2024 |
Dinsdale A, Thomas L, Forbes R, Treleaven J, 'Is proprioception affected in those with persistent intra-articular temporomandibular disorders? A cross-sectional study exploring joint position sense and force sense of the jaw.', Musculoskelet Sci Pract, 69 102904 (2024) [C1]
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2023 |
Thomas LC, Seth T, Der A, Ho K, Eide L, Roenaas S, Treleaven J, 'Improving the recognition of cervical arterial dissection in clinical practice: investigation of a five criteria diagnostic support tool', Physiotherapy Theory and Practice, 39 1297-1304 (2023) [C1]
Background: Cervical arterial dissection (CeAD) is a serious condition that can mimic a musculoskeletal condition. A diagnostic tool using five key criteria could help prompt earl... [more]
Background: Cervical arterial dissection (CeAD) is a serious condition that can mimic a musculoskeletal condition. A diagnostic tool using five key criteria could help prompt early medical referral, but these criteria may occur in healthy people or benign neck pain/headache. Objective: To determine the frequency of CeAD criteria in healthy individuals and those with neck pain/headache, and identify refinements needed to improve specificity. Methods: An interview and neurological screen to identify the presence of the five criteria was conducted. Definitions were refined and the frequency of the modified criteria in each individual was determined. The criteria were re-administered using data from 37 CeAD cases of the derivation cohort, to examine how the modifications impact sensitivity of the tool. Results: One hundred healthy and 20 participants with neck pain/headache were interviewed. Most participants had = 2 criteria, mainly age or trauma, 3% had 3 criteria, but had migraine or resolving symptoms. None had >3. Modifications to definitions were needed to improve potential specificity of the tool (96.7%). Changes did not impact sensitivity of the tool (81%). Further refinements may be required. Conclusions: Strictly defined CeAD criteria may assist in identifying when to refer, when to wait and monitor, or when management can proceed. Trialing the tool in those with migraine and in emergency departments to calculate risk scores is recommended.
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2023 |
Dinsdale A, Thomas L, Forbes R, Treleaven J, 'Do intra-articular temporomandibular disorders show an association between physical bite function, self-perceived bite limitation and kinesiophobia? A case-control study', Musculoskeletal Science and Practice, 65 (2023) [C1]
Background: Little is known about the impact of intra-articular temporomandibular disorders (TMDs) on bite function, or how bite impairments in this subgroup relate to self-percei... [more]
Background: Little is known about the impact of intra-articular temporomandibular disorders (TMDs) on bite function, or how bite impairments in this subgroup relate to self-perceived bite limitation or kinesiophobia. This presents a challenge to practitioners involved in delivering care. Objectives: To determine what bite impairments are associated with intra-articular TMDs, and explore how these impairments relate to self-perceived bite limitations and kinesiophobia. Design: Observational, case-control study. Method: Sixty participants (n = 30 intra-articular TMDs, n = 30 healthy controls) were recruited via convenience sampling. Bite function was explored using pain-free bite force and bite endurance/steadiness (submaximal bite hold) measures. Self-perceived bite function and kinesiophobia were evaluated via the Patient specific functional scale (PSFS) and the Tampa Scale for kinesiophobia of Temporomandibular disorders (TSK-TMD) respectively. Between-group data were compared and associations between physical bite impairments, self-perceived bite limitation and kinesiophobia were explored in the intra-articular TMD group. Results: Pain-free bite force was significantly impaired in the intra-articular TMD group (-108N, p < 0.01, d = 0.9), and this impairment demonstrated moderate association with degree of kinesiophobia (p < 0.01, r = -0.4). No significant between-group difference was observed for bite endurance or force steadiness (p > 0.05). No association was observed between pain-free bite force and self-perceived bite limitation, or self-perceived bite limitation and kinesiophobia (p > 0.05). Conclusions: Impaired pain-free bite force appears to be an important feature of intra-articular TMDs which should be considered within management. Kinesiophobia may be important to consider when assessing bite function in this subgroup. Future research is needed to guide optimal interventions and inform subsequent management guidelines.
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2023 |
Hammerle MH, Lu LH, Thomas LC, Swan AA, Hoppes CW, Nelson JT, Treleaven JM, 'Possible autonomic or cranial nerve symptoms triggered during sustained neck rotation in persistent headache post-concussion: a retrospective observational cross-sectional study', Journal of Manual and Manipulative Therapy, 31 113-123 (2023) [C1]
Objectives: To examine and categorize symptoms occurring within 60¿s of vertebrobasilar-insufficiency (VBI) testing (left- and right-neck rotation) in individuals with persistent ... [more]
Objectives: To examine and categorize symptoms occurring within 60¿s of vertebrobasilar-insufficiency (VBI) testing (left- and right-neck rotation) in individuals with persistent post-traumatic headache. Background: As part of routine clinical cervical screening in our patients, we found extended VBI testing often triggered additional symptoms. Therefore, we aimed to document the prevalence and precise symptoms occurring during each movement direction of this test and determine any demographic or baseline signs or symptoms associated with a positive test. Methods: A retrospective medical record review on military personnel receiving treatment for persistent post-traumatic headache was performed. Participants were grouped according to presence of non-headache related symptoms triggered during the tests. Frequency, onset, and symptom characteristics reported were categorized as potentially vascular and/or possible autonomic or cranial nerve in nature Results: At least one symptom was reported by 81.3% of 123 patients. Of these, 54% reported symptoms in one and 46% in both directions of rotation, yielding 146 abnormal tests. Most reported symptoms were tear disruption (41%), altered ocular-motor-control (25%), and blepharospasm (16%). Enlisted individuals and those with altered baseline facial sensation were more likely to have a positive test. Conclusions: The majority reported symptoms not typical of VBI within 60¿seconds of sustained neck rotation. Further study is needed to better understand the mechanisms and clinical relevance.
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2023 |
Xie Y, Thomas L, Johnston V, Coombes BK, 'Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability', Journal of Electromyography and Kinesiology, 69 (2023) [C1]
Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cer... [more]
Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.
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2023 |
Russek LN, Block NP, Byrne E, Chalela S, Chan C, Comerford M, et al., 'Presentation and physical therapy management of upper cervical instability in patients with symptomatic generalized joint hypermobility: International expert consensus recommendations', FRONTIERS IN MEDICINE, 9 (2023) [C1]
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2023 |
Hammerle MH, Thomas LC, Swan AA, Lu LH, Treleaven JM, 'Sub-occipital muscle pressure pain thresholds correlate to direction of symptomatic active comfortable sustained neck rotation testing in post-concussive headache: a retrospective observational cross-sectional study', Journal of Manual and Manipulative Therapy, 31 124-129 (2023) [C1]
Objectives: To compare sub-occipital muscle pressure sub pain thresholds (PPTs) in individuals with persistent-post-traumatic-headache (PPTH) in relation to the presence or not of... [more]
Objectives: To compare sub-occipital muscle pressure sub pain thresholds (PPTs) in individuals with persistent-post-traumatic-headache (PPTH) in relation to the presence or not of cranial nerve and/or autonomic symptoms reported during sustained neck rotation (SNR). Background: Previously 81% of military service members with PPTH demonstrated symptoms with SNR up to 60 seconds. Of these, 54% reported symptoms in one (Uni-Symp) and 46% in both directions of rotation (Bi-Symp). Sub-occipital PPTs, in relation to SNR direction, were of interest. Methods: Retrospective review of records of 77 individuals, with PPTH with both SNR and PPTs. Average suboccipital and scalene PPTs were compared between Asymptomatic (n = 13), upon SNR testing, or Symptomatic (Uni-Symp, n = 32, Bi-Symp, n = 32), groups. Results: The Bi-Symp group had significantly reduced sub-occipital PPTs relative to the Asymptomatic group on both sides [p < 0.009] with no side-to-side differences in either group. The Uni-Symp group had significantly lower sub-occipital PPTs on the symptomatic SNR test direction compared to the asymptomatic side [t(31) = 3.37, p = 0.002]. There were no differences within or between groups in the scalene PPTs(p¿s > 0.08). Conclusions: An upper cervical mechanical trigger of symptoms during SNR tests in some individuals with PPTH is possible. The direction of symptomatic SNR tests may indicate direction of guarded hypermobile dysfunction and direct treatment.
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2023 |
Treleaven J, Thomas L, Jull G, Liang Z, 'Letter to the Editor', CLINICAL REHABILITATION, 37 1717-1718 (2023)
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2023 |
Treleaven J, Thomas L, Jull G, Liang Z, 'Letter to the Editor', CLINICAL REHABILITATION, 37 1717-1718 (2023)
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2023 |
Liang Z, Thomas L, Jull G, Treleaven J, 'Subgrouping individuals with migraine associated neck pain for targeted management', Musculoskeletal Science and Practice, 66 (2023) [C1]
Introduction: Neck pain is one of the most common and burdensome symptoms associated with migraine. Many individuals with migraine and neck pain seek neck treatment, but evidence ... [more]
Introduction: Neck pain is one of the most common and burdensome symptoms associated with migraine. Many individuals with migraine and neck pain seek neck treatment, but evidence for such treatment is limited. Most studies have treated this population as a homogenous group, providing uniform cervical interventions that have yet to show clinically important effects. However, different neurophysiological and musculoskeletal mechanisms can underlie neck pain in migraine. Targeting treatment to specific underlying mechanisms may therefore be the key to improving treatment outcomes. Our research characterised neck pain mechanisms and identified subgroups based on cervical musculoskeletal function and cervical hypersensitivity. This suggests that specific management aimed towards addressing mechanisms relevant to each subgroup might be beneficial. Purpose: This paper explains our research approach and findings to date. Potential management strategies for the identified subgroups and future research directions are discussed. Implications: Clinicians should perform skilled physical examination with the aim of identifying if patterns of cervical musculoskeletal dysfunction and or hypersensitivity are present in the individual patient. There is currently no research into treatments differentiated for subgroups to address specific underlying mechanisms. It is possible that neck treatments addressing musculoskeletal impairments may be most beneficial for those subgroups where neck pain is primarily due to musculoskeletal dysfunction. Future research should define treatment aims and select specific subgroups for targeted management to determine which treatments are most effective for each subgroup. Trial registration: Not applicable.
