The initial effects of different rates of lumbar mobilisations on pressure pain thresholds in asymptomatic subjects

Lumbar mobilisations are commonly used in clinical practice to reduce pain and increase function. Mobilisations to the cervical spine have been shown to reduce pain using pressure pain thresholds (PPTs). Yet there is no evidence to confirm that this happens in the lumbar spine. Furthermore little is known about the effects of different treatment doses on the amount of hypoalgesia produced. It is unknown if changing the rate of application of mobilisations has an effect on hypoalgesia. The aim of this study was to investigate the immediate effects of lumbar posteroanterior mobilisations performed at different rates on PPT and the extent of the hypoalgesia.A repeated measures, single blind, randomised-trial was conducted on 30 asymptomatic subjects. PPTs were measured at 4 sites in the upper and lower quadrants, before and after the application of lumbar posteroanterior mobilisations performed at 2 Hz, 1 Hz and quasi-static. The results demonstrated an immediate and significant improvement in PPT measures (P = 0.000) irrespective of the rate or site tested. The effects were both local and widespread. There was no significant difference in PPT between the rates of mobilisations.This study provides new experimental evidence that lumbar posteroanterior mobilisations produce an immediate and significant widespread hypoalgesic effect, regardless of the rates of mobilisation in asymptomatic subjects.     

An investigation into the potential hypoalgesic effects of different amplitudes of PA mobilisations on the lumbar spine as measured by pressure pain thresholds (PPT)

Mobilisation of the spine is a common technique used in clinical practice. Studies have shown that mobilisation to the spine can decrease pain. The optimum treatment dose for achieving this has not so far been investigated. Previous studies that demonstrate the pain relieving effects of mobilisations have used large amplitude of oscillations. The importance of amplitude on pain relief has not been established. The current study aims to: a) Investigate the importance of amplitude as part of the treatment dose. b) To explore the extent of any pain reliving effects seen following mobilisations.The study employed a randomised, single blind, within-subjects repeated measure design. Thirty asymptomatic subjects participated. The subjects completed three experimental conditions on three separate occasions. The conditions were: large amplitude of oscillations (forces between 50 and 200 N), small amplitude of oscillations (150 N–200 N) and quasi-static (maintained at 200 N). Each condition involved a 3x1 minute central PA mobilisation at a frequency of 1.5 Hz on the lumbar spine. Pressure pain thresholds (PPT) were measured immediately before and after each intervention at 4 different sites. The sites were chosen to determine the extent of the hypoalgesic response.Results demonstrated a significant increase in PPT following lumbar mobilisations (p = 0.013) at all measured sites. However, no significant difference was found between amplitude conditions (p = 0.864). This study suggests that in asymptomatic subjects a systemic hypoalgesic response is caused by lumbar mobilisation regardless of amplitude.     

The effect of posteroanterior mobilisation on sagittal mobility of the lumbar spine

The purpose of this study was to investigate the effect of a posteroanterior central vertebral pressure (PA mobilisation) on sagittal mobility of the lumbar spine in asymptomatic subjects. On 3 separate days an experienced manipulative physiotherapist stood on a force platform and applied a PA mobilisation to L3 spinous process for 2 minutes on 18 female subjects. Prior to this, subjects acted as their own control by lying prone for the same length of time but without receiving mobilisation treatment. The force platform was used to indirectly measure the minimum and maximum peak forces, and the frequency of oscillation of the applied PA mobilisation. A CA-6000 Spine Motion Analyser (SMA) was used to measure lumbar spine flexion and extension before and after the mobilisation and control treatments. Prior to the main experiment, intra-therapist reliability of the SMA was found to be good, with no significant difference (p > 0.05) in flexion or extension range of movement between 3 days of testing and root mean square error (RMSE) values of 7.43 degrees for flexion and 8.6 degrees for extension. The results indicated that a PA mobilisation with a mean maximum force of 92.5 N, amplitude of force oscillation of 9.6 N and a frequency of oscillation of 4.5 Hz had no significant affect (p > 0.05) on sagittal mobility of the lumbar spine in the asymptomatic subject population.     

The effect of soft tissue deloading tape on thoracic spine pressure pain thresholds in asymptomatic subjects

The application of tape to deload soft tissue is used in the management of thoracic spine pain. A reported clinical feature of this treatment is reduced tenderness of the spine during postero-anterior mobilizations. A randomized, single blind, placebo controlled, repeated measures design study was employed to investigate the effects of deloading tape on pressure pain threshold measurements at the level of the T7 spinous process in an asymptomatic group of 24 subjects. Pressure pain thresholds were assessed prior to and following the application of deloading tape, placebo sham tape and no-tape control conditions. All subjects received all three conditions in a randomized order on three separate days. Differences between the pre- and post-measurements were used as indicators of change in a subject's pressure pain threshold. No significant change in pressure pain threshold measurements was found between conditions. In summary, this study demonstrated that deloading tape applied to the level of the T7 spinous process did not significantly change pressure pain threshold measurements in asymptomatic subjects, raising the possibility that any pain relieving effect may well be conditional upon pain being present.     

Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry.

This study aimed at determining whether there are differences in pressure pain sensitivity in different tissues in the same body region when systematically assessed, before and after skin hypoesthesia. Pressure pain thresholds (PPTs) were assessed bilaterally in 15 healthy females at the bony part of the epicondylus lateralis humeri, at the belly of m. extensor carpi ulnaris and at m. brachioradialis where the superficial radial nerve branches pass underneath ("muscle/nerve" site). Following a double blind design, a local anaesthetic cream (EMLA) or a control cream was applied to the skin and PPTs were reassessed. The PPT was significantly (p < 0.001) lower at the "muscle/nerve" site than at the bony and "pure" muscle sites. The PPTs over the bony and "pure" muscle sites did not differ. There was no significant difference when PPTs were compared before and after application of EMLA cream. However, PPTs after control cream were lower (p < 0.001) over all examined areas than those obtained prior to cream application. Thus, EMLA cream increased PPTs compared to control sites in all examined areas (p < 0.001). Under the given circumstances, skin pressure pain sensitivity was demonstrated to influence the PPT.     

The influence of non-specific low back pain on pressure pain thresholds and disability.

The purpose of this study was to investigate the pressure pain thresholds (PPTs) with respect to the Erector spinae and the hip muscles in 87 patients with subacute non-specific low back pain (LBP) and to evaluate the relationship between the PPTs and disability. In order to establish reference values, 64 healthy subjects were examined with respect to PPTs and used as a control group against the group of LBP patients. The mean PPT values of the Erector spinae and the hip at all examined points of the LBP group were significantly lower (p<0.001) in comparison to the PPT values of the healthy group. An exceptionally high difference (2.7 kg/cm2) was found at the L3 Erector spinae level. The correlation between having LBP or not in the whole group (n=151) and PPT, was highest at the L3 level of the Erector spinae (r=-0.710, p<0.001). When the group of patients with LBP was divided into two subgroups in terms of having an Oswestry disability index (ODI) lower than 40 ("moderate LBP disability") or an ODI higher than 40 ("severe LBP disability") it was surprising to notice that there was no significant difference between the PPTs of the Erector spinae and the hip musculature. This study has shown the possibility of the existence of muscular disorder in the lumbar part of the Erector spinae in patients with non-specific low back pain, but also reveals the strong inter-individual differences in muscular fibrosis sensitivity and pain behaviour related to gender.     

The effect of kyphoplasty parameters on the dynamic load transfer within the lumbar spine considering the response of a bio-realistic spine segment

BackgroundWith an increasing prevalence of osteoporosis, physicians have to optimize treatment of relevant vertebral compression fractures, which have significant impact on the quality of life in the elder population. Retrospective clinical studies suggest that kyphoplasty, despite being a procedure with promising potential, may be related to an increased fracture risk of the adjacent untreated vertebrae.MethodsA bio-realistic model of a lumbar spine is introduced to determine the morbidity of cemented augmentation. The model was verified and validated for the purpose of the study and subjected to a dynamic finite element analysis. Anisotropic bone properties and solid ligamentous tissue were considered along with α time varying loading scenario.FindingsThe yielded results merit high clinical interest. Bi-pedicular filling stimulated a symmetrically developing stress field, thus comparing favourably to uni-pedicular augmentation which resulted in a non-uniform loading of the spine segment. An enslavement of the load transfer was also found to both patient bone mineral density and reinforcement–nucleous pulpous superimposition.InterpretationThe investigation presented refined insight into the dynamic biomechanical response of a reinforced spine segment. The increase in the calculated occurring stresses was considered as non-critical in most cases, suggesting that prevalent fractures are a symptomatic condition of osteoporosis rather than a sequel of efficiently preformed kyphoplasty.     

不同方式的单次步行训练对中老年男性收缩压的影响

摘要 目的：观察单次不同强度和时间的步行训练对中老年男性24h内收缩压的效应。 方法：实验选取40例血压正常或者轻中度高血压的中老年男性受试者,所有受试者均在研究开始时进行1d的血压监测,记录受试者日常生活状态下的血压以进行空白对照（空白对照组）。受试者在进行心肺运动试验检测其峰值摄氧量VO2peak之后,采用自身对照法,分别进行运动量为30min 45% VO2peak（3045组）、30min 65%VO2peak（3065组）、60min 45%VO2peak（6045组）的单次步行训练,每两次步行训练之间间隔3—5d。每次干预后,分别记录每组受试者在运动前、运动结束时、运动结束后1h、4h、12h和24h的收缩压。 结果：与运动前相比,3045组患者收缩压在运动后、运动结束后1h均明显下降（P＜0.05）,在运动结束后4h降低程度最显著（P＜0.01）,在运动结束后12h时仍有降低,但差异已无显著性（P＞0.05）;3065组和6045组患者收缩压在运动后1h时显著下降（P＜0.05）,在运动后4h时仍有降低,但差异无显著性意义（P＞0.05）。空白对照组患者24h内血压波动无明显变化,所有干预组在运动后24h时收缩压均回到原有水平。 结论：相对于30min 65%VO2peak、60min 45%VO2peak的运动量来说,30min 45%VO2peak的单次步行训练降压时效更长,接近12h。因此,对于血压正常或轻中度高血压的中老年男性来说,一天两次30min 45%VO2peak的步行训练能够有效维持急性运动的降压效应。     

不同孔径输液器对喹诺酮类抗生素所致疼痛和静脉炎的影响

目的探讨使用不同孔径的输液器输液对喹诺酮类抗生素所致疼痛和静脉炎的影响。方法将210例患者以分层随机的方法分为试验组1(70例)、试验组2(67例)和对照组(73例),均以40滴/min的滴速静脉输注喹诺酮类抗生素,试验组1、试验组2分别采用5.0μm、3.0μm孔径的精密输液器,对照组采用15.0μm孔径的普通输液器。观察3组输液时疼痛及静脉炎的发生率。结果 3组输液滴速均达标,采用5.0μm孔径的精密输液器输液时疼痛和静脉炎的发生率低于采用普通输液器输液,采用3.0μm孔径的精密输液器输液时疼痛和静脉炎的发生率低于采用5.0μm孔径的精密输液器输液。结论采用5.0μm和3.0μm孔径的精密输液器均可有效地减少疼痛和静脉炎的发生,但3.0μm孔径的精密输液器效果更显著。     

腰椎定点牵扳疗法与银质针导热疗法治疗腰椎间盘突出症的互补作用

目的:观察腰椎定点牵扳疗法与银质针导热疗法治疗腰间盘突出症的互补作用。方法:于2002-02/2005-08选择解放军总医院康复医学科诊治的均由CT扫描或MRI检查确诊的腰椎间盘突出症患者240例。随机数字表法分成3组:腰椎定点牵扳组,银质针导热组,腰椎定点牵扳及银质针导热联合组,每组80例。腰椎定点牵扳组采用腰椎定点牵扳疗法,对间盘突出节段施行该疗法,1次/周,共做2次;银质针导热组采用银质针导热疗法对腰部和臀部软组织病变部位施行银质针导热疗法,1次/周,共2次;腰椎定点牵扳及银质针导热联合组为两种疗法的联合使用:腰椎定点牵扳疗法1周后对腰、臀部软组织病变部位分两次施行银质针肌肉导热疗法。比较各组患者治疗前、治疗后3个月和6个月疼痛数字评分及治疗后3个月的临床体征改善情况及疗效结果。疗效评定标准:①症状消失:腰腿疼痛消失,临床体征均转为阴性,可恢复工作。②有效:腰腿疼痛基本消失,临床体征2～3项转为阴性,可作轻工作。③好转:腰腿疼痛减轻,临床体征有1项转为阴性,尚需继续治疗。④无效:治疗前后疼痛与体征无变化。结果:所有患者均完成治疗和指标评定,全部进入结果分析。①治疗后3个月腰椎定点牵扳组、银质针导热组、腰椎定点牵扳及银质针导热联合组疼痛数字评分值与治疗前相比均有降低,而联合组更为明显(t=8.52P<0.01)。治疗后6个月,各组病例的疼痛症状大多数获得控制,以联合组更为明显(t=7.08,P<0.01)。其中银质针导热组和腰椎定点牵扳组、腰椎定点牵扳及银质针导热联合组与银质针导热组相比差异均有显著性意义(t=9.09,9.82,P<0.05)。②治疗后3个月各组临床体征均较治疗前明显改善,尤其是直腿抬高试验阳性率,治疗3个月后联合组与银质针导热组,联合组与腰椎定点牵扳组相比差异均有非常显著性意义(χ2=9.27,9.04,P<0.01),而银质针导热组与腰椎定点牵扳组相比差异无显著性意义(χ2=11.51,P>0.05)。③银质针导热组、腰椎定点牵扳组、联合组的有效率(痊愈及有效)分别为72%,73%和88%,联合组与银质针导热组、联合组与腰椎定点牵扳组相比差异有非常显著性意义(χ2=6.31,6.13,P<0.01)。结论:腰椎定点牵扳疗法具有解除肌肉痉挛,松解神经根粘连;银质针导热疗法则有消除椎管内外软组织无菌性炎症、改善血供和松解肌肉的作用。两种疗法治疗腰间盘突出症具有互补性。     

腰椎定点牵扳疗法与银质针导热疗法治疗腰椎间盘突出症的互补作用

目的：观察腰椎定点牵扳疗法与银质针导热疗法治疗腰间盘突出症的互补作用。方法：于2002—02／2005—08选择解放军总医院康复医学科诊治的均由CT扫描或MRI检查确诊的腰椎间盘突出症患者240例。随机数字表法分成3组：腰椎定点牵扳组，银质针导热组，腰椎定点牵扳及银质针导热联合组，每组80例。腰椎定点牵扳组采用腰椎定点牵扳疗法，对间盘突出节段施行该疗法，1次／周，共做2次；银质针导热组采用银质针导热疗法对腰部和臀部软组织病变部位施行银质针导热疗法，1次／周，共2次；腰椎定点牵扳及银质针导热联合组为两种疗法的联合使用：腰椎定点牵扳疗法1周后对腰、臀部软组织病变部位分两次施行银质针肌肉导热疗法。比较各组患者治疗前、治疗后3个月和6个月疼痛数字评分及治疗后3个月的临床体征改善情况及疗效结果。疗效评定标准：①症状消失：腰腿疼痛消失，临床体征均转为阴性，可恢复工作。③有效：腰腿疼痛基本消失，临床体征2-3项转为阴性，可作轻工作。③好转：腰腿疼痛减轻，临床体征有1项转为阴性，尚需继续治疗。④无效：治疗前后疼痛与体征无变化。结果：所有患者均完成治疗和指标评定，全部进入结果分析。①治疗后3个月腰椎定点牵扳组、银质针导热组、腰椎定点牵扳及银质针导热联合组疼痛数字评分值与治疗前相比均有降低，而联合组更为明显（t=8．52P〈0．01）。治疗后6个月，各组病例的疼痛症状大多数获得控制，以联合组更为明显（t=7．08，P〈0．01）。其中银质针导热组和腰椎定点牵扳组、腰椎定点牵扳及银质针导热联合组与银质针导热组相比差异均有显著性意义（t=9．09，9．82，P〈0．05）。②治疗后3个月各组临床体征均较治疗前明显改善，尤其是直腿抬高试验阳性率，治疗3个月后联合组与银质针导热组，联合组与腰椎定点牵扳组相比差异均有非常显著性意义（χ2=9．27，9．04，P〈0．01），而银质针导热组与腰椎定点牵扳组相比差异无显著性意义（χ2=11．51,P〉0．05）。（勤银质针导热组、腰椎定点牵扳组、联合组的有效率（痊愈及有效）分别为72％，73％和88％，联合组与银质针导热组、联合组与腰椎定点牵扳组相比差异有非常显著性意义（r=6．31，6．13，P〈0．01）。结论：腰椎定点牵扳疗法具有解除肌肉痉挛，松解神经根粘连；银质针导热疗法则有消除椎管内外软组织无菌性炎症、改善血供和松解肌肉的作用。两种疗法治疗腰间盘突出症具有互补性。     

The effect of chronic clinical pain on thermal and mechanical thresholds in sheep

Threshold responses were measured to a thermal skin test and a mechanical pressure test in two groups of conscious unrestrained sheep. The first group of sheep were healthy adult females and formed a control sample, the second group were also adult females, but were all suffering from a condition known as footrot. Footrot is a chronic infective lesion affecting usually one foot which appears to cause severe pain in its worst manifestation. These sheep were assessed for the severity of the lesion and degree of lameness and were divided into high and low severity subgroups. Footrot did not alter the threshold to the thermal test but the mechanical pressure threshold was significantly reduced in both footrot sub-groups compared to controls. A local anaesthetic block of the affected foot restored values to close to the control level. After treatment of the affected foot, the mechanical threshold in the low severity sub-group was returned to normal, but in the high severity sub-group it was still significantly reduced compared to the control animals. However, when retested 3 months later these values had returned to the normal control levels.     

The effect of real and sham acupuncture on thermal sensation and thermal pain thresholds

OBJECTIVE: To compare the effect of real and sham acupuncture and a control intervention on thermal sensation and thermal pain thresholds. DESIGN: Single-blind, randomized controlled, repeated-measures trial. SETTING: Laboratory. PARTICIPANTS: Eighteen acupuncture-naive, healthy subjects with no history of upper-limb pathology or acupuncture contraindications. INTERVENTION: Subjects were randomly assigned (blind card allocation) to 1 of 6 possible orders of application of the interventions, which consisted of 25 minutes each of control, real, and sham acupuncture. MAIN OUTCOME MEASURES: Thermal sensation and thermal pain thresholds measured with a thermal sensory analyzer before and after each intervention. RESULTS: There were increases in cold and hot pain and cold sensation thresholds with real acupuncture. The level of increase did not differ significantly from the changes that occurred with sham acupuncture and control interventions. CONCLUSIONS: Although we observed a trend toward a decreased sensitivity to thermal pain and thermal sensation with real acupuncture, this trend did not differ significantly from the changes with control or sham interventions. Therefore, no support was provided for analgesic or placebo effects of acupuncture. The trend, combined with the relatively low power of the inferential tests applied does, however, suggest that further research is merited.     

