Manual Therapists Research Articles

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey.

Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET). Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice. Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice. The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study

BackgroundPerson-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AimThis study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. MethodsThe methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. ResultsThe core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. ConclusionFostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.

The DECISION project: DiscrEte Choice experIment Spinal manipulative therapy for lOw back paiN: A study protocol

The smallest worthwhile effect (SWE) is the smallest beneficial effect of an intervention that justifies the costs, risks, and inconveniences. The objective is to establish the SWE of spinal manipulative therapy (SMT) for the treatment of low back pain (LBP), and to gain insight into how different attributes of the treatment are traded among each other when choosing SMT. Part 1. A mixed-methods study will be conducted to establish and prioritize a list of attributes influencing choices for those who consider SMT for the treatment of LBP. Individual interviews and consensus groups with chiropractors, manual therapists, and osteopaths and their patients will be conducted. Interviews and consensus groups will be voice-recorded and transcribed verbatim. Part 2. A Discrete Choice Experiment (DCE) will be conducted among people with LBP who have limited to no experience with SMT. Participants will be recruited through an online independent panel company. The survey will consist of several choice sets with attributes and their levels established from Part 1. The DCE will be preceded by a short survey to understand the clinical aspects (i.e. presentation, history and previous treatment for LBP) as well as socio-demographic characteristics of the participants.

Pelvic Palpatory Tests in Manual Therapy and Osteopathy: A Critical Review of the Literature and Suggestions for New Research.

Manual therapists apply physical interventions to the entire structure of the body to promote healing, prevent pathologies, and improve patient health. In osteopathic practice, palpatory evaluation is considered a fundamental clinical practice requirement for identifying somatic dysfunction. Most of the articles published in this area have failed to demonstrate a level of reproducibility that supports palpation in evidence-based clinical practice. When considering the poor reliability of the palpatory tests highlighted in the literature, a discrepancy is noted with what is known about the tactile sensitivity of human hands. For static touch, the minimum size that can be detected, in the absence of applied movement or vibration, is approximately 0.2 mm. Yet, it seems that this high level of precision is insufficient to ensure reliability in the tests used to evaluate osteopathic somatic dysfunction. The purpose that underscores this article is to determine how these two contradictory elements, high sensitivity and low reliability, can be present in palpatory tests. The article reports the literature findings regarding palpatory tests of pelvic, which is an important structure for clinical purposes. Additionally, a critical review of how these studies were conducted is provided to identify any elements that may justify the obtained results. Following recent accredited guidelines present in the literature, we propose suggestions on vision training methods, manual perception refinement training, the search for anatomical markers, and the position of the examiner in relation to the examineethat may be useful for future studies on the topic covered by the article.

From Muscle-Bone Concept to the ArthroMyoFascial Complex: A Pragmatic Anatomical Concept for Physiotherapy and Manual Therapy.

In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. This study is a narrative review and ultrasound observation. Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.

Reducing low-value imaging-A qualitative evaluation of a pilot intervention in Norway.

Low-value radiological imaging threatens patient safety and efficient use of limited health resources. It is important to evaluate measures for reducing low-value utilisation, to learnand to improve. Accordingly, the objective of this study was to qualitatively evaluate a pilot intervention for reducing low-value imaging in Norway. Semi-structured interviews were conducted aimed at describing stakeholders'experience with a multicomponent pilot intervention consisting of a standardised procedure for referral assessment, a standardised return letter, and information about the value and possible risks ofmagnetic resonance imaging-examinations to the public. Data were analysed in line with qualitative content analysis with a deductive approach. Seven healthcare providers were interviewed, including two radiologists, two radiographers, one manual therapist, one practice consultant and onegeneral practitioner. Data analysis yielded four categories: (1) information and reception,(2) referral- and assessment processes, (3) suggestions for improvement and facilitationand (4) outcomes of the pilot intervention. The pilot intervention was deemed acceptable, feasible, engagingand relevant. Specific training in the use of the new procedure was suggested to improve the intervention. The simple design, as well as the positive acceptance demonstrated and the few resources needed, make the pilot intervention and methodology highly relevant for other settings or when aiming to reduce the number of other low-value radiology examinations.

Must The Show Go On? A Qualitative Study Exploring Barriers And Enablers To Manual Therapists' Care Of Dancers.

Dance Medicine is a growing discipline, and healthcare for dancers requires appreciating particularities of their artistic craft. Manual therapists (MTs) are often dancers' first choice when seeking care. Whilst dancers' experiences of injury and healthcare have been extensively researched, little is known of MTs' perspectives of caring for them. This study aimed to gain an understanding of MTs' perspectives of caring for dancers. Communication, treatment strategies and obstacles to a successful therapeutic alliance were examined to broaden knowledge and improve care. This was a qualitative study using Grounded Theory as a framework for data collection and analysis. A purposive sample of 8 participants was recruited-physiotherapists, chiropractors, and osteopaths with 2+ years' experience of treating dancers. Data collection was conducted via semi-structured interviews, which were transcribed verbatim, anonymized, member checked, and later analyzed. Data analysis constructed 3 categories which described the range of participants' experiences. Two categories were identified-(i) A Strangled Industry and (ii) Be-all End-all Patients-and found to culminate in a core category: (iii) Beyond Hands-on, which exemplified MTs' attempts to address clinical challenges. MTs experience several challenges when providing healthcare to dancers. These encompass psychosocial aspects relating to dancers' internal world and the dance industry environment. It suggests that caring for dancers demands comprehensive, collaborative, and psychologically informed approaches. Emphasis should also be given to developing and implementing dance-specific pain science for all stakeholders.

Manual therapists’ appraisal of optimal non-pharmacological conservative management of patients with lumbar spinal stenosis. An international Delphi study

BackgroundLumbar Spinal Stenosis (LSS) is a slow progressive degenerative disorder associated with chronic pain and disability. Although consensus-based international guidelines for invasive treatment of patients with LSS exist, few consensus-based guidelines for optimal conservative management strategies have been published. ObjectiveTo achieve manual therapists’ consensus on optimal physiotherapeutic management strategies for LSS. MethodsThe study employed a three-round, email–based International Delphi survey. All qualified members of the International Maitland Teacher Association (IMTA) (n = 30) were invited to participate. ResultsTwelve IMTA teachers participated in the study. Eight essential physiotherapy management strategies were identified, as follows: 1. Detailed assessment with in-depth interview; 2. Recognition of red flags, contraindications and precautions; 3. Neurological examination; 4. Postural and movement analysis with related ergonomics; 5. Functional analysis; 6. Individualized treatment based on assessment findings and research evidence; 7. Aerobic training and 8. Patient education. ConclusionThis Delphi survey provides a foundation for physiotherapists to individualize and optimise management approaches for patients with LSS. With a growing elderly population, there is an increasing need for evidence-based conservative management guidelines based on high quality research.

Feasibility of a Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder

ABSTRACT Female sexual interest/arousal disorder (SIAD) is strongly influenced by interpersonal factors; however, there are no empirically-supported, couple-based sex therapy interventions for this disorder. This pre-registered study tested the feasibility of a cognitive-behavioral couple therapy (CBCT) intervention for SIAD. A sample of 19 couples in which a female partner was diagnosed with SIAD completed a 16-session CBCT intervention delivered online by therapists with PhD-level training in clinical psychology. Women with SIAD (M age = 43.47, SD = 12.76) and their partners (M age = 43.74, SD = 11.68) were in long-term relationships (M = 13.86, SD = 9.15). The CBCT sessions were video recorded and independently coded for treatment manual adherence and therapists reported on the completion of in-session and homework exercises. Participants completed measures of treatment satisfaction following the intervention as well as dyadic sexual desire (women with SIAD only) and sexual distress prior to treatment, post-treatment, and at 6 months follow-up. The therapists exhibited a high level of adherence to the treatment manual and couples had high rates of homework completion. Moreover, couples had low dropout rates, high attendance rates, and reported moderately high global treatment satisfaction and high satisfaction with virtual care. Women with SIAD reported large improvements in dyadic sexual desire and sexual distress from pre-treatment to post-treatment and pre-treatment to 6-month follow-up. Partners reported moderate and small improvements in sexual distress for post-treatment and 6-month follow-up, respectively. Results support the feasibility of an evidence-based CBCT intervention for SIAD and the need for a randomized clinical trial of the intervention.

