Welcome to our fifth Thieves' Market issue for Topics in Geriatric Rehabilitation! We hope you will enjoy these articles written by rehabilitation professionals from all over the globe. We are pleased to feature diverse articles from the United States, Malaysia, Spain, and Iran. In this issue, we discuss a myriad of topics ranging from chronic and acute low back pain (LBP) to the effects of light therapy on osteoarthritis (OA). We also discuss research related to such topics as fall risk screening, the Patient-Specific Functional Scale (PSFS), the Muscle Quality Index (MQI), insoles and dynamic postural control, and working memory exercises (WMEs) for nursing home patients. But before we look at the issue as a whole, I would like to tell you a story about the author of this issue's first article, “Chronic and Acute Low Back Pain and Its Relationship to the Sacral x-Axis, Leg Length Changes, Sciatica, Abdominal Pain, Idiopathic Scoliosis, and Incontinence.”
About 25 years ago, when I was a new physical therapist (PT), I heard about Richard L. DonTigny, PT, a physical therapist who had developed a treatment of LBP through addressing sacroiliac (SI) joint dysfunction. While attending his continuing education seminar in Raleigh, North Carolina, I remember being impressed by his creative thinking and technical expertise in the evaluation and treatment of SI joint dysfunction, a possible cause of LBP. Mr DonTigny, now 88 years old, has graciously written and submitted to Topics in Geriatric Rehabilitation what he describes as “possibly my last effort on the SIJ.” We are honored to publish his piece, based on a lifetime of research. Allow me introduce you to Mr Richard L. DonTigny, PT.
Richard L. DonTigny, PT, born on August 9, 1931, grew up in Havre, Montana. He attended Northern Montana College for 2 years (with a quarterly tuition cost of $26). In 1954, he finished his college undergraduate work at Montana State in Bozeman with a major in Applied Science, after which he served 2 years in the army as a medic. Not knowing what he wanted to do next for his profession, he asked his brother, David (who was considering being a PT), “What do PTs do?” David responded, “They rub people and work on little kids.” DonTigny thought, “I can do that!” So, he applied to the University of Iowa and became a PT in 1958. His first job was a staff PT in Colorado Springs, Colorado. By 1959, he was in charge of the therapy department. Through a quirk of fate, he became curious about the efficacy of cold. He had a patient with multiple sclerosis who had rigid lower limbs bilaterally. DonTigny put diathermy over her abdomen to keep her core temperature up while he applied homemade “cold packs” (with ice cubes and towels) to her lower extremities. The patient was free of clonus following this procedure. After a similar successful outcome treating a patient with polio, he wrote up his findings on cryotherapy to treat muscle rigidity/spasms and, in 1962, was published in the Archives of Physical Medicine and Rehabilitation. He then worked with Jack Walker of Chattanooga Pharmaceutical to help develop the “cold packs” as we know them today.
DonTigny worked at the Northern Pacific Beneficial Association hospital for 2 years with Nora Staael to learn proprioceptive neuromuscular facilitation (PNF). She had worked with Knott and Voss, and she had introduced the rotational component into the PNF method. DonTigny became quite skilled in use of PNF and used it over the years. In 1964, he moved back to Havre, Montana, where he was introduced to the problem of LPB. He treated a woman who had persistent LBP, and she was no better after physical therapy treatment. The next day, she called to cancel her appointment because she was “pain free.” DonTigny asked her what had happened. She said, “I fell off my tractor.” He jokingly asked if he could purchase her tractor (to potentially treat other patients with LBP), but she declined, stating she needed it for plowing. It was this incident that started DonTigny thinking that LBP could be a reversible lesion of the pelvis. He began to think if he could understand the mechanics of the pelvis and the corrective motion, then he could repeat the result.
In 1965, DonTigny began his research and publishing on LBP and SI joint dysfunction. DonTigny describes this pathology as a “commonly overlooked reversible biomechanical vulnerability in the sacroiliac joint that appears to be a partial dislocation or subluxation of a sacral axis just posterior to the S3 sacral segment.”1 In 2007, he found the lateral points of the sacral x-axis, figured out the biomechanics of the pelvis, and, as a result, he has relieved back pain for thousands of patients over the last 50+ years.
Since his discovery of the functional biomechanics and management of the pathomechanics of the SI joint, DonTigny has published numerous articles and has taught thousands of students his discovery. His teachings are generally known as “the DonTigny method.” More information is available on his Web site at www.thelowback.com. You could also learn more about his work by enrolling in a 5-hour online continuing education seminar by Great Seminars Online featuring Mr DonTigny himself at https://greatseminarsonline.com/dontigney-course. His useful, practical, and ingenious techniques for addressing SI joint/lumbar pathology have helped thousands of patients worldwide. This is his life work. We are privileged to present it to you.
Not only does this Thieves' Market issue showcase the DonTigny method but also it features much other valuable research and information on topics of light therapy and OA, fall risk screening, the PSFS, the MQI, insoles and dynamic postural control, and WMEs for nursing home patients.
Michael Bridges, DPT, et al present a meta-analysis on therapeutic phototherapy. This literature review assesses the effectiveness of therapeutic phototherapy, including laser, light-emitting diode, and supraluminous diode energy, in the management of OA in aging and older adults. The comprehensive meta-analysis in this article suggests that phototherapy appears to be an effective treatment of controlling pain and improving function, possibly alone and also used in conjunction with exercise.
While the silver surge is upon us, many family physicians in some middle-income developing nations are not actively asking patients about falls or fear of falling. This Malaysian-based research study, by Maw Pin Tan, MD, et al., revealed major gaps in the delivery of evidence-based fall prevention in practice by family physicians. A systematic approach for fall assessment and prevention is needed to improve evidence-based clinical practices.
The PSFS is a 5-question self-reported, patient-specific outcome measure, designed to assess functional change in 3 to 5 activities that are important to the patient. In this study, J. David Taylor, PhD, PT, and Ruth Ann Mathis, PhD, PT, investigated the capability of the PSFS to discern between different categories of physical function loss in community-dwelling older adults.
The MQI may be a useful tool to predict the presence of hip OA. The MQI is quantified using a timed sit-to-stand test, body mass, and leg length to calculate a power index that is expressed in watts. In this study, F. Ramón Machado Payer et al evaluate the usefulness of the MQI as a predictor of hip OA and to assess the influence of strength and body composition in subjects with hip OA.
Evidence suggests that orthotic intervention can alter dynamic balance reactions in older adults. This Iranian study, by Mohammad Hadadi, PhD, et al, compared the effect of textured and prefabricated insoles on dynamic postural control using the Star Excursion Balance Test (SEBT). Interestingly, this study concluded that the use of 2 different kinds of insoles in combination with either medical or sports shoes reduced the reach distance during the SEBT as compared with barefoot. This may suggest that the use of certain orthotics could potentially make an older adult move with more caution.
These days care delivery models are requiring “better, faster” outcomes coupled with a reduced hospital readmission rate. This is especially affecting the skilled nursing facility (SNF) who is being expected to shift from the usual and customary approach of post–acute care. Growing evidence suggests that a strong link exists between functional skills with executive function and memory. This study, by Erin Knoepfel, MS, et al, examined the effectiveness of WMEs, applied concurrently with rehabilitation services, for improving activities of daily living among older SNF residents with cognitive impairment.
These and many more treasures are awaiting you on these pages. Let's delve into this issue and see what practical advice we can glean from clinicians who happen to be researchers and who happen to also love their patients just as much as we do. Ready. Set. Go.
—Wendy Powers James, PT
Topics in Geriatric Rehabilitation