Ashokan Arumugam

Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine – A systematic review

Optimal lumbopelvic stability is a function of form closure (joint anatomy), force closure (additional compressive forces acting across the joints) and neuromotor control. Impairment of any of these mechanisms can result in pain, instability, altered lumbopelvic kinematics, and changes in muscle strength and motor control. External pelvic compression (EPC) has been hypothesised to have an effect on force closure and neuromotor control. However, the specific application parameters (type, location and force) and hypothesized effects of EPC are unclear. Thus, a systematic review was conducted to summarize the in vivo and in vitro effects of EPC. Eighteen articles met the eligibility criteria, with quality ranging from 33% to 72% based on a modified Downs and Black index. A modified van Tulders rating system was used to ascertain the level of evidence synthesised from this review. There is moderate evidence to support the role of EPC in decreasing laxity of the sacroiliac joint, changing lumbopelvic kinematics, altering selective recruitment of stabilizing musculature, and reducing pain. There is limited evidence for effects of EPC on decreasing sacral mobility, and affecting strength of muscles surrounding the SIJ, factors which require further investigation.

Interrater reliability of the craniocervical flexion test in asymptomatic individuals--a cross-sectional study.

OBJECTIVE The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects. METHODS A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed 3 trials of craniocervical flexion with each trial consisting of 5 incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by 2 raters. The outcome measure was the activation score-the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the 2 repeated scores out of 3 trials for either rater. RESULTS Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test. CONCLUSION The study has shown high interrater reliability when 2 raters simultaneously scored the CCFT trials in asymptomatic individuals.

Can application of a pelvic belt change injured hamstring muscle activity

Hamstring injuries are commonly reported in various sports involving sprinting, high-velocity running and kicking. Aberrant biomechanics and neuromotor control of the lumbopelvic and thigh segments have been reported to play a significant role in hamstring injury incidence and recurrence. Recent evidence suggests that external pelvic compression (EPC) applied with a pelvic belt can augment the stability of the pelvic joints, and alter neuromotor control of the lumbopelvic and thigh muscles in individuals with and without (somatic) lumbopelvic and groin dysfunction. However, the effects of EPC on neuromotor control of injured hamstring muscles remain unknown. We have explored the putative neuromotor link between the lumbopelvic segment and hamstring muscles, and generated hypotheses based on plausible mechanisms through which EPC could affect injured hamstring muscle strength and recruitment. Recent guidelines argue that rehabilitation of hamstring injuries should follow a multi-modal approach and include strategies to improve stability and neuromotor control of the lumbopelvic segment. Further investigations exploring these hypotheses would confirm whether EPC could be recommended as an assessment, intervention and rehabilitation tool for hamstring injury.

Effects of external pelvic compression on isokinetic strength of the thigh muscles in sportsmen with and without hamstring injuries

OBJECTIVES To investigate whether application of a pelvic compression belt affects isokinetic strength of the thigh muscles in sportsmen with and without hamstring injuries. DESIGN Randomized crossover, cross-sectional. METHODS Twenty sportsmen (age 22.0±1.5 years) with hamstring injuries (hamstring-injured group) and 29 (age 23.5±1.5 years) without hamstring injuries (control group) underwent isokinetic testing of the thigh muscles. Testing included five reciprocal concentric quadriceps and hamstring contractions, and five eccentric hamstring contractions at an angular velocity of 60°/s, with and without a pelvic compression belt in randomized order. The outcome measures were average torque normalized to bodyweight for terminal range eccentric hamstring contractions and peak torque normalized to bodyweight for concentric quadriceps, concentric hamstring and eccentric hamstring contractions. RESULTS There was a significant increase in normalized average torque of eccentric hamstring contractions in the terminal range for both groups (p≤0.044) and normalized peak torque of eccentric hamstring contractions for injured hamstrings (p=0.025) while wearing the pelvic compression belt. No significant changes were found for other torque variables. Injured hamstrings were weaker than the contralateral uninjured hamstrings during terminal range eccentric hamstring (p=0.040), and concentric hamstring (p=0.020) contractions recorded without the pelvic compression belt. However, no between-group differences were found for any of the investigated variables. CONCLUSION Wearing the pelvic compression belt appears to have a facilitatory effect on terminal range eccentric hamstring strength in sportsmen with and without hamstring injuries. Future investigations should ascertain whether there is a role for using a pelvic compression belt for rehabilitation of hamstring injuries.

Evaluation of Changes in Pelvic Belt Tension During 2 Weight-Bearing Functional Tasks

OBJECTIVE The purposes of this study were to evaluate changes in pelvic belt tension during 2 weight-bearing functional tasks (transition from bipedal to unipedal stance [BUS] and walking) and to evaluate the reliability and the percentage variation for belt tension scores from trial to trial. METHODS A cross-sectional repeated-measures study was conducted with 10 healthy male participants (mean age, 28.3 ± 8.8years). Participants performed 10 trials of BUS and walking while wearing a nonelastic pelvic compression belt (PCB) applied distal to the anterior superior iliac spines, with a load cell positioned in the center of the belt. The load cell was calibrated using known weights (1-10kg) to define the relationship between the applied tension and voltage change (R(2) = 0.99). Load cell tension values were recorded in voltage signals and then converted to newtons of force using appropriate conversion values (0.012V = 10N). Mean and standard deviation values, intraclass correlation coefficients (ICC 3,1), and percentage standard error of measurements (% SEM) were analyzed for PCB tension recorded during the BUS and walking trials. RESULTS The mean tension achieved with a PCB was found to be 41.02 (±4.23) N during BUS and 44.07 (±5.80) N during walking. The trial-to-trial reliability (ICC 3,1) was high (ICC ≥0.9), and the variation in PCB tension across 10 trials (% SEM) was 4% or less. CONCLUSION The mean tension achieved during the tasks was 44 N or less. The reliability is high, and the variation is low across the trials, which implies that a PCB could be used to produce consistent effects during repetition of the tasks (BUS and walking).

Social media for physiotherapy clinics: considerations in creating a Facebook page

Abstract Social media websites play a prominent role in modern society, and the most popular of these websites is Facebook. Increasingly, physiotherapy clinics have begun to utilize Facebook in order to create pages to publicize their services. There are many factors to consider in the planning, implementing, and maintenance of Facebook pages for physiotherapy clinics, including ethical and privacy issues. The primary purpose of creating a page must be clearly defined, with dedicated clinicians given adequate time to manage the page. This technical article discusses these factors and summarizes the experiences at the University of Otago, New Zealand, in creating a Facebook page for the physiotherapy clinic and provides suggestions for physiotherapy clinicians in operating a Facebook page.

Effects of external pelvic compression on electromyographic activity of the hamstring muscles during unipedal stance in sportsmen with and without hamstring injuries

There is some evidence that hamstring function can be influenced by interventions focusing on the pelvis via an anatomic and neurophysiologic link between these two segments. Previous research demonstrated increased electromyographic activity from injured hamstrings during transition from bipedal to unipedal stance (BUS). The aim of this study was to investigate the effects of a pelvic compression belt (PCB) on electromyographic activity of selected muscles during BUS in sportsmen with and without hamstring injury. Electromyographic amplitudes (normalised to maximum voluntary isometric contraction [MVIC]) of the hamstrings, gluteus maximus, gluteus medius and lumbar multifidus were obtained during BUS from 20 hamstring-injured participants (both sides) and 30 healthy participants (one side, randomly selected). There was an increase in biceps femoris (by 1.23 ± 2.87 %MVIC; p = 0.027) and gluteus maximus (by 0.63 ± 1.13 %MVIC; p = 0.023) electromyographic activity for the hamstring-injured side but no significant differences other than a decrease in multifidus activity (by 1.36 ± 2.92 %MVIC; p = 0.023) were evident for healthy participants while wearing the PCB. However, the effect sizes for these findings were small. Wearing the PCB did not significantly change electromyographic activity of other muscles in either participant group (p > 0.050). Moreover, the magnitude of change induced by the PCB was not significantly different between groups (p > 0.050) for the investigated muscles. Thus, application of a PCB to decrease electromyographic activity of injured hamstrings during BUS is likely to have little effect. Similar research is warranted in participants with acute hamstring injury.

Letter to the Editor regarding a study titled “A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study” by Coppieters et al. (2015)

I would like to commend Coppieters et al. (2015) for investigating the variations in strain and excursion of the sural nerve and Achilles tendon during a modified straight leg raise test. Indeed, this article makes an important contribution to the literature on lower limb neural biomechanics as there are not many cadaveric studies in this area. The authors have used a robust and feasible method to answer the research question. Pragmatically, positioning the cadaver in side-lying appears suitable for doing a modified straight leg raise test. If the reliability of goniometer readings in measuring hip and ankle angles would have been analysed then this would have been an added strength to the study because these measurements are the predictors of strain and excursion in the sural nerve and Achilles tendon in this study. Whether calibration of the strain gauges and digital calliper was done before and/or during the study to determine the accuracy/precision of the equipment was not reported. The cumulative increase in strain (% or mm?) induced in the sural nerve was 1.2 (0.6) (mean (SD)) with ankle dorsiflexion and 2.1 (0.5) with hip flexion and ankle dorsiflexion. The mean excursion (proximal sliding) of the sural nerve with ankle dorsiflexion was found to be 1.2 mm with a standard deviation of 1.8 mm. Why the standard deviation value (1.8 mm) was larger than the mean value (1.2 mm) should be discussed. As three repetitions were used for documenting strain and excursion of the sural nerve and Achilles tendon, would reporting ICC (2,3) be adequate rather than calculating both ICC (2,1) and ICC (2,3) values? SEM repeated formula (standard error of measurement [SEM] value multiplied by the square root of the number of repetitions) has been recommended for calculating measurement error associated with repeated measures (Domholdt, 2005). This value will be larger than SEM values reported by the authors. Further, calculating smallest real difference or minimal detectable change values at a 95% confidence interval will clarify whether the measured values (outcome measures), which were relatively small in the current study, show a real difference that is free from measurement error. The authors have discussed that one of the reasons for the poor reliability of the strain measurement of the Achilles tendon following ankle dorsiflexion during the modified straight leg raise test was small inter-cadaver variability when compared to the within-cadaver variation. Was there a lack of consistent and linear relationship between the applied tension or tendon stretch with ankle dorsiflexion and corresponding change in the strain of the Achilles tendon in the cadavers? From Fig. 2, it is evident that the mean strain value of the Achilles tendon with ankle dorsiflexion is negligible (1.4% [0.1%]). If so, discussing the biomechanical behaviour of the Achilles tendon in embalmed cadavers will be useful. In Fig. 2, the scale of the vertical (Y) axis reads as cumulative increase in strain in percentage (%); however, in the discussion section, the standard deviation values of the strain measurements have been reported in mm. This needs further clarification.

The Effect of a Circuit Training Program on Functional Performance in Children with Spastic Cerebral Palsy - A Quasi-experimental Pilot Study

Background: There is a plethora of literature with some conflicting findings on the effects of implementing strength and/or aerobic (fitness) training to improve motor function of children with spastic cerebral palsy (CP). Purpose: This aim of the study was to investigate the effects of a circuit training regimen on static and dynamic motor function of children diagnosed to have spastic CP. Materials and Methods: This is a pilot quasi-experimental study on children with spastic CP (aged 6-11 y; 7 males and 3 females) who underwent a circuit exercise training program (combined endurance and strength training) for 6 weeks. Changes in static (standing) and dynamic (jumping, running, walking) motor function were assessed by dimensions D and E of the Gross Motor Function Measure (GMFM) scale, respectively. In addition, walking capacity was also assessed using the 30 s walk test. The Wilcoxon Signed Rank test was used to compare pre- vs. post-intervention scores. Results: There was an increase in static and dynamic motor function scores in the GMFM scale of children with spastic CP by 9 % (p = 0.005). An increase of 18.5 cm was found in the walking distance following intervention (p = 0.005). Conclusion: Circuit training used in the current study might increase standing as well as jumping, walking, and running abilities of children with spastic CP. However, randomized clinical trials are warranted to confirm these findings.