Wendy L Gilleard

Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain

STUDY DESIGN Cross-sectional study of electromyographic onsets of trunk and hip muscles in subjects with a clinical diagnosis of sacroiliac joint pain and matched control subjects. OBJECTIVES To determine whether muscle activation of the supporting leg was different between control subjects and subjects with sacroiliac joint pain during hip flexion in standing. BACKGROUND Activation of the trunk and gluteal muscles stabilize the pelvis for load transference; however, the temporal pattern of muscle activation and the effect of pelvic pain on temporal parameters has not been investigated. METHODS Fourteen men with a clinical diagnosis of sacroiliac joint pain and healthy age-matched control subjects were studied. Surface electromyographic activity was recorded from seven trunk and hip muscles of the supporting leg during hip flexion in standing. Onset of muscle activity relative to initiation of the task was compared between groups and between limbs. RESULTS The onset of obliquus internus abdominis (OI) and multifidus occurred before initiation of weight transfer in the control subjects. The onset of obliquus internus abdominis, multifidus, and gluteus maximus was delayed on the symptomatic side in subjects with sacroiliac joint pain compared with control subjects, and the onset of biceps femoris electromyographic activity was earlier. In addition, electromyographic onsets were different between the symptomatic and asymptomatic sides in subjects with sacroiliac joint pain. CONCLUSIONS The delayed onset of obliquus internus abdominis, multifidus, and gluteus maximus electromyographic activity of the supporting leg during hip flexion, in subjects with sacroiliac joint pain, suggests an alteration in the strategy for lumbopelvic stabilization that may disrupt load transference through the pelvis.

Three-dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normals during stance phase of walking.

BACKGROUND Many studies have shown that lack of functional activity of tibialis posterior leads to changes in the longitudinal arch and affects the motion of the foot. A quantitative description of the affects on the motion of the foot in detail has not been reported. OBJECTIVE To describe three-dimensional motion of the leg, rearfoot and forefoot with tibialis posterior dysfunction during stance phase of walking in comparison with normals. This study compared one case without the function of tibialis posterior with the ensemble average of 10 normals (five males, five females). METHODS Subjects with 10, 12 mm retroreflective markers placed on their right leg, rearfoot and forefoot, performed five trials of walking at self-selected speed on a 10 m walkway. A four-camera three-dimensional motion analysis system and a synchronized force platform were used to record three-dimensional motions of the segments and force variables during stance phase of walking. RESULTS The patterns and range of motion of the rearfoot relative to the leg, and the forefoot relative to the rearfoot demonstrated some differences between the tibialis posterior dysfunction case and normals. Most of the major differences occurred from just prior to heel-off through to toe-off, the period when a stable arch would be required. CONCLUSION The observed differences in the three-dimensional foot motions of the tibialis posterior dysfunction case compared with normals during walking were consistent with the expected mechanical consequences of a foot without the function of tibialis posterior. The one exception was the inversion of the rearfoot which remained normal. RELEVANCE Tibialis posterior dysfunction has been recognized as one of the significant impairments of the musculoskeletal system which affects normal walking. Dynamic investigation adds an understanding of how the muscle controls the foot during walking which is essential information for the diagnosis and the adjustment of treatment and rehabilitation for a tibialis posterior dysfunction case.

Evaluation of the Ability of Physical Therapists to Palpate Intrapelvic Motion With the Stork Test on the Support Side

