STUDY DESIGN: Case report. BACKGROUND: Based on our assumption that subtle deviations in the precision of shoulder movement cause tissue injury, we have developed a set of movement-related diagnoses for shoulder problems. The purposes of this case report are to: 1) illustrate the use of a movement system impairment (MSI) diagnosis in a patient with shoulder pain, 2) illustrate how the MSI diagnosis guided treatment prescription, and 3) describe the outcomes of treatment based on a MSI diagnosis for shoulder impingement. CASE DESCRIPTION: The patient was a 46-year-old female with recurrent right shoulder pain of 2 months' duration. Initially she reported her pain was constant but varied in intensity and had increased gradually over time. Shoulder pain limited her ability to bicycle and perform reaching movements. The systematic clinical examination for assessing the patient's preferred alignment and movements included items related to pain, alignment, movement, muscle length, muscle strength, and function. Based on the examination, the MSI diagnosis was humeral anterior glide with scapular downward rotation. The treatment focused on correction of her shoulder alignment, functional movements, and associated impairments of muscle function. The patient was seen 4 times in 6 weeks. OUTCOMES: The patient was pain free with all activities at 1 month and there was no recurrence of symptoms 3 years after the last physical therapy visit. DISCUSSION: A MSI diagnosis of humeral anterior glide with scapular downward rotation guided physical therapy treatment and resulted in positive short- and long-term outcomes.

J Orthop Sports Phys Ther. 2007;37(9):551-553, published online 20 June 2007. doi:10.2519/jospt.2007.2283

KEY WORDS: glenohumeral joint, impingement, scapula, rotator cuff

Study Design: A descriptive, correlational study of patients with mechanical low back pain (LBP). Objectives: To assess the effect of active limb movements on symptoms in patients with LBP and to examine the relationship between symptoms with limb movements and select patient characteristics. Background: Limb movements result in forces applied to the spine and, thus, may be important in the examination and treatment of patients with LBP. Methods and Measures: A total of 188 people with LBP, 84 men and 104 women, participated in a standardized examination. Six of the items required patients to move their limbs and note LBP symptoms as increased, remained the same, or decreased. The prevalence of various symptom responses with each limb movement test was calculated. Relationships between patient characteristics and reports of increased symptoms were examined with Cochran's linear trend statistic and the Spearman and Pearson correlation coefficients. Differences in characteristics of patients with and without increased symptoms were examined with X2 test, Mann-Whitney U test, or Student's t test for independent groups. Results: An increase in symptoms was reported by 149 patients with at least 1 of the limb movement tests, and 3 of the patients reported a decrease in symptoms. Across the patient sample, the mean number of limb movement tests for which symptoms were reported as increased was 2.30 ± 1.64. Patients with an increase in symptoms reported higher average pain intensity the week prior to the examination (median = 2; range: 1-5) and higher functional disability (mean = 0.25; SD = 0.15) than those without a change in symptoms (pain intensity: median = 1; range: 0-2 and functional disability: mean = 0.16; SD = 0.12). The correlation between the number of increased symptoms and the person's average pain intensity was r = 0.23; the correlation with the functional disability score was r = 0.36. Patients with a history of LBP tended to report an increase in symptoms with more of the limb movement tests (mean = 3.5; SD = 1.40) than those without a previous history of LBP (mean = 2.0; SD = 1.11). Conclusions: Active limb movements performed during the examination primarily resulted in increased LBP symptoms. The presence and number of increased symptoms with the active limb movements was related to the patient's report of average pain intensity and functional disability. Tests of symptoms with active limb movements may provide insight into factors contributing to a LBP problem, as well as information to guide the treatment of patients with LBP.

J Orthop Sports Phys Ther. 2001;31(8):402-418.

Key Words: limb movements, low back pain assessment, motor control, spinal disorders

Study Design: Cross-sectional, secondary analysis. Objectives: To examine whether there were differences in the numbers and types of impairments on examination between 2 groups of people with low back pain (LBP), those who participated in symmetric leisure activities and those who participated in asymmetric leisure activities. Background: It has been proposed that people who repeatedly perform an activity that involves trunk movements and alignments in the same direction will develop strategies that are generalized to many activities. The repeated use of these strategies is proposed to contribute to impairments identifiable on examination and to LBP. Methods and Measures: Forty males and 40 females (mean ± SD age, 41.4 ± 13.9 years) with LBP who reported participation in either a symmetric or an asymmetric leisure activity participated in a standardized examination. Responses from 10 trunk-rotation-related impairment tests were analyzed using the Mann-Whitney U and chi-square statistics. Results: Thirty people participated in asymmetric leisure activities and 50 people participated in symmetric leisure activities. The total number of rotation-related impairments was different for the 2 groups (U = 1112, P<.01). The asymmetric group displayed more total rotation-related impairments (median, 4.0; range, 7) than the symmetric group (median, 2.0; range, 6). A greater percentage of the asymmetric group displayed more impairments on 5 out of 10 individual tests, as compared to the symmetric group (P≤.05 for all comparisons). Conclusions: Our results provide preliminary data to suggest that trunk-rotation related impairments, identified on examination, may be related to the general type of movements and alignments used repeatedly by patients with LBP.

 J Orthop Phys Ther. 2006;36(2):58-71. doi:10.2519/jospt.2006.2161

Key Words: examination, lumbar spine, spinal disorders, sports

J Ortho Sports Phys Ther. 2003;33:126-142.

Key Words: classification, impairment, low back pain, principal components analysis, validity