The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model

Bialosky, Joel E.; Bishop, Mark D.; Price, Donald D.; Robinson, Michael E.; George, Steven Z.

doi:10.1016/j.math.2008.09.001

Cited by 822 publications

(621 citation statements)

References 96 publications

(105 reference statements)

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“…Additionally, patients with neurogenic neck and arm pain have demonstrated signs of generalized sensory hypersensitivity hypoesthetic changes that may be indicative of central sensitization and well as peripheral nerve dysfunction. 64 Manual therapy interventions may affect not only peripheral sources of nociceptive input, but also descending inhibitory pathways, 65 which may explain the greater effect of manual therapy in this population.…”

Section: Discussionmentioning

confidence: 99%

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Costello

Puentedura

Cleland

et al. 2016

Journal of Manual & Manipulative Therapy

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Study design: Randomized clinical trial. Objectives: To investigate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain who demonstrate neural mechanical sensitivity. Background: While experts have suggested that individuals with neck and arm pain associated with neural tissue mechanical sensitivity may benefit from STM, there has been little research to investigate this hypothesis. Methods: Twenty-three patients with neck and arm pain and a positive upper limb neurodynamic test (ULNT) were randomly assigned to receive STM or therapeutic US during a single session. Outcome measures were collected immediately before and after treatment, and at 2-4 day follow-up. Primary outcomes were the Global Rating of Change (GROC), range of motion (ROM) during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), Numeric Pain Rating Scale (NPRS), and active range of shoulder abduction motion combined with the wrist neutral or wrist extension. Results: A greater proportion of patients in the STM group reported a significant improvement on the GROC immediately after treatment (P50.003, STM575%, US59%), and at 2-4 day follow-up (P50.027, STM558%, US59%). Patients who received STM demonstrated greater improvements in ROM during ULNT (P50.026), PSFS (P50.007), and shoulder active ROM combined with wrist extension (P50.028). Improvements in Numeric Pain Rating Scale and pain during the ULNT were observed only in the STM group. There was no difference between groups for the NDI or shoulder abduction ROM with wrist neutral. Conclusion: Patients with neck and arm pain demonstrated greater improvements in ULNT ROM, GROC, and PSFS, and pain following STM than after receiving therapeutic US. Level of evidence: Therapy, level 1b.

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Section: Discussionmentioning

confidence: 99%

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Costello

Puentedura

Cleland

et al. 2016

Journal of Manual & Manipulative Therapy

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“…29 Despite clinical evidence for the benefits of spinal mobilization, the biological mechanisms underlying the effects of spinal mobilization are not known. [32][33][34] One of the principal rationales for manual therapy intervention is that an ongoing barrage of noxious sensory input from biomechanical spinal dysfunction increases the excitability of neurons or circuits in the spinal cord. [35][36][37] Mechanoreceptors including proprioceptors (muscle spindles, both primary and secondary endings and Golgi tendon organs), low-and high-threshold mechanoreceptors, high-threshold mechano-nociceptors, and high-threshold polymodal nociceptors 38 within deep paraspinal tissues react to mechanical deformation of these tissues.…”

