The purposes of this editorial are to acquaint the physical therapy profession and readers of the JOSPT with an abridged and focused summary of the new anatomical terminology currently being used in health education, scholarly publication, research, and practice, and to provide a rationale for the implemented changes. The current anatomical terms are being utilized in the education and training of students of physical therapy, medicine, and other allied health programs, and are being integrated into clinical practice. Acceptance and adherence to the new standard will enable clear understanding and increase the accuracy of documentation, and improve communication among health care professionals who will all be speaking the same language.

J Orthop Phys Ther. 2004; 34(7):363-367. doi:10.2519/jospt.2004.0107

Key Words: anatomical terminology

Study Design: Clinical trial. Objective: To determine the effect of 2 conservative intervention approaches for functional hallux limitus. Background: Metatarsophalangeal joint (MPJ) sprains are common and can result in long-term sequelae such as persistent pain and loss of range of motion (ROM) secondary to bony proliferation and articular degeneration. It is important to determine the most effective intervention for functional hallux limitus to decrease pain and restore function. Methods and Measures: Twenty individuals with first MPJ pain, loss of motion, and weakness participated in the study. All patients received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick-up exercise, cold packs, and electrical stimulation. Ten of the 20 patients (experimental group) also received sesamoid mobilizations, flexor hallucis strengthening exercises, and gait training. Treatment was provided 3 times a week for 4 weeks. Measurements of first MPJ extension ROM, flexor hallucis strength, and subjective pain level were performed on the first and last visits. Results: Following the 12 therapy sessions, the experimental group achieved significantly greater MPJ extension ROM and flexor hallucis strength and had significantly lower pain levels as compared to the control group (P<.001). Conclusions: These results suggest that sesamoid mobilization, flexor hallucis strengthening, and gait training should be included in the plan of care when treating an individual with functional hallux limitus.

J Orthop Sports Phys Ther. 2004;34(7):368-376. doi:10.2519/jospt.2004.0783

Key Words: foot, manual therapy, metatarsophalangeal joint, turf toe

Study Design: Prospective, researcher-blinded, repeated-measures, randomized complete block design. Objectives: To compare the effects of a single treatment of Pneumatherm, moist heat pack, and a control treatment on hamstring muscle length. Background: Traditionally, heating modalities have been used to facilitate increases in tissue length. The Pneumatherm has been developed over the past 20 years for use in the clinical treatment of a variety of musculoskeletal pathologies. However, there is no published evidence supporting the use of Pneumatherm for improving muscle length. Subjects: Participants consisted of 30 healthy, college-age males taken from a convenience sampling from the University of Indianapolis student population. Methods and Measures: Participants received a 3-treatment sequence on consecutive days. Treatments involved applying the determined modality to the posterior thigh using standard treatment protocols. A hand-held dynamometer was used to establish a consistent passive measurement force to measure hamstring muscle length. Results: A mixed-model analysis of variance with pretest-posttest (3 pretest and 3 posttest measures) and treatment sequence of the modalities (6 sequences of Pneumatherm, moist heat, and control) was completed. The only significant effect was for pretest-posttest measures. Post hoc comparisons revealed that the Pneumatherm posttest value was significantly different from all other measures. There were no differences found between pretest scores and the moist heat and control posttest scores. Conclusions: Our results demonstrate that the Pneumatherm modality is an effective agent for increasing hamstring muscle length following a single 20-minute treatment. In this study, a significant gain in hamstring muscle length was not found following a 1-time treatment with moist heat. The Pneumatherm may be a good option when heat is used to assist in gaining flexibility of the hamstring musculature.

J Orthop Sports Phys Ther. 2004;34(7):377-384. doi:10.2519/jospt.2004.1311

Key Words: hand-held dynamometer, heat modality, muscle length, pulsed heat, therapeutic heat

