Physiospot Musculoskeletal

Blood Investigations in Advanced Musculoskeletal Practice at Sheffield Hallam University

This course is designed for physiotherapists working or developing towards an Advanced Practice/Extended Scope role.

The module aims to develop an understanding of
• blood investigations in advanced musculoskeletal practice
• the consequences of such investigations
• how blood investigations might influence patient management.

The module will promote reflection on the practitioners' clinical role and scope of practice and will include the practical skills around taking blood. Successful completion of this module will earn you 15 level 7 credits which may be put towards the MSc Advancing Physiotherapy.

Provisional Timetable
Fri 3rd Oct, Fri 24th Oct, Fri 7th Nov, Fri 21st Nov, Fri 12th Dec.

More Information

High inter-tester reliability of the new mobility score in patients with hip fracture.

Kristensen MT, Bandholm T, Foss NB, Ekdahl C, Kehlet H

The purpose of this study was to assess the inter-tester reliability of the New Mobility Score in patients with acute hip fracture. The New Mobility Score, which evaluates the prefracture functional level with a score from 0 (not able to walk at all) to 9 (fully independent), was assessed by 2 independent physiotherapists at the orthopaedic ward.

The inter-tester reliability of the New Mobility Score is very high and can be recommended to evaluate the prefracture functional level in patients with acute hip fracture.

Journal of Rehabilitation Medicine, 2008, 40(7), 589-91

Link to Abstract

Identification of abnormal hip motion associated with acetabular labral pathology.

Austin AB, Souza RB, Meyer JL, Powers CM

The purpose of this case study was to explore the extent to which abnormal movement at the hip is a possible contributor to acetabular labral pathology. The patient was a 25-year-old female with a 4-year history of anterior-medial groin pain. Based on a combination of the clinical examination and magnetic resonance imaging findings, she was given a diagnosis of acetabular labral tear by her orthopaedic surgeon and referred to a physical therapist for assessment. Movement analysis during a single-leg step down, running, and a drop jump maneuver revealed excessive hip adduction and internal rotation on the involved side, which reproduced her symptoms. Application of a hip-strapping device resulted in decreased hip adduction and internal rotation, and an immediate decrease in symptoms.

The reduction in pain secondary to controlling hip motion suggests that excessive frontal and transverse plane hip motions may contribute to FAI. Accordingly, physical therapy intervention aimed at controlling and reducing hip adduction and internal rotation during activities may be indicated in patients who present with this movement pattern associated with anterior hip/groin pain.

Journal of Orthopaedic and Sports Physical Therapy, 2008, 38(9), 558-65

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Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain.

Sutlive TG, Lopez HP, Schnitker DE, Yawn SE, Halle RJ, Mansfield LT, Boyles RE, Childs JD

The objevtive of this studywas to determine the diagnostic accuracy of common clinical examination items and to construct a preliminary clinical prediction rule for diagnosing hip osteoarthritis (OA) in individuals with unilateral hip pain. 72 subjects received a standardized history, physical examination, and standing AP radiograph of the pelvis to assess for OA. Twenty-one of the 72 subjects had radiographic evidence of hip OA. A clinical prediction rule consisting of 5 examination variables was identified. If at least 4 of 5 variables were present, the positive LR was equal to 24.3, increasing the probability of hip OA to 91%.

The preliminary clinical prediction rule provides the ability to a priori identify patients with hip pain who are likely to have hip OA. A validation study should be done before the rule can be implemented in routine clinical practice.

Journal of Orthopaedic and Sports Physical Therapy, 2008, 38(9), 542-50

Link to Abstract

Neck Pain

Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW

The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

Journal of Orthopaedic and Sports Physical Therapy, 2008, 38(9), A1-A34

Link to Abstract

Mobilizations of the asymptomatic cervical spine can reduce signs of shoulder dysfunction in adults

Lynda McClatchie, Judi Laprade, Shelley Martin, Susan B. Jaglal, Denyse Richardson and Anne Agur

This study examined the immediate effects of cervical lateral glide mobilizations on pain intensity and shoulder abduction painful arc in subjects with shoulder pain. Twenty-one subjects received interventions of both cervical mobilization and placebo over two sessions. Evaluation of cervical mobilization revealed the shoulder abduction painful arc and shoulder pain intensity were significantly decreased.

The results of this study suggest that any immediate change in shoulder pain or active shoulder range of motion following cervical mobilizations indicate that treatment directed toward the asymptomatic cervical spine may expedite recovery.

