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Journal Cover Journal of Manipulative and Physiological Therapeutics
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0161-4754
   Published by Elsevier Homepage  [3032 journals]
  • Comparing Trigger Point Dry Needling and Manual Pressure Technique for the
           Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial
    • Authors: Kayleigh E. De Meulemeester; Birgit Castelein; Iris Coppieters; Tom Barbe; Ann Cools; Barbara Cagnie
      Pages: 11 - 20
      Abstract: Publication date: January 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 1
      Author(s): Kayleigh E. De Meulemeester, Birgit Castelein, Iris Coppieters, Tom Barbe, Ann Cools, Barbara Cagnie
      Objective The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women. Methods In this randomized clinical trial, 42 female office workers with myofascial neck/shoulder pain were randomly allocated to either a DN or MP group and received 4 treatments. They were evaluated with the Neck Disability Index, general numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment. For each outcome parameter, a linear mixed-model analysis was applied to reveal group-by-time interaction effects or main effects for the factor “time.” Results No significant differences were found between DN and MP. In both groups, significant improvement in the Neck Disability Index was observed after 4 treatments and 3 months (P < .001); the general numerical rating scale also significantly decreased after 3 months. After the 4-week treatment program, there was a significant improvement in pain pressure threshold, muscle elasticity, and stiffness. Conclusion Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.

      PubDate: 2017-01-11T17:33:56Z
      DOI: 10.1016/j.jmpt.2016.10.008
       
  • Response to Letter to the Editor on “Forces of Commonly Applied
           Chiropractic Pediatric Techniques: A Review of the Literature”
    • Authors: Angela J. Todd; Matthew T. Carroll; Eleanor Mitchell
      Abstract: Publication date: Available online 7 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Angela J. Todd, Matthew T. Carroll, Eleanor Mitchell


      PubDate: 2017-03-12T02:33:57Z
      DOI: 10.1016/j.jmpt.2017.01.006
       
  • Manipulation Peak Forces Across Spinal Regions for Children Using
           Mannequin Simulators
    • Authors: John J. Triano; Steven Lester; David Starmer; Elise G. Hewitt
      Abstract: Publication date: Available online 6 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): John J. Triano, Steven Lester, David Starmer, Elise G. Hewitt
      Objective The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose–response and safety studies on therapeutic benefit. Methods The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature. Results Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies. Conclusions The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.

      PubDate: 2017-03-12T02:33:57Z
      DOI: 10.1016/j.jmpt.2017.01.001
       
  • A Feasibility Study to Assess Vibration and Sound From Zygapophyseal
           Joints During Motion Before and After Spinal Manipulation
    • Authors: Gregory D. Cramer; Matthew Budavich; Preetam Bora; Kim Ross
      Abstract: Publication date: Available online 6 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Gregory D. Cramer, Matthew Budavich, Preetam Bora, Kim Ross
      Objective This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulative therapy (SMT). Methods This study included 5 healthy and 5 low back pain (LBP) participants. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus. Each participant underwent full lumbar ranges of motion (ROM), bilateral lumbar SMT, and repeated full ROM. After full ROMs the participants received side-posture lumbar SMT on both sides by a licensed doctor of chiropractic. Accelerometer and microphone recordings were made during all pre- and post-SMT ROMs. Primary outcome was a descriptive report of crepitus prevalence (average number of crepitus events/participant). Participants were also divided into 3 age groups for comparisons (18-25, 26-45, and 46-65 years). Results Overall, crepitus prevalence decreased pre–post SMT (average pre = 1.4 crepitus/participant vs post = 0.9). Prevalence progressively increased from the youngest to oldest age groups (pre-SMT = 0.0, 1.67, and 2.0, respectively; and post-SMT = 0.5, 0.83, and 1.5). Prevalence was higher in LBP participants compared with healthy (pre-SMT–LBP = 2.0, vs pre-SMT–healthy = 0.8; post-SMT–LBP = 1.0 vs post-SMT–healthy = 0.8), even though healthy participants were older than LBP participants (40.8 years vs 27.8 years); accounting for age: pre-SMT–LBP = 2.0 vs pre-SMT–healthy = 0.0; post-SMT–LBP = 1.0 vs post-SMT–healthy = 0.3. Conclusions Our findings indicated that a larger study is feasible. Other findings included that crepitus prevalence increased with age, was higher in participants with LBP than in healthy participants, and overall decreased after SMT. This study indicated that crepitus assessment using accelerometers has the potential of being an outcome measure or biomarker for assessing spinal joint (facet/zygapophyseal joint) function during movement and the effects of LBP treatments (eg, SMT) on zygapophyseal joint function.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.003
       
  • Effects of Diaphragmatic Breathing Patterns on Balance: A Preliminary
           Clinical Trial
    • Authors: Rylee J. Stephens; Mitchell Haas; William L. Moore; Jordan R. Emmil; Jayson A. Sipress; Alex Williams
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rylee J. Stephens, Mitchell Haas, William L. Moore, Jordan R. Emmil, Jayson A. Sipress, Alex Williams
      Objective The purpose of this study was to determine the feasibility of performing a larger study to determine if training in diaphragmatic breathing influences static and dynamic balance. Methods A group of 13 healthy persons (8 men, 5 women), who were staff, faculty, or students at the University of Western States participated in an 8-week breathing and balance study using an uncontrolled clinical trial design. Participants were given a series of breathing exercises to perform weekly in the clinic and at home. Balance and breathing were assessed at the weekly clinic sessions. Breathing was evaluated with Liebenson’s breathing assessment, static balance with the Modified Balance Error Scoring System, and dynamic balance with OptoGait’s March in Place protocol. Results Improvement was noted in mean diaphragmatic breathing scores (1.3 to 2.6, P < .001), number of single-leg stance balance errors (7.1 to 3.8, P = .001), and tandem stance balance errors (3.2 to 0.9, P = .039). A decreasing error rate in single-leg stance was associated with improvement in breathing score within participants over the 8 weeks of the study (–1.4 errors/unit breathing score change, P < .001). Tandem stance performance did not reach statistical significance (–0.5 error/unit change, P = .118). Dynamic balance was insensitive to balance change, being error free for all participants throughout the study. Conclusion This proof-of-concept study indicated that promotion of a costal-diaphragmatic breathing pattern may be associated with improvement in balance and suggests that a study of this phenomenon using an experimental design is feasible.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.005
       
  • Integrative Acupuncture and Spinal Manipulative Therapy Versus Either
           Alone for Low Back Pain: A Randomized Controlled Trial Feasibility Study
    • Authors: Anupama Kizhakkeveettil; Kevin A. Rose; Gena E. Kadar; Eric L. Hurwitz
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Anupama Kizhakkeveettil, Kevin A. Rose, Gena E. Kadar, Eric L. Hurwitz
      Objectives The objective of this study was to assess the feasibility of conducting a large-scale randomized controlled trial (RCT) examining whether an integrative care model combining spinal manipulative therapy (SMT) and acupuncture can lead to better outcomes for low back pain (LBP) than either therapy alone. Methods This study was conducted at a complementary and alternative medicine university health center. Participants with acute or chronic LBP were randomized to (1) acupuncture, (2) SMT, or (3) integrative acupuncture and SMT groups. Treatments were provided over 60 days by licensed doctors of chiropractic and acupuncturists. Acupuncture treatments consisted of needling of acupoints combined with electrotherapy, moxibustion, cupping, and Tui Na. SMT used specific contact points on vertebral processes, along with soft tissue therapy and physiotherapy. Primary outcome measures were the Roland-Morris LBP Disability Questionnaire and 0 to 10 Numeric Rating Scale for LBP. Results Participants in all 3 groups experienced clinically meaningful improvements in the primary outcome measures; however, no between-group differences in outcomes were apparent. Conclusions This study indicated that it is feasible to conduct an RCT to compare the effectiveness of integrative acupuncture and SMT for LBP to either therapy alone. Future studies should include a larger sample to increase the power for detecting clinically meaningful differences between groups.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.002
       
