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Segmental Stabilization Beyond the Multifidus

Posted by NAIOMT on Mar 16, 2017 8:44:30 PM

In the manual therapy video below, NAIOMT faculty instructor Steve Allen, PT, OCS, COMT, FAAOMPT takes you through structures to be considered when looking at stabilization of the lumbar spine.

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Topics: lumbar spine, lumbopelvic spine, manual therapy, NAIOMT, back pain, manual therapy techniques, Manual Therapy Videos

Abstract of the Week: The effects of a standardized belly dance program on perceived pain, disability, and function in women with chronic low back pain.

Posted by NAIOMT on Jan 2, 2017 10:02:00 PM

Alright, this week's abstract isn't your average study. And while I know that an "N" of one does not hold a lot of statistical power, I still think this one warrants a quick read. Why? Let me tell you.

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Topics: Abstract of the Week, physical therapy, back pain, belly dancing

Increasing Movement in the Lumbar Spine of Older Patients

Posted by NAIOMT on Nov 19, 2016 10:36:22 AM

In the manual therapy video below, NAIOMT faculty Member Kathy Stupansky, PT, DSc, OCS, FAAOMPT demonstrates her technique for increasing movement in the lumbar spine in older patient populations.

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Topics: lumbar spine, lumbopelvic spine, manual therapy, physical therapy, back pain, Manual Therapy Videos, elderly

Abstract of The Week: The association between dry needling-induced twitch response and change in pain and muscle function in patients with low back pain

Posted by NAIOMT on Nov 11, 2016 10:36:08 AM
This week we recommend taking a look at the following abstract:
Koppenhaver SL et al.  The association between dry needling-induced twitch response and change in pain and muscle function in patients with low back pain: a quasi-experimental study.  Physiotherapy (2016)

Objective: To investigate the relationship between dry needling-induced twitch response and change in pain, disability, nociceptive sensitivity,and lumbar multifidus muscle function, in patients with low back pain (LBP).

Design:
Quasi-experimental study.Setting Department of Defense Academic Institution.

Participants:
Sixty-six patients with mechanical LBP (38 men, 28 women, age: 41.3 [9.2] years).

Interventions:
Dry needling treatment to the lumbar multifidus muscles between L3 and L5 bilaterally.

Main outcome measure:s
Examination procedures included numeric pain rating, the Modified Oswestry Disability Index, pressure algometry,and real-time ultrasound imaging assessment of lumbar multifidus muscle function before and after dry needling treatment. Pain pressurethreshold (PPT) was used to measure nocioceptive sensitivity. The percent change in muscle thickness from rest to contraction was calculatedto represent muscle function. Participants were dichotomized and compared based on whether or not they experienced at least one twitchresponse on the most painful side and spinal level during dry needling.

Result:s
Participants experiencing local twitch response during dry needling exhibited greater immediate improvement in lumbar multifidusmuscle function than participants who did not experience a twitch (thickness change with twitch: 12.4 [6]%, thickness change without twitch:5.7 [11]%, mean difference adjusted for baseline value, 95%CI: 4.4 [1 to 8]%). However, this difference was not present after 1-week, andthere were no between-groups differences in disability, pain intensity, or nociceptive sensitivity.

Conclusions:
The twitch response during dry needling might be clinically relevant, but should not be considered necessary for successfultreatment.

To pop, or not to pop?  That has long been a questions among clinicians who utilize spinal manipulation.  Is the cavitation, or audible pop, necessary to achieve a "successful" manipluation?  While some literature indicates that it may not be necessary, this remains a viable question.

In an almost synonymous fashion, achieving a local twitch response (LTR) has been viewed by some as one of the primary goals with dry needling as it has been associated with better treatment outcomes (1,2).  The local twitch response has been shown to be associated with a decrease in nociceptive and inflammatory chemicals (1,3-6), increased blood flow (7), and decrease pain (8) to name a few.  In some circles, the LTR considered as the hallmark of a successful dry needling treatment.  Recently, the authors sought to investigate the association between the LTR and changes in pain and function in patients with lumbar pain.

Outcome measures included numeric pain rating, Modified Oswestry Disability Index, pressure algometry and real time ultrasound imaging (RUSI) of the lumbar multifidus function before and after dry needling treatment.  Muscle function was defined as the percent change in multifidus muscle thickness from rest to contraction measured via (RUSI).  The presence of a LTR during dry needling treatment was deemed to have occurred if at least one visible or palpable twitch was observed by the examiner or reported by the participant.
Following treatment, subjects were dichotomized into two groups: those experiencing a LTR and those not experiencing a LTR on the most painful multifidus identified during baseline assessment.  Data analysis revealed that those patients experiencing a LTR exhibited greater immediateimprovement in lumbar multifidus muscle function than those patients that did not experience a LTR.  This difference, although present immediately after treatment, was not present at a 1 week follow up assessment.  Additionally there were no between-group differences in disability, pain intensity or nociceptive sensitivity as measured by pressure algometry.
The first investigation to look at the clinical importance of the LTR led authors to conclude that the LTR may be clinically relevant, but should not be considered as the hallmark of a successful treatment.  Regardless of your opinions on this topic, the outcomes of this investigation point to a bigger picture.  Our manual techniques have temporal effects.  In other words, if all you are doing is dry needling with your patient, you're missing a big piece of the clinical puzzle.  Most of our patients will have a host of other impairments, i.e. joint dysfunction, poor motor control, faulty movement patterns, limited dural mobility, etc. that dry needling may or may not be able to address.  This begs the question......where does dry needling fit into the overall management of your patient?
Gary Kearns, PT, COMT, FAAOMPT

**Abstract of the week shared by NAIOMT Clinical Fellowship Instructor Gary Kearns, PT, COMT, FAAOMPT

1. Dommerholt J, Mayoral del Moral O, Grobli C.  Trigger point dry needling.  J Man Manip Ther.  2006;14(4):70E-87E

2. Hong CZ.  Lidocaine injection versus dry needling to myofascial trigger points.  The importance of the local twitch response.  Am J Phys Med Rehabil.  1994;73(4):256-263.

3. Bron C, Dommerholt JD.  Etiology of myofascial trigger points.  Curr Pain Headache Rep.  2012;16(5):439-444.

4. Huguenin LK.  Myofascial trigger points: the current evidence.  Phys Ther Sport.  2004;5(1).

5.  Shah JP, Phillips T, Danoff JV, Gerber LH.  A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active.  Arch Phys Med Rehabil.  2003;84(9):E4.

6.  Shat JP, Phillips TM, Danoff, JV, Gerber LH.  An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.  J App Physiol.  2005;99(5):1977-1984.

7.  Jimbo S, Atsuta Y, Kobayashi T, Matsuno T.  Effects of dry needling at tender points for neck pain (Japanese: Katakori): near-infrared spectroscopy for monitoring muscular oxygenation of the trapezius.  J Orthop Sci.  2008;13(2):101-106.

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Topics: Abstract of the Week, manual therapy, back pain, Dry Needling, low back pain, Uncategorized

Abstract of The Week: Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain

Posted by NAIOMT on Mar 12, 2016 7:09:37 AM

ABSTRACT: Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study

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Topics: Abstract of the Week, NAIOMT, pain, rebecca lowe, back pain, chronic pain, therapeutic Alliance, Uncategorized

Here's What The Health Care System Needs Most

Posted by NAIOMT on Mar 1, 2016 8:36:00 AM

We've said it before, and we'll say it again and again.

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Topics: manual therapy, pain, Physical Therapy, physical therapy, PT, back pain, getpt1st

Abstract of the Week: Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain

Posted by NAIOMT on Oct 15, 2015 6:59:11 PM

Abstract: Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain

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Topics: Abstract of the Week, physical therapy, PT for back pain, back pain, Clinical Reasoning, low back pain

5 Tips for Helping Chronic Pain Patients Using the Power of the Mind

Posted by NAIOMT on Oct 11, 2015 1:40:00 PM
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Topics: mindfulness, psychology of pain, back pain, chronic pain, clinical skills

Abstract of The Week: Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

Posted by NAIOMT on Sep 27, 2015 11:46:00 AM

Abstract: Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

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Topics: Abstract of the Week, back pain, chronic pain, low back pain, Thoracolumbar Dissociation

3 Key Concepts to Embrace After 30

Posted by NAIOMT on Sep 8, 2015 10:20:46 AM

By the age of 26 I had been fighting some type of back pain for years. It had become a normal way of life. I still was able to do most of anything I wanted to until “The Day.” While replacing our garage door, I went to lift the old door when it happened, a big pop in my back. Four hours later I was unable to get out of bed. I was experiencing what we know as a “classic disc protrusion.” For the next two weeks I was bed ridden. After that I went back to work using a cane for about a month to keep weight off my left leg.

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Topics: lumbopelvic spine, Manual Physical Therapy, manual therapy, back pain, getting older, low back pain

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