Category Archives: Research Review

Icing Injuries: Are We Evidence-Based?

Are you an evidence-based practitioner? Think about it; are you really?

An athletic trainer working a Division 1 women’s volleyball tournament with elite Top-25 teams sent me a text: “You should do a study on the average number of ice bags used by volleyball teams after a match… Entire teams are getting ice on both knees and the hitting shoulder. No post-match mobility work, just pounds of ice. Crazy! Some athletic trainers and strength and conditioning coaches are too ignorant and too lazy to provide proper warm-up and cool-down protocols to address mobility.” This is not shocking to me. I worked with Division I volleyball for several years and I observed this too. This is where I learned ice is overused.  This isn’t just a volleyball thing; this is an all-sport issue. Continue reading

ACL Injury: New Information on Prevention, Rehabilitation, and Consequences

I have written about knee injuries so much. Every day we are bombarded with research that quite frankly, it gets boring. The problem is with approximately a quarter-million ACL injuries per year, it is safe to say the injury is rampant. The devastating nature and commonality of the injury has provided loads of information on prevention, rehabilitation and mechanisms of injury. I am not going to regurgitate them all, but do want to share some recently published articles that sports medicine experts should read.

Article 1: Negahban, Et al. A systematic review of postural control during single-leg stance in patients with untreated anterior cruciate ligament injury. Knee Surgery Sports Traumatology and Arthroscopy, May, 2013.

I love systematic lit reviews and this SLR aimed to determine postural control on those with ACL injuries. We have many internal systems and senses that help us balance.  Beyond the use of our eyes and ears to sense balance, tiny mechanoreceptors and proprioceptors exist in our tissue that sense abnormal movement. This study found that when the eyes are closed individuals with ACL injuries had increased postural sway and loss of balance. This indicates that the injury and inflammation following injury inhibits our body’s internal mechanism to sense balance. When rehabilitating, be sure to emphasize proprioception exercises.

Article 2: Thomas, Abbey, et al.  Lower Extremity Muscle Strength After Anterior Cruciate Ligament Injury and Reconstruction. Journal of Athletic Training published online first, 2013.

Despite advances in rehabilitation and the numerous studies published on ACL rehabilitation protocols, we appear to be failing. This study shows that at 6 months Status Post ACL reconstruction that global weakness still exists. When comparing strength output from injured vs. uninjured legs it appears the knee-extensors (quads) and knee flexors (hamstrings) are weaker at 6 months when compared to the contralateral side. Conversely hip and ankle strength was not significantly different at 6 months. The timeline to return a player back to competition and activity is 6 months following activity and/or 95% strength of the uninjured side. This study indicates 6 months might be too early. Also, we may need to adjust our strengthening protocols to further stress knee flexion / extension strength.

Article 3 – Bell, DR, Clark, MA, Padua, DA, et al., Two- and 3-Dimensional Knee Valgus Are Reduced After an Exercise Intervention in Young Adults With Demonstrable Valgus During Squatting. Journal of Athletic Training published online first, 2013.

Darin Padua and the UNC Department of Exercise and Sport Science has done a lot of work on knee displacement and correlating the findings with ankle hypomobility and hip underactivity. This particular model used the NASM Corrective Exercise Model as the intervention procedure. This method systematically turns off hyperactive tissue and activates hypotonic tissues. The data revealed that following intervention of the ankle and hip medial knee displacement was significantly reduced.  This information is important as several studies have shown medial knee displacement to be a primary cause of ACL injuries and chronic knee pain.

Article 4: Ericksen, et, al. Different Modes of Feedback and Peak Vertical Ground Reaction Force During Jump Landing: A Systematic Review. Journal of Athletic Training published online first, 2013.

