Orthopaedic Manual Physical Therapy: A Modern Definition and Description.

Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.

Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction.

OBJECTIVES: The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DESIGN: Repeated measures. SETTING: University. PARTICIPANTS: 8 female, 4 male with unilateral autogenous ACLr. MAIN OUTCOME MEASURES: Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50-0.75), good (0.75-0.90). RESULTS: ACLr-side intra-rater/inter-rater ICCs ranged: LT, -0.27-0.80/-0.01-0.84; VS, 0.12-0.90/0.25-0.90; PPT, 0.49-0.98/0.86-0.99; AJPS, 0.15-0.79/0.55-0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12-0.66/-0.09-0.64; VS, 0.35-0.89/0.05-0.81; PPT, 0.65-0.99/0.45-0.95; AJPS, 0.07-0.81/0.37-0.99; ACHD, 0.99/0.98. CONCLUSIONS: Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.

Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain.

OBJECTIVES: Sleep impairments are a strong predictor of pain, making sleep a potential interest when treating patients with spine pain. Typical beliefs about the importance of sleep in patients seeking care for spinal pain are unknown. The purpose of this study was to describe the beliefs and attitudes about sleep in patients seeking care for spinal pain and to examine the relationships between dysfunctional beliefs and attitudes about sleep (DBAS), disordered sleep, and pain interference. MATERIALS AND METHODS: This cross-sectional study included patients presenting to physical therapy with spine pain. Participants completed questionnaires including demographics, medical history, pain interference (pain, enjoyment, and general activity), DBAS-16, and sleep-related impairment (Patient-Reported Outcome Measurement Information System). Correlations were calculated between DBAS-16 scores and measures of sleep quality/quantity, and a generalized linear model was used to investigate the predictive ability of DBAS-16 scores on pain interference. RESULTS: The mean DBAS-16 score was 4.22 (SD=2.03), with 52.5% of participants having DBAS. There was a strong relationship between DBAS-16 and Patient-Reported Outcome Measurement Information System ( rs =0.7; P <0.001). For every point higher score on the DBAS-16, pain interference scores increased by approximately half a point (B=0.46; 95% CI 0.33, 0.59, 1.80; P <0.001). DISCUSSION: These results highlight a strong relationship between beliefs and attitudes about sleep and measures of sleep quality/quantity and a linear association with pain interference scores. These findings provide a rationale for targeting beliefs and attitudes about sleep when managing pain-related symptoms in patients seeking care for spine pain.

SHOULDER EXTERNAL ROTATOR ECCENTRIC TRAINING VERSUS GENERAL SHOULDER EXERCISE FOR SUBACROMIAL PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL.

BACKGROUND: Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS. PURPOSE: To compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. STUDY DESIGN: Randomized controlled trial. METHODS: Forty-eight individuals (mean age 46.8 years + /-17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention. RESULTS: The primary outcome of function, measured by the Western Ontario Rotator Cuff Index, demonstrated a significant interaction effect derived from a multilevel hierarchical model accounting for repeated measures favoring the experimental group at week 3: 14.65 (p=.003), Week 6: 17.04 (p<.001) and six months: 15.12 (p=.007). After six months, secondary outcome measures were improved for Numeric Pain Rating Scale levels representing pain at worst (p=.006) and pain on average (p=0.02), external rotator (p<.001), internal rotator (p=0.02), and abductor strength (p<.001). There were no statistically significant differences in secondary outcome measures of Global Rating of Change, Active Range of Motion, the Upper Quarter Y Balance Test and strength ratios after six months. CONCLUSION: An eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with SAPS. LEVEL OF EVIDENCE: 2b.

The Effect of Fatigue on Upper Quarter Y-Balance Test Scores in Recreational Weightlifters: A Randomized Controlled Trial.

BACKGROUND: A paucity of research currently exists for upper extremity return to sport testing. The Upper Quarter Y-Balance Test (YBT-UQ) is a clinical test of closed kinetic chain performance with demonstrated reliability. Prior investigations of the YBT-UQ were conducted with individuals in a resting state and no comparison to performance in a fatigued state has been conducted. PURPOSE: To examine the effect of upper extremity fatigue on the performance of the YBT-UQ in recreational weightlifters. STUDY DESIGN: Randomized controlled trial. METHODS: 24 participants who participated in recreational weight training three days per week were randomly allocated to a control or experimental group. Individuals in the control group were tested using the YBT-UQ and re-tested after a 20-minute rest period. Participants in the experimental group were tested with the YBT-UQ, performed an upper extremity exercise fatigue protocol, and immediately re-tested. Examiners were blinded to participant allocation. RESULTS: Differences from pre- to post-fatigue YBT-UQ testing revealed score reductions between 2.04cm - 12.16cm for both composite scores and individual reach directions. The repeated measures ANOVA revealed significant differences when comparing the pre- and post-testing results between the fatigue and non-fatigue groups for all individual directions (p ≤ .006) and composite scores both limbs (p<.035). CONCLUSION: The performance of an upper body fatigue protocol significantly reduces YBT-UQ scores in recreational weightlifters. LEVEL OF EVIDENCE: 1b.

CUBOID MANIPULATION AND EXERCISE IN THE MANAGEMENT OF POSTERIOR TIBIALIS TENDINOPATHY: A CASE REPORT.

BACKGROUND AND PURPOSE: Posterior tibialis tendinopathy is a prevalent musculoskeletal condition often resulting in gait abnormalities along with medial ankle and foot pain. The purpose of this case report is to describe the treatment of a patient with a three year history of posterior tibialis tendinopathy utilizing a combination of cuboid manipulation and exercise. CASE DESCRIPTION: The patient was a 23-year old female recreational runner and collegiate basketball player reporting a three year history of chronic left ankle and lower leg pain. Outcome measures included the numeric pain rating scale, lower extremity functional scale, strength, passive joint mobility, and functional activities including running distance. Standard care for the treatment of tendinopathy was followed for six weeks with minimal functional improvements. Clinical reasoning skills were applied to redirect the hypothesis implicating limitations in cuboid-calcaneus internal rotation joint mobility contributing to a posterior tibialis tendinopathy. Manipulation at this joint was utilized to restore mobility. This intervention resulted in an immediate reduction in symptoms and improved functioning. Both muscle strengthening and functional task training were implemented post manipulation. OUTCOMES: At discharge, the patient reported full recovery and no pain with running 14 miles. Her lower extremity functional score improved to 78/80, posterior tibialis strength increased to 4/5 and the patient was able to perform 12 single leg heel raises without pain. DISCUSSION: By restoring cuboid internal rotation mobility, associated midtarsal pronation, and lower extremity neuromuscular control, the posterior tibialis muscle was able to perform efficiently, thus resolving the chronic tendinopathy and returning the patient to optimum functional ability of running. LEVEL OF EVIDENCE: 4.