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van Benten E, de Kruif A, Kiers H, Coppieters MW, Pool-Goudzwaard AL. Exploring health and illness perceptions to identify the perceived cause of pregnancy-related pelvic girdle pain. A mixed-methods study among primiparous women in The Netherlands. Midwifery 2024; 129:103892. [PMID: 38043479 DOI: 10.1016/j.midw.2023.103892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pregnancy-related pelvic girdle pain (PPGP) is common and considered a multifactorial condition with biomechanical and psychosocial contributions. The patient's perceived cause is an important aspect of illness perceptions, and a strong predictor of self-management and healthcare utilization. It is unknown what causal beliefs primiparae hold regarding PPGP. OBJECTIVE To explore and describe health and illness perceptions among primiparae towards PPGP and its cause. DESIGN Exploratory, convergent parallel mixed-methods. SETTING At the participants' homes. PARTICIPANTS Sixteen primiparae with and without PPGP. FINDINGS Primiparae with and without PPGP held comparable causal beliefs about PPGP. PPGP was described as the result of hormonal softening and loosening of the pelvis, and failure of the muscular system to compensate for that. Women who experienced similar physical symptoms attributed them differently, leading to different coping strategies. Interestingly, maternal healthcare providers reinforced the unidimensional- and predominantly biomechanical view when women sought healthcare. CONCLUSION The causal mechanism of PPGP held by the women was not determined by their lived experience. It was primarily based on the concept of inevitable hormonal softening of the pelvis. This biomechanical belief is based on theories that are not in line with current knowledge of PPGP and contemporary pain science, yet they were reinforced by maternity healthcare providers. IMPLICATIONS FOR PRACTICE Healthcare seeking behavior is influenced by illness beliefs. Maternity healthcare providers may play a key role in providing reassurance and addressing the multifactorial nature of PPGP when providing care and support to pregnant women.
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Affiliation(s)
- Esther van Benten
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Anja de Kruif
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Henri Kiers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane, Gold Coast, Australia
| | - Annelies L Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Amersfoort, the Netherlands
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Kharaji G, ShahAli S, Ebrahimi Takamjani I, Kashanian M, Sarrafzadeh J, Shanbehzadeh S. Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study. Int Urogynecol J 2023; 34:2909-2917. [PMID: 37561174 DOI: 10.1007/s00192-023-05621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks. METHODS Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration. RESULTS The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement. CONCLUSION The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.
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Affiliation(s)
- Ghazal Kharaji
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ismail Ebrahimi Takamjani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Kashanian
- Department of Obstetrics and Gynaecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Shanbehzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Ali A, Andrzejowski P, Kanakaris NK, Giannoudis PV. Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: A Narrative Literature Review. J Clin Med 2020; 9:jcm9123992. [PMID: 33317183 PMCID: PMC7764306 DOI: 10.3390/jcm9123992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
Pelvic girdle pain (PGP) refers specifically to musculoskeletal pain localised to the pelvic ring and can be present at its anterior and/or posterior aspects. Causes such as trauma, infection and pregnancy have been well-established, while patients with hypermobile joints are at greater risk of developing PGP. Research exploring this association is limited and of varying quality. In the present study we report on the incidence, pathophysiology, diagnostic and treatment modalities for PGP in patients suffering from Hypermobility Spectrum Disorder (HSD) and Hypermobility-Type Ehlers-Danlos Syndrome (hEDS). Recommendations are made for clinical practice by elaborating on screening, diagnosis and management of such patients to provide a holistic approach to their care. It appears that this cohort of patients are at greater risk particularly of mental health issues. Moreover over, they may require a multidisciplinary approach for their management. Ongoing research is still required to expand our understanding of the relationship between PGP, HSD and hEDS by appropriately diagnosing patients using the latest updated terminologies and by conducting randomised control trials to compare outcomes of interventions using standardised patient reported outcome measures.
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Affiliation(s)
- Ahmed Ali
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Paul Andrzejowski
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
- NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS7 4SA, UK
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4
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Crasto C, Montes AM, Carvalho P, Carral JC. Abdominal muscle activity and pelvic motion according to active straight leg raising test results in adults with and without chronic low back pain. Musculoskelet Sci Pract 2020; 50:102245. [PMID: 32919292 DOI: 10.1016/j.msksp.2020.102245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/29/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Active Straight Leg Raise (ASLR) is a clinical test that challenges lumbopelvic stability and have been used in low back pain patients. There are reports of positive tests in asymptomatic individuals, however, it is not clear if they are false positives or a consequence of performing the test differently. OBJECTIVES To compare abdominal muscles activity and pelvic motion during an ASLR between adults with chronic low back pain and asymptomatic participants with a positive and negative ASLR test. DESIGN Cross-sectional study design. METHOD Nineteen volunteers with chronic nonspecific low back pain (LBP) and 19 asymptomatic, 12 with a negative ASLR (AG-) and 7 with a positive ASLR test (AG+) were assessed while performing an ASLR (dynamic postural challenge). Pelvic rotation and medio-lateral center of pressure displacement (COPml), as well as bilateral EMG abdominal muscles activity were assessed. Muscles asymmetry index were also analyzed. Kruskal-wallis test was used to compare groups (α = 0.05). RESULTS Both LBP and AG + displayed significantly less contralateral internal oblique/transversus abdominis (IO/TrA) muscle activation than AG- (p = 0.003 and p = 0.005, respectively) and also more asymmetry between sides in the IO/TrA than AG- (p = 0.022 and p = 0.004, respectively). No significant differences between LBP and AG+ were found (p > 0.05). CONCLUSION A positive ASLR test in an asymptomatic person could be more than a false positive, since IO/TrA muscle activation appears to be lower and more asymmetrical in people with a positive ASLR test, both with and without low back pain. Future studies may consider removing asymptomatic individuals with a positive ASLR.
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Affiliation(s)
- Carlos Crasto
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal; Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.
| | - António Mesquita Montes
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal; Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.
| | - Paulo Carvalho
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal.
| | - Jm Cancela Carral
- Faculty of Education and Sports Science, University of Vigo, Pontevedra, Spain.
