Manual Therapy Interventions Research Articles

Do manual therapies have a specific autonomic effect? An overview of systematic reviews.

The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied. We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation. We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied. The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.

Plantar fasciopathy\u2014looking beyond the obvious? A case report

BackgroundThe biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility.Case presentationThe patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes.ConclusionThe manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

A comparison of treatment signatures of high and low performing physical therapists for patients with lower back pain: analysis of spine care from a physical therapy outcomes registry

IntroductionLower back pain (LBP) is the most common orthopedic complaint in the United States. Physical therapy is recommended as a conservative, non-pharmacological intervention for LBP. While it is thought that skill level and effectiveness of physical therapists differ, there is little understanding regarding characteristics that distinguish high and low performing physical therapists. The purpose of this study was to compare differences in care delivery, termed treatment signatures, between high and low performing physical therapists previously differentiated by a risk-adjusted performance measure. MethodsUsing previously published methodology, 1,240 physical therapists were classified as “outperforming”, “meeting expectations”, or “underperforming” relative to predicted change in Modified Low Back Pain Disability Questionnaire (MDQ) across patients receiving care for LBP. Patients were divided into quartiles of baseline disability per initial MDQ. Two-way analyses of variance were used to compare billed (1) active, exercise-based units per visit (UPV), (2) manual therapy UPV, (3) modality UPV, and (4) the combination of active and manual therapy UPV (broadly termed skilled UPV) by performance cohort and baseline patient disability quartile among physical therapists deemed “outperforming” and “underperforming”. Tukey's post hoc tests established mean differences with 95% confidence intervals. ResultsPhysical therapists that “outperformed” (n=120; 17,404 patients) used more active UPV (mean difference (diff) = 0.1, p<.001), manual therapy UPV (mean diff = 0.2, p<.001), and skilled UPV (mean diff = 0.3, p<.001), and less modality UPV (mean diff = 0.1, P < 0.001) than those that “underperformed” (n=139; 21,800 patients). Tukey's post hoc tests showed that while differences in care were negligible in patients with low baseline disability, the highest performing PT cohort delivered skilled (0.4 UPV), active (0.2 UPV), and manual therapy (0.2 UPV) UPV at a significantly higher mean rate in patients with the highest baseline disability. ConclusionsClinically effective physical therapists incorporated a treatment signature that included a consistent blend of skilled active and manual therapy interventions that was distinct from lower performing physical therapists. While group mean differences were relatively small, a consistent pattern emerged in which high performing physical therapists maintained a high level of skilled, one-on-one interventions across their entire caseload—while their lower performing counterparts significantly decreased use of the same interventions as baseline disability increased. These differences highlighted a treatment signature that was associated with clinically important improvements for patients with greater baseline disability. Future guideline recommendations should consider the importance of baseline disability and the consistent application of skilled active and manual therapy interventions.

Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes

Introduction/purposeLiterature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement (MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions. Methodology/sampleIn this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance. ResultsANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm. Discussion/clinical relevanceSpecifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a “low risk-high reward” clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.

Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions.

Background: Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m2) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen's d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen's d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable.

Efficacy of manual therapy interventions in management of lumbar prolapsed intervertebral disc: A pilot randomized controlled trial

Background. This pilot trial reports the initial estimates of the efficacy of manual therapy interventions in lumbar prolapsed intervertebral disc and determines the feasibility and acceptability of full powered “randomized controlled trial” on efficacy of “spinal mobilization with leg movement (SMWLM)”, high velocity low amplitude thrust (HVLA) and neural mobilization (NM) in lumbar PIVD (Prolapsed Inter-Vertebral Disc) and pilot data will be used to perform sample size calculation for full trial. Material and methods. 48 subjects diagnosed lumbar PIVD were randomly distributed into 4 groups. The primary outcomes were feasibility, assessment procedure, retention rate, adherence and acceptability to the intervention. The secondary outcomes measures were pain, disability and straight leg raise (SLR) range of motion. Results. 90 subjects were screened based on selection criteria. Out of them, 50 (55.55%) were eligible. 48(96%) subjects accepted to participate in study. Baseline data of all the groups was similar but post-intervention score were significant when compared the data between the groups. Highest mean change for visual analog scale (VAS), oswestry disability index (ODI) and SLR were found in SMWLM group. No adverse effects were reported by subjects. Results also suggest that the outcome measures were feasible and acceptable and the treatment considered as the beneficial approach. Conclusions. Present study suggests that it is feasible and acceptable to do a fully powered “randomized controlled trial (RCT)” to evaluate the efficacy of manual therapy interventions in management of lumbar PIVD. This study also reveals that manual therapy interventions are effective in management of lumbar PIVD.

Exercise therapy for chronic low back pain.

