Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia最新文献

Background: Objective outcome measures reflecting the level of effectiveness of care is a clinical imperative for practitioners dealing with neck and back pain. It is widely recognised that there is no relationship between physical pathology, pain and disability. Traditional measures of function such as range of motion and strength, on their own, are no longer sufficient when assessing treatment outcomes.

Objective: Five patient-based objective outcome tools for measuring pain and four for measuring disability are outlined with a view to encouraging their use when managing back and neck pain.

Discussion: All of the outcome measures presented in this review have a high clinical utility when managing patients with neck and back pain. That is, they have been shown to be valid and reliable as well as being easy to administer and score.

A patient with traumatic rotator cuff tear of the left shoulder developed severe myofascial pain syndrome with reflex sympathetic dystrophy (RSD) involving the left upper extremity. He was unable to tolerate any type of manual therapy or needle treatment due to severe allodynia in the whole left upper limb. This patient presented for treatment approximately 6 months after the onset of trauma. Treatment consisting of specific myofascial trigger point (MTrP) therapy, beginning with desensitization and gentle massage on the MTrP of the first dorsal interosseous muscle, followed by treatment of MTrPs of the wrist-finger extensors and anterior deltoid muscles was commenced. Allodynia was remarkably reduced and further physical therapy with modalities was administered. After 2 weeks of daily MTrP therapy, he received local steroid injection to the left shoulder and continued MTrP therapy 2-3 times per week. Approximately 2 months after the injection the patient was almost pain free with nearly full range of motion in his left shoulder. The mechanism of MTrPs and their association with RSD is discussed in this paper.

Soft tissue techniques, including Integrative Myofascial Release (IFR) can be more effective if the area of treatment can be determined by functional testing. The patient's source of pain may not necessarily be located at the area of complaint and functional testing helps in pinpointing the source. Post-treatment functional testing will provide feedback to both the patient and the doctor as to whether the technique was effective. This paper will describe some typical functional tests and treatment using IFR of the posterior cervical/thoracolumbar fascia.

Soft tissues follow every movement of bones and joints. Their free movement is essential for normal functioning of the motor system. Scars form mainly in the soft tissues, and if abnormal, or 'active', can interfere with the function of the motor system as well. For diagnosis and treatment the barrier phenomenon is a most useful concept: a pathological barrier restricts movement and does not spring when engaged. After engaging the barrier and waiting, release, relief and normal mobility are obtained. An illustrative case with an active appendectomy scar is presented, with both low back and abdominal pain. Extensive and costly examination were all negative. After diagnosis and treatment of the active scar symptoms were promptly relieved. Diagnosis and treatment of active scars should become part of the physical therapist's approach to the patient's problems.

Objective: To investigate a patient with atopic eczema and assess how they responded to chiropractic care.

Method: The study was run over a 7 week period with chiropractic treatments (diversified technique) on a once weekly schedule.

Outcome measures: To measure the effect of treatment, a rating system was developed and the intensity of a range of symptoms was recorded (through a questionnaire) on a twice weekly basis.

Results: The results attained showed there was a marked improvement in the eczema symptoms following the chiropractic care. The patient reported an improvement in eczematous symptoms of excoriation, pruritus, oedema and general psychological ease. These findings were also confirmed by photographic evidence which documented the change in the lesions.

Discussion: The case is presented to assist practitioners making a more informed decision on the treatment of choice for eczema. The outcome of this case is also discussed in relation to recent research that concludes that chiropractic spinal manipulative therapy has a role in the treatment for some people with non-neuromusculoskeletal conditions.

Conclusion: It appears that chiropractic care may have assisted this patient with eczema. However, more research is required to investigate the role that chiropractic has in the treatment of patients with eczema, and the potential mechanisms that could explain the improvement.

Much research has investigated shoulder pain which inhibits the performance of elite swimmers. An ever increasing understanding of the epidemiology and aetiology of what has been termed 'swimmer's shoulder' has enabled better treatment, rehabilitation and prevention programs to be implemented. This paper reviews the current research relevant to 'swimmer's shoulder' and the methods of treatment being employed to treat the problem.

Objective: To assess the response of a patient with chronic migraines to a short program of chiropractic care (diversified technique).

Method: The study was run over a 13 week period with chiropractic spinal manipulative therapy (CSMT) on a once weekly schedule for 5 weeks, followed by an 8 week re-evaluation.

Outcome measures: To measure the effect of treatment, a previously reported diary system was used which noted the intensity of a range of symptoms that are recorded following each migraine episode.

Results: The results attained showed there was a marked improvement in the migraine symptoms following the chiropractic care. The patient reported an improvement in frequency, intensity, duration and use of medication. These findings appear to also confirm other evidence which documented similar changes following a large randomised controlled trial of chiropractic treatment of migraine.

Discussion: The case is presented as further support for CSMT in the treatment of migraine. The outcome of this case is also discussed in relation to recent research that concludes that CSMT is a very effective treatment for some people with non-neuromusculoskeletal conditions.

Conclusion: It now appears clear that chiropractic care may be used to assist patients with migraine. Research is currently being undertaken to investigate the potential mechanisms of chiropractic in the treatment of migraine. This research should also assess what (if any) prognostic signs can be identified to assist practitioners making a more informed decision on the treatment of choice for migraine.

Acute pain in peripheral joints is not a common presenting symptom for chiropractors or osteopaths. However, chiropractors or osteopaths may be asked to assess peripheral joints when patients present with other conditions such as back pain. This paper reviews the literature on bacterial arthritis as a specific type of infectious arthritis. Information was obtained from Medline and internet search using the keyword: "bacterial arthritis". The most common presenting symptoms are described, with specific reference for chiropractors and osteopaths in clinical presentation of patients' with this condition.