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Meekins MM, Zucker-Levin A, Harris-Hayes M, Singhal K, Huffman K, Kasser R. The effect of chronic low back pain and lumbopelvic stabilization instructions on gluteus medius activation during sidelying hip movements. Physiother Theory Pract 2024:1-8. [PMID: 38801071 DOI: 10.1080/09593985.2024.2357130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND People with chronic low back pain (LBP) often demonstrate altered muscle activation with movements that involve the lumbopelvic region and hips. OBJECTIVE The purpose of this study was to compare gluteus medius activity during sidelying hip abduction (SHA) and sidelying hip abduction-lateral rotation (SHALR) with and without instruction for lumbopelvic stabilization in people with and without chronic LBP. METHODS A cross-sectional study was conducted recruiting participants with (n = 17) and without (n = 17) chronic LBP. Gluteus medius activity was recorded with surface electromyography during the performance of SHA and SHALR with and without instructions including the abdominal drawing-in maneuver for lumbopelvic stabilization. RESULTS For SHA and SHALR, there was a significant main effect for instruction for stabilization indicated by a decrease in gluteus medius activity with instructions (p = .001, p < .001). There was not a significant main effect of chronic LBP on gluteus medius activity between groups for either activity. There was no significant interaction effect of pain and instruction for stabilization with SHA or SHALR. CONCLUSION Knowledge of changes in gluteus medius muscle activation patterns with trunk stabilization instruction may help clinicians with assessment of exercise performance to optimize gluteus medius activation.
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Affiliation(s)
- Myra M Meekins
- College of Health Professions, Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Audrey Zucker-Levin
- College of Medicine, School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marcie Harris-Hayes
- Physical Therapy and Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kunal Singhal
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, Austin, TX, USA
| | - Kyle Huffman
- College of Health Professions, Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Richard Kasser
- College of Health Professions, Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
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Park C, Kim K, Yoon S, Park I, Cha Y. Physiotherapeutic effects of an innovative golf swing-assist device on discomfort and mobility in amateur golfers with low back pain: A randomized controlled trial. Technol Health Care 2023; 31:137-144. [PMID: 37038788 DOI: 10.3233/thc-236013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Although the biomechanical features of the golf swing are extremely determined, multiple joint movements with limited pelvic and thoracic rotation movement can cause injury to the golfer and are linked with low back pain (LBP). We have developed the Pulley Master machine (PM), which is designed to offer active movement evaluation and monitoring as well as repetitive and task-specific training. OBJECTIVE The primary goal of the present research was to analyze the effects of PM and Transfer of Electricity-Capacitive and Resistive (TECAR) therapy on the lumbar pain scale and thoracic and pelvic mobility in amateur golfers with LBP. METHODS Twenty-one amateur golfers with LBP (six females, mean age = 23.43 ± 2.36 years) were randomly assigned to either PM or TECAR groups for five days per week over one week. Clinical outcome measurements included pelvic and thoracic mobility as well as a pain rating scale. Statistical analyses were presented using the analysis of variance (ANOVA), and the statistical significance level was set at P< 0.05. RESULTS ANOVA showed that PM outperformed TECAR in terms of pelvic and thoracic mobility as well as a pain rating scale. CONCLUSION The results provide novel and encouraging clinical evidence that PM improves pain control and mobility in amateur golfers with LBP.
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Affiliation(s)
- Chanhee Park
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Kyoungtae Kim
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
| | - Samwon Yoon
- Department of Physical Therapy, Catholic University of Pusan, Busan, Korea
| | - Ilbong Park
- Department of Sports Rehabilitation, Busan University of Foreign Studies, Busan, Korea
| | - Youngjoo Cha
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
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Kim WD, Shin D. Effects of Pelvic-Tilt Imbalance on Disability, Muscle Performance, and Range of Motion in Office Workers with Non-Specific Low-Back Pain. Healthcare (Basel) 2023; 11:healthcare11060893. [PMID: 36981550 PMCID: PMC10048650 DOI: 10.3390/healthcare11060893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/22/2023] Open
Abstract
Imbalance in the pelvic tilt is considered to be a major variable in low back pain. The purpose of this study was to investigate the effects of pelvic-tilt imbalance on trunk- and hip-muscle performance, range of motion, low-back pain, and the degree of disability in office workers. This was a cross-sectional study conducted in a physical therapy clinic on forty-one office workers diagnosed with non-specific low-back pain. Among the office workers with non-specific low-back pain, 25 were assigned to the pelvic-tilt-imbalance group and 16 to the normal group without pelvic-tilt imbalance. In order to determine the differences according to the imbalance in pelvic tilt, the pain intensity and disability indices were compared between the groups. In addition, the muscle performance and range of motion of the trunk and hip joints and foot pressure were measured and compared. There were differences between the groups in the disability indices and the ratio of internal and external rotation of the hip joint. However, there were no differences in the other variables. Pelvic-tilt imbalance in office workers with non-specific chronic low-back pain may exacerbate the degree of disability and be related to hip-joint rotational range of motion.
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Affiliation(s)
- Won-Deuk Kim
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon-si 51767, Republic of Korea
| | - Doochul Shin
- Department of Physical Therapy, College of Health Science, Kyungnam University, Changwon-si 51767, Republic of Korea
- Correspondence: ; Tel.: +82-55-249-2017
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Ansari S, Sharma S. Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study. PHYSICIAN SPORTSMED 2022:1-10. [PMID: 35914545 DOI: 10.1080/00913847.2022.2108351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This study aimed to establish the prevalence of chronic low back pain (CLBP) in university-level athletes and to examine the influence of age, sex, body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP. The secondary purpose was to check the association of certain variables in athletes having CLBP with the sports discipline and chronicity of LBP. METHODS A total of 340 players (100% response rate) from different sports, aged 18-30 years with at least 1 year of participation in sports at the university level were screened for the present study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their demographic variables, personal and pain-related factors. The study was registered on the clinical trials registry, India (CTRI/2021/09/036675). RESULTS The results revealed the sport-wise point prevalence as follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%), badminton (7.7%) and tennis (7.7%). A higher number of years at university-level participation (>4 years), smoking, anxiety and BMI (>25 kg/m2) are risk factors for CLBP. The type of LBP, the intensity of the pain (current and last week), variation of the pain intensity, disability, intake of oral medications, physiotherapy for CLBP, number of missed days of training and number of missed matches are not significantly related to the chronicity of LBP or the sports discipline. Only the number of missed days of training had a significant association with the chronicity of LBP. CONCLUSIONS CLBP is a common complaint in Indian university athletes, and our findings indicate the necessity for a specific prevention program.
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Affiliation(s)
- Sumbul Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
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5
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Neves RP, Oliveira D, Fanasca MA, Vechin FC. Shortening of hip flexor muscles and chronic low-back pain among resistance training practitioners: applications of the modified Thomas test. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Miñambres-Martín D, Martín-Casas P, López-de-Uralde-Villanueva I, Fernández-de-las-Peñas C, Valera-Calero JA, Plaza-Manzano G. Physical Function in Amateur Athletes with Lumbar Disc Herniation and Chronic Low Back Pain: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063743. [PMID: 35329430 PMCID: PMC8953459 DOI: 10.3390/ijerph19063743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to analyze if chronic low back pain (LBP) and lumbar disc herniation induce biomechanics, flexibility, body balance, physical activity, and muscular function alterations compared to a similar asymptomatic cohort. Fifty male volunteers (n = 25 with chronic LBP and lumbar disc herniation and n = 25 pain-free subjects) were enrolled. Range of motion (internal and external hip rotation, ankle dorsiflexion, and active straight leg raise, ASLR), trunk flexibility (finger−floor distance), body balance (Y-balance test) and muscle function (Biering−Sorensen test, prone and lateral bridges) outcomes were assessed. Comparative analyses between sides and group were conducted. Results: Patients showed greater weight and BMI compared with controls (p < 0.05). None of the outcomes bilaterally assessed showed side-to-side differences for pain-free participants (all, p > 0.05) or LBP patients (all, p > 0.05). Regarding the differences between groups, LBP patients showed limited internal hip rotation (p < 0.001), finger−floor distance (p < 0.001), body balance (p < 0.001), and muscle endurance (planks p < 0.001; Biering−Sorensen test p < 0.05). External hip rotation, ASLR, and ankle dorsiflexion range of movement were comparable in both groups (p > 0.05). The sample of pain-free amateur athletes showed greater range of movement for internal hip rotation, lower finger−floor distance, better body balance, and muscle function. However, the external hip rotation, ankle dorsiflexion, and ASLR tests showed no difference between cases and controls.
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Affiliation(s)
- Diego Miñambres-Martín
- Premium Madrid Global Health Care, 28016 Madrid, Spain;
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
- Correspondence:
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
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Rice RP, Roach K, Kirk-Sanchez N, Waltz B, Ellenbecker TS, Jayanthi N, Raya M. Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players. Sports Health 2022; 14:466-477. [PMID: 35037501 PMCID: PMC9214903 DOI: 10.1177/19417381211062834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population. HYPOTHESIS Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM. RESULTS A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides. CONCLUSION Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments. CLINICAL RELEVANCE Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.
