Manual Therapists Research Articles

Emission of Biophotons and Adjustable Sounds by the Fascial System: Review and Reflections for Manual Therapy.

Every body structure is wrapped in connective tissue or fascia, creating a structural continuity that gives form and function to every tissue and organ. The fascial tissue is uniformly distributed throughout the body, enveloping, interacting with and permeating blood vessels, nerves, viscera, meninges, bones and muscles, creating various layers at different depths and forming a tridimensional metabolic and mechanical matrix. This article reviews the literature on the emission of biophotons and adjustable sounds by the fascial system, because these biological changes could be a means of local and systemic cellular communication and become another assessment tool for manual (therapy) practitioners. This is the first article that discusses these topics in a single text, attempting to bring such information into an area of application that is beneficial to osteopaths, chiropractors, and manual therapists.

Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Brief and Useful Guide—Part 2

This work aims to describe a well standardized therapeutic path in reference to the article “Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Part 1 in the form of a practical guide for manual therapist, Open Journal of Therapy and Rehabilitation, Vol. 10, No. 7, July 2018, https://doi.org/10.4236/health.2018.107074”. The osteopathic manipulative treatment (OMT) approach we propose can be complementary to the psychological therapy in use today, and consists of ten standardized techniques directed to the anatomical structures more involved in the stress answer. This protocol was designed to improve and sustain the management of subjects exposed to extraordinary exogenous stress or post-traumatic stress disorder patients (PTSD).

Common Manual Therapy Practices in the Netherlands for Infants With Upper Cervical Dysfunction: A Prospective Cohort Study

ObjectiveThe purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). MethodsA prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. ResultsBetween 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. ConclusionsThis is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions.

Physicians using spinal manipulative treatment in The Netherlands: a description of their characteristics and their patients

BackgroundVarious health care professionals apply Spinal Manipulative Treatment (SMT) in daily practice. While the characteristics of chiropractors and manual therapists and the characteristics of their patient populations are well described, there is little research about physicians who use SMT techniques. A distinct group of physicians in The Netherlands has been trained in musculoskeletal (MSK) medicine, which includes the use of SMT. Our objective was to describe the characteristics of these physicians and their patient population.MethodsAll registered MSK physicians were approached with questionnaires and telephone interviews to collect data about their characteristics. Data about patient characteristics were extracted from a web-based register. In this register physicians recorded basic patient data (age, gender, the type and duration of the main complaint, concomitant complaints and the type of referral) at the first consultation. Patients were invited to fill in web-based questionnaires to provide baseline data about previous treatments and the severity of their main complaint. Functional impairment was measured with Patient Reported Outcome Measures (PROMs).ResultsQuestionnaires were sent to 138 physicians of whom 90 responded (65%). Most physicians were trained in MSK medicine after a career in other medical specialities. They reported to combine their SMT treatment with a variety of diagnostic and treatment options part of which were only permissible for physicians, such as prescription medication and injections. The majority of patients presented with complaints of long duration (62.1% > 1 year), most frequently low back pain (48.1%) or neck pain (16.9%), with mean scores of 6.0 and 6.2, respectively, on a 0 to10 numerical rating scale (NRS) for pain intensity. Mean scores on all PROMs showed moderate impairment. Patients most frequently reported previous treatment by physical therapists (68.1%), manual therapists (37.7%) or chiropractors (17.0%).ConclusionOur study showed that MSK physicians in The Netherlands used an array of SMT techniques. They embedded their SMT techniques in a broad array of other diagnostic and treatment options, part of which were limited to medical doctors. Most patients consulted MSK physicians with spinal pain of long duration with moderate functional impairment.

Work-related musculoskeletal injuries among Australian osteopaths: A preliminary investigation

BackgroundWork-related musculoskeletal injury (WRMI) is a significant risk factor for registered manual therapists, including physiotherapists, occupational therapists and chiropractors. The physically demanding nature of manual therapy has been identified as the common factor in WRMIs among these professions. There is currently no available literature on the prevalence of WRMIs among osteopaths. ObjectiveThis research sought to collect preliminary data to establish the prevalence and characteristics of WRMIs among Australian osteopaths; including body area injured, risk factors and strategies used to manage injury. MethodRegistered osteopaths, who were members of the professional association Osteopathy Australia, were invited to participate via an online survey. ResultsA total of 160 surveys were completed. The incidence of WRMI was high, with 58% of respondents having sustained one or more injuries. Results indicated that the wrist and the fingers are the most frequently injured areas (41%), while the least injured body part was the knee (1.1%). Performing repetitive tasks accounted for 52% of injuries, followed by performing manipulative techniques (23%). Working too many hours per week (43%) and fatigue (38%) were the main factors contributing to injury. ConclusionsThe findings highlight the risk to osteopaths of sustaining musculoskeletal injuries while working in clinical practice.

