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 THREE-DIMENSIONAL KINEMATIC ANALYSIS OF THE THORAX IN

STANDING AND SITTING

VOLUME I

By

Gordon J. Alderink

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A DISSERTATION
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Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Mechanical Engineering

2003

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 UMI Number: 3115929

Copyright 2003 by
Alderink, Gordon J.

All rights reserved.

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 ABSTRACT

THREE-DIMENSIONAL KINEMATIC ANALYSIS OF THE THORAX IN

STANDING AND SITTING

By

Gordon J. Alderink

Back injuries affect eight of ten people, with direct and indirect costs

approximating over $20 billion annually in the United States. Poor control of costs stems

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partially from inadequate understanding o f normal spine function and difficulty in

accurately diagnosing spinal disorders. Many diagnosis and intervention strategies used
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in manual medicine depend on a model of spinal behavior described by Harrison Fryette

(1918). Presently, there is no consensus regarding thoracic three-dimensional motion

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characteristics, and no one has systematically examined Fryette’s laws of vertebral

movement. Fryette stated the following: (1) When sidebending is introduced with the
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thoracic spine in a neutral posture, axial rotation will always be coupled to the opposite

side, (2) When sidebending is introduced with the thoracic spine in a non-neutral posture

(flexed or hyperextended) axial rotation will always be coupled to the same side, and (3)

When spinal motion is introduced in one plane, mobility will be reduced in secondary

planes. The purpose of this investigation was to examine Fryette’s laws using a video-

based motion analysis system to parameterize (with Cardan and helical axis analysis) the

three-dimensional kinematics of the thoracic spine/cage in healthy subjects with normal

spinal alignment.

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 When subjects were motion tested with their spine in a neutral position only 22%

exhibited contralateral coupling of sidebending and axial rotation, thus there are

insufficient data to support Fryette’s law of neutral spine mechanics for the thoracic

spine. In non-neutral postures (either flexed or hyperextended) subjects demonstrated

ipsilateral coupling of sidebending and axial rotation 79% of the time, although with axial

rotation in a slouched position 46% of the subjects showed contralateral coupling.

Overall, data support Fryette’s second law. There was borderline support for Fryette’s

third law that says that motion is reduced in secondary planes of motion. The finite

helical axis unit vectors were found to correspond with Cardan parameterizations of

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three-dimensional thoracic spine movements suggesting some clinical relevance for the

use of helical paramters.

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Results suggest manual medicine practitioners, who base their diagnostic and
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intervention strategies on Fryette’s laws of spinal behavior, may need to re-examine their

working assumptions. It appears also that helical axis analysis of the spine might have a

more important role in the clinical setting than previously thought. Further research on
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normal subjects and application to clinical cases will continue to add to our

understanding o f dysfunction o f the thoracic spine.

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Copyright by
GORDON J. ALDERINK
2003

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To Sally, Jenny and Liz.
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 ACKNOWLEDGEMENTS

Dr. Robert Soutas-Little: You started me on this journey by encouraging me to

pursue my graduate education in biomechanics/engineering. Because of your

encouragement I began to trust my own intuitions. I wish more people had your passion

for living and learning.

Dr. “Bob” Hubbard: You share my vision for bridging the engineering and

clinical sciences. You consistently and enthusiastically reminded me to create balance

between scientific rigor, clinical relevance and life.

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Dr. Gary Cloud: Your demand for scientific rigor was expected, feared at times,

but, in the end, absolutely critical to my success.

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Dr. Clarence Nicodemus: You joined late, but your contributions, in terms of
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questions, insights and affirmations, were invaluable. I look forward to our continued

collaboration.

Dr. Tammy Reid-Bush: You are especially good about attending to important
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details.

Dr. Philip Greenman: Your humility, clinical insights and modeling of lifelong

learning are attributes I greatly admire.

Yasin Dhaher: An extraordinary friend and colleague; I have such fond memories

of our biomechanics and philosophical conversations at the MSU Union.

Krisanne: Most never find one soul mate; I feel so fortunate because I have two

soul mates. I wouldn’t have made it without you.

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 Gordon and Marian Alderink, parents who have steadfastly supported me in

thought and prayer.

Doug Kindschi, PhD., and Grand Valley State University, for your commitment

and financial support.