The inability of the body to absorb and control joint movement during high levels of ground reaction forces has been shown to increase risk of ACL injury as well as other chronic knee conditions.  This study evaluated the effect of expert provided and self-analysis feedback reduced peak ground reaction forces. This is not a paramount study but does shows the effectiveness of verbal queuing and observation to correct suboptimal neuromuscular control, specifically during landing and absorption of ground reaction forces through the kinetic chain. Rehab practitioners should incorporate feedback to teach clients appropriate muscle control during ACL rehabilitation.

I would like to say thank you to Darin Padua, PhD, ATC for keeping me abreast with current data. Darin is a leader in sports medicine research and specifically has many published papers on ACL injuries. Darin manages his blog site and also shares info on his twitter account. If you are a health and wellness professional seeking important information rehabilitation and prevention of injury, I recommend you give Darin a follow.

Cheers!

Recommended Readings for Health and Wellness Geeks: March, 2013

Each day we are bombarded with new data. My goal is to share a breakdown of what I have discovered and read this past month. There is a little something for everyone here. How do I choose which articles to share? Is it clinically relevant? Does the story share something new or raise an interesting question? Most studies have some internal flaw that can be poked and while I try to only share those having high quality, my number one goals is to share something unique, progressive or surprising.

Published research:

In the recent release of The American Journal of Clinical Nutrition there is a good article supporting the benefits of a high-protein breakfast. Data reveals that a high-protein diet alters ghrelin and peptide YY concentrations subsequently leading to decreased appetite and also curbed late night snacking. Is this study perfect – no. But it is pretty darn good – Yes. I have been blogging on this topic for sometime. Where, when and why did the public begin thinking high protein intake is unhealthy? Did you know quality of protein is measured by how it compares to egg protein? That is because the protein in egg, albumin, has near perfect amino acid distribution. Yet many consider eggs bad.

Here is another topic area I have been yapping about for some time – risk factors for hamstring strains. This systematic literature review was first published online and is now in print in the latest edition of the British Journal of Sports Medicine. This SLR included 34 articles for review, which is a pretty good number to include. Unfortunately, only 1 evaluated hip extension strength. Three found decreased hip extension ROM measures indicating shortened hip flexors. It baffles me as to why studies do not look at glute weakness and hip flexor tightness as a risk factor for hamstring strains. I’ve written about this and hope someday a good study will come out and study the correlation.

Mild Traumatic Brain Injury – MTBI is getting a lot of media attention lately and rightfully so. NFL labor union disputes and an enormous amount of published research has athletes and parents taking MTBI seriously. If that wasn’t enough, Junior Seau’s suicide was linked to depression secondary to chronic TBI. In the Archives of Physical Medicine and Rehabilitation, April 2013 issue, an article discusses depression after TBI. It’s a nice short quick-hitting synopsis, with full-text available.

Website finds:

I subscribe to daily email updates from ScienceDialy. Two or three times per week they share something good that I get caught reading. Two articles they shared link positive benefits of Vitamin D. One shows that Vitamin D replacement improves muscle efficiency and another found Vitamin D may lower diabetes risk in children. Now I am not advocating to go overboard on Vitamin D, but I am saying drink Vitamin D fortified milk and cereals and get outside in the sun to ensure you are getting adequate vitamin D.

ScienceDaily also had an write-up that I loved regarding foods to help fight inflammation. The article states citrus fruits, dark leafy green vegetables, tomatoes, and foods high in omega-3s, such as salmon are anti-inflammatory foods. Notice none of these foods are grains, breads and/or pasta. All are earth foods and not processed. This supports and is similar to blogs I wrote previously: how the US Food Guide Pyramid and MyPlate could be to blame for our chronic disease epidemic, another which is very similar linking arthritis and osteoarthritis to diet. Finally two of my most popular posts written Stop Destroying Your Body and Is Your Diet Making You Sick discuss the link between diet and disease.

Must Read Blogs:

There are so many smart people out there and I enjoy learning from them all. Here are some good blog posts from this month.

