Yearly Archives: 2016

/2016

Headache and Manipulation

Recently I found a research paper conducted by a group of physiotherapists in America which compared the effectiveness of manipulation versus mobilisation and exercise for treatment of headache amongst a group of 110 people. The primary outcome measured in this study was the patient’s headache intensity. Patients were asked to complete a questionnaire to indicate the average intensity of their headache pain on a scale of 1-10 at the beginning of the study in addition to their intensity at 1-week, 1-month, and 3-months following the initial treatment session. Secondary outcome measures included a disability questionnaire, headache frequency, headache duration, and medication intake. On the initial visit patients completed all outcome measures then received the first treatment session. Patients completed 6–8 treatment sessions of either manipulation of the upper neck and upper back, or mobilization of the same areas combined with exercises over a 4 week period. The exact areas of the spine to be treated were left to the discretion of the treating therapist and it was based on the combination of patient reports and examination. The exercises given to the second group was neck flexion exercises during treatment, and 10 minutes take home resistance exercises using a resistance band within their own tolerance. This study is the first clinical trial to directly compare the effectiveness of both neck and upper back manipulation versus mobilisation and exercise in patients with headache. The results suggest 6–8 sessions of manipulation over 4 weeks, directed mainly to both the upper neck and  upper back, resulted in greater improvements in all aspects of the patients headache than the mobilisation/exercise group. This included headache intensity, disability, headache frequency, headache duration, and medication intake. Most importantly the effects of manipulation were maintained at 3 months follow-up. Additionally there were no adverse reactions to either group aside from mild discomfort either at the point of manipulation/mobilisation or post exercise, which is completely normal in clinical practice. The underlying mechanisms as to why manipulation may have resulted in greater improvements than mobilisation plus exercise is still under investigation. In addition our current thinking about how manipulation affects patients positively in clinical practice delves into neurology far more deeply than what is possible in this column. More than likely it has something to do with joint receptors being stimulated which leads to pain reduction, greater range of motion and less muscle spasm. Fortunately in clinical practice patients will vote [...]

Teens and Technology

For this month’s column I found an interesting article online about spinal pain in adolescents and its relation to computer and tablet usage. This study was performed in Brazil, a country which due to government programs has seen a great increase in computer usage throughout all schools over the last 10 years. The use of electronic devices especially in more recent years has become an important part in the lives of adolescents throughout the world, who regularly use computers to carry out academic and leisure activities. The study consisted of 961 boys and girls aged 14–19 years who answered a questionnaire regarding the use of electronic devices and painful symptoms. Specifically these questions related to pain severity, a body diagram for symptom location, and questions related to the use of computer and video games over the last 6 months. The results indicated that the presence of pain was reported by 65.1% adolescents with pain located in the following areas. Thoracolumbar spine (point between the mid and low back), 46.9%.followed by Arm 20%. Neck 18.5% Shoulder blade region (15.8%) The triggering factors for these symptoms were reported as Using a computer 31.8% Physical exercise 20.5% Electronic games 2.9% Adolescents also indicated that pain interfered with activities of daily living like Study tasks 22.8% Sleeping 18.4% Playing sports 17.6% Additionally, 29.7% of adolescents said that the presence of pain made them more nervous. Finally and most importantly 32.1% of adolescents reported that they occasionally made use of analgesics, while another 11.1% reported that they frequently used these drugs. This study is important because it indicates how computer and tablet usage affects adolescents in our modern world. This study assessed a variety of important measures regarding adolescent health. Not only did it demonstrate the percentage of adolescents in pain but also reported on important measures like pain location, triggering factors, activities of daily living and medication usage. As younger generations are exposed to more technological advancement it will be interesting to see how we as a society adapt to these changes. Even now we are realizing that we have to take measures to either assist or limit computer and tablet use in our children. Balancing how much they have to do for school and leisure and supporting them with the best ergonomics possible is a challenge we all have to deal with.   Silva GR, et al. Prevalence of musculoskeletal pain in adolescents [...]

How I Roll

  I’ve discovered over the years especially before and after a gym workout that people will commonly use a foam roller to self-massage. This apparently has benefits to the individual and seems to be a way a person will manage muscle soreness pre and post workout. I’ve always been a bit sceptical about foam rolling as I never thought it really did anything beneficial and was more akin to stretching for the lazy. So I decided to look into whether there’s been any research into foam rolling and surprisingly there was, measuring different aspects of rolling, Ill discuss a couple below. The 3 studies that I’ll focus on today studied the benefits of rolling on the range of motion of a joint. Meaning after a workout was that joint able to move more as a result of the rolling. A few things stood out. The range of motion of the joint (hip extension) immediately increased after rolling the front of the thigh (quads) however these changes were short lived. When the patient was reassessed a week later there was no observable difference. Secondly in another study when foam rolling was performed along with stretching of the quads the range of motion in the hip joint was significantly greater than both rolling and stretching alone. This wasn’t just with the hip joint, there was another study that compared ankle motion.  This study found that foam rolling of the calf alone did not produce any increase in ankle range of motion at all, where calf stretching improved the motion by 6.2%. However as with the hip example above, foam rolling plus stretching increased the range of motion by 9.1%. Studies into foam rolling are still in their early days, however there is some initial evidence that if you are going to roll, it’s important to stretch as well. The extra benefits from both stretching and rolling seem to exceed that of stretching or rolling alone. Also to make a bigger difference it’s important to roll and stretch regularly. You really should stretch and roll whenever you train even if it’s only 15 minutes and you focus on a different region each time. It’ll be more effective than rolling each muscle for 30 seconds then moving on. The long‐term benefits of these interventions are still unknown plus the physiological mechanisms responsible for these interesting findings still need more investigation. As for rolling to [...]