ORCID Profile
0000-0002-7216-4536
Current Organisation
Northwestern University
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Publisher: Informa UK Limited
Date: 20-03-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.GAITPOST.2004.07.002
Abstract: To clarify the mechanisms of compensation in subjects with anterior cruciate ligament deficiency (ACL-D), we examined proprioception, quadriceps strength, somatosensory evoked potentials (SEPs) and muscle responses during gait in varied combinations of speed and incline. Seventeen subjects with ACL-D were grouped by functional level and report of giving way. Seven subjects without ACL-D served as a control s le for muscle response measures. ACL-D subjects with quadriceps weakness experienced giving way and could not resume sport activities. Those without weakness fell into one of two groups: (1) copers, who had full return to previous activity and no giving way despite proprioceptive loss and altered SEPs, and (2) adapters, who were unable to return to previous activity level and experienced giving way despite neither proprioceptive loss or altered SEPs. The unique muscle pattern in copers during inclined fast walking included larger and earlier hamstring activation. These results suggest that in in iduals with ACL-D without a strength deficit, altered SEPs and altered neuromuscular patterns are the factors that enable resumption of pre-injury functional levels. Loss of proprioception may drive the central changes, which in turn drives the development of altered muscle patterns.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.GAITPOST.2005.08.006
Abstract: To examine the mechanisms underlying return to pre-injury function in in iduals with anterior cruciate ligament deficiency (ACL-D), we grouped 15 in iduals (18-50 years of age) with ACL-D by functional status and strength (i.e. copers, non-copers and adapters) and compared measures of proprioception, somatosensory evoked potentials and neuromuscular responses to dynamic testing between groups. Seven subjects without ACL-D provided a comparative s le for dynamic balance testing (DBT). DBT consisted of bilateral EMG recordings of anterior tibialis, medial gastrocnemius, medial hamstrings and quadriceps during toes-down platform rotation. Relative latencies and relative litudes were calculated. Somatosensory evoked potential (SEPs) testing was based on identifying the presence or absence of the P27 potential. Proprioception was tested using threshold to detection of passive movement (TDPM). Those with the highest level of function, the copers, had a proprioceptive deficit, loss of P27 and altered postural synergies consisting of earlier and larger hamstring activation. Conversely, those with the lowest functional status, the non-copers, had strength and proprioception deficits, intact SEPs and inconsistent postural synergies. These results suggest that changes in central sensory representation may facilitate altered postural synergies that enable return to pre-injury functional status.
Publisher: Oxford University Press (OUP)
Date: 25-08-2017
DOI: 10.2522/PTJ.20160036
Abstract: The Mexican artist Frida Kahlo (1907–1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities Diego Rivera and Leon Trotsky, less known is the fact that she had lifelong chronic pain. Frida Kahlo developed poliomyelitis at age 6 years, was in a horrific trolley car accident in her teens, and would eventually endure numerous failed spinal surgeries and, ultimately, limb utation. She endured several physical, emotional, and psychological traumas in her lifetime, yet through her art, she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This article uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this article is to discuss Frida Kahlo's medical history and her art from a modern pain sciences perspective, and perhaps to increase our understanding of the pain experience from the patient's perspective.
