Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP

Effects of a 12-Week Global Corrective Exercise Intervention on Sway Back Posture in Young Adults: A Randomized Controlled Trial

Background: Sway back posture (SBP) is a common postural deviation of sagittal alignment and is the most common postural deviation in 18 to 28-year-old individuals, but there is no standard exercise protocol for treating SBP. Our objective was to assess the effectiveness of the global corrective exercise intervention (GCEI) on spinal posture of healthy individuals 18-25 years of age with SBP. Methods: This study was a randomized controlled design with a parallel group, two-arm trial with 1:1 allocation ratio. Seventy participants (mean age 20.9±2.1 years) with SBP (⩾ 10°) were enrolled in the study for 12 weeks. The participants were randomly assigned to an exercise (n=35) or control group (n=35). The targeted global spine strengthening and stretching exercise intervention included core and postural training, delivered by a corrective exercise specialist in 2 groups of 20 and 15 participants 3 times a week for 12 weeks. Forward head angle and sway angle were measured using a digitized side-view photograph. Kyphosis index and llordosis index were measured using a flex curve ruler. Results: The 12-week intervention program resulted in significant within group differences in forward head, kyphosis, lordosis and postural sway angle (p<0.001). There was also a significant between group difference in the changes of all postural variables (p<0.001). Conclusions: The GCEI resulted in improved sway back posture in our sample of 18-25-year-old participants. This study supports the theoretical basis for clinical rehabilitation of postural deviations. Further studies are required to generalize these findings to other age and population groups. Key words: posture, sway back, corrective exercise, spinal alignmen

Effects of a 12-Week Global Corrective Exercise Intervention on Sway Back Posture in Young Adults: A Randomized Controlled Trial

Background: Sway back posture (SBP) is a common postural deviation of sagittal alignment and is the most common postural deviation in 18 to 28-year-old individuals, but there is no standard exercise protocol for treating SBP. Our objective was to assess the effectiveness of the global corrective exercise intervention (GCEI) on spinal posture of healthy individuals 18-25 years of age with SBP. Methods: This study was a randomized controlled design with a parallel group, two-arm trial with 1:1 allocation ratio. Seventy participants (mean age 20.9±2.1 years) with SBP (⩾ 10°) were enrolled in the study for 12 weeks. The participants were randomly assigned to an exercise (n=35) or control group (n=35). The targeted global spine strengthening and stretching exercise intervention included core and postural training, delivered by a corrective exercise specialist in 2 groups of 20 and 15 participants 3 times a week for 12 weeks. Forward head angle and sway angle were measured using a digitized side-view photograph. Kyphosis index and llordosis index were measured using a flex curve ruler. Results: The 12-week intervention program resulted in significant within group differences in forward head, kyphosis, lordosis and postural sway angle (p<0.001). There was also a significant between group difference in the changes of all postural variables (p<0.001). Conclusions: The GCEI resulted in improved sway back posture in our sample of 18-25-year-old participants. This study supports the theoretical basis for clinical rehabilitation of postural deviations. Further studies are required to generalize these findings to other age and population groups. Key words: posture, sway back, corrective exercise, spinal alignmen

The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis.

ObjectiveThe purpose of this study was to investigate the intra-rater reliability and validity of a designed load cell setup for the measurement of back extensor muscle force and endurance.ParticipantsThe study sample included 19 older women with hyperkyphosis, mean age 67.0 ± 5.0 years, and 14 older women without hyperkyphosis, mean age 63.0 ± 6.0 years.MethodsMaximum back extensor force and endurance were measured in a sitting position with a designed load cell setup. Tests were performed by the same examiner on two separate days within a 72-hour interval. The intra-rater reliability of the measurements was analyzed using intraclass correlation coefficient (ICC), standard errors of measurement (SEM), and minimal detectable change (MDC). The validity of the setup was determined using Pearson correlation analysis and independent t-test.ResultsUsing our designed load cell, the values of ICC indicated very high reliability of force measurement (hyperkyphosis group: 0.96, normal group: 0.97) and high reliability of endurance measurement (hyperkyphosis group: 0.82, normal group: 0.89). For all tests, the values of SEM and MDC were low in both groups. A significant correlation between two documented forces (load cell force and target force) and significant differences in the muscle force and endurance among the two groups were found.ConclusionThe measurements of static back muscle force and endurance are reliable and valid with our designed setup in older women with and without hyperkyphosis