Section: Discussionmentioning

confidence: 99%

Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex

Watson

Drummond

2014

Headache

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Objective.-To investigate cervical, interictal reproduction of usual head pain and its effect on the nociceptive blink reflex in migraineurs.Background.-Anatomical and neurophysiological studies in animals and humans have confirmed functional convergence of trigeminal and cervical afferent pathways. Migraineurs often present with occipital and neck symptoms, and cervical pain is referred to the head in most cases, suggesting that cervical afferent information may contribute to headache. Furthermore, the effectiveness of greater occipital nerve blockade in migraine and demonstrable modulation of trigeminal transmission following greater occipital nerve blockade suggest an important role for cervical afferents in migraine. However, to what extent cervical afferents contribute actively to migraine is still unknown.Methods.-The passive accessory intervertebral movements of the atlanto-occipital and C2-3 spinal segments of 15 participants (14 females, 1 male; age 24-44 years, mean age 33.3 years) with migraine were examined interictally. During 1 session, either the atlanto-occipital or C2-3 segment was examined, resulting in referred usual head pain, while in another session, pressure was applied over the common extensor origin (lateral epicondyle of the humerus) of the ipsilateral arm. Each intervention was repeated 4 times. The nociceptive blink reflex to a supraorbital electrical stimulus was elicited ipsilaterally during both sessions before and during each intervention. The main outcome variables were the number of recorded blinks, area under the curve and latencies of the R2 components of the nociceptive blink reflex. Participants also rated the intensity of referred head pain and the supraorbital stimulus on a scale of 0-10, where 0 = "no pain" and 10 = "intolerable pain," and rated the intensity of applied pressure where 0 = "pressure but no pain" and 10 = "intolerable pain."Results.-Participants reported a significant reduction in local tenderness ratings across the 4 trials for the cervical intervention but not for the arm (P = .005). The cervical intervention evoked head pain in all participants. As the cervical intervention was sustained, head pain decreased significantly from the beginning to the end of each trial (P = .000) and from the beginning of the first trial to the end of the last (P = .000). Pain evoked by the supraorbital stimulus was consistent from baseline to across the 4 trials (P = .635) and was similar for the cervical and arm interventions (P = .072). The number of blinks decreased significantly across the experiment (P = .000) and was comparable in the cervical and arm interventions (P = .624). While the R2 area under the curve decreased irrespective of intervention (P = .000), this reduction was significantly greater for the cervical intervention than when pressure was applied to the arm (P = .037). Analysis of the R2 latencies revealed a notable increase across the experiment (P = .037). However, this increase was significantly greater following the cervical than arm intervention (P ...

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“…21 Application of the MYK system involves exclusive one-on-one clinician-patient interaction and contact, which incorporates the components of manual therapy that increase a patient's sense of well-being and may elicit the release of an endorphin that aids in pain relief. 22 Although the patient's KOOS quality-of-life scores did not change from intake to discharge, they did improve over time. All other areas of the KOOS also improved, as did her PSFS score.…”

Section: Discussionmentioning

confidence: 88%

Using the MyoKinesthetic System to Treat Bilateral Chronic Knee Pain: A Case Study

Stevenson

Baker

May

et al. 2016

Journal of Chiropractic Medicine

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Objective: The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) system on pain, functional ability, and psychosocial well-being of a 20-year-old female collegiate softball athlete diagnosed with chronic bilateral knee pain associated with osteoarthritis. Clinical Features: The patient presented with bilateral chronic knee pain lasting more than 2 years. A clinical examination and radiographic imaging revealed chondromalacia and the beginning stages of osteoarthritis of the knee. No other comorbidities were noted. Intervention and Outcome: The patient received 4 treatments with the MYK system over 2 weeks. Treatments 1 through 3 were directed at the S1 nerve root; the fourth treatment was directed at the L4 nerve root. Outcome measures included the Numeric Pain Scale, the Patient-Specific Functional Scale, and the Disability in the Physically Active Scale. Pain, function, and quality of life were measured collectively using the Knee Injury and Osteoarthritis Outcome Score. The patient experienced clinical improvements (minimal clinical important differences, minimal detectable changes) for all outcome measures, with the exception of the quality-of-life subscale within the Knee Injury and Osteoarthritis Outcome Score. Conclusions: The patient in this case study reported a decrease in pain and an increase in function during the course of 4 treatments, which were administered over 14 days and in accordance to the MYK guidelines. Traditional treatment guidelines typically recommend 8 weeks for positive effects to manifest. Manual therapy techniques, such the MYK system, may be a viable treatment option for patients with osteoarthritis of the knee. (J Chiropr Med 2016;15:294-298)

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The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model

Cited by 822 publications

References 96 publications

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex

Using the MyoKinesthetic System to Treat Bilateral Chronic Knee Pain: A Case Study

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