Research Article

Geriatric Orthopaedic Surgery

& Rehabilitation
Gynecological Surgery and Low Back Pain 1(1) 27-35
ª The Author(s) 2010
Reprints and permission:
in Older Women: Testing the Association sagepub.com/journalsPermissions.nav
DOI: 10.1177/2151458510378006
With Sacroiliac Joint Stiffness and Pelvic http://gos.sagepub.com

Floor Movements

Jeffery Ericksen, MD1,2, Peter E. Pidcoe, PT, DPT, PhD1,

Jessica M. Ketchum-McKinney, PhD1, Evie N. Burnet, DPT, PhD3,
Emily Huang, DO4, James C. Wilson, MSPT, MD1, and
Vincent Hoogstad, BScPT5

Abstract
Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to
gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical
research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured
by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results:
Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and
sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated
with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement
was found during the active straight leg raise test between subject groups. All P values were .4159. Conclusions: Prior
gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the
sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women.

Keywords
aging, back pain, gynecologic surgery, sacroiliac joint, pelvic floor, Doppler imaging of vibrations

Extensive low-back pain (LBP) research has modeled
lumbopelvic stability derived from both global (multi-
segmental) muscles and more local or single-segment mus-
cles.1 A control system model integrated the active anatomic
elements, passive anatomic elements, and the arthrokinetic
control elements (sensory afferents; spinal, subcortical, and
cortical neurons; efferent motor elements).2,3 These models
fostered extensive investigation into neuromuscular control
and stability of the lumbopelvic junction with early observa-
tions of altered motor control in specific muscles in LBP
populations4-7 with rapid carryover into rehabilitation efforts
focused on neuromuscular reeducation of the deep abdominal
and pelvic floor muscles, part of the so-called core stability
system, in LBP populations.8,9
The abdominal wall muscles are postulated to contribute
to lumbopelvic stability in part due to linkage with the thora-
columbar fascia system.10 Deep abdominal muscles were
observed to have altered activation patterns in chronic LBP
populations during specific load challenges compared with nor-
mal populations.5,6,11,12 Further work described similar pre-
movement activation implicated as postural contributions to
spine stability, in the pelvic floor muscles, deep fibers of the
multifidus muscle, and the respiratory diaphragm.13-22 Altered
neurophysiological control of pelvis and abdominal muscles
using electromyographic, ultrasound, athletic performance, and
postural measures has been linked to LBP conditions.11,23-27
These observations of changes in muscle neurophysiological
control in LBP populations, combined with observations of the
stabilizing role of abdominal and pelvic muscles, suggest that
pelvic and abdominal muscle functional integrity are important
1
Virginia Commonwealth University, Richmond, VA USA
2
Hunter Holmes McGuire Veteran’s Administration Hospital
3
Virginia Center for Physical Therapy, Tidewater Physicians Multispecialty
Group, Williamsburg, VA USA
4
Middlemore Hospital, Auckland NZ
5
Spine & Joint Centre, Rotterdam, the Netherlands
Corresponding Author:
Jeffery Ericksen, Richmond VAMC, 1201 Broad Rock Blvd, Stop 117, Richmond,
VA 23249, USA
Email: jeffery.ericksen@va.gov