Manual Therapy, 26 Aug 2008, online article ahead of print

Link to Abstract

ICF: Clinical relevance for physiotherapy? A critical review

Lara Allet; Elisabeth Brge; Dominique Monnin

The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines with a universal language. However, the ICF is still highly complex and questions remain about its practicability. The aims of this review were to (i) identify how the ICF is integrated in the clinical activity of physiotherapists, (ii) discuss advantages and limits of the use of the ICF, and (iii) suggest further possibilities for implementing the ICF by physiotherapists. Of 155 identified articles, 22 were specific to physiotherapy. These articles described the utility of the ICF to facilitate decision-making for physiotherapists; to classify the evaluation of therapy outcomes; to ensure that all aspects of human functioning are represented while testing the effectiveness and the reliability of these outcomes; to structure the documentation of assessments and interventions, as well as to ameliorate the communication.

ICF has a clinical relevance for physiotherapists, although the limited reliability of the qualifier system for the feasibility of its implementation was shown. The authors emphasize that the ICF is a tool that facilitates the decision of what to measure but not how to measure.

Advances in Physiotherapy, 2008, 10(3), 127-137

Link to Abstract

Static Progressive Splinting for Restoration of Rotational Motion of the Forearm

Mike S. McGrath, Slif D. Ulrich, Peter M. Bonutti, David R. Marker, Henning R. Johanssen and Michael A. Mont

This study examined the use of a bidirectional, patient-directed orthosis that used the principles of static progressive stress to improve forearm rotation. Thirty-eight patients who had limited pronation and supination motions after injuries and who failed other physical therapy techniques underwent a 30- to 60-minute stretching protocol with the orthosis one to three times per day. The mean arc of rotation increased by 42 degrees after a mean treatment duration of 12 weeks.

The gains in motion were comparable to the published results of other orthoses as well as surgical procedures such as external fixators and closed manipulation, but fewer complications occurred with the static progressive stress technique. This orthosis is a useful treatment for patients who have limitations of forearm rotation.

Journal of Hand Therapy, 30 August 2008, online article ahead of print

Link to Abstract

Rotator cuff coactivation ratios in participants with subacromial impingement syndrome

Joseph B. Myers, Ji-Hye Hwang, Maria R. Pasquale, J. Troy Blackburn, Scott M. Lephart

The purpose of this study was to determine if abnormal rotator cuff coactivation and deltoid activation patterns exist in participants with subacromial impingement. Rotator cuff coactivation and middle deltoid activation was assessed during an elevation task. Participants with impingement exhibited decreased rotator cuff coactivation and increased middle deltoid activation at the initiation of elevation. The participants with impingement also had higher subscapularis–infraspinatus and supraspinatus–infraspinatus coactivation above the level of the shoulder where pain is typically present.

Individuals with subacromial impingement exhibit rotator cuff muscle coactivation and deltoid activation abnormalities during humeral elevation that might contribute to the encroachment of the subacromial structures associated with subacromial impingement.

Journal of Science and Medicine in Sport, 31 August 2008, online article ahead of print

Link to Abstract

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

Paul Little, George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley, Sandra Hollinghurst and Debbie Sharp

A randomised controlled trial involving 579 patients with lower back pain of more than 3 weeks duration. The study compared Alexander technique over 6 sessions, Alexander technique over 24 sessions, massage, advice to exercise with behavioral intervention and a control. The exercise therapy was also added to each leg of the trial. The main outcome measure used was the Roland Morris Disability Index.

The results showed that all inteventions reduced back pain at 3 months. 6  sessions of alexander technique combined with exercise were shown to be nearly as effective as 24 sessions at one year. Massage showed mainly short term benefits.

  BMJ, 2008 Aug 19;337

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Alterations of stiffness and resting position of the elbow joint following flexors resistance training

Juliana M. Ocarino, Sérgio T. Fonseca, Paula L.P. Silva, Marisa C. Mancini, Gabriela G.P. Gonçalves

This study investigated whether the modification of muscle stiffness and length induced by resistance training can alter joint stiffness and, theoretically, change joint resting position.  Thirty subjects were submitted to a resistance training of the elbow flexor muscles of the non-dominant arm. This training was performed in the inner range in group 1 and throughout the complete range of motion in group 2. The dominant arm of each subject was considered the control. There was a significant increase in joint stiffness of the experimental arm after complete range of motion training, which was not observed after the training performed in inner range. The resting position of the experimental arm was modified to a significantly greater flexion angle in both groups.

The results showed that modifications in joint stiffness seem to depend on the volume of work imposed to skeletal muscles. In addition, both models of resistance training changed, through different mechanisms, the elbow joint resting position. These findings suggest that posture and joint stability may be modified by specific strengthening protocols.

Manual Therapy, 2008, 13(5), 411-418

Link to Abstract