We believe there is a need to identify a practical method for determining objective measurement of forward head posture. In our study, we determined the within-tester and between-tester reliabilities for clinical measurements of static, sitting, forward head posture using the cervical range of motion (CROM) instrument. Repeated measurements were made using a standardized protocol on 40 patients seated in a standardized position. The seven testers had from 1 to 8 years of clinical experience. All measurements were recorded by the same investigator. The intraclass correlation coefficient (ICC[1,1]) was used to quantitate within-tester and between-tester reliability. Measurements of forward head position performed by the same physical therapist had high reliability (ICC = 0.93). Good reliability (ICC = 0.83) was demonstrated when different physical therapists measured the forward head posture of the same patient. We concluded that measurements of forward head posture made by physical therapists trained in the correct use of the CROM instrument are reliable. This reliability is important for determining the effectiveness of treatment programs. On the basis of our data, the CROM instrument will assist clinicians in the objective evaluation and reassessment of the patient population demonstrating forward head posture.

J Orthop Sports Phys Ther 1993;17(3):155-160.

Key Words: reliability, head posture, cervical spine

Study Design: Masked randomized trial. Objective: To examine the effects of a 6-week program of static stretching of the calf muscle-tendon unit (MTU) on active ankle dorsiflexion range of motion (ADFROM) in healthy subjects. Background: Static stretching of the calf MTU is often prescribed to increase flexibility in patients with shortened connective tissues or to maintain ADFROM in healthy individuals. Presently, physical therapists lack specific information on the optimal dosage of calf MTU stretching necessary to produce improvement in ADFROM. Methods and Measures: One hundred one adults (63 women, 38 men; mean age ± SD, 40.0 ± 10.9 years; range, 21-59) with no visual evidence of gait impairment due to lower-extremity dysfunction participated in the study. Active ADFROM was measured with a universal goniometer. Participants were randomly assigned to group 1, no stretch controls (n = 24), or to 1 of 3 experimental groups carrying out a 6-week program of standing wall stretches once per day: individuals in group 2 stretched for 30 seconds (n = 26); individuals in group 3 stretched for 1 minute (n = 24); individuals in group 4 stretched for 2 minutes (n = 27). Results: After 6 weeks, the results of an analysis of variance found no effect of treatment on active ADFROM. Conclusion: The results of this study show that a 6-week program of once-per-day static stretching for up to 2 minutes is not sufficient to increase active ADFROM in healthy subjects.

J Orthop Sports Phys Ther. 2003;33(7):408-417.

Key Words: flexibility, lower extremity, rehabilitation, triceps surae

Study Design: Repeated measures of 14 temporal factors of gait obtained with a multimemory stopwatch from a variety of subjects with locomotor impairments. Objectives: To estimate the intratester and intertester reliability of 14 temporal factors of gait by using a multimemory stopwatch; to compare novice and expert clinicians at mastery of making these temporal measurements. Background: Temporal gait measures are useful for describing the effectiveness of treatment interventions in patients with locomotor impairments. Methods and Measures: Eleven adult subjects (mean age, 48.4 years; SD, 5.7 years), 10 with locomotor impairments and 1 elderly adult, ambulated along a 6-m walkway 3 times at a self-selected walking speed. The subjects were videotaped from the side as they walked. Four physical therapists independently analyzed the videotapes on 2 occasions; 2 examiners were recent graduates, and 2 others had 23 years of clinical experience. Intraclass correlation coefficients were used to estimate intratester reliability. A component of variance analysis quantified the sources of variation. Results: Intraclass correlation coefficients for each of the 14 variables varied from 0.88 to 0.98. The major contributor to variance was subject, followed by trial, error, and tester; the tester factor generally contributed less than 1% to the total variance. Conclusions: Reliable measurements of the temporal aspects of gait can be made by using a multimemory stopwatch and videotape in a clinical setting on patients with various locomotor problems. Our data suggest that measurements obtained by more experienced physical therapists were no more reliable than those made by recent graduates.

J Orthop Sports Phys Ther. 2000;30(5):279-286.

Key Words: evaluation, gait disorder, videography

Study Design: Cross-sectional descriptive study. Objectives: To examine the factors of gender and age, stratified by 10-year increments, on hamstring muscle length (HML) as measured by passive straight leg raise (PSLR) and popliteal angle (PA). Background: Differences in HML between men and women have not been examined for a large group of healthy adults over a wide range of ages. The usefulness of these data is to provide some typical values of HML for future reference. Methods and Measures: Two hundred fourteen adults (108 women, 106 men; age range, 20-79 years) with no known history of hip or knee joint disease and no history of recent hamstring strain participated in the study. PSLR (trunk-thigh angle) and PA (thigh-leg angle) were estimated with a goniometer. A 2-way analysis of variance (ANOVA) was used to analyze the effects of 2 independent variables (gender and age) on 2 dependent variables (PSLR and PA). Statistical significance was established at a<.05. Results: HML differed significantly (P<.001) between genders for both methods of measurement, with females demonstrating greater flexibility than their male counterparts. The difference between genders was 8° for PSLR and 11° for PA. HML was not influenced by age. Conclusions: This study provides physical therapists with typical values of HML in healthy men and women.

J Orthop Sports Phys Ther. 2005;35(4):246-252. doi:10.2519/jospt.2005.1428

Key Words: flexibility, hip extensors, lower extremity, straight-leg raise

Study Design: Single-group repeated measures for single rater reliability. Objectives: To describe the intratester reliability for measurements of active lumbar spine mobility and pelvic inclination during standing obtained with the back range-of-motion (BROM) device. Background: The BROM device has often been used to quantify lumbar spine active range of motion. No studies have reported the reliability of the BROM device in a clinical setting. Methods and Measures: One examiner measured all 3 planes of lumbar range of motion in 40 nonimpaired subjects. For each plane of motion, 2 BROM device measurements were made. lntraclass correlation coefficients were calculated to express the intratester reliability for each plane of motion measured. Results: lntraclass correlation coefficients were in the range of 0.67 to 0.94 for lumbar measurements with the BROM device. Conclusions: lntratester reliability was fair to poor for sagittal plane measurements and pelvic inclination. Measurements obtained by the same examiner for lumbar lateral flexion and rotation with the BROM device, however, were reliable.

J Orthop Sports Phys Ther. 1999;29(8):470-477.

Key Words: lumbar spine, range of motion, reliability

Presently, there is no available scientific information that examines the interchangeability of tangent and trigonometric methods used to calculate measurements of sagittal mobility of the lumbar spine obtained with a flexible curve. Repeated measurements of the lumbar curvature were made with a flexible curve by using a standardized protocol on 10 healthy volunteers under 3 conditions: 1) standing, 2) sitting with maximum trunk forward bending, and 3) lying prone with maximum backward bending. A team of 2 physical therapists working together made measurements; one therapist instructed the subject, and the other therapist performed the measurement. Agreement between the tangent and trigonometric methods was assessed graphically by plotting the difference between methods against the mean value of each pair of readings for each of the 3 conditions. Measurements differed by 4° to 7° for each of the 3 positions of the lumbar spine. We believe such error is clinically acceptable and should not affect the clinical decision made on the basis of the measurement.

J Orthop Sports Phys Ther. 1995;21(1):13-20.

Key Words: lumbar spine, reliability, range of motion