BOOK
Grieve's Modern Musculoskeletal Physiotherapy E-Book
Gwendolen Jull | Ann Moore | Deborah Falla | Jeremy Lewis | Christopher McCarthy | Michele Sterling
(2015)
Additional Information
Book Details
Abstract
- Presents state-of-the-art manual therapy research from the last 10 years
- Multidisciplinary authorship presents the viewpoints of different professions crucial to the ongoing back pain management debate
- Highly illustrated and fully referenced
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Grieve's Modern Musculoskeletal Physiotherapy | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface to the Fourth Edition | ix | ||
| Acknowledgements | x | ||
| Foreword | xi | ||
| Contributors | xii | ||
| Plate section | P1 | ||
| I | 1 | ||
| 1 Introduction to the Text | 3 | ||
| References | 4 | ||
| II Advances in Theory and Practice | 5 | ||
| 2.1 | 7 | ||
| Section_2.1 text | 7 | ||
| 2 The Neurophysiology of Pain and Pain Modulation: | 8 | ||
| Introduction | 8 | ||
| The Neurophysiology of Musculoskeletal Pain: From Tissue Nociception to the Pain Neuromatrix | 8 | ||
| Temporal Summation and Wind-Up | 9 | ||
| Brain-Orchestrated Pain Modulation | 9 | ||
| Descending Nociceptive Facilitation | 10 | ||
| Descending Nociceptive Inhibition | 10 | ||
| The Pain Neuromatrix | 11 | ||
| Central Sensitization | 13 | ||
| Does the Autonomic Nervous System Influence Pain? | 14 | ||
| Conclusion | 16 | ||
| References | 16 | ||
| 3 Neuro-Electrochemistry of Movement | 19 | ||
| Fundamental Principles Underlying Neuro- Electrochemistry | 19 | ||
| Electrical Potential and Current | 19 | ||
| Conductance | 20 | ||
| Resistance | 20 | ||
| Resting Membrane Potential | 20 | ||
| Experimentally Measuring the Membrane Potential | 21 | ||
| Sodium–Potassium Pump | 21 | ||
| Action Potential and Its Propagation | 22 | ||
| Decomposing an Action Potential | 23 | ||
| Action Potential Propagation | 23 | ||
| A Note on Synaptic Transmission | 24 | ||
| Summary | 25 | ||
| Suggested Reading | 26 | ||
| References | 26 | ||
| 4 Postural Control and Sensorimotor Integration | 28 | ||
| Summary | 28 | ||
| Postural Control | 28 | ||
| Sensorimotor Integration | 29 | ||
| Perception | 29 | ||
| Selection | 29 | ||
| Motor Control | 30 | ||
| Sensory Integration | 30 | ||
| Perception | 32 | ||
| Generation of Action Possibilities | 33 | ||
| Selection | 33 | ||
| Motor Control | 36 | ||
| The Fast Loop | 36 | ||
| The Slow Loop | 36 | ||
| Principles Applicable for Physiotherapeutic Practice | 38 | ||
| Acknowledgements | 38 | ||
| References | 38 | ||
| 5 Motor Control and Motor Learning | 42 | ||
| Introduction | 42 | ||
| Theories of Motor Control | 42 | ||
| Sensory Feedback as an Integral Part of Motor Control | 43 | ||
| Sensory Feedback during Locomotion | 44 | ||
| Sensory Feedback as Part of a Reflex Loop Is Not Stereotyped | 46 | ||
| Sensory Feedback Is a Key Component in Motor (Re)Learning | 49 | ||
| Chronic Pain States | 49 | ||
| Central Nervous System Lesions | 49 | ||
| Conclusions | 50 | ||
| References | 50 | ||
| 6 Interaction Between Pain and Sensorimotor Control | 53 | ||
| Introduction | 53 | ||
| Sensorimotor Dysfunction in Musculoskeletal Pain | 53 | ||
| Sensorimotor Control | 53 | ||
| Relationship Between Pain, Injury and Sensorimotor Dysfunction | 54 | ||
| Pain and/or Injury: The Cause or Consequence of Sensorimotor Dysfunction | 55 | ||
| Sensorimotor Dysfunction in Pain and/or Injury Across a Spectrum from ‘Subtle’ to ‘Major’ Adaptations | 56 | ||
| Sensorimotor Adaptations Provide a Short-Term Solution, but have Potential Long-Term Consequences | 59 | ||
| Mechanisms for Sensorimotor Changes in Musculoskeletal Conditions | 62 | ||
| Sensory System Mechanisms. | 62 | ||
| Motor System Mechanisms. | 62 | ||
| Interaction with Psychosocial Factors. | 63 | ||
| Conclusions | 64 | ||
| Acknowledgements | 65 | ||
| References | 65 | ||
| 7 Neuromuscular Adaptations to Exercise | 68 | ||
| Introduction | 68 | ||
| Skeletal Muscle | 68 | ||
| Neural Control of Muscle Contraction | 68 | ||
| Muscle Function | 68 | ||
| Muscle Fibre Types | 69 | ||
| Adaptation to Exercise: The Overload Principle | 69 | ||
| Adaptations to High-Resistance Strength Training | 70 | ||
| Neural Adaptations | 70 | ||
| Muscular Adaptations | 70 | ||
| Muscle Protein Synthesis | 71 | ||
| Satellite Cells | 71 | ||
| Hormonal Influences | 73 | ||
| Testosterone | 73 | ||
| Growth Hormone/Insulin-Like Growth Factor 1 | 73 | ||
| Myostatin | 73 | ||
| Endurance Training | 74 | ||
| Mitochondrial Adaptations | 74 | ||
| Angiogenesis | 74 | ||
| Substrate Utilization | 74 | ||
| Can We Switch Muscle Fibre Types? | 75 | ||
| Neural Adaptations | 75 | ||
| Summary | 75 | ||
| References | 76 | ||
| 8 The Peripheral Nervous System and its Compromise in Entrapment Neuropathies | 78 | ||
| Introduction | 78 | ||
| Anatomy and Physiology | 78 | ||
| Peripheral Neurons | 78 | ||
| Schwann Cells and Myelin | 79 | ||
| Neural Connective Tissue and Its Innervation | 80 | ||
| Neural Blood Circulation and Blood–Nerve Interface | 80 | ||
| Axonal Transport | 82 | ||
| The Immune Cells of the Nervous System | 82 | ||
| Central Nervous System | 82 | ||
| Pathophysiology of Entrapment Neuropathies | 82 | ||
| Entrapment Neuropathies and Ischaemia | 82 | ||
| Entrapment Neuropathies Cause Demyelination | 83 | ||
| Entrapment Neuropathies Affect Both Large- and Small-Diameter Nerve Fibres | 84 | ||
| The Role of the Immune System in Entrapment Neuropathies | 84 | ||
| Neurogenic Inflammation | 85 | ||
| Experimental Mild Nerve Compression Impairs Axonal Transport | 86 | ||
| Central Nervous System Changes | 87 | ||
| Summary | 88 | ||
| Acknowledgement | 88 | ||
| References | 89 | ||
| 9 Functional Anatomy | 93 | ||
| CHAPTER OUTLINE | 93 | ||
