To: Jonnie and others
From: one of the alls
>
>
> Dear all,
>
> Another question:
> What is resistance?
> What does it mean and does it exist?
> Is it muscle spasm, is it rapidly increasing stiffness, is it merely
> a change in the tactile stimulation of the therapists hand (or
> thumbs), or is it resistance??
>
> yours
> jonnie
>
There are a tremendous number of issues related to the clinical
assessment of the mechanical properties of an
articulation. However, if we look at one particular test,
Lachman's test for ACL deficiency, there is a potential
template for the other clinical tests.
Lachman's test is probably the most studied of any of the clincal
laxity tests. This test has undergone studies of it's validity,
reliability, and specificity. It has also undergone adaptation to
quantitative methods.
The validity of the test (and its specificity) were originally
documented in the original description by Torg et al.Clinical
Diagnosis of anterior cruciate instability in the athlete. AM J Sports
Med 1976;4:84-93
The biological validity including the joint angle and the
specificity to ACL injury has been investigate through in vitro
studies.
Comparisons of both the quantitative and clinical methods have
been compared to gold standards (materials testing, xray stress
tests, MRI and arthroscopy).
The interrater reliability of both clinical and quantitative
methods have been documented.
The difficulty with Lachman's test is the number of false
negatives.
Greg Kawchuk and I have examined some of the issues of clinical
laxity tests in the paper:
Maitland ME, Kawchuck GN. Towards the quantification of end-feel
for the assessment of passive joint motion. Physical Therapy
Reviews 1997;2:217-226
So I think for this one test we can answer the questions you have
posted above. But for all of the other clinical articular
mechanical tests, it would be very helpful to begin to assess
them in the same manner has the Lachman test has been subjected
to in the last 23 years.
Murray
________________________________________________________________
Murray Maitland PhD PT
Associate Professor and Physical Therapist
Faculty of Kinesiology
Sport Medicine Centre
University of Calgary
2500 University Drive NW
Calgary, Alberta
T2N 1N4
(403) 220-8943 office
(403) 220-8232 clinic
(403) 282-6170 fax
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