1
|
Vesting S, Gutke A, Fagevik Olsén M, Rembeck G, Larsson MEH. The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study. Phys Ther 2024; 104:pzad171. [PMID: 38109793 PMCID: PMC11021861 DOI: 10.1093/ptj/pzad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/25/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum. METHODS In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance. RESULTS At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months. CONCLUSION The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum. IMPACT Physical therapists should encourage women to start with low-impact exercise early after pregnancy. LAY SUMMARY This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.
Collapse
Affiliation(s)
- Sabine Vesting
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Eriksberg Rehabilitation, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gun Rembeck
- Research, Education, Development and Innovation Primary Health Care, Region Västra Götaland, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regional Health, Youth Guidance Centre, Borås, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Research and Education, Region Värmland, Karlstad, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| |
Collapse
|
2
|
Ojukwu CP, Ugwoke MO, Mohammed J, Ilo IJ, Ativie NR. Effects of abdominal girdle belt on pulmonary function variables of postpartum women in Enugu, Nigeria: a quasi-experimental study. J OBSTET GYNAECOL 2023; 43:2182671. [PMID: 36892185 DOI: 10.1080/01443615.2023.2182671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
This quasi-experimental study was aimed at investigating the effects of wearing an abdominal girdle belt on pulmonary function variables of postpartum women. 40 consenting postpartum women aged between 18 and 35 years were recruited from a post-natal clinic in Enugu, Nigeria. The participants were conveniently assigned into girdle belt and control groups (20 each). Their lung function (forced expiratory volume in first second[FEV1], and %FEV1, forced vital capacity[FVC], peak expiratory flow [PEF], forced expiratory flows [25th, 75th & 25-75th percentiles]) values were measured prior to and after eight weeks of the study intervention period for each participant. Data obtained were analysed using descriptive and inferential statistics. Following the intervention period, 19 and 13 participants completed the study in the girdle belt and control groups, respectively. The main results showed that both groups were comparable at baseline for all the study variables assessed (p > 0.05). Following the intervention period, only the PEF was significantly reduced in the girdle belt group compared to control group participants (p = 0.012). Thus, wearing girdle belts for an extended period of time has no effect on the lung function values of postpartum women.IMPACT STATEMENTWhat is already known on the subject? Postpartum abdominal girdle belts are commonly utilised for resolution of abdominal protrusion and obesity after childbirth. Unfortunately, several adverse effects, including bleeding, compressive pain and discomfort and abnormally increased intra-abdominal pressure, have been associated with this practice. Consistent increase in intra-abdominal pressure of variable duration has been reported to affect pulmonary functions.What do the results of this study add? The study findings indicate that wearing girdle belts for eight weeks by postpartum women has no substantial effect on the pulmonary function variables.What are the implications of these findings for clinical practice and/or further research? Utilisation of abdominal girdle belts of equal or less than 8 weeks duration should not be discouraged for post-partum women due to fear of its potential negative impact on pulmonary function.
Collapse
Affiliation(s)
- Chidiebele Petronilla Ojukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Enugu, Nigeria
| | - Modester Odinaka Ugwoke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Enugu, Nigeria
| | - Jibril Mohammed
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Ijeoma Judith Ilo
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Enugu, Nigeria
| | - Nkechi Rita Ativie
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Enugu, Nigeria
| |
Collapse
|
3
|
Vesting S, Gutke A, Fagevik Olsén M, Praetorius Björk M, Rembeck G, Larsson MEH. Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study. Phys Ther 2022; 103:pzac152. [PMID: 36326139 PMCID: PMC10071582 DOI: 10.1093/ptj/pzac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. METHODS Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. RESULTS Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. CONCLUSION The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. IMPACT This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.
Collapse
Affiliation(s)
- Sabine Vesting
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Praetorius Björk
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
- Department of Research, Education and Innovation, Region Västra Götaland, South Älvsborg Hospital, Borås, Sweden
| | - Gun Rembeck
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Borås, Sweden
- Region Västra Götaland, Regional Health, Borås Youth Guidance Center, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| |
Collapse
|
4
|
Madle K, Svoboda P, Stribrny M, Novak J, Kolar P, Busch A, Kobesova A, Bitnar P. Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions. Musculoskelet Sci Pract 2022; 62:102655. [PMID: 35998419 DOI: 10.1016/j.msksp.2022.102655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. OBJECTIVE To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. METHODS In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. RESULTS AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. CONCLUSION The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.
