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Unuvar BS, Gercek H, Tufekci O, Torlak MS, Erbas O. The relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific chronic low back pain. Work 2024:WOR230547. [PMID: 38393876 DOI: 10.3233/wor-230547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Low back pain is a common health issue, and such pains are often associated with muscle tightness. Understanding the link between lower back pain and tight lower extremity muscles is essential for effective pain management and enhanced quality of life. OBJECTIVE The objective of this study was to investigate the relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific low back pain (NSLBP). METHODS A total of 52 individuals with NSLBP were enrolled in this cross-sectional study. Lower extremity muscle tightness was assessed using various clinical tests, including the Active Knee Extension Test, Active Straight Leg Raise, Ober Test, and Modified Thomas Test. Pain intensity and disability were evaluated using the Visual Analog Scale and the Oswestry Disability Index, respectively. Statistical analyses were conducted to assess the correlation between muscle tightness, pain, and disability. RESULTS The study found weak to moderate negative correlations between lower extremity muscle tightness and both pain intensity and disability in individuals with NSLBP (r: -0.287 to -0.526, p < 0.05). Dominant and non-dominant extremities exhibited differences in muscle flexibility, with the dominant extremity showing greater flexibility (p < 0.05). CONCLUSIONS In individuals with NSLBP, lower extremity muscle tightness is closely related to pain severity and disability. These findings suggest that lower extremity muscle tightness plays a significant role in the severity of low back pain and disabilities. Additionally, the observed flexibility difference between dominant and non-dominant extremities warrants further investigation for more personalized treatment approaches.
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Affiliation(s)
- Bayram Sonmez Unuvar
- Department of Audiology, Faculty of Health Sciences, KTO Karatay University, Konya, Turkiye
| | - Hasan Gercek
- Department of Therapy and Rehabilitation, Vocational School of Health Services, KTO Karatay University, Konya, Turkiye
| | | | - Mustafa Savas Torlak
- Department of Therapy and Rehabilitation, Vocational School of Health Services, KTO Karatay University, Konya, Turkiye
| | - Onur Erbas
- Health Sciences Institute, Karamanoğlu Mehmetbey University, Karaman, Turkiye
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Nzamba J, Van Damme S, Favre J, Christe G. The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis. Eur J Pain 2024; 28:37-53. [PMID: 37475698 DOI: 10.1002/ejp.2162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. DATABASES AND DATA TREATMENT We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. RESULTS A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. CONCLUSIONS These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. SIGNIFICANCE The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.
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Affiliation(s)
- J Nzamba
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - S Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - J Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Christe
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Tavares FAG, Rossiter JVA, Lima GCL, de Oliveira LG, Cavalcante WS, Ávila MA, George SZ, Chaves TC. Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther 2023; 27:100555. [PMID: 37866011 PMCID: PMC10598742 DOI: 10.1016/j.bjpt.2023.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/25/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect. OBJECTIVES To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP). METHOD One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days). RESULTS No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up). CONCLUSION The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.
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Affiliation(s)
- Fernando Augusto Gonçalves Tavares
- Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Witor Souza Cavalcante
- União das Faculdades dos Grandes Lagos (UNILAGO), São José do Rio Preto, São Paulo, Brazil
| | - Mariana Arias Ávila
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Steven Zachary George
- Duke Clinical Research Institute, Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Thais Cristina Chaves
- Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
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Aguiar ADS, Moseley GL, Bataglion C, Azevedo B, Chaves TC. Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2023; 24:251-263. [PMID: 36220481 DOI: 10.1016/j.jpain.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.
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Affiliation(s)
- Aroldo D S Aguiar
- Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - G Lorimer Moseley
- DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Cesar Bataglion
- Ph.D in Dental Sciences, Professor and Researcher from the Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz Azevedo
- Master's Degree in Progress in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thaís C Chaves
- Ph.D, Adjunct Professor and Researcher from the Department of Physical Therapy, University Federal of São Carlos, UFSCar, São Carlos, Brazil; Researcher from the Graduate Program on Rehabilitation and Functional Performance, Laboratory of Research on Movement and Pain (LabMovePain), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Louw A, Farrell K, Nielsen A, O’Malley M, Cox T, Puentedura EJ. Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series. J Man Manip Ther 2023; 31:46-52. [PMID: 35739614 PMCID: PMC9848382 DOI: 10.1080/10669817.2022.2092822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach. OBJECTIVES To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain. METHODS A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise. RESULTS Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID). CONCLUSIONS A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.
