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Title: The significance of disordered muscle activity in the perpetuation and treatment of low back pain, with particular reference to the effect of manipulation
Author: Fisk, J. W.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1978
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This thesis is devided into five separate parts. 1. Studies the passive hamstring stretch test which is unknown to most allopathic physicians. The accuracy of the test is researched, using independant trained examiners. Its value in both the clinical and research setting is discussed. 2. Explores the interrelationship between this test and changes in tension as the leg is raised. The relaxed straight leg is raised by a pulley system which incorporates a linear tension gauge. There is a close correlation between a marked increase in tension and the clinical end point of the passive hamstring stretch test. The value of the tension gauge measurements as an objective research tool is discussed. 3. Consists of a pilot study of a patient with one sided low back pain associated with unilateral reduction in the passive hamstring stretch test on the painful side. Both clinical and tension gauge measurements are taken before and after manipulation. A marked change takes place in both measurements after manipulation of the painful side. Follow up checks of both measurements show that this change relates to the patient's recovery. 4. This is a controlled trial of the effect of a specific manipulative technique on ten controls and ten patients with predominantly unilateral symptoms and restricted passive hamstring stretch on the painful side. The tension gauge measurements show a highly significant and statistically valid change in the patients as compared to the controls. Follow up studies show that further tension measurements reflect improvement in the patients' symptoms. 5. Consists of a study of the effect on the tension measurements of fixing the ankle joint at varying degrees of dorsiflexion. Increased dorsiflexion has a marked effect on these measurements. It is argued that the sum total of these findings point to a segmental-increase in the excitability of the alpha motor neurones on the painful side that has the potential of becoming self perpetuating, and that this is probably mediated through increased gamma motor nerve activity. It is also argued that manipulation and other modalities of treatment have their effect on this increased gamma outflow by stimulating high threshold large fibred inhibitory proprioceptors. Further possible avenues of neurophysiological research are discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available