Journal of Manual & Manipulative Therapy最新文献

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: 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.

Objective: To examine the efficacy of cervical physical therapy (e.g. cervical mobilization, exercise, and myofascial treatments) on pressure pain thresholds (PPTs) in patients with migraine, compared to no treatment, sham treatment, or usual medical care.

Method: A systematic search was performed in PubMed, Embase.com, Web of Science, SPORTDiscus, Cinahl Plus and PEDro. Two independent reviewers assessed the selected randomized controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias tool 2, and the certainty of evidence was evaluated according to the GRADE approach. The meta-analysis included PPTs from cervical muscles and cephalic muscles.

Results: Five papers out of 965 screened papers met our inclusion criteria, of which two originated from the same randomized controlled trial. Four RCTs had some risk of bias due to the absence of a pre-specified analysis plan and missing outcome data. One RCT had a high risk of bias due to a lack of information on concealment and blinding. All studies reported increased PPTs after cervical treatment. However, statistically significant differences were only found for the sternocleidomastoid muscle (mean difference (MD) 1.13 kg/cm²; 95% confidence interval (CI): 0.48 to 1.78) and the frontal muscle (MD 0.53 kg/cm²; 95% CI: 0.07 to 1.00). The certainty of evidence was low to very low.

Conclusion: The efficacy of cervical physical therapy on PPTs is uncertain. More studies of high methodological quality are needed to elucidate the pain-modulatory effects of cervical physical therapy in migraine.

Objective: To evaluate the augmented effects of trigger point dry needling (TPDN) and instrument-assisted soft tissue mobilization (IASTM) on pain and function in patellofemoral pain syndrome (PFPS).

Methods: A single-blinded, randomized controlled trial was conducted with 102 participants (15-25 years) diagnosed with PFPS. Participants were randomly assigned to four groups: TPDN (n = 27), IASTM (n = 25), combined TPDN and IASTM (n = 26), and a control group (n = 24). The intervention groups received two treatment sessions per week for four consecutive weeks, in addition to a standardized exercise program for all groups. Primary (pressure pain threshold, PPT) and secondary (Kujala Anterior Knee Pain Scale, AKPS) outcomes were assessed at baseline and post-intervention.

Results: Combined TPDN+IASTM demonstrated superior improvements in both outcomes: PPT increased by 78% and AKPS scores improved by 39% in the combined group. By comparison, the TPDN group showed a 53% increase in PPT and a 24% increase in AKPS, while the IASTM group showed a 54% increase in PPT and a 25% increase in AKPS (p < 0.001).

Conclusion: Both TPDN and IASTM are effective in reducing pain and improving function in PFPS. However, their synergistic application offers enhanced clinical benefits over either intervention alone or exercise therapy. These findings support integrating multimodal approaches for managing PFPS.