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Abdollahi S, Sheikhhoseini R, Rahimi M, Huddleston WE. The sacroiliac dysfunction and pain is associated with history of lower extremity sport related injuries. BMC Sports Sci Med Rehabil 2023; 15:36. [PMID: 36941717 PMCID: PMC10029172 DOI: 10.1186/s13102-023-00648-w] [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: 11/12/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The purpose of this study was to examine the association of sacroiliac joint (SIJ) dysfunction and pain with overuse and acute lower limb and pelvic girdle injuries of Iranian basketball players. METHODS In this cross-sectional study, basketball-related injury data were collected during 2019-2020 from 204 basketball players of the Iranian league using the online Information Retrospective Injury Questionnaire. A researcher then performed ten clinical tests to assess SIJ dysfunction and pain (five tests for dysfunction and five tests for pain). Data analysis was performed by logistic regression at the confidence interval of 95%. RESULTS Within our sample (n = 204), injury rates were calculated across sub-groups of athletes that had only SIJ pain (n = 19), only SIJ dysfunction (n = 67), both SIJ pain and dysfunction (n = 15) or no SIJ complaints (n = 103). Across these groups, a total of 464 injuries were reported. SIJ pain group reported 80 injuries (17.2%), SIJ dysfunction group reported 210 injuries (45.2%), both SIJ pain and dysfunction group reported 58 injuries (12.5%, and the no SIJ pain or SIJ dysfunction group reported 116 injuries (25.0%). Participants with SIJ pain were more likely to report previous pelvic girdle injuries (overuse: odds ratio (OR): 0.017; 95% CI: 0.005-0.56; p < 0.001 and acute: OR: 0.197; 95%CI: 0.101-0.384; p < 0.001) and also lower limb injuries (overuse: OR: 0.179, 95%CI: 0.082-0.392, p < 0.001). Participants with SIJ dysfunction only were likely to report acute pelvic girdle injuries (OR: 0.165; 95%CI: 0.070-0.387; p < 0.001) and acute lower limb injuries (OR: 0.165; 95%CI: 0.030-0.184; p < 0.001). CONCLUSION The presence of SIJ dysfunction and pain is associated with a history of acute and overuse injuries in the pelvic girdle and lower limb. Thus, SIJ dysfunction and pain should be specifically evaluated and addressed when designing rehabilitation programs for sports-related injuries.
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Affiliation(s)
- Sajjad Abdollahi
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran.
| | - Mohammad Rahimi
- Department of Corrective Exercise & Sport Injuries, Faculty of Sport Sciences, Shahid Rajaee Teacher Training University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Wendy E Huddleston
- Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Loudovici-Krug D, Lemhöfer C, Best N. Standing Flexion Test: A Manual Diagnostic Test as First Indication
of Sacroiliac Dysfunction – Study from Practice. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2022. [DOI: 10.1055/a-1967-2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Background The standing flexion test (SFT) is an orienting test,
supporting to diagnose a sacroiliac joint dysfunction (SIJ-D) in manual
medicine. However, the literature research for this term shows the paucity of
according investigations. The aim is to investigate the importance of the SFT
with regard to possible functional disorder of the SIJ.
Method Teachers of the Medical Association for Manual Medicine
(physiotherapists and physicians) were asked to fill in a documentation sheet
considering different exsmination procedures belonging to routine manual
medicine anamnestic findings. The only inclusion criterion was the positive SFT.
The results are presented descriptive with according percentages.
Results From January to August 2019, a total of 366 SIJ data sheets with
positive SFTs were completed by 20 ÄMM-teachers, involving six
imcomplete ones. 263 of the 360 patients enrolled actually had a SIJ-D
(73.06%).Further relevant results refer to pain oft he SIJ region (205 of 360; 173 with
SIJ-D), the Patrick-Kubis-Test (246 of 360; 201 with SIJ-D), the pelvic tilt
(134 of 360; 134 with SIJ-D), the pelvic torsion (209 of 360; 164 with SIJ-D)
and the increased iliac muscle tone (282 of 360; 216 with SIJ-D).
Discussion After a positive SFT, the Patrick-Kubis-test, the tonus check
of the iliac muscle and the indication of pain in the SIJ-region can be used for
the diagnosis of a SIJ-D. If at least two of the three aspects are conspicuous,
SIJ-D is very likely to be present.
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Affiliation(s)
- Dana Loudovici-Krug
- Institute for Physiotherapy, Jena University Hospital,
Jena
- Research Consulting office of the ÄMM (Medical Association
Manual Medicine)
| | | | - Norman Best
- Institute for Physiotherapy, Jena University Hospital,
Jena
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3
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Exploring lumbo-pelvic functional behaviour patterns during osteopathic motion tests: A biomechanical (en)active inference approach to movement analysis. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fonteyne L, Guinois-Côté S, Perugino L, Truong M, Zaichenko D, Lord MJ, Brown C, Preuss R. Interrater Reliability among Novice Raters in the Assessment of Pelvic Floor Muscle Tone Using the Reissing Tone Scale. Physiother Can 2021; 73:313-321. [PMID: 34880535 DOI: 10.3138/ptc-2019-0093] [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: 11/20/2022]
Abstract
Purpose: The authors sought to determine the interrater reliability among novice raters of intra-vaginal manual assessment of pubococcygeus muscle tone in women using the Reissing tone scale (RTS). Method: Three graduating physiotherapy students (novice raters) and one experienced pelvic floor physiotherapist assessed 31 female participants (aged 20-66 y). Assessors gave RTS scores for pubococcygeus tone at three intra-vaginal locations (6:00, 9:00, and 3:00). Interrater reliability was determined for the novice raters using a two-way random single-measures absolute agreement intra-class correlation coefficient (ICC). Spearman rank correlation (SRC) analysis determined the correlation between the novice and expert scores. Results: The ICC values for the novice raters were 0.523, 0.274, and 0.336 at 6:00, 9:00, and 3:00, and the SRC values between the novice and expert raters were 0.580, 0.320, and 0.340. Conclusions: The novice raters demonstrated low to moderate interrater reliability for intra-vaginal manual assessment of pubococcygeus tone. This result indicates that manual assessment of pelvic floor muscle tone is not reliable enough to use as a stand-alone test to guide treatment, at least for physiotherapists with limited clinical experience.
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Affiliation(s)
- Louise Fonteyne
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Stéphanie Guinois-Côté
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Liana Perugino
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marianne Truong
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daria Zaichenko
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Lord
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Claudia Brown
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Constance-Lethbridge Rehabilitation Centre, Research Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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Ribeiro RP, Guerrero FG, Camargo EN, Pivotto LR, Aimi MA, Loss JF, Candotti CT. Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT). J Osteopath Med 2021; 121:849-856. [PMID: 34551460 DOI: 10.1515/jom-2021-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/29/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. OBJECTIVES This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). METHODS In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized. RESULTS The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=-0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836). CONCLUSIONS The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.
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Affiliation(s)
- Rafael P Ribeiro
- School of Physical Education, Physiotherapy and Dance (ESEFID), Brazilian Institute of Osteopathy (IBO), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Filipe G Guerrero
- Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo N Camargo
- School of Physical Education, Physiotherapy and Dance (ESEFID), Brazilian Institute of Osteopathy (IBO), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiza R Pivotto
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Mateus A Aimi
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Jefferson F Loss
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia T Candotti
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Nolet PS, Yu H, Côté P, Meyer AL, Kristman VL, Sutton D, Murnaghan K, Lemeunier N. Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropr Man Therap 2021; 29:33. [PMID: 34446040 PMCID: PMC8390263 DOI: 10.1186/s12998-021-00384-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults. METHOD We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes. RESULTS We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy. CONCLUSION Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.
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Affiliation(s)
- Paul S. Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario Canada
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario Canada
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6211 LM Maastricht, The Netherlands
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | | | - Vicki L. Kristman
- EPID@Work Research Institute, Department of Health Sciences, and the Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario Canada
- Institute for Work and Health, Toronto, Ontario Canada
| | - Deborah Sutton
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Nadège Lemeunier
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- UMR1295, Université de Toulouse, UPS, Inserm, Toulouse, France
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Posłuszny MO, Waszak MM. The Influence of Sacroiliac Joint Manipulation on Changes in the Values of the Center of Pressure in the Process of Maintaining Static Body Balance. J Manipulative Physiol Ther 2021; 44:408-419. [PMID: 34376320 DOI: 10.1016/j.jmpt.2021.05.003] [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: 10/14/2019] [Revised: 08/03/2020] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to determine the influence of manipulative treatment of sacroiliac joint (SIJ) hypomobility on the ability to maintain static balance of the body. METHODS We compared displacements of the center of pressure (COP) in 2 groups of students of the University of Physical Education: the experimental group (30 people exhibiting SIJ hypomobility) and the control group (29 people without SIJ hypomobility). A manipulation was performed in the experimental group and a placebo procedure in the control group. Sacroiliac joint hypomobility was diagnosed by the following SIJ mobility tests: forward flexion test, Gillet test, long sitting test, lower limb adduction test. These and podometric tests were performed on all participants twice-before and after the procedure. The influence of experimental manipulation was examined by applying repeated-measures analysis of variance, and comparisons were made with Student's t test for dependent and independent samples and nonparametric tests. RESULTS A statistically significant difference between before and after treatment was found in the experimental group (P < .05) in terms of COP pathway, COP pathway area, and average COP speed. Furthermore, the groups differed in before-treatment values of these parameters in favor of the control group, but after-treatment measurement revealed normalization of the levels of these characteristics in the experimental group to the level of the control group. CONCLUSION As a result of SIJ manipulation, parameters related to the ability to maintain balance improved in the experimental group.
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Affiliation(s)
- Michał O Posłuszny
- Department of Anatomy, Poznan University of Physical Education, Poznań, Poland.
| | - Małgorzata M Waszak
- Department of Anatomy, Poznan University of Physical Education, Poznań, Poland
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8
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Ribeiro RP, Guerrero FG, Camargo EN, Beraldo LM, Candotti CT. Validity and Reliability of Palpatory Clinical Tests of Sacroiliac Joint Mobility: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther 2021; 44:307-318. [PMID: 33896601 DOI: 10.1016/j.jmpt.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/18/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The primary objective of this review was to investigate the reliability and validity of palpatory clinical tests of sacroiliac mobility. The secondary objective was to investigate which palpatory clinical tests of sacroiliac mobility exist in the literature. METHODS PubMed, Embase, Scopus, Medline, and the Physiotherapy Evidence Database were searched. There was no restriction on the study design or participants. The data extracted from each study were sample size, study deign, and clinical test used. If there was information on reliability values, number of examiners, concurrent validity values, gold standard used, or inferential statistical test used, that was also extracted. For intraexaminer reliability, the data were expressed as κ values that were meta-analyzed using random effects. RESULTS Fifteen palpatory clinical tests of sacroiliac mobility were identified from 28 studies; 14 studies performed inferential statistical analysis, all including analysis of interexaminer reliability, with κ values ranging from -0.05 to 0.77. Analysis of intraexaminer reliability was performed in 8 studies, with κ values ranging from 0.08 to 0.73. No study included in this systematic review verified the concurrent validity of the tests. Our meta-analysis of intraexaminer reliability showed moderate to good agreement results for the Gillet test (κ = 0.46), the standing flexion test (κ = 0.61), and the sitting flexion test (κ = 0.68). CONCLUSION We found 15 palpatory clinical tests of sacroiliac mobility in this systematic review. According to our meta-analysis, only the sitting flexion test obtained a good and statistically significant intraexaminer agreement. Further studies are necessary to evaluate the reliability and validity of these tests.
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Affiliation(s)
- Rafael P Ribeiro
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Filipe G Guerrero
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo N Camargo
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas M Beraldo
- Institute of Mathematics and Statistics (IME), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cláudia T Candotti
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Differential diagnosis of endometriosis in patient with nonspecific low back pain: A case report. J Bodyw Mov Ther 2021; 27:227-232. [PMID: 34391238 DOI: 10.1016/j.jbmt.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriosis is one of the most widespread gynecological disorders and a very common condition amongst fertile women, thus it has to be considered one of the possible sources of lumbopelvic pain. Endometriosis is commonly related to low back pain (LBP) and therefore often mistaken for a musculoskeletal disorder. The purpose of this case report is to underline the primary role of clinical reasoning and assessment process, which led the physiotherapist to the differential diagnosis, considering endometriosis among the possible causes of low back pain. CASE PRESENTATION S.C, 45 years old, complained to physiotherapist of lumbar spine and left buttock pain, spreading to the hypogastric, inguinal and left pubic areas. The patient's past medical history included gynecological visceral disorders, regularly monitored. Functional evaluation and clinical tests revealed a disorder referred to the lumbar spine and sacroiliac region. Initial physical therapy management included education, manual therapy and therapeutic exercise. Nevertheless, after five treatment sessions, the symptoms remained unchanged, and therefore the patient was referred to a gynecologist for a consultation. The patient underwent a laparoscopy for endometriosis eradication and the intervention resulted in complete abolition of symptoms, enabling the patient to return to work and to do physical activities. CONCLUSIONS this case report highlights the importance of a thorough clinical assessment and the identification of relevant findings from patient's medical history to be carried out by the physiotherapist. Those are of crucial importance to make an appropriate differential diagnosis and to screen amongst the possible causes of lumbopelvic pain also visceral ones as endometriosis, which often manifests with associated symptoms such as nonspecific LBP.
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10
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Park J, Chon SC. Comparative Analysis of the Pain Provocation Test and the HABER Test to Diagnose Nonspecific Low-Back Pain Associated with the Sacroiliac Joint. Med Sci Monit 2021; 27:e929307. [PMID: 33654050 PMCID: PMC7938439 DOI: 10.12659/msm.929307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to investigate the correlation between the pain provocation test and the hip abduction-external rotation (HABER) test for diagnosing low-back pain (LBP)-related sacroiliac joint (SIJ) syndrome, and to determine the efficacy of the HABER test as a potential diagnostic tool for SIJ syndrome. Material/Methods One hundred patients with LBP participated. The first and second examiner examined the patients using the pain provocation test and the HABER test, respectively. Positive and negative findings were analyzed to determine the correlation and reliability. Results The HABER test showed similar pain reproduction in groups that were positive or negative for SIJ syndrome (P<0.05). Based on the analysis of the receiver-operating characteristic curve, the cutoff values from the HABER test were found to be 29° and 32° of external rotation in the left and right hip joints, respectively. Conclusions The HABER test can reproduce similar level of pain in patients with chronic LBP associated with SIJ syndrome, and it can be used as a diagnostic tool in patients presenting with chronic LBP.
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Affiliation(s)
- Jujeong Park
- Department of Physical Therapy, College of Medical Science, Konyang University, Deajeon, South Korea
| | - Seung-Chul Chon
- Department of Physical Therapy, College of Medical Science, Konyang University, Deajeon, South Korea
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11
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Balcı A, Ünüvar E, Akınoğlu B, Kocahan T. The effect of different neural mobilization exercises on hamstring flexibility and functional flexibility in wrestlers. J Exerc Rehabil 2021; 16:503-509. [PMID: 33457386 PMCID: PMC7788253 DOI: 10.12965/jer.2040700.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to compare the short-term effects of sciatic nerve neural sliding and neural stretching exercises on hamstring muscle length and functional flexibility in wrestlers. The study participants included 74 wrestlers. The athletes were randomly divided into two groups: neural sliding and neural stretching groups. The hamstring flexibility and the functional flexibility were assessed using the active knee extension limitation (AKEL) angle and the sit and reach (SR) test one day before and immediately after the neural mobilization exercises, respectively. A three-way repeated measures analysis of variance was conducted that examined the effect of mobilization type, time, and gender on interest in AKEL right leg, AKEL left leg, and SR test. There is not a significant difference between the effect of two different mobilizations on AKEL right and left leg, and SR test (P>0.05). It was determined there is statistically significant differences between premobilization and post-mobilization outcome measures for AKEL right leg (F=59.886, P=0.001), AKEL left leg (F=31.896, P=0.001), and SR test (F=22.630, P=0.001). There is not a statistically significant difference between males and females by these three measures neural sliding and neural stretching exercises to the sciatic nerve in wrestlers were effective in increasing hamstring flexibility and functional flexibility and not superior to each other.
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Affiliation(s)
- Aydın Balcı
- Department of Sports Medicine, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Ezgi Ünüvar
- Center of Athlete Training and Health Research, Department of Health Services, Sports General Directorship, The Ministry of Youth and Sports, Ankara, Turkey
| | - Bihter Akınoğlu
- Center of Athlete Training and Health Research, Department of Health Services, Sports General Directorship, The Ministry of Youth and Sports, Ankara, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Tuğba Kocahan
- Center of Athlete Training and Health Research, Department of Health Services, Sports General Directorship, The Ministry of Youth and Sports, Ankara, Turkey
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12
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Srivastava S, Kumar K U D, Mittal H, Dixit S, Nair A. Short-term effect of muscle energy technique and mechanical diagnosis and therapy in sacroiliac joint dysfunction: A pilot randomized clinical trial. J Bodyw Mov Ther 2020; 24:63-70. [PMID: 32826010 DOI: 10.1016/j.jbmt.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/02/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sacroiliac joint dysfunction (SIJD) is a prominent source of pain in low back pain (LBP) patients. Tenderness inferior to the posterior superior iliac spine (PSIS) is an important sign presented in SIJD. Techniques including muscle energy technique (MET) and mechanical diagnosis and therapy (MDT) have shown benefits in SIJD. However, the effects of these treatments on tenderness and pain around the PSIS are yet to be determined. AIM Compare and examine the preliminary short-term effect of MET and MDT on tenderness and pain around the PSIS in SIJD. METHODS Twenty patients, aged between 20 and 65 years and diagnosed with unilateral, sub-acute, or chronic SIJD, were screened for the inclusion criteria and were randomly allocated to the MET or the MDT group. Both the groups received treatment for four sessions over one week. Pain pressure threshold (PPT) and visual analogue scale (VAS) were determined by a blinded assessor on pre- and post-treatment basis. RESULTS Although no significant differences were observed following the treatment between the groups, some statistically significant (p < 0.05) improvements were observed within each of the groups. No drop-outs and no adverse events were reported. CONCLUSION The findings of the study suggest that both interventions may be equally effective in reducing symptoms around the PSIS. However, due to the small sample size, the results need to be interpreted cautiously. Future studies on larger sample size and long-term follow up are warranted.
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Affiliation(s)
- Saumya Srivastava
- Nitte Institute of Physiotherapy, Nitte (deemed to be) University, Mangalore, Karnataka, 575018, India.
| | - Dhanesh Kumar K U
- Nitte Institute of Physiotherapy, Nitte (deemed to be) University, Mangalore, Karnataka, 575018, India
| | - Harramb Mittal
- Department of Trauma and Orthopedics, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India.
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, King Khalid University, Saudi Arabia
| | - Aishwarya Nair
- Nitte Institute of Physiotherapy, Nitte (deemed to be) University, Mangalore, Karnataka, 575018, India
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Klerx SP, Pool JJM, Coppieters MW, Mollema EJ, Pool-Goudzwaard AL. Clinimetric properties of sacroiliac joint mobility tests: A systematic review. Musculoskelet Sci Pract 2020; 48:102090. [PMID: 31744776 DOI: 10.1016/j.msksp.2019.102090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous systematic reviews revealed poor reliability and validity for sacroiliac joint (SIJ) mobility tests. However, these reviews were published nearly 20 years ago and recent evidence has not yet been summarised. OBJECTIVES To conduct an up-to-date systematic review to verify whether recommendations regarding the clinical use of SIJ mobility tests should be revised. STUDY DESIGN Systematic review. METHOD The literature was searched for relevant articles via 5 electronic databases. The review was conducted according to the PRISMA guidelines. COSMIN checklists were used to appraise the methodological quality. Studies were included if they had at least fair methodology and reported clinimetric properties of SIJ mobility tests performed in adult patients with non-specific low back pain, pelvic (girdle) pain and/or SIJ pain. Only tests that can be performed in a clinical setting were considered. RESULTS Twelve relevant articles were identified, of which three were of sufficient methodological quality. These three studies evaluated the reliability of eight SIJ mobility tests and one test cluster. For the majority of individual tests, the intertester reliability showed slight to fair agreement. Although some tests and one test cluster had higher reliability, the confidence intervals around most reliability estimates were large. Furthermore, there were no validity studies of sufficient methodological quality. CONCLUSION Considering the low and/or imprecise reliability estimates, the absence of high-quality diagnostic accuracy studies, and the uncertainty regarding the construct these tests aim to measure, this review supports the previous recommendations that the use of SIJ mobility tests in clinical practice is problematic.
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Affiliation(s)
- S P Klerx
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, the Netherlands
| | - J J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, the Netherlands
| | - M W Coppieters
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia; Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - E J Mollema
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, the Netherlands
| | - A L Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Amersfoort, the Netherlands.
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Naranjo-Cinto F, Falcon-Machado G, Garrido-Marin A, Senin-Camargo FJ, Jacome-Pumar MA, Fernandez-Matias R, Pecos-Martin D, Gallego-Izquierdo T. Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography. ACTA ACUST UNITED AC 2020; 56:medicina56020083. [PMID: 32085506 PMCID: PMC7073570 DOI: 10.3390/medicina56020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
Background and objectives: Palpation is an inherent and basic skill of health professionals—particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current studies that evaluate palpation concordance reliability for the SMT in this particular position. This study aimed to investigate the intra- and inter-rater reliabilities of supraspinatus muscle tendon (SMT) palpation. Materials and Methods: Thirty-six healthy participants (14 females; aged 22–35 years) were recruited. Musculoskeletal ultrasound was used to measure the SMT localization after two physiotherapists performed the SMT palpation at two different times. The distance between the two marked points was used to analyze the analysis of true agreement between examiners. Finally, we analyzed if the demographic variables influenced the palpation procedure. Results: The intra-examiner reliability showed a high percentage of concordance for examiner 1 (E.1) (first palpation procedure (P.1) = 91.7%: second palpation procedure (P.2) = 95.8%) and examiner 2 (E.2) (P.1 = 91.6%; P.2 = 97.2%) and high percentage of inter-palpation agreement for E.1 (87.5%) and E.2 (88.9%). The inter-examiner reliability showed a high total concordance for the right shoulder (E.1 = 94.4%; E.2 = 95.8%) and left shoulder (E.1 = 93.05%; E.2 = 95.05%). The agreement (%) according to both examiners was 93.05% for the right shoulder and 94.4% for the left shoulder. The agreement between both examiners and the ultrasound (% of true agreement) was 92.9% for the right shoulder and 92.8% for the left shoulder. A statistically significant association (p = 0.02) was found for weight regarding concordance reliability; this was not seen for dominant arm, age, gender, body mass index, height, and tendon depth (p > 0.05). Conclusions: The SMT palpation technique showed a high level of concordance and reproducibility.
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Affiliation(s)
- Fermin Naranjo-Cinto
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Alcalá de Henares, 28871 Madrid, Spain; (F.N.-C.); (T.G.-I.)
| | - Giezi Falcon-Machado
- Instituto de Investigación Fisioterapia y Dolor, University of Alcala, Alcalá de Henares, 28805 Madrid, Spain; (G.F.-M.); (R.F.-M.)
| | - Alejandro Garrido-Marin
- CARMASALUD Clinical and Research Center, 28037 Madrid, Spain;
- Department of Physical Therapy and Podiatry, Faculty of Health, Exercise and Sport, European University of Madrid, 28670 Madrid, Spain
| | - Francisco Jose Senin-Camargo
- Department of Biomedical Sciences, Medicine and Physiotherapy, Faculty of Physiotherapy, Universidade da Coruña, 15006 A Coruña, Spain;
| | - Maria Amalia Jacome-Pumar
- MODES group, CITIC, Department of Mathematics, Faculty of Sciences, Universidade da Coruña, 15008 A Coruña, Spain;
| | - Ruben Fernandez-Matias
- Instituto de Investigación Fisioterapia y Dolor, University of Alcala, Alcalá de Henares, 28805 Madrid, Spain; (G.F.-M.); (R.F.-M.)
| | - Daniel Pecos-Martin
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Alcalá de Henares, 28871 Madrid, Spain; (F.N.-C.); (T.G.-I.)
- Correspondence:
| | - Tomas Gallego-Izquierdo
- Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, Alcalá de Henares, 28871 Madrid, Spain; (F.N.-C.); (T.G.-I.)
- Instituto de Investigación Fisioterapia y Dolor, University of Alcala, Alcalá de Henares, 28805 Madrid, Spain; (G.F.-M.); (R.F.-M.)
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15
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Sakamoto A, Hoshi K, Gamada K. Transcultural Reliability and Validity of the Japanese-Language Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther 2020; 43:68-77. [PMID: 32061416 DOI: 10.1016/j.jmpt.2018.11.019] [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: 05/13/2018] [Revised: 07/17/2018] [Accepted: 11/02/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to validate a Japanese version of the Pelvic Girdle Questionnaire (PGQ) and to confirm that the Japanese version of the PGQ (PGQ-J) was as valid as the original version. METHODS This study involves 2 phases: (1) a cross-cultural adaptation study and (2) a cross-sectional study. The English PGQ was translated referring to the cross-cultural adaptation study process. Forty healthy pregnant or postpartum Japanese women participated. Women with pelvic girdle pain (PGP) completed the PGQ-J and 5 other instruments. Internal consistency, construct validity, test-retest reliability, ceiling and floor effects, and discrimination validity of the PGQ-J were analyzed. RESULTS The PGQ-J showed high internal consistency with a Cronbach α of .968, and an interclass correlation coefficient of .79. The content validity showed a high positive correlation with the Oswestry Disability Index and Disability Rating Scale. CONCLUSION The PGQ-J was reliable and valid with high internal consistency and content validity for assessing disability owing to PGP in Japanese pregnant and postpartum women. The PGQ-J is expected to facilitate research and clinical practice for PGP in Japan and contribute to the welfare of postpartum women.
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Affiliation(s)
- Asuka Sakamoto
- Graduate School of Medical Technology and Health Welfare Sciences, Higashi Hiroshima City, Hiroshima, Japan
| | - Kenji Hoshi
- Graduate School of Medical Technology and Health Welfare Sciences, Higashi Hiroshima City, Hiroshima, Japan
| | - Kazuyoshi Gamada
- Graduate School of Medical Technology and Health Welfare Sciences, Higashi Hiroshima City, Hiroshima, Japan.
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16
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Neamat Allah N, Sigward S, Mohamed G, Elhafez S, Emran I. Effect of repeated application of rigid tape on pain and mobility deficits associated with sacroiliac joint dysfunction. J Back Musculoskelet Rehabil 2019; 32:487-496. [PMID: 30584116 DOI: 10.3233/bmr-181156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sacroiliac joint dysfunction (SIJD) accounts for up to 30% of patients with low back pain. Rigid taping techniques are often used for conservative treatment of SIJD related symptoms; however, its effectiveness has not been systematically evaluated. OBJECTIVES The aim of our study was to investigate the effect of rigid tape on pain, malalignment and mobility deficits associated with anterior innominate SIJD. METHODS Two groups (n= 37; experimental and control) diagnosed with SIJD participated in a randomized, controlled trial. Tape was applied for 2 weeks in the experimental group, whereas the control group received no treatment. 2 × 2 (group × time) GLM-MANOVA assessed effects of tape on pain; innominate rotation; and hip rotation range of motion. Chi-square and McNemar tests assessed the effect of tape on Gillet and Sitting forward flexion mobility tests; the Patrick, Posterior shear and Gaenslen pain provocation tests were used to test pain. Variables were assessed before (PRE) and after (POST) two weeks. RESULTS No group differences were observed for any variable PRE. Pain intensity, innominate rotation (p< 0.05) and number of positive mobility and pain provocation tests (p< 0.05) decreased from PRE versus POST in the experimental group. No differences were observed in the control group. CONCLUSION Two weeks of rigid tape for anterior innominate correction successfully reduced symptoms related to SIJD.
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Affiliation(s)
- Neama Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt.,Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Susan Sigward
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Ghada Mohamed
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Salam Elhafez
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Ihab Emran
- Department of Orthopaedic Surgery, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo 11559, Egypt
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17
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M Z, M A, A A J, A A, I N. Manipulation Effect on Lumbar Kinematics in Patients with Unilateral Innominate Rotation and Comparison with Asymptomatic Subjects. J Biomed Phys Eng 2019; 9:295-302. [PMID: 31341875 PMCID: PMC6613156 DOI: 10.31661/jbpe.v0i0.760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/04/2017] [Indexed: 11/16/2022]
Abstract
Background Lumbar motion analysis is used as a clinical method in the diagnosis and treatment of low back pain (LBP). So far, no studies have shown if manipulating the sacroiliac joint (SIJ) will change spinal kinematics. Objective The main objectives of this study were to investigate the effects of SIJ manipulation on the lumbar kinematics in subjects with innominate rotation and to compare lumbar kinematics among experiment and control groups. Material and Methods This study was a quasi-experiment-control trial study. 21 LBP patients with anterior or posterior innominate rotations in experiment group and 22 asymptomatic subjects in control group were evaluated. Lumbar kinematic variables (LKV) include lumbar range of motion (ROM) and speed, lumbar lateral flexion and rotation asymmetry were evaluated using Qualysis Track Manager (QTM) twice within two days in control group, and these parameters with pelvic asymmetry and disability were tested before and after intervention in the experiment group. Results While pre-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.0001), rotation (p=0.008) ROM and lower lateral flexion speed (p=0.014), post-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.01) ROM in comparison with control group. Pelvic asymmetry (p=0.049) and disability (p=0.01) significantly decreased in the experiment group after manipulation, but LKV did not change significantly after the intervention (p˃0.05). Conclusion Experiment groups had different lumbar kinematics in comparison with control group before and after SIJ manipulation. Despite the changes in pelvic asymmetry and disability, intervention had no effect on lumbar kinematics.
