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SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers... more
SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.
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Opzet van het onderzoek: Casusbespreking.Doel: Een behandeling beschrijven die bestaat uit een specifiek programma met actieve oefeningen en verbetering van de houding bij een persoon met cervicogene hoofdpijn.Achtergrond: De patient was... more
Opzet van het onderzoek: Casusbespreking.Doel: Een behandeling beschrijven die bestaat uit een specifiek programma met actieve oefeningen en verbetering van de houding bij een persoon met cervicogene hoofdpijn.Achtergrond: De patient was een 46-jarige man met een voorgeschiedenis van cervicogene hoofdpijn sinds zeven jaar. Zijn symptomen waren constant met een gemiddelde intensiteit van 5/10 op een visueel analoge schaal waarbij 0 staat voor geen pijn en 10 voor ondraaglijke pijn. De pijnintensiteit in de week voorafgaand aan zijn eerste consult was gemiddeld 3/10 na triggerpointinjecties. De symptomen werden erger bij activiteiten waarbij hij de armen gebruikte en bij langdurig zitten.Methoden en metingen: De patient werd in een periode van drie maanden zeven keer behandeld. Er werden afwijkingen gevonden in de stand, spierfunctie en in de bewegingspatronen van de cervicale, scapulothoracale en lumbale regionen. Uitkomstmaten waren de frequentie en intensiteit van de hoofdpijn en de Neck Disability Index (ndi). De interventies bestonden uit correctie van de houding en van de bewegingspatronen bij actieve bewegingen van de cervicale wervelkolom en van de armen. Ook kreeg de patient functionele instructies ter minimalisering van het effect van het gewicht van de armen op de cervicale wervelkolom.Conclusie: Interventies bestaande uit correctie van de houding in de cervicale, scapulothoracale en lumbale regionen in combinatie met instructie van een specifiek programma met actieve oefeningen gericht op bewegingsafwijkingen in die drie regionen, waren bij deze patient succesvol tegen hoofdpijn en leverden functieverbetering op.
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ABSTRACT: The changing nature of health care and the expanding knowledge about diagnoses made by physical therapists require education programs to update their curricula continually. This article describes a curriculum that prepares... more
ABSTRACT: The changing nature of health care and the expanding knowledge about diagnoses made by physical therapists require education programs to update their curricula continually. This article describes a curriculum that prepares entry‐level physical therapy students to be diagnosticians. The curriculum is characterized by (1) immediate introduction of students to their roles as diagnosticians, (2) instruction in impairment‐based diagnostic systems, (3) teaching diagnostic process through instruction in content, and (4) a systematic increase in the complexity of learning. An outline of the four‐semester curriculum is provided with brief descriptions of the teaching methods used. Instruments that guide students to make judgments about diagnosis are provided. Examples are given of the classification schemes and diagnoses used for patients with medical‐surgical, musculoskeletal, neurological, and cardiopulmonary problems. Preliminary evidence is provided of the extent to which graduates report using the diagnostic skills they have learned, and suggestions are made for encouraging increased usage. Collaborative research is needed to develop further the content on diagnosis in physical therapy.
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Research Interests: Cognitive Science, Neurology, Evidence Based Medicine, Medicine, Movement disorders, and 15 moreHumans, Child, Clinical Sciences, Adult, Age Factors, Lower limb, Essential Tremor, Literature Search, Botulinum Toxin, Lower Extremity, Movement Disorder, Cervical Dystonia, Clinical Trials as Topic, Motor Neurons, and Muscle spasticity
... MARILYN R. GOSSMAN, SHIRLEY A. SAHRMANN, and STEVEN J. ROSE ... The purpose of this article is to review the literature related to length-associated changes in muscle. ... The length-associated changes may be secondary to the primary... more
... MARILYN R. GOSSMAN, SHIRLEY A. SAHRMANN, and STEVEN J. ROSE ... The purpose of this article is to review the literature related to length-associated changes in muscle. ... The length-associated changes may be secondary to the primary problem for which the patient is ...
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1. Introduction 2. Staging System for Rehabilitation 3. Movement System Syndromes of the Cervical Spine 4. Movement System Syndromes of the Thoracic Spine 5. Movement System Syndromes of the Hand and Wrist 6. Movement System Syndromes of... more
1. Introduction 2. Staging System for Rehabilitation 3. Movement System Syndromes of the Cervical Spine 4. Movement System Syndromes of the Thoracic Spine 5. Movement System Syndromes of the Hand and Wrist 6. Movement System Syndromes of the Elbow 7. Movement System Syndromes of the Knee 8. Movement System Syndromes of the Foot and Ankle
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Diagnosis and Treatment of Movement Impairment Syndromes is the long-awaited book by Shirley Sahrmann, who has been considered an expert in movement disorders and the musculoskeletal system. This text examines the effect of normal and... more
Diagnosis and Treatment of Movement Impairment Syndromes is the long-awaited book by Shirley Sahrmann, who has been considered an expert in movement disorders and the musculoskeletal system. This text examines the effect of normal and abnormal movement patterns and ...
