Manual therapy
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This study investigated the reliability, validity and diagnostic accuracy of manual palpation of the sciatic, tibial and common peroneal nerves in the examination of 45 subjects with low-back related leg pain. The nerves were palpated manually and with an algometer, to determine pressure pain thresholds (PPTs). A second examiner performed the straight leg raise (SLR) and slump tests to determine nerve trunk mechanosensitivity. ⋯ PPTs were significantly lower on the symptomatic side, for each of the three nerves, in subjects who were positive on manual palpation. In subjects who were negative on manual palpation, PPTs were not significantly different between sides, demonstrating criterion-based validity, using PPT as the criterion. Highest scores of diagnostic accuracy were obtained when two or more of the three nerves were positive on palpation (sensitivity = 0.83; specificity = 0.73).
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Back pain treatment in water has been commonly used although there is little evidence about its effects. One purported advantage for exercise is the reduced loading due to the buoyant force. The purpose of this study was to compare stature change, as a marker of spinal loading, after sitting in aquatic and dry land environments. ⋯ Stature loss following exercise was as expected similar in both groups (SITT=89.2+/-5.4% and HOWI=86.5+/-8.1%; p=0.33). When stature recovery was compared between the water and land environments, HOWI (102.2+/-8.7%) showed greater recovery than SITT (86.5+/-6.3%) after 30 min (p<0.05). These results suggest that HOWI facilitated more rapid stature recovery through lower spinal loading and supports use of this technique to reduce spinal loading during recovery.
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Comparative Study
Gender and site of injection do not influence intensity of hypertonic saline-induced muscle pain in healthy volunteers.
The aim of the study was to determine whether the same stimulus to different muscles results in comparable pain and whether gender has any influence on the pain. We compared the quality and intensity of muscle pain induced by a hypertonic saline injection into the tibialis anterior (leg) muscle to that after an injection into the lumbar erector spinae (back) muscle in both male (n=10) and female (n=10) volunteers. Hypertonic or isotonic saline was injected into the leg and back muscles and pain intensity (visual analogue scale, VAS) and pain quality (McGill Pain Questionnaire) were measured. ⋯ The site of injection did not influence the quality of pain but there was a gender bias in the descriptive words chosen (chi(2) test, P<0.05) and female subjects were more sensitive to pressure than male subjects. Experimentally induced muscle pain is equivalent in intensity and quality in the leg and back muscle. Gender does not influence muscle pain intensity but does influence sensitivity to pressure and the description of pain.
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Multicenter Study
Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non-traumatic neck pain.
The purpose of this study was to evaluate the construct and content validity of the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD) in patients with chronic, non-traumatic neck pain. Twenty patients (mean age=64.5 years) completed a patient-specific questionnaire, the Problem Elicitation Technique (PET), followed by the NDI and NPAD. Content validity was assessed by comparing the items of the NDI and NPAD with problems identified from the PET. ⋯ The NDI and NPAD scores were strongly correlated (r=0.86, p<0.01), while the correlation between the PET and the fixed-item questionnaires was moderate (NDI: r=0.62, p<0.01; NPAD: r=0.71, p<0.01). Both the NDI and the NPAD include most of the functional problems common to this patient group, and display good content validity. The PET is better able to evaluate the problems specific to the individual patient and is therefore measuring a somewhat different construct to the fixed-item questionnaires.