Manual therapy
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Comparative Study
Measurement of segmental cervical multifidus contraction by ultrasonography in asymptomatic adults.
The deep muscles that play significant roles in maintaining segmental stability have been measured using ultrasonography (US). However, few studies have been carried out to determine the reliability and validity of US for measuring the cervical multifidus during contraction. The aims of this investigation were to evaluate the reliability of the dimensions of the cervical multifidus as measured using US and compare the US measurements with those determined with magnetic resonance imaging (MRI), the gold standard. ⋯ The thickness of the cervical multifidus muscle increased significantly during contraction (1.13+/-0.20, 1.19+/-0.20 and 1.17+/-0.12 cm for the C4, C5, and C6 levels, P<0.05). However, no significant differences were noted among the three levels. The results indicate that US can detect changes in segmental cervical multifidus during contraction.
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Randomized Controlled Trial
The initial effects of knee joint mobilization on osteoarthritic hyperalgesia.
Physiotherapists often employ lower limb joint mobilization to reduce pain and increase function. However, there is little experimental data confirming its efficacy. The purpose of this study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. ⋯ Knee joint mobilization also increased PPT at a distal, non-painful site and reduced 'up and go' time significantly more (-5% (-9.3 to 0.8)) than manual contact (-0.4% (-4.2 to 3.5)) or no-contact control (+7.9% (2.6-13.2)) interventions. This study therefore provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population.
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Case Reports
Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint.
This case report describes the clinical reasoning and management of the sacroiliac joint, utilising the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). A patient with a 2 year history of buttock and thigh pain demonstrates a directional preference for repeated anterior SIJ rotation. The MDT approach is discussed and is an ideal method for emphasising the patients involvement in managing their own back problem.
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The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP disorders have no identified pathoanatomical basis leaving a management vacuum. Diagnostic and treatment paradigms for PGP disorders exist although many of these approaches have limited validity and are uni-dimensional (i.e. biomechanical) in nature. ⋯ It also acknowledges the complex interaction that hormonal factors may play in these pain disorders. This classification model is flexible and helps guide appropriate management of these disorders within a biopsychosocial framework. While the validity of this approach is emerging, further research is required.
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Comparative Study
Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp.
Chiropractors, osteopaths and physiotherapists play key roles in the management of low back pain (LBP) patients in the UK. We investigated the attitudes of these three professional groups to back pain using a recently developed and validated questionnaire, the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp). A cross-sectional questionnaire survey was sent to 300 of each professional group (n=900). ⋯ However, physiotherapists and osteopaths tend to endorse attitudes towards limiting the number of treatment sessions offered to LBP patients more than chiropractors, and chiropractors endorse a more biomedical approach than physiotherapists. When practice setting (NHS versus private practice) was considered (in physiotherapists alone), physiotherapists working for the NHS endorsed limiting the number of treatment sessions more than those working in the private sector and would also less frequently advise their patients to restrict activities and be vigilant. The results may help explain current clinical practice patterns observed in these groups and their uptake of clinical guideline recommendations.