Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain

OBJECTIVE: To establish the short-term effects of lumbar posteroanterior mobilization in patients with low-back pain, compared with a control intervention. DESIGN: Self-controlled cross-over design. Main Outcome Measures: The force-displacement characteristics of the spine in response to the application of a posteroanterior force, lumbar flexion, and extension range of movement; pain during flexion, extension, and on worst movement; pain on posteroanterior loading; and overall pain relief. PATIENTS: Twenty-six patients with nonspecific low-back pain who experienced pain on flexion or extension and whose pain settled quickly after provocation, from a physiotherapy clinic and university campus. METHODS: Patients received posteroanterior mobilization and a control intervention in an order that was randomly allocated. The magnitude of force in treatment dose was selected by the treating physiotherapist. An observer who was blinded to the order of interventions performed all measurements. Outcome measures were recorded before and after each intervention, and change scores were calculated to quantify the effect of the intervention. RESULTS: No significant differences were found between the mobilization and control interventions in relation to posteroanterior response or range of movement. The score for pain on worst movement showed significantly greater improvement for the mobilization than for the control procedure. CONCLUSIONS: Lumbar posteroanterior mobilization was not observed to produce any objectively measurable change in the mechanical behavior of the lumbar spine of patients with low-back pain. Improvement in some pain variables was observed in comparison with a control procedure, but this may be due to a placebo effect.     

McKenzie诊疗法在颈椎病患者中的应用

目的：探讨Mckenzie疗法在颈椎病患者中的临床应用及其治疗效果。方法：将82例颈椎病患者随机分为Mckenzie疗法组（治疗组）和对照组，治疗组按颈椎Mckenzie疗法进行治疗，并结合牵引，手法整复或加用物理因子等常规疗法，对照组仅用常规疗法进行治疗，治疗前后评定患者的临床疗效。项目有VAS、Mckenzie运动功能缺失度等。结果：两组临床治愈率都高，疼痛明显减轻（P＜0．001），颈椎活动范围明显增加（P＜0．05）。治疗组效果优于对照组，两组比较差异有非常显著性（P＜0．01），结论：Mckenzie疗法对现患者在临床症状改善，疼痛减轻和颈椎活动度增加方面，有较好的临床治疗效果，并适用于神经根型和椎动脉型颈椎病患者，有较好的依从性。     

Manual therapy in the treatment of ankle hemophilic arthropathy. A randomized pilot study

Abstract

Purpose: Although physiotherapy has demonstrated effectiveness in preventing ankle arthropathy compared to prophylaxis treatment from early ages, there have been no conclusive studies examining physiotherapy intervention once hemophilic arthropathy of the ankle has been established. The aim of this study was to evaluate the effectiveness of two physiotherapy interventions, in patients with hemophilic arthropathy of the ankle that had not been operated on previously. Method: Nine patients with hemophilia (mean age of 35.7 SD 11.9 years) were randomized to a mobilization group (n?=?5) and manual therapy group (n?=?4). The two physiotherapy interventions were: (1) passive mobilization and stretching; and (2) manual orthopaedic therapy, both with proprioception training. The study lasted for six weeks, with two sessions a week. Ankle mobility and pain perception, lower limb proprioception and quality of life were the outcome measures. Results: Both treatments improved all ankle movements (p?<?0.05). The treatment with passive mobilizations also improved the perception of pain and quality of life. Six months later, both groups still had improved articular movement with the exception of plantar flexion and continued to perceive less pain. Conclusions: Both physiotherapy interventions improved the range of movement and lessened pain in patients with ankle arthropathy. No haemarthrosis was recorded during treatment or during the follow-up period.     

