Mechanical Diagnosis And Therapy Research Articles

Japanese Clinical Physical Therapists With the Mechanical Diagnosis and Therapy License Are More Competent and Confident in Pain Management Than Those Without It: A Cross-Sectional Study.

Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitationand the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R2 = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.

Ecological Validation and Reliability of an Ai-Based Mechanical Diagnosis and Therapy (MDT) System for Chronic Mechanical Low Back Pain

Ecological Validation and Reliability of an Ai-Based Mechanical Diagnosis and Therapy (MDT) System for Chronic Mechanical Low Back Pain

Research Priorities in the Mechanical Diagnosis and Therapy Among Diploma Therapists: An International Delphi Study.

Introduction Mechanical diagnosis and therapy (MDT) is the most researched approach in musculoskeletal physical therapy and involves classifying patients into sub-groups based on their response to loading strategies. MDT diploma therapists (Dip-MDTs) fully recognize the value of MDT in musculoskeletal physical therapy. MDT is updating its system based on the latest research, but the system has not yet been fully established. Therefore, more research is required to increase the comprehensibility of the system. Thus, we aimed to identify future research priorities of MDT. Methods We conducted a modified Delphi study with three rounds. The Research Advisory Committee(RAC) members (n=7) of the McKenzie Institute International were invited to participate in the initial idea generation round. In the subsequent two consensus rounds, Dip-MDTs (n=299) were asked to indicate their level of agreement with the results of the idea generation round using a five-point Likert scale.The criteria for consensus weremean score ≥4.0, coefficient of variation ≤30%, percent agreement ≥75%, and quartile deviation ≤1. A post-hoc analysis of the consensus was conducted when the number of participants from a certain country exceeded one-third of the total number of participants. Results The participation rates for each round were 57.1%, 52.2%, and 49.8%. The USA accounted for 43.6% and 44.3% of all participants at the two consensus rounds, respectively. Finally, nine items reached consensus in the second consensus round. After the post-hoc analysis, eight items reached consensus: (1) cost-effectiveness, (2) cervical and thoracic spine, (3) extremity classifications, (4) filtered randomized controlled trials (RCTs), (5) spinal source classification, (6) centralization and directional preferences, (7) predictive factors for recurrence, and (8) patient education. Conclusion In this study, we identified the research priorities of MDT that would enhance the completion of the MDT system.

The application of directional preference for chronic non-specific knee pain: A pragmatic, controlled, randomized clinical trial

Functional disability and chronic knee pain are frequent in combats sports participants. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a system for specific function examination and intervention for spinal and extremity musculoskeletal disorder. This clinical trial aimed to investigate the effectiveness of MDT, through Directional Preference, for specific function disability in Brazilian Jiu-Jitsu practitioners (BJJPs) experiencing chronic non-specific knee pain. MethodsSixty-five BJJPs with chronic non-specific knee pain were evaluated and classified according to the MDT system. Following classification, 28 BJJPs were randomized pairwise into intervention (IG) and control (CG) groups. The procedures were consistent with the principles of DP and the intervention period was 6 weeks and follow up was included. The primary outcome was specific functional disability evaluated using the Patient Specific Function Scale (PSFS) and the secondary outcomes were pain intensity and fear-avoidance in utilizing the symptomatic limb. Data were analyzed with a two-way analysis of variance (ANOVA) and repeated measures for the outcome factor were performed (p < 0.05). ResultsFor the specific functional disability, ANOVA revealed significant differences between groups based on group interaction and treatment factors (F (2, 52): 162,015; p < 0.001; η2: 0.208). The BJJPs allocated to the IG achieved significant improvements in specific functional disability, a mean difference of −4.36 (−5.01 to −3.72) post-interventional and −4.80 (−6.07 to −3.53) follow-up in the PSFS. Improvements in pain intensity and fear-avoidance were also achieved post-intervention and follow-up. ConclusionIntervention in accordance with DP promoted resulted in favorable outcomes for clinical effects on specific functional disability pain intensity, and symmetry index of the lower limbs. These findings suggest that intervention based on DP may be effective in the management of chronic knee pain in BJJPs.

