Manual therapy
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Randomized Controlled Trial
The initial effects of knee joint mobilization on osteoarthritic hyperalgesia.
Physiotherapists often employ lower limb joint mobilization to reduce pain and increase function. However, there is little experimental data confirming its efficacy. The purpose of this study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. ⋯ Knee joint mobilization also increased PPT at a distal, non-painful site and reduced 'up and go' time significantly more (-5% (-9.3 to 0.8)) than manual contact (-0.4% (-4.2 to 3.5)) or no-contact control (+7.9% (2.6-13.2)) interventions. This study therefore provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population.
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Comparative Study
Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp.
Chiropractors, osteopaths and physiotherapists play key roles in the management of low back pain (LBP) patients in the UK. We investigated the attitudes of these three professional groups to back pain using a recently developed and validated questionnaire, the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp). A cross-sectional questionnaire survey was sent to 300 of each professional group (n=900). ⋯ However, physiotherapists and osteopaths tend to endorse attitudes towards limiting the number of treatment sessions offered to LBP patients more than chiropractors, and chiropractors endorse a more biomedical approach than physiotherapists. When practice setting (NHS versus private practice) was considered (in physiotherapists alone), physiotherapists working for the NHS endorsed limiting the number of treatment sessions more than those working in the private sector and would also less frequently advise their patients to restrict activities and be vigilant. The results may help explain current clinical practice patterns observed in these groups and their uptake of clinical guideline recommendations.
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The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP disorders have no identified pathoanatomical basis leaving a management vacuum. Diagnostic and treatment paradigms for PGP disorders exist although many of these approaches have limited validity and are uni-dimensional (i.e. biomechanical) in nature. ⋯ It also acknowledges the complex interaction that hormonal factors may play in these pain disorders. This classification model is flexible and helps guide appropriate management of these disorders within a biopsychosocial framework. While the validity of this approach is emerging, further research is required.
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Neck and shoulder pain is a common disorder which is often associated with a low-pressure pain threshold (PPT) of muscle tissues as manifested by hyperalgesia on palpation or the use of a pressure algometer. The objective of the present study was to evaluate the intratester repeatability of pressure algometer (Force-Five) on the neck and shoulder area in women with neck pain. The study was cross-sectional with single-group repeated measurements. ⋯ Considerable individual variation was observed when consecutive measures were analysed against their mean. On the group level the repeatability of the measurements allows the pressure algometer to be used for research purposes. However, on the individual level, due to the considerable variation found in the PPT results, caution is advised when interpreting the results in clinical practice.
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Case Reports
Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint.
This case report describes the clinical reasoning and management of the sacroiliac joint, utilising the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). A patient with a 2 year history of buttock and thigh pain demonstrates a directional preference for repeated anterior SIJ rotation. The MDT approach is discussed and is an ideal method for emphasising the patients involvement in managing their own back problem.