Journal of Manual & Manipulative Therapy

OBJECTIVE: This study aimed to investigate the difference between the integrated neuromuscular inhibition technique (INIT) and spray and stretch technique in patients with neck pain and upper trapezius active trigger points. Methods: A convenience sample of 60 patients with neck pain and active trigger points were recruited from physiotherapy students and allocated randomly to three groups INIT plus stretching exercise spray and stretch technique plus stretching exercise, and stretching exercise only...

OBJECTIVES: To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR). DESIGN: Parallel group, single-blind randomized clinical trial. SETTING: The study was conducted in a governmental tertiary hospital. PARTICIPANTS: Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups...

BACKGROUND: Most people with lower-limb loss (PLL) have musculoskeletal conditions and range-of-motion and muscle performance impairments. Such impairments limit potential for functional movement but can be reduced with manual therapy. Manual therapy, however, is rarely used for PLL. This case demonstrated how integrating manual therapy, exercise, and functional training led to lasting benefits for one low functioning PLL. CASE DESCRIPTION: A 54-year-old woman more than 1 year after transtibial amputation due to peripheral artery disease presented with multiple comorbidities and yellow flags...

INTRODUCTION: Vertebrobasilar vascular pathology and upper cervical ligament instability may contraindicate the use of cervical manual therapy. We examined physical therapists' documentation of screening for these conditions and hypothesized screening would be more common with specific risk factors and when using manual therapy. METHODS: This chart review included adults with neck pain presenting for outpatient physical therapy from 2015-2021. Exclusions were age<18 and history of cervical spine surgery...

OBJECTIVES: This study includes two separate parts: the objective for part A was to evaluate the practical manual therapy skills of undergraduate physiotherapy students who had learned manual therapy techniques either online or in classroom depending on the phases of the pandemic. The objective for part B was to evaluate in a randomized prospective design the effectiveness of video-based versus traditional teaching of a manual therapy technique. DESIGN: Cross-sectional cohort study (part A) and randomized controlled trial (part B)...

Physical therapists (PTs) working in primary care settings commonly encounter mechanical causes of knee pain. Non-mechanical causes of knee pain, such as bone tumors, are rare, and therefore, PTs often have a low index of suspicion regarding sinister pathology. The purpose of this case report is to describe the physical therapist's clinical reasoning process for a 33-year-old female presenting with medial knee pain and a subsequent history of metastatic melanoma. Initially, subjective and objective testing pointed to a mechanical internal derangement of the knee...

BACKGROUND: Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions. OBJECTIVE: The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions. METHODS: Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined...

BACKGROUND: Cervical spine mobilizations may differentially modulate both components of the stress response, consisting of the autonomic nervous system and hypothalamic pituitary adrenal-axis, depending on whether the target location is the upper or lower cervical spine. To date, no study has investigated this. METHODS: A randomized, crossover trial investigated the effects of upper versus lower cervical mobilization on both components of the stress response simultaneously...

OBJECTIVE: To compare if the degenerative findings from MRI differ between the sciatica patients classified as centralizers (CEN) and non-centralizers (Non-CEN) according to the McKenzie Method of mechanical diagnosis and therapy. STUDY DESIGN: A cross-sectional study. METHODS: Patients ( N  = 100) referred to a spine clinic of a single tertiary hospital for specialist consultation for sciatica. The McKenzie-based assessment was performed by the mechanical diagnosis and therapy-trained physiotherapists...

BACKGROUND: The clinical presentation and pain experience of patients with (sub)-acute low back pain ((S)ALBP) can strongly vary in clinical practice. However, despite growing evidence that psychological factors are associated with disability in chronic pain conditions including low back pain, studies examining the influence of psychological factors, quantitative sensory testing (QST) (i.e. pressure pain thresholds (PPTs)) and conditioned pain modulation (CPM) on future disability are still lacking in (S)ALBP...

INTRODUCTION: The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization. OBJECTIVE: The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students' adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach...

No abstract text is available yet for this article.

BACKGROUND: A history of traumatic life events is associated with chronic pain in later life. Physical therapists utilize a variety of methods to treat pain, however, they have struggled to find effective interventions to improve patient outcomes. OBJECTIVE: To compare impairment-based, regional (REGION-PT) physical therapy (PT) to a global (GLOBAL-PT) model consisting of pain neuroscience education, graded motor imagery, and exercise for adults with chronic pain and history of trauma...

No abstract text is available yet for this article.

INTRODUCTION: Physiotherapists and students may be vulnerable to false information and may learn faulty treatment techniques due to inadequate educational quality and uncertainty about sources and trustworthiness of YouTube videos. OBJECTIVE: To investigate educational quality, trustworthiness, and content completeness of joint mobilization techniques demonstrating videos available on YouTube. DESIGN: This is a descriptive study. METHODS: We performed a YouTube search on 1st April 2019, using the keyword 'Maitland joint mobilization technique for shoulder joint'...

BACKGROUND: The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length. METHODS: Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers...

Teaching hypothetico-deductive clinical reasoning (CR) should be an essential part of the physiotherapy education system, but currently there are very few learning tools for teachers in the musculoskeletal discipline. The aim of this article was to describe and present the rules of a new game-based and structured didactic tool that can be used by teachers for 'players' (students and licensed clinicians) to learn systematic CR in musculoskeletal physiotherapy.Our tool is based on the 'Happy Families' card game, and we propose to use it as part of a classic musculoskeletal subjective examination-based hypothesis category framework and the International Classification of Functioning, Disability and Health model...

INTRODUCTION: The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature. METHODS: A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa...

OBJECTIVE: Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months. METHODS: Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores...

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders...