Back Pain Relief: Skin Impedance Measurements Can Help Identify Trigger Points Interview with:
Giovanni Barassi PhD

Center for Physiotherapy, Rehabilitation and Reeducation
Center of Sports Medicine
“G.d’Annnunzio” University
Chieti, Italy  What is the background for this study?

Response: Our research started with the observations made during standard clinical practice concerning the inefficiency of standard physiotherapeutic procedures used for pain relief in chronic nonspecific low back pain, a scourge of modern times, particularly in industrialized countries. Therefore, the need has arisen to search for new approaches in the evaluation and treatment of musculoskeletal problems.

Chronic low back pain is clinically manifest as the pain between rib margins and folds of the inferior gluteus muscle. It usually results from an incorrect lifestyle, typical of modern society having too little physical activity, too much psycho-physical stress, and poor management of body weight. On the background of osteopathic medicine, we developed a concept of the dysfunctional flow of body fluids as a plausible underlier of low back pain, referring by and large to spine bony structures.

It has been shown that alterations in afferent activity coming from visceral, structural, and emotional nociception converge in the same metamers of the spinal cord, resulting in information noise and jam. The final motor output of the reflex arc encompasses somatic, myofascial, and connective tissue responses, with the inevitably added influence of the autonomic nervous system. There also are studies demonstrating the importance of interpreting myofascial dysfunction, not as an isolated local phenomenon but rather as an expression of the central nervous activity. Therefore, a concept has been shaped of somatic and myofascial dysfunction, currently gaining increasing recognition among physicians, osteopaths, and physiotherapists, the professionals dealing with tissue and joint manipulation. The practical crux of the issue is the identification of the “major dysfunction” site, expressing the specific spinal information jam.

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Study Compares Dry Needling Techniques for Relief from Heel Pain Interview with:
Dr. Pablo Herrero Gallego. PT, PhD.
Head of iPhysio Research Group.
Editor-in-Chief Journal of Invasive Techniques in Physical Therapy
Zaragoza, Spain  What is the background for this study?

Response: The background of this study is that there has been an increasing use of minimally invasive techniques in physiotherapy in the last years, that apparently leading to very good results in the clinical practice, but there are no studies comparing the effectiveness of different treatment modalities. In the case of this study, about plantar heel pain (PHP), many physiotherapists use dry needling (DN) or percutaneous needle electrolysis (PNE) to treat myofascial trigger points when conservative treatment fails. However, although some clinicians claim that PNE has a superior effect to DN because it adds a galvanic current to the mechanical stimuli with the needle, there is no evidence to support this. Because of it, we decided to conduct this first study comparing these two treatment options for PHP.

Early Physical Therapy Can Be Protective Against Chronic Opioid Use Interview with:

Steven Z. George, PT, PhD  Professor Director of Musculoskeletal Research Duke Clinical Research Institute Vice Chair of Clinical Research Orthopaedic Surgery

Dr. George

Steven Z. George, PT, PhD 
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
Orthopaedic Surgery What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.

The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care.  What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy).  The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).

There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.

First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.

Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.  Continue reading