Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

BACKGROUND

The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm.

OBJECTIVE

Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain.

METHODS

Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria.

RESULTS

Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001).

CONCLUSIONS

The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

Diaphragm and core stabilization exercises in low back pain: A narrative review

INTRODUCTION

Core stabilization is a vital concept in clinical rehabilitation (including low back pain rehabilitation) and competitive athletic training. The core comprises of a complex network of hip, trunk and neck muscles including the diaphragm.

AIMS

The paper aims to discuss the role of the diaphragm in core stability, summarize current evidence and put forth ideal core training strategies involving the diaphragm.

METHOD

Narrative review RESULTS: The diaphragm has a dual role of respiration and postural control. Evidence suggests that current core stability exercises for low back pain are superior than minimal or no treatment, however, no more beneficial than general exercises and/or manual therapy. There appears to be a higher focus on the transversus abdominis and multifidi muscles and minimal attention to the diaphragm. We propose that any form of core stabilization exercises for low back pain rehabilitation should consider the diaphragm. Core stabilization program could commence with facilitation of normal breathing patterns and progressive systematic restoration of the postural control role of the diaphragm muscle.

CONCLUSION

The role of the diaphragm is often overlooked in both research and practice. Attention to the diaphragm may improve the effectiveness of core stability exercise in low back pain rehabilitation.

Association of patellofemoral pain syndrome (PFPS) with quadratus lumborum and lower limb muscle tightness a cross-sectional study

Background

Patellofemoral pain syndrome (PFPS) is characterized by peripatellar or retro patellar pain, as a result of changes in the physical and biochemical components of the patellofemoral joint. The main contributory factor is being the excessive load on the patellofemoral joint. The change in the flexibility of lower limb muscles is one of the factors for developing PFPS.

Objective

To find the association of quadratus lumborum (QL) and lower limb muscles tightness in patients with unilateral PFPS.

Materials and methods

50 PFPS participants (21 male and 29 female) were included and assessed for muscle tightness on both affected and unaffected side. The QL, rectus femoris, hamstring, iliotibial band (ITB) and gastrocnemius tightness were measured using inch tape and mobile inclinometer. A Chi Square test and phi crammer's v criteria were used to check the association and the strength of it.

Results

A significant association was found between tightness of rectus femoris (PFPS-right Chi 19.99 p < 0.001; Phi-0.632, PFPS-left Chi-5.52 p = 0.019 and Phi- 0.332), gastrocnemius (PFPS-right Chi 8.78 p = 0.003; Phi-0.419, PFPS-left Chi- 11.41 p = 0.001; Phi- 0.478), iliotibial band (PFPS-right Chi 7.83 p = 0.005; Phi-0.396, PFPS left Chi-3.68 p = 0.055; Phi- 0.27). There was no significant association of hamstring tightness (PFPS-right Chi - 3.68 p = 0.055; Phi-0.055, PFPS left Chi-1.11 p = 0.291; Phi- 0.019) and QL (PFPS right Chi - 1.10 p = 0.293; Phi-0.293, PFPS left Chi-0.79 p = 0.372; Phi- 0.372).

Conclusion

PFPS was associated with tightness of rectus femoris, gastrocnemius, ITB and no association found between hamstring and QL muscle tightness and PFPS.

Normative values for the functional movement screentm in adolescent school aged children

BACKGROUND

International sports programs have established pre-participation athletic screening procedures as an essential component to identify athletes that are at a high risk of becoming injured. The Functional Movement Screen (FMS™) is a screening instrument intended to evaluate deficiencies in the mobility and stability of an athlete that might be linked to injury. To date, there are no published normative values for the FMS™ in adolescent school aged children. The purpose of this study was to establish normative values for the FMS™ in adolescent school aged children (10 to 17 years). Secondary aims were to investigate whether the performance differed between boys and girls and between those with or without previous history of injury.

METHODS

1005 adolescent school students, including both males and females between the ages of 10 and 17 years who fulfilled the inclusion and exclusion criteria, were selected for the study. The test administration procedures, instructions and scoring process associated with the standardized version of the test were followed in order to ensure accuracy in scoring. The components of the FMS™ include the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotary stability.

RESULTS

The mean composite FMS™ score was 14.59 (CI 14.43 - 14.74) out of a possible total of 21. There was a statistically significant difference in scores between females and males (p= .000). But no statistically significant difference in scores existed between those who reported a previous injury and those who did not report previous injury (p=.300). The variables like age (r= -.038, p=.225), height(r= .065, p= .040), weight (r=.103, p=.001) did not show a strong correlations with the mean composite score.

CONCLUSION

This study provides normative values for the FMS™ in adolescent school aged children, which could assist in evaluation of functional mobility and stability in this population.

LEVEL OF EVIDENCE

2c.