PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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2003 - Vol. 11, No. 4
* this issue only available in PDF format
Measurement of Upper Cervical Flexion and Extension with the 3-Space Fastrak Measurement System: A Repeatability Study
Mohsen Amiri, MPhty, BPhty, Gwendolen Jull, PhD, MPhty, FACP, Joanne Bullock-Saxton PhD, MPhtySt, BPhty (Hons)
Abstract: Most external measurement devices do not allow ready differentiation of upper cervical flexion and extension from total cervical movement. This study investigated the "within" and "between-days" repeatability of measurement focused on upper cervical flexion and extension in three dimensions using the Fastrak, a 3-Space measurement system, on 21 subjects. To localize the measurement, one sensor of the Fastrak was centered over the subject's forehead and the other was held manually over the C2 spinous process. Three repetitions of upper cervical flexion (nod of the head) and extension (chin lift) were performed in each trial. Two trials were performed on the first day with the third trial one-week later. Results indicated high levels of repeatability for "within" and "between-days" measurements (ICC2,1: 0.97 to 0.99). The mean ranges of upper cervical flexion and extension were 15.03º ± 2.80º and 23.32º ± 4.20º respectively, were accompanied by a small amount of lateral flexion and rotation, predominantly in a contralateral pattern. The method appears suitable for clinical evaluation of upper cervical motion.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 4 (2003), 198 - 203
The Use of an Educational Model in the Improvement of Student Reliability in Finding R1
Eric Anson, MPT, Chad Cook, PT, MBA, PhD, OCS, COMT, Cecilia Camacho, MPT, Brian Gwilliam, MPT, Tasos Karakostas, PhD, MPT
Abstract: Low inter-therapist reliability determining R1 has been reported in numerous studies. A lack of a standardized teaching method for mobilizations is frequently suggested as a reason for the poor reliability. The purpose of this study was to determine if a standardized educational intervention could improve the inter-therapist reliability in physical therapy students. In a pre- post-test repeated measures design, 12 physical therapy students performed 3 sets of mobilization oscillations in an attempt to find R1. The mobilization force of R1 was indirectly measured using the Kistler Force Plate. A one-hour educational session was administered between pre- and post-testing. Pre-test values were poor (ICC = 0.0326; p = 0.309). The post-test scores did show improved reliability greater than chance (ICC = 0.416; p < 0.0001). Although the post-test scores were not significantly better than the pre-test scores, the trend toward improved reliability warrants further investigation of the education protocol.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 4 (2003), 204 - 212
Position-Assisted Combination Technique (PACT) in the Management of Type-II Impairment in the Thoracic and Lumbar Spine
Howard W. Makofsky, PT, DHSc, OCS
Abstract: In the osteopathic literature, manipulative techniques are classified as either direct or indirect. Direct technique passively mobilizes articular and myofascial tissues against an opposing restrictive barrier, whereas indirect manipulation moves these same tissues away from the motion barrier into tissue "ease." Direct technique is suited for low reactive tissues characterized as stiff and tight, whereas indirect technique is indicated when there is reflex muscle splinting associated with somatic and/or neurologic pain. In this article, direct and indirect forms of manipulation are combined into one technique and referred to as Position-Assisted Combination Technique (PACT). The theory and clinical application of PACT is described and illustrated for common Type-II impairments (FRS, ERS) with major motion loss present in the thoracic and lumbar spine. The integration of other forms of spinal manual therapy into PACT, including muscle energy technique, non-thrust mobilization/manipulation, and high-velocity/low-amplitude thrust is described in detail.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 4 (2003), 213 - 222
Lower Extremity Pain of Lumbar Spine Origin: Differentiating Somatic Referred and Radicular Pain
Jeffery R. Robinson, PT, FAAOMPT
Abstract: The primary purpose of this literature review is to determine if descriptions of the quality of lower extremity pain originating in the lumbar spine can reliably be used to identify potential structures at fault. The secondary purpose of this review is to determine if the segmental level of the spine can be identified based on the location of the pain in the lower extremity in circumstances where the lower extremity pain is of lumbar spine origin. A literature review revealed that somatic structures from the lumbar spine can refer pain into the lower extremities. The quality of somatic referred pain is most commonly perceived as deep, achy, diffuse, and poorly localized. Somatic structures of the lumbar spine do not refer pain consistently in a segmental pattern into the lower extremity, and the concept of sclerotomes is not supported in the current literature. Radicular pain is described as intense, radiating, severe, sharp, darting, lancinating, and well localized. It is generally accepted that radicular pain from L5 and S1 consistently follows a dermatomal pattern into the lower extremity most of the time, especially if the pain extends past the ankle. It is difficult to distinguish between L5 and S1 radicular pain patterns above the ankle. More research is needed in order to draw conclusions concerning the L1-L4 and S2 nerve roots as to whether or not they consistently cause radicular pain into their respective dermatomes. It appears, based on the literature, one cannot develop a reliable, consistent initial hypothesis of which somatic structure(s) (ligaments, vertebrae, dura, musculature, zygoapophyseal joints, or intervertebral discs) may be at fault based on the description of the pain; however, the quality of the pain may assist the clinician in hypothesizing whether the patient's problems are predominantly somatic in origin, of nerve root origin, or a combination of both. Based on the literature, one cannot identify what segmental level of the spine may be involved based on the location of the pain if the pain is somatic in origin. However, for radicular pain, the pattern will more likely follow a dermatome if it is caused by a L5 or S1 nerve root.
The Journal of Manual & Manipulative Therapy Vol. 11 No. 4 (2003), 223 - 234
* this issue only available in PDF format