  • Cross-Cultural Adaptation of the Profile Fitness Mapping Neck
           Questionnaire to Brazilian Portuguese: Internal Consistency, Reliability,
           and Construct and Structural Validity
    • Authors: Mariana Cândido Ferreira; Martin Björklund; Fabiola Dach; Thais Cristina Chaves
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Mariana Cândido Ferreira, Martin Björklund, Fabiola Dach, Thais Cristina Chaves
      Objective The purpose of this study was to adapt and evaluate the psychometric properties of the ProFitMap-neck to Brazilian Portuguese. Methods The cross-cultural adaptation consisted of 5 stages, and 180 female patients with chronic neck pain participated in the study. A subsample (n = 30) answered the pretest, and another subsample (n = 100) answered the questionnaire a second time. Internal consistency, test-retest reliability, and construct validity (hypothesis testing and structural validity) were estimated. For construct validity, the scores of the questionnaire were correlated with the Neck Disability Index (NDI), and the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale of Kinesiophobia (TSK), and the 36-item Short-Form Health Survey (SF-36). Results Internal consistency was determined by adequate Cronbach's α values (α > 0.70). Strong reliability was identified by high intraclass correlation coefficients (ICC > 0.75). Construct validity was identified by moderate and strong correlations of the Br-ProFitMap-neck with total NDI score (–0.56 < R < –0.71) and with the SF-36, HADS-anxiety, HADS-depression, and TSK (–0.32 < R < –0.82). Exploratory factor analysis revealed 2 factors for the Symptom scale: intensity index and the Function scale. Symptom scale–frequency index identified 1 factor. Structural validity was determined by percentage of cumulative variance >50%, Kaiser-Meyer-Olkin index > 0.50, eigenvalue > 1, and factor loadings > 0.2. Conclusion Br-ProFitMap-neck had adequate psychometric properties and can be used in clinical settings, as well as research, in patients with chronic neck pain.

      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2017.01.004
       
  • Response to “Forces of Commonly Used Chiropractic Techniques for
           Children: A Review of the Literature”
    • Authors: Mark A. Lopes; Gregory Plaugher
      Abstract: Publication date: Available online 1 March 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Mark A. Lopes, Gregory Plaugher


      PubDate: 2017-03-07T02:16:32Z
      DOI: 10.1016/j.jmpt.2016.10.015
       
  • Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual
           Somatosensory Input in Chronic Pain Patients: A Preliminary Study
    • Authors: Heidi Haavik; Imran Khan Niazi; Kelly Holt; Bernadette Murphy
      Abstract: Publication date: Available online 10 February 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Heidi Haavik, Imran Khan Niazi, Kelly Holt, Bernadette Murphy
      Objective The purpose of this preliminary study was to assess whether the dual somatosensory evoked potential (SEP) technique is sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck or upper extremity pain and, if so, whether changes are associated with changes in pain scores. Methods The dual peripheral nerve stimulation SEP ratio technique was used for 6 subjects with a history of chronic neck or upper limb pain. SEPs were recorded after left or right median and ulnar nerve stimulation at the wrist. SEP ratios were calculated for the N9, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median and ulnar nerves. Outcome measures of SEP ratios and subjects’ visual analog scale rating of pains were recorded at baseline, after a 2-week usual care control period, and after 12 weeks of multimodal chiropractic care (chiropractic spinal manipulation and 1 or more of the following: exercises, peripheral joint adjustments/manipulation, soft tissue therapy, and pain education). Results A significant decrease in the median and ulnar to median plus ulnar ratio and the median and ulnar amplitude for the cortical P22-N30 SEP component was observed after 12 weeks of chiropractic care, with no changes after the control period. There was a significant decrease in visual analog scale scores (both for current pain and for pain last week). Conclusion The dual SEP ratio technique appears to be sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck pain. The observations in 6 subjects revealed that 12 weeks of chiropractic care improved suppression of SEPs evoked by dual upper limb nerve stimulation at the level of the motor cortex, premotor areas, and/or subcortical areas such as basal ganglia and/or thalamus. It is possible that these findings explain one of the mechanisms by which chiropractic care improves function and reduces pain for chronic pain patients.

      PubDate: 2017-02-13T16:25:50Z
      DOI: 10.1016/j.jmpt.2016.10.002
       
  • Procedure Selection and Patient Positioning Influence Spine Kinematics
           During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low
           Back
    • Authors: Spencer Bell; Kevin D’Angelo; Gregory N. Kawchuk; John J. Triano; Samuel J. Howarth
      Abstract: Publication date: Available online 10 February 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Spencer Bell, Kevin D’Angelo, Gregory N. Kawchuk, John J. Triano, Samuel J. Howarth
      Objectives This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. Methods Twenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient’s pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. Results Lumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. Conclusions This investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition.

      PubDate: 2017-02-13T16:25:50Z
      DOI: 10.1016/j.jmpt.2016.10.014
       
  • Information for Readers
    • Abstract: Publication date: February 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 2


      PubDate: 2017-02-13T16:25:50Z
       
  • Reference Values for Human Posture Measurements Based on Computerized
           Photogrammetry: A Systematic Review
    • Authors: Ana Freire Macedo Ribeiro; Anke Bergmann; Thiago Lemos; Antônio Guilherme Pacheco; Maitê Mello Russo; Laura Alice Santos de Oliveira; Erika de Carvalho Rodrigues
      Abstract: Publication date: Available online 7 January 2017
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ana Freire Macedo Ribeiro, Anke Bergmann, Thiago Lemos, Antônio Guilherme Pacheco, Maitê Mello Russo, Laura Alice Santos de Oliveira, Erika de Carvalho Rodrigues
      Objective The main objective of this study was to review the literature to identify reference values for angles and distances of body segments related to upright posture in healthy adult women with the Postural Assessment Software (PAS/SAPO). Methods Electronic databases (BVS, PubMed, SciELO and Scopus) were assessed using the following descriptors: evaluation, posture, photogrammetry, physical therapy, postural alignment, postural assessment, and physiotherapy. Studies that performed postural evaluation in healthy adult women with PAS/SAPO and were published in English, Portuguese and Spanish, between the years 2005 and 2014 were included. Results Four studies met the inclusion criteria. Data from the included studies were grouped to establish the statistical descriptors (mean, variance, and standard deviation) of the body angles and distances. A total of 29 variables were assessed (10 in the anterior views, 16 in the lateral right and left views, and 3 in the posterior views), and its respective mean and standard deviation were calculated. Reference values for the anterior and posterior views showed no symmetry between the right and left sides of the body in the frontal plane. There were also small differences in the calculated reference values for the lateral view. Conclusion The proposed reference values for quantitative evaluation of the upright posture in healthy adult women estimated in the present study using PAS/SAPO could guide future studies and help clinical practice.

      PubDate: 2017-01-11T17:33:56Z
      DOI: 10.1016/j.jmpt.2016.12.001
       
  • Information for Readers
    • Abstract: Publication date: January 2017
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 40, Issue 1


      PubDate: 2017-01-11T17:33:56Z
       
  • T4 Syndrome: A Scoping Review of the Literature
    • Authors: Steve Karas; Albert Pannone
      Abstract: Publication date: Available online 23 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Steve Karas, Albert Pannone
      Objective The purpose of this scoping review was to identify any available evidence regarding T4 syndrome. Methods Databases were searched from inception through October 2015 and included PubMed, CINAHL, PEDro, Google Scholar, Osteomed-DR; Index to Chiropractic Literature, PROSPERO, and Chiroaccess. All studies with information about T4 syndrome that were published in a peer-reviewed journal or textbook were included. The information was organized in the format of the International Classification of Functioning, Disability, and Health. Studies were ranked using Sackett’s levels of evidence. Results Eight articles met the inclusion criteria. Studied areas included theoretical pathophysiology and symptom etiology, diagnosis, symptoms, treatment, and outcomes of T4 syndrome. The methodological quality of included studies was low. Conclusion T4 syndrome is a diagnosis of exclusion that appears to be rare. It has been treated conservatively in the literature using mobilization and exercise. There is no high-quality evidence published about T4 syndrome, and we caution clinicians when considering it as a primary means to determine patient care.