John Butzer, M.D., Mary Free Bed Hospital & Rehabilitation Center, The Mary

Free Bed Guild, Motion Analysis Center Staff, Bill Hoyer and volunteers.

The biomechanics community, in particular Ton van den Bogert and Neil

Crawford: Your role in the successful completion of my project was more than you may

know.

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 TABLE OF CONTENTS

TABLE OF CONTENTS....................... viii

LIST OF TABLES ......... xi

LIST OF FIGURES ..... xiii

DEFINITIONS OF TERM S ..... xix

CHAPTER 1
INTRODUCTION... .......... .....1

CHAPTER 2
LITERATURE REVIEW ..... 7

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Introduction ............................................................................. 7
Anatomy............. .........7
Bony Configuration ...... 7
Intervertebral D isc.............................................................................. 16
Ligaments....
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..... .17
M uscles ..... 22
Clinical Measures o f Spinal M obility ...... ............32
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Physiological Movements of the Spine................. .......44
Radiographic and Invasive Measures of Spinal Kinematics.. ..... ....54
Two-Dimensional Kinematics ...... ....55
The Cervical Spine....................... .55
The Thoracic Spine ...... 72
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The Lumbar Spine........................................ 80

Three-Dimensional Kinematics................. 95
The Cervical Spine......................... .............95
The Thoracic Spine..... ..... ........106
The Lumbar Spine.......................... 112
Geometrical and Analytical Models of the Spine ..... ....122
The Cervical Spine..... ...... 123
The Thoracic Spine ..... ....126
The lumbar spine... ....... 133
Summary o f Experimental and Analytical Research on Spinal Kinematics.. 136
Videographic and Non-Invasive Measures of Spinal Kinematics .......................142
The Cervical Spine..................... ....143
The Thoracic Spine/Cage............................ 152
The Lumbar Spine.............. ...162
Summary of in vivo Research on Cervical, Thoracic, and Lumbar Kinematics 176
Implications of Literature Review and Statement of Purpose ...... 181

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 CHAPTER 3
METHODOLOGY .... - .....-......... 186
Introduction.... ...................... - ............... 186
Determination of Euler Angles........................ .....187
Rationale for Choice of Cardan Convention ........ 197
Helical A x is .............................. 201
Methods for the Calculation of Rigid Body Kinematics ...... 203
Error Analysis ....................... -2 0 7
Instrumentation Error. ....................... 207
Error Related to Skin Motion........................................... ................ ............... 211
Error Related to Cross-talk..................... ..216
Reliability ........................................... 224
Subjects ........ 225
Instrumentation and Calibration.................................... 226
Procedures ...................................................... 230
Screening Examination.... ...... 230
Test Preparation....................................................... 231
Testing Protocol................. 232

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Data Processing and Analysis........................ 234
Data Processing....................................................... ...234
Data Analysis ..... 235
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CHAPTER 4
RESULTS............................................... ..244
Subjects.......................................... 244
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Thoracic Spine Range o f M otion ............................................................ 245

Repeatability o f Thoracic Spine Range of M otion .......... 250
Coupled M otion ..... 251
Helical Axis ...... 262
Finite Helical A xis ..... ....262
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Instantaneous Helical Axis ......................... ....267

Summary ..... 280

CHAPTER 5
DISCUSSION ..... 281
Introduction................. 281
Measurement E rror ............... 282
Thoracic Spine Range o f M otion ..... 288
Fryette’s Laws: Physiologic Motion of the Thoracic Spine ........... 289
Law I. Neutral Mechanics................ 289
Law II. Non-Neutral Mechanics................................................ 294
Law III. Reduction of Mobility in Secondary Planes ..... ...295
Helical Axis Analysis ..... 297
Finite Helical A xis ..... 297
Instantaneous Helical Axis ....... ....302

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 Engineering and Biomechanical Significance ..... 304
Clinical Significance .......... .......................305
Limitations ...................... ..............307
Future Directions ....... •••......-......... ......307
Summary and Conclusion.... ..... ....................................308

APPENDIX A
REPEATED CALIBRATION TESTS ......... ..........312

APPENDIX B
ANGLE ACCURACY.... ...... .....................313

APPENDIX C
LINEAR ACCURACY................................... .......................314

APPENDIX!)
CARDAN ANGLES CROSS-TALK FROM DUMMY TEST DATA ..... 315

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APPENDIX E
INSTANTANEOUS HELICAL AXIS FOR DUMMY TRIAL 0 4 ................................. 320
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APPENDIX F
INFORMED CONSENT................................ 323

APPENDIX G
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MEDICAL HISTORY FORM ............... 325

APPENDIX H
SCREENING EXAMINATION................................................. .......................326
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APPENDIX I
TEST DATE CALIBRATIONS ..... 328

APPENDIX J
DATA COLLECTION SHEET.... ...... 329

APPENDIX K
THREE-DIMENSIONAL IHAS FOR S56JD....................... 330

LITERATURE CITED..................................... .357

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 LIST OF TABLES

Table 2.1 Spinal Coupling: Sidebending (SB) and Axial Rotation (AR) .................54

Table 2.2. Mean Flexion and Extension (degrees) of Cervical Spine Segments.............. 59

Table 2.3. Mean Flexion and Extension (degrees) of Cervical Spine Segments.. .......60

Table 2.4. Mean Range (degrees, one direction only) for Frontal and Transverse
Plane Motion for Upper Cervical Spine Segments ......... 63

Table 2.5. Mean (degrees, one direction only) Axial Rotation for Cervical Spine
Segments ..... ....67

Table 2.6. Mean Thoracic Segmental Motion (degrees) .............. 73

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Table 2.7. Mean (± SD) Range of Flexion Angles for 122 Lumbar Motion
Segments............................................................................ 84

Table 2.8. Mean Flexion and Extension (degrees) of Lumbar Segment Motion ......... 89
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Table 2.9. Mean (± SD) Anterior and Posterior Translation (mm) During Lumbar
Flexion and Extension ...... 91
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Table 2.10. Total Sidebending to the Right and Left in Lumbar Spine (degrees)............ 93

Table 2.11. Mean (± SD) Segmental Motion (degrees) for the Lower Cervical
Spine ..... 97
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Table 2.12. Mean (degrees) Total Axial Rotation for Cervical Segments ..... ..101

Table 2.13. Mean (± SD) Joint Angles (degrees) for Upper Cervical Segments............ 103

Table 2.14. Mean Lumbar Segmental Motion (degrees) in Sagittal, Frontal, and
Transverse Planes Based on In Vitro Studies .......... ..118

Table 2.15. Mean Lumbar Segmental Motion (degrees) in Sagittal, Frontal, and
Transverse Planes.................. 120

Table 2.16. Mean Passive Motion (degrees) for the Cervical Spine ...... 147

Table 2.17. Mean Range (degrees) of Active Cervical Movements... .......... 151

Table 2.18. Mean (± SD) Primary Motion (degrees) in Specified Thoracic

Regions ................. 161

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 Table 2.19. Mean (±SD) Degrees of El Flexion Mobility of Lumbar Spine
Segments............. —.........•••..........——•................ 168

Table 2.20. Mean Degrees of El Lumbar Mobility in LB Left and Right ..............168

Table 3.1. Helical Parameters for Dummy Flexion/Extension Test ................222

Table 4.1. Subject Characteristics .................... ..................................... .....................244

Table 4.2. Total Thoracic Spine Range o f M otion................. .................. .............. ........246

Table 4.3. Right/Left SB and AR Range of Motion for Primary M otions ..... ......... 249

Table 4.4. Mean o f Individual Differences Between Test 1 and Test 2 (n - 10) ......250

Table 4.5. Frequency o f Coupling Patterns for Standing and Sitting SB and AR
Trials ..... 252

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Table 4.6. Cross-Correlation Analysis of Thoracic SB and A R .............................. 259

Table 4.7. Comparison of Cardan and Finite Helical Angles for Primary M otions.......263
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Table 4.8. Summed Translation Along Helical A xis.............. 264

Table 4.9. Mean Helical Unit Vectors and Piercing Points for Standing
Flexion/Extension.............................................................. 264
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Table 4.10. Mean Helical Unit Vectors and Piercing Points for Ipsilateral
Coupling o f SB and A R ...... 266

Table 4.11. Mean Helical Unit Vectors and Piercing Points for Tests that
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Demonstrated Contralateral Coupling.......................... 267

Table 5.1. Thoracic Spine Range o f Motion Comparisons with Previous Studies.........289

