Renaissance Physical Therapy Newsletter

Renaissance Physical Therapy

RENAISSANCE PHYSICAL THERAPY

Research Update

This update is intended as a means for us to keep busy clinicians in the medical community up to date with recent research as it relates to physical therapy. Hopefully, this will increase the options you have when prescribing physical therapy for your patients.

Relationship of Forward Head Posture and Cervical Backward Bending to Neck Pain
Haughie LJ, Fiebert IM, Roach KE. The Journal of Manual and Manipulative Therapy 1995; 3: 91-7

This study investigated the relationship of forward head posture and cervical extension to the incidence of neck pain. The subjects were 54 volunteer office-setting workers who spent at least 4 hours of their day at a computer terminal. There were 17 males and 37 females. The subjects were divided into two groups. The case group included people with pain in four or more areas. The control group included people with pain in less than three areas. A cervical range of motion device (CROM) was used to take measurements of forward head posture and cervical extension.

The members in the case group had greater forward head posture and decreased cervical extension when compared to the control group. In addition, after thirty days the case group subjects complained of more pain, and after twelve months they visited health care professionals more frequently due to this greater incidence of pain. The results of this study support that there is a correlation between forward head posture with decreased backward bending, and complaints of neck pain.

Many patients with forward head posture complain of pain in the inter-scapular, cervical, and pectoral regions, shoulders and sometimes in the upper extremities. A forward head posture creates a state of musculoskeletal imbalance with shortening of the posterior and sub-occipital muscles and tightening of the anterior chest muscles. Furthermore, a functional weakness of the anterior neck flexors and more importantly, the cervical para-spinals develops. Para-spinal weakness leads to fatigue-related pain patterns throughout the cervical and thoracic regions, as well as increased stress on supporting ligaments.

Therapists at Renaissance are skilled in manual therapy techniques including joint mobilization, muscle-energy and myofascial release that address problems occuring with forward head posture. A thorough postural screen is included with all neck and shoulder evaluations to identify the causative factors leading to patients’ pain patterns. Patients are also instructed in extensive exercise and stretching programs for self-management of their symptoms. Renaissance’s cervical Med-X program is an effective tool for objective strength testing and isolated strengthening of the cervical para-spinal muscle groups.

Knee Joint Movements in Subjects without Knee Pathology and Subjects with Injured Anterior Cruciate Ligaments
Hollman JH, Deusinger RH, Van Dillen LR, Matava M. Physical Therapy. Volume 82(10). October 2002.

The authors of this study compared joint surface rolling and gliding of subjects with injured ACL’s to subjects without knee pathology in weight bearing (WB) and non-weight bearing (NWB) activities. Previous studies suggest there is increased knee joint surface gliding and rolling in NWB movements as compared to WB. The authors hypothesized that ACL deficient knees would have increased gliding in both WB and NWB activities.

Fifteen adult subjects with injured ACL’s were included as were 15 control subjects with no history of knee pathology. Subjects sat in a wooden chair and performed 5 repetitions each of the WB and NWB movements. The NWB movement was a seated knee extension, performed to a maximally extended position. The subjects then executed a 2-legged sit-to-stand movement for the WB activity. Joint movement was analyzed with photoreflective markers placed on the lateral thigh and lower leg to provide rigid body representation of the thigh and lower leg segments. EMG electrodes were placed on the vastus lateralis, semitendinosus, medial gastrocnemius, and gluteus maximus muscles.

The data analysis showed that joint surface gliding was greater in knees with injured ACL’s than in knees without pathology. Specifically, greater gliding was seen at full knee extension (10 degrees of flexion) in the NWB movement and throughout the range of motion (10-90 degrees) in the WB movement. Also, more joint surface gliding occurred in the NWB movement than in the WB movement among subjects in both groups, particularly at full knee extension. EMG results found no greater muscle activity between the injured and non-injured groups.

Although it has been accepted that there is increased anterior displacement in NWB knee extension, these results suggest that there is excessive joint surface gliding in WB as well. It was previously thought that increased hamstring and gastrocnemius activity in ACL deficient knees helped decrease anterior tibial displacement but the EMG results from this study did not support that theory. The authors concluded that since anterior tibial displacement may not be completely reduced as a function of WB movement, further investigation into efficacy of WB exercise and potential effects of WB movement on knees with injured ACL’s is warranted.

The therapists at Renaissance Physical Therapy are dedicated to staying current with research studies for the most effective treatments to achieve optimal outcomes. They employ a spectrum of knee rehab techniques to tailor the rehab process to the invididual.

Examination of and Intervention for a Patient With Chronic Lateral Elbow Pain With Signs of Nerve Entrapment
Ekstrom RA, Holden K. Physical Therapy. Volume 82(11). November 2002.

This study examines the importance of differential diagnosis for lateral elbow pain. Often, lateral elbow pain is associated with lateral epicondylitis, an overuse injury or strain of the common extensor tendon of the wrist. This most frequently affects the extensor carpi radialis brevis tendon, with varying degrees of disruption. The injury may be a minor irritation of the tendinous fibers or a partial tear of the tendon at its attachment point, the lateral epicondyle. Other causes include a dysfunction at the radio-humeral joint or at cervical spine segments C5/6 or C6/7, which may refer symptoms to the area. These need to be addressed during the evaluation of lateral elbow pain.

Another cause, that may be involved, is radial tunnel syndrome (RTS) or entrapment of the deep radial nerve. One common site of entrapment is near the origin of the extensor musculature, which can make it difficult to differentiate from lateral epicondylitis. As the treatment techniques will vary, it is very important that an accurate assessment be performed to differentiate between the two. The history of someone with RTS may include a deep, diffuse pain that may radiate to the dorsal aspect of the hand. Symptoms are often aggravated with repetitive pronation activities. The patient is also often very tender to palpation of the radial tunnel itself. Signs of increased neural tension will be present in someone with RTS when the nerve is placed in a stressed position.

Lateral epicondylitis, on the other hand, presents with increased symptoms with resisted extension of the wrist or fingers, as well as localized pain to the lateral epicondyle. Specifically, pain with resistance to extension of the middle finger will create pain at the epicondyle with lateral epicondylitis and the radial tunnel with RTS, approximately 1-3 cm distal to the lateral epicondyle.

The authors of this study examined a 43-year-old female patient with complaints of lateral elbow pain. Her symptoms were increased with extensive keyboarding at the computer, and resistance to middle finger extension resulted in pain at the radial tunnel. She had more pain with palpation of the radial tunnel than the lateral epicondyle. Neural tension testing was then performed for the radial and median nerves. She presented with signs of increased neural tension during both tests.

Intervention for this patient included radial nerve gliding mobilizations, ultrasound, and a home exercise program. An ergonomic assessment of her work-station was also requested to decrease stress to the area. She was seen for a total of 14 visits over a 10-week period. At the conclusion of therapy, she had minimal tenderness, improved functional strength, and no pain symptoms 70-80% of the time. When contacted 4 months after treatment, she reported no pain and that she had resumed all normal activity.

At Renaissance, our therapists are trained in advanced manual therapy techniques including neural tension testing and mobilization techniques. Of course, the most important part of any physical therapy program is the evaluation, and we pride ourselves on being thorough from the beginning to the end of the treatment process.