Low Back Pain and Sciatica: Pathogenesis, Diagnosis and Nonoperative Treatment
Gary W. Jay in 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).
Chronic joint pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
The goal of treatment of rotator cuff disorders is to control symptoms and maintain activity, relieve ongoing cuff impingement, and manage existing cuff tears. NSAIDs have been shown to be useful in the short term (within four weeks), but the long-term efficacy remains unclear.150[I] Flexibility and strengthening exercises combined with joint mobilization are used widely and there is some evidence to support the use of these approaches.151[I] Laser therapy and electromagnetic field therapy may also be useful but there is no evidence that other commonly used physical techniques are substantially better than placebo. Shoulder injections of local anesthetic may be helpful diagnostically and therapeutically, at least in the short term although this approach remains controversial, particularly given the risks of soft tissue atrophy associated with these agents.152 [I], 153[II] Cognitive-behavioral therapy may have a role to play in managing chronic symptoms, although this remains to be shown in clinical trials. Finally, surgical decompression and/or repair is warranted for patients who do not respond to conservative measures after three to six months with acromioplasty being the surgical procedure of choice for patients with refractory impingement.154[III]
Manual medicine
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
This leap forward in getting better pain control enabled future treatment to be much more focused on improving his physical impairments. Larger amplitude joint mobilization techniques were progressed from side-lying to prone positions and further into range. The progress with pain relief was paralleled with graded increases in repetitions, range, and speed/confidence of spinal exercises, as well as walking and sitting-based activities. Manual therapy techniques, called sustained natural apophyseal glides (SNAG), were found to be helpful in facilitating further increases in painless lumbar spine flexion and extension.26 Limitation of left leg movement/sciatic nerve sensitivity were addressed using neural mobilizations,18,19 these were performed as passive rhythmical mobilizations by the therapist in positions of SLR, as well as the base slump test. An active variation of the slump technique, whereby he performed smooth oscillatory repetitions of left knee flexion and extension was also included in his home exercise program because it helped to produce improvements in his pain-free flexion range (Figure 20.2). The specific program given for this exercise was carefully graded for the first few sessions to help prevent any flare up in nerve reactivity.
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.
High-dose cervical mobilization to improve central sensitization for a patient with post-fusion neck pain
Published in Physiotherapy Theory and Practice, 2023
Robert T. LeBeau, Stephen Shaffer, Darren Earnshaw
During the initial stages of treatment, high-dose accessory and physiologic joint mobilization were used to reduce pain and improve mobility. The addition of strength and stretching exercises were added after the patient could tolerate movement-based exercise. Although the independent effects of exercise were not studied, the use of high-dose mobilizations appears to have allowed the patient to complete a multi-modal movement-based treatment. This case combined current theories of pain science (e.g. conditioned pain modulation) with a biomechanical approach to improve post-operative cervical function in the presence of signs indicating centrally sensitized tissues. Further research on therapeutic dosage effects and joint mobilization on post-cervical fusion patients and adjacent segment syndrome is warranted.
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.
Related Knowledge Centers
- Manual Therapy
- Mechanoreceptor
- Range of Motion
- Synovial Joint
- Golgi Tendon Organ
- Range of Motion
- Bulbous Corpuscle
- Pacinian Corpuscle
- Natural Apophyseal Glides
- Orthopedic Surgery
- Passive Accessory Intervertebral Movements