| CHAPTER 9.1 ■ The Cervical Spine | 93 | ||
| Introduction | 93 | ||
| Craniocervical-Coupled Movements and Clinical Implications | 93 | ||
| Synovial Folds in the Craniocervical Spine | 94 | ||
| The Anatomy of Craniocervical Stability and Clinical Implications | 94 | ||
| Ligamentous System | 94 | ||
| Clinical Anatomy and Biomechanics of the Alar Ligaments | 94 | ||
| Clinical Anatomy and Biomechanics of the Transverse Ligament and Relevance to Clinical Testing | 94 | ||
| Clinical Anatomy and Biomechanics of the Tectorial Membrane and Relevance to Clinical Testing | 94 | ||
| Craniocervical Muscles and Their Clinical Significance | 94 | ||
| Mid to Low Cervical Spine | 96 | ||
| The Vertebral Body | 96 | ||
| The Vertebral Arch | 97 | ||
| Ligaments | 97 | ||
| The Intervertebral Disc | 98 | ||
| The Intervertebral Foramina and Spinal Nerves | 99 | ||
| References | 99 | ||
| CHAPTER 9.2 ■ Lumbar Spine | 101 | ||
| The Vertebral Column | 101 | ||
| Lumbar Vertebrae | 102 | ||
| The Vertebral Body | 102 | ||
| Neural Arch | 102 | ||
| Apophyseal Joints | 102 | ||
| Intervertebral Discs | 102 | ||
| Nucleus Pulposus | 102 | ||
| Annulus Fibrosus | 102 | ||
| Vertebral Endplates | 103 | ||
| Internal Mechanical Function of Intervertebral Discs | 103 | ||
| Blood and Nerve Supply | 103 | ||
| Intervertebral Ligaments | 104 | ||
| Longitudinal Ligaments | 104 | ||
| Ligamentum Flavum | 104 | ||
| Supraspinous and Interspinous Ligaments | 104 | ||
| Iliolumbar Ligaments | 104 | ||
| Muscles of the Lumbar Spine | 104 | ||
| Anterolateral Muscles | 104 | ||
| Back Muscles | 104 | ||
| Intersegmental Back Muscles | 104 | ||
| Short Polysegmental Back Muscles | 104 | ||
| Long Polysegmental Back Muscles | 104 | ||
| Other Muscles Relevant to the Lumbar Spine | 104 | ||
| References | 104 | ||
| 10 Tendon and Tendinopathy | 106 | ||
| CHAPTER OUTLINE | 106 | ||
| CHAPTER 10.1 ■ Tendon and Tendon Pathology | 106 | ||
| Introduction and Tendon Function | 106 | ||
| Composition and Structure | 106 | ||
| Mechanical Behaviour | 108 | ||
| Tendon Injuries and Repair | 110 | ||
| References | 111 | ||
| CHAPTER 10.2 ■ Managing Tendinopathies | 112 | ||
| Introduction | 112 | ||
| Tendon Pathology | 112 | ||
| Pathoaetiology | 113 | ||
| Source of Tendon Pain | 113 | ||
| What Causes Tendon to Become Painful? | 114 | ||
| Assessment | 114 | ||
| Management of Tendinopathy | 115 | ||
| Conclusion | 115 | ||
| References | 115 | ||
| 11 Lifestyle and Musculoskeletal Health | 117 | ||
| Introduction | 117 | ||
| Non-Communicable Diseases and Evidence-Informed Orthopaedic Physiotherapy | 117 | ||
| Smoking and Musculoskeletal Health | 118 | ||
| Deleterious Effects of Smoking | 118 | ||
| Beneficial Effects of Quitting Smoking | 119 | ||
| Nutrition and Musculoskeletal Health | 119 | ||
| Bone Mineralization | 120 | ||
| Body Composition | 120 | ||
| Chronic Systemic Low-Grade Inflammation | 120 | ||
| Pain Threshold | 120 | ||
| Immunity and Immune Response | 120 | ||
| Obesity | 120 | ||
| Inactivity/Activity and Musculoskeletal Health | 121 | ||
| Deleterious Effects of Inactivity | 121 | ||
| Beneficial Effects of Regular Physical Activity | 121 | ||
| Sleep and Musculoskeletal Health | 121 | ||
| Deleterious Effects of Sleep Deprivation | 121 | ||
| Beneficial Effects of Optimal Sleep | 122 | ||
| Mental Health and Musculoskeletal Health | 122 | ||
| Deleterious Effects of Mental Ill Health | 122 | ||
| Beneficial Effects of Mental Hygiene | 122 | ||
| Conclusion | 122 | ||
| References | 123 | ||
| 12 Ageing and the Musculoskeletal System | 126 | ||
| Ageing of the Musculoskeletal System | 126 | ||
| Ageing Joints | 126 | ||
| Ageing Muscles | 126 | ||
| Ageing Nervous System | 127 | ||
| Ageing, Falling and Pain | 128 | ||
| Ageing and the Beneficial Effects of Movement | 128 | ||
| The Ageing Spine | 128 | ||
| Disc Degeneration | 130 | ||
| Osteophytosis | 130 | ||
| Vertebral End-Plate Lesions and Schmorl’s Nodes | 131 | ||
| Zygapophysial and Costovertebral Joint Degeneration | 131 | ||
| Degenerative Spinal Curvature Anomalies | 132 | ||
| Osteoporosis and Osteoporotic Fracture | 132 | ||
| Intervertebral Disc Prolapse | 133 | ||
| Summary | 133 | ||
| References | 133 | ||
| 2.2 | 136 | ||
| Section_2.2 text | 136 | ||
| 13 Movement Analysis | 137 | ||
| Introduction | 137 | ||
| A Mechanical Model of the Musculoskeletal System | 137 | ||
| Motion Capture | 137 | ||
| Stereophotogrammetry | 138 | ||
| Magnetic and Inertial Measurement Units | 140 | ||
| Measure of External Forces | 141 | ||
| Joint Mechanics | 141 | ||
| Joint Kinematics | 141 | ||
| Joint Kinetics | 142 | ||
| Future Developments | 142 | ||
| References | 143 | ||
| 14 New Developments in Ultrasound Imaging in Physiotherapy Practice and Research | 144 | ||
| Introduction | 144 | ||
| Types of Ultrasound Imaging and Technical Considerations | 144 | ||
| Assessment of Muscle Morphometry and Morphology (Architecture) | 144 | ||
| Contracted Muscles | 146 | ||
| Relationship Between Muscle Size and Strength | 146 | ||
| Perimuscular Connective Tissue Thickness | 146 | ||
| Validity of USI Against Other Imaging Techniques and Electromyography | 146 | ||
| Reliability | 146 | ||
| Biofeedback of Muscle Function | 146 | ||
| Measuring Tissue Motion and Mechanical Properties of Muscle–Tendon Unit | 146 | ||
| M-Mode | 148 | ||
| Motion Tracking Using Tissue Doppler and B-Mode Speckle Tracking | 148 | ||
| Tissue Doppler Imaging (TDI) | 148 | ||
| B-Mode Speckle Tracking | 148 | ||
| Elastography | 149 | ||
| Future Directions | 150 | ||
| References | 150 | ||
| 15 Advances in Magnetic Resonance Imaging (MRI) Measures | 153 | ||
| Introduction | 153 | ||
| MRI Contrasts | 153 | ||
| Fat/ Water Separation: Macroscopic Structure of Muscle | 154 | ||
| Muscle Functional MRI: Microscopic Activation and Function of Muscle | 155 | ||
| Advanced Techniques: Microscopic Evaluation of the Muscle and Nervous Systems | 156 | ||
| Magnetization Transfer Ratios | 156 | ||
| Diffusion Weighted Imaging | 156 | ||
| Functional Magnetic Resonance Imaging: Functional and Structural | 157 | ||
| Caution | 157 | ||
| MRI in Musculoskeletal Clinical Practice | 158 | ||
| References | 158 | ||
| 16 Musculoskeletal Pain in the Human Brain: | 161 | ||
| Introduction | 161 | ||
| The Brain Network for Pain | 161 | ||
| Components of Pain Experience | 161 | ||
| Functional Components of the Pain Network | 161 | ||
| Spinobulbar Pathways | 161 | ||
| Spinothalamic Pathways and Other Hemispheric Regions | 162 | ||
| The Pain Network in Musculoskeletal Disorders | 164 | ||
| Evoked Pain in Musculoskeletal Disease | 164 | ||
| Central Processing of Spontaneous Pain | 165 | ||
| Musculoskeletal Physiotherapy and Pain Processing | 165 | ||
| Conclusions | 166 | ||
| References | 166 | ||
| 17 Advances in Electromyography | 168 | ||
| Introduction | 168 | ||
| Electrode Systems | 168 | ||
| Applications | 169 | ||
| Timing of Muscle Activity | 169 | ||
| Myoelectric Manifestations of Fatigue | 170 | ||
| EMG Amplitude | 171 | ||
| EMG Tuning Curves | 171 | ||
| Distribution of Muscle Activity | 172 | ||
| Muscle Synergies | 172 | ||
| Single Motor Unit Behaviour | 174 | ||
| Monitoring Change with Rehabilitation | 175 | ||
| Limitations | 175 | ||
| Conclusion | 175 | ||
| References | 175 | ||
| 18 Non-invasive Brain Stimulation in the Measurement and Treatment of Musculoskeletal Disorders | 179 | ||
| Single-Pulse Transcranial Magnetic Stimulation | 179 | ||
| Cortical Representation Mapping | 179 | ||
| Resting and Active Motor Threshold | 180 | ||
| Motor Evoked Potential Latency | 180 | ||
| Motor Evoked Potential Amplitude | 180 | ||
| Recruitment Curves | 181 | ||
| Cortical Silent Period | 183 | ||
| Fatigue | 183 | ||
| Paired-Pulse Transcranial Magnetic Stimulation | 183 | ||
| Repetitive Transcranial Magnetic Stimulation | 183 | ||
| Neuromodulation: A New Treatment Strategy in Physiotherapy | 183 | ||
| Repetitive Transcranial Magnetic Stimulation | 184 | ||
| Transcranial Direct Current Stimulation | 184 | ||
| Safety Considerations | 184 | ||
| References | 184 | ||
| 19 Musculoskeletal Modelling | 187 | ||
| Introduction | 187 | ||
| Basics of Musculoskeletal Modelling Based on Inverse Dynamics | 187 | ||
| A Simple Example | 188 | ||
| Example 1: Simulated Changes in Lumbar Muscle Activation from a Pelvic Tilt | 189 | ||
| Example 2: Understanding the Recruitment of the Semispinalis Cervicis Muscle Using Musculoskeletal Modelling | 190 | ||
| Description of the Cervical Spine Model and Simulation | 190 | ||
| Results | 191 | ||
| Conclusion and Perspectives | 192 | ||
| References | 193 | ||
| 20 Quantitative Sensory Testing: | 194 | ||
| Quantitative Sensory Testing | 194 | ||
| Importance of Standardizing Protocols | 194 | ||
| Test Parameters | 195 | ||
| Mechanical Quantitative Sensory Testing | 195 | ||
| Vibration Thresholds | 195 | ||
| Light Touch | 196 | ||
| Pressure Pain Thresholds | 196 | ||
| Mechanical Pain Thresholds | 197 | ||
| Temporal Summation of Pain (Wind-Up Ratio) | 197 | ||
| Thermal Quantitative Sensory Testing | 197 | ||
| Test Site and Interpretation of Quantitative Sensory Testing Data | 198 | ||
| Clinical Utility of Quantitative Sensory Testing in Physiotherapy | 199 | ||
| References | 199 | ||
| 21 Outcome Measures in Musculoskeletal Practice | 202 | ||
| Introduction | 202 | ||
| Types of Outcome Measures | 202 | ||
| The Development and Validation of Outcome Measures | 207 | ||
| Practical Issues in Collecting Outcome Measures | 207 | ||
| Set a Clear Purpose | 207 | ||
| Decide on the Timing | 207 | ||
| Case-Mix Adjustment | 208 | ||
| Data Collection Method | 209 | ||
| Acting on Information | 209 | ||
| Summary | 209 | ||
| References | 209 | ||
| 2.3 | 211 | ||
| Section_2.3 text | 211 | ||
| 22 Clinical Research to Test Treatment Effects | 212 | ||
| Introduction | 212 | ||
| Classic Multiple Group Parallel Design Randomized Controlled Trial | 212 | ||
| The Cross-Over Design, Diamond Design, Factorial Design and Fractional Factorial Design | 212 | ||
| Randomized Withdrawal and Expertise-based Designs | 216 | ||
| Clinical Research to Test Treatment Effects: N-of-1 Trial Designs | 217 | ||
| Conclusion | 218 | ||
| References | 219 | ||
| 23 Research Approaches to Musculoskeletal Physiotherapy | 220 | ||
| CHAPTER OUTLINE | 220 | ||
| CHAPTER 23.1 ■ Quantitative Research | 221 | ||
| What is Quantitative Research? | 221 | ||
| Methodology and Methods | 221 | ||
| Findings | 222 | ||
| Summary | 222 | ||
| References | 222 | ||
| CHAPTER 23.2 ■ Qualitative Research | 223 | ||
| What is Qualitative Research? | 223 | ||
| Ontological and Epistemological Assumptions | 223 | ||
| Methodology and Methods | 223 | ||
| Findings | 224 | ||
| When Might You Use Qualitative Research? | 224 | ||
| Summary | 224 | ||
| References | 224 | ||
| CHAPTER 23.3 ■ Mixed Methods Research | 224 | ||
| What is Mixed Methods Research? | 224 | ||
| When Might You Use Mixed Methods Research? | 225 | ||
| Methodology and Methods | 225 | ||
| Difficulties Associated with Mixed Methods Research | 225 | ||
| Summary | 225 | ||
| Conclusion | 225 | ||
| Quantitative Research | 225 | ||
| Qualitative Research | 226 | ||
| Mixed Methods Research | 226 | ||
| References | 226 | ||
| 24 Standardized Data Collection, Audit and Clinical Profiling | 227 | ||
| Introduction | 227 | ||
| Context | 227 | ||
| Development of a Standardized Data Collection Tool | 228 | ||
| The Delphi Process | 228 | ||
| Nominal Group Technique | 229 | ||
| Process of Standardized Data Collection Development Utilizing a Nominal Group Technique | 229 | ||
| A Nominal Group Technique Protocol as an Example | 229 | ||
| References | 231 | ||
| 25 Implementation Research | 232 | ||
| Introduction | 232 | ||
| What is the Problem? | 232 | ||
| What is Implementation Research? | 233 | ||
| What are the Types of Implementation Research? | 233 | ||
| Which Interventions Help to Change Clinical Practice? | 234 | ||
| How are Interventions Developed that Aim to Increase Implementation of Research? | 234 | ||
| Does Theory Have a Role in Complex Intervention Development? | 236 | ||
| How Best Should Theory be Used in Implementation Research? | 236 | ||
| Conclusion | 237 | ||
| References | 237 | ||
| III Advances in Clinical Science and Practice | 239 | ||
| 3.1 | 241 | ||
| Section_3.1 text | 241 | ||
| 26 Clinical Reasoning and Models for Clinical Management | 242 | ||
| Evidence-Based Clinical Reasoning | 242 | ||
| Sources of Evidence | 242 | ||
| Inductive and Deductive Clinical Reasoning | 243 | ||
| Stepped Care and Adaptive Care | 244 | ||
| Clinical Prediction Rules | 244 | ||
| Technology and Paper-Based Aides for Clinical Reasoning | 245 | ||
| Stratified Health Care and Treatment Effect Modification | 246 | ||
| The Challenge of Making Clinical Reasoning Models Relevant to the Care of Individual Patients | 246 | ||
| The Biopsychosocial Model – Why Dealing with the Physical is Often Not Enough | 247 | ||
| Future Directions for Clinical Reasoning and Management | 248 | ||
| References | 248 | ||
| 27 Communicating with Patients | 250 | ||
| CHAPTER OUTLINE | 250 | ||
| CHAPTER 27.1 ■ Patient-Focused Practice and Communication: Use of Communication in the Clinical Setting | 250 | ||
| Introduction | 250 | ||
| Some Key Features of Communication | 251 | ||
| Some Specific Practices for Building Towards Common Ground | 251 | ||
| Pursuing Patients’ Contributions, and Designing What You Say in Relation to Their Contributions | 251 | ||
| Stepwise Building of Agreement | 251 | ||
| ‘You Tell Me First’ Sequences | 253 | ||
| Online Commentary About Your Examination Findings | 253 | ||
| Explaining Reasons for Treatments and Recommendations | 253 | ||
| Make Positive, Specific Recommendations First | 253 | ||
| Concluding Remarks | 253 | ||
| References | 253 | ||
| CHAPTER 27.2 ■ Patient Education: A Collaborative Approach | 254 | ||
| Consider the Characteristics of the Learner (e.g. Patient or Carer) | 255 | ||
| What Are the Patient’s Learning Needs? | 255 | ||
| What Are the Learner’s (Patient’s) Personal Characteristics? | 255 | ||
| Select Approaches to Facilitate the Learning | 256 | ||
| Assess the Learning | 257 | ||
| Evaluate your Own Practice as an Educator | 257 | ||
| Summary | 258 | ||
| References | 258 | ||
| CHAPTER 27.3 ■ Communicating Risk | 258 | ||
| Understanding Risk | 258 | ||
| Understanding Probabilities | 259 | ||
| Relative Versus Absolute Risk | 259 | ||
| Probabilities Versus Natural Frequencies | 259 | ||
| Communication Tools | 259 | ||
| Framing Risk | 259 | ||
| Personalizing Risk | 261 | ||
| References | 261 | ||
| 28 Pain Management Introduction | 262 | ||
| CHAPTER OUTLINE | 262 | ||
| CHAPTER 28.1 ■ The Patient’s Pain Experience | 262 | ||
| Coming to Terms With Pain and Disability | 263 | ||
| Personal and Social Changes in Response to Pain | 263 | ||
| Adopting a Role in the Health and Social Care System | 263 | ||
| Conclusion | 264 | ||
| References | 264 | ||
| CHAPTER 28.2 ■ Educational Approaches to Pain Management | 265 | ||
| Delivery of Patient Education | 265 | ||
| Content of Education Interventions for Low Back Pain | 265 | ||
| The Effectiveness of Patient Education for Low Back Pain | 265 | ||
| Biomedical Education (Back Schools) | 265 | ||
| Biopsychosocial Education (Advice/Brief Education) | 266 | ||
| Pain Neurophysiology/Pain Biology Education | 266 | ||
| Patient Education and Maladaptive Beliefs | 266 | ||
| Common Beliefs Targeted by Patient Education | 267 | ||
| Pain Neurophysiology Education | 267 | ||
| References | 267 | ||
| CHAPTER 28.3 ■ Physical Interventions of Pain Management and Potential Processes | 269 | ||
| Exercise | 269 | ||
| Clinical Studies | 269 | ||
| Dosing | 269 | ||
| Basic Mechanisms | 270 | ||
| Central Mechanisms | 270 | ||
| Peripheral Mechanisms | 270 | ||
| Additional Mechanisms | 270 | ||
| TENS | 270 | ||
| Clinical Studies | 270 | ||
| Dosing | 271 | ||
| Basic Science Mechanisms | 271 | ||
| Manual Therapy | 272 | ||
| Basic Science Mechanisms | 272 | ||
| References | 273 | ||
| 29 Spinal Manipulation | 277 | ||
| Introduction | 277 | ||
| Defining Spinal Manipulation | 277 | ||
| Objectives of Spinal Manipulation (Biomechanical) | 278 | ||
| Stretching/Tearing Tissue? | 278 | ||
| Inducing Cavitation Within the Joint? | 278 | ||
| Reducing Muscle Hypertonicity/Stiffness | 279 | ||
| Objectives of Spinal Manipulation (Neurophysiological) | 279 | ||
| Limitations of the Biomechanical Model | 279 | ||
| Neurophysiological Mechanisms of Spinal Manipulation | 280 | ||
| Potential Peripheral Mechanisms | 280 | ||
| Potential Spinal Cord Mediated Mechanisms | 280 | ||
| Potential Supraspinally Mediated Mechanisms | 281 | ||
| Safety and Practical Issues Associated With Spinal Manipulation | 281 | ||
| Minimizing Risk in Applying Manipulation | 281 | ||
| Clinical Reasoning and Patient Selection | 282 | ||
| International Context | 283 | ||
| Conclusion – Definition of Spinal Manipulation | 283 | ||
| References | 283 | ||
| 30 Neurodynamic Management of the Peripheral Nervous System | 287 | ||
| Introduction | 287 | ||
| Neurodynamic Tests | 287 | ||
| Neurodynamic Management | 289 | ||
| Sliding and Tensioning Techniques | 289 | ||
| Mobilization of Surrounding Structures | 289 | ||
