A Review of Laser Technology and Light-Tissue Interactions as a Background to Therapeutic Applications of Low Intensity Lasers and Other Light Sources

Abstract

This paper reviews aspects of laser physics, radiometry and photochemistry relevant to the use of low intensity light therapy delivered by lasers or conventional lamps. Current theories regarding the biophysical mechanisms of low intensity laser therapy are reviewed. Characteristics of laser radiation such as monochromaticity, coherence, collimation, speckle, beam profile, penetration depth and temporal modulation of irradiation, and the relevance of these factors to photon propagation are explained. Physical principles that describe light–tissue interactions are presented. The importance of irradiance and radiant exposure is discussed and methods of quantifying these values are shown. Clinical implications are briefly discussed.     

The efficacy of cervical/thoracic active range of motion for detecting changes associated with individuals receiving muscle energy techniques

Abstract

Background: Muscle energy techniques (METs) have been used to treat cervical and thoracic range of motion (ROM) restrictions for over 40 years. Of the trials published on METs, most have examined the effectiveness of METs on ROM in the cervical and thoracic spine.

Objectives: The aim of this systematic review was to investigate the sensitivity of cervical and thoracic rotation active range of motion, as an objective measure of function, for detecting changes associated with individuals receiving METs compared to (1) individuals receiving no treatment and (2) individuals receiving manipulation.

Methods: Relevant databases were searched from January 1970 up to March 2010. Methodological quality of each included study was assessed using the PEDro scale. Effect sizes (Hedges' g) and their 95% confidence intervals were calculated for active rotation ROM scores between and within the MET and comparison groups.

Results: Five randomized controlled trials were included in this review. Four studies addressed the first clinical question and one study answered the second. The average PEDro score was 5.8. In general, between and within group effect sizes were moderate to strong in favour of METs.

Conclusion: There is fair evidence that cervical and thoracic active range of motion is sensitive to changes associated with individuals who receive an MET. The change in ROM was associated with asymptomatic individuals having restricted rotation. Further studies with higher methodological quality are needed to make a stronger clinical conclusion about the effectiveness of METs.     

Effectiveness of Neural Mobilization in the Treatment of a Patient with Lower Extremity Neurogenic Pain: A Single-Case Design

Abstract

It is postulated that neural tissue mechanosensitivity contributes to symptoms associated with peripheral neurogenic pain disorders. However, there is a paucity of literature regarding the most effective clinical practices for managing pain of peripheral neurogenic origin. As clinical use of neural mobilization continues to flourish in the management of these pain syndromes, it is imperative to document outcomes associated with these techniques. The purpose of this single-case A1-B1-A2-B2 design was to investigate the effectiveness of neural mobilization in the management of a 29-year-old female patient with symptoms suggestive of peripheral neurogenic involvement. The intervention phases (B1 and B2) consisted of neural mobilizations specifically directed at the sciatic continuum. Outcome measures (degrees of hip flexion during the straight-leg-raise and pain) demonstrated both visual improvement and statistically significant improvements following implementation of the neural mobilization techniques. This single-case design provides a measure of scientific support for the use of neural mobilizations with patients presenting with lower extremity neurogenic pain disorders. However, generalizability is poor, and further methodologically sound clinical trials are necessary to investigate the effectiveness of neural mobilization in a larger patient population.     

Chronic Musculoskeletal Conditions

Abstract

Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic efficacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the keywords neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identified were reviewed to select papers specifically detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic efficacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identified that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research need store-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.     

Complex Regional Pain Syndrome I: Management through the Use of Vertebral and Sympathetic Trunk Mobilization

Abstract

The purpose of this study was to describe the clinical differential diagnostic process and effective management of an individual presenting with lower-extremity complex regional pain syndrome I (CRPS I). A 50-year-old female 8-weeks status post ORIF right tibia/fibula presented with a warm, red, edematous, hyperhidrotic right lower extremity. She also exhibited hyperalgesia, allodynia, and a positive slump test on the right. The patient satisfied clinical diagnostic criteria for a diagnosis of CRPS I. The subject was treated for 10 sessions over a 3-month period using progressive desensitization, weight-bearing activities, thoracolumbar mobilizations, and a neural mobilization technique referred to as slump long sitting with sympathetic emphasis (SLSSE). An analysis of outcome measures at the time of discharge and at a one-year follow-up demonstrated a significant improvement in both pain and function. Effective management was achieved by addressing both the patient's proximal and distal impairments including thoracolumbar segmental lesions and positive neurodynamic tests. It is speculated that the influence of neural mobilizations to the ipsilateral sympathetic ganglia directly affected the pathophysiology associated with autonomic dysregulation and pain in this subject. This case report provides initial evidence that the SLSSE may be an effective neural mobilization technique in reducing the magnitude of symptoms and improving function in patients with CRPS.     

Differential Diagnosis and Treatment of Chronic Neck and Upper Trapezius Pain and Upper Extremity Paresthesia: A Case Study Involving the Management of an Elevated First Rib and Uncovertebral Joint Dysfunction

Abstract

Diagnosis and effective treatment of patients presenting with cervicobrachial symptoms are often challenging due to the large number of potential pain sources and the high degree of convergence of sensory afference in the cervical region. A 42-year-old female presented in the clinic with a six-month history of neck pain, upper trapezius pain, and upper extremity paresthesia. A careful history, specific functional examination, and selected special tests led to diagnosis-specific orthopedic manual therapy management of this patient. The patient fully recovered within 6 physical therapy treatment sessions, which included management of an elevated first rib, double-crush phenomenon, uncovertebral joint dysfunction, and careful ergonomic intervention with home instructions. Although controlled trials are needed to evaluate the effectiveness of these techniques and allow generalizability of such interventions, the recovery of this patient suggests the efficacy of manual techniques and ergonomic intervention in the management of uncovertebral joint dysfunction and thoracic outlet syndrome associated with a double-crush phenomenon.     

Effect of Mobilization of the Anterior Hip Capsule on Gluteus Maximus Strength

Abstract

Loss of hip extension is often compensated for by extension of the lumbar spine. This compensation can result in hypermobility and ultimately be a source of low back dysfunction and pain. Joint mobilizations have been known to return physiologic and accessory motion to hypomobile structures. Mobilization has also been demonstrated to improve muscular strength when secondary to joint hypomobility. The purpose of this study was to determine the usefulness of posteroanterior (P-A) hip-joint mobilization in improving strength of the gluteus maximus muscle. Forty subjects were randomly assigned to a control group (Grade I P-A mobilization) and an experimental group (Grade IV P-A mobilization). The subjects performed a pretest/posttest set of five isometric repetitions on the Cybex Norm? isokinetic machine. The peak torque was determined for both pretest and posttest measurements. The data collected were analyzed using an independent t-test with a significance level of p < .05. The results demonstrated a statistically significant difference between the experimental and control groups (t=1.68, p=0.002). This study demonstrated a significant increase in gluteus maximus strength in response to Grade IV P-A mobilizations performed on the anterior hip capsule. Clinicians can utilize these findings in everyday practice to improve muscle strength by integrating manual therapy with therapeutic exercise.     

Effect of Different Neurodynamic Mobilization Techniques on Knee Extension Range of Motion in the Slump Position

Abstract

Mobilization of the nervous system has emerged as a significant adjunct to the treatment of musculoskeletal injuries. Clinical studies have shown that neurogenic symptoms can be resolved by treatment techniques directed at restoring normal neural biomechanics and physiology. Two alternate mobilization techniques have been proposed: the slider and tensioner techniques. A search of the literature revealed no peer-reviewed studies comparing the effects of these two treatment techniques, although a number of studies have investigated these techniques in isolation and found them to have positive effects on range of motion and other outcome measures. The aim of this study was to investigate the effects of these two techniques on knee range of motion of normal subjects (30 females [mean age 21.4+/?1.2 years, range 19-24]) in the slump position. Knee flexion angle of the right leg was measured using a universal 360° goniometer while in a fully slumped position, prior to and after the application of the respective mobilization technique. The tensioner technique brought about a significant decrease in knee flexion angle (P=0.003) with a mean percentage change of 14.7+/?11.8%(3.4+/?2.5°). The slider technique brought about a significant decrease in knee flexion angle (P<0.001) with a mean percentage change of 19.9+/?15%(4.3+/?2.6°). There was a non-significant between-group difference for the effect of the two techniques on range of motion (P=0.075). The findings of this study indicate that in normal female subjects, both the tensioner and slider techniques have a positive and significant effect on improving knee extension range of motion in the slump position. This could decrease the sensitivity of the sciatic nerve and the neuromeningeal structures to mechanical load. The clinical significance of changes of this magnitude on neural tissue and of these techniques in a symptomatic population requires further investigation.     

Value of 18FDG PET scan in staging of ocular adnexal lymphomas: a large single-center experience

Abstract

Autologous hematopoietic stem cell transplantation (HSCT) has proved efficient to treat hematological malignancies. However, some patients fail to mobilize HSCs. It is known that the microenvironment may undergo damage after allogeneic HSCT. However little is known about how chemotherapy and growth factors contribute to this damage. We studied the stromal layer formation (SLF) and velocity before and after HSC mobilization, through long-term bone marrow culture from 22 patients and 10 healthy donors. Patients' SLF was similar at pre- (12/22) and post-mobilization (9/20), however for controls this occurred more at pre-mobilization (9/10; p=0·03). SLF velocity was higher at pre than post-mobilization in both groups. Leukemias and multiple myeloma showed faster growth of SLF than lymphomas at post-mobilization, the latter being similar to controls. These findings could be explained by less uncommitted HSC in controls than patients at post-mobilization. Control HSCs may migrate more in response to mobilization, resulting in a reduced population by those cells.