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Affiliation(s)
- Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Anthony Nielsen
- Department of Physical Therapy, Rock Valley Physical Therapy, Bettendorf, IA, USA
| | - Max O’Malley
- Department of Physical Therapy, AMN Healthcare, Lincolnwood, IL, USA
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, MO, USA
| | - Emilio J. Puentedura
- Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, Waco, TX, USA,CONTACT Emilio J. Puentedura Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, One Bear Place, Waco, TX97303, USA
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Adenis N, Gosselin K, Stetsenko N, Thevenon A. Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review. J Back Musculoskelet Rehabil 2023; 36:995-1010. [PMID: 37458022 DOI: 10.3233/bmr-220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. INCLUSION CRITERIA publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. RESULTS From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.
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Affiliation(s)
- Nicolas Adenis
- URePSSS University of Lille, Lille, France
- Physiotherapy Practice, Lille, France
| | | | | | - André Thevenon
- URePSSS University of Lille, Lille, France
- Pôle RRSS, Lille, France
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Tekmyster G, Jonely H, Lee DW, Myerson J, Avery M, Moradian M, Desai MJ. Physical Therapy Considerations and Recommendations for Patients Following Spinal Cord Stimulator Implant Surgery. Neuromodulation 2023; 26:260-269. [PMID: 33819381 DOI: 10.1111/ner.13391] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) is an established therapy option in interventional pain medicine. Recent advances in technology have allowed for greater compliance with treatment and improved efficacy in pain control. This article was proposed to fill the gap in the literature addressing this specific patient population and to facilitate further research. Even though there is a lack of consensus among societies and experts on exact parameters of physical therapy (PT) considerations and postoperative limitations in patients with SCS, we propose rehabilitative care for this population should be standardized. As the number of patients with SCS implants grow, it is vital to understand how to appropriately approach patients with implantable devices when additional treatments such as PT are prescribed. MATERIALS AND METHODS A literature search was performed on the use of PT following SCS implantation. Presently, there is no literature to date which addresses the use of PT in this patient population. The lack of data is the largest hurdle in the creation of formal SCS therapy guidelines. The authors therefore proposed recommendations for rehabilitation based upon a detailed understanding of SCS hardware alongside well-studied physiotherapy concepts. RESULTS Considerations when initiating PT in the SCS patient population should include: 1) biomechanics and quality of SCS output; 2) therapeutic exercise and spinal manipulation in association with risk for lead migration and fracture; 3) the application of therapeutic modalities and risk for injury to the patient and/or damage to the SCS componentry; and 4) integration of a biopsychosocial, person-centered approach. CONCLUSIONS PT treatment protocol in patients with a recently implanted SCS device should be person-centered addressing individual needs, values, and goals. Further research is needed to fully appreciate the impact of an interprofessional approach to management of SCS patients, particularly following stimulator implantation.
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Affiliation(s)
- Gene Tekmyster
- Keck Medicine of USC, Orthopaedic Surgery, Los Angeles, CA, USA
| | - Holly Jonely
- International Spine Pain & Performance Center, Washington, DC, USA
| | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
| | - Jason Myerson
- Performance Physical Therapy & Wellness, Westport, CT, USA
| | - Melinda Avery
- International Spine Pain & Performance Center, Washington, DC, USA
| | | | - Mehul J Desai
- International Spine Pain & Performance Center, Washington, DC, USA
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Pain Education in the Management of Patients with Chronic Low Back Pain: A Systematic Review. J Funct Morphol Kinesiol 2022; 7:jfmk7040074. [PMID: 36278735 PMCID: PMC9590060 DOI: 10.3390/jfmk7040074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
New prospective of chronic low back pain (CLBP) management based on the biopsychosocial model suggests the use of pain education, or neurophysiological pain education, to modify erroneous conceptions of disease and pain, often influenced by fear, anxiety and negative attitudes. The aim of the study is to highlight the evidence on the outcomes of a pain education-oriented approach for the management of CLBP. The search was conducted on the Pubmed, Scopus, Pedro and Cochrane Library databases, leading to 2673 results until September 2021. In total, 13 articles published in the last 10 years were selected as eligible. A total of 6 out of 13 studies support a significant reduction in symptoms in the medium term. Disability is investigated in only 11 of the selected studies, but 7 studies support a clear reduction in the medium-term disability index. It is difficult to assess the effectiveness of the treatments of pain education in patients affected by CLBP, due to the multimodality and heterogeneity of the treatments administered to the experimental group. In general, methods based on pain education or on cognitive-behavioral approaches, in association with physical therapy, appear to be superior to physiotherapeutic interventions alone in the medium term.
