Journal of Orthopaedic & Sports Physical Therapy - December 2007 Volume 37, No. 12

None of Us Is as Smart as All of Us

"None of us is as smart as all of us." This simple quote from Ken Blanchard speaks very clearly to the role a scientific journal such as JOSPT plays in its profession.

J Orthop Sports Phys Ther 2007;37(12):714-716. doi:10.2519/jospt.2007.0111

KEY WORDS: authors, reviewers, team effort

Changes Associated With a Quota-Based Approach on a Walking Program for Individuals With Fibromyalgia

Karen Holtgrefe, Constance McCloy, Lisa Rome

STUDY DESIGN: Single-subject, multiple-baseline design across 3 subjects. OBJECTIVE: To investigate the use of a quota-based approach to prescribing a walking program for individuals with fibromyalgia (FM). BACKGROUND: Exercise has been found to be beneficial for individuals with FM. What has not been determined is the best way to implement an exercise program that does not increase FM symptoms. METHODS AND MEASURES: Three women with FM were randomly assigned a baseline period of 5, 6, or 7 weeks, which served as the control phase, followed by an intervention period consisting of an 8-week walking program. The walking program progression was prescribed using a quota-based approach. Weekly outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and SF-36v2 (acute). A 6-minute walk test was recorded twice: at the start of the baseline phase (after a trial phase) and at the end of the intervention phase. RESULTS: Subjects 1 and 3 had a significant decrease in the symptoms associated with FM during the intervention phase (FIQ, P<.05), but no significant increase in self-efficacy (ASES). They increased their walking distances used for exercise by 640 and 480 m, respectively. Subject 2 had no significant improvements in her symptoms of FM. Despite a significant decrease in ASES (P<.05), walking distance used for exercise by subject 2 increased by 2080 m. Six-minute walk test distances increased 76, 32, and 106 m for subjects 1, 2, and 3, respectively. CONCLUSIONS: Prescribing a walking program using a quota-based exercise prescription resulted in increasing the distance walked for 3 subjects. It also decreased symptoms associated with FM in 2 of the 3 subjects, but did not increase self-efficacy.

J Orthop Sports Phys Ther 2007;37(12):717-724. doi:10.2519/jospt.2007.2607

KEY WORDS: exercise, Fibromyalgia Impact Questionnaire, self-efficacy

Quadriceps Angle and Risk of Injury Among High School Cross-Country Runners

Mitchell J. Rauh, Thomas D. Koepsell, Frederick P. Rivara, Stephen G. Rice, Anthony J. Margherita
DESIGN: Prospective cohort study. OBJECTIVES: To determine the relationship between quadriceps angle (Q-angle) and risk of lower extremity injury among adolescent cross-country runners. BACKGROUND: No consensus exists on the role of the Q-angle as a risk factor for lower-extremity overuse injury, especially the effect of large Q-angle or right-left Q-angle difference. METHODS AND MEASURES: The Q-angles of 393 high school cross-country runners, 13 to 19 years of age, were goniometrically measured in a static, standing position with quadriceps relaxed. The runners were followed during a cross-country season to assess lower extremity injuries resulting from running in practices or competitions. RESULTS: Runners with a Q-angle >20° were at 1.7 times greater risk of injury (relative risk [RR], 1.7; 95% confidence interval [CI]: 1.2, 2.4) compared with runners whose Q-angle was 10° to <15°. The RR estimates were similar among girls and boys. Runners with >4° absolute right-left Q-angle difference were at 1.8 times greater risk (RR, 1.8; 95% CI: 1.4, 2.5) compared to runners with a smaller difference. Runners with a Q-angle >20° were more likely to injure their knee, while runners with >4° Q-angle difference were more likely to injure their shin. Runners with a Q-angle >20° had greater time lost due to injury. CONCLUSIONS: High school cross-country runners with large or asymmetric Q-angles may be at greater risk for running injury. Our study suggests that Q-angle measurement be included in preseason screening exams.

J Orthop Sports Phys Ther 2007;37(12):725-733, published online 29 August 2007. doi:10.2519/jospt.2007.2453

KEY WORDS: asymmetry, athletic injuries, prospective cohort, Q-angle, running injuries

Rehabilitation Following Reverse Total Shoulder Arthroplasty

Stephanie Boudreau, Ed Boudreau, Laurence D. Higgins, Reg B. Wilcox III

SYNOPSIS: Reverse or inverse total shoulder arthroplasty (rTSA) is becoming a widely accepted surgical intervention. This procedure is specifically designed for the treatment of glenohumeral (GH) joint arthritis or complex fractures, when associated with irreparable rotator cuff (RC) damage or in the presence of RC arthropathy. Additionally, rTSA is an option for the revision of a previously failed conventional total shoulder arthroplasty (TSA) or hemiarthroplasty (HA) in the RC-deficient shoulder. The physical therapist, surgeon, and patient must take into consideration that the postoperative course for a patient following rTSA should be different than the rehabilitation following a traditional TSA. rTSA has only recently been approved by the Food and Drug Administration in the United States; however, nearly a 20-year history of its use exists in Europe. To date, we are aware of no peer-reviewed published descriptions of the postoperative rehabilitation for patients having undergone this procedure. The purpose of this paper is to review the indications for rTSA, focusing on underlying pathology, and to outline a rehabilitation protocol founded on basic science principles and our experience working with patients following rTSA.

J Orthop Sports Phys Ther 2007;37(12):734-743, published online 28 August 2007. doi:10.2519/jospt.2007.2562

KEY WORDS: cuff tear arthropathy, inverse total shoulder arthroplasty, physical therapy, shoulder rehabilitation

Gender-Related Differences in Prevalence of Lumbopelvic Region Movement Impairments in People With Low Back Pain

Sara A. Scholtes, Linda R. Van Dillen

STUDY DESIGN: Cross-sectional, secondary analysis. OBJECTIVES: To examine potential gender differences in prevalence of lumbopelvic region movement impairments during clinical tests in a sample of people with low back pain (LBP). BACKGROUND: A number of studies have identified factors contributing to differences between men and women in prevalence of lower extremity injuries. Few studies have examined potential gender differences in impairments of people with LBP. METHODS AND MEASURES: Eighty-four males and 86 females (mean ± SD age, 41.5 ± 13.3 years) with LBP participated in a standardized examination. Responses from 7 movement tests that examine early lumbopelvic movement were analyzed using chi-square statistics. RESULTS: A greater proportion of men than women displayed early lumbopelvic movement during the majority of limb movements (3/4) and movements potentially affected by limb tissue stiffness (2/2) (P<.05). There were no differences in the proportions of men and women displaying early lumbopelvic movement during a movement presumed to not be affected by limb tissue stiffness (P>.05). Similar results were obtained when analyzing only the subsets of subjects who reported an increase in symptoms with a specific test. CONCLUSION: Our results provide data to suggest men and women with LBP may move differently in the lumbopelvic region during clinical tests of limb movements and movements potentially affected by limb tissue stiffness. Recognition of gender differences in prevalence of movement impairments is important for improving examination and intervention of people with LBP.

J Orthop Sports Phys Ther 2007;37(12):744-753, published online 29 August 2007. doi:10.2519/jospt.2007.2610

KEY WORDS: limb, lumbar, physical therapy

Electromyographic Analysis of Core Trunk, Hip, and Thigh Muscles During 9 Rehabilitation Exercises

Robert A. Donatelli, Kenji C. Carp, Richard A. Ekstrom

STUDY DESIGN: Prospective, single-group, repeated-measures design. OBJECTIVE: To identify exercises that could be used for strength development and the exercises that would be more appropriate for endurance or stabilization training. BACKGROUND: The exercises analyzed are often used in rehabilitation programs for the spine, hip, and knee. They are active exercises using body weight for resistance; thus a clinician is unable to determine the amount of resistance being applied to a muscle group. Electromyographic (EMG) analysis can provide a measure of muscle activation so that the clinician can have a better idea about the effect the exercise may have on the muscle for strength, endurance, or stabilization. METHODS AND MEASURES: Surface EMG analysis was carried out in 19 males and 11 females while performing the following 9 exercises: active hip abduction, bridge, unilateral-bridge, side-bridge, prone-bridge on the elbows and toes, quadruped arm/lower extremity lift, lateral step-up, standing lunge, and using the Dynamic Edge. The rectus abdominis, external oblique abdominis, longissimus thoracis, lumbar multifidus, gluteus maximus, gluteus medius, vastus medialis obliquus, and hamstring muscles were studied. RESULTS: In healthy subjects, the lateral step-up and the lunge exercises produced EMG levels greater than 45% maximum voluntary isometric contraction (MVIC) in the vastus medialis obliquus, which suggests that they may be beneficial for strengthening that muscle. The side-bridge exercise could be used for strengthening the gluteus medius and the external oblique abdominis muscles, and the quadruped arm/lower extremity lift exercise may help strengthen the gluteus maximus muscle. All the other exercises produced EMG levels less than 45% MVIC, so they may be more beneficial for training endurance or stabilization in healthy subjects. CONCLUSION: Our results suggest these exercises could be used for a core rehabilitation or performance enhancement program. Depending on the individual needs of a patient or athlete, some of the exercises may be more beneficial than others for achieving strength.

J Orthop Sports Phys Ther 2007;37(12):754-762, published online 29 August 2007. doi:10.2519/jospt.2007.2471

KEY WORDS: endurance, lower extremity, spine, stabilization, strength

Manual Therapy Intervention for a Patient With a Total Hip Arthroplasty Revision

Paul D. Howard, Beth Levitsky
STUDY DESIGN: Case report. BACKGROUND: A 73-year-old active woman with a total hip arthroplasty, who later had revision surgery, developed left hip and buttock pain 2 years after the revision surgery, subsequent to lifting her foot while seated. This movement was performed so that her spouse could assist her in putting on her sock and shoe. CASE DESCRIPTION: During the first physical therapy session, the patient exhibited a forward-flexed trunk posture and difficulty weight bearing on the involved lower limb. The patient was successfully treated with manual therapy techniques and a home exercise program. The manual therapy techniques included long-axis hip distraction, lateral hip distraction, posterior-to-anterior hip joint mobilization, and a contract-relax proprioceptive neuromuscular facilitation technique. The patient's home program consisted of long-axis hip distraction, performed by her spouse, and standing lower limb pendular movements into flexion and extension. Pain scale ratings, posture and gait observations, strength, range of motion, and return to functional activities served as outcome measures. OUTCOMES: After 1 physical therapy visit, in which manual therapy techniques were utilized, the patient had a significant decrease in hip symptoms. The patient and spouse were compliant with the home exercise program and continued with physical therapy for 3 more visits, and the patient ultimately became symptom free. The patient returned to all previous activities, including household chores, cooking, and a walking program. The patient was contacted at 6 months, 1 year, and 4 years, and reported no recurrences of hip or buttock symptoms. DISCUSSION: Manual therapy techniques and home exercises described in this case report were apparently effective in eliminating symptoms and returning this patient, who had total hip arthroplasty and revision surgery 2 years earlier, to all previous functional activities after a dressing incident produced hip and buttock symptoms.

J Orthop Sports Phys Ther 2007;37(12):763-768, published online 7 September 2007. doi:10.2519/jospt.2007.2437

KEY WORDS: THA, THR, total hip replacement

Erratum December 2007

Correction to a recent citation of an article originally published by in the Archives of Physical Medicine and Rehabilitation in 2005.

Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290-302.

2007 Author Index

This index includes all authors and co-authors of manuscripts published in the Journal during 2007.

J Orthop Sports Phys Ther 2007;37(12):770-785

The original article was corrected in March 2008, and the amended article PDF is provided here. Please see Correction: A comparison of select trunk muscle thickness change between subjects with low back pain classified in the treatment-based classification system and asymptomatic controls. J Orthop Sports Phys Ther. 2008;38(3):161.

2007 Subject Index

Index by subject of all manuscripts published by the Journal during 2007.

J Orthop Sports Phys Ther 2007;37(12):786-794