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Zegarra-Parodi R, D’Alessandro G, Baroni F, Swidrovich J, Mehl-Madrona L, Gordon T, Ciullo L, Castel E, Lunghi C. Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy. Healthcare (Basel) 2024; 12:1149. [PMID: 38891224 PMCID: PMC11171789 DOI: 10.3390/healthcare12111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.
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Affiliation(s)
| | - Giandomenico D’Alessandro
- Clinical-Based Human Research Department, Foundation Centre for Osteopathic Medicine (COME) Collaboration, 65121 Pescara, Italy;
- Research Department, A.T. Still Academy Italia (ATSAI), 70124 Bari, Italy
| | | | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | | | - Travis Gordon
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA;
| | - Luigi Ciullo
- Istituto Europeo per la Medicina Osteopatica (IEMO), 16122 Genova, Italy;
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Silvernail JL, Deyle GD, Jensen GM, Chaconas E, Cleland J, Cook C, Courtney CA, Fritz J, Mintken P, Lonnemann E. Orthopaedic Manual Physical Therapy: A Modern Definition and Description. Phys Ther 2024; 104:pzae036. [PMID: 38457654 DOI: 10.1093/ptj/pzae036] [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: 06/11/2023] [Revised: 11/04/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.
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Affiliation(s)
| | - Gail D Deyle
- Graduate School, Baylor University, San Antonio, Texas, USA
| | - Gail M Jensen
- Graduate School and College of Professional Studies, Creighton University, Omaha, Nebraska, USA
| | - Eric Chaconas
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Josh Cleland
- Department of Rehabilitation Science, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Chad Cook
- Division of Physical Therapy, Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carol A Courtney
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Julie Fritz
- Orthopaedic Surgery, Orthopaedic Surgery Operations, Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Paul Mintken
- Department of Physical Therapy, Hawai'i Pacific University, Honolulu, Hawaii, USA
| | - Elaine Lonnemann
- Physical Therapy, University of St. Augustine for Health Sciences, St. Augustine, Florida, USA
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Carayannopoulos A, Johnson D, Lee D, Giuffrida A, Poply K, Mehta V, Amann M, Santillo D, Ghandour Y, Koch A, Langhorst M, Heros R. Precision Rehabilitation After Neurostimulation Implantation for Multifidus Dysfunction in Nociceptive Mechanical Chronic Low Back Pain. Arch Rehabil Res Clin Transl 2024; 6:100333. [PMID: 39006113 PMCID: PMC11240036 DOI: 10.1016/j.arrct.2024.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Chronic low back pain (CLBP) is a debilitating, painful, and costly condition. Implantable neuromuscular electrical stimulation targeting the multifidus musculature is growing as a non-pharmacologic option for patients with recalcitrant nociceptive mechanical CLBP who have failed conservative treatments (including medications and physical therapy) and for whom surgery is not indicated. Properly selecting patients who meet specific criteria (based on historical results from randomized controlled trials), who diligently adhere to implant usage and precisely implement neuromuscular rehabilitation, improve success of significant functional recovery, as well as pain medication reductions. Patients with nociceptive mechanical CLBP who underwent implanted multifidus neurostimulation have been treated by physicians and rehabilitation specialists who have honed their experience working with multifidus neurostimulation. They have collaborated on consensus and evidence-driven guidelines to improve quality outcomes and to assist providers when encountering patients with this device. Physicians and physical therapists together provide precision patient-centric medical management with quality neuromuscular rehabilitation to encourage patients to be experts of both their implants and quality spine motion to help override long-standing multifidus dysfunction related to their CLBP.
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Affiliation(s)
- Alexios Carayannopoulos
- Departments of Neurosurgery and Neurology, Brown University/Warren Alpert Medical School, Providence, RI
| | - David Johnson
- A City to Coast Neurosurgery, Brisbane, Queensland, Australia
| | - David Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA
| | - Anthony Giuffrida
- Cantor Spine Center, Paley Orthopedic & Spine Institute, Fort Lauderdale, FL
| | - Kavita Poply
- Queen Mary University of London/St. Bartholomew's Hospital/Health NHS Trust, London, UK
| | - Vivek Mehta
- St. Bartholomew's Hospital/Health NHS Trust, London, UK
| | - Marco Amann
- Orthopädische Klinik Schloss Werneck, Germany
| | | | - Yousef Ghandour
- Physical Rehabilitation Network/University of St. Augustine for Health Sciences, San Diego, CA
| | - Amy Koch
- Methodist Health System, Omaha, NE
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Sinderholm Sposato N, Bjerså K, Gilljam M, Lannefors L, Fagevik Olsén M. Musculoskeletal aspects of respiratory function in cystic fibrosis: a cross-sectional comparative study. Eur Clin Respir J 2024; 11:2350206. [PMID: 38726022 PMCID: PMC11080665 DOI: 10.1080/20018525.2024.2350206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Background Respiration is an intricate interaction between visceral and musculoskeletal structures. In cystic fibrosis (CF), the airways and lungs are subject to progressive obstruction and destruction. However, knowledge about the musculoskeletal aspects of respiratory function and symptoms is still limited in this patient group. Methods In a cross-sectional comparative study, 21 adults with CF enrolled at the Gothenburg CF Centre were matched with 42 healthy controls. The two groups were examined and compared in terms of thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain in accordance with a predefined protocol. Results Significant differences were observed between the groups in the number of tender points, thoracic excursion, forced vital capacity (FVC), and forced expiratory volume (FEV). The CF group also demonstrated a tendency toward reduced function in other measurements, although these were not statistically significant. Conclusion This cross-sectional study revealed that people with CF have reduced thoracic mobility and an increased prevalence of muscular tender points, alongside decreased lung function, compared to healthy controls. These findings stress the need for greater emphasis on the often-overlooked musculoskeletal aspects of CF care, especially as people with CF are living longer and may require more musculoskeletal health support.
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Affiliation(s)
- Niklas Sinderholm Sposato
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Primary Care, Närhälsan Majorna, Gothenburg, Sweden
| | - Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Lannefors
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Delgadillo BE, Bui A, Debski AM, Miller B, Wu DO SS. Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials. Cureus 2024; 16:e59439. [PMID: 38826947 PMCID: PMC11140634 DOI: 10.7759/cureus.59439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Patellofemoral pain syndrome (PFPS) is among the most common causes of musculoskeletal pain in the United States. It is defined as retropatellar or peripatellar pain that is reproduced with functional activities that load the patellofemoral joint in a flexed position, such as stair climbing or squatting. While it presents in both adolescents and adults, it is commonly found in physically active individuals, such as athletes and military recruits. Exploring the role of osteopathic manipulative treatment (OMT) in PFPS is of particular interest given the absence of a definitive treatment and the poor long-term prognosis associated with PFPS. This meta-analysis includes three studies exploring the use of OMT to reduce pain in patients suffering from PFPS and exploring the efficacy of OMT as a primary intervention. In these studies, pain assessments, pre-treatment, and post-treatment follow-up of at least 30 days were performed using a 10-cm visual analog scale (VAS). The mean difference in pain between OMT and no treatment (NT) groups using the random effects model was -3.95 (-6.39; -1.50) with a p<0.01, suggesting OMT resulted in significant knee pain reduction in those with PFPS. A measure of heterogeneity, known as I2, was found to be high at 97%, which suggests caution should be taken when interpreting the overall results. Given the lack of definitive treatment and the poor long-term prognosis for PFPS, the authors suggest OMT provides an effective option for pain relief in patients with PFPS. Further research is needed to provide results that may be more clinically applicable or valuably interpreted.
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Affiliation(s)
- Blake E Delgadillo
- Orthopaedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Audrey Bui
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Alyssa M Debski
- Anatomy, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Brooke Miller
- Urology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Shan Shan Wu DO
- Allergy/Immunology, Allergy/Immunology Associates, Inc., Mayfield Heights, USA
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Whetstone KS, Matsel KA, Patton AS, Gehres SE, Schwartzkopf-Phifer K. Reliability and Validity of Visual Estimation in Determining Thorax Rotation Mobility using the Quadruped Lumbar-Locked Position. Int J Sports Phys Ther 2024; 19:581-590. [PMID: 38707852 PMCID: PMC11065767 DOI: 10.26603/001c.116154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the sport. Accurate differentiation between normal mobility and active and passive physiological deficits in the thoracic region is critical for identifying the need for intervention to the thorax. Purpose To establish the reliability and discriminant validity of visual estimation of thorax rotation range of motion across clinicians of differing experience levels in determining normal mobility and active or passive physiological deficits when utilizing the quadruped lumbar-locked position. Study Design Cross-sectional. Methods Thirty-eight subjects (21 female, 17 male) with a mean age of 27 years ± 6.67 were assessed with the quadruped lumbar-locked thorax rotation test by three examiners with various clinical experience in real-time and again one week later. Bilateral active and passive lumbar-locked thorax rotation mobility was assessed by all raters and categorized as "Unrestricted" (≥50°) or "Restricted" (<50°) while a research assistant simultaneously measured the motion with a digital inclinometer. All raters were blinded to the results. All results were analyzed for intra-rater reliability and agreement. Results Test-retest intra-rater reliability ranged from 0.55-0.72 and percent absolute agreement ranged from 0.82-0.89. Inter-rater reliability ranged from 0.45-0.59 while percent absolute agreement between raters ranged from 0.74-0.84. There was a significant difference in range of motion between "Unrestricted" and "Restricted" categories for both active (Unrestricted=54.6-58.9; Restricted=40.4-44.4; p<0.001) and passive motion (Unrestricted=61.3-63.5; Restricted=39.2-39.7; p<0.001). The only interaction effect was for passive left rotation [Rater A Restricted x ® =34.3(30.4-38.2); Rater C Restricted (x ) ®=43.8(41.3-46.4); p=.000]. Conclusion The quadruped lumbar-locked thorax rotation test demonstrates moderate to substantial test-retest intra-rater and inter-rater reliability regardless of clinical experience. The quadruped lumbar-locked thorax rotation test can accurately discriminate between individuals with active and passive physiological deficits regardless of rater experience using visual estimation. Level of Evidence 3b.
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Glass SM, Morelli R, Mellinger E, Delaney C, Plassmann C, Kolb C, Parcetich KM. Acute responses of postural alignment and intermuscular coherence to anti-gravitational muscle engagement-A randomized crossover trial. J Bodyw Mov Ther 2024; 38:133-142. [PMID: 38763552 DOI: 10.1016/j.jbmt.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Posture is a facet of clinical assessment in several rehabilitative disciplines. Despite extensive clinical focus, the precision with which posture can be evaluated and intervened upon is limited by the very general terms used to describe it. The purpose of this crossover trial was to quantify the effects of targeted postural intervention motivated by theoretical sagittal gravitational collapsing (SGC) tendencies on: 1) distance from SGC, 2) intermuscular coherence (iCOH), and 3) kinematic chain connectivity. METHODS Ten healthy adults (24.50 ± 1.18 years, 172.72 ± 10.19 cm, 76.47 ± 14.60 kg) completed pre- and post-intervention testing on two occasions involving contrasting interventions: promote postural muscle (PPM) vs. reduce compensatory muscle (RCM) engagement. Distance from SGC, iCOH, and kinematic chain connectivity were quantified from electromyography and/or kinematic data acquired during tests administered before and after interventions. Effects of Treatment [PPM, RCM] and Time [Pre, Post] were tested with linear mixed models. RESULTS A Treatment*Time interaction was observed for distance from SGC. Post-intervention distance from SGC was greater following PPM only (p < 0.01). A Treatment*Time interaction was observed for hi-frequency trunk muscle iCOH, with a post-intervention increase corresponding to the RCM intervention (p < 0.007). Additional iCOH effects did not differ by intervention. CONCLUSION Distance from SGC is acutely modifiable and increases following exercises to facilitate anti-SGC muscles. Convergent findings related to kinematic chain connectivity and prescriptive neural binding were not observed. These observations suggest that it may be possible to describe, evaluate, and intervene upon posture in reference to a specific, mechanistic theory regarding the function of postural alignment.
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Affiliation(s)
- Stephen M Glass
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA.
| | - Ryan Morelli
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
| | - Emily Mellinger
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
| | - Caitlyn Delaney
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
| | - Christine Plassmann
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
| | - Caleb Kolb
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
| | - Kevin M Parcetich
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA, 24013, USA
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Roda GF, Awad ME, Melton DH, Christiansen CL, Stoneback JW, Gaffney BMM. The Amputated Limb Gluteus Medius is Biomechanically Disadvantaged in Patients with Unilateral Transfemoral Amputation. Ann Biomed Eng 2024; 52:565-574. [PMID: 37946055 PMCID: PMC10922424 DOI: 10.1007/s10439-023-03400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Patients with transfemoral amputation (TFA) are at an increased risk of secondary musculoskeleteal comorbidities, primarily due to asymmetric joint loading. Amputated limb muscle weakness is also prevalent in the TFA population, yet all factors that contribute to muscle strength and thus joint loading are not well understood. Our objective was to bilaterally compare gluteus medius (GMED) muscle factors (volume, fatty infiltration, moment arm) that all contribute to joint loading in patients with TFA. Quantitative magnetic resonance (MR) images of the hip were collected from eight participants with unilateral TFA (2M/6F; age: 47.3 ± 14.7 y/o; BMI: 25.4 ± 5.3 kg/m2; time since amputation: 20.6 ± 15.0 years) and used to calculate normalized GMED muscle volume and fatty infiltration. Six participants participated in an instrumented gait analysis session that collected whole-body kinematics during overground walking. Subject-specific musculoskeletal models were used to calculate bilateral GMED (anterior, middle, posterior) moment arms and frontal plane hip joint angles across three gait cycles. Differences in volume, fatty infiltration, hip adduction-abduction angle, and peak moment arms were compared between limbs using paired Cohen's d effect sizes. Volume was smaller by 36.3 ± 18.8% (d = 1.7) and fatty infiltration was greater by 6.4 ± 7.8% (d = 0.8) in the amputated limb GMED compared to the intact limb. The amputated limb GMED abduction moment arms were smaller compared to the intact limb for both overground walking (anterior: d = 0.9; middle: d = 0.1.2) and during normal range of motion (anterior: d = 0.8; middle: d = 0.8) while bilateral hip adduction-abduction angles were similar during overground walking (d = 0.5). These results indicate that in patients with TFA, the amputated limb GMED is biomechanically disadvantaged compared to the intact limb, which may contribute to the etiology of secondary comorbidities. This population might benefit from movement retraining to lengthen the amputated limb GMED abduction moment arm during gait.
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Affiliation(s)
- Galen F Roda
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA
| | - Mohamed E Awad
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Danielle H Melton
- University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cory L Christiansen
- University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA.
- University of Colorado Osseointegration Research Consortium, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Lena F, Cesarano S, D'Onghia A, Torre M, Santilli M, Modugno N, Al-Wardat M. A novel manual therapy approach for managing acute interscapular pain following median sternotomy for open cardiac surgery: A clinical comparative analysis. J Bodyw Mov Ther 2024; 37:278-282. [PMID: 38432818 DOI: 10.1016/j.jbmt.2023.11.061] [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] [Received: 03/11/2022] [Revised: 09/09/2023] [Accepted: 11/26/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Acute interscapular pain is a frequent postoperative complication observed in patients who have undergone median sternotomy. This study aimed to assess a novel approach to manual therapy utilizing the Regional Interdependence (RI) concept for managing interscapular pain in post-sternotomy patients. MATERIALS AND METHODS In an observational study, a cohort of 60 consecutively admitted patients undergoing median sternotomy was enrolled. Data collection involved standardized clinical evaluations conducted at specific time points: prior to manual treatment (T0), following five manual treatments (T5), and at post-treatment days 10 (T10) and 30 (T30). The Experimental Group (EG) received manual treatment based on the RI concept, performed in a seated position to accommodate individual clinical conditions and surgical wound considerations. The Control Group (CG) received simulated treatment involving identical exercises to the EG but lacking the physiological or biomechanical stimulation. RESULTS Among the initial 60 patients, 36 met the inclusion criteria, while 24 were excluded due to one or more exclusion criteria. Treatment outcomes revealed a statistically significant improvement in the EG compared to the CG, not only in terms of pain reduction but also in functional recovery and consequent disability reduction. DISCUSSION The RI concept emerges as a potentially valuable therapeutic approach for addressing interscapular dysfunction, particularly in highly complex post-sternotomy patients. This study highlights the clinical relevance of the RI concept in the management of interscapular pain and highlights its potential utility in improving patient outcomes in the challenging context of sternotomy surgery.
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Affiliation(s)
- Francesco Lena
- Department of Neurology, IRCCS INM Neuromed, Pozzilli, IS, Italy
| | - Simone Cesarano
- Department of Neurorehabilitation, San.Stef.ar Arbuzzo, Pescara, PE, Italy
| | | | - Monica Torre
- Department of Neurorehabilitation, San.Stef.ar Arbuzzo, Pescara, PE, Italy
| | - Marco Santilli
- Department of Neurology, IRCCS INM Neuromed, Pozzilli, IS, Italy
| | - Nicola Modugno
- Department of Neurology, IRCCS INM Neuromed, Pozzilli, IS, Italy
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
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Rodrigues-de-Souza DP, Casas-Castro A, Carmona-Pérez MC, García-Luque L, Alcaraz-Clariana S, Garrido-Castro JL, Alburquerque-Sendín F. Between-sexes differences in lumbopelvic muscle mechanical properties of non-climacteric adults: a cross-sectional design. Sci Rep 2023; 13:21612. [PMID: 38062151 PMCID: PMC10703780 DOI: 10.1038/s41598-023-48984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
The lumbopelvic muscle mechanical properties (MMPs) are clinically relevant, but their dependence on sex remains unknown. Therefore, this study aimed to identify if lumbopelvic MMPs depend on the sex in a young adult population. Thirty-five healthy nulliparous women and 35 healthy men were analyzed (age range: 18-50). Lumbopelvic MMPs, that is, tone, stiffness, elasticity, relaxation and creep, assessed with MyotonPRO®, and pelvic floor (PF) health questionnaires were compared between-sexes. Intra-group correlations between sociodemographic and clinical data, and MMPs were also determined. The MMPs of PF were different between healthy non-climacteric adults of both sexes, with women showing higher values of tone and stiffness and lower values of elasticity and viscoelastic properties than men (in all cases, p < 0.03). At lumbar level, tone and stiffness were higher for men at both sides (in all cases, p < 0.04), and relaxation was lower at left side (p = 0.02). The MMPs showed few correlations with sociodemographic data within women. However, within males, there were positive correlations for PF stiffness and viscoelastic parameters with age, BMI and function (0.334 < r < 0.591) and, at lumbar level, negative correlations for tone and stiffness ( - 0.385 < r < -0.590) and positive correlations for viscoelastic properties (0.564 < r < 0.719), with BMI. This indicated that between-sexes differences of lumbopelvic MMPs depend on the specific location of assessment in healthy non-obese young individuals. Women show higher tone and stiffness and lower elasticity and viscoelasticity than men, at PF level.
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Affiliation(s)
- Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Córdoba, Spain
| | - Azahara Casas-Castro
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain
| | - María Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Córdoba, Spain
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071, Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004, Córdoba, Spain.
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004, Córdoba, Spain.
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12
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Pranata A, Farragher J, Perraton L, El-Ansary D, Clark R, Meyer D, Han J, Mentiplay B, Bryant AL. Impaired Lumbar Extensor Force Control Is Associated with Increased Lifting Knee Velocity in People with Chronic Low-Back Pain. SENSORS (BASEL, SWITZERLAND) 2023; 23:8855. [PMID: 37960555 PMCID: PMC10647238 DOI: 10.3390/s23218855] [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: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The ability of the lumbar extensor muscles to accurately control static and dynamic forces is important during daily activities such as lifting. Lumbar extensor force control is impaired in low-back pain patients and may therefore explain the variances in lifting kinematics. Thirty-three chronic low-back pain participants were instructed to lift weight using a self-selected technique. Participants also performed an isometric lumbar extension task where they increased and decreased their lumbar extensor force output to match a variable target force within 20-50% lumbar extensor maximal voluntary contraction. Lifting trunk and lower limb range of motion and angular velocity variables derived from phase plane analysis in all planes were calculated. Lumbar extensor force control was analyzed by calculating the Root-Mean-Square Error (RMSE) between the participants' force and the target force during the increasing (RMSEA), decreasing (RMSED) force portions and for the overall force error (RMSET) of the test. The relationship between lifting kinematics and RMSE variables was analyzed using multiple linear regression. Knee angular velocity in the sagittal and coronal planes were positively associated with RMSEA (R2 = 0.10, β = 0.35, p = 0.046 and R2 = 0.21, β = 0.48, p = 0.004, respectively). Impaired lumbar extensor force control is associated with increased multiplanar knee movement velocity during lifting. The study findings suggest a potential relationship between lumbar and lower limb neuromuscular function in people with chronic low-back pain.
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Affiliation(s)
- Adrian Pranata
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn 3122, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Joshua Farragher
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville 3052, Australia;
| | - Luke Perraton
- Department of Physiotherapy, Monash University, Frankston 3199, Australia;
| | - Doa El-Ansary
- School of Health and Biomedical Science, RMIT University, Mill Park 3082, Australia; (J.F.); (D.E.-A.)
- Department of Surgery, Royal Melbourne Hospital, Parkville 3052, Australia
| | - Ross Clark
- School of Health, University of Sunshine Coast, Sippy Downs 4556, Australia;
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Hawthorn 3122, Australia;
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
- Research Institute for Sports and Exercise, University of Canberra, Bruce 2617, Australia
| | - Benjamin Mentiplay
- LaTrobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora 3086, Australia;
| | - Adam L. Bryant
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville 3052, Australia;
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13
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Rebelatto MN, Alburquerque-Sendín F, Gava V, Camargo PR, Haik MN. Cervical sensitivity, range of motion and strength in individuals with shoulder pain: A cross-sectional case control study. Musculoskelet Sci Pract 2023; 67:102834. [PMID: 37527568 DOI: 10.1016/j.msksp.2023.102834] [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: 02/21/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To assess whether cervical sensitivity, range of motion (ROM) and strength are impaired in individuals with shoulder pain and how they interact with sociodemographic and clinical data. METHODS Forty-eight individuals with shoulder pain and 48 asymptomatic matched ones were included. Pressure pain thresholds (PPTs) in cervical region and tibialis anterior muscles, ROM of cervical flexion, extension, lateral flexions and rotations and cervical muscle strength of flexion, extension and lateral flexions were assessed. Between-groups comparisons and a logistic multiple regression model were performed. RESULTS The symptomatic group showed lower and not meaningful PPTs in trapezius of the unaffected/unmatched side, both sternocleidomastoid muscles, and tibialis anterior and reduced ROM in cervical extension (MD = -9.00°) when compared to the asymptomatic group. No differences were identified in muscle strength. Reduced PPT of the trapezius and reduced cervical extension ROM together accounted for 40.2% of the variance of the chance of presenting shoulder pain. CONCLUSION Individuals with shoulder pain have more, but not clinically relevant, cervical sensitivity and lower cervical extension than asymptomatic individuals. The lower the PPT of the upper trapezius and the cervical extension ROM, the higher was the chance to present shoulder pain. Regional interdependence between cervical spine and shoulder may explain cervical physical function alterations in shoulder pain.
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Affiliation(s)
- Marcelo N Rebelatto
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Francisco Alburquerque-Sendín
- Universidad de Córdoba, Department of Nursing, Pharmacology and Physical Therapy, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Vander Gava
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Paula R Camargo
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Melina N Haik
- Universidade Federal de São Carlos, Department of Physical Therapy, São Carlos, Brazil
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14
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Devecchi V, Falla D, Cabral HV, Gallina A. Neuromuscular adaptations to experimentally induced pain in the lumbar region: systematic review and meta-analysis. Pain 2023; 164:1159-1180. [PMID: 36730706 DOI: 10.1097/j.pain.0000000000002819] [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: 03/09/2022] [Accepted: 10/20/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy individuals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.
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Affiliation(s)
- Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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15
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Zarrin M, Ansari NN, Saadat M, Yazdi MJS, Shalilahmadi D. A Pilot Study In to the Effects of Cervical Manual Therapy Plus Conventional Physical Therapy on Clinical Outcomes and Electrodiagnostic Findings in People With Carpal Tunnel Syndrome. Int J Ther Massage Bodywork 2023; 16:12-28. [PMID: 37265535 PMCID: PMC10212565 DOI: 10.3822/ijtmb.v16i2.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that has a significant impact on patients' quality of life. Current physical therapy treatment options show limited effects or low-quality evidence, especially in the long term. To date, there has been little research to look at the effects of treating the cervical spine on decreasing symptoms distally to the carpal tunnel. This study aimed to evaluate the effects of cervical manual therapy plus conventional physical therapy on patients with carpal tunnel syndrome. Methods This pilot pretest/posttest and six-month follow-up clinical study included 15 adult patients with CTS. For two weeks, each patient received 10 sessions of supervised intervention treatment. The efficacy of the therapies was assessed at baseline (T0), immediately after treatment (T1), and six months after treatment (T2). The visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the Boston Carpal Tunnel Questionnaire (BCTQ), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were outcome measures. Results There were significant improvements in all measures between the baseline values at T0 and those recorded immediately after the treatment at T1 or six months later at T2 (p<.05). Conclusion This pilot study indicates that cervical manual therapy plus conventional physical therapy applied for two weeks improves clinical outcomes and electrodiagnostic findings in people with CTS.
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Affiliation(s)
- Milad Zarrin
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran
| | - Maryam Saadat
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Mohammad Jafar Shaterzaedeh Yazdi
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Davood Shalilahmadi
- Department of Neurology, School of Medicine, Imam Khomeini Hospital, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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16
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Vandenberg NW, Stoneback JW, Davis-Wilson H, Christiansen CL, Awad ME, Melton DH, Gaffney BMM. Unilateral transfemoral osseointegrated prostheses improve joint loading during walking. J Biomech 2023; 155:111658. [PMID: 37276681 PMCID: PMC10330663 DOI: 10.1016/j.jbiomech.2023.111658] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.
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Affiliation(s)
- Nicholas W Vandenberg
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Hope Davis-Wilson
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cory L Christiansen
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mohamed E Awad
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Danielle H Melton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States; Center for Bioengineering, University of Colorado Denver, Aurora, CO, United States.
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17
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Teepe GW, Kowatsch T, Hans FP, Benning L. Postmarketing Follow-Up of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time-Series and Matched-Pair Analysis. J Med Internet Res 2023; 25:e43775. [PMID: 36848211 PMCID: PMC10012010 DOI: 10.2196/43775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Musculoskeletal conditions are the main drivers of global disease burden and cause significant direct and indirect health care costs. Digital health applications improve the availability of and access to adequate care. The German health care system established a pathway for the approval of "Digitale Gesundheitsanwendungen" (DiGAs; Digital Health Applications) as collectively funded medical services through the "Digitale-Versorgung-Gesetz" (Digital Health Care Act) in 2019. OBJECTIVE This article presents real-world prescription data collected through the smartphone-based home exercise program "Vivira," a fully approved DiGA, regarding its effect on self-reported pain intensity and physical inability in patients with unspecific and degenerative pain in the back, hip, and knee. METHODS This study included 3629 patients (71.8% [2607/3629] female; mean age 47 years, SD 14.2 years). The primary outcome was the self-reported pain score, which was assessed with a verbal numerical rating scale. The secondary outcomes were self-reported function scores. To analyze the primary outcome, we used a 2-sided Skillings-Mack test. For function scores, a time analysis was not feasible; therefore, we calculated matched pairs using the Wilcoxon signed-rank test. RESULTS Our results showed significant reductions in self-reported pain intensity after 2, 4, 8, and 12 weeks in the Skillings-Mack test (T3628=5308; P<.001). The changes were within the range of a clinically relevant improvement. Function scores showed a generally positive yet more variable response across the pain areas (back, hip, and knee). CONCLUSIONS This study presents postmarketing observational data from one of the first DiGAs for unspecific and degenerative musculoskeletal pain. We noted significant improvements in self-reported pain intensity throughout the observation period of 12 weeks, which reached clinical relevance. Additionally, we identified a complex response pattern of the function scores assessed. Lastly, we highlighted the challenges of relevant attrition at follow-up and the potential opportunities for evaluating digital health applications. Although our findings do not have confirmatory power, they illustrate the potential benefits of digital health applications to improve the availability of and access to medical care. TRIAL REGISTRATION German Clinical Trials Register DRKS00024051; https://drks.de/search/en/trial/DRKS00024051.
