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Pain Science

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  - Pain is a decision by the brain based on perception of threat - You can have an injury and no pain. Think about a bruise that you don't know how you got.­­­­ Statistics - 40% of people with no back pain had a bulging disc. (disc bulges absorb over time which has been shown on repeated scans) - 1/3 of people over age 30 have abnormal findings on MRI - After successful rotator cuff surgery, 90% of people have abnormal findings on MRI - MRI scans of 35% of collegiate basketball players with no knee p­­­ain show significant abnormalities - Over 77% of asymptomatic hockey players demonstrated MRI findings of hip or goin pathological abnormalities - Bulging discs are found in about 30% of 20-year olds and 84% of 80 year olds. Disc protrusion, a type of herniation, are found in 29% of those 20-year olds and 43% of 80 year olds.           -  Jarvik 2002 Finally, over ⅔ of individuals with a herniated disc- symptomatic or not-    ...
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Vestibular

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  Epley Maneuver for right-sided posterior canal BPPV Anterior BPPV Evaluation and Treatment Evaluation: Supine Head-Hanging Test for the Diagnosis of Anterior Canal BPPV. Clinically, ac-BPPV is characterized by a vertical downbeat nystagmus with a torsional component toward the affected side when the individual is looking straight ahead as evoked by the supine head-hanging test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497794/#:~:text=Supine%20Head%2DHanging%20Test%20for%20the%20Diagnosis%20of%20Anterior%20Canal,the%20supine%20head%2Dhanging%20test.  Treatment with Yacovino maneuver: Doesn't matter which ear you are treating, the maneuver is the same. (1) supine with head extended 30 deg, (2) supine head flexed 45 deg, (3) seated with head flexed 45 deg. (step two for too long, you risk the otoconia staying in the posterior canal.  Habituation Exercises: -Gaze stabilization Gaze stabilization protocol: -3x/day, at least 12 min daily.  -VORx1 (head movement...
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Modalities

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Electrotherapy TENS (Conventional high-rate/sensory TENS) Frequency: 100-150 pps. Pulse Duration: 50-80  µs. Amplitude: sensory. Treatment Time: whenever there is pain. Duration of Action: only while on. Typical Conditions: acute injury or repetitive strain. Duration of application: unlimited. TENS  (Low-rate/motor TENS) Frequency: <10 pps. Pulse Duration: 200-300  µs. Amplitude: small muscle contractions. Treatment Time: maximum 20-30 minutes every 2 hours. Duration of Action: 4-5 hours aftertreatment. Typical Conditions: chronic conditions. Duration of application: 20-30 minutes maximum.  Interferential Current  (Acute pain) Frequency: 100-150 Hz. Time: throughout duration of pain. May be used for 24 hours/day if needed. Modulation: use if available. Amplitude: to produce tingling. Interferential Current  (Chronic pain) Frequency: 2-10 Hz. Time: 20-30 minutes. Modulation: none. Amplitude: to visible contraction. Neuromuscular Electrical Stimulation (NM...
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