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Louw A, Farrell K, Nielsen A, O’Malley M, Cox T, Puentedura EJ. Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series. J Man Manip Ther 2023; 31:46-52. [PMID: 35739614 PMCID: PMC9848382 DOI: 10.1080/10669817.2022.2092822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach. OBJECTIVES To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain. METHODS A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise. RESULTS Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID). CONCLUSIONS A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.
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Affiliation(s)
- Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Anthony Nielsen
- Department of Physical Therapy, Rock Valley Physical Therapy, Bettendorf, IA, USA
| | - Max O’Malley
- Department of Physical Therapy, AMN Healthcare, Lincolnwood, IL, USA
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, MO, USA
| | - Emilio J. Puentedura
- Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, Waco, TX, USA,CONTACT Emilio J. Puentedura Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, One Bear Place, Waco, TX97303, USA
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O’Neill M, Louw A, Podalak J, Maiers N, Cox T, Zimney K. A Case-Series of Dry Needling as an Immediate Sensory Integration Intervention. J Man Manip Ther 2022; 30:165-171. [PMID: 34898385 PMCID: PMC9255097 DOI: 10.1080/10669817.2021.2011556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) has been associated with altered cortical mapping in the primary somatosensory cortex. Various sensory discrimination treatments have been explored to positively influence CLBP by targeting cortical maps. OBJECTIVES To determine if dry needling (DN) applied to patients with CLBP would yield changes in two-point discrimination (TPD) and left-right judgment (LRJ) tasks for the low back. Secondary measurements of pain and limited range of motion (ROM) was also assessed. METHODS A sample of 15 patients with CLBP were treated with DN to their low back. Prior to and immediately after DN, TPD, LRJ tasks, low back pain, spinal ROM, and straight leg raise (SLR) were measured. RESULTS Following DN, there was a significant (p < 0.005) improvement in LRJ for low back images in all measures, except accuracy for the right side. TPD significantly improved at the L3 segment with a moderate effect size. A significant improvement was found for pain and trunk ROM after DN with a large effect in changing pain of 3.33 points and improving SLR by 9.0 degrees on average, which exceeds the minimal detectable change of 5.7 degrees. CONCLUSIONS This is the first study to explore if DN alters TPD and LRJ tasks in patients with CLBP. Results show an immediate significant positive change in TPD and LRJ tasks, as well as pain ratings and movement.
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Affiliation(s)
- Matt O’Neill
- Department of Physical Therapy Catawba Valley Medical Center, Hickory, NC, USA
| | | | | | - Nicholas Maiers
- Physical Therapy Education, Des Moines University, Des Moines, IA, USA
| | - Terry Cox
- Physical Therapy Education, Southwest Baptist University, Bolivar, MO, USA
| | - Kory Zimney
- School of Health Sciences; Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
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Paolucci T, Agostini F, Mangone M, Torquati A, Scienza S, Sorgi ML, Pellicano GR, Lai C, Bernetti A, Paoloni M. Effects of a motor imagery-based exercise protocol on chronic pain and emotional distress in patients with fibromyalgia syndrome: A pilot study. J Back Musculoskelet Rehabil 2022; 35:403-412. [PMID: 34250931 DOI: 10.3233/bmr-200328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic condition characterized by widespread muscular or musculoskeletal pain of at least 3 months' duration, occurring above and below the waist, on both sides of the body. OBJECTIVE The aim of this study was to evaluate the effectiveness of a rehabilitation program based on motor imagery versus a conventional exercise program in FM in terms of pain, functional and psychological outcomes. METHODS Twenty-nine female subjects were randomly assigned to a group receiving motor imagery-based rehabilitation (MIG) or to a control group (CG) performing conventional rehabilitation. Outcome assessments were performed before (T0) and after 10 sessions of treatment (T1) and at a 12-week follow-up (T2). Pain, function and psychological measurements were conducted by means of different questionnaires. RESULTS Both treatments improved all outcomes at post-treatment (T1) and follow-up (T2). The MIG showed a significant improvement in anxiety disorder associated with FM with respect to the CG, as well as improvements in coping strategies. CONCLUSIONS Rehabilitation treatment based on motor imagery showed a stronger effect on anxiety and coping behavior than traditional physiotherapy in patients with FM. Integrated psychological support would be desirable in this setting. Further research is needed to explore the aspects investigated in more depth.
