Publication of an article in a peer-reviewed journal does not guarantee that the evidence is valid, sincere efforts of reviewers and editors notwithstanding. For the sake of our patients, clinicians must consider strengths and weaknesses of research literature, rejecting some evidence and embracing other relevant research with adequate protections against key validity threats. Although it's almost impossible to find published research without some flaw or limitation, the savvy reader will be able to distinguish the fatal flaws from lesser problems. Even when an excellent article is found, we must realize that clinical research is cumulative; a single article will rarely provide a definitive answer about a clinical topic. Academicians have an obligation to perform this same evidence-sorting and interpretive process, and to make the process transparent while teaching, so that students can learn to do it for themselves.

J Orthop Sports Phys Ther. 2005; 35(5):271-272. doi:10.2519/jospt.2005.0105

Key Words: evidence, research

Pathology of the superior aspect of the glenoid labrum (SLAP lesion) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical evaluation and proper identification of the extent of labral injury is important to determine the most appropriate nonoperative and/or surgical management. Postoperative rehabilitation is based on the specific surgical procedure as well as the extent, location, and mechanism of labral pathology and associated lesions. Emphasis is placed on protecting the healing labrum, while gradually restoring range of motion, strength, and dynamic stability of the glenohumeral joint. The purpose of this paper is to provide an overview of the anatomy and pathomechanics of SLAP lesions and review specific clinical examination techniques used to identify these lesions, including 3 newly described tests. Furthermore, a review of the current surgical management and postoperative rehabilitation guidelines is provided.

J Orthop Sports Phys Ther. 2005;35(5):273-291. doi:10.2519/jospt.2005.1701

Key Words: dynamic stability, glenohumeral, rehabilitation, shoulder

Study Design: Controlled laboratory study. Objectives: To determine whether gender differences in electromyographic (EMG) activity of hip-stabilizing muscles are present during single-leg landing. Background: Numerous factors may explain the greater rate of anterior cruciate ligament (ACL) injuries in female athletes. However, gender differences in hip muscle activity during dynamic events have not been well characterized. Methods and Measures: Twenty-two Division I collegiate athletes (13 female, 9 male) performed drop landings from 30.5- and 45.8-cm heights. Surface EMG was used to examine relative muscle activity from 200 milliseconds prior to initial contact to 250 milliseconds postcontact. Peak and mean values for each muscle (gluteus maximus, gluteus medius, rectus femoris) in each time epoch were analyzed using 2 ×2 (group by height) analyses of variance (ANOVAs) to determine significance. Results: Females demonstrated lower gluteus maximus peak (mean ± SD, 69.5 ± 30.2 versus 98.0 ± 33.4 percent maximum voluntary contraction [%MVIC]; P = .019) and mean (mean ± SD, 37.5 ± 15.6 versus 53.9 ± 18.0 %MVIC; P = .018) muscle activation during the postcontact phase of landing than males. Furthermore, females demonstrated greater peak rectus femoris activity during the precontact phase (mean ± SD, 33.6 ± 18.5 versus 18.7 ± 8.2 %MVIC; P = .029). A positive effect of drop height on relative activity of all muscles was observed during both phases (P<.05). Conclusions: Females utilize different muscular activation patterns compared to males (ie, decreased gluteus maximus and increased rectus femoris muscle activity) during landing maneuvers. Decreased hip muscle activity and increased quadriceps activity may be important contributors to the increased susceptibility of female athletes to noncontact ACL injuries.

J Orthop Sports Phys Ther. 2005;35(5):292-299. doi:10.2519/jospt.2005.1734

Key Words: ACL, hip stability, knee

Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks, such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, ‘‘How does one proceed in the absence of certainty?’’ Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.

J Orthop Sports Phys Ther. 2005;35(5):300-306. doi:10.2519/jospt.2005.1312

Key Words: cervical spine, diagnostic accuracy, manipulation, mobilization, vertebral artery