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2023 |
Schulz M, Xu W, Treleaven J, Thomas L, Liang Z, 'Individual perceptions on the relationship between migraine and neck pain', Musculoskeletal Science and Practice, 66 (2023) [C1]
Background: Despite neck pain being a common complaint for people with migraine, little is known about how individuals perceive the relationship between their migraine and neck pa... [more]
Background: Despite neck pain being a common complaint for people with migraine, little is known about how individuals perceive the relationship between their migraine and neck pain. Exploring their beliefs and perceptions could provide valuable understanding to improve overall management and reduce the burden of migraine and neck pain. Objectives: To investigate individual perspectives on how migraine and neck pain relate. Methods: A retrospective qualitative study was performed. Seventy participants (mean age 39.2, 60 female) were recruited via community and social media advertisements, and interviewed by an experienced physiotherapist using a semi-structured interview framework. An Inductive thematic analysis was used to analyse the responses. Results: Five themes were identified from the interviews: (i) the timing of neck pain and migraine, (ii) causality beliefs, (iii) burden of neck pain and migraine, (iv) experiences with treatment and (v) mismatched perspectives. Diverse views emerged, revealing links between the first two themes of timing and causality, showing increased burden in those suffering from both neck pain and migraine, and providing insights into apparently ineffective or even aggravating treatments. Conclusions: Valuable insights for clinicians emerged. Due to the complex relationship, clinicians should discuss the aetiology of neck pain in migraine with patients. For some individuals, neck treatment may not produce long-term relief and may even aggravate migraine, but the value of short-term relief in a chronic condition must be considered individually. Clinicians are ideally placed to have discussions with patients individually to tailor individual decisions about management.
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2023 |
Cummins D, Rivett DA, Thomas LC, Osmotherly PG, 'Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization may help identify cervicogenic headaches: a case-control study', JOURNAL OF MANUAL & MANIPULATIVE THERAPY, 31 198-205 (2023) [C1]
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Nova |
2023 |
Thomas LC, Holliday E, Attia JR, Levi C, 'Development of a diagnostic support tool for predicting cervical arterial dissection in primary care.', J Man Manip Ther, 1-9 (2023) [C1]
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2022 |
Liang Z, Thomas L, Jull G, Treleaven J, 'The Neck Disability Index Reflects Allodynia and Headache Disability but Not Cervical Musculoskeletal Dysfunction in Migraine', PHYSICAL THERAPY, 102 (2022) [C1]
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2022 |
Xie Y, Coombes BK, Thomas L, Johnston V, 'Time Course and Risk Profile of Work-Related Neck Disability: A Longitudinal Latent Class Growth Analysis', PHYSICAL THERAPY, 102 (2022) [C1]
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2022 |
Liang Z, Thomas L, Jull G, Treleaven J, 'The temporal behaviour of migraine related neck pain does not inform on the origin of neck pain: An observational study', Musculoskeletal Science and Practice, 58 (2022) [C1]
Background: Clinicians seek to identify associations between pain behaviours to understand if symptoms are related or separate conditions. This study determined whether the tempor... [more]
Background: Clinicians seek to identify associations between pain behaviours to understand if symptoms are related or separate conditions. This study determined whether the temporal behaviour of migraine related neck pain related to i) the presence of cervical musculoskeletal function or ii) migraine hypersensitivity. Methods: Cross-sectional study of migraineurs with neck pain (n = 110). Participants reported daily for one month via an online survey, on migraine and other headaches, neck symptoms, location of onset and self-identified triggers. Allodynia Symptom Checklist (ASC12), Pressure pain thresholds (PPTs), and presence or absence of cervical musculoskeletal dysfunction were also assessed. Results: The temporal behaviours of neck pain in 92 participants (46 migraine only, 46 migraine plus another headache) were categorised as: i) ictal only (n = 42), ii) ictal and infrequent interictal (n = 26), iii) ictal and frequent interictal (n = 17), and iv) undecipherable (n = 7). Cervical musculoskeletal dysfunction was present in 43%. Temporal behaviours of neck pain were not associated with cervical musculoskeletal dysfunction (p = 1.00 and 0.21), nor related to ASC12, PPTs, headache triggers, neck pain, nor region of symptom onset, whether migraine only or migraine and another headache was reported (p = 0.29 to 0.97). Conclusion: Individuals with migraine present with varied behaviours of neck pain in relation to the headache. As temporal behaviour is not informative, a physical examination is needed to negate or confirm a cervical source of neck pain in migraine.
