ABSTRACT BODY:
Background & Purpose:Coccydynia is defined as pain felt in the region of the coccyx, or tailbone. It can be a debilitating condition, negatively impacting one's quality of life and ability to perform activities of daily living. Because there are many potential causes of coccydynia, patients often undergo various forms of medical treatment and therapy before the condition is treated effectively. One understudied cause of coccydynia is pelvic floor muscle dysfunction. The purpose of this case report is to describe the physical therapy management of a postpartum woman with coccydynia. Case Description: A 28-year-old primiparous woman with a chief complaint of pain in the coccyx and low back was referred to physical therapy 6-weeks postpartum. Her symptoms began immediately after vaginal delivery and were precipitated by prolonged sitting and any increase in activity level. Initially, the patient underwent an ineffective course of pharmacologic therapy. The physical therapy examination revealed pelvic floor muscle dysfunction (muscle spasm, weakness, and incoordination), pelvic malalignment, and constipation as potential causes of her coccydynia and low back pain. The patient completed a 3-week course of physical therapy that included interventions to improve and maintain pelvic alignment, reduce pelvic floor muscle spasm and pain, and improve bowel function. Outcomes: The patient attended 3 physical therapy sessions. At discharge from physical therapy, her coccydynia and low back pain were resolved and sitting and activities of daily living were pain free. The patient no longer complained of constipation, and pelvic alignment was achieved and maintained. The colorectal anal distress inventory subscale of Pelvic Floor Distress Inventory improved from 25 of 100 at baseline to 0 of 100 at discharge. The pelvic organ prolapse impact subscale of the Pelvic Floor Impact Questionnaire improved from 33 of 100 at baseline to 0 of 100 at discharge. Discussion: In this postpartum woman, pelvic floor muscle spasm, pelvic malalignment, and constipation were hypothesized as potential causes of her symptoms and functional limitations. After a multicomponent physical therapy intervention aimed toward resolving these impairments and improving bowel function, this patient achieved full resolution of coccydynia and low back pain. This case report illustrates that in persons with coccydynia, the coccyx itself may not be the source of etiology. It also suggests that a comprehensive physical therapy evaluation for persons with coccydynia should include a history of bowel function and examination of pelvic alignment and the pelvic floor musculature. Future research is needed to fully explore the possible etiologies of coccydynia to promote more efficient and effective management of patients with this diagnosis.
TITLE: Acute Changes in Frontal Plane Gait Mechanics During Pregnancy as Simulated by the Empathy Belly
AUTHORS: Robert J. Butler1, Melissa Elpers3, Robin Queen2
INSTITUTIONS: 1. Community and Family Medicine, Duke University, Durham, North Carolina, USA.2. Surgery, Duke University, Durham, North Carolina, USA.3. Physical Therapy, University of Evansville, Evansville, Indiana, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this study was to simulate changes in frontal plane gait mechanics that would result from an acute change in the center of mass position that is typical in pregnancy by utilizing the Empathy Belly pregnancy simulator. This study may be able to provide an insight as to how gait mechanics alter from a baseline state to the latter stages of pregnancy. It is hypothesized that there will be greater joint motion and greater frontal plane joint moments in the Empathy Belly conditions. Number of Subjects: Twenty-four college-aged women with no history of pregnancy and no history of back pain. Materials/Methods: Subjects were free from any pathology at the time of collection. After providing informed consent, patients were tested in 3 conditions: (1) walking at an intentional speed (INT); (2) walking with the Empathy Belly at the initial intentional speed (IEB); and (3) walking with the Empathy Belly at a new preferred intentional speed (PEB). The INT condition was collected first and then the IEB and PEB conditions, which were randomly ordered. After the INT testing, patients accommodated to the Empathy Belly for 5 minutes. During the gait analysis, lower extremity reflective marker and ground reaction force data were collected to calculate lower extremity kinetics and kinematics. Body weight normalization was with respect to the subject's non-Empathy Belly weight. The peak frontal plane angles, joint moments, and angular excursion were examined during the first half of stance for the ankle, knee, and hip. The data were analyzed with a repeated measures analysis of variance (P = .05) to identify statistically significant differences. Results: Significant differences existed for peak eversion, eversion excursion, and the peak inversion moment, with the INT being less than the IEB. In addition, the PEB was greater than INT for peak eversion and eversion excursion but not the peak inversion moment. The peak knee abduction moment was lowest in INT compared to PEB, which was lower than IEB. The hip angular excursion was least in the PEB in comparison with IEB, which was lower than INT. The peak hip abduction moment was lowest in the INT compared with both EB conditions. No statistically significant differences existed for any of the other variables of interest. Conclusions: Women wearing the Empathy Belly exhibited greater joint motion at the ankle and hip along with greater peak joint moments at the ankle, knee, and hip. Clinical Relevance: These findings met all expected hypotheses; however, the question still remains as to whether gait mechanics return to prepregnancy values after 9 months of involuntary gait retraining. If gait mechanics are permanently altered, it may place the women at a greater risk for degenerative joint disease. In addition, it may be that women may benefit from postpartum interventions to ameliorate any permanent changes that occurred to their gait during pregnancy. Future studies should assess the changes in gait from baseline measures to determine effects across the term of pregnancy.
TITLE: Complex Decongestive Physical Therapy for the Treatment of Breast Cancer-Related Lymphedema: A Systematic Review
AUTHORS: Connie Matheny, Allison Snider
INSTITUTION: Southwest Baptist University, Bolivar, Missouri, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this systematic review is to determine whether complex decongestive physical therapy reduces the mean volume of lymphedema in patients with breast cancer-related lymphedema. Reducing the volume of lymphedema can improve the quality of life and function of patients diagnosed with breast cancer-related lymphedema. Number of Subjects: Not applicable. Materials/ Methods: An extensive search, including EBSCO HOST, ProQuest, CINAHL, New England Journal of Medicine, and PubMed, was performed. For the article to be incorporated into this systematic review, the following inclusion criteria had to be met: (1) The patients included in the study were diagnosed with breast cancer-related lymphedema; (2) The intervention applied was complex decongestive physical therapy; (3) The researchers measured success of complex decongestive physical therapy treatment in volumetric measurements of lymphedema reduction; (4) Single-subject case studies were excluded. Results: Five studies were included in this review. All the studies presented data that demonstrated a reduction in mean volume percentage of the affected extremity. Three studies included the results stating the mean volume percentage after a month-long maintenance phase and found slight increases in the volume of the affected extremity. Conclusions: Complex decongestive physical therapy is an effective treatment for addressing breast cancer-related lymphedema. Complex decongestive physical therapy leads to a reduction in the mean volume percentage of the affected extremity. Clinical Relevance: This systematic review explores the efficacy of a relatively new treatment option for patients with breast cancer.
TITLE: Diabetes Prevention: A Systematic Literature Review Exploring Physical Therapists' Impact on Gestational and Type 2 Diabetes
AUTHORS: Connie Matheny, Rebekah Pounds
INSTITUTION: Southwest Baptist University, Bolivar, Missouri, USA.
ABSTRACT BODY:
Purpose/Hypothesis: In the United States, 28% of all childbearing-age women (20-39 years) are obese and participating in a diabetogenic lifestyle (Villamor and Cnattingius). These choices increase a woman's risk of developing a type of diabetes during pregnancy known as gestational diabetes (GDM). Gestational diabetes can cause significant maternal and fetal complications, including fetal demise. In the past, the only treatments for GDM were diet and pharmaceutical management. There is mounting evidence to suggest the benefits of exercise as a preventative modality to the development of GDM. Using physical activity as a treatment modality, can physical therapy have an impact in delaying or preventing the onset of GDM or type 2 diabetes? Number of Subjects: Not applicable. Materials/Methods: A full-text literature review was collected and analyzed from February 2007 to May 2010. The following key terms applied to PubMed, Google scholar, and CINAHL: gestational diabetes/ diabetes, pregnancy, young women, obesity, exercise beliefs, physical activity/exercise. Inclusion Criteria: Primarily female subjects aged 20 to 45 years, obese, sedentary lifestyle assessment, and at risk for GDM/type 2 diabetes. Exclusion Criteria: Hypertension, preeclampsia, preterm labor, premature rupture of membranes, or any other pregnancy complication; other endocrine disorders; polycystic ovary syndrome human immunodeficiency virus or other immunologic disorder; and diabetes research with primarily male subjects. A total of 16 articles met criteria for exclusion. Results: A total of 24 articles met inclusion criteria. Thirteen of those articles were research articles appropriate for in-depth analysis in this review. Nine of these articles were large, population-based, randomized, and controlled studies. Four articles were smaller, population-based studies that were consistent with larger studies and were also included for analysis. Conclusions: Diabetes prevention requires a multidisciplinary team approach, including physical therapists. Current literature was reviewed concerning physical activity as an effective treatment modality for diabetes prevention. Physical therapy can make a considerable impact in preventing GDM or type 2 diabetes before conception, during pregnancy, and in the postpartum period in 4 specific way: (1) early screening and requesting appropriate referrals; (2) assessing barriers, beliefs, and social influence to exercise; (3) creating individualized treatment plans; and (4) promoting long-term lifestyle modification through exercise by providing periodic follow-up care. Clinical Relevance: Physical therapists can contribute to the prevention and treatment of GDM and type 2 diabetes.
TITLE: Physical Therapist Management of Patients With Dyspareunia Can Improve Symptoms of Stress Urinary Incontinence: A Case Report
AUTHORS: Karen Snowden, Lauren Garges
INSTITUTION: Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
ABSTRACT BODY:
Background & Purpose: Pelvic floor dysfunction can result in dyspareunia and stress urinary incontinence. Patients with a diagnosis of dyspareunia referred to physical therapy may exhibit pelvic floor muscle hypertonicity while also reporting symptoms of stress urinary incontinence. The purpose of this case report is to describe the physical therapy management of a woman with a diagnosis of dyspareunia, who benefited from a reduction in her symptoms of stress urinary incontinence. Case Description: A 41-year-old woman diagnosed with dyspareunia was referred to physical therapy by a pelvic-pain specialist. During her history taking, she reported signs of stress urinary incontinence. Physical therapy treatment once weekly for 12 weeks consisted of therapeutic exercise, manual therapy, relaxation training, electrical stimulation, and instruction in home use of vaginal dilators. Outcomes: The patient completed 4 types of outcome measures, including the Vulvar Pain Functional Questionnaire, Urogenital Distress Inventory-Short Form, Quality-of-Life Scale adapted from the Female National Institutes of Health-Chronic Prostatitis Symptom Index, and Verbal Numeric Pain Scale rating. She experienced a reduction in scores on all scales, indicating an improvement with all measures. Furthermore, all short- and long-term functional goals were met, and the patient experienced a reduction in her stress urinary incontinence symptoms, improved functioning with activities of daily living, and reduced back pain and dyspareunia. Discussion: This case study highlights the need for physical therapists to be vigilant in properly diagnosing the cause of patients' pelvic floor symptoms. It is commonplace for clinicians, even physicians, to advise patients with stress urinary incontinence to perform pelvic floor muscle exercises to reduce symptoms of leakage. In the case of this client, however, it became apparent that her leakage symptoms were because of muscle fatigue from a hypertonic pelvic floor. It was only when the muscles learned to relax that the tone could return to normal and her stress urinary incontinence symptoms improved. In this case, pelvic floor muscle exercises would have likely exacerbated not only her incontinence but also her pain by further shortening her already-tense muscles.
TITLE: Conservative Management of Axillary Web Syndrome: A Case Report
AUTHORS: Kathryn L. Preston, Stacy L. Tylka
INSTITUTION: Washington University School of Medicine, Program in Physical Therapy, St Louis, Missouri, USA.
ABSTRACT BODY:
Background & Purpose: One in 4 women will be diagnosed with breast cancer (BC) over the course of their lifetime. (1) Fortunately for those who are diagnosed and wish to seek care, a variety of medical advancements are available; however, it is important to recognize the impending side-effects of these life-saving interventions. Axillary web syndrome (AWS) is 1 such side-effect that may arise in up to 48.3% of patients after BC-related procedures. (2) Currently, conservative rehabilitation for the shoulder is not adequately described in the literature for those who develop AWS postoperatively. Therefore, the purpose of this case report is to describe a conservative approach to treatment for the purposes of increasing range of motion (ROM), strength, and function in a patient with AWS, status post simple mastectomy and axillary lymph node dissection. Case Description: The patient was a 55-year-old woman with complaints of left shoulder pain and limited ROM following bilateral simple mastectomies and a left axillary lymph node dissection who sought physical therapy (PT) services at a hospital-based orthopedic clinic. On examination, the patient presented with pain, abnormal posturing, decreased strength, a glenohumeral-capsular pattern, decreased function as illustrated by the DASH, and axillary cording. The presence of axillary cording is consistent with AWS, a condition characterized by visible "webbing" in the axillary region that results in painful and/or restricted ROM. On the basis of these examination findings, the patient was assigned a PT diagnosis of glenohumeral hypomobility (3) with signs and symptoms consistent with AWS. Outcomes: The patient was seen approximately twice weekly for 8 weeks during which she was progressed through a program consisting of therapeutic exercises to address related strength, ROM, and scapular movement impairments. In addition, manual therapy, including mobilizations and myofascial release to the pectoral and axillary regions, was performed to directly address the patient's capsular pattern, pectoral adhesions, and soft tissue restrictions, resulting from the axillary cording. After the completion of PT, notable reductions in axillary cording were detected on visual assessment and palpation. The patient also demonstrated significant improvements in left-shoulder ROM, strength, and function, as indicated by the DASH. Discussion: The majority of lumpectomies and mastectomies that are performed in conjunction with lymph node dissection, whether sentinel or axillary, have been linked to the development of AWS. (4) The patient described in this case study presented to the clinic with post-breast-cancer-surgery shoulder impairments, including AWS, and demonstrated significantly improved outcomes after conservative, PT-based rehabilitation. Additional research is needed to determine the most effective treatment approaches for patients with AWS and the extent to which surgical type, BC stage, and age have an effect on the resolution of this syndrome.
