Interrater reliability of performing a step-by-step procedure for selected pain provocation tests for hamstrings and special tests for other lower extremity musculoskeletal injuries

Objective@#Our study aims to establish interrater reliability in performing the step-by-step procedure of selected pain provocation tests for hamstrings and special tests for lower extremity musculoskeletal injuries. @*Study Design@#An interrater reliability study @*Setting@#University of Santo Tomas - Sports Science Laboratory @*Participants@#Ten healthy adults (five females, five males; age = 22.2 ± 0.42) from the university community. @*Main outcome measures@#Interrater reliability of performing step-by-step procedures for selected pain provocation tests for hamstrings (painful resisted knee flexion 90°, painful resisted knee flexion 30°, active slump test, Puranen-Orava Test, bent knee stretch) and special tests for lower extremity musculoskeletal injuries (Lachman’s test, McMurray’s test, posterior drawer test, valgus, and varus stress test). @*Results@#Fleiss kappa showed perfect agreement (κ = 1.00) for all test procedures except for Lachman’s test procedure 1 (κ= -0.11 [95% CI, -0.36 to 0.14]), active slump test procedure 4 (κ= -0.03 [95% CI, -0.28 to 0.23]), active slump test procedure 5 (κ= -0.11 [95% CI, -0.28 to 0.23]), and active slump test procedure 6 (κ= -0.05 [95% CI, -0.31 to 0.20]), which resulted in negative agreements. @*Conclusions@#The researcher developed protocols for each special and provocative test were consistent in measuring the intended procedures, and the raters were generally consistent with their ability to measure these tests.

Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability.

BACKGROUND: Clinical examination of male football players with longstanding groin pain can be considered difficult. Pain provocation tests are used to examine and classify longstanding groin pain into clinical entities as adductor-, iliopsoas-, inguinal-, and pubic-related. It is unknown if pain provocation tests and clinical entities are associated with pain intensity and disability. OBJECTIVES: To investigate if the number of positive pain provocation tests and clinical entities are associated with pain intensity and disability, measured by the Copenhagen 5-Second Squeeze Test (5SST) and the Copenhagen Hip and Groin Outcome Score (HAGOS), respectively. DESIGN: Cross-sectional. METHOD: Forty male football players (age: mean 24 years [SD: 3.2]; height: mean 182 cm [SD: 5.7]; weight: mean 78 Kg [SD: 6.6]) with longstanding groin pain for a median of 8.5 months (IQR: 4-36) were included. The players underwent a bilateral groin examination with 33 pain provocation tests and were classified with clinical entities (0-7) based on the test findings. RESULTS: The number of positive pain provocation tests (median 10, range 2-23) correlated with pain intensity (5SST: rs = 0.70 [95% CI: 0.50, 0.83]) and disability (HAGOS subscales Sport: rs =-0.62 [95% CI: -0.81, -0.36], Pain: rs = -0.38 [95% CI: -0.69, -0.06], Symptoms: rs = 0.52 [95% CI: -0.73, -0.24], ADL: rs = -0.48 [95% CI: -0.71, -0.18]). The number of clinical entities (median 3, range: 1-7) showed similar but weaker correlations to pain intensity and disability. CONCLUSIONS: In male football players with longstanding groin pain, the number of positive pain provocation tests and clinical entities shows weak to strong correlations with pain intensity and disability. Consequently, when pain intensity and disability are severe, a higher number of pain provocation tests may be positive, and more clinical entities may be present.

Effects of double air-cushion biofeedback exercises in a patient with sacroiliac joint pain.

[Purpose] We developed a double air-cushion biofeedback device to be used for sacroiliac (SI) joint exercises and investigated the effects of exercising using the device in a patient with SI joint pain. [Subject] A 40-year-old man, who complained of pain in the left posterior iliac crest area and SI joints over a 6-month period participated. [Methods] After a 4-week exercise program using the double air-cushion biofeedback device, the subject was assessed using the Gaenslen, Patrick, posterior shear (POSH), and resisted abduction (REAB) tests. [Results] After performing exercise designed to strengthen subdivisions of the gluteus medius, the subject had no pain in the Gaenslen, Patrick, POSH, or REAB tests of the SI joint. The visual analog scale (VAS) score for pain on palpation of the left posterior iliac crest area decreased to 4/10 from an initial score of 7/10. [Conclusion] Exercises with the double air-cushion biofeedback device improved hip asymmetry, SI joint mobility, and muscle strength.

Effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain.

[Purpose] We investigated the effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain. [Subject] A 36-year-old female complained of pain in the sacroiliac joints. [Methods] The subject performed individual strengthening exercises for the stabilization muscles for nutation torque of the sacroiliac joint for 3 weeks. Pain-provocation tests and visual analog scale (VAS) scores were evaluated before and after the exercises. [Results] After performing the individual strengthening exercises for the erector spinae, rectus abdominis, and biceps femoris muscles for 3 weeks, the subject displayed no pain in the pain provocation tests, and the VAS score was 2/10. [Conclusion] The individual strengthening exercises for the stabilization muscles of the sacroiliac joint performed in the present study appear to be effective for sedentary workers with sacroiliac joint pain.

Effects of individual strengthening exercises on subdivisions of the gluteus medius in a patient with sacroiliac joint pain.

[Purpose] We investigated the effects of individual strengthening exercises for subdivisions of the gluteus medius in a patient with sacroiliac joint pain. [Subject] A 32 year-old female who complained of pain in the posterior area of the left iliac crest and sacroiliac joints over a period of 6 months was the subject of this study. [Methods] She performed individual strengthening exercises for subdivisions of the gluteus medius over 3 weeks. Pain-provocation tests and VAS scores were evaluated before and after the intervention. [Results] After individual strengthening exercises for subdivisions of the gluteus medius, the subject showed no pain in the Gaenslen, Patrick, or REAB tests for the left sacroiliac joint. The VAS score was less the 3/10, compared with 7/10 initially. [Conclusion] Individual strengthening exercises for the subdivisions of the gluteus medius were effective at reducing SI joint pain for this patient.

Pain referral and regional deep tissue hyperalgesia in experimental human hip pain models.

Hip disorder patients typically present with extensive pain referral and hyperalgesia. To better understand underlying mechanisms, an experimental hip pain model was established in which pain referrals and hyperalgesia could be studied under standardized conditions. In 16 healthy subjects, pain was induced by hypertonic saline injection into the gluteus medius tendon (GMT), adductor longus tendon (ALT), or gluteus medius muscle (GMM). Isotonic saline was injected contralaterally as control. Pain intensity was assessed on a visual analogue scale (VAS), and subjects mapped the pain distribution. Before, during, and after injections, passive hip joint pain provocation tests were completed, together with quantitative sensory testing as follows: pressure pain thresholds (PPTs), cuff algometry pain thresholds (cuff PPTs), cutaneous pin-prick sensitivity, and thermal pain thresholds. Hypertonic saline injected into the GMT resulted in higher VAS scores than hypertonic injections into the ALT and GMM (P<.05). Referred pain areas spread to larger parts of the leg after GMT and GMM injections compared with more regionalized pain pattern after ALT injections (P<.05). PPTs at the injection site were decreased after hypertonic saline injections into GMT and GMM compared with baseline, ALT injections, and isotonic saline. Cuff PPTs from the thigh were decreased after hypertonic saline injections into the ALT compared with baseline, GMT injections, and isotonic saline (P<.05). More subjects had positive joint pain provocation tests after hypertonic compared with isotonic saline injections (P<.05), indicating that this provocation test also assessed hyperalgesia in extra-articular soft tissues. The experimental models may open for better understanding of pain mechanisms associated with painful hip disorders.

Short-term effect of muscle energy technique on pain in individuals with non-specific lumbopelvic pain: a pilot study.

Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited. This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET or control) after magnitude of pain was determined. MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods, while the control group received a sham treatment. Tests for current and worst pain, and pain with provocation were administered at baseline, immediately following intervention and 24 hours after intervention. Separate 2x3 ANOVAs were used to assess results as change scores. Visual analog score (VAS) for worst pain reported in the past 24 hours decreased for the MET group (4.3mm+/-19.9, p=.03) and increased for the sham (control) group (17.1mm+/-21.2, p=.03). Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours, thereby suggesting that MET may be useful to decrease LPP over 24 hours.