Joint Mobilization Techniques Research Articles

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study.

The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.

Comparison of Joint Mobilization and Energy Conservation Technique in Rheumatoid Arthritis Patients in Hand Joints

Background: Rheumatoid arthritis is an auto-immune inflammatory condition that affects the hand, wrist,andknee joints.Joint mobilization is frequently used in RA patients. This study was to find the effectiveness of Jointmobilization and Energy conservation technique using range of motion measurement and Sollerman handfunction test in hand joints.Purpose: This study is to find the effect of Joint mobilization and Energy conservation technique which is a noninvasiveprocedure on Rheumatoid arthritis patients.Materials and Methods: A group of 60 Rheumatoid arthritis patients were selected according to inclusion andexclusion criteria from Saveetha medical college and hospital and SAGA Rehabilitation centre.they were dividedinto Joint mobilization group: (n=30) the subjects were treated with Joint mobilization and taught exercises to gainstrength and mobility for 3 days a week for 4 weeks for 15-30 minutes and Energy conservation group: (n=30) thesubjects are taught pacing the activities, prescribing assistive devices, foam-covered handles, wide grip handlesusing large joints to lift objects, teaching Proper body mechanics and Ergonomic considerations to be followed for4 weeks.Study period: November 2022 to April 2023.Result: A statistically significant difference between Joint Mobilization and Energy conservation technique groupsreveals that Joint mobilization has significant effects in lowering stiffness and pain and improving ROM of handjoints.Conclusion: Joint mobilization worked more effectively than energy conservation techniques in RA patients.

Integrating Artificial Intelligence for Improved Management of Frozen Shoulder and Complications in Breast Cancer Surgery: A Perspective from Thailand

Breast cancer is a leading cause of mortality among women worldwide, necessitating surgical interventions like lumpectomy, mastectomy, or modified radical mastectomy. However, these procedures often lead to postoperative complications, such as frozen shoulder, significantly impacting patients’s quality of life. This review focuses on the challenges associated with frozen shoulder and other complications following breast cancer surgery. It proposes the integration of Artificial Intelligence (AI) in assessment and intervention as a cost- effective solution. Frozen shoulder, also known as adhesive capsulitis, affects around 22.2% of breast cancer patients, particularly those undergoing axillary approaches. It is frequently accompanied by Axillary Web Syndrome (AWS) and Post-Mastectomy Pain Syndrome (PMPS), resulting in pain, limited range of motion, and compromised functional abilities. Conservative treatments, including exercises and rehabilitation programs, have shown positive outcomes in managing these symptoms. Previous studies have demonstrated the effectiveness of exercises, joint mobilization techniques, and home-based exercise programs in improving muscle strength, range of motion, and functional ability in breast cancer survivors. Abnormal neuromuscular control and kinematic distortions in shoulder and spinal movements have also been identified, highlighting the significance of neuromuscular training for shoulder joint complex recovery. The integration of AI in the assessment and intervention of frozen shoulder can offer cost-effective solutions and reduce waiting times at healthcare centers in Thailand. AI technologies can enable precise evaluations and personalized treatment plans, optimizing patient outcomes and resource utilization. In conclusion, physical therapy plays a crucial role in managing frozen shoulder and other complications following breast cancer surgery. Evidence-based practices, including comprehensive patient education, tailored exercise programs, manual therapy techniques, and pain management strategies, are essential for effective treatment. Integrating AI in assessment and intervention can further enhance outcomes and alleviate the burden on healthcare resources.

