Pub Date : 2014-12-01DOI: 10.1179/1753614614Z.00000000086
A. Kobesova
Professor Karel Lewit was born in 1916. He was forced to interrupt his studies at the Prague medical school because of World War II. He spent this time in the Czechoslovakian Army in England and later in France where he functioned as a member of the Czechoslovakian Armoured Brigade. In France, he met his beloved wife Iris, the charming young Englishwoman with whom he later spent over 60 years. Karel Lewit completed medical school in 1946 and began working at the Neurology Department under the legendary Professor Kamil Henner in the same year. Here, Professor Lewit found a unique setting for his work, which determined the rest of his career. Professor Henner brought the French style of clinical neurological assessment to Prague, mentoring young doctors but at the same time supporting them in their own studies and in the development of their own area of interest. It was no coincidence that not only Professor Lewit, but also two more ‘gurus’ of international rehabilitation, Professors Vojta and Janda came from the same clinic. Learning manipulation techniques, Karel realized that his treatment would have no permanent effect unless rehabilitation followed and the patient is educated in self-treatment. Closely working with neuroradiologist Professor Jirout, studying neuroradiology and functional pathology of the movement system, Karel soon understood that manipulation does not change the shape or the position of the structure but that via manipulative treatment he could change function in the musculoskeletal system. This led him to develop the whole self-treatment system for patients with pain in the musculoskeletal system that, with many modifications, is used worldwide now. Karel was the first clinician (probably not only in Czechoslovakia) introducing self-treatment techniques systematically. He also emphasized that the patient must leave the office with homework. His classic quotes are: ‘The one who knows a technique must not become the slave of it’, ‘For me, manipulation is a marginal type of treatment. The patient’s own muscles always do a better job than those of the best therapists. Therefore, we have to tailor the self-treatment for the specific patient and suggest an adequate selftreatment. If treatment is not helping it becomes frustrating: individual approach is critical’ (Figs. 1 and 2). Karel worked under Professor Henner for about 15 years, and after 1960 successfully continued his work at the various Neurology and Rehabilitation Departments in Czechoslovakia and later the Czech Republic. Progressively more lecturing and being involved in numerous research projects, Karel started to systematize his functional assessment and treatment techniques introducing a series of manipulative–rehabilitation–physiological courses together with Vladimir Janda and Frantisek Vele. In 1966, Karel published his first book called ‘Manipulative Treatment within a Context of Reflex Therapy’. The book that has been later rewritten many times, published in fi
{"title":"Professor Karel Lewit, MD, DrSc: an appreciation","authors":"A. Kobesova","doi":"10.1179/1753614614Z.00000000086","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000086","url":null,"abstract":"Professor Karel Lewit was born in 1916. He was forced to interrupt his studies at the Prague medical school because of World War II. He spent this time in the Czechoslovakian Army in England and later in France where he functioned as a member of the Czechoslovakian Armoured Brigade. In France, he met his beloved wife Iris, the charming young Englishwoman with whom he later spent over 60 years. Karel Lewit completed medical school in 1946 and began working at the Neurology Department under the legendary Professor Kamil Henner in the same year. Here, Professor Lewit found a unique setting for his work, which determined the rest of his career. Professor Henner brought the French style of clinical neurological assessment to Prague, mentoring young doctors but at the same time supporting them in their own studies and in the development of their own area of interest. It was no coincidence that not only Professor Lewit, but also two more ‘gurus’ of international rehabilitation, Professors Vojta and Janda came from the same clinic. Learning manipulation techniques, Karel realized that his treatment would have no permanent effect unless rehabilitation followed and the patient is educated in self-treatment. Closely working with neuroradiologist Professor Jirout, studying neuroradiology and functional pathology of the movement system, Karel soon understood that manipulation does not change the shape or the position of the structure but that via manipulative treatment he could change function in the musculoskeletal system. This led him to develop the whole self-treatment system for patients with pain in the musculoskeletal system that, with many modifications, is used worldwide now. Karel was the first clinician (probably not only in Czechoslovakia) introducing self-treatment techniques systematically. He also emphasized that the patient must leave the office with homework. His classic quotes are: ‘The one who knows a technique must not become the slave of it’, ‘For me, manipulation is a marginal type of treatment. The patient’s own muscles always do a better job than those of the best therapists. Therefore, we have to tailor the self-treatment for the specific patient and suggest an adequate selftreatment. If treatment is not helping it becomes frustrating: individual approach is critical’ (Figs. 1 and 2). Karel worked under Professor Henner for about 15 years, and after 1960 successfully continued his work at the various Neurology and Rehabilitation Departments in Czechoslovakia and later the Czech Republic. Progressively more lecturing and being involved in numerous research projects, Karel started to systematize his functional assessment and treatment techniques introducing a series of manipulative–rehabilitation–physiological courses together with Vladimir Janda and Frantisek Vele. In 1966, Karel published his first book called ‘Manipulative Treatment within a Context of Reflex Therapy’. The book that has been later rewritten many times, published in fi","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"125 - 127"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717081","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}
Pub Date : 2014-12-01DOI: 10.1179/1753614614Z.00000000085
M. Hutson
We are dedicating this issue of the journal to the life and work of Professor Karel Lewit, whose international recognition in the discipline of Manual Medicine and generosity to the physiotherapists, osteopaths, doctors, and chiropractors who were inspired by him is testament to his remarkable intellect, capabilities, and attention to the needs of all who met him, patients and clinicians. He was always supportive of the International Musculoskeletal Medicine, and the underlying principles of international cooperation, collaboration, and implementation of scientific evidence into clinical practice. Manual/Musculoskeletal medical practice has benefited enormously from his dedication to basic concepts and manual diagnostic and therapeutic techniques that he described and demonstrated so well. He will of course be sadly missed. This editorial is based on a presentation made by Professor Lewit in England some years ago. The exact location and date are not of relevance as the message is timeless. The slide texts used by Professor Lewit are followed by my commentary. Lewit: The examination and assessment of dysfunction of the motor system, by far the most frequent cause of so-called non-specific pain, cannot yet be done by apparatus, but only by those most sophisticated instruments, the human hands and eyes, and a little thought. Comment: The haptic experiences (for both doctor and patient) remain the core component of diagnosis in manual medicine, though exposure to palpatory techniques and cognitive responses to those techniques during medical training is extremely variable and often poor. Lewit: The problem of doctors. The modern Universities, proud of their scientific advance, impress their students with the latest achievements in genetics, molecular chemistry, and by the technical inventions. The student is crammed with theory, with technicalities, but lacks clinical experience. Comment: The technological revolution of recent years, particularly the emergence of imaging/scanning for soft tissue disorders is a potential and actual deterrent to the achievement of a high standard of manual diagnostics. Lewit: Only when he leaves hospital work does he realize standing on his own, that he has not been taught how to deal with the most common ailments, in particular with the ever increasing number of patients with ‘non-specific pain of the motor system’. He was never taught proper physical examination including palpation, or how to take a specific anamnesis, let alone how to think in terms of function. Comment: The conceptual basis of soft tissue dysfunction and ‘non-specific’ pain must be learned in combination with relevant examination techniques and exposure to patients as early as possible during training. Lewit: Many doctors then use manipulation only occasionally, using acupuncture, many types of physical therapy, applying it all mainly where the patient feels pain. Having reached a certain age, before getting involved in manual medicine, a few week
