Salter-Harris Fracture of the Proximal Humerus in an Adolescent Gymnast.

A 13-year-old male gymnast presented via direct access to physical therapy with a chief complaint of insidious-onset right anterolateral shoulder pain that occurred only when performing on the rings and high bar. Following physical examination, the patient was advised to avoid any gymnastic activities that might cause pain while completing stretching and neuromuscular training over the following 2 weeks. Due to continued symptoms, the patient was then referred to an orthopaedist. Radiographs were performed, followed by magnetic resonance imaging without contrast. The patient was diagnosed with a type 1 Salter-Harris fracture. J Orthop Sports Phys Ther 2018;48(9):729. doi:10.2519/jospt.2018.7296.

How should we teach lumbar manipulation? A consensus study.

BACKGROUND: Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught. OBJECTIVES: The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust. DESIGN: A multi-disciplinary correspondence-based Delphi method. METHODS: Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75% of respondents identified a characteristic as very important/extremely important on a 5-point Likert scale. RESULTS: 265 educators and clinicians completed the three rounds of questioning. There was consensus that localization to target segment, patient comfort, table height, and logrolling the patient towards the operator are important characteristics of patient position during the preparatory phase. During the manipulation phase, respondents agreed that it is important to maintain localization to the segment and rotate the patient's pelvis and lumbar spine. For the operator characteristics, consensus was reached for the following items; moving up and over the patient, maintaining contact using forearms, and close contact between the operator and patient (preparatory phase); generating force through the body and legs, dropping the body downwards, maintaining localization, and providing a high-velocity and low-amplitude thrust (manipulation phase). CONCLUSIONS: This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations.