Published jointly by JOSPT and The Journal of Bone & Joint Surgery (JBJS), “It Takes a Team: Working Together Works for Patients” is a first-of-its-kind publication that describes how collaboration among orthopaedic surgeons, physical therapists, and other healthcare clinicians working in a variety of clinical settings has improved patient outcomes. This Special Report is available as a free download from JOSPT's website at the following link: It Takes a Team: Working Together Works for Patients

J Orthop Sports Phys Ther 2013;43(3):117. doi:10.2519/jospt.2013.0103

KEY WORDS: collaboration, JBJS, orthopaedic surgeons, patient outcomes, physical therapists

We hope you enjoy reading this Special Report and would appreciate your feedback about it. Please take a few moments to access an online survey at https://www.surveymonkey.com/s/ITTAKESATEAMJOSPT

Neck pain is very common, but the good news is that most neck pain is not caused by serious disease. “Mechanical neck pain” is the name healthcare professionals use when joint and muscle problems result in neck pain. Current evidence suggests that a combination of manual therapy and exercise is effective for patients with mechanical neck pain. A research report published in the March 2013 issue of JOSPT focused on finding which combination of exercise and manual therapy was more effective in quickly reducing neck pain.

J Orthop Sports Phys Ther 2013;43(3):128. doi:10.2519/jospt.2013.0502

KEY WORDS: cervical spine, manipulation, manipulative therapy, mechanical neck pain, mobilization, thoracic spine

STUDY DESIGN: Case report. BACKGROUND: Traumatic glenohumeral dislocations with concomitant rotator cuff and capsular injuries present a unique and challenging surgical and rehabilitative condition, particularly in the overhead-throwing athlete. Multiple injuries of the shoulder complex create the potential for complications in the course of recovery and place a full return to high-level sport at risk. The purpose of this case report is to present the multiphased rehabilitation approach of an elite professional quarterback after an acute 330° capsulolabral reconstruction and rotator cuff repair as a result of a luxatio erecta injury. CASE DESCRIPTION: A 26-year-old male professional football player, a quarterback, sustained a right luxatio erecta shoulder dislocation while trying to recover a fumble during a regular-season game. The injury occurred when he was hit in the back of his throwing shoulder, which was in an abducted and externally rotated position, while lying on the ground. Five days postinjury, he underwent a 330° capsulolabral repair, with concomitant rotator cuff repair and subacromial decompression. He completed 28 weeks of a multiphased rehabilitation program. OUTCOMES: The patient returned to play in the National Football League (NFL) 8 months later, for the start of the next season, during which he had his most productive year as a professional quarterback, leading the league in passing yards and finishing third in the league for the number of touchdowns. Since the injury, the patient has played 6 consecutive seasons, starting over 96 consecutive, regular-season games and maintaining a very high level of play. DISCUSSION: This case report highlights the clinical decision-making process and management of this rare, severe injury. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2013;43(3):142-153. Epub 12 February 2013. doi:10.2519/jospt.2013.3726

KEY WORDS: dislocation, luxatio erecta, shoulder, SLAP

STUDY DESIGN: Clinical measurement. OBJECTIVES: To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. BACKGROUND: It is important to objectively measure symptoms and functional limitations related to patellar tendinopathy using outcome measures that have been validated in the language of the target population. Cross-cultural adaptations are also useful to enhance the understanding of the measurement properties of an assessment tool, regardless of the target language. METHODS: The VISA-P questionnaire was translated into Brazilian Portuguese, culturally adapted, and titled VISA-P Brazil. It was then administered on 2 occasions with a 24- to 48-hour interval between them, and a third time after a month of physical therapy treatment. The following measurement properties were analyzed: internal consistency, test-retest reliability, agreement, construct validity, floor and ceiling effects, and responsiveness. RESULTS: The VISA-P Brazil had high internal consistency (Cronbach α = .76; if item deleted, Cronbach α = .69-.78), excellent reliability and agreement (intraclass correlation coefficient = 0.91; 95% confidence interval: 0.85, 0.95; standard error of measurement, 5.2 points; minimal detectable change at the 90% confidence level, 12.2 points), and good construct validity (Pearson r = 0.60 compared to Lysholm). No ceiling and floor effects were detected for the VISA-P Brazil, and the responsiveness, based on 32 patients receiving physical therapy intervention for 1 month, demonstrated a large effect size of 0.97 (95% confidence interval: 0.68, 1.25). CONCLUSION: The VISA-P Brazil is a reproducible and responsive tool and can be used in clinical practice and research to assess the severity of pain and disability of patients with patellar tendinopathy.

J Orthop Sports Phys Ther 2013;43(3):163-171. Epub 14 January 2013. doi:10.2519/jospt.2013.4287

KEY WORDS: Brazil, knee, patellar tendinopathy, questionnaire, tendinopathy

STUDY DESIGN: Descriptive laboratory study. OBJECTIVE: To determine if a proposed clinical test (pressure biofeedback) could detect changes in transversus abdominis (TrA) muscle thickness during an abdominal drawing-in maneuver. BACKGROUND: Pressure biofeedback may be used to assess abdominal muscle function and TrA activation during an abdominal drawing-in maneuver but has not been validated. METHODS: Forty-nine individuals (18 men, 31 women) with low back pain who met stabilization classification criteria underwent ultrasound imaging to quantify changes in TrA muscle thickness while a pressure transducer was used to measure pelvic and spine position during an abdominal drawing-in maneuver. A paired t test was used to compare differences in TrA activation ratios between groups (able or unable to maintain pressure of 40 ± 5 mmHg). The groups were further dichotomized based on TrA activation ratio (high, greater than 1.5; low, less than 1.5). Sensitivity, specificity, and likelihood ratios were calculated. RESULTS: There was not a significant difference (P = .57) in TrA activation ratios (able to maintain pressure, 1.59 ± 0.28; unable to maintain pressure, 1.54 ± 0.24) between groups. The pressure biofeedback test had low sensitivity of 0.22 (95% confidence interval [CI]: 0.10, 0.42) but moderate specificity of 0.77 (95% CI: 0.58, 0.89), a positive likelihood ratio of 0.94 (95% CI: 0.33, 2.68), and a negative likelihood ratio of 1.02 (95% CI: 0.75, 1.38). CONCLUSION: Successful completion on pressure biofeedback does not indicate high TrA activation. Unsuccessful completion on pressure biofeedback may be more indicative of low TrA activation, but the correlation and likelihood coefficients indicate that the pressure test is likely of minimal value to detect TrA activation. This study was registered with ClinicalTrials.gov (NCT01015846).

J Orthop Sports Phys Ther 2013;43(3):184-193. Epub 16 November 2012. doi:10.2519/jospt.2013.4397

KEY WORDS: lumbar stabilization, sonography, trunk control

The patient was a 17-year-old adolescent male who was referred to a physical therapist for a chief complaint of anterior right hip pain. The physical therapist reviewed the patient's radiographs, which had been completed and interpreted as normal prior to referral, and determined that there were radiographic signs present that may be concerning for an avulsion fracture. Further evaluation through magnetic resonance imaging confirmed the presence of an avulsion fracture at the right anterior superior iliac spine.

J Orthop Sports Phys Ther 2013;43(3):195. doi:10.2519/jospt.2013.0406

KEY WORDS: hip, magnetic resonance imaging, radiography, running

The Fifth International Ankle Symposium (IAS5), a multidisciplinary conference focused predominantly on ankle injury evaluation, rehabilitation, and prevention, was held in Lexington, KY in October 2012. IAS5 brought together over 90 clinicians and scientists from disciplines such as athletic training, physical therapy, sports medicine, orthopaedics, and biomechanics. In this supplement, you will find a summary statement, keynote addresses from invited lectures and workshops, a program schedule, and the abstracts of the original research, both podium and poster presentations, from IAS5.

J Orthop Sports Phys Ther 2013;43(3):A1-A27. doi:10.2519/jospt.2013.0301

KEY WORDS: ankle injury, IAS5

Published jointly by JOSPT and The Journal of Bone & Joint Surgery (JBJS), this Special Report tells the success stories of 8 healthcare teams that include orthopaedic surgeons and physical therapists, as well as physician assistants, nurses, and physiatrists. The settings range from military and university sports-medicine clinics to academic medical centers and private group practices. They cover a range of musculoskeletal conditions and treatments, both surgical and nonsurgical, and stress the vital importance of effective and collaborative patient management by a responsible healthcare team.The clinical scenarios detailed in “It Takes a Team” represent models of successful teamwork between orthopaedic surgeons and physical therapists. Similarly, JOSPT and JBJS have collaborated to bring these stories and their insights to both our audiences. We look forward to continuing to work together to expand and strengthen this partnership to best serve our respective professions and, ultimately, patients.

KEY WORDS: collaboration, JBJS, orthopaedic surgeons, patient outcomes, physical therapists

We hope you enjoy reading this Special Report and would appreciate your feedback about it. Please take a few moments to access an online survey at https://www.surveymonkey.com/s/ITTAKESATEAMJOSPT