STUDY DESIGN: Case-control, descriptive pilot study. OBJECTIVE: To describe the differences in the performance of the craniocervical flexion test (CCFT) between individuals with chronic tension-type headache (CTTH) and healthy controls. To assess the relationship between the CCFT, forward head posture, and several clinical variables related to the intensity and temporal profile of headache. BACKGROUND: Musculoskeletal impairments of the craniocervical region might play an important role on the pathogenesis of CTTH. Deficits in the performance of the CCFT have been reported in patients with cervicogenic headache, nonspecific neck pain, and whiplash injury, but not in individuals with CTTH. MATERIAL AND METHODS: Ten patients with CTTH and 10 comparable controls without headache were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and to record the pain history. The CCFT was performed with the subject supine and required performing a gentle head-nodding action of craniocervical flexion. The activation pressure score (pressure that the subject can achieve and hold for 10 seconds), the performance pressure index (calculated by multiplying the activation pressure score by the number of successful repetitions), and the highest pressure score (the highest level that each subject was able to hold for 10 seconds from 20 to 30 mm Hg) were measured. Side-view pictures of each subject were taken in both sitting and standing positions to assess forward head posture (FHP) by measuring the craniovertebral angle. All measures were taken by an assessor blinded to the subject’s condition. RESULTS: Patients with CTTH had significantly lower values in both active pressure score and performance pressure index (P<.001), but not in the highest pressure score (P = .057), compared to controls. Patients with CTTH had a smaller craniovertebral angle (mean ± SD, 42.0° ± 6.6°), indicating a more FHP than controls (48.8° ± 2.5°), in the standing position (P<.01); but not in the sitting position (CTTH, 39° ± 8.9°; controls, 42.8° ± 8.9°, P = .10). No association between FHP and any of the CCFT variables was found (P>.05). Headache intensity and frequency did not seem to be related to the CCFT variables, but there was a positive association between headache duration and activation pressure score (r_s = 0.746, P = .02) and highest pressure score (r_s = 0.743, P = .02). CONCLUSIONS: These findings suggest possible impairments of the musculoskeletal system in individuals with CTTH, although it is not possible to determine if these impairments contributed to the etiology of CTTH or are as a result of the chronic headache condition.  

J Orthop Sports Phys Ther. 2007;37(2):33-39. doi:10.2519/ jospt.2007.2401

KEY WORDS: cervical spine, head, neck, pain

STUDY DESIGN: Prospective single-group repeated-measures design. OBJECTIVES: To quantify electromyographic (EMG) signal amplitude of the gluteus maximus, gluteus medius, vastus medialis oblique, and biceps femoris during 5 unilateral weight-bearing exercises. BACKGROUND: Using normalized EMG (NEMG) signal amplitude as a measure of muscle activation and, therefore, an estimate of exercise intensity, the relative contributions and interac­tion of the hip and thigh muscles during unilateral weight-bearing exercise can be examined. With regard to potential efficiency for strengthening, data on the amount of EMG signal amplitude for these 4 muscles during commonly used exercises are limited. METHODS AND MEASURES: Twenty-three healthy, asymptomatic subjects (16 men, 7 women; mean ± SD age, 31.2 ± 5.8 years) participated. A repeated-measures analysis was conducted using general linear models. The percent maximum voluntary isometric contraction was measured within each subject across 4 muscles during 5 exercises for 2 sepa­rate trials. Effect sizes of pairwise comparisons were computed. RESULTS: Statistically significant differences were noted in the amount of mean NEMG signal amplitude for the 4 muscles across the 5 ex­ercises. A similar recruitment pattern between muscles was observed across all exercises. CONCLUSION: Even though all muscles except the biceps femoris demonstrated mean NEMG signal amplitudes sufficient for strength­ening, the wall squat produced the highest levels of activation and should be considered the most efficient for targeting any of the 4 muscles or for training a cooperative effort among the muscles. 

