The following are definitions of terms commonly encountered in musculoskeletal medicine.

Absolute risk: The probability that a person will experience a specified outcome during a specified period.

Absolute risk difference: The difference in absolute risk of an outcome between the control group and the treatment group, or between two treatment groups. An absolute risk of difference of zero indicates no difference between the groups. 

Acupuncture: The piercing of specific body sites with needles to produce pain relief.

Aerobic exercise: Any physical exercise that requires additional heart and lung effort to meet the increased demand by muscles for oxygen.

Back Schools: A course of instruction about backs and back pain conducted in classroom like settings. The course is aimed at providing people with a better understanding of their back and related problems. It also aims to help them to take responsibility for their pain while assisting them to work out how to relieve their pain and overcome any disability they may have. More Info

Confidence interval: The range of values within which the true value for the whole population represented by the study patients is likely to lie.

Continuous low level heat wrap therapy: a specially designed corset containing a warming device is worn around the waist for 2 days following injury to keep the back warm, providing pain relief and allowing the patient to remain active.

Contrast: a liquid (usually iodine or gadolinium) that is injected into your body to make certain tissues show up clearly during diagnostic imaging (angiography, CT, myelogram, MRI). In musculoskeletal medicine it is commonly used for the following purposes:

  • in discography to demonstrate the form (structure) of the disc
  • in MRI in patients who have had surgery to delineate whether shadows are due to scar tissue or not
  • in diagnostic injections to make sure that the material injected actually reaches the spot it is intended to reach.

Coping strategies: Ways in which people deal with stress, solve problems and make decisions, developed ahead of time in preparation for possible adverse or stressful events.

Disability: The extent to which a person's ability to perform home and work activities is affected due to a physical or mental impairment.

Effectiveness: The extent to which an intervention provides benefit for the patient, compared to no treatment or to some reference treatment, under normal (i.e. everyday) conditions.

Efficacy: The extent to which an intervention provides benefit for the patient, compared to no treatment or to some reference treatment, under ideal (ie. research) conditions.

False-positive: When a test result is shown to be positive when it is in reality negative. Most medical tests carry a false-positive rate. Good tests are never falsely positive. More Info

Impairment: The loss of a body part or the loss of function of a body part or body process; refers essentially to something in the body that is missing, broken or which doesn't work.

Level of evidence: Refers to the study design used by investigators to minimise bias. Level 1 is the highest level (best evidence) and level 4 is the lowest.

Manipulation: The sudden application of a single forceful thrust (high velocity thrust = HVT) to a region of the spine aiming to target a selected joint or joints in that region.

Massage: The application of forces, usually by the hands, to the soft tissue of the body through stroking, rubbing, kneading or tapping to increase circulation, to improve muscle tone and to relax the patient.

Mobilisation: The systematic application of progressively increasing forces to a region of the spine aiming to improve the movements of that joint or region.

Multimodal therapy: a combination of treatments incorporating explanation and reassurance to stay active, manual therapy (manipulation and mobilisation), stretching exercises and cortisone injections, shown to have good effect in one randomised controlled trial.

Neurogenic Pain: This is pain from nerves. In scientific language, it is pain evoked by the stimulation of peripheral axons or their cell bodies, (rather than their peripheral endings). Radicular pain is a subset of neurogenic pain, in which pain is evoked by stimulation of the nerve roots or dorsal root ganglion of a spinal nerve. In neurogenic pain, the pain is perceived in the peripheral territory of the affected nerve. In as much as the pain is perceived in a region remote from the actual source of pain, neurogenic pain is, by definition, a form of referred pain. It differs, however, from somatic and visceral referred pain in that it does not involve the stimulation of nerve endings, and does not involve convergence. Rather, it is perceived as arising from the periphery because the nerves from that region are artificially stimulated proximal to their peripheral distribution. More Info

Number Needed to Treat (NNT): The number of people that need to be treated with one treatment instead of another treatment in a given time for one additional person to benefit in the outcome of interest.

Observational Study: A survey or non-experimental study, in which the researchers observe and report on what is happening, without intervening in the course of events.

Orthotic: An external appliance to support a body part by restricting a specific type of movement, or to correct musculoskeletal deformities. Derived from the Greek word meaning to keep straight.

Oswestry Disability Questionnaire: A functional status scale consisting of 10 questions asking the patient to rate pain and simple tasks such as walking, sitting and lifting. More Info

Radicular Pain: Commonly known as sciatica, is typically an electric type of pain related to irritation of a nerve root or nerve root ganglion. The pain typically spreads along a narrow band, distally, in a dermatomal distribution. The term radicular pain does not imply reduced nerve function and should be distinguished from radiculopathy. More Info

Radiculopathy: Literally means sick nerve and is defined as impaired function of a peripheral nerve, usually accompanied by radicular pain.

Red-flag: A clue in the history as to increased risk of a serious underlying medical condition that needs to be recognised early in the patient's history because it potentially threatens the health of the patient more than other possible causes of the presenting symptom. More Info

Referred Pain: A type of pain that is felt at a distance from the source of the pain. Referred pain may arise from body organs (visceral referred pain) or musculoskeletal structures (somatic referred pain). Expressed more scientifically, it is pain perceived in a region innervated by nerves or branches of nerves other than those that innervate primary source of pain, where that source lies in one of the tissues or structures of the body wall (soma) or limbs. More Info

Rehabilitation: The process of restoring an injured person to the fullest physical, psychological, social, vocational and economic function of which they are capable.

Relative risk: The ratio of how often an event occurs in two groups receiving different treatments. A relative risk of zero indicates no difference between the groups.

Somatic Referred Pain: A type of pain that is felt at a distance from the source of the pain, which may arise from muscle, bone, ligament, periosteum or tendon. The pain is typically dull, aching, deep and diffuse in quality and concentrates proximally in the limb.

Surface Anatomy: The depiction of internal anatomy with reference to the skin. More Info

Transcutaneous electrical nerve stimulation (TENS): A method of pain control by the application of electric impulses to the nerve endings. This is done through electrodes that are placed on the skin and attached to a stimulator by flexible wires.

Visual Analogue Scale: A scale used to measure pain levels. It is generally derived from a line of 10 cms, representing the pain scores from 0/10 to 10/10, or from numbered boxes, again from 0 to 10. More Info

Yellow flag: Psychosocial conditions or behaviours that some authorities believe should be recognised early in the person's history, and managed. An example is fear of increased pain with activity. Yellow flags are not as urgent to recognise as Red flags.

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