Pain-related fear of (re-)injury in patients with low back pain: Estimation or measurement in manual therapy primary care practice? A pilot study.

Manual physical therapists (MPTs) working in primary care get limited information about patient's courses of (chronic) low back pain (LBP). Identification of kinesiophobia is mostly based on clinical perception. The aim of this study was to evaluate the association between the scores with which manual physical therapists in a primary care setting identify kinesiophobia in patients with low back pain, and the patients' self-reported measures of kinesiophobia. The cross-sectional study comprised 104 patients with LBP and 17 MPTs. Patients first independently completed the Tampa Scale for Kinesiophobia (TSK-17). The therapists, blinded to the TSK-scores, rated their perception of a patient's kinesiophobia using the Visual Analogue Scale-Estimation (VAS-est) and the accuracy of their ratings using the Visual Analogue Scale-Accuracy (VAS-ac). Kendall's tau b was used to determine the level of correlation between scores on the TSK-17 and the VAS-est.

‘I just don't have the tools’ - Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: A qualitative study

ObjectivesChronic pain is a complex and challenging problem for manual therapists, such as osteopaths, especially in identifying and managing the multiplicity of psychosocial factors associated with chronic musculoskeletal pain. This study explored Italian osteopaths' attitudes and beliefs towards chronic pain, particularly their understanding of the biomedical and biopsychosocial (BPS) dimensions of chronic pain, and the role they play in their clinical practice. MethodsA qualitative study was conducted using in-depth semi-structured interviews. A purposive sample of 11 osteopaths practising in Italy was recruited from a poster advert sent to 8 Italian osteopathic schools. Interview data were transcribed verbatim and interpreted using a constructivist approach to grounded theory as a framework for data collection, analysis, and conceptualisation. ResultsThree themes were constructed from the data: 1) process of patient evaluation; 2) professional view; 3) developing professional knowledge. ConclusionsOsteopaths displayed a greater orientation towards the biomedical dimensions of chronic pain than dimensions associated with the BPS model. Although the importance of the BPS model has been recognised as part of the osteopathic philosophy of clinical practice and the role of psychosocial factors (PS) are considered important in pain experience, the osteopaths included in this study highlighted a lack of knowledge and skills to assess and address psychosocial risk factors in the management of long term pain sufferers. These findings indicate the need for osteopaths to acquire additional skills and knowledge in professional training programs to develop a more operational holistic view in managing chronic pain sufferers.

August 2017 Letters to the Editor-in-Chief.

Letter to the Editor-in-Chief of JOSPT as follows: "Manual Therapy: More Than Elaborate Swordplay" with Authors' Response "Comparing Dry Needling to Corticosteroid Injection for Greater Trochanteric Pain Syndrome" with Authors' Response J Orthop Sports Phys Ther 2017;47(8):580-585. doi:10.2519/jospt.2017.0204.

A fundamental critique of the fascial distortion model and its application in clinical practice

IntroductionThe therapeutic techniques used in the fascial distortion model (FDM) have become increasingly popular among manual therapists and physical therapists. The reasons for this trend remain to be empirically explored. Therefore this paper pursues two goals: first, to investigate the historical and theoretical background of FDM, and second, to discuss seven problems associated with the theory and practice of FDM. Materials and methodsThe objectives of this paper are based on a review of the literature. The research mainly focuses on clinical proofs of concept for FDM treatment techniques in musculoskeletal medicine. ResultsFDM as a treatment method was founded and developed in the early 1990s by Stephen Typaldos. It is based on the concept that all musculoskeletal complaints can be traced back to three-dimensional deformations or distortions of the fasciae. The concept is that these distortions can be undone through direct application of certain manual techniques. A literature review found no clinical trials or basic research studies to support the empirical foundations of the FDM contentions. DiscussionBased on the absence of proof of concept for FDM treatment techniques along with certain theoretical considerations, seven problems emerge, the most striking of which include (1) diagnostic criteria for FDM, (2) the biological implausibility of the model, (3) the reduction of all such disorders to a single common denominator: the fasciae, (4) the role of FDM research, and (5) potentially harmful consequences related to FDM treatment. ConclusionThe above problems can only be invalidated through high-quality clinical trials. Allegations that clinical experience is sufficient to validate therapeutic results have been abundantly refuted in the literature.

Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients

Objectives: To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients’ and clinicians’ perspectives, and have an acceptable number of categories.Methods: Design: A three-round Delphi study. Participants: Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure: Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration.Results: Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE.Discussion: A consensus-based classification system of AE is established which includes patients’ and clinicians’ perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.

Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders

Objective: Clinical tests used to examine patients with temporomandibular disorders vary in methodological quality, and some are not tested for reliability. The purpose of this cross-sectional study was to evaluate inter-tester reliability of clinical tests and a cluster of tests used to examine patients with long-lasting temporomandibular disorders.Methods: Forty patients with pain in the temporomandibular area treated by health-professionals were included. They were between 18–70 years, had 65 symptomatic (33 right/32 left) and 15 asymptomatic joints. Two manual therapists examined all participants with selected tests. Percentage agreement and the kappa coefficient (k) with 95% confidence interval (CI) were used to evaluate the tests with categorical outcomes. For tests with continuous outcomes, the relative inter-tester reliability was assessed by the intraclass-correlation-coefficient (ICC3,1, 95% CI) and the absolute reliability was calculated by the smallest detectable change (SDC).Results: The best reliability among single tests was found for the dental stick test, the joint-sound test (k = 0.80–1.0) and range of mouth-opening (ICC3,1 (95% CI) = 0.97 (0.95–0.98) and SDC = 4 mm). The reliability of cluster of tests was excellent with both four and five positive tests out of seven.Conclusion: The reliability was good to excellent for the clinical tests and the cluster of tests when performed by experienced therapists. The tests are feasible for use in the clinical setting. They require no advanced equipment and are easy to perform.

Pregnancy-Related Hormonal Influences on the Musculoskeletal System, Lumbo-Pelvic Structures and Peripheral Joints: Some Practical Considerations for Manual Therapists

The effects of maternal hormones upon the spine and pelvis, is not very well defined in the literature with evidence conflicting. Reports of hormonal effects (relaxin), appear to have mainly focused on the anterior cruciate, wrist ligaments, and anthropomorphic foot changes. Pregnancy hormonal influences upon peripheral joint capsulo-ligamentous structures, particular those of the lower limb, may also have indirect effects upon lumbo-pelvic structures by transferring ground reactive force (GRF) further up to kinetic chain. Objective: Review the current evidence base to increase awareness among clinicians managing maternal pain populations of how hormonal influences may affect the musculoskeletal system. Method: Literature published between 1982 and 2016 was reviewed through NCBI, Pubmed, Medline, and Ovid search engines. Additionally, a Google search of online media was conducted using the same terms. Conclusion: Hormonal changes occurring during pregnancy may affect the female musculoskeletal system in a number of ways, with potential later in life consequence. Pregnancy associated lower limb changes such as maternal reduction of the plantar arch, may indirectly contribute to lower back pain, by causing redistribution of ground reactive force (GRF) centripetally, thereby increasing axial load upon already hormonally-compromised lumbo-pelvic structures. Future research is warranted to validate and verify hormonal influences upon musculoskeletal pain and dysfunction in this population group. Despite the popularity of manual management (chiropractic/osteopathy) for pregnancy back pain management, the evidence base for this is sparse. Though a review of available literature indicated manual therapies are probably both safe and effective means of management further research is imperative support clinical practice.

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Compression of the Fourth Ventricle Using a Craniosacral Osteopathic Technique: A Systematic Review of the Clinical Evidence.

Compression of the fourth ventricle (CV4) is a well-known osteopathic procedure, utilized by osteopaths, osteopathic physicians, craniosacral therapists, physical therapists, and manual therapists as part of their healthcare practice based on some evidence suggesting impact on nervous system functions. The main objective of the study was to identify randomized controlled trials (RCTs) assessing the clinical benefits of CV4 and to show the evidence supporting clinical prescriptions, guides, and advice in treating. A computerized search of the PubMed, CINAHL Complete, Scopus, Web of Science, and ScienceDirect databases was performed. Two filters were used (article type: RCTs; species: humans). The methodological quality of the trials was assessed using the Downs and Black quality checklist for healthcare intervention studies. Only six studies met the inclusion criteria, of which four were RCTs and two were observational studies. The Downs and Black score ranged from 17 to 24 points out of a maximum of 27 points. The present review revealed the paucity of CV4 research in patients with different clinical problems, as five out of six included studies investigated healthy adults. According to the results of the included studies, CV4 may be beneficial for patients with different functional problems.

An Alternative Approach to the Gastroesophageal Reflux Disease: Manual Techniques and Nutrition

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that affects a growing number of people in the world and is one of the most common gastric complaints that prompts an individual to consult a doctor. Heartburn and regurgitation are the most predominant esophageal symptoms of GERD, but patients with the disease may also have extra esophageal symptoms, such as epigastric pain, bronchospasm, and chronic cough. All of these symptoms may compromise health-related quality of life with modification of eating habits and sleep pattern that have a great impact on the normal daily. Furthermore, GERD is a multifactorial disease that can be complicated and difficult to treat. Mechanical, chemical, physiopathologic, and functional factors that predispose patients to the disease are still under investigation. A simple treatment plan for manual therapists is presented based on current evidence-based literature; it is designed to reduce symptoms of GERD through somatovisceral approach and the nutrition.

Influence of the Sternum Mobilization Technique on the Spirometry Data

Introduction. Alteration of the mobility of the sternum, decrease of the external respiration functions are most often due to two groups of diseases: chronic obstructive lung disease and degenerative dystrophic diseases of the spinal column. Patients presenting degenerative dystrophic lesion of the spinal column often address to osteopaths and manual therapists. It is important to justify the most effective method of osteopathic correction in treatment of this type of patients.Research objectives. To evaluate the effectiveness of the sternum mobilization technique according to the lung capacity indices, peakfluorometric index, chest excursion.Research methods. Patients aged from 20 to 45 took part in the research. They were divided into two groups regardless of sex. There were 15 people in each group. All the patients had regional biomechanical disorder of the sternum from 1 to 3 points with predominant structural constituent and all of them complained of discomfort in the thoracic region. Osteopathic correction of patients from the first (experimental) group included sternum mobilization technique with the use of the recoil methods during the first and the second consultation. In the control group the sternum mobilization techniques were not realized. The evaluation of the treatment results was held on the basis of the analysis of the spirometry data. Indices of the chest excursion, lung capacity and peakfluorometric index were evaluated.Results. It was proven that the sternum mobilization technique is effective and demonstratively increases lung capacity and peakfluorometric index. At the same time the sternum mobilization technique is not effective in respect of the chest excursion volume.Conclusion. Sternum mobilization technique can be recommended for using in osteopathy and manual therapy in order to improve the restrictive lung function.

Preliminary evidence of Regional Interdependent Inhibition, using a ‘Diaphragm Release’ to specifically induce an immediate hypoalgesic effect in the cervical spine

In clinical practice, Osteopaths and Manual Therapists commonly direct treatment towards the diaphragm by the use of a 'Diaphragm Release'. Currently, there is paucity within the literature to support the use of this technique, specifically in pain outcomes. This research aims to support a neurophysiological mechanism based upon the osteopathic principle "The body is a unit". Demonstrating that directing treatment to distal tissue which is neurologically related can reduce pain in the originating spinal segments. This study investigated the immediate hypoalgesic effects of a 'Diaphragm Release' on pain pressure thresholds in the cervical spine. A single-blind, randomised, sham-controlled, repeated measures within subject, crossover design was conducted on 17 asymptomatic subjects. Pain pressure thresholds were measured bilaterally in the C4 paraspinal musculature, lateral end of the clavicle and upper third of the tibialis anterior before and after a 'Diaphragm Release'. Results demonstrated a statistically significant hypoalgesic effect was only found in the spinal segment C4 in both the right (p=0.016) and left (p=0.004) sides. Averaging the hypoalgesic effect from both sides equates to a 17.17% change which is considered clinically significant, the effect magnitude was calculated to be small but educationally significant for the right (d=0.26) and left (d=0.40) sides. This study supports a novel neurophysiological mechanism, Regional Interdependent Inhibition, to induce a hypoalgesic state at segmentally related spinal segments, specifically C4. Suggesting that directing treatment towards the diaphragm, using a 'Diaphragm Release', could induce an immediate clinically and statistically significant hypoalgesic effect local to the fourth cervical segment due to its relationship with the phrenic nerve.

Can fascia's characteristics be influenced by manual therapy?

This essay looks into some fundamental properties of collagen and attempts to relate what the manual therapist does to the necessity of maintaining the collagen's strength under loads. In so doing we point out some difficulties in gathering relevant data applicable to the clinic and propose direction for further research.

Exercise prescription in chronic pain: Do manual therapists need to understand emotion?

Exercise prescription in chronic pain: Do manual therapists need to understand emotion?

Adverse events after cervical spinal manipulative therapy: Consensus based classification and definitions

Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result, incidence rates may be underestimated. The aim of this study was to develop a consensus-based classification of adverse events following cervical spinal manipulations which has good feasibility in clinical practice and research. Design: A three round Delphi-study. Medical specialists, manual therapists, and patients (n=30) participated in an online survey. In Round 1, participants were invited to select a classification system of adverse events. Potential complications were inventoried and detailed in accordance with the ICF and the ICD-10. In Round 2, panel members categorized the potential complications in their selected classification. During the third round, it was inquired of the participants whether they concurred with the answer of the majority of participants. Results: Thirty four complications were defined. Consensus was achieved for 29 complications for all durations [hours, days, weeks]. For the remaining five complications, consensus was reached for two of the three durations [hours, days, weeks]. Conclusions: A consensus-based classification system of adverse events after cervical spinal manipulation was developed which comprises patients’ and clinicians’ perspectives and has only a small number of categories. The classification system includes a precise description of potential adverse events and is based on international accepted classifications (ICD-10 and ICF). This classification system may be useful for utilization in both clinical practice and research.