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Glakousakis G, Kalatzis P, Mandalidis D. Exploring 3D Pelvis Orientation: A Cross-Sectional Study in Athletes Engaged in Activities with and without Impact Loading and Non-Athletes. J Funct Morphol Kinesiol 2024; 9:19. [PMID: 38249096 PMCID: PMC10801472 DOI: 10.3390/jfmk9010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Female athletes subjected to various types of impact loading, especially over a long period of time, may experience changes in their pelvic orientation, which may affect their sport performance and increase the likelihood of injury. The aim of the present study was to determine whether female athletes involved in high-impact loading sports (HILS), odd-impact loading sports (OILS), and repetitive non-impact loading sports (NILS) demonstrate changes in pelvis orientation compared to non-athletes (NATH). Pelvic orientation was determined using Euler/Cardan angles, calculated from the coordinates of the right, and left anterior superior iliac spines and pubic symphysis via a novel method. Two-way ANOVA tests showed significant differences between groups for pelvis position in the frontal plane (p < 0.05), with HILS and OILS demonstrating greater pelvic obliquity compared to NILS athletes and NATH. Significant main effects were also obtained for directions within the sagittal plane (p < 0.001). Significant within-group differences were observed in sagittal pelvic position among female athletes engaged in NILS (p < 0.01) and non-athletes (NATH) (p < 0.05), with a greater anterior pelvic tilt compared to posterior. Our findings suggest that pelvis orientation in female athletes across sports is influenced by sport-specific impact loads, potentially affecting performance and injury occurrence.
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Affiliation(s)
- Georgios Glakousakis
- Sports Physical Therapy Laboratory, Department of Physical Education and Sports Science, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece;
| | - Perikles Kalatzis
- Section of Informatics 1st Vocational Lyceum of Vari, Directorate of Secondary Education of East Attica, Hellenic Ministry of Education and Religious Affairs, 15122 Athens, Greece;
| | - Dimitris Mandalidis
- Sports Physical Therapy Laboratory, Department of Physical Education and Sports Science, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece;
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Yoon JD, Jung JH, Cho HY, Shin HJ. The Immediate Effects of Muscle Energy Technique in Chronic Low Back Pain Patients with Functional Leg Length Discrepancy: A Randomized and Placebo-Controlled Trial. Healthcare (Basel) 2023; 12:53. [PMID: 38200959 PMCID: PMC10778948 DOI: 10.3390/healthcare12010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
This study was conducted to determine the effect of muscle energy technique (MET) on pelvic alignment, leg length, pain, and fatigue in chronic low back pain (CLBP) patients with leg length discrepancy (LLD). Forty-two CLBP patients with LLD volunteered to participate and were randomly assigned to the MET group (n = 21) and placebo group (n = 21). The intervention group performed three METs with 5 s of isometric contraction and 30 s of rest once, and the placebo group performed three times the placebo-MET, maintaining the same posture as the MET group without muscle isometric contraction. X-ray equipment, tape measure, and visual analog scale were used to evaluate pelvic alignment, leg length, pain, and fatigue before and after each intervention. In comparison pre- and postintervention, only the MET group showed significant changes in pelvic alignment, leg length, pain, and fatigue (p < 0.05). In comparison between groups, there were significant differences in all variables (pelvic alignment, leg length, pain, fatigue) (p < 0.05). The results of this study confirmed the therapeutic effect of MET for improving pelvic alignment, functional LLD, pain, and fatigue in CLBP patients with functional LLD. Future research is needed to evaluate the long-term effect on more chronic low back pain patients.
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Affiliation(s)
- Jung-Dae Yoon
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea;
- Barum Pilates and Rehabilitation Center, Incheon 22014, Republic of Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Republic of Korea;
| | - Hwi-Young Cho
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea;
- Department of Physical Therapy, Gachon University, Incheon 21936, Republic of Korea
| | - Ho-Jin Shin
- Department of Physical Therapy, Gachon University, Incheon 21936, Republic of Korea
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Plehuna A, Green DA, Amirova LE, Tomilovskaya ES, Rukavishnikov IV, Kozlovskaya IB. Dry immersion induced acute low back pain and its relationship with trunk myofascial viscoelastic changes. Front Physiol 2022; 13:1039924. [PMID: 36311233 PMCID: PMC9606241 DOI: 10.3389/fphys.2022.1039924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
Microgravity induces spinal elongation and Low Back Pain (LBP) but the pathophysiology is unknown. Changes in paraspinal muscle viscoelastic properties may play a role. Dry Immersion (DI) is a ground-based microgravity analogue that induces changes in m. erector spinae superficial myofascial tissue tone within 2 h. This study sought to determine whether bilateral m. erector spinae tone, creep, and stiffness persist beyond 2 h; and if such changes correlate with DI-induced spinal elongation and/or LBP. Ten healthy males lay in the DI bath at the Institute of Biomedical Problems (Moscow, Russia) for 6 h. Bilateral lumbar (L1, L4) and thoracic (T11, T9) trunk myofascial tone, stiffness and creep (MyotonPRO), and subjective LBP (0-10 NRS) were recorded before DI, after 1h, 6 h of DI, and 30min post. The non-standing spinal length was evaluated on the bath lifting platform using a bespoke stadiometer before and following DI. DI significantly modulated m. erector spinae viscoelastic properties at L4, L1, T11, and T9 with no effect of laterality. Bilateral tissue tone was significantly reduced after 1 and 6 h DI at L4, L1, T11, and T9 to a similar extent. Stiffness was also reduced by DI at 1 h but partially recovered at 6 h for L4, L1, and T11. Creep was increased by DI at 1 h, with partial recovery at 6 h, although only T11 was significant. All properties returned to baseline 30 min following DI. Significant spinal elongation (1.17 ± 0.20 cm) with mild (at 1 h) to moderate (at 6 h) LBP was induced, mainly in the upper lumbar and lower thoracic regions. Spinal length increases positively correlated (Rho = 0.847, p = 0.024) with middle thoracic (T9) tone reduction, but with no other stiffness or creep changes. Spinal length positively correlated (Rho = 0.557, p = 0.039) with Max LBP; LBP failed to correlate with any m. erector spinae measured parameters. The DI-induced bilateral m. erector spinae tone, creep, and stiffness changes persist beyond 2 h. Evidence of spinal elongation and LBP allows suggesting that the trunk myofascial tissue changes could play a role in LBP pathogenesis observed in real and simulated microgravity. Further study is warranted with longer duration DI, assessment of IVD geometry, and vertebral column stability.