A study of the use of acupuncture in physiotherapy

OBJECTIVES: This two-phase study was designed to establish the current use of acupuncture within physiotherapy and to determine the opinions of those who received acupuncture therapy. DESIGN: Retrospective study and questionnaire survey. PATIENTS: Patients who attended an outpatient physiotherapy department over a 2-year period (phase 1, retrospective study of clinical records; n = 599). Patients who had received acupuncture treatment from outpatient physiotherapy (phase 2, patient survey; n = 200). MAIN OUTCOME MEASURE: Patient records and questionnaire. RESULTS: The patients who attended for outpatient physiotherapy were categorized into three main groups: low back pain, cervical/thoracic spine problems and soft-tissue injuries of peripheral joints. Acupuncture appeared to be used as a secondary form of treatment for these conditions, where other modalities failed rather than being used for best effect. The response rate to the questionnaire was 78%, of whom 60% stated that they had experienced pain relief following their acupuncture therapy, and 31% were still experiencing pain relief. The majority had achieved sufficient relief to carry out daily activities at home (80%) and at work (57%). Ninety-four per cent of respondents were either 'satisfied' or 'very satisfied' with their treatment. CONCLUSION: Further investigation is required to adequately assess the efficacy of acupuncture as a pain-relieving modality.     

Mind-body therapies in traditional Chinese medicine for Neuropathic Pain: A Systematic Review of Randomized Controlled Trials

ObjectivesTo evaluate the effectiveness and safety of traditional Chinese medicine (TCM) mind-body therapies in patients with neuropathic pain. Design: This systematic review was undertaken according to the PRISMA 2020 statement.Data sourcesWe searched randomized controlled trials (RCTs) in seven English databases and four Chinese databases up to March 2022.Review/Analysis methodsThe Cochrane Risk of Bias 2 was used for the quality assessment, and the mean difference with a 95% confidence interval for data pooling. The review was registered in the INPLASY (INPLASY202240016).ResultsTwenty-three RCTs were identified, including 1,693 patients with lumbar herniated discs (LHD), cervical spondylotic radiculopathy (CSR), sympathetic cervical spondylosis (SCS), trigeminal neuralgia, and central poststroke pain. Pooled results showed that for LHD, TCM mind-body therapy used alone (MD: -0.57, [-0.77, -0.36], P＜0.01, week 8) or combined with physiotherapy (MD: -1.02, [-1.12, -0.91], P＜0.01, week 4) showed advantages over physiotherapy alone on pain relief. However, there was no statistical difference on physical function. For CSR, TCM mind-body movement combined with physiotherapy had better effect than physiotherapy alone on pain relief (MD: -1.15, [-1.37, -0.94], P＜0.01, week 4). Six trials reported safety. Nausea, dizziness, fatigue, and pain at the acupuncture point were observed.ConclusionsLow-quality evidence showed that TCM mind-body therapies might reduce pain intensity and improve physical function when used as an adjuvant therapy or monotherapy. There is a need to conduct high-quality trials to confirm the effectiveness and safety of TCM mind-body therapies for neuropathic pain.     

Ergebnisse der frühfunktionellen krankengymnastischen Übungsbehandlung nach HWS-Distorsion

BACKGROUND: Diagnostic evaluation and therapeutic management of acute neck pain after whiplash is a frequent but unsolved clinical problem. Long-lasting symptoms and disability are common. Former studies proposed beneficial effects of physiotherapy in the early management of whiplash injury. The purpose of this study was to assess the effects of early active mobilization versus standard treatment with a soft cervical collar. METHODS: Between August 1997 and February 2000 a prospective randomized clinical trial with a total of 168 patients was performed. Of these patients 81 (31 male, 50 female; average age 28,78 years) were randomly assigned to the standard therapy group, which received a soft cervical collar, and 87 (31 male, 56 female; average age 29,62 years) to the early mobilization group, treated by physiotherapy. Study participants documented pain and disability twice (baseline and six week follow-up) during a one week period by diary, using numeric rating scales ranging from 0 to 10. RESULTS: The initial mean pain intensity (4,75) reported by the standard therapy group was similar to disability (4,76). There were no significant differences to initial pain (4,50) and disability (4,39) reported by the early mobilization group. The mean pain intensity reported by the standard therapy group after 6 weeks was 2,66 and disability was 2,40. The mean pain intensity indicated by physiotherapy group was 1,44 and mean disability was 1,29. The differences between the groups were both significant. CONCLUSIONS: Early mobilization is superior to the standard therapy regarding pain intensity and disability. We conclude that mobilization should be recommended as the new adequate standard-therapy in the acute management of whiplash injury.     

Effect of early mobilization on discharge disposition of mechanically ventilated patients

[Purpose] The purpose of this study was to clarify the benefits of early mobilization for mechanically ventilated patients for their survival to discharge to home from the hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients who satisfied the following criteria: age ≥ 18 years; performance status 0–2 and independent living at their home before admission; mechanical ventilation for more than 48 h; and survival after mechanical ventilation. Mechanically ventilated patients in the early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with discharge disposition. [Results] Early mobilization was a positive independent factor and the presence of neurological deficits was a negative factor contributing to discharge to home. Among patients surviving mechanical ventilation without neurological deficits, the rate of discharge to home was significantly higher among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early mobilization can improve the rate of discharge to home of patients requiring mechanical ventilation because of non-neurological deficits.Key words: Mechanical ventilation, Early mobilization, Physiotherapy     

Immediate effects of the central posteroanterior mobilization technique on pain and range of motion in patients with mechanical neck pain

Purpose.?To determine the immediate effects of the central posteroanterior (PA) mobilization technique on both pain and active cervical range of motion in patients with mechanical neck pain presenting with central or bilateral symptoms.

Methods.?A randomized controlled trial was conducted in 60 patients who were randomly allocated into either ‘central PA’ or ‘random’ mobilization group. Two physical therapists and one assessor participated. Outcome measures included neck pain at rest, pain on the most painful movement, and active cervical range of motion taken before and immediately 5?min after the mobilization treatment.

Results.?Significant reductions in pain at rest and on the most painful movement were noted within-group comparisons (p?<?0.001). However, the ‘central PA’ mobilization group obtained a significantly greater reduction in pain on the most painful movement than the ‘random’ mobilization group (p?<?0.05). Both mobilization techniques had no effects on the active cervical range of motion. However, the differences in the means of pain reduction between both mobilization techniques were modest (<10?mm).

Conclusion.?The clinical recommendation regarding the selection of the central PA mobilization technique for treating patients with central or bilateral mechanical neck pain is therefore arguably.     

Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain

Purpose: The present study examined the profile of physical and psychosocial changes that occur in physiotherapy intervention when patients also participate in a psychosocial intervention. The psychosocial intervention, delivered by physiotherapists, was designed to target catastrophic thinking, fear of pain, perceived disability, and depression.Methods: The study sample consisted of 48 individuals referred for the rehabilitation treatment of disabling back pain. Half the sample was enrolled in a physiotherapy intervention only; the other half was enrolled in a psychosocial intervention in addition to receiving a physiotherapy intervention.Results: At post-treatment, the two treatment groups did not differ significantly on measures of pain severity, physical function, or self-reported disability. Patients who participated in the psychosocial intervention in addition to physiotherapy showed significantly greater reductions in pain catastrophizing, fear of movement, and depression than patients who received only the physiotherapy intervention. Reductions in psychosocial risk factors contributed to reduced use of the health care system, reduced use of pain medication, and improved return-to-work outcomes.Conclusions: The findings of the present study suggest that a psychosocial intervention provided by physiotherapists can lead to meaningful reductions in psychosocial risk factors for pain and disability and may contribute to more positive rehabilitation outcomes.     

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

Objectives:

Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Rotatory thrust manipulation applied to the lower cervical segments is associated with controversy and the potential for eliciting adverse reactions (AR). The purpose of this clinical trial was to describe two translatory non-thrust mobilization techniques and evaluate their effect on cervical pain, motion restriction, and whether any adverse effects were reported when applied to the C7 segment.