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Affiliation(s)
- Robyn Porter Rice
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida,Robyn Porter Rice, PT, PhD, Department of Physical Therapy, Miller School of Medicine, University of Miami, 5915 Ponce de Leon Boulevard, Coral Gables FL 33146 () (Twitter: @RiceRobynp)
| | - Kathryn Roach
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Bret Waltz
- DocWaltz LLC, Scottsdale, Arizona,USTA Player Development, Orlando, Florida
| | - Todd S. Ellenbecker
- Vice President Medical Services, ATP Tour, Ponte Vedra Beach, Florida,Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona
| | - Neeru Jayanthi
- Emory Sports Medicine Center, Department of Orthopedic Surgery and Family Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michele Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, Florida
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Brown-Taylor L, Bordner H, Glaws K, Vasileff WK, Walrod B, Di Stasi S. Prevalence of low back pain and related disability in patients with femoroacetabular impingement syndrome. PM R 2022; 14:8-18. [PMID: 33583131 DOI: 10.1002/pmrj.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Low back pain (LBP) has been associated with worse hip function for persons with femoroacetabular impingement syndrome (FAIS). Reports are limited to surgical populations and based on the presence or absence of LBP, regardless of pain severity. OBJECTIVES To report the prevalence of clinically significant LBP for persons with FAIS; compare demographics, pain, and function between those with and without clinically significant LBP; and evaluate relationships between hip function and both LBP-related disability and LBP severity. We hypothesized that participants with LBP would be older, have higher body mass index (BMI), and report worse groin pain, longer symptom duration, and worse hip function. We hypothesized that worse LBP-related disability and LBP severity would be related to worse hip function. DESIGN Observational cross-sectional study. SETTING Hip preservation clinic. PARTICIPANTS 158 persons with FAIS. INTERVENTIONS n/a MAIN OUTCOME MEASURE(S): Visual analog pain scales (VAS 0-100) were used to categorize participants with (≥30) and without (<30) clinically significant LBP. Age, sex, BMI, pain severity and duration, and hip function (33-item Hip Outcome Tool [iHOT33]) were compared between those with and without clinically significant LBP. Correlations were evaluated between the modified Oswestry Disability Index (ODI) and iHOT33, ODI and groin pain severity, LBP severity and iHOT33, and LBP and groin pain severity. RESULTS Sixty percent of participants reported clinically significant LBP (n = 95). These participants reported worse iHOT33 scores (mean difference: 10.1 points) than those without clinically significant LBP (p = .001). Worse ODI scores were associated with worse iHOT33 scores (P < .001; ρ = -0.74). Significant relationships were also observed between (1) ODI and groin pain, (2) LBP and iHOT33, and (3) LBP and groin pain, but the magnitudes of these correlations were weak (ρ ≤ 0.36). CONCLUSIONS Clinically significant LBP is highly prevalent in persons with FAIS and is associated with worse hip function. Worse LBP-related disability, but not LBP severity, was strongly associated with worse hip function.
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Affiliation(s)
- Lindsey Brown-Taylor
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Haley Bordner
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kathryn Glaws
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Bryant Walrod
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Family Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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Nagamoto H, Abe M, Konashi Y, Kimura R, Takahashi M, Oizumi A. Rotation-related sports players demonstrate rotation-type lumbar spondylolysis fracture angle and decreased hip internal rotation range of motion. J Orthop 2021; 28:101-106. [PMID: 34898928 DOI: 10.1016/j.jor.2021.11.010] [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: 08/18/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
Relationship between sports and spondylolysis fracture angle (SFA), and hip internal rotation range of motion (IR ROM) between the sports groups among athletes with spondylolysis were investigated. Sports requiring repeated rotation of the trunk and hips during most aspects of the activity was defined as rotation-related sports (RRS). The SFA was defined as rotation-type or horizontal-type by using the axial view of the CT scan. Percentage of rotation type and SFA of the non-dominant side for RRS group was significantly greater than those of non-RRS group. Hip IR ROM of RRS group was significantly smaller than that of non-RRS group. Level of evidence Level IV.
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Affiliation(s)
- Hideaki Nagamoto
- Department of Orthopaedic Surgery, Tohoku University, Japan.,Department of Orthopaedic Surgery, Kurihara Centeral Hospital, Japan
| | - Masaya Abe
- Department of Physical Medicine and Rehabilitation, Tohoku University Hospital, Japan
| | - Yu Konashi
- Department of Rehabilitation, Kurihara Central Hospital, Japan
| | - Rei Kimura
- Department of Orthopaedic Surgery, Tohoku University, Japan.,Department of Orthopaedic Surgery, Kurihara Centeral Hospital, Japan
| | | | - Akira Oizumi
- Department of Orthopaedic Surgery, Kurihara Centeral Hospital, Japan
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Zaworski K, Gawlik K, Krȩgiel-Rosiak A, Baj-Korpak J. The effect of motor control training according to the Kinetic Control concept on the back pain of female football players. J Back Musculoskelet Rehabil 2021; 34:757-765. [PMID: 33896810 DOI: 10.3233/bmr-200226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Due to a significant burden associated with training sessions and matches, female football players often suffer from lumbar pain. Physical exercise is considered an effective form of therapy for this condition. The exercises in the Kinetic Control concept are one of the forms of motor control training. OBJECTIVE The aim of the study was to evaluate the effectiveness of motor control training according to the Kinetic Control concept on the level of lumbar spine pain, degree of disability, functional level and load distribution of lower limbs in football players. METHODS The study included 18 football players, randomly divided into two study groups: A - female players implementing their training plan with additional Kinetic Control training (n= 9) and B (control) - female players implementing their training plan only (n= 9). Pain intensity was measured using Visual Analogue Scale (VAS) and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). The asymmetry index was assessed in a balance test with open and closed eyes and a countermovement jump (CMJ). RESULTS There was a significant statistical difference between the groups (p< 0.05) in measurements using VAS, ODI and BPFS, in favor of group A. Asymmetry index values in tests on the dynamometer platform did not differ significantly between the groups (p> 0.05). A statistically significant correlation was found between the asymmetry index score in the closed-eye balance test (r= 0.567, p= 0.049) and the CMJ landing phase (r= 0.641, p= 0.033), and the level of pain measured using VAS. CONCLUSIONS Motor control training in the Kinetic Control concept reduced the pain symptoms of the lumbar spine and the degree of disability and increased the functional level in football female players.
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Cejudo A, Centenera-Centenera JM, Santonja-Medina F. The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168654. [PMID: 34444402 PMCID: PMC8393976 DOI: 10.3390/ijerph18168654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/05/2022]
Abstract
It is assumed that mechanical restriction of hamstring tightness disrupts sagittal spine–pelvis–leg alignment and alters the lumbar–pelvic rhythm predisposing to low back pain (LBP) in athletes; however, this association is not clear. A prospective cross-sectional cohort study was conducted to determine the influence of hamstring extensibility (HE) on sagittal pelvic tilt, sagittal spinal curves, and LBP in 94 soccer and basketball players (61 man and 33 woman) with (n = 36) and without recurrent LBP (n = 58). Descriptive analysis displayed significant gender differences for HE, sagittal pelvic tilt, and lumbar curve. Differences were found between the low-HE and high-HE groups in lumbosacral angle in for the maximum trunk forward flexion (LH-MTFP). Low-HE was associated with LH-MTFP, lumbar curve and LBP in male players (p ≤ 0.023). In female players, LH-MTFP and lumbar curve were associated with low-HE (p ≤ 0.020). Low-HE predicted LH-MTFP (p = 0.000; OR = 65.6950) and LBP (p = 0.028; OR = 13.915) in male players. The decision tree analysis showed that 50.8% of the players were classified with restricted LH-MTFP, 77.4% with low-HE among male players. The 100% of male players with recurrent LBP had low-HE. The 65% of female players with low-HE had restricted LH-MTFP. Measurement of HE, lumbar curve, and LH-MTFP are important in making training decisions for to reduce the incidence of recurrent LBP in soccer and basketball players.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-888-430 (A.C.); +34-972-204-350 (J.M.C.-C.)
| | - Josep María Centenera-Centenera
- Department of Surgery, Traumatology and Orthopedics, Bofill Clinic, 17002 Gerona, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-888-430 (A.C.); +34-972-204-350 (J.M.C.-C.)
| | - Fernando Santonja-Medina
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain;
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12
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Hatefi M, Babakhani F, Ashrafizadeh M. The effect of static stretching exercises on hip range of motion, pain, and disability in patients with non-specific low back pain. J Exp Orthop 2021; 8:55. [PMID: 34318348 PMCID: PMC8316530 DOI: 10.1186/s40634-021-00371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The benefits of providing static stretching exercise targeting the hips in patients with non-specific Low Back Pain (NSLBP) are not well established. The objective of the study was to verify the effects of static stretching on function, pain and range of motion on patients with non-specific Low Back Pain (NSLBP). Methods Thirty females with NSLBP were randomly assigned to two control (n = 15) and experimental (n = 15) groups. The experimental group received 3 stretch practice sessions per week for a period of 8 weeks. The Oswestry low back pain Disability Questionnaire (ODI), visual analog scale (VAS), and passive hip range of motion (PROM) were employed before and after the intervention. Results The results of mixed model analysis of variance indicate that the group × time interactions was not significant (p > 0.05) for all measurement outcomes. However, there was a main effect for Time (ODI: p = 0.002, VAS: p = 0.001, PROM-R: p = 0.016, PROM-L: p = 0.001). Such that the ODI, VAS, PROM-R, and PROM-L were showed significant differences before and after the intervention in the experimental group. Conclusions The results demonstrated a significant difference in PROM, pain, and disability after 8 weeks of stretching exercises in participants with NSLBP and limited hip extension. Therefore, it would be reasonable to infer that NSLBP might be partly related to hip flexors tightness.