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Alshami A, Alqassab FH. The short-term effects of instrument-based mobilization compared with manual mobilization for low back pain: A randomized clinical trial. J Back Musculoskelet Rehabil 2022; 36:407-418. [PMID: 36120765 DOI: 10.3233/bmr-220042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP). OBJECTIVE To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization. METHODS This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2-3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation. RESULTS There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm2), lumbar spine ROM (PIM: ⩽ 9.49∘, Manual: ⩽ 0.88∘), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm). CONCLUSIONS Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.
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Affiliation(s)
- Ali Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fadhila H Alqassab
- Department of Physical Therapy, Rehabilitation Center, Qatif Central Hospital, Qatif, Saudi Arabia
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Over Half of Clinical Trials of Mobilization and Manipulation for Patients With Low Back Pain May Have Limited Real-World Applicability: A Systematic Review of 132 Clinical Trials. J Orthop Sports Phys Ther 2022; 52:532-545. [PMID: 35722756 DOI: 10.2519/jospt.2022.10962] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the existing body of trials assessing manual therapy for low back pain (LBP) to determine where it falls on the efficacyeffectiveness continuum. DESIGN Methodology systematic review. LITERATURE SEARCH PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and PEDro (Physiotherapy Evidence Database) were searched for trials published between January 1, 2000, and April 30, 2021. STUDY SELECTION CRITERIA We included randomized clinical trials investigating joint mobilization and manipulation for adults with nonspecific LBP that were available in English. DATA SYNTHESIS We used the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool to score included trials across 4 domains: participant characteristics, trial setting, flexibility of intervention(s), and clinical relevance of experimental and comparison intervention(s). Proportions of trials with greater emphasis on efficacy or effectiveness were calculated for each domain. RESULTS Of the 132 included trials, a greater proportion emphasized efficacy than effectiveness for domains participant characteristics (50% vs 38%), trial setting (71% vs 20%), and flexibility of intervention(s) (61% vs 25%). The domain clinical relevance of experimental and comparison intervention(s) had lower emphasis on efficacy (41% vs 50%). CONCLUSION Most trials investigating manual therapy for LBP lack pragmatism across the RITES domains (ie, they emphasize efficacy). To improve real-world implementation, more research emphasizing effectiveness is needed. This could be accomplished by recruiting from more diverse participant pools, involving multiple centers that reflect common clinical practice settings, involving clinicians with a variety of backgrounds/experience, and allowing flexibility in how interventions are delivered. J Orthop Sports Phys Ther 2022;52(8):532-545. Epub: 19 June 2022. doi:10.2519/jospt.2022.10962.
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O’Neill M, Louw A, Podalak J, Maiers N, Cox T, Zimney K. A Case-Series of Dry Needling as an Immediate Sensory Integration Intervention. J Man Manip Ther 2022; 30:165-171. [PMID: 34898385 PMCID: PMC9255097 DOI: 10.1080/10669817.2021.2011556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) has been associated with altered cortical mapping in the primary somatosensory cortex. Various sensory discrimination treatments have been explored to positively influence CLBP by targeting cortical maps. OBJECTIVES To determine if dry needling (DN) applied to patients with CLBP would yield changes in two-point discrimination (TPD) and left-right judgment (LRJ) tasks for the low back. Secondary measurements of pain and limited range of motion (ROM) was also assessed. METHODS A sample of 15 patients with CLBP were treated with DN to their low back. Prior to and immediately after DN, TPD, LRJ tasks, low back pain, spinal ROM, and straight leg raise (SLR) were measured. RESULTS Following DN, there was a significant (p < 0.005) improvement in LRJ for low back images in all measures, except accuracy for the right side. TPD significantly improved at the L3 segment with a moderate effect size. A significant improvement was found for pain and trunk ROM after DN with a large effect in changing pain of 3.33 points and improving SLR by 9.0 degrees on average, which exceeds the minimal detectable change of 5.7 degrees. CONCLUSIONS This is the first study to explore if DN alters TPD and LRJ tasks in patients with CLBP. Results show an immediate significant positive change in TPD and LRJ tasks, as well as pain ratings and movement.