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Affiliation(s)
- Teresa Paolucci
- Department of Medical Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Torquati
- Department of Neurorehabilitation, MultiMedica IRCCS, Limbiate - Monza-Brianza, Italy
| | - Simona Scienza
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Sorgi
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gaia Romana Pellicano
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
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Outeda LR, Cousiño LAJ, Carrera IDC, Caeiro EML. EFFECT OF THE MAITLAND CONCEPT TECHNIQUES ON LOW BACK PAIN: A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102258429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Low back pain has a prevalence that reaches up to 70% of the population between 35-55 years of age and is the principal cause of occupational disability. The scientific evidence on the effect of manual therapy on low back pain is conflicting and there are no specific reviews on the Maitland concept of manual therapy. Therefore, the objective of this systematic review is to analyze the effect of the techniques of the Maitland concept of manual therapy in patients with low back pain and/or determine the level of scientific evidence.For this, a search was carried out in the Cinahl, Medline, Web of Science, PubMed and Scopus databases during the months of January and February 2021 and it was updated in August 2021. In the search, 894 records were obtained, of which 15 randomized clinical trials that obtained a minimum of 3 points out of 5 on the Jadad scale were included.The main results in the current scientific literature suggest that there is solid evidence that the manipulations and mobilizations described in the Maitland Concept, applied alone or in combination with other interventions, reduce pain and disability in subjects with low back pain.The effects on musculature are contradictory. Exercise and patient education increase the effect of manual therapy. Future research requires analyzing whether the effects are preserved in the long term and more homogeneous treatment protocols are needed to determine a prescriptive guideline for manual therapy. Level of evidence I; Systematic review.
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Beisheim E, Pohlig R, Medina J, Hicks G, Sions J. Body representation among adults with phantom limb pain: Results from a foot identification task. Eur J Pain 2022; 26:255-269. [PMID: 34490685 PMCID: PMC8671232 DOI: 10.1002/ejp.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impaired body representation (i.e. disrupted body awareness or perception) may be a critical, but understudied, factor underlying phantom limb pain (PLP). This cross-sectional study investigated whether adults with lower-limb loss (LLL) and PLP demonstrate impaired body representation as compared to Pain-Free peers with and without LLL. METHODS Participants (n = 41 adults with PLP, n = 27 Pain-Free peers with LLL, n = 39 Controls with intact limbs) completed an online foot identification task. Participants judged whether randomized images depicted left or right feet (i.e. left-right discrimination) as quickly as possible without limb movement. Using two Generalized Estimating Equations, effects of group, image characteristics (i.e. side, foot type, view, angle) and trial block (i.e. 1-4) were evaluated, with task response time and accuracy as dependent variables (a ≤ 0.050). RESULTS Adults with PLP demonstrated slower and less accurate performance as compared to Controls with intact limbs (p = 0.018) but performed similarly to Pain-Free peers with LLL (p = 0.394). Significant three-way interactions of group, view and angle indicated between-group differences were greatest for dorsal-view images, but smaller and angle-dependent for plantar-view images. While all groups demonstrated significant response time improvements across blocks, improvements were greatest among adults with PLP, who also reported significant reductions in pain intensity. CONCLUSIONS Adults with PLP demonstrate body representation impairments as compared to Controls with intact limbs. Body representation impairments, however, may not be unique to PLP, given similar performance between adults with and without PLP following LLL. SIGNIFICANCE Following lower-limb loss, adults with phantom limb pain (PLP) demonstrate impaired body representation as compared to Controls with intact limbs, evidenced by slower response times and reduced accuracy when completing a task requiring mental rotation. Importantly, 80% of participants with pre-task PLP reported reduced pain intensity during the task, providing compelling evidence for future investigations into whether imagery-based, mind-body interventions have positive effects on PLP.
