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At least 901 records · Page 50Linked to original sources
PubMed2001

Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine.

OBJECTIVE: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. DESIGN: Prospective, matched single-blind control trial. SETTING: University hospital clinic. PATIENTS: Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head). INTERVENTIONS: Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm(2) at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months. MAIN OUTCOME MEASURES: The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion. RESULTS: Neither group differed statistically before the study, with a poor rating for all patients (p >.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001). CONCLUSION: ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.

Adult↗
PubMed1999

Pain memory.

Explore the source record for details and available documents.

Accidental Falls↗
PubMed1999

Comparison of ribcage and posteroanterior thoracic spine stiffness: an investigation of the normal response.

Evaluation of the movement response to posteroanterior (PA) loads applied to the spinous processes is a recognized part of the physical examination of the thoracic spine. During this clinical procedure the thoracic spine is supported by the ribcage which may contribute to the movement response. However, the contribution of ribcage stiffness to the PA stiffness of the thoracic spine has not been established. The purpose of this study was to measure the PA stiffness of the thoracic spine and compare this to the stiffness of the ribcage under anteroposterior load. Using force-displacement analysis, this study measured the PA stiffness of the thoracic spine at T4, T7 and T10 in 20 asymptomatic individuals, and compared this to the ribcage stiffness measured through sternal compression. The mean PA stiffness at T7 (10.7 N/mm) was significantly greater than at T4 (9.1 N/mm, P < 0.001), and there was a non-significant increase between T7 and T10 (11.4 N/mm, P = 0.08). The stiffness of the ribcage measured via sternal compression (7.6 N/mm) was significantly lower than the thoracic PA stiffness at all levels (P < 0.01). A significant proportion (33%) of the thoracic spine PA stiffness was accounted for by the stiffness of the ribcage (P < 0.01). In young, asymptomatic subjects, the PA stiffness of the thoracic spine is significantly greater than the stiffness of the ribcage. This suggests that the response to PA load application in the thoracic spine can be attributed to factors relating to the spine as well as the ribcage. Defining consistent patterns of PA stiffness in the thoracic spine may assist in the interpretation of clinical measurements of patients with mechanical dysfunction of the thoracic spine.

Adult↗
PubMed2001

Chiropractic manipulation for the foot: Diversified chiropractic techniques.

There has been increasing acceptance and development of manual methods in providing for the needs of patients with musculoskeletal dysfunction. Several professions have helped fuel this growth, including the chiropractic profession. To date, there has been only a small amount of collaboration between chiropractors and physical therapists. This paper provides a base foundation for one small part of general chiropractic practice, i.e. procedures used for manipulating the foot. Information is provided about the specific diagnostic procedures used by the chiropractic profession in assessing the joints and soft tissues of the foot, followed by descriptions of a number of chiropractic manipulative techniques drawn from the form of chiropractic in widest usage, Diversified technique. For each technique, information is provided on indications for use, patient position, therapist position, hand placements and procedure. In addition, a short discussion on the genesis of Diversified technique is provided.

Chiropractic↗
PubMed2002

Forebrain-mediated sensitization of central pain pathways: 'non-specific' pain and a new image for MT.

Manual therapy (MT-) is moving beyond its empirical origins and into an era of evidence-based practice. Mechanisms for the appearance of clinically observed symptoms and signs are beng incorporated into its clinical reasoning process. The recent, but well-documented phenomenon, central sensitization, is recognized as being one such mechanism. Anatomical, physiological, behavioural and clinical evidence demonstrate that, in addition to input from the periphery, central sensitization can be enhanced or maintained by supraspinal processes involving cognitions, attention ('focussing') and emotions. These forebrain products may, therefore, make a significant contribution to the symptoms and signs of common musculoskeletal presentations such as 'non-specific' back pain and fibromyalgia. The evidence can also be interpreted to provide MT with an acceptable role in the management of these patients.

Attention↗
PubMed2002

Thoracic pain in a collegiate runner.

This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the university track team.

Adult↗
PubMed2003

Manipulation of the cervical spine.

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient and the therapist. This is combined with biomechanical considerations, which have made the teaching and learning of these manipulative techniques less complicated and easily progressed from palpation to mobilization and onto manipulation. Appropriate patient screening and selection identified through thorough subjective and objective assessments are important aspects of this approach and reflective interpretation of all clinical findings is essential. The refinement of cervical joint positioning and an increased anatomical awareness have led to the utilization of new upper cervical high-velocity thrust techniques. Consequently, it is envisaged that an increase in the safety and specificity of cervical manipulative techniques is achieved.

Cervical Vertebrae↗
PubMedDate not supplied

[Reliability of manual medical examination techniques of the cervical spine. Study of quality assurance in manual diagnosis].

OBJECTIVE: Chiropractic techniques are of particular importance for the examination of the cervical spine. The aim of this study was to assess interexaminer reliability of examination techniques of the cervical spine in subjects with and without musculoskeletal distortions of the neck. The interrater method was used with five independent examiners. METHOD: Twenty patients suffering from neck diseases and 20 asymptomatic subjects of similar age and gender were randomized and assessed by five examiners blind to patient histories. Statistical analysis was carried out using multiple logistic regression and the calculation of kappa. RESULTS: Compared to asymptomatic subjects, patients experienced pain significantly often when pressure was applied to the cervical zygapophysial joints and the superficial neck muscles (p < or = 0.05 and p < or = 0.01). In addition, segmental function tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p < or = 0.05 and p < or = 0.01). A significant relationship was not found between the patient's health status and the findings from muscle palpation and functional examination of the motion segments. The assessment of agreement within examiners beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 < kappa < or = 0.6). CONCLUSIONS: Chiropractic techniques are an essential part of every examination of the cervical spine. The clinical impact has not been scientifically established until up to now. Based on our findings and literature, we conclude that interexaminer reliability of manual diagnosis in the examination of the cervical spine should be improved by standardizing the examination process and setting guidelines for documentation and evaluation criteria. Controlled and frequently repeated training sessions also contribute to the reproducibility of findings from manual examinations.

Adult↗
PubMedDate not supplied

[Non-cerebrovascular complication in chirotherapy manipulation of the cervical vertebrae].

PURPOSE: Chirotherapy is a popular and successful management option for reversible functional disorders of the cervical spine. Though rarely observed, complications do occur, mainly involving the cerebrovascular system. By means of the here described case and a literature survey, we aim to highlight non-cerebrovascular complications of chirotherapeutic cervical spine manipulation. RESULTS: A 43-year-old male initially consulted an ENT specialist, suffering from tinnitus aurium and loss of hearing ability. His hearing significantly increased after intravenous drug therapy, but the tinnitus remained. During chiropractic manipulation of the cervical spine by an orthopaedic surgeon for the tinnitus, the patient described severe neck pain following a clearly audible clicking sound. Scans of the cervical spine prior to and after manipulation showed an intracapsular/intraosseus oedema of the facet joints C2/C3 with lesion of the nerve root C3, most probably induced by chirotherapy. CONCLUSION: Although complications after chiropractic manipulation are extremely rare, treatment of the spine, especially the cervical spine, is not wholly harmless. An adequate history taking followed by clinical and radiographic patient evaluation is necessary to keep the risk of iatrogenic trauma at a minimum. Above all, the chiropractic manipulation of the cervical spine belongs in the hands of a qualified and experienced medical practitioner.

Adult↗
PubMedDate not supplied

[Fatal outcome during physiotherapy (Vojta's method) in a 3-month old infant. Case report and comments on manual therapy in children].

Detailed clinical and neuropathological report on a fatal incident during the first manual therapy according to Vojta conducted in a 3 months old baby: during forced active rotation and head retraction the baby suffered from a bleeding into the adventitia of both her vertebral arteries at the level of C1 prompting ischemia of the caudal brainstem with subarachnoid haemorrhage around. It has to be suggested that similar cases already have occurred but have not been reported yet. There might be a time lag between the performance of physiotherapy and the beginning of neurologic symptoms. The risks of manual therapy in children will be discussed.

Brain Stem Hemorrhage, Traumatic↗
PubMedDate not supplied

[Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain - range of motion analysis].

AIM: The aim of this study was to compare the effects of acupuncture on active motion of the cervical spine in patients with chronic neck pain with those of "sham" laser acupuncture and massage. MATERIAL AND METHODS: 177 patients with chronic neck pain were included in this prospective, randomized, placebo-controlled study. The patients were allocated by external randomization to five treatments over three weeks with acupuncture, massage and "sham" laser acupuncture. The range of active motion was measured by means of a 3D ultrasound real time motion analyzer. RESULTS: The analysis of cervical motion in three directions showed the largest increase in range of motion 14 days after acupuncture. Compared to massage, a significant improvement in total range of motion was seen in those patients treated by acupuncture immediately (p = 0,03) and one week (p = 0,03) weeks after therapy. There was no significant difference in those patients treated by sham laser acupuncture. CONCLUSION: The results of the study indicate that acupuncture is superior to conventional massage for improving active range of motion in patients with chronic neck pain. Because of its positive effects, its acceptance among patients and the lack of severe side effects, acupuncture can be recommended for the treatment of chronic neck pain, although there was no significant difference in results between "sham" laser acupuncture and acupuncture.

Acupuncture Therapy↗
PubMedDate not supplied

[Guidelines for back pain].

Chronic back pain is one of our society's most important health problems, causing long periods of sick leave and early retirements. Recently the German Society of General Practice and Family Medicine (DEGAM) published an evidence-based guideline for low back pain. It has been developed according to the 10-step concept of guideline development of the DEGAM, aiming for early detection of complicated clinical conditions, avoidance of unnecessary diagnostic tests and prevention of chronicity. Complicated, uncomplicated and radicular pain are defined by patient history and a short clinical examination. Imaging and further diagnostic tests are reserved for patients at risk. Basic therapy consists of structured advice. The aim of the guideline is to get patients back to their usual activity supported by effective pain relief. Psychosocial factors which are important for the prognosis should be evaluated already during the first consultation. Manual therapy might help in acute pain. Patients with persistent pain symptoms and long periods of sick leave should be transferred to multiprofessional management including pain treatment, behavioural therapy and physiotherapy. A randomised controlled trial has been set up to study the efficacy of guideline implementation.

Activities of Daily Living↗
PubMed2005

[Effects of Maitland's manual mobilization on the thoracic spine].

The goal of manual therapy is to decrease pain and to increase function of the spine and peripheral joints. The method introduced by Maitland is widely used in manual medicine. However, no objective changes in the mobility of the thoracic spine after performing manual mobilization have been published in the literature. The aim of this study is to reveal possible changes in the segmental mobility of the thoracic spine after posterior-anterior manipulations without thrust in comparison with a control group. In addition, significant changes within the treatment group were examined. Thirty-six volunteers were randomized into an intervention (16) and a control group (20). The intervention group was treated two times a week for three weeks. The control group received no treatment. The mobility was objectively measured by using Medimouse. No significant difference in the mobility of the thoracic spine could be shown within the intervention group and in comparison with the control group.

Adult↗