The polio epidemic was one of the most influential factors to transform a profession of revered ‘‘reconstruction aides'' of the First World War era (such as the honorable Mary McMillan) to a profession of physical therapists as recognized today. From the design of the Hubbard tank to the evolution of manual muscle testing, our response to treating persons with polio has left many permanent impressions on the practice of physical therapy, both technical and philosophical. My recent historical adventure compelled me to share this story through a contribution titled, Polio: Its Impact on the People of the United States and the Emerging Profession of Physical Therapy, published in this month's Journal.

J Orthop Sports Phys Ther. 2004; 34(8):428-429. doi:10.2519/jospt.2004.0108

Key Words: polio, physical therapy, profession

Study Design: Repeated-measures analysis of intervention. Objectives: To determine the effects of foot orthoses on quality of life for individuals with patellofemoral pain who demonstrate excessive foot pronation. Background: Foot orthoses are a common intervention for patients with patellofemoral pain. Limited information is available, however, regarding the effects of foot orthoses on quality of life for these patients. Methods and Measures: Sixteen subjects with patellofemoral pain who also exhibited signs of excessive foot pronation were studied. Subjects underwent a 2-week period of baseline study followed by custom foot orthotic intervention. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was administered to subjects at the time of screening, just prior to foot orthotic intervention, and at 2 weeks and 3 months following foot orthotic intervention. Results: Wilcoxon matched-pairs signed-rank test results indicated statistically significant improvements in the pain and stiffness subscales 2 weeks following the start of foot orthotic intervention. All WOMAC subscale scores were significantly improved at 3 months compared with preintervention measurements. Conclusions: Custom-fitted foot orthoses may improve patellofemoral pain symptoms for patients who demonstrate excessive foot pronation.

J Orthop Sports Phys Ther. 2004;34(8):440-448. doi:10.2519/jospt.2004.1384

Key Words: biomechanics, knee pain, physical function, stiffness

Osteoarthritis of the hip is a common condition physical therapists see in the clinic. The fundamental radiological and pathological characteristic of osteoarthritis of the hip is joint space loss. Consequently, the best radiological criterion used to detect osteoarthritis of the hip is by measuring joint space width. Because most physical therapists do not have immediate access to radiographs and do not have the ability to order radiographs, they must either rely on a physician to order a hip radiograph or rely on a clinical method to diagnose osteoarthritis of the hip. Radiographs, though usually helpful in the diagnosis of severe hip osteoarthritis, are not always beneficial in the diagnosis of mild or moderate hip osteoarthritis. In patients with severe hip osteoarthritis, radiographs usually show joint space narrowing, subchondral sclerosis, or osteophytes. However, patients with early osteoarthritis often do not show these kind of radiographic changes. Thus, relying only on radiographs to determine osteoarthritis of the hip, especially in patients with early or mild hip osteoarthritis, can result in false-negative diagnosis. Using the clinical presentation (signs and symptoms) along with imaging findings will likely improve the diagnosis of osteoarthritis of the hip. The ability to clinically determine osteoarthritis of the hip without a radiograph, especially in early cases, would be valuable to many clinicians, not just physical therapists. Finding a clinical method to detect osteoarthritis of the hip would give physical therapists an opportunity for early intervention. Early intervention may improve the chance of clinical success. A number of studies have suggested using a clinical method to diagnose hip osteoarthritis. Studies by Altman et al, Birrell et al, and Bierma-Zienstra et al have recommended using clinical variables, such as pain location or duration, hip range of motion, age, or aggravating movement. Among the different clinical criteria, diminished hip range of motion is the most common component used to indicate the presence of hip joint osteoarthritis. Using hip motion to diagnose hip problems is not new. Many studies have shown the relationship between different hip conditions and diminished hip motion. For example, osteoarthritis of the hip has been linked to patients with femoral neck retroversion, where hip external rotation is increased while hip internal rotation is limited. In osteoarthritis of the hip, the first 2 motions that are diminished are usually hip internal rotation and hip flexion. The purpose of this paper is to describe how we made a clinical diagnosis of osteoarthritis of the hip in a patient with diminished hip range of motion and hip pain.

J Orthop Sports Phys Ther. 2004;34(8):461-467. doi:10.2519/jospt.2004.1313  

The original article was corrected in September 2007, and the amended article PDF is provided here. Please see Correction: Altman's criteria for osteoarthritis of the hip and knee. J Orthop Sports Phys Ther. 2007; 37(9):573.

Key Words: osteoarthritis, hip motion, hip pain, radiograph

Admittedly, it may appear incongruous that a review of a disease that infected the nervous system of persons in the first half of the twentieth century would appear in the Journal of Orthopaedic & Sports Physical Therapy at the start of the twenty-first century. As will be described, however, most of the physical therapy procedures developed during the polio epidemic involved muscles and their interaction with the skeletal system. Many of the treatments and rehabilitation philosophies created during this time are still very evident today. The ‘‘polio days’’ presented an enormous challenge and an equally enormous opportunity for the budding profession of physical therapy.

Much of the growth had to do with timing. Managing the rehabilitation of hundreds of thousands of persons, many in the prime of their own lives or careers, required just the services that a physical therapist could potentially provide. In essence, the polio epidemic created a unique void in the medical arena—a void that was filled by the rapid expansion of the profession of physical therapy.

A full appreciation of the impact that the polio epidemic had on the profession requires a history lesson of the many interrelated and concurrent events that transpired in this country between 1916 and 1955. Within these turbulent times, the United States experienced 2 world wars, the Great Depression, the Korean War, and the insidious rise and swift fall of the polio epidemic—one of the most significant public health epidemics ever to strike the United States. For more than 2 decades leading up to the success of the Salk vaccine in 1955, the treatment and care of persons with polio dominated virtually every aspect of the physical therapy profession.
The full story of how the growth, politics, philosophy, and even ‘‘personality’’ of physical therapy were shaped by the interactions between physical therapists and those infected by polio has been well chronicled. Two notable works are a recent article by Dr Marilyn Moffat and a very well presented text, Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, by Ms Wendy Murphy. This present historical review, intentionally less global than the aforementioned works, focuses more on the poliovirus itself, its impact on those it infected, and, most importantly, on several important lessons and benefits gained by the profession’s steadfast involvement with the epidemic.

J Orthop Sports Phys Ther. 2004;34(8):479-492. doi:10.2519/jospt.2004.0301

Key Words: polio, physical therapy