Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the... more
Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally.Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain. A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N)...
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The current study was conducted to examine ethnic, gender, and age-related differences in femorotibial angle (FTA), femoral antetorsion and tibiofibular torsion. Healthy Japanese (n = 120) and Australian Caucasian (n = 82) subjects were... more
The current study was conducted to examine ethnic, gender, and age-related differences in femorotibial angle (FTA), femoral antetorsion and tibiofibular torsion. Healthy Japanese (n = 120) and Australian Caucasian (n = 82) subjects were examined using a series of clinically reliable methods for measuring FTA and torsion of the lower limb. Subjects between 18-29 years of age were categorized as younger, 30-59 years as middle age, and 60 or more as older age. Three-way analysis of variance was utilized for data analysis. The Japanese subjects had significantly greater FTA (more varus) than the Australian subjects (P < 0.001). Femoral antetorsion in the Japanese subjects was significantly smaller in middle and older age groups than younger group (P < 0.05), but did not differ between the age groups in the Australian subjects. Further, tibiofibular torsion in female subjects was significantly greater in younger and middle age groups than the older age group (P < 0.01), but was not different between different age groups in males. The results suggest that healthy Japanese may have more genu varus alignment compared to the corresponding Australian population. Age-related ethnic and gender differences in femoral and tibiofibular torsion are worthy of further study.
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Aging, Adolescent, Clinical Anatomy, Humans, Fibula, and 15 moreTibia, Femur, Female, Male, Medical Physiology, Clinical Sciences, Aged, Middle Aged, Adult, Analysis of Variance, European Continental Ancestry Group, Asian Continental Ancestry Group, Cross sectional Study, Cross Sectional Studies, and Biomechanical Phenomena
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The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were... more
The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.
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The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic pain (NeP) using the following categories: no NeP, possible,... more
The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/upper limb pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs pain scale [LANSS] and the painDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/upper limb pain appears limited.
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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... more
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 other's findings and the subject's 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.
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Data Analysis, Manual Therapy, High Frequency, Humans, Goodness of Fit, and 14 moreFemale, Young Adult, Cervical Vertebrae, Clinical Sciences, Motion Segmentation, Middle Aged, Adult, Physical examination, Reproducibility of Results, Rotation, Cervical Spine, Sensitivity and Specificity, Cross Sectional Studies, and Pain Measurement
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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). This was an observational study. Ninety-two... more
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). 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. 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. These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.
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The painDETECT questionnaire (PD-Q) has been used as a tool to characterize sensory abnormalities in patients with persistent pain. This study investigated whether the self-reported sensory descriptors of patients with painful cervical... more
The painDETECT questionnaire (PD-Q) has been used as a tool to characterize sensory abnormalities in patients with persistent pain. This study investigated whether the self-reported sensory descriptors of patients with painful cervical radiculopathy (CxRAD) and patients with fibromyalgia (FM), as characterized by responses to verbal sensory descriptors from PD-Q (sensitivity to light touch, cold, heat, slight pressure, feeling of numbness in the main area of pain), were associated with the corresponding sensory parameters as demonstrated by quantitative sensory testing (QST). Twenty-three patients with CxRAD (eight women, 46.3 ± 9.6 years) and 22 patients with FM (20 women, 46.1 ± 11.5 years) completed the PD-Q. Standardized QST of dynamic mechanical allodynia, cold and heat pain thresholds, pressure pain thresholds, mechanical and vibration detection thresholds, was recorded from the maximal pain area. Comparative QST data from 31 age-matched healthy controls (HCs; 15 women) were obtained. Patients with CxRAD demonstrated a match between their self-reported descriptors and QST parameters for all sensory parameters except for sensitivity to light touch, and these matches were statistically significant compared with HC data (p ≤ 0.006). The FM group demonstrated discrepancies between the PD-Q and QST sensory phenotypes for all sensory descriptors, indicating that the self-reported sensory descriptors did not consistently match the QST parameters (p = ≤0.017). Clinicians and researchers should be cautious about relying on PD-Q as a stand-alone screening tool to determine sensory abnormalities in patients with FM.
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The aim of this study was to investigate, using quantitative sensory testing (QST) parameters and the painDETECT (PD-Q) screening questionnaire, the presence of neuropathic pain (NeP) in patients with unilateral painful cervical... more
The aim of this study was to investigate, using quantitative sensory testing (QST) parameters and the painDETECT (PD-Q) screening questionnaire, the presence of neuropathic pain (NeP) in patients with unilateral painful cervical radiculopathy (CxRAD) and in patients with unilateral nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). All patients completed the PD-Q before QST. QST was performed bilaterally in the maximal pain area and the affected dermatome in 23 patients with painful C6 or C7 radiculopathy and in 8 patients with NSNAP following a C6/7 dermatomal pain distribution. Patients with CxRAD demonstrated a significant loss of sensory function in mechanical (P≤0.021) and vibration sense (P≤0.003) on the symptomatic side compared with the asymptomatic side in both tested body regions and in the dermatome reduced cold detection (P=0.021) and pressure pain sensitivity (P=0.005), findings consistent with nerve root damage. These sensory alterations in the maximal pain area/symptomatic side are confirmative for the presence of NeP. In contrast to these QST data, only 30% of patients with CxRAD demonstrated a NeP component according to the PD-Q score. In patients with NSNAP, a significant side-to-side difference was demonstrated for warm detection threshold in the dermatome (P=0.030). The PD-Q score indicated that NeP components were unlikely in this group. QST data suggest that NeP is likely to be observed in patients with painful CxRAD, but not in patients with NSNAP.
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Humans, Female, Male, Neck Pain, Clinical Sciences, and 4 moreMiddle Aged, Adult, Neurosciences, and Pain Measurement
Previous studies have evaluated reliability and validity of clinical measurements of femoral and tibiofibular torsion, however, the results are conflicting, warranting an alternative method. The authors developed modified methods of... more
Previous studies have evaluated reliability and validity of clinical measurements of femoral and tibiofibular torsion, however, the results are conflicting, warranting an alternative method. The authors developed modified methods of measuring femoral and tibiofibular torsion using different reference axes, and validity and reliability of the modified and existing methods were examined in healthy subjects. Reference values were established using magnetic resonance imaging (MRI) for the validity study. There were significant differences between all clinical methods and corresponding MRI outcomes (P <0.05), whereas Pearson's correlation coefficients between the clinical methods and MRI ranged from 0.67-0.92. For modified methods, intraclass correlation coefficients were 0.89-0.97, whereas those of existing methods were 0.75-0.81. Modified methods were more precise, with standard error of measurements (SEM) of 1.5-2.9 degrees , compared to existing methods (SEM=4.0-5.1 degrees). These results indicate that clinical methods available currently do not accurately measure true torsion of the femur and tibia. Nevertheless, the clinical methods may be useful for screening and descriptive purposes as indices of true torsion, and use of different reference axes could improve their reliability.
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Question: Is it likely that physiotherapists stigmatise patients due to their body size and could this affect the way patients are treated? Design: Cross-disciplinary review of literature. Participants: Literature was reviewed on the... more
Question: Is it likely that physiotherapists stigmatise patients due to their body size and could this affect the way patients are treated? Design: Cross-disciplinary review of literature. Participants: Literature was reviewed on the current status of weight stigma generally, weight stigmatising attitudes of health professionals specifically and the effects of weight stigma on treatment of patients including subsequent health outcomes. Intervention: A review of literature was conducted across numerous disciplines including medicine, psychology, fat studies, sociology and public health. The outcomes, conclusions and relevance to the research question were reviewed in 186 scholarly resources. Outcome measures: Overall outcomes of research in scientific literature regarding weight stigma in general, weight stigma by health professionals (including physiotherapists) towards patients, and the impact of this stigma on treatment of patients. Results: Weight is a salient characteristic for ...
Descriptive correlational study. To determine relationships between aspects of turnout and injury history in preprofessional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout. In... more
Descriptive correlational study. To determine relationships between aspects of turnout and injury history in preprofessional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout. In Australia 50% of professional dancers currently have persistent or recurrent injuries, with 36% of these injuries commencing before 18 years of age (preprofessional level). Overuse or nontraumatic dance injuries are often attributed to faults in technique, with poor turnout and inappropriate compensatory strategies consistently cited as the main cause. Twenty-nine dancers (24 female), aged 15 to 22 years, were recruited from a preprofessional classical ballet program. Measurements were taken of passive and active hip external rotation (ER) range of motion (ROM) in supine, and functional turnout angles in standing. Three turnout variables were derived: active ER lag, compensated turnout, and static-dynamic turnout difference. Injury history over the pre...
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Australia, Dancing, Adolescent, Humans, Female, and 4 moreMale, Clinical Sciences, Adult, and Lower Extremity
The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT). A single blind, comparative group design was used to investigate whether lower CFP influences FRT... more
The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT). A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26-63 years) and 12 with lower CFP (age 44-62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included. The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups re...
