Linda R. Van Dillen

Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests

BACKGROUND Clinical data suggest that active limb movements may be associated with early lumbopelvic motion and increased symptoms in people with low back pain. METHODS Forty-one people without low back pain who did not play rotation-related sports and 50 people with low back pain who played rotation-related sports were examined. Angular measures of limb movement and lumbopelvic motion were calculated across time during active knee flexion and active hip lateral rotation in prone using a three-dimensional motion capture system. Timing of lumbopelvic motion during the limb movement tests was calculated as the difference in time between the initiation of limb movement and lumbopelvic motion normalized to limb movement time. FINDINGS During knee flexion and hip lateral rotation, people with low back pain demonstrated a greater maximal lumbopelvic rotation angle and earlier lumbopelvic rotation, compared to people without low back pain (P<0.05). INTERPRETATION The data suggest that people with low back pain who play rotation-related sports may move their lumbopelvic region to a greater extent and earlier during lower limb movements than people without low back pain. Because people perform many of their daily activities in early to midranges of joint motion the lumbopelvic region may move more frequently across the day in people with low back pain. The increased frequency may contribute to increased lumbar region tissue stress and potentially low back pain symptoms. Lower limb movements, therefore, may be important factors related to the development or persistence of low back pain.

Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports.

OBJECTIVE To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP. DESIGN Two group, case-control. SETTING University-based musculoskeletal analysis laboratory. PARTICIPANTS Forty-eight subjects (35 males, 13 females; mean age: 26.56+/-7.44 years) who reported regular participation in a rotation-related sport participated. Two groups were compared; people with LBP (N=24) and people without LBP (N=24; NoLBP). MAIN OUTCOME MEASURES Data were collected on participant-related, LBP-related, sport-related and activity-related variables. Measures of passive hip rotation range of motion were obtained. The differences between the LBP and NoLBP groups were examined. RESULTS People with and without a history of LBP were the same with regard to all participant-related, sport-related and activity-related variables. The LBP group had significantly less total rotation (P=.035) and more asymmetry of total rotation, right hip versus left hip, (P=.022) than the NoLBP group. Left total hip rotation was more limited than right total hip rotation in the LBP group (P=.004). There were no significant differences in left and right total hip rotation for the NoLBP group (P=.323). CONCLUSIONS Among people who participate in rotation-related sports, those with LBP had less overall passive hip rotation motion and more asymmetry of rotation between sides than people without LBP. These findings suggest that the specific directional demands imposed on the hip and trunk during regularly performed activities may be an important consideration in deciding which impairments may be most relevant to test and to consider in prevention and intervention strategies.

Prevalence of diastasis recti abdominis in a urogynecological patient population.

A urogynecologist’s examination typically includes assessment of the abdominal musculature, including the determination of whether a diastasis recti abdominis (DRA) is present. The purposes of the current study were to examine the (1) prevalence of DRA in a urogynecological population, (2) differences in select characteristics of patients with and without DRA, and (3) relationship of DRA to support-related pelvic floor dysfunction diagnoses. A retrospective chart review was conducted by an independent examiner. Fifty-two percent of the patients examined presented with DRA. Patients with DRA were older, reported higher gravity and parity, and had weaker pelvic floor muscles than patients without DRA. Sixty-six percent of all the patients with DRA had at least one support-related pelvic floor dysfunction (SPFD) diagnosis. There was a relationship between the presence of DRA and the SPFD diagnoses of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse.

The Inter-Tester Reliability of Physical Therapists Classifying Low Back Pain Problems Based on the Movement System Impairment Classification System

The classification of patients with low back pain (LBP) may be important for improving clinical outcomes and research efficiency. The purpose of this study was to examine the inter‐tester reliability of 2 trained physical therapists to classify patients with LBP by using the standardized Movement System Impairment (MSI) classification system. The 5 proposed MSI classifications are based on the most consistent patterns of movement and alignment observed throughout the examination that correlate with the patients symptom behavior.

Patterns of Lumbar Region Movement During Trunk Lateral Bending in 2 Subgroups of People With Low Back Pain

Background and Purpose The movement system impairment (MSI) system is one proposed system for classifying low back pain (LBP) problems. Prior clinical data and observations for the MSI system suggest that different LBP subgroups demonstrate different patterns of movement during clinical tests, such as trunk lateral bending (TLB). The purpose of this study, therefore, was to examine the validity of the observation that lumbar region (LR) movement patterns during TLB are different between 2 subgroups of people with LBP: lumbar rotation with extension (Rotation With Extension) and lumbar rotation (Rotation). Subjects Participants were 44 people (28 men and 16 women; age [X̄±SD], 28.5±8.4 years) with chronic or recurrent LBP. Methods Each participants LBP problem was classified with the MSI system. Kinematic variables were measured, and LBP symptoms were recorded during the TLB test. Results People in the 2 LBP subgroups demonstrated different patterns of LR movement during TLB. People in the Rotation With Extension subgroup displayed an asymmetric (right versus left) pattern of LR movement across the TLB movement, whereas people in the Rotation subgroup displayed a symmetric pattern of LR movement. Equal proportions of people in the 2 subgroups reported an increase in symptoms with the TLB test. Discussion and Conclusion The patterns of LR movement across the TLB movement were different in 2 subgroups of people with LBP. The difference in the LR movement patterns between subgroups may be an important factor to consider in specifying the details of the interventions for these 2 LBP problems.

Prospective Measurement of Function and Pain in Patients with Non-Neoplastic Compression Fractures Treated with Vertebroplasty

BACKGROUND There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. METHODS Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. RESULTS Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). CONCLUSIONS Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.

Classification, treatment and outcomes of a patient with lumbar extension syndrome.

The purpose of the current report is to describe the classification, treatment, and outcomes of a patient with lumbar extension syndrome. The patient was a 40-year-old female with an 18-month history of mechanical low back pain (LBP). The patient reported a history of daily, intermittent pain (mean intensity of 9/10) that limited her ability to sit, stand, walk, and sleep, as well as perform work-related activities. Symptom-provoking movement and alignment impairments associated with the direction of lumbar extension were identified and modification of these impairments consistently resulted in a decrease in pain. Treatment was provided in 3 sessions over a 2-month period. Priority of treatment was to train the patient to restrict lumbar extension-related alignments and movements during symptom-provoking functional activities. Exercises to address the extension-related impairments also were prescribed. The primary change in outcome was a decrease in the mean intensity (2 months: 2/10; 6 months: 1/10) and frequency of pain (2 months: decreased pain with standing and walking; 6 months: additional decrease with sitting, standing and walking). She also reported a decreased duration and number of LBP episodes. Classification directed treatment resulted in improvement in short and long term impairment and functional-level outcomes.

Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain

Increased and early lumbopelvic motion during trunk and limb movements is thought to contribute to low back pain (LBP). Therefore, reducing lumbopelvic motion could be an important component of physical therapy treatment. Our purpose was to examine the effects of classification-specific physical therapy treatment (Specific) based on the Movement System Impairment (MSI) model and non-specific treatment (Non-Specific) on lumbopelvic movement patterns during hip rotation in people with chronic LBP. We hypothesized that following treatment people in the Specific group would display decreased lumbopelvic rotation and achieve more hip rotation before lumbopelvic rotation began. We hypothesized that people in the Non-Specific group would display no change in these variables. Kinematic data collected before and after treatment for hip lateral and medial rotation in prone were analyzed. The Specific group (N = 16) demonstrated significantly decreased lumbopelvic rotation and achieved greater hip rotation before the onset of lumbopelvic rotation after treatment with both hip lateral and medial rotation. The Non-Specific group (N = 16) demonstrated significantly increased lumbopelvic rotation and no change in hip rotation achieved before the onset of lumbopelvic rotation. People who received treatment specific to their MSI LBP classification displayed decreased and later lumbopelvic motion with hip rotation, whereas people who received generalized non-specific treatment did not.

GENDER DIFFERENCES IN TRUNK, PELVIS AND LOWER LIMB KINEMATICS DURING A SINGLE LEG SQUAT

The relationship between trunk and lower limb kinematics in healthy females versus males is unclear since trunk kinematics in the frontal and transverse planes have not been systematically examined with lower limb kinematics. The aim of this study was to investigate the existence of different multi-joints movement strategies between genders during a single leg squat. We expected that compared to males, females would have greater trunk and pelvis displacement due to less trunk control and display hip and knee movement consistent with medial-collapse (i.e. greater hip adduction, hip medial rotation, knee abduction, and knee lateral rotation) on the weight-bearing limb. Nine females and 10 males participated in the study. Kinematic data were collected using an 8-camera, 3D-motion-capture-system. Trunk relative to pelvis, pelvis relative to the laboratory, hip and knee angles in three planes (sagittal, frontal and transverse) were examined at two time events relevant to knee joint mechanics: 45° of knee flexion and peak knee flexion. Females flexed their trunk less than males and rotated their trunk and pelvis toward the weight-bearing limb more than males. Females also displayed greater hip adduction and knee abduction than males. Taken together these results suggest that females and males used different movement strategies during a single leg squat. Females displayed a trunk and pelvic movement pattern that may put them at risk of knee injury and pain.

The immediate effect of passive scapular elevation on symptoms with active neck rotation in patients with neck pain.

ObjectiveTo examine the effect of elevating the scapulae on symptoms during neck rotation. MethodsA retrospective analysis of clinical records was conducted. One physical therapist examined 46 patients with neck pain (30 women, 16 men; mean age 45.89+14.39 y) using a standardized examination. Patients had a long-standing history of neck pain with a moderate level of symptoms and disability. Reports of symptoms were obtained in 2 scapulae position conditions: a patient-preferred scapulae position and a passively elevated scapulae position. ResultsIn the patient-preferred positions, 29 (63%) of the 46 patients reported an increase in symptoms with neck rotation in at least one direction. In the scapulae elevated position, a significant percentage of patients reported a decrease in symptoms with neck rotation, right (82%) and left (76%) (both comparisons, P≤0.01). ConclusionsPassive elevation of the scapulae resulted in a decrease in symptoms with right and left neck rotation in the majority of patients. These findings are important because they indicate that neck symptoms can be immediately improved within the context of the examination. Such information potentially can be used to assist in directing intervention.