Publisher: Informa UK Limited
Date: 11-2011
Publisher: Informa UK Limited
Date: 07-2009
Publisher: Informa UK Limited
Date: 12-2009
Publisher: Informa UK Limited
Date: 05-01-2018
Publisher: Maney Publishing
Date: 03-03-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2018
DOI: 10.1097/AJP.0000000000000560
Abstract: The objective of this study was to investigate somatosensory nerve fiber function by applying different quantitative sensory testing including thermal, mechanical, and vibration thresholds over latent trigger points (TrP) and in its associated referred pain area. A total of 20 patients with unilateral latent TrPs in the extensor carpi radialis brevis were included. Warmth detection threshold (WDT), cold detection threshold (CDT) and heat/cold pain thresholds (HPT, CPT), mechanical detection (MDT) and pain (MPT) thresholds, vibration threshold (VT), and pressure pain thresholds (PPT) were blinded assessed over the TrP, in the referred pain area, and in the respective contralateral mirror areas. A multilevel mixed-model ANOVA with site (TrP, referred pain area) and side (real or contralateral) as within-patient factors and sex as between-patients factor was conducted. No significant differences for thermal detection (WDT, CDT) or thermal pain thresholds (HPT, CPT) were found (all, P s .141). The assessments over the TrP area showed lower PPT and MDT compared with the mirror contralateral TrP area ( P .05). MDT were higher ( P =0.001) but PPT ( P .001) and MPT ( P =0.032) were lower over the TrP area and contralateral mirror point compared with their respectively referred pain areas. Finally, VT was higher over the TrP area than in the referred pain area and over both mirror contralateral points. Assessing sensory changes over latent myofascial TrPs reveal mechanical hyperesthesia, pressure pain hyperalgesia, and vibration hypoesthesia compared with a contralateral mirror area.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.CLINPH.2010.07.029
Abstract: Hyperexcitability of nociceptive pathways has been demonstrated with several musculoskeletal conditions but not anterior cruciate ligament (ACL) injury. The purpose was to investigate flexor withdrawal reflex (FWR) excitability following ACL rupture and determine if painless stretch of knee joint structures enhanced reflexive responses. Ten subjects with and 10 subjects without unilateral ACL rupture were compared. FWRs were induced through sural nerve stimulus in symmetrical stance and recumbent positions, with the knee in relaxed and stressed condition. Latencies and litudes of hamstring electromyographic activity were analyzed. FWR thresholds were significantly diminished (p=0.05) on the injured limb (11.8±8 mA) compared to non-injured limb (18.6±13 mA) and controls (22.5±3 mA). Anterior tibial translation resulted in increased (p=0.001) litude of EMG hamstring response on the injured limb (70±50%) versus control (-1±20%) and decreased latency (p=0.01) of hamstring activation (82.0±13 ms). In iduals with ACL rupture demonstrated increased excitability of FWR responses indicated by decreased FWR threshold and reduced hamstring muscle latency. Responses were enhanced by passive stretch of the knee joint. Subjects with ACL rupture demonstrated hyperexcitability of nociceptive pathways on the injured limb which may trigger the FWR more readily and promote the sensation of instability at the knee.
Publisher: Informa UK Limited
Date: 02-2014
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.JPAIN.2009.07.005
Abstract: Patients with chronic pain often present with hyperalgesia, possibly due to hyperexcitability of nociceptive pathways. The aim of the present study was to investigate alterations in flexor withdrawal reflex (FWR) excitability in in iduals with knee osteoarthritis (OA) and the potential effect of specific physical inputs or therapeutic interventions (ie, joint compression and mobilization) on these behaviors. Ten subjects with and 10 without knee OA (age 45-75) were recruited. The FWR was examined utilizing suprathreshold, noxious electrocutaneous stimuli applied at the medial foot. Surface electromyographic (EMG) was recorded from the tibialis anterior (TA) and biceps femoris (BF), and peak joint torques recorded at the hip, knee, and ankle. FWR threshold was ascertained and responses at 2x threshold recorded after the following conditions: a maximal, volitional, joint-compression task, a sham hands-on intervention, and a Grade III oscillatory joint-mobilization intervention. A decreased threshold-to-flexor withdrawal response was found in the OA vs control group (P < .01). EMG and joint-torque FWR responses were further augmented in the OA group following the maximal joint-compression task (P < .05), yet remained unchanged or diminished in controls. Joint mobilization, but not sham intervention, reduced reflex responses significantly, although primarily by decreasing BF activity and knee torques (P < .05). Application of specific physical inputs to in iduals with knee OA similar to those encountered during activity of daily living or during therapeutic interventions appear to modulate involuntary, nociceptive reflex responses. Routine weight-bearing activities such as walking may potentially enhance heightened FWR responses, while joint mobilization, a commonly used clinical intervention, may diminish reflex excitability.
Publisher: Informa UK Limited
Date: 02-2014
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 04-08-2013
DOI: 10.1007/S00520-012-1549-X
Abstract: Our aim was to compare the effects of land versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors. Ninety-eight breast cancer survivors were assigned to three groups: control, land exercise, and water exercise. Both exercise groups participated in an 8-week multimodal program. Adiposity was measured by anthropometry (body mass index, waist circumference) and bioelectrical impedance (body fat and muscle lean body mass). Incidence of clinically significant secondary lymphedema was also assessed. Finally, specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23. Using ANCOVA, significant group × time interactions for body fat percentage (F = 3.376 P = 0.011) and lean body mass (F = 3.566 P = 0.008) were found. Breast cancer survivors in the land exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise (P < 0.001) and control (P = 0.002) groups. The ANCOVA revealed a significant group × time interaction for waist circumference (F = 4.553 P = 0.002): breast cancer survivors in the control group showed a greater waist circumference when compared to water (P = 0.003) and land (P < 0.001) exercise groups. A significant group × time interaction was also found for breast symptoms (F = 9.048 P < 0.001): participants in the water exercise group experienced a greater decrease of breast symptoms than those in the land exercise (P < 0.01) and control (P < 0.05) groups. Land exercise produced a greater decrease in body fat and an increase in lean body mass, whereas water exercise was better for improving breast symptoms.
Publisher: Informa UK Limited
Date: 21-03-2017
Publisher: Springer Science and Business Media LLC
Date: 29-09-2012
DOI: 10.1007/S11916-012-0299-2
Abstract: Pain is a major cause of impaired mobility in elderly patients with chronic osteoarthritis (OA) of the knee. Central sensitization and impaired nociceptive inhibitory mechanisms have both been identified as contributing factors to heightened pain in this patient population. While central sensitization has been shown to produce enhanced pain responses and spread of pain to adjacent and remote body regions, conditioned pain modulation has also been shown to be adversely affected, and may be characteristic of those patients with chronic pain. Alterations of quantitative sensory testing measures have been demonstrated in patients with knee OA, and may serve as a clinical means of staging chronic musculoskeletal pain, including assessment of hyperalgesia and hypoesthesia. In addition, pain and altered somatosensation commonly associated with OA may be correlated with functional deficits.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-01-2022
DOI: 10.1097/J.PAIN.0000000000002577
Abstract: Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold) and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination—134 features, quantitative sensory testing—34, imaging and diagnostic testing—14, and pain-type questionnaires—14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 03-2016
Abstract: An experimental laboratory study with a repeated-measures crossover design. Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia. To examine the effect of joint mobilization on impaired CPM. An examination of 40 in iduals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing. Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention. Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis.
Publisher: Informa UK Limited
Date: 20-08-2014
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2014
Abstract: Case report. Pain can lead to a significant reduction in quality of life. A pain mechanisms-based classification scheme has been outlined to improve management of patients with pain, but studies describing its use are limited. Evidence for physical therapy interventions in those with chronic pain and multiple health conditions is also lacking. This case report describes management of a patient with chronic pain and multiple health conditions. A 29-year-old man presented with a 3-year history of low back pain and 11-month history of lower extremity paresthesia. Current health conditions included left-sided hemiparesis secondary to a stroke, pancreatic kidney transplant, left-sided blindness, and osteoporosis secondary to hyperparathyroidism. Inability to walk to school and sit through class, and pain-related sleep disruption were the primary activity and participation restrictions. Outcome measures included the numeric pain rating scale, global rating of change, Oswestry Disability Index, and pain medication usage. A score of 12 on the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale indicated the presence of neuropathic pain, but other pain mechanisms were also hypothesized to be present. Treatment was designed to improve patient goals considering these pain mechanisms. The patient was seen for 20 visits over 6 months. Ten months after the initial evaluation, the patient's Oswestry Disability Index scores improved by more than 50% and the patient achieved all initially stated goals without pain medication. A pain mechanisms-based approach assisted in the management of a patient with chronic pain and multiple health conditions. Using this approach may enhance clinical decision making when managing in iduals with chronic pain. Therapy, level 4.