J Orthop Sports Phys Ther. 2007;37(2):48-55. doi:10.2519/jospt.2007.2354

KEY WORDS: gluteus maximus, gluteus me­dius, lower extremity, step-up, wall squat

STUDY DESIGN: Resident's case problem. BACKGROUND: In the United States, minocy­cline is a frequently prescribed medication for the treatment of moderate to severe acne, a common condition in adolescents. The use of minocycline has been associated with severe adverse effects that frequently comprise a musculoskeletal com­ponent, including drug-induced lupus. Physical therapists have the responsibility to identify drug reactions that mimic musculoskeletal symptoms. The patient described herein was a 15-year-old adolescent boy who had taken minocycline for 14 days. He was initially treated by his primary physician on the 15th day of minocycline therapy for symptoms of fever, joint swelling, and a rash. The patient presented to a physical therapist on the 22nd day with complaints of severe myalgia, arthralgia, and severely limited mobility secondary to pain. The patient was referred to a pediatric rheumatologist because of the systemic nature and severity of the symptoms. DIAGNOSIS: The patient was subsequently diagnosed as having drug-induced lupus by a pediatric rheumatologist. The patient's myalgia and arthralgia subsided within 6 weeks, but his strength, coordination, and endurance did not reach their prior levels for 3 to 4 months. DISCUSSION: Physical therapists who include a comprehensive pharmacovigilance component in their patient examination may recognize musculoskeletal symptoms that arise from a nonmusculoskeletal origin. Minocycline is commonly prescribed in the United States as an antibiotic and for treatment of acne and rheumatoid arthritis. Therefore, physical thera­pists should screen for minocycline use when an adolescent patient or a patient with rheumatoid arthritis presents with diffuse musculoskeletal symptoms. An automated medication monitor­ing system would provide physical therapists with a means of accessing current information on medication use.

J Orthop Sports Phys Ther. 2007;37(2):65-71. doi:10.2519/jospt.2007.2312

KEY WORDS: adverse reaction, arthralgia, myalgia, pharmacovigilance

This was the third research retreat focused on gender bias in anterior cruciate ligament (ACL) injuries. The first 2 took place in Lexington, KY in April of 2001 and 2003. The purpose of this third retreat was to continue to examine the factors thought to be associated with gender bias in ACL injuries. In addition, we sought to revisit and update the consensus statement from 2003. A call for abstracts for the retreat was announced in the summer of 2005. All received abstracts were then peer-reviewed for scientific merit and relevance to the retreat topic. 

There was a 50% increase in the number of abstract submissions this year. In the end, 33 abstracts were accepted. These were grouped into sessions addressing structural, neuromuscular, biomechanical, and hormonal factors that may influence the gender bias in ACL injury in­cidence. It was interesting to note that the majority of abstracts submitted were in the area of neuromuscular and biomechanical factors, with only a few in the ar­eas of structural and hormonal factors. This suggests a trend in the research focus towards the more modifiable factors.  

The retreat was cohosted by Kentucky Sports Medicine and Drayer Physical Therapy Institute and sponsored by DonJoy, Aircast, Bluegrass Bracing, and Smith and Nephew. To accommodate the increase in number of high-quality abstracts, the meeting was ex­tended to 2 full days. The retreat was attended by both clinicians and scientists with a common interest in the ACL injury gender bias. The 60-plus participants in­cluded registrants from across the United States as well as Canada and Australia. As with the previous retreats, the group consisted of physicians, physical therapists, athletic trainers, and scientists in the areas of biome­chanics, motor control, and neuromuscular function. Thirty percent of the participants in the 2006 retreat were participants in a previous retreat as well. 

The for­mat of the meeting included 1 keynote presentation per day, along with 15-minute podium presentations made by some of the participants. The keynote presenters were chosen for their scientific contribution to the un­derstanding of factors associated with the gender bias seen in the incidence of ACL injuries. Ton van den Bo­gert, PhD, from the Department of Biomedical Engi­neering at the Cleveland Clinic gave the first keynote titled "ACL Injuries: Do We Know the Mechanisms?" The second keynote presenter was William Garrett, MD, PhD, from the Department of Orthopedics at Duke University, whose talk was titled "Anterior Cruciate Lig­ament Injury Mechanisms and Risk Factors." Following all of the presentations, a consensus development ses­sion was held. In the pages of this supplement, you will find the consensus statement and an abstract on each of the 33 presentations made at the conference, organized by the topics listed above. 

J Orthop Sports Phys Ther. 2007;37(2):A1-A32. doi:10.2519/jospt.2007.0301

KEY WORDS: anterior cruciate ligament, ACL injuries, gender