Study Design: Intrarater and interrater reliability.

Objectives: Examine intrarater and interrater reliability of the resisted-testing component of Cyriax’s selective tension testing for patients with painful shoulders and knees.

Background: Clinicians make diagnostic and intervention decisions about lesions in contractile tissues based on resisted testing. Diagnostic and intervention decisions require reliable data gathering, especially when more than 1 physical therapist manages a patient. No studies have examined agreement of the results of the resisted tests used in selective tension testing, either within or between physical therapists, in subjects having pathology.

Methods and Measures: Subjects with pain in 1 knee (18 male, 22 female; mean age ± SD = 31.8 ± 9.5 years) or shoulder (21 male, 25 female; mean age ± SD = 34.3 ± 12.9 years) were examined twice. Referring diagnoses included ligament injuries, overuse syndromes, joint instability, and postsurgical symptoms, with some subjects seeking initial diagnosis. Two physical therapists used standardized positions to evaluate 2 knee motions or 6 shoulder and elbow motions. Evaluators applied maximal isometric manual resistance and rated the contraction as strong or weak while subjects identified the presence or absence of pain during the contraction. Evaluators did not interview the subjects and were masked to previous test results. Analyses included percentage of agreement, kappa coefficients, confidence intervals, and maximum kappa coefficients.

Results: Intrarater kappa coefficients ranged from 0.44 to 0.82 and interrater coefficients ranged from 0.00 to 0.46. The small number of subjects who were classified as weak affected the kappa coefficients. In the intrarater condition, evaluators averaged 91% of maximum kappa for the knee and 66.5% for the shoulder. In the interrater condition, they averaged 60.4% of the maximum kappa for both the knee and the shoulder.

Conclusions: Based on 2 physical therapist evaluators with previous education in the selective tension system and an additional 6 hours of formal training on the methods, intrarater reliability of resisted tests was generally acceptable for the knee but not for the shoulder. Interrater reliability of these tests, however, was generally not acceptable. Results were limited by subjects who were younger and had mostly chronic conditions that were mildly to moderately severe and by the small subject samples in the analyses. Reliability might be improved by more intensive training of the evaluators and by standardizing the magnitude of the applied resistance and stabilization of the subjects.

J Orthop Phys Sports Ther. 2003;33(5):235-246.

Key Words: orthopedics, physical therapy, tests and measurements

Study Design: This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and serratus anterior muscles.

Objective: To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and serratus anterior muscles.

Background: The trapezius and serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises.

Methods and Measures: Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and serratus anterior muscles during 10 exercises in 30 healthy subjects.

Results: The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapezius, the greatest EMG amplitudes were generated with 2 exercises: shoulder horizontal extension with external rotation and the overhead arm raise in line with the lower trapezius muscle in the prone position. The arm raise overhead exercise in the prone position produced the maximum EMG activity in the lower trapezius. The serratus anterior was activated maximally with exercises requiring a great amount of upward rotation of the scapula. The exercises were shoulder abduction in the plane of the scapula above 120° and a diagonal exercise with a combination of shoulder flexion, horizontal flexion, and external rotation.

Conclusion: This study identified exercises that maximally activate the trapezius and serratus anterior muscles. This information may be helpful for clinicians in developing exercise programs for these muscles.

J Orthop Sports Phys Ther. 2003;33(5):247-258.

Key Words: scapula, shoulder, strength, upper extremity

The purpose of this paper is to review relevant literature concerning limb length inequalities in adults and to make recommendations for assessment and intervention based on the literature and our own clinical experience. Literature searches were conducted in the MEDLINE, PubMed, and CINAHL databases. Limb length inequality and common classification criteria are defined and etiological factors are presented. Common methods of detecting limb length inequality include direct (tape measure methods), indirect (pelvic leveling), and radiological techniques. Interventions include shoe inserts or external shoe lift therapy for mild cases. Surgery may be appropriate in severe cases. Little agreement exists regarding the prevalence of limb length inequality, the degree of limb length inequality that is considered clinically significant, and the reliability and validity of assessment methods. Based on correlational studies, the relationship between limb length inequality and orthopaedic pathologies is questionable. Stronger support for the link between low back pain (LBP) and limb length inequality is provided by intervention studies. Methods involving palpation of pelvic landmarks with block correction have the most support for clinical assessment of limb length inequality. Standing radiographs are suggested when clinical assessment methods are unsatisfactory. Clinicians should exercise caution when undertaking intervention strategies for limb length inequality of less than 5 mm when limb length inequality has been identified with clinical techniques. Recommendations are provided regarding intervention strategies. J Orthop Sports Phys Ther. 2003;33(5):221-234. Key Words: assessment, leg length discrepancy, leg length inequality, treatment, unequal leg lengths