This study was a case series design. The objectives of the study were to investigate the ability ... more This study was a case series design. The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test. The ASLR test is a valid and reliable tool to assist
Aberrant motor control strategies have been identified in chronic pelvic girdle pain (PGP) subjec... more Aberrant motor control strategies have been identified in chronic pelvic girdle pain (PGP) subjects. It has been proposed that aberrant motor control strategies could provide a mechanism for ongoing pain and disability in these subjects. This thesis consists of a series of studies that have investigated motor control strategies during the active straight leg raise (ASLR) test, under various loading conditions, in pain free nulliparous female subjects (n=14) and female subjects with chronic PGP (n=12). Clinical examination of the chronic PGP subjects had identified the SIJ and surrounding structures as the primary source of symptoms. Heaviness of the leg (+/- pain) when the pain subjects performing the ASLR was relieved in all the pain subjects with the addition of manual pelvic compression during the ASLR, consistent with a pain disorder associated with impaired force closure mechanism. Phase of respiration was monitored with the pneumotach. Electromyography was recorded bilaterally...
This study investigated the association between menstrual pain severity and psychophysical measur... more This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was utilised with young women (n=432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20- and 22-year follow-ups. A visual analog scale (VAS; range from 0 (none) to 10 (unbearable)) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with three groups created: 1) no pain/mild pain (VAS 0-3), 2) at least moderate pain at a minimum of one of the two time points (hereafter named 'mixed', 3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain s...
Objective: This study investigated beliefs related to ‘grey areas’ of in- jured worker management... more Objective: This study investigated beliefs related to ‘grey areas’ of in- jured worker management in the West Australian workers’ compen- sation system. Methods: Six common scenarios related directly to the management of injured workers were devised with two main themes of ‘Reason- able Expenses’ and ‘Health Worker Roles’. The scenarios were fo- cused on musculoskeletal disorders. Eighty physiotherapists and 48 insurance workers (case managers, injury management advisors) par- ticipated in an online questionnaire. Level of agreement with each scenario was assessed and opportunity provided for individual com- ments. Results: Differences were identified in the beliefs related to the six scenarios both between and within professions. Both professions had varied opinions as to when treatment under the workers’ com- pensation system should cease. There was a lack of consensus in both professions on the provision of treatment for comorbidity within the system. There were differing opinion...
For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. Whil... more For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. While multiple factors may contribute to disability in this group, previous studies have not investigated sleep impairments, body perception or mindfulness as potential factors associated with disability post-partum. To compare women experiencing no pain post-pregnancy with those experiencing pregnancy-related persistent lumbopelvic pain (either low- or high-level disability) across multiple biopsychosocial domains. Cross-sectional. Participants completed questionnaires for thorough profiling of factors thought to be important in pregnancy-related lumbopelvic pain. Specific measures were the Urinary Distress Inventory, Medical Outcomes Study Sleep Scale, Back Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Depression Anxiety Stress Scale, Coping Strategies Questionnaire, Pain Catastrophising Scale, The Fremantle Back Awareness Questionnaire and the Mindful Attention Awareness Scale. Wo...
Correlations between clinical and quantitative measures of pain sensitivity are poor, making it d... more Correlations between clinical and quantitative measures of pain sensitivity are poor, making it difficult for clinicians to detect people with pain sensitivity. This is important as these people have a different prognosis and may require different treatment. To investigate the relationship between clinical and quantitative measures of pain sensitivity across individuals with and without neck pain. This cross sectional study included 40 participants with chronic neck pain and 40 age matched controls. Participants underwent quantitative sensory testing of cold pain thresholds (CPT) and pressure pain thresholds (PPT). Clinical tests for pain sensitivity were the 'ice-pain' test and the 'pressure-pain' test. All tests were undertaken at standardised local (neck and upper trapezius) and remote (wrist and tibialis anterior) sites. Median (IQR) statistics were calculated between neck pain and control groups and correlation coefficients were calculated between quantitative a...
Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and opt... more Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1-4), profiling their clinical presentations within a multidimensional framework. P1's profile was characterised by localised lumbar sensitisation consistent with dominant peripheral nociception. P2 presented a 'mixed' profile characterised by localised lumbar hypersensitivity, combined with factors suggestive of centrally-mediated facilitation of nociception. P3's profile suggested widespread hypersensitivity possibly reflective of dominant centrally-m...
