comparing subjects that had a history of habitual knuckle cracking with those who didn’t, the QuickDASH scores showed no differences.

The ROM comparisons between the two groups showed increased ROM in the knuckle-cracking subjects after ultrasound recorded manipulation. And swelling wasn’t observed at all in any of the subjects.

What Was Concluded?

The results of this study shared that yes, conflicting opinions do exist when it comes to knuckle cracking and the possible relationship with impairments. However, this study was unable to find any adverse effects of knuckle cracking habits in human hands.

The results did share that a person with such a habit does tend to have a higher likelihood of cracking other joints in their body. Maybe to help relax their posture?

Also, small increase in ROM was seen in joints that were cracked compared to ones that weren’t. But more research should be done to examine any possible long-term effects (both beneficial or adversarial) of the knuckle-cracking habit.


Facet joint degeneration

A very recent study from 2019, 1 in the Journal of Biomechanics offered some interesting results. It set out to analyze the relationship between IVD intervertebral disc (IVD) and facet joint (FJ) degeneration with regards to chronic low back pain. The results suggested that FJ loading is significantly impacted by the early mechanical changes linked to IVD degeneration. However, the said impact decreased as the degeneration progressed.

What Was the Context?

LBP or low back pain has been researched to be the most common condition (musculoskeletal), negatively affecting humans around the world. The impact of LBP is psychological, physical, economic, and sociological. While a majority of LBP cases are non-specific or generalized (which at our company does not exist), individual research studies have identified several specific causes behind LBP. The most common of these causes are IVD degeneration as well as FJ degeneration. Even though genetics is considered to be a contributor to degeneration, an important role is played by the mechanical environment with regards to pathogenesis. Furthermore, as degenerative changes occur, so can the load transfer from the disc to facets and vice-versa. The present study decided to look deeper into this relationship.

The Study

The current research effort developed a parametric finite element (FE) model using ANSYS APDL of an L4-L5 human motion segment. A total of five loading scenarios were considered for this experiment. The degree of disc degeneration was analyzed for each model based on the ratio of the intact disc height to the actual disc height. A similar method was used for FJ degeneration. Four groups were made to cover grades 0 to 3; Grade 0 = non-degenerated disc, Grade 1 = mild degeneration, Grade 2 = moderately degenerated, and Grade 3 = severely degenerated.

The analysis was conducted using a custom Python code. Volumetric operations and imaging were done using the vtk module v6.3. The statistical module of the SciPy library was used for data analysis. (To understand more we advise getting a hold of the full text)

What Were the Results?

Of the total of 1000 models, 14 of them were excluded from further evaluation. This was because they didn’t converge in a single loading scenario. The remaining models showed some interesting results. In the four groups made for disc degeneration (from grade 0 to 3), the said groups, respectively, had 248, 245, 246, and 247 models. In the FJ group, it was 178, 427, 330, and 51.

In Grade 0, 141 showed non-degenerated FJ. Grade 1 had 106 mild degeneration of FJ. The FJ was moderately degenerated in only one sample in Grade 2. Coming to the mildly degenerated disc group, there was an affinity toward higher FJ degeneration grades. The moderately degenerated disc group showed four instances of non-degenerated faces, with 111 being Grade 1, 126 being Grade 2, and 5 being Grade 3. In the severely degenerated disc group, the results showed FJ degeneration in 27 instances in Grade 1, 174 in Grade 2, and 64 models in Grade 3. A strong association between intervertebral disc and facet joint degeneration was observed. A strong positive correlation was analyzed between the FJ gap as well as both the strain in the anterior annulus and the force acting on the IVD.

What was Concluded?

The results of the current study put forth a strong association between IVD degeneration and FJ. The results were backed by previous literature. The gap width of the FJ showed the strongest correlation with disc load (the load which comes through the IVD). The research team of this study agreed that FJ degeneration causes loading and abnormal motion of the IVD, leading to the latter’s degeneration.

Furthermore, the team observed a strong negative correlation existing between FJ capsule tension and disc degeneration. The results of the study suggested that early mechanical changes linked to IVD degeneration had a significant effect on FJ loading. Also, as the degeneration progressed, the said impact is decreased. FJ degeneration also continued to affect disc loading, pointing toward a possible increase in support of disc degeneration.

The results of the current research study tend to suggest that early mechanical changes linked to IVD degeneration have the highest effect on the FJ loading. And as the degeneration continues, the said effect is lowered, whereas FJ degeneration seems to increasingly influence the disc loading, which might indicate increasing support of the disc degeneration.

The research team hopes their efforts help others in further understanding the existing link between FJ and IVD degeneration.





head posture and pain

A recent systematic review 1 published in November of 2019 in ‘Current Reviews in Musculoskeletal Medicine’ went over the relationship between neck pain and head posture. The results of the review found that age played a vital role.

What Was the Purpose?

Research has shown that neck pain is a common issue in the human population. It goes on to adversely impact a person’s family, business, healthcare, etc. Apparently, human neck pain’s overall prevalence in the general population can be more than 86%. When considering the physical factors, neck pain showed a strong association with a person’s neck having a forward bent for a long time as well as making repetitive movements.

The risk of neck pain has increased due to more people spending hours in front of screens for work or leisure in unhealthy postures. The forward head posture or FHP is the most common cervical postural fault. A higher FHP level is linked to higher deficits in a person’s cervical range of motion (specifically the neck’s flexion and rotation).

Furthermore, static balance control in asymptomatic adults is reported to be negatively impacted by FHP. However, there are still contradictory results. That’s why this study set out to determine whether or not FHP showed any differences between asymptomatic and neck pain subjects — investigating the relationship between neck pain and head posture was the study’s secondary objective.

The Methodology

This review covered the electronic databases EMBASE, MEDLINE/PubMed, Cochrane Library Web search, Physiotherapy Evidence Database (PEDro), and CINAHL for observational studies that were published in English and indexed from 2009 to April 2017. Also, an updated search was performed on 19 September 2018. Mendeley Desktop was used for importing abstracts and titles. The duplicates and irrelevant articles were removed.

An adapted form of the EPHPP (Effective Public Health Practice Project) assessment tool was utilized for determining the quality of selected articles.

What Did the Results Show?

A total of 15 cross-sectional studies were deemed eligible to be included in this meta-analysis and systematic review procedure. A total of 10 studies compared FHP between the group of participants with neck pain and a group of asymptomatic participants. Eight studies displayed a significant negative correlation between the intensity of neck pain and FHP (as well as disability in older adults and adults).

Furthermore, when it came to adolescents, the significant predictors of FHP were doctor visits and lifetime prevalence.

What was Concluded?

The current review shared that age seemed to play a vital role as a confounding factor when it came to the relation between neck pain and FHP. Also, the results of this review helped conclude that increased Forward Head Posture was seen in adults with neck pain when compared to adults that were asymptomatic.

Other than that, FHP was determined to be highly correlated with neck pain measures linked to adults as well as older adults. Take note; no association could be found between most neck pain measures in adolescents and FHP.

More in-depth research is required to help people realize the damaging effects of their posture and how it relates to them experiencing neck pain.

Biomechanical stress and Modic 1

A study 1, in the European Spine Journal, set out to uncover some theories related to low back pain (LBP) and biomechanical stress. It concluded that using weight-bearing MRI scans offer a valuable complement to standard sequences due to them presenting the radiologist with additional (and beneficial) diagnostic information about low back pain.

The Context

For many individuals out there, low back pain (LBP) caused by the degenerative disc disease of the spine is a leading reason for chronic disability and morbidity. Although there is a trend to avoid using this language with patients because of the mood it may create about their own spines. The preferred technique to evaluate a spine’s degenerative changes is an MRI because of its ability to detect water content in the discs. According to recent studies, the MRI signal changes in vertebral endplates, particularly the Modic changes (MC) type I, have been deemed a potential specific cause of LBP. More research is required to understand MC’s exact pathophysiology as the relationship between endplates, disc degeneration, and bone marrow is yet to be quantified.

