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Low Back Pain and Sciatica: Pathogenesis, Diagnosis and Nonoperative Treatment
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Manual therapy includes passive stretching, soft-tissue mobilization, myofascial release, manual traction, muscle energy techniques, joint mobilization, and manipulation. Joint mobilization is a low-velocity passive stretch applied to a joint within or at the limit of its range. Manipulation uses a high-velocity thrust maneuver beyond a joint’s restricted range of motion (71, 72). More controlled trials have been carried out to evaluate manipulation than any other nonoperative treatment measures (73). However, it is difficult to interpret these studies because of a variety of methodological issues. Manipulative therapy may vary due to the variable skill levels and techniques among different practitioners, that is, physiotherapists, osteopaths, physicians, and chiropractors. A recent systematic review showed evidence of a modest beneficial effect of spinal manipulation on cLBP when compared to sham interventions judged to have no efficacy; however, this effect was not greater than other usually applied therapies (74). Spinal manipulation is probably most beneficial for the treatment of acute axial spinal pain, without radiculopathy or neurological impairment (73).
Principles of fracture fixation
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Stephen Tai, Panagiotis Gikas, David Marsh
The primary use of intramedullary nails is in the stabilization of diaphyseal long bone fractures, by acting as load-sharing devices. This technique allows early joint mobilization, ambulation and weightbearing and promotes both endochondral and intramembranous fracture healing.
An Occupational Therapy Experience in Ecuador
Published in Susan Cook Merrill, Occupational Therapy Across Cultural Boundaries, 2012
We saw a woman who had fallen five months earlier and fractured both elbows and had been casted from her hands up past her elbows. Now her elbows were contracted at 90° and she had also lost a lot of range of her shoulders, wrists and fingers. Apparently she had not exercised her shoulders and hands while her elbows were immobilized. We were able to help her obtain some increased range after a short session of prolonged stretch and contract/relax techniques. We would have liked to teach the therapists some joint mobilization techniques but since our time with those therapists was limited, we did not want to leave them with a little knowledge that might do more harm than good.
The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial
Published in Physiotherapy Theory and Practice, 2022
Ismail Saracoglu, Meltem Isintas Arik, Emrah Afsar, Hasan Huseyin Gokpinar
In our study, MT was individualized according to each patient’s response to treatment, as described by Cook (2011). The clinician identifies and performs the joint mobilization techniques from those described below that improve the patient’s symptoms. Joint mobilization techniques used in this study included low velocity, mid-range, posterior-to-anterior force to the lower lumbar spine in a prone position (Ali, Sethi, and Noohu, 2019); low velocity, mid-range, right or left rotational force to the lower lumbar spine on the upper lumbar spine in a right or left side-lying, right or left lower thoracic lumbar side-bent position (Sato, Koumori, and Uchiyama, 2012); and mobilization with movement techniques for lumbar spine (Hing et al., 2015). The individualized treatment program was implemented in a total of 8 sessions, held twice a week for 4 weeks. Each mobilization session lasted 30 minutes. The entire treatment program was carried out by the same physiotherapist (I.S.) who holds an MSc degree and has 10 years of experience in MT.
Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness
Published in Brain Injury, 2021
A Estraneo, A Pascarella, O Masotta, M Bartolo, F Pistoia, C Perin, S Marino, L Lucca, V Pingue, E Casanova, AM Romoli, S Gentile, R Formisano, GP Salvi, F Scarponi, A De Tanti, P Bongioanni, E Rossato, A Santangelo, AR Diana, M Gambarin, D Intiso, R Antenucci, S Premoselli, M Bertoni, L Trojano
Thirty-one out of 278 patients (11.2%) showed NHO (Table 2). NHO were localized at upper limbs in five patients (16.1%), at lower limbs in 23 patients (74.2%) and at both upper and lower limbs in three patients (9.7%). NHO involved a single joint in 19 patients (61.3%), two joints in 10 patients (32.3%), three or more joints in two patients (6.4%). The site of NHO was: hip in 25 patients (unilateral = 17; bilateral = 8), elbow in seven (unilateral = 6; bilateral = 1), knee in two (unilateral = 2; bilateral = 0) patients, whereas no NHO involved shoulder. Six patients (19.4%) showed severe limitation in joint mobilization. Eight out of 31 patients with NHO had bone fractures: four of them developed NHO in fractured skeletal structures (i.e. hip = 3, knee = 1), whereas the remaining four had bone fractures in other sites. Seven of the eight patients with bone fractures and NHO suffered from traumatic brain injury.
Passive accessory joint mobilization in the multimodal management of chronic dysesthesia following thalamic stroke
Published in Disability and Rehabilitation, 2019
Kristina Griffin, Michael O’Hearn, Carla C. Franck, Carol A. Courtney
An interesting finding of this case was that thoracic spine passive joint examination (i.e. stretch of joint articular structures), but not cutaneous stimulation, provoked the patient’s dysesthestic sensory symptoms. Poststroke dysesthesia or allodynia has been reported to be exacerbated by movement [50]. In this case, a novel approach to management of thalamic stroke symptoms was chosen, oscillatory joint mobilization. Joint mobilization is a common intervention for painful musculoskeletal conditions. Studies on the underlying mechanisms of joint mobilization have demonstrated a decrease in neuroexcitability as measured by the nociceptive reflex [17,18], indicating a potential central neurophysiological effect of this intervention. A subsequent study suggested this effect may occur via facilitation of descending inhibitory mechanisms [19]. Passive oscillatory joint mobilization may have had an inhibitory effect on cortical excitability. Previous studies have demonstrated that passive physiological movement at the wrist [51] and passive accessory movement at the ankle [52] resulted in cortical inhibition as measured by transcranial magnetic stimulation. It is also important to note that as her shoulder improved, the patient increased the use of the upper extremity which may have contributed to the dampening of sensory dysesthesias.