Participants with restricted dominant shoulder internal rotation range of motion demonstrate no side-to-side difference in humeral head translation; and no difference before and after joint mobilization: a pilot study.

[Purpose] To compare humeral head translation (HHT) during shoulder elevation between dominant and non-dominant shoulders in participants with limited dominant shoulder internal rotation range of motion (ROM). To determine if joint mobilization alters HHT, and if relationships exist between the bicipital forearm angle and HHT. [Participants and Methods] Fifteen (9 female) participants (age 25.7 ± 6.8 years) with a minimum 15-degree dominant shoulder internal rotation ROM deficit compared to the opposite shoulder participated. All participants underwent bicipital forearm angle (BFA) measurements and ultrasound imaging to measure acromiohumeral and posterior glenohumeral distances in 3 positions: Resting, 90 degrees of shoulder flexion, and 60 degrees of shoulder abduction with full external rotation. Ultrasound images were used to calculate HHT. Participants' dominant shoulders underwent posterior glide mobilization, followed immediately by repeated ultrasound images and ROM measures. [Results] There was no dominant to non-dominant shoulder, or before and after mobilization HHT differences. No correlations existed between bicipital forearm angles and HHT or ROM gains after mobilization. [Conclusion] Participants with internal rotation ROM loss demonstrated symmetrical HHT. Joint mobilization increased ROM, but HHT was unchanged. No relationships existed between BFA and HHT.

Clinical Accuracy of the Lateral-Anterior Drawer Test for Diagnosing Posterior Cruciate Ligament Rupture.

BACKGROUND: Commonly used clinical posterior cruciate ligament (PCL) tests present with diagnostic weaknesses requiring alternative clinical tests. The Lateral-Anterior Drawer test (LAD-test) is a suggested alternative that previously demonstrated concurrent validity in situ. Further in vivo LAD-test clinical accuracy examination is required prior to any recommendation for clinical adoption. Thus, this case-control study aims to (1) investigate the LAD-test's in vivo interrater and intra-rater reliability; (2) establish LAD-test concurrent validity against MRI as the reference standard; and (3) examine the correspondence between examiners' professional working experience and LAD-test diagnostic accuracy. METHODS: Three examiners with different professional experience levels, blindfolded during testing, and blinded from subjects' identity, medical history, and reference test outcome performed all LAD-testing twice per subject. Reliability analyses included percent agreement, Fleiss' kappa and Cohen's kappa coefficients with 95% Confidence Intervals (CIs) and prevalence-adjusted bias-adjusted kappa (PABAK) calculations. Validation parameters included sensitivity, specificity, likelihood ratios (LR + ; LR-), and predictive values (PPV; NPV) each accompanied by 95%CIs; each tester's percent agreement with the MRI; and their Youden Index. RESULTS: The study sample was comprised of 31 subjects of which 14 had a history of unilateral full-thickness PCL-rupture. Their 14 contralateral knees and both knees of 17 healthy subjects served as controls. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. Interrater reliability was moderate (test-1: Fleiss'κ = 0.41; 95% CI 0.40;0.41; test-2:Fleiss'κ = 0.51; 95% CI 0.50;0.51). Pairwise examiner's LAD-test outcome agreement ranged from 74 to 89%. Pairwise interrater reliability was fair-to-substantial (κ = 0.27 to κ = 0.65) with moderate-to-substantial PABAK (0.48-0.77). Intra-rater reliability was substantial-to-almost perfect (PABAK 0.65-0.97). Sensitivity and specificity ranged from 57 to 86% and 83 to 98%, respectively. The advanced and novice clinicians' Youden Indexes were acceptable. The same examiners' positive likelihood ratios revealed important and relative important effects, respectively. Positive predictive values were considerable for the advanced and novice clinicians, while negative predictive values were high for all examiners. CONCLUSION: Overall, the study results suggested LAD-test practicability. In vivo LAD-test performance did not produce any negative ramifications for the tested subjects. In subjects presenting with a chronic PCL-deficiency (i.e., > 3 months since initial injury), the LAD-test's clinical accuracy was comparable-to-superior to other commonly used clinical PCL-tests. Future studies to establish the LAD-test's usefulness in isolation as well as in combination with other clinical tests for acute PCL-rupture diagnostics are warranted. TRIAL REGISTRATION NUMBER: DRKS00013268 (09. November 2017).