What did this Study do?

The study’s objective was to evaluate the relationship between endplate modic changes type 1, degenerative disc, and pain level during a lumbar spine’s upright weight-bearing MRI scan. The study used patients with non-specific LBP, in other words, without an exact diagnosis.

The underlying hypothesis of the study was that loading could serve a role in the presentation of symptoms of LBP and Modic Type 1 changes.

What was Used?

The study evaluated 38 patients (20 females and 18 males) that had a general lower back pain diagnosis (non-specific LBP) as well as MRI evidence of Modic Type 1 vertebral changes. The age range of the participants was 27 to 69 years. An MRI unit was used to evaluate patients in a standard and upright weight-bearing position. The study compared the type 1 modic endplate  extend, intervertebral disc height at the involved level, as well as the degree of degeneration at the same intervertebral disc.

A visual analog scale questionnaire was used to assess pain. MedCalc was used for statistical analysis.

The Results

Compared to the supine position, a total of 26 participants showed an increase in the area of Modic 1 changes in the upright position. A reduction in the disc height was also observed in the upright position. A moderate negative correlation was analyzed between the area of Modic I changes and intervertebral disc height. Furthermore, a weak positive correlation was seen between Pfirrmann grade and an increase in the area of Modic type 1 changes.

The clinical evaluation showed that 30 patients reported their LBP worsening in an upright position. A significant correlation was seen between an increase in the Modic Type 1 changes and an increase in VAS values (in the upright position).

What Does It Mean?

The study showed the modifications of Modic 1 changes under loading while offering evidence (through MRI) of increased Modic changes area extent in the upright position. The results also displayed a correlation between an increase in pain and as Modic type 1 increases. It was concluded that upright scans under physiological load may offer a valid complement to standard sequences by offering more diagnostic information for treating pain because of “active discopathy” in the presence of Modic Type 1 changes.

Disc Height loss response

A study 1 in the journal of Ergonomics investigated the likelihood of variability of height loss in the sitting position being impacted by the time of day. The day-to-day variability in asymptomatic participants was also analyzed. The results shared data about height loss changes in the morning and the afternoon.

LBP and Height Loss

Millions of people (ranging from the young to the elderly) suffer from low back pain, or LBP, around the world. Such a condition has physical, psychological, and social implications. Sedentary work (which involves sitting for long periods) has become quite common for students, office workers, and more. Prolonged sitting increases the risk of lumbar disc pathology (which is, in part, associated with loading on the lumbar discs).

Spinal loading is considered as a cause for LBP as it causes spinal tissue shrinkage. Such shrinkage is known as height loss. Studies do show that prolonged sitting can lead to height shrinkage and thus, LBP.

Effects of Time of Day in Height Loss

Certain studies display a significant difference between height loss following loading activity applied during the morning and in the afternoon. Changes in height seem to occur in a ‘fast’ and ‘slow’ phase. The rate of change is higher when individuals wake up in the morning, and then it slows down throughout the day. That’s why, for ergonomic researchers, the influence of time of day is essential to consider when it comes to height loss. Day-to-day variability of height loss response is another factor to observe the influence of activities done during the day.

The Study

The research utilized a test-retest design to assess the effects of time of day on the variability of height loss. A total of fifty asymptomatic participants (25 males and 25 females) were involved. The study only included participants without current neck or back pain.

Take note, the participants were requested to sleep for eight hours (before every test) as well as to avoid vigorous activity for 24 hours before every test.

A seated stadiometer device was used for measuring height loss response.

What was found?

The current study is deemed to be the first of its kind to investigate the effects of time of day on the height loss response variability because of sitting for two consecutive days.

No significant difference in the magnitude of height loss during the morning and the afternoon was observed. Take note, changes higher than 0.886 mm (morning) and 1.128 mm (afternoon) can be attributed to intervention effects.

The study suggested the collection of future data during the morning or in the afternoon. Also, more significant responses are needed to confidently state that height loss responses have been influenced by an intervention.