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.
Effectiveness of manual physical therapy in cervical radiculopatyDelky Meza
This systematic review examined the effectiveness of manual physical therapy for treating cervical radiculopathy. Four randomized controlled trials met the inclusion criteria. The trials involved the use of manual therapy techniques like mobilization combined with therapeutic exercises. The results showed that manual therapy along with exercises was effective in improving function, range of motion, and decreasing pain and disability levels for patients with cervical radiculopathy. High quality randomized controlled trials are still needed to establish clear treatment protocols.
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
This study examined the effects of manual therapy techniques on 5 former professional football players with histories of concussion. The players underwent cognitive, pain, and mobility tests before and after a 5-day intensive manual therapy program. The therapies aimed to address post-concussion imbalances and included craniosacral, visceral, and neuromeningeal techniques. Results showed improvements in quality of life, depression symptoms, sleep, pain levels, and range of motion. However, the small sample size and lack of controls were limitations; further research with more participants is needed to validate the findings.
This systematic review examined the effects of stretching before and after exercise on muscle soreness and injury risk. Five studies on stretching and muscle soreness were included, all using static stretching. A meta-analysis found that stretching had a negligible effect on soreness up to 72 hours later, reducing it by less than 2mm on a 100-mm scale. Two studies on injury risk in army recruits found that a specific stretching protocol reduced lower extremity injuries by 5%, which was not a meaningful risk reduction. The evidence does not support stretching for reducing muscle soreness or injury risk.
Three randomized controlled trials were reviewed to determine the efficacy of kinesio tape for shoulder impingement pathologies. Two studies found that kinesio tape used in conjunction with therapeutic exercises was more effective at reducing pain and improving function and range of motion, as measured by DASH and VAS scores, than exercises alone. One study found no significant differences between kinesio tape and sham taping without additional interventions. Overall, the evidence suggests kinesio tape combined with exercises may provide better outcomes than exercises alone for shoulder impingement, though more research is still needed.
This study examined the relationship between personality traits, pain tolerance, and exercise frequency in 97 undergraduate college students. Participants completed questionnaires on personality and exercise habits and a cold pressor task to measure pain tolerance. The study found no significant correlations between pain tolerance and personality traits like extraversion or neuroticism. There were also no significant correlations found between exercise frequency and pain tolerance or personality traits. The lack of significant findings may be due to limited variability in exercise habits and a lack of competitive athletes in the study population. Future research with a wider range of athletic abilities is needed to better understand connections between personality, pain tolerance, and athleticism.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study compared the effectiveness of hydroplasty versus intra-articular steroid injection for the treatment of idiopathic frozen shoulder. The study included 50 patients divided into two groups. The hydroplasty group showed significantly greater improvement in pain, shoulder function and range of motion compared to the steroid injection group at the 1 month and 3 month follow ups. Hydroplasty was found to be a more effective treatment for idiopathic frozen shoulder than intra-articular steroid injection alone.
12 aaom reeves workshop apr 19 research summaryNomienredes
The document summarizes research on prolotherapy, which involves injections to repair soft tissues like ligaments and tendons. It discusses definitions of prolotherapy and focuses on dextrose prolotherapy. It provides evidence that prolotherapy is not experimental, as it is taught in postgraduate medical programs and supported by published studies. Several studies on specific conditions like Achilles tendinosis, knee osteoarthritis, and low back pain are summarized, demonstrating safety and efficacy of prolotherapy though some need further research.
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
The document discusses shoulder pain, specifically subacromial pain/non-specific shoulder pain. It notes that shoulder pain is prevalent, can impact daily activities, and for 40% of patients the pain is ongoing or recurrent after 12 months. Imaging and physical exams are not always reliable in diagnosing the source of pain. Exercise appears to be the most promising intervention for shoulder pain, though what type or amount of exercise is unclear. A proposed intervention focuses on teaching patients self-management skills and a home exercise program with 1-5 sessions from a physiotherapist and proactive follow-up.
Atraumatic/MDI - Physiotherapy Principles and ManagementThe Arm Clinic
Physiotherapy management of multidirectional instability (MDI) of the shoulder is complex due to various drivers of the condition. Research on MDI has been difficult to interpret due to inconsistent definitions, heterogeneous populations, lack of standardization, and insensitive outcome measures across studies. Physiotherapy aims to address drivers both local to the shoulder like atypical muscle activation patterns and scapular kinematics, as well as central nervous system drivers involving cortical reorganization. Rehabilitation focuses on normalizing range of motion, improving neuromuscular control, and training into positions of vulnerability using modalities that target specific muscles individually and create synergies between muscles.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
IM PNS vs UC for Motor Impairment 2014_04_10Henry Wu
This randomized controlled trial compared peripheral nerve stimulation (PNS) to usual care for reducing hemiplegic shoulder pain after stroke. The study assessed whether PNS improved glenohumeral stability through enhancing motor recovery. Both PNS and usual care groups showed significant improvements over time in isometric shoulder strength, pain-free range of motion, and motor impairment measures, but there were no significant differences between the groups, suggesting PNS did not enhance motor recovery more than usual care.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
Exercise Therapy in the Management of Low Back PainOlubusola Johnson
This document discusses exercise therapy for the management of low back pain. It provides background on low back pain, noting that most episodes are non-specific and occur with normal activities. It reviews the epidemiology of low back pain and classifications by duration and etiology. The document then discusses the anatomy of core muscles like the transversus abdominis and multifidus. It reviews evidence on exercises for flexibility, strengthening, core stabilization and their effectiveness in treating low back pain according to studies. Core stabilization exercises targeting the transversus abdominis and multifidus are emphasized as important for both treatment and prevention of recurrent low back pain.
Br j sports med 2011-o'sullivan-bjsm.2010.081638Meziat
This editorial discusses the need for changes in how non-specific chronic low back pain (NSCLBP) is managed. It summarizes evidence that challenges the traditional view of LBP as a biomechanical problem and the focus on interventions aiming to increase spinal stability. While exercises targeting the deep spinal muscles were commonly prescribed, research shows these are not more effective than other treatments and do not predict better patient outcomes. The editorial calls for a biopsychosocial approach that addresses cognitive, behavioral, lifestyle and neurophysiological factors associated with NSCLBP.
Work related musculoskeletal disorders in physical therapistsTuğçehan Kara
This study examined work-related musculoskeletal disorders (WMSDs) in physical therapists through a prospective cohort study with 1-year follow up. The study found that 57.5% of physical therapists reported a WMSD in the follow up year, with a 1-year prevalence rate of 28% and incidence rate of 20.7%. Risk factors for low back WMSDs included patient transfers, repositioning, bent/twisted postures, and job strain. Risk factors for wrist/hand WMSDs included soft tissue work, joint mobilization, and manual therapy techniques. The study recommends safer patient handling policies and further research to examine the link between physical therapy exposures and WMSDs.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
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
The document summarizes 10 research breakthroughs from the last decade that support chiropractic care. Some of the key findings include:
1) Seeing a chiropractor as a first contact provider was associated with decreases in hospital admissions, days, surgeries, and pharmaceutical costs compared to conventional medicine.
2) One study found that upper cervical chiropractic care was associated with marked and sustained reductions in blood pressure similar to two-drug combination therapy.
3) A wellness program implemented by chiropractors improved various health metrics such as weight, blood pressure, and strength.
The document concludes that these and other studies provide evidence that chiropractic care can positively impact multiple dimensions
This study evaluated the discriminative validity of classifying musculoskeletal pain into three categories based on assumed underlying pain mechanisms: nociceptive pain, peripheral neuropathic pain, and central sensitization pain. The study assessed 464 patients with low back or leg pain using standardized criteria. Clinicians then assigned each patient's primary pain mechanism and indicated which clinical criteria were present. Statistical analysis identified clusters of 7, 3, and 4 criteria, respectively, that accurately predicted assignment to the three pain categories. The results provide preliminary evidence of discriminative validity for mechanisms-based classification of musculoskeletal pain. Further research is still needed to fully validate such classification systems.
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 ...
Evaluation of Level of Anxiety among the Patients of Hip OsteoarthritisBRNSSPublicationHubI
The study evaluated anxiety levels among 98 patients with hip osteoarthritis in Pakistan. Most patients were female (57.1%) and from rural areas (68.3%). When assessing anxiety, 44.8% of patients reported moderate anxiety and 25.5% reported severe anxiety. The study determined that patients with hip osteoarthritis generally experienced moderate anxiety levels due to factors like pain limiting physical activity and independence, concerns about disability progression, and impacts on socioeconomic status from reduced work ability.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This document reviews current treatment strategies for spinal compression fractures and potential future directions. The major current treatment strategies are conservative pain management and vertebral augmentation procedures like vertebroplasty and kyphoplasty. However, there is a lack of consensus on the optimal treatment approach. Prospective clinical trials with new biomarkers are needed to better assess treatment efficacy and develop clearer guidelines. The document provides an overview of common pain management strategies like NSAIDs, opioids, and bisphosphonates as well as vertebral augmentation procedures and calls for future research to establish standardized treatment pathways.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
This study examined whether pain-related psychosocial factors predicted whether treatment gains were maintained following participation in a physical rehabilitation program for musculoskeletal injuries. The study assessed 310 individuals at admission to rehabilitation, discharge, and 1-year follow up. It found that individuals with high scores on measures of pain catastrophizing and fear of pain at discharge were more likely to experience a return of their pain symptoms and failure to maintain treatment gains at the 1-year follow up. The results suggest that treatment gains may not be sustained long-term if end-of-treatment scores on catastrophizing and fear of pain remain elevated.
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.
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
This randomized controlled trial compared the effectiveness of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain. The trial found that:
1) SMT had a statistically significant advantage over medication in reducing pain up to 1 year after treatment based on participant-reported pain levels.
2) HEA was as effective as SMT, with no important differences in pain reduction between the two treatments at any time point.
3) Both SMT and HEA were more effective for reducing neck pain than medication in both the short and long term.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
This case study describes a 56-year-old female seen for physical therapy two months post lumbar laminectomy and fusion surgery. Despite surgery and prior physical therapy, she continued to experience right lower extremity weakness, hip stiffness, and pain with sitting, standing, and activities. A physical examination revealed decreased hip strength and range of motion on the right side. Due to persistent groin pain and minimal functional improvements, the physical therapist referred the patient to an orthopedic specialist who diagnosed severe right hip osteoarthritis requiring hip replacement surgery. Following hip surgery, the patient's pain and function significantly improved.
This randomized controlled trial evaluated the efficacy of platelet-rich plasma (PRP) injections for reducing return-to-play times in professional athletes with acute hamstring injuries. 90 athletes were randomized to receive a PRP injection, platelet-poor plasma injection, or standard rehabilitation only (no injection). All athletes followed a standardized intensive 6-stage rehabilitation program. The study found no benefit of PRP injections over rehabilitation alone. Athletes who received PRP injections had significantly longer return-to-play times than those who received platelet-poor plasma or no injections. Intensive physiotherapy-led rehabilitation remains the primary means of ensuring optimal return to sport following muscle injuries.
This document discusses hamstring strain injuries, which are common in sports requiring sprinting. It notes that about one-third of hamstring injuries will recur within two weeks of returning to sport, suggesting rehabilitation programs may be inadequate. The injuries typically occur during the late swing phase of running when the hamstrings absorb energy. Rehabilitation aims to address weakness, inflexibility and movement impairments from the injury. Future research should develop more individualized rehabilitation based on injury location and measures of reinjury risk.
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
This document provides guidelines from the Infectious Diseases Society of America (IDSA) for the diagnosis and management of skin and soft tissue infections (SSTIs) updated in 2014. It summarizes recommendations for evaluating and treating common SSTIs like impetigo, ecthyma, and cutaneous abscesses. Gram stains and cultures are recommended for diagnostic purposes but treatment can begin without these in typical cases. Incision and drainage is the primary treatment for purulent SSTIs like abscesses along with antibiotics for systemic signs of infection. The guidelines provide recommendations for appropriate antibiotic therapy based on infection severity and whether methicillin-resistant Staphylococcus aureus is a concern.
Br j sports med 2014 effectiveness of exercise interventionsSatoshi Kajiyama
This systematic review and meta-analysis examines the effectiveness of exercise interventions in preventing sports injuries. The review analyzed 25 randomized controlled trials involving over 26,000 participants and 3,400 injuries. It found that overall, exercise programs were effective in reducing sports injuries, with certain types of exercises working better than others. Strength training was the most effective at reducing injuries, cutting the risk to less than one-third. Proprioception training and programs combining multiple exercises also significantly reduced injuries. Both acute and overuse injuries saw reduced risk from exercise programs.
This document provides a summary of discussions from the second International Scientific Tendinopathy Symposium (ISTS) held in 2012 regarding tendinopathy clinical and research issues. It highlights recent findings in several areas:
1) Advances in the understanding of the pathogenesis and involvement of the central nervous system in chronic tendon pain.
2) Updates on specific tendinopathy locations including the Achilles, patella, rotator cuff, and elbow tendons.
3) The role of imaging techniques like ultrasound and MRI in diagnosis, noting their limitations, and emerging quantitative analysis methods.
4) Factors to consider in developing individualized rehabilitation plans for tendinopathy patients.
The document discusses the basics of soft tissue examination for practitioners who treat the human structure using their hands. It emphasizes the importance of functional testing through observation, palpation, and passive and contractile muscle testing to determine the source of soft tissue pain. Dr. James Cyriax developed orthopedic medicine based on examining, diagnosing and treating non-surgical lesions of the musculoskeletal system through assessing soft tissues and their patterns of limitation.
Pitching biomechanics place high stresses on the shoulder and elbow joints that can lead to injury. During pitching, the lag between upper body and arm rotation forces the shoulder into excessive horizontal abduction and external rotation. This places tension on anterior shoulder structures and compresses posterior rotator cuff and labrum. Extreme external rotation also increases tension on the biceps-labrum complex, potentially causing SLAP lesions. Additionally, shoulder movement creates high valgus moments at the elbow, stressing medial elbow structures and increasing injury risk. Evidence links pitching mechanics to increased joint loading and certain pitching techniques to reports of pain and injury.
This case series describes the conservative treatment of 6 collegiate athletes (4 males, 2 females aged 19-22) diagnosed with a sports hernia, or athletic pubalgia. A sports hernia is an injury involving weakness of the posterior inguinal wall without a hernia, causing severe groin pain with exertion. The athletes were evaluated for 5 key findings of sports hernia and treated with physical therapy including manual therapy, exercises, for a mean of 7.7 sessions. 3 athletes improved with conservative care alone while the other 3 improved after additional surgical repair and a mean of 6.7 sessions of post-surgical physical therapy. Conservative management including manual therapy appears to be a viable initial treatment option for sports hern
A neuroscience approach_to_managing_athletes_with_low_back_pain_puentedura_ph...Satoshi Kajiyama
This document discusses a neuroscience-informed biopsychosocial approach to managing low back pain in athletes. It begins by describing the traditional biomedical model used to treat athlete back pain, focusing on identifying pathology and correcting biomechanics. However, research shows this approach often fails to explain persistent pain. The document then proposes a biopsychosocial model incorporating knowledge of anatomy, biomechanics, tissue pathology, pain mechanisms, and how the nervous system processes injury and pain. It describes moving beyond a solely biological understanding to address psychological and social factors. Finally, it discusses components of a biopsychosocial approach including the brain's representation of injury and how the nervous system's sensitivity can develop centrally over time independent
The document discusses treatment of sacroiliac joint dysfunction. It describes the axes and movements of the sacroiliac joint, including nutation and counternutation. Physiologic and non-physiologic movements are outlined. Muscle functions related to sacroiliac joint movement are provided. Normal gait mechanics and pelvic girdle function are summarized. Examination techniques including positional tests, motion tests, passive mobility tests, and pain provocation tests are described. Common sacroiliac joint dysfunctions like forward and backward sacral torsion are discussed.
This study examined how altering stride length affects physiological exertion and fastball velocity in baseball pitchers. Nineteen pitchers participated in simulated games where they pitched with either a 25% increased or decreased stride length from their desired stride length. Physiological measures like heart rate, salivary biomarkers, and perceived exertion were assessed throughout. Pitching with a shortened stride reduced heart rate and improved recovery capacity, but did not affect fastball velocity. Pitching with a lengthened stride increased physiological stress without improvements in performance. Therefore, stride length can be adjusted as a biomechanical response to exertion without compromising velocity.
This document summarizes current concepts in evaluating and treating shoulder injuries in overhead throwing athletes. It discusses the unique physical characteristics of overhead throwers, including increased shoulder range of motion (ROM) with excessive external rotation and decreased internal rotation. It also notes adaptations in scapular positioning. The summary provides an overview of evaluating the throwing shoulder through examination of ROM, joint laxity, scapular positioning, and strength as well as understanding the athlete's injury history and symptoms. Adaptations like increased external rotation are normal for overhead athletes while decreased total ROM or a hard end feel during internal rotation may indicate pathology.
The document discusses sleep in elite athletes and potential nutritional interventions to enhance sleep. It summarizes that sleep is important for physiological recovery but many athletes experience reduced quality and quantity of sleep, which can negatively impact performance. Certain nutrients like carbohydrates, tryptophan, and melatonin have been investigated as possible sleep aids. While some research has studied the effects of nutrition on sleep, more research is still needed to determine the best nutritional interventions to enhance sleep for athletes.
1. Intertester Reliability of the Cyriax Evaluation in
Assessing Patients With Shoulder Pain
Authors: Geraldine L. Pellecchia, MA, PT1 Julie Paolino, PT, ATC2 Jeanne Connell,
PT3
AFFILIATIONS:
1 Assistant Professor, University of Hartford, Physical Therapy Program, 200 Bloomfield
Avenue, West Hartford, CT 06117; Research Coordinator, Physical Therapy and Sports
Medicine Associates, Farmington, CT
2 Site Director, Physical Therapy and Sports Medicine Associates, East Hartford, CT
3 Ms. Connell was Regional Director of Physical Therapy and Sports Medicine
Associates at the time of this study.
Published: Journal of Orthopaedic & Sports Physical Therapy, 1996, Volume: 23
Issue: 1 Pages: 34-38 doi:10.2519/jospt.1996.23.1.34
PDF
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Abstract
James Cyriax's approach to diagnosis and treatment of soft tissue disorders is
frequently used by orthopaedic and sport physical therapists. The reliability of using
Cyriax' s system to determine diagnostic categories, however, has not been
established. The purpose of this study was to examine the intertherapist reliability of
assessments made using Cyriax's shoulder evaluation. Twenty-one cases of painful
shoulder were evaluated independently by two experienced physical therapists.
Therapists used a checklist to indicate their assessment of each case by selecting a
specific shoulder lesion or by indicating that the case did not fit the Cyriax model.
Cohen's kappa statistic was used to measure intertherapist agreement. Therapists
classified 19 of the 21 cases into the same diagnostic category for a percent agreement
of 90.5%. The kappa value was .875, indicating “almost period” agreement. Both
therapists classified the same four cases of painful shoulder as not fitting the Cyriax
model of soft issue examination. The results of this study show that the Cyriax
evaluation can be a highly reliable schema for assessing patients with shoulder pain.
Read More: http://www.jospt.org/doi/abs/10.2519/jospt.1996.23.1.34
2. Diagnosisof ShoulderPain by History and
Selective Tissue Tension: Agreement
Between Assessors
Nigel C. A. Hanchard, MSc1
Tracey E. Howe, PhD2
Meg M. Gilbert, BSc(Hons)3
Study Design: Evaluation of agreement between assessors.
Objective: To evaluate agreement between an expert in selective tissue tension (STT) and 3
other
trained assessors, all using STT in conjunction with a preliminary clinical history, on their
diagnostic labeling of painful shoulders.
Background: Consensus on diagnostic labeling for shoulder pain is poor, hampering
interpretation
of the evidence for interventions. STT, a systematic approach to physical examination and
diagnosis, offers potential for standardization, but its reliability is contentious.
Methods and Measures: Four trained assessors, 1 of whom was considered an expert,
separately
assessed 56 painful shoulders in 53 subjects (32 male [mean ± SD age, 51 ± 13 years], 21
female
[mean ± SD age, 57 ± 12 years]), using STT in conjunction with a preliminary clinical history.
Assessors labeled each painful shoulder as ‘‘rotator cuff lesion,’’ ‘‘bursitis,’’ ‘‘capsulitis,’’ ‘‘other
diagnosis,’’ or ‘‘no diagnosis.’’ Combinations of diagnoses were allowed.
Results: A diagnosis was made in every case, with less than 7% of the diagnoses being
combined.
With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI])
between the expert assessor and each of the other assessors was good, ranging from 0.61
(0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert
and each of the others (dichotomized data) ranged from 0.35 (–0.03-0.73) to 0.58 (0.29-0.87)
for
bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96)
for
rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses.
Conclusions: Overall, STT in conjunction with a preliminary clinical history enables good
agreement between trained assessors. Future work is required to evaluate its criterion validity.
J Orthop Sports Phys Ther 2005;35:147-153.
Key Words: orthopedics, physical therapy, tests
3. Reliability of Classifications Derived From Cyriax's Resisted Testing in Subjects
With Painful Shoulders and Knees
Authors: Karen W. Hayes , PT, PhD1 Cheryl M. Petersen , PT, MS2
AFFILIATIONS:
1Associate Professor, Physical Therapy and Human Movement Sciences, Director, Professional
Education, Department of Physical Therapy and Human Movement Sciences, Feinberg School of
Medicine, Northwestern University, Chicago, IL.
2Assistant Professor, Department of Physical Therapy, Concordia University Wisconsin, Mequon, WI.
Please send correspondence to Karen W. Hayes, 645 N. Michigan Avenue, Suite 1100, Chicago, IL
60611. E-mail: k-hayes@northwestern.edu
Published: Journal of Orthopaedic & Sports Physical Therapy, 2003, Volume: 33
Issue: 5 Pages: 235-246 doi:10.2519/jospt.2003.33.5.235
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Abstract
Study Design Intrarater and interrater reliability.
Objectives Examine intrarater and interrater reliability of the resisted-testing component
of Cyriax's selective tension testing for patients with painful shoulders and knees.
Background Clinicians make diagnostic and intervention decisions about lesions in
contractile tissues based on resisted testing. Diagnostic and intervention decisions
require reliable data gathering, especially when more than 1 physical therapist manages
a patient. No studies have examined agreement of the results of the resisted tests used
in selective tension testing, either within or between physical therapists, in subjects
having pathology.
