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ontinuous passive motion (CPM) is a machinedependent rnodality in which an external motorized device moves the limb through a pre-set arc of m e tion ( 1 0). The biologic concept of CPM was originated by Salter to provide optimal conditions for the healing and regeneration of articular cartilage (22). From his clinical observations on the value of early active motion and the deleterious effects of prolonged immobilization, Salter developed a CPM machine, which was used in a series of animal experiments. In rabbits treated with immediate postoperative CPM, Salter demonstrated enhanced healing of cartilage which grossly, histologically, and biochemically resembled articular cartilage with a predominance of type I1 collagen (24). In addition, CPM improved wound healing (22). accelerated clearance of hemarthrosis (18), and prevented cartilage degeneration in septic arthritis (23).Coutts, who initiated the use of CPM on total knee arthroplasty patients, believes that CPM modulates the process of postoperative scarring that interferes with restoration of joint motion (3,4,7). During normal healing, collagen fibers grow in a random fiber orientation, producing resistance to free movement. Thus, Coutts and Coutts et al contend that CPM enhances the restoration of Arthroplasty patients There is insufficient information on continuous passive motion (CPM) parameters in total

A comprehensive evaluation of patients with low back pain must include a method of testing the integrity of related neural tissues (14,20,34). The straight leg raise test is recognized as the first neural tissue tension test to appear in the literature (48). During straight leg raise testing, the leg is elevated with the knee extended and the patient in a supine position. This places a tensile stress on the sciatic nerve and exerts a caudal traction on the lumbosacral nerve roots from L, to S, (15,18,21,48). Assessment of the straight leg raise test requires that the range of motion (ROM) measured is compared with the contralatera1 side and expected norms (14,41, 45,48).Confounding the straight leg raise test, nonneural structures, such as lumbar zygapophyseal joints, muscles, and connective tissue, can limit leg elevation and provoke patient discomfort during testing ( 1 7,41,45, 48). Including supplementaly maneuvers in the straight leg raise test p r e cedure may reduce patient responses caused by nonneural tissues. Flexing the cervical spine, dorsiflexing the ankle, and medially rotating the hip during the straight leg raise test increases tension exerted on the spinal cord, spinal dura, and lumbosacral nerve roots (1-5,26,42,44). Research conducted by Breig (2) and others (3-5,27,38,42,43) indicates that flexing the cervical spine during straight leg raise testing lengthens the spinal cord and dura (2-5,27,38,42,43

Objective: Examine embalmed human cadavers for diastasis rectus abdominis by measuring inter-recti distance (IRD) at 3 locations: supraumbilical, umbilical, and infraumbilical. Factors examined that can infl uence IRD included gender, waist girth, subcutaneous fat, waist-hip ratio (WHR), abdominal scarring, and age. Study Design: Basic science. Background: Diastasis rectus abdominis is an abnormal separation of the rectus abdominis muscles at the linea alba. The criteria for and factors that predispose an individual to diastasis rectus abdominis remain unclear in the literature. Methods and Measures:Thirty-four embalmed cadavers (16 women and 18 men) between 47 and 99 years of age were included. Morphological measures-waist and hip girth-were taken, followed by dissection of the rectus sheath/rectus abdominis muscles. Digital calipers were used to measure IRD at the umbilicus and 4.5 cm above and below the umbilicus; the depth of subcutaneous fat was recorded. Regression analysis was used to determine whether gender, waist girth, subcutaneous fat, WHR, abdominal scarring, or age infl uenced maximal IRD. Results: Upon optimizing the mathematical model, a 102-cm threshold was identifi ed and included in the regression as "waist index" ( R 2 ϭ 0.539). This threshold indicates that at more than 102 cm, waist girth has a greater contribution to IRD. Factors increasing IRD were waist girth ( P ϭ .0016) and scarring ( P ϭ .0222) in the supraumbilical region, waist index ( P ϭ .0100) and scarring ( P ϭ .0131) at the umbilicus, and WHR ( P ϭ .0169) and gender ( P ϭ .0000) in the infraumbilical region. Age did not increase IRD. Conclusions: Waist girth more than 102 cm, female gender, abdominal scarring, and increased WHR are predictors of increased IRD in cadavers.

Parous women had a narrower IRD in the curl-up condition than at rest, as hypothesized. However, an unexpected finding of a lack of significant within-group change in IRD in nulliparous women and men occurred. Findings suggest that the IRD in men may only differ from that of nulliparous women.

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