Study Design: Controlled laboratory cross-sectional Objectives: To investigate the relationship b... more Study Design: Controlled laboratory cross-sectional Objectives: To investigate the relationship between femoral version (FV), measured by MRI (FVMRI), Craig's test and hip rotation range of motion (ROM). To determine rotation ROM values associated with FVMRI categories: excessive anteversion, normal version and retroversion. Background: Abnormal FV values are associated with hip disorders, such as osteoarthritis, structural instability, acetabular labral tears and femoroacetabular impingement. Clinical assessment of FV may allow clinician to identify the effect of bony abnormalities on hip rotation ROM to guide clinical decisions.
Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although su... more Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing.
To investigate the effect of hip joint position on hip rotator muscle strength of healthy young a... more To investigate the effect of hip joint position on hip rotator muscle strength of healthy young adults by using a hand-held dynamometer. A cross-sectional cohort study. A university medical center. Thirty-four healthy (19 women, 15 men; mean [standard deviation] age, 25 ± 2.3 years) participated in this study. A hand-held dynamometer was used to measure the strength of hip internal rotators and external rotators in 2 positions: hip flexion in sitting and hip extension in supine. The hip was tested in a neutral position with respect to rotation, abduction, and adduction. Isometric force in pounds was measured as the subject pushed against the device. For each subject, hip rotator muscle strength measurements were taken during a single session. Hypotheses were developed before data collection. Hip internal rotators were significantly stronger in hip flexion compared with hip extension (P < .01). There was no significant difference found in the hip external rotators between the 2 positions. Hip internal rotators and external rotators behave differently when comparing strength measurements between the positions of hip flexion and hip extension. A hand-held dynamometer provided an objective measurement of strength that was clinically feasible to use. Both muscle length and moment arms influence force production of the hip rotators as the hip position changes. Understanding these relationships may help clinicians interpret strength findings and direct intervention toward strengthening the appropriate muscles by using the most advantageous position.
Journal of Orthopaedic & Sports Physical Therapy, 2014
Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip... more Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip rotator and abductor muscle groups in young adults with chronic hip joint pain (CHJP) and asymptomatic controls. A secondary objective was to determine if strength in the uninvolved hip of those with unilateral CHJP differs from that in asymptomatic controls. Little is known about the relationship between hip muscle strength and CHJP in young adults. Thirty-five participants with CHJP and 35 matched controls (18 to 40 years of age) participated. Using handheld dynamometry, strength of the hip external rotators and internal rotators was assessed with the hip flexed to 90° and 0°. To assess external rotator and internal rotator strength, the hip was placed at the end range of external rotation and internal rotation, respectively. Strength of the hip abductors was assessed in sidelying, with the hip in 15° of abduction. Break tests were performed to determine maximum muscle force, and the average torque was calculated using the corresponding moment arm. Independent-sample t tests were used to compare strength values between (1) the involved limb in participants with CHJP and the corresponding limb in the matched controls, and (2) the uninvolved limb in participants with unilateral CHJP and the corresponding limb in the matched controls. Compared to controls, participants with CHJP demonstrated weakness of 16% to 28% (P<.01) in all muscle groups tested in the involved hip. The uninvolved hip of 22 subjects with unilateral CHJP demonstrated weakness of 18% and 16% (P<.05) in the external rotators (0°) and abductors, respectively, when compared to the corresponding limb of the matched controls. The results of the present study demonstrate that persons with CHJP have weakness in the hip rotator and hip abductor muscles. Weakness also was found in the uninvolved hip of persons with CHJP.
