Cervical afferents in migraine: orchestrating central sensitisation or innocent bystanders?

Dr Dean H Watson

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This article aims to augment the comprehension of migraine through an integrative approach, combining insights into upper cervical musculoskeletal dysfunction, contemporary principles
of neuroscience, and my own extensive clinical experience. This multidisciplinary perspective is designed to provide a more holistic understanding of the complexities underlying migraine, bridging the gap between musculoskeletal pathology, neuroscientific advancements, and practical clinical observations. I will present my perspective on migraine, which entails a critical examination and potential challenge to some of the established paradigms based on the medical model of headache, as delineated in the International Classification of Headache Disorders -3 (ICHD-3) (International Headache Society 2018).

Read Dean's article here 

 

Iatrogenic pneumothorax as a sequela to acupuncture or dry needling

Jonathan Hobbs

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Presently, there exists no minimum standard for acupuncture or dry needling training within the UK for physiotherapists, nor is there an overseeing professional body that enforces
standards in acupuncture or dry needling training or practice. The responsibility to ensure adequate standards of training and practice is, therefore, a task that falls to the individual
clinician. This article explores the evidence surrounding incidence and outcomes of iatrogenic pneumothorax and discusses the considerations for safe practice.

 

Shockwave and TECAR therapies: fad, fashion, hype or evidenced?

Tim Watson

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In therapy, as we are all aware, a range of “new” interventions come along at alarmingly frequent intervals, some but not all of which survive the test of time and earn, through gathering evidence and clinical uptake, a sustained place in the therapy toolkit. When a new modality comes along in the world of the Electrophysical Agents (EPAs), there is often a wide promotion, a range of claims (some of which are almost pure fantasy), and limited uptake in some healthcare sectors. In the current climate and under the auspices of evidence-based practice, for any such modality, robust and believable evidence is needed for the intervention to make its way from being a fashionable new thing into the established armoury. At some point in the past, Ultrasound was just such a fashionable new thing, followed by others like TENS and Laser. For many of us who have been around for some time, these constitute long-standing and established tools, but
in their day, they were new, innovative and uptake was patchy. The aim of this article is to try to tease apart the fact from the fiction when it comes to two relatively recent modalities, i.e.
Shockwave and TECAR-based therapies, and to paint a picture of the current knowledge base to support them, or not. This is NOT a promotion or an endorsement, or advertising, it is instead
intended as an objective evaluation from the current knowledge and evidence base

 

Is the viscera a cause of lower back pain?

Solomon Abrahams

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Lower back pain (LBP) is commonly seen in private practice and primary care physiotherapy. However, due to an ever-changing NHS and patients bypassing their general practitioner or
missing routine blood tests, viscera pathologies referring to the lower back are increasingly being seen by physiotherapists. This article discusses the common medical pathologies that refer to
the lower back and presents various examination options to understand and identify viscera referred pain.

 

Degenerative cervical myelopathy

Sean Case

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Degenerative cervical myelopathy (DCM) is a condition that is both poorly recognised and under-diagnosed and, for many private physiotherapists who do refer patients on suspicion
of this condition, validation of their concerns, and any achievement of timely intervention through the referral pathway for investigation and diagnosis can be a challenge. The aim of this article is to support private physiotherapy practitioners in identifying and assessing clients that may have degenerative cervical myelopathy, and to know when and how to refer on and / or manage their care.