27
28
Figure 1. Doppler imaging of vibration schematic demonstrating the
piston transmitting vibration from the motor up through the anterior
superior iliac spine. The ultrasound probe is shown straddling the
sacroiliac joint at the posterior superior iliac spine level.
for some role in spine stability. The potential for a primary
muscle injury leading to motor control alteration that is clini-
cally silent after injury although resulting in new adverse tissue
loads, perhaps cumulative in potential injury over time, is an
intriguing model to link apparently minor events with later
LBP conditions.28,29
In parallel with the description of spine motor control and
stability has been the enhanced understanding of lumbopelvic
functional anatomy. Extensive anatomical and neurophysiolo-
gical research has defined the biomechanical role provided
by the pelvis linking the lower limb propulsion system and the
spine.30 The sacroiliac joint (SIJ) has been extensively studied
relative to its ligament support and muscle-stabilizing sys-
tem.31-33 The SIJ contribution to postpartum LBP and non-
radicular LBP has been described with biomechanical and
injection response methods.34-37 Asymmetric (left vs right) SIJ
compliance, measured by Doppler imaging of vibration (DIV),
has been correlated with peripartum LBP.34,38 The DIV method
was used to quantify the compliance of the SIJ by measuring
the relative reduction in transmitted vibration energy applied
by an oscillator motor, from ilium to sacrum, using real-time
color Doppler images (Figure 1). DIV has been described in
pelvis and cadaver models and human postpartum pain syn-
dromes, and it was used to demonstrate the effects of pelvic
28
Geriatric Orthopaedic Surgery & Rehabilitation 1(1)
Figure 2. Active straight leg raise schematic: intra-abdominal
pressure influences pelvic pressure and pelvic floor movement during
the leg lift.
belts and muscle activation on SIJ compliance.34,38-47 The DIV
method appears to offer an objective method to detect altered
SIJ biomechanics relative to traditional physical examination
methods primarily criticized for their lack of correlation with
intra-articular diagnostic gold standard injections.36,48-51 Spe-
cific quantification of the biomechanical integrity of the SIJ
load transfer function influenced by joint architecture, ligament
and fascia integrity, and muscle function is possible.
Pelvic floor dysfunction has been implicated with altered
lumbopelvic motor control in LBP populations with ultra-
sound observations of greater decline in the pelvic floor dur-
ing a standardized load challenge, the active straight leg raise
(ASLR) test.26,52-54 The ASLR (Figure 2) places a load (sub-
ject’s leg) across the pelvis, and abnormal responses have
been linked to posterior pelvic pain in patients with SIJ dys-
function.55,56 The normalization in pelvic floor descent in
LBP patients with external pelvis compressive force applica-
tions during the ASLR supports the hypothesis that an altered
motor control strategy (MCS) for load transfer across the pel-
vis creates a force imbalance that compromised the support
system of the pelvic floor.26 One hypothesis is that a lax or
overly compliant SIJ requires greater muscle-stabilizing
forces to transfer load across the lumbopelvic junction, cre-
ating excessive intra-abdominal pressure precipitating greater
pelvic floor descent.53
The potential for a clinically silent injury precipitating SIJ
dysfunction and LBP in later life due to altered abdominal and
pelvis muscle function led us to study older women who
had undergone gynecological surgery (GS). We speculated that
women with a GS history would demonstrate altered MCS and
SIJ biomechanics compared to women without a GS history.
The observation that older women treated with hysterectomy
reported a significantly higher degree of moderate severity of
LBP in later life offers preliminary epidemiological support for
our hypothesis.57 GS might serve as a clinically silent marker
for altered motor control of the lumbopelvic junction, possibly
from surgically induced dysfunction of local muscles, leading
to LBP later in life. The purpose of our study was to determine
if older women with LBP and a history of GS demonstrated
Ericksen et al
Figure 3. Doppler image of vibration of a left sacroiliac joint (SIJ)
showing posterior superior iliac spine and sacrum color proportional
to vibration intensity. The ultrasound probe is positioned to overlap
the sacrum medially and ilium laterally as shown in Figure 1; the
dorsal SIJ ligament is seen superficially.
altered SIJ compliance using DIV and greater pelvic floor des-
cent during the ASLR using real-time sonography to measure
pelvic floor descent. Increased SIJ compliance would support
the hypothesis that ineffective stabilizing MCS results in
excessive stress, strain, and creep, as forces normally modu-
lated by the MCS are applied to passive joint structures
in excess. We hypothesized that women with a history of
GS suffering from LBP would demonstrate the greatest degree
of SIJ compliance asymmetry, similar to younger women with
pregnancy-associated LBP shown previously.38,40 In addition,
it was hypothesized that women with a history of GS suffering
from LBP would demonstrate a greater degree of pelvic floor
descent during the ASLR, supporting our belief that prior GS
would compromise the so-called core stability MCS of the
lumbopelvic region, requiring greater large-muscle activation
for low-load stability, leading to excessive abdominal pressure
generation relative to pelvic floor muscle, ligament, and fascia
support.
Materials and Methods
Subjects
Subjects were recruited to participate in a single data-gathering
session through university medical center flyers, online jour-
nals circulated to geriatric populations, retirement facility
lectures, and word of mouth. The Institutional Review Board
of the university’s Office of Human Subjects Protection
approved the protocol. Twenty-five women met the inclusion
and exclusion criteria and participated in the study. Women
aged 65 years or older were recruited and classified into one of
the following medical and surgical history categories:
29
1. no history of LBP or GS,
2. history of LBP but no history of GS,
3. history of GS but no history of LBP, or
4. history of GS and history of LBP.
Exclusion criteria included any history of lumbar spine surgery
to avoid surgically altered lumbopelvic biomechanics, neurolo-
