The elements of Kellgren's manual treatment

Although massage and medical gymnastics seem to have been in use as far back as authentic records of history can lead us, the first to attempt a movement cure on a scientific basis was the Swede, P. H. Ling.Ling's system soon awoke public interest, though his attempts to get the Swedish Government to assist him in founding an institution were at first futile. However, in 1813 the Royal Central Gymnastic Institute, subsidized by State, was opened for him in Stockholm and he was appointed at the head of it.The medical part of his system the profession . did not take to readily at first and did all it could to prevent its gaining ground. Ling and his pupils, however, persisted in their efforts to get a recognition from them, by showing them practically what they could do - and finally attained success, although this took many years to effect.Ling died in 1839 and according to his own words, left behind him only two men who really under- stood his system and who were capable of furthering its progress and aiding in its development. These were Gabriel Branting and Augustus Georgia.Henrik Kellgren, born in 1837, entered the Central Gymnastic Institute at Stockholm, 1863, and worked there under Professors Branting, Hartelius and Hjalrnar Ling until 1865. After leaving, he commenced to practise as a Gymnastic Director. He soon found many shortcomings in Ling's system, which he corrected; and he likewise improved many of the manipulations and added some practically new ones, without however attempting to make these known by writing about them. Not only this, but he brought his treatment into quite new spheres with great success; for he was able to apply it, for example, in the treatment of acute conditions - not merely in such cases as acute joint inflammations, but in those like scarlet fever, pneumonia, typhoid, etc. Among his additions and inventions we must first mention his direct nerve treatment. Although a kind of nerve pressing had been used before to a small extent, he replaced this by nerve frictions and nerve vibrations - infinitely superior methods. These have been able to accomplish so much that could not be done before, that all the medical profession in course of time have had their attention drawn to them; and the name of "Kellgren's nerve frictions and vibrations" is one which is well known to them all.In the course of 36 years continued practice, Kellgren has been able to introduce improvements into all the exercises he had taken from Ling's original system; he has modified some, discarded others, and ones. improvements have drawn a well- marked line between Ling's methods and his, and we can thus regard his system as standing alone, as one complete in itself, and as such it stands ripe and mature for the medical profession generally to adopt. Until now, however, very few medical men have taken an interest in it and the literature on the subject is of the most scanty. The only writings which treat of Kellgren's method, exclusive of a few brief articles in various periodicals, are those of Dr Arvid Kellgren, Gymnastic Director, Stockholm, 1879, M.B., C.M., Edin., 1886 who for many years studied under his brother, Henrik Kellgren, and whose "Technic of Manual Treatment" was accepted in 1889 by the University of Edinburgh as a thesis for his degree of M.D. with recommendation. No one, however, has as yet endeavoured to give anything like a systematic description.Neither have the practical results of Kellgren's treatment awakened much interest amongst his own gymnastic colleagues, although some of them have come to him to study this method. Professor Hartelius was one of them; after visiting Mr Kellgren's institute, he wrote a very favourable opinion in "Tidskrift I Gymnastik" (the bi- annual journal of the Central Gymnastic Institute) for 1886, part VII, p.444. Dr Levin, now head of the department for female students in the Institute, did the same in the second number for 1892, page 687, and not only that, but endeavoured to learn some of the manipulations of Kellgren's method that were new to him and introduced them with success into his clinique on his re- turn to Stockholm.In my opinion, the time has come when Kellgren's treatment should be recognised and receive the place it deserves in the world of modern therapeutics. This little work is only meant to try and give an impulse in this direction and to interest the medical profession in its workings. I sincerely trust that it may fulfil its aim and that this treatment will receive the acknowledgement it so richly deserves

Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: A protocol for a randomised, placebo-controlled study

