STUDY DESIGN: Controlled laboratory study using a single-group, within-subjects comparison. OBJECTIVES: To determine whether different types of neural mobilization exercises are associated with differing amounts of longitudinal sciatic nerve excursion measured in vivo at the posterior midthigh region. BACKGROUND: Recent research focusing on the upper limb of healthy subjects has shown that nerve excursion differs significantly between different types of neural mobilization exercises. This has not been examined in the lower limb. It is important to initially examine the influence of neural mobilization on peripheral nerve excursion in healthy people to identify peripheral nerve excursion impairments under conditions in which nerve excursion may be compromised. METHODS: High-resolution ultrasound imaging was used to assess sciatic nerve excursion at the posterior midthigh region. Four different neural mobilization exercises were performed in 31 healthy participants. These neural mobilization exercises used combinations of knee extension and cervical spine flexion and extension. Frame-by-frame cross-correlation analysis of the ultrasound images was used to calculate nerve excursion. A repeated-measures analysis of variance and isolated means comparisons were used for data analysis. RESULTS: Different neural mobilization exercises induced significantly different amounts of sciatic nerve excursion at the posterior midthigh region (P<.001). The slider exercise, consisting of the participant performing simultaneous cervical spine and knee extension, resulted in the largest amount of sciatic nerve excursion (mean ± SD, 3.2 ± 2.0 mm). The amount of excursion during the slider exercise was slightly greater (mean ± SD, 2.6 ± 1.5 mm; P = .002) than it was during the tensioner exercise (simultaneous cervical spine flexion and knee extension). The single-joint neck flexion exercise resulted in the least amount of sciatic nerve excursion at the posterior midthigh (mean ± SD, –0.1 ± 0.1 mm), which was significantly smaller than the other 3 exercises (P<.001). CONCLUSION: These findings are consistent with the results of previous research that has examined median nerve excursion associated with different neural mobilization exercises. Such nerve excursion supports theories of nerve motion associated with cervical spine and extremity movement, as generalizable to the lower limb.
J Orthop Sports Phys Ther 2012;42(8):667-675, Epub 18 June 2012. doi:10.2519/jospt.2012.3854
KEY WORDS: diagnostic ultrasound, nerve biomechanics, nerve sliding, neurodynamics
STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To compare the effectiveness of cervical spine thrust manipulation to that of Kinesio Taping applied to the neck in individuals with mechanical neck pain, using self-reported pain and disability and cervical range of motion as measures. BACKGROUND: The effectiveness of cervical manipulation has received considerable attention in the literature. However, because some patients cannot tolerate cervical thrust manipulation, alternative therapeutic options should be investigated. METHODS: Eighty patients (36 women) were randomly assigned to 1 of 2 groups: the manipulation group, which received 2 cervical thrust manipulations, and the tape group, which received Kinesio Taping applied to the neck. Neck pain (11-point numeric pain rating scale), disability (Neck Disability Index), and cervical-range-of-motion data were collected at baseline and 1 week after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of variance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: No significant group-by-time interactions were found for pain (F = 1.892, P = .447) or disability (F = 0.115, P = .736). The group-by-time interaction was statistically significant for right (F = 7.317, P = .008) and left (F = 9.525, P = .003) cervical rotation range of motion, with the patients who received the cervical thrust manipulation having experienced greater improvement in cervical rotation than those treated with Kinesio Tape (P<.01). No significant group-by-time interactions were found for cervical spine range of motion for flexion (F = 0.944, P = .334), extension (F = 0.122, P = .728), and right (F = 0.220, P = .650) and left (F = 0.389, P = .535) lateral flexion. CONCLUSION: Patients with mechanical neck pain who received cervical thrust manipulation or Kinesio Taping exhibited similar reductions in neck pain intensity and disability and similar changes in active cervical range of motion, except for rotation. Changes in neck pain surpassed the minimal clinically important difference, whereas changes in disability did not. Changes in cervical range of motion were small and not clinically meaningful. Because we did not include a control or placebo group in this study, we cannot rule out a placebo effect or natural changes over time as potential reasons for the improvements measured in both groups. LEVEL OF EVIDENCE: Therapy, level 1b.
