The Journal of orthopaedic and sports physical therapy
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J Orthop Sports Phys Ther · Jan 2020
The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice.
While advances in assessment and management of musculoskeletal conditions have improved care for many people, there have been other, less beneficial developments in the provision of care for people with musculoskeletal pain conditions, one of which is the worrying tendency to provide too much medicine. Too much medicine occurs when the provision of either investigation or intervention (or both) is unjustifiably excessive. ⋯ The authors (1) list 2 common examples of too much medicine, and 2 examples of medicalizing normality, relevant to physical therapy practice; (2) outline the drivers of too much medicine and medicalizing normality; and (3) make suggestions for change. J Orthop Sports Phys Ther 2020;50(1):1-4. doi:10.2519/jospt.2020.0601.
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J Orthop Sports Phys Ther · Dec 2019
Case ReportsPelvic Ring Fractures: Role of Physical Therapy in the Emergency Department.
An 87-year-old woman with a history of osteoporosis presented to the emergency department with complaints of low back pain and difficulty walking due to falling onto her left hip 2 weeks prior. Given the delay in diagnostic evaluation and persistent symptoms, computed tomography (CT) of the lumbar spine was ordered. ⋯ A CT scan of the hip, which was ordered due to its superior specificity in detecting subtle fractures and to assist intervention planning in the setting of geriatric trauma, revealed 3 pelvic ring fractures. J Orthop Sports Phys Ther 2019;49(12):942. doi:10.2519/jospt.2019.9093.
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J Orthop Sports Phys Ther · Dec 2019
Muscle Function and Muscle Size Differences in People With and Without Plantar Heel Pain: A Systematic Review.
Plantar heel pain is a common condition, but little is known about the relationship between muscle strength and plantar heel pain. ⋯ People with plantar heel pain have reduced strength and volume of the foot muscles, but there is no discernible difference in calf muscle endurance. These findings should be interpreted with respect to the very low GRADE ratings and are likely to change with further research. Accordingly, the role of muscle strength in plantar heel pain is worthy of further investigation. J Orthop Sports Phys Ther 2019;49(12):925-933. Epub 9 Oct 2019. doi:10.2519/jospt.2019.8588.
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J Orthop Sports Phys Ther · Dec 2019
Individuals With and Without Low Back Pain Use Different Motor Control Strategies to Achieve Spinal Stiffness During the Prone Instability Test.
The prone instability test is used to identify individuals with low back pain (LBP) who would benefit from trunk stabilization exercises. Although activity from muscles during the leg-raising portion of the prone instability test theoretically enhances spinal stiffness and reduces pain, evidence for this is lacking. ⋯ Spinal stiffness increased in all participants; however, participants without LBP demonstrated a muscle synergy pattern where each synergy was associated with a distinct function of the prone instability test. Participants with LBP used a more global stabilization pattern, which may reflect a maladaptive method of enhancing spinal stability. J Orthop Sports Phys Ther 2019;49(12):899-907. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8577.
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J Orthop Sports Phys Ther · Dec 2019
Reduced Trunk Coupling in Persons With Recurrent Low Back Pain Is Associated With Greater Deep-to-Superficial Trunk Muscle Activation Ratios During the Balance-Dexterity Task.
Motor control dysfunction persisting during symptom remission in persons with recurrent low back pain (LBP) may contribute to the recurrence of pain. ⋯ The balance-dexterity task is a submaximal, internally driven unstable balance task during which more dissociated trunk motion was observed in persons in remission from recurrent LBP. Findings underscore the task-dependent nature of trunk control research and assessment in persons with recurrent LBP. J Orthop Sports Phys Ther 2019;49(12):887-898. Epub 15 May 2019. doi:10.2519/jospt.2019.8756.