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2021 |
Dinsdale A, Forbes R, Thomas L, Treleaven J, 'The management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders: A qualitative study', JOURNAL OF ORAL REHABILITATION, 49 10-21 (2021) [C1]
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2021 |
Dinsdale A, Liang Z, Thomas L, Treleaven J, 'Is jaw muscle activity impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis', JOURNAL OF ORAL REHABILITATION, 48 487-516 (2021) [C1]
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2021 |
Dinsdale A, Forbes R, Thomas L, Treleaven J, ' What if it doesn't unlock? : A qualitative study into the lived experiences of adults with persistent intra-articular temporomandibular disorders', Musculoskeletal Science and Practice, 54 (2021) [C1]
Background: Temporomandibular disorders (TMD) are associated with increased self-reported disability and psychosocial issues, although little is known about those who specifically... [more]
Background: Temporomandibular disorders (TMD) are associated with increased self-reported disability and psychosocial issues, although little is known about those who specifically experience mechanical signs and symptoms such as clicking and locking. Understanding the lived experiences of individuals with persistent intra-articular TMD is an important first step to gaining insight into specific domains of self-reported disability associated with these conditions. This information can be helpful to improve clinical management of this subgroup. Objectives: To explore the lived experiences of adults with persistent intra-articular TMD, including its impact on activity, participation and psychological wellbeing, and the influence of contextual factors on disability. Design: Qualitative study. Methods: Semi-structured interviews explored the lived experiences of adults with persistent intra-articular TMD, and data were analysed using thematic analysis. Participants were recruited via convenience sampling from private physiotherapy and dental practices, and the community. Results: Sixteen participants were interviewed. Four themes emerged from the data: i) The challenge of living with intra-articular TMD, ii) Living with uncertainty, iii) Seeking control, and iv) Learning to live with it. Novel findings included the impact of persistent intra-articular TMD on dreams, work, intimacy and socialising; and the role of non-pain symptoms (e.g. locking) in disability. Conclusions: Persistent intra-articular TMD are associated with numerous activity limitations, participation restrictions and psychological issues. Disability is complex and multi-directional, and influenced by various contextual factors including individuals¿ thoughts, beliefs and support networks. These findings emphasise the need for biopsychosocial and person-centred care in clinical practice.
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2021 |
Liang Z, Thomas L, Jull G, Minto J, Zareie H, Treleaven J, 'Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction', HEADACHE, 61 882-894 (2021) [C1]
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2021 |
Xie Y, Thomas L, Barbero M, Falla D, Johnston V, Coombes BK, 'Heightened pain facilitation rather than impaired pain inhibition distinguishes those with moderate/ severe disability in work-related neck pain', Pain, 162 2225-2236 (2021) [C1]
To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with vari... [more]
To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI # 8%, n 5 31, reference group), mild (NDI 5 10%-20%, n 5 43), or moderate/severe (NDI $ 22%, n 5 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that individuals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
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2021 |
Alhusuny A, Cook M, Khalil A, Thomas L, Johnston V, 'Characteristics of headaches among surgeons and associated factors: A cross-sectional study', SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, 19 E79-E87 (2021) [C1]
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2021 |
Liang Z, Thomas L, Jull G, Treleaven J, 'Cervical musculoskeletal impairments in migraine', ARCHIVES OF PHYSIOTHERAPY, 11 (2021)
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2020 |
Xie Y, Coombes BK, Thomas L, Johnston V, 'Musculoskeletal Pain and Disability in Sonographers: More Than an Ergonomic Issue', JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 33 1526-1527 (2020)
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2020 |
Xie Y, Jun D, Thomas L, Coombes BK, Johnston V, 'Comparing Central Pain Processing in Individuals With Non-Traumatic Neck Pain and Healthy Individuals: A Systematic Review and Meta-Analysis', Journal of Pain, 21 1101-1124 (2020) [C1]
This systematic review and meta-analysis examined the evidence for altered central pain processing in people with nontraumatic neck pain and the relationship among central pain pr... [more]
This systematic review and meta-analysis examined the evidence for altered central pain processing in people with nontraumatic neck pain and the relationship among central pain processing, demographics, and pain-related characteristics. Case-control studies reporting measures of altered central pain processing using quantitative sensory testing were reviewed. Standardized mean differences (SMDs) and 95% confidence intervals between people with nontraumatic neck pain and controls were calculated. Meta-analysis was performed using random-effects models when appropriate. Associations between SMDs with demographics and pain-related characteristics were explored on a study level using metaregression. Twenty-six studies were eligible with 25 included for meta-analysis. Meta-analysis demonstrated mechanical hyperalgesia at remote nonpainful sites in the full sample (sample size [n] = 1305, SMD = -0.68) and in the subgroup with moderate/severe disability (n = 165, SMD = -0.86; moderate-quality evidence). Metaregression indicated that remote mechanical hyperalgesia was negatively associated with age (R2 = 25.4%, P = 0.031). Very low- to low-quality evidence of remote cold and heat hyperalgesia and dysfunctional conditioned pain modulation were identified. This review suggests that altered central pain processing is present in people with nontraumatic neck pain and may be associated with disability levels and age. Perspective: This review found moderate-quality evidence of mechanical hyperalgesia at remote nonpainful sites in patients with nontraumatic neck pain compared with controls, indicating altered central pain processing. However, more studies are needed to confirm findings from dynamic quantitative sensory testing.