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Affiliation(s)
- Zamanlou M
- School of Rehabilitation Sciences, Department of Physical Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Akbari M
- School of Rehabilitation Sciences, Department of Physical Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Jamshidi A A
- School of Rehabilitation Sciences, Department of Physical Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Amiri A
- School of Rehabilitation Sciences, Department of Physical Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Nabiyouni I
- School of Public Health, Department of Kinesiology, Indiana University, Bloomington, United State of America
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18
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Lima POP, Melo WPX, Bezerra MA, Almeida GPL, Nunes ACL, Oliveira RR. Intraexaminer and Interexaminer Reproducibility of the Downing Test for Sacroiliac Joint Evaluation of Symptomatic and Asymptomatic Individuals. J Chiropr Med 2019; 18:163-170. [PMID: 32884497 DOI: 10.1016/j.jcm.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 01/15/2023] Open
Abstract
Objective This study aimed to assess the intraexaminer and interexaminer reproducibility of the Downing test in sacroiliac joint evaluation in symptomatic and asymptomatic individuals. Methods A reliability study was conducted with a test-retest design in 54 college students of both sexes. To assess the intraexaminer reproducibility, each participant was evaluated twice by the same examiner with a 7-day interval, and to assess the interexaminer reproducibility, each participant was evaluated by 2 examiners. Results Of the 54 participants included in the study, 18 (33.3%) were asymptomatic and 36 (66.7%) were symptomatic; a total of 108 sacroiliac joints were evaluated. Sacroiliac joint diagnosis based on the Downing test presented low intraexaminer reproducibility in all participants (κ = 0.12, 95% confidence interval [CI] 0.03-0.22), in asymptomatic individuals (κ = 0.18, 95% CI 0.02-0.34), and in symptomatic individuals (κ = 0.28, 95% CI 0.17-0.39). The interexaminer reproducibility also was low in all participants (κ = 0.18, 95% CI 0.09-0.27), in asymptomatic individuals (κ = 0.22, 95% CI 0.15-0.37), and in symptomatic individuals (κ = 0.16, 95% CI 0.05-0.27). The standard error of the measurement values were not lower than smallest detectable change values considering a CI of 95% for all participants. Conclusion For this group of asymptomatic and symptomatic participants, the reproducibility of the Downing test was poor. The clinical utility of this test used in isolation is not supported by the present study.
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Affiliation(s)
- Pedro O P Lima
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil.,League of Sport Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
| | - Wenya P X Melo
- League of Sport Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
| | - Márcio A Bezerra
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil.,League of Sport Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
| | - Gabriel P L Almeida
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil.,League of Sport Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
| | - Ana Carla L Nunes
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
| | - Rodrigo R Oliveira
- Department of Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil.,League of Sport Physical Therapy, Federal University of Ceará, Fortaleza, Ceará, CE, Brazil
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19
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20
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Clinical Diagnosis of Sacroiliac Joint Pain. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Prather H, Decker G, Bonnette M, Simpson S, Hunt D, Sahrmann S, Cheng A, Nepple J. Hip Radiograph Findings in Patients Aged 40 Years and Under with Posterior Pelvic Pain. PM R 2019; 11 Suppl 1:S46-S53. [PMID: 31059595 DOI: 10.1002/pmrj.12180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several sacroiliac joint (SIJ) provocative tests used to assess posterior pelvic pain involve moving and stressing the hip. It is unknown if there is a subgroup of patients with posterior pelvic pain who have underlying hip deformity that could potentially influence performance and interpretation of these tests. OBJECTIVE To describe the prevalence of radiographic hip deformity and hip osteoarthritis in a group of adults 40 years old and under who met the clinical diagnostic criteria for treatment of posterior pelvic pain with an image guided intra-articular SIJ injection. DESIGN Retrospective cohort study. SETTING Tertiary university orthopedic department PATIENTS (OR PARTICIPANTS): One hundred and forty-eight patients were evaluated (83% (123/148) female; mean age 31.3 ± 6.2 years). All had completed a trial of comprehensive noninvasive treatment for posterior pelvic pain and had a minimum of three positive SIJ provocative tests on physical examination. METHODS Retrospective review identified patients undergoing SIJ injection for pain recommended and performed by seven physiatrists between 2011 and 2017. Hip radiographs were read by a physician with expertise in hip measurements with previously demonstrated excellent intrarater reliability. MAIN OUTCOME MEASUREMENTS Percentage of patients with hip deformity findings. RESULTS No patients meeting the inclusion criteria had significant radiographic hip osteoarthritis (Tonnis ≥2 indicating moderate or greater radiographic hip osteoarthritis) and 4/148 (3%) were found to have mild radiographic hip osteoarthritis. Prearthritic hip disorders were identified in 123 (83%, 95% CI: 76, 89%) patients. For those patients with prearthritic hip disorders, measurements consistent with femoroacetabular impingement (FAI) were seen in 61 (41%) patients, acetabular dysplasia in 49 (33%) patients, and acetabular retroversion in 85 (57%) patients. Acetabular retroversion was identified in 43% (crossover sign) and 39% (prominent ischial spine) of patients. CONCLUSIONS Approximately 57% of adult patients under the age of 40 years with the clinical symptom complex of SIJ pain were found to have radiographic acetabular retroversion. This is a higher percentage than the 5%-15% found in asymptomatic people in the current literature. Further study is needed to assess links between hip structure, hip motion, and links to pelvic pain including peri and intra-articular SIJ pain. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Heidi Prather
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Gregory Decker
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Michael Bonnette
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Scott Simpson
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Devyani Hunt
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Shirley Sahrmann
- Program in Physical Therapy, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Abby Cheng
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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Shimpi A, Hatekar R, Shyam A, Sancheti P. Reliability and validity of a new clinical test for assessment of the sacroiliac joint dysfunction. Hong Kong Physiother J 2019; 38:13-22. [PMID: 30930575 PMCID: PMC6385549 DOI: 10.1142/s1013702518500026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/08/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Dysfunctional sacroiliac joint (SIJ) has been cited as a source of low backache (LBA). Numerous non-invasive clinical tests are available for its assessment having poor validity and reliability which challenges their clinical utility. Thus, introduction of a new clinical test may be necessary. Objective: To assess reliability and validity of a new clinical test for the assessment of patients with SIJ movement dysfunction. Methods: Forty-five subjects (23 having LBA of SIJ origin and 22 healthy asymptomatic volunteers) with mean age 28.62 +∕− 5.26 years were assessed by 2 blinded examiners for 3 different clinical tests of SIJ, including the new test. The obtained values were assessed for reliability by intraclass correlation, kappa coefficient and percentage agreement. Validity was assessed by averaging sensitivity and specificity. Positive and negative predictive values and accuracy were assessed. Results: The new test demonstrates good intra- (r=0.81) and inter-rater (r=0.82) reliability with substantial agreement between raters (k>0.60). It has 79.9% validity, 82% sensitivity, 77% specificity, 79% positive-predictive, 80% negative-predictive value and accuracy. Conclusion: The new “Shimpi Prone SIJ test” has a good intra- and inter-rater reliability with a substantial rater agreement and a good validity and accuracy for the assessment of patients with SIJ movement dysfunction.