The relationship between measures of foot mobility and subtalar joint stiffness using vibration energy with color Doppler imaging-A clinical proof-of-concept validation study.

INTRODUCTION: Subtalar joint (STJ) dysfunction can contribute to movement disturbances. Vibration energy with color Doppler imaging (VECDI) may be useful for detecting STJ stiffness changes. OBJECTIVES: (1) Support proof-of-concept that VECDI could detect STJ stiffness differences; (2) Establish STJ stiffness range in asymptomatic volunteers; (3) Examine relationships between STJ stiffness and foot mobility; and (4) Assess VECDI precision and reliability for examining STJ stiffness. METHODS: After establishing cadaveric testing model proof-of-concept, STJ stiffness (threshold units, ΔTU), ankle complex passive range-of-motion (PROM) and midfoot-width-difference (MFWDiff) data were collected in 28 asymptomatic subjects in vivo. Three reliability measurements were collected per variable; Rater-1 collected on all subjects and rater-2 on the first ten subjects. Subjects were classified into three STJ stiffness groups. RESULTS: Cadaveric VECDI measurement intra-rater reliability was 0.80. A significantly lower STJ ΔTU (p = .002) and ankle complex PROM (p < .001) was observed during the screw fixation versus normal condition. A fair correlation (r = 0.660) was observed between cadaveric ΔTU and ankle complex PROM. In vivo VECDI measurements demonstrated good intra-rater (0.76-0.84) versus poor inter-rater (-3.11) reliability. Significant positive correlations were found between STJ stiffness and both dorsum (r = .440) and posterior (r = .390) PROM. MFWDiff exhibited poor relationships with stiffness (r = .103) and either dorsum (r = .256) or posterior (r = .301) PROM. STJ stiffness ranged from 2.33 to 7.50 ΔTUs, categorizing subjects' STJ stiffness as increased (n = 6), normal (n = 15), or decreased (n = 7). Significant ANOVA main effects for classification were found based on ΔTU (p< .001), dorsum PROM (p = .017), and posterior PROM (p = .036). Post-hoc tests revealed significant: (1) ΔTU differences between all stiffness groups (p < .001); (2) dorsum PROM differences between the increased versus normal (p = .044) and decreased (p = .017) stiffness groups; and (3) posterior PROM differences between the increased versus decreased stiffness groups (p = .044). A good relationship was found between STJ stiffness and dorsum PROM in the increased stiffness group (r = .853) versus poor, nonsignificant relationships in the normal (r = -.042) or decreased stiffness (r = -.014) groups. CONCLUSION: PROM may not clinically explain all aspects of joint mobility. Joint VECDI stiffness assessment should be considered as a complimentary measurement technique.

THE TENSILE BEHAVIORS OF THE ILIOTIBIAL BAND - A CADAVERIC INVESTIGATION.

BACKGROUND: Clinical stretching is frequently recommended for iliotibial band syndrome management. Current literature lacks conclusive findings regarding isolated human iliotibial band tissue elongation and stiffness behaviors. Applying clinical-grade stretching force results to iliotibial band tissue behavior is thus challenging. PURPOSE: This study's objectives were to determine isolated iliotibial band tissue tensile behaviors during tension-to-failure testing and to relate the results to previously reported iliotibial band stretch findings. STUDY DESIGN: Descriptive in vitro laboratory study. METHODS: Ten isolated un-embalmed iliotibial band specimens were exposed to tension-to-failure testing using a 10kN material testing system. Peak load, load at yield point, and ultimate failure load were measured in Newtons. Corresponding absolute (mm) and relative (%) tissue deformation was recorded. Load-deformation curves were established to calculate iliotibial band stiffness (N/mm). RESULTS: A mean peak load of 872.8 ± 285.9N and resulting 9.0 ± 3.9% tissue deformation from initial length was recorded. An 805.5 ± 249.7N mean load at yield point and resulting 7.0 ± 1.9% tissue deformation was observed. A 727.6 ± 258.4N mean load was recorded directly prior to ultimate tissue failure. Mean tissue deformation at ultimate failure was 11.3 ± 4.2%. Mean iliotibial band system stiffness was 27.2 ± 4.5N/mm. CONCLUSION: The iliotibial band can withstand substantial tensile forces. Clinical stretching forces likely fall within the load-deformation curve elastic region and may not result in permanent iliotibial band tissue deformation. Sustained elongation resulting from stretching the ITB may require substantial patient compliance. Future studies should investigate potential underlying factors related to positive symptom relief from iliotibial band stretching that include immunological responses, fluid accumulation, altered proprioception, and pain perception. LEVEL OF EVIDENCE: 3.

