Manual therapy
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Flexion and extension movements or positions have been advocated in the treatment of various forms of low back dysfunction due to the potential pain relieving effects attributed to displacements of the intervertebral disc (IVD). Objective in vivo determination of the segmental behaviour of the disc to contrasting positions has until recently been difficult. Magnetic resonance imaging (MRI) was used in this study to evaluate the influence of sagittal plane positions on lumbar IVD height and nucleus displacement in a small asymptomatic population. ⋯ Lumbar spine position was found to be associated with small measured changes in anterior disc height and nucleus position, however, this response was variable within and between individuals. The theoretical concept of a stereotypical effect of spinal position on the lumbar IVD is challenged by these initial data. Since the health of the disc is often unknown in clinical practice, manual therapy treatment for lumbar spine pain should be based on the symptomatic response to movement and position rather than biomechanical theory.
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Passive intervertebral motion of the cervical spine was assessed independently by two physical therapists. The therapists had equal backgrounds concerning education and clinical experience. ⋯ Data were analysed by percentage agreement and kappa coefficient which indicates inter-examiner reliability greater than expected by chance. Results demonstrated inter-examiner reliability of between 70 and 87% and kappa coefficients ranging between 0.28 and 0.43 considered to be only 'fair to moderate'.
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Despite the paucity of research into the reliability of static palpation, it is still employed extensively as a diagnostic tool by manual medicine practitioners. This study tested the inter- and intra-examiner agreement of ten senior osteopathic students using static palpation on ten asymptomatic subjects. Four assessments of the posterior superior iliac spine (PSIS), sacral sulcus (SS), and the sacral inferior lateral angle (SILA) on every subject by all examiners resulted in 1200 assessments in total. ⋯ Inter-examiner agreement was slight (PSIS Kg=0.04; SILA Kg=0.08; SS Kg=0.07) and significant at the 0.01 level. Intra-examiner agreement was greater than inter-examiner agreement, which was consistent with existing palpation reliability studies. The poor reliability of clinical tests involving palpation may be partially explained by error in landmark location.
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Review Comparative Study
Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients.
Chronic pain syndromes such as chronic low back pain are responsible for enormous costs for health care and society. For these conditions a pure biomedical approach often proves insufficient. ⋯ The main assumption is that pain and pain disability are not only influenced by organic pathology, if found, but also by psychological and social factors. In this contribution, a behavioural analysis of chronic musculoskeletal pain will be discussed, with special attention to the role of pain-related fear in the development and maintenance of chronic pain disability, and the behavioural rehabilitation perspective of chronic pain management.
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Complex regional pain syndrome (CRPS) is the newest name for the confusing conditions of reflex sympathetic dystrophy and causalgia. The epidemiology and the signs and symptoms of these conditions are discussed. Although much is only poorly understood about the aetiology of CRPS, the roles of neuropathic pain, prolonged inflammation and psychological factors are becoming clearer. Physical therapies remain the lynchpin of management but the roles of anti-inflammatory medication, sympathectomies and a team approach are emphasized.