PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Orthopaedic Manual physical Therapy including Thrust Manipulation and Exercise in the Management of a Patient with Cervicogenic Headache: A Case Report

Jacqueline van Duijn, PT, DPT, OCS, Arie J. van Duijn, PT, EdD, OCS, Wanda Nitsch, PT, PhD

Abstract: It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to significant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 1 (2007), 10-24

Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-old Patient Using Strain Counterstrain: A Case Report

Cristiana Kahl Collins, PT, MA, NCS

Abstract: This report describes the examination, intervention, and outcomes for a patient with Complex Regional Pain Syndrome I (CRPS I) treated with Strain Counterstrain (SCS). The patient was diagnosed with CRPS I following a Grade II ankle sprain. Treatment consisted of SCS once per week for six months with one additional session each week in Months 4 through 6 for strengthening, endurance, and gait training. A re-examination was performed monthly. A clinically significant decrease of 2 points in overall pain as measured with a numeric pain rating scale (NPRS) occurred as of Month 2; a 2-point decrease in tenderness on 10 of 13 SCS tender points also measured with an NPRS was documented as early as Month 1. Throughout the treatment period, an increase in function was noted by way of patient report and objective tests and measures. Gait improved with regard to cadence, use of an assistive device, and weight-bearing status. Single limb stance on the involved leg increased from 0 (s) to 40 (s) over the course of treatment and ankle active range of motion as measured with a goniometer and muscle strength as measured with manual muscle tests both returned to normal values. CRPS I remains a poorly understood and difficult-to-treat chronic syndrome. By way of its proposed effects on the neuromuscular system and facilitated segments, SCS may be an additional effective treatment tool in the management of some patients diagnosed with CRPS I.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 1 (2007), 25-41

Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain

Pamela J. Leerar, PT, DHSc, OCS, COMPT, William Boissonnault, PT, DHSc, FAAOMPT, Elizabeth Domholdt, PT, EdD, FAPTA, Toni Roddey, PT, PhD, OCS, FAAOMPT

Abstract: The comprehensiveness of physical therapists' adherence to the guidelines for red lag documentation for patients with low back pain has not previously been described. Therefore, the purpose of this study was to describe that comprehensiveness. Red flags are warning signs that suggest that physician referral may be warranted. Clinic charts for 160 patients with low back pain seen at 6 outpatient physical therapy clinics were retrospectively reviewed, noting the presence or absence of 11 red flag items. Seven of the 11 red flag items were documented over 98% of the time. Most charts (96.3%) had at least 64% of the red flag items documented. Documentation of red flags was comprehensive in some areas but lacking in others. Red flags that were regularly documented included age over 50, bladder dysfunction, history of cancer, immune suppression, night pain, history of trauma, saddle anesthesia, and lower extremity neurological deicit. The red lags not regularly documented included weight loss, recent infection, and fever/chills. Factors inluencing item documentation comprehensiveness are discussed, and suggestions are provided to enhance the completeness of recording patient examination data. The study results provide a red flag documentation benchmark for clinicians working with patients with low back pain and they lay the groundwork for future research.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 1 (2007), 42-49

Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary

Bill Vicenzino, PT, PhD, Joshua A. Cleland, PT, PhD, OCS, FAAOMPT, Leanne Bisset, PT, MPhty (Sports)

Abstract: Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. The underlying pathology remains to be fully elucidated; however, evidence indicates that the disorder does not involve an inflammatory process but rather impairments of the pain and motor systems as well as morphological changes in the structure of both the extensor carpi radialis brevis muscle and tendon. Although the most efficient management approach remains controversial, there is a growing body of literature reporting the effects and underlying mechanisms of joint manipulation in the management of lateral epicondylalgia. Evidence exists demonstrating that joint manipulation directed at the elbow and wrist as well as at the cervical and thoracic spinal regions results in clinical alterations in pain and the motor system. In addition to presenting this evidence, this paper describes proposed underlying physiological mechanisms of joint manipulation associated with the observed clinical effects. We propose that this information will be useful for the physical therapist in making clinical decisions regarding the selection of treatment technique for the management of patients with lateral epicondylalgia.

The Journal of Manual & Manipulative Therapy Vol. 15 No. 1 (2007), 50-56

RSS: A Brief Introduction

Jim Doree, PT

Abstract: The JMMT website has recently added an RSS feed. This technology allows users to keep track of changes to websites of interest without having to regularly visit those sites. This article briefly discusses the history of RSS, explains how to access RSS feeds, and provides step-by-step information on using this new feature on the JMMT website.
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To Run or Not to Run: A Post-Meniscectomy Qualitative Risk Analysis Model for Osteoarthritis When Considering a Return to Recreational Running

Bob Baumgarten, MS, PT, FAAOMPT

Abstract: The increased likelihood of osteoarthritic change in the tibiofemoral joint following meniscectomy is well documented. This awareness often leads medical practitioners to advise patients previously engaged in recreational running who have undergone meniscectomy to cease all recreational running. This literature review examines the following questions: 1) Is there evidence to demonstrate that runners, post-meniscectomy, incur a great enough risk for early degenerative OA to cease all running? 2) Does the literature yield risk factors for early OA that would guide a physical therapist with regard to advising the post-meniscectomy patient contemplating a return to recreational running? Current literature related to meniscal structure and function, etiology and definition of osteoarthritis, methods for assessing osteoarthritis, relationship between running and osteoarthritis, and relationship between meniscectomy and osteoarthritis are reviewed. This review finds that while the probability for early osteoarthritis in the post-meniscectomy population is substantial, it is a probability and not a certainty. To help guide a physical therapist with regard to advising the patient for a safe return to running following a meniscectomy, a qualitative risk assessment based on identified risk factors for osteoarthritis in both the running and the post-meniscectomy populations is proposed.
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Acceptance Speech for the John McMillan Mennell Service Award of the American Academy of Orthopaedic Manual Physical Therapy

Ann Porter Hoke, PT, OCS, FCAMT, FAAOMPT

Mr. President of the American Academy, members of the Executive, Mr. President of the International Federation of Orthopaedic Manual Therapists (IFOMT), IFOMT Standards Committee, distinguished guest speakers, past recipients of this award, fellows and members of the Academy, I was surprised and am deeply honored to be the 2006 recipient of the John McM. Mennell Service Award. [no abstract available]
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