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.

Reliability of Safe Maximum Lifting Determination of a Functional Capacity Evaluation
Gross DP, Battie MC. Physical Therapy. May 2002.

Frequently health care professionals are challenged with deciding when patients with low back pain (LBP) are able to safely return to work. The main concern is whether or not that person’s job duties will exacerbate his/her pain from premature spinal loading. Functional capacity evaluations (FCEs) administered by a trained therapist can help determine when a patient is ready to return to work based on the tasks they can perform safely. If the person does not have a job to return to, vocational rehabilitation services can use the information for job placement by comparing results with known demands of other occupations. In order to be useful, the FCE must be a valid and reliable measure. The goal of this study was to examine test-retest reliability of lifting determinations of maximal safe manual handling levels during kinesiophysical FCE in patients with LBP who were medically stable and receiving workers’ compensation.

Twenty-eight subjects were tested separately by 2 raters and simultaneously observed by 3 more raters. Each subject was tested on 2 separate occasions, separated by 2-4 treatment days. Testing took place during the subjects’ last week of rehabilitation. Tasks rated were floor-to-waist, waist-to-crown, and horizontal lifting and front, right, and left side carrying.

The inter-correlation coefficient values for inter-rater reliability on sessions one and two were between .95 and .98. Test-retest values ranged from .78-.94. This high degree of similarity between ICC values and CI’s for the duplicate measures indicates significant stability of the test-retest values. Raters agreed substantially or perfectly on the performance-limiting factor for test-termination on most subtests according to the Landis and Koch categorization for Kappa values. Overall, inter-rater reliability of lifting and carrying determinations by trained therapists was excellent.

In addition to providing effective out-patient orthopedic care, Renaissance Physical Therapy NW can perform FCE’s with state of the art technology to provide objective strength and ROM measures for nearly every joint. We use that information to generate a comprehensive analysis of our findings for the patient, physician, employer, and insurance company. This data can then be used to help determine the best POC for that particular patient. Please contact us if you would like further information about our testing procedure or to schedule a FCE for your patient.

Short-Term Effects of Workstation Exercises on Musculoskeletal Discomfort and Postural Changes in Seated Video Display Unit Workers
Fenety A, Walker JM. Physical Therapy. July 2002.

As the number of computers sold in this country grows, the number of people that routinely use a video display unit (VDU) while at work is also growing. These VDUs are being used for data entry, electronic sales, word processing, and service work. With more and more jobs requiring the use of a computer, many of these jobs are subject to external pacing of tasks. This leads the VDU operator to take fewer self-selected breaks. Extended periods of VDU use has been linked to infrequent postural changes and discomfort while sitting, both of which are predictors for musculoskeletal problems. The authors of this study examined whether or not they could increase in-chair movement (ICM) and decrease musculoskeletal discomfort by adding an exercise program performed at the workstation.

The subjects for this study were eleven directory assistance operators with no recent history of musculoskeletal problems. The furniture, environment, workload, and tasks were standardized in this group of subjects. The operators work with a headset, VDU, and keyboard as they are speaking with customers.

Discomfort was assessed using the Body Part Discomfort Scale (BPDS) and the Localized Musculoskeletal Discomfort (LMD) body map. ICM was measured by tracking the center of pressure changes on the chair surface as subjects sat on a pressure-sensing mat.

The subjects were tested over a two-hour period. They were tested twice; once prior to starting the exercises and then once again after 6-10 days of performing the exercise program. The exercise program consisted of a series of stretches held for five seconds during set exercise break times during the workday. Subjects were observed from a distance to ensure adherence to the program.

The results of this study demonstrated that workstation exercises did increase ICM, which would indicate more frequent changes in posture. This would decrease the stress on any one part of the body. The researchers also found a decrease in musculoskeletal discomfort after starting the program of workstation exercises. This is significant because VDU operators have a high incidence of musculoskeletal discomfort, especially in the neck and low back. The combination of increased movement and changes in posture with reports of decreased musculoskeletal discomfort support the use of regular workstation exercises as an appropriate means of decreasing discomfort in the workplace and, therefore, improving efficiency and decreasing work-related injury for VDU operators. It is important to note that adherence to the exercise program is key to its success.

At Renaissance, every patient is given a home exercise program and we frequently tailor individual programs to a patient’s work site and duties. We also place a heavy emphasis on consistency with exercises to ensure the best possible results.

Headache?
Physical Therapy Can Help! (part 2)
By Jennifer Swift, DPT

The diagnosis of a cervical headache requires the presence of a pattern of symptoms and cervical musculoskeletal signs that were discussed in the previous newsletter. Treatment of the cervicogenic headache must address the specific impairments the patient has and successful outcomes rely on skilled delivery of treatment. Treatment aims to help the patient with the cervicogenic headache must be precise and comprehensive in order to cope with the often complex dysfunctions in the musculoskeletal system that might be present.

Musculoskeletal conditions usually manifest as pain associated with physical impairments in the articular (joint) and/or neuromuscular systems. The joint impairment is managed by a combination of mobilization and active movement therapies. Mobilization is used to restore proper joint function and mobility, and also to relieve joint pain through analgesic properties. Active movement is necessary to maintain effects gained by mobilization and to reeducate the segments and surrounding muscles to move.

A joint without adequate muscular support will be vulnerable for further injury. Cervical supporting muscles have a vital function in stabilizing the cervical spine. When the deep supporting musculature is weak the outer scalenes, levator scapula and trapezius muscles become overworked and dysfunctional trying to support the neck. The dysfunction of these muscles is normally shortening and tightness. Tightening of these muscles can then lead to cervical range of motion dysfunction therefore not allowing the neck to move freely, and causing further compensation patterns from other muscle groups. When these muscles get tight it is necessary to relax them through stretching and myofascial release or soft tissue mobilization techniques.

If the deep neck flexors or the scapular supporting muscles are dysfunctional then activation and re-education of their tonic supporting capacity is essential in the treatment of headaches. This can be accomplished through scapular stabilization exercise, cervical range of motion and isometric exercise and by incorporating the Cervical Med-X strengthening machine into their treatment. The Cervical Med-X machine specifically targets and isolates the deep cervical paraspinal muscles and does not allow the patient to use any compensatory muscles in order to accomplish the movements.

Another important aspect in treatment is posture analysis and re-education. The patient must be taught how to assume a correct neutral and upright spinal posture as part of a motor skills retraining program to the supporting muscles. In addition to postural retraining, the patient must be given ergonomic and lifestyle advice in order to ensure proper postures and positioning while performing work and home duties.

It is important to understand that the physical changes that have developed with the prolonged history of cervical headache are unlikely to resolve in just a couple of treatment sessions. The patient and the clinician need to understand that it will take time and dedication to make the necessary musculoskeletal changes in order to relieve the headache symptoms.

References:
Sjaastad O, Bovin G. Cervicogenic headache, the differentiation from common migraine. An overview. Functional Neurology 1991;6:93-100. Jull G. Management of cervicogenic headache. Manual Therapy 1997;2 (4), 182-190.