Received Joint Mobilization Research Articles

Efficacy of tissue-bone homeostasis manipulation on the gait and knee function for the patients with knee osteoarthritis: a randomized controlled trial.

Knee osteoarthritis (KOA) was characterized by pain and limited joint function, which seriously affected the quality of life of patients. The vast majority of KOA was closely related to degeneration of the patellofemoral joint and abnormal patellar movement trajectory. Tissue-bone homeostasis manipulation (TBHM) could correct abnormal patellar movement trajectory on the basis of loosening soft tissue. However, there was little strong evidence to verify its efficacy on the patients with KOA. The study objective was to explore the efficacy of the TBHM on gait and knee function in the patients with KOA. Sixty KOA patients were randomly assigned to either the joint mobilization (n = 30) or TBHM (n = 30) group. The joint mobilization group received joint mobilization, while the TBHM group received TBHM. For two groups, the patients participated in 30min rehabilitation sessions thrice per week for 12weeks. The primary outcome was biomechanical gait outcomes during walking, including step length, step velocity, double support, knee range of motion (ROM), and knee adduction moment (KAM). The secondary outcomes were the Western Ontario and McMaster Index (WOMAC) and 36-Item short- form health survey (SF-36), which reflected improvements in knee function and quality of life, respectively. At baseline and 12weeks, evaluations were conducted and compared between groups. After a 12-week intervention, significant group differences were observed in KAM (p = 0.018), WOMAC-Pain (p = 0.043) and WOMAC-Stiffness (p = 0.026). A noteworthy finding was the presence of a significant interaction effect between group and time specifically observed in step velocity during gait (p = 0.046), WOMAC-Function (p = 0.013) and SF-36 (p = 0.027). Further analysis revealed a significant difference in step velocity (p = 0.034), WOMAC-Function (p = 0.025) and SF-36 (p = 0.042) during post-assessment between the two groups. Moreover, a significant time effect was observed across all outcomes of the two groups (p < 0.05). The TBHM intervention has better improved the gait, knee function, and quality of life in the patients with KOA. ITMCTR, ITMCTR2200005507. Registered 06/01/2022, http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=09cdadad-0aef-41ee-81bd-a8dceb63f7f5 .

Randomized controlled trial on ankle biomechanics in the treatment of functional ankle instability with joint mobilization

Functional ankle instability (FAI) patients often experience restricted ankle dorsiflexion, increased inversion angle, and elevated ground reaction forces during walking, all related to altered kinematics of the talocrural and subtalar joints. This study aimed to investigate the potential positive impact of joint mobilization on FAI patients from a biomechanical perspective. The experimental group (EG, n = 17; Age: 20.06 ± 1.34 years; Height: 1.74 ± 0.07 m; Weight: 69.79 ± 11.20 kg; BMI:22.88 ± 2.63 kg/m2; CAIT:15.59 ± 2.58; M/F: 15/2) received joint mobilization + routine rehabilitation training, while the control group (CG, n = 16; Age: 20.50 ± 0.73 years; Height: 1.73 ± 0.09 m; Weight: 64.59 ± 7.21 kg; BMI: 21.65 ± 2.47 kg/m2; CAIT: 16.75 ± 2.21; M/F: 14/2) only received regular rehabilitation training. Biomechanical tests were performed in both groups after the 4-week intervention. The spatial parameters during walking (including step length, stride length, step width, step time, cadence, step speed, support time, and swing time), ankle flexion and dorsiflexion angle, inversion, and eversion angles, internal and external rotation angles, ankle torque, as well as the vertical ground reaction force were measured before and after the intervention. The results of the two-way ANOVA showed that the main effect of time was significant for step length (P < 0.001), stride length (P = 0.008), step speed (P < 0.001), the sagittal plane angle at touchdown (P < 0.001), maximum dorsiflexion angle (P = 0.005), sagittal plane toe off-ground angle (P < 0.001), peak flexion-dorsiflexion torque (P = 0.033), the first peak vGRF (P = 0.013), and second peak vGRF (P = 0.011). The main effect of Time * Group was significant for step speed (P = 0.044). The EG demonstrated significant improvements in step speed (P = 0.047), maximum dorsiflexion angle (P = 0.047), and the first peak vGRF (P = 0.028) compared to the CG. This study reveals that joint mobilization intervention enhances gait spatiotemporal parameters, kinematics, and kinetics, particularly in step speed, maximum dorsiflexion angle, and the first vGRF peak for the EG compared to the CG. Therefore, the rehabilitation strategy for patients with functional ankle instability should appropriately increase the use of joint movement to promote the functional recovery of FAI patients.

Joint mobilization and therapeutic exercises in the hands of patients with systemic sclerosis: A preliminary randomized controlled trial

Objective: To investigate the effectiveness of Maitland’s joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. Design: Randomized controlled trial. Setting: Tertiary university hospital. Subjects: Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group (n = 12) or control group (n = 12). Interventions: The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. Main measures: The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). Results: Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group (P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). Conclusion: Maitland’s joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.