The first is from Sport Injury Matt (@SportInjuryMatt – twitter handle). He had two posts about foot mechanics and foot wear. Part I shares good crucial information on foot mechanics. Part II of this post talks about what one should run in and considerations when selecting certain shoes.

My good friend Jay Barss (@sportsrehabtalk – twitter handle) is new to the blog and twitter world. He is a smart dude and deserves some following. His most recent post talks about the a new perspective on management on patellofemoral pain management. As we all know, correction of faulty movement patterns is critical in management of the oft-diagnosed PFPS.

Last is a series posted by  Allan Besselink (@abesselink – twitter handle). If you have not followed Allan’s blog I highly recommend it. In fact his blog was recently nominated as top choice for health and wellness. Everything he posts is high quality. I particularly liked his three-part series titled the Low Back Pain Paradox. Low back pain effects 80% of the adult population and Allan does a great job covering all the bases in Part I, Part II, and Part III.

Stay healthy and well!

Recommended Reading for Sports Performance and Sports Medicine Geeks Everywhere

Sharing a breakdown of what I have discovered and read this past month. There is a little something for everyone here. Although there is a lot out there, these four articles (2 sports medicine, 2 performance)  are my favorites. All have something unique, progressive or surprising about them. Enjoy!

Sports Medicine:

Muscle Force Output and Electromyographic Activity in Squats with Various Unstable Surfaces, from the latest JSCR.

When progressing through rehabilitation programs the practitioner consistently battles the question of priority: improve strength and risk pain, set-back? Do we focus on balance and have slow progression to strength development? Can we super-set strength with balance? Can we go hard strength one day and light balance the next? Here’s a novel idea (sarcasm), let’s do both at once.

Saeterbakken and Finland measured muscle force output through on stable and unstable surfaces. The measurement was done through surface EMG, and, yes, I question reliability of surface EMG, but it is the best option out there.  What the authors found was surprising and useful. Performing isometric exercise on an unstable surface (BOSU Ball) produced lower force output, but muscle in the trunk and lower limb was similar when compared to the stable surface.

Why is this important? We have a solution to the aforementioned dilemma. We can overload the muscle to stimulate strength gains, while avoiding the load. This allows practitioners to meet obtain strength gains while avoiding the risk of set-back associated with high loading.

Full reference: Saeterbakken, AH and Finland, MS. Muscle force output and electromyographic activity in squats with various unstable surfaces. J Strength Cond Res 27(1): 130–136, 2013

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Assessing Post-surgical ACL Postural Control using a Wii Board was an article I came across Sports Med Research BlogSpot.

At first I was tepid on this article figuring it was just another article showing how Wii can be used as a modality to improve balance control. I quickly jumped to the conclusion and began saying “people, it’s not the Wii board; it’s the task of balancing and stressing local and global neuromuscular control mechanisms to improve postural control.” To my surprise I was wrong.

The authors did something rather unique and plugged the Wii board in to a laptop and utilized a customized software program to assess postural control. The authors received high-quality data that may help clinicians objectively quantify postural control and neuromuscular inefficiency. Few assessments exist that provide objective, reliable data. I would love to see the authors do another study to examine the specificity and sensitivity of assessment.

Full reference: Howells BE, Clark RA, Ardern CL, Bryant AL, Feller JA, Whitehead TS, & Webster KE. Br J of Sports Med. Epub ahead of print Dec 25, 2012.

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Performance Training:

EFFECTS OF COMBINED CREATINE AND SODIUM BICARBONATE SUPPLEMENTATION ON REPEATED SPRINT PERFORMANCE IN TRAINED MEN, from the latest JSCR.

When working with athletes on maximal speed or speed endurance, human physiology is our biggest limiting factor. Training allows body adaptation and physiological changes to improve performance and curb fatigue, but physiology is physiology – it can only be altered so much. Thus, supplements exist to cheat human physiology.