| Treating the Neural Container | 289 | ||
| Indications and Contraindications | 289 | ||
| Influences on Pathobiological Processes | 291 | ||
| Normalization of Impaired Nerve Movement | 291 | ||
| Evacuation of Intraneural Oedema | 292 | ||
| Reduction of Extraneural Oedema and Pressure | 292 | ||
| Dispersal of Inflammatory Mediators | 292 | ||
| Influence on the Neuro-Immune Response | 292 | ||
| Facilitation of Descending Modulation | 293 | ||
| Clinical Trial Evidence | 293 | ||
| Final Considerations | 294 | ||
| References | 294 | ||
| 31 Therapeutic Exercise | 298 | ||
| Introduction | 298 | ||
| Principles of Management | 298 | ||
| Clinical Prescription of Exercise | 298 | ||
| Indications for Exercise | 298 | ||
| Assessment to Guide Exercise Prescription | 298 | ||
| Assessment of Movement Quality | 299 | ||
| Assessment of Motor Control | 299 | ||
| Assessment of Muscle Structure | 299 | ||
| Assessment of Strength Parameters | 300 | ||
| Assessment of Muscle Fatigue | 300 | ||
| Summary of Assessment | 300 | ||
| Specificity and Selectivity of Exercise | 300 | ||
| Timing of Exercise | 301 | ||
| Variability in Response to Exercise | 301 | ||
| Forms of Exercise Commonly Applied to Manage Musculoskeletal Pain | 301 | ||
| Motor Control Training | 302 | ||
| Training Principles of Motor Control Training | 303 | ||
| Neuromuscular Adaptations | 303 | ||
| Resistance Training | 304 | ||
| Intensity of Resistance Training | 304 | ||
| Volume of Resistance Training | 305 | ||
| Frequency and Duration of Resistance Training | 305 | ||
| Clinical Prescription of Resistance Training | 305 | ||
| Summary and Conclusion | 306 | ||
| References | 306 | ||
| 32 Management of the Sensorimotor System | 310 | ||
| CHAPTER OUTLINE | 310 | ||
| CHAPTER 32.1 ■ The Cervical Region | 310 | ||
| Reported Complaints and Impairments | 310 | ||
| Overall Management Approach | 310 | ||
| Tailored Local Treatment | 311 | ||
| Tailored Sensorimotor Exercise Approach Based on Impairments | 311 | ||
| Head Position and Movement Control | 311 | ||
| Cervical Joint Position Error | 311 | ||
| Cervical Movement Sense | 311 | ||
| Oculomotor Control | 312 | ||
| Gaze Stability | 312 | ||
| Smooth Pursuit | 312 | ||
| Eye–Head–Trunk Coordination | 312 | ||
| Eye–Head Coordination | 312 | ||
| Trunk–Head Coordination | 312 | ||
| Postural Control | 312 | ||
| General Recommendations, Progression of Treatment | 312 | ||
| Conclusion | 313 | ||
| References | 314 | ||
| CHAPTER 32.2 ■ Sensorimotor Control of Lumbar Spine Alignment | 315 | ||
| Motor Control and Low Back Pain | 315 | ||
| Sensorimotor Control of the Lumbar Spine | 316 | ||
| Sensorimotor Control in Low Back Pain | 316 | ||
| Assessment of Sensorimotor Control in Low Back Pain | 317 | ||
| Management of Sensorimotor Control in LBP | 317 | ||
| References | 317 | ||
| CHAPTER 32.3 ■ The Lower Limb | 319 | ||
| Introduction | 319 | ||
| Brief Review of the Sensorimotor System | 319 | ||
| The Sensory Component of the Sensorimotor System | 320 | ||
| Effects of Injury on the Sensorimotor System | 320 | ||
| Manual Therapy and the Sensorimotor System | 320 | ||
| Taping and Bracing and the Sensorimotor System | 322 | ||
| Exercise Therapy and the Sensorimotor System | 323 | ||
| Summary | 324 | ||
| References | 324 | ||
| 33 Consideration of Cognitive and Behavioural Influences on Physiotherapy Practice | 328 | ||
| Understanding the Problem Presentation | 328 | ||
| Psychological Co-Morbidity and What to Do About It? | 328 | ||
| Skills and Procedures of Cognitive Behavioural Therapy Relevant to Physiotherapy Practice | 329 | ||
| Breathing Retraining and Body Scan Relaxation | 329 | ||
| Problem Solving | 330 | ||
| Cognitive Coping Skills | 330 | ||
| Behavioural Graded Activity Approaches | 330 | ||
| Promoting Behaviour Change | 331 | ||
| Integrating Psychological Factors in to Clinical Practice | 331 | ||
| Conclusion | 332 | ||
| References | 332 | ||
| 34 Adjunct Modalities for Pain | 334 | ||
| CHAPTER OUTLINE | 334 | ||
| CHAPTER 34.1 ■ Electrophysical Agents | 334 | ||
| References | 335 | ||
| CHAPTER 34.2 ■ Acupuncture/Dry Needling | 336 | ||
| Physiological Effects of Acupuncture | 336 | ||
| Acupuncture in the Treatment of Musculoskeletal Pain | 337 | ||
| References | 338 | ||
| CHAPTER 34.3 ■ The Use of Tape in Managing Spinal Pain | 339 | ||
| What is Pain? | 339 | ||
| Why are Some Individuals More Susceptible to Pain? | 339 | ||
| Where is the Pain Coming From? | 339 | ||
| References | 341 | ||
| 35 Cautions in Musculoskeletal Practice | 342 | ||
| CHAPTER OUTLINE | 342 | ||
| CHAPTER 35.1 ■ Masqueraders | 343 | ||
| Introduction | 343 | ||
| Cauda Equina Syndrome | 343 | ||
| What is It? | 343 | ||
| CES-I (48-Hour Emergency Window Open Where Surgery is Likely to be Helpful) | 344 | ||
| CES-R (Emergency Window Passed Where Surgery is Less Likely to be Beneficial) | 344 | ||
| Important Issues | 344 | ||
| IV Overview of Contemporary Issues in Practice | 407 | ||
| 4.1 | 409 | ||
| Section_4.1 text | 409 | ||
| 41 Cervical Spine: | 410 | ||
| Profiling Patients with Mechanical Neck Pain | 410 | ||
| Biological Perspectives | 410 | ||
| Psychological Perspectives | 411 | ||
| Social Perspectives | 411 | ||
| Patient Profiling in Clinical Practice | 412 | ||
| Summary Statement | 413 | ||
| Training | 413 | ||
| Training for Pain Relief | 413 | ||
| Training to Restore Neuromuscular Function | 413 | ||
| Transfer to Function | 414 | ||
| Variability in Response to Training | 415 | ||
| Exercise Dosage to Address Recurrence | 415 | ||
| Summary | 416 | ||
| Cervical Spine Mobilization and Manipulation | 416 | ||
| Specific Effectiveness of Cervical Spinal Manipulation | 417 | ||
| Neurophysiological Mechanisms of Spinal Manipulation | 417 | ||
| Risks of Cervical Spinal Manipulation | 418 | ||
| Summary | 418 | ||
| References | 418 | ||
| 42 Whiplash-Associated Disorders | 423 | ||
| Introduction | 423 | ||
| The Role of Tissue Damage in Whiplash-Associated Disorders | 423 | ||
| Evidence Supporting the Presence of Tissue Damage | 423 | ||
| The Relationship of Tissue Damage to the Clinical Presentation of Whiplash-Associated Disorders | 424 | ||
| Summary | 424 | ||
| Is Whiplash-Associated Disorder a Culturally Dependent Condition? | 425 | ||
| The Clinical Relevance of Outcome Prediction | 426 | ||
| Predisposed Does Not Mean Predestined | 426 | ||
| Summary of Current Evidence – What are Risk Factors, What are Not? | 427 | ||
| Summary | 428 | ||
| The Treatment of Whiplash-Associated Disorders | 428 | ||
| Acute Whiplash-Associated Disorders | 428 | ||
| Chronic Whiplash-Associated Disorders | 429 | ||
| Future Directions | 430 | ||
| References | 430 | ||
| 43 Temporomandibular Disorders: | 433 | ||
| Introduction | 433 | ||
| Do Temporomandibular Disorders have their Own Entity? | 433 | ||
| Myogenic Temporomandibular Disorders | 433 | ||
| Dental Occlusal Factors | 434 | ||
| Neuroendocrine and Genetic Factors | 434 | ||
| Parafunctions | 434 | ||
| Increased Muscle Activity During Rest | 434 | ||
| Arthrogenic Temporomandibular Disorders | 435 | ||
| Disc Displacements | 435 | ||
| Hypermobility and Dislocation | 435 | ||
| Arthralgia | 435 | ||
| Neurogenic Temporomandibular Disorders | 435 | ||
| Assessment | 436 | ||
| Subjective Examination | 436 | ||
| Physical Examination | 436 | ||
| The Relationship between an Altered Posture of the Head and Temporomandibular Disorders | 437 | ||
| Measurement of Head Position | 437 | ||
| Clinical Diagnostic Testing of Temporomandibular Disorders | 437 | ||
| Quality of Clinical Tests | 437 | ||
| Which Clinical Neuromusculoskeletal Tests Should be Chosen for Assessing Temporomandibular Disorders? | 438 | ||
| Physiological and Accessory Movements. | 438 | ||
| Structural Differentiation of Temporomandibular Disorder Pain Associated with Peripheral Nerve Sensitization. | 438 | ||
| Additional Tests | 438 | ||
| Muscle Testing. | 438 | ||
| Nervous System. | 438 | ||
| Management | 439 | ||
| Evidence for Physiotherapy in Temporomandibular Disorders | 439 | ||
| Summary | 440 | ||
| References | 441 | ||
| 44 Thoracic Spine: | 444 | ||
| CHAPTER OUTLINE | 444 | ||
| CHAPTER 44.1 ■ Clinical Examination and Targeted Management of Thoracic Musculoskeletal Pain | 444 | ||
| Anatomical and Biomechanical Considerations | 445 | ||
| Assessment and Diagnosis of TSP | 445 | ||
| Subjective Examination | 445 | ||
| Area of Symptoms | 445 | ||
| Behaviour of Symptoms | 445 | ||
| History | 445 | ||
| Specific Spinal Pathologies | 445 | ||
| Red Flags | 445 | ||
| Yellow Flags | 445 | ||
| Physical Examination | 446 | ||
| Posture | 446 | ||
| Motion Assessment | 446 | ||
| Muscle System Assessment | 447 | ||
| Manual Examination | 447 | ||
| Diagnosis | 447 | ||
| Management of Thoracic Musculoskeletal Pain Disorders | 448 | ||
| Postural Correction | 448 | ||
| Improve Thoracic Spine Mobility | 448 | ||
| Optimize Muscle Function | 448 | ||
| Address Contributing Impairments | 448 | ||
| References | 449 | ||
| CHAPTER 44.2 ■ The Thoracic Ring Approach™ – A Whole Person Framework to Assess and Treat the Thoracic Spine and Ribcage | 449 | ||
| Connecting the Thoracic Spine and Ribcage as a Series of ‘Thoracic Rings’ | 450 | ||
| Connecting the Thorax to Whole Body Function: Determining if the Thoracic Rings are the ‘Driver’ for the Patient’s Problem | 450 | ||
| Treatment of the Thoracic Ring Driver | 453 | ||
| Summary | 453 | ||
| References | 455 | ||
| CHAPTER 44.3 ■ Management of the Thoracic Spine in Patients with COPD | 455 | ||
| Anatomy and Biomechanics | 456 | ||
| Relationship Between the Musculoskeletal System and Pulmonary Function | 456 | ||
| Symptomatic Features of COPD | 456 | ||
| Management of COPD to Improve Flexibility | 456 | ||
| Manual Therapy: Passive Interventions | 456 | ||
| Exercise: Active Interventions | 457 | ||
| References | 458 | ||
| 45 Lumbar Spine | 460 | ||
| CHAPTER OUTLINE | 460 | ||
| CHAPTER 45.1 ■ The McKenzie Method of Mechanical Diagnosis and Therapy – An Overview | 460 | ||
| Introduction | 460 | ||
| Assessment | 461 | ||
| Repeated Movements | 461 | ||
| Evidence About the Assessment Process | 462 | ||
| Evidence Regarding Prognosis | 462 | ||
| Management | 462 | ||
| Evidence Regarding Management | 463 | ||
| The ‘Other’ Syndromes | 463 | ||
| Application of Mechanical Diagnosis and Therapy in the Cervical Spine | 463 | ||
| Conclusions | 464 | ||
| References | 464 | ||
| CHAPTER 45.2 ■ Multidimensional Approach for the Targeted Management of Low Back Pain | 465 | ||
| The Failure of Current Practice | 465 | ||
| Multidimensional Clinical Reasoning Framework for LBP | 465 | ||
| Clinical Reasoning Framework for Targeted Management of Low Back Pain | 467 | ||
| Cognitive Functional Therapy for the Targeted Management of Low Back Pain Disorders | 467 | ||
| Skills Required to Implement the Multidimensional Approach for Individualized Care | 468 | ||
| Summary | 468 | ||
| References | 468 | ||
| CHAPTER 45.3 ■ Treatment-Based Classification System | 470 | ||
| Overview of the Treatment-Based Classification Categories | 470 | ||
| Manipulation Classification | 470 | ||
| Stabilization Classification | 472 | ||
| Specific Exercise Classification | 472 | ||
| Traction Classification | 472 | ||
| Conclusion | 473 | ||
| References | 473 | ||
| CHAPTER 45.4 ■ Movement System Impairment Syndromes of the Low Back | 474 | ||
| Movement System: Inclusion not Exclusion | 474 | ||
| Movement System Impairment Syndromes Versus Movement System Syndromes | 474 | ||
