Features of central sensitisation in patients with shoulder pain : A feasibility study

Design. A case-control feasibility study, comparing people with unilateral shoulder pain and pain free controls. Background. Previous studies have suggested that central sensitisation (CS) may be present in people with shoulder pain, mostly based on testing of nociception rather than mechanosensitivity, both of which can change as part of CS. Changes in mechanosensitivity are important for physiotherapy, which often involves non-noxious mechanoreceptor stimulation. Objectives. This study tested sensitivity to arangea range of mechanical stimuli potentially associated with CS in people with and without shoulder pain, compared to asymptomatic individuals. It was hypothesised that if CS was present, the response to mechanoreceptor stimulation would be increased. Methods. Both shoulders in both groups were tested for sensitivity of static and dynamic touch, vibration and punctate stimulation, plus temporal summation and pressure pain threshold (PPT). Participants completed a demographic questionnaire, pain scales, PainDETECT for neuropathic pain, and QuickDASH for upper limb function. Results. PPT was found to be significantly lower in the affected compared to the unaffected shoulders (p<0.003), but no other statistically significant between-group differences were found. Conclusion. This study found a lowered PPT in people with unilateral shoulder pain compared with asymptomatic individuals, but no evidence of a heightened response to other forms of mechanoreceptor stimulation. The study protocol was suitable for future studies and the required participant numbers were established. The variation in findings between studies suggests that a larger longitudinal study may be warranted .Peer reviewedFinal Published versio

Rotator cuff related shoulder pain: Assessment, management and uncertainties.

This document is the Accepted Manuscript version of the following article: Jeremy Lewis, ‘Rotator cuff related shoulder pain: Assessment, management and uncertainties’, Manual Therapy, Vol. 23: 57-68, June 2016, DOI: https://doi.org/10.1016/j.math.2016.03.009. This manuscript version is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions including; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. For those diagnosed with RCRSP one aim of treatment is to achieve symptom free shoulder movement and function. Findings from published high quality research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness rotator cuff (RC) tears and atraumatic full thickness rotator cuff tears. However considerable deficits in our understanding of RCRSP persist. These include; (i) cause and source of symptoms, (ii) establishing a definitive diagnosis, (iii) establishing the epidemiology of symptomatic RCRSP, (iv) knowing which tissues or systems to target intervention, and (v) which interventions are most effective.Peer reviewedFinal Accepted Versio

Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion?

This document is the Accepted Manuscript version of the following paper: Jeremy Lewis, 'Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion?', British Journal of Sports Medicine, Editorial to Vol. 49 (5): 280-281, December 2014, doi: 10.1136/bjsports-2014-094367. Published by the BMJ Publishing Group Limited.Peer reviewedFinal Accepted Versio

Rotator Cuff related shoulder pain. Advances in understanding and management.

This document is the Accepted Manuscript version of the following paper: Jeremy Lewis, ‘Rotator Cuff related shoulder pain. Advances in understanding and management’, Journal of Science and Medicine in Sport, Vol. 20, Supp. 3, Nov 2017, page 47, DOI: https://doi.org/10.1016/j.jsams.2017.09.376. Under embargo. Embargo end date: 21 October 2018Peer reviewe

Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?

The current approach to musculoskeletal pain is failing The majority of persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individual’s pain experience and disability. We contend this has resulted in two concerning developments in the management of people with such disorders. First, structural changes observed on imaging that are highly prevalent in pain free populations, such as rotator cuff tears, intervertebral disc degeneration, labral tears and cartilage changes, are ascribed to individuals as a diagnosis for their condition. In this context, this information may result in the individual believing that their body is damaged, fragile and in need of protection, resulting in a cascade of movement and activity avoidance behaviours and seeking interventions to correct the structural deficits. This trend has led to exponential increases in elective surgery rates and associated costs, while the efficacy of repairing (eg, rotator cuff and medical meniscal tears), reshaping (eg, subacromial decompression) or replacing (eg, lumbar intervertebral discs) the structures considered to be at fault has been substantially challenged. Second, it is arguable that musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected (such as trigger points, sacral torsions), and they have developed and perpetuated treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) that do not conform to current research evidence. These two trends have created an expectation that interventions (frequently ‘passive’) will provide a ’cure’, and typically quickly, with minimal self-contribution. This expectation may have been derived from a conversation with a friend or family member, from the Internet or from an advertising campaign, but almost certainly originated from health professionals.Peer reviewe

Constructing an understanding of mind : the development of children's social understanding within social interaction

Theories of children's developing understanding of mind tend to emphasize either individualistic processes of theory formation, maturation, or introspection, or the process of enculturation. However, such theories must be able to account for the accumulating evidence of the role of social interaction in the development of social understanding. We propose an alternative account, according to which the development of children's social understanding occurs within triadic interaction involving the child's experience of the world as well as communicative interaction with others about their experience and beliefs (Chapman 1991; 1999). It is through such triadic interaction that children gradually construct knowledge of the world as well as knowledge of other people. We contend that the extent and nature of the social interaction children experience will influence the development of children's social understanding. Increased opportunity to engage in cooperative social interaction and exposure to talk about mental states should facilitate the development of social understanding. We review evidence suggesting that children's understanding of mind develops gradually in the context of social interaction. Therefore, we need a theory of development in this area that accords a fundamental role to social interaction, yet does not assume that children simply adopt socially available knowledge but rather that children construct an understanding of mind within social interaction

Helical axis analysis to quantify humeral kinematics during shoulder rotation.

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Information pertaining to the helical axis during humeral kinematics during shoulder rotation may be of benefit to better understand conditions such as shoulder instability. The aim of this study is to quantify the behavior of humeral rotations using helical axis (HA) parameters in three different conditions. A total of 19 people without shoulder symptoms participated in the experiment. Shoulder kinematics was measured with an optoelectric motion capture system. The subjects performed three different full range rotations of the shoulder. The shoulder movements were analyzed with the HA technique. Four parameters were extracted from the HA of the shoulder during three different full-range rotations: range of movement (RoM), mean angle (MA), axis dispersion (MDD), and distance of their center from the shoulder (D). No significant differences were observed in the RoM for each condition between left and right side. The MA of the axis was significantly lower on the right side compared to the left in each of the three conditions. The MDD was also lower for the right side compared to the left side in each of the three conditions.The four parameters proposed for the analysis of shoulder kinematics showed to be promising indicators of shoulder instability.Peer reviewe

Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?

This document is the Accepted Manuscript version of the following article: Parle PJ, Riddiford-Harland DL, Howitt CD, et al. 'Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?.' Br J Sports Med 2017;51:208-209, doi: http://dx.doi.org/10.1136/bjsports-2016-096107.Rotator cuff tendinopathies are the most commonly diagnosed musculoskeletal shoulder conditions and are associated with pain, weakness and loss of function.1 Tendon swelling may be associated with tendinopathy and may result from acute overload.2–3 An increase in tendon cells (tenocytes) and upregulation of large molecular weight proteoglycans, such as aggrecan, may increase tendon water content.2 There is uncertainty as to whether the swelling is related to the pain or is instead an observed but unrelated phenomenon. Weakness detected clinically may be due to pain inhibition.4–5 Early treatment of acute rotator cuff tendinopathy involves patient education and relative rest, and may include non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain, swelling and inflammation. Subacromial corticosteroid injections are also used to achieve the same purpose. These techniques show low to moderate evidence of reducing short-term pain but they do not improve function.6 The medications have side effects such as gastrointestinal tract complaints,7 and corticosteroids may damage tendon tissue.8 Identifying alternative ways to control pain and inflammation may be warranted. Two clinical procedures to manage RC tendinopathy include ice wraps and isometric exercise, however, there are no empirical data supporting their use. This pilot study, conducted at the Illawarra Sports Medicine Clinic, NSW, Australia, was designed to test (1) the short term analgaesic effect of these interventions and (2) the feasibility of a larger clinical trial for adults diagnosed with acute rotator cuff tendinopathy (<12 weeks).Peer reviewe

Intranasal Inhalation of Oxytocin Improves Face Processing in Developmental Prosopagnosia

Developmental prosopagnosia (DP) is characterised by a severe, lifelong impairment in face recognition. Little work has attempted to improve face processing in these individuals, but intriguingly, recent evidence suggests oxytocin can improve face processing in both healthy participants and individuals with autism. This study examined whether oxytocin could also improve face processing in individuals with DP. Ten adults with the condition and 10 matched controls were tested using a randomized placebo-controlled double-blind within-subject experimental design (AB-BA). Each participant took part in two testing sessions where they inhaled 24IU of oxytocin or placebo spray and completed two face processing tests: one assessing face memory and the other face perception. Results showed main effects of both participant group and treatment condition in both face processing tests, but the two did not interact. Specifically, the performance of DP participants was significantly lower than control performance under both oxytocin and placebo conditions, but oxytocin improved processing to a similar extent in both groups