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Objective: The hip extension test may be a clinical sign of impaired motor control in the lumbar spine, which may have a negative impact on spine stability. The purpose of this study is to evaluate the interexaminer reliability of the hip extension test for suspected dynamic instability of the lumbar spine in patients with chronic low back pain. Methods: Forty-two patients with chronic low back pain participated in this interexaminer reliability study. Chronic low back pain was defined as pain of greater than 7 weeks duration in the area between T12 and the buttocks, with or without leg pain. Two doctors of chiropractic simultaneously observed and independently assessed the left and right prone hip extension test on all 42 patients. Results for both examiners were given to an independent recorder. Each examiner was blinded to the results of the other examiner. Results: The mean age of subjects was 38 years (SD 12.35); 73.8% were female. Sixty-eight percent (SD 1.72) reported current back pain intensity greater than 5 on an 11-point numerical rating scale. The mean score for the Roland-Moms Low Back Pain and Disability questionnaire was 5.8 (SD 4.34). The κ measure of agreement was 0.72 for the left leg and 0.76 for the right leg. This indicated a substantial strength of agreement between examiners for both left and right hip extension tests. For the 8 cases of disagreement, rater 1 generally rated the tests as positive, whereas rater 2 consistently rated the tests as negative. Conclusions: The hip extension test appears to have good reliability in detecting deviation of the lumbar spine from the midline. Validity with regard to the test's ability to distinguish patients with chronic low back pain from normal individuals and its relation to lumbar spine stability remains to be determined. [ABSTRACT FROM AUTHOR]

Diagnosis and effective treatment of patients presenting with cervicobrachial symptoms are often challenging due to the large number of potential pain sources and the high degree of convergence of sensory afference in the cervical region. A 42-year-old female presented in the clinic with a six-month history of neck pain, upper trapezius pain, and upper extremity paresthesia. A careful history, specific functional examination, and selected special tests led to diagnosis-specific orthopedic manual therapy management of this patient. The patient fully recovered within 6 physical therapy treatment sessions, which included management of an elevated first rib, double-crush phenomenon, uncovertebral joint dysfunction, and careful ergonomic intervention with home instructions. Although controlled trials are needed to evaluate the effectiveness of these techniques and allow generalizability of such interventions, the recovery of this patient suggests the efficacy of manual techniques and ergonomic intervention in the management of uncovertebral joint dysfunction and thoracic outlet syndrome associated with a double-crush phenomenon. [ABSTRACT FROM AUTHOR]

Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care. ▪ [ABSTRACT FROM AUTHOR]

Patients of different ages present with different lumbar spine afflictions. These afflications are linked to age-related changes in the intervertebral disc, zygapophyseal joints, and capsuloligamentous structures. Disc degeneration precedes all other changes, resulting in nonspecific low back pain that can potentially advance into specific low back pain conditions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate interrater reliability of a specific palpatory test to assess the three-dimensional (3-D) mobility of L4-L5. Subjects included 17 men and 37 women with a mean age of 24 years (range 20-39 years) who were tested independently by three manual physical therapists with a mean of 15 years of experience. Testers performed 3-D motion testing of the L4-L5 spinal segment in a non-weight-bearing position. Interrater reliability was assessed with Cohen's Kappa statistics, using three pair-wise comparisons for determination of the direction (right or left) of lateral flexion leading to the greatest amount of segmental rotation. Percent agreement ranges were 46.3% to 62.9%, with Kappa scores ranging from -0.16 to 0.04, respectively. The palpatory test demonstrated poor to slight strength of interrater reliability. Further examination of a symptomatic population and/or other age categories is recommended. This study suggests that quantitative manual palpatory assessment of rotation at L4-L5 in combination with ipsilateral or contralateral lateral flexion is not reliable between testers. Such testing is not recommended for clinical use. [ABSTRACT FROM AUTHOR]