Shoulder complaints are common in physiotherapy practice and consist of pain and functional limitations.
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The scapula plays an important role in the function of the shoulder. During humeral elevation of the arm, a complex scapular movement of upward rotation, posterior tilt and external rotation is needed to create a stable base for the glenohumeral joint.
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Manchikanti and colleagues (2011) make in their paper entitled ‘placebo and nocebo in interventional pain management: a friend or a foe – or simply foes?’ an argument for a revaluation of placebo effects in clinical practice. They make the claim that clinicians should not try to avoid the placebo effect, but should try to potentiate it, as this effect isn’t just unethical and mythical but must seen as a very real phenomenon, which can be understood from a vast body of both psychological and neurophysiological research.
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​Scapular dyskinesia has been widely accepted in the literature as associated with glenohumeral joint pathology. Clinicians who manage patients with shoulder pain need to have the skills to assess static and dynamic scapular positioning. At this point, clinicians can use reliable (and valid) clinical tests for the assessment of both static and dynamic scapular positioning in patients with shoulder pain.
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​In a very recent review and clinical guideline of Heather Kroll, a nice overview is given about how exercise affects pain. But besides listing possible mechanisms of exercise induced analgesia, she reviews the therapeutic modalities and benefits for a wide variety of chronic pain diagnoses.
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The concept of myofascial trigger points keeps on inspiring researchers and clinicians. With the recent publication of an interesting review article in Rheumatology, the concept is really challenged.
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Hyperexcitability of the central nervous system, or central sensitization, is considered to be a maladaptive type of neuroplasticity often seen in patients with chronic pain. Central sensitization is frequently seen in patients with osteoarthritis, fibromyalgia, whiplash, neuropathic pain and chronic fatigue syndrome. Up to recently, shoulder pain was considered to be a pure ‘local’ problem. Tissues that are frequently linked to shoulder pain include (rotator cuff) muscles, ligaments, subacromial bursa and joint capsules.
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Therapeutic pain neuroscience education (TPNE) is becoming increasingly popular as (part of) the treatment of (chronic) pain and aims at altering the patient’s thoughts and beliefs about pain. Previous research has demonstrated the efficacy of TPNE in the treatment of chronic pain. TPNE is mostly given in one-on-one sessions, which has limitations, as it is time intensive, cost intensive and limited to patients in remote areas. Pain in Motion previously showed that written TPNE does little to alter pain, pain cognitions or illness perceptions in patients with fibromyalgia.
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Interpreting scientific results in clinical practice can be, to say at least, challenging. Especially when it is somewhat contradictory to what you have heard during all those years of extensive training in both physiotherapy education and other courses. As one of my friends recently put it this way: ‘The more I learn about pain, the less I know and the more confused I get.’
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In 2011, Pain in Motion published a paper explaining to clinicians the various options we have for treating the mechanisms involved in central sensitization.
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Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories.
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Why does my shoulder hurt?   January 1st, 2014
Dean et al. recently reviewed the neuroanatomical and biochemical basis of shoulder pain. Shoulder pain is often a very challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. As shoulder pain is very common in the physiotherapeutic clinical practice, a vast understanding of pain processing could enlarge the specificity of the patients’ diagnosis and steer treatment.
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The prevalence of tendinopathies is high both in athletes and in the general population. Despite a wealth of literature, the pain mechanisms of tendinopathies are not well understood. Currently, some studies have described whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies.
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