Anatomy Review - The Thoracic and Lumbar Spine (video)

Lets start the day by reviewing some of the basics around Thoracic and Lumbar Spine anatomy structures. This is video is created by Kenhub

A recap of Low back Pain (video)

As World Spine Day approaches ( 16th Oct. 18 ) ... let's have a recap on Low Back Pain via this useful video by Mike Evans.

Midsubstance Tendinopathy Infograph

(from link)

Smart infograph and things to look out, from Clinical Edge's David Pope, when possible midsubstance tendinopathy occurs.

How do nerves work ?

Source from https://www.youtube.com/watch?v=uU_4uA6-zcE

Sports hernia and pelvic rehab

(picture)

Hi guys !

It's that time where we do a quick exploration of another MSK topic and its management from a physio-point of view. It has been long since my previous blog but this has been due to a good cause as I am currently undergoing an OMT diploma in the University of Birmingham. Sooo more great stuff to come through !

Recently, I have had the chance to treat a post-op inguinal hernia patient.  The inguinal hernia is known with multiple nomenclature such as Sports Hernia (SH) or Gillmore's groin. However they all share common clinical characteristics. I am not going to discuss about the relevant anatomy or pathophysiology, though you can find further information by pressing this link !

I will mainly touch on some key study findings which I think  are important when focussing on the pelvic rehabilitation of such cases.

Core stabilisation exercises are important to increase motor recruitment of the Transverse Abdominis (TrA) and Internal Obliques. These two muscles attach at the anterior iliac spine and inguinal ligament providing anterior and superior pelvic stability though, decreasing  inferior pubical control through distraction. Thus, pelvic muscle activation seems to be a logical theory where the pelvic floor muscles provide compressive forces to the inferior pubic symphisis (PS) and thus forming a stable pelvic ring. This theory seems to be achievable via pelvic floor strengthening which can allow stability during the shear forces at kicking, landing and twisting, especially during sport (increased forces !).

(picture from Yuill et al. 2012)

The study by Cowan et al. (2004) depicted a significant decrease in the activation of TrA (via EMG) during an Active Straight Leg Raise (ASLR), in patients with long standing groin pain compared to a control group. They found no significant difference in the activation of Internal / External Oblique (IO/EO), Rectus Abdominis (RA) and Rectus Femoris (RF). Thus once could speculate that TrA strengthening could actually improve TrA motor recruitment during ASLR and potentially during multidirectional tasks as in sport.

However, there were some major limitations of this study making it hard to generalise its findings to post-operative inguinal patients.

Firstly, they excluded any lower abdominal surgery or inguinal hernia patients. Nevertheless, further studies could include such cases or focus only in these cases since a SH may affect the oblique core activation and hip isokinetic strength (link).

Secondly, the authors tested the subjects only during ASLR which is a non functional test. Lumbar pertubations can occur as well apart from pelvic rotations. Thus, TrA activation could not be directly attributed to the pelvic movement.

Furthermore, the researchers examined only the symptomatic side, though the decreased TrA recruitment could be bilateral. Lastly there was a variable sample selection and placement of fine electrodes which could be the reason for the variable temporal responce in this study.

Another study by Yuill et al. (2012) showed good results after a conservative 8wk treatment of 3 sports related hernia cases. It consisted of manual / physical therapy and exercise which included pelvic stabilisations. Despite the clear treatment protocol and the improved pain outcomes it is very hard to generalise these findings due to methodological flaws and the variation in the treatment modalities that were used.

To conclude, pelvic stabilisation exercises might prove fruitful in decreasing pain and improving overall function and return to previous activities or sport via correction of stability and biomechanics of the pelvic ring.

As always, thanks for reading !

Art.