Comparison of Effectiveness of Maitland’s Mobilizations at End-Range Versus Within Pain-Free Joint Range of Movement in Treatment of Patients with Frozen Shoulder RCT

Maitland’s mobilizations are an important treatment option for treating patients with Frozen shoulder or Adhesive capsulitis of shoulder joint. In this study we compared the efficacy of Maitland’s mobilization at end-range of tissue resistance with high intensity glides i.e. High Grade with low intensity glides i.e. Low grade within pain free range of joint movement. The study was conducted at OPD of Department of Physical Therapy, Mayo Hospital, Lahore. In this study total of 57 patients were taken and only 36 patients were selected after assessing on inclusion criteria. Those 36 patients were divided into 3 groups with 12 patients in individual group. With the joint close to its neutral position, translation and distraction techniques were used to begin mobilization techniques in the fundamental starting positions. Numeric Pain Rating Scale (NPRS) and SPADI scales were used for measuring pain and disability index. ROMs were measured before, during and after treatment course i.e. at Day 1, after 2 weeks and after 4 weeks respectively. Statistical analysis was done on SPSS using ANOVA. When the ranges were compared by using ANOVA on SPSS it was evident that Group A patients showed better treatment outcomes as compared to other two groups. P-value (0.000) less than 0.05 is considered significant for group A patient. Mean of demographic data also support the fact that AC is more common in women than man. As a result of this study we can conclude that all treatment options gave good results in enhancing range of motion (ROM) and decreasing pain in shoulder joint but high-grade mobilization techniques applied at end range gave a significant treatment outcome on Ranges when compared. Numeric Pain Rating Scale (NPRS) and SPADI scales

Effects of Laser and Sacroiliac Joint Mobilization for Sacroiliac Joint Dysfunction

To evaluate the effects of laser and sacroiliac join mobilization for sacroiliac joint dysfunction.The SI Joint`s primary functions are to provide to distribute trunk load to the lower limbs. Lowback discomforts are frequently caused by sacroiliac joint dysfunction (SI) Joint, which can bedifficult to diagnose. Prolonged standing or sitting postures can also make pain worse. Low Intensity Laser Therapy also known as Low Level Laser Therapy is thought to work by inducing a photochemical-reaction (Response) to light (Laser) Physiotherapist frequently Recommend spine mobilization to treat Musculoskeletal Problems. The Amplitude of Oscillating mobilization can be classified as considerable (GradesII and III) or little (Grades I and IV) depending on the possible range of motion. 5 Large amplitude oscillations excite more mechanoreceptors and hence reduce pain more effectively than small amplitude oscillations. To evaluate the effects of laser therapy and laser therapy with sacroiliac joint mobilization in patient with sacroiliac joint dysfunction. The total number of test subjects was 40. The Group(A) 20 Samples) and Group(B) 20 Samples, both groups pre and post-test values noted NPRS scale. Group-A Laser therapy was given by patient being in prone lying position and Group-B Laser therapy with sacroiliac joint mobilization techniques was given in being pronelying position. Both Groups treatment Will be given 4 weeks for Thrice a week for 30 minutes. This study was conducted as a experimental study. The sample were collected by convenient sampling technique. The data that had been gathered was statistically analyzed using an unpaired t-test. Compared to the laser group, the Laser with sacroiliac joint mobilization group exhibits significant effects in lowering pain and improving physical functional activity, as assessed by NPRS scale. It is concluded that laser therapy with sacroiliac joint mobilization technique was found to be more effective than laser therapy in sacroiliac joint dysfunction. Key Words: Sacroiliac joint dysfunction, Laser, Maitland mobilization Technique

Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial

ObjectiveThe objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). MethodsSixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. ResultsThere were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to −0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. ConclusionThe IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. Trial registrationRBR-44v8y7.

