"Since the third edition of Grieve''s Modern Manual Therapy was published in 2005, the original concepts of manipulative therapy have grown to embrace new research-generated knowledge. Expansions in practice have adopted new evidence which include consideration of psychological or social moderators. The original manual therapy or manipulative therapy approaches have transformed into musculoskeletal physiotherapy and this is recognized by the change in title for the new fourth edition - Grieve''s Modern Musculoskeletal Physiotherapy. Grieve''s Modern Musculoskeletal Physiotherapy continues to bring together the latest state-of-the-art research, from both clinical practice and the related basic sciences, which is most relevant to practitioners. The topics addressed and the contributing authors reflect the best and most clinically relevant contemporary work within the field of musculoskeletal physiotherapy. With this as its foundation and a new six-strong editorial team at its helm, the fourth edition now expands its focus from the vertebral column to the entire musculoskeletal system. For the first time both the spine and extremities are covered, capturing the key advances in science and practices relevant to musculoskeletal physiotherapy. The book is divided into five parts containing multiple sections and chapters. The first part of the book looks at advances in the sciences underpinning musculoskeletal physiotherapy practice. Here there is commentary on topics such as movement, the interaction between pain and motor control as well as neuromuscular adaptations to exercise. Applied anatomical structure is covered in addition to the challenges of lifestyle and ageing. A new section highlights the important area of measurement and presents the scope of current and emerging measurements for investigating central and peripheral aspects relating to pain, function and morphological change. Another section discusses some contemporary research approaches such as quantitative and qualitative methods as well as translational research. Part III contains sections on the principles of and broader aspects of management which are applicable to musculoskeletal disorders of both the spine and periphery. Topics include models for management prescription, communication and pain management and contemporary principles of management for the articular, nervous and sensorimotor systems. In recognition of the patient centred and inclusive nature of contemporary musculoskeletal practice, there is also discussion about how physiotherapists may use cognitive behavioural therapies when treating people with chronic musculoskeletal disorders. The final part of the book focuses on selected contemporary issues in clinical practice for a particular region, condition or the most topical approaches to the diagnosis and management of a region. A critical review of the evidence (or developing evidence) for approaches is given and areas for future work are highlighted."--Back cover

Grieve's Modern Musculoskeletal Physiotherapy E-Book

Gwendolen Jull Dip Phty Grad Dip Manip Ther MPhty PhD FACP,Ann Moore PhD FCSP FMACP Dip TP Cert Ed,Deborah Falla BPhty (Hons) PhD,Jeremy Lewis BApSci (Physio) PhD FCSP,Christopher McCarthy PhD FCSP FMACP,Michele Sterling PhD MPhty BPhty Grad Dip Manip Physio FACP

Gwendolen Jull, Ann P. Moore, Deborah Falla, Jeremy Lewis, Christopher McCarthy

Jull, Gwendolen; Moore, Ann; Falla, Deborah

Gwendolen A Jull

Elsevier Health Sciences UK

Butterworth-Heinemann Ltd

Elsevier Science Ltd

W B Saunders Co Ltd

United Kingdom and Ireland, United Kingdom

Fourth edition, London, 2015

4th ed, Edinburgh, 2015

producers:
Adobe PDF Library 9.0

Grieve's Modern Musculoskeletal Physiotherapy, Fourth Edition (2015) 669pp. 978-0-7020-5152-4
Front Cover 1
Grieve's Modern Musculoskeletal Physiotherapy 2
Copyright Page 5
Table Of Contents 6
Preface to the Fourth Edition 10
Acknowledgements 11
Foreword 12
Contributors 13
Plate section 20
I 44
1 Introduction to the Text 46
References 47
II Advances in Theory and Practice 48
2.1 50
Section_2.1 text 50
2 The Neurophysiology of Pain and Pain Modulation: 51
Introduction 51
The Neurophysiology of Musculoskeletal Pain: From Tissue Nociception to the Pain Neuromatrix 51
Temporal Summation and Wind-Up 52
Brain-Orchestrated Pain Modulation 52
Descending Nociceptive Facilitation 53
Descending Nociceptive Inhibition 53
The Pain Neuromatrix 54
Central Sensitization 56
Does the Autonomic Nervous System Influence Pain? 57
Conclusion 59
References 59
3 Neuro-Electrochemistry of Movement 62
Fundamental Principles Underlying Neuro- Electrochemistry 62
Electrical Potential and Current 62
Conductance 63
Resistance 63
Resting Membrane Potential 63
Experimentally Measuring the Membrane Potential 64
Sodium–Potassium Pump 64
Action Potential and Its Propagation 65
Decomposing an Action Potential 66
Action Potential Propagation 66
A Note on Synaptic Transmission 67
Summary 68
Suggested Reading 69
References 69
4 Postural Control and Sensorimotor Integration 71
Summary 71
Postural Control 71
Sensorimotor Integration 72
Perception 72
Selection 72
Motor Control 73
Sensory Integration 73
Perception 75
Generation of Action Possibilities 76
Selection 76
Motor Control 79
The Fast Loop 79
The Slow Loop 79
Principles Applicable for Physiotherapeutic Practice 81
Acknowledgements 81
References 81
5 Motor Control and Motor Learning 85
Introduction 85
Theories of Motor Control 85
Sensory Feedback as an Integral Part of Motor Control 86
Sensory Feedback during Locomotion 87
Sensory Feedback as Part of a Reflex Loop Is Not Stereotyped 89
Sensory Feedback Is a Key Component in Motor (Re)Learning 92
Chronic Pain States 92
Central Nervous System Lesions 92
Conclusions 93
References 93
6 Interaction Between Pain and Sensorimotor Control 96
Introduction 96
Sensorimotor Dysfunction in Musculoskeletal Pain 96
Sensorimotor Control 96
Relationship Between Pain, Injury and Sensorimotor Dysfunction 97
Pain and/or Injury: The Cause or Consequence of Sensorimotor Dysfunction 98
Sensorimotor Dysfunction in Pain and/or Injury Across a Spectrum from ‘Subtle’ to ‘Major’ Adaptations 99
Sensorimotor Adaptations Provide a Short-Term Solution, but have Potential Long-Term Consequences 102
Mechanisms for Sensorimotor Changes in Musculoskeletal Conditions 105
Sensory System Mechanisms. 105
Motor System Mechanisms. 105
Interaction with Psychosocial Factors. 106
Conclusions 107
Acknowledgements 108
References 108
7 Neuromuscular Adaptations to Exercise 111
Introduction 111
Skeletal Muscle 111
Neural Control of Muscle Contraction 111
Muscle Function 111
Muscle Fibre Types 112
Adaptation to Exercise: The Overload Principle 112
Adaptations to High-Resistance Strength Training 113
Neural Adaptations 113
Muscular Adaptations 113
Muscle Protein Synthesis 114
Satellite Cells 114
Hormonal Influences 116
Testosterone 116
Growth Hormone/Insulin-Like Growth Factor 1 116
Myostatin 116
Endurance Training 117
Mitochondrial Adaptations 117
Angiogenesis 117
Substrate Utilization 117
Can We Switch Muscle Fibre Types? 118
Neural Adaptations 118
Summary 118
References 119
8 The Peripheral Nervous System and its Compromise in Entrapment Neuropathies 121
Introduction 121
Anatomy and Physiology 121
Peripheral Neurons 121
Schwann Cells and Myelin 122
Neural Connective Tissue and Its Innervation 123
Neural Blood Circulation and Blood–Nerve Interface 123
Axonal Transport 125
The Immune Cells of the Nervous System 125
Central Nervous System 125
Pathophysiology of Entrapment Neuropathies 125
Entrapment Neuropathies and Ischaemia 125
Entrapment Neuropathies Cause Demyelination 126