Background and Purpose Clinical indicators of pelvic girdle dysfunction are limited. However, research has shown that the pattern of intrapelvic motion is altered during single-leg support in subjects with pelvic girdle pain (PGP). Functionally, no relative motion should occur within the pelvis during load transfer, whereas anterior rotation of the innominate bone relative to the sacrum occurs during weight bearing in the presence of PGP. The aim of this study was to investigate whether the pattern of intrapelvic motion could be detected reliably during a new clinical assessment test for functional load transfer: the Stork Test on the support side. Subjects and Methods Three physical therapists were randomly assigned to palpate the motion of the innominate bones and sacrum in 33 subjects during the Stork Test on the support side. The direction of bone motion was indicated on 2-point and 3-point scales. Results When a 2-point scale was used, intertherapist agreement on the pattern of intrapelvic motion occurring during load transfer showed good reliability (left κ=.67, right κ=.77), and the percentage of agreement was high (left=91.9%, right=89.9%). A 3-point scale resulted in moderate reliability for both the left and the right sides (left κ=.59, right κ=.59), and the percentage of agreement decreased to 82.8% (left) and 79.8% (right). Discussion and Conclusion The ability of the physical therapists to reliably palpate and recognize an altered pattern of intrapelvic motion during the Stork Test on the support side was substantiated. The ability to distinguish between no relative movement and anterior rotation of the innominate bone during a load-bearing task was good. Further research is needed to determine the validity of this test for detecting pelvic girdle dysfunction.

Automatic Recognition of Gait Patterns Exhibiting Patellofemoral Pain Syndrome Using a Support Vector Machine Approach

Patellofemoral pain syndrome (PFPS) is a common disorder that afflicts people across all age groups, and results in various degrees of knee pain. The diagnosis of PFPS is difficult since the exact biomechanical factors and the extent to which they are affected by the disorder are still unknown. Recent research has reported significant statistical differences in ground reaction forces (GRFs) and foot kinematics, which could be indicative of PFPS, but the interrelationship between many of these measures and the pathology have been absent so far. In this paper, we applied the support vector machines (SVMs) to detect PFPS gait based on 14 GRF and 16 foot kinematic features recorded from 27 subjects (14 healthy and 13 with PFPS). The influence of combined gait parameters on classification performance was investigated through the use of a feature-selection algorithm. The optimal feature set was then compared against the most statistically significant individual features (p < 0.05) found by previous study. Test results indicated that GRF features alone resulted in a higher leave-one-out (LOO) classification accuracy (85.15%) compared to 74.07% using only kinematic features. A hill-climbing feature-selection algorithm was applied to determine the subset of combined kinematic and kinetic features, which provided optimal classifier performance. This subset, which consists of six features (two from GRF and four from foot kinematic features), provided an improved LOO accuracy of 88.89% . The optimal feature set detected by the SVM, which best identified gait characteristics of PFPS, was found to be closely related to inferential statistical analysis with the added distinction that the SVM could potentially be deployed as an automated system for detecting gait changes in patients with PFPS.

Effect of pregnancy on trunk range of motion when sitting and standing

Background.  During pregnancy, apposition of body segments and changes in trunk mobility and motion control due to increased mass and dimensions may reduce the functional range of motion of the trunk segments. Although static postures have been investigated, dynamic trunk motion during pregnancy in sitting and standing has had very limited investigation.

Trunk motion and gait characteristics of pregnant women when walking: report of a longitudinal study with a control group

BackgroundA longitudinal repeated measures design over pregnancy and post-birth, with a control group would provide insight into the mechanical adaptations of the body under conditions of changing load during a common female human lifespan condition, while minimizing the influences of inter human differences. The objective was to investigate systematic changes in the range of motion for the pelvic and thoracic segments of the spine, the motion between these segments (thoracolumbar spine) and temporospatial characteristics of step width, stride length and velocity during walking as pregnancy progresses and post-birth.MethodsNine pregnant women were investigated when walking along a walkway at a self-selected velocity using an 8 camera motion analysis system on four occasions throughout pregnancy and once post birth. A control group of twelve non-pregnant nulliparous women were tested on three occasions over the same time period. The existence of linear trends for change was investigated.ResultsAs pregnancy progresses there was a significant linear trend for increase in step width (p = 0.05) and a significant linear trend for decrease in stride length (p = 0.05). Concurrently there was a significant linear trend for decrease in the range of motion of the pelvic segment (p = 0.03) and thoracolumbar spine (p = 0.01) about a vertical axis (side to side rotation), and the pelvic segment (p = 0.04) range of motion around an anterio-posterior axis (side tilt). Post-birth, step width readapted whereas pelvic (p = 0.02) and thoracic (p < 0.001) segment flexion-extension range of motion decreased and increased respectively. The magnitude of all changes was greater than that accounted for with natural variability with re testing.ConclusionsAs pregnancy progressed and post-birth there were significant linear trends seen in biomechanical changes when walking at a self-determined natural speed that were greater than that accounted for by natural variability with repeated testing. Not all adaptations were resolved by eight weeks post birth.

