The relationship between the piriformis muscle, low back pain, lower limb injuries and motor control training among elite football players

Journal article

Leung, Felix T., Dilani Mendis, Marianne, Stanton, Warren R. and Hides, Julie A.. (2015). The relationship between the piriformis muscle, low back pain, lower limb injuries and motor control training among elite football players. Journal of Science and Medicine in Sport. 18(4), pp. 407-411. https://doi.org/10.1016/j.jsams.2014.06.011
AuthorsLeung, Felix T., Dilani Mendis, Marianne, Stanton, Warren R. and Hides, Julie A.
Abstract

Objectives
Australian Football League (AFL) players have a high incidence of back injuries. Motor control training to increase lumbopelvic neuromuscular control has been effective in reducing low back pain (LBP) and lower limb injuries in elite athletes. Control of pelvic and femoral alignment during functional activity involves the piriformis muscle. This study investigated (a) the effect of motor control training on piriformis muscle size in AFL players, with and without LBP, during the playing season, and (b) whether there is a relationship between lower limb injury and piriformis muscle size.

Design
Stepped-wedge intervention.

Methods
46 AFL players participated in a motor control training programme consisting of two 30 min sessions per week over 7–8 weeks, delivered across the season as a randomised 3 group single-blinded stepped-wedge design. Assessment of piriformis muscle cross-sectional area (CSA) involved magnetic resonance imaging (MRI) at 3 time points during the season. Assessment of LBP consisted of player interview and physical examination. Injury data were obtained from club records.

Results
An interaction effect for Time, Intervention Group and LBP group (F = 3.7, p = 0.03) was found. Piriformis muscle CSA showed significant increases between Times 1 and 2 (F = 4.24, p = 0.046), and Times 2 and 3 (F = 8.59, p = 0.006). Players with a smaller increase in piriformis muscle CSA across the season had higher odds of sustaining an injury (OR = 1.08).

Conclusions
Piriformis muscle size increases across the season in elite AFL players and is affected by the presence of LBP and lower limb injury. Motor control training positively affects piriformis muscle size in players with LBP.

Keywordspiriformis; Australian Football League; lower limb injury; motor control training; magnetic resonance imaging
Year2015
JournalJournal of Science and Medicine in Sport
Journal citation18 (4), pp. 407-411
PublisherElsevier Ltd
ISSN1440-2440
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jsams.2014.06.011
Scopus EID2-s2.0-84946471249
Open accessPublished as green open access
Page range407-411
FunderBrisbane Lions AustralianFootball Club
Research GroupSchool of Allied Health
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Output statusPublished
Publication dates
Online27 Jun 2014
Publication process dates
Accepted20 Jun 2014
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Mendis, Dilani, Wilson, Stephen, Stanton, Warren and Hides, Julie. (2010). Validity of real-time ultrasound imaging to measure anterior hip muscle size: A comparison with magnetic resonance imaging. Journal of Orthopaedic and Sports Physical Therapy. 40(9), pp. 577 - 581. https://doi.org/10.2519/jospt.2010.3286
A magnetic resonance imaging investigation of the transversus abdominins muscle during drawing-in of the abdominal wall in elite Australian football league players with and without low back pain
Hides, Julie Anne, Boughen, Carly, Stanton, Warren Robert, Strudwick, Mark and Wilson, Steve. (2010). A magnetic resonance imaging investigation of the transversus abdominins muscle during drawing-in of the abdominal wall in elite Australian football league players with and without low back pain. Journal of Orthopaedic and Sports Physical Therapy. 40(1), pp. 4 - 10. https://doi.org/10.2519/jospt.2010.3177
Countermeasures against lumbar spine deconditioning in prolonged bed rest : resistive exercise with and without whole body vibration
Hides, Julie Anne, Belavy, Daniel, Armbrecht, Gabriele, Richardson, Carolyn, Felsenberg, Dieter and Gast, U. (2010). Countermeasures against lumbar spine deconditioning in prolonged bed rest : resistive exercise with and without whole body vibration. Journal of Applied Psychology. 109(6), pp. 1801 - 1811. https://doi.org/10.1152/japplphysiol.00707.2010
Retraining motor control of abdominal muscles among elite cricketers with low back pain
Hides, Julie Anne, Stanton, Warren Robert, Wilson, Stephen, Freke, Matt, McMahon, Shaun and Sims, K. (2010). Retraining motor control of abdominal muscles among elite cricketers with low back pain. Scandinavian Journal of Medicine & Science in Sports. 20(6), pp. 834 - 842. https://doi.org/10.1111/j.1600-0838.2009.01019.x
The reliability and validity of the alcohol, smoking and substance involvement screening test (assist)
Hides, L., Cotton, Sue, Berger, G., Gleeson, John, O'Donnell, C., Proffitt, T., McGorry, Patrick and Lubman, Dan. (2009). The reliability and validity of the alcohol, smoking and substance involvement screening test (assist). Addictive Behaviors. 34(10), pp. 821 - 825. https://doi.org/10.1016/j.addbeh.2009.03.040
Different ways to balance the spine: Subtle changes in sagittal spinal curves affect regional muscle activity
Claus, Andrew, Hides, Julie, Moseley, G. Lorimer and Hodges, Paul. (2009). Different ways to balance the spine: Subtle changes in sagittal spinal curves affect regional muscle activity. Spine. 34(6), pp. 208 - 214. https://doi.org/10.1097/BRS.0b013e3181908ead
The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles
Grimaldi, Alison, Richardson, Carolyn, Durbridge, Gail, Donnelly, William, Darnell, Ross and Hides, Julie Anne. (2009). The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles. Manual Therapy. 14(6), pp. 611 - 617. https://doi.org/10.1016/j.math.2008.11.002
The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle
Wallwork, Tracy, Stanton, Warren, Freke, Matt and Hides, Julie. (2009). The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Manual Therapy. 14(5), pp. 496 - 500. https://doi.org/10.1016/j.math.2008.09.006
Effect of prolonged bed rest on the anterior hip muscles
Mendis, Dilani, Hides, Julie, Wilson, Stephen, Grimaldi, Alison, Belavy, Daniel, Stanton, Warren, Felsenberg, Dieter, Rittweger, Jorn and Richardson, Carolyn A.. (2009). Effect of prolonged bed rest on the anterior hip muscles. Gait & Posture. 30(4), pp. 533 - 537. https://doi.org/10.1016/j.gaitpost.2009.08.002
The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles
Grimaldi, Alison, Richardson, Carolyn, Stanton, Warren Robert, Durbridge, Gail, Donnelly, William and Hides, Julie Anne. (2009). The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. Manual Therapy. 14(6), pp. 605 - 610. https://doi.org/10.1016/j.math.2009.07.004
Altered response of the anterolateral abdominal muscles to stimulated weight-bearing in subjects with low back pain
Hides, Julie, Belavy, Daniel, Cassar, Lana, Willia, Michelle, Wilson, Stephen and Richardson, Carolyn A.. (2009). Altered response of the anterolateral abdominal muscles to stimulated weight-bearing in subjects with low back pain. European Spine Journal. 18(3), pp. 410 - 418. https://doi.org/10.1007/s00586-008-0827-2
Is 'ideal' sitting posture real?: Measurement of spinal curves in four sitting postures
Claus, Andrew, Hides, Julie, Moseley, G. Lorimer and Hodges, Paul. (2009). Is 'ideal' sitting posture real?: Measurement of spinal curves in four sitting postures. Manual Therapy. 14(4), pp. 404 - 408. https://doi.org/10.1016/j.math.2008.06.001
MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain
Hides, Julie, Stanton, Warren, Freke, Matt, Wilson, Stephen, McMahon, Shaun and Richardson, Carolyn A.. (2008). MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. British Journal of Sports Medicine. 42(10), pp. 809 - 813. https://doi.org/10.1136/bjsm.2007.044024
Sitting versus standing: Does the intradiscal pressure cause disc degeneration or low back pain?
Claus, Andrew, Hides, Julie, Moseley, G. Lorimer and Hodges, Paul. (2008). Sitting versus standing: Does the intradiscal pressure cause disc degeneration or low back pain? Journal of Electromyography and Kinesiology. 18(4), pp. 550 - 558. https://doi.org/10.1016/j.jelekin.2006.10.011
Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-res
Belavy, Daniel, Hides, Julie, Wilson, Stephen, Stanton, Warren, Dimeo, Fernando, Rittweger, Jorn, Felsenberg, Dieter and Richardson, Carolyn A.. (2008). Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-res. Spine. 33(5), pp. 121 - 131. https://doi.org/10.1097/BRS.0b013e3181657f98
Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain
Hides, Julie, Stanton, Warren, McMahon, Shaun, Si, K. and Richardson, Carolyn A.. (2008). Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. Journal of Orthopaedic and Sports Physical Therapy. 38(3), pp. 101 - 108. https://doi.org/10.2519/jospt.2008.2658
Multifidus size and symmetry among chronic IBP and healthy asymptomatic subjects
Hides, Julie, Gilmore, Craig, Stanton, Warren and Bohlscheid, Emma. (2008). Multifidus size and symmetry among chronic IBP and healthy asymptomatic subjects. Manual Therapy. 13(1), pp. 43 - 49. https://doi.org/10.1016/j.math.2006.07.017
Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a randomised controlled trial
Challis, Murray, Jull, Gwendolen, Stanton, Warren and Welsh, Mark. (2007). Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a randomised controlled trial. Journal of Physiotherapy. 53(4), pp. 247 - 252. https://doi.org/10.1016/S0004-9514(07)70005-3
Assessment of abdominal muscle function during a simulated unilateral weigh bearing task using ultrasound imaging
Hides, Julie, Wong, Ian, Wilson, Stephen, Belavy, Daniel and Richardson, Carolyn A.. (2007). Assessment of abdominal muscle function during a simulated unilateral weigh bearing task using ultrasound imaging. Journal of Orthopaedic and Sports Physical Therapy. 37(8), pp. 467 - 471. https://doi.org/10.2519/jospt.2007.2417
Ultrasound imaging assessment of abdominal muscle function during drawing-in of the abdominal wall: an intrarater reliability study
Richardson, Carolyn A., Miokovic, Tanja, Belavy, Daniel, Stanton, Warren and Hides, Julie. (2007). Ultrasound imaging assessment of abdominal muscle function during drawing-in of the abdominal wall: an intrarater reliability study. Journal of Orthopaedic and Sports Physical Therapy. 37(8), pp. 480 - 486. https://doi.org/10.2519/jospt.2007.2416
Rehabilitative ultrasound imaging of the posterior paraspinal muscles
Stokes, Maria, Hides, Julie, Elliott, James, Kiesel, Kyle and Hodges, Paul. (2007). Rehabilitative ultrasound imaging of the posterior paraspinal muscles. Journal of Orthopaedic and Sports Physical Therapy. 37(10), pp. 581 - 595. https://doi.org/10.2519/jospt.2007.2599
Rehabilitative ultrasound imaging of the abdominal muscles
Teyhen, Deydre, Gill, Norman, Whitake, Jackie, Henry, Sharon, Hides, Julie and Hodges, Paul. (2007). Rehabilitative ultrasound imaging of the abdominal muscles. Journal of Orthopaedic and Sports Physical Therapy. 37(8), pp. 450 - 466. https://doi.org/10.2519/jospt.2007.2558
Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest
Hides, Julie, Belavy, Daniel, Stanton, Warren, Wilson, Stephen, Rittweger, Jorn, Felsenberg, Dieter and Richardson, Carolyn A.. (2007). Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Spine. 32(15), pp. 1687 - 1692. https://doi.org/10.1097/BRS.0b013e318074c386
Intrarater and interrater reliability of assessment of lumbar multifidus thickness using rehabilitative ultrasound imaging
Wallwork, Tracy, Hides, Julie and Stanton, Warren. (2007). Intrarater and interrater reliability of assessment of lumbar multifidus thickness using rehabilitative ultrasound imaging. Journal of Orthopaedic and Sports Physical Therapy. 37(10), pp. 608 - 612. https://doi.org/10.2519/jospt.2007.2418
Lateral positioning of ventilated intensive care patients: A study of oxygenation, respiratory mechanics, hemodynamics, and adverse events
Thomas, Peter, Paratz, Jennifer, Lipman, Jeffery and Stanton, Warren. (2007). Lateral positioning of ventilated intensive care patients: A study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart & Lung: the journal of acute and critical care. 36(4), pp. 277 - 286. https://doi.org/10.1016/j.hrtlng.2006.10.008
Determinants of stages of smoking uptake among secondary school students
Baade, Peter and Stanton, Warren. (2006). Determinants of stages of smoking uptake among secondary school students. Addictive Behaviors. 31(1), pp. 143 - 148. https://doi.org/10.1016/j.addbeh.2005.04.007
Sitting posture affects pelvic floor muscle activity in parous women: An observational study
Sapsford, Ruth, Richardson, Carolyn A. and Stanton, Warren. (2006). Sitting posture affects pelvic floor muscle activity in parous women: An observational study. Journal of Physiotherapy. 52(3), pp. 219 - 222. https://doi.org/10.1016/S0004-9514(06)70031-9
Predictors of smoking cessation processes among secondary school students
Stanton, Warren, Baade, Peter and Moffatt, Jenny. (2006). Predictors of smoking cessation processes among secondary school students. Substance Use and Misuse. 41(13), pp. 1683 - 1694. https://doi.org/10.1080/10826080601006284
An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall
Hides, Julie, Wilson, Stephen, Stanton, Warren, McMahon, Shaun, Keto, Heidi, McMahon, Catherine, Bryant, Mary and Richardson, Carolyn A.. (2006). An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall. Spine. 31(6), pp. 175 - 178. https://doi.org/10.1097/01.brs.0000202740.86338.df
The use of real-time ultrasound imaging for biofeedback of lumbar multifidus muscle contraction in healthy subjects
Van, Khai, Hides, Julie and Richardson, Carolyn A.. (2006). The use of real-time ultrasound imaging for biofeedback of lumbar multifidus muscle contraction in healthy subjects. Journal of Orthopaedic and Sports Physical Therapy. 36(12), pp. 920 - 925. https://doi.org/10.2519/jospt.2006.2304
Low back pain patients demonstrate increased hip extensor muscle activity during standardized submaximal rotational efforts
Pirouzi, Soraya, Hides, Julie, Richardson, Carolyn A., Darnell, Ross and Toppenberg, Rowena. (2006). Low back pain patients demonstrate increased hip extensor muscle activity during standardized submaximal rotational efforts. Spine. 31(26), pp. 999 - 1005. https://doi.org/10.1097/01.brs.0000250076.74366.9d
Positioning practices for ventilated intensive care patients: Current practice, indications and contraindications
Thomas, Peter, Paratz, Jennifer, Stanton, Warren, Deans, Renae and Lipman, Jeffery. (2006). Positioning practices for ventilated intensive care patients: Current practice, indications and contraindications. Australian Critical Care. 19(4), pp. 122 - 132. https://doi.org/10.1016/S1036-7314(06)80025-1
Community perceptions of suspicious pigmented skin lesions: are they accurate when compared to general practitioners?
Baade, Peter, Balanda, Kevin, Stanton, Warren, Lowe, John and Del Mar, Chris B.. (2005). Community perceptions of suspicious pigmented skin lesions: are they accurate when compared to general practitioners? Cancer Epidemiology: the international journal of cancer epidemiology, detection and prevention. 29(3), pp. 267 - 275. https://doi.org/10.1016/j.cdp.2004.06.007
MRI measures of the lumbo-pelvic muscles in bedrest and follow-up: Implications for exercise countermeasures in microgravity.
Richardson, Carolyn A., Hides, Julie, Wilson, Stephen, Belavy, Daniel, Stanton, Warren, McCook, D, Elmann-Larsen, B, Rittweger, Jorn and Felsenberg, Dieter. (2005). MRI measures of the lumbo-pelvic muscles in bedrest and follow-up: Implications for exercise countermeasures in microgravity. Journal of Gravitational Physiology. 12(1), pp. 117 - 118.
The effect of weightbearing exercise with low frequency, whole body vibration on lumbosacral proprioception: A pilot study on normal subjects
Fontana, Tania, Richardson, Carolyn A. and Stanton, Warren. (2005). The effect of weightbearing exercise with low frequency, whole body vibration on lumbosacral proprioception: A pilot study on normal subjects. Journal of Physiotherapy. 51(4), pp. 259 - 263. https://doi.org/10.1016/S0004-9514(05)70007-6
Long-term overactivity in the abdominal oblique muscle after 8 weeks bed-rest - possible implications for musculoskeletal health
Belavy, Daniel, Richardson, Carolyn A., Wilson, Stephen, Darnell, Ross, Hides, Julie, Toppenberg, Rowena, Elmann-Larsen, B, Rittweger, Jorn and Felsenberg, Dieter. (2005). Long-term overactivity in the abdominal oblique muscle after 8 weeks bed-rest - possible implications for musculoskeletal health. Journal of Gravitational Physiology. 12(1), pp. 117 - 118.
Community perceptions of adequate levels and reasons for skin protection
Stanton, Warren, Moffatt, Jenny and Clavarino, Alexandra. (2005). Community perceptions of adequate levels and reasons for skin protection. Behavioral Medicine: relating behavior and health. 31(1), pp. 5 - 15. https://doi.org/10.3200/BMED.31.1.5-17
Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community
Hughes, Karen, Leggett, Barbara, Del Mar, Chris B., Croese, John, Fairley, Stephen, Masson, John, Aitken, Joanne, Clavarino, Alexandra, Janda, Monika, Stanton, Warren, Tong, Shilu and Newman, Beth. (2005). Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community. Australian and New Zealand Journal of Public Health. 29(4), pp. 358 - 364. https://doi.org/10.1111/j.1467-842X.2005.tb00207.x
Suntans and sun protection in Australian teen media: 1999 to 2000
McDermott, Liane, Lowe, John, Stanton, Warren and Clavarino, Alexandra. (2005). Suntans and sun protection in Australian teen media: 1999 to 2000. Health Education & Behavior. 32(4), pp. 504 - 513. https://doi.org/10.1177/1090198105276214
Predictors of responsiveness to physiotherapy management of cervicogenic headache
Jull, Gwendolen and Stanton, Warren. (2005). Predictors of responsiveness to physiotherapy management of cervicogenic headache. Cephalalgia: an international journal of headache. 25(2), pp. 101 - 108. https://doi.org/10.1111/j.1468-2982.2004.00811.x
Smoking and parenting among males in low socio-economic occupations
Moffatt, Jenny and Stanton, Warren. (2005). Smoking and parenting among males in low socio-economic occupations. International Journal of Health Promotion and Education. 43(3), pp. 81 - 86. https://doi.org/10.1080/14635240.2005.10708045