Gait parameters and functional performance following multi-factorial treatment among degenerative joint disease patients

Introduction and Aim: Degenerative Joint Disease (DJD) poses a challenge to manage and restore functional capabilities among patients. Incorporation of structured exercises, manual therapy and patient education had a significant impact on clinical and functional status of patients. Past research hasexplored benefits of therapy on functions and gait. Although, such studies did not address the functional restoration. Hence, present study was aimedto address the lacunae.&#x0D; &#x0D; Materials and Methods: 100 patients with mean age and SD; 51.61(5.4) were included. Participants had knee Degenerative Joint Disease (DJD); grade 2 or 3 on Kellgren and Lawrence scale, were allocated to Experimental Group (EG) and Comparative Group (CG). EG received joint mobilization and Muscle Energy Technique (MET). CG received Interferential therapy (carrier frequency 4 kHz; beat frequency 100 Hz; and sweep frequency 150 Hz). Strengthening exercises and patient education were common for both groups. Intervention lasted two weeks, the post-intervention metrics included; stride length, step length, and cadence for gait and knee injury and osteoarthritis outcome score.&#x0D; &#x0D; Results: Data obtained was subjected to statistical analysis. Frequency and percentage were used for categorical variables; mean andstandard deviation (SD) were used for continuous variables. Post-intervention, there was a significant improvement of gait parameters and Knee Injury and Osteoarthritis Outcome Score (KOOS) in both groups. CG had a better improvement in STL, SL, CAD with mean of 39.84(5.68), 20.22(2.84), 97.16(3.75) and EG with mean of 44.36(4.48), 22.30(3.75), 92.82(3.75) and p &lt; .0005. However, it was evident that the proportion of functional improvement among CG was lesser.&#x0D; &#x0D; Conclusion: Inclusion of structured exercises, manual therapy and patient education in intervention would be effective and improve the functional status of DJD patients.&#x0D;

Comparison of mobilization with supervised exercise for patients with subacromial impingement syndrome.

This study aims to investigate the effects of joint mobilization with supervised exercise in patients with subacromial impingement syndrome (SAIS). This prospective, randomized-controlled study included a total of 40 patients (18 males, 22 females; mean age 43.52 years; range, 27 to 67 years) with SAIS of more than six weeks between June 2014 and June 2015. The patients were randomly allocated into two groups: Group 1 (n=20) received joint mobilization and neuromuscular electrical stimulation and Group 2 (n=20) received a supervised exercise program and neuromuscular electrical stimulation. The outcome measures included the range of motion, pain intensity, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form-patient self-report section, Short Form-36, and Global Rating of Change Questionnaire. Pain was evaluated using the visual analog scale (VAS). In both groups, the mean VAS scores significantly decreased and the range of motion significantly increased after treatment (p<0.05). Both joint mobilization and supervised exercise combined with neuromuscular electrical stimulation led to a significant improvement in function in patients with SAIS (p<0.05), although it did not significantly differ between the groups (p>0.05). Patient satisfaction with treatment was similar in both groups (p=0.28). Based on our study results, mobilization and supervised exercise yield comparable outcomes in patients with SAIS.

AB1310-HPR EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON FROZEN SHOULDER: A RANDOMIZED CONTROLLED TRIAL

Background:Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients. Management is based on the underlying cause of pain and stiffness. Joint mobilization has been reported to improve joint range of motion in frozen shoulder. However, there is no information regarding the effect of instrument-assisted soft tissue mobilization (IASTM) in frozen shoulder. We proposed that there would be no significant difference between the two manual physical therapy techniques with relatively similar treatment effects in the frozen shoulder.Objectives:The aim of this randomized controlled study was to compare the effectiveness of IASTM and joint mobilization in the treatment of patients with frozen shoulder.Methods:Thirty patients with phase II frozen shoulder (mean age 50,9 years, age range 39–65 years) were randomly assigned to one of the two treatment groups: Group I received joint mobilization combined with manual stretching exercise and Group II received IASTM with manual stretching exercise (two days per week for six weeks) (Figure 1). The pain level was evaluated with a visual analogue scale (VAS) and the active range of motion (ROM) was measured with a universal goniometer. The Disabilities of the Arm, Shoulder and Hand score and the Constant-Murley score were used for functional assessment. The assessments were performed at baseline and after the 6-week intervention.Figure 1.Instrument-Assisted Soft Tissue MobilizationResults:Both groups had a significant decrease in pain according to VAS and a significant increase in ROM and function level (p&lt;0.05). After the 6-week intervention, improvement of shoulder abduction ROM in Group I was found significantly higher than Group II (p=0.01), on the other hand, Constant-Murley score in Group II was found significantly higher compared to Group I (p=0,001).Conclusion:Our results supported the hypothesis that either joint mobilization or IASTM, performed in addition to stretching exercise, provided similar improvements in pain levels in patients with the frozen shoulder.

Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients

BackgroundApproximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.ObjectiveTo investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.Patients and methodsThirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.ResultsThere was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.ConclusionCombining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

A Comparative Study between Joint Mobilization and Conventional Physiotherapy in Knee Osteoarthritis

Background:&nbsp;Osteoarthritis (O.A.) is an active disease process involving articular cartilage destruction, subchondral bone thickening and new bone formation. Worldwide osteoarthritis is estimated to be the fourth leading cause of disability, in which 10% are males and 13% are females. Studies from china, Bangladesh and Pakistan have shown high prevalence of knee osteoarthritis. Pharmacological interventions, surgical procedures and Physiotherapy management play important role in knee Osteoarthritis. In Physiotherapy management of osteoarthritis, manual therapy along with thermotherapy and/or electrotherapy is used. Current study was to evaluate the effectiveness of joint mobilization in knee osteo-arthritis.Methods:&nbsp;Comparative study was undertaken on 50 patients with osteoarthritis of the knee who were randomly assigned to one of two groups that received Joint mobilization alone (n = 25; mean age, 53 years) or Conventional Physiotherapy (n = 25; mean age, 50 years).Both groups were received their programs for 8 weeks; two sessions per week. Analysis of data within group and between groups of the pre and post treatment values of the function and pain was done using pair t test and independent t test.Results:&nbsp;Both groups showed significant improvement in ISOA score and VAS. There was statistical significant difference between the two groups (Group A and B) i.e. p &lt; 0.005.Conclusion: Manual joint mobilization improves the effectiveness of the treatment program in treating symptoms of knee OA and improves function in elderly people with knee OA.

A Randomized Trial Comparing Interventions in Patients with Lumbar Posterior Derangement

This pretest/posttest study compared the outcomes of people with low back pain who were treated with exercises or joint mobilization. Thirty-one patients referred to physical therapy with a physician's diagnosis of lumbar radiculopathy were initially recruited as subjects. All 31 patients were examined and treated by a physical therapist with 17 years of clinical experience. Following the initial examination, those subjects classified into the derangement category (n=25) were randomly assigned to a group that received joint mobilization (n=10) or a group that performed therapeutic exercises as described by the McKenzie method (n=15). The remaining six patients were not classified into the derangement category and were not included in the analysis. The subjects were also classified according to the Quebec Task Force (QTF) system. The patient's pain as reported on the verbal analog scale and the patient's perceived level of function as indicated by Oswestry scores were recorded at the initial evaluation and following the third physical therapy visit. The McKenzie group performed exercises that were based on their response to repeated movements and the mobilization group received manual techniques based on active and passive movements and passive intervertebral motion testing. All subjects were instructed in postural correction. Data were analyzed through the use of t-tests and correlation coefficients. Subjects who performed therapeutic exercise were found to have significantly greater decreases in pain level (p<.014) and significantly greater improvement in function (p<.032) as compared to the mobilization group. Low correlations were found in regard to QTF classification and the outcome measures. The results indicated that exercises based on repeated movements might be more beneficial in terms of pain reduction and recovery of function than joint mobilization in the early stages of recovery from lumbar disc derangement. The results also point toward the importance of including repeated movements as part of the lumbar evaluation to assist in the prescription of appropriate therapeutic exercise.

Knee joint mobilization reduces secondary mechanical hyperalgesia induced by capsaicin injection into the ankle joint

Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. Capsaicin (0.2%, 50 μ l) was injected into the lateral aspect of the left ankle joint and mechanical withdrawal threshold assessed before and after capsaicin injection in Sprague-Dawley rats. Joint mobilization of the ipsilateral knee joint was performed 2 h after capsaicin injection for a total of 3 min, 9 min or 15 min under halothane anaesthesia. Control groups included animals that received halothane for the same time as the group that received joint mobilization and those whose limbs were held for the same duration as the mobilization (no halothane). Capsaicin resulted in a decreased mechanical withdrawal threshold by 2 h after injection that was maintained through 4 h. Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin.

Effects of Joint Mobilization on Joint Stiffness and Active Motion of the Metacarpal-Phalangeal Joint

Joint mobilization is a common technique used to restore joint motion; however, documentation of its effectiveness is lacking. The purpose of this study was to determine if joint mobilization is effective in counteracting joint stiffness and decreased active range of motion of the metacarpal-phalangeal joint. It was hypothesized that there would be a significant increase in range of motion in those patients who received joint mobilization. Eighteen subjects who had been immobilized for the treatment of metacarpal fractures were randomly assigned to a treatment group that received joint mobilization or a control group that received no treatment. Measurements of active range of motion and torque range of motion prior to and after treatment/rest sessions were obtained for three sessions over a 1 week period. Analyses of variance were performed on the mean changes in excursion between groups and across sessions. The joint mobilization resulted in a significantly greater increase in excursion for subjects in the treatment group over subjects in the control group (p < 0.05). Joint mobilization does appear to be able to counteract the effects of immobilization and alter joint mechanics. J Orthop Sports Phys Ther 1992;16(1):30-36.