The association between body composition and foot structure and function: a systematic review

The aim of this systematic review was to investigate the relationship between body composition and foot structure and function. Six electronic databases (Ovid MEDLINE, Ovid EMBASE, Ovid AMED, CINAHL, Scopus and The Cochrane Library) and reference lists from relevant papers were searched on 2 September 2013. Sixteen papers that reported on the association between body composition and foot structure and function met our inclusion criteria and were reviewed. The evidence indicates that obesity is strongly associated with planus (low‐arched) foot posture, pronated dynamic foot function and increased plantar pressures when walking. However, there is limited evidence to support an association between other body composition measures, such as fat mass, with foot structure or function.

A longitudinal study of the effect of pregnancy on rising to stand from a chair

Rising to stand from a chair becomes more difficult to perform as pregnancy progresses, which may lead to altered biomechanics affecting the musculoskeletal demands on the body segments. The kinematic and kinetic adaptations in the lower limbs and trunk as pregnancy progresses are unknown. Nine maternal subjects were investigated using an eight-camera motion analysis system and two force plates, four times throughout pregnancy and once post-birth during rising to stand. Twelve nulliparous female subjects were used to establish natural variation with retesting over the time period. The maternal subjects used temporal-spatial, kinematic and kinetic strategies to widen the base of support, minimize propulsion, increase motion of the thoracic segment and minimize anterior trunk-thigh apposition. A fear of postural instability may have made the subjects more cautious, and as they were able to adequately flex the trunk forward, propulsion was minimized in favor of maintaining upright terminal balance.

Relationship between static posture and rearfoot motion during walking in patellofemoral pain syndrome: effect of a reference posture for gait analysis.

The reference posture used in angular motion calculations may play an important role in the relationship found between static posture and rearfoot motion in the frontal plane in a clinical population such as patients with patellofemoral pain syndrome. This study examined the relationship between rearfoot inversion and eversion during the stance phase of walking and the static relaxed standing measurement in women (aged 18 years and older) with patellofemoral pain syndrome and controls and examined the influence of the reference posture used when calculating dynamic motion. Two reference postures were investigated: vertical alignment between the rearfoot and the lower leg and relaxed calcaneal standing. When using the latter reference posture, a significant correlation was found between the static relaxed standing measurement and peak eversion in controls only. When using the vertical alignment reference posture, significant correlation was found only in the patellofemoral pain syndrome group for peak eversion and inversion. The positive relationship found in the patellofemoral pain syndrome group between dynamic angular measures, based on a neutral reference posture, and static relaxed standing indicated that for subjects with patellofemoral pain syndrome, the clinical rearfoot measurement of relaxed standing can be used to explain the pattern of rearfoot motion during walking.

Evidence for the impact of assessment on mood and motivation in first-year students

Learning, and particularly assessment practices, that encourages a self‐determined approach enhances feelings of well‐being and achievement motivation. Students (n = 137) in a common first‐year unit were the participants for an evaluation of the impact of assessment. The Intrinsic Motivation Inventory and the Brunel Mood Scale were used to assess psychological reactions. A repeated measures comparison for each motivation and mood variable was conducted using mixed‐model analysis. Changes in all moods were significant at week 7, when the greatest number of assessment items per student was due. For this particular week, negative moods also increased, along with a decrease in the positive mood of vigour. The intrinsic motivation variables of interest/enjoyment and perceived competence were significantly lower in week 7, with pressure/tension being significantly higher. For this group of students the demands of assessment have been shown to have a psychological impact.