J Korean Soc Phys Ther Vol. 24, No. 3, June, 2012
pISSN 1229-0475 • eISSN 2287-156X
The Journal of Korean Society of Physical Therapy
Original Article
A Comparison of Lumbar Lordotic Curves between Herniated
Nucleus Pulposus Patients and Normal Subject Using a Flexible
Curve Ruler
Yong-Mi Jung, PT, BHSc1, Jong-Duk Choi, PT, PhD2
1
Department of Physical Therapy, Daejeon Jaseng Hospital of Oriental Medicine, Graduate School, Daejeon University, 2Department of
Physical Therapy, College of Natural Science, Daejeon University
Purpose: We attempt to assess the differences in the degree of lumbar lordosis in patients with lower back pain caused by
the herniation of the nucleus pulposus and in normal people (divided into male and female groups).
Methods: This study was conducted with 14 patients (7 males, 7 females) diagnosed with, and being treated for, lumbar
herniated nucleus pulposus and 14 normal people (7 males, 7 females). In order to examine the degree of lumbar lordosis in
these subjects, hip flexor lengthening tests were conducted and the lumbar curves were measured in three postures (supine,
sitting, and prone) and the results were compared.
Results: The measured values of the curves for the standing and prone postures showed statistically significant differences
between the normal group and the patient group, between the normal male group and the male patient group, and between
the normal female group and the female patient group (p<0.05).
Conclusion: The measurement method that uses flexible curve rulers in the standing or prone postures can be usefully
utilized in assessing the lumbar lordosis of patients with lumbar herniation of the nucleus pulposus.
Keywords: Lumbar Herniated nucleus pulposus, Lumbar lordosis, Flexible curve rulers
I. Introduction
In most cases, the herniation of the nucleus pulposus
occurs on the posterolateral or posterior side of the spinal
The frequency of occurrence of lower back pain is increasing
cord or spinal nerve roots.7 Four types of herniation of the
as society is further industrialized.1 Lower back pain is a
nucleus pulposus have been presented, based on the degree
common affliction that appears in 60~80% of adults and
of severity.8 Nuclear protrusions, which are the most minor
is known to restrict daily activities.2-4 The causes of lower
type of herniation, may compress the posterior fibers of the
back pain include reduced physical activities, reduced psoas
annulus fibrosus and the posterior ligament, causing local
muscle strength, poor posture, the use of immoderate force,
low back pain.7 A general mechanism of the herniation of
and excessive tension,4.5 as well as spinal injuries, such as
the nucleus pulposus is the accumulation of minor injuries,
fractures and dislocations, and structural causes, such as
caused by repeated work performed with the lumbar part
scoliosis, spondylolisthesis, stenosis, and the herniation of the
excessively flexed.9 Lumbar part extension is the reverse
nucleus pulposus.6
of flexion and it increases natural lumbar lordosis. Lumbar
hyperextension tends to cause anterior movements of the
Received May 16, 2012 Revised June 4, 2012
Accepted June 7, 2012
Corresponding author Jong-Duk Choi, [email protected]
Copyright © 2012 by The Korean Society of Physical Therapy
This is an Open Access article distributed under the terms of the Creative Commons
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/)
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
208 J Korean Soc Phys Ther 2012:24(3):208-215
annulus fibrosus, thereby reducing intradiscal pressure.
For this reason, the pain of nuclear protrusion or prolapse
patients’, which is related to the compression of the spine or
nerve roots, is relieved.10
The degrees of lumbar lordosis and reduced lumbar
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Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
motility are considered important as clinical characteristics
Many studies on the degree of lumbar lordosis for lower
of patients who suffer from lower back pain caused by
back pain patients have been reported, although different
11
the herniation of the nucleus pulposus. Clinicians mainly
results have been reported by individual researchers. Christie
assess the posture of patients with spinal dysfunction when
et al.22 reported that the degree of lumbar lordosis increased
the patients are standing comfortably.12 Many researchers
more in the lower back pain patient groups and in the
have presented that, if a patients were standing in a posture
chronic lower back pain patient groups than in the non-
of excessive lumbar lordosis, the patient’s erector muscle
lower back pain groups. However, Youdas et al.21 reported
and hip flexor should contract to support his/her body,
that there was no significant difference in the degree of
while his/her abdominal muscle should be weakened and
lumbar lordosis between low back pain groups and non-
13-16
These assessments of postures were based
lower back pain groups. Park et al.23 reported that the degree
on visual inspections. Visual inspections do not reliably
of lumbar lordosis decreased in lower back pain patient
provide quantitative information on lumbar lordosis. Surface
groups compared to normal people. As such, different results
measuring methods that can quantify lumbar lordosis include
were drawn according to the researcher and the study
a pantograph, a De Brunner Kyphometer, an inclinometer,
method. Although studies on the relationship between lower
drooping.
17,18
back pain and lumbar lordosis have drawn different results,
Bergenudd et al. reported that the degree of lumbar
the studies conducted in Korea that compare the degree of
lordosis measured using pantographs in standing postures
lumbar lordosis in patients with lower back pain caused by
19
were higher in women than in men, and Youdas et al.
the herniation of the nucleus pulposus and normal people are
reported that the degree of lumbar lordosis measured using
insufficient. Therefore, we attempt to assess the differences
flexible curve rulers was higher in women than in men.
in the degree of lumbar lordosis in patients with lower back
Metrecom, and flexible curves.
17
20
Norton et al. reported that the degree of lumbar lordosis
pain caused by the herniation of the nucleus pulposus and in
measured using Metrecom was higher in women than in
normal people (divided into male and female groups).
men. Through these three studies, it can be seen that the
degree of lumbar lordosis in standing postures was higher
II. Materials and Methods
in women than in men. In a study conducted on 90 subjects
(45 males, 45 females), Youdas et al.21 reported that the age
of the patient and the degree of lumbar lordosis in standing
1. Subjects
This study was conducted with 14 patients (7 males, 7
postures were not highly associated (r=0.11, 0.42). Youdas et
females), who had been diagnosed with lumbar herniated
21
al. also reported that BMIs and the degree of lumbar lordosis
nucleus pulposus (LHNP) and were being treated, and 14
in standing posture were not highly associated (r=0.07, 0.10).
normal people (7 males, 7 females). The selection criteria
Table 1. General characteristics of HNP and normal subjects (N=28)
Variables
Age (yr)
HNP (n=14)
Mean±SD
40.0±11.5
Normal (n=14)
Range
Mean±SD
Range
23~25
29.6±4.5
24~40
Height (cm)
168.2±7.6
153.6~74.2
168.9±7.8
155.2~178.0
Weight (kg)
64.2±6.2
53.8~74.2
64.2±14.8
41.9~89.0
BMI (kg/m2)
22.8±2.8
18.5~28.7
22.2±3.4
17.3~28.3
VAS (cm)
3.5±1.6
2~7
ODQ (%)
27.9±11.1
14~15
HNP: herniated nucleus pulposus, BMI: body mass index, VAS: visual analogue scale (range 0~10), ODQ: Oswestry back pain disability
questionnaire (range 0~100).
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Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
for patients with LHNP required that the patients had been
Higher scores indicated higher degrees of dysfunction.26
diagnosed with a protrusion, from among the types of LHNP,
based on findings from magnetic resonance imaging (MRI),
2) Length of hip flexor muscle19
had no experience with orthopedic surgery, and could
Kendall et al.12 reported that as the degree of lumbar lordosis
sufficiently assume the experimental postures in this study.
increased, the passive tension of the hip flexor increased,
The selection criteria for the normal subjects required that
and thus the lengthening of the hip flexor decreased. The
they had not experienced any orthopedic or neurological
subject should lie supine, with his/her hip joint and knees
disorder in their lumbar part, had not experienced lower back
completely straightened and arms crossed on his/her chest.
pain for the last six months, and had no history of surgery on
The right leg should be measured first for all subjects. A
lumbar-part joints. All the subjects sufficiently understood
hand of tester 2 should completely bend the left knee of the
the purpose and method of this study and voluntarily agreed
subject and slowly and passively bend the subject’s hip joint
before they participated in the experiment. The general
to move the knee toward the chest of the subject, another
characteristics of the subjects are as follows (Table 1).