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2020 |
Thomas L, Treleaven J, 'Should we abandon positional testing for vertebrobasilar insufficiency?', Musculoskeletal Science and Practice, 46 (2020) [C1]
Positional testing for vertebrobasilar insufficiency (VBI) is used by physiotherapists as part of pre-manipulative screening protocols. Recently, the validity of the tests have be... [more]
Positional testing for vertebrobasilar insufficiency (VBI) is used by physiotherapists as part of pre-manipulative screening protocols. Recently, the validity of the tests have been questioned because a negative test does not infer safety with cervical manipulative therapy but the reasoning surrounding this opinion may be questioned. While the positional tests were developed to test vertebral artery flow contralateral to the direction of head movement and the subsequent effect on cerebral blood supply, as inferred by symptom reproduction, ultrasound studies have shown that vertebral artery flow is inherently variable. Rather, the tests should be considered as testing for adequacy of collateral flow in particular head positions rather than decreased blood flow in a particular artery, with more attention to characteristics of symptom reproduction. We contend that positional testing for VBI remains valuable for testing adequacy of collateral flow, and also has an important place as part of the differential diagnosis of individuals with dizziness or imbalance. The physiotherapist's ability to differentially diagnose dizziness and recognise the presence or not of VBI is not only critical for prompt medical investigation and management because it is a risk factor for transient ischaemic events and stroke, but has important influences over management decisions regarding cervical musculoskeletal treatment including exercise interventions. Importantly, the positional tests should not be considered as tests of arterial integrity and used to assess the risk of damage to the vertebral or internal carotid artery or presence of cervical arterial dissection. Urgent research is needed before we abandon positional testing prematurely.
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2020 |
Avijgan M, Thomas LC, Osmotherly PG, Bolton PS, 'A Systematic Review of the Diagnostic Criteria Used to Select Participants in Randomised Controlled Trials of Interventions Used to Treat Cervicogenic Headache', Headache, 60 15-27 (2020) [C1]
Objective: The aim of this study was to determine the diagnostic criteria used in randomized controlled trials to define trial participants as having cervicogenic headache (CeH). ... [more]
Objective: The aim of this study was to determine the diagnostic criteria used in randomized controlled trials to define trial participants as having cervicogenic headache (CeH). Background: While animal and human studies suggest a biological basis for ¿cervicogenic¿ headaches the diagnostic criteria necessary to evidence CeH are debated. Methods: A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of MEDLINE, Cochrane, CINHAL, Pedro, AMED, and EMBASE online databases of randomized controlled trials published between January 1983 and October 2018 found 39 randomized controlled trials which met the study inclusion criteria. Results: Two independent reviewers found most trials cited 1 (31/39; 79.5%) or more (3/39; 7.6%) references to define the criteria used to identify CeH in their study participants. In spite of updated publications concerning the characteristics and definition of CeH, many (27/39; 69.2%) used diagnostic criteria published between 5 and 24¿years prior to the randomized controlled trial. The most commonly cited diagnostic criteria included unilateral headache (18/39; 46.2%), cervical movement or sustained posture that either provoked (18/39; 46.2%) or precipitated (17/39; 43.6%) the headache. Fifteen trials did not exclude participants with signs or symptoms of other forms of headache. Although anesthetic blockade of cervical tissue or nerves is considered necessary for a ¿definitive¿ diagnosis, only 7.6% (3/39) of trials used anesthetic blockade at recruitment. Conclusions: This systematic review evidences the heterogeneity in the clinical characteristics used to diagnose CeH in participants recruited in randomized controlled trials. It raises a significant concern about the usefulness of currently available randomized controlled trials to determine the clinical merits of the treatment and management of people with CeHs. Our systematic review suggests that most randomized controlled trials published to date have investigated headaches with a clinical presentation involving the neck that maybe better defined as ¿possible,¿ ¿probable,¿ or ¿definitive¿ CeH depending on how well the diagnostic criteria used align with the most recent edition (3rd) of the International Classification of Headache Disorders.
