Study Design: Anatomical study of the interosseous region of the sacroiliac joint (SIJ) complex.

Objectives: To document and quantify the surface topography of the interosseous region of the SIJ.

Background: A review of the literature reveals that little consideration has been given to the interosseous region of the SIJ anatomically, biomechanically, and clinically.

Methods and Measures: The interosseous region of 11 cadaveric specimens (9 formalin embalmed and 2 fresh frozen) were studied. Ten specimens were 55 years of age or older and 1 was 20 years old. To view the interosseous surfaces of the sacrum and ilium the specimens were either axially sectioned (1-cm slices) or disarticulated. One fresh-frozen and 6 embalmed specimens were disarticulated and the remainder axially sectioned. The topography (surface ridging and areas of ossification) of the interosseous region was documented in all specimens and in 2 specimens the surfaces were 3-dimensionally reconstructed using modeling and animation software (MAYA; Autodesk, Inc, San Rafael, CA).

Results: Surface characteristics of the SIJ complex observed in specimens 55 years of age or older included moderate to extensive ridging of the interosseous region of the sacrum and ilium in 100% of specimens and ossification of the central interosseous region of the sacroiliac (SI) ligament in 60% of specimens.

Conclusions: Central region ossification of the interosseous SI ligament and the presence of ridges and depressions over the opposing interosseous surfaces of the sacrum and ilium are features common to specimens that are in or beyond their sixth decade. These findings further support the contention that there is little to no movement available at this joint in older individuals.

J Orthop Sports Phys Ther. 2006;36(4):200-208, doi:10.2519/jospt.2006.2099.

Key Words: ilium, joint morphology, pelvis, sacrum, surface topography

Study Design: A case series of patients with low back pain (LBP) who satisfy a clinical prediction rule (CPR).

Background: A CPR that identifies patients with LBP who are likely to respond with rapid and prolonged reductions in pain and disability following spinal manipulation was developed and recently validated. The CPR developed to predict favorable response to manipulation investigated the effects of only 1 manipulation technique. The accuracy of the CPR for predicting outcomes using other manipulation techniques is not known. The purpose of the case series was to describe the outcomes of patients presenting to physical therapy with LBP who met the CPR and were treated with an alternative lumbar manipulation technique.

Case Description: Consecutive patients referred to physical therapy who satisfied the eligibility criteria, including the presence of at least 4 of the 5 criteria on the CPR, were invited to participate in the case series. Patients were treated for 2 visits with a side-lying lumbar manipulation technique, followed by a basic range of motion exercise. Patients who exhibited a 50% reduction or greater in disability, as measured by the Oswestry Disability Index (ODI), were considered to have experienced a successful outcome.

Outcomes: A total of 12 patients participated in the case series. The mean age of the group was 39 years (SD, 8.9 years) and the median duration of symptoms was 19 days (range, 8-148 days). Of the 12 patients who participated in this case series, the mean reduction in disability as measured with the ODI was 57% (SD, 9%). Only 1 patient did not surpass the 50% reduction in ODI scores.Discussion: Eleven of the 12 patients (92%) in this case series who satisfied the CPR and were treated with an alternative lumbar manipulation technique demonstrated a successful outcome in 2 visits. It is plausible that patients with LBP who satisfy the CPR may obtain a successful outcome with either manipulation technique directed at the lumbopelvic region.

J Orthop Sports Phys Ther. 2006;36(4):209-214, doi:10.2519/jospt.2006.2163.

Key Words: low back pain, manual therapy, physical therapy

Study Design: Prospective cohort study.

Objective: To examine clinical and magnetic resonance imaging (MRI) features of hamstring muscle injury to determine if any are predictive for recurrent injury.

Background: Hamstring muscle strain injury and subsequent recurrent injury are common. Little information exists on factors that may increase the risk for recurrent injury.

Methods and Measures: The subjects were athletes from 3 professional Australian Rules football teams (n = 162). Anthropometric measurements, clinical signs, convalescent interval, and MRI assessment and measurement were undertaken and recorded in athletes with hamstring muscle strain injury. Athletes were followed for the presence, or absence, of recurrent injury to the same-side posterior thigh over the same and subsequent playing seasons.

Results: Thirty athletes met criteria for hamstring injury. Twelve (40%) of 30 athletes had recurrent injury within the same season, with an additional 7 athletes having recurrent injury in the subsequent season. None of the features examined were associated with increased recurrent injury risk within the same playing season. Statistical analysis demonstrated that when combining the same with the subsequent playing season a larger size of initial hamstring injury, as measured by MRI, was associated with an increased risk for recurrent injury (P<.01). A measured transverse size of injury greater than 55% of the muscle, or calculated volume of injury greater than 21.8 cm³, resulted in an increased risk for hamstring recurrence of 2.2 (95% CI, 0.88-5.32) and 2.3 (95% CI, 0.94-5.81) times, respectively, when compared to athletes with hamstring injuries below these measurements.

Conclusions: A larger size of hamstring injury was indicative of higher risk for recurrent injury but only after the subsequent playing season was considered along with the same playing season. None of the other parameters tested, including a shorter convalescent interval and clinical features, were associated with an increased risk for recurrent injury. However, due to low sample size the certainty of these conclusions may be limited.