我们将这期杂志献给Karel Lewit教授的生活和工作，他在手工医学领域的国际认可，以及对受他启发的物理治疗师、整骨治疗师、医生和脊椎按摩师的慷慨，证明了他非凡的智慧、能力，以及对所有见过他的人(患者和临床医生)的需求的关注。他一直支持国际肌肉骨骼医学，以及国际合作、协作和将科学证据应用于临床实践的基本原则。手动/肌肉骨骼医学实践从他对基本概念和手动诊断和治疗技术的奉献中受益匪浅，他描述和演示得非常好。我们当然会非常怀念他。这篇社论是根据几年前刘易斯教授在英国所作的报告改编的。确切的地点和日期无关紧要，因为信息是永恒的。Lewit教授使用的幻灯片文本后面是我的评论。莱维特:运动系统功能障碍的检查和评估，到目前为止所谓的非特异性疼痛的最常见原因，还不能通过仪器来完成，而只能通过那些最复杂的仪器，人的手和眼睛，再加上一点思想。评论:触觉体验(对于医生和患者)仍然是手工医学诊断的核心组成部分，尽管在医学培训期间接触触诊技术和对这些技术的认知反应是极不相同的，而且往往很差。莱维特:医生的问题。现代大学为自己的科学进步感到自豪，用遗传学、分子化学和技术发明方面的最新成果给学生留下深刻印象。这个学生满脑子都是理论和专业知识，但缺乏临床经验。评论:近年来的技术革命，特别是软组织疾病成像/扫描的出现，是实现高水平人工诊断的潜在和实际阻碍。莱维特:只有当他离开医院工作时，他才意识到自己站在自己的位置上，他没有被教过如何处理最常见的疾病，特别是越来越多的“非特异性运动系统疼痛”患者。他从来没有被教过适当的身体检查，包括触诊，或者如何做具体的记忆，更不用说如何从功能的角度思考了。评论:软组织功能障碍和“非特异性”疼痛的概念基础必须在训练过程中结合相关检查技术和尽早接触患者来学习。莱维特:许多医生只是偶尔使用手法，使用针灸，许多类型的物理疗法，主要应用在病人感到疼痛的地方。到了一定年龄，在开始手工治疗之前，几周或周末的课程是不足以教授真正好的和温和的技术的，并感觉到释放。评论:如果医生的实践经验仅限于在病人疼痛时进行检查和治疗，他们就无法真正理解和识别运动系统中的张力。紧张和释放紧张不是一朝一夕就能学会的。Lewit:另一方面，医生们经常被塞满了科目，他们本应该在学生时代或专业课程中学习，但却被教得太少，以至于无法从功能的角度思考，即把运动系统作为一个整体来理解，把它作为一个程序来运作。当面对一个训练有素的治疗师，他的主要工作是用温柔的方式运用他的手，他一定会印象深刻。评论:运动系统的功能障碍是引起疼痛的最常见原因。它与病理形态学的关系相关时，对应于:Michael Hutson, Village House, Owthorpe, Nottingham NG12 3GE, UK。电子邮件:mahutson@aol.com
{"title":"Karel Lewit: In memoriam","authors":"M. Hutson","doi":"10.1179/1753614614Z.00000000085","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000085","url":null,"abstract":"We are dedicating this issue of the journal to the life and work of Professor Karel Lewit, whose international recognition in the discipline of Manual Medicine and generosity to the physiotherapists, osteopaths, doctors, and chiropractors who were inspired by him is testament to his remarkable intellect, capabilities, and attention to the needs of all who met him, patients and clinicians. He was always supportive of the International Musculoskeletal Medicine, and the underlying principles of international cooperation, collaboration, and implementation of scientific evidence into clinical practice. Manual/Musculoskeletal medical practice has benefited enormously from his dedication to basic concepts and manual diagnostic and therapeutic techniques that he described and demonstrated so well. He will of course be sadly missed. This editorial is based on a presentation made by Professor Lewit in England some years ago. The exact location and date are not of relevance as the message is timeless. The slide texts used by Professor Lewit are followed by my commentary. Lewit: The examination and assessment of dysfunction of the motor system, by far the most frequent cause of so-called non-specific pain, cannot yet be done by apparatus, but only by those most sophisticated instruments, the human hands and eyes, and a little thought. Comment: The haptic experiences (for both doctor and patient) remain the core component of diagnosis in manual medicine, though exposure to palpatory techniques and cognitive responses to those techniques during medical training is extremely variable and often poor. Lewit: The problem of doctors. The modern Universities, proud of their scientific advance, impress their students with the latest achievements in genetics, molecular chemistry, and by the technical inventions. The student is crammed with theory, with technicalities, but lacks clinical experience. Comment: The technological revolution of recent years, particularly the emergence of imaging/scanning for soft tissue disorders is a potential and actual deterrent to the achievement of a high standard of manual diagnostics. Lewit: Only when he leaves hospital work does he realize standing on his own, that he has not been taught how to deal with the most common ailments, in particular with the ever increasing number of patients with ‘non-specific pain of the motor system’. He was never taught proper physical examination including palpation, or how to take a specific anamnesis, let alone how to think in terms of function. Comment: The conceptual basis of soft tissue dysfunction and ‘non-specific’ pain must be learned in combination with relevant examination techniques and exposure to patients as early as possible during training. Lewit: Many doctors then use manipulation only occasionally, using acupuncture, many types of physical therapy, applying it all mainly where the patient feels pain. Having reached a certain age, before getting involved in manual medicine, a few week","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"123 - 124"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717057","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}
Pub Date : 2014-12-01DOI: 10.1179/1753615414Y.0000000032
P. Wheeler
Abstract Objective To study the subjective perceptions of benefits of the use of tension night splints (TNS) in a clinical population of patients with plantar fasciitis. Methods Twenty consecutive patients who were prescribed TNS were identified from clinical logs. These were contacted to understand their perception of benefit from the TNS and their outcome. Seventeen of 20 patients responded (85% response rate). Results There was a mean reduction in pain first thing in the morning of 2.8 points, and pain overall of 1.9 points on a 0–10 visual analogue scale. Overall function improved by 17 percentage points. However, compliance was limited with about one-third of patients having significant sleep disturbance while wearing the TNS, and 30% ceasing to wear the splint within 1 month. Discussion TNS appear to have a beneficial role in the treatment of chronic plantar fasciitis. However, the exact benefits remain unclear, and issues including patient comfort and tolerability can limit their use.
{"title":"The effectiveness and tolerability of tension night splints for the treatment of patients with chronic plantar fasciitis – A case-series study","authors":"P. Wheeler","doi":"10.1179/1753615414Y.0000000032","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000032","url":null,"abstract":"Abstract Objective To study the subjective perceptions of benefits of the use of tension night splints (TNS) in a clinical population of patients with plantar fasciitis. Methods Twenty consecutive patients who were prescribed TNS were identified from clinical logs. These were contacted to understand their perception of benefit from the TNS and their outcome. Seventeen of 20 patients responded (85% response rate). Results There was a mean reduction in pain first thing in the morning of 2.8 points, and pain overall of 1.9 points on a 0–10 visual analogue scale. Overall function improved by 17 percentage points. However, compliance was limited with about one-third of patients having significant sleep disturbance while wearing the TNS, and 30% ceasing to wear the splint within 1 month. Discussion TNS appear to have a beneficial role in the treatment of chronic plantar fasciitis. However, the exact benefits remain unclear, and issues including patient comfort and tolerability can limit their use.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"51 1","pages":"130 - 136"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723374","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}
Pub Date : 2014-12-01DOI: 10.1179/1753614614Z.00000000083
P. Dieppe, M. Greville-harris
A placebo is defined as a dummy or sham intervention that has no active (‘specific’) ingredient that can affect the target condition.1 Why and how it is that a dummy treatment can have a positive e...
{"title":"Are we dispensing nocebos to patients in pain?","authors":"P. Dieppe, M. Greville-harris","doi":"10.1179/1753614614Z.00000000083","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000083","url":null,"abstract":"A placebo is defined as a dummy or sham intervention that has no active (‘specific’) ingredient that can affect the target condition.1 Why and how it is that a dummy treatment can have a positive e...","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"128 - 129"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716975","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}
Pub Date : 2014-12-01DOI: 10.1179/1753615414Y.0000000036
M. Yelland
Abstract Background Chronic lateral epicondylar tendinopathy is frequent in athletes, and platelet-rich plasma (PRP) is being used increasingly in its treatment. Objective To systematically review the literature on the efficacy of PRP injections for chronic lateral epicondylar tendinopathy. Methods The databases of PubMed, EMBASE, CINAHL, Medline OvidSP, Scopus, Google Scholar, Web of Science, and Cochrane Library were searched in October 2013. Inclusion criteria were a clinical diagnosis of chronic lateral epicondylar tendinopathy, a randomized-controlled trial, an intervention with a PRP injection, and the outcome measures described in terms of pain and/or function. One author screened the search results and two authors independently assessed the study quality using the Physiotherapy Evidence Database (PEDro) score. A study was considered to be of high quality if its PEDro score was ≥6. A best evidence synthesis was used to identify the level of evidence. Results Six studies were included, of which four were considered to be of high quality. Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy. Conclusions There is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.
背景慢性外上髁肌腱病变在运动员中很常见，富血小板血浆(PRP)在其治疗中的应用越来越多。目的系统回顾PRP注射液治疗慢性上髁外侧肌腱病变的临床疗效。方法检索2013年10月PubMed、EMBASE、CINAHL、Medline OvidSP、Scopus、谷歌Scholar、Web of Science、Cochrane Library等数据库。纳入标准为慢性上髁外侧肌腱病变的临床诊断，随机对照试验，PRP注射干预，以及根据疼痛和/或功能描述的结果测量。一名作者筛选搜索结果，两名作者使用物理治疗证据数据库(PEDro)评分独立评估研究质量。如果该研究的PEDro评分≥6，则认为该研究质量高。采用最佳证据综合来确定证据水平。结果纳入6项研究，其中4项为高质量研究。三项高质量研究(75%)和两项低质量研究显示，与对照组相比，在最终随访测量或预定义的主要结局评分方面没有显著的益处。一项高质量的研究(25%)显示，与皮质类固醇注射相比，PRP注射有有益的效果(皮质类固醇注射对肌腱病变有害)。基于最佳证据综合，有强有力的证据表明，PRP注射对慢性上髁外侧肌腱病变无效。结论有充分证据表明PRP注射治疗慢性肘关节外侧肌腱病变无效。
{"title":"Commentary on systematic review of PRP injections for chronic lateral epicondylar tendinopathy","authors":"M. Yelland","doi":"10.1179/1753615414Y.0000000036","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000036","url":null,"abstract":"Abstract Background Chronic lateral epicondylar tendinopathy is frequent in athletes, and platelet-rich plasma (PRP) is being used increasingly in its treatment. Objective To systematically review the literature on the efficacy of PRP injections for chronic lateral epicondylar tendinopathy. Methods The databases of PubMed, EMBASE, CINAHL, Medline OvidSP, Scopus, Google Scholar, Web of Science, and Cochrane Library were searched in October 2013. Inclusion criteria were a clinical diagnosis of chronic lateral epicondylar tendinopathy, a randomized-controlled trial, an intervention with a PRP injection, and the outcome measures described in terms of pain and/or function. One author screened the search results and two authors independently assessed the study quality using the Physiotherapy Evidence Database (PEDro) score. A study was considered to be of high quality if its PEDro score was ≥6. A best evidence synthesis was used to identify the level of evidence. Results Six studies were included, of which four were considered to be of high quality. Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy. Conclusions There is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"154 - 155"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723456","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}
Pub Date : 2014-12-01DOI: 10.1179/1753615414Y.0000000033
Gordon A. Smith, S. Meadows, J. Myers, Julie Reynolds, P. Woodhead
Abstract Objectives To determine pain scores for injection therapy and to review the overall change in outcomes post-injection for a variety of musculoskeletal injections compared with the previous audits of a primary-care physiotherapy injection clinic. Methods Subjects were assessed using a numerical rating scale between 0 and 10 before and 4 weeks post-injection. Results All average pain scale scores were reduced 4 weeks after injection for all conditions. There is an overall average reduction in pain on provoking activity of 45.7%. Trigger finger/thumb (65%) demonstrated the most significant reduction in pain. Contrary to a common patient perception, injection therapy is not an exceptionally painful experience, with an average score of 3.2. Discussion Results are comparable with previous scores for injections carried out within the same primary-care physiotherapy clinic.
