ABSTRACT
BACKGROUND: The rapid growth of women's rugby union has underscored the need for female-specific player welfare protocols, particularly regarding the risk of head injuries. Instrumented mouthguards (iMGs) play a vital role in gathering comprehensive data on head acceleration events (HAEs), including their frequency, magnitude, and spatial distribution during games and training. By doing so, iMGs offer valuable context for circumstances in women's matches that may increase player risk. OBJECTIVES: The study aimed to contextualize HAEs in female community rugby players using instrumented mouthguards and video review. METHODS: This prospective, observational cohort study involved 332 female rugby players across 38 matches and 80 training sessions during the 2021/2022 seasons. Players were representative of four playing grades: U13 (N = 9), U15 (N = 111), U19 (N = 95) and Premier women (N = 115). HAEs were recorded using boil-and-bite iMGs, with a single-axis recording threshold of 5 g. The incidence and prevalence of HAEs was expressed by grade, years of experience, playing positions, and session types (match or training). The effect of playing grade and previous playing experience on HAE propensity during tackles and rucks was also examined. RESULTS: Throughout the study, 9151 iMG events over 5 g were recorded, with 80% verified for analysis. Overall, the incidence rate (IR) was highest for HAEs between 10 and 29 g, 12-18 times higher than the IR for > 30-g events. Premier grade players had the highest weekly HAE load (26.2 per player per week) and the highest prevalence of players (49%) exposed to events over 30 g. An inverse relationship was found between years of rugby experience and peak angular acceleration (PAA) in U13-U19 players (p = 0.002, 95% CI [47,177 rads/s2]), showing that more experienced school-age players had lower rotational acceleration during HAEs. However, propensity for HAEs in tackle events was highest in Premier players with > 9 years of experience compared with U13-U19 grade players with similar years of experience (RR = 1.21, 95% CI 1.06-1.37; p = 0.004). Ball carries consistently resulted in the highest propensity of events over 30 g, regardless of playing grade or experience. CONCLUSIONS: This research presents unique information regarding head accelerations that occur during women's community rugby matches and practices. The results have significant implications for recognising populations that are at the highest risk of experiencing high cumulative and acute head accelerations. The findings may assist in managing training loads and instructing skill execution in high-risk activities, particularly for younger players who are new to the sport. Consideration of playing grade, experience, and contact phases is crucial for understanding head acceleration exposure and injury risk in female rugby players. These insights can inform injury prevention strategies.
ABSTRACT
OBJECTIVES: The aim of this study was to examine the cumulative head acceleration event (HAE) exposure in male rugby players from the Under-13 (U13) to senior club level over 4 weeks of matches and training during the 2021 community rugby season. METHODS: This prospective, observational cohort study involved 328 male rugby players. Players were representative of four playing grades: U13 (N = 60, age 12.5 ± 0.6 years), U15 (N = 100, age 14.8 ± 0.9 years), U19 (N = 78, age 16.9 ± 0.7 years) and Premier senior men (N = 97, age 22.5 ± 3.1 years). HAE exposure was tracked across 48 matches and 113 training sessions. HAEs were recorded using boil-and-bite instrumented mouthguards (iMGs). The study assessed the incidence and prevalence of HAEs by ages, playing positions, and session types (match or training). RESULTS: For all age grades, weekly match HAE incidence was highest at lower magnitudes (10-29 g). Proportionally, younger players experienced higher weekly incidence rates during training. The U19 players had 1.36 times the risk of high-magnitude (> 30 g) events during matches, while the U13 players had the lowest risk compared with all other grades. Tackles and rucks accounted for the largest HAE burden during matches, with forwards having 1.67 times the risk of > 30 g HAEs in rucks compared with backs. CONCLUSIONS: This study provides novel data on head accelerations during rugby matches and training. The findings have important implications for identifying populations at greatest risk of high cumulative and acute head acceleration. Findings may guide training load management and teaching of skill execution in high-risk activities, particularly for younger players who may be exposed to proportionally more contact during training and for older players during matches.
