Manual Therapy - Articles in Press

Which types of stretching modifies biomechanical dimensions of a muscle-tendon unit? - Corrected Proof

Vikram Mohan, Srijit Das — 2012-02-01

We enjoyed reading the published article entitled ‘The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties’ by . The authors presented an interesting article on the biomechanical properties of the muscle following a dynamic stretching on the plantar flexors group of muscle. Stretching is considered as one of the integral part of any exercise program. In the present study, stretching was incorporated as a dynamic form to know the displacement of the Myotendinous junction (MTJ) as well as on other dimensions of the muscle-tendon unit.

Corrected Proof

Jason Porr — 2012-01-30

For many western healthcare professionals, Traditional Chinese Acupuncture can be both confusing and frustrating, which has lead to the anatomically and physiologically based Western Medical Acupuncture. The text Biomedical Acupuncture for Sports and Trauma Rehabilitation presents an approach to dry needling techniques that amalgamates these two distinct views on acupuncture. This book has been written for any medical professional trained in acupuncture, with the intent that once the proper understanding of the physiological mechanisms underlying dry needling have been understood, the technique can be adapted for a variety of practice styles and techniques.

Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy - Corrected Proof

Nina K. Vøllestad, Peter A. Torjesen, Hilde Stendal Robinson — 2012-01-30

Abstract: There is a common belief that the laxity of pelvic joints increases in pregnancy. The hormone relaxin is suggested to be one of the most influential factors implementing this effect. Furthermore, increased laxity is assumed to induce pelvic girdle pain (PGP). The objectives were to examine the serum relaxin levels in pregnancy and to investigate whether relaxin levels relate to symptoms and clinical tests for PGP. Data from questionnaires, clinical tests and blood samples were collected once in pregnancy (gestation week 5–24) from 212 women. Serum from blood samples were analyzed by ELIZA to determine the concentration of relaxin. Self reported symptoms were assessed by Disability Rating Index (DRI) and pain intensity (VAS). Clinical examinations included Active Straight Leg Raise (ASLR) test and pain provocation tests. ANOVA was used to assess the effect of gestation age and multivariable statistics to examine the association between relaxin levels and the symptoms or responses to clinical tests.The serum levels of relaxin varied widely between individuals and were only marginally influenced by the gestation age. There was no association between gestation age and responses to clinical tests or pain intensity, but DRI increased with gestation age. Serum concentration of relaxin showed a significant association to positive score on the ASLR test, but no significant associations to responses to pain provocation tests, pain intensity or DRI.The results indicate that relaxin contributes to laxity of pelvic joints in pregnancy. Yet, no evidence of relaxin having an impact on symptoms or perceived disability was found.

Comparison of hip rotation range of motion in judo athletes with and without history of low back pain - Corrected Proof

2012-01-27

Abstract: This study compared hip rotation range of motion in judo athletes with and without a history of low back pain. Forty-two athletes (22 males) were divided into two groups: 21 with history of low back pain (HLBP) and 21 without history of low back pain (Control). Internal and external hip rotation range of motion in active and passive movement were measured using computed photogrammetry. The HLBP group exhibited a significant reduction in active internal rotation (27.5 ± 6.5° vs 38.2 ± 6.5°), active total rotation (80.1 ± 9.5° vs 87.4 ± 7.9°) of the non-dominant limb (P < 0.01) and active total rotation (82.6 ± 7.6° vs 87.6 ± 9.8°; P = 0.04) in comparison with the control group. In passive rotation, the HLBP group showed a significant reduction in internal rotation of the dominant (41.9 ± 6.1° vs 46.1 ± 8.4°; P = 0.04) and non-dominant limb (37.1 ± 8.4° vs 47.3 ± 7.6°; P < 0.001), total rotation of the non-dominant limb (96.7 ± 10.2° vs 105.1 ± 11°; P = 0.005) and total rotation (98.5 ± 9.2° vs 105 ± 11.2°; P = 0.02). Within the HLBP group, a significant reduction in both active and passive internal rotation (P < 0.001) and active and passive total rotation (P < 0.01) of the non-dominant limb was detected. The same was not found in the control group. The results demonstrate that judo athletes with a history of low back pain exhibit deficits in hip rotation and greater asymmetry between limbs.

Comments on the article by Jing-lan Yang et al. “Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: A randomized control trial”, Manual Therapy 2012; 17 (1): 47–52 - Corrected Proof

Amrita S. Raghoenath, Jantine Scheele, Arianne P. Verhagen — 2012-01-27

With interest we read the article of Yang et al. about the end-range mobilization and scapular mobilization approach (). It is interesting to evaluate whether a subgroup of subjects with frozen shoulder syndrome will benefit from the end-range mobilization/scapular mobilization treatment approach (EMSMTA). However, a few questions about the control-group, the number of patients and their characteristics and the measurements remain unanswered.

Psychometric properties of the Pain Attitudes and Beliefs Scale for Physiotherapists: A systematic review - Corrected Proof

J.-H.A.M. Mutsaers, R. Peters, A.L. Pool-Goudzwaard, B.W. Koes, A.P. Verhagen — 2012-01-25

Abstract: Objective: Evidence suggests that care providers' attitudes influence their perception of patient characteristics and the way they manage their cases. Attitudes and beliefs of care providers can be measured with the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PT). This study evaluates the measurement properties of the PABS-PT.Methods: Databases (PubMed-Medline, Embase, Cinahl and Pedro) were searched for studies on the development or evaluation of measurement properties of the PABS-PT. Methodological quality was assessed and rated using the COSMIN checklist and scoring system.Results: Of the 139 identified publications, 10 met the selection criteria. Most of the included studies had fair to excellent methodological quality scores. Positive results were found for internal consistency, construct validity, reliability and responsiveness. No psychometric data were found for the content validity and interpretability of the PABS-PT.Conclusion: The PABS-PT is still in a developmental stage. Results for the psychometric properties are promising, but content validity and interpretability need more study. The relationship between implicit and explicit attitudes, and their influence on test scores, remains unclear.

Inter-examiner reliability of a proposed decision-making treatment based classification system for low back pain patients - Corrected Proof

2012-01-20

Abstract: Evolving evidence has shown increased clinical outcomes, when low back pain (LBP) patients are classified and receive matched physical treatment. The present study aimed to examine the inter-examiner reliability of a proposed new decision-making classification system for non-specific LBP patients, using a mixed simultaneous and independent examiner design. With minimal familiarization, two pairs of experienced physiotherapists trained in Orthopedic Manual Therapy (OMT) at two different out-patient clinics in primary care, examined and classified 64 consenting consecutive patients. Further, inter-examiner reliability on five examination items was examined. The agreement between examiners was expressed by percentage of agreement (%) and by the un-weighted (κ) or weighted (κw) kappa coefficient. The overall % agreement, categorizing patients into one of four classifications was 80% and κ = 0.72. For each classification, pain modulation, stabilization exercise, mobilization and training, agreement was 90%, 83%, 58% and 89% (κ = 0.77, 0.67, 0.11 and 0.75), respectively. Agreement on five individual examination items was; irritability 82% (κw = 0.41), specific movement pattern 68% (κ = 0.38), specific segmental signs 67% (κ = 0.28), uni- or bilateral signs 62% (κ = 0.42), and neurological signs and symptoms 92% (κ = 0.84). This study demonstrated that this new classification system had substantial inter-examiner reliability when used by clinically experienced OMT-trained physiotherapists. Agreement within classification was substantial, except for mobilization which was poor. Inter-examiner reliability for the individual examination items varied from fair to almost perfect. Further studies are needed to investigate utility and validity of this new classification system.

Differences in end-range lumbar flexion during slumped sitting and forward bending between low back pain subgroups and genders - Corrected Proof

Shannon L. Hoffman, Molly B. Johnson, Dequan Zou, Linda R. Van Dillen — 2012-01-19

Abstract: Patterns of lumbar posture and motion are associated with low back pain (LBP). Research suggests LBP subgroups demonstrate different patterns during common tasks. This study assessed differences in end-range lumbar flexion during two tasks between two LBP subgroups classified according to the Movement System Impairment model. Additionally, the impact of gender differences on subgroup differences was assessed. Kinematic data were collected. Subjects in the Rotation (Rot) and Rotation with Extension (RotExt) LBP subgroups were asked to sit slumped and bend forward from standing. Lumbar end-range flexion was calculated. Subjects reported symptom behaviour during each test. Compared to the RotExt subgroup, the Rot subgroup demonstrated greater end-range lumbar flexion during slumped sitting and a trend towards greater end-range lumbar flexion with forward bending. Compared to females, males demonstrated greater end-range lumbar flexion during slumped sitting and forward bending. A greater proportion of people in the Rot subgroup reported symptoms with each test compared to the RotExt subgroup. Males and females were equally likely to report symptoms with each test. Gender differences were not responsible for LBP subgroup differences. Subgrouping people with LBP provides insight into differences in lumbar motion within the LBP population. Results suggesting potential consistent differences across flexion-related tasks support the presence of stereotypical movement patterns that are related to LBP.

Rehabilitative ultrasound measurement of trapezius muscle contractile states in people with mild shoulder pain - Corrected Proof

Cliona O’Sullivan, Ulrik McCarthy Persson, Catherine Blake, Maria Stokes — 2012-01-16

Abstract: Introduction: The utility of rehabilitative ultrasound imaging (RUSI) for assessing trapezius muscle contractile characteristics was investigated by examining whether muscle thickness changes during contraction (CT) differed between people with and without mild shoulder pain.Methods: In 18 subjects with mild shoulder pain (aged 28±8 years) and 18 matched controls, trapezius muscle thickness change was measured in prone at rest at 0° and during isometric CTs at 90° and 120° of shoulder abduction. Images were taken at four sites using a real-time ultrasound scanner (7-MHz linear transducer, 40mm footprint). Percentage change in muscle thickness from rest was calculated. Differences between painful and non-painful shoulders and participant groups were examined by analysis of variance (ANOVA) and t-tests.Results: There were no significant differences between groups or sides in trapezius muscle thickness change during CT. There was no significant difference in trapezius muscle resting thickness (RT) between painful and non-painful shoulders in the same subjects.Conclusion: Contractile ability of the trapezius muscle, assessed using RUSI was not impaired in subjects with mild shoulder pain during the test manoeuvres used. Further research is warranted involving patients with different severity of symptoms, using other test manoeuvres before RUSI can be advocated for assessing scapular muscle dysfunction.

The association between pelvic floor muscle function and pelvic girdle pain – A matched case control 3D ultrasound study - Corrected Proof

Britt Stuge, Kaja Sætre, Ingeborg Hoff Brækken — 2012-01-16

Abstract: There is uncertainty regarding the association between the function of the pelvic floor muscles (PFM) and pelvic girdle pain (PGP), and whether exercises to strengthen the PFM should be recommended for patients with PGP. This one-to-one matched case-control study examined whether there is any difference in voluntary PFM function between women with and without clinically diagnosed PGP. PFM function was assessed by manometry and three-dimensional ultrasound. Images were saved anonymously and analyses were performed offline by one investigator. A special Cox regression model was used to fit a conditional logistic regression procedure for one-to-one matched case-control studies. Forty-nine pairs of women were successfully matched according to age and parity. The study showed no difference in voluntary PFM function measured by palpation, manometry or ultrasound. The size of the levator hiatus area, together with BMI, was significantly associated with PGP. Women with PGP had statistically significantly smaller levator hiatus areas and a tendency for higher vaginal resting pressure compared to the control group. A significantly smaller levator hiatus and a tendency for higher vaginal resting pressure may indicate increased activity of the PFM. Hence, no evidence was found to recommend strengthening exercises for the PFM in patients with PGP. It is important to note that in this study we examined only voluntary contractions and not an automatic response of the PFM to a functional activity.

Sacroiliac joint and weight distribution to feet: An opinion towards clinical and research practice – Authors reply - Corrected Proof

2012-01-16

We appreciate the queries brought forth and would like to share our point of view regarding our article. The study by is part of an ongoing larger research study related to functional alterations in gait, balance, and weight distribution behavior in response to manual therapy interventions. We agree that walking resembles more closely the functional mobility of the sacroiliac joint (SIJ). However, force transmission during standing is also a fundamental role of the joint due to its anatomical and functional nature (), and we opted to utilize only baropodometric values during standing.

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Tracy L. Bougie — 2012-01-16

“Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines” is the continuation and extension of Shirley Sahrmann’s previous book, “Diagnosis and Treatment of Movement Impairment Syndromes”, which was published in 2001. The book is directed towards healthcare practitioners with the purpose of providing a detailed method to evaluate movement patterns and impairments in the clinical setting.

Chiari Malformation Type I, presenting as scapulothoracic pain: A case report - Corrected Proof

David R. Worth, Steven Milanese — 2012-01-16

Abstract: Patients presenting with recalcitrant symptoms, which are resistant to a range of physical interventions over an extended period of time, need to be examined with care. A ‘forensic’ approach to the assessment of these patients, with a sensitive approach to the results of the test procedures is required to ensure the practitioner does not miss the more obscure causes.This case report presents a patient who was referred for a clinical assessment for long standing scapular pain, which had been labelled myofascial pain. Through a thorough approach to examination a number of flags appeared which suggested a need for further investigation. These investigations identified that the patient demonstrated a Chiari Malformation Type 1. On review 5 months following neurosurgical intervention her symptoms were significantly reduced.Chiari Malformations Type 1 are often diagnosed in adulthood when symptoms usually first appear. These symptoms may mimic those found with musculoskeletal conditions. Whilst we lack specific clinical tests for this condition, a thorough assessment should identify sufficient ‘flags’ for referral for further investigations.

Severity of signs and symptoms in lumbopelvic pain during pregnancy - Corrected Proof

Jan M.A. Mens, Yvonne H. Huis in ’t Veld, Annelies Pool-Goudzwaard — 2012-01-16

Abstract: Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms.Women with an uncomplicated pregnancy of 20–30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction.Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p<0.001), had a higher body mass index (p<0.01), more often had urinary incontinence (p<0.05), had less isometric hip adduction force (p<0.001), had more pain on isometric hip adduction (p<0.01), had a higher ASLR score (p<0.001) and more had often a positive PPPP test (p<0.001). Fatigue was not related to LPP during pregnancy.The main conclusion is that pain and disability of LPP during pregnancy can be interpreted as mild to moderate in most cases, and as severe in about 20%.

Priming the brain to learn: The future of therapy? - Corrected Proof

Siobhan M. Schabrun, Lucinda S. Chipchase — 2011-12-26

Abstract: Neuromodulatory techniques with the ability to alter cortical excitability are gaining interest for their potential to enhance the brain’s sensitivity to traditional therapies. Neuromodulatory techniques that prime the brain prior to manual or exercise therapy hold therapeutic promise for enhancing clinical outcomes in musculoskeletal and neurological conditions. The integration of these techniques into physiotherapy practice represents an exciting opportunity for the therapists of the future. Here, an overview is provided of three neuromodulatory techniques (peripheral electrical stimulation, transcranial direct current stimulation and repetitive transcranial magnetic stimulation) and the potential implications of these techniques for therapists discussed. Understanding these techniques and their therapeutic implications will ensure that therapists are well positioned to contribute to their clinical translation and adoption into clinical practice in an appropriate time frame. A therapeutic landscape defined by neuromodulatory techniques and improved clinical outcomes across a range of conditions is no longer far-fetched.

Screening of patients suitable for diagnostic cervical facet joint blocks – A role for physiotherapists - Corrected Proof

Geoff M. Schneider, Gwendolen Jull, Kenneth Thomas, Paul Salo — 2011-12-23

Abstract: The cervical facet joint is a prevalent source of pain in patients with chronic cervical spine pain. Patients with persistent, disabling neck pain, are increasingly being referred for diagnostic facet joint blocks, with the aim of assessing their suitability for interventional procedures such as radiofrequency neurotomy (RFN). A positive response to the block is an indicator of more substantive benefits from RFN. Physiotherapists and medical practitioners are challenged to make appropriate referrals for diagnostic facet joint blocks. This lack of selection contributes to lengthy wait-lists, unnecessary invasive procedures for those who have a negative response and significant costs to the health care system. Physiotherapists use manual examination to identify the facet joint as the primary source of a patient’s pain but its diagnostic accuracy and reliability is variable. It is reasoned that a combination of findings of a physical, manual and psychological assessment may better indicate that a patient will respond positively or negatively to a diagnostic facet joint block. Clinical prediction guides (CPG) allow practitioners to use the results of the patient history, self-report measures and physical examination toward optimal diagnostic and therapeutic decisions. It is proposed that the development and validation of a CPG may aid in the appropriate selection of patients for this diagnostic procedure.

