PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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1999 - Vol. 7, No. 4
* this issue only available in PDF format
Critical Analysis of the Sequence and Extent of the Result of the Pathological Failure of Self-Bracing of the Sacroiliac Joint
Richard L. DonTigny, PT
Abstract: When the sacrum is loaded with superincumbent weight, the sacroiliac joint functions as a self-compensating force couple. This couple creates and tends to rotate around an axis perpendicular to itself. The location of this axis may vary and depends upon the forces applied to the couple. As ligamentous tension increases in the couple, the sacroiliac joints are drawn tightly together through a mechanism of self-bracing. Self-bracing and its normal release or diminution provides for the storage and release of energy, which enhances the efficiency of normal ambulation and which modifies external forces. Failure of the force couple causes failure of the transverse axis of rotation of the sacroiliac joint and failure of the self-bracing mechanism. Because of the decrease in friction and stability, the innominate bones rotate anteriorly on the sacrum on an acetabular axis with the onset of pain and an alteration in apparent leg length. The resultant dysfunction may range from slight to severe, from minor ligamentous sprains to major sprains, muscle separations, and rents in the joint capsule. These rents may leak synovial fluid to the fifth lumbar nerve root, the lurnbosacral plexus, and other tissues; and the resulting lesion may mimic disc dysfunction or create the impression of a multifactorial etiology. However it is seldom included in assessment of low back pain. A critical analysis of the biomechanics demonstrates the sequence and extent of involvement of adjacent tissues and structures, and it provides some direction for the restoration of normal function.
The Journal of Manual & Manipulative Therapy Vol. 7 No. 4 (1999), 173 - 181
Manipulation in the Treatment of Acute Low Back Pain
Janette E. Morton, Dip Phty, M Hlth Sc (Ortho Manip T)
Abstract: This prospective research project statistically analyses the difference between two randomized groups of patients, one receiving manipulation plus exercises for acute low back pain of mechanical origin, the other receiving an exercise program alone. Objectives. To determine if orthopaedic manipulation is beneficial in treating acute low back pain of mechanical origin. Summary of Background Data. Orthopaedic manipulative physiotherapists have frequently observed dramatic results including elimination of pain and restoration of pain-free range of movement following manipulation of the acute locked back. Spinal manipulative therapy is a widely used method of treating lower back pain with millions of patient treatments performed each year, the majority in Western societies. Trials have emphasized the immediate and short-term symptomatic relief of low back pain following manipulation; however, the long- term difference in effects between manipulated and control groups has required further evaluation. Methods. A sample of convenience of acute low back pain participants were randomly assigned to two groups. A pre-test/post-test experimental design approach was used with 29 participants. This design included three dependent variables (pain, range of movement, and disability assessment) and one independent variable (15 participants in Group I received an exercise program with manipulation and 14 participants in Group 11 received an exercise program only). Participants were assessed for pain, range of movement, and disability before treatment. Participants were reassessed weekly for four weeks, then at two months and three months after initiation of treatment. Results. The findings of this study illustrate a statistically significant difference between the two treatments (p = <0.0005). Univariate post hoc tests concluded that the two treatment regimens had significantly different effects at three months on disability (p = 0.001), pain (p = <0.0005), and ROM (p = <0.0005). As well as being statistically significant, the magnitude of the relationships was strong, with 42.8% of the variability attributed to the disability measure, 64.3% of the variability attributed to the pain measure, and 65.9% of the variability attributed to the ROM measure. Conclusion. Patients who receive orthopaedic manipulation with an exercise program for acute low back pain of mechanical origin are likely to improve more than patients who receive an exercise program alone.
The Journal of Manual & Manipulative Therapy Vol. 7 No. 4 (1999), 182 - 189
The Swiss Ball: An Overview of Applications in Sports Medicine
Cynthia St. Amaud Liggett MPA, PT, OCS, ATC
Abstract: This paper reviews the historical development of the exercise ball and the theoretical basis and current treatment use of it for sports medicine patients. The more common uses are to increase joint range of motion (ROM) and strength, to enhance joint proprioception, to improve cardiovascular function, and to promote trunk stabilization. The use of the exercise ball has undergone exponential growth over the past decade. Its variability of use, convenience, and low cost make it an ideal toot for the sports medicine setting. Empirical evidence has shown benefits in improving joint ROM, strength, spinal stabilization, and proprioception. However, no peer-reviewed controlled studies have been reported. Clinical research is needed to define the most appropriate exercises and optimal frequency or duration of treatment for a given diagnosis.
The Journal of Manual & Manipulative Therapy Vol. 7 No. 4 (1999), 190 - 196
Comparison of Abdominal Muscle Strength Following Ball and Mat Exercise Regimens: A Pilot Study
Cynthia St. Arnaud Liggett MPA, PT, OCS, ATC Marilys Randolph PT, PhD
Abstract: Purpose: The purposes of this study were a) to verify test-retest experimental design reliability for trunk flexion using the BiodeXTM isokinetic dynamometer and b) to compare the strength gain in abdominal muscles during traditional sit-up exercises with the gain during sit-up exercises performed on an exercise ball. Subjects: Twenty-six healthy subjects with no prior history of low back pain participated in this study. Methods: The control group (females=3 males=3) abstained from any exercise. The mat group (females=7 males=3) performed traditional sit-ups on a mat beginning with a scapula lift and advancing to a full sit-up as strength increased. The ball group (females=7 males=3) performed sit-ups seated on a ball, beginning with a backward lean to 45 and advancing to a horizontal trunk position. Both exercise groups performed 6 sets of 10 repetitions during each session 3 x week x 3 weeks. Strength was measured prior to and following the 3 week exercise program with the BiodexTM isokinetic back testing unit at 60'/sec and 120'/ sec using a test-retest protocol. Analyses andresults: A Pearson correlation coefficient performed on the test-retest data achieved significance, r =.95. A 3-way ANOVA with repeated measures revealed a significant difference between pre-test and post-test values for all groups (109.3 vs 114.4 ftab, p<.02) at 60'/sec. The control group pre-test and post-test values (131.3 and 133.6 ft/ lb) showed no change. An interaction effect between speeds and groups was significant (p<.0004) with an increase at 601/sec (108.4 vs 117 ft/lb) but no change at 1201/sec. Increases for the ball, mat, and control groups at 60'/sec were 12.5, 8.6, and 2.3 ft/lbs, respectively. These increases were not significant. Conclusions: Based on these findings, we conclude that the testing method was reliable and both mat and ball exercises can improve abdominal strength. Although the ball exercises produced the largest strength gain, testing with a larger sample will be necessary to establish a clear advantage for this technique.
The Journal of Manual & Manipulative Therapy Vol. 7 No. 4 (1999), 197 - 202
* this issue only available in PDF format
