Orthopaedic Manual Therapy Research Articles

Is the cadaveric model valid for examining orthopaedic manual therapy techniques? A cross-sectional comparative study in vivo and in vitro

BackgroundCadaveric models are sometimes used to test the effect of manual techniques. We have not found any studies comparing the effect of tibiotarsal joint distraction on cadaveric models versus live models for clinical use. The aim was to compare the effect on tibiotarsal joint distraction movement when applying three force magnitudes of tibiotarsal axial traction technique force between a cadaveric model and volunteers. In addition, to compare the magnitude of force applied between the cadaveric model and volunteers. Finally, to assess the reliability of applying the same magnitude of force in three magnitudes of tibiotarsal axial traction force. MethodsA cross-sectional comparative study was conducted. Sixty ankle joints were in open-packed position and three magnitudes of tibiotarsal axial traction technique force were applied. Tibiotarsal joint distraction movement was measured with ultrasound. FindingsNo differences were found in applied force or tibiotarsal joint distraction between volunteers and cadavers in each magnitude of force (p > 0.05). The application of the technique showed moderate reliability for detecting low forces in both models. For medium and high force, it showed good reliability in the in vitro model and excellent reliability in the live model. InterpretationThe amount of distraction produced in the tibiotarsal joint was similar in volunteers and cadavers. The cadaveric model is a valid model for testing and investigating orthopaedic manual therapy techniques. The force applied was similar in the two models. Medium and high force detection showed good reliability, while low force showed moderate.

Effectiveness and efficiency of patient care while enrolled in an orthopedic physical therapy fellowship program

Rationale: Post-professional orthopedic manual physical therapy education programs have proliferated, in part due to increasing therapist demand. Despite the time, effort, and money required to complete these programs, there is scant research addressing their impact. We investigated whether physical therapists enrolled in an accredited manual physical therapy fellowship program achieved better outcomes, determined by patient changes in function, number of physical therapy visits, and episode of care duration while enrolled in the program. We also examined whether outcomes varied by clinician demographics, clinician life circumstances, and clinic characteristics. Methods: Forty-two therapists contributed patient data addressing functional status, number of visits, and episode of care duration. We compared data from the first 30 patients with data from the last 30 patients seen by each therapist while enrolled in the program. We also surveyed therapists regarding their demographics, life circumstances, and clinic characteristics. Results: There were no clinically meaningful or statistically significant differences in change in functional status when comparing results from the first 30 patients with the last 30 patients seen by therapists. However, there was a significant reduction in the number of visits and episode of care duration. Outcomes were influenced by entry-level degree and the presence of children at home. Conclusion: In our study, enrollment in a physical therapy fellowship program did not improve patient functional status but did reduce the number of visits and episode of care duration. Outcomes were influenced by some clinician life circumstances and clinic characteristics.

Orthopaedic Manual Physical Therapy: A Modern Definition and Description.

Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.

The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology

BackgroundTo evaluate the reliability of the Soft Tissue Tension Cloud Chart (STTCC) technology, an original method combining multi-point Cervical Paravertebral Soft Tissue Test (CPSTT) with MATLAB software, we conducted a preliminary analysis on the immediate effects of Orthopaedic Manual Therapy (OMT) on cervical paravertebral soft tissue.Methods30 patients with Cervical Spondylotic Radiculopathy (CSR) were included in this study. We analyzed the differences in CPSTT before and after treatment with Cervical Rotation-Traction Manipulation (CRTM), a representative OMT technique in Traditional Chinese Medicine, using the STTCC technology.ResultsThe STTCC results demonstrated that post-treatment CPSTT levels in CSR patients were significantly lower than pre-treatment levels after application of CRTM, with a statistically significant difference (P < 0.001). Additionally, pre-treatment CPSTT levels on the symptomatic side (with radicular pain or numbness) were higher across the C5 to C7 vertebrae compared to the asymptomatic side (without symptoms) (P < 0.001). However, this difference disappeared after CRTM treatment (P = 0.231).ConclusionsThe STTCC technology represents a reliable method for analyzing the immediate effects of OMT. CSR patients display uneven distribution of CPSTT characterized by higher tension on the symptomatic side. CRTM not only reduces overall cervical soft tissue tension in CSR patients, but can also balance the asymmetrical tension between the symptomatic and asymptomatic sides.Trial registrationThis study was approved by the Chinese Clinical Trials Registry (Website: .https://www.chictr.org.cn.) on 20/04/2021 and the Registration Number is ChiCTR2100045648.

The Mechanisms, Effects, and Outcomes of Manual Therapy in the Treatment of Adhesive Capsulitis: A Literature Review

Purpose of the Study: Adhesive capsulitis, commonly called frozen shoulder, is frequently treated with manual therapy. This pathology cycles through three stages and usually resolves itself; however, many patients will use traditional treatments to expedite their recovery. The researchers theorize that a variety of manual therapy techniques improve the adverse effects of this condition, greater than that of traditional treatments. This literature review aimed to explore various manual therapy techniques that are beneficial in preventing and minimizing lifelong symptoms associated with adhesive capsulitis and analyze which ones are most effective in treating this pathology. Methods: The mechanisms of orthopedic manual therapy for adhesive capsulitis are vast. This literature review examined the following techniques. The first technique reviewed was Mulligan’s mobilization with movement techniques applied to the GH joint in elevation, internal rotation, and flexion compared with passive stretching. Proprioceptive neuromuscular facilitation (PNF) techniques were reviewed, where specific techniques were picked based on the patient’s dysfunctions and compared to traditional manual therapies. In addition, Maitland’s mobilization techniques were reviewed, and patients were given mobilizations to treat pain or restrictions in the tissue. These were compared to Kaltenborn’s mobilization techniques. Next, Maitland’s mobilization techniques were compared with a myofascial release arm-pull technique. Finally, scapular mobilization was compared to posterior capsular stretching in treating adhesive capsulitis. Discussion: The outcomes of this literature review evaluated various manual therapy techniques for treating adhesive capsulitis, aiming to improve shoulder movement and alleviate pain. Researchers expected manual therapy to outperform traditional treatments like medications and surgery by enhancing ROM and reducing pain. Mulligan’s manual therapy demonstrated significant pain reduction and ROM improvement, particularly in flexion, abduction, and rotation. Combining Mulligan’s technique with other modalities yielded superior outcomes compared to passive stretching. Proprioceptive Neuromuscular Facilitation (PNF) techniques showed better pain reduction, ROM enhancement, and coracohumeral thickness reduction than traditional manual therapy. Maitland and Kaltenborn’s techniques significantly improved shoulder rotation and functional movement, especially with soft tissue mobilization. Scapular mobilization techniques increased joint motions, but ROM improvements varied. Manual therapy techniques like Mulligan’s, PNF, Maitland, and scapular mobilization offer promising results in improving the quality of life for adhesive capsulitis patients by enhancing ROM and reducing pain. As more research is done with this pathology, it was found that Mulligan’s, Maitland’s, PNF’s, and soft tissue mobilizations were effective in increasing ROM and decreasing stiffness in patients with this diagnosis. These are all effective forms of manual therapy, specifically when performed by a skilled clinician, further advocating for education on these techniques. Additionally, understanding the mechanisms, effects, and outcomes of different manual therapies for treating adhesive capsulitis can reduce the risk of life-long symptoms and improve quality of life. Results: Various manual therapy methods, such as Mulligan’s mobilization with movement (MWM), Maitland’s mobilization, and PNF have been used to treat adhesive capsulitis. These manual therapy techniques increased joint range of motion (ROM) and reduced the patients’ perceived pain.

Comparing Muscle Energy Technique and Kaltenborn-Evjenth Orthopaedic Manual Therapy: A Study on Effectiveness in Treating Chronic Low Back Pain