Collapse
Affiliation(s)
- Katerina Madle
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Petr Svoboda
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Stribrny
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jakub Novak
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Petr Bitnar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| |
Collapse
|
5
|
Reddy D, Zulfeen M, Pandey D. Stress incontinence combined score (SICS): A novel combined grading system to assess the severity of stress urinary incontinence in women. Eur J Obstet Gynecol Reprod Biol 2022; 278:57-65. [PMID: 36115261 DOI: 10.1016/j.ejogrb.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Natural history of urinary incontinence (UI) in women is a less understood domain. Stratifying severity of stress urinary incontinence (SUI) can be an important tool to understand the natural history, prognosticate the disease and plan optimal management. Present study was aimed to test a novel score (Stress Incontinence Combined score: SICS) with the currently popular tools International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Incontinence Symptom Index (ISI) scores. MATERIAL AND METHODS This was a prospective study conducted at a university teaching hospital, over a period of 2 years. After screening women for SUI, SICS was administered. The novel SICS score was then compared with ICIQ-UI SF and ISI. RESULTS A total of 1750 women, attending various OPDs in a tertiary care hospital, were screened for urinary incontinence. The prevalence of UI and SUI was 26.6% and 12.8% respectively. The agreement between ISI and SICS was 81.7%, while the ICIQ- UI SF agreed with the SICS in 80.8% of the cases. AUROC analysis done showed that a score of 10 or more on the SICS (total score 16) could diagnose high-grade SUI with a sensitivity of 97%, specificity of 96% (Reference: ISI), and a sensitivity of 100%, and specificity of 93% (Reference: ICIQ- UI SF) CONCLUSION: SICS is the first of its kind tool, developed to specifically grade the severity of SUI, while incorporating both subjective and objective measures, with excellent reliability and reproducibility.
Collapse
Affiliation(s)
- Deepa Reddy
- KMC Manipal, Manipal Academy of Higher Education, Manipal (MAHE), India
| | | | - Deeksha Pandey
- KMC Manipal, Manipal Academy of Higher Education, Manipal (MAHE), India.
| |
Collapse
|
6
|
Guo J, Guo W, Ren G. Embodiment of intra-abdominal pressure in a flexible multibody model of the trunk and the spinal unloading effects during static lifting tasks. Biomech Model Mechanobiol 2021; 20:1599-1626. [PMID: 34050846 DOI: 10.1007/s10237-021-01465-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
The role of intra-abdominal pressure (IAP) in spinal load reduction has remained controversial, partly because previous musculoskeletal models did not introduce the pressure generating mechanism. In this study, an integrated computational methodology is proposed to combine the IAP change with core muscle activations. An ideal gas relationship was introduced to calculate pressure distribution within the abdominal cavity. Additionally, based on flexible multibody dynamics, a muscle membrane element was developed by incorporating the muscular fiber deformation, inter-fiber stiffness, and volume constancy. This element was then utilized in discretizing the diaphragm and transversus abdominis, forming an IAP-muscle coupling system of the abdominal cavity. Based on this methodology, a forward dynamic simulation of spinal flexion was presented to examine the unloading effect of abdominal breathing. The results confirm that core muscle contraction during the abdominal breathing cycle can substantially reduce the forces of spinal compression together with trunk extensor muscles, and this effect is more pronounced when the IAP increase is produced by contraction of the transversus abdominis. This unloading effect still holds even with the co-activation of other abdominal muscles, providing a potential choice when designing trunk movements during weight-lifting tasks.
Collapse
Affiliation(s)
- Jianqiao Guo
- MOE Key Laboratory of Dynamics and Control of Flight Vehicle, School of Aerospace Engineering, Beijing Institute of Technology, Beijing, 100081, China.
