Subjects in this study demonstrated the ability to voluntarily activate the TrA during upright static and functional tasks. Additionally, the TrA thickness may change in a direction-specific manner. These findings support a protective role of the ADIM during functional activity and may add information to ways for promoting low back pain prevention. Future studies should include the effectiveness in the use of ADIM during functional tasks for the prevention of low back pain.

Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.

Pelvic pain is a common condition. Treatment interventions have traditionally targeted biomedical conditions with variable success. Utilizing a systematic approach to examination of the pelvic girdle and related organ systems contained within the pelvis will aid the clinician in identifying the painful structure(s) as well as the associated impairments limiting functional recovery. From this, a complete management program can be instituted. The following description of gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain leads to conservative management proposals based on the available evidence. Finally, nonoperative interventional strategies are described, which target the pain system from a cognitive behavioral perspective, address movement dysfunctions, and address interventional pain technique possibilities.

Repetitive simulated neural mobilization, incorporating stretch/relax cycles, of excised cadaveric peripheral nerve tissue produced an increase in intraneural fluid dispersion. Neural mobilization may alter nerve tissue environment, promoting improved function and nerve health, by dispersing tissue fluid and diminishing intraneural swelling and/or pressure.

Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.

The AHD was not affected by resistive isometric internal rotation of the shoulder, although it decreased with resistive isometric external rotation at 45 degrees of shoulder abduction. Resistive isometric shoulder external rotation in a position of abduction should be used with caution when the goal is to maintain the AHD. Further research is required to determine the effects of isometric contraction in patients with subacromial impingement syndrome.

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