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Delshad B, Zarean E, Yeowell G, Sadeghi-Demneh E. The immediate effects of pelvic compression belt with a textured sacral pad on the sacroiliac function in pregnant women with lumbopelvic pain: A cross-over study. Musculoskelet Sci Pract 2020; 48:102170. [PMID: 32560872 DOI: 10.1016/j.msksp.2020.102170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/08/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pelvic belt is being used to alleviate the symptoms of lumbopelvic pain. OBJECTIVE To investigate the immediate effects of a pelvic belt with a textured sacral pad in pregnant women with lumbopelvic pain. METHODS Twenty-eight pregnant women participated in a randomized crossover study. Hip joint position sense, maximum hip flexion force, and perceived effort during the active straight leg raising test were measured in twenty-eight pregnant women with lumbopelvic pain. Outcomes were measured in three randomized conditions including no pelvic belt (control), with a pelvic belt, and while a sacral pad was used with the pelvic belt. Data were analyzed using a one-way repeated measures analysis of variance for each variable. RESULTS Improvements in all study outcomes have been shown with a pelvic belt compared with the control condition. The addition of a textured sacral pad to the pelvic belt improved all study outcomes compared with the pelvic belt: hip joint position sense (p < 0.001; 95% confidence interval:1.3to2.3), perceived effort (p = 0.003; 95% confidence interval: 0.35 to 1.86), and maximum flexion force (p < 0.001; 95% confidence interval:2.77to6.47) in the active straight leg raising. CONCLUSION Further improvements were noted with the addition of the textured pad for all outcome measures. This finding may inform new benefits in adding a textured sacral pad to pelvic compression belts.
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Affiliation(s)
- Bahareh Delshad
- Student Research Committee, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Zarean
- Department of Obstetrics and Gynecology, Feto-maternal Medicine Unit, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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6
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Crasto CFB, Montes AM, Carvalho P, Carral JMC. Pressure biofeedback unit to assess and train lumbopelvic stability in supine individuals with chronic low back pain. J Phys Ther Sci 2019; 31:755-759. [PMID: 31645801 PMCID: PMC6801331 DOI: 10.1589/jpts.31.755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine if pressure biofeedback unit readings are related to abdominal muscle activation and centre of pressure displacement as well as to test the effects of using it as a biofeedback tool to control lumbopelvic motion. [Participants and Methods] Eighteen volunteers with chronic nonspecific low back pain (21.28 ± 1.41 years old) who performed an active straight leg raising (dynamic postural challenge) with and without pressure biofeedback. Changes in the pressure biofeedback unit and on centre of pressure displacement were assessed, as well as bilateral electromyographic abdominal muscle activity. Participants were not allowed to use a Valsalva manoeuvre. [Results] Pressure variation was not significantly correlated with abdominal muscle activity or with mediolateral centre of pressure displacement. When used as a biofeedback instrument, there was a significant increase in almost all abdominal muscles activity as well as a significant decrease in pressure variation and in mediolateral centre of pressure displacement while performing an active straight leg raising with a normal breathing pattern. [Conclusion] Despite not being an indicator of abdominal muscle activity or mediolateral load transfer in the supine position, the pressure biofeedback unit could have great relevance when used in the clinic for biofeedback purposes in individuals with low back pain.
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Affiliation(s)
- Carlos Filipe Barbosa Crasto
- School of Health, Polytechnic Institute of Porto (IPP): Rua Dr. António Bernardino de Almeida 4200-072 Porto, Porto 4200-465, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.,School of Health, Polytechnic Institute of Porto (IPP), Portugal
| | - Paulo Carvalho
- School of Health, Polytechnic Institute of Porto (IPP), Portugal
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Abstract
The principles of form and force closure were introduced to describe the complex mechanism of sacroiliac joint (SIJ) stability. Form closure refers to a theoretical stable state of a joint with close fitting articular surfaces, where no extra forces are needed to maintain the stable state of the system during loading and unloading situations. If the sacrum would fit in the pelvis with perfect form closure, no lateral compressional forces would be needed to maintain stability. However, such a construction would make mobility practically impossible. Force closure is the theoretical state where lateral force and friction resulting in joint compression, are required for the joint to withstand a vertical load. Structures that contribute to SIJ stability via "form closure" include (1) the configuration of the interfacing joint surfaces, along with dorsocranial "wedging" of the sacrum into the ilia; (2) the corresponding ridges and grooves of the articular surfaces of the SIJs and resultant high coefficient of friction; and (3) the integrity of the binding ligaments, which are among the strongest in the body. Shearing forces absorbed in the SIJ occur because of a combination of person-specific anatomical features. This results in unique form and force closure situations that provide effective and tailored joint accommodation that balance both friction and compression in the joint. Force closure occurs because of altered joint reaction force via taut ligaments, fascia, muscles, and the ground reaction force they are reacting to at the moment. In the ideal state, force closure creates a perpendicular compressive reaction force to the SIJ to adapt and overcome the forces of gravity. In order for force closure to be effective, sacral nutation must occur and is considered to be anticipatory for joint loading. Sacral nutation results in tensing all of the dorsal SIJ ligaments (interosseous, dorsal sacroiliac) with the exception of one, the long dorsal ligament (LDL). This prepares the pelvis to absorb and increase in load. As a result, the posterior ilium are pressed together causing an increase in SIJ compression. This review will discuss the importance of understanding form and force closure principles because they are related to understanding the relationship of anatomy and function of the SIJ.
