Louis Gifford’s scientific contributions

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Publications (13)


Fisioterapia y dolor
  • Chapter

December 2007

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40 Reads

Louis Gifford

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Physiotherapy management of pain

August 2005

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69 Reads

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2 Citations

Physiotherapy, due to its knowledge of science and rehabilitation offers the potential to revolutionise the management of the pain and alleviate much suffering. Patrick Wall Introduction Physiotherapy is a movement and rehabilitation based profession. It is impossible to define a generic role for physiotherapists as they are engaged in all major areas of medical practice. Physiotherapists/physical therapists from all backgrounds have frequent contact with patients in pain; it is estimated that over 90% of all patients seen by physical therapists have pain at presentation. The original aim of the profession was to return people to function. However, during the period from the 1970s to the early 1990s musculoskeletal therapists shifted from rehabilitation to tissue-specific, modalityfocused approaches that were heavily dependent on passive interventions. This trend has recently reversed and resulted in the profession receiving growing attention as a valuable tool in the management of pain. The various modalities used to treat and manage pain can be broadly divided into passive and active therapies. The evidence base for specific modalities remains weak. The problem in the clinic is that therapists tailor concurrent therapeutic inputs and interventions/exercises to the individual, making it difficult to evaluate the efficacy of the intervention and/or a given dosage/regimen. © Cambridge University Press 2005 and Cambridge University Press, 2009.



Fig. 1FThe Mature Organism Model.
Fig. 2FModel of disability illustrating influences of biomedical, physiological, psychological, socioeconomic and iatrogenic factors on disability (Reprinted from Pain Management, an interdisciplinary approach, 2000 Main et al. by permission of the publisher Churchill Livingstone).
Clinical reasoning strategies representing tasks within clinical practice (Edwards et al. 2001)
Conceptual models for implementing biopsychosocial theory in clinical practice
  • Literature Review
  • Full-text available

March 2002

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3,055 Reads

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125 Citations

Manual Therapy

The integration of the biopsychosocial model into manual therapy practice is challenging for clinicians, especially for those who have not received formal training in biopsychosocial theory or its application. In this masterclass two contemporary models of health and disability are presented along with a model for organizing clinical knowledge, and a model of reasoning strategies that will assist clinicians in their understanding and application of biopsychosocial theory. All four models emphasise the importance of understanding and managing both the psychosocial and the biomedical aspects of patients' problems. Facilitating change in patients' (and clinicians') perspectives on pain and its biopsychosocial influences requires them to reflect on their underlying assumptions and the basis of those beliefs. Through this reflective process perspectives will be transformed, and for clinicians, in time, different management practices will emerge.

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Acute low cervical nerve root conditions: Symptom presentations and pathobiological reasoning

June 2001

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51 Reads

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27 Citations

Manual Therapy

Acute low cervical nerve root conditions may be easily misdiagnosed. The perspective presented is that their symptom presentation is not as straightforward as the classic descriptions of brachialgia would have us believe. This clinical commentary presents a series of observations and reasoning models that are relevant to patient symptom presentations believed to be of cervical nerve root origin. Clinicians are urged to consider low cervical nerve root assessment in the light of our current understanding of neural sensitivity, pain science, nerve root biomechanics and the presence and effect of degenerative changes. This particularly relates to thoughts about cervical movements and postures being able to bring forces to bear on nerve roots via compressive as well as elongation forces.


A medico-legal report to a solicitor

December 1999

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5 Reads

Manual Therapy

This is an example of the influence that modern pain science can have on medico-legal reporting. The report has been reproduced with minor changes. These changes have been made so as to protect the identities of those involved and to assist the reader.


Pain, the Tissues and the Nervous System: A conceptual model

January 1998

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622 Reads

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137 Citations

Physiotherapy

This paper challenges current clinical models and systems for assessing and managing on-going pain states to incorporate a broader biological and therapeutic framework. Included is an acceptance of the current criticisms made towards a purely tissue based/modality based paradigm for pain treatment. The mature organism model proposed is presented as a workable conceptual starting block for incorporating mechanisms of pain into the broad science of stress biology and the biopsychosocial model of pain.


The integration of pain science into clinical practice

April 1997

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320 Reads

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119 Citations

Journal of Hand Therapy

In the past three decades, a scientific revolution has occurred in the understanding of the experience of pain. However, a clinical revolution based on the new science is yet to occur. Pain is a multidimensional experience with many contributing and interacting biological/pathobiological mechanisms. These mechanisms may be nociceptive, peripheral neurogenic, central, affective/cognitive or relate to output systems such as the motor and autonomic nervous system. With a better understanding of pain-related neurobiology and some clinical decision making skills, reasoned attempts at a diagnosis of pain can be made. The essential question and first step related to clinical integration is to ask, "what is (are) the predominant mechanism(s) in a given patient's pain state?" This paper provides the underlying clinical biology of pain mechanisms and proposes pain patterns related to the mechanisms.


Citations (6)


... Given this comprehensive approach, an educational component grounded in these principles appears highly suitable for individuals with MSK pain, as it helps patients understand their condition more deeply and manage their pain more effectively [9,10].The underlying premise is that a deeper understanding of their condition empowers individuals, enhancing their ability to manage their pain more effectively [11,12]. ...

Reference:

Effects of pain education delivered through telerehabilitation on pain and disability in patients with chronic musculoskeletal pain: A systematic review protocol
Pain, the Tissues and the Nervous System: A conceptual model
  • Citing Article
  • January 1998

Physiotherapy

... In conclusion, the relatively low effectiveness of traditional conservative treatments is due to the focus on the patient's symptoms and where they occur, rather than on the root causes, which are often located away from the lumbar spine [52][53][54]. ...

The Concept of Adverse Mechanical Tension in the Nervous System Part 1: Testing for “Dural tension”
  • Citing Article
  • November 1989

Physiotherapy

... Moment arms may be altered. Nerves innervating shoulder musculature may be lengthened and tensioned from contralateral rotation [6,7] or compressed at the intervertebral foramen from coupled cervical motions [8]. Yet traditional clinical isometric shoulder strength testing is performed almost exclusively with the cervical spine in neutral [9]. ...

The Concept of Adverse Mechanical Tension in the Nervous System Part 2: Examination and Treatment
  • Citing Article
  • November 1989

Physiotherapy

... Additionally, treatments are often guided by pathoanatomical classifications, which may not fully consider the complexity of such disorders 5,6 . A promising approach to overcome this challenge is the categorization of patients into clusters based on the neurobiological mechanisms underlying their pain [7][8][9][10][11][12] . This approach could enhance the understanding of a patient's specific clinical condition, thereby guiding the selection of more effective treatment strategies by looking at multiple domains and delivering more personalized treatments [6][7][8][9][10][11] . ...

The integration of pain science into clinical practice
  • Citing Article
  • April 1997

Journal of Hand Therapy

... DIFFERENTIAL DIAGNOSIS E ntering the exam, the distribution of symptoms might suggest a number of concurrent sources (eg, glenohumeral osteoarthritis [OA], a rotator cuff tendinopathy/tear, cervical somatic referral) 3,23 or a singular parsimonious differential (eg, cervical somatic referral or emerging radiculopathy, possibly but less likely glenohumeral OA 13,15 ). It also was considered for the potential of a concurrent early-stage glenohumeral OA or rotator cuff tendinopathy or tear 3 (see FIGURE 3). ...

Acute low cervical nerve root conditions: Symptom presentations and pathobiological reasoning
  • Citing Article
  • June 2001

Manual Therapy

... For the "Skill" category, we included "Proficiency" [23,24] and "Subject Evaluation/Effectiveness" [25] as indicator evaluation dimensions and divided "Applicability Judgment" [26][27][28][29] and "Positioning selection" into four levels of indicators. For the "Emotion" category, we revised the indicators of "Car" and "Respect" to "Conduct and Demeanor" and "Professional Conduct, " dividing "Conduct and Demeanor" into four levels and "Professional Conduct" into three levels [30]. These recommendations were integrated into the design of the second-round consultation form to further explore the scientific nature of the model. ...

Conceptual models for implementing biopsychosocial theory in clinical practice

Manual Therapy