gical diseases that might affect underlying motor control func-
tion for spine stability, and spine compression fractures as a
cause of LBP.
LBP was quantified using both the 100-mm visual analog
scale (VAS) and the 11-point numerical rating scale. The
impact of LBP on daily function was assessed using the
Modified Oswestry Disability Questionnaire.58 Clinical
research center nursing staff recorded height and weight on
the visit day to obtain a body mass index (BMI). The research
team was blinded to prior history. Subjects were asked to not
discuss their prior history or pain locations during the mea-
surement protocol.
Procedures
SIJ compliance measure. The DIV measurement was performed
by applying a sinusoidal vibration force to the prone subject’s
anterior superior iliac spine (ASIS; Figure 1), as previously
described.40,46,53 The bed height was adjusted to ensure contact
without excessive preload of the shaker motor floating platform.
The subjects’ feet were supported with pillows to ensure a
relaxed prone position. The subjects were instructed to relax the
muscles of the lower back, buttocks, abdomen, and pelvic floor
to minimize the influence of muscle tone on SIJ compliance. The
shaker motor (model LW126-13, Labworks, Inc, Costa Mesa,
California) was programmed to provide a 200-Hz sinusoidal
vibration with amplitude of approximately 0.05 mm. The
motor’s driver amplifier was adjusted until the subject felt the
vibration and the operator could palpate vibration in the pos-
terior pelvis tissues. The 200-Hz frequency has been previously
demonstrated to be safe.43 The vibration signal of the posterior
SIJ bones was quantified using real-time color Doppler imaging
(HDI 5000 1997, software version 4252-0913-15-190-17; ATL
Ultrasound, Inc, Bothell, Washington) of the ilium and sacrum.
A linear probe (ATL Linear Array L7-4 38 mm) was positioned
over the SIJ using the posterior superior iliac spine (PSIS) as the
palpation landmark giving an image of the PSIS and sacrum
(Figure 3). The scanner was configured in the peripheral vas-
cular tissue specific preset using the venous category based on
preliminary testing to optimize the DIV images. The image
depth was adjusted to display both the PSIS and sacrum in the
image. The system was converted to the power-imaging mode
(PWR IMG), and the power region of interest column size was
maximized and column position adjusted to include the entire
image. The color gain was adjusted to show power intensity on
both the PSIS and sacrum that was not present when the vibra-
tion was turned off (CPA range, 70%-90%). Once a stable power
image was obtained with vibration applied, the image was saved
using the research quality output module on the HDI 5000 system
29
30
Figure 4. Typical pelvis ultrasound demonstrating the change in pelvic floor position during the active straight leg raise.
to an optical disc. Thus, the power Doppler signal data for the
sacrum and the ilium were recorded simultaneously to compare
the vibration intensity across the SIJ at one point in time. Three
independent sequential measurements of each SIJ were per-
formed with transducer repositioning each time. Left-sided
measurements were performed first, and the subject turned
around on the bed to perform right-sided measurements. One
investigator (J.E.) performed all the measurements after training
in the DIV method with previous authors41 and assembling the
system and training for 3 months.
Pelvic floor measurements. Subjects were positioned supine
and taught the ASLR by asking them to hold one foot 12
to 24 inches above the bed mattress and to demonstrate
proper performance before testing. The ultrasound system
was converted to the phased array probe (ATL P4-2 20
mm) and the abdominal imaging tissue-specific preset using
the general category. The probe was positioned over the
superior aspect of the pubic symphysis with the beam aimed
caudally to capture the sharpest delineation of the inferior
bladder floor and the image stored. The split-screen mode
was used with the baseline bladder floor image saved on 1
screen. The subject was then asked to raise 1 leg, and the
operator maintained the same inferior bladder floor image.
The image was stored, and on-screen distance measurement
was performed to determine the distance from the probe to
the pelvic floor at the inferior bladder wall (Figure 4). The
absolute values at rest and during the ASLR were recorded
with 3 separate measures from each side obtained in serial
fashion beginning with the right leg for all subjects. One
investigator (J.E.) performed all measurements.
30
Geriatric Orthopaedic Surgery & Rehabilitation 1(1)
Data Analysis
The optical disc images were transferred to a Windows operat-
ing system (Microsoft Inc, Bellevue, Washington) computer
for analysis. For each DIV measure, the image was analyzed
using the region of interest plug in for the QLAB software
package (QLAB version 2.0, copyright 2003; Philips Corpora-
tion, Andover, Massachusetts). The images were accessed
using a color suppression setting, enabling the operator to place
the region of interest target (0.5 cm2) over the ultrasound image
without motion color biasing placement of the target. The oper-
ator placed the target over the best bone image of the sacrum
and ilium. The analysis was then done providing the average
power signal (dB) of the region of interest based on the color
intensity embedded in the image. A direct comparison between
the vibratory motion of the sacrum and ilium was possible for
the same moment in time, providing a differential measurement
proportional to compliance of the SIJ. A highly compliant SIJ
was predicted to have a greater difference in the power Doppler
signal intensity between the ilium and sacrum. A stiffer or less
compliant SIJ would demonstrate less difference or more sim-
ilar power Doppler signals on both sides of the joint. The mean
difference between the ilium and sacrum region of interest
average power signal was calculated for the 3 measurements
on each side. The side-to-side (left to right) difference was
calculated by subtracting the mean right ilium to sacrum
intensity difference from the mean left ilium to sacrum inten-
sity difference.
Pelvic floor motion during the ASLR was calculated by sub-
tracting the inferior bladder wall depth measurement (probe
surface to bladder floor) during the ASLR from the resting
Ericksen et al 31

