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Research Findings
Listed below are 3 abstracts of research findings presented by Barbara Hungerford. There are 2 abstracts from published papers, plus the abstract from her PhD thesis. Journal references are provided in case you wish to search for a complete copy of the articles.
- Evidence of Altered Lumbo-Pelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain
- Altered Patterns of Pelvic Bone Motion Determined in Subjects with Posterior Pelvic Pain Using Skin Markers
- Analysis of functional load transfer through the pelvis: patterns of intra-pelvic motion and muscle recruitment for pelvic stability
- Evaluation of the reliability of therapists to palate intra-pelvic motion using the stork test on the support side
1. Evidence of Altered Lumbo-Pelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain
1 Barbara Hungerford PhD, 2 Wendy Gilleard PhD, 3 Paul Hodges PhD
published in Spine 2003, 28(14), pp1593-1600, Lippincott Williams & Wilkins, Inc.
1 School of Exercise
and Sport Science, University of Sydney, Sydney, Australia
2 School of Exercise Science and Sport Management, Southern
Cross University, Lismore, Australia
3 Department of Physiotherapy, The University of Queensland,
Brisbane, Australia
Abstract
Study design: Cross-sectional study of electromyographic (EMG) onsets of trunk and hip muscles in subjects with a clinical diagnosis of sacroiliac joint pain (SIJP) and matched controls
Objectives: To determine whether muscle activation of the supporting leg is different between controls and subjects with SIJP during hip flexion in standing.
Background: Activation of the trunk and gluteal muscles stabilise the pelvis for load transference, however the temporal pattern of muscle activation, and the effect of pelvic pain on temporal parameters has not been investigated.
Methods: Fourteen males with a clinical diagnosis of sacroiliac joint pain and healthy age-matched controls were studied. Surface EMG activity was recorded from seven trunk and hip muscles of the supporting leg during hip flexion in standing. Onset of muscle activity relative to initiation of the task was compared between groups, and between limbs.
Results: Onset of obliquus internus abdominis (OI) and multifidus occurred prior to initiation of weight transfer in the controls. The onset of OI, multifidus, and gluteus maximus was delayed on the symptomatic side in SIJP subjects compared to controls, and the onset of biceps femoris EMG was earlier. In addition, EMG onsets were different between the symptomatic and asymptomatic side in subjects with SIJP.
Conclusions: The delayed onset of OI, multifidus, and
gluteus maximus EMG of the supporting leg during hip flexion, in subjects
with SIJP, suggests an alteration in the strategy for lumbo-pelvic stabilisation
that may disrupt load transference through the pelvis.
2. Altered Patterns of Pelvic Bone Motion Determined in Subjects with Posterior Pelvic Pain Using Skin Markers
1 Barbara Hungerford PhD, 2 Wendy Gilleard PhD, 3 Diane Lee FCAMT
published in Clinical Biomechanics, 2004; 19: pp 456-464
Abstract
Objective: To determine whether the pattern of pelvic bone motion, determined by skin markers, differs between control subjects and subjects with posterior pelvic pain
Design: Cross-sectional study of three dimensional (3D) angular and translational motion of the innominates relative to the sacrum in two subject groups.
Background: Comparative in vivo analysis of the 3D patterning of pelvic motion in subjects with posterior pelvic pain and controls is limited.
Methods: Fourteen males with posterior pelvic pain and healthy age and height matched controls were studied. A 6 camera motion analysis system was used to determine 3D angular and translational motion of pelvic skin markers during standing hip flexion.
Results: Posterior rotation of the innominate occurred with hip flexion in control subjects and pelvic pain subjects as previously reported in the literature. On the supporting leg, the innominate rotated posteriorly in controls and anteriorly in symptomatic subjects.
Conclusion: Posterior rotation of the innominate, as measured using skin markers during weight bearing in controls may reflect activation of optimal lumbo-pelvic stabilisation strategies for load transfer. Anterior rotation occurred in symptomatic subjects, suggesting failure to stabilise intra-pelvic motion for load transfer.
3. Analysis of functional load transfer through the pelvis: patterns of intra-pelvic motion and muscle recruitment for pelvic stability
The work presented below is the abstract from Barbara Hungerford’s PhD thesis of the same title. The thesis can be found in the Library at University of Sydney, Australia.
Abstract
Introduction. The sacroiliac joint (SIJ) is a known source of low back and posterior pelvic pain, however little is known about the in vivo biomechanics of intra-pelvic motion or the motor recruitment patterns that are initiated to stabilise intra-pelvic motion for optimal load transfer between the spine and legs during weightbearing activities. Comparison of the patterns of motion in the presence of pelvic pain or biomechanical impairment to load transfer through the pelvis, and muscle activation in the trunk and pelvic region, is also limited. The objectives of this study were to investigate if three dimensional (3D) intra-pelvic motion could be reliably determined using a non-invasive motion analysis procedure in females subjects with normal lumbo-pelvic motion patterns (normal subjects), and subsequently to evaluate whether the pattern of intra-pelvic motion altered between normal subjects and subjects with posterior pelvic pain associated with clinically determined Failed Load Transfer through the Pelvis (FLTP). Electromyographic (EMG) onsets of trunk and hip muscles were also investigated in normal subjects and subjects with posterior pelvic pain associated with FLTP to determine if the temporal relationship of muscle activation varied between groups.
