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A critical review of the role of manual therapy in the treatment of individuals with low back pain. 人工疗法在腰背痛患者治疗中的作用评述。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-10-01 Epub Date: 2024-02-21 DOI: 10.1080/10669817.2024.2316393
Jean-Pascal Grenier, Maria Rothmund

The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey.

预计到 2050 年,腰背痛(LBP)病例数将增至 8 亿以上。为了解决与患病率上升相关的巨大疾病负担,我们需要有效的治疗方法。虽然临床实践指南(CPG)一直建议将非药物疗法作为一线治疗方法,但有关人工疗法(MT)治疗腰背痛的建议却各不相同。本综述旨在批判性地总结这些建议背后有关手法治疗的现有证据,仔细研究其作用机制,并就如何将这些知识融入以人为本的方法中为临床医生提出一些可行的步骤。尽管CPG的建议不尽相同,但MT与其他现有治疗方法一样有效,可以提供给腰痛患者,尤其是作为运动和教育的一揽子治疗方案的一部分。MT的大多数效果并非该技术所特有。腰椎间盘突出症和其他干预措施有几种共同的作用机制,它们是治疗成功的中介。这些机制包括患者的期望、先前的经验、信仰和信念、认识信任以及非特异性的环境效应。虽然 MT 对腰椎间盘突出症患者来说比阿片类药物更安全,但仅此还不够。我们的目标是鼓励临床医生摒弃 MT 中过时和被驳斥的观点,采用以人为本的方法,这种方法植根于全面的生物心理社会框架,同时纳入患者的信念,解决疾病行为问题,并寻求了解每位患者的心路历程。
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引用次数: 0
The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. 大多数评估颈部活动和手法治疗颈部疼痛的临床试验缺乏实用方法:对 174 项试验的系统回顾。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-10-01 Epub Date: 2024-03-25 DOI: 10.1080/10669817.2024.2327127
Kyle A Cottone, Matthew R Schumacher, Jodi L Young, Daniel I Rhon

Background: Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice.

Objective: The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum.

Methods: A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool.

Results: A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias.

Conclusion: Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.

背景:颈椎疾病是全球治疗费用最高的肌肉骨骼疾病之一。关节活动和手法已被证明是治疗颈部疼痛的有效方法。然而,其推广性和临床应用取决于指导其使用的试验设计的性质。评估颈椎病手法治疗的随机对照试验(RCT)在疗效(解释性)-效果(实用性)范围内的程度往往会影响到如何将研究结果转化为临床实践:本系统综述旨在确定颈椎病手法治疗的 RCT 在疗效谱中的位置:方法: 我们在 PubMed、CINAHL 和 CENTRAL 等三个电子数据库中检索了从开始到 2023 年 5 月期间发表的试验。使用 "纳入试验的疗效-效果谱评级"(RITES)工具对使用关节活动或手法治疗颈椎病的研究试验进行疗效-效果谱评估,并使用 "修订版科克伦偏倚风险 "工具评估偏倚风险:共有 174 项试验符合资格要求。RITES领域二的试验设置(71.3% vs 16.1%)、领域三的干预措施灵活性(62.1% vs 23%)和领域四的试验与对比干预措施的临床相关性(51.7% vs 29.3%)均倾向于疗效而非有效性。与疗效相比,领域一的参与者特征(36.8% 对 44.8%)更强调有效性。大多数研究(96%)至少存在一定的偏倚风险:结论:在评估关节活动和手法治疗颈痛效果的研究性临床试验中,半数以上倾向于疗效(解释性)设计,而非有效性(实用性)设计。未来有关该主题的研究性临床试验应考虑更加重视实用性试验的设计内容,以更好地反映临床实践中的实际情况。
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引用次数: 0
Pain improvement after three weeks of daily self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain: a case report. 病例报告:一名新近发病的足跟痛患者每天使用筋膜球进行自我交叉摩擦按摩三周后疼痛有所改善。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-10-01 Epub Date: 2024-03-06 DOI: 10.1080/10669817.2024.2325186
Martin Alfuth

Background: Plantar heel pain is described as sharp pain at the medial plantar aspect of the calcaneus and medial longitudinal arch of the foot. There are various treatment options that usually need a clinician or a therapist for application. The present case report aimed to describe the outcomes of self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain.

