PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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2003 - Vol. 11, No. 1
Formative Dynamics: The Pelvic Girdle
Bruce A. Franke Jr., PT, MSc, OCS, FAAOMPT, MTC
Abstract: Altered mechanics and/or forces related to the lumbar/pelvic/hip regions may result in pelvic-girdle dysfunction and or instability, which then may contribute to the development, persistence, or reoccurrence of low back pain (LBP). This series of three case studies outlines an integrated biomechanical clinical evaluation and treatment approach utilizing manual care, education, and exercise in the treatment of patients with chronic pelvic-girdle dysfunction and/or instability. This integrated approach was used on three patients with a primary diagnosis of sacroiliac joint (SIJ) dysfunction. These patients had similar patterns of altered mechanics, movement patterns, and muscle imbalances. The treatment they received was an integration of three components: 1) restoration of optimal soft tissue/joint mechanics to the thoracic/lumbar/pelvic region and lower quarters; 2) patient education in specific self-stretching/mobilization exercises, spinal/pelvic stabilization exercises, and body mechanics training; 3) pelvic external bracing and/or prolotherapy injections (sclerosing) for those patients with hypermobile/unstable, chronic and recurring pelvic girdle dysfunction. Treatment varied from 24 to 35 visits over a 3-4 month period. The treatment outcomes demonstrated a correlation between improved patient function and pain reduction after restoring optimal mobility, functional strength, and movement patterns. These benefits lasted well beyond the course of treatment. Further research is needed to determine whether patients with chronic pelvic-girdle dysfunction and/or instability who receive this integrated approach will consistently achieve lasting pain relief and restoration of function when compared with no treatment or other treatment approaches.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 1 (2003), 12 - 40
Acceptance Speech-2002 John McM. Mennell Service Award
Stephania L. Bell, MS, PT, OCS, Patricia A. McCord, PT, FAAOMPT
Abstract: The following acceptance speech for the John McM. Mennell Service Award was presented at the 8th annual meeting of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) in Orlando, Florida, on October 4, 2002. Before all else is said, we want to thank the Academy, the Executive Board, and the membership for this great honor you are bestowing on us. When we reflected on the past recipients, it was hard for us to imagine that we were joining such an esteemed list: Jane Wolthers, Helene Fearon, Steve McDavitt, and Carol Jo Tichenor. These previous recipients, leaders, and activists in our profession have made a difference in PT practice in many arenas: clinical, educational and political. We recognized a common theme among us all: we are all passionate about what we do. This theme certainly extends to everyone in the audience or we would not be here as an organization.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 1 (2003), 41 - 42
Differential Diagnosis and Treatment of Upper Thoracic Pain: A Case Study
Meghann McRae, MPT, Joshua Cleland, PT, DPT, OCS
Abstract: An estimated 80% of Americans will suffer from back pain in their lifetime. Differential diagnosis of upper thoracic pain can be difficult secondary to complicated anatomy, biomechanics, function, proximity to vital organs, and articulation with ribs. The purpose of this study is to describe a complete clinical exam of a patient presenting with upper thoracic pain, using the hypothetico-deductive clinical reasoning process and evidenced-based clinical test and measures. The subject was a 32-year-old male with a chief complaint of tightness/discomfort under the right shoulder blade, of insidious onset approximately one month in duration. An extensive examination including a complete history, systems review and administration of tests and measures combined with the hypothetico-deductive clinical reasoning process was used. The patient's lung infection (with excessive coughing) within the previous months (determined by a history and systems review), along with the systematic clinical reasoning process, revealed two possible origins of thoracic pain: visceral referral or serratus posterior superior (SPS) muscle trigger point. The final diagnosis was SPS trigger point (mechanically reproduced with palpation). At the two-week follow-up, the patient reported complete resolution of symptoms. An assessment that the SPS trigger point was the origin of pain was achieved using the hypothetico-deductive clinical reasoning process. This case study demonstrates an accurate diagnosis followed by an efficient treatment plan.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 1 (2003), 43 - 48
A Multi-Structural Approach to Treatment of a Patient With Sub-Acromial Impingement: A Case Report
Gisela Sole, BSc (Physio), MSc (Med) Exercise Science
Abstract: Sub-acromial impingement is a condition commonly seen by physical therapists, however little evidence is available regarding the efficacy of this treatment. This case report describes the use of manual therapy and exercise, using a multi-structural approach to manage this condition. The subject was a 48-year-old retired physiotherapist complaining of recurrent shoulder pain during daily activities, although her daily function was not limited. Passive joint mobilization techniques of the cervical spine, costovertebral joints, and the glenohumeral joint as well as soft tissue mobilization techniques of the rotator cuff muscles were used. Exercises were prescribed to "set" the scapula in an optimal position and to facilitate and strengthen the rotator cuff muscles. After two treatments, the patient consulted an orthopaedic surgeon due to imminent decrease in funding for her treatment and a cortisone injection was administered. This decreased her pain immediately by 90%. However, two months later she attended three further physical therapy treatments because of recurrence of the pain. Six months after these treatments she was still pain-free. This case illustrates that physical therapy can be effective in the treatment of sub-acromial impingement, using a multi-structural approach to treatment.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 1 (2003), 49 - 55
