This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
‘Clinical Neurodynamics: clinical application from an anatomical perspective’ NVMT-symposium
This document provides an overview of neurodynamics, including:
1. The history and key figures in the development of neurodynamics from the 1920s to present.
2. Anatomy of the peripheral nervous system, including gross anatomy of major nerves in the upper and lower limbs, microanatomy of nerves, and biomechanics of nerve movement.
3. Applications to clinical examination including common nerve pathoanatomies and how joint movement affects nerves.
4. Research on neurodynamic techniques and their effects on nerve displacement and strain.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
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.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
This document discusses chronic pain from a physical therapy perspective. It outlines how acute pain becomes chronic, risk factors for chronic pain, and models for treating tendinopathies and chronic pain. Treatment approaches discussed include manual therapy, Tai Chi, graded exposure, and eccentric exercise programs like the Alfredson model. The document emphasizes examining for movement dysfunctions, addressing both physical and psychological factors, and finding the right balance between rest and progressive loading over time to reduce chronic pain.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
‘Clinical Neurodynamics: clinical application from an anatomical perspective’ NVMT-symposium
This document provides an overview of neurodynamics, including:
1. The history and key figures in the development of neurodynamics from the 1920s to present.
2. Anatomy of the peripheral nervous system, including gross anatomy of major nerves in the upper and lower limbs, microanatomy of nerves, and biomechanics of nerve movement.
3. Applications to clinical examination including common nerve pathoanatomies and how joint movement affects nerves.
4. Research on neurodynamic techniques and their effects on nerve displacement and strain.
The document discusses a maladaptive perception model of chronic low back pain (CLBP). It summarizes evidence that CLBP is associated with changes in brain structure and function, sensory processing, motor control, and body perception. A plausible model is that maladaptive cognitive and sensory processes could influence tissue loading, sensitivity, fear and worry in a way that perpetuates pain. Experimental research supports the idea that correcting maladaptive body perception through sensory discrimination training and graded cortical retraining can reduce pain. Functional rehabilitation targeting both cognitive perception and self-perception may help normalize movement behaviors and integrate activities to mutually normalize perception and pain.
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.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
This document discusses chronic pain from a physical therapy perspective. It outlines how acute pain becomes chronic, risk factors for chronic pain, and models for treating tendinopathies and chronic pain. Treatment approaches discussed include manual therapy, Tai Chi, graded exposure, and eccentric exercise programs like the Alfredson model. The document emphasizes examining for movement dysfunctions, addressing both physical and psychological factors, and finding the right balance between rest and progressive loading over time to reduce chronic pain.
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
ISMST - 2014 Presentation Final PresentationKenneth Craig
This document summarizes a case series study on the use of extracorporeal shockwave therapy (ESWT) to treat complex/neuropathic pain syndromes. It describes 12 patients who underwent 4 treatments of ESWT at weekly intervals and experienced significant reductions in pain, physical impairment, and emotional distress that were maintained at 24-week follow up based on standardized questionnaires. The proposed mechanisms of action of ESWT for neuropathic pain and rationale for its application are discussed. The study concludes that ESWT shows promise for treating neuropathic pain and warrants further research.
The document discusses chronic pain disorders, specifically chronic muscle pain. It provides epidemiological data showing chronic muscle pain is highly prevalent and costly. It discusses the importance of differential diagnosis to determine if pain has central or peripheral causes. Trigger points in muscles are identified as a key peripheral mechanism of chronic pain. The document also summarizes research supporting the role of sympathetic nervous system activation in triggering and maintaining trigger points. It concludes by outlining a treatment approach focused on education to change causal attributions of pain, in addition to physical therapies and cognitive interventions.
To Compare The Effect Of Proprioceptive Neuromuscular Facilitation Program Ve...IOSR Journals
Abstract: Low back pain has been a matter of concern, affecting up to 90% of population at some point in
their lifetime, up to 50% have more than one episode. People of all age group can be affected 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 Proprioceptive
neuromuscular facilitation program etc. It has been concluded in various studies core stability exercises and
Proprioceptive neuromuscular facilitation 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 Proprioceptive neuromuscular facilitation program and Core stabilization exercises on
low back pain patients. 40 subjects aged 30 – 50 years with low back pain for more than 4 weeks were made
part of the study based on inclusion and exclusion criteria and were then divided into two groups named A, B.
Group A received Proprioceptive neuromuscular facilitation and group B received Core stabilization exercises
and hot pack given initially for 10-15 minutes to the lower back. The exercise program was given for 4 weeks
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, Oswestry Disability Questionnaire and Functional Reach Test.
Results were analyzed using paired, unpaired t- test. Results showed that there is significant effect on pain,
Oswestry Disability Questionnaire and Functional Reach Test in the two groups but group A was clinically
more significant than groups B. The study concluded that patients with low back pain are benefitted more by
Proprioceptive neuromuscular facilitation program. So, Proprioceptive neuromuscular facilitation program
should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Proprioceptive Neuromuscular Facilitation.
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Positive and negative thinking can affect pain and outcomes following total knee arthroplasty (TKA). Psychological factors like catastrophizing and fear of movement have been shown to correlate with increased post-surgical pain and decreased function. Cognitive and behavioral interventions can help address these factors. Guided imagery, distraction techniques, relaxation strategies, and therapeutic touch have all demonstrated benefits in reducing pain for TKA patients. Negative pre-surgical expectations can lead to higher reported pain levels after surgery, while positive thinking may improve outcomes.
A two day workshop presented by Albion Musculoskeletal Therapist Paula Nutting. Paula discusses stretching options for treatment of conditions including headaches, lower back pain, shoulder problems and more. Queensland born Remedial massage therapist Paula Nutting will show you easy effective stretches to help return to normal muscle length which should lead to pain relief.
This document discusses medication options for low back pain. It begins by outlining first-line treatments including non-opioid analgesics like paracetamol and NSAIDs. Combination therapy using both is recommended if pain persists. The document then discusses second-line options if pain involves neuropathic components, such as tricyclic antidepressants, tramadol, or tapentadol. Strong opioids are a fourth-line treatment option if other medications are ineffective.
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
Physical therapy exercises for low back painHealthQuest
Physical therapy exercises are highly acclaimed solutions for low back pain. Under proper guidance, you can undertake various physical therapy exercises to reduce pain and bring back muscle strength.
Maladaptive movement and motor control impairments as underlying mechanismMeziat
Artigo (5) importante para a preparação para o curso de dor lombar crônica. "Diagnóstico e classificação da dor lombar crônica: Disfunções de movimento e de controle mal adaptativas como mecanismo principal." É antigo, algumas coisas mudaram, mas vale à pena ler.
The document summarizes several research initiatives being conducted by the NMCSD Pain Medicine department, including studies on:
1) Mirror therapy for phantom limb pain, which has shown promising results in reducing pain levels.
2) Intradiscal biacuplasty versus spinal fusion for treating low back pain, with biacuplasty showing reduced pain, improved function and fewer complications compared to fusion.
3) Developing a cricothyroidotomy simulator to enhance procedural training for deployed medical personnel, with initial studies showing improved comfort but moderate ease of use.
This document summarizes the management of tremor and spasticity in multiple sclerosis. It discusses tremor, including types, assessment, and interventions like physiotherapy, oral medications, botulinum toxin injections, and deep brain stimulation. It also covers spasticity, defining it as part of the upper motor neuron syndrome and discussing its impact. Assessment of spasticity is highlighted as key to management. A multidisciplinary team approach is advocated to accurately assess issues, determine treatment goals, and provide non-pharmacological and pharmacological interventions.
This document provides an overview of day 2 of a course on integrating whole health approaches for pain and suffering. The day includes sessions on integrative health and whole health in practice, as well as mind-body skills training. Specific mind-body skills covered are diaphragmatic breathing, progressive muscle relaxation, autogenic training, guided imagery, and biofeedback training. The benefits of these skills for reducing pain and stress are discussed. Manual therapies like chiropractic, osteopathic medicine, massage, and physical therapy are presented as professional care approaches. Complementary therapies like acupuncture are also explored, including evidence for their effectiveness in treating low back pain and other conditions.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
1) The document describes a study that examined the effectiveness of Action Potential Simulation (APS) Therapy in reducing pain for 60 people with multiple sclerosis (MS) over an 8-week period.
2) APS Therapy uses micro-currents to simulate nerve cell action potentials and is thought to help reduce pain and inflammation. In the study, participants received APS Therapy 3 times per week for 8 minutes each time.
3) Results found that APS Therapy significantly reduced usual and worst pain levels according to Visual Analogue Scale scores, with 78% of participants reporting reduced pain and 33% becoming pain-free. Common types of pain like back pain, joint pain, and neuropathic pain all saw significant reductions.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
Cervicogenic Dizziness - identification and treatmentNVMT-symposium
Cervicogenic dizziness is a controversial diagnosis caused by dysfunction in the upper cervical spine that results in imbalance or disequilibrium. It is identified through a 5-step process including characteristics of imbalance-type dizziness, neck pain or stiffness exacerbating dizziness, and physical exam findings. Sustained natural apophyseal glides are an effective manual therapy treatment, shown to decrease dizziness and pain more than mobilizations or placebo. Multi-modal treatment including balance exercises is also recommended. Long-term follow up shows treatment effects are maintained for up to 12 months.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
ISMST - 2014 Presentation Final PresentationKenneth Craig
This document summarizes a case series study on the use of extracorporeal shockwave therapy (ESWT) to treat complex/neuropathic pain syndromes. It describes 12 patients who underwent 4 treatments of ESWT at weekly intervals and experienced significant reductions in pain, physical impairment, and emotional distress that were maintained at 24-week follow up based on standardized questionnaires. The proposed mechanisms of action of ESWT for neuropathic pain and rationale for its application are discussed. The study concludes that ESWT shows promise for treating neuropathic pain and warrants further research.
The document discusses chronic pain disorders, specifically chronic muscle pain. It provides epidemiological data showing chronic muscle pain is highly prevalent and costly. It discusses the importance of differential diagnosis to determine if pain has central or peripheral causes. Trigger points in muscles are identified as a key peripheral mechanism of chronic pain. The document also summarizes research supporting the role of sympathetic nervous system activation in triggering and maintaining trigger points. It concludes by outlining a treatment approach focused on education to change causal attributions of pain, in addition to physical therapies and cognitive interventions.
To Compare The Effect Of Proprioceptive Neuromuscular Facilitation Program Ve...IOSR Journals
Abstract: Low back pain has been a matter of concern, affecting up to 90% of population at some point in
their lifetime, up to 50% have more than one episode. People of all age group can be affected 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 Proprioceptive
neuromuscular facilitation program etc. It has been concluded in various studies core stability exercises and
Proprioceptive neuromuscular facilitation 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 Proprioceptive neuromuscular facilitation program and Core stabilization exercises on
low back pain patients. 40 subjects aged 30 – 50 years with low back pain for more than 4 weeks were made
part of the study based on inclusion and exclusion criteria and were then divided into two groups named A, B.
Group A received Proprioceptive neuromuscular facilitation and group B received Core stabilization exercises
and hot pack given initially for 10-15 minutes to the lower back. The exercise program was given for 4 weeks
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, Oswestry Disability Questionnaire and Functional Reach Test.
Results were analyzed using paired, unpaired t- test. Results showed that there is significant effect on pain,
Oswestry Disability Questionnaire and Functional Reach Test in the two groups but group A was clinically
more significant than groups B. The study concluded that patients with low back pain are benefitted more by
Proprioceptive neuromuscular facilitation program. So, Proprioceptive neuromuscular facilitation program
should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Proprioceptive Neuromuscular Facilitation.
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Assessment and management of complex pain conditionsSaurab Sharma
This was a presentation made at NITTE University during their first Physiotherapy Conference where I was invited as a Speaker. I am posting this thinking if this will be useful revision for those who attended and may be of some use to those who could not listen.
Positive and negative thinking can affect pain and outcomes following total knee arthroplasty (TKA). Psychological factors like catastrophizing and fear of movement have been shown to correlate with increased post-surgical pain and decreased function. Cognitive and behavioral interventions can help address these factors. Guided imagery, distraction techniques, relaxation strategies, and therapeutic touch have all demonstrated benefits in reducing pain for TKA patients. Negative pre-surgical expectations can lead to higher reported pain levels after surgery, while positive thinking may improve outcomes.
A two day workshop presented by Albion Musculoskeletal Therapist Paula Nutting. Paula discusses stretching options for treatment of conditions including headaches, lower back pain, shoulder problems and more. Queensland born Remedial massage therapist Paula Nutting will show you easy effective stretches to help return to normal muscle length which should lead to pain relief.
