Effectiveness of mid thoracic spine mobilization on postural balance and gait ability in subacute stroke patients: A randomized clinical trial.

BACKGROUND: Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. OBJECTIVE: To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. METHODS: Fifty subacute stroke patients were randomly allocated to the SNAG (n= 17), MM (n= 16), and control (n= 17) groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). RESULTS: Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p< 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. CONCLUSIONS: Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques.

Talonavicular joint mobilization and foot core strengthening in patellofemoral pain syndrome: a single-blind, three-armed randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS. METHODS: Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m2) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up. RESULTS: The two-way repeated-measures ANOVA revealed significant interactions in all groups (p < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, - 0.938; 95% Confidence interval [CI], - 1.664 to - 0.211; p < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p < 0.05) and valgus knee (mean difference, - 11.019; 95% CI, - 17.007 to - 5.031; p < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, - 1.250; 95% CI, - 2.195 to - 0.305; p < 0.05), and TJM (mean difference, - 1.563; 95% CI, - 2.640 to - 0.485; p < 0.05) and blended intervention (mean difference, - 1.500; 95% CI, - 2.578 to - 0.422; p < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p < 0.05) at 4 weeks follow-up. CONCLUSIONS: Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS. TRIAL REGISTRATION: KCT0003176 , 16/08/2018 (retrospectively registered).

Effectiveness of mid-thoracic spine mobilization versus therapeutic exercise in patients with subacute stroke: A randomized clinical trial.

BACKGROUND: Although commonly used in clinical settings, evidence regarding the beneficial effectiveness of joint mobilization and therapeutic exercise in patients with stroke is still lacking. OBJECTIVE: This study aimed to investigate the effects of mid-thoracic spine mobilization and therapeutic exercise on dynamic balance and inspiratory function in patients with subacute stroke. METHODS: The participants included 33 patients with subacute stroke. Participants were randomly allocated to 1 of 2 groups: (1) a group that received segmental mobilization (T4-8), and (2) a group that received foam roller exercises (T4-8). Outcome measure included the limits of stability (LOS), inspiratory function, and global rating of change (GRC). RESULTS: The improvement in inspiratory function was statistically significant at 4 and 6 weeks after the initiation of the intervention and changes in the LOS were statistically significant at 6 weeks in the mobilization group (p< 0.05). In addition, 15 of 17 (88.2%) participants in the mobilization group, compared to 9 of 16 participants (56.2%) in the exercise group, indicated a GRC score of +4 or higher at the 4-week follow-up. CONCLUSIONS: This study demonstrates that patients with subacute stroke who receive mid-thoracic spine mobilization demonstrate effective short-term improvements in LOS and GRC.

Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial.

BACKGROUND Ankle sprain reduces capacity for neurosensory information processing, and these patients commonly progress to chronic ankle instability (CAI). To address this problem, the short-foot exercise (SFE) may be used. However, there has been no previous research on the neurosensory impact of SFE. Therefore, the aim of this study was to assess improvement of quantitative neurosensory indicators after SFE and to determine the effect of proprioceptive sensory exercise (PSE) in patients with CAI. MATERIAL AND METHODS The present study included 30 adults (age range: 19-29 years; 50% female). Selection criteria for CAI (Cumberland Ankle Instability Tool £24) were implemented, and participants were randomly allocated to 2 groups: SFE (n1=15) and PSE (n2=15). Exercises were conducted 3 times per week for 8 weeks. Measurements of quantitative somatosensory of joint position sense and vibration sensory thresholds, dynamic balance, and ankle instability assessment were evaluated before and after completion of each intervention. Data were analyzed using a repeated- measures analysis of variance. RESULTS In a time-by-group comparison, the SFE group showed a more significant improvement with regards to eversion joint position sense (F1,28=4.543, p<0.05). For vibration sensory threshold, the SFE group showed a more significant improvement (F1,28=8.280, p<0.01). Balance index according to anterio-posterior, mediolateral, and overall index the SFE group a more significant improvement (F1,28=6.666, 4.585, 5.207, p<0.05). And ankle instability SFE group showed a more significant improvement (F1,28=6.890, p<0.05). CONCLUSIONS SFE is more effective than PSE for treating ankle sprain patients. There is a need to develop and promote an effective and controlled exercise program to facilitate the return of ankle sprain patients to normal daily life.

Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: A randomized clinical trial investigating their effectiveness.

BACKGROUND: Although commonly utilized treatments, no study has directly compared the effectiveness of joint mobilization and stabilization exercise in individuals with forward head posture (FHP). OBJECTIVE: This study aimed to investigate the effects of upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise (DCFE) in individuals with FHP. METHODS: Thirty-one participants with FHP were randomized into the mobilization (n= 15) or exercise (n= 16) group. The treatment period was 4 weeks with follow-up assessment at 4 weeks and 6 weeks after the initial examination. Outcomes assessed included the craniovertebral angle (CVA), numeric pain rating scale (NPRS), respiratory function, and the global rating of change (GRC). RESULTS: Participants in the mobilization group demonstrated significant improvements (p< 0.05) in CVA, NPRS, and respiratory function, as compared to those in the exercise group. In addition, 9 of 15 (60%) participants in the mobilization group, as compared to 4 of 16 participants (25%) in the exercise group, had a GRC score of +4 or higher. CONCLUSIONS: The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in CVA, NPRS, respiratory function, and GRC compared with DCFE in individuals with FHP.

Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial.

BACKGROUND: Although upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP. METHODS: Thirty-two participants with FHP were randomized into the cervical group or the thoracic group. The treatment period was 4 weeks, with follow-up assessment at 4 and 6 weeks after the initial examination. Outcome measures including the craniovertebral angle (CVA), cervical range of motion, numeric pain rating scale (NPRS), pressure pain threshold, neck disability index (NDI), and global rating of change (GRC) were collected. Data were examined with a two-way repeated-measures analysis of variance (group × time). RESULTS: Participants in the thoracic group demonstrated significant improvements (p < .05) in CVA, cervical extension, NPRS, and NDI at the 6-week follow-up compared with those in the cervical group. In addition, 11 of 15 (68.8%) participants in the thoracic group compared with 8 of 16 participants (50%) in the cervical group showed a GRC score of +4 or higher at the 4-week follow-up. CONCLUSIONS: The combination of upper thoracic spine mobilization and mobility exercise demonstrated better overall short-term outcomes in CVA (standing position), cervical extension, NPRS, NDI, and GRC compared with upper cervical spine mobilization and stabilization exercise in individuals with FHP. TRIAL REGISTRATION: KCT0002307 , April 11, 2017 (retrospectively registered).