BOOK
Manual Therapy for Musculoskeletal Pain Syndromes E-Book
Cesar Fernandez de las Penas | Joshua Cleland | Jan Dommerholt
(2015)
Additional Information
Book Details
Abstract
A pioneering, one-stop manual which harvests the best proven approaches from physiotherapy research and practice to assist the busy clinician in real-life screening, diagnosis and management of patients with musculoskeletal pain across the whole body. Led by an experienced editorial team, the chapter authors have integrated both their clinical experience and expertise with reasoning based on a neurophysiologic rationale with the most updated evidence.
The textbook is divided into eleven sections, covering the top evidence-informed techniques in massage, trigger points, neural muscle energy, manipulations, dry needling, myofascial release, therapeutic exercise and psychological approaches. In the General Introduction, several authors review the epidemiology of upper and lower extremity pain syndromes and the process of taking a comprehensive history in patients affected by pain. In Chapter 5, the basic principles of the physical examination are covered, while Chapter 6 places the field of manual therapy within the context of contemporary pain neurosciences and therapeutic neuroscience education.
For the remaining sections, the textbook alternates between the upper and lower quadrants. Sections 2 and 3 provide state-of-the-art updates on mechanical neck pain, whiplash, thoracic outlet syndrome, myelopathy, radiculopathy, peri-partum pelvic pain, joint mobilizations and manipulations and therapeutic exercises, among others. Sections 4 to 9 review pertinent and updated aspects of the shoulder, hip, elbow, knee, the wrist and hand, and finally the ankle and foot. The last two sections of the book are devoted to muscle referred pain and neurodynamics.
- The only one-stop manual detailing examination and treatment of the most commonly seen pain syndromes supported by accurate scientific and clinical data
- Over 800 illustrations demonstrating examination procedures and techniques
- Led by an expert editorial team and contributed by internationally-renowned researchers, educators and clinicians
- Covers epidemiology and history-taking
- Highly practical with a constant clinical emphasis
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Manual Therapy for Musculoskeletal Pain Syndromes | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Dedication | viii | ||
| Acknowledgements | ix | ||
| Contributors | x | ||
| Forewords | xiv | ||
| Foreword by Ola Grimsby | xiv | ||
| Foreword by Rob A.B. Oostendorp: Learning from the past as a bridge to the future of manual therapy | xiv | ||
| The transition from authority-based practice to evidence-based practice | xv | ||
| The transition from the International Classification of Diseases (ICD) to the International Classification of Functioning, Disability and Health (ICF) | xv | ||
| The transition from unimodal manual therapy to an integration of manual therapy into the current understanding of the neurophysiology and psychology of pain | xv | ||
| Foreword by Prof. Dr Andry Vleeming | xvi | ||
| Preface | xvii | ||
| References | xviii | ||
| In Memoriam | xix | ||
| 1 General introduction | 1 | ||
| 1 Epidemiology of Upper Extremity Pain Syndromes | 3 | ||
| Chapter Contents | 3 | ||
| Introduction | 3 | ||
| Epidemiological Issues | 3 | ||
| Terminology | 3 | ||
| Non-specific pain | 4 | ||
| Classification criteria | 4 | ||
| Study design | 5 | ||
| Population | 5 | ||
| Measurement of exposure | 5 | ||
| Occurrence of Upper Extremity Disorders | 6 | ||
| Prevalence of upper extremity pain | 6 | ||
| Prevalence of specific upper extremity disorders | 6 | ||
| Healthcare Utilization and Impact | 9 | ||
| Risk Factors for Upper Extremity Disorders | 9 | ||
| Gender | 9 | ||
| Age | 10 | ||
| Anthropometry | 10 | ||
| Hand dominance | 10 | ||
| Hormonal factors | 10 | ||
| Occupational risk factors: physical / mechanical factors | 10 | ||
| Occupational risk factors: psychosocial | 10 | ||
| Conclusion | 11 | ||
| References | 11 | ||
| 2 Epidemiology of Lower Extremity Pain Disorder | 13 | ||
| Chapter Contents | 13 | ||
| Introduction | 13 | ||
| Prevalence and Incidence of Specific Lower Extremity Disorders | 13 | ||
| Lumbar conditions | 13 | ||
| Prevalence | 13 | ||
| Incidence | 15 | ||
| Hip conditions | 16 | ||
| Hip symptoms and osteoarthritis | 16 | ||
| Incidence | 17 | ||
| Labral tears | 17 | ||
| Greater trochanteric pain syndrome | 17 | ||
| Knee conditions | 17 | ||
| Knee symptoms and osteoarthritis | 17 | ||
| Incidence of knee osteoarthritis | 18 | ||
| Meniscus injury | 18 | ||
| Patellofemoral pain syndrome | 18 | ||
| Foot and ankle conditions | 18 | ||
| Ankle sprains | 18 | ||
| Achilles tendinopathy | 19 | ||
| Plantar fasciitis | 19 | ||
| Healthcare Utilization and Impact | 19 | ||
| Conclusion | 20 | ||
| References | 20 | ||
| 3 History Taking | 22 | ||
| Chapter Contents | 22 | ||
| Introduction | 22 | ||
| Patient Profile | 23 | ||
| Location and Description of Symptoms | 24 | ||
| Symptom Behaviour | 26 | ||
| Symptom History | 27 | ||
| Medical History | 28 | ||
| Systems Review | 29 | ||
| Conclusion | 34 | ||
| References | 34 | ||
| 4 History Taking for Patients with Lower Extremity Syndromes | 36 | ||
| Chapter Contents | 36 | ||
| Purpose of the Interview | 36 | ||
| Communication Style and Approach | 37 | ||
| Medical Interview Content | 37 | ||
| Systems Review and Differential Diagnosis Inquiry | 37 | ||
| Neurological screen | 38 | ||
| Cardiovascular screen | 38 | ||
| Gastrointestinal screen | 39 | ||
| Non-mechanical pathologies: differential diagnosis | 39 | ||
| Psychosocial factors | 40 | ||
| Red Flags | 40 | ||
| Symptom Investigation | 40 | ||
| Nature and Behaviour of the Problem | 41 | ||
| History-taking Questions Specific to Lower Extremity Pain Syndromes | 42 | ||
| Central and peripheral nerve sensitization | 42 | ||
| Specific Low-back-associated Musculoskeletal Pain Syndromes | 42 | ||
| Lumbar spinal stenosis | 42 | ||
| Nerve root compression / radiculopathy | 43 | ||
| Lumbar disc herniation | 43 | ||
| Clinical lumbar instability | 43 | ||
| Specific Lower-extremity-associated Musculoskeletal Pain Syndromes | 43 | ||
| Hip osteoarthritis | 43 | ||
| Other hip pathology | 43 | ||
| Knee osteoarthritis | 43 | ||
| Patellofemoral pain syndrome | 43 | ||
| Knee meniscal injury | 44 | ||
| Knee ligamentous injury | 44 | ||
| Achilles tendinopathy | 44 | ||
| Heel pain / plantar fasciitis | 44 | ||
| Conclusion | 44 | ||
| References | 44 | ||
| 5 Physical Examination | 47 | ||
| Chapter Contents | 47 | ||
| Introduction | 47 | ||
| Observation and Screening for Medical Conditions | 48 | ||
| Screening for Severe Injuries to the Spine | 50 | ||
| Screening for Neurological Deficits | 51 | ||
| Nerve root examination | 51 | ||
| Sensation | 52 | ||
| Myotomes | 52 | ||
| Reflexes | 53 | ||
| Neurodynamic assessment | 56 | ||
| Upper motor neuron examination | 59 | ||
| Cranial nerve examination | 60 | ||
| Clearing the Spine | 60 | ||
| Region-specific Examination | 63 | ||
| References | 64 | ||
| 6 Treating the Brain in Chronic Pain | 66 | ||
| Chapter Contents | 66 | ||
| Changes in the Nervous System and Brain in People with Chronic Pain | 66 | ||
| Neuromatrix | 66 | ||
| Structural changes in the brain | 68 | ||
| Functional changes in the brain | 69 | ||
| Descending pathways | 69 | ||
| Treatment | 70 | ||
| Therapeutic neuroscience education – restricting meaning | 71 | ||
| Graded motor imagery – restructuring brain / body maps | 73 | ||
| Conclusion | 73 | ||
| References | 73 | ||
| 7 Mechanical Diagnosis and Therapy for the Spine: | 76 | ||
| Chapter Contents | 76 | ||
| Introduction | 76 | ||
| The Literature Base for MDT | 77 | ||
| Epidemiological Perspective | 77 | ||
| Review of Anatomy and Biomechanics in MDT | 78 | ||
| Review of Proposed Pathology and Anatomy in MDT | 79 | ||
| Evidence Regarding Diagnosis in MDT | 80 | ||
| Evidence Regarding Prognosis in MDT | 80 | ||
| Evidence Regarding Conservative Treatment with MDT | 80 | ||
| Conclusion | 82 | ||
| Acknowledgements | 83 | ||
| References | 83 | ||
| 8 Mechanical Diagnosis and Therapy for Extremity Problems: | 85 | ||
| Chapter Contents | 85 | ||
| Introduction | 85 | ||
| Brief Epidemiology of Extremity Musculoskeletal Pain Conditions | 85 | ||
| Medical Diagnosis for Extremity Conditions | 86 | ||
| Anatomy and Biomechanics in MDT | 86 | ||
| Proposed Pathological Model in MDT | 87 | ||
| Evidence Regarding Diagnosis in MDT | 88 | ||
| Evidence Regarding Prognosis in MDT | 88 | ||
| Evidence Regarding Treatment of Extremity Conditions with MDT | 88 | ||
| Conclusion | 89 | ||
| Acknowledgement | 90 | ||
| References | 90 | ||
| 2 Cervicothoracic spine in upper extremity pain syndromes | 93 | ||
| 9 Mechanical Neck Pain | 95 | ||
| Chapter Contents | 95 | ||
| Mechanical Neck Pain Definition | 95 | ||
| Prevalence of Mechanical Neck Pain | 96 | ||
| Financial impact of mechanical neck pain | 97 | ||
| Risk factors and prognosis in mechanical neck pain | 97 | ||
| Prevalence of neck pain in working individuals | 98 | ||
| Prognostic factors of neck pain in working individuals | 98 | ||
| Prevalence of neck pain in the general population | 98 | ||
| Prognostic factors for neck pain in the general population | 99 | ||
| Review of Anatomy Specific to Mechanical Neck Pain | 99 | ||
| Causes of Mechanical Neck Pain | 99 | ||
| Clinical Presentation of Neck Pain | 100 | ||
| Proposed Management of Mechanical Neck Pain | 100 | ||
| First level of classification | 101 | ||
| Red flag screening | 101 | ||
| Spinal fractures | 102 | ||
| Cervical myelopathy | 102 | ||
| Primary neoplastic conditions | 102 | ||
| Cervical arterial dysfunction | 102 | ||
| Clinical cervical spine instability | 103 | ||
| Yellow flag screening | 103 | ||
| Second level of classification | 103 | ||
| Mechanical neck pain classification | 104 | ||
| Treatment-based classification | 105 | ||
| Classification categories | 105 | ||
| Cervical Spine Self-report Measures of Pain and Function | 105 | ||
| Numerical Pain Rating Scale | 106 | ||
| Neck Disability Index | 106 | ||
| Patient Specific Functional Scale | 106 | ||
| Fear-avoidance Beliefs Questionnaire | 107 | ||
| Global Rating of Change scale | 107 | ||
| Conclusion | 107 | ||
| References | 107 | ||
| 10 Whiplash-associated Disorders | 110 | ||
| Chapter Contents | 110 | ||
| Introduction | 110 | ||
| The Whiplash Condition | 111 | ||
| Classification of Whiplash Injury | 111 | ||
| Physical and Psychological Characteristics of the Whiplash Condition | 111 | ||
| Motor and sensorimotor control dysfunction | 111 | ||
| Augmented pain-processing mechanisms in whiplash | 112 | ||
| Psychological factors in whiplash-associated disorders | 113 | ||
| The Prediction of Outcome Following Whiplash Injury | 113 | ||
| Implications for Assessment of Whiplash | 114 | ||
| Implications for Management of Whiplash-associated Disorders | 114 | ||
| Conclusion | 115 | ||
| References | 115 | ||
| 11 Differential Diagnosis and Treatment of Cervical Myelopathy, Cervical Radiculopathy and Cervical Myeloradiculopathy | 118 | ||
| Chapter Contents | 118 | ||
| Introduction | 118 | ||
| Review of Proposed Pathology and Patho-Biomechanics | 119 | ||
| Clinical Signs and Symptoms | 119 | ||
| Myelopathy | 119 | ||
| Radiculopathy | 120 | ||
| Myeloradiculopathy | 120 | ||
| Current Best Evidence with Regard to Diagnosis | 120 | ||
| Cervical myelopathy | 120 | ||
| Patient history | 120 | ||
| Outcome measures | 121 | ||
| Physical examination | 121 | ||
| Observation | 121 | ||
| Active and passive movements | 121 | ||
| Confirmation tests | 121 | ||
| Cervical radiculopathy | 122 | ||
| Patient history | 122 | ||
| Outcome measures | 122 | ||
| Physical examination | 122 | ||
| Observation | 122 | ||
| Active and passive movements | 122 | ||
| Confirmation tests | 123 | ||
| Neurological testing | 123 | ||
| Provocation tests | 123 | ||
| Cervical myeloradiculopathy | 124 | ||
| Patient history | 124 | ||
| Physical examination | 124 | ||
| Outcome measures | 124 | ||
| Confirmation tests | 124 | ||
| Imaging | 124 | ||
| Plain film radiograph | 124 | ||
| Magnetic resonance imaging and computed tomography scan | 124 | ||
| Nerve condition responses | 125 | ||
| Essential Aspects of Differential Diagnosis | 126 | ||
| Current Best Evidence with Regard to Prognosis | 126 | ||
| Current Best Evidence with Regard to Treatment | 127 | ||
| Conservative approaches | 127 | ||
| Myelopathy | 127 | ||
| Radiculopathy | 127 | ||
| Myeloradiculopathy | 127 | ||
| Surgical approaches | 128 | ||
| Anterior approaches | 128 | ||
| Posterior approaches | 128 | ||
| References | 129 | ||
| 12 Thoracic Outlet Syndrome | 132 | ||
| Chapter Contents | 132 | ||
| Overview and History of Thoracic Outlet Syndrome | 132 | ||
| Pathoanatomical Causes of Thoracic Outlet Syndrome | 132 | ||
| Functional causes of thoracic outlet syndrome | 133 | ||
| Entrapment sites | 133 | ||
| Interscalene space triangle | 133 | ||
| Costoclavicular space | 134 | ||
| Subpectoralis minor space | 134 | ||
| Aetiology of Thoracic Outlet Syndrome | 134 | ||
| Clinical Symptoms of Thoracic Outlet Syndrome | 134 | ||
| Neurological symptoms | 135 | ||
| Arterial symptoms | 135 | ||
| Venous symptoms | 135 | ||
| Sympathetic-mediated Pain in Thoracic Outlet Syndrome | 136 | ||
| Diagnosing Thoracic Outlet Syndrome | 136 | ||
| Differential diagnosis | 136 | ||
| Provocative test – used in diagnosis of thoracic outlet syndrome | 136 | ||
| Imaging assessment of thoracic outlet syndrome | 138 | ||
| Clinical Treatment and Management of Thoracic Outlet Syndrome | 138 | ||
| Therapy evaluation of thoracic outlet syndrome | 138 | ||
| Breathing patterns | 138 | ||
| Muscle imbalance | 138 | ||
| Joint stiffness | 139 | ||
| Neurogenic pain | 139 | ||
| Intervention for thoracic outlet syndrome | 139 | ||
| Conclusion | 140 | ||
| References | 140 | ||
| 13 Thoracic Spine Manipulation | 142 | ||
| Chapter Contents | 142 | ||
| Introduction | 142 | ||
| Regional Interdependence of the Thoracic Spine, Rib Cage and the Upper Quarter | 143 | ||
| Biomechanical relationship between the thoracic spine and upper quarter | 143 | ||
| Pain referral patterns of the thoracic spine | 143 | ||
| Association between thoracic spine impairments and upper quarter pain syndromes | 143 | ||
| Evidence for Manual Therapy Management of the Thoracic Spine and Rib Cage in Upper Quarter Pain Syndromes | 144 | ||
| Examination and Screening of the Thoracic Spine and Rib Cage in Patients with Upper Quarter Musculoskeletal Pain | 148 | ||
| Postural screen of the thoracic spine and rib cage | 148 | ||
| Thoracic spine active range of motion | 149 | ||
| Mobility testing of the first rib | 149 | ||
| Segmental mobility testing of the thoracic spine and rib cage | 149 | ||
| Interpretation of the examination and reassessment | 149 | ||
| Manual Therapy Interventions for the Thoracic Spine and Rib Cage | 150 | ||
| Seated upper thoracic thrust manipulation | 150 | ||
| Seated mid-thoracic thrust manipulation | 151 | ||
| Prone upper thoracic thrust manipulation | 151 | ||
| Prone mid-thoracic thrust and non-thrust manipulation | 151 | ||
| Supine upper and mid-thoracic thrust manipulation | 152 | ||
| Seated first-rib thrust and non-thrust manipulation | 153 | ||
| Supine first-rib thrust and non-thrust manipulation | 154 | ||
| Prone or side-lying ribs non-thrust manipulation | 154 | ||
| Supine ribs thrust manipulation | 154 | ||
| Exercise interventions to augment the manual therapy techniques | 154 | ||
| Conclusion | 155 | ||
| References | 155 | ||
| 14 Joint Mobilization and Manipulation of the Cervical Spine | 158 | ||
| Chapter Contents | 158 | ||
| Introduction | 158 | ||
| Evidence for Cervical Manipulation and Mobilization | 158 | ||
| Hypothesized Mechanisms of Effect | 159 | ||
| Specificity of Manipulation and Mobilization | 159 | ||
| Selecting Patients for Cervical Manipulation and Mobilization | 160 | ||
| Adverse Reactions to Cervical Manipulation and Mobilization | 160 | ||
| Translatoric Cervical Manipulation and Mobilization | 161 | ||
| Translatoric traction techniques | 161 | ||
| C2–C7 disc traction in supine (Fig. 14.1) | 162 | ||
| C2–C7 disc traction seated (Fig. 14.2) | 162 | ||
| Translatoric articular / facet separation techniques | 162 | ||
| Occipito-atlanto separation in supine (Fig. 14.3) | 163 | ||
| Atlanto-axial separation in side-lying (Fig. 14.4) | 163 | ||
| C2–C7 facet separation seated version 1 (Fig. 14.5) | 163 | ||
| C2–C7 facet separation seated version 2 (Fig. 14.6) | 164 | ||
| C2–C7 facet separation in supine contralateral gap (Fig. 14.7) | 164 | ||
| C7 facet separation in supine (Fig. 14.8) | 165 | ||
| Translatoric facet-gliding techniques | 165 | ||
| Occipito-atlanto unilateral dorsal glide in supine (Fig. 14.9) | 166 | ||
| C2–C6 facet ventral-cranial glide in supine (Fig. 14.10) | 166 | ||
| C2–C6 facet ventral-cranial glide seated (Fig. 14.11) | 166 | ||
| C2–C6 facet dorsal-caudal glide seated (Fig. 14.12) | 167 | ||
| C7 facet ventral-cranial glide in supine (Fig. 14.13) | 167 | ||
| C7 facet ventral-cranial glide seated (Fig. 14.14) | 167 | ||
| C7 facet dorsal-caudal glide seated (Fig. 14.15) | 168 | ||
| Posterior–anterior Cervical Mobilization | 168 | ||
| Posterior–anterior unilateral upper cervical spine mobilization (Fig. 14.16) | 168 | ||
| Posterior–anterior unilateral mid-cervical spine mobilization (Fig. 14.17) | 168 | ||
| Transverse unilateral mid-cervical spine mobilization (Fig. 14.18) | 169 | ||
| Cervical Spine Manipulative Procedures | 169 | ||
| C2–C6 separation of zygapophyseal articular joint: manipulation in rotation (Fig. 14.19) | 169 | ||
| Atlanto-axial separation of zygapophyseal articular joint: upper cervical spine manipulation (Fig. 14.20) | 170 | ||
| Conclusion | 170 | ||
| References | 170 | ||
| 15 Therapeutic Exercise for Mechanical Neck Pain | 174 | ||
| Chapter Contents | 174 | ||
| Introduction | 174 | ||
| Exercises for Motor Function | 175 | ||
| Recruitment | 175 | ||
| Deep neck flexors | 175 | ||
| Deep neck extensors | 176 | ||
| Strength and endurance | 176 | ||
| Higher load flexor progressions | 176 | ||
| Higher load extensor progressions | 178 | ||
| Side-flexion / rotation exercises for asymmetric weakness | 179 | ||
| Motor control | 180 | ||
| Cervical neutral during limb load | 180 | ||
| Segmental control during neck motion | 181 | ||
| Mobility Exercises | 182 | ||
| Generalized active range of motion | 182 | ||
| Articular / self-mobilization | 183 | ||
| Craniovertebral region | 183 | ||
| Mid-cervical spine | 184 | ||
| Myofascial extensibility | 184 | ||
| Neurodynamics | 185 | ||
| Postural Correction Exercises | 185 | ||
| Muscle imbalance | 185 | ||
| Articular system | 186 | ||
| Neuromeningeal system | 186 | ||
| Posture corrections | 186 | ||
| Somatosensory Dysfunction | 186 | ||
| References | 187 | ||
| 3 Lumbar spine pain syndromes | 189 | ||
| 16 Mechanical Low Back Pain | 191 | ||
| Chapter Contents | 191 | ||
| Introduction | 191 | ||
| Screening | 191 | ||
| Staging Process | 192 | ||
| Stage I | 192 | ||
| Spinal manipulation group | 193 | ||
| Manipulation performed with the patient supine (Fig. 16.1) | 194 | ||
| Manipulation performed with the patient side-lying (Fig. 16.2) | 194 | ||
| Specific exercise group | 194 | ||
| Flexion-oriented exercises | 195 | ||
| Extension-oriented exercises | 195 | ||
| Joint mobilization to promote extension | 195 | ||
| Lateral shift exercises | 195 | ||
| Stabilization group | 195 | ||
| Examination items | 196 | ||
| Intervention | 196 | ||
| Traction group | 197 | ||
| Stage II and III individuals | 197 | ||
| Conclusion | 197 | ||
| References | 197 | ||
| 17 Lumbar Radiculopathy | 199 | ||
| Chapter Contents | 199 | ||
| Aetiology and Background | 199 | ||
| Prevalence | 199 | ||
| Definitions | 199 | ||
| Natural history | 200 | ||
| Clinical signs and symptoms | 200 | ||
| Anatomy and Pathogenesis of Lumbar Radiculopathy | 200 | ||
| Anatomy | 200 | ||
| Pathogenesis | 201 | ||
| Essential Aspects of Differential Diagnosis | 201 | ||
| An Evidence-based Clinical Examination | 201 | ||
| Patient history | 201 | ||
| Physical examination | 202 | ||
| Observation | 202 | ||
| Active and passive movements | 202 | ||
| Neurological testing | 202 | ||
| Provocation tests | 202 | ||
| Straight leg raise | 202 | ||
| Bowstring sign | 203 | ||
| Crossed straight leg raise | 203 | ||
| Slump sit test | 203 | ||
| Femoral nerve tension test | 203 | ||
| Outcome measures | 204 | ||
| Imaging | 204 | ||
| Plain film radiograph | 204 | ||
| Magnetic resonance imaging | 204 | ||
| Computed tomography scan | 204 | ||
| Nerve condition responses | 204 | ||
| Current Best Evidence with Regard to Treatment | 205 | ||
| Conservative approaches | 205 | ||
| Injection | 207 | ||
| Surgical approaches | 207 | ||
| References | 208 | ||
| 18 Lumbar Spine Instability | 210 | ||
| Chapter Contents | 210 | ||
| Historical Appreciation of Low Back Pain | 210 | ||
| Guideline Adherence and Practice Variability | 211 | ||
| Diagnostic Challenge of Low Back Pain | 211 | ||
| The Treatment-Based Classification System | 212 | ||
| Research Investigating the Treatment-based Classification System | 213 | ||
| The Treatment-based Classification System: Focus on the Stabilization Subgroup | 213 | ||
| Clinical Management of Lumbar Spine Instability | 214 | ||
| First level of classification and the patient interview | 214 | ||
| Self-reported symptoms and clinician pattern recognition | 214 | ||
| Second level of classification: physical examination | 215 | ||
| Evidence for physical examination findings | 216 | ||
| Sequencing of the physical examination | 216 | ||
| Proposed Clinical Examination for Lumbar Spine Instability | 216 | ||
| Screening tests | 216 | ||
| Percussion test | 217 | ||
| Supine sign | 217 | ||
| Instability catch sign | 217 | ||
| Confirmatory tests | 217 | ||
| Passive lumbar extension test | 217 | ||
| Passive accessory intervertebral motion | 217 | ||
| Passive physiological intervertebral movements for extension and flexion | 217 | ||
| Prone instability test | 218 | ||
| Clinical prediction rules in the treatment-based classification system | 218 | ||
| Conclusion | 219 | ||
| References | 219 | ||
| 19 Lumbar Spine in Lower Extremity Pain Syndromes | 221 | ||
| Chapter Contents | 221 | ||
| Introduction | 221 | ||
| Lumbar Spine Treatment for Hip Disorders | 221 | ||
| Lumbar Spine Treatment for Knee Disorders | 222 | ||
| Lumbar Spine Treatment for Foot and Ankle Disorders | 223 | ||
| Lumbar Spine Treatment for Lower Extremity Neurodynamics | 223 | ||
| Conclusion | 223 | ||
| References | 225 | ||
| 20 The Contribution of the Pelvic Floor Muscles to Pelvic Pain | 226 | ||
| Chapter Contents | 226 | ||
| Introduction | 226 | ||
| Anatomy and Neural Control | 226 | ||
| Pelvic Floor Muscles and Lumbopelvic pain | 227 | ||
| Chronic Pelvic Pain | 227 | ||
| Conservative Management of Chronic Pelvic Pain | 228 | ||
| A Clinical-reasoned Approach for Conservative Management of Chronic Pelvic Pain | 230 | ||
| Understanding current pain science | 230 | ||
| Movement system dysfunction | 230 | ||
| Pelvic floor muscle function | 230 | ||
| Case Reports | 232 | ||
| Conclusion | 233 | ||
| References | 233 | ||
| 21 Chronic Low Back Pain | 236 | ||
| Chapter Contents | 236 | ||
| Introduction | 236 | ||
| Acute versus Chronic Low Back Pain | 236 | ||
| Altered Nociceptive Transmission in Chronic Low Back Pain | 237 | ||
| Neuroimaging in Chronic Low Back Pain | 237 | ||
| Manual Interventions for Chronic Low Back Pain | 239 | ||
| Joint-biased manual therapies | 239 | ||
| Soft-tissue-biased manual therapies | 240 | ||
| Nerve-biased manual therapies | 240 | ||
| Factors Associated with Efficacy of Interventions in Chronic Low Back Pain | 241 | ||
| Expectation | 241 | ||
| Patient preference | 241 | ||
| Patient–clinician relationship | 242 | ||
| Conclusion | 242 | ||
| References | 242 | ||
| 22 Joint Mobilization and Manipulation of the Lumbar Spine | 245 | ||
| Chapter Contents | 245 | ||
| Towards Standardizing Nomenclature | 245 | ||
| Evidence for Spinal Manipulative Therapy | 246 | ||
| Clinical Prediction Rules | 246 | ||
| The Audible Pop | 248 | ||
| Spinal Positioning and Locking | 248 | ||
| Safety and Manipulative Techniques | 249 | ||
| Contraindications and precautions | 249 | ||
| Spinal Mobilization and Manipulation Techniques | 250 | ||
| Central posterior-to-anterior mobilization | 250 | ||
| Unilateral posterior-to-anterior mobilization | 250 | ||
| Lumbar rotation mobilization: grades I–IV | 251 | ||
| Lumbopelvic regional manipulation | 251 | ||
| Lumbar rotation in neutral or extension manipulation | 252 | ||
| Lumbar rotation in flexion manipulation | 252 | ||
| Conclusion | 253 | ||
| References | 253 | ||
| 23 Therapeutic Exercise for Mechanical Low Back Pain | 255 | ||
| Chapter Contents | 255 | ||
| Evidence for Exercise in Low Back Pain | 255 | ||
| Mobility Exercises | 256 | ||
| Motor Control: Stabilization, Motor Pattern Retraining, Strength | 259 | ||
| Exercises | 259 | ||
| Abdominal draw-in manoeuvre | 259 | ||
| Adding lower limb challenges | 260 | ||
| Abdominal curl-up | 261 | ||
| Multifidus activation exercises | 262 | ||
| Bridge exercises in supine | 262 | ||
| Quadruped | 262 | ||
| Side plank / horizontal side support | 263 | ||
| Front plank / prone bridge | 264 | ||
| Exercises on unstable surfaces | 264 | ||
| Motor Pattern Retraining / Functional Integration | 266 | ||
| Pilates / Yoga | 267 | ||
| Balance / Proprioception | 268 | ||
| Higher Level Strengthening Exercises | 269 | ||
| Exercise Parameters | 270 | ||
| Conclusion | 271 | ||
| References | 271 | ||
| 24 Sacroiliac Joint as a Source of Pain: | 274 | ||
| Chapter Contents | 274 | ||
| Introduction | 274 | ||
| Prevalence | 274 | ||
| Economic impact | 275 | ||
| Anatomy and Biomechanics | 275 | ||
| Pathology and Pathomechanics | 277 | ||
| Diagnosis | 277 | ||
| Medical diagnosis | 277 | ||
| Clinical diagnosis: subjective examination | 278 | ||
| Clinical diagnosis: physical examination | 278 | ||
| Clinical examination summary | 283 | ||
| Prognosis | 283 | ||
| Treatment | 284 | ||
| Exercise therapy | 284 | ||
| Manual therapy | 286 | ||
| Sacroiliac belts | 288 | ||
| Conclusion | 288 | ||
| References | 288 | ||
| 4 The shoulder region in upper extremity pain syndromes | 291 | ||
| 25 Acromioclavicular Joint | 293 | ||
| Chapter Contents | 293 | ||
| Introduction | 293 | ||
| Anatomy of the Acromioclavicular Joint | 293 | ||
| Biomechanics of the Acromioclavicular Joint | 293 | ||
| Pathology of the Acromioclavicular Joint | 294 | ||
| Diagnosis of the Acromioclavicular Joint | 295 | ||
| Management of the Acromioclavicular Joint | 298 | ||
| Conclusion | 299 | ||
| References | 300 | ||
| 26 Sternoclavicular Joint | 302 | ||
| Chapter Contents | 302 | ||
| Introduction | 302 | ||
| Anatomy of the Sternoclavicular Joint | 302 | ||
| Biomechanics of the Sternoclavicular Joint | 304 | ||
| Pathology of the Sternoclavicular Joint | 304 | ||
| Patients requiring a medical / surgical consultation | 304 | ||
| Patients with indication for physical therapy intervention | 305 | ||
| Diagnosis of the Sternoclavicular Joint | 305 | ||
| Management of the Sternoclavicular Joint | 306 | ||
| Anterior disc / manubrial rotation mobilization (left shoulder) | 306 | ||
| Posterior disc / manubrial rotation mobilization (left shoulder) | 306 | ||
| Inferior clavicular / disc glide (right shoulder) | 306 | ||
| Posterior clavicular / disc glide (right shoulder) | 306 | ||
| Adjunct exercises | 307 | ||
| Conclusion | 307 | ||
| References | 307 | ||
| 27 Rotator Cuff Lesions: Shoulder Impingement | 309 | ||
| Chapter Contents | 309 | ||
| Introduction | 309 | ||
| Anatomy | 309 | ||
| Biomechanics | 310 | ||
| Pathology of the Rotator Cuff | 311 | ||
| Diagnosis of Shoulder Impingement | 313 | ||
| Prognosis | 315 | ||
| Management | 315 | ||
| Conclusion | 318 | ||
| References | 318 | ||
| 28 Glenohumeral Instability | 321 | ||
| Chapter Contents | 321 | ||
| Introduction | 321 | ||
| Anatomy | 321 | ||
| Biomechanics | 322 | ||
| Pathology | 323 | ||
| Diagnosis of Glenohumeral Instability | 325 | ||
| History | 325 | ||
| Examination | 325 | ||
| Stability tests | 326 | ||
| Apprehension test | 326 | ||
| Relocation test | 326 | ||
| Surprise (release) test | 326 | ||
| Laxity tests | 326 | ||
| NAIOMT SGHL / CHL test | 326 | ||
| NAIOMT MGHL test | 327 | ||
| NAIOMT IGHL test | 327 | ||
| NAIOMT posterior capsule test | 327 | ||
| NAIOMT sulcus stability test for AB- / PB-IGHL and inferior labrum | 328 | ||
| Imaging | 328 | ||
| Prognosis | 329 | ||
| Clinical risk factors | 329 | ||
| Anatomical risk factors | 330 | ||
| Management of Glenohumeral Instability | 330 | ||
| Conclusion | 331 | ||
| References | 331 | ||
| 29 Superior Labrum Anterior-to-Posterior (SLAP) Lesions | 333 | ||
| Chapter Contents | 333 | ||
| Introduction | 333 | ||
| Anatomy | 334 | ||
| Biomechanics | 335 | ||
| Pathology | 336 | ||
| Diagnosis | 337 | ||
| Management | 340 | ||
| Prognosis | 341 | ||
| Conclusion | 341 | ||
| References | 342 | ||
| 30 Frozen Shoulder | 344 | ||
| Chapter Contents | 344 | ||
| Introduction | 344 | ||
| Incidence | 344 | ||
| Pathology | 344 | ||
| Natural History and Prognosis | 345 | ||
| Diagnosis | 346 | ||
| History | 346 | ||
| Physical examination | 347 | ||
| Treatment | 347 | ||
| Recalcitrant frozen shoulders | 348 | ||
| Prevention of frozen shoulder | 348 | ||
| Conclusion | 348 | ||
| References | 349 | ||
| 31 Joint Mobilization of the Shoulder | 350 | ||
| Chapter Contents | 350 | ||
| Introduction | 350 | ||
| Passive Mobilization Interventions of the Glenohumeral Joint | 350 | ||
| Inferior glide (Fig. 31.1) | 351 | ||
| Posterior glide (Fig. 31.2) | 351 | ||
| Posterior glide in flexion (Fig. 31.3) | 352 | ||
| Inferior and anterior glide (Fig. 31.4) | 352 | ||
| Anteroposterior or lateral–medial glide at end-of-range elevation (Fig. 31.5) | 352 | ||
| Mobilization with Movement of the Shoulder Complex | 352 | ||
| Overhead elevation mobilizations with movement | 353 | ||
| Mobilization with movement – elevation (Fig. 31.6) | 353 | ||
| Mobilization with movement – elevation, belt assisted (Fig. 31.7) | 354 | ||
| Overhead elevation: progression of range of motion | 354 | ||
| Mobilization with movement – end-range elevation (external rotation) (Fig. 31.8) | 354 | ||
| Mobilization with movement – end-range elevation (inferior glide) (Fig. 31.9) | 354 | ||
| Mobilization with movement – elevation (shoulder girdle) (Fig. 31.10) | 355 | ||
| Hand behind back | 355 | ||
| Mobilization with movement – hand behind back (Fig. 31.11) | 355 | ||
| Mobilization with movement – hand behind back, belt assisted (Fig. 31.12) | 355 | ||
| Horizontal adduction motion | 356 | ||
| Mobilization with movement – horizontal adduction (AC / SC joints) | 356 | ||
| Spinal mobilization with upper extremity movement – horizontal adduction (Fig. 31.14) | 356 | ||
| Conclusion | 357 | ||
| References | 357 | ||
| 32 Motor Control of the Shoulder Region | 358 | ||
| Chapter Contents | 358 | ||
| Introduction | 358 | ||
| Motor Control | 358 | ||
| Motor control and joint stability | 358 | ||
| Evidence of altered motor control around the scapula | 359 | ||
| Evidence of altered motor control around the glenohumeral joint | 360 | ||
| Evaluation of Motor Control around the Shoulder Girdle | 360 | ||
| Postural assessment | 360 | ||
| Evaluation of movement impairments and awareness | 361 | ||
| Evaluation of specific motor control impairments around the scapula | 364 | ||
| Shoulder shrug (Roberts 2009) | 364 | ||
| Scapular control through glenohumeral rotations in prone and supine (Sahrmann 2002) | 364 | ||
| Scapular PNF patterns (Voss et al 1985) | 365 | ||
| Evaluation of range and control of scapular upward rotation | 365 | ||
| Evaluation in four-point kneeling | 365 | ||
| Evaluation of thoracic extension and control of scapular retraction | 366 | ||
| Evaluation of isolated motor control around the shoulder | 366 | ||
| Dynamic rotary stability test (Magarey & Jones 2003a, 2003b) | 366 | ||
| Dynamic relocation test (Magarey & Jones 2003a, 2003b) | 367 | ||
| Management of Motor Control Impairments around the Shoulder Girdle | 367 | ||
| Management of shoulder motor control through patient examples | 368 | ||
| Conclusion | 371 | ||
| References | 371 | ||
| 33 Therapeutic Exercises for the Shoulder Region | 373 | ||
| Chapter Contents | 373 | ||
| Introduction | 373 | ||
| Clinical Background | 373 | ||
| Shoulder Exercise: Evidence | 374 | ||
| Principles of Exercise | 374 | ||
| Posture | 376 | ||
| Stretching | 376 | ||
| Isometric Exercise of the Shoulder | 378 | ||
| Isotonic Exercises of the Shoulder | 378 | ||
| Supraspinatus muscle | 379 | ||
| Infraspinatus and teres minor muscles | 379 | ||
| Subscapularis muscle | 380 | ||
| Trapezius muscle | 380 | ||
| Serratus anterior muscle | 381 | ||
| Functional Exercises | 381 | ||
| Conclusion | 383 | ||
| Acknowledgements | 383 | ||
| References | 383 | ||
| 5 The hip region in lower extremity pain syndromes | 387 | ||
| 34 Hip Osteoarthritis | 389 | ||
| Chapter Contents | 389 | ||
| Introduction | 389 | ||
| Prevalence | 389 | ||
| Economic Impact | 390 | ||
| Anatomy | 390 | ||
| Pathomechanics | 390 | ||
| Diagnosis | 390 | ||
| Risk factors | 391 | ||
| Clinical presentation | 392 | ||
| Prognosis | 392 | ||
| Treatment | 392 | ||
| Non-pharmacological treatment | 392 | ||
| Patient education | 393 | ||
| Exercise therapy | 393 | ||
| Manual therapy | 393 | ||
| Indirect distraction manipulation (Fig. 34.1) | 394 | ||
| Posterior-to-anterior mobilization of the hip (Fig. 34.2) | 394 | ||
| Posterior-to-anterior mobilization – ‘figure 4’ position (Fig. 34.3) | 394 | ||
| References | 394 | ||
| 35 Other Hip Disorders: | 397 | ||
| Chapter Contents | 397 | ||
| Introduction | 397 | ||
| Iliotibial Band Syndrome | 397 | ||
| Epidemiology | 397 | ||
| Pathomechanics | 397 | ||
| Diagnosis and clinical examination | 398 | ||
| Manual therapy treatment | 398 | ||
| Prognosis | 399 | ||
| Summary | 399 | ||
| Hip Flexor Tendinopathy (Internal Snapping Hip Syndrome) | 400 | ||
| Epidemiology | 400 | ||
| Pathomechanics | 400 | ||
| Diagnosis and clinical examination | 400 | ||
| Treatment | 400 | ||
| Prognosis | 401 | ||
| Summary | 401 | ||
| Gluteus Medius Tendinopathy | 401 | ||
| Epidemiology | 401 | ||
| Pathomechanics | 401 | ||
| Patient history | 402 | ||
| Diagnosis and clinical examination | 402 | ||
| Functional movement testing | 402 | ||
| Treatment | 403 | ||
| Prognosis | 404 | ||
| Summary | 405 | ||
| Adductor Tendinopathy | 405 | ||
| Epidemiology | 405 | ||
| Pathomechanics | 405 | ||
| Patient history | 405 | ||
| Diagnosis | 406 | ||
| Treatment | 406 | ||
| Summary | 407 | ||
| Sports Hernia | 407 | ||
| Epidemiology | 407 | ||
| Pathomechanics | 408 | ||
| Diagnosis and clinical examination | 408 | ||
| Treatment | 409 | ||
| Prognosis | 409 | ||
| Summary | 409 | ||
| Conclusion | 409 | ||
| References | 410 | ||
| 36 Postoperative Management of Hip Disorders | 413 | ||
| Chapter Contents | 413 | ||
| Introduction and Overview | 413 | ||
| Hip Disorders and Arthroscopic Surgical Procedures | 413 | ||
| Femoroacetabular impingement | 413 | ||
| Pincer-type impingement: definition and arthroscopic intervention | 413 | ||
| Cam-type impingement: definition and arthroscopic intervention | 414 | ||
| Chondral defects | 414 | ||
| Capsular and ligamentous structures | 414 | ||
| Postoperative considerations | 415 | ||
| Precautions | 415 | ||
| Labral debridement with / without rim trimming and arthroscopy in general | 415 | ||
| Precautions for acetabular labral debridement | 415 | ||
| Femoroplasty | 415 | ||
| Precautions for femoroplasty | 415 | ||
| Acetabular labral repair | 415 | ||
| Precautions for acetabular labral repair | 415 | ||
| Capsular modification | 415 | ||
| Precautions for capsular modification | 416 | ||
| Micro-fracture | 416 | ||
| Precautions for micro-fracture | 416 | ||
| Phases of Rehabilitation of Hip Disorders | 416 | ||
| Maximum protection phase: day of surgery (day 0) to postoperative day 14 | 416 | ||
| Moderate protection phase: 2–6 weeks postoperative | 416 | ||
| Minimal protection phase: 6–12 weeks postoperative | 417 | ||
| Return to sport or daily life activities phase: 12–24 weeks postoperative | 418 | ||
| An Example Acetabular Labral Repair with Femoroplasty Postoperative Progression | 418 | ||
| Weeks 0–2 | 418 | ||
| Weeks 2–4 | 418 | ||
| Weeks 4–6 | 419 | ||
| Weeks 6–12 | 419 | ||
| Weeks 12–24 | 419 | ||
| References | 419 | ||
| 37 Joint Mobilization and Manipulation of the Hip | 421 | ||
| Chapter Contents | 421 | ||
| Introduction | 421 | ||
| Joint Mobilization/Manipulation of the Hip Joint | 421 | ||
| Longitudinal traction mobilization / manipulation | 422 | ||
| Lateral distraction mobilization | 422 | ||
| Flexion / adduction mobilization: mobilization with movement internal rotation non-weight-bearing | 423 | ||
| Flexion / adduction mobilization: mobilization with movement internal rotation weight-bearing | 423 | ||
| Mobilization with movement in flexion | 424 | ||
| Mobilization with movement in extension weight-bearing | 424 | ||
| References | 425 | ||
| 38 Therapeutic Exercises for the Lower Quadrant | 426 | ||
| Chapter Contents | 426 | ||
| Introduction | 426 | ||
| Muscle Performance: Activation, Endurance and Strength | 427 | ||
| Neuromotor Control: Balance, Proprioception, Movement Repatterning and Functional Integration | 431 | ||
| Mobility, Myofascial and Articular Impairments | 432 | ||
| Designing an Evidence-informed Exercise Programme | 434 | ||
| Mobility exercises | 435 | ||
| Muscle performance and neuromuscular control exercises | 437 | ||
| Phase 1 | 437 | ||
| Phase 2 | 437 | ||
| Phase 3 | 439 | ||