TITLE: Patient-Centered Approach to Managing Pregnancy-Related Pelvic Girdle Pain
AUTHORS: Elena A. Karpeisky1, Christine Buzzell2, Cory L. Christiansen1
INSTITUTIONS: 1. Physical Medicine & Rehabilitation, University of Colorado Denver, Denver, Colorado, USA.2. Physical Therapy, Platte Valley Medical Center, Brighton, Colorado, USA.
ABSTRACT BODY:
Background & Purpose: Pregnancy-related pelvic girdle pain (PGP) is an often-misdiagnosed and undertreated condition affecting 20% of pregnant women. Stability of the sacroiliac joint is controlled through form-closure and force-closure mechanisms. Form closure depends on shape and congruity of joint surfaces between sacrum and ilium and integrity of surrounding ligaments. Force closure requires neuromuscular and myofascial systems to keep the joint dynamically stable. The purpose of this case study is to describe the presentation of a patient with pregnancy-related PGP from the combination of reduced form and force closure, the diagnostic tests used to identify this pathology, the course of treatment and outcomes, and to provide an overview of current literature regarding these aspects of PGP. Case Description: A 20-year-old patient presented to outpatient physical therapist care at 22.5 weeks into her third pregnancy. Initially, she complained that she had difficulty walking, ascending stairs, and bed mobility secondary to posterior left leg and groin pain. Her symptoms were consistent with PGP with potential multifactorial etiology related to increased load from progressing pregnancy, muscular imbalances, and altered motor control created from faulty movement patterns. Intervention included manual therapy techniques, pelvic stabilization exercises, motor learning of functional movement patterns, and patient education. Outcomes: After physical therapy intervention, the patient was able to walk for 15 minutes and pick her children's toys off the floor without pain. Pain level at rest was 4 of 10 initially and 0 of 10 after intervention, measured by Numerical Pain Rating Scale. The Active Straight Leg Raise test was positive before intervention and negative after intervention. Sacroiliac Provocation tests were positive for symptoms pre- and postintervention. However, functional scores measured by the Lower Extremity Functional Scale improved from 41 of 80 initially to 76 of 80 at the final assessment. Discussion: Reduced form closure is common in women suffering from postpartum PGP. Reduced force closure is a result of a maladaptive motor control system, which results in abnormal load transfer through the pelvis, creating ongoing strain and chronic pain. The individualized intervention approach described in this case study targeted improving motor control of local stabilizer musculature and controlling symptoms. This intervention, designed to remediate reduced force closure while compensating for reduced form closure, effectively improved the patients' participation and function.
TITLE: Exercise Readiness in Female Survivors of Domestic Violence
AUTHORS: Cynthia L. Lewis, Brittany Holcomb, Lindsey Sharpe, Lorraine Snyder, Stephen Bailey
INSTITUTION: Department of Physical Therapy Ed, Elon University, Elon, North Carolina, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Researchers have documented the benefits of exercise in persons who experienced psychological conditions such as depression, posttraumatic stress disorder, and substance abuse. However, research on the effects of exercise in survivors of domestic violence is limited. Domestic violence is characterized as an abuse from a current or former intimate partner. Both men and women are recipients of domestic violence, but statistically, women are most often the victims. Domestic violence can result in major depression, low self-esteem, substance abuse, and physical injury in recipients. Social support interventions for women in community-based shelters are effective in improving health outcomes. As an initial first step, the purpose of this study was to investigate the readiness to participate in physical activity in the female survivors of domestic violence who were short-term residents in a community family-based shelter. Number of Subjects: Nine women were recruited from a community Family Abuse Service Center (FASC). The center is involved in the prevention and intervention of domestic violence, providing emergency relief support to survivors. Each woman gave signed consent to participate. Materials/Methods: To establish readiness for physical activity, subjects completed the following questionnaires: The International Physical Activity Questionnaire, Exercise Benefits/Barriers Scale, Self-efficacy for Exercise Scale, and the Social Support for Exercise Scale. Permission was received from the authors to use these instruments. Copies of each of these questionnaires were distributed by the director of the FASC. Participants' identities remained anonymous. Participants received a $10.00 gift card for the completion of the questionnaires. Results: All data were analyzed and scored according to the protocol established by the survey authors. Subjects reported low to moderate levels (1.44 of a scale of 3) of physical activity (#1). They perceived the benefits to exercise (87.5%) as being greater than the barriers (28.5%) (#2). They reported confidence in being successful with exercise (67%), and 56% rated themselves as "maybe" with regards to continuing an exercise program, but most stated that they had little motivation to exercise. They reported a lack of family support (11%) and support by friends (0%) for their participation in physical activity (#4). Conclusions: The subjects perceived that the benefits outweighed the barriers to exercise. They indicated their confidence to be successful with exercise. However, the subjects expressed that they lacked motivation to participate in an exercise program, which may be attributed to a lack of support and structure. Clinical Relevance: Physical therapist may work with female survivors of domestic violence recovering from emotional or physical injury. On the basis of these preliminary findings, physical therapists need to be mindful of the barriers to motivation for exercise and develop support structures to aid these women in being successful in participating in physical activity.
TITLE: Evidence-Based Clinical Decision Making for the Patient With Chronic Pelvic Pain: A Case Report
AUTHORS: Ivy Devitt, Meryl J. Alappattu
INSTITUTION: Physical Therapy, University of Florida, Gainesville, FL, United States.
ABSTRACT BODY:
Background & Purpose: Chronic pelvic pain conditions, including dyspareunia, are prevalent and are associated with decreased quality of life and sexual functioning. The causes of pelvic pain are multiple and complex. Those causes may be musculoskeletal based, such as muscle trigger points or hypertonicity; those organic in nature, including endometriosis or infections; or those induced by surgical procedures, such as scarring and adhesions. Previous research supports the use of physical therapy interventions in women with chronic pelvic pain. The purpose of this case report is to describe how clinical judgment combined with the use of objective outcome measures helps to guide the course of treatment for a woman with dyspareunia. Case Description: A 23-year-old woman with a 1-year history of dyspareunia and with a diagnosis of chronic pelvic pain was referred to physical therapy. Her physical therapy intervention consisted of manual therapy techniques, including trigger-point release and visceral and soft tissue mobilization, and a patient-specific flexibility and strengthening program. Approximately half way through her course of treatment, she began to display an increase in symptoms, including low back pain and dysmenorrhea, in addition to decreased sexual and physical functioning, as evidenced by the outcome measures. Outcomes: Outcomes were assessed with the following: 36-Item Short Form Health Survey (SF-36), Female Sexual Function Index (FSFI), Visual Analogue Scale for Pain (VAS-P), and Beck Depression Inventory (BDI). All measures were administered at the initial evaluation, the one-month visit, and discharge. The SF-36 mental component score increased by discharge, but the physical function scores decreased. The patient initially improved from 14 to 27 on the FSFI, but the score decreased to a 16 at discharge. The dyspareunia rating on the VAS-P remained unchanged throughout the treatment. The BDI scores decreased from 15 to 9 during the course of treatment. Discussion: Despite initial objective improvements in sexual and physical functioning, the patient began to exhibit increased symptoms, including low back pain and dysmenorrhea. Given the exacerbation of these symptoms and her lack of progress with physical therapy, we suspected that her impairments were not musculoskeletal in nature and she was referred back to her physician for further medical workup. The physical therapy management of this case utilized both clinical expertise and outcome measure-based assessments to determine the appropriate course of treatment for this patient. Standardized, objective outcome measures should accompany clinical knowledge to make cost-effective, patient-centered decisions in the management of patients with chronic pelvic pain.
TITLE: A Comparison of Two Pelvic Floor Muscle Training Programs in Females With Stress Incontinence: A Pilot Study
AUTHORS: Betsy Donahoe-Fillmore, C. Jayne Brahler, Wendy Chorny, Allison Ingley, Jennifer Kennedy, Valerie Osterfeld
INSTITUTION: HSS/DPT, University of Dayton, Dayton, Ohio, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Stress urinary incontinence (SUI) is a condition affecting millions of Americans. Few studies have assessed the benefits of different exercises involved in pelvic floor muscle training (PFMT). The purpose of this study was to compare the effects of a traditional PFMT program with an assisted pelvic floor muscle training (APFMT) program that included contraction of hip musculature. Number of Subjects: Eleven subjects, aged 42 to 74 years, were obtained from a convenience sample of women diagnosed with SUI by an urogynecologist. Materials/Methods: The degree of incontinence was determined by the International Consultation on Incontinence Modular Questionnaire (ICIQ UI Short Form), the Urogenital Distress Inventory (UDI-6 Short Form), and the Incontinence Severity Index (ISI). Changes in the electrical activity of the pelvic floor musculature were determined by using the Prometheus Pathway NMR 400 quad channel EMG, and a 4-day bladder journal was completed. Subjects were randomly divided into 2 groups: traditional PFMT and APFMT, and they received instructions from a physical therapist on these exercises. The EMG data were taken monthly, and all baseline measurements were repeated at the end of 12 weeks. General linear model repeated measures tests were run to determine whether there was a statistically significant, within-group difference in the long, moderate, or short hold measures taken at baseline, and at week 4, 8, and 12 and to determine whether there was a statistically significant difference in these measures between the 2 groups. Paired-samples t tests were run to determine whether there was a statistically significant difference between baseline and study completion on the ICIQ, UD1-6, or ISI. Gain scores were calculated as final minus initial ICIQ, UD1-6, and ISI scores, and independent-samples t tests were run to determine whether there was a statistically significant difference in gain scores between groups. Results: Six subjects completed the study. There was a statistically significant within-group improvement from pre- to posttest for long, moderate, and short hold measures for both groups. There was no statistically significant between-group effect on these measures. Paired-samples t tests revealed a statistically significant difference in the pre- to post-ICIQ, UDI-6, and the ISI. Independent-samples t tests revealed a statistically significant difference in the gain scores for the UDI-6 between groups. Subjects reported increases in quality of life. Conclusions: The results of this study are consistent with previous research that pelvic floor muscle training is beneficial in increasing function and decreasing subjective views on the level of incontinence. Further research with a larger sample size, a control group, and utilization of more sensitive measures is needed to determine the most effective exercises. Clinical Relevance: Implementing a program focused on increasing the strength and endurance of the pelvic floor musculature may enhance the overall quality of life of women with SUI.
TITLE: Best Physical Therapy Practice for Screening and Prevention of Lower Extremity Stress Fractures in Adolescent Female Athletes
AUTHORS: Elizabeth Calabria, Kathryn Chabot, Mary Gagstetter, Kelly Moran, Katherine Plichta, Laura Stanley
INSTITUTION: Duke University, Durham, North Carolina, USA.
ABSTRACT BODY:
Purpose: Stress fractures are a common musculoskeletal injury, particularly among the adolescent, skeletally immature female athlete. Few studies have attempted to prospectively identify risk factors for stress fractures; instead, research has focused on retrospective analysis after injuries have been sustained. The purpose of this project was to review the relevant intrinsic and extrinsic factors related to stress-fracture occurrence in order to develop best-practice recommendations for screening and prevention of lower extremity stress fractures in adolescent female athletes. Description: A comprehensive literature search was completed to identify factors that were significantly correlated with stress-fracture occurrence in adolescent female athletes. Intrinsic factors, such as overpronation, decreased hip abductor strength, observable increased hip adduction motion during dynamic activities, leg-length discrepancy, and decreased calf girth, can all contribute to altered biomechanics, which may predispose a woman to developing a lower extremity stress fracture. Various nutritional, genetic, and menstrual factors have also been found to be associated with an increased risk of stress-fracture development. Extrinsic risk factors include abrupt changes in training volume, running on hard or uneven surfaces, decreased shock absorption in footwear, and the use of semirigid orthoses. These factors were then compiled into a comprehensive screening tool, with the goal of implementation in a clinical setting. Summary of Use: Factors found to be associated with an increased risk of stress fracture injury in adolescent female athletes were included in the screening tool. Future research will be necessary to determine the reliability and validity of this tool to correctly identify female athletes who require interventions for risk factor modification. The screening tool is designed for use in the medical and athletic community settings to facilitate early identification, intervention, and education for any athlete who may be at a higher risk of developing a stress fracture. Importance to Members: After reviewing the literature and surveying middle- and high-school athletic personnel, it appears that there are currently no available screening tools addressing prevention of lower extremity stress fractures in adolescent female athletes. As there continues to be an increase in participation of women in athletics, as well as an increase in stress-fracture injuries among adolescent female athletes, we feel that the development of this screening tool is vital to provide early identification, intervention, and modification of certain risk factors.
