Abstract: Griffin, Heather Complex regional pain syndrome (CRPS) is a relatively uncommon, but painful and disabling condition. It is characterised by limb pain with sensory, vasomotor, sudomotor, motor and dystrophic changes, usually occurring after injury. The diagnosis can be difficult to make, as it lacks an objective test. The diagnosis is therefore based on clinical findings. The Budapest criteria are the accepted standard for this.
Abstract: Patel, Vinay; Kanji, Giresh Lumbar spine pain is the most common musculoskeletal complaint we see in practice. The disc has been found to be the most common source of lumbar spine pain. A disc prolapse occurs when the nucleus of the disc protrudes through a torn annulus. Disc bulges and prolapses can often cause irritation to an adjacent nerve root, and may cause radicular symptoms down the leg. Disc prolapse is often preceded by actions involving bending and lifting that place some pressure on the disc. The annular ligament is a layered structure and layers may sequentially tear, hence the final force that causes the nucleus to protrude may be minimal such as bending over. Disc prolapse accounts for diminished quality of life, as well as associated costs financially from medical care and lost earnings.
Abstract: McKay, ABreck Academic blindness occurs when researchers and reviewers, believing their confirmation bias, obtain or support further research funding and waste that funding on error laden hypotheses and research programmes. This paper addresses three examples, one internationally recognised whiplash research study and two examples of erroneous internationally recognised chronic low back pain (CLBP) research. The researchers persist in pursuing these false models despite confirmation bias errors being repeatedly demonstrated. The secondary problem of many peer reviewers also blinded by academic and confirmation bias is identified.
The author uses his personal experience, primary care observation, analysis and clinical research of the underlying anatomy, physiology and whole body function models to identify where the errors exist and why they need to be corrected. By considering the results of this primary care research, new and simple explanations for the results seen in whiplash injuries and CLBP can be more readily provided with explanations and managements developed in primary care, and immediately applicable throughout the world.
Further interpretation of the results has led the author to propose a better, simpler hypothesis leading to an understanding of the importance of enthesis damage and periosteal biomechanical injury in the onset and persistence of musculoskeletal pain, fibromyalgia (chronic widespread pain syndrome), chronic low back pain (CLBP), vertebral or bony degeneration and osteophytes, or spur formation visualised on imaging of the spine and other bony tissues.
These identified issues form the often ignored pain elephant in the room. Pain researchers have frequently been enticed by confirmation bias and trapped by fiscal servitude, merely for academic survival. Those asked to peer review appear to have also suffered from similar bias. The author raises the issue of research funds being wasted on programmes involving confirmation bias (confounded by academic blindness) and promulgates a potential method to prevent further inappropriate fund application approval.
Abstract: Chandra, Nathaniel In Australia in 2013, there were an estimated 4.7 million people over the age of 50 with either osteoporosis or poor bone health1. Generally under-diagnosed, osteoporosis was associated with 144 000 fractures in 2013. With the total cost of osteoporosis estimated to be approximately $7.4 billion per year, the burden of the disease and its complications are enormous.
Abstract: du Toit, Paul Francois Background: Total Knee Arthroplasty is a common and costly surgical procedure. The majority of patients have successful surgery and post operative rehabilitation, however, there is a group that fail to gain adequate ROM and develop chronic pain. There have been many studies demonstrating the effect of preoperative pain catastrophising as a predictor of chronic postoperative pain. The aim of this study is to assess the effect of pain catastrophising on functional outcome following total knee arthroplasty.
Methods: 50 patients were included in a study over a period of one year at the Eden Rehabilitation Centre. The patients completed a Pain Catastrophising Scale (PCS) on admission and then their functional outcome was measured on their discharge using ROM, Timed Up and Go (TUG) and Functional Independence Measure (FIM).
Results: There was no statistical evidence that pain catastrophising postoperatively had any effect on functional outcomes. There was, however, a significant difference between the PCS reported by the male patients compared to the female patients. Conclusion: The data from this study does not support the PCS being used post-operatively as a screen for poor functional outcome.
Abstract: McBride, David Carpal tunnel syndrome (CTS) is a condition best described as a 'constellation of symptoms:' a pattern or arrangement which is more complex than most. A CTS patient may therefore present an 'ill structured clinical problem,' the diagnosis of which must be approached with caution, and a thorough understanding of the pathophysiological mechanisms which contribute.
Abstract: Ganderton, Charlotte; Cook, Jill; Docking, Sean; Rio, Ebonie; van Ark, Mathijs; Gaida, Jamie Achilles tendinopathy is commonly encountered in clinical practice yet can be quite difficult to successfully treat. Relative overload is the precursor to most presentations, while systemic conditions can decrease the amount of load that triggers overload. While there is evidence for the use of eccentric exercise, it is not recommended in isolation for most presentations of Achilles tendinopathy as it fails to address strength and kinetic chain deficits, which can leave the individual vulnerable to recurrence. Insertional tendinopathy requires a tailored management that avoids dorsiflexion, as this position compresses the tendon onto the calcaneus.
Purpose: This masterclass summarises the tendinopathy continuum and articulates the authors' clinical reasoning and hands-on experience managing Achilles tendinopathy. We outline graded loading concepts while emphasising that relying on recipes is likely to fail. We also provide a perspective on the role of central pain processing and peripheral input from nociceptive fibres in the context of tendinopathy.
