The Guide to Physical Therapist Practice affirms that physical therapists should determine the appropriateness of physical therapy to address a patient's disablement. The decision facing all therapists-during the initial evaluation and every subsequent clinic visit-is whether to treat the patient, refer the patient, or initiate both treatment and referral. This decision is based on whether the patient's clinical presentation is consistent with symptoms and signs of pathology that seem amenable to physical therapy. At minimum, deciding the appropriateness of physical therapy takes confirmation of the pathology suggested in a physician's referral diagnosis, if present. However, anecdotal evidence suggests that more extensive questioning, clinical testing, and referral to other specialists frequently are needed.

J Orthop Sports Phys Ther. 2006; 36(1):1-2. doi:10.2519/jospt.2006.0101

Key Words: diagnosis 

Study Design: Case control study. Objectives: The purpose of this study was to assess the position of the distal fibula in individuals with chronic ankle instability (CAI). Background: Recent literature has suggested that a positional fault of the fibula on the tibia may contribute to CAI; however, there is a lack of objective scientific evidence to support this claim. Methods and Measures: Thirty subjects with unilateral CAI (mean ± SD age, 20.3 ± 1.3 years) and 30 subjects with no previous history of ankle injury (mean ± SD age, 21.3 ± 3.8 years) participated in this study. Subjects completed a pair of subjective functional scales and fluoroscopic lateral images of both the right and left ankles were recorded. The distance from the anterior margin of the distal tibia to the anterior margin of the distal fibula was measured in millimeters. Nonparametric statistics were used to assess the relationship between fibular position and CAI status. Results: There were significant differences between the CAI and control group ankles (P = .045) and within the involved and uninvolved sides of the CAI group (P = .006). Those with CAI had a significantly more anterior fibular position on their involved ankle in relation to their uninvolved limb, and the ankles of the control group. Conclusions: The fibula was positioned significantly more anterior in relation to the tibia in subjects with unilateral CAI. It is unclear if repetitive bouts of ankle instability caused the anterior fibular position or if the more anterior position was a predisposing factor to injury.

J Orthop Sports Phys Ther. 2006;36(1):3-9. doi:10.2519/jospt.2006.2153

Key Words: ankle sprain, fibula, fluoroscopy, tibiofibular joint

Study Design: Prospective test-retest, intrarater reliability study. Objectives: To estimate the intrarater reliability, asymmetry, and associated error with measurement of the cross-sectional area (CSA) of the bilateral S1 multifidi when measured by a physical therapist following a short course of self-directed training in ultrasound imaging. Background: There is increasing interest in the assessment of the lumbar multifidus during the recovery from low back injury. It is important to know the error associated with the CSA measurements obtained by a physical therapist with limited experience in ultrasound imaging when using a portable unit. Methods and Measures: Thirty healthy females (mean ± SD age, 23 ± 2 years; mean ± SD mass, 63.1 ± 9.2 kg; mean ± SD height, 1.63 ± 0.06 m) participated. Fourteen subjects returned within 1 to 4 days for repeated measurements. Results: For all 30 subjects, the average (±SD) CSA of the left S1 multifidus (4.18 ± 0.55 cm 2 ) was larger (P<.05) than the right (4.11 ± 0.57 cm 2 ), with a standard error of the measurement (SEM) of 0.13 cm² and average ± SD asymmetry of 3.5% ± 3.4%. For a subset of 14 subjects, the between-day intrarater reliability for the right S1 multifidus muscle was ICC 3,1 = 0.80 (95% CI, 0.49-0.93), while the ICC for the left side was 0.72 (95% CI, 0.34-0.90). The day-to-day average differences for the left and right side were 0.02 cm² and 0.04 cm² , respectively. For the most conservative estimate, the between-day SEM was 0.37cm². Conclusions: A physical therapist, newly trained in ultrasound imaging, obtained reasonable between-day intrarater reliability when imaging the S1 multifidus. A high degree of symmetry was found between the bilateral S1 multifidi in a sample of healthy subjects, which is consistent with previous reports from measurements by skilled ultrasonographers.

