Predatory Journals

What are Predatory Journals?

As a health professional, you live and work in an evidence-based practice era.  In order for health professionals to utilize information from research, we must be able to access the research. A few years ago, most journal articles had to be purchased or you were required to subscribe to the journal. Over the past few years, there has been a flood of open access (OA)  journals into the research system.  The only problem with this is, some of these open access journals are less than acceptable.

I have been doing an incredible amount of research on the update of my new seminar and book that I am writing.   I seem to spend more time evaluating the credibility of a journal than reading it, it seems. There are a number of distinguished sites that give their opinion of predatory journals and I have linked them to this post for your information.

Directory of Open Access Journals

Think Science

The Scholarly Kitchen

Slip and Fall Case History and Quiz

A 54-year-old female attends your clinic after suffering a slip and fall at work.  She is NWB on her right leg and on crutches.  Her pain level is 6/10, 24/7 and is noted in the buttock and she has significant bruising of the entire right thigh anterior and laterally.  She has difficulty with transfers in and out of chairs and on and off the bed.


Her initial evaluation was markedly limited due to her pain and tolerance.

Standing posture and standing lumbar ROM is limited by her NWB status and crutches

Supine testing:

painful and limited PROM into hip flexion with flexion to 70 degrees/empty endfeel.

Painful but full abduction/adduction

Painful but no limitation of rotations in either direction

SLR is painful at 70 degrees

Femoral nerve test was painful but negative when done in side lie to her tolerance

Myotomes: Painful weakness of L2, L3 with functional strength of L4, L5

Difficulty testing S1 S2

Muscle testing: painful weakness of hip flexors at 2+/5, hip abd 4/5, hip add 4/5

Difficulty testing hip extensors

You treat her for a period of three weeks where she shows notable improvement. Her pain level has dropped to 3/10 in the buttock region but remains 24/7 and worse at night.   She is now able to walk without crutches although she has a slight limp. Standing Lumbar ROM was limited into flexion and all other ROM was WNL.   Her bruising has cleared well.  The strength of her myotomes has improved with the exception of L2 which remains weak and now painless even with repeated testing.   She continues to have painful, limited hip flexion and a painful limited SLR at 70 degrees but her hip rotations remain full and relatively pain-free.  Muscle testing of her hip muscles, with the exception of psoas, are now WNL.


Take the quiz and see what the problem was.

First of all, no complaints from anyone about the overreacting female.  People will often categorize patients when there is a delay in progress that doesn’t follow normal patterns.  When this happens, do not assume it is a psychological issue when there may be something more sinister happening.

This case history is another true story in my career.  When she arrived at my clinic, she was a straightforward slip and fall with trauma.  As she progressed through her treatments, certain objective signs did not change.  At four weeks, the slip and fall trauma issues had resolved and she remained with the weak and painless L2. That should be considered a red flag as disc herniations are rare at that level but metastasis may be common.  Other issues such as fractures or acute spondylolisthesis were a possibility but she was clear on a repeated x-ray.   Hip pathology was ruled out with x-ray, as well as the fact she had full, painless medial rotation at four weeks.  Psoas damage may have been another possibility but this is rare. (Dutton, 2004)  Her hip flexion and SLR remained limited and painful as well.  That should have improved with her treatment by four weeks.

The limitation of hip flexion equal to the limitation of her SLR and the non-limitation of medial rotation is called the Sign of the Buttock.  Sign of the buttock was first introduced by James Cyriax in his Textbook of Orthopedic Medicine.  It is a combination of seven signs or findings that may indicate serious pathology in the gluteal region posterior to flexion-extension axis of the hip.  The pain is nonremarkable and maybe felt in the buttock and down the posterior aspect of the leg to the knee or calf.

If the following seven signs exist, it is considered a red flag and should be referred out for further evaluation.

  1. trunk flexion is limited to the same extent as hip flexion with other lumbar ROM being full
  2. hip flexion is limited and more painful than the SLR
  3. empty endfeel on passive hip flexion
  4. straight leg raising is limited and painful
  5. non-capsular pattern of the hip i.e.: medial rotation being of full range instead of limited
  6. weak and painful resisted hip motion especially extension
  7. Buttock on examination is larger than the other side, swollen, tender and sometimes increase in warmthover the area

If a straight leg raise is positive and painful but passive hip flexion is full and painless, this is considered a negative. Magee considers if both the straight leg raise and hip flexion are positive for limitation and pain as a positive for the sign of the buttock with a subsequent testing of the pattern of limitation of the hip to be non-capsular.

There are no specific studies on the reliability, sensitivity or specificity of this test.

The various possibilities of pathology that could be the cause of the Sign of the Buttock are:

  • osteomyelitis of the upper femur
  • chronic septic sacroiliac arthritis
  • ischiorectal abscess
  • septic bursitis
  • rheumatic fever with bursitis
  • neoplasm of the upper femur
  • iliac neoplasm
  • fractured sacrum

This particular patient went on for further testing and was found to have a neoplasm within her right pelvis.  We concluded that the initial fall was provoked by the weakness that was developing with the neoplasm.  If we had persisted in treating her thinking that she was non-compliant or overreacting or had discharged her without having these particular OBJECTIVE signs correctly evaluated, this would have delayed the correct diagnosis and treatment of this patient.

Cyriax, J. Diagnosis of Soft Tissue Lesions. Volume 1. London: Bailliere Tindall. 1977.

Magee. DJ, Sueki, D. Orthopedic Physical Assessment Atlas and Video: Selected Special Tests and Movements.    Elsevier Saunders: st Louis Missouri 2011.

Goodman, C, Kelly Snyder, T. Differential Diagnosis for Physical Therapists.St. Louis: Elsevier, 2013

Pogare, V. Sign of the Buttock. .Jan 17 2016.

Dutton, M. (2004). Orthopaedic examination, evaluation, and intervention. McGraw-Hill.




Headache Case History and Quiz

A 27-year-old attends your clinic with complaints of a near constant 24/7 type headache that he has had for two months.  This headache is widespread and does not seem to have a specific generator for this pain.  It doesn’t seem to change with position, time of day, activity or whether he is upright or supine or sitting. He denies the loss of sensation.  It does not affect his work other than he has a constant 24/7 type headache which is steadily getting more intense over the past three weeks.   He denied systemic changes of fever, stiff neck or malaise.

On examination:

Posture is WNL
Gait is WNL
Rom of his Cervical and thoracic spines are WNL.
ROM neither increases nor decreases his headache.
ROM of his UE is WNL
Key muscles or myotomes are 5/5 for his Cervical region.

On further neurological testing, there is no loss in dermatomal sensation but his slump test causes sharp radiation of pain from his mid-thoracic region outward bilaterally and his plantar response is consistently positive.

You send him back to his family Physician. This Physician has him return to you for treatment.  You proceed to retest him, have your colleague retest him.  He continues to be consistent in his symptoms and objective findings.

Take the Quiz

This was an actual patient of mine. The Physician did not have a problem with the patient being referred back to him a second time and appreciated my vigilance in searching for the correct diagnosis of this patient. He had an MRI and found to have a 2 cm cyst within the spinal canal. He went on to have the cyst surgically removed. The cyst was small at the time and he was not having any prevalent upper motor neuron issue such as gait, ataxia or multisegmental weakness or sensory changes. Most of his tests were negative with the exception of the (+) plantar response, the (+) slump test, and that constant unrelenting headache. With this patient, the cyst returned and he required a final but successful removal of the cyst in a second surgery. I always do a plantar response on every patient I have, you might be surprised what you find. If there is a positive finding, you need to correlate it with other findings and symptoms and if they have had a previous history of some type of upper motor neuron lesion.

Idiopathic Intradural Arachnoid cysts are rare. When they become symptomatic they can often cause gait issues such as ataxia, paraparesis or quadriparesis and neuropathic pain. Sometimes these cysts can extend 2-4 vertebral lengths. Often these cysts can be cystic neoplastic lesions, acquired cysts after trauma, inflammation after meningitis causing adhesions or parasitic lesions. Idiopathic intradural arachnoid cysts are the most prevalent of CSF type cysts to actually cause spinal cord compression.

MRI is the gold standard for diagnosis.  Treatment depends on the size and length of the cyst, the point of compression and the communication of the cyst with the arachnoid space.  If the cyst is small and not connected to the arachnoid space, an aspiration under MRI guidance can be attempted.  If large and extensive, surgical excision of the cyst would be attempted.  Generally, reoccurrence is low with good to excellent outcomes.
.Differential Diagnosis of the Spine is available on Amazon in soft cover and kindle editions

Differential Diagnosis of the Spine