TITLE: Providing Literature and Resources to Expectant Mothers of Children With Down Syndrome
AUTHORS: Ashley Mott Murphree1, Malcolm T. Whitehead2, Shanna Painter2
INSTITUTIONS: 1. Physical Therapy, Arkansas State University, Jonesboro, Arkansas, USA.2. Physical Therapy, Arkansas State University, Jonesboro, Arkansas, USA.
ABSTRACT BODY:
Purpose: The diagnosis of Down syndrome resulting from diagnostic prenatal testing can have a negative emotional impact on the family of the affected children and induces stress in the expectant mother, primarily due to the lack of knowledge, resources, and support. The purpose of this pilot study was to determine the prevalence of prenatal diagnostic testing as well as resources and support available to expectant mothers after the diagnosis of Down syndrome. Description: Personal interviews with 5 mothers of children who had been diagnosed with Down syndrome were utilized to gather qualitative data. Each mother was asked a series of open-ended questions related to prenatal diagnostic testing for Down Syndrome. In addition, inquiries were made regarding the delivery of diagnosis and availability of literature and resources after diagnosis. Summary of Use: Examination of the data indicated that participants were given little to no information regarding diagnosis and prognosis and were not provided with any resources for early intervention. Most participants had to search for this information without assistance from a health care professional. All participants indicated that enhanced knowledge would have assisted during the pre- and postnatal coping and planning periods. Importance to Members: These findings suggest that awareness among health care professionals regarding the knowledge to facilitate anticipated outcomes of children with Down syndrome and early intervention should be enhanced. Further research is needed to determine whether these findings are regionally unique and in order to establish the role of physical therapy with this cohort.
TITLE: Postural Sway and Balance Responses in Women Across the Menstrual Cycle
AUTHORS: Catherine Maher1, Vicci Hill-Lombardi2, Dhara Dahal1, Tanya Galofaro1, Emilia Quezada1, Jillian Regis1
INSTITUTIONS: 1. Physical Therapy, Seton Hall University, South Orange, New Jersey, USA.2. Athletic Training, Seton Hall University, South Orange, New Jersey, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Research has studied the influence of menstrual cycle hormones as a factor in higher rates of musculoskeletal injuries among women. Fluctuation of hormone levels during the menstrual cycle has documented effects on proprioceptive inputs to maintain postural control, ligamentous laxity for joint stability, and generation of motor output. The purpose of this study was to determine whether the phases of menstrual cycle alter postural sway and balance responses in dominant and nondominant lower extremity measured on standardized tests on Balance Master system. Number of Subjects: Female subjects (n = 14) aged from 18 to 28 years with normal menstrual cycles; inclusion criteria included no use of hormonal supplements or oral contraceptives within the past 3 months before testing. Materials/Methods: Subjects were tested on the Balance Master system by using Sensory Organization and 6 Functional Limitation tests: single limb stance, walk across, tandem walk, step quick turn, step up and over 8" box and forward lunge during each of 3 phases of menstrual cycle. Follicular, ovulatory and luteal phases were determined by daily salvia testing with Saliva Ovulation test, Q test, and Urinary Stick Ovulation test for 2 months before and during study. A repeated-measures analysis of variance was used to determine within-subject differences (P < .05). A post hoc paired t test was used to determine specific phase differences. Pearson correlation coefficient was used to determine relationship between anthropomorphic measures, leg dominance, age and postural sway, and balance. Results: Significant differences were found during functional tests of forward lunge during follicular and ovulatory phases (P < .007), and step up and over 8" box during follicular and ovulatory phases (P = .034). Differences were noted between dominant and nondominant legs during phases for forward lunge sway, step quick turn sway, and step up and over impact load and sway. Sensory organization test postural sway showed no significant differences during 6 conditions across 3 phases. Conclusions: Fluctuation of hormone levels may produce changes in postural control and balance responses making women prone to injuries during different phase of the menstrual cycle. These results demonstrate that subjects also have less balance responses and more postural sway in their nondominant leg in different phases of their cycle. Clinical Relevance: Assessment of functional balance test during the 3 phases of menstrual cycle may provide insight into impairments in postural sway and balance responses, indicating changes in the ability to generate neuromuscular control during anticipated tasks that are influenced by hormones. While these responses under test conditions differ from the unexpected challenges to balance that may result in injuries, it would be important to develop balance intervention strategies to address potential impairments across menstrual cycle phases.
TITLE: Balance Performance, Functional Mobility and Fall Risk in Community-Dwelling Older Women With Incontinence
AUTHORS: Patricia Nelson, Kimberly K. Cleary, Sara Thompson
INSTITUTION: Eastern Washington University, Spokane, WA, United States.
ABSTRACT BODY:
Purpose/Hypothesis: Urinary incontinence is an important health concern among older women that can negatively impact quality of life and even ability to live independently. Incontinence is particularly important to consider within the context of balance, mobility, and falls. Incontinence is one of several factors that increase the risk of falling, and balance performance is known to be diminished in people with incontinence. The purpose of this study was to use valid and reliable outcome measures to describe balance performance, functional mobility, and fall risk among community-dwelling older women with urinary incontinence. Number of Subjects: Twelve women aged 65 years and older with urinary incontinence participated in this study. They lived independently in a senior living community in the northwest region of the United States. Key inclusion criteria were ability to provide informed consent and to walk within their home (with or without an assistive device) without help from another person. Materials/Methods: Subjects completed functional balance performance measures, including the Berg Balance Scale (BBS) and the Four Square Step Test (FSST). The BBS is well established as a valid measure of static and dynamic balance in community-dwelling older adults. The FSST measures dynamic balance, timing a subject as they step over small objects and change directions, and has high concurrent validity with other established fall-risk measures. Subjects also completed valid, reliable functional mobility performance measures, including the Tinetti Assessment Tool (Tinetti) and the Timed Up and Go (TUG) test. For each instrument, subject scores were compared with established threshold values to classify fall risk. Subjects also provided information about their fall history and demographics. A fall was defined as an unintentional movement resulting in coming to rest on a lower surface like the floor or ground. Descriptive statistics were calculated by using SPSS version 17.0. Results: On the basis of BBS scores (x = 47.5), no subjects were classified at high risk of falls, 1 (8%) was at medium risk, and most (92%) were at low risk of falls. The FSST scores (x = 19.3) indicated that more than half (58%) of subjects were at risk of falls. On the basis of the Tinetti (x = 23.1), some subjects (17%) were classified at high risk, some (25%) at medium risk, and more than half (58%) at low risk of falls. The TUG scores (x = 14.8) indicated that half (50%) of subjects were at high risk of falls. Mean subject age was 84.5 years. Five subjects (45%) reported 1 or more falls in the previous year, and 4 (36%) reported a fear of falling. Conclusions: Little research on balance performance in older women with incontinence exists. This study begins to document functional balance and mobility in this patient population, using multiple outcome measures that also provide fall-risk classification. Clinical Relevance: The results of this study will benefit the physical therapy community by describing functional balance performance and corresponding fall risk among older women with incontinence who live independently.
