Pain modulation from manual therapy

NewsBot · Jul 16, 2016

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The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review
Andrew D. Vigotsky and Ryan P. Bruhns
Pain Research and Treatment; Volume 2015 (2015), Article ID 292805 (full text)

Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy?s analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed.
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NewsBot · Jul 16, 2016

Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee
Carol A. Courtney et al
J Orthop Sports Phys Ther 2016;46(3):168–176. Epub 1 Jan 2016. doi:10.2519/jospt.2016.6259

Study Design
An experimental laboratory study with a repeated-measures crossover design.

Background
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.

Objective
To examine the effect of joint mobilization on impaired CPM.

Methods
An examination of 40 individuals 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.

Results
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.

Conclusion
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.
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NewsBot · Jul 21, 2016

Blog post:
The Decline of Manual Therapy Skills?

For those of you who followed the #IFOMPT2016 conference on social media or were lucky enough to be there it was apparent that the pain revolution was at the forefront of the meeting. Lorimer Moseley, Jo Nijs, Joel Bialosky among others were there and pushing us to consider factors such as emotions, pain mechanisms, and the overall neuroscience of pain when applying manual therapy.
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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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