For some patients, spinal manipulative therapy is an effective treatment for spine pain, yet we really don't fully understand how or why. The mechanisms of spinal manipulative therapy are not well defined, and common explanations for why spinal manipulative therapy works lack supporting evidence. Traditionally, the decision to incorporate spinal manipulative therapy into a plan of care is based on a seductively plausible biomechanical theory. Examination techniques, sometimes quite elaborate in nature, are used to determine painful structures and associated abnormalities related to alignment and mobility. The appropriately matched spinal manipulative therapy treatment techniques are then implemented to correct "pathological" findings. The underlying implication of these approacheds is that success of spinal manipulative therapy is dependent upon correction of biomechanical faults detected on examination.

J Orthop Sports Phys Ther. 2008;38(6):293-295. doi:10.2519/jospt.2008.0118

KEY WORDS: biomechanics, spine

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

• Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0201
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0202
• Slipped Capital Femoral Epiphysis in a Patient Referred to Physical Therapy for Knee Pain. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0203
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0204

STUDY DESIGN: Nonexperimental. OBJECTIVES: To determine interrater and intrarater agreement for 2 methods of evaluating movement quality during 2 lower extremity func­tional tasks, and to descriptively compare levels of agreement between the 2 methods. BACKGROUND: Clinicians typically use observational analysis to evaluate movement quality during functional tasks, but the extent of agreement is unknown. METHODS AND MEASURES: Twenty-five uninjured subjects performed 3 trials of unilateral squat and lateral step-down tasks. Three clinicians evaluated the trunk, pelvis, and hips for coronal plane and transverse plane movement deviations. Two rating methods were used: assessment of the entire movement (“overall method”) and rating each segment individually (“specific method”). Movement deviation severity was rated using basic clinical guidelines and ratings were repeated from videotape. Percent agreement and weighted kappa coefficients were calculated between rater pairs and rating sessions. Generalized kappa coefficients were calculated across raters. RESULTS: Interrater and intrarater percent agreement were higher using the overall method. Interrater weighted kappa coefficients were similar between rating methods (overall method, 0-0.55; specific method, 0.23-0.53). Intrarater weighted kappa coefficients were higher for the specific method (0.38-0.68) compared to the overall method (0.13-0.50). Generalized kappa coefficients were also higher for specific method compared to the overall method (unilateral squat, 0.19 and 0.01, respectively; lateral step-down, 0.22 and 0.18, respectively) and 95% confidence intervals remained above zero. CONCLUSIONS: Rating movement at body segments appears to result in agreement among raters that is better than chance. Neither rating method produced high agreement, indicating a need to develop more explicit criteria for rating movement deviation severity.  

J Orthop Sports Phys Ther. 2007;37(3):122-129. doi:10.2519/jospt.2007.2457 

KEY WORDS: functional testing, hip, knee, movement analysis, neuromuscular, reliability