Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study.

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.

Treatment of Women With Primary Dysmenorrhea With Manual Therapy and Electrotherapy Techniques: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this study was to evaluate the efficacy of electrotherapy and manual therapy for the treatment of women with primary dysmenorrhea. METHODS: Systematic searches were conducted in Scopus, Web of Science, PubMed, CINAHL, and MEDLINE. The articles must have been published in the last 10 years, had a sample exclusively of women with primary dysmenorrhea, had a randomized controlled trial design, and used interventions that included some form of manual therapy and/or electrotherapy techniques. Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS: Twelve selected studies evaluated interventions, with 5 evaluating electrotherapy techniques and 7 evaluating manual therapy techniques. All studies analyzed identified improvements in pain intensity and meta-analysis confirmed their strong effect. CONCLUSIONS: Manual therapy and electrotherapy are effective for the treatment of women with primary dysmenorrhea. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage stands out for its effects on the intensity and duration of pain with the application of a few sessions and their long-term effects. IMPACT: Manual therapy techniques and electrotherapy methods reduce the pain intensity of women with primary dysmenorrhea. Quality of life and degree of anxiety improved significantly with manual therapy interventions. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage are the interventions with which positive effects were achieved with fewer sessions.

The mechanism of action for laryngeal manual therapies: the need for an update.

PURPOSE OF REVIEW: To propose a pathway for expanding the understanding of potential mechanisms of action with laryngeal-based manual therapy (LMT) for muscle tension dysphonia (MTD). This review may help determine if current LMT literature has kept up with advances in the more general manual therapy (MT) findings. RECENT FINDINGS: Studies over the past thirty years, including recently published articles, have confirmed the efficacy of various manual therapy interventions in treating MTD. However, gaps exist between current LMT literature and that being presented in the more general MT field. Instead of viewing peripheral manipulation's influences as a local cause/effect process, the MT literature paints a richer tapestry of centrally mediated impacts. SUMMARY: Evidence from outside the LMT field has introduced a broad tapestry of factors that may contribute to the efficacy of MT, extending beyond the local effects reported in LMT literature. To better understand the effect and mechanism of action touch-based interventions have on a patient's voice and to potentially improve outcomes, it is necessary to broaden investigations to include a broader range of perspectives.

Effectiveness of musculoskeletal manipulations in patients with neck pain: a protocol for a systematic review and network meta-analysis.

INTRODUCTION: Neck pain is a common problem that severely affects physical and mental health. While musculoskeletal manipulations are recommended as the first-line treatment for adults with neck pain, the comparative effectiveness of different musculoskeletal manipulations remains unclear. This systematic review and network meta-analysis of randomised controlled trials (RCTs) will compare the effectiveness of different types of musculoskeletal manipulations, with the overarching aim of guiding clinical practice. METHODS AND ANALYSIS: Two independent reviewers will search four English electronic databases (Web of Science, Cochrane Library, EMBASE, PubMed) and three Chinese electronic databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang) for relevant RCTs published from 1 January 2013 to 30 April 2023. The Clinical Trials Registry (ClinicalTrials.gov) will be searched for completed but unpublished RCTs. English and Chinese will be used to search English databases and Chinese databases, respectively. RCTs of musculoskeletal manipulations for adults (aged ≥18 years) with neck pain will be considered eligible for inclusion. A pairwise meta-analysis and network meta-analysis will be performed, and pooled risk ratios, standardised mean differences and 95% CIs will be determined. ETHICS AND DISSEMINATION: Ethics approval is not required as this study is a literature review. The results of this review will be published in peer-reviewed journals or disseminated at conferences. PROSPERO REGISTRATION NUMBER: CRD42023420775.

Dry Needling Versus Manual Therapy for Patients With Mechanical Neck Pain: A Randomized Controlled Trial.

OBJECTIVE: To compare the short- and intermediate-term effects of dry needling to manual therapy on pain, disability, function, and patient-perceived improvement in patients with mechanical neck pain. DESIGN: A single (therapist) blinded randomized controlled trial. METHODS: Seventy-eight patients (mean ± SD age, 50.74 ± 13.81) were randomly assigned to one of the 2 groups: (1) dry needling and therapeutic exercises (DN + Exercises) and (2) manual therapy and therapeutic exercises (MT + Exercises). Both groups received 7 treatment sessions over a maximum of 6 weeks. Outcome measures, collected at baseline, 2 weeks, discharge (7th treatment session), and 3 months after discharge, were as follows: Neck Disability Index (NDI), numeric pain-rating scale (NPRS), Patient-Specific Functional Scale (PSFS), global rating of change (GROC), Fear-Avoidance Belief Questionnaire (FABQ), and Deep Neck Flexor Endurance Test (DNFET). Data were analyzed with mixed-model analysis of covariance (ANCOVA), using pretest scores as covariates, and a Mann-Whitney U test for GROC scores. RESULTS: The ANCOVA revealed significant group-by-time interaction for all variables. Significant between-group differences, favoring MT + Exercises, were observed at all 3 time points on the NDI (2 weeks: F1,446 = 172.68, P≤.001, [Formula: see text] = .27; discharge: F1,446 = 254.15, P≤.001, [Formula: see text] = .36; and 3 months: F1,446 = 339.40, P≤.001, [Formula: see text] = .43). Results for the MT + Exercises group exceeded recommended minimal clinically important difference for all variables, at all follow-up points. CONCLUSION: MT + Exercises was more effective, both in the short term and intermediate term, than DN + Exercises in reducing pain, disability, and improving function in patients with mechanical neck pain. J Orthop Sports Phys Ther 2024;54(4):1-12. Epub 29 January 2024. doi:10.2519/jospt.2024.12091.

Effectiveness of focused extracorporeal shock wave versus manual therapy in postpartum patients with sacroiliac joint dysfunction: a prospective clinical trial.

OBJECTIVE: To investigate the effectiveness of focused extracorporeal shock wave therapy (FESWT) in treating postpartum sacroiliac joint (SIJ) dysfunction. METHODS: A total of 90 patients with SIJ dysfunction were included and randomly assigned to FESWT, manual therapy (MT), or combination therapy (CT) groups. Pain intensity and Oswestry Disability Index (ODI) score were measured upon admission, after 1 and 2 weeks of treatments. The treatment efficacy and adverse events of each group were also assessed. RESULTS: There were no significant differences among three groups regarding clinical data, pain intensity, and ODI score on admission (all P > 0.05). After 1 week of treatment, FESWT exhibited similar pain intensity and lower ODI score (P < 0.001) compared to MT. After 2 weeks of treatment, the pain and ODI in FESWT were similar with MT. The pain in CT was lower than MT after 1 week, but lower than FESWT after 2 weeks. Furthermore, we identified interaction effects between treatment method and duration in relation to pain intensity (Fgroup*time = 5.352, P = 0.001) and ODI score (Fgroup*time = 5.902, P < 0.001). FESWT group exhibited the highest improvement rate of 66.7%, while CT group achieved the highest cure rate of 73.3%. No adverse events were observed in any of the patients during 2 months follow-up period. CONCLUSIONS: Compared to MT, FESWT mainly reduced the ODI score rather than pain after 1 week of treatment. After 2 weeks, the effect of FESWT in relieving the pain was inferior to the MT.

Specific and shared mechanisms associated with treatment for chronic neck pain: study protocol for the SS-MECH trial.

BACKGROUND: Treatment mechanisms involve the steps or processes through which an intervention unfolds and produces change in an outcome variable. Treatment mechanisms can be specific to the intervention provided (i.e. pain modulation) or shared with other treatments (i.e. reduced fear of movement). Whether specific and shared treatment mechanisms are different across interventions and whether they lead to the outcomes seen in trials is largely unknown. The management of individuals with chronic neck pain routinely include manual therapy (MT) and resistance exercise (RE), as both approaches are included in clinical practice guidelines and both yield similar outcomes. OBJECTIVES: Our study plans to answer two research questions: 1) what are the specific mechanisms associated with MT versus interventions (and are these different), and 2) what are the shared mechanisms associated with these interventions, and do specific or shared mechanisms mediate clinical outcomes? METHODS: This study will involve a 2-group parallel (1:1) single-blinded randomized trial to compare the specific and potential shared treatment mechanisms between these two approaches. We will enroll individuals with a history of chronic neck pain and evaluate whether specific or shared mechanisms mediate clinical outcomes. RESULTS: We hypothesize that MT and RE approaches will both exhibit different specific treatment mechanisms, and that both approaches will exhibit shared treatment mechanisms, which will notably influence outcomes at both discharge and 6-months. CONCLUSIONS: This study is important because it will help identify what specific or shared treatment mechanisms are associated with different interventions and, how different treatment mechanisms influence clinical outcomes.

Evaluating and Characterizing the Scope of Care for Interventions Labeled as Manual Therapy in Low Back Pain Trials: A Scoping Review.

OBJECTIVE: The purpose of this scoping review was to evaluate and characterize the scope of care for low back pain that falls under the specific label of manual therapy. METHODS: PubMed database, Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus were searched from journal inception through May 2022 for randomized controlled trials that investigated the treatment of low back pain using manual therapy. Terminology used to define manual therapy was extracted and categorized by using only the words included in the description of the intervention. An expert consultation phase was undertaken to gather feedback. RESULTS: One hundred seventy-six trials met final inclusion criteria, and 169 unique terms labeled as manual therapy for the treatment of low back pain were found. The most frequent terms were mobilization (29.0%), manipulation (16.0%), and thrust (6.4%). Eight percent of trials did not define or specify what type of manual therapy was used in the study. After removing duplicates, 169 unique terms emerged within 18 categories. CONCLUSIONS: Manual therapy intervention labels used in low back pain trials are highly variable. With such variation, the heterogeneity of the intervention in trials is likely large, and the likelihood that different trials are comparing the same interventions is low. Researchers should consider being more judicious with the use of the term manual therapy and provide greater detail in titles, methods, and supplementary appendices in order to improve clarity, clinical applicability, and usefulness of future research. IMPACT: The ability to interpret and apply findings from manual therapy-related research for low back pain is challenging due to the heterogeneity of interventions under this umbrella term. A clear use of terminology and description of interventions by researchers will allow for improved understanding for the role of manual therapy in managing back pain.

Comparison of the efficacy of manual treatment according to fascial distortion model versus joint mobilization in patients with shoulder impingement: A randomized clinical trial.

BACKGROUND: The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, but to date no study has been conducted to compare its' effect in comparison with joint mobilization on patients with shoulder impingement syndrome. OBJECTIVE: The present study aims to compare the efficacy of the FDM versus joint mobilization in pain intensity, pain-free abduction range of motion and function of patients with shoulder impingement syndrome. DESIGN: single-blind, parallel-arm randomized controlled trial. METHODS: 26 patients diagnosed with shoulder impingement syndrome were equally randomized into 2 groups: manual treatment according to the FDM, and joint mobilization of the shoulder complex. All patients received 3 intervention sessions every other day. Pain intensity (by visual analogue scale), pain-free abduction range of motion (by goniometry) and function (by Persian version of shoulder pain and disability index) were measured before and after every session and at follow-up 2 weeks later. Patients' satisfaction with treatment was also measured (by a 4-point Likert scale) at follow-up. RESULTS: FDM therapy group showed statistically significant greater pain reduction (P = 0.014) and range of motion increment (P = 0.044) than joint mobilization group after intervention, while only range of motion maintained the difference at follow-up (P = 0.034). Function improvement was not statistically different after the intervention (P = 0.582) and at follow-up (P = 0.094). There was no difference in patients' satisfaction with treatment between groups (P > 0.05). CONCLUSION: The FDM is a safe and effective treatment approach with comparable results to joint mobilization in patients with shoulder impingement syndrome.

Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS: Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS: After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION: Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.

Terapia manual para la mejora del flujo sanguíneo de las arterias uterinas en el área vascular endometrial/subendometrial en mujeres infértiles mediante ultrasonografía tridimensional: estudio piloto / Manual therapy for the improvement of blood flow of the uterus arteries in the endometrial/subendometrial vascular area in infertilized women through three-dimensional ultrasonography: Pilot study

