Effect of motor control training on hip muscles in elite football players with and without low back pain

Objectives: Previous research has shown that motor control training improved size and function of trunk muscles in elite football players with and without low back pain (LBP). Imbalances in hip muscles have been found in athletes with LBP and it is not known if motor control training can change these muscles. This study investigated if a motor control intervention program affected hip muscle size in elite football players with and without LBP. Design: Panel-randomised intervention design. Methods: Forty-six players from one club in the Australian Football League (AFL) participated in a motor control training program delivered across the season as a stepped-wedge intervention design with 3 treatment arms: 15 weeks intervention, 8 weeks intervention and a wait-list control who received 7 weeks intervention toward the end of the playing season. Presence of LBP was assessed by interview and physical examination. Cross-sectional areas of iliacus, psoas, iliopsoas, sartorius, gluteus minimus, and gluteus medius muscles were measured from magnetic resonance images taken at 3 time points during the season. Results: Iliopsoas, sartorius and gluteus medius muscle size increased for players who received intervention (p < 0.05). For players with current LBP, sartorius and gluteus medius muscle size increased for those who received motor control training (p < 0.05). Conclusions: Motor control training programs aimed at the lumbo-pelvic region also benefit the hip muscles. For players with current LBP, the intervention mitigated sartorius muscle atrophy and increased gluteus medius muscle size. These findings may help guide the management of LBP in elite football players

The relationship between the piriformis muscle, low back pain, lower limb injuries and motor control training among elite football players

Objectives: Australian Football League (AFL) players have a high incidence of back injuries. Motor control training to increase lumbopelvic neuromuscular control has been effective in reducing low back pain (LBP) and lower limb injuries in elite athletes. Control of pelvic and femoral alignment during functional activity involves the piriformis muscle. This study investigated (a) the effect of motor control training on piriformis muscle size in AFL players, with and without LBP, during the playing season, and (b) whether there is a relationship between lower limb injury and piriformis muscle size. Design: Stepped-wedge intervention. Methods: 46 AFL players participated in a motor control training programme consisting of two 30. min sessions per week over 7-8 weeks, delivered across the season as a randomised 3 group single-blinded stepped-wedge design. Assessment of piriformis muscle cross-sectional area (CSA) involved magnetic resonance imaging (MRI) at 3 time points during the season. Assessment of LBP consisted of player interview and physical examination. Injury data were obtained from club records. Results: An interaction effect for Time, Intervention Group and LBP group (F=3.7, p=0.03) was found. Piriformis muscle CSA showed significant increases between Times 1 and 2 (F=4.24, p=0.046), and Times 2 and 3 (F=8.59, p=0.006). Players with a smaller increase in piriformis muscle CSA across the season had higher odds of sustaining an injury (OR. =1.08). Conclusions: Piriformis muscle size increases across the season in elite AFL players and is affected by the presence of LBP and lower limb injury. Motor control training positively affects piriformis muscle size in players with LBP

Quadratus femoris: an EMG investigation during walking and running

Dysfunction of hip stabilizing muscles such as quadratus femoris (QF) is identified as a potential source of lower extremity injury during functional tasks like running. Despite these assumptions, there are currently no electromyography (EMG) data that establish the burst activity profile of QF during any functional task like walking or running. The objectives of this study were to characterize and compare the EMG activity profile of QF while walking and running (primary aim) and describe the direction specific action of QF (secondary aim). A bipolar fine-wire intramuscular electrode was inserted via ultrasound guidance into the QF of 10 healthy participants (4 females). Ensemble curves were generated from four walking and running trials, and normalized to maximum voluntary isometric contractions (MVICs). Paired t-tests compared the temporal and amplitude EMG variables. The relative activity of QF in the MVICs was calculated. The QF displayed moderate to high amplitude activity in the stance phase of walking and very high activity during stance in running. During swing, there was minimal QF activity recorded during walking and high amplitudes were present while running (run vs walk effect size = 4.23,