THE CONSTRAINING EFFECT OF THE LATERAL FEMORAL INTERMUSCULAR SEPTUM ON PASSIVE HIP ADDUCTION IN UN-EMBALMED CADAVERS.

BACKGROUND: Due to the lack of verifiable iliotibial band elongation in response to stretching, the anatomical, biomechanical, and physiological responses to treatment of iliotibial band syndrome remain unclear. The lateral intermuscular septum, consisting of multiple myofibroblasts, firmly anchors the iliotibial band to the femur. PURPOSE AND HYPOTHESIS: The purpose of this in-situ study was to examine the constraining effect of the lateral intermuscular septum on available passive hip adduction range of motion in un-embalmed cadavers. It was hypothesized that an iliotibial band-septum-complex release would significantly increase passive hip adduction. DESIGN: Within-specimen repeated measures in-situ design. SETTING: Anatomy laboratory. METHODS: Metal markers were inserted into selected anatomical landmarks in eleven (11) un-embalmed human cadavers. With the specimen supine, the test-side lower limb was passively adducted until maximum passive hip adduction was reached. This movement was repeated three times each within two conditions: (1) band-septum-complex intact and (2) band-septum-complex dissected. Digital video of marker displacement was captured throughout each trial. Still images from a start and an end position were extracted from each video sequence. A custom Matlab program was used to calculate frontal plane hip adduction angle changes from obtained images. RESULTS: Mean change in passive hip adduction after band-septum-complex release was -0.3 ° (SD 1.6 °;95% CI: -1.33,0.76). A paired samples t-test revealed a non-significant difference (t=-.611; p=.555) in passive hip adduction for the band-septum-dissected condition (18.8 ± 3.9 °) versus the band-septum-intact condition (18.5 °±4.7 °). CONCLUSION: The lateral intermuscular septum does not appear to have a constraining effect on passive hip adduction in un-embalmed cadavers. Future research should evaluate the constraining effect of other selected tissues and conditions on hip adduction. Furthermore, inflammatory, metabolic, viscoelastic, and sensorimotor control properties within the iliotibial band in response to stretching should be investigated. LEVEL OF EVIDENCE: 3.

Inter-Rater Reliability of Pain Provocation Tests for Painful Lumbar Facet Joints. A Pilot Study.

BACKGROUND: With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints. If a clinically significant level of inter-rater reliability were to be determined, this study could constitute a first step towards establishing the clinical utility of this new set of tests in the structural diagnosis of low back disorders. MATERIAL AND METHODS: Patients participating in this study were recruited in a specialist hospital throughout June 2015 until September 2016. Both female and male patients with current LBP, with or without buttock or lower extremity symptoms were screened for inclusion. Patients had preferably to be 50 years or older in order to be included in this study. The upper age limit was set at 90 years. They also had to be fluent in German to be able to follow verbal instructions. Exclusion criteria comprised the presence of red flags, surgical spinal fusion at any level of the lumbar spine, discectomy within the past 12 months, radiculopathy and/or radicular pain, interventional treatments for the IVD, SIJs or ZAJs within the past three months, psychiatric disorders, current litigation issues concerning back pain, and central nervous system diseases. Three certified manual therapy instructors tested patients independently. Fleiss' kappa values and percent agreements were calculated. RESULTS: Subjects included a sample of 48 patients (15 males and 33 females) with a mean age of 66.48 years (range 33 - 90) presenting at a specialist hospital with low back pain. The new pain provocation tests for lumbar zygapophyseal joints showed moderate reliability (Fleiss' κ = 0.46) and an overall percent agreement of 68.8%. Separate tests for the zygapophyseal joints of L5-S1 showed fair reliability (Fleiss' κ = 0.37) and an overall percent agreement of 64.6%. Unidimensional tests that were used in the study to exclude the intervertebral disc as a nociceptive generator showed fair reliability as well (average κ of 0.28 and 0.39, respectively). Neither drop outs nor adverse events occurred. CONCLUSION: The new pain provocation tests for lumbar zygapophyseal joints showed clinically significant levels of inter-rater reliability. Validation of these tests against fluoroscopy-guided medial branch blocks is warranted.