First a quick exercise physiology review. When performing maximal exertion activity the phosphocreatine system kicks in. Our cells gobble up free floating phosphocreatine stores as our primary source of energy. This energy supply gives us a maximum of 10 seconds worth of energy. Quickly our body begins breaking down glycogen stores so our body as energy to keep producing movement. After 60-90 seconds though if our intensity is still too high we hit our lactate threshold – the period where lactic acid build exceeds the cells removal rate – causing increased cellular acidity. Acidity inhibits enzymatic function and if you recall on your exercise physiology class; enzymes are responsible for breakdown of substrates to energy. So, 2 physiological factors inhibiting performance; 1- depletion of phosphocreatine, and 2- increased acidity causing enzymatic inhibition.

This study examines the combined effects of creatine and sodium bicarbonate (to retard acidic effects) supplementation of sprint performance. To no surprise the authors found that the combination of these supplements increased peak / mean power and attenuated the decline in power. Alas, we found a way to cheat human physiology.

Full reference: Barber, JJ, McDermott, AY, McGaughey, KJ, Olmstead, JD, and Hagobian, TA. Effects of combined creatine and sodium bicarbonate supplementation on repeated sprint performance in trained men. J Strength Cond Res. 27(1): 252–258, 2013.

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EFFECTS OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION STRETCHING AND STATIC STRETCHING ON MAXIMAL VOLUNTARY CONTRACTION, from the latest JSCR.

A study done a few years ago demonstrated static stretching reduced power output and performance. Since then, there has been a lot of debate and negative press on static stretching on maximal voluntary contraction (MVC). Suddenly performance experts are saying “Static stretching is the worst thing you can do.”

This is not true! First the performance declined occurred after 45 second static holds. When a stretch was held for 30 seconds or less – as recommended – there was no performance loss. This was supported by a systematic literature review done Kay and Blazevich, published in Medicine and Science in Sports and Exercise last year (Jan 2012). This current study examined effects of Proprioceptive Neuromuscular Facilitation and static stretching on Maximum Voluntary Control.

Unfortunately, the static stretch protocols  were to perform static stretches for 5 repetitions of 45 seconds. These parameters exceed the recommended static stretching variables of 2 sets of 30 seconds. As expected the authors came to the same conclusions – that static stretching decreased MVC.   Although this is a good study, you must take the data for what it is. Static stretching reduces MVC if the stretch variables is held for 45 seconds. Before you start knocking static stretching understand the data you are interpreting.

Full reference: Miyahara, Y,Naito, H, Ogura, Y, Katamoto, S, and Aoki, J. Effects of proprioceptive neuromuscular  facilitation stretching and static stretching on maximal voluntary contraction. J Strength Cond Res. 27(1): 195–201, 2013.

Prevent Dysfunctional Movement by Improving Ankle Mobility – A Research Review of Manual Therapy Techniques

Topic Overview:

A single joint with altered arthrokinematics can precipitate a kinetic chain domino effect that will wreck havoc on functional human movement.  One such joint is the ankle, where altered arthrokinematics has been linked to several forms of human movement dysfunction and subsequent musculoskeletal injury. Specifically, limited ankle dorsiflexion, has been associated with patellar tendionopathy, ipsilateral gluteus medius weakness, plantar fasciitis, medial tibial stress syndrome, contralateral shoulder pathologies, sacroiliac joint dysfunction, recurrent ankle sprains, chondromalacia, ACL tears, Iliotibial band syndrome, increasing frontal plane motion of the knee, external snapping hip syndrome and osteitis pubis (just to name a few).  In addition to the aforementioned injuries athletes ware at risk of significant performance declines in overall power, agility, and speed.  I am not saying that these are all caused from limited ankle dorsiflexion, but I am saying that limited ankle dorsiflexion can cause these issues.