      PubDate: 2017-01-11T17:33:56Z
      DOI: 10.1016/j.jmpt.2016.11.002
       
  • Effect of the Abdominal Hollowing and Bracing Maneuvers on Activity
           Pattern of the Lumbopelvic Muscles During Prone Hip Extension in Subjects
           With or Without Chronic Low Back Pain: A Preliminary Study
    • Authors: Amir H. Kahlaee; Leila Ghamkhar; Amir M. Arab
      Abstract: Publication date: Available online 22 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Amir H. Kahlaee, Leila Ghamkhar, Amir M. Arab
      Objective The purpose of this study was to compare the effect of abdominal hollowing (AH) and abdominal bracing (AB) maneuvers on the activity pattern of lumbopelvic muscles during prone hip extension (PHE) in participants with or without nonspecific chronic low back pain (CLBP). Methods Twenty women with or without CLBP participated in this cross-sectional observational study. The electromyographic activity (amplitude and onset time) of the contralateral erector spinae (CES), ipsilateral erector spinae (IES), gluteus maximus, and biceps femoris muscles was measured during PHE with and without abdominal maneuvers. A 3-way mixed model analysis of variance and post hoc tests were used for statistical analysis. Results Between-group comparisons showed that the CES onset delay during PHE alone was greater (P = .03) and the activity level of IES, CES, and biceps femoris in all maneuvers (P < .05) was higher in patients with CLBP than in asymptomatic participants. In asymptomatic participants, PHE + AH significantly decreased the signal amplitude (AMP) of IES (P = .01) and CES (P = .02) muscles. In participants with CLBP, IES muscle AMP was lower during PHE + AH compared with PHE + AB and PHE alone. With regard to onset delay, the results also showed no significant difference between maneuvers within either of the 2 groups (P > .05). Conclusions Performance of the AH maneuver decreased the erector spinae muscle AMP in both groups, and neither maneuver altered the onset delay of any of the muscles in either group. The low back pain group showed higher levels of activity in all muscles (not statistically significant in gluteus maximus during all maneuvers). The groups were similar according to the onset delay of any of the muscles during either maneuver.

      PubDate: 2017-01-11T17:33:56Z
      DOI: 10.1016/j.jmpt.2016.10.009
       
  • Guideline for Reporting Interventions on Spinal Manipulative Therapy:
           Consensus on Interventions Reporting Criteria List for Spinal Manipulative
           Therapy (CIRCLe SMT)
    • Authors: Ruud Groeneweg; Sidney M. Rubinstein; Rob A.B. Oostendorp; Raymond W.J.G. Ostelo; Maurits W. van Tulder
      Abstract: Publication date: Available online 22 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ruud Groeneweg, Sidney M. Rubinstein, Rob A.B. Oostendorp, Raymond W.J.G. Ostelo, Maurits W. van Tulder
      Objective The aim of the Consensus on Interventions Reporting Criteria List for Spinal Manipulative Therapy (CIRCLe SMT) study was to develop a criteria list for reporting spinal manipulative therapy (SMT). Methods A Delphi procedure was conducted from September 2011 to April 2013 and consisted of international experts in the field of SMT. The authors formed a steering committee and invited participants, selected initial items, structured the comments of the participants after each Delphi round, and formulated the feedback. To ensure content validity, a large number of international experts from different SMT-related disciplines were invited to participate. A workshop was organized following the consensus phase, and it was used to discuss and refine the wording of the items. Results In total, 123 experts from 18 countries participated. These experts included clinicians (70%), researchers (93%), and academics working in the area of SMT (27%), as well as journal editors (14%). (Note: The total is more than 100% because most participants reported 2 jobs.) Three Delphi rounds were necessary to reach a consensus. The criteria list comprised 24 items under 5 domains, including (1) rationale of the therapy, (2) description of the intervention, (3) SMT techniques, (4) additional intervention/techniques, and (5) quantitative data. Conclusions A valid criteria list was constructed with the aim of promoting consistency in reporting SMT intervention in scientific publications.

