Non-thrust Mobilization Research Articles

Comparison of thrust manipulation and non-thrust mobilization techniques on pain in athletes with chronic ankle sprain

Background: Chronic ankle sprains can be effectively treated with either thrust manipulation or non-thrust mobilisation of the ankle joint, according to a number of studies. On the other hand, it is unknown if thrust manipulation or non-thrust mobilization is superior to other techniques in terms of improving clinical and functional outcomes. Comparison of the pain-relieving benefits of thrust manipulation versus non-thrust mobilization was the primary objective of this study, which was conducted on athletes with chronic ankle sprains. Methodology: It was a randomized control trial. The study was completed from May 2021 to Jan 2022 and it was conducted at Pakistan sports board and Model town football club, Lahore. Purposive sampling techniques was used to collect the data as per inclusion criteria the participant age between 16 to 40 years males. Screening was carried out of 30 participants, 20 fulfilled the inclusion criteria and 16 finally gave written consent for enrollment in the study. All the participants were placed into two groups by sealed envelope method. In group A high-velocity manual intervention was given at proximal and distal tibiofibular joint, and distraction thrust manipulation technique at talo-crural joint.

Comparison of Short-Term Effects of Thrust Manipulation and Non-Thrust Mobilization at Cervicothoracic Junction in Mechanical Neck Pain

Objective: The objective of this study was to compare the effects of thrust manipulation and non-thrust mobilization at cervicothoracic junction in patients with mechanical neck pain. Methodology: The study design used was a Quasi-Experimental Trial conducted at Riphah Rehabilitation Center, Lahore. A sample size of 80 patients was taken using the non-probability convenient sampling technique. Patients were divided into two groups; group A was treated with Thrust manipulation while group B was treated with non-thrust mobilization at the cervicothoracic junction. The numeric pain rating scale (NPRS) and Universal Goniometer for Pain and Active Cervical Range of Motions (ACROM) were used. Patients were assessed at baseline (Pre-treatment), after the first treatment session (T1) and after the second treatment session (T2) after 48 hours. Data were analyzed by using SPSS 25. Results: Both groups showed significant improvement in pain and cervical range of motion. p-value of NPRS across the groups at pre-treatment time was p =0.86 and there was a significant difference at T1 & T2 with a p-value <0.05. The p-value for all cervical range of motions across the groups at pre-treatment time was > 0.05 and at post-treatment T1 & T2, all movements showed significant improvement in ROM with a p-value < 0.05. Conclusion: The study concludes that patients who received thrust manipulation at the cervicothoracic junction showed more significant short-term improvements in Pain and cervical range of motion than those who received non-thrust mobilization. Key Words: Neck Pain, Manipulation, Range of Motion, Vertebrae.

Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial

BACKGROUND CONTEXTSpinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other. PURPOSEThe present study aims to compare the combined effects of spinal manipulation and dry needling with spinal mobilization and exercise on pain and disability in individuals with CH. STUDY DESIGN/SETTINGRandomized, multicenter, parallel-group trial. PATIENT SAMPLEOne hundred forty-two patients (n=142) with CH from 13 outpatient clinics in 10 different states were recruited over a 36-month period. OUTCOME MEASURESThe primary outcome was headache intensity as measured by the Numeric Pain Rating Scale. Secondary outcomes included headache frequency and duration, disability (Neck Disability Index), medication intake, and the Global Rating of Change (GROC). Follow-up assessments were taken at 1 week, 4 weeks, and 3 months. METHODSPatients were randomized to receive upper cervical and upper thoracic spinal manipulation plus electrical dry needling (n=74) or upper cervical and upper thoracic spinal mobilization and exercise (n=68). In addition, the mobilization group also received a program of craniocervical and peri-scapular resistance exercises; whereas, the spinal manipulation group also received up to eight sessions of perineural electrical dry needling. The treatment period for both groups was 4 weeks. The trial was prospectively registered at ClinicalTrials.gov (NCT02373605). Drs Dunning, Butts and Young are faculty within the AAMT Fellowship and teach postgraduate courses in spinal manipulation, spinal mobilization, dry needling, exercise and differential diagnosis. The other authors declare no conflicts of interest. None of the authors received any funding for this study. RESULTSThe 2 × 4 analysis of covariance revealed that individuals with CH who received thrust spinal manipulation and electrical dry needling experienced significantly greater reductions in headache intensity (F=23.464; p<.001), headache frequency (F=13.407; p<.001), and disability (F=10.702; p<.001) than those who received nonthrust mobilization and exercise at a 3-month follow-up. Individuals in the spinal manipulation and electrical dry needling group also experienced shorter duration of headaches (p<.001) at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2=54.840; p<.001) more patients (n=57, 77%) within the spinal manipulation and electrical dry needling group achieved a successful outcome compared to the mobilization and exercise group (n=10, 15%) at 3-month follow-up. Between-groups effect sizes were large (0.94<standardized mean score difference<1.25) in all outcomes in favor of the spinal manipulation and electrical dry needling group at 3 months. In addition, significantly (X2=29.889; p<.001) more patients in the spinal manipulation and electrical dry needling group (n=49, 66%) completely stopped taking medication for their pain compared to the spinal mobilization and exercise group (n=14, 21%) at 3 months. CONCLUSIONUpper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.

Effect of thrust versus non-thrust mobilization directed at the thoracic spine in patients with mechanical neck pain: A randomized control trial

Background: Neck pain (NP) is a major public health problem, both in terms of personal health and overall well-being as well as indirect expenses. Recently, published clinical practice guidelines suggest that the combination of manual therapy and therapeutic exercise is effective in patients with mechanical NP. One approach to conservative treatment of NP includes cervical mobilization, but it causes complications such as vertebra-basilar artery injury and paraplegia. Alternatively, thoracic spine thrust manipulation may effectively address mechanical NP. Aim and Objective: This study aims to compare the effect of thrust versus non-thrust mobilization of the thoracic spine in patients with mechanical NP. Materials and Methods: Seventy-five participants participated with 38 in Group 1 and 37 in Group 2. Group 1 received thrust mobilization whereas Group 2 received non-thrust mobilization. Outcomes were measured in the form of the numerical rating scale and neck disability index pre-intervention, immediately after treatment, and after 5 days of intervention. Results: Data were analyzed using paired and unpaired “t-test” and results showed that there was a significant improvement in both outcomes immediately and after 5 days of intervention in both groups. However, the greater improvement was seen in Group 1 compared to Group 2. Conclusion: It is concluded that thrust and non-thrust mobilizations of the thoracic spine are effective in patients with NP but thrust mobilization is more effective.

Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study

The aim of this study is to compare Dutch usual care musculoskeletal therapy in patients with non-specific neck pain with recommendations from international clinical practice guidelines. Physical therapy is diverse, as it may consist of exercise, massage, advice, and other modalities. Physical therapists with post graduate qualifications in manual therapy (MT) may additionally apply spinal thrust manipulation or non-thrust mobilization techniques to treat neck pain. It is important that, in the absence of a Dutch clinical guideline for the treatment of patients with neck pain, musculoskeletal therapists use the available recommendations from international clinical practice guidelines when treating patients with neck pain. One updated clinical practice guideline was identified (Blanpied, 2017), a report from the Task Force on Neck Pain (Guzman et al., 2008) and the IFOMPT International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention (Rushton et al., 2014). At baseline 1193 patients are included and data with regard to pain, disability, fear avoidance, expectations and applied treatment modalities are gathered. Outcome is measured using the Global Perceived Effect questionnaire. Results show that patients with acute neck pain are treated significantly more often with manipulation compared to patients with sub-acute or chronic neck pain (p < .000) and younger patients are treated with manipulation more often than older patients (p < .000). In the presence of comorbidity, the preference of spinal manipulation seems to diminish, in favour of mobilization and exercise. Almost every patient receives multimodal therapy (94.3%) and spinal manipulation and mobilization are rarely used as a stand-alone treatment (4.5% and 0.8%). Dutch musculoskeletal therapists choose treatment strategies that correspond with recommendations from international guidelines.

EFFICACY OF MUSCLE ENERGY TECHNIQUE AND DEEP NECK FLEXORS TRAINING IN MECHANICAL NECK PAIN- A RANDOMIZED CLINICAL TRIAL

BACKGROUND: A long term habitual posture with abnormal loading of ligaments and muscles, leads to development of neck pain. More recently, muscle based treatments approaches for MNP (Mechanical Neck Pain) evolved from a passive treatment technique such as myofascial release towards more active treatment technique such as MET (Muscle Energy Technique) and DNF (Deep Neck Flexors) training. METHOD: 33 patients including 18 males and 15 females were selected and randomly allocated into three groups using sealed opaque envelope containing treatment allocation. Group A (n=11) received conventional treatment such as MHP (Moist Heat Pack), Static Stretching exercises, Cervical spine nonthrust mobilization, Cervical spine active ROM (Range of Motion) exercises and Postural exercises. Group B (n=11) received DNF training with conventional treatment. Group C (n=11) received MET in additional to conventional treatment. Primary outcome measure functional disabilities and secondary measure pain and ROM were recorded at baseline, 7 th day and 14 th day. RESULTS: One-way ANOVA was used for within group analysis. Repeated measure ANOVA followed by post hoc analysis was employed for between group comparisons. The results suggest that there was a significant improvement in mean change scores of NDI, VAS and ROM after treatment of 2 weeks in all three groups - A, B and C, but significant improvement was found in group B and group C (p value ≤0.05). Between group effect size was medium (f> 0.25) for primary outcome measure NDI. CONCLUSIONS: Both DNF training and MET have additional therapeutic effects over a standard care by reducing functional disabilities, pain and in improving ROM in mechanical neck pain patients. Whereas, on comparing DNF training group and MET group, the former have statistically more significant improvement than the later.

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

Objectives:Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Rotatory thrust manipulation applied to the lower cervical segments is associated with controversy and the potential for eliciting adverse reactions (AR). The purpose of this clinical trial was to describe two translatory non-thrust mobilization techniques and evaluate their effect on cervical pain, motion restriction, and whether any adverse effects were reported when applied to the C7 segment.Methods:This trial included 30 participants with painful and restricted cervical rotation. Participants were randomly assigned to receive one of the two mobilization techniques. Active cervical rotation and pain intensity measurements were recorded pre- and post-intervention. Within group comparisons were determined using the Wilcoxon signed-rank test and between group comparisons were analyzed using the Mann–Whitney U test. Significance was set at P = 0·05.Results:Thirty participants were evaluated immediately after one of the two mobilization techniques was applied. There was a statistically significant difference (improvement) for active cervical rotation after application of the C7 facet distraction technique for both right (P = 0·022) and left (P = 0·022) rotation. Statistically significant improvement was also found for the C7 facet gliding technique for both right (P = 0·022) and left rotation (P = 0·020). Pain reduction was statistically significant for both right and left rotation after application of both techniques. Both mobilization techniques produced similar positive effects and one was not statistically superior to the other.Discussion:A single application of both C7 mobilization techniques improved active cervical rotation, reduced perceived pain, and did not produce any AR in 30 patients with neck pain and movement limitation. These two non-thrust techniques may offer clinicians an additional safe and effective manual intervention for patients with limited and painful cervical rotation. A more robust experimental design is recommended to further examine these and similar cervical translatory mobilization techniques.

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Randomized clinical trial. To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain. Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain. Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. Therapy, level 1b.

Development of a Clinical Prediction Rule for Identifying Women With Tension-Type Headache Who Are Likely to Achieve Short-Term Success With Joint Mobilization and Muscle Trigger Point Therapy

To identify prognostic factors from the history and physical examination in women with tension-type headache (TTH) who are likely to experience self-perceived clinical improvement following a multimodal physical therapy session including joint mobilization and muscle trigger point (TrP) therapies. No definitive therapeutic intervention is available for TTH. It would be useful for clinicians to have a clinical prediction rule for selecting which TTH patients may experience improved outcomes following a multimodal physical therapy program. Women diagnosed with pure TTH by 3 experienced neurologists according to the International Headache Society criteria from different neurology departments were included. They underwent a standardized examination (neck mobility, pressure pain thresholds, total tenderness score, presence of muscle TrPs, Medical Outcomes Study 36-Item Short Form, the Neck Disability Index [NDI], the Beck Depression Inventory, and the Headache Disability Inventory) and then a multimodal physical therapy session including joint mobilization and TrP therapies. The treatment session included a 30-second grade III or IV central posterior-anterior nonthrust mobilization applied from T4 to T1 thoracic vertebrae, at C7-T1 cervico-thoracic junction and C1-C2 vertebrae for an overall intervention time of 5 minutes Different TrP techniques, particularly soft tissue stroke, pressure release, or muscle energy were applied to head and neck-shoulder muscles (temporalis, suboccipital, upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid) to inactivate active muscle TrPs. Participants were classified as having achieved a successful outcome 1 week after the session based on their self-perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of success. Data for 76 subjects were included in the analysis, of which 36 experienced a successful outcome (48%). Eight prognostic variables were retained in the regression model: mean age <44.5 years, presence of left sternocleidomastoid TrP, presence of suboccipital TrP, presence of left superior oblique muscle TrP, cervical rotation to the left > 69°, total tenderness score <20.5, NDI <18.5, referred pain area of right upper trapezius muscle TrP >42.23. The current clinical prediction rule may allow clinicians to make an a priori identification of women with TTH who are likely to experience short-term self-report improvement with a multimodal session including joint mobilizations and TrP therapies. Future studies are necessary to validate these findings.

Short-Term Effects of Thrust versus Nonthrust Mobilization Directed at the Thoracic Spine in Patients with Neck Pain: A Randomized Clinical Trial

Short-Term Effects of Thrust versus Nonthrust Mobilization Directed at the Thoracic Spine in Patients with Neck Pain: A Randomized Clinical Trial

Answer to the letter to the editor of J. Hebert et al. concerning “Hancock MJ, Maher CG, Latimer J, Herbert RD, McAuley JH (2008) Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. Epub ahead of publication DOI:10.1007/s00586-008-0679-9”

The primary concern of the letter to editor from Drs Hebert and Perle revolves around the fact that in our trial [4] the spinal manipulative therapy was delivered in a manner that was at the discretion of the therapists. In our trial, most patients received low velocity techniques while in the original trial by Childs et al. [2] all therapists were required to use the same single high velocity technique. We see this as strength of the analysis, not a weakness, because the aim of our analysis was to see if the clinical prediction rule developed by Childs and colleagues [2] would generalize to other forms of spinal manipulative therapy selected by highly skilled and experienced clinicians. The consensus view from the literature on clinical prediction rules is that it is important to test the generalizability of these rules [1, 7–9]. It is recommended that clinical prediction rules should be tested in different settings on diverse patients, with different therapists providing the intervention in different ways [1, 7–9]. Childs and colleagues clearly appreciate the importance of testing the generalizability of their clinical prediction rule because they have published the protocol for a trial to examine if their rule generalizes to other forms of spinal manipulative therapy (a different high velocity technique or non-thrust mobilization technique) in diverse clinical settings [3]. We went to great lengths in our manuscript to point out the differences between our trial and the trial by Childs and colleagues that may explain why the clinical prediction rule did not generalize. Drs Hebert and Perle imply that the clinical prediction rule did not generalize to our study because of differences in the way the treatment was provided in our study. It is important to appreciate that this is only one of several explanations for why the clinical prediction rule did not generalize. The lack of generalization could equally be due to differences in patients, settings or co-interventions in the two studies. Currently the clinical prediction rule, which has been tested in only two randomised controlled trials [2, 4], has not been shown to generalize to a setting different to that of the original trial. Further investigation is required to determine if the clinical prediction rule does generalize. Drs Herbert and Perle raise concerns about the terminology used to describe the treatment in our trial. While we agree that the terminology in this area can be confusing we designed and conducted a trial where therapists could use a mix of high or low velocity techniques and believe that the term “spinal manipulative therapy” is the most appropriate and widely used terminology for such treatment. Our use of terminology is consistent with that agreed to by United Kingdom chiropractors, physiotherapists and osteopaths prior to the BEAM trial [5]. We clearly described both the treatments available to therapists and the proportion of high velocity and low velocity techniques used [4], so that interested readers can make up their own mind about the importance of different types of spinal manipulative therapy used. We wish to dispute the assertion of Drs Perle and Herbert that allowing therapists choice as to the type of technique has been shown to lead to smaller treatment effects. The paper they cite [6] in support of this assertion is a non-randomized comparison of a small number of trials with no adjustment for other factors known to influence the magnitude of treatment effects (such as methodological quality). The effect was only apparent in some comparisons. The authors of the paper concluded that “there is insufficient data available to definitely quantify the effect of clinician treatment choice on the results of RCTs of manual therapy for LBP” [6].

Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study

Joint mobilization and manipulation stimulate mechanoreceptors, which may influence the joint and surrounding muscles. The purpose of this pilot study was to determine the effect of grade IV inferior hip joint mobilization on hip abductor torque. Thirty healthy subjects were randomly assigned to a control group (grade I inferior hip joint mobilization) or an experimental group (grade IV inferior hip joint mobilization). Subjects performed a pre- and post-intervention test of five isometric repetitions on the Cybex Normö dynamometer; the average torque was determined for both pre- and post-intervention measurements. These data were analyzed using the independent samples t-test with the significance level set at P<0.05. The results showed a statistically significant difference between the two groups for an increase in hip abductor torque in the experimental group (P=0.03). The experimental group demonstrated a 17.35% increase in average torque whereas the control group demonstrated a 3.68% decrease in average torque. These findings are consistent with other studies demonstrating that the use of grade IV non-thrust mobilization improves strength immediately post-intervention in healthy individuals. The results of this pilot study provide physical therapists with further support for the utilization of manual therapy in conjunction with therapeutic exercise to enhance muscle strength.