Validation, Intrarater and Interrater Reliability Study of the Lateral-Anterior Drawer Test for Detecting Posterior Cruciate Ligament Ruptures: Study Protocol of a Prospective Controlled Single-Blinded Cross-Sectional Study.

INTRODUCTION: Commonly used clinical tests for posterior cruciate ligament (PCL) rupture detection exhibit several limitations, thus requiring more precise clinical PCL tests. The lateral-anterior drawer (LAD) test has been proposed as a manually applied testing alternative but not yet been evaluated in vivo. METHODS AND ANALYSIS: Fifteen patients presenting with an MRI-confirmed acute or chronic unilateral PCL rupture and 15 subjects with no prior knee injury in their medical history will be included in this prospective single-blinded cross-sectional cohort study. Three examiners with different lengths of working experience (range 1-30 years), blinded to MRI outcomes and patient history, will use the LAD test on both knees of each participant to test for PCL integrity. Examiners will independently document the PCL status of each knee on a blank case report form. Fleiss-Kappa values will be calculated to investigate whether the LAD test shows clinically significant interrater and intrarater reliability. Furthermore, LAD test outcomes will be compared with MRI which serves as reference standard to check for concurrent validity. Moreover, LAD test accuracy with respect to tester experience will be evaluated. ETHICS AND DISSEMINATION: The study will be conducted in agreement with the World Medical Association Declaration of Helsinki (2013). Ethical permission (EK16-081-0616) to conduct this study was obtained from the review board of the city of Vienna on 1 September 2016. All personal and research data will be used in accordance with the Austrian Federal Data Protection Act and will be anonymised before publication in relevant international peer-reviewed journals. TRIAL REGISTRATIONNUMBER: DRKS00013268; Pre-results.

Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs.

BACKGROUND: Upright and slouched sitting are frequently adopted postures associated with increased intradiscal pressure, spinal height loss and intervertebral disc pathology. OBJECTIVES: To examine the effects of two sustained propped slouched sitting (PSS) postures on spinal height after a period of trunk loading. METHODS: Thirty-four participants without a history of low back pain (LBP) were recruited (age 24.4 ± 1.6 years). Subjects sat in (1) PSS without lumbar support and (2) PSS with lumbar support for 10 min, after a period of trunk loading. Spinal height was measured using a stadiometer. RESULTS: Mean spinal height increase during PSS without lumbar support was 2.94 ± 3.63 mm and with lumbar support 4.74 ± 3.07 mm. CONCLUSIONS: Both PSS with and without lumbar support significantly increased spinal height after a period of trunk loading (p < 0.001). Such PSS postures can provide a valuable alternative to upright sitting and may be recommended for recovering spinal height in the working environment following periods of loading.

CADAVERIC EVALUATION OF THE LATERAL-ANTERIOR DRAWER TEST FOR EXAMINING POSTERIOR CRUCIATE LIGAMENT INTEGRITY.

