Amir Massoud Arab

The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy

Objective: To determine if combining intermittent cervical traction with conventional physical therapy methods is more effective than using conventional approaches alone in the improvement of the grip strength and treatment of the patients with unilateral cervical 7 (C7) radiculopathy. Design: Randomized controlled trial (RCT). Setting: An outpatient physical therapy clinic, University of Social Welfare and Rehabilitation Science, Iran. Patients: A sample of convenience of 30 patients with unilateral C7 radiculopathy participated in this study. Patients were assigned randomly to a control (N=15, mean age=46.939 ±5.32) and an experimental group (N=15, mean age=47.53 ±5.6). Interventions: Electrotherapyu/exercise treatment for control group and combined cervical traction and electrotherapyu/exercise for experimental group. Ten physical therapy sessions, three times a week for each group. Main outcome measures: Grip strength as an appropriate objective parameter was measured before treatment and after 5 and 10 treatment sessions. Results: Statistical analysis (paired t-test) revealed significant increase in grip strength after 10 treatment sessions in control (p<0.01) and experimental group (p<0.01) compared with pretreatment score. In the ANCOVA, controlling for pretest scores, no significant difference was found between the two groups in the after 10 treatment sessions grip score (p=0.65). However, the change in grip strength after five sessions was significantly greater for the experimental group than for the control group (P=0.04). Conclusions: The application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy.

Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint.

The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. This study examined the inter- and intra-examiner reliability of single and composites of the motion palpation and provocation tests together. Twenty-five patients between the ages of 20 and 65 years participated. Four motion palpation and three provocation tests were examined three times on both sides (left, right) by two examiners. Kappa coefficient and prevalence-adjusted and bias-adjusted kappa (PABAK) were calculated to evaluate the reliability. PABAK for intra- and inter-examiner reliability of individual tests ranged from 0.36 to 0.84 (95% CI: -0.22 to 1.12) and 0.52 to 0.84 (95% CI: -0.18 to 1.08) which is considered fair to substantial. PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: -0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: -0.22 to 1.12) and 0.52 to 0.92 (95% CI: -0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.

Ultrasound measurement of deep abdominal muscle activity in sitting positions with different stability levels in subjects with and without chronic low back pain

The purpose of this study was to investigate the changes in the thickness of the transversus abdominis (TrA) and internal oblique (IO) muscles in three sitting postures with different levels of stability. The technique of ultrasound imaging was used for individuals with and without chronic low back pain (LBP). A sample of 40 people participated in this study. Subjects were categorised into two groups: with LBP (N = 20) and without LBP (N = 20). Changes in the thickness of tested muscles were normalized under three different sitting postures to actual muscle thickness at rest in the supine lying position and were expressed as a percentage of thickness change. The percentage of thickness change in TrA and IO increased as the stability of the sitting position decreased in both groups. However, the percentages of thickness change in all positions were less in subjects with LBP. There was a significant difference in thickness change in TrA when sitting on a gym ball between subjects with and without LBP but no difference was found when sitting on a chair. There was no significant difference in thickness change in IO in all positions between the two groups. Our findings indicate that difference in the percentage of thickness change in TrA between subjects with and without LBP increases as the stability of sitting position decreases.

The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain

BackgroundShortening of the iliotibial band (ITB) has been considered to be associated with low back pain (LBP). It is theorized that ITB tightness in individuals with LBP is a compensatory mechanism following hip abductor muscle weakness. However, no study has clinically examined this theory. The purpose of this study was to investigate the muscle imbalance of hip abductor muscle weakness and ITB tightness in subjects with LBP.MethodsA total of 300 subjects with and without LBP between the ages of 20 and 60 participated in this cross-sectional study. Subjects were categorized in three groups: LBP with ITB tightness (n = 100), LBP without ITB tightness (n = 100) and no LBP (n = 100). Hip abductor muscle strength was measured in all subjects.ResultsAnalysis of Covariance (ANCOVA) with the body mass index (BMI) as the covariate revealed significant difference in hip abductor strength between three groups (P < 0.001). Post hoc analysis showed no significant difference in hip abductor muscle strength between the LBP subjects with and without ITB tightness (P = 0.59). However, subjects with no LBP had significantly stronger hip abductor muscle strength compared to subjects with LBP with ITB tightness (P < 0.001) and those with LBP without ITB tightness (P < 0.001).ConclusionThe relationship between ITB tightness and hip abductor weakness in patients with LBP is not supported as assumed in theory. More clinical studies are needed to assess the theory of muscle imbalance of hip abductor weakness and ITB tightness in LBP.

Altered muscular activation during prone hip extension in women with and without low back pain

BackgroundAltered movement pattern has been associated with the development of low back pain (LBP). The purpose of this study was to investigate the activity pattern of the ipsilateral erector spinae (IES) and contralateral erectorspinae (CES), gluteus maximus (GM) and hamstring (HAM) muscles during prone hip extension (PHE) test in women with and without LBP. A cross-sectional non-experimental design was used.MethodsConvenience sample of 20 female participated in the study. Subjects were categorized into two groups: with LBP (n = 10) and without LBP (n = 10). The electromyography (EMG) signal amplitude of the tested muscles during PHE (normalized to maximum voluntary electrical activity (MVE)) was measured in the dominant lower extremity in all subjects.ResultsStatistical analysis revealed greater normalized EMG signal amplitude in women with LBP compared to non-LBP women. There was significant difference in EMG activity of the IES (P = 0.03) and CES (P = 0.03) between two groups. However, no significant difference was found in EMG signals of the GM (P = 0.11) and HAM (P = 0.14) among two groups.ConclusionThe findings of this study demonstrated altered activation pattern of the lumbo-pelvic muscles during PHE in the women with chronic LBP. This information is important for investigators using PHE as either an evaluation tool or a rehabilitation exercise.