Entrapment Neuropathies Affect Both Large- and Small-Diameter Nerve Fibres 127
The Role of the Immune System in Entrapment Neuropathies 127
Neurogenic Inflammation 128
Experimental Mild Nerve Compression Impairs Axonal Transport 129
Central Nervous System Changes 130
Summary 131
Acknowledgement 131
References 132
9 Functional Anatomy 136
CHAPTER OUTLINE 136
CHAPTER 9.1 ■ The Cervical Spine 136
Introduction 136
Craniocervical-Coupled Movements and Clinical Implications 136
Synovial Folds in the Craniocervical Spine 137
The Anatomy of Craniocervical Stability and Clinical Implications 137
Ligamentous System 137
Clinical Anatomy and Biomechanics of the Alar Ligaments 137
Clinical Anatomy and Biomechanics of the Transverse Ligament and Relevance to Clinical Testing 137
Clinical Anatomy and Biomechanics of the Tectorial Membrane and Relevance to Clinical Testing 137
Craniocervical Muscles and Their Clinical Significance 137
Mid to Low Cervical Spine 139
The Vertebral Body 139
The Vertebral Arch 140
Ligaments 140
The Intervertebral Disc 141
The Intervertebral Foramina and Spinal Nerves 142
References 142
CHAPTER 9.2 ■ Lumbar Spine 144
The Vertebral Column 144
Lumbar Vertebrae 145
The Vertebral Body 145
Neural Arch 145
Apophyseal Joints 145
Intervertebral Discs 145
Nucleus Pulposus 145
Annulus Fibrosus 145
Vertebral Endplates 146
Internal Mechanical Function of Intervertebral Discs 146
Blood and Nerve Supply 146
Intervertebral Ligaments 147
Longitudinal Ligaments 147
Ligamentum Flavum 147
Supraspinous and Interspinous Ligaments 147
Iliolumbar Ligaments 147
Muscles of the Lumbar Spine 147
Anterolateral Muscles 147
Back Muscles 147
Intersegmental Back Muscles 147
Short Polysegmental Back Muscles 147
Long Polysegmental Back Muscles 147
Other Muscles Relevant to the Lumbar Spine 147
References 147
10 Tendon and Tendinopathy 149
CHAPTER OUTLINE 149
CHAPTER 10.1 ■ Tendon and Tendon Pathology 149
Introduction and Tendon Function 149
Composition and Structure 149
Mechanical Behaviour 151
Tendon Injuries and Repair 153
References 154
CHAPTER 10.2 ■ Managing Tendinopathies 155
Introduction 155
Tendon Pathology 155
Pathoaetiology 156
Source of Tendon Pain 156
What Causes Tendon to Become Painful? 157
Assessment 157
Management of Tendinopathy 158
Conclusion 158
References 158
11 Lifestyle and Musculoskeletal Health 160
Introduction 160
Non-Communicable Diseases and Evidence-Informed Orthopaedic Physiotherapy 160
Smoking and Musculoskeletal Health 161
Deleterious Effects of Smoking 161
Beneficial Effects of Quitting Smoking 162
Nutrition and Musculoskeletal Health 162
Bone Mineralization 163
Body Composition 163
Chronic Systemic Low-Grade Inflammation 163
Pain Threshold 163
Immunity and Immune Response 163
Obesity 163
Inactivity/Activity and Musculoskeletal Health 164
Deleterious Effects of Inactivity 164
Beneficial Effects of Regular Physical Activity 164
Sleep and Musculoskeletal Health 164
Deleterious Effects of Sleep Deprivation 164
Beneficial Effects of Optimal Sleep 165
Mental Health and Musculoskeletal Health 165
Deleterious Effects of Mental Ill Health 165
Beneficial Effects of Mental Hygiene 165
Conclusion 165
References 166
12 Ageing and the Musculoskeletal System 169
Ageing of the Musculoskeletal System 169
Ageing Joints 169
Ageing Muscles 169
Ageing Nervous System 170
Ageing, Falling and Pain 171
Ageing and the Beneficial Effects of Movement 171
The Ageing Spine 171
Disc Degeneration 173
Osteophytosis 173
Vertebral End-Plate Lesions and Schmorl’s Nodes 174
Zygapophysial and Costovertebral Joint Degeneration 174
Degenerative Spinal Curvature Anomalies 175
Osteoporosis and Osteoporotic Fracture 175
Intervertebral Disc Prolapse 176
Summary 176
References 176
2.2 179
Section_2.2 text 179
13 Movement Analysis 180
Introduction 180
A Mechanical Model of the Musculoskeletal System 180
Motion Capture 180
Stereophotogrammetry 181
Magnetic and Inertial Measurement Units 183
Measure of External Forces 184
Joint Mechanics 184
Joint Kinematics 184
Joint Kinetics 185
Future Developments 185
References 186
14 New Developments in Ultrasound Imaging in Physiotherapy Practice and Research 187
Introduction 187
Types of Ultrasound Imaging and Technical Considerations 187
Assessment of Muscle Morphometry and Morphology (Architecture) 187
Contracted Muscles 189
Relationship Between Muscle Size and Strength 189
Perimuscular Connective Tissue Thickness 189
Validity of USI Against Other Imaging Techniques and Electromyography 189
Reliability 189
Biofeedback of Muscle Function 189
Measuring Tissue Motion and Mechanical Properties of Muscle–Tendon Unit 189
M-Mode 191
Motion Tracking Using Tissue Doppler and B-Mode Speckle Tracking 191
Tissue Doppler Imaging (TDI) 191
B-Mode Speckle Tracking 191
Elastography 192
Future Directions 193
References 193
15 Advances in Magnetic Resonance Imaging (MRI) Measures 196
Introduction 196
MRI Contrasts 196
Fat/ Water Separation: Macroscopic Structure of Muscle 197
Muscle Functional MRI: Microscopic Activation and Function of Muscle 198
Advanced Techniques: Microscopic Evaluation of the Muscle and Nervous Systems 199
Magnetization Transfer Ratios 199
Diffusion Weighted Imaging 199
Functional Magnetic Resonance Imaging: Functional and Structural 200
Caution 200
MRI in Musculoskeletal Clinical Practice 201
References 201
16 Musculoskeletal Pain in the Human Brain: 204
Introduction 204
The Brain Network for Pain 204
Components of Pain Experience 204
Functional Components of the Pain Network 204
Spinobulbar Pathways 204
Spinothalamic Pathways and Other Hemispheric Regions 205
The Pain Network in Musculoskeletal Disorders 207
Evoked Pain in Musculoskeletal Disease 207
Central Processing of Spontaneous Pain 208
Musculoskeletal Physiotherapy and Pain Processing 208
Conclusions 209
References 209
17 Advances in Electromyography 211
Introduction 211
Electrode Systems 211
Applications 212
Timing of Muscle Activity 212
Myoelectric Manifestations of Fatigue 213
EMG Amplitude 214
EMG Tuning Curves 214
Distribution of Muscle Activity 215
Muscle Synergies 215
Single Motor Unit Behaviour 217
Monitoring Change with Rehabilitation 218
Limitations 218
Conclusion 218
References 218
18 Non-invasive Brain Stimulation in the Measurement and Treatment of Musculoskeletal Disorders 222
Single-Pulse Transcranial Magnetic Stimulation 222
Cortical Representation Mapping 222
Resting and Active Motor Threshold 223
Motor Evoked Potential Latency 223
Motor Evoked Potential Amplitude 223
Recruitment Curves 224
Cortical Silent Period 226
Fatigue 226
Paired-Pulse Transcranial Magnetic Stimulation 226
Repetitive Transcranial Magnetic Stimulation 226
Neuromodulation: A New Treatment Strategy in Physiotherapy 226
Repetitive Transcranial Magnetic Stimulation 227
Transcranial Direct Current Stimulation 227
Safety Considerations 227
References 227
19 Musculoskeletal Modelling 230
Introduction 230
Basics of Musculoskeletal Modelling Based on Inverse Dynamics 230
A Simple Example 231
Example 1: Simulated Changes in Lumbar Muscle Activation from a Pelvic Tilt 232
Example 2: Understanding the Recruitment of the Semispinalis Cervicis Muscle Using Musculoskeletal Modelling 233
Description of the Cervical Spine Model and Simulation 233
Results 234
Conclusion and Perspectives 235
References 236
20 Quantitative Sensory Testing: 237
Quantitative Sensory Testing 237
Importance of Standardizing Protocols 237
Test Parameters 238
Mechanical Quantitative Sensory Testing 238
Vibration Thresholds 238
Light Touch 239
Pressure Pain Thresholds 239
Mechanical Pain Thresholds 240
Temporal Summation of Pain (Wind-Up Ratio) 240
Thermal Quantitative Sensory Testing 240
Test Site and Interpretation of Quantitative Sensory Testing Data 241
Clinical Utility of Quantitative Sensory Testing in Physiotherapy 242
References 242
21 Outcome Measures in Musculoskeletal Practice 245
Introduction 245
Types of Outcome Measures 245
The Development and Validation of Outcome Measures 250
Practical Issues in Collecting Outcome Measures 250
Set a Clear Purpose 250
Decide on the Timing 250
Case-Mix Adjustment 251
Data Collection Method 252
Acting on Information 252
Summary 252
References 252
2.3 254
Section_2.3 text 254
22 Clinical Research to Test Treatment Effects 255
Introduction 255
Classic Multiple Group Parallel Design Randomized Controlled Trial 255
The Cross-Over Design, Diamond Design, Factorial Design and Fractional Factorial Design 255
Randomized Withdrawal and Expertise-based Designs 259
Clinical Research to Test Treatment Effects: N-of-1 Trial Designs 260
Conclusion 261
References 262
23 Research Approaches to Musculoskeletal Physiotherapy 263
CHAPTER OUTLINE 263
CHAPTER 23.1 ■ Quantitative Research 264