| | - Wei Guo
- Air Force Medical Center, PLA, Beijing, 100142, China
| | - Gexue Ren
- Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
| |
Collapse
|
7
|
The Effect of Maternity Support Garments on Alleviation of Pains and Discomforts during Pregnancy: A Systematic Review. J Pregnancy 2019; 2019:2163790. [PMID: 31467715 PMCID: PMC6699320 DOI: 10.1155/2019/2163790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Maternity support garments (MSGs) are widely available and commonly recommended and used for alleviation of lower back pain (LBP) and pelvic girdle pain (PGP) during pregnancy; however, most studies available use the garments as a conjunct intervention with other therapies, with scarce research demonstrating the effects of the garments as a sole intervention. This study aims to review the available literature on the effects of using MSGs as sole intervention for comfort improvement of women during pregnancy, as well as to discuss the attributes of the garments which may influence their performance. A systematic review was undertaken, which adheres to PRISMA guideline for systematic reviews. Multiple databases, such as ScienceDirect, CINAHL, EBSCO, Elsevier, SCOPUS, Wiley Online Library, ProQuest, ProQuest Health and Medical Complete, PubMed, and Cochrane Central Register of Controlled Trials, were electronically searched. Six studies met the inclusion criteria and covered three trial studies, two pilot studies and one observational study. Three outcome measurements were identified from the included studies: alleviation of pain, improvement of balance, and improvement of functionality and mobility. The study concluded that wearing MSGs during pregnancy could have beneficial effects in women such as LBP and PGP alleviation, improvement of functionality and mobility, and reduction of risk of fall during pregnancy; however, the mechanisms of the garments' actions as well as the duration of the garments' effectiveness are not elucidated through the studies. This study contributes to the understanding of the effects and effectiveness of the use of MSGs as a sole intervention for improvement of comfort during pregnancy as well as information about the different types of garments commercially available and the attributes that may influence the garment performance.
Collapse
|
8
|
Contraction of the transverse abdominal muscle in pelvic girdle pain is enhanced by pain provocation during the task. Musculoskelet Sci Pract 2017; 32:78-83. [PMID: 28898747 DOI: 10.1016/j.msksp.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/03/2017] [Accepted: 09/02/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Understanding of the pathogenesis of pain in the lumbopelvic region remains a challenge. It is suggested that lumbopelvic pain is related to decreased contraction of the transverse abdominal muscles (TrA). OBJECTIVE To investigate how pain provoked by a task influences TrA contraction during that task. DESIGN A case-control cross-sectional study. METHOD We recruited 40 non-pregnant women with persistent pregnancy-related posterior pelvic girdle pain (PGP) and 33 parous women (healthy controls) without PGP. TrA thickness was measured by ultrasound at various levels of bilateral hip adduction, with increments of 20 N from 0 to 140 N. Pain during the tests was registered. RESULTS After correction for the level of adduction force, TrA thickness increase during pain-provoking tests of participants with PGP was 6.3 percentage points higher than in their pain-free tests (p = 0.01) and 0.91 percentage points higher than in the pain-free tests of healthy controls (p < 0.01). CONCLUSION TrA contraction in PGP is enhanced when a task provokes pain. These results may have consequences for the treatment of persistent pregnancy-related posterior pelvic girdle pain.
Collapse
|
9
|
Mens JMA, Pool-Goudzwaard A. The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study. BMC Musculoskelet Disord 2017; 18:372. [PMID: 28841825 PMCID: PMC5574111 DOI: 10.1186/s12891-017-1732-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for a force to compress both innominate bones against the sacrum is the basis for treatment of pregnancy-related pelvic girdle pain (PGP). Therefore, it is advised to use a pelvic belt and do exercises to enhance contraction of the muscles which provide this compression. However, our clinical experience is that contraction of those muscles appears to be excessive in PGP. Therefore, in patients with long-lasting pregnancy-related posterior PGP, there is a need to investigate the contraction pattern of an important muscle that provides a compressive force, i.e. the transverse abdominal muscle (TrA), during a load transfer test, such as active straight leg raising (ASLR). METHODS TrA thickness was measured by means of ultrasound imaging at rest and during ASLR in 43 non-pregnant women with ongoing posterior PGP that started during a pregnancy or delivery, and in 39 women of the same age group who had delivered at least once and had no current PGP (healthy controls). RESULTS In participants with PGP, the median TrA thickness increase with respect to rest during ipsilateral and contralateral ASLR was 31% (SD 46%) and 31% (SD 57%), respectively. In healthy controls, these values were 11% (SD 25%) and 13% (SD 22%), respectively. CONCLUSIONS Significant excessive contraction of the TrA is present during ASLR in patients with long-lasting pregnancy-related posterior PGP. The present findings do not support the idea that contraction of the TrA is decreased in long-lasting pregnancy-related PGP. This implies that there is no rationale for the prescription of exercises to enhance contraction of TrA in patients with long-lasting pregnancy-related PGP.