Management of Concussion in the Young Athlete.

Sports-related concussion continues to be a rapidly growing public health concern in nearly all sports, and at all levels, in children and adolescents. Evidence-based clinical guidelines are constantly evolving but those specific to the pediatric population are less robust. There are nuances to treatment of the developing pediatric brain in the context of mild traumatic brain injury (mTBI). The purposes of this review are to (1) analyze the differences in concussion symptom presentation and recovery in children versus adults, (2) describe the role of the physical therapist in management of pediatric concussion, (3) examine current recommendations for return to participation in school and return to sport, and (4) highlight the psychological implications of concussion in the young athlete. We find that additional research is needed in nearly all aspects of concussion in the young athletic population. The current evidence stresses the importance of an active approach to recovery using a stepwise progression.

Clinical reasoning skills of German and Dutch manual therapists: a cross-sectional study

ABSTRACT Introduction Reflective clinical reasoning (CR) is believed to play a crucial role in achieving an efficient therapy process, supported by evidence-based approaches that improve patient outcomes. The aim of this study was to evaluate the CR process of German manual therapists (MTs) using the CR skills of Dutch MTs as a reference. Methods This cross-sectional study evaluated the CR process and diagnostic ability of German MTs. Dutch MTs served as the reference standard due to their experience with direct access. The CR skills were assessed using the Diagnostic Thinking Inventory (DTI), a questionnaire measuring diagnostic competence. Descriptive and inferential statistics were conducted to compare the groups. Subgroup analyses were performed to analyze the influence of work experience (in years) and the level of education on CR. Results 396 manual therapists (229 German and 167 Dutch) completed the DTI. Dutch MTs revealed higher DTI sum-scores compared to German MTs (p < .001; Cohen´s d = .41). Subgroup analyses regarding professional education revealed no significant differences in DTI sum-scores within German MTs and between both groups. In the subgroup analyses regarding professional experience, differences of moderate effect size were reached between German and Dutch novice MTs (in favor of Dutch novice MTs; p = .001; Cohen´s d = .62), and between German novice MTs and experienced German MTs (in favor of experienced German MTs; p < .001; Cohen´s d = .6). Conclusion The results suggest that academically educated German and Dutch MTs as well as experienced German and Dutch MTs are similar in terms of their hypothetical-deductive CR skills. In turn, German novice MTs seem to use hypothetical-deductive processing to a lesser extent compared to Dutch novice MTs and experienced German MTs, which in turn may support the hypothesis that the level of professional experience and education has a significant impact on the development of hypothetical-deductive CR skills.

The Effect of Soft Tissue Release at the Thoracolumbar Junction in a Patient with Bilateral Leg Symptoms: A Case Report