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Affiliation(s)
- Mohamadreza Hatefi
- Department of Biomechanics and Sport Injuries, Faculty of Physical Education, Kharazmi University, Tehran, Iran.
| | - Farideh Babakhani
- Department of Sports Injury and Corrective Exercise, Faculty of Physical Education, Allameh Tabataba'i University, Tehran, Iran
| | - Mohadeseh Ashrafizadeh
- Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran
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Jin Y, Mao G, Yang C, Xia C, Chen C, Shi F, Chen Q. Establishment of a New Model of Lumbar Intervertebral Disc Degeneration With Pathological Characteristics. Global Spine J 2021; 13:984-994. [PMID: 33906472 DOI: 10.1177/21925682211012323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A prospective study. OBJECTIVES Intervertebral disc degenerative disease is a common and frequently-occurring disease in adults and is the main cause of lower back pain. However, there is a lack of universal animal models to study disc degeneration. METHODS Forty-two male New Zealand white rabbits aged 12 months were used in this study. We established an endplate ischemic disc degeneration model though surgical ligation of rabbit lumbar vertebral body segment arteries. Two weeks after surgery, 6 experimental animals were randomly selected for follow-up tests. First, ischemia and lumbar disc degeneration were confirmed using imaging techniques. Then, immunohistochemical staining was performed to observe the growth of the annulus fibrosus. Finally, quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, and western blotting were used to detect mRNA expression and protein content of IL-1α, TNFα, collagen II, MMP-3, aggrecan, and PLA2 in the nucleus pulposus of the disc. RESULTS Imaging examination confirmed the successful construction of a lumbar disc degeneration model. Histological analysis and biochemical analysis showed a damaged intervertebral disc structure, and collagen II and aggrecan, the key extracellular matrix components of intervertebral discs, were reduced in synthesis and content. The synthesis and expression of IL-1α, TNFα, PLA2, and MMP-3 related to disc catabolism and inflammatory response were enhanced. CONCLUSIONS We successfully constructed a lumbar disc degeneration ischemia model, which provides a novel approach to study the pathological mechanisms involved in discogenic low back pain and to prevent and treat discogenic low back pain.
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Affiliation(s)
- Yongming Jin
- Department of Orthopedic Surgery, 74678Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Guangfeng Mao
- Department of Orthopedic Surgery, The Third People's Hospital of Zhuji, Shaoxing, Zhejiang, People's Republic of China
| | - Chen Yang
- Department of Orthopedic Surgery, The First People's Hospital of Akesu, Akesu, Xinjiang, People's Republic of China
| | - Chen Xia
- Department of Orthopedic Surgery, 74678Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Chuyong Chen
- Department of Orthopedic Surgery, 74678Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Fangfang Shi
- Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Qi Chen
- Department of Orthopedic Surgery, 74678Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
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Kim WD, Shin D. Correlations Between Hip Extension Range of Motion, Hip Extension Asymmetry, and Compensatory Lumbar Movement in Patients with Nonspecific Chronic Low Back Pain. Med Sci Monit 2020; 26:e925080. [PMID: 32968039 PMCID: PMC7523415 DOI: 10.12659/msm.925080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to confirm the correlations among hip extension range of motion, hip extension asymmetry, pain intensity, disability index, and compensatory lumbar movement in patients with nonspecific chronic low back pain. MATERIAL AND METHODS Of 66 patients with nonspecific chronic low back pain and limited hip extension, 59 met the inclusion criteria and were enrolled in the study. Pain intensity, Oswestry Disability Index (ODI), hip range of motion, compensatory lumbar extension, and compensatory lumbar rotation of the subjects were assessed. Pain was measured using a numeric pain rating scale (NPRS), and hip extension range of motion and compensatory lumbar movement were evaluated using a digital dual inclinometer (Dualar IQ, JTech Medical, United States). Correlation analysis was used to analyze the data. RESULTS A strong correlation was observed among hip extension asymmetry, pain intensity, and disability index (P<0.05). However, no correlation was observed among compensatory lumbar rotation and extension, pain intensity, and ODI. A strong correlation also was observed between limited hip extension range of motion and compensatory lumbar rotation (P<0.05) but not between limited hip extension range of motion and compensatory lumbar extension (P>0.05). CONCLUSIONS The results of this study showed that hip extension asymmetry might be a more critical factor than hip extension range of motion. The strong correlation between limited hip extension and compensatory lumbar rotation suggests a risk of micro-trauma due to compensatory lumbar rotation.
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Affiliation(s)
- Won-deuk Kim
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - DooChul Shin
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, South Korea
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Cejudo A, Moreno-Alcaraz VJ, Izzo R, Santonja-Medina F, Sainz de Baranda P. External and Total Hip Rotation Ranges of Motion Predispose to Low Back Pain in Elite Spanish Inline Hockey Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134858. [PMID: 32640586 PMCID: PMC7369919 DOI: 10.3390/ijerph17134858] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022]
Abstract
Low back pain (LBP) is a common ailment in competitive athletes. Although the association between limited range of motion (ROM) and prevalence of LBP has been widely investigated in other sports, there is no research about this topic in inline hockey (IH). The main purposes of this study in IH players were (1) to analyze the association between hip ROM and LBP and (2) to establish a diagnostic cutoff for ROM of high risk of LBP. Twenty elite IH players from the two Spanish National Teams (male and female) were assessed for passive maximum hip ROMs; the movement evaluated were the hip external [HER] and internal [HIR] rotation, hip flexion with flexed [HF-KF] and extended [HF-KE] knee, hip adduction with flexed hip [HAD-HF], hip abduction with neutral [HAB] and flexed [HAB-HF] hip, and hip extension [HE]. LBP was retrospectively monitored for the last 12 months before the date of ROM assessment by using a questionnaire. The data were analyzed via a binary logistic regression and receiver operating characteristic curves. The 70% of players had developed LBP during the retrospective study period. Significant differences between LBP group and asymptomatic group for HER (p = 0.013, d [Cohen’s effect size] = 1.17) and hip total rotation [HTR] (p = 0.032, d [Cohen’s effect size] = 1.05) were observed. The cutoff points with the greatest discriminatory capacity were 56.5° for HER and 93° for HTR ROMs.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 San Javier (Murcia) C.P., Spain; (A.C.); (V.J.M.-A.)
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, 30720 Murcia, Spain;
| | - Víctor Jesús Moreno-Alcaraz
- Department of Physical Activity and Sport, Faculty of Sport sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 San Javier (Murcia) C.P., Spain; (A.C.); (V.J.M.-A.)
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, 30720 Murcia, Spain;
| | - Ricardo Izzo
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, 30720 Murcia, Spain;
- Dipartimento di Scienze Biomolecolari, Scuola di Scienze Motorie, Università degli Studi, 61029 Urbino C.P., Italy
| | - Fernando Santonja-Medina
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, 30720 Murcia, Spain;
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia C.P., Spain
- Traumatology and Orthopedic Surgery Service, Virgen de la Arrixaca University Clinical Hospital, 30120 El Palmar (Murcia) C.P., Spain
- Correspondence: (F.S.-M.); (P.S.d.B.); Tel.: +34-868-88-7159 (F.S.-M.); +34-868-88-7876 (P.S.d.B.)
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sport sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 San Javier (Murcia) C.P., Spain; (A.C.); (V.J.M.-A.)
- Sports and Musculoskeletal System Research Group (RAQUIS), University of Murcia, 30720 Murcia, Spain;
- Correspondence: (F.S.-M.); (P.S.d.B.); Tel.: +34-868-88-7159 (F.S.-M.); +34-868-88-7876 (P.S.d.B.)
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Tak IJR, Weerink M, Barendrecht M. Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study. Phys Ther Sport 2020; 45:30-37. [PMID: 32619846 DOI: 10.1016/j.ptsp.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility. DESIGN Cross-sectional. SETTING Judo training centres. PARTICIPANTS Judokas with (n = 29) and without (n = 33) LBP. MAIN OUTCOME MEASURES Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD). RESULTS The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP. CONCLUSION Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.
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Affiliation(s)
- I J R Tak
- Fysiotherapie Utrecht Oost, Bloemstraat 65d, 3581 WD, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - M Weerink
- Paramedisch Centrum Albergen, Albergen, Hoofdstraat 51, 7665 AN, the Netherlands; Avans+ Improving Professionals, Heerbaan 14/40, 4817 NL, Breda, the Netherlands
| | - M Barendrecht
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Avans+ Improving Professionals, Heerbaan 14/40, 4817 NL, Breda, the Netherlands; Mijn Fysio en Adviespunt, Rhijnvis Feithlaan 12, 2533 GE, Den Haag, the Netherlands
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Miyachi R, Miyazaki J. Relationship Between Lumbar Motor Control Ability and Spinal Curvature in Elderly Individuals. Healthcare (Basel) 2020; 8:healthcare8020130. [PMID: 32397367 PMCID: PMC7349748 DOI: 10.3390/healthcare8020130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
This study aimed to clarify the relationship between spine curvature and the movement pattern/motor control ability of the lumbar and hip joints during prone hip extension in elderly individuals. The participants were 14 elderly people who attended a community health class. We measured the motion angle, motion ratio (movement pattern), and motor control ability of the lumbar and hip joints during prone hip extension. In addition, the lumbar lordosis angle and thoracic kyphosis angle were measured in the standing position. There was no correlation between the spinal curvature in the standing position and the lumbar/hip joint movement pattern and motor control ability during prone hip extension. When evaluating the lumbar spine, it is necessary to perform a comprehensive evaluation by interpreting static evaluations such as spinal alignment or dynamic evaluations such as movement patterns and motor control abilities.
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Todd C, Karlsson J, Baranto A. Resolving anterior hip pain in a young male footballer following arthroscopic surgery for Femoroacetabular Impingement Syndrome: A case report. J Bodyw Mov Ther 2020; 24:63-68. [PMID: 31987564 DOI: 10.1016/j.jbmt.2019.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There appear to be limited studies available regarding the conservative management of patients following hip joint arthroscopic surgery, or investigating reasons for which patients still report hip and groin pain post surgery. OBJECTIVES Treatment was applied to restore spino-pelvic mechanics and to reduce soft tissue restrictions in hip joint motion. Neuromuscular movement control and work capacity exercises were encouraged to support the integrity of the hip joint and spino-pelvic complex. CLINICAL FEATURES A 22-year-old male footballer, (height 190cm and weight 82kg) presented reporting an eighteen-month history of hip and groin pain, having previously undergone bilateral arthroscopic surgery twelve months earlier for Femoroacetabular Impingement Syndrome. Strength measurements were recorded using the MicroFET 2 Wireless Digital Handheld Dynamometer. Trunk muscular endurance was evaluated with Sorenson test. RESULTS Five treatment consultations over a five-week period resulted in pain reduction, (Visual Analogue Scale 8/10 to 0/10). Improvement in range of motion, right hip flexion (70-100°) and left (80-100°), right internal rotation (30-45°) and left (40-45°). Improvement in strength, specifically right hip flexion (0.29-0.43Nm/kg, 48%) and right hip abduction (0.35-0.46Nm/kg, 31%). Improvement in trunk muscular endurance increased 41% from 170 seconds to 240 seconds. CONCLUSION This case report supports the rationale that the post arthroscopic management of Femoroacetabular Impingement Syndrome, should include both treatment to address spino-pelvic restrictions, if appropriate, combined with exercises that specifically target hip flexor strength. However, a larger randomized study would provide a clearer understanding for the management of this particular subset of patients.
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Affiliation(s)
- Carl Todd
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, Wiltshire, UK; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Moreno-Pérez V, López-Valenciano A, Ayala F, Fernandez-Fernandez J, Vera-Garcia FJ. Comparison of hip extension and rotation ranges of motion in young elite tennis players with and without history of low back pain. J Back Musculoskelet Rehabil 2019; 32:629-638. [PMID: 30614792 DOI: 10.3233/bmr-181296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although low back pain (LBP) is known to be multi-factorial, certain studies have suggested that a deficit in hip extension and rotation range of motion (ROM) may be associated with LBP in athletes. OBJETIVE The purpose of this study was to compare hip extension and rotation ROMs in elite tennis players with and without a history of LBP. METHODS Forty-two male and 22 female young elite tennis players completed this study. Participants were divided into two groups: (1) 32 with history of LBP and (2) 32 without history of LBP. Descriptive measures of passive hip extension and rotation ROMs of the dominant and non-dominant limbs were taken. Active hip rotation ROMs were also assessed. Magnitude-based inferences on differences between groups and legs were made by standardizing differences. RESULTS The inter-group statistical analysis reported no significant differences (p> 0.05; trivial effect with a probability higher than 95%; d⩽ 0.4) in any ROM measure analyzed. Further, neither LBP group nor control group reported significant bilateral or side-to-side differences (p> 0.05; trivial effect with a probability higher than 99%; d< 0.3) between legs regarding hip extension and rotation ROM measures. CONCLUSION No relationship between hip extension and rotation ROM and history of LBP was found.
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Affiliation(s)
- V Moreno-Pérez
- Department of Pathology and Surgery, Sport Research Centre, Miguel Hernández University of Elche, Sant Joan d'Alacant, Spain
| | - A López-Valenciano
- Department of Sport Science, Sport Research Centre, Miguel Hernández University of Elche, Elche (Alicante), Spain
| | - F Ayala
- Department of Sport Science, Sport Research Centre, Miguel Hernández University of Elche, Elche (Alicante), Spain
| | | | - F J Vera-Garcia
- Department of Sport Science, Sport Research Centre, Miguel Hernández University of Elche, Elche (Alicante), Spain
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Avman MA, Osmotherly PG, Snodgrass S, Rivett DA. Is there an association between hip range of motion and nonspecific low back pain? A systematic review. Musculoskelet Sci Pract 2019; 42:38-51. [PMID: 31030110 DOI: 10.1016/j.msksp.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/04/2019] [Accepted: 03/14/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP). DATA SOURCES MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018, using a combination of LBP and hip joint search terms. Commonly cited journals were also hand searched within the previous two years. STUDY SELECTION Two reviewers independently screened identified articles, by title and abstract and then by full-text. After first round screening of 2908 identified records, 248 progressed to full-text screening. Due to the heterogeneity of studies identified, post hoc inclusion criteria of English language, studies comparing subjects with NSLBP and healthy controls, cross-sectional design, and clinical measures of hip ROM were applied. Twenty-four records were finally included. DATA EXTRACTION Extracted data included population characteristics, duration and severity of NSLBP, hip movement direction, testing position, measurement tool and between-group difference. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for study bias. DATA SYNTHESIS Hip flexion ROM was measured in seven studies, extension in 13, internal rotation (IR) in 14, external rotation (ER) in 13, abduction in six, and adduction in only two studies. Among all directions tested, IR ROM was reported in more studies as significantly reduced in NSLBP subjects compared to healthy individuals. Overall the quality of evidence was very low. Common sources of study bias included lack of sample size justification, blinding of outcome assessors, adjusting for key confounders, and poor reporting. CONCLUSION There is very low-quality evidence to support an association between limited hip ROM and NSLBP. Limited hip IR ROM was the only movement impairment found to be significantly associated with NSLBP, however this should be viewed with caution due to the low-quality supportive evidence. Further studies are needed.
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Affiliation(s)
- Maya Abady Avman
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Suzanne Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Darren A Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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Campbell RS, Lehr ME, Livingston A, McCurdy M, Ware JK. Intrinsic modifiable risk factors in ballet dancers: Applying evidence based practice principles to enhance clinical applications. Phys Ther Sport 2019; 38:106-114. [PMID: 31078704 DOI: 10.1016/j.ptsp.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The risk of musculoskeletal injury is multifactorial (Bahr 2005). Injury risk is a composite of intrinsic and extrinsic risk factors that can be modifiable or non-modifiable. Ballet dancers have unique risk factors, due to the nature of their art and sport. The purpose of this literature review is to identify intrinsic modifiable risk factors for injury in ballet dancers. The secondary purpose is to investigate potential screening tools which can be used to identify these risk factors. METHODS The authors performed a review of the literature in October 2017 within the databases of MEDLINE Complete, SPORTDiscus, and PubMed Central following a list of inclusion and exclusion criteria. RESULTS A review of the available literature identified seven intrinsic modifiable factors specifically for ballet dancers and seven appropriate screening tools. DISCUSSION The literature identified the most common intrinsic modifiable risk factors associated with ballet dancers to be: hypermobility, fatigue, overuse, neuromuscular dysfunction, degree of turnout, weakness of core and lower extremity musculature, and lower extremity range of motion (ROM) discrepancies. CONCLUSION Sports medicine professionals who manage these performing artists can use this literature review to help develop injury prevention programs and enhance return to sport decision.
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Affiliation(s)
| | - Michael E Lehr
- Lebanon Valley College, Department of Physical Therapy, 101 North College Avenue, Annville, PA, 17003-1400, USA
| | - Andrew Livingston
- Lebanon Valley College, Department of Physical Therapy, 101 North College Avenue, Annville, PA, 17003-1400, USA
| | - Meghan McCurdy
- Lebanon Valley College, Department of Physical Therapy, 101 North College Avenue, Annville, PA, 17003-1400, USA
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Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain. J Orthop Sports Phys Ther 2019; 49:437-452. [PMID: 31092126 DOI: 10.2519/jospt.2019.8451] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient. J Orthop Sports Phys Ther 2019;49(6):437-452. Epub 15 May 2019. doi:10.2519/jospt.2019.8451.
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Abstract
STUDY DESIGN A prospective cross-sectional study. OBJECTIVE The aim of this study was to evaluate the prevalence and associated factors with low back pain (LBP) in female adolescents of high school age. SUMMARY OF BACKGROUND DATA The prevalence of LBP in Tehran is high, and the majority of previous studies on LBP in adolescent and its risk factors have been performed in the developed countries. Therefore, identification of risk factors and planning appropriate protocols for prevention of LBP in adolescents may substantially decrease the prevalence of LBP and its burden in developing countries in future. METHODS In a prospective cross-sectional study, demographic characteristics, including age, body mass index (BMI), weight and mode of using backpack, family history of LBP in first degree relatives, and passive smoking status of the participants along with a history of LBP were recorded. Joint hypermobility was assessed using Beighton scale. Also, anthropometric measurements, spinal flexion, and hip joint range of motion were measured for each participant. RESULTS In total, 372 students participated in the study. The mean (SD) age of the participants was 15.8 (0.9) years. The lifetime, more than 3 months, and last month history of LBP was 46.2%, 11.6%, and 31.2%, respectively. Positive history of LBP in the first-degree relatives was significantly associated with LBP in the participants (P < 0.01). The prevalence of passive smoking was significantly higher in the participants with last month history of LBP (P = 0.03). The prevalence of joint hypermobility was 15.9% and was significantly higher in those with the lifetime and last month history of LBP (P < 0.01). CONCLUSION LBP is a common complaint among adolescent and high school girl students. The results of this study identified the prevalence and associated factors with LBP in high school students and will help develop strategies for prevention and treatment of LBP in the adolescent population. LEVEL OF EVIDENCE 3.
