Evaluation of Latissimus Dorsi Muscle During Isometric Exercises in Scoliosis
Condition: Scoliosis
MeSH terms: Scoliosis
Study type: Observational

Summary: 
      Scoliosis is a complex three-dimensional deformity of the spine, of uncertain etiology, but
      multifactorial and mainly involves characteristic changes in the sagittal plane also, changes
      in the coronal plane, and varying degrees of vertebral rotation in the axial plane. In recent
      studies, pre-scoliotic changes are also examined. Some risk factors for the development of
      scoliosis include gender, age, ethnicity, and family history. Since apical rotation,
      gibbosity, and costa vertebral angle are considered to be associated with rotation in the
      literature, these parameters have been defined as risk factors for the progression of the
      curve.

      Cobb angle, Risser sign, and chronological age are taken as the basis to determine the
      progression of scoliosis.The onset, progression, and treatment of scoliosis include
      biomechanical changes and parameters. Structural changes, biomechanical changes, and
      asymmetries develop between the concave and convex sides. Some studies show that
      paravertebral muscle asymmetry is caused by the curvature of the spine. Trapeze, LD
      (latissimus dorsi), and erector spine muscles are examples of paravertebral muscles affected.

      The LD is a large, smooth muscle lining the lower posterior rib cage and is one of the
      paravertebral muscles most commonly affected in scoliosis. LD has shoulder, lumbar spine, and
      sacroiliac joint connections. Scapula, rib cage, and lumbar region deformities seen in
      scoliosis can be explained by LD. This may make LD a significant cause of scoliosis. In
      addition, dynamic and static muscle activation rates of LD should be considered in the
      diagnosis of scoliosis.In the treatment of scoliosis, treatment methods such as
      physiotherapeutic scoliosis-specific exercise (PSSE), corset, surgery, EMG biofeedback, and
      neuromuscular training are used.This asymmetry observed in the paraspinal muscles of
      individuals with scoliosis made us think that we should analyze the LD muscular activations
      in more detail. The aim of our study is to examine the muscle activation values of the
      lateral and medial parts of the LD during isometric exercises.
    

Detailed description: 
      Scoliosis is a complex three-dimensional deformity of the spine, of uncertain etiology, but
      multifactorial and mainly involves characteristic changes in the sagittal plane also, changes
      in the coronal plane, and varying degrees of vertebral rotation in the axial plane. The
      prevalence of scoliosis in the general population worldwide is 0.93% to 12%. In the last few
      decades, different factors affecting the prevalence of scoliosis have been identified, such
      as gender, age, skeletal maturity, body mass index, family history, and ethnicity.
      Discussions about the causes of scoliosis are still ongoing, whether it is only genetic or
      due to factors such as exercise and environment. In recent studies, pre-scoliotic changes are
      also examined. Some risk factors for the development of scoliosis include gender, age,
      ethnicity, and family history. Since apical rotation, gibbosity, and costa vertebral angle
      are considered to be associated with rotation in the literature, these parameters have been
      defined as risk factors for the progression of the curve.

      Cobb angle, Risser sign, and chronological age are taken as the basis to determine the
      progression of scoliosis. The main diagnostic criterion for scoliosis with varying degrees of
      vertebral axial rotation is spinal curvature greater than or equal to 10° in the coronal
      plane on a flat anteroposterior X-ray image. The Adam's Test is universally accepted as the
      primary means of diagnosing scoliosis. The Adam's test shows the rotational component of
      scoliosis. The onset, progression, and treatment of scoliosis include biomechanical changes
      and parameters. Structural changes, biomechanical changes, and asymmetries develop between
      the concave and convex sides. Some studies show that paravertebral muscle asymmetry is caused
      by the curvature of the spine. Trapeze, LD (latissimus dorsi), and erector spine muscles are
      examples of paravertebral muscles affected.

      The LD is a large, smooth muscle lining the lower posterior rib cage and is one of the
      paravertebral muscles most commonly affected in scoliosis. LD has shoulder, lumbar spine, and
      sacroiliac joint connections. Scapula, rib cage, and lumbar region deformities seen in
      scoliosis can be explained by LD. This may make LD a significant cause of scoliosis. In
      addition, dynamic and static muscle activation rates of LD should be considered in the
      diagnosis of scoliosis.

      Although guidelines have been established for treatments in the direction of spinal
      curvature, the choice of treatment type is often subjective and based on clinicians'
      experience. In the treatment of scoliosis, treatment methods such as physiotherapeutic
      scoliosis-specific exercise (PSSE), corset, surgery, EMG biofeedback, and neuromuscular
      training are used. Asymmetry observed in the paraspinal muscles of individuals with scoliosis
      made us think that we should analyze the LD muscular activations in more detail. The aim of
      our study is to examine the muscle activation values of the lateral and medial parts of the
      LD during isometric exercises.
    

Intervention name(s): Evaluation of Muscle Activation
Intervention type(s): Other
Intervention description(s): Evaluation of Muscle Activation The sEMG device, which is a surface EMG system (Myomonitor, Delsys Inc, Boston, MA), was used to measure the lateral and medial muscle activation levels of the latissimus dorsi.
Electrode placement was determined according to SENIAM (Surface Electromyography for Non-Invasive Evaluation of Muscles) criteria.
Evaluation of the Gibbosity Trunk rotation (gibbosity) assessments were performed using Adam's test and using a scoliometer . The bending test (Adam's test) is performed in both standing and forward bending positions. The standing version was used in our study.Each measurement equal to 0° on the scoliometer was defined as symmetry at the measured level of the trunk. All other scoliometer values were defined as asymmetry.
Evaluation of the Cobb Angle Cobb angles of the curves of the individuals participating in the study were measured with the MicroDicom application.
Other intervention name(s): Evaluation of Cobb Angle; Evaluation of Gibbosity
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        This study, which was designed to evaluate the lateral and medial part muscular activations
        of the LD muscle during isometric exercises in 20 healthy individuals (8 females, 12 males)
        and 20 individuals with scoliosis (14 females and 6 males) participated total of 40
        individuals.

        In the scoliotic group, scoliosis was diagnosed by radiographic imaging by a specialist,
        referred to receive exercise therapy participated in the study was included.
      
Keywords: Scoliosis; Latissimus Dorsi Muscle; EMG; Izometric exercises