The plans of Maas et al (1) to evaluate back pain treatments have two important features not usually included in such studies. One is to check for cost effectiveness. The second is to study subgroups. But individual treatments need to be inspected for each...
read full comment
Comment on: Maas et al. BMC Musculoskeletal Disorders, 13:260
Pain drawings; similar observations but different interpretations. (Brian Sweetman, 24 January 2013)
Egloff and colleagues (1) provide one of the most detailed assessments of pain drawings in terms of the number of criteria they inspected. They compared a group of 62 patients selected as seemingly having somatoform-functional pain with a control group of 49 patients from the orthopaedic department with what the authors described as somatoform- nociceptive type pain. They identified 13 drawing criteria out of 24 that distinguish the ¿psychological¿ functional pain element. The number of criteria could be reduced to three, which identified the functional cases almost as effectively as did all thirteen criteria. These three best drawings criteria included the total number of marks, the length of the longest mark, and the presence of symmetric patterns....
read full comment
Comment on: Egloff et al. BMC Musculoskeletal Disorders, 13:257
Neck trauma or no trauma, that is the question. (Brian Sweetman, 24 January 2013)
Bruls et al (1) have recently published the protocol for their arm, neck and shoulder study. It is possible that the study has already started, but there are some aspects that might be worth incorporating if it is not too late or that might be added in one of the follow up stages. Indeed, some aspects might best be added at the end of the study so as not to influence the participants...
read full comment
Comment on: Bruls et al. BMC Musculoskeletal Disorders, 14:8
Lumbar facet joint asymmetric ¿contralaterality¿ (Brian Sweetman, 04 December 2012)
Comment on: Kuo et al. BMC Musculoskeletal Disorders, 11:151
Study Protocol ¿ Lumbar Epidural Steroid Injections for Spinal STENOSIS (LESS): A Double-Blind Randomized Controlled Trial of Epidural Steroid Injections for Lumbar Spinal Stenosis Among Older Adults (Laxmaiah Manchikanti, 19 July 2012)
We read with great interest the study protocol by Friedly et al for lumbar epidural injections for spinal stenosis [1]. The protocol is well designed and a useful contribution to the literature. Unfortunately, the authors have demonstrated a seemingly superficial approach with what is potentially a misinterpretation of the previously available research. With reference to the previous available research, the authors have quoted a preliminary article by Manchikanti et al [2] published in 2008; however, they have ignored multiple other publications in reference to the one-year follow-up of the complete manuscript of the 2008 publication [3] as well as lumbar interlaminar epidural injections for spinal stenosis by the same authors and other multiple manuscripts by various other authors. The...
read full comment
Comment on: Friedly et al. BMC Musculoskeletal Disorders, 13:48
Wrong power calculation and analysis (David J Torgerson, 01 March 2012)
You are doing a cluster randomised controlled trial. However, your sample size is incorrect: you have not adjusted for clustering. Also your analysis strategy is incorrect: again you need to adjust for clustering. Even if you did the adjustment you only have 4 clusters, which is insufficient cluster replication. You need to increase the number of clusters to at least 8 and recalculate your sample size.
read full comment
Comment on: Rathleff et al. BMC Musculoskeletal Disorders, 13:9
Comment (Robert Borden Hopkins, 29 February 2012)
After the work [1] was published we realized a minor error with regard to...
read full comment
Comment on: Hopkins et al. BMC Musculoskeletal Disorders, 12:209
Error of pain measurement (Iben Axén, 06 July 2011)
In the methods section, the pain measurement is described as a Numeric Rating Scale, which is correct. However, in the result section as well as in Table 1, pain is described as a measurement with the Visual Analogue Scale, which is incorrect. This fact has no bearing on the figures (means and SD) presented, but they should, of course, read "NRS" even in the result and in the Table. We apologize for this error.
read full comment
Comment on: Axén et al. BMC Musculoskeletal Disorders, 12:99
MRI imaging in acute whiplash has no value: is this a surprise? (Stephen Faulkner, 25 January 2011)
We were interested to review the results reported in the recent publication by Vetti et al. [1] While we agree with these authors’ conclusion that upper cervical MRI is a poor screening tool for all patients with an acute whiplash injury, the paper may leave the reader with the impression that diagnostic MRI of the craniovertebral ligaments is not a useful modality in certain subpopulations of chronic whiplash-injured patients. It is important to note that the study design employed by the authors only allowed for the evaluation of upper cervical MRI as a screening tool of acutely injured patients (n = 114); there were too few patients in the study with significant chronic pain (n = 23) to draw any meaningful conclusions regarding the ability of the test to discriminate between...
read full comment
Comment on: Vetti et al. BMC Musculoskeletal Disorders, 11:260
Is fibromyalgia a progressive condition? (Kim Lawson, 05 August 2010)
The primary focus of the article of Silverman et al (BMC Musculoskeletal Disorders 2010, 11:66) towards the characterization of fibromyalgia (FM) severity is fundamental to a greater understanding of this condition. As correctly identified the limitations associated with potential biomarkers has not assisted in attempts of defining FM severity. It should also be noted a similar circumstance exists for the definition of the state of remission in FM, where often a lack of symptoms is viewed as a lack of the condition (ie an altered biology). While the study and general interpretations of the outcomes are well constructed, there is however concern of the attempts to relate the measurement of FM severity with disease progression. This has led the authors to propose "..to slow progression...
read full comment
Comment on: Silverman et al. BMC Musculoskeletal Disorders, 11:66
query (Paule Morbois, 15 July 2010)
I was only questioning the number in the sample of the study you presented here and the result you may have received provide little or no ground to as the validity based on the sample examined (2 patients only). Do you intend in continuing such study as to increase the number presented and therefore improve the reliability of such results?
Comment on: Lerario et al. BMC Musculoskeletal Disorders, 11:157
Not all physiotherapy is the same (Bill Vicenzino, 06 July 2010)
long-term delay in healing after corticosteroid injections [2]. Olausson and his colleagues are commended for undertaking such a trial.
On reading the physiotherapy intervention in this protocol I was concerned to read that our previous randomised clinical trial [3] was used as the basis of their physiotherapy treatment. My concern is that in our clinical trial the physiotherapy program consisted of mobilisation with movement treatment plus exercise [3-5], whereas their program consists of friction massage, Mill’s manipulation and soft tissue treatment with stretching of radial wrist extensors plus instructions for home exercises of eccentric exercise and stretching [1]. So my intention in posting this comment is to inform readers that it is not readily apparent how the...
read full comment
Comment on: Olaussen et al. BMC Musculoskeletal Disorders, 10:152
The heredity of the hallux valgus (Carlos Piqué-Vidal, 06 July 2010)
I want to congratulate the authors for this interesting study.
I agree with the authors in the fact that, besides the hereditary factors, the exogenous factors as the footwear play an important role in the appearance and the evolution of the hallux valgus.
I think that it would have been interesting that they had stated the hereditary factor of the hallux valgus, they might have asked the parents for this information when they asked for the parental consent.
I want to index a recent article on the heredity of the hallux valgus (1). In this article the authors demonstrate that the hallux valgus has an inheritance autosomal dominant with uncomplete penetrance of 56 %.
The article explains that the affected women of hallux valgus have the mother...
read full comment
Comment on: Klein et al. BMC Musculoskeletal Disorders, 10:159
Which Style of Tai Chi Are You Studying? (Jordan Keats, 07 August 2009)
Hello, As you may know there are five major styles of taiji, in your abstract you simply say tai chi, what style of tai chi are you studying? As to the affect of various styles of taiji on the body I can not comment, but I have been practicing Chen Style tai chi for four years and it has completely alleviated my lower back pain caused by scoliosis. Who are the teachers/ masters participating in this study, and for how long does the study run? Thanks, Jordan
read full comment
Comment on: Hall et al. BMC Musculoskeletal Disorders, 10:55
vitamin c can prevent crps post colles fracture (Jan fisher, 15 January 2009)
Just thought I'd mention this study which seems to fit well with this cohort study, "Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?"A Randomized, Controlled, Multicenter Dose-Response StudyP.E. Zollinger, MD1, W.E. Tuinebreijer, MD, PhD, MSc, MA2, R.S. Breederveld, MD, PhD3 and R.W. Kreis, MD, PhD3.Identification of risks and early intervention is vital as you have indicated. http://www.ejbjs.org/cgi/content/abstract/89/7/1424Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures? A Randomized, Controlled, Multicenter Dose-Response Study -- Zollinger et al. 89 (7): 1424 -- Journal of Bone and Joint Surgery
read full comment
Comment on: Brunner et al. BMC Musculoskeletal Disorders, 9:92
Ethical situation (Daniel Hernandez-Vaquero, 01 August 2008)
This study is retrospective and involves the use of clinical data collected from adults who underwent low-friction arthroplasties. The Reseearch Committee of the Hospital confirms that do not require any approval from the local ethics committee.
read full comment
Authors' response to comments (Neil O'Connell, 06 May 2008)
We have read with interest the comments made regarding our debate paper and thank the authors for their contribution to the discussion. Addressing the points raised we would argue that while interventional techniques such as facet joint injection and discography are commonly used in an attempt to make specific diagnoses in CNSLBP, the early promise of these techniques has not been supported by high-quality evidence. For a discussion of the limitations of interventional diagnostics in CNSLBP we would refer readers to the excellent review by Carragee and Hannibal (2004). It is possible that the low specificity and reliability of these approaches may rest with the techniques themselves. However an alternative explanation for this (and one which fits with our proposed model) is that CNSLBP is...
read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
subgroups may exist! (Shahram Sadeghi, 21 April 2008)
Conventional interventions do not reveal the pain source in many cases. But with the use of joint blocks and discography; the facet joint, the sacroiliac joint and internal disc disruption can be identified as pain generators in almost 80% of patients; so we can see subgroups in low back pain!
read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
MRI reliability (James Hall, 25 February 2008)
My daughter had an MRI that diagnosed her ACL as partially torn. It was the same ACL (hamstring graff) that was reconstructed a year earlier. She however had no pain and went the conservative route of treatment. She resumed activity(collegiate Basketball) about 4 weeks later and so far so good.She does wear a custom fit brace. After reading this article I am wandering about the reliability of the MRI.
read full comment
Comment on: Tsai et al. BMC Musculoskeletal Disorders, 5:21
MD (Mike Montbriand, 07 February 2008)
In the 21st century where 85% of chronic low back pain can be diagnosed by interventional techniques, it is sad to still see articles talking about chronic non-specific back pain. Dr. N. Bogduk (1) has delineated these statistics for years and made a recent educational module for neurologists for such. I have an interest in myofascial pain and can see 3 cases of predominantly Quadratus Lumborum spasm daily. If you sit behind a patient side-sitting and grab the back muscle mass, one will find the front edge often three times more tender than the back edge. Further examination will delineate Quadratus lumborum myofascial pain. Much of these co-exists with disc or facet disease but they do help explain the 15% Dr. Bogduk could not determine. Talking about low back pain is like...
read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
Centralization key to this algorithm (M Miglis, 21 August 2007)
The algorithm includes determination as to whether or not centralization is occuring at a key point in responose to Question 2 (Reference: Table 1). Skill in determining the presence or absence of centraliztion has been shown to be sensitive to the level of training of the examiner. That is, examiners with formal training in the McKenzie method have been shown to be more reliable in eliciting the centralization phenomenon than untrained counterparts. Given the fact that many examiners have little or no supervised training in this method, how reliable is a pivotal finding of "no centralization"? Isn't this finding especially critical, since it leads along the decision tree to other forms of assessment (segmental provocaton signs, neurodynamic signs, etc.)when, in fact, a false negative for...
read full comment
Comment on: Murphy et al. BMC Musculoskeletal Disorders, 8:75
Cut off (Gyrd Thrane, 09 August 2007)
This study clearly show us that the cut-off at 2,6 for the pectoralis minor length test is inappropriate. Though, I do not understand why it is necessary to calculate sensitivity, specificity and likelihood ratios with this cut-off that is obviously out of the normal values (as provided by Borstad). Table 5 and 6, and the conclusions based on them, is therefore of lesser interest. I wonder if there was done a ROC analysis to check the diagnostic properties? Are other cut-offs more suitable?
read full comment
Comment on: Lewis et al. BMC Musculoskeletal Disorders, 8:64
An answer to question about the favorable outcome of group 1 (Ali Montazeri, 18 June 2007)
Tom Shillock raises question that since the scoring of the intervention was done upon completion of the three month intervention, how can the authors be sure that responses were not due to some version of the Hawthorne effect? After all, the attention, information and support may have raised participants' expectations (hope) about reductions in pain and improvement in quality of life that skewed their assessments of their immediate post-intervention improvement? Then, Tom adds wouldn't it be more meaningful to asses them at say six months or 12 months after termination of the intervention?We are grateful to Tom for raising a thoughtful question. However, this is to indicate that data for six and 12 months also were collected. The preliminary analysis showed that the group 1 (Back School...
read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21
Thanks for sharing your research findings! (Dorothy D. Zeviar, Ed.D., LAc, 29 March 2007)
Hello,Because in my practice I see many people with chronic low-back pain, including sciatica, I am especially grateful to you for writing up your very interesting research results and posting them for all healthcare practitioners to use. It demonstrates to me that a little education on correct alignment, proper exercises, and walking each day can help people feel more self-empowered to control and even eliminate their back pain. Additionally, I wish to add that "complementary" modalities such as acupuncture and Oriental Medicine are proven very effective in reducing the debilitation of back pain. In my practice, I combine electro-acupuncture, Chinese herbs, Tuina massage, dietary changes and exercise recommendations to reduce the incapacitation of low-back pain. I hope your country...
read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21
A question about the favorable outcome of group 1 (Tom Shillock, 29 March 2007)
Since the scoring of the intervention was done upon completion of the three month intervention, how can the authors be sure that responses were not due to some version of the Hawthorne effect? After all, the attention, information and support may have raised participants' expectations (hope) about reductions in pain and improvement in quality of life that skewed their assessments of their immediate post-intervention improvement? Wouldn't it be more meaningful to asses them at say six months or 12 months after termination of the intervention?
read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21
RSS
Latest comments
Trial plans (Brian Sweetman, 24 January 2013)
The plans of Maas et al (1) to evaluate back pain treatments have two important features not usually included in such studies. One is to check for cost effectiveness. The second is to study subgroups. But individual treatments need to be inspected for each... read full comment
Comment on: Maas et al. BMC Musculoskeletal Disorders, 13:260
Pain drawings; similar observations but different interpretations. (Brian Sweetman, 24 January 2013)
Egloff and colleagues (1) provide one of the most detailed assessments of pain drawings in terms of the number of criteria they inspected. They compared a group of 62 patients selected as seemingly having somatoform-functional pain with a control group of 49 patients from the orthopaedic department with what the authors described as somatoform- nociceptive type pain. They identified 13 drawing criteria out of 24 that distinguish the ¿psychological¿ functional pain element. The number of criteria could be reduced to three, which identified the functional cases almost as effectively as did all thirteen criteria. These three best drawings criteria included the total number of marks, the length of the longest mark, and the presence of symmetric patterns.... read full comment
Comment on: Egloff et al. BMC Musculoskeletal Disorders, 13:257
Neck trauma or no trauma, that is the question. (Brian Sweetman, 24 January 2013)
Bruls et al (1) have recently published the protocol for their arm, neck and shoulder study. It is possible that the study has already started, but there are some aspects that might be worth incorporating if it is not too late or that might be added in one of the follow up stages. Indeed, some aspects might best be added at the end of the study so as not to influence the participants... read full comment
Comment on: Bruls et al. BMC Musculoskeletal Disorders, 14:8
Lumbar facet joint asymmetric ¿contralaterality¿ (Brian Sweetman, 04 December 2012)
Dear... read full comment
Comment on: Kuo et al. BMC Musculoskeletal Disorders, 11:151
Study Protocol ¿ Lumbar Epidural Steroid Injections for Spinal STENOSIS (LESS): A Double-Blind Randomized Controlled Trial of Epidural Steroid Injections for Lumbar Spinal Stenosis Among Older Adults (Laxmaiah Manchikanti, 19 July 2012)
We read with great interest the study protocol by Friedly et al for lumbar epidural injections for spinal stenosis [1]. The protocol is well designed and a useful contribution to the literature. Unfortunately, the authors have demonstrated a seemingly superficial approach with what is potentially a misinterpretation of the previously available research. With reference to the previous available research, the authors have quoted a preliminary article by Manchikanti et al [2] published in 2008; however, they have ignored multiple other publications in reference to the one-year follow-up of the complete manuscript of the 2008 publication [3] as well as lumbar interlaminar epidural injections for spinal stenosis by the same authors and other multiple manuscripts by various other authors. The... read full comment
Comment on: Friedly et al. BMC Musculoskeletal Disorders, 13:48
Wrong power calculation and analysis (David J Torgerson, 01 March 2012)
You are doing a cluster randomised controlled trial. However, your sample size is incorrect: you have not adjusted for clustering. Also your analysis strategy is incorrect: again you need to adjust for clustering. Even if you did the adjustment you only have 4 clusters, which is insufficient cluster replication. You need to increase the number of clusters to at least 8 and recalculate your sample size. read full comment
Comment on: Rathleff et al. BMC Musculoskeletal Disorders, 13:9
Comment (Robert Borden Hopkins, 29 February 2012)
After the work [1] was published we realized a minor error with regard to... read full comment
Comment on: Hopkins et al. BMC Musculoskeletal Disorders, 12:209
Error of pain measurement (Iben Axén, 06 July 2011)
In the methods section, the pain measurement is described as a Numeric Rating Scale, which is correct. However, in the result section as well as in Table 1, pain is described as a measurement with the Visual Analogue Scale, which is incorrect. This fact has no bearing on the figures (means and SD) presented, but they should, of course, read "NRS" even in the result and in the Table. We apologize for this error. read full comment
Comment on: Axén et al. BMC Musculoskeletal Disorders, 12:99
MRI imaging in acute whiplash has no value: is this a surprise? (Stephen Faulkner, 25 January 2011)
We were interested to review the results reported in the recent publication by Vetti et al. [1] While we agree with these authors’ conclusion that upper cervical MRI is a poor screening tool for all patients with an acute whiplash injury, the paper may leave the reader with the impression that diagnostic MRI of the craniovertebral ligaments is not a useful modality in certain subpopulations of chronic whiplash-injured patients. It is important to note that the study design employed by the authors only allowed for the evaluation of upper cervical MRI as a screening tool of acutely injured patients (n = 114); there were too few patients in the study with significant chronic pain (n = 23) to draw any meaningful conclusions regarding the ability of the test to discriminate between... read full comment
Comment on: Vetti et al. BMC Musculoskeletal Disorders, 11:260
Is fibromyalgia a progressive condition? (Kim Lawson, 05 August 2010)
The primary focus of the article of Silverman et al (BMC Musculoskeletal Disorders 2010, 11:66) towards the characterization of fibromyalgia (FM) severity is fundamental to a greater understanding of this condition. As correctly identified the limitations associated with potential biomarkers has not assisted in attempts of defining FM severity. It should also be noted a similar circumstance exists for the definition of the state of remission in FM, where often a lack of symptoms is viewed as a lack of the condition (ie an altered biology).
While the study and general interpretations of the outcomes are well constructed, there is however concern of the attempts to relate the measurement of FM severity with disease progression. This has led the authors to propose "..to slow progression... read full comment
Comment on: Silverman et al. BMC Musculoskeletal Disorders, 11:66
query (Paule Morbois, 15 July 2010)
I was only questioning the number in the sample of the study you presented here and the result you may have received provide little or no ground to as the validity based on the sample examined (2 patients only).
Do you intend in continuing such study as to increase the number presented and therefore improve the reliability of such results?
truthfully,
read full comment
Comment on: Lerario et al. BMC Musculoskeletal Disorders, 11:157
Not all physiotherapy is the same (Bill Vicenzino, 06 July 2010)
long-term delay in healing after corticosteroid injections [2]. Olausson and his colleagues are commended for undertaking such a trial.
On reading the physiotherapy intervention in this protocol I was concerned to read that our previous randomised clinical trial [3] was used as the basis of their physiotherapy treatment. My concern is that in our clinical trial the physiotherapy program consisted of mobilisation with movement treatment plus exercise [3-5], whereas their program consists of friction massage, Mill’s manipulation and soft tissue treatment with stretching of radial wrist extensors plus instructions for home exercises of eccentric exercise and stretching [1]. So my intention in posting this comment is to inform readers that it is not readily apparent how the... read full comment
Comment on: Olaussen et al. BMC Musculoskeletal Disorders, 10:152
The heredity of the hallux valgus (Carlos Piqué-Vidal, 06 July 2010)
I want to congratulate the authors for this interesting study.
I agree with the authors in the fact that, besides the hereditary factors, the exogenous factors as the footwear play an important role in the appearance and the evolution of the hallux valgus.
I think that it would have been interesting that they had stated the hereditary factor of the hallux valgus, they might have asked the parents for this information when they asked for the parental consent.
I want to index a recent article on the heredity of the hallux valgus (1). In this article the authors demonstrate that the hallux valgus has an inheritance autosomal dominant with uncomplete penetrance of 56 %.
The article explains that the affected women of hallux valgus have the mother... read full comment
Comment on: Klein et al. BMC Musculoskeletal Disorders, 10:159
Which Style of Tai Chi Are You Studying? (Jordan Keats, 07 August 2009)
Hello,
As you may know there are five major styles of taiji, in your abstract you simply say tai chi, what style of tai chi are you studying? As to the affect of various styles of taiji on the body I can not comment, but I have been practicing Chen Style tai chi for four years and it has completely alleviated my lower back pain caused by scoliosis. Who are the teachers/ masters participating in this study, and for how long does the study run?
Thanks,
Jordan read full comment
Comment on: Hall et al. BMC Musculoskeletal Disorders, 10:55
vitamin c can prevent crps post colles fracture (Jan fisher, 15 January 2009)
Just thought I'd mention this study which seems to fit well with this cohort study, "Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?"A Randomized, Controlled, Multicenter Dose-Response StudyP.E. Zollinger, MD1, W.E. Tuinebreijer, MD, PhD, MSc, MA2, R.S. Breederveld, MD, PhD3 and R.W. Kreis, MD, PhD3.Identification of risks and early intervention is vital as you have indicated. http://www.ejbjs.org/cgi/content/abstract/89/7/1424Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures? A Randomized, Controlled, Multicenter Dose-Response Study -- Zollinger et al. 89 (7): 1424 -- Journal of Bone and Joint Surgery read full comment
Comment on: Brunner et al. BMC Musculoskeletal Disorders, 9:92
Ethical situation (Daniel Hernandez-Vaquero, 01 August 2008)
This study is retrospective and involves the use of clinical data collected from adults who underwent low-friction arthroplasties. The Reseearch Committee of the Hospital confirms that do not require any approval from the local ethics committee. read full comment
Comment on: Hernández-Vaquero et al. BMC Musculoskeletal Disorders, 9:69
Authors' response to comments (Neil O'Connell, 06 May 2008)
We have read with interest the comments made regarding our debate paper and thank the authors for their contribution to the discussion. Addressing the points raised we would argue that while interventional techniques such as facet joint injection and discography are commonly used in an attempt to make specific diagnoses in CNSLBP, the early promise of these techniques has not been supported by high-quality evidence. For a discussion of the limitations of interventional diagnostics in CNSLBP we would refer readers to the excellent review by Carragee and Hannibal (2004). It is possible that the low specificity and reliability of these approaches may rest with the techniques themselves. However an alternative explanation for this (and one which fits with our proposed model) is that CNSLBP is... read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
subgroups may exist! (Shahram Sadeghi, 21 April 2008)
Conventional interventions do not reveal the pain source in many cases. But with the use of joint blocks and discography; the facet joint, the sacroiliac joint and internal disc disruption can be identified as pain generators in almost 80% of patients; so we can see subgroups in low back pain! read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
MRI reliability (James Hall, 25 February 2008)
My daughter had an MRI that diagnosed her ACL as partially torn. It was the same ACL (hamstring graff) that was reconstructed a year earlier. She however had no pain and went the conservative route of treatment. She resumed activity(collegiate Basketball) about 4 weeks later and so far so good.She does wear a custom fit brace. After reading this article I am wandering about the reliability of the MRI. read full comment
Comment on: Tsai et al. BMC Musculoskeletal Disorders, 5:21
MD (Mike Montbriand, 07 February 2008)
In the 21st century where 85% of chronic low back pain can be diagnosed by interventional techniques, it is sad to still see articles talking about chronic non-specific back pain. Dr. N. Bogduk (1) has delineated these statistics for years and made a recent educational module for neurologists for such. I have an interest in myofascial pain and can see 3 cases of predominantly Quadratus Lumborum spasm daily. If you sit behind a patient side-sitting and grab the back muscle mass, one will find the front edge often three times more tender than the back edge. Further examination will delineate Quadratus lumborum myofascial pain. Much of these co-exists with disc or facet disease but they do help explain the 15% Dr. Bogduk could not determine. Talking about low back pain is like... read full comment
Comment on: Wand et al. BMC Musculoskeletal Disorders, 9:11
Centralization key to this algorithm (M Miglis, 21 August 2007)
The algorithm includes determination as to whether or not centralization is occuring at a key point in responose to Question 2 (Reference: Table 1). Skill in determining the presence or absence of centraliztion has been shown to be sensitive to the level of training of the examiner. That is, examiners with formal training in the McKenzie method have been shown to be more reliable in eliciting the centralization phenomenon than untrained counterparts. Given the fact that many examiners have little or no supervised training in this method, how reliable is a pivotal finding of "no centralization"? Isn't this finding especially critical, since it leads along the decision tree to other forms of assessment (segmental provocaton signs, neurodynamic signs, etc.)when, in fact, a false negative for... read full comment
Comment on: Murphy et al. BMC Musculoskeletal Disorders, 8:75
Cut off (Gyrd Thrane, 09 August 2007)
This study clearly show us that the cut-off at 2,6 for the pectoralis minor length test is inappropriate. Though, I do not understand why it is necessary to calculate sensitivity, specificity and likelihood ratios with this cut-off that is obviously out of the normal values (as provided by Borstad). Table 5 and 6, and the conclusions based on them, is therefore of lesser interest. I wonder if there was done a ROC analysis to check the diagnostic properties? Are other cut-offs more suitable? read full comment
Comment on: Lewis et al. BMC Musculoskeletal Disorders, 8:64
An answer to question about the favorable outcome of group 1 (Ali Montazeri, 18 June 2007)
Tom Shillock raises question that since the scoring of the intervention was done upon completion of the three month intervention, how can the authors be sure that responses were not due to some version of the Hawthorne effect? After all, the attention, information and support may have raised participants' expectations (hope) about reductions in pain and improvement in quality of life that skewed their assessments of their immediate post-intervention improvement? Then, Tom adds wouldn't it be more meaningful to asses them at say six months or 12 months after termination of the intervention?We are grateful to Tom for raising a thoughtful question. However, this is to indicate that data for six and 12 months also were collected. The preliminary analysis showed that the group 1 (Back School... read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21
Thanks for sharing your research findings! (Dorothy D. Zeviar, Ed.D., LAc, 29 March 2007)
Hello,Because in my practice I see many people with chronic low-back pain, including sciatica, I am especially grateful to you for writing up your very interesting research results and posting them for all healthcare practitioners to use. It demonstrates to me that a little education on correct alignment, proper exercises, and walking each day can help people feel more self-empowered to control and even eliminate their back pain. Additionally, I wish to add that "complementary" modalities such as acupuncture and Oriental Medicine are proven very effective in reducing the debilitation of back pain. In my practice, I combine electro-acupuncture, Chinese herbs, Tuina massage, dietary changes and exercise recommendations to reduce the incapacitation of low-back pain. I hope your country... read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21
A question about the favorable outcome of group 1 (Tom Shillock, 29 March 2007)
Since the scoring of the intervention was done upon completion of the three month intervention, how can the authors be sure that responses were not due to some version of the Hawthorne effect? After all, the attention, information and support may have raised participants' expectations (hope) about reductions in pain and improvement in quality of life that skewed their assessments of their immediate post-intervention improvement? Wouldn't it be more meaningful to asses them at say six months or 12 months after termination of the intervention? read full comment
Comment on: Tavafian et al. BMC Musculoskeletal Disorders, 8:21