Predictors of 1-Year Perceived Recovery, Absenteeism, and Expenses Due to Low Back Pain in Workers Receiving Mechanical Diagnosis and Therapy: A Prospective Cohort Study.

This multicenter prospective cohort study aimed to preliminarily explore statistically relevant modifiable and predetermined factors for 1-year perceived recovery, absenteeism, and personal expenses in workers who received Mechanical Diagnosis and Therapy (MDT) for low back pain (LBP). Three stepwise multiple regression models were explored with 42 independent variables, including (1) socio-demographic factors; (2) risk stratification; (3) pain-related variables, psychological variables, and behavioral variables at baseline and changes after a month; (4) therapeutic alliance and exercise adherence at 1-month follow-up; and (5) MDT classification and therapist levels. Data from 58 participants were analyzed, after which a model with a medium effect size was developed for 1-year perceived recovery only. Consequently, patients with derangement syndrome were expected to have improved 1-year perceived recovery, with expected predetermined prognostic factors including shorter symptom duration, self-management skills to lead a healthy life, and less pain catastrophization at baseline. A stronger therapeutic alliance between patient and therapist during the 1-month MDT intervention was identified as an expected modifiable prognostic factor. It may be difficult to accurately predict the annual absenteeism and personal expenses due to LBP given the weak to low effect sizes of the developed models.

Mechanical diagnosis and therapy in musculoskeletal pain of individuals with spinal cord injury

Context/Objective Musculoskeletal pain (MSKP) has high prevalence in individuals with spinal cord injury (SCI). Mechanical Diagnosis and Therapy (MDT) is a method focused on identifying the pain source in the musculoskeletal system and presents good results in pain relief in people without neurological impairment. However, no studies have investigated the use of MDT in SCI population. The objective was to evaluate the applicability and outcomes of MDT treatment in pain relief and independence improvement in daily activities of individuals with SCI presenting MSKP. Design Single-arm trial. Setting Rehabilitation Hospital Participants Twenty-four individuals with SCI who presented MSKP. Intervention MDT-certified physical therapist conducted assessments and treatments of pain according to the MDT approach. Outcomes Measures Numeric rating scale (NRS) was used to measure pain and Pain Disability Index (PDI) and Patient-Specific Functional Scale (PSFS) to evaluate daily activities. Results Significant median decreases were found for NRS (from 7 to 2) and PDI (from 27 to 8) after MDT, whereas PSFS score presented a significant mean increase (from 3.2–7.7). The average decrease in pain after MDT treatment was 70.9% (5.36 on the NRS). Conclusion MDT can reduce pain and enhance independence in daily activities in individuals with SCI and MSKP.

A Comparative Study between NSAID with McKenzie Exercise versus NSAID Treatment in Ankylosing Spondylitis

Background: McKenzie method of mechanical diagnosis and therapy (MDT)) is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) a system encompassing assessment, diagnosis and treatment for the spine and extremities. On the other hand, Ankylosing spondylitis (AS) is a type of arthritis that causes lower back pain, hip pain and a stiff back which causes due to overtime work, vertebrae in the spinal column. In relieving pain and inflammation in AS patients, non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world. Aim of the Study: The aim of this study was to compare between NSAID with McKenzie exercise versus NSAID treatment in Ankylosing spondylitis. Methods: This was a comparative experimental study which was conducted in the department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh from October 2019 to September 2020. The study was approved by Institutional Review Board (IRB) of BSMMU. A total of 112 patients with ankylosing spondylitis were selected who were divided into two groups. 56 patients were allotted in group A (NSAID group) and another 56 were allotted in group B (NSAID with McKenzie exercise). All comparative data were analyzed and disseminated by using MS Excel and SPSS version 23.0. Results: The mean age was 28.02±5.86 years in group A whereas 28.8±5.94 years in group B and the difference was statistically not significant (p&gt;0.05). The mean VAS score at baseline was 34.44±2.78 in group A and 34.03±2.23 in group B, at 4 weeks 28.89±3.67 in group A and 21.23±3.57 in group B, at 8 weeks 30.59±3.69 in group A and 16.95±3.62 in group B and at 12 weeks 28.08±3.34 in group A and 15.04±3.77 in group B. The mean BASFI at baseline was 3.19±0.15 in group A and 3.51±0.18 in group B, at 4 weeks 2.99±0.15 in group A and 2.15±0.05 in .....