{"title":"Review of injection therapy clinics performed by physiotherapists working in primary care","authors":"Gordon A. Smith, S. Meadows, J. Myers, Julie Reynolds, P. Woodhead","doi":"10.1179/1753615414Y.0000000033","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000033","url":null,"abstract":"Abstract Objectives To determine pain scores for injection therapy and to review the overall change in outcomes post-injection for a variety of musculoskeletal injections compared with the previous audits of a primary-care physiotherapy injection clinic. Methods Subjects were assessed using a numerical rating scale between 0 and 10 before and 4 weeks post-injection. Results All average pain scale scores were reduced 4 weeks after injection for all conditions. There is an overall average reduction in pain on provoking activity of 45.7%. Trigger finger/thumb (65%) demonstrated the most significant reduction in pain. Contrary to a common patient perception, injection therapy is not an exceptionally painful experience, with an average score of 3.2. Discussion Results are comparable with previous scores for injections carried out within the same primary-care physiotherapy clinic.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"878 1","pages":"150 - 153"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723017","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}
Pub Date : 2014-10-31DOI: 10.1179/1753615415Y.0000000001
Kieran Macphail
Abstract C-reactive protein (CRP) is best known as an acute phase protein and is typically assessed in most general blood work. High sensitivity CRP (hsCRP) may be a useful clinical marker of chronic inflammatory states in musculoskeletal conditions. It appears that it is raised in inflammatory chronic low back pain (CLBP) and associated with reduced pain thresholds, weakness, and reduced function. It is also possible CRP could contribute towards the development and maintenance of CLBP by activating the complement system, which increases peripheral nociception. Diet and lifestyle factors can promote raised CRP. An hsCRP level of <1 mg/l appears ideal, and the higher the level, the more emphasis should be placed on chronic inflammation as a contributor to symptoms. Diet and lifestyle can significantly reduce CRP levels and may be a useful adjunct in treating CLBP patients with elevated CRP. This might make CRP a useful clinical marker of inflammation in CLBP and a therapeutic target for diet and lifestyle interventions.
c -反应蛋白(CRP)是一种急性期蛋白，在大多数常规血液工作中都有检测。高敏CRP (hsCRP)可能是肌肉骨骼疾病慢性炎症状态的有用临床标志物。它似乎在炎症性慢性腰痛(CLBP)中升高，并与疼痛阈值降低、虚弱和功能下降有关。也有可能CRP通过激活补体系统促进CLBP的发展和维持，从而增加外周伤害感觉。饮食和生活方式因素可促进CRP升高。hsCRP水平<1 mg/l似乎是理想的，水平越高，越应强调慢性炎症是引起症状的因素。饮食和生活方式可以显著降低CRP水平，可能是治疗CRP升高的CLBP患者的有用辅助手段。这可能使CRP成为CLBP炎症的有用临床标志物和饮食和生活方式干预的治疗靶点。
{"title":"C-reactive protein, chronic low back pain and, diet and lifestyle","authors":"Kieran Macphail","doi":"10.1179/1753615415Y.0000000001","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000001","url":null,"abstract":"Abstract C-reactive protein (CRP) is best known as an acute phase protein and is typically assessed in most general blood work. High sensitivity CRP (hsCRP) may be a useful clinical marker of chronic inflammatory states in musculoskeletal conditions. It appears that it is raised in inflammatory chronic low back pain (CLBP) and associated with reduced pain thresholds, weakness, and reduced function. It is also possible CRP could contribute towards the development and maintenance of CLBP by activating the complement system, which increases peripheral nociception. Diet and lifestyle factors can promote raised CRP. An hsCRP level of <1 mg/l appears ideal, and the higher the level, the more emphasis should be placed on chronic inflammation as a contributor to symptoms. Diet and lifestyle can significantly reduce CRP levels and may be a useful adjunct in treating CLBP patients with elevated CRP. This might make CRP a useful clinical marker of inflammation in CLBP and a therapeutic target for diet and lifestyle interventions.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"29 - 32"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723571","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}
Pub Date : 2014-07-01DOI: 10.1179/1753615414Y.0000000034
Alex Daulat, Emily Goodlad
Abstract Objectives To conduct a phase II pilot randomized controlled trial (RCT) comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy for the management of non-specific chronic low back pain (CLBP) and determine the feasibility for a larger RCT. Introduction There is moderate evidence for exercise combined with manual therapy in the treatment of CLBP. Patients with CLBP have decreased muscle power and cardiac capacity due to their low activity levels that leads to a de-conditioning syndrome and pain. This de-conditioning syndrome may be best addressed by total body strengthening. Methods Thirteen patients with CLBP were allocated to two groups by block randomization. Group A was the home total body strengthening programme plus manual therapy and group B was the standard physiotherapy exercise regimen plus manual therapy. Both groups received a course of manual therapy and a specific home exercise programme for 3 months. Three outcome measures pre- and post-treatment were used measuring function, pain, and quality of life. Results The treatment programmes in this pilot study were implemented successfully with a dropout rate of 19%. All the outcome measures used in this pilot study were responsive to change. Both groups showed a clinically important difference to function following treatment as well as improvements to pain and health-related quality of life. Conclusion The small sample size was one of the weaknesses of this pilot study. The findings from this pilot study suggest a future RCT is feasible to determine whether a home total body strengthening programme plus manual therapy is an effective management strategy for CLBP.
