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Vidt ME, Santago AC, Marsh AP, Hegedus EJ, Tuohy CJ, Poehling GG, Freehill MT, Miller ME, Saul KR. The effects of a rotator cuff tear on activities of daily living in older adults: A kinematic analysis. J Biomech 2016; 49:611-7. [PMID: 26879327 DOI: 10.1016/j.jbiomech.2016.01.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 01/29/2023]
Abstract
Rotator cuff tears (RCT) in older individuals may compound age-associated physiological changes and impact their ability to perform daily functional tasks. Our objective was to quantify thoracohumeral kinematics for functional tasks in 18 older adults (mean age=63.3±2.2), and compare findings from nine with a RCT to nine matched controls. Motion capture was used to record kinematics for 7 tasks (axilla wash, forward reach, functional pull, hair comb, perineal care, upward reach to 90°, upward reach to 105°) spanning the upper limb workspace. Maximum and minimum joint angles and motion excursion for the three thoracohumeral degrees of freedom (elevation plane, elevation, axial rotation) were identified for each task and compared between groups. The RCT group used greater minimum elevation angles for axilla wash and functional pull (p≤0.0124) and a smaller motion excursion for functional pull (p=0.0032) compared to the control group. The RCT group also used a more internally rotated maximum axial rotation angle than controls for functional reach, functional pull, hair comb, and upward reach to 105° (p≤0.0494). The most differences between groups were observed for axial rotation, with the RCT group using greater internal rotation to complete functional tasks, and significant differences between groups were identified for all three thoracohumeral degrees of freedom for functional pull. We conclude that older adults with RCT used more internal rotation to perform functional tasks than controls. The kinematic differences identified in this study may have consequences for progression of shoulder damage and further functional impairment in older adults with RCT.
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Affiliation(s)
- Meghan E Vidt
- Exercise Science and Health Promotion, Arizona State University, Phoenix, AZ, USA.
| | - Anthony C Santago
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
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Kopkow C, Lange T, Schmitt J, Kasten P. Interrater reliability of the modified scapular assistance test with and without handheld weights. ACTA ACUST UNITED AC 2015; 20:868-74. [DOI: 10.1016/j.math.2015.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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Abstract
Synopsis The hallmark characteristics of rotator cuff (RC) tendinopathy are pain and weakness, experienced most commonly during shoulder external rotation and elevation. Assessment is complicated by nonspecific clinical tests and the poor correlation between structural failure and symptoms. As such, diagnosis is best reached by exclusion of other potential sources of symptoms. Symptomatic incidence and prevalence data currently cannot be determined with confidence, primarily as a consequence of a lack of diagnostic accuracy, as well as the uncertainty as to the location of symptoms. People with symptoms of RC tendinopathy should derive considerable comfort from research that consistently demonstrates improvement in symptoms with a well-structured and graduated exercise program. This improvement is equivalent to outcomes reported in surgical trials, with the additional generalized benefits of exercise, less sick leave, a faster return to work, and reduced costs to the health care system. This evidence covers the spectrum of conditions that include symptomatic RC tendinopathy and atraumatic partial- and full-thickness RC tears. The principles guiding exercise treatment for RC tendinopathy include relative rest, modification of painful activities, an exercise strategy that initially does not exacerbate pain, controlled reloading, and gradual progression from simple to complex shoulder movements. Evidence also exists for a specific exercise program being beneficial for people with massive inoperable tears of the RC. Education is an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) may enhance outcomes. Outcomes may also be enhanced by subgrouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation and the patient's response to shoulder symptom modification procedures outlined herein. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. J Orthop Sports Phys Ther 2015;45(11):923-937. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5941.
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Phadke V, Makhija M, Singh H. The use of evidence-based practices for the management of shoulder impingement syndrome among Indian physical therapists: a cross-sectional survey. Braz J Phys Ther 2015; 19:473-81. [PMID: 26647749 PMCID: PMC4668341 DOI: 10.1590/bjpt-rbf.2014.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 06/14/2015] [Indexed: 11/23/2022] Open
Abstract
Background: The understanding of the pathomechanics of shoulder impingement has evolved over
the years. Likewise, assessment techniques and effective treatment strategies have
also been developed. Physical therapists should keep up-to-date on the current
evidence. Objective: This study explored the practices currently used by Indian physical therapists
for the assessment and management of shoulder impingement syndrome (SIS). Method: Using an online questionnaire, therapists were asked to declare the causes,
methods of assessment and their choices of physical therapy techniques for the
management of SIS. The proportions of therapists using different techniques were
analyzed descriptively, and comparisons across gender, experience level, and
training were made. Data were analyzed to see if the choices of respondents
compared with their responses for etiology. Results: A total of 211 responses were analyzed. Most respondents (>75%) believed that
overuse and abnormal motion/posture are the most significant causes of SIS.
