Research Report
John V. Chidley, Evangeline Yoder, John A. Buford, Deborah Givens Heiss
Study Design: Multiple single-subject design in 2 parts: 1 in anesthetized monkeys and a follow-up in human cadavers.
Objectives: To determine whether anterior, middle, and posterior scalene muscles rotate the cervical spine to the same (ipsilateral to the muscle) or opposite (contralateral to the muscle) side.
Background: Some physical therapy and anatomy textbooks indicate that all 3 scalenes rotate the cervical spine to the same side, some indicate that all rotate to the opposite side, and the rest ascribe different functions to the different scalenes.
Methods and Measures: While under anesthesia, macaques (n = 3) already scheduled for euthanasia were implanted with stimulating electrodes in each scalene muscle on one side, and then a neuromuscular junction blocker was administered to prevent confounding movement from brachial plexus stimulation. Three observers independently rated the direction of rotation produced by electrical stimulation. Postmortem dissection of the macaques was used to determine which direction of passive rotation stretched each scalene. Postmortem analyses in 2 human cadavers were also conducted to determine which direction of rotation stretched the human scalenes.
Results: Electrical stimulation in the macaque produced rotation to the same side for each of the 3 scalenes. Passive rotation to the opposite side put each scalene muscle of the macaque on stretch. In the human, rotation to the opposite side also stretched each scalene.
Conclusions: All 3 scalene muscles produce rotation of the cervical spine to the same side. Maximum stretching of the scalenes should include rotation to the opposite side.
J Orthop Sports Phys Ther 2002;32(10):488–496.
Keywords: electrical stimulation, stretching, thoracic outlet syndrome
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Research Report
Steven C. Andrews, Gregory F. Martel, Christopher G. Roseboom
Study Design: Prospective, randomized, double-blind, placebo-controlled crossover design.
Objectives: To examine the effects of static magnets on resting forearm blood flow and vascular resistance.
Background: Despite little scientific evidence indicating benefits of wearing static magnets, recent reports have indicated a dramatic increase in the usage of magnets to treat a variety of medical conditions. Magnet manufacturers have proposed that one mechanism for pain reduction involves magnet-related blood flow alterations to the affected area.
Methods and Measures: Twenty young, healthy men (mean age ± SD = 25 ± 2 years) wore commercially available static magnets and placebos for 30 minutes on 2 separate occasions. Resting forearm blood flow was assessed in triplicate at minutes 10, 20, and 30, using venous occlusion plethysmography. Forearm vascular resistance was estimated by dividing mean arterial pressure by blood flow.
Results: The average blood flow over the 30-minute measurement period was not significantly different between the magnet and placebo sessions (mean ± SD for magnet session = 1.40 ± 0.63 ml blood × 100 ml tissue-1 × min-1; mean ± SD for placebo session = 1.36 ± 0.46 ml blood × 100 ml tissue-1 × min-1; P = 0.66). Blood flow measurements at minutes 10, 20, and 30 were also not significantly different between the magnet and placebo sessions, and forearm vascular resistance was not different between the magnet and placebo sessions at any time (P >0.05).
Conclusion: Exposure to static magnets for up to 30 minutes had the same effect on resting forearm blood flow and vascular resistance as placebo magnets. These data suggest that static magnets do not result in significant alterations in resting blood flow.
J Orthop Sports Phys Ther. 2002; 32(10):518–524.
Key Words: magnet therapy, pain management, venous occlusion plethysmography
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Research Report
Carl Gabbard, Susan Hart
Study Design: A repeated-measures design was used to compare finger-tapping performance (hand functional control) across 4 standing and sitting conditions of limb body support postures.
Objectives: The intent was to examine the hypothesized hemispheric control interference effects of lower limb body support postures on finger-tapping performance. A secondary objective was to gain a better understanding of the relationship between lower limb posture and concurrent finger-tapping activity.
Background: In a task such as kicking a ball with the right foot, foot control theory suggests that the left hemisphere contralaterally controls right-foot kicking action. However, it can also be interpreted that the postural support (with the left foot in this example) involving the action of antigravity muscles (leg extensors) is driven ipsilaterally. Based on this explanation, we would expect a hemispheric effect to occur during standing on the left limb while performing a finger-tapping task with the right hand. This study has theoretical and clinical significance for understanding hemispheric and functional control of limbs, which may underlie the assessment of movement control and the development and use of therapeutic interventions that can potentially improve functional movement control.
Methods and Measures: Ninety-eight (98) adult participants (ages 19 to 32 years) performed a finger-tapping task in 4 postural conditions: seated, standing on both feet, standing on the right foot only (RF), and standing on the left foot only (LF).
Results: As predicted, manual performance was significantly slower in the LF condition as compared to the standing and sitting positions. However, when comparing performance between the LF and RF conditions, the difference was minimal.
Conclusions: Although support for the ipsilateral effect was not found, postural position did influence manual performance.
J Orthop Sports Phys Ther. 2002; 32(10):525–529.
Keywords: foot dominance, laterality, motor control
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Research Report
Patrick D. Meek, William G. Boissonnault
Study Design: Prospective, multicenter, observational research study.
Background: Minimal research exists that describes the potential for serious gastrointestinal complications in individuals receiving outpatient physical therapy care.
Objective:To identify the prevalence of risk factors for gastrointestinal complications induced by anti-inflammatory drugs or aspirin in individuals receiving outpatient physical therapy services.
Methods and Measures: A self-administered questionnaire was used at 65 ambulatory physical therapy clinics to document past medical history, history of present illness, and medication use. Risk factors for anti–inflammatory-drug- or aspirin-induced gastrointestinal complications were identified and the proportion of patients reporting each factor was determined.
Results: A total of 2433 patients completed the survey. Of the 2311 evaluable patients included in the study, 78.6% reported over-the-counter or prescribed use of an anti-inflammatory drug or aspirin during the week prior to the survey. Forty-nine percent of the patients reported at least 1 risk factor for drug-induced gastrointestinal complications, while 12.9% reported 2 or more risk factors. The most frequently reported established risk factors among anti-inflammatory drug or aspirin users were (1) combination (dual) therapy (22.3% reported concomitant use of anti–inflammatory and aspirin therapy), (2) advanced age (15.7% were over the age of 61 years), (3) history of peptic ulcer disease (7.8% had a history of peptic ulcer disease), and (4) significant systemic illness (6.8% reported having rheumatoid arthritis or heart disease). A frequently encountered risk factor combination was advanced age with a history of peptic ulcer disease (12.7%).
Conclusions: Patients seen at physical therapy ambulatory clinics present with multiple risk factors for anti–inflammatory-drug- or aspirin-induced gastrointestinal complications and provide a potential opportunity for risk reduction by clinicians working in this environment.
J Orthop Sports Phys Ther. 2002; 32(10):510–517.
Keywords: anti–inflammatory drug, aspirin, gastrointestinal complications, physical therapy
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Clinical Commentary
Mary Callanan, Kimberley Hayes, George A. C. Murrell, Anastasios Paxinos, Judie Walton
Shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and sixth decades. The majority (98%) of traumatic dislocations are in the anterior direction. The most frequent complication of shoulder dislocation is recurrence, a complication that occurs much more frequently in the adolescent population. The static (predominantly capsuloligamentous and labral) and dynamic (neuromuscular) restraints to shoulder instability are now well defined. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability. This paper reviews the nonoperative treatment and the postoperative management of patients with various classifications of shoulder instability. J Orthop Sports Phys Ther. 2002; 32(10):497–509.
Keywords: dislocation, muscle control, pathogenesis, recurrence, surgery
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