The patient-specific functional scale (PSFS) is a patient-reported outcome measure of disability that has high responsiveness and can be adapted to a variety of musculoskeletal disorders. It is often difficult for patients to recall the activities to rate and their pre-disability status on the PSFS, and the PSFS 2.0 has recently been developed to make it easier for respondents to answer. The purpose of this study was the cross-cultural adaptation of the PSFS 2.0 into Japanese. Following an international guideline for cross-cultural adaptation of patient-reported outcome measures, the adaptation was conducted through the following five steps: forward-translation, creation of an integrated version, backward-translation, creation of a provisional Japanese version, and pilot testing. In the pilot testing, 30 Japanese participants with musculoskeletal disorders rated each sentence on a 5-point numerical rating scale (from 1: I don't understand the meaning of the sentence at all, to 5: I can understand the sentence sufficiently), and comments were obtained. In sentences that were commented upon, ≥ 80% of the participants posted a score of ≥4. Based on the comments obtained, the final Japanese version of the PSFS 2.0 was developed via discussions among all six members of its translators and authors.

[Objective] We report the immediate effects of the mobilization with movement (MWM） approach for a patient with limited belt-tying movement. [Case presentation] A woman in her 60s sustained multiple fractures in a fall. Her chief complaints were back pain, and pain during the belt-tying movement and elevation of the shoulder joint. [Evaluation and treatment] Contracture of the posterior inferior tissue of the shoulder joint and a deviated movement pattern of the trunk and scapula during the belt-tying movement were observed. Accordingly, MWM for internal rotation of the shoulder joint was carried out. [Results] Although the range of motion and muscle strength of the shoulder joint did not improve, the distance between the spinous process of the fifth lumbar vertebra and the thumb tip (L5-TD) increased from 5 cm to 19 cm, demonstrating a marked immediate effect. [Conclusion] MWM for internal rotation of the shoulder joint may be a useful intervention at the thoracic spine level for the belt-tying movement.

Movement system is a large component of physical therapists’ identity. Two models have been proposed to describe the development of movement impairments: pathokinesiologic and kinesiopathologic models. The Movement System Impairment diagnostic system, which has been proposed by Sahrmann, is based on the kinesiopathologic model. MSI is a theoretical construct, which states that the daily repetitive movements and sustained alignment (lifestyle) induce movement impairments that eventually lead to musculoskeletal pain problems. This article describes the general principles of MSI, such as the likelihood of hypermobility site being the symptomatic location, the effects of relative flexibility and relative stiffness, the results of utilizing movement system diagnosis, importance of performing a standardized examination, and the need for activity specific retraining. Common misunderstandings regarding MSI diagnostic system are also discussed.

This case report describes the diagnosis and management of a shoulder pain patient using the Movement System Impairment (MSI) diagnostic system. The patient was a 25 year-old female professional clarinet player, who experienced an inferior subluxation of her right shoulder during overhead press exercise at the gym 5 weeks ago. Through a standardized movement examination, there was relative flexibility of the glenohumeral joint compared to the scapulo-thoracic joint, and relative flexibility of the posterior glenohumeral joint compared to anterior glenohumeral joint. Her MSI diagnosis was determined to be Scapular Internal Rotation with Insufficient Upward Rotation Syndrome, and Humeral Anterior Glide Syndrome. Treatments focused on isolated movements such as shoulder rotation and overhead reach with correct scapulo-humeral rhythm. Correct humeral head and scapular movements and alignment were addressed during functional activities. Patient was treated 1-2 times a week for 2.5 months. Her symptom abolished and she was able to practice the clarinet 5 hours a day without pain. She was able to return to light weight lifting at the gym without symptom or instability sensation.

This case report demonstrates the diagnosis and management of a low back pain patient using the Movement System Impairment (MSI) diagnostic system. The patient was a 69 year-old female with low back pain after falling from a stepladder and suffering L1 compression fracture 2 months ago. Through a standardized movement examination, early and increased lumbar extension / rotation movements were identified as the cause of her low back pain exacerbation, which lead to the MSI diagnosis of Lumbar Extension / Rotation Syndrome. With a combination of in-person treatments and teletherapy treatments, treatments focused on progressing from simple isolated movements to functional movements, all with emphasis on preventing lumbar extension / rotation movement impairments. After 5 months of PT treatments at 1-2 times a week frequency, her symptom significantly decreased and she was able to resume her prior level of activities. Compared to her initial 10-15 minutes of standing tolerance, she was able to go shopping, perform gardening, and return to her decorating hobby without symptoms.