Jules M Rothstein

Intertester reliability of McKenzie's classifications of the syndrome types present in patients with low back pain.

The McKenzie system for examining and treating patients with low back pain is frequently used by clinicians. The primary purpose of this multicenter study was the determine the intertester reliability of assessments of patients with low back pain when physical therapists used the McKenzie method. A second purpose was to determine if previous postgraduate training in the McKenzie system affects reliability. Some therapists had previously undertaken postgraduate training in the McKenzie system. All therapists were given written descriptions of the McKenzie method and the criteria used to classify patients, Classifications were made on 363 patients with low back pain by randomly paired physical therapists in eight clinics. The Kappa value on agreement of patient classification was 0.26, which suggests poor reliability. Therapists agreed on which syndrome was present 39% of the time. Previous postgraduate training did not reliability. The results suggest that assessments of the syndrome present in patients; with low back pain appear to be unreliable when using the McKenzie system.

Effect of lordosis on the position of the nucleus pulposus in supine subjects: A study using magnetic resonance imaging

Study Design Healthy young women (N =20) underwent magnetic resonance imaging while supine with their hips and knees fiexed (fiexed position) and supine with a lumbar roll under the low back (extended position). The posterior and anterior margins of the nucleus pulposus (NP) relative to posterior and anterior margins of the adjacent vertebral bodies were calculated from mid-sagittal T2-weighted images to determine the position change of the NP as a function of two supine postures. Objectives This study describes the effect of two commonly used supine postures on the position of the NP. Summary of Background Data Management of patients with low back pain is often based on theorized positional changes of the NP during spinal extension and flexion. Data describing NP positional changes have not been reported for noninvasive measurements. Results The distance of the posterior margin of the NP to the posterior margins of the adjacent vertebral bodies was greater in the extended compared with the fiexed position. There was no difference in the anterior distance. Eight of the 20 subjects had at least one degenerative disc in the lower lumbar spine. The NPs of the degenerative discs did not move the same as normal discs. Conclusions The use of a lumbar roll under the low back when supine causes an increase in the distance from the posterior margin of the NP to the posterior portions of the vertebral bodies in normal discs of healthy young females. Degenerative discs deform differently from nondegenerative discs.

We Walk the Line

Once upon a time, the primary function of journals was to offer researchers and academics in search of status and tenure a place to publish, and to provide graduate students with an outlet for their efforts. Although few people would admit it, at that time there was more concern about how authors would be viewed by their peers (by “peers,” I mean their colleagues who also conducted and published research) and how readers would deal with new information. Those days have almost disappeared. Now as then, dynamic tension exists among authors, editors, and readers. The arrogance of the old days has diminished, and few authors today would state publicly that it is the “readers problem” when the reader cannot understand a paper or apply its findings. But there still is some resentment on the part of authors when editors demand that they write readable papers. Similarly, journals still hear from readers who believe that articles are too complicated to be understood easily. Some readers seem to want everything pre-digested and do not care what is lost in the process. The Journal does care, however. The Journal Editors take no solace from the fact that two of their most important constituent groups may not be completely happy. The old line is that if you are getting criticism from both sides, you are probably doing something …

An experimental investigation of the validity of the manual muscle test positions for the extensor pollicis longus and flexor pollicis brevis muscles

Abstract This study examined the validity of Kendalls classic manual muscle test (MMT) positions for the extensor pollicis longus (EPL) and the flexor pollicis brevis (FPB) muscles. We hypothesized that these positions did not eliminate forces contributed by synergist muscles. The use of alternate MMT positions designed to reduce the forces contributed by the synergists was investigated. Maximal isometric force values obtained for the EPL and FPB in the classic, proposed synergist lengthened, and proposed synergist shortened MMT positions were compared. For both muscles, there was a significant difference among the three test positions. The EPL classic and the synergist shortened positions produced significantly less force than the synergist lengthened position. Less force was produced in the FPB shortened position than in the other test positions for the FPB. There appear to be better positions for manual muscle testing of the EPL and FPB. The clinician should consider using the classic test position and the proposed synergists shortened position for isolation of the EPL. Use of the proposed synergist shortened position is recommended for testing the FPB.

An American Original

When I was a child, Ebbets Field, the home of the now long-departed Brooklyn Dodgers, seemed enormous. Little did I know that the rest of the world thought the stadium was small and almost intimate. Whenever an outraged fan (a redundant term in the Brooklyn of my youth) verbally corrected an umpires call and made the miscreant official turn to take note, I was in awe. Back then, I never personally knew anyone who could bellow with the appropriate style and content to make the original men in black take notice, so those fans who did had my respect and envy: respect for their skill and envy for their ability to shed inhibitions, to become one with the game.…

Review the Journal

When 1999 comes to a close, there will be little time for reflection on the immediate. Like all people on the planet, I will be forced to deal with more monumental issues as I contemplate the new millennium. But what about this year? Where do we stand as we enter 1999? Will the Y2K problem really change life as we know it? I wonder how the Journal should prepare for the new millenium. Journals are supposed to be fonts of information, suppliers of evidence and insight, and arenas for dialogue and discussion. The emphasis is on communicating with readers. But how can we hope to achieve these lofty goals unless we also undergo scrutiny by all those we claim to serve? The Journal reviews manuscripts; you should review the Journal. Like many Journals, we seek to better understand our performance by conducting reader surveys.…

Of Weddings and Baseball

Weddings can make you think in unusual ways. Last month this father of the bride was flooded with a variety of emotions as he and his wife walked their firstborn down the aisle. Memories flew past at supersonic speeds, and there was a sharpening of the senses that made every second more intense and memorable. And right in the middle of all those images and emotions were thoughts of Minnie Minoso and Ernie Banks. Even in spirit these great Chicago baseball legends had no business being at my daughters wedding, but nonetheless there they were, and they just would not leave. Minnie Minoso, a Cuban immigrant who began playing baseball on sugar plantations, became fodder for parody and derision when he said, “Baseball has been very, very good to me.” Minosos heartfelt remarks—both the content and the accent—have been mocked time and again.…

The Role of Dialogue and Discussion

Articles that appear in Physical Therapy have passed through what is generally agreed upon to be a rather demanding peer-review process, a process that is designed to assist authors in refining and improving their manuscripts and to ensure that all published papers meet a minimal level of credibility. We do not publish research papers unless we believe that the paper is appropriate for our readers and contains a credible method used in an appropriate manner to answer a meaningful question. If the process is so rigorous, why do we often invite commentaries and conduct conferences in which people comment on articles? Its certainly not because we have second thoughts or hesitations about the articles! If we have concerns about a paper, either we will not publish it or we will continue to work with the authors to eliminate the source of our concerns.…

Meetkarakteristieken van de KIN-COM dynamometer

Het doel van het hier gepresenteerde onderzoek was na te gaan welke karakteristieken de kin-com dynamometer heeft bij gecontroleerde metingen.

De McKenzie-classificatie van syndromen bij patiënten met lage-rugpijn: een betrouwbaarheidsvergelijking

Het eerste doel van dit onderzoek dat in verschillende praktijken werd uitgevoerd was het vergelijken van de betrouwbaarheid van evaluaties van patienten met lage-rugklachten die door fysiotherapeuten behandeld worden volgens de ‘McKenzie-methode’.