The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques.

BACKGROUND: Static palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented. AIM: To evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine. SETTING: This study was conducted on human T1-T6 vertebrae. METHOD: A skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations. RESULTS: Spinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence. CONCLUSION: Spinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.

Manual therapy interventions in the treatment of plantar fasciitis: A comparison of three approaches.

BACKGROUND: Plantar fasciitis is one of the common causes of heel pain and a common musculoskeletal problem often observed by clinicians. Numerous options are available in treating plantar fasciitis conservatively, but no previous studies have compared combined conservative management protocols. AIM: The aim of this study was to compare manipulation of the foot and ankle and cross friction massage of the plantar fascia; cross friction massage of the plantar fascia and gastrocsoleus complex stretching; and a combination of the aforementioned protocols in the treatment of plantar fasciitis. SETTING: This study was conducted at the University of Johannesburg, Chiropractic Day Clinic, and included participants that complied with relevant inclusion criteria. METHODS: Forty-five participants between the ages of 18 and 50 years with heel pain for more than 3 months were divided into three groups and received one of the proposed treatment interventions. The data collected were range of motion (ROM) of the ankle (using a goniometer) and pain perception using the McGill Pain Questionnaire and Functional foot index and algometer. RESULTS: The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion ROM, whereas the combination group showed the greatest increase in plantar flexion. CONCLUSION: The results demonstrated that all three protocols had a positive effect on the ROM and pain perception to patients with plantar fasciitis.

Manual therapy interventions in the treatment of plantar fasciitis: a comparison of three approaches

Background: Plantar fasciitis is one of the common causes of heel pain and a common musculoskeletal problem often observed by clinicians. Numerous options are available in treating plantar fasciitis conservatively, but no previous studies have compared combined conservative management protocols. Aim: The aim of this study was to compare manipulation of the foot and ankle and cross friction massage of the plantar fascia; cross friction massage of the plantar fascia and gastrocsoleus complex stretching; and a combination of the aforementioned protocols in the treatment of plantar fasciitis. Setting: This study was conducted at the University of Johannesburg, Chiropractic Day Clinic, and included participants that complied with relevant inclusion criteria. Methods: Forty-five participants between the ages of 18 and 50 years with heel pain for more than 3 months were divided into three groups and received one of the proposed treatment interventions. The data collected were range of motion (ROM) of the ankle (using a goniometer) and pain perception using the McGill Pain Questionnaire and Functional foot index and algometer. Results: The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion ROM, whereas the combination group showed the greatest increase in plantar flexion. Conclusion: The results demonstrated that all three protocols had a positive effect on the ROM and pain perception to patients with plantar fasciitis

Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomised clinical trial.

CONTEXT: Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal research findings. Surgery often only provides modest improvement and post-surgery complications may significantly hamper outcomes, implying the need for trials testing conservative treatment, such as manual and manipulative therapy, particularly in cases where surgery may be contraindicated or premature. The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial. DESIGN: Parallel-group randomised trial set in an out-patient teaching clinic. PARTICIPANTS: A convenience sample of 75 patients was assessed for eligibility, with 30 participants (15 per group) being consented and randomly allocated to either the control group (standard care with a night splint) or the experimental group (MMT). INTERVENTION: Participants in the control group used a night splint(s) and those in the experimental group (MMT) received a structured protocol of MMT, with the participants in the experimental group receiving 4 treatments over a 2-week period. OUTCOME MEASURES: Visual analogue scale (HAV-related pain), foot function index (HAV-related disability) and hallux dorsiflexion (goniometry). RESULTS: There were no participant dropouts and no data was missing. There were no statistical (p<0.05) or clinically meaningful differences (MCID<20%) between the two groups based on outcome measure scores. However, the outcome measure scores in the control group (night splint) regressed between the 1-week follow-up and 1-month follow-up, while the scores in the experimental group (MMT) were sustained up to the 1-month follow-up. The within-group data analysis produced statistically and clinically significant changes from baseline to the 1-week flow-up across all outcome measures. Post hoc power analysis and sample size calculations suggest that the average between group power of this trial was approximately 60% (ES = 0.33) and that a definitive trial would require a minimum of 102 participants per group (N = 204) to achieve satisfactory power of ≥80%. CONCLUSIONS: The trend in results of this trial suggest that an innovative structured protocol of manual and manipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery is premature or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.