hand of tester 2 should push the right knee toward the table
in order to full extension. Tester 1 should palpate the spinous
2. Methods
1) Measurement tools and assessment
processes of the L3-4 of the subject to place the end of the
(1) Visual analog scale (VAS)
After having the subject bend his/her hip joint only until he/
The VAS was used for measurement of pain. Participants
she can maintain his/her L3-4 level against the table, tester
rated their level of neck pain at rest on a VAS; a 10 cm sliding
1 should use a 360o universal goniometer (UG) to measure
scale anchored by the descriptors “no pain” and “worst pain
the right trunk-thigh angle of the subject, while the axis of
tester’s finger between the L4-5 of the subject and the table.
24
imaginable.”
UG is positioned at the subject’s greater trochanter, placing
the fixed arm parallel to the longitudinal axis of the trunk
(2) Body mass index (BMI)
of the subject and the table and placing the moving arm
BMI is defined as the ratio of weight (kg) to the square of
on the longitudinal axis of the right thigh of the subject.
height (m). For the BMI of the subjects, a score of 20 to 25 was
The left leg should be measured using the same method.
defined as normal weight, a score less than 20 was classified
Intraclass coefficient (ICC) estimates the reliability of a single
as underweight, and a score of 25 to 30 was classified as
measurement made by the tester. The indirect measurement
25
overweight. A score over 30 indicated obesity.
of length of the right and left one-joint hip flexor estimates
the ICC of 0.60, 0.54 respectively.
(3) Oswestry back pain disability questionnaire (ODQ)
This tool was used to assess dysfunction in daily life resulting
3) Lumbar curve
from lower back pain. Restrictions on functional daily
(1) Standing19
activities were divided into ten sections and the subjects
The subject should stand in a comfortable posture in bare
were encouraged to voluntarily answer the related questions.
feet, facing forward. Tester 1 should attach adhesive points
Each section was divided into six sub-levels, represented by
to the spinous processes of the T12, L4, and S2 of the subject
scores ranging from 0 points to 5 points. 0 points indicates
and place a flexible curve ruler along the spinal curvature of
that there was no restriction on functional activities, while 5
the subject to form the same shape. Tester 2 should record
points indicates that there was a high degree of restriction.
the locations where the adhesive points cross the flexible
The maximum score for the six sub-levels of the ten sections
curve ruler. After moving the flexible curve ruler to a piece
was 50 points, and the degree of dysfunction for each subject
of paper, without changing the shape, tester 1 should hold
was summed up as a score and integrated as a percentage (%).
the flexible curve ruler while tester 2 draws a line along its
210 J Korean Soc Phys Ther 2012:24(3):208-215
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Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
convex contour. The location of the points corresponding to
should palpate the spinous processes of the T12, L4, and S2
the spinous processes of the T12, L4, and S2 should also be
to attach adhesive points. Tester 2 should instruct the subject
marked on the contour line on the paper.
to straighten his/her shoulders and elbows and then press
the table with his/her palms to extend his/her lumbar spine.
19
(2) Sitting
At this time, tester 2 should hold the subject’s iliac crest with
The method for measuring the peak lumbar flexion range of
his thumbs and place the distal tips of the remaining fingers
motion is used to indirectly measure the length of the muscle
between the anterior superior iliac spine (ASIS) of the subject
in the lower lumbar part of the subject. The subject should
and the table. This is to find the point where the subject’s
perch on the edge of a chair. The subject should spread his/
ASIS begins to separate from the distal tips of the fingers of
her legs to the width of his/her shoulders, hang his/her hands
tester 2 (when the subject is extending his/her lumbar spine),
to the sides of his/her feet, and bend his/her waist forward
as this is the end point of the lumbar movement. The subject
maximally, so that his/her head is placed between his/her
should maintain the maximum passive extension of the
knees. Then, tester 1 should palpate the spinous processes of
lumbar spine for 15 minutes and then repeat this three times.
the subject’s T12, L4, and S2 to attach adhesive points on the
On the fourth time, tester 1 should place a flexible curve ruler
spinous processes; the subject should maintain this posture
along the spinal curvature of the subject, so that it takes the
for 15 seconds at the end range of the posture, so that the
same shape.
soft tissues of the lower lumbar part are relaxed and become
soft. After recovering the initial posture, the subject should
4) Procedure
be encouraged to bend his/her waist forward maximally
As study subjects, patients who had been diagnosed with a
once again. Tester 1 should place a flexible curve ruler along
protrusion, from among the types of LHNP, based on MRI
the spinal curvature of the subject, so that it forms the same
findings, were classified into a herniated nucleus pulposus
shape.
(HNP) group and 14 normal subjects were selected (7 males,
19
(3) Prone
7 females) per group. The HNP patient group completed
By passively extending the lumbar spine, using the same
one highly reliable questionnaires (ODQ). All the subjects
method as Mckenzie’s prone press-up method, the length
changed into clothes suitable for measurement before the hip
of the abdominal muscle can be indirectly estimated. The
flexor length tests were conducted. Beginning with their right
subject should take a prone posture on a table and tester 1
legs, their lumbar curves were measured in three postures
Figure 1. Posture of loumbar lordosis
in standing and two methods for
calculating lumbar curves. (A) Measure­
ment size of lumbar lordosis (stan­
ding). (B) To calculate lumbar cu­rves,
tangents and trigonometry were
used. (range 21~49o, mean 43o) θ=4
×[arctan(2H/L)]. (C) Index of lumbar
lordosis=I/K×100 I=width of lumbar
lordosis K=length of the lumbar spine.
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J Korean Soc Phys Ther 2012:24(3):208-215 211
Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
III. Results
(standing, sitting, and prone).
The curves were quantified using two measurement
methods: the angles of lumbar lordosis and the indexes of
lumbar lordosis. The angles of lumbar lordosis are measured
1. Subjects
As study subjects, the LHNP patient group average age,
by connecting point T12 and point S2 on the contour line
height, weight, and BMI were 40 (11.5) years old, 168.2
with a straight line (L) and then measuring the straight line
(7.6) cm, 64.2 (6.3) kg and 22.8 (2.8) kg/m2 respectively. In
in millimeters. Then, a line vertically connects this line with
addition, the LHNP patient group average VAS and ODQ
point L4 (H); it is measured in millimeters. This length is the
were 3.5 (1.6) cm and 27.9 (11.1) % respectively. The normal
height of the curve. The angle of lordosis (θ) is obtained from
group average age, height, weight, and BMI were 29.6 (4.5)
the following equation: A; θ=4 ×[arctan(2H/L)] (Figure 1A).
years old, 168.9 (7.8) cm, 64.2 (14.8) kg and 22.1 (3.4) kg/m2
27
The indexes of lumbar lordosis indirectly measure the
respectively.
degree of lumbar lordosis; the indexes of lumbar lordosis
are calculated using a modified De Brunner kyphometer
measuring method. The horizontal distance (I) between the
2. Measurement of the hip flexor length
This measurement method is frequently used to indirectly
straight line (K) that connects point T12 with point S2 and
measure the length of the hip flexor. The larger is the angle of
the point that is farthest from this straight line should be
lumbar lordosis, shorter the length of the hip flexor, and thus
obtained. The indexes of lumbar lordosis are obtained from
the smaller the trunk-thigh angle. However, in this study,
the following equation: B; index of lumbar lordosis=l/k×
the measured values of the lengthening of the hip flexor
28
100 (Figure 1B).
were shown to be smaller in the LHNP patient group (right
side=176.86o, left side=177.07o) than in the normal group (right
3. Statistical analysis
The data from this study were statistically processed using
side=177.14o, left side=178.29o). The length of the hip flexor
the SPSS ver. 18.0 program for Windows (SPSS Inc., Chicago,
normal group through independent sample t-tests, and the
IL, USA). For normality test of fewer subjects (14 patients
results showed no statistically significant differences between
per group), the Shapiro-Wilk normality test was conducted.
the two groups, except for the left trunk-thigh angles
Independent sample t-tests were conducted to examine
(p<0.05).
was compared between the HNP patient group and the
the differences in the lengths of hip flexors and the degree
of lumbar lordosis in the HNP patient group (7 males, 7
females) and the normal subjects (7 males, 7 females), and the
significance level for all statistical tests was determined as α
=0.05.
3. Measurement of the lumbar curves of the subjects
1) Measurement of the lumbar curves of the HNP and normal
groups
The lumbar curves of the HNP patient group and the normal
Table 2. A comparison of lumbar lordosis in HNP and normal subjects
Variables
o
Angle ( )
Index
HNP (n=14)
Normal (n=14)
t
Standing
22.36±8.68*
40.33±8.59
5.51
0.00†
Sitting
21.38±9.53
26.32±6.06
1.64
0.11
Prone
28.57±9.37
44.41±14.61
3.41
0.00†
Standing
5.31±2.35
9.74±2.10
5.26
0.00†
Sitting
5.90±2.71
6.42±1028
0.65
0.52
Prone
7.33±2.68
4.01
0.00†
11.62±2.98
p
HNP: herniated nucleus pulposus.
*Values are number or mean±standard deviation. †p＜0.05.
212 J Korean Soc Phys Ther 2012:24(3):208-215
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Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
group were measured in three postures (standing, sitting, and
independent sample t-tests; in the results, both the angles
prone) and were compared with independent sample t-tests;
and indexes showed statistically significant differences for the
in the results, both the angles and indexes showed statistically
curves in the standing and prone postures (p<0.05) (Table 4).
significant differences for the curves in the standing and
prone postures (p<0.05) (Table 2).
IV. Discussion
2) Measurement of the lumbar curves of the male HNP and
This study was conducted with 14 patients (7 males, 7
normal groups
females) diagnosed with, and being treated for, LHNP and
The lumbar curves of the male HNP patient group and
14 normal people (7 males, 7 females). In order to examine
the normal male group were measured in three postures
the degree of lumbar lordosis in these subjects, hip flexor
(standing, sitting, and prone) and were compared using
lengthening tests were conducted and the lumbar curves
independent sample t-tests; in the results, both the angles
were measured in three postures (supine, sitting, and prone)
and indexes showed statistically significant differences for the
and the results were compared.
curves in the standing and prone postures (p<0.05) (Table 3).
Flexible curves were used to measure the degree of lumbar
lordosis. Hart and Rose29 reported that the ICC of the results
3) Measurement of the lumbar curves of the female HNP and
of measurement for the lumbar curves of 89 subjects obtained
in standing postures, and when the subjects maximally
normal groups
The lumbar curves of the female HNP patient group and
bent their waists forward, was 0.97 the validity of this figure
the normal female group were measured in three postures
was obtained by comparing the results with the images of
(standing, sitting, and prone) and were compared using
lumbar curves taken in radiographs. Link et al.30 reported the
Table 3. A comparison of lumbar lordosis in HNP and normal male
o
Angle ( )
Index
HNP (n=7)
Normal (n=7)
t
20.04±9.58*
38.89±10.50
3.50
0.00†
Sitting
25.33±10.27
26.80±4.90
0.34
0.74
Prone
26.96±10.27
40.33±10.34
2.42
0.03†
Standing
4.57±2.49
8.92±2.43
3.31
0.01†
Sitting
7.39±2.38
6.90±6.1
-0.52
0.61
Prone
7.05±2.81
11.07±1.40
3.39
0.01†
HNP (n=7)
Normal (n=7)
t
Standing
24.68±7.69*
41.78±6.67
4.93
0.00†
Sitting
17.43±7.43
25.83±7.43
0.11
0.92
Prone
30.18±8.86
48.48±17.79
2.78
0.02†
Standing
6.05±2.12
10.56±1.43
5.53
0.00†
Sitting
4.41±2.26
5.93±1.62
-1.33
0.21
Prone
7.61±2.72
12.16±4.08
2.73
0.02†
Standing
p
HNP: herniated nucleus pulposus.
*Values are number or mean±standard deviation. †p＜0.05.
Table 4. A comparison of lumbar lordosis in HNP and normal female
o
Angle ( )
Index
p
HNP: herniated nucleus pulposus.
*Values are number or mean±standard deviation. †p＜0.05.
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J Korean Soc Phys Ther 2012:24(3):208-215 213
Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
degree of lumbar lordosis for 61 men measured in a standing
the passive tension of the hip flexor increased, and thus the
o
lengthening of the hip flexor decreased. However, in this
on average; Nourbakhsh and Arab reported the degree of
study, the measured values of the lengthening of the hip
lumbar lordosis for 150 men measured using flexible curves,
flexor were shown to be smaller in the LHNP patient group
posture using flexible curves, and the result was 34.3±9.9
31
o
(right side=176.86o. left side=177.07o) than in the normal
and the result was 35±13 on average.
Youdas et al.21 reported the degree of lumbar lordosis for
group (right side=177.14o, left side=178.29o). This is likely
90 people (45 male; 45 female) using flexible curves, and
because the end points of measurement, determined when
o
the result was 37.5±11 on average for the men and 52.7±
o
the hip joint was passively bent, might have been inaccurate.
15.3 on average for the women. Although these measured
The limitations of this study are as follows: First, the
values are a little different from the values obtained in this
number of compared subjects was small. There were
o
study-38.89±10.50 on average among the normal men
o
difficulties in selecting patients diagnosed with a protrusion
and 41.78±1.43 on average among the normal women-
from among the LHNP patients. Second, the ages of the
the fact that the degree of lumbar lordosis for the women
LHNP patients and the ages of the normal subjects could not
was larger than for the men was the same in both studies.
be equalized. However, some researchers reported that age
21
Youdas et al. also measured the degree of lumbar lordosis
in the prone posture and reported that the values were 50.1
o
o
and lumbar curve were not highly associated.
This study was intended to compare the degree of lumbar
±9.2 on average for the normal men, 42.7±8.8 on average
lordosis in the lumbar herniation of nucleus pulposus patients
o
and normal people, divided into male and female groups.
on average for the normal women, and 56±12 on average
The lumbar curves of the LHNP patients and the normal
for the CLBP women. The measured values in this study
subjects were measured in three postures using flexible curve
for the chronic lumber back pain (CLBP) men, 56.5±10.4
o
o
were shown to be 40.33±10.34 on average among normal
o
men, 26.96±10.27 on average among LHNP men, 48.48
o
±17.79 on average among normal women, and 30.18±
o
rulers; in the results, the measured values of the curves for the
standing and prone postures showed statistically significant
differences between the normal group and the patient group,
8.86 on average among LHNP women. The reason why the
between the normal male group and the male patient group,
differences in the measured values between the two groups
and between the normal female group and the female patient
are larger than in previous studies is likely because, in the case
group (p<0.05).
of LHNP patients, the pain is severe when the lumbar spine is
The above results show that patients with lumbar
extended, and the range of extending motion is limited due
herniation of the nucleus pulposus had a decreased degree
to the weakened lumbar extensors. The measured values of
of lumbar lordosis in the standing posture, as compared to
lumbar curves in the sitting posture did not show statistically
normal subjects. Therefore, the measurement method that
significant differences between the LHNP patients and the
uses flexible curve rulers in the standing or prone postures
normal group. This is because LHNP patients had less severe
can be usefully utilized in assessing the lumbar lordosis of
pain during lumbar flexion and their range of flexion was not
patients with lumbar herniation of the nucleus pulposus.
as limited, compared to lumbar extension, because of their
Author Contributions
flattened lumbar curves.
Link et al.30 reported that they measured the associations
between the degree of lumbar lordosis and the lengthening
Research design: Jung YM, Choi JD
of the hip flexor in two postures (standing and sitting) in 61
Acquisition of data: Jung YM
men, using flexible curves, and the results showed statistically
Analysis and interpretation of data: Jung YM, Choi JD
12
significant associations (r=0.25, p=0.05). Kendall et al.
Drafting of the manuscript: Jung YM
reported that as the degree of lumbar lordosis increased,
Research supervision: Choi JD
214 J Korean Soc Phys Ther 2012:24(3):208-215
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Yong-Mi Jung and Jong-Duk Choi: A Comparison of Lumbar Lordotic Curves between Herniated Nucleus Pulposus Patients and Normal Subject
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