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Affiliation(s)
| | - Tobias Kowatsch
- Centre for Digital Health Intervention, ETH Zürich, Zürich, Switzerland.,Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland.,School of Medicine, University of St. Gallen, St.Gallen, Switzerland
| | - Felix Patricius Hans
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Vivira Health Lab GmbH, Berlin, Germany
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18
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Young JL, Sell TC, Boeth R, Foster K, Greenlee TA, Rhon DI. What is the Incidence of Subsequent Adjacent Joint Injury After Patellofemoral Pain? Clin Rehabil 2023:2692155231157177. [PMID: 36793225 DOI: 10.1177/02692155231157177] [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: 02/17/2023]
Abstract
OBJECTIVE To investigate the incidence of subsequent lumbar spine, hip, and ankle-foot injuries after a diagnosis of patellofemoral pain. DESIGN Retrospective cohort study. SETTING Military Health System. PARTICIPANTS Individuals (n = 92,319) ages 17-60 diagnosed with patellofemoral pain between 2010-2011. INTERVENTIONS Therapeutic exercise. MAIN OUTCOME MEASURES Frequency of adjacent joint injuries in the 2-year period after initial patellofemoral pain injury, and hazard ratios (HR) with 95% confidence interval (CI) and Kaplan-Meier survival curves for risk of adjacent joint injury based on receiving therapeutic exercise for the initial injury. RESULTS After initial patellofemoral pain diagnosis, 42,983 (46.6%) individuals sought care for an adjacent joint injury. Of these, 19,587 (21.2%) were subsequently diagnosed with a lumbar injury, 2837 (3.1%) a hip injury, and 10,166 (11.0%) an ankle-foot injury. One in five (19.5%; n = 17,966) received therapeutic exercise which reduced the risk of having a subsequent lumbar (HR = 0.78, 95% CI 0.76-0.81), hip (HR = 0.93, 95% CI 0.87-0.98) or ankle-foot (HR = 0.86, 95% CI 0.83-0.90) injury. CONCLUSION The results suggest that a high number of individuals with patellofemoral pain will sustain an adjacent joint injury within 2 years although causal relationships cannot be determined. Receiving therapeutic exercise for the initial knee injury reduced the risk of sustaining an adjacent joint injury. This study helps provide normative data for subsequent injury rates in this population and guide development of future studies designed to understand causal factors.
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Affiliation(s)
- Jodi L Young
- 15638Physical Therapy Department, Bellin College, Green Bay, WI, USA.,104849The Geneva Foundation, Tacoma, WA, USA
| | - Timothy C Sell
- 2351Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Riley Boeth
- 104849The Geneva Foundation, Tacoma, WA, USA
| | - Kaitlyn Foster
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA
| | - Tina A Greenlee
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA
| | - Daniel I Rhon
- 104849The Geneva Foundation, Tacoma, WA, USA.,Department of Rehabilitation Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA.,Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Aghi A, Salvagnini D, Berton G, Cecconi M, Della Valle E, Spera R, Mambelli M, Palermi S, Neunhaeuserer D, Vecchiato M. Selective Functional Movement Assessment (SFMA) Reliability and Proposal of Its Use in Sports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2032. [PMID: 36767405 PMCID: PMC9915240 DOI: 10.3390/ijerph20032032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The Selective Functional Movement Assessment (SFMA) is a functional movement assessment method to observe movement restrictions in individuals with known musculoskeletal disorders, although it has also been used to evaluate healthy athletes of different sports. AIM The present paper aimed to evaluate the applicability of SFMA in a clinical setting and to verify whether a student can correctly perform it. METHODS An introductory and explanatory email was sent to the subjects, containing the instructions needed to produce a video with SFMA evaluation movements. SFMA methodology was then used to analyze the received videos. The results between interobserver and intraobserver agreement were compared to the literature, considered the gold standard methods. RESULTS Twenty-eight subjects (17.71 ± 1.96 years aged) were rated. The functional non-painful scenario (FN) has been assigned more frequently by all raters. The student's intra-rater reliability proved to be moderate (Kappa coefficient 0.49). Results for inter-rater reliability showed that the reliability degree between the senior physiotherapist and student before and after their educational path is good (Kappa coefficient 0.60 and 0.62, respectively). CONCLUSIONS The results of this study showed SFMA intra-rater reliability to be moderate, while inter-rater reliability can be considered good. These characteristics make it a valuable tool for sport's needs, even when used by students.
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Affiliation(s)
- Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
- Rehabilitation Center “Fisioterapia Raimondi di Giovanni e Daniele”, 35030 Selvazzano Dentro-Padova, Italy
| | | | - Giovanni Berton
- Rehabilitation Center “Fisioterapia Raimondi di Giovanni e Daniele”, 35030 Selvazzano Dentro-Padova, Italy
| | - Mattia Cecconi
- Rehabilitation Center “Fisiomedic”, Oriago, 30034 Venice, Italy
| | | | - Rocco Spera
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Mambelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
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20
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Carnegie DR, Zehr JD, Howarth SJ, Beach TAC. Kinematic adaptations to restricting spine motion during symmetrical lifting. J Electromyogr Kinesiol 2022; 67:102716. [PMID: 36274440 DOI: 10.1016/j.jelekin.2022.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
When lifting an object from the ground a person has many possible whole-body movement solutions to accomplish the task. It is unclear why lifters use most of their available lumbar spine flexion range-of-motion despite many ergonomic guidelines advising against doing so. Experimentally restricting spine motion and observing compensatory movement strategies is one approach to address this knowledge gap. A kinematic analysis was performed on 16 participants who completed symmetrical lifting tasks with and without wearing a spine motion-restricting device. Sagittal trunk, lumbar spine, and lower extremity kinematics, along with stance width and foot orientation in the transverse plane were evaluated between restricted and unrestricted lifting conditions. Restricting spine motion required greater ankle dorsiflexion (p < 0.001), knee flexion (p < 0.001), and hip flexion (p < 0.001) motion in comparison to unrestricted lifting. Motion was reallocated such that hip flexion showed the largest increase in restricted lifting, followed by ankle dorsiflexion, then knee flexion compared to unrestricted lifting. Trunk inclination decreased (i.e., more upright) in restricted compared to unrestricted lifting (p < 0.001). Neither stance width (p = 0.163) nor foot orientation (p = 0.228) were affected by restricting spine motion. These adaptive movements observed indicate lower extremity joint motion must be available and controlled to minimize lumbar spine flexion during lifting.
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Affiliation(s)
- Danielle R Carnegie
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Jackie D Zehr
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tyson A C Beach
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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Piraino AB, Davis BM. The Management of Valgus Extension Overload Syndrome Experienced with Hitting in a High School Baseball Player: A Case Report. Int J Sports Phys Ther 2022; 17:1156-1169. [PMID: 36237658 PMCID: PMC9528722 DOI: 10.26603/001c.38168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background Valgus extension overload syndrome (VEOS) of the elbow is a condition associated with overhead athletes. However, the non-surgical management of these individuals is not well documented. Purpose To discuss the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting. Case Description A 15-year-old right-handed high school baseball catcher presented with a six-month history of right-sided ulnar elbow pain. Elbow MRI w/ contrast was consistent with VEOS. The initial examination demonstrated excessive resting right-sided humeral external rotation compared to his left. Valgus stress testing in the subject's hitting position reproduced symptoms, which were alleviated with retest while correcting excessive humeral external rotation. Weakness of the humeral internal rotators and stiffness/shortness of the posterior shoulder were found and thought to relate to the humeral contribution to his elbow movement dysfunction. Rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting. Outcomes After five weeks of physical therapy, the subject returned to soft toss hitting at approximately 75% velocity for the first time since symptom onset, without pain. At seven months after discharge, a phone conversation confirmed that the subject had returned to baseball without limitations. Discussion Despite the concept of 'regional interdependence', common proximal impairments are often assumed to contribute to elbow pain without a clear biomechanical rationale. Future research demonstrating the specific biomechanical effects of the shoulder on the elbow is needed, in addition to more accessible examination strategies to assess their relationship. Level of Evidence 5.
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Affiliation(s)
- Andrew B Piraino
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA; University of Southern California Division of Biokinesiology and Physical Therapy, Los Angeles, CA, USA
| | - Brent M Davis
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA
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Vijayalakshmi T, Subramanian SK, Dharmalingam A, Itagi AB, M SV, Loganathan S. A short term evaluation of scapular upper brace on posture and its influence on cognition and behavior among adult students. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Belcher J, Richards D. Effect of rehabilitative exercise and spinal manipulative therapy on veteran with chronic diffuse spine pain. J Bodyw Mov Ther 2022; 32:43-45. [DOI: 10.1016/j.jbmt.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/16/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022]
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Sheldon A, Karas S. Adverse events associated with manual therapy of peripheral joints: A scoping review. J Bodyw Mov Ther 2022; 31:159-163. [DOI: 10.1016/j.jbmt.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
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Requejo-Salinas N, Lewis J, Michener LA, La Touche R, Fernández-Matías R, Tercero-Lucas J, Camargo PR, Bateman M, Struyf F, Roy JS, Jaggi A, Uhl T, Bisset L, Wassinger CA, Donatelli R, Haik MN, Lluch-Girbés E. International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study. Braz J Phys Ther 2022; 26:100395. [PMID: 35366589 DOI: 10.1016/j.bjpt.2022.100395] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, United States
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain; Neuroscience and Craniofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; Research Institute of Physical Therapy and Pain, University of Alcala, Alcala de Henares, Madrid, Spain.