What is Quantitative Research? 264
Methodology and Methods 264
Findings 265
Summary 265
References 265
CHAPTER 23.2 ■ Qualitative Research 266
What is Qualitative Research? 266
Ontological and Epistemological Assumptions 266
Methodology and Methods 266
Findings 267
When Might You Use Qualitative Research? 267
Summary 267
References 267
CHAPTER 23.3 ■ Mixed Methods Research 267
What is Mixed Methods Research? 267
When Might You Use Mixed Methods Research? 268
Methodology and Methods 268
Difficulties Associated with Mixed Methods Research 268
Summary 268
Conclusion 268
Quantitative Research 268
Qualitative Research 269
Mixed Methods Research 269
References 269
24 Standardized Data Collection, Audit and Clinical Profiling 270
Introduction 270
Context 270
Development of a Standardized Data Collection Tool 271
The Delphi Process 271
Nominal Group Technique 272
Process of Standardized Data Collection Development Utilizing a Nominal Group Technique 272
A Nominal Group Technique Protocol as an Example 272
References 274
25 Implementation Research 275
Introduction 275
What is the Problem? 275
What is Implementation Research? 276
What are the Types of Implementation Research? 276
Which Interventions Help to Change Clinical Practice? 277
How are Interventions Developed that Aim to Increase Implementation of Research? 277
Does Theory Have a Role in Complex Intervention Development? 279
How Best Should Theory be Used in Implementation Research? 279
Conclusion 280
References 280
III Advances in Clinical Science and Practice 282
3.1 284
Section_3.1 text 284
26 Clinical Reasoning and Models for Clinical Management 285
Evidence-Based Clinical Reasoning 285
Sources of Evidence 285
Inductive and Deductive Clinical Reasoning 286
Stepped Care and Adaptive Care 287
Clinical Prediction Rules 287
Technology and Paper-Based Aides for Clinical Reasoning 288
Stratified Health Care and Treatment Effect Modification 289
The Challenge of Making Clinical Reasoning Models Relevant to the Care of Individual Patients 289
The Biopsychosocial Model – Why Dealing with the Physical is Often Not Enough 290
Future Directions for Clinical Reasoning and Management 291
References 291
27 Communicating with Patients 293
CHAPTER OUTLINE 293
CHAPTER 27.1 ■ Patient-Focused Practice and Communication: Use of Communication in the Clinical Setting 293
Introduction 293
Some Key Features of Communication 294
Some Specific Practices for Building Towards Common Ground 294
Pursuing Patients’ Contributions, and Designing What You Say in Relation to Their Contributions 294
Stepwise Building of Agreement 294
‘You Tell Me First’ Sequences 296
Online Commentary About Your Examination Findings 296
Explaining Reasons for Treatments and Recommendations 296
Make Positive, Specific Recommendations First 296
Concluding Remarks 296
References 296
CHAPTER 27.2 ■ Patient Education: A Collaborative Approach 297
Consider the Characteristics of the Learner (e.g. Patient or Carer) 298
What Are the Patient’s Learning Needs? 298
What Are the Learner’s (Patient’s) Personal Characteristics? 298
Select Approaches to Facilitate the Learning 299
Assess the Learning 300
Evaluate your Own Practice as an Educator 300
Summary 301
References 301
CHAPTER 27.3 ■ Communicating Risk 301
Understanding Risk 301
Understanding Probabilities 302
Relative Versus Absolute Risk 302
Probabilities Versus Natural Frequencies 302
Communication Tools 302
Framing Risk 302
Personalizing Risk 304
References 304
28 Pain Management Introduction 305
CHAPTER OUTLINE 305
CHAPTER 28.1 ■ The Patient’s Pain Experience 305
Coming to Terms With Pain and Disability 306
Personal and Social Changes in Response to Pain 306
Adopting a Role in the Health and Social Care System 306
Conclusion 307
References 307
CHAPTER 28.2 ■ Educational Approaches to Pain Management 308
Delivery of Patient Education 308
Content of Education Interventions for Low Back Pain 308
The Effectiveness of Patient Education for Low Back Pain 308
Biomedical Education (Back Schools) 308
Biopsychosocial Education (Advice/Brief Education) 309
Pain Neurophysiology/Pain Biology Education 309
Patient Education and Maladaptive Beliefs 309
Common Beliefs Targeted by Patient Education 310
Pain Neurophysiology Education 310
References 310
CHAPTER 28.3 ■ Physical Interventions of Pain Management and Potential Processes 312
Exercise 312
Clinical Studies 312
Dosing 312
Basic Mechanisms 313
Central Mechanisms 313
Peripheral Mechanisms 313
Additional Mechanisms 313
TENS 313
Clinical Studies 313
Dosing 314
Basic Science Mechanisms 314
Manual Therapy 315
Basic Science Mechanisms 315
References 316
29 Spinal Manipulation 320
Introduction 320
Defining Spinal Manipulation 320
Objectives of Spinal Manipulation (Biomechanical) 321
Stretching/Tearing Tissue? 321
Inducing Cavitation Within the Joint? 321
Reducing Muscle Hypertonicity/Stiffness 322
Objectives of Spinal Manipulation (Neurophysiological) 322
Limitations of the Biomechanical Model 322
Neurophysiological Mechanisms of Spinal Manipulation 323
Potential Peripheral Mechanisms 323
Potential Spinal Cord Mediated Mechanisms 323
Potential Supraspinally Mediated Mechanisms 324
Safety and Practical Issues Associated With Spinal Manipulation 324
Minimizing Risk in Applying Manipulation 324
Clinical Reasoning and Patient Selection 325
International Context 326
Conclusion – Definition of Spinal Manipulation 326
References 326
30 Neurodynamic Management of the Peripheral Nervous System 330
Introduction 330
Neurodynamic Tests 330
Neurodynamic Management 332
Sliding and Tensioning Techniques 332
Mobilization of Surrounding Structures 332
Treating the Neural Container 332
Indications and Contraindications 332
Influences on Pathobiological Processes 334
Normalization of Impaired Nerve Movement 334
Evacuation of Intraneural Oedema 335
Reduction of Extraneural Oedema and Pressure 335
Dispersal of Inflammatory Mediators 335
Influence on the Neuro-Immune Response 335
Facilitation of Descending Modulation 336
Clinical Trial Evidence 336
Final Considerations 337
References 337
31 Therapeutic Exercise 341
Introduction 341
Principles of Management 341
Clinical Prescription of Exercise 341
Indications for Exercise 341
Assessment to Guide Exercise Prescription 341
Assessment of Movement Quality 342
Assessment of Motor Control 342
Assessment of Muscle Structure 342
Assessment of Strength Parameters 343
Assessment of Muscle Fatigue 343
Summary of Assessment 343
Specificity and Selectivity of Exercise 343
Timing of Exercise 344
Variability in Response to Exercise 344
Forms of Exercise Commonly Applied to Manage Musculoskeletal Pain 344
Motor Control Training 345
Training Principles of Motor Control Training 346
Neuromuscular Adaptations 346
Resistance Training 347
Intensity of Resistance Training 347
Volume of Resistance Training 348
Frequency and Duration of Resistance Training 348
Clinical Prescription of Resistance Training 348
Summary and Conclusion 349
References 349
32 Management of the Sensorimotor System 353
CHAPTER OUTLINE 353
CHAPTER 32.1 ■ The Cervical Region 353
Reported Complaints and Impairments 353
Overall Management Approach 353
Tailored Local Treatment 354
Tailored Sensorimotor Exercise Approach Based on Impairments 354
Head Position and Movement Control 354
Cervical Joint Position Error 354
Cervical Movement Sense 354
Oculomotor Control 355
Gaze Stability 355
Smooth Pursuit 355
Eye–Head–Trunk Coordination 355
Eye–Head Coordination 355
Trunk–Head Coordination 355
Postural Control 355
General Recommendations, Progression of Treatment 355
Conclusion 356
References 357
CHAPTER 32.2 ■ Sensorimotor Control of Lumbar Spine Alignment 358
Motor Control and Low Back Pain 358
Sensorimotor Control of the Lumbar Spine 359
Sensorimotor Control in Low Back Pain 359
Assessment of Sensorimotor Control in Low Back Pain 360
Management of Sensorimotor Control in LBP 360
References 360
CHAPTER 32.3 ■ The Lower Limb 362
Introduction 362
Brief Review of the Sensorimotor System 362
The Sensory Component of the Sensorimotor System 363
Effects of Injury on the Sensorimotor System 363
Manual Therapy and the Sensorimotor System 363
Taping and Bracing and the Sensorimotor System 365
Exercise Therapy and the Sensorimotor System 366
Summary 367
References 367
33 Consideration of Cognitive and Behavioural Influences on Physiotherapy Practice 371
Understanding the Problem Presentation 371
Psychological Co-Morbidity and What to Do About It? 371
Skills and Procedures of Cognitive Behavioural Therapy Relevant to Physiotherapy Practice 372
Breathing Retraining and Body Scan Relaxation 372
Problem Solving 373
Cognitive Coping Skills 373
Behavioural Graded Activity Approaches 373
Promoting Behaviour Change 374
Integrating Psychological Factors in to Clinical Practice 374
Conclusion 375
References 375
34 Adjunct Modalities for Pain 377
CHAPTER OUTLINE 377
CHAPTER 34.1 ■ Electrophysical Agents 377
References 378
CHAPTER 34.2 ■ Acupuncture/Dry Needling 379
Physiological Effects of Acupuncture 379
Acupuncture in the Treatment of Musculoskeletal Pain 380
References 381
CHAPTER 34.3 ■ The Use of Tape in Managing Spinal Pain 382
What is Pain? 382
Why are Some Individuals More Susceptible to Pain? 382
Where is the Pain Coming From? 382
References 384
35 Cautions in Musculoskeletal Practice 385
CHAPTER OUTLINE 385
CHAPTER 35.1 ■ Masqueraders 386
Introduction 386
Cauda Equina Syndrome 386
What is It? 386
CES-I (48-Hour Emergency Window Open Where Surgery is Likely to be Helpful) 387
CES-R (Emergency Window Passed Where Surgery is Less Likely to be Beneficial) 387
Important Issues 387
What Causes Confusion? 388
Emerging Issues 388
New Advances 388
Metastatic Spinal Cord Compression 388
What is It? 388
Important Issues 388
What Causes Confusion? 388
Emerging Issues 389
New Advances 389
Medication 389
References 389
CHAPTER 35.2 ■ Haemodynamics and Clinical Practice 390
Introduction 390
Case Studies 392
Case Study 1 393
Case Analysis 393
What Was the Haemodynamic Status of the Patient? 393
Should Manual Therapy Assessment Have Proceeded in the ‘Usual’ Way or Been Modified? 393
Were There Haemodynamic Considerations for Treatment/Management of the Patient? 393
Clinical Reasoning Note 393
Case Study 2 394
Case Analysis 394
What Was the Haemodynamic Status of the Patient? 394
Should Manual Therapy Assessment Have Proceeded in the ‘Usual’ Way or Been Modified? 394
Were There Haemodynamic Considerations for Treatment/Management of the Patient? 394
Clinical Reasoning Note 394
Conclusion 394
References 394
CHAPTER 35.3 ■ Pre-Manipulative Screening for Craniocervical Ligament Integrity 395
Introduction 395
Screening for Craniocervical Instabilities 395
Tests for Transverse Ligament Integrity 396
Sharp-Purser Test 396
Anterior Shear Test 396
Tests for Alar Ligament Integrity 397
Side-Bending Stress Test 397
Rotation Stress Test 397
Distraction Test for the Tectorial Membrane 397
Controversies in Craniocervical Ligament Testing 397
References 398
3.2 400
Section_3.2 text 400
36 Supported Self-Management and an Overview of Self-Help 401
Introduction 401
Context and Definition 401
Patient Education and Self-Management 401
Self-Management Strategies 402
Evidence and Self-Management 402
Self-Management – Patients’ and Clinicians’ Viewpoints 404
Discussion 404
Summary 405
References 405
37 Role of Physiotherapy in Lifestyle and Health Promotion in Musculoskeletal Conditions 407
Introduction 407
Clustering of Unhealthy Lifestyle-Related Behaviours and Risks 407
Physiotherapists as Health Advocates 407
Health and Risk Assessments and Interventions 407
Health Assessment 407
Assessment of Lifestyle-Related Health Behaviours 408
Lifestyle-Related Health Risk Assessment 408
Multisystem Review 408
Health Improvement Card 414
Health Behaviour Change Interventions 414
Interventions 414
Behaviour Modification 414
Cognitive Behaviour Therapy 414
Motivational Interviewing 414
Decision Balance Analysis 417
The 5 As and the 5 Rs 417
Other Behaviour Change Strategies 417
Examples of Physiotherapy-Directed Health Behaviour Change Initiatives 418
Conclusion 420
References 420
38 Musculoskeletal Health in the Workplace 422
Introduction 422
Factors Threatening Worker Health 422
What is a Work-Related Musculoskeletal Disorder? 423
Prevention 423
Primary Prevention 423
Ergonomics Human–technology Systems Model 424
Risk-management Model 424
Work-Related MSD Hazards. 424
Tools Available for Risk Management. 424
Risk Control. 425
Evidence of the Efficacy of the Ergonomics/Risk-Management Approach 425
Prevention of Work Disability – Secondary and Tertiary Prevention 425
A Systems Approach to Work Disability Prevention 425
Beyond Physical Symptoms 427
Promoting Ability Not Disability 428
Summary 428
References 428
39 Screening 431
CHAPTER OUTLINE 431
CHAPTER 39.1 ■ Screening for Musculoskeletal Disorders 431
Introduction 431
The Importance of Musculoskeletal Screening 432
The Difficulties of Screening 432
Risk Factors and Injury 432
Screening and Prevention 432
Developing a Screening Tool 434
When to Screen 435
Screening Functional Movement Patterns 435
Clinical Screening 435
References 435
CHAPTER 39.2 ■ What is Our Baseline for Movement? The Clinical Need for Movement Screening, Testing and Assessment 437
Introduction 437
Movement Patterns 437
Functional Movement Systems 438
The Functional Movement Screen – The Categorization and Predictive System 438
The Y Balance Tests – The Measurement System 439
The Selective Functional Movement Assessment – The Diagnostic System 439
Conclusion 441
References 441
40 Advanced Roles in Musculoskeletal Physiotherapy 443
Introduction 443
Background to Development of Advanced Roles 443
Drivers of Advanced Role Development 443
Definitions 444
Models of Advanced Practice 444
Orthopaedics, Neurosurgery and Rheumatology in Hospital-Based Services 444
Emergency Departments 444
Primary Care Settings 444
Other Aspects of Advanced Practice 445
Evaluation of Advanced Practice Roles and Impacts on Health Services 445
Diagnostic Accuracy 445
Treatment Effectiveness 445
Patient Satisfaction/Experience 445
Process/Organizational Impacts 445
Health Economic Impacts 446
Professional Issues 446
Conclusions and Recommendations 446
References 447
IV Overview of Contemporary Issues in Practice 450
4.1 452
Section_4.1 text 452
41 Cervical Spine: 453
Profiling Patients with Mechanical Neck Pain 453
Biological Perspectives 453
Psychological Perspectives 454
Social Perspectives 454
Patient Profiling in Clinical Practice 455
Summary Statement 456
Training 456
Training for Pain Relief 456
Training to Restore Neuromuscular Function 456
Transfer to Function 457
Variability in Response to Training 458
Exercise Dosage to Address Recurrence 458
Summary 459
Cervical Spine Mobilization and Manipulation 459
Specific Effectiveness of Cervical Spinal Manipulation 460
Neurophysiological Mechanisms of Spinal Manipulation 460
Risks of Cervical Spinal Manipulation 461
Summary 461
References 461
42 Whiplash-Associated Disorders 466
Introduction 466
The Role of Tissue Damage in Whiplash-Associated Disorders 466
Evidence Supporting the Presence of Tissue Damage 466
The Relationship of Tissue Damage to the Clinical Presentation of Whiplash-Associated Disorders 467
Summary 467
Is Whiplash-Associated Disorder a Culturally Dependent Condition? 468
The Clinical Relevance of Outcome Prediction 469
Predisposed Does Not Mean Predestined 469
Summary of Current Evidence – What are Risk Factors, What are Not? 470
Summary 471
The Treatment of Whiplash-Associated Disorders 471
Acute Whiplash-Associated Disorders 471
Chronic Whiplash-Associated Disorders 472
Future Directions 473
References 473
43 Temporomandibular Disorders: 476
Introduction 476
Do Temporomandibular Disorders have their Own Entity? 476
Myogenic Temporomandibular Disorders 476
Dental Occlusal Factors 477
Neuroendocrine and Genetic Factors 477
Parafunctions 477
Increased Muscle Activity During Rest 477
Arthrogenic Temporomandibular Disorders 478
Disc Displacements 478
Hypermobility and Dislocation 478
Arthralgia 478
Neurogenic Temporomandibular Disorders 478
Assessment 479
Subjective Examination 479
Physical Examination 479
The Relationship between an Altered Posture of the Head and Temporomandibular Disorders 480
Measurement of Head Position 480
Clinical Diagnostic Testing of Temporomandibular Disorders 480
Quality of Clinical Tests 480
Which Clinical Neuromusculoskeletal Tests Should be Chosen for Assessing Temporomandibular Disorders? 481
Physiological and Accessory Movements. 481
Structural Differentiation of Temporomandibular Disorder Pain Associated with Peripheral Nerve Sensitization. 481
Additional Tests 481
Muscle Testing. 481
Nervous System. 481
Management 482
Evidence for Physiotherapy in Temporomandibular Disorders 482
Summary 483
References 484
44 Thoracic Spine: 487
CHAPTER OUTLINE 487
CHAPTER 44.1 ■ Clinical Examination and Targeted Management of Thoracic Musculoskeletal Pain 487
Anatomical and Biomechanical Considerations 488
Assessment and Diagnosis of TSP 488
Subjective Examination 488
Area of Symptoms 488
Behaviour of Symptoms 488
History 488
Specific Spinal Pathologies 488
Red Flags 488
Yellow Flags 488
Physical Examination 489
Posture 489
Motion Assessment 489
Muscle System Assessment 490
Manual Examination 490
Diagnosis 490
Management of Thoracic M

2024-06-27