Perception of subjective visual vertical and horizontal in patients with chronic neck pain: A cross-sectional observational study - Corrected Proof

Sharon Docherty, Rebekka Schärer, Jeff Bagust, B. Kim Humphreys — 2011-12-19

Abstract: Previous studies have shown that chronic neck pain (CNP) patients have a larger spread of perceptual errors for subjective visual vertical (SVV) than those exhibited by asymptomatic controls. The current study investigated whether this was also the case for perception of subjective visual horizontal (SVH) and whether there was a correlation between the two measurements. Fifty patients with CNP were compared with a group of 50 age- and gender-matched controls. All subjects were required to complete a test to measure SVH as well as SVV using the computerised rod and frame (CRAF) test. These tests were conducted under various frame conditions. No difference was found between the errors of the CNP and control groups in the absence of a surrounding frame. When a tilted frame was added to the CRAF test, the range of errors observed in the CNP group increased for both SVV and SVH. In particular, significantly more CNP patients fell outside the reference range of errors and a subgroup of patients, characterised by higher neck pain disability indices, was identified who demonstrated higher than expected errors for both SVV and SVH. However no conclusion could be drawn with regards to the direction of error asymmetry and laterality of pain as those patients with unilateral pain exhibited errors both towards and away from the affected area.

Derangement of the temporomandibular joint; a case study using Mechanical Diagnosis and Therapy - Corrected Proof

C. Krog, S. May — 2011-12-19

Abstract: Mechanical Diagnosis and Therapy (MDT) is widely used for spinal problems, and more recently the principles and mechanical syndromes have been applied to extremity musculoskeletal problems. One of the most common classifications is derangement syndrome, which describes a presentation in which repeated movements causes a decrease in symptoms and a restoration of restricted range of movement. The case study describes the application of repeated movements to a patient with a 7-year history of non-specific temporomandibular pain and reduced function, who had had lots of previous failed treatment. Examination using repeated movements resulted in a classification of derangement, and the patient rapidly responded in 4 treatment sessions, with an abolition of pain and full restoration of function, and remained improved after many years. The case study demonstrates the application of Mechanical Diagnosis and Therapy principles to a patient with a temporomandibular problem.

Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study - Corrected Proof

W. Scott Christie, Aaron A. Puhl, Octavian Calin Lucaciu — 2011-11-28

Abstract: Objective: To examine the potential for treatment of palmar adhesions associated with Dupuytren’s contracture using instrument-assisted cross-frictional massage (CFM) and stretching.Methods: This was a prospective case study. The primary intervention consisted of a 2-min multi-planar CFM over the affected area of the palm, followed by a 2-min maximal finger-extension stretch.Results: Following eight weeks of treatment there were increases in both passive and active extension range of motion of the digits, reduction in the visibility of palmar adhesions, and subjective improvements in hand function.Conclusions: This treatment protocol may offer a substitute for the current invasive surgical and injection procedures that are available.

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Jairus J. Quesnele — 2011-11-21

Netter’s Sports Medicine was designed to carry forward the popular Team Physician’s Handbook. This new edition is best suited for physicians and other health care professionals who provide care to a variety of athletes and active individuals. Whether caring for the pediatric little leaguer, an elite ice hockey player or a senior athlete, Netter’s Sports Medicine provides the sport medicine practitioner with a very useful quick reference textbook.

Augmented home exercise program for a 37-year-old female with a clinical presentation of femoroacetabular impingement - Corrected Proof

Alexis A. Wright, Eric J. Hegedus — 2011-11-14

Abstract: Previous researchers have reported on the use of augmented home exercise programs with potential carry-over effects from manual therapy treatment. While there is no direct evidence to support augmented manual therapy, tangential evidence demonstrates that specific, supervised, and adherent exercises result in improved outcomes. The purpose of this case report is to describe an augmented home program simulating the manual techniques provided by the therapist. A 37-year-old female presented with symptoms and signs consistent with femoroacetabular impingement (FAI). Grade III lateral and inferior femoral glides decreased reported pain from 5/10 to 0/10. Given the immediate response to hip mobilizations, the patient was prescribed standing lateral glides and supine inferior glides of the hip with the use of a belt. During this time, the patient’s Lower Extremity Functional Scale score improved from 74 to 78 and she reported increased ability to self-manage her symptoms. The immediate report of decreased pain helped determine the specific home program selected for this individual patient. This case highlights the importance of a specific augmented home exercise program unique to the individual patient resulting in self-management of pain associated with FAI.

Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain - Corrected Proof

Keith M. Smart, Catherine Blake, Anthony Staines, Catherine Doody — 2011-11-10

Abstract: Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of ‘nociceptive’ (NP), ‘peripheral neuropathic’ (PNP) and ‘central sensitisation’ (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain.This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient’s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance.There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai’s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP.Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

Normal neurodynamic responses of the femoral slump test - Corrected Proof

Weng-Hang Lai, Yi-Fen Shih, Pei-Ling Lin, Wen-Yin Chen, Hsiao-Li Ma — 2011-11-07

Abstract: Femoral slump test is a neurodynamic testing, which could be used to assess the mechanosensitivity of the femoral component of the nervous system. Although Trainor and Pinnington reported the diagnosis accuracy of the femoral slump test, the neurodynamic responses of the femoral slump test have never been studied. The purposes of this study were to evaluate whether maneuvers that changed the nerve tension altered the responses of the femoral slump test and if these responses were influenced by gender and leg dominance; and to identify the correlations between flexibility and measured hip extension angle. Thirty-two asymptomatic subjects (16 males, 16 females) were recruited. The femoral slump test was performed in trunk slump and neutral positions, and cervical extension was used as the structure differential technique. Hip extension angle and visual analog scale (VAS) of thigh pain was measured during the test. Our results showed the decrease of nerve tension significantly increased hip extension ROM (P 0.05). These findings indicated that femoral slump test resulted in normal neurodynamic responses in individuals free of lower extremity problems, and these responses were independent of the influence of muscle flexibility or gender. Future research should emphasize the use of femoral slump test in patient groups such as low back and anterior knee pain.

Sacroiliac joint and weight distribution to feet: An opinion towards clinical and research practice - Corrected Proof

Leonard Joseph, Aatit Puangmali, Ubon Pirunsan, Srijit Das — 2011-10-20

We enjoyed reading the published manuscript entitled ‘Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint.’ by . We thought of sharing our views on the published article. The authors took a common clinical concept and related it eloquently to sacroiliac joint dysfunction and after effects of sacroiliac manipulation.

Neck-shoulder pain and weakness: An uncommon presentation - Corrected Proof

Hilla Sarig Bahat, Hilla Eshkol Izrael — 2011-10-10

Abstract: Neck and shoulder pain is a very common complaint in Western society that most often does not include motor compromise. Although peripheral nerve injuries are not as common, they should not be misdiagnosed. This case report describes the subjective assessment and physical examination of a patient with neck-shoulder pain and disabilities following a cervicofacial lift surgery. The patient was referred to physiotherapy treatment for what was diagnosed as a multi-level cervical disorder. Physical examination by the physiotherapist revealed diagnostic signs of accessory and suprascapular nerve injury as the cause of the shoulder impairment. Physiotherapy treatment included electrical motor stimulation and a comprehensive strengthening program, which resulted in full recovery.The purpose of this case study is to differentiate this presentation from commonly seen neck and shoulder pain by exploring the diagnostic factors for accessory and suprascapular nerve injury, based on the available evidence. The presented case report aims to raise the awareness of clinicians about the potential risk of peripheral nerve injury following cervicofacial lift, a common and elective surgical procedure.

Manual palpation of lumbo-pelvic landmarks: A validity study - Corrected Proof

Julia Kilby, Nicola R. Heneghan, Mark Maybury — 2011-09-26

Abstract: Manual palpation (MP) is commonly used for the assessment of patients with neuromusculoskeletal dysfunction. During assessment of lumbo-pelvic disorders in particular, it may be used not only to explore pain and resistance in the region, but also to evaluate the symmetry and movement quality of the area. Whilst reliability of MP has been extensively investigated, its validity remains relatively under researched. The aim of this study was to explore the accuracy of MP of lumbo-pelvic bony points. Ultrasound images of three bony landmarks [4th lumbar spinous process (L4), left and right posterior superior iliac spines (PSIS)] were acquired from models (n = 3) in the prone position and the points marked with an ultra-violet (UV) pen. Nine musculoskeletal physiotherapists were asked to identify the bony landmarks using MP. Measurements (mms) were taken between the UV marks and the palpators’ marks. The mean error (standard deviation) (mm) for MP of L4, LPSIS, RPSIS were 15.63 (3.89), 20.07 (4.60), 20.59 (2.79) respectively. Bland and Altman analysis gave a mean value of 0.173, with 95% limits of agreement ranging from −27.8 to 26.3. This study suggests that MP of specific lumbo-pelvic bony points has limited validity.

