Interferential Current Therapy for Musculoskeletal Pain

Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysisfrom Physical Therapy current issue by Fuentes, J. P., Armijo Olivo, S., Magee, D. J., Gross, D. P.

Background
Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is widely used, the available information regarding its clinical efficacy is debatable.

Purpose
The aim of this systematic review and meta-analysis was to analyze the available information regarding the efficacy of IFC in the management of musculoskeletal pain.

Data Sources
Randomized controlled trials were obtained through a computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010.

Data Extraction
Two independent reviewers screened the abstracts found in the databases. Methodological quality was assessed using a compilation of items included in different scales related to rehabilitation research. The mean difference, with 95% confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was performed.

Data Synthesis
A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3 articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were considered to be of moderate methodological quality, and 3 studies were considered to be of poor methodological quality. Fourteen studies were included in the meta-analysis.

Conclusion
Interferential current as a supplement to another intervention seems to be more effective for reducing pain than a control treatment at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions. Interferential current alone was not significantly better than placebo or other therapy at discharge or follow-up. Results must be considered with caution due to the low number of studies that used IFC alone. In addition, the heterogeneity across studies and methodological limitations prevent conclusive statements regarding analgesic efficacy.

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Manual therapy and exercise for neck pain: a systematic review

Manual therapy and exercise for neck pain: a systematic review.

Miller J, Gross A, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggestsgreater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Dr. Paul S. Tetro
Takoma Park/Silver Spring, MD

Is Asymptomatic Lumbar Spine Pathology Predictive of Future Low Back Pain?

This study investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in a group of 67 asymptomatic individuals with no history of back pain. In 1989, 21 subjects (31%) had an identifiable abnormality of a disc or of the spinal canal.

A questionnaire concerning the development and duration of low-back pain over a 7 year period was sent to the 67 asymptomatic individuals from the 1989 study. A total of 50 subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for 31 of these subjects.

Of the 50 subjects who returned the questionnaire, 29 (58%) had no back pain. Low-back pain developed in 21 subjects during the 7 year study period. The 1989 scans of these subjects demonstrated normal findings in twelve, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four of them had had normal findings on the original scans, two had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans.

The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.

Source: http://thepainsource.com/archives/399

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Save Your Knees

Land on your toes, save your knees
August 10, 2010


Aggie player Paige Mintun goes for a layup and will be landing on those toes. (Wayne Tilcock/Davis Enterprise photo)
Anterior cruciate ligament injuries are a common and debilitating problem, especially for female athletes. A new study from UC Davis shows that changes in training can reduce shear forces on knee joints and could help cut the risk of developing ACL tears. The research was published online Aug. 3 in the Journal of Biomechanics.

"We focused on an easy intervention, and we were amazed that we could reduce shear load in 100 percent of the volunteers," said David Hawkins, professor of neurobiology, physiology and behavior at UC Davis. Hawkins conducted the study at the UC Davis Human Performance Laboratory with graduate student Casey Myers.

The anterior cruciate ligament lies in the middle of the knee and provides stability to the joint. Most ACL injuries do not involve a collision between players or a noticeably bad landing, said Sandy Simpson, UC Davis women's basketball coach.

"It almost always happens coming down from a rebound, catching a pass or on a jump-stop lay-up," Simpson said. "It doesn't have to be a big jump."

Hawkins and Myers worked with 14 female basketball players from UC Davis and local high schools. They fitted them with instruments and used digital cameras to measure their movements and muscle activity, and calculated the forces acting on their knee joints as they practiced a jump-stop movement, similar to a basketball drill.

First, they recorded the athletes making their normal movement. Then they instructed them in a modified technique: Jumping higher to land more steeply; landing on their toes; and bending their knees more deeply before taking off again.

After learning the new technique, all 14 volunteers were able to reduce the force passed up to the knee joint through the leg bone (the tibial shear force) by an average of 56 percent. At the same time, the athletes in the study actually jumped an inch higher than before, without losing speed.

Hawkins recommends warm-ups that exercise the knee and focusing on landing on the toes and balls of the feet. The study does not definitively prove that these techniques will reduce ACL injuries, Hawkins said: that would require a full clinical trial and follow-up. But the anecdotal evidence suggests that high tibial shear forces are associated with blown knees.

Hawkins and Myers shared their findings with Simpson and other UC Davis women’s basketball and soccer coaches, as well as with local youth soccer coaches.

Simpson said that the team had tried implementing some changes during last year's preseason, but had found it difficult to continue the focus once the full regular season began. In live play, athletes quickly slip back to learned habits and "muscle memory" takes over, he noted. More intensive off-court training and practice would be needed to change those habits, he said.

"We will be talking about this again this season," Simpson said. Implementing the techniques in youth leagues, while children are still learning how to move, might have the most impact, he said.

About UC Davis
For more than 100 years, UC Davis has engaged in teaching, research and public service that matter to California and transform the world. Located close to the state capital, UC Davis has 32,000 students, an annual research budget that exceeds $600 million, a comprehensive health system and 13 specialized research centers. The university offers interdisciplinary graduate study and more than 100 undergraduate majors in four colleges — Agricultural and Environmental Sciences, Biological Sciences, Engineering, and Letters and Science. It also houses six professional schools — Education, Law, Management, Medicine, Veterinary Medicine and the Betty Irene Moore School of Nursing.

Media contact(s):
•David Hawkins, Neurobiology, Physiology and Behavior, (530) 752-2748, dahawkins@ucdavis.edu
•Mike Robles, Intercollegiate Athletics, (530) 752-3680, merobles@ucdavis.edu
•Andy Fell, UC Davis News Service, (530) 752-4533, ahfell@ucdavis.edu

Dr. Joshua Brooks
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

Efficacy of spinal manipulation for chronic cervicogenic headaches

Headaches are among the common complaints in patients presenting for professional care. Patients with headaches often seek chiropractic care because they find spinal manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine is often the origin of the headache as the nerves in the upper neck pass through the thick, overly taught neck muscles in route to the scalp/head. When the muscles of the neck are in spasm, the nerves get irritated or squeezed by the overly tight muscles resulting in headache pain.

A research study published in October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as spinal manipulation therapy (SMT) offers a perfect remedy for patients who doesn't want to utilize medications in the treatment of headaches. Combine SMT with dietary management, lifestyle modifications, stress management, and vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural approach to the management of chronic headaches can be accomplished.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic