This issue of the Manual Therapy Review looks at a Cochrane review for knee osteoarthritis (OA), biopsychosocial approaches chronic pain management, clinical tests for cervicogenic headaches and rehabilitation approaches to tendon disorders.
Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 10: 2015.
This review pooled 54 past randomized controlled trials through 2013 looking at the effectiveness of exercise for knee OA. It was found that results last 2-6 months for land based exercises. This article suggests that physiotherapy can be a successful alternative to surgery or other management suggestions such as injections.
Lotze M, Moseley GL. Theoretical Considerations for Chronic Pain Rehabilitation. Phys Ther. 2015. Sep;95(9):1316-20.
Better understanding of the neural mechanisms of chronic pain has led to improved therapy. New strategies include explaining the pain processing mechanism to patients. A biopsychosocial approach can be helpful in reducing pain and disability. Pain processing is modulated by sensory inputs, cognitive, emotional and social factors which can not be ignored. The main treatment goal should be to give the patient the resources to master his/her own situation, to set attainable goals and to learn the principles of slow and steady progression, all on the platform of a modern understanding of their pain.
Rubio-Ochoa J, et al.Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. Man Ther. 2015. Sep 21.
To date, no studies have summarized clinical tests for cervicogenic headaches. This study assesses the reliability and diagnostic accuracy of these tests. The cervical flexion-rotation test (CFRT) exhibited both the highest reliability and the strongest diagnostic accuracy for the diagnosis of CGH.
Rio E, Kidgell D, Moseley GL, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med Published Online. 2015.
Strength training is key for improving tendon quality. Current strategies may fail to address the corticospinal control of the muscle which can result in inefficient muscle recruitment, increased tendon load, and may cause tendon calcification or recurring symptoms. This paper:
- Review what is known about changes to the primary motor cortex and motor control in tendinopathy
- Identifies the parameters which induce neuroplasticity in strength training and
- Aligns principles with tendon rehabilitation loading introducing a neuroplastic training.