| The Kinesiopathological Model | 474 | ||
| Tissue Adaptations Associated with Repeated Movements and Prolonged Alignment | 475 | ||
| Relative Flexibility | 475 | ||
| Relative Stiffness | 475 | ||
| Neuromuscular Activation Patterns | 476 | ||
| Movement System Impairment Syndromes of the Lumbar Spine | 476 | ||
| General Pattern and Distribution of Syndromes | 476 | ||
| Movement System Impairment Examination | 478 | ||
| Treatment | 478 | ||
| Research | 478 | ||
| Conclusions | 481 | ||
| References | 481 | ||
| CHAPTER 45.5 ■ The Role of Motor Control Training | 482 | ||
| Introduction | 482 | ||
| Clinical Framework for Motor Control Training | 483 | ||
| Basic Principles | 483 | ||
| Clinical Application of Motor Control Training | 484 | ||
| Assessment | 484 | ||
| Correction of Motor Control Faults | 484 | ||
| Progression of Exercise | 484 | ||
| Potential Barriers to Recovery | 486 | ||
| Common Misconceptions | 486 | ||
| Evidence for Motor Control Training | 486 | ||
| How Can Motor Control Training Relieve and Prevent Pain and Disability? | 486 | ||
| Is Motor Control Training Effective? | 486 | ||
| Is it Possible to Identify Patients Likely to Respond? | 486 | ||
| Can Motor Control be Changed with Training? | 487 | ||
| Conclusion | 487 | ||
| References | 487 | ||
| 46 The Sacroiliac Joint (Pelvic Pain): | 488 | ||
| Chapter Outline | 488 | ||
| Chapter 46.1 ■ A Person-Centred Biopsychosocial Approach to Assessment and Management of Pelvic Girdle Pain | 488 | ||
| Challenging Health-Care Practitioner Beliefs Regarding the Pelvis | 488 | ||
| Embracing the Biopsychosocial Model of Pelvic Girdle Pain | 489 | ||
| Neurophysiological Factors | 489 | ||
| Psychosocial Factors | 489 | ||
| Lifestyle Factors | 490 | ||
| Physical Factors – Motor Control Factors | 490 | ||
| Co-morbidities | 492 | ||
| Genetic and Individual Factors | 492 | ||
| Key Considerations in the Biopsychosocial Management of Pelvic Girdle Pain | 492 | ||
| Communication and Language | 492 | ||
| Risk Profiling | 492 | ||
| Cognitive–Functional Approach to Management | 492 | ||
| Conclusion | 493 | ||
| References | 493 | ||
| Chapter 46.2 ■ The Pelvic Girdle: A Look at How Time, Experience and Evidence Change Paradigms | 495 | ||
| The Integrated Systems Model for Disability and Pain | 496 | ||
| The One Leg Standing (OLS) Test | 496 | ||
| Case Report | 497 | ||
| Conclusion | 499 | ||
| References | 499 | ||
| Chapter 46.3 ■ A Critical Viewpoint on Models, Testing and Treatment of Patients with Lumbopelvic Pain | 500 | ||
| Introduction | 500 | ||
| Theoretical Models | 500 | ||
| The Diagnostic Process | 501 | ||
| Classification of Low Back Pain Patients | 501 | ||
| Interventions | 503 | ||
| References | 503 | ||
| 47 Hip-Related Pain | 506 | ||
| Articular and Muscle Control of the Hip | 506 | ||
| Bony Morphology | 506 | ||
| Passive Joint Structures | 506 | ||
| Acetabular Labrum | 506 | ||
| Ligaments of the Hip | 506 | ||
| Hip Musculature | 506 | ||
| Joint-Related Hip Pain | 507 | ||
| Background | 507 | ||
| Femoroacetabular Impingement | 507 | ||
| Acetabular Labral Pathology | 507 | ||
| Chondropathy of the Hip | 507 | ||
| Assessment | 508 | ||
| Key Clinical Diagnostic Features of Joint-Related Hip Pain | 508 | ||
| The Role of Imaging: When to and When Not to Image? | 508 | ||
| Red Flags | 508 | ||
| Treatment | 508 | ||
| Conservative Management | 508 | ||
| Advice. | 508 | ||
| Exercise. | 510 | ||
| Manual Therapy. | 510 | ||
| Effectiveness of Conservative Therapies | 510 | ||
| Medical and Surgical Management | 510 | ||
| Controversies, Uncertainties and Future Directions | 514 | ||
| Tendinopathy-Related Hip Pain | 514 | ||
| Background | 514 | ||
| Assessment | 514 | ||
| Key Clinical Diagnostic Features of Tendinopathy-Related Hip Pain | 514 | ||
| The Role of Imaging: When to and When Not to Image? | 514 | ||
| Treatment | 515 | ||
| Gluteal Tendinopathy | 515 | ||
| Proximal Hamstring Tendinopathy | 516 | ||
| Effectiveness of Conservative Therapies | 516 | ||
| Controversies, Uncertainties and Future Directions | 516 | ||
| References | 518 | ||
| 48 The Knee: Introduction | 522 | ||
| Chapter Outline | 522 | ||
| Chapter 48.1 ■ Acute Knee Injuries | 522 | ||
| Introduction | 522 | ||
| Common Acute Knee Injuries | 522 | ||
| Nature of Loads | 522 | ||
| Strengthening | 524 | ||
| Muscle Inhibition | 524 | ||
| Strength, Power and Work Capacity Development | 524 | ||
| Development of Neuromuscular Control | 524 | ||
| Conclusion | 525 | ||
| References | 526 | ||
| Chapter 48.2 ■ Patellofemoral Pain | 528 | ||
| Articular and Muscle Control of the Patellofemoral Joint | 528 | ||
| Anatomy and Motor Control of the Patellofemoral Joint and Adjacent Structures | 528 | ||
| Anatomy of Remote Structures and Impact on the Patellofemoral Joint | 528 | ||
| Patellofemoral Pain | 528 | ||
| Background | 528 | ||
| Evidence for Impairments in Local Motor Control in Patellofemoral Pain | 528 | ||
| Evidence for Impairments in Remote Contributors to Patellofemoral Pain | 529 | ||
| Assessment | 529 | ||
| Key Clinical Diagnostic Features of Patellofemoral Pain | 529 | ||
| The Role of Imaging | 529 | ||
| Treatment | 529 | ||
| Exercise | 529 | ||
| Taping | 531 | ||
| Manual Therapy | 532 | ||
| Foot Orthoses | 532 | ||
| Effectiveness of Treatments | 532 | ||
| Emerging Issues and New Advances | 533 | ||
| Controversies, Uncertainties and Future Directions | 533 | ||
| References | 533 | ||
| Chapter 48.3 ■ Knee Osteoarthritis | 536 | ||
| Impact on Individuals and Society | 536 | ||
| Concepts of Osteoarthritis | 537 | ||
| Risk Factors for Development and Progression | 537 | ||
| The Role of Biomechanics and Neuromuscular Factors | 538 | ||
| Diagnosis and Assessment | 538 | ||