Bilateral leg symptoms – The T10 syndrome? - Corrected Proof

Wouter Kristiaan Geerse — 2011-09-23

Abstract: Prior studies have investigated the role of the sympathetic nervous system and the thoracic spine related to the upper extremities (known as the T4 syndrome). However, there is only little known about the role of the thoracic spine related to the lower extremities. In this case report, a patient with a heavy, tired feeling in both legs and hypomobile thoracic segments was treated with passive mobilisations of the thoracic spine.

Evaluation of outcome measures for use in clinical practice for adults with musculoskeletal conditions of the knee: A systematic review - Corrected Proof

Tracey E. Howe, Lesley J. Dawson, Grant Syme, Louise Duncan, Judith Reid — 2011-08-29

Abstract: Background: This systematic review reported on the clinimetric properties of outcome measures for use in clinical practice for adults with musculoskeletal conditions of the knee.Methods: A systematic search was performed in Medline, EMBASE, Cinahl and AMED to identify studies examining the clinimetric properties of outcome measures for adults undergoing conservative treatment of ligament injuries, meniscal lesions, patellofemoral pain and osteoarthritis of the knee. Outcomes measures taking less than 20 min to administer and requiring minimal equipment and space were included. Pairs of authors used a checklist to record the characteristics of the outcome measures, their reported clinimetric properties and the demographics of the study populations. The OMERACT filters of ‘truth’ and ‘discrimination’ were applied to the data for each outcome measure by an expert panel.Results: Forty-seven studies were included evaluating 37 outcome measures. Ten outcome measures had adequate supporting evidence for ‘truth’ and ‘discrimination’: AAOS, AKPS, goniometer measurement, IKDC, KOOS, LEFS, Lysholm, Tegner, WOMAC and WOMET. However none of the outcome measures had been comprehensively tested across all clinimetric properties.Conclusion: Despite the widespread use of some outcome measures in clinical practice and primary research, data on the clinimetric properties were available for only 37 and of these only 10 had adequate supporting evidence for use in this population. However, before a core set of outcome measures can be recommended use in clinical practice, for adults with musculoskeletal conditions of the knee, consensus should be obtained on ‘feasibility’ in terms of burden on the clinician and the participant.

Ultrasound transducer shape has no effect on measurements of lumbar multifidus muscle size - Corrected Proof

Peter R. Worsley, Nicholas Smith, Martin B. Warner, Maria Stokes — 2011-08-04

Abstract: Objective: Evidence is currently lacking for guidance on ultrasound transducer configuration (shape) when imaging muscle to measure its size. This study compared measurements made of lumbar multifidus on images obtained using curvilinear and linear transducers.Method: Fifteen asymptomatic males (aged 21–32 years) had their right lumbar multifidus imaged at L3. Two transverse images were taken with two transducers (5 MHz curvilinear and 6 MHz linear), and linear and cross-sectional area (CSA) measurements were made off-line. Reliability of image interpretation was shown using intra-class correlation coefficients (0.78–0.99). Muscle measurements were compared between transducers using Bland and Altman plots and paired t-tests. Relationships between CSA and linear measurements were examined using Pearson's Correlation Coefficients.Results: There were no significant differences (p > 0.05) in the measurements of the two transducers. Thickness and CSA measurements had small differences between transducers, with mean differences of 0.01 cm (SDdiff = 0.21 cm) and 0.03 cm2 (SDdiff = 0.58 cm2) respectively. Width measures had a mean difference of 0.14 cm, with the linear transducer giving larger measures. Significant correlations (p < 0.001) were found between all linear measures and CSA, with both transducers (r = 0.78–0.89).Conclusion: Measurements of multifidus at L3 were not influenced by the configuration of transducers of similar frequency. For the purposes of image interpretation, the curvilinear transducer produced better definition of the lateral muscle border, suggesting it as the preferable transducer for imaging lumbar multifidus.

Clinical conundrums in a case of upper quadrant dysfunction - Corrected Proof

Lisa Roberts — 2011-06-16

Abstract: This case study charts the progress of a 60-year-old angling coach presenting with a complex upper quadrant dysfunction. Following a brief summary of the history and physical examination, the main focus of the paper explores the mechanical and physiological rationale for adopting a neurodynamic approach for a proposed double crush condition. This case further highlights mismatches that arose between the clinical findings and traditional healing timescales, and the importance of considering pathomechanics of the whole quadrant in complex clinical circumstances.