Heightened flexor withdrawal responses following ACL rupture are enhanced by passive tibial translation

Courtney, Carol A.; Durr, Reuben K.; Emerson, Alicia J.; Witte, Eric O.; Santos, Márcio Aurélio Líns dos

doi:10.1016/j.clinph.2010.07.029

Cited by 16 publications

(7 citation statements)

References 45 publications

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“…69 Heightened nociceptive reflexes, indicating central sensitization of nociceptive pathways, have been demonstrated in subjects following anterior cruciate rupture, in spite of the fact that all subjects were reportedly pain-free at the time of testing. 70 Furthermore, the excitability of the reflex response was increased by application of a pain-free, passive anterior tibial translation, indicating that non-noxious stimuli (i.e., afferent input from stretch of joint tissues) may promote spinal nociceptive excitability. Given that central nociceptive excitability is considered a component of chronic knee OA as well, 4 it follows that management of the patient with acute or chronic knee condition must address pain mechanisms in addition to impairments at the knee.…”

Section: Kneementioning

confidence: 99%

Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions

Courtney

Clark

Duncombe

et al. 2011

Journal of Manual & Manipulative Therapy

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Chronic lower quadrant injuries constitute a significant percentage of the musculoskeletal cases seen by clinicians. While impairments may vary, pain is often the factor that compels the patient to seek medical attention. Traumatic injury from sport is one cause of progressive chronic joint pain, particularly in the lower quarter. Recent studies have demonstrated the presence of peripheral and central sensitization mechanisms in different lower quadrant pain syndromes, such as lumbar spine related leg pain, osteoarthritis of the knee, and following acute injuries such as lateral ankle sprain and anterior cruciate ligament rupture. Proper management of lower quarter conditions should include assessment of balance and gait as increasing pain and chronicity may lead to altered gait patterns and falls. In addition, quantitative sensory testing may provide insight into pain mechanisms which affect management and prognosis of musculoskeletal conditions. Studies have demonstrated analgesic effects and modulation of spinal excitability with use of manual therapy techniques, with clinical outcomes of improved gait and functional ability. This paper will discuss the evidence which supports the use of manual therapy for lower quarter musculoskeletal dysfunction.

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Section: Kneementioning

confidence: 99%

Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions

Courtney

Clark

Duncombe

et al. 2011

Journal of Manual & Manipulative Therapy

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“…A growing body of brain activation imaging research has revealed that ACL deficiency can cause reorganization of the central nervous system at both the spinal and supraspinal levels. 15,29 These changes appear to persist following ACLR, 7 potentially manifesting in bilateral postural control impairments.…”

mentioning

confidence: 99%

Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk

Culvenor¹,

Alexander²,

Clark³

et al. 2016

J Orthop Sports Phys Ther

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“…Indirect evidence in patient populations may provide further support. Courtney et al [34] demonstrated exaggerated FWR responses following active joint compression in patients with knee OA, and in a subsequent study, a pain-free anterior translatory stress applied to anterior cruciate deficit joint resulted in substantially increased reflex responses as compared to baseline [35]. Thus, afferent signaling from the articular tissues of the knee may be augmented, and spinal excitability maintained, with various forms of weight-bearing activities (standing, walking, pivoting).…”

Section: Spinal Hyperexcitabilitymentioning

confidence: 92%

“…Using the flexor withdrawal reflex (FWR) as a measure of spinal excitability, central sensitization has been reported in many chronic musculoskeletal conditions, including in patients with whiplash associated disorder [32,33], fibromyalgia [32], and knee OA [15,34], and in patients following anterior cruciate rupture [35]. While the FWR is commonly used in animal model studies [36,37], one advantage of using this method in patient populations is the opportunity to monitor subjective pain responses with quantitative measures of nociceptive reflex excitability.…”

Section: Spinal Hyperexcitabilitymentioning

confidence: 99%

Neuromuscular Function in Painful Knee Osteoarthritis

Courtney

O’Hearn

Hornby

2012

Curr Pain Headache Rep

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Pain is a major cause of impaired mobility in elderly patients with chronic osteoarthritis (OA) of the knee. Central sensitization and impaired nociceptive inhibitory mechanisms have both been identified as contributing factors to heightened pain in this patient population. While central sensitization has been shown to produce enhanced pain responses and spread of pain to adjacent and remote body regions, conditioned pain modulation has also been shown to be adversely affected, and may be characteristic of those patients with chronic pain. Alterations of quantitative sensory testing measures have been demonstrated in patients with knee OA, and may serve as a clinical means of staging chronic musculoskeletal pain, including assessment of hyperalgesia and hypoesthesia. In addition, pain and altered somatosensation commonly associated with OA may be correlated with functional deficits.

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Heightened flexor withdrawal responses following ACL rupture are enhanced by passive tibial translation

Cited by 16 publications

References 45 publications

Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions

Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions

Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk

Neuromuscular Function in Painful Knee Osteoarthritis

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