A Study to Compare the Effectiveness of L4/L5 Zygoapophyseal Joint Mobilization versus Sub Occipital Muscle Inhibition Technique on Hamstring Extensibility in Athletes

A Study to Compare the Effectiveness of L4/L5 Zygoapophyseal Joint Mobilization versus Sub Occipital Muscle Inhibition Technique on Hamstring Extensibility in Athletes

Effect of Mulligan’s mobilization combined with motor control exercises on pain functional ability and muscle activity in sacroiliac joint dysfunction

Introduction and Aim: Sacroiliac joint dysfunction accounts 15% to 30% 0f low back ache conditions, If the SIJ is hypomobile, it cannot be effectively absorbed forces causing other body parts may be overstressed causing musculoskeletal dysfunction. This study’s aim is to identify the effect of mulligan’s joint mobilization techniques, motor control exercises and, aerobic exercises on pain functional ability and muscle activity in patients with SI joint dysfunction. Methodology: Randomized controlled study was done by selecting patients with SI joint dysfunction. 185 participants with low back pain were evaluated and out of them 116 had positive SI joint dysfunction and 95 were selected based on selection criteria. Computer- assisted randomization was done to divide the participants into three groups. Based on that group I has got 30, group II has 33, and group III has 32. Group I participants underwent Mulligan’s mobilisation for SI joint and followed by motor control exercises, Group II participants underwent motor control exercises and Group III participants underwent Aerobic exercises. All the treatment was given for 45 minutes 5 days per week for 6 weeks of duration. This study uses functional disability, Transverses abdominis muscle endurance, and pain measured using the Oswestry disability index, pressure biofeedback and numerical pain scale respectively. Results: On comparing group I and group II, the group I shows a significant improvement in all the outcomes. The ANOVA results show that the p-value is &lt; .00001. The result is significant at p &lt;0.05. Conclusion: This study concludes that mulligans mobilization with motor control exercises would significantly improve pain, functional disability, and transverses abdominis muscle endurance.

Effectiveness of Kaltenborn Joint Mobilization Technique Versus Muscle Energy Technique on Pain and Disability in Patients with Shoulder Adhesive Capsulitis

The objective of this study was to compare the effectiveness of Kaltenborn joint mobilization techniques with muscle energy techniques in adhesive capsulitis. Study was conducted in population of Sargodha who is seeking physiotherapy treatment for adhesive capsulitis in physiotherapy rehabilitation departments and centers. The study design was randomized, controlled, and multicenter. Around 75 patients were selected by inclusion and exclusion criteria, and were divided into three groups by lottery method of randomization. Group 1 obtained Kaltenborn method of treatment, Group 2 obtained muscle energy technique, and Group 3 is control group that obtained conventional treatment in the form of heat and range of motion exercises. Duration of study was 6 months, and the interventions were performed for two weeks, with a total of 10 sessions. A baseline measurement was taken on shoulder pain and disability index (SPADI). A post intervention measurement was taken on same outcome measurement tools and was compared using ANOVA statistical analysis. The pre-intervention measurements on SPADI were 61.11±8.79, 60.91±9.90, and 61.18±9.00 in control, Kaltenborn, and METs groups, respectively. The post intervention measurements were 49.33±9.95, 39.09±9.45, and 27.69±11.97 in control, Kaltenborn, and METs groups, respectively. This study concluded that both techniques are effective in the treatment of adhesive capsulitis to decrease the pain and disability in experimental groups in comparison to control groups. METs is superior to Kaltenborn in pain and disability management when compared to each other.

Randomized Controlled Trial Comparing Fibular Versus Talocrural Mobilization With Movement in Individuals With Chronic Ankle Instability

Talocrural mobilization with movement (MWM) and fibular MWM are ankle joint mobilization techniques which may treat deficits in ankle dorsiflexion range of motion (DFROM) and balance in individuals with chronic ankle instability (CAI). The purpose of this study was to compare the acute effect of fibular MWM versus talocrural MWM in individuals with CAI. Thirty-nine individuals with CAI were enrolled and randomized to intervention (fibular MWM, talocrural MWM, or control). Baseline DFROM, inversion range of motion, and balance were assessed pre- and postintervention. Only the talocrural MWM group significantly increased DFROM postintervention. There were no significant group differences in inversion range of motion or balance. The results support the use of talocrural MWM, but not fibular MWM, to acutely improve DFROM in individuals with CAI.

