During APTA's Combined Sections Meeting in Boston last month, the Journal of Orthopaedic & Sports Physical Therapy recognized for the third time the most outstanding research manuscript and clinical practice paper published in the JOSPT within a calendar year. The 2006 JOSPT Excellence in Research Award was presented to Rochenda A. Rydeard, Andrew B. Leger, and Drew Smith for their research report, "Pilates-Based Therapeutic Exercise: Effect on Subjects With Nonspecific Chronic Low Back Pain and Functional Disability: A Randomized Controlled Trial" (J Orthop Sports Phys Ther. 2006;36(7):472-484). The 2006 George J. Davies - James A. Gould Excellence in Clinical Inquiry Award was presented by George Davies to Cameron W. MacDonald, Julie M. Whitman, Joshua A. Cleland, Marcia Smith, and Hugo L. Hoeksma for their case report, "Clinical Outcomes Following Manual Physical Therapy and Exercise for Hip Osteoarthritis: A Case Series" (J Orthop Sports Phys Ther. 2006;36(8):588-599).

J Orthop Sports Phys Ther. 2007;37(3):86-87. doi:10.2519/jospt.2007.0103

STUDY DESIGN: Randomized, double-blind, placebo controlled trial. OBJECTIVES: To determine the effect of a C1-C2 self-sustained natural apophyseal glide (SNAG) on cervicogenic headache. BACKGROUND: Cervicogenic headache is a common condition causing significant disability. Recent studies have shown a high incidence of C1-C2 dysfunction, evaluated by the flexion-rotation test (FRT), in subjects with cervicogenic headache. To manage this dysfunction, Mulligan has described a C1-C2 self-SNAG, though no studies have investigated the efficacy of this intervention approach. METHODS: A sample of 32 subjects (mean ± SD age, 36 ± 3 years) with cervicogenic headache and FRT limitation were randomized into a C1-C2 self-SNAG or placebo group. After an initial instruction and practice visit in the clinic, interven­tions consisted of exercises applied independently by the subject twice daily at home on a continual basis. FRT range was measured twice, before and immediately after the instruction and practice visit. Headache symptoms were determined by a headache index over time, assessed by question­naire preintervention, at 4 weeks postintervention, and at 12 months postintervention. RESULTS: No differences were found in baseline measures between groups. Immedi­ately after the initial instruction and practice visit performed with the supervision of the therapist, FRT range increased by 15° (SD, 9) for the C1-C2 self-SNAG group (P<.001), which was significantly more than 5° (SD, 5) for the placebo intervention (P<.001). There was also a significant interaction for the variable headache index between group and time (P<.001), indicating that group difference was dependent on time. There was no difference in headache index scores at baseline between groups. Headache index scores were substantially less in the C1-C2 self-SNAG group (mean ± SD points at 4 weeks, 31 ± 9; mean ± SD points at 12 months, 24 ± 9) compared to the placebo group (mean ± SD points at 4 weeks, 51 ± 15; mean ± SD points at 12 months, 44 ± 13) at 4 weeks (P<.001) and 12 months (P<.001), with an overall (±SD) reduction of 54% (±17%) for the individu­als in the C1-C2 self-SNAG group. CONCLUSIONS: These results provide evidence for the efficacy of the C1-C2 self-SNAG technique in the management of individuals with cervicogenic headache.  

