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The National Center for Complementary and Integrative Health recommends that research be judged on the merit of scientific findings rather than on the basis of professional degrees held by investigators.
In this spirit, the American Academy of Osteopathy provides OsteoBlast citations that are likely to be of interest to AAO members. The AAO offers these items from peer-reviewed journals without comment, and it endorses neither the research nor the advertisements contained in OsteoBlast.
The Journal of the American Osteopathic Association
The location of the more superficial thoracic spinous processes is used to help osteopathic physicians locate the deeper and more difficult-to-palpate thoracic transverse processes. In 1979, Mitchell et al proposed the thoracic rule of threes to describe the relationship of the spinous processes to the transverse processes in the thoracic spine. This rule is currently taught at osteopathic medical schools. The rule of threes separates the thoracic vertebrae into three distinct groups, each with a different relationship between transverse processes and spinous processes. In 2006, Geelhoed et al proposed a new relationship between the spinous processes and transverse processes for all thoracic vertebrae (ie, Geelhoed's rule).
The objective of this study was to determine which anatomical relationship — the rule of threes or Geelhoed's rule — is most accurate in locating the transverse processes and to define anatomical relationships between thoracic spinous and transverse processes.
The thoracic spinous and transverse processes of 44 formalin-embalmed human cadavers were dissected, marked, and photographed. Six different measurements per vertebra were made between spinous processes and transverse processes in the thoracic spine. Geelhoed's protocol was used to determine the validity of each rule. The measurements were analyzed for additional relationships between thoracic spinous processes and transverse processes. Group 1 consisted of vertebrae T1 to T3 and T12; group 2 consisted of T4 to T6 and T11; and group 3 consisted of T7 to T10.
Of the 528 vertebrae measured, 0 percent of the first group vertebrae, 10.8 percent of the second group vertebrae, and 69.3 percent of the third group vertebrae followed the rule of threes. In total, 26.7 percent of vertebrae followed the rule of threes, whereas 62.3 percent of vertebrae followed Geelhoed's rule. Additional relationships worth noting include the distance between the transverse process and the adjacent caudal transverse process on the same side is approximately 25.4 mm (one inch), and the distance between the transverse processes of the same vertebra is approximately 50.8 mm (two inches) for male T3-T10 vertebrae and female T1-T12 vertebrae.
According to our findings, the rule of threes is not as accurate anatomically as Geelhoed's rule in locating the transverse processes of the thoracic spine. This study suggests osteopathic medical schools should teach Geelhoed's rule rather than the rule of threes. (This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Annals of Musculoskeletal Disorders
Chronic musculoskeletal pain is one of the largest unsolved problems in medicine, as measured
by incidence and cost. Current concepts of specific mechanical causation of musculoskeletal
pain often overlook one very important root cause — disequilibrium of posture. This includes the
imbalance of forces that necessitate additional force to maintain stability. Causation for postural
disequilibrium is multifactorial, thus studies addressing only single factor observation or intervention
have had inconclusive results. These outcomes have led to the premature conclusion that posture is
not a significant player in the genesis of chronic pain.
Studies show that the preponderance of chronic pain and disease of the musculoskeletal
system is mediated by mechanical stress. Origins of chronic musculoskeletal pain have been
thought to be either contiguous with or, by mechanical chain, neighboring to the painful site. A researcher
proposes a third etiology, “centric” causation, as a treatable origin for chronic musculoskeletal pain.
Three regions of the body have a large, pan corporeal influence on posture and related
chronic pain, previously thought to be of non-specific cause: the central nervous system (CNS), the
sacral base, and the feet/ankles. This relies on the concepts that the CNS is central anatomically
with respect to the neurologic system, the sacral base is central with respect to the geometry of
the outstretched human body, and the feet/ankles are central with respect to ground support,
gravity, and total body load.
Custom orthotics, which align these regions of the body while sitting or standing with respect
to gravitation, can significantly reduce mechanical stress as a pain generator. Synchronous
correction of the “attitudes” of the feet and ankles, and the unlevel sacral base, simultaneously
reduce mechanical stress and chronic pain throughout the body. Improved postural symmetry with
pain reduction is outlined in the illustrations and case presentations in this paper. Outcomes are
very favorable, and “centric” causation of chronic musculoskeletal pain should be considered so
that early treatment can be initiated.
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Archives of Physical Medicine and Rehabilitation
The objective of this study was to evaluate the added value of isolated core postural control training on knee pain and function in women with patellofemoral pain syndrome (PFPS).
Thirty-three women between 18 and 30 years of age with patellofemoral pain syndrome were randomly assigned to a control group (n=16) or the experimental group (n=17).
Participants in both groups received the same stretching and strengthening exercises during four weeks (12 sessions, three days per week). The experimental group also received isolated core postural training with an unstable seat apparatus.
Center of pressure (CoP) trajectories in sitting postural control, pain intensity and function were recorded before and after the four-week intervention period. Functional capacity and pain intensity were reassessed three months after the intervention.
After treatment, both groups had significant improvements in pain, function (P < 0.001), and CoP trajectories in sitting postural control (control group P < 0.05, experimental group P < 0.001). Between-group comparisons demonstrated greater improvements in pain, function and CoP trajectories in the experimental group (P < 0.001). This group also had significantly greater improvements in pain and Kujala Anterior Knee Pain Scale score at three-month follow-up compared to the control group (P < 0.001).
Adding isolated core postural control training to physiotherapy exercises was associated with significantly greater improvements in pain, function and CoP trajectories than physiotherapy exercises alone. Therefore, unstable sitting postural control training is potentially useful to enhance rehabilitation management in patients with PFPS.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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European Journal of Pain
Actigraphy is a quantitative method for the investigation of human physical activity and is normally based on accelerometric and/or kinematic data.
