Musculoskeletal Physiotherapy

MSc/PGDip/PGCert MSK physiotherapy: University of Brighton

Musculoskeletal physiotherapists’ perceptions of health promotion

Heather Shore and Clair Hebron, (2020). Background: Non-communicable diseases from unhealthy lifestyles account for most preventable deaths in the UK. Physiotherapy training now includes Health Promotion (HP) for the reduction of unhealthy lifestyles such as obesity, smoking, alcohol and inactivity. However, physiotherapists’ perceptions of HP in the context of musculoskeletal care in the UK have…

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Physiotherapists’ lived experiences of decision making in therapeutic encounters with persons suffering from whiplash‐associated disorder: A hermeneutic phenomenological study

Elles Hartholt, Pirjo Vuoskoski, Clair Hebron (2020) Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as…

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Sensory descriptors which identify neuropathic pain mechanisms in low back pain: a systematic review,

Michelle Heraughty & Colette Ridehalgh (2020). To link to this article: https://doi.org/10.1080/03007995.2020.1790349 Descriptors provided by patients with neuropathic low back pain (NLBP) with or without spinally referred leg pain are frequently used by clinicians to help to identify the predominant pain mechanisms. Indeed, many neuropathic screening tools are primarily based on subjective descriptors to determine…

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How we may be misdiagnosing peripheral entrapment neuropathies. (Part 1)

The purpose of this blog is to critically review how I and other physiotherapists assess and diagnosis peripheral entrapment neuropathies (PEN) and make the case that there may be inadequacies in the way we do so. To demonstrate this, we will encounter a fictitious case study with annotated thought processes labelled “Brain” to suggest how our findings…

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Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis

Georgi Daluiso-King and Clair Hebron 2020 It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current con- ceptual framework for practice.  Literature was selected through a systematic…

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Neuro-dynamic Mobilisations in Clinical Practice and the Experience of Radicular Symptoms

Part 1 of this Blog presented literature on the efficacy of NDM, with some supporting its use in painful radiculopathy. In discussing NDM use in clinical practice, it is worth noting that although natural history and conservative treatment like NDM can be favourable for these conditions, at 12 months post onset, at least 33% of…

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How effective are ‘Sliders’ and ‘Tensioners’ in the management of Lumbar Radicular Pain and Radiculopathy?

Blog by Claire Powell MSc Musculoskeletal Physiotherapy student Illustrations by Laura Jazwinski Low back pain with leg symptoms is a presentation that I commonly see in my workplace. In a recent clinical case discussion with a colleague, we considered sliders and tensioners as an intervention for painful lumbar radiculopathy and they stated, “There isn’t evidence…

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The craft of writing: weaving a golden thread.

The challenging of writing for postgraduate studies can be met with an array of emotions; anticipation, apprehension and perhaps even paralysing anxiety. So how are you going to get started, what skills do you need to demonstrate, and how are you going to make your work a pleasure to read? And it doesn’t end there;…

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Conceptualisation of the therapeutic alliance in physiotherapy: is it adequate?

PetterSøndenå, GeorgiDalusio-King, ClairHebron (2020) https://www.sciencedirect.com/science/article/pii/S2468781219306198 Objective: The Therapeutic Alliance (TA) is an emerging concept within physiotherapy practice, reflecting the ongoing paradigm shift from a biomedical- (BMM) towards a biopsychosocial model (BPSM) of care. Current conceptual understanding of the TA is commonly based on Bordin’s (1979) definition, developed within a psychotherapy context. A concept analysis was…

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My experiences

This course has had the biggest impact of anything I have done in my career to date (18 years). It has reignited my interest in my career and now I feel I can continue working as a physiotherapist for the next 20 years. It has changed how I view and treat patients, with the biggest…

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“Selling” chronic pain: physiotherapists’ lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients

Nick Sullivan , Clair Hebron and Pirjo Vuoskoski (2019) https://www.tandfonline.com/doi/full/10.1080/09593985.2019.1672227 Abstract Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However,…

