Physical Therapy and Pain Management

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Questions and Answers

Which age group of children is least likely to engage in physical activity?

Children aged 15-17

What is the term for a progressive condition involving loss of skeletal muscle mass and subsequent function?

Sarcopenia

What is the accelerating factor in bone loss in women 5-10 years after menopause?

Reduced testosterone

What type of exercises are recommended for beneficial effects on balance and subsequent falls reduction?

Challenging balance exercises Signup and view all the answers

What is the name of the famous middle-aged Aussie sedentary specimen who often appeared on TV in the late 70's and early 80's?

Norm Signup and view all the answers

What is a major challenge in medical guidelines for complex patient populations, such as the older population?

All of the above Signup and view all the answers

What is the current evidence suggesting about chiropractors influencing patients' long-term health and wellbeing through physical activity prescription?

There is limited evidence to support this Signup and view all the answers

What is a category of people who cope adaptively with stress?

Adaptive copers Signup and view all the answers

What is an example of contextual effects that can impact physical therapy outcomes?

Clinic cleanliness and convenient clinic hours Signup and view all the answers

How can the outcome of pain be expressed through our health?

Through changes to multiple output systems, including the brain Signup and view all the answers

What should practitioners aim to adopt when discussing patient care?

A behavioural approach, discussing lifestyle factors Signup and view all the answers

What did Aker and Martel's systematic review in 1996 describe maintenance care as?

A controversial topic lacking scientific evidence Signup and view all the answers

What was the result of the randomised controlled trial by Eklund et al. comparing chiropractic maintenance care to symptom-guided care?

The MC group had 33 fewer days with activity limiting LBP Signup and view all the answers

Which sub-group fared worse with maintenance care in the secondary analysis by Eklund et al.?

The answer is not provided in the text Signup and view all the answers

What is an example of a contextual effect that can impact physical therapy outcomes?

Private consultation rooms and natural lighting Signup and view all the answers

Why should practitioners adopt a more behavioural approach when discussing patient care?

To discuss lifestyle factors that influence patient care Signup and view all the answers

What is the most appropriate advice for a patient in the acute inflammatory stage of low back pain?

Keep moving but avoid any lifting or bending movements or any movement that increases pain Signup and view all the answers

What is the primary aim of treatment for a patient with chronic pain?

To help the patient manage their pain levels during everyday activities Signup and view all the answers

What does a score of 5 on the STaRT back test indicate?

Medium risk of developing persistent low back pain Signup and view all the answers

What is chronic inflammation?

Inflammation that persists for longer than 12 weeks Signup and view all the answers

What is passive insufficiency?

A joint cannot be actively moved back to a centrated position Signup and view all the answers

What is the primary goal of treatment for a patient with acute low back pain?

To reduce pain and inflammation Signup and view all the answers

What is the main difference between acute and chronic inflammation?

Duration of inflammation Signup and view all the answers

What is the best approach for a patient with chronic low back pain?

To focus on managing pain levels and improving quality of life Signup and view all the answers

What was discovered by Australian researchers in chronic low back pain patients in the late 1990s?

Changes in the transverse abdominus and multifidus muscles Signup and view all the answers

What is the role of the deep multifidus muscles?

To sense intervertebral motion and have a proprioceptive role Signup and view all the answers

Which muscle group forms the oblique posterior sling?

Ipsilateral latissimus dorsi, contralateral gluteus maximus and biceps femoris Signup and view all the answers

What did numerous recent systematic reviews on motor control/spinal stabilisation exercises show?

These exercises are more effective than other forms of active exercise in the long-term Signup and view all the answers

What does the Apprehension Test help identify?

Anterior shoulder instability Signup and view all the answers

What is indicated by the inability to keep the low back flat against the wall during the Wall Angel test?

Poor thoracic extension or tightness in the lumbar region Signup and view all the answers

What did a recent systematic review in 2020 show about the McKenzie method for chronic non-specific low back pain?

The McKenzie method is no more effective than other active or passive physical therapy treatments Signup and view all the answers

What two lifestyle factors did Robin McKenzie believe predisposed an individual to low back pain?

Frequency of extension and poor sitting posture Signup and view all the answers

Which joint restriction may be present in athletes with anterior shoulder problems?

Thoracic spine restriction Signup and view all the answers

What is the role of the transverse abdominus muscle in chronic low back pain?

To delay muscle firing and inhibit muscle activity Signup and view all the answers

What muscle may require a lengthening procedure if the hand is unable to reach the wall during the Wall Angel test?

Pectoralis minor Signup and view all the answers

What is the name of the therapy method that was shown to be no more effective than other active or passive physical therapy treatments for chronic non-specific low back pain?

Mechanical diagnosis and therapy method Signup and view all the answers

What is the positioning required for the PIR procedure to lengthen the pectoralis minor muscle?

Patient supine with arm abducted and externally rotated Signup and view all the answers

What is the purpose of the isometric contraction phase in the PIR procedure?

To gently contract the muscle against resistance Signup and view all the answers

What is the goal of adding resistance training to Jarrah's exercise program?

To build shoulder strength Signup and view all the answers

What are the three key exercise principles for success in Jarrah's resistance training program?

Progressive overload, proper form, andconsistent frequency Signup and view all the answers

Study Notes

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.

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