      PubDate: 2017-01-11T17:33:56Z
      DOI: 10.1016/j.jmpt.2016.10.013
       
  • Non–Weight-Bearing and Weight-Bearing Ultrasonography of Select Foot
           Muscles in Young, Asymptomatic Participants: A Descriptive and Reliability
           Study
    • Authors: Patrick J. Battaglia; Ross Mattox; Brett Winchester; Norman W. Kettner
      Pages: 655 - 661
      Abstract: Publication date: November–December 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 9
      Author(s): Patrick J. Battaglia, Ross Mattox, Brett Winchester, Norman W. Kettner
      Objective The primary aim of this study was to determine the reliability of diagnostic ultrasound imaging for select intrinsic foot muscles using both non–weight-bearing and weight-bearing postures. Our secondary aim was to describe the change in muscle cross-sectional area (CSA) and dorsoplantar thickness when bearing weight. Methods An ultrasound examination was performed with a linear ultrasound transducer operating between 9 and 12 MHz. Long-axis and short-axis ultrasound images of the abductor hallucis, flexor digitorum brevis, and quadratus plantae were obtained in both the non–weight-bearing and weight-bearing postures. Two examiners independently collected ultrasound images to allow for interexaminer and intraexaminer reliability calculation. The change in muscle CSA and dorsoplantar thickness when bearing weight was also studied. Results There were 26 participants (17 female) with a mean age of 25.5 ± 3.8 years and a mean body mass index of 28.0 ± 7.8 kg/m2. Inter-examiner reliability was excellent when measuring the muscles in short axis (intraclass correlation coefficient >0.75) and fair to good in long axis (intraclass correlation coefficient >0.4). Intraexaminer reliability was excellent for the abductor hallucis and flexor digitorum brevis and ranged from fair to good to excellent for the quadratus plantae. Bearing weight did not reduce interexaminer or intraexaminer reliability. All muscles exhibited a significant increase in CSA when bearing weight. Conclusions This is the first report to describe weight-bearing diagnostic ultrasound of the intrinsic foot muscles. Ultrasound imaging is reliable when imaging these muscles bearing weight. Furthermore, muscle CSA increases in the weight-bearing posture.

      PubDate: 2016-11-26T03:10:16Z
      DOI: 10.1016/j.jmpt.2016.10.001
       
  • The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated
           Disorders: A Clinical Practice Guideline
    • Authors: André E. Bussières; Gregory Stewart; Fadi Al-Zoubi; Philip Decina; Martin Descarreaux; Jill Hayden; Brenda Hendrickson; Cesar Hincapié; Isabelle Pagé; Steven Passmore; John Srbely; Maja Stupar; Joel Weisberg; Joseph Ornelas
      Pages: 523 - 564.e27
      Abstract: Publication date: October 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 8
      Author(s): André E. Bussières, Gregory Stewart, Fadi Al-Zoubi, Philip Decina, Martin Descarreaux, Jill Hayden, Brenda Hendrickson, Cesar Hincapié, Isabelle Pagé, Steven Passmore, John Srbely, Maja Stupar, Joel Weisberg, Joseph Ornelas
      Objective The objective was to develop a clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. Methods Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. Results For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). Conclusions A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.08.007
       
  • Injury Threshold of Rectus Capitis Muscles at the Atlanto-occipital Joint
    • Authors: Richard Hallgren
      Abstract: Publication date: Available online 16 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Richard C. Hallgren
      Objective The objective of this study was to collect muscle stiffness data from the 4 rectus capitis (RC) muscles to better understand their role in stabilizing the atlanto-occipital joint. The passive load displacement properties of these muscles have not been previously reported. Methods Rectus capitis muscles were removed from 3 unembalmed head and neck specimens. Passive length-force (stiffness) data were collected by using a servo-controlled hydraulic test machine. Multivariate analysis of variance with Bonferroni correction was used to assess the significance of the differences among passive stiffness within the elastic region of each muscle and the load and strain at the yield points. Results Rectus capitis lateralis (RCL) muscles failed at significantly higher levels of load and strain compared with the other 3 pairs of muscles. Passive stiffness of both RCL and RC anterior muscles was significantly higher than the other 2 pairs of muscles. Conclusion The anatomic location of the RCL muscles, along with their high levels of passive stiffness, would be expected to facilitate the maintenance of atlanto-occipital joint congruence during normal daily activities. The level at which the RC posterior minor muscles failed could put them at risk of a strain injury during a rear end motor vehicle accident. Diagnostic and treatment protocols that apply forces to the upper cervical spine should be tailored to consider the patient’s age, gender, and history of previous injuries to avoid overstretching RC muscles.

