Thrust Manipulation Research Articles

Bilateral hand dystonia following high-velocity thrust manipulation: a case report.

Thrust manipulation is one of the most commonly used techniques for managing musculoskeletal pain in clinical practice. This involves the application of a high-velocity, low-amplitude force directed to the joints with the intent of achieving joint cavitation. This current case report describes a female in her mid-20s who presented with excessive bilateral and involuntary hand muscle contractions after bilateral thrust manipulation. Dystonia appeared both at rest and during voluntary movements but was aggravated by actions such as finger flexion or spreading and disappeared during sleep. A diagnosis of complex regional pain syndrome (CRPS) type I combined with dystonia was made. Prednisolone administered between 2 and 5 weeks after symptom onset significantly reduced CRPS symptoms, but intramuscular botulinum toxin injection 5 weeks after symptom onset was ineffective at controlling her symptoms. Seven weeks after symptom onset, the patient was administered 2 mg trihexyphenidyl oral twice a day, 2.5 mg diazepam oral twice a day and 5 mg baclofen oral three times a day for 1 month and this significantly reduced dystonia, but complete resolution was not achieved. Clinicians should be aware that dystonia is a rare complication of thrust manipulation.

Do Audible Sounds during a Lumbar Spine Thrust Manipulation Have an Impact on Brainwave Activity?

To manage pain and stiffness of the lumbar spine, thrust manipulation is commonly used. High-velocity, small-amplitude thrust manipulation often elicits audible sounds. What causes this audible sound remains unclear, and its clinical significance has not been shown. This study aimed to identify how audible sound affects brainwave activity following a side-lying right rotatory thrust manipulation in a group of healthy individuals. This was a quasi-experimental repeated measures study design in which 44 subjects completed the study protocol. A portable Bluetooth EEG device was used to capture brainwave activity. The environment was controlled during testing to minimize any factors influencing the acquisition of real-time EEG data. After a short accommodation period, initial brainwaves were measured. Following this, each subject underwent a lumbar 4-5 side-lying right rotatory thrust manipulation, immediately followed by a second brainwave measurement. A third measurement took place one minute later, followed by a fourth one at the three-minute mark. 21 subjects did not experience audible sounds, while 23 subjects experienced audible sounds. Both groups had significant changes measured by the 14 electrodes (p < 0.05). The audible group had more significant changes, which lasted only two minutes. The lack of brainwave response differences between the audible and non-audible groups implies no direct, measurable placebo or beneficial effect from the audible sound. This study could not identify a benefit from the audible sound during an HVLA manipulation of the subjects.

Multidisciplinary Optimization of Aircraft Aerodynamics for Distributed Propulsion Configurations

The combination of different aerodynamic configurations and propulsion systems, namely, aero-propulsion, affects flight performance differently. These effects are closely related to multidisciplinary collaborative aspects (aerodynamic configuration, propulsion, energy, control systems, etc.) and determine the overall energy consumption of an aircraft. The potential benefits of distributed propulsion (DP) involve propulsive efficiency, energy-saving, and emissions reduction. In particular, wake filling is maximized when the trailing edge of a blended wing body (BWB) is fully covered by propulsion systems that employ boundary layer ingestion (BLI). Nonetheless, the thrust–drag imbalance that frequently arises at the trailing edge, excessive energy consumption, and flow distortions during propulsion remain unsolved challenges. These after-effects imply the complexity of DP systems in multidisciplinary optimization (MDO). To coordinate the different functions of the aero-propulsive configuration, the application of MDO is essential for intellectualized modulate layout, thrust manipulation, and energy efficiency. This paper presents the research challenges of ultra-high-dimensional optimization objectives and design variables in the current literature in aerodynamic configuration integrated DP. The benefits and defects of various coupled conditions and feasible proposals have been listed. Contemporary advanced energy systems, propulsion control, and influential technologies that are energy-saving are discussed. Based on the proposed technical benchmarks and the algorithm of MDO, the propulsive configuration that might affect energy efficiency is summarized. Moreover, suggestions are drawn for forthcoming exploitation and studies.

Assessing the transparency in reporting of clinical trials investigating manual therapy interventions for low back pain: A methodological review.