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Anterior hip or groin pain is a common complaint for which people are referred for physical therapy, with the hip region being involved in approximately 5% to 9% of injuries in high school athletes.1 Although anterior hip pain is known to... more
Anterior hip or groin pain is a common complaint for which people are referred for physical therapy, with the hip region being involved in approximately 5% to 9% of injuries in high school athletes.1 Although anterior hip pain is known to result from a number of musculoskeletal and systemic pathologies, a tear of the acetabular labrum is a recent addition to the list that is of particular interest to physical therapists. This mechanically induced pathology is thought to result from excessive forces at the hip joint2,3 and has been proposed as part of a continuum of hip joint disease that may result in articular cartilage degeneration.2 Although the number of recent articles in the orthopedic literature identifying acetabular labral tears as a source of hip pain is increasing, labral tears often evade detection, resulting in a long duration of symptoms, greater than 2 years on average, before diagnosis.4–8 Studies have shown that 22% of athletes with groin pain9 and 55% of patients w...
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To determine the relationships between sensorimotor impairments and upper extremity reaching performance during the acute phase of stroke and to determine which, if any, measures of sensorimotor impairment can predict variance in reaching... more
To determine the relationships between sensorimotor impairments and upper extremity reaching performance during the acute phase of stroke and to determine which, if any, measures of sensorimotor impairment can predict variance in reaching performance during this phase. Sensorimotor impairments of upper extremity (UE) strength, active range of motion, isolated movement control, light touch sensation, joint position sense, spasticity, and shoulder pain were evaluated in a group of 46 individuals with acute hemiparesis (mean time since insult = 9.2 days). Subjects performed a reaching task to a target placed on their affected side. Three-dimensional kinematic analyses were used to assess reaching speed, accuracy, and efficiency. Forward stepwise multiple linear regression analyses were used to determine which impairment was the best predictor of variance in reaching performance. Measures of UE strength predicted the largest proportion of variance in the speed, accuracy, and efficiency ...
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Background and Purpose Little is known about the relationship between upper-extremity (UE) sensorimotor impairment and reaching performance during the first few months after stroke. The purpose of this study was to examine: (1) how... more
Background and Purpose Little is known about the relationship between upper-extremity (UE) sensorimotor impairment and reaching performance during the first few months after stroke. The purpose of this study was to examine: (1) how measures of UE sensorimotor impairment are related to the speed, accuracy, and efficiency of reaching in subjects with hemiparesis during the subacute phase after stroke and (2) how impairments measured during the acute phase after stroke may predict the variance in reaching performance a few months later. Subjects and Methods Upper-extremity sensorimotor impairments and reaching performance were evaluated in 39 subjects with hemiparesis at 2 time points: during the acute phase (8.7±3.6 [X̅±SD] days) and the subacute phase (108.7±16.5 days) after stroke. Ten subjects who were healthy (control subjects) were evaluated once. Regression analyses were used to determine which impairments were the best predictors of variance in reaching performance in the subac...
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Research Interests: Psychology, Clinical Trial, Medicine, Movement disorders, Activities of Daily Living, and 15 moreHumans, Female, Male, Hemiplegia, Arm, Clinical Sciences, Aged, Middle Aged, Adult, Pilot Projects, Outcome Assessment, Cerebrovascular Accident, Motor Skills, Activity of Daily Living, and Motor activity
Several sacroiliac joint (SIJ) provocative tests used to assess posterior pelvic pain involve moving and stressing the hip. It is unknown if there is a subgroup of patients with posterior pelvic pain who have underlying hip deformity that... more
Several sacroiliac joint (SIJ) provocative tests used to assess posterior pelvic pain involve moving and stressing the hip. It is unknown if there is a subgroup of patients with posterior pelvic pain who have underlying hip deformity that could potentially influence performance and interpretation of these tests.
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Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment. This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide... more
Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment. This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide the current research on movement system impairment syndromes. The conceptual basis of the movement system impairment syndromes is that sustained alignment in a non-ideal position and repeated movements in a specific direction are thought to be associated with several musculoskeletal conditions. Classification into movement system impairment syndromes and treatment has been described for all body regions. The classification involves interpreting data from standardized tests of alignments and movements. Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns. The reliability and validity of movement system impairment syndrome...
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The Movement System was adopted as the identity of physical therapy as one of the 8 guiding principles accompanying the Vision Statement of 2013. At its inception physical therapy was considered more of a technical field rather than that... more
The Movement System was adopted as the identity of physical therapy as one of the 8 guiding principles accompanying the Vision Statement of 2013. At its inception physical therapy was considered more of a technical field rather than that of a professional field. Physicians were to diagnose the patient's problem and the therapist was to follow the prescription provided by the physician with the primary purpose being to relieve symptoms such as pain or muscle weakness. Even by the 1960's, the prescription became more of a referral and there was recognition that therapists were making decisions about the patient's treatment and discharge disposition. The role of the physical therapist in pathokinesiologic problems has been well accepted over the years but as insights are gained about the role of movement in musculoskeletal pain, the concept of kinesiopathologic problems is being defined. Whether the movement dysfunction is from a pathokinesiologic or a kinesiopathologic mec...
