Sept. 11 FMT Abstracts
Arthritis & Rheumatism, 09/02/2011
Shakoor N et al. – This study demonstrates an association between greater somatosensory deficits and higher dynamic loads in osteoarthritis (OA) . It also demonstrates structural consequences associated with somatosensory deficits in OA since the extent of sensory loss directly correlated with radiographic knee
OA severity. However, there was no relationship observed between vibratory sense and symptomatic knee OA severity or pain.
Methods

Subjects with symptomatic knee OA underwent evaluation of vibratory perception threshold


(VPT) using a biothesiometer at five sites at the lower extremity.
Dynamic joint loading was assessed through gait analyses.
Knee pain was evaluated using the WOMAC visual analog scale and radiographic knee OA severity was assessed using the Kellgren–Lawrence (KL) grading scale on standing knee radiographs.
Results

Dynamic knee loading was directly associated with VPT at the metatarsophalangeal (MTP) joint
(Spearman rho=0.384, p=0.033), so that the worse the vibratory sense, the higher the knee loads
 during gait. KL grade was directly associated with VPT at the MTP and lateral femoral condyle after adjustment for age, gender, BMI and knee pain.
After adjustment for confounders, there were no significant associations observed between VPT and pain at any of the sites tested.
Results:
Dynamic knee loading was directly associated with VPT at the metatarsophalangeal (MTP) joint
(Spearman rho=0.384, p=0.033), so that the worse the vibratory sense, the higher the knee loads during gait. KL grade was directly associated with VPT at the MTP and lateral femoral condyle after adjustment for age, gender, BMI and knee pain. After adjustment for confounders, there were no significant associations observed between VPT and pain at any of the sites tested.
Conclusions:
This study demonstrates an association between greater somatosensory deficits and higher dynamic loads in OA. It also demonstrates structural consequences associated with somatosensory deficits in OA since the extent of sensory loss directly correlated with radiographic knee OA severity. However, there was no relationship observed between vibratory sense and symptomatic knee OA severity or pain. http://onlinelibrary.wiley.com/doi/10.1002/art.30657/abstract;jsessionid=411FB5404D969A5381574B44
5F93F0B8.d02t04?systemMessage=Wiley+Online+Library+will+be+disrupted+3+Sep+from+10-
12+BST+for+monthly+maintenance
Shakoor N et al. The relationship of vibratory perception with dynamic joint loading, radiographic severity, and pain in knee osteoarthritis. Arthrisitis & Rheumatism . Sept 2001. (Entered September 2011)
Category: Lower Quarter Bib- Knee

Kevin M. Cross, Chris Kuenze, Terry L. Grindstaff, Jay HertelDOI: 10.2519/jospt.2011.3670
STUDY DESIGN: Systematic review. BACKGROUND: Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of thoracic spine thrust manipulation for the treatment of individuals with mechanical neck pain. OBJECTIVE: The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain.
METHODS: Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "thoracic mobilization,"
"thoracic spine mobilization," "thoracic manipulation," and "thoracic spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals. RESULTS: Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect. CONCLUSIONS: Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable. LEVEL OF EVIDENCE: Therapy, level 1b–.
J Orthop Sports Phys Ther 2011;41(9):633-642. doi:10.2519/jospt.2011.3670
http://www.jospt.org/issues/articleID.2620,type.1/article_detail.asp
Cross KM, Kuenze C, Grindstaff TL, Hertel J.
Thoracic Spine Thrust Manipulation Improves Pain, Range of Motion, and Self-Reported Function in Patients With Mechanical Neck Pain: A Systematic Review
J Orthop Sports Phys Ther. 2011;41(9):633-642. (Emtered September 2011)
Category: Upper Quarter Bib- Thoracic Spine Manipulations

Richard W. Willy, Irene S. Davis
DOI: 10.2519/jospt.2011.3470
STUDY DESIGN: Block randomized controlled trial. OBJECTIVES: To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. BACKGROUND: Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered. METHODS: Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance.
Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. RESULTS: While hip abductor and external rotation strength increased significantly ( P <.005) in the training group, there were no significant changes in hip or knee mechanics during running.
However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly ( P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study. CONCLUSION: A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics. LEVEL OF EVIDENCE: Therapy, level 2b.
J Orthop Sports Phys Ther 2011;41(9):625-632, Epub 12 July 2011. doi:10.2519/jospt.2011.3470 http://www.jospt.org/issues/articleID.2608,type.1/article_detail.asp
Willy RW, Davis IS . The Effect of a Hip-Strengthening Program on Mechanics During Running and
During a Single-Leg Squat. J Orthop Sports Phys Ther . 2011;41(9):625-632 . (Entered September 2011)
Category: Lower Quarter Bib- Running

DOI: 10.2519/jospt.2011.0506
J Orthop Sports Phys Ther 2011;41(9):643. doi:10.2519/jospt.2011.0506
NECK PAIN IS VERY COMMON.
In the United States, between 30% and 50% of people suffer from an aching neck each year. Although neck pain can be caused by injury, most of this pain results from more gradual stresses, such as particular sitting, standing, or work postures, lifting patterns, or sleeping positions. Typical neck pain can also cause headaches, pain between your shoulders, or a feeling of knots in your neck and upper back muscles. Although manual therapy, sometimes called "manipulation," is a common treatment for many types of spine pain, some people are uncomfortable having their necks manipulated. Recently, though, researchers have tested the benefits of a thrust manipulation of the upper back to treat neck pain. A study published in the September 2011 issue of JOSPT provides new insight and an evidence-based summary of the benefits of manipulating the upper back to ease and eliminate neck pain.
NEW INSIGHTS
In this study, the researchers evaluated published articles using a process called systematic review, which locates all relevant articles on a topic and selects those studies of the highest quality. Their initial search of the literature found 44 possible articles of interest. The researchers ultimately chose 6 high-quality articles that, when combined, included 187 patients who received upper back manipulation and were then compared to 173 patients who received another form of treatment. The research team found that performing upper back manipulations as part of the treatment resulted in less pain, increased neck motion, and improved function. These improvements were seen after the first treatment and continued up to 6 months after a 3-week treatment program that included several upper back manipulations.
PRACTICAL ADVICE
Patients with typical neck pain may benefit from a physical therapy program that includes upper back manipulation. Potential benefits are less pain, better neck motion, and improved ability to perform daily activities. This type of manipulation is very safe and may help you feel better faster. In addition to upper back manipulation, physical therapy treatment may include exercises to help improve the strength and endurance of the muscles around your neck, decreasing your chance of feeling neck pain in the future.
Your physical therapist can help determine if you are a good candidate for this treatment as part of a program designed to help get rid of the aching in your neck. For more information on the treatment of neck pain, contact your physical therapist specializing in musculoskeletal disorders.
Neck Pain: Manipulating the Upper Back Helps Lessen Pain and Improve Neck Motion. J Orthop Sports
Phys Ther. 2011;41(9):643 . (Entered September 2011)
Category: Upper Quarter Bib- Cervical Spine

Lisa N. Konitzer, Norman W. Gill, Shane L. Koppenhaver
DOI: 10.2519/jospt.2011.3685
STUDY DESIGN: Prospective case series. OBJECTIVES: To investigate changes in abdominal muscle thickness with ultrasound imaging, after spinal manipulative therapy (SMT), in a subgroup of patients with low back pain (LBP) who meet a proposed clinical prediction rule for lumbar stabilization exercise
(LSE). BACKGROUND: The characteristics of a subgroup of patients with LBP who respond clinically to LSE has been proposed. Although the pathoanatomical characteristics of this subgroup have not been determined, clinicians often assume that this type of LBP is related, in part, to neuromuscular deficits of the lateral abdominal muscles. Recent evidence suggests that SMT may facilitate abdominal muscle activity and, therefore, enhance exercises targeting these deficits. METHODS: Nineteen patients (mean age ± SD, 32.5 ± 7.8 years; 11 female) with LBP, who met the criteria for LSE, underwent ultrasound imaging of the transversus abdominis (TrA) and internal oblique (IO) muscles before, immediately after, and 3 to 4 days after lumbopelvic SMT. Measurements of resting thickness, contracted thickness during the abdominal drawing-in maneuver, and percent thickness change from rest to contraction of the TrA and
IO muscles were analyzed with repeated-measures analysis of variance. Numeric pain rating scale and
Oswestry Disability Index data were also collected. RESULTS: No significant differences in resting, contracted, or percent thickness change in the TrA or IO were found over the 3 time periods. There were statistically significant reductions in numeric pain rating scale and Oswestry Disability Index scores, but mean differences failed to meet the minimal clinically important difference.
CONCLUSION: The results provide preliminary evidence that TrA and IO muscle resting and contracted thicknesses do not change post-SMT in patients with LBP in the LSE subgroup. In addition, while reductions in pain and disability were noted, they were not clinically meaningful.
J Orthop Sports Phys Ther 2011;41(9):666-674, Epub 12 July 2011. doi:10.2519/jospt.2011.3685
http://www.jospt.org/issues/articleID.2612,type.1/article_detail.asp
Konitzer LN, Gill NW, Koppenhaver SL . Investigation of Abdominal Muscle Thickness Changes After
Spinal Manipulation in Patients Who Meet a Clinical Prediction Rule for Lumbar Stabilization
J Orthop Sports Phys Ther. 2011;41(9):666-674. (Entered September 2011)
Category: Lower Quarter Bib- Abdominal Muscles

Kornelia Kulig, John M. Popovich, Lisa M. Noceti-Dewit, Stephen F. Reischl, Dong Kim
DOI: 10.2519/jospt.2011.3427
STUDY DESIGN: Controlled laboratory study using a cross-sectional design.
OBJECTIVES: To characterize ankle and hip muscle performance in women with posterior tibial tendon dysfunction
(PTTD) and compare them to matched controls. We hypothesized that ankle plantar flexor strength, and hip extensor and abductor strength and endurance, would be diminished in women with PTTD and this impairment would be on the side of dysfunction.
BACKGROUND: Individuals with PTTD demonstrate impaired walking abilities. Walking gait is strongly dependent on the performance of calf and hip musculature. METHODS: Thirty-four middle-aged women (17 with PTTD) participated. Ankle plantar flexor strength was assessed with the single-leg heel raise test. Hip muscle performance, including strength and endurance, were dynamometrically measured. Differences between groups and sides were assessed with a mixed-model analysis of variance. RESULTS: Females with PTTD performed significantly fewer single-leg heel raises and repeated sagittal and frontal plane non–weight-bearing leg lifts, and also had lower hip extensor and abductor torques than age-matched controls. There were no differences between sides for hip strength and endurance measures for either group, but differences between sides in ankle strength measures were noted in both groups. CONCLUSION: Women with
PTTD demonstrated decreased ankle and hip muscle performance bilaterally.
J Orthop Sports Phys Ther 2011;41(9):687-694. doi:10.2519/jospt.2011.3427
KEY WORDS: acquired flatfoot deformity, PTTD, walking
Kulig K, Popovich JM, Noceti-Dewit LM, Reischl SF, Kim D. Women With Posterior Tibial Tendon
Dysfunction Have Diminished Ankle and Hip Muscle Performance. J Orthop Sports Phys Ther.
2011;41(9):687-694. (Entered September 2011)
Category: Lower Quarter Bib- Posterior Tibialis

.
Carroll TJ, Selvanayagam VS, Riek S, Semmler JG
201106202(2):119-40Language: engCountry: EnglandSchool of Human Movement Studies, The
University of Queensland, Brisbane, Queensland, Australia Sports Centre, University of Malaya, Kuala
Lumpur, Malaysia Discipline of Physiology, School of Medical Sciences, The University of Adelaide,
Adelaide, South Australia, Australia.
Acta physiologica (Oxford, England) It has long been believed that training for increased strength not only affects muscle tissue, but also results in adaptive changes in the central nervous system. However, only in the last 10 years has the use of methods to study the neurophysiological details of putative neural adaptations to training become widespread. There are now many published reports that have used single motor unit recordings, electrical stimulation of peripheral nerves, and non-invasive stimulation of the human brain [i.e. transcranial magnetic stimulation (TMS)] to study neural responses to strength training.
In this review, we aim to summarize what has been learned from single motor unit, reflex and TMS studies, and identify the most promising avenues to advance our conceptual understanding with these methods. We also consider the few strength training studies that have employed alternative neurophysiological techniques such as functional magnetic resonance imaging and electroencephalography. The nature of the information that these techniques can provide, as well as their major technical and conceptual pitfalls, are briefly described. The overall conclusion of the review is that the current evidence regarding neural adaptations to strength training is inconsistent and incomplete. In order to move forward in our understanding, it will be necessary to design studies that are based on a rigorous consideration of the limitations of the available techniques, and that are specifically targeted to address important conceptual questions.
Carrol TJ, Selvanavagam VS, Riek S, Semmler JG. Neural adaptations to strength training: Moving beyond transcranial magnetic stimulation and reflex studies. England School of Human Movement
Studies. Jun 2011;202(2):119-40. (Entered September 2011)
Category: Misc Bib- Neuroplasticity

Rombaut L, Malfait F, De Wandele I, Cools A, Thijs Y, De Paepe A, Calders P
20110792(7):1106-12Language: engCountry: United StatesDepartment of Rehabilitation Sciences and
Physiotherapy, Ghent University, Artevelde University College, Ghent, Belgium.
UNLABELLED: Rombaut L, Malfait F, De Wandele I, Cools A, Thijs Y, De Paepe A, Calders P.
Medication, surgery, and physiotherapy among patients with the hypermobility type of Ehlers-Danlos syndrome.
OBJECTIVES: To describe medication use, surgery, and physiotherapy, and to examine the effect of these treatment modalities on functional impairment and amount of complaints among patients with the hypermobility type of Ehlers-Danlos syndrome (EDS-HT).
DESIGN: Cross-sectional study.
SETTING: Physical and rehabilitation medicine department and center for medical genetics.
PARTICIPANTS: Patients with EDS-HT (N=79; 8 men, 71 women) were recruited for this study.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Patients filled out questionnaires regarding type of complaints, medication use, surgery, physiotherapy, and outcome of treatment. Functional impairment in daily life was measured by the Sickness Impact Profile. Pain severity was assessed with visual analog scales.
RESULTS: Patients reported a large number of complaints, a considerable presence of severe pain, and a clinically significant impact of disease on daily functioning. Most patients (92.4%) used medications, among which analgesics were the most prevalent. Fifty-six patients (70.9%) underwent surgery, including mainly interventions of the extremities and abdomen. Forty-one patients (51.9%) are currently enrolled in a physical therapy program, mainly comprising neuromuscular exercises, massage, and electrotherapy.
Patients with a high consumption of analgesics, who visited the physiotherapist, or who underwent surgery had a higher dysfunction in daily life. Only 33.9% of the patients who underwent surgery and
63.4% of patients in physical therapy reported a positive outcome.
CONCLUSIONS: Patients with EDS-HT have numerous complaints and an impaired functional status that strongly determine their high rate of treatment consumption. The outcome of surgical and physiotherapy treatment is disappointing in a large percentage, which illustrates a strong need for evidence-based therapy.
Arch Phys Med Rehabil
Issue: 7, 1106-12Rombaut L et, al.
2011 JulPMID: 21636074
Rombaut L et al. Medication, surgery, and physiotherapy among patients with the hypermobility type of ehlers-danlos syndrome.
Arch Phys Med Rehabil. Jul 2011;7:1106-1112. (Entered September 2011)
Category: Misc Bib- Hypermobile Syndrome

Journal of Shoulder and Elbow Surgery, 09/06/2011 Evidence Based Medicine Clinical Article
Marinko LN et al. - Therapeutic exercise is an effective intervention for the treatment of painful shoulder conditions; however, subsequent research is necessary for translation into clinical practice.
Methods

Medline via Ovid, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the
Cochrane Central Register of Controlled Trials were searched from 1997 through March 2011.

Randomized controlled trials comparing physical therapist–prescribed exercises against any other type of intervention were included.

Articles were qualitatively evaluated by use of the Physiotherapy Evidence Database scale by 5 separate reviewers.

Data from included studies were extracted and synthesized with respect to the primary outcomes of ROM, pain, and function.

Results
Individual effect sizes were calculated with a standard formula, and overall effect was calculated by use of random- and fixed-effects models.

The authors qualitatively reviewed 19 articles; 17 achieved the criterion of 6 or better on the
Physiotherapy Evidence Database scale.

Significant heterogeneity in reporting among included studies limited quantitative assessment.

Overall, therapeutic exercise has a positive effect on pain and function above all other interventions.

The findings for ROM were inconclusive
Conclusion
Therapeutic exercise is an effective intervention for the treatment of painful shoulder conditions; however, subsequent research is necessary for translation into clinical practice. http://www.jshoulderelbow.org/article/PIIS1058274611002448/abstract?rss=yes
Marinko LN et al. The effectiveness of therapeutic exercise for painful shoulder conditions: a metaanalysis. Journal of Shoulder and Elbow Surgery. September 2011. (Entered September 2011)
Category: Upper Quarter Bib- Shoulder

American Journal of Sports Medicine, 09/06/2011
Thijs Y et al. – The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of patellofemoral dysfunction syndrome (PFDS)
Background: Hip muscle weakness has been proposed to contribute to patellofemoral malalignment and the development of the patellofemoral dysfunction syndrome (PFDS). However, from the retrospective studies that have addressed this issue, it is still unclear if hip muscle weakness is a cause or a consequence of PFDS.
Purpose: This study was undertaken to investigate if hip muscle weakness is a predisposing factor for the development of PFDS.
Study Design: Cohort study (prognosis); Level of evidence, 2.
Methods: Before the start of a 10-week “start to run” program, the isometric strength of the hip flexor, extensor, abductor, adductor, and external and internal rotator muscles was measured in 77 healthy female novice runners. During the 10-week training period, patellofemoral pain was diagnosed and registered by an orthopaedic surgeon.
Results: Statistical analysis revealed that there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop PFDS. Logistic regression analysis did not identify a deviation in strength of any of the assessed hip muscle groups as a risk factor for PFDS.
Conclusion: The findings of this study suggest that isometric hip muscle strength might not be a predisposing factor for the development of PFDS. http://ajs.sagepub.com/content/39/9/1877.abstract?rss=1
Thijs Y et al. Is Hip Muscle Weakness a Predisposing Factor for Patellofemoral Pain in Female Novice
Runners? A Prospective Study. American Journal of Sports Medicine . September 2011. (Entered
September 2011)
Category: Lower Quarter Bib- Patellofemoral Pain

Cephalalgia, 09/06/2011
Varkey E et al. – Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication.
Methods

In a randomized, controlled trial of adults with migraine, exercising for 40 minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use, which was slowly increased to the individual’s highest tolerable dose (maximum 200 mg/day).
 The treatment period lasted for 3 months, and migraine status, quality of life, level of physical activity, and oxygen uptake were evaluated.
 The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline.
Results
 91 patients were randomized and included in the intention–to–treat analysis.

The primary efficacy variable showed a mean reduction of 0.93 (95% confidence interval (CI)
0.31–1.54) attacks in the exercise group, 0.83 (95% CI 0.22–1.45) attacks in the relaxation group, and 0.97 (95% CI 0.36–1.58) attacks in the topiramate group.

No significant difference was observed between the groups (p = 0.95).
Conclusion: Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication. http://cep.sagepub.com/content/early/2011/09/01/0333102411419681.abstract
Varkey E et al. Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Migraine

Manual Therapy , 09/06/2011
Treleaven J et al. – Less sensorimotor dysfunction appears to occur in those with lower compared to upper cervical region pain, although this depends on whether trauma is involved in the onset of pain.
Impairments in sensorimotor control have been demonstrated in neck pain disorders. However, there are more anatomical and neurophysiological connections between the sensorimotor control system and the upper cervical region and thus potential for greater disturbances in those with upper region pain. This study investigated whether sensorimotor impairment was greater in those suffering pain from the upper rather than lower cervical spine region, taking the onset of pain into account.
Sixty-four subjects with persistent neck pain were divided into 4 groups -upper and lower region nontraumatic and upper and lower region traumatic. Cervical Joint Position Error (JPE), smooth pursuit neck torsion (SPNT) and standing balance tests were compared between groups.
The lower non-traumatic group demonstrated significantly less ( p < 0.03) deficit in SPNT compared to all other groups as well as less total energy of sway on the eyes open balance tests ( p < 0.05) compared to both traumatic neck pain groups. The upper traumatic group demonstrated significantly greater JPE following rotation to the right ( p < 0.04) when compared to both lower groups.
Less sensorimotor dysfunction appears to occur in those with lower compared to upper cervical region pain, although this depends on whether trauma is involved in the onset of pain. http://www.manualtherapyjournal.com/article/PIIS1356689X11001214/abstract?rss=yes
Treleaven J et al. Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders. Manual Therap. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Cervical Spine

Journal of Orthopaedic & Sports Physical Therapy, 09/06/2011
Walton DM et al. – This manuscript presents information regarding the expected scores for pressure pain threshold (PPT) testing in people with acute or subacute neck pain. Clinicians can compare the results of individual patients against these population values, and researchers can incorporate the significant confounders of age, sex, and self–reported pain intensity into future research designs
STUDY DESIGN: Cross-sectional convenience sample.
OBJECTIVES: To describe the distribution of scores for pressure pain threshold (PPT) at 2 standardized testing sites in people with neck pain of less than 90 days' duration: the angle of the upper trapezius and the belly of the tibialis anterior. A secondary objective was to identify important influences on PPT.
BACKGROUND: PPT may be a valuable assessment and prognostic indicator for people with neck pain.
However, to facilitate interpretation of scores, knowledge of means and variance for the target population, as well as factors that might influence scores, is needed.
METHODS: Participants were recruited from community-based physiotherapy clinics and underwent
PPT testing using a digital algometer and standardized protocol. Descriptive statistics (mean, standard deviations, quartiles, skewness, and kurtosis) were calculated for the 2 sites. Simple bivariate tests of association were conducted to explore potential moderators.
RESULTS: A positively skewed distribution was described for the 2 standardized sites. Significant moderators were sex (male higher than female), age (r = 0.22), and self-reported pain intensity (r = –
0.24). Neither litigation status nor most symptomatic/least symptomatic side influenced PPT.
CONCLUSIONS: This manuscript presents information regarding the expected scores for PPT testing in people with acute or subacute neck pain. Clinicians can compare the results of individual patients against these population values, and researchers can incorporate the significant confounders of age, sex, and selfreported pain intensity into future research designs. http://www.jospt.org/issues/articleID.2623,type.1/article_detail.asp
Walton DM et al. A Descriptive Study of Pressure Pain Threshold at 2 Standardized Sites in People With
Acute or Subacute Neck Pain. Journal of Orthopaedic & Sports Physical Therapy . Sep 2011. (Entered
September 2011)
Category: Upper Quarter Bib- Cervical Spine

Headache: The Journal of Head and Face Pain, 09/09/2011
Oliveira RVD et al. – Patients who did not seek medical assistance for headache had more tension–type headache, less migraine with aura, lower headache intensity and frequency, but the same headache disability. Most of them needed preventive treatment and did not seek doctors because their headache was mild or received relief from painkillers.
Methods


Cross–sectional study.

A total of 200 consecutive patients attended by family doctors had their complaints registered.

Those with headaches were interviewed.
A semi–structured questionnaire, Headache Impact Test and Hospital Anxiety and Depression
Scale were used.
Results

52 percent had headaches.

Ten percent sought medical assistance for headache, 11% already had received some form of

 medical assistance for headache.
There was no association between headache disability and seeking a doctor for headache.
Patients that did not seek a doctor for headache had a higher prevalence of tension–type headache
(59.6% vs 22.1%; P < .01), a lower prevalence of migraine with aura (32.3% vs 40.5%; P < .01), headache intensity (5.4 vs 6.8; P = .01) and frequency (4.2 × 7.4 days/month; P < .01).


Fifty–two percent of them needed preventive treatment.
Most of them did not seek a doctor because their headaches were mild or received relief from painkillers.
Conclusions.— Patients who did not seek medical assistance for headache had more tension-type headache, less migraine with aura, lower headache intensity and frequency, but the same headache disability. Most of them needed preventive treatment and did not seek doctors because their headache was mild or received relief from painkillers.
Oliveira RVD et al. Which Patients With Headache Do Not Seek Medical Attention? Headache: The
Journal of Head and Face Pain . Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Headache

Journal of Occupational and Environmental Medicine, 09/09/2011
Waters TR et al. – It is clear that as the lifting index (LI) increases, the risk of low back pain (LBP) increases.
Objective: To evaluate whether the Revised NIOSH Lifting Equation (RNLE) is a valid tool for assessing risk of low back pain (LBP) due to manual lifting by using combined data from two cross-sectional studies of 1-year prevalence.
Methods: Results from a symptom and occupational history questionnaire and RNLE analysis for 677 subjects employed in 125 manual lifting jobs at nine industrial sites were combined from two studies.
Results: The odds of LBP increased as the lifting index (LI) increased from 1.0 to 3.0. A statistically significant odds ratio (OR) was found for both the 1 < LI ≤ 2 (OR = 1.81) and the 2 < LI ≤ 3 categories
(OR = 2.26). For jobs with an LI value greater than 3.0, however, the OR remained nonsignificant. The 2
< LI ≤ 3 group remained statistically significant after adjusting for age, gender, body mass index, and psychosocial factors.
Conclusions: It is clear that as the LI increases, the risk of LBP increases. Longitudinal studies are needed. http://journals.lww.com/joem/Abstract/2011/09000/Efficacy_of_the_Revised_NIOSH_Lifting_Equation_ to.16.aspx
Waters TR et al. Efficacy of the Revised NIOSH Lifting Equation to Predict Risk of Low Back Pain
Due to Manual Lifting: Expanded Cross-Sectional Analysis. Journal of Occupational and
Environmental Medicine. Sep 2011. (Entered September 2011)
Category: Misc Bib- BET Lifting

Rheumatology, 09/07/2011 Clinical Article
Aviel YB et al. – Sleep disturbance and fatigue are prevalent among children with different rheumatic diseases. Sleep disturbance and fatigue are strongly associated with increased pain and decreased quality of life. Strategies aimed at improving sleep and reducing fatigue should be studied as possible ways of improving quality of life for children with rheumatic illness.
Methods

155 patients (115 JIA, 40 JDM) randomly sampled and mailed questionnaires

Sleep disturbance assessed by sleep self–report (SSR) and children's sleep habits questionnaire


(CSHQ)
Fatigue, pain and function assessed by the paediatric quality of life inventory (PedsQL) and disease activity by visual analogue scales (VASs)
Joint counts self–reported
Results

81% responded

44% reported disturbed sleep (CSHQ>41)

No differences between disease groups

Poor reported sleep (SSR) highly correlated with PedsQL fatigue (r=0.56, P<0.0001)

Fatigue was highly negatively correlated with quality of life (r=–0.77, P<0.0001)
 Worst pain intensity in last week correlated to sleep disturbance (r=0.32, P=0.0005)

Fatigue was associated with prednisone and DMARD use
Conclusions.
Sleep disturbance and fatigue are prevalent among children with different rheumatic diseases. Sleep disturbance and fatigue are strongly associated with increased pain and decreased quality of life. Strategies aimed at improving sleep and reducing fatigue should be studied as possible ways of improving quality of life for children with rheumatic illness. http://rheumatology.oxfordjournals.org/content/early/2011/08/25/rheumatology.ker256.abstract
Aviel YB et al. Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis. Rheumatology. Sep 2011. (Entered September
2011)
Category: Misc Bib- Juvenile RA

Current Rheumatology Reports, 09/07/2011
Holliday KL et al. – Findings have been largely equivocal, predominantly due to small sample size, but larger studies of pain in general population samples are being conducted. Interesting candidate genes from animal models and monogenic pain disorders are beginning to emerge. Recent advances in genetics research have yet to make an impact in the pain field but provide considerable scope for future research effort
Regional (e.g., low back) and widespread chronic pain disorders are common in the general population and are known to be heritable. Recent research suggests that genetic factors increase the risk of developing chronic pain independent of the site of pain. Candidate gene studies have been conducted on key pathways to elucidate susceptibility genes that are likely to be involved in both the sensory and affective components of pain. Findings have been largely equivocal, predominantly due to small sample size, but larger studies of pain in general population samples are being conducted. Interesting candidate genes from animal models and monogenic pain disorders are beginning to emerge. Recent advances in genetics research have yet to make an impact in the pain field but provide considerable scope for future research efforts. http://www.metapress.com/content/f850746l3007222h/
Holliday KL et al. Recent Advances in the Understanding of Genetic Susceptibility to Chronic Pain and
Somatic Symptoms. Current Rheumatology Reports.
Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

The Clinical Journal of Pain, 09/13/2011
Blumenstiel K et al. – Fibromyalgia syndrome (FMS) patients showed increased sensitivity for different pain modalities at all measured body areas, suggesting central disinhibition as a potential mechanism.
Chronic back pain (CBP) participants in contrast, showed localized alterations within the affected segment possibly due to peripheral sensitization.
Methods

Authors used the quantitative sensory testing protocol of the German Research Network on
Neuropathic Pain to obtain comprehensive profiles of somatosensory functions.

The protocol comprised thermal and mechanical detection and pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli.

Authors studied 21 FMS patients (mean pain duration: 13.4 y), 23 CBP subjects (mean pain duration: 15.9 y), and 20 healthy controls (HCs).

Results
Each participant received the test battery on the back and on the dorsal hand (pain–free control site).
 On the back, FMS patients showed increased thermal and mechanical pain sensitivity compared with HCs and CBP participants.

On the hand dorsum, FMS patients showed higher mechanical pain sensitivity compared with
CBP participants and HCs and higher cold pain sensitivity compared with HCs.

CBP participants showed increased pressure pain sensitivity and lower vibration sensitivity on the back, but no significant differences on the hand dorsum compared with HCs.
Discussion: FMS patients showed increased sensitivity for different pain modalities at all measured body areas, suggesting central disinhibition as a potential mechanism. CBP participants in contrast, showed localized alterations within the affected segment possibly due to peripheral sensitization. http://journals.lww.com/clinicalpain/Abstract/2011/10000/Quantitative_Sensory_Testing_Profiles_in_Ch ronic.5.aspx
Blumenstiel K et al. Quantitative Sensory Testing Profiles in Chronic Back Pain Are Distinct From Those in Fibromyalgia. The Clinical Journal of Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Fibromyalgia

Journal of Clinical Rheumatology (JCR), 09/13/2011
De Bruijn ST et al. – The results demonstrate some associations between physical fitness and pain in fibromyalgia and point to the importance of activity avoidance. Although the causal directionality of the associations needs substantiation in clinical research, the findings support the notion that low fitness and activity–avoidance beliefs should be targeted while treating pain in fibromyalgia.
Methods

Physical fitness of 18 patients with fibromyalgia was examined using maximal ergocycling and the 6–minute walking test (6MWT).

Pain intensity was assessed using self–report scales and quantitative sensory testing.
Results

A reduced walking distance on the 6MWT was correlated with more severe self–reported pain on the Fibromyalgia Impact Questionnaire (r = –0.52, P < 0.05).

Recovery of heart rate after ergocycling was correlated with cold pain thresholds (r = 0.70, P <
0.01), pressure pain thresholds (r = –0.70, P < 0.01), and heat wind–up (r = 0.66, P < 0.05).

Activity–avoidance beliefs correlated with a lower peak VO2 on the cycle test (r = –0.52, P <
0.05), a shorter distance on the 6MWT (r = –0.56, P < 0.05), and more severe self–reported pain
(r = 0.61, P < 0.05), reflecting that patients with activity–avoidance beliefs were less physically fit and experienced more severe pain.
Conclusions: The results demonstrate some associations between physical fitness and pain in fibromyalgia and point to the importance of activity avoidance. Although the causal directionality of the associations needs substantiation in clinical research, the findings support the notion that low fitness and activity-avoidance beliefs should be targeted while treating pain in fibromyalgia. http://journals.lww.com/jclinrheum/Abstract/2011/09000/Relevance_of_Physical_Fitness_Levels_and.1.a
spx
De Bruijn ST et al. Relevance of Physical Fitness Levels and Exercise-Related Beliefs for Self-reported and Experimental Pain in Fibromyalgia: An Explorative Study. Journal of Clinical Rheumatology. Sep
2011. (Entered September 2011)
Category: Misc Bib- Fibromyalgia

The Clinical Journal of Pain, 09/13/2011
Smart KM et al. – By identifying a discriminatory cluster of symptoms and signs predictive of nociceptive, peripheral neuropathic, and central pain, this study provides some preliminary discriminative validity evidence for mechanisms–based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms–based classifications of musculoskeletal pain.
Methods
 This study was a cross–sectional, between–patients design using the extreme–groups method.



464 patients with low back (±leg) pain were assessed using a standardized assessment protocol.
After each assessment, patients' pain was assigned a mechanisms–based classification.
Clinicians then completed a clinical criteria checklist indicating the presence/absence of various clinical criteria.
Results
 Multivariate analyses using binary logistic regression with Bayesian model averaging identified a
 discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of
“nociceptive,” “peripheral neuropathic,” and “central sensitization” pain, respectively.
Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios).
Discussion: By identifying a discriminatory cluster of symptoms and signs predictive of “nociceptive,”
“peripheral neuropathic,” and “central” pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended.
Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain. http://journals.lww.com/clinicalpain/Abstract/2011/10000/The_Discriminative_Validity_of__Nociceptive
,_.1.aspx
Smart KM et al. The Discriminative Validity of "Nociceptive," "Peripheral Neuropathic," and "Central
Sensitization" as Mechanisms-based Classifications of Musculoskeletal Pain. The Clinical Journal of
Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Central Sensitization

British Medical Bulletin, 09/13/2011 Evidence Based Medicine Clinical Article
Del Buono A et al. – Significant pain relief and improved outcomes were observed after conservative and surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82), evidencing an overall low–to–moderate quality of the studies. Repetitive low–energy radial shock wave therapy and home training approach provide beneficial effect over months, with almost 80% success rate at 15 months. The effectiveness of the various treatment modalities needs to be tested in carefully conducted randomized controlled trials
Introduction Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain located at or around the greater trochanter.
Source of data We performed a comprehensive search of Pubmed, Medline, Ovid, Google Scholar and
Embase databases, from inception of the database to 20th of June 2011, using a variety of keywords. We identified 52 relevant abstracts of articles published in peer-reviewed journals. Fourteen studies reporting the outcomes of patients undergoing conservative and surgical management of GTPS were selected.
Areas of agreement Significant pain relief and improved outcomes were observed after conservative and surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82), evidencing an overall low-to-moderate quality of the studies. Repetitive low-energy radial shock wave therapy and home training approach provide beneficial effect over months, with almost 80% success rate at 15 months.
Areas of controversy Poor available data extracted from small studies do not allow definitive conclusions to be drawn on the best treatment for GTPS.
Growing points Further multi-centre prospective studies are necessary to confirm the general validity of the findings reported.
Areas timely for developing research Future research and trials should focus on the application and effectiveness of the various conservative modalities for management of GTPS.
Conclusion The effectiveness of the various treatment modalities needs to be tested in carefully conducted randomized controlled trials. http://bmb.oxfordjournals.org/content/early/2011/09/04/bmb.ldr038.abstract
Del Buono A et al. Management of the greater trochanteric pain syndrome: a systematic review. British
Medical Bulletin. Sep 2011. (Entered September 2011)
Category: Lower Quarter Bib- Hip

The Clinical Journal of Pain, 09/13/2011
Thorsell J et al. – A manual–based self–help intervention with weekly therapist support in an acceptance and commitment therapy (ACT) format adds value to the treatment repertoire for persons suffering with chronic pain.
Methods

This study is a randomized control trial (N=90) with a mixed between–within participants design
 with repeated measures.
Interventions in both conditions comprised an initial face–to–face session, a 7–week manual– based self–help intervention including weekly therapist telephone support and a concluding face– to–face session. Outcome measures included satisfaction with life, depression, anxiety, acceptance of chronic pain, level of function, and pain intensity. Effects were measured at preintervention and postintervention and at 6 and 12 months after the end of intervention.
Results
 The results show that the ACT condition increased their level of acceptance significantly
 compared with the AR condition.
There was also a marginally significant interaction effect regarding satisfaction with life in which
 the ACT condition had improved in comparison to the AR condition.
Further, the ACT condition reported a higher level of function and decreased pain intensity compared with the AR condition.

Both conditions improved significantly regarding depression and anxiety.
 Objective: The aim of this study was to compare 2 self-help-based interventions; a copingoriented approach, applied relaxation (AR) and an acceptance-oriented approach, acceptance and commitment therapy (ACT), for persons with chronic pain.

Method: This study is a randomized control trial (N=90) with a mixed between-within participants design with repeated measures. Interventions in both conditions comprised an initial face-to-face session, a 7-week manual-based self-help intervention including weekly therapist telephone support and a concluding face-to-face session. Outcome measures included satisfaction with life, depression, anxiety, acceptance of chronic pain, level of function, and pain intensity.
Effects were measured at preintervention and postintervention and at 6 and 12 months after the end of intervention.

Results: The results show that the ACT condition increased their level of acceptance significantly compared with the AR condition. There was also a marginally significant interaction effect regarding satisfaction with life in which the ACT condition had improved in comparison to the
AR condition. Further, the ACT condition reported a higher level of function and decreased pain intensity compared with the AR condition. Both conditions improved significantly regarding
 depression and anxiety.
Conclusions: A manual-based self-help intervention with weekly therapist support in an ACT format adds value to the treatment repertoire for persons suffering with chronic pain. http://journals.lww.com/clinicalpain/Abstract/2011/10000/A_Comparative_Study_of_2_Manual_based_S elf_Help.9.aspx
Thorsell J et al. A Comparative Study of 2 Manual-based Self-Help Interventions, Acceptance and
Commitment Therapy and Applied Relaxation, for Persons With Chronic Pain . The Clinical Journal of
Pain.
Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

Indian Journal of Palliative Care, 09/13/2011
Desai G et al. – Despite patients using complementary medicine services, often health professionals are unaware of the issues associated with these services. These myths may interfere in using hypnotherapy as therapeutic tool in palliative care. It is important for health professionals to have an appropriate and evidence–based understanding about the complementary therapies including hypnotherapy.
Methods

A semi–qualitative method to survey opinions of the health professionals from various disciplines

 attending a programme on hypnotherapy was conducted.
The survey form consisted of 32 statements about hypnosis and hypnotherapy.
Participants were asked to indicate whether they agreed, disagreed, or were not sure about each statement.

A qualitative feedback form was used to obtain further views about hypnotherapy.
Results

The sample consisted of 21 participants from various disciplines.

Two–thirds of the participants gave correct responses to statements on dangerousness of hypnosis

(90%), weak mind and hypnosis (86%), and hypnosis as therapy (81%).
The participants gave incorrect responses about losing control in hypnosis (57%), hypnosis being
 in sleep (62%), and becoming dependent on hypnotist (62%).
Participants were not sure if one could not hear the hypnotist one is not hypnotized (43%) about the responses on gender and hypnosis (38%), hypnosis leading to revealing secrets (23%).
Conclusions: Despite patients using complementary medicine services, often health professionals are unaware of the issues associated with these services. These myths may interfere in using hypnotherapy as therapeutic tool in palliative care. It is important for health professionals to have an appropriate and evidence-based understanding about the complementary therapies including hypnotherapy. http://www.jpalliativecare.com/article.asp?issn=0973-
1075;year=2011;volume=17;issue=2;spage=146;epage=149;aulast=Desai
Desai G et al. Hypnotherapy: Fact or Fiction: A review in palliative care and opinions of health professionals. Indian Journal of Palliative Care . Sep 2011. (Entered September 2011)
Category: Misc Bib- Hypnotherapy

The Clinical Journal of Pain, 09/13/2011
Wong SYS et al. – This randomized, clinical trial showed that both Mindfulness–Based Stress Reduction
(MBSR) and multidisciplinary pain intervention (MPI) programs reduced pain intensity and pain–related distress although no statistically significant differences were observed between the 2 groups and the improvements were small.
Methods

A randomized, comparative clinical trial was conducted, including 6–month posttreatment follow–up.
 Ninety–nine participants, aged 24 to 64 years, with pain for a minimum of 3 months, were recruited from community–based clinics, hospitals, and community service centers.

Participants were randomly allocated to either the MBSR program (51 participants) or a MPI program (48 participants).
 The study used validated Chinese versions of self–reported questionnaires measuring pain, mood symptoms, and health–related quality of life.
Results
 Thirty–nine participants (77%) completed the MBSR program and 44 (90%) completed the MPI
 program.
Patients in both the groups were comparable with regard to demographical characteristics, pain intensity, mood symptoms, and health–related quality–of–life measures before intervention.

In both the groups, patients who completed the trial demonstrated statistically significant improvements in pain intensity and pain–related distress.

However, no statistically significant differences were observed in overall results between the
MBSR and MPI groups.

Results: Thirty-nine participants (77%) completed the MBSR program and 44 (90%) completed the MPI program. Patients in both the groups were comparable with regard to demographical characteristics, pain intensity, mood symptoms, and health-related quality-of-life measures before intervention. In both the groups, patients who completed the trial demonstrated statistically significant improvements in pain intensity and pain-related distress. However, no statistically
 significant differences were observed in overall results between the MBSR and MPI groups.
Conclusions: This randomized, clinical trial showed that both MBSR and MPI programs reduced pain intensity and pain-related distress although no statistically significant differences were observed between the 2 groups and the improvements were small. http://journals.lww.com/clinicalpain/Abstract/2011/10000/Comparing_the_Effectiveness_of_Mindfulness
_based.10.aspx
Wong SYS et al. Comparing the Effectiveness of Mindfulness-based Stress Reduction and
Multidisciplinary Intervention Programs for Chronic Pain: A Randomized Comparative Trial. The
Clinical Journal of Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

The Clinical Journal of Pain, 09/13/2011
Mongardon N et al. – Chronic pain is common after thoracotomy and its neuropathic component is infrequent. As age, american Society of Anesthesiologists (ASA) scores, number of drains, and situations relating to daily life seem to play a role in pain occurrence, a multifaceted approach against the onset of chronic pain is advisable.
Methods

All 86 patients, who had undergone a posterolateral thoracotomy at this institution between
October 2007 and March 2008, received a questionnaire 1 year after the surgical procedure and were contacted by phone 1 week later.
Results


65 patients responded.
Prevalence of chronic pain was 48%; among them 8 patients had neuropathic pain (12% of the
 whole group).
Current, average, and maximal pain scale scores were 1.1±1.2, 1.3±1.3, and 3.4±1.7 (visual

 analog scale), respectively.
Patients with chronic pain were about 10 years younger (P=0.07) and had a significantly less severe American Society of Anesthesiologists (ASA) score (29% grade I versus 17%, P=0.04).
With regard to risk factors, age and ASA score were negatively correlated with chronic pain
 whereas number of drains was positively correlated to it.
In most patients with pain (84%), activities of daily life were affected.
Discussion: Chronic pain is common after thoracotomy and its neuropathic component is infrequent. As age, ASA scores, number of drains, and situations relating to daily life seem to play a role in pain occurrence, a multifaceted approach against the onset of chronic pain is advisable. http://journals.lww.com/clinicalpain/Abstract/2011/10000/Assessment_of_Chronic_Pain_After_Thoracot omy__A.4.aspx
Mongardon N et al. Assessment of Chronic Pain After Thoracotomy: A 1-Year Prevalence Study. The
Clinical Journal of Pain.
Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

The Clinical Journal of Pain, 09/13/2011
Finocchietti S et al. – The pressure pain sensitivity of the deep layer is related to the amount of muscle strain, which is affected by the muscle hardness and the thickness of adipose tissue. This is clinically relevant as these two factors are not taken into consideration when pressure pain assessments are performed in clinical routine.
Methods

Three–dimensional finite–element computer–models were developed to simulate the tissue stress
 and strain distribution during pressure stimulation on muscles with different hardness (I, II, III,
IV (hardest)) and subcutaneous adipose tissue thickness (normal and thicker).
The computer model was validated based on data recorded by computer–controlled pressure– induced muscle pain in 8 and 16 partecipants, respectively.
Results

The experimental pressure–indentation curve fitted the outcome of the FE model (R2>0.73).

Stress and strain were extracted from the models at a known painful pressure stimulation level.

PPT and PPTO were not significantly different in subjects with normal and thick adipose tissue in
 accordance with the simulation model where the strain in muscle tissue was comparable in the two conditions.
The strain in adipose tissue was larger in subjects with thick adipose tissue compared with normal adipose thickness.


In relaxed muscle (hardness I) the principal strain peaked at 0.12 in the adipose tissue, was reduced to 0.07 in the muscle tissue and 0.05 in the harder muscle.
Significantly higher PPT and PPTO were recorded in harder compared with softer muscles
(P<0.02).
Discussion: The pressure pain sensitivity of the deep layer is related to the amount of muscle strain, which is affected by the muscle hardness and the thickness of adipose tissue. This is clinically relevant as these two factors are not taken into consideration when pressure pain assessments are performed in clinical routine. http://journals.lww.com/clinicalpain/Abstract/2011/10000/Effects_of_Adipose_Thickness_and_Muscle_
Hardness.11.aspx
Finocchietti S et al.
Effects of Adipose Thickness and Muscle Hardness on Pressure Pain Sensitivity. The
Clinical Journal of Pain.
Sep 2011. (Entered September 2011)
Catergory: Misc Bib- Pain

The Clinical Journal of Pain, 09/13/2011
Giummarra MJ et al. – Authors propose that somatosensory pain memories likely relate to the generation and maintenance of limb representations upon which intense or emotionally powerful past experiences have been imprinted.
Objectives: Phantom limb perception is common following amputation, and is sometimes characterised by pain that resembles the characteristics, intensity or location of past pain. We tested Flor's model that phantom pain results from memory for long-lasting znoxious input.
Methods: We report a questionnaire study of 283 amputees, that explored the experience of painful, nonpainful and postural somatosensory memories in the phantom. We explore the impact of pre-amputation pain and impairment duration, and complications in the limb (eg, infection, gangrene, surgery, and vascular disease). Differences in mood, coping and adjustment to amputation are also explored in those with somatosensory pain memories.
Results: Our findings support Flor's model, as amputation-related and non-amputation-related pain memories, and non-painful memories comprised pains or sensations that were either enduring/recurring pains or sensations (eg, ingrown toenail, corns, chilblains, arthritis-type pain in winter, night-cramps, or holding a tennis racquet), or resulted from a painful event with a “core-trauma” element (eg, fracture, crushing/penetration injury). Pain memories related to amputation were more common following functional impairment before amputation; infection or surgery prior to amputation; or having diabetic or vascular amputations—which are associated with multiple complications, including neuropathic changes, infection and prior surgery. Furthermore, participants with amputation-related pain memories exhibited higher sensory pain ratings, as well as poorer mood and adjustment to the limitations of amputation.
Discussion: We propose that somatosensory pain memories likely relate to the generation and maintenance of limb representations upon which intense or emotionally powerful past experiences have been imprinted. http://journals.lww.com/clinicalpain/Abstract/2011/10000/Maladaptive_Plasticity__Imprinting_of_Past.6.
aspx
Giummarra MJ et al. Maladaptive Plasticity: Imprinting of Past Experiences Onto Phantom Limb
Schemata. The Clinical Journal of Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Phantom Pain

.
Lam LC, Chau RC, Wong BM, Fung AW, Lui VW, Tam CC, Leung GT, Kwok TC, Chiu HF, Ng
S, Chan WM
20110726(7):733-40Language: engCountry: EnglandDepartment of Psychiatry, the Chinese University of
Hong Kong, China. cwlam@cuhk.edu.hk.
OBJECTIVES: We reported the interim findings of a randomized controlled trial (RCT) to examine the effects of a mind body physical exercise (Tai Chi) on cognitive function in Chinese subjects at risk of cognitive decline.
SUBJECTS: 389 Chinese older persons with either a Clinical Dementia Rating (CDR 0.5) or amnestic-
MCI participated in an exercise program. The exercise intervention lasted for 1?year; 171 subjects were trained with 24 forms simplified Tai Chi (Intervention, I) and 218 were trained with stretching and toning exercise (Control, C). The exercise comprised of advised exercise sessions of at least three times per week.
RESULTS: At 5th months (2?months after completion of training), both I and C subjects showed an improvement in global cognitive function, delayed recall and subjective cognitive complaints (paired ttests, p?
CONCLUSIONS: Our interim findings showed that Chinese style mind body (Tai Chi) exercise may offer specific benefits to cognition, potential clinical interests should be further explored with longer observation period. Copyright © 2010 John Wiley & Sons, Ltd.
Lam LC et al.

Hagman C, Janson C, Emtner M
201108105(8):1153-9Language: engCountry: EnglandDepartment of Physiotherapy, Falu Hospital, SE-
791 82 Falun, Sweden; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala
University, SE-751 85 Uppsala, Sweden; Department of Neuroscience, Physiotherapy, Uppsala
University, Box 593, SE-751 24 Uppsala, Sweden.
INTRODUCTION: The term dysfunctional breathing (DB) has been introduced to describe patients who display divergent breathing patterns and have breathing problems that cannot be attributed to a specific medical diagnosis. Patients with DB are often misdiagnosed as having asthma.
OBJECTIVES: To describe patients with DB, five years after a breathing retraining intervention.
METHODS: Out of initially 25 patients with DB and 25 age and sex-matched patients with asthma, 22 patients with DB and 23 patients with asthma (ages 25-78 years) were followed up after five years. Data were collected from posted self-report questionnaires. Only patients with DB had received breathing retraining, consisting of information, advice and diaphragmatic breathing. Patients were evaluated regarding quality of life (SF-36), anxiety, depression, sense of coherence, hyperventilation, influence on daily life, emergency room (ER) visits, and symptoms associated with DB.
RESULTS: Quality of life (SF-36), physical component summary scale (PCS), had improved in patients with DB from 43 to 47 (p = 0.03). The number of ER visits had decreased from 18 to 2 in patients with
DB (p = 0.02). Symptoms associated with DB had decreased extensively, from a mean score of 6.9 to 2.7, on a DB criterion list (p < 0.001). Patients with DB were less impaired by their breathing problems both in daily life and when exercising (p < 0.001). The only difference found over time in the asthma group concerned quality of health, bodily pain, which had deteriorated, from 77 to 68 (p = 0.049).
CONCLUSION: This five-year follow-up study indicates that patients with dysfunctional breathing benefit from breathing retraining.
PMID: 21454062
Hagman C, Janson C, Emtner M.

Pain, 09/16/2011
Domenech J et al. – Authors conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.
The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-
Avoidance Beliefs Questionnaire (FABQ), Health Care Providers’ Pain and Impairment Relationship
Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions.
The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs ( P
< .001) and Pain-Impairement beliefs ( P < .001), which was strongly correlated with an improvement in clinicians’ activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores ( P < .01), and their recommendations for activity levels worsened significantly ( P < .001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.

Journal of Orthopaedic & Sports Physical Therapy, 09/16/2011 Evidence Based Medicine
Cross KM et al. – Thoracic spine thrust manipulation may provide short–term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable.
STUDY DESIGN: Systematic review. BACKGROUND: Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of thoracic spine thrust manipulation for the treatment of individuals with mechanical neck pain. OBJECTIVE: The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain.
METHODS: Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "thoracic mobilization,"
"thoracic spine mobilization," "thoracic manipulation," and "thoracic spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals. RESULTS: Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect. CONCLUSIONS: Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable. LEVEL OF EVIDENCE: Therapy, level 1b–.
J Orthop Sports Phys Ther 2011;41(9):633-642. doi:10.2519/jospt.2011.3670
Cross KM et al. Thoracic Spine Thrust Manipulation Improves Pain, Range of Motion, and Self-Reported
Function in Patients With Mechanical Neck Pain: A Systematic Review. Journal of Orthopaedic & Sports
Physical Therapy.
2011;41(9):633-642. (Entered September 2011)
Category: Upper Quarter Bib- Thoracic Spine Manipulation

Full Text
Journal of Pain Research, 09/16/2011
Syazwan AI et al. – A single–session, early intervention, group ergonomics education program for children aged 8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group.
Objectives: The purpose of this study was to evaluate a multidisciplinary, interventional, ergonomic education program designed to reduce the risk of musculoskeletal problems by reducing schoolbag weight and correcting poor sitting posture.
Methods: Data were collected twice before and twice following intervention using the Standardized
Nordic Body Map Questionnaire, a rapid upper limb assessment for posture evaluation, and schoolbag weight measurement in children aged 8 and 11 years attending two schools within the central region of
Malaysia.
Results: Students who received the ergonomic intervention reported significant improvements in their sitting posture in a classroom environment and reduction of schoolbag weight as compared with the controls.
Conclusion: A single-session, early intervention, group ergonomics education program for children aged
8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group. http://dovepress.com/poor-sitting-posture-and-a-heavy-schoolbag-as-contributors-to-musculos-peerreviewed-article-JPR
Syazwan AI et al. Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program. Journal of Pain Research.
Sep 2011.
(Entered September 2011)
Category: Misc Bib- Posture

Pain, 09/15/2011
Oldenmenger WH et al. – The overall reduction in pain intensity and daily interference was significantly greater after randomization to PC–PEP than to SC (average pain 31% vs 20%, P=.03; current pain 30% vs
16%, P=.016; interference 20% vs 2.5%, P=.01). Adequacy of pain management did not differ between the groups. Patients were more adherent to analgesics after randomization to PC–PEP than to SC (P=.03).
In conclusion, PC–PEP improves pain, daily interference, and patient adherence in oncology outpatients.
Pain education programs (PEP) and pain consultations (PC) have been studied to overcome patientrelated and professional-related barriers in cancer pain management. These interventions were studied separately, not in combination, and half of the studies reported a significant improvement in pain.
Moreover, most PEP studies did not mention the adequacy of pain treatment. We studied the effect of PC combined with PEP on pain and interference by pain with daily functioning in comparison to standard care (SC). Patients were randomly assigned to SC (n = 37) or PC-PEP (n = 35). PEP consisted of patienttailored pain education and weekly monitoring of pain and side effects. We measured overall reduction in pain intensity and daily interference over an 8-week period as well as adequacy of pain treatment and adherence. The overall reduction in pain intensity and daily interference was significantly greater after randomization to PC-PEP than to SC (average pain 31% vs 20%, P = .03; current pain 30% vs 16%, P =
.016; interference 20% vs 2.5%, P = .01). Adequacy of pain management did not differ between the groups. Patients were more adherent to analgesics after randomization to PC-PEP than to SC ( P = .03). In conclusion, PC-PEP improves pain, daily interference, and patient adherence in oncology outpatients. http://www.painjournalonline.com/article/PIIS0304395911005021/abstract?rss=yes
Oldenmenger WH et al. A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: a randomized controlled trial. Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

Neurology, 09/15/2011
Lenz M et al. – The authors found a significant reduction of paired–pulse suppression in both sides of patients with complex regional pain syndrome(CRPS), compared with control patients and healthy control subjects. These findings resemble their findings in the motor system and strongly support the hypothesis of a bilateral complex impairment of central motor–sensory circuits in CRPS I.
Objective: In a previous study, we found bilateral disinhibition in the motor cortex of patients with complex regional pain syndrome (CRPS). This finding suggests a complex dysfunction of central motorsensory circuits. The aim of our present study was to assess possible bilateral excitability changes in the somatosensory system of patients with CRPS.
Methods: We measured paired-pulse suppression of somatosensory evoked potentials in 21 patients with unilateral CRPS I involving the hand. Eleven patients with upper limb pain of non-neuropathic origin and
21 healthy subjects served as controls. Innocuous paired-pulse stimulation of the median nerve was either performed at the affected and the unaffected hand, or at the dominant hand of healthy controls, respectively.
Results: We found a significant reduction of paired-pulse suppression in both sides of patients with
CRPS, compared with control patients and healthy control subjects.
Conclusion: These findings resemble our findings in the motor system and strongly support the hypothesis of a bilateral complex impairment of central motor-sensory circuits in CRPS I. http://www.neurology.org/content/77/11/1096.abstract
Lenz M et al. Bilateral somatosensory cortex disinhibition in complex regional pain syndrome type I.
Neurology. Sep 2011. (Entered September 2011)
Category: Misc Bib- CRPS

Schmerz, 09/14/2011
Otti A et al. – Besides the responses to nociceptive stimuli other neural function modes of the brain are necessary to obtain a comprehensive understanding of pain processing in humans. During a resting state without extrinsic stimulation the human brain generates spontaneous low frequency fluctuations of neural activity. This intrinsic activity does not reflect random background noise but is highly organized in several networks. Based on the findings of recent functional imaging studies, the role of these resting state networks in acute and chronic pain is discussed.
Besides the responses to nociceptive stimuli other neural function modes of the brain are necessary to obtain a comprehensive understanding of pain processing in humans. During a resting state without extrinsic stimulation the human brain generates spontaneous low frequency fluctuations of neural activity.
This intrinsic activity does not reflect random background noise but is highly organized in several networks. Based on the findings of recent functional imaging studies, the role of these resting state networks in acute and chronic pain is discussed. http://www.springerlink.com/content/v473888x19w1g877/
Otti A et al. Intrinsic brain activity with pain. Schmerz. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

The Spine Journal, 09/20/2011
Froholdt A et al. – Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross–sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7– to 11–year follow–up.
Methods

Randomized controlled study with a follow–up examination at 8.5 years (range, 7–11 years).

Patients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3–week cognitive intervention and
 exercise program were included.
Isokinetic muscle strength was measured by a Cybex 6000 (Cybex–Lumex, Inc., Ronkonkoma,





NY, USA).
All patients had previous experience with the test procedure.
The back extension (E) flexion (F) muscles were tested, and the E/F ratios were calculated.
Cross–sectional area and density of the back muscles were measured at the L3–L4 segment by computed tomography.
Patients rated their function by the General Function Score.
Trunk muscle strength, cross–sectional area, density, and self–rated function.
Results


Fifty–five patients (90%) were included at long–term follow–up.
There were no significant differences in cross–sectional area, density, muscle strength, or self– rated function between the two groups.

The cognitive intervention and exercise group increased trunk muscle extension significantly
(p<.05), and both groups performed significantly better on trunk muscle flexion tests (p<.01) at long–term follow–up.

On average, self–rated function improved by 56%, cross–sectional area was reduced by 8.5%, and muscle density was reduced by 27%.
Results
Fifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The cognitive intervention and exercise group increased trunk muscle extension significantly (p<.05), and both groups performed significantly better on trunk muscle flexion tests (p<.01) at long-term follow-up.
On average, self-rated function improved by 56%, cross-sectional area was reduced by 8.5%, and muscle density was reduced by 27%.
Conclusion
Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up. http://www.thespinejournalonline.com/article/PIIS1529943011003949/abstract?rss=yes
Froholdt A et al. No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises. The Spine Journal. Sep 2011. (Entered September 2011)
Category: Lower Quarter Bib- Low Back Pain

Full Text
Journal of the American Board of Family Medicine, 09/20/2011
Young RA et al. – Future studies attempting to demonstrate the effectiveness of interventions in Chronic low back pain (CLBP) should measure depressive symptoms and the magnitude and effect of painful flare–ups, not just the overall pain score. The majority of CLBP patients seen in these practices take opioids for their pain. Screening and treating for depression may be reasonable for some patients, though evidence of its effectiveness is lacking.
Methods

360 outpatients with CLBP for more than 3 months.

10 participating family physicians' offices of the Residency Research Network of Texas.

The effect of pain on work effect as measured by a Likert scale.
Results

Patients were typically female (72%), overweight or obese (mean body mass index, 33.4), had


 pain for many years (mean, 13.6 years), and screened positive for recent depressive symptoms
(83%).
The majority of patients took at least some opioid medication for their pain (59%).
Multivariate linear regression analysis found that the larges single contributor to effect on work was the subjects' score on the SF–36 physical function scale (beta = –0.382).
Other contributors included average daily pain (beta = 0.189), the frequency of flare–ups of pain
(beta = 0.108), the effect of the painful flare–ups (beta = 0.170), and current depressive symptoms

(beta = 0.131) (adjusted R2 for model = 0.535).
Age, sex, race/ethnicity, total time the patient has had CLBP, other comorbidities (including a diagnosis of depression), disability status, use of opioids, history of intimate partner violence,

 social support, and procedures attempted were not predictive.
Results: Patients were typically female (72%), overweight or obese (mean body mass index,
33.4), had pain for many years (mean, 13.6
years), and screened positive for recent depressive symptoms (83%). The majority of patients took at least some opioid medication for their pain
(59%). Multivariate linear regression analysis found that the largest single contributor to effect on work was the subjects' score on the SF-36 physical function scale (β = –0.382). Other contributors included average daily pain (β = 0.189), the frequency of flare-ups of pain (β = 0.108), the effect of the painful flare-ups (β = 0.170), and current depressive symptoms (β = 0.131) (adjusted R 2 for model = 0.535). Age, sex, race/ethnicity, total time the patient has had CLBP, other comorbidities
(including a diagnosis of depression), disability status, use of opioids, history of intimate partner violence, social support, and procedures attempted were not predictive.
Discussion: Future studies attempting to demonstrate the effectiveness of interventions in CLBP should measure depressive symptoms and the magnitude and effect of painful flare-ups, not just the overall pain score. The majority of CLBP patients seen in these practices take opioids for their pain. Screening and treating for depression may be reasonable for some patients, though evidence of its effectiveness is lacking http://www.jabfm.org/cgi/content/abstract/24/5/503
Young RA et al. Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A
Residency Research Network of Texas (RRNeT) Study.
Journal of the American Board of Family
Medicine.
Sep 2011. (Entered September 2011)
Category: Lower Quarter Bib- Low Back Pain

The Lancet Neurology, 09/20/2011 Clinical Article
Leroux E et al. – Suboccipital cortivazol injections can relieve cluster headaches rapidly in patients having frequent daily attacks, irrespective of type (chronic or episodic). Safety and tolerability need to be confirmed in larger studies.
Methods

Adults aged 18—65 years with more than two cluster headache attacks per day were enrolled in this randomised, double–blind, placebo–controlled trial at the Emergency Headache Centre in
Paris, France.
 Patients were randomly allocated to receive three suboccipital injections (48—72 h apart) of cortivazol 3•75 mg or placebo, as add–on treatment to oral verapamil in patients with episodic


 cluster headache and as add–on prophylaxis for those with chronic cluster headache, on the basis of a computer–generated list (blocks of four for each stratum).
Injections were done by physicians who were aware of treatment allocation, but patients and the evaluating physician were masked to allocation.
Primary outcome was reduction of the number of daily attacks to a mean of two or fewer in the
72 h period 2–4 days after the third injection.
All patients were assessed who received at least one dose of study drug in the intention–to–treat analysis
Results

Between November, 2008, and July, 2009, the authors randomly allocated 43 patients (15 with chronic and 28 with episodic cluster headache) to receive cortivazol or placebo.

20 of 21 patients who received cortivazol had a mean of two or fewer daily attacks after injections compared with 12 of 22 controls (odds ratio 14•5, 95% CI 1•8–116•9; p=0•012).

Patients who received cortivazol also had fewer attacks (mean 10•6, 95% CI 1•4–19•9) in the first
15 days of study than did controls (30•3, 21•4–39•3; mean difference 19•7, 6•8–32•6; p=0•004).

No serious adverse events were noted , and 32 (74%) of 43 patients had other adverse events (18 of 21 patients who received cortivazol and 14 of 22 controls; p=0•162); the most common adverse events were injection–site neck pain and non–cluster headache.
Interpretation
Suboccipital cortivazol injections can relieve cluster headaches rapidly in patients having frequent daily attacks, irrespective of type (chronic or episodic). Safety and tolerability need to be confirmed in larger studies. http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(11)70186-7/abstract
Leroux E et al.
Suboccipital steroid injections for transitional treatment of patients with more than
two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. The
Lancet Neurology. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Headache

Pain, 09/19/2011
Thorn BE et al. – The findings indicate that Cognitive behavioral therapies (CBT) and education intervention (EDU) are viable treatment options in low–socioeconomic status (SES) minority and nonminority groups.
Methods

The authors conducted a randomized controlled trial within a low-SES, rural chronic pain

 population.
Specifically, they examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU).
They hypothesized that although both interventions would elicit short- and long-term
 improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing.
Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N=26), the intention-to-treat sample (ITT; N=83), and the completer
 sample (N=61).
Factors associated with treatment completion were examined.
Results

Results indicated significantly more drop-outs occurred in CBT.

ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more
 in CBT than EDU.
Results of the completer analyses produced a similar pattern of findings; however, CBT produced

 greater gains on cognitive and affect variables than EDU.
Treatment gains were maintained at 6-month follow-up (N=54).
Clinical significance of the findings and the number of treatment responders is reported.
Abstract Chronic pain is a common and costly experience. Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban
(white) samples. It is unknown whether CBT works in low-socioeconomic status (SES) minority and nonminority groups. To address this question, we conducted a randomized controlled trial within a low-
SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). We hypothesized that although both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing. Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N = 26), the intention-to-treat sample (ITT; N = 83), and the completer sample (N = 61).
Factors associated with treatment completion were examined. Results indicated significantly more dropouts occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6-month follow-up (N = 54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate that CBT and EDU are viable treatment options in low-SES minority and nonminority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations. http://www.painjournalonline.com/article/PIIS0304395911004477/abstract?rss=yes
Thorn BE et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain.
Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

European Spine Journal, 09/19/2011
Benoist M et al. – Epidural steroid injections have a moderate short–term effect in the management of low–back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury.
Methods

A literature search of systematic reviews analysing the effectiveness and complications of ESIs

 was carried out.
The scientific quality of the reviews was assessed using the validated index of Oxman and
Guyatt.
The authors relied on data abstraction and quality ratings of the placebo-controlled trials as reported by high-quality systematic reviews.
Results

Two types of systematic reviews were found.

The Cochrane high-quality systematic reviews combining the three approaches and different
 pathologies were predominantly non-conclusive.
The second type of review, emanating from the US Evidence-based Practice Centers,


 distinguishing between the routes of administration and between the principal pathologies found a moderate short-term benefit of ESIs versus placebo in patients with disc herniation and radiculitis, in keeping with the clinical experience.
ESIs are generally well tolerated and most complications are related to technical problems.
Cases of paraplegia, complicating the foraminal route and related to the violation of a radiculomedullary artery, have been recently reported.
They are predominantly observed in previously operated patients.
Conclusions
Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury. http://www.springerlink.com/content/k1kx766582152545/
Benoist M et al. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. European Spine Journal.
Sep 2011. (Entered September 2011)
Category: Lower Quarter Bib- Low Back Pain

Manual Therapy , 09/08/2011
Lewis S et al. – The mediating role of muscle activity between psychological factors and pain suggests that interventions that are able to reduce muscle tension may be of particular benefit to patients demonstrating such characteristics, which may help in the targeting of treatment for low back pain (LBP).
Sandra Lewisa , Paul Holmesa, Steve Wobyb, Jackie Hindlec, Neil Fowlera
Received 7 January 2011; received in revised form 29 July 2011; accepted 2 August 2011. published online 07 September 2011.
Corrected Proof
Abstract
Individuals with low back pain (LBP) often exhibit elevated paraspinal muscle activity compared to asymptomatic controls during static postures such as standing. This hyperactivity has been associated with a delayed rate of stature recovery in individuals with mild LBP. This study aimed to explore this association further in a more clinically relevant population of NHS patients with LBP and to investigate if relationships exist with a number of psychological factors. Forty seven patients were recruited from waiting lists for physiotherapist-led rehabilitation programmes. Paraspinal muscle activity while standing was assessed via surface electromyogram (EMG) and stature recovery over a 40-min unloading period was measured on a precision stadiometer. Self-report of pain, disability, anxiety, depression, pain-related anxiety, fear of movement, self-efficacy and catastrophising were recorded.
Correlations were found between muscle activity and both pain ( r = 0.48) and disability ( r = 0.43). Muscle activity was also correlated with self-efficacy ( r = −0.45), depression ( r = 0.33), anxiety ( r = 0.31), painrelated anxiety ( r = 0.29) and catastrophising ( r = 0.29) and was a mediator between self-efficacy and pain. Pain was a mediator in the relationship between muscle activity and disability. Stature recovery was not found to be related to pain, disability, muscle activity or any of the psychological factors. The findings confirm the importance of muscle activity within LBP, in particular as a pathway by which psychological factors may impact on clinical outcome. The mediating role of muscle activity between psychological factors and pain suggests that interventions that are able to reduce muscle tension may be of particular benefit to patients demonstrating such characteristics, which may help in the targeting of treatment for
LBP. http://www.manualtherapyjournal.com/article/PIIS1356689X11001238/abstract?rss=yes
Lewis S et al. The relationships between measures of stature recovery, muscle activity and
psychological factors in patients with chronic low back pain. Manual Therapy. Aug 2011. (Entered
September 2011)
Category: Lower Quarter Bib- Low Back Pain

Jo Nijsabc , C. Paul van Wilgenef, Jessica Van Oosterwijckabc, Miriam van
Ittersumde, Mira Meeusab
Received 30 November 2010; received in revised form 21 April 2011; accepted 23 April 2011. published online 01 June 2011.
Manual Therapy Volume 16, Issue 5, Pages 413-418 (October 2011
Central sensitization provides an evidence-based explanation for many cases of ‘unexplained’ chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders.
These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session
1). Written information about pain physiology should be provided as homework in between session 1 and
2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program http://www.manualtherapyjournal.com/article/S1356-689X(11)00073-7/abstract
Nijs J. How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain:
Practice guidelines. Manual Therapy.
Oct 2011;16(5):413-418. (Entered September 2011)
Category: Misc Bib- Central Sensitization

Sionnadh Mairi McLeana , Jennifer Klaber Moffettb, Donald Macfie Sharpb, Eric Gardinerb
Manual Therapy Volume 16 , Issue 5 , Pages 434-439 (October 2011
Received 11 June 2010; received in revised form 16 December 2010; accepted 7 January 2011. published online 23 February 2011.
Abstract
This study investigated the relationship between neck pain and upper limb disability in patients with nonspecific neck pain ( n = 151) recruited from physiotherapy departments in the United Kingdom. Baseline neck pain/disability was measured using the Northwick Park Neck Pain Questionnaire (NPQ). Baseline upper limb disability was measured using the Disabilities of Arm, Shoulder, Hand questionnaire (DASH).
A range of baseline psychosocial variables were measured as potential confounding variables. Pairwise analysis revealed a positive correlation between NPQ score and DASH score
(Pearsons’ r = 0.799, p < 0.001). After adjusting for potential confounding variables, stepwise linear regression indicated that increasing upper limb disability was predicted by two baseline variables: higher
NPQ scores ( B = 0.743) and lower pain self efficacy (PSE) scores ( B = −0.489)
{ R 2 = 0.713; n = 100, p < 0.001}. This study provides preliminary evidence that patients with severe neck pain/disability also report severe upper limb disability. The relationship between neck pain/disability and upper limb disability was mediated by PSE. Clinically, the presence of severe neck pain or low PSE should direct clinicians towards an assessment of upper limb function. In these cases upper limb disability may need to be addressed as part of the neck management process. http://www.manualtherapyjournal.com/article/S1356-689X(11)00004-X/abstract
McLean SM et al. An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: A secondary analysis. Manual Therapy.
Oct
2011;16(5):434-439. (Entered September 2011)
Category: Upper Quarter Bib- Neck Pain

