Diego Leoni

Test–retest reliability of pain extent and pain location using a novel method for pain drawing analysis

Pain drawings (PDs) are an important component of the assessment of a patient with pain. The aim of this work is to present the test–retest reliability of a novel method of quantifying the extent and location of pain. Additionally, the association between PD variables and clinical features in patients with chronic neck pain (CNP) and chronic low back pain (CLBP) was explored.

Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

BackgroundThe popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation.MethodsNineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab.ResultsBilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P < 0.001) more likely to occur bilaterally than unilaterally. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation. In other words, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = 0.294). The mean number of pops per C1-2 rotatory HVLA thrust manipulation was 3.57 (95% CI: 3.19, 3.94) and the mean number of pops per subject following both right and left C1-2 thrust manipulations was 6.95 (95% CI: 6.11, 7.79). The mean duration of a single audible pop was 5.66 ms (95% CI: 5.36, 5.96) and the mean duration of a single manipulation was 96.95 ms (95% CI: 57.20, 136.71).ConclusionsCavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. Most subjects produced 3–4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 articulation; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint. Furthermore, the traditional manual therapy approach of targeting a single ipsilateral or contralateral facet joint in the upper cervical spine may not be realistic.

Test-retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis

Pain drawings (PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test–retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers.

Upper Limb Neurodynamic Test 1 on Healthy Individuals: Intra- and Intersession Reliability of the Angle between Pain Onset and Submaximal Pain

Assessment of nerve trunk mechanosensitivity using the upper limb neurodynamic test 1 (ULNT1) often includes measurement of the angle of occurrence in the range of pain onset (PO) and submaximal pain (SP). A measurement that better fits the idea of mechanosensitivity could be the angle between PO and SP (AbOS). This study investigated the intra- and intersession reliability of AbOS, PO, and SP during the ULNT1. Forty-four healthy volunteers underwent three ULNT1 to the point of PO and SP, twice in the first session and once in the second. AbOS, PO, and SP angles of occurrence reliability were examined using the Intraclass Correlation Coefficient (ICC 3,1) and Bland-Altman plots. The intra- and intersession ICC values for AbOS were 0.71 (95% CI: 0.47; 0.85) and 0.79 (95% CI: 0.60; 0.89), respectively. The intra- and intersession mean difference and 95% limits of agreement (±1.96 SD) in the Bland-Altman plots were 2.3° (−18.3°; 23.1°) and 2.8° (−14.7°; 20.4°), respectively. The intra- and intersession reliability of the AbOS during the ULNT1 in healthy individuals is high and higher than the reliability of PO and SP angles of occurrence. The AbOS could be a preferable variable in the assessment of neural mechanosensitivity.

Stretching optimization for lower limb posterior chain: comparison between two different executions of the same exercise

Stretching of the posterior kinetic chain muscles, especially the hamstrings, is one of the most practiced exercises in all types of physical activity and postural rehabilitation protocols (1). Objective of our experimental trial was to compare the performance of two different variants of muscle stretching (A and B), highlighting for each one the regions of the posterior kinetic chain (lumbar region, gluteus muscles, hamstrings) most affected by the exercise. 161 selected subjects reported on a specific Body Chart the localization of the stretching sensation; the software Pain-drawing (2) was employed for the analysis of the stretching sensation felt by each subject (75 men and 86 women) aged between 20 and 80 years old, with different lifestyles but subjected to defined exclusion criteria (prosthesis, artificial implants, crippling arthritis, flare–up pain, recent surgical procedures). Stretching A is the generally accepted practice available in the literature. The proposed variant (Stretching B) is the experimental suggested procedure which adapts the execution of the exercise on biomechanical reasoning, in order to focus the stretching sensation on the hamstrings muscles and, at the same time, decreasing the stress in the lumbar region. In stretching B, subjects were positioned with lower limb in neutral position, knee with approximately 18° of feeble bending (variable depth, compact rolls in various size, behind popliteal fossa. Notably, results show that the same area has not been affected; when subjects performed Stretching B exercise avoids both the pre-tension of the hamstrings and the lever created by the arms stretched forward, focusing the stretching sensation on the hamstrings muscles and gastrocnemius and affecting only marginally the lumbar region and never the back region. This appears particularly relevant for the prevention of lower back pain and for situation when the stretching of the posterior kinetic chain is performed as a cool-down following physical activity or for rehabilitation purposes.