Inplications: Rehabilitation should be tailored to address identified impairments (muscle bulk asymmetries, kinetic chain dysfunction, tolerance of energy storage and release in the Achilles tendon), and progressively work toward movements and activities relevant for the individual's sport or daily activities. Within the three-stage rehabilitation sequence, stage 1 aims to reduce pain and increase calf muscle bulk; stage 2 focuses on improving power within the whole kinetic chain, and movement control during jumping and landing; and stage 3 begins to retrain sport specific load, and carefully introduces movements that require energy storage and release within the tendon.
Abstract: Kanji, Giresh Low back pain is the most common musculoskeletal complaint. In surveys 60 to 69% of 40 year olds have experienced low back pain in the last year with over 80% experiencing low back pain within their lifetime1. The origin of spinal pain has been elusive with many pain textbooks stating that up to 85% of low back pain is of unknown origin. The integration of new technologies such as MRI for spinal pain has not been fully established. This article will attempt to outline pain generators in the lumbar spine to present a model of spinal pain which integrates pathology, neurophysiology and central nervous system pain sensitivity.
Abstract: Krechman, Belinda As a clinician dealing with musculoskeletal pains on a daily basis, patients often have a chief musculoskeletal pain complaint that becomes aggravated by their work situation; daily tasks or ergonomic settings. Office work is dominated by keyboarding while looking at visual display units often in a seated position. Poor sitting postures have been shown to have a strong influence in the development and perpetuation of musculoskeletal dysfunctions (MSD). Work related MSD as a result of prolonged poor sitting postures, means a musculoskeletal complaint that may have been induced by work and also worsens during working hours and days.
Abstract: Kanji, Giresh; Weatherall, Mark; Peter, Raja; Purdie, Gordon; Page, Rachel Objective: Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH.
Methods: Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n = 20) received advice and education while the intervention group (n = 17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured.
Results: Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F = 10.17; df = 1, 117; p = 0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups.
Conclusion: Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.
Abstract: Krechman, Belinda The following two case studies from a clinical myotherapy practice are described to distinguish between piriformis syndrome (PS) and lumbar radicular leg pain (sciatica). The differences in etiology and symptoms will be outlined as well as the administered treatments. Patient identity has been changed to preserve confidentiality.
Abstract: Baster, Thomas Obesity is a common association with the musculoskeletal pain patient and can create significant treatment barriers. The current advice and treatment for obesity is ineffective in most cases. There are probably components in the contemporary food chain that are contributing to the epidemic of obesity. Such components include an excess of omega 6 fatty acids which contain linoleic acid, trans and saturated fats, excess refined carbohydrates, sugar and salt intake. The saturated fats and linoleic acid result in a low grade inflammatory state and activation of the endocannabinoid system that can lead to obesity. Such dietary items should ideally be minimised. Other food items that need to be increased in consumption are those with omega 3 fatty acids, with polyphenols and containing fructans. Exercise is more of a weight maintenance tool. If obesity is addressed as part of a comprehensive approach to a musculoskeletal pain case, the clinical emphasis should be directed towards providing healthy eating advice, as successful weight loss is difficult for most patients.
Abstract: Khor, KE Chronic pain has generally been defined as "pain that persists beyond normal tissue healing time, which is assumed to be about 3 months". It is now well known that the prevalence of chronic pain in Australia is about 20% overall. Of these, 33% of patients experience significant interference of activities of daily living by pain. This high number, coupled with the immense burden of chronic pain, means the management of chronic pain would need to be undertaken at all levels of medical care, mainly at the primary care level and supported by appropriate specialists and secondary and tertiary pain management centres.
Abstract: Bogduk, Nikolai This article continues the consideration of truth in diagnosis by addressing validity. Whereas reliability measures the extent to which two observers agree when using the same test on the same population, validity measures the extent to which the test actually does what it is supposed to do.
Abstract: Brooks, Christine M Age-related decline in lean body mass is often associated with serious functional impairment during the older years. In 1988 Irwin Rosenberg suggested using the term "sarcopenia" to bring attention to the condition and to stimulate research that would provide an understanding of what caused skeletal muscle wasting as one ages. In this paper the medical practitioner is provided with a clinically relevant base of knowledge for counselling older patients about how to avoid or delay the onset of disability due to their gradual reduction in muscle mass as they get older. Six issues are briefly discussed, including how to categorise sarcopenia, progression of sarcopenia throughout the lifespan, impact of an inactive lifestyle, the effect of age on muscle composition, how to detect sarcopenia in the clinical setting, and the effect of exercise interventions. Age-related skeletal muscle decline is often accelerated due to inactivity. Data from master athletes suggest it is possible to slow the progress of muscle wasting through physical activity. Inactivity, on the other hand, accelerates muscle wasting. Resistance training is a useful intervention strategy for the medical practitioner to recommend highly to all patients.
Abstract: Masters, Scott Persistent spinal pain is a common problem in the community, affecting around 10% of the Australian population. It is one of the most common causes of work insurance claims and causes of disability. Care of these people is often left in the hands of primary care health practitioners. These patients often fall outside the scope of specialist care in that they are most commonly suffering from a non-operative, non-rheumatologic condition.
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