Kathy Briffa

Vitamin D action and regulation of bone remodeling : suppression of osteoclastogenesis by the mature osteoblast

Vitamin D acts through the immature osteoblast to stimulate osteoclastogenesis. Transgenic elevation of VDR in mature osteoblasts was found to inhibit osteoclastogenesis associated with an altered OPG response. This inhibition was confined to cancellous bone. This study indicates that vitamin D–mediated osteoclastogenesis is regulated locally by OPG production in the mature osteoblast.

Assessment of pelvic floor movement using transabdominal and transperineal ultrasound

The aims of the study were (1) to assess the reliability of transabdominal (TA) and transperineal (TP) ultrasound during a pelvic floor muscle (PFM) contraction and Valsalva manoeuvre and (2) to compare TA ultrasound with TP ultrasound for predicting the direction and magnitude of bladder neck movement in a mixed subject population. A qualified sonographer assessed 120 women using both TA and TP ultrasound. Ten women were tested on two occasions for reliability. The reliability during PFM was excellent for both methods. TP ultrasound was more reliable than TA ultrasound during Valsalva. The percentage agreement between TA and TP ultrasound for assessing the direction of movement was 85% during PFM contraction, 100% during Valsalva. There were significant correlations between the magnitude of the measurements taken using TA and TP ultrasound and significant correlations with PFM strength assessed by digital palpation.

Classification of low back-related leg pain—A proposed patho-mechanism-based approach

Leg pain is a frequent accompaniment to low back pain, arising from disorders of neural or musculoskeletal structures of the lumbar spine. Differentiating between different sources of radiating leg pain is important to make an appropriate diagnosis and identify the underlying pathology. It is proposed that low back-related leg pain be divided into four subgroups according to the predominating pathomechanisms involved. The first subgroup features central sensitization with mainly positive symptoms such as hyperalgesia, the second subgroup involves denervation with significant axonal damage showing predominantly negative sensory symptoms and possibly motor loss and the third subgroup involves peripheral nerve sensitization with enhanced nerve trunk mechanosensitization. The fourth subgroup features somatic referred pain from musculoskeletal structures, such as the intervertebral disc or facet joints. Accordingly, four groups of patients with leg pain associated with structures in the lower back can be identified: Each group presents with a distinct pattern of symptoms and signs. Although there may be considerable overlap between the classifications, the authors propose the existence of an overriding mechanism. The importance of distinguishing low back-related leg pain into these four groups is to facilitate diagnosis and provide a more effective, appropriate treatment.

Throwing velocity and jump height in female water polo players: performance predictors.

Throwing velocity and vertical jumping ability are essential components for shooting and passing in water polo. The purpose of this study was to determine whether there is a relationship between throwing velocity and water jump height in highly skilled female water polo players. Throwing velocity and head height at ball release were measured in twenty-two female players (age 20.41 years (6.16); weight 68.28 kg (8.87)) with two 50 frames per second cameras while shooting at goal. Water jump height was also measured with a modified Yardstick device. Multiple regression analyses showed that peak lower limb power was the most significant predictor of maximal velocity. Power alone accounted for 62% of the variance in maximum velocity (p<0.001). Once power was entered into the model none of the other physical characteristics (lean mass, fat mass, land jump height and anthropometry) made a significant contribution to throwing velocity. After controlling for the effect of power, head height at ball release accounted for an additional significant proportion of the variance in maximal velocity (R(2) change 7%; p=0.049). Lower body power was a significant predictor of higher throwing velocity in highly skilled female water polo players. Players with relatively higher underlying levels of lower limb power who are able to generate greater elevation out of the water are able to throw the ball faster.

Motor control patterns during an active straight leg raise in pain-free subjects

Study Design. Repeated measures. Objective. To investigate motor control (MC) patterns of normal subjects during the low level physical load of the active straight leg raise (ASLR). Summary of Background Data. Aberrant MC patterns, as observed with the ASLR test, are considered to be a mechanism for ongoing pain and disability in subjects with chronic musculoskeletal pelvic girdle pain. These patterns may not only affect the provision of lumbopelvic stability, but also respiration and the control of continence. Greater understanding of MC patterns in pain-free subjects may improve the management of pelvic girdle pain. Methods. Fourteen pain-free nulliparous women were examined during the ASLR. Electromyography of the anterior abdominal wall, right chest wall and the anterior scaleni, intraabdominal pressure (IAP), intrathoracic pressure (ITP), respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between a left and right ASLR. Results. There was greater activation of obliquus internus abdominis and obliquus externus abdominis on the side of the ASLR. The predominant pattern of activation for the chest wall was tonic activation during an ipsilateral ASLR, and phasic respiratory activation lifting the contralateral leg. Respiratory fluctuation of both IAP and ITP did not differ lifting either leg. The baseline shifts of these pressure variables in response to the physical demand of lifting the leg was also the same either side. There was no difference in respiratory rate, pelvic floor kinematics, or downward leg pressure. Conclusion. Pain-free subjects demonstrate a predominant pattern of greater ipsilateral tonic activation of the abdominal wall and chest wall on the side of the ASLR. This was achieved with minimal apparent disruption to IAP and ITP. The findings of this study demonstrate the plastic nature of the abdominal cylinder and the flexibility of the neuromuscular system in controlling load transference during an ASLR.

Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective

Abstract Headache is a common complaint that affects the majority of the population at some point in their lives. The underlying pathological bases for headache symptoms are many, diverse, and o en difficult to distinguish. Classification of headache is principally based on the evaluation of headache symptoms as well as clinical testing. Although manual therapy has been advocated to treat a variety of different forms of headache, the current evidence only supports treatment for cervicogenic headache (CGH). This form of headache can be identified from migraine and other headache forms by a comprehensive musculoskeletal examination. Examination and subsequent diagnosis is essential not only to identify patients with headache where manual therapy is appropriate but also to form a basis for selection of the most appropriate treatment for the identified condition. The purpose of this paper is to outline, in clinical terms, the classification of headache, so that the clinician can readily identify those patients with headache suited to manual therapy.

Long-Term Stability and Minimal Detectable Change of the Cervical Flexion-Rotation Test

STUDY DESIGN Reliability of clinical measurements over time. OBJECTIVES To determine the long-term stability and minimal detectable change (MDC) of the flexion-rotation test (FRT) measurements over days in subjects with cervicogenic headache (CGH). BACKGROUND The FRT is used by physical therapists to assist in identifying upper cervical movement impairment, as well as to gauge treatment effectiveness. Test-retest reliability for the FRT has been reported, but the stability of range-of-motion measures taken during the FRT over time and the MDC have not been investigated. METHODS Fifteen subjects with CGH were evaluated on headache-free days using the FRT by a blinded examiner at baseline, 2, 4, and 14 days later. An additional 10 asymptomatic subjects were included for blinding purposes. On each occasion, the examiner measured range of motion and determined whether the FRT was positive or negative. RESULTS For subjects with CGH, there was no significant change in FRT range of motion over days (P>.05). Intraclass correlation coefficients for intratester reliability were 0.95 (95% CI: 0.90 to 0.98) and 0.97 (95% CI: 0.94 to 0.99) for right and left rotation, respectively. MDC90 was 4.7 degrees for right rotation and 7 degrees for left rotation. Examiner interpretation of the FRT was consistent over time, with kappa = 0.92. CONCLUSIONS This study provides evidence that FRT measurements are stable over time, and the MDC90 indicates that a change in FRT range of motion of at least 7 degrees is required to be confident that a change has occurred due to an intervention rather than measurement error.

Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache

This study investigated the reliability of manual examination procedures and the frequency that each or multiple segments in the upper cervical spine above the C4 vertebra were the dominant source of pain in subjects with cervicogenic headache (CGH). Eighty subjects were evaluated, 60 with CGH (39 females, mean age 33 years) and arbitrarily a further 20 asymptomatic subjects (13 females, mean age 34 years) included to reduce examiner bias, but subsequently omitted from data analysis. Two experienced physiotherapists examined on the same day each subject with standard manual examination procedures, independently rating each segment in the upper cervical spine above the C4 vertebra for involvement. Examiners were blind to each others findings and the subjects clinical status. Standard and adjusted Kappa coefficients were calculated for each segment in symptomatic subjects only. Chi-squared analysis for goodness of fit was used to identify the segment that was most frequently determined the predominant symptomatic segment. Manual examination above the C4 vertebra showed good reliability. The C1/2 segment was most commonly symptomatic, with a positive finding at this segment in 63% of cases. The high frequency of C1/2 involvement in CGH highlights the importance of examination and treatment procedures for this motion segment.

Physiotherapists demonstrate weight stigma: a cross-sectional survey of Australian physiotherapists.

QUESTION Do physiotherapists demonstrate explicit and implicit weight stigma? DESIGN Cross-sectional survey with partial blinding of participants. PARTICIPANTS responded to the Anti-Fat Attitudes questionnaire and physiotherapy case studies with body mass index (BMI) manipulated (normal or overweight/obese). The Anti-Fat Attitudes questionnaire included 13 items scored on a Likert-type scale from 0 to 8. Any score greater than zero indicated explicit weight stigma. Implicit weight stigma was determined by comparing responses to case studies with people of different BMI categories (where responses were quantitative) and by thematic and count analysis for free-text responses. PARTICIPANTS Australian physiotherapists (n=265) recruited via industry networks. RESULTS The mean item score for the Anti-Fat Attitudes questionnaire was 3.2 (SD 1.1), which indicated explicit weight stigma. The Dislike (2.1, SD 1.2) subscale had a lower mean item score than the Fear (3.9, SD 1.8) and Willpower (4.9, SD 1.5) subscales. There was minimal indication from the case studies that people who are overweight receive different treatment from physiotherapists in clinical parameters such as length of treatment time (p=0.73) or amount of hands-on treatment (p=0.88). However, there were indications of implicit weight stigma in the way participants discussed weight in free-text responses about patient management. CONCLUSION Physiotherapists demonstrate weight stigma. This finding is likely to affect the way they communicate with patients about their weight, which may negatively impact their patients. It is recommended that physiotherapists reflect on their own attitudes towards people who are overweight and whether weight stigma influences treatment focus.

The Relationship between Cervicogenic Headache and Impairment Determined by the Flexion-Rotation Test

OBJECTIVE This study evaluates the association between probable cervicogenic headache (CGH) and associated headache symptoms and cervical spine impairment identified by the flexion-rotation test (FRT). METHODS This was an observational study. Ninety-two subjects were evaluated, 72 with probable CGH and 20 who were asymptomatic. Headache symptoms were evaluated by questionnaire. A single blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion (ROM). Fifteen subjects reported headache during testing and were subsequently retested when pain-free. A paired t test was used to determine whether FRT mobility to the most restricted side differed when the subject was experiencing headache. Univariate linear regression analysis and multiple regression analysis were used to examine the relationship between subject and headache characteristics, and range of motion during the FRT. Logistic regression analysis was used to examine relationships between subject and headache characteristics and whether the FRT was positive or negative. RESULTS Mean ROM was significantly reduced (P < .01) by 6° in the presence of headache, but this did not influence test interpretation. Regression analysis revealed that half the variance in FRT ROM was explained by an index of headache severity or component parts but not by other headache characteristics. CONCLUSIONS These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.