AN EXAMINATION OF THE SELECTIVE TISSUE TENSION SCHEME, WITH EVIDENCE FOR THE CONCEPT OF A CAPSULAR PATTERN OF THE KNEE

Background and Purpose. The purpose of this study was to examine wheth er there is evidence to support 2 elements of the passive-range-of-mot ion (PROM) portion of Cyriax's selective tissue tension scheme for pat ients with knee dysfunction: a capsular pattern of motion restriction and the pain-resistance sequence. Subjects. One hundred fifty-two subj ects with unilateral knee dysfunction participated. The subjects had a mean age of 40.0 years (SD=15.9, range = 13-82). Methods. Passive ran ge of motion of the knee and the relationship between the onset of pai n and resistance to FROM (pain-resistance sequence) were measured, and 4 tests for inflammation were used. Interrater reliability was assess ed on 35 subjects. Results. Kappa values for the individual inflammato ry tests ranged from .21 to .66 for categorization of the joint as inf lamed, based on at least 2 positive inflammatory tests (kappa=.76). Re liability of FROM measurements was indicated by intraclass correlation coefficients of .72 to .97. Reliability of measurements of the pain-r esistance sequence was indicated by a weighted kappa of .28. A capsula r pattern, defined as a ratio of loss of extension to loss of flexion during FROM of between 0.03 and 0.50, was more likely than a noncapsul ar pattern in patients with an inflamed knee or osteoarthrosis (likeli hood ratio=3.2). An association was found between a capsular pattern a nd arthrosis or arthritis. Conclusion and Discussion. These findings p rovide evidence to support the concept of a capsular pattern of motion restriction in persons with inflamed knees or evidence of osteoarthro sis.