The effect of chronic low back pain and lumbopelvic stabilization instructions on gluteus medius activation during sidelying hip movements.

BACKGROUND: People with chronic low back pain (LBP) often demonstrate altered muscle activation with movements that involve the lumbopelvic region and hips. OBJECTIVE: The purpose of this study was to compare gluteus medius activity during sidelying hip abduction (SHA) and sidelying hip abduction-lateral rotation (SHALR) with and without instruction for lumbopelvic stabilization in people with and without chronic LBP. METHODS: A cross-sectional study was conducted recruiting participants with (n = 17) and without (n = 17) chronic LBP. Gluteus medius activity was recorded with surface electromyography during the performance of SHA and SHALR with and without instructions including the abdominal drawing-in maneuver for lumbopelvic stabilization. RESULTS: For SHA and SHALR, there was a significant main effect for instruction for stabilization indicated by a decrease in gluteus medius activity with instructions (p = .001, p < .001). There was not a significant main effect of chronic LBP on gluteus medius activity between groups for either activity. There was no significant interaction effect of pain and instruction for stabilization with SHA or SHALR. CONCLUSION: Knowledge of changes in gluteus medius muscle activation patterns with trunk stabilization instruction may help clinicians with assessment of exercise performance to optimize gluteus medius activation.

The influence of jump-landing direction on dynamic postural stability following anterior cruciate ligament reconstruction.

BACKGROUND: Traditional testing prior to return to sport following anterior cruciate ligament reconstruction typically involves jump-landing tasks in the forward direction. As injury is most likely the result of multiplanar neuromuscular control deficits, assessment of dynamic postural stability using landing tasks that require multiplanar stabilization may be more appropriate. The purpose of this study was to examine how dynamic postural stability is affected when performing jump-landing tasks in three different directions. METHODS: Fifteen athletes [11 females (18.0 ± 3.0 years) and 4 males (18.5 ± 3.1 years)] following anterior cruciate ligament reconstruction performed a series of single-limb jump-landing tasks in 3 directions. Individual directional stability indices and a composite dynamic postural stability index were calculated using ground reaction force data and were compared using separate one-way repeated measures ANOVAs. FINDINGS: All directional stability indices demonstrated a significant main effect for jump-landing direction (medial-lateral P < 0.001, η2p = 0.95; anterior-posterior P < 0.001, η2p = 0.97; vertical P = 0.021, η2p = 0.24). The diagonal jump-landing direction produced increased medial-lateral stability and vertical stability scores, while the forward and diagonal jump-landing directions produced increased anterior-posterior stability scores. There was no significant effect for the composite dynamic stability index score. INTERPRETATION: Jump-landing direction affects dynamic postural stability in all 3 planes of movement in athletes following anterior cruciate ligament reconstruction. Results indicate the potential need to incorporate multiple jump-landing directions to better assess dynamic postural stability prior to return to sport.

Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport.

OBJECTIVE: Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN: Cross-sectional case-control study. SETTING: Sports medicine clinic. SUBJECTS: Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES: Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS: Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION: Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.

The effect of monochromatic infrared energy on sensation in patients with diabetic peripheral neuropathy: a double-blind, placebo-controlled study.

OBJECTIVE: The purpose of this study was to determine the effect of monochromatic infrared energy (MIRE) on plantar sensation in subjects with diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: In this randomized, double-blind, placebo-controlled study, 39 subjects with diabetic peripheral neuropathy completed the 8-week study. Subjects received 30 min of active or placebo MIRE three times a week for 4 weeks. Plantar sensation was tested with monofilaments at the beginning of the study (M1), following 4 weeks of treatment (M2), and after an additional 4 weeks of nontreatment (M3). The number of sites that could sense the 5.07 monofilament was totaled at M1, M2, and M3. Data were analyzed using a special repeated-measures statistic followed by a post hoc Tukey-Kramer test. RESULTS: The average number of sites that patients could sense the 5.07 monofilament increased for both the active and placebo groups. There were significant gains from M1 to M2 (P < 0.002), no significant gains from M2 to M3 (P = 0.234), and significant gains from M1 to M3 (P < 0.002) for both the active and placebo groups. There were no significant differences between active and placebo groups at any measurement. CONCLUSIONS: Thirty minutes of active MIRE applied 3 days per week for 4 weeks was no more effective than placebo MIRE in increasing sensation in subjects with diabetic peripheral neuropathy. Clinicians should be aware that MIRE may not be an effective modality for improving sensory impairments in patients with diabetic neuropathy.

Rehabilitation of a child with a split cord malformation and hemimeningomyelocele.

PURPOSE: The purpose of this case report is to recount the rehabilitation progress of a child with a hemimeningomyelocele and to clarify terminology used to describe this condition. SUMMARY OF KEY POINTS: A young girl with a diagnosis of a hemimeningomyelocele, involving the left hemicord only, at the level of the seventh to the ninth thoracic vertebrae, was followed from two and a half months until seven years of age. Deciphering the medical record was a challenge because clinicians involved in the case used different terminology to describe the split cord malformation. The authors had to review the literature about split cord malformations to interpret the medical record. The child also had a severe kyphoscoliosis and a ventriculoperitoneal shunt (Arnold-Chiari II deformity). The child was followed by an orthopedist and a neurosurgeon. She participated in an early intervention program that included physical therapy. Her clinical course did not follow that anticipated for a child with a meningomyelocele at the seventh through ninth thoracic vertebrae. Standing and ambulation typically are goals for children with thoracic-level lesions, primarily for exercise and for movement within the home or classroom. However, by four years of age this child was able to ambulate on even and uneven surfaces using a single-quad cane. She exhibited a normal gait pattern in the right lower extremity during ambulation. Additionally, functional movement in the left lower extremity during ambulation occurred without the use of an ankle-foot orthosis. CONCLUSIONS: The rehabilitation progress of this child was atypical of that seen in a child with a meningomyelocele at the level of the seventh through ninth thoracic vertebrae. Because of her split cord malformation, she retained normal function in the right lower extremity although function was impaired in the left lower extremity.