Background: Chronic Low Back Pain (CLBP) is a prevalent condition globally, affecting quality of life and work efficiency. Traditional treatment methods often fall short in providing long-term relief, highlighting the need for alternative therapeutic approaches. Objective: The objective of this study was to compare the effectiveness of Muscle Energy Technique (MET) and Kaltenborn-Evjenth Orthopedic Manual Therapy (KEOMT) against conventional treatment methods in reducing pain and improving mobility in patients with CLBP. Methods: This randomized control trial involved 120 patients with CLBP from Sargodha, who were divided into three groups: Control Group (conventional treatment), Group A (MET), and Group B (KEOMT). All treatments were administered over a period of six months, with interventions carried out for four weeks totaling 12 sessions. Baseline and post-intervention measurements included pain scale (VAS), Flexion and Extension Range of Motion (ROM) using a Goniometer, and the Oswestry Disability Index (ODI). Data were analyzed using ANOVA and SPSS version 25. Results: All groups showed significant improvements post-treatment. The Control Group's pain scale decreased from 6.63 ± 0.925 to 4.68 ± 1.206, Group A from 6.70 ± 0.939 to 2.75 ± 0.899, and Group B from 6.77 ± 0.891 to 3.00 ± 1.038. Flexion ROM increased in the Control Group from 40.80 ± 3.023 to 42.10 ± 3.003, in Group A from 40.78 ± 2.684 to 44.97 ± 1.804, and in Group B from 40.53 ± 2.746 to 44.90 ± 1.751. Similar trends were observed in Extension ROM and ODI scores. The improvements in Groups A and B were significantly greater than in the Control Group (P=0.00). Conclusion: Both MET and KEOMT were found to be more effective than conventional treatment in reducing pain and improving ROM in patients with CLBP. These findings suggest that MET and KEOMT could be incorporated as part of the standard physical therapy regimen for CLBP, offering potentially more effective and lasting relief.

Modernizing patient-centered manual therapy: Findings from a Delphi study on orthopaedic manual therapy application

BackgroundRecent literature challenges the process by which orthopaedic manual therapy (OMT) has traditionally been applied. Progressive understanding of the complexities surrounding OMT analgesia and the decreased reliance on technique specific characteristics in determining treatment effectiveness promotes an update to training paradigms related to OMT. Objectives: The purpose of this Delphi study was to establish consensus on what trainees should be focusing on when demonstrating OMT techniques and how candidates for OMT should be identified. DesignAn international three-round Delphi study following recommended guidelines for conducting and reporting of Delphi studies (CREDES) was performed. MethodsOne-hundred sixty-four expert manual therapy educators were identified for participation across four countries. Participants were asked to provide what concepts trainees should be focusing on when demonstrating OMT techniques and how candidates for OMT should be identified. Twenty-one themes were identified for each question. ResultsTwenty-eight participants completed all three rounds of the Delphi. Consensus was reached on nineteen themes and eighteen themes respectively. Results from this Delphi stress patient-centered care within a biopsychosocial pain management model. Representation across all pillars of evidence-based practice were represented. Themes reaching consensus within this study favored the importance of neurophysiological, psychological, and biomechanical principles. ConclusionThis Delphi presents consensus-based recommendations for what manual therapy trainees should focus on when demonstrating OMT techniques and on how candidates for OMT should be identified. These findings in collaboration with previous consensus recommendations on concepts to focus on within OMT education promote restructuring of OMT curriculum to evidence-based patient-centered care models.

Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients with Chronic Musculoskeletal Pain: An Umbrella Review with Meta-Meta-Analysis.

The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain. A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. We statistically synthesized the results of the different reviews through a random-effect meta-analysis of all standardized mean differences and the corresponding 95% confidence interval reported by each study. For mechanical hyperalgesia, the meta-meta-analysis of three meta-analysis revealed a statistically significant small-moderate effect of orthopedic manual therapy, with no evidence of heterogeneity and moderate quality evidence. In terms of temporal summation, one meta-analysis revealed a statistically significant small effect of orthopedic manual therapy intervention, with moderate heterogeneity and low quality of evidence. Finally, one review without meta-analysis found that orthopedic manual therapy improved endogenous analgesia with low quality evidence. Orthopedic manual therapy in isolation improved mechanical hyperalgesia with moderate quality evidence, as well as temporal summation and conditioned pain modulation with low quality evidence. However, its effects are limited only to immediate and short-term.

Priorities in updating training paradigms in orthopedic manual therapy: an international Delphi study

Orthopedic manual therapy (OMT) education demonstrates significant variability between philosophies and while literature has offered a more comprehensive understanding of the contextual, patient specific, and technique factors which interact to influence outcome, most OMT training paradigms continue to emphasize the mechanical basis for OMT application. The purpose of this study was to establish consensus on modifications & adaptions to training paradigms which need to occur within OMT education to align with current evidence. A 3-round Delphi survey instrument designed to identify foundational knowledge to include and omit from OMT education was completed by 28 educators working within high level manual therapy education programs internationally. Round 1 consisted of open-ended questions to identify content in each area. Round 2 and Round 3 allowed participants to rank the themes identified in Round 1. Consensus was reached on 25 content areas to include within OMT education, 1 content area to omit from OMT education, and 34 knowledge components which should be present in those providing OMT. Support was seen for education promoting understanding the complex psychological, neurophysiological, and biomechanical systems as they relate to both evaluation and treatment effect. While some concepts were more consistently supported there was significant variability in responses which is largely expected to be related to previous training. The results of this study indicate manual therapy educators understanding of evidence-based practice as support for all 3 tiers of evidence were represented. The results of this study should guide OMT training program development and modification.