Low back pain (LBP) is a common condition with a significant societal burden. Manual therapy is an effective treatment for LBP and recommended in clinical practice guidelines. While the quantity of literature supporting the use of manual therapy is large, the methodological quality and transparency of this collective work are unclear. Explore the transparency in reporting of clinical trials assessing manual therapy interventions in patients with LBP by comparing planned components in the trial registration with what was reported in the published manuscript. Three databases were searched to identify trials assessing the treatment effect of manual therapy for LBP from January 2005 to May 2023. Studies were included if the manual therapy consisted of thrust manipulations, mobilizations or muscle energy techniques. From 4462 studies initially identified, 167 studies remained in the final review after title, abstractand full-text review. Only 87 (52.1%) of the 167 studies were registered (n = 57 prospectively and n = 30 retrospectively). Primary outcomes in the publications were identical to the registration in 54 (62.1%) of the registered trials. Secondary outcomes in the publication were identical to the registration in 27 (31.0%) of the registered trials. The CONSORT reporting guideline was referenced in only 19 (21.8%) trials. Multiple discrepancies between registration and publication were noted for primary and secondary outcomes. All trials had eligibility criteria in the registration that matched their corresponding manuscript, while only four (4.6%) trial registrations addressed any type of statistical analysis plan. Approximately half of the trials were not registered. Of those registered, only half were registered prospectively. Substantial discrepancies existed between registered and published outcomes that were never addressed by the authors, raising questions about potential bias. Transparency can be improved through more stringent requirements during manuscript submission to journals, and better reporting of the rationale for discrepancies between registration and publication.

Diagnosis and Management of Knee Arthrofibrosis and Associated Pain-Related Fear Using Multidimensional Clinical Reasoning and Exposure In Vivo Concept: A Case Report

BACKGROUND: A plethora of treatment approaches are used to manage persistent pain, disability, and fear associated with restricted knee range of motion following knee surgery. We used the pain and disability driver model and exposure in vivo concepts to manage pain-related fear and disability. CASE PRESENTATION: A 68-year-old male who underwent arthroscopic partial meniscectomy presented to physical therapy with a medical diagnosis of Complex Regional Pain Syndrome Type I and knee range-of-motion restriction. Despite extensive medical care and physical therapy for 3 years (202 visits), he continued to experience debilitating knee pain and demonstrated a high level of fear. To ambulate, he wore a knee brace and used a trekking pole. OUTCOME AND FOLLOW UP: Interventions to address the knee stiffness included combined tibiofemoral joint mobilization and high-velocity low-amplitude thrust manipulation targeting tibial internal rotation and low-load long-duration sustained capsular stretching using total end range time principle for extension. His fear was managed using techniques inspired by in vivo exposure concepts. Total knee range of motion improved 110 degrees and the patient was able to ambulate for 30 minutes (0.5 mile) without an assistive device with &lt;2/10 pain intensity. DISCUSSION: Outside-the-box clinical reasoning suggested that poor outcomes with previous interventions were likely due to hypervigilance and pain-related fear. This case delineates the value of nonreductionist clinical reasoning in diagnosis and management of musculoskeletal conditions. It also outlines how the exposure in vivo approach helped the patient overcome his long-established avoidance behaviors. JOSPT Cases 2024;4(3):121-132. Epub 2 July 2024. doi:10.2519/josptcases.2024.0034

Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study

BackgroundNeck pain is a common condition, and a frequent treatment is chiropractic cervical spinal manipulation therapy (cSMT). However, cervical spinal manipulations have been associated with excessive cervical artery elongations, allegedly causing arterial dissection leading to stroke. PurposeThe primary purpose of this study was to quantify the total vertebral artery elongations during cSMT, and secondarily, quantify the vertebral artery elongations during the pre-manipulative orientation of the head and neck and the subsequent elongations during the actual thrust. MethodsVertebral artery strains were measured at the cervical levels C0–C1, C1–C2, and C2–C3 using piezoelectric crystals that were sutured to the wall of the left and right vertebral artery in three cadavers. Vertebral artery strains were measured continuously for a full set of passive range of motion testing and for the chiropractic spinal manipulation. FindingsFor the range of motion testing, the greatest average vertebral artery strains at the C0–C1 level were 6.9% for ipsilateral flexion-rotation, at the C1–C2 level 4.3% for contralateral rotation, and at the C2–C3 level 3.7% for contralateral flexion-rotation. For the chiropractic spinal manipulation, the average maximal strains at the C0–C1, C1–C2 and C2–C3 levels were 1.3%, 0.1%, and 1.0%, respectively. The maximal average vertebral artery strains in the pre-manipulative phase were 0.5% and the corresponding maximal vertebral artery strains during the manipulative thrust was 1.1%. InterpretationPassive range of motion testing produced strains in the vertebral artery were 5.3 times (C0–C1), 7.2 times (C1–C2), and 3.7 times (C2–C3) greater than the corresponding strains during chiropractic spinal manipulation, suggesting that strains in the vertebral artery during chiropractic spinal manipulation were much smaller than the strains that can occur during normal everyday movements of the head and neck. Furthermore, vertebral artery strains in the pre-manipulative phase did not contribute to the peak strains on the contralateral vertebral artery and helped reduce strains on the ipsilateral side.

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial

Objective The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Design Randomized, single-blinded, multicenter, parallel-group trial. Setting Thirteen outpatient physical therapy clinics in nine different US states. Participants One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Intervention Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. Main measures The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. Results The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. Conclusions The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

The effectiveness of thoracic spine thrust manipulation on patient with mechanical neck pain: Systematic Review

The effectiveness of thoracic spine thrust manipulation on patient with mechanical neck pain: Systematic Review

Development of Physiotherapy Standard Operating Procedures Case of Ankle Sprain in Basketball Players

Physiotherapy is a form of health service aimed at individuals and groups as maintaining and restoring body movement functions throughout life. Ankle Sprain is a stretching or tearing that occurs due to (overstretch) trauma to the lateral ligament complex, due to inversion and plantar flexion movements that occur excessively when the foot is unable to provide perfect support on the floor/ground. A common injury to the ankle is Ankle Sprain, a sports injury that often occurs in volleyball and basketball players. To develop Standard Operating Procedures in performing physiotherapy treatment in chronic Ankle Sprain cases. This study was conducted using the research method of developing physiotherapy operational standards with this ankle sprain injury handling model starting with preliminary studies, history taking, assessment, diagnosis, intervention, and evaluation. The type of research conducted is Quantitative research using quasi experimental methods with pretest-posttest control group design. Experimental and control groups conducted an initial test. Both groups received different treatments, where the experimental group received thrust manipulation intervention and the control group received non thrust intervention in the form of myofascial release. There was a significant reduction in pain after manipulation therapy with the thrust and nonthrust methods on two groups were measured using the Numeric Rating Scale and after being evaluated for two weeks the pain did not increase. The provision of thrust and nonthrust manipulation therapy measures is highly recommended for the treatment of ankle pain. However, between the two methods there has not been. However, there is no significant difference between the two methods given the limited time of the study.

The effect of a spinal thrust manipulation's audible pop on brain wave activity: a quasi-experimental repeated measure design.

High velocity thrust manipulation is commonly used when managing joint dysfunctions. Often, these thrust maneuvers will elicit an audible pop. It has been unclear what conclusively causes this audible sound and its clinical meaningfulness. This study sought to identify the effect of the audible pop on brainwave activity directly following a prone T7 thrust manipulation in asymptomatic/healthy subjects. This was a quasi-experimental repeated measure study design in which 57 subjects completed the study protocol. Brain wave activity was measured with the Emotiv EPOC+, which collects data with a frequency of 128 HZ and has 14 electrodes. Testing was performed in a controlled environment with minimal electrical interference (as measured with a Gauss meter), temperature variance, lighting variance, sound pollution, and other variable changes that could have influenced or interfered with pure EEG data acquisition. After accommodation each subject underwent a prone T7 posterior-anterior thrust manipulation. Immediately after the thrust manipulation the brainwave activity was measured for 10 seconds. The non-audible group (N=20) consisted of 55% males, and the audible group (N=37) consisted of 43% males. The non-audible group EEG data revealed a significant change in brain wave activity under some of the electrodes in the frontal, parietal, and the occipital lobes. In the audible group, there was a significant change in brain wave activity under all electrodes in the frontal lobes, the parietal lobe, and the occipital lobes but not the temporal lobes. The audible sounds caused by a thoracic high velocity thrust manipulation did not affect the activity in the audible centers in the temporal brain region. The results support the hypothesis that thrust manipulation with or without audible sound results in a generalized relaxation immediately following the manipulation. The absence of a significant difference in brainwave activity in the frontal lobe in this study might indicate that the audible pop does not produce a "placebo" mechanism.

