PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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2002 - Vol. 10, No. 4
* this issue only available in PDF format
Complex Regional Pain Syndrome I: Management through the Use of Vertebral and Sympathetic Trunk Mobilization
Joshua Cleland, PT, DPT, OCS, Meghann McRae, MPT
Abstract: The purpose of this study was to describe the clinical differential diagnostic process and effective management of an individual presenting with lower-extremity complex regional pain syndrome I (CRPS I). A 50-year-old female 8-weeks status post ORIF right tibia/fibula presented with a warm, red, edematous, hyperhidrotic right lower extremity. She also exhibited hyperalgesia, allodynia, and a positive slump test on the right. The patient satisfied clinical diagnostic criteria for a diagnosis of CRPS I. The subject was treated for 10 sessions over a 3-month period using progressive desensitization, weight-bearing activities, thoracolumbar mobilizations, and a neural mobilization technique referred to as slump long sitting with sympathetic emphasis (SLSSE). An analysis of outcome measures at the time of discharge and at a one-year follow-up demonstrated a significant improvement in both pain and function. Effective management was achieved by addressing both the patient's proximal and distal impairments including thoracolumbar segmental lesions and positive neurodynamic tests. It is speculated that the influence of neural mobilizations to the ipsilateral sympathetic ganglia directly affected the pathophysiology associated with autonomic dysregulation and pain in this subject. This case report provides initial evidence that the SLSSE may be an effective neural mobilization technique in reducing the magnitude of symptoms and improving function in patients with CRPS.
The Journal of Manual & Manipulative Therapy Vol. 10 No. 4 (2002), 188 - 199
Predictive Factors in Poor Inter-Rater Reliability Among Physical Therapists
Chad Cook, PT, MBA, PhD, OCS, COMT, Lori Turney, MPT, Letticia Ramirez, MPT, Andy Miles, MPT, Shane Haas, PT, MSIE, CSCS, Tasos Karakostas, PhD
Abstract: Manual therapy is a widely used form of treatment among physical therapists and has been shown to be effective in the treatment of musculoskeletal disorders. In numerous studies, the reliability of clinicians performing the four grades of mobilization of manual therapy has been poor. A sample of 23 licensed physical therapists participated in quasi-experimental repeated measures designed to determine if predictive factors such as gender or years of experience contribute to inter-rater reliability variances. In this design, therapists performed Grade I, II, III and IV mobilizations on two asymptomatic volunteers at the level of L3, based on resistance defined Grades of Movement. The Kistler Force Plate ™ was used to record mobilization forces for each physical therapist at a rate of 600 data-point measurements per second. Data were assessed to determine if poor inter-rater reliability is reflective of certain predictive variables. The results identified that the independent variables of age, years of experience, gender, frequency of use, education, and background of the rater did not contribute to the overall variance within the study. Further investigation is required as to what determines the poor inter-rater reliability of spinal accessory mobilizations by practicing clinicians.
The Journal of Manual & Manipulative Therapy Vol. 10 No. 4 (2002), 200 - 205
Thumb Pain in Physiotherapists: Potential Risk Factors and Proposed Prevention Strategies
Suzanne J. Snodgrass, BSc(PT), ATC, Darren A. Rivett, BAppSc(Phty), MAppSc(ManipPhty), PhD
Abstract: Work-related injury to the thumb has become a recognized problem for physiotherapists who perform manual techniques in the treatment of patients with orthopaedic musculoskeletal disorders. Pain in the thumb often causes physiotherapists to alter their methods of treatment, which may decrease the effectiveness of physiotherapy services and lead to increased financial costs for patients and their funding agencies. Substantial numbers of physiotherapists have changed their specialty area or left the profession because of work-related injury, which further burdens education and healthcare systems. The extent of the influence of individual risk factors and preventive strategies on the development of thumb pain in physiotherapists has not been conclusively determined. This paper discusses the potential causes and consequences of thumb pain in physiotherapists, and reviews the supporting evidence on the incidence, risk, prevention, and treatment of this common occupational injury in physiotherapists.
The Journal of Manual & Manipulative Therapy Vol. 10 No. 4 (2002), 206 - 217
Effect of Mobilization of the Anterior Hip Capsule on Gluteus Maximus Strength
Scott Yerys, PT, MS, Howard Makofsky, PT, DHSc, OCS Charles Byrd, PT, MS, Joseph Pennachio, PT, MS, Jonathan Cinkay, PT, MS
Abstract: Loss of hip extension is often compensated for by extension of the lumbar spine. This compensation can result in hypermobility and ultimately be a source of low back dysfunction and pain. Joint mobilizations have been known to return physiologic and accessory motion to hypomobile structures. Mobilization has also been demonstrated to improve muscular strength when secondary to joint hypomobility. The purpose of this study was to determine the usefulness of posteroanterior (P-A) hip-joint mobilization in improving strength of the gluteus maximus muscle. Forty subjects were randomly assigned to a control group (Grade I P-A mobilization) and an experimental group (Grade IV P-A mobilization). The subjects performed a pretest/posttest set of five isometric repetitions on the Cybex NormTM isokinetic machine. The peak torque was determined for both pretest and posttest measurements. The data collected were analyzed using an independent t-test with a significance level of p < .05. The results demonstrated a statistically significant difference between the experimental and control groups (t=1.68, p=0.002). This study demonstrated a significant increase in gluteus maximus strength in response to Grade IV P-A mobilizations performed on the anterior hip capsule. Clinicians can utilize these findings in everyday practice to improve muscle strength by integrating manual therapy with therapeutic exercise.
The Journal of Manual & Manipulative Therapy Vol. 10 No. 4 (2002), 218 - 224
* this issue only available in PDF format
