Pelvic Lift Research Articles

An electromyographical comparison of torso muscle activity and ratio during modified side bridge exercises.

Individualized exercise programs based on personal impairment could lead to successful rehabilitation. An effective way to train spine stability is to find exercises that take advantage of the synergistic relation between local and global stabilization systems. This study aimed to investigate synergistic relationship between the muscles of the local and global systems during three modified side bridge exercises compared with traditional side bridge (TSB). Twenty healthy participants performed TSB, both leg lift while side-lying (BLLS), torso lift on a 45∘ bench while side-lying (TLBS), and pelvic lift on side-lying (PLS) in random order. Surface electromyography data were analyzed. The results indicate that PLS was effective as TSB on trunk muscle activity. However, BLLS and TLBS demonstrated significantly less rectus abdominal (RA) muscle activity compared to TSB (p< .001). Additionally, BLLS and TLBS had a higher internal oblique (IO)/RA muscle activity ratio than TSB (p< .001). PLS could be a suitable alternative exercise for individuals who are unable to perform TSB, as it can effectively activate trunk muscles. BLLS and TLBS may be appropriate for training the local stability system, while limiting activation of the RA.

Activation of Anterolateral Abdominal Muscles During Sling Bridge Exercises: Comparison of Different Pelvic Positions.

Inappropriate activation of the anterolateral abdominal muscles affects the stability of the lumbopelvic zone and increases the appearance of pain and lesion in the area. Therefore, ways to improve its effective contraction are crucial in rehabilitation. The aim of this study was to compare the activation of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles in 3 different pelvic positions (down pelvis [DP], horizontal pelvis [HP], and up pelvis [UP]) during sling bridge exercise (SBE) to determinate which position is more effective to promote a correct contraction of the anterolateral abdominal muscles. Cross-sectional study. Fifteen participants performed 3 variations (DP, HP, and UP) of a one-legged exercise called "supine pelvic lift" on a sling device. The thicknesses of the TrA, IO, and EO were recorded at rest and at the 3 positions using ultrasound imaging. Thickness, change ratio, lateral slide of TrA, and preferential and contraction activation ratio of TrA, IO, and EO were analyzed. TrA and IO showed greater activation (P = .01) in the UP position than the other pelvic positions. In addition, UP position decreased the activation ofthe EO (P = .01). Based on the results of this study, SBE in the UP position has the potential to improve normal contraction patterns of the musculature and can be used in future intervention of the lumbopelvic zone.

Surface electromyography (sEMG) of equine core muscles and kinematics of lumbo-sacral joint during core strengthening exercises

Dynamic Mobilisation Exercises (DME) and myotatic reflex exercises were developed with the aim of improving core strengthening in horses. Previous studies have shown DME can increase cross sectional area (CSA) and symmetry of multifidus muscle, as well as activating the external oblique abdominal, and superficial descending pectoral muscles. The aim of this study was to objectively measure activity differences in m. longissimus dorsi (LD) and m. rectus abdominus (RA) whilst performing three levels of spinal flexion and lateral bending, as well as comparing thoracic and pelvic lift exercises in nine adult sport horses. Three repetitions of each exercise was performed for five seconds. Surface electromyography (sEMG) was used to record muscle electric activity, whilst sagittal lumbo-sacral flexion was measured with kinematics analysis. Overall, the results have shown that spinal flexion and lateral bending activate the m. rectus abdominis (RA) progressively as the exercise requires further reach, with a lateral bending effect evident on the ipsilateral side of RA. RA also had increased activation during thoracic lifts in comparison with pelvic lifts. M. longissimus dorsi (LD) has shown no significant differences in peak or average rectified EMG measures on the contralateral side during lateral bending. Pelvic lifts generated the greatest flexion of the lumbo-sacral (LS) joint. Results provide a guideline of the level of muscle effort required in relation to each exercise.