Table 1. Baseline Characteristics Across Groups Based on Low-Back Pain (LBP) and Gynecological Surgery (GS) History, No Significant
Differences Across Groups (P ¼ .05)

No GS þGS

No LBP (n ¼ 8) þLBP (n ¼ 4) No LBP (n ¼ 8) þLBP (n ¼ 3)

Mean (SD) Mean (SD) Mean (SD) Mean (SD)

Age, y 72.4 (6.09) 73.3 (5.38) 73.6 (5.24) 68.7 (5.51)

Body mass index, kg/m2 26.7 (5.05) 27.6 (2.95) 25.6 (4.10) 33.1 (4.78)
Visual analog scale, mm NA 33.3 (12.12) NA 33.0 (26.06)
Modified Oswestry Disability Scale NA 13.5 (6.61) NA 16.3 (7.57)

Table 2. DIV Measurements for Each SIJ Ilium to Sacrum Difference (dB) and Pelvic Floor Motion (cm) During the ASLR by Groups

No GS þGS

No LBP (n ¼ 8) þLBP (n ¼ 4) No LBP (n ¼ 8) þLBP (n ¼ 3)

Mean (SE) 95% CI Mean (SE) 95% CI Mean (SE) 95% CI Mean (SE) 95% CI

R ilium to sacrum DIV 4.27 (1.09) (2.00 to 6.55) 3.46 (1.54) (0.24 to 6.68) 4.43 (1.09) (2.15 to 6.70) 2.87 (1.78) (–0.85 to 6.59)
measure difference
L ilium to sacrum DIV 2.22 (0.75) (0.65 to 3.79) 1.58 (1.06) (–0.64 to 3.80) 3.44 (0.75) (1.87 to 5.01) 1.60 (1.22) (–0.96 to 4.16)
measure difference
Pelvic floor motion 0.26 (0.13) (–0.01 to 0.52) 0.19 (0.18) (–0.18 to 0.56) 0.49 (0.13) (0.21 to 0.77) 0.39 (0.21) (–0.04 to 0.82)
(right ASLR)
Pelvic floor motion 0.32 (0.16) (–0.02 to 0.66) 0.62 (0.23) (0.14 to 1.10) 0.65 (0.17) (0.29 to 1.01) 0.53 (0.26) (–0.02 to 1.08)
(left ASLR)

Abbreviations: ASLR, active straight leg raise; CI, confidence interval; DIV, Doppler imaging of vibration; SE, standard error; SIJ, sacroiliac joint.

