Manual therapy
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Comparative Study
Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash--further evidence of a neuropathic condition.
Hypersensitivity to a variety of stimuli has been shown in whiplash associated disorders and may be indicative of peripheral nerve involvement. This cross-sectional study utilised Quantitative sensory testing (QST) including vibration, thermal, electrical detection thresholds as an indirect measure of primary afferents that mediate innocuous and painful sensation. Pain thresholds and psychological distress (SCL-90-R) were also measured. ⋯ A combination of pain threshold and detection measures best predicted the whiplash group. Sensory hypoaesthesia and hypersensitivity co-exist in the chronic whiplash condition. These findings may indicate peripheral afferent nerve fibre involvement but could be a further manifestation of disordered central pain processing.
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Review Comparative Study
Classification of low back-related leg pain--a proposed patho-mechanism-based approach.
Leg pain is a frequent accompaniment to low back pain, arising from disorders of neural or musculoskeletal structures of the lumbar spine. Differentiating between different sources of radiating leg pain is important to make an appropriate diagnosis and identify the underlying pathology. It is proposed that low back-related leg pain be divided into four subgroups according to the predominating pathomechanisms involved. ⋯ Accordingly, four groups of patients with leg pain associated with structures in the lower back can be identified: Each group presents with a distinct pattern of symptoms and signs. Although there may be considerable overlap between the classifications, the authors propose the existence of an overriding mechanism. The importance of distinguishing low back-related leg pain into these four groups is to facilitate diagnosis and provide a more effective, appropriate treatment.
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Comparative Study
Interobserver reliability of physical examination of shoulder girdle.
The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint. ⋯ In total 11 (48%) items fulfilled the criteria of acceptable reliability. In conclusion, there appears to be a great deal of variation in the reliability of the tests used in the physical examination of the shoulder girdle. Over 50% of the tests did not meet the statistical criteria for acceptable reliability.
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The objective of the study was to establish the specific use of advice and exercise by physiotherapists, for the management of chronic low back pain (LBP). A questionnaire was mailed to a random sample of 600 members of the Irish Society of Chartered Physiotherapists. Open and closed questions were used to obtain information on treatments provided to chronic LBP patients. ⋯ Pain relief was an important treatment goal. Emphasis on exercise programme supervision, incorporating reassurance that its safe to stay active and 'hurt does not mean harm', must be more effectively disseminated and promoted in practice. The influence of follow-up advice on exercise adherence warrants further investigation.
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Comparative Study
A neuropathic pain component is common in acute whiplash and associated with a more complex clinical presentation.
Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. This study investigated the presence of a neuropathic pain component in acute whiplash using the Self-reported Leeds Assessment of Neuropathic Signs and Symptoms' scale (S-LANSS) and evaluated relationships among S-LANSS responses, pain/disability, sensory characteristics (mechanical, thermal pain thresholds, and Brachial plexus provocation test (BPPT) responses) and psychological distress (General Health Questionnaire-28 (GHQ-28)). Participants were 85 people with acute whiplash (<4 weeks) (54 females, age 36.27+/-12.69 years). ⋯ None of the S-LANSS items could discriminate those with cold hyperalgesia (p=0.06). A predominantly neuropathic pain component is related to a complex presentation of higher pain/disability and sensory hypersensitivity. The S-LANSS may be a useful tool and the BPPT a useful clinical test in the early assessment of whiplash.