Immediate or Short-term Effects of Thrust Manipulation on Acute to Subacute Low Back Pain: A Systematic Review and Meta-Analysis

Immediate or Short-term Effects of Thrust Manipulation on Acute to Subacute Low Back Pain: A Systematic Review and Meta-Analysis

Beliefs and practice patterns of spinal thrust manipulation for mechanical low back pain of physical therapists in the state of Minnesota

ABSTRACT Introduction The primary purpose of this study was to examine the perceptions and utilization of spinal thrust manipulation (STM) techniques of physical therapists who treat patients with low back pain (LBP) in the State of Minnesota. A secondary purpose was to investigate differences between physical therapists who perform STM and those who do not. Methods A cross-sectional design was utilized through the completion of an electronic survey. 74 respondents completed the survey. Descriptive measures were recorded as frequencies for categorical data or mean ± standard deviation for continuous data. For between-group comparisons, chi-square analyses were used for categorical items of nominal or ordinal data and t-tests were utilized for continuous data. The alpha level was set at p < 0.05. Result 60.2% of respondents reported using STM when treating patients with LBP. 69.9% of respondents utilize a classification system. 76.7% of individuals answered correctly regarding the Minnesota State practice act. Of those who use STM, 81.8% utilize a Clinical Prediction Rule. Respondents who use STM were more likely to have a specialist certification (chi-square = 6.471, p = 0.011) and to have completed continuing education courses on manual therapy (chi-square = 4.736, p = 0.030). Discussion/Conclusions Physical therapists who perform STM are more likely to have a better understanding of their state practice act, be board certified, and have completed continuing education in manual therapy.

An international consensus on gaps in mechanisms of forced-based manipulation research: findings from a nominal group technique

ABSTRACT Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind why analgesia occurs with these hands-on interventions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neurotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanism-based research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was performed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.

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

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

Effects of Core Stabilization Exercises and High-Velocity Thrust Manipulation on Pelvic-Girdle Pain: A Randomized Controlled Trial

Pelvic-girdle pain is a mechanical disorder is very prevalent that leads the individual to suffer with disability and functional limitations. Objective: To determine the effectiveness of core stabilization exercises with thrust manipulation (HVT) on pelvic girdle pain in postpartum women. Methods: This randomized, placebo treatment-controlled trial was conducted in Physiotherapy OPD clinic in Jinnah Memorial Trust Hospital Gujranwala, Pakistan. We included 40 post-partum females consecutively aged 18 to 45 years presenting with pelvic girdle pain for over the past 6 to 16 months of the delivery meeting were isolated in two groups using convenient sampling. The control group received stabilization exercises with routine physical therapy treatment and the treatment group received a high velocity thrust manipulations technique (HVTT). The study instruments included Oswestry Disability Index Questionnaire and numeric pain rating scale. Data were analysed using SPSS 21.0. Results: The findings indicated demographics age with a mean and S.D score of 31.08 ± 6.36. In participants pain numeric pain and ODI scores in the post-treatment group were significant with a p &lt;0.01 and general exercise with a p&lt;0.02. The pre and post ODI scores in both groups had a p-value &lt;0.05 except the within-group score of p &gt;0.068. Conclusions: The application of high velocity thrust manipulation is effective approach in reducing pelvic girdle pain and discomfort in postpartum women. The HVTT treatment therapy can be deemed superior to core stabilization exercises.

Assessment of forces during side-posture adjustment with the use of a table-embedded force plate: Reference values for education.

Force-sensing treatment tables are becoming more commonly used by chiropractic educational institutions. However, when a table-embedded force platform is the sole measurement method, there is little information available about what force-time values instructors and students should expect for side-posture spinal manipulative thrusts. The purpose of this report is to provide force-time values recorded with such a system during side-posture manipulation with human recipients. Student volunteers were examined by and received lumbar or pelvic side-posture manipulation from experienced chiropractors who were diplomates of the Gonstead Clinical Studies Society. Forces were recorded using proprietary software of a Bertec force platform; force and time data were analyzed with a custom-programmed software tool in Excel. Seven doctors of chiropractic performed 24 thrusts on 23 student recipients. Preload forces, averaging 69.7 N, and thrust loading duration, averaging 167 milliseconds, were similar to previous studies of side-posture manipulation. Peak loads were higher than previous studies, averaging 1010.9 N. Other variables included prethrust liftoff force, times from thrust onset to peak force and peak load to resolution of thrust, and average rates of force loading and unloading. The values we found will be used for reference at our institution and may be useful to instructors at other chiropractic educational institutions, in the teaching of lumbar side-posture manipulation. A caveat is that the values of this study reflect multiple sources of applied force, not solely the force applied directly to the spine.