J Orthop Sports Phys Ther. 2006;36(1):10-18. doi:10.2519/jospt.2006.2049

Key Words: low back, lumbar spine, muscles, reliability, sonography

Study Design: A single-group comparative study. Objectives: To compare lumbopelvic kinematics and muscle activation patterns while sitting on stable and unstable surfaces. Background: Unstable surfaces are commonly used during the rehabilitation of certain low back pain disorders. The benefits postulated are increased muscle activity and facilitation of sustainable midrange positions via neuromuscular control. The use of unstable sitting devices in the workplace is controversial, as the postulated increase in muscle activity is thought to lead to a muscle fatigue/pain response. However, little evidence exists for or against the ability of these devices to alleviate or prevent spinal pain. Methods and Measures: This study included 26 healthy adults (14 male, 12 female). Fastrak 3-dimensional motion analysis detected lumbar curvature, pelvic tilt, and postural sway during sitting on a stable and unstable surface over 5-minute periods. Surface electromyography was used to measure activity in the superficial lumbar multifidus, transverse fibers of internal oblique, and iliocostalis lumborum pars thoracis. Results: Spinal postures were similar for sitting on a stable and unstable surface. Significant increases in postural sway were detected (P = .013) in 3 dimensions of movement during sitting on an unstable surface. Gender differences were noted. No EMG amplitude or variance differences were detected between seating conditions. Conclusions: Preliminary data show that sitting on unstable surfaces induces greater spinal motion, but does not significantly alter the lumbosacral posture or the amount of activity in the superficial trunk muscles under investigation.

J Orthop Sports Phys Ther. 2006;36(1):19-25. doi:10.2519/jospt.2006.2094

Key Words: ergonomics, lumbar spine, postural sway, posture, trunk muscles

The Journal of Orthopaedic & Sports Physical Therapy is pleased to publish abstracts of research presentations made by the Orthopaedic and Sports Physical Therapy Sections during the 2006 Combined Sections Meeting (CSM) in San Diego, CA, February 1-5, 2006. This collection of abstracts provides a glimpse into the research presented as part of the scientific programming of these 2 sections. The number and variety of the presentations scheduled for CSM are testimony to the dynamic research activities taking place in the field of physical therapy. The abstracts presented here are reviewed and selected by members of the research committee of each section based on content and format. The abstracts are not, however, reviewed by the Associate Editors or the Editor-in-Chief of the JOSPT. By design, each abstract presents only a brief summary of a research project–a summary that typically does not permit a full evaluation of the scientific rigor with which the work was conducted. In many cases, these abstracts serve the purpose of sharing new research ideas and, therefore, offer only preliminary results that will require future validation. Yet, presenting this type of research information at CSM plays an important role in encouraging a dialog among researchers, clinicians, and educators.

J Orthop Sports Phys Ther. 2006;36(1):26.

CSM Orthopaedic and Sports Physical Therapy Section Programming Schedule 2006

February 1-5, 2006
San Diego, California

A summary of the schedule of platform and poster research presentations made by the Orthopaedic Section and Sports Physical Therapy Section of the American Physical Therapy Association during APTA’s Combined Sections Meeting.

J Orthop Sports Phys Ther. 2006;36(1):27-35.

Orthopaedic Section Abstracts: Platform Presentations (Abstracts OPL1-OPL64)

The abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPL designates an Orthopaedic platform presentation. The presenter’s name is underlined where that information was available to the JOSPT.

J Orthop Sports Phys Ther. 2006;36(1):A1-A25.

Orthopaedic Section Abstracts: Poster Presentations (Abstracts OPO 212-OPO 321)

The abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPO designates an Orthopaedic poster presentation. The presenter’s name is underlined where that information was available to the JOSPT.

J Orthop Sports Phys Ther. 2006;36(1):A26-A66.

Sports Physical Therapy Section Abstracts: Platform Presentations (Abstracts SPL1-SPL26)

The abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, SPL designates a Sports platform presentation. The presenter’s name is underlined where that information was available to the JOSPT.

J Orthop Sports Phys Ther. 2006;36(1):A67-A76.

Sports Physical Therapy Section Abstracts: Poster Presentations (Abstracts SPO396-SPO414)

The abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, SPO designates a Sports poster presentation. The presenter’s name is underlined where that information was available to the JOSPT.

J Orthop Sports Phys Ther. 2006;36(1):A77-A83.