Gwendolen Jull - Profile on Academia.edu (original) (raw)

Papers by Gwendolen Jull

Physiotherapy Canada, 2013

Headache in a mature athlete

Clinical Reasoning for Manual Therapists, 2004

Journal of Physiotherapy, 2010

Workstation Set-Up Measure

PsycTESTS Dataset, 2000

BMC Musculoskeletal Disorders - BMC MUSCULOSKELET DISORD, 2010

Background: Musculoskeletal disorders are common and costly disorders to workers compensation and... more Background: Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation.

Australian Journal of Physiotherapy, 1979

Conservative management, including an early introduction of pendular exercises to prevent shoulde... more Conservative management, including an early introduction of pendular exercises to prevent shoulder stiffness, has always been advocated in the treatment of the fractured neck of humerus. However, the problem of glenohumeral joint stiffness can still be present many weeks after the fracture. It was proposed that the inclusion of passive mobilization in the treatment programme could lessen this problem. A method of passive mobilization which could be begun within the first few days post fracture, was used in a pilot study of 14 patients with fractures of the neck of humerus. Initial results indicated that with the inclusion of passive mobilization in an active treatment programme, good functional results could be obtained, while the period of rehabilitation and the number of treatments could also be substantially reduced.

The Case of the Missing Lower Trapezius Muscle

Journal of Orthopaedic & Sports Physical Therapy, 2011

Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain

Archives of Physical Medicine and Rehabilitation, 2013

To investigate sensory and sensorimotor function in violin and viola players with and without nec... more To investigate sensory and sensorimotor function in violin and viola players with and without neck pain. Prospective, cross-sectional study. University laboratory. Convenience sample of violin players with playing-related neck pain (n=22), violinists without neck pain (n=21), and healthy nonmusician comparison subjects (n=21). Not applicable. Measures include thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reaction times, speed of movement, accuracy, coordination, and tapping speed assessed with a special upper-limb test battery. Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5-6 (P<.01) and over the tibialis anterior (P<.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and nonmusician comparison groups (P>.05). Violin players with neck pain demonstrated signs of sensory impairment, suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.

Motor control problems in patients with spinal pain: a new direction for therapeutic exercise

Journal of Manipulative and Physiological Therapeutics, 2000

Recent research into muscle dysfunction in patients with low back pain has led to discoveries of ... more Recent research into muscle dysfunction in patients with low back pain has led to discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing spinal segmental support and control. The muscle impairments are not those of strength but rather problems in motor control. These findings call for a different approach in therapeutic exercise, namely a motor learning exercise protocol. The specific exercise approach has an initial focus on retraining the cocontraction of the deep muscles (ie, the transversus abdominis and lumbar multi-fidus Initial clinical trials point to the effectiveness of the approach in patients with both acute and chronic low back pain in terms of reducing the neuromuscular impairment and in control of pain.

Applying principles of self-management to facilitate workers to return to or remain at work with a chronic musculoskeletal condition

Manual Therapy, 2013

It is incumbent on health care professionals to support patients with chronic musculoskeletal con... more It is incumbent on health care professionals to support patients with chronic musculoskeletal conditions to manage the impact of the condition on their life. Work is a positive health behaviour for which self-management skills are essential. In this paper, self-management is defined and the role of clinicians in promoting self-management for return to work is outlined with examples and tips on how the clinician can incorporate self-management into practice. The clinician is ideally placed to assist individuals with chronic musculoskeletal conditions manage to remain at work or return to work. This can be achieved through such activities as the promotion of the core self-management skills of problem-solving, decision making, resource utilisation, developing a cooperative partnership between clinician and patient and making an action plan.

The influence of thoracic posture and movement on range of arm elevation

Physiotherapy Theory and Practice, 1993

Wireless orientation sensors: Their suitability to measure head movement for neck pain assessment

Manual Therapy, 2007

The purpose of this study was to verify the performance and suitability of new generation 3D wire... more The purpose of this study was to verify the performance and suitability of new generation 3D wireless orientations sensors to measure cervical range of movement against a criterion standard instrument, an electromagnetic motion analysis system (Fastrak-Polhemus). The wireless orientation sensor (InertiaCube 3) consists of 9 motion-sensing elements: 3 accelerometers, 3 angular velocity rate transducers and 3 magnetometers. Measurements of cervical range of motion in each primary plane, left-lateral flexion, flexion and left rotation were directly compared from both systems in 10 normal asymptomatic subjects. Results showed very high cross-correlations (.99-.97) and low average root mean square errors (0.7-2.5 degrees). We conclude that orientation sensors are a valid, accurate and suitable device for obtaining cervical joint ranges of motion in the primary plane of movement.

Manual Therapy, 2007

Specific strategies to optimally facilitate postural muscles to retrain postural form are advocat... more Specific strategies to optimally facilitate postural muscles to retrain postural form are advocated in the clinical management of neck pain. The purpose of this study was to compare the activation of selected cervical, thoracic and lumbar muscles during independent and facilitated postural correction in sitting in 10 subjects with chronic neck pain. Deep cervical flexor (DCF) muscle activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the thoracic erector spinae and lumbar multifidus muscles. Root-mean-square EMG amplitude was measured for each muscle across two conditions. In the first condition, subjects were instructed to spontaneously ''sit up straight'' from a slumped posture without any other guidance from the therapist. In the second condition the therapist provided specific manual and verbal facilitation to assist the patient to correct to an upright pelvic position with a neutral spinal lumbo-pelvic position. Activation of the DCF and lumbar multifidus muscles (Po0.05) were significantly greater when the therapist facilitated postural correction compared to independent sitting correction. Specific postural-correction strategies result in better facilitation of key postural muscles compared to non-specific postural advice. The results of this study highlight the need for clinical skill and precision in postural training of patients with neck pain. r

Editorial for Special Issue of Manual Therapy Journal based on the Second International Conference on Movement Dysfunction

Manual Therapy, 2006

Manual Therapy, 2009

Deficits in cervical proprioception have been identified in subjects with neck pain through the m... more Deficits in cervical proprioception have been identified in subjects with neck pain through the measure of head repositioning accuracy (HRA). Nevertheless there appears to be no general consensus regarding the construct of measurement of error used for calculating HRA. This study investigated four different mathematical methods of measurement of error to determine if there were any differences in their ability to discriminate between a control group and subjects with a whiplash associated disorder.

The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash

Manual Therapy, 2006

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to dete... more Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The results indicated that over all subjects, significant but weak-to-moderate correlations existed between all comfortable stance balance tests and both the SPNT and rotation cervical JPE tests. A weak correlation was found between the SPNT and right rotation cervical JPE. An abnormal rotation cervical JPE score had a high positive prediction value (88%) but low sensitivity (60%) and specificity (54%) to determine abnormality in balance and or SPNT test. The results suggest that in patients with persistent WAD, it is not sufficient to measure JPE alone. All three measures are required to identify disturbances in the postural control system.

Manual Therapy, 2008

Neck pain has been shown to be associated with balance disturbances. Balance and gait speed are a... more Neck pain has been shown to be associated with balance disturbances. Balance and gait speed are also known to decline with ageing. The aim of this study was to determine whether the presence of neck pain was associated with a decline in postural stability and gait speed over and above what is expected with normal ageing. Twenty female subjects with idiopathic neck pain and 20 healthy female controls aged between 65 and 82 years were studied. Subjects performed balance tests on a computerised force plate under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable and narrow stance. Sway energy and root mean square (RMS) amplitude of sway were measured. Subjects also undertook a Timed Ten Metre Walk Test, with and without head turning.

Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain

Spine, 2001

A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. To report ... more A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. To report a specific exercise intervention's long-term effects on recurrence rates in acute, first-episode low back pain patients. The pain and disability associated with an initial episode of acute low back pain (LBP) is known to resolve spontaneously in the short-term in the majority of cases. However, the recurrence rate is high, and recurrent disabling episodes remain one of the most costly problems in LBP. A deficit in the multifidus muscle has been identified in acute LBP patients, and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity. Any relation between this deficit and recurrence rate was investigated in the long-term. Thirty-nine patients with acute, first-episode LBP were medically managed and randomly allocated to either a control group or specific exercise group. Medical management included advice and use of medications. Intervention consisted of exercises aimed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle. One year and three years after treatment, telephone questionnaires were conducted with patients. Questionnaire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group. One year after treatment, specific exercise group recurrence was 30%, and control group recurrence was 84% (P < 0.001). Two to three years after treatment, specific exercise group recurrence was 35%, and control group recurrence was 75% (P < 0.01). Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone.

Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain

Spine, 1996

A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain... more A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group. To document the natural course of lumber multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery. Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms. Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination. Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination. Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.

Physiotherapy Canada, 2013

Headache in a mature athlete

Clinical Reasoning for Manual Therapists, 2004

Journal of Physiotherapy, 2010

Workstation Set-Up Measure

PsycTESTS Dataset, 2000

BMC Musculoskeletal Disorders - BMC MUSCULOSKELET DISORD, 2010

Background: Musculoskeletal disorders are common and costly disorders to workers compensation and... more Background: Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation.

Australian Journal of Physiotherapy, 1979

Conservative management, including an early introduction of pendular exercises to prevent shoulde... more Conservative management, including an early introduction of pendular exercises to prevent shoulder stiffness, has always been advocated in the treatment of the fractured neck of humerus. However, the problem of glenohumeral joint stiffness can still be present many weeks after the fracture. It was proposed that the inclusion of passive mobilization in the treatment programme could lessen this problem. A method of passive mobilization which could be begun within the first few days post fracture, was used in a pilot study of 14 patients with fractures of the neck of humerus. Initial results indicated that with the inclusion of passive mobilization in an active treatment programme, good functional results could be obtained, while the period of rehabilitation and the number of treatments could also be substantially reduced.

The Case of the Missing Lower Trapezius Muscle

Journal of Orthopaedic & Sports Physical Therapy, 2011

Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain

Archives of Physical Medicine and Rehabilitation, 2013

To investigate sensory and sensorimotor function in violin and viola players with and without nec... more To investigate sensory and sensorimotor function in violin and viola players with and without neck pain. Prospective, cross-sectional study. University laboratory. Convenience sample of violin players with playing-related neck pain (n=22), violinists without neck pain (n=21), and healthy nonmusician comparison subjects (n=21). Not applicable. Measures include thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reaction times, speed of movement, accuracy, coordination, and tapping speed assessed with a special upper-limb test battery. Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5-6 (P<.01) and over the tibialis anterior (P<.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and nonmusician comparison groups (P>.05). Violin players with neck pain demonstrated signs of sensory impairment, suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.

Motor control problems in patients with spinal pain: a new direction for therapeutic exercise

Journal of Manipulative and Physiological Therapeutics, 2000

Recent research into muscle dysfunction in patients with low back pain has led to discoveries of ... more Recent research into muscle dysfunction in patients with low back pain has led to discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing spinal segmental support and control. The muscle impairments are not those of strength but rather problems in motor control. These findings call for a different approach in therapeutic exercise, namely a motor learning exercise protocol. The specific exercise approach has an initial focus on retraining the cocontraction of the deep muscles (ie, the transversus abdominis and lumbar multi-fidus Initial clinical trials point to the effectiveness of the approach in patients with both acute and chronic low back pain in terms of reducing the neuromuscular impairment and in control of pain.

Applying principles of self-management to facilitate workers to return to or remain at work with a chronic musculoskeletal condition

Manual Therapy, 2013

It is incumbent on health care professionals to support patients with chronic musculoskeletal con... more It is incumbent on health care professionals to support patients with chronic musculoskeletal conditions to manage the impact of the condition on their life. Work is a positive health behaviour for which self-management skills are essential. In this paper, self-management is defined and the role of clinicians in promoting self-management for return to work is outlined with examples and tips on how the clinician can incorporate self-management into practice. The clinician is ideally placed to assist individuals with chronic musculoskeletal conditions manage to remain at work or return to work. This can be achieved through such activities as the promotion of the core self-management skills of problem-solving, decision making, resource utilisation, developing a cooperative partnership between clinician and patient and making an action plan.

The influence of thoracic posture and movement on range of arm elevation

Physiotherapy Theory and Practice, 1993

Wireless orientation sensors: Their suitability to measure head movement for neck pain assessment

Manual Therapy, 2007

The purpose of this study was to verify the performance and suitability of new generation 3D wire... more The purpose of this study was to verify the performance and suitability of new generation 3D wireless orientations sensors to measure cervical range of movement against a criterion standard instrument, an electromagnetic motion analysis system (Fastrak-Polhemus). The wireless orientation sensor (InertiaCube 3) consists of 9 motion-sensing elements: 3 accelerometers, 3 angular velocity rate transducers and 3 magnetometers. Measurements of cervical range of motion in each primary plane, left-lateral flexion, flexion and left rotation were directly compared from both systems in 10 normal asymptomatic subjects. Results showed very high cross-correlations (.99-.97) and low average root mean square errors (0.7-2.5 degrees). We conclude that orientation sensors are a valid, accurate and suitable device for obtaining cervical joint ranges of motion in the primary plane of movement.

Manual Therapy, 2007

Specific strategies to optimally facilitate postural muscles to retrain postural form are advocat... more Specific strategies to optimally facilitate postural muscles to retrain postural form are advocated in the clinical management of neck pain. The purpose of this study was to compare the activation of selected cervical, thoracic and lumbar muscles during independent and facilitated postural correction in sitting in 10 subjects with chronic neck pain. Deep cervical flexor (DCF) muscle activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the thoracic erector spinae and lumbar multifidus muscles. Root-mean-square EMG amplitude was measured for each muscle across two conditions. In the first condition, subjects were instructed to spontaneously ''sit up straight'' from a slumped posture without any other guidance from the therapist. In the second condition the therapist provided specific manual and verbal facilitation to assist the patient to correct to an upright pelvic position with a neutral spinal lumbo-pelvic position. Activation of the DCF and lumbar multifidus muscles (Po0.05) were significantly greater when the therapist facilitated postural correction compared to independent sitting correction. Specific postural-correction strategies result in better facilitation of key postural muscles compared to non-specific postural advice. The results of this study highlight the need for clinical skill and precision in postural training of patients with neck pain. r

Editorial for Special Issue of Manual Therapy Journal based on the Second International Conference on Movement Dysfunction

Manual Therapy, 2006

Manual Therapy, 2009

Deficits in cervical proprioception have been identified in subjects with neck pain through the m... more Deficits in cervical proprioception have been identified in subjects with neck pain through the measure of head repositioning accuracy (HRA). Nevertheless there appears to be no general consensus regarding the construct of measurement of error used for calculating HRA. This study investigated four different mathematical methods of measurement of error to determine if there were any differences in their ability to discriminate between a control group and subjects with a whiplash associated disorder.

The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash

Manual Therapy, 2006

Cervical joint position error (JPE) has been used as a measure of cervical afferent input to dete... more Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal the presence of disturbances in the two other tests. One hundred subjects with persistent whiplash-associated disorders (WADs) and 40 healthy controls subjects were assessed on measures of cervical JPE, standing balance and the smooth pursuit neck torsion test (SPNT). The results indicated that over all subjects, significant but weak-to-moderate correlations existed between all comfortable stance balance tests and both the SPNT and rotation cervical JPE tests. A weak correlation was found between the SPNT and right rotation cervical JPE. An abnormal rotation cervical JPE score had a high positive prediction value (88%) but low sensitivity (60%) and specificity (54%) to determine abnormality in balance and or SPNT test. The results suggest that in patients with persistent WAD, it is not sufficient to measure JPE alone. All three measures are required to identify disturbances in the postural control system.

Manual Therapy, 2008

Neck pain has been shown to be associated with balance disturbances. Balance and gait speed are a... more Neck pain has been shown to be associated with balance disturbances. Balance and gait speed are also known to decline with ageing. The aim of this study was to determine whether the presence of neck pain was associated with a decline in postural stability and gait speed over and above what is expected with normal ageing. Twenty female subjects with idiopathic neck pain and 20 healthy female controls aged between 65 and 82 years were studied. Subjects performed balance tests on a computerised force plate under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable and narrow stance. Sway energy and root mean square (RMS) amplitude of sway were measured. Subjects also undertook a Timed Ten Metre Walk Test, with and without head turning.

Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain

Spine, 2001

A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. To report ... more A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. To report a specific exercise intervention's long-term effects on recurrence rates in acute, first-episode low back pain patients. The pain and disability associated with an initial episode of acute low back pain (LBP) is known to resolve spontaneously in the short-term in the majority of cases. However, the recurrence rate is high, and recurrent disabling episodes remain one of the most costly problems in LBP. A deficit in the multifidus muscle has been identified in acute LBP patients, and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity. Any relation between this deficit and recurrence rate was investigated in the long-term. Thirty-nine patients with acute, first-episode LBP were medically managed and randomly allocated to either a control group or specific exercise group. Medical management included advice and use of medications. Intervention consisted of exercises aimed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle. One year and three years after treatment, telephone questionnaires were conducted with patients. Questionnaire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group. One year after treatment, specific exercise group recurrence was 30%, and control group recurrence was 84% (P < 0.001). Two to three years after treatment, specific exercise group recurrence was 35%, and control group recurrence was 75% (P < 0.01). Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone.

Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain

Spine, 1996

A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain... more A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group. To document the natural course of lumber multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery. Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms. Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination. Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination. Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.