J Orthop Sports Phys Ther. 2007;37(3):100-107. doi:10.2519/jospt.2007.2379  

KEY WORDS: atlantoaxial joint, cervical spine, flexion-rotation test, joint mobilization, Mulligan

STUDY DESIGN: Cross-sectional. OBJECTIVES: To (1) determine the association between pain severity and pain drawing area for men and women; (2) determine if sex differences exist in pain severity or pain drawing area; (3) determine the relative influence of pain sever­ity, anatomical location of pain, personality, and psychological coping factors on pain drawing area for men and women. BACKGROUND: Pain drawings have been pos­tulated to assist in clinical decision making regard­ing classification and treatment of musculoskeletal pain. Prior studies have been ambiguous on this topic, possibly because they have not considered if sex differences exist for pain drawing area. METHODS AND MEASURES: One hundred twenty-six subjects referred to a multidisciplinary chronic pain clinic with chronic musculoskeletal pain were included in this study. Subjects com­pleted a pain drawing, the Multidimensional Pain Inventory (MPI), the Coping Strategies Question­naire (CSQ), and the Minnesota Multiphasic Per­sonality Inventory (MMPI-2). Pearson correlations investigated the associations of pain severity and pain drawing area, independent t tests investigated sex differences in pain severity and pain drawing area, and multiple regression investigated factors that influenced pain drawing area. RESULTS: Pain severity was positively corre­lated with pain drawing area for men (r = 0.38, P = .003) and women (r = 0.23, P = .052), account­ing for approximately 14% and 5% of the total variance, respectively. There was no significant sex difference in pain severity ratings, but women reported a significantly larger area of symptoms on the pain drawings (effect size, 0.61; P = .002). The sex difference in pain drawing area was consistent across different anatomical locations of pain. In women, the final regression model accounted for 39% (P<.001) of the variance in pain drawing area, with anatomical location of pain (β = .42, P<.001) and hypochondriasis (β = .31, P = .005) as the only unique predictors in the final model. In men, the regression model accounted for 27% (P = .003) of the variance in pain drawing area, with pain severity (β = .32, P = .021) and a coping style of ignoring pain (β = –.32, P = .018) as the only unique predictors in the final model. CONCLUSIONS: Women had larger pain draw­ing area and this area was significantly associated with anatomical location of pain and hypochon­driasis. Men had smaller pain drawing area and this area was associated with pain severity and a coping style of ignoring pain. These findings sug­gest that clinicians interpreting pain diagram area should consider the sex of the individual. 

J Orthop Sports Phys Ther. 2007;37(3):115-121. doi:1.2519/jospt.2007.2399 

KEY WORDS: chronic pain, coping styles, personality style, pain drawing, sex difference, yellow flags

STUDY DESIGN: Repeated-measures experi­mental design. OBJECTIVE: To examine the acute effects of static stretching on peak torque, the joint angle at peak torque, mean power output, and electromyo­graphic and mechanomyographic amplitudes and mean power frequency of the vastus lateralis and rectus femoris muscles during maximal eccentric isokinetic muscle actions. BACKGROUND: A bout of static stretching may impair muscle strength during isometric and concentric muscle actions, but it is unclear how static stretching may affect eccentric force production. METHODS AND MEASURES: Fifteen men (mean 6 SD age, 23.4 6 2.4 years) performed maximal eccentric isokinetic muscle actions of the dominant and nondominant knee extensor muscles at 60°·s–1 and 180°·s–1 on an isokinetic dynamometer, while electromyographic and mech­anomyographic amplitudes (root-mean-square) and mean power frequency were calculated for the vastus lateralis and rectus femoris muscles. Peak torque (Nm), the joint angle at peak torque (°), and mean power output (W) values were recorded by the dynamometer. Subsequently, the dominant lower extremity knee extensors underwent static stretching exercises, then the assessments were repeated. RESULTS: There were no stretching-related changes in peak torque, the joint angle at peak torque, mean power output, electromyographic or mechanomyographic amplitude, or mean power frequency (P>.05). However, there were expected velocity-related, limb-related, and muscle-related differences (P≤.05) that were unrelated to the stretching intervention. CONCLUSION: These results suggest that static stretching does not affect maximal eccentric isokinetic torque or power production, nor does it change muscle activation.  

J Orthop Sports Phys Ther. 2007;37(3):130-139. doi:10.2519/jospt.2007.2389 

KEY WORDS: EMG, muscle activation, muscle stiffness, stretching-induced force deficit