This document discusses medication options for low back pain. It begins by outlining first-line treatments including non-opioid analgesics like paracetamol and NSAIDs. Combination therapy using both is recommended if pain persists. The document then discusses second-line options if pain involves neuropathic components, such as tricyclic antidepressants, tramadol, or tapentadol. Strong opioids are a fourth-line treatment option if other medications are ineffective.
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
Physical therapy exercises for low back painHealthQuest
Physical therapy exercises are highly acclaimed solutions for low back pain. Under proper guidance, you can undertake various physical therapy exercises to reduce pain and bring back muscle strength.
Maladaptive movement and motor control impairments as underlying mechanismMeziat
Artigo (5) importante para a preparação para o curso de dor lombar crônica. "Diagnóstico e classificação da dor lombar crônica: Disfunções de movimento e de controle mal adaptativas como mecanismo principal." É antigo, algumas coisas mudaram, mas vale à pena ler.
The document summarizes several research initiatives being conducted by the NMCSD Pain Medicine department, including studies on:
1) Mirror therapy for phantom limb pain, which has shown promising results in reducing pain levels.
2) Intradiscal biacuplasty versus spinal fusion for treating low back pain, with biacuplasty showing reduced pain, improved function and fewer complications compared to fusion.
3) Developing a cricothyroidotomy simulator to enhance procedural training for deployed medical personnel, with initial studies showing improved comfort but moderate ease of use.
This document summarizes the management of tremor and spasticity in multiple sclerosis. It discusses tremor, including types, assessment, and interventions like physiotherapy, oral medications, botulinum toxin injections, and deep brain stimulation. It also covers spasticity, defining it as part of the upper motor neuron syndrome and discussing its impact. Assessment of spasticity is highlighted as key to management. A multidisciplinary team approach is advocated to accurately assess issues, determine treatment goals, and provide non-pharmacological and pharmacological interventions.
This document provides an overview of day 2 of a course on integrating whole health approaches for pain and suffering. The day includes sessions on integrative health and whole health in practice, as well as mind-body skills training. Specific mind-body skills covered are diaphragmatic breathing, progressive muscle relaxation, autogenic training, guided imagery, and biofeedback training. The benefits of these skills for reducing pain and stress are discussed. Manual therapies like chiropractic, osteopathic medicine, massage, and physical therapy are presented as professional care approaches. Complementary therapies like acupuncture are also explored, including evidence for their effectiveness in treating low back pain and other conditions.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
1) The document describes a study that examined the effectiveness of Action Potential Simulation (APS) Therapy in reducing pain for 60 people with multiple sclerosis (MS) over an 8-week period.
2) APS Therapy uses micro-currents to simulate nerve cell action potentials and is thought to help reduce pain and inflammation. In the study, participants received APS Therapy 3 times per week for 8 minutes each time.
3) Results found that APS Therapy significantly reduced usual and worst pain levels according to Visual Analogue Scale scores, with 78% of participants reporting reduced pain and 33% becoming pain-free. Common types of pain like back pain, joint pain, and neuropathic pain all saw significant reductions.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
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.
The document discusses an innovative neuromodulation technique called Scrambler Therapy (ST) for treating Complex Regional Pain Syndrome (CRPS). A study was conducted on 37 patients with CRPS Type I who received 10 ST treatment sessions. Patients reported pain levels before, during, and 6 months after treatment using the Visual Analog Scale (VAS) and Brief Pain Inventory (BPI). Results showed significantly reduced pain scores after ST compared to before. A control group of 42 neuralgia patients undergoing the same ST treatment showed similar pain reductions. The study provides evidence that ST is an effective treatment for reducing chronic neuropathic pain like CRPS.
ZMPCZM016000.11.23 Electrotherapy for pain managementpainezeeman
This document summarizes research on the use of electrotherapy/electrical stimulation for pain management. It discusses two major theories for how electrotherapy relieves pain through gate control and opiate-mediated control. Research studies cited found electrotherapy effective at reducing pain and improving function for chronic musculoskeletal pain, low back pain, and post-operative knee pain. Meta-analyses showed significant decreases in pain from electrical nerve stimulation and reductions in analgesic consumption when using adequate stimulation parameters.
This study examined the effects of craniosacral therapy (CST) on heart rate variability (HRV) in 31 patients with subjective discomforts. HRV was measured before and after a 30-minute control rest period and a 30-minute CST session on consecutive days using a mobile device. Standard deviation of heart rate intervals (SDNN) and total power (TP), indicators of autonomic nervous system activity, increased significantly after CST but not the control rest. Heart rate also decreased significantly after CST compared to rest. However, interactions between treatment and HRV changes were not fully statistically significant. The study provides preliminary evidence that CST may positively influence autonomic nervous system regulation.
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.
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 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.
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 ...
This document describes a modern neuroscience approach for treating chronic spinal pain that combines pain neuroscience education with cognition-targeted motor control training. It discusses evidence that chronic spinal pain patients have abnormalities in brain structure and function, including decreased grey matter density, impaired motor control-related brain areas, and a sensitized brain due to central sensitization. The proposed approach has three phases: 1) Therapeutic pain neuroscience education to reconceptualize pain and explain central sensitization, 2) Cognition-targeted motor control training to address motor dysfunction, 3) Both 1) and 2) together to target peripheral and central mechanisms of chronic spinal pain.
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.
Spinal manipulation therapy (SMT) was more effective than medication for relieving acute or subacute neck pain in both the short and long term. Home exercise with advice (HEA) resulted in similar pain outcomes to SMT at most time points. For 272 participants with neck pain lasting 2-12 weeks, SMT had statistically significantly less pain than medication after 8 weeks and up to 1 year later. HEA was superior to medication for pain relief at 26 weeks. No important differences in pain were found between SMT and HEA. The trial demonstrated that SMT and HEA were both more effective than medication for acute or subacute neck pain.
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 various interventional treatments for headaches including occipital nerve blocks, pulsed radiofrequency of the occipital nerve, and occipital nerve stimulation. It provides epidemiological data on migraine and cluster headaches. It also discusses indications for occipital nerve blocks including various headache types. Peripheral nerve blocks are described as commonly used but with variable methodology. Effectiveness of occipital nerve stimulation is supported for various intractable headache conditions but lead migration is a technical challenge.
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.
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.
Similar to ‘Neurodynamics as a therapeutic intervention; the effectiveness and scientific evidence?’ (20)
Cervical Arterial Dysfunction – implications for clinical practice" NVMT-symposium
Cervical arterial dysfunction (CAD) is an area that requires a broader conceptual framework and updated clinical guidelines. CAD can initially manifest as neck and head pain and assessing blood pressure and performing cranial nerve and eye exams may help direct patient management. A new classification system categorizes CAD into 5 classes based on symptoms and risk level to better frame the condition. Evidence around CAD continues to emerge so re-evaluation of current practices is needed.
This document discusses contemporary theories of motor adaptation related to neck pain. It proposes that motor adaptation: (1) involves diverse changes from subtle muscle activity changes to movement avoidance; (2) is specific to individuals; (3) aims to protect painful areas from further injury; (4) can precede or follow pain; and (5) has potential long-term consequences if maintained improperly. Studies show examples of adaptive changes in people with neck pain, such as altered muscle recruitment patterns and delayed responses to perturbations. Long-term motor adaptations can potentially cause further injury issues if excessive or inappropriate.
Presentatie Dr. Sue Shea - Providing Compassionate Healthcare NVMT-symposium
Getting to the ‘Heart’ of the Therapeutic Relationship – A Compassionate Approach discusses the importance of compassion in healthcare. It defines compassion as desiring to help relieve another's suffering through understanding, empathy, and action. The document explores how compassion benefits both patients and providers physically and mentally. It emphasizes the need for communication, individualized care, and seeing patients as more than their conditions to establish compassionate therapeutic relationships.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientific evidence?’
1. Title
Name
Neurodynamics as a therapeutic
intervention; effectiveness and
scientific evidence
Dr Toby Hall
Specialist Musculoskeletal Physiotherapist
Adjunct Associate Professor (Curtin University)
Snr Teaching Fellow (The University of Western Australia)
Accredited Mulligan Concept Teacher
toby@manualconcepts.com
‘I cringe every time I hear a physical therapist claim
that they use neural mobilization’
‘We have assumed too much when it comes to neural tension
tests and the treatments associated with these assessments’
‘There is no plausible evidence that we can mobilize neural
tissue ….. or that "neural mobilization" is effective in the
treatment of musculoskeletal dysfunction’
Neural Mobilization: The
impossible?
Di Fabio Editorial JOSPT 2001
Presentation Outline
• Is neural mobilisation
the best way to
manage neural tissue
pain disorders: have
we assumed too
much?
– Drugs; Exercise;
Neural mobilisation;
Do nothing: advice?
Severe Mod
Nerve damage does
not always cause pain
Ishimoto, 2013
n=938
• Most common painful neuropathies,
pain present <20%
– Zusman, 2010; Bennea, 2006
• Traumacc nerve injury causes pain <10%
– Zusman, 2010; Marchedni, 2006
• Severe stenosis in 30% >40 years
– Ishimoto, 2013
• Neural mobilisacon not necessary in all
cases for nerve recovery
– Scrimshaw, 2001; Svernlov, 2009
3. Exercise reduces features of acute neuropathic pain
• Rat sciacc nerve CCI
– Daily progressive exercise on
treadmill (60 minutes) or
swimming (90 minutes with rests)
– Mechanical & thermal
hyperalgesia improved
– Aaenuated cytokine produccon
(TNF-α & IL-1β)
9
Chen, 2012
Thermal
hyperalgesia
Mechanical
hyperalgesia
Exercise reduces neuropathic pain
• Rat sciacc nerve chronic constriccon or
inflammatory model
– Treadmill daily progressive exercise 30 minutes 7 days
post surgery for 14 days
– Mechanical & thermal hyperalgesia improved
– Aaenuated pain within 3 weeks, sensory
hypersensicvity returned 5 days aher stopping exercise.
Effect of exercise reversed with opioid receptor
antagonist. Same effect if exercise delayed by 4 weeks.
• Exercise upregulates endogenous opioids
10
Stagg, 2011
CC
CCI NMI
Sham NM
Naive
Movement promotes nerve recovery: reduces NP
• Rat sciacc nerve CCI model
– 10 sessions NM under light anaestheczacon 14
days post injury
– Allodynia & hyperalgesia improved
– Significant change in glial cell density & nerve
growth factor expression in the DRG & spinal
cord
11
Santos, Molecular Pain 2011
Mechanical hyperalgesia
Exercise reduces NP post CCI
• Rat sciacc CCI
– Wheel running 6/52 prior to CCI & aher
CCI
– Allodynia improved aher injury
– Prior exercise decreased neuroimmune
signalling in DH & neuron injury.
Suppressed pro-inflammatory and
increased anc-inflammatory mediators
– Significant changes in glial cell density &
NGF expression in the DRG & spinal cord
• Exercise prevents pain, promotes
recovery & relieves pain
12
Grace, Pain 2016
Allodynia
4. Summary
Basic science
• Movement
– Exercise prevents development of NP
– Exercise aids nerve recovery aher injury & reduces NP in
animal models
• Passive limb movement
• Aerobic non-specific exercise: walking, running and swimming
• Neural mobilisacon
13
But…..
14
– Is movement effective in humans?
– Is movement effective for all
nerve disorders?
– Is movement effective for chronic
& acute nerve disorders?
– Is specific nerve movement (NM)
more effective than other forms
of movement/exercise?
What is the evidence in humans?
• Limited evidence
– SR of RCT’s for neural mobilization
– 20 trials identified; generally small scale
– Evidence NM more effective minimal treatment (pain &
disability), but no better than other treatments.
• Su, 2016
• SR identified 6 studies of NM for CTS
– NM better than no treatment: weak effect size
• McKeon, 2008
• Cochrane review found no benefit for NM
• Page, 2012
• European guidelines for management of CTS do not include
physiotherapy!
• Huisstede, 2014
15
Neural gliding exercise
• Limited & poor quality evidence for the effeccveness of
neural gliding exercises in CTS
16
Effectiveness of Nerve Gliding Exercises
on Carpal Tunnel Syndrome: A
Systematic Review
Ruth Ballestero-Pérez, PhD,a
Gustavo Plaza-Manzano, PhD,b
Alicia Urraca-Gesto, PT,c
Flor Romo-Romo, PT,c
María de los Ángeles Atín-Arratibel, MD,a
Daniel Pecos-Martín, PhD,d
Tomás Gallego-Izquierdo, PhD,d
and Natalia Romero-Franco, PhDe
ABSTRACT
Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding
exercises for the management of carpal tunnel syndrome (CTS).
Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database
(PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue,
gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical
trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged
18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of
systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All
studies were independently appraised using the PEDro scale.
Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients
after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2
studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater
and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound
and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale.
Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to
be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate
recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of
patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59)
Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement
Effectiveness of Nerve Gliding Exercises
on Carpal Tunnel Syndrome: A
Systematic Review
Ruth Ballestero-Pérez, PhD,a
Gustavo Plaza-Manzano, PhD,b
Alicia Urraca-Gesto, PT,c
Flor Romo-Romo, PT,c
María de los Ángeles Atín-Arratibel, MD,a
Daniel Pecos-Martín, PhD,d
Tomás Gallego-Izquierdo, PhD,d
and Natalia Romero-Franco, PhDe
ABSTRACT
Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding
exercises for the management of carpal tunnel syndrome (CTS).
Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database
(PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue,
gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical
trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged
18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of
systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All
studies were independently appraised using the PEDro scale.
Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients
after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2
studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater
and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound
and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale.
Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to
be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate
recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of
patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59)
Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement
Effectiveness of Nerve Gliding Exercises
on Carpal Tunnel Syndrome: A
Systematic Review
Ruth Ballestero-Pérez, PhD,a
Gustavo Plaza-Manzano, PhD,b
Alicia Urraca-Gesto, PT,c
Flor Romo-Romo, PT,c
María de los Ángeles Atín-Arratibel, MD,a
Daniel Pecos-Martín, PhD,d
Tomás Gallego-Izquierdo, PhD,d
and Natalia Romero-Franco, PhDe
ABSTRACT
Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding
exercises for the management of carpal tunnel syndrome (CTS).
Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database
(PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue,
gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical
trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged
18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of
systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All
studies were independently appraised using the PEDro scale.
Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients
after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2
studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater
and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound
and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale.
Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to
be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate
recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of
patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59)
Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement
INTRODUCTION
Carpal tunnel syndrome (CTS) is the result of an
irritation, compression, or stretching of the median nerve
as it passes through the carpal tunnel in the wrist. Symptoms
range from pain (mainly nightly)1
and paresthesia to thenar
eminence muscle atrophy2-6
This syndrome represents the
most prevalent neural injury in the general population
(1-4%)7-9
and workers at risk (15-20%)10-12
(those requiring
a
Departamento de Medicina Física y Rehabilitación, Universidad
Complutense de Madrid, Madrid, Spain.
b
Departamento de Medicina Física y Rehabilitación, Facultad
de Medicina, Universidad Complutense de Madrid; Instituto de
Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC),
Madrid, Spain.
c
Departamento de Rehabilitación y Fisioterapia, Hospital
Universitario Fundación Alcorcón, Madrid, Spain.
d
Departamento de Enfermería y Fisioterapia, Universidad de
Alcalá, Madrid, Spain.
e
Department of Nursing and Physiotherapy, University of the
7. Sub-groups of neural disorders
• Some pacents respond well others not - Why ?
– Sub-groups?
• Schafer, 2008
Compressive neuropathy
sliding
Central sensiczacon
Other
Axonal mechanosensicvity
Musculoskeletal
transverse sliding
Nerve swelling
Neural sub-group classificaEon based on mechanisms
Trauma, compression, or chemical
irritaEon of nerve/nerve roots
Neuropathic
pain sensory
hypersensiEvity
InflammaEon
Peripheral nerve
sensiEsaEon
NegaEve featuresPosiEve features
“Neuropathic”
Compressive
neuropathy
Musculoskeletal
pain
DeafferentaEon, loss of inhibiEon,
facilitaEon etc
AMS or nervi nervorum
sensiEzaEon
If none
Convergence
Axonal damage
Neuropathic Mixed
Inflammatory
Mechanism?
Hall, 2011
Classification of Neural Pain
• Syndrome based classification
Peripheral neural pain
DN, PHN, MS, radiculopathy, CTS, CUTS
• Mechanism based classification
Aß
C
Dorsal root
ganglion
Dorsal horn
midline
Woolf, 1999
Central mechanism
Peripheral mechanism
Classification by syndrome
• Does not explain pain
• Does not help treatment
– Patients with similar
diagnoses have diverse
symptoms
– Resolution of the
pathology does not always
improve the disorder