When stirrups aren't available: Innovation of a low-cost pelvic lift cushion

IntroductionGynecological exam beds with stirrups are considered by many the gold standard for patient positioning when performing a pelvic exam and suturing following a birth. However, there are many instances when a stirrup bed is not available due to the cost of the equipment, insufficient number of stirrup beds, or emergent procedures in centers that do not regularly stock such beds due to cost or lack of sufficient space. When a stirrup bed is not available, many clinicians resort to using work-arounds such as an upside-down bedpan or rolled towels to lift the patient's pelvis. While this may lift the patient's pelvis, this is uncomfortable for the patient and may even cause the patient to tense up during the medical procedure, making the exam or procedure harder to complete. Materials and MethodsIn 2018, a team at Stanford University developed a low-cost pelvic lift cushion as an alternative to upside-down bedpans that aimed improve patient comfort while maintaining satisfactory levels of visibility and physical access for clinicians. The Stanford team surveyed patient/clinician interactions in which the novel pelvic lift cushion, the stirrup bed, or an upside-down bedpan/rolled towels, were used. ResultsBased on 19 patient and clinician interactions, the pelvic lift cushion was found to provide patient comfort and appropriate access for clinicians during a pelvic exam. Clinicians scored it higher than the upside-down bedpan/rolled towels in every area. ConclusionThis inexpensive innovation can improve patient comfort by using an appropriately designed device while maintaining clinician satisfaction in settings where gynecological stirrup beds are not available or desired. Further research is needed to determine the device's effectiveness for different procedures and with a more diverse sample size.

Predictability of walking ability and of bed-chair transfers at the end of inpatient rehabilitation period of elderly patients after stroke

Walking independently is one of the most important goals for patients post-stroke and their families. Standing up is an essential function for walking independently. The aim was to explore initial physical evaluation component that predict patients ability to stand up and walk independently at discharge from rehabilitation, in older adults’ post-stroke. One hundred and thirty-one elderly patients post-stroke admitted to rehabilitation. Excluded were patients with debilitating orthopedic conditions, or previous progressive neurological diseases. Initial evaluation, within 3–7 days of admission, included motor function, lower extremities muscle strength, sitting balance and cognitive assessment. Patients had a follow-up one week before discharge, the follow-up included two parts of the Functional Independence Measure (FIM) test: walking and chair-bed transition. Initial pelvic lift, bed rolling performance were significantly correlate ( r > 0.7, P < 0.01) to patients’ outcome measures at discharge and had highly significant prediction value. A combination of the inadequate static balance upon admission, dependence of rolling to the affected side and lack of independence at pre-stroke daily function predicted 85% chance that a patient will be dependent in walking at discharge. Inadequate static balance upon admission, major/full dependence of rolling to the less affected side and major/full dependence in pelvic lift at bed predicted 89% chance that patient will be dependent in chair-bed transfer at discharge. Initial physiotherapists evaluation to evaluate patient current functional status have a significant predictive value for patients’ outcome at discharge in terms of standing and walking. These clinical predictors can help in setting treatment goals, educating families, and coordinating expectations.

Patient Obesity Influences Pelvic Lift During Cup Insertion in Total Hip Arthroplasty Through a Lateral Transgluteal Approach in Supine Position

BackgroundMovement of the pelvis during implantation of total hip arthroplasty (THA) has a major influence on the positioning of the acetabular cup. Strong traction caused by retractors leads to iatrogenic pelvic lift and can thus be partly responsible for cup malpositioning. The objective of this study was to investigate such factors that influence pelvic lift. MethodsThe dynamic movement of the pelvis was measured during implantation of THA in 67 patients. This was done by measuring the acceleration using the SensorLog app on a smartphone. ResultsAt its maximum, the pelvis was lifted by an average of 6.7°. When impacting the press-fit cup, the surgical side was raised by 4.4° compared with the time of skin incision. This lift at the time of cup implantation correlates significantly with the body mass index and the patient's abdominal and pelvic circumference. ConclusionEvery surgeon performing THA must be aware of the pelvic lift during an operation. Especially in patients with a high body mass index, a large abdominal circumference, or a large pelvic circumference, there is an increased risk of malpositioning of the acetabular cup. When impacting the cup, we recommend releasing the traction of the retractor, so that the pelvis can tilt back into its natural position, and thus, the anticipated cup positioning can be implemented as exactly as possible.

Course of pelvic lift during total hip arthroplasty.

