Articles in this issue:

• Editorial: So Close and Yet so Far—Growth and Progress in the Accessory Motion Testing Literature
• Manual Therapy Awards 2009
• The Reliability of Maitland's Irritability Judgments in Patients with Low Back Pain
• Clinimetrics Corner: Publishing a Scientific Manuscript on Manual Therapy
• Correlation of Magnetic Resonance Imaging Findings and Reported Symptoms in Patients with Chronic Cervical Dysfunction
• Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis
• Global Rating of Change Scales: A Review of Strengths and Weaknesses and Considerations for Design
• Cyriax Physiotherapy Versus Phonophoresis with Supervised Exercise in Subjects with Lateral Epicondylalgia: A Randomized Clinical Trial
• Abstracts: Accepted Platform Presentations AAOMPT 2009
• Book and Multimedia Reviews
• Information For Authors
• Correlation of Digital Palpation and Transabdominal Ultrasound for Assessment of Pelvic Floor Muscle Contraction
• Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach
• Abstracts: Accepted Abstracts Poster Presentations AAOMPT 2009
• Letter to the Editor with Author Response: "Upper Limb Neural Tension and Seated Slump Tests: The False Positive Rate Among Healthy Young Adults without Cervical or Lumbar Symptoms"

The Reliability of Maitland's Irritability Judgments in Patients with Low Back Pain

EDWARD T. BARAKATT, PT, PhD; PATRICK S. ROMANO, MD, MPH; DANIEL L. RIDDLE, PT, PhD; LAUREL A. BECKETT, PhD

Abstract: Maitland's construct of musculoskeletal pain irritability is widely used by physical therapists but has not been defined to the extent that its measurement properties can be tested. The purpose of this study was to examine the inter-rater reliability of physical therapists' irritability judgments during application to patients with low back pain (LBP). Eighty patients with LBP received two consecutive examinations at their initial clinic visit by two physical therapists. Patients reported pain location and intensity prior to each evaluation. Therapists judged subjects' LBP as irritable or non-irritable. Inter-rater agreement of physical therapist irritability judgments was moderate (kappa = 0.44, prevalence-adjusted kappa = 0.50). This level of reliability of therapists LBP irritability judgments may be improved upon by development of an operational definition of pain irritability. Further research is needed to identify measures appropriate for inclusion in an operational definition of pain irritability and to assess the value of making pain irritability judgments in evidence-based physical therapy practice.

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Correlation of Magnetic Resonance Imaging Findings and Reported Symptoms in Patients with Chronic Cervical Dysfunction

ROGELIO CORONADO PT; BEVERLY HUDSON PT, DPT; CHARLES SHEETS PT, Dip MDT; MATTHEW ROMAN PT, FAAOMPT; ROBERT ISAACS MD; JESSIE MATHERS PT, OCS, FAAOMPT; CHAD COOk PT, PhD, MBA, OCS, FAAOMPT

Abstract: Information gathered from the patient history, physical examination, and advanced testing augments the decision-making process and is proposed to improve the probability of diagnostic and prognostic accuracy. However, these findings may provide inconsistent results and can lead to errors in decision-making. The purpose of this study was to examine the relationship between common clinical complaints and specific findings on magnetic resonance imaging (MRI) in patients with chronic neck dysfunction. Forty-five English-speaking participants (25 female), with mean age of 52 (SD = 13.4), were evaluated by a neurosurgeon for complaints of symptoms related to the cervical spine. All participants answered a subjective questionnaire and received an MRI of the cervical spine. Cramer's V nominal correlation was performed to explore the relationship between the targeted variables. The correlation matrix calculations captured three significant findings. Evidence of spinal cord compression was significantly correlated to 1) anteroposterior canal diameter of less than or equal to 9 mm (r = .31; p<0.05) and 2) diminished subarachnoid fluid around the cord (r = .48; p<0.01). Report of loss of dexterity was significantly correlated with 3) report of lower extremity clumsiness (r = .33; p<0.05). In this study, no definitive relationships were found between the clinical complaints of neck pain, hand function, or clumsiness and specific MRI findings of spinal cord compression. Further research is needed to investigate the diagnostic utility of subjective complaints and their association with advanced testing.

