STUDY DESIGN: Single-group, prospective, repeated-measures design. OBJECTIVES: To determine differences in the changes of diffusion of water in the L5-S1 intervertebral disc between subjects with nonspecific low back pain (LBP) who reported an immediate reduction in pain intensity of 2 or greater on an 11-point (0-10) numeric rating scale after a 10-minute session of lumbar joint mobilization, followed by prone press-up exercises, compared to those who did not report an immediate reduction in pain intensity of 2 or greater on the pain scale. BACKGROUND: Combining lumbar joint mobilization and prone press-up exercises is a common intervention for patients with LBP; however, there is conflicting evidence regarding the effectiveness and efficacy of this approach. Increased knowledge of the physiologic effects of the combined use of these treatments, and the relationship to pain reports, can lead to refinement of their clinical application. METHODS: Twenty adults, aged 22 to 54, participated in this study. All subjects reported LBP of at least 2 on an 11-point (0-10) verbally administered numeric rating scale at the time of enrollment in the study and were classified as being candidates for the combination of joint mobilization and prone press-ups. Subjects underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans before and immediately after receiving a 10-minute session of lumbar pressures in a posterior-to-anterior direction and prone press-up exercises. Subjects who reported a decrease in current pain intensity of 2 or greater immediately following treatment were classified as immediate responders, while the remainder were classified as not-immediate responders. The apparent diffusion coefficient, representing the diffusion of water in the nucleus pulposis, was calculated from the midsagittal diffusion-weighted images. RESULTS: Following treatment, immediate responders (n = 10) had a mean increase in the apparent diffusion coefficient in the middle portion of the L5-S1 intervertebral disc of 4.2% compared to a mean decrease of 1.6% for the not-immediate responders (P<.005). CONCLUSION: In a group of subjects with LBP, who were classified as being candidates for extension-based treatment, the report of an immediate reduction in pain intensity of 2/10 of greater after a treatment of posterior-to-anterior–directed pressures, followed by prone press-up exercises, was associated with an increase in diffusion of water in the nuclear region of the L5-S1 intervertebral disc. Subjects who did not report a pain reduction of at least 2/10 did not have a change in diffusion.

J Orthop Sports Phys Ther 2010;40(5):256-264, Epub 12 March 2010. doi:10.2519/jospt.2010.3284

KEY WORDS: low back pain, magnetic resonance imaging, manual therapy

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To compare patellofemoral joint kinematics, femoral rotation, and patella rotation between females with patellofemoral pain (PFP) and pain-free controls using weight-bearing kinematic magnetic resonance imaging. BACKGROUND: Recently, it has been recognized that patellofemoral malalignment may be the result of femoral motion as opposed to patella motion. METHODS: Fifteen females with PFP and 15 pain-free females between the ages of 18 and 45 years participated in this study. Kinematic imaging of the patellofemoral joint was performed using a vertically open magnetic resonance imaging system. Axial-oblique images were obtained using a fast gradient-echo pulse sequence. Images were acquired at a rate of 1 image per second while subjects performed a single-limb squat. Measures of femur and patella rotation (relative to the image field of view), lateral patella tilt, and lateral patella displacement were made from images obtained at 45°, 30°, 15°, and 0° of knee flexion. Group differences were assessed using a mixed-model analysis of variance with repeated measures. RESULTS: When compared to the control group, females with PFP demonstrated significantly greater lateral patella displacement at all angles evaluated and significantly greater lateral patella tilt at 30°, 15°, and 0° of knee flexion. Similarly, greater medial femoral rotation was observed in the PFP group at 45°, 15°, and 0° of knee flexion when compared to the control group. No group differences in patella rotation were found. CONCLUSION: Altered patellofemoral joint kinematics in females with PFP appears to be related to excessive medial femoral rotation, as opposed to lateral patella rotation. Our results suggest that the control of femur rotation may be important in restoring normal patellofemoral joint kinematics.

J Orthop Sports Phys Ther 2010;40(5):277-285, Epub 12 March 2010. doi:10.2519/jospt.2010.3215

KEY WORDS: biomechanics (lower extremity), hip, knee, medical imaging, MRI

STUDY DESIGN: Case report. BACKGROUND: The healing response procedure is a minimally invasive arthroscopic surgical technique used to stimulate healing in the treatment of partial cruciate ligament tears. The purpose of this report is to provide information on the surgical procedure, the postoperative rehabilitation, and the overall functional results in a patient who underwent such a procedure. CASE DESCRIPTION: A 15-year-old male, who sustained a partial tear of both the anterior cruciate and posterior cruciate ligament while playing football, underwent arthroscopic surgical management utilizing a healing response technique. Precautions concerning range of motion and resisted activities were followed postoperatively to protect the healing cruciate ligaments. The postoperative protocol consisted of 3 phases, culminating in return-to-sport training. Treatment incorporated cardiovascular, proprioceptive, strength, power, plyometric, and sport-specific activities. Treatment was progressed based on specific criteria emphasizing proper movement patterns and eccentric control during functional activities. OUTCOMES: The patient attended 31 physical therapy sessions over 17 weeks. Strength improved from 3/5 to 5/5, knee range of motion returned to normal, Lower Extremity Functional Scale scores improved from 21/80 to 80/80, and successful outcomes on functional return-to-sport testing allowed the patient to return to competitive athletics. DISCUSSION: Primary repair of cruciate ligament tears has yielded poor results, and partial cruciate ligament tears may not require complete surgical reconstruction. The healing response technique offers a possible solution for the treatment of partial cruciate ligament tears. A criterion-based postoperative protocol was derived based on current evidence regarding rehabilitation following cruciate ligament reconstruction and evidence regarding lower extremity rehabilitation principles and injury prevention. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2010;40(5):297-309, Epub 12 March 2010. doi:10.2519/jospt.2010.3162

KEY WORDS: ACL, anterior cruciate ligament, healing response, physical therapy, PCL, posterior cruciate ligament

STUDY DESIGN: Clinical measurement, validity and intrarater reliability study. OBJECTIVES: (1) To confirm the validity and assess between-day test-retest reliability of cervical spine motion measurements made with the cervical range of motion (CROM) device in flexion, extension, bilateral rotation, and bilateral side flexion; (2) to provide meaningful information to clinicians about the standard error of measurement and the minimal detectable change for the CROM device. BACKGROUND: Range of motion is a common outcome measure used in the assessment of the cervical spine. The CROM device is one of the tools used to measure cervical range of motion in the clinical setting. However, its psychometric properties are not well established, especially for measurements taken on separate days. METHODS: Quasi-experimental design with 1 group comparison. Twenty healthy adults (9 men and 11 women) participated in this study. Cervical range of motion was simultaneously recorded with the CROM device and the Fastrak motion analysis system for all 6 cervical movements mentioned above. The CROM device was placed on the participant’s head consistent with standard clinical procedures. Two Fastrak sensors were positioned with 1 on the forehead and 1 over the spinous process of the T6 vertebra. Test-retest reliability of measurements made with the CROM device was assessed, as well as its standard error of measurement and minimal detectable change, with measures taken on 2 separate days spaced 48 hours apart. RESULTS: Values obtained by the 2 measuring devices yielded Pearson correlation coefficients ranging between 0.93 and 0.98. Test-retest reliability of measurements of cervical range of motion using the CROM was found to be good, with ICCs ranging between 0.89 and 0.98. The standard errors of measurement across the 6 movements ranged from 1.6° to 2.8° and the minimal detectable changes across the 6 movements ranged from 3.6° to 6.5°. CONCLUSIONS: The measurements made with the CROM were shown to be reliable in all movement directions.

J Orthop Sports Phys Ther 2010;40(5):318-323, Epub 12 March 2010. doi:10.2519/jospt.2010.3180

KEY WORDS: clinical tool, MDC, neck, psychometrics, spine

The patient was a 44-year-old man who reported palmar/ulnar-sided right wrist pain after injuring his wrist while
playing golf. Although pain and function were improved at 6 months following the injury with conservative treatment measures and golfing with a modified grip, the patient was still limited during golf. This prompted the ordering of
additional wrist radiographs, which included a carpal tunnel view, that revealed a fracture at the base of the hook
of the hamate. The patient was referred to an orthopaedic surgeon and underwent a hook of hamate excision, and at 12 weeks following surgery, he had returned to full golfing activities without limitations.

J Orthop Sports Phys Ther 2010;40(5):325. doi:10.2519/jospt.2010.0408

KEY WORDS: carpal tunnel view radiograph, golf, radiographs, wrist