J Orthop Sports Phys Ther 2012;42(8):724-730, Epub 20 April 2012. doi:10.2519/jospt.2012.4086
KEY WORDS: cervical spine, manual therapy, mobilization
STUDY DESIGN: Retrospective, descriptive analysis. OBJECTIVES: To describe the prevalence and nature of insurance claims for injuries attributed to physiotherapy care. BACKGROUND: In New Zealand, a national insurance scheme, the Accident Compensation Corporation, provides comprehensive, no-fault personal injury coverage. The patterns of injury sustained during physiotherapy care have not previously been described. METHODS: De-identified data for all injuries registered with the Accident Compensation Corporation from 2005 to 2010 and attributed to physiotherapy were accessed. Prevalence patterns (percentages) of new-claim data were determined for physiotherapy intervention category, injury site, nature of injury, age, and sex. A subcategory, exercise-related injuries, was analyzed according to injury site and whether the injury was related (primary) or unrelated (secondary) to the intended therapeutic goal. RESULTS: There were 279 claims related to physiotherapy care filed with the Accident Compensation Corporation during the studied reporting period. Injury was attributed predominantly to exercise (n = 88, 31.5% of cases) and manual therapy (n = 74, 26.5% of cases). The prevalence of events categorized as exercise related was greatest in those who were 55 to 59 years of age (n = 14, 16.3%) and greater in females (n = 47, 54.7%). Of the exercise-related injuries, 39.8% were in the lower-limb region and 35.2% were categorized as sprains/strains. CONCLUSION: Injuries attributed to exercise exceeded those linked to other therapies provided by physiotherapists, yet exercise therapy rarely features as a cause of adverse events reported to the physiotherapy profession. The proportion of exercise-related injury events underlines the need for ensuring safe and careful consideration of exercise prescription. LEVEL OF EVIDENCE: Harm, level 4.
J Orthop Sports Phys Ther 2012;42(8):698-704, Epub 18 June 2012. doi:10.2519/jospt.2012.3877
KEY WORDS: adverse event, harms, healthcare administration, therapeutic exercise
STUDY DESIGN: Secondary analysis, pretreatment-posttreatment observational study. OBJECTIVE: To compare the reliability and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Outcome Survey activities of daily living subscale (KOS-ADL), and the Lower Extremity Functional Scale (LEFS) in individuals with knee osteoarthritis (OA). BACKGROUND: The WOMAC is the current standard in patient-reported measures of function in patients with knee OA. The KOS-ADL and LEFS were designed for potential use in patients with knee OA. If the KOS-ADL and LEFS are to be considered viable alternatives to the WOMAC for measuring patient-reported function in individuals with knee OA, they should have measurement properties comparable to the WOMAC. It would also be important to determine whether either of these instruments may be superior to the WOMAC in terms of reliability or responsiveness in this population. METHODS: Data from 168 subjects with knee OA, who participated in a rehabilitation program, were used in the analyses. Reliability and responsiveness of each outcome measure were estimated at follow-ups of 2, 6, and 12 months. Reliability was estimated by calculating the intraclass correlation coefficient (ICC2,1) for subjects who were unchanged in status from baseline at each follow-up time, based on a global rating of change score. To examine responsiveness, the standard error of the measurement, minimal detectable change, minimal clinically important difference, and the Guyatt responsiveness index were calculated for each outcome measure at each follow-up time. RESULTS: All 3 outcome measures demonstrated reasonable reliability and responsiveness to change. Reliability and responsiveness tended to decrease somewhat with increasing follow-up time. There were no substantial differences between outcome measures for reliability or any of the 3 measures of responsiveness at any follow-up time. CONCLUSION: The results do not indicate that one outcome measure is more reliable or responsive than another when applied to subjects with knee OA. We believe that all 3 instruments are appropriate outcome measures to examine change in functional status of patients with knee OA.
J Orthop Sports Phys Ther 2012;42(8):716-723, Epub 8 March 2012. doi:10.2519/jospt.2012.4038
KEY WORDS: clinimetrics, function, measurement, physical therapy, psychometrics
The patient was a 38-year-old man evaluated by a physical therapist 14 weeks after repair of the left patellar tendon. The physical therapist requested radiographs, which revealed findings consistent with a patellar tendon retear. The radiologist recommended further evaluation with magnetic resonance imaging, which showed a left patellar tendon tear.
J Orthop Sports Phys Ther 2012;42(8):738. doi:10.2519/jospt.2012.0414
KEY WORDS: knee, lower extremity, patella, magnetic resonance imaging, radiography