The Journal of orthopaedic and sports physical therapy
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Distressing postoperative pain remains a prevalent problem. Poorly treated pain contributes to patient suffering and may prevent rapid recovery and rehabilitation. ⋯ More advanced methods of pain control can allow excellent relief for virtually all patients but may require the presence of a dedicated pain management service. This article reviews the principles and practice of modern postoperative pain management.
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J Orthop Sports Phys Ther · Oct 1996
ReviewTranscutaneous electrical nerve stimulation for the control of pain in musculoskeletal disorders.
The literature on the use of transcutaneous electrical nerve stimulation (TENS) for pain control in several common musculoskeletal disorders is reviewed. The need for this review stems from apparently contradictory results of numerous studies designed to address the efficacy of electrical stimulation procedures for pain control. ⋯ Other areas discussed include TENS use in arthritic conditions, soft tissue inflammatory disorders, and in postoperative pain following orthopaedic surgical procedures. Methodological strengths and weaknesses of TENS studies are emphasized in order to assist the reader in understanding the relative value of TENS studies which either support or refute the efficacy of electrical stimulation procedures for pain control.
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J Orthop Sports Phys Ther · Sep 1996
Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome.
Various authors have indicated that imbalance of the vastus medialis/vastus lateralis muscles might lead to patellofemoral pain syndrome. However, few reports have been published to substantiate such a hypothesis. The purpose of this study was to attempt to set a scale for the normal reflex response times of the vastus medialis oblique and vastus lateralis muscles after a patellar tendon tap and to determine if patellofemoral pain syndrome patients have an alteration in this firing sequence. ⋯ When comparing these data in the patellofemoral pain syndrome group, a significant earlier firing was obtained from the vastus lateralis in comparison with the vastus medialis oblique (p < or = .01). These findings suggest that a reversal has occurred in the firing pattern of the vastus medialis oblique and vastus lateralis muscles in patellofemoral pain syndrome patients. The results indicate an alteration in the neuromuscular answer of the vastus medialis oblique and vastus lateralis muscles during a patellar tendon tap.
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J Orthop Sports Phys Ther · Sep 1996
The effects of pelvic movement on lumbar lordosis in the standing position.
The purpose of this study was to investigate whether the maneuver of altering the angle of pelvic tilt when standing is effective in changing the angle of lumbar lordosis. The importance of the study was to establish a scientific basis for a common clinical assumption. Pelvic tilt and lumbar lordosis were measured during three conditions: with subjects in a normal standing posture, with subjects assuming a maximal anterior pelvic tilt posture, and with subject assuming a maximal posterior pelvic tilt posture. ⋯ Adopting a maximal posterior pelvic tilt changed the pelvic attitude by an average of 8.7 degrees (p < 0.001) and decreased the lumbar lordosis by an average of 9.0 degrees (p < 0.001). The results of this study demonstrate that altering the pelvic tilt significantly changes the angle of lumbar lordosis. This lends support to the use of pelvic tilting exercises to increase or decrease the degree of lumbar lordosis, at least for the duration of the exercise.
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J Orthop Sports Phys Ther · Aug 1996
Glenohumeral gliding manipulation following interscalene brachial plexus block in patients with adhesive capsulitis.
Previous studies describing nonconservative treatment of shoulder adhesive capsulitis include distention arthrography, brisement techniques, arthrotomy of the anterior/inferior axillary fold and subscapularis tendon, and manipulation under general anesthesia. The purpose of this study was to develop and describe an alternative treatment method that utilizes glide manipulation under interscalene brachial plexus block. Eight patients (four females and four males), age 31-55 years, with a mean age of 44 years, were treated conservatively for adhesive capsulitis of the shoulder and failed to produce increased measurable objective active or passive ranges of motion. ⋯ At the time of discharge, average increases in passive range of motion/active range of motion for flexion, abduction, external rotation, and internal rotation were 76/67 degrees, 82/73 degrees, 50/44 degrees, and 49/40 degrees, respectively. All patients manipulated showed increases in function, such as overhead activities, dressing activities, and hair care. These preliminary findings show that effective gliding manipulation can be carried out under regional blockade and performed in an office setting by practitioners knowledgeable in manipulation techniques.