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marcus Bateman
- Derby Shoulder Unit, Orthopaedic Outpatient Department, Royal Derby Hospital, Derby, United Kingdom
| | - Filip Struyf
- Department Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, London Borough of Harrow, London, United Kingdom
| | - Timothy Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, United States
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, South East Queensland, Australia
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, United States
| | | | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, University of Valencia, Valencia, Spain
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Schenk R, Donaldson M, Parent-Nichols J, Wilhelm M, Wright A, Cleland JA. Effectiveness of cervicothoracic and thoracic manual physical therapy in managing upper quarter disorders - a systematic review. J Man Manip Ther 2022; 30:46-55. [PMID: 34252013 PMCID: PMC8865095 DOI: 10.1080/10669817.2021.1923313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY DESIGN Systematic review. BACKGROUND Physical therapists often use cervicothoracic and thoracic manual techniques to treat musculoskeletal disorders of the upper quarter ,however, the overall effectiveness of this approach remains to be elucidated. OBJECTIVE This systematic review explored studies that examined the short- and long-term effectiveness of manual physical therapy directed at the cervicothoracic and thoracic region in the management of upper quarter musculoskeletal conditions. METHODS The electronic databases MEDLINE, AMED, CINAHL, and Embase were searched from their inception through 30 October 2020. Eligible clinical trials included those where human subjects treated with cervicothoracic and/or thoracic manual procedures were compared with a control group or other interventions. The methodological quality of individual studies was assessed using the PEDro scale. RESULTS The initial search returned 950 individual articles. After the screening of titles and abstracts, full texts were reviewed by two authors, with 14 articles determined to be eligible for inclusion. PEDro scores ranged from 66 to 10 (out of a maximum score of 10). In the immediate to 52-week follow-up period, studies provided limited evidence that cervicothoracic and thoracic manual physical therapy may reduce pain and improve function when compared to control/sham or other treatments. CONCLUSIONS Evidence provides some support for the short-termeffectiveness of cervicothoracic and thoracic manual physical therapy in reducing pain and improving function in people experiencing upper quarter musculoskeletal disorders. Evidence is lacking for long-term effectiveness as only two studies explored outcomes beyond 26 weeks and this was for patient-perceived improvement. PROSPERO ID CRD42020219456.
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Affiliation(s)
- Ronald Schenk
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
| | - Megan Donaldson
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
| | - Jennifer Parent-Nichols
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
| | - Mark Wilhelm
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
| | - Alexis Wright
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
| | - Joshua A. Cleland
- Department of Public Health and Community Medicine, Program in Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
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Singh T, Kumar P. Pelvic pain in Maigne’s syndrome—a multi-segmental approach. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-021-00062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Maigne’s syndrome is a poorly understood condition that affects the thoracolumbar junction. The symptoms can range from pain in the low back, pelvis, hip, lower abdomen, and groin. These symptoms can have bio-mechanical and neurophysiological attributions due to the complexity of spinal mechanics. Thoraco-lumbar junction (T12-L1) is a transitional zone with a higher degree of mean angular motion and a mean translation motion than T10-T11 and T11-T12. This higher degree of translational and rotation mobility predisposes these segments to a higher degree of stress, making them more prone to biomechanical faults such as dysfunctions and positional faults. These altered static and dynamic mechanics can create a cascade of problems along the biomechanical chain. The co-existence of thoracolumbar junction problems with pelvic pain and dysfunctions strengthens the idea of regional interdependence.
Case presentation
The patient is a 44-year-old Caucasian male who reported pain in the low back with symptoms radiating to the right hip, iliac region, lower abdomen, and gluteal region. The patient tested positive for Sacroiliac joint dysfunction with both Laslett’s cluster testing and palpatory sacroiliac examination. In addition, the segmental examination showed restriction in thoracolumbar junction with positive skin rolling test and hypomobility in manual segmental testing. Thus, the manual therapy treatment targeted the thoracolumbar junction and sacroiliac joint to address the underlying biomechanical dysfunctions.
Conclusions
The manual therapy targeting both sacroiliac and thoracolumbar spine can improve pelvic and thoracic spine mobility. In addition, therapeutic exercises can focus on enhancing anterior and posterior chain force generation capacity. This combined approach helped improve functional outcomes with a significant decrease in the Modified Oswestry Disability index and significant improvement on Visual analog scale.
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Effect of Age on Thoracic, Lumbar, and Pelvis Coordination During Trunk Flexion and Extension. J Appl Biomech 2022; 38:170-178. [DOI: 10.1123/jab.2021-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/11/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate normative and age-related differences in trunk and pelvis kinematics and intersegmental coordination during sagittal plane flexion–extension. Trunk and pelvis kinematics were recorded while 76 participants performed a maximal range of motion task in the sagittal plane. Cross-correlation was calculated to determine the phase lag between adjacent segment motion, and coupling angles were calculated using vector coding and classified into one of 4 coordination patterns: in-phase, antiphase, superior, and inferior phase. A 2-way mixed-model multivariate analysis of variance was used to compare lumbar spine and pelvis angular kinematics, phase lags, and cross-correlation coefficients between groups. Young participants exhibited greater trunk range of motion compared with middle-aged participants. The lumbar spine and pelvis were predominantly rotating with minimum phase lag during flexion and extension movement for both age groups, and differences in coordination between the groups were seen during hyperextension and return to upright position. In conclusion, middle-aged adults displayed lower range of motion but maintained similar movement patterns to young adults, which could be attributed to protective mechanisms. Healthy lumbar and pelvis movement patterns are important to understand and need to be quantified as a baseline, which can be used to develop rehabilitation protocols for individuals with spinal ailments.
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Lehr ME, Fink ML, Ulrich E, Butler RJ. Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes. J Bodyw Mov Ther 2022; 29:206-214. [DOI: 10.1016/j.jbmt.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/23/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022]
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Concurrent musculoskeletal complaints in elbows, shoulders, and necks after common hand and forearm injuries or conditions: A cross-sectional study among 600 patients. J Hand Ther 2021; 34:543-548. [PMID: 32893097 DOI: 10.1016/j.jht.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 05/02/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional study among 600 patients. INTRODUCTION Isolated hand and forearm injuries or conditions are common in the emergency and orthopedic departments. So far, little is known about whether these patients suffer from concurrent musculoskeletal complaints (MSCs) besides their hand and forearm complaints. Neglecting concurrent MSCs in the upper limbs and necks could hamper rehabilitation and prolong the time taken to return to daily and work-related activities. PURPOSE OF THE STUDY The purpose of this study was to investigate the prevalence of concurrent MSCs in the elbow, shoulder, and neck after common hand and/or forearm injuries or conditions. METHODS This study included 600 patients with any type of diagnosis referred to rehabilitation after hand and/or forearm injuries or conditions. Basic characteristics, diagnoses, and location of patients' symptoms were collected and analyzed. RESULTS The overall prevalence of concurrent MSCs was 40%. Twenty-eight percent of the whole sample developed concurrent MSCs after the hand and forearm injury or condition. The gender distribution was 68% women and 32% men. The most common location for complaints was the shoulder (62%), followed by the elbow (49%), and the neck (32%). DISCUSSION The present results suggest that MSCs from the elbows, shoulders, or necks are very common in patients with hand and/or forearm injuries or conditions. CONCLUSION Clinicians treating patients with isolated hand and forearm injuries or conditions should be aware of the high prevalence of concurrent MSCs. Future research should investigate if specific rehabilitation, focusing on concurrent MSCs, may influence the outcome in this population.
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Trunk muscle size and function in volleyball players with and without injuries to the head, neck and upper limb. Phys Ther Sport 2021; 54:1-7. [PMID: 34922033 DOI: 10.1016/j.ptsp.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate trunk muscle size and function in elite and community volleyball players with and without a history of head, neck or upper limb injury. DESIGN Cross-sectional observational study. SETTING Volleyball training camp or training sessions. PARTICIPANTS 86 volleyball players (elite = 29; community = 57). MAIN OUTCOME MEASURES Information regarding history of head, neck or upper limb injuries was collected by self-report questionnaires. Trunk muscle size (multifidus, transversus abdominis, internal oblique and quadratus lumborum) and voluntary contraction (multifidus, transversus abdominis, internal oblique) were assessed using ultrasound imaging. RESULTS For trunk muscle size, no significant differences were found between elite and community volleyball players with and without a history of injury (all p > 0.05). A significant difference was found for voluntary contraction of the multifidus and transversus abdominis muscles for elite and community volleyball players with and without a history of injury (all p < 0.05). CONCLUSION A difference in trunk muscle contraction but no change in trunk muscle size in players with a history of head, neck or upper limb injuries may represent an altered muscle recruitment pattern rather than a deficiency in trunk muscle strength. Prospective studies are required to determine if these adaptations are compensatory (and protective) or predispose players to further injuries.
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Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial. Turk J Phys Med Rehabil 2021; 67:291-299. [PMID: 34870115 PMCID: PMC8606989 DOI: 10.5606/tftrd.2021.6397] [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: 04/18/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives
This study aims to investigate how exercise programs not directly applied to the cervical spine affect office workers with forward head posture (FHP).
Patients and methods
Between March 2018 and June 2018, a total of 32 office workers with FHP (13 males, 19 females; mean age 36.63 years; range, 23 to 57 years) were randomized either to experimental (n=16) or control groups (n=16). Scapular stabilization and thoracic extension exercises were applied to the experimental group and cervical stabilization and stretching exercises to the control group. The results of the pre-intervention and after six weeks measurement of the craniovertebral angle (CVA), respiration, pain, and disability were compared and analyzed.
Results
For intra-group comparison, both groups showed significant differences (p<0.05) in CVA, forced expiratory volume at 1 sec (FEV1), Visual Analog Scale (VAS), and neck disability index at pre- and post-intervention, while only the experimental group showed a significant difference (p<0.05) in maximum inspiratory pressure, maximum expiratory pressure, and forced vital capacity. For inter-group comparison, a significant difference (p<0.05) between FEV1 and VAS was observed.
Conclusion
The combination of scapular stabilization and thoracic extension exercises, not directly applied to the cervical spine, has an effect on improving the posture, respiration, neck pain, and disability in office workers with FHP.
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Closed chain dorsiflexion and the regional interdependence implications on fundamental movement patterns in collegiate athletes. Foot (Edinb) 2021; 49:101835. [PMID: 34417100 DOI: 10.1016/j.foot.2021.101835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE An association between limited ankle closed kinetic chain dorsiflexion range of motion (CKCDFROM) and movement dysfunction in the lower quarter is often implied, limited research exists linking CKCDFROM and gross movement patterns, such as the squatting. The purpose of this study is to investigate the association between CKCDFROM and movement patterns in collegiate athletes, as measured by the functional movement screen (FMS). MATERIALS AND METHODS A quasi-experimental observational analytical cohort study with 147 athletes from five Division III collegiate men's and women's athletic teams were included in the study. CKCDFROM was assessed utilizing the lunge test. Movement patterns, specifically the deep squat (DS) and inline lunge (ILL) were assessed utilizing the FMS qualitative criteria. Descriptive statistical analysis examined the association between CKCDFROM limitations and a dysfunctional deep squat or ILL. RESULTS Seventy-nine (53.7%) and 30 (20.4%) participants scored a "1" on their FMS deep squat test and ILL, respectively. Participants who scored a "1" on the deep squat and ILL were 3.75 times as likely (3.75 odds ratio; 95% CI 1.57-9.14; p = 0.002) and 1.53 times as likely (1.53 odds ratio; 95% CI 0.65-3.60; p = 0.392), respectively, to have at least one ankle CKCDFROM limitation. The deep squat (DS) was statistically significant, but the ILL did not rise to the level of significance. DISCUSSION Physical therapists should consider regional interdependence implications of movement dysfunction stemming from impairments within the kinetic chain. CONCLUSION A dysfunctional lower extremity movement pattern might be associated with a lack of CKCDFROM. Clinicians will likely benefit from assessing CKCDFROM in those exhibiting dysfunctional squatting and/or lunging.
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Matsel KA, Brown SN, Hoch MC, Butler RJ, Westgate PM, Malone TR, Uhl TL. The Intra- and Inter-rater Reliability of an Arm Care Screening Tool in High School Baseball Coaches. Int J Sports Phys Ther 2021; 16:1532-1540. [PMID: 34909258 PMCID: PMC8637259 DOI: 10.26603/001c.29680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players. PURPOSE To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches. STUDY DESIGN Methodological intra- and inter-rater reliability study. METHODS Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement. RESULTS Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05). CONCLUSIONS High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training. LEVEL OF EVIDENCE Level 3, Reliability study.
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Alcaraz-Clariana S, García-Luque L, Garrido-Castro JL, Aranda-Valera IC, Ladehesa-Pineda L, Puche-Larrubia MÁ, Carmona-Pérez C, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Paravertebral Muscle Mechanical Properties in Patients with Axial Spondyloarthritis or Low Back Pain: A Case-Control Study. Diagnostics (Basel) 2021; 11:1898. [PMID: 34679595 PMCID: PMC8535094 DOI: 10.3390/diagnostics11101898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 12/29/2022] Open
Abstract
Different musculoskeletal disorders are a source of pain in the spinal region; most of them can be divided into mechanical, such as low back pain (LBP), or inflammatory origins, as is the case of axial spondyloarthritis (axSpA). Nevertheless, insufficient information is available about the muscle negative consequences of these conditions. Thus, the objective of this study was to identify whether mechanical muscle properties (MMPs) of cervical and lumbar muscles are different between patients with axSpA, subacute LBP (sLBP), and healthy controls. Furthermore, we aimed identify whether MMPs were related to sociodemographic and clinical variables in various study groups. The MMPs, sociodemographic, and clinical variables were obtained in 43 patients with axSpA, 43 subjects with sLBP, and 43 healthy controls. One-way ANOVAs and ROC curves were applied to identify whether the MMPs could differentiate between the study groups. Intra-group Pearson r coefficients to test the associations between MMPs and the rest of the variables were calculated. The results showed that axSpA subjects have a higher tone and stiffness and a lower relaxation and creep than sLBP and healthy ones (p < 0.05). All lumbar and cervical MMPs, except for decrement, could correctly classify axSpA and healthy subjects and axSpA and sLBP patients (in both cases, Area Under the Curve > 0.8). However, no MMP could differentiate between sLBP and healthy subjects. Each group had a different pattern of bivariate correlations between MMPs and sociodemographic and clinical data, with a worse state and progression of the axSpA group associated with a higher tone and stiffness in both spinal regions. This study supports that MMPs are different and show different patterns of correlations depending on the type of spinal pain.
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Affiliation(s)
- Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.); (C.C.-P.); (F.A.-S.)
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.); (C.C.-P.); (F.A.-S.)
| | - Juan Luis Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Cordoba, 14071 Cordoba, Spain;
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (I.C.A.-V.); (L.L.-P.); (M.Á.P.-L.)
| | - I. Concepción Aranda-Valera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (I.C.A.-V.); (L.L.-P.); (M.Á.P.-L.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (I.C.A.-V.); (L.L.-P.); (M.Á.P.-L.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - María Ángeles Puche-Larrubia
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (I.C.A.-V.); (L.L.-P.); (M.Á.P.-L.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.); (C.C.-P.); (F.A.-S.)
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.); (C.C.-P.); (F.A.-S.)
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.); (C.C.-P.); (F.A.-S.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (I.C.A.-V.); (L.L.-P.); (M.Á.P.-L.)
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Mendes-Fernandes T, Puente-González AS, Márquez-Vera MA, Vila-Chã C, Méndez-Sánchez R. Effects of Global Postural Reeducation versus Specific Therapeutic Neck Exercises on Pain, Disability, Postural Control, and Neuromuscular Efficiency in Women with Chronic Nonspecific Neck Pain: Study Protocol for a Randomized, Parallel, Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010704. [PMID: 34682453 PMCID: PMC8535440 DOI: 10.3390/ijerph182010704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background: Chronic nonspecific neck pain is the most frequent form of neck pain. It is more prevalent in women, and a costly public health issue. It is commonly associated with biomechanical, functional, proprioceptive, and postural impairments. The aim of this trial is to compare the effects of global postural exercises versus specific therapeutic exercises on neck pain, disability, mobility, pressure pain threshold, kinesiophobia, pain catastrophizing, postural control, and neuromuscular efficiency in women with chronic nonspecific neck pain. Methods and analysis: This study is a randomized, parallel-group and single blinded clinical trial. Sixty-two women with nonspecific chronic neck pain were recruited from the community of Guarda, Portugal, and randomly assigned to one of two intervention groups: (1) global postural reeducation (GPR group), (2) specific therapeutic exercises (STE group). The intervention was carried out over 4 weeks, with two sessions per week (eight sessions), and applied by a physiotherapist and paired with a daily individual at-home-exercise program. Primary outcomes are neck pain intensity and disability (Numerical Pain Rating Scale, Neck Disability Index). Secondary outcomes are cervical mobility and pressure pain threshold (CROM, algometry), attitude to pain (kinesiophobia, pain catastrophizing), standing postural control (Center of Pressure (COP) displacements), and neuromuscular efficiency (electromyography). There are four points of evaluation where the outcomes were assessed twice before the intervention, 1 week apart, and the two post-intervention assessments will be carried out after four and eight sessions. The objective was to increase scientific knowledge of different exercise modalities, such as global postural reeducation, in musculoskeletal disorders. Trial registration: ClínicalTrials.gov (NCT04402463), prospectively registered (data 22 May 2020).
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Affiliation(s)
- Tânia Mendes-Fernandes
- Centro EMA, 6300-537 Guarda, Portugal;
- Doctoral Programme in Health, Disability, Dependency and Welfare, University of Salamanca, 37007 Salamanca, Spain;
| | - Ana Silvia Puente-González
- Department of Nursing and Physical Therapy, University of Salamanca, C/Donante de Sangre s/n, 37007 Salamanca, Spain;
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Manuel Antonio Márquez-Vera
- Doctoral Programme in Health, Disability, Dependency and Welfare, University of Salamanca, 37007 Salamanca, Spain;
- Department of Nursing and Physical Therapy, University of Salamanca, C/Donante de Sangre s/n, 37007 Salamanca, Spain;
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Physiotherapy Unit, Universitary Hospital of Salamanca, 37007 Salamanca, Spain
| | - Carolina Vila-Chã
- Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal;
- Research Center in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physical Therapy, University of Salamanca, C/Donante de Sangre s/n, 37007 Salamanca, Spain;
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Correspondence:
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McDevitt AW, Cleland JA, Rhon DI, Altic RAK, Courtney DJ, Glynn PE, Mintken PE. Thoracic spine thrust manipulation for individuals with cervicogenic headache: a crossover randomized clinical trial. J Man Manip Ther 2021; 30:78-95. [PMID: 34269160 DOI: 10.1080/10669817.2021.1947663] [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: 10/20/2022] Open
Abstract
Objective: To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH).Methods: A randomized controlled crossover trial was conducted on 48 participants (mean age: 34.4 years) with CeH symptoms. Participants were randomized to 6 sessions of TSM or no treatment (Hold) and after 4-weeks, groups crossed over. Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). Outcomes were analyzed using a linear mixed-effects model with Bonferroni correction. Odds of achieving the minimal clinically important difference (MCID) on the GRC of +4 or greater were also calculated. Scores at 4 weeks represent the only timepoint where 1 group is fully treated and other group has not received any treatment.Results: Comparing hold to active treatment, HDI were not significantly different between groups (mean difference = 7.39, 95 CI: -4.39 to 19.18; P = 0.214) at any timepoint; the NDI was significant (mean difference = 6.90, 95 CI: 0.05 to 13.75; P = 0.048) at 4 weeks. Odds of achieving the +4 MCID on the GRC (OR = 38.0, 95 CI: 6.6 to 220.0; p < 0.001) favored TSM at 4 weeks.Conclusion: TSM had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Future studies are needed to examine the long-term impact of TSM in this population.
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Affiliation(s)
- Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Rebecca A K Altic
- CU Sports Physical Therapy and Rehabilitation, University of Colorado Health, Denver, Colorado, USA
| | - Drew J Courtney
- DBS Fitness San Diego Physical Therapy, San Diego, California, USA
| | - Paul E Glynn
- Glynn Physical Therapy, Lexington, Massachusetts, USA
| | - Paul E Mintken
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Clark NG, Hill CJ, Koppenhaver SL, Massie T, Cleland JA. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskelet Sci Pract 2021; 53:102366. [PMID: 33831698 DOI: 10.1016/j.msksp.2021.102366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dry needling (DN) has been consistently shown to decrease pain sensitivity and increase flexibility local to the site of treatment, however it is unclear whether these effects are limited to the region of treatment or can be observed remote to the area of treatment. OBJECTIVE To determine the immediate, short-term effects of DN to the thoracolumbar junction on regional and remote flexibility, and to observe if changes in pain sensitivity can occur remote to site of treatment. DESIGN Double-blind randomized clinical trial. METHODS Fifty-four subjects with low back pain and decreased length in at least one hamstring were randomized to receive either DN or sham DN to the T12 and L1 multifidi. Participants underwent regional (fingertip-to-floor) and remote flexibility (passive knee extension, passive straight leg raise) and pressure pain threshold (PPT) testing of the upper and lower extremity before, immediately after and 1 day after treatment. ANCOVAs were used to analyze flexibility data, with the covariate of pre-treatment values. Paired t-tests were used for difference in remote pain sensitivity. RESULTS Statistically larger improvements in regional flexibility, but not remote flexibility, were observed immediately post-treatment in those who received DN than in those receiving sham DN (p = .0495; adjusted difference 1.2, 95% CI 0.002-2.3). Differences between upper and lower extremity PPT were not significant. CONCLUSION DN can potentially have immediate changes in regional flexibility, but effects are not sustained at 24-h follow-up. DN may not affect remote flexibility or segmental pain sensitivity.
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Affiliation(s)
- Nicole G Clark
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Cheryl J Hill
- Doctor of Physical Therapy Program, Dr. Pallavi Patel College of Healthcare Sciences, Nova Southeastern University, 3200 South University, Dr. Ft. Lauderdale, FL, 33328, USA.
| | - Shane L Koppenhaver
- Baylor University, Doctoral Program in Physical Therapy, 1 Bear Place #97264, Waco, TX, 76798, USA.
| | - Thomas Massie
- Stefani Doctor of Physical Therapy Program, University of Saint Mary, 4100 South 4th St, Leavenworth, KS, 66048, USA.
| | - Joshua A Cleland
- Director of Research and Faculty Development, Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
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Movement patterns and neuromusculoskeletal impairments observed in a female Olympic Field Hockey team: An observational cohort study. J Bodyw Mov Ther 2021; 26:128-133. [PMID: 33992233 DOI: 10.1016/j.jbmt.2020.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of the cross-sectional observational cohort study was to quantify movement patterns and neuromuscular impairments in Olympic Female Field Hockey utilizing a standardized movement-centered assessment model. METHODOLOGY/SAMPLE A sample of convenience was obtained from the active roster of the 2016 USA Women's Olympic Field Hockey team. Inclusion and exclusion criteria were applied and resulted in nine participants. The study was conducted over 1 session in which each athlete was tested using the SFMA™, Y Balance Test Lower Quarter (YBT-LQ™) FMS™, and closed chain dorsiflexion range of motion (CKCDFROM). Injury risk assignment was generated based on an evidenced based algorithm. Descriptive statistics and frequency distributions were applied to the subjects. RESULTS Injury risk stratification was applied to the subjects with 44% being at moderate risk and 56% at slight risk. 100% of the athletes exhibited spinal extension deficits and 89% of the athletes displayed a dysfunctional single leg stance pattern. Regional impairments included the following observations: anterior hip mobility deficits (5/9 subjects) and rolling motor control dysfunction (7/9 subjects). IMPLICATIONS A battery of movement centered tests combined with an evidenced based algorithm can provide meaningful information informing future programming for the elite female athlete. Considering regional interdependence applications, impairments at the hip and thoracic spine, combined with poor quality of movement in extension could create undue stress in remote regions of the spine and lower quarter, thus contributing to injury risk for the spine and lower quarter.
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Scafoglieri A, Van den Broeck J, Willems S, Tamminga R, van der Hoeven H, Engelsma Y, Haverkamp S. Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:446. [PMID: 33992100 PMCID: PMC8126114 DOI: 10.1186/s12891-021-04310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients. Methods Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: − 20.2, − 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: − 19.9, − 3.3; ES: − 0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own. This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04310-9.
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Affiliation(s)
- Aldo Scafoglieri
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium. .,SOMT University of Physiotherapy, Softwareweg 5, Amersfoort, BN, 3821, The Netherlands.
| | - Jona Van den Broeck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Experimental Anatomy Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium
| | - Stijn Willems
- Department of Neuroscience, VU University Medical Center, Amsterdam, HV, 1081, The Netherlands
| | - Rob Tamminga
- Fysioholland, Medicort, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | | | - Yde Engelsma
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
| | - Stijn Haverkamp
- Bergman Clinics BV, Rijksweg 69, Naarden, GE, 1411, The Netherlands
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Effects of Manual Therapy on the Diaphragm in the Musculoskeletal System: A Systematic Review. Arch Phys Med Rehabil 2021; 102:2402-2415. [PMID: 33932362 DOI: 10.1016/j.apmr.2021.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 03/23/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults. DATA SOURCES Systematic review using 4 databases: PubMed, Science Direct, Web of Science, and Scopus. STUDY SELECTION AND DATA EXTRACTION Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review. DATA SYNTHESIS Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain. CONCLUSION Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal, and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long-term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.
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Barranco-Trabi J, Mank V, Roberts J, Newman DP. Atypical Costochondritis: Complete Resolution of Symptoms After Rib Manipulation and Soft Tissue Mobilization. Cureus 2021; 13:e14369. [PMID: 33976991 PMCID: PMC8106472 DOI: 10.7759/cureus.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Costochondritis is a self-limiting, poorly described, and benign condition that usually manifests as non-cardiac chest pain. The symptoms usually tend to resolve in a couple of weeks. Serious causes of chest pain should be ruled out prior to diagnosing costochondritis, as it is often a diagnosis of exclusion. Costochondritis that does not self-resolve is referred to as atypical costochondritis and is associated with high medical expenses and psychological burden on the patient. In this report, we discuss the case of a 37-year-old healthy male patient who presented with a two-year history of intermittent pain along the right anterolateral rib cage without any history of trauma. After extensive diagnostic work-up by Cardiology and Gastroenterology, Physical Medicine and Rehabilitation (PM&R) got involved. The initial diagnosis of chest pain evolved into atypical costochondritis given the time course, physical examination findings of focal tenderness, along with normal laboratory values, electrocardiogram, and imaging studies. A multimodal approach was adopted for the treatment of this patient, including manipulative therapy to determine if regional interdependence was present, followed by instrument-assisted soft tissue mobilization (IASTM) and stretching to address the potential myofascial pain generators. After three appointments, there was complete resolution of morning pain and there was no pain upon examination. This case highlights how osteopathic manipulation techniques (OMT) can be useful in the treatment of rib dysfunction, especially in atypical costochondritis. Further studies are required to expand our knowledge of costochondritis and physical therapy (PT) techniques, which would allow for early identification and effective treatment of the condition.
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Affiliation(s)
| | - Victoria Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA
| | - Jefferson Roberts
- Department of Rheumatology, Tripler Army Medical Center, Honolulu, USA
| | - David P Newman
- Pain Management-Physiotherapy, Tripler Army Medical Center, Honolulu, USA
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Gaffney BM, Van Dillen LR, Foody JN, Burnet PE, Clohisy JC, Chen L, Harris MD. Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2021; 84:105335. [PMID: 33812201 PMCID: PMC8845490 DOI: 10.1016/j.clinbiomech.2021.105335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/22/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage. METHODS Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05). FINDINGS During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking. INTERPRETATION Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.