These issues can create a huge headache for the athlete, health care practitioner, personal trainer or performance coach. So, the question is what can we do that to prevent or treat these dysfunctional patterns or injuries? Simple, increase ankle dorsiflexion. But how? There are several treatment methods so I began thinking what is the single best way to improve ankle dorsiflexion; static stretching, manual therapy, soft tissue release, dynamic flexibility? I could come up with only one solid, and universal one stop treatment option – manual therapy, specifically Movement with Mobilization (MWM). So I found a good research article to review that talks about MWM and the effect it has on ankle dorsiflexion.

Complete Reference: Vicenzino B, Branjerdporn M, Teys P, Jordan K. Initial Changes in Posterior Talar Glide and Dorsiflexion of the Ankle After Mobilization With Movement in Individuals With Recurrent Ankle Sprain. J Ortho Sports Phys Ther Jul 2006;36(7):464-71.

Introduction to the Study:

Mobilization with Movement  (MWM) techniques are commonly utilized to improve joint range of motion and reduce pain. Recent evidence indicates posterior glide of the talus and ankle dorsiflexion is deficient in patients suffering from recurrent ankle sprains. Clinicians have used MWM techniques as an effective tool to increase posterior talar glide and increase talocrural dorsiflexion. The purpose of this study is to evaluate effectiveness of two MWM techniques (weight-bearing and non-weight bearing) for treatment of recurrent ankle inversion ankle sprains.

Study Limitations:

  • Imaging studies have not been done to validate assessment of posterior talar glide.
  • Age range was limited to University’s student population age range of 18-27.
  • Time from injury only  9.4 months (mean) since most recent injury

Methods:

Subjects:

  • 16 subjects (8 male, 8 female) age 18-27 from University of Queensland student population. Subjects must have history of recurrent unilateral ankle sprains, must not have had injury on contralateral side and must not have had injury within the past 6 months.

Dependent Variables:

  • Posterior Talar Glide – Posterior glide was applied while passively dorsiflexing at the ankle and flexing the knee.  Posterior talar glide measured with use of tibial inclinometer.
  • Weight-Bearing Ankle Dorsiflexion – Standing lunge until anterior knee touches wall. Measurement taken via tape measurement of toe to wall distance was taken.

Independent Variables:

  • Weight Bearing  Mobilization with Movement (MWM-WB)
  • Non-Weight Bearing Mobilization With Movement (MWM-NWB)
  • Control Group               

Procedures:

  • Randomized, double-blind, repeated-measures, cross over control design.

Statistical Analysis:

  • Three repeated trials of posterior talar glide and dorsiflexion taken pre and post treatment.
  • Omnibus 3×2 repeated-measures ANOVA
  • Paired t tests to determine pretreatment differences of affected and unaffected limbs for intrastudy use.

Results:

  • Pretreatment:
    • Posterior Talar Glide – 2.4° for the affected side and 6.3° for unaffected side.
    • Dorsiflexion – 4.2° affected side and 6.4° unaffected side.
  • Post treatment :
    • Posterior talar glide increased to 4.0° or 55% following MWM-WB.
    • Posterior talar glide increased to 4.1° or 50% following MWM-NWB.
    • Dorsiflexion increased to 4.8° or 26% following MWM-WB.
    • Dorsiflexion increased to 4.8° or 26% following MWM-NWB.
    • Control group increased to 3.3° or 17% following MWM-WB
    • Control group increased to 4.4° or 9% following MWM-NWB

Conclusion:

Overall, both weight-bearing and non-weight-bearing MWM demonstrated significant positive effectiveness for improving posterior talar glide and ankle dorsiflexion. Maximum possible effect (MPE) for posterior talar glide utilizing Weight bearing MWM and non weight-bearing MWM was 55% and 50% respectively. MPE for ankle dorsiflexion was 26% for both weight-bearing and non-weight bearing MWM.  There was not a significant difference when comparing weight bearing and non-weight bearing MWM.

If you are an athlete, health care practitioner, personal trainer or performance coach and think that your issue might be associated with limited ankle mobility seek out a qualified practitioner. They will be able to identify if dorsiflexion limitations exist and will be able to treat that limitation properly and restore proper function.

Research Review: Anterior Positional Fault of the Fibula after Sub-acute Lateral Ankle Sprains

Complete Reference: Hubbard TJ, Hertel J. Anterior Positional Fault of the Fibula after Sub-acute lateral Ankle Sprains. Manual Therapy. 2008; 13: 63-67.

Clinical Relevance:

Ankle sprains are the most common sports related injury. Unfortunately rehabilitation can be problematic and recurrent injury is possible. A significant side effect of an ankle sprain is decreased ankle dorsiflexion. Research has linked limited ankle dorsiflexion to recurrent ankle sprains, chronic knee injury, ACL tears, increased knee frontal plane movement and excessive femoral rotation. When implementing a recovery program for ankle sprains it would be conducive to perform distal fibular posterior mobilizations to regain lost ankle dorsiflexion.

Introduction:

Recent studies suggest a positional fault of the distal fibula on chronically injured ankles. Studies have not been done to evaluate fibular translation during sub-acute lateral ankle sprains. Additionally studies have not examined the relationship of ankle inflammation and fibular positional fault. Positional fault of the fibula can increase pain, and decrease talocrural dorsiflexion and sub talar range of motion. The purpose of this study is to examine fibular positional fault during sub-acute lateral ankle sprains and correlate positional fault with ankle swelling.

Methods:

Subjects:

  • 22 subjects (10 male, 12 female) recreationally active subjects.
    • 11 of 22 subjects (5 male, 6 female) with sub-acute lateral ankle sprains
    • 11 of 22 subjects (5 male, 6 female) with no history of previous ankle injury

Dependent Variables:

  • Fibula displacement measured with fluoroscope in relation to the tibia
  • Figure 8 tape measure method to evaluate swelling.

Instrumentation:

  • Mini 6600 Fluoroscope with a digital mobile C-Arm

Procedures:

  • Lateral fluoroscopic images taken with on both legs of the lateral ankle sprain (LAS) group and the control group.  Bolsters were added and a fluid inclinometer was utilized to ensure proper positioning.
  • Figure 8 measurement following Tatro-Adams, et al, 1995 to evaluate swelling. This was performed on both ankles of the LAS and control group.

Statistical Analysis:

  • Wilcoxon signed rank test was used to evaluate side-to-side differences within both LAS and control groups
  • Mann-Whitney tests to evaluate injured ankle of LAS group and same ankle of control group.
  • Mann-Whitney tests to evaluate uninjured ankle of LAS group and same ankle of the control group.
  • Pearson product moment calculated side-to-side difference in swelling and the corresponding fibular displacement

Results:

  • Wilcoxon signed rank test:
    • Significant differences within the ankles of the sub-acute LAS group (p=.008).
    • No significant difference within ankles of the healthy group (p=.563).
  • Mann-Whitney Test:
    • Significant difference between injured ankle and matched ankle of control group (p=.045)
    • No significant difference between uninjured ankle of LAS group and matched ankle of control group (p=.438)
  • Pearson Product moment:
    • Significant positive correlation of side to side differences in fibular position and swelling (r = 0.793, p = .004)
    • 63% of variance in the fibular position difference was explained by variance in ankle girth measurement.

Study Limitations:

  • Unknown if an altered fibular position existed prior to the injury.
  • Study does not indicate any literature review regarding possible translation of the tibia following ankle injury.
  • Study did not indicate whether subjects in the LAS group were excluded if they had previous injury on contralateral ankle.

Conclusion:

Statistically significant outcomes indicate the fibula takes on an anterior positional fault in sub-acute LAS. Effect sizes were .91 within the sub-acute LAS group and 1.15 between sub-acute involved ankle and control group. These indicate clinically meaningful effects. In addition, the greater the swelling, as indicated by ankle girth measurement, the greater the anterior positional fault of the fibula. Previous studies have been done on this topic. Recent studies indicate posterior or no translation of the fibula, however these studies measured fibular movement in relation to the talus. Mulligan, 1995 showed the talus also translates anteriorly following inversion ankle sprain, which can explain the findings of those recent studies.

