Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Technikon Natal, 2002 1 v. (various pagings) / The purpose of this study was to evaluate the effect of wearing a scuba diving cylinder on static lumbar spine posture, in terms of clinical objective findings, namely radiographic changes in the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, and the lumbar gravity line, during upright standing on land.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban University of Technology, 2008. x, 52 leaves, Appendices A-E, [25] leaves. / To determine whether a relationship exists between core stability and bowling speed in Action Cricket bowlers. Methods: Thirty asymptomatic indoor Action Cricket fast and fast-medium bowlers were divided into two groups of 15 each, with Group A having well-developed core stability and group B having poorly-developed core stability. The concept of matched pairs was used for age and cricket experience in order to maintain homogeneity between the groups. The core stability and bowling speed of each participant was measured using a pressure biofeedback unit (PBU) and speed sports radar respectively. SPSS version 15.0 was used to analyse the data.

The purposes of this dissertation were to determine: 1) the relationship betweenmuscle thickness change (MTC) as measured by rehabilitative ultrasound imaging(RUSI) and EMG activity in the lumbar multifidus (LM), 2) if motor control changesproduced by experimentally induced pain are measurable with RUSI, 3) if a differenceexists in MTC between subjects with low back pain (LBP) classified in the treatmentbasedclassification system (TBC) system and controls, 4) if MTC improves followingintervention.Current literature suggests sub-groups of patients with LBP exist and responddifferently to treatment, challenging whether the majority of LBP is "nonspecific". TheTBC system categorizes subjects into one of four categories (stabilization, mobilization,direction specific exercise, or traction). Currently, only stabilization subjects receive anintervention emphasizing stability. Because recent research has demonstrated that motorcontrol impairments of lumbar stabilizing muscles are present in most subjects with LBP,it is hypothesized that impairments may be present across the TBC classifications.Study 1: Established the relationship between MTC as measured by RUSI andEMG in the LM. Study 2: Assessed MTC of the LM during control and painfulconditions to determine if induced pain changes in LM and transverse abdominis (TrA)are measurable with RUSI. Study 3: Measured MTC of the LM and TrA in subjects withLBP classified in the TBC system and 20 controls. Subjects completed a stabilizationprogram and were re-tested.The inter-tester reliability of the RUSI measurements was excellent (ICC3,3 =.91,SEM=3.2%). There was a curvilinear relationship (r = .79) between thickness changeand EMG activity. There was a significant difference (p andlt; .01) between control andpainful conditions on 4 of the 5 LM tasks tested and on the TrA task. There was adifference in MTC between subjects and controls on the loaded LM test which varied bylevel and category. All categories were different from control on the TrA. Followingintervention the TrA MTC improved (p andlt; .01). The LM MTC did not (p values from .13-.86).These findings suggest MTC can be clinically measured and that deficits existwithin TBC system. Significant disability and pain reduction were measured.

This study is a prospective longitudinal outcome study investigating the presence of response shift in disease and generic functional outcome measures in 105 patients undergoing spinal surgery. The then-test method which compares pre-test scores to retrospective pre-test scores was used to quantitate response shift. There was a statistically significant response shift for the Oswestry Disability Index (ODI) (p=0.001) and the Short Form-36-PCS (p=0.078). At three months, seventy-two percent of patients exhibited a response shift with the ODI. Fifty-six and 21 percent of patients exhibited a response shift with the SF-36 physical and mental component scores respectively. When accounting for response shift and using the minimal clinically important difference, the success rate of the surgery at 3 months increased by 20 percent. The presence of response shift has implications for the measurement properties of standard spinal surgery outcome measures including the effect size of treatment and the number of responders to treatment.

This study is a prospective longitudinal outcome study investigating the presence of response shift in disease and generic functional outcome measures in 105 patients undergoing spinal surgery. The then-test method which compares pre-test scores to retrospective pre-test scores was used to quantitate response shift. There was a statistically significant response shift for the Oswestry Disability Index (ODI) (p=0.001) and the Short Form-36-PCS (p=0.078). At three months, seventy-two percent of patients exhibited a response shift with the ODI. Fifty-six and 21 percent of patients exhibited a response shift with the SF-36 physical and mental component scores respectively. When accounting for response shift and using the minimal clinically important difference, the success rate of the surgery at 3 months increased by 20 percent. The presence of response shift has implications for the measurement properties of standard spinal surgery outcome measures including the effect size of treatment and the number of responders to treatment.

Qualitative studies investigating the sexual activity of people with low back pain found a substantial reduction in the frequency of coitus and have shown that pain during coitus due to mechanical factors (i.e., movements and postures) are the primary reason for this decreased frequency. However, a biomechanical analysis of coitus has never been done. The main objective of this study was to describe male and female lumbar spine and hip motion and muscle activation patterns during coitus and compare these motions and muscle activity across five common coital positions. Specifically, lumbar spine and hip motion in the sagittal plane and electromyography signal amplitudes of selected trunk, hip, and thigh muscles were described and compared. A secondary objective was to determine if simulated coitus could be used in place of real coitus for future coitus biomechanics research. Ten healthy males (29.3 ± 6.9 years, 176.5 ± 8.6 centimeters, 84.9 ± 14.5 kilograms) and ten healthy females (29.8 ± 8.0 years, 164.9 ± 3.0 centimeters, 64.2 ± 7.2 kilograms) were included for analysis in this study. These couples had approximately 4.7 ± 3.9 years of sexual experience with each other. This study was a repeated-measures design, where the independent variables, coital position and condition, were varied five (i.e., QUADRUPED1, QUADRUPED2, MISSIONARY1, MISSIONARY2, and SIDELYING) and two (i.e., real and simulated) times, respectively. Recruited participants engaged in coitus in five pre-selected positions (presented in random order) for 20 seconds per position first in a simulated condition, and again in a real condition. Three-dimensional (3D) lumbar spine and hip kinematic data were continuously collected for the duration of each trial by optoelectronic and electromagnetic motion capture systems. Electromyography (EMG) signals were also continuously collected for the duration of each trial. The kinematic data and EMG signals were collected simultaneously for both participants. Five sexual positions were chosen for this study based on the findings of previous literature and a biomechanical rationale. QUADRUPED – rear-entry, female quadruped, male kneeling behind – had two variations; in QUADRUPED1 the female was supporting her upper body with her elbows and in QUADRUPED2 the female was supporting her upper body with her hands. MISSIONARY – front-entry, female supine, male prone on top – also had two variations; in MISSIONARY1 the female was not flexing her hips or knees and the male was supporting his upper body with his hands, but in MISSIONARY2, the female was flexing her hips and knees and the male was supporting his upper body with his elbows. SIDELYING – rear-entry, female side-lying on her left side, male side-lying behind – did not have any variations. To determine if each coital position had distinct spine and hip kinematic and muscle activation profiles, separate univariate general linear models (GLM) (factor: coital position = five levels, α=0.05) followed by Tukey’s honestly significant difference (HSD) post hoc analysis were used. To determine if simulated coitus was representative of real coitus across all spine and hip kinematic and muscle activation outcome variables, paired-sample t-tests (α=0.05) were performed on all outcome variables for the real condition and their respective simulated values. In general, the coital positions studied showed that, for both males and females, coitus is mainly a flexion-extension movement of the lumbar spine and hips. Males used a greater range of their spine and hip motion in comparison to females. As expected, differences were found between coital positions for males and females and simulated coitus was not representative of real coitus, in particular the spine and hip kinematic profiles. The results found in this biomechanical analysis of common coital positions may be useful in a clinical context. It is recommended that during the acute stage of a low back injury resulting in flexion-, extension-, or motion-intolerance that coitus be avoided. If the LBP is a more chronic issue, particular common coital positions should be avoided. For the flexion-intolerant male patient, avoid SIDELYING and MISSIONARY2 as they were shown to require the most flexion. Both variations of QUADRUPED are the more spine-sparing of coital positions followed by, MISSIONARY1. Coaching the male patient on proper hip-hinging technique while thrusting – an easy technique to incorporate in both variations of QUADRUPED – will likely decrease spine movement and increase the spine-sparing quality of QUADRUPED. For the flexion-intolerant female patient, avoid both variations of MISSIONARY, especially with hip and knee flexion, as they were shown to elicit the most spine flexion. QUADRUPED2 and SIDELYING are the more spine-sparing coital positions, followed by QUADRUPED1. Subtle posture changes for a coital position should not be considered lightly; seemingly subtle differences in posture can change the spine kinematic profile significantly, resulting in a coital position that was considered spine-sparing becoming a position that should be avoided. Thus, spine-sparing coitus appears to be possible for the flexion-, extension-, and motion-intolerant patient. Health care practitioners may recommend appropriate coital positions and coach coital movement patterns, such as speed control and hip-hinging. With respect to future research in the area of sex biomechanics, using simulated coitus in replace of real coitus is not justifiable according to the data of this study. However, including a simulated condition did prove beneficial for increasing the comfort level of the couples and allowing time to practice the experimental protocol. Future directions may address female-centric positions (e.g., ‘reverse missionary’ with male supine and female seated on top), and back-pained patients with and without an intervention (e.g., movement pattern coaching or aides, such as a lumbar support).