Objetivo Evaluar cuantitativamente el efecto de la técnica manual de fisioterapia sobre el volumen endometrial y los valores del histograma en participantes infértiles. Métodos Estudio piloto, analítico, intervencionista, con grupo control, desarrollado en la Clínica Juana Crespo sobre 34 participantes infértiles. Se midió el volumen endometrial y subendometrial del útero, los índices de vascularización (IV%), el índice de flujo de vascularicación (IVF%) y el índice de flujo (IF%) mediante ultrasonografía Doppler 3D, después de aplicar la técnica manual de movilización de tejidos blandos de las fosas ilíacas. Resultados En el grupo experimental la comparación de los volúmenes endometriales totales antes (M=41,09) y después de la aplicación de la técnica fisioterápica (M=47,29) presentó diferencias estadísticamente significativas, z=–3,946 (p<0,001), r=–0,73, al igual que el estudio de los histogramas, alcanzando diferencias significativas en el índice de flujo (IF%) entre los registros pre (M=35,22) y post (M=37,62), z=–2,849 (p<0,005), r=–52. El índice de flujo de vascularización (IFV%) y el índice de vascularización (IV%) no tuvieron diferencias significativas entre el tiempo pre y post. Los histogramas IV%, IF%, IFV% indican p<0,005. Conclusiones La técnica de fisioterapia aumenta los volúmenes endometriales totales y el IF% endometrial después de su aplicación, aunque no varían las variables IV% e IFV% (AU)

Objective To quantitatively assess the effect of physical therapy manual technique on endometrial volume and histogram values in infertile participants. Methods Pilot, analytical, interventional study, with a control group, developed at the Juana Crespo Clinic on 34 infertile participants. The endometrial and subendometrial volume of the uterus, Vascularization Indices (VI%), Vascularization Flow Index (VFI%) and Flow Index (IF%) were measured by 3D Doppler Ultrasonography, after applying the manual mobilization technique in soft tissue of the iliac fossa. Results In the experimental group, the comparison of the total endometrial volumes before (M=41.09) and after the application of the physiotherapy technique (M=47.29) presented statistically significant differences, z=-3.946 (p<0.001), r=-, 73, like the study of histograms, reaching significant differences in the flow index (IF%) between the pre (M=35.22) and post (M=37.62) records, z=-2.849 (p<0.005), r=- 52. The vascularization flow index (IFV%) and the vascularization index (IV%) did not have significant differences between the pre and post time. Histograms IV%, IF%, IFV% indicate p<0.005. Conclusions The physiotherapy technique increases the total endometrial volumes and the endometrial IF% after its application, although the IV% and IFV% variables do not vary (AU)

Tuina in a Frozen Shoulder Rat Model: An Efficient and Reproducible Protocol.

Frozen shoulder (FS) is a common condition with no defined optimal therapy. Tuina therapy, a traditional Chinese medicine (TCM) technique used to treat FS patients in Chinese hospitals, has demonstrated excellent results, but its mechanisms are not fully understood. Building on a previous study, this work aimed to develop a Tuina protocol for an FS rat model. We randomly divided 20 SD rats into control (C; n = 5), FS model (M; n = 5), FS model Tuina treatment (MT; n = 5), and FS model oral treatment (MO; n = 5) groups. This study used the cast immobilization method to establish the FS rat model. The effect of Tuina and oral dexamethasone on the glenohumeral range of motion (ROM) was evaluated, and the histological findings were assessed. Our study showed that Tuina and oral dexamethasone were able to improve shoulder active ROM and preserve the structure of the capsule, with Tuina therapy proving to be more effective than oral dexamethasone. In conclusion, the Tuina protocol established in this study was highly effective for FS.

[Manual spinal therapy techniques to stimulate the autonomic nervous system: a scoping review]. / Manuelle Therapietechniken an der Wirbelsäule zur Stimulation des autonomen Nervensystems - ein Scoping Review.

BACKGROUND: Physical interventions or manual therapeutic techniques (MTTe) such as mobilisation, manipulation or soft tissue techniques not only have an influence on the target tissue with improvement of metabolism or reduction of hypertonic muscles. They are also used for balance regulation in central nervous changes of the autonomic nervous system (ANS). To date, there is a lack of empirical evidence on impact mechanisms and target locations of MTTe on the ANS. This scoping review aims to provide an overview of the evidence on the application of MTTe at diverse levels of the spine with a view to the ANS. METHOD: A systematic literature search was conducted on CENTRAL, Google Scholar, Osteopathic Research Web, PEDro and PubMed. The scope and content of the literature were documented. The results of the included and referenced studies were summarised in a narrative approach with the focus being on the most significant clinical aspects. RESULTS: MTTe was described as manipulations, mobilisations, myofascial techniques and cervical traction. In 27 out of 35 studies, therapeutic treatments were carried out on healthy volunteers. Ten studies analysed immediate effects in patients, while two studies were designed as longitudinal studies in patients with hypertension. Over a period of four to eight weeks, the frequency of intervention was between one and three MTTe sessions a week. CONCLUSION: The study results proved to be heterogeneous. For this reason, it is not possible to draw definitive, explicit and generally valid statements regarding the type and intensity as well as the segmental level at which MTTe should be applied in order to trigger specific positive ANS response mechanisms. Consequently, longitudinal studies with follow-up are recommended for future studies. In addition, comprehensive effects of MTTe should be evaluated in groups of patients with different characteristics.

Is manual therapy of the diaphragm effective for people with obstructive lung diseases? A systematic review.

BACKGROUND: Diaphragm dysfunction is common among people with obstructive lung disease (OLD). The effectiveness of manual therapy (MT) techniques specifically targeting this region remains unclear. The scope of this systematic review is to investigate the effectiveness of MT on the zone of apposition (ΖΟΑ) of the diaphragm in lung function, diaphragm excursion (DE), chest expansion, exercise capacity (EC), maximal inspiratory pressure (PImax) and dyspnea in people suffering from OLD. METHODS: Key databases were systematically searched. Two independent reviewers screened the papers for inclusion. Methodological quality and the quality of evidence were assessed using the PEDro scale and the GRADE approach, respectively. RESULTS: Two studies were included. One showed that diaphragmatic stretching and the manual diaphragm release technique (MDRT) improved DE and CE (p<0.001, p<0.05, respectively). The other showed that MDRT improved DE and EC (p<0.05, p<0.05, respectively). CONCLUSION: This systematic review provides preliminary evidence on the effectiveness of MT on the ZOA of the diaphragm in people with COPD. Further research is needed in order for definitive conclusions to be drawn. REGISTRATION NUMBER IN PROSPERO: CRD42022308595.

Effectiveness of scapular mobilization in people with subacromial impingement syndrome: A randomized controlled trial.

BACKGROUND: Scapular mobilization is a manual therapy technique widely used in the management of musculoskeletal disorders of the shoulder. OBJECTIVE: To determine the effects of scapular mobilization in addition to an exercise program in people with subacromial impingement syndrome (SIS). METHODS: Seventy-two adults with SIS were randomly allocated to 1 of 2 groups. The control group (n=36) participated in a 6-week exercise program, and the intervention group (n = 36) participated in the same exercise program plus passive manual scapular mobilization. Both groups were assessed at baseline and 6 weeks (end of treatment). The primary outcome measure was upper limb function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcome measures were the Constant-Murley questionnaire, pain (visual analog scale [VAS]), and scapular upward rotation. RESULTS: All participants completed the trial. The between-group difference in DASH was -1.1 points (Cohen d = 0.05; p = 0.911), Constant-Murley 2.1 points (Cohen d = 0.08; p = 0.841), VAS rating of pain at rest -0.1 cm (Cohen d = 0.05; p = 0.684), and VAS rating of pain during movement -0.2 cm (Cohen d = 0.09; p = 0.764); scapular upward rotation at rest (arm by the side) was 0.6° (Cohen d = 0.09; p = 0.237), at 45° shoulder abduction was 0.8° (Cohen d = 0.13; p = 0.096), at 90° was 0.1° (Cohen d = 0.04; p = 0.783), and at 135° was 0.1° (Cohen d = 0.07; p = 0.886). Most differences were in favor of the intervention group; however, the effect sizes were weak and not statistically significant. CONCLUSIONS: In the short-term, the addition of scapular mobilization did not provide significant clinical benefits in terms of function, pain or scapular motion in participants with SIS. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN number U1111-1226-2081. Registered February 25, 2019.

The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis.

