Core stability: The centerpiece of any training program

Core strengthening and stability exercises have become key components of training programs for athletes of all levels. The core muscles act as a bridge between upper and lower limbs, and force is transferred from the core, often called the powerhouse, to the limbs. Stability initially requires maintenance of a neutral spine but must progress beyond the neutral zone in a controlled manner. Some studies have demonstrated a relationship between core stability and increased incidence of injury. A training program should start with exercises that isolate specific core muscles but must progress to include complex movements and incorporate other training principles.     

Use of strategies to improve antihypertensive medication adherence within United States outpatient health care practices,DocStyles 2015‐2016

Patients’ adherence to antihypertensive medications is key to controlling high blood pressure. Evidence‐based strategies to improve adherence exist, but their use, individually and in combination, has not been described. 2015‐2016 DocStyles data were analyzed to describe health care professionals’ and their practices’ use of 10 strategies to improve antihypertensive medication adherence across 3 categories: prescribing, education, and tracking/encouragement. Among 1590 respondents, a mean of using 5 strategies was reported, with individual strategy use ranging from 17.2% (providing patients adherence‐related rewards) to 69.4% (prescribing once‐daily regimens). Those with higher odds of using ≥7 strategies and strategies across all 3 categories included: (1) nurse practitioners compared to family practitioners/internists and (2) health care professionals in practices with standardized hypertension treatment protocols who routinely recommend home blood pressure monitor use compared to respondents without those characteristics. Despite using an array of evidence‐based adherence‐promoting strategies, additional opportunities exist for health care professionals to provide adherence support among hypertensive patients.     

Self-Reported Musculoskeletal Pain in Latino Vineyard Workers

ABSTRACT

The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the back (32% of all men and 43.7% of all women). In most cases, those who reported MSS were significantly older than those who did not report MSS. Future research is necessary to identify personal and work related injury risk factors in order to develop prevention programs.     

Temporomandibular disorders. 2. Non-surgical treatment

There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented.     

The use of pain neuroscience education in older adults with chronic back and/or lower extremity pain

Introduction: Chronic pain due to musculoskeletal disorders is the leading cause of disability among older adults and is associated with a lower quality of life, reduced function, and increased risk of institutionalization. Pain Neuroscience Education (PNE) has demonstrated effectiveness in reducing pain and improving pain self-efficacy in individuals under 60 years of age, but there is a paucity of research examining its use with older adults. If PNE has similar effects in older adults, it has the potential to be a useful non-pharmacological intervention for this population. Methods: This quasi-experimental feasibility study included 25 subjects over the age of 65 with a 3 month or greater history of lower back and/or lower extremity pain. Subjects participated in two semi-standardized one-on-one PNE sessions and were asked to read a booklet (Why Do I Hurt, Louw, International Spine and Pain Institute, USA) in between sessions. Subjects’ perception of PNE was measured after the second session and gait speed, pain disability, and fear of movement were measured pre- and post-PNE. Results: Subjects consistently reported a positive experience with PNE. There were statically significant positive improvements in gait speed, pain disability, and fear of movement after the intervention. Conclusion: PNE is a feasible and potentially efficacious treatment for older adults with chronic pain.     

Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education

Pain neuroscience education (PNE) is an educational strategy aimed at teaching people more about pain from a neurobiological and neurophysiological perspective. Current best-evidence provides strong support for PNE to positively influence pain ratings, dysfunctions, fear-avoidance and pain catastrophization, limitations in movement, pain knowledge, and healthcare utilization. To date, all PNE studies have been conducted on adult populations. This study set out to explore if an abbreviated PNE lecture to middle school children would result in a positive shift in pain knowledge as well as healthier beliefs regarding pain. One-hundred-and-thirty-three middle school students spanning 5th to 8th grade attended a 30-minute PNE lecture. The primary outcome measures of pain knowledge (neurophysiology of pain questionnaire [NPQ]) and beliefs regarding pain (numeric rating scale) were measured before and immediately after the PNE lecture. Significant improvement in knowledge was found with mean score on NPQ test scores improving from 3.83 (29.5%) pre-PNE to 7.90 (60.8%) post-PNE (p < 0.001), with a large effect size (r = .711). Significant shifts in beliefs were also found in all but one of the pain beliefs questions, with a medium effect size for “you can control how much pain you feel” (p < 0.001; r = 0.354) and large effect size for “your brain decides if you feel pain, not your tissues” (p < 0.001; r = 0.545). This study shows that a 30-minute PNE lecture to middle school children resulted in a significant increase in their knowledge of pain as well various beliefs regarding pain.     

The behavioral role of physical therapy in pain management

Physical therapy assessment and treatment of chronic pain patients focuses on increasing functional ability and decreasing disability. A range of behavioral techniques discussed in this paper are used to achieve these goals.