Understanding foot motion is pivotal to understanding lower extremity mechanics during gait. The aim of the second Foot and Ankle Research Retreat was to address the issues related to the measurement of foot motion. It was sponsored by the Foot and Ankle Special Interest Group and the Orthopaedic Section of the APTA, along with the Department of Biokinesiology and Physical Therapy at the University of Southern California, and was held this past spring. A variety of different foot models were presented. Issues related to reliability and validity were discussed. New techniques, including the use of gait simulators and fast-PC MRI imaging, were presented. The description of this retreat, along with the abstracts of the presentations and the consensus statement from the participants are included in this issue. It is hoped that, as those interested in measuring foot motion read through these abstracts and the consensus statement, ideas for future research will be generated.

J Orthop Sports Phys Ther. 2004; 34(9):502-503. doi:10.2519/jospt.2004.0109

Key Words: foot motion, lower extemity mechanics, gait

Study Design: Clinical case report. Objectives: To describe a physical therapy program addressing impairments of the upper thoracic and cervical spine region for an individual with a whiplash-associated disorder. Background: A 32-year-old female with complaint of diffuse posterior cervical and upper thoracic region pain was evaluated 2 weeks following a motor vehicle accident. The patient reported that she was unable to sit for longer than 10 minutes or perform household duties for longer than 1 hour. In addition, she was unable to perform her tasks as a postal worker or participate in her customary running and aerobic exercise activities because of pain in the cervical and upper thoracic region. Methods and Measures: An examination for physical impairments was performed, including the measurement of cervical range of motion using the CROM device, and the assessment of soft tissue and segmental mobility of the upper thoracic and cervical spine regions. The Northwick Park Neck Pain Questionnaire was used to assess functional limitations and disability. Manual therapy and therapeutic exercises were applied to address the identified impairments. Manual therapy techniques included soft tissue mobilization, joint mobilization, and joint manipulation. Results: The patient’s cervical range of motion was improved and the disability score improved from 25% to 19.5% 3 days after the initial session addressing the thoracic spine. Following a second session also addressing thoracic spine impairments and the use of therapeutic exercises for 7 days, the disability score improved to 11.1%. At the final visit 17 days following the third visit, which focused on addressing the cervical spine impairments, there was complete resolution of signs and symptoms and disability. Conclusions: Interventions addressing the impairments of the upper thoracic and cervical spine region were associated with reducing pain, increasing cervical range of motion, and facilitating return to work and physical activities in a patient with a whiplash-associated disorder. There is a need for continued research investigating the efficacy of providing interventions to the thoracic spine for patients with whiplash-related injuries.

Invited Commentary by Kathryn Refshauge 

J Orthop Sports Phys Ther. 2004;34(9):511-523. doi:10.2519/jospt.2004.1393

Key Words: manipulation, manual therapy, mobilization, neck, thoracic spine

Study Design: Single-case A1-B-A2 design. Objective: To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. Background: A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. Methods and Measures: Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. Results: Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. Conclusions: The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.

J Orthop Sport Phys Ther. 2004;34(9):535-548. doi:10.2519/jospt.2004.1508

Key Words: jaw, maximal mouth opening, orofacial pain, temporomandibular disorder

This was the second Foot and Ankle Research Retreat sponsored by the Foot and Ankle Interest Group of the Orthopedic Section of the American Physical Therapy Association. It was hosted by the Department of Biokinesiology and Physical Therapy at the University of Southern California and was held April 30 to May 1, 2004. The purpose of this second retreat was to address the measurement of foot motion, focusing on the various foot models that have recently been proposed in the scientific community. Clinicians and scientists with a common interest in the measurement of foot and ankle mechanics attended the retreat. The 40-plus participants included registrants from across the United States as well as Australia, Singapore, and England. A scientific call for abstracts for the retreat was announced in the summer of 2003. All abstracts were then peer reviewed for scientific merit and relevance to the retreat. In the end, 14 abstracts were accepted for podium presentations. These were grouped into sessions addressing multisegment foot models, hindfoot modeling, and new techniques and applications. The format of the 2-day meeting included 1 keynote presentation each day, along with 20-minute podium presentations made by some of the participants. Thirty-minute discussions followed each session and each keynote address. The keynote presenters were chosen for their scientific contributions in the area of measuring foot and ankle motion. Arne Lundberg, MD, PhD, from the Karolinska Institute in Stockholm, Sweden gave the first keynote. Dr. Lundberg is a pioneer in the area of measuring multisegment foot motion, and his address was titled ‘‘The Ankle/Foot Complex: Solid Block, Gearbox or Cushion?’’ The second keynote presenter was Neil Sharkey, PhD, from The Pennsylvania State University. Dr. Sharkey developed one of the first gait simulators, and he presented his research in a keynote titled ‘‘One Step at a Time: Lessons Learned from Cadaver Simulation of Locomotion.’’ In this special report, you will find a consensus statement, a listing of the presentations and authors, and an abstract of each of the presentations made at the conference.

J Orthop Sports Phys Ther. 2004;34(9):A1-A18. doi:10.2519/jospt.2004.0302

Key Words: foot and ankle motion, measurement, multisegment foot models, hindfoot models