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Affiliation(s)
- Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME
| | - Mark Schuenke
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME
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Enix DE, Mayer JM. Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients. PM R 2019; 11 Suppl 1:S32-S39. [DOI: 10.1002/pmrj.12176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
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Suehiro T, Yakushijin Y, Nuibe A, Ishii S, Kurozumi C, Ishida H. Effect of pelvic belt on the perception of difficulty and muscle activity during active straight leg raising test in pain-free subjects. J Exerc Rehabil 2019; 15:449-453. [PMID: 31316940 PMCID: PMC6614771 DOI: 10.12965/jer.1938140.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
A pelvic belt decreases patient-reported perception of difficulty during the active straight leg raising (ASLR) test in individuals with pelvic girdle pain. However, the influence of a pelvic belt on the perception of difficulty during ASLR was not investigated in pain-free subjects. Therefore, this influence excluding the impact of pain is not clear. This paper aimed to clarify the effect of a pelvic belt on the perception of difficulty and muscle activity during ASLR performance in the subjective heavier side leg in pain-free subjects. Twenty pain-free female subjects participated. ASLR using the subjective heavier side leg was performed under two conditions: without and with a pelvic belt. Muscle activation of the external oblique, internal oblique, rectus abdominis, rectus femoris, and biceps femoris was measured during ASLR using a surface electromyograph. Difference in perceived difficulty in performing ASLR with and without a belt was assessed. In total, 80% of subjects had decreased perception of difficulty using a pelvic belt during ASLR. For ASLR performed with a pelvic belt, muscle activity significantly decreased in the contralateral rectus abdominis, ipsilateral external oblique, and bilateral internal oblique (P<0.05), while it significantly increased in the contralateral biceps femoris (P<0.05). There were no significant differences in muscle activity of the ipsilateral rectus abdominis, contralateral external oblique, and ipsilateral rectus femoris between the two conditions (P>0.05). In conclusion, using a pelvic belt can decrease the perception of difficulty during ASLR, and the pelvic belt may improve impairment of load transfer between the trunk and pelvis.
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Affiliation(s)
- Tadanobu Suehiro
- Department of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Yuri Yakushijin
- Department of Rehabilitation, Matsuyama Rehabilitation Hospital, Matsuyama, Japan
| | - Ami Nuibe
- Department of Rehabilitation Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Sakura Ishii
- Department of Rehabilitation, Saiseikai Kibi Hospital, Okayama, Japan
| | - Chiharu Kurozumi
- Department of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Hiroshi Ishida
- Department of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
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Cholewicki J, Breen A, Popovich JM, Reeves NP, Sahrmann SA, van Dillen LR, Vleeming A, Hodges PW. Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point-Counterpoint Debate. J Orthop Sports Phys Ther 2019; 49:425-436. [PMID: 31092123 PMCID: PMC7394249 DOI: 10.2519/jospt.2019.8825] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.
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A Pilot RCT Investigating the Effects of Targeted Compression on Athletes With Pelvic/Groin Pain. J Sport Rehabil 2018; 28:133-143. [PMID: 29091519 DOI: 10.1123/jsr.2017-0097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Athletic pelvic/groin pain is a common yet often challenging problem to both diagnose and manage. A new tool has been developed based on the clinical effects of applied force on the pelvis. Early findings indicate that this customized compression orthosis may have a positive effect on pelvic/groin pain and performance measures. OBJECTIVES To inform the design and test the practicality of procedures for a future definitively powered randomized controlled trial and to provide an estimate of the effect size of this orthosis on selected clinical and performance measures. DESIGN Pilot randomized controlled trial with participants randomly allocated to an intervention or waiting-list control group. SETTING The training location of each athlete. PARTICIPANTS 24 athletes with subacute and chronic pelvic conditions were proposed to be recruited. INTERVENTION A customized compression orthosis, delivering targeted compression to the pelvic girdle. OUTCOME MEASURES Measures were the active straight leg raise (ASLR) test, squeeze test, broad jump, and the multiple single-leg hop-stabilization test. RESULTS A total of 16 athletes completed the study. The invention group demonstrated moderate to large estimated effect sizes on the squeeze test and active straight leg raise tests (d = 0.6-1.1) while wearing the orthosis. Small effect sizes (d = 0.2) were seen on jump distance and the dominant leg balance score. Compared with the control group, the intervention group also showed moderate to large estimated effect sizes on the active straight leg raise measures (d = 0.5-0.9) when wearing sports shorts. CONCLUSIONS The protocol was feasible. Effect sizes and recruitment/attrition rates suggest that the intervention holds promise and that a future definitively powered randomized controlled trial appears feasible and is indicated.
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12
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Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study. Sci Rep 2018; 8:15980. [PMID: 30374032 PMCID: PMC6206162 DOI: 10.1038/s41598-018-34387-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
The sacroiliac joint (SIJ) is a well-known source of low back pain, with increasing interest for both conservative and surgical treatment. Alterations in pelvis kinematics are hypothesized as a contributor to SIJ pain and pelvic orthoses one treatment option, but their effects on the pelvis are poorly understood. Alterations in movement patterns induced by the application of pelvic orthoses were determined in five human cadaveric pelvises. Deformations were obtained from the lumbosacral transition and the bilateral SIJ, using digital image correlation and a customized routine to compute the movements within the pelvis. Significant alterations were found for the movements at the SIJ, in particular a vast increase in axial (x-axis) rotation, accompanied by increased inferior (y-) translation of the sacrum relative to the ilium. Movement patterns at the lumbosacral transition changed, causing increases in axial rotation and decreased inferior translation of L5 relative to S1. Using a physiologic mode of load application gives novel insights into the potential effects of pelvic orthoses. The results of these in-vitro experiments vary markedly from previous experiments with loading limited to two or less axes. Furthermore, the influence of pelvic orthoses on the lumbosacral transition warrants further investigation.
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Kim JM, Je HD, Kim HD. Effects of pelvic compression belts on the kinematics and kinetics of the lower extremities during sit-to-stand maneuvers. J Phys Ther Sci 2017; 29:1311-1317. [PMID: 28878454 PMCID: PMC5574350 DOI: 10.1589/jpts.29.1311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effects of a pelvic compression belt (PCB) and chair height on the kinematics and kinetics of the lower extremity during sit-to-stand (STS) maneuvers in healthy people. [Subjects and Methods] Twenty-two people participated in this study. They were required to perform STS maneuvers under four conditions. Hip joint moment and angular displacement of the hip, knee, and ankle were measured. A PCB was also applied below the anterior superior iliac spine. [Results] The angular displacement of the ankle joint increased while performing STS maneuvers from a normal chair with a PCB in phase 1, and decreased during phase 2 when performing STS maneuvers from a high chair. The overall angular displacement in phase 3 was decreased while rising from a chair with a PCB and rising from a high chair. When performed STS maneuvers from a high chair, the angular displacement of the hip, knee, and ankle joint decreased considerably in phase 3. This decreased lower extremity motion in phase 3 indicated that participants required less momentum to complete the maneuver. [Conclusion] The results of this study suggest that a PCB might be appropriate for patients with pelvic girdle pain and lower back pain related to pregnancy.
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Affiliation(s)
- Jong Moon Kim
- Department of Physical Therapy, College of Health Science, Korea University, Republic of Korea
| | - Hyun Dong Je
- Department of Pharmacology, College of Pharmacy, Catholic University of Daegu, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Republic of Korea
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14
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An investigation into the immediate effects of pelvic taping on hamstring eccentric force in an elite male sprinter - A case report. Phys Ther Sport 2017; 28:15-22. [PMID: 28923589 DOI: 10.1016/j.ptsp.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hamstring Injuries commonly cause missed training and competition time in elite sports. Injury surveillance studies have demonstrated high injury and re-injury rates, which have not improved across sports despite screening and prevention programmes being commonplace. The most commonly suggested intervention for hamstring prevention and rehabilitation is eccentric strength assessment and training. CASE DESCRIPTION This case study describes the management of an elite sprinter with a history of hamstring injury. A multi-variate screening process based around lumbar-pelvic dysfunction and hamstring strength assessment using the Nordbord is employed. The effect of external pelvic compression using a taping technique, on eccentric hamstring strength is evaluated. OUTCOMES A persistent eccentric strength asymmetry of 17% was recorded as well as lumbar-pelvic control deficits. Pelvic taping appears to improve load transfer capability across the pelvis, resulting in correction of eccentric strength asymmetry. DISCUSSION Screening strategies and interventions to prevent hamstring injury have failed to consistently improve injury rates across various sports. In this case study external pelvic compression resulted in normalising eccentric strength deficits assessed using the Nordbord. The inclusion of lumbar-pelvic motor control assessment, in relation to hamstring strength and function, as part of a multi-variate screening strategy requires further research.
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Kibsgård TJ, Röhrl SM, Røise O, Sturesson B, Stuge B. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clin Biomech (Bristol, Avon) 2017; 47:40-45. [PMID: 28582642 DOI: 10.1016/j.clinbiomech.2017.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 05/05/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Active Straight Leg Raise is a functional test used in the assessment of pelvic girdle pain, and has shown to have good validity, reliability and responsiveness. The Active Straight Leg Raise is considered to examine the patients' ability to transfer load through the pelvis. It has been hypothesized that patients with pelvic girdle pain lack the ability to stabilize the pelvic girdle, probably due to instability or increased movement of the sacroiliac joint. This study examines the movement of the sacroiliac joints during the Active Straight Leg Raise in patients with pelvic girdle pain. METHODS Tantalum markers were inserted in the dorsal sacrum and ilium of 12 patients with long-lasting pelvic girdle pain scheduled for sacroiliac joint fusion surgery. Two to three weeks later movement of the sacroiliac joints during the Active Straight Leg Raise was measured with radiostereometric analysis. FINDINGS Small movements were detected. There was larger movement of the sacroiliac joint of the rested leg's sacroiliac joint compared to the lifted leg's side. A mean backward rotation of 0.8° and inward tilt of 0.3° were seen in the rested leg's sacroiliac joint. INTERPRETATION The movements of the sacroiliac joints during the Active Straight Leg Raise are small. There was a small backward rotation of the innominate bone relative to sacrum on the rested leg's side. Our findings contradict an earlier understanding that a forward rotation of the lifted leg's innominate occur while performing the Active Straight Leg Raise.
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Affiliation(s)
- Thomas J Kibsgård
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Olav Røise
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Bengt Sturesson
- Department of Orthopaedics, Aleris specialistvård, Ängelholm Hospital, Ängelholm, Sweden
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
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Hilde G, Gutke A, Slade SC, Stuge B. Physical therapy interventions for pelvic girdle pain (PGP) after pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gunvor Hilde
- Akershus University Hospital; Department of Obstetrics and Gynecology; Sykehusveien 25 Lørenskog Akershus Norway 1478
| | - Annelie Gutke
- Sahlgrenska Academy, University of Gothenburg; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy; Gothenburg Sweden 405 30
| | - Susan C Slade
- Monash University; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
| | - Britt Stuge
- Oslo University Hospital; Department of Orthopaedics; Kirkeveien 166 Oslo Norway N-0407
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Mieritz RM, Thorhauge K, Forman A, Mieritz HB, Hartvigsen J, Christensen HW. Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain: A Preliminary Descriptive Survey. J Manipulative Physiol Ther 2016; 39:616-622. [DOI: 10.1016/j.jmpt.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
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Nishi K, Saiki K, Imamura T, Okamoto K, Wakebe T, Ogami K, Hasegawa T, Moriuchi T, Sakamoto J, Manabe Y, Tsurumoto T. Degenerative changes of the sacroiliac auricular joint surface-validation of influential factors. Anat Sci Int 2016; 92:530-538. [PMID: 27343049 DOI: 10.1007/s12565-016-0354-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/14/2016] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to clarify the relevance of degenerative changes in the sacroiliac joint (SIJ) and the joints in the lower limb and lumbar spine using age estimation methods. We also examined the shape of the auricular surface to determine the effect of degenerative changes on each joint. A total of 200 iliac auricular surfaces from 100 Japanese male skeletons were examined macroscopically in accordance with conventional methods of age estimation. From the obtained estimated age, we calculated the deflection values, which represented the degree of degenerative changes of the joints. For comparison, we used osteophyte score data of the hip, knee, and zygapophyseal joints in lumbar spines from previous studies which had used the same bone specimens. As a quantitative indicator of auricular surface morphology, we defined the constriction ratio (CR) of the auricular surface and compared the CR values obtained with various measured values. Degenerative changes in the SIJ were positively correlated with those in both the hip joint and zygapophyseal joint, but a correlation with knee joints was found only on the left side. In skeletons from individuals aged ≥60 years as time of death, the CR was significantly different between the group with high scores and those with low scores in both the hip and sacroiliac joints. It has been suggested that degenerative changes in SIJs interact with those in the hip joint and zygapophyseal joint. In addition, the shape of the auricular surface may also be a relevant factor for degenerative changes in these joints.
