Journal of Back and Musculoskeletal Rehabilitation - Volume 3, issue 4
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Pain is a common symptom in cancer patients. Thirty to fifty percent of patients will experience pain while undergoing cancer treatment, and 70 to 90% of patients with advanced disease report pain.1–7 In addition, greater than 50% of patients state their pain is incompletely controlled. In part, this is due to the difficulty physicians have in accurately assessing the patient's level of pain and response to treatment, as well as utilizing a treatment approach that is agreeable to the patient. It is common that patients underreport the severity of the pain that they are experiencing, as well as their…inability to achieve pain control. There are many possible reasons for this, including their wish to appease the physician; the fear of confirming progression of their disease by admitting to having increased pain; and the concern of possible narcotic addiction. To address these problems, the World Health Organization, the American Pain Society, and the American Society of Clinical Oncology's Ad Hoc Committee on Cancer Pain have published guidelines for assessing and treating pain.8–10 Pain is one of the most disabling conditions experienced by cancer patients.7,11–14 This disabling effect is exacerbated by the patient's fear of the loss of control of both the ability to regulate his/her pain and loss of control of his physical mobility due to the pain. Therefore, it affects the patient both physically and emotionally and further compromises the ability of the patient and family to deal with the disease. The perceived intensity of the pain as well as the level of disability experienced by the patient can be influenced by many variables such as family support and cultural background of the patient. These influences in the patient's life can magnify or diminish his/her perception of pain and disability. Therefore, in the same way that patients tolerate pain differently, the treatment approach must to some extent be appropriately individualized, periodically reviewed, and frequently altered to change with the needs of the patient. This is one reason why those involved with cancer rehabilitation use an individualized interdisciplinary approach to the patients' needs, including pain control. In addition to the traditional use of analgesics, chemotherapy, radiation therapy, surgery, and nerve blocks to palliate pain, cancer rehabilitation employs a wide range of other modalities, both physical and cognitive behavioral, in its treatment approach. Physical and occupational therapy utilize positioning, strengthening, transcutaneous electrical nerve stimulation (TENS), and other electrical stimulation modalities, orthotics, and other assistive devices to alleviate pain and maximize function. In addition, psychological support in its various forms, with both patient and family counseling, affords better handling of the disease. In some cases biofeedback and/or hypnosis can be utilized as an adjunct to pain control. Since the pathophysiology of cancer pain and its pharmacologic, surgical, and radiation treatments were dealt with in a previous issue, they will not be addressed further. This article will focus primarily on the more unique aspects of cancer rehabilitation, and the physical, nonpharmacologic, and behavioral approaches to pain management that practitioners commonly use in relation to neurological pain syndromes in cancer.
Abstract: The purpose of this study was to assess the amount of thoracic segmental flexion associated with cervical forward bending. Twenty-four healthy men and women between the ages of 21–29, with no past or present cervical or thoracic dysfunction, participated. Spinal segmental mobility in the thoracic region was measured in the neutral sitting position and sitting with the cervical spine in the forward bent position. Mobility was measured by the Faro Metrecom Skeletal Analysis System. The Faro Metrecom is an external measuring device that records each individual spinal segment's position within the body. Descriptive statistics were used to describe the position…of the thoracic segments when the cervical region was in the neutral and in the forward bent positions. Additionally, intrarater reliability, .83 and .76, and interrater, .72, were analyzed for the thoracic segments in the neutral position. The results show that with cervical flexion there was thoracic segmental flexion. Segments T1–4 demonstrated forward bending ranging from 2.88–4.42°. The greatest amount of flexion occurred at T2, 4.42 degrees, and T3, 4.19 degrees. Below T4 no pattern was noted. The results indicate that upper-thoracic segmental flexion occurs during cervical forward bending. During evaluation and treatment of patients with cervical dysfunction physical therapists routinely evaluate spinal segmental mobility. It is clear to clinicians that cervical segmental mobility is important to cervical range of motion. What it not clear is the role of thoracic segmental mobility in cervical range of motion. Physical therapists frequently evaluate and treat the thoracic region when patients have cervical dysfunction. Therefore, the purpose of this study was to assess the amount of thoracic segmental flexion associated with cervical forward bending. Since the early 1970s when the concept of joint mobilization was brought to American physical therapists, interest in spinal segmental motion has increased. Though interest in this area exists, there is a scarcity ofresearch documenting normal and abnormal spinal segmental mobility. Additionally, most of the studies on spinal segmental mobility have been conducted on cadavers or through radiographic methods. Lysell studied intersegmental movements of the cervical spine using autopsy specimens. Steel balls were placed in fixed points on each vertebrae and then a three-dimensional radiographic examination was used to measure movements of these points during cervical range of motion.1 Ball and Meijers studied cervical mobility using fresh cadaveric cervical spinal specimens. In this study steel pins were inserted into the cervical bodies and serial x-rays were taken.2 Panjabi, Dvorak, and Duranceau studied upper-cervical spine mobility using fresh cadaveric whole cervical spine specimens and steel balls. Their specimens were set into a quick-setting epoxy material to help align the centers of C2 and C7, thereby providing fixation.3 Yamamoto et al. studied three-dimensional movements of the lumbar spine and lumbosacral joint. They used fresh cadaveric whole lumbar spine specimens analyzing from L1 to the sacrum.4 Robert studied intervertebral motion of the whole spine. This was performed with cadavers as the segmental excursions were determined from a point at the inferior surface of the vertebrae to the tip of the spinous process.5 Three separate noncadaveric studies were conducted by Penning,6 Felding7 and Moll and Wright.8 Penning studied normal movements of the cervical spine by superimposing two x-ray films representing the cervical spine in the end positions (i.e., flexion and extension). Fielding studied normal and abnormal motion of the cervical spine from C2 and C7 using cineroentgenography; roentgenograms were taken while the subjects were moving. Moll and Wright studied normal range of spinal mobility using live subjects with markers on the skin. When the subjects moved the separation of the skin markers was recorded. The above studies used procedures that are not convenient for use during clinical sessions. Additionally, the above studies did not evaluate thoracic mobility in relation to cervical motion. In the textbook, Common Vertebral joint Problems,9 Grieve presents a complete discussion of vertebral motion. This section is highly referenced as it pertains to segmental spinal mobility.9 White and Panjabi are the most frequently cited source on spinal segmental mobility.10,11 They reported flexion/extension degrees of motion for the thoracic segments. The ranges of the motion and the “representative angle” (most likely the mean angle) in degrees for each thoracic segment are T1–T5 2–5 (4); T6 2–7 (5); T7–T9 3–8 (6); T10 4–14 (9); and T11–T12 6–20 (12). However, they did not state how their estimated range and “representative angle” in degrees of segmental spinal mobility were measured.10,11 Valencia in the book Physical Therapy of the Cervical and Thoracic Spine states similar motion for the thoracic segments.12 The upper-thoracic spine, T1–T6, has been related to the cervical region anatomically. The upper-thoracic facet joints are orientated like the cervical facet joints and have a similar pattern of movement.11,13 Additionally, the caudal attachment of many cervical muscles is in the thoracic region.13