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Affiliation(s)
- Anastasija Plehuna
- King’s College London, Centre of Human & Applied Physiological Sciences, London, United Kingdom
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - David Andrew Green
- King’s College London, Centre of Human & Applied Physiological Sciences, London, United Kingdom
- Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle Laboratories GmbH, Cologne, Germany
| | - Liubov E. Amirova
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Elena S. Tomilovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Ilya V. Rukavishnikov
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Inessa B. Kozlovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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Plandowska M, Kędra A, Kędra P, Czaprowski D. Trunk Alignment in Physically Active Young Males with Low Back Pain. J Clin Med 2022; 11:jcm11144206. [PMID: 35887971 PMCID: PMC9317919 DOI: 10.3390/jcm11144206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Systematic physical activity has become an essential part of the guidelines for the prevention and treatment of low back pain (LBP). The aim of this study was to assess differences in trunk alignment parameters with regard to the level of physical activity in groups of individuals with and without LBP. Methods: 43 participants with LBP and 37 healthy persons were recruited. Participants were divided into two subgroups: (1) students with a moderate level of physical activity (MPA); (2) students with a high level of physical activity (HPA). An original questionnaire was used to assess the prevalence of LBP. The spinal posture was measured using the Formetric 4D rasterstereographic system. Results: There were no significant differences between groups for any of the parameters assessed: trunk imbalance, trunk inclination, trunk torsion, pelvic tilt, pelvic inclination, pelvic torsion, kyphotic angle and lordotic angle. Conclusions: There are no differences in trunk alignment parameters in the sagittal, frontal and transversal planes between physically active males with and without LBP. Therefore, it can be assumed that physical activity may reduce the risk of the deterioration of trunk alignment in males with LBP younger than 25 years.
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Affiliation(s)
- Magdalena Plandowska
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland; (A.K.); (P.K.)
- Correspondence:
| | - Agnieszka Kędra
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland; (A.K.); (P.K.)
| | - Przemysław Kędra
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland; (A.K.); (P.K.)
| | - Dariusz Czaprowski
- Department of Health Sciences, University College in Olsztyn, 10-283 Olsztyn, Poland;
- Center of Body Posture, Bydgoska 33, 10-243 Olsztyn, Poland
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Mandalidis D, Glakousakis G, Kalatzis P. An anthropometric-based method for the assessment of pelvis position in three-dimensional space. MethodsX 2022; 9:101616. [PMID: 35464806 PMCID: PMC9019700 DOI: 10.1016/j.mex.2022.101616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022] Open
Abstract
Determining the pelvis position remains a challenge for clinical therapists and researchers mainly due to the difficulty in assessing its potential triaxial rotations in the upright standing posture. The method described in this study aims to determine the position of the pelvis in the upright standing posture by calculating the Euler/Cardan angles of pelvic rotations based on the triaxial coordinates of the anterior superior iliac spines and the pubic symphysis. The coordinates of these bony landmarks were determined with two laser distance meters and a standard metric ruler, all mounted on a custom-made structure. The calculations of all Euler/Cardan angle rotation sequences for both the internal and external rotations of the pelvis were performed by developing an algorithm that executed via a computer program specifically designed for the purpose of this study. The validity of the algorithm was tested by comparing the actual angles of known positions at which an anatomical model of the pelvis was placed with the calculated angles. Our findings revealed <1° differences between the actual and the calculated angles of pelvis rotations regardless of the axis around which it was rotated suggesting that the proposed method can be used for clinical and research purposes.The triaxial coordinates of pelvis bony landmarks can be measured anthropometrically using simple measuring instruments Pelvis posture can be determined in 3D space with great accuracy by means of the Euler/Cardan angles
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Yoo HI, Hwang UJ, Ahn SH, Gwak GT, Kwon OY. Comparison of pelvic rotation angle in the transverse plane in the supine position and during active straight leg raise between people with and without nonspecific low back pain. Clin Biomech (Bristol, Avon) 2021; 83:105310. [PMID: 33721727 DOI: 10.1016/j.clinbiomech.2021.105310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Faults in postural alignment and movement of the pelvis are associated with non-specific low back pain. However, limited studies have investigated the differences in pelvic rotation angle in the transverse plane in the supine position and during active straight leg raise between subjects with and without non-specific low back pain. METHODS Thirty-one subjects with non-specific low back pain and 31 subjects without non-specific low back pain were examined. Angular measures of the pelvic rotation angle in the transverse plane were obtained in the supine position and during active straight leg raise using a Smart KEMA measurement system. FINDING The pelvic rotation angle in the transverse plane during active straight leg raise was significantly greater in subjects with non-specific low back pain than in healthy subjects (p < 0.05). However, the pelvic rotation angle in the transverse plane in the supine position and asymmetry index of the pelvic rotation angle during active straight leg raise were not significantly different between subjects with and those without non-specific low back pain. INTERPRETATION This indicates that a greater pelvic rotation angle in the transverse plane during active straight leg raise could be contributing factors to the development of a non-specific low back pain related to lumbopelvic instability.
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Affiliation(s)
- Hwa-Ik Yoo
- Department of Physical Therapy, Graduate School, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea; Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea
| | - Sun-Hee Ahn
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea
| | - Gyeong-Tae Gwak
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, 234 Maeji-ri, Heungeup-Myeon, Wonju, Kangwon-Do 220-710, South Korea.
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Yu Q, Huang H, Zhang Z, Hu X, Li W, Li L, Chen M, Liang Z, Lo WLA, Wang C. The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system. BMC Musculoskelet Disord 2020; 21:596. [PMID: 32891129 PMCID: PMC7487478 DOI: 10.1186/s12891-020-03617-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empirical evidence that demonstrates the relationship between pelvic asymmetry and non-specific chronic low back pain (NCLBP) is currently lacking. OBJECTIVE To establish the reliability of the Global Postural System (GPS) in assessing pelvic asymmetry and identify the association between pelvic asymmetry parameters and the occurrence of NCLBP in young adults. DESIGN A cross-sectional, regression study. METHODS People who were aged between 18 and 30 and were diagnosed with NCLBP were recruited. Healthy individuals who were matched for age, sex, and education level were recruited as controls. Global Postural System (GPS) was employed to assess pelvic asymmetry. Prior to exploring the association, the reliability of GPS was assessed by the ICC (2, k) for interrater reliability, ICC (3, k) for intra-rater reliability, standard error and minimal detectable difference. Bivariate correlation analysis and logistic regression analysis were used to determine the relationship between pelvic asymmetry and the occurrence of NCLBP. RESULTS Twenty-eight healthy participants and 28 people with NCLBP were recruited. Moderate to excellent ICCs were observed for the inter-rater and intra-rater reliability of most postural parameters. The bivariate correlation analysis indicated that age, body mass index and pelvic asymmetry parameters were related to the occurrence of NCLBP. Pelvic angle asymmetry (odds ratio = 1.17), and asymmetry of the distance between the posterior superior iliac spine and the floor (odds ratio = 1.21) were associated with NCLBP. LIMITATIONS This study did not explore the causal relationship between pelvic asymmetry in the sagittal plane/pelvic asymmetry in the transverse plane and the occurrence of NCLBP. The interpretation of the results may not be generalized beyond the sample population. CONCLUSIONS The GPS is a reliable method to assess pelvic asymmetry in a clinical setting. Two pelvic parameters were associated with the presence of NLBP. Measurement of pelvic asymmetry may assist in the early identification of potential occurrence of NCLBP but further work is required.
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Affiliation(s)
- Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Zhou Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Xiaoqian Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wenfeng Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
- Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China
| | - Zhenwen Liang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China.
- Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Lu, Guangzhou, 5100800, China.
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Back pain in adolescents with idiopathic scoliosis: the contribution of morphological and psychological factors. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1959-1971. [DOI: 10.1007/s00586-020-06489-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/25/2020] [Accepted: 05/31/2020] [Indexed: 01/13/2023]
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9
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Enix DE, Mayer JM. Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients. PM R 2019; 11 Suppl 1:S32-S39. [DOI: 10.1002/pmrj.12176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
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Rannisto S, Okuloff A, Uitti J, Paananen M, Rannisto PH, Malmivaara A, Karppinen J. Correction of leg-length discrepancy among meat cutters with low back pain: a randomized controlled trial. BMC Musculoskelet Disord 2019; 20:105. [PMID: 30871549 PMCID: PMC6417033 DOI: 10.1186/s12891-019-2478-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background The etiology of non-specific low back pain (LBP) is complex and not well understood. LBP is common and causes a remarkable health burden worldwide. Leg-length discrepancy (LLD) is potentially a risk factor for development of LBP, although this relationship has been questioned. Yet only one randomized controlled study (RCT) has been performed. The objective of our study was to evaluate the effect of insoles with leg-length discrepancy (LLD) correction compared to insoles without LLD correction among meat cutters in a RCT-design. Methods The study population consisted 387 meat cutters who were over 35 years old and had been working 10 years or more. The LLD measurement was done by a laser ultrasound technique. All workers with an LLD of at least 5 mm and an LBP intensity of at least 2 on a 10-cm Visual Analog Scale were eligible. The LLD of all the participants in the intervention group was corrected 70%, which means that if the LLD was for example 10 mm the correction was 7 mm. The insoles were used at work for eight hours per day. The control group had insoles without LLD correction. The primary outcome was between-group difference in LBP intensity. Secondary outcomes included sciatic pain intensity, disability (Roland Morris), RAND-36, the Oswestry Disability Index, physician visits and days on sick leave over the first year. We used a repeated measures regression analysis with adjustments for age, gender and BMI. The hurdle model was used for days on sick leave. Results In all, 169 workers were invited and 114 (67%) responded. Of them, 42 were eligible and were randomized to the intervention (n = 20) or control group (n = 22). The workers in the intervention group had a higher improvement in LBP intensity (− 2.6; 95% confidence intervals − 3.7 – − 1.4), intensity of sciatic pain (− 2.3; − 3.4 – − 1.07) and RAND-36 physical functioning (9.6; 1.6–17.6) and a lesser likelihood of sick leaves (OR -3.7; − 7.2 - -0.2). Conclusions Correction of LLD with insoles was an effective intervention among workers with LBP and a standing job. Trial registration ISRCTN11898558. Registration date 11. Feb 2011. BioMed Central Ltd.
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Affiliation(s)
- Satu Rannisto
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33014, Tampere Yliopisto, Finland.
| | - Annaleena Okuloff
- Information Systems Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Uitti
- Finnish Institute of Occupational Health, Oulu, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön katu 34, 33014, Tampere Yliopisto, Finland
| | - Markus Paananen
- Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Pasi-Heikki Rannisto
- Faculty of Social Sciences, Health sciences, University of Tampere, Tampere, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.,Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Jaro Karppinen
- Finnish Institute of Occupational Health, Oulu, Tampere, Finland.,Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Sheha ED, Steinhaus ME, Kim HJ, Cunningham ME, Fragomen AT, Rozbruch SR. Leg-Length Discrepancy, Functional Scoliosis, and Low Back Pain. JBJS Rev 2018; 6:e6. [DOI: 10.2106/jbjs.rvw.17.00148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Shokri E, Kamali F, Sinaei E, Ghafarinejad F. Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. Chiropr Man Therap 2018; 26:16. [PMID: 29796250 PMCID: PMC5956754 DOI: 10.1186/s12998-018-0185-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 04/04/2018] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility. Methods Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010. Patients who had sequestrated disc herniation were excluded. All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. Back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline. Results A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT. Mean changes in ODI in the 5th session and 1 month after treatment also showed significant improvement. The MCIC for NRS and ODI scores in the present study were considered 20 and 6 points, respectively. Therefore, the mentioned improvements were not clinically significant in the 5th session or at 1-month follow-up. Conclusion Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility. Trial registration Irct.ir (Identifier: IRCT2017011924149N33), registered 19 February 2017 (retrospectively registered).
