Background: The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS.

An EOTA was more effective than trunk strengthening exercise in a subgroup of subjects hypothesized to benefit from this treatment approach. Additional research is needed to explore whether an EOTA may benefit other subgroups of patients.

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Objectives: Mechanical neck pain is generally treated with a multimodal approach that includes electro/thermal modalities, exercise and non-thrust manual therapy to the neck. Recent studies reported beneficial effects of thoracic thrust manipulation (TTM) but evidence for additive effects of TTM over multimodal neck program (MNP) is limited. The purpose of this pilot study was to assess the supplementary effects of TTM on pain and disability when applied in addition to a MNP to treat mechanical neck pain.Methods: Twenty-two eligible subjects (age: 38 ± 11 years, BMI: 25 ± 5 Kg/m 2 , 68% female) were randomized to receive MNP only or MNP+TTM for a maximum of 12 sessions. Outcomes were assessed at baseline and at 6 weeks follow up, and consisted of the numeric pain rating scale (NPS), Neck Disability Index (NDI), Global Rating of Change, duration of care, and neck active range of motion (AROM).Results: At 6 weeks both groups showed similar improvement in pain and disability that were clinically important. The NPS improved 2.9 points in the MNP+TTM group and 2.7 points in MNP group. The NDI reduced 14.6% in MNP+TTM and 11.8% in MNP. Increases in neck range of motion were small and similar in both groups. The percentage of subjects who improved in the global rating of change was 60%. Both groups reported similar duration of care (40 and 33 days in the MNP and MNP+TTM respectively).Conclusion: TTM does not appear to provide additional benefits over the MNP on the outcomes of pain, disability, neck range of motion, duration of care or global perception of change.

Study Design: Resident's case problem. Background: The purpose of this resident's case problem is to describe a 39-year-old female patient with insidious onset of hip pain. This patient had discrete findings on subjective and physical examination that prompted referral for further imaging studies of the left hip and pelvis. Despite having seen multiple providers, no imaging of the involved hip or pelvis had been performed. A prolonged duration of symptoms, severe gait disturbance with an associated Trendelenburg sign, difficulty sleeping, and an empty end feel with passive range of motion increased concern that a pathological process might be present. Diagnosis: Imaging studies revealed a large destructive soft-tissue tumor later found to be non-Hodgkin's lymphoma. Discussion: It is incumbent upon physical therapists to be aware of the potential for severe pathological conditions that mimic musculoskeletal complaints to exist and understand how to identify patients for whom further testing and/or referral may be appropriate. Existing guidelines for low back pain may assist with decision making in the absence of specific guidelines for when to request imaging in patients with nontraumatic hip and pelvis pain. Proficiency in screening for conditions not amenable to physical therapy treatment or that require consultation to other health care professionals is essential to physical therapy practice. J Orthop Sports Phys Ther 2005;11:738-744.

3Study Design: Case series. Objective: To describe the management of 7 patients with grade 1 cervical compressive myelopathy attributed to herniated disc using intermittent cervical traction and manipulation of the thoracic spine. Background: Intermittent cervical traction has been indicated for the treatment of patients with herniated disc and has been suggested to be helpful for patients with cervical compressive myelopathy. Manipulation of the thoracic spine has been utilized to safely improve active range of motion and decrease pain in patients with neck pain. Methods and Measures: Seven women with neck pain, 35 to 45 years of age, were identified as having signs and symptoms consistent with grade 1 cervical compressive myelopathy. Symptom duration ranged from less than 1 week to 52 weeks. All patients were treated with intermittent cervical traction and thoracic manipulation for a median of 9 sessions (range, 2-12 sessions) over a median of 56 days (range, 14-146 days). Numeric Pain Rating Scale and Functional Rating Index scores served as the primary outcome measures. Results: The median decrease in pain scores was 5 (range, 2-8) from a baseline of 6 (range, 4-8), and median improvement in Functional Rating Index scores was 26% (range, 10%-50%) from a baseline of 44% (range, 35%-71%). Dizziness was eliminated in 3 out of 4 patients and chronic headache symptoms were improved in 3 out of 3 patients. There were no adverse events or outcomes. Conclusions: Intermittent cervical traction and manipulation of the thoracic spine seem useful for the reduction of pain scores and level of disability in patients with mild cervical compressive myelopathy attributed to herniated disc. A thorough neurological screening exam is recommended prior to mechanical treatment of the cervical spine.