Research Review: Muscle Energy Technique on Non-Specific Lumbopelvic Pain

Complete Reference: Selkow NM, Grindstaff TL, Cross KM, Pugh K, Hertel J, Saliba S. Short-Term Effect of Muscle Energy Technique on Pain in Individuals with Non-Specific Lumbopelvic Pain: A Pilot Study. J Manual and Manip. Ther 2009; 17(1): E14–E18.

Clinical Relevance:

Low back pain effects nearly 80% of the adult population. It is the most costly injury in terms of workers’ compensation costs and indemnity. Oftentimes clinicians treat non-specific low back pain with unfocused rehabilitation, medications, or biophysical modalities. Hypertonicity of neuromyofascial tissue can be the primary cause of low back pain. This can be quickly and effectively addressed with manual therapy techniques.

Introduction:

Muscle Energy Techniques (MET) is a form of manipulative therapy that has been used to treat muscle imbalance and pain disorders. Clinicians have frequently utilized MET as a tool to treat lumbopelvic pain (LPP). Lumbopelvic pain is often associated with muscular imbalance which can cause unilateral anterior innominate rotation of the pelvis. The purpose of this study is to examine the effectiveness of a single MET treatment for immediate lumbopelvic pain reduction and pain reduction 24 hours following treatment.

Study Limitations:

  • Control group had a higher visual analog scale (VAS) for current pain than worst pain.
  • Only 1 MET treatment intervention was used
  • Subjects were selected from general population, not from health care settings.
  • No measures taken to confirm if the pain was secondary to lumbopelvic disorder.
  • Post-study measure pain but did not measure correction of anterior innominate rotation.

Methods:

Subjects:

  • 20 subjects taken from general population; 10 control and 10 treatment
  • 16 male; 4 female
  • Average age; control group = 29.7 years, treatment group = 24.1 years
  • Subjects must have acute episode of LPP and demonstrated anterior innominate rotation of at least 2°.
  • Subjects exclusions: LBP for > 6 weeks, radicular pain below the knee, history of back surgery, or have been diagnosed by a physician.

Dependent Variables:

  • Current pain
  • Worst pain over 24 hours
  • Pain provocation test yielded greatest pain
  • Pain intensity produced by the provocation test

Independent Variables:

  • Treatment Condition
    • MET treatment
    • Control
  •  Time
    • Pretest
    • Post treatment
    • 24 hours post treatment            

Procedures:

  • Double blind, randomized, controlled trial
  •  Examiner #1 – performed 5 sacro-illiac pain provocative exams then notified in writing of physical exam findings to ensure treatment was performed on proper side for treatment group
  • Examiner #2 – Performed MET or control treatment

Instrumentation:

  • Visual Analog Scale (VAS) – used to measure subjective pain rating
  • PALM – Palpation meter to measure relative anterior innominate rotation

Statistical Analysis:

  • Baseline VAS current and worst pain measured by t-tests.
  • 2X3 repeated ANOVA to analyze treatment and control groups for current VAS, worst over 24 hour VAS, and worst pain provocation VAS
  • Mann-Whitney U test analyzed difference in the number of pain provocative tests pre and post treatment.

Results:

  • VAS worst pain; significant difference with MET treatment group for worst pain over 24 hours (F=5.36, P= .03)
  • No significant difference for VAS of current pain (F=3.93, P=.06
  • No significant difference for VAS pain provocation (F=0.81, P=.46)
  • Significant pain reduction for both groups (P=.04) between days

Conclusion:

Overall, worst pain over 24 hours was significantly reduced following MET treatment when compared to the control. As a clinician working with clients and non-specific low back look for muscle imbalances that can be corrected with manual therapy techniques such as muscle energy, which inhibits overactive tissue then allows for elongation.