PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Human Ligamentum Nuchae in the Elderly: Its Function in the Cervical Spine

Paula Allia, PT, DHSc, MTC, OCS, Gary Gorniak, PT, PhD

Abstract: The human ligamentum nuchae is commonly referenced as a site for muscle at- tachments in the neck, but it is rarely described as being associated with stability of the cervical spine. This descriptive anatomical study re-examines the structure of the ligamen- tum nuchae in the context of spinal stability and compares this information with previous studies on the structure and function of this ligament. Dissections were performed on 13 elderly cadavers to observe the attachments and fiber direction of the ligamentum nuchae. Digital photographs were taken during each phase of the dissection, and all of the parts of the ligament were observed. This observational study shows that the ligamentum nuchae has four portions: A central cord-like portion, a central septal portion, and two paired "fan- like" portions. Only the cord-like portion provides a site for muscle attachment. From these observations, the potential contributions of all portions of the ligamentum nuchae to cervical stability are discussed.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 1 (2006), 11 - 21

Lumbar Isthmic Spondylolisthesis Detection with Palpation: Interrater Reliability and Concurrent Criterion-Related Validity

Jeff W. Collaer, PT, MHSc, D. Michael McKeough, PT, EdD, William G. Boissonnault, PT, DHSc, FAAOMPT

Abstract: Lumbar spinous process palpation to detect spondylolisthesis is a technique fre- quently used by clinicians and taught in professional education courses, but it has not been shown to be reliable or valid. The purpose of this study was to assess the diagnostic utility of lumbar spinous palpation as a means of detecting isthmic spondylolisthesis in patients with low back pain. Interrater reliability was assessed by pair-wise comparison of the findings of three therapists palpating the spinous processes on 30 subjects with low back pain. Validity was evaluated by comparing the findings of one therapist to a reference standard of plain film radiographs in 44 patients. The pair-wise kappa values were poor to fair at 0.179, 0.394, and 0.314. Validity testing revealed a sensitivity of 60% (95% CI, 14.7-94.7) and a specificity of 87.2% (95% CI, 72.6-95.7%). The positive likelihood ratio was 4.68 (95% confidence interval (CI): 1.57-13.88) and the negative likelihood ratio was 0.458 (95% CI, 0.155-1.35). Both likelihood ratios produced only a small change in pre- to post-test probabilities. Based on our results, static spinous process palpation by itself is not a definitive method for the detection of spondylolisthesis. However, the study data do not preclude the possible future use of palpation along with other, yet to be identified, validated predictive variables for isthmic spondylolisthesis.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 1 (2006), 22 - 29

Test-Retest Reliability and Face Validity of a Modified Neural Tissue Provocation Test in Patients with Cervicobrachial Pain Syndrome

Brigitte van der Heide, PT, Grad Dip Manip Ther, MSc, Claire Bourgoin, MManipTher, MCSP, MMACP, Georgina Eils, MManipTher, PT, Bjorn Garnevall, MManipTher, PT, Marie Blackmore, PhD

Abstract: The Neural Tissue Provocation Test (NTPT) via median nerve is used to assess the compliance and mechanosensitivity of neural tissues in the upper limb. However, the standard requires 90 degrees of shoulder abduction, a position that may be unsuitable for patients with cervicobrachial pain, who often present with limited range of shoulder abduction. This study, therefore, examined the test-retest reliability of pain responses to a modified testing procedure in 12 subjects with unilateral cervicobrachial pain syndrome (CBPS). The test was performed on the symptomatic and asymptomatic arm with the cervical spine in neutral position. The angles of elbow extension at the onset of pain/pain threshold (P1) and at the limitation of elbow extension due to pain/pain tolerance (P2) were measured using an external trigger and an electrogoniometer. Results showed that the onsets of P1 and P2 were sufficiently reliable across trials to warrant clinical use of this test (ICC_3,1 >= 0.925). The elbow extension angles associated with pain threshold and pain tolerance were significantly lower in the symptomatic arm compared to the asymptomatic arm (p=0.003). In the majority of subjects, their exact symptoms were reproduced in the symptomatic arm and normal sensory responses occurred on the other side. The difference between sides in the elbow extension angle associated with pain responses, the type of pain responses, and the available elbow extension range of motion suggest that this modified version of the NTPT via median nerve has face validity for the assessment of the presence of heightened mechanosensitivity of neural tissues in patients with CBPS.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 1 (2006), 30 - 36

High-Velocity Thrust Technique for Traumatic Onset Lateral Elbow Pain

Brett Windsor, PT, OCS, COMT, FAAOMPT

Abstract: A 35 year-old male presented to physical therapy following a fall onto his out- stretched right hand. He developed pain and dysfunction in the right lateral epicondyle region. The patient was assessed and received a physical therapy diagnosis of abducted ulna syndrome. The patient was treated with a high-velocity, low-amplitude manipulation technique to the humeroulnar joint. This technique coincided with a restoration in the patient's normal function, along with an elimination of painful symptoms. This case study suggests that a high-velocity, low-amplitude manipulation technique performed by a physical therapist may play an important role in the successful treatment of traumatically induced lateral epicondyle pain.

The Journal of Manual & Manipulative Therapy Vol. 14 No. 1 (2006), 37 - 47

Management of Lumbar Spinal Stenosis through the Use of Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series

Douglas S. Creighton, DPT, OCS, FAAOMPT, John Krauss PhD, PT, OCS, FAAOMPT, Beth Marcoux, PhD, PT

Abstract: Lumbar spinal stenosis is a narrowing of the spinal canal or intervertebral foramen that can produce low back pain and leg pain and weakness. Surgical intervention is commonly performed to relieve these symptoms. Symptom reduction and longitudinal management of functional deficits with conservative care is less well documented. The purpose of this case series was to describe the outcomes of a conservative physical therapy program consisting of low- and high-velocity translatoric manipulations of T1-T9 and L1-L3, and two lumbar flexion exercises on 6 subjects diagnosed with lumbar spinal stenosis and neurogenic clau- dication. A treadmill test was repeated on a weekly basis and at discharge for each patient. All six subjects demonstrated improvements in treadmill walking time prior to the onset of neurogenic claudication (range: 1 min 34 sec to 26 min); in Oswestry Low Back Pain Dis- ability Index scores (range: 7.5% to 64.7%); and in McGill Pain Questionnaire scores (range: 25% to 57%). Five subjects were measured using the Schober technique, and all showed improvement in thoracolumbar flexion mobility. Combined use of translatoric manipulation and spinal flexion exercises may have resulted in improved spinal flexibility, ambulatory abilities, and pain and functional status in six subjects with lumbar spinal stenosis.
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Acceptance Speech for the John McM. Mennell Service Award

Ben F. Massey, Jr., PT, MA

Abstract: Mr. President of the Academy, Mr. President of the International Federation of Orthopaedic Manual Physical Therapy, members of the Academy's Board of Directors, Members of the Academy, and distinguished guests. I am deeply honored to be the American Academy of Orthopaedic Manual Physical Therapists' 2005 recipient of the John McM. Mennell Service Award. To be recognized by an organization of which one is not a member is truly a distinct honor. But even more meaningful for me is to be recognized by an organization for which I have the deepest respect and personal affection.
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