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Affiliation(s)
- Apurv Shimpi
- Department of Community Physiotherapy Sancheti Institute College of Physiotherapy, Pune, India
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Manual therapy applied by general practitioners for nonspecific low back pain: results of the ManRück pilot-study. Chiropr Man Therap 2018; 26:39. [PMID: 30186593 PMCID: PMC6120085 DOI: 10.1186/s12998-018-0202-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background Nonspecific acute low back pain (LBP) is a common reason for accessing primary care. German guidelines recommend non-steroidal anti-inflammatory drugs and physical activity as evidence-based treatments. Manual Therapy (MT) remains controversial. To increase evidence-based treatment options for general practitioners (GPs), a Pilot-Study was set up to gather information about the required conditions and setting for an RCT. Methods The open pilot-study assesses recruitment methods for GPs and patients, timelines, data collection and outcomes of treatment immediately (T0) and 1, 6 and 12 weeks after consultation (T1, T2, T3). Inclusion criteria for GPs were: no experience of MT; for patients: adults between 18 and 50 suffering from LBP for less than 14 days. Study process: Patients’ control-group (CG) was consecutively recruited first and received standard care. After GPs received a single training session in MT lasting two and a half hours, they consecutively recruited patients with LBP to the intervention group (IG). These patients received add-on MT. Primary outcomes: (A): timelines and recruitment success, (B): assessment tools and sample size evaluation, (C) clinical findings: pain intensity change from baseline to day 3 and time till (a) analgesic use stopped and (b) 2-point pain reduction on an 11-point scale occurred. Secondary outcomes: functional capacity, referral rate, use of other therapies, sick leave, patient satisfaction. Results 14 GPs participated, recruiting 42 patients for the CG and 45 for the IG; 49% (56%) of patients were women. Average baseline pain was 5.98 points, SD: ±2.3 (5.98, SD ±1.8). For an RCT an extended timeline and enhanced recruitment procedures are required. The assessment tools seem appropriate and provided relevant findings: additional MT led to faster pain reduction. IG showed reduced analgesic use and reduced pain at T1 and improved functional capacity by T2. Conclusions Before verifying the encouraging findings that additional MT may lead to faster pain reduction and reduced analgesic use via an RCT, the setting, patients’ structure, and inclusion criteria should be considered more closely. Trial registration Number: DRKS00003240 Registry: German Clinical Trials Registry (DRKS) URL: https://www.drks.de/drks_web/. Registration date: 14.11.2011. First patient: March 2012. Funding: the Rut and Klaus Bahlsen Stiftung, Hannover.
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Quantification of Equine Sacral and Iliac Motion During Application of Manual Forces and Comparison Between Motion Capture With Skin-Mounted and Bone-Fixated Sensors. J Equine Vet Sci 2018; 64:5-11. [PMID: 30973152 DOI: 10.1016/j.jevs.2018.01.007] [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: 03/16/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
Abstract
Diagnosis of sacroiliac dysfunction in horses includes manual motion palpation of the equine ilium and sacrum. Motion of the ilium and sacrum during manual force application to the equine pelvis has been measured previously in vitro. The aim of this study was to measure the amount and direction of motion in vivo, including comparison of bone-fixated and skin-mounted inertial sensors. Sensors were skin-mounted over tuber sacrale (TS) and third sacral spinous process of six Thoroughbred horses and later attached via Steinmann pins inserted into the same bony landmarks. Orientations of each TS and sacrum were recorded by one investigator during six trials of manual force applied to the pelvis, inducing cranial, caudal, and oblique rotations. Mean values were reported in Euler angles for the three orthogonal planes lateral bending, flexion-extension (FE), and axial rotation (AR). Differences between skin- and bone-fixated markers were determined with significance set at P < .05. The largest mean values recorded during rotations applied to the pelvises were for FE, (2.08° ± 0.35°) with bone-fixated sensors. AR gave the largest values recorded with skin mountings (1.70° ± 0.48°). There was a poor correlation between skin-mounted and bone-fixated markers with AR being the orthogonal plane in which results from skin mounting were closest to results from bone-fixated sensors Bony kinematics during external movement applied to the pelvis cannot be predicted from skin-mounted sensors, due to differences between skin- and bone-mounted sensors.
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25
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Kivlan BR, Martin RL, Martin HD. Defining the greater trochanter-ischial space: a potential source of extra-articular impingement in the posterior hip region. J Hip Preserv Surg 2016; 3:352-357. [PMID: 29632696 PMCID: PMC5883177 DOI: 10.1093/jhps/hnw017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to describe greater trochanteric-ischial impingement and the relative position of the hip joint where impingement occurs. Twenty-three hips from 13 embalmed cadavers (seven males and six females) with a lifespan ranging between 46 and 91 years were used for this study. The pelvic region of each cadaver was skeletonized leaving only the hip capsule and the sciatic nerve. From 90° of flexion, the hip was extended while maintaining a position of 30° abduction and 60° external rotation. The position of hip flexion was recorded when there was contact between the greater trochanter and the ischium. The procedure was repeated in 0° abduction. A Flexion-Abduction-External Rotation (FABER) test was then performed on all specimens with a positive finding defined as contact between the greater trochanter and the ischium. In 30° abduction, contact of the ischium and the greater trochanter occurred in 87% (20/23) of the hips at an average of 47° of flexion (SD 10; range 20–60°). In 0° abduction, a positive finding was noted in 39% (9/23) of hips at an average of 59° flexion (SD 6; range 52–70°). A positive finding in the FABER test position was noted in 96% (22/23) of hips. The greater trochanter can impinge on the ischium when the hip is extended from 90° flexion in a 60° externally rotated position. This impingement occurred more commonly when the hip was in 30° abduction compared with neutral abduction. The FABER test position consistently created greater trochanteric–ischial impingement.
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Affiliation(s)
- Benjamin R Kivlan
- John G. Rangos Sr, School of Health Sciences, Duquesne University, Pittsburgh, PA 15282, USA.,Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - RobRoy L Martin
- John G. Rangos Sr, School of Health Sciences, Duquesne University, Pittsburgh, PA 15282, USA.,Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - Hal D Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
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Adhia DB, Tumilty S, Mani R, Milosavljevic S, Bussey MD. Can hip abduction and external rotation discriminate sacroiliac joint pain? ACTA ACUST UNITED AC 2015; 21:191-7. [PMID: 26299325 DOI: 10.1016/j.math.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022]
Abstract
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(β) (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.
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Affiliation(s)
- Divya Bharatkumar Adhia
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand; School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Steve Tumilty
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | | | - Melanie D Bussey
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
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Joseph LH, Hussain RI, Naicker AS, Htwe O, Pirunsan U, Paungmali A. Pattern of changes in local and global muscle thickness among individuals with sacroiliac joint dysfunction. Hong Kong Physiother J 2015. [DOI: 10.1016/j.hkpj.2014.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sharma S, Balthillaya G, Rao R, Mani R. Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial. Phys Ther Sport 2015; 17:30-7. [PMID: 26482098 DOI: 10.1016/j.ptsp.2015.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the added benefit of nerve-biased interventions over static stretching in hamstring flexibility and to compare the effectiveness of two types of nerve-biased interventions over a week. DESIGN Three-arm assessor-blinded randomized controlled trial. SETTING University Laboratory. PARTICIPANTS Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone. OUTCOME MEASURE Knee extension angle (KEA) in degrees. RESULTS Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p < 0.001). However there was no significant difference between NS-SS and NT-SS groups (mean difference: 4.8; 95%CI = 0.4, 9.9; p = 0.074). CONCLUSIONS Neural sliders and tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another. CLINICAL TRIAL REGISTRATION This clinical trial is registered in Clinical Trials Registry- India (CTRI) with registration number CTRI/2012/05/002619.