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity.For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment

Aim: An observational cohort study to determine whether localised manual therapy results in a preferential increase in mobility of the targeted motion segment.Method: Eighteen participants with mechanical neck pain had three MRIs of their cervical spine. The first two were taken prior to treatment in neutral and at the end of active rotation in their more limited rotation. Participants received localised manual therapy targeting a motion segment deemed to be relevant to their presentation until either their range increased by > 10° or 8 min, whichever came first. A third MRI was performed immediately after treatment with their head in the same rotated position as pre-treatment. In the images, each vertebra was segmented using a semi-automated process. Movement between neutral and rotated positions was calculated as Euler angles and distance of facet translations for each motion segment.Results: Rotation and lateral flexion at the targeted location increased by 40% (mean 0.86° (CI: 0.24–1.48) and 15% (mean 0.52° (CI: 0.17–1.21) respectively with only the CIs for rotation not containing zero. The mean changes for the non-targeted locations were less than 0.1° for each axis and all CIs contained zero. Facet translations at the targeted location increased by 25% (0.419 mm) and decreased by >4% (>0.01 mm) at the untreated locations but the wide CIs both contained zero.Conclusion: Localised manual therapy seems to have a preferential effect on mobility of the targeted motion segment. The findings support considering segmental dysfunction in clinical reasoning and the use of specifically targeted manual therapy interventions.

A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%-15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group Pretest-Posttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. “Foot function index,” “Podia scan,” “Navicular drop test” will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. That will be the first study to compare the effect of hip abductors strengthening and manual therapy.

Exercise Programs Targeting Scapular Kinematics and Stability Are Effective in Decreasing Neck Pain: A Critically Appraised Topic

Clinical Scenerio: Neck pain is a costly symptom in both civilian and military worlds. While traditional treatments include deep neck flexor stabilizing exercises, manual therapy, electrical therapy, and other nonsurgical interventions, scapular orientation and stability training has emerged as a possible tool to reduce neck pain severity. Methods that can be coached at a distance could be of value in virtual appointments or circumstances where access to a qualified manual therapist is limited. Focused Clinical Question: What is the effectiveness of including exercise programs targeting scapular kinematics and stability to decrease neck pain? Summary of Key Findings: Exercise programs targeting scapular kinematics and stability, with coaching and individualized progressions, appear to reduce neck pain severity. Clinical Bottom Line: Evidence supports the inclusion of exercises for scapular kinematics and stability at a prescription of 3 sessions per week, with a duration of 4 or 6 weeks. Exercise programs should include a "learning" or coaching phase to ensure exercises are performed as intended, and exercise progressions should be based on participant ability rather than predetermined timelines. Further research is needed to better understand the benefits of this potential strategy and the statistical impact of scapular-focused exercise interventions on neck pain in specific populations like military and athletes. Strength of Recommendation: There is 'Fair' to 'Good' evidence from 2 level 1b single-blind randomized control studies and 1 level 2b pre-post test control design study supporting the inclusion of exercise programs targeting scapular kinematics and stability to decrease chronic neck pain severity.

Perceptions and experiences of a manual therapy trial: a qualitative study of people with moderate to severe COPD

BackgroundChronic obstructive pulmonary disease (COPD) presents with physical, emotional and social difficulties that affect quality of life. Multimodal management includes both pharmacological and non-pharmacological strategies, and pulmonary rehabilitation (PR) plays an important role. Recent research has suggested that manual therapies may improve perceptions of dyspnea for people with COPD.MethodsFocus group interviews were conducted as part of a mixed methods study to assess the feasibility of implementing a manual therapy technique—muscle energy technique (MET)—as an adjunct to PR for people with moderate to severe COPD. Focus group interviews were conducted to examine trial participants views of the intervention and the trial design. A thematic analysis was undertaken to explore the data.ResultsTwelve participants with moderate to severe COPD participated in three focus groups. Participants were motivated to participate in the trial to be proactive about their health. They perceived MET to be a gentle, comfortable form of stretching that allowed them to ‘breathe easier’ and prepared them for PR. A small number of participants reported mild muscular discomfort during MET, but this was short-lasting and was not bothersome. Participants enjoyed the one-on-one contact with researchers and learned more about their breathing while performing spirometric testing. Most participants wanted longer and more frequent MET sessions, and some requested ‘homework’ stretching exercises.ConclusionsThe findings of this study show that a manual therapy intervention was received well by participants in a clinical trial setting. A small number of participants reported mild musculoskeletal discomfort in relation to the MET treatment. Participant preferences for additional and longer treatment sessions should be carefully considered against available resources in future clinical trials.Trial registrationANZCTR, ACTRN12618000801213. Registered 11 May 2018 - Retrospectively registered. http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374643&isReview=true

