Jerome S. Tobis

Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles

OBJECTIVES To determine the interexaminer reliability of palpation of three characteristics of trigger points (taut band, local twitch response, and referred pain) in patients with subacute low back pain, to determine whether training in palpation would improve reliability, and whether there was a difference between the physiatric and chiropractic physicians. DESIGN Reliability study. SETTING Whittier Health Campus, Los Angeles College of Chiropractic. PARTICIPANTS Twenty-six nonsymptomatic individuals and 26 individuals with subacute low back pain. INTERVENTION Twenty muscles per individual were first palpated by an expert and then randomly by four physician examiners. MAIN OUTCOME MEASURES Palpation findings. RESULTS Kappa scores for palpation of taut bands, local twitch responses, and referred pain were .215, .123, and .342, respectively, between the expert and the trained examiners, and .050, .118, and .326, respectively, between the expert and the untrained examiners. Kappa scores for agreement for palpation of taut bands, twitch responses, and referred pain were .108, -.001, and .435, respectively, among the nonexpert, trained examiners, and -.019, .022, and .320, respectively, among the nonexpert, untrained examiners. CONCLUSIONS Among nonexpert physicians, physiatric or chiropractic, trigger point palpation is not reliable for detecting taut band and local twitch response, and only marginally reliable for referred pain after training.

Effectiveness of four conservative treatments for subacute low back pain: A randomized clinical trial

Study Design. A randomized, assessor-blinded clinical trial was conducted. Objective. To investigate the relative effectiveness of three manual treatments and back school for patients with subacute low back pain. Summary of Background Data. Literature comparing the relative effectiveness of specific therapies for low back pain is limited. Methods. Among the 5925 inquiries, 206 patients met the specific admission criteria, and 200 patients randomly received one of four treatments for 3 weeks: back school, joint manipulation, myofascial therapy, and combined joint manipulation and myofascial therapy. These patients received assessments at baseline, after 3 weeks of therapy, and 6 months after the completion of therapy. The primary outcomes were evaluated using visual analog pain scales and Roland–Morris activity scales. Results. All four groups showed significant improvement in pain and activity scores after 3 weeks of care, but did not show further significant improvement at the 6-month follow-up assessment. No statistically significant between-group differences were found either at the 3-week or 6-month reassessments. Conclusions. For subacute low back pain, combined joint manipulation and myofascial therapy was as effective as joint manipulation or myofascial therapy alone. Additionally, back school was as effective as three manual treatments.

S-Adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: A double-blind cross-over trial. [ISRCTN36233495]

BackgroundS-Adenosylmethionine (SAMe) is a dietary supplement used in the management of osteoarthritis (OA) symptoms. Studies evaluating SAMe in the management of OA have been limited to Non Steroidal Anti-inflammatory Drugs (NSAIDs) for comparison. The present study compares the effectiveness of SAMe to a cyclooxygenase-2 (COX-2) inhibitor (celecoxib) for pain control, functional improvement and to decrease side effects in people with osteoarthritis of the knee.MethodsA randomized double-blind cross-over study, comparing SAMe (1200 mg) with celecoxib (Celebrex 200 mg) for 16 weeks to reduce pain associated with OA of the knee. Sixty-one adults diagnosed with OA of the knee were enrolled and 56 completed the study. Subjects were tested for pain, functional health, mood status, isometric joint function tests, and side effects.ResultsOn the first month of Phase 1, celecoxib showed significantly more reduction in pain than SAMe (p = 0.024). By the second month of Phase 1, there was no significant difference between both groups (p < 0.01). The duration of treatment and the interaction of duration with type of treatment were statistically significant (ps ≤ 0.029). On most functional health measures both groups showed a notable improvement from baseline, however no significant difference between SAMe and celecoxib was observed. Isometric joint function tests appeared to be steadily improving over the entire study period regardless of treatment.ConclusionSAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used.

Visual Perception Dominance of Fallers Among Community-dwelling Older Adults

The authors postulated that older adult fallers show a greater tendency than older adult nonfallers to rely more on visual information sources in maintaining upright posture than on kinesthetic and vestibular cues. This paper presents descriptive statistics on 199 older adults living independently in the community. Their visual perception of the vertical and horizontal was analyzed with respect to age, sex, health status, and severity of injury as a result of a fail. The finding of significant impairments for fallers in visual perceptual abilities confirmed a trend previously established by one of the authors (Tobis). When the visual field entailed only misleading or ambiguous cues in the form of a tilted frame, fallers again showed a larger error than nonfallers in establishing the vertical and horizontal. The authors feel that this relatively greater dependence on visual sources may develop in response to impairment of feedback on posture and gait from the kinesthetic and vestibular systems as a result of age and chronic health problems. Errors in visual perception of the vertical and horizontal intercorrelated with age, sex, and a large number of medical problems. However, visual variables were more important in predicting faller status than physical characteristics.

Why Do Healthy Older Adults Fall

Falls among elders at senior centers may be due more to behavioral and environmental risks than to impaired health, strength, and balance. We monitored 222 older adults at senior centers weekly for two years and documented 242 falls; their location (outdoors: inside the home, or in transition areas, such as garage or patio), activities associated with the fall, and consequences of the fall, such as parts of the body that received the impact of the fall and the associated level of injury. As hypothesized, healthy elderly fell more often outdoors and in transition areas than inside their home. They fell most often due to inattention and in association with hazardous activities.