Richard Stephenson

Can vastus medialis oblique be preferentially activated? A systematic review of electromyographic studies

Debate exists as to whether the vastus medialis oblique (VMO) can be activated to a greater degree than the vastus lateralis to produce preferential strengthening. This systematic review aims to determine whether preferential activation of VMO can be achieved by altering lower limb joint orientation or muscular co-contraction. A search of pertinent specialist journals and of the electronic databases AMED, CINAHL, the Cochrane database, EMBASE, ovid Medline, Physiotherapy Evidence Database (PEDro), Pubmed, and Zetoc from their inception to February 2008 was undertaken. All English-language clinical papers assessing the electromyographic activity of the human VM against the vastus lateralis (VL) muscles, in a neutral lower limb joint orientation, compared to a different hip, knee, ankle, and foot position; or with the addition of a co-contraction were included. Twenty papers reviewing 387 participants were reviewed. These reported principally that altering lower limb joint orientation or the addition of a co-contraction does not preferentially enhance VMO activity over VL. Nonetheless, the evidence-base presented with a number of significant methodological limitations. Accordingly, well-designed studies evaluating large samples of patients with patellofemoral joint disorders are required, to rectify the present limitations in the evidence-base, and to thoroughly investigate this topic.

The analgesic effects of interferential therapy on cold-induced pain in healthy subjects: a preliminary report

Interferential (IF) therapy is an electrotherapeutic modality used by physiotherapists for the management of a variety of painful conditions. However, the analgesic efficacy of IF remains in doubt and its mechanism of analgesic action is far from understood. This preliminary study examined the effect of IF on cold-induced pain threshold and tolerance in healthy student volunteers. Interferential therapy, when applied to the anterior aspect of the forearm of healthy subjects, significantly elevated ice pain threshold when compared with a control (no treatment) group. These preliminary findings provide objective evidence for the analgesic effects of IF currents.

A Review of Neuroplasticity: Some Implications for Physiotherapy in the Treatment of Lesions of the Brain

Summary This paper reviews the literature relating to neuroplasticity within the brain and draws implications pertinent to physiotherapy practice. Developmental, functional and post-lesion evidence of neuroplasticity is presented. Using neuroplastic phenomena as a model, physiotherapeutic intervention for sensorimotor deficits following brain lesions is justified and principles of treatment are developed. It is concluded that unilateral compensatory treatments are no longer physiologically justified and that intervention should guide axonal and dendritic development and the ‘opening up’ of the ‘new pathways’. This is facilitated by active patient participation, sensory input and the normality of experience in movement. Early treatment and intensive stimulation is recommended. However, neuroplastic changes can account for ‘abnormal’ tone and physiotherapists are warned that their role includes the minimising of this potential. Also, as reorganisation of the CNS is ongoing, long-term physiotherapy (over many years) can continue to enhance recovery. The author concludes that physiotherapists must justify intervention based upon physiologic evidence and not necessarily on treatment philosophies. An eclectic approach to practice is recommended so that the therapist can utilise all weapons to combat lesion changes.

The 20-item Toronto Alexithymia Scale: validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients.

OBJECTIVE Whilst the 20-item Toronto Alexithymia Scale (TAS-20) was developed to measure three intercorrelated dimensions, there is some debate as to whether the scale is best served by a two- or three-factor construct. In particular, there is some doubt as to whether clinical data exhibit the third factor. This study uses data from a sample of physiotherapy (physical therapy) out-patients in the UK to validate the factorial structure of a set of models postulated in the literature, including the three-factor model hypothesized by Bagby et al. (1994). METHOD Data were collected from a sample of physiotherapy out-patients (N=242). Specialist factor analysis software (LISREL 8.54) was used to perform confirmatory factor analyses on a range of models proposed in the literature. RESULTS The analysis supports the three-factor model assumed by Bagby et al. (1994), as well as most of the two-factor models suggested in the literature. CONCLUSIONS This new set of clinical data supports most of the two- and three-factor models postulated in the recent literature, including the three-factor model advocated by Bagby et al. (1994).

The analgesic effects of interferential (IF) current on cold-pressor pain in healthy subjects: a single blind trial of three IF currents against sham IF and control

Interferential (IF) therapy is well documented as a therapeutic medium for pain relief. Despite widespread use by physiotherapists, there remains very limited laboratory or clinical evidence for the analgesic effect of IF.Fifty volunteers were randomly allocated to one of five groups ( n =10): control group (no treatment throughout); IF 100 Hz applied to the ipsilateral limb; IF 100 Hz applied to the contralateral limb; IF 30 Hz applied to the ipsilateral limb; Sham IF applied to the ipsilateral limb. Subjects were given repeated (six) cycles of cold-pressor pain and pain threshold scores were recorded for each cycle and compared using repeated measure ANOVA. Mean pain threshold values for all groups increased with the exception of the control group: where pain threshold values decreased across the cycles. Pain thresholds within IF treatment groups repeatedly increased, but no more than sham IF. IF at 30 Hz and 100 Hz applied to the contralateral limb offered more consistency in the rise in mean values, with the sham group demonstrating more variation in performance. However, statistical analysis failed to show any significant differences for the treatment effects either within groups across repeated cycles (P=0.123) or between the groups across cycles (P=0.552). IF does not significantly alter pain threshold.

More efficient iterative uses of tricarbonyliron complexes are possible by diastereoselective formation of η5-cyclohexadienyl complexes

Abstract Diastereoselective addition of nucleophiles to 1-(RCO)-substituted tricarbony η 4 -cyclohexadiene)iron(0) complexes, and a diastereoselective acid-induced rearrangement to form 1-(branched alkyl)-substituted tricarbonyl( η 5 -cyclohexadienyl)iron(1+) salts, are described. Stereocontrol in the rearrangement has been studied, and HPF 6 , Ac 2 O has been shown to be the most suitable acid to promote diastereoselectivity. The product was reacted with LiCH(SO 2 Ph) 2 , completing one turn of an iterative cycle which formed a chiral centre at each step.

Discussion paper - Attending to pain: 'Mechanisms of musculoskeletal physiotherapy'

Abstract Zusman (Zusman M. Mechanisms of musculoskeletal physiotherapy. Phys Ther Rev 2004;9:39–49) offers a welcome paper hypothesising potential neurophysiological mechanisms (habituation and extinction) underpinning musculoskeletal physiotherapy. The strong review of clinical and physiological evidence relating to cellular learning offers a potential theoretical base to practice, supplementing recent physiotherapy literature in this field. His paper raises several themes that relate to the ways in which physiotherapists interpret evidence and the discussion here will focus on these contextual themes.

Pain: A Literature Review and Implications for Practice

Pain is a highly complex phenomenon involving sensory, affective and cognitive components. This paper reviews the nociceptive (noxious sensory) system associated with trauma to the hand. Potential physiological mechanisms that may generate altered pain states and complicate presenting features in clients are focused upon. Specific attention is given to peripheral nociception and the potential role of the limbic system in the integration of sensory, cognitive and affective domains. Mechanisms of cellular plasticity contributing to pain states such as allodynia, hyperalgesia, hyperesthesia, sympathetic and referred pain are offered. Potential therapeutic ways of modulating pain and influencing the frequency and patterning of nociceptive information are considered.