Manual Therapy Volume 16 , Issue 5 , Pages 440-446 (October 2011)
Lisa C. Carlessoa , John Cairneybc, Lisa Dolovichb, Jennifer Hoogenesad
Received 6 September 2010; received in revised form 31 January 2011; accepted 3 February 2011. published online 07 March 2011.
Abstract
Rare, serious, and common, benign adverse events (AE) are associated with MT techniques. A proposed standard for defining AE in manual therapy (MT) practise has been published but it did not include the patient perspective. Research comparing clinician and patient reporting of AE demonstrates that several differences exist; for example, the reporting of objective versus subjective events. The objective of this study was to describe how patients define AE associated with MT techniques. A descriptive qualitative design was employed. Semi-structured interviews were used with a purposive sample of patients ( n = 13) receiving MT, from physiotherapy, chiropractic and osteopathic practises in Ontario, Canada. The interview guide was informed by existing evidence and consultation with content and methodological experts. Interviews were audiotaped and transcribed verbatim. Date were analysed by two independent team members using thematic content analysis. A key finding was that patients defined mild, moderate and major AE by pain/symptom severity, functional impact, duration and by ruling out of alternative causes. An overarching theme identified multiple factors that influence how the AE is perceived. These concepts differ from the previously proposed framework for defining AE that did not include the patient perspective. Future processes to create standard definitions or measures should include the patient viewpoint to provide a broader, client-centred foundation. http://www.manualtherapyjournal.com/article/S1356-689X(11)00035-X/abstract
Carlessoa LC. Defining adverse events in manual therapy: An exploratory qualitative analysis of the patient perspective. Manual Therapy. Oct 2011;16(5):440-446. (Entered September 2011)
Category: Misc Bib- Red Flags

Shaun O’Learyab , Deborah Fallacd, Gwendolen Julla
Manual Therapy Volume 16 , Issue 5 , Pages 452-455 (October 2011
Received 6 October 2010; received in revised form 9 December 2010; accepted 11 February 2011. published online 11 March 2011.
Abstract
Changes in motor behavior are a known feature of chronic mechanical neck pain disorders. This study examined the strength of the association between reported levels of pain and disability from 84 individuals (63 women, 21 men) with chronic mechanical neck pain and levels of electromyographic activity recorded from superficial cervical flexor (sternocleidomastoid; SCM and anterior scalene; AS) muscles during progressive stages of the cranio-cervical flexion muscle test. A significant positive association was observed between superficial muscle activity and pain intensity ( P < 0.003), but not pain duration ( P > 0.5) or perceived disability ( P > 0.21). The strongest relationship between pain intensity and superficial muscle activity occurred at the final increment of the cranio-cervical flexion test (inner-range test position) for both the SCM and AS muscles ( R 2 = 0.16). Although a positive and significant relationship between pain intensity and superficial muscle activity was shown, the relationship was only modest (16% explained variance), indicating that multiple factors contribute to the altered motor function observed in individuals with chronic mechanical neck pain. http://www.manualtherapyjournal.com/article/S1356-689X(11)00042-7/abstract
O’Leary S, Falla D, Jull G. The relationship between superficial muscle activity during the craniocervical flexion test and clinical features in patients with chronic neck pain. Manual Therapy. Oct
2011;16(5):452-455. (Entered September 2011)

Arianne P. Verhagena , Martyn Lewisb, Jasper M. Schellingerhouta, Martijn
W. Heymansc, Krysia Dziedzicb, Henrica C.W. de Vetc, Bart W. Koesa
Received 19 July 2010; received in revised form 8 February 2011; accepted 11 February 2011. published online 15 March 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 456-462 (October 2011
Abstract
We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints.
Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at shortterm and long term for whiplash and non-trauma neck pain patients separately.
The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17–18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25–50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients.
Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain.
Highlights
► Neck pain is one of the most common musculoskeletal disorders. ► Whiplash patients are often considered as a different group from non-specific neck pain patients. ► The clinical course of neck pain patients and whiplash patients is good: between 60 and 80% recover. ► The prevalence of self-reported whiplash patients among patients with neck pain was 16.5%. ► Patients with self-reported whiplash do not differ from patients with other painful neck complaints regarding pain, function or prognosis. http://www.manualtherapyjournal.com/article/S1356-689X(11)00043-9/abstract
Verhagena AP et al. Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis? Manual Therapy.
Oct 2011;16(5):456-462. (Entered September 2011)
Category: Upper Quarter Bib- Whiplash

Paulo H. Ferreiraa , Manuela L. Ferreirab, Dafne P. Nascimentoab, Rafael Z. Pintob, Marcia
R. Francob, Paul W. Hodgesc
Received 20 October 2010; received in revised form 9 February 2011; accepted 11 February 2011. published online 14 March 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 463-469 (October 2011)
Abstract
Rehabilitative ultrasound imaging has a great potential to be used as a tool in the assessment of trunk muscle function in patients with low back pain (LBP). However, a further investigation of the discriminative ability of this tool as well as the effect of operators’ levels of training on reliability is warranted.
Discriminative analysis of ultrasound and electromyography (EMG) measurements of transversus abdominus (TrA), obliquus internus (OI), and obliquus externus (OE) muscles function between people with and without LBP and the effect of operator’s training on reliability of TrA muscle function of chronic LBP patients were conducted. For the discriminative study, measurements were collected from 10 subjects with LBP and 10 matched controls during isometric low load tasks with their limbs suspended.
For the reliability study, in stage 1 the reliability of single ultrasonographic static images involved 4 operators (1 trained and 3 non-trained), whereas, in stage 2, two operators (1 trained and 1 non-trained) were used to determine the reliability of TrA thickness change. Methods used in the statistical analysis were pearson correlation and receiver operating characteristic curve for the discriminative study and intraclass correlation coefficient (ICC) for the reliability study.
While ultrasound measures of OE muscle function showed poor association with EMG
( r = 0.28, p = 0.22), TrA and OI function showed moderate to excellent association
(TrA: r = 0.74, p < 0.000; OI: r = 0.85, p < 0.000). Ultrasound and EMG measures of TrA and OI function discriminated LBP patients from controls. Reliability of the assessment of TrA function with a trained operator (ICC = 0.92; 95% CI: 0.81–0.97) was substantially higher than a non-trained one
(ICC = 0.44; 95% CI: −0.41–0.78).
In conclusion, ultrasound measures of deep trunk function is a valid discriminative tool in LBP but highly dependent on operator’s level of training.
Ferreira PH et al. Discriminative and reliability analyses of ultrasound measurement of abdominal muscles recruitment. Manual Therapy. Oct 2011;16(5):463-469. (Entered September 2011)
Category: Lower Quarter Bib- Low Back Pain

B. Cagniea , R. Dirksa, M. Schoutena, T. Parlevlietb, D. Cambiera, L. Danneelsa
Received 20 October 2010; received in revised form 15 February 2011; accepted 21 February 2011. published online 24 March 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 470-475 (October 2011)
Abstract
There is mounting evidence of an association between chronic neck pain and impaired cervical flexor muscle performance. It is likely that the deep cervical flexors demonstrate changes very early after the onset of pain, but evidence is currently lacking. This study investigated the effect of experimental neck muscle pain on the activation of the cervical flexor muscles during the performance of craniocervical flexion (CCF) by use of muscle functional magnetic resonance imaging. Activity of the longus colli
(Lco), longus capitis (Lca) and sternocleidomastoid (SCM) muscles were investigated bilaterally and at three cervical levels (C0–C1, C2–C3 and C6–C7) in 14 healthy subjects. Measurements were performed at rest and after the performance of CCF without and with induced pain of the upper trapezius
(intramuscular injection of hypertonic saline). In the non-pain condition, the Lca ( p = 0.005) and Lco
( p = 0.029) were significantly more active during CCF compared to SCM. In the pain condition, the activity of the Lco and Lca was reduced bilaterally and at multiple levels ( p ≤ 0.009), whereas the left
SCM showed increased activity at only the C6–C7 level ( p ≤ 0.001). The results suggest that local excitation of nociceptive afferents causes an immediate reorganization of the cervical flexor muscle activity similar to that identified in clinical populations.
Cagnia B et al. Functional reorganization of cervical flexor activity because of induced muscle pain evaluated by muscle functional magnetic resonance imaging. Manual Therapy.
Oct 2011;16(5):470-475.
(Entered September 2011)
Category: Upper Quarter Bib- Cervical Spine

E. Cattryssea , S. Provyna, P. Koolb, J.P. Clarysa, P. Van Roya
Received 7 September 2010; received in revised form 8 March 2011; accepted 14 March 2011. published online 21 April 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 481-486 (October 2011
Abstract
Background data
At present little data are available on the relationship between spinal anatomy and kinematics. No studies have verified the relationship between atlanto-axial kinematics during manual mobilization and the spatial features of the atlanto-axial ligaments and the lateral joints.
Materials and methods
Twenty un-embalmed cervical spine specimens (9 male and 11 female; 80 ± 11 years) were studied.
Atlanto-axial kinematics were registered during manual axial rotation mobilization using an ultrasoundbased motion tracking system. Anatomical landmarks were digitized and spatial features of the lateral atlanto-axial joint surfaces and alar ligaments were extracted. The relationship between the anatomical features and the spinal kinematics was analyzed using statistical regression analysis.
Results
Only the range of motion of the coupled flexion–extension motion component, the ratio and the time shift between main axial rotation and coupled lateral bending motion components could be predicted for about
52%, 49% and 73%, respectively, by a selected set of anatomical features.
Conclusion
Supposed relationships between anatomical features and joint kinematics are only partially confirmed.
The results indicate that the kinematics of the atlanto-axial joint during manual regional axial mobilization are not completely predetermined by the specimens’ specific anatomy. http://www.manualtherapyjournal.com/article/S1356-689X(11)00050-6/abstract
Cattrysse E et al. Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical rotation mobilization. Manual Therapy. Oct 2011;16(5):481-486. (Entered September
2011)
Category: Upper Quarter Bib- Upper Cervical Spine

☆
JoEllen M. Seftona , Ceren Yarara, David M. Carpenterb, Jack W. Berryc
Received 29 December 2010; received in revised form 4 April 2011; accepted 12 April 2011. published online 13 May 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 487-494 (October 2011)
Abstract
Little is known regarding the physiological and clinical effects of therapeutic massage (TM) even though it is often prescribed for musculoskeletal complaints such as chronic neck pain. This study investigated the influence of a standardized clinical neck/shoulder TM intervention on physiological measures assessing α-motoneurone pool excitability, muscle activity; and the clinical measure of range of motion
(ROM) compared to a light touch and control intervention. Flexor carpi radialis (FCR) α-motoneurone pool excitability (Hoffmann reflex), electromyography (EMG) signal amplitude of the upper trapezius during maximal muscle activity, and cervical ROM were used to assess possible physiological changes and clinical effects of TM. Sixteen healthy adults participated in three, 20 min interventions: control (C), light touch (LT) and therapeutic massage (TM). Analysis of Covariance indicated a decrease in FCR αmotoneurone pool excitability after TM, compared to both the LT ( p = 0.0003) or C ( p = 0.0007) interventions. EMG signal amplitude decreased after TM by 13% ( p < 0.0001), when compared to the control, and 12% ( p < 0.0001) as compared to LT intervention. The TM intervention produced increases in cervical ROM in all directions assessed: flexion ( p < 0.0001), lateral flexion ( p < 0.0001), extension
( p < 0.0001), and rotation ( p < 0.0001). TM of the neck/shoulders reduced the α-motoneurone pool excitability of the flexor carpi radialis after TM, but not after the LT or C interventions. Moreover, decreases in the normalized EMG amplitude during MVIC of the upper trapezius muscle; and increases in cervical ROM in all directions assessed occurred after TM, but not after the LT or C interventions.
Sefton JM et al. Physiological and clinical changes after therapeutic massage of the neck and shoulders.
Manual Therapy. Oct 2011;16(5):487-494. (Entered September 2011)
Category: Misc Bib- Soft Tissue Mobilization

Daniel de Oliveira Grassia, Marcial Zanelli de Souzaa, Silvia Belissa Ferraretoa, Maria Imaculada de
Lima Montebeloa, Elaine Caldeira de Oliveira Guirrob
Received 14 September 2010; received in revised form 11 April 2011; accepted 14 April 2011. published online 16 May 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 495-500 (October 2011
Abstract
The biomechanics of the sacroiliac joint makes the pelvic segment responsible for proper weight distribution between lower extremities; however, it is known to be susceptible to altered mobility. The objective of this study was to analyze baropodometric responses following thrust manipulation on subjects with sacroiliac joint restrictions. Twenty asymptomatic subjects were submitted to computerized baropodometric analysis before, after, and seven days following sacroiliac manipulation. The variables peak pressure and contact area were obtained at each of these periods as the average of absolute values of the difference between the right and left foot based on three trials. Data revealed significant reduction only in peak pressure immediately after manipulation and at follow-up when compared to premanipulative values ( p < 0.05). Strong correlation was found between the dominant foot and the foot with greater contact area ( r = 0.978), as well as between the side of joint restriction and the foot with greater contact area ( r = 0.884). Weak correlation was observed between the dominant foot and the foot with greater peak pressure ( r = 0.501), as well as between the side of joint restriction and the foot with greater peak pressure ( r = 0.694). The results suggest that sacroiliac joint manipulation can influence peak pressure distribution between feet, but contact area does not seem to be related to the biomechanical aspects addressed in this study.
Grassia DDO et al. Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint.
Manual Therapy.
Oct 2011;16(5):495-500. (Entered September 2011)
Category: Lower Quarter Bib- SI Joint

Sofia H.H. Seaha, Andrew M. Briggsa, Peter B. O’Sullivana, Anne J. Smitha, Angus F. Burnettbc, Leon
M. Strakera
Received 3 December 2010; received in revised form 4 March 2011; accepted 9 May 2011. published online 06 June 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 501-509 (October 2011
Abstract
The primary aim of this study was to examine familial associations in spinal posture, defined using postural angles and a clinical classification method. A secondary aim was to investigate the reliability of clinical postural classification. Postural angles were calculated from sagittal photographs, while two experienced clinicians made use of standing sagittal images to classify participants into one of four postural groups (sway, flat, hyperlordotic, neutral). Parent–child associations in postural angles and postural groups were evaluated using Pearson’s correlation and Fisher’s exact test, respectively. Interrater reliability was expressed using percentage agreement and Kappa coefficients ( K ). Daughters whose father or mother had a hyperlordotic posture were 4.0 or 3.5 times, respectively, more likely to have a hyperlordotic posture than daughters whose parents did not have a hyperlordotic posture. These participants in the hyperlorotic group had a significantly higher body mass index than members of the other postural groups ( p < 0.03). Percentage agreement between clinicians was 63.5% ( K = 0.48). These results provide preliminary evidence of a familial association in the hyperlordotic posture and support the use of postural classification.
Seah SHH et al. An exploration of familial associations in spinal posture defined using a clinical grouping method. Manual Therapy. Oct 2011;16(5):501-509. (Entered September 2011)
Category: Misc Bib- Posture

Pain, 09/21/2011
Ruscheweyh R et al. – These results suggest that some, but not all, forms of pain reduction by distraction rely on descending pain inhibition. In addition, pain reduction by distraction seems to preferentially affect mechanisms of basal nociceptive transmission, not of temporal summation.
Abstract
Distraction from pain reduces pain perception, and imaging studies have suggested that this may at least partially be mediated by activation of descending pain inhibitory systems. Here, we used the nociceptive flexor reflex (RIII reflex) to directly quantify the effects of different distraction strategies on basal spinal nociception and its temporal summation. Twenty-seven healthy subjects participated in 3 distraction tasks
(mental imagery, listening to preferred music, spatial discrimination of brush stimuli) and, in a fourth task, concentrated on the painful stimulus. Results show that all 3 distraction tasks reduced pain perception, but only the brush task also reduced the RIII reflex. The concentration-on-pain task increased both pain perception and the RIII reflex. The extent of temporal summation of pain perception and the extent of temporal summation of the RIII reflex were not affected by any of the tasks. These results suggest that some, but not all, forms of pain reduction by distraction rely on descending pain inhibition.
In addition, pain reduction by distraction seems to preferentially affect mechanisms of basal nociceptive transmission, not of temporal summation. http://www.painjournalonline.com/article/PIIS0304395911005094/abstract?rss=yes
Ruscheweyh R et al. The effect of distraction strategies on pain perception and the nociceptive flexor reflex (RIII reflex). Pain. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

Headache: The Journal of Head and Face Pain, 09/21/2011
Ichesco E et al. – Since the pregenual region of the ACC is critically involved in antinociception, authors hypothesize that an increase in anterior IC–ACC connectivity is indicative of an adaptation of the pain modulatory system early in the chronification process.
Background.— Among the most common chronic pain conditions, yet poorly understood, are temporomandibular disorders (TMDs), with a prevalence estimate of 3-15% for Western populations.
Although it is increasingly acknowledged that central nervous system mechanisms contribute to pain amplification and chronicity in TMDs, further research is needed to unravel neural correlates that might abet the development of chronic pain.
Objective.— The insular cortex (IC) and cingulate cortex (CC) are both critically involved in the experience of pain. The current study sought specifically to investigate IC–CC functional connectivity in
TMD patients and healthy controls (HCs), both during resting state and during the application of a painful stimulus.
Methods.— Eight patients with TMD, and 8 age- and sex-matched HCs were enrolled in the present study. Functional magnetic resonance imaging data during resting state and during the performance of a pressure pain stimulus to the temple were acquired. Predefined seed regions were placed in the IC
(anterior and posterior insular cortices) and the extracted signal was correlated with brain activity throughout the whole brain. Specifically, we were interested whether TMD patients and HCs would show differences in IC–CC connectivity, both during resting state and during the application of a painful stimulus to the face.
Results.— As a main finding, functional connectivity analyses revealed an increased functional connectivity between the left anterior IC and pregenual anterior cingulate cortex (ACC) in TMD patients, during both resting state and applied pressure pain. Within the patient group, there was a negative correlation between the anterior IC–ACC connectivity and clinical pain intensity as measured by a visual analog scale.
Conclusions.— Since the pregenual region of the ACC is critically involved in antinociception, we hypothesize that an increase in anterior IC–ACC connectivity is indicative of an adaptation of the pain modulatory system early in the chronification process. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-
4610.2011.01998.x/abstract;jsessionid=F86907A2F8EE9987E78C85DB717E4FA8.d02t02
Ichesco E et al.
Altered Functional Connectivity Between the Insula and the Cingulate Cortex in Patients
With Temporomandibular Disorder: A Pilot Study. Headache: The Journal of Head and Face Pain. Sep
2011. (Entered September 2011)
Category: Upper Quarter Bib- TMJ

Full Text
Chiropractic & Osteopathy , 09/22/2011 Clinical Article
Murphy DR et al. – The diagnosis–based clinical decision guide (DBCDG) can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter–examiner reliability, validity and efficacy of treatment based on the DBCDG.
Methods

Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP
 patients examined by one of three examiners trained in the application of the DBCDG.
Data were gathered on 95 patients.
Results

Signs of visceral disease or potentially serious illness were found in 1%.

Centralization signs were found in 27%, segmental pain provocation signs were found in 69%

 and radicular signs were found in 19%.
Clinically relevant myofascial signs were found in 22%.
Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.
Results
Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in
1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.
Conclusion
The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG. http://chiromt.com/content/19/1/19
Murphy DR et al. Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain.
Chiropractic & Osteopathy. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Cervical Spine

Full Text
BMC Musculoskeletal Disorders, 09/22/2011
Langevin HM et al. .
Background
The role played by the thoracolumbar fascia in chronic low back pain is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP).
Methods
We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace.
Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity.
Results
Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group
(56.4% +/- 3.1% vs. 70.2% +/- 3.6% respectively (p<0.01). There was no evidence that this difference was sex-specific (group by sex interaction p=.09), although overall, males had significantly lower shear strain than females (p=.02). Significant correlations were found in male subjects between thoracolumbar fascia shear strain and the following variables: perimuscular connective tissue thickness (r= -0.45, p<.001), echogenicity (r= -0.28, p<.05), trunk flexion range of motion (r= 0.36, p<.01), trunk extension range of motion (r= 0.41, p<.01), repeated forward bend task duration (r= -0.54, p<.0001) and repeated sit-to-stand task duration (r= -0.45, p<.001).
ConclusionThoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in
altered connective tissue function. http://www.biomedcentral.com/1471-2474/12/203
Langevin HM et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain.
BMC
Musculoskeletal Disorders. Sep 2011. (Entered September 2011)
Category: Misc Bib- Fascia

E. Cattryssea , S. Provyna, P. Koolb, J.P. Clarysa, P. Van Roya
Received 7 September 2010; received in revised form 8 March 2011; accepted 14 March 2011. published online 21 April 2011.
Manual Therapy Volume 16 , Issue 5 , Pages 481-486 (October 2011
Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers.
Methods: Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9). Results: 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2,
95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity >=3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity <3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders. Conclusion: Highintensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. Trial registration:
NCT01071980. http://www.biomedcentral.com/1471-2474/12/205
Cattryssea E et al. Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical rotation mobilization. Manual Therapy.
Oct 2011;16(5):481-486. (Entered September
2011)
Category: Upper Quarter Bib- Cervical Spine

Headache: The Journal of Head and Face Pain, 09/22/2011
Bagley CL et al. – The MSQ is a reliable and valid questionnaire in the chronic migraine (CM) population that can differentiate the functional impact between CM and episodic migraine (EM). The MSQ can assist researchers in evaluating treatment effectiveness by obtaining input directly from the patients on multidimensional aspects other than frequency of headache days.
Methods


Cross–sectional data were collected via web–based survey in 9 countries/regions.
Participants were classified as having CM (≥15 headache days/month) or EM (<15 headache
 days/month).
Three MSQ domains – Role Function–Preventive (RP), Role Function–Restrictive (RR), and
Emotional Function (EF) – were rescaled to 0–100, where higher scores indicate better HRQL, and analyzed for internal consistency reliability (Cronbach's α), construct validity (correlations between MSQ scales and measures of depression/anxiety [Patient Health Questionnaire; PHQ–4], disability [Migraine Disability Assessment Questionnaire; MIDAS], and functional impact
[Headache Impact Test; HIT–6], where lower scores indicate better HRQL for each measure), as well as discriminant validity across migraine groups.
Results

A total of 8726 eligible respondents were classified: 5.7% CM (n = 499) and 94.3% EM (n =
8227).

Subjects were mostly female (83.5%) with a mean (±SD) age of 40.3 ± 11.4, and were similar
 between the 2 groups.
MSQ domain scores for CM and EM groups, respectively, were: RP = 61.4 ± 26.1 and 71.7 ±
24.0; RR = 44.4 ± 22.1 and 56.5 ± 24.1; EF = 48.3 ± 28.1 and 67.2 ± 26.7.
 Internal consistency of the overall sample for RP, RR, and EF was 0.90, 0.96, and 0.87,
 respectively.
Similar values were observed for CM and EM. MSQ scores for the overall sample correlated moderately to highly with scores from the PHQ–4 (r = –0.21 to –0.42), MIDAS (r = –0.38 to –
0.39), and HIT–6 (r = –0.60 to –0.71).


Similar values were observed for CM and EM.
Known–groups validity indicated significant differences (P < .0001) in the hypothesized direction between CM and EM for RP (F = 86.19), RR (F = 119.24), and EF (F = 235.90).
Conclusion.— The MSQ is a reliable and valid questionnaire in the CM population that can differentiate the functional impact between CM and EM. The MSQ can assist researchers in evaluating treatment effectiveness by obtaining input directly from the patients on multidimensional aspects other than frequency of headache days. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-
4610.2011.01997.x/abstract;jsessionid=C0E64A725A794A474DBAD9823CA52A88.d01t02
Bagley CL et al. Validating Migraine-Specific Quality of Life Questionnaire v2.1 in Episodic and
Chronic Migraine. Headache: The Journal of Head and Face Pain. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Migraine

Pain Medicine, 09/23/2011
Busch V et al. – This results suggest that the way of breathing decisively influences autonomic and pain processing, thereby identifying deep and slow breathing (DSB) in concert with relaxation as the essential feature in the modulation of sympathetic arousal and pain perception.
Methods. In order to disentangle the effects of relaxation and respiration, we investigated two different DSB techniques at the same respiration rates and depths on pain perception, autonomic activity, and mood in 16 healthy subjects. In the attentive DSB intervention, subjects were asked to breathe guided by a respiratory feedback task requiring a high degree of concentration and constant attention. In the relaxing DSB intervention, the subjects relaxed during the breathing training. The skin conductance levels, indicating sympathetic tone, were measured during the breathing maneuvers.
Thermal detection and pain thresholds for cold and hot stimuli and profile of mood states were examined before and after the breathing sessions.
Results. The mean detection and pain thresholds showed a significant increase resulting from the relaxing DSB, whereas no significant changes of these thresholds were found associated with the attentive DSB. The mean skin conductance levels indicating sympathetic activity decreased significantly during the relaxing DSB intervention but not during the attentive DSB. Both breathing interventions showed similar reductions in negative feelings (tension, anger, and depression).
Conclusion. Our results suggest that the way of breathing decisively influences autonomic and pain processing, thereby identifying DSB in concert with relaxation as the essential feature in the modulation of sympathetic arousal and pain perception. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01243.x/abstract
Busch V et al. The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and
Mood Processing-An Experimental Study. Pain Medicine. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

Full Text
International Journal of General Medicine, 09/23/2011 Clinical Article
Fontani V et al. – One cycle of neuropsychophysical optimization radioelectric asymmetric conveyer brain stimulation (REAC–BS) appears to reduce subjective perceptions of stress as measured by the
Psychological Stress Measure, particularly on the pain and physical problems cluster.
Background: The aim of this study was to investigate the effects of noninvasive radioelectric asymmetric conveyer brain stimulation (REAC-BS) on pain and physical problems, a measurement cluster of the
Psychological Stress Measure (PSM) test. When the symptoms of pain and physical problems do not respond to various therapeutic approaches such as medication, physiotherapy, and psychotherapy, they are often called medically unexplained symptoms. As such, these symptoms are reported to be a response to stressful situations or emotional states, often unknown to patients themselves. To explore the effectiveness of noninvasive radioelectric brain stimulation in the amelioration of symptoms of pain and physical problems, we administered a neuropsychophysical optimization protocol using a REAC device.
Methods: The PSM, a self-administered questionnaire, was used to measure psychological stress and pain and physical problems in a group of 888 subjects. Data were collected immediately prior to and following a 4-week REAC treatment cycle.
Results: There was a significant reduction in scores measuring subjective perceptions of stress for subjects treated with one cycle of neuropsychophysical optimization REAC-BS. At the end of the study, the number of treated subjects reporting symptoms of stress-related pain and physical problems on the
PSM test was significantly reduced, whereas there was no difference in placebo-treated subjects.
Conclusion: One cycle of neuropsychophysical optimization REAC-BS appears to reduce subjective perceptions of stress as measured by the PSM, particularly on the pain and physical problems cluster. http://dovepress.com/noninvasive-radioelectric-asymmetric-brain-stimulation-in-the-treatmen-peerreviewed-article-IJGM
Fontani V et al. Noninvasive radioelectric asymmetric brain stimulation in the treatment of stress-related pain and physical problems: psychometric evaluation in a randomized, single-blind placebo-controlled, naturalistic study. International Journal of General Medicine. Sep 2011. (Entered September 2011)
Category: Misc Bib- Pain

Cognitive Therapy and Research, 09/23/2011
Vago DR et al. – Preliminary results suggest that mindfulness–based meditation training (MMT) reduces avoidance of pain–related threat at early levels of processing, and facilitates disengagement from threat at later stages of processing.
The current study investigated the effects of an 8-week mindfulness-based meditation training (MMT) intervention on attentional bias, engagement and disengagement of pain-related threat in fibromyalgia patients as compared to an age-matched control group. A well validated dot-probe task was used to explore early versus later stages of attentional processing through the use of two stimulus exposure durations (100, 500 ms) of pain-related threat words. The enduring effects of MMT were assessed 6months after completion of MMT. Preliminary results suggest that MMT reduces avoidance of painrelated threat at early levels of processing, and facilitates disengagement from threat at later stages of processing. Furthermore, it appears that effects of MMT on early attentional threat processing do not remain stable after long-term follow-up. http://www.springerlink.com/content/f17266p628282417/
Vago DR et al. Selective Attentional Bias Towards Pain-Related Threat in Fibromyalgia: Preliminary
Evidence for Effects of Mindfulness Meditation Training. Cognitive Therapy and Research. Sep 2011.
(Entered September 2011)
Category: Misc Bib- Fibromyalgia

.
Grammatopoulou EP, Skordilis EK, Stavrou N, Myrianthefs P, Karteroliotis K, Baltopoulos
G, Koutsouki D
20110848(6):593-601Language: engCountry: EnglandDepartment of Physical Education and Sport
Sciences, National and Kapodistrian University of Athens , Athens , Greece .
The Journal of asthma : official journal of the Association for the Care of Asthma
Background. The mechanism of the breathing retraining effect on asthma control is not adequately based on evidence. Objective. The present study was designed to evaluate the effect of physiotherapy-based breathing retraining on asthma control and on asthma physiological indices across time. Study design. A
6-month controlled study was conducted. Adult patients with stable, mild to moderate asthma (n = 40), under the same specialist's care, were randomized either to be trained as one group receiving 12 individual breathing retraining sessions (n = 20), or to have usual asthma care (n = 20). The main outcome was the Asthma Control Test score, with secondary outcomes the end-tidal carbon dioxide, respiratory rate, spirometry, and the scores of Nijmegen Hyperventilation Questionnaire, Medical
Research Council scale, and SF-36v2 quality-of-life questionnaire. Results. The 2 × 4 ANOVA showed significant interaction between intervention and time in asthma control (F = 9.03, p < .001, ?(2) = 0.19), end-tidal carbon dioxide (p < .001), respiratory rate (p < .001), symptoms of hypocapnia (p = .001),
FEV1% predicted (p = .022), and breathlessness disability (p = .023). The 2 × 4 MANOVA showed significant interaction between intervention and time, with respect to the two components of the SF-36v2
(p < .001). Conclusion. Breathing retraining resulted in improvement not only in asthma control but in physiological indices across time as well. Further studies are needed to confirm the benefits of this training in order to help patients with stable asthma achieve the control of their disease.
PMID: 21668321
Grammatopoulou EP. The effect of physiotherapy-based breathing retraining on asthma control.
The
Journal of asthma : official journal of the Association for the Care of Asthma. Aug 2011;48(6):593-601.
(Entered September 2011)
Category: Upper Quarter Bib- Breathing

Current Rheumatology Reports, 09/29/2011
Lavigne GL et al. – Because sleep alterations in common musculoskeletal pain are neither specific nor pathognomonic, the aim is to provide a critical overview of the current understanding of pain and sleep interaction, discussing evidence–based and empiric knowledge that should be considered in further research and clinical applications.
Abstract
Most patients with chronic musculoskeletal pain report poor-quality sleep. The impact of chronic pain on sleep can be described as a vicious circle with mutual deleterious influences between pain and sleepassociated symptoms. It is difficult, however, to extract quantitative or consistent and specific sleep variables (eg, total sleep time, slow-wave sleep, sleep stage duration) that characterize the pain-related disruption of sleep. Comorbidity (eg, fatigue; depression; anxiety, sleep, movement, or breathing disorders) often confounds the reading and interpretation of sleep traces. Furthermore, many other methodologic issues complicate our ability to generalize findings (low external validity) to first-line medicine. Because sleep alterations in common musculoskeletal pain are neither specific nor pathognomonic, the aim is to provide a critical overview of the current understanding of pain and sleep interaction, discussing evidence-based and empiric knowledge that should be considered in further research and clinical applications.
Keywords http://www.metapress.com/content/j058240356215571/
Lavigne GL et al. Does Sleep Differ Among Patients with Common Musculoskeletal Pain Disorders.
Current Rheumatology Reports. Sep 2011. (Entered September 2011)
Category: Misc Bib- Sleep

Bill Vicenzino, Michelle Branjerdporn, Pam Teys, Kate Jordan
DOI: 10.2519/jospt. 2006.2265
Study Design: A double-blind randomized crossover experimental study with repeated measures, including a no-treatment control condition.
Objective: To evaluate the initial effect of 2 mobilization with movement (MWM) treatment techniques performed in weight bearing and non-weight bearing on posterior talar glide and talocrural dorsiflexion in individuals with recurrent lateral ankle sprain.
Background: MWM treatment techniques are commonly used in the treatment of musculoskeletal pain, such as lateral ankle sprain. Recent evidence indicates that a lack of posterior talar glide and weightbearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains.
MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. The recurrent ankle sprain injury and the MWM treatment techniques for the ankle seemingly provide an appropriate model to further evaluate the effects and mechanism(s) of action of the MWM treatment techniques in a way that they have not been tested to date.
Methods: Sixteen subjects (mean ± SD age, 19.8 ± 2.3 years) with a history of recurrent lateral ankle sprain and deficits in posterior talar glide (71%) and weight-bearing dorsiflexion (34%) were studied. A within-subjects study design was used to evaluate the effect of 2 independent variables: treatment conditions (weight-bearing MWM, non–weight-bearing MWM, and a no-treatment control group) and time (pretreatment and posttreatment) on the dependent variables of posterior talar glide and weightbearing dorsiflexion.
Results: Both the weight-bearing and non–weight-bearing MWM treatment techniques significantly improved posterior talar glide by 55% and 50% of the preapplication deficit between affected and unaffected sides, respectively, which was significantly greater than that of the control group (P<.001).
The weight-bearing and non–weight-bearing MWM treatment techniques improved weight-bearing dorsiflexion by 26% (P<.017), compared to 9% for the control condition. The change in posterior talar glide, expressed as a proportion of pretreatment deficit, was correlated to the change in weight-bearing dorsiflexion (r = .88, P<.001), but only after the weight-bearing MWM technique.
Conclusion: This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glide and dorsiflexion range of motion in individuals with recurrent lateral ankle sprain. These results suggest that this technique should be considered in rehabilitation programs following lateral ankle sprain. This study provides justification for follow-up research of the long-term effects of MWM on lateral ankle sprain and proposes further work be conducted on the posterior talar glide test.
Vicenzino B et al. Initial Changes in Posterior Talar Glide and Dorsiflexion of the Ankle After
Mobilization With Movement in Individuals With Recurrent Ankle Sprain. J Orthop Sports Phys Ther.
2006;36(6):464-471. (Entered September 2011)
Category: Lower Quarter Bib- Ankle

Full Text
BMC Neurology, 09/28/2011
Chu MK et al. – Headache associated with mobile phone use(HAMP) usually showed stereotyped clinical features including mild intensity, a dull or pressing quality, localisation ipsilateral to the side of MP use, provocation by prolonged MP use and often accompanied by a burning sensation.
Methods
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14-item questionnaire investigating MP use and headache was administered to 247 medical
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 students at Hallym University, Korea.
Individual telephone interviews were subsequently conducted with those participants who reported HAMP more than 10 times during last 1 year on the clinical features of HAMP.
Study defined HAMP as a headache attack during MP use or within 1 hour after MP use.
Results
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In total, 214 (86.6%) students completed and returned the questionnaire.
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40 (18.9%) students experienced HAMP more than 10 times during last 1 year in the

 questionnaire survey.
In subsequent telephone interviews, 37 (97.4%) interviewed participants reported that HAMP was triggered by prolonged MP use.
HAMP was usually dull or pressing in quality (30 of 38, 79.0%), localised ipsilateral to the side
Results of MP use (32 of 38, 84.2%), and associated with a burning sensation (24 of 38, 63.2%).
In total, 214 (86.6%) students completed and returned the questionnaire. Forty (18.9%) students experienced HAMP more than 10 times during last 1 year in the questionnaire survey. In subsequent telephone interviews, 37 (97.4%) interviewed participants reported that HAMP was triggered by prolonged MP use. HAMP was usually dull or pressing in quality (30 of 38, 79.0%), localised ipsilateral to the side of MP use (32 of 38, 84.2%), and associated with a burning sensation (24 of 38, 63.2%).
Conclusion
We found that HAMP usually showed stereotyped clinical features including mild intensity, a dull or pressing quality, localisation ipsilateral to the side of MP use, provocation by prolonged MP use and often accompanied by a burning sensation. http://www.biomedcentral.com/1471-2377/11/115
Chu MK et al.
Clinical features of headache associated with mobile phone use: a cross-sectional
study in university students. BMC Neurology. Sep 2011. (Entered September 2011)
Category: Upper Quarter Bib- Headache

The Journal of Pain, 09/28/2011
Glass JM et al. – Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls. FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes.
The primary symptom of fibromyalgia (FM) is chronic, widespread pain; however, patients report additional symptoms including decreased concentration and memory. Performance-based deficits are seen mainly in tests of working memory and executive function. Neural correlates of executive function were investigated in 18 FM patients and 14 age-matched healthy controls during a simple Go/No-Go task
(response inhibition) while they underwent functional magnetic resonance imaging (fMRI). Performance was not different between FM and healthy control, in either reaction time or accuracy. However, fMRI revealed that FM patients had lower activation in the right premotor cortex, supplementary motor area, midcingulate cortex, putamen and, after controlling for anxiety, in the right insular cortex and right inferior frontal gyrus. A hyperactivation in FM patients was seen in the right inferior temporal gyrus/fusiform gyrus. Despite the same reaction times and accuracy, FM patients show less brain activation in cortical structures in the inhibition network (specifically in areas involved in response selection/motor preparation) and the attention network along with increased activation in brain areas not normally part of the inhibition network. We hypothesize that response inhibition and pain perception may rely on partially overlapping networks, and that in chronic pain patients, resources taken up by pain processing may not be available for executive functioning tasks such as response inhibition.
Compensatory cortical plasticity may be required to achieve performance on a par with control groups.
Perspective
Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls.
FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes. http://www.jpain.org/article/PIIS1526590011006614/abstract?rss=yes
Glass JM et al. Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia.
The Journal of Pain. Sep 2011. (Entered
September 2011)
Category: Misc Bib- Fibromyalgia

Clinical Rehabilitation, 09/28/2011
Diab AA et al. – Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak–to–peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.
Objective: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy.
Design: A randomized controlled study with six months follow-up.
Setting: University research laboratory.
Subjects: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5–C6 and C6–
C7) and craniovertebral angle measured less than or equal to 50° were randomly assigned to an exercise or a control group.
Interventions : The control group ( n = 48) received ultrasound and infrared radiation, whereas the exercise group ( n = 48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation.
Main outcome measures: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months).
Results: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P = 0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables ( P = 0.000).
Conclusion: Forward head posture correction using a posture corrective exercise programme in addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-topeak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy. http://cre.sagepub.com/content/early/2011/09/20/0269215511419536.abstract?rss=1
Diab AA et al. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clinical Rehabilitation. Sep 2011. (Entered September
2011)
Category: Upper Quarter Bib- Headache

European Journal of Physical and Rehabilitation Medicine, 09/28/2011
Murtezani A et al. – Participants with chronic low back pain, excluding those with “red flag” criteria were assigned randomly to one of the two treatment groups: an aerobic exercise group, and an passive modalities group. At 12–week follow–up, significant improvements in pain intensity and disability had occurred in the exercise group. High intensity aerobic exercise reduces pain, disability and psychological strain in patients with chronic low back pain.
BACKGROUND:In recent years, disability due to chronic low back pain (LBP) has steadily increased in all industrialized countries. In the treatment of chronic LBP, the objectives are to reduce pain, to improve function and minimize avoiding behavior. Exercise therapy is a management strategy that is widely used as a treatment for LBP.
AIM: The aim of this study was to investigate the effects of high- intensity aerobic exercise on pain, disability, anxiety or depression in people with chronic LBP.
DESIGN: This was a randomized controlled trial
SETTING: Institute of Occupational Medicine, Department of Physical Medicine and Rehabilitation –
Outpatient Ward
POPULATION: Kosovo power plant workers.
METHODS: Participants with chronic low back pain, excluding those with “red flag” criteria were assigned randomly to one of the two treatment groups: an aerobic exercise group (N.=50), and an passive modalities group (N.=51). Data on low back pain intensity (visual analogue scale), disability (Oswestry
Low Back Pain Disability Questionnaire), fingertip-to-floor distance, and psychosocial factors (Hospital
Anxiety and Depression Scale) were collected at baseline and after 12-weeks follow-up points.
RESULTS: At 12-week follow-up, significant improvements in pain intensity and disability had occurred in the exercise group. We have verified significant improvements in comparison with basic values in pain intensity (6±2.6 vs. 2±1.7, diff. of mean=3.9, P<0.001), disability (31±17.4 vs. 15.8±12.7, diff. of mean=15.2, P<0.001), anxiety and depression (21.1±8.2 vs. 14±6.7, diff. of mean=7.1, P<0.001), and fingertip- to-floor distance (27.8±-9.1 vs. 14.2±-5.7, P<0.001). Whereas, differences in average pain, disability, anxiety and depression and fingertip-to-floor distance are not significant in the control group.
CONCLUSION: High intensity aerobic exercise reduces pain, disability and psychological strain in patients with chronic low back pain.
CLINICAL REHABILITATION IMPACT: This research is important for the fact that High Intensity
Aerobic Exercise Programs are not so exploited in the current available literature for the treatment of
LBP. Therefore, this is another modest contribution which can reinforce the need for more frequent use of
High Intensity Aerobic Exercise Programs in the treatment of LBP. http://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2011N03A0359
Murtezani A et al. A comparison of high intensity aerobic exercise and passive modalities for the treatment of workers with chronic low back pain: a randomized, controlled trial.
European Journal of
Physical and Rehabilitation Medicine.
Sep 2011. (Entered September 2011)
Category: Lower Quarter Bib- Low Back Pain

Full Text
Pain Physician, 09/27/2011
Manchikanti L et al. – This study illustrates that postoperative nausea, vomiting, and respiratory depression are extremely rare and aspiration is almost nonexistent, despite almost all of the patients receiving sedation and without preoperative fasting prior to provision of the interventional techniques.
Methods
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All patients presenting for interventional techniques from May 2008 to December 2009 are included with documentation of various complications related to interventional techniques including nausea and vomiting.
Results
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From May 2008 to December 2009 a total of 3,179 patients underwent 12,000 encounters with
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18,472 procedures, with patients receiving sedation during 11,856 encounters.
Only 189, or 1.6% of the patients complained of nausea and 3 of them, or 0.02%, experienced vomiting.
There were no aspirations.
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Of the 189 patients with nausea, 80 of them improved significantly prior to discharge without further complaints.
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Overall, 109 patients, or 0.9% were minimally nauseated prior to discharge.
The postoperative complaints of continued nausea were reported in only 26 patients for 6 to 72 hours.
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There were only 2 events of respiratory depression, which were managed with brief oxygenation with mask without any adverse consequence of nausea, vomiting, aspiration, or other adverse effects.
CONCLUSION: This study illustrates that postoperative nausea, vomiting, and respiratory depression are extremely rare and aspiration is almost nonexistent, despite almost all of the patients receiving sedation and without preoperative fasting prior to provision of the interventional techniques. http://www.painphysicianjournal.com/crrent_issue_vw.php?journal=63&code=1508&issue=current_issue
Manchikanti L et al. Preoperative Fasting Before Interventional Techniques: Is It Necessary or Evidence-
Based. Pain Physician. Sep 2011. (Entered September 2011)
Category: Misc Bib- Surgical