https://nottingham-repository.worktribe.com/preview/1574428/EURJPAIN-D-17-00611_R3.pdf

A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability.

Approximately 90% of low back pain (LBP) diagnoses are non-specific (NSLBP; i.e. with unknown cause). In NSLBP patients, the hamstrings, iliopsoas, piriformis, and tensor fasciae latae are overactive due to weak hip abductor, extensor, and core muscles. Core stability is essential for proper load balance within the pelvis, spine, and kinetic chain, and core stability exercise (CSE) is an exercise treatment regimen for LBP conditions. We investigated how core stability and hip muscle stretching exercises affected NSLBP patients' physical function and activity. Patients were randomly allocated to three groups. The Stretch group (n = 24) performed exercises for hip muscle stretching for maximal motion; the Strengthen group (n = 22) performed exercises for hip muscle strengthening while maintaining the maximal isometric contraction. The Sham group (n = 20) received gentle palpation of the skin. Therapy was conducted thrice weekly for 6 weeks. Pain intensity, lower back instability, and hip muscle flexibility were measured to assess physical function. Disability level, balance ability, and quality of life were measured to assess physical activity. Data were collected prior to intervention and at 6-week follow-up. There were significant within-group changes for all measurements (P < 0.05). The Stretch and Strengthen groups had greater improvements in pain intensity, disability level, balance ability, and quality of life than the Sham group. Lower back instability and hip muscle flexibility had the greatest improvement in the Stretch group. In conclusion, CSE and hip muscle stretching are effective at improving physical function and activity in NSLBP patients.

/pdf/core-stability-and-hip-exercises-improve-physical-function-594g0qm7n7.pdf

Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial.

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization An area of physical therapy where the biomedical mod

/pdf/a-clinical-perspective-on-a-pain-neuroscience-education-4looq199w3.pdf

A clinical perspective on a pain neuroscience education approach to manual therapy

This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were -0.13 (-0.18 to -0.09; 2832) for pain-related fear, -0.16 (-0.23 to -0.09; 756) for catastrophizing, -0.08 (-0.13 to -0.03; 1570) for depression, -0.08 (-0.30 to 0.14; 336) for anxiety, and -0.06 (-0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.

Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis.

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

Objective: To determine if a neuroplasticity educational explanation for a manual therapy technique will produce a different outcome compared to a traditional mechanical explanation.Methods: Sixty-two patients with chronic low back pain (CLBP) were recruited for the study. Following consent, demographic data were obtained as well as pain ratings for low back pain (LBP) and leg pain (Numeric Pain Rating Scale), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance-Beliefs Questionnaire), forward flexion (fingertips-to-floor), and straight leg raise (SLR) (inclinometer). Patients were then randomly allocated to receive one of two explanations (neuroplasticity or mechanical), a manual therapy technique to their lumbar spine, followed by post-intervention measurements of LBP, leg pain, forward flexion, and SLR.Results: Sixty-two patients (female 35 [56.5%]), with a mean age of 60.1 years and mean duration of 9.26 years of CLBP participated in the study. There were no statistically sig...

/pdf/the-effect-of-manual-therapy-and-neuroplasticity-education-mam9ipm376.pdf

The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial

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The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial