Journal of Manual & Manipulative Therapy最新文献

Introduction: Individuals with hip-related groin pain typically present reduced hip range of motion (ROM), particularly hip internal rotation. This movement restriction may increase stress on pelvic structures contributing to pain, altered muscle function, and reduced physical function, thereby affecting quality of life (QoL). Manual therapy techniques aimed at improving hip ROM may therefore have beneficial effects in this population. The objective of this study is to compare the effects of a high-force hip lateral distraction mobilization to a sham hip lateral distraction mobilization in individuals with hip-related groin pain.

Methods: A double- blind randomized controlled trial was conducted. Thirty-five individuals with hip-related groin pain were randomized into an experimental group (EG) or a sham group (SG). Both groups performed four sessions (two per week) over two consecutive weeks. The primary outcomes were pain intensity and passive hip ROM. The secondary outcomes were muscle function, physical function, QoL, and self-perceived improvement. Data were collected at baseline and post-treatment.

Results: Significant between-group differences in favor of EG were found at post-treatment for pain intensity (in the last week, in sport activities, and in pain provocation tests); peak asymptomatic force and peak force in the squeeze test; passive hip ROM (except for adduction); physical function (sport and recreation, and participation physical activities); QoL; and self-perceived improvement.

Conclusion: High-force hip lateral distraction mobilization was more effective than sham hip lateral distraction mobilization for improving pain intensity, force in the squeeze test, passive hip ROM, physical function, and QoL in individuals with hip-related groin pain.

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.

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.

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.

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.