STUDY DESIGN: Case control study. OBJECTIVE: To compare posterior tibialis (PT) length between subjects with stage II posterior tibial tendon dysfunction (PTTD) and healthy controls during the stance phase of gait. BACKGROUND: The abnormal kinematics demonstrated by subjects with stage II PTTD are presumed to be associated with a lengthened PT musculotendon, but this relationship has not been fully explored. METHODS AND MEASURES: Seventeen subjects with stage II PTTD and 10 healthy controls volunteered for this study. Subject-specific foot kinematics were collected using 3-D motion analysis techniques for input into a general model of PT musculotendon length (PTLength). The kinematic inputs included hindfoot eversion/inversion (HF Ev/Inv), forefoot abduction/adduction (FF Ab/Add), forefoot plantar flexion/dorsiflexion (FF Pf/Df), and ankle plantar flexion/dorsiflexion (Ankle Pf/Df). To estimate the change in PTLength from neutral the following was used: PTLength = 0.401(HF Ev/Inv) + 0.270(FF Ab/Add) + 0.137(FF Pf/Df) + 0.057(Ankle Pf/Df). Positive values indicated lengthening from the subtalar neutral (STN) position, while negative values indicated shortening relative to the STN position. A 2-way analysis of variance (ANOVA) model was used to compare PTLength between groups across the stance phases of walking (loading response, midstance, terminal stance, and preswing). Also, a 2-way ANOVA was used to assess the foot kinematics that contributed to alterations in PTLength. The Short Musculoskeletal Functional Assessment Index and Mobility subscale were used to compare function and mobility. RESULTS: PTLength was significantly greater (lengthened) relative to the STN position in the PTTD group compared to the control group across all phases of stance, with the greatest between-group difference in PTLength occurring during preswing. The greater PTLength in subjects with PTTD compared to controls was principally attributed to significantly greater HF Ev/Inv during loading response (P=.014) and midstance (P=.015). During terminal stance and preswing, each kinematic input to estimate PTLength contributed to lengthening (main effect, P=.03 and P=.01, respectively). Subjects with PTTD with abnormally greater PTLength reported significantly lower function (P = .04) and mobility (P = .03) compared to subjects with PTTD with normal PTLength during walking. CONCLUSIONS: The greater PTLength, as determined from foot kinematics, suggests the PT musculotendon is lengthened in subjects with stage II PTTD, compared to healthy controls. The amount of lengthening is not dependent on the phase of gait; however, different foot kinematics contribute to PTLength across the stance phase. Targeting these foot kinematics may limit lengthening of the PT musculotendon. Subjects with excessive PT lengthening experience a decrease in function.

J Orthop Sports Phys Ther 2007;37(11):661-669, published online 12 July 2007. doi:10.2519/jospt.2007.2539

KEY WORDS:  foot kinematics, pronation, tendinopathy, walking

STUDY DESIGN: Prospective series of consecutive cases. OBJECTIVES: To observe if kinesiophobia was altered through an education- and quota-based exercise physical therapy program, and to observe the relationship of kinesiophobia with other measures related to chronic low back pain. BACKGROUND: The role of kinesiophobia in worsening the chronic low back pain predicament has been documented in numerous studies. However, less is known of the effect of an exercise-only-based physical therapy program's ability to alter kinesiophobia and improve functional abilities in patients with chronic low back pain. METHODS: Eighty-two patients with at least 3 months of low back pain, and a moderate level of disability (Owestry score greater than or equal to 20) were willing to participate in this study. Sixty-eight of these patients completed treatment. For 68 compliant patients, females comprised 56%, the mean age was 43 years, the mean duration of symptoms was 28 months, and the primary anatomic diagnosis was disc degeneration (70%). Patients underwent a course of non-pain-contingent, quota-based physical therapy to address impairments in flexibility, strength, and lifting capacity. These were quantified prior to and following treatment using validated methods. Before and after treatment, patients completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK) Questionnaire, Owestry Disability Index (ODI) Questionnaire, and a 0-to-10 visual analog scale for back and lower extremity pain. A 12-month follow-up was conducted using mailed questionnaires. RESULTS: The mean number of physical therapy visits was 14. Clinically and statistically significant (P<.001) improvement in flexibility, strength, and lifting ability were observed. Statistically significant (P<.001) improvement in back pain, disability, and measures of kinesiophobia were also noted at discharge and maintained at 12-month follow-up. At discharge, Owestry scores correlated with TSK (r=.59, P<.001), FABQ-Activities (r=.55, P<.001), and FABQ-Work (r=.50, P<.001) scores. CONCLUSION: In this study we observed that kinesiophobia decreased during an intensive physical therapy program in which exercises were performed in a quota-based manner. Following the successful performance of non-pain-contingent, quota-based exercise, patients' fears of injury lessened, and this may have had a positive influence on disability.

J Orthop Sports Phys Ther 2007;37(11):679-687. doi:10.2519/jospt.2007.2480

KEY WORDS: disability, fear-avoidance behaviors, lumbar spine, Owestry

STUDY DESIGN: Multifactorial, repeated-measures, within-subjects design. OBJECTIVES: To investigate the immediate effects of scapular taping on surface electromyographic (EMG) signal amplitude of shoulder girdle muscles during upper extremity elevation in individuals with suspected shoulder impingement syndrome. BACKGROUND: Individuals with shoulder impingement syndrome may present with increased activity of the upper trapezius and inhibition of other shoulder muscles active during upper extremity elevation. Scapular taping is theorized to normalize shoulder girdle function during scapular upward rotation by decreasing upper trapezius activity and increasing the activity of the lower trapezius and other muscles. METHODS AND MEASURES: Twenty-one volunteers with suspected shoulder impingement syndrome performed shoulder abduction in the scapular plane and a functional overhead-reaching ("shelf") task, both with and without tape. Surface electrodes were applied over the upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscles. Mean root-mean-square of the EMG signal, normalized to maximum contraction, was assessed for each muscle. RESULTS: Upper trapezius activity was significantly lower with tape during shelf task elevation (P=.002), especially above 90^° (P<.002). Lower trapezius activity was significantly higher with tape (P=.043). No significant differences were found between the tape and no tape for other muscles for the shelf task. During shoulder abduction in the scapular plane, the main effect for upper trapezius showed a significant decrease (P=.047) for tape versus no tape, but no significant interactions were found among components of this activity, or for other muscles. CONCLUSION: Scapular taping decreased upper trapezius and increased lower trapezius activity in people with suspected shoulder impingement during a functional overhead-reaching task, and decreased upper trapezius activity during shoulder abduction in the scapular plane. Taping did not affect the other muscles under the loads tested, but it is possible that the activity of these muscles was not deficient at the time of testing.

J Orthop Sports Phys Ther 2007;37(11):694-702, published online 12 July 2007. doi:10.2519/jospt.2007.2467

KEY WORDS: biomechanics/upper extremity, electromyographic activity, EMG, pain, scapula

The JOSPT offers invited reviews of current titles. The November 2007 column includes 6 reviews of the following books: Pocket Atlas of Human Anatomy, Fifth Revised Edition; Practical Orthopaedic Sports Medicine and Arthroscopy; Musculoskeletal Interventions: Techniques for Therapeutic Exercise; Decision Making in Spinal Care; Surgical Treatment of Orthopaedic Trauma; and Treat Your Own Back, Eighth Edition.