Subject(s)
Football , Rugby , Humans , Male , Child , Adolescent , Young Adult , Adult , Prospective Studies , Cohort Studies , AccelerationABSTRACT
BACKGROUND: Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that deliver PFMT programs are readily available, yet uncertainty exists regarding whether they are scientifically valid, appropriate, and culturally relevant and meet the needs of women at specific life stages. OBJECTIVE: This scoping review aims to provide a narrative synthesis of DTs used for PFMT to manage UI in women across their life course. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework. A systematic search of 7 electronic databases was conducted, and primary quantitative and qualitative research and gray literature publications were considered. Studies were eligible if they focused on women with or without UI who had engaged with DTs for PFMT, reported on outcomes related to the use of PFMT DTs for managing UI, or explored users' experiences of DTs for PFMT. The identified studies were screened for eligibility. Data on the evidence base for and features of PFMT DTs using the Consensus on Exercise Reporting Template for PFMT, PFMT DT outcomes (eg, UI symptoms, quality of life, adherence, and satisfaction), life stage and culture, and the experiences of women and health care providers (facilitators and barriers) were extracted and synthesized by ≥2 independent reviewers. RESULTS: In total, 89 papers were included (n=45, 51% primary and n=44, 49% supplementary) involving studies from 14 countries. A total of 28 types of DTs were used in 41 primary studies, including mobile apps with or without a portable vaginal biofeedback or accelerometer-based device, a smartphone messaging system, internet-based programs, and videoconferencing. Approximately half (22/41, 54%) of the studies provided evidence for or testing of the DTs, and a similar proportion of PFMT programs were drawn from or adapted from a known evidence base. Although PFMT parameters and program compliance varied, most studies that reported on UI symptoms showed improved outcomes, and women were generally satisfied with this treatment approach. With respect to life stage, pregnancy and the postpartum period were the most common focus, with more evidence needed for women of various age ranges (eg, adolescent and older women), including their cultural context, which is a factor that is rarely considered. Women's perceptions and experiences are often considered in the development of DTs, with qualitative data highlighting factors that are usually both facilitators and barriers. CONCLUSIONS: DTs are a growing mechanism for delivering PFMT, as evidenced by the recent increase in publications. This review highlighted the heterogeneity in types of DTs, PFMT protocols, the lack of cultural adaptations of most of the DTs reviewed, and a paucity in the consideration of the changing needs of women across their life course.
Subject(s)
Pelvic Floor , Urinary Incontinence , Pregnancy , Female , Humans , Aged , Adolescent , Quality of Life , Digital Technology , Exercise Therapy/methods , Urinary Incontinence/therapyABSTRACT
OBJECTIVES: The primary objective of this study was to examine rugby players anticipatory and compensatory head control during predictable and unpredictable impact events. METHODS: An observational cross-sectional study design. Fifty-one (17_healthy 34_concussion) male rugby players were exposed to external predictable and unpredictable impact perturbations at mid-chest level. Surface EMG of the upper-trapezius (UT), splenius-capitis (Spl) and sternocleidomastoid (Scm) was recorded and analysed across three temporal epochs typical for anticipatory and compensatory postural control. Synchronized sagittal head-kinematics were measured from high-speed video (500 fps). Nonparametric tests were used to examine within and between group effects. RESULTS: Anticipatory head control was evident in predictable conditions, expressed by early posterior head displacement and activation of the Spl. Compared to unpredictable conditions, muscle amplitudes were significantly lower, as was head acceleration. Compared to Healthy, the Concussion athletes lacked early activation of the Spl, exhibited delayed anticipatory head adjustments and experienced higher head accelerations in predictable conditions. CONCLUSION: Rugby players with concussion injuries have significant deficits in cervical spinal motor control. The concussed motor control strategy leads to higher inertial head accelerations and delayed anticipatory head displacements. Effects may persist for two or more years following injury, which may indicate re-injury vulnerability in these athletes.
Subject(s)
Athletic Injuries , Brain Concussion , Humans , Male , Cross-Sectional Studies , Rugby , Neck , Neck MusclesABSTRACT
OBJECTIVES: Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health. DESIGN AND PARTICIPANTS: Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds. RESULTS: Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches. CONCLUSION: This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.
Subject(s)
Pelvic Girdle Pain , Consensus , Delphi Technique , Female , Humans , Pain , Pelvic Girdle Pain/therapy , Physical Therapy Modalities , PregnancyABSTRACT
BACKGROUND: Prospective studies have described evidence about the risk of developing pregnancy-related pelvic girdle pain (PPGP) such as, parity, previous history of low back and pelvic girdle pain. No previous studies have prospectively associated PPGP with postural control. AIM: This study aimed to identify postural control predictors of PPGP during pregnancy. METHODS: Forty-six pregnant women were surveyed throughout their pregnancy for the presence of PPGP. At baseline, participants were evaluated for muscle latencies, mediolateral centre-of-pressure (COP) displacement and velocity during single-leg lift performed with eyes open and closed. PPGP was considered if they presented with one positive clinical assessment as well as pain within the pelvic area. RESULTS: Eighteen (45%) of the participants developed PPGP. This group presented with PPGP around a mean 29th week (SD = 5.7), with mean pelvic pain intensity of 4 mm VAS (SD = 2) on a (0-10 cm VAS) and mean PPGP questionnaire score of 21.5 points (SD = 10.6) out of a possible 100 points with 0 indicating no functional disability. The two factors that were significantly associated with PPGP were the right and left biceps femoris (BF) muscle. For every 50 ms of difference of BF muscles latency between eyes open and closed, the risk of PPGP increases by 20% (right BF) and 30% (left BF) to develop PPGP. CONCLUSION(S): This study shows that BF muscle delay during single-leg lift presented at baseline was a significant predictor for the development of PPGP in late pregnancy.
Subject(s)
Pelvic Girdle Pain , Pregnancy Complications , Female , Guanine Nucleotides , Humans , Pelvic Pain , Pregnancy , Prospective StudiesABSTRACT
PURPOSE: The aim of this study was to examine the effect of vision on anticipatory postural control (APA) responses in two groups of clinically diagnosed chronic low back pain patients, those with Posterior Pelvic Girdle pain and those with Non-Specific Low Back Pain compared to a matched group of healthy controls during the modified Trendelenburg task. METHODS: Seventy-eight volunteer participants (60 females and 18 males) gave informed consent to take part in this study. 39 with confirmed LBP or PGP lasting longer than 12â¯weeks and 39 healthy matched controls performed 40 single leg lift tasks (hip flexion to 90° as quickly as possible) with their non-dominant lower limb. A force plate was used to determine the medial-lateral displacement of the center of pressure, and the initiation of weight shift; kinematics was used to determine initiation of leg lift; and electromyography was used to determine onset times from the external oblique (EO), internal oblique (IO) and lumbar multifidus (MF), gluteus maximus (GM) and biceps femoris (BF). RESULTS: The PGP group showed significantly longer muscle onset latencies in the BF, EO MF with visual occlusion (F2,746â¯=â¯4.51, pâ¯<â¯.0001). CONCLUSION: The muscle onset delays identified between the two LBP sub-groups suggests that pain may not be the primary factor in alteration of APA response. The PGP group show a greater reliance on vision which may signal impairment in multiple feedback channels.