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Affiliation(s)
- Esmaeil Shokri
- 1Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- 1Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,2Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,3School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Abiverdi 1 St,Chamran Blvd., P.O. Box 71345-1733, Shiraz, Iran
| | - Ehsan Sinaei
- 2Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farahnaz Ghafarinejad
- 1Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,2Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Li Y, Zhang X, Wang Q, Peng X, Wang Q, Jiang Y, Chen Y. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip: classification and management. Bone Joint J 2017; 99-B:872-879. [PMID: 28663391 DOI: 10.1302/0301-620x.99b7.bjj-2016-1328.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/23/2017] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication. PATIENTS AND METHODS We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed. RESULTS Type-I included 53 patients with unilateral dislocation, in which 25 (category A) had no pelvic obliquity or spinal deformity, 19 (category B) had pelvic obliquity with a compensated spinal curvature and nine (category C) had pelvic obliquity and decompensated spinal degenerative changes. Type-II included 25 patients with one dislocated and one dysplastic hip, in which there were eight of category A, 15 of category B and two of category C. Pre-operatively, there were significant differences between the anatomical and functional LLD in type-IB (p = 0.005) and -IC (p < 0.001), but not in type-IA, -IIA or -IIB. Post-operatively, bony LLD increased significantly in types-IB, -IC and -IIB, whereas functional LLD decreased significantly in each type except for IIA. The mean functional LLD decreased from 30.7 mm (standard deviation (sd) 18.5) pre-operatively to 6.2 mm (sd 4.4) post-operatively and the mean anatomical LLD improved from 35.8 mm (sd 19.7) pre-operatively to 12.4 mm (sd 8.3) post-operatively. CONCLUSION Pelvic and spinal changes are common in patients with Crowe type-IV DDH and need to be taken into consideration when planning THA, in order to obtain equal leg lengths post-operatively. The principal subdivisions of Crowe type-IV DDH which we describe proved effective in achieving equal leg lengths and satisfactory outcomes. Cite this article: Bone Joint J 2017;99-B:872-9.
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Affiliation(s)
- Y Li
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - X Zhang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Q Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - X Peng
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Q Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Y Jiang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
| | - Y Chen
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 6 Building, No. 600 Yishan Road, Shanghai, China
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Tobolsky VA, Kurki HK, Stock JT. Patterns of directional asymmetry in the pelvis and pelvic canal. Am J Hum Biol 2016; 28:804-810. [PMID: 27224219 DOI: 10.1002/ajhb.22870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/18/2016] [Accepted: 05/01/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The human pelvis is unique among modern taxa for supporting both parturition of large brained young and obligate bipedalism. Though much work has focused on pelvic development and variation, little work has explored the presence or absence of asymmetry in the pelvis despite well-known patterns of asymmetry in other skeletal regions. This study investigated whether patterns of directional asymmetry (DA) could be observed in the pelvis or pelvic canal. METHODS Seventeen bilaterally paired osteometric measurements of the os coxae (34 measures in total) were taken from 128 skeletons (female n = 65, male n = 63) from recent human populations in five geographic regions. Paired sample t-tests and Mann-Whitney U-tests were used to investigate DA. RESULTS Results from a pooled sample of all individuals showed that the pelvis exhibited a left-bias in DA. In contrast, the pelvic canal exhibited a pattern in which the anterior canal exhibited a right-bias and the posterior canal exhibited a left-bias. Neither sex nor populational differences in DA were observed in the pelvis or pelvic canal. CONCLUSIONS The varying patterns of asymmetry uncovered here accord with prior work and may indicate that loading from the trunk and legs place differing stresses on the pelvis and canal, yielding these unequal asymmetries. However, this is speculative and the possible influence of genetics, biomechanics, and nutritional status on the development of pelvic and canal asymmetries presents a rich area for future study. Additionally, the potential influence of pelvic canal asymmetry on obstetric measures of pelvic capacity merits future research. Am. J. Hum. Biol. 28:804-810, 2016. © 2016Wiley Periodicals, Inc.
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Affiliation(s)
- Victoria A Tobolsky
- Division of Biological Anthropology, Department of Archaeology and Anthropology, University of Cambridge, Cambridge, UK.,Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, 02138
| | - Helen K Kurki
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada, V8W 3P5
| | - Jay T Stock
- Division of Biological Anthropology, Department of Archaeology and Anthropology, University of Cambridge, Cambridge, UK
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Rannisto S, Okuloff A, Uitti J, Paananen M, Rannisto PH, Malmivaara A, Karppinen J. Leg-length discrepancy is associated with low back pain among those who must stand while working. BMC Musculoskelet Disord 2015; 16:110. [PMID: 25943907 PMCID: PMC4433073 DOI: 10.1186/s12891-015-0571-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/29/2015] [Indexed: 11/28/2022] Open
Abstract
Background Some studies suggest that leg length discrepancy (LLD) is associated with low back pain (LBP) but many have not found such an association leading to conflicting evidence on the role of LLD in LBP. Methods The study population consisted of meat cutters with a standing job and customer service workers with a sedentary job from Atria Suomi Ltd (Nurmo, Finland) who were at least 35 years old and had been working in their jobs for at least 10 years. Leg length of each participant was measured with a laser range meter fixed in a rod, which was holding the scanning head of the ultrasound apparatus. Association of the intensity of LBP (10-cm Visual Analog Scale) with LLD was analysed by linear regression model, while the hurdle model was used in analysing the association of number of days with LBP and days on sick leave during the past year. Associations were adjusted by gender, age, BMI, smoking, depressive feelings and type of work (standing or sedentary job). Results The final study population consisted of 114 meat cutters (26 females and 88 males) and 34 customer service workers (30 females and four males). Forty-nine percent of the meat cutters and 44% of the customer service workers had LLD of at least 6 mm, while 16% and 15%, respectively, had LLD of at least 11 mm. In the whole study population, LLD of 6 mm or more was associated with higher intensity of LBP and number of days with LBP. In the stratified analysis, both intensity of LBP and number of days of LBP were associated with LLD among meat cutters but not among customer service workers. The sick leaves during past year were slightly longer among those with LLD 10 mm or more, but the differences were not statistically significant. Conclusions LLD, measured with a laser range meter, was associated with intensity of LBP and self-reported days with LBP during the past year among meat cutters engaged in standing work. Trial registration ISRCTN11898558 - The role of leg length discrepancy in low back pain.