Methods:

This trial included 30 participants with painful and restricted cervical rotation. Participants were randomly assigned to receive one of the two mobilization techniques. Active cervical rotation and pain intensity measurements were recorded pre- and post-intervention. Within group comparisons were determined using the Wilcoxon signed-rank test and between group comparisons were analyzed using the Mann–Whitney U test. Significance was set at P = 0.05.

Results:

Thirty participants were evaluated immediately after one of the two mobilization techniques was applied. There was a statistically significant difference (improvement) for active cervical rotation after application of the C7 facet distraction technique for both right (P = 0.022) and left (P = 0.022) rotation. Statistically significant improvement was also found for the C7 facet gliding technique for both right (P = 0.022) and left rotation (P = 0.020). Pain reduction was statistically significant for both right and left rotation after application of both techniques. Both mobilization techniques produced similar positive effects and one was not statistically superior to the other.

Discussion:

A single application of both C7 mobilization techniques improved active cervical rotation, reduced perceived pain, and did not produce any AR in 30 patients with neck pain and movement limitation. These two non-thrust techniques may offer clinicians an additional safe and effective manual intervention for patients with limited and painful cervical rotation. A more robust experimental design is recommended to further examine these and similar cervical translatory mobilization techniques.     

Effectiveness of manipulative physiotherapy for the treatment of a neurogenic cervicobrachial pain syndrome: a single case study -- experimental design

A single case study ABC design was used to evaluate the effectiveness of manipulative physiotherapy in a 44-year-old woman with an 8-month history of neurogenic cervicobrachial pain. Clinical examination demonstrated significant signs of upper quadrant neural tissue mechanosensitivity indicating that neural tissue was the dominant tissue of origin for the subject's complaint of pain. Magnetic resonance imaging revealed correlating discal pathology at the C5/6 intersegmental level. The study involved a 4-week pre-assessment phase, a 4-week treatment phase and a 2-week home exercise phase. Functional disability was measured using the Northwick Park Neck Pain Questionnaire and pain was assessed using the McGill Short Form Pain Questionnaire. Cervical motion was measured by a cervical range of motion device (CROM) and the range of shoulder abduction with a mediclino inclinometer. Manipulative physiotherapy treatment involved a cervical lateral glide mobilization technique. Following treatment, visual analysis revealed beneficial effects on pain, functional disability as well as cervical and shoulder mobility. These improvements were maintained over the home exercise phase and at 1-month follow-up. The single case limits generalization of the findings, but the results support previous studies in this area and gives further impetus to controlled clinical trials.     

Mulligan技术配合按摩手法治疗颈型颈椎病的临床研究

目的:观察Mulligan技术在颈型颈椎病中的应用效果。方法:随机将56名颈型颈椎病患者分为2组,观察组采用Mulligan技术治疗,对照组采用关节松动术治疗。治疗前后分别用VAS评估疼痛的程度和用关节活动度测量评估颈椎活动度的变化,治疗结束后统计2组治疗有效率和治疗所需的次数,治疗结束后半年随访患者颈椎病复发的情况。结果:治疗后,2组VAS评分和关节活动度均较治疗前明显改善(P0.01),观察组VAS评分更低于对照组(P0.05),观察组的后伸和左旋转这两个活动方向比对照组改善更明显(P0.05,0.01)。治疗后,观察组的治疗次数较对照组明显减少(P0.01);观察组的有效率明显高于对照组(P0.01);观察组的复发率明显低于对照组(P0.01)。结论:Mulligan技术治疗颈型颈椎病是一种简便易行、安全有效的治疗方法,值得临床推广。     

关节松动术治疗腰椎间盘突出症临床疗效的生物力学探索

目的：探讨关节松动术治疗腰椎间盘突出症的生物力学作用。方法：实验组采用关节松动术，理疗（超短波，中频电疗）配合腰椎牵引进行治疗；对照组采用理疗（超短波，中频电疗）配合腰椎牵引进行治疗。结果：实验组腰椎功能治疗后评分和改善指数明显高于对照组（P＜0．01）。结论：关于松动术治疗腰椎间盘突出症有较好的生物力学作用。     

