Manual therapy
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Comparative Study
Relationships between pain thresholds, catastrophizing and gender in acute whiplash injury.
The mechanisms underlying sensory hypersensitivity (SH) in acute whiplash associated disorders (WAD) are not well understood. We examined the extent of the relationships between the sensory measures of pressure pain threshold (PPT) and cold pain threshold (CPT), catastrophizing, pain and disability levels and gender in acute WAD. Thirty-seven subjects reporting neck pain following a motor vehicle accident were examined within five weeks post-injury. ⋯ Finally, gender modulated the relationships between sensory measures, catastrophizing, and pain and disability levels. In conclusion, subjects with higher levels of catastrophizing presented with sensory hypersensitivity to cold stimuli in the acute phase of whiplash. Differences between genders are in accordance with the growing body of evidence suggesting that the relationships between some psychological factors and injury-related symptoms are modulated by gender.
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Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with musculoskeletal pain are provided. ⋯ The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward, however manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization. The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia.
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The aim of this cross-sectional pilot-study was to investigate the relationship between psychological distress and free-living physical activity (PA) in individuals with chronic low back pain (CLBP). Thirty-eight participants with non-specific CLBP (29=distressed; 9=non-distressed) were recruited. PA levels were measured using an accelerometer (activPAL activity monitor) over a one week period. ⋯ Depressive symptoms were a statistically significant independent predictor of time upright (beta=-0.49, p<0.05). This pilot-study found that individuals with CLBP and elevated levels of distress spend less time upright than their non-distressed counterparts. Clinically, when treating individuals with CLBP and elevated distress levels, free-living PA may be low and interventions aimed at increasing upright activity may be appropriate.
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Spinal stabilisation exercises are commonly used in the management of low back pain (LBP). There is limited evidence relating to patients' experiences of their involvement in such programmes. The aim of this study was to explore the experiences of a sample of individuals with chronic LBP who participated in a randomised controlled trial (RCT) investigating the most efficacious dosage and frequency of spinal stabilisation exercises. ⋯ Four themes emerged: Physical dimensions of the LBP experience, emotional and psychological dimensions of the LBP experience and perceived effects of the programme and lastly, the impact of the treatment programme on participants' knowledge, understanding and adherence. In conclusion participants' experiences were not limited to the positive effects of stabilisation exercises on pain, functional disability and quality of life, but also reflected increases in confidence, the formulation of self help strategies and the ability to exert better control over their LBP. The findings highlight the importance of well planned associated educational support packages in the treatment of LBP paving the way for future qualitative research.
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Randomized Controlled Trial Comparative Study
Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial.
This study investigated effects of physical exercise on musculoskeletal pain symptoms in all regions of the body, as well as on other musculoskeletal pain in association with neck pain. A single blind randomized controlled trial testing a one-year exercise intervention was performed among 549 office workers; specific neck/shoulder resistance training, all-round physical exercise, or a reference intervention. Pain symptoms were determined by questionnaire screening of twelve selected body regions. ⋯ The additional number of pain regions in neck cases decreased in the two exercise groups only (P<0.01-0.05). In individuals with no or minor pain at baseline, development of pain was minor in all three groups. In conclusion, both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body.