BACKGROUND: Common clinical tests often fail to identify posterior cruciate ligament (PCL) ruptures, leading to undetected tears and potential degenerative changes in the knee. The lateral-anterior drawer (LAD) test has been proposed but not yet evaluated regarding its effectiveness for diagnosing PCL-ruptures. HYPOTHESIS: The LAD will show greater tibial translation values in lateral-anterior direction in a PCL-Cut condition compared to a PCL-Intact condition, thus serving as a useful test for clinical diagnosis of PCL integrity. STUDY DESIGN: Descriptive laboratory study. METHODS: Threaded markers were inserted into the distal femur and proximal tibia in eighteen cadaveric knees. Each femur was stabilized and the tibia translated in lateral-anterior direction for the LAD test versus in a straight posterior direction for the posterior sag sign (PSS). Each test was repeated three times with the PCL both intact and then cut, in that order. During each trial, digital images were captured at start and finish positions for the evaluation of tibial marker displacement. Tibial marker translation during each trial was digitally analyzed using photography. The PSS values served as a reference standard. RESULTS: The LAD tibial translation was significantly greater (U=-3.680; p<;0.002) during the PCL-Cut (10.6±5.6mm) versus PCL-Intact (7.7±5.1mm) conditions. The PSS tibial translation was significantly greater (U=-3.724; p<0.002) during the PCL-Cut (11.0±5.3mm) versus PCL-Intact (6.4±3.5mm) conditions. There was no significant difference (t=2.029; p=0.07) in mean tibial translation in respective directions after PCL dissection during the LAD test (2.9±2.1mm) versus the PSS (4.6±2.8mm). CONCLUSION: The LAD test detected changes in cadaveric tibial translation corresponding with changes in PCL integrity to a degree at least as effective for assessing PCL integrity as the PSS. Further clinical study will be required to assess the utility of the LAD as a physical examination tool for diagnosing PCL injuries. LEVEL OF EVIDENCE: 2 (laboratory study).

DEFORMATION RESPONSE OF THE ILIOTIBIAL BAND-TENSOR FASCIA LATA COMPLEX TO CLINICAL-GRADE LONGITUDINAL TENSION LOADING IN-VITRO.

BACKGROUND: Iliotibial Band (ITB) syndrome is a troublesome condition with prevalence as high as 12% in runners. Stretching has been utilized as a conservative treatment. However, there is limited evidence supporting ITB elongation in response to a stretching force. PURPOSE/HYPOTHESES: The purpose of this study was to describe the iliotibial band tensor fascia lata complex (ITBTFLC) tissue elongation response to a simulated clinical stretch in-vitro. The authors hypothesized that the ITBTFLC would undergo statistically significant elongation when exposed to a clinical-grade stretching regimen, with the majority of the elongation occurring within the proximal ITBTFLC region. STUDY DESIGN: Within subjects repeated measures in-vitro design. METHODS: The strain response of six un-embalmed ITBTFLCs to a simulated clinical stretch of 2.75% elongation was assessed. Four sets of array marks were placed along the length of the ITBTFLC. Photographic images were taken in resting position (with 1.0% in-situ elongation) and with an additional 2.75% elongation. Tissue elongation was compared between proximal, middle, and distal ITBTFLC regions. RESULTS: A paired samples t-test demonstrated a significantly longer ITBTFLC in the "stretched" versus resting condition (p = 0.001). Significant elongation was observed in the proximal (3.96mm (SD = 1.35); p = 0.001), middle (2.12mm (SD = 1.49); p = 0.018) and distal (2.25mm (SD = 1.37); p = 0.01) regions during the "stretched" versus the resting condition. A one-way ANOVA demonstrated a significant main effect for region (p = 0.002). The proximal region exhibited significantly greater elongation versus the middle (p = 0.003) and distal (p = 0.007) regions, with no significant difference between the middle and distal regions (p = 0.932). CONCLUSION: The results of this study demonstrate that the ITBTFLC is capable of elongation in response to a clinically simulated stretch. The proximal ITB region underwent significantly greater elongation than the middle and distal regions and may be more likely to respond to "stretching" in clinical situations. Future investigation should assess the ITBTFLC load/deformation properties to determine whether a short-term clinically available stretch translates into permanent tissue elongation. LEVEL OF EVIDENCE: III.