Sensitivity, specificity and predictive value of the clinical trunk muscle endurance tests in low back pain

Objective: To describe the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of five clinical tests used to measure trunk muscle endurance in low back pain. Design: A cross-sectional non-experimental design. Setting: Orthopaedic and physical therapy departments of four hospitals and outpatient physical therapy clinics, Tehran, Iran. Subjects: Convenience sample of 200 subjects participated in this study. Subjects were categorized into four groups: men without low back pain (N = 50, mean (SD) age = 38 (12) years), women without low back pain (N = 50, mean (SD) age = 43 (11) years), men with low back pain (N = 50, mean (SD) age = 39 (12) years) and women with low back pain (N = 50, mean (SD) age = 43 (12) years). Main measures: Five clinical static endurance tests of trunk muscles such as: Sorensen test, prone isometric chest raise test, prone double straight-leg raise test, supine isometric chest raise test and supine double straight-leg raise test were measured in each group. Results: The result of receiver operating characteristics (ROC) curve analysis revealed that in a separate analysis of data for men and women, among all tests, the prone double straight-leg raise test had the highest sensitivity, specificity and predictive value in low back pain compared with other performed tests. Conclusions: It seems that the prone double straight-leg raise test has more sensitivity, specificity and predictive value in low back pain than other tests and could be used as a useful clinical method for testing the spinal muscle endurance to predict the probability of the occurrence of low back pain.

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction

Abstract It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0·02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0·31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0·02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0·05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability.

Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound

Pelvic floor muscle (PFM) dysfunction has been recently associated with the development of low back pain (LBP). Transabdominal ultrasound imaging has been established as an appropriate method for visualizing and measuring PFM function. No study has directly evaluated PFM function in individuals with and without LBP. The purpose of this study was to investigate the PFM function in women with and without LBP using transabdominal ultrasound. Convenience sample of 40 non-pregnant female participated in the study. Subjects were categorized into two groups: with LBP (n = 20) and without LBP (n = 20). The amount of bladder base movement on ultrasound (normalized to body mass index) was measured in all subjects and considered as an indicator of PFM function. Statistical analysis (Independent t-test) revealed significant difference in transabdominal ultrasound measurements for PFM function between the two groups (P = 0.04, 95% CI of difference: 0.002-0.27). The results of this study indicate PFM dysfunction in individuals with LBP compared to those without LBP. The results could be beneficial to clinicians when assessing and prescribing therapeutic exercises for patients with LBP.

Assessment of pelvic floor muscle contraction in stress urinary incontinent women: comparison between transabdominal ultrasound and perineometry

Introduction and hypothesisTransabdominal (TA) ultrasound and perineometry have been currently used to assess lifting aspect and squeezing action of pelvic floor muscles (PFM) function, respectively, in women with stress urinary incontinence (SUI). However, no study has directly compared these measurements. The purpose of this study was to investigate the reliability and correlation between perineometry and TA ultrasound as measurements of different aspect of PFM function.MethodsA total of 28 women with SUI participated in the study. Vaginal squeeze pressure using a perineometer and bladder base movement on TA ultrasound was measured. Scattergram was depicted to determine the correlation between variables. Intraclass correlation coefficient and Bland–Altman plot were used to assess reliability.ResultsScatter diagram depicted significant correlation of TA ultrasound with vaginal squeeze pressure (r = 0.72, R2 = 0.52, p < 0.0001). High reliability was found for measurements.ConclusionTA ultrasound measurement may be an alternative measurement to perineometry when assessing PFM function.

Correlation of digital palpation and transabdominal ultrasound for assessment of pelvic floor muscle contraction.

Abstract Pelvic oor muscle (PFM) dysfunction has been commonly associated with urinary disorders and lumbo-pelvic pain. Transabdominal (TA) ultrasound is currently used by physical therapists to assess PFM function. Controversy exists regarding the correlation between TA ultrasound measurement and vaginal palpation for assessment of PFM contraction, and this relationship has not yet been examined concurrently during the same contraction. The purpose of this study was to determine the correlation of digital palpation and TA ultrasound to assess PFM contraction when recorded 1) simultaneous to digital palpation during one contraction and 2) following digital palpation testing in another contraction. A descriptive correlational design was used to describe the relationship between variables. A total of 19 women (both asymptomatic women and those with incontinence or lumbo-pelvic pain) participated in the study. The modified Oxford scale was used to grade PFM contraction in digital palpation testing. The amount of bladder base movement on ultrasound was measured and considered as an indicator of PFM activity. Two trials were performed for TA ultrasound measurement: 1) simultaneous to digital palpation during one contraction, and 2) following digital palpation testing in another contraction. Spearmans correlation coe cient was used for analysis. ere was a signi cant correlation between digital palpation and TA ultrasound for PFM assessment when measured simultaneously in one contraction (rho=0.62, p=0.01) and separately in a di erent contraction (rho=0.52, p=0.02), with a stronger correlation found in simultaneous testing. In conclusion, digital palpation and TA ultrasound measurement are significantly correlated and measure comparable parameters in evaluation of PFM contraction.