Study Design: Prospective single-group repeated-measures design. Objectives: To quantify electromyographic (EMG) muscle activity of the infraspinatus, teres minor, supraspinatus, posterior deltoid, and middle deltoid during exercises commonly used to strengthen the shoulder external rotators. Background: Exercises to strengthen the external rotators are commonly prescribed in rehabilitation, but the amount of EMG activity of the infraspinatus, teres minor, supraspinatus, and deltoid during these exercises has not been thoroughly studied to determine which exercises would be most effective to achieve strength gains. Methods and Measures: EMG measured using intramuscular electrodes were analyzed in 10 healthy subjects during 7 shoulder exercises: prone horizontal abduction at 100° of abduction and full external rotation (ER), prone ER at 90° of abduction, standing ER at 90° of abduction, standing ER in the scapular plane (45° abduction, 30° horizontal adduction), standing ER at 0° of abduction, standing ER at 0° of abduction with a towel roll, and sidelying ER at 0° of abduction. The peak percentage of maximal voluntary isometric contraction (MVIC) for each muscle was compared among exercises using a 1-way repeated-measures analysis of variance (P<.05). Results: EMG activity varied significantly among the 7 exercises. Sidelying ER produced the greatest amount of EMG activity for the infraspinatus (62% MVIC) and teres minor (67% MVIC). The greatest amount of activity of the supraspinatus (82% MVIC), middle deltoid (87% MVIC), and posterior deltoid (88% MVIC) was observed during prone horizontal abduction at 100° with full ER. Conclusions: Results from this study provide initial information to develop rehabilitation programs. It also provides information helpful for the design and conduct of future studies.

J Orthop Sports Phys Ther. 2004;34(7):385-394. doi:10.2519/jospt.2004.0665 

Key Words: dynamic stabilization, infraspinatus, supraspinatus, teres minor

Study Design: A repeated-measure crossover design was used. The independent variable was the type of ultrasound (pulsed or continuous) and the dependent variable was intramuscular temperature. Objective: To compare changes in intramuscular temperature resulting from the use of pulsed ultrasound versus continuous ultrasound with an equivalent spatial average temporal average (SATA) intensity. Background: There is a lack of research on the heat-generating capabilities of pulsed ultrasound within human muscle. Methods and Measures: The subjects were 16 healthy volunteers (mean age ± SD, 21.3 ± 2.5 years). Each subject was treated with pulsed ultrasound (3 MHz, 1.0 W/cm ₂, 50% duty cycle, for 10 minutes) and continuous ultrasound (3 MHz, 0.5 W/cm ₂, for 10 minutes) during a single testing session. Tissue temperature returned to baseline and stabilized between treatments and treatment order was randomized. Tissue temperature was measured every 30 seconds using a 26-gauge needle microprobe inserted at a depth of 2 cm in the left medial gastrocnemius muscle. Data were analyzed using a linear mixed model. Results: Treatment with continuous ultrasound produced a mean (±SD) temperature increase of 2.8°C ± 0.8°C above baseline. Treatment with pulsed ultrasound produced a mean (±SD) temperature increase of 2.8°C ± 0.7°C above baseline. Statistical analysis revealed no significant differences in either the extent or rate of temperature increases between the 2 modes of ultrasound application. Conclusion: Pulsed ultrasound (3 MHz, 1.0 W/cm ₂, 50% duty cycle, for 10 minutes) produces similar intramuscular temperature increases as continuous ultrasound (3 MHz, 0.5 W/cm₂, for 10 minutes) at a 2-cm depth in the human gastrocnemius. Spatial average temporal average intensity is an important consideration when selecting pulsed ultrasound parameters intended to deliver nonthermal effects.

J Orthop Sports Phys Ther. 2004;34(7):395-401. doi:10.2519/jospt.2004.1363 

Key Words: heat, physical agents, spatial average temporal average intensity

Study Design: Cross sectional. Objectives: To compare the strength and range of motion of the dominant and Nondominant shoulders of adult female amateur tennis players. The secondary purpose of the study was to examine whether there were any differences in the observed relationships between women with a past history of shoulder pain and those with no history of shoulder pathology. Background: Information on characteristics of the shoulder in amateur female tennis players is scarce, as research has concentrated on highly skilled or male players, despite the cumulative prevalence of shoulder pain in this group. Methods and Measures: Fifty-one female competitive, amateur tennis players (average age, 45 years) were tested bilaterally for shoulder internal/external rotation passive range of motion and isokinetic concentric strength. Results: Shoulder range of motion and strength ratios were comparable between sides. In the dominant arm, the total rotational range of motion was 221°, with an internal to external rotator peak torque ratio of 1.05. External rotator strength was significantly greater in the dominant arm of individuals with no history of pain. Conclusions: Range of motion and strength adaptations widely reported in highly skilled tennis players were not apparent in amateur female players. In assessment and management, clinicians should regard the amateur female tennis player as a separate entity from the highly skilled player.

J Orthop Sports Phys Ther. 2004;34(7):402-409. doi:10.2519/jospt.2004.1203

Key Words: isokinetic, upper extremity, injury