TITLE: Physical Therapy Treatment of Facial Lymphedema: A Case Report
AUTHORS: Lesley A. Turner, Stacy L. Tylka, Jenn Miller
INSTITUTION: Washington University Program in Physical Therapy, St Louis, Missouri, USA.
ABSTRACT BODY:
Background & Purpose:Lymphedema is an abnormal accumulation of protein-rich fluid in the cellular interstitium, which leads to chronic inflammation and reactive fibrosis in the affected tissues of the extremities as well as the face, neck, abdomen, and genitals. Most often, facial lymphedema is a result of malignant disease. The patient in this case report, however, developed facial lymphedema as a result of Morbihan's disease and rosacea, which were then complicated by the use of a cPAP machine after being diagnosed with sleep apnea. The purpose of this case report was to describe the evaluation and successful treatment of a patient with facial lymphedema utilizing physical therapy techniques. Case Description: The patient was a 68-year-old man referred by a dermatologist for facial lymphedema. The patient's comorbidities include asthma, hypertension, heart disease, Morbihan's disease, rosacea, and a history of melanoma. The patient's primary complaint was swelling in the supra- and infraorbital regions along with minimal swelling in the buccal regions bilaterally. The edema was exacerbated when the patient was recently diagnosed with sleep apnea and was fitted with a mask to wear at night. The patient's orbital regions would swell to the point of visual obstruction on awakening each morning. The patient was seen for 4 physical therapy visits over a 1-month period. Complex decongestive therapy (CDT) treatments included construction of a foam eye mask to assist in supra- and infraorbital region compression nightly, instructions in self-manual lymphatic drainage (MLD) for the head and neck, and instructions in skin care and facial exercises. In addition, the patient's cPAP machine was adjusted to an oral mouth piece for nighttime use to aid in edema reduction. Outcomes: Tracked outcome measures included visual appraisal, edema measurements, 36-Item Short Form Health Survey (SF-36) scores, and subjective information. Photographs taken at each visit demonstrated a decrease in fluid in the supra- and infraorbital regions bilaterally. Skin-fold measurements showed a decrease in 0.5 cm of the infraorbital regions bilaterally by the last visit. The SF-36 outcomes were also taken at visit 1, visit 2, and visit 4. Scores in the subscales of mental health and physical functioning improved throughout the course of treatment. Subjectively, the patient reported less swelling after wearing the nightly compression mask. He also reported decreased visual obstruction and more confidence with public speaking. The patient was compliant with nightly compression but only performed self-MLD 2 to 3 times per week. Discussion: Historically, physical therapy is not the treatment of choice when addressing facial lymphedema secondary to Morbihan's disease and rosacea. Often, oral antibiotics, steroids, and debulking procedures have been utilized instead. However, CDT is a comprehensive approach used to treat swelling with minimal side-effects. The patient discussed in this case report was able to decrease and manage facial edema without the use of medications or surgery.
TITLE: Fall and Bone-Related Risk Factors in Individuals With Fragility Fractures of the Distal Radius: Are We Adequately Addressing Secondary Prevention of Falls and Fractures?
AUTHORS: Cathleen C. Harro, Kathleen Campbell, Jessica McLeod, Elizabeth Langstaff
INSTITUTION: Grand Valley State University, Grand Rapids, Michigan, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Fragility fractures indicate a significant risk for future fractures and necessitate referrals for comprehensive evaluation and risk reduction. Although there are clinical guidelines for best practice for falls and fragility fracture prevention, previous research raises a concern regarding the use of these guidelines. Physical therapists play an important role in evaluation and providing customized interventions for those at high risk for falls and/or fragility fractures; however, physical therapy services may be underutilized. The primary objective of this descriptive study was to describe fall and bone-related risk factors associated with a positive fall history and referral patterns for physical therapy services in persons with a fragility fracture. Number of Subjects: A total of 100 adults postfragility fracture participated in the study. Materials/Methods: A comprehensive survey was developed by an interdisciplinary research team to identify risk factors for osteoporosis, future fracture, and falls. The survey was distributed to 264 adults who sustained a distal radius fragility fracture that required surgical fixation. Response rate was 42% and 100 adults (91 women and 9 men) were included in the study. Chi-square test, Fisher exact test, and odds ratios (ORs) were performed to analyze associations in this cohort between bone and fall-related risk factors and postfracture fall history or referral to physical therapy. Results: Only one-third of the sample was diagnosed with osteoporosis/osteopenia before fragility fracture; however, 72% had 3 or more bone-related risk factors. A positive fall history postfragility fracture was reported by 25% of the sample, and 41% reported 3 or more fall-related risk factors. Positive history of near falls (OR = 16.55, P = .000), fear of falling (OR = 5.42, P = .001), poor self-rated general health (OR = 4.28, P = .035), and no prescription for calcium plus vitamin D supplementation (OR = 7.00, P = .009) were significantly associated with positive fall history postfracture. Only 16% of the sample was referred for exercise or fall prevention postfracture and 27% were referred for an osteoporosis evaluation. Referral for osteoporosis evaluation (OR = 3.28, P = .010) and calcium supplement prescription (OR = 3.21, P = .042) were the only factors significantly associated with referral for exercise. There was a lack of referral for exercise in 80% of those subjects who experienced frequent falls postfracture. Conclusions: These results illustrate a gap between best-practice guidelines for secondary prevention and current clinical management in individuals with fragility fracture. Clinical Relevance: Education of health care professionals and development of clinical pathways for risk reduction after fragility fractures are needed to enhance patient outcomes.
TITLE: Physical Therapy Referral and Treatment for Patients With Gestational Diabetes: Is the Need Being Met?