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Affiliation(s)
- Keita Nishi
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Department of Rehabilitation, Wajinkai Hospital, Nagasaki, Japan.
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takeshi Imamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Keishi Okamoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Tetsuaki Wakebe
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Keiko Ogami
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takashi Hasegawa
- Department of Rehabilitation, Wajinkai Hospital, Nagasaki, Japan
| | - Takefumi Moriuchi
- Department of Community-based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshitaka Manabe
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Nelson-Wong E, Gallant P, Alexander S, Dehmer K, Ingvalson S, McClenahan B, Piatte A, Poupore K, Davis AM. Multiplanar lumbopelvic control in patients with low back pain: is multiplanar assessment better than single plane assessment in discriminating between patients and healthy controls? J Man Manip Ther 2016; 24:45-50. [PMID: 27252582 PMCID: PMC4870031 DOI: 10.1179/2042618614y.0000000078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Patients with low back pain (LBP) commonly have lumbopelvic control deficits. Lumbopelvic assessment during sagittal motion is incorporated into commonly used clinical examination algorithms for Treatment Based Classification. The purpose of this study was to investigate whether combined assessment of lumbopelvic control during sagittal and frontal plane motion discriminates between people with and without LBP better than single plane assessment alone. METHODS Nineteen patients with LBP and 18 healthy control participants volunteered for this study. The active straight leg raise (ASLR) and active hip abduction (AHAbd) tests were used to assess lumbopelvic control during sagittal and frontal plane motion, respectively. The tests were scored as positive or negative using published scoring criteria. Contingency tables were created for each test alone and for the combined tests (both positive/both negative) with presence/absence of LBP as the reference standard to calculate accuracy statistics of sensitivity (sn), specificity (sp), likelihood (+LR and -LR), and diagnostic odds ratios (OR). RESULTS Active straight leg raise and AHAbd tests alone had sn of 0·63, 0·74, respectively, sp of 0·61, 0·50, respectively, and OR of 2·7, 2·8, respectively. The combined tests had sn = 0·89, sp = 0·60, and OR = 12·0. Forty percent of patients with LBP had control deficits in both planes of motion. DISCUSSION The AHAbd and ALSR tests appear to have greater diagnostic discrimination when used in combination than when used independently. A percentage of patients with LBP had control deficits in both planes, while others demonstrated uniplanar deficits only. These findings highlight the importance of multiplanar assessment in patients with LBP.
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Affiliation(s)
- E. Nelson-Wong
- Regis University School of Physical Therapy, Denver, CO, USA
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Gnat R, Spoor K, Pool-Goudzwaard A. The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis. Clin Biomech (Bristol, Avon) 2015; 30:827-31. [PMID: 26094778 DOI: 10.1016/j.clinbiomech.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of so-called local muscle system in motor control of the lower back and pelvis is a subject of ongoing debate. Prevailing beliefs in stabilizing function of this system were recently challenged. This study investigated the impact of in vitro simulated force of transversely oriented fibres of the transversus abdominis muscle (a part of the local system) on flexibility of the sacroiliac joint during asymmetric moment application to the pelvis. METHODS In 8 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixed contralateral innominate. Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion Capture System. Load-deformation curves were plotted and flexibility of the sacroiliac joint was calculated separately for anterior and posterior rotations of the innominate, with and without simulated muscle force. FINDINGS Flexibility of the sacroiliac joint was significantly bigger during anterior rotation of the innominate, as compared to posterior rotation (Anova P<0.05). After application of simulated force of transversus abdominis, flexibility of the joint did not change both during anterior and posterior rotations of the innominate. INTERPRETATION A lack of a stiffening effect of simulated transversus abdominis force on the sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening influence of this muscle on the pelvis cannot be confirmed. Consistent with previous findings smaller flexibility of the joint recorded during posterior rotation of the innominate may be of clinical importance for physio- and manual therapists. However, major limitations of the study should be acknowledged: in vitro conditions and simulation of only solitary muscle force.
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Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Motion Analysis Laboratory, Faculty of Physiotherapy, University of Physical Education, ul. Mikolowska 72, 40-065 Katowice, Poland; Faculty of Physiotherapy, Academy of Business, ul. Cieplaka 1c, 41-300 DąbrowaGórnicza, Poland.
| | - Kees Spoor
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat, 9, 1081 BT Amsterdam, The Netherlands
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Jonely H, Brismée JM, Desai MJ, Reoli R. Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach. J Man Manip Ther 2015; 23:20-6. [PMID: 26309378 DOI: 10.1179/2042618614y.0000000086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Sacroiliac joint pain and dysfunction affect 15-25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. CASE DESCRIPTION A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. OUTCOMES The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient's Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient's rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. DISCUSSION A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.
