Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review

Thiago Dos Santos Sousa Abner,Josimari Melo Desantana,Maria Ivone Oliveira Dantas,Isabela Freire Azevedo-Santos

doi:10.5935/2595-0118.20200015

Thiago Dos Santos Sousa Abner, Josimari Melo Desantana + Show 2 more

Open Access

https://doi.org/10.5935/2595-0118.20200015

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Abstract

BACKGROUND AND OBJECTIVES: Joint mobilization is a non-pharmacological technique used to treat chronic musculoskeletal pain. However, it is controversial due to a lack of studies comparing its effects on this painful condition. The objective of this study was to assess the risk of bias in clinical trials investigating the effect of joint mobilization on chronic musculoskeletal pain. CONTENTS: A systematic search on Pubmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science, and Scopus was performed on September 2019 from the combination of three keywords: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Randomized controlled clinical trials that evaluated the use of joint mobilization associated or not to other therapies in chronic musculoskeletal pain treatment were included. Five thousand five hundred eighty-seven articles were screened, and 14 studies were analyzed, including 812 participants, with a mean age of 54 years, and female being the most affected. According to these articles, joint mobilization promoted the reduction of pain intensity in short and long terms, increase in range of motion, strength and function when used alone or in association with conventional physiotherapy. Regarding methodological quality, most of the studies were classified with low risk for selection, performance, detection and reporting bias. In the “other bias” item, which considered therapists experience time and types of treatment applied, only one study presented low risk and other study presented an unclear risk. CONCLUSION: Joint mobilization seems to be an effective technique for the treatment of chronic musculoskeletal pain. However, it is still necessary to investigate and compile studies with greater methodological quality, thus promoting greater support to evidence-based practice.

Highlights

Chronic musculoskeletal pain (CMP) is defined as a painful condition associated with dysfunction in muscles, ligaments, tendons, bones, and/or adjacent structures that lasts for more than three months[1,2]
Quality of included studies was moderate and the authors concluded that combined treatment consisting of Manual therapy (MT) and exercise therapy (ET) does not appear to be more effective in reducing the intensity of resting neck pain, cervical spine disability, or quality of life improvement in adult patients with cervicalgia when compared to only ET35
The active group showed a significant improvement in Shoulder Pain and Disability Index (SPADI) than placebo group after 22 weeks, there was no difference between groups for pain reduction or percentage of participants who reported treatment success

Summary

Introduction

Chronic musculoskeletal pain (CMP) is defined as a painful condition associated with dysfunction in muscles, ligaments, tendons, bones, and/or adjacent structures that lasts for more than three months[1,2]. A recently published meta-analysis about manipulation and mobilization, for the treatment of chronic low back pain, has shown that both therapies appear to be safe and that there is moderate quality in the studies that support the use of these techniques to reduce this type of pain[14]. Another meta-analysis addressed the use of manual therapy, exercise therapy (ET), or combined treatment for adults with cervicalgia.

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