Table A .l Repeated Calibration Wand Tests............................. 312

Table B.l Angle Accuracy Test Results..................................................... .313

Table C.l Linear Accuracy Test Results ..... .314

Table 1.1 Test Date Calibration Residuals..................... 328

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 LIST OF FIGURES

Figure 2.1 Whole vertebral column ......................... 8

Figure 2.2 Superior (A) and lateral (B) viewsof a typical vertebra.. ............ 10

Figure 2.3. Superior (A) and anterolateral (B) viewsof cervical vertebra C4....................11

Figure 2.4. Posterolateral and superior views of atlas (C l) and axis (C 2). .... ....... 12

Figure 2.5. Lateral view of thoracic vertebra T 7 . ..... ......................................................13

Figure 2.6. Lateral (A) and posterior (B) views of lumbar vertebra L4 ..... ................14

Figure 2.7. Anterior and posterior views of L5, sacrum, and coccyx .... ........ 15

Figure 2.8. Transverse and sagittal sections of the intervertebral disc. ...... ........16

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Figure 2.9. Superior and sagittal views of typical ligaments of the vertebral
column... ....... 18
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Figure 2.10. Front (A) and top (B) view of the left iliolumbar ligament................... 20

Figure 2.11. Posterior views o f suboccipital ligaments. ....... 22

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Figure 2.12. Superficial posterior trunk muscles......................................................... ......23

Figure 2.13. Intermediate and deep plane posterior spine muscles. .................. 24
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Figure 2.14. Psoas major (PM) and quadratus lumborum (QL). ..... 26

Figure 2.15. Suboccipital muscles. ..................... ...27

Figure 2.16. Sternocleidomastoid and scalenius muscles............................. 28

Figure 2.17. Anterior and lateral cervical muscles. ..... ....29

Figure 2.18. Suprahyoid and infrahyoid muscles................. 30

Figure 2.19. Musculature of the anterolateral abdominal wall.. .................. 31

Figure 2.20. Classification of spinal curves according to the inclination o f the

vertebrae ...................... 129

Figure 2.21. Position of the joint facet of the zygapophyseal joints, as illustrated
by parameter 5i (left) in relation to the transverse plane and by parameter
82 (right) in relation to the frontal plane. ..... 130

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 Figure 3.1. Orientation o f the body relative to the global (laboratory) coordinate
system ..... —....... ..........189

Figure 3.2. Marker arrays with body-fixed coordinate systems for the thoracic,
lumbar, and pelvic segments ...................... - ...............191

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Figure 3.3. Rotations defining the Eulerian angles using the z,x,z-convention. ......... 194

Figure 3.4. The generalized joint coordinate system (JCS) composed o f three
axes: two embedded (with unit base vectors ex and e3) in the two bodies
whose relative motion is to be described and the third axis, y, is the
common perpendicular to both body-fixed axes ..................... ..196

Figure 3.5. Instantaneous helical axis defining relative motion between thoracic
and lumbar segments................... 202

Figure 3.6. Finite helical axis describing relative motion of thoracic segment
relative to lumbar segment................ 203

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Figure 3.7. Sagittal plane projection vectors with a right-side view of a cylinder
representing the thoracic segment ....... 214
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Figure 3.8. Frontal plane projection vectors with a front view of a cylinder
representing the thoracic segment ....... 214
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Figure 3.9. Transverse plane projection vectors with a superior view of a cylinder
representing the thoracic segment ...................... 215

Figure 3.10. Dummy set-up illustrating marker arrangement for thorax and
pelvis. ..... 218
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Figure 3.11. Results of trial 04 sensitivity test........................ 221

Figure 3.12. Results o f trial 07 sensitivity test ........ 221

Figure 3.13. Results of trial 11 sensitivity test............................................. ....221

Figure 3.14. Sagittal view o f the instantaneous helical axis relative to the fixed
flexion/extension axis for dummy trial 04. ..... .224

Figure 3.15. Marker rigs used to track motion of the thoracic and thoraco-lumbar
vertebral segments ..... 227

Figure 3.16. Marker placements for head, spine and pelvis. ...... 231

Figure 3.17. Motion test to evaluate the fidelity of marker fixation to skin. ..... .232

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 Figure 3.18. Consistency plots for three of the five test motion cycles with CVs
for a) standing flexion/extension, b) standing sidebending, and c) standing
axial rotation .... ............................................. —.............. ...237

Figure 4.1. Time normalized ensemble average (± SD) for standing a) sagittal, b)
frontal and c) transverse plane range of motion ...... 247

Figure 4.2. Time normalized ensemble average (± SD) for sitting neutral a)
sidebending and b) axial rotation range of m otion. ....................... 248

Figure 4.3. Time normalized ensemble average (± SD) for slouched sitting a)
sidebending and b) axial rotation range of motion ..... ..248

Figure 4.4. Time normalized ensemble average (± SD) for erect sitting a)
sidebending and b) axial rotation range of m otion. ........ ....248

Figure 4.5. Three-dimensional angle-angle plots for the standing sidebending

test ...... ..253

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Figure 4.6. Three-dimensional angle-angle plots for the standing axial rotation
test.......................................... 254
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Figure 4.7. Three-dimensional angle-angle plots for the sitting neutral
sidebending test ..... 254
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Figure 4.8. Three-dimensional angle-angle plots for the sitting neutral axial
rotation test........... 255

Figure 4.9. Three-dimensional angle-angle plots for the sitting slouch

sidebending test ..... ..256
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Figure 4.10. Three-dimensional angle-angle plots for the sitting slouch axial
rotation test....................... 256

Figure 4.11. Three-dimensional angle-angle plots for the sitting erect sidebending
test .......................... 257

Figure 4.12. Three-dimensional angle-angle plots for the sitting erect axial
rotation test ..... 257

Figure 4.13. Three-dimensional angle-angle plots illustrating contralateral

coupling o f sidebending and axial rotation during the sitting erect
sidebending test.......................... ...258

Figure 4.14. Typical cross correlation plot for the standing sidebending test
where sidebending and axial rotation are coupled ipsilaterally................... 260

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 Figure 4.15. Typical cross correlation plot for the sitting erect sidebending test
where sidebending and axial rotation were coupled to the opposite side. ........260

Figure 4.16. Typical three-dimensional angle-angle plot of sitting erect axial

rotation test where sidebending and axial rotation are coupled ipsilaterally,
also showing the tertiary sagittal plane motion ........................... ....261

Figure 4.17. A typical cross-correlation plot of the sitting erect axial rotation test
illustrating the relationship between axial rotation and flexion.................. ......... 262

Figure 4.18. Sagittal view o f IHAs for the third cycle of the standing
flexion/extension motion test ...... 269

Figure 4.19. Frontal view o f IHAs for standing flexion/extension ..... 270

Figure 4.20. Transverse (top) view of IHAs for standing flexion/extension .........271

Figure 4.21. Frontal view IHAs for standing sidebending ............................ ..272

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Figure 4.22. Sagittal view o f IHAs for standing sidebending................... 273

Figure 4.23. Transverse (top) view of IHAs for standing sidebending .274
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Figure 4.24. Transverse (top) view of IHAs for standing axial rotation ..... 275

Figure 4.25. Frontal view of IHAs for standing axial rotation........................... .276
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Figure 4.26. Sagittal view of IHAs during standing axial rotation ..... 277

Figure 4.27. Frontal view o f IHAs for sitting neutral sidebending ...... 278
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Figure 4.28. Transverse (top) view of IHAs for sitting neutral axial rotation ..... 279

Figure D.l Dummy trial 04 where ~60° flexion and 30° extension was
introduced......................... 315

Figure D.2 Dummy trial 07 where -30° of right and left sidebending was
introduced............................ 315

Figure D.3 Dummy trial 11 where -45° of left and right axial rotation were
introduced................. 316

Figure D.4 Dummy trial 12 where -20° right sidebending then ~5° right axial
rotation was introduced ............................................................... 316

Figure D.5 Dummy trial 14 where -30° left axial rotation then ~5° left
sidebending was introduced................................. 316

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 Figure D.6 Dummy trial 18 where -60° flexion, then 5° right and 5° left
sidebending was introduced................ ..317

Figure D.7 Dummy trial 19 where -60° flexion, then -15° right and left
sidebending was introduced................. .........................317

Figure D.8 Dummy trial 111 where -60° flexion, then ~15° left and right axial
rotation was introduced.... ...... 317

Figure D.9 Dummy trial 112 where —60° flexion, then ~15° left sidebending and
~5° left axial rotation was introduced ...... 318

Figure D.10 Dummy trial 114 where -60° flexion, then -15° left sidebending and
~5° right axial rotation was introduced................. 318

Figure D .ll Dummy trial 116 where ~60 flexion, then ~15° left axial rotation
an d -5 ° left sidebending was introduced. ..... 318

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Figure D. 12 Dummy trial 118 where -60° flexion, then ~15° left axial rotation
and~5° right sidebending was introduced ..... 319

Figure E.l Sagittal view of IHA relative to fixed flexion/extension axis ...... ...320
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Figure E.2 Frontal view of IHA relative to fixed flexion/extension axis. ..... ..321

Figure E.3 Transverse (top) view of IHA relative to fixed flexion/extension axis .......322
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Figure K.1 Sagittal view of IHAs for standing flexion/extension.............. 330

Figure K.2 Frontal view of IHAs for standing flexion/extension. .........331

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Figure K.3 Transverse (top) view of IHAs for standing flexion/extension. ............ 332

Figure K.4 Frontal view o f IHAs for standing sidebending. ...... 333

Figure K.5 Sagittal view of IHAs for standing sidebending.... ...... 334

Figure K.6 Transverse (top) view of IHAs for standing sidebending ......... 335

Figure K.7 Transverse (top) view of IHAs for standing axial rotation ..... ....336

Figure K.8 Frontal view of IHAs for standing axial rotation. ................. 337

Figure K.9 Sagittal view o f IHAs for standing axial rotation.................... 338

Figure K.10 Frontal view of IHAs for sitting neutral sidebending................... 339

Figure K . ll Sagittal view of IHAs for sitting neutral sidebending ..... 340

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 Figure K.12 Transverse (top) view of IHAs for sitting neutral sidebending.. ........341

Figure K.13 Transverse (top) view of IHAs for sitting neutral axial rotation ..... 342

Figure K.14 Frontal view o f IHAs for sitting neutral axial rotation.. .....................343

Figure K.15 Sagittal view of IHAs for sitting neutral axial rotation............................... 344

Figure K.16 Frontal view of IHAs for sitting slouch sidebending .....................345

Figure K.17 Sagittal view o f IHAs for sitting slouch sidebending............................. 346

Figure K.18 Trasnverse (top) view of IHAs for sitting slouch sidebending................... 347

Figure K.19 Transverse (top) view of IHAs for sitting slouch axial rotation .....348

Figure K.20 Frontal view o f IHAs for sitting slouch axial rotation.... ........................349

Figure K.21 Sagittal view of IHAs for sitting slouch axial rotation................................ 350

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Figure K.22 Frontal view of IHAs for sitting erect sidebending
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Figure K.23 Sagittal view of IHAs for sitting erect sidebending .......................352

Figure K.24 Transverse (top) view of IHAs for sitting erect sidebending .........353
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Figure K.25 Transverse (top) view of IHAs for sitting erect axial rotation ..... 354

Figure K.26 Frontal view of IHAs for sitting erect axial rotation.................... ..355

Figure K.27 Sagittal view o f IHAs for sitting erect axial rotation................................... 356
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 DEFINITIONS OF TERMS

Kinematics. That phase of mechanics concerned with the study of motion of rigid
bodies, with no consideration of the forces involved.

Osteokinematics. Refers to the study of motion of the bones that articulate to form a
joint regardless of motion which occurs at the joint surface.

Arthokinematics. Refers to the study of motion of one bone relative to another at the
joint surfaces.

Rotation. A rigid body is said to be in rotation when it’s movement is such that all
particles along some straight line in the body or a hypothetical extension of it have zero
velocity relative to a fixed axis system. Rotation is a spinning or angular displacement of
a body about some axis. Rotation is measured in degrees or radians.

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Flexion/extension (forward bending/backward bending). This occurs when one or
more bones rotate about a frontal (coronal) axis.

Anterior/posterior. This is a rotation when one or more appendicular (peripheral) bones

rotate about a paracoronal axis.
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Abduction/adduction. This occurs when one or more bones rotate about a
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sagittal axis.

Sidebending (lateral flexion, lateral bending). This occurs when a vertebral

bone (skull, vertebral column) rotates about a sagittal axis.
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Medial/lateral. This occurs when one or more appendicular bones rotate about a
vertical or longitudinal axis.

Axial. This occurs when a vertebral bone rotates about a vertical or longitudinal
axis.

Translation. A body is said to be in translation when its movement is such that all
particles in the body at a given time have the same direction o f motion relative to a fixed
axis system. Translation can occur along posteroanterior, mediolateral and vertical axes.
Translation is measured using metric (e.g., millimeters) or English units (e.g., inches).

Protrusion. Anterior translation o f a segment(s), as in translating the head and neck

forward or anteriorly.

Retrusion. Posterior translation of a segment(s), as in translating the head and neck

backward or posteriorly.

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 Range of motion. The difference between the physiological extremes of movement is
the range o f motion. The range of motion can be expressed for the translation or rotation
of vertebrae for different directions of movement.

Instantaneous axes of rotation. At every instant, for a rigid body moving in a plane,
there is a line in the body or its hypothetical extension that does not move. This is the
instantaneous axis of rotation (IAR). Plane motion is fully defined by the position o f IAR
and the magnitude of the rotation about it. Woltring suggests that IARs are often
inappropriately used since merely the beginning and end of segment displacements are
studied. He suggested that the more appropriate description of the position and attitude
change o f the planar image o f a distal segment with respect to the planar image of a
proximal segment is described in terms of a single rotation about a calculated, fixed
center of rotation.

Instantaneous helical axes of rotation (screw axis). At every instant, for a rigid body
moving in space, there is a line in the body or its hypothetical extension that does not
move. This is the instantaneous helical (screw) axis (IHA). Spatial motion of a rigid
body relative to another rigid body or a fixed coordinate system is fully defined by

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movement about and along the IHA.

Finite helical axis. At discrete intervals, for a rigid body moving in space, there is a line
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in the body or its hypothetical extension that does not move. This is the finite helical axis
(FHA). Spatial motion of a rigid body relative to another body or a fixed coordinate
system is fully defined by movement about and along the FHA.
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Coupling. Coupling refers to motion in which the rotation or translation of a body about
or along one axis is consistently associated with simultaneous rotation or translation
about or along another axis. The associated motions of axial rotation and lateral bending
of the spine is an example o f coupling. Coupled motion is the motion produced by the
phenomenon of coupling. An example is the turning o f a screw, which causes the
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coupled motion o f axial translation.

Somatotypes (body types). A particular category o f body build, determined on the basis
o f certain physical characteristics. There are three fundamental body types:
endomorphic, ectomorphic, and mesomorphic. An endomorphic type is characterized by
excessive fatness, softness and roundness of the body, ectomorphic by linearity, fragility
and delicacy o f structure, and mesomorphic by prominent musculature with broad
shoulders and narrow hips. Most individuals have a combination of somatotype features
and could then be described by compound terminology. For example, a person with an
ectomorphic-mesomorphic descriptor would be an individual with some features o f each
with dominant features o f the mesomorph.

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 Chapter 1

INTRODUCTION

A back injury will affect eight o f ten people at some point in their lifetime.

Additionally, between 20% and 30% of the general population are suffering from low

back pain at any given time. Research on the natural history of spinal injuries suggests

that approximately 90% of those affected will recover, without residual problems, within

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2-3 months (Frymoyer, 1996). However, the cost of spinal disorders, in terms of sick

leave, lost productivity, medical/surgical management, etc. has been estimated at over
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$20 billion annually (Cats-Baril & Frymoyer, 1991). Further analysis of the costs of low

back pain indicate that a small majority o f cases (10-25%) account for as much as 85-
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90% of the total costs (Bigos & Battie, 1991; Frymoyer & Cats-Baril, 1987).

Reducing society’s costs related to spinal injury therefore seems necessary. This
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will likely occur secondary to changes in the medical/surgical management of these

patients, which is being forced by the recent trends in healthcare, e.g. managed care.

Although some o f the changes, i.e., serving as the gatekeeper, reduction in treatment

time, inspired by third party payers have been necessary, it would be better if changes in

low back pain management could be attained by healthcare practitioners through

additional bench and clinical research. For example, the continued development of

accurate and reliable measurement tools and methodologies could contribute to a better

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