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

OBJECTIVE:The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS:Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS:Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS:Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women

Exercise for Improving Age-Related Hyperkyphotic Posture: A Systematic Review

OBJECTIVE: To evaluate previous research to determine if exercise can improve preexisting hyperkyphosis by decreasing the angle of thoracic kyphosis in adults aged ≥45 years. DATA SOURCES: PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature databases were searched for studies related to posture, exercise, and age ≥45 years. Online conference proceedings of the American Society for Bone and Mineral Research, American Physical Therapy Association, and Gerontological Society of America were also searched. STUDY SELECTION: Two independent reviewers screened the titles and abstracts and selected studies that tested the effect of exercise on measures of kyphosis, or forward head posture, in individuals with hyperkyphosis at baseline (defined as angle of kyphosis ≥40°). Reviews, letters, notes, and non-English language studies were excluded. DATA EXTRACTION: A pilot-tested abstraction form was used by each reviewer to extract data from each study regarding details of exercise intervention, participant characteristics, safety, adherence, and results. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess methodologic quality. Discrepancies on the abstraction forms between the 2 reviewers were resolved by a third reviewer. A formal meta-analysis was not performed. DATA SYNTHESIS: Thirteen studies were abstracted and included in the review; of these, 8 studies saw improvements in ≥1 measure of posture. The main sources of bias were related to blinding participants and incomplete outcome data. The adherence reported across studies suggests that exercise is an acceptable intervention for individuals with age-related hyperkyphosis. CONCLUSIONS: The scarcity and quality of available data did not permit a pooled estimate of the effect of exercise on hyperkyphotic posture; however, the positive effects observed in high-quality studies suggest some benefit and support the need for an adequately designed randomized controlled trial examining the effect of exercise on hyperkyphosis

Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the osteoporotic fractures in men (MrOS) research group

BACKGROUND: The prevalence of hyperkyphosis is increased in older men; however, risk factors other than age and vertebral fractures are not well established. We previously reported that poor paraspinal muscle composition contributes to more severe kyphosis in a cohort of both older men and women. METHODS: To specifically evaluate this association in older men, we conducted a cross-sectional study to evaluate the association of paraspinal muscle composition and degree of thoracic kyphosis in an analytic cohort of 475 randomly selected participants from the Osteoporotic Fractures in Men (MrOS) study with baseline abdominal quantitative computed tomography (QCT) scans and plain thoracic radiographs. Baseline abdominal QCT scans were used to obtain abdominal body composition measurements of paraspinal muscle and adipose tissue distribution. Supine lateral spine radiographs were used to measure Cobb angle of kyphosis. We examined the linear association of muscle volume, fat volume and kyphosis using loess plots. Multivariate linear models were used to investigate the association between muscle and kyphosis using total muscle volume, as well as individual components of the total muscle volume, including adipose and muscle compartments alone, controlling for age, height, vertebral fractures, and total hip bone mineral density (BMD). We examined these associations among those with no prevalent vertebral fracture and those with BMI < 30 kg/m(2). RESULTS: Among men in the analytic cohort, means (SD) were 74 (SD = 5.9) years for age, and 37.5 (SD = 11.9) degrees for Cobb angle of kyphosis. Men in the lowest tertile of total paraspinal muscle volume had greater mean Cobb angle than men in the highest tertile, although test of linear trend across tertiles did not reach statistical significance. Neither lower paraspinal skeletal muscle volume (p-trend = 0.08), or IMAT (p-trend = 0.96) was associated with greater kyphosis. Results were similar among those with no prevalent vertebral fractures. However, among men with BMI < 30 kg/m(2), those in the lowest tertile of paraspinal muscle volume had greater adjusted mean kyphosis (40.0, 95% CI: 37.8 – 42.1) compared to the highest tertile (36.3, 95% CI: 34.2 – 38.4). CONCLUSIONS: These results suggest that differences in body composition may potentially influence kyphosis

Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN.</p> <p>Methods/Design</p> <p>Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment.</p> <p>Discussion</p> <p>Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN23032339</p