Manuscript reviewers.

Physiother Theory Pract. 2007 Nov-Dec;23(6):365-6

Authors:

PMID: 18075909 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Outcomes following plyometric rehabilitation for the young throwing athlete: A case report.

Physiother Theory Pract. 2007 Nov-Dec;23(6):351-64

Authors: Peters C, George SZ

The current literature offers limited evidence supporting sport-specific plyometric rehabilitation for young throwing athletes. The purposes of this case report were to 1) describe the focused differential diagnosis of a young throwing athlete with shoulder pain and 2) use previously validated, region-specific, health-related quality of life measures to describe clinical outcomes for a rehabilitation program that included sport-specific, plyometric training. The 13-year-old male patient presented in this case report experienced a sudden onset of right shoulder pain while pitching in a baseball game. On physical examination, this patient demonstrated shoulder pain, pain with palpation of the infraspinatus and teres minor muscles, decreased strength of the infraspinatus and teres minor with resultant impaired rotator cuff performance, and signs consistent with anterior shoulder instability. Early rehabilitation consisted of modalities for pain relief and therapeutic exercises to improve strength. In the return to sport phase of rehabilitation, the patient performed sport-specific plyometric exercises that were progressed in difficulty based on the patient’s report of pain and muscle soreness. Health-related quality of life was assessed by using the Shoulder Pain and Disability Index (SPADI) and the sports module of the Disability of Arm, Shoulder and Hand (DASH) questionnaires. A standard error of measurement (SEM)-based criterion was used to determine if the patient demonstrated meaningful changes in outcome measures. The patient did not demonstrate meaningful improvement in pain or general disability with the SPADI. The patient did demonstrate a meaningful improvement in sport-specific function with the DASH. It is possible that sport-specific plyometric rehabilitation may have provided additional benefit for this athlete’s ability to return to sport, but definite conclusions regarding treatment effectiveness are limited by the case report design. Properly designed studies investigating the benefits of sport-specific plyometric rehabilitation are warranted before the effectiveness of these techniques can be determined.

PMID: 18075908 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Rehabilitation of a glenohumeral instability utilizing the body blade.

Physiother Theory Pract. 2007 Nov-Dec;23(6):333-49

Authors: Buteau JL, Eriksrud O, Hasson SM

Traditional rehabilitation for shoulder dislocation has a success rate of only 20%. The body blade has been hypothesized to strengthen the muscles stabilizing the shoulder girdle by training the contractile tissues directly and also indirectly affecting the joint and surrounding noncontractile tissues when responding to rapid positional changes and mechanical energy. Shoulder dislocation negatively affects both the active (musculature) and passive (joint and ligaments) stabilizers of the glenohumeral joint. Therefore, the purpose of this case report was to evaluate the efficacy of therapeutic exercise using the body blade in the conservative management of an individual with glenohumeral instability. The patient, an 18-year-old male, dislocated his left shoulder after a wave crashed on top of him. Intervention included therapeutic exercise using the body blade. Measures were taken at examination, re-evaluation (6th visit), and discharge (11th visit). According to the 11-point numeric pain rating scale, worst pain was reduced from 4 to 0. Glenohumeral ROM measures at discharge were all within normal range except external rotation (deficit of 10 degrees), compared to the initial ROM deficits of 10-35% of noninvolved values. Post intervention strength, as assessed by handheld dynamometry, revealed deficits only in scapular retraction compared to the uninvolved side (21% compared to an initial deficit of 39%). Other muscle groups showing deficits from 20% to 40% at initial examination exceeded the comparative strength of the other limb at discharge. The SPADI and WOSI scores were reduced from 13 to 0 and 482 to 46, from initial examination to discharge, respectively. Furthermore 6 months post episode of care the patient reported no recurrent dislocation of the involved shoulder. The success rate of an exercise program with individuals who have dislocated their glenohumeral joint is poor. After 11 visits of physical therapy using the body blade the patient improved in ROM, strength, and function.

PMID: 18075907 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Are elderly pedestrians allowed enough time at pedestrian crossings in Cape Town, South Africa?

Physiother Theory Pract. 2007 Nov-Dec;23(6):325-32

Authors: Amosun SL, Burgess T, Groeneveldt L, Hodgson T

A descriptive, cross-sectional analytical study was conducted to determine whether the recommended walking speed of 1.2 ms(-1) would allow elderly pedestrians to safely clear pedestrian crossings in Cape Town, South Africa. Male and female volunteers (n = 47), aged 65-93 years and resident in four homes for older persons, were recruited. Pedestrian clearance intervals at 40 traffic lights within 5-km radius of the selected homes were measured. The mean walking speed required at these traffic lights was 0.86 +/- 0.32 ms(1). The maximal walking speed over 12 m was measured without carrying any load and when carrying a predetermined weight of an average shopping bag. Participants’ emotions associated with pedestrian road safety were also assessed through an interview. The mean maximal unloaded and loaded walking speeds were 1.36 +/- 0.31 ms(-1) (0.73-2.03 ms(-1)), and 1.36 +/- 0.33 ms(-1) (0.58-2.12 ms(-1)), respectively. Over 30% of the participants walked slower than the recommended walking speed of 1.2 ms(-1). Participants felt that traffic lights did not allow for sufficient time to cross roads (51.1%) and reported emotions of apprehension (44.7%), anxiety (17.0%), and fear (10.6%) when crossing. A review of traffic planning and public policy is recommended to ensure older pedestrians safely clear pedestrian crossings.

PMID: 18075906 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Does stabilization of the tibiofemoral joint affect passive prone hip rotation range of motion measures in unimpaired individuals? A preliminary report.

Physiother Theory Pract. 2007 Nov-Dec;23(6):315-23

Authors: Harris-Hayes M, Wendl PM, Sahrmann SA, Van Dillen LR

Use of the tibia as a lever to produce hip rotation for the purpose of measuring passive hip rotation range of motion (ROM) could result in inaccurate values if motion is allowed at the tibiofemoral joint (TFJ). The purpose of this study was to examine the effect of stabilizing the TFJ during measurement of prone hip rotation ROM in men and women. Passive hip rotation was measured in 20 unimpaired subjects (M = 10, F = 10) in two different stabilization conditions, with the TFJ stabilized and without the TFJ stabilized. A 2 x 2 analysis of variance was used to test for the effects of stabilization condition and gender on hip rotation measures. A significant interaction of gender and stabilization condition was obtained. Women displayed more hip rotation when the TFJ was not stabilized (M = 41.03 degrees , SD = 6.53 degrees ) than when the TFJ was stabilized (M = 35.05 degrees ; SD = 5.12 degrees ). Men displayed no difference in ROM between the two stabilization conditions (not stabilized: M = 39.07 degrees , SD = 4.87 degrees ; stabilized: M = 37.60 degrees , SD = 5.12 degrees ). To avoid measurement error of hip rotation ROM, use of the tibia as a lever to produce passive hip rotation should be used with caution, particularly in women.

PMID: 18075905 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Doppler insonation of vertebral artery blood flow changes associated with cervical spine rotation: Implications for manual therapists.

Physiother Theory Pract. 2007 Nov-Dec;23(6):303-13

Authors: Mitchell J

The controversy related to changes in vertebral artery (VA) blood flow associated with rotation of the cervical spine and the implications for professional practice is still of concern to manual therapists. The aim of this review of the literature is, first, to assess current evidence of altered VA blood flow following cervical spine rotation in persons with and without signs and symptoms of vertebrobasilar ischemia/insufficiency (VBI). Second, any reported, related alterations in blood flow that may have consequences for the individual will be discussed to assist manual therapists in pretreatment risk assessment of patients. The most commonly used noninvasive, in vivo technique for measuring blood flow is Doppler ultrasonography. Of the 88 relevant papers retrieved by a systematic literature search covering the past 50 years, 20 studies reported measurement of VA blood flow related to cervical spine rotation. A critical analysis of these reports revealed that there is no standardization of methods used (heterogeneous samples, small sample sizes, various measurement positions and instruments, and different parts of the VA measured); no consensus of findings (no change, and a significant reduction in contralateral VA blood flow, with or without VBI); and no correlations found between rotation, blood flow, and VBI. Nevertheless, this review is of value in increasing our knowledge of the possible mechanisms and consequences of repeated minor arterial trauma and of blood flow changes related to rotational movements used in cervical manual therapy. It highlights, too, the need for caution in the interpretation of pretreatment risk assessment outcome measures.

PMID: 18075904 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Update on the Journal: Trends over the past 5 years (2002-2007).

Physiother Theory Pract. 2007 Nov-Dec;23(6):301-2

Authors: Hasson S

PMID: 18075903 [PubMed - in process]

(Source: Physiotherapy Theory and Practice)

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Background: Walking sticks are used widely by people with arthritis, principally to reduce pain and improve stability and balance. However, they are frequently used incorrectly and can be dangerous if not properly maintained.Methods: Fifty randomly selected patients attending a rheumatology department were surveyed to determine whether their stick was appropriate to their needs and whether they were using it correctly.Results: Of the 50 patients, 38% used their stick incorrectly, usually in the wrong hand. Forty-four per cent of sticks were of the wrong length and 54% were in imperfect condition, the main defect being a worn ferrule. Among the minority (18 patients) who had received instruction and training, 72% used their stick correctly, while only 50% of those who had not been trained used their stick in the correct hand where applicable to their condition.Conclusions: These findings highlight the importance of educating patients on how to obtain greatest benefit from their walking stick and of the necessity to check it regularly for defects to ensure safe usage. (Source: Musculoskeletal Care)

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Related Articles

Hypermobility and the hypermobility syndrome.

Man Ther. 2007 Nov;12(4):298-309

Authors: Simmonds JV, Keer RJ

Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life. This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes; education and lifestyle advice, behaviour modification, manual therapy, taping and bracing, electrotherapy, exercise prescription, functional rehabilitation and collaborative working with a range of medical, health and fitness professionals. Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.

PMID: 17643337 [PubMed - indexed for MEDLINE]

(Source: Manual Therapy)

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Related Articles

Advice for the management of low back pain: a systematic review of randomised controlled trials.

Man Ther. 2007 Nov;12(4):310-27

Authors: Liddle SD, Gracey JH, Baxter GD

To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of ‘high’ or ‘medium’ methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area. Advice to stay active is sufficient for acute LBP; however, it appears that RCTs do not commonly reflect these recommendations. No conclusions could be drawn as to the content and frequency of advice that is most effective for subacute LBP, due to the limited number and poor quality of RCTs in this area: this review provides preliminary support for advice as part of a back school approach. Given that the effectiveness of treatment for subacute symptoms will directly influence the development of chronicity, these results would suggest that education and awareness of the causes and consequences of back pain may be a valuable treatment component for this patient subgroup. For chronic LBP there is strong evidence to support the use of advice to remain active in addition to specific advice relating to the most appropriate exercise, and/or functional activities to promote active self-management. More investigation is needed into the role of follow-up advice for chronic LBP patients.

PMID: 17395522 [PubMed - indexed for MEDLINE]

(Source: Manual Therapy)

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