Subject(s)
Chronic Pain/physiopathology , Feedback, Sensory , Low Back Pain/physiopathology , Pelvic Girdle Pain/physiopathology , Postural Balance , Adult , Biomechanical Phenomena , Electromyography , Female , Hamstring Muscles/physiopathology , Humans , Lower Extremity , Lumbosacral Region , Male , Young AdultABSTRACT
AIM: Magnetic resonance imaging (MRI) can be used to identify sacroiliac joint (SIJ) inflammation and provide an earlier diagnosis of nonradiographic axial spondyloarthritis (nrAxSpA). However, MRI is frequently a resource-limited examination. Our aim was to assess if a set of physical clinical tests can identify SIJ inflammation in patients with nrAxSpA. METHODS: Twenty participants with nrAxSpA underwent two functional tests (active straight leg raise, and stork test on the support side) and four pain provocation tests (Gaenslen's, posterior pelvic pain provocation, Patrick's Faber and palpation of the long dorsal SIJ ligament) for the SIJ, and then proceeded to a contemporaneous reference standard MRI. The Spondyloarthritis Research Consortium of Canada scoring system (SPARCC) was used to score MRI. Specificity, sensitivity, and likelihood ratios (LR) were calculated for individual clinical tests, and for the composite of tests. RESULTS: Pain provocation tests were superior to functional tests, which showed poor accuracy. The Patrick's Faber test was the best performing procedure (sensitivity 71%, specificity 75%, positive LR 2.9, negative LR 0.4). When combining the provocation tests, a positive test in one out of two tests demonstrated the strongest predictive value (sensitivity 86%, specificity 62%, positive LR 2.2, negative LR 0.2). CONCLUSIONS: Sacroiliac joint pain provocation tests correlate modestly with inflammation. The Patrick's Faber test showed the greater LR to identify SIJ inflammation in patients with nrAxSpA. SIJ pain provocation tests may offer a simple and cost-effective way of identifying patients with nrAxSpA who are most likely to have MRI evidence of inflammation.
Subject(s)
Arthralgia/diagnosis , Pain Measurement , Patient Positioning , Sacroiliac Joint/physiopathology , Spondylarthritis/diagnosis , Adult , Arthralgia/physiopathology , Biomechanical Phenomena , Cross-Sectional Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , Reproducibility of Results , Sacroiliac Joint/diagnostic imaging , Spondylarthritis/diagnostic imaging , Spondylarthritis/physiopathologyABSTRACT
The aim of this study was to assess the influence of sex on the kinetic, kinematic and neuromuscular correlates of anticipatory postural adjustments (APAs) during a single leg lift task performed by healthy participants. Fifty healthy age and body mass index matched participants (25 women and 25 men) performed 20 single leg lift task (hip flexion to 90⯰ as quickly as possible) with their dominant and their non-dominant lower limbs. A force plate was used to determine the medial-lateral displacement of the center of pressure (COPML), and the initiation of weight shift (T0); kinematics was used to determine leg lift (T1); and electromyography was used to determine onset times from eight muscles: bilateral external oblique, internal oblique and lumbar multifidus, and unilateral (stance limb) gluteus maximus and biceps femoris. Movement control limb dominance was included in the analysis. Statistically significant interactions between sex and limb dominance (pâ¯<â¯.001) were observed for T1, COPML, and muscle onsets. Also, statistically significant main effect of sex on T0 was observed. Women showed increased APA time (T1) and magnitude (COPML) in their dominant limbs compared to men. Such differences between sexes did not occur in the non-dominant limb. Women recruited proximal muscles later than their man counterparts. Overall, women appear to have a stronger effect of limb dominance on their anticipatory postural control strategy which requires further investigation. The findings of the current study indicate that women and men differ in their anticipatory postural control strategy for rapid single leg lift.
Subject(s)
Hamstring Muscles/physiology , Lower Extremity/physiology , Movement/physiology , Postural Balance/physiology , Posture/physiology , Sex Factors , Adult , Biomechanical Phenomena , Body Mass Index , Electromyography , Female , Humans , Male , Pelvis/physiology , Pressure , Range of Motion, Articular , Young AdultABSTRACT
BACKGROUND: Normalizing to a reference signal is essential when analysing and comparing electromyography signals across or within individuals. However, studies have shown that MVC testing may not be as reliable in persons with acute and chronic pain. OBJECTIVES: The purpose of this study was to compare the test-retest reliability of the muscle activity in the biceps femoris and gluteus maximus between a novel sub-MVC and standard MVC protocols. METHODS: This study utilized a single individual repeated measures design with 12 participants performing multiple trials of both the sub-MVC and MVC tasks on two separate days. The participant position in the prone leg raise task was standardised with an ultrasonic sensor to improve task precession between trials/days. Day-to-day and trial-to-trial reliability of the maximal muscle activity was examined using ICC and SEM. FINDINGS: Day-to-day and trial-to-trial reliability of the EMG activity in the BF and GM were high (0.70-0.89) to very high (≥0.90) for both test procedures. %SEM was <5-10% for both tests on a given day but higher in the day-to-day comparisons. The lower amplitude of the sub-MVC is a likely contributor to increased %SEM (8-13%) in the day-to-day comparison. CONCLUSIONS: The findings show that the sub-MVC modified prone double leg raise results in GM and BF EMG measures similar in reliability and precision to the standard MVC tasks. Therefore, the modified prone double leg raise may be a useful substitute for traditional MVC testing for normalizing EMG signals of the BF and GM.