Effects of Myofascial Release Using Finding-Oriented Manual Therapy Combined with Foam Roller on Physical Performance in University Athletes. A Randomized Controlled Study.

Sport is a science of constant reinvention that is always searching for strategies to improve performance. Objective: This study seeks to compare the effects of myofascial release with Findings-Oriented Orthopedic Manual Therapy (OMT) combined with Foam Roller (FR), versus FR by itself, on the physical performance of university athletes. A randomized controlled study was conducted with a total of twenty-nine university athletes, measuring Range of Motion (ROM), jump height and flight time, strength and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum (1RM) and Mean Propulsive Velocity (MPV) and the Sit and Reach (V) test, correspondingly. This study was registered at clinicaltrials.gov prior to the initial measurement of the participants under the code NCT05347303. Through a univariate analysis, together with an analysis of independent groups with ANOVA and an analysis of covariance, it was evidenced that OMT combined with FR generated more and better effects in all the evaluated ROM, jump height and flight time, RM and VMP tests. Finally, it was found that OMT combined with FR is better when it is desired to improve ROM, muscle power, strength and flexibility, while FR alone only improves dynamic flexibility.

Survey on the Current Status of Orthopedic Manual Therapy

With the emergence of an aging society, the number of orthopedic manual therapy prescriptions is increasing. However, no clear prescription guidelines exist for orthopedic manual therapy in the Republic of Korea. This study aimed to examine the current status of orthopedic manual therapy in the Republic of Korea by examining the satisfaction, time, and cost adequacy of orthopedic manual therapy for patients. This survey was conducted among adults who visited a clinic or hospital in the Republic of Korea. The survey had 26 questions and was distributed through a Google questionnaire URL. This study performed descriptive statistics and Chi-squared test of the general characteristics of the respondents, orthopedic manual therapy experience, treated hospital type, perception, expectation, satisfaction, and the right price and duration for orthopedic manual therapy. Of the total 278 respondents, 113 (40.6%) had undergone orthopedic manual therapy previously, and 165 had not experienced the therapy (59.4%). Orthopedic manual therapy was mainly performed twice a week for 30-60 min, and the price was between 100,000 and 140,000 won per session. The desired price and time were 50,000-90,000 won and 30-60 min, respectively. The longer the duration of receiving orthopedic manual therapy and the greater the time/frequency satisfaction, and the effect of the therapy. Activities of daily living (ADL) are particularly likely to improve when receiving orthopedic manual therapy at a rehabilitation hospital than others. Satisfaction with orthopedic manual therapy increases as time/frequency satisfaction increases and ADL improves. Thus, it is important to suggest an appropriate manual therapy time according to patients’ circumstances and develop a manual therapy plan to improve ADL.

Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain.

(1) Background and Objectives: The aim of this narrative review was to analyze the neuroanatomical and neurophysiological basis of cervicogenic pain in cervico-cranial pain syndromes, focusing particularly on cervico-orofacial syndromes as a background for the proper diagnosis and non-surgical treatment. Relevant literature on the topic from past 120 years has been surveyed. (2) Material and Methods: We surveyed all original papers, reviews, or short communications published in the English, Spanish, Czech or Slovak languages from 1900 to 2020 in major journals. (3) Results: The cervicogenic headache originates from the spinal trigeminal nucleus where axons from the C1–C3 cervical spinal nerves and three branches of the trigeminal nerve converge (trigeminocervical convergence) at the interneurons that mediate cranio-cervical nociceptive interactions. The role of the temporomandibular joint in the broad clinical picture is also important. Despite abundant available experimental and clinical data, cervicogenic orofacial pain may be challenging to diagnose and treat. Crucial non-surgical therapeutic approach is the orthopedic manual therapy focused on correction of body posture, proper alignment of cervical vertebra and restoration of normal function of temporomandibular joint and occlusion. In addition, two novel concepts for the functional synthesis of cervico-cranial interactions are the tricentric concept of mouth sensorimotor control and the concept of a cervicogenic origin of bruxism. (4) Conclusions: Understanding the basis of neuroanatomical and neurophysiological neuromuscular relations enables an effective therapeutic approach based principally on orthopedic manual and dental occlusal treatment.