<p>Abstract</p> <p>Background</p> <p>Lateral epicondylitis is a painful condition responsible for loss of function and sick leave for long periods of time. In many countries, the treatment guidelines recommend a wait-and-see policy, reflecting that no conclusions on the best treatment can be drawn from the available research, published studies and meta-analyses.</p> <p>Methods/Design</p> <p>Randomized double blind controlled clinical trial in a primary care setting. While earlier trials have either compared corticosteroid injections to physical therapy or to naproxen orally, we will compare the clinical effect of physiotherapy alone or physiotherapy combined with corticosteroid injection in the initial treatment of acute tennis elbow. Patients seeing their general practitioner with lateral elbow pain of recent onset will be randomised to one of three interventions: 1: physiotherapy, corticosteroid injection and naproxen or 2: physiotherapy, placebo injection and naproxen or 3: wait and see treatment with naproxen alone. Treatment and assessments are done by two different doctors, and the contents of the injection is unknown to both the treating doctor and patient. The primary outcome measure is the patient's evaluation of improvement after 6, 12, 26 and 52 weeks. Secondary outcome measures are pain, function and severity of main complaint, pain-free grip strength, maximal grip strength, pressure-pain threshold, the patient's satisfaction with the treatment and duration of sick leave.</p> <p>Conclusion</p> <p>This article describes a randomized, double blind, controlled clinical trial with a one year follow up to investigate the effects of adding steroid injections to physiotherapy in acute lateral epicondylitis.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT00826462</p

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness

Background: Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness. ;Methods: A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive. ;Results: Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9 degrees v.s. 34.9 degrees; P &lt;= 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage. ;Conclusions: Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness

Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows

Purpose The objectives of this study were to evaluate the results in the outpatient treatment of recalcitrant lateral epicondylitis with release of the common extensor origin according to Hohmann and to determine any prognostic factors. Methods Eighty tennis elbows in 77 patients with a characteristic history of activity-related pain at the lateral epicondyle interfering with the activities of daily living refractory to conservative care for at least 6 months and a confirmatory physical examination were included. Clinical outcome was evaluated using the QuickDASH score system. Data were collected before the operation and at the medians of 18 months (range 6–36 months; short term) and 4 years (range 3–6 years; medium term) postoperatively. Results The mean QuickDASH was improved both at the short- and the medium-term follow-ups and did not change significantly between the follow-ups. At the final followup, the QuickDASH was improved in 78 out of 80 elbows and 81% was rated as excellent or good (QuickDASH\40 points). We found a weak correlation between residual symptoms (a high QuickDASH score) at the final follow-up and high level of baseline symptoms (r = 0.388), acute occurrence of symptoms (r = 0.362), long duration of symptoms (r = 0.276), female gender (r = 0.269) and young age (r = 0.203), whereas occurrence in dominant arm, a work-related cause or strenuous work did not correlate significantly with the outcome. Conclusion Open lateral extensor release performed as outpatient surgery results in improved clinical outcome at both short- and medium-term follow-ups with few complications. High baseline disability, sudden occurrence of symptoms, long duration of symptoms, female gender and young age were found to be weak predictors of poor outcome

The acute response of the nucleus pulposus of the cervical intervertebral disc to three supine postures in an asymptomatic population

Background The dynamic disc model refers to the ability of a spinal disc's position to be manipulated by body postures and movements. Research on lumbar discs has indicated movement of the anterior and posterior disc that correlates with posture of the spine. The aim of this study was to assess whether, despite its structural differences, the cervical disc responds to flexed and extended postures in a similar fashion to the lumbar disc. Method A repeated measures study. Twenty five asymptomatic participants (age: 33.7 ± 9.1 years) volunteered. Scans were performed in supine using an Esaote 0.2T magnetic resonance imaging scanner. Participants lay with their cervical spine initially placed in neutral, followed by flexion and finally extension. The position of the posterior disc nucleus pulposus at C5-6 and C6-7 was measured against a vertical line connecting the posterior vertebral bodies above and below each disc. Results Changes in cervical spine position were associated with significant changes in posterior disc nucleus pulposus position at both C5-6 and C6-7 (p < 0.01 for both). Post hoc testing showed a significant difference in posterior disc nucleus pulposus position at C5-6 between flexion and extension (p = 0.02). There was similarly a significant change at C6-7 between neutral and flexion (p = 0.001), and between flexion and extension (p = 0.02). Conclusions These results indicate that the cervical posterior nucleus pulposus is affected by spinal loading, consistent with the concept of the dynamic disc model

