[Show abstract][Hide abstract] ABSTRACT: Study Design Cross-sectional, laboratory study. Objectives To compare peak lower limb, pelvis, and trunk kinematics and inter-joint and inter-segmental coordination in women with strong and weak hip muscle performance. Background Persons with lower extremity musculoskeletal disorders often demonstrate a combination of weak hip musculature and altered kinematics during weight bearing dynamic tasks. However, the association between hip strength and kinematics independent of pathology or pain is unclear. Methods Peak hip extensor and abductor torque were measured in 150 healthy young women. Of these, 10 fit the criteria for the strong group and 9 for the weak group. Kinematics of the hip, knee, pelvis, and trunk were measured during the stance phases of walking and rate-controlled hopping. Hip/knee and pelvis/trunk coordination were calculated using the vector coding technique. Results There were no group differences in peak hip, knee, or pelvis kinematics. Weak participants demonstrated greater trunk lateral bend towards the stance limb during hopping (P = .002, effect size d = 1.88). In the transverse plane, the weak group utilized less in-phase coordination between the hip and the knee during walking (P = .036, d = 1.45) and more anti-phase coordination between the hip and knee during hopping (P = .03, d = 1.47). Conclusion In the absence of pain or pathology, poor hip muscle performance does not affect peak hip or knee joint kinematics in young women, but is associated with significantly different lower limb and trunk/pelvis coordination during weight bearing dynamic tasks. J Orthop Sports Phys Ther, Epub 10 May 2014. doi:10.2519/jospt.2014.5028.
The Journal of orthopaedic and sports physical therapy. 05/2014;
[Show abstract][Hide abstract] ABSTRACT: Objective:The purpose of the study was to examine changes in quality of life measures in patients who have undergone an intensive exercise program following a single level microdiskectomy.Design:Randomized controlled trial with blinded examiners.Setting:The study was conducted in outpatient physical therapy clinics.Subjects:Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy allocated to receive exercise and education or education only.Interventions:A 12-week periodized exercise program of lumbar extensor strength and endurance training, and mat and upright therapeutic exercises was administered.Outcome measures:Quality of life was tested with the Short Form 36 (SF-36). Measurements were taken 4-6 weeks postsurgery and following completion of the 12-week intervention program. Since some participants selected physical therapy apart from the study, analyses were performed for both an as-randomized (two-group) design and an as-treated (three-group) design.Results:In the two-group analyses, exercise and education resulted in a greater increase in SF-36 scales, role physical (17.8 vs. 12.1) and bodily pain (13.4 vs. 8.4), and the physical component summary (13.2 vs. 8.9). In the three-group analyses, post-hoc comparisons showed exercise and education resulted in a greater increase in the SF-36 scales, physical function (10.4 vs. 5.6) and bodily pain (13.7 vs. 8.2), and the physical component summary (13.7 vs. 8.9) when compared with usual physical therapy.Conclusions:An intensive, progressive exercise program combined with education increases quality of life in patients who have recently undergone lumbar microdiskectomy.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND CONTEXT: Intervertebral disc and facet joints are the two primary load-bearing structures of the lumbar spine, and altered loading to these structures may be associated with frontal plane spinal deviations. PURPOSE: To determine the load on the lumbar facet joint and intervertebral disc under simulated frontal plane pelvic obliquity combined loading, an in vitro biomechanical study was conducted. STUDY DESIGN/SETTING: An in vitro biomechanical study using a repeated-measures design was used to compare L4-L5 facet joint and intervertebral disc loading across pure moment and combined loading conditions. METHODS: Eight fresh-frozen lumbosacral specimens were tested under five loading conditions: flexion/extension, lateral bending, axial rotation using pure moment bending (±10 Nm), and two additional tests investigating frontal plane pelvic obliquity and axial rotation (sacrum tilted left 5° and at 10° followed by a ±10-Nm rotation moment). Three-dimensional kinematics, facet load, and intradiscal pressures were recorded from the L4-L5 functional spinal unit. RESULTS: Sagittal and frontal plane loading resulted in significantly smaller facet joint forces compared with conditions implementing a rotation moment (p<.05). The facet joint had the highest peak load during the 10° combined loading condition (124.0±30.2 N) and the lowest peak load in flexion (26.8±16.1 N). Intradiscal pressure was high in lateral flexion (495.6±280.9 kPa) and flexion (429.0±212.9 kPa), whereas intradiscal pressures measured in rotation (253.2±135.0 kPa) and 5° and 10° combined loading conditions were low (255.5±132.7 and 267.1±127.1 kPa, respectively). CONCLUSIONS: Facet loading increased during simulated pelvic obliquity in frontal and transverse planes, whereas intradiscal pressures were decreased compared with sagittal and frontal plane motions alone. Altered spinopelvic alignment may increase the loads experienced by spinal tissue, especially the facet joints.
The spine journal: official journal of the North American Spine Society 05/2013; · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we investigated trunk coordination during rate-controlled bipedal vertical dance jumps. The aims of the study were to investigate the pattern of coordination and the magnitude of coordination variability within jump phases and relative to phase-defining events during the jump. Lumbar and thoracic kinematics were collected from seven dancers during a series of jumps at 95 beats per minute. The vector coding technique was used to quantify the pattern and variability of trunk coordination. Coordination was predominantly anti-phase during propulsion and landing. Mean coordination variability peaked just before the landing phase and at the transition from landing to propulsion phases, and was lowest during the propulsion phase just before toe-off. The results indicate that peaks in variability could be explained by task and phase-specific biomechanical demands.
Journal of Sports Sciences 11/2011; 30(2):139-47. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low back pain affects a substantial number of adults each year and is persistent or recurrent for many. Self-efficacy is an important predictor of functional recovery.
The purpose of this investigation was to assess the preliminary reliability and validity of the Low Back Activity Confidence Scale (LoBACS) for individuals with histories of low back pain or lumbar surgery.
Two overlapping samples of patients who had undergone a microdiskectomy participated: a test-retest sample of 21 individuals and a validity sample of 53 individuals.
Low Back Activity Confidence Scale items pertaining to self-efficacy for functional activities (FnSE subscale), self-regulation of back health (Self-RegSE subscale), and regular exercise (ExSE subscale) were generated from existing literature and clinical observations. The test-retest sample completed the LoBACS twice, approximately 10 days apart. The validity sample completed the LoBACS and measures of functional performance, self-reported leisure and occupational physical activity, pain, fear beliefs, disability, and quality of life.
The FnSE, Self-RegSE, and ExSE subscale scores and LoBACS total score had excellent to acceptable test-retest reliability (intraclass correlation coefficients of .924, .634, .710, and .850, respectively) and internal consistency (Cronbach α coefficients of .924, .804, .941, and .911, respectively). The LoBACS subscales were correlated in expected directions with physical performance, physical activity, pain, fear beliefs, disability, and quality of life, providing initial evidence of concurrent validity.
The findings provide preliminary content and concurrent validity and interrater and internal consistency reliability for the LoBACS measure of self-efficacy for individuals with histories of low back pain and lumbar microdiskectomy.
[Show abstract][Hide abstract] ABSTRACT: Hip muscle weakness has been associated with altered lower extremity mechanics and the increased likelihood of receiving treatment for low back problems, although biomechanical injury mechanisms focused on the trunk have not been investigated. The purpose of this study was to compare lumbopelvic kinematic variables and muscle activation of the trunk and gluteal muscles in females with strong and weak hip muscle strength during a demanding single-leg task.
Twenty-two asymptomatic females were categorized into a strong or weak group (11 per group) as determined by isometric hip extension and abduction dynamometry profiles. Participants performed a single-leg landing task during which three-dimensional lumbopelvic kinematics and trunk (lumbar erector spinae, external obliques, and rectus abdominis) and gluteal (gluteus maximus and gluteus medius) muscle activities were recorded. Peak lumbopelvic angular displacement, total angular excursion, and mean and peak angular velocity during the first 0.5 s of landing were reported. Mean normalized EMG and muscle cocontraction index (between the lumbar erector spinae and the external obliques) were also reported.
Significant between-group differences existed for each of the following: peak displacement, excursion, velocity, and muscle activity. Differences in peak angular displacement occurred in the frontal plane, whereas excursion differences were observed in all planes. Differences in peak velocity were noted in the sagittal and frontal planes. Weaker subjects showed increased muscle activation (across all muscles except the rectus abdominis) and cocontraction index.
Individuals with diminished hip muscle strength exhibit greater lumbopelvic angular displacement, velocity, and muscle activity during the single-leg landing task. Future studies targeting hip strengthening may provide more insight to rehabilitation protocols as well as the relation between hip strength, low back motion, and muscle activity.
Medicine and science in sports and exercise 06/2011; 44(1):146-53. · 4.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A new sensor array intended to accurately and directly measure spatial and time-dependent pressures within a highly curved biological intra-articular joint was developed and tested. To evaluate performance of the new sensor array for application within intra-articular joints generally, and specifically to fit within the relatively restrictive space of the lumbar spine facet joint, geometric constraints of length, width, thickness and sensor spatial resolution were evaluated. Additionally, the effects of sensor array curvature, frequency response, linearity, drift, hysteresis, repeatability, and total system cost were assessed. The new sensor array was approximately 0.6mm in thickness, scalable to below the nominal 12 mm wide by 15 high lumbar spine facet joint size, offered no inherent limitations on the number or spacing of the sensors with less than 1.7% cross talk with sensor immediately adjacent to one another. No difference was observed in sensor performance down to a radius of curvature of 7 mm and a 0.66±0.97% change in sensor sensitivity was observed at a radius of 5.5mm. The sensor array had less than 0.07 dB signal loss up to 5.5 Hz, linearity was 0.58±0.13% full scale (FS), drift was less than 0.2% FS at 250 s and less than 0.6% FS at 700 s, hysteresis was 0.78±0.18%. Repeatability was excellent with a coefficient of variation less than 2% at pressures between 0 and 1.000 MPa. Total system cost was relatively small as standard commercially available data acquisition systems could be utilized, with no specialized software, and individual sensors within an array can be replaced as needed. The new sensor array had small and scalable geometry and very acceptable intrinsic performance including minimal to no alteration in performance at physiologically relevant ranges of joint curvature.
Medical Engineering & Physics 04/2011; 33(8):950-6. · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Controlled laboratory study using a cross-sectional design.
To analyze lower extremity kinematics during takeoff of a "saut de chat" (leap) in dancers with and without a history of Achilles tendinopathy (AT). We hypothesized that dancers with AT would demonstrate different kinematic strategies compared to dancers without pathology, and that these differences would be prominent in the transverse and frontal planes.
AT is a common injury experienced by dancers. Dance leaps such as the saut de chat place a large demand on the Achilles tendon.
Sixteen female dancers with and without a history of AT (mean ± SD age, 18.8 ± 1.2 years) participated. Three-dimensional kinematics at the hip, knee, and ankle were quantified for the takeoff of the saut de chat, using a motion analysis system. A force platform was used to determine braking and push-off phases of takeoff. Peak sagittal, frontal, and transverse plane joint positions during the braking and push-off phases of the takeoff were examined statistically. Independent samples t tests were used to evaluate group differences (α = .05).
The dancers in the tendinopathy group demonstrated significantly higher peak hip adduction during the braking phase of takeoff (mean ± SD, 13.5° ± 6.1° versus 7.7° ± 4.2°; P = .046). During the push-off phase, dancers with AT demonstrated significantly more internal rotation at the knee (13.2° ± 5.2° versus 6.9° ± 4.9°; P = .024).
Dancers with AT demonstrate increased peak transverse and frontal plane kinematics when performing the takeoff of a saut de chat. These larger displacements may be either causative or compensatory factors in the development of AT.
The Journal of orthopaedic and sports physical therapy. 01/2011; 41(8):606-13.
