Journal of Orthopaedic & Sports Physical Therapy - Carl G. Mattacola, PhD, ATC

A Comparison of Select Trunk Muscle Thickness Change Between Subjects With Low Back Pain Classified in the Treatment-Based Classification System and Asymptomatic Controls

Tue, 28 Aug 2007 00:00:00 EST

Kyle B. Kiesel, Arthur J. Nitz, Terry R. Malone, Frank B. Underwood, Carl G. Mattacola
STUDY DESIGN: Cross-sectional descriptive. OBJECTIVES: To investigate if muscle thickness change, as measured with rehabilitative ultrasound imaging (RUSI), is different across subgroups of patients with low back pain (LBP) classified in the Treatment-Based Cassification (TBC) system when compared to controls. BACKGROUND: Researchers have demonstrated that subgroups of patients with LBP exist and respond differently to treatment, challenging the assertion that LBP is "nonspecific." The TBC system uses 4 categories (stabilization, mobilization, direction-specific exercise, or traction) to subgroup patients. Recently, researchers have demonstrated impairments of the transverse abdominis (TrA) and lumbar multifidus (LM) in those with LBP, regardless of classification. Although distinct differences in impairments have been identified between sub-groups, TrA and LM impairments have not been studied and may be present across categories of the TBC system. METHODS AND MEASURES: RUSI was utilized to measure percent thickness change from rest to contracted state during a voluntary task of the TrA and during an upper extremity task known to activate the LM in 56 subjects classified in the TBC system and 20 controls. RESULTS: During the prone upper extremity lifting task with a hand weight, there was a significant group difference for the LM at L4-L5 (P = .03) and at L5-S1 (P = .04), and during volitional activation for the TrA (P<.01). Post-hoc testing revealed the differences were between controls and both the direction-specific and stabilization categories at the L4-L5 level, between control and direction-specific category for the L5-S1 level, and between controls and all 3 categories for the TrA. CONCLUSION: Deficits in the ability to generate muscle thickness changes in the TrA and LM occurred across categories of the TBC system. Intervention studies should be performed to determine if intervention can correct these deficits and if deficit corrections are related to outcomes.

J Orthop Sports Phys Ther. 2007;37(10):596-607, published online 28 August 2007. doi:10.2519/jospt.2007.2574. The original article was corrected in March 2008, and the amended article PDF is provided here. Please see Correction: A comparison of select trunk muscle thickness change between subjects with low back pain classified in the treatment-based classification system and asymptomatic controls. J Orthop Sports Phys Ther. 2008;38(3):161.

KEY WORDS: multifidus, sonography, spine stabilization, therapeutic exercise, transverse abdominis

Effect of a Semi-Rigid Ankle Stabilizer on Performance in Persons With Functional Ankle Instability

Mon, 05 Feb 2007 09:45:00 EST

Toni-Marie Verrone Hals, Michael R. Sitler, Carl G. Mattacola

Study Design: Within-group repeated measures. Objectives: To determine the effect of a semi-rigid prophylactic ankle stabilizer (PAS) on performance of subjects with post-acute, unilateral ankle sprains who have mechanically stable ankles, but are functionally impaired. Background: Most studies on PAS performance to date are limited to subjects with noninjured, nonimpaired ankles. No research has been reported to determine the effect PASs have on performance in subjects who have a mechanically stable, nonacute ankle sprain with functional impairment. Methods and Measures: Twenty-five subjects (8 men and 17 women; average height = 168.91 ± 33.02 cm, average weight = 61.10 ± 29.5 kg, and average age = 16.2 ± 6 years) met the qualification criteria of the study. Subjects had unilateral grade I or II lateral ankle sprains of 3 to 4 weeks duration and were cleared medically to return to activities of daily living. Each subject's injured ankle was mechanically stable as determined by physical exam but was functionally impaired as determined by instability during the modified Rhomberg test. Separate 2 x 2 ANOVAs with repeated measures on brace condition (Aircast SportStirrup and nonbraced control) and test session (test session 1 and test session 2) were completed to assess the effect of ankle stabilization on 2 dependent variables (36.58-m shuttle-run and vertical-jump). Results: Shuttle-run time was significantly faster for the braced condition (mean = 9.43 ± .72 seconds) than for the nonbraced control (mean = 9.57 ± .75 seconds), regardless of test session. Shuttle-run time was significantly faster for test session 2 (mean = 9.43 ± .79 seconds) than for test session 1 (mean = 9.57 ± .68 seconds), regardless of brace condition. No significant main or interaction effects occurred for vertical-jump. Conclusions: Use of a semi-rigid PAS significantly increased shuttle-run but not vertical-jump performance. This effect was immediate and did not require PAS acclimation.

J Orthop Sports Phys Ther. 2000;30(9):552-556.

Key Words: postural instability unilateral ankle sprain

Shoulder Musculature Activation During Upper Extremity Weight-BearingExercise

Wed, 06 Dec 2006 00:00:00 EST

Thomas J. Carver, Scott D. Mair, Arthur J. Nitz, Carl G. Mattacola, Timothy L. Uhl

Study Design: Repeated-measures design comparing 7 static weight-bearing shoulder exercises. Objective:The purpose of this study was to determine the demand on shoulder musculature during weight-bearing exercises and the relationship between increasing weight-bearing posture and shoulder muscle activation. Background: Weight-bearing shoulder exercises are commonly prescribed in the rehabilitation of shoulder injuries. Limited information is available as to the demands placed on shoulder musculature while these exercises are performed. Methods: Eighteen healthy college students volunteered for this study. Surface bipolar electrodes were applied over the infraspinatus, posterior deltoid, anterior deltoid, and pectoralis major muscles. Fine-wire bipolar intramuscular electrodes were inserted into the supraspinatus muscle. Electromyographic (EMG) root mean square signal intensity was normalized to 1 second of EMG obtained with a maximal voluntary isometric contraction (MVIC). Subjects were tested under 7 isometric exercise positions that progressively increased upper extremity weight-bearing posture. Results: There was a high correlation between increasing weight-bearing posture and muscular activity (r = 0.97, p<0.01). There was relatively little demand on the shoulder musculature for the prayer and quadruped positions (2%-10% MVIC). Muscular activation was greater for the infraspinatus than for other shoulder muscles throughout most of the exercise positions tested. Conclusion: These results indicate that alterations of weight-bearing exercises, by varying the amount of arm support and force, resulted in very different demands on the shoulder musculature. Specifically, the infraspinatus was particularly active during the weight-bearing exercises used in this study.

J Ortho Sports Phys Ther. 2003;33:109-117.

Key Words: electromyography, muscles, progressive resistive exercise, rehabilitation