PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

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2008 - Vol. 16, No. 4

Free Content:

Indices	Author Index and Subject Index
Clinimetrics Corner	The Minimal Clinically Important Change Score (MCID): A Necessary Pretense
Free Content	A Morphological Comparison of the Human Lumbar Multifidus by Chemical Dissection
Online-Only Article	The Association of Nutritional Status and Gender with Cross-Sectional Area of the Multifidus Muscle in Establishing Normative Data
Online-Only Article	American Academy of Orthopedic Manual Physical Therapy (AAOMPT): Once Upon a Time. The John McM. Mennell Service Award Recipient Speech
Free Content	Letters to the Editor
Free Content	Abstracts: AAOMPT Conference, 2008
Online-Only Article	Book and Multimedia Reviews

Abstracts:

Editorial: Trample the Weak, Hurdle the Dead: The Tribulations of Integrating Research into Clinical Practice

Chad Cook PT, PhD, MBA, OCS, FAAOMPT, EDITOR IN CHIEF, JMMT

[no abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 194-196

Spinal Manipulative Therapy for Acute Low Back Pain: A Clinical Perspective

MARK J. HANCOCK, PhD, CHRISTOPHER G. MAHER, PhD, JANE LATIMER, PhD

Abstract: Low back pain (LBP) is an extremely common cause of pain and disability. While many treatments for acute LBP exist, one of the most widely used, but also most controversial, is spinal manipulative therapy (SMT). This therapy includes both high-velocity manipulative techniques and low-velocity mobilization techniques. The literature regarding the use of SMT is often conflicting, which explains the difference in recommendations regarding SMT in international LBP guidelines. The lack of a clear tissue diagnosis in the majority of patients with LBP combined with the unknown mechanism of action of SMT adds to the difficulty for clinicians in providing SMT in a logical and effective manner. Despite these limitations, the existing literature does provide some assistance to clinicians on when to provide SMT and how to provide it in an optimal way. This review aims to summarize the key research literature investigating SMT in LBP in order to help clinicians make informed decisions about the use of SMT for their patients with acute LBP.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 198-203

INVITED COMMENTARY: Spinal Manipulative Therapy for Acute Low Back Pain

J. HAXBY ABBOTT, PhD, MScPT, FNZCP

[no abstract available]

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 204-207

INVITED COMMENTARY: Spinal Manipulative Therapy for Acute Low Back Pain

PHIL S. SIZER, JR, PT, PhD

[no abstract available]

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 208-209

Reliability of Joint Mobility and Pain Assessment of the Thoracic Spine and Rib Cage in Asymptomatic Individuals

BRYAN HEIDERSCHEIT, PT, PhD, WILLIAM BOISSONNAULT, PT, DHSc, FAAOMPT

Abstract: Despite the importance of correctly diagnosing a spinal dysfunction, limited research exists related to physical therapists’ ability to reliably identify a joint exhibiting signs of dysfunction. The purpose of this investigation was to determine the inter- and intra-examiner reliability of a thoracic spine and rib cage joint mobility and pain assessment between two experienced manipulative physical therapists. Nine healthy subjects (3 male, 6 female; ages 23-35) without history of mid- or low back pain participated. Posterior-to-anterior pressures were applied to the thoracic spine and rib articulations with anterior-to-posterior pressures applied to the costosternal joints of each subject by two examiners to evaluate joint mobility and pain provocation. Both examiners assessed all subjects twice and were blinded to subject identity. Kappa statistics were calculated using a strict and expanded definition of agreement to determine the between- and within-examiner reliability for each outcome. Intra-examiner reliability of joint mobility assessment ranged from slight to fair based on the strict agreement but improved to good when findings were compared across ± 1 spinal/rib level. Pain provocation reliability increased to very good under the expanded agreement; however, this finding should be viewed with caution due to limited pain prevalence in the subject sample. Selected clinical prediction rules, applied to the care of individuals with back pain, characterize the patient’s regional mobility simply as hypomobile, normal, or hypermobile; consequently, we feel the results of an expanded definition of agreement may be more appropriate for clinical practice. Further research is needed to determine the reliability in individuals with thoracic spine and rib cage symptoms.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 210-216

Multimodal Management of Mechanical Neck Pain Using a Treatment Based Classification System