{"title":"A phase II pilot study comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy in the management of chronic low back pain","authors":"Alex Daulat, Emily Goodlad","doi":"10.1179/1753615414Y.0000000034","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000034","url":null,"abstract":"Abstract Objectives To conduct a phase II pilot randomized controlled trial (RCT) comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy for the management of non-specific chronic low back pain (CLBP) and determine the feasibility for a larger RCT. Introduction There is moderate evidence for exercise combined with manual therapy in the treatment of CLBP. Patients with CLBP have decreased muscle power and cardiac capacity due to their low activity levels that leads to a de-conditioning syndrome and pain. This de-conditioning syndrome may be best addressed by total body strengthening. Methods Thirteen patients with CLBP were allocated to two groups by block randomization. Group A was the home total body strengthening programme plus manual therapy and group B was the standard physiotherapy exercise regimen plus manual therapy. Both groups received a course of manual therapy and a specific home exercise programme for 3 months. Three outcome measures pre- and post-treatment were used measuring function, pain, and quality of life. Results The treatment programmes in this pilot study were implemented successfully with a dropout rate of 19%. All the outcome measures used in this pilot study were responsive to change. Both groups showed a clinically important difference to function following treatment as well as improvements to pain and health-related quality of life. Conclusion The small sample size was one of the weaknesses of this pilot study. The findings from this pilot study suggest a future RCT is feasible to determine whether a home total body strengthening programme plus manual therapy is an effective management strategy for CLBP.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"87 - 95"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723228","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}
Pub Date : 2014-07-01DOI: 10.1179/1753615414Y.0000000031
Ashraf M. Fansa, M. Tanios, N. Ebraheim
Abstract Objective and importance People in close contact with rodents, particularly those with rodents as pets, may become infected with the Streptobacillus moniliformis organism. Such patients may present with a triad of fever, rash, and arthritis. This medical condition is also known as rat-bite fever. It is imperative for the clinician to consider and recognize rat-bite fever in cases of septic arthritis in order to prevent delay in treatment. Severe involvement of the bursa requiring its excision during joint irrigation and debridement surgery has not been reported in the literature. Clinical presentation We are reporting on a recent case of septic shoulder arthritis and severe subdeltoid bursitis due to rat-bite fever in a 19-year-old female. Pre-operative magnetic resonance imaging scans demonstrated severe bursal involvement. Intervention In addition to antibiotics, excision of the bursa was necessary in this case in combination with irrigation and debridement of the joint. Conclusion The bursa adjacent to the involved joints in cases of rat-bite fever should be thoroughly investigated. Their severe involvement may necessitate their excision during the initial irrigation and debridement procedure.
