Abstract: Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30N force was applied 1000 times to the lateral malleolus at a speed of 15N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 time…

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Kinesio Taping was a technique developed by Dr. Kenzo Kase in the 70s. The adhesive pliable material, directly applied to the skin, differs from classical tape in its physical characteristics. Furthermore, its clinical application departs from the usual restriction of mobility. This technique claims four effects: to normalize muscular function, to increase lymphatic and vascular flow, to diminish pain and aid in the correction of possible articular malalignments (). This taping technique is frequently applied for pathologies in the musculoskeletal system, especially in the field of sports injuries (). (Source: Manual Therapy)

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CONCLUSION: This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule.
PMID: 19681741 [PubMed - indexed for MEDLINE] (Source: Aust J Physiother)

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My colleague presented a wonderful collection of rehab Haikus at our last staff meeting. I work at a Planetree hospital and the start of our staff meetings always have a reminder of how we can help beyond PT/OT/ST and treat the person as a whole. My colleague has generously allowed be to reprint these for you all here. They are about - in order - OT, ancillary staff, PT, and ST.

OT with sock aid
ADLs begin the day
Patient dressed,
refreshed

Crisp morn, charts askew
Efficient fingers, phone
shrill
Calm restored . . . coffee

PT smiles, enters
Strenuous
protests occur
Patient ambulates

Teary eyes, cough,
gag
Silent aspiration beware
Mechanical soft

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Dear Orthopaedic Section Member,

The Orthopaedic Section mourns the loss of Richard Erhard, PT, DC, who
passed away Sunday, October 3, 2009 after a long battle with cancer. Dr.
Erhard was a colleague, a teacher, a researcher, a mentor, and a friend to many
in the Orthopaedic Section. Dr. Erhard was a world-renown manual physical
therapist and he taught and lectured extensively throughout the United States
and internationally. His work has been instrumental in development
clinical prediction rules and clinical practice guidelines for low back
pain.

Dr. Erhard’s contributions to the clinical practice of orthopaedic physical
therapy were recognized by the Orthopaedic Section with the establishment of the
Bowling-Erhard Clinical Practice Award. Dr. Erhard and Richard Bowling
were honored as the first recipients of this award during the 2007 Combined
Sections Meeting in Boston, Massachusetts. Dr. Erhard elevated the
physical therapy profession through his work, his mentorship and his friendship
and he will be greatly missed.

A viewing will be held Thursday, October 8 from 2-4 pm and 6-9 pm and
Friday October 9 at 10:00 AM with funeral to follow at the John S. Maykuth Jr.
Funeral Home, 7 River Ave, Masontown, PA 15461-1959.

A memorial service will also be held at Heinz Chapel at the University of
Pittsburgh on October 16th from 10:00 to 11:00 AM. A reception will follow
at the Holiday Inn in Oakland. Please contact Tina Fuller at tfuller@pitt.edu or call 412-383-6579 to
RSVP.

Cards and condolences may be sent to Natalie Erhard, PO Box 424, 145
Messick Lane, Lottsburg, VA 22511

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According to the results of a subgroup analysis, treatment with raloxifene safely increases bone mineral density (BMD) in postmenopausal women with chronic kidney disease and cuts the risk of vertebral fractures.

While patients with chronic renal disease are known to be at increased risk for bone loss, women with elevated creatinine levels are usually excluded from trials of osteoporosis drugs, according to the report in the April 9th online issue of the Journal of the American Society of Nephrology.

The authors note that the majority of clinical trials evaluating pharmacological therapies in preventing fractures in postmenopausal women have excluded those with renal impairment. It is therefore uncertain whether the beneficial effects of osteoporosis therapy extend to those with kidney disease, and whether such therapies are safe in this patient population. They therefore used data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial to examine the efficacy and safety of raloxifene in risk subgroups defined at baseline according to presence and severity of chronic kidney disease (CKD).

MORE was a multicentre, international placebo controlled trial of the effects of raloxifene on BMD and fracture incidence in postmenopausal women over three years (n=7316). Baseline serum creatinine values were used to assign participants to a category of creatinine clearance (calculated using Cockcroft-Gault formula). Among the cohort, 1480 (20%) had a CrCl of <45 ml/min, 3493 (48%) had a CrCl of 45 to 59 ml/min, and 2343 (32%) had CrCl =60 ml/min. Among the women with a CrCl <45 ml/min, only 55 had a CrCl <30 ml/min, and the lowest was CrCl 20.0 ml/min. There were several differences in baseline characteristics across categories of CrCl; e.g. women with lower CrCl were more likely to be older and more years postmenopausal; to have a lower body mass index (BMI); to have a lower baseline BMD and to have prevalent fractures. BMD was measured at baseline and then annually with dual x-ray absorptiometry (DEXA).

The main findings were as follows:

• In the placebo group, a lower CrCl at baseline correlated with higher annual losses of BMD at the femoral neck, but this trend did not reach statistical significance (p=0.09). In the raloxifene group, lower CrCl at baseline correlated with greater increases in the femoral neck BMD (P=0.01 for trend).

• Compared with placebo, the effect of raloxifene on increasing femoral neck BMD was 1.0% per year among women with a CrCl <45 ml/min, 0.7% per year among women with a CrCl of 45 to 59 ml/min, and 0.6% per year among women with a CrCl =60 ml/min (P <0.001 for all comparisons between pooled raloxifene treatment group and placebo group).

• Raloxifene was associated with an overall decrease in the incidence of vertebral fractures (odds ratio [OR] 0.57; 95% CI 0.47 to 0.69), and there was no evidence that this effect differed according to CrCl at baseline. In addition, the effect of raloxifene on rate of change in spine BMD did not differ according to renal function.

• Women with reduced kidney function overall were more likely to experience one or more serious adverse effects and to discontinue the study permanently as a result of an adverse event; however, the rates of adverse events were similar between the raloxifene and placebo groups within each category of kidney function.

The authors conclude that their results support the use of raloxifene as a safe and effective means to increase BMD and prevent vertebral fractures in postmenopausal women with osteoporosis and compromised kidney function. [Editor’s note: as this was a subgroup analysis, the findings need to be confirmed in a prospective trial adequately powered to test this].

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