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Affiliation(s)
- Matt O’Neill
- Department of Physical Therapy Catawba Valley Medical Center, Hickory, NC, USA
| | | | | | - Nicholas Maiers
- Physical Therapy Education, Des Moines University, Des Moines, IA, USA
| | - Terry Cox
- Physical Therapy Education, Southwest Baptist University, Bolivar, MO, USA
| | - Kory Zimney
- School of Health Sciences; Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
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Athanasiadis D, Dionyssiotis Y, Krumov J, Obretenov V, Panayotov K, Papathanasiou J. The cognitive-behavioral aspects of the Mulligan concept of manual therapy: A systematic review. Eur J Transl Myol 2022; 32. [PMID: 35588313 PMCID: PMC9295178 DOI: 10.4081/ejtm.2022.10504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023] Open
Abstract
Low back pain (LBP) is a common clinical problem imposing a prominent socio-economic burden. The purpose of this systematic review was to investigate the biopsychosocial effects of the Mulligan Concept (MC) of manual therapy (MT) when applied to patient's with LBP. Three researchers independently evaluated the literature quality, and completed a review on five online databases (Medline, Cochrane Library, Science Direct, ProQuest and Google Scholar) for articles published from January 1st 2010 to November 20th 2021, using a combination of free words, Wildcards and Medical Subject Headings (MESH) terms: " Mulligan mobilization " AND " back pain " OR " SNAGs." In total, 62 studies were selected for full-text reading, from which finally 6 studies were included in the present review. The results revealed that the studies where the MC of MT was applied to treat LBP mainly lacked concern regarding the effect that the intervention has on the cognitive and behavioural parameters. The ones that introduced measure outcomes for at least some parts of the cognitive behavioural components, showed that the MC has a positive effect, even though without a long-term follow-up assessment. This review summarized that the evidence of the MC on cognitive behavioural (CB) aspects of patients with LBP is controversial and scarce.
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Affiliation(s)
| | | | - Julian Krumov
- Clinic of Orthopedics and Traumatology, Military Medical Academy Varna.
| | - Vasil Obretenov
- Clinic of Orthopedics and Traumatology, Military Medical Academy Varna.
| | | | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria; Department of Kinesitherapy, Faculty of Public Health "Prof. Dr. Tzecomir Vodenicharov, DSci.", Medical University of Sofia.
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Outeda LR, Cousiño LAJ, Carrera IDC, Caeiro EML. EFFECT OF THE MAITLAND CONCEPT TECHNIQUES ON LOW BACK PAIN: A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102258429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Low back pain has a prevalence that reaches up to 70% of the population between 35-55 years of age and is the principal cause of occupational disability. The scientific evidence on the effect of manual therapy on low back pain is conflicting and there are no specific reviews on the Maitland concept of manual therapy. Therefore, the objective of this systematic review is to analyze the effect of the techniques of the Maitland concept of manual therapy in patients with low back pain and/or determine the level of scientific evidence.For this, a search was carried out in the Cinahl, Medline, Web of Science, PubMed and Scopus databases during the months of January and February 2021 and it was updated in August 2021. In the search, 894 records were obtained, of which 15 randomized clinical trials that obtained a minimum of 3 points out of 5 on the Jadad scale were included.The main results in the current scientific literature suggest that there is solid evidence that the manipulations and mobilizations described in the Maitland Concept, applied alone or in combination with other interventions, reduce pain and disability in subjects with low back pain.The effects on musculature are contradictory. Exercise and patient education increase the effect of manual therapy. Future research requires analyzing whether the effects are preserved in the long term and more homogeneous treatment protocols are needed to determine a prescriptive guideline for manual therapy. Level of evidence I; Systematic review.
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14
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Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial. Turk J Phys Med Rehabil 2021; 67:283-290. [PMID: 34870114 PMCID: PMC8606998 DOI: 10.5606/tftrd.2021.5556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives
The aim of this study was to investigate the effect of therapeutic neuroscience education (TNE) combined with physiotherapy on pain, kinesiophobia, endurance, and disability in chronic low back pain (CLBP) patients.