Lumbopelvic pain is common in pregnancy but the sensitization factors underlying the condition ar... more Lumbopelvic pain is common in pregnancy but the sensitization factors underlying the condition are largely unknown. This study characterized the somatosensory profile of pregnant and nonpregnant women and the relationship between pain, hypersensitivity, and commonly used manual clinical tests. Thirty-nine pregnant and 22 nonpregnant women were included. Although lumbopelvic pain was not an inclusion criterion, the pregnant women were divided into low- and high-pain groups following data collection. The sensitivity to light brush, pin-prick, and pressure pain was assessed bilaterally at 3 sites in the lumbopelvic region, at the shoulder, and in the lower leg. Responses to the active straight leg raise test and pain provocation tests of the sacroiliac joint were recorded. Participants completed questionnaires addressing emotional and physical well-being and rated disability using the Pelvic Girdle Questionnaire. Compared with controls, the high-pain group rated the active straight leg raise test as more difficult (P < .05), and both pain groups had more positive pain provocation tests (P < .05). The pregnant groups demonstrated significantly lower pressure pain thresholds at most assessment sites compared with controls (P < .05), but self-reported disability and pain were not correlated with pressure pain thresholds within pregnant participants. The high-pain group reported worse emotional health and poorer sleep quality than controls (P < .05). This article presents the somatosensory profile of a healthy pregnant cohort. The results indicate that pain sensitivity increases during pregnancy possibly owing to the physical changes the body undergoes during pregnancy but also owing to changes in emotional health. This should be accounted for in clinical management of pregnant women with lumbopelvic pain.
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2011
To identify distinct age-related trajectory classes of body mass index (BMI) z-scores from childh... more To identify distinct age-related trajectory classes of body mass index (BMI) z-scores from childhood to adolescence, and to examine the association of these trajectories with measures of standing sagittal spinal alignment at 14 years of age. Adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study contributed data to the study (n=1 373). Age- and gender-specific z-scores for BMI were obtained from height and weight at the ages of 3, 5, 10 and 14 years. Latent class group analysis was used to identify six distinct trajectory classes of BMI z-score. At the age of 14 years, adolescents were categorised into one of four subgroups of sagittal spinal posture using k-means cluster analysis of photographic measures of lumbar lordosis, thoracic kyphosis and trunk sway. Regression modeling was used to assess the relationship between postural angles and subgroups, and different BMI trajectory classes, adjusting for gender. Six trajectory classes of BMI z-score were es...
Pelvic girdle pain (PGP) is frequently managed by physiotherapists. Little is known about current... more Pelvic girdle pain (PGP) is frequently managed by physiotherapists. Little is known about current physiotherapy practice and beliefs in the management of PGP disorders. The primary aim of this study was to investigate current practice and beliefs in management of PGP among physiotherapists working in Norway and Australia. A secondary aim was to compare current practice with clinical guidelines. A questionnaire was developed and electronically distributed to physiotherapists in Norway (n = 65) and Australia (n = 77). Treatment and management were determined via responses to 2 case vignettes (during pregnancy, not related to pregnancy), with participants selecting their four primary preferences for treatment and management from a list of 33 possibilities. During pregnancy, 'education around instability' and 'soft tissue treatment' were selected amongst the most common interventions by physiotherapists in both countries. Norwegian physiotherapists selected 'pelvic floor exercises' more frequently, while Australian physiotherapists more commonly selected 'correcting functional impairments'. In the other case, common responses from both countries were 'hip strengthening in weight bearing' and 'correction of functional impairments'. Norwegian physiotherapists selected 'general physical exercise' and 'general education' more frequently, while Australian physiotherapists more commonly selected 'hip strengthening in non-weight bearing' and 'muscular relaxation of the abdominal wall/pelvic floor'. Beliefs about PGP were generally positive in both groups while knowledge of and adherence to clinical guidelines were limited. The findings provide direction for future research related to the management and treatment of PGP, and targets for education of physiotherapists working in this area.
Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, lead... more Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood. The purpose of the study was to build a biopsychosocial profile of children and adolescents with CNSMSP. CNSMSP subjects (n = 30, 18 females, age 7-18) were compared with age matched pain free controls across a number of biopsychosocial domains. In the psychosocial domain CNSMSP subjects had increased levels of anxiety and depression, and had more somatic pain complaints. In the lifestyle domain CNSMSP subjects had lower physical activity levels, but no difference in television or computer use compared to pain free subjects. Physically, CNSMSP subjects tended to sit with a more slumped spinal posture, had reduced back muscle endurance, increased presence of joint hypermobility and poorer gross motor skills. These findings support the notion that CNSMSP is a multidimensional biopsychosocial disorder. Further rese...
An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in... more An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted. To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern. The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise. In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography. The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stability via manual compression through the ilia reversed these differences. The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.
Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the ... more Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the active straight leg raise (ASLR). This study investigated how pain-free subjects coordinate motor control during an ASLR when this task is complicated by the addition of a respiratory challenge. Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR, breathing with inspiratory resistance (IR) and ASLR+IR. Subjects responded to ASLR+IR with an increase in the motor activation in the abdominal wall and chest wall compared to when ASLR and IR were performed in isolation. Activation of obliquus internus abdominis was greater on the side of the leg lift during the ASLR+IR, in comparison to symmetrical activation observed in the other abdominal wall muscles. The incremental increase of motor activity was associated with greater intra-abdominal pressure baseline shift when lifting the leg during ASLR+IR compared to ASLR. Individual variation was apparent in the form of the motor control patterns, mostly reflected in variable respiratory activation of the abdominal wall. The findings highlight the flexibility of the neuromuscular system in adapting to simultaneous respiratory and stability demands.
It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strat... more It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strategy during the low load task of the active straight leg raise (ASLR). This study investigated this premise by observing the motor control patterns adopted by pain free subjects during a loaded ASLR (ASLR+PL). Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR and ASLR+PL. Additionally, side-to-side comparisons were performed for ASLR+PL. Incremental increases in muscle activation were observed from resting supine to ASLR to ASLR+PL. During the ASLR+PL there was a simultaneous increase in intra-abdominal pressure with a decrease in intra-thoracic pressure, while respiratory fluctuation of these variables were maintained. The ASLR+PL also resulted in increased pelvic floor descent and greater downward pressure of the non-lifted leg. Trunk muscle activation was comparable between sides during ASLR+PL in all muscles except lower obliquus internus abdominis, which was more active on the leg lift side. Pain free subjects respond to an ASLR+PL by a general increase in anterior trunk muscle activation, but preserve the pattern of greater activation on the side of the leg lift observed during an unloaded ASLR. This contrasts to findings in PGP subjects who, despite having a high load strategy for performing an ASLR on the symptomatic side of the body, display equal bilateral activation of the anterior abdominal wall during the ASLR. This differentiates PGP subjects from pain free subjects, supporting the notion that PGP subjects have aberrant motor control patterns during an ASLR.
This study was a case series design. The objectives of the study were to investigate the ability ... more This study was a case series design. The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test. The ASLR test is a valid and reliable tool to assist
Aberrant motor control strategies have been identified in chronic pelvic girdle pain (PGP) subjec... more Aberrant motor control strategies have been identified in chronic pelvic girdle pain (PGP) subjects. It has been proposed that aberrant motor control strategies could provide a mechanism for ongoing pain and disability in these subjects. This thesis consists of a series of studies that have investigated motor control strategies during the active straight leg raise (ASLR) test, under various loading conditions, in pain free nulliparous female subjects (n=14) and female subjects with chronic PGP (n=12). Clinical examination of the chronic PGP subjects had identified the SIJ and surrounding structures as the primary source of symptoms. Heaviness of the leg (+/- pain) when the pain subjects performing the ASLR was relieved in all the pain subjects with the addition of manual pelvic compression during the ASLR, consistent with a pain disorder associated with impaired force closure mechanism. Phase of respiration was monitored with the pneumotach. Electromyography was recorded bilaterally...
This study investigated the association between menstrual pain severity and psychophysical measur... more This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was utilised with young women (n=432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20- and 22-year follow-ups. A visual analog scale (VAS; range from 0 (none) to 10 (unbearable)) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with three groups created: 1) no pain/mild pain (VAS 0-3), 2) at least moderate pain at a minimum of one of the two time points (hereafter named 'mixed', 3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain s...
Objective: This study investigated beliefs related to ‘grey areas’ of in- jured worker management... more Objective: This study investigated beliefs related to ‘grey areas’ of in- jured worker management in the West Australian workers’ compen- sation system. Methods: Six common scenarios related directly to the management of injured workers were devised with two main themes of ‘Reason- able Expenses’ and ‘Health Worker Roles’. The scenarios were fo- cused on musculoskeletal disorders. Eighty physiotherapists and 48 insurance workers (case managers, injury management advisors) par- ticipated in an online questionnaire. Level of agreement with each scenario was assessed and opportunity provided for individual com- ments. Results: Differences were identified in the beliefs related to the six scenarios both between and within professions. Both professions had varied opinions as to when treatment under the workers’ com- pensation system should cease. There was a lack of consensus in both professions on the provision of treatment for comorbidity within the system. There were differing opinion...
For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. Whil... more For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. While multiple factors may contribute to disability in this group, previous studies have not investigated sleep impairments, body perception or mindfulness as potential factors associated with disability post-partum. To compare women experiencing no pain post-pregnancy with those experiencing pregnancy-related persistent lumbopelvic pain (either low- or high-level disability) across multiple biopsychosocial domains. Cross-sectional. Participants completed questionnaires for thorough profiling of factors thought to be important in pregnancy-related lumbopelvic pain. Specific measures were the Urinary Distress Inventory, Medical Outcomes Study Sleep Scale, Back Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Depression Anxiety Stress Scale, Coping Strategies Questionnaire, Pain Catastrophising Scale, The Fremantle Back Awareness Questionnaire and the Mindful Attention Awareness Scale. Wo...
Correlations between clinical and quantitative measures of pain sensitivity are poor, making it d... more Correlations between clinical and quantitative measures of pain sensitivity are poor, making it difficult for clinicians to detect people with pain sensitivity. This is important as these people have a different prognosis and may require different treatment. To investigate the relationship between clinical and quantitative measures of pain sensitivity across individuals with and without neck pain. This cross sectional study included 40 participants with chronic neck pain and 40 age matched controls. Participants underwent quantitative sensory testing of cold pain thresholds (CPT) and pressure pain thresholds (PPT). Clinical tests for pain sensitivity were the 'ice-pain' test and the 'pressure-pain' test. All tests were undertaken at standardised local (neck and upper trapezius) and remote (wrist and tibialis anterior) sites. Median (IQR) statistics were calculated between neck pain and control groups and correlation coefficients were calculated between quantitative a...
Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and opt... more Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1-4), profiling their clinical presentations within a multidimensional framework. P1's profile was characterised by localised lumbar sensitisation consistent with dominant peripheral nociception. P2 presented a 'mixed' profile characterised by localised lumbar hypersensitivity, combined with factors suggestive of centrally-mediated facilitation of nociception. P3's profile suggested widespread hypersensitivity possibly reflective of dominant centrally-m...
Lumbopelvic pain is common in pregnancy but the sensitization factors underlying the condition ar... more Lumbopelvic pain is common in pregnancy but the sensitization factors underlying the condition are largely unknown. This study characterized the somatosensory profile of pregnant and nonpregnant women and the relationship between pain, hypersensitivity, and commonly used manual clinical tests. Thirty-nine pregnant and 22 nonpregnant women were included. Although lumbopelvic pain was not an inclusion criterion, the pregnant women were divided into low- and high-pain groups following data collection. The sensitivity to light brush, pin-prick, and pressure pain was assessed bilaterally at 3 sites in the lumbopelvic region, at the shoulder, and in the lower leg. Responses to the active straight leg raise test and pain provocation tests of the sacroiliac joint were recorded. Participants completed questionnaires addressing emotional and physical well-being and rated disability using the Pelvic Girdle Questionnaire. Compared with controls, the high-pain group rated the active straight leg raise test as more difficult (P < .05), and both pain groups had more positive pain provocation tests (P < .05). The pregnant groups demonstrated significantly lower pressure pain thresholds at most assessment sites compared with controls (P < .05), but self-reported disability and pain were not correlated with pressure pain thresholds within pregnant participants. The high-pain group reported worse emotional health and poorer sleep quality than controls (P < .05). This article presents the somatosensory profile of a healthy pregnant cohort. The results indicate that pain sensitivity increases during pregnancy possibly owing to the physical changes the body undergoes during pregnancy but also owing to changes in emotional health. This should be accounted for in clinical management of pregnant women with lumbopelvic pain.
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2011
To identify distinct age-related trajectory classes of body mass index (BMI) z-scores from childh... more To identify distinct age-related trajectory classes of body mass index (BMI) z-scores from childhood to adolescence, and to examine the association of these trajectories with measures of standing sagittal spinal alignment at 14 years of age. Adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study contributed data to the study (n=1 373). Age- and gender-specific z-scores for BMI were obtained from height and weight at the ages of 3, 5, 10 and 14 years. Latent class group analysis was used to identify six distinct trajectory classes of BMI z-score. At the age of 14 years, adolescents were categorised into one of four subgroups of sagittal spinal posture using k-means cluster analysis of photographic measures of lumbar lordosis, thoracic kyphosis and trunk sway. Regression modeling was used to assess the relationship between postural angles and subgroups, and different BMI trajectory classes, adjusting for gender. Six trajectory classes of BMI z-score were es...
