Physical Therapy and Pain Management

Contextual Effects on Physical Therapy Outcomes

• Private consultation rooms, clinic cleanliness, natural lighting, low noise levels, convenient clinic hours, location, ease of parking, and approachable staff are all examples of contextual effects that could impact the outcomes associated with physical therapy.

Pain Expression and Health

• The outcome of pain can be expressed through our health, as the brain is interpreting information from multiple output systems, including the limbic system, endocrine system, sympathetic system, and others.

Chiropractic Maintenance Care

• A published systematic review by Aker and Martel on Maintenance care in 1996 described this controversial topic as lacking scientific evidence, with sparse and anecdotal evidence.
• Eklund et al.'s randomised controlled trial compared chiropractic maintenance care (MC) vs. symptom-guided care for recurrent & persistent low back pain (LBP).
• The trial results showed that the MC group had 13 fewer days with activity-limiting LBP.

Physical Activity and Health

• Evidence suggests few Australians meet the physical activity guideline recommendations, with children aged 2-17 being a particular age group that is least likely to engage in physical activity.
• A famous middle-aged Aussie sedentary specimen who often appeared on TV in the late 70's and early 80's, known as "Norm," resisted all invitations to exercise.
• Anecdotally, chiropractors can influence patients' long-term health & wellbeing through physical activity prescription, but there is limited evidence to suggest this is the case.

Muscle Function and Low Back Pain

• Australian researchers, including Hodges and Richardson, discovered changes in the transverse abdominus and multifidus muscles in chronic low back pain patients, related to delayed muscle firing and inhibition of these muscles.
• The deep multifidus attachments to the vertebrae are known to control and sense intervertebral motion, and also have a proprioceptive role, rather than generating torque.

Balance and Falls Prevention

• Challenging balance exercises are recommended for beneficial effects on balance and subsequent falls reduction.

Spinal Stabilization Exercises

• Numerous recent systematic reviews on motor control / spinal stabilisation exercises show these exercises (in the long-term) are more effective than other forms of active exercise.

McKenzie Method and Low Back Pain

• A recent systematic review in 2020 showed that the McKenzie method - mechanical diagnosis and therapy method (MDT) - is no more effective than other active or passive physical therapy treatments for chronic non-specific low back pain.
• Robin McKenzie believed that two key lifestyle factors predisposed an individual to low back pain: frequency of extension and poor sitting posture.

Managing Chronic Pain

• When a patient has developed chronic pain, the primary aim of treatment is to help the patient manage their pain levels during everyday activities.
• A score of 5 on the STaRT back test indicates a high risk of developing persistent low back pain.
• Chronic inflammation is inflammation that persists for longer than 12 weeks.

Muscle Imbalances and Joint Restrictions

• Passive insufficiency means that a joint cannot be actively moved back to a centrated position.
• The wall angel test helps identify anterior shoulder instability, which can be a contributing factor to shoulder pain.
• Joint restrictions that may be present include thoracic spine restriction, which can affect shoulder function.
• Pectoralis minor lengthening may be necessary to alleviate shoulder pain.