Collapse
Affiliation(s)
- Jan M A Mens
- Department of Rehabilitation Medicine & Physical Therapy, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,MOVE research Institute, Faculty of behavioural and movement sciences VU University Amsterdam, Amsterdam, The Netherlands.
| | | |
Collapse
|
10
|
Gnat R, Spoor K, Pool-Goudzwaard A. The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis. Clin Biomech (Bristol, Avon) 2015; 30:827-31. [PMID: 26094778 DOI: 10.1016/j.clinbiomech.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of so-called local muscle system in motor control of the lower back and pelvis is a subject of ongoing debate. Prevailing beliefs in stabilizing function of this system were recently challenged. This study investigated the impact of in vitro simulated force of transversely oriented fibres of the transversus abdominis muscle (a part of the local system) on flexibility of the sacroiliac joint during asymmetric moment application to the pelvis. METHODS In 8 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixed contralateral innominate. Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion Capture System. Load-deformation curves were plotted and flexibility of the sacroiliac joint was calculated separately for anterior and posterior rotations of the innominate, with and without simulated muscle force. FINDINGS Flexibility of the sacroiliac joint was significantly bigger during anterior rotation of the innominate, as compared to posterior rotation (Anova P<0.05). After application of simulated force of transversus abdominis, flexibility of the joint did not change both during anterior and posterior rotations of the innominate. INTERPRETATION A lack of a stiffening effect of simulated transversus abdominis force on the sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening influence of this muscle on the pelvis cannot be confirmed. Consistent with previous findings smaller flexibility of the joint recorded during posterior rotation of the innominate may be of clinical importance for physio- and manual therapists. However, major limitations of the study should be acknowledged: in vitro conditions and simulation of only solitary muscle force.
Collapse
Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Motion Analysis Laboratory, Faculty of Physiotherapy, University of Physical Education, ul. Mikolowska 72, 40-065 Katowice, Poland; Faculty of Physiotherapy, Academy of Business, ul. Cieplaka 1c, 41-300 DąbrowaGórnicza, Poland.
| | - Kees Spoor
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat, 9, 1081 BT Amsterdam, The Netherlands
| |
Collapse
|
11
|
Experimental Pelvic Pain Impairs the Performance During the Active Straight Leg Raise Test and Causes Excessive Muscle Stabilization. Clin J Pain 2015; 31:642-51. [DOI: 10.1097/ajp.0000000000000139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Soisson O, Lube J, Germano A, Hammer KH, Josten C, Sichting F, Winkler D, Milani TL, Hammer N. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction. PLoS One 2015; 10:e0116739. [PMID: 25781325 PMCID: PMC4364533 DOI: 10.1371/journal.pone.0116739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/14/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Methods Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Results Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Discussion Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest.
Collapse
Affiliation(s)
- Odette Soisson
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Juliane Lube
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Andresa Germano
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | | | - Christoph Josten
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Freddy Sichting
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Dirk Winkler
- Department of Neurosurgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Thomas L. Milani
- Institute of Applied Kinesiology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- * E-mail:
| |
Collapse
|
13
|
Arora AS, Kruger JA, Budgett DM, Hayward LM, Smalldridge J, Nielsen PF, Kirton RS. Clinical evaluation of a high-fidelity wireless intravaginal pressure sensor. Int Urogynecol J 2014; 26:243-9. [DOI: 10.1007/s00192-014-2500-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
|
14
|
Abstract
OBJECTIVE Surgical trainees may tie air knots, which have a questionable tensile strength and rate of untying. The purpose of this study was to determine the effect of an air knot on knot integrity. METHODS The 5 suture materials tested were 0-0 gauge coated polyethylene, polyglyconate, glycolide/lactide, polypropylene, and silk. The suture was tied between 2 hex screws 50 mm on center. The strands were tied using 5 square throws, and the knot tails were cut at 3-mm length. To create a standardized air knot, a round common nail measuring 3 mm in diameter was inserted between throws before tying square throw #3. The suture loop was positioned around the upper and lower hooks of the tensiometer so the location of the knot was roughly equidistant from the hooks. Ultimately, either the loop broke or the knot slipped. At that time, the peak tensile force as well as the outcome of the knot were recorded. RESULTS A total of 480 knots were tied. The presence of an air knot significantly lowered the tension at knot failure in the glycolide/lactide (P = 0.0003), polypropylene (P = 0.0005), and silk (P = 0.0001) knot configurations. Air knots had the same integrity as surgical knots when coated polyethylene and polyglyconate suture were used. Linear regression was performed and identified both suture material (P < 0.0001) and presence of an air knot (P < 0.0001) to be independently associated with a lower tension at failure. CONCLUSIONS Under laboratory conditions, an air knot may contribute to a lower tensile strength at failure for certain suture materials.
Collapse
|
15
|
Design and development of a novel intra-vaginal pressure sensor. Int Urogynecol J 2013; 24:1715-21. [DOI: 10.1007/s00192-013-2097-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
|
16
|
Gnat R, Spoor K, Pool-Goudzwaard A. Simulated transversus abdominis muscle force does not increase stiffness of the pubic symphysis and innominate bone: an in vitro study. Clin Biomech (Bristol, Avon) 2013; 28:262-7. [PMID: 23312210 DOI: 10.1016/j.clinbiomech.2012.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transversus abdominis muscle is thought to exert a stiffening effect on the sacroiliac joints. However, it is unknown whether this muscle is capable of increasing pubic symphysis and innominate bone stiffness during load exerted on the pelvis. The objective of this study is to investigate whether in vitro simulated force of transversely oriented fibres of the transversus abdominis increases stiffness of the pubic symphysis and innominate bone. METHODS In 15 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixated contralateral innominate. For pubic symphysis motion and innominate bone deformation load-deformation curves were plotted and slopes of adjusted linear regression lines were calculated. The slopes are considered to be a measure of pubic symphysis and innominate bone stiffness. Slopes were tested for significant differences before and after simulation of the transversus abdominis force. FINDINGS Stiffness of pubic symphysis and innominate bone does not change under influence of simulated force of the transversus abdominis. For pubic symphysis, the slope of the regression line hardly changes, from 0.0341mm/Nm (SD 0.0277) before transversus abdominis force simulation to 0.0342mm/Nm (SD 0.0273) during simulation. For innominate bone, the mean slope increases minimally, from 0.0368mm/Nm (SD 0.0369) to 0.0413mm/Nm (SD 0.0395), respectively. INTERPRETATION Simulation of the force of a single muscle - transversus abdominis - does not increase stiffness of the pubic symphysis and innominate bone. The hypothesized stiffening influence of the transversus abdominis on the pelvic ring was not confirmed in vitro.
Collapse
Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Faculty of Medicine and Health Sciences, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
| | | | | |
Collapse
|
17
|
George SE, Clinton SC, Borello-France DF. Physical therapy management of female chronic pelvic pain: Anatomic considerations. Clin Anat 2012; 26:77-88. [DOI: 10.1002/ca.22187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/21/2012] [Indexed: 12/20/2022]
|
18
|
The effect of increased physical load during an active straight leg raise in pain free subjects. J Electromyogr Kinesiol 2010; 20:710-8. [DOI: 10.1016/j.jelekin.2009.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 11/22/2009] [Accepted: 12/21/2009] [Indexed: 11/23/2022] Open
|
19
|
Muffly TM, Boyce J, Kieweg SL, Bonham AJ. Tensile strength of a surgeon's or a square knot. JOURNAL OF SURGICAL EDUCATION 2010; 67:222-6. [PMID: 20816357 PMCID: PMC4167833 DOI: 10.1016/j.jsurg.2010.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/07/2010] [Accepted: 06/15/2010] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To test the integrity of surgeon's knots and flat square knots using 4 different suture materials. STUDY DESIGN Chromic catgut, polyglactin 910, silk, and polydioxanone sutures were tied in the 2 types of knot configurations. For all sutures, a 0-gauge United States Pharmacopeia suture was used. Knots were tied by a single investigator (J.B.). The suture was soaked in 0.9% sodium chloride for 60 s and subsequently transferred to a tensiometer where the tails were cut to 3-mm length. We compared the knots, measuring knot strength with a tensiometer until the sutures broke or untied. RESULTS A total of 119 throws were tied. We found no difference in mean tension at failure between a surgeon's knot (79.7 N) and a flat square knot (82.9 N). Using a chi(2) test, we did not find a statistically significant difference in the likelihood of knots coming untied between surgeon's knots (29%) and flat square knots (38%). CONCLUSIONS Under laboratory conditions, surgeon's knots and flat square knots did not differ in tension at failure or in likelihood of untying.