Pelvic girdle pain (PGP) is frequently managed by physiotherapists. Little is known about current... more Pelvic girdle pain (PGP) is frequently managed by physiotherapists. Little is known about current physiotherapy practice and beliefs in the management of PGP disorders. The primary aim of this study was to investigate current practice and beliefs in management of PGP among physiotherapists working in Norway and Australia. A secondary aim was to compare current practice with clinical guidelines. A questionnaire was developed and electronically distributed to physiotherapists in Norway (n = 65) and Australia (n = 77). Treatment and management were determined via responses to 2 case vignettes (during pregnancy, not related to pregnancy), with participants selecting their four primary preferences for treatment and management from a list of 33 possibilities. During pregnancy, 'education around instability' and 'soft tissue treatment' were selected amongst the most common interventions by physiotherapists in both countries. Norwegian physiotherapists selected 'pelvic floor exercises' more frequently, while Australian physiotherapists more commonly selected 'correcting functional impairments'. In the other case, common responses from both countries were 'hip strengthening in weight bearing' and 'correction of functional impairments'. Norwegian physiotherapists selected 'general physical exercise' and 'general education' more frequently, while Australian physiotherapists more commonly selected 'hip strengthening in non-weight bearing' and 'muscular relaxation of the abdominal wall/pelvic floor'. Beliefs about PGP were generally positive in both groups while knowledge of and adherence to clinical guidelines were limited. The findings provide direction for future research related to the management and treatment of PGP, and targets for education of physiotherapists working in this area.
Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, lead... more Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood. The purpose of the study was to build a biopsychosocial profile of children and adolescents with CNSMSP. CNSMSP subjects (n = 30, 18 females, age 7-18) were compared with age matched pain free controls across a number of biopsychosocial domains. In the psychosocial domain CNSMSP subjects had increased levels of anxiety and depression, and had more somatic pain complaints. In the lifestyle domain CNSMSP subjects had lower physical activity levels, but no difference in television or computer use compared to pain free subjects. Physically, CNSMSP subjects tended to sit with a more slumped spinal posture, had reduced back muscle endurance, increased presence of joint hypermobility and poorer gross motor skills. These findings support the notion that CNSMSP is a multidimensional biopsychosocial disorder. Further rese...
An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in... more An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted. To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern. The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise. In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography. The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stability via manual compression through the ilia reversed these differences. The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.
Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the ... more Alterations of respiratory patterns have been observed in pelvic girdle pain subjects during the active straight leg raise (ASLR). This study investigated how pain-free subjects coordinate motor control during an ASLR when this task is complicated by the addition of a respiratory challenge. Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR, breathing with inspiratory resistance (IR) and ASLR+IR. Subjects responded to ASLR+IR with an increase in the motor activation in the abdominal wall and chest wall compared to when ASLR and IR were performed in isolation. Activation of obliquus internus abdominis was greater on the side of the leg lift during the ASLR+IR, in comparison to symmetrical activation observed in the other abdominal wall muscles. The incremental increase of motor activity was associated with greater intra-abdominal pressure baseline shift when lifting the leg during ASLR+IR compared to ASLR. Individual variation was apparent in the form of the motor control patterns, mostly reflected in variable respiratory activation of the abdominal wall. The findings highlight the flexibility of the neuromuscular system in adapting to simultaneous respiratory and stability demands.
It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strat... more It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strategy during the low load task of the active straight leg raise (ASLR). This study investigated this premise by observing the motor control patterns adopted by pain free subjects during a loaded ASLR (ASLR+PL). Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR and ASLR+PL. Additionally, side-to-side comparisons were performed for ASLR+PL. Incremental increases in muscle activation were observed from resting supine to ASLR to ASLR+PL. During the ASLR+PL there was a simultaneous increase in intra-abdominal pressure with a decrease in intra-thoracic pressure, while respiratory fluctuation of these variables were maintained. The ASLR+PL also resulted in increased pelvic floor descent and greater downward pressure of the non-lifted leg. Trunk muscle activation was comparable between sides during ASLR+PL in all muscles except lower obliquus internus abdominis, which was more active on the leg lift side. Pain free subjects respond to an ASLR+PL by a general increase in anterior trunk muscle activation, but preserve the pattern of greater activation on the side of the leg lift observed during an unloaded ASLR. This contrasts to findings in PGP subjects who, despite having a high load strategy for performing an ASLR on the symptomatic side of the body, display equal bilateral activation of the anterior abdominal wall during the ASLR. This differentiates PGP subjects from pain free subjects, supporting the notion that PGP subjects have aberrant motor control patterns during an ASLR.
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