Publisher: Informa UK Limited
Date: 16-10-2023
Publisher: Informa UK Limited
Date: 02-2014
Publisher: Informa UK Limited
Date: 26-10-2011
DOI: 10.3109/09593985.2010.521542
Abstract: Whiplash injuries of the cervical spine comprise 30% of injuries reported following motor vehicle accident (MVA) and often progress to chronic painful conditions. The purpose of this case report is to describe the management of a 37-year-old female referred to physical therapy with neck and shoulder pain after whiplash injury. The patient demonstrated limited cervical and shoulder active range of motion as well as quantitative sensory testing (QST) results consistent with central nervous system sensitization. She was treated for 11 visits over a 6-week period with manual therapy and specific exercise directed to the cervicothoracic spine. Her pain decreased from 9/10 to 2/10 by the end of treatment and remained improved at 1/10 at the 6-month follow-up. Her Copenhagen Neck Functional Disability Scale decreased from 23/30 to 4/30 by the 11th visit. In addition, she demonstrated clinically significant increases in cervical active range of motion and normal somatosensation. Manual therapy of the cervicothoracic spine may be a beneficial adjunct to the standard care of patients with signs and symptoms of central sensitization after whiplash-associated disorder and primary report of neck and shoulder pain.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Informa UK Limited
Date: 02-2012
Publisher: Wiley
Date: 11-2018
DOI: 10.1002/JOR.24159
Abstract: Impaired descending pain inhibition has been linked to chronic pain and poorer patient outcomes. Vibration perception threshold (VPT) has also been observed and linked to radiographic stage of OA. However, it is not known how duration of symptoms may influence these neurophysiological measures. Our purpose was to evaluate the relationship between duration of symptoms and conditioned pain modulation (CPM), a measure of descending pain inhibition, and VPT, and to determine whether these relationships differed in men and women seeking orthopedic care. We evaluated 18 men and 27 women with moderate to severe knee OA. We assessed CPM using a submaximal-effort tourniquet test: Pressure pain threshold (PPT) at the symptomatic knee was evaluated before and after a noxious stimulus. CPM impairment was indicated by a ratio of pre-to-post stimulus PPT ≥1. VPT was assessed using a biothesiometer at the medial femoral condyle. We used chi-square, t-tests and Pearson correlations to address study questions. 72% of men, but only 44% of women had CPM impairment. Duration of symptoms was associated with CPM impairment in women (R = 0.566, p = 0.003) but not men (R = 0.366, p = 0.135). Duration of symptoms was also associated with VPT in both men (R = 0.580, p = 0.012) and women (R = 0.406, p = 0.039). These results suggest that longer duration of knee OA may predict more severe pain sensitization and that important sex differences exist in descending pain inhibition in people with chronic knee OA that may affect disease and course of treatment in male and female patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Publisher: Informa UK Limited
Date: 10-02-2016
DOI: 10.3109/09593985.2015.1114691
Abstract: Massive irreparable rotator cuff tears can be difficult to treat conservatively, especially when the patient has multiple comorbidities. Although there is evidence to support interventions aimed at the spine, there is paucity in the literature describing interventions to the sternoclavicular joint (SCJ) in in iduals with rotator cuff pathology. A 57-year-old female with multiple comorbidities and a body mass index of 59 was referred to physical therapy with a 4-month history of right shoulder pain, significant functional limitations, and magnetic resonance imaging (MRI), demonstrating a full-thickness supraspinatus tear. She presented initially with active shoulder flexion range of motion (ROM) 0-80°, numeric pain rating scale (NPRS) 7/10, and QuickDASH 65.9%. After six physical therapy sessions, the patient had plateaued with improvements in pain and ROM. SCJ mobilizations at visit 7 immediately improved pain, active ROM, and subjective reports of function. The patient was discharged after 13 visits with increased active shoulder flexion ROM to 0-170°, NPRS 1/10, QuickDASH 31.8%, and Global Rating of Change (GROC) +5. This case highlights the successful conservative treatment of an in idual with an irreparable rotator cuff tear and numerous comorbidities by using a multimodal approach including SCJ mobilizations.
