William P. Hanten

Maximum grip strength in normal subjects from 20 to 64 years of age

The purposes of this study were to develop normative maximum grip strength (GRIP) data for men and women aged 20 to 64 years, separated into nine five-year age groups, and to develop prediction equations for GRIP using gender, age, height, weight, and hand dominance. A total of 1,182 volunteers (553 men and 629 women) participated in the study. Maximum hand grips were obtained using the Jamar dynamometer with standardized positioning and instructions. The hand to be tested first was chosen randomly. Each hand was then tested alternately. Three trials were performed on each hand. The highest GRIP for each hand was used for analysis. Two-way analyses of variance showed significant differences between the right and left hands and across the age groups for both genders. Follow-up analyses showed that significant decreases occurred between the age groups of 50-54 and 55-59 years in men and between the age groups of 50-54 and 60-64 years in women. The data also indicated that right and left GRIPs were highly correlated with each other (r = 0.93). Gender, height, and weight moderately correlated with both GRIPS (r = 0.52-0.73. Age correlated weakly with both GRIPs (r = -0.17). If either the right or the left GRIP was known, the other GRIP could be predicted easily from the known GRIP, with 87% of variance accounted for. Without the knowledge of the other GRIP, either GRIP could be predicted through gender, height, weight, age, and hand dominance, with 61% to 62% of the explained variance. The norms and prediction equations of GRIP developed in this study for men and women aged 20 to 64 years will help clinicians with decision making regarding grip strength.

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.

Wang WTJ, Olson SL, Campbell AH, Hanten WP, Gleeson PB: Effectiveness of physical therapy for patients with neck pain: An individualized approach using a clinical decision-making algorithm. Am J Phys Med Rehabil 2003;82:203–218. Objective The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. Design One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests. Results Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores. Conclusions This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.

Assessment of total head excursion and resting head posture

Clinicians typically evaluate head posture and cervical range of motion in both standing and sitting positions. There are currently few quantitative data available regarding resting head posture (RHP) or total head excursion (THE), a retraction-protraction gliding range of head motion in the sagittal plane, and where the RHP lies within THE. The purposes of this study were to describe quick and simple methods to determine quantitative measurements of THE, RHP while sitting, and RHP while standing, to provide preliminary data on these postural measurements for men and women in four age categories; and to determine the effects of gender and age on these measurements. Subjects included 218 able-bodied adults. Measurements of THE, RHP while sitting, and RHP while standing were taken. A two-way multivariate analysis of variance followed by two-way analyses of variance showed only the main effect of gender to be significant (p less than .05) for each of the dependent measurements. Across the age groups, men had a greater excursion distance from retraction to protraction than women. Within THE, women held their heads more forward than men. Men held their heads farther from the vertical than women while standing. These results indicate that normal head and neck posture is different for men and women and should not be judged by the same standard. The methods used in this study are clinically advantageous in that they produce objective, quantitative measurements of THE and RHP that may be obtained quickly and with minimal equipment.

Total head excursion and resting head posture: Normal and patient comparisons

OBJECTIVE To determine whether significant differences existed between normal and patient groups on three postural measurements: anterior-posterior total head excursion (THE), resting head posture in sitting (RHPsit), and resting head posture in standing (RHPstd). SUBJECTS Forty-two healthy subjects, 13 men and 29 women between the ages of 20 and 60 years, were matched to 42 patients according to gender and age. DESIGN Measurements of THE, RHPsit, and RHPstd were taken for each subject. Patients were measured during their initial evaluation and had neck pain as a primary or secondary complaint. RESULTS A two-way multivariate analysis of variance followed by two-way analyses of variance showed that normal subjects had a significantly (p<.05) greater THE than did the patients and that men (patients and controls) scored significantly higher (p<.05) than women (patients and controls) on both THE and RHPstd. CONCLUSION Clinical assessment of patients with cervical pain should focus on cervical mobility rather than resting head posture. Head/neck posture is different for males and females and they should not be judged by the same standard.

Functional activities characteristics of shoulder complex movements: Exploration with a 3-D electromagnetic measurement system.

The high prevalence of shoulder-related dysfunction has focused increased attention on functional activity assessment. This study (1) tested the reliability of three-dimensional shoulder complex movements during four functional tasks representing different levels of task difficulty, (2) characterized the four functional tasks, and (3) examined the relationships between age and shoulder movements. Twenty-five asymptomatic subjects, all veterans aged 30-82, performed the four functional tasks. Good within-session reliability was found (movement pattern: similarity index = 0.81 to 0.97, peak values: intraclass correlation coefficients = 0.88 to 0.99). The raising arm to overhead height task (hard task) placed the greatest demand on scapular motions and humeral elevation (p < 0.005). During the functional tasks, significant correlations existed between age and scapular tipping, humeral elevation, and scapular upward rotation (r = -0.62 to 0.50, p < 0.05). Correlation results indicated that elderly subjects have a greater potential for serratus anterior muscle weakness and shoulder capsule tightness.

The Effectiveness of CV-4 and Resting Position Techniques on Subjects with Tension-Type Headaches

AbstractTension-type headache (TTH) is a common reason for consulting a clinician. Manual therapies are being used in clinical settings to treat TTH with no documented research to validate their efficacy. This study investigated the effectiveness of CV-4 and resting position techniques on TTH sufferers. Sixty adults between the ages of 21 and 65 (x=36, SD=12) who were experiencing a TTH were randomly assigned to groups. Subjects in the first group received a 10-minute session wherein multiple still points were induced using the CV-4 craniosacral technique. Subjects in the second group were placed supine in a resting position with the head and neck positioned for ten minutes in the most comfortable points in the ranges of protraction-retraction and flexion-extension. Subjects in the third group received no treatment; they lay quietly for 10 minutes. Pain intensity and the affective component of pain were measured before and after the treatments using visual analog scales. To determine if significant differ...

