Manual therapy
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Randomized Controlled Trial
A randomised controlled study examining the short-term effects of Strain-Counterstrain treatment on quantitative sensory measures at digitally tender points in the low back.
Strain-Counterstrain (SCS) intervention has been claimed to elicit immediate and sustained reductions in tenderness at digitally tender points (DTPs), however, there is little experimental evidence to support this. Twenty-eight volunteer participants with low back pain--LBP (17 females and 11 males with mean [SD] age of 39.2 [11.1] and Oswestry disability index of 15.7 [8.6]) participated in this controlled, within-participants study of the immediate and short-term effects of SCS intervention, on pressure pain threshold (PPT) electrical detection threshold (EDT) and electrical pain threshold (EPT) at DTPs in the low back region. Immediate increases in PPT at DTPs were found following all interventions; control intervention: 30.7 kPa [CI 95% - 3.3-64.8] (p = 0.041), sham-SCS intervention: 48.2kPa [CI 95% 14.8-81.7] (p = 0.008) and SCS intervention: 93.4kPa [CI 95% 60.0-126.9] (p<0.0001). ⋯ Increases in PPT at DTPs following SCS intervention did not appear to be maintained between 24 and 96 h after treatment. A further finding was that the control intervention elicited significant increases in both EDT (p = 0.044) and EPT (p = 0.026). The explanation for these findings is unclear.
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Comparative Study
Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability.
Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. ⋯ There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found.
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The presence of fear of movement is related to higher disability rates in several patient groups. The purpose of this study was first to analyze fear of movement and the relation with pain and disability in pre-operative patients with low back pain and radiculopathy and secondly to analyze the factor structure of the Dutch version of the Tampa Scale for Kinesiophobia (TSK). The TSK and Pain Disability Index (PDI) were assessed in 128 patients. ⋯ A four-factor model had an explained variance of 49%. After further analyses a solution with three factors (harm, somatic focus, activity avoidance) and nine items (1, 3, 6, 7, 9, 11, 14, 15, 17) had the best fit. Based on the content of this study clinically a factor structure with three subscales with nine items is favorable for usage in pre-operative patients with low back pain and radiculopathy.
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Review
Manual therapy with or without physical medicine modalities for neck pain: a systematic review.
Manual therapy interventions are often used with or without physical medicine modalities to treat neck pain. This review assessed the effect of 1) manipulation and mobilisation, 2) manipulation, mobilisation and soft tissue work, and 3) manual therapy with physical medicine modalities on pain, function, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults with neck pain. A computerised search for randomised trials was performed up to July 2009. ⋯ We included 19 trials, 37% of which had a low risk of bias. Moderate quality evidence (1 trial, 221 participants) suggested mobilisation, manipulation and soft tissue techniques decrease pain and improved satisfaction when compared to short wave diathermy, and that this treatment combination paired with advice and exercise produces greater improvements in GPE and satisfaction than advice and exercise alone for acute neck pain. Low quality evidence suggests a clinically important benefit favouring mobilisation and manipulation in pain relief [1 meta-analysis, 112 participants: SMD -0.34(95% CI: -0.71, 0.03), improved function and GPE (1 trial, 94 participants) for participants with chronic cervicogenic headache when compared to a control at intermediate and long term follow-up; but no difference when used with various physical medicine modalities.