The Effect of Joint Manipulation Techniques on Active Range of Motion in the Mid-Thoracic Spine of Asymptomatic Subjects

Abstract

This study assesses the effect of the manipulation of restricted thoracic spine segments on thoracic active range of motion (AROM). Range of motion (ROM) is measured routinely to assess joint mobility, tissue extensibility, and function of the spine and the extremities. Manipulation has been used to restore normal joint mechanics and increase ROM. However, no research specifically shows that ROM in the thoracic spine increases after spinal manipulation. Seventy-eight healthy subjects (29 male, 49 female), ages 18-44, were divided into three categories. Group 1 was the control, group 2 received mobility testing only, and group 3 received mobility testing and joint manipulation to a restricted segment. All subjects were pre-tested for AROM of T3-T8; then either rested, received mobility tests, or were manipulated, after which post-test measurements were performed. Forward bending and side bending right and left were measured. In a comparison of pre-treatment versus post-treatment AROM, a significant difference was seen in side bending to the left only. This demonstrates that one session of manipulation techniques can influence AROM in the mid-thoracic spine.     

Limitations in activities in patients with osteoarthritis of the hip or knee: The relationship with body functions,comorbidity and cognitive functioning

Purpose. To determine the relationship between body functions, comorbidity and cognitive functioning on the one side and limitations in activities on the other, in elderly patients with osteoarthritis (OA) of the hip or knee.

Method. A cross-sectional cohort study was conducted in which 288 patients with hip or knee OA were included. Patients were recruited from rehabilitation centres and hospitals (Departments of Orthopedics, Rheumatology or Rehabilitation). Apart from demographic and clinical data, information about limitations in activities, body functions (pain, muscle strength, range of joint motion), comorbidity and cognitive functioning was collected by questionnaires and tests. Statistical analyses included univariate and stepwise multivariate regression analysis.

Results. Self-reported limitations in activities (Western Ontario and McMaster Universities Osteoarthritis Index) were significantly associated with pain, muscle strength knee extension, range of motion (ROM) hip flexion and morbidity count. Performance-based limitations in activities (timed walking test) were significantly associated with ROM (knee flexion, hip flexion and knee extension), muscle strength hip abduction, pain, cognitive functioning and age.

Conclusions. Self-reported limitations in activities in hip or knee OA are largely dependent on pain and to a lesser extent on range of joint motion, muscle strength and comorbidity. Performance-based limitations in activities are largely dependent on range of joint motion and muscle strength, and to a lesser extent on pain, cognitive functioning and other factors. These findings point to the role of body functions in limitations in activities in OA of the hip or knee. Although less important, comorbidity and cognitive functioning play a role as well.     

Relationships among severity of osteonecrosis, pain, range of motion, and functional mobility in children, adolescents, and young adults with acute lymphoblastic leukemia

BACKGROUND AND PURPOSE: Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL. SUBJECTS: Thirty-three subjects aged 5 to 27 years with ALL and osteonecrosis participated. METHODS: The extent of osteonecrosis was determined by magnetic resonance imaging (MRI) of the hip and knee according to 2 classification systems, including the Association Research Circulation Osseous (ARCO) and a knee staging scale. Pain, hip and knee ROM, and the Timed Up and Down Stairs (TUDS) Test were used as measures. RESULTS: Correlations were observed between ARCO and hip pain (r=.34), between hip flexion ROM and hip pain (r=-.34), and between knee pain and time on the TUDS Test (r=-.35). DISCUSSION AND CONCLUSION: Physical therapists should consider that people with ALL may have hip or knee osteonecrosis without clinical symptoms. This notion supports the need for MRI in addition to a comprehensive examination of functional mobility.     

