This paper was submitted in response to the clinical commentary entitled "Diagnoses Enhances, Not Impedes, Boundaries of Physical Therapy Practice" (JOSPT 13(5):218-219).

We have read with interest and respect the clinical commentary by Behr et al (1) regarding boundaries of physical therapy practice. Their review of "Pathological Origins of Trunk and Neck Pain-Parts I (2), II (3), III (4)" reflects some philosophical similarities and differences regarding the physical therapist's role in the differential diagnosis process.

We believe that physical therapists should include a medical screening component in their examinations. This screening is a necessary adjunct to history and physical examination components, which are designed to identify mechanical dysfunction(s) related to patients' symptoms and/or functional limitations. The Review of Systems Checklists (Tables 5-10, Part I) (2) present items designed to screen a body system (i.e. gastrointestinal system) for general pathology. The checklists are NOT designed for screening specific diseases-such as peptic ulcer, cholecystitis, pancreatic cancer, or hepatitis. "Yes" responses should prompt therapists to refer their patient to a physician. This is clearly stated in the forward (5) and the subsequent articles (2-4).

J Orthop Sports Phys Ther 1991;14(6):241-242.

This project was supported in part by a grant from The Foundation for Physical Therapy, 1111 North Fairfax Street, Alexandria, VA 22314

Foreshortened hamstring muscles have been associated with various clinical disorders. This study examined the effects of three weeks of daily static stretching of short hamstrings on passive straight leg raising (SLR), maximal hamstring length (MHL), and their maximal resistance to passive stretch (MRPS). Twenty-four healthy men (18-37 yrs) with SLR ≤ 70° were assigned randomly to a stretching group (N = 12) or a control group (N = 12). All subjects were positioned on their left sides with the pelvis stabilized and the right thigh fixed at 90° on a horizontal platform. The right knee was then passively extended until amplified EMG activity (>50 μV) from the hamstrings was observed. The knee angle represented MHL, and MRPS (torque in nm) was calculated. Subjects in the stretching group completed daily static stretching of the hamstrings for three weeks. After three weeks, SIR increased for the stretching group, but not for the control group (< 0.001). The knee angle for the stretching group was less than the control group (p < 0.001), and the MRPS for the stretching group exceeded the control group (p < 0.05). The results indicated that static stretching increased SLR with concomitant increases in the MHL and the MRPS. The results also support using SLR as a valid clinical test for measuring hamstring length changes resulting from therapeutic interventions.

J Orthop Sports Phys Ther 1991;14(6):250-255.

Key Words: passive stretch, electromyography, hamstring muscles

Leg length inequalities result from a variety of clinical abnormalities. The purpose of this study was to compare repeated leg length measurements taken by two examiners with two devices during a single session. The two devices that were used were a standard tape measure and a Metrecom. Since reliability coefficients do not fully describe the comparability of measurements, ANOVAs were used to describe differences, and Pearson correlations were used to describe relationships between measurements of leg length obtained by the two examiners using the two instruments. Results of the study showed that although reliability and correlation coefficients are high between testers and devices, significant differences in measurements exist between both testers and devices. The measures found to be most comparable were those taken by one examiner using one device. The authors concluded that for clinical purposes, the tape measure may be the more practical device based on its price. It was theorized, however, that in cases of asymmetry or orthopaedic deformity, the accuracy of the Metrecom may be superior.

J Orthop Sports Phys Ther 1991;14(6):263-268.

Key Words: leg length inequality, linear measurement, evaluation of methods

Index by subject of all manuscripts published by the Journal from July through December 1991.