Shoulder sports injury overview and instability basicsPuneet Monga
This document discusses shoulder injuries in sports. It covers categories of shoulder injuries including contact, overhead, combat, and riding injuries. It focuses on shoulder instability, describing the static and dynamic stabilizers of the shoulder joint. It discusses classifications of instability and assessments including clinical exams and imaging studies. The management of traumatic dislocations and surgical options for instability are outlined.
This document provides an overview of rotator cuff disorders and evidence related to diagnosis and management. Key points include:
- Rotator cuff tears can be caused by mechanical or degenerative factors and progress from tendinosis to partial or full thickness tears.
- Physical exams have low diagnostic accuracy for tears but clusters of tests may help. Investigations like ultrasound and MRI can better identify soft tissue pathology.
- Factors like age, tear size, tendon retraction and fatty infiltration affect outcomes, with larger/retracted tears and more fatty changes correlating to poorer prognosis.
- Initial management focuses on rest, analgesics and physiotherapy, with surgery for failed non-operative treatment. Surgical techniques like
The document discusses anterior glenohumeral instability, including epidemiology, pathoanatomy, diagnosis, and management options. It notes that anterior dislocations are most common in athletes under age 25, with the primary pathology being a Bankart lesion. Diagnosis involves history, physical exam including tests like the apprehension test, and imaging like x-rays and MRI. Treatment depends on factors like number of dislocations, age, and physical exam findings, ranging from rehabilitation to surgical procedures.
This document discusses the throwing shoulder from an orthopaedic surgeon's perspective. It begins by outlining common overhead athlete pathologies like internal impingement and unstable painful shoulders. Internal impingement occurs when the rotator cuff impinges against the glenoid rim and can cause articular sided tears and labral lesions. Unstable painful shoulders present with pain but no instability symptoms. The document then reviews surgical decision making, the role of non-operative treatment and imaging, and finally presents a management algorithm focusing on internal impingement.
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
This audit summarizes the first 100 consecutive shoulder arthroplasties performed by a single surgeon between 2013-2016. It found:
1) The majority of procedures were for osteoarthritis or cuff tear arthropathy. The proportion of revisions is increasing.
2) Outcomes were comparable to national joint registry data, with reverse replacements being more common than anatomical replacements.
3) Complication rates were lower than literature reports, with 3 periprosthetic fractures, 2 dislocations, and 1 acromial stress fracture being the main surgical complications.
Clavicle fractures are commonly caused by falls on the shoulder or outstretched hand. They are classified based on location (medial, middle, lateral). Most are managed non-operatively with a sling or figure-of-eight bandage. Early surgery is indicated for fractures in young patients from high-energy trauma, comminuted fractures, fractures with skin jeopardy, or >20mm of shortening. Floating shoulder injuries and open or lateral fractures also typically require surgery. Surgical management involves open reduction and internal fixation followed by a short period of protected motion and early return to sports. Studies show reliable healing and functional outcomes when surgery is performed for appropriately indicated fractures.
This study evaluated 114 patients who underwent arthroscopic surgery for shoulder instability to determine if humeral or glenoid bone loss were factors in recurrence. The mean age was 28 and most patients were male athletes. Glenoid and Hill-Sachs lesions were common. Recurrence occurred in 5 patients who all had Hill-Sachs lesions and participated in overhead/contact sports. Reoperation was successful in these 5 cases. Overall, 94.6% of patients were satisfied with the procedure and returned to work and sports without bone loss appearing to significantly increase recurrence risk.
Distal clavicle fractures are classified into 5 types based on the location and involvement of ligaments. Type I fractures involve minimal displacement and are treated non-operatively. Type II fractures have greater controversy in management, with some advocating surgery for Type II fractures that have medial displacement of the distal fragment. Surgical options include plate fixation, CC ligament reconstruction, and arthroscopic techniques. While surgery aims to improve union rates, it also carries risks of complications that must be weighed against non-operative treatment. Further research is still needed to determine the optimal treatment approach for different types of distal clavicle fractures.
Labral injuries and traumatic instabilityPuneet Monga
The document discusses labral injuries of the shoulder. It describes the anatomy of the labrum and its attachments in the shoulder joint. Common types of labral injuries are described including variants such as Bankart lesions, SLAP tears, and HAGL lesions. The evaluation, diagnosis, and management of labral injuries are covered. Key factors in decision making for treatment include the patient's history and factors, the pathology identified, and clinician experience. Surgical repair of labral injuries involves preparing the area, reattaching the labrum, and testing the stability of the repaired shoulder joint. Outcomes depend on thorough assessment and individualized treatment that considers the patient, surgeon, and therapist factors.
Acromioclavicular joint arthritis is a degenerative disease of the joint between the clavicle and acromion. It causes pain and stiffness. Risk factors include age over 45, previous injury to the joint, and weightlifting activities. The disease can be caused by primary osteoarthritis, post-traumatic osteoarthritis following an injury, or distal clavicle osteolysis from repetitive microtrauma. It is diagnosed based on symptoms, physical examination findings like tenderness over the joint, and imaging like x-rays showing signs of arthritis.
Current concepts in the management of shoulder instabilityPonnilavan Ponz
This document discusses the current concepts in the management of shoulder instability. It covers the causes, classifications, investigations, and treatment options for shoulder instability. For treatment, it emphasizes the importance of a systematic approach that considers the patient's age, activity level, and nature of the soft tissue and bony injuries. Non-operative treatments include physiotherapy, while operative options depend on the specific injuries and may include arthroscopic bankart repair, open latarjet procedure, remplissage, or capsular shift procedures. The goal of treatment and rehabilitation is to return the patient to their prior level of function and activity.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
The document discusses injuries to the acromioclavicular (AC) joint. It provides details on the anatomy and biomechanics of the AC joint and surrounding ligaments. Common mechanisms of injury include falling on an outstretched arm or direct force to the lateral shoulder. Injuries are classified using the Rockwood system from Type I to VI based on the degree of ligament disruption and bone displacement. Treatment options include nonoperative measures for lower grades and surgery for higher grades or failed nonoperative treatment. Surgical techniques and associated conditions are also reviewed.
This document discusses the current surgical management and rehabilitation of rotator cuff disease. It covers various surgical techniques for partial thickness tears, full thickness tears, and massive tears, including arthroscopic and open approaches. For massive tears, options discussed include debridement, repair, tendon transfers such as latissimus dorsi or pectoralis major, and reconstruction. The rehabilitation process is described in phases focusing initially on protection and range of motion, followed by strengthening exercises over 4 to 6 months.
This document discusses the terrible triad injury of the elbow, which involves fractures of the radial head and coronoid process along with disruption of the lateral collateral ligament complex. It begins by noting that these injuries are typically seen by trauma and orthopaedic surgeons. It then outlines the anatomy and stabilizers of the elbow joint. The remainder describes an algorithmic approach to managing terrible triad injuries, focusing on restoring the coronoid, replacing the radial head, and repairing the lateral ligament complex while protecting surrounding soft tissues and nerves. Key steps include using fluoroscopy, considering prosthetic replacement for comminuted fractures, and having fixation devices available depending on the injury and stability.
This document discusses shoulder arthritis and its management. It begins by outlining the two broad types of arthritis - those with an intact rotator cuff and those with a torn rotator cuff. It then discusses the two broad types of shoulder replacements - anatomical and reverse geometry. Making the right diagnosis and assessment of bone stock, predicting rotator cuff failure, and performing a good surgery are key to avoiding complications. Trends in shoulder replacements over time and future projections are also presented.
Total Shoulder Arthroplasty | Reverse Shoulder Replacement | South Windsor, R...James Mazzara
https://hartfordsportsorthopedics.com/
In this presentation, Dr. Mazzara discusses the pathology, surgical techniques, and potential complications during a total shoulder replacement and a reverse total shoulder replacement.
To learn more about shoulder replacements, please visit: https://hartfordsportsorthopedics.com/total-shoulder-replacement-arthroplasty-south-windsor-rocky-hill-glastonbury-ct/
Cervical radiculopathy is caused by spinal nerve root dysfunction resulting in dermatomal pain, parasthesias, myotomal weakness, and impaired deep tendon reflexes. It is commonly caused by herniated discs or bony spurs compressing nerve roots. Diagnosis involves history, physical exam testing dermatomes and myotomes, and imaging such as MRI. Treatment includes immobilization, traction, medications, injections, and sometimes surgery for severe or progressive cases.
Cervical spondylosis is a common cause of neck pain, radiculopathy, and myelopathy. It involves chronic degenerative changes in the cervical discs and vertebrae due to aging. Common symptoms include neck pain, headaches, and radiating arm pain. Diagnosis involves clinical exam showing signs of radiculopathy or myelopathy as well as imaging like x-rays, CT, and MRI to identify areas of nerve root or spinal cord compression. Treatment options include conservative measures or surgery to decompress the spinal cord if conservative treatment fails.
This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
This document provides an overview of techniques for evaluating injuries to the pelvis and thigh. It discusses the importance of obtaining a thorough history and details key components of the history including location of symptoms, onset, training factors, and prior medical conditions. It then outlines the process of inspection, palpation of various anatomical structures, and assessment of range of motion including specific tests like Thomas test and Trendelenburg's test. It concludes by describing special tests for ligaments, joints, and neurovascular assessment of the pelvis and thigh region.
Neck Pain and Arm Pain : Cervical Radiculopathy by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Radiculopathy and Cervical Herniations. When herniations begins to affect the nerves and spinal cord this is called Cervical Radiculopathy. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniation/Radiculopathy feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
This document provides an overview of musculoskeletal trauma, including:
1) Musculoskeletal injuries occur in 70-80% of multi-trauma patients and can range from minor impairments to life-threatening injuries like pelvic or femur fractures.
2) A thorough musculoskeletal assessment involves evaluating the six P's (pain, pallor, paresthesia, pulses, paralysis, pressure) as well as inspection and palpation of injuries.
3) Initial management of musculoskeletal trauma focuses on immobilization, hemorrhage control, and splinting fractures to prevent further injury while stabilizing the patient for transport.
This document defines joint mobilization techniques and provides guidelines for their use. It describes mobilization as a manual therapy that uses passive joint movement to increase range of motion or decrease pain. Accessory joint movements like gliding and traction are explained. Precautions and contraindications for mobilization are outlined. A grading scale from I to V is presented to indicate the amplitude of oscillations used in different mobilization techniques.
Basic Introduction about Joint Mobilisation and Manipulation, This article gives clear notes for the students to understand the Mobilisation techniques.
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
The document discusses pain and the nervous system's response to harmful stimuli. It describes two waves of pain - the initial sharp pain from A-delta fibers and the longer-lasting dull pain from C-nerve fibers. It outlines the ascending pathway where pain signals travel from nociceptors to the dorsal horn and then to the brain. Chronic pain can persist after injury healing or for unknown reasons, and can be caused by various physical and neurological conditions.
The document discusses principles of joint mobilization including using lower grades to reduce pain and higher grades to increase mobility. It outlines convex-concave rules for determining glide direction in different joints. Treatment glides are described to improve range of motion in various joints like the shoulder, knee, ankle and elbow. Open-packed positions and grades of movement are also defined. The goal of a joint mobilization treatment is to increase range of motion through appropriate gliding techniques.
This document provides an overview of pain and pain pathways. It defines pain, discusses the history of pain theories, and describes the different types of pain receptors and neural pathways involved in pain perception and modulation. Specifically, it outlines fast and slow pain pathways conducted by myelinated and unmyelinated fibers, discusses peripheral and central mechanisms of injury-induced pain, and classification of pain including somatic and visceral pain.
The musculoskeletal system consists of two main systems - the skeletal system and the muscular system. The three types of muscles are smooth, skeletal, and cardiac muscles. Skeletal muscles are voluntary muscles that produce movement and are attached to bones via tendons. Bones provide structure, protect organs, allow movement, produce blood cells, and store minerals. The skeletal system works with skeletal muscles to provide functions like protection, support, movement, and mineral storage.
1. The document discusses the anatomy and pathways of the pain sensation system. It describes how nociceptors detect painful stimuli and transmit signals to the spinal cord and brain.
2. The spinal cord plays an important role in pain processing. It contains ascending tracts that carry pain signals to the brain and descending tracts that modulate pain. Key nuclei in the spinal cord dorsal horn relay and modulate pain transmission.
3. Pain signals are transmitted from the spinal cord via the spinothalamic tract to the thalamus and then to regions of the cerebral cortex involved in pain perception and modulation like the somatosensory, cingulate, and insular cortices. The periaqueductal
Medical shockwaves for chronic low back pain - a case seriesKenneth Craig
This case series examines the use of medical shockwave therapy for 10 patients with chronic low back pain. Shockwave therapy involves using focused acoustic pulses to target deep tissue. After 3 sessions of 1000 pulses each over 3 weeks, 8 of the 9 patients showed excellent improvement in pain levels, functional disability, and reduced need for pain medication that was maintained at the 12 week follow up. This positive preliminary outcome supports further investigation of shockwave therapy as a potential disease-modifying treatment for chronic low back pain.
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Presented an in-service on the evidence behind and the application of thoracic spine manipulation to the Martinsburg VA Medical Center's rehabilitation staff including: 7 PTs, 8 PTAs, 3 OTs, and 4 students.
The document discusses a client named Glenn who underwent pre-screening that revealed high risk during exercise due to medical conditions. An exercise program was implemented based on GP recommendations to help manage his conditions and reduce disease risks. Pre-screening methods are discussed as an effective way to reduce adverse events during exercise.
Chronic neck pain can last more than 6 months and is considered chronic. A physical therapist can effectively assess and treat chronic neck pain. The PT will perform assessments like questionnaires, range of motion and strength tests to determine the condition. Treatments may include exercises, manual therapy, education and ergonomic advice. Prognostic factors like age over 40 or prior history of neck issues can increase the risk of chronic neck pain.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
This document summarizes evidence on the use of manual therapy and manipulation in the treatment of shoulder impingement syndrome (SIS). Several randomized controlled trials have found that combining manual therapy/manipulation with exercise therapy leads to better outcomes in pain, strength, and function compared to exercise therapy alone. While more research is still needed, the existing evidence supports the use of manipulation as a component of comprehensive treatment for SIS. Manipulation appears to be a safe intervention when applied properly to appropriate patients by a skilled provider.
This study examined whether early improvement in neck function predicted overall response to a cervical strengthening program for chronic neck pain. 214 patients completed a 3-week strengthening program and were assessed for changes in neck disability index (NDI) scores. Patients with a positive change in NDI scores after 3 weeks had a 25 times greater odds of overall improvement. Early improvement likely reflects motor skill acquisition rather than muscle hypertrophy. While early responders saw small additional gains, continued strengthening may provide further benefits like reduced muscle co-activation.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
The document summarizes a study that compared the effectiveness of different combinations of manual therapy and exercise for treating mechanical neck pain. All patients received neck exercises and cervical spine mobilization. Additionally, some patients received thoracic spine manipulation. Those who received all three treatments experienced greater reductions in neck pain and improvements in daily functioning after one week compared to those who only received exercises and cervical mobilization. The combination of neck exercises, cervical mobilization, and thoracic manipulation led to quicker relief of neck pain symptoms.
Concussions are a growing concern, especially in young athletes. Common symptoms include headaches, dizziness, and memory issues. While rest is usually recommended, longer periods of inactivity do not necessarily lead to faster recovery. Physical therapy can help address lingering symptoms through manual therapy, soft tissue work, vestibular rehabilitation, education, and light aerobic exercise. Further research is still needed to better understand and treat concussions.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
Short-term effects of teriparatide versus placebo on bone biomarkers, structu...Ellen Almirol
This pilot study evaluated the effects of 8 weeks of teriparatide (TPTD) versus placebo treatment on bone biomarkers, structure, and stress fracture healing in premenopausal women with lower-extremity stress fractures. The study found that TPTD treatment led to greater increases in bone formation markers and a larger "anabolic window" compared to placebo. TPTD treatment also showed improvements in bone structure at weight-bearing sites on imaging. A higher percentage of stress fractures showed improvement or healing with TPTD versus placebo on MRI, though the results were not statistically significant. The study provides preliminary evidence that TPTD may help hasten stress fracture healing in premenopausal women.
This document provides information on Healing Touch, an energy therapy practice that uses gentle touch to balance physical, mental, emotional, and spiritual well-being. The document discusses what Healing Touch involves, its uses in treating conditions like stress, pain, and surgery recovery, and several research studies that have found Healing Touch can reduce anxiety, pain, and length of hospital stays. The document aims to educate about integrative medicine options and provides takeaways on the benefits Healing Touch can provide patients.
1. This document provides summaries of 4 recent studies related to chiropractic care, beginning with a major study published in Annals of Internal Medicine that found spinal manipulative therapy and home exercises were superior to medication for neck pain.
2. The second study summarized was the first randomized controlled trial to examine chiropractic management for patients with chest pain, finding that chiropractic patients improved significantly more than those receiving self-management.
3. References and appendices are provided for each study summarized. The document concludes by commenting on how chiropractic addresses the mechanical cause of problems rather than just symptoms.
Fizyoterapide Klinik ve Araştırma Alanlarında Yenilikçi BakışlarUfuk Yurdalan
This document discusses innovative perspectives in clinical and research areas in physiotherapy. It outlines new areas of focus in clinical practice, including acute care, chronic conditions, intellectual disabilities, and women's health. It also discusses new areas of research focus, including online physiotherapy education, various medical conditions and specializations, international networks, and focus symposium topics. The document advocates for innovative approaches to physiotherapy, including exploring new technologies, interactive learning, global health competencies, and multidisciplinary collaboration.
This study examined the intertester reliability of using James Cyriax's system for assessing patients with shoulder pain. Two experienced physical therapists independently evaluated 21 cases of painful shoulders using Cyriax's evaluation method. They classified the cases into specific shoulder lesions or indicated that the case did not fit the Cyriax model. The therapists agreed on the classification for 19 of the 21 cases, showing 90.5% agreement. Statistical analysis found "almost perfect" agreement between the therapists. Both therapists also agreed on the same 4 cases that did not fit the Cyriax model. The results demonstrate that Cyriax's evaluation can be a highly reliable method for assessing patients with shoulder pain.
A lecture about Technology in Physical Therapy Practice. Given at the OPTA Western District Meeting on 06/30/11 by Casey Kirkes PT, DPT and Dale Boren Jr. PT, MPT, O
This new employee orientation covers the following key points in 3 sentences:
The orientation reviews PTC's core values, the employee's role and responsibilities, professional development training, who the various company partners are, documentation and billing standards, and emphasizes having fun while embracing change. Employees will complete personality and learning assessments, learn about mentoring resources, and get an overview of performance reviews, social media guidelines, and the importance of teamwork and excellent customer service. The goal is to onboard new employees effectively and get them started on a path of continued learning and professional growth as part of the PTC team.
This document summarizes research on the treatment of femoroacetabular impingement (FAI) with manual therapy. It discusses the anatomy and causes of FAI, as well as diagnosis using imaging and clinical exams. While evidence directly comparing manual therapy to exercise for FAI is limited, manual therapy techniques used successfully for hip osteoarthritis may also benefit FAI by increasing range of motion and reducing pain. Case reports show positive outcomes with manual therapy including traction, mobilization, and soft tissue techniques for FAI patients. More research is still needed on rehabilitation approaches for FAI.
This document provides information about fibromyalgia including its definition, symptoms, diagnosis, treatment, and prognosis. Fibromyalgia is defined as a chronic pain condition characterized by widespread muscle aches, pain and tenderness in at least 11 of 18 tender points. It predominantly affects women and has no known cause but may involve abnormalities in how the brain processes pain signals. Treatment involves lifestyle modifications like exercise, stress management and adequate sleep, along with medications to reduce pain and improve symptoms. While there is no cure for fibromyalgia, treatment can help manage symptoms and many people are able to lead active lives.
The document provides information on medical red flags and common red flags associated with various body regions. It defines red flags as signs or symptoms that may warrant referral to another provider. The document then summarizes several studies on red flag documentation and lists many common red flags for various areas including back, chest/ribs, shoulder, sacrum/pelvis, lower quadrant, and leg. Red flags listed indicate potential serious conditions needing referral such as cancer, infection, fractures, or cardiovascular issues.
The document provides information on performing a differential diagnosis examination for the hip. It discusses evaluating the hip for common conditions like osteoarthritis, fractures, bursitis, labral tears, and referred pain from the low back. Physical examination tests are outlined to help determine the likely cause of hip pain, including assessing range of motion, special tests, and risk factors. The goal is to systematically examine the hip to form an evidence-based diagnosis and guide appropriate treatment.
This document provides an overview of a physical therapy course on total hip rehabilitation. The course objectives are to understand hip surgery and exercises, describe hip biomechanics, and effectively progress patients through rehabilitation. The schedule covers topics like evidence-based practice, anatomy, exercises, and outcome measures. Recent advances in hip rehabilitation include smaller incisions, reduced hospital stays, and early mobilization leading to better short-term outcomes. Assessment tools for hip function include the Lower Extremity Function Scale and Harris Hip Score.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
Chair, Benjamin M. Greenberg, MD, MHS, discusses neuromyelitis optica spectrum disorder in this CME activity titled “Mastering Diagnosis and Navigating the Sea of Targeted Treatments in NMOSD: Practical Guidance on Optimizing Patient Care.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4av12w4. CME credit will be available until June 27, 2025.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Ontotext’s Clinical Trials Eligibility Design Assistant helps with one of the most challenging tasks in study design: selecting the proper patient population.
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition By {Tod...rightmanforbloodline
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition By {Todd W. Vanderah, 2024,} Verified Chapter
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition By {Todd W. Vanderah, 2024,} Verified Chapter
TEST BANK For Katzung's Basic and Clinical Pharmacology, 16th Edition By {Todd W. Vanderah, 2024,} Verified Chapter
Mainstreaming #CleanLanguage in healthcare.pptxJudy Rees
In healthcare, every day, millions of conversations fail. They fail to cover what’s really important, fail to resolve key issues, miss the point and lead to misunderstandings and disagreements.
Clean Language is one approach that can improve things. It’s a set of precise questions – and a way of asking them – which help us all get clear on what matters, what we’d like to have happen, and what’s needed.
Around 1000 people working in healthcare have trained in Clean Language skills over the past 20+ years. People are using what they’ve learnt, in their own spheres, and share anecdotes of significant successes. But the various local initiatives have not scaled, nor connected with each other, and learning has not been widely shared.
This project, which emerged from work done by the NHS England South-West End-Of-Life Network, with help from the Q Community and especially Hesham Abdalla, aims to fix that.
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
Descoperă Bucuria Vieții Sănătoase cu Jurnalul Fericirii Life Care - Iulie 2024!
Gata să te bucuri de o vară vibrantă și plină de energie? Life Care îți vine în ajutor cu Jurnalul Fericirii din Iulie 2024, un ghid complet pentru o viață armonioasă și echilibrată.
Pe parcursul a cateva de pagini pline de informații utile și inspirație, vei descoperi:
Sfaturi practice pentru o alimentație sănătoasă:
Rețete delicioase și ușor de preparat: Bucură-te de preparate gustoase și nutritive, perfecte pentru zilele călduroase de vară.
Recomandări pentru o alimentație echilibrată: Asigură-ți aportul necesar de nutrienți esențiali pentru un organism sănătos și plin de vitalitate.
Sfaturi pentru alegeri alimentare inteligente: Învață cum să faci cumpărături sănătoase și să eviți tentațiile nesănătoase.
Trucuri pentru un stil de viață activ:
Rutine de exerciții fizice adaptate nevoilor tale: Găsește antrenamente potrivite pentru a te menține în formă și energic pe tot parcursul verii.
Idei de activități în aer liber: Descoperă modalități distractive de a te bucura de vremea frumoasă și de a petrece timp de calitate cu cei dragi.
Sfaturi pentru un somn odihnitor: Asigură-ți un somn profund și reparator pentru a te trezi revigorat și pregătit pentru o nouă zi.
Sfaturi pentru o stare de bine mentală:
Tehnici de relaxare și gestionare a stresului: Învață cum să te relaxezi și să faci față provocărilor zilnice cu mai multă ușurință.
Sfaturi pentru cultivarea optimismului și a gândirii pozitive: Descoperă cum să abordezi viața cu o perspectivă optimistă și să atragi mai multă bucurie în ea.
Recomandări pentru a te conecta cu natura: Bucură-te de beneficiile naturii asupra stării tale mentale și emoționale.
Bonus:
Oferte exclusive la produsele Life Care: Beneficiază de reduceri și promoții speciale la o gamă largă de produse pentru o viață sănătoasă.
Concursuri și premii: Participă la concursuri distractive și câștigă premii valoroase.
Jurnalul Fericirii Life Care - Iulie 2024 este mai mult decât o simplă revistă. Este un ghid complet și personalizat pentru a te ajuta să obții o viață mai sănătoasă, mai fericită și mai plină de satisfacții.
Nu rata această șansă de a te bucura de vară la maximum! Descoperă Jurnalul Fericirii Life Care - Iulie 2024 astăzi!
Comandă-ți exemplarul acum și fă un pas important către o viață mai bună!
#JurnalulFericirii #LifeCare #Iulie2024 #ViataSanatoasa #Bunastare #Fericire #Oferte #Concursuri #Premii
Join the leading All Range PCD Pharma Franchise in India and grow your business with a trusted partner. We offer an extensive range of high-quality pharmaceutical products, competitive pricing, and comprehensive marketing support. Benefit from our expertise, wide distribution network, and excellent customer service. Elevate your pharma business with See Ever Healthcare's proven PCD franchise model.
https://www.seeeverhealthcare.com/all-range-pcd-pharma-franchise-in-india/
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIAL
Mnp ppt jw
1. Neck Pain with/without HeadacheEvidence validates that PTs can help your patients….WITHOUT NARCOTICS OR SURGERY!
2. Problem: Neck Pain with/without HeadacheNeck pain, without symptoms or signs of serious medical or psychological conditions, associated with motion limitations in the cervical and upper thoracic regions, headaches, and referred or radiating pain into an upper extremity (Childs et al, 2008)
7. Intervention: Manual TherapyThrust and non-thrust techniques at the Thoracic and Cervical Spine1-71. Cleland et al. Phys Ther. 2007;87(4):431-440.2. Gonzalez-Iglesias et al. J Orthop Sports Phys Ther. 2009;39(1):20-27.3. Cleland et al. Phys Ther. 2010;90(9):1239-1250.4. Lau et al. Man Ther. 2011;16:141-147.5. Walker et al. Spine. 2008;33(22):2371-2378.6. Jull et al. Spine. 2002;27(17):1835-1843.7.Childs et al. J Orthop Sports Phys Ther. 2008;38(9):A1-A34 8. Wainner RS, Flynn T. With permission, Copyright Evidence In Motion, LLC. www.evidenceinmotion.com, all rights reserved .
8. Intervention: Manual TherapyCervical Spine Mobilization with Upper Limb Neurodynamics Positioning1, 2 1. Cleland JA et al. J Orthop Sports Phys Ther. 2005.2. Childs et al. J Orthop Sports Phys Ther. 2008.
9. Intervention: Specific ExerciseDeep Neck Flexor Retraining and Endurance1, 2 1. Jull et al. Spine. 2002.2. Childs et al. J Orthop Sports Phys Ther. 2008.3. Wainner RS, Flynn T. With permission, Copyright Evidence In Motion, LLC. www.evidenceinmotion.com, all rights reserved .
10. Intervention: Specific ExerciseScapular Stabilizer Strengthening1,21. Jull et al. Spine. 2002.2. Childs et al. J Orthop Sports Phys Ther. 2008.3.Wainner RS, Flynn T. With permission, Copyright Evidence In Motion, LLC. www.evidenceinmotion.com, all rights reserved .
11. Intervention: Specific ExerciseStretching as indicated1,2 1. Jull et al. Spine. 2002.2. Childs et al. J Orthop Sports Phys Ther. 2008.3. Wainner RS, Flynn T. With permission, Copyright Evidence In Motion, LLC. www.evidenceinmotion.com, all rights reserved .
12. Evidence - Manual Therapy + ExerciseA. Manual therapy & exercise - indicated for patients with neck pain, +/- headache, & +/- arm pain. B. Mobilization and/or manipulation and exercise is more effective than either alone. (Level 1 evidence, systematic review, Gross et al. Spine. 2004) NNT = 2 with Manual Therapy and Exercise to achieve one additional successful outcome than would have occurred with an alternative treatment approach
13. Evidence - Manual Therapy + ExerciseLong-Term ResultsA. Walker et al, Spine, 2008 – RCT, MTE vs MIN interventionDisability, UE pain, & patient perceived recovery significantly better at 3 week, 6 week, and 1 year follow-up in the MTE group.B. Bronfort et al, Spine, 2001 – RCT, Manip+ low tech TEX, high tech TEX, Manip alone1 year follow-up: Manip + low tech TEX group demonstrated significantly greater satisfaction with care
14. Pain better in both exercise groups vs. manip alone C. Evans et al, Spine, 2002 – 2 yr f/u of Bronfort et alSatisfaction maintained @ 2 yrs; Imp pain with both exercise groups maintained
15. Evidence: Manual Therapy + ExerciseHoving et al, Ann Intern Med, 2002A. RCT – Man Ther (no thrust, 6 visits) vs Ex/Stretch (12 visits) vs Meds/Advice (1 visit, more optional) B. Outcomes @ 7 week follow-up 1. Patient Perceived Recovery (defined a priori) Man Ther 68%; Ex/Stretching 51%; Meds/Advice 36% 2. Pain - Manual Therapy > Ex/Stretch > Meds/Advice C. Other Noteworthy Items 1. Man Ther & Ex/Stretching took less analgesics 2. Man Ther - missed less work 3. NNT with Manual Therapy is 3
16. Evidence - Manual Therapy + ExerciseCost EffectivenessA. Korthals-de Bos, BMJ, 2003Cost effectiveness analysis of Hoving et al RCT
17. Over 1 yr, patients with neck pain treated with 6 visits of Manual Physical Therapy and Exercise incurred an average cost of $402, compared to exercise alone ($1,167) or Meds/Advice group ($1241)Evidence - Manual Therapy + Exercise Cervicogenic Headache (CGHA)A. Cervicogenic Headache Criteria - Sjstaad et al, Headache, 1998Unilateral or unilateral dominant side-consistent headache associated with neck pain and aggravated by neck postures or movement
19. Headache frequency of at least one per week over a period of 2 months to 10 years B. Results of Jull et al, Spine, 2002 Man Ther & Exercise - most effective in treating CGHA , outcomes lasting up to 1 yr
20. Patients :less additional care sought, reduction in headache duration, neck pain, headache intensity, & frequency, reduction on medication intake (93% decrease in MT with Ex,100% decrease in Ex/MT only)
21. Average length of headaches was 6.1 years with moderate intensity headaches; Jull et al did not find chronicity to be a prognostic factor
22. 10% better chance of having a good to excellent outcome with combined therapiesIntervention: TractionI. Types of traction A. Manual vs. Mechanical B. Continuous vs. Intermittent1. Kisner, 1996.II. Effects of traction may include: A. Separation of vertebral bodies B. Distraction/Gliding of facet joints C. Widening of the intervertebral foramen D. Straightening of spinal curves E. Stretching of spinal musculature2. Graham N, 2006.
23. Evidence: TractionA. Mechanical traction for the cervical spine involves a tractive force applied to the neck via a mechanical system - Intermittent or ContinuousB. Indications: radicularsxs, sx with distraction test, fit CPR by Raney et alC. Systematic review, mod evidence of benefit for intermittent traction for acute @ chronic neck pain (Level 1 Evidence) (Graham, J Rehabil Med. 2006.)
24. Evidence: Traction CPR Raney et al, Eur Spine J, 2009A. Developed CPR to determine who would respond to traction68 patients/30 positive outcomes included in analysisB. 5 variable CPR identifiedAge >55Positive shoulder abduction testPositive ULTT ASymptom peripheralization with central posterior–anterior motion testing at lower cervical (C4–7) spinePositive neck distraction testC. 3/5 variables present= +LR of 4.8D. 4/5 variables present= +LR of 11.7 and post-test probability of 90.2% of having improvement
28. Multidisciplinary Approach: Referral to appropriate discipline (psychologist, vocational specialist, pharmaceutical) as indicated by presence of yellow flags1,3 1. Childs et al. J Orthop Sports Phys Ther. 2008.2. Nijs et al. Man Ther. 2011. Available at: http://www.ncbi.nlm.nih.gov/pubmed/216322733. Sterling M. Man Ther. 2009.
29. Evidence: Patient Education and CounselingRCT for patients with whiplashEncouragement to exercise/move vs collarExercise/move advice - outcomes/ pain vs collar (Crawford 2004)B. RCT for patients with whiplashEarly PT/education vs collarPT/education - long term outcomes vs collar (Rosenfeld 2003))
30. Refer: Who, Why and How to Refer- High quality evidence supports manual physical therapy and exercise for neck pain of gradual or sudden onset (ie trauma) that is provoked by movement, +/- associated headaches. Send to PT with“Evaluate and Treat” option checked.
31. You will receive a copy of your patient’s initial note as well as a copy of the discharge note summarizing their outcome.References Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine. 1994;19:1307–1309.
32. Bronfort G, Evans R, Nelson B, et al. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine. 2001;26(7):788-799.
33. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.
34. Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. J Orthop Sports Phys Ther. 2005;35(12):802-811.
35. Cleland JA, Glynn P, Whitman JM, et al. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007;87(4):431-440.
36. Cleland JA, Mintken PE, Carpenter K, et al. Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial. Phys Ther. 2010;90(9):1239-1250.
37. Cote P, Cassidy JD, Carroll L. The epidemiology of neck pain: what we have learned from our population-based studies. J Can Chiropract Assoc. 2003;47:284–290.
38. Crawford et al. Early management and outcome following soft tissue injuries of the neck - a randomised controlled trial. Injury. 2004;35(9):891-5.
39. Evans R, Bronfort G, Nelson B, Goldsmith CH. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine. 2002;27(21):2383-2389.
40. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(1):20-7.
41. Graham N, Gross AR, Goldsmith C. Mechanical traction for mechanical neck disorders: a systematic review. J Rehabil Med 2006;38(3):145-152. ReferencesGross AR, et al. A Cochrane Review of Manipulation and Mobilization for Mechanical Neck Disorders. Spine. 2004;29(14):1541-1548.oving JL, Koes BW, de Vet HCW, et al. Manual therapy, physical therapy, or continued care by general practitioner for patients with neck pain: a randomized controlled trial. Ann Intern Med. 2002;136:713-722.
42. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835-1843; discussion 1843.
43. Kisner C, Colby LA. The spine: traction procedures. In: Therapeutic exercise: foundations and techniques 3rd edn. Philadelphia: FA Davis Co.; 1996, p. 575-591.
44. Korthals-de Bos IBC, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003;326:911.
45. Lau HMC, Chiu TTW, Lam TH. The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain - a randomized controlled trial. Man Ther. 2011;16:141-147.
46. Linton SJ, Hellsing AL, Hallden K. A population-based study of spinal pain among 35-45-year-old individuals. Prevalence, sick leave, and health care use. Spine 1998;23(13):1457-6.
47. Nijs J, Paul van Wilgen C, Van Oosterwijck J, van Ittersum M, Meeus M. How to explain central sensitization to patients with “unexplained” chronic musculoskeletal pain: Practice guidelines. Man Ther. 2011. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21632273. Accessed August 11, 2011.
48. Raney NH, Petersen EJ, Smith TA, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009; 18(3):382.
49. Rosenfeld et al. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine. 2003;28(22):2491-8.
50. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. Headache. 1998;38:442-445.
51. ReferencesSterling M. Physical and psychological aspects of whiplash: important considerations for primary care assessment, part 2--case studies. Man Ther. 2009;14(1):e8-12.
52. Walker MJ, Boyles RE, Young BA, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine. 2008;22:2371-2378.
53. Wright A, Mayer T, Gatchel R. Outcomes of disabling cervical spine disorders in compensation injuries: a prospective comparison to tertiary rehabilitation response for chronic lumbar disorders. Spine. 1999; 24:178–183.