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Cannon A, Finn K, Yan Z. COMPARISON OF HIP INTERNAL AND EXTERNAL ROTATION BETWEEN INTERCOLLEGIATE DISTANCE RUNNERS AND NON-RUNNING COLLEGE STUDENTS. Int J Sports Phys Ther 2018; 13:956-962. [PMID: 30534461 PMCID: PMC6253754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The increased incidence of lower extremity injury in runners compared to the general population is well documented. The amount of passive hip rotation and the position of hip flexion or extension at which it occurs may be factors related to injury incidence. PURPOSE The purpose of the current study was to measure and compare hip rotation passive range of motion in male and female runners and non-runners at 0 and 90 degrees (°) of hip flexion. STUDY DESIGN Descriptive Laboratory Study. METHODS Eighteen Division II collegiate distance runners (9 female, 9 male, mean age = 19.1, +/- 1.1 years) who had run for an average of 7.1 (SD = 1.7) years participated in the study. Twenty non-runners (10 female, 10 male, mean age = 19.6, +/- 1.1 years) from the same institution were also recruited. Passive hip internal rotation (IR) and external rotation (ER) were measured with a universal goniometer in 90 ° of hip flexion in a seated position, and in 0 ° of hip flexion in prone position. RESULTS There was a significant difference in IR measured in 0 ° of hip flexion, between runners and non-runners (F(1,37) = 8.04, p = .007). Additionally, the difference in IR between males (36.68 + /-9.19 degrees) and females (45.99 + /- 9.12) was significantly different (F(1,37) = 20.79, p = .001). There were no other statistically significant differences in measurements between groups. CONCLUSIONS Collegiate runners had significantly greater passive hip IR when measured at 0 ° of hip flexion compared to the non-runners. Female runners had significantly greater passive hip IR compared to the male participants across both runners and non-runners. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Andrew Cannon
- Merrimack College, School of Health Sciences, North Andover, MA, USA
| | - Kevin Finn
- Merrimack College, School of Health Sciences, North Andover, MA, USA
| | - Zi Yan
- Merrimack College, School of Health Sciences, North Andover, MA, USA
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Tsang SM, Lam AH, Ng MH, Ng KW, Tsui CO, Yiu B. Abdominal muscle recruitment and its effect on the activity level of the hip and posterior thigh muscles during therapeutic exercises of the hip joint. J Electromyogr Kinesiol 2018; 42:10-19. [DOI: 10.1016/j.jelekin.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 04/06/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022] Open
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Gwon AJ, Kim SY, Oh DW. Effects of integrating Neurac vibration into a side-lying bridge exercise on a sling in patients with chronic low back pain: a randomized controlled study. Physiother Theory Pract 2018; 36:907-915. [DOI: 10.1080/09593985.2018.1513616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ae-Jeong Gwon
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea
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Flores-León A, Redenz G, Valencia OD, Guzmán-Venegas R, Araneda OF, Berral de la Rosa F. Coordination of the rotational movement of the pelvis and the hip in men without low back pain, with control impairment of the lumbopelvic region in the sagittal plane. Physiother Theory Pract 2018; 36:810-817. [PMID: 30130429 DOI: 10.1080/09593985.2018.1510451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose To assess the presence of control impairment (CI) of the lumbopelvic region in the axial plane in men without low back pain (LBP) with CI in the sagittal plane. Methods : Twenty-four males, between 18 and 23 of age, BMI = normal, who did not report episodes of LBP in the 12 months prior to the study, were studied. Assessment of the sagittal control of the lumbopelvic region was performed during stand to sit. Nine participants demonstrated CI in sagittal plane and 15 did not. An active hip lateral rotation (HLR) test was performed, in which lumbopelvic rotation during HLR was assessed using a three-dimensional motion analysis system. Results : Patients with CI in sagittal plane had a greater percentage of their total lumbopelvic pelvic rotation at 60% of HLR range compared to those without CI (p < 0.05; d = 0.93). No significant differences in the total lumbopelvic and HLR range of motion were found between the groups. Conclusion : Men without LBP who experience CI of the lumbopelvic region in the sagittal plane also show CI in the axial plane. The control deficiencies were not related to the total range of lumbopelvic or HLR range of motion.
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Affiliation(s)
- Andres Flores-León
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Gunther Redenz
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Oscar David Valencia
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Oscar Florencio Araneda
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Francisco Berral de la Rosa
- Department of Sport and informatics. Biomechanics, Kinesiology and Kinanthropometry Laboratory, Universidad Pablo de Olavide , Sevilla, Spain
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Smith JA, Hawkins A, Grant-Beuttler M, Beuttler R, Lee SP. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Sports Health 2018; 10:538-546. [PMID: 30130164 PMCID: PMC6204638 DOI: 10.1177/1941738118795425] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data Sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study Selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, California
| | | | - Marybeth Grant-Beuttler
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, California
| | | | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, Nevada
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Jung SH, Kwon OY, Yi CH, Cho SH, Jeon HS, Weon JH, Hwang UJ. Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: The STROBE study. Medicine (Baltimore) 2018; 97:e11363. [PMID: 30024508 PMCID: PMC6086501 DOI: 10.1097/md.0000000000011363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Findings about predictors of chronic lower-back pain (CLBP) were inconsistent and inconclusive in previous studies because patients with CLBP are heterogeneous. Subgrouping patients with CLBP, according to a CLBP classification system, might thus clarify the research findings. CLBP in the direction of lumbar flexion movement, that is, the flexion pattern, is common in clinical situations. Therefore, the purpose of this study was to determine the predictors of dysfunction (pain, disability) and health-related quality of life in the flexion pattern subgroup of patients with CLBP.A cross-sectional study of prospectively collected data. One hundred eight subjects in the flexion pattern subgroup of CLBP. Thirteen variables were measured: the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Short Form-36 (SF-36), the Beck Depression Inventory (BDI), hip internal rotation range of motion, hip flexion range of motion, knee extension range of motion, knee extension with dorsiflexion range of motion, ratio forward flexion, knee extension strength, hip extension strength, hip flexion strength, and lumbopelvic stability.The models for predictors of lower-back pain in the CLBP flexion pattern subgroup included knee extension and the BDI as predictor variables that accounted for 8.1% of the variance in the VAS (P < .05); predictors for disability included the BDI, age, and hip flexion strength, which accounted for 21.2% of the variance in the ODI (P < .05); predictors for health-related quality of life included the BDI, sex, knee extension with dorsiflexion range of motion, and age, which accounted for 38.8% of the variance in the SF-36 (P < .05) in multiple regression models with a stepwise selection procedure.The current results suggest that knee extension, the BDI, age, hip flexion strength, knee extension with dorsiflexion, and sex should be considered when determining appropriate prediction, prevention, and intervention in the flexion pattern subgroup of patients with CLBP.
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Affiliation(s)
- Sung-hoon Jung
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
| | - Oh-yun Kwon
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
| | | | | | | | - Jong-hyuck Weon
- Department of Physical Therapy, Graduate School, Joongboo University, Geumsan, South Korea
| | - Ui-jae Hwang
- Department of Physical Therapy
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju
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Todd C, Aminoff AS, Agnvall C, Thoreson O, Swärd L, Karlsson J, Baranto A. No difference in prevalence of spine and hip pain in young Elite skiers. Knee Surg Sports Traumatol Arthrosc 2018; 26:1959-1965. [PMID: 29204863 PMCID: PMC6061433 DOI: 10.1007/s00167-017-4733-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the prevalence between back and hip pain in young Elite skiers. METHODS Sample group (n = 102), consisted of young Elite skiers (n = 75) and age-matched non-athletes (n = 27), all completed a three-part back and hip pain questionnaire, Oswestry Disability Index and EuroQoL to evaluate general health, activity level, back and hip pain prevalence. RESULTS No significant differences were shown for lifetime prevalence of back pain in the skiers (50%) compared with controls (44%) (n.s.). Duration of back pain for the skiers showed (30%) > 1 year, whilst (46%) > 5 years. A significant difference was shown with increased Visual Analogue Scale back pain levels for skiers 5.3 (SD 3.1) compared with controls 2.4 (SD 1.9, p = 0.025). No significant differences were shown for lifetime prevalence of hip pain in skiers (21%) compared with controls (8%) (n.s.). CONCLUSION Young Elite skiers are shown not to have increased lifetime prevalence for back and hip pain compared with a non-athletic control group. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden.
