STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. BACKGROUND: There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. METHODS: Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. RESULTS: TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean ± SD change, 2.6 ± 1.1), Neer (2.6 ± 1.3), and Hawkins-Kennedy (2.8 ± 1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean ± SD change, 2.0 ± 1.5; P<.001) and improved shoulder function (force production, 2.5 ± 1.4 kg; Penn Shoulder Score, 7.7 ± 9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4 ± 13.2) (all, P<.001). CONCLUSION: Immediate improvements in shoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. LEVEL OF EVIDENCE: Therapy, level 4.
STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (STP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS: The STP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The STP group had weaker lower trapezius strength (mean difference, –9.0 N; 95% confidence interval [CI]: –13.5, –4.4) and wrist extensor strength (–12.7 N; 95% CI: –24.4, –1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the STP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION: In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest.
STUDY DESIGN: Within-subject, repeated-measures design. OBJECTIVES: To measure tibiofemoral contact forces during cycling in vivo and to quantify the influences of power, pedaling cadence, and seat height on tibiofemoral contact forces. BACKGROUND: Cycling is usually classified as a low-demand activity for the knee joint and is therefore recommended for persons with osteoarthritis and rehabilitation programs following knee surgery. However, there are limited data regarding actual joint loading. METHODS: Instrumented knee implants with telemetric data transmission were used to measure the tibiofemoral contact forces. Data were obtained in 9 subjects, during ergometer cycling and walking, 15 ± 7 months after total knee arthroplasty. Tibiofemoral forces during cycling at power levels between 25 and 120 W, cadences of 40 and 60 rpm, and 2 seat heights were investigated. RESULTS: Within the examined power range, tibiofemoral forces during cycling were smaller than those during walking. At the moderate condition of 60 W and 40 rpm, peak resultant forces of 119% of body weight were measured during the pedal downstroke. Shear forces ranged from 5% to 7% of body weight. Forces increased linearly with cycling power. Higher cadences led to smaller forces. A lower seat height did not increase the resultant force but caused higher posterior shear forces. CONCLUSION: Due to the relatively small tibiofemoral forces, cycling with moderate power levels is suited for individuals with osteoarthritis and rehabilitation programs following knee surgery, such as cartilage repair or total knee replacement. The lowest forces can be expected while cycling at a low power level, a high cadence, and a high seat height.
Clinical trial registration involves placing the protocol for a clinical trial on a free, publicly available, and electronically searchable register. Registration is considered to be prospective if the protocol is registered before the trial commences (ie, before the first participant is enrolled). Prospective registration has several potential advantages. It could help avoid trials being duplicated unnecessarily and it could allow people with health problems to identify trials in which they might participate. Perhaps more importantly, however, it tackles 2 big problems in clinical research: selective reporting and publication bias. Prospective clinical trial registration is of great potential value to the clinicians, consumers, and researchers who rely on clinical trial data, and that is why the International Society of Physiotherapy Journal Editors (ISPJE) is recommending that members enact a policy for prospective trial registration.
Editor-in-Chief Dr. Guy Simoneau recognizes the authors, associate editors, International Editorial Review Board members, and manuscript and musculoskeletal imaging reviewers who contributed to the various aspects of the Journal over the past 12 months.
STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine the effectiveness of a community-based program of stationary group cycling on gait, pain, and physical function in individuals with mild-to-moderate knee osteoarthritis (OA). BACKGROUND: Knee pain and disability are common symptoms in individuals with knee OA. Though exercise for knee OA has acknowledged benefits, it has the potential to aggravate symptoms in some instances. METHODS: Thirty-seven subjects (27 women, 10 men) with a mean ± SD age of 57.7 ± 9.8 years were randomly assigned to a cycling (n = 19) or control (n = 18) group for a 12-week intervention study. Outcome variables, measured at baseline and 12 weeks, included preferred and maximal gait velocity, a visual analog pain scale at rest and following a 6-minute walk test, muscle strength, and functional-outcome questionnaires. Data were analyzed using mixed-model analyses of variance for group and time differences. RESULTS: After 12 weeks, the individuals receiving the cycling intervention showed significantly greater improvements (P<.05) for preferred gait velocity (mean difference between groups, 8.7 cm/s; 95% confidence interval [CI]: 2.2, 15.1), visual analog pain scale on the 6-minute walk test (mean difference, 16.5 mm; 95% CI: 2.1, 31.0), the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (mean difference, 14.9 points; 95% CI: 2.6, 27.0) and stiffness subscale (mean difference, 10.8 points; 95% CI: 0.7, 21.3), the Knee injury and Osteoarthritis Outcome Score pain subscale (mean difference, 13.3 points; 95% CI: 3.4, 23.3), and the Knee Outcome Survey activities of daily living subscale (mean difference, 13.9 points; 95% CI: 2.0, 25.9) compared to controls. CONCLUSION: Stationary group cycling may be an effective exercise option for individuals with mild-to-moderate knee OA and may reduce pain with walking. US trial registration NCT00917618. LEVEL OF EVIDENCE: Therapy, level 1b–.
STUDY DESIGN: Cross-sectional. OBJECTIVE: To investigate predictors of increased frontal plane knee projection angle (FPKPA) in athletes. BACKGROUND: The underlying mechanisms that lead to increased FPKPA are likely multifactorial and depend on how the musculoskeletal system adapts to the possible interactions between its distal and proximal segments. Bivariate and linear analyses traditionally employed to analyze the occurrence of increased FPKPA are not sufficiently robust to capture complex relationships among predictors. The investigation of nonlinear interactions among biomechanical factors is necessary to further our understanding of the interdependence of lower-limb segments and resultant dynamic knee alignment. METHODS: The FPKPA was assessed in 101 athletes during a single-leg squat and in 72 athletes at the moment of landing from a jump. The investigated predictors were sex, hip abductor isometric torque, passive range of motion (ROM) of hip internal rotation (IR), and shank-forefoot alignment. Classification and regression trees were used to investigate nonlinear interactions among predictors and their influence on the occurrence of increased FPKPA. RESULTS: During single-leg squatting, the occurrence of high FPKPA was predicted by the interaction between hip abductor isometric torque and passive hip IR ROM. At the moment of landing, the shank-forefoot alignment, abductor isometric torque, and passive hip IR ROM were predictors of high FPKPA. In addition, the classification and regression trees established cutoff points that could be used in clinical practice to identify athletes who are at potential risk for excessive FPKPA. CONCLUSION: The models captured nonlinear interactions between hip abductor isometric torque, passive hip IR ROM, and shank-forefoot alignment.
STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To compare hip and knee kinematics and pain during a single-limb squat between 3 movement conditions (usual, exaggerated dynamic knee valgus, corrected dynamic knee valgus) in women with patellofemoral pain. BACKGROUND: Altered kinematics (increased hip adduction, hip medial rotation, knee abduction, and knee lateral rotation, collectively termed dynamic knee valgus) have been proposed to contribute to patellofemoral pain; however, cross-sectional study designs prevent interpreting a causal link between kinematics and pain. METHODS: The study sample included 20 women with patellofemoral pain, who demonstrated observable dynamic knee valgus. Participants performed single-limb squats under usual, exaggerated, and corrected movement conditions. Pain during each condition was assessed using a 0-to-100-mm visual analog scale. Hip and knee frontal and transverse plane angles at peak knee flexion and pain levels were compared using repeated-measures 1-way analyses of variance. Pearson correlation coefficients were used to determine within-condition associations between kinematic variables and pain. RESULTS: In the exaggerated compared to the usual condition, increases were detected in hip medial rotation (mean ± SD difference, 5.8° ± 3.2°; P<.001), knee lateral rotation (5.5° ± 4.9°, P<.001), and pain (8.5 ± 10.8 mm, P = .007). In the corrected compared to the usual condition, decreases were detected in hip adduction (mean ± SD difference, 3.5° ± 3.7°; P = .001) and knee lateral rotation (1.6° ± 2.8°, P = .06); however, average pain was not decreased (1.2 ± 14.8 mm, P = 1.0). Pain was correlated with knee lateral rotation in the usual (r = –0.47, P = .04) and exaggerated (r = –0.49, P = .03) conditions. In the corrected condition, pain was correlated with hip medial rotation (r = 0.44, P = .05) and knee adduction (r = 0.52, P = .02). CONCLUSION: Avoiding dynamic knee valgus may be an important component of rehabilitation programs in women with patellofemoral pain, as this movement pattern is associated with increased pain.
STUDY DESIGN: Longitudinal cross-sectional study. BACKGROUND: In the early stages after total knee arthroplasty (TKA), quadriceps strength of the operated limb decreases and is substantially less than that of the nonoperated limb. This asymmetry in strength is related to asymmetrical movement patterns that increase reliance on the nonoperated limb. Over time, quadriceps strength in the operated limb increases but remains less than that in age-matched controls without knee pathology, whereas the quadriceps strength in the nonoperated limb gradually decreases. The purpose of this study was to investigate the changes in quadriceps strength and function of both limbs up to 3 years after TKA and to evaluate change in interlimb kinematic and kinetic parameters over time compared to that in age-matched individuals without knee pathology. METHODS: Fourteen individuals after TKA and 14 healthy individuals matched for age, weight, height, and sex participated in the study. Outcome measures included kinematics, kinetics, quadriceps strength, and functional performance. RESULTS: In participants who underwent TKA, quadriceps strength was significantly different between limbs at 3 months and 1 year after TKA, but not at 3 years after TKA. In this group, there was also a significant improvement in self-reported function between 3 months and 1 year after TKA, but a significant decrease between years 1 and 3 for the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey. In the TKA group, there were few interlimb differences in joint kinematics and kinetics 3 years after TKA, which may be attributed to a combination of worsening in the nonoperated limb, as well as improvement in the operated limb. Differences between participants without knee pathology and those 3 years after TKA still existed for kinematic, kinetic, and spatiotemporal variables. CONCLUSION: As interlimb differences in quadriceps strength decrease after TKA, there are concomitant symmetrical improvements in temporospatial and kinetic gait parameters. The symmetry 3 years after TKA in quadriceps strength is primarily the result of progressive weakness in the nonoperated limb.
The patient was a 25-year-old male college student with a chief complaint of right shoulder pain. The patient was initially diagnosed with bicipital tendinitis by his physician and had been treated for 4 weeks by a physical therapist. However, his symptoms did not improve and he was unable to return to his preinjury activity levels, so he sought the services of another physical therapist for a second opinion. Due to concern for a labrum tear, the physical therapist referred the patient to an orthopaedic surgeon. Magnetic resonance arthrography revealed findings consistent with a superior labrum anterior-to-posterior tear.
The patient was a 61-year-old woman who was referred to a physical therapist with a diagnosis of right common fibular neuropathy at the fibular head involving both the deep and superficial nerve branches. Physical therapist intervention included fitting the patient with a right ankle-foot orthosis and referring the patient to her physician due to concern for a potential compressive lesion at the right proximal tibiofibular joint. Subsequent magnetic resonance imaging identified a lobulated, fluid-filled mass likely representing a ganglion cyst.