      PubDate: 2016-12-16T14:38:20Z
       
  • Locating the Seventh Cervical Spinous Process: Development and Validation
           of a Multivariate Model Using Palpation and Personal Information
    • Authors: Ana Paula A. Ferreira; Luciana C. Póvoa; José F.C. Zanier; Arthur S. Ferreira
      Abstract: Publication date: Available online 13 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ana Paula A. Ferreira, Luciana C. Póvoa, José F.C. Zanier, Arthur S. Ferreira
      Objective The aim of this study was to develop and validate a multivariate prediction model, guided by palpation and personal information, for locating the seventh cervical spinous process (C7SP). Methods A single-blinded, cross-sectional study at a primary to tertiary health care center was conducted for model development and temporal validation. One-hundred sixty participants were prospectively included for model development (n = 80) and time-split validation stages (n = 80). The C7SP was located using the thorax-rib static method (TRSM). Participants underwent chest radiography for assessment of the inner body structure located with TRSM and using radio-opaque markers placed over the skin. Age, sex, height, body mass, body mass index, and vertex-marker distance (DV-M) were used to predict the distance from the C7SP to the vertex (DV-C7). Multivariate linear regression modeling, limits of agreement plot, histogram of residues, receiver operating characteristic curves, and confusion tables were analyzed. Results The multivariate linear prediction model for DV-C7 (in centimeters) was DV-C7 = 0.986DV-M + 0.018(mass) + 0.014(age) – 1.008. Receiver operating characteristic curves had better discrimination of DV-C7 (area under the curve = 0.661; 95% confidence interval = 0.541-0.782; P = .015) than DV-M (area under the curve = 0.480; 95% confidence interval = 0.345-0.614; P = .761), with respective cutoff points at 23.40 cm (sensitivity = 41%, specificity = 63%) and 24.75 cm (sensitivity = 69%, specificity = 52%). The C7SP was correctly located more often when using predicted DV-C7 in the validation sample than when using the TRSM in the development sample: n = 53 (66%) vs n = 32 (40%), P < .001. Conclusions Better accuracy was obtained when locating the C7SP by use of a multivariate model that incorporates palpation and personal information.

      PubDate: 2016-12-16T14:38:20Z
      DOI: 10.1016/j.jmpt.2016.10.012
       
  • A Calibrated Method of Massage Therapy Decreases Systolic Blood Pressure
           Concomitant With Changes in Heart Rate Variability in Male Rats
    • Authors: Kurt A. Spurgin; Anthony Kaprelian; Roberto Gutierrez; Vidyasagar Jha; Christopher G. Wilson; Abigail Dobyns; Karen H. Xu; Margarita C. Curras-Collazo
      Abstract: Publication date: Available online 10 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kurt A. Spurgin, Anthony Kaprelian, Roberto Gutierrez, Vidyasagar Jha, Christopher G. Wilson, Abigail Dobyns, Karen H. Xu, Margarita C. Curras-Collazo
      Objective The purpose of this study was to develop a method for applying calibrated manual massage pressures by using commonly available, inexpensive sphygmomanometer parts and validate the use of this approach as a quantitative method of applying massage therapy to rodents. Methods Massage pressures were monitored by using a modified neonatal blood pressure (BP) cuff attached to an aneroid gauge. Lightly anesthetized rats were stroked on the ventral abdomen for 5 minutes at pressures of 20 mm Hg and 40 mm Hg. Blood pressure was monitored noninvasively for 20 minutes following massage therapy at 5-minute intervals. Interexaminer reliability was assessed by applying 20 mm Hg and 40 mm Hg pressures to a digital scale in the presence or absence of the pressure gauge. Results With the use of this method, we observed good interexaminer reliability, with intraclass coefficients of 0.989 versus 0.624 in blinded controls. In Long-Evans rats, systolic BP dropped by an average of 9.86% ± 0.27% following application of 40 mm Hg massage pressure. Similar effects were seen following 20 mm Hg pressure (6.52% ± 1.7%), although latency to effect was greater than at 40 mm Hg. Sprague-Dawley rats behaved similarly to Long-Evans rats. Low-frequency/high-frequency ratio, a widely-used index of autonomic tone in cardiovascular regulation, showed a significant increase within 5 minutes after 40 mm Hg massage pressure was applied. Conclusions The calibrated massage method was shown to be a reproducible method for applying massage pressures in rodents and lowering BP.

