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Function & Mobility

Chronic low back pain and associated functional decline in elderly populations — assessment of ROM, balance, and ADL limitations to guide rehabilitation.

Overview

Spinal inclination angles of 5° serve as a cutoff to predict exacerbation of mobility function and health-related quality of life in community-dwelling middle-aged and older women [1]. In the context of shoulder pathology, idiopathic frozen shoulder is typically self-limiting, with symptoms subsiding and full movement returning within a maximum of two years [5]. While moderately enhancing range of motion at the surgical level facilitates paraspinal muscle remodeling [3], the distinction between active and passive motion remains critical for accurate clinical documentation and interprofessional discourse [4].

Current evidence indicates that no improvement in fracture reduction or functional outcomes has been established for 3D-assisted operative treatment of pelvic ring injuries [6]. Similarly, there may be no clinically significant difference in failure rates, complications, range of motion, or patient-reported outcomes between early and delayed mobilization following primary distal biceps tendon repair [15]. For scoliosis patients, both conventional and 3D-printed braces limit trunk range of motion compared to the unbraced condition but do not affect gait parameters during timed-up and go tests [14].

In the realm of nerve transfer for spinal cord injury, using expendable donor nerves with redundant function has relatively little impact on strength or activities of daily living [28]. Regarding hand rehabilitation, the relative motion extension (RME) program supports safer, earlier recovery of hand function and motion compared to a continuous active motion (CAM) program following repair of zones V and VI extensor tendons [27]. New devices such as the stand-up wheelchair and shuttlebug have successfully facilitated upright mobility in paraplegic children [21]. Finally, a core set of outcome measures based on international acceptance is needed for future shoulder studies [2], as no current osteoarthritis assessment tool meets the stringent requirements of newer quality-reporting programs [11].

Anatomy & Pathophysiology

Kinematics and Biomechanics

A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1]. Patients with severe spinal deformity demonstrated significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry [9]. Lordosis, range of movement, and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests [22]. Pelvic rotation is an important method to compensate for limited lumbar motion in patients with lumbar disc herniation during activities of daily living [29]. Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights, exhibiting a significant degree of lumbar hyperextension [40]. Compared with healthy controls, the low back pain remission group exhibited higher lumbar erector spinae activation during the swing phase and altered movement redundancy between adjacent spinal segments in the sagittal plane [41]. The coronal Cobb angle and the symmetry index of paraspinal muscle activity in adolescent idiopathic scoliosis patients vary with posture changes [36].

Neuromuscular Adaptation and Bracing

Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery [3]. Neuromuscular changes in healthy subjects occur during a 3-week period of regular lumbosacral orthosis use, specifically involving trunk stiffness, damping, muscle activation patterns, and spine compression forces [33]. Adding dorsal and ventral panels to an extensible lumbar belt produces the largest lumbar spine restrictions and alters lumbopelvic rhythm in healthy subjects [34]. Both conventional and 3D-printed braces limited trunk range of motion compared to the unbraced condition but did not affect gait parameters during timed-up and go tests [14]. A range of wearable technologies and biofeedback modalities are used to modulate spine motor control, though standardized reporting and further research are needed to establish clinical efficacy [35].

Alignment Correlations and Functional Limitations

Spinal sagittal parameters showed a low correlation with gait parameters in asymptomatic subjects [19]. The altered contribution of cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment [10]. No differences were observed among low back pain subgroups regarding physical abilities, necessitating further studies to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [8]. Driving readiness depends on specific biomechanical functions like braking force and reaction time, which may persist for weeks or months post-spine surgery [45]. Posterior and posterior superior labral injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [42].

Classification

Functional Thresholds: A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1].

Outcome Measures: A core set of outcome measures for future studies on patients with shoulder pathologies is needed based on international acceptance and diffusion of each patient-reported outcome measure (PROM) [2]. No osteoarthritis (OA) pain and functional assessment tool currently exists capable of meeting the stringent requirements established by newer quality-reporting programs [11].

Motion Parameters: Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery [3]. The distinction between active and passive motion is important to specify when addressing joint motion in clinical documentation and academic and interprofessional discourse [4]. Lordosis, range of movement, and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests in people with and without back pain [22].

