Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation.

BACKGROUND: Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics. OBJECTIVE: Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers. DESIGN: In situ repeated measures. METHODS: Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots. RESULTS: Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots. CONCLUSIONS: The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy.

The deep neck flexor endurance test: normative data scores in healthy adults.

OBJECTIVE: To investigate (1) the average hold time for the deep neck flexors (DNF) endurance test in subjects without neck pain or pathology, and (2) whether different groups of subjects categorized by age, gender, and lifestyle display different hold times. DESIGN: Normative research. PATIENTS: A convenience sample of 126 adults participated. METHODS: Intertester reliability of 4 therapists was evaluated by using intraclass correlation coefficients. The DNF endurance test hold time was conducted on each subject twice. The 2 hold-time scores were averaged and recorded. RESULTS: Inter-rater reliability coefficient of reproducibility for DNF muscle endurance measured by 4 physical therapists was ICC (2,k) 0.66 (confidence interval, 0.34-0.86). The mean (SD) DNF endurance hold times for men was 38.9 ± 20.1 seconds, whereas women was 29.4 ± 13.7 seconds. Results of the 2 x 2 analysis of variance indicated that gender significantly influenced DNF endurance (F = 8.643; P = .004), whereas, the activity level did not (F = 3.143; P = .079). Correlations were not significant between age and DNF endurance (r = 0.11; P = .2) and between activity level and DNF endurance (r = -0.156; P = .08). CONCLUSIONS: Asymptomatic men displayed greater DNF endurance than women. The variability between subjects' DNF endurance capabilities was high. Age between 20 and 80 years and activity level did not affect DNF endurance. This is the first normative data set available for the DNF endurance test, which lays the foundation for further research in subjects with a history of cervicalgia and assists clinicians to objectify a milestone for DNF endurance deficits in patients.

Knowledge in managing musculoskeletal conditions and educational preparation of physical therapists in the uniformed services.

The purpose of this study was to describe knowledge in managing musculoskeletal conditions among physical therapists in the uniformed services based on their educational background and preparation. A cross-sectional design was used. A total of 182 physical therapists in the uniformed services completed a standardized examination that assesses knowledge in managing musculoskeletal conditions. Physical therapists in the uniformed services who graduated from the U.S. Army-Baylor Doctoral Program in Physical Therapy or had attended a specific continuing medical education course that emphasizes the management of musculoskeletal conditions achieved higher scores and passing rates than their colleagues who had not. Compared with previously published data, physical therapists in the uniformed services demonstrated higher scores than medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists. Physical therapists in the uniformed services have the requisite knowledge to provide direct access for patients with musculoskeletal conditions. These data may have implications for health and public policy decisions within the military health care system related to the utilization and educational preparation of physical therapists in the uniformed services.

Evaluation of body composition methods for accuracy.

The objective of this study was to evaluate the accuracy of a variety of portable methods and instruments used to estimate body composition or percentage body fat (%BF) in a systematic, comprehensive manner on a wide range of subjects. The %BF was estimated using four skinfold protocols, three girth measurement protocols, two bioelectric impedance analysis (BIA) instruments, and one near-infrared instrument on 121 subjects. The subjects ranged in age from 21 to 51 years; weight ranged from 105 to 226 pounds and %BF from 8.3% to 38.3%; and the group was 29% male. The %BF estimates were compared to the values obtained from the generally accepted reference standard, underwater weighing (UWW). The correlation coefficients (r) between the test methods and UWW ranged from 0.48 to 0.72. Regression analysis resulted in a range of slopes from 0.48 to 0.93, y-intercept range from 3.8 to 13.1, and standard error of the estimate range from 3.8 to 7.5. All of the methods tended to overestimate lower and underestimate higher %BF. With two exceptions, all methods appeared more accurate for males than females. In general, the near-infrared appeared least and BLA appeared most accurate. In conclusion, in our opinion, most of the methods were not sufficiently accurate to use on a wide range of individuals. Although they may be sufficiently accurate on the narrow sample of subjects on which they were developed, they may not be as accurate for the general population.