In December of 2006, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) convened a task force to create a framework for standardizing manual physical therapy procedures. The impetus came from many years of frustration with our ability to precisely communicate to each other, as well as to stakeholders outside our profession. To this end, a contribution titled "A Model for Standardizing Manipulation Terminology In Physical Therapy Practice" is published in this issue of the Journal.

J Orthop Sports Phys Ther. 2008;38(3):97-98. doi:10.2519/jospt.2008.0103

KEY WORDS: guidelines, manual physical therapy, terminology

STUDY DESIGN: A single-blinded, pretreatment-posttreatment assessment. OBJECTIVES: To investigate, using ultrasound imaging, the cross-sectional area (CSA) of the lumbar multifidus muscle at 4 vertebral levels (L2, L3, L4, L5) in elite cricketers with and without low back pain (LBP) and (2) to document the effect of a staged stabilization training program on multifidus muscle CSA. BACKGROUND: Despite high fitness levels and often intensive strength training programs, athletes still suffer LBP. The incidence of LBP among Australian cricketers is 8% and as high as 14% among fast bowlers. Previous researchers have found that the multifidus muscle contributes to segmental stability of the lumbopelvic region; however, the CSA of this muscle has not been previously assessed in elite cricketers. METHODS AND MEASURES: CSAs of the multifidus muscles were assessed at rest on the left and right sides for 4 vertebral levels at the start and completion of a 13-week cricket training camp. Participants who reported current or previous LBP were placed in a rehabilitation group. The stabilization program involved voluntary contraction of the multifidus, transversus abdominis, and pelvic floor muscles, with real-time feedback from rehabilitative ultrasound imaging (RUSI), progressed from non-weight-bearing to weight-bearing positions and movement training. Pain scores (using a visual analogue scale) were also collected from those with LBP. RESULTS: The CSAs of the multifidus muscles at the L5 vertebral level increased for the 7 cricketers with LBP who received the stabilization training, compared with the 14 cricketers without LBP who did not receive rehabilitation (P = .004). In addition, the amount of muscle asymmetry among those with LBP significantly decreased (P = .029) and became comparable to cricketers without LBP. These effects were not evident for the L2, L3, and L4 vertebral levels. There was also a 50% decrease in the mean reported pain level among the cricketers with LBP. CONCLUSION: Multifidus muscle atrophy can exist in highly active, elite athletes with LBP. Specific retraining resulted in an improvement in multifidus muscle CSA and this was concomitant with a decrease in pain. LEVEL OF EVIDENCE: Therapy, level 2b.

J Orthop Sports Phys Ther. 2008;38(3):101-108, published online 7 December 2007. doi:10.2519/jospt.2008.2658

KEY WORDS: asymmetry, low back/lumbar spine rehabilitation, rehabilitative ultrasound imaging, therapeutic exercise, ultrasound imaging

STUDY DESIGN: Retrospective, observational cohort design. OBJECTIVES: Purpose 1 was to determine the association between age, symptom chronicity, and prevalence of centralization in a sample of patients with nonserious cervical or lumbar spinal syndromes referred to a hospital-based outpatient rehabilitation clinic. Purpose 2 was to examine if classifying these patients at intake by centralization or noncentralization predicts functional status, pain intensity, and number of treatment visits at discharge from rehabilitation. Purpose 3 was to compare clinically meaningful changes in functional status and pain intensity between patients subgrouped by centralization and noncentralization. BACKGROUND: Variations in operational definitions and measurements used to identify centralization affect patient classification, contribute to variation in reported prevalence rates, and influence treatment strategy and outcome interpretation. Investigating a standardized operational definition and measurement method for centralization may reduce practice and outcomes variation. METHODS AND MEASURES: Adults (n = 418) with cervical or low back syndromes (mean ± SD age, 58 ± 17; range 19–91; 33% male; 76% lumbar symptoms; 53% chronic symptoms) were assessed. Therapists classified patients using a standardized operational definition and method for centralization during initial evaluation. Prevalence rates were calculated for centralization by age and acuity. Multivariate models were used to assess discharge functional status, pain intensity, and visits while controlling important variables. Percentage of patients subgrouped by centralization and noncentralization achieving minimal clinically important differences (MCID) in functional status and pain intensity was assessed. RESULTS: Overall prevalence rate for centralization was 17%, but increased for patients who were younger and reported acute symptoms regardless of body part. For patients with lumbar syndromes, noncentralization was associated with lower discharge functional status and more pain, but not associated with visits compared to patients classified as centralization. For patients with cervical syndromes, noncentralization was associated with more pain but not associated with functional status or number of visits compared to patients classified as centralization. Pain pattern classification affected percentage of patients with lumbar and cervical impairment achieving MCID. CONCLUSION: Results supported the clinical use of a standardized definition of centralization to facilitate patient classification and management and interpretation of outcomes. LEVEL OF EVIDENCE: Prognosis, level 2b.

J Orthop Sports Phys Ther. 2008;38(3):116-125, published online 9 November 2007. doi:10.2519/jospt.2008.2596

STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: We compared lower extremity anatomical characteristics in males and females between different maturation groups. BACKGROUND: Sex differences have been observed in lower extremity anatomical characteristics. While the reasons contributing to these sex differences in adults are unknown, there is evidence that anatomy and posture change considerably during growth and development. METHODS AND MEASURES: One hundred seventy-three young athletes (age range, 9–18 years) were assessed for stage of maturation and placed into 1 of 3 groups, according to Tanners stages 1 and 2 (MatGrp₁), 3 and 4 ( MatGrp₂), and 5 (MatGrp₃). Participants were measured for pelvic angle, hip anteversion, quadriceps angle, tibiofemoral angle, femur length, tibial length, genu recurvatum, tibial torsion, navicular drop, general joint laxity, and anterior knee laxity. Data were compared by sex and maturation group. RESULTS: When comparing maturation groups, limb length, pelvic angle, and tibial torsion increased with maturation, and anterior knee laxity, genu recurvatum, tibiofemoral angle, and foot pronation decreased with maturation. Females had greater general joint laxity, hip anteversion, and tibiofemoral angles, and shorter femur and tibial lengths than males, regardless of maturation group. Maturational changes in knee laxity and quadriceps angles were sex dependent. CONCLUSIONS: We observed a general change in posture with maturation that began with greater knee valgus, knee recurvatum, and foot pronation in MatGrp₁, then moved toward a relative straightening and external rotation of the knee, and supination of the foot in later maturation groups. While the majority of the measures changed similarly in males and females across maturation groups, decreases in quadriceps angles and anterior knee laxity were greater in males compared to females, and females were observed to have a more inwardly rotated hip and valgus knee posture, compared to males, particularly in later maturation groups. LEVEL OF EVIDENCE: Diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(3):137-149, published online 16 October 2007. doi:10.2519/jospt.2008.2645

KEY WORDS:  alignment, development, growth, joint laxity, posture

The patient was a 26-year-old female with a 14-year history of right-sided patellofemoral pain and frequent episodes of patellar subluxation/dislocation. Because of her longstanding history of patellofemoral pain and failure to respond to conservative management, magnetic resonance imaging was ordered. Axial and sagittal images of the patellofemoral joint revealed a bone spur on the anterior-medial surface of the femoral trochlear groove. After further consultation with an orthopedic surgeon, an arthroscopic surgical procedure was scheduled to remove the bone spur. At the time of publication, the subject was 1 month postsurgery and symptom free.

J Orthop Sports Phys Ther. 2008;38(3):158. doi:10.2519/jospt.2008.0403

KEY WORDS: magnetic resonance imaging, patellar subluxation/dislocation

Letters to the Editor-in-Chief of the JOSPT as follows:

• Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0201
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0202
• Slipped Capital Femoral Epiphysis in a Patient Referred to Physical Therapy for Knee Pain. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0203
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0204