PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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1998 - Vol. 6, No. 2
* this issue only available in Hardcopy format
Achilles Tendinitis Part 1: Anatomy, Histology, Classification, Etiology, and Pathomechanics
Ilene M. Chazan, MS, PT, FAAOMPT
Abstract: The term "Achilles tendinitis" long has been used to describe pain in the posterior part of the heel. This term misleadingly implies an inflammation within the tendon itself, but other pathologic processes also may cause posterior heel pain. Because many different terms frequently are given to the same pathology, both the terminology and the classification system contribute to this confusion'. This paper presents current literature on this common and often confused clinical pathology and discusses its incidence, anatomy, histology, classification, etiology, and pathomechanics. Throughout this paper, the author endeavors to use consistent terminology for each entity, but on occasion will call the condition in its entirety "Achilles tendonitis".
The Journal of Manual & Manipulative Therapy Vol. 6 No. 2 (1998), 63 - 69
Achilles Tendinitis Part II: Clinical Examination, Differential Diagnosis, and Approaches to Management
Ilene M. Chazan, MS, PT, FAAOMPT
Abstract: "Achilles tendinitis" is a common diagnosis given to pain occurring in the region of the posterior heel. Many other pathologic processes, however, also can cause posterior-heel pain. Clinically, it is difficult to isolate which portion of the tendon most contributes to the pain. Determining the tissue's stage of heating often also proves challenging. This paper addresses these issues by presenting detailed differential diagnoses of Achilles tendon injuries and approaches to management based on stages of tendon-healing. The paucity of studies related to the specific treatment of chronic tendon injuries suggests that further research in this area is warranted.
The Journal of Manual & Manipulative Therapy Vol. 6 No. 2 (1998), 63 - 69
The Effect of Levator Scapula Tightness on the Cervical Spine: Proposal of Another Length
Ina Diener, BSc (Physio)
Abstract: Levator scapulae is a "twisted" muscle with four separate origins from upper cervical vertebrae and two folds at its attachment on the scapula. It is active with every movement of the arm and is frequently in static contraction in order to stabilize the scapulae during precision use of the hand. Although its role in shoulder movement has been well researched, its effect on cervical function has seldom been investigated. Described tests for length and tone seem to test only the more vertical fibres or do not make use of enough cervical rotation to test the more horizontal fibres. The hypothesis is made that the more horizontal fibres have a stronger tendency to become tight. An alternative muscle length test, emphasizing C2 contralateral rotation, is described and substantiated from anatomy and possible biomechanics. 102 subjects were assessed to determine the most effective way to test the length of levator scapula. The tests described by Janda, Travell and Simons were compared with the suggested alternative test. It was found that more subjects tested positive for decreased length in levator scapula in the C2 rotation test than in any of the others. A combination of this test and Janda's length test is suggested as a true assessment of levator scapula dysfunction.
The Journal of Manual & Manipulative Therapy Vol. 6 No. 2 (1998), 78 - 86
Radiographic Assessment and Reliability Study of the Craniovertebral Sidebending
Kenneth A. Olson, MSc, PT, OCS, FAAOMPT Stanley V Paris, PhD, PT Clifford Spohr, MD Gerard Gorniak, PhD, PT
Abstract: Background and Purpose: In orthopaedic manual physical therapy, passive intervertebral joint testing of the upper cervical spine is widely used for clinical assessment. However, the test position has not been standardized and tester reliability has not been well established. The purpose of this study is to determine whether patient positioning affects the degree of reliability of passive motion testing and end-feel assessment when passively testing craniovertebral sidebending. Subjects: Ten subjects participated in both the radiographic and clinical assessment portion of this study with mean age of 32.5 +/- 6.9 years. Methods: Open-mouth position radiographs were used to measure passive craniovertebral sidebending at the "erect" neutral and the "physiological" neutral positions. lntertester and intratester reliability were determined on the same group of subjects using six physical therapists to assess end-feel and mobility grades for passive craniovertebral sidebending in five positions. Results: The mean total sidebending motion for COC2 was 8.3 degrees for the physiological neutral position and 7.2 degrees for the erect neutral position. In the clinical assessment portion of the study, Kappa scores ranged from -.027 to .182 for intertester reliability and from -.022 to .137 for intratester reliability for mobility grade assessment with minimal difference noted between the five test positions. For end-feel assessment, the Kappa scores ranged from -.043 to .119 for intertester reliability and from .01 to .308 for intratester reliability with the physiological neutral position demonstrating the highest intratester reliability. Conclusion and Discussion: The results of the radiographic assessment portion of this study demonstrate greater passive range of motion in the physiological neutral position for the majority of the subjects offering some support for the use of the physiological neutral position as the standard position of the cervical spine for testing passive craniovertebral sidebending motion. However, all the test positions showed poor intertester reliability for the craniovertebral sidebending passive motion test. Follow-up studies are needed that allow testers an opportunity to correlate clinical findings with the passive craniovertebral motion test in order to establish reliability in using this manual assessment procedure.
The Journal of Manual & Manipulative Therapy Vol. 6 No. 2 (1998), 87 - 96
* this issue only available in Hardcopy format