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Cyriax Physiotherapy Versus Phonophoresis with Supervised Exercise in Subjects with Lateral Epicondylalgia: A Randomized Clinical Trial

AMIT V. NAGRALE, MPhT; CHRISTOPHER R. HERD, PT, DPT, CSCS; SHYAM GANVIR, MPhT; GOPICHAND RAMTEKE, MPhT

Abstract: Cyriax and Cyriax advocated the use of deep transverse friction massage in combination with Mill's manipulation in treating lateral epicondylalgia. Evidence comparing this approach with other physical therapies is lacking. The purpose of this randomized clinical trial was to compare the effectiveness of deep transverse friction massage with Mill's manipulation versus phonophoresis with supervised exercise in managing lateral epicondylalgia. Sixty patients age 30-60, presenting with the teno- periosteal variety of lateral epicondylalgia with symptom duration greater than one month, were randomized into two groups. The control group received phonophoresis with diclofenac gel over the area of the lateral epicondyle for 5 minutes combined with supervised exercise. The experimental group received 10 minutes of deep transverse friction massage followed by a single application of Mill's manipulation. Both groups received treatment 3 times per week for 4 weeks. Outcomes of interest included pain via visual analog scale (VAS), pain-free grip strength, and functional status measured with the Tennis Elbow Function Scale. Data were analyzed using a one-way ANOVA. Whereas both groups improved significantly from the initiation of treatment, a between- group comparison revealed significantly greater (p<0.05) improvements regarding pain, pain-free grip, and functional status for the experimental group compared to the control group. The results of this study demonstrate that Cyriax physiotherapy is a superior treatment approach compared to phonophoresis and exercise in managing lateral epicondylalgia.

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Publishing a Scientific Manuscript on Manual Therapy

CHAD COOK PT, PhD, MBA, OCS, FAAOMPT; JEAN-MICHEL BRISMEE PT, ScD, OCS, FAAOMPT; CAROL COURTNEY PT, PhD, FAAOMPT; MARK HANCOCK PT, PhD4; STEPHEN MAY PT, FCSP, Dip MDT, MSc, PhD

Abstract: Publication in peer-reviewed journals is the way to introduce new information that has clinical implications. However, clinicians may be reluctant to embark on the publication process because of lack of confidence or uncertainty about the process. The aim of this paper is to summarize the requirements of that process and to provide tips for successful publication to encourage potential clinical authors of manual therapy articles. Articles should generally contribute knowledge, corroborate or contradict previous knowledge, or summarize existing knowledge. Articles should be clearly structured, with abstract, introduction, methods, discussion, conclusion, and references; will often include tables and figures. The content of each of these sections is described. The use of standardized checklists is encouraged and the format should adhere to each journal's author guidelines. Submission is electronic and typically first the editor or deputy editor reviews for suitability, adherence to journal format, and quality of writing. If deemed suitable, the article is then sent out for blinded review by two reviewers with expertise in that area. Review typically takes 6-8 weeks, and all communication is via the editor. A decision is made then to either accept, accept with amendments to be made, reject but with advice to resubmit, or reject outright. In any re-submissions, the review teams' comments should be diligently addressed, either making the recommended changes or justifying why they have not been adopted. Common reasons for rejection of articles are given. Finally, the authors provide some tips for publication to help readers with successful submission of articles.

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Management and Treatment of Temporomandibular Disorders: A Clinical Perspective

EDWARD F. WRIGHT, DDS, MS; SARAH L. NORTH, PT, MPT

Abstract: A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist's region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients.

The full article is available online to JMMT subscribers.

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Articles in this issue:

• Editorial: Sub-group Classification of Low Back Related Leg Pain: Is this the Catalyst Needed for Other Challenging Conditions?
• Interaction between Trigger Points and Joint Hypomobility: A Clinical Perspective
• Manual Correction of an Acute Lumbar Lateral Shift: Maintenance of Correction and Rehabilitation: A Case Report with Video
• Changes in Psychological Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study
• Applying Joint Mobilization at Different Cervical Vertebral Levels does not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomized Clinical Trial
• The Effect of an Analgesic Mobilization Technique When Applied at Symptomatic or Asymptomatic Levels of the Cervical Spine in Subjects with Neck Pain: A Randomized Controlled Trial
• Interrater Reliability of a New Classification System for Patients with Neural Low Back-Related Leg Pain
• Classification of Low Back-Related Leg Pain: Do Subgroups Differ in Disability and Psychosocial Factors?
• Invited Commentary: "Interrater Reliability of a New Classification System for Patients with Neural Low Back-Related Leg Pain" and "Classification of Low Back-Related Leg Pain: Do Subgroups Differ in Disability and Psychosocial Factors?"
• Clinimetrics Corner: Analysis of Variance: The Fundamental Concepts
• Mulligan's Mobilization with Movement: A Systematic Review
• Letter to the Editor with Author Response: Evidenced-Based-Diagnosis and Treatment of the Painful Sacroiliac Joint: A Clinical Perspective
• Book and Multimedia Reviews
• Manual Therapy Announcements
• Information for Authors

Articles in this issue:

• Editorial: Trample the Weak, Hurdle the Dead: The Tribulations of Integrating Research into Clinical Practice
• Spinal Manipulative Therapy for Acute Low Back Pain: A Clinical Perspective
• Invited Commentary: Spinal Manipulative Therapy for Acute Low Back Pain
• Invited Commentary: Spinal Manipulative Therapy for Acute Low Back Pain
• Reliability of Joint Mobility and Pain Assessment of the Thoracic Spine and Rib Cage in Asymptomatic Individuals
• Multimodal Management of Mechanical Neck Pain Using a Treatment Based Classification System
• A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia
• Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial
• The Comparative Prognostic Value of Directional Preference and Centralization: A Useful Tool for Front-Line Clinicians?
• Clinimetrics Corner: The Minimal Clinically Important Change Score (MCID): A Necessary Pretense
• A Morphological Comparison of the Human Lumbar Multifidus by Chemical Dissection
• The Association of Nutritional Status and Gender with Cross-Sectional Area of the Multifidus Muscle in Establishing Normative Data
• 2008 AAOMPT John McM. Mennell Service Award Acceptance Speech
• Letters to the Editor
• Book and Multimedia Reviews

... plus plenty of additional content.

Articles in this issue:

• Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Eficacy
• Invited Commentary - Michael Shacklock
• Three-dimensional Movements of the Sacroiliac Joint: A Systematic Review of the Literature and Assessment of Clinical Utility
• Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective
• A Model for Standardizing Manipulation Terminology in Physical Therapy Practice
• Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report
• Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation
• American Academy of Orthopedic Manual Physical Therapy (AAOMPT): History, Advocacy, and Education

... plus plenty of additional content.

Articles in this issue:

• Immediate Effects of Inhibitive Distraction on Active Range of Cervical Flexion in Patients with Neck Pain: A Pilot Study
• Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools
• Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study
• Management of Low Back Pain: A Case Series Illustrating the Pragmatic Combination of Treatment- and Mechanism-Based Classification Systems
• Letter to the Editor: Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity?
• Roots of Physical Medicine, Physiotherapy, and Mechanotherapy in the Netherlands in the Nineteenth century: A Disputed Area within the Health Care Domain

... plus plenty of additional content.

Articles in this issue:

• Orthopaedic Manual physical Therapy including Thrust Manipulation and Exercise in the Management of a Patient with Cervicogenic Headache: A Case Report
• Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-old Patient Using Strain Counterstrain: A Case Report
• Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain
• Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary
• RSS: A Brief Introduction
• To Run or Not to Run: A Post-Meniscectomy Qualitative Risk Analysis Model for Osteoarthritis When Considering a Return to Recreational Running

... plus plenty of additional content including reviews and video clips.

Articles in this issue:

• Myofascial Trigger Points: An Evidence-Informed Review
• Contributions of Myofascial Trigger Points to Chronic Tension Type Headache
• Myofascial Trigger Points: Translating Molecular Theory into Manual Therapy
• Trigger Point Dry Needling
• Physical Therapy Diagnosis and Management of a Patient with Chronic Daily Headache: A Case Report
• Myofascial Trigger Points and Myofascial Pain Syndrome: A Critical Review of Recent Literature (With an Introduction by the Editor-in-Chief)

... plus plenty of additional content including reviews and video clips.