Background: Manual therapists mostly see patients with bilateral leg symptoms. Pain, pins and needles, fatigue, heaviness, lower limb coldness, and loss of neurological conduction are the patients’ symptoms. It is hypothesized to be caused by the sympathetic nervous system. Few publications cover its pathophysiology, diagnosis, and treatment. Limited research has examined the consequences of soft tissue release at the thoracolumbar junction. This case describes STR in a patient with bilateral leg symptoms.Case Report: A 39-year-old female presented with bilateral leg symptoms, especially the left leg, with more intensity at night. The symptoms started without a clear cause almost two years ago. She had clear low back pain 2 years ago. The sacroiliac joint and neurologic tests were normal. The examiner found some stiffness in the hip joint range of motion and SLR, especially on the left side. The patient reported some stiffness during active lumbar ROM, especially in rotation to the right and flexion. Palpation revealed tenderness in the piriformis, biceps femoris, and gastrocnemius muscles and L5, especially on the left side, and hypomobility in the thoracolumbar junction. The patient has been treated for 10 sessions with a 6-week multimodal approach consisting of STR, the Garston technique, and electrical stimulation in the thoracolumbar junction. The patient was assessed four times. She had a significant decrement in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), the Global Rating of Change Scales (GRC), and the Beck Anxiety Index following the interventions. She could do her personal activities and would sleep without the sedative.Conclusion: T10 to L2 supply lower extremity sympathetic nerve fibers. This case study demonstrates that these treatments could help these clinical presentations. Interventions with STR need more research. Therapists should evaluate the thoracolumbar junction and SNS in individuals with bilateral leg symptoms without a dermatomal pattern.

Translation, validity and reliability of the pain attitudes and beliefs scale for physiotherapists in French.

The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire evaluates manual therapists' biomedical and biopsychosocial beliefs regarding the management of chronic low back pain. Its usage in clinical settings is an important step in the implementation of national guidelines and policies to improve patient management. The objective of this study was to translate the PABS-PT questionnaire into French, to adapt it culturally, and to conduct a psychometric analysis. Qualitative and cross-sectional study. The translation process followed published guidelines with cross-cultural validation by an expert committee. We followed a forward and backward translation procedure and an expert committee, including the original author of the questionnaire and a linguistics expert ensuring good cultural adaptation, issued a finalised version. Psychometric analysis of the French version of the questionnaire was conducted among 390 French manual therapists in two phases. The first phase evaluated structural validity as well as external validity compared with the TSK and BBQ questionnaires. Then, reliability and scalability were analysed. The second phase evaluated test-retest reproducibility by sending the same questionnaire 3months later. The validity study revealed three subscales: the classic biomedical subscale and two subscales for biopsychosocial beliefs (aetiology of pain and physical activity). With 21 items in total for the PABS-PT-FR, the structural validity scores were good (BM: alpha=0.82, H=0.38; Physical Activity: alpha=0.62, H=0.32; Aetiology of Pain: alpha=0.55, H=0.29). This study provides a validated tool to assess French physiotherapists' and, more generally, healthcare providers' beliefs about chronic low back pain, with a new insight into the BPS subscale internal construct.

Immediate effects of myofascial release to the pectoral fascia on posture, range of motion, and muscle excitation: a crossover randomized clinical trial

ABSTRACT Context Forward shoulder posture (FSP) is a risk factor for shoulder pathology. Manual therapists often use myofascial release (MFR) to elongate restricted pectoral fascia to reduce FSP and improve shoulder function; however, the effects of this treatment approach remain anecdotal. Objective Determine the acute effects of 4-min of MFR, compared to a soft-touch control (CON), to the pectoral fascia on: 1) FSP, 2) shoulder horizontal abduction ROM (HA-ROM), and 3) muscle excitation of the trapezius (upper, middle, lower [UT, MT, LT]) and pectoralis major (PEC). Methods Fifty-nine right-handed participants (27 ± 9 years, 30 female) with FSP, but otherwise asymptomatic shoulders participated in a randomized crossover clinical trial by attending two experimental sessions: one MFR and one CON treatment, each administered by a Registered Massage Therapist. FSP, HA-ROM, and muscle excitation during a reaching task, were measured before and after each treatment. Results There was a significant interaction between treatment and time for FSP (p = .018, ηp = .093) with FSP decreasing from PRE MFR (128 ± 19 mm) to POST MFR (123 ± 19 mm; p < .001, ηp = .420) and PRE CON (126 ± 19 mm) to POST CON (124 ± 18 mm; p < .001, ηp = .191) interventions. There were no significant differences in HA-ROM or muscle excitation. Conclusion Four minutes of MFR or CON to the pectoral fascia acutely reduces FSP.