Objective-To examine whether passive hip rotation motion was different between people with and wi... more Objective-To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2001
A descriptive, correlational study of patients with mechanical low back pain (LBP). To assess the... more A descriptive, correlational study of patients with mechanical low back pain (LBP). To assess the effect of active limb movements on symptoms in patients with LBP and to examine the relationship between symptoms with limb movements and select patient characteristics. Limb movements result in forces applied to the spine and, thus, may be important in the examination and treatment of patients with LBP. A total of 188 people with LBP, 84 men and 104 women, participated in a standardized examination. Six of the items required patients to move their limbs and note LBP symptoms as increased, remained the same, or decreased. The prevalence of various symptom responses with each limb movement test was calculated. Relationships between patient characteristics and reports of increased symptoms were examined with Cochran's linear trend statistic and the Spearman and Pearson correlation coefficients. Differences in characteristics of patients with and without increased symptoms were examined with chi2 test, Mann-Whitney U test, or Student's t test for independent groups. An increase in symptoms was reported by 149 patients with at least 1 of the limb movement tests, and 3 of the patients reported a decrease in symptoms. Across the patient sample, the mean number of limb movement tests for which symptoms were reported as increased was 2.30 +/- 1.64. Patients with an increase in symptoms reported higher average pain intensity the week prior to the examination (median = 2; range: 1-5) and higher functional disability (mean = 0.25; SD = 0.15) than those without a change in symptoms (pain intensity: median = 1; range: 0-2 and functional disability: mean = 0.16; SD = 0.12). The correlation between the number of increased symptoms and the person's average pain intensity was r = 0.23; the correlation with the functional disability score was r = 0.36. Patients with a history of LBP tended to report an increase in symptoms with more of the limb movement tests (mean = 3.5; SD = 1.40) than those without a previous history of LBP (mean = 2.0; SD = 1.11). Active limb movements performed during the examination primarily resulted in increased LBP symptoms. The presence and number of increased symptoms with the active limb movements was related to the patient's report of average pain intensity and functional disability. Tests of symptoms with active limb movements may provide insight into factors contributing to a LBP problem, as well as information to guide the treatment of patients with LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2006
Cross-sectional, secondary analysis. To examine whether there were differences in the numbers and... more Cross-sectional, secondary analysis. To examine whether there were differences in the numbers and types of impairments on examination between 2 groups of people with low back pain (LBP), those who participated in symmetric leisure activities and those who participated in asymmetric leisure activities. It has been proposed that people who repeatedly perform an activity that involves trunk movements and alignments in the same direction will develop strategies that are generalized to many activities. The repeated use of these strategies is proposed to contribute to impairments identifiable on examination and to LBP. Forty males and 40 females (mean +/- SD age, 41.4 +/- 13.9 years) with LBP who reported participation in either a symmetric or an asymmetric leisure activity participated in a standardized examination. Responses from 10 trunk-rotation-related impairment tests were analyzed using the Mann-Whitney U and chi-square statistics. Thirty people participated in asymmetric leisure activities and 50 people participated in symmetric leisure activities. The total number of rotation-related impairments was different for the 2 groups (U = 1112, P < .01). The asymmetric group displayed more total rotation-related impairments (median, 4.0; range, 7) than the symmetric group (median, 2.0; range, 6). A greater percentage of the asymmetric group displayed more impairments on 5 out of 10 individual tests, as compared to the symmetric group ( < or = .05 for all comparisons). Our results provide preliminary data to suggest that trunk-rotation-related impairments, identified on examination, may be related to the general type of movements and alignments used repeatedly by patients with LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2003
Cross-sectional study of patients with mechanical low back pain (MLBP). To test the construct val... more Cross-sectional study of patients with mechanical low back pain (MLBP). To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.
Journal of Orthopaedic & Sports Physical Therapy, 2009
The Orthopaedic Section, APTA appointed content experts as developers and authors of clinical pra... more The Orthopaedic Section, APTA appointed content experts as developers and authors of clinical practice guidelines for musculoskeletal conditions of the hip which are commonly treated by physical therapists. These content experts were given the task to identify impairments of body function and structure, activity limitations, and participation restrictions, described using ICF terminology, which could (1) categorize patients into mutually exclusive impairment patterns upon which to base intervention strategies, and serve as measures of changes in function over the course of an episode of care. The second task given to the content experts was to describe the supporting evidence for the identified impairment pattern classification as well as interventions for patients with activity limitations and impairments of body function and structure consistent with the identified impairment pattern classification. It was also acknowledged by the Orthopaedic Section, APTA content experts that a systematic search and review of the evidence solely related to diagnostic categories based on International Statistical Classification of Diseases and Related Health Problems (ICD) 209 terminology would not be useful for these ICF-based clinical practice guidelines as most of the evidence associated with changes in levels of impairment or function in homogeneous populations is not readily searchable using the ICD terminology.
Archives of Physical Medicine and Rehabilitation, 2003
Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N. The effect of modifyin... more Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys Med Rehabil 2003;84:313-22.
Background—Athletic activity is a proposed factor in the development and progression of intraarti... more Background—Athletic activity is a proposed factor in the development and progression of intraarticular hip pathology. Early diagnosis and preventive treatments in " at risk " athletes is needed.