The position of the cup makes a major contribution to the success of total hip arthroplasty (THA). In conventional implantation of the prosthesis without navigation, the surgeon relies on the spatial position of the pelvis. However, iatrogenic manipulation of the pelvis during different surgical steps constantly changes the position of the pelvis during the operation. The position of the pelvis is substantial for the correct placement of the cup. The objective of this study was to investigate and visualize the course of this pelvic lift and correlate it to certain surgical steps. Pelvic lift was measured in 67 patients during implantation of a THA. This was done by measuring acceleration using the SensorLog app on a smartphone. It was placed on the patient's contralateral anterior superior iliac spine and recorded the movement of the pelvis throughout the whole surgical procedure. The position of the pelvis was allocated to each of eight relevant surgical steps during the operation. These surgical steps were normed over the time axis and transferred to a diagram. We found an average pelvic lift displacement of up to 14.9° upon placement in the figure-of-four position. This lift is particularly critical when exposing the acetabulum, as the true cup position can be unconsciously influenced. Average values of between 5.6° and 6.9° were found here. When implanting a THA in supine position, the pelvis is not fixed on the operating table. Rather, the side to be operated on is lifted to a greater or lesser degree, depending on the surgical step to be performed. The retractor traction immediately before cup implantation should be minimized. Nevertheless, it should be taken into account that anteversion of the cup implant in relation to the table plane is systematically higher than in relation to the pelvic entry plane.

New aspects of physical therapy for osteoporosis

SummaryFractures due to osteoporosis are among the leading causes of functional limitation, chronic pain, and greater morbidity in advanced age. Apart from bone, risk factors for osteoporotic fractures include non-osseous causes such as falls or reduced neuromuscular capacity. Muscle and coordination exercises enhance the patient’s abilities in daily life and prevent falls. In view of recent conclusions drawn from competitive sports, which stress the significance of muscles of the trunk with regard to reducing back pain and optimizing posture, we used sling exercises to determine whether they benefit patients with osteoporosis and are more useful than traditional physiotherapy. A stable ceiling construction was installed for sling exercise; slings were suspended from this construction. Fifty patients were randomized into two groups. Group A received traditional physiotherapy while group B was given sling exercises, in each case twice a week for a period of three months. The exercises were similar in the two groups. Both performed chair-rising exercises and pelvic lift in supine position; the sling exercise group used the slings for this purpose. The results of treatment (pre-post) were analyzed in terms of pain levels, mobility, trunk strength, and the shape of the back. For the latter we used the spine scanner Diers®Formetric 4D to measure the spine surface of the patients with low radiation. After a further three months with no specific exercise treatment, we re-tested the patients to establish the long-term effects of the two types of exercises. Forty-four patients (88 %) completed the study. Patients were assigned to small groups for the exercises (a maximum of 5 patients each), and thus received individual attention and motivation. Positive training effects were achieved in both groups. Significantly better results in regard of improved mobility (8.2 ± 1.9 vs. 6.7 ± 1.4; p = 0.005) and pain at rest (3.1 ± 1.7 vs. 1.9 ± 1.4; p = 0.011) were registered in the sling exercise group. A comparison of the baseline values for these parameters to those reported at follow-up, without specific stabilization or strengthening exercises, it was found that the effect lasted for a minimum period of 3 months (p &lt; 0.001). The results of the investigation confirm the known positive effects of physical therapy with regard to back pain in patients with osteoporosis. Simultaneously, sling exercise proved to be a treatment alternative that improves trunk strength and posture as well as provides greater mobility, thus improving quality of life in patients with osteoporosis.

Neuromuscular Training to Prevent Knee Injuries in Adolescent Female Soccer Players

