Reappraisal of a proposed neurophysiological mechanism for the relief of joint pain with passive joint movements

[Physiotherapy and physical therapy in pain management]

Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.

Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points

Studies have shown a clinical relationship between trigger points and joint impairments. However the cause-and effect relationship between muscle and joint dysfunctions in trigger points could not be established. The purpose of this study was to investigate effects of mobilization and ischemic compression therapy on cervical range of motion and pressure pain sensitivity in participants with latent trigger point in the upper trapezius muscle. Ninety asymptomatic participants with upper trapezius latent trigger point were randomized in to 3 groups: mobilization, ischemic compression and a control. The outcomes were measured over a 2 week period. Repeated measures ANOVA showed statistically and clinically significant pre to post improvement in both the interventional groups compared to control (p < 0.05). However the effect sizes between the intervention groups were small (<0.3) revealing minimal clinical detectable difference.

Introduction to manipulation

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