Research Report
Mark Brown, Elizabeth Ricker, Peter Altenburger, Janet Tompkins, Kathryn E. Roach
Even when a patient is referred by a physician, the physical therapist must remain alert to the possibility that the patient may require medical care outside the realm of physical therapy. Physical therapists must be able to screen low back pain patients to identify those who have serious low back problems that require additional diagnostic evaluation and treatment by a physician. It is important for physical therapists to know which symptoms and signs or combination of symptoms and signs best indicate the likelihood of a serious problem. The purpose of this study was to test the sensitivity and specificity of low back pain symptoms in distinguishing individuals with a benign low back problem from those requiring surgical or medical intervention. Demographic and clinical data were collected retrospectively from a standardized low back pain questionnaire located in the medical records of 174 low back pain patients. Patients were classified as having a benign low back problem (N = 41) or a serious low back problem (N = 133) based on surgical findings or long-term follow-up. Some individual symptoms had high specificity, but none had high sensitivity. To improve sensitivity while attempting to maintain moderate specificity, a number of symptoms were considered in parallel. The highest combination of sensitivity (.87) and specificity (.50) was obtained by combining in parallel the symptoms of unable to sleep, awakened and unable to fall back to sleep, medication required to sleep, and pain worsened by walking.
J Orthop Sports Phys Ther. 1995;21(1):2-6.
Key Words: screening, low back pain, clinical decision-making
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Research Report
Frank M. Ambrosius, Anne M. Kremer, Peter B. Herkner, Mark DeKraker, Steve Bartz
Low back pain is both common and costly. A paucity of information exists within the literature comparing workers' compensation and noncompensation back-injured individuals. The intent of this study was to examine differences between the two groups – individuals injured and seeking compensation, and injured individuals not pursuing a compensation claim. Sixty subjects referred to a functional restoration facility were identified and evaluated, and their progress was tracked. Demographic and return-to-employment data were collected. Of the 35 workers' compensation subjects, 23 (65.71 %) were not working during therapy, while only 1 of 25 noncompensation individuals was not working throughout treatment. Thirty-two compensation individuals (91 %) and all of the noncompensation group members made successful returns to employment (p = .05). The authors conclude that while some differences existed between the 2 groups, a high return-to-work frequency was achieved (91 %) (p = .05). Results indicate high success outcomes as measured by return-to-work, increased function, and reduced pain. These outcomes were obtained through highly structured, medically supervised functional restoration programs.
J Orthop Sports Phys Ther. 1995;21(1):7-12.
Key Words: functional restoration, low back pain, medical management
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Research Report
James W. Youdas, Vera J. Suman, Tom R. Garrett
Presently, there is no available scientific information that examines the interchangeability of tangent and trigonometric methods used to calculate measurements of sagittal mobility of the lumbar spine obtained with a flexible curve. Repeated measurements of the lumbar curvature were made with a flexible curve by using a standardized protocol on 10 healthy volunteers under 3 conditions: 1) standing, 2) sitting with maximum trunk forward bending, and 3) lying prone with maximum backward bending. A team of 2 physical therapists working together made measurements; one therapist instructed the subject, and the other therapist performed the measurement. Agreement between the tangent and trigonometric methods was assessed graphically by plotting the difference between methods against the mean value of each pair of readings for each of the 3 conditions. Measurements differed by 4° to 7° for each of the 3 positions of the lumbar spine. We believe such error is clinically acceptable and should not affect the clinical decision made on the basis of the measurement.
J Orthop Sports Phys Ther. 1995;21(1):13-20.
Key Words: lumbar spine, reliability, range of motion
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Research Report
Ellen Hansen Guth
Physical therapists routinely compare range of motion measurements with the opposite side and/or with a standard for "normal" range. However, "normal" range may vary in relation to the individual's occupational and recreational movement patterns. The purposes of this study were 1) to compare the range of active physiological cervical rotation in 14- to 17-year-old male competitive swimmers (N = 40) and controls (N = 40) and 2) to investigate the relationship between the freestyle stroke breathing pattern and differences in right and left cervical rotation in swimmers. Analysis of variance determined if a group difference existed in goniometric measurement of cervical rotation. The experimental group demonstrated a significantly greater mean range of total active cervical rotation right (p = 0.002) than the control group. Swimmers also demonstrated a significantly greater (p = 0.0002) range of rotation on their breathing side (x¯ difference of 5°). It was concluded that the differences in physiological cervical rotation between swimmers and nonswimmers and between sides in the swimmers were influenced by the swimming activity. The clinician needs to consider the influence of activity when assessing range of motion.
J Orthop Sports Phys Ther. 1995;21(1):21-27.
Key Words: cervical spine, swimming, range of motion
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Clinical Commentary
Helen W. M. Lee
Shoulder injuries are common among athletes involved in repetitive overhead arm movements, particularly baseball pitchers and tennis players. Due to the similarities between pitching and serving, both athletes often present with similar types of shoulder injuries. However, subtle differences in neck and shoulder movements between the pitcher and tennis player may be responsible for additional mechanisms of injuries specific to tennis players. This paper outlines the similarities and differences between the pitch and serve and discusses how these differences may relate to additional neck and/or shoulder injuries specific to tennis players. In the analyses of mechanisms of injuries sustained by tennis players, such detailed analyses of movement patterns occurring during the serve may optimize a clinician's sports-specific rehabilitation protocol.
J Orthop Sports Phys Ther. 1995;21(1):28-37.
Key Words: neck injuries, shoulder injuries, tennis
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Clinical Commentary
Matthew J. Mitten, Robert J. Mitten
This article is intended to inform physical therapists about legal considerations impacting the practice of sports physical therapy. Our objective is to generate an awareness of these issues to enhance the quality of physical therapy provided to injured athletes and to minimize potential legal liability. Three areas in which physical therapists who treat injured athletes need to be particularly careful are: 1) providing treatment designed to enable continued play with an injury before it is fully healed, 2) informing an athlete of the potential health risks of continued athletic activity in his or her physical condition, and 3) evaluating and advising an athlete concerning his or her ability to resume athletic activity. Based on the parallels between industrial rehabilitation and sports physical therapy, the authors propose that consensus objective criteria and guidelines should be established to assist therapists in advising referring physicians and athletes whether return to play is appropriate under the circumstances.
J Orthop Sports Phys Ther. 195;21(1):38-43.
Key Words: legal liability, sports, therapist, return to play
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