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There are several types of mobilization procedures that may differ in terms of the amount of force applied (very gentle versus rigorous) prostate cancer fatigue buy eulexin 250mg otc, the frequency or length of application prostate cancer gleason score 9 eulexin 250mg sale, the specific methods employed to produce the motion (small oscillations versus large movements) prostate oncology center purchase eulexin 250 mg overnight delivery, and their specific goal (neuromuscular rehabilitation versus breaking up of chronic fibrous adhesions). The motion applied through mobilization may be active (performed by the patient), passive (performed by the therapist), or a combination thereof. Complementary and alternative medicine treatment of back and neck pain 295 Mobilization is often combined with other types of physical therapies such as traction, massage, or stretching. While there are several different ways to apply mobilization to neck and back pain, there is no reason to believe that one form of treatment is superior to another. Our review therefore combines all mobilization procedures, recognizing that future research may eventually elucidate differences between these various procedures. Mobilization for back pain There is ample and growing evidence of the value of early general mobilization of 26 patients with back pain. However, as far as specific mobilization procedures are concerned, there is very little evidence that any provides a particular advantage in patients with low back pain. Much of this assessment arises from the fact that there are few studies that have employed mobilization as an independent or even primary 27 intervention. For example, Hadler and associates employed mobilization as a control procedure in a study of spinal manipulation. In this study, patients were randomized to treatment with a single manipulation or mobilization procedure. At 2–4 weeks post- treatment, manipulation was superior to mobilization in relief of back pain. One of the better designed studies of physical interventions for back pain randomized 256 patients with chronic (i. Out come measures included severity of the main complaint, global perceived effect, pain and functional status. In the short term (12 weeks post-treatment), both physical therapy and manual therapy were superior to the medically treated group in terms of complaint severity and perceived effect, although there were no differences between the two approaches. At the 1-year follow-up, manual therapy was slightly superior to physical therapy in terms of complaint severity and functioning. However, this study examined patients with diagnosed radiculopathy rather than the non- specific chronic low back pain in previous studies. Although there have been several systematic reviews of mobilization therapy for low back pain, these reviews were combined with manipulation, with most of the discussion focusing on the latter 31–33 treatment. Mobilization for neck pain 34–38 Several studies have examined the effect of mobilization procedures on neck pain. These reports provide limited evidence for its effectiveness, particularly for short-term improvement in range of motion and reduction in pain. There is no evidence for improvement in functional status or disability and the duration of the effects of mobilization remains to be determined. Very recently, two studies have made substantial contributions to the understanding of 39 mobilization for neck pain. In the first study, 183 patients with at least 2 weeks of neck pain were randomized into three groups: weekly treatments of specific mobilization for 6 Complementary therapies in neurology 296 weeks; twice-weekly physical therapy sessions; and continued care by a general practitioner (analgesics, counseling and education). The principal outcome measure (percentage of patients reporting significant improvement or resolution of symptoms) was measured 1 -week post-treatment; pain scores and disability were secondary outcome measures. Mobilization was found to be significantly better than the other two methods of treatment in terms of recovery, pain and disability, although the difference in disability was fairly small. The authors concluded that manual therapy was a good option for the treatment of neck pain. Over the 6 months of observation, the treatment groups showed improvement over baseline in terms of pain and disability, with no statistically significant differences between groups.
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Osteopathic considerations in neurology 93 Headache Headache is a common symptom resulting from many etiologies—ranging from visceral to somatic and from metabolic to idiopathic prostate oncology 24 purchase cheap eulexin line. Seasoned neuromusculoskeletal clinicians are also attuned to the cervical spine that may play a central rather than a secondary or non-contributory role man health news za exit cheap 250 mg eulexin with mastercard. The International Headache Society (IHS) includes the cervical 101 spine in its classification schema prostate 8k springfield order eulexin 250 mg overnight delivery. According to the IHS, inclusion criteria for the cervical spine features several of the T- A-R-T characteristics used to diagnosis cervical somatic dysfunction: (1) Local neck or occipital pain projecting to forehead, orbital region, temples, vertex or ears; (2) Either diminished cervical motion, abnormal cervical contour, texture, tone or response to active and passive stretching and contraction; or abnormal tenderness of neck muscles; (3) Radiographic evidence of pathology and abnormal posture; or reduced range of motion. Table 5 denotes some of the common headache causes and the osteopathic consideration 102 associated with each. Recent attempts to document the interrelationship between articular and myofascial components and to link them to relevant historical and physical findings have expanded our understanding of the diagnosis and treatment of the suboccipital region. The combination of articular and myofascial somatic dysfunction is common, as are patterns of somatic dysfunction in functional units. Other examples link patterns of somatic dysfunction with specific headache 77 presentations. Greenman reported that the majority of patients presenting with cervical spine stiffness and associated hemi-cephalgia running from the occiput to the retro-orbital area were found to have the following palpable structural diagnostic findings: (1) Left occipitomastoid suture restriction; (2) C0 (OA) sidebent right, rotated left (SRRL); (3) C1 (AA) rotated right; (4) C2–3 extended, rotated and sidebent left (E RLSL). In a population of patients with cervicogenic headaches, 91% of patients had C0 or C1 articular somatic dysfunction and 56% had trigger points in the semispinalis capitis 104 muscle predominantly ipsilateral to the symptomatic side. Palpatory diagnosis for somatic dysfunction is therefore useful in identifying a significant number of the primary musculoskeletal and cervicogenic causes of headache where co-existence of articular and myofascial dysfunction is common. Because soft tissue dysfunction often alters articular motion characteristics in the craniocervical Complementary therapies in neurology 94 junction, this author prefers to diagnose and address any soft tissue dysfunction prior to attempting a definitive articular diagnosis through specific segmental examination. Others find that treatment of articular somatic dysfunction addresses both articular and myofascial components at the same time. Regardless of the varied sequences, treatment of the somatic dysfunction (articular and myofascial) with OMT has been demonstrated 105 positively to affect patient satisfaction and to reduce the level of pain in patients with 51 cephalgia. Low back pain Patients present to neuromusculoskeletal medicine physicians with low back (lumbopelvic) pain more so than with any other area of the body, with the possible exception of headache. These physicians have moved significantly beyond the 106 historically unifocal preoccupation with discogenic back pain. Farfan, for example, described the cause of low back pain as mechanical with numerous pain generators 107 influenced by biomechanical stress and strain. In the low back, the key pain generators 108,109 are the somatic dysfunctions of the lumbar zygopophyseal joints, the muscular 74 elements associated with lumbopelvic function and dysfunction and the sacroiliac joint 110,111 77 itself. The value of diagnosing lumbar and pelvic (sacral, innominate and pubic) somatic dysfunction is well established in the literature. Greenman performed a study of 183 consecutive patients presenting with disabling low back pain (average duration 30. Middle semispinalis capitis at location 3 results in ipsilateral posterior parietal headache. Correction of the dysfunction using integrated rehabilitative approaches that specifically included OMT resulted in the return to work and restoration of normal activities of daily living for 75% of these patients. It includes the early diagnosis and treatment of identified somatic dysfunctions with emphasis on addressing certain perpetuating factors, including even minor postural asymmetries and muscle imbalances. However, inadequate numbers of quality Complementary therapies in neurology 98 studies prevent the use of meta-analysis to make conclusions concerning the efficacy of spinal manipulation for chronic low back pain or to comment on long-term effects of this form of treatment in general. Even the largest of the osteopathic studies in the treatment of low back pain was limited to an OMT-added group without any protocol to allow for treatment of underlying postural or other biomechanical abnormalities that might have co-existed.
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