However, fewer respondents reported assessing posture (60.2%) and dyskinesis,
especially in women (24.2%). Ninety-four percent of the respondents reported using
exercises, but exercise prescription was rather generic. Therapists additionally
trained in the techniques of joint mobilization or taping declared using these
techniques more frequently. The use of interferential therapy and ultrasound was
reported by 89.5% and 98.4% of respondents, respectively Conclusion: Most therapists declared awareness of current recommended practices, but patient
assessment, exercise prescription, and use of electrotherapy modalities were only
partially based on current evidence. The study helps to identify gaps in current
physical therapy approaches to SIS in India.
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Affiliation(s)
- Vandana Phadke
- Clinical Research Department, Indian Spinal Injuries Center, New Delhi, India
| | - Meena Makhija
- Institute of Rehabilitation Sciences, New Delhi, India
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Abstract
INTRODUCTION Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. METHOD This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. RESULTS All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds. DISCUSSION It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.
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Affiliation(s)
- John Borstad
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, US
| | - Christopher Woeste
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, US
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Nicholas ND, Ambler SB. External Rotation Strengthening With Manual Distraction for Individuals With Glenohumeral Osteoarthritis. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chopp-Hurley JN, Dickerson CR. The potential role of upper extremity muscle fatigue in the generation of extrinsic subacromial impingement syndrome: a kinematic perspective. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Staged Approach for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder). Phys Ther 2015; 95:791-800. [PMID: 25504491 DOI: 10.2522/ptj.20140156] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/25/2014] [Indexed: 11/17/2022]
Abstract
Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissues. However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision making in rehabilitation. An expanded classification system is proposed that includes the pathoanatomic diagnosis and a rehabilitation classification based on tissue irritability and identified impairments. For the rehabilitation classification, 3 levels of irritability are proposed and defined, with corresponding strategies guiding intensity of treatment based on the physical stress theory. Common impairments are identified and are used to guide specific intervention tactics with varying levels of intensity. The proposed system is conceptual and needs to be tested for reliability and validity. This classification system may be useful clinically for guiding rehabilitation intervention and provides a potential method of identifying relevant subgroups in future research studies. Although the system was developed for and applied to shoulder disorders, it may be applicable to classification and rehabilitation of musculoskeletal disorders in other body regions.
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Lopes AD, Timmons MK, Grover M, Ciconelli RM, Michener LA. Visual Scapular Dyskinesis: Kinematics and Muscle Activity Alterations in Patients With Subacromial Impingement Syndrome. Arch Phys Med Rehabil 2015; 96:298-306. [DOI: 10.1016/j.apmr.2014.09.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/02/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Cutti AG, Chadwick EK. Shoulder biomechanics and the success of translational research. Med Biol Eng Comput 2014; 52:205-10. [PMID: 24567068 DOI: 10.1007/s11517-014-1143-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 2009, the International Shoulder Group (ISG) had the opportunity to propose to the readers of Medical and Biological Engineering and Computing a Special Issue on shoulder biomechanics. At that time, we pointed out that the field was evolving to include more applied research. After 4 years, we can confirm that impression: 10 out of 12 papers included in this second Special Issue deal with clinical related questions, through theoretical and experimental methodologies. This demonstrates that the translational research at the base of ISG foundation in 1989 is effective. We think that the papers of this issue will have an impact on clinics in general and on the treatment of work-related injuries and diseases in particular. Based on the statistics of the Italian Workers' Compensation Authority (INAIL), injuries at the shoulder are first in terms of average duration of "temporary total disability to work". Moreover, occupational diseases at the shoulder in the industrial and services sector represented 16 % of all occupational diseases in 2012, i.e., 46 % of those related to the upper limb. These data stress the need for specific interventions, with the contribution of both researchers and policy makers. Starting from the papers included here, we would encourage additional efforts on: (1) quantitative analysis of shoulder loading during tasks associated with musculoskeletal injuries, and ways to reduce that loading, (2) simple and effective tools to improve the diagnosis and outcome assessment of motion-related shoulder diseases, and (3) the development of rehabilitation treatments focused on occupational tasks, taking advantage of state-of-the-art biofeedback technologies, and exploiting the power of biomechanical models for muscle force prediction.
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Michener LA, Kardouni JR, Sousa CO, Ely JM. Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. ACTA ACUST UNITED AC 2014; 20:171-5. [PMID: 25261090 DOI: 10.1016/j.math.2014.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/13/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022]
Abstract
The evidence to guide use of spinal manipulative therapy (SMT) for patients with shoulder pain is limited. A validated sham comparator is needed to ascertain the unique effects of SMT. We investigated the plausibility of a thoracic sham-SMT comparator for SMT in patients with shoulder pain. Participants (n = 56) with subacromial impingement syndrome were randomized to thoracic SMT or a sham-SMT. An examiner blinded to group assignment took measures pre- and post-treatment of shoulder active range of motion (AROM) and perceived effects of the assigned intervention. Treatment consisted of six upper, middle and lower thoracic SMT or sham-SMT. The sham-SMT was identical to the SMT, except no thrust was applied. Believability as an active treatment was measured post-treatment. Believability as an active treatment was not different between groups (χ(2) = 2.19; p = 0.15). Perceptions of effects were not different between groups at pre-treatment (t = 0.12; p = 0.90) or post-treatment (t = 0.40; p = 0.69), and demonstrated equivalency with 95% confidence between groups at pre- and post-treatment. There was no significant change in shoulder flexion in either group over time, or in the sham-SMT for internal rotation (p > 0.05). The SMT group had an increase of 6.49° in internal rotation over time (p = 0.04). The thoracic sham-SMT of this study is a plausible comparator for SMT in patients with shoulder pain. The sham-SMT was believable as an active treatment, perceived as having equal beneficial effects both when verbally described and after familiarization with the treatment, and has an inert effect on shoulder AROM. This comparator can be considered for used in clinical trials investigating thoracic SMT. IRB number: HM 13182.
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Affiliation(s)
- Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA 90089, USA.
| | - Joseph R Kardouni
- United States Army Research Institute for Environmental Medicine, 15 Kansas Street, Natick, MA 01760, USA
| | - Catarina O Sousa
- Faculdade de Ciências de Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
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Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J Orthop Sports Phys Ther 2014; 44:636-45, A1-8. [PMID: 25103135 PMCID: PMC4684907 DOI: 10.2519/jospt.2014.5339] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion. METHODS Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction. CONCLUSION The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions.
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Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 2: glenohumeral joint. J Orthop Sports Phys Ther 2014; 44:646-55, B1-3. [PMID: 25103132 PMCID: PMC4684908 DOI: 10.2519/jospt.2014.5556] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 asymptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and asymptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy.
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Morrow MMB, Van Straaten MG, Murthy NS, Braman JP, Zanella E, Zhao KD. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. BIOMED RESEARCH INTERNATIONAL 2014; 2014:769649. [PMID: 25180192 PMCID: PMC4142383 DOI: 10.1155/2014/769649] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.
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Affiliation(s)
- Melissa M. B. Morrow
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Meegan G. Van Straaten
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Naveen S. Murthy
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elia Zanella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
The 2013 House of Delegates of the American Physical Therapy Association adopted a vision statement that addresses the role of physical therapy in transforming society through optimizing movement. The accompanying guidelines address the movement system as key to achieving this vision. The profession has incorporated movement in position statements and documents since the early 1980s, but movement as a physiological system has not been addressed. Clearly, those health care professions identified with a system of the body are more easily recognized for their expertise and role in preventing, diagnosing, and treating dysfunctions of the system than health professions identified with intervention but not a system. This perspective article provides a brief history of how leaders in the profession have advocated for clear identification of a body of knowledge. The reasons are discussed for why movement can be considered a physiological system, as are the advantages of promoting the system rather than just movement. In many ways, a focus on movement is more restrictive than incorporating the concept of the movement system. Promotion of the movement system also provides a logical context for the diagnoses made by physical therapists. In addition, there is growing evidence, particularly in relation to musculoskeletal conditions, that the focus is enlarging from pathoanatomy to pathokinesiology, further emphasizing the timeliness of promoting the role of movement as a system. Discussion also addresses musculoskeletal conditions as lifestyle issues in the same way that general health has been demonstrated to be clearly related to lifestyle. The suggestion is made that the profession should be addressing kinesiopathologic conditions and not just pathokinesiologic conditions, as would be in keeping with the physical therapist's role in prevention and as a life-span practitioner.
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