Dynamic spine models designed by chiropractors. Our spine models are scientifically accurate, showing details in the discs, lumbar, pelvis and cervical spine. They can be used to demonstrate a range of clinical conditions which contribute to back pain or discomfort. Our models use an elastomeric two-part intervertebral disc design to show important anatomical features so are perfect for chiropractors, osteopaths, spine surgeons, physiotherapists and medicine students. See the back under compression and conditions such as disc herniation, epidural punctures and more.

Can Verbal Suggestions Manage Musculoskeletal Pain A Review

How much of an impact do verbal suggestions have on managing pain? We can’t be entirely sure. There has been a lot of controversy surrounding the power of suggestion and pain management. A review 1, in the journal of Physical Therapy Reviews, was conducted to find some answers. While there is potential in such a field, more research is required to see any clinical significance associated with pain management and verbal suggestions.

What’s the Context?

Numerous studies prove that pain has socioeconomic and health implications. This includes disability and functional limitation. Chronic lumbar pain has been observed to have the greatest prevalence. Low Back Pain or LBP is an economically draining ailment for individuals around the globe. Furthermore, reduction in pain due to surgeries and other LBP treatments isn’t always accompanied by improvement. Due to LBP being multi-faceted (including psychological factors), a person’s psyche has been suggested to help with recovery. So, verbal suggestions might have a role to play in the treatment of LBP.

Musculoskeletal lower back pain

The Purpose of This Review

The aim of the current review was to describe as well as explore the neurobiological mechanisms associated with verbal suggestions when it came to managing musculoskeletal pain in patients.

The literature search was conducted by two independent reviewers. The databases included were PEDro databases, Medline, Cochrane Library, Lilacs. Systematic reviews, randomized clinical trials, and literature reviews were included in this review.

After the study’s exclusion criteria, a total of 13 studies were involved in the current review. The total included four randomized controlled trials and nine reviews. The current review covered the neurobiology of verbal suggestion, and the effects of verbal suggestion in pain sufferers.

What did the Review Conclude?

The review concluded that there’s potential in positive verbal suggestion to improve the effectiveness of LBP management in patients. The review pointed out that such suggestions could generate hypoalgesia via the placebo effect. However, more research is required to fully determine the clinical significance of verbal suggestions for pain management in patients.

Can Hypersensitivity Be Decreased in Patients of Chronic Whiplash after a Medial Branch Block Procedure

A study 1, in the BMC Musculoskeletal Disorders, was conducted to determine if there was any change in sensory hypersensitivity in patients of chronic whiplash disorders after a medial branch block procedure in the cervical spine. The results showed a decrease in the patient’s pain.

What’s the Context?

It’s common for motor vehicle collision (MVC) to result in cervical spine pain and dysfunction. While many are able to recover (significantly) from neck pain and disability in about six months or even a year, reports show that 32% to 56% of patients continue to suffer.

According to studies, the cervical zygapophyseal joints are known to be a primary source of pain in as many as 60% of people who experience WAD or whiplash associated disorders. Such joints may also be playing a role in peripheral and centrally mediated pain (sensory hypersensitivity).

The Study

The current study was conducted to determine any change in sensory hypersensitivity in WAD grade II patients after a medial brank block (or MBB) procedure in their cervical spine.

This exploratory study utilized a pretest-posttest design. Eighteen participants (3 males, and 15 females) with whiplash associated disorders grade II, and 18 healthy (matches gender breakdown) participants were involved in this study. Take note, patients with chronic WAD and aged 18 to 60 years, who reported neck pain for more than 6 months, and who experienced a minimum of 80% decrease in the said neck pain after an intra-articular zygapophyseal joint block procedure were included.

zygapophyseal joints

The study used a single item Numeric Pain Rating Scale (0-10) for measuring the cervical spine pain intensity of patients before as well as after the MBB procedure.

Quantitative sensory testing (QST), which considered pressure pain thresholds (PPTs’) and cold pain thresholds (CPT’s), was used to measure sensory hypersensitivity. In patients dealing with WAD, the measures were taken at three sites bilaterally, pre and post-MBB. The study used an independent and dependent t-test to determine differences between thresholds.

The Results

The study revealed that, at baseline, the PPT’s were decreased at all three sites in the WAD group. The cervical spine had an increase of cold pain thresholds in the WAD group. Significant increases in PPT’s at all sites was observed in the WAD group (post-MBB), along with a substantial decrease in CPT’s at the cervical spine.

What was Concluded?

The study concluded that chronic WAD patients showed evidence of widespread sensory hypersensitivity in the presence of thermal or mechanical stimuli. Decreased levels of sensory hypersensitivity were observed in the WAD group after the decrease in the primary source of pain caused by the cervical zygapophyseal joints.

However, the study did note that large clinical trials, addressing long-term follow-up interventions targeted at eliminating or reducing the source of cervical pain in WAD patients, were required.

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes in the Lumbar Spine in CLBP Patients

There still seems to be some controversy when it comes to addressing the relationship between biomechanical instability and the degenerative changes in the lumbar spine in CLBP (chronic lower back pain) patients. A study 1 decided to gather more data about it.

