Physiotherapy Articles

The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) has long been accepted by many practitioners who work hard to treat this condition.

However, the authors of this article maintain that there is no scientific basis for this diagnosis. So what now? What if patients present with the clinical phenomena associated with MPS and TrPs?

This paper looks at all the evidence relating to the subject and offers plausible explanations and considerations for the treatment of MPS patients.

Manual and physical therapists often use a postural structural biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions. It is believed that postural deviations, body asymmetries and pathomechanics are the predisposing/maintaining factors for many musculoskeletal conditions.

The PSB model also plays an important role in clinical assessment and management, including the choice of manual techniques and the exercise prescribed.

However, this model has been eroded by research in the last two decades, introducing profound challenges to the practice of manual and physical therapy. This on-line course will examine how the sciences are challenging the PSB model, using lower back pain as an example.

The mechanisms through which manual therapy inhibits musculoskeletal pain are likely multifaceted and related to the interaction between the intervention, the patient, the practitioner, and the environment.

Placebo is traditionally considered an inert intervention; however, the pain research literature suggests that placebo is an active hypoalgesic agent. Placebo response likely plays a role in all interventions for pain and we suggest that the same is true for the treatment effects associated with manual therapy.

The magnitude of a placebo response may be influenced by negative mood, expectation, and conditioning. We suggest that manual therapists conceptualize placebo not only as a comparative intervention, but also as a potential active mechanism to partially account for treatment effects associated with manual therapy.

We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain.