A few chapters of my dissertation looked at the relation between anthropometry, hamstring shortness, and spine curvature in the sagittal plane in adolescent athletes. The bottom line was a suggestion of a positive relation between leg length:overall height ratio and hamstring shortness. The latter was also positively related to increased thoracic hyperkyphosis. It also suggested a positive relation between thoracic spine length:overall spine length ratio and thoracic hyperkyphosis. A suggestion was made that these relationships be considered when screening youngsters for pre-participation in sporting events.

Various sources in the literature have demonstrated an link between modifications of curvature of onearea of the spine to another (e.g., hyperkyphosis and hyperlordosis). In addition, anecdotal clinical observation has also suggested that certain anthropometric patterns seem to be linked with a other musculoskeletal issues, including those of the low back and lower extremities.

Dear Dr Dent

You can create an evaluation instrument considering risk factors for low bone density and muscle mass loss. The diagnostic questions can be directed to the following factors:

1 - Genetic factors (family history); Descendants (European or African);

2 - Socioeconomic level;

3 - Alimentary Habits (potential food consumption in calcium and protein);

4 - Habits of life related to the tobacco and alcohol consumption ;

5 - Age and sex (male or female) of the patient;

5 - If in the process of menopause (female);

6 - Low Mass Index (BMI);

7 - Low muscle mass (sarcopenia)

8 - Regular exercise practice

9 - Has the number of falls or fractures.

These risk factors indicators may be interesting for a preliminary assessment to the low bone density and low muscle mass diseases.

Best regards

Claudio Borba-Pinheiro

Thank-you Claudio and Paul for your answers. Much appreciated!

When I hear the word "triage" I consider prioritisation of injuries/diagnoses according to a severity or significance rating. Were you looking for that kind of system or a method for screening for risk factors prior to injury?

Phil: yes, I'm looking for prioritization of injuries/diagnoses. We have patients with bone and joint problems who have been pre-identified by a phone survey. We aim to triage them into levels of care. And I have been searching the literature high and low to work out how to design a "decision making framework" flowchart/series of questions to triage patients.

So these patients sound like they have chronic conditions rather than acute trauma right? There are lots of quality of life, ADL, functional impairment type scales you could use... (KOOS, Oswestry, Lysholm etc) but I'm trying to read between the lines here.... Are you trying to weigh up say degree of joint laxity, Pain scale, irritability, duration of symptoms, depth of chondral wear, range limitation, number of sites affected, immediacy of treatment required- that kind of data? There are certainly severity scales designed to grade specific conditions (RA, OA, Osteoporosis etc). Not sure if this is helpful or if I'm off track....

Thanks Phil, that is most helpful. Yes, the patients have chronic joint problems. We're seeing which patients we should refer to (1) the physio (2) the GP and (3) a general physical activity program. We're hoping for an easy assessment tool. All patients will get quality of life, ADL, VAS pain questionnaires, etc and then in person, we will assess their bone and joint issues. I was hoping for something generic, but injuries vary so much that I know this is not possible. Your reply has helped give me a lot of insight. Ta

Hi Elsa, I was working on an answer assist, managed to hit the wrong key and the letter disappeared - here goes another try.

I feel it will be difficult to differentiate muscle overuse indications and R.A., and joint problems due to muscle overuse.

First, muscle overuse injuries have been poorly addressed, - overactive spindle cells have a pain circuit shown by recent research, and this pain can result in a referred pain even at quite a distance, or the pain may seem to originate in the joint. Chronic overuse results in tendinosis, ( the mechanical degradation of the collagen in the tendon ) - this can affect joint health w/o any arthritic contribution. Recent research seems to indicate R.A. is caused by gut microbiota and this seems to affect joint degradation, tendon and ligament and muscle condition and resulting pain.

It is difficult to anticipate how the average citizen who is likely not very body conscious will be able to differentiate one from the other - your questions will need to be quite sophisticated to give a good indication of status.

If R.A. is present the first consideration should likely be reseeding the gut micro biome. Curing the problem - not simply treating symptoms needs to be the goal.

In the case of muscle overuse the hyper tonus muscle will be causing a relax signal to the opposing muscle group. The resulting muscle imbalance will result in recruitment of muscles to compensate - and result in additional overuse and uneven joint loading.

High pressure - deep tissue massage to reset the hyper tonus muscle tissue can allow the joint to recover, there have been reports of unnecessary joint surgery resulting from pain from structure around the joint, ( muscle, tendon and ligament pain ).

For muscle overuse injuries, the diagnostic is a result of pronounced pain with very minor amounts of direct pressure - ( 5 pounds ) W/O any R.A. involvement. In the case of pain localized to one side, testing the unaffected side for a baseline and then testing the problem side will point up the level of injury/chronic status.

http://www.sciencedaily.com/releases/2013/11/131108124854.htm

http://www.sciencedaily.com/releases/2013/11/131103140157.htm

http://www.sciencedaily.com/releases/2013/11/131105132031.htm

http://www.sciencedaily.com/releases/2013/10/131030185153.htm

http://www.medpagetoday.com/Rheumatology/Arthritis/42799

http://www.sciencedaily.com/releases/2010/06/100624091755.htm

http://www.ncbi.nlm.nih.gov/pubmed/20086639

http://www.ncbi.nlm.nih.gov/pubmed/20086644

My product, PowerCranks (www.powercranks.com), can be used as a functional assessment tool. It easily uncovers functional weaknesses and imbalances in the lower extremities because the legs are isolated. When combined with pedal force analysis (coming soon) it can give objective results and measure improvement with therapy. It doesn't work well in populations that have severe issues but in the ordinary week-end to elite athlete it can be extremely illuminating (as well as help with rehab).

As regards patients with chronic joint issues we are finding that the typical crank length found on the typical bicycle/exercycle contributes to the problem because of the large ROM required, especially of the knee. Going to much shorter cranks seems to greatly facilitate these people being able to improve their exercise ability. Crank lengths in the 110-145 range seem to be very helpful in facilitating exercise in this population.

I notice you are from Australia. You might look into an Australian company that has a product called BioBike that incorporates my product with pedal force analysis and a highly adjustable bike (including crank length adjustments). It is just now coming onto the market. It might be exactly what you are looking for. Here is a link to the kind of data you will be able to get from the product: http://www.biobike.us/torque-analysis.html As you can see left right weaknesses are easy to quantify as are specific weakness at different points of the circle where different muscle groups are being used.