Manual therapy
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Comparative Study
Is the psychosocial profile of people with low back pain seeking care in Danish primary care different from those in secondary care?
Differences between the psychosocial risk factors of low back pain (LBP) patients in primary and secondary care are under-investigated. Similarly, differences in the psychosocial profile of people classified into STarT Back Screening Tool (SBT) subgroups in primary and secondary care settings have not been investigated. The aim of the study was to determine: (1) if movement-related fear, catastrophisation, anxiety and/or depression in LBP patients are different between primary and secondary care settings, and (2) if those differences are retained when stratified by SBT subgroup. ⋯ These differences in psychosocial scores were broadly retained when stratified by SBT subgroup. However, questionnaire-specific reported thresholds for important difference scores indicate the size of these differences between the care settings were unlikely to be clinically important from a patient perspective. Longitudinal studies are required to investigate the predictive ability of SBT in secondary care settings and whether treatment targeted to SBT subgroups is effective in secondary care.
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It is unclear how age-related postural changes such as thoracic spine kyphosis influence cervical range-of-motion (ROM) in patients with cervical spine dysfunction. The purpose of this study was to explore the mediating effects of forward head posture (FHP) on the relationship between thoracic kyphosis and cervical mobility in older adults with cervical spine dysfunction. Fifty-one older adults (30 females, mean[SD]age = 66[4.9] years) with cervical spine dysfunction - that is, cervical pain with or without referred pain, numbness or paraesthesia - participated. ⋯ Bootstrap mediational analyses, adjusted for age, gender, weight and NDI, revealed significant indirect effects of thoracic kyphosis on cervical flexion and general rotation ROM through a FHP. Our results show that FHP mediated the relationship between thoracic kyphosis and cervical ROM, specifically general cervical rotation and flexion. These results not only support the justifiable attention given to addressing FHP to improve cervical impairments, but they also suggest that addressing thoracic kyphosis impairments may constitute an "upstream" approach.
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Impaired integration of the body schema with motor processes may contribute to painful and/or restricted movement in chronic pain. Laterality judgment tasks assess this integration of the body schema with motor processes. The purpose of this study was to assess if patients with chronic whiplash associated disorders (WAD) are impaired on laterality judgment tasks. ⋯ Cervical spine PPT were significantly correlated with accuracy (r = 0.36) and RT (r = 0.29) in patients with WAD. These findings suggest that patients with chronic WAD are not impaired on neck or foot laterality judgment tasks. Laterality training is not indicated in the management of chronic WAD.
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Lumbar muscle degeneration is a common feature in non-specific low back pain (LBP). It is hypothesized that degenerated muscles might compromise spinal stability and lead to further injury/pain. However, little is known about lumbar muscle morphometry after resolution of LBP. ⋯ There were no differences between the previously painful and non-painful side of the LBP group for any of the parameters. These results show a generalized increase in intramuscular fatty infiltration in lean muscle tissue in the absence of macroscopical signs of muscle degeneration after resolution of LBP. These findings reflect a decreased muscle quality, but not quantity, and might indicate a pathophysiological mechanism contributing to recurrence of LBP.
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There is currently a lack of information regarding neck muscle activity during specific exercises. The purpose of the present study was to investigate deformation and deformation rate in different layers of dorsal and ventral neck muscles during isometric neck muscle contraction in individuals after anterior cervical decompression and fusion and in healthy controls. This study included 10 individuals (mean age 60 years; SD 7.1) with a verified, long-standing neck disorder and 10 healthy, age- and sex-matched controls. ⋯ Among the healthy controls, the multifidus showed a higher degree of deformation (p = 0.02) than the trapezius. In conclusion, our results showed no significant differences between the two groups in mechanical neck muscle activation. Larger studies with different exercises, preferably with a standardized measure of resistance, are needed to investigate whether patients and controls show differences in deformation and deformation rates in neck muscles.