MyPhysicalTherapySpace.com - A part of the 1T - the "One Thing" you need for PT practice.

Clinical Consult

Hello all-- anyone have any recommendations or literature review articles for exercise guidelines for patients with multiple sclerosis for general fitness, not for those in a relapse period.  My experience with these patients is limited, and any recommendations would be greatly appreciated.  Thanks in advance

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

I recall that this subject may have already been discussed on the blog but I am unable to find the entry.

I did a lit search on VAX-D, DRX9000 and non-surgical decompression therapy (marketing terms seemed like a good place to start).  There is some evidence:

1. effect on nerve conduction http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11680509

2. mechanism of the treatment http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=8057141

3. I found one RCT which compared VAX-D to TENS http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11680522

4. interestingly there is was case of sudden progression of disc protrusion reported during treatment http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14661685&query_hl=4&itool=pubmed_docsum .
Has anyone done a systematic review on this subject as some chiropractors in my area are doing extensive marketing of these devices and I’d like to know a little bit more about the evidence in support of, or against their use. 

Greg

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on this blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions. See you on MyPTConnect!    

 

Clinical Consult

I have been reading the book by Dr. Shirley Sahrmann, entitled, "Diagnosis and Treatment of Movement Impairment Syndromes," and it appears there are at least two impairment-based classifications for the patients with hip osteoarthritis (OA). Specifically, patients in the "femoral accessory motion hypermobility" group (p166) have hypermobility of accessory motions, and their medial/lateral hip rotation may be associated with superior glide of the femur. In contrast, patients in the "femoral hypomobility with superior glide" (page 168) group have markedly limited hip range-of-motion, and these patients usually develop compensatory movements of lumbar extension and rotation while walking because of restriction hip motion. In addition, Dianne Lee describes, in "The Pelvic Girdle," that "overactivation if the deep external rotators of the hip pulls the greater trochanter posteriorly and forces the femoral head anteriorly" (page 102). On the basis of the abovementioned description, I wonder if anyone in the EIM community has used found these classifications to be useful when managing the patients with hip OA. Specifically, I would like to know how confident clinicians are in detecting a superior or anterior glide of the femoral head.

I would appreciate any comments. Many thanks and have a good weekend :P

Yonghao

Note:   This post will also be posted in the "Orthopaedics" group on MyPTConnect.  All comments and questions should be addressed there.  The comments feature on this blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

I have a general question which I believe can be answered by this readership.  In both the recent Spine publication by Whitman et al and the slump sitting article by Cleland et al the frequency of visits were BIW.  Why is BIW chosen vs. TIW or one time per week?  This question often comes up in my clinic as to what is the best general frequency for patients.  Is there research to show one frequency is significantly better than another?

Mark Boncser

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1t.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

Does anyone know how to perform the "hooking manuever", which is used to clinically diagnose a "slipped rib?"  I can't find the original article that actually describes the procedure, and it's not in any of my orthopedic test texts.

John W. Ware, PT, MS, FAAOMPT
Maller and Swoverland Orthopaedic Physical Therapy

Note:  This post will also be posted in the 'Ortho' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

I am looking for references on the sensitivity of the Homan’s Sign/Test for ruling out DVT in a patient s/p arthroscopic knee surgery.  I have found several references concerning reliability, specificity, risk factors, clinical signs and symptoms, etc (and even an article that suggested it was not sensitive, but didn’t elaborate or reference this statement).  I have yet to encounter any reference that reports sensitivity numbers.  I would also appreciate any thoughts on what would be considered “entry-level” knowledge in terms of screening for DVT.  Is it enough to recognize risk factors and clinical signs and symptoms (such as the Homan’s sign), or would entry-level clinicians be expected to know algorithms such as the Wells criteria (as studied in the PT population by Riddle, et al, Physical Therapy, August 2004)?

Thanks,

Mike

 

Clinical Consult

In Baton Rouge, there are "pain clinics" popping up everywhere and the docs are injecting anything that moves. The internists and primary care MDs are getting marketed hard by the pain docs to send musculoskeletal patients to them.  Of course there is no manual therapy or therapeutic exercise associated with them. Is anyone aware of studies comparing manual physical therapy and/or exercise to epidural steroid injections?

Seth Kaplan PT, OCS, MHA
President and CEO
BRPT-LAKE
Rehabilitation Centers, L.L.C.

Clinical Consult

Does anyone out there have any literature/references/recommendations for patients returning to running after ankle surgical procedures--(most specifically brostrom-gould, peroneal tendon repair, osteophyte removal).  I'm searching for some resources to provide me with more guidance for these patients.  Not necessarily elite/competitive runners, but also those recreational runners (10k and less).. any insight would be greatly appreciated..

Thanks
AW

Clinical Consult

Hi All,
Currently I am looking for references regarding rehabilitation principles after cervical fusion, mostly anterior fusion. I did run Medline search and found two somewhat similar articles but only abstract as below. Can anyone be able to post full text articles or share your clinic rehabilitation principles with evidence regarding anterior cervical fusion?

1. Long-Term Effectiveness of Combined Spine Surgery and Functional
Restoration: A Prospective Study, Journal Journal of Occupational Rehabilitation Issue Volume 10, Number 3 / September, 2000, Pages 235-239

2. Impact of functional restoration after anterior cervical fusion on chronic disability in work-related neck pain.
Source Spine Journal: Official Journal of the North American Spine Society. 2(4):267-73, 2002 Jul-Aug.

Many Thanks in Advance,
Francis Jung

Clinical Consult

I am working with a 46 y/o female who underwent THR revision one week ago. While in the hospital the PT told her not to do SLR because of the negative impact of posterior glide of the femoral head. I have never heard of this and have always included SLR as a core exercise. I researched this question and could find no information. Does anyone know of a reference? Thank you for your help.

Terri Greenfield