Richard B. Westrick

Immediate Effects of Lumbopelvic Manipulation and Lateral Gluteal Kinesio Taping on Unilateral Patellofemoral Pain Syndrome: A Pilot Study

Objectives: To determine the immediate effects of Kinesio taping directed to the hip and manipulation directed to the lumbopelvic region in individuals with unilateral patellofemoral pain syndrome (PFPS). Background: PFPS affects up to 25% of the general population. Despite the high prevalence, this condition is not clearly understood, as evidenced by the numerous proposed causes and recommended treatments. Notwithstanding, recent evidence suggests that treatments directed at the hip or spine may lead to beneficial results. Methods: A convenience sample of 18 participants (12 men and 6 women, 19.5 ± 1.15 years old) with unilateral PFPS was recruited. Participants were randomized by sex to 1 of 3 groups: Kinesio taping, manipulation, and control taping. The main outcome measures included the Y-balance test, squatting range of motion (ROM), and the Lower Extremity Functional Scale. Results: Compared with the lumbopelvic manipulation and control groups, those in the Kinesio taping group performed significantly better on the Y-balance test (F = 5.59, P = 0.02) and with squatting ROM (F = 3.93, P = 0.04). The Kinesio taping and lumbopelvic groups were also significantly better than the control (sham) group with double-leg squatting ROM performance 3 days later. Conclusion: Kinesio taping may facilitate gluteus medius activation and improve postural stability and a double-leg squat. Clinical Relevance: The improvement in affected limb reach and double-leg squatting ROM highlights the potential for Kinesio taping to improve gluteus medius activation. Lumbopelvic manipulation may also immediately improve rehabilitation programs for PFPS.

Isometric Shoulder Strength Reference Values for Physically Active Collegiate Males and Females

Background: It is common clinical practice to assess muscle strength during examination of patients following shoulder injury or surgery. Strength comparisons are often made between the patient’s injured and uninjured shoulders, with the uninjured side used as a reference without regard to upper extremity dominance. Despite the importance of strength measurements, little is known about expected normal baselines of the uninjured shoulder. The purpose of this study was to report normative values for isometric shoulder strength for physically active college-age men and women without history of shoulder injury. Methods: University students—546 males (18.8 ± 1.0 years, 75.3 ± 12.2 kg) and 73 females (18.7 ± 0.9 years, 62.6 ± 7.0 kg)—underwent thorough shoulder evaluations by an orthopaedic surgeon and completed bilateral isometric strength measurements with a handheld dynamometer. Variables measured included internal rotation, external rotation, abduction, supine internal rotation and external rotation at 45°, and lower trapezius in prone flexion. Results: Significant differences were found between the dominant and nondominant shoulder for internal rotation, internal rotation at 45°, abduction, and prone flexion in males and in internal rotation at 45° and prone flexion for females (P ≤ 0.01).

Posterior Labral Tear With a Paralabral Cyst Causing Suprascapular Nerve Compression

The patient was a 21-year-old man who was currently enrolled in a military academy. He was seen by a physical therapist in a direct-access capacity for a chief complaint of right shoulder fatigue and discomfort that was present for the past week. Due to marked atrophy and weakness with no history of injury, an orthopaedic surgeon was consulted and diagnostic imaging was requested. Magnetic resonance imaging revealed a posterior labral tear with a large paralabral cyst, likely resulting in significant compression of the suprascapular nerve.

Rotator Cuff Weakness Is Not a Risk Factor for First-Time Anterior Glenohumeral Instability