The acute effect of two massage techniques on functional capability and balance in recreationally trained older adult women: A cross-over study

With aging comes a reduction in neuromuscular and neuromotor function. Different strategies have been used to mitigate these functional losses. Certain manual therapy techniques and interventions have been explored with regard to their ability to improve functional capability and balance in an older adult population. The purpose of this study was to analyze the acute effects of two massage techniques on functional capability and balance performance in recreationally trained older adult women. Twenty-eight older adult women (66.74 ± 4.61 years) completed three interventions: a) stick massage followed by functional capability and balance performance tests (MMS), b) manual massage followed by functional capability and balance performance tests (MM), c) no MMS or MM (control condition (CC)) – only performed the functional capability and balance performance tests. Functional capability was assessed by four tests that are part of the Senior Fitness Test: the 6-min walk (W6), the chair sit-and-reach (CSR), the 8-foot up-and-go (8FUG), and the 30s-chair stand (30s-CS). Balance was assessed using the Berg Balance Scale (BBS). Significant differences (p < 0.001) were observed between MM and MMS compared to CC among 30s-CS, W6, CSR, and 8FUG. BBS showed a significant difference between MM and CC (p = 0.041). Both MM and MMS demonstrated significant acute improvements in the functional capability of recreationally trained elderly women and may be included in an exercise program.

Effect of Manual Therapy Interventions on Range of Motion Among Individuals with Myofascial Trigger Points: A Systematic Review and Meta-Analysis.

Patients with myofascial trigger points (MTPs) frequently manifest restricted range of motion (ROM) during physical evaluation. Multiple manual therapy interventions have been developed for the treatment of MTPs, but their effect on ROM has not been clarified through a systematic review and meta-analysis. Thus, this systematic review aimed to assess the effect of manual therapy interventions on ROM among individuals with MTPs. A systematic search was conducted in PubMed, Web of Science, Cochrane, Scopus, and Clinical Trials.gov. Articles analyzing the effect of manual therapy interventions on ROM were included. The risk of bias was assessed with the Cochrane Risk of Bias (RoB) 2 tool. The DerSimonian-Laird method was used to compute the pooled effect size (ES) and its 95% confidence interval (95% CI) for ROM. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES for ROM was 0.52 (95% CI: 0.42-0.63). The pooled ES for ROM evaluated in centimeters was 0.36 (95% CI: 0.14-0.59), and the pooled ES for ROM evaluated in degrees was 0.57 (95% CI: 0.47-0.68). Manual therapy interventions may be an effective approach for improving ROM among individuals with MTPs.

Manual Therapy: Always a Passive Treatment?

The use of manual therapy as an intervention has garnered intense debate, one that is often mired in a straw-man argument that manual therapy is a purely passive intervention. When passive interventions are equated with low-value care, it is easy to deride manual therapy as low-value care. However, manual therapy describes a wide variety of treatments, some with passive components and some that are primarily passive in certain scenarios. But manual therapy can be an integral part of highly active treatment strategies. We implore investigators to describe manual therapy interventions in sufficient detail so that they can be reproduced and thereby help the end users of research (including clinicians) to better assess the value of such interventions. This Viewpoint challenges the assumption that manual therapy is always a passive treatment of low value. J Orthop Sports Phys Ther 2021;51(10):474-477. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10330.

The Management of Balance and Proprioception Discrepancies for a Patient with Cervicogenic Headache: A Case Report

Introduction: Previous research studies have established a link between cervical dysfunction, proprioception, and balance deficits in patients with cervicogenic headache. However, no current research exists to determine if the implementation of a balance program for these patients has any effect on their balance and proprioception capabilities. This case study aimed to identify if significant changes can be made the overall balance of a patient with cervicogenic headache as measured by the NeuroCom Sensory Organization Test. Case Description: The patient was a 50-year-old female, who had been suffering from long term cervicogenic headaches with increasing frequency and intensity for 6 months. Outcomes: The patient was seen for six visits over six weeks for balance training in addition to traditional physical therapy interventions including manual therapy and therapeutic exercise. After 6 sessions the patient made an overall improvement in balance (+7.9%) measured via the NeuroCom Sensory Organization Test and clinically significant improvements in reported pain via the Headache Disability Index (91.6%), Neck Disability Index (63.6%) and the Visual Analog Scale (2.5 points). Discussion: This case report demonstrates when balance training is added to standard manual therapy interventions for the management of cervicogenic headache you can successfully improve overall balance control measured with the NeuroCom Sensory Organization Test. Further research is necessary to further validate balance programming as a key intervention strategy for the general population with cervicogenic headache and guide decision-making for these patients.