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Affiliation(s)
- Holly Jonely
- The George Washington University School of Medicine & Health Sciences Department of Physical Therapy, Washington, DC, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, DC, USA
| | - Rachel Reoli
- The George Washington University School of Medicine & Health Sciences Department of Physical Therapy, Washington, DC, USA
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Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain. PLoS One 2015; 10:e0136375. [PMID: 26305790 PMCID: PMC4549265 DOI: 10.1371/journal.pone.0136375] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 07/31/2015] [Indexed: 02/07/2023] Open
Abstract
Introduction The sacroiliac joint (SIJ) is a common source of low back pain. However, clinical and functional signs and symptoms correlating with SIJ pain are widely unknown. Pelvic belts are routinely applied to treat SIJ pain but without sound evidence of their pain-relieving effects. This case-control study compares clinical and functional data of SIJ patients and healthy control subjects and evaluates belt effects on SIJ pain. Methods 17 SIJ patients and 17 healthy controls were included in this prospective study. The short-form 36 survey and the numerical rating scale were used to characterize health-related quality of life in patients in a six-week follow-up and the pain-reducing effects of pelvic belts. Electromyography data were obtained from the gluteus maximus, biceps femoris, rectus femoris and medial vastus. Alterations of muscle activity, variability and gait patterns were compared in patients and controls along with the belts’ effects in a dynamic setting when walking. Results Significant improvements were observed in the short-form 36 survey of the SIJ patients, especially in the physical health subscores. Minor declines were also observed in the numerical rating scale on pain. Belt-related changes of muscle activity and variability were similar in patients and controls with one exception: the rectus femoris activity decreased significantly in patients with belt application when walking. Further belt effects include improved cadence and gait velocity in patients and controls. Conclusions Pelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Belt effects include decreased rectus femoris activity in patients and improved postural steadiness during locomotion. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain. Trial Registration ClinicalTrials.gov NCT02027038
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Experimental Pelvic Pain Impairs the Performance During the Active Straight Leg Raise Test and Causes Excessive Muscle Stabilization. Clin J Pain 2015; 31:642-51. [DOI: 10.1097/ajp.0000000000000139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bussey MD. Mechanics of pelvic girdle stability and self-bracing in SIJ-related pelvic girdle pain: a review. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Soisson O, Lube J, Germano A, Hammer KH, Josten C, Sichting F, Winkler D, Milani TL, Hammer N. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction. PLoS One 2015; 10:e0116739. [PMID: 25781325 PMCID: PMC4364533 DOI: 10.1371/journal.pone.0116739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/14/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Methods Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Results Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Discussion Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest.
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Affiliation(s)
- Odette Soisson
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Juliane Lube
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Andresa Germano
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | | | - Christoph Josten
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Freddy Sichting
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Dirk Winkler
- Department of Neurosurgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Thomas L. Milani
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- * E-mail:
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Brizzolara K, Wang-Price S, Roddey T, Wilson I. The effect of pelvic compression on deep abdominal muscle thickness during the active straight leg raise test. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.2.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The estimated prevalence of sacroiliac joint (SIJ) pain is 13–30% in patients with non-specific low back pain. One common presentation is pain at or near the SIJ, and common physical therapy interventions include lumbopelvic stabilisation programmes and pelvic compression belts. The aim of this study was to: i) assess how compression of the SIJ affects the thickness of the deep abdominal muscles during the active straight leg raise (ASLR); ii) determine between-day intra-tester reliability of ultrasound imaging to assess percentage change in thickness of the deep abdominal muscles. Methods: Participants (n=15) with unilateral symptoms near the SIJ and age-matched and sex-matched controls (n=15) were recruited for this study. Ultrasound imaging was used to obtain the thickness of the transverse abdominis (TrA) and internal oblique (IO) muscles. Measurements were taken at rest and during the ASLR, with and without pelvic compression. Results: Two separate two-way (group × pelvic compression) analysis of variance (ANOVA) designs with repeated measures were used to analyse the thickness of the TrA and IO muscles; interactions were not significant for percentage change in the TrA (p=0.57) or IO (p=0.10) muscles. Intra-tester reliability was higher when testing with pelvic compression and in the control group (ICC: 0.85–0.89 vs 0.70–0.76). Conclusions: Pelvic compression did not immediately affect the muscular response of the TrA or IO muscles during the ASLR. Pelvic compression belts may be used to address the passive systems of the pelvis by increasing stability; however, specific localised exercises may be needed to improve the percentage change in thickness of the deep abdominal muscles during the ASLR.
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Affiliation(s)
- Kelli Brizzolara
- Assistant professor, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Sharon Wang-Price
- Associate professor and professional programme coordinator, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Toni Roddey
- Professor and coordinator of research, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Iseult Wilson
- Lecturer in physiotherapy, School of Health Sciences, University of Ulster, UK
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Noh KH, Kim JW, Kim GM, Ha SM, Oh JS. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain. J Phys Ther Sci 2014; 26:717-9. [PMID: 24926138 PMCID: PMC4047238 DOI: 10.1589/jpts.26.717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study was performed to assess the influence of applying dual pressure
biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity
during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back
pain (LBP) participated in this study. [Methods] The subjects were asked to perform an
active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The
angles of pelvic rotation were measured using a three-dimensional motion-analysis system,
and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique
abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography
(EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and
muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral
IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the
DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest
that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and
increasing abdominal muscle activity in women with chronic low back pain.
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Affiliation(s)
- Kyung-Hee Noh
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Ji-Won Kim
- Department of Physical Therapy, Nambu University, Republic of Korea
| | - Gyoung-Mo Kim
- Department of Physical Therapy, Baekseok University, Republic of Korea
| | - Sung-Min Ha
- Department of Physical Therapy, Sangji University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University: 607 Obang-dong, Gimhae-si, Gyeongsangnam-do 621-749, Republic of Korea
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Lee JH, Yoo WG, Kim MH, Oh JS, Lee KS, Han JT. Effect of posterior pelvic tilt taping in women with sacroiliac joint pain during active straight leg raising who habitually wore high-heeled shoes: a preliminary study. J Manipulative Physiol Ther 2014; 37:260-8. [PMID: 24780371 DOI: 10.1016/j.jmpt.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/24/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether a 1-day application of posterior pelvic tilt taping (PPTT) using a kinesiology tape would decrease anterior pelvic tilt and active straight leg raising test scores in women with sacroiliac joint who habitually wore high-heeled shoes. METHODS Sixteen women (mean age, 23.63 ± 3.18 years) were enrolled in this study. Anterior pelvic tilt was measured using a palpation meter before PPTT application, immediately after PPTT application, 1 day after PPTT application, and immediately after PPTT removal after 1 day of application. Active straight leg raising scores were measured at the same periods. Posterior pelvic tilt taping was applied in the target position (posterior pelvic tilt position). RESULTS The anterior pelvic tilt was decreased during and after 1 day of PPTT application (before and after kinesiology tape removal) compared with the initial angle (all P < .05). Active straight leg raising scores were decreased during and 1 day after PPTT application (before and after kinesiology tape removal) compared with the initial score (all P < .05). CONCLUSION The results of this preliminary study suggests that PPTT may temporarily decrease anterior pelvic tilt and active straight leg raising score in women with sacroiliac joint pain who habitually wear high-heeled shoes.
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Affiliation(s)
- Jung-Hoon Lee
- Professor, Department of Physical Therapy, College of Nursing and Healthcare Sciences, Dong-Eui University, Republic of Korea
| | - Won-Gyu Yoo
- Professor, Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea.
| | - Mi-Hyun Kim
- Professor, Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
| | - Jae-Seop Oh
- Professor, Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
| | - Kyung-Soon Lee
- Professor, Department of Physical Therapy, Dong Ju College University, Busan, Republic of Korea
| | - Jin-Tae Han
- Professor, Department of Physical Therapy, Kyung-sung University, Busan, Republic of Korea
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Abstract
Primary musculoskeletal etiologies, such as stress fractures, strains, facet arthropathy, and sacroiliac joint dysfunction, are more common causes of pediatric pain than systemic diseases, both in the office setting and the emergency room. Systemic features, young age, and atypical pain should clue physicians to causes other than a primary musculoskeletal cause and prompt an intensive search for other conditions.
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Hammer N, Steinke H, Lingslebe U, Bechmann I, Josten C, Slowik V, Böhme J. Ligamentous influence in pelvic load distribution. Spine J 2013; 13:1321-30. [PMID: 23755919 DOI: 10.1016/j.spinee.2013.03.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 01/03/2013] [Accepted: 03/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results. PURPOSE AND STUDY DESIGN The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries. METHODS An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions. RESULTS Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL. CONCLUSIONS Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting, load concentrations occur at the IL, ISL, and PSL, which goes in coherence with the clinical findings of these ligaments serving as generators of low back pain.
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Affiliation(s)
- Niels Hammer
- Faculty of Medicine, Institute of Anatomy, University of Leipzig, Liebigstraße 13, 04103 Leipzig, Germany; Department of Trauma and Reconstructive Surgery, Faculty of Medicine, University of Leipzig, Liebigstraße 13, 04103 Leipzig, Germany.
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Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain. J Electromyogr Kinesiol 2013; 23:1317-24. [PMID: 24080287 DOI: 10.1016/j.jelekin.2013.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/12/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022] Open
Abstract
Observation-based assessments of movement are a standard component in clinical assessment of patients with non-specific low back pain. While aberrant motion patterns can be detected visually, clinicians are unable to assess underlying neuromuscular strategies during these tests. The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessments for lumbopelvic control in people with low back pain (LBP) and matched control subjects. Electromyography was recorded from hip and trunk muscles of 34 participants (17 with LBP) during performance of the Active Hip Abduction (AHAbd) and Active Straight Leg Raise (ASLR) tests. Relative muscle timing was calculated using cross-correlation. Participants with LBP demonstrated a variable strategy, while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements. Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches.
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Stuge B, Sætre K, Ingeborg Hoff B. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. ACTA ACUST UNITED AC 2013; 18:327-32. [DOI: 10.1016/j.math.2012.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 01/08/2023]
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Effects of the pelvic rotatory control method on abdominal muscle activity and the pelvic rotation during active straight leg raising. ACTA ACUST UNITED AC 2013; 18:220-4. [DOI: 10.1016/j.math.2012.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 10/07/2012] [Accepted: 10/09/2012] [Indexed: 11/18/2022]
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Expanding Panjabi's stability model to express movement: a theoretical model. Med Hypotheses 2013; 80:692-7. [PMID: 23561576 DOI: 10.1016/j.mehy.2013.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/24/2013] [Accepted: 02/07/2013] [Indexed: 12/28/2022]
Abstract
Novel theoretical models of movement have historically inspired the creation of new methods for the application of human movement. The landmark theoretical model of spinal stability by Panjabi in 1992 led to the creation of an exercise approach to spinal stability. This approach however was later challenged, most significantly due to a lack of favourable clinical effect. The concepts explored in this paper address and consider the deficiencies of Panjabi's model then propose an evolution and expansion from a special model of stability to a general one of movement. It is proposed that two body-wide symbiotic elements are present within all movement systems, stability and mobility. The justification for this is derived from the observable clinical environment. It is clinically recognised that these two elements are present and identifiable throughout the body in different joints and muscles, and the neural conduction system. In order to generalise the Panjabi model of stability to include and illustrate movement, a matching parallel mobility system with the same subsystems was conceptually created. In this expanded theoretical model, the new mobility system is placed beside the existing stability system and subsystems. The ability of both stability and mobility systems to work in harmony will subsequently determine the quality of movement. Conversely, malfunction of either system, or their subsystems, will deleteriously affect all other subsystems and consequently overall movement quality. For this reason, in the rehabilitation exercise environment, focus should be placed on the simultaneous involvement of both the stability and mobility systems. It is suggested that the individual's relevant functional harmonious movements should be challenged at the highest possible level without pain or discomfort. It is anticipated that this conceptual expansion of the theoretical model of stability to one with the symbiotic inclusion of mobility, will provide new understandings on human movement. The use of this model may provide a universal system for body movement analysis and understanding musculoskeletal disorders. In turn, this may lead to a simple categorisation system alluding to the functional face-value of a wide range of commonly used passive, active or combined musculoskeletal interventions. Further research is required to investigate the mechanisms that enable or interfere with harmonious body movements. Such work may then potentially lead to new and evolved evidence based interventions.
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Jung HS, Jeon HS, Oh DW, Kwon OY. Effect of the pelvic compression belt on the hip extensor activation patterns of sacroiliac joint pain patients during one-leg standing: A pilot study. ACTA ACUST UNITED AC 2013; 18:143-8. [DOI: 10.1016/j.math.2012.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 07/13/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
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Hu H, Meijer OG, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu W, Xia C, van Dieën JH. Understanding the Active Straight Leg Raise (ASLR): An electromyographic study in healthy subjects. ACTA ACUST UNITED AC 2012; 17:531-7. [DOI: 10.1016/j.math.2012.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 05/21/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012; 221:537-67. [PMID: 22994881 PMCID: PMC3512279 DOI: 10.1111/j.1469-7580.2012.01564.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/28/2022] Open
Abstract
This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure.
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Affiliation(s)
- A Vleeming
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA
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Abstract
Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts.
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Can innominate motion be used to identify persons with ankylosing spondylitis? A pilot study. ACTA ACUST UNITED AC 2012; 18:118-23. [PMID: 22964081 DOI: 10.1016/j.math.2012.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 07/23/2012] [Accepted: 07/30/2012] [Indexed: 01/13/2023]
Abstract
Innominate movements during hip abduction and external rotation have recently been described in healthy individuals. In the present study the aim was to determine whether these hip movement tests could discriminate altered movement patterns in people with specific pelvic girdle pain (PGP) disorder. This pilot study is the first step in determining the usefulness of prone hip abduction and external rotation in the differential diagnosis of PGP disorders. A cross-sectional comparison between a convenient sample of 6 individuals who had been referred for exercise and advice following diagnosis of ankylosing spondylitis (AS) via a Medical/Rheumatological pathway and 18 healthy age and gender matched controls. Transverse and sagittal plane innominate motion was measured using a palpation and digitizing technique with a magnetic tracking device. Data analysis involved applying best-fit equations to the data and visual inspection of the produced graphs as well as conditional logistical regression for each test position to determine our ability to predict group association. Graphical comparisons demonstrate a distinction between the patients with AS and the healthy controls. Further, for all three hip conditions the innominate angle was a significant predictor of group association (p = 0.002 for AB, p = 0.005 for AB + ER and p = 0.007 for ER).
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Arumugam A, Milosavljevic S, Woodley S, Sole G. Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine – A systematic review. ACTA ACUST UNITED AC 2012; 17:275-84. [DOI: 10.1016/j.math.2012.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 01/27/2012] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
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Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Phys Ther 2012; 92:781-90. [PMID: 22282770 DOI: 10.2522/ptj.20110119] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Many women have low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy, but there is limited evidence of effective primary and secondary preventive strategies. OBJECTIVE The purpose of this study was to investigate whether a group-based exercise program can reduce the prevalence and severity of LBP and PGP in pregnant women. DESIGN An observer-blinded randomized controlled trial with equal assignments to a training group and a control group was conducted. SETTING The study was conducted in primary care maternity units in 2 suburban municipalities in the southeastern part of Norway. PATIENTS The participants were 257 pregnant women who were healthy and between 18 and 40 years of age before gestation week 20. INTERVENTION The training group received supervised exercises in groups once a week, and the control group received standard care. MEASUREMENTS The main outcome measures were self-reported LBP and self-reported PGP. Secondary outcome measures were pain intensity in the morning and evening, disability, and 8-Item Short-Form Health Survey (SF-8) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Follow-up measurements were performed at gestation weeks 24, 28, 32, and 36. RESULTS Overall, there was no effect of the program on the prevalence of PGP (odds ratio = 1.03, 95% confidence interval [CI] = 0.66 to 1.59) or LBP (odds ratio = 0.77, 95% CI = 0.50 to 1.19). For the secondary outcomes, the estimated mean differences between the groups were -0.4 (95% CI = -0.8 to 0.1) for pain intensity in the morning, -0.4 (95% CI = -1.0 to 0.2) for pain intensity in the evening, -1.0 (95% CI = -2.2 to 0.0) for disability, 1.8 (95% CI = 0.0 to 3.7) for the SF-8 PCS, and -0.6 (95% CI = -2.2 to 1.4) for the SF-8 MCS. LIMITATIONS Due to low statistical power, the estimates for the primary outcomes are imprecise. CONCLUSIONS Supervised group exercise did not reduce the prevalence of LBP or PGP in pregnancy.
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Evaluation of Changes in Pelvic Belt Tension During 2 Weight-Bearing Functional Tasks. J Manipulative Physiol Ther 2012; 35:390-5. [DOI: 10.1016/j.jmpt.2012.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/03/2012] [Accepted: 03/01/2012] [Indexed: 11/23/2022]
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Arumugam A, Milosavljevic S, Woodley S, Sole G. Can application of a pelvic belt change injured hamstring muscle activity? Med Hypotheses 2012; 78:277-82. [PMID: 22169627 DOI: 10.1016/j.mehy.2011.10.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/27/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Ashokan Arumugam
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
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Abstract
STUDY DESIGN Clinical measurement. OBJECTIVES To determine the interrater and intrarater reliability of the active hip abduction (AHAbd) test. BACKGROUND The AHAbd test is used to assess lumbopelvic movement during a dynamic lower limb activity. The test has previously been shown to predict low back pain development during a prolonged standing exposure in previously asymptomatic individuals. As an observation-based assessment for which rater reliability has not been established, similar scoring on the test between clinicians is essential. METHODS One hundred twenty-eight video clips of participants performing the AHAbd test were recorded. Sixteen practicing physical therapists scored test performance by viewing 20 preselected videos to establish interrater reliability. Fourteen of the 16 raters rescored the videos after a 3-week period to establish intrarater reliability. Demographic data were collected for all raters. Intraclass correlation coefficients (ICCs) were calculated for reliability statistics. Correlations were performed between demographic data and ICCs. RESULTS Interrater reliability (ICC2,1) for the test using the 4-point scale was 0.70 (95% confidence interval [CI]: 0.56, 0.84) and 0.59 (95% CI: 0.43, 0.76) when the scale was dichotomized into positive/negative scores. Intrarater reliability (ICC3,1) was 0.74 on average. Demographic characteristics were not significantly associated with reliability scores. CONCLUSION Interrater and intrarater reliability for scoring of the AHAbd test by practicing clinicians was similar, regardless of experience level or practice setting. The AHAbd test can be considered to be a reliable observational tool.
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