Decreased Risk of Low Back Pain During Pregnancy Associated With the Use of Orthopedic Manual Therapy: A Nested Case-Control Study.

BackgroundRecent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy.MethodsFrom Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20–55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly diagnosed LBP were matched to 3,846 controls according to age and cohort entry year. Multivariate conditional logistic regression was employed to estimate the association between OMT use before pregnancy and LBP during pregnancy.ResultsOMT users had a lower risk of LBP than did non-users, with an adjusted OR of 0.86 (95% CI, 0.78–0.93). Subgroup analysis showed that women with high intensity use of OMT treatment prior to pregnancy reported the lowest level of LBP during pregnancy by nearly 30%.ConclusionThe pre-pregnancy use of OMT treatment significantly decreased LBP risk during pregnancy, especially with high-intensity use. Thus, clinicians may consider recommending OMT for pregnant women to avoid possible obstetric complications during the pregnancy.

Comparative assessment of osteopathy technique with manual therapy associated with biofeedback in patients with the lumbar spine pain

Introduction: The aim of the study is to assess the impact of physiotherapy containing elements of osteopathy on the change of pain level of the lumbar spine of patients in comparison to traditional management using orthopedic manual therapy combined with biofeedback. Material and methods: The study included 60 people qualified for outpatient rehabilitation. Patients were divided into two groups (research and control) consisting of 30 people. The mean age of patients was 52.75 ± 11.58 years. Patients were examined before and after the implementation of the rehabilitation process, pain scale (VAS) and Oswestry Disability Index were used for the study. Rehabilitation lasted every day for four weeks. The control group used orthopedic manual therapy combined with biofeedback, while the research group used a series of treatments based on osteopathy techniques. In addition, both groups of patients underwent a standard physical therapy program. Results: The study showed the effectiveness of manual therapy combined with biofeedback and osteopathic therapy in patients with lumbar spine pain syndrome. A decrease in pain was noted in patients of both groups, however a greater decrease was noted in the research group. In the assessment using the Oswestry Disability Index, a comparable level of quality of life was noted in both treatment groups. Conclusions: The introduced therapeutic programs show an improvement both in terms of reducing pain and improving functioning in everyday life, however, the rehabilitation process based on osteopathic techniques is more effective in reducing pain.

Designing Pillow as a Cure for Cervicogenic Headache: A Review

Background: Presently there is probably no device such as pillows designed or available in the market for relief in case of cervicogenic headache.&#x0D; Objective: The objective is to come up with a pillow which could be used by the persons having cervicogenic headache in case of orthopedic manual therapy.&#x0D; Method: A pillow for cervicogenic headache with adjustable neck dimensions is characterized by left side ball, right side ball and mechanism for adjusting distance between these balls as per size of the neck of patient, entire assembly of the balls and the mechanism is embedded in socket. Result: The result is the pillow has memory foam with plush covering outside.&#x0D; Conclusion: The invention provides a pillow with two balls for the treatment of cervicogenic head ache.

Knowledge, Attitude, and Practice of Orthopedic Manual Physical Therapists Toward Lifestyle Screening and Education: A Descriptive Study.

Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research. A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education. There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent while doing so. Additionally, 92.9-94.8% thought that lifestyle screening and education was important and that physical therapists should be doing it. Participants discussed exercise most frequently with their patients (96.1%) and alcohol the least (12.9%). Participants with advanced degrees (ie, PhD or DSc) had significantly higher Practice (MΔ= -3.755, P = .001) and Knowledge (MΔ= -4.14904, P = .020) ratings than those with entry-level physical therapy degrees. There was strong acceptance of lifestyle screening and education in orthopedic manual physical therapy with an emphasis on exercise. This study provides a foundational basis for continued research.