A multichannel actigraphy system, able to record both acceleration and spine angles, was employed in this study to measure the quality of movement in 17 individuals with chronic low back pain (LBP) and 18 healthy individuals during unrestricted daily activities. An indication of movement complexity was computed by means of non‐negative matrix factorization throughout the 24-hour period and in the 60 minutes of highest activity.
Movement complexity differed only when the 60 minutes of highest activity were taken into account, with the LBP group showing reduced complexity (e.g. for dimensionality = 8, over 90 percent of the comparisons showed a significant reduction in the LBP group).
The results are compatible with the hypothesis that pain induces a reduction of the available kinematic trajectories and degrees of freedom during natural movements, which becomes more evident when more demanding tasks are performed.
A reduced movement complexity suggests a persistent alteration of the descending neural pathways and/or a disrupted somatosensory information processing, which could be possibly contrasted by administering highly variable motor tasks.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Journal of Back and Musculoskeletal Rehabilitation
Mulligan Mobilization techniques cause pain and affect the function in patients with rotator cuff syndrome.
The aim of the study was to investigate the effect of Mulligan Mobilization on pain and quality of life in individuals with rotator cuff syndrome.
This study was conducted on 30 patients with rotator cuff syndrome. The patients were randomized into Mulligan and a control group. All the patients participating in this study were treated with conventional physiotherapy. Additionally, the Mobilization with Movement (MWM) technique was used in the Mulligan group. Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), goniometer for the normal range of motion (ROM) and Short Form-36 (SF-36) questionnaires were used for assessment.
Statistically significant improvement was found in the post-treatment VAS, DASH, SF-36, and ROM values significantly improved in both groups (P < 0.05). However, the Mulligan group showed much better results when compared to the control group in ROM, VAS, DASH (P < 0.05). In the SF-36 questionnaire, significant results were obtained for both groups, except the social function parameter. For the SF-36 parameters, both groups performed equally.
Mulligan Mobilization was more effective than general treatment methods for pain as well as normal joint motion, DASH scoring and some parameters of SF-36 compared with general treatment methods. (This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Musculoskeletal Science and Practice
Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations.
The objective of this study was to investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain.
Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a nine-minute, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength and disability were measured immediately before and after each intervention.
No significant differences were found among the treatment conditions in any of the variables investigated. A significantly greater mean decrease in self-reported shoulder pain was observed following treatment condition [0.63 (0.12, 1.14); P=0.01]. PPT at the affected shoulder increased significantly following both the treatment [0.23 (-0.43, 0.02); >P=0.02] and manual contact [0.28 (-0.51, 0.04); P=0.01] conditions. Shoulder AP joint mobilization also increased PPT at a distal, non-painful site [0.42 (-0.85, 0.01); P=0.04]. No changes were observed in shoulder ROM or muscle strength.
This study found no superior effects in various pain or function-related outcome measures of a passive oscillatory anteroposterior mobilization applied to the glenohumeral joint compared to manual contact and no-contact interventions in overhead athletes with chronic shoulder pain. Some ability to modulate shoulder pain and local and widespread pain sensitivity was observed in the short term after the passive oscillatory anteroposterior mobilization.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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Evidence-Based Complementary and Alternative Medicine
This systematic review and meta-analysis aims to evaluate the current evidence from randomized controlled trials (RCTs) related to the effectiveness and safety of acupuncture treatment (AT), including electroacupuncture or thread-embedding therapy in combination with modern technology, for chronic pelvic pain (CPP) in women.
Researchers searched 12 electronic databases up to December 2017. All randomized controlled trials evaluating the effect of AT for CPP were considered. Four RCTs with 474 participants were included. The methodological quality of included studies was generally low. The results of meta-analysis of two studies showed that AT combined with conventional treatment (CT) was associated with significantly reduced CPP, based on the total effectiveness rate (n=277, mean difference = 1.29, confidence interval = 1.13 to 1.47, P=0.0001, I2 = 0 percent).
This review suggests the potential of AT combined with CT compared to CT alone for treating female CPP. However, there is insufficient evidence to conclude that AT can be recommended as a complementary and alternative (CAM) treatment for women with CPP. To draw a firm conclusion, future studies should require not only larger, more rigorously designed RCTs but also research on different AT types.
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Journal of Ultrasound in Medicine
Prolotherapy is an injection‐based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound‐guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy.
Thirty‐one patients with chronic moderate‐to‐severe shoulder pain were recruited from September 2015 to September 2017. Ultrasound‐guided prolotherapy was performed by injecting 10 mL of a 15 percent dextrose solution into the acromial enthesis of the deltoid or acromioclavicular joint capsule aseptically. Prolotherapy was given in two sessions separated by a one‐month interval. The pretreatment‐to‐posttreatment change in the pain visual analog scale (VAS) score was recorded as the primary outcome. The mean follow‐up duration was 61.8 days. A paired t test was used to assess the difference in pretreatment and posttreatment VAS scores. A univariate logistic regression analysis was conducted to identify the demographic variables associated with substantial pain reduction after the intervention. Substantial pain reduction was defined as a posttreatment VAS score of 3 or less.
Twenty of the 31 patients reported substantial pain reduction without adverse effects after the intervention. The mean VAS score reduction ± SD was 4.3 ± 2.6 (pretreatment, 6.8 ± 1.5; posttreatment, 2.5 ± 2.1; P < .01).
Ultrasound‐guided prolotherapy with a 15 percent dextrose solution is an effective and safe therapeutic option for moderate‐to‐severe acromial enthesopathy and acromioclavicular joint arthropathy.
(This is a hyperlink to the abstract for this article. To view the full article, you will need to log in to the journal's website.)
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