AUTHORS: Nicole L. Gee, Mary Page, Dave Pariser, Gina L. Pariser
INSTITUTION: Bellarmine University, Louisville, Kentucky, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this pilot study was to gain information on women's health physicians' referral pattern to physical therapy and their understanding of the role physical therapists can play in treating women with gestational diabetes mellitus (GDM). Number of Subjects: Online surveys were sent to 105 physicians who treat women's health issues. Materials/Methods: An online survey was developed to investigate the current use of physical therapy (PT) referral by physicians treating women with GDM. The survey addressed physicians' demographics, current utilization of referral to PT for treatment of GDM, and their interest in reviewing current research for PT intervention. The survey consisted of 4 demographic questions and 8 questions regarding the physicians' referral patterns and opinions for the use of PT. These items allowed the physicians to elaborate on their clinical decisions on whether to refer their patients with GDM for PT intervention. Results: Early results: 12 physicians had responded. None of the responding physicians referred patients with GDM to PT. Seven of the 12 physicians indicated that they were not familiar with the potential benefits of PT intervention for patients with GDM and expressed interest in receiving research about this topic. Conclusions: Early results show that physicians treating patients with GDM may not be aware of the benefits of PT intervention for these patients and may be receptive to receiving more information. Clinical Relevance: The GDM may increase the risk of developing type 2 diabetes mellitus. Furthermore, children born to mothers with GDM have greater risks of obesity, impaired glucose tolerance, and diabetes mellitus. Many health care professionals are wary of physical activity for women with high-risk pregnancies (such as GDM). However, research has shown that physical activity is not only safe but may also decrease or eliminate the need for insulin for patients diagnosed with GDM, decrease the risk of medical complications during pregnancy, and decrease long-term heath risks for the mother and child. Physical therapists are ideally qualified to provide exercise prescription for patients with GDM and need to communicate this to physicians caring for this patient population.
TITLE: An Exploratory Study on the Dynamic Q-Angle as a Potential Risk Factor for Osteoarthritis in Postmenopausal Women: Relationships With Lower Extremity Strength, Gait, and Balance
AUTHORS: Sue Schuerman, Lindsay Appuglise, Trustin Anderson, Chandler Squire
INSTITUTION: Physical Therapy, University of Nevada, Las Vegas, Nevada, USA.
ABSTRACT BODY:
Purpose/Hypothesis: To determine whether a relationship exists between dynamic Q-angle during a step-down task and hip and knee muscle strength, balance, and gait pattern characteristics in healthy women who are postmenopausal. Number of Subjects: A total of 30 subjects participated in the study. Materials/ Methods: Static and dynamic Q-angle were measured in standing and on the stance leg during a step-down task via videorecording and angle measurement through Dartfish software. Hip and knee muscle strengths were measured via hand-held dynamometer. Gait parameters were measured on the GaitRite Electronic Walkway. Balance was measured on the Sensory Organization Test (SOT). Results: No significant correlation was found between hip and knee muscle strength and right or left dynamic Q-angle. No statistical significance was found between composite balance scores on the SOT and right or left dynamic Q angle (r = -0.182, P = .335; and r = 0.042, P = .827, respectively). Data revealed statistically, but not clinically, significant correlations between right dynamic Q-angle and left and right step length (r = 0.421, P = .02, and r2 = 0.177; and r = 0.481, P = .007, r2 = 0.231, respectively) and between right single-leg stance time and left dynamic Q-angle (r = 0.419, P = .021, r2 = 0.176). Conclusions: The findings do not support a relationship between dynamic Q-angle and hip and knee muscle strength, gait pattern characteristics, and balance in women who are postmenopausal. Clinical Relevance: As no association was found among muscle strength, balance, gait parameters, and knee alignment in this study, no particular exercise protocol or intervention can be recommended for this population of individuals to assist in maintaining good knee alignment.
The primary clinical implication of this study was established by the observation of the subjects during the step-down task. Subjects walked 10 ft on the level floor onto a ramp and then stepped down a standard 8-in step without stopping in an effort to simulate natural motion in community activities. The majority of the subjects used a lower extremity external rotation compensatory strategy on the stance leg to meet the demands of the step descent. This population of community-dwelling postmenopausal women might have developed different compensatory patterns to decrease repetitive loading on the knee, thus keeping them active in the community and without debilitating pain or the use of an assistive device. Future evaluation of the compensatory strategies employed by this population of subjects with a multicamera system might allow the identification of optimal compensatory strategies of movement and body mechanics. These strategies might then be used to retrain patients to avoid movements resulting in abnormal joint forces at the knee during functional weight-bearing activities.
TITLE: A Comparison of Pelvic Floor Muscle Responsiveness in Nulliparous Young Women With and Without Asthma
AUTHORS: Melissa E. Myers1, Katie M. Denovich2, Karen Grossnickle3
INSTITUTIONS: 1. Physical Therapy, Central Michigan University, Mt Pleasant, Michigan, USA.2. Physical Therapy, Central Michigan University, Mt Pleasant, Michigan, USA.3. Physical Therapy, Central Michigan University, Mt Pleasant, Michigan, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this study was to identify asthma as a potential predisposing factor to the development of pelvic floor muscle (PFM) weakness in young nulliparous women. Number of Subjects: Sixteen college-aged nulliparous women (aged 20-23 years), 8 with self-reported asthma and 8 without asthma, participated in this study. Materials/Methods: Subjects completed a bowel and bladder diary, a Sleep-Work-Play Asthma Questionnaire, and a Pelvic Floor Distress Inventory (PFDI-20). Lung function was assessed by using spirometry, and PFM strength was assessed by using pressure perinometry. Results: The PFDI-20 and bowel and bladder diary showed lower quality-of-life scores, increased urinary leakage, and increased urinary voids per day among women with asthma. Spirometry measures showed altered respiratory mechanics among women with asthma. Pressure perinometry did not identify a significant difference in PFM strength between the 2 groups. Conclusions: It is speculated that pressure perinometry may not be the best tool for assessing PFM strength, or the impact of asthma on the pelvic floor has not become significant at this point in time for these women, beyond quality-of-life implications. The results of this study have the potential to help health care professionals recognize asthma as a predisposing factor to muscle weakness in the pelvic floor, and it can be a stimulus to pursue research in which preventative intervention protocols for people with asthma are identified and developed. Results of this study suggest further study of PFM function and strength in individuals with asthma. Clinical Relevance: Respiratory conditions, including cystic fibrosis and chronic coughing, have been investigated as having an effect on PFM strength in women. Chronic respiratory conditions impact intra-abdominal pressure linearly. Scientific evidence supports the connection of abnormal abdominal pressures contributing to weak pelvic floor musculature. Pelvic floor muscle weakness is often a precursor to incontinence.