Patients and methods
Between November 2016 and December 2017, a total of 31 patients with CLBP (5 males, 26 females; mean age: 42.3±10.8 years; range, 20 to 58 years) were randomly allocated to receive physiotherapy combined with TNE (experimental group, EG, n=16) and physiotherapy alone (control group, CG, n=15). All participants received physiotherapy consisting of five sessions per week for a total of three weeks. In addition to physiotherapy, the EG received TNE sessions consisting of two sessions per week for a total of three weeks. The primary outcomes were pain intensity as assessed by Visual Analog Scale (VAS) and kinesiophobia by Tampa Scale for Kinesiophobia (TSK), while and the secondary outcomes were trunk muscle endurance as assessed by the partial curl-up test (trunk flexor endurance [TFE]) and modified Sorensen test (trunk extensor endurance [TEE]) and disability by Roland-Morris Disability Questionnaire (RMDQ).
Results
All patients completed the study. The median VAS, TSK, TFE, TEE, and RMDQ scores for the EG significantly improved after three weeks, while there was only significant improvement in the VAS, TSK, and RMDQ scores in the CG. The TSK decreased more in the EG than in the CG. The significant difference was evident in TSK and TFE in favor of the EG (p<0.05).
Conclusion
These results suggest that the combination of TNE with physiotherapy can improve kinesiophobia and trunk flexor muscle endurance of patients with CLBP in the short-term.
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15
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Cerritelli F, Chiera M, Abbro M, Megale V, Esteves J, Gallace A, Manzotti A. The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Front Neurol 2021; 12:700211. [PMID: 34276550 PMCID: PMC8278005 DOI: 10.3389/fneur.2021.700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
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Affiliation(s)
| | | | - Marco Abbro
- Foundation COME Collaboration, Pescara, Italy
| | | | | | | | - Andrea Manzotti
- Foundation COME Collaboration, Pescara, Italy
- RAISE Lab, Foundation COME Collaboration, Milan, Italy
- SOMA Istituto Osteopatia Milano, Milan, Italy
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16
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Bülow K, Lindberg K, Vaegter HB, Juhl CB. Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:891-904. [DOI: 10.1093/pm/pnaa484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Objectives
To estimate the effectiveness and safety of Pain Neurophysiology Education (PNE) on pain, disability, and psychological distress at post-intervention and long-term (closest to twelve months after initiating the intervention) in musculoskeletal pain (MSKP).
Methods
Randomized Controlled Trials (RCT) were identified in six engines, reference lists, ClinicalTrials.gov, and by contacting key researches. Risk of bias was assessed using Cochrane Collaboration Risk of Bias Tool 2.0. Meta-analyses, using Restricted Maximum Likelihood Method, were conducted to estimate standardized mean differences (SMD) and overall quality of evidence was evaluated according to GRADE.
Results
In total, 18 RCTs (n = 1,585) were included. There was small to moderate effects of PNE on pain at post-intervention and long-term: SMD = -0.32 (95% confidence interval [CI]: −.58; −.05) and SMD = −0.40 (95% CI: −.78; −.03), respectively. On disability, PNE had a small effect at post-intervention: SMD = -0.17 (95% CI: −.34; −.01) but was insignificant at long-term: SMD = −0.27 (95% CI: −.59; .06). Likewise, there was a small to moderate effect on psychological distress at post-intervention: SMD = −0.36 (95% CI: −.67; −.06) but was insignificant at long-term: SMD = −0.37 (95% CI: −.75; .01). Quality of evidence was low across all outcomes. Additional analyses showed significant effects of PNE, corresponding to moderate effects, on pain and psychological distress at both time points in chronic MSKP.
Conclusions
Overall quality of evidence was low, supporting PNE being safe and having small to moderate effects on pain at both time points, and on disability as well as psychological distress at post-intervention.