Non-Operative Management of Symptomatic Hallux Limitus: A Novel Approach of Foot Core Stabilization and Extracorporeal Shockwave Therapy

Background: This video presents assessment and management of hallux limitus using intrinsic foot strengthening and joint mobilization techniques with combination of extracorporeal shockwave therapy (ESWT). Indications: Clinical history includes pain with walking, running, jumping, or loaded plantarflexion localized to the first metatarsophalangeal (MTP) joint. Indications for our treatment approach of hallux limitus include pain localized to the first MTP joint, corresponding lack of active range of motion/passive range of motion, and reduced foot/ankle strength often with joint space narrowing on imaging. Technique Description: Our program uses the principle of foot core exercises that enhance intrinsic muscles of the foot to assist in medial longitudinal arch stabilization and hallux strengthening. Progression of these exercises can be done in weight-bearing and impact activities specific to patient goals. In addition to these foot intrinsic exercises, calf raises should be incorporated to strengthen the gastroc-soleus complex to both improve plantar foot strength and facilitate extension of the first MTP joint. Manual therapy techniques reduce the rigidity of the first MTP joint and restore appropriate medial-lateral and plantar-dorsal balance. With severe limitations in mobility or pain limitations, ESWT can be incorporated to treat the joint and surrounding soft tissue restrictions. Results: Increased first MTP extension is observed. Reduced symptoms of first MTP joint pain with activity allow patients to return to walking and other physical activities with improved comfort. Complications are rare. Pain over the first MTP joint is expected during ESWT. Rarely, irritation of the plantar components of the first MTP joint, including the tibial and fibular sesamoid bones, may occur. Discussion/Conclusion: Non-surgical management of hallux limitus may improve using the described technique of intrinsic foot strengthening with focus on stabilization of the medial longitudinal arch and strategies of improved mobility of the first MTP joint. Adding ESWT may address joint limitations and facilitate gains in exercise and mobility.

Low educational quality and trustworthiness of YouTube videos by physiotherapists on shoulder joint mobilization techniques: a descriptive study

ABSTRACT Introduction Physiotherapists and students may be vulnerable to false information and may learn faulty treatment techniques due to inadequate educational quality and uncertainty about sources and trustworthiness of YouTube videos. Objective To investigate educational quality, trustworthiness, and content completeness of joint mobilization techniques demonstrating videos available on YouTube. Design This is a descriptive study. Methods We performed a YouTube search on 1st April 2019, using the keyword ‘Maitland joint mobilization technique for shoulder joint’. Three academic physiotherapists independently rated each video for educational quality, trustworthiness, and content completeness using the Global Quality Score, Journal of American Medical Association (JAMA) Benchmark Criteria and joint mobilization content completeness scale, respectively. Results Fifteen videos were included in the study. The median number of views for videos was 1263 (IQR 578–1478), and the median duration was 140 seconds (IQR 71–301 seconds). Most videos had low content quality (87%), poor joint mobilization content completeness (80%), and limited trustworthiness. All videos had low source quality (100%). Conclusions There is a lack of quality information on shoulder joint mobilization techniques on YouTube, which makes it a limited educational tool for physiotherapists and students.

Effect of IFT with Anterior Glide versus Posterior Glide Joint Mobilisation Technique on Shoulder External Rotation Rom in Patients with Adhesive Capsulitis: Comparative Study

Background: Adhesive capsulitis is a clinical diagnosis made from a history of the gradual onset of severe shoulderpain with the progressive limitation of active and passive glenohumeral movements. The most significant loss ofmovement is in the external rotation of the joint. Traditionally physical therapists have used an anterior glide ofthe humeral head on the glenoid technique to improve external rotation range of motion a choice based on ‘convexon concave’ concept of joint surface motion.Aim &amp; objective of the study: To compare the effect of IFT with anterior glide versus posterior glide jointmobilization technique on shoulder external rotation ROM in patients with adhesive capsulitis.Data Analysis and Results: This study results shows that there is statistically significant improvement in thevariables of shoulder pain and disability index (SPADI) and Shoulder External Rotation ROM between pre and postmean values in both control and experimental group with p&lt;0.05. The Post mean values of SPADI and ShoulderExternal Rotation ROM in degrees with p values p&lt;0.05 in Control group when compared to Experimental Group.Conclusion: This study concluded that both anterior glide and posterior glide with Interferential therapy reducethe pain and improve the external rotation range of motion in adhesive capsulitis. Meanwhile, interferentialtherapy with anterior glide is more effective than the interferential therapy with posterior glide in reducing thepain and improving the external rotation range of motion in adhesive capsulitis.