{"title":"A case of shoulder joint Streptobacillus moniliformis septic arthritis with severe subdeltoid bursitis","authors":"Ashraf M. Fansa, M. Tanios, N. Ebraheim","doi":"10.1179/1753615414Y.0000000031","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000031","url":null,"abstract":"Abstract Objective and importance People in close contact with rodents, particularly those with rodents as pets, may become infected with the Streptobacillus moniliformis organism. Such patients may present with a triad of fever, rash, and arthritis. This medical condition is also known as rat-bite fever. It is imperative for the clinician to consider and recognize rat-bite fever in cases of septic arthritis in order to prevent delay in treatment. Severe involvement of the bursa requiring its excision during joint irrigation and debridement surgery has not been reported in the literature. Clinical presentation We are reporting on a recent case of septic shoulder arthritis and severe subdeltoid bursitis due to rat-bite fever in a 19-year-old female. Pre-operative magnetic resonance imaging scans demonstrated severe bursal involvement. Intervention In addition to antibiotics, excision of the bursa was necessary in this case in combination with irrigation and debridement of the joint. Conclusion The bursa adjacent to the involved joints in cases of rat-bite fever should be thoroughly investigated. Their severe involvement may necessitate their excision during the initial irrigation and debridement procedure.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"117 - 119"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723282","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}
Pub Date : 2014-07-01DOI: 10.1179/1753614614Z.00000000068
M. Cummings
Background I was surprised to come across a senior colleague using acupuncture in the British military when I started my general practice training. I had joined the Royal Air Force (RAF) rather than a civilian vocational training scheme, because I was interested in musculoskeletal pain and sports medicine. I trained in Western medical acupuncture with the British Medical Acupuncture Society and found dry needling appeared to be a very useful intervention in soft tissue pain, particularly muscle pain. After 7 years in the RAF as a general duties medical officer, I retired to pursue a career in orthopaedic medicine, but having taken over an established medical acupuncture practice, I found myself mostly in demand for acupuncture services. It was the early 1990s and systematic reviews (SRs) had just been developed, and Adrian White, one of my former acupuncture tutors, got me involved in both performing and reviewing SRs. The first meta-analysis of acupuncture was performed by Ernst and White in 1998, and this reported that acupuncture was superior to non-acupuncture controls. A subsequent SR by the Cochrane Collaboration Back Group (van Tulder et al.) opted to avoid data pooling in meta-analysis, and instead performed a best evidence synthesis within a qualitative review. Van Tulder et al. concluded that there was no evidence for an effect of acupuncture in back pain. This conclusion was a shock to me after the positive meta-analysis by Ernst and White, so I read the entire review. The conclusions were influenced by one of the two trials that were judged to be ‘high quality’. I knew this trial well, as it had been included in my first SR – Garvey et al. It was with some consternation that I realized the conclusions of an SR of acupuncture could be influenced by reviewers opinions over a trial that had not actually used acupuncture needles at all – Garvey et al. used insertion of a hypodermic needle at a single point and referred to it as acupuncture. So this was the start of my evolving understanding of the limitations, within the review process, of championing the avoidance of bias over the judgement of clinicians.
当我开始我的全科训练时，我很惊讶地发现在英国军队里有一位高级同事在使用针灸。因为我对肌肉骨骼疼痛和运动医学感兴趣，所以我加入了皇家空军(RAF)，而不是一个平民职业培训计划。我在英国医学针灸协会接受过西医针灸的培训，发现干针似乎是一种非常有效的治疗软组织疼痛的方法，尤其是肌肉疼痛。在英国皇家空军担任了7年的一般职责医务人员后，我退休了，开始从事骨科医学方面的职业，但在接手了一项既定的医疗针灸实践后，我发现自己最需要的是针灸服务。那是20世纪90年代初，系统评价(SRs)刚刚发展起来，我以前的针灸导师之一阿德里安·怀特(Adrian White)让我参与了系统评价的实施和评价。1998年恩斯特和怀特对针灸进行了第一次荟萃分析，报告称针灸优于非针灸对照。Cochrane协作组(van Tulder et al.)随后的一项研究选择避免荟萃分析中的数据汇集，而是在定性评价中进行最佳证据合成。Van Tulder等人得出结论，没有证据表明针灸对背痛有影响。在恩斯特和怀特的积极元分析之后，这个结论对我来说是一个震惊，所以我阅读了整个评论。结论受到两个被判定为“高质量”试验中的一个的影响。我很了解这个试验，因为它被纳入了我的第一个SR - Garvey等人。当我意识到针灸的SR结论可能会受到评论者对一项实际上根本没有使用针灸针的试验的意见的影响时，我感到有些惊愕——Garvey等人使用皮下针头在一个点插入，并将其称为针灸。所以这是我开始逐渐理解的局限性，在审查过程中，倡导避免对临床医生判断的偏见。
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