how to implement strategies to reduce hand pain

Excerpt from Australian Physiotherapy Association Conference 2015 Abstract E-book available at http://www.physiotherapy.asn.au/DocumentsFolder/CONFERENCE2015/APA%202015%20Abstracts%20Final.pdf Conference location Gold Coast, QLD, Australia. Dates 3-6 October 2015

HOW TO IMPLEMENT STRATEGIES TO REDUCE HAND PAIN DURING MANUAL THERAPY TECHNIQUES Evans K1, 2, Tuttle N1, 2 School of Allied Health Sciences, Griffith University Menzies Health Institute Queensland

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Background: A large number of physiotherapists develop pain in their thumbs or hands particularly associated with manual therapy assessment and treatment. Aims / objectives: The aim of the session is to provide participants with strategies to reduce or prevent these symptoms. By the end of the session, the participants will 1) have strategies to reduce the force applied during assessment and treatment techniques and 2) perform one technique in a variety of ways to make it more suitable for individual therapists or patients. Approach: Evidence will be presented for how less force than the average values reported in the literature can be effective in assessment and treatment of the cervical spine and that when therapists undergo training to become more precise in their techniques that the force employed can be reduced. A technique can be considered as a means to achieve an intention such as producing a particular movement or effect. The standard form of a technique including aspects such as hand position and posture provide a starting point for each technique. From that starting point, using one technique, participants will perform and modify that standard form in a variety of ways to suit their own (or their student’s or patients) particularities to best achieve the intention with the minimum strain on their hands and thumbs. Conclusion / Key Practice Points: Participants will have strategies to • Modify techniques to achieve their intention with less load on their hands • Reduce the force applied during techniques while potentially increasing their effectiveness.

CERVICAL MENISCOID MORPHOLOGY IN WHIPLASH ASSOCIATED DISORDER: A PRELIMINARY COMPARATIVE ANALYSIS Farrell SF1, Osmotherly PG1, Cornwall J2, Lau P3, Rivett DA1 1 Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Newcastle 2 Departments of Anatomy and Physiology, and Faculty of Law, University of Otago, Dunedin, New Zealand 3 Hunter New England Imaging and Department of Clinical Research and Pain Management, Newcastle

Question: This study investigated the size and composition of cervical meniscoids in people experiencing chronic whiplash associated disorder (WAD). Design: Comparative observational study. Participants: Seven volunteers (three female; mean age 40.7 years, SD 15.3 years) with grade II WAD lasting more than three months; seven age/ gender matched pain-free controls. Outcome Measures: Participants underwent cervical spine magnetic resonance imaging. Each lateral atlantoaxial and zygapophyseal joint (C1/2-C6/7) was inspected for meniscoids. Meniscoid anterior-posterior length was measured and composition (adipose/fibrous/fibroadipose) inferred based upon signal intensities. Data were analysed using contingency tables and Wilcoxon signed-rank tests (p ≤ 0.05). Results: Meniscoids were identified in the WAD (n = 112) and control (n = 90) groups. At the lateral atlantoaxial joints, median meniscoid length was greater in the control group (6.8 mm) than WAD group (5.7 mm; p = 0.014). There was a greater proportion of fibrous meniscoids in the WAD group, whereas the control group had a greater proportion of fibroadipose meniscoids (Fisher’s exact < 0.001). Conclusion: Cervical meniscoids may be affected by a fibrotic process following WAD, which may contribute to the chronicity of this condition. Key Practice Points: • Cervical meniscoids are thought to contribute to pain in WAD, however pathoanatomical changes in these structures have not been previously investigated. • Meniscoids in people following WAD appear more frequently composed of fibrous tissue, whereas in their age-matched counterparts meniscoids appear more frequently fibroadipose in composition. • A possible fibrotic process of cervical meniscoids may contribute to the clinical presentation of chronic WAD.

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VISUALISATION OF INTRA-ARTICULAR SPINAL MENISCOIDS USING E12 SHEET PLASTINATION – A TOOL FOR PHYSIOTHERAPY CLINICAL ANATOMY EDUCATION Farrell SF1, Osmotherly PG1, Rivett DA1, Cornwall J2 1 Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Newcastle 2 Departments of Anatomy and Physiology, and Faculty of Law, University of Otago, Dunedin, New Zealand

Question: Intra-articular meniscoids are thought to be involved in some spinal pain presentations. Meniscoids have been identified using dissection and imaging, however no studies have identified these structures using E12 sheet plastination. Moreover, these modalities are not generally available in physiotherapy clinical anatomy education. This study therefore sought to examine the presence of intra-articular meniscoids in the spines of cadaver sections that had undergone E12 sheet plastination to investigate their potential use as an educational aid. Design: Observational anatomical study. Participants: Two female cadavers (65, 86 years) that had undergone E12 sheet plastination (2 mm sagittal and transverse sections). Outcome Measures: All 195 sections were photographed on a light box. Lateral atlantoaxial, cervical, thoracic and lumbar zygapophyseal joints were inspected under magnification to identify meniscoids. Results: Ninety-two zygapophyseal and four lateral atlantoaxial joints were identified on 281 photographs. Meniscoids were observed in all cervical joints, 79% of thoracic joints and 80% of lumbar joints. In sagittal sections, 24 meniscoids were observed in cervical joints, and 32 meniscoids in the thoracic spine. In transverse sections, 14 meniscoids were identified in the thoracic spine and 12 meniscoids in the lumbar spine. Conclusion: Meniscoids were visualised in all spinal regions on E12 sheet plastinates, at rates of prevalence comparable to previous reports using dissection and imaging. E12 sheet plastinates are cheaper and more accessible than dissection or imaging; this study confirms their potential usefulness as an educational tool in physiotherapy clinical anatomy education to convey the form and location of intra-articular spinal meniscoids. Key Practice Points: • Intra-articular spinal meniscoids can be effectively visualised on E12 sheet plastinates in sagittal and transverse sections. • Intra-articular spinal meniscoids were identified at rates of prevalence comparable to previous reports using dissection and imaging. • E12 sheet plastination can be utilised in physiotherapy clinical anatomy education to effectively convey the form and location of these clinically important structures.