Background: In the clinical examination of patients with low back pain (LBP), musculoskeletal physiotherapists routinely assess lumbar spinal segmental motion by performing physical examination procedures such as observation of active range of motion and palpation of intervertebral motion. The validity of manual assessment of segmental motion, however, has not been adequately investigated. Methods: In this pragmatic, multi-centre, criterion-related validity study, 138 consecutive patients with LBP were recruited and examined by physiotherapists with postgraduate training in musculoskeletal manual therapy. Clinicians examined each patient�s spine for the presence of segmental motion abnormalities, described as lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI), then referred the patients for flexion-extension (FE) radiographs. The physical examination procedures of interest were: 1) assessment of forward-bending (FB) active range of motion (AROM); 2) FB and backward-bending (BB) passive physiological intervertebral motion testing (PPIVMs) in the sagittal plane; and 3) central postero-anterior passive accessory intervertebral motion testing (PAIVMs). Sagittal displacement kinematics of the lumbar spinal segments were measured from the FE radiographs, and served as the criterion standard against which the clinical assessment results were compared. The kinematic parameters measured were sagittal rotation, sagittal translation, ratio of translation per degree of rotation (TRR), instantaneous axis of rotation (IAR), and centre of reaction (CR). Reference ranges for normal motion were calculated from the analysis of FE radiographs of 30 asymptomatic volunteers. The accuracy and validity of the clinical examination procedures were then calculated, and reported as sensitivity, specificity, and likelihood ratios for a positive test (LR+) and a negative test (LR-). Results: In patients with LBP, sagittal rotation LSR and sagittal translation LSR had a prevalence of approximately 5.7% (p <0.0005) in this cohort. Sagittal rotation LSI was not found in statistically significant numbers. Sagittal translation LSI was found at a prevalence of 3.6% (p <0.05). Abnormal TRR (23.3%), IAR (17.7%), and CR (16.5%) were more prevalent findings (all p <0.0005). Observation of the quantity of AROM, during FB, is not valid for the assessment of either total lumbar segmental sagittal rotation, or detection of individual segments with abnormal segmental motion. PPIVMs and PAIVMs are specific, but not sensitive, for the detection of rotation LSI and translation LSI. A positive test (grade 4 on a scale from 0 to 4) with BB PPIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 8.4 and 7.1 respectively (and 95% CIs from around 1.7 to 38). Likelihood ratio statistics for FB PPIVMs were not statistically significant. A positive test (grade 2 on a scale from 0 to 2) with PAIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 2.7 and 2.5 respectively (and 95% CIs from around 1.01 to 7.5). Neither PPIVMs nor PAIVMs were useful for the detection of LSR, or abnormal quality of motion as measured by TRR, CR, and IAR. Conclusions: Abnormal spinal segmental motion is associated with the symptom of LBP, in patients presenting to physiotherapists with a new episode of recurrent or chronic LBP, however prevalence is low due to highly variable lumbar segmental motion among asymptomatic individuals. Manual physical examination has moderate validity, but limited utility on its own, for the detection of translation LSI. Further research should investigate the utility of other clinical examination findings for the detection of lumbar segmental mobility disorders.

Thesis (M.S.)--Indiana University, School of Health, Physical Education and Recreation, 2005.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.