Effects of stretching exercise during strength training in prepubertal,pubertal and adolescent boys

The purpose of the study was to investigate the effect of stretching exercises on lower extremity range of motion (ROM) in prepubertal, pubertal and adolescent boys. We also aimed to examine the initial ROM among the three age groups for both sides of the body. A total of 110 boys aged 10, 13 and 16 years old were divided into two equal groups (training group A and control group B), each group including three age subgroups. Group A participated in school physical activities and an interval strength training programme (12 weeks, 50 min/day, 3 days/week) at high intensity (80–85% of max) and at light intensity (30–40% of max). High-intensity workload was performed on a cycle ergometer for 4 min, alternating with light intensity workload for 8 min including stretching exercises. Group B participated only in the school physical activities, 2–3 times/week. ROM was determined during hip flexion, extension and abduction and knee flexion for right and left sides, using a flexometer and a goniometer. A mixed within- and between-subjects analysis of variance (ANOVA) with repeated measures revealed that initial ROM in hip joint flexion and extension for the left side were similar at all three ages. ROM in hip joint abduction and knee joint flexion was significantly greater in 10-year-old boys than 16-year-olds boys (P<0.05). For all age groups, the initial ROM between the right and left sides was similar. No significant differences were revealed in ROM before and after the training programme for the control group. However, significant improvements in ROM were shown in all three age groups of the training subjects (P<0.01). These findings suggest that ROM is similar between the right and the left sides of boys during prepuberty, puberty and adolescence. The initial ROM differences observed in some joints with advancing age are not accredited to age. However, improvements in ROM after the training programme are not affected by age factor, but by incorporating stretching exercises.     

Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis – OA: 29 knees; rheumatoid arthritis – RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.     

Relationship Between Muscle Quality or Stiffness Measured by Ultrasonography and Range of Motion in Hospitalized Older Adults

Older adults who require nursing care have joint contractures characterized by limited range of motion (ROM). The present study investigated age-related muscle changes using ultrasonography and the relationship between ROM and muscle changes in older adults. Twenty-two healthy young adults (mean age: 23.3 y) and 60 hospitalized older adults (mean age: 86.1 y) participated. ROM of hip abduction was measured using a goniometer. Echo intensity (EI), reflecting interstitial fibrous tissue or fat within adductor longus (ADDl) was measured using B-mode ultrasonography, and strain ratio (SR), reflecting ADDl stiffness, was measured by strain elastography. The Mann–Whitney U-test and Spearman's correlation test were used for analysis. The ROM and SR of older adults were significantly lower than those of young adults (both p values <0.001). The EI was significantly higher in older adults than in young adults (p < 0.001). In older adults, the SR was moderately correlated with ROM (ρ = 0.49, p < 0.001). In conclusion, limited ROM and increase in interstitial fibrous tissue or fat and stiffness occur with aging, and the SR measured by strain elastography is useful for investigating the effect of muscle stiffness on the ROM of hospitalized older adults.     

A comparison of kinetic gait parameters for 3-13 year olds

BACKGROUND: Normative gait data is essential for diagnosing and treating abnormal gait patterns. The examination of the onset of adult-like kinetic gait patterns in children has generated inconsistent results. The purpose of this study was to identify age-related differences in kinematic and kinetic gait parameters across children aged 3-13 years old. METHODS: A motion capture system and three force plates were employed to compute sagittal joint angles and joint kinetics during walking and compare results between children aged 3-4 years (n=13), 5-6 years (n=10), 7-8 years (n=12), and 9-13 years (n=12). Anthropometric data was estimated using a mathematical model (elliptical cylinder method). Peak flexion and extension joint angles and moments, and peak concentric and eccentric joint powers were analyzed using multivariate analyses of variance. FINDINGS: For most of the variables examined, similar results were obtained across age groups. Reduced peak hip flexion moments and knee extension moments were observed in the 3-4 year olds compared to the oldest group of walkers. Compared to the 9-13 year olds, reduced ankle joint moments and power were observed in most age groups. INTERPRETATION: The results suggest that adult-like kinetic patterns for the hip and knee were attained by 5 years of age. However, for the ankle joint, adult-like patterns are not achieved until nine years of age or older. These findings stress the importance of using age-matched normative data for clinical gait analysis.     