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Nova |
2020 |
Thomas LC, Chan K, Durbridge G, 'Changes in internal carotid and vertebral arterial wall stiffness with head movement can be detected with shear wave elastography', Journal of Manual and Manipulative Therapy, 28 103-110 (2020) [C1]
Background: Safe practice is important for patients with neck pain, with the potential for injury to cervical arteries. Cervical manipulation or end range techniques/positions may... [more]
Background: Safe practice is important for patients with neck pain, with the potential for injury to cervical arteries. Cervical manipulation or end range techniques/positions may place considerable strain on the arteries. Altered integrity of the arterial wall may render them more susceptible to minor trauma, particularly in the upper cervical region. Screening of blood flow velocity is limited for predicting those at risk. Examining properties of the cervical arterial wall (stiffness characteristics) and their response to head movement may provide an alternate measure of arterial susceptibility. Objectives: To investigate whether shear wave ultrasound elastography can detect any changes in internal carotid (ICA) and vertebral (VA) arterial wall stiffness in neutral compared with contralateral head rotation. Design: Observational study Methods: Shear wave ultrasound elastography was used to measure the stiffness of the ICA and VA. Shear wave velocity (m/s), indicative of arterial stiffness, was measured in both arteries proximally (C3¿4) and distally (C1¿2) in neutral and contralateral head rotation as were intimal thickness (mm) and flow velocity (cm/s). Results: Thirty participants (20¿62 years) were successfully imaged. The VA was stiffer than ICA and it became significantly stiffer in contralateral rotation (p = 0.05). The ICA became significantly less stiff (p = 0.01). Effects were more apparent at C1¿2 but significant in the ICA only (p = 0.03). Flow velocity and intimal thickness were unchanged in rotation. Conclusions: Changes in VA and ICA arterial wall stiffness can be measured with shear wave ultrasound elastography. This measure may ultimately help identify arteries with greater vulnerability to rotational stresses.
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2020 |
Thomas LC, Treleaven J, 'Response to the letter to the editor regarding the continued use of the vertebrobasilar insufficiency test', Musculoskeletal Science and Practice, 45 (2020)
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2020 |
Dinsdale A, Liang Z, Thomas L, Treleaven J, 'Are jaw range of motion, muscle function and proprioception impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis', JOURNAL OF ORAL REHABILITATION, 47 1448-1478 (2020) [C1]
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2019 |
Xie Y, Thomas L, Hug F, Johnston V, Coombes BK, 'Quantifying cervical and axioscapular muscle stiffness using shear wave elastography', Journal of Electromyography and Kinesiology, 48 94-102 (2019) [C1]
This study aimed to assess intra-rater (intra-session and inter-day) reliability and influence of side dominance and the scapular resting position on the shear modulus (an index o... [more]
This study aimed to assess intra-rater (intra-session and inter-day) reliability and influence of side dominance and the scapular resting position on the shear modulus (an index of stiffness) of resting cervical and axioscapular muscles. Sixteen healthy participants were recruited. On day one, ultrasound shear wave elastography was used to measure the shear modulus of superficial and deep cervical extensor and axioscapular muscles bilaterally. Clinical assessments of scapular resting position were performed bilaterally. On day two, testing was repeated on the dominant side. Both intra-session and inter-day reliability were good to excellent for shear modulus of superficial muscles, and poor to excellent for deep muscles. Side differences of shear modulus for posterior upper trapezius were statistically significant but clinically irrelevant. The shear modulus of posterior upper trapezius and middle trapezius were significantly correlated with scapular depression. Ultrasound shear wave elastography is a reliable tool for quantitatively assessing stiffness of superficial cervical and axioscapular muscles. The influence of scapular position should be considered in future comparative studies of healthy controls and patients with neck/shoulder pain. This study provides the necessary first step for future studies on assessing and interpreting the stiffness of cervical and axioscapular muscles for neck and shoulder musculoskeletal disorders.
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2019 |
Liang Z, Galea O, Thomas L, Jull G, Treleaven J, 'Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis', Musculoskeletal Science and Practice, 42 67-83 (2019) [C1]
Aims: Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches. Metho... [more]
Aims: Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches. Methods: Databases PubMed (Medline), EMBASE, CINAHL, SCOPUS, and Web of Science were searched from inception to December 2018. Observational studies using a comparator group were included. Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Results were pooled using random effects meta-analysis. Level of evidence for each outcome was assigned based on risk of bias, consistency of results and magnitude of difference between participants with headache and controls. (PROSPERO registration: CRD42018083683). Results: Of 48 studies included, the majority were rated moderate risk of bias due to possible confounding influences. In total, 17 cervical outcomes were assessed, with confidence in findings ranging from very low to moderate levels. Compared to controls, participants with TTH had greater forward head posture (FHP) (MD = -6.18°, 95% CI [-8.18°, -4.18°]) and less cervical range of motion (ROM) (greatest difference transverse plane MD = -15.0°, 95% CI [-27.7°, -2.3°]. Participants with migraine demonstrated minimally reduced cervical ROM (greatest difference sagittal plane MD = -5.4°, 95% CI [-9.9°, -0.9°]. No differences presented in head posture, strength, craniocervical flexion test performance or joint position error between migraineurs and controls. Conclusions: TTH presented with more findings of cervical musculoskeletal impairments than migraine however levels of confidence in findings were low. Future studies should differentiate episodic from chronic headache, identify coexisting musculoskeletal cervical disorders, and describe neck pain behaviour in headache.
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2019 |
Thomas L, Allen M, Shirley D, Rivett D, 'Australian musculoskeletal physiotherapist's perceptions, attitudes and opinions towards pre-manipulative screening of the cervical spine prior to manual therapy: Report from the focus groups.', Musculoskeletal science & practice, 39 123-129 (2019) [C1]
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Nova |
2019 |
Thomas L, Low J, Chan K, Durbridge G, 'Shear wave elastography of the cervical arteries: A novel approach to the assessment of cervical arterial wall stiffness. An investigation of psychometric properties and intra-rater reliability', MUSCULOSKELETAL SCIENCE AND PRACTICE, 40 96-100 (2019) [C1]
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2018 |
Daly L, Giffard P, Thomas L, Treleaven J, 'Validity of clinical measures of smooth pursuit eye movement control in patients with idiopathic neck pain', Musculoskeletal Science and Practice, 33 18-23 (2018) [C1]
Background Electrooculography is useful in detecting smooth pursuit neck torsion (SPNT) abnormalities in patients with neck pain, however, a validated, clinically relevant measure... [more]
Background Electrooculography is useful in detecting smooth pursuit neck torsion (SPNT) abnormalities in patients with neck pain, however, a validated, clinically relevant measure is lacking. Objectives To explore the validity of visual assessment of formal and clinical videotaped SPNT tests in comparison to electrooculography. Design Cross-sectional observational study. Method Twenty patients with idiopathic neck pain (INP) and twenty healthy controls performed the electrooculography SPNT test: first in neutral, then 45° trunk-under-head torsion to the left then right. The formal video test involved the participant following a horizontal laser stimulus simultaneous to electrooculography. The clinical video test was then performed where the participant followed the clinician's finger in the horizontal direction. One blinded investigator interpreted and analysed the electrooculography trace and two others interpreted the videos. Results Patients with INP had a significantly (p < 0.05) greater SPNT difference than healthy controls. Visual observation of the formal test had 82.5% agreement with electrooculography and showed fair sensitivity (63.5%) and good specificity (89.6) whilst the clinical test had 65% agreement with electrooculography and showed poor sensitivity (27.3%) and good specificity (79.3%). There was an 82.5% agreement between investigators for the formal video taped measure. Conclusions Visual analysis of assessment of SPNT is sufficient for detecting SPNT abnormalities in patients with INP. Accuracy of the clinical method could be improved by, altering how the visual stimulus is presented and including subjective reporting of symptoms to aid diagnosis resulting in implications for future research.
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2017 |
Thomas LC, Hall LA, Attia JR, Holliday EG, Markus HS, Levi CR, 'Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites', Journal of Stroke and Cerebrovascular Diseases, 26 177-185 (2017) [C1]
Background Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence... [more]
Background Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors. Methods This was a retrospective observational study of patients older than 18 years with radiological diagnosis of internal carotid or vertebral arterial dissection, from sites in Australia and the UK. Clinical variables were compared between autumn-winter and spring-summer and site of dissection. Results A total of 133 CAD cases were documented in Australia and 242 in the UK. There was a seasonal pattern to CAD incidence in countries in both the northern and the southern hemispheres, with a trend for dissection to occur more commonly in autumn, winter, and spring than in summer (incidence rate ratios [IRR] 1.4-1.5, P¿<¿.05). CAD counts were also slightly higher in internal carotid than in vertebral artery (IRRs 1.168, 1.43, and 1.127, respectively). Neither systolic blood pressure nor pulse pressure was significantly associated with CAD counts. Conclusions CAD occurs more commonly in cooler months regardless of geographical location, suggesting transient seasonal causes may be important in the pathophysiology. This effect was slightly higher in internal carotid than in vertebral artery, suggesting differing trigger mechanisms between dissection sites.