To evaluate the effectiveness of a neuromuscular warm-up program in preventing acute knee injury in adolescent female football (soccer) players. Cluster randomized (by team) controlled trial, stratified by geographical district. Sample size was calculated (n = 8118) with 80% power to show a reduction of 50% in an estimated 1.15% annual incidence of anterior cruciate ligament (ACL) injury at P ≤ 0.05. Clubs in 8 regional districts of the Swedish Football Association, during the 2009 season (April through October). Female under-14 to under-18 football clubs (ages 12-17 years) were recruited. Reasons for the exclusion of clubs were lack of response, <2 training sessions per week, and the current use of an injury prevention program. The clubs were randomized to a neuromuscular warm-up intervention (Knäkontroll, SISU Idrottsböcker, Sweden, 2005) or to a control group, who were instructed to continue with their usual training and playing practices. The neuromuscular training program included 6 exercises that focused on knee control and core stability (1- and 2-legged knee squats, a pelvic lift, the bench, the lunge, and jump/landing). The exercises were to be done twice per week and were to take about 15 minutes, after a brief running warm-up. They progressed through 4 levels of difficulty. The team coaches supervised the program after instruction from study therapists. The primary outcome was the rate of ACL injuries. Diagnosis was confirmed, as appropriate, by a physician and by magnetic resonance imaging. Secondary outcomes were the rates of serious knee injury and any acute knee injury, defined as those with sudden onset during play that led to a player being unable to participate in training or competition. Severe injuries were those that caused absences of >4 weeks. Two study therapists evaluated the injuries. The coaches recorded data, including when the intervention was performed, any injuries, individual playing times, and periods of absence. Assessment of the primary outcome was done by physicians blinded to group assignment. During 278 298 hours of play, 96 knee injuries occurred in 92 players (intervention group 48, control group 44). The rate did not differ between groups. Of the 21 ACL injuries, 7 occurred in the intervention group and 14 in the control group, giving a rate ratio (RR) of 0.36 (95% confidence interval [CI] 0.15-0.85; P = 0.02). Severe injuries (intervention group 26, control group 31) did not differ between groups. They included 22 collateral or capsular sprains, 21 ACL injuries, 7 patella dislocations or subluxations, 6 meniscal or chondral lesions, and 1 tibial plateau fracture. Compliant players (those who performed ≥ 1 exercise session per week; 1303 players) had a lower rate of ACL injury (RR, 0.17; 95% CI, 0.05-0.57), of severe knee injury (RR, 0.18; 95% CI, 0.07-0.45), and of any acute knee injury (RR, 0.53; 95% CI, 0.30-0.94) than the control group. A short weekly neuromuscular exercise program reduced the rate of ACL injuries among adolescent female football (soccer) players. Those who were compliant with the intervention had fewer severe knee injuries and fewer injuries overall.

Inter-rater reliability of three standardized functional tests in patients with low back pain

BackgroundOf all patients with low back pain, 85% are diagnosed as "non-specific lumbar pain". Lumbar instability has been described as one specific diagnosis which several authors have described as delayed muscular responses, impaired postural control as well as impaired muscular coordination among these patients. This has mostly been measured and evaluated in a laboratory setting. There are few standardized and evaluated functional tests, examining functional muscular coordination which are also applicable in the non-laboratory setting. In ordinary clinical work, tests of functional muscular coordination should be easy to apply. The aim of this present study was to therefore standardize and examine the inter-rater reliability of three functional tests of muscular functional coordination of the lumbar spine in patients with low back pain.MethodsNineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs). Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ) and by percentage agreement.ResultsThe inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0), for sitting on a Bobath ball good (κ: 0.79) and very good (κ: 0.88) and for the unilateral pelvic lift: good (κ: 0.61) and moderate (κ: 0.47).ConclusionThe present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their ability to evaluate lumbar stability is required.

Chapter 33 Intricate tactile sensitivity: a key variable in western integrative bodywork

During the past 150 years throughout the US and Western Europe, there have been a widespread development and rapid proliferation of experiential approaches to the human body involving highly sophisticated methods of touch, body movement, and body awareness. Outside investigators mistakenly lump these bodyworks together with other qualitatively different practices, massage, physical therapy, “laying on of hands” - leading to deficiencies in the design of studies to investigate them. The family of bodyworks analyzed in the chapter differs from these other kinds of practices in significant ways, one of which is the focus of this chapter. Another common mistake on the part of outside investigators is to isolate an individual “move” or technique from the rich complex of a given method. The application of that atomistic piece is subjected to outcome studies, for example, use of the pelvic lift in the treatment of chronic back pain. If successful, the atomized piece is investigated as to how it might be integrated into clinical medical practice. The problem with this approach is that, it is constrained to an understanding of the narrowest range of efficacies. The focus on an isolated practice loses the wholeness of the method, and by doing so distorts the meaning and efficacy of the practice itself.