Manual therapy
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The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. ⋯ PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: -0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: -0.22 to 1.12) and 0.52 to 0.92 (95% CI: -0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.
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Randomized Controlled Trial
Reduction of experimental muscle pain by passive physiological movements.
The analgesic effects of passive movements on deep-tissue pain have not been sufficiently explored in human studies. The purpose of this study was to examine the effect of passive physiological movements (PPMs) on deep-tissue pain sensitivity. Seventeen healthy subjects were included in this randomised crossover study. ⋯ McGill Pain Questionnaire (MPQ) was used to describe the quality of the induced pain. Compared with the control session PPM demonstrated: (1) a reduction of the experimental muscle pain intensity (VAS area and peak) and duration (17-31%, P<0.03), (2) lower MPQ score and a change in quality profile of experimental muscle pain (25%, P<0.01) and (3) an increased PPT (17%, P<0.0005). The present study demonstrated that PPM produced an immediate analgesic effect on deep-tissue pain indicating a possible involvement of neural inhibitory mechanisms.
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Comparative Study
Relationship between spinal stiffness and outcome in patients with chronic low back pain.
Many manual therapists assess and treat spinal stiffness of people with low back pain. The objectives of this study were to investigate: (i) whether spinal stiffness changes after treatment; (ii) the relationship between pre-treatment spinal stiffness and change in stiffness with treatment; (iii) the relationship between spinal stiffness, pain, disability and global perceived effect of treatment; (iv) whether spinal stiffness predicts outcome of treatment or response to treatment in chronic low back pain patients. One hundred and ninety-one subjects with chronic low back pain were randomly allocated to groups that received either spinal manipulative therapy, motor control exercise, or a general exercise program. ⋯ No significant association was observed between initial stiffness score and any of the final outcome measures following treatment. Initial stiffness did not predict response to any treatment. In conclusion, spinal stiffness decreases over the course of an episode of treatment, more so in those with the stiffest spines, but the decrease is not dependent on treatment and is not generally related to outcome.
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Randomized Controlled Trial
Training the cervical muscles with prescribed motor tasks does not change muscle activation during a functional activity.
Both low-load and high-load training of the cervical muscles have been shown to reduce neck pain and change parameters of muscle function directly related to the exercise performed. The purpose of this study was to investigate whether either training regime changes muscle activation during a functional task which is known to be affected in people with neck pain and is not directly related to either exercise protocol. Fifty-eight female patients with chronic neck pain were randomised into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or low-load training of the cranio-cervical flexor muscles. ⋯ At the 7th week follow-up assessment both intervention groups demonstrated a reduction in their average intensity of pain (P<0.05). However, neither training group demonstrated a change in SCM EMG amplitude during the functional task (P>0.05). The results demonstrate that training the cervical muscles with a prescribed motor task may not automatically result in improved muscle activation during a functional activity, despite a reduction in neck pain.
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In patients with non-specific arm pain (NSAP; also known as repetitive strain injury), there are clinical signs of altered median nerve sliding. It is possible that a restriction along the nerve course will lead to abnormal increases in local strain during limb movements, possibly contributing to symptoms. The present study uses ultrasound imaging to examine median nerve sliding through the proximal and distal nerve segments in 18 NSAP patients. ⋯ There was no significant difference in nerve sliding (p>0.05) or in the angle of elbow extension at which the nerve began to move (mean=53.4 degrees in patients, 52.0 degrees in controls; p>0.05). In summary, restriction of median nerve sliding is unlikely to play a major role in NSAP. Therefore, painful responses during limb movements which tension the nerve are unlikely to result from abnormal increases in nerve strain.