The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden-The CAMP cohort study.

This study examined manual therapy business owners' perception of official recommendations during the COVID-19 pandemic and the impact on their clinics' economic performance, including clinic activity hours and business turnover. In a longitudinal study design, data were collected in November 2021 (baseline), and after three months, six months, and 12 months. Participants were manual therapists who were business owners. A growth curve model was used to analyze differences in clinical activity trajectories. Multinomial logistic regression analysis was used to assess the relationship between perceived disruptions in business and turnover. Qualitative text analysis was used to examine participants' responses to open-ended questions concerning economic measures taken to sustain their business during the pandemic. This study of 443 manual therapy business owners found that clinics were initially active with minimal variation, but activity changed following COVID-19 recommendations. Business owners perceived that the disruptions had no significant impact on turnover during the initial stages of the official recommendations. Economic support and the previous decrease in turnover increased the likelihood of experiencing a decreased turnover at 12 months. Business owners implemented cost-cutting measures and diversified income sources to navigate COVID-19 challenges and sustain their businesses. The official recommendations in Sweden had an impact on manual therapists' businesses as the COVID-19 pandemic lingered. Some business owners were concerned at the early stages about lower turnover but showed financial resilience by cutting costs and finding new revenue sources to overcome COVID-19 challenges.

Instrument-Assisted Soft Tissue Mobilization 2-Handed Grip Force Production Consistency During Simulated Treatment: A Technical Report.

Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip. Randomized crossover study conducted in a university biomechanics laboratory. Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (Fpeak) and average mean forces (Fmean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland-Altman plots were assessed. The clinicians' average Fpeak ranged from 3.0N to 11.6N and average Fmean from 1.9N to 8.1N. Fpeak CVs for all instruments ranged from 14% to 31%, and Fmean CVs ranged from 15% to 35%. Bland-Altman plots indicated that for both Fpeak and Fmean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9N (91.8g) to 4.1N (418.1g) for Fpeak and from 1.0N (102.0g) to 2.8N (285.5g) for Fmean. Thus, CVs, box and density plots, and Bland-Altman plots supported general force application consistency. Trained IASTM clinicians produced consistent treatment application forces (ie,Fpeak and Fmean) within treatment sessions during 2-handed simulated application.

Correlation of Handgrip Strength with Thumb Flexibility, Strength and Pain in Manual Therapists

Objective: To find the correlation bwteen hand grip strength with thumb muscle strength, flexibility and thumb pain in manual therapists and to find out the variation of these variables in healthy manual therapists. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Pakistan Society of Rehabilitation and Disability, Jinnah Hospital, Ittefaq Hospital, and Riphah University Pakistan, from Nov 2021 to Jan 2022. Methodology: One hundred thirty-five manual therapists were enrolled. Informed consent was taken from participants meeting inclusion and exclusion criteria. The questionnaire was filled out using a Dynamometer for Handgrip strength check, a Manual Muscle testing technique for Thumb muscle strength check, a Numeric pain rating scale for Pain intensity, and Goniometry for Flexibility of the Thumb muscles. Results: Results showed that most manual therapists had no wrist pain (99,73.3%) or thumb pain (104,77%). The majority of therapists (116 ,85.9%), had less than normal grip strength of hand, and 58(43%) had maximum thumb strength. There was a positive correlation between grip strength and thumb strength (r=0.234). There was a negative correlation between grip strength and thumb pain (r=-0.077). Conclusion: The study concluded that most manual therapists did not suffer from wrist and thumb pain. The majority had good thumb muscle strength but poor hand grip strength. Thumb strength positively correlates with grip strength, while thumb pain negatively correlates with handgrip strength.