The influence of increasing sacroiliac joint force closure on the hip and lumbar spine extensor muscle firing pattern

The prone hip extension (PHE) test is commonly used in the evaluation of lumbo-pelvic dysfunction. It has been suggested that altered motor control identified by the PHE test can be improved with the application of compression force across the pelvis, to increase force closure on the sacroiliac joint (SIJ). This repeated measure study design investigated the effect of three levels of pelvis compression (0 N, 50 N, 100 N) on the muscle firing pattern during the PHE test in 20 asymptomatic male subjects tested on two occasions 4-weeks apart. The right gluteus maximus, right semitendinosus and bilateral lumbar erector spinae were analyzed using surface electromyography (EMG). Subjects were instructed to perform right hip extension in prone position while maintaining knee-extension in each measurement condition. Compared with the onset of the semitendinosus muscle, gluteus maximus became active 263.3 ± 99.5 ms later with no pelvic compression, 183.5 ± 77.9 ms later with 50 N compression, 91.5 ± 49.7 ms later with 100 N compression. While significant differences (α = 0.05) were found in EMG onset for gluteus maximus under different levels of pelvis compression, this was not the case for the erector spinae, which had an inconsistent pattern of temporal onset and was not influenced by the level of pelvis compression force.     

通用型脊柱椎弓根内固定系统改善腰椎滑脱患者下腰疼痛及间歇性跛行症状的作用

背景腰椎滑脱症患者多有下腰痛和下肢行走障碍的症状表现,目前手术治疗以应用内固定器较多.目的观察自行研制的通用型脊柱内固定系统对退行性腰椎滑脱患者下腰疼痛及间歇性跛行症状的干预效果.设计以患者为观察对象,前后对照疗效分析.单位北京协和医院骨科.对象2001-09/12北京协和医院骨科收治的退行性腰椎滑脱患者共16例,男10例,女6例,平均年龄58.5岁(42～72岁).有下腰痛症状者16例,有下肢跛行症状者15例;术前Ⅰ度滑脱10例,Ⅱ度滑脱6例.方法对16例患者均采用脊柱后路椎管减压及通用型脊柱内固定系统复位滑脱椎体、内固定和脊柱融合手术.对所有患者分别于术后2周,1,3,6,12,18,24个月进行门诊随访,采用Yuan的评价标准评估下腰疼痛症状及下肢活动情况.术中及术后末次随访均以X射线片评估椎体滑脱复位情况.主要观察指标①患者术后下腰及下肢功能活动情况.②滑脱椎体复位情况.结果16例患者术后平均随访21.2个月(18～24个月).①下腰疼痛症状消失15例,无变化为1例.间歇性跛行症状消失、步态正常15例.②术中及末次随访时X射线结果显示滑脱椎体均完全复位,滑脱复位率为100%(16/16).结论通用型脊柱内固定系统用于腰椎滑脱患者可获得满意的腰椎复位效果,改善患者腰背痛及下肢跛行症状.     

The result of treatment on vestibular and general pain thresholds in women with provoked vestibulodynia

OBJECTIVE: To correlate changes in vestibular pain thresholds to general pain thresholds in a subgroup of women with provoked vestibulodynia taking part in a treatment study. METHODS: Thirty-five women with provoked vestibulodynia were randomized to 4 months' treatment with either electromyographic biofeedback (n=17) or topical lidocaine (n=18). Vestibular and general pressure pain thresholds (PPTs) were measured and the health survey Short Form-36 (SF-36) was filled out before treatment and at a 6-month follow-up. Subjective treatment outcome and bodily pain were analyzed. Thirty healthy women of the same age served as controls for general PPTs and SF-36. RESULTS: No differences in outcome measures were observed between the 2 treatments. Vestibular pain thresholds increased from median 30 g before to 70 g after treatment in the anterior vestibule (P<0.001) and from median 20 to 30 g in the posterior vestibule (P<0.001). PPTs on the leg and arm were lower in the patients as compared with controls both before and at the 6-month follow-up. Patients reporting total cure were 3/35; 25/35 were improved. The number of patients who frequently reported of other bodily pain was reduced after the treatment. The patients had lower scores for SF-36 (General Health, Vitality) before treatment, which was restored at the 6-month follow-up. DISCUSSION: Treating provoked vestibulodynia by either topical lidocaine or electromyographic biofeedback increased vestibular pain thresholds, reduced dyspareunia, and improved bodily pain. The patients showed a general hypersensitivity to pressure pain compared with controls and in this study the hypersensitivity did not seem to be affected by treating the superficial dyspareunia.