Methods. Initial evaluation of the motion analysis protocol determined the system could accurately determine 1° changes to an accuracy of 0.25°. Intra-pelvic motion was investigated in normal female and male subjects, and female and male subjects with posterior pelvic pain using a 6 camera motion analysis system. Subjects with pelvic pain were included if they tested positive to four objective assessment tests for FLTP on the side of their pain. Fifteen retro-reflective markers were used to define bone landmarks of the innominates, sacrum, and femurs. Subjects performed five trials of Standing Hip Flexion and the Hip Drop movement on each leg. 3D angular and translational motion of the innominates relative to the sacrum was determined about the coronal, sagittal, and vertical axes on the side of single leg support, and the side of hip motion, during each movement activity. Two-tailed student t-tests were used to compare intra-pelvic motion within, and between groups. Trial to trial and retrial reliability was investigated using Intra- class Correlations and Percentage Close Agreement. Surface EMG activity was recorded simultaneously from the male subjects on the side of single leg support during Standing Hip Flexion trials. Onset of muscle activity relative to initiation of motion was compared between groups, and between limbs for seven trunk and hip muscles using two tailed student t-tests.
Results. Intra-pelvic motion was reliable when measured at the point of maximal coronal axis motion of the innominate on the side of hip flexion during Standing Hip Flexion. Posterior rotation of the innominate occurred with hip flexion in normal subjects. A concurrent pattern of anterior, superior and lateral translation of the innominate was shown during hip flexion. There was no significant difference between groups during the hip motion component of the movement activities. On the side of single leg support the innominate rotated posteriorly relative to the sacrum in normal subjects. The innominate anteriorly rotated on the side of single leg support in subjects with FLTP. EMG onsets of obliquus abdominis internus (OI), multifidus, and gluteus maximus were delayed on the symptomatic side in subjects with FLTP compared to controls, and onset of biceps femoris EMG was earlier.
Discussion. The pattern of posterior rotation of the innominate during hip flexion corresponded to sacroiliac joint motion reported previously. The direction of concurrent translation has not been reported previously, however translational motion has been considered necessary for angular motion to occur at the SIJ. The pattern of posterior rotation on the side of single leg support may indicate activation of the self-bracing mechanism for load transference through the pelvis. In subjects with FLTP, however, the innominate anteriorly rotated, suggesting failure to control intra-pelvic motion during load transfer for single leg support. It is interesting to note that the altered pattern of intra-pelvic motion occurred on the same side, and in the same subjects with delayed recruitment of OI, multifidus, and gluteus maximus. It is possible that failure to activate OI and multifidus prior to initiation of motion decreased the forces required to initiate self-bracing of the pelvis, and resulted in a relative failure to produce the compressive forces required to maintain stabilisation of intra-pelvic motion.
4. Evaluation of the reliability of therapists to palate intra-pelvic motion using the stork test on the support side
Hungerford B PhD, Gilleard W PhD, Moran M MHlth Sci Sports Physio, Emmerson C MHlth Sci Sports Physio
Published in: Journal Physical Therapy, 2007; 87(7), 879-887
Abstract
Background. Clinical indicators of pelvic girdle dysfunction are limited, however research has shown that patterning of intra-pelvic motion alters during single leg support in subjects with pelvic girdle pain (PGP). Functionally, no relative motion should occur within the pelvis during load transfer, while anterior rotation of the innominate relative to the sacrum occurs during weight bearing in the presence of PGP. The aim of this study was to investigate whether the pattern of intra-pelvic motion could be reliably detected during a new clinical assessment test for functional load transfer: the Stork test on the support side.
Methods. Three therapists were randomly assigned to palpate bone motion of the innominates and sacrum in 33 subjects during the stork test on the support side. The direction of bone motion was indicated on a 2-point and 3-point scale.
Results. Inter-therapist reliability to agree on the pattern of intra-pelvic motion occurring during load transfer showed good reliability (Left k = 0.67 and Right k = 0.77) and high percentage of agreement (left =91.9%, right = 89.9%) when using a two point scale. A three point scale showed moderate reliability for both the left and right sides (Left k = 0.59 and Right k = 0.59), with the percentage of agreement decreasing to 82.8% (left) and 79.8% (right).
Conclusions. The ability of the therapists to reliably palpate and recognise altered patterning of intra-pelvic motion during the Stork test on the support side was substantiated. The ability to distinguish between no relative movement, versus anterior rotation of the innominate during a load bearing task, was good. Further research is required to determine the validity of this test in detecting pelvic girdle dysfunction.