measurement. Positive values indicate descent and negative
values ascent of the pelvic floor during the load test of the
ASLR. The 3 measurements were averaged for each side ASLR
maneuver to provide a mean pelvic floor measurement for both
the left and right ASLR.
Statistical Analysis
The baseline characteristics (age, BMI, pain scores, and the
modified Oswestry Disability Questionnaire scores) were
compared among the 4 groups using 2-way analysis of
variance (ANOVA) models with factors for LBP and GS.
Two-way ANOVA models were further used to test whether
the 4 groups had significantly different compliance on either
side, compliance asymmetry (right-left), or pelvic floor
motion on either side. The consistency of the DIV mea-
surement was evaluated using Cronbach a for the right and
left ilium and sacrum measurements individually across the
3 measurements.
Results
DIV data were not obtained on 2 subjects due to data collection
problems. These subjects were not included in the results anal-
yses. Table 1 summarizes the characteristics of the groups rela-
tive to age, VAS pain score, modified Oswestry Disability
Questionnaire rating, BMI, and GS history. Subjects reporting
LBP (n ¼ 7) described fairly modest degrees of LBP (mean
VAS ¼ 33.14, SD ¼ 17.32 mm) and limited disability (mean
Oswestry score ¼ 14.71, SD ¼ 6.58). There was no significant
difference in the mean BMI between the pain-free and LBP
groups, F(1, 21) ¼ 3.61, P ¼ .0714.
The DIV measurement demonstrated excellent internal
reliability for the ilium (Cronbach a ¼ .852 [right], .701 [left])
and sacrum (Cronbach a ¼ .898 [right], .810 [left]). Similarly,
the ilium to sacrum DIV difference for the SIJ demonstrated rea-
sonable internal reliability (Cronbach a ¼ .757 [right], .705
[left]).
Table 2 shows measurements for each of the subgroups for
the mean DIV power image data of the ilium and sacrum, the
ilium to sacrum difference for each SIJ compliance measure,
and the right to left SIJ compliance difference. There was no
significant difference in the SIJ compliance measure right to
left difference among the subgroups, F(3, 19) ¼ 0.17, P ¼
.9124. Similarly, there was no significant difference in the
mean absolute SIJ compliance measurement for either SIJ
across groups: right side, F(3, 19) ¼ 0.25, P ¼ .8613; left
side, F(3, 19) ¼ 0.99, P ¼ .4159. The results of the pelvic
floor movement during the ASLR measurement are shown
in Table 2 for each of the subgroups. There was no signifi-
cant difference in the amount of pelvic floor motion across
groups during either the right- or left-sided ASLR: right
side, F(3, 18) ¼ 0.82, P ¼ .4976; left side, F(3, 18) ¼ 0.77,
P ¼ .5253). The ANOVA results are shown in Table 3 for
both the SIJ compliance measurement and the pelvic floor
measurement.

31
32
Table 3. ANOVA Results for the DIV Measurement of Compliance
Within Each SIJ and Left to Right Difference of the SIJ Compliance
Measurement and the Pelvic Floor Motion During the ASLR by Sidea
F Statistic
R ilium to sacrum DIV 0.25
measure difference
L ilium to sacrum DIV 0.99
measure difference
L to R SIJ DIV 0.17
measure difference
Pelvic floor motion (right ASLR) 0.82
Pelvic floor motion (left ASLR) 0.77
Abbreviations: ANOVA, analysis of variance; ASLR, active straight leg raise;
DIV, Doppler imaging of vibration; SIJ, sacroiliac joint.
a
Numerator and denominator degrees of freedom for all DIV tests were 3 and
19, respectively, and for all pelvic floor motion tests, 3 and 18, respectively.
Discussion
The results of this study indicate that older women with LBP or
with a history of GS do not demonstrate greater SIJ compliance
asymmetry relative to age-matched women with no LBP or
history of GS. We hypothesized that prior GS could trigger an
ineffective MCS, leading to increased SIJ stress and strain,
precipitating more SIJ compliance asymmetry as reported in
women with pregnancy-related LBP.34,38,40 Women reporting
both LBP and a history of GS (n ¼ 3) did not demonstrate more
asymmetry of SIJ laxity. Women with either LBP or history of
GS did not demonstrate differences in right or left absolute SIJ
compliance compared with their null counterparts. Thus, our
hypothesis that prior GS or the presence of LBP in older
women would be associated with more SIJ compliance asym-
metry was not supported.
Differences in pelvic floor movement during the ASLR, inter-
preted to suggest altered lumbopelvic MCS with changes in the
balance between intra-abdominal pressure and pelvic floor sup-
port mechanisms, were not observed in women with LBP or GS
history. Thus, our hypothesis that altered MCS inherent in LBP or
due to prior GS would be demonstrated by greater pelvic floor
movement during a load challenge was not supported.
The DIV method employed in this study differed from initial
reports in the analysis of SIJ compliance. Prior experiments
measured the difference in color Doppler gain between the
ilium and sacrum to provide a stiffness or, conversely, laxity
measure.34,38,40,41,43-47 That method used serial changes in
instrument settings to compare the threshold gain when the
sacrum color Doppler signal was lost to when the ilium signal
was lost. One limitation of that method is the moment-to-
moment variation of the bone vibration from changing mus-
cle tone and vibration plate contact from factors such as
respiration. The ASIS contact and therefore intensity of the
applied vibration force could potentially vary between the 2
measurement points for color Doppler thresholds of the sacrum
and then ilium. We used a single-point-in-time measurement of
the sacrum and ilium vibration analyzed to determine the
relative difference in energy between the 2 vibrating bones.
32
Geriatric Orthopaedic Surgery & Rehabilitation 1(1)
The internal consistency of the DIV measurements of the ilium
and sacrum within subjects suggests our measurement on each
SIJ structure and thus the difference between the 2 SIJ struc-
tures was derived with consistency.
P Value
Other factors limit the analysis of the results. The severity of
.8613 LBP was small in women reporting current LBP in both the GS
and no-GS groups (33.0 mm, 33.3 mm mean VAS scores),
.4159 suggesting our groups lacked sufficient SIJ compliance
asymmetry to precipitate LBP as described in peripartum
.9124
women suffering LBP.34,38,40 Those studies focused on the
.4976 more specific pelvic girdle pain diagnosis rather than the
.5253 nonspecific LBP our subjects described. We did not localize
the region of our subjects’ LBP to the lumbar spine or posterior
pelvis. In addition, the small number in each subgroup limited
the power to detect clinically meaningful differences.
Degenerative changes in the SIJ could reduce inherent compli-
ance in older women with increased joint congruity relative to
younger women. Thus, the population might have been too
advanced in age to detect compliance asymmetry potentially pres-
ent in younger years. It is possible that altered MCS for stability
developed earlier in life leads to higher compressive loads over
time, causing accelerated degenerative changes that reduce SIJ
compliance. Histological analysis of older human SIJs demon-
strated degenerative changes with incomplete ankylosis in a dis-
cussion of manual therapies for SIJ conditions.59 Radiographic
analysis demonstrated that degenerative changes progressed
beyond age 40 years and varied in location within the SIJ stud-
ied.60 The radiographic variation of degenerative changes with
observations of marked variation in the viscoelastic properties
of different SIJ regions suggests that the choice of the PSIS
landmark to perform the DIV analysis might have missed more
mobile sections of the SIJ and did not reflect overall SIJ compli-
ance.61 Further refinement of the DIV method comparing mea-
surements at various levels across the SIJ could enhance the
understanding of this measurement in older subjects.
The pelvic floor motion assessment used an indirect mea-
sure of movement using the perceived bladder floor motion
during the ASLR. Potential error exists in the method due to
changes in probe angle and compression during the ASLR, cre-
ating a change in the perceived edge for measuring the move-
ment. Altered MCS during the ASLR may not affect bladder
floor motion in our cohort if the MCS included excessive pelvic
floor muscle tone, best observed with electrophysiological
methods, or increased stiffness of pelvic floor ligaments. As
noted, the subjects with LBP had very little pain and disability
and may not represent women with significant alterations in
their MCS during the ASLR.
Conclusions
Older women reporting a history of GS and/or LBP did not
demonstrate differences in absolute SIJ compliance or greater
asymmetry of SIJ compliance (stiffness) compared with older
women without LBP or a history of GS. Similarly, the cohort
did not demonstrate a significant difference in pelvic floor
motion during the ASLR challenge, suggesting they did not use
Ericksen et al
excessive muscle activation to provide lumbopelvic stability
during the load challenge that exceeded the pelvic floor active
and passive support systems. We present a variation in the
method for assessing SIJ compliance using DIV that compares
induced vibration signals on both sides of the SIJ simultane-
ously that demonstrated reasonable internal consistency.
Acknowledgments
The research reported was supported by the American Geriatrics Soci-
ety. The investigators retained full independence in the conduct of this
research. The research reported was presented in part at the 2007 Sixth
World Interdisciplinary Congress on Pelvis and Low Back Pain, Bar-
celona, Spain, November 8, 2007, and the American Geriatrics Soci-
ety Annual Scientific Meeting, Washington, DC, April 30, 2008, in
poster format. The authors wish to thank Jan-Paul Wingerden, MD,
of the Spine and Joint Centre, Rotterdam, the Netherlands, for his
assistance in DIV training; Flemming Forsberg, PhD, of Thomas
Jefferson University, Philadelphia, Pennsylvania, USA, for his gui-
dance with ultrasound image interpretation; and Mary Beatty of the
McGuire VAMC, Richmond, Virginia, USA, for her illustrations.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the authorship and/or publication of this article.
Funding
This research was supported by the American Geriatrics Society, and
Jeffery J. Ericksen was supported by a Career Development Award
from the American Geriatrics Society.
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