The Effects of Thrust Joint Manipulation on the Resting and Contraction Thickness of Transversus Abdominis in Patients With Low Back Pain: A Randomized Control Trial.

OBJECTIVE: To investigate the immediate changes in resting and contracted thickness of the transversus abdominis (TrA) muscle after application of thrust joint manipulation (TJM) vs sham manipulation in participants with low back pain. METHODS: A pretest-posttest randomized controlled trial design was performed. Consecutive subjects satisfying eligibility criteria completed patient-report outcome baseline measures, pretreatment rehabilitative ultrasound imaging (RUSI) measurements, followed by the randomly assigned intervention then, post-treatment RUSI measurements, and post-treatment & final patient-reported outcome measures. To compare the outcomes of TJM and sham manipulation on the TrA muscle thickness, a 2-by-2 analysis of variance (treatment [TJM and sham manipulation]) by time (pretreatment and post-treatment) was completed for both the TrA muscle thickness at rest and muscle thickness during contraction. Descriptive statistics including independent-sample t tests for continuous variables and χ2 tests for categorical variables were used to analyze differences in patient-reported outcome measures between groups. RESULTS: Sixty-seven eligible participants agreed to participate. No significant interactions were identified for either muscle thickness at rest or contraction. CONCLUSION: This study did not support the hypothesis that manipulation would result in greater changes in TrA thickness at rest or during contraction in participants with low back pain. Based on prior research that identified subgroups of participants likely to respond to manipulation, future research should include participants more likely to respond favorably to TJM. This study was a priori registered with clinicaltrails.gov (NCT02558855).

Symptomatic Oral Crohn's Disease in an Adolescent.

Crohn's Disease (CD) is a granulomatous inflammatory disease that can affect any part of the gastrointestinal tract. Oral ulcers can appear months or years before intestinal signs or symptoms are seen, which can lead to a diagnosis of other granulomatous inflammatory diseases, including or facial granulomatosis. A 16-year-old female diagnosed with CD presented with asymptomatic white linear patches and erosions bilaterally in mandibular vestibules. Cobble-stoning lesions were seen on the buccal mucosa bilaterally, and pyostomatitis vegetans was seen palatally. Non-alcoholic oral chlorohexidine rinse was prescribed. The patient was referred to an oral surgeon for a biopsy of the retromolar pad, which confirmed the presence of granulomatous inflammation consistent with CD. The patient was told to follow up with a gastroenterologist for a CD medication adjustment. At a two-week follow-up following an increase in adalimumab, her oral mucosa showed marked improvement compared to her initial presentation.

Interrater and Intrarater Reliability of the Tuck Jump Assessment by Health Professionals of Varied Educational Backgrounds.

Objective. The Tuck Jump Assessment (TJA), a clinical plyometric assessment, identifies 10 jumping and landing technique flaws. The study objective was to investigate TJA interrater and intrarater reliability with raters of different educational and clinical backgrounds. Methods. 40 participants were video recorded performing the TJA using published protocol and instructions. Five raters of varied educational and clinical backgrounds scored the TJA. Each score of the 10 technique flaws was summed for the total TJA score. Approximately one month later, 3 raters scored the videos again. Intraclass correlation coefficients determined interrater (5 and 3 raters for first and second session, resp.) and intrarater (3 raters) reliability. Results. Interrater reliability with 5 raters was poor (ICC = 0.47; 95% confidence intervals (CI) 0.33-0.62). Interrater reliability between 3 raters who completed 2 scoring sessions improved from 0.52 (95% CI 0.35-0.68) for session one to 0.69 (95% CI 0.55-0.81) for session two. Intrarater reliability was poor to moderate, ranging from 0.44 (95% CI 0.22-0.68) to 0.72 (95% CI 0.55-0.84). Conclusion. Published protocol and training of raters were insufficient to allow consistent TJA scoring. There may be a learned effect with the TJA since interrater reliability improved with repetition. TJA instructions and training should be modified and enhanced before clinical implementation.