| Diagnosis | 538 | ||
| Beyond Diagnosis | 539 | ||
| Treatment Strategies | 539 | ||
| Education | 539 | ||
| Exercise | 539 | ||
| Manual Therapy | 541 | ||
| Braces | 541 | ||
| Footwear and Orthoses | 542 | ||
| Gait Aids and Gait Retraining | 543 | ||
| Acupuncture | 543 | ||
| Conclusion | 543 | ||
| References | 543 | ||
| 49 Ankle Injury | 547 | ||
| Epidemiology | 547 | ||
| Prognosis | 547 | ||
| Risk Factors | 548 | ||
| Diagnosis | 548 | ||
| Fracture | 548 | ||
| Ankle Sprain | 548 | ||
| Inversion Sprain | 548 | ||
| Syndesmosis Injury | 549 | ||
| Chronic Ankle Instability | 550 | ||
| Impairments | 551 | ||
| Management | 551 | ||
| Ankle Sprain | 551 | ||
| Syndesmosis Injury | 552 | ||
| Chronic Ankle Instability | 552 | ||
| Prevention of Further Ankle Sprain | 552 | ||
| Conclusion | 552 | ||
| References | 553 | ||
| 50 The Shoulder | 557 | ||
| CHAPTER OUTLINE | 557 | ||
| CHAPTER 50.1 ■ Shoulder Assessment | 557 | ||
| Introduction | 557 | ||
| Assessment Overview and Clinical Decision Making | 557 | ||
| The Importance of Epidemiology Data in Shoulder Assessment and Diagnosis | 557 | ||
| The Patient Interview, Flags and Establishing a Baseline for Outcomes | 558 | ||
| Physical Examination | 558 | ||
| Observation | 558 | ||
| The Screening Examination | 558 | ||
| Active Motion, Passive Motion, Palpation and Muscle Testing | 559 | ||
| Orthopaedic Special Tests and Diagnostic Accuracy | 559 | ||
| Summary | 560 | ||
| References | 561 | ||
| CHAPTER 50.2 ■ Rotator Cuff Tendinopathy and Subacromial Pain Syndrome | 563 | ||
| Introduction | 563 | ||
| Rotator Cuff Function | 563 | ||
| Diagnosis | 564 | ||
| Treatment | 564 | ||
| What Else Influences Outcome? | 565 | ||
| Measuring Outcome | 566 | ||
| Posture and Muscle Imbalance | 566 | ||
| Conclusions | 566 | ||
| References | 566 | ||
| CHAPTER 50.3 ■ The Unstable Shoulder | 568 | ||
| Introduction | 568 | ||
| Assessment | 569 | ||
| Interview | 569 | ||
| Physical Examination | 569 | ||
| Orthopaedic Instability Tests | 570 | ||
| Management | 570 | ||
| Anterior Dislocation | 570 | ||
| Posterior Dislocation | 571 | ||
| Anterior or Posterior Subluxation and Multidirectional Instability (MDI) | 571 | ||
| Conservative Rehabilitation Principles | 571 | ||
| Generalized Joint Hypermobility, Joint Hypermobility Syndrome and Shoulder Instability | 573 | ||
| References | 573 | ||
| CHAPTER 50.4 ■ Posterior Shoulder Tightness | 575 | ||
| Overview | 575 | ||
| Mechanisms | 576 | ||
| Evidence | 576 | ||
| Diagnosis | 576 | ||
| Management | 576 | ||
| Recommendations | 576 | ||
| References | 577 | ||
| CHAPTER 50.5 ■ Frozen Shoulder Contraction Syndrome | 577 | ||
| Introduction | 577 | ||
| Epidemiology | 578 | ||
| Natural History | 578 | ||
| Diagnosis | 578 | ||
| Management | 579 | ||
| Conclusion | 581 | ||
| References | 581 | ||
| 51 Elbow | 583 | ||
| Introduction | 583 | ||
| Clinical Interview | 583 | ||
| History | 583 | ||
| Symptoms | 583 | ||
| Functional Demands | 583 | ||
| Co-morbidity | 583 | ||
| Outcome Measures | 583 | ||
| Physical Examination of the Elbow | 584 | ||
| Range of Motion | 584 | ||
| Elbow Stability | 584 | ||
| Lateral Instability | 584 | ||
| Medial Instability | 584 | ||
| Muscle–Tendon Function | 585 | ||
| Palpation | 585 | ||
| Nerve Function | 585 | ||
| Strength | 586 | ||
| Diagnostic Imaging | 587 | ||
| Conservative Management of the Elbow | 587 | ||
| Acute Traumatic Injuries of Bone and Ligaments | 587 | ||
| Elbow Instability | 590 | ||
| Lateral Epicondylalgia | 590 | ||
| Posterolateral Impingement | 591 | ||
| Medial Epicondylalgia | 591 | ||
| Ulnar Neuropathy | 591 | ||
| Radial Nerve Entrapment | 591 | ||
| Conclusion | 591 | ||
| Acknowledgement | 592 | ||
| References | 592 | ||
| 52 Wrist/Hand | 595 | ||
| Principles of Assessment | 595 | ||
| History | 595 | ||
| Mechanism of Injury | 595 | ||
| Previous Injuries | 595 | ||
| Clinical Context | 595 | ||
| Examination | 595 | ||
| Inspection | 595 | ||
| Sensation | 595 | ||
| Range of Motion | 595 | ||
| Strength | 596 | ||
| Palpation and Provocative Tests | 596 | ||
| Investigations | 596 | ||
| Principles of Management | 596 | ||
| Hand Therapy | 596 | ||
| Immobilization | 597 | ||
| Oedema Control | 597 | ||
| Scar and Wound Care | 597 | ||
| Exercises | 597 | ||
| Managing Common Conditions | 597 | ||
| Fractures | 597 | ||
| Metacarpal and Phalangeal Fractures | 597 | ||
| Distal Radius Fractures | 597 | ||
| Scaphoid Fractures | 598 | ||
| Tendon Injury | 599 | ||
| Mallet Injury | 599 | ||
| Boutonniere | 599 | ||
| Flexor Tendon – Flexor Digitorum Profundus Avulsion | 599 | ||
| Joint Injury | 599 | ||
| Volar Plate Injury at the Proximal Interphalangeal Joint | 599 | ||
| Swan-neck Deformity | 600 | ||
| Collateral Ligament Injury | 600 | ||
| Ulnar Collateral Ligament Injury of the Thumb | 600 | ||
| Wrist Instabilities | 600 | ||
| Scapholunate Ligament | 600 | ||
| Distal Radio-ulnar Joint and Ulnocarpal Complex | 601 | ||
| Osteoarthritis | 602 | ||
| Thumb Carpometacarpal Joint | 602 | ||
| Soft Tissue Conditions | 603 | ||
| Carpal Tunnel Syndrome | 603 | ||
| De Quervain’s Disease | 603 | ||
| Trigger Finger | 603 | ||
| Complex Regional Pain Syndrome | 603 | ||
| References | 603 | ||
| V Future Directions | 607 | ||
| 53 Future Directions in Research and Practice | 609 | ||
| Reference | 610 | ||
| Index | 611 | ||
| A | 611 | ||
| B | 611 | ||
| C | 612 | ||
| D | 613 | ||
| E | 613 | ||
| F | 614 | ||
| G | 615 | ||
| H | 615 | ||
| I | 615 | ||
| J | 616 | ||
| K | 616 | ||
| L | 616 | ||
| M | 617 | ||
| N | 619 | ||
| O | 619 | ||
| P | 620 | ||
| Q | 622 | ||
| R | 622 | ||
| S | 622 | ||
| T | 624 | ||
| U | 625 | ||
| V | 625 | ||
| W | 625 | ||
| X | 626 | ||
| Y | 626 | ||
| Z | 626 |