The term 'regional interdependence' or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.
Background: It is commonplace for clinicians to utilize treatment of the thoracic spine as an adjunct to traditional interventions focused solely upon the shoulder. Research is beginning to substantiate this clinical practice. While still in its infancy, a clinical link between the thoracic spine and shoulder pain, function, strength, and motion potentially exists. This relationship between seeming unrelated areas of the body has been termed 'Regional Interdependence'. While evidence for regional interdependence between the thoracic spine and shoulder is being established, very little is known about the physiological mechanism behind such a link. Objectives: The purpose of this paper is to explore the evidence that currently exists for a relationship between thoracic spine manipulation, shoulder pain, and shoulder function. Existing and proposed physiological mechanisms underlying manipulation are discussed and placed in the context of regional interdependence. Major findings: Several models will be introduced to explain the physiological effects of thoracic manipulation on shoulder function including a novel allostatic response model. In addition, the clinical implications of regional interdependence will be discussed. Conclusion: Research is demonstrating that a relationship exists between thoracic spine manipulation, shoulder pain, and shoulder function. While the physiology underlying such a relationship is still unclear, homeostasis and the body's allostatic response may provide an explanation for the regionally interdependent relationship.
Background: Associative learning is the theory that two stimuli can be paired to produce similar behavioral responses. In this model, a previously innocuous stimulus can become paired with a noxious stimulus to a point that this previously innocuous stimulus can result in the perception of pain. Objectives: This review discusses concepts related to neural activation and structural alterations in the presence of both chronic pain and post-traumatic stress disorder (PTSD). The role of associative learning and protective memory-based behavioral responses in the perception of pain is explored to provide a framework to inform clinical management of individuals with chronic pain and will be linked to the presence of actual or perceived threat or fear. Major Findings: Current research demonstrates that in individuals with chronic pain, cortical and subcortical processing of information shifts from normal nocioceptive processing areas to the medial prefrontal, anterior cingulate, and insular cortices, as well as the hippocampus (Hip) regions, all of which also show dysregulation, signs of gray matter atrophy, and changes in epigenetic coding. Because these regions are involved in memory, emotional processing, learning, and conditioning, it is reasonable to suggest that associative learning may be involved in the processing of both pain and PTSD. Conclusions: Clinically, rehabilitation paradigms that incorporate early intervention, positive expectation, therapeutic neuroscience education, visual imagery, movement retraining, and manual therapy all have the potential to change not only pain behavior but also the neural circuitry, epigenetic coding, and cortical morphology underlying chronic pain.
MTM may immediately increase lower extremity passive range of motion, but the effect was lost by the 1-week follow-up. This supports evolving research suggesting that spinal manipulation may have a generalized but transient physiological effect.
Purpose: Memory has been identified as an important protective feature to prevent future injury, but its role has yet to be ascertained. The current study aimed to determine whether there was a difference in pressure pain threshold (PPT) responses between participants with a prior history of injury of lower extremity injury (PSI) and those without (NPSI) when exposed to 1) experimental mechanical pain, 2) short-term memory recall of a painful stimulus, or 3) long-term memory of the pain associated with a prior injury. Subjects and Methods: The study used a pretest-posttest quasi-experimental design. A convenience sample of 59 pain-free participants was recruited from an urban university. Twenty-nine PSI and 30 NPSI were stratified into two groups based on their injury history with PPT values measured at baseline and immediately following each of the three experimental conditions. A repeated measure ANCOVA analysis was conducted for each condition to determine whether there was a difference in PPT responses between the two groups. Results: There was a statistically significant difference in PPT values between the two groups when exposed to experimental pain, F(1,57) = 6.010, p = 0.017, partial η 2 = 0.095 and with long-term pain memory, F(1,57) = 4.886, p = 0.031, partial η 2 = 0.079. There was no statistically significant difference between groups with short-term pain memory, F(1,57
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