Clinical Reasoning
The Role of Manual Therapy
Now the most obvious key role of manual therapy is that it provides pain relief in some patients (for those interested in the research relating to the mechanisms of manual therapy this topic please see this previous post and this recent systematic review by Voogt et al (2014)). Pain reduction in patients is great, but there […]
The Core Stability Problem
When I refer to “Core Stability” I mean teaching patients isolated contractions of transverses abdominus and multifidus. This is then usually progressed (depending on the practitioner) to having the patient contracting these muscle in functional movement patterns. The end aim being reduction of pain and improvement in function. From my perspective the “core stability” direction started following […]
In Pursuit of Pathology
I have recently attended a couple of seminars that have mentioned how newer and better MRI units will begin to be used in the attempt to identify pathology in patients with musculoskeletal pain. Now this sounds a fantastic and a worthwhile cause, especially if it enables us to identify symptomatic pathology in a patient population […]
Red Flags for Low Back Pain- Research Update – July 2014
Sorry for the delay in posts. I was pleased to recently be asked by the Western Australian branch of Musculoskeletal Physiotherapy Australia (MPA) to present a day of lecturing on their annual “Spinal 1” course, and an evening seminar on “Red Flags for Low Back Pain”. Hence my last couple of months have been taken […]
Cold Hyperalgesia Testing
I have often read in the literature the view that Cold Hyperalgesia is suggestive of more “severe” pain states and hence poorer prognosis. For example: Van Oosterwijck et al (2013) reported in their Systematic literature review on the evidence for central sensitisation in chronic whiplash that: The outcome of the processes involved in central sensitization […]
Neurological Examination for Radiculopathy
I found this recent article regarding neurological examination for radiculopathy interesting. Al Nezari et al (2013) conducted a systematic review and meta-analysis of the literature investigating the diagnostic accuracy of the neurological examination to detect lumbar disc herniation with suspected radiculopathy. The authors found 14 studies that investigated three standard neurological examination components (sensory, motor, and reflexes) […]
Treatment of Chronic Pain?
Hopefully anyone seeing the title of this post will not be clicking on it thinking that I have the answers to chronic pain……please note the maze in the cover image and the question mark at the end of the title! Lets be honest, the outcomes that chronic pain patients are achieving, via all forms of […]
MRI Findings in Low Back Pain
Hopefully we are all familiar with the current view that most lower back pain is “non-specific” in nature. What this means is that there is no obvious finding on imaging (MRI etc) that can explain a cause of the patients pain. But what is some of evidence base in relation to MRI findings in low […]
Clinical Diagnosis of Meniscal Tears in the Knee – Research Evidence
Hi all. This post continues on with the theme relating to the “usefulness” of clinical tests. The time the topic of this post is “Clinical Diagnosis of Meniscal Tears in the Knee – Research Evidence”. Once again this post throws values around for sensitivity, specificity, LR’s etc. So here is some information from a previous […]
Diagnosis of Spinal Pain – Research Evidence
For this post I wanted to continue the trend of posts regarding the usefulness of clinical tests to diagnose specific “structural” dysfunctions. The previous post being about the hip, this post being about “spinal” clinical tests. How useful are our clinical tests in the diagnosis of spinal pain? I think the article by Cook and […]
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