Deep Learning Frameworks for Cervical Mobilization Based on Website Images

Background: Deep learning related research works on website medical images have been actively conducted in the field of health care, however, articles related to the musculoskeletal system have been introduced insufficiently, deep learning-based studies on classifying orthopedic manual therapy images would also just be entered. Objectives: To create a deep learning model that categorizes cervical mobilization images and establish a web application to find out its clinical utility. Design: Research and development. Methods: Three types of cervical mobilization images (central posteroanterior (CPA) mobilization, unilateral posteroanterior (UPA) mobilization, and anteroposterior (AP) mobilization) were obtained using functions of ‘Download All Images’ and a web crawler. Unnecessary images were filtered from 'Auslogics Duplicate File Finder' to obtain the final 144 data (CPA=62, UPA=46, AP=36). Training classified into 3 classes was conducted in Teachable Machine. The next procedures, the trained model source was uploaded to the web application cloud integrated development environment (https://ide.goorm.io/) and the frame was built. The trained model was tested in three environments: Teachable Machine File Upload (TMFU), Teachable Machine Webcam (TMW), and Web Service webcam (WSW). Results: In three environments (TMFU, TMW, WSW), the accuracy of CPA mobilization images was 81-96%. The accuracy of the UPA mobilization image was 43~94%, and the accuracy deviation was greater than that of CPA. The accuracy of the AP mobilization image was 65-75%, and the deviation was not large compared to the other groups. In the three environments, the average accuracy of CPA was 92%, and the accuracy of UPA and AP was similar up to 70%. Conclusion: This study suggests that training of images of orthopedic manual therapy using machine learning open software is possible, and that web applications made using this training model can be used clinically.

Effects of Lumbar Mobilization on the Paravertebral Muscle Activity and Muscle Tone in Patients with Lumbar Spinal Stenosis

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients’ quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, MyotonⓇPRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

Identifying vascular pathologies or flow limitations: Important aspects in the clinical reasoning process

Cervical spine manipulation and mobilisation are frequently used in the management of neck pain and headache. Although very rare, serious adverse events (SAEs) following cervical spine manipulation and mobilisation have been described. Recently, a revised version of the International IFOMPT Cervical Framework was published, to provide guidance for the assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned Orthopaedic Manual Physical Therapy (OMPT) interventions. Clinicians should realise that following the Framework does not guarantee that vascular pathologies or flow limitations will be identified. To illustrate this, in this Professional Issue, we use a case description of a SAE that occurred in the Netherlands during a mobilisation technique used by a physiotherapist and discuss this case using the IFOMPT Cervical Framework and highlight some important aspects in the clinical reasoning process.

Osteopathic Manual Treatment vs Kaltenborn-Evjenth Orthopedic Manual Therapy for Chronic Low Back Pain: A Proposal for a Protocol for Randomized Trials

Introduction: Numerous modalities of conservative therapeutic interventions are available to achieve the best health benefits in people with Low Back Pain (LBP), e.g., kinesiotherapy, physical therapy, behavior therapy. People with LBP continue to experience pain and disability despite receiving the best evidence based therapy. Osteopathic Manual Therapy (OMT) and Kaltenborn-Evjenth Ortopedic Manual Therapy (KEOMT) are the other options, although their effectiveness remains controversial. The aim of this study is a proposal for a protocol for randomized trials to compare the effectiveness of OMT vs. KEOMT on pain and disability in people suffering from LBP. Methods and analysis: It’s a randomized study with two-arms parallel, designed with concealed allocation, the assessor’s blinding with intention to-treat analysis. It will include 34 people a group with severe disability ranged from 41 to 60% in Oswestry Disability Index (ODI). There will be two groups: a treatment group (OMT) and a comparison group (KEOMT). All the patients in both groups will receive 2 treatments a week for 5 weeks. Each session in both groups will not exceed 30 minutes. During each session OMT and KEOMT techniques will be repeated 3 times. A baseline assessment will be performed pre and post intervention, two days later. The following parameters will be assessed during the evaluations: Numeric Pain Rating Scale – NPRS, ODI. Ethics and dissemination: The trial was approved by the Scientific Research Ethics Committee of University of Warmia and Mazury, Olsztyn, Poland. Registration approval number: 9/2018. Trial registration: The study protocol was prospectively registered in the Chinese Clinical Trial Registry on December 28, 2019 (registration ID: ChiCTR1900028580). Strengths and Limitations of this Study The participants’ random allocation to the experimental and the control groups. The same experienced physiotherapist, blind to the outcome measures, provides the interventions. The same assistant, blind to the group allocation, administrates the outcomes. The same number of the interventions, the compared contact time with the physiotherapist providing the interventions. A short follow-up period and/or a rather small sample size.