In a 36-year-old woman with neck pain, will manipulation and mobilization be beneficial for reducing her reports of neck pain?

\u3cLEAP\u3e highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a patient with neck pain. Can manipulation or mobilization reduce her neck pain

The Back Pain and Movement (B-PAM) registry; a study protocol

BACKGROUND:Low back pain (LBP) is a ubiquitous, heterogeneous disorder that affects most people at some point in their lives. The efficient management of LBP remains elusive, with direct and indirect costs attributed to LBP surpassing many other common conditions. An emphasis on a structural basis of LBP often fails to recognize movement, specifically patterns of movement that may provide biomechanical signatures of painful conditions. The primary objective of this registry is to understand the differences in movement patterns among those with LBP and those without pain in a U.S. population sample. METHODS:This ongoing, non-randomized, prospective post-market registry will consist of two groups: patients with LBP, and age and sex-matched controls without LBP. We will seek to recruit 132 subjects in each group. Data collection will take place in two phases: (1) baseline assessment of LBP patients and matched controls; (2) assessment of LBP patients at 6 and 12-months follow up. The primary outcome measure will be differences in movement patterns between those with LBP and those without LBP. Secondary outcomes will include differences in patient reported outcomes including pain, disability and quality of life. DISCUSSION:The findings will help determine if there are meaningful differences in movement patterns between those with and those without LBP. Further, an initial understanding of movement signatures specific to certain subtypes of patients with LBP may be achieved. TRIAL REGISTRATION:The study was registered on the clinicaltrials.gov portal: NCT03001037 . Trial retrospectively registered 12/22/2016

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach

BACKGROUND AND PURPOSE: Sacroiliac joint pain and dysfunction affect 15–25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. CASE DESCRIPTION: A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. OUTCOMES: The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient’s Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient’s rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. DISCUSSION: A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up

Changes in pulmonary function following thoracic spine manipulation in a healthy inactive older adult population-a pilot study

[Purpose] Pulmonary function pathology is primarily treated pharmacologically, with a range of medication side effects. Few studies have systematically examined non-pharmacologic approaches such as joint manipulation effects on pulmonary function. This study examined the immediate and short-term effects of thoracic manipulation on pulmonary function. [Participants and Methods] Twenty-one physically inactive otherwise healthy participants aged 50 years or older were randomly assigned to either receive three sessions of thoracic manipulation (n=10) or three sessions of sham intercostal training (n=11). Outcome measures included forced vital capacity, maximal voluntary ventilation and thoracic excursion during maximal inhalation and exhalation. [Results] There was a statistically significant difference in maximal voluntary ventilation in the manipulation group, when measured within a week of the third intervention session and immediate effects in thoracic excursion during exhalation in the sham group following a single intervention session. There were no significant changes in other measures. [Conclusion] Spinal manipulation had no immediate effect on pulmonary function, however, affected an improvement in maximal voluntary ventilation within 7 days following a third session. The sham intervention showed a change in thoracic excursion during exhalation after the first session. Future research is necessary to further explore the relationship between thoracic manipulation and pulmonary function

The interdisciplinary management of coccydynia: A narrative review

Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies

Early ambulatory outpatient sequenced antiviral multidrug COVID-19 treatment (including for Delta or similar variants) for high-risk children and adolescents

During the past 19 months the global spread of the Severe Acute Respiratory Syndrome, Coronavirus2 (SARS-CoV-2 or COVID-19) has led to acute hospitalizations and death in primarily high-risk elderly and younger age groups who often present with comorbidities associated with increased risk. Otherwise, the virus is largely self-limiting in those infected outside of high-risk groups. Presently, the global community is confronting a predominant Delta variant of the virus, distinct from the initial variants, highly contagious and less virulent. The good news for high-risk populations is that early drug treatment (sequenced multi-drug treatment/SMDT) for all variants, has been shown to reduce the risk of hospitalization and death by as much as 85%. This paper is a combination of scientific research including clinical expert opinion of front-line doctors treating patients with COVID-19 and focuses on early treatments in children. The authors however, in support of the scientific literature recognize the risk of severe illness or death in the pediatric population is significantly low (statistical zero). Outlined are some of the key issues and pathophysiological principles that relate to the pediatric population with early infection. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral anti-infective ‘repurposed’ therapy, 3) immunomodulation via oral/inhaled corticosteroids, 4) antiplatelet/antithrombotic/anticlotting therapy, and 5) administration of oxygen, monitoring, and telemedicine as needed. The key message is that as with adults, high-risk persons of any age, including the pediatric population, should not be left in a ‘wait-and-see’ mode whereby there is the potential for clinical decline; this, while effective, affordable, accessible, and safe treatments exist that could be administered in the pre-hospital phase. This paper should not in any way be taken as an indication or endorsement of elevated COVID-19 risk to pediatric populations, but rather as a proactive position in the rare instance a young child requires treatment. Future comparative effectiveness research comprised of high-quality and trustworthy observational study research and randomized controlled trials (especially study involving multiple therapeutic combinations/SMDT) will undoubtedly refine and clarify our clinical observations