International musculoskeletal medicine最新文献

{"title":"Professor Karel Lewit, MD, DrSc: an appreciation","authors":"A. Kobesova","doi":"10.1179/1753614614Z.00000000086","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000086","url":null,"abstract":"Professor Karel Lewit was born in 1916. He was forced to interrupt his studies at the Prague medical school because of World War II. He spent this time in the Czechoslovakian Army in England and later in France where he functioned as a member of the Czechoslovakian Armoured Brigade. In France, he met his beloved wife Iris, the charming young Englishwoman with whom he later spent over 60 years. Karel Lewit completed medical school in 1946 and began working at the Neurology Department under the legendary Professor Kamil Henner in the same year. Here, Professor Lewit found a unique setting for his work, which determined the rest of his career. Professor Henner brought the French style of clinical neurological assessment to Prague, mentoring young doctors but at the same time supporting them in their own studies and in the development of their own area of interest. It was no coincidence that not only Professor Lewit, but also two more ‘gurus’ of international rehabilitation, Professors Vojta and Janda came from the same clinic. Learning manipulation techniques, Karel realized that his treatment would have no permanent effect unless rehabilitation followed and the patient is educated in self-treatment. Closely working with neuroradiologist Professor Jirout, studying neuroradiology and functional pathology of the movement system, Karel soon understood that manipulation does not change the shape or the position of the structure but that via manipulative treatment he could change function in the musculoskeletal system. This led him to develop the whole self-treatment system for patients with pain in the musculoskeletal system that, with many modifications, is used worldwide now. Karel was the first clinician (probably not only in Czechoslovakia) introducing self-treatment techniques systematically. He also emphasized that the patient must leave the office with homework. His classic quotes are: ‘The one who knows a technique must not become the slave of it’, ‘For me, manipulation is a marginal type of treatment. The patient’s own muscles always do a better job than those of the best therapists. Therefore, we have to tailor the self-treatment for the specific patient and suggest an adequate selftreatment. If treatment is not helping it becomes frustrating: individual approach is critical’ (Figs. 1 and 2). Karel worked under Professor Henner for about 15 years, and after 1960 successfully continued his work at the various Neurology and Rehabilitation Departments in Czechoslovakia and later the Czech Republic. Progressively more lecturing and being involved in numerous research projects, Karel started to systematize his functional assessment and treatment techniques introducing a series of manipulative–rehabilitation–physiological courses together with Vladimir Janda and Frantisek Vele. In 1966, Karel published his first book called ‘Manipulative Treatment within a Context of Reflex Therapy’. The book that has been later rewritten many times, published in fi","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"125 - 127"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Karel Lewit: In memoriam","authors":"M. Hutson","doi":"10.1179/1753614614Z.00000000085","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000085","url":null,"abstract":"We are dedicating this issue of the journal to the life and work of Professor Karel Lewit, whose international recognition in the discipline of Manual Medicine and generosity to the physiotherapists, osteopaths, doctors, and chiropractors who were inspired by him is testament to his remarkable intellect, capabilities, and attention to the needs of all who met him, patients and clinicians. He was always supportive of the International Musculoskeletal Medicine, and the underlying principles of international cooperation, collaboration, and implementation of scientific evidence into clinical practice. Manual/Musculoskeletal medical practice has benefited enormously from his dedication to basic concepts and manual diagnostic and therapeutic techniques that he described and demonstrated so well. He will of course be sadly missed. This editorial is based on a presentation made by Professor Lewit in England some years ago. The exact location and date are not of relevance as the message is timeless. The slide texts used by Professor Lewit are followed by my commentary. Lewit: The examination and assessment of dysfunction of the motor system, by far the most frequent cause of so-called non-specific pain, cannot yet be done by apparatus, but only by those most sophisticated instruments, the human hands and eyes, and a little thought. Comment: The haptic experiences (for both doctor and patient) remain the core component of diagnosis in manual medicine, though exposure to palpatory techniques and cognitive responses to those techniques during medical training is extremely variable and often poor. Lewit: The problem of doctors. The modern Universities, proud of their scientific advance, impress their students with the latest achievements in genetics, molecular chemistry, and by the technical inventions. The student is crammed with theory, with technicalities, but lacks clinical experience. Comment: The technological revolution of recent years, particularly the emergence of imaging/scanning for soft tissue disorders is a potential and actual deterrent to the achievement of a high standard of manual diagnostics. Lewit: Only when he leaves hospital work does he realize standing on his own, that he has not been taught how to deal with the most common ailments, in particular with the ever increasing number of patients with ‘non-specific pain of the motor system’. He was never taught proper physical examination including palpation, or how to take a specific anamnesis, let alone how to think in terms of function. Comment: The conceptual basis of soft tissue dysfunction and ‘non-specific’ pain must be learned in combination with relevant examination techniques and exposure to patients as early as possible during training. Lewit: Many doctors then use manipulation only occasionally, using acupuncture, many types of physical therapy, applying it all mainly where the patient feels pain. Having reached a certain age, before getting involved in manual medicine, a few week","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"123 - 124"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness and tolerability of tension night splints for the treatment of patients with chronic plantar fasciitis – A case-series study","authors":"P. Wheeler","doi":"10.1179/1753615414Y.0000000032","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000032","url":null,"abstract":"Abstract Objective To study the subjective perceptions of benefits of the use of tension night splints (TNS) in a clinical population of patients with plantar fasciitis. Methods Twenty consecutive patients who were prescribed TNS were identified from clinical logs. These were contacted to understand their perception of benefit from the TNS and their outcome. Seventeen of 20 patients responded (85% response rate). Results There was a mean reduction in pain first thing in the morning of 2.8 points, and pain overall of 1.9 points on a 0–10 visual analogue scale. Overall function improved by 17 percentage points. However, compliance was limited with about one-third of patients having significant sleep disturbance while wearing the TNS, and 30% ceasing to wear the splint within 1 month. Discussion TNS appear to have a beneficial role in the treatment of chronic plantar fasciitis. However, the exact benefits remain unclear, and issues including patient comfort and tolerability can limit their use.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"51 1","pages":"130 - 136"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we dispensing nocebos to patients in pain?","authors":"P. Dieppe, M. Greville-harris","doi":"10.1179/1753614614Z.00000000083","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000083","url":null,"abstract":"A placebo is defined as a dummy or sham intervention that has no active (‘specific’) ingredient that can affect the target condition.1 Why and how it is that a dummy treatment can have a positive e...","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"128 - 129"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on systematic review of PRP injections for chronic lateral epicondylar tendinopathy","authors":"M. Yelland","doi":"10.1179/1753615414Y.0000000036","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000036","url":null,"abstract":"Abstract Background Chronic lateral epicondylar tendinopathy is frequent in athletes, and platelet-rich plasma (PRP) is being used increasingly in its treatment. Objective To systematically review the literature on the efficacy of PRP injections for chronic lateral epicondylar tendinopathy. Methods The databases of PubMed, EMBASE, CINAHL, Medline OvidSP, Scopus, Google Scholar, Web of Science, and Cochrane Library were searched in October 2013. Inclusion criteria were a clinical diagnosis of chronic lateral epicondylar tendinopathy, a randomized-controlled trial, an intervention with a PRP injection, and the outcome measures described in terms of pain and/or function. One author screened the search results and two authors independently assessed the study quality using the Physiotherapy Evidence Database (PEDro) score. A study was considered to be of high quality if its PEDro score was ≥6. A best evidence synthesis was used to identify the level of evidence. Results Six studies were included, of which four were considered to be of high quality. Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy. Conclusions There is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"154 - 155"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of injection therapy clinics performed by physiotherapists working in primary care","authors":"Gordon A. Smith, S. Meadows, J. Myers, Julie Reynolds, P. Woodhead","doi":"10.1179/1753615414Y.0000000033","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000033","url":null,"abstract":"Abstract Objectives To determine pain scores for injection therapy and to review the overall change in outcomes post-injection for a variety of musculoskeletal injections compared with the previous audits of a primary-care physiotherapy injection clinic. Methods Subjects were assessed using a numerical rating scale between 0 and 10 before and 4 weeks post-injection. Results All average pain scale scores were reduced 4 weeks after injection for all conditions. There is an overall average reduction in pain on provoking activity of 45.7%. Trigger finger/thumb (65%) demonstrated the most significant reduction in pain. Contrary to a common patient perception, injection therapy is not an exceptionally painful experience, with an average score of 3.2. Discussion Results are comparable with previous scores for injections carried out within the same primary-care physiotherapy clinic.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"878 1","pages":"150 - 153"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C-reactive protein, chronic low back pain and, diet and lifestyle","authors":"Kieran Macphail","doi":"10.1179/1753615415Y.0000000001","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000001","url":null,"abstract":"Abstract C-reactive protein (CRP) is best known as an acute phase protein and is typically assessed in most general blood work. High sensitivity CRP (hsCRP) may be a useful clinical marker of chronic inflammatory states in musculoskeletal conditions. It appears that it is raised in inflammatory chronic low back pain (CLBP) and associated with reduced pain thresholds, weakness, and reduced function. It is also possible CRP could contribute towards the development and maintenance of CLBP by activating the complement system, which increases peripheral nociception. Diet and lifestyle factors can promote raised CRP. An hsCRP level of <1 mg/l appears ideal, and the higher the level, the more emphasis should be placed on chronic inflammation as a contributor to symptoms. Diet and lifestyle can significantly reduce CRP levels and may be a useful adjunct in treating CLBP patients with elevated CRP. This might make CRP a useful clinical marker of inflammation in CLBP and a therapeutic target for diet and lifestyle interventions.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"29 - 32"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase II pilot study comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy in the management of chronic low back pain","authors":"Alex Daulat, Emily Goodlad","doi":"10.1179/1753615414Y.0000000034","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000034","url":null,"abstract":"Abstract Objectives To conduct a phase II pilot randomized controlled trial (RCT) comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy for the management of non-specific chronic low back pain (CLBP) and determine the feasibility for a larger RCT. Introduction There is moderate evidence for exercise combined with manual therapy in the treatment of CLBP. Patients with CLBP have decreased muscle power and cardiac capacity due to their low activity levels that leads to a de-conditioning syndrome and pain. This de-conditioning syndrome may be best addressed by total body strengthening. Methods Thirteen patients with CLBP were allocated to two groups by block randomization. Group A was the home total body strengthening programme plus manual therapy and group B was the standard physiotherapy exercise regimen plus manual therapy. Both groups received a course of manual therapy and a specific home exercise programme for 3 months. Three outcome measures pre- and post-treatment were used measuring function, pain, and quality of life. Results The treatment programmes in this pilot study were implemented successfully with a dropout rate of 19%. All the outcome measures used in this pilot study were responsive to change. Both groups showed a clinically important difference to function following treatment as well as improvements to pain and health-related quality of life. Conclusion The small sample size was one of the weaknesses of this pilot study. The findings from this pilot study suggest a future RCT is feasible to determine whether a home total body strengthening programme plus manual therapy is an effective management strategy for CLBP.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"87 - 95"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of shoulder joint Streptobacillus moniliformis septic arthritis with severe subdeltoid bursitis","authors":"Ashraf M. Fansa, M. Tanios, N. Ebraheim","doi":"10.1179/1753615414Y.0000000031","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000031","url":null,"abstract":"Abstract Objective and importance People in close contact with rodents, particularly those with rodents as pets, may become infected with the Streptobacillus moniliformis organism. Such patients may present with a triad of fever, rash, and arthritis. This medical condition is also known as rat-bite fever. It is imperative for the clinician to consider and recognize rat-bite fever in cases of septic arthritis in order to prevent delay in treatment. Severe involvement of the bursa requiring its excision during joint irrigation and debridement surgery has not been reported in the literature. Clinical presentation We are reporting on a recent case of septic shoulder arthritis and severe subdeltoid bursitis due to rat-bite fever in a 19-year-old female. Pre-operative magnetic resonance imaging scans demonstrated severe bursal involvement. Intervention In addition to antibiotics, excision of the bursa was necessary in this case in combination with irrigation and debridement of the joint. Conclusion The bursa adjacent to the involved joints in cases of rat-bite fever should be thoroughly investigated. Their severe involvement may necessitate their excision during the initial irrigation and debridement procedure.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"117 - 119"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NICE, electroacupuncture, and osteoarthritis","authors":"M. Cummings","doi":"10.1179/1753614614Z.00000000068","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000068","url":null,"abstract":"Background I was surprised to come across a senior colleague using acupuncture in the British military when I started my general practice training. I had joined the Royal Air Force (RAF) rather than a civilian vocational training scheme, because I was interested in musculoskeletal pain and sports medicine. I trained in Western medical acupuncture with the British Medical Acupuncture Society and found dry needling appeared to be a very useful intervention in soft tissue pain, particularly muscle pain. After 7 years in the RAF as a general duties medical officer, I retired to pursue a career in orthopaedic medicine, but having taken over an established medical acupuncture practice, I found myself mostly in demand for acupuncture services. It was the early 1990s and systematic reviews (SRs) had just been developed, and Adrian White, one of my former acupuncture tutors, got me involved in both performing and reviewing SRs. The first meta-analysis of acupuncture was performed by Ernst and White in 1998, and this reported that acupuncture was superior to non-acupuncture controls. A subsequent SR by the Cochrane Collaboration Back Group (van Tulder et al.) opted to avoid data pooling in meta-analysis, and instead performed a best evidence synthesis within a qualitative review. Van Tulder et al. concluded that there was no evidence for an effect of acupuncture in back pain. This conclusion was a shock to me after the positive meta-analysis by Ernst and White, so I read the entire review. The conclusions were influenced by one of the two trials that were judged to be ‘high quality’. I knew this trial well, as it had been included in my first SR – Garvey et al. It was with some consternation that I realized the conclusions of an SR of acupuncture could be influenced by reviewers opinions over a trial that had not actually used acupuncture needles at all – Garvey et al. used insertion of a hypodermic needle at a single point and referred to it as acupuncture. So this was the start of my evolving understanding of the limitations, within the review process, of championing the avoidance of bias over the judgement of clinicians.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"47 - 49"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}