J Orthop Sports Phys Ther. 2006; 36(4):215-224, doi:10.2519/jospt.2006.2086.

Key Words: Australian Football, biceps femoris, muscle injury, reinjury, risk factor assessment

Study Design: Longitudinal, repeated-measures, factorial design. The trunk axial rotation repositioning error was the dependent variable, while the orthoses, test mode (passive versus active), and the testing session were the independent variables.

Objectives: To verify whether lumbosacral orthoses (LSOs) affect proprioception in the lumbar spine and whether these effects change over a 3-week period during which the LSO is consistently worn.

Background: To date, there is no compelling evidence that lumbar orthoses support the spine. One hypothesis advanced by several authors is that they may enhance position sense (proprioception) in the lumbar spine.

Methods and Measures: Fourteen subjects without low back pain wore lumbosacral orthoses 3 hours a day for 3 weeks. Spine proprioception was tested in a seated posture in 3 sessions (days 0, 7, and 21).

Results: A significant 3-way interaction was found between the effects of the orthoses, session, and test mode (P = .03). The ratio of passive to active average error indicated that after 3 weeks of wearing LSO, proprioception in the passive test worsened in relation to the active test with the LSO. In contrast, proprioception in the passive test improved in relation to the active test when performed without the LSO.

Conclusions: The LSO did affect proprioception in the lumbar spine. These effects most likely changed over time due to sensorimotor adaptation. However, no overall proprioceptive benefits could be ascertained from healthy subjects wearing the LSO.

J Orthop Sports Phys Ther. 2006;36(4):225-231, doi:10.2519/jospt.2006.2143.

Key Words: brace, low back pain, lumbar support, spinal orthoses

Study Design: A systematic review.

Objective: To determine the strength of evidence of the effect of low-Dye taping on lower limb kinematic, kinetic, and electromyographic variables.

Background: Low-Dye taping is a foot-taping technique that aims to limit foot pronation and is commonly used to treat a number of foot disorders.

Methods and Measures: Systematic review of randomized or quasi-randomized trials examining the effect of low-Dye taping compared with no taping on kinematic, kinetic, and electromyographic variables. Trials were identified by searching CINAHL, EMBASE, MEDLINE, SPORTDiscus, and CENTRAL, and by recursive checking of bibliographies. Data were extracted from published trials and from mail contact with authors for further information as necessary. Meta-analyses were planned for all outcomes using the generic inverse variance method. Sensitivity analyses were planned by pooling data from nonrandomized trials. Statistical heterogeneity was assessed using the quantity I2.

Results: Six trials met inclusion criteria and, of these, 5 trials reported sufficient data on kinematic and kinetic variables to be included in the analysis. Results from the 5 randomized trials were considered robust when pooled with data from 7 nonrandomized trials in a sensitivity analysis. When compared to no taping, low-Dye taping increased navicular height immediately after application (weighted mean difference [WMD], 5.90 mm; 95% confidence interval [CI], 0.41 to 11.39; P = .04) and had no effect on navicular height post exercise (WMD, 4.70 mm; 95% CI, –0.61 to 10.01; P = .08), maximum rearfoot eversion while walking (WMD, –0.59°; 95% CI, –2.53 to 1.35; P = .55), and total rearfoot range of motion while walking (WMD, 2.3°; 95% CI, –0.64 to 5.24; P = .13).

Conclusions: Low-Dye taping provides a small change in navicular height post application, although it is unclear whether this change is clinically important. There was high heterogeneity between some trials examining other variables, indicating that more research is needed to confirm the results of previous trials.

J Orthop Sports Phys Ther. 2006;36(4):232-241, doi:10.2519/jospt.2006.2190.

Key Words: arch, foot, pronation, strapping, tape

Study Design: This study compared range of motion (ROM) measurements using a cervical range of motion device (CROM) and an optoelectronic system (OPTOTRAK).

Objectives: To examine the criterion validity of the CROM for the measurement of cervical ROM on healthy adults.

Background: Whereas measurements of cervical ROM are recognized as part of the assessment of patients with neck pain, few devices are available in clinical settings. Two papers published previously showed excellent criterion validity for measurements of cervical flexion/extension and lateral flexion using the CROM.

Methods and Measures: Subjects performed neck rotation, flexion/extension, and lateral flexion while sitting on a wooden chair. The ROM values were measured by the CROM as well as the OPTOTRAK

Results: The cervical rotational ROM values using the CROM demonstrated a good to excellent linear relationship with those using the OPTOTRAK: right rotation, r = 0.89 (95% confidence interval, 0.81-0.94), and left rotation, r = 0.94 (95% confidence interval, 0.90-0.97). Similar results were also obtained for flexion/extension and lateral flexion ROM values.

Conclusion: The CROM showed excellent criterion validity for measurements of cervical rotation. We propose using ROM values measured by the CROM as outcome measures for patients with neck pain.

J Orthop Sports Phys Ther. 2006; 36(4):242-248, doi:10.2519/jospt.2006.2148.

Key Words: measurement, neck, spine