Musculoskeletal Physiotherapy

“Finding a new normal: the lived experience of persons’ journey towards coping with persistent low back pain”

Kurz and Hebron 2022 Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. However, there is a paucity of research exploring the lived experience of persons who self-identify as coping…

Building bespoke exercise: The clinical reasoning processes of physiotherapists when prescribing exercise for persons with musculoskeletal disorders

Josie Grimus, Chris Horler and Clair Hebron (2022) Aims: This qualitative study aimed to explore physiotherapists’ clinical reasoningwhen prescribing exercise for persons with musculoskeletal disorders.Methods: A constructivist grounded theory inspired methodological approach wasused. Six physiotherapists working in the United Kingdom were recruited via pur-posive sampling. Data collection and analysis included semi‐structured interviews,memo writing, coding, and…

What am I trying to say, or not say? Importance of appropriate language during consultations of persons with low back pain (LBP)

INTRODUCTION Why do people with LBP seek physiotherapy? They may attend because they would like to understand the whys, how, ifs, of their complaints and how to overcome them. They would like answers, they need information and understanding (Stenner et al., 2018). They may ask their friends, relatives and the internet for advice, but one…

Managing Complexity: Physiotherapists’ experience of managing persons with persistent low back pain

Physiotherapists’ experience of managing persons with persistent low back pain. Elisavet Anastasiadi and Clair Hebron (2021). Low back pain is one of the leading causes of disability globally. Most back pain episodes resolve quickly but a significant number of people report having back pain that lasts more than 3 months. The current understanding is that…

The Management of Carpal Tunnel Syndrome

The Management of Carpal Tunnel Syndrome by Vinoth Ketheeswaran Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy where there is a compression of the median nerve at the wrist as it passes through an osteofibrous canal known as the carpal tunnel. In addition to the median nerve, the carpal tunnel contains the carpal…

Are Nerve Sliders and Tensioners Effective for Sciatica? (Part 2)

Seeing the Wood for the Trees What is ‘Sciatica’?! ‘Sciatica’ is used to describe a host of back-related leg pain presentations of different causes; Bogduk (2009) argues that ‘sciatica’ is outdated, and as pain physiology has evolved so should nomenclature. It is well established (Genevay et al., 2017; Ostelo, 2020; Schmid, Fundaun and Tampin, 2020)…

Are Nerve Sliders and Tensioners Effective for Sciatica? (part 1)

As an MSK physiotherapist aligned to a spinal pathway I treat a lot of people with sciatica. It is a condition I find frustrating to treat and have inconsistent results with. I was recently asked to clinically reason my use of nerve sliders and tensioners and realised how little I knew of their supporting evidence….

How we may be misdiagnosing peripheral entrapment neuropathies. (Part 2)

Hi All I last posted Part 1 of my blog assignment June 2020 which can be found here. I have since returned to Eastbourne for my Upper Limb Module and it has been great to get back into academia and catching up/meeting others from the course. It has also reminded me to post part 2…

Clement’s experiences as a student on the MACP pathway

In this video Clement Noel talks about his experiences on the course and top tips for others. Thank you for sharing your journey with our Clement.

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…

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…

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…

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…

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…

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…

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…

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;…

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…

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…

“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,…

‘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,…

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…

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…

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…

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….

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…

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….

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…

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…

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…