[Show abstract][Hide abstract] ABSTRACT: Controlled laboratory study using a cross-sectional design.
To characterize ankle and hip muscle performance in women with posterior tibial tendon dysfunction (PTTD) and compare them to matched controls. We hypothesized that ankle plantar flexor strength, and hip extensor and abductor strength and endurance, would be diminished in women with PTTD and this impairment would be on the side of dysfunction.
Individuals with PTTD demonstrate impaired walking abilities. Walking gait is strongly dependent on the performance of calf and hip musculature.
Thirty-four middle-aged women (17 with PTTD) participated. Ankle plantar flexor strength was assessed with the single-leg heel raise test. Hip muscle performance, including strength and endurance, were dynamometrically measured. Differences between groups and sides were assessed with a mixed-model analysis of variance.
Females with PTTD performed significantly fewer single-leg heel raises and repeated sagittal and frontal plane non-weight-bearing leg lifts, and also had lower hip extensor and abductor torques than age-matched controls. There were no differences between sides for hip strength and endurance measures for either group, but differences between sides in ankle strength measures were noted in both groups.
Women with PTTD demonstrated decreased ankle and hip muscle performance bilaterally.
The Journal of orthopaedic and sports physical therapy. 01/2011; 41(9):687-94.
[Show abstract][Hide abstract] ABSTRACT: Aesthetic constraints allow dancers fewer technique modifications than other athletes to negotiate the demands of leaping. We examined vertical ground reaction force and knee mechanics during a saut de chat performed by healthy dancers. It was hypothesized that vertical ground reaction force during landing would exceed that of take-off, resulting in greater knee extensor moments and greater knee angular stiffness. Twelve dancers (six males, six females; age 18.9 ± 1.2 years, mass 59.2 ± 9.5 kg, height 1.68 ± 0.08 m, dance training 8.9 ± 5.1 years) with no history of low back pain or lower extremity pathology participated in the study. Saut de chat data were captured using an eight-camera Vicon system and AMTI force platforms. Peak ground reaction force was 26% greater during the landing phase, but did not result in increased peak knee extensor moments. Taking into account the 67% greater knee angular displacement during landing, this resulted in less knee angular stiffness during landing. In conclusion, landing was accomplished with less knee angular stiffness despite the greater peak ground reaction force. A link between decreased joint angular stiffness and increased soft tissue injury risk has been proposed elsewhere; therefore, landing from a saut de chat may be more injurious to the knee soft tissue than take-off.
Journal of Sports Sciences 01/2011; 29(2):125-31. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In vitro evaluation of a chemical, injectable intervention for discectomy induced destabilization.
To investigate the ability of two collagen crosslinking agents to restore mechanical properties to lumbar joints destabilized by surgical decompression procedures.
Posterior decompression surgery is a common procedure indicated for tissue pathology that interferes with surrounding neural structures. Previous in vitro, analytical, and clinical studies have shown that removal of load-supporting tissue can compromise joint stability mandating some form of postsurgical stabilization. Currently, no nonsurgical treatments are capable of restoring stability and preventing subsequent degeneration. Exogenous crosslinking of intact discs has shown a fourfold increase in joint stability.
Fifteen bovine lumbar intervertebral joints were randomly separated into methylglyoxal or genipin treatment groups. Flexion-extension flexibility was quantified in three conditions: intact, postdecompression surgery, and after crosslinking reagent injections. Instability was quantified by calculating neutral zone (NZ), percentage of hysteresis, range of motion, and percentage of strain energy.
Simulated surgical decompression increased NZ 111% (P = 0.009), 28% (P = 0.004), range of motion 57% (P = 0.003), and decreased strain energy 37% (P = 0.004). For those discs undergoing methylglyoxal treatment NZ was subsequently reduced 68% (P = 0.012), hysteresis 28% (P = 0.018), range of motion 29% (P = 0.012), and strain energy was increased 71% (P = 0.018). For discs subjected to genipin treatment, NZ was reduced 52% (P = 0.018), hysteresis 23% (P = 0.012), range of motion 44% (P = 0.017), and strain energy was increased 66% (P = 0.012). Mean NZ was lower than intact mean after both methylglyoxal and genipin treatments, 10% and 17% less, respectively, but these differences were not significant. Mean values for all other parameters posttreatment were within 6% of the corresponding intact mean values.
Injections of crosslinking reagents into lumbar intervertebral discs after simulated decompression surgery restored joint stability according to all parameters. Similar results were found for genipin and methylglyoxal reagents. Implementing exogenous collagen crosslinking as an adjunct to current surgical decompression procedures may be beneficial in preventing or delaying subsequent spinal instability and degeneration.
[Show abstract][Hide abstract] ABSTRACT: In vitro study of genipin crosslinking effect on disc water content changes under compressive loading and unloading.
To investigate the influence of collagen crosslinking on hydration and fluid flow in different regions of intact discs, and to evaluate the nutritional implications.
Age-related reductions of nutrient supply and waste product removal are critically important factors in disc pathogenesis. Diffusion and fluid flow are blocked by subchondral bone thickening, cartilaginous endplate calcification, loss of hydrophilic proteoglycans, and clogging of anular pores by degraded matrix molecules. Previous studies demonstrated increased hydraulic permeability and macromolecular transport through crosslinked collagenous matrices. Genipin has also demonstrated the capability to increase retention of proteoglycans.
A total of 57 bovine lumbar motion segments were divided randomly into phosphate buffered saline and 0.33% genipin-soaked treatment groups. Water content changes were measured using a mass-loss technique in 3 intervertebral disc regions following successive stages of compressive loading and unloading (post-treatment, after 1 hour 750 N compression, and after a subsequent 24-hour period of nominal loading). Net flow of fluid into or out of a region was determined from the percentage change in mean water content from successive groups.
Fluid flow to and from the nucleus doubled with genipin crosslinking. Relative to the buffer-only controls, overall net fluid flow increased 103% in the nucleus pulposus, 36% in the inner anulus, and was 31% less in the outer anulus of genipin treated discs.
The effects of genipin crosslinking on matrix permeability and proteoglycan retention can alter hydration levels and fluid flow in the intervertebral disc. Resulting increases in fluid flow, including a doubling of flow to and from the nucleus, could lead to enhanced nutritional inflow and waste product outflow for the disc, and may have implications for emerging cell-based therapies.
[Show abstract][Hide abstract] ABSTRACT: Restoration of physical function following lumbar microdiskectomy may be influenced by the postoperative care provided.
The purpose of this study was to examine the effectiveness of a new interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy.
The study was conducted in physical therapy outpatient clinics.
Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy were randomly allocated to receive education only or exercise and education.
The exercise intervention consisted of a 12-week periodized program of back extensor strength (force-generating capacity) and endurance training and mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and physical measures of functional performance were tested 4 to 6 weeks postsurgery and 12 weeks later, following completion of the intervention program. Because some participants sought physical therapy outside of the study, postintervention scores were analyzed for both an as-randomized (2-group) design and an as-treated (3-group) design.
In the 2-group analyses, exercise and education resulted in a greater reduction in ODI scores and a greater improvement in distance walked. In the 3-group analyses, post hoc comparisons showed a significantly greater reduction in ODI scores following exercise and education compared with the education-only and usual physical therapy groups.
The limitations of this study include a lack of adherence to group assignment, disproportionate therapist contact time among treatment groups, and multiple use of univariate analyses.
An intensive, progressive exercise program combined with education reduces disability and improves function in patients who have undergone a single-level lumbar microdiskectomy.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was 2-fold: (1) to analyze the degree and the location of lumbar multifidus asymmetry among patients scheduled for L4-L5 microdiscectomy, and (2) to determine the amount of asymmetry recognizable by a radiologist on magnetic resonance imaging.
Bilateral multifidi cross-sectional areas were measured on magnetic resonance axial images of 20 patients scheduled to undergo L4-L5 microdiscectomy. The sides were compared and the location and amount of asymmetry (%)determined. The axial slices were assigned to two different categories based on their anatomical proximity to the L4-L5 disc (Disc(Ref)) and to the fascicles of the lumbar multifidus attaching to the spinous process of L5 (Muscle(Ref)). The maximal percent difference in cross-sectional area was compared between these categories. A radiologist rated the degree of asymmetry visually. These ratings were compared slice by slice to the computed percent difference in the cross-sectional area.
Mean differences in multifidus cross-sectional area were 11.5 +/- 5.6% in the Disc(Ref) and 15.8 +/- 9.5% in the Muscle(Ref) categories and were statistically significant (P = 0.03). The radiologist recognized asymmetry when the quantitative difference was at least 12.6%. This level of asymmetry was identified in the Muscle(Ref) category in 45% of cases and in Disc(Ref) in 30% of cases.
Nearly half of the cases scheduled for lumbar microdiscetomy exhibited asymmetry of at least 12.6% in the lumbar multifidus innervated by the L5 nerve root, which is located below the level of the injured disc. A trained radiologist can readily identify this multifidus asymmetry.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 06/2009; 88(5):355-61. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low back pain remains a costly quality-of-life-related health problem. Microdiscectomy is often the surgical procedure of choice for a symptomatic, single-level, lumbar disc herniation in younger and middle-aged adults. The question of whether a post-microdiscectomy exercise program enhances function, quality of life, and disability status has not been systematically explored. Thus, the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program, developed at University of Southern California (USC), targeting the trunk and lower extremities (USC Spine Exercise Program) for persons who have undergone a single-level microdiscectomy for the first time.
One hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study. Subjects will be randomly assigned to one of two groups: 1) one session of back care education, or 2) a back care education session followed by the 12-week USC Spine Exercise Program. The outcome examiners (evaluators), as well as the data managers, will be blinded to group allocation. Education will consist of a one-hour "one-on-one" session with the intervention therapist, guided by an educational booklet specifically designed for post-microdiscectomy care. This session will occur four to six weeks after surgery. The USC Spine Exercise Program consists of two parts: back extensor strength and endurance, and mat and upright therapeutic exercises. This exercise program is goal-oriented, performance-based, and periodized. It will begin two to three days after the education session, and will occur three times a week for 12 weeks. Primary outcome measures include the Oswestry Disability Questionnaire, Roland-Morris Disability Questionnaire, SF-36 quality of life assessment, Subjective Quality of Life Scale, 50-foot Walk, Repeated Sit-to-Stand, and a modified Sorensen test. The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program. Long-term follow up assessments will occur every six months beginning one year after surgery and ending five years after surgery. Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance (MANOVA). If significant interactions are found, one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons.
We have presented the rationale and design for a randomized controlled trial evaluating the effectiveness of a treatment regimen for people who have undergone a single-level lumbar microdiscectomy.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION The ankle is the primary contributor to support moment during running and hopping [1, 2]. We hypothesized that this contribution will be decreased in the presence of Achilles tendinopathy and that the alterations in contribution will be task dependent. This study aims to compare differences in joint contributions to support moment between the involved and non-involved leg in a subject with unilateral Achilles tendinopathy during running and hopping tasks. METHODS One experienced male runner (56 y/o) with chronic right side Achilles tendinopathy participated in this study. The condition was identified clinically and the pathology was confirmed using ultrasonography (Figure 1). Lower extremity kinematics (Vicon 612 motion analysis system, Oxford, UK; 250 Hz), and kinetics (AMTI force plate, Watertown, MA; 1500 Hz) were obtained during running, single-legged hopping and double-legged hopping. The running speed was controlled at 4 m/s ±5% for all trials (N=6). Single-and double-legged hopping (N=20) frequency was set at 2.2Hz using a metronome. The vertical ground reaction force was recorded, and the sagittal plane hip, knee, and ankle joint moments were computed using standard inverse dynamics equations. The support moment was calculated by the summation of the sagittal extensor moments .