Study Design: Controlled laboratory cross-sectional Objectives: To investigate the relationship b... more Study Design: Controlled laboratory cross-sectional Objectives: To investigate the relationship between femoral version (FV), measured by MRI (FVMRI), Craig's test and hip rotation range of motion (ROM). To determine rotation ROM values associated with FVMRI categories: excessive anteversion, normal version and retroversion. Background: Abnormal FV values are associated with hip disorders, such as osteoarthritis, structural instability, acetabular labral tears and femoroacetabular impingement. Clinical assessment of FV may allow clinician to identify the effect of bony abnormalities on hip rotation ROM to guide clinical decisions.
Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although su... more Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing.
To investigate the effect of hip joint position on hip rotator muscle strength of healthy young a... more To investigate the effect of hip joint position on hip rotator muscle strength of healthy young adults by using a hand-held dynamometer. A cross-sectional cohort study. A university medical center. Thirty-four healthy (19 women, 15 men; mean [standard deviation] age, 25 ± 2.3 years) participated in this study. A hand-held dynamometer was used to measure the strength of hip internal rotators and external rotators in 2 positions: hip flexion in sitting and hip extension in supine. The hip was tested in a neutral position with respect to rotation, abduction, and adduction. Isometric force in pounds was measured as the subject pushed against the device. For each subject, hip rotator muscle strength measurements were taken during a single session. Hypotheses were developed before data collection. Hip internal rotators were significantly stronger in hip flexion compared with hip extension (P < .01). There was no significant difference found in the hip external rotators between the 2 positions. Hip internal rotators and external rotators behave differently when comparing strength measurements between the positions of hip flexion and hip extension. A hand-held dynamometer provided an objective measurement of strength that was clinically feasible to use. Both muscle length and moment arms influence force production of the hip rotators as the hip position changes. Understanding these relationships may help clinicians interpret strength findings and direct intervention toward strengthening the appropriate muscles by using the most advantageous position.
Journal of Orthopaedic & Sports Physical Therapy, 2014
Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip... more Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip rotator and abductor muscle groups in young adults with chronic hip joint pain (CHJP) and asymptomatic controls. A secondary objective was to determine if strength in the uninvolved hip of those with unilateral CHJP differs from that in asymptomatic controls. Little is known about the relationship between hip muscle strength and CHJP in young adults. Thirty-five participants with CHJP and 35 matched controls (18 to 40 years of age) participated. Using handheld dynamometry, strength of the hip external rotators and internal rotators was assessed with the hip flexed to 90° and 0°. To assess external rotator and internal rotator strength, the hip was placed at the end range of external rotation and internal rotation, respectively. Strength of the hip abductors was assessed in sidelying, with the hip in 15° of abduction. Break tests were performed to determine maximum muscle force, and the average torque was calculated using the corresponding moment arm. Independent-sample t tests were used to compare strength values between (1) the involved limb in participants with CHJP and the corresponding limb in the matched controls, and (2) the uninvolved limb in participants with unilateral CHJP and the corresponding limb in the matched controls. Compared to controls, participants with CHJP demonstrated weakness of 16% to 28% (P<.01) in all muscle groups tested in the involved hip. The uninvolved hip of 22 subjects with unilateral CHJP demonstrated weakness of 18% and 16% (P<.05) in the external rotators (0°) and abductors, respectively, when compared to the corresponding limb of the matched controls. The results of the present study demonstrate that persons with CHJP have weakness in the hip rotator and hip abductor muscles. Weakness also was found in the uninvolved hip of persons with CHJP.
Objective-To examine whether passive hip rotation motion was different between people with and wi... more Objective-To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2001
A descriptive, correlational study of patients with mechanical low back pain (LBP). To assess the... more A descriptive, correlational study of patients with mechanical low back pain (LBP). To assess the effect of active limb movements on symptoms in patients with LBP and to examine the relationship between symptoms with limb movements and select patient characteristics. Limb movements result in forces applied to the spine and, thus, may be important in the examination and treatment of patients with LBP. A total of 188 people with LBP, 84 men and 104 women, participated in a standardized examination. Six of the items required patients to move their limbs and note LBP symptoms as increased, remained the same, or decreased. The prevalence of various symptom responses with each limb movement test was calculated. Relationships between patient characteristics and reports of increased symptoms were examined with Cochran's linear trend statistic and the Spearman and Pearson correlation coefficients. Differences in characteristics of patients with and without increased symptoms were examined with chi2 test, Mann-Whitney U test, or Student's t test for independent groups. An increase in symptoms was reported by 149 patients with at least 1 of the limb movement tests, and 3 of the patients reported a decrease in symptoms. Across the patient sample, the mean number of limb movement tests for which symptoms were reported as increased was 2.30 +/- 1.64. Patients with an increase in symptoms reported higher average pain intensity the week prior to the examination (median = 2; range: 1-5) and higher functional disability (mean = 0.25; SD = 0.15) than those without a change in symptoms (pain intensity: median = 1; range: 0-2 and functional disability: mean = 0.16; SD = 0.12). The correlation between the number of increased symptoms and the person's average pain intensity was r = 0.23; the correlation with the functional disability score was r = 0.36. Patients with a history of LBP tended to report an increase in symptoms with more of the limb movement tests (mean = 3.5; SD = 1.40) than those without a previous history of LBP (mean = 2.0; SD = 1.11). Active limb movements performed during the examination primarily resulted in increased LBP symptoms. The presence and number of increased symptoms with the active limb movements was related to the patient's report of average pain intensity and functional disability. Tests of symptoms with active limb movements may provide insight into factors contributing to a LBP problem, as well as information to guide the treatment of patients with LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2006
Cross-sectional, secondary analysis. To examine whether there were differences in the numbers and... more Cross-sectional, secondary analysis. To examine whether there were differences in the numbers and types of impairments on examination between 2 groups of people with low back pain (LBP), those who participated in symmetric leisure activities and those who participated in asymmetric leisure activities. It has been proposed that people who repeatedly perform an activity that involves trunk movements and alignments in the same direction will develop strategies that are generalized to many activities. The repeated use of these strategies is proposed to contribute to impairments identifiable on examination and to LBP. Forty males and 40 females (mean +/- SD age, 41.4 +/- 13.9 years) with LBP who reported participation in either a symmetric or an asymmetric leisure activity participated in a standardized examination. Responses from 10 trunk-rotation-related impairment tests were analyzed using the Mann-Whitney U and chi-square statistics. Thirty people participated in asymmetric leisure activities and 50 people participated in symmetric leisure activities. The total number of rotation-related impairments was different for the 2 groups (U = 1112, P < .01). The asymmetric group displayed more total rotation-related impairments (median, 4.0; range, 7) than the symmetric group (median, 2.0; range, 6). A greater percentage of the asymmetric group displayed more impairments on 5 out of 10 individual tests, as compared to the symmetric group ( < or = .05 for all comparisons). Our results provide preliminary data to suggest that trunk-rotation-related impairments, identified on examination, may be related to the general type of movements and alignments used repeatedly by patients with LBP.
Journal of Orthopaedic & Sports Physical Therapy, 2003
Cross-sectional study of patients with mechanical low back pain (MLBP). To test the construct val... more Cross-sectional study of patients with mechanical low back pain (MLBP). To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.
Journal of Orthopaedic & Sports Physical Therapy, 2009
The Orthopaedic Section, APTA appointed content experts as developers and authors of clinical pra... more The Orthopaedic Section, APTA appointed content experts as developers and authors of clinical practice guidelines for musculoskeletal conditions of the hip which are commonly treated by physical therapists. These content experts were given the task to identify impairments of body function and structure, activity limitations, and participation restrictions, described using ICF terminology, which could (1) categorize patients into mutually exclusive impairment patterns upon which to base intervention strategies, and serve as measures of changes in function over the course of an episode of care. The second task given to the content experts was to describe the supporting evidence for the identified impairment pattern classification as well as interventions for patients with activity limitations and impairments of body function and structure consistent with the identified impairment pattern classification. It was also acknowledged by the Orthopaedic Section, APTA content experts that a systematic search and review of the evidence solely related to diagnostic categories based on International Statistical Classification of Diseases and Related Health Problems (ICD) 209 terminology would not be useful for these ICF-based clinical practice guidelines as most of the evidence associated with changes in levels of impairment or function in homogeneous populations is not readily searchable using the ICD terminology.
Archives of Physical Medicine and Rehabilitation, 2003
Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N. The effect of modifyin... more Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys Med Rehabil 2003;84:313-22.
Background—Athletic activity is a proposed factor in the development and progression of intraarti... more Background—Athletic activity is a proposed factor in the development and progression of intraarticular hip pathology. Early diagnosis and preventive treatments in " at risk " athletes is needed.
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Papers by Nancy Bloom