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Affiliation(s)
- E.H. Beisheim
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - R.T. Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower, Newark, DE, 19713, USA
| | - J. Medina
- University of Delaware Department of Psychological and Brain Sciences, 105 The Green, Room 108, Newark, DE, 19716, USA
| | - G.E. Hicks
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - J.M. Sions
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
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Amundsen O, Starcevich C, Frisell EJ, Nordal T, Williams S, Mitchell T, Beales D. Does body scanning through visual imagery improve perception and function in patients after anterior cruciate ligament-reconstruction? An exploratory study. Physiother Theory Pract 2021; 38:1996-2006. [PMID: 33726630 DOI: 10.1080/09593985.2021.1901328] [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: 10/21/2022]
Abstract
Introduction: Many people who have undergone Anterior Cruciate Ligament (ACL)-reconstruction do not return to their pre-injury level, with nonphysical factors recognized as barriers to recovery. Fear of movement has been linked to body schema distortions, and interventions directed at the body schema have shown potential to improve function.Objective: 1) Describe participants' ability to perform a visual imagery intervention (Body Scan); 2) investigate knee perception differences; 3) investigate if Body Scan led to improvements in perceptual differences; and 4) determine if some individuals improved in functional measures following the intervention.Methods: A single-arm intervention study was undertaken in people >12-month post ACL-reconstruction (n = 30). Body Scan was delivered using a standardized script developed for this study. Participants were assessed regarding their capacity to perform the Body Scan, perceptual differences between the knees and how perception changed following the intervention. Functional measures (vertical hop, triple hop, mSEBT, quadriceps strength, and hamstring strength) were taken.Results: 96.7% were able to perform a Body Scan, with 93.1% demonstrating a difference in perception between the knees. Of participants with perceptual differences, 92.5% demonstrated improvement in perception following the intervention. Ten participants had a clinically significant improvement in a functional measure following the intervention.Conclusion: Most participants could perform Body Scanning. The majority perceived perceptual differences between operated and non-operated knees, and reported more symmetric perception following the intervention. One-third of participants also showed improvements in a functional performance measure. Results suggest this intervention may be a helpful adjunct to rehabilitation post ACL-reconstruction, with further research warranted.
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Affiliation(s)
- Olav Amundsen
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Cobie Starcevich
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | | | - Tom Nordal
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Sian Williams
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Tim Mitchell
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
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Araya-Quintanilla F, Gutiérrez-Espinoza H, Jesús Muñoz-Yanez M, Rubio-Oyarzún D, Cavero-Redondo I, Martínez-Vizcaino V, Álvarez-Bueno C. The Short-term Effect of Graded Motor Imagery on the Affective Components of Pain in Subjects with Chronic Shoulder Pain Syndrome: Open-Label Single-Arm Prospective Study. PAIN MEDICINE 2020; 21:2496-2501. [PMID: 32003812 DOI: 10.1093/pm/pnz364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the short-term effect of graded motor imagery (GMI) on the affective components of pain and range of motion in subjects with chronic shoulder pain syndrome. DESIGN Open-label single-arm prospective study. SETTING The Physical Therapy Laboratory, Universidad de las Americas. SUBJECTS One hundred seven patients with chronic shoulder pain syndrome. METHODS The subjects received a six-week GMI program based on laterality training, imagined movements, and mirror therapy. We assessed pain intensity using a visual analog scale (VAS), fear of movement was assessed using the Tampa Scale of Kinesiophobia (TSK), and catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The patient's flexion active range of motion (AROM) was also recorded. RESULTS At the end of treatment, the VAS showed a decrease of 4.2 cm (P < 0.001, Cohen's d = 3.3), TSK showed a decrease of 17.0 points (P < 0.001, Cohen's d = 2.8), catastrophizing showed a decrease of 19.2 points (P < 0.001, Cohen's d = 3.2), and shoulder flexion AROM showed an increment of 30.3º (P < 0.000, Cohen's d = 1.6). CONCLUSIONS We conclude that a short-term GMI program improves the affective components of pain and shoulder flexion AROM in patients with chronic shoulder pain syndrome.
