Here are a couple of papers testing the testers. There is a battery of assessment tests for every joint. Many of the ones reported here are standard practise in physiotherapy. Both these papers give food for thought. In particular the comparison of the therapist’s interpretation of lumbar spine movement and the MRI brings into question what exactly the therapist is feeling...

THE RELIABILITY OF MUSCULOSKELETAL SCR

SCREENING TESTS USED IN CRICKET. Dennis RJ, Finch CF, Elliott BC, Farhart PJ.

Physical Therapy in Sport 2008;9(1) Feb:25-33

The objectives of this piece of research were to determine the inter- and intra-observer reliability of a field-based musculoskeletal screening protocol used to measure potential injury risk factors in cricket fast bowlers. Two sports physiotherapists conducted the testing on ten volunteers who completed the following tests: knee extension; modified Thomas test (hip extension and abduction); hip internal and external rotation; combined elevation; ankle dorsiflexion lunge; bridging hold; prone four point hold; and calf heel raises. For each of the tests the participants

were tested by each physiotherapist twice, and the inter- and intra-observer reliability were concurrently assessed. The results showed that the inter-

observer reliability of the tests was generally poor, with only four of the ten tests having an intraclass correlation coefficient (ICC) greater

EFFECTS OF LOW-LEVEL LASER THERAPY AND ECCENTRIC EXERCISES IN THE TREATMENT OF RECREATIONAL ATHLETES

WITH CHRONIC ACHILLES TENDINOPATHY. Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins R, Bjordal JM, American Journal of Sports Medicine Web Feb 2008

Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect of EE is a slow onset. The addition of low-level laser therapy (LLLT) to EE was examined to ascertain if there may be a more rapid clinical improvement. Fifty two recreational athletes with chronic Achilles tendinopathy symptoms were randomised to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy was

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than 0.80. The intra-observer reliability of the tests was considerably higher, with nine tests having an ICC greater than 0.80. With the exception of the bridging hold, all tests would be considered acceptable where only one observer was conducting the testing. However, only the ankle dorsiflexion lunge, combined elevation test, calf heel raise test and prone four point hold have acceptable reliability when there are multiple physiotherapists recording measurements.

INTERTESTER RELIABILITY AND VALIDITY OF MOTION ASSESSMENTS DURING

LUMBAR SPINE ACCESSORY MOTION TESTING. Landel R, Kulig K, Fredericson M, Li B,

Powers CM. Physical Therapy 2008;88(1) Jan:43-49

ers CM

Posterior-anterior (PA) assessment of the lumbar spine correlates with radiographic signs of instability and can guide treatment choices. However studies of the validity of lumbar PA assessments have not been conducted in vivo. The purpose of this study was to determine the intertester

administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session. The results showed that on a VAS scale pain intensity during physical activity was significantly lower in the LLLT group than in the placebo group. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favour of the true LLLT group.

sportEX comment One of the problems of manual therapy research is deciding which interventions have a positive effect. Consequently much research into single treatment effects seem to show negative results. The good thing about this research is that it suggests that one modality enhances another, something that often happens in drug treatments.

reliability of the PA examination in assessing intersegmental lumbar spine motion and to evaluate the validity of this procedure in vivo with dynamic magnetic resonance imaging (MRI). Twenty-nine subjects with central lumbar pain participated in this study. Two physical therapists independently identified each subject’s most and least mobile lumbar segments using the PA procedure. Midsagittal lumbar images were obtained simultaneously during one examiner’s assessment. Lumbar segmental mobility was quantified from magnetic resonance images as the change in the intervertebral angle between the resting position and the end range of the PA force application. For each vertebral level tested, maximal sagittal-plane segmental motion was determined.

The intertester reliability for identifying the least mobile segment was good, but it was poor for identifying the most mobile segment. The level of agreement between the PA assessments and intervertebral motion measured by MRI was poor. Despite good intertester reliability for identifying the least mobile segment, PA assessments of lumbar segmental mobility did not agree with sagittal- plane motion measured by dynamic MRI.

POSTOPERATIVE RANGE OF MOTION FOLLOWING ACL RECONSTRUCTION USING AUTOGRAFT HAMSTRINGS: A PROSPECTIVE RANDOMIZED

CLINICAL TRIAL OF EARLY VERSUS

DELAYED RECONSTRUCTIONS. Bottoni CR, Liddell TR et al. American Journal of Sports Medicine 2008;36(Apr):656-662

There is a common belief that surgical reconstruction of an acutely torn anterior cruciate ligament (ACL) should be delayed for at least 3 weeks because of the increased incidence of postoperative motion loss (arthrofibrosis) and suboptimal clinical results. Sixty-nine ACL tear patients (34 acute, 35 delayed) years were randomised to either early (within 21 days) or delayed (beyond 6 weeks) reconstruction using autograft hamstring tendon. Postoperative assessments

sportEX medicine 2008:36(Apr):4-5