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, SN13 0HN, UK.
| | - Anna Swärd Aminoff
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Cecilia Agnvall
- Sportsmedicine Åre and Åre Ski High School, Göthenburg, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Leif Swärd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
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Rosenhagen A, Niederer D, Vogt L, Banzer W. Knee misalignment and exercise amount: Predictive value for chronic low back pain in young competitive athletes. Hum Mov Sci 2018; 57:178-183. [DOI: 10.1016/j.humov.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 01/30/2023]
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Sung PS, Danial P. Gender difference of shoulder-pelvic kinematic integration for trunk rotation directions in healthy older adults. Clin Biomech (Bristol, Avon) 2017; 50:56-62. [PMID: 28987872 DOI: 10.1016/j.clinbiomech.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The trunk coordination pattern has been extensively studied, and there is a higher pain prevalence and asymmetry in female older adults. However, there is a lack of investigation of different directions of trunk rotation and asymmetrical compensatory strategies of motor control between genders. The purpose of this study was to investigate shoulder and pelvic ranges of motion (ROM) as well as relative phases (RP) for the different directions of trunk rotation between genders in healthy older adults. METHODS There were 62 right hand dominant older adults in this study (31 female subjects (68.4 [5.62]years) and 31 male subjects (68.7 [5.68]years)). The participants performed trunk axial rotation from the left to the right direction (RP1) and then returned to the left side (RP2), three times repeatedly in standing. The measurements included shoulder and pelvic ROM, RP1, and RP2. The RP was defined as the average absolute relative phase, which was the difference between the phase angle of the shoulder and the phase angle of the pelvis during trunk rotation. FINDINGS The female group demonstrated significantly greater pelvic rotation compared to the male group (98.64 [24.67] vs. 86.96 [18.97]; t=2.09, p=0.04) during trunk rotation. The pelvic ROM demonstrated a significant positive correlation with shoulder ROM in both genders; however, the RP was negatively correlated with the pelvis. For pelvic rotation, the male group demonstrated a negative correlation with RP1 (r=-0.68, p<0.01) and RP2 (r=-0.60, p<0.01) while the female group demonstrated a negative correlation with RP2 (r=-0.53, p<0.01). The ageing factor demonstrated negative correlations with ROM for the shoulder and pelvis in both genders. INTERPRETATION Although no gender difference was indicated on the direction of RP, the pelvic ROM was significantly lesser in the male group. The male group demonstrated lesser pelvic rotation in both directions of rotation; however, the female group showed lesser pelvic rotation in RP2. The male group demonstrated stiffened pelvic rotation and greater shoulder rotation in both directions while the female group demonstrated pelvic stiffness only in the direction from right to left rotation. Clinicians need to consider this directional asymmetry of trunk rotation to enhance integrated shoulder-pelvic coordination in female older adults. MINI ABSTRACT A coordinative pattern of different directions of trunk rotation was investigated in healthy older adults. The pelvic range of motion was lesser in the male group compared with the female group. The female group demonstrated pelvic stiffness only in the direction from right to left rotation, while the male group demonstrated pelvic stiffness in both directions. Clinicians need to understand the gender difference of directional coordination as integrated coordination in female older adults.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, United States.
| | - Pamela Danial
- Department of Physical Therapy, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, United States
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Short S, Short G, Strack D, Anloague P, Brewster B. A COMBINED TREATMENT APPROACH EMPHASIZING IMPAIRMENT-BASED MANUAL THERAPY AND EXERCISE FOR HIP-RELATED COMPENSATORY INJURY IN ELITE ATHLETES: A CASE SERIES. Int J Sports Phys Ther 2017; 12:994-1010. [PMID: 29158960 PMCID: PMC5675375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND/PURPOSE Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control. CASE DESCRIPTIONS Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise. OUTCOMES Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention. DISCUSSION The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons. CONCLUSION Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain. LEVEL OF EVIDENCE Therapy, Level 4, Case Series.
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Affiliation(s)
- Steve Short
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
| | | | - Donald Strack
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
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Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther 2017; 21:391-399. [PMID: 29097026 PMCID: PMC5693453 DOI: 10.1016/j.bjpt.2017.08.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment. OBJECTIVES This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide the current research on movement system impairment syndromes. RESULTS The conceptual basis of the movement system impairment syndromes is that sustained alignment in a non-ideal position and repeated movements in a specific direction are thought to be associated with several musculoskeletal conditions. Classification into movement system impairment syndromes and treatment has been described for all body regions. The classification involves interpreting data from standardized tests of alignments and movements. Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns. The reliability and validity of movement system impairment syndromes have been partially tested. Although several case reports involving treatment using the movement system impairment syndromes concept have been published, efficacy of treatment based on movement system impairment syndromes has not been tested in randomized controlled trials, except in people with chronic low back pain.
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Affiliation(s)
- Shirley Sahrmann
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, USA.
| | - Daniel C Azevedo
- Universidade Cidade de São Paulo (UNICID), Masters and Doctoral Programs in Physical Therapy, São Paulo, SP, Brazil; Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil
| | - Linda Van Dillen
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, USA
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Investigating the Association Between Lower Extremity and Low Back Symptoms Among Saskatchewan Farmers Using the Standardized Nordic Questionnaire. Spine (Phila Pa 1976) 2017; 42:E1147-E1154. [PMID: 28187075 DOI: 10.1097/brs.0000000000002113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE The aim of this study was to investigate the association between self-reported low back symptoms and symptoms in the hip, knee, and ankle in a high-risk occupational group. SUMMARY OF BACKGROUND DATA Low back pain, with or without lower extremity referral, poses a major challenge to occupational productivity, especially in farming. Although low back symptoms can occur independent of lower extremity symptoms, anatomical positioning of nerves supplying the lower limbs means structural and physiological changes in the spine can lead to referred pain in the lower limbs, but the magnitude of the association between low back and lower extremity symptoms is unclear. METHODS Baseline postal questionnaire data from the Saskatchewan Farm Injury Cohort Study yielded surveys from 2653 adults from 1020 farms, who responded to Standardized Nordic Questionnaire (SNQ) items on "ache, pain, discomfort" in nine body parts during the last 12 months. Bivariate and multivariate regression modeling was performed with low back symptoms as the outcome and lower extremity symptoms as the independent variable. RESULTS After adjustment for age, sex, depression, and heavy lifting, low back symptom was significantly related with hip pain (odds ratio [OR] = 3.84, 95% confidence interval [CI] 3.04-4.84), knee pain (OR = 1.84, 95% CI 1.49-2.28), and ankle pain (OR = 1.79, 95% CI 1.40-2.29). Results showed a significant but decreasing relationship to low back symptoms as sites became more distal. CONCLUSION Hip and low back symptoms are highly associated, suggesting a common mechanism may be at work. Although there appears be increased risk of knee and ankle region symptoms among those with back pain, the SNQ is not designed to differentiate types of referred symptoms (i.e., numbness, tingling, shooting pain) and/or clinical diagnoses. Other tools, possibly corroborated with clinical examination findings, are likely necessary for a more thorough investigation of referred pain patterns in this high-risk occupational group. LEVEL OF EVIDENCE 3.
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Hernandez A, Gross K, Gombatto S. Differences in lumbar spine and lower extremity kinematics during a step down functional task in people with and people without low back pain. Clin Biomech (Bristol, Avon) 2017; 47:46-52. [PMID: 28600994 DOI: 10.1016/j.clinbiomech.2017.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND When functional movements are impaired in people with low back pain, they may be a contributing factor to chronicity and recurrence. The purpose of the current study was to examine lumbar spine, pelvis, and lower extremity kinematics during a step down functional task between people with and without a history of low back pain. METHODS A 3-dimensional motion capture system was used to analyze kinematics during a step down task. Total excursion of the lumbar spine, pelvis, and lower extremity segments in each plane were calculated from the start to end of the task. Separate analysis of variance tests (α=0.05) were conducted to determine the effect of independent variables of group and plane on lumbar spine, pelvis, and lower extremity kinematics. An exploratory analysis was conducted to examine kinematic differences among movement-based low back pain subgroups. FINDINGS Subjects with low back pain displayed less lumbar spine movement than controls across all three planes of movement (P-values=0.001-0.043). This group difference was most pronounced in the sagittal plane. For the lower extremity, subjects with low back pain displayed more frontal and axial plane knee movement than controls (P-values=0.001). There were no significant differences in kinematics among movement-based low back pain subgroups. INTERPRETATION People with low back pain displayed less lumbar region movement in the sagittal plane and more off-plane knee movements than the control group during a step down task. Clinicians can use this information when assessing lumbar spine and lower extremity movement during functional tasks, with the goal of developing movement-based interventions.
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Affiliation(s)
- Alejandra Hernandez
- San Diego State University, Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Karlie Gross
- San Diego State University, Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Sara Gombatto
- San Diego State University, Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182, USA.
