Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation

Journal of Integrative Medicine - Published 2019

Spinal manipulation has been an effective intervention for the management of various musculoskeletal disorders. However, the mechanisms underlying the pain modulatory effects of spinal manipulation remain elusive. Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin. In this article, we reviewed the relevance of various neurophysiological theories with respect to the findings of mechanistic studies that demonstrated neural responses following spinal manipulation. This article also discussed whether these neural responses are associated with the possible neurophysiological mechanisms of spinal manipulation. The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more. However, the clinical relevance of these changes in relation to the mechanisms that underlie the effectiveness of spinal manipulation is still unclear. In addition, there were some major methodological flaws in many of the reviewed studies. Future mechanistic studies should have an appropriate study design and methodology and should plan for a long-term follow-up in order to determine the clinical significance of the neural responses evoked following spinal manipulation.

Occupational hand injuries: a current review of the prevalence and proposed prevention strategies for physical therapists and similar healthcare professionals

Journal of Integrative Medicine - Published 2018

Hand injury is the second most common work-related musculoskeletal injury among physical therapists (PTs) and other manual therapy professionals such as osteopaths, physiotherapists, chiropractors, acupuncturists and massage therapists. However, the nature and extent of this problem have not been fully explored yet. Therefore, the objective of this study was to review the existing literature published on the prevalence, risk factors, consequences, and prevention of hand injuries among PTs and similar healthcare professionals. The lifetime prevalence of hand injuries was about 15%–46%, and the annual prevalence was reported as 5%–30%. Thumb injuries were found to be the most prevalent of all injuries, accounting more than 50% of all hand-related problems. The most significant risk factors for job-related hand injuries were performing manual therapy techniques, repetitive workloads, treating many patients per day, continued work while injured or hurt, weakness of the thumb muscles, thumb hypermobility, and instability at the thumb joints. PTs reported modifying treatment technique, taking time off on sick leave, seeking intervention, shifting the specialty area, and decreasing patient contact hours as the major consequences of these injuries. The authors recommend that PTs should develop specific preventive strategies and put more emphasis on the use of aids and equipment to reduce the risk of an unnecessary injury.

Is Prolotherapy an Effective Long-term Management for Discogenic Low Back Pain? – A Case Study with 10 Year Follow Up

OnJourn - Published 2017

Discogenic low back pain (DLBP), has been reported to account for 39% of all chronic lower back pain. Several studies have also concluded that the presence of a high intensity zone (HIZ) in the annulus on T2-weighted sagittal lumbar MRI and in the context of a DLBP pattern, (88-99% correlation), suggest that an annular fissure of the disc is the main pain generator. Nevertheless, finding effective non-surgical long-term pain management solutions for chronic DLBP remains challenging. Prolotherapy, also known as Sclerotherapy, ‘Bongling’ or Regenerative injections, commonly utilizes substances such as dextrose, dextrose-glycerol-phenol (Ongley’s Solution or P2G), and sodium morrhuate. Targeted injections of these solutions into the tendon enthesis, facet joints space, and lumbosacral ligaments, aims to stimulate natural healing processes through inflammation, thereby optimizes lumbar motor unit stability, which in turn may relieve pain. Accurate lumbar ligament injection delivery requires practical knowledge of anatomical landmarks, but may also be performed under ultrasound or fluoroscopic guidance. There are few studies reviewing the sustained effects of prolotherapy for the management of chronic low back pain. This case report with 10-year post spinal prolotherapy follow up, reviews a patient with MRI-confirmed lumbar degenerative disc disease and an annular tear.

Rotator cuff impingement associated with Type III acromial morphology in a young athlete—a case for early imaging

Journal of surgical case studies - Published 2017

Down-sloped or hooked acromion morphologies may cause bony encroachment on the soft tissues of the subacromial space, predisposing to shoulder impingement syndrome. Of the latter, a hooked or Type III acromion (T3A) has also been linked to rotator cuff (RC) pathology. However, as bony acromial impingement is typically thought to occur over the age of 40, its occurrence in younger shoulder athletes presenting with shoulder pain, impingement and RC pathology may be overlooked. This case serves to illustrate the occurrence of T3A in a younger shoulder athlete, and the importance of early imaging in achieving diagnostic accuracy. Appropriate surgical referrals are patients with subacromial impingement syndrome refractory to 3–6 months of appropriate conservative treatment. Surgery may be particularly beneficial in patients with a T3A.