Collapse
Affiliation(s)
- Tyler M Muffly
- Center of Urogynecology and Pelvic Floor Disorders, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | |
Collapse
|
20
|
Beales DJ, O'Sullivan PB, Briffa NK. The effects of manual pelvic compression on trunk motor control during an active straight leg raise in chronic pelvic girdle pain subjects. ACTA ACUST UNITED AC 2010; 15:190-9. [DOI: 10.1016/j.math.2009.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 10/14/2009] [Accepted: 10/25/2009] [Indexed: 01/13/2023]
|
21
|
The myth of core stability. J Bodyw Mov Ther 2010; 14:84-98. [PMID: 20006294 DOI: 10.1016/j.jbmt.2009.08.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 05/03/2009] [Accepted: 08/04/2009] [Indexed: 01/13/2023]
Abstract
The principle of core stability has gained wide acceptance in training for the prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal conditions in particular of the lower back. There has been surprisingly little criticism of this approach up to date. This article re-examines the original findings and the principles of core stability/spinal stabilisation approaches and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury.
Collapse
|
22
|
Jansen J, Weir A, Dénis R, Mens J, Backx F, Stam H. Resting thickness of transversus abdominis is decreased in athletes with longstanding adduction-related groin pain. ACTA ACUST UNITED AC 2010; 15:200-5. [PMID: 20074995 DOI: 10.1016/j.math.2009.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 09/21/2009] [Accepted: 11/26/2009] [Indexed: 11/17/2022]
Abstract
The purpose of the study was to compare thickness of the transversus abdominis (TA) and obliquus internus (OI) muscles between athletes with and without longstanding adduction-related groin pain (LAGP). Forty two athletes with LAGP and 23 controls were included. Thickness of TA and OI were measured with ultrasound imaging on the right side of the body during rest. Relative muscle thickness (compared to rest) was measured during the active straight leg raise (ASLR) left and right, and during isometric hip adduction. TA resting thickness was significantly smaller in injured subjects with left-sided (4.0+/-0.82mm; P<0.001) or right-sided (4.3+/-0.64mm; P=0.015) groin complaints compared with controls (4.9+/-0.90mm). No significant differences between patients and controls in TA or OI relative thickness during the ASLR and isometric hip adduction were found (all cases P>/=0.15). In conclusion, TA resting thickness is smaller in athletes with LAGP and may thus be a risk factor for (recurrent) groin injury. This may have implications for therapy and prevention of LAGP.
Collapse
Affiliation(s)
- Jaap Jansen
- University Medical Center Utrecht, Department of Rehabilitation and Sport Medicine, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
23
|
Muffly TM, Cook C, Distasio J, Bonham AJ, Blandon RE. Suture end length as a function of knot integrity. JOURNAL OF SURGICAL EDUCATION 2009; 66:276-280. [PMID: 20005500 DOI: 10.1016/j.jsurg.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/16/2009] [Accepted: 10/10/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate tension at the failure of 3 commonly used sutures when suture ends were cut to 3 lengths. STUDY DESIGN Knots were tied using U.S. Pharmacopeia Size 0-0 polyglactin 910, silk, or polydioxanone sutures. The knots were tied randomly on a jig by the same surgeon. End lengths were then cut to random lengths of 0, 3, and 10 mm. We compared the individual knot strength when subjected to tensile forces via tensiometer with the point of knot failure, which was defined as untying and/or breaking of the knot. RESULTS Three types of suture were divided into 3 groups based on end lengths for a total of 178 knots. A logistic regression analysis showed the odds of knots coming untied were highest for polyglactin 910 (odds ratio [OR] = 33.7; 95% confidence interval [CI] = 4.1-277.1). End length also had a significant effect on knots untying, with the 0-mm knots being more likely to come untied (OR, 21.2; 95% CI, 2.9-153.0). Post hoc tests for a 3 x 3 analysis of variance found that silk knots failed at significantly lower tension than polydioxanone (p < 0.001) and polyglactin 910 (p < 0.001) knots. CONCLUSIONS The knots with an end length of 0 mm were significantly more likely to come untied than either 3- or 10-mm knots. Among all the materials, polyglactin 910 was the most prone to untying; however, it resulted in untying at a mean tension greater than the breaking point of silk.
Collapse
Affiliation(s)
- Tyler M Muffly
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, 9500 Euclid Avenue,Cleveland, OH 44195, USA.
| | | | | | | | | |
Collapse
|
24
|
Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine (Phila Pa 1976) 2009; 34:861-70. [PMID: 19531994 DOI: 10.1097/brs.0b013e318198d212] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Repeated measures. OBJECTIVE To investigate motor control (MC) patterns in chronic pelvic girdle pain (PGP) subjects during an active straight leg raise (ASLR). SUMMARY OF BACKGROUND DATA The ASLR is a test used to assess load transference through the pelvis. Altered MC patterns have been reported in subjects with chronic PGP during this test. These patterns may impede efficient load transfer, while having the potential to impinge on respiratory function and/or to adversely affect the control of continence. METHODS Twelve female subjects with chronic PGP were examined. Electromyography of the anterior abdominal wall, right chest wall and the scalene, intraabdominal pressure, intrathoracic pressure, respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between an ASLR lifting the leg on the affected side of the body versus the nonaffected side. RESULTS Performing an ASLR lifting the leg on the affected side of the body resulted in a predominant MC pattern of bracing through the abdominal wall and the chest wall. This was associated with increased baseline shift in intraabdominal pressure and depression of the pelvic floor when compared with an ASLR lifting the leg on the nonaffected side. CONCLUSION This MC pattern, identified during an ASLR on the affected side of the body, has the potential to be a primary mechanism driving ongoing pain and disability in chronic PGP subjects.
Collapse
|
25
|
|
26
|
Moncayo R, Moncayo H. A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease. BMC Musculoskelet Disord 2007; 8:17. [PMID: 17319961 PMCID: PMC1820789 DOI: 10.1186/1471-2474-8-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 02/23/2007] [Indexed: 12/16/2022] Open
Abstract
Background Low level connective tissue inflammation has been proposed to play a role in thyroid associated ophthalmopathy (TAO). The aim of this study was to investigate this postulate by a musculoskeletal approach together with biochemical parameters. Methods 13 patients with TAO and 16 controls were examined. Erythrocyte levels of Zn, Cu, Ca2+, Mg, and Fe were determined. The musculoskeletal evaluation included observational data on body posture with emphasis on the orbit-head region. The angular foot position in the frontal plane was quantified following gait observation. The axial orientation of the legs and feet was evaluated in an unloaded supine position. Functional propioceptive tests based on stretch stimuli were done by using foot inversion and foot rotation. Results Alterations in the control group included neck tilt in 3 cases, asymmetrical foot angle during gait in 2, and a reaction to foot inversion in 5 cases. TAO patients presented facial asymmetry with displaced eye fissure inclination (mean 9.1°) as well as tilted head-on-neck position (mean 5.7°). A further asymmetry feature was external rotation of the legs and feet (mean 27°). Both foot inversion as well as foot rotation induced a condition of neuromuscular deficit. This condition could be regulated by gentle acupressure either on the lateral abdomen or the lateral ankle at the acupuncture points gall bladder 26 or bladder 62, respectively. In 5 patients, foot rotation produced a phenomenon of moving toes in the contra lateral foot. In addition foot rotation was accompanied by an audible tendon snapping. Lower erythrocyte Zn levels and altered correlations between Ca2+, Mg, and Fe were found in TAO. Conclusion This whole body observational study has revealed axial deviations and body asymmetry as well as the phenomenon of moving toes in TAO. The most common finding was an arch-like displacement of the body, i.e. eccentric position, with foot inversion and head tilt to the contra lateral side and tendon snapping. We propose that eccentric muscle action over time can be the basis for a low grade inflammatory condition. The general implications of this model and its relations to Zn and Se will be discussed.
Collapse
Affiliation(s)
- Roy Moncayo
- WOMED, Karl-Kapferer-Strasse 5, A-6020 Innsbruck, Austria
| | - Helga Moncayo
- WOMED, Karl-Kapferer-Strasse 5, A-6020 Innsbruck, Austria
| |
Collapse
|