Study Design: Descriptive correlational study. Objectives: To determine relationships between aspects of turnout and injury history in preprofessional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout. Background: In Australia 50% of professional dancers currently have persistent or recurrent injuries, with 36% of these injuries commencing before 18 years of age (preprofessional level). Overuse or nontraumatic dance injuries are often attributed to faults in technique, with poor turnout and inappropriate compensatory strategies consistently cited as the main cause. Methods and Measures: Twenty-nine dancers (24 female), aged 15 to 22 years, were recruited from a preprofessional classical ballet program. Measurements were taken of passive and active hip external rotation (ER) range of motion (ROM) in supine, and functional turnout angles in standing. Three turnout variables were derived: active ER lag, compensated turnout, and static-dynamic turnout difference. Injury history over the previous 2 years was ascertained by interview. Pearson product moment and Spearman rank correlation coefficients were used to determine associations between turnout variables and injury history. Results: All dancers reported a history of injury, with 93.1% reporting a history of nontraumatic injuries and 41.4% reporting a history of traumatic injuries. Number and severity of nontraumatic injuries were associated with reduced functional turnout (r or rho >0.38; P<.04), but not with hip ER ROM. Number and severity of traumatic injuries were not associated with turnout. No correlation was found between hip ER ROM and functional turnout. Conclusions: Functional measures of turnout are more relevant than hip ER ROM to prevalence of nontraumatic dance injuries. Control of turnout in classical ballet dancers should be assessed dynamically and in functional positions.

J Orthop Sports Phys Ther. 2005;35(5):307-318. doi:10.2519/jospt.2005.1600

Key Words: dance, external rotation, hip, injury

Study Design: Resident’s case problem. Background: A 26-year-old male sought physical therapy services via direct access secondary to a flare-up of a chronic low back pain condition. The patient complained of recent onset of lumbosacral joint pain, including (1) constant right-sided deep-bruise sensation, (2) intermittent right-sided sharp stabbing pain, and (3) constant bilateral aching. The patient’s past medical history included a hyperextension low back injury while playing football at age 17. Physical examination revealed (1) deep pain with palpation over the right lumbosacral joint region, (2) sharp right lumbosacral joint pain with 1 repetition of active trunk backward bending, and (3) a marked increase in pain and joint hypomobility with right unilateral joint assessment at the L4 and L5 spinal levels. Diagnosis: The examining therapist referred the patient for radiographic evaluation due to strong suspicions of a pars interarticularis bony defect. Lumbar plain films, oblique views, revealed an L5 bilateral pars defect, leading to a diagnosis of a longstanding bilateral L5 spondylolysis. Discussion: Patients with low back pain often seek physical therapy services. Identification of pathology requiring examination by other health care providers, leading to patient referral to other health care practitioners, is a potential important outcome of the therapist’s examination. This resident’s case problem illustrates the importance of a systematic examination scheme, including a thorough medical screening component that led to a patient referral for radiographic evaluation. The resultant diagnosis, although not representing serious pathology, did impact the therapist’s patient plan of care.

J Orthop Sports Phys Ther. 2005;35(5):319-326. doi:10.2519/jospt.2005.1564

Key Words: fracture, lumbar spine, pars interarticularis, radiograph

The Second International Ankle Symposium was a multidisciplinary conference focused on topics related to ankle instability and associated pathologies and was held on the campus of the University of Delaware in October 2004. The first symposium was held in Ulm, Germany in 2000 and its success served as the catalyst for the second symposium. The most recent symposium brought together over 75 clinicians and scientists from disciplines such as physical therapy, athletic training, orthopedics, podiatry, and biomechanics. Participants represented many countries, including Australia, Belgium, Germany, Ireland, Japan, Sweden, and the United States. A call for abstracts was initially distributed in the fall of 2003. Members of the organizing committee reviewed all submitted abstracts for scientific merit. Thirty-two abstracts were accepted and presented at the symposium. The educational program consisted of several invited plenary lectures from internationally recognized experts and 19 podium and 13 poster presentations of original research. The symposium also provided for considerable scholarly interaction among the attendees. The meeting culminated with the formation of the International Ankle Consortium, a multidisciplinary group aiming to further the scientific understanding and to improve the clinical care of ankle instability and related pathologies. This group will work to develop standards for ankle instability research, such as guidelines for inclusion and exclusion criteria in ankle instability studies and development of a standardized clinical outcomes tool for use in ankle instability studies. Plans have already commenced for the third International Ankle Symposium to be held at University College Dublin, Dublin, Ireland, September 1-3, 2006. This special supplement to the Journal of Orthopaedic & Sports Physical Therapy includes a summary statement, synopses of 5 plenary lectures, and the abstracts of the original research presentations from the second International Ankle Symposium.

J Orthop Sports Phys Ther. 2005; 35(5):A1-A28.  doi:10.2519/jospt.2005.0301

Key Words: ankle instability, outcomes tool, clinical care