Reliability of specific physical examination tests for the diagnosis of shoulder pathologies: a systematic review and meta-analysis.

BACKGROUND: Shoulder pain in the general population is common and to identify the aetiology of shoulder pain, history, motion and muscle testing, and physical examination tests are usually performed. OBJECTIVE: The aim of this systematic review was to summarise and evaluate intrarater and inter-rater reliability of physical examination tests in the diagnosis of shoulder pathologies. METHODS: A comprehensive systematic literature search was conducted using MEDLINE, EMBASE, Allied and Complementary Medicine Database (AMED) and Physiotherapy Evidence Database (PEDro) through 20 March 2015. Methodological quality was assessed using the Quality Appraisal of Reliability Studies (QAREL) tool by 2 independent reviewers. RESULTS: The search strategy revealed 3259 articles, of which 18 finally met the inclusion criteria. These studies evaluated the reliability of 62 test and test variations used for the specific physical examination tests for the diagnosis of shoulder pathologies. Methodological quality ranged from 2 to 7 positive criteria of the 11 items of the QAREL tool. CONCLUSIONS: This review identified a lack of high-quality studies evaluating inter-rater as well as intrarater reliability of specific physical examination tests for the diagnosis of shoulder pathologies. In addition, reliability measures differed between included studies hindering proper cross-study comparisons. TRIAL REGISTRATION NUMBER: PROSPERO CRD42014009018.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry.

OBJECTIVES: The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). METHODS: Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. RESULTS: Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). CONCLUSIONS: In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

Reliability and validation of in vitro lumbar spine height measurements using musculoskeletal ultrasound: A preliminary investigation.

BACKGROUND: Stadiometry measures total trunk height variations but cannot quantify individual spinal segment height changes. Different methods exist to measure both intervertebral disc and lumbar spine height (LSH) variations but they are either limited by radiation exposure or cost. Musculoskeletal ultrasound could be a valuable alternative to measure spinal segmental height changes as a result of intervention. OBJECTIVE: To validate the use of musculoskeletal ultrasound (MSU) and new anatomical landmark references used in assessing inter-mammillary distances (IMD) and LSH changes resulting from lumbar spine traction. METHODS: Two unembalmed cadaveric lumbar spines were extracted to assess (1) the reliability and validity of MSU, as compared to caliper, for measuring in vitro IMD and LSH using alternative anatomical landmarks than previously reported, and (2) the reliability of MSU for measuring in vitro IMD and lumbar spine height changes recorded during standardized mechanical traction up to 1.20 cm. RESULTS: Intra- and inter-rater reliability of musculoskeletal ultrasound for within and between sessions and for all experimental design, Standard Error ranged from 0.01 to 0.02 and from 0.03 to 0.04 cm for IMDs and LSHs, respectively. Root Mean Square Errors ranged from 1.6 to 6.8% and from 1 to 1.1% for IMDs and LSHs, respectively and mean ICC ranged from 0.98 to 1 for LSH. During traction, mean lumbar spine height measurement change using MSU was 1.15 ± 0.03 cm. Bland and Altman plots demonstrated confidence intervals included in the limits of agreement. Nevertheless, there were significant differences (p< 0.001) for both IMD measurements and lumbar spine height between caliper and ultrasound measurements. Musculoskeletal ultrasound overestimated distances of about 5.5 ± 1.5%. CONCLUSIONS: Musculoskeletal ultrasound is reliable and accurate for measuring intersegmental spinal distances and lumbar spine height with an apparent slight overestimation of distances. Based on mean differences, ultrasound technology seems to be valid for measuring lumbar spine height changes and could be suitable for in vivo research.

Co-contractive activation of the superficial multifidus during volitional preemptive abdominal contraction.