MEGAN M. HEINTZ, PT, DPT, CSCS, ERIC J. HEGEDUS, PT, DPT, MHSc, OCS, CSCS

Abstract: The purpose of this case study was twofold: 1) to illustrate the use of a treatment-based classification (TBC) system to direct the early intervention of a patient with mechanical neck pain, and 2) to show the progression of this patient with multimodal-modal intervention. The patient exhibited axial neck pain with referral into her upper extremity. Her pain peripheralized with cervical range of motion and centralized with joint mobilization placing her primarily in the centralization category. Her poor posture and associated muscle weakness along with the chronicity of symptoms placed her secondarily into the exercise and conditioning group resulting in a multi-modal treatment as the patient progressed. Although the design of this case report prevents wide applicability, this study does illustrate the effective use of the TBC system for the cervical spine as captured by accepted outcomes measures.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 217-224

A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia

CHRISTOPHER R. HERD, PT, DPT, CSCS, BRENT B. MESERVE, DPT

Abstract: Lateral epicondylalgia is a commonly encountered musculoskeletal complaint. Currently, there is no agreement regarding the exact underlying pathoanatomical cause or the most effective management strategy. Various forms of joint manipulation have been recommended as treatment. The purpose of this study was to systematically review available literature regarding the effectiveness of manipulation in treating lateral epicondylalgia. A comprehensive search of Medline, CINAHL, health Source, SPORTDiscus, and the Physiotherapy Evidence Database ending in November 2007 was conducted. Thirteen studies, both randomized and non-randomized clinical trials, met inclusion criteria. Articles were assessed for quality by one reviewer using the 10-point PEDro scale. Quality scores ranged from 1-8 with a mean score of 5.15 ± 1.85. This score represented fair quality overall; however, trends indicated the presence of consistent methodological flaws. Specifically, no study achieved successful blinding of the patient or treating therapist, and less than 50% used a blinded outcome assessor. Additionally, studies varied significantly in terms of outcome measures, follow-up, and comparison treatments, thus making comparing results across studies difficult. Results of this review support the use of Mulligan's mobilization with movement in providing immediate, short-, and long-term benefits. In addition, positive results were demonstrated with manipulative therapy directed at the cervical spine, although data regarding long-term effects were limited. Currently, limited evidence exists to support a synthesis of any particular technique whether directed at the elbow or cervical spine. Overall, this review identified the need for further high-quality studies using larger sample sizes, valid functional outcome measures, and longer follow-up periods.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 225-237

Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial

AIMIE F. KACHINGWE, PT, EdD, OCS, FAAOMPT, BETH PHILLIPS, PT, DPA, ERIC SLETTEN, MD, SCOTT W. PLUNKETT, PhD

Abstract: The purpose of this double-blind, randomized controlled pilot study was to compare the effectiveness of four physical therapy interventions in the treatment of primary shoulder impingement syndrome: 1) supervised exercise only, 2) supervised exercise with glenohumeral mobilizations, 3) supervised exercise with a mobilization-with-movement (MWM) technique, or 4) a control group receiving only physician advice. Thirty-three subjects diagnosed with primary shoulder impingement were randomly assigned to one of these four groups. Main outcome measures included 24-hour pain (VAS), pain with the Neer and Hawkins-Kennedy tests, shoulder active range of motion (AROM), and shoulder function (SPADI). Repeated-measures analyses indicated significant decreases in pain, improved function, and increases in AROM. Univariate analyses on the percentage of change from pre- to post-treatment for each dependent variable found no statistically significant differences (P < 0.05) between the four groups. Although not significant, the MWM and mobilization groups had a higher percentage of change from pre- to post-treatment on all three pain measures (VAS, Neer, Hawkins-Kennedy). The three intervention groups had a higher percentage of change on the SPADI. The MWM group had the highest percentage of change in AROM, and the mobilization group had the lowest. This pilot study suggests that performing glenohumeral mobilizations and MWM in combination with a supervised exercise program may result in a greater decrease in pain and improved function although studies with larger samples and discriminant sampling methods are needed.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 238-247

The Comparative Prognostic Value of Directional Preference and Centralization: A Useful Tool for Front-Line Clinicians?

AUDREY LONG, BSc, PT, STEPHEN MAY, MSc, TAK FUNG, PhD

Abstract: abstract: A large number of prognostic factors have been associated with recovery from an episode of back pain, and much emphasis has been placed on psychosocial prognostic factors. The large number of prognostic factors and the lack of comparative analysis of different factors make use of these difficult in clinical practice. The aim of this study was to evaluate the comparative usefulness of a range of factors to predict outcome using data from a randomized controlled trial (RCT) in which 312 patients with sub-acute to chronic back pain received a mechanical evaluation and were sub-grouped based on the presence or absence of directional preference (DP). Patients were then randomized to treatment that was matched or unmatched to that DP. Patients with a minimal reduction of 30% in Roland- Morris Disability Questionnaire (RMDQ) score were defined as the good outcome group. Seventeen baseline variables were entered into a step-wise logistic regression analysis for the ability to predict a good outcome. Of the patients, 84 met the good outcome criteria and had a mean RMDQ decrease of 58.2% (9.8 points) in 4 visits. Leg pain, work status, depression, pain location, chronicity, and treatment assignment were significant predictors of outcome in univariate analysis. Only leg bothersomeness rating and treatment assignment survived multivariate analysis. Subjects with DP/centralization who received matched treatment had a 7.8 times greater likelihood of a good outcome. Matching patients to their DP is a stronger predictor of outcome than a range of other biopsychosocial factors.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), 248-254

Clinimetrics Corner: The Minimal Clinically Important Change Score (MCID): A Necessary Pretense

Chad E. Cook, PT, PhD, MBA, OCS, FAAOMPT

Abstract: Minimal clinically important differences (MCID) are patient derived scores that reflect changes in a clinical intervention that are meaningful for the patient. At present, there are a number of different methods to obtain an MCID, as there are a number of different factors that can influence the MCID value. This clinimetric corner outlines the hidden challenges associated with identifying a viable MCID and possible suggestions to improve the future development of these single scores.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), E82-E83

A Morphological Comparison of the Human Lumbar Multifidus by Chemical Dissection

M. ELAINE LONNEMANN DPT, MSC, OCS, MTC, STANLEY V. PARIS PhD, PT, NZSP, MCSP, GERARD C. GORNIAK PhD, PT

Abstract: This anatomical study describes the morphology of the human lumbar multifidus muscle through gross and chemical dissection of fresh cadavers. Previous morphological descriptions were analyzed with regard to fascicular divisions and cleavage planes. Gross dissection was performed on the lumbar multifidus of four fresh adult human cadavers and four preserved cadavers. Gradual chemical dissection using nitric or formic acid was used for connective tissue digestion to enhance the documentation of muscle fiber direction. Results revealed four distinct layers of the lumbar multifidus separated by cleavage planes. The superficial layer was more extensive than previously described with bony attachments at both the origin and insertion at several vertebral levels. The attachments of the second through fourth layers differed in that distinct cleavage planes between the various fascicles were not found with chemical dissection. The lumbar multifidus has a multipennate fiber arrangement, and the fascicles between the various layers inter-attach. Inter-fascicle attachment differs with the description by Macintosh et al of distinct cleavage planes between and within the fascicles of each layer. Accurate anatomical knowledge of the fascicles of the lumbar multifidus is integral for defining the actions of this complex lumbar muscle. This study supports the clinical belief that the multifidus has a significant role in control and stabilization of the lumbar spine in multiple planes of action. The multipennate arrangement of this muscle with fascicular inter-attachment supports the clinical premise that the multifidus is activated in a variety of positions and can potentially produce and mediate intersegmental mobility and provide proprioception.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), E84-E92

The Association of Nutritional Status and Gender with Cross-Sectional Area of the Multifidus Muscle in Establishing Normative Data

TODD WATSON, PT, DPT, OCS, FAAOMPT, SUE MCPHERSON, PhD, KATHY STARR, PhD

Abstract: Despite recognized evidence for the importance of the multifidus muscle in stabilizing the lumbar spine, identifying subjects at risk for injury and subsequent loss of intrinsic spinal stabilization remains difficult. Previous research has failed to associate multifidus muscle size and height, weight, or body mass index (BMI). The purpose of this study was to begin to establish normative data for the multifidus muscle cross-sectional area (CSA) at the L5 level and to identify factors associated with size. Twenty-five participants (17 female), with a mean age of 32.5 (SD 11.6) years without history of LBP were considered for inclusion. Participants' height and weight were recorded and BMI calculated. Ultrasound imaging was used to obtain a CSA in cm2 of the subjects' multifidus muscles at the L5 level bilaterally; testing was done by two trained testers. Prior to testing, intra- and inter-tester reliability were determined. Percent body fat was determined using a three-site skinfold caliper measurement, also using two trained testers. Mean BMI was 24.18 and mean body fat (%) was 22.88 for all participants. As expected, age and BMI were moderately correlated. Left and right multifidus muscle CSA were highly correlated (r = 0.92, p < 0.001). The mixed model ANOVA indicated a significant main effect for gender as males exhibited larger CSA than females. Participants without history of low back pain present with symmetrical multifidus muscle CSA at the L5 level. Clear gender differences in CSA show that males tend to have larger multifidus muscles at the L5 level, indicating a need to establish gender-specific norms for clinicians examining the L5 multifidus muscle.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 4 (2008), E93-E98