Journal of Manual & Manipulative Therapy最新文献

Background: Manual therapists use manually applied physical force as their medium to achieve expected therapeutic effects. Force control ability based on proprioception is highly demanded for efficient 'hands-on' work and in the education process of manual therapy.

Objective: The aim of the presented study is to investigate the effects of manually applied, device-assisted force control training in manual therapy students and experienced manual therapists.

Design: A quasi-experimental design was applied with 2 groups of volunteers (students and experienced manual therapists), intervention in the form of 20-session manually applied, device-assisted force control training, and 3 measurements of dependent variables (baseline, post-training and 1-month follow-up).

Method: Force reproduction tests with no visual control were performed using a force plate and electronic dynamometer. Force control training was implemented using regular kitchen scales. A minimum of 1000 force reproduction trials was carried out during the training. Absolute errors of force reproduction were calculated.

Results: In the post-training and follow up-measurements students made significantly larger absolute errors than therapists. In follow-up they completely returned to their initial status, while the therapists retained much of the skills they had acquired.

Conclusions: Device-assisted force control training reduces the magnitude of the force reproduction error in students and therapists. Therapists seem to retain more of the training gains. Further research should consider effects of a mixed form of force control training (with human-partner and device-assisted ones) implemented for the longer periods of time. This could bring a new quality to the process of manual therapist education.

Objectives: This systematic review and meta-analysis aimed to summarize the effects of fascial manipulation (FM) on pain alleviation in adults, providing valuable insights for future research and practitioners by addressing a significant gap in the existing literature.

Methods: Systematic review with meta-analysis. Key databases, including PubMed, Scopus, and Web of Science, were searched for relevant studies. The eligibility criteria required randomized clinical trials involving adults (>18 years) with musculoskeletal pain, who participated in FM, and included either true control or active control groups as comparators. To assess the risk of bias, the PEDro scale was used, while the certainty of the evidence was evaluated using the GRADE scale. Out of the initial pool of 138 studies, 15 were determined to be eligible for inclusion in this systematic review.

Results: Results showed significant favoring effect for the FM compared to the active-control group in pain-related outcomes (ES = -0.80, 95% CI -1.30 to -0.29, p = 0.002, I²  = 85%). The certainty of evidence, as determined by the GRADE assessment, was rated as very low.

Conclusions: Although the included studies provide evidence of very low certainty - given the small sample sizes, lack of blinding, and significant limitations in the intervention - the meta-analysis suggests that FM may potentially be beneficial in reducing pain associated with various musculoskeletal conditions. However, more robust research is needed to strengthen these findings, with a focus on increasing the number of blinded studies, reducing methodological heterogeneity, and further exploring the underlying mechanisms that may explain the observed trends in the evidence.

Objective: The purpose of this study was to compare the accuracy of two dry needling (DN) techniques in embalmed cadavers that are commonly used to target the gluteus medius osteotendinous junction (OTJ).

Methods: Seven embalmed cadaveric specimens were placed in prone. Technique 1 used a needle insertion point that was measured 2 fingerbreadths superior and 3 fingerbreadths posteromedial to the greater trochanter (GT) apex using the donor's fingerbreadths. The needle insertion point for technique 2 involved locating a line between the GT apex and the sacro-coccygeal hiatus and estimating one-third of the distance from the GT. Using the entry point for each technique, a dry needle was then inserted in each body with an anterior and inferolateral angulation until contact with a boney backdrop was achieved. Dissections of the posterior hip muscles were then performed to confirm with a binary decision (yes/no) the needle tip location at the gluteus medius OTJ.

Results: In embalmed cadavers, the accuracy rate of the needle tip reaching the gluteus medius OTJ using Technique 1 (9 out of 10, 90%) was significantly higher (chi-squared test with Yates' correction = 9.800; p = 0.0017) than Technique 2 (1 out of 10, 10%).

Discussion/conclusion: Surface palpation of bony landmarks and a direction-specific fingerbreadth measurement is an appropriate method to locate the correct needle insertion point superomedial to the greater trochanter to reach the gluteus medius OTJ with a 90% accuracy rate.

Background: The obturator nerve may be injured during surgery or trauma. Neurodynamic testing (NDT) is theorized to assist in obturator nerve injury identification, but the optimum hip position for NDT has not been biomechanically supported.

Objectives: This study evaluated the displacement and strain of the obturator nerve within the pelvis using three NDT positions of the hip (neutral, flexion, and extension) combined with hip abduction.

Design: One-way repeated measures.

Methods: Nine cadavers were selected by consecutive sampling, and metal markers were glued to the exposed intrapelvic obturator nerves in situ. Cadavers were secured in a side-lying slumped knee bend position, and fluoroscopic images of the intrapelvic obturator nerve were taken in a starting position. Images were repeated during three testing positions: end-range hip abduction with sagittal hip positions in neutral, flexion, and extension. Images were digitized, and displacement and strain values were calculated and compared. Alpha was set at 0.05, and data were analyzed.

Results: The obturator nerve displaced distally from the starting position during end-range hip abduction with the sagittal hip position in neutral (mean = 2.76 ± 2.46 mm; p = 0.015) and extension (mean = 3.31 ± 2.14 mm; p = 0.003) but not with flexion. No lateral displacement or strain value differences were measured between the three testing positions (p = 0.948, p = 0.925, p = 0.359).

Conclusion: Obturator nerve NDT using end-range hip abduction with the sagittal hip position in neutral or extension significantly displaces the nerve distally, suggesting these positions may be most useful when performing NDT of the obturator nerve.

Introduction: Plantar Fasciitis (PF) is a common foot disorder. Kinesio Taping (KT) and dry needling (DN) are frequently used treatment options; however, their comparative efficacy remains poorly understood. This study aimed to evaluate and compare the effects of KT and DN on pain, functional performance, and plantar fascia thickness in patients with PF.

Methods: In this single-blinded randomized controlled trial, 52 PF patients (30 women and 22 men; mean age 45.3 ± 8.1 years) were randomly assigned to DN, KT, and control groups. All groups received routine physiotherapy five days per week. Pain, functional performance, and plantar fascia thickness were evaluated at three time points: before, immediately, and two weeks post-intervention. Assessments included the Visual Analog Scale (VAS) for pain, the Foot and Ankle Outcome Score (FAOS) for performance, and ultrasonography for plantar fascia thickness.

Results: VAS scores decreased significantly across all groups immediately post-intervention (p < 0.05). However, no significant interaction effect was observed, indicating similar pain reduction trends among groups at the two-week follow-up. The mean VAS scores before the intervention were 6.53 ± 0.91 (DN group), 6.07 ± 1.10 (KT group), and 6.00 ± 1.51 (control group), and after the intervention were 4.20 ± 2.00 (DN group), 4.33 ± 1.87 (KT group), and 4.87 ± 2.16 (control group). Both KT and DN groups showed improvements in FAOS score (p < 0.02), with a significant time × group interaction effect favoring greater improvements in the DN group compared to the control group. A significant group effect was observed for D2 thickness, with the DN group showing a greater reduction compared to the KT and control groups (p < 0.002).

Conclusion: All interventions effectively reduced pain, improved performance, and decreased plantar fascia thickness in PF patients. DN demonstrated superior efficacy in reducing central plantar fascia thickness (D2) compared to KT.

Introduction: Knee osteoarthritis (KOA) is a common joint disease that affects mobility and daily activities. Instrument-assisted soft tissue mobilization (IASTM) is widely used as a conservative treatment due to its potential effects on soft tissues. This study evaluates the effects of IASTM on pain, range of motion (ROM), health status, and gait kinetics in KOA patients.

Methods:   Thirty individuals with unilateral KOA were randomized into two groups: IASTM with routine exercises and sham IASTM with exercises, over four sessions in two weeks. Pain, ROM, and WOMAC scores were assessed pre-treatment and 48 hours post-treatment. Gait kinetics, including vertical ground reaction force and knee adduction moment, were measured at three walking speeds (preferred, fixed, and fast) before and after treatment.