| Exercise Parameters | 440 | ||
| Conclusion | 441 | ||
| References | 441 | ||
| 6 The elbow region in upper extremity pain syndromes | 443 | ||
| 39 Elbow Tendinopathy: | 445 | ||
| Chapter Contents | 445 | ||
| Introduction | 445 | ||
| Diagnostic Considerations | 445 | ||
| Pathological Considerations | 446 | ||
| Prognostic Considerations | 447 | ||
| Considerations in Conservative Treatment | 447 | ||
| Conclusion | 448 | ||
| References | 448 | ||
| 40 Other Elbow Disorders: | 451 | ||
| Chapter Contents | 451 | ||
| Introduction | 451 | ||
| Elbow Instability | 451 | ||
| Anatomy review for elbow instability | 451 | ||
| General treatment planning guidelines for elbow instability | 451 | ||
| Lateral elbow instability | 452 | ||
| Anatomy review for lateral elbow instability | 452 | ||
| Incidence / prevalence of lateral elbow instability | 452 | ||
| Pathology / pathoanatomy of lateral elbow instability | 452 | ||
| Diagnosis of lateral elbow instability | 452 | ||
| Prognosis and treatment planning for patients with lateral elbow instability | 453 | ||
| Medial elbow instability | 454 | ||
| Anatomy review for medial elbow instability | 454 | ||
| Incidence / prevalence of medial elbow instability | 454 | ||
| Pathology / pathoanatomy of medial elbow instability | 454 | ||
| Diagnosis of medial elbow instability | 454 | ||
| Prognosis and treatment planning for patients with medial elbow instability | 455 | ||
| Arthritic Conditions | 455 | ||
| Anatomy review for arthritic conditions of the elbow | 455 | ||
| Incidence / prevalence of arthritic conditions of the elbow | 455 | ||
| Pathology / pathoanatomy of arthritic conditions of the elbow | 456 | ||
| Diagnosis of arthritic conditions of the elbow | 456 | ||
| Prognosis and treatment planning for patients with arthritic conditions of the elbow | 456 | ||
| Conclusion | 457 | ||
| References | 457 | ||
| 41 Joint Mobilization and Manipulation of the Elbow | 458 | ||
| Chapter Contents | 458 | ||
| Introduction | 458 | ||
| Evidence-based Decision Making | 458 | ||
| Definitions and Clinical Applications | 459 | ||
| Mobilization and Manipulation Techniques | 460 | ||
| Mobilization in extension combined with adduction (varus mobilization) | 460 | ||
| Mobilization in adduction and abduction (varus to valgus mobilization) | 460 | ||
| Mobilization in pronation / supination combined with flexion | 461 | ||
| Mobilization of the radiohumeral joint | 461 | ||
| Lateral glide mobilization with movement | 462 | ||
| Manipulation in lateral glide of the elbow (varus thrust manipulation) | 462 | ||
| Conclusion | 462 | ||
| References | 462 | ||
| 7 The knee region in lower extremity pain syndromes | 465 | ||
| 42 Ligamentous and Meniscal Injuries of the Knee | 467 | ||
| Chapter Contents | 467 | ||
| Introduction | 467 | ||
| Anterior Cruciate Ligament | 467 | ||
| Anatomy | 467 | ||
| Biomechanics | 467 | ||
| Incidence / prevalence of injury | 468 | ||
| Biomechanical / neuromuscular risk factors | 468 | ||
| Trunk | 468 | ||
| Hip | 469 | ||
| Knee | 470 | ||
| Ankle / foot | 470 | ||
| Posterior Cruciate Ligament | 470 | ||
| Anatomy | 470 | ||
| Biomechanics | 470 | ||
| Incidence / prevalence of injury | 470 | ||
| Mechanism of injury / risk factors | 470 | ||
| Lateral Collateral Ligament | 471 | ||
| 8 The wrist and hand regions in upper extremity pain syndromes | 543 | ||
| 48 Tendinopathies of the Wrist and Hand | 545 | ||
| Chapter Contents | 545 | ||
| Introduction | 545 | ||
| Definition of Tendinopathy | 545 | ||
| Aetiology | 546 | ||
| Anatomy of the Tendon | 546 | ||
| Basic components | 546 | ||
| Blood and nerve supply | 546 | ||
| Pathoanatomy | 547 | ||
| Tendon injury | 547 | ||
| Tendon healing | 547 | ||
| Tendinopathy Classification | 548 | ||
| Tendinosis | 548 | ||
| Tendinitis | 548 | ||
| Paratenonitis | 548 | ||
| Combined paratenonitis and tendinosis | 548 | ||
| Examination and Diagnosis | 549 | ||
| Clinical tests | 549 | ||
| Diagnostic imaging and invasive testing | 549 | ||
| Tendinopathic Entities of the Hand and Wrist | 550 | ||
| Flexor carpi ulnaris | 550 | ||
| Testing | 550 | ||
| Differential diagnosis | 550 | ||
| Extensor carpi ulnaris | 550 | ||
| 9 The foot and ankle in lower extremity pain syndromes | 603 | ||
| 54 Ankle Sprains | 605 | ||
| Chapter Contents | 605 | ||
| Introduction | 605 | ||
| Anatomy and Physiology | 605 | ||
| Distal tibiofibular joint | 605 | ||
| Talocrural joint | 606 | ||
| Subtalar joint | 606 | ||
| Biomechanics of the ankle | 606 | ||
| Range of motion | 607 | ||
| Open-packed and closed-packed positions | 607 | ||
| Axes of rotation / osteokinematics | 607 | ||
| Arthrokinematics | 607 | ||
| Lateral Ankle Sprains | 607 | ||
| Medial Ankle Sprains / Syndesmotic Injuries | 607 | ||
| Chronic Ankle Instability | 608 | ||
| Examination | 608 | ||
| Ottawa ankle rules | 608 | ||
| Subjective history | 608 | ||
| Ankle range of motion | 609 | ||
| Anterior drawer test | 609 | ||
| Medial talar tilt test | 609 | ||
| Figure-of-eight test | 609 | ||
| Functional testing | 610 | ||
| Single-limb balance | 610 | ||
| Star excursion balance test | 610 | ||
| Conservative Treatment | 610 | ||
| Thrust and non-thrust joint mobilization | 610 | ||
| Anterior–posterior non-thrust mobilization (see Fig. 57.2) | 611 | ||
| Lateral–medial non-thrust mobilization (see also Figs 57.3–57.5) | 611 | ||
| Talocrural joint lateral glide | 611 | ||
| Subtalar joint lateral glide | 611 | ||
| Rearfoot distraction thrust manipulation (see also Fig. 57.1) | 611 | ||
| Distal tibiofibular joint non-thrust mobilization (see Fig. 57.7) | 612 | ||
| Proximal tibiofibular joint thrust manipulation (see also Fig. 57.6) | 612 | ||
| Weight-bearing dorsiflexion mobilization with movement (see also Fig. 57.4B) | 612 | ||
| Cuboid whip thrust manipulation (see also Fig. 57.8) | 612 | ||
| Therapeutic exercise | 613 | ||
| Mobility exercise | 613 | ||
| Strengthening | 613 | ||
| Proprioceptive exercises | 613 | ||
| References | 613 | ||
| 55 Plantar Heel Pain | 616 | ||
| Chapter Contents | 616 | ||
| Introduction | 616 | ||
| Prevalence | 616 | ||
| Origin of plantar heel pain | 616 | ||
| Anatomical considerations | 616 | ||
| Pathology of Plantar Heel Pain | 616 | ||
| Diagnosis | 617 | ||
| Symptoms | 617 | ||
| Signs | 617 | ||
| Imaging | 617 | ||
| Risk Factors | 618 | ||
| Prognosis | 618 | ||
| Management Strategies for Plantar Heel Pain | 618 | ||
| Non-invasive manual therapy for plantar heel pain | 618 | ||
| Invasive manual therapy for plantar heel pain – dry needling | 620 | ||
| Conclusion and Recommendations | 621 | ||
| References | 621 | ||
| 56 Postoperative Management of Foot and Ankle Disorders | 623 | ||
| Chapter Contents | 623 | ||
| 10 Soft tissues in the upper and lower quadrants | 657 | ||
| 59 Referred Pain from Myofascial Trigger Points | 659 | ||
| Chapter Contents | 659 | ||
| Introduction | 659 | ||
| Myofascial Trigger Points | 660 | ||
| Definition of a trigger point | 660 | ||
| Characteristics of the referred pain elicited by muscle trigger points | 660 | ||
| Manual identification of myofascial trigger points | 660 | ||
| Neurophysiological basis of myofascial trigger points | 661 | ||
| TrPs: are they a focus of peripheral sensitization? | 661 | ||
| TrPs and central sensitization mechanisms | 661 | ||
| TrPs and the sympathetic nervous system | 661 | ||
| TrPs: the integrated hypothesis | 662 | ||
| Exploration of Trigger Points Related to Upper Quadrant Pain Syndromes | 662 | ||
| Neck–shoulder muscles | 662 | ||
| Scalene muscles | 663 | ||
| Pectoralis minor muscle | 663 | ||