A comparison of two stretching programs for hamstring muscles: A randomized controlled assessor-blinded study

Most parameters regarding hamstring flexibility training programs have been investigated; however, the joint (i.e. hip or knee) on which the stretching should preferentially be focused needs to be further explored. This randomized controlled assessor-blinded study aimed to investigate the influence of this parameter. We randomly assigned 111 asymptomatic participants with tight hamstring muscles in three groups: a control group and two groups following a different home-based 8-week (five 10-minute sessions per week) hamstring stretching program (i.e. stretching performed by flexing the hip while keeping the knee extended [SH] or by first flexing the hip with a flexed knee and then extending the knee [SK]). Range of motion (ROM) of hip flexion and knee extension were measured before and after the stretching program by means of the straight leg raising test and the passive knee extension angle test, respectively. Eighty-nine participants completed the study. A significant increase in ROM was observed at post-test. Analyses showed significant group-by-time interactions for changes regarding all outcomes. Whereas the increase in hip flexion and knee extension ROM was higher in the stretching groups than in the CG (especially for the SH group p < 0.05), no differences between the two stretching groups were observed (p > 0.05). In conclusion, the fact that both stretching programs resulted in similar results suggests no influence of the joint at which the stretching is focused upon, as assessed by the straight leg raising and knee extension angle tests.     

Knee and Elbow Range of Motion in Healthy Older Individuals

Normative values for range of motion in older individuals, essential in evaluation and treatment planning, are few. In this study, effect of age, sex, sidedness, type of motion, and general activity level on range of motion was examined, with a clinical goniometer, in knee and elbow joints of 60 healthy subjects. Subjects, 10 per group, were divided into 3 age groups, 55 to 64,65 to 74, and 75 to 84 years, for each sex. Data for right and left sides were combined since a significant difference was demonstrated only for elbow flexion in females. A significant decrease in female knee joint range of motion with age was observed but was not considered clinically relevant. Only small differences between the sexes, and no relationship between activity levels and range of motion were observed. Arnerican Academy of Orthopaedic Surgeons' values for the knee joint may not be appropriate for older individuals because their estimates differ by more than the known measurement error from these data and other published studies of this age group.     

Range of motion of the wrist: implications for designing computer input devices for the elderly

PURPOSE: The purpose of this study was to report normative values of the amplitude of joint wrist motions and grip strength for older age groups. METHOD: Volunteers. (N = 147) were divided into four age groups, 60-69, 70-79, 80-89 and 90+ years, with a total of 62 men and 85 women. Maximum range motion values were obtained for wrist flexion, extension and ulnar deviation. In addition, grip strength measures were obtained for each participant. RESULTS: In general, the strength and ROM values for the oldest participants in this study were lower than those of the younger age group (age 60 to 69) and significantly lower than those published for subjects between 25 and 54 years of age. Furthermore, across all age groups males were significantly stronger than females. However, females tended to have greater ROM than males, particularly for wrist extension and ulnar deviations. Joint ROM and grip strength declined significantly with age for both males and females. Comparisons with published data for younger subjects (age 25-35) indicate that a 60-69 year old male, will on average experience a decline in wrist flexion, extension and ulnar deviation of 12%, 41%, and 22% respectively. By age 90, an individual may be expected to have ROM values that are only approximately 60% of an average 30 year old individual. CONCLUSION: The results suggest that the ageing population (particularly men) may face greater difficulty using an input device such as a mouse that relies on motions of the wrist. In addition, the reduced ROM of the wrist may put the elderly at greater risk of developing cumulative trauma disorders. The implications of these findings for the design of input devices are discussed.     

自我效能干预在创伤后膝关节活动受限中的应用

目的:观察自我效能干预对于创伤后膝关节活动受限的影响.方法:将符合纳入标准的创伤后膝关节活动受限患者99例,随机分为对照组49例和观察组50例,2组均接受常规综合康复治疗,包括肌力训练、关节松动术、物理因子治疗、中医治疗和牵伸技术,观察组在常规治疗基础上给予自我效能干预.2组治疗前和治疗4周后采用膝关节ROM,视觉模拟...     