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Affiliation(s)
- Brecca M.M. Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Linda R. Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Paige E. Burnet
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA,Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA,Corresponding author at: Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO 63108, United States. (M.D. Harris)
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Paravertebral Muscle Mechanical Properties and Spinal Range of Motion in Patients with Acute Neck or Low Back Pain: A Case-Control Study. Diagnostics (Basel) 2021; 11:diagnostics11020352. [PMID: 33672470 PMCID: PMC7923441 DOI: 10.3390/diagnostics11020352] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 12/26/2022] Open
Abstract
Our aims were to identify potential differences in muscle mechanical properties (MMPs) of cervical and lumbar tissues and in spinal range of motion (ROM) between patients with acute low back pain (LBP) or acute neck pain (NP) and healthy controls, and to identify if ROMs and MMPs are able to identify subjects among the three groups. Clinical variables (pain, disability, fear of movement, kinesiophobia, quality of life), MMPs and ROMs were obtained in 33 subjects with acute LBP, 33 with acute NP, and 33 healthy control subjects. Between-groups differences and explanatory models to discriminate groups depending on MMPs and ROMs were calculated. The results showed that cervical tone was higher in patients with acute NP than in controls, while cervical decrement was higher in both spinal pain groups. Patients with acute NP showed reduced cervical flexion when compared to acute LBP and control groups, and also cervical rotation, but just against controls. Furthermore, lumbar flexion was reduced in patients with acute LBP when compared to those with acute NP. Cervical decrement was able to discriminate spinal pain individuals from controls in a multinominal regression (R2: Cox–Snell estimation = 0.533; Nagelkerke estimation = 0.600). Lumbar flexion differentiated patients with acute LBP and controls, whereas cervical flexion differentiated patients with acute NP and controls. This study supports a tendency of the affectation of other spinal regions when only one is affected.
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Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
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Scozzafava A, Newman DP, Jacobs AN, Sorge J, Elster EA. A Novel Approach to Assessing and Treating Musculoskeletal-Mediated Atypical Abdominal Pain: A Case Study. Cureus 2020; 12:e12359. [PMID: 33520553 PMCID: PMC7839810 DOI: 10.7759/cureus.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/05/2022] Open
Abstract
Abdominal pain is a common and functionally limiting complaint within the healthcare system linked to impaired quality of life and increased health care utilization. This chief complaint is associated with an extensive differential diagnosis leading to high utilization of diagnostic testing, increased healthcare cost, and delayed access to care. In patients presenting with acute or chronic abdominal pain, musculoskeletal pain often requires expensive testing, thereby delaying definitive care. An improved triage process is warranted. Performing a musculoskeletal examination to determine if pain patterns can be mechanically reproduced at the site of origin, or remote to the site of pain, warrants referral to a musculoskeletal specialist. In our young and healthy population, once the musculoskeletal mediated abdominal pain origin is determined, we see significant success in the application of a treatment approach consisting of manipulative therapy, exercise, and instrument-assisted soft tissue mobilization. A multimodal treatment approach for musculoskeletal-mediated abdominal pain has not been previously described. This case study outlines a novel management approach for musculoskeletal-mediated abdominal pain and provides an alternative diagnostic technique, when implemented early in the evaluation and management process of atypical abdominal pain, that improves the quality of life.
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Affiliation(s)
| | - David P Newman
- Interdisciplinary Pain Management Center, Tripler Army Medical Center, Honolulu, USA
| | - Aimee N Jacobs
- Physical Therapy Department, Tripler Army Medical Center, Honolulu, USA
| | - Joshua Sorge
- Physical Therapy Department, Tripler Army Medical Center, Honolulu, USA
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, USA
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Thoracic thrust joint manipulation: An international survey of current practice and knowledge in IFOMPT member countries. Musculoskelet Sci Pract 2020; 50:102251. [PMID: 32992076 DOI: 10.1016/j.msksp.2020.102251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to a growth in evidence supporting use in practice. Yet adverse events (AE) have been documented following TTJM. Knowledge of current practice is therefore required to support further research. PURPOSE To investigate TTJM knowledge and pre-TTJM examination across IFOMPT Member Organisations (MO) and Registered Interest Groups (RIG). METHODS An e-survey was designed based on existing evidence and piloted. Eligibility criteria: physiotherapists from member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) who use TTJM. Recruitment was through IFOMPT networks (May 2018-March 2019). Data analyses included descriptive analyses and content analysis for free text data. RESULTS Respondents (n = 363) from 20 countries. Pre-TTJM examination included patient history (22%, n = 81) and physical examination (69%, n = 248). Across presentations (>80% threshold of agreement) contraindications included osteomyelitis, fracture and metastatic disease. Spinal deformity, respiratory disease, serious joint disease and hypermobility achieved >60% agreement as precautions. Consent was obtained by 93% respondents (n = 250). Preferred technique was PA/AP thrust (61%, n = 144). Perception of primary effect was neurophysiological (52%, n = 134), biomechanical (42%, n = 109) and placebo (3%, n = 8). From those who reported AE (n = 100), these included fractures (36%, n = 42) and cord signs/symptoms (6%, n = 7). CONCLUSION Pre-TTJM examination is common, although bias towards physical examination. Differential testing for upper versus lower thoracic spine is limited. Inconsistencies across knowledge of contraindications and precautions, and beliefs for biomechanical effect were found. Findings highlight the importance of high levels of clinical reasoning during patient history for TTJM.
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Blackmon AM, Elson L. Dry Needling and Acupuncture in Treatment of Dance-Related Injuries, MD, and PT Perspectives. Phys Med Rehabil Clin N Am 2020; 32:169-183. [PMID: 33198894 DOI: 10.1016/j.pmr.2020.08.005] [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: 10/23/2022]
Abstract
Dancers frequently present to health care professionals with musculoskeletal impairments. The role of the health care practitioner, whether physician, physical therapist, or acupuncturist, is to decrease pain and restore function in the short term and to restore adaptive potential and neural connectivity in the long term. When dysfunction is treated, pain improves. Acupuncture and dry needling improve tissue perfusion by improving vasomotor control and can improve strength by removing motor inhibition. Acupuncture and dry needling are safe, complementary modalities aimed at improving the function of the dancer.
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Affiliation(s)
- Amanda M Blackmon
- Department of Physical Therapy, College of Health Professions, Mercer University, Atlanta, GA, USA; Myopain Seminars, Atlanta Ballet; Atlanta Dance Medicine, Atlanta, GA, USA; MandyDancePT, LLC, Atlanta, GA, USA.
| | - Lauren Elson
- Spaulding Rehabilitation, Boston, MA, USA; Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. https://twitter.com/laurenelsonMD
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50
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Huang L, Liu H, Zhao L, Peng L. The Effect of Exercise Intervention Based Upon the Selective Functional Movement Assessment in an Athlete With Non-specific Low Back Pain: A Case Report and Pilot Study. Front Psychol 2020; 11:2010. [PMID: 32973616 PMCID: PMC7473504 DOI: 10.3389/fpsyg.2020.02010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives To illustrate the effectiveness of the Selective Functional Movement Assessment (SFMA) as a guide to exercise intervention on chronic non-specific low back pain (CNLBP). Methods A 23-year-old male volleyball athlete with CNLBP was evaluated using the SFMA to assess the degree of physical dysfunctions. And then two-stage exercise protocol was designed based on the results of SFMA. The athlete conducted the exercise intervention for 8 weeks, 1 h each time, three times a week. Transverse abdominal muscles and multifidus muscle thickness, the degree of low back pain, and the degree of physical dysfunctions were measured at pre-intervention, midintervention, and post-intervention. Results Based on the results of SFMA, the exercise protocol in the first 4-week session was designed mainly to develop the mobility of ankle, hip, and chest and the stability of lumbar, hip, and knee, in order to improve core strength and gluteal muscle strength. The second 4-week session was an advanced stage with the increase of exercise load on the basis of flexibility and stability; its main purpose was to loosen the hamstring muscles and continue strengthening the core stability and finally help the participant to establish the correct movement pattern and solve the problems of dysfunctions. After 8-week exercise intervention, all movement patterns became functional/non-painful except the deep squat pattern; the Quebec Back Pain Disability Scale score decreased from 11 to 2; visual analog scale score decreased from 4 to 2; the thicknesses of the transverse abdominis muscles (right side: 0.2 vs. 0.31 cm, left side: 0.22 vs. 0.33 cm) and multifidus muscles (right side: 2.09 vs. 2.26 cm, left side: 2.15 vs. 2.29 cm) were both increased. Conclusion In this case, the SFMA helped to recognize problems related to mobility and stability on the hip joint, thoracic spine, and even areas far away from the lumbar spine in an athlete with CNLBP that were not seen with more conventional examination procedures. The improvements of physical function, the increase in deep core muscles thickness, and the released pain after exercise intervention all verified the effectiveness of SFMA to qualitatively analyze movement patterns at examination and to direct subsequent exercise intervention.
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Affiliation(s)
- Li Huang
- College of Physical Education, Southwest University, Chongqing, China
| | - Haowei Liu
- College of Physical Education, Southwest University, Chongqing, China
| | - Li Zhao
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
| | - Li Peng
- College of Physical Education, Southwest University, Chongqing, China.,Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
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