Letter to the Editor-in-Chief of JOSPT.

J Orthop Sports Phys Ther 2012;42(5):484. doi:10.2519/jospt.2012.0203

The convex-concave rules purportedly help describe the roll-and-slide relationships that naturally occur between moving articular surfaces. There are 2 components of this rule, depending on whether the convex or concave articular member of the joint is considered the moving segment. As a teacher of kinesiology and a physical therapist, I have always respected these rules, primarily because of their ability to assist with the mental imaging of joint motion. Recently, I have been perplexed by questions from experienced physical therapists as to why the convex-concave rules are still being taught in college or continuing education venues, when research has shown that they are flawed. Perhaps I am so hopelessly infatuated with, and blinded by, the educational charm and utility of the convex-concave rules that I fail to realize they are flawed. Are they? I don’t think so, which is the topic of this editorial.

J Orthop Sports Phys Ther 2012;42(2):53-55. doi:10.2519/jospt.2012.0103

KEY WORDS: arthrology, articular surfaces, kinesiology, morphology

SYNOPSIS: The 21 muscles that cross the hip provide both triplanar movement and stability between the femur and acetabulum. The primary intent of this clinical commentary is to review and discuss the current understanding of the specific actions of the hip muscles. Analysis of their actions is based primarily on the spatial orientation of the muscles relative to the axes of rotation at the hip. The discussion of muscle actions is organized according to the 3 cardinal planes of motion. Actions are considered from both femoral-on-pelvic and pelvic-on-femoral perspectives, with particular attention to the role of coactivation of trunk muscles. Additional attention is paid to the biomechanical variables that alter the effectiveness, force, and torque of a given muscle action. The role of certain muscles in generating compression force at the hip is also presented. Throughout the commentary, the kinesiology of the muscles of the hip are considered primarily from normal but also pathological perspectives, supplemented with several clinically relevant scenarios. This overview should serve as a foundation for understanding the assessment and treatment of musculoskeletal impairments that involve not only the hip, but also the adjacent low back and knee regions.

J Orthop Sports Phys Ther 2010;40(2):82-94, Epub 14 January 2010. doi:10.2519/jospt.2010.3025

KEY WORDS: adductor magnus, biomechanics, gluteus maximus, gluteus medius, hip

The JOSPT offers invited reviews of current titles. The May 2007 column includes 12 reviews of the following books: Surgical Techniques for the Knee; Cartilage Injury in the Athlete; Therapeutic Modalities for Musculoskeletal Injuries, Second Edition; Posterolateral Knee Injuries: Anatomy, Evaluation, and Treatment; Low Back Syndromes: Integrated Clinical Management; Rehabilitation of the Spine: A Practitioner's Manual, Second Edition; Orthotics and Prosthetics in Rehabilitation, Second Edition; Whiplash-Associated Diseases; Sports Injuries of the Knee: Surgical Approaches; Imaging Strategies for the Knee; Shoulder Rehabilitation: Non-Operative Treatment; and Pilates for Fragile Backs.

J Orthop Sports Phys Ther. 2007;37(5):277-285.

The carpometacarpal (CMC) of the thumb is a saddle joint that permits a wide range of motion and is largely responsible for the characteristic dexterity of human prehension. This joint, located at the very base of the thumb, is subject to large physical stresses throughout life. Osteoarthritis (posttraumatic or idiopathic), rheumatoid arthritis, and postmenopausal laxity of the capsular ligaments can predispose structural instability and impairment of this important joint. The instability is characterized by varying and often progressive dislocation of the joint surfaces, resulting in a displaced axis of rotation and abnormal actions of thumb muscles. The main consequence of the instability is most often pain and weakness, most notably during pinch and grasping actions. This paper is conceptually divided into 2 sections. The first section describes the anatomic structures that maintain stability in the normal CMC joint of the thumb and how disease or trauma can cause instability and ultimate deformity. The second section describes both nonsurgical and surgical interventions that are most often used to treat an unstable CMC joint. This paper is intended primarily as an overview for the physical therapist who does not specialize in the treatment of the hand, although desires basic information on this important topic.

J Orthop Sports Phys Ther. 2003;33(7):386-399.

Key Words: hand, osteoarthritis, thumb

Admittedly, it may appear incongruous that a review of a disease that infected the nervous system of persons in the first half of the twentieth century would appear in the Journal of Orthopaedic & Sports Physical Therapy at the start of the twenty-first century. As will be described, however, most of the physical therapy procedures developed during the polio epidemic involved muscles and their interaction with the skeletal system. Many of the treatments and rehabilitation philosophies created during this time are still very evident today. The ‘‘polio days’’ presented an enormous challenge and an equally enormous opportunity for the budding profession of physical therapy.

Much of the growth had to do with timing. Managing the rehabilitation of hundreds of thousands of persons, many in the prime of their own lives or careers, required just the services that a physical therapist could potentially provide. In essence, the polio epidemic created a unique void in the medical arena—a void that was filled by the rapid expansion of the profession of physical therapy.

A full appreciation of the impact that the polio epidemic had on the profession requires a history lesson of the many interrelated and concurrent events that transpired in this country between 1916 and 1955. Within these turbulent times, the United States experienced 2 world wars, the Great Depression, the Korean War, and the insidious rise and swift fall of the polio epidemic—one of the most significant public health epidemics ever to strike the United States. For more than 2 decades leading up to the success of the Salk vaccine in 1955, the treatment and care of persons with polio dominated virtually every aspect of the physical therapy profession.
The full story of how the growth, politics, philosophy, and even ‘‘personality’’ of physical therapy were shaped by the interactions between physical therapists and those infected by polio has been well chronicled. Two notable works are a recent article by Dr Marilyn Moffat and a very well presented text, Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association, by Ms Wendy Murphy. This present historical review, intentionally less global than the aforementioned works, focuses more on the poliovirus itself, its impact on those it infected, and, most importantly, on several important lessons and benefits gained by the profession’s steadfast involvement with the epidemic.

J Orthop Sports Phys Ther. 2004;34(8):479-492. doi:10.2519/jospt.2004.0301

Key Words: polio, physical therapy

The polio epidemic was one of the most influential factors to transform a profession of revered ‘‘reconstruction aides'' of the First World War era (such as the honorable Mary McMillan) to a profession of physical therapists as recognized today. From the design of the Hubbard tank to the evolution of manual muscle testing, our response to treating persons with polio has left many permanent impressions on the practice of physical therapy, both technical and philosophical. My recent historical adventure compelled me to share this story through a contribution titled, Polio: Its Impact on the People of the United States and the Emerging Profession of Physical Therapy, published in this month's Journal.

J Orthop Sports Phys Ther. 2004; 34(8):428-429. doi:10.2519/jospt.2004.0108

Key Words: polio, physical therapy, profession

The 2 most common deformities of the MCP joints associated with RA and instability are palmar subluxation and ulnar ‘‘drift.’’ Therapists and physicians often collaborate to treat these conditions through a combination of surgical and nonsurgical interventions. Two of the more conservative nonsurgical interventions typically involve a combination of splinting and education on joint protection. Additional nonsurgical treatment may include the judicious use of exercise and methods for relieving pain and reducing inflammation. Surgical intervention is often indicated when the more conservative treatments fail to arrest the progression of the pain or deformity. Regardless of the specific approach, effective intervention for instability of the MCP joint requires that the clinician possess a sound knowledge of the anatomy and the pathomechanical influences that predispose or cause the instability.

This clinical commentary is intended to provide this information, as well as offer treatment guidelines based on our clinical experience. Whenever possible, research will be cited to support clinical interventions. This paper is especially geared to the therapist who may not currently specialize in the treatment of instability of the MCP joint but may require basic information on this important topic.

J Orthop Sports Phys Ther. 2005;35(8):502-520. doi:10.2519/jospt.2005.1863

Key Words: fingers, hand deformity, patient education, splinting

Decreasing the relative force demands on the hip abductor muscles may reduce hip joint forces. The purpose of this study was to use surface electromyography (EMG) to determine the relative demand on the hip abductor muscles as subjects walked and carried single hand-held loads of multiple weights. Thirty healthy, college-aged subjects carried single hand-held loads by their side. The loads weighed between 3% and 30% of body weight. Loads were carried in a position either ipsilateral or contralateral to a given hip side. Normalized EMG (%EMG) was collected during the middle stance phase of walking. The amount of %EMG remained statistically equal to or less than the no-load EMG baseline for all ipsilateral-held loads and greater than the no-load EMG for all contralateral-held loads above 3% body weight. Load positions and weights that generated %EMG levels less than or equal to the no-load baseline most likely offer a degree of hip joint protection for persons with hip disability.

J Orthop Sports Phys Ther. 1994;19(5):296-304.

Key Words: electromyography, load carriage, hip osteoarthritis