An investigation of neurological and/or biomechanical factors underpinning the effect of a thrust manipulation on chronic ankle symptoms: an observational study

ABSTRACT Background Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur. Objective The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred. Methods Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle. Results There were no significant differences in ankle dorsiflexion (DF) (p = 0.62), plantarflexion (PF) (p = 0.23), ground reaction force (GRF), or velocity (p = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (p = 0.046). There were no significant differences in dynamic pain measurements. Conclusions Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms.

Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review

IntroductionUpper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust...

EFFECT OF SPINAL THRUST MANIPULATION VERSUS MAITLAND MOBILIZATION AT T10-L1 IN PRIMARY DYSMENORRHEA - A RANDOMIZED CONTROLLED TRIAL

Background: Primary Dysmenorrhea refers to painful menstruation without any pelvic pathology. Women with this condition reported that menstruation have a negative impact on their quality of life. To compare the effect of Objective: Spinal thrust Manipulation versus Maitland Mobilization in subjects with primary Dysmenorrhea in terms of pain and Quality of life by using VAS and MOOS Questionnaire. Setting and design: A Randomized controlled study was conducted in tertiary health centre, Belagavi Methods: Forty-two females between 19-25 years of age with Primary Dysmenorrhea were recruited and were randomly allocated in three groups. All groups received hot moist pack and deep transverse massage as a conventional therapy, in addition Group B received spinal thrust manipulation and Group C received Maitland mobilization on their 21st, 23rd and 1st day of menstrual cycle. Patients were assessed at baseline and post intervention using VAS and MOOS Questionnaire. The Intra group analysis showed a Results: considerable amount of change in percentage of VAS in group B and MOOS in group C (p&lt;0.05). Inter group analysis of group A and B showed statistical differences in VAS. Group C showed statistical difference in MOOS score as compare to group A. Post HOC analysis showed no signicant differences in the variables. Conclusion: Spinal thrust manipulation and Maitland mobilization were equally effective in reducing pain and improving quality of life in subjects with primary dysmenorrhea

Sacroiliac joint manipulation helps to improve pain pressure threshold in chronic piriformis syndrome: a 6-week randomized controlled trial US

Background: Piriformis syndrome (PS) has negative impact on the daily activities of the patients and lead to disability. There is an anatomical association of piriformis muscle with sacroiliac joint (SIJ). So manual therapy including manipulation of SI joint may be the option for relieving the symptoms of PS Objective: To investigate the effectiveness of Sacroiliac joint manipulation in improving pain pressure threshold in patients with chronic piriformis syndrome. Materials and Methods: A randomized clinical trial (NCT04603703) was conducted at Max Rehab and Physical Therapy Centre G8-Markaz, Islamabad, Pakistan. A total of n=30 patients were randomly divided into Experimental group (n=15) and control group (n=15). Both groups received conventional physical therapy including therapeutic ultrasound, moist hot pack, piriformis muscle stretching, myofascial release of paraspinal muscles, gluteal strengthening, sciatic neurodynamics. The experimental group additionally received sacroiliac joint manipulation. The outcome measures were pain, straight leg raise (SLR), pain pressure threshold and piriformis muscle length. The total time frame of the treatment was 3 days per week for 6 weeks and pre and post intervention assessment was done. Result: The mean age of participants was 40.46 ±10.513 years. Pain, SLR, pain pressure threshold and piriformis length was significantly improved (p&lt;0.001) in both the experimental and control group after 6th week intervention. Between group comparison there was no significant difference between the groups after 6-week intervention regarding the pain, SLR and piriformis muscle length, except pain pressure threshold which was significantly improved in experimental group as compared to control group (67.7±18.42 vs 52.51±15.26, p=0.020) . Conclusion: Addition of the sacroiliac joint thrust manipulation technique and conventional physical therapy alone were equally effective in decreasing pain intensity and normalizing length of Piriformis and Straight leg raise. But SIJ manipulation showed promising results on pain pressure threshold. Keywords: Articular, physical therapy modalities, piriformis muscle syndrome, pain threshold, range of motion, sacroiliac joint.