The SpineScottsdale Physical Therapy Blog Page http://spinescottsdale.posterous.com Moving in the Right Direction posterous.com Sat, 13 Aug 2011 11:37:46 -0700 Pain and Connective Tissue Properties: Tissue Repair Process http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-tissue http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-tissue
Tissue repair process
 
Following tissue injury, the process that in principle leads to recovery is divided into 3 overlapping phases: Inflammation, repair, and Remodelling. In fact, each part of this process is essential to the structure of the final result. Connective tissue and muscle do not regenerate if damaged, but are replaced by inferior scar tissue. To produce optimal repair tissue, all phases of this process need to be completed in the appropriate time.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 26 Jun 2011 13:26:44 -0700 Pain and Connective Tissue Properties: Chemical vs. Mechanical Pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-chemica http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-chemica
As the cause of pain is an important determinant of the appropriateness of mechanical therapy, it is vital to distinguish between mechanical and chemical sources of nociception. A key characteristic that indicates the possibility of pain of chemical origin is constant pain. Not all constant pain is inflammatory in nature, but chemical pain is always constant.
 
Key factors in the identification of pain of an inflammatory nature:
  • constant pain
  • shortly after onset
  • cardinal signs may be present (swelling, redness, heat, tenderness)
  • lasting aggravation of pain by all movements
  • no movement found that reduces, abolishes, or centralises pain.
Key factors in identifying constant pain of mechanical origin:
  • certain repeated movements cause lasting reduction, abolition, or centralisation of pain.
  • movements in one direction worsens symptoms, whereas movements in another direction improves them
  • the mechanical presentation improves with the symptoms

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 15 May 2011 14:57:23 -0700 Pain and Connective Tissue Properties: Trauma as a cause of pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-trauma http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-trauma
Pain due to trauma is produced by a combination of mechanical deformation and chemical irritation. Initially, mechanical deformation causes damage to soft tissues, and pain of mechanical origin will be felt. Shortly after injury chemical substances accumulate in the damaged tissues. As soon as the concentration of these chemical irritants is sufficient to enhance the activity of the nociceptive receptor system in the surrounding tissues, pain will be felt.
 
 

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 07 May 2011 12:17:46 -0700 Pain and Connective Tissue Properties: http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-8 http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-8
Chemical Nociception
In this situation pain is produced by the irritation of free nerve endings in the presence of certain chemicals, such as histamine, serotonin, hydrogen ions, substance p and bradykinin. These chemicals are released as a result of cell damage or by cells associated with the inflammatory process. Therefore, except in the case of inflammatory or infective diseases and certain degenerative conditions, chemical pain only occurs following trauma and actual tissue damage.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 24 Apr 2011 11:11:25 -0700 Pain and Connective Tissue Properties: Activation of Nociceptors http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-activat http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-activat
Only three mechanisms are known that can activate nociceptors: thermal, mechanical, and chemical. Let's look at Mechanical Nociception
 
Mechanical nociception
Pain may be produced in the absence of actual tissue damage by excessive mechanical strain or tension upon collagen fibres. This is thought to be the result of the deformation of collagen networks so that nerve endings are squeezed between the collagen fibres with the excessive pressure perceived as pain. No damage to the tissues need have occurred, and when the stress is removed the pain will abate. Mechanical pain can ensue from normal stresses upon weakneded, damaged, or abnormal tissues. If the excessive strain is so great as to produce actual tissue damage the inflammatory process will be provoked.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 06 Mar 2011 14:13:47 -0800 Pain and Connective Tissue Properties: Central Pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-central http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-central Another form of neurogenic pain may arise from cells within the central nervous system, known as central pain. Classic examples of this are phatom limb pain, post-herpetic neuralgia and the the pain from brachial plexus lesion. There is growing speculation that in some musculoskeletal pains, especially chronic conditions, central mechanisms may be more importatn in the maintanence of symptoms than peripheral nociception. Pain in this instance would be the result of abnormalities with the central nervous system.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 26 Feb 2011 15:11:07 -0800 Pain and Connective Tissue Properties: Combined States http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-combine http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-combine Referred pain is either somatic or radicular in origin. These two states may be combined in one individual. For instance, a patient may have back pain of somatic origin from pressure of the annulus fibrosus, and leg pain of radicular origin, which is caused by involvement of the nerve root.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 23 Jan 2011 09:09:57 -0800 Pain and Connective Tissue Properties: Radicular Pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-radicul http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-radicul
Radicular or neurogenic pain is produced when the nerve root or dorsal root ganglia are involved in symptom production. This is the product of pressure on nerve roots that are already inflammed or irritated, not on normal nerve roots. Although sudden onset of sciatica does occur, experimentally tension or pressure has only reproduced radicular pain on sensitised, not normal nerve roots.
 
It is different in quality from somatic pain. Radicular pain is severe and shooting in quality, felt along a narrow strip, and this different in quality from the vague, dull aching associated with somatic-referred pain. All nerve root pain will be felt in the leg, and its always referred pain; oftne the leg pain will be worse than any back pain that may be present. However, all leg pain is not nerve root pain. Radicular pain tends to be distributed in dermatomal patterns, with the L4, L5, and S1 nerve roots most commonly affected. Typically pain from the L4 is felt down the anterior aspect of the thigh and leg, L5 is down the lateral aspect and S1 down the posterior aspect--however, variety exists.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Fri, 07 Jan 2011 18:34:12 -0800 Pain and Connective Tissue Properties: Somatic Pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-somatic http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-somatic
Somatic Pain
 
Somatic structures include the intervertebral disc, posterior longitudinal ligament, SIJ, facet joint capsule, etc. Only pain that originates from cutaneous tissue is felt localised to the area; all pain that stems from deep somatic structures is referred pain to a greater or lesser extent. The deeper the structure the more difficult it is to localise the pain source--therefore, most musculoskeletal pain is referred pain to a varying degree. Referred pain simply reflects the lack of localising information available with nociceptor activity from deep structures. the quality of somatic referred pain is deep and aching in quality, vague, and hard to localise.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 14 Nov 2010 12:20:21 -0800 Pain and Connective Tissue Properties: Types of Pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-types-o http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-types-o
Tissue injury pain relates to somatic structures, while nervous system injury pain includes neurogenic or radicular and pain generated with the central nervous system. The other source of pain that occasionally must be considered in the differential diagnosis is visceral pain from organs.
 
Basic Pain Types
 
Pain Type                                    Structures Involved
 
Somatic pain                              Musculoskeletal tissue
Radicular pain                           Nerve root/dorsal root ganglion/dura
Central pain                               Central Nervous System
Visceral pain                              Visceral organs

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 30 Oct 2010 10:35:24 -0700 Pain and Connective Tissue Properties: Sources of back pain and sciatica http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-sources http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-sources
Any structure that has a nerve supply is acapable of triggering the nociceptive process. This means possible sources of pain around the lumbar region are the capsules of the facet joints and sacroiliac joints, the outer part of the discs, the interspinous and longitudinal ligaments, the vertebral bodies, the dura mater, nerve root sleeve, connective tissue of nerves, blood vessels of the spinal canal and local muscles. The wide distribution of nociceptors around the lumbar spine makes it impossible to devise testing procedures that selectively stress individual components of the spinal segment.
 
An interesting insight into the most common sources of back pain and sciatica is provided by the progressive local anesthetic studies performed by Kulich et al (1991) in patients undergoing surgery for decompression operations for disc herniations or spinal stenosis. In 193 consecutive patients who were awake or lightly sedated, each successive tissue was stimulated prior to anaesthetisation and incision and the area of provoked pain was recorded. This study identifies compressed nerve roots as the source of significant leg pain, and the outer annulus fibrosus as the source of significant back pain, while all other anatomical sources of pain appear to be much less relevant.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 24 Oct 2010 08:27:45 -0700 Pain and Connective Tissue Properties: Nociception and pain http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-nocicep http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties-nocicep
The means by which information concerning tissue damage is experienced and transmitted to the cortex is termed nociception. This has several components:
  • the detection of tissue damage
  • the transmission of nociceptive information along peripheral nerves
  • its transmission up the spinal cord
  • modulation of the nociceptive signals
After tissue damage is detected, this information is transmitted via the peripheral and central nervous system to the cortex; however, en route the nociceptive message is modulated. In this way the central nervous system can exert an inhibitory or excitatory influence on the nociceptive input.
 
Its important to recognise that the experience of pain involves patients' emotional and cognitive reactions to the process of nociception. Patients anxieties , fears, and beliefs can strongly determine their response to injury, pain, and treatment.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 16 Oct 2010 10:07:56 -0700 Pain and Connective Tissue Properties http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties http://spinescottsdale.posterous.com/pain-and-connective-tissue-properties Pain is usually the prime concern of the patient, and so some means of understanding and interpreting pain is important. The following posts will review certain aspects of pain that are relevant to the lumbar spine. The distinction between nociception and the pain experience is made; the most common sources of pain in the lumbar spine will be identified; the differences between pain of somatic and neural origin, between local and referred pain, and also between pains initiated by mechanical or chemical mechanisms will be made. The distinction between these two mechanisms of pain is an important determinant of the appropraiteness of mechanical therapy. In musculoskeletal problems a common cause of inflammation follows soft tissue trauma; the healing process of inflammation, repair and remodelling will also be described.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 09 Oct 2010 09:03:31 -0700 Risk and Prognostic Facctors in Low Back pain: Conclusions http://spinescottsdale.posterous.com/risk-and-prognostic-facctors-in-low-back-pain http://spinescottsdale.posterous.com/risk-and-prognostic-facctors-in-low-back-pain We have looked at some of the individual, biomechanical, and psychosocial factors involved with precipitating and perpetuating episodes of back pain.One of the strongest risk factors for a future episode of back pain is a past history of back pain--such patients need education and information to reduce this risk. Biomechanical variables are risk factors in back pain onset, but also are notable in the perpetuation and aggravation of symptoms. There are some recent suggestions that psychological factors may predispose to back pain onset in a few individuals, and there is stronger evidence forthe role of these factors in perpetuating episodes of back pain.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 02 Oct 2010 13:31:23 -0700 Risk and Prognostic Factors in Low Back Pain: All Prognostic Factors http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-9 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-9
Numerous factors have abeen associated with chronic  back pain and failure to return to work. Generally these relate to three different aspects of a patient's presentation--clinical, psychological and social factors.
 
The following lists the factors that have been associated with chronic back pain, disability, or failure to return to work:
 
Clinical
  • Leg pain
  • Nerve root pain
  • Previous history of back pain
  • Disc herniation
  • Specific diagnosis
  • Lack of centralisation
Psychological
  • Fear avoidance behavior
  • Depression
  • Anxiety about pain
  • Passice coping strategoes
  • Catastrophising
  • Poor general health
Social factors
  • Lower education level
  • Lower income
  • Heavy manual work
  • Sitting occupation
  • Low job satisfaction

It is now widely accepted that psychological and social factors play a role in the maintenance of illness as pain moves from the acute to the chronic stage.

 
 
 
 

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 25 Sep 2010 09:05:35 -0700 Risk and Prognostic Factors in Low Back Pain: Psychosocial prognostic factors http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-8 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-8
While the evidence implicating psychosocial factors in the onset of back pain is limited, there is considerably more evidence relating these factors to the transition from acute to chronic back pain.
 
A cutting-edge review on fear-avoidance and its consequences concluded that pain-related fear and avoidance appear to be an essential feature in the development of a chronic problem for a substantial number of patients with musculoskeletal pain.
 