Case description: The patient was a 42-year-old man who reported plantar heel pain during the first steps in the morning along with decreased function of the foot and ankle lasting about three months. He was instructed to self-execute cross-friction massage using a fascia ball daily in the evening at home for six weeks.

Outcomes: Pain during treatment decreased from a Numeric Pain Rating Scale (NPRS)-score of 8/10 and from a Short-Form McGill Pain Questionnaire (SF-MPQ)-score of 34/60 at initial treatment to NPRS- and SF-MPQ-scores of 0/10 and 0/60, respectively, after about three weeks. The patient reported no pain and restored function after six weeks of treatment, and in the follow-up measurements.

Discussion: Daily self-executed cross-friction massage using a fascia ball may be a useful alternative intervention for treating recent-onset plantar heel pain.

背景:足跟痛是指小腿内侧足底和足内侧纵弓处的剧烈疼痛。目前有多种治疗方法,但通常需要临床医生或治疗师来实施。本病例报告旨在描述一名近期发病的足跟痛患者使用筋膜球进行自我交叉摩擦按摩的效果:患者是一名 42 岁的男性,报告称在早上迈出第一步时足底跟部疼痛,同时足部和踝关节功能下降,持续约三个月。医生指导他每天傍晚在家使用筋膜球进行交叉摩擦按摩,持续六周:治疗期间的疼痛从最初治疗时的数字疼痛评分量表(NPRS)8/10 分和短式麦吉尔疼痛问卷(SF-MPQ)34/60 分分别降至大约三周后的 NPRS 0/10 分和 SF-MPQ 0/60。治疗六周后,患者表示没有疼痛感,功能也得到了恢复:讨论:每天使用筋膜球进行自我交叉摩擦按摩可能是治疗近期发病的足跟痛的一种有效替代干预方法。
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引用次数: 0
Study of the electromyographic activity in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling: a randomized clinical trial. 干针疗法后髌骨股骨痛综合征伴继发性肌筋膜疼痛综合征的肌电活动研究:随机临床试验。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-28 DOI: 10.1080/10669817.2024.2396709
Fatemehzahra Khammar, Cyrus Taghizadeh Delkhoush, Fatemeh Ehsani

Objectives: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling.

Methods: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling.

Results: During step-up, the onset and offset latencies of the local and proximal muscles of the knee joint, except for the offset latency of the gluteus maximus muscle (p-value=0.162), significantly decreased in the intervention group compared to the control group (p-value<0.046). Additionally, there were no significant differences (p-value>0.116) between the groups in the amplitude ratio of the local and proximal muscles of the knee joint during both step-up and step-down.

Conclusions: The present study revealed that dry needling of the popliteus muscle with secondary myofascial pain syndrome associated with patellofemoral pain syndrome constructively modified the local and proximal motor control of the knee joint during step-up.

目标:腘绳肌肌筋膜疼痛综合征可能会因本体感觉和痛觉传入的变化而改变受影响肌肉和相关肌肉的运动控制,从而加重髌骨股骨疼痛综合征。本研究的主要目的是探讨髌骨股骨痛综合征伴有继发性肌筋膜疼痛综合征的膝关节局部和近端肌肉在干针疗法后的肌电活动,特别是影响腘绳肌的肌电活动:腘绳肌肌筋膜疼痛综合征可能会因本体感觉和痛觉传入的变化而改变受影响肌肉和相关肌肉的运动控制,从而加重髌骨股骨疼痛综合征。本研究的主要目的是探讨干针疗法后,髌骨股骨痛综合征伴继发性肌筋膜疼痛综合征(特别是影响腘绳肌的肌肉)患者膝关节局部和近端肌肉的肌电活动:结果:在上台阶过程中,除臀大肌的偏移潜伏期(P值=0.162)外,干预组膝关节局部肌肉和近端肌肉的起始和偏移潜伏期均显著下降,而对照组在上台阶和下台阶过程中膝关节局部肌肉和近端肌肉的振幅比值均显著下降(P值=0.116):本研究表明,干针治疗腘绳肌伴继发性肌筋膜疼痛综合征和髌骨股骨疼痛综合征能建设性地改变膝关节在上台阶时的局部和近端运动控制。
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引用次数: 0
Short-term effects of Kinesiotaping combined with a rehabilitation program for rotator cuff-related shoulder pain: a randomized, assessor-blinded clinical trial. 运动塑形结合康复计划治疗肩袖相关疼痛的短期效果:一项随机、评估者盲法临床试验。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-09 DOI: 10.1080/10669817.2024.2387913
Trang Ngoc Anh Nguyen, Nam Hoai Nguyen, Duy Kim Vu, Lam Tung Ngoc Cu

Objectives: This study aimed to determine the clinical efficacy of Kinesiotaping (KT) combined with a rehabilitation program to reduce symptoms and functional limitations in patients with Rotator Cuff-Related Shoulder Pain (RCRSP) in Vietnam.

Methods: In total, 82 participants who were diagnosed with RCRSP were randomly allocated into two groups. Both groups received a standard rehabilitation program; additionally, the intervention group was treated with KT. Outcomes, assessed at baseline, and 3, 7, and 14 days postintervention, included pain intensity (Visual Analogue Scale, VAS), functional disability (Shoulder Pain and Disability Index, SPADI), and active range of motion (ROM).

Results: The KT group exhibited significant improvements in all outcome measures. VAS scores decreased by an average of 13.3 points in the KT group at 14 days, which was notably greater than that in the control group (95% CI: -17.77 to -8.82). SPADI scores also improved significantly in the KT group, with reductions of -11.36, -15.27, and -13.3 at days 3, 7, and 14, respectively. Regarding ROM, the KT group showed notable improvements in flexion and external rotation, with flexion ROM differences of 10.78, 10.35, and 11.8 degrees at the respective time points. No significant changes were observed in the abduction or internal rotation ROM. After adjusting for age, baseline scores, and gender, there was a statistically significant interaction between Group and Time on the VAS, SPADI, and ROM abduction.

Conclusion: Incorporating KT into a standard rehabilitation program for RCRSP demonstrated enhanced efficacy in reducing pain and improving shoulder function. The results suggest that KT can be a valuable component of the treatment regimen for RCRSP.

研究目的本研究旨在确定运动塑形术(KT)与康复计划相结合对减少越南肩袖相关性肩痛(RCRSP)患者的症状和功能限制的临床疗效:总共有 82 名被诊断为肩袖相关性疼痛(RCRSP)的患者被随机分为两组。两组均接受标准康复计划;此外,干预组还接受了 KT 治疗。评估结果包括基线、干预后 3、7 和 14 天的疼痛强度(视觉模拟量表,VAS)、功能性残疾(肩痛与残疾指数,SPADI)和主动活动范围(ROM):结果:KT 组在所有结果指标上都有明显改善。14 天后,KT 组的 VAS 评分平均下降了 13.3 分,明显高于对照组(95% CI:-17.77 至 -8.82)。KT 组的 SPADI 评分也有明显改善,在第 3、7 和 14 天分别降低了 -11.36、-15.27 和 -13.3。在关节活动度方面,KT 组在屈曲和外旋方面有明显改善,在各时间点的屈曲关节活动度分别为 10.78 度、10.35 度和 11.8 度。外展和内旋 ROM 没有明显变化。在对年龄、基线评分和性别进行调整后,组别与时间之间在VAS、SPADI和外展ROM上存在统计学意义上的显著交互作用:结论:将 KT 纳入 RCRSP 的标准康复计划,在减轻疼痛和改善肩关节功能方面具有更好的疗效。这些结果表明,KT可以成为RCRSP治疗方案的重要组成部分。
{"title":"Short-term effects of Kinesiotaping combined with a rehabilitation program for rotator cuff-related shoulder pain: a randomized, assessor-blinded clinical trial.","authors":"Trang Ngoc Anh Nguyen, Nam Hoai Nguyen, Duy Kim Vu, Lam Tung Ngoc Cu","doi":"10.1080/10669817.2024.2387913","DOIUrl":"10.1080/10669817.2024.2387913","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine the clinical efficacy of Kinesiotaping (KT) combined with a rehabilitation program to reduce symptoms and functional limitations in patients with Rotator Cuff-Related Shoulder Pain (RCRSP) in Vietnam.</p><p><strong>Methods: </strong>In total, 82 participants who were diagnosed with RCRSP were randomly allocated into two groups. Both groups received a standard rehabilitation program; additionally, the intervention group was treated with KT. Outcomes, assessed at baseline, and 3, 7, and 14 days postintervention, included pain intensity (Visual Analogue Scale, VAS), functional disability (Shoulder Pain and Disability Index, SPADI), and active range of motion (ROM).</p><p><strong>Results: </strong>The KT group exhibited significant improvements in all outcome measures. VAS scores decreased by an average of 13.3 points in the KT group at 14 days, which was notably greater than that in the control group (95% CI: -17.77 to -8.82). SPADI scores also improved significantly in the KT group, with reductions of -11.36, -15.27, and -13.3 at days 3, 7, and 14, respectively. Regarding ROM, the KT group showed notable improvements in flexion and external rotation, with flexion ROM differences of 10.78, 10.35, and 11.8 degrees at the respective time points. No significant changes were observed in the abduction or internal rotation ROM. After adjusting for age, baseline scores, and gender, there was a statistically significant interaction between Group and Time on the VAS, SPADI, and ROM abduction.</p><p><strong>Conclusion: </strong>Incorporating KT into a standard rehabilitation program for RCRSP demonstrated enhanced efficacy in reducing pain and improving shoulder function. The results suggest that KT can be a valuable component of the treatment regimen for RCRSP.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141910139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters. 肌筋膜触发点敏感性、颈椎姿势异常与临床紧张型头痛参数之间的关系。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-01 Epub Date: 2024-01-01 DOI: 10.1080/10669817.2023.2299186
Eman Embaby, Aya A Khalil, Abdallah Mansour, Hend A Hamdy

Background: Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH.

Objectives: To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH).

Methods: A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured.

Results: Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males.

Conclusions: There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

背景:肌筋膜触发点(MTrPs)在紧张型头痛(TTH)的发病机制中起着重要作用。颅颈姿势异常与各种类型的头痛有关。然而,目前尚未对 TTH 患者的 MTrPs 敏感性、颈椎姿势排列和头痛临床指标之间的相关性进行广泛研究:研究 TTH 患者颈部和颅周肌肉 MTrPs 敏感性、颈椎姿势异常与临床头痛指标之间的关系。此外,研究性别对所研究变量的影响及其与头痛类型(发作性头痛与慢性头痛)的关系:方法:本研究共纳入了 72 名男女 TTH 患者。方法:该研究共纳入了 72 名男女 TTH 患者,测量了作为头痛临床测量指标的头痛频率和残疾程度、双侧斜方肌上部(UT)和枕下肌(SUB)的压痛阈值(PPT)、颈椎前凸角(CA)和头前平移(AHT):结果:颅周 MTrPs 敏感性与临床头痛参数或颈椎姿势异常没有任何相关性。然而,头痛频率与残疾程度之间存在明显相关性(r = 0.32,P 结论:头痛频率与残疾程度之间不存在相关性:TTH患者的头痛频率和残疾程度与颈椎姿势排列或MTrPs敏感度之间没有相关性。根据研究结果,临床医生在评估 TTH 患者时应考虑性别差异。
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引用次数: 0
Non-invasive assessment of sacroiliac joint and lumbar spine positioning in different unilateral sitting postures. 不同单侧坐姿下骶髂关节和腰椎定位的无创评估。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-01 Epub Date: 2023-10-26 DOI: 10.1080/10669817.2023.2273005
Sara Riazi, Olena Klahsen, Merwa Al-Rasheed, Shawn M Beaudette, Stephen H M Brown

Background: Sacroiliac joint (SIJ) motion has been documented using invasive and noninvasive kinematic techniques. No study has explored SIJ angular positions in functional postures using noninvasive techniques. The purpose of this study was to quantify SIJ positioning among different seated postures in a healthy population.

Methods: Twelve female and 11 male healthy young participants participated. Left and right anterior and posterior superior iliac spines were manually digitized during standing, neutral sitting and four different seated postures. Rigid bodies recorded the kinematics of the lumbar spine. Angles calculated included transverse sacroiliac angle, innominate sagittal angle, sacral tilt, lumbar flexion-extension, lumbar lateral bend and lumbar axial twist.

Findings: The observed range of angular positions was approximately 3 to 4 degrees across the SIJ-related angles. The main effect of seated posture was observed for all angles measured. The main effect of sex was observed for all angles except lumbar lateral bending. Females consistently experienced more posterior sacral tilt than males. Interaction effects between sex and posture were only observed at the right-transverse sacroiliac angle and sacral tilt. Previous sitting posture affected the subsequent neutral sitting posture for the right-transverse sacroiliac angle and lumbar spine angle.

Interpretation: SIJ angular position differences among the seated postures were similar in magnitude to motions previously reported in participants undergoing prone passive hip abduction and external rotation. Sex differences, including greater sacral posterior tilt observed in females, likely reflect underlying morphological and physiological differences. Future studies should explore SIJ positioning during functional tasks in pathological populations to help elucidate the underlying causes of SIJ pain and inform treatment strategies.

背景:骶髂关节(SIJ)运动已被记录使用有创和无创运动学技术。没有研究使用非侵入性技术探索功能性姿势中的SIJ角位置。本研究的目的是量化健康人群中不同坐姿之间的SIJ定位。方法:12名女性和11名男性健康青年参与者参与。在站立、中性坐姿和四种不同坐姿期间,人工数字化左、右髂前、后上棘。刚体记录腰椎的运动学。计算的角度包括骶髂横角、无名矢状角、骶骨倾斜、腰椎屈伸、腰椎侧弯和腰椎轴扭转。研究结果:在SIJ相关角度中,观察到的角度位置范围约为3至4度。对于所有测量的角度,都观察到了坐姿的主要影响。除腰椎侧弯外,所有角度均观察到性别的主要影响。女性经历的骶骨后倾始终多于男性。性别和姿势之间的相互作用效应仅在右侧骶髂横角和骶骨倾斜处观察到。先前的坐姿影响随后右侧骶髂横角和腰椎角的中性坐姿。解释:坐姿之间的SIJ角位置差异在大小上与之前报道的俯卧被动髋关节外展和外旋参与者的运动相似。性别差异,包括在女性中观察到的更大的骶骨后倾,可能反映了潜在的形态学和生理学差异。未来的研究应探索病理人群中SIJ在功能任务中的定位,以帮助阐明SIJ疼痛的根本原因并为治疗策略提供信息。
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引用次数: 0
Biopsychosocial contributors to irritability in individuals with shoulder or low back pain. 肩痛或腰痛患者易怒的生物心理社会因素。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-01 Epub Date: 2023-12-18 DOI: 10.1080/10669817.2023.2294679
Abigail T Wilson, William J Hanney, Randi M Richardson, Sheila H Klausner, Joel E Bialosky

Objectives: Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability.

Methods: 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low).

Results: Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation.

Discussion/conclusion: Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.

目的:易激惹性是康复治疗中的一个基本临床推理概念,用于评估检查和治疗的反应性。虽然最初的理论认为疼痛反映了组织损伤,但大量证据表明疼痛是一种受疼痛敏感性和心理因素影响的生物心理社会体验。方法:40 名肩部(20 人)和腰背部(20 人)疼痛患者接受了定量感觉测试(QST)(压力痛阈值、热痛阈值、条件性疼痛调节、时相加),填写了疼痛相关心理问卷、运动诱导低痛觉方案,并根据《临床实践指南》进行了标准化的易激惹性评估。然后,根据梅特兰标准和《临床实践指南》的易激惹程度,将参与者分为易激惹和非易激惹两类。采用独立样本 t 检验法检测了不同易怒类别在 QST 和心理因素方面的差异。MANOVA 检验了不同烦躁程度(高、中、低)的 QST 和心理因素的差异:结果:多个部位的热痛阈值和压痛阈值(p p = 0.02)明显低于被归类为易怒的人。高度易怒患者的热痛阈和压痛阈也明显低于其他级别的患者。据报告,易激惹患者的抑郁和愤怒情绪明显较高,自我效能感也较低:讨论/结论:生物心理社会因素(包括广泛的痛觉减退和心理因素升高)可能会导致易激惹表现。
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引用次数: 0
Beliefs and practice patterns of spinal thrust manipulation for mechanical low back pain of physical therapists in the state of Minnesota. 明尼苏达州物理治疗师对机械性腰痛脊柱推力手法的信念和实践模式。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-01 Epub Date: 2023-11-08 DOI: 10.1080/10669817.2023.2279821
Matthew Kuik, Darren Calley, Ryan Buus, John Hollman

Introduction: The primary purpose of this study was to examine the perceptions and utilization of spinal thrust manipulation (STM) techniques of physical therapists who treat patients with low back pain (LBP) in the State of Minnesota. A secondary purpose was to investigate differences between physical therapists who perform STM and those who do not.

Methods: A cross-sectional design was utilized through the completion of an electronic survey. 74 respondents completed the survey. Descriptive measures were recorded as frequencies for categorical data or mean ± standard deviation for continuous data. For between-group comparisons, chi-square analyses were used for categorical items of nominal or ordinal data and t-tests were utilized for continuous data. The alpha level was set at p < 0.05.

Result: 60.2% of respondents reported using STM when treating patients with LBP. 69.9% of respondents utilize a classification system. 76.7% of individuals answered correctly regarding the Minnesota State practice act. Of those who use STM, 81.8% utilize a Clinical Prediction Rule. Respondents who use STM were more likely to have a specialist certification (chi-square = 6.471, p = 0.011) and to have completed continuing education courses on manual therapy (chi-square = 4.736, p = 0.030).

Discussion/conclusions: Physical therapists who perform STM are more likely to have a better understanding of their state practice act, be board certified, and have completed continuing education in manual therapy.

引言:本研究的主要目的是检查在明尼苏达州治疗腰痛(LBP)患者的物理治疗师对脊椎推力手法(STM)技术的认知和使用情况。第二个目的是调查进行STM和不进行STM的物理治疗师之间的差异。方法:采用横断面设计完成电子调查。74名受访者完成了调查。描述性测量被记录为分类数据或平均值的频率 ± 连续数据的标准偏差。对于组间比较,卡方分析用于名义或顺序数据的分类项目,t检验用于连续数据。alpha级别设置为p 结果:60.2%的受访者报告在治疗LBP患者时使用STM。69.9%的受访者使用分类系统。76.7%的人对《明尼苏达州实践法》的回答是正确的。在那些使用STM的人中,81.8%使用临床预测规则。使用STM的受访者更有可能获得专业认证(卡方 = 6.471,p = 0.011),并完成了手工治疗的继续教育课程(卡方 = 4.736,p = 0.030)。讨论/结论:进行STM的物理治疗师更有可能更好地了解他们的国家实践行为,获得董事会认证,并完成了手动治疗的继续教育。
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引用次数: 0
A novel model for developing thrust joint manipulation skills: a teaching and learning perspective. 培养推力关节操作技能的新模式:教与学的视角。
IF 1.6 Q2 REHABILITATION Pub Date : 2024-08-01 Epub Date: 2024-01-11 DOI: 10.1080/10669817.2023.2299184
Kyle R Adams, William H Kolb, Mary Beth Geiser, Michelle Dolphin

Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test-retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.

脊柱和四肢推压关节手法(TJM)已被证明是治疗各种肌肉骨骼疾病患者的有效干预措施。学习熟练的 TJM 需要正确执行许多独立的任务。如果缺少其中任何一项,有效性和安全性都会受到限制。虽然大家都认为物理治疗师在学习临床任务时,练习和反馈非常重要,但对于学习执行 TJM 任务而言,最佳的练习类型尚未确定。在本文中,我们提出了一种指导关节操作的教育模式,该模式具有以下特点1)将反馈术语标准化;2)描述适用于大多数 TJM 任务的四项离散任务(抬起、放下、牵拉和组合旋转)的核心集。该模型包括指导 TJM 任务,然后识别与设置和推力组件相关的关键错误。一旦确定了这些关键错误,就会提供有意的练习活动,以解决注意到的位置和动作错误。最后,进行重新评估,以确定错误是否已经减少。这种模式类似于治疗病人时常用的测试-再测试方法。我们希望这一教学模式能为 TJM 教学提供一个框架,并促进未来的研究。
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引用次数: 0
期刊
Journal of Manual & Manipulative Therapy
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