Effects of active head retraction with retraction/extension and occipital release on the pressure pain threshold of cervical and scapular trigger points

Pain in the cervical and scapular regions is often associated with trigger points in these regions. Although there are many types of manual therapies used in the clinic to relieve trigger points, there is no documented research to validate their efficacy. The aim of this study was to evaluate the effectiveness of a single session of each of two manual therapy techniques on the pressure pain thresholds of trigger points in the cervical and scapular regions. Sixty volunteers with one or more trigger points were recruited. Subjects were randomly assigned to groups receiving one treatment session of head retraction and retraction/extension exercises, occipital release, or no treatment. A pre-test and post-test of pressure pain threshold were performed on each subject using a pressure algometer. A one-way analysis of covariance, using the pre-test as the covariate, was conducted to analyse the data. The results of the analysis indicated that there were no significant differences between the groups. No changes ...

Reliability of Manual Mobility Testing of the Upper Cervical Spine in Subjects with Cervicogenic Headache

Abstract The identification of a cervicogenic headache is determined by criteria as stated by the International Headache Society (IHS). One of the criteria involves a finding of abnormal tenderness or resistance to movement in the neck region. The purpose of this study was to examine the inter-examiner and intra-examiner reliability of manual mobility testing of the upper cervical spine in the diagnosis of cervicogenic headaches in symptomatic subjects. Two groups of 20 subjects were required to meet initial criteria for a cervicogenic headache as adapted from the IHS. Subjects were not currently receiving medical treatment for headaches. To determine inter-examiner reliability, two examiners independently examined the 20 subjects (ages 22-48; 5 males and 15 females). Each examiner performed 15 mobility tests in random order on each subject. To establish intra-examiner reliability, a separate group of 20 subjects (ages 21-48; 3 males and 17 females) was evaluated by one examiner on two consecutive days. The Spearmans rho correlation was applied to the total number of abnormal findings recorded across each group of subjects. The Kappa correlation coefficient and percent agreement were used to compare the findings of each of the 15 mobility tests. They were also used to compare the identification of at least one abnormal finding for every subject. For this study, Kappa values ≥0.400 were considered acceptable. The Spearmans rho value for inter-examiner reliability was 0.943. Acceptable inter-examiner reliability was found on 11 out of 15 mobility tests, with Kappa values ranging from –0.053 to 1.000 and percent agreement values ranging from 70 to 100%. There was 100% agreement between examiners on whether the subject met the IHS criteria, resulting in a Kappa value of 1.000. The Spearmans rho value for intra-examiner reliability was also 0.943. Kappa values for intra-examiner reliability were acceptable for 11 out 15 tests and ranged from 0.208 to 1.000. The percent agreement values ranged from 60 to 100%. There was 100% agreement on consecutive days on whether the subject met the IHS criteria, yielding a Kappa value of 1.000. This study found that mobility testing, which includes palpation of the cervical spine, is a reliable tool, specifically in the identification of a cervicogenic headache in symptomatic subjects.

The Effect of Manual Therapy and a Home Exercise Program on Cervicogenic Headaches: A Case Report

Abstract The objective of our study was to determine the effectiveness of manual therapy for balancing C1 and a home exercise program, including active neck retraction exercises performed in a series of progressions, in the treatment of cervicogenic headache. The subjects included a 42-year-old male (Subject 1) and a 25-year-old female (Subject 2), both with a primary complaint of right-side suboccipital headache. Subject 1 was functionally limited in reading, sleeping, and playing basketball. Subject 2 reported problems with working, sleeping, and running on a treadmill. Both subjects met the criteria for cervicogenic headache as adapted from the International Headache Society. On Day 1, each subject completed three self-report measures: a numeric pain scale for both worst and average headache pain as well as the Patient Specific Functional Scale. Each subject was treated on Days 1, 3, and 5. Intervention included using a muscle energy technique for balancing C1 and a home program consisting of a progression of McKenzies retraction/extension/rotation exercises. Each subject was told he/she may continue the home program on his/her own accord every 2 hours or as a headache occurred. On days 12 and 26, each subject completed the previous three self-report measures as well as the Global Rating Scale during blinded follow-up phone visits. The subjects demonstrated an increase in functional activities, a decrease in average and worst headache pain, and an overall improvement in their perception of change in the headache. Manual therapy in addition to a home program of active neck retraction exercises in a series of progressions was successful in relieving cervicogenic headache and improving function in two subjects. Patients with cervicogenic headaches could be empowered to alleviate their own symptoms with decreased physical therapy visits and decreased cost by having a manual therapy technique performed on them followed by a home exercise program.

Het effect van oefeningen op de elektromyografische activiteit van de M. vastus medialis obliquus en de M. vastus lateralis

Dit onderzoek had ten doel na te gaan of het schuin verlopende deel van de M. vastus medialis of de ‘M. vastus medialis obliquus’ (vmo) een grotere elektrische activiteit vertoonde dan de M. vastus lateralis (vl), bij uitvoering van heup-adductie- en onderbeen-endorotatie-oefeningen.