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Local dynamic stability of the spine and its coordinated lower joints during repetitive Lifting: Effects of fatigue and chronic low back pain. Hum Mov Sci 2017; 54:339-346. [DOI: 10.1016/j.humov.2017.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/29/2017] [Accepted: 06/25/2017] [Indexed: 11/20/2022]
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Answer to the Letter to the Editor of R. K. Rajnish et al. concerning "The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis" by W. Weng et al. Eur Spine J (2016);25(11):3608-3614. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2212-2213. [PMID: 28547572 DOI: 10.1007/s00586-017-5138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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Miller E, Sahrmann SA, Avers D. A Movement system impairment approach to evaluation and treatment of a person with lumbar radiculopathy: A case report. Physiother Theory Pract 2017; 33:245-253. [PMID: 28339334 DOI: 10.1080/09593985.2017.1282997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE There are several systems of classification and treatment of patients with low back pain (LBP) based on assessment of the effect of lumbar postures and movements on symptoms. The efficacy of one of these systems, The Movement System Impairment (MSI) method, has not yet been demonstrated in the literature. The purpose of this case report is to describe the approach of the MSI method for an individual with lumbar radiculopathy. CASE DESCRIPTION A 79-year-old woman with a history of chronic LBP was referred to PT with a physician's diagnosis of sciatica. The patient was classified utilizing a standardized MSI evaluation. She was instructed to modify her daily postures and movements, as well as perform specific exercises to address these impairments. OUTCOMES Her Oswestry LBP disability score improved by over 30% and pain level per the NPRS improved by 3 out of 10 points. DISCUSSION Despite the challenges of advanced joint degeneration and neurological involvement, this approach of identifying and addressing specific movement impairments appeared helpful for this older individual.
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Affiliation(s)
| | - Shirley A Sahrmann
- b School of Medicine- Physical Therapy, Washington University , St Louis , MO , USA
| | - Dale Avers
- c Physical Therapy Education, College of Health Professions SUNY Upstate Medical University , Syracuse , NY , USA
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Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain, With or Without Lower Extremity Pain. J Orthop Sports Phys Ther 2017; 47:163-172. [PMID: 28158964 PMCID: PMC8898168 DOI: 10.2519/jospt.2017.6567] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Prospective cohort study, cross-sectional design. Background The hip-spine syndrome is described in patients with known arthritis of the hip. This study describes the hip examination findings of people presenting with low back pain (LBP). Objectives To (1) report examination findings of the hip in patients with LBP and (2) compare pain and function in patients with positive hip examination findings to those in patients without positive hip examination findings. Methods An examination and validated questionnaires of spine and hip pain and function were completed. Pain and function scores were compared between patients with and without positive hip findings. Results Consecutive patients (68 women, 33 men) with a mean age of 47.6 years (range, 18.4-79.8 years) participated. On physical examination, 81 (80%) had reduced hip flexion; 76 (75%) had reduced hip internal rotation; and 25 (25%) had 1, 32 (32%) had 2, and 23 (23%) had 3 positive provocative hip tests. Patients with reduced hip flexion had worse LBP-related (mean modified Oswestry Disability Index, 35.3 versus 25.6; P = .04) and hip-related function (mean modified Harris Hip Score, 66.0 versus 82.0; P = .03). Patients with reduced hip internal rotation had worse LBP-related function (mean Roland-Morris questionnaire, 12.4 versus 8.2; P = .003). A positive provocative hip test was coupled with more intense pain (median, 9 versus 7; P = .05) and worse LBP-related (mean Roland-Morris questionnaire, 12.1 versus 8.5; P = .02) and hip-related function (mean modified Harris Hip Score, 65.8 versus 89.7; P = .005). Conclusion Physical examination findings indicating hip dysfunction are common in patients presenting with LBP. Patients with LBP and positive hip examination findings have more pain and worse function compared to patients with LBP but without positive hip examination findings. Level of Evidence Symptom prevalence, level 1b. J Orthop Sports Phys Ther 2017;47(3):163-172. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6567.
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Spine Kinematics During Prone Extension in People With and Without Low Back Pain and Among Classification-Specific Low Back Pain Subgroups. J Orthop Sports Phys Ther 2016; 46:571-9. [PMID: 27170528 DOI: 10.2519/jospt.2016.6159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional observational design. Background Spine extension is used in physical therapy during examination and treatment for low back pain (LBP). However, kinematics during prone extension have not been examined using 3-D motion capture. Objectives The primary purpose was to determine differences in spine kinematics during prone extension between subjects with and without LBP. An exploratory analysis was conducted to examine kinematic differences among LBP subgroups. Methods Kinematics of the thoracic and lumbar spine were examined during prone extension, using optical motion capture, in 18 subjects with LBP and 17 subjects without LBP (control group). Excursion of each spinal region was calculated for the entire movement and during 25% increments of extension movement duration. Subjects with LBP were examined and assigned to subgroups using 3 different classification systems for LBP. Repeated-measures analysis-of-variance tests were used to examine effects of group (LBP, control), spine region, and increment of movement duration, and to explore effects of LBP subgroup. Results For spine kinematics, there was a significant group-by-region interaction effect (P<.05). Subjects with LBP displayed less lower lumbar extension (13.3° ± 4.9°) than control subjects (21.4° ± 9.2°). The majority of lower lumbar extension occurred during the first 50% of the motion for subjects with LBP. Subgroup-by-region interaction effects were significant for 2 of 3 LBP classification systems (P<.05). Conclusion Subjects with LBP displayed less lower lumbar extension than control subjects during prone extension. These differences should be considered when evaluating and prescribing prone extension. The interpretation of subgroup differences with prone extension kinematics is limited in the current study by the small sample size, but may need to be considered in future studies of spine kinematics. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(7):571-579. Epub 12 May 2016. doi:10.2519/jospt.2016.6159.
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Association Between Farm Machinery Operation and Low Back Disorder in Farmers: A Retrospective Cohort Study. J Occup Environ Med 2016; 58:e212-7. [PMID: 27206126 DOI: 10.1097/jom.0000000000000746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The association between whole body vibration (WBV) as measured by annual accumulated use of all-terrain vehicles (ATV)/combine/tractor operation and low back disorders (LBDs) among farmers was investigated. METHODS Saskatchewan Farm Injury Cohort Study data was used. Baseline data were collected in 2007 on the three vehicle types and other factors. Follow-up data on LBD symptoms were collected during 2013 resulting in 1149 samples. RESULTS Adjusted for age, education, and gender, LBDs were associated with tractor operation for 1 to 150 hours/year (Relative Risk [RR] = 1.23, 95%CI 1.05 to 1.44), 151 to 400 hours/year (RR = 1.32, 95%CI 114 to 1.54) and 401+ hours/year (RR = 1.34, 95%CI 1.15 to 1.56). Additionally, hip symptoms were associated with tractor operation. Only unadjusted associations were found in combine and ATV operation. CONCLUSIONS Duration of tractor operation and older age are important predictors of both low back and hip symptoms in farmers.
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Diagnosis and Treatment of Hip Girdle Pain in the Athlete. PM R 2016; 8:S45-60. [DOI: 10.1016/j.pmrj.2015.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/03/2015] [Accepted: 12/18/2015] [Indexed: 01/27/2023]
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The effect of total hip arthroplasty on sagittal spinal–pelvic–leg alignment and low back pain in patients with severe hip osteoarthritis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3608-3614. [DOI: 10.1007/s00586-016-4444-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
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Nagai T, Abt JP, Sell TC, Keenan KA, Clark NC, Smalley BW, Wirt MD, Lephart SM. Lumbar spine and hip flexibility and trunk strength in helicopter pilots with and without low back pain history. Work 2015; 52:715-22. [DOI: 10.3233/wor-152192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Takashi Nagai
- Warrior Human Performance Research Center, Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, USA
| | - John P. Abt
- College of Health Sciences, University of Kentucky, KY, USA
| | - Timothy C. Sell
- Warrior Human Performance Research Center, Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, USA
| | - Karen A. Keenan
- Warrior Human Performance Research Center, Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, USA
| | - Nicholas C. Clark
- School of Sport, Health and Applied Science, St Mary’s University, UK
| | | | - Michael D. Wirt
- US Army Institute of Surgical Research, Fort Sam Houston, TX, USA
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Roach SM, San Juan JG, Suprak DN, Lyda M, Bies AJ, Boydston CR. Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. Int J Sports Phys Ther 2015; 10:13-20. [PMID: 25709858 PMCID: PMC4325283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Non-specific low back pain is a common condition often without a clear mechanism for its presentation. Recently more attention has been placed on the hip and its potential contributions to non-specific chronic low back pain (NSCLBP). Emphasis in research has mainly been placed on motor control, strength and endurance factors in relation to NSCLBP. Limited focus has been placed on hip mobility and its potential contribution in subjects with NSCLBP. PURPOSE/AIM The aim of this study was to compare passive ROM in hip extension, hip internal rotation, hip external rotation and total hip rotation in active subjects with NSCLBP to healthy control subjects. The hypothesis was that active subjects with NSCLBP would present with decreased total hip ROM and greater asymmetry when compared to controls. DESIGN Two group case controlled. SETTING Clinical research laboratory. PARTICIPANTS 30 healthy subjects without NSCLBP and 30 active subjects with NSCLBP. Subjects categorized as NSCLBP were experiencing pain in the low back area with or without radicular symptoms of greater than three months duration. MAIN OUTCOME MEASURE Passive hip extension (EXT), hip internal rotation (IR), hip external rotation (ER) and total hip rotation ROM. A digital inclinometer was used for measurements. RESULTS There was a statistically significant difference (p<0.001) in hip passive extension ROM between the control group and the NSCLBP group bilaterally. Mean hip extension for the control group was 6.88 bilaterally. For the NSCLBP group, the mean hip extension was -4.28 bilaterally. This corresponds to a difference of means between groups of 10.88. There was no statistically significant differences (p>0.05) in hip IR, ER, or total rotation ROM between groups. CONCLUSIONS The results of this study indicate that a significant difference in hip extension exists in active subjects with NSCLBP compared to controls. It may be important to consider hip mobility restrictions and their potential impact on assessment of strength in NSLBP subjects. Future studies may be needed to investigate the relationship between measurements and intervention strategies. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Sean M Roach