Manual Therapy Interventions for Adhesive Capsulitis: A Review

Adhesive Capsulitis is a debilitating condition which causes the capsule of the Gleno-humeral joint to get thickened and contracted progressively. The prevalence of the disease is much higher in the middle aged and elderly community. It is characterized by pain in the shoulder, and advance towards the restriction of the active and passive glenohumeral motions and thereby obstructing the overall functional activities of the daily living. The effectiveness of various non-operative methods in the treatment of Adhesive Capsulitis has been demonstrated in the literature. Corticosteroid injections and the oral medications are known to be alleviating the pain levels and the inflammatory reactions but not the mobility of the affected joint. Joint mobilization techniques, electrotherapeutic modalities and other manual treatment methods are also found to be effective. In summary, this review focuses on the pathophysiology of the adhesive capsulitis, stages of the condition progress and various manual therapy interventions. Keywords: Gleno-humeral joint, frozen shoulder, rehabilitation, active and passive movements, functional activities.

Physiotherapist’s approach and treatment preference in the patients of rheumatoid arthritis in Karachi, Pakistan: A cross sectional survey

Objective: To assess the treatment approach of physiotherapists towards patients with Rheumatoid Arthritis. Material &amp; methods: A cross-sectional study was conducted from June to August 2016 among the 116 selected participants who were working in different physical therapy setups of Karachi Pakistan. A self-constructed questionnaire was used among the participants which consist of demographic Characteristics (age, gender, Qualification, and experience). While the Knowledge and utilization related close-ended questions were the 1. Type of exercise (isometrics and isotonic exercise), utilization of manual techniques (use of Maitland peripheral joint mobilization techniques, Cyrix mobilization techniques, Mulligan mobilization techniques &amp; Manual joint distraction). 2. The use of electrotherapy modalities (use of TENS, Ultrasound, Cryotherapy &amp; Heating) &amp; 3. Treatment preference includes (results of manual therapy, electrotherapy or electrotherapy &amp; manual therapy both in combination). Data were analyzed by using Statistical Package for Social Sciences (SPSS) version 21. Results: The majority of physiotherapists (n=71, 61.2%) belong to the age group of 31 to 45 years, and (n=71, 61.2%) were male. After checking the Qualification the majority (n=65, 56%) were Post-graduate and (n=62, 53.2%) were having 7 to 15 years of experience. Among all (n=94, 81%) of physiotherapists were using an isometric type of exercises in the patients with Rheumatoid arthritis. Most of (n=101, 87%) the Physiotherapist was using peripheral joint distraction in patients with Rheumatoid arthritis. The majority (n=109, 93.9%) of physiotherapists were using manual therapy and electrophysical agents in combination among the patients with Rheumatoid arthritis. Conclusion: The physiotherapists who are working in different setups of Karachi were treating the patients of RA by using different techniques of manual therapy along with the combination of electrophysical agents. In electrophysical agents, they were using the tens and heating combination for pain management.

Immediate effect of manual therapy techniques on the limitation of ankle dorsiflexion: a randomized, controlled, blind clinical trial protocol

BackgroundThe range of motion (RoM) of dorsiflexion (DF) plays an important role in human mobility, such as absorption of body weight during gait deceleration, jump landings, balance, and eccentric movements. This limitation can generate potentially damaging movements. This way, evaluating techniques for DF RoM increase could help improve immediate performance in such functional activities. This being the case, the objective of this study will be to verify the sum effect of different joint mobilization techniques for DF gain in persons practicing physical activities and its relationship with functional performance and balance.MethodologyThis is a randomized, controlled, and blind clinical trial. Fifty-four (54) volunteers will be recruited, aged between 18 and 40 years, who have DF limitations. After checking eligibility criteria, the participants will be submitted to a physiotherapeutic evaluation. A researcher, blind to evaluation and treatment, will perform the randomization of patients in groups: (A) Joint Mobilization - Mulligan Concept and (B) Joint Mobilization - Maitland Method. All volunteers will be submitted by two blind evaluators for randomization and treatment groups. They will realize the initial evaluation (A0), immediately after techniques (A1) and after 3–4 days of the technique application (A2). A different researcher, blind for evaluation, will perform the treatment, according to the randomization group.DiscussionIt is already known that DF RoM limitation can lead to compensatory and potentially damaging lower limb movements and that joint mobilizations are effective to treatment. However, there is no consensus whether the application of these techniques would also improve aspects of dynamic postural balance and performance in individuals practicing physical activity, and whether the sum of two joint mobilization techniques could enhance this effect.Trial registrationBrazilian Registry of Clinical Trials (ReBEC) RBR-93xv9t. Registered on 09 April 2020.

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial

IntroductionMechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP.MethodsThis FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1.DiscussionIf found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial.Trial registrationClinicalTrials.gov CTRI/2020/01/022934. Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry – India.

Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke.

Background and Objectives: Patients with stroke have a forward neck posture due to neurological damage and often have impaired pulmonary function. This study investigated the effect of diaphragmatic breathing with cervical mobilization to improve pulmonary function cervical alignments. Materials and Methods: This study used a one-group pre-test–post-test design including 20 patients with stroke. Two types of cervical joint mobilization techniques, consisting of left and right lateral glide mobilization and posterior–anterior mobilization, were utilized. During joint mobilization, the patients performed diaphragmatic breathing. The measurements were performed immediately after the intervention. Pulmonary function was evaluated using a spirometer to measure the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). The craniovertebral angle (CVA) was measured using lateral photographs. Results: After diaphragm breathing with cervical joint mobilization, subjects had significantly increased FEV1, FVC, PEF and CVA. Conclusion: Diaphragm breathing with cervical joint mobilization are possible interventions to increase pulmonary function and improve the craniovertebral angle in patients with stroke. However, a complete conclusion can be reached only after a follow-up study has been conducted with a comparison of more subjects and controls.

Efficacy of Three Directional Capsular Stretching Versus Angular Joint Mobilization in Patients with Frozen Shoulder: A Randomized Controlled Trial

Background: The evidence regarding efficacy of the new concept of Angular Joint Mobilization technique(AJM) is scare hence this study aimed to compare the effectiveness of AJM versus three dimensionalCapsular Stretching exercises (CS) in reducing shoulder pain, functional limitations, shoulder disability andin improving ROM of FS survivors.Methodology: A randomized controlled, parallel group design study was conducted on FS patients.Participants with the history of FS and aged 35 to 60 years were included however subjects with glenohumeralarthritis, trauma, infection or congenital abnormality of shoulder were excluded. Four outcome measureswere assessed including Numeric pain rating scale (NPRS), Simple Shoulder Test (SST), Shoulder Pain andDisability Index (SPADI) and goniometer. 50 volunteers were equally divided into AJM and CS group.Result: The mean comparison of post NPRS in AJM group was 3.4 and in CS group was 4.4, SST score inAJM was 10.4 and CS was 9.4, SPDAI and ROM in all the direction showed significant improvement inAJM as compared to CS group at p-value &lt;0.05.Conclusion: AJM is significantly more effective in reducing shoulder pain, functional limitations andshoulder disability, also in improving ROM of FS patients as compared to CS.

Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain.

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.