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Affiliation(s)
- Satu Rannisto
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland. .,Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. .,Finnish Institute of Occupational Heath, Health and Work Ability, Tampere, Finland.
| | - Annaleena Okuloff
- Finnish Institute of Occupational Heath, Health and Work Ability, Tampere, Finland. .,Finnish Social Science Data Archive, University of Tampere, Tampere, Finland.
| | - Jukka Uitti
- Finnish Institute of Occupational Heath, Health and Work Ability, Tampere, Finland. .,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland. .,School of Health Sciences, University of Tampere, Tampere, Finland.
| | - Markus Paananen
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland. .,Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | | | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
| | - Jaro Karppinen
- Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland. .,Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. .,Finnish Institute of Occupational Heath, Health and Work Ability, Oulu, Finland.
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A New Approach to the Measurement of Pelvic Asymmetry: Proposed Methods and Reliability. J Manipulative Physiol Ther 2015; 38:295-301. [DOI: 10.1016/j.jmpt.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/15/2015] [Accepted: 02/08/2015] [Indexed: 11/22/2022]
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Cooperstein R, Haneline M, Young M. The location of the inferior angle of the scapula in relation to the spine in the upright position: a systematic review of the literature and meta-analysis. Chiropr Man Therap 2015; 23:7. [PMID: 25729566 PMCID: PMC4343265 DOI: 10.1186/s12998-014-0050-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/26/2014] [Indexed: 11/12/2022] Open
Abstract
Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a meta-analysis of the pooled data from retrieved studies to increase their statistical power. Electronic searching retrieved primary studies relating the IAS to a spinal level, as determined by an imaging reference standard, using combinations of these search terms: scapula, location, landmark, spinous process, thoracic vertebrae, vertebral level, palpation, and spine. Only primary studies were included; review articles and reliability studies related to scapular position but lacking spinal correlations were excluded. Eight-hundred and eighty (880) articles of interest were identified, 43 abstracts were read, 22 full text articles were inspected, and 5 survived the final cut. Each article (with one exception) was rated for quality using the QUADAS instrument. Pooling data from 5 studies resulted in normal distribution in which the upright IAS on average aligns closely with the T8 SP, range T4-T11. Since on average the IAS most closely identifies the T8 SP in the upright position, it is very likely that health professionals, both manual therapists and others, who have been diagnosing and treating patients based on the IAS = T7 SP rule (the conventional wisdom), have not been as segmentally accurate as they may have supposed. They either addressed non-intended levels, or made numeration errors in their charting. There is evidence that using the IAS is less preferred than using the vertebra prominens, and may be less preferred than using the iliac crest for identifying spinal levels Manual therapists, acupuncturists, anesthesiologists, nurses, and surgeons should reconsider their procedures for identifying spinal sites in light of this modified information. Inaccurate landmark benchmark rules will add to patient variation and examiner errors in producing spine care targeting errors, and confound research on the importance of specificity in treating spinal levels.
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Affiliation(s)
- Robert Cooperstein
- Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 USA
| | - Michael Haneline
- University of Western States, 2900 NE 132nd Avenue, Portland, OR 97230 USA
| | - Morgan Young
- Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 USA
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Kendall JC, Bird AR, Azari MF. Foot posture, leg length discrepancy and low back pain--their relationship and clinical management using foot orthoses--an overview. Foot (Edinb) 2014; 24:75-80. [PMID: 24703513 DOI: 10.1016/j.foot.2014.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 02/04/2023]
Abstract
Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.
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Affiliation(s)
- Julie C Kendall
- Discipline of Chiropractic, School of Health Sciences, RMIT University, Melbourne, Australia
| | - Adam R Bird
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Michael F Azari
- Discipline of Chiropractic, School of Health Sciences, RMIT University, Melbourne, Australia; Health Innovations Research Institute, RMIT University, Melbourne, Australia.
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20
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Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. ACTA ACUST UNITED AC 2011; 16:646-8. [DOI: 10.1016/j.math.2011.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
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Cooperstein R. Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions. J Chiropr Med 2011; 9:146-53. [PMID: 22027038 DOI: 10.1016/j.jcm.2010.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/25/2010] [Accepted: 06/16/2010] [Indexed: 11/15/2022] Open
Abstract
Several primary studies have shown that an anatomical short leg predicts anterior rotation of the ipsilateral ilium, whereas anatomical long leg predicts posterior rotation of the ilium on the long leg side. At the same time, in chiropractic and other manual therapy professions, it is widely believed that the leg check finding of a short leg is associated with posterior ilium rotation, and a long leg with anterior ilium rotation. The purpose of this commentary is to explore the consequences of this paradox for the manual therapy professions, insofar as leg checking procedures are commonly used to derive appropriate vectors for chiropractic manipulation/adjustive procedures.
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Affiliation(s)
- Robert Cooperstein
- Professor, Director of Technique, Director of Research, Palmer Chiropractic College West, San Jose, CA 95134
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22
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Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. J Bodyw Mov Ther 2011; 15:131-8. [DOI: 10.1016/j.jbmt.2011.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Fryer G, Johnson JC, Fossum C. The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 1: Assessment. INT J OSTEOPATH MED 2010. [DOI: 10.1016/j.ijosm.2010.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Al-Sayegh NA, George SE, Boninger ML, Rogers JC, Whitney SL, Delitto A. Spinal Mobilization of Postpartum Low Back and Pelvic Girdle Pain: An Evidence-Based Clinical Rule for Predicting Responders and Nonresponders. PM R 2010; 2:995-1005. [DOI: 10.1016/j.pmrj.2010.07.481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/26/2010] [Accepted: 07/10/2010] [Indexed: 11/26/2022]
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Stovall BA, Bae S, Kumar S. Anterior superior iliac spine asymmetry assessment on a novel pelvic model: an investigation of accuracy and reliability. J Manipulative Physiol Ther 2010; 33:378-85. [PMID: 20605557 DOI: 10.1016/j.jmpt.2010.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/27/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a novel pelvic model and determine the accuracy and the inter- and intraexaminer reliability of anterior superior iliac spine (ASIS) positional asymmetry assessment from both sides of the model by osteopathic predoctoral fellows and osteopathic physicians and to evaluate the effect of training. METHODS Five osteopathic predoctoral fellows and 5 osteopathic physicians assessed 13 settings of varied ASIS asymmetry of a novel pelvic model for superior/inferior positional asymmetry from both sides of the model in a random order. Assessment from the right and left sides of the model occurred on 2 separate days. Fellows were trained for a week and retested. RESULTS Average interexaminer reliability was greatest from the left side of the model for physicians and from the right side for fellows (physicians: kappa = 0.46, fellows: kappa = 0.37), whereas intraexaminer reliability was greatest from the right in both groups (physicians: kappa = 0.49, fellows: kappa = 0.52). Following training of fellows, interexaminer reliability remained highest from the right side of the model (right: kappa = 0.48, left: kappa = 0.36), whereas intraexaminer reliability was higher from the left side (right: kappa = 0.53, left: kappa = 0.59). Physicians and fellows before training were more accurate from the right side of the model (kappa = 0.56 and kappa = 0.52, respectively). Following training of fellows, accuracy increased from both sides of the model (right: kappa = 0.59, left: kappa = 0.53). CONCLUSIONS A novel pelvic model was developed to allow assessment of accuracy and reliability of ASIS asymmetry assessment. Individually, physicians and fellows varied in accuracy and inter-/intraexaminer reliability. Further investigation is warranted to understand the clinical and educational application of these results.
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Affiliation(s)
- Bradley A Stovall
- Department of Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX 76107, USA
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The myth of core stability. J Bodyw Mov Ther 2010; 14:84-98. [PMID: 20006294 DOI: 10.1016/j.jbmt.2009.08.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 05/03/2009] [Accepted: 08/04/2009] [Indexed: 01/13/2023]
Abstract
The principle of core stability has gained wide acceptance in training for the prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal conditions in particular of the lower back. There has been surprisingly little criticism of this approach up to date. This article re-examines the original findings and the principles of core stability/spinal stabilisation approaches and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury.
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Stovall BA, Kumar S. Anatomical Landmark Asymmetry Assessment in the Lumbar Spine and Pelvis: A Review of Reliability. PM R 2010; 2:48-56. [DOI: 10.1016/j.pmrj.2009.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 11/01/2009] [Accepted: 11/02/2009] [Indexed: 02/08/2023]
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The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med 2009; 8:107-18. [PMID: 19703666 DOI: 10.1016/j.jcm.2009.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 06/10/2009] [Accepted: 06/11/2009] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Although it is common to find assertions relating functional leg length inequality (LLI) to pelvic torsion and other states of subluxation, comments and/or data concerning anatomical LLI in this same context are uncommon. This review of the literature synthesizes the evidence on pelvic torsion in relation to anatomical LLI. METHODS The literature was searched using the PubMed; Manual, Alternative, and Natural Therapy Index System; Allied and Complementary Medicine Database; Cumulative Index to Nursing and Allied Health Literature; and Index to Chiropractic Literature databases for primary studies that related LLI, either artificially created or naturally occurring, to pelvic torsion. Extracted data included natural vs artificial LLI, method of creating or detecting LLI, subject selection, methodology for measuring pelvic torsion, and results. RESULTS Nine English-language studies were retrieved published 1936-2004. Seven determined the impact of artificial, transient LLI on pelvic torsion, whereas 2 studied the effect of naturally occurring LLI. CONCLUSION Across varying methodologies for measuring LLI and pelvic torsion, a consistent, dose-related pattern was identified in which the innominate rotates anteriorly on the side of a shorter leg and posteriorly on the side of the longer leg. This finding was contrary to the common assertion that the ilium rotates posteriorly on the side of a short leg and vice versa. Practitioners of manual medicine who derive vectors for intervention based on leg checking procedures should consider the possibility that the direction of pelvic torsion may be variable depending on whether the LLI is of anatomical or functional origin.
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Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009; 82:797-806. [DOI: 10.1007/s00420-009-0410-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Accepted: 02/22/2009] [Indexed: 10/21/2022]
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Abstract
BACKGROUND AND PURPOSE This case report describes the examination, evaluation, and intervention by a physical therapist for a female collegiate tennis player with a right ilial anterior rotation hypermobility. CASE DESCRIPTION The patient was a 21-year-old, female collegiate tennis player who developed a right anterior ilial rotation hypermobility as a result of her tennis stroke. Functional limitations were related to sitting, squatting, gait, and playing tennis. Treatment interventions consisted of massage, joint manipulation, stretching, stabilization exercises, sport-specific exercises and modification of tennis stroke, proprioceptive taping, and the use of a sacroiliac belt. OUTCOMES After 26 weeks (33 treatments), tissue tenderness of the sacroiliac joint region was normalized, pelvic/trunk and lower-extremity mobility and flexibility were restored, sacroiliac symmetry and stability were regained, and the patient achieved her goal of returning to competitive tennis at the collegiate level. DISCUSSION The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies.
