SYNOPSIS: The rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate, despite evidence that it is not accompanied by improved patient outcomes. Overutilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to, a 2- to 3-fold increase in surgical rates over the last 10 years. Furthermore, a patient's knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear-avoidance and catastrophizing behaviors that may predispose people to chronicity. The purpose of this clinical commentary is as follows: (1) to describe an outline of the appropriate use, as defined in recent guidelines, of diagnostic imaging in patients with low back pain; (2) to describe how inappropriate use of lumbar spine imaging can increase the risk of patient harm and contributes to the recent large increases in healthcare costs; (3) to provide physical therapists with clear guidelines to educate patients on both appropriate imaging and information to dampen the potential negative effects of imaging on patients' perceptions and health; and (4) to present an example of a successful clinical pathway that has reduced imaging and improved outcomes. LEVEL OF EVIDENCE: Diagnosis/prognosis/therapy, level 5.

J Orthop Sports Phys Ther 2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618

KEY WORDS: lumbar spine, MRI, magnetic resonance imaging, overutilization, screening, prognosis

Letters to the Editor-in-Chief of JOSPT as follows:

• "Manual Magic: The Method Is Not the Trick" and Authors' Response
• "Moving Past Sleight of Hand" and Authors' Response
• "Core Muscle Activation During Swiss Ball and Traditional Abdominal Exercises" and Authors' Response

J Orthop Sports Phys Ther 2010;40(8):535-541. doi:10.2519/jospt.2010.0201

Medical care historically has had a strong association with magic, illusion, and secrecy. Although we profess to be
modern healthcare practitioners, utilizing manual therapy techniques, and strive for evidence-based practice, the reality is that one of the most ubiquitous of all manual therapy techniques, manipulation, is obscured by illusive
and ill-defined terminology. As a first step in moving from magician to modern clinician, we recently proposed a
nomenclature intended to standardize and clarify the terminology used in describing specific manual therapy techniques, recommending the use of 6 key characteristics. The persistent obfuscations appear to be aimed at
obscuring the differentiation of manipulation from mobilization. The time has come for a more precise delineation
between manipulation and mobilization and to move beyond seeing these valuable interventions simply as some sleight-of-hand technique.

J Orthop Sports Phys Ther 2010;40(5):253-255. doi:10.2519/jospt.2010.0105

KEY WORDS: manipulation, mobilization, terminology

SYNOPSIS: We propose describing a manipulative technique using 6 characteristics:

1. Rate of force application: Describe the rate at which the force was applied.
2. Location in range of available movement: Describe whether motion was intended to occur only at the beginning of the available range of movement, towards the middle of the available range of movement, or at the end point of the available range of movement.
3. Direction of force: Describe the direction in which the therapist imparts the force.
4. Target of force: Describe the location to which the therapist intended to apply the force.
5. Relative structural movement: Describe which structure or region was intended to remain stable and which structure or region was intended to move, with the moving structure or region being named first and the stable segment named second, separated by the word "on."
6. Patient position: Describe the position of the patient, for example, supine, prone, recumbent. This would include any premanipulative positioning of a region of the body, such as being positioned in rotation or side bending.

J Orthop Sports Phys Ther. 2008;38(3):A1-A6. doi:10.2519/jospt.2008.0301

Three contributors discuss the divide that seems to exist between physical therapy research and clinical practice.

J Orthop Sports Phys Ther. 2006; 36(7):451-461. doi:10.2519/jospt.2006.0108