Biomechanical & Demographic Factors: Spinal sagittal parameters showed a low correlation with gait parameters in asymptomatic subjects [19]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores on numerous scoring systems devised to evaluate patients with knee symptoms [17]. No differences were observed among low back pain (LBP) subgroups regarding physical abilities, necessitating further studies with appropriate diagnostic procedures to elucidate if different types of LBP are related to altered biomechanics, physiology, and function [8].

Interventional Outcomes: Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period [12]. Both conventional and 3D-printed braces limited trunk range of motion compared to the unbraced condition but did not affect gait parameters during timed-up and go tests [14].

Neurological & Oncologic Classifications: Wheelchair propulsion strategies vary significantly among individuals with identical spinal cord injury (SCI) levels, demonstrating that neurological classification alone does not determine movement patterns [38]. Musculoskeletal oncology involves the diagnosis and management of neoplastic conditions affecting the musculoskeletal system, including benign tumors, sarcomas, and metastatic carcinoma, with classification based on histomorphology to yield insight into behavior and prognosis [24].

Assistive Mobility: New devices like the stand-up wheelchair and shuttlebug have been employed with success to facilitate upright mobility and greater freedom in paraplegic children [21].

Other Considerations: Evidence regarding functional classification includes the need for standardized outcome measures [2], the lack of OA assessment tools meeting current quality-reporting standards [11], and the variability of lumbo-pelvic rhythm testing [22].

Clinical Presentation

Assessment of spinal mobility relies on specific angular thresholds and activity metrics. A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1]. Patients with severe spinal deformity demonstrated significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry [9]. In older adults, thigh intramuscular adipose tissue (IMAT) is a potent muscle variable related to the ability to move about in their community [32]. Conversely, no differences were observed among low back pain subgroups regarding physical abilities [8], and the altered contribution of cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment [10].

Joint motion documentation requires precise differentiation between movement types. The distinction between active and passive motion is important to specify when addressing joint motion in clinical documentation and academic and interprofessional discourse [4]. In the great majority of patients, idiopathic frozen shoulder is a self-limiting condition in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms [5, 7]. For specific contractures, forty-seven (96 per cent) of forty-nine shoulders had a good clinical result after distal release of deltoid muscle contracture [13].

Functional assessment tools vary in their ability to capture patient variability and demographic influences. Numerous scoring systems for knee symptoms are significantly affected by demographic variables such as advanced age, low family income, and multiple medical conditions [17]. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment for symptomatic acetabular dysplasia [18]. The PROMIS Profile allows for an in-depth look at patients' dysfunction not asked in current legacy scores [23]. However, there currently exists no osteoarthritis pain and functional assessment tool capable of meeting the stringent requirements established by newer quality-reporting programs [11]. Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport [25], and a core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each patient-reported outcome measure (PROM), is needed [2].

Surgical intervention timing and sick leave protocols directly impact functional trajectories. Early diagnosis, accurate reduction, and internal fixation are important to avoid growth disturbance, articular incongruence, and functional disability in displaced fractures of the medial humeral condyle in children [26]. Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period [12].

Investigations

Plain radiography: In patients with severe spinal deformity, plain radiography reveals significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry [9]. For pelvic ring injuries, 3D-assisted operative treatment has not established improvement in fracture reduction or functional outcome [6]. In displaced fractures of the medial humeral condyle in children, early diagnosis via radiography is critical to avoid growth disturbance, articular incongruence, and functional disability [26].

MRI: Magnetic resonance imaging is prudent for high-energy posterior dislocations when weakness in external rotation or abduction is present, as these signs may indicate rotator cuff injury [49]. MRI also indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [51].

Other Considerations: A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1]. In the great majority of patients, idiopathic frozen shoulder is a self-limiting condition in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms [5, 7]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion [16]. Patients with vertebral compression fracture showed an overall worse global sagittal alignment and decreased quality of life [44]. Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting fusion status at one year after posterior lumbar interbody fusion [48]. Lordosis, range of movement, and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests [22]. Pelvic rotation is an important method to compensate for limited lumbar motion in patients with lumbar disc herniation [29]. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment [10]. No differences were observed among low back pain subgroups, and further studies with appropriate diagnostic procedures are needed to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [8]. Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery [3]. The distinction between active and passive motion is important to specify when addressing joint motion in clinical documentation and academic and interprofessional discourse [4]. A core set of outcome measures for future studies on patients with shoulder pathologies, based on international acceptance and diffusion of each PROM, is needed [2]. There currently exists no osteoarthritis pain and functional assessment tool capable of meeting the stringent requirements established by newer quality-reporting programs [11].

Treatment

Non-Operative

Idiopathic frozen shoulder is a self-limiting condition in the great majority of patients, with symptoms subsiding and full shoulder movement returning within a maximum of two years from onset [5, 7]. Exercise therapy effectively improves Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and SF-36 indexes in the elderly with chronic low back pain [37]. Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period [12]. A walking intervention for chronic low back pain showed no significant difference in change of levels of Oswestry Disability Index (ODI) disability compared to a waitlist group [20]. New devices like the stand-up wheelchair and shuttlebug have been employed with success to facilitate upright mobility and greater freedom in paraplegic children [21].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [39]. Patients with severe spinal deformity demonstrated significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry [9]. A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1].

Surgical Approach / Technique: Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion [16]. Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the deltoid muscle contracture [13]. Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery [3].

Adjuncts: Both conventional and 3D-printed braces limited trunk range of motion compared to the unbraced condition but did not affect gait parameters during timed-up and go tests [14]. There may be no clinically significant difference in failure rates, complications, range of motion, or patient-reported outcomes for early versus delayed mobilization after primary distal biceps tendon repair [15]. The relative motion extension (RME) program supports safe earlier recovery of hand function and motion when compared to a continuous active motion (CAM) program following repair of zones V and VI extensor tendons [27]. Use of expendable donor nerves with redundant function to perform nerve transfer surgery has relatively little impact on strength or capacity to perform activities of daily living in the spinal cord injury population [28].

Other Considerations: No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established for 3D-assisted operative treatment of pelvic ring injuries [6]. There currently exists no osteoarthritis pain and functional assessment tool capable of meeting the stringent requirements established by newer quality-reporting programs [11]. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment for symptomatic acetabular dysplasia [18]. The distinction between active and passive motion is important to specify when addressing joint motion in clinical documentation and academic and interprofessional discourse [4]. A core set of outcome measures for future studies on patients with shoulder pathologies, based on international acceptance and diffusion of each PROM, is needed [2]. No differences were observed among low back pain subgroups, and further studies with appropriate diagnostic procedures are needed to elucidate if different types of low back pain are related to altered biomechanics, physiology, and function [8]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [46].

Complications

Stiffness / Arthrofibrosis: Idiopathic frozen shoulder is a self-limiting condition where symptoms subside and full shoulder movement returns within a maximum of two years from onset [5, 7]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though the patient later required total joint replacement due to restricted motion [16]. Distal release of deltoid muscle contracture yielded a good clinical result in forty-seven (96 per cent) of forty-nine shoulders [13].

Functional Outcomes & Mobility Limitations: A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1]. Patients with severe spinal deformity demonstrated significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry [9]. Spinal sagittal parameters showed a low correlation with gait parameters in asymptomatic subjects [19], and the altered contribution of cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment [10]. Numerous scoring systems for knee symptoms are significantly affected by demographic variables such as advanced age, low family income, and multiple medical conditions [17]. Preoperative symptom duration of two years or greater does not result in inferior patient-reported or clinical outcomes compared to symptom duration of less than two years after high tibial osteotomy at mid-term follow-up [31].

Perioperative & Rehabilitation Considerations: No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established for 3D-assisted operative treatment of pelvic ring injuries [6]. There may be no clinically significant difference in failure rates, complications, range of motion, or patient-reported outcomes for early versus delayed mobilization after primary distal biceps tendon repair [15]. No significant difference in change of levels of ODI disability was found between the study group and waiting group following a walking intervention for chronic low back pain [20]. Standing should occur 30 minutes 5 times a week for a positive impact on most outcomes in adults with stroke, spinal cord injury, and other neurological conditions [43]. Standing for 60 minutes daily is suggested for mental function and bone mineral density in adults with stroke, spinal cord injury, and other neurological conditions [43].

Recovery

Light activity (weeks): Evidence regarding specific week ranges for light activity, such as desk work or driving, is not present in the current evidence base. However, patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period [12].

Full activity (months): For idiopathic frozen shoulder, full shoulder movement returns within a maximum of two years from the onset of symptoms in the great majority of patients [5, 7]. In the context of distal biceps tendon repair, there may be no clinically significant difference in range of motion or patient-reported outcomes for early versus delayed mobilization [15]. Additionally, patients with a preoperative duration of symptomatic medial knee overload or arthritis of two years or greater do not experience inferior patient-reported or clinical outcomes at mid-term follow-up compared to those with a symptom duration of less than 2 years [31].

Complete recovery / outcome plateau (months): A spinal inclination angle of 5° serves as a cutoff value to predict exacerbation of mobility function and health-related quality of life status [1]. Skeletal dysplasias restrict functioning extensively and significantly affect daily living [50]. For patients with symptomatic acetabular dysplasia, PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment [18]. Overall, there was no significant difference in change of levels of ODI disability between the study group and the waiting group following a walking intervention for chronic low back pain [20].

Rehabilitation protocol: Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery [3]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion [16]. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment [10].

Functional milestones: Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport [25]. The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [30]. Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture [13]. Patients with mild upper limb impairment showed greater improvement after surgery for spasticity [47].

Other Considerations: No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established for 3D-assisted operative treatment of pelvic ring injuries [6].

Key Evidence

  • [L3] A spinal inclination angle of 5° was identified as a cutoff value to predict exacerbation of mobility function and health-related quality of life status. (10.1186/s12891-023-06686-2)
  • [L4] A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed. (10.1302/2058-5241.6.200109)
  • [L3] Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery. (10.1186/s13018-025-05837-6)
  • [Letter] The distinction between active and passive motion is important to specify when addressing joint motion in clinical documentation and academic and interprofessional discourse. (10.5435/jaaos-d-24-00795)
  • [L4] In the great majority of patients idiopathic frozen shoulder is a self-limiting condition, in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms. (10.2106/00004623-197860040-00030)
  • [L1] No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. (10.3390/jpm11090930)
  • [L4] In the great majority of patients idiopathic frozen shoulder is a self-limiting condition, in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms. (10.2106/00004623-197860040-00029)
  • [L4] No differences were observed among the LBP subgroups, and further studies with appropriate diagnostic procedures are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function. (10.3390/life11030226)
  • [L3] Patients with severe spinal deformity demonstrated significantly lower physical activity and mobility scores compared to those with mild deformity or spinal asymmetry, indicating that spinal deformity impacts functional limitations and quality of life. (10.1177/2325967120s00193)
  • [L4] The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. (10.1186/s12891-024-07423-z)
  • [L2] There currently exists no OA pain and functional assessment tool capable of meeting the stringent requirements established by newer quality-reporting programs. (10.5435/jaaos-d-16-00303)
  • [L3] Patients prescribed full, graded, or no sick leave exhibited significant, albeit not clinically meaningful, reductions in pain-related disability over a six-months period. (10.1186/s12891-025-08570-7)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [L4] Both brace types limited trunk range of motion compared to the unbraced condition but did not affect gait parameters during TUG tests. (10.1186/s12891-025-08311-w)
  • [L3] These results suggest there may be no clinically significant difference in failure rates, complications, ROM, or PROs for early versus delayed mobilization after primary distal biceps tendon repair. (10.1177/03635465251317207)
  • [Case_report] The lesion was benign, and surgical excision resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion. (10.2106/00004623-198062020-00017)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L2] PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment. (10.1177/0363546519894323)
  • [L4] Spinal sagittal parameters also showed a low correlation with gait parameters. (10.1186/s12891-023-06672-8)
  • [L1] Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. (10.1186/s12891-021-04060-8)
  • [L4] New devices like the stand-up wheelchair and shuttlebug have been employed with success to facilitate upright mobility and greater freedom. (10.2106/00004623-197658010-00006)
  • [L3] Lordosis, range of movement and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests. (10.1186/s12891-016-1250-1)
  • [L4] The PROMIS Profile allows for an in-depth look at patients' dysfunction not asked in current legacy scores. (10.1177/2325967118s00105)
  • [L5] Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport, and psychological factors are potentially modifiable, allowing for early identification and intervention to improve final outcomes. (10.1016/j.arthro.2022.11.028)
  • [L4] Early diagnosis, accurate reduction, and internal fixation are important to avoid growth disturbance, articular incongruence, and functional disability. (10.2106/00004623-198062070-00016)
  • [L1] The RME program supports safe earlier recovery of hand function and motion when compared to a CAM program following repair of zones V and VI extensor tendons. (10.1016/j.jht.2018.10.003)
  • [L2] Use of expendable donor nerves with redundant function to perform nerve transfer surgery has relatively little impact on strength or capacity to perform activities of daily living, even in the unique and highly vulnerable spinal cord injury population. (10.1016/j.jhsa.2022.08.014)
  • [L4] Pelvic rotation is an important method to compensate for the limited lumbar motion. (10.1186/s12891-017-1572-7)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L3] Thigh IMAT, a newly identified muscle impairment appears to be a potent muscle variable related to the ability of older adults to move about in their community. (10.1155/2012/629637)
  • [L4] The study documented neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO, specifically measuring trunk stiffness, damping, muscle activation patterns, and spine compression forces. (10.1186/1471-2474-11-154)
  • [L4] Adding dorsal and ventral panels to an extensible lumbar belt produces the largest lumbar spine restrictions and alters lumbopelvic rhythm. (10.1186/1471-2474-15-307)
  • [L1] The review identifies a range of wearable technologies and biofeedback modalities used to modulate spine motor control, highlighting the need for standardized reporting and further research to establish clinical efficacy. (10.1186/s12891-024-07867-3)
  • [L3] The coronal Cobb angle and the SI of paraspinal muscle activity in AIS patients vary with posture changes. (10.1186/s12891-024-07329-w)
  • [L1] Exercise therapy effectively improved VAS, ODI, and SF-36 indexes in the elderly. (10.1186/s13018-023-03988-y)
  • [L4] Wheelchair propulsion strategies vary significantly among individuals with identical SCI level, demonstrating that neurological classification alone does not determine movement patterns. (10.1186/s12891-025-08987-0)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights, exhibiting a significant degree of lumbar hyperextension. (10.1177/0363546506298276)
  • [L4] Compared with healthy controls, the LBP-R group exhibited higher lumbar ES activation during the swing phase and altered movement redundancy between adjacent spinal segments in the sagittal plane. (10.1186/s12891-025-08506-1)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L1] Standing should occur 30 min 5 times a week for a positive impact on most outcomes while 60 min daily is suggested for mental function and bone mineral density. (10.1186/s12891-015-0813-x)
  • [L3] Patients with VCF showed an overall worse global sagittal alignment and decreased quality of life. (10.1186/s12891-021-04311-8)
  • [L4] Driving readiness depends on specific biomechanical functions like braking force and reaction time, which may persist for weeks or months post-surgery. (10.1186/s13018-025-05787-z)
  • [L4] Patients with mild upper limb impairment showed greater improvement after surgery. (10.1177/1753193418758852)
  • [L2] Overall bone metabolism of the operated intervertebral disc space at six weeks had the highest diagnostic accuracy for predicting the fusion status at one year. (10.1186/s13018-025-05814-z)
  • [L4] The authors suggest that patients with weakness in external rotation or abduction after posterior dislocation may have rotator cuff injury and that early MRI investigation is prudent for high-energy injuries. (10.1177/03635465030310060301)
  • [L4] Our study indicates that skeletal dysplasias restrict functioning extensively and significantly affect daily living. (10.1186/s12891-020-03835-9)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)

References

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[2] Choosing patient-reported outcome measures for shoulder pathology. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.200109

[3] Effects of dynamic stabilization and fusion on postoperative paraspinal muscle degeneration and lumbar function recovery. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05837-6

[4] Letter to the Editor: “Correlation Between Patient-reported and Clinician-measured Shoulder Range of Motion in Patients Undergoing Shoulder Surgery”. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00795

[5] Brief Note The Natural History of 'Idiopathic' Frozen Shoulder. The Journal of Bone & Joint Surgery. 1978. DOI: 10.2106/00004623-197860040-00030

[6] Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?—A Systematic Review of the Literature. Journal of Personalized Medicine. 2021. DOI: 10.3390/jpm11090930

[7] The natural history of 'idiopathic' frozen shoulder.. The Journal of Bone & Joint Surgery. 1978. DOI: 10.2106/00004623-197860040-00029

[8] Physical Abilities in Low Back Pain Patients: A Cross-Sectional Study with Exploratory Comparison of Patient Subgroups. Life. 2021. DOI: 10.3390/life11030226

[9] EVALUATING THE EFFECT OF SPINAL DEFORMITY ON PEDIATRIC PATIENT ACTIVITY LEVELS. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00193

[10] An observational study of quality of motion in the aging cervical spine: sequence of segmental contributions in dynamic fluoroscopy recordings. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07423-z

[11] Measures for Pain and Function Assessments for Patients With Osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-16-00303

[12] Health consequences of graded, full, and no sickness absence among workers with musculoskeletal disorders: health profiles and six-months symptom changes of patients referred to Norwegian outpatient clinics for chronic neck and back pain. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08570-7

[13] Contracture of the Deltoid Muscle. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00010

[14] On mobility and gait in scoliosis patients: a comparison of conventional and 3D-printed braces during an instrumented timed-up and go test. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08311-w

[15] No Clinically Significant Differences in Patient-Reported Outcomes and Range of Motion Between Early and Delayed Mobilization After Primary Distal Biceps Tendon Repair: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251317207

[16] Dysplasia epiphysealis hemimelica of the scapula. A case report.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062020-00017

[17] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

[18] PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519894323

[19] Relationship between gait parameter and spinal sagittal profiles in asymptomatic subjects. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06672-8

[20] A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04060-8

[21] Mobility aids for the paraplegic child. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00006

[22] How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1250-1

[23] Prospective Validation of Patient-Reported Outcomes Measurement Information Systems (PROMIS) CAT Scores in a Hip Preservation Population. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00105

[24] 5. Musculoskeletal Oncology. 2013.

[25] Editorial Commentary: Designing Patient‐Reported Outcome Measures That Have High Clinical Utility and Minimum Responder Burden: When Less Is More. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.11.028

[26] Displaced fractures of the medial humeral condyle in children.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062070-00016

[27] A randomized clinical trial comparing early active motion programs: Earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2018.10.003

[28] Quantifying Donor Deficits Following Nerve Transfer Surgery in Tetraplegia. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.08.014

[29] Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1572-7

[30] Comparison of the Musculoskeletal Function Assessment Questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile Health-Status Measures. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199709000-00006

[31] Preoperative symptom duration does not affect clinical outcomes after high tibial osteotomy at a minimum of 2-year follow-up. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2022.03.003

[32] Intramuscular Adipose Tissue, Sarcopenia, and Mobility Function in Older Individuals. Journal of Aging Research. 2012. DOI: 10.1155/2012/629637

[33] The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-154

[34] The effect of different lumbar belt designs on the lumbopelvic rhythm in healthy subjects. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-307

[35] Wearable technology mediated biofeedback to modulate spine motor control: a scoping review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07867-3

[36] The role of the paraspinal muscles in the development of adolescent idiopathic scoliosis based on surface electromyography and radiographic analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07329-w

[37] Effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03988-y

[38] Influence of time since injury and physical activity level on upper limb kinematics and muscle activation during wheelchair propulsion in complete T12/L1 spinal cord injury. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08987-0

[39] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[40] Three-dimensional Motion Analysis of the Lumbar Spine during “Free Squat” Weight Lift Training. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546506298276

[41] Motion analysis of 3D multi-segmental spine during gait in symptom remission people with low back pain: a pilot study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08506-1

[42] 2025 Basic Science Neer Award Winner: The impact of posterior and posterior superior labral injuries and the effect of their treatment on glenohumeral kinematics in the deceleration and follow-through phase of throwing: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.023

[43] Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0813-x

[44] Global sagittal alignment of the spine, pelvis, lower limb after vertebral compression fracture and its effect on quality of life. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04311-8

[45] Driving after spine surgery: biomechanics, recovery pathways, and medico-legal insights. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05787-z

[46] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[47] Activity gains after upper limb surgery for spasticity in patients with spinal cord injury. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418758852

[48] 18F-fluoride PET/CT as an early predictor of bony fusion after posterior lumbar interbody fusion– a prospective study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05814-z

[49] Traumatic Posterior Dislocation of the Shoulder Associated with a Massive Rotator Cuff Tear. The American Journal of Sports Medicine. 2003. DOI: 10.1177/03635465030310060301

[50] Functioning and equality according to International Classification of Functioning, Disability and Health (ICF) in people with skeletal dysplasia compared to matched control subjects – a cross-sectional survey study. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03835-9

[51] Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507306465

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