A tailored training based on students’ and teachers’ needs to improve palpation skills: A quantitative part of a mixed-method study

BackgroundPalpation is a fundamental and complex skill for manual practitioners, it is a very difficult task to teach and to learn. Trials suggest that training might increase the reliability of palpation in detection of bony landmarks, nevertheless the poor dependability of the examined tests suggests that teaching methods must be reviewed. Different training methodologies have been implemented to improve learning experience of manual therapists, but none of them were based on students' and teachers’ suggestions. ObjectivesThis study aims to find an efficient training, tailored on students' needs, that improve students’ palpatory skills. DesignMixed-method study. Methodsthis study was divided in four phases, two quantitative and two qualitative. Pelvis asymmetries were evaluated by 112 students from the Accademia Italiana di Medicina Osteopatica osteopathic Institute using two bony landmarks: the greater trochanter (GT) and the posterior superior iliac spine. The volunteers had a hidden wedge of 2 cm under their heel using a randomization process. Nine students and three teachers were interviewed to explore their lived learning experiences. A tailored training of 1 h was implemented based on their suggestions. Students were then randomly divided into three training groups: tailored training, P.A.L.P.A.T.E. and no training. A second data collection was performed. Students were re-evaluated, asked to make another assessment on another volunteer. Two students and one teacher were then re-interviewed to assess if the tailored training met their expectations. A generalized linear model was used to analyze the data. Results76 students completed the trial. Generally, correct detections of higher landmarks increased from the first to the second data collection, except for 5th year students who decreased their performances. Tailored training achieved the best results with a correct detection of the great trochanter by 69% of students and for posterior superior iliac spine by 78% of students. The generalized linear model showed a strong association between correct detection of PSIS and training type (p-value = 0.009) and over time (p-value = 0.01) but no association with year of school (p-value = 0.434). No association between year of study (p-value = 0.228), training types (p-value = 0.267) and correct GT detection over time (p-value = 0.529) was found. ConclusionsTailored training was shown to be effective and useful in the improvement of students’ performance, especially for posterior superior iliac spine. Interest levels played an important role in correct detection.

The effect of manual therapy on ankle dorsiflexion range of motion: A pilot crossover randomized trial

IntroductionRestricted ankle dorsiflexion is common after lower limb injury. The aim of this pilot study was to investigate the effect of passive ankle joint mobilization and calf muscle massage on ankle dorsiflexion range of motion in adults with residual restricted dorsiflexion. The secondary aim was to assess the methodology of the pilot study to inform a larger clinical trial. MethodThe study design was a randomized crossover trial with assessor blinding. Twenty-five healthy participants with a history of lower limb injury were included in the study. Ankle joint mobilization and calf muscle massage were applied for 5 min in a random order, one to two weeks apart. Ankle dorsiflexion was measured by using the weight-bearing lunge pre- and post-intervention (cm). Paired t-tests were used to analyze the effect of the manual therapy interventions on restricted ankles. A minimal detectable difference 95% (MMD95) was calculated. The pilot study was analyzed for suitability of inclusion criteria, blinding of assessors and the manual therapist, and the washout period. ResultsA significant increase in dorsiflexion was demonstrated for ankle joint mobilization (change score = 0.51 ± 0.76, p = 0.003) and calf muscle soft tissue massage (change score = 0.91 ± 1.07, p < 0.001). There was no difference in change scores between manual therapy techniques (mobilization 0.51 ± 0.76, massage 0.91 ± 1.07, p = 0.12). Evaluation of the pilot study revealed limitations to be modified in future studies. ConclusionThese preliminary data indicate ankle joint mobilization and calf muscle soft tissue massage had similar effects on increasing ankle dorsiflexion range of motion in ankles with residual dorsiflexion restriction.

The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques

BackgroundStatic palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented. AimTo evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine. SettingThis study was conducted on human T1-T6 vertebrae. MethodA skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations. ResultsSpinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence. ConclusionSpinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.