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Affiliation(s)
- Saurab Sharma
- Department of Physiotherapy, Manipal School of Allied Health Sciences, Manipal University, Karnataka, India.
| | - Ganesh Balthillaya
- Department of Physiotherapy, Manipal School of Allied Health Sciences, Manipal University, Karnataka, India
| | - Roopa Rao
- Department of Physiotherapy, Manipal School of Allied Health Sciences, Manipal University, Karnataka, India
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Cooperstein R, Blum C, Cooperstein EC. Assessment of Consistency Between the Arm-Fossa Test and Gillet Test: A Pilot Study. J Chiropr Med 2015; 14:24-31. [PMID: 26693214 DOI: 10.1016/j.jcm.2014.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this pilot study was to test methods needed to conduct a study with adequate power to investigate consistency between the arm-fossa test (AFT) and the Gillet test. METHODS A convenience sample of chiropractic college students enrolled in a weekend Sacro-Occipital Technique seminar participated. Each was tested with AFT and sacroiliac orthopedic tests, including the Gillet test. Statistical testing included calculation of κ for consistency of the AFT and Gillet test and their diagnostic efficiency. RESULTS This study recruited 14 participants. Important issues arose in gathering and recording data, the standardization of examiner methods, and the flow of participants to examination stations. κ for AFT and Gillet test consistency = 0.55, corresponding to "moderate." CONCLUSION This pilot suggests that the future study should include a mix of symptomatic and asymptomatic participants; record trichotomous data, where appropriate; use washout periods between diagnostic tests; and refine the selection of orthopedic tests deployed besides the AFT. The preliminary data are consistent with but do not establish due to the very small sample size and experimental design issues, that a positive AFT may be consistent with a negative Gillet test.
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Affiliation(s)
- Robert Cooperstein
- Professor Palmer Center for Chiropractic Research, Palmer Chiropractic College, West, San Jose, CA
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Deutschmann KC, Jones AD, Korporaal CM. A non-randomised experimental feasibility study into the immediate effect of three different spinal manipulative protocols on kicking speed performance in soccer players. Chiropr Man Therap 2015; 23:1. [PMID: 25635222 PMCID: PMC4310142 DOI: 10.1186/s12998-014-0046-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The most utilized soccer kicking method is the instep kicking technique. Decreased motion in spinal joint segments results in adverse biomechanical changes within in the kinematic chain. These changes may be linked to a negative impact on soccer performance. This study tested the immediate effect of lumbar spine and sacroiliac manipulation alone and in combination on the kicking speed of uninjured soccer players. METHODS This 2010 prospective, pre-post experimental, single-blinded (subject) required forty asymptomatic soccer players, from regional premier league teams, who were purposively allocated to one of four groups (based on the evaluation of the players by two blinded motion palpators). Segment dysfunction was either localized to the lumbar spine (Group 1), sacroiliac joint (Group 2), the lumbar spine and sacroiliac joint (Group 3) or not present in the sham laser group (Group 4). All players underwent a standardized warm-up before the pre-measurements. Manipulative intervention followed after which post-measurements were completed. Measurement outcomes included range of motion changes (digital inclinometer); kicking speed (Speed Trac™ Speed Sport Radar) and the subjects' perception of a change in kicking speed. SPSS version 15.0 was used to analyse the data, with repeated measures ANOVA and a p-value <0.05 (CI 95%). RESULTS Lumbar spine manipulation resulted in significant range of motion increases in left and right rotation. Sacroiliac manipulation resulted in no significant changes in the lumbar range of motion. Combination manipulative interventions resulted in significant range of motion increases in lumbar extension, right rotation and right SI joint flexion. There was a significant increase in kicking speed post intervention for all three manipulative intervention groups (when compared to sham). A significant correlation was seen between Likert based-scale subjects' perception of change in kicking speed post intervention and the objective results obtained. CONCLUSIONS This pilot study showed that lumbar spine manipulation combined with SI joint manipulation, resulted in an effective intervention for short-term increases in kicking speed/performance. However, the lack of an a priori analysis, a larger sample size and an unblinded outcome measures assessor requires that this study be repeated, addressing these concerns and for these outcomes to be validated.
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Affiliation(s)
| | | | - Charmaine Maria Korporaal
- />Department of Chiropractic and Somatology, Chiropractic Programme, M.Tech:Chiropractic, CCFC, CCSP, ICSSD, Durban University of Technology, Durban, South Africa
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van Trijffel E, Lindeboom R, Bossuyt PMM, Schmitt MA, Lucas C, Koes BW, Oostendorp RAB. Indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain: protocol of an inter-examiner reliability study among manual therapists. Chiropr Man Therap 2014; 22:22. [PMID: 24982754 PMCID: PMC4074830 DOI: 10.1186/2045-709x-22-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Manual spinal joint mobilisations and manipulations are widely used treatments in patients with neck and low-back pain. Inter-examiner reliability of passive intervertebral motion assessment of the cervical and lumbar spine, perceived as important for indicating these interventions, is poor within a univariable approach. The diagnostic process as a whole in daily practice in manual therapy has a multivariable character, however, in which the use and interpretation of passive intervertebral motion assessment depend on earlier results from the diagnostic process. To date, the inter-examiner reliability among manual therapists of a multivariable diagnostic decision-making process in patients with neck or low-back pain is unknown. METHODS This study will be conducted as a repeated-measures design in which 14 pairs of manual therapists independently examine a consecutive series of a planned total of 165 patients with neck or low-back pain presenting in primary care physiotherapy. Primary outcome measure is therapists' decision about whether or not manual spinal joint mobilisations or manipulations, or both, are indicated in each patient, alone or as part of a multimodal treatment. Therapists will largely be free to conduct the full diagnostic process based on their formulated examination objectives. For each pair of therapists, 2×2 tables will be constructed and reliability for the dichotomous decision will be expressed using Cohen's kappa. In addition, observed agreement, prevalence of positive decisions, prevalence index, bias index, and specific agreement in positive and negative decisions will be calculated. Univariable logistic regression analysis of concordant decisions will be performed to explore which demographic, professional, or clinical factors contributed to reliability. DISCUSSION This study will provide an estimate of the inter-examiner reliability among manual therapists of indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain based on a multivariable diagnostic reasoning and decision-making process, as opposed to reliability of individual tests. As such, it is proposed as an initial step toward the development of an alternative approach to current classification systems and prediction rules for identifying those patients with spinal disorders that may show a better response to manual therapy which can be incorporated in randomised clinical trials. Potential methodological limitations of this study are discussed.
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Affiliation(s)
- Emiel van Trijffel
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick MM Bossuyt
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten A Schmitt
- Institute for Master Education in Musculoskeletal Therapy, Amersfoort, the Netherlands
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Rob AB Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Rehabilitation, Physiotherapy and Manual Therapy, Faculty of Medicine and Pharmacology, Free University of Brussels, Brussels, Belgium
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Méndez-Sánchez R, González-Iglesias J, Sánchez-Sánchez JL, Puente-González AS. Immediate Effects of Bilateral Sacroiliac Joint Manipulation on Plantar Pressure Distribution in Asymptomatic Participants. J Altern Complement Med 2014; 20:251-7. [DOI: 10.1089/acm.2013.0192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Roberto Méndez-Sánchez
- Department of Physical Therapy, Universidad de Salamanca, Salamanca, Spain
- Madrid School of Osteopathy, Madrid, Spain
| | - Javier González-Iglesias
- Madrid School of Osteopathy, Madrid, Spain
- Clinic of Physical Therapy Integral Candás, Candás, Asturias, Spain
| | | | - Ana Silvia Puente-González
- Department of Physical Therapy, Universidad de Salamanca, Salamanca, Spain
- Madrid School of Osteopathy, Madrid, Spain
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Åström M, Gummesson C. Assessment of asymmetry in pelvic motion – An inter- and intra-examiner reliability study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.884162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim YH, Yao Z, Kim K, Park WM. Quantitative investigation of ligament strains during physical tests for sacroiliac joint pain using finite element analysis. ACTA ACUST UNITED AC 2014; 19:235-41. [PMID: 24378472 DOI: 10.1016/j.math.2013.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 11/03/2013] [Accepted: 11/11/2013] [Indexed: 11/19/2022]
Abstract
It may be assumed that the stability is affected when some ligaments are injured or loosened, and this joint instability causes sacroiliac joint pain. Several physical examinations have been used to diagnose sacroiliac pain and to isolate the source of the pain. However, more quantitative and objective information may be necessary to identify unstable or injured ligaments during these tests due to the lack of understanding of the quantitative relationship between the physical tests and the biomechanical parameters that may be related to pains in the sacroiliac joint and the surrounding ligaments. In this study, a three-dimensional finite element model of the sacroiliac joint was developed and the biomechanical conditions for six typical physical tests such as the compression test, distraction test, sacral apex pressure test, thigh thrust test, Patrick's test, and Gaenslen's test were modelled. The sacroiliac joint contact pressure and ligament strain were investigated for each test. The values of contact pressure and the combination of most highly strained ligaments differed markedly among the tests. Therefore, these findings in combination with the physical tests would be helpful to identify the pain source and to understand the pain mechanism. Moreover, the technology provided in this study might be a useful tool to evaluate the physical tests, to improve the present test protocols, or to develop a new physical test protocol.
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Affiliation(s)
- Yoon Hyuk Kim
- Department of Mechanical Engineering, Kyung Hee University, Yongin 446-701, South Korea.
| | - Zhidong Yao
- Department of Mechanical Engineering, Kyung Hee University, Yongin 446-701, South Korea
| | - Kyungsoo Kim
- Department of Applied Mathematics, Kyung Hee University, Yongin 446-701, South Korea
| | - Won Man Park
- Department of Mechanical Engineering, Kyung Hee University, Yongin 446-701, South Korea
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Abstract
Primary musculoskeletal etiologies, such as stress fractures, strains, facet arthropathy, and sacroiliac joint dysfunction, are more common causes of pediatric pain than systemic diseases, both in the office setting and the emergency room. Systemic features, young age, and atypical pain should clue physicians to causes other than a primary musculoskeletal cause and prompt an intensive search for other conditions.
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Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J, Tepe R. Review of methods used by chiropractors to determine the site for applying manipulation. Chiropr Man Therap 2013; 21:36. [PMID: 24499598 PMCID: PMC4028787 DOI: 10.1186/2045-709x-21-36] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/29/2013] [Indexed: 01/13/2023] Open
Abstract
Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.
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Affiliation(s)
- John J Triano
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Brian Budgell
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | | | | | - Thomas Bergmann
- Northwestern Health Sciences University, Bloomington, MN, USA
| | | | - Brian Gleberzon
- Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada
| | - Christopher Good
- University of Bridgeport College of Chiropractic, Bridgeport, CT, USA
| | | | - Rodger Tepe
- Logan College of Chiropractic, Chesterfield, MO, USA
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Sudarshan A. Physical therapy management of osteitis pubis in a 10-year-old cricket fast bowler. Physiother Theory Pract 2012; 29:476-86. [DOI: 10.3109/09593985.2012.753650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jardine WM, Gillis C, Rutherford D. The effect of osteopathic manual therapy on the vascular supply to the lower extremity in individuals with knee osteoarthritis: A randomized trial. INT J OSTEOPATH MED 2012. [DOI: 10.1016/j.ijosm.2012.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ridgeway K, Silvernail J. Innominate 3D motion modeling: biomechanically interesting, but clinically irrelevant. MANUAL THERAPY 2012; 17:e11-e13. [PMID: 22459603 DOI: 10.1016/j.math.2012.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
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Joseph L, Puangmali A, Pirunsan U, Das S. Sacroiliac joint and weight distribution to feet: An opinion towards clinical and research practice. ACTA ACUST UNITED AC 2012; 17:e7; author reply e8-9. [DOI: 10.1016/j.math.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/22/2011] [Indexed: 10/16/2022]
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Grassi DDO, de Souza MZ, Ferrareto SB, Montebelo MIDL, Guirro ECDO. Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint. ACTA ACUST UNITED AC 2011; 16:495-500. [DOI: 10.1016/j.math.2011.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 04/11/2011] [Accepted: 04/14/2011] [Indexed: 10/18/2022]
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Barakatt ET, Romano PS, Riddle DL, Beckett LA. The Reliability of Maitland's Irritability Judgments in Patients with Low Back Pain. J Man Manip Ther 2011; 17:135-40. [PMID: 20046619 DOI: 10.1179/jmt.2009.17.3.135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Maitland's construct of musculoskeletal pain irritability is widely used by physical therapists but has not been defined to the extent that its measurement properties can be tested. The purpose of this study was to examine the inter-rater reliability of physical therapists' irritability judgments during application to patients with low back pain (LBP). Eighty patients with LBP received two consecutive examinations at their initial clinic visit by two physical therapists. Patients reported pain location and intensity prior to each evaluation. Therapists judged subjects' LBP as irritable or non-irritable. Inter-rater agreement of physical therapist irritability judgments was moderate (kappa = 0.44, prevalence-adjusted kappa = 0.50). This level of reliability of therapists' LBP irritability judgments may be improved upon by development of an operational definition of pain irritability. Further research is needed to identify measures appropriate for inclusion in an operational definition of pain irritability and to assess the value of making pain irritability judgments in evidence-based physical therapy practice.
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Abstract
BACKGROUND AND PURPOSE Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) negatively affects quality of life and sexual function in men of all ages. Typical treatment with antibiotic and antimicrobial drugs often is not successful. The purpose of this case report is to describe a multimodal physical therapy intervention that included manual therapy techniques applied to the pelvic floor in 2 patients who were unsuccessfully treated with the biomedical model of prescription drug therapies. CASE DESCRIPTION Two men, aged 45 years and 53 years and diagnosed with chronic prostatitis, were referred for physical therapy following unsuccessful pharmacological treatment. The patients were treated with manual therapy techniques applied to the pelvic floor and instructed in progressive muscle relaxation, flexibility exercises, and aerobic exercises. OUTCOMES Changes in the patients' National Institutes of Health Chronic Prostatitis Symptom Index revealed differences between preintervention and postintervention scores reflecting decreased pain and improved quality of life. One patient improved from a score of 25 (total possible score = 43) before treatment to a score of 0 after treatment, and the other patient improved from a score of 29 to a score of 21. DISCUSSION Manual therapy techniques applied to the pelvic floor and performed by a physical therapist specially trained in these techniques, along with progressive muscle relaxation, flexibility exercises, and aerobic exercises, appeared to be beneficial to both patients in reducing pain and improving sexual function.
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Paatelma M, Karvonen E, Heinonen A. Inter- and intra-tester reliability of selected clinical tests in examining patients with early phase lumbar spine and sacroiliac joint pain and dysfunction. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903582154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Berthelot JM, Laslett M. Par quels signes cliniques s’assurer au mieux qu’une douleur est bien d’origine sacro-iliaque (sensu lato) ? ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.rhum.2009.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prather H, Dugan S, Fitzgerald C, Hunt D. Review of Anatomy, Evaluation, and Treatment of Musculoskeletal Pelvic Floor Pain in Women. PM R 2009; 1:346-58. [DOI: 10.1016/j.pmrj.2009.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/10/2008] [Accepted: 01/02/2009] [Indexed: 10/20/2022]
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