Why such a focus?

Chronic low back pain or CLBP may be caused by the biomechanical instability following degenerative changes in the lumbar spine. Low back pain is experienced by millions of people around the globe. The course of clinical treatment for such an issue can be guided through radiographical assessment. Such an assessment would be of the bending motions of the lumbar spine as it might aid with the identification of the absence or presence of biomechanical instability in patients with CLBP.

Lumbar spine

Due to the said controversy, this study decided to look into the relationship between biomechanical instability and degree of degenerative changes in the lumbar spine in CLBP patients. Being a retrospective radiographical study, it focused on evaluating the changes in kinematics at various lumbar levels (the L5-S1 level, in particular) with progressive grades of disc degeneration as well as facet joint osteoarthritis in CLBP patients.

The Study

The current study involved 72 (51 males and 21 females) consecutive CLBP patients. The age range of the participants was kept 18 to 70 years.

It used standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine to evaluate the in vivo segmental kinematics at the L1-L2 through L5-L1. Changes in signal intensity and central disc height on mid-sagittal T2-weight MR (magnetic resonance) scans were used to quantify disc degeneration.

What were the Results?

The study shared that disc degeneration and facet joint osteoarthritis was able to occur independently of each other at the L5-L1 level. However, an association was observed at the L4-L5 as well as the L3-L4 levels. A greater range of motion in Ex and a smaller range of motion in Fx was observed in the absence of facet joint osteoarthritis (when compared to the upper lumbar levels). No change in the L5-L1 kinematics was observed with progressive disc degeneration in the absence of facet joint osteoarthritis. However, in the presence of such osteoarthritis, re-stabilization of the L5-L1 segment was observed between the severe and mild disc degeneration states.

 

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes

The Conclusion

The study concluded that unique degenerative and kinematic characteristics were exhibited by the L5-S1 motion segment compared with the upper lumbar motion segments. Furthermore, at the L5-S1 level, facet joint osteoarthritis and disc degeneration occurred independently of each other. The L5-S1 motion segment was biomechanically re-stabilized by severe disc degeneration if facet joint osteoarthritis was present.

What does it mean?

The study shared that the L5-S1 level, due to having unique anatomical features, may play a significant role in re-stabilizing the level with severe degeneration of the disc and facet joints. The data will prove beneficial in understanding more about CLBP and its clinical treatments.

 

Do Concepts of Stability and Instability Matter for Back Pain

A clinical commentary 1 in the Journal of Orthopaedic & Sports Physical Therapy was conducted to see if the concepts of stability and instability had any value when talking about Back Pain. The commentary’s argument was that the view of stability needed to be broadened and should also integrate interdisciplinary knowledge. Such a change was deemed necessary due to the complex nature of back pain.

What did it set out to do?

The current clinical commentary had the objective of providing a broad definition of stability. It showed how a unifying framework could be used to integrate different interpretations of spine stability. Furthermore, basic and clinical studies were examined to determine the link of spine stability to back pain. Recent scientific, as well as technological advancements, were also considered. The commentary also speculated on how to evolve the concept of stability (in a manner that also addresses non-mechanical issues lined to experiencing pain).

The main goal of the commentary was to display critical knowledge gathered from studying the concepts of stability and to share the potential present in understanding the etiology concerned with back pain.

Disc Herniation

 

Did it reach the intended goal?

While lumbar spine stability was the focus of this commentary, it was determined that similar concepts could still be used when covering different forms of back pain.

It shared that stability is linked to the central nervous system and how neural and mechanical coupling can help reduce the risk of instability connected to a healthy spine.

The commentary talked about how the messaging surrounding the human spine and its susceptibility should be made better for the general public’s understanding. A better understanding can also help reduce the likelihood of maladaptive strategies. A systems-based framework can also prove beneficial for interdisciplinary integration of knowledge; something this commentary stated needed improvement in the spine community.

The basic conclusion was that we still have a lot to learn about back pain. However, using a framework and using the potential that still exists, we can make the spine community efficient to help others.

How Much Does Pelvic Incidence Impact Sitting and Standing Positions

A study 1 in the European Science Journal aimed to observe if (and how) lumbo-pelvic sagittal alignment was likely affected by pelvic incidence (or PI). The results showed a correlation between PI and the change in lumbo-pelvic parameters between sitting and standing positions.

Why conduct such a study?

Over the decades, modern society has urged people to spend large amounts of their day in a sitting position; whether it’s for work, academics, or for leisure. Prolonged periods of sitting are linked to particular health concerns with nonspecific lower back pain in younger people being the most prevalent. That’s why it’s important to study the differences in spinal alignment when a person is standing and sitting as well as the effects of aging.

The current study had an objective to clarify the association of positional change to PI (pelvic incidence) and aging. The purpose was to investigate the difference in lumbo-pelvic sagittal alignment between standing and sitting positions and observe the level of association with PI and a person’s age.

The Study

A total of 253 participants were included (160 men and 93 women). They were divided into three groups. The 20 to 49 age range was the Younger Group, the 50 to 69 years being the Middle Age Group, and the 70 years and more being the Older Group. All of the participants underwent frontal and lateral radiography of the lumbar spine (this included the hip joints) while in sitting as well as standing positions.

lumbar spine

The study analyzed the lumbar lordotic angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and the associations between the changes in LL (∆LL), SS (∆SS), PT (∆PT), and PI.

The Kruskal–Wallis test was administered to determine intergroup differences. The differences in lumbo-pelvic parameters between sitting and standing positions were analyzed using the t-test. The Spearman rank correlation coefficient was used to analyze correlations between the variables of lumbo-pelvic parameters.

The Results

The study shared that it couldn’t find a correlation between age and changes in lumbo-pelvic sagittal alignment between the standing and sitting positions. However, take note, these parameters correlated with age at the standing but not in the sitting position. All of the groups showed positive correlations between PI and the changes between sitting and standing positions.

What was concluded?

The study concluded that there’s a correlation when observing a change in lumbo-pelvic parameters (between the sitting and standing positions) and PI. However, the same couldn’t be said when age was involved.

The results showed that PI is an important parameter for estimating the amount of changes in lumbo-pelvic alignment between standing and sitting positions. Furthermore, the data could prove to be beneficial in understanding the link between lower back pain and how people should sit or stand (and for how long).

Analyzing the Sensorimotor Control of the Spine

A review 1 was conducted to analyze the sensorimotor control of the spine. The overall conclusion of the review was that spinal structures were capable of monitoring sensory information and can control spinal muscles. They could likely offer kinesthetic perception to the sensory cortex.

Why Conduct such a Review?

One of the most common medical ailments affecting the middle-age population is low back pain or LBP. According to reports, LBP is an expensive musculoskeletal ailment. It’s multi-faceted and needs to be covered under sociological and psychological parameters. Trying to find the origin of LBP still requires a lot of research. Studies have speculated LBP being the cause of intervertebral disc damage. It has been linked to the damage of zygapophysial joints as well. The damage can be due to disc prolapse or traumatic injuries. It can be due to a degenerative process, too (particularly loading patterns).

sensorimotor control spine

The mechanics behind numerous spinal disorders can act in combination or single variables. Direct and referred pain can be caused by the derangement in the zygapophysial joints and lumbar intervertebral disc. The point being that we are yet to fully understand the link between structural alignment and pain.

What did this Review Do?

The current review went over the spinal viscoelastic structures. These structures included capsule, ligaments, and disc. The review gave particular focus to the structures’ sensory motor functions. The review shared that electrical stimulation of the lumbar afferents in the capsules, discs, and ligaments showed elicit reflex contraction of the longissimus and the multifidus muscles. Furthermore, the mechanical stimulation of the spinal viscoelastic tissues was able to excite the muscles with a higher excitation intensity. This occurred when more than one tissue was stimulated.

The review covered reflexes from different lumbosacral structures, the neuromuscular interaction between the spinal structures, and the reflexes from spinal ligaments. It also looked at the clinical implications of reflexes from the passive structures in the spine.

What did the Review Conclude?

The current review concluded that spinal structures were capable of monitoring sensory information in humans. They were also able to control spinal muscles.

Sacroiliac Joint

According to research, at least 10 to 30% of LBP or low back pain is linked to the sacroiliac joints. A review 1 in the journal of Best Practice & Research Clinical Rheumatology decided to give the said link a more in-depth look.

The Context
As mentioned, studies have shown an approximate 10-30% of all LBP being attributed to sacroiliac joints SIJ. While almost 44% of SIJ pain is associated with trauma onset, the etiology is still unclear. So, even today, there are numerous challenges when it comes to diagnosing as well as treating sacroiliac joints. One of the biggest challenges is determining whether or not pain or dysfunction in the human body is primarily due to the sacroiliac joint. SIJ being a causative factor, while theorized, doesn’t have a lot of evidence for support.

The Purpose of This Review

The current content aimed to cover the available data regarding the anatomy of SIJ along with its examination, etiology, and treatment to assist clinical approaches. One of the major questions dealt with: when pain is experienced at the SIJ, is it better to direct treatment at local tissues, or should it focus on factors that are remote to the joint?

Furthermore, the review also wanted to analyze if the pain in a region was primarily due to SIJ or were other factors in place (on and around the said joint)?

The review went over the anatomy and function of the Sacroiliac joints, the etiology of Sacroiliac joint dysfunction, the clinical assessment of the SIJ, and managing SIJ pain.

The review tried its best to consider all of the complexities associated with SIJ’s diagnosis and management (including sport and exercise-related SIJ pain). It took a bio-psycho-social perspective.

What did the Review Find?

The review summarized that clinicians and researchers shouldn’t conflate sacroiliac pain, stability, and dysfunction (as all three are separate). Furthermore, trauma and repeated training might be associated with SIJ pain in athletes.

Clinical evaluations should administer clustered pain provocation testing. Such a suggestion was made after determining that palpation and mobility test didn’t offer any proven value. When addressing persistent pain, taking a bio-psycho-social approach is crucial. Treatments (backed by evidence) included pelvic compression belts, surgery, manipulation, exercise, and corticosteroid injections.

Also, further research is required for understanding SIJ pain better.