Study Design: A double-blind randomized crossover experimental study with repeated measures, including a no-treatment control condition.
Objective: To evaluate the initial effect of 2 mobilization with movement (MWM) treatment techniques performed in weight bearing and non-weight bearing on posterior talar glide and talocrural dorsiflexion in individuals with recurrent lateral ankle sprain.
Background: MWM treatment techniques are commonly used in the treatment of musculoskeletal pain, such as lateral ankle sprain. Recent evidence indicates that a lack of posterior talar glide and weight-bearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains. MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. The recurrent ankle sprain injury and the MWM treatment techniques for the ankle seemingly provide an appropriate model to further evaluate the effects and mechanism(s) of action of the MWM treatment techniques in a way that they have not been tested to date.
Methods: Sixteen subjects (mean ± SD age, 19.8 ± 2.3 years) with a history of recurrent lateral ankle sprain and deficits in posterior talar glide (71%) and weight-bearing dorsiflexion (34%) were studied. A within-subjects study design was used to evaluate the effect of 2 independent variables: treatment conditions (weight-bearing MWM, non–weight-bearing MWM, and a no-treatment control group) and time (pretreatment and posttreatment) on the dependent variables of posterior talar glide and weight-bearing dorsiflexion.
Results: Both the weight-bearing and non–weight-bearing MWM treatment techniques significantly improved posterior talar glide by 55% and 50% of the preapplication deficit between affected and unaffected sides, respectively, which was significantly greater than that of the control group (P<.001). The weight-bearing and non–weight-bearing MWM treatment techniques improved weight-bearing dorsiflexion by 26% (P<.017), compared to 9% for the control condition. The change in posterior talar glide, expressed as a proportion of pretreatment deficit, was correlated to the change in weight-bearing dorsiflexion (r = .88, P<.001), but only after the weight-bearing MWM technique.
Conclusion: This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glide and dorsiflexion range of motion in individuals with recurrent lateral ankle sprain. These results suggest that this technique should be considered in rehabilitation programs following lateral ankle sprain. This study provides justification for follow-up research of the long-term effects of MWM on lateral ankle sprain and proposes further work be conducted on the posterior talar glide test. 

J Orthop Sports Phys Ther. 2006;36(6):464-471. doi:10.2519/jospt. 2006.2265

Key Words: inversion ankle sprain, positional fault, physical therapy

Study Design: Case control group study.
Objectives: To compare scapular position and orientation between baseball players with and without pathologic internal impingement.
Background: Scapular dysfunction has been implicated as a contributor to throwing-related pathologic internal impingement of the shoulder due to its role in increasing the contact between the greater tuberosity and posterior-superior glenoid, thereby impinging the posterior rotator cuff tendon(s) and labrum. However, to date, no definitive data demonstrate this scapular dysfunction in throwing athletes. The purpose of this study was to assess, in a controlled laboratory environment, whether scapular position and orientation would be different in throwing athletes diagnosed with pathologic internal impingement than in a control group of throwing athletes.
Methods and Measures: Eleven throwing athletes diagnosed with pathologic internal impingement, using both clinical examination and a magnetic resonance arthrogram, were demographically matched with a control group of 11 throwers with no history of upper extremity injury. An electromagnetic tracking device was used to measure scapular internal/external rotation, anterior/ posterior tilt, upward/downward rotation, sternoclavicular protraction/retraction, and elevation/ depression during humeral elevation within the scapular plane. Comparisons were made between groups with analysis of variance models (P<.05).
Results: The individuals in the pathologic internal impingement group demonstrated statistically significant increased sternoclavicular elevation when elevating their humerus from 30° to 120° (P = .002) and from 60° to 120° (P = .003), compared to the control group. Furthermore, these patients also had increased posterior scapular tilt position (P = .016). No statistically significant differences were present in any other scapular variables measured.
Conclusions: Based on the results of this study, throwing athletes diagnosed with pathologic internal impingement present with statistically significant increases in sternoclavicular elevation and scapular posterior tilt position during humeral elevation in the scapular plane.

J Orthop Sports Phys Ther. 2006;36(7):485-494. doi:10.2519/jospt.2006.2146

Key Words: pathologic internal impingement, scapular kinematics, throwing athletes

The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging.

Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.

J Orthop Sports Phys Ther. 2006:36(7):503-515. doi:10.2519/jospt.2006.2135

Key Words: diagnosis, labrum, MRI

Study Design: Resident’s case problem.
Background: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient’s past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament.
Diagnosis: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist’s diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient’s symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient’s worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture.
Discussion: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident’s case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.

J Orthop Sports Phys Ther. 2006;36(7):526-534. doi:10.2519/jospt.2006.2125

Key Words: bone injury, female athlete triad, tibia