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Affiliation(s)
- Kasper Bülow
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kasper Lindberg
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group / Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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17
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Christe G, Crombez G, Edd S, Opsommer E, Jolles BM, Favre J. Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain 2021; 162:672-686. [PMID: 33591109 DOI: 10.1097/j.pain.0000000000002065] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were -0.13 (-0.18 to -0.09; 2832) for pain-related fear, -0.16 (-0.23 to -0.09; 756) for catastrophizing, -0.08 (-0.13 to -0.03; 1570) for depression, -0.08 (-0.30 to 0.14; 336) for anxiety, and -0.06 (-0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Shannon Edd
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Emmanuelle Opsommer
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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18
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Shala R, Roussel N, Lorimer Moseley G, Osinski T, Puentedura EJ. Can we just talk our patients out of pain? Should pain neuroscience education be our only tool? J Man Manip Ther 2021; 29:1-3. [PMID: 33427587 DOI: 10.1080/10669817.2021.1873259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Rilind Shala
- Department of Physiotherapy, Faculty of Medicine, University of Prishtina , Prishtina, Kosovo
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Research Group MOVANT, University of Antwerp , Antwerp, Belgium
| | - G Lorimer Moseley
- Neuroscience Research Australia , Randwick, Australia.,IMPACT in Health, University of South Australia , Australia
| | - Thomas Osinski
- UR 20201 ERPHAN, Université Versailles Saint Quenti, Hôpital R. Poincaré/Garches (92)
| | - Emilio J Puentedura
- Baylor University Doctor of Physical Therapy Program, Robbins College of Health and Human Services , Texas, USA
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19
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The short-term effects of neuroscience pain education on quality of life in patients with chronic low back pain: A single-blinded randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Strunce J, Spoonemore S, Golding J, Randall T, Krok M, Lee S, Bordt D, Walker-Ferrell W, Cordel D. Physical rehabilitation therapists' perspective of the opioid crisis with evidence-based recommendations. Pain Manag 2019; 9:483-495. [PMID: 31452447 DOI: 10.2217/pmt-2019-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2017, the Secretary of Health and Human Services and Office of the Surgeon General declared the opioid crisis of our nation to be a public health emergency. In response to the Office of the Assistant Secretary of Health and Office of the Surgeon General's 'Call to Action', the Therapist category of the US Public Health Service commissioned a nine-member task force consisting of pain science subject matter experts to study the Therapists' role in effectively reducing chronic pain and opioid abuse. This article addresses the opioid epidemic, how patients with chronic pain have been managed inappropriately, and five key, evidence-based recommendations from this task force.
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Affiliation(s)
- Joseph Strunce
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| | - Stephen Spoonemore
- Rehabilitation Department, Physical Therapy & Exercise Southcentral Foundation, Anchorage, AK 99508, USA
| | - Joseph Golding
- Rehabilitation Department, Parker Indian Health Center, Parker, AZ 85344, USA
| | - Tarri Randall
- Rehabilitation Department, Whiteriver Indian Hospital, Whiteriver, AZ 85941, USA
| | - Michael Krok
- Rehabilitation Department, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Steven Lee
- Rehabilitation Department, Valley Native Primary Care Center, Wasilla, AK 99654, USA
| | - Daniel Bordt
- Rehabilitation Department, Federal Medical Center Rochester, Rochester, MN 55904, USA
| | - Wendy Walker-Ferrell
- Rehabilitation Department, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Douglas Cordel
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
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21
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Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain 2018; 23:234-249. [DOI: 10.1002/ejp.1314] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Lianne Wood
- Centre for Spinal Studies and Surgery; Nottingham University Hospitals NHS Trust; Nottingham UK
- Research Institute for Primary Care and Health Sciences; Keele University; Staffordshire, ST5 5PB
| | - Paul A. Hendrick
- Division of Physiotherapy and Rehabilitation Sciences; School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus); Nottingham UK
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22
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Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther 2017; 25:160-168. [PMID: 28694679 PMCID: PMC5498797 DOI: 10.1080/10669817.2017.1323699] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
- Corresponding author.
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Emilio J. Puentedura
- Department of Physical Therapy, University of Nevada Las Vegas, School of Allied Health Sciences, Las Vegas, NV, USA
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23
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Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion. Arch Phys Med Rehabil 2017; 98:1941-1947. [PMID: 28483657 DOI: 10.1016/j.apmr.2017.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DESIGN Single-blind case series. SETTING Three outpatient physical therapy clinics. PARTICIPANTS Patients with shoulder pain and limited AROM (N=69). INTERVENTION Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. MAIN OUTCOME MEASURES We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. RESULTS There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. CONCLUSIONS A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.
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