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Associations between torsion of the lower limb and knee osteoarthritis (OA) appear to be inconsistent across populations. We examined whether femoral and tibiofibular torsion differed between people with and without knee OA (main effect),... more
Associations between torsion of the lower limb and knee osteoarthritis (OA) appear to be inconsistent across populations. We examined whether femoral and tibiofibular torsion differed between people with and without knee OA (main effect), and whether the differences were consistent across Japanese and Australian Caucasian persons, and between women and men (interaction effect). Data collection was conducted in Japan and Australia. Subjects with knee OA included 100 Japanese and 102 Australian Caucasians, and healthy subjects included 52 Japanese and 34 Australian Caucasians. Femoral and tibiofibular torsion were measured using reliable clinical techniques. Three-way analysis of variance was conducted to examine the main and interaction effects. While there were no significant differences in femoral and tibiofibular torsion between the subjects with and without knee OA as a whole (main effect), there were significant interactions (p < 0.05). Femoral antetorsion was lower only in t...
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Immunology, Australia, Japan, Humans, Tibia, and 14 moreFemur, Female, Male, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Analysis of Variance, Knee Osteoarthritis, European Continental Ancestry Group, Asian Continental Ancestry Group, Cross Sectional Studies, Knee Joint, and Case Control Studies
This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia. Currently, the... more
This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia. Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women. Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling. In adults with a baseline calcium intake of 500-900 mg/day, increasing or supplementing this intake by a further 500-1000 mg/day has a beneficial effect on bone mineral density. Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.
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Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly... more
Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly in acute edema populations. This study aimed to confirm the reliability and investigate the impact of time between repeated trials on the sensitivity of WDV as a measure of whole UL volume change in an uninjured cohort and a burn injured pilot group. Within session, duplicate measures of whole UL WDV were recorded in two groups of noninjured volunteers and a group of burn patients. Each noninjured group differed only in the time between WDV repeats. The reliability trials were performed &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 minutes apart (T10) and 20 to 30 minutes apart (T20). The time between repetitions for burn patients was 20 to 30 minutes, based on the results of the noninjured participant trials. All trial groups demonstrated excellent correlation between trials (ICCT10 = 0.999, ICCT20 = 0.997). The minimum detectable difference calculated for WDV when measuring whole UL volume change of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 ml for noninjured and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 ml for burn patients. Despite this, a systematic bias was demonstrated between the T10 group means. The T20 group trials did not indicate such error on statistical testing (P = .297). The study confirms that WDV measurement of whole ULs is reliable and sensitive, if used at least 20 minutes apart. However, a significant and clinically relevant subject-by-method interaction was demonstrated. Researchers and clinicians are reminded to be aware of the performance of the technique when designing investigations in patient populations.
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Calcitriol has been shown to have immunomodulatory effects. We examined whether heart transplant recipients, randomly assigned to receive calcitriol to reduce bone loss, required less immunosuppressive therapy or demonstrated different... more
Calcitriol has been shown to have immunomodulatory effects. We examined whether heart transplant recipients, randomly assigned to receive calcitriol to reduce bone loss, required less immunosuppressive therapy or demonstrated different rejection and survival outcomes. Patients receiving low-dose calcitriol required substantially lower cumulative doses of cyclosporin (29% [95% confidence interval; 8%-50%] and 28% [7%-50%] for 1 and 2 years, respectively) for organ rejection without any detectable change in episodes of rejection, infection, or deaths. This major reduction of oral cyclosporine requirement, in addition to the skeletal benefits of calcitriol in those receiving immunosuppressive therapy, indicates a potential role for co-therapy with calcitriol or its analogues in the management of patients with solid-organ transplantation.
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ABSTRACT Background Massage is frequently used in prevention and management of soft tissue injuries in sport. There is little scientific evidence to support its use.
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The purpose of this study was to determine if, within a normal population: (1) palpation of the humeral head, relative to the acromion, in three static positions, was a reliable technique (2) there was a difference in humeral head... more
The purpose of this study was to determine if, within a normal population: (1) palpation of the humeral head, relative to the acromion, in three static positions, was a reliable technique (2) there was a difference in humeral head position between the dominant and non-dominant shoulders in the three positions (3) there was a difference in humeral head position relative to the acromion between the arm at side (AS), the 90 degrees abduction/external rotation (AER) and 90 degrees abduction/internal rotation (AIR) positions. This test-retest study recorded palpation landmarks using a standardized protocol. Intra-tester reliability was above 0.8 for both AS and AER and all other ICCs were below 0.6. There was no systematic difference between dominant and non-dominant sides in any of the three positions (AS P=0.408, AER P=0.448, AIR P=0.233). There was a significant difference in measurements between each position (P&lt;0.001). It can be concluded that, palpation of humeral head position in relation to the acromion is a reliable technique in the AS position. These normative data provide a baseline that can be used for future comparison if differences are found to exist in subgroups with pathological shoulder conditions where larger glenohumeral translations are thought to exist.
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Australia, Risk assessment, Comorbidity, Urinary incontinence, Humans, and 13 moreFemale, Sleep disorders, Incidence, Clinical Sciences, Aged, Analysis of Variance, Geriatric Assessment, Australian, Risk Assessment, Elderly Women, Cross Sectional Studies, Logistic Models, and Predictive value of tests
Cross sectional. To compare the strength and range of motion of the dominant and nondominant shoulders of adult female amateur tennis players. The secondary purpose of the study was to examine whether there were any differences in the... more
Cross sectional. To compare the strength and range of motion of the dominant and nondominant shoulders of adult female amateur tennis players. The secondary purpose of the study was to examine whether there were any differences in the observed relationships between women with a past history of shoulder pain and those with no history of shoulder pathology. Information on characteristics of the shoulder in amateur female tennis players is scarce, as research has concentrated on highly skilled or male players, despite the cumulative prevalence of shoulder pain in this group. Fifty-one female competitive, amateur tennis players (average age, 45 years) were tested bilaterally for shoulder internal/external rotation passive range of motion and isokinetic concentric strength. Shoulder range of motion and strength ratios were comparable between sides. In the dominant arm, the total rotational range of motion was 221 degrees, with an internal to external rotator peak torque ratio of 1.05. External rotator strength was significantly greater in the dominant arm of individuals with no history of pain. Range of motion and strength adaptations widely reported in highly skilled tennis players were not apparent in amateur female players. In assessment and management, clinicians should regard the amateur female tennis player as a separate entity from the highly skilled player.
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Pain, Tennis, Humans, Female, Clinical Sciences, and 7 moreAged, Middle Aged, Adult, Age Factors, Torque, Range of Motion, and Cross Sectional Studies
Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the active straight leg raise (ASLR). This study investigated how pain-free subjects coordinate motor control during an ASLR when this task is... more
Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the active straight leg raise (ASLR). This study investigated how pain-free subjects coordinate motor control during an ASLR when this task is complicated by the addition of a respiratory challenge. Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR, breathing with inspiratory resistance (IR) and ASLR+IR. Subjects responded to ASLR+IR with an increase in the motor activation in the abdominal wall and chest wall compared to when ASLR and IR were performed in isolation. Activation of obliquus internus abdominis was greater on the side of the leg lift during the ASLR+IR, in comparison to symmetrical activation observed in the other abdominal wall muscles. The incremental increase of motor activity was associated with greater intra-abdominal pressure baseline shift when lifting the leg during ASLR+IR compared to ASLR. Individual variation was apparent in the form of the motor control patterns, mostly reflected in variable respiratory activation of the abdominal wall. The findings highlight the flexibility of the neuromuscular system in adapting to simultaneous respiratory and stability demands.
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It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strategy during the low load task of the active straight leg raise (ASLR). This study investigated this premise by observing the motor control... more
It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strategy during the low load task of the active straight leg raise (ASLR). This study investigated this premise by observing the motor control patterns adopted by pain free subjects during a loaded ASLR (ASLR+PL). Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR and ASLR+PL. Additionally, side-to-side comparisons were performed for ASLR+PL. Incremental increases in muscle activation were observed from resting supine to ASLR to ASLR+PL. During the ASLR+PL there was a simultaneous increase in intra-abdominal pressure with a decrease in intra-thoracic pressure, while respiratory fluctuation of these variables were maintained. The ASLR+PL also resulted in increased pelvic floor descent and greater downward pressure of the non-lifted leg. Trunk muscle activation was comparable between sides during ASLR+PL in all muscles except lower obliquus internus abdominis, which was more active on the leg lift side. Pain free subjects respond to an ASLR+PL by a general increase in anterior trunk muscle activation, but preserve the pattern of greater activation on the side of the leg lift observed during an unloaded ASLR. This contrasts to findings in PGP subjects who, despite having a high load strategy for performing an ASLR on the symptomatic side of the body, display equal bilateral activation of the anterior abdominal wall during the ASLR. This differentiates PGP subjects from pain free subjects, supporting the notion that PGP subjects have aberrant motor control patterns during an ASLR.