Results: Mixed ANOVA revealed significant improvements in pain, ROM, and WOMAC scores in both groups. The IASTM group showed greater improvements in pain, knee flexion, ankle plantarflexion, and WOMAC pain scores, as indicated by a significant group*time interaction. For kinetics, the only significant finding was a longer time to heel strike transient in the IASTM group. At fast speed, most kinetic variables increased significantly in both groups.

Conclusion: Both IASTM and sham interventions with exercise improved pain and ROM. However, the IASTM group experienced greater improvements. Additionally, IASTM led to a longer time to heel strike transient, suggesting improved shock absorption. Overall, IASTM may serve as a beneficial adjunctive intervention for alleviating symptoms in KOA patients and improving gait under challenging conditions, such as fast-speed walking.

Introduction: In recent years, invasive physiotherapy techniques have seen a significant rise in use for the treatment of musculoskeletal pain. However, there is currently no standardization in the anatomical landmarks, needle length, and insertion angles applied across different muscles, which is critical for ensuring both safety and reliability, especially in non-ultrasound-guided interventions.

Objective: To analyze the results of studies evaluating invasive puncture techniques performed on cadaveric specimens and to assess their methodological quality.

Methods: A systematic review was conducted according to PRISMA guidelines. A comprehensive search was performed in the MEDLINE, Scopus, Web of Science, CINAHL, and SPORTDiscus databases, including all records up to 23 December 2024. Studies were included if they assessed the anatomical safety and procedural accuracy of invasive physiotherapy techniques on cadavers. The quality of reporting was assessed using the QUACS scale, and risk of bias was evaluated with the JBI Critical Appraisal Checklist for Systematic Reviews.

Results: Twenty-one cadaveric observational studies were included. All studies demonstrated anatomically safe approaches, with no reported injury to adjacent neural or vascular structures. However, there was variability in methodological quality and consistency in reporting across studies. The mean QUACS score across the included studies was 8.95 out of 13, corresponding to an average methodological quality of 68.84% (30.76% to 92.30%).

Conclusion: The current evidence supports the anatomical safety of invasive physiotherapy techniques applied to cadavers. Nevertheless, the development and implementation of standardized, reproducible protocols are necessary to improve the consistency, safety, and clinical applicability of these interventions, particularly when performed without ultrasound guidance.

Introduction: Neck pain is a common condition associated with high treatment costs, reduced productivity, and work limitations. It represents the second-largest group requiring physiotherapy services. Given its high prevalence, it is crucial to evaluate intervention effectiveness and ensure optimal implementation in practice. Literature highlights sensorimotor training (SMT) as an important approach in managing neck pain, though dosage recommendations for clinical application are only partially defined. This study aims to develop practical dosage guidelines for SMT in neck pain to support its implementation in daily physiotherapy.

Methods: A Delphi study was conducted. Based on literature and the expertise of 12 specialists from Switzerland and Germany, dosage recommendations were developed. Two questionnaire rounds were required to reach consensus (≥ 80%).

Results: After the second round, 92-100% consensus was achieved on key aspects: targeted abilities, training cycle, frequency, training duration, number of exercises, sets per exercise, repetitions, time per exercise, and rest time. Additional background questions and comments contributed to a factsheet designed as a practical clinical guide. Recommended parameters include: training cycle of 4-12 weeks, 3-21 sessions/week, 10-20 minutes/session, 2-6 exercises/session, 2-5 sets/exercise, 7-15 repetitions or 20-60 seconds/exercise, and 20-40 seconds rest between sets. Further guidance is provided on targeted abilities, clinical indicators of positive effects, criteria for progression, and required adjustments for effective SMT.    .

Conclusion: This study closes a knowledge gap regarding SMT dosage. The resulting factsheet aims to simplify SMT implementation for neck pain and promote its integration in daily physiotherapy practice.