| Supraspinatus muscle | 664 | ||
| Infraspinatus muscle | 664 | ||
| Teres minor and major muscles | 665 | ||
| Subscapularis muscle | 665 | ||
| Pectoralis major muscle | 665 | ||
| Deltoid muscle | 666 | ||
| Biceps brachii muscle | 666 | ||
| Triceps brachii muscle | 666 | ||
| Brachioradialis muscle | 667 | ||
| Supinator muscle | 667 | ||
| Wrist / hand extensor muscles | 667 | ||
| Pronator teres muscle | 669 | ||
| Wrist / hand flexor muscles | 669 | ||
| Other muscles of the upper quadrant | 670 | ||
| Exploration of Trigger Points Related to Lower Quadrant Pain Syndromes | 670 | ||
| Quadratus lumborum muscle | 670 | ||
| Psoas major muscle | 670 | ||
| Piriformis muscle | 671 | ||
| Gluteus medius muscle | 671 | ||
| Gluteus minimus muscle | 671 | ||
| Quadriceps muscle | 672 | ||
| Adductor muscles | 672 | ||
| Gastrocnemius and soleus muscles | 672 | ||
| Tibialis anterior, extensor digitorum longus and extensor hallucis longus muscles | 673 | ||
| Other muscles of the lower quadrant | 673 | ||
| Conclusion | 673 | ||
| References | 673 | ||
| 60 Manual Treatment of Myofascial Trigger Points | 678 | ||
| Chapter Contents | 678 | ||
| Introduction | 678 | ||
| Treatment interventions for myofascial trigger points | 678 | ||
| Best evidence of manual therapies for myofascial trigger points | 679 | ||
| Manual Therapies for the Management of Myofascial Trigger Points | 679 | ||
| Compression interventions | 679 | ||
| Massage therapies | 680 | ||
| Stretching interventions | 680 | ||
| Dynamic interventions | 680 | ||
| Clinical Applications of Manual Therapies over Myofascial TrPs | 681 | ||
| Stretching compression of levator scapulae muscle taut band | 681 | ||
| Longitudinal strokes of scalene muscle taut band | 681 | ||
| Compression and contraction of supraspinatus muscle | 681 | ||
| Stretching strokes of infraspinatus muscle taut band | 682 | ||
| Stretching longitudinal strokes of infraspinatus muscle taut band | 682 | ||
| Stretching compression of teres major muscle taut band | 682 | ||
| Stretching compression of subscapularis muscle taut band | 683 | ||
| Dynamic transverse strokes of deltoid muscle trigger points | 683 | ||
| Dynamic longitudinal strokes of biceps / triceps brachii muscle taut band | 683 | ||
| Dynamic longitudinal strokes of hand / wrist extensor muscle taut band | 684 | ||
| Transverse massage of hand / wrist flexor muscle trigger points | 684 | ||
| Stretching compression of thumb muscles taut bands | 684 | ||
| Transverse massage of quadratus lumborum muscle taut bands | 685 | ||
| Post-isometric relaxation of quadratus lumborum muscle taut bands | 685 | ||
| Stretching compression of psoas major muscle taut bands | 686 | ||
| Stretching longitudinal stroke / dynamic longitudinal stroke of gluteus medius muscle taut bands | 686 | ||
| Stretching longitudinal stroke of quadriceps muscle taut bands | 687 | ||
| Stretching longitudinal massage of adductor muscle taut bands | 687 | ||
| Stretching compression of gastrocnemius muscle taut bands | 687 | ||
| Compression and contraction of anterior–lateral leg muscles | 687 | ||
| Conclusion | 688 | ||
| References | 688 | ||
| 61 Dry Needling of Trigger Points | 690 | ||
| Chapter Contents | 690 | ||
| Introduction to Trigger Point Dry Needling | 690 | ||
| Scientific Evidence of Dry Needling | 691 | ||
| General Guidelines for Dry Needling | 692 | ||
| Dry Needling of Selected Neck, Shoulder and Arm Muscles | 693 | ||
| Scalene muscles | 693 | ||
| Pectoralis minor muscle | 693 | ||
| Pectoralis major muscle | 693 | ||
| Supraspinatus muscle | 693 | ||
| Infraspinatus / teres major / teres minor muscles | 694 | ||
| Rhomboid major and minor muscles | 694 | ||
| Subscapularis muscle | 694 | ||
| Latissimus dorsi muscle | 695 | ||
| Deltoid muscle | 695 | ||
| Biceps brachii muscle | 696 | ||
| Brachialis muscle | 696 | ||
| Brachioradialis muscle | 696 | ||
| Supinator muscle | 696 | ||
| Wrist and finger extensor muscles | 697 | ||
| Dry Needling of Selected Trunk Muscles | 697 | ||
| Thoracic and lumbar multifidus muscles | 697 | ||
| Longissimus thoracis muscle | 698 | ||
| Quadratus lumborum muscle | 698 | ||
| Rectus abdominis muscle | 698 | ||
| External and internal oblique muscles | 699 | ||
| Dry Needling of Selected Hip and Leg Muscles | 700 | ||
| Gluteus maximus muscle | 700 | ||
| Gluteus medius muscle | 700 | ||
| Gluteus minimus muscle | 700 | ||
| Piriformis muscle | 700 | ||
| Adductor longus muscle | 701 | ||
| Adductor brevis muscle | 701 | ||
| Adductor magnus muscle | 701 | ||
| Pectineus muscle | 702 | ||
| Psoas major muscle | 702 | ||
| Iliacus muscle | 703 | ||
| Quadriceps femoris muscle group | 703 | ||
| Rectus femoris muscle | 703 | ||
| Vastus lateralis muscle | 704 | ||
| Vastus medialis muscle | 704 | ||
| Biceps femoris muscle | 704 | ||
| Semimembranosus muscle | 705 | ||
| Semitendinosus muscle | 705 | ||
| Tibialis anterior muscle | 705 | ||
| Gastrocnemius muscle | 705 | ||
| Soleus muscle | 706 | ||
| Flexor digitorum longus muscle | 706 | ||
| Fibularis (peroneus) longus and brevis muscles | 707 | ||
| References | 707 | ||
| 62 Muscle Energy Approaches | 710 | ||
| Chapter Contents | 710 | ||
| Introduction | 710 | ||
| Evidence of effectiveness | 710 | ||
| Physiological mechanisms | 711 | ||
| An integrated approach to muscle energy | 711 | ||
| Principles of Muscle Energy Application | 712 | ||
| General principles | 712 | ||
| Cautions and contraindications | 712 | ||
| Techniques for the Spine, Rib Cage and Pelvis | 712 | ||
| Principles of application of muscle energy to the joints of the spine | 713 | ||
| Spinal coupled motion | 713 | ||
| Variations of application | 713 | ||
| Applications for acute dysfunctions | 714 | ||
| Applications to promote proprioception and control | 714 | ||
| Cervical spine | 714 | ||
| Typical cervical (C2–C7) segments | 714 | ||
| Procedure for restriction of flexion, side-bending and rotation (Fig. 62.1, main photo) | 714 | ||
| Procedure for restriction of extension, side-bending and rotation (Fig. 62.1, inset photo) | 715 | ||
| Atlanto-axial (C1–C2) segment | 715 | ||
| Procedure for restricted C1–C2 rotation (Fig. 62.2) | 715 | ||
| Occipito-atlanto (C0–C1) segment | 716 | ||
| Procedure for single-plane restricted flexion (or extension) (Fig. 62.3, main photo) | 716 | ||
| Procedure for multiple-plane restriction: flexion (or extension), lateral flexion and contralateral rotation (Fig. 62.3, inset photo below) | 716 | ||
| Thoracic spine | 716 | ||
| Restriction of flexion combinations | 717 | ||
| Procedure for restriction of flexion, with or without concurrent restrictions of rotation and side-bending (Fig. 62.4, mid–low thoracic segments; inset: upper thoracic segments) | 717 | ||
| Restriction of extension combinations | 717 | ||
| Procedure for restriction of extension, with or without concurrent restrictions of rotation and side-bending (Fig. 62.5, mid–low thoracic segments; inset: upper thoracic segments) | 717 | ||
| Alternative procedure for restriction of extension, with or without concurrent restrictions of rotation and side-bending (Fig. 62.6, mid–low thoracic segments; inset: upper thoracic segments) | 717 | ||
| Rib cage | 718 | ||
| Restriction of inhalation | 718 | ||
| Procedure for restricted inhalation motion (Fig. 62.7) | 718 | ||
| Restriction of exhalation | 719 | ||
| Elevated first rib | 719 | ||
| Procedure for elevated first rib (Fig. 62.8) | 719 | ||
| Acute rib dysfunction | 719 | ||
| Lumbar spine | 720 | ||
| Restriction of uniplanar motion | 720 | ||
| Restriction of flexion combinations | 720 | ||