Cervical SNAGs: a biomechanical analysis

A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the cervical spine. In the manual therapy literature, the biological basis and empirical efficacy of cervical SNAGs have received scant attention. In particular, an examination of their potential biological basis in order to stimulate informed discussion seems overdue. This paper discusses the likely biomechanical effects of both the accessory and physiological movement components of a unilateral cervical SNAG applied ipsilateral to the side of pain when treating painfully restricted cervical rotation. The use of flexion and extension SNAGS, and rotation SNAGS performed contralateral to the side of pain are not considered. Although a cervical SNAG may clinically be able to resolve painfully restricted cervical spine movement, it is difficult to explain biomechanically why a technique which first distracts (opens) and then compresses (closes) the zygapophyseal joint ipsilateral to the side of pain, and perhaps slightly distracts the uncovertebral cleft, would be superior to a technique which distracts the articular surfaces with both accessory and physiological movement components. Therefore, the reported clinical efficacy of cervical SNAGs cannot be explained purely on the basis of the resultant biomechanical effects in the cervical spine.     

Manipulation of the cervical spine

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient and the therapist. This is combined with biomechanical considerations, which have made the teaching and learning of these manipulative techniques less complicated and easily progressed from palpation to mobilization and onto manipulation. Appropriate patient screening and selection identified through thorough subjective and objective assessments are important aspects of this approach and reflective interpretation of all clinical findings is essential. The refinement of cervical joint positioning and an increased anatomical awareness have led to the utilization of new upper cervical high-velocity thrust techniques. Consequently, it is envisaged that an increase in the safety and specificity of cervical manipulative techniques is achieved.     

A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims.

BACKGROUND: Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck. OBJECTIVES: To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training. DESIGN: A randomized multi-centre trial with 4 parallel groups. METHODS: A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests. RESULTS: A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02). CONCLUSION: No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.     

Kosteneffizienzvergleich von Physiotherapie, manueller Therapie und hausärztlicher Therapie in der Behandlung von Nackenschmerzen

Objective

To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neckpain.

Design

Economic evaluation alongside a randomized controlled trial.

Setting

Primary care.

Participants

A total of183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilization), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counseling, education, and drugs).

Main outcome measures

Clinical outcomes were perceived: recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques.

Results

The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow-up at 52 weeks. The total costs of manual therapy (447 EUR) were around one third of the costs of physiotherapy (1297 EUR) and general practitioner care (1379 EUR). These differences were significant: p<0.01 for manual therapy vs. physiotherapy and manual therapy vs. general practitioner care, and p=0.55 for general practitioner care vs. physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care.

Conclusions

Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.     

Cervico-brachial disorders in dentists. A comparison between two kinds of physiotherapeutic interventions

We have evaluated two kinds of physiotherapy treatment for dentists with occupational cervico-brachial disorders. Group A received treatment with a psychosomatic approach and individual ergonomic instruction and group B received ergonomic instruction only. A reduction of the cervico-brachial disorders after the intervention was observed in both groups. In group A there was a significant decrease of pain and discomfort in the neck (p less than 0.05), and a significant improvement was also found concerning the experience of well-being (p less than 0.05). Five weeks after the intervention the feeling of self-confidence had increased significantly in group A (p less than 0.05). Both groups of dentists experienced that their control over the work had decreased (p less than 0.01 in group A and p less than 0.05 in group B). In group B it was also found that the dentists' confidence in the future had decreased, compared with the answers given a year before.     

5. Cervical Facet Pain

More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet‐related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven. Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments. Interventional pain management techniques, including intra‐articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0). At present, there is no evidence to support cervical intra‐articular corticosteroid injection. When applied, this should be done in the context of a study. Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short‐term pain relief (2 B+). Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).