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‘I have a High Pain Threshold!’ Part 1

It’s a phrase I commonly hear as a physiotherapist, and yet I still find it tricky to comment on. Reviewing the literature highlights how pain is highly individual and subjective, making it so difficult to fully understand from another person’s perspective (Eccleston 2001). As a clinician, the greater my understanding of the factors influencing pain,…

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Reflection on a clinical placement

Nicolas Bellot is a French physiotherapist working in Brussels, Belgium in a MSK private practice and teaches Musculoskeletal post-graduate courses in France with a company named IAMPT. He is a part time student of the MSK MSc at the University of Brighton. He completed his first clinical placement in October-November 2018 and here is his…

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The immediate effects of serving on shoulder rotational range of motion in tennis players.

Katy Williams and Clair Hebron (2018) https://www.ncbi.nlm.nih.gov/pubmed/30142622 Abstract OBJECTIVE: This study aimed to investigate the immediate effects of serving on shoulder rotational range of motion (ROM) in tennis players by comparing to groundstrokes. DESIGN: Same-subject, randomised, crossover study. SETTING: Indoor hard courts. PARTICIPANTS: Eighteen male and 12 female professional and university level tennis players. MAIN OUTCOME MEASURES: Passive glenohumeral internal…

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The effectiveness of Mulligan’s mobilisation with movement (MWM) on peripheral joints in musculoskeletal (MSK) conditions: A systematic review.

Kim Westad, Frode Tjoestolvsen, Clair Hebron (2019) https://www.ncbi.nlm.nih.gov/pubmed/30583976 Abstract: Musculoskeletal (MSK) conditions are very common and represent a major concern for the society and global health. The manual therapy technique Mulligan’s Mobilisation with Movement (MWM) has shown promising results in treating a variety of MSK conditions. The aim of this review was to systematically review…

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A randomised trial into the effect of an isolated hip abductor strengthening programme and a functional motor control programme on knee kinematics and hip muscle strength.

Kathryn Palmer, Clair Hebron, Jon Williams (2015) https://www.ncbi.nlm.nih.gov/pubmed/25935843 ABSTRACT OBJECTIVE: This study aimed to investigate the immediate effects of serving on shoulder rotational range of motion (ROM) in tennis players by comparing to groundstrokes. DESIGN: Same-subject, randomised, crossover study. SETTING: Indoor hard courts. PARTICIPANTS: Eighteen male and 12 female professional and university level tennis players….

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A critical evaluation of the efficacy of Pain Neuroscience Education

Christian Hanssen is a physiotherapist working in Norway studying part-time for the MSc MSK physiotherapy. He has kindly offered for the essay he submitted for the introductory module ‘MSK Physiotherapy: evaluting practice’ to be posted. If you are starting your journey on the MSK course, please note that this essay takes a more formal scientific…

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The intra-rater reliability of a revised 3-point grading system for accessory joint mobilizations

Jennifer Ward, Clair Hebron, Nicola J Petty (2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592344/ Abstract Objectives Joint mobilizations are often quantified using a 4-point grading system based on the physiotherapist’s detection of resistance. It is suggested that the initial resistance to joint mobilizations is imperceptible to physiotherapists, but that at some point through range becomes perceptible, a point termed R1….

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The outcome of hip exercise in patellofemoral pain: A systematic review

Catherine Thomson Oliver Krouwel Raija Kuisma Clair Hebron (2016) https://www.sciencedirect.com/science/article/abs/pii/S1356689X16306348 Abstract Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in clinical practice. Current evidence shows that there are hip strength deficits, delayed onset and shorter activation of gluteus medius in people with PFP. The aim of this review was to systematically review the literature…

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Comparison of surface electromyographic activity of erector spinae before and after the application of central posteroanterior mobilisation on the lumbar spine

Georgios Krekoukias, Nicola J Petty, Liz Cheek (2009) https://www.sciencedirect.com/science/article/pii/S1050641107001137 Abstract Lumbar spine accessory movements, used by therapists in the treatment of patients with low back pain, is thought to decrease paravertebral muscular activity; however there is little research to support this suggestion. This study investigated the effects of lumbar spine accessory movements on surface electromyography…

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The effect of increasing sets (within one treatment session) and different set durations (between treatment sessions) of lumbar spine posteroanterior mobilisations on pressure pain thresholds

Lital Pentelka Clair Hebron Rebecca Shapleski Inbal Goldshtein (2012) https://www.ncbi.nlm.nih.gov/pubmed/22726916 Abstract Spinal mobilisations are a common form of treatment intervention applied by physiotherapists in clinical practice to manage musculoskeletal pain and/or dysfunction. Previous research has demonstrated that mobilisations cause a hypoalgesic effect. However, there is very little research investigating the optimal treatment dose inducing this…

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The initial effects of different rates of lumbar mobilisations on pressure pain thresholds in asymptomatic subjects

Elaine Willett Clair Hebron Oliver Krouwel (2010) https://www.sciencedirect.com/science/article/pii/S1356689X09001878?via%3Dihub Abstract Lumbar mobilisations are commonly used in clinical practice to reduce pain and increase function. Mobilisations to the cervical spine have been shown to reduce pain using pressure pain thresholds (PPTs). Yet there is no evidence to confirm that this happens in the lumbar spine. Furthermore little…

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An investigation into the potential hypoalgesic effects of PA mobilisations on the lumbar spine as measured by pressure pain thresholds

Oliver Krouwel Clair Hebron Elaine Willett (2010) https://doi.org/10.1016/j.math.2009.05.013 Abstract Mobilisation of the spine is a common technique used in clinical practice. Studies have shown that mobilisation to the spine can decrease pain. The optimum treatment dose for achieving this has not so far been investigated. Previous studies that demonstrate the pain relieving effects of mobilisations…

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Student researchers

Over the years, a number of students of the MSK course have successfully published the research they conducted during their studies. Many have also presented at national and international conferences.  Please find links to some of their work here. Very well done everyone who went onto to present and publish!!  

Katy Williams

A short video from Katy Williams, a former MSK student working at the University of Bath. Katy talks about her experiences on the MSc MSK. She also talks about her research project, progressing to writing for publication and plans to present at a forthcoming conference. Please find a link to Katy’s research here https://www.sciencedirect.com/science/article/pii/S1466853X18301986 Thank…

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The role of patient expectations in physiotherapy Part 2: How patient expectations can guide and enhance treatment.

In this second part of my blog I am going to discuss how patient expectations can help to guide and enhance treatment. Expectations are a major factor that can influence clinical outcomes so if they are not established prior to treatment, not only treatment success, but also patient satisfaction may be affected (Bialosky et al…

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The role of patient expectations in physiotherapy Part 1: how expectations can influence clinical outcomes

When I first assess my patients I usually ask them what their expectations of physiotherapy are. I want to know what they think will happen during their physiotherapy treatment and, more importantly, what they want to get out of it.  If I can find this out this I am hopefully more likely to provide some…

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Return to play following ACL reconstruction; do we need more time? Part 2

  The second part of this blog aims to review the more common outcome measures that can be utilised to assess return to play readiness, and how these are integrated into our rehabilitation. This will hopefully give some direction as to maximise our patients’ chance of successful return to play.   Time Based Outcomes A…

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Return to play following ACL reconstruction; do we need more time? Part 1

“When will I be able to compete again?”. The question I seem to be asked multiple times a day as an MSK physiotherapist, especially in relation to Anterior Cruciate ligament (ACL) reconstructions. Patients who have undergone this surgery seem to be bombarded with a wide variance of answers, creating fear and avoidance which potentially leads…

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Manual therapy : Journey from faith to facts

Do spinal mobilization / manipulation techniques have a role in treatment of patients with LBP? When I first trained to graduate as a physiotherapist, I learned techniques to mobilize joints of the back. At this point of my life I had absolutely no idea of any form of critical thinking. When I began my MSc,…

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