Manual therapy
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Comparative Study
Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain.
Both sensory hypersensitivity and hypoaesthesia are features of chronic whiplash associated disorders (WAD). Sensory hypersensitivity is not a consistent feature of chronic idiopathic (non-traumatic) neck pain but the presence of hypoaesthesia has not been investigated. This study compared the somatosensory phenotype of whiplash and idiopathic neck pain. ⋯ For detection thresholds, the whiplash group showed elevated vibration (p<0.04), heat (p<0.02) and electrical (p<0.04) thresholds at all upper limb sites compared to the idiopathic neck pain group and the controls (p<0.04). Sensory hypoesthesia whilst present in chronic whiplash is not a feature of chronic idiopathic neck pain. These findings indicate that different pain processing mechanisms underlie these two neck pain conditions and may have implications for their management.
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The clinical criteria by which clinicians determine mechanisms-based classifications of pain are not known. The aim of this study was to generate expert consensus-derived lists of clinical criteria suggestive of a clinical dominance of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain. A web-based 3 round Delphi survey method was employed as an expert consensus building technique. ⋯ Twelve 'nociceptive', 14 'peripheral neuropathic' and 17 'central' clinical indicators reached consensus. These expert consensus-derived lists of clinical indicators of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain provide some indication of the criteria upon which clinicians may base such mechanistic classifications. Further empirical testing is required in order to evaluate the discriminative validity of these clinical criteria in particular and of mechanisms-based approaches in general.
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To determine if real-time feedback enables students to apply mobilisation forces to the cervical spine that are similar to an expert physiotherapist. ⋯ Practice with real-time objective feedback enables students to apply forces similar to an expert, supporting its use in manual therapy training.
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Deep cervical flexor muscle (DCF) activation is impaired with neck pain. This study investigated the effects of low load cranio-cervical flexion (C-CF) and neck flexor strengthening exercises on spatial and temporal characteristics of DCF activation during a neck movement task and a task challenging the neck's postural stability. Forty-six chronic neck pain subjects were randomly assigned to an exercise group and undertook a 6-week training program. ⋯ No change occurred in DCF EMG amplitude following strength training. There was no significant between group difference in pre-post intervention change in relative latency of DCF but a greater proportion of the C-CF group shortened the relative latency between the activation of the deltoid and the DCF during rapid arm movement compared to the strength group (P<0.05). Specific low load C-CF exercise changes spatial and temporal characteristics of DCF activation which may partially explain its efficacy in rehabilitation.