Manual Treatment Techniques Research Articles

Dosimetry and effect of talocrural thrust manipulation on the range of motion in subjects with chronic ankle instability

Introduction: Chronic ankle instability (CAI) is described as the patient’s sense of an abnormal ankle, which is characterized by a combination of symptoms such as recurrent sprains, discomfort, edema, or activity avoidance. Talocrural thrust manipulation (TCTM) is a manual treatment technique that includes applying a manual push to a specific motion segment, often in the form of a joint glide. The study aimed to find out the dosimetry and effect of TCTM on the range of motion (ROM) and quality of life (QoL) in subjects with CAI. Materials and Methods: Forty subjects fulfilling the selection criteria were included in the study, with single group repeated measures design. A talocrural thrust is given to the ankle and outcomes were assessed during 1st week, 2nd week, and 3rd week after the intervention, and the scores were recorded. Results: The group was ranging from 13 to 22, with a mean and standard deviation (SD) of 16.15 ± 2.28. After 1 week, showed an increase in the range of 17–29, with a mean and SD of 22.40 ± 2.75. Similarly, for 2 weeks, the range increased to 24–32 with a mean and SD of 29.53 ± 1.71 after 2 weeks. However, the range was found to have increased to 31–34, with a mean and SD of 32.35 ± 0.70, and found to be statistically significant (P < 0.001). Conclusion: TCTM is effective in improving ROM and QoL in people who have persistent ankle instability. Talocrural thrust manipulation technique stimulates the proprioceptive awareness which is often impaired in chronic instability subjects targeting the joints with specific thrust to treat pain and dysfunction and the consistency of the movement underlying the tissues which is more crucial in identifying the restrictions of the joint. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice

A Comparative Study on the Effects of Trigger Point Release vs Myofascial Release for Myofascial Trigger Points of Upper Trapezius in Smartphone Users

Background/aim: The increasing use of smartphone in daily life has brought about numerous musculoskeletal problems. Impairments in the neck is the most common when compared to other parts of the body. The aim of this study was to compare the effects of two different manual treatment techniques in two separate groups, i.e., trigger point release and Myofascial release (MFR) on the trigger points (TrPs) in the upper trapezius muscle in smartphone users. Both group received Ultrasound therapy. The smartphone addiction scale -short version was administered to all participants to determine the level of addiction and those who scores were high were included in the study. The set criteria in the study included the pain intensity on the visual analogue scale (VAS) neck disability using the Neck Disability Index and Cervical Range of motion side flexion using cervical goniometer. Subjects and methods: This clinical trial study assessed the outcome measures within and between groups before, after the intervention and a follow up was done after 15 days. The target population were smartphone users between the age group of 18 to 35 years. 106 subjects (48 males, 53 females) participants who had been selected from among the eligible participants of 176 and who had TrPs in their upper trapezius muscle. Results: The effect of Trigger point release and Myofascial release on patients of each groups with TrPs in the upper trapezius muscle resulted in increased cervical lateral flexion (P < 0.001), decreased pain intensity on VAS (P < 0.001) and decreased decrease in Neck disability (P < 0.001) within the groups and between the group there was no significance. Conclusion: Both manual techniques Trigger point release and Myofascial release reduced the symptoms of TrPs in the upper trapezius in both the groups equally, neither technique being superior to the other.

Integration of Osteopathic Manual Treatments in the Management of Foot Dystonia in Parkinson’s Disease: A Case Series

Parkinson’s disease and focal limb dystonia are neurological movement disorders that may occur co-morbidly, often leading to more severe gait impairment and pain. Treatment options for foot dystonia in Parkinson’s disease are limited and have variable outcomes. Osteopathic manual treatment techniques were previously found to improve gait in Parkinson’s disease. Here, we present three cases in which osteopathic manual treatment was used to treat foot dystonia in patients with Parkinson’s disease. The most prominent features of the foot dystonia were cramping and pain in the foot and ankle radiating up to the ipsilateral torso and involuntary foot inversion. The common musculoskeletal dysfunctions found were spasm of ipsilateral hip adductor muscles, psoas, gastrocnemius, and one or more intrinsic ankle and foot muscles as well as calcaneal inversion and restrictions to motion of the tarsal bones. All patients reported improvement in pain and mobility following treatment that lasted five to seven days. Future research is necessary to define and test the effectiveness of a specific treatment protocol in the long term management.

Somatic Dysfunction and Use of Osteopathic Manual Treatment Techniques During Ambulatory Medical Care Visits: A CONCORD-PBRN Study

Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Cross-sectional card study. Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. A total of 668 patients seen between January and March 2013. Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial

BackgroundThe safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy. The aim of this randomized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists (i.e. chiropractors, naprapaths, osteopaths, physicians and physiotherapists) for patients seeking care for back and/or neck pain. In addition women and men were compared regarding the occurrence of adverse events.MethodsParticipants were recruited among patients, ages 18–65, seeking care at the educational clinic of the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 767) were randomized to one of three treatment arms 1) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage) (n = 249), 2) manual therapy excluding spinal manipulation (n = 258) and 3) manual therapy excluding stretching (n = 260). Treatments were provided by students in the seventh semester of total eight. Adverse events were measured with a questionnaire after each return visit and categorized in to five levels; 1) short minor, 2) long minor, 3) short moderate, 4) long moderate and 5) serious adverse events, based on the duration and/or severity of the event. Generalized estimating equations were used to examine the association between adverse event and treatments arms.ResultsThe most common adverse events were soreness in muscles, increased pain and stiffness. No differences were found between the treatment arms concerning the occurrence of adverse event. Fifty-one percent of patients, who received at least three treatments, experienced at least one adverse event after one or more visits. Women more often had short moderate adverse events (OR = 2.19 (95% CI: 1.52-3.15)), and long moderate adverse events (OR = 2.49 (95% CI: 1.77-3.52)) compared to men.ConclusionAdverse events after manual therapy are common and transient. Excluding spinal manipulation or stretching do not affect the occurrence of adverse events. The most common adverse event is soreness in the muscles. Women reports more adverse events than men.Trial registrationThis trial was registered in a public registry (Current Controlled Trials) (ISRCTN92249294).

The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 2: Treatment

Background and Objectives Little is known concerning the preferences for technique selection by osteopaths in the United Kingdom (UK) for the treatment of spinal, pelvic and sacroiliac dysfunction or for the methods of documentation of dysfunction in case records. Part 1 described the perception of usefulness and reported use of physical assessment procedures. This second part surveys the treatment methods reported to be commonly used by UK osteopaths. Methods A web-based questionnaire using a 5-point Likert scale and open-ended responses was developed. Invitations were e-mailed to all registrants of the General Osteopathic Council in the UK with a listed e-mail address. The available response categories (strongly disagree, disagree, etc.) were converted into numerically weighted scales. Responses in the “frequently” and “nearly always” categories were combined for summary reporting purposes. Friedman tests were used to determine if significant differences existed for the reported usage of each item. The effect of gender was analysed using Mann–Whitney tests. The effect of years of practice was examined by categorizing practice experience by decade (0–9, 10–19, 20+) and analysing using Kruskal–Wallis tests. Results 520 Osteopaths (56% male, 44% female) participated in the survey, which was a 19% response rate. Procedures for the treatment of dysfunction of the spine reported to be most commonly used were passive joint articulation (91%) and soft tissue technique (91%), followed by prescription of patient self-stretches (76%) and high velocity low amplitude thrust (HVLA, 74%, p < 0.001). Females reported more frequent use of a number of procedures, but male respondents reported more frequent use of HVLA ( p < 0.012). Respondents with 20 or more years experience reported use of a number of techniques less frequently than less experienced respondents. Preferences for the treatment of pelvic and sacroiliac dysfunction mirrored those for the spine. The majority of respondents document the physical findings associated with spinal dysfunction and note the specifics of dysfunction using motion restriction terminology. Conclusion Survey respondent osteopaths in the UK use a large range of manual treatment techniques, with a preference for direct techniques, such as passive joint articulation, soft tissue technique, and HVLA. Females reported more frequent use of a number of procedures, which may represent a reporting bias, but male respondents reported more frequent use of HVLA.

The Effect of an Analgesic Mobilization Technique When Applied at Symptomatic or Asymptomatic Levels of the Cervical Spine in Subjects with Neck Pain: A Randomized Controlled Trial

The purpose of this single-blinded, randomized controlled trial was to compare the effects of a manual treatment technique on neck pain and movement sensation when applied in different segments of the cervical spine. Consecutive patients with neck pain (n=126) were recruited and randomly allocated to two groups (A or B). Group A received a single 4-minute pain-alleviating traction at the most symptomatic zygopophyseal joint of the cervical segment, where movement was correlated with pain. Group B received the same treatment 3 segments away from the concordant segment. Pain intensity and sensation of movement were assessed with a numeric rating scale (NRS). Statistical analysis included a t-test for paired and unpaired samples. Pre- and post-test findings demonstrated significant improvements in both types of mobilization although there was no significant difference between the two groups. Similar results have been reported in the literature for cervical manipulation. The findings of this study question the necessity of precise symptom localization tests for a pain treatment. However, limitations of the study prevent generalization of these results.

Myofascial release: an evidence-based treatment approach?

Objectives To assess the current state of scientific knowledge about myofascial release, a noninvasive manual treatment technique, and to identify the reliability of diagnostic tests for myofascial dysfunction and efficacy of the treatment. Methods A literature search was undertaken, as well as exploring more widely for information concerning the subject, allowing an assessment of the rationale for the treatment and of the studies carried out. Results Twenty-three items were identified in the literature search. No studies were found with which to determine reliability of the diagnostic method, but four randomised controlled studies of the treatment were identified. Two of the efficacy studies comprised several different modalities of treatment, so that no conclusions could be drawn. In one further study, the numbers were too small to allow safe conclusions; in the other, the myofascial release treatment was inferior to an isometric contract-relax technique. Overall, no good evidence of efficacy has been shown. Conclusions We are unable to reach any conclusion on the diagnostic criteria and methods or on any efficacy of myofascial release. We recommend strongly that reliability studies be performed on diagnostic tests for myofascial dysfunction (tightness/looseness), so that efficacy studies can be performed on a more solid diagnostic foundation.

Evidence behind stroke rehabilitation

Stroke is a common and serious condition for which there is no routinely available curative treatment. Because of the high burden of disability and the lack of a widely applicable...

Upper Extremity Syndromes

This article reviews various manual treatment techniques for the upper extremity with an emphasis on their application to common nerve compression syndromes. Aggressive and carefully focused manipulation that avoids direct pressure on the nerve is applied to alleviate symptoms and circumvent the need for more invasive action. Relevant manipulative treatment approaches are defined independently and directed toward common joint, mus-culoligamentous, and inflammatory disorders. Palpatory assessment also is introduced as a potential adjunctive method to assist with diagnosis and treatment.