Effects of individual strengthening exercises on subdivisions of the gluteus medius in a patient with sacroiliac joint pain

Hip and Core Muscle Activation During High-Load Core Stabilization Exercises

BACKGROUND

There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles.

HYPOTHESIS

Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

LEVEL OF EVIDENCE

Level 4.

METHODS

In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years).

RESULTS

The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise (P < 0.001), back bridge with left leg lift (P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg (P = 0.002), and elbow-toe exercise with right leg horizontally lifted (P < 0.001).

CONCLUSION

The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation.

CLINICAL RELEVANCE

The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

Comparing the Effectiveness of the Muscle Energy Technique and Kinesiotaping in Mechanical Sacroiliac Joint Dysfunction: A Non-blinded, Two-Group, Pretest-Posttest Randomized Clinical Trial Protocol

STUDY DESIGN

Two-group, pretest-posttest randomized clinical trial.

PURPOSE

To evaluate the efficacy of the muscle energy technique (MET) and Kinesiotaping (KT) in addition to conventional physiotherapy among patients with mechanical sacroiliac joint dysfunction (SIJD).

OVERVIEW OF LITERATURE

Patients with SIJD suffer from lower back and gluteal pain, as well as stiffness, due to restricted pelvic joint movement. To restore function and reduce pain among individuals with mechanical SIJD, the MET and KT may be helpful. However, a limited number of studies have compared MET and KT in mechanical SIJD.

METHODS

A total of 40 male and female participants aging between 30 and 50 years experiencing unilateral pain around the gluteal area, groin area, and lower limbs for more than 4 weeks but less than 1 year will be selected. Patients will then be randomized into two groups: METCp (n=20) and KTCp groups (n=20). The METCp group will receive MET along with conventional physiotherapy, while the KTCp group will receive conventional physiotherapy with KT. Both groups will receive three alternating days of treatment per week that will continue for 4 weeks. The modified Oswestry Disability Index, a digital pressure algometer, and sacroiliac joint motion testing will be used for evaluation. Between- and within-group pre- and post-intervention results for mechanical SIJD were compared using the Wilcoxon signed-rank test/paired t-test and Mann-Whitney U -test/independent t -test.

RESULTS

Modified Oswestry Disability Index, digital pressure algometer, and sacroiliac joint motion will be measured at baseline, 2nd week during intervention, and 4th week at the end of intervention.

CONCLUSIONS

The present study will provide data regarding the effects of MET and KT among patients with mechanical SIJD.

The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients

[Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

Effects of double air-cushion biofeedback exercises in a patient with sacroiliac joint pain

[Purpose] We developed a double air-cushion biofeedback device to be used for sacroiliac (SI) joint exercises and investigated the effects of exercising using the device in a patient with SI joint pain. [Subject] A 40-year-old man, who complained of pain in the left posterior iliac crest area and SI joints over a 6-month period participated. [Methods] After a 4-week exercise program using the double air-cushion biofeedback device, the subject was assessed using the Gaenslen, Patrick, posterior shear (POSH), and resisted abduction (REAB) tests. [Results] After performing exercise designed to strengthen subdivisions of the gluteus medius, the subject had no pain in the Gaenslen, Patrick, POSH, or REAB tests of the SI joint. The visual analog scale (VAS) score for pain on palpation of the left posterior iliac crest area decreased to 4/10 from an initial score of 7/10. [Conclusion] Exercises with the double air-cushion biofeedback device improved hip asymmetry, SI joint mobility, and muscle strength.

Intra-observer reliability in three-dimensional kinematic analysis of sacroiliac joint mobility

[Purpose] Physical therapists, osteopathic practitioners, and chiropractors often perform manual tests to evaluate sacroiliac joint (SIJ) mobility. However, the available evidence demonstrates an absence of reliability in these tests and in investigations with kinematic analysis. The aim of this study was to verify the three-dimensional kinematic reliability in SIJ movement measurements. [Subjects] This cross-sectional study analyzed 24 healthy males, aged between 18 and 35 years. [Methods] Three-dimensional kinematic analysis was performed for measurements of posterior superior iliac displacement and greater trochanter (femur) displacement during hip flexion movement in an orthostatic position. The distance variations were measured from a reference point in 3 blocks. The intra-observer reliability was compared with the mean of three 3 blocks using the interclass correlation coefficient (ICC) and a 99% significance level. [Results] The measurements indicated a strong correlation among blocks: ICC = 0.94 for right side SIJ and ICC = 0.91 for left side SIJ. The mean displacement between the reference points was 7.7 mm on the right side and 8.5 mm on the left side. [Conclusion] Our results indicate that three-dimensional kinematic analysis can be used for SIJ mobility analyses. New studies should be performed for subjects with SIJ dysfunction to verify the effectiveness of this method.