Utilizing a Multi-Modal Approach of Spinal Manipulation and McKenzie Method of Mechanical Diagnosis and Therapy (MDT) Cervical Protocol in the Treatment of Cervical Radiculopathy in a 31-Year-Old Female

Neck pain is a leading cause of disability in the United States. Neck pain with radiculopathy is commonly seen in the Chiropractic office. Patients presenting with these symptoms may not benefit from immediate high velocity adjustments. Approaches like The McKenzie Method of Mechanical Diagnosis and Therapy provides a useful alternative.

Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients.

To determine predictors of failure to achieve minimal clinical important difference (MCID) for pain and disability at discharge after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain (NP). Pre- and post-treatment numerical pain rating scale (NPRS) and neck disability index (NDI) in patients with mechanical NP were analysed in this retrospective study. Multivariate analysis was performed to investigate the effect of covariates such as age, gender, lifestyle, body mass index, presentation, diabetes, osteoporosis, response to repeated movement testing, treatment sessions, compliance rate, and pre-treatment NPRS and NDI scores on failure to achieve MCID of ≥ 30% for NPRS and NDI scores post-treatment. In the 4998 patients analysed for this study, 7% and 14.5% of patients failed to achieve MCID for NPRS and NDI scores, respectively, at the end of treatment. Age > 70years, diabetes, osteoporosis, partial or non-response to repeated movements, lesser treatment sessions, and lower compliance rate were associated with increased risk for failure to achieve MCID for NPRS and NDI scores. A higher pre-treatment NDI score was associated with failure to achieve MCID for NPRS score, whereas lower pre-treatment NPRS and NDI scores were associated with failure to achieve MCID for NDI score. Although MDT-based multimodal rehabilitation helped to achieve significant reduction in pain and disability in mechanical NP, several baseline risk factors were associated with failure to achieve MCID for pain and disability after treatment. Identifying and modifying these factors as part of rehabilitation treatment may help to achieve better outcomes in mechanical NP.

Flexion Directional Preference in a Patient With Low Back Pain, Utilizing Mechanical Diagnosis and Therapy: A Case Report

Background Low back pain (LBP) is a complaint commonly seen by primary care physicians. Societal efforts to prevent LBP have led to more erect work environments to avoid excessive lumbar flexion. This case report involves an individual presenting with acute LBP after a hyperextension injury. Case Presentation The patient was assessed using Mechanical Diagnosis and Therapy (MDT), which is based on symptomatic and mechanical responses to repeated and sustained movements. The patient required movements into flexion, with modifications in loading strategies. Outcome and Follow-Up The patient was able to return to his prior level of function after 5 treatment sessions over 14 days and remained symptom free at long-term follow-ups. He was able to manage his symptoms without further health care management. Discussion This case report demonstrates that not all individuals require lumbar extension movements. It also demonstrates the clinical reasoning involved in a thorough MDT assessment, resulting in the resolution of symptoms. JOSPT Cases 2022;2(1):44–49. doi:10.2519/josptcases.2022.10006

Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study

ABSTRACT Objective To explore indicators that predict whether patients with extremity pain have a spinal or extremity source of pain. Methods The data were from a prospective cohort study (n = 369). Potential indicators were gathered from a typical Mechanical Diagnosis and Therapy (MDT) history and examination. A stepwise logistic regression with a backward elimination was performed to determine which indicators predict classification into spinal or extremity source groups. A Receiver Operating Characteristic (ROC) curve was constructed to examine the number of significant indicators that could predict group classification. Results Five indicators were identified to predict group classification. Classification into the spinal group was associated with the presence of paresthesia [odds ratio (OR) 1.984], change in symptoms with sitting/neck or trunk flexion/turning neck/when still (OR 2.642), change in symptoms with posture change (OR 3.956), restrictions in spinal movements (OR 2.633), and no restrictions in extremity movements (OR 2.241). The optimal number of indicators for classification was two (sensitivity = 0.638, specificity = 0.807). Discussion This study provides guidance on clinical indicators that predict the source of symptoms for isolated extremity pain. The clinical indicators will allow clinicians to supplement their decision-making process in regard to spinal and extremity differentiation so as to appropriately target their examinations and interventions.