Publisher: Informa UK Limited
Date: 11-2011
Publisher: SAGE Publications
Date: 12-01-2018
Abstract: To investigate and synthesize the effects of joint mobilization on in iduals with patellofemoral pain syndrome. Five electronic databases (CINAHL, the Cochrane Central Register of Controlled Trials, PubMed, Scopus, and SPORTDiscus) were used. Each database was searched from inception to 1 November 2017. Randomized controlled trials investigating a manual therapy intervention, with or without co-interventions, for persons with patellofemoral pain were included. Two reviewers independently screened the retrieved literature and appraised the quality of the selected studies using the PEDro rating scale. A third reviewer was used in cases of discrepancy to create a consensus. A total of 361 articles were identified in the search. Twelve randomized trials with a total of 499 participants were selected for full review. Within-group improvements in pain and function were noted for the manual therapy groups. Between-group improvements for short-term outcomes (three months or less) were greatest when joint mobilization was directed to the knee complex and used as part of a comprehensive approach. In the articles reviewed, joint mobilization appears to be most effective in improving pain and function when coupled with other interventions, although its discrete effect is unclear due to the reviewed studies' design and reporting.
Publisher: Informa UK Limited
Date: 19-12-2014
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.JPAIN.2009.05.004
Abstract: Patients with osteoarthritic (OA) knee pain often present with impaired muscle activation and function that may be attributed in part to hyperexcitability of flexion withdrawal reflexes (FWRs). The aim of this study was to investigate alterations in the excitability of FWR in in iduals with knee OA and its potential associations with impaired quadriceps activation (QA) and subjective reports of pain. Twenty subjects with and 20 without knee OA (age, 45 to 75 years) participated. Impaired QA was determined in OA subjects during maximal volitional contraction of the quadriceps. FWRs were tested in isometric conditions using electrocutaneous stimulation applied at the medial foot at 1x and 2x FWR threshold and surface electromyographic recordings obtained from tibialis anterior (TA) and biceps femoris (BF). Joint torques at the hip, knee, and ankle were calculated and normalized to body mass. FWR threshold was significantly diminished in OA versus the control group (P < .01). In addition, FWR latencies were consistent with spinally mediated responses, with significantly earlier responses in OA versus control subjects of TA at threshold (P = .002) and BF at suprathreshold stimulation (P = .0006). Impaired QA was found in 4 of 20 OA subjects but was not correlated to FWR threshold or pain levels. Peak joint torques were diminished in the OA versus the control group (P < .0006). Increased excitability of FWRs was evident in subjects with chronic knee osteoarthritis, including those subjects without resting pain, but was not associated with impaired QA. Management strategies for this patient population must consider altered pain processing in addition to addressing impairments found at the knee.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 12-2010
Abstract: Pain is a common complaint among clients seeking physical therapy services, yet interpretation of associated sensory changes can be difficult for the clinician. Musculoskeletal injury typically results in nociceptive pain due to noxious stimuli of the damaged muscle or joint tissues. However, with progression from acute to chronic stages, altered nociceptive processing can give rise to an array of sensory findings. Specifically, patients with chronic joint injury may present with signs and symptoms typically associated with neuropathic injury, due to changes in nociceptive processing. Clinical presentation may include expansion of hyperalgesia into adjacent and remote areas, allodynia, dysesthesias, and perceptual deficits. Quantitative sensory testing (QST) may provide an objective method of examining sensation and, thereby, of recognizing potential changes in the nociceptive pathways. The purpose of this paper is to provide an overview of altered nociceptive processing and somatosensory changes that may occur following a musculoskeletal injury without associated neural injury. Recommendations are made on clinical uses of quantitative sensory testing in orthopaedic physical therapy practice, and supporting clinical and laboratory evidence are presented. Ex les related to joint injury are discussed, specifically, osteoarthritis of the knee and low back pain. Quantitative sensory testing may be a useful clinical tool to aid clinical decision making and for determination of prognosis.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.KNEE.2018.10.014
Abstract: While surgical reconstruction restores mechanical stability following anterior cruciate ligament (ACL) rupture, many experience early-onset osteoarthritis despite surgery. Neurophysiological changes are hypothesized to contribute to knee osteoarthritis progression. Proprioceptive deficits have been reported following ACL injury/reconstruction however, vibration perception threshold (VPT) has been less studied. This study explored relationships between pain, VPT, proprioception, function, and strength following ACL-reconstruction. Twenty in iduals (27 ± 6 years 10 males) (standard deviation) status-post ACL-reconstruction were compared with a control group. Measurements included VPT, proprioception (threshold to detect passive movement), pain, function (Knee Outcome Survey (KOS)) and isometric quadriceps strength. Group differences were assessed using Mann-Whitney U tests, side-to-side differences with Wilcoxon Signed Rank tests, and associations evaluated using Spearman correlations. The ACL-reconstruction group had minor functional deficits (15 ± 11%) and resting pain (1.8 ± 1.7). Impaired VPT and proprioception (hypoesthesia) were demonstrated on surgical compared to contralateral and control limbs (p ≤ 0.008). Proprioception was significantly different between contralateral and control knees, but not VPT. Surgical knee proprioceptive deficits and VPT deficits were positively correlated (ρ = 0.462, p = 0.047) but not in controls (ρ = -0.042, p = 0.862). Strength was negatively correlated to pain (ρ = -0.589 p = 0.006), but not to KOS scores, proprioception or VPT (p ≥ 0.099). Proprioceptive deficits following ACL injury have been ascribed to loss of afferent input from the torn ligament. Alternatively, multi-modality as well as contralateral sensory deficits suggest a spinal/supraspinal source of neurophysiological findings which may predispose to early osteoarthritis. III.
Publisher: Informa UK Limited
Date: 02-08-2017
DOI: 10.1080/09638288.2017.1358770
Abstract: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement on clinically relevant descriptors. It is proposed that identification of a dominance of central sensitization pain is based on descriptors derived from the subjective assessment and the physical examination. In the former, clinicians are recommended to inquire about intensity and duration of pain and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal hyperalgesia, hypoesthesia and reduced vibration sense. This article describes a set of clinically relevant descriptors that might indicate the presence of central sensitization in patients with knee osteoarthritis in clinical practice. Although based on research data, the descriptors proposed in this review require experimental testing in future studies. Implications for Rehabilitation Laboratory evaluation of central sensitization for people with knee osteoarthritis is yet to be incorporated into clinical practice. A set of clinical indicators for the recognition of central sensitization in patients with knee osteoarthritis is proposed. Although based on research data, the clinical indicators proposed require further experimental testing of psychometric properties.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2015
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 06-2013
Abstract: Controlled laboratory study: cross-sectional. To determine if proprioception, measured by the threshold to detection of passive motion (TDPM), differed in in iduals who regularly participate in moderate-intensity exercise for fitness as compared to in iduals involved in high-intensity skilled exercise. Previous research has been equivocal as to whether exercise training is associated with superior proprioceptive acuity, in particular, exercise that includes dynamic postural challenges such as cutting and pivoting. Two groups of 25 healthy in iduals (18-32 years old) were recruited. One group consisted of in iduals who performed moderate-activity level exercises for 5 to 10 hours per week. Participants in the other group performed high-activity level exercises, including high-speed cutting and pivoting activities, at least 10 hours per week. Proprioception was determined using TDPM, in which the knee was slowly extended or flexed at an angular velocity of 0.5°/s or less from a starting position of 40° of knee flexion. In iduals participating in competitive, high-intensity skilled exercise demonstrated better acuity (average of both limbs) of TDPM (mean ± SD, 0.81° ± 0.38° P<.001) than those participating in moderate-intensity exercise for fitness (1.53° ± 0.58°). A low but statistically significant association (r = -0.38, P = .006) was found between weekly duration of exercise and proprioceptive threshold as measured by TDPM. These results suggest that perceptual thresholds of passive movement may be enhanced, depending on activity level and associated postural challenge, and that higher level and increased amount of exercise may promote enhanced neurosensory processing in these in iduals. Consequently, high-intensity skilled training may deserve further emphasis in orthopaedic rehabilitation.
Location: United States of America
Location: United States of America
No related grants have been discovered for Carol A. Courtney.