STUDY DESIGN: Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. OBJECTIVES: To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. BACKGROUND: Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. METHODS AND MEASURES: Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. RESULTS: The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean ± SD increase, 16.9° ± 23.2°; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. CONCLUSION: KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported.  LEVEL OF EVIDENCE: Therapy, level 1b-.

J Orthop Sports Phys Ther. 2008;38(7):389-395, published online 29 May 2008. doi:10.2519/jospt.2008.2791

KEY WORDS:  impingement, rehabilitation, taping

STUDY DESIGN: Experimental laboratory study. OBJECTIVES: To examine how a change in trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. BACKGROUND: Altering the position of the trunk during the forward lunge exercise is thought to affect the muscular actions of the lead lower extremity. However, no studies have compared the biomechanical differences between the traditional forward lunge and its variations. METHODS AND MEASURES: Ten healthy adults (5 males, 5 females; mean age ± SD, 26.7 ± 3.2 years) participated. Lower extremity kinematics, kinetics, and surface electromyographic (EMG) data were obtained while subjects performed 3 lunge exercises: normal lunge with the trunk erect (NL), lunge with the trunk forward (LTF), and lunge with trunk extension (LTE). A 1-way analysis of variance with repeated measures was used to compare lower extremity kinematics, joint impulse (area under the moment-time curve), and normalized EMG (highest 1-second window of activity for selected lower extremity muscles) among the 3 lunge conditions. RESULTS: During the LTF condition, significant increases were noted in peak hip flexion angle, hip extensor and ankle plantar flexor impulse, as well as gluteus maximus and biceps femoris EMG (P<.015) when compared to the NL condition. During the LTE condition, a significant increase was noted in peak ankle dorsiflexion and a significant decrease was noted in peak hip flexion angle (P<.015) compared to the NL condition. CONCLUSIONS: Performing a lunge with the trunk forward increased the hip extensor impulse and the recruitment of the hip extensors. In contrast, performing a forward lunge with the trunk extended did not alter joint impulse or activation of the lower extremity musculature. LEVEL OF EVIDENCE: Therapy, level 5.

J Orthop Sports Phys Ther. 2008;38(7):403-409, published online 15 April 2008. doi:10.2519/jospt.2008.2634

KEY WORDS: biomechanics, EMG, impulse, weight bearing

STUDY DESIGN: Resident's case problem. BACKGROUND: The purpose of this paper is to provide the examination of and decision-making process for a patient referred to physical therapy for the treatment of neck pain following trauma. She was found to have an underlying odontoid fracture that precluded physical therapy intervention. DIAGNOSIS: This case involved a 73-year-old woman who had a sudden onset of neck and left upper extremity pain after a fall 15 days prior to her initial physical therapy visit. Conventional cervical spine radiographs completed 1 day prior to her initial physical therapy visit were negative for a fracture. However, several components of this patient's history and physical examination were consistent with a condition for which physical therapy intervention would not be indicated until more definitive cervical spine diagnostic imaging had been completed; more specifically, the physical therapist was primarily concerned about the possibility of an undetected fracture. The referring physician was contacted and immediate magnetic resonance imaging was requested, which revealed a type II fracture of the odontoid. Thirty-four days after her fall, the patient underwent a C1-C2 fusion. DISCUSSION: When evaluating patients with neck pain who have a history of cervical spine trauma, it is important that physical therapists understand the clinical findings associated with cervical spine fractures, as these findings provide guidance for the use of cervical spine diagnostic imaging and medical referral prior to implementing physical therapy interventions. LEVEL OF EVIDENCE: Diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(7):418-424, published online 3 June 2008. doi:10.2519/jospt.2008.2687

KEY WORDS: cervical spine, dens fracture, diagnostic imaging, differential diagnosis

STUDY DESIGN: Resident's case problem BACKGROUND: Nonossifying fibroma (NOF) is the most common fibrous bone lesion in children. The lesion is usually asymptomatic, and rarely leads to pathological fractures. DIAGNOSIS: We present the case of a 12-year-old boy who appeared to be normally developed but had a pathological insufficiency fracture associated with NOF in the distal femur. He was a member of a track athletics club and ran more than 5 km every day. Seven weeks prior to the initial evaluation he felt discomfort in the left distal thigh when running and felt pain upon knee flexion. The amount of discomfort increased gradually and he began to experience pain while running 4 weeks prior to his initial evaluation. At the time of the initial evaluation, he had tenderness over the distal thigh region and there was increased pain with weight bearing. Plain radiographs showed an irregular, well-defined cortical bone lesion, suggesting NOF, with vague increased density in the bone marrow across the femur and periosteal new bone, suggesting a fracture. Computed tomography confirmed a linear fracture with increased density across the femur leading to the cortical lesion. In the process of differential diagnosis osteosarcoma, or Ewing sarcoma, and bone/joint infection were ruled out using magnetic resonance imaging. The final diagnosis based upon the images and clinical course was pathological insufficiency fracture associated with NOF. The patient was treated with initial avoidance of weight bearing using 2 crutches for ambulation, followed by progressive weight bearing over a period of 5 weeks. Active range of motion of the knee joint was allowed. Three months after onset (5 weeks after the initial evaluation), the patient had normal gait without pain, whereupon the patient resumed his sport activities, beginning with jogging. DISCUSSION: Although pathological fractures secondary to NOF in the femur are rare, NOF can cause pathological insufficiency fractures in athletes, even if the lesion is confined and small. The current case is a reminder of such a possibility. This case also provides a time course as a reference for the rehabilitation of patients in similar cases. LEVEL OF EVIDENCE: Diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(7):434-438, published online 12 March 2008. doi:10.2519/jospt.2008.2655

KEY WORDS: athletes, bone lesion, femur, fibroxanthoma