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Affiliation(s)
- Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center CIRES, Universidad de Las Americas, Santiago, Chile.,Faculty of Health Sciences, Universidad SEK, Santiago, Chile
| | - Héctor Gutiérrez-Espinoza
- Rehabilitation and Health Research Center CIRES, Universidad de Las Americas, Santiago, Chile.,Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | - María Jesús Muñoz-Yanez
- Rehabilitation and Health Research Center CIRES, Universidad de Las Americas, Santiago, Chile
| | - David Rubio-Oyarzún
- Rehabilitation and Health Research Center CIRES, Universidad de Las Americas, Santiago, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Vicente Martínez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Faculty of Health Sciences, Universidad Autonoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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Salik Sengul Y, Kaya N, Yalcinkaya G, Kirmizi M, Kalemci O. The effects of the addition of motor imagery to home exercises on pain, disability and psychosocial parameters in patients undergoing lumbar spinal surgery: A randomized controlled trial. Explore (NY) 2020; 17:334-339. [PMID: 32147444 DOI: 10.1016/j.explore.2020.02.001] [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: 11/12/2019] [Revised: 12/26/2019] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Patients who have suffered from persistent symptoms often undergo lumbar spinal surgery (LSS). Motor imagery should be added to postoperative home exercises to reduce patient complaints. OBJECTIVE The aim of this study was to compare the effects of home exercise plus motor imagery and only home exercise in patients undergoing LSS. DESIGN A randomized controlled study. SETTINGS This study was designed by researchers at Dokuz Eylul University. PARTICIPANTS Thirty-seven patients undergoing LSS were randomized to motor imagery group (n = 19) and control group (n = 18). MAIN OUTCOME MEASURES Pain was measured by Visual Analogue Scale, disability related to low back pain by Oswestry Disability Index, pain-related fear by Tampa Scale of Kinesiophobia, depression by Beck Depression Inventory, quality of life by World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF). All assessments were repeated in the preoperative period, three weeks after and six weeks after the surgery. INTERVENTIONS Motor imagery group underwent home exercise plus motor imagery program applied by voice recording. Control group underwent only home exercise program. Exercise program compliance was monitored by exercise diary and telephone calls once every week. RESULTS There was a significant improvement in pain at rest and during activity, disability, kinesiophobia, depression, physical health and psychological sub-parameters of WHOQOL-BREF between preoperative period, and the third week and sixth week in both groups (p < 0.05). When comparing groups for gain scores, there was a more significant improvement in pain during activity in motor imagery group (p < 0.05). Motor imagery should be addressed as an effective treatment after LSS.
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Affiliation(s)
- Yesim Salik Sengul
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Nergis Kaya
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Gamze Yalcinkaya
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Muge Kirmizi
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey; Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University
| | - Orhan Kalemci
- Department of Neurosurgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain: A Critical Review. Am J Phys Med Rehabil 2019; 97:200-211. [PMID: 29112509 DOI: 10.1097/phm.0000000000000859] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Low back pain (LBP) coincides with sensorimotor impairments, for example, reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available functional magnetic resonance imaging studies on brain activation related to nonnociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area, and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. In addition, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Overactivation in these regions could indicate an overresponsiveness to sensory inputs that signal potential harm to the spine, thereby inducing overgeneralized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.
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Shepherd M, Louw A, Podolak J. The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report. Physiother Theory Pract 2018; 36:1043-1055. [PMID: 30499359 DOI: 10.1080/09593985.2018.1548047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI). CASE DESCRIPTION A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Complicating psychosocial factors such as kinesiophobia and catastrophization were present. The patient engaged in a treatment plan including GMI: pain neuroscience education (PNE), laterality training, motor imagery, and mirror training. As symptoms improved, graded functional exposure and functional restoration occurred. OUTCOMES The patient was seen for a total of 26 visits over a 9-month period. FAAM measures exceeded reported clinically important change that was sustained at two-year follow-up. Long term outcomes showed no functional deficits related to her foot or ankle and minimal to no catastrophizing and fear avoidance behaviors. DISCUSSION This case report showcases the use of GMI with a patient with CRPS type 1 in an outpatient orthopedic clinic. Clinicians may consider the use of GMI to progress a patient toward maximal functional gains.
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Affiliation(s)
- Mark Shepherd
- Department of Physical Therapy, South College , Knoxville, TN, USA.,Evidence in Motion Institute of Health Professions , Louisville, KY, USA
| | - Adriaan Louw
- International Spine and Pain Institute , Louisville, KY, USA
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Use of Pain Neuroscience Education, Tactile Discrimination, and Graded Motor Imagery in an Individual With Frozen Shoulder. J Orthop Sports Phys Ther 2018; 48:174-184. [PMID: 29257926 DOI: 10.2519/jospt.2018.7716] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case report. Background Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. Case Description A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. Outcomes The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. Discussion Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(3):174-184. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7716.
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Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther 2017; 25:160-168. [PMID: 28694679 PMCID: PMC5498797 DOI: 10.1080/10669817.2017.1323699] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
- Corresponding author.
