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Innominate movements during hip abduction and external rotation have recently been described in healthy individuals. In the present study the aim was to determine whether these hip movement tests could discriminate altered movement patterns in people with specific pelvic girdle pain (PGP) disorder. This pilot study is the first step in determining the usefulness of prone hip abduction and external rotation in the differential diagnosis of PGP disorders. A cross-sectional comparison between a convenient sample of 6 individuals who had been referred for exercise and advice following diagnosis of ankylosing spondylitis (AS) via a Medical/Rheumatological pathway and 18 healthy age and gender matched controls. Transverse and sagittal plane innominate motion was measured using a palpation and digitizing technique with a magnetic tracking device. Data analysis involved applying best-fit equations to the data and visual inspection of the produced graphs as well as conditional logistical regression for each test position to determine our ability to predict group association. Graphical comparisons demonstrate a distinction between the patients with AS and the healthy controls. Further, for all three hip conditions the innominate angle was a significant predictor of group association (p = 0.002 for AB, p = 0.005 for AB + ER and p = 0.007 for ER)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Identifying factors which influence guideline-informed clinical decisions by therapists will help tailor implementation strategies to improve guideline use. The aims of this study were to investigate; the extent to which current physiotherapy practice in New Zealand adheres to low back pain (LBP) guidelines and the factors which influence the use of guidelines to inform clinical decisions for patients with non-specific low back pain (NSLBP). A cross-sectional on-line survey of NZ physiotherapists (n = 1039) was conducted which included the guideline adherence measures, therapists' treatment orientation about NSLBP and a question on the perceived helpfulness of guidelines in decisions for patients with NSLBP. Data from 170 physiotherapists were analysed descriptively and univariate and multivariate associations were conducted for therapist factors (predictor variables) which predicted guidelines being helpful in decisions for management of patients with NSLBP (Y|N). The majority of respondents provided advice which was broadly inline with guideline recommendations [work (60%), activity (87.6%), and bed rest (63%)]. A lower biomedical belief orientation for LBP, higher reported LBP caseload and postgraduate qualifications demonstrated significant univariate associations (P ≤ 0.20) for guidelines being helpful to inform decisions for a patient with NSLBP. The only significant (P = 0.043) predictor variable in the multivariate model was the therapists' biomedical treatment orientation (Exp (B): odd ratio: 1.56). Differences between behaviours and beliefs in guideline use were found. A lower focus on a biomedical model for LBP influenced usage of LBP guidelines to inform clinical decisions for patients with LBP. Implications for improving guideline usage are discussed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Joint kinematic assessment using an electromagnetic tracking device (EMTD) requires palpation-digitization (PD) of bony landmarks to define the anatomical axes. Errors in PD of bony landmarks can perturb the anatomical axes and affect the validity and reliability of kinematic measurements. The validity and reliability of PD for kinematic measurement needs to be explored before recommending its wider use. A systematic search of 15 electronic databases located studies assessing validity and/or reliability of PD for joint kinematic assessment. Two independent reviewers used the QUADAS and QAREL tools to assess quality of validity and reliability studies respectively. The results were synthesized qualitatively using a level of evidence approach. Eight studies satisfied the final eligibility criteria and were included in the review. The validity, intra-rater reliability and inter-rater reliability were assessed in three, seven and one study respectively. The overall level of evidence for validity of PD technique was strong with high correlation (≥0.80) reported by three high (≥60%) quality studies. The overall level of evidence for intra-rater reliability was also strong with very high ICC (≥0.90) and satisfactory SEM (SEM% ≤ 10%) reported by four high quality studies. However the level of evidence for inter-rater reliability was limited and needs to be addressed by future research., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Optimal lumbopelvic stability is a function of form closure (joint anatomy), force closure (additional compressive forces acting across the joints) and neuromotor control. Impairment of any of these mechanisms can result in pain, instability, altered lumbopelvic kinematics, and changes in muscle strength and motor control. External pelvic compression (EPC) has been hypothesised to have an effect on force closure and neuromotor control. However, the specific application parameters (type, location and force) and hypothesized effects of EPC are unclear. Thus, a systematic review was conducted to summarize the in vivo and in vitro effects of EPC. Eighteen articles met the eligibility criteria, with quality ranging from 33% to 72% based on a modified Downs and Black index. A modified van Tulder's rating system was used to ascertain the level of evidence synthesised from this review. There is moderate evidence to support the role of EPC in decreasing laxity of the sacroiliac joint, changing lumbopelvic kinematics, altering selective recruitment of stabilizing musculature, and reducing pain. There is limited evidence for effects of EPC on decreasing sacral mobility, and affecting strength of muscles surrounding the SIJ, factors which require further investigation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Hamstring injuries are commonly reported in various sports involving sprinting, high-velocity running and kicking. Aberrant biomechanics and neuromotor control of the lumbopelvic and thigh segments have been reported to play a significant role in hamstring injury incidence and recurrence. Recent evidence suggests that external pelvic compression (EPC) applied with a pelvic belt can augment the stability of the pelvic joints, and alter neuromotor control of the lumbopelvic and thigh muscles in individuals with and without (somatic) lumbopelvic and groin dysfunction. However, the effects of EPC on neuromotor control of injured hamstring muscles remain unknown. We have explored the putative neuromotor link between the lumbopelvic segment and hamstring muscles, and generated hypotheses based on plausible mechanisms through which EPC could affect injured hamstring muscle strength and recruitment. Recent guidelines argue that rehabilitation of hamstring injuries should follow a multi-modal approach and include strategies to improve stability and neuromotor control of the lumbopelvic segment. Further investigations exploring these hypotheses would confirm whether EPC could be recommended as an assessment, intervention and rehabilitation tool for hamstring injury., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Although the complex anatomical orientation and position of the sacroiliac joints (SIJ) has rendered their 3D kinematic evaluation difficult, recent techniques of palpation-digitization of pelvic landmarks using electromagnetic tracking device have been able to accurately and non-invasively quantify the subtle SIJ kinematics. While this technique demonstrates radiographic validity and high test-retest reliability, it is yet to be assessed with regards to inter-tester and trial-to-trial reliability. A single-group repeated measure design using 4 testers was conducted to evaluate the inter-tester and trial-to-trial reliability of palpation-digitization technique for innominate vector length measurements using the Polhemus electromagnetic tracking device. Fourteen young, healthy adults between the ages of 18-40 years participated in the study. The innominate vector length was calculated from 3D co-ordinates of palpated and digitized pelvic landmarks in two test positions of hip. A sensitivity analysis was conducted to determine how palpation-digitization errors for pelvic landmarks impacts on innominate angle calculation. Reliability indexes of Intraclass correlation coefficient (ICC) (≥0.97) and Standard error of measurement (SEM) (≤2.02 mm) demonstrated very high inter-tester and trial-to-trial reliability and accuracy of palpation-digitization technique for innominate vector length measurements, irrespective of the two test positions. A higher consistency of measurements was obtained within-testers as compared to between testers, and sensitivity analysis demonstrated a negligible influence of palpation-digitization errors on the innominate angle measurements. The results support clinical and research utility of this technique for non-invasive kinematic evaluation of SIJ motion for this population. Further research on the use of this palpation-digitization technique in symptomatic population is warranted., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Wool handling is an important rural occupation where workers process 200 or more fleeces daily, separating them into various quality components. Loads and postures they experience carry substantial risk of low back pain (LBP). Although a formal skill training structure exists, interaction with loads and LBP is unknown. We examined whether skill and LBP influenced trunk postures and loads of 60 wool handlers representing 3 skill levels. LBP prevalence ranged from 20% for junior (lowest skill) to 45% for open class (highest skill) wool handlers. Open class wool handlers demonstrated increased lateral bend and more axially twisted postures, generating greater medio-lateral shear forces and lateral bend and axial twist moments. LBP was associated with open class wool handlers spending more time in severe axially twisted postures. These findings suggest that skill-based training needs to be reviewed to reduce the quantity of axially twisted posture which may help reduce the prevalence of LBP in this workforce., (Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Introduction: Many New Zealand rural workers have repeated low back pain (LBP) episodes yet continue to work. We wanted to find out why, given that other manual workers with LBP often end up on long term sick leave or permanently disabled., Methods: Our primarily qualitative approach used mixed methods to investigate rural workers with non-specific LBP. Participants (n = 33) were surveyed for demographic data, the Brief Illness Perception Questionnaire and the General Self Efficacy Scale followed by one-to-one semi-structured interviews. Analysis ranged from descriptive content to detailed qualitative Interpretative Phenomenological Analysis., Results: Participants had high self efficacy scores, positive perceptions about LBP but strong beliefs that LBP is lifelong. Four distinct themes emerged. "Thinking with my head before my back" and "Knowing the risks" described participants' innovation regarding job modifications. "Just carry on" and "Love of the land" related to stoical resilience and commitment to something more than employment., Conclusions: This rural workforce adopts a 'can do' attitude to work, managing LBP within the context of having job control and flexible work practices., Implications: Rehabilitation interventions promoting job control and targeting positive attitudes towards getting on with work, whilst accepting LBP as part of everyday life, may have merit for other workers with LBP.

Effective intervention for low back pain (LBP) can include feedback in one form or other. Although extrinsic feedback (EF) can be provided in a number of ways, most research has not considered how different EF characteristics (e.g. timing and content) influence treatment outcomes. A systematic search related to feedback and LBP was performed on relevant electronic databases. This narrative review aims to describe the forms of feedback provision in the literature regarding management of LBP, and to discuss these in light of previously recommended principles for the use of extrinsic feedback. The present review found support for the provision of EF that focuses on content characteristics including program feedback, summary results feedback, and external focus of attention. Temporal characteristics should enhance the use of intermittent or self-selected feedback. The literature does not support the provision of concurrent or constant EF. As much of the literature related to EF in the management of LBP has not considered content and timing characteristics we have identified future research directions that will clarify the use of content and timing characteristics of EF relative to the management of LBP., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Low back pain (LBP) is associated with dysfunction of global and local muscle systems, feedback and feedforward postural control mechanisms. Physiotherapists include the use of feedback as part of treatment protocols. Such feedback can focus on a variety of neuromuscular impairments, although the literature related to feedback on the management of LBP has focused mainly on local muscle system impairments. Furthermore, there are various characteristics of feedback that can lead to motor control enhancement or deterioration. The aim of this manuscript is to present a rationale for feedback provision as a rehabilitation tool on the management of LBP. Feedback provision should focus on the main neuromuscular impairment presented by the patient. The suggested rationale describes decision-making stages for the use and progress of feedback interventions. Local muscle system impairment might benefit more from parameter feedback provision, while global muscle system and feedback mechanism impairments may benefit better from program feedback. The described rationale has the potential to help clinicians select the appropriate feedback for the treatment of their patients. Additionally, the presented rationale could be used by researchers to assess how different forms of feedback provision impact on clinical outcomes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)