- Western Institute of Neuromechanics Eugene, OR USA
| | - Jun G San Juan
- Western Washington University, Department of Physical Education, Health and Recreation Bellingham, WA USA
| | - Dave N Suprak
- Western Washington University, Department of Physical Education, Health and Recreation, Bellingham, WA USA
| | - Marc Lyda
- Western Institute of Neuromechanics Eugene, OR USA
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Shimamura KK, Cheatham S, Chung W, Farwell D, De la Cruz F, Goetz J, Lindblom K, Powers D. Regional interdependence of the hip and lumbo-pelvic region in divison ii collegiate level baseball pitchers: a preliminary study. Int J Sports Phys Ther 2015; 10:1-12. [PMID: 25709857 PMCID: PMC4325282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Pitchers may be at greater risk of injury in comparison to other overhead throwing athletes due to the repetition of the pitching motion. It has been reported that approximately 30% of all baseball injuries occur in the lower body. This may be related to limited hip mobility, which can compromise pitching biomechanics while placing excessive stress on the trunk and upper quarter. Hip motion and strength measurements have been reported in professional baseball pitchers but have not been reported in collegiate pitchers. PURPOSE The purpose of this study was to report preliminary findings for passive hip motion and isometric hip muscle strength in collegiate pitchers and compare them to previously published values for professional level pitchers. STUDY DESIGN Cross sectional study. METHODS Twenty-nine collegiate baseball pitchers (age = 20.0 + 1.4 years, height = 1.88 + 0.06 m; weight = 89.3 + 10.7 kg; body mass index = 25.3 + 2.5 kg/m2) were recruited. Subjects were assessed for hip internal rotation (IR) and external rotation (ER) passive motion, hip anteversion or retroversion, gluteus maximus, gluteus medius, hip internal rotator, hip external rotator strength, and lumbo-pelvic control with the prone active hip rotation test as described by Sahrmann. Statistical analysis included calculation of subject demographics (means and SD) and use of a two-tailed t-test (p >0.05). RESULTS Fifty-two percent of the right-handed and 50% of the left-handed pitchers demonstrated poor lumbo-pelvic motor control with an inability to stabilize during active hip IR and ER even though isolated strength deficits were not detected at a significant level. There were no significant differences in hip passive motion or gluteus medius strength between right and left-handed pitchers. Differences did exist between collegiate data and previously published values for professional pitchers for IR motion measured in prone and gluteus maximus strength. Hip retroversion was present in 55% of the pitchers primarily in both limbs with four of the pitchers presenting with retroversion singularly in either the stride or trail limb where the ER rotation motion was greater than the IR. CONCLUSION Assessing mobility and muscle strength of the lower quarter in isolation can be misleading and may not be adequate to ensure the potential for optimal pitching performance. These findings suggest that lumbo-pelvic control in relation to the lower extremities should be assessed as one functional unit. This is the first study to explore hip motion, strength, and lumbo-pelvic control during active hip rotation in collegiate baseball pitchers. EVIDENCE LEVEL 2.
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Affiliation(s)
| | - Scott Cheatham
- Division of Kinesiology and Recreation, California State University Dominguez Hills, Carson, CA USA
| | - Wendy Chung
- Department of Physical Therapy, Azusa Pacific University, Azusa CA, USA
| | - Daniel Farwell
- Department of Physical Therapy, Azusa Pacific University, Azusa CA, USA
| | | | - Jennifer Goetz
- Department of Physical Therapy, Azusa Pacific University, Azusa CA, USA
| | - Kaleigh Lindblom
- Department of Physical Therapy, Azusa Pacific University, Azusa CA, USA
| | - Darcy Powers
- Department of Physical Therapy, Azusa Pacific University, Azusa CA, USA
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Bussey MD, Milosavljevic S. Asymmetric pelvic bracing and altered kinematics in patients with posterior pelvic pain who present with postural muscle delay. Clin Biomech (Bristol, Avon) 2015; 30:71-7. [PMID: 25467764 DOI: 10.1016/j.clinbiomech.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/14/2014] [Accepted: 11/02/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to examine the muscle activity and hip-spine kinematics in a group of individuals diagnosed with posterior pelvic girdle pain and confirmed postural muscle delay during a repeated fast hip flexion task. METHODS Twenty-four (12 pain and 12 control) age and sex matched participants performed a repeated fast hip flexion task to auditory signal. Surface EMG activity in the external and internal oblique, the multifidus, the gluteus maximus and biceps femoris in the stance-limb was examined for onset timing and EMG integral. Sagittal plane hip (swing limb) and spine kinematics were examined for group and side differences over the repeated trials. FINDINGS While the pain group lacked significant feedforward muscle activity they displayed higher muscle activity at movement onset in the biceps femoris bilaterally (p<0.05) as well as the external oblique (p<0.05) during motion of the symptomatic side. Furthermore, the pain group experienced asymmetrical spinal range of motion with increased motion on the contralateral side (p<0.001) and reduced flexion velocity on the symptomatic side (p<0.001). INTERPRETATION The findings support previous hypotheses regarding the effect of increased biceps activity on pelvic control during lumbo-pelvic rotation. Further, there appears to be a symptom led strategy for bracing the innominate through opposing tension in the biceps and external oblique during movement of the painful side. Such asymmetrical pelvic girdle bracing may be a strategy to increase the stability of the pelvis in light of the failed load transfer mechanism. Putatively, this strategy may increase the mechanical stress on the sacroiliac joint exacerbating pain complaints.
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Affiliation(s)
- Melanie D Bussey
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
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Redmond JM, Gupta A, Nasser R, Domb BG. The hip-spine connection: understanding its importance in the treatment of hip pathology. Orthopedics 2015; 38:49-55. [PMID: 25611411 DOI: 10.3928/01477447-20150105-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Discuss the kinematic relationship between the hip and lumbar spine. 2. Explain the innervation of the hip and lumbar spine and how they relate to one another. 3. Recognize the effect of hip disease on the lumbar spine in an athletic population, prior to the onset of degenerative changes. 4. Describe an algorithm for diagnosis and treatment of patients who present with concomitant hip and lumbar spine pain. The hip and lumbar spine are closely related and can create similar patterns of pain and dysfunction. Diagnosis and treatment of hip and spine-related conditions can be challenging due to symptom overlap. Successful evaluation and treatment of hip and lumbar spine conditions requires a thorough understanding the hip-spine connection. Historically the hip-spine connection has been considered in the context of arthrosis; however, the hip-spine connection also needs to be considered in a younger athletic population. The purpose of this review is to describe the hip-spine connection, discuss the clinical implications of this connection, and offer an approach to diagnosis and treatment.
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Kim SB, You JSH, Kwon OY, Yi CH. Lumbopelvic kinematic characteristics of golfers with limited hip rotation. Am J Sports Med 2015; 43:113-20. [PMID: 25398245 DOI: 10.1177/0363546514555698] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the biomechanical characteristics of the golf swing are well established, the lumbopelvic kinematic characteristics of professional golfers with limited hip internal rotation warrant further investigation. PURPOSE The specific aim was to ascertain mechanical differences in lumbopelvic-hip movement of asymptomatic professional golfers with and without limited hip internal rotation during the golf swing. STUDY DESIGN Controlled laboratory study. METHODS Thirty professional male golfers (aged 25-35 years and 0 handicap matched) were classified into either the limited hip internal motion (LHIM) group (range of motion<20°) or the normal hip internal motion (NHIM) group (range of motion≥30°). All participants underwent clinical tests (muscle strength, muscle length, and range of motion) and a biomechanical assessment using 8 infrared optic cameras in a motion analysis system. Independent t tests were performed to determine potential mean differences in muscle strength, length, and range of motion and lumbopelvic kinematics at P<.05. RESULTS Kinematic analysis revealed that the LHIM group showed significantly greater lumbar flexion (P<.001), right and left axial rotation (P<.025), and right-side lateral bending (P=.003) than the NHIM group. A greater pelvic posterior tilt was observed in the LHIM group when compared with the NHIM group (P=.021). Clinical tests showed reduced internal rotator muscle strength and shorter muscle length in the iliopsoas (P=.017) and hamstring (P<.001) among those in the LHIM group when compared with the NHIM group. CLINICAL RELEVANCE The study data suggest that constraints to hip joint internal rotation, along with muscle strength imbalances between the agonist and antagonist muscles and muscle tightness, are associated with substantially greater lumbopelvic movement during the golf swing.
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Affiliation(s)
- Sol-Bi Kim
- Research and Development Team, Korea Orthopedics and Rehabilitation Engineering Center, Incheon, Republic of Korea Department of Ergonomic Therapy, Graduate School of Health and Environment, Yonsei University, Wonju, Republic of Korea
| | - Joshua Sung H You
- Department of Ergonomic Therapy, Graduate School of Health and Environment, Yonsei University, Wonju, Republic of Korea Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Republic of Korea
| | - Oh-Yun Kwon
- Department of Ergonomic Therapy, Graduate School of Health and Environment, Yonsei University, Wonju, Republic of Korea Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Republic of Korea
| | - Chung-Hwi Yi
- Department of Ergonomic Therapy, Graduate School of Health and Environment, Yonsei University, Wonju, Republic of Korea Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Republic of Korea
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