A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study

Background Sports concussion is a risk for players involved in high impact, collision sports. Post-concussion, the majority of symptoms subside within 7–10 days, but can persist in 10–20% of athletes. Understanding the effects of sports concussion on sensorimotor systems could inform physiotherapy treatment. Objective To explore changes in sensorimotor function in the acute phase following sports concussion. Design Prospective cohort study. Methods Fifty-four players from elite rugby union and league teams were assessed at the start of the playing season. Players who sustained a concussion were assessed three to five days later. Measures included assessments of balance (sway velocity), vestibular system function (vestibular ocular reflex gain; right-left asymmetry), cervical proprioception (joint position error) and trunk muscle size and function. Results During the playing season, 14 post-concussion assessments were performed within 3–5 days of injury. Significantly decreased sway velocity and increased size/contraction of trunk muscles, were identified. Whilst not significant overall, large inter-individual variation of test results for cervical proprioception and the vestibular system was observed. Limitations The number of players who sustained a concussion was not large, but numbers were comparable with other studies in this field. There was missing baseline data for vestibular and cervical proprioception testing for some players. Conclusions Preliminary findings post-concussion suggest an altered balance strategy and trunk muscle control with splinting/over-holding requiring consideration as part of the development of appropriate physiotherapy management strategies

Clinical effectiveness of a physiotherapy-led, hospital-based vestibular service

BACKGROUND: To investigate clinical effectiveness of a physiotherapy-led, hospital-based vestibular service by assessing initial and longer-term clinical outcomes, and to compare outcomes for immediate and delayed intervention pathways. METHODS: Pragmatic, prospective, observational study reporting baseline, discharge and follow-up outcomes. Set in hospital-based vestibular rehabilitation service including emergency/acute settings and those referred to out-patients. Participants included adults (N.=193) presenting to hospital with non-emergent dizziness (mean age: 64.21±15.28 years; female 60%). Physiotherapy vestibular diagnostic tests categorized people as vestibular/non-vestibular. Vestibular rehabilitation commenced immediately (<48 hours of hospital presentation) or was delayed (referred and wait-listed for outpatient services, average 22 days). Vestibular rehabilitation, a program of exercises, consisting of eye/head movements integrated with balance and mobility exercises designed to promote adaptive vestibular system changes. Dizziness impairment, functional vestibular ocular reflex, static balance, gait velocity and functional gait were measured at initial presentation, discharge, and 3 months post-discharge. RESULTS: Participants had significantly reduced dizziness and significantly improved functional gait at discharge, which was maintained 3 months post-discharge (P≤0.001). Both immediate and delayed intervention groups reported significantly reduced dizziness impairment (P≤0.001) but only the immediate group significantly improved in all mobility measures (P≤0.005). Resultant symptoms and functional impact of a vestibular disorder did not significantly subside to normal without vestibular rehabilitation, even 3 weeks after presenting to hospital. CONCLUSIONS: Physiotherapy-led vestibular service was clinically effective in managing people presenting to hospital with suspected vestibular dysfunction with outcomes maintained in the longer term. Immediate intervention allows for quicker improvements in symptoms, and patients’ symptoms do not spontaneously resolve whilst waiting for intervention

A systematic review of patient-reported measures associated with vestibular dysfunction

Objectives/Hypothesis Use of clinical questionnaires to assist in the screening of vestibular disorders in the acute hospital setting is needed. The objective is to detail the clinimetric properties and clinical utility of patient-reported questionnaires for quantifying dizziness/vertigo symptoms associated with vestibular dysfunction, and to determine validity and utility for screening dizziness/vertigo in the emergency department. Data Sources We performed a systematic review of PubMed, CINAHL, Embase, and Web of Science in May 2015. Methods Two independent reviewers selected studies reporting clinimetric properties of patient-reported questionnaires that aim to evaluate symptomology of dizziness/vertigo associated with vestibular dysfunction. A third reviewer resolved disparities. Of 1,901 articles initially found in the database search, 58 articles and 9 patient-reported questionnaires were included. Results Clinimetric properties of content validity, criterion validity, internal consistency, inter-/intrarater reliability, test–retest reliability, and responsiveness to vestibular rehabilitation are reported, and methodological quality is rated using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist. Clinical utility is described in terms of target population, purpose, number of items, and whether the questionnaire was validated in the emergency department. Conclusions The Vestibular Rehabilitation Benefit Questionnaire, a relatively new tool, scored an “excellent” rating on three COSMIN criteria, and may be the best measure to address treatment outcomes. Questions on respective tools ranged from nine to 36, and no questionnaire was validated in the emergency department. Due to the number of questions and lack of validity, none of the questionnaires was deemed appropriate as a screening tool for dizziness/vertigo in the emergency department

Evaluation of patellar tendinopathy using the single leg decline squat test: is pain location important?