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Anterior hip pain is common in young, active adults. Clinically, we have noted that patients with anterior hip pain often walk in a swayback posture, and that their pain is reduced when the posture is corrected. The purpose of this study... more
Anterior hip pain is common in young, active adults. Clinically, we have noted that patients with anterior hip pain often walk in a swayback posture, and that their pain is reduced when the posture is corrected. The purpose of this study was to investigate a potential mechanism for the reduction in pain by testing the effect of posture on movement patterns and internal moments during gait in healthy subjects. Fifteen subjects were instructed to walk while maintaining three postures: 1) natural, 2) swayback, and 3) forward flexed. Kinematic and force data were collected using a motion capture system and a force plate. Walking in the swayback posture resulted in a higher peak hip extension angle, hip flexor moment and hip flexion angular impulse compared to natural posture. In contrast, walking in a forward flexed posture resulted in a decreased hip extension angle and decreased hip flexion angular impulse. Based on these results, walking in a swayback posture may result in increased ...
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Movement dysfunction that may be caused by length-associated changes in muscle is a problem of people treated by physical therapists. The purpose of this article is to review the literature related to length-associated changes in muscle.... more
Movement dysfunction that may be caused by length-associated changes in muscle is a problem of people treated by physical therapists. The purpose of this article is to review the literature related to length-associated changes in muscle. An analysis of length-associated changes in animal and human studies is presented. The methods used to produce the changes in animals are discussed, and the clinical implications of the length-associated changes in muscle are suggested.
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The purposes of this study were 1) to assess the relative participation of the hip extensor and abdominal musculature during unilateral straight leg raising in the naive subject and 2) to examine quantitatively alterations in the pattern... more
The purposes of this study were 1) to assess the relative participation of the hip extensor and abdominal musculature during unilateral straight leg raising in the naive subject and 2) to examine quantitatively alterations in the pattern of pelvic stabilization when the subject was instructed to relax the contralateral extremity. Surface electrodes were used to record bilaterally the electromyographic activity of the rectus abdominus, external oblique, and medial hamstring muscles. Each healthy subject performed a unilateral straight leg raise three times in each of two modes, Preferred and Relaxed. The electromyographic values for each muscle were normalized to a maximum isometric contraction and analyzed using a three-factor (2 X 2 X 2) mixed design analysis of variance. Results indicate that 9 of the 11 subjects used the tested medial hamstrings and abdominal muscles during a unilateral straight leg raise performed in the Preferred Mode. When instructed to relax the contralateral...
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A critical step for the future of the profession of physical therapy is the development of diagnostic categories. The purpose of this communication is to clarify issues regarding the role of the physical therapist in developing... more
A critical step for the future of the profession of physical therapy is the development of diagnostic categories. The purpose of this communication is to clarify issues regarding the role of the physical therapist in developing classifications of the signs and symptoms that are identified by the therapist's examinations and tests. A primary premise is that treatment should be based on the diagnosis derived by the physical therapist because the medical diagnosis does not provide sufficient direction. A generic definition is given as a guide for development of diagnostic classification schemes. Arguments are provided that these diagnoses will 1) clarify practice, 2) provide an important means of communication with colleagues and consumers, 3) classify and group conditions that can direct research and assessment of treatment effectiveness, and 4) reduce the tendency toward cultism associated with practice based almost entirely on treatment approaches.
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The position of elbow flexion commonly observed in patients with upper motor neuron lesions is attributed by many clinicians to hyperactive stretch reflexes. The purpose of this study was to examine the passive stretch reflexes of the... more
The position of elbow flexion commonly observed in patients with upper motor neuron lesions is attributed by many clinicians to hyperactive stretch reflexes. The purpose of this study was to examine the passive stretch reflexes of the biceps and brachioradialis muscles in order to assess their possible relative contributions to the flexion posture. Twenty-one patients with upper motor neuron lesions were tested, using an automated system to produce controlled passive movement strech reflexes. Ratios derived from the electromyographic activity elicited during passive movement were used for quantitative comparisons. The stretch reflex response of the brachioradialis muscle was larger and earlier than the biceps response. A surprising finding was reciprocal activity in these two synergists following phasic stretch.
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The purpose of this study was to quantify the effect of combining voluntary effort with passive muscle stretch in the major flexors and extensors of the elbow and knee joints in order to test the validity of the assumption that stretching... more
The purpose of this study was to quantify the effect of combining voluntary effort with passive muscle stretch in the major flexors and extensors of the elbow and knee joints in order to test the validity of the assumption that stretching a muscle in conjunction with voluntary effort enhances the production of muscle activity more than muscle stretch or voluntary effort alone. This was accomplished by using a computer-controlled test instrument to produce the conditions necessary for measuring stretch reflex activity, voluntary effort, and stretch reflex activity plus voluntary effort, and then quantitatively examining the EMG activity associated with each test condition. In general, greater EMG activity was produced by the combination of muscle stretch and voluntary effort than by either muscle stretch or voluntary effort alone. Clinical implications of these findings are discussed.