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).
Physical Therapy and Pain Management
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
The evaluation process determines the tissue lesion or what structure needs treatment. Manual therapy techniques including massage, mobilization, and manipulation are highly effective in reducing pain, muscle guarding, and producing increased range of motion. The evaluation will determine whether there is a hypermobility or a hypomobility of a joint and the amount of tension in the muscles surrounding the joint. Hypermobilities, or excessive motion, in a spinal or extremity joint are effectively treated with stabilization exercises and are addressed later in this chapter. Hypomobility, or restricted motion, at a spinal or extremity joint is effectively treated with manual therapy. Manual therapy philosophies include Mennell’s — there is a pathological condition or joint disease; osteopathic structure governs function according to Cyriax — all pain has an anatomical source and with correct diagnosis and treatment directed at the cause a positive outcome will occur. The majority of information covered is a combination of osteopathic and Cyriax philosophies.
Physiotherapy
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
At the moment, there is only little evidence that supports the use of passive modalities in the treatment of patients with chronic pain. Spinal manipulative therapy has no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school in patients with CLBP.46 Massage, on the other hand, might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.47 Locally applied thermal treatments (ice and heat packs) are commonly used in painful conditions and can be easily applied by the patient at home. There is no evidence to demonstrate that treatment by a practitioner is better than treatment by patients themselves. The evidence base to support the common practice of superficial heat and cold for low back pain is limited. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.43 Temperature modalities should rarely be used alone, but rather in conjunction with appropriate exercises, such as stretching, for increasing range of motion and for strengthening.48
The fidelity of comparison intervention in manual therapy trial for patients with low back pain: a systematic review
Published in Physical Therapy Reviews, 2019
Mackenzie Snow, Sean Trexler, Christine Gates, Kathryn Pudoka, Mark Wilhelm
One aspect of physical therapy treatment that the CPG presents as beneficial is manual therapy. In this systematic review, manual therapy was chosen as the intervention to compare to the comparison group. According to the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), manual therapy is defined as ‘a specialized area of physical therapy for the management of musculoskeletal conditions, based on clinical reasoning, using highly specific manual techniques and therapeutic exercises’ [5]. Manual therapy techniques may consist of, but are not limited to, mobilizations and/or manipulations of soft tissue and joints. In a systematic review and meta-analysis conducted by Coulter et al., manual therapy was shown to be a safe and effective treatment strategy used to significantly reduce pain as well as disability, demonstrating its value in physical therapy care in patients with low back pain [6].
Design recommendations for exoskeletons: Perspectives of individuals with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Lysanne van Silfhout, Allard J.F. Hosman, Henk van de Meent, Ronald H.M.A. Bartels, Michael J.R. Edwards
Technological advances in robotics have led to the development of lower extremity robotic exoskeletons for rehabilitation therapy. Exoskeletons are wearable robotic suits with electromotors at the hip and knee joints, rechargeable batteries, and a computer-based control system.2 Robotic exoskeletons are suitable for taking over strenuous and repetitive tasks from therapists, and could thus be used to relieve some of the burden required by rehabilitation therapists to aid in ambulation. Moreover, these exoskeletons may potentially increase the efficiency of the therapy, since they could provide more intensive training, better quantitative feedback and improved functional outcomes compared to manual therapy.3 In this way, therapists could focus more on other tasks, such as interacting with patients, assessing the outcome of the therapy and intervening during the training session if necessary.3 Optimal robotic training programs could be designed and adjusted according to the patient’s condition.4,5 Multiple studies have already reported the safety of mobilizing with an robotic exoskeleton, as well as their feasibility and efficiency.3,6–11 Moreover, exoskeleton training has already been shown to be beneficial for more than just walking function.12,13 Examples include a potential 38% reduction in spasticity and 61% improvement in bowel function.12
Conservative management of De Quervain’s tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series
Published in Physiotherapy Theory and Practice, 2022
Scott W. Young, Thomas W. Young, Cameron W. MacDonald
An impairment based multi-modal treatment plan was initiated for each patient. Each visit was 45 minutes in duration and all interventions were performed by the same PT who performed the initial examination (SY). The selection of manual therapy techniques was based on patient presentation each visit. High velocity low amplitude first CMC thrust manipulation was performed in mid-range to the patients affected wrist (Figure 1) to improve MCP extension. If a cavitation was not noted a second thrust was performed but no more than two thrusts were performed each visit. Immediately following the thrust manipulation(s) grade III–IV posterior to anterior oscillations were performed at end range to the first CMC joint to facilitate mobility (Figure 2). Because each patient had wrist extension hypomobility, grade III–IV posterior to anterior oscillations were applied at end range to resolve this impairment (Figure 3). Each of the thrust and non-thrust techniques utilized have been described in Maitland’s Peripheral Manipulation text (Hengeveld and Banks, 2013). The MWM technique described by Rabin, Israeli, and Kozol (2015) and Backstrom (2002) was utilized to improve abductor pollicis longus and extensor pollicis brevis soft tissue mobility. The MWM technique involved a lateral glide of the proximal carpal row moving on the radioulnar joint while the patient performed active thumb flexion (Figure 4). Each patient responded very favorably to the manual therapy techniques with reports of improved thumb/ wrist mobility and decreased pain.
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