Background: Shoulder instability is a common problem in young athletes and can lead to pain and decreased ability to participate in high-level activities. Little is known about the modifiable risk factors for glenohumeral joint instability. Hypothesis: Isometric shoulder strength at baseline would be a modifiable risk factor associated with subsequent first-time anterior instability events. Study Design: Cohort study. Methods: Study participants were freshmen entering the United States Military Academy in June 2006. All participants completed bilateral isometric strength evaluations with a hand-held dynamometer at baseline upon entry into the study. Variables measured included internal and external rotation at 0° (IR0, ER0) and internal and external rotation at 45° of abduction (IR45, ER45). All subjects were followed for subsequent glenohumeral joint instability events until graduation in May 2010. Independent t tests were used to analyze the data. Results: Baseline strength data were available for 1316 shoulders with no prior history of instability, of which 26 went on to have an acute first-time anterior shoulder instability event while the individuals were at the academy. There were no significant differences in mean strength between shoulders that did not go on to develop instability (uninjured; n = 1290) and those that did develop anterior instability (injured; n = 26). The mean strength values in pounds of force for uninjured and injured shoulders, respectively, were as follows: IR0 (49.80 vs 49.29; P = .88), ER0 (35.58 vs 33.66; P = .27), IR45 (47.38 vs 46.93; P = .88), and ER45 (40.08 vs 38.98; P = .59). Conclusion: No association was found between isometric shoulder strength measures at baseline and subsequent first-time anterior glenohumeral joint instability within the high-risk athletic population studied in this prospective cohort.

Morel-Lavallée lesion of the lumbar region.

The patient was a 21-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of low back pain that began the previous day after falling directly onto his back while snowboarding. Given the patients history of trauma, worsening low back pain, and enlarged soft tissue mass in the lumbar region, the physical therapist ordered magnetic resonance imaging. The findings were consistent with a Morel-Lavallée lesion of the lumbar region.

Isolated Posterior Cruciate Ligament Injury

The patient was a 19-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right knee pain and giving way after falling onto his right knee while snow sledding at a high rate of speed 2 weeks earlier. Knee radiographs were ordered by the physical therapist, which demonstrated a large suprapatellar joint effusion. Due to concern for a posterior cruciate ligament injury and to assess for concomitant injury, magnetic resonance imaging was ordered, which revealed disruption of the posterior cruciate ligament without injury to surrounding tissues.

Fracture of the Capitate

The patient was a 21-year-old female cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right wrist pain that began 1 day prior after a fall on an outstretched hand. Due to concern for a fracture, the physical therapist ordered radiographs of the right wrist, which were interpreted as normal. At the time of the patients follow-up visit 2 weeks later, active range of motion of the right wrist was still limited due to pain, and there was exquisite tenderness to palpation over the dorsal aspect of the capitate. Repeat radiographs of the right wrist were ordered and interpreted as normal. Despite the normal radiographs, a high index of suspicion still remained for a fracture. Therefore, magnetic resonance imaging of the right wrist was ordered, which revealed a nondisplaced fracture of the capitate. J Orthop Sports Phys Ther 2014;44(7):541. doi:10.2519/jospt.2014.0408

Cervical Myelopathy in a Special Operations Soldier

The patient was a 31-year-old man who was currently serving in a military special operations combat unit. He was evaluated by a physical therapist for a chief complaint of upper extremity weakness and decreased hand dexterity bilaterally. Due to strong suspicion of spinal cord involvement, the physical therapist ordered magnetic resonance imaging, which revealed advanced degenerative changes of the cervical spine and a large disc extrusion at C5-C6.

Fractures Through the Base of the Second and Third Metacarpals

The patient was a 21-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right wrist and hand pain. The symptoms began 5 days earlier following a punching injury, after which the patient reported immediate pain and swelling in the right wrist and hand. The physical therapist ordered radiographs of the right hand, which demonstrated nondisplaced, nonangulated transverse fractures through the bases of the second and third metacarpals. J Orthop Sports Phys Ther 2014;44(2):129. doi:10.2519/jospt.2014.0403

Dorsal Triquetrum Fracture

The patient was a 39-year-old man who self-referred to a physical therapist with a chief complaint of right wrist pain after falling backward onto an outstretched right hand the previous day. Based on the suspicion of a fracture, right wrist radiographs (posterior-to-anterior, lateral, and oblique views) were completed, which revealed a comminuted dorsal triquetrum fracture. The patient was referred to an orthopaedic surgeon who recommended nonoperative management.