Mechanical diagnosis and therapy in patients with extremity problems: A Systematic review

Background: Mechanical Diagnosis and Therapy (MDT) is used in the treatment of extremity problems. It is an effective approach in cases of spinal conditions for target population. Availability of the reliable data like RCT and systematic review is a key factor to determine the precise clinical problem and to direct an appropriate intervention. Objectives: The primary aim of this systematic review is to assess the methodological quality of well-designed RCTs related to the MDT classification and treatment for extremity problems. Design: Systematic review. Method: Electronic search on various data bases was done. The level of evidence was determined considering the methodological quality of the studies. Results: 1 RCT was included and it met the criteria for high quality. After the assessment of RCT according to the CONSORT guidelines it was found that out of 25 checklist points; 4 methodological faults were found in assessed RCT. Those were; a) sample size determination, b) Blinding after assessment c) Generisability of the trial findings d) Where the full trial protocol can be accessed. Conclusion: The current systematic review found strong evidence of benefits of MDT approach for extremity problems (knee joint). But there was limited evidence in other extremity joints.

Development and Feasibility Testing of an Animated Cartoon-Based Self-Care Application for Low-Back Pain – a Pilot Study

Objectives: Use of animated cartoon for pain management is an emerging area, however, no study have explored it as a digital platform for rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This two-phase study comprised a development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocolplus back hygiene following standard iteration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with 'direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilized the cartoon-based app thrice weekly for two weeks. Outcomes were assessed in terms of usability, satisfaction and user’s experience using the system usability scale and mobile application rating scale. Quadruple visual analogue scale was used to assess pain intensity of the participants. Results: On a unified scale of 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42 respectively. Total impact and usability score was 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants reported that back care cartoon app mostly affect mindfulness/meditation/relaxation (42.9%), increases happiness/well-being (46.4%), leads to behavioural change (60.7%) and targets physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p&gt;0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP.

Rehabilitation and return to sport of a high-level track & field athlete with low back pain - a case report.

ABSTRACT INTRODUCTION: Low back pain is prevalent among elite athletes with initial high levels of physical activity. Currently, there is a lack of evidence describing the optimal management strategy of high-level track and field athletes presenting with low back pain. CASE DESCRIPTION: This case report describes the clinical management and return-to-sport strategies of a male high-level track and field athlete presenting with low back pain in an outpatient physiotherapy clinic. Mechanical diagnosis and therapy (MDT) served as an important tool in the clinical management of the athlete. Patient-Specific Function Scale (PSFS), an 11-point scale (0 = unable to perform activity to 10 = able to perform activity at preinjury level), was used during three activities: hammer throw, squats and getting socks and shoes on. OUTCOMES: Eight weeks after initial consultation (15 weeks after the index injury), the athlete returned to sport and competition at national championship-level. PFPS scores at final consultation: hammer throw – 10/10; squats – 10/10 and getting socks and shoes on – 10/10. CONCLUSION: In combination with modern rehabilitation strategies, MDT provided the opportunity to engage the athlete as an active collaborator, which is in accordance with current clinical guidelines and best practice.