Conclusions based on the evidence from thirty-seven studies and supported by two or more good-quality prspective trials were as follows:
 
  • psychosocial variables are clearly linked to the transition from acute to chronic pain and disability
  • psycosocial factors are aassociated with reported onset of pain
  • psychosocial variables generally have more impact than biomedical or biomechanical factors on disability
  • cognitive factors are related to the development of pain and disability--especially passive copping, catastrophising, and fear-avoidance.
  • depression, anxiety and distress are related to pain and disbility
  • self-perceived poor health is related to chronic pain and disability
  • psychosocial factors may be used as predictors of the reisk of developing long-term pain and disability

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sun, 19 Sep 2010 13:50:54 -0700 Risk and Prognostic Factors in Low Back Pain: Biomechanical prognostic factors http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-7 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-7
Biomechanical factors are important both in the causation of an episode of back pain and in its perpetuation and aggravation. The majority of spinal pain is seen as varying in intensity with the patient's activity and is almost always aggravated by mechanical factors.Indeed, this important report referred to activity-related spinal disorders, with the clear assumption of the importance of day-to-day and postures that influence patients' pain.
Various reports have investigated the role of physical loading strategies in symptom response--these highlight the effect that normal mechanical loads, such as sitting, walking, and lying, have on aggravating or relieving symptoms. The common picture is of symptoms aggravated in positions involving flexion (sitting, rising from sitting, bending, driving) and improvement when walking, or being generally active, which are positions of extension.
Controlling early morning lumbar flexion is a form of self-care that can help develop a sense of control or mastery over low back pain, and thereby build confidence and improve outcome." McKenzie had previously identified the morning as a time when patients were frequently worse and at a risk of suffering a relapse or exacerbation.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 11 Sep 2010 14:52:00 -0700 Risk and Prognostic Factors in Low Back Pain: Individual and Clinical Prognostic Factors http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-6 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-6

History of previous back pain is both a risk factor for future back pain and a prognostic factor for prolonged symptoms. Reported leg at onset is associated with poor outcomes and a greater likelihood of developing chronic symptoms. Centralisation of leg pain, where distal limb pain is immediately or eventually abolished in response to loading strategies, has been shown to be a predictor of good outcomes.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 04 Sep 2010 07:59:19 -0700 Risk and Prognostic Factors in Low Back Pain: Onset http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-5 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-5
Although mechanical factors are associated with back pain and can therefore be seen as predisposing factors, onset is not always related to a specific event. Patients often report the precipitation factor involved flexion activities, such as lifting and bending. Generally however, more patients report back pain that commenced for no apparent reason.
 
The degree to which contemporary lifestyles are dominated by activities that onvolve flexion should thus be borne in mind; this may be sustained as in sitting or repeated motions such as bending. Sitting is the most common posture in today's workplace, particularly in industry and business.Three-quarters of all workers in industrial countries have sedentary jobs. About 45% of employed Americans work in offices. Many display poor posture and report increased pain when sitting.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan Sat, 28 Aug 2010 08:48:43 -0700 Risk and Prognostic Factors in Low Back Pain: All risk factors http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-4 http://spinescottsdale.posterous.com/risk-and-prognostic-factors-in-low-back-pain-4 The evidence would suggest that individual, physical and psychosocial factors all could have an influence upon back pain onset. Severak studies have shown that previous back pain is a much stronger predictor of serious or future back pain than psychological distress. In a review of risk factors for occupational back pain, it was concluded that biomechanical factors are more significant factors of causation than psychological ones. It is apparent that there are not simple causal explanations for back pain and that individual, physical and psychosocial factors may to varying degrees, all have a role in aetiology. However, at most these factors, individually or combined, can only explain a small proportion of back pain. A past history of back pain is the factor most consistently associated with future back pain.

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]]> http://files.posterous.com/user_profile_pics/567300/spineLogo.jpg http://posterous.com/users/5AGeJITy4dhL Shane Sullivan spinescottsdale Shane Sullivan