OBJECTIVE: To investigate whether the superficial multifidus (MF) muscle at the lower lumbar spine displayed co-contraction during volitional preemptive abdominal contraction (VPAC) through the abdominal drawing-in maneuver (ADIM) or the abdominal bracing maneuver (ABM) in 3 different postural positions. DESIGN: A within-subject cohort design. SETTING: A clinical laboratory. PARTICIPANTS: A healthy convenience sample of 21 women and 13 men; mean age (SD), 25.5 ± 6.5 years. METHODS: We collected surface electromyographic measurements for the superficial MF at the L5 vertebral level and abdominal wall muscles. Ultrasound imaging was used during screening and testing sessions for confirming transverse abdominis muscle activation while subjects maintained a relaxed state without volitional abdominal contraction (no-VPAC) and performed ADIM and ABM in 3 postural positions: supine, 4-point kneeling, and upright standing. MAIN OUTCOME MEASUREMENT: The frequency of superficial MF co-contraction occurrences (percentage of the total number of conditions) was measured during ADIM and ABM in 3 different postural positions. DATA ANALYSES: A Cochran Q test for k-related samples (α = 0.05) was used for data analysis. RESULTS: Activation of the abdominal wall by using either VPAC strategy resulted in a significantly greater MF co-contraction occurrence when compared with no-VPAC in each position. The ABM produced a significantly higher MF co-contractive occurrence versus the ADIM in the supine position. CONCLUSION: Both VPAC strategies produced a co-contractive MF response, which appears to be important for lumbar segmental stabilization and control. Analysis of the results suggests that VPAC strategies are appropriate for coactivating the MF, which can enhance spinal protection and rehabilitation responses.

Interrater reliability of a passive physiological intervertebral motion test in the mid-thoracic spine.

OBJECTIVE: To examine the interrater reliability of a passive physiological intervertebral motion (PPIM) test of a mid-thoracic spine motion segment. METHODS: Nineteen males and 22 females with a mean age of 22.7 years (range, 19-40 years) and no known spinal pathologies were tested independently by 3 certified manual therapy instructors. Investigators performed 3-dimensional segmental mobility testing at a preselected thoracic motion segment. Interrater reliability was assessed with Cohen's kappa statistics, using 3 pairwise comparisons for determination of the direction of lateral flexion leading to the greatest amount of segmental rotation. RESULTS: Percent agreement ranges were 63.4% to 82.5%, with kappa scores ranging from 0.27 to 0.65. CONCLUSION: The PPIM testing demonstrated fair to substantial interrater reliability. A majority of females (91%) demonstrated greatest segmental PPIM motion in contralateral rotation with lateral flexion, whereas a majority of males (90%) demonstrated greatest segmental PPIM motion in ipsilateral rotation with lateral flexion. These findings are applicable to asymptomatic subjects of the same age category. Interrater reliability of 3-dimensional PPIM testing is fair to substantial for assessing passive segmental mobility of the mid-thoracic spine.

Diagnosis and management of the painful ankle/foot part 1: clinical anatomy and pathomechanics.

Distinctive anatomical features can be witnessed in the ankle/foot complex, affording specific pathological conditions. Disorders of the ankle/foot complex are multifactoral and features in both the clinical anatomy and biomechanics contribute to the development of ankle/foot pain. The superior tibiofibular, distal tibiofibular, talocrural, subtalar, and midtarsal joint systems must all participate in function of the ankle/foot complex, as each biomechanically contributes to functional movements and clinical disorders witnessed in the lower extremity. A clinician's ability to effectively evaluate, diagnose, and treat the distal lower extremity is largely reliant upon a foundational understanding of the clinical anatomy and biomechanics of this complex complex. Thus, clinicians are encouraged to consider these distinctions when examining and diagnosing disorders of the ankle/foot.

Diagnosis and management of the painful ankle/foot. Part 2: examination, interpretation, and management.

Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.

Differential diagnosis and management of spinal nerve root-related pain.

Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Distinctions in the patho-anatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of root-related pain. Root-related pain can emerge from the tension events in the dura mater and nerve tissue associated with primary disc related disorders. Conversely, secondary disc-related degeneration can produce compression on the nerve roots. This compression can result in chemical and mechanical consequences imposed on the nervous tissue within the spinal canal, lateral recess, intervertebral foramina, and extraforminal regions. Differences in root-related pathology can be observed between lumbar, thoracic, and cervical spinal levels, meriting the implementation of different diagnostic tools and management strategies.