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Hazle CR, Nitz AJ. Evidence-based assessment and diagnosis of pelvic girdle disorders: a proposal for an alternate diagnostic category. PHYSICAL THERAPY REVIEWS 2008. [DOI: 10.1179/174328808x251975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Golightly YM, Tate JJ, Burns CB, Gross MT. Changes in pain and disability secondary to shoe lift intervention in subjects with limb length inequality and chronic low back pain: a preliminary report. J Orthop Sports Phys Ther 2007; 37:380-8. [PMID: 17710907 DOI: 10.2519/jospt.2007.2429] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Preassessment and postassessment of treatment intervention. OBJECTIVE To determine the changes in pain and disability secondary to shoe lift intervention for subjects with chronic low back pain (LBP) who have a limb length inequality (LLI). BACKGROUND Previous reports have suggested that LLI may be a cause of LBP Most prior studies of lift therapy for management of LLI in patients with LBP have lacked clear guidelines for clinicians regarding the implementation of shoe lift intervention. METHODS AND MEASURES Twelve subjects (6 male, 6 female) between the ages of 19 and 62 years with LLI (6.4-22.2 mm) and chronic LBP (1-30 years) participated. Visual analog scale pain ratings and disability questionnaire scores were acquired before and after lift intervention. Subjects determined their lift height based on resolution of LBP symptoms. RESULTS Subjects experienced relief of general pain symptoms (P = .0006) and pain associated with standing (P= .002) following lift intervention, with minimally clinically important (MCID) reductions in general pain for 9 of 12 subjects and MCID reductions in standing pain for 8 of 10 subjects. Subjects also had less disability on the disability questionnaire (P = .001) following the intervention, with 9 of 12 subjects experiencing MCID reductions in disability. CONCLUSION Shoe lifts may reduce LBP and improve function for patients who have chronic LBP and an LLI. Randomized controlled trials are needed to assess the efficacy of this intervention.
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Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil 2006; 85:997-1006. [PMID: 17117004 DOI: 10.1097/01.phm.0000247633.68694.c1] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The sacroiliac joint is an underappreciated cause of low back and buttock pain. It is thought to cause at least 15% of low back pain. It is more common in the presence of trauma, pregnancy, or in certain athletes. The pelvic anatomy is complex, with the joint space being variable and irregular. The joint transmits vertical forces from the spine to the lower extremities and has a role in lumbopelvic dynamic motion. History and physical examination findings can be helpful in screening for sacroiliac joint pain, but individual provocative maneuvers have unproven validity. Fluoroscopically guided injections into the joint have been found to be helpful for diagnostic and therapeutic purposes. Conservative treatment, which also can include joint mobilization, antiinflammatory medicines, and sacroiliac joint belts, generally is effective. Surgical arthrodesis should be considered a procedure of last resort.
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Affiliation(s)
- Brian S Foley
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Timgren J, Soinila S. Reversible Pelvic Asymmetry: An Overlooked Syndrome Manifesting as Scoliosis, Apparent Leg-Length Difference, and Neurologic Symptoms. J Manipulative Physiol Ther 2006; 29:561-5. [PMID: 16949945 DOI: 10.1016/j.jmpt.2006.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 02/28/2006] [Accepted: 04/26/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the occurrence of pelvic asymmetry in neurologic patients with symptoms not explained by their neurologic diagnosis. METHODS We analyzed 150 consecutive neurologic patients referred to physiatric consultation based on their clinical examination findings. RESULTS We observed pelvic asymmetry associated with either C-type or S-type scoliosis and apparent leg-length difference in 87% of the patients. Symmetry could be reestablished by all patients, although 15% showed immediate or imminent relapse. Maintenance of symmetry showed a highly significant (P < .001) correlation with improvement in functional ability and reduction of pain as evaluated during the last visit to the physiatrist. In the follow-up questionnaire, 78% of the patients reported improvement in functional ability and reduced pain. CONCLUSIONS Our results support the view that leg-length difference and scoliosis may be more often of reversible nature than previously considered. Acquired postural asymmetry of the sacroiliac joint may be a neglected cause of several neurologic and other pain-related symptoms that can be relieved by a simple and safe treatment.
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Affiliation(s)
- Jussi Timgren
- Unit of Physiatry, Helsinki University Central Hospital, Helsinki, Finland
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Fryer G. Factors affecting the intra-examiner and inter-examiner reliability of palpation for supine medial malleoli asymmetry. INT J OSTEOPATH MED 2006. [DOI: 10.1016/j.ijosm.2005.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fryer G, McPherson HC, O'Keefe P. The effect of training on the inter-examiner and intra-examiner reliability of the seated flexion test and assessment of pelvic anatomical landmarks with palpation. INT J OSTEOPATH MED 2005. [DOI: 10.1016/j.ijosm.2005.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. CHIROPRACTIC & OSTEOPATHY 2005; 13:11. [PMID: 16026625 PMCID: PMC1232860 DOI: 10.1186/1746-1340-13-11] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 07/20/2005] [Indexed: 05/03/2023]
Abstract
BACKGROUND Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. METHODS Online database--Medline, CINAHL and MANTIS--and library searches for the time frame of 1970-2005 were done using the term "leg-length inequality". RESULTS AND DISCUSSION Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches approximately 20 mm (approximately 3/4"). CONCLUSION Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.
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Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms--a systematic review. ACTA ACUST UNITED AC 2004; 9:134-43. [PMID: 15245707 DOI: 10.1016/j.math.2004.03.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2003] [Revised: 12/03/2003] [Accepted: 03/04/2004] [Indexed: 11/28/2022]
Abstract
The centralization phenomenon was first described 20 years ago. It refers to the abolition of distal pain emanating from the spine in response to therapeutic exercises. Since then a number of papers on the subject have been published. A review of current knowledge is appropriate. Selection criteria were established prior to a computer-aided search for published papers. Two reviewers independently extracted data and checked quality; a third reviewer resolved any disagreements. A narrative review was conducted based on the findings. The review primarily considered prevalence, reliability of assessment, and prognostic significance. These have been most commonly reported, and are important to establish the clinical worth of this symptom response. Fourteen studies were identified. Quality of studies varied; prognostic studies were given a mean score of 3.3 out of 6 by using established quality criteria. The prevalence rate of pure or partial centralization was 70% in 731 sub-acute back patients, and 52% in 325 chronic back patients. It is a symptom response that can be reliably assessed during examination (kappa values 0.51-1.0). Centralization was consistently associated with a range of good outcomes, and failure to centralize with a poor outcome. Centralization appears to identify a substantial sub-group of spinal patients; it is a clinical phenomenon that can be reliably detected, and is associated with a good prognosis. Centralization should be monitored in the examination of spinal patients.
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Badii M, Shin S, Torreggiani WC, Jankovic B, Gustafson P, Munk PL, Esdaile JM. Pelvic bone asymmetry in 323 study participants receiving abdominal CT scans. Spine (Phila Pa 1976) 2003; 28:1335-9. [PMID: 12811280 DOI: 10.1097/01.brs.0000065480.44620.c5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of all CT scans of pelvis and abdomen performed at our institution in October and November 2000. OBJECTIVE To determine the prevalence and extent of radiographic pelvic asymmetry in a population of patients not preselected for having low back pain. SUMMARY OF BACKGROUND DATA Pelvic asymmetry refers to asymmetric positioning of landmarks on the two sides of the pelvis and may have a structural or functional etiology. Pelvic asymmetry can be associated with the presence of true leg length discrepancy, lead to false diagnosis or inaccurate measurement of leg length discrepancy, or itself be independently associated with back pain. Although the prevalence of pelvic asymmetry has been reported in patients with back pain to be 24-91%, its prevalence in the general population is not known. METHODS A total of 323 consecutive CT scans of the pelvis/abdomen were assessed for pelvic asymmetry by one of three examiners. Pelvic asymmetry was defined as an unequal distance from the iliac crests to the acetabuli bilaterally, measured on the anteroposterior scout view of the CT scan. Measurements made on 30 randomly selected scans by the three examiners were used to assess interrater reliability of the measurement method. RESULTS Pelvic asymmetry ranged in magnitude from -11 mm to 7 mm [right pelvis (mm) - left pelvis (mm)]. Pelvic asymmetry was >5 mm in 17 of 323 (5.3%) and >10 mm in 2 of 323 (0.6%) of the subjects; 172 of 323 (53.3%) had a smaller right hemipelvis (mean asymmetry = -3.0 mm). A total of 95 of 323 (29.4%) had a smaller left hemipelvis (mean asymmetry = 2.1 mm). The intraclass correlation coefficient [ICC(2,1)] between the three observers was high (0.91). CONCLUSION Pelvic asymmetry of >5 mm was uncommon, with a prevalence of approximately 5% in the population studied. CT scanography was found to be a practical and reliable method for the assessment of suspected pelvic asymmetry.
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Affiliation(s)
- Maziar Badii
- Division of Rheumatology, Faculty of Medicine, Department of Health Care and Epidemiology, Vancouver General Hospital, British Columbia, Canada.
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Resnik L, Dobrzykowski E. Guide to outcomes measurement for patients with low back pain syndromes. J Orthop Sports Phys Ther 2003; 33:307-16; discussion 317-8. [PMID: 12839205 DOI: 10.2519/jospt.2003.33.6.307] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Guide for Physical Therapist Practice states that the physical therapist determines the expected outcomes for each intervention and engages in outcomes data collection and analysis. Outcomes tracking provides a systematic way for therapists to monitor treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is indispensable for therapists in the outpatient orthopaedic setting, where patients with lumbar pain often comprise the majority of the caseload. The therapist must be able to evaluate and choose appropriate measurement tools and understand the clinical meaning of measurements to successfully employ these instruments. The purpose of this article is to review measurement instruments for patients with low back pain and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided with specific commentary on the use of the SF-36, SF-12, Oswestry Questionnaire, Roland-Morris Questionnaire, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.
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Affiliation(s)
- Linda Resnik
- Center for Gerontology and Health Care Research, Brown University, Providence, RI 02906, USA.
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Childs JD, Fritz JM, Piva SR, Erhard RE. Clinical decision making in the identification of patients likely to benefit from spinal manipulation: a traditional versus an evidence-based approach. J Orthop Sports Phys Ther 2003; 33:259-72. [PMID: 12775000 DOI: 10.2519/jospt.2003.33.5.259] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- John D Childs
- US Air Force, Wilford Hall Medical Center, Lackland AFB, TX, USA.
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Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber M, Allison S. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine (Phila Pa 1976) 2002; 27:2835-43. [PMID: 12486357 DOI: 10.1097/00007632-200212150-00021] [Citation(s) in RCA: 420] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, cohort study of patients with nonradicular low back pain referred to physical therapy. OBJECTIVE Develop a clinical prediction rule for identifying patients with low back pain who improve with spinal manipulation. SUMMARY OF BACKGROUND DATA Development of clinical prediction rules for classifying patients with low back pain who are likely to respond to a particular intervention, such as manipulation, would improve clinical decision-making and research. METHODS Patients with nonradicular low back pain underwent a standardized examination and then underwent a standardized spinal manipulation treatment program. Success with treatment was determined using percent change in disability scores over three sessions and served as the reference standard for determining the accuracy of examination variables. Examination variables were first analyzed for univariate accuracy in predicting success and then combined into a multivariate clinical prediction rule. RESULTS Seventy-one patients participated. Thirty-two had success with the manipulation intervention. A clinical prediction rule with five variables (symptom duration, fear-avoidance beliefs, lumbar hypomobility, hip internal rotation range of motion, and no symptoms distal to the knee) was identified. The presence of four of five of these variables (positive likelihood ratio = 24.38) increased the probability of success with manipulation from 45% to 95%. CONCLUSION It appears that patients with low back pain likely to respond to manipulation can be accurately identified before treatment.
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Affiliation(s)
- Timothy Flynn
- U.S. Army-Baylor University Graduate Program in Physical Therapy, San Antonio, Texas, USA.
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Cibulka MT, Aslin K. How to use evidence-based practice to distinguish between three different patients with low back pain. J Orthop Sports Phys Ther 2001; 31:678-88; discussion 689-95. [PMID: 11767244 DOI: 10.2519/jospt.2001.31.12.678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M T Cibulka
- Jefferson County Rehabilitation and Sports Clinic, Crystal City, MO, USA.
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