Methods and Measures Subjects with pain in 1 knee (18 male, 22 female; mean age ±
SD = 31.8 ± 9.5 years) or shoulder (21 male, 25 female; mean age ± SD = 34.3 ± 12.9
years) were examined twice. Referring diagnoses included ligament injuries, overuse
syndromes, joint instability, and postsurgical symptoms, with some subjects seeking
initial diagnosis. Two physical therapists used standardized positions to evaluate 2 knee
motions or 6 shoulder and elbow motions. Evaluators applied maximal isometric manual
resistance and rated the contraction as strong or weak while subjects identified the
presence or absence of pain during the contraction. Evaluators did not interview the
subjects and were masked to previous test results. Analyses included percentage of
agreement, kappa coefficients, confidence intervals, and maximum kappa coefficients.
Results Intrarater kappa coefficients ranged from 0.44 to 0.82 and interrater coefficients
ranged from 0.00 to 0.46. The small number of subjects who were classified as weak
affected the kappa coefficients. In the intrarater condition, evaluators averaged 91% of
maximum kappa for the knee and 66.5% for the shoulder. In the interrater condition,
they averaged 60.4% of the maximum kappa for both the knee and the shoulder.
4. Conclusions Based on 2 physical therapist evaluators with previous education in the
selective tension system and an additional 6 hours of formal training on the methods,
intrarater reliability of resisted tests was generally acceptable for the knee but not for the
shoulder. Interrater reliability of these tests, however, was generally not acceptable.
Results were limited by subjects who were younger and had mostly chronic conditions
that were mildly to moderately severe and by the small subject samples in the analyses.
Reliability might be improved by more intensive training of the evaluators and by
standardizing the magnitude of the applied resistance and stabilization of the subjects.
Read More: http://www.jospt.org/doi/abs/10.2519/jospt.2003.33.5.235
5. Article about END-FEEL
Construct Validity of Cyriax's Selective Tension Examination: Association of End-
Feels With Pain at the Knee and Shoulder
Authors: Cheryl M. Petersen, PT, MS1Karen W. Hayes, PT, PhD1
AFFILIATION:
1 Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical
School, Chicago, Ill.
Send correspondence to: Cheryl M. Petersen, 645 N. Michigan Avenue, Suite 1100, Chicago, IL 60611.
E-mail: c-petersen@nwu.edu
Published: Journal of Orthopaedic & Sports Physical Therapy, 2000, Volume: 30 Issue: 9
Pages: 512-527 doi:10.2519/jospt.2000.30.9.512
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Abstract
Study Design Descriptive.
Objectives To examine the relationship between pain and normal and abnormal-pathologic end-
feels during passive physiologic motion assessment at the knee and shoulder. We theorized
that abnormal-pathologic end-feels would be more painful than normal end-feels.
Background End-feel testing and pain intensity information are part of physical therapy
musculoskeletal patient examinations. End-feels are categorized as normal or abnormal-
pathologic. No previous studies have examined the relationship between pain during end-feel
testing and the type of end-feel.
Methods and Measures Two physical therapists examined subjects with unilateral knee or
shoulder pain. Each subject was examined twice. Passive physiologic motions, 2 at the knee
and 5 at the shoulder, were tested by applying an overpressure at the end of range of motion
using standardized positions. Subjects reported the amount of pain (0–10) immediately after the
evaluator recorded the end-feel. Analyses included one-way ANOVAs and post-hoc Tukey's
Honestly Significant Difference tests.
Results Some abnormal-pathologic end-feels were significantly more painful than the normal
end-feels at both the knee and the shoulder for all physiologic motions. Among the abnormal-
pathologic end-feel categories there were no statistical differences in pain intensity, although
small samples in some categories may be responsible for this finding.
Conclusion Abnormal-pathologic end-feels are associated with more pain than normal end-feels
during passive physiologic motion testing at the knee or shoulder. Dysfunction should be
suspected when abnormal-pathologic end-feels are present. J Orthop Sports Phys Ther
2000;30:512–527.
Read More: http://www.jospt.org/doi/abs/10.2519/jospt.2000.30.9.512