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Emilio J. Puentedura
- Department of Physical Therapy, University of Nevada Las Vegas, School of Allied Health Sciences, Las Vegas, NV, USA
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Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion. Arch Phys Med Rehabil 2017; 98:1941-1947. [PMID: 28483657 DOI: 10.1016/j.apmr.2017.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DESIGN Single-blind case series. SETTING Three outpatient physical therapy clinics. PARTICIPANTS Patients with shoulder pain and limited AROM (N=69). INTERVENTION Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. MAIN OUTCOME MEASURES We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. RESULTS There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. CONCLUSIONS A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.
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Louw A, Farrell K, Landers M, Barclay M, Goodman E, Gillund J, McCaffrey S, Timmerman L. The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial. J Man Manip Ther 2016; 25:227-234. [PMID: 29449764 DOI: 10.1080/10669817.2016.1231860] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective To determine if a neuroplasticity educational explanation for a manual therapy technique will produce a different outcome compared to a traditional mechanical explanation. Methods Sixty-two patients with chronic low back pain (CLBP) were recruited for the study. Following consent, demographic data were obtained as well as pain ratings for low back pain (LBP) and leg pain (Numeric Pain Rating Scale), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance-Beliefs Questionnaire), forward flexion (fingertips-to-floor), and straight leg raise (SLR) (inclinometer). Patients were then randomly allocated to receive one of two explanations (neuroplasticity or mechanical), a manual therapy technique to their lumbar spine, followed by post-intervention measurements of LBP, leg pain, forward flexion, and SLR. Results Sixty-two patients (female 35 [56.5%]), with a mean age of 60.1 years and mean duration of 9.26 years of CLBP participated in the study. There were no statistically significant interactions for LBP (p = .325), leg pain (p = .172), and trunk flexion (p = .818) between the groups, but SLR showed a significant difference in favor of the neuroplasticity explanation (p = .041). Additionally, the neuroplasticity group were 7.2 times (95% confidence interval = 1.8-28.6) more likely to improve beyond the MDC on the SLR than participants in the mechanical group. Discussion The results of this study show that a neuroplasticity explanation, compared to a traditional biomechanical explanation, resulted in a measureable difference in SLR in patients with CLBP when receiving manual therapy. Future studies need to explore if the increase in SLR correlated to changes in cortical maps of the low back.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Merrill Landers
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Martin Barclay
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Elise Goodman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Jordan Gillund
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Sara McCaffrey
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Laura Timmerman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
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Galve Villa M, Rittig-Rasmussen B, Moeller Schear Mikkelsen L, Groendahl Poulsen A. Complex regional pain syndrome. ACTA ACUST UNITED AC 2016; 26:223-230. [PMID: 27491326 DOI: 10.1016/j.math.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a chronic pain condition that can occur after a minor trauma or surgery. It is a multifactorial condition with a complex cause and even more complex pathophysiology. There are disturbances and changes in the sympathetic, somatosensory and motor nervous system, resulting in severe pain and disability. Patients with CRPS can have their quality of life and functional ability greatly affected and they need appropriate and interdisciplinary interventions. PURPOSE This article contributes towards an up-to-date knowledge and an overall view of CRPS, which can contribute to a structured and systematic rehabilitation process for patients. IMPLICATIONS This Masterclass describes a functional restoration algorithm to assist therapists in the development of a treatment plan based on the available evidence and international guidelines. Early diagnosis and treatment is of great importance as patients (adults and children), can be severely affected in their functional capacity and quality of life.
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Affiliation(s)
- Maria Galve Villa
- Pain and Headache Clinic, Aarhus University Hospital, Noerrebrogade 44, Building 1A, 8000 Aarhus C, Denmark.
| | | | - Lene Moeller Schear Mikkelsen
- The Multidisciplinary Pain Center, Copenhagen University Hospital, Rigshospitalet, Afsnit 7612, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Groendahl Poulsen
- Surgical Therapy Department, Regional Hospital Silkeborg, Falkevej 1-3, 8600 Silkeborg, Denmark
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Diener I, Kargela M, Louw A. Listening is therapy: Patient interviewing from a pain science perspective. Physiother Theory Pract 2016; 32:356-67. [PMID: 27351690 DOI: 10.1080/09593985.2016.1194648] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.
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Affiliation(s)
- Ina Diener
- a Department of Physical Therapy , Stellenbosch University , Stellenbosch , South Africa
| | - Mark Kargela
- b Department of Physical Medicine and Rehabilitation , Mayo Clinic , Phoenix , AZ , USA
| | - Adriaan Louw
- c International Spine and Pain Institute , Story City , IA , USA
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