Previous Page
JOURNAL WATCH Journal Watch
DIFFERENCES IN RANGE OF MOTION (ROM) BETWEEN DOMINANT AND NONDOMINANT SIDES OF UPPER AND LOWER EXTREMITIES. Macedo GM, Magee DJ. Journal of Manipulative and Physiological Therapeutics 2008;31:577–582
Ninety healthy white women aged 18–59 years were
measured in this study. Active and passive range of motion (ROM) was measured for the ankle, knee, hip, shoulder, elbow and wrist using a standard goniometer. Results: The results showed a statistically significant difference between dominant and non-dominant sides for 34 of the 60 ROMs measured. The maximum mean difference
between sides for all ROM measured was 7.5°.
sportEX comment It is standard practice during
examinations to compare left and right sides of the body when considering an indicator of pre-injury or normal-extremity ROM. This study validates the method. Although there can be differences, they are minimal and may not be clinically significant.
FOOT ORTHOSES AND PHYSIOTHERAPY IN THE TREATMENT OF PATELLOFEMORAL PAIN SYNDROME: RANDOMISED CLINICAL TRIAL. Collins N, Crossley K, Beller E, et al. British Medical Journal 2008;337:a1735
This was a single-blind, randomised clinical trial involving 179 participants (100 women)
aged 18–40 years, with a clinical diagnosis of patellofemoral pain syndrome of greater than 6 weeks’ duration, and who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months. The interventions were 6 weeks of wearing shelf-foot orthoses or flat inserts, or multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy. The foot orthoses were prefabricated, commercially available orthoses (from Vasyli International), which were fitted to the shoes with comfort as a primary goal. These orthoses are customisable to some degree in order to optimise comfort through heat moulding
and by adding wedge or heel raises. As a control for these orthoses, the study used flat inserts, manufactured from the same material (ethylenevinyl acetate) with identical covering fabric. These were of uniform thickness, with no inbuilt arch or wedging. Participants assigned to orthoses plus physiotherapy received both interventions. The participants were encouraged to continue exercise and activities that did not provoke their pain. The use of non-study interventions was discouraged throughout the trial, although the use of over-the-counter drugs was permitted. The main outcome measures were global improvement, severity of usual and worst pain over the preceding week, anterior knee pain scale, and functional index questionnaire measured at 6, 12 and 52 weeks. Results: Foot orthoses produced improvement beyond that of flat inserts in the short term,
RELIABILITY AND VALIDITY OF A PALPATION TECHNIQUE FOR IDENTIFYING THE SPINOUS PROCESSES OF C7 AND L5. Robinson R, Robinson HS, Bjørke G, Kvale A. Manual Therapy 2008
The objective was to examine
inter-tester reliability and validity of two therapists identifying the spinous processes (SP) of C7 and L5, using one predefined surface palpation procedure for each level. Two manual therapists examined 49 patients (29 women) aged 26–79 years. Of these patients, 18 were cervical patients and 31
were lumbar patients. An invisible marking pen and ultraviolet light were used, and the findings were compared. X-rays were taken as an objective measure of the correct spinal level. Results: The best inter-therapist agreement was found for the skin marks. Percentage agreement within 10mm and 20mm was 67% and 85%, respectively. The inter-tester
notably at 6 weeks. No significant differences were found between foot orthoses and physiotherapy, or between physiotherapy and physiotherapy plus orthoses. All groups showed clinically meaningful improvements in primary outcomes over 52 weeks.
sportEX comment
There is probably too much going on in this study to draw firm conclusions. In the short term, foot orthoses did bring about symptom relief. The problem in the UK is that, although such products are available over the counter, few health professionals other than podiatrists have training in their use or the biomechanical assessment for prescription, an issue that should be addressed by the provision of initial training or CPD courses.
reliability for identifying a radiological nominated SP by palpation was found to be poor for C7 and moderate for L5.
sportEX comment Both therapists indicated the same surface point, but it wasn’t what they were aiming for. The study took place in Norway. The question is whether therapists trained in other countries would fare any better. Is this another identified training need?
5