Subject(s)
Buttocks/physiology , Electromyography/standards , Hamstring Muscles/physiology , Isometric Contraction/physiology , Muscle, Skeletal/physiology , Adult , Female , Humans , Male , Reproducibility of ResultsABSTRACT
BACKGROUND: Electromagnetic palpation-digitization technique for measurement of innominate motion involves calculation of innominate rotation using the innominate vector length in the neutral (NEUT) and combined hip abduction and external rotation (HABER) test positions. The innominate vector length [i.e., the segment between anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS)] is not a rigid structure and its deformation could introduce an error influencing the final innominate rotation measurement. OBJECTIVES: The aim of this study is to determine if there is significant deformation occurring in innominate vector length when the hip is loaded into the HABER test position. METHOD: A cross sectional study using sixteen healthy individuals and a single tester was conducted. Four pelvic landmarks, left and right PSIS and ASIS, were palpated and digitized using 3D digitizing stylus of Polhemus electromagnetic tracking device, in two hip test positions, NEUT and 50° HABER. The innominate vector lengths were calculated from the 3D coordinates of pelvic landmarks, for each hip test positions. RESULTS AND CONCLUSION: Paired t-tests demonstrated no significant differences (p > 0.05) in the innominate vector lengths at the side of the load as well as the opposite innominate when either the right or left hip was loaded; thus indicating no significant bone deformation in innominate segment during the HABER test position.
Subject(s)
Biomechanical Phenomena/physiology , Hip Joint/anatomy & histology , Hip Joint/physiology , Pelvic Bones/anatomy & histology , Pelvic Bones/physiology , Range of Motion, Articular/physiology , Rotation , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
AIM: The primary aim of the study is to determine if Hip Abduction and External Rotation (HABER) test is capable of reproducing familiar pain in individuals with low back pain (LBP) of sacroiliac joint (SIJ) origin (SIJ-positive) when compared with LBP of Non-SIJ origin (SIJ-negative). If so, the secondary aim is to determine the diagnostic accuracy of HABER test against the reference standard of pain provocation tests, and to determine which increments of the HABER test has highest sensitivity and specificity for identifying SIJ-positive individuals. DESIGN: Single-blinded diagnostic accuracy study. METHOD: Participants [n(122)] between ages of 18-50 y, suffering from chronic non-specific LBP (≥3 months) volunteered in the study. An experienced musculoskeletal physiotherapist evaluated and classified participants into either SIJ-positive [n(45)] or SIJ-negative [n(77)], based on reference standard of pain provocation tests [≥3 positive tests = SIJ-positive]. Another musculoskeletal physiotherapist, blinded to clinical groups, evaluated participants for reproduction of familiar pain during each increment (10°, 20°, 30°, 40°, and 50°) of HABER test. RESULTS: The HABER test reproduced familiar pain in SIJ-positive individuals when compared with SIJ-negative individuals [p (0.001), R(2) (0.38), Exp(ß) (5.95-10.32)], and demonstrated moderate level of sensitivity (67%-78%) and specificity (71%-72%) for identifying SIJ-positive individuals. Receiver operator curve analysis demonstrated that the HABER increments of ≥30° have the highest sensitivity (83%-100%) and specificity (52%-64%). CONCLUSIONS: The HABER test is capable of reproducing familiar pain in SIJ-positive LBP individuals and has moderate levels of sensitivity and specificity for identifying SIJ-positive LBP individuals.
Subject(s)
Low Back Pain/diagnosis , Low Back Pain/therapy , Musculoskeletal Manipulations/methods , Pelvic Pain/diagnosis , Pelvic Pain/therapy , Rotation , Sacroiliac Joint/physiopathology , Adolescent , Adult , Biomechanical Phenomena , Female , Humans , Male , Middle Aged , New Zealand , Pain Measurement , Predictive Value of Tests , Prospective Studies , Range of Motion, Articular/physiology , Sensitivity and Specificity , Single-Blind Method , Young AdultABSTRACT
OBJECTIVES: To examine the effect of prolonged standing on gluteus medius coactivation and to observe whether the changes in gluteus medius coactivation over time were related to the development of low back pain in elite female field hockey players. DESIGN: Prospective cohort design. METHODS: Participants were 39 elite female field hockey players (14 with a history of low back pain). Before the prolonged stand, maximal hip abduction strength, side bridge hold endurance and hip abduction range of motion were measured bilaterally. Surface electromyography was collected from the gluteus medius for coactivation analysis during a prolonged stand for 70 min. Low back pain was rated every 10 min on a visual analogue scale. RESULTS: Fourteen of 39 participants developed low back pain. The Time effect was significant for gluteus medius coactivation response (p = 0.003) and visual analogue scale score (p < 0.001). There were no significant group × time interactions. Yet athletes who developed pain had higher coactivation for the majority of the stand task. CONCLUSIONS: While female field hockey players have high agonist-antagonist coactivation patterns during prolonged standing, stand task is a useful tool to predict low back pain occurrence in players with and without history of pain.
Subject(s)
Hockey/physiology , Low Back Pain/physiopathology , Muscle Contraction/physiology , Posture/physiology , Electromyography , Female , Follow-Up Studies , Hip Joint/physiopathology , Humans , Low Back Pain/diagnosis , Muscle, Skeletal , Pain Measurement , Prospective Studies , Range of Motion, Articular/physiology , Young AdultABSTRACT
The study aimed to determine, using systematic review and meta-analysis, the level of evidence supporting the construct validity of spinal mobility tests for assessing patients with ankylosing spondylitis. Following the guidelines proposed in the Preferred Reporting Items for Systematic reviews and Meta-Analyses, three sets of keywords were used for data searching: (i) ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; (ii) accuracy, association, construct, correlation, Outcome Measures in Rheumatoid Arthritis Clinical Trials, OMERACT, truth, validity; (iii) mobility, Bath Ankylosing Spondylitis Metrology Index-BASMI, radiography, spinal measures, cervical rotation, Schober (a further 19 keywords were used). Initially, 2558 records were identified, and from these, 21 studies were retained. Fourteen of these studies were considered high level of evidence. Compound indexes of spinal mobility showed mostly substantial to excellent levels of agreement with global structural damage. Individual mobility tests for the cervico-thoracic spine showed only moderate agreements with cervical structural damage, and considering structural damage at the lumbar spine, the original Schober was the only test that presented consistently substantial levels of agreement. Three studies assessed the construct validity of mobility measures for inflammation and low to fair levels of agreement were observed. Two meta-analyses were conducted, with assessment of agreement between BASMI and two radiological indexes of global structural damage. The spinal mobility indexes and the original Schober test show acceptable construct validity for inferring the extent of structural damage when assessing patients with ankylosing spondylitis. Spinal mobility measures do not reflect levels of inflammation at either the sacroiliac joints and/or the spine.
Subject(s)
Lumbar Vertebrae/physiopathology , Range of Motion, Articular , Sacroiliac Joint/physiopathology , Spondylitis, Ankylosing/diagnostic imaging , Spondylitis, Ankylosing/physiopathology , Humans , Magnetic Resonance Imaging , Physical Examination , Severity of Illness IndexABSTRACT
BACKGROUND: Innominate kinematic anomalies resulting in low back pain (LBP) of sacroiliac joint (SIJ) origin (SIJ-positive), has always been a topic of contention, owing to difficultly in its evaluation. Recent technique of electromagnetic palpation-digitization has been able to accurately quantify innominate kinematics in healthy individuals. OBJECTIVES: The purpose of this study is to determine if participants with LBP of SIJ origin (SIJ-positive) demonstrate significantly different innominate kinematics than participants with LBP of non-SIJ origin (SIJ-negative). DESIGN: Single-blinded cross-sectional case-control study. METHOD: Participants [n(122)] between the ages of 18 to 50 years, suffering from chronic non-specific LBP (≥3 months) volunteered in the study. An experienced musculoskeletal physiotherapist evaluated and classified participants into either SIJ-positive [n(45)] or SIJ-negative [n(77)] group, using the reference standard pain provocation tests [≥3 positive tests = SIJ-positive]. A research physiotherapist, blinded to clinical groups, conducted the innominate kinematic testing using a valid and reliable electromagnetic palpation-digitization technique, during prone lying incremental hip abduction-external rotation test positions. RESULTS: The results of the mixed model regression analyses demonstrated that SIJ-positive participants exhibited significantly different innominate movement patterns and trends of rotation, but not innominate ranges of motion, when compared with SIJ-negative LBP participants. CONCLUSIONS: These findings demonstrate association between SIJ pain and altered innominate kinematics, and have led the groundwork for further exploration of clinical measurement, relevance, and management of these potentially important movement observations.
Subject(s)
Biomechanical Phenomena/physiology , Low Back Pain/physiopathology , Movement/physiology , Range of Motion, Articular/physiology , Rotation , Sacroiliac Joint/physiopathology , Adolescent , Adult , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: Palpation-digitization technique for measurement of innominate motion involves repeated manual palpation-digitization of pelvic landmarks, which could introduce a systematic variation between subsequent trials and thereby influence final innominate angular measurement. OBJECTIVES: The aim of this study is to quantify the effect of repeated palpation-digitization errors on overall variability of innominate vector length measurements; and to determine if there is a systematic variation between subsequent repeated trials. METHOD: A single group repeated measures study, using four testers and fourteen healthy participants, was conducted. Four pelvic landmarks, left and right posterior superior iliac spine and anterior superior iliac spine, were palpated and digitized using 3D digitizing stylus of Polhemus electromagnetic tracking device, for ten consecutive trials by each tester in their random order. The ten individual trials of innominate vector lengths measured by each tester for each participant were used for the analysis. RESULTS AND CONCLUSIONS: Repeated measures ANOVA demonstrated a very small effect of repeated trial factor (≤0.66%) as well as error component (≤0.32%) on innominate vector length variability. Further, residual versus order plots demonstrated a random pattern of errors across zero; thus indicating no systematic variation between subsequent trials of innominate vector length measurements.
Subject(s)
Biomechanical Phenomena/physiology , Medical Errors/prevention & control , Palpation/methods , Pelvic Pain/therapy , Pelvis/physiology , Pelvis/physiopathology , Range of Motion, Articular/physiology , Adult , Female , Healthy Volunteers , Humans , Male , Psychometrics , Reproducibility of ResultsABSTRACT
The aim of this study was to present a rationale to explore the use of clinical tests for the sacroiliac joints to detect early axial spondyloarthritis (SpA) and to suggest a protocol to validate these clinical tests. Based on the European Guidelines for Diagnosis and Treatments of Pelvic Girdle Pain, we propose a set of six clinical tests to identify the likely presence of inflammation in the sacroiliac joints associated with early axial SpA. As magnetic resonance imaging (MRI) is the current gold standard used to identify inflammation in the sacroiliac joints, the results of the proposed set of clinical tests are compared with those from the MRI examinations. We hypothesize that specific clinical tests, which combine pain provocation and functional tests, for assessing the sacroiliac joints will help to identify early active inflammation at the sacroiliac joints in axial SpA. If such tests prove to be sensitive and specific, they could add further value to the diagnostic classification criteria for axial SpA.
ABSTRACT
BACKGROUND: The purpose of the study was to examine the muscle activity and hip-spine kinematics in a group of individuals diagnosed with posterior pelvic girdle pain and confirmed postural muscle delay during a repeated fast hip flexion task. METHODS: Twenty-four (12 pain and 12 control) age and sex matched participants performed a repeated fast hip flexion task to auditory signal. Surface EMG activity in the external and internal oblique, the multifidus, the gluteus maximus and biceps femoris in the stance-limb was examined for onset timing and EMG integral. Sagittal plane hip (swing limb) and spine kinematics were examined for group and side differences over the repeated trials. FINDINGS: While the pain group lacked significant feedforward muscle activity they displayed higher muscle activity at movement onset in the biceps femoris bilaterally (p<0.05) as well as the external oblique (p<0.05) during motion of the symptomatic side. Furthermore, the pain group experienced asymmetrical spinal range of motion with increased motion on the contralateral side (p<0.001) and reduced flexion velocity on the symptomatic side (p<0.001). INTERPRETATION: The findings support previous hypotheses regarding the effect of increased biceps activity on pelvic control during lumbo-pelvic rotation. Further, there appears to be a symptom led strategy for bracing the innominate through opposing tension in the biceps and external oblique during movement of the painful side. Such asymmetrical pelvic girdle bracing may be a strategy to increase the stability of the pelvis in light of the failed load transfer mechanism. Putatively, this strategy may increase the mechanical stress on the sacroiliac joint exacerbating pain complaints.
Subject(s)
Muscle, Skeletal/physiopathology , Pelvic Pain/physiopathology , Pelvis/physiopathology , Posture/physiology , Adult , Biomechanical Phenomena , Electromyography , Female , Hip/physiopathology , Humans , Leg/physiology , Male , Movement , Range of Motion, Articular/physiology , Spine/physiopathology , Young AdultABSTRACT
OBJECTIVE: To examine the level of evidence for criterion-concurrent validity of spinal mobility assessments in patients with ankylosing spondylitis (AS). METHODS: Guidelines proposed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to undertake a search strategy involving 3 sets of keywords: accura*, truth, valid*; ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; mobility, spinal measure*, (a further 16 keywords with similar meaning were used). Seven databases were searched from their inception to February 2014: AMED, Embase, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies (with modifications) was used to assess the quality of articles reviewed. An article was considered high quality when it received "yes" in at least 9 of the 13 items. RESULTS: From the 741 records initially identified, 10 articles were retained for our systematic review. Only 1 article was classified as high quality, and this article suggests that 3 variants of the Schober test (original, modified, and modified-modified) poorly reflect lumbar range of motion where radiographs were used as the reference standard. CONCLUSION: The level of evidence considering criterion-concurrent validity of clinical tests used to assess spinal mobility in patients with AS is low. Clinicians should be aware that current practice when measuring spinal mobility in AS may not accurately reflect true spinal mobility.
Subject(s)
Range of Motion, Articular/physiology , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/physiopathology , Humans , Physical Examination , Severity of Illness IndexABSTRACT
Joint kinematic assessment using an electromagnetic tracking device (EMTD) requires palpation-digitization (PD) of bony landmarks to define the anatomical axes. Errors in PD of bony landmarks can perturb the anatomical axes and affect the validity and reliability of kinematic measurements. The validity and reliability of PD for kinematic measurement needs to be explored before recommending its wider use. A systematic search of 15 electronic databases located studies assessing validity and/or reliability of PD for joint kinematic assessment. Two independent reviewers used the QUADAS and QAREL tools to assess quality of validity and reliability studies respectively. The results were synthesized qualitatively using a level of evidence approach. Eight studies satisfied the final eligibility criteria and were included in the review. The validity, intra-rater reliability and inter-rater reliability were assessed in three, seven and one study respectively. The overall level of evidence for validity of PD technique was strong with high correlation (≥0.80) reported by three high (≥60%) quality studies. The overall level of evidence for intra-rater reliability was also strong with very high ICC (≥0.90) and satisfactory SEM (SEM% ≤ 10%) reported by four high quality studies. However the level of evidence for inter-rater reliability was limited and needs to be addressed by future research.