BACKGROUND: Neck pain is among the most prevalent and costly musculoskeletal disorders. Manual therapy and exercise are two standard treatment approaches to manage neck pain. In addition, clinical practice guidelines recommend a multi-modal approach, including both manual therapy and exercise for the treatment of neck pain; however, the specific effects of these combined interventions have not recently been reported in the literature. OBJECTIVE: To perform a systematic review and meta-analysis to determine the effect of manual therapy combined with exercise on pain, disability, and quality of life in individuals with nonspecific neck pain. DESIGN: Systematic Review and Meta-Analysis. METHODS: Electronic database searches were completed in PubMed, CINAHL, Cochrane, EMBASE, Ovid, and SportDiscus, with publication dates of January 2000 to December 2022. The risk of bias in the included articles was completed using the Revised Cochrane Risk of Bias Tool (RoB 2). Raw data were pooled using standardized mean differences and mean differences for pain, disability, and quality of life outcomes, and forest plots were computed in the meta-analysis. RESULTS: Twenty-two studies were included in the final review. With moderate certainty of evidence, three studies demonstrated no significant difference between manual therapy plus exercise and manual therapy alone in pain (SMD of -0.25 (95% CI: -0.52, 0.02)) or disability (-0.37 (95% CI: -0.92, 0.18)). With a low certainty of evidence, 16 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing pain (-0.95 (95%CI: -1.38, -0.51)). Similarly, with low certainty of evidence, 13 studies demonstrated that manual therapy plus exercise is significantly better than exercise alone for reducing disability (-0.59 (95% CI: -0.90, -0.28)). Four studies demonstrated that manual therapy plus exercise is significantly better than a control intervention for reducing pain (moderate certainty) (-2.15 (95%CI: -3.58, -0.73)) and disability (low certainty) (-2.39 (95% CI: -3.80, -0.98)). With a high certainty of evidence, four studies demonstrated no significant difference between manual therapy plus exercise and exercise alone in quality of life (SMD of -0.02 (95% CI: -0.21, 0.18)). CONCLUSION: Based on this systematic review and meta-analysis, a multi-modal treatment approach including exercise and manual therapy appears to provide similar effects as manual therapy alone, but is more effective than exercise alone or other interventions (control, placebo, 'conventional physical therapy', etc.) for the treatment of nonspecific neck pain and related disability. Some caution needs to be taken when interpreting these results given the general low to moderate certainty of the quality of the evidence.

Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis.

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. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form. RESULTS: Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low. CONCLUSION: Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.

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

OBJECTIVE: 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. DESIGN: 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. The results of the different reviews were statistically synthesized through a random-effect meta-analysis, of all standardized mean differences and the corresponding 95% confidence interval reported by each study. RESULTS: For mechanical hyperalgesia, the meta-meta-analysis of three meta-analyses 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. CONCLUSION: 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.

Select Manual Assessment Techniques and Clinical Reasoning Skills Used in Canine Physical Rehabilitation Before Engaging in Manual Therapy Treatment.

Manual therapy is a cornerstone of physical therapy and canine physical rehabilitation. Although veterinary literature has tackled the topic of manual therapy treatments in animal patients, less attention has been paid to the assessment techniques and clinical reasoning skills that guide a practitioner toward determining if, when, and where manual therapies will be most effective. This article tackles the topics of clinical reasoning, the functional diagnosis, observational skills, and physical evaluation techniques that serve as prerequisites to the use of manual therapeutics.

Effects of diacutaneous fibrolysis in patients with tension-type headache: A randomized controlled trial.

BACKGROUND: Manual therapy appears to be effective for the relief of tension-type headache (TTH), just as diacutaneous fibrolysis (DF) has shown to be a beneficial technique for the relief of symptoms in other dysfunctions. However, no studies have evaluated the potential beneficial effect of DF in TTH. The aim of this study is to analyze the effect of three sessions of DF in patients with TTH. METHODS: Randomized controlled trial in 86 subjects (43 intervention/ 43 control group). The headache frequency, the headache intensity, the pressure pain thresholds (PPTs) at trapeziometacarpal joint, upper trapezius, suboccipital, frontal and temporal muscles, parietal sutures and the cervical mobility were measured at baseline, at the end of the third intervention and one-month after the last intervention. RESULTS: Statistically significant differences with p values <0.05 were observed between groups in favor of the intervention group in the one-month follow-up in the following variables: headache frequency, headache intensity, flexion, extension, right and left side-bending, right and left rotation, PPTs in left trapeziometacarpal joint, right suboccipital muscle, right and left temporal muscle, left frontal muscle and right and left parietal. CONCLUSIONS: DF provides a beneficial effect in reducing headache frequency, relieving pain, and improving cervical mobility in patients with TTH.