The scene of the crime: inventing the serial killer

This article examines the meanings of the crime scene in serial killings, and the tensions between the real and the imagined in the circulation of those meanings. Starting with the Whitechapel Murders of 1888 it argues that they, as well as forming an origin for the construction of the identity of 'the serial killer', initiate certain ideas about the relationship of subjects to spaces and the existence of the self in the modern urban landscape. It suggests that these ideas come to play an integral part in the contemporary discourse of serial killing, both in the popular imagination and in professional analysis. Examining the Whitechapel Murders, more recent cases and modern profiling techniques, it argues that popular and professional representations of crime scenes reveal more of social anxieties about the nature of the public and the private than they do about serial killers. It suggests that 'the serial killer' is not a coherent type, but an invention produced from the confusions of persons and places. Copyright 2006 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: a three-year prospective study

<p>Abstract</p> <p>Background</p> <p>Although osteoarthritis (OA) of the knee joints is the most common and debilitating joint disease in developed countries, the factors that determine the severity of symptoms are not yet understood well. Subjects with symptomatic medial knee OA were followed up prospectively to explore the relationship between radiographic changes and symptoms or physical examination findings.</p> <p>Methods</p> <p>One-hundred six OA knees in 68 subjects (mean age 71.1 years; 85% women) were followed up at 6-month intervals over 36 months. At each visit, knee radiographs were obtained, symptoms were assessed by a validated questionnaire, and the result of physical examination was recorded systematically using a specific chart. Correlations between the change of radiographs and clinical data were investigated in a longitudinal manner.</p> <p>Results</p> <p>During the study period, the narrowing of joint space width (JSW) was observed in 34 joints (32%). Although those knees were clinically or radiographically indistinguishable at baseline from those without JSW narrowing, differences became apparent at later visits during the follow-up. The subjects with knees that underwent JSW narrowing had severer symptoms, and the symptoms tended to be worse for those with higher rates of narrowing. A significant correlation was not found between the severity of symptoms and the growth of osteophytes. For the knees that did not undergo radiographic progression, the range of motion improved during the follow-up period, possibly due to the reduction of knee pain. Such improvement was not observed with the knees that underwent JSW narrowing or osteophyte growth.</p> <p>Conclusion</p> <p>The result of this study indicates that the symptoms of knee OA patients tend to be worse when JSW narrowing is underway. This finding may explain, at least partly, a known dissociation between the radiographic stage of OA and the severity of symptoms.</p

Non-surgical treatment of hip osteoarthritis. Hip school, with or without the addition of manual therapy, in comparison to a minimal control intervention: Protocol for a three-armed randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Hip osteoarthritis is a common and chronic condition resulting in pain, functional disability and reduced quality of life. In the early stages of the disease, a combination of non-pharmacological and pharmacological treatment is recommended. There is evidence from several trials that exercise therapy is effective. In addition, single trials suggest that patient education in the form of a hip school is a promising intervention and that manual therapy is superior to exercise.</p> <p>Methods/Design</p> <p>This is a randomized clinical trial. Patients with clinical and radiological hip osteoarthritis, 40-80 years of age, and without indication for hip surgery were randomized into 3 groups. The active intervention groups A and B received six weeks of hip school, taught by a physiotherapist, for a total of 5 sessions. In addition, group B received manual therapy consisting of joint manipulation and soft-tissue therapy twice a week for six weeks. Group C received a self-care information leaflet containing advice on "live as usual" and stretching exercises from the hip school. The primary time point for assessing relative effectiveness is at the end of the six weeks intervention period with follow-ups after three and 12 months.</p> <p>Primary outcome measure is pain measured on an eleven-point numeric rating scale. Secondary outcome measures are the hip dysfunction and osteoarthritis outcome score, patient's global perceived effect, patient specific functional scale, general quality of life and hip range of motion.</p> <p>Discussion</p> <p>To our knowledge this is the first randomized clinical trial comparing a patient education program with or without the addition of manual therapy to a minimal intervention for patients with hip osteoarthritis.</p> <p>Trial registration</p> <p>ClinicalTrials <a href="http://www.clinicaltrials.gov/ct2/show/NCT01039337">NCT01039337</a></p