Study design: A cross-sectional study of non-elite volleyball players aged 13–17years.Objectives: To evaluate the presence and location of pain during the single leg decline squat (SLDS) and compare patellar tendon thickness, structure, neovascularisation and symptom severity between SLDS-derived groups.Methods: 32 male and 25 female participants attending a 5-day volleyball training camp underwent clinical evaluation by SLDS, describing the location of pain during this test using a pain map. The patellar tendon was examined using ultrasound imaging, performed by an assessor blinded to other assessments. Differences between participants experiencing local patellar tendon pain (PTP), other knee pain (OKP) or no-pain during the SLDS were evaluated.Results: Fifteen (26.3%) participants experienced pain during the SLDS. Local PTP was recorded for 12.3% and OKP for 10.5% of right legs. The PTP group was distinguished from the other groups by larger thickness and cross-sectional area of the mid-patellar tendon (p\ua

The effect of motor control training on abdominal muscle contraction during simulated weight bearing in elite cricketers

Objectives: To investigate whether motor control training alters automatic contraction of abdominal muscles in elite cricketers with low back pain (LBP) during performance of a simulated unilateral weight bearing task.Design: Clinical trial.Methods: 26 male elite-cricketers attended a 13-week cricket training camp. Prior to the camp, participants were allocated to a LBP or asymptomatic group. Real-time ultrasound imaging was used to assess automatic abdominal muscle response to axial loading. During the camp, the LBP group performed a staged motor control training program. Following the camp, the automatic response of the abdominal muscles was re-assessed.Results: At pre-camp assessment, when participants were axially loaded with 25% of their own body weight, the LBP group showed a 15.5% thicker internal oblique (IO) muscle compared to the asymptomatic group (p = 0.009). The post-camp assessment showed that participants in the LBP group demonstrated less contraction of the 10 muscle in response to axial loading compared with the asymptomatic group. A trend was found in the automatic recruitment pattern of the transversus abdominis (p = 0.08).Conclusions: Motor control training normalized excessive contraction of abdominal muscles in response to a low load task. This may be a useful strategy for rehabilitation of cricketers with LBP. (C) 2016 Elsevier Ltd. All rights reserved

Concurrent validity and responsiveness to change of the vestibular screening tool

BACKGROUND: Vestibular disorders are common in the Emergency Department and valid tools are required to screen for vestibular disorders and monitor outcomes. The aim was to determine the new vestibular screening tool’s (VST) concurrent validity with the dizziness handicap inventory (DHI), responsiveness to change in symptoms after vestibular rehabilitation across the continuum of care and the minimal clinically important difference. METHODS: Longitudinal prospective study undertaken with adults (N.=195) presenting to hospital with non-emergent dizziness (mean age=64.4±15.4 years; female=59.5%). The VST and DHI were completed concurrently at three assessment points: initial, discharge and 3-month follow-up. Physiotherapy tests categorized people (vestibular/non-vestibular). People in the vestibular group were offered treatment. RESULTS: The VST demonstrated moderate to high associations with DHI total (r=0.673-0.768) with DHI physical sub-category scores (r=0.759-0.809) at each assessment-point. The mean change scores for both measures significantly decreased across the continuum of care (P≤0.05) with a clinically meaningful VST change score of 2-points determined. Across the care pathway, moderate to high associations presented between changes in VST and DHI total scores (r=0.697-0.709). CONCLUSIONS: The VST demonstrates concurrent validity with the DHI and is responsive to change following vestibular rehabilitation intervention. The VST could be clinically useful in a hospital setting