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2016 |
Thomas LC, 'Cervical arterial dissection: An overview and implications for manipulative therapy practice', Manual Therapy, 21 2-9 (2016) [C1]
Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection.... [more]
Introduction: Cervical arterial dissection (CAD) is a common cause of stroke in young people under 55 years. It can occur spontaneously or subsequent to minor trauma or infection. The incidence is difficult to determine accurately as not all CAD progress to stroke. CAD is the most catastrophic adverse event associated with cervical manipulative therapy but it is rare. Early features of CAD can mimic a painful musculoskeletal presentation and a patient may present for treatment of neck pain and headache with a dissection in progress. Whether the manipulative technique is responsible for dissection or whether the diagnosis of CAD has been missed is unclear. Identification of individuals at risk, or early recognition of CAD could help expedite medical intervention and avoid inappropriate treatment. Purpose: The aims of this masterclass are to outline current research into the pathophysiology, aetiology and clinical presentation of CAD, to place the risk in context in a manipulative therapy setting and to discuss its possible clinical recognition. Implications: For those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk of dissection. Clinicians should also be alert to reports of transient neurological dysfunction such as visual disturbance and balance deficits, arm paraesthesia and speech deficits, as these may be subtle. If clinicians suspect arterial dissection is in progress patients should be urgently referred for medical evaluation.
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Nova |
2015 |
Thomas L, McLeod L, Osmotherly PG, Rivett DA, 'The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study', Manual Therapy, 20 475-480 (2015) [C1]
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Nova |
2015 |
Thomas LC, Rivett DA, Attia JR, Levi C, 'Risk factors and clinical presentation of cervical arterial dissection: Preliminary results of a prospective case-control study', Journal of Orthopaedic and Sports Physical Therapy, 45 503-511 (2015) [C1]
STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors and clinical presentation of individuals with cervical arterial dissection. BACKGROUND: Cerv... [more]
STUDY DESIGN: Cross-sectional case-control study. OBJECTIVES: To identify risk factors and clinical presentation of individuals with cervical arterial dissection. BACKGROUND: Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment. METHODS: Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken. RESULTS: Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection. CONCLUSION: Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.
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2014 |
Thomas LC, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2014) [C1]
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Nova |
2013 |
Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR, 'Effect of Selected Manual Therapy Interventions for Mechanical Neck Pain on Vertebral and Internal Carotid Arterial Blood Flow and Cerebral Inflow', PHYSICAL THERAPY, 93 1563-1574 (2013) [C1]
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Nova |
2012 |
Thomas L, Rivett DA, Parsons M, Levi C, 'Risk factors, radiological features and infarct topography of craniocervical arterial dissection.', International Journal of Stroke, 9 1073-1082 (2012)
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2012 |
Thomas L, Rivett DA, Attia JR, Levi CR, 'Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study', BMC Musculoskeletal Disorders, 13 1-6 (2012) [C3]
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2011 |
Thomas L, Rivett DA, Attia JR, Parsons MW, Levi CR, 'Risk factors and clinical features of craniocervical arterial dissection', Manual Therapy, 16 351-356 (2011) [C1]
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Nova |
2009 |
Thomas L, Rivett DA, Bolton PS, 'Validity of the Doppler velocimeter in examination of vertebral artery blood flow and its use in pre-manipulative screening of the neck', Manual Therapy, 14 544-549 (2009) [C1]
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Nova |
2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor', Manual Therapy, 14 E7-E8 (2009) [C3]
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Nova |
2009 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letter to the editor by Karl et al. Manual Therapy 2009;14(6):e17', Manual Therapy, 14 E18 (2009) [C3]
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Nova |
2008 |
Thomas L, Rivett DA, Bolton PS, 'Pre-manipulative testing and the use of the velocimeter', Manual Therapy, 13 29-36 (2008) [C1]
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Nova |
2008 |
Thomas L, Rivett DA, Bolton PS, 'Comments in response to letters to editor regarding article: Thomas LC, et al. Premanipulative testing and the velocimeter. Manual Therapy (2007)', Manual Therapy, 13 E5-E6 (2008) [C3]
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Nova |
2007 |
Cretikos M, Eastwood K, Durrheim D, 'LETTER TO THE EDITOR', COMMUNICABLE DISEASES INTELLIGENCE, 31 419-419 (2007)
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2005 |
Rivett DA, Thomas L, Bolton PS, 'Pre-manipulative testing: where do we go from here?', New Zealand Journal of Physiotherapy, 33 78-84 (2005) [C1]
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Nova |