Effectiveness of manual therapy in patients with thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis

ABSTRACT Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29–1.44, p = .003), for pinch strength was 0.10kg (95% CI = –0.01–0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07–1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.

Effect Of Cupping Massage and Modified Spinal Decompression Therapy With Exercise Therapy in Neck Radiculopathy Syndrome

Cervical radiculopathy Syndrome (CRS) is a common neuro-musculo-skeletal disorder causing pain and disability. Manual therapy interventions including cervical traction with other treatment modalities have been advocated to decrease pain and disability caused by cervical radiculopathy (CR). Al-Qudah &amp; AL-Jazzazi (2021) conducted a new method of Spinal Decompression Therapy (SDT) in patients with Chronic Lumbar Disc Herniation (CLDH) which includes Combination of Lumbar Traction With Cervical Traction (CLTCT) as one intervention. Despite of that this new method clinically reduces pain and disability more effectively than the conventional types of Traction, CLTCT method was not previously used in CR patients nor with Cervical Disc Herniation (CDH). The clinical effectiveness of this new method with other treatment modalities in patients with CRS was not approved yet. OBJECTIVE: The purpose of the presented work is to identify the effectiveness of rehabilitative program on patients with Cervical Radiculopathy, by (15) sessions for (4) Weeks. The suggested Rehabilitative program consisted of: 1.Supine Soft Full Back, Shoulders and Neck Cupping Massage (CM) for (10) minutes, 2.CLTCT: Combined Lumbar Traction with Cervical Traction as one intervention for (20) minutes, 3.Gradual Therapeutic Exercise Package of Neck Stretching and Strengthening Exercise for approximately (15) minutes. METHODS: In this study, Five outdoor male patients had accepted to participate and were randomly chosen from Al-Karak Governmental Hospital, All subjects applied the proposed rehabilitative program. The results were analyzed using the SPSS system. RESULTS: indicates that there was statistically significant difference between the pre and post measurements in favor of the post measurements in terms of Pain, Disability. CONCLUSIONS: The present study demonstrated that the use of proposed rehabilitative program has a positive effect on patients with Cervical Radiculopathy.

169 Literature Review on Efficacy of Manual Therapy in The Conservative Treatment of Adolescent Idiopathic Scoliosis (AIS)

Abstract AIS is a common condition whose conservative options usually involve physical therapy. Manual therapy can be part of an adequate conservative strategy due to his ability to improve range of motion and decrease muscle tone and pain. However, his indications and efficacy remain controversial. What is the current evidence on indications and efficacy of manual therapy in the treatment of AIS? Customized structured electronic searches: PubMed, Cochrane. Key terms: AIS manual therapy, AIS manipulative therapy, AIS mobilization exercises. 17 works included. 5 case reports, 3 case series, 2 group-control studies, 3 narrative reviews, 4 systematic reviews. Complications:0. Reviews suggested that manual therapy is a promising option if in adjunct to physical therapy exercises. Prevention of curve progression and better spine flexibility are often achieved. It remains unclear whether this should be attributed to physical therapy, manual therapy, or combination of both. Lacks in methodology leave room for uncertainty. Only few papers analyse the indications and efficacy of manual therapy in treatment of AIS. The current evidence suggest that manual therapy is a promising beneficial treatment strategy for AIS with conservative indications, especially if in conjunction with physical therapy. This is further supported by absence of reported complications. Further research with better methodology is needed.

The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review.

Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED. We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises. The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training. A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED. Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev 2022;10:162-167.

Repetitive in vivo manual loading of the spine elicits cellular responses in porcine annuli fibrosi.

Back pain and intervertebral disc degeneration are prevalent, costly, and widely treated by manual therapies, yet the underlying causes of these diseases are indeterminate as are the scientific bases for such treatments. The present studies characterize the effects of repetitive in vivo manual loads on porcine intervertebral disc cell metabolism using RNA deep sequencing. A single session of repetitive manual loading applied to the lumbar spine induced both up- and down-regulation of a variety of genes transcribed by cells in the ventral annuli fibrosi. The effect of manual therapy at the level of loading was greater than at a level distant to the applied load. Gene ontology and molecular pathway analyses categorized biological, molecular, and cellular functions influenced by repetitive manual loading, with over-representation of membrane, transmembrane, and pericellular activities. Weighted Gene Co-expression Network Analysis discerned enrichment in genes in pathways of inflammation and skeletogenesis. The present studies support previous findings of intervertebral disc cell mechanotransduction, and are the first to report comprehensively on the repertoire of gene targets influenced by mechanical loads associated with manual therapy interventions. The present study defines the cellular response of repeated, low-amplitude loads on normal healthy annuli fibrosi and lays the foundation for future work defining how healthy and diseased intervertebral discs respond to single or low-frequency manual loads typical of those applied clinically.