The effect of isolytic contraction and passive manual stretching on pain and knee range of motion after hip surgery: A prospective, double-blinded, randomized study

Stretching has its impact on both contractile and noncontractile tissues and is the most important rehabilitation technique utilised used to prevent and treat joint stiffness. Passive manual stretch (PMS) and muscle energy technique (MET) are two of the most commonly used techniques. Our study evaluates the effectiveness of isolytic form of MET in gaining knee range of motion (ROM) and decreasing pain in acute knee involvement and comparing it with standard PMS. We used the clinical scenario of knee joint mobilization in patients operated for hip fractures. Fifty-two subjects were alternatively randomized to two groups, isolytic contraction (ILC) group (n = 26) and PMS group (n = 26). In both the PMS and ILC groups, significant improvements in pain score (measured by the visual analog scale) and knee ROM were reported after the treatment period (p < 0.001). The ILC had significantly better improvement in pain score than the PMS group (p = 0.003). The improvement in knee ROM, however, demonstrated no significant between-group difference (p > 0.05). Thus, isolytic form of MET may be a viable method to decrease pain and improve knee ROM in patients who had undergone surgery after a hip fracture.     

Pilates Reformer exercises for fall risk reduction in older adults: A randomized controlled trial

Objective

To investigate the effects of Pilates exercises using a Reformer on measures of fall risk, balance and mobility, self-efficacy, and active range of motion in adults age 65 and over at risk for falls compared to a control group.

Relationship between selected static an dynamic lower extremity measures

Twenty-four non-symptomatic subjects were recruited for this study. They were evaluated for foot-type and selected static parameters to determine their influence on kinematic and kinetic variables measured during barefoot overground walking. Foot-type and lower extremity characteristics were examined through the measurement of arch index, range of motion measurements of the ankle, subtalar, first metatarsal and hip joints, and the measurement of the orientation of the calcaneus and tibia. Measurements collected during the support phase of the gait cycle included kinetic measures via a force platform, kinematic measures of the knee joint using a three-dimensional electrogoniometer and kinematic measures of the rearfoot angle using a high speed motion camera. Angle of gait and step parameters were also measured utilizing an inked paper track system. Using the static evaluation measures to predict dynamic gait resulted in significant canonical correlations between first ray mobility and rotational values at the knee, first ray mobility and anteroposterior ground reaction force variables, and static hip internal-external rotation with varus-vaigus motion at the knee. The results suggest that static lower extremity measures have limited value in predicting dynamic lower extremity function to any great degree.     

Inter-tester reliability of passive intervertebral and active movements of the cervical spine

Measurements of active range of motion (AROM) and passive intervertebral movements (PIM) of the cervical spine are frequently used for patients with neck pain. However, there is a paucity of studies that investigate the psychometric properties of these measurements. Objectives of this study were to: (1) determine the inter-tester reliability of PIM, AROM, and the effects of AROM on symptom provocation; (2) establish the minimal detectable change (MDC) in cervical AROM; and (3) determine the association between AROM and disability. Thirty subjects (age 41+/- 12) with neck pain participated in this study. Two masked examiners performed the measurements during the same testing session. PIM was assessed manually and recorded as hypomobile or normal. AROM was measured in degrees with a gravity goniometer. The effect of AROM on patient's symptoms was recorded as no change, decreased, increased, centralization, or peripheralization. Measures of AROM had moderate to substantial reliability (.78 - .91) and resulted in a MDC adequate for clinical use (from 9 degrees to 16 degrees). The effect of AROM on symptom provocation resulted in Kappa values that ranged from slight to substantial (.25 - .87). Measures of PIM resulted in substantial and moderate reliability of assessing occipital-atlas mobility, tenderness of the transverse processes of atlas, and symptom provocation during PIM testing of the lower cervical segments. Fair Kappa values were observed during judgment of mobility in the C2 segment and symptom reproduction during PIM of C2 and C5. The additional PIM had Kappa values that ranged from none to slight. Low prevalence of positive findings likely resulted in an artificial deflation of the Kappa statistic during some PIM measures. Measures of AROM in saggital and transverse planes were associated with disability scores (r = .43 and .40, respectively). Findings are relevant to the planning of future studies to establish the criterion validity of these tests to guide the selection of interventions and establish prognosis in patients with neck pain.     

Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

Background and Purpose. Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra‐articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra‐tester and inter‐tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra‐tester and inter‐tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. Method. The design was an intra‐tester, inter‐tester and intra‐day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC_2,1) and smallest real difference (SRD) were calculated. Results. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6° and 10° (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. Conclusions. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. Copyright © 2009 John Wiley & Sons, Ltd.     

水中运动疗法配合中药熏蒸和冷疗治疗胫骨平台骨折术后膝关节功能障碍的效果观察

目的 探讨水中运动疗法配合下肢中药熏蒸、冷疗治疗胫骨平台骨折术后膝关节功能障碍的效果观察,为临床胫骨平台骨折术后康复方案的制定提供参考。方法 收集西安工会医院2018年2月至2021年1月收治的胫骨平台骨折术后康复患者病例,整理资料根据患者住院期间的治疗方式分为观察组和对照组。然后对照组和观察组均随机抽取28例纳入研究,共计56例。对照组采用徒手运动疗法配合蜡疗进行治疗,观察组采用水中运动配合下肢中药熏蒸、冷疗进行治疗;两组治疗均为1个月。应用标准量角器测量两组的膝关节主动活动度(AROM)和被动活动度(PROM),应用视觉模拟评分(VAS)评估膝关节最大被动活动疼痛程度。比较两组治疗前后的膝关节主、被动活动度,关节VAS评分,膝关节处肿胀程度以及日常生活活动能力(ADL)。结果 治疗1个月后两组患者膝关节症状主动、被动关节活动度、VAS评分、肿胀程度、ADL评分差异具有统计学意义(P <0.05),且观察组的膝关节AROM (120.71±8.99)°、PROM (126.96±8.95)°、VAS(2.14±0.89)分、肿胀值(0.28±0.46)cm、ADL (97.67...     

Computerized biofeedback knee goniometer: acceptance and effect on exercise behavior in post-total knee arthroplasty rehabilitation

OBJECTIVE: To assess device accuracy, patient acceptance, and effect of a computerized biofeedback knee goniometer (CBG), on patients' compliance with active range of motion (AROM) exercises after total knee arthroplasty (TKA). DESIGN: Two-stage study: measurement validation on asymptomatic controls and an unblinded, multiple crossover trial. SETTING: Inpatient rehabilitation. PARTICIPANTS: Asymptomatic controls (n=14) and post-TKA inpatients (n=11). INTERVENTIONS: For measurement validation, CBG-angle measurements were compared with manual, clinician-obtained angles. To assess motivational effect, the CBG was worn after TKA; on alternating days, it either monitored AROM silently (no feedback) or provided audiovisual feedback about reaching preset range of motion (ROM) goals and prompted the patients to exercise when idle. MAIN OUTCOME MEASURES: To assess accuracy, the device's readings were compared with manual measurements. Patient satisfaction was determined by a self-report questionnaire; exercise compliance was assessed by calculating activity rate and stratified interactivity intervals. RESULTS: CBG readings reproduced clinician measurements reliably between 0 degrees and 100 degrees (eta(2)=98.5%). Auditory feedback was more helpful than visual feedback for motivating exercise. During feedback-on days, the mean total activity rate +/- standard deviation was 15.1+/-10.9 activity counts per hour, and the interactivity interval was 6.7+/-5.7 minutes. The activity rate was higher on feedback-off days-22.5+/-11.1 counts/hour (P=.11)-and the mean interactivity interval was 3.6+/-2.7 minutes (P=.07). CONCLUSIONS: The CBG provided reliable, unbiased estimates of clinician measurements of joint angle within the range of 0 degrees to 100 degrees. The CBG was accepted well by most patients. Surprisingly, slightly more ROM activity was noted during feedback-off days than feedback-on days.