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Next to the common cold, low back pain (LBP) is the most common reason that people visit a physician's office, (1) and billions of dollars in medical expenditures and lost [...], Background and Purpose A clinical prediction rule (CPR) has been reported to identify patients with low back pain who are likely to benefit from stabilization exercises. The aim of this study was to characterize the spinal motion, using digital fluoroscopic video, of a subgroup of subjects with low back pain. Subjects Twenty subjects who were positive on the CPR were compared with 20 control subjects who were healthy. Methods The magnitude and timing of lumbar sagittal-plane intersegmental angular and linear displacement were assessed. Receiver operating characteristic curves and accuracy statistics were used to develop a kinematic model. Results A 10-variable model was developed that could distinguish group membership. Seven of these variables described a disruption in timing of angular or linear displacement during mid-range movements. None of the variables suggested hypermobility. Discussion and Conclusion The findings suggest that individuals with mid-range aberrant motion without signs of hypermobility are likely to benefit from these exercises. The developed model describes altered kinematics of this subgroup of subjects and helps to provide construct validity for the developed CPR.

As the rollout of The Sarbanes-Oxley Act continues, the pressure on corporate governance has been unrelenting. The following articles look at different aspects of that phenomenon: advice to audit committees [...]

Many interventions used by physical therapists in the management of patients with low back pain (LBP) lack evidence supporting their effectiveness. (1-4) For example, interventions such as thermal modalities, electrical [...], Background and Purpose. Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. Subjects. Seventy-five people with nonradicular low back pain (mean age = 37.6 years, SD = 10.6, range = 19-59; mean duration of symptoms = 41.7 days, SD = 54.7, range = 1-252) participated. Methods. Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated. Results. Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome. Discussion and Conclusion. The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve. [Fritz JM, Whitman JM, Flynn TW, et al. Factors related to the inability of individuals with low back pain to improve with a spinal manipulation. Phys Ther. 2004;84:173-190.] Key Words: Evidence-based practice, Low back pain, Spinal manipulation.

Patellofemoral pain syndrome (PFPS) is an important clinical problem and the most prevalent disorder of the knee. (1-3) In a retrospective survey of 2,002 patients with running-related injuries, PFPS was [...], Background and Purpose. In patients with patellofemoral pain syndrome (PFPS), the authors determined which aspects of the examination could be used to identify those patients most likely to respond to off-the-shelf foot orthoses and instruction in activity, modification. Participants and Methods. Fifty participants were enrolled in the study, and data for 5 individuals were excluded from analysis. Thirty-four men and 11 women completed the study. Participants were given foot orthoses and instructed in activity modification for 3 weeks. A 50% reduction in pain was considered a success. Likelihood ratios (LRs) were computed to determine which examination findings were most predictive of success. Results. The best predictors of improvement were forefoot valgus alignment of ≥ 2 degrees (+LR=4.0, 95% confidence interval [CI]=0.7-21.9), great toe extension of ≥ 78 degrees (+LR=4.0, 95% CI=0.7-21.9), and navicular drop of ≥ 3 mm (+LR=2.4, 95% CI=1.3-4.3). Discussion and Conclusion. The results suggest that patients with PFPS who have forefoot valgus alignment of ≥ 2 degrees, passive great toe extension of ≥ 78 degrees, or navicular drop of ≥ 3 mm are most likely to respond favorably to initial intervention with an oft-the-shelf foot orthosis and instruction in activity modification. Key Words: Knee pain Ortholics, Patellofemoral, Physical examination, Rehabilitation.