TITLE: A Comparative Study Among Ballet, Jazz, and Modern Dancers
AUTHORS: Brittney Kerchief1, Meghan L. Shafer2, David Boyce3
INSTITUTIONS: 1. Physical Therapy Department, Bellarmine University, Louisville, Kentucky, USA.2. Physical Therapy Department, Bellarmine University, Louisville, Kentucky, USA.3. Physical Therapy Department, Bellarmine University, Louisville, Kentucky, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this study was to investigate the various types of injuries sustained by ballet, jazz, and modern dancers and whether type of dance, age, body mass index (BMI), type of exercise training, and years of experience have an impact on injury prevalence among dancers. Number of Subjects: A total of 90 female ballet, modern, and jazz dancers ranging in age from 14 to 22 years participated in this study. Materials/Methods: All dancers completed a 6-question survey regarding subject age, weight, height, type and frequency of exercise training, injury history, and years of dance experience. The results of this survey were used to examine the specific characteristics of each dance type. Further analysis was then performed to examine differences among and within the different dance disciplines. Results: It was determined that the mean number of years of dance experience was 13 years. On average, the subjects were found to be underweight when comparing normal BMI to that of age- and gender-matched norms. The vast majority of subjects exercised outside of dance practice; the most common form of exercise training was found to be aerobic conditioning. On average, the subjects were found to practice their style of dance greater than 10 hours per week excluding outside conditioning. Injury frequency and type among various dance disciplines demonstrated a predilection toward the lower extremity. The most frequent injury involved the foot/ankle and then in a descending order of frequency, the hip, knee, back, arm/hand, head/neck, and shoulder. On average, ballet and modern dancers demonstrated the highest rates of foot/ankle injuries when compared with jazz dancers. In addition, it appeared that hip and knee injuries were more prevalent in jazz dancers. Conclusions: The subjects of this study were determined to be underweight, as determined by BMI when compared to age- and gender-matched norms. A positive correlation between lower BMI and injury rates were found in this sample. The number of practice hours per week and years of experience also demonstrated a positive correlation with overall rate of injuries. Finally, lower limb injuries were the most common in this sample, with foot and ankle injuries occurring at the highest rate. The investigators also determined that certain lower limb injuries had a predilection for a certain type of dance. Clinical Relevance: This study provides physical therapists with a more accurate picture of body composition, injury types, and training type and frequency in female ballet, modern, and jazz dancers. It appears that lower than normal BMI has a negative impact on musculoskeletal health of dancers. Proper nutritional habits that would normalize BMI may be of benefit in reducing injuries in this sample. Increasing amounts of time spent on training and the type of training appear to have an increase in lower limb injuries in dancers. Overtraining or lack of variability in training more than likely leads to an increase in lower limb injuries in this sample. Finally, efforts could be made to protect the foot and ankle, knowing that they sustain the highest frequency of injury.
TITLE: Association Between Lumbar Motion and Self-reported Orthopedic History of Musculoskeletal Injury of the Low Back in Adult Women
AUTHOR: Nicole P. Borman
INSTITUTION: School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Collectively, women are more likely to be physically inactive. Some studies have reported female predominance in chronic musculoskeletal pain and back impairments and even a potential association between musculoskeletal pain and injuries. Yet, limited research exists for exploring the association between lumbar motion and self-reported orthopedic history of musculoskeletal injury (SR-MSI) of the low back in community-dwelling women. The purpose of this research was to quantify the association between lumbar motion and SR-MSI for these women. Number of Subjects: A total of 868 subjects participated in the study. Materials/Methods: Participants in the Women's Injury Study at the Cooper Institute in Dallas, Texas, completed Web-based assessments of baseline demographic data and orthopedic history of symptoms, injuries, and physical activity. All participants were apparently healthy volunteers, older than 20 years (M +/- SD = 53.07 +/- 12.5 years), with no disease or condition that prevented or limited their daily recreational activities. Measurements for height, weight, and sagittal lumbar motion were recorded by using a stadiometer, an electronic scale, and a digital inclinometer. Lumbar motion measurements were grouped into quartiles for comparisons (highest [Q4], lowest [Q1], and middle [Q2 + Q3]). Results: Comparison based on lumbar motion quartiles of those women who reported having an SR-MSI versus those women who reported no SR-MSI showed significant associations: across all lumbar flexion motion quartiles for pain (Odds ratio [OR] = 10.42 [5.5-19.9] [Q2 + Q3]; OR = 7.5 [3.5-15.9] [Q1]; and OR = 6.7 [2.9-16.0] [Q4]), and stiffness (OR = 2.63 [1.43-4.87] [Q2 + Q3]; OR = 2.92 [1.30-6.54] [Q1]; and OR = 4.02 [1.56-10.41] [Q4]). Meaning, for pain, women with an SR-MSI were 10.42 times more likely to report pain when lumbar flexion motion in Q2 + Q3, 7.5 times more likely to report pain when lumbar flexion motion in Q1, or 6.7 times more likely to report pain when lumbar flexion motion in Q4 as compared with women who reported no SR-MSI in similar lumbar flexion motion quartiles. For stiffness, corresponding statements were reported. Conclusions: The findings show clear association between lumbar flexion motion, pain, stiffness, and musculoskeletal injuries of the low back in these women. Overall, given that a woman has an SR-MSI, the odds of pain (stiffness) are 1.39 (1.11) times more likely for a woman with lumbar flexion motion in the highest quartile and 1.55 (1.53) times more likely for a woman with lumbar flexion motion in the lowest quartile when compared with women in the middle quartiles. Clinical Relevance: Understanding the association between lumbar flexion motion, pain, and stiffness with SR-MSI of the low back in these women will assist health care professionals to categorize and identify probable risk factors for musculoskeletal injuries among community-dwelling women as well as aid in creating intervention strategies and/or recommendations to increase physical activity in women with comparable characteristics.
TITLE: Physical Therapy Management of Pelvic Floor Pain and Lumbosacral Dysfunction With Complications of Constipation and other Comorbidities: A Case Report
AUTHOR: Susan C. Clinton
INSTITUTION: Physical Therapy-Moon Office, Centers For Rehab Services, Coraopolis, Pennsylvania, USA.
ABSTRACT BODY:
Background & Purpose: Pelvic floor pain and dyspareunia are prevalent conditions for women and can be complicated by factors of lumbosacral dysfunction, constipation, and other comorbidities. Treatment of the musculoskeletal dysfunctions without the consideration for treatment of the comorbidities can lead to unsatisfactory outcomes in complicated cases. The purpose of this case report was to describe the examination, differential diagnosis, and treatment of chronic pelvic floor pain in an algorithm that would delineate the appropriate physical therapy measures as well as the identification and referral for mitigating factors. Case Description: The patient was a 38-year-old woman referred for pelvic floor pain with previous unsuccessful outcomes in physical therapy. The patient had accompanying problems of lumbosacral dysfunction, cyclical constipation, and autonomic nervous system disorders. The patient received manual therapy, exercise, and educational interventions as well as identification and appropriate referral for other factors that could limit healing. Outcomes: At the end of her treatment plan, she reported complete resolution of pelvic floor and minimal lumbosacral pain and associated dysfunctions. She was independent in managing all of her symptoms and was able to maintain an improved quality of life. Discussion: The use of evidence-based examination and intervention, along with identification and referral for complicating factors, resulted in an improved outcome for this patient with chronic pelvic pain.