RR-PL-1074

Tuesday 10:00, Palau de Congressos, Hall 5, Room 5

INVESTIGATION OF A CLINICAL TEST AND TRANSABDOMINAL ULTRASOUND DURING PELVIC FLOOR MUSCLE CONTRACTION IN SUBJECTS WITH AND WITHOUT LUMBOSACRAL PAIN.  O'Sullivan P, Bryniolfsson G, Cawthorne A, Karakasidou P, Pederson P, Waters N; Department of Physiotherapy. Curtin University. Perth. Western Australia. PURPOSE: The levator plate (LP) and transversus abdominis have been shown to play a dynamic role in lumbopelvic stabilisation. Altered control of the LP has been demonstrated in subjects with sacroiliac joint pain. Levator plate control in subjects with lumbosacral pain has not yet been investigated. In addition, a clinical test is proposed which indicates whether the LP is elevated or depressed during a pelvic floor contraction. RELEVANCE: Pelvic floor dysfunction may be an area which requires assessment, when examining subjects with lumbosacral pain. This study proposes a non-invasive clinical test, which indicates whether LP elevation or depression is taking place during a pelvic floor contraction. SUBJECTS: Control of the LP in 17 subjects with lumbosacral pain was compared with that of 20 pain-free controls, matched for age, sex and parity. METHODS AND MATERIALS: The transverse abdominal wall was first palpated, while each subject performed a pelvic floor contraction. Either a 'bracing' or a 'drawing-in' contraction was noted. Control of the LP during pelvic floor contraction was then assessed using transabdominal ultrasound. Elevation or depression of the bladder neck was recorded in millimetres. Duration of elevation, if present, was recorded in seconds. ANALYSES: Statistical analysis of data was performed using the software package SPSS. Comparison between the two groups in their ability to elevate the LP was caculated using a Chi square test. The ability of the 2 groups to sustain elevation of the LP was compared using an independent t-test. The accuracy of the clinical test at predicting LP elevation or depression was calculated using the Phi coefficient test. RESULTS: A significant difference between the two groups was demonstrated in all categories. In the asymptomatic group, 65% were able to elevate their LP, compared with 12% of the symptomatic group (P=0.01). The difference between the 2 groups in their ability to sustain a LP elevation was also significant (P=0.01).The accuracy of the clinical test at predicting whether the LP depressed or elevated was 97% (P=0.01). CONCLUSION: Altered control of the LP was demonstrated in subjects with lumbosacral pain, compared with matched pain-free controls. A clinical test involving palpation of the transverse abdominal wall was demonstrated to have 97% accuracy at predicting LP elevation or depression.