Inter-rater Reliability of the McKenzie Method of Mechanical Diagnosis and Therapy for the Provisional Classification of Low Back Pain in Adolescents and Young Adults

ABSTRACT Objective To investigate the inter-rater reliability of Mechanical Diagnosis and Therapy (MDT)-trained Diplomats in classifying adolescents and young adults with lumbar pain. Methods Forty-three participants (mean age 15 ± 2 years) with lumbar pain, with or without lower extremity symptoms, were assessed simultaneously by three MDT Diploma holders and classified into one of three groups: 1) Derangement, 2) Dysfunction, 3) Postural/OTHER. Inter-rater reliability was calculated using the Fleiss kappa statistics with 95% confidence intervals (CI). Analyses were repeated with the younger (11 to 15 years old) and older (16 to 21 years old) age groups. Results There was moderate reliability (Fleiss kappa = 0.50, 95% CI = 0.45 to 0.54) for the entire sample, which was statistically significant (p < 0.001). There was good reliability in older participants (Fleiss kappa = 0.63, 95% CI = 0.57 to 0.70), but poor reliability in younger participants (Fleiss kappa = 0.33, 95% CI = 0.27 to 0.39). There was 100% agreement in classifications among assessors for 70% of participants. Discussion The MDT system has moderate reliability when classifying lumbar pain in adolescents and young adults. Future reliability studies may include a balanced group for classifications or a second session.

Single case study applying Mechanical Diagnosis and Therapy (MDT) to assess and manage shoulder pain

Single case study applying Mechanical Diagnosis and Therapy (MDT) to assess and manage shoulder pain

Primary care management of patients with pain complaints and the influence of physician training in mechanical diagnosis and therapy

Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits. The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT. This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19). The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints. Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care.

The biomechanical Nature of nucleus Pulposus in a fissured disc revealed by quantitative MRI performed under dynamic conditions

Physiotherapy is a health care discipline based on movement assessment and treatment. Mechanical Diagnosis and Therapy (MDT) is a reliable and efficient approach using repeated end-range movements ...

Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain?

Background: Mechanical diagnosis and therapy (MDT) and the stratified approach using the Keele STarT Back Screening Tool (SBST) are examples of stratified low back pain (LBP) management. We investigated whether the medium–high risk in SBST can contribute to the time and sessions until discharge from MDT (Question 1) and to the loss of follow-up before identifying a promising management strategy (Question 2). Methods: A retrospective chart study was conducted. Multiple regression modeling was constructed using 10 independent variables, including whether the SBST was medium–high risk or not for Question 1, and the 9/10 independent variables for Question 2. Results: The data of 89 participants for Question 1 and 166 participants for Question 2 were analyzed. SBST was not a primary contributing factor for Question 1 (R2 = 0.17–0.19). The model for Question 2 included SBST as a primary contributing factor and the shortest distance from the patient address to the hospital as a secondary contributing factor (93.4% correct classification). Conclusion: SBST status was not a primary contributing factor for time and sessions until discharge from MDT, but was a critical factor for the loss of MDT follow-up before identifying a promising management strategy.

Short-term effect of muscle energy technique and mechanical diagnosis and therapy in sacroiliac joint dysfunction: A pilot randomized clinical trial

IntroductionSacroiliac joint dysfunction (SIJD) is a prominent source of pain in low back pain (LBP) patients. Tenderness inferior to the posterior superior iliac spine (PSIS) is an important sign presented in SIJD. Techniques including muscle energy technique (MET) and mechanical diagnosis and therapy (MDT) have shown benefits in SIJD. However, the effects of these treatments on tenderness and pain around the PSIS are yet to be determined. AimCompare and examine the preliminary short-term effect of MET and MDT on tenderness and pain around the PSIS in SIJD. MethodsTwenty patients, aged between 20 and 65 years and diagnosed with unilateral, sub-acute, or chronic SIJD, were screened for the inclusion criteria and were randomly allocated to the MET or the MDT group. Both the groups received treatment for four sessions over one week. Pain pressure threshold (PPT) and visual analogue scale (VAS) were determined by a blinded assessor on pre- and post-treatment basis. ResultsAlthough no significant differences were observed following the treatment between the groups, some statistically significant (p < 0.05) improvements were observed within each of the groups. No drop-outs and no adverse events were reported. ConclusionThe findings of the study suggest that both interventions may be equally effective in reducing symptoms around the PSIS. However, due to the small sample size, the results need to be interpreted cautiously. Future studies on larger sample size and long-term follow up are warranted.