Spine
Understanding Delayed-Onset Exercise-Induced Pain in Individuals with Chronic Pain Syndromes
Introduction Two patients with chronic musculoskeletal pain and Ehlers-Danlos Syndrome (EDS) recently demonstrated similar but unexpected responses to routine exercise interventions. Their experiences prompted me to reexamine my understanding of exercise-induced pain in individuals with chronic musculoskeletal conditions. Patient Case Studies Patient A: During a physical therapy session, a patient with EDS performed a spinal…
Read MoreAdjusting the exercise load to manage musculoskeletal pain syndrome
Adjusting the amount of exercise load involves seeking a balance between increasing or decreasing the load. Athletes and healthy individuals the bias is towards increasing the load to improve capacity and performance. For musculoskeletal injuries, post-orthopedic surgery, or musculoskeletal pain syndromes, the bias is towards decreasing the load to facilitate healing and recovery. Tactics to…
Read MoreHow does the natural progression of osteoarthritis influence the management of osteoarthritic flares?
Case Example: Over the last year, on several occasions, a patient has sought assistance for recurring flaring neck pain. Radiographs show moderate osteoarthritic (OA) changes in the cervical spine. A history of mild to moderate scoliosis of the spine has existed since childhood. Over the years, the neck pain has alternated from long periods of…
Read MoreOrthopedic surgery is not always necessary – coper vs non-coper
A diagnostic image such as an MRI can show significant structural damage such as a complete tear of the anterior cruciate ligament (ACL), a complete tear of the rotator cuff of the shoulder, a herniated spinal disc, or other musculoskeletal tissue damage. In 1983 Frank Noyes and colleagues in a seminal study of patients without…
Read MoreDeviant movement resulting in pain – Excessive Toe Out Gait
Asymmetrical movements walking or running are considered deviant or less than optimal movements. The individual in the video below is complaining of musculoskeletal pain in the left lower extremity. What do you see? Do you see the asymmetrical movement? Do you see the right foot is pointing straight ahead, and the left foot is not…
Read MoreUnderstanding the Nuances of Disease, Syndrome, & Uncertainty in Musculoskeletal Pain
Disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to an external injury. Syndrome is a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms. While disease and syndrome both involve…
Read MorePath of least resistance is not always the best option – sometimes it is better to have some stiffness
There are three possible relationships between movement and musculoskeletal pain syndromes. There is either too much movement, not enough movement, or an optimal amount of movement. When a muscle tendon unit and/or joint is flexible, hypermobile, or unstable there is too much movement. When a muscle tendon unit and/or joint is stiff or hypomobile there…
Read MorePain – Movement
If pain occurs with movement, then observation and analysis of movement is required. The measurement of the symptom of pain occurs using the familiar numeric pain scale (zero to 10). 0-10 Numeric pain scale diagram. Clipart image In 1996 the American Pain Society lead a campaign to consider the measurement of pain as the 5th…
Read More“Deme Bones” – inter-limb deviation related to the musculoskeletal pain syndromes
“The toe bone is connected to the foot bone” is the common reframe from the old gospel song “Dem Bones.” The concept of mechanical connectedness or regional interdependence applied to musculoskeletal pain syndromes suggests that in addition to examining a patient’s local area of complaint examination of the adjacent joints above and below the primary…
Read MoreShould we discharge from Physical Therapy
Why is the terminology “discharged from Physical Therapy” used? I have not heard of anyone being “discharged from dentistry”. I have not heard of anyone being discharged from massage therapy. The meaning of “discharge” is – to relieve of a charge, load, or burden; or to release from confinement, custody, or care; or to set…
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