Physiotherapy at the XII Commonwealth Games Part II: Injuries and Management

At the XII Commonwealth Games held in Brisbane in 1982, Australian physiotherapists as members of the host nation's medical division, treated the injuries of competitors from the ten sports contested. The nature and incidence of the injuries treated by the host physiotherapists is tabulated and comment is made regarding several significant features. Implications for the management skills of physiotherapists required either to travel with teams or work as host physiotherapists are made. Furthermore, the utilization of equipment is indicated. Overall the paper provides a resource to assist in future planning for such events in respect to physiotherapy manpower, expertise and equipment needs

A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

Background: Whiplash is the most common injury following a motor vehicle accident. Approximately 60% of people suffer persistent pain and disability six months post injury. Two forms of exercise; specific motor relearning exercises and graded activity, have been found to be effective treatments for this condition. Although the effect sizes for these exercise programs, individually, are modest, pilot data suggest much larger effects on pain and disability are achieved when these two treatments are combined. The aim of this study is to investigate the effectiveness and cost-effectiveness of this comprehensive exercise approach for chronic whiplash

Standing balance in persistent whiplash: A comparison between subjects with and without dizziness

Objective: Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes

Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial

BACKGROUND: Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation. METHODS/DESIGN: 182 participants with acute and sub-acute neck pain will be recruited from physiotherapy, chiropractic and osteopathy practices in Sydney, Australia. Participants will be randomly allocated to treatment with either manipulation or mobilisation. Randomisation will occur after the treating practitioner decides that manipulation is an appropriate treatment for the individual participant. Both groups will receive at least 4 treatments over 2 weeks. The primary outcome is number of days taken to recover from the episode of neck pain. Cox regression will be used to compare survival curves for time to recovery for the manipulation and mobilisation treatment groups. DISCUSSION: This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain

The Temporal Development of Fatty Infiltrates in the Neck Muscles Following Whiplash Injury: An Association with Pain and Posttraumatic Stress

Radiological findings associated with poor recovery following whiplash injury remain elusive. Muscle fatty infiltrates (MFI) in the cervical extensors on magnetic resonance imaging (MRI) in patients with chronic pain have been observed. Their association with specific aspects of pain and psychological factors have yet to be explored longitudinally.44 subjects with whiplash injury were enrolled at 4 weeks post-injury and classified at 6 months using scores on the Neck Disability Index as recovered, mild and moderate/severe. A measure for MFI and patient self-report of pain, loss of cervical range of movement and posttraumatic stress disorder (PTSD) were collected at 4 weeks, 3 months and 6 months post-injury. The effects of time and group and the interaction of time by group on MFI were determined. We assessed the mediating effect of posttraumatic stress and cervical range of movement on the longitudinal relationship between initial pain intensity and MFI. There was no difference in MFI across all groups at enrollment. MFI values increased in the moderate/severe group and were significantly higher in comparison to the recovered and mild groups at 3 and 6 months. No differences in MFI values were found between the mild and recovered groups. Initial severity of PTSD symptoms mediated the relationship between pain intensity and MFI at 6 months. Initial ROM loss did not.MFI in the cervical extensors occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent PTSD in patients with persistent symptoms

Evaluation of a Temporary Prosthetic Insert in the Rehabilitation of Elderly Ischaemic Below-Knee Amputees: A Pilot Study

The physiotherapy management of elderly, ischaemic below knee amputees is often compromised by delayed and/or complicated wound healing. Such patients are often unable to ambulate on a prosthesis for prolonged periods. Problems concommitant with immobilization such as weakness, contractures, and decreased morale tend to arise. This pilot study investigated the efficacy of incorporating a shaped Dunlopillo insert into a temporary prosthetic socket to allow the at risk group to ambulate as soon as the sutures were removed regardless of the state of wound healing. Two parameters were evaluated, namely wound healing and stump maturation. A total of eighteen subjects were observed in a control and an experimental group. Both wound healing (p < 0.05) and stump maturation (p < 0.05) were significantly enhanced by the inclusion of a Dunlopillo insert

Motor control problems in patients with spinal pain: A new direction for therapeutic exercise

Recent research into muscle dysfunction in patients with low back pain has led to discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing spinal segmental support and control. The muscle impairments are not those of strength but rather problems in motor control. These findings call for a different approach in therapeutic exercise, namely a motor learning exercise protocol. The specific exercise approach has an initial focus on retraining the cocontraction of the deep muscles tie, the transversus abdominis and lumbar multifidus. Initial clinical trials point to the effectiveness of the approach in patients with both acute and chronic low back pain in terms of reducing the neuromuscular impairment and in control of pain