STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the quality and scope of recently published systematic reviews on the topic of patellofemoral pain syndrome (PFPS) and to provide an overview of their findings. BACKGROUND: PFPS is a commonly treated condition. There is a large body of literature on conservative nonpharmacological interventions for PFPS, including multiple systematic reviews, which require critiquing and summarizing. METHODS AND MEASURES: A systematic review of systematic reviews on conservative nonpharmacological treatment strategies for PFPS was performed. Published systematic reviews were identified by searching MEDLINE, EMBASE, CINAHL, SPORTDISCUS, Current Contents, The Cochrane Library, and PEDro electronic databases from the year 2000 until May 2007. Cited reference searches of each author in the Web of Science complemented this search. Review quality was evaluated by a specifically designed scale and only high-quality reviews were retained to validate and summarize reported findings. RESULTS: Ten reviews met the inclusion criteria. Among them, only 3 were considered to be high quality, covering exercise, foot and knee orthoses, and ultrasound intervention for PFPS. None of the 3 reviews included literature published after the year 2001. Some limited evidence for the use of exercise, exercise combined with taping, and exercise combined with the use of a Protonics brace was found for treatment of individuals with PFPS. CONCLUSION: Published systematic reviews and clinical trials need to be conducted with more rigorous methodological design. There are no up-to-date, high-quality systematic reviews covering conservative nonpharmacological treatments for individuals with PFPS, which indicates that updates in all areas are needed. LEVEL OF EVIDENCE: Therapy, level 1a.

J Orthop Sports Phys Ther. 2008;38(9):529-541, published online 3 June 2008. doi:10.2519/jospt.2008.2861

KEY WORDS: exercise, literature, orthoses, physical therapy, ultrasound

STUDY DESIGN: Resident's case problem. BACKGROUND: A 38-year-old man with a history of chronic episodic low back pain (LBP) was referred to physical therapy by his physician. DIAGNOSIS: Concerns ascertained from the patient's history included an insidious onset of unrelenting, deep, boring pain that was constant, irrespective of movements or posture changes, or time of day. In addition, the patient reported night pain and the inability to find relief in recumbent positions. The primary warning signs associated with the physical examination were unremarkable examination of the lumbar spine, pelvis, and hip regions (symptoms not altered and minimal impairments detected), and a strong nontender, palpable pulse noted over the left lateral lumbar region, with the patient prone, and over the midline and left upper/lower abdominal quadrants, with the patient supine. Suspicion of the presence of an abdominal aortic aneurysm led the therapist to immediately refer the patient to an allopathic physician. The subsequent abdominal ultrasound and computed tomography scanning revealed a 10-cm-diameter abdominal aortic aneurysm. The patient was immediately hospitalized and underwent surgical repair within two days. DISCUSSION: LBP is the most frequent condition for patients seeking care from physical therapists in outpatient settings. The challenge for clinicians is to recognize patients in whom LBP may be related to underlying pathological conditions. A prompt referral of patients presenting with suspicious findings to the appropriate physician may lead to a more timely diagnosis, with the goal of minimizing or preventing morbidity and mortality. LEVEL OF EVIDENCE: Differential diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(9):551-557, published online 3 June 2008. doi:10.2519/jospt.2008.2719

The original article was corrected in October 2008, and the amended article PDF is provided here. Please see: October 2008 Errata

KEY WORDS: aorta, medical screening, night pain, palpation, visceral back pain

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To examine the natural recovery from grade I and II ankle injuries over a 1-month period. BACKGROUND: There is a high rate of injury recurrence and persistence of symptoms following ankle sprains, suggesting that these injuries may not be adequately managed. However, little is known about the recovery process after discharge from emergency departments. METHODS AND MEASURES: Clinical assessment of ankle swelling, strength, and joint mobility and laboratory assessment of peak torque and joint range of motion (ROM) were performed 4 and 30 days following initial clinical assessment in the emergency department. Analyses for repeated measures determined change over time and differences between injured and noninjured ankles. Self-assessed ankle function was evaluated on day 4 and day 30, and its relationship to clinical and laboratory assessments determined. RESULTS: Forty-six subjects entered the study and complete datasets were obtained from 28. Significant swelling, weakness, and mobility restrictions were evident on initial assessment. Symptoms improved over time and, while clinical variables were normal by day 30, laboratory assessment indicated weakness of plantar flexors and limited active and passive ROM at 1 month. Swelling and reduced passive ROM were associated with overall function and limitations in sports and recreation activities, as well as quality of life 1 month postinjury. CONCLUSION: Clinically assessed strength and ankle dorsiflexion mobility suggested full recovery at 1 month post injury, yet more sensitive measures of ankle impairment and performance detected residual deficits. Persistent impairment and incomplete recovery of self-assessed function suggest the need for management beyond standard emergency department care. Associations between impairment measures and function may provide guidance for treatment intervention.

J Orthop Sports Phys Ther. 2008;38(9):566-571, published online 29 May 2008. doi:10.2519/jospt.2008.2811

KEY WORDS: function, impairment, injury, soft tissue, strength

The patient was a 22-year-old male with progressively worsening left hip pain for the past 5 days. He had been evaluated by a physician and diagnosed with an inguinal hernia and an adductor strain. Radiographs were not ordered, but he was given crutches due to an antalgic gait. At his initial physical therapy evaluation, 5 days after onset of pain, the patient was unable to bear weight on his left lower extremity. Based on the patient's history and physical examination, the physical therapist was concerned about the possibility of a hip fracture. Pelvic anterior-posterior and lateral frog leg radiographs were ordered, and the radiologist's report was significant for a displaced left femoral neck fracture. The patient was referred to an orthopaedic surgeon and underwent open reduction internal fixation on his left hip the next day. In this case, despite the recent history of pain and the insensitivity of radiographs to the early changes associated with a stress fracture, the fracture was visible on radiographs and it did not require further imaging.

J Orthop Sports Phys Ther. 2008;38(9):578-578. doi:10.2519/jospt.2008.0409

KEY WORDS: hip, lower extremity, radiograph