| Procedure for restriction of flexion, rotation and side-bending (Fig. 62.11) | 720 | ||
| Restriction of extension combinations | 721 | ||
| Procedure for restriction of extension, rotation and side-bending (Fig. 62.12) | 721 | ||
| Pelvic girdle | 721 | ||
| Restriction of innominate anterior rotation | 722 | ||
| Procedure for restriction of innominate anterior rotation (Fig. 62.13) | 722 | ||
| Restriction of innominate posterior rotation | 722 | ||
| Procedure for restriction of innominate posterior rotation (Fig. 62.14) | 722 | ||
| Sacroiliac ‘gapping’ technique | 723 | ||
| Techniques for Myofascial Tissues | 723 | ||
| Principles of application of muscle energy to myofascial tissues | 723 | ||
| Muscles of the upper quadrant | 724 | ||
| Upper trapezius and levator scapulae muscles | 724 | ||
| Scalene muscles | 724 | ||
| Pectoralis major muscle | 724 | ||
| Pectoralis minor muscle | 724 | ||
| Subscapularis muscle | 725 | ||
| Latissimus dorsi muscle | 725 | ||
| Muscles of the lower quadrant | 726 | ||
| Quadratus lumborum muscle | 726 | ||
| Hip flexor muscle group | 726 | ||
| Gluteus medius and gluteus minimus muscles | 726 | ||
| Piriformis muscle | 726 | ||
| Acknowledgements | 727 | ||
| References | 727 | ||
| 63 Myofascial Induction Approaches | 729 | ||
| Chapter Contents | 729 | ||
| Introduction | 729 | ||
| Fascia and its Dynamics | 730 | ||
| Functions of the fascial system | 730 | ||
| Information transmission process | 730 | ||
| Mechanical (anatomical) pattern | 730 | ||
| Functional pattern | 731 | ||
| Chemical pattern | 731 | ||
| Anatomical Considerations Related to the Continuity of the Fascial System of the Neck and Upper Extremity | 732 | ||
| Fascial anatomy of the cervical region | 732 | ||
| Superficial cervical fascia | 732 | ||
| Deep cervical fascia | 733 | ||
| Fascial anatomy of the upper extremity | 733 | ||
| The upper limb fascia superficial layer | 733 | ||
| Arm fascia deep layer | 734 | ||
| Front and anterior–lateral span | 735 | ||
| Posterior and posterior–lateral span | 736 | ||
| Anatomical Considerations Related to the Continuity of the Fascial System of the Pelvis and Lower Extremity | 738 | ||
| Superficial and deep fascial anatomical links between the trunk and lower limbs | 738 | ||
| Superficial fascia (firmly attached to the skin) | 738 | ||
| Deep fascia (located directly under the superficial fascia) | 739 | ||
| Deep fascia of the thigh segment | 739 | ||
| Deep fascia of the leg segment | 740 | ||
| Deep fascia of the foot segment | 740 | ||
| Deep fascial intermuscular links | 740 | ||
| Thoracolumbar segment | 740 | ||
| Thigh segment | 741 | ||
| Leg and foot segment (Figs 63.34–63.39) | 741 | ||
| Knee joint and popliteal fossa segment | 743 | ||
| Theoretical Aspects Related to the Treatment of Myofascial Dysfunction Syndrome | 743 | ||
| Mechanics of myofascial dysfunction syndrome formation | 743 | ||
| Fascial entrapment areas | 744 | ||
| Proposed neurophysiological mechanisms of myofascial induction techniques | 745 | ||
| Piezoelectricity | 746 | ||
| Myofibroblast dynamics | 746 | ||
| Viscoelasticity | 746 | ||
| Scientific Evidence Related to the Results in the Myofascial Approach (Pilat 2014) | 747 | ||
| Research related to pathology | 747 | ||
| Clinical research in healthy subjects | 747 | ||
| Therapeutic Strategies Applied in the Myofascial Induction Process | 748 | ||
| General observations related to the therapeutic process | 748 | ||
| Definition of the myofascial induction therapy process | 748 | ||
| Bases for clinical applications | 748 | ||
| Assessment process | 748 | ||
| Clinical procedure principles (Pilat 2003, 2009, 2014) | 748 | ||
| Examples of Practical Applications for Upper Quadrant Disorders | 749 | ||
| Techniques related to the cervical spine | 749 | ||
| Clinical considerations (Pilat 2003) | 749 | ||
| Suboccipital induction (Fig. 63.47) | 749 | ||
| Suprahyoid region induction (Fig. 63.48) | 749 | ||
| Induction of the scalene muscles (Fig. 63.49) | 750 | ||
| Induction of the prevertebral fascia (Fig. 63.50) | 750 | ||
| Techniques related to the shoulder girdle | 750 | ||
| Clinical considerations (Pilat 2003) | 750 | ||
| Induction of the pectoralis and deltoid fascia (Fig. 63.51) | 750 | ||
| Induction of the clavipectoral and the pectoralis minor muscle fascia (Fig. 63.52) | 750 | ||
| Integrated induction of the arm (Fig. 63.53) | 751 | ||
| Induction of the spine of the scapula (Fig. 63.54) | 751 | ||
| Induction of the trapezius muscle (Fig. 63.55) | 751 | ||
| Techniques related to the brachial and antebrachial fascia | 752 | ||
| 11 Neurodynamics in the upper and lower quadrants | 763 | ||
| 64 Peripheral Nerve Mechanisms of Chronic Upper Limb Pain: Dynamics, Inflammation and Neurophysiology | 765 | ||
| Chapter Contents | 765 | ||
| Introduction | 765 | ||
| Anatomy of a Peripheral Nerve | 765 | ||
| Mechanical Properties of a Peripheral Nerve | 766 | ||
| Physical tests of nerve movement | 767 | ||
| In Vivo Measurements of Nerve Movement | 768 | ||
| Median nerve | 768 | ||
| Longitudinal nerve movement | 768 | ||
| Nerve compliance | 768 | ||
| Nerve loading | 769 | ||
| Transverse median nerve movement | 770 | ||
| Ulnar nerve | 770 | ||
| Nerve Movement Studies in Patients | 770 | ||
| Inflammation of a Peripheral Nerve | 771 | ||
| Causes of inflammation | 772 | ||
| Inflammation and the microenvironment of the nerve | 772 | ||
| Animal models of nerve inflammation | 772 | ||
| Neuritis model | 773 | ||
| Physiological Role of Inflammatory Mediators | 775 | ||
| Disruption of axoplasmic transport | 775 | ||
| Nervi Nervorum | 776 | ||
| Imaging Nerve Inflammation | 776 | ||
| Conclusion | 776 | ||
| References | 777 | ||
| 65 Clinical Neurodynamics of the Upper and Lower Quadrants | 781 | ||
| Chapter Contents | 781 | ||
| Introduction to Clinical Neurodynamics | 781 | ||
| Appropriate Terminology | 781 | ||
| Operational definitions | 782 | ||
| Clinical neurodynamics | 782 | ||
| Neurodynamic test | 782 | ||
| Neurogenic pain | 782 | ||
| Sensitizing movements | 782 | ||
| Differentiating movements | 782 | ||
| Sliders | 782 | ||
| Tensioners | 782 | ||
| Neurophysiology in Upper and Lower Quadrant Pain | 783 | ||
| Nerve sensitivity | 783 | ||
| Central nervous system processing in neurodynamic tests | 784 | ||
| Clinical Neuro-biomechanics in the Upper and Lower Quadrants | 784 | ||
| Neurodynamic Testing | 785 | ||
| Neurodynamic testing for the upper quadrant | 786 | ||
| ULNT1 (median) active test | 786 | ||
| ULNT1 (median) passive test | 786 | ||
| Indications for the ULNT1 | 788 | ||
| ULNT2 (median) active test | 788 | ||
| ULNT2 (median) passive test | 788 | ||
| ULNT2 (radial) active test | 789 | ||
| ULNT2 (radial) passive test | 789 | ||
| ULNT3 (ulnar) active test | 790 | ||
| ULNT3 (ulnar) passive test | 790 | ||
| Neurodynamic testing for the lower quadrant | 791 | ||
| Straight leg raise active test | 791 | ||
| Straight leg raise passive test | 791 | ||
| Indications for the straight leg raise test | 792 | ||
| Slump test | 792 | ||
| Side-lying slump test | 792 | ||
| Clinical Application of Neurodynamics in Upper and Lower Quadrants | 793 | ||
| Treatment | 795 | ||
| Conclusion | 796 | ||
| References | 796 | ||
| Index | 799 | ||
| A | 799 | ||
| B | 800 | ||
| C | 800 | ||
| D | 802 | ||
| E | 802 | ||
| F | 803 | ||
| G | 804 | ||
| H | 804 | ||
| I | 805 | ||
| J | 805 | ||
| K | 805 | ||
| L | 806 | ||
| M | 807 | ||
| N | 809 | ||
| O | 809 | ||
| P | 810 | ||
| Q | 811 | ||
| R | 811 | ||
| S | 812 | ||
| T | 814 | ||
| U | 815 | ||
| V | 816 | ||
| W | 816 | ||
| Y | 816 | ||
| Z | 816 |