      PubDate: 2016-12-16T14:38:20Z
      DOI: 10.1016/j.jmpt.2016.10.010
       
  • Locating the Seventh Cervical Spinous Process: Accuracy of the Thorax-Rib
           Static Method and the Effects of Clinical Data on Its Performance
    • Authors: Ana Paula A. Ferreira; Luciana C. Póvoa; José F.C. Zanier; Arthur S. Ferreira
      Abstract: Publication date: Available online 8 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ana Paula A. Ferreira, Luciana C. Póvoa, José F.C. Zanier, Arthur S. Ferreira
      Objectives The aim of this study was to assess the thorax-rib static method (TRSM), a palpation method for locating the seventh cervical spinous process (C7SP), and to report clinical data on the accuracy of this method and that of the neck flexion-extension method (FEM), using radiography as the gold standard. Methods A single-blinded, cross-sectional diagnostic accuracy study was conducted. One hundred and one participants from a primary-to-tertiary health care center (63 men, 56 ± 17 years of age) had their neck palpated using the FEM and the TRSM. A single examiner performed both the FEM and TRSM in a random sequence. Radiopaque markers were placed at each location with the aid of an ultraviolet lamp. Participants underwent chest radiography for assessment of the superimposed inner body structure, which was located by using either the FEM or the TRSM. Results Accuracy in identifying the C7SP was 18% and 33% (P = .013) with use of the FEM and the TRSM, respectively. The cumulative accuracy considering both caudal and cephalic directions (C7SP ± 1SP) increased to 58% and 81% (P = .001) with use of the FEM and the TRSM, respectively. Age had a significant effect on the accuracy of FEM (P = .027) but not on the accuracy of TRSM (P = .939). Sex, body mass, body height, and body mass index had no significant effects on the accuracy of both the FEM (P = .209 or higher) and the TRSM (P = .265 or higher). Conclusions The TRMS located the C7SP more accurately compared with the FEM at any given level of anatomic detail, although both still underperformed in terms of acceptable accuracy for a clinical setting.

      PubDate: 2016-12-09T14:20:53Z
      DOI: 10.1016/j.jmpt.2016.10.011
       
  • Comparison of the BackJoy SitSmart Relief and Spine Buddy LT1 H/C
           Ergonomic Chair Supports on Short-Term Neck and Back Pain
    • Authors: John Ward; Jesse Coats
      Abstract: Publication date: Available online 3 December 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): John Ward, Jesse Coats
      Objective The purpose of this study was to perform a needs assessment to determine whether short-term use of BackJoy SitSmart Relief and Spine Buddy LT1 H/C chair supports influences neck, upper back, and lower back pain. Methods Forty-eight college students (age, 27.5 ± 6.3 years; height, 1.72 ± 0.08 m; body mass, 78.7 ± 19.8 kg; time seated that day, 4.3 ± 2.8 hours; means ± SD) were recruited for this study. The Nordic Musculoskeletal Questionnaire was used to measure pain for the neck, upper back, and lower back regions. Subjects were randomized to sit in a stationary office chair for a single 12-minute period under 1 of 4 conditions: office chair only (control group), BackJoy SitSmart Relief and chair, freezer-cooled Spine Buddy LT1 H/C and chair, or microwave-heated Spine Buddy LT1 H/C and chair. Participants then completed a posttest Nordic Musculoskeletal Questionnaire. A between-within repeated-measures analysis of variance using the between-subject factor intervention (group) and within-subject factor time (baseline and posttest) was used to analyze study data. Results The main effect of time across the whole sample was statistically significant for neck (P = .000), upper back (P = .032), and lower back (P = .000) pain; however, there was no statistically significant interaction effect between intervention and time. Thus, as long as participants sat down and rested, symptoms improved similarly across the different groups. Conclusions In this preliminary study, short-term and single use of a support product for an office chair had no additive effect on reducing neck and back pain.

      PubDate: 2016-12-09T14:20:53Z
      DOI: 10.1016/j.jmpt.2016.10.006
       
  • Information for Readers
    • Abstract: Publication date: November–December 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 9


      PubDate: 2016-11-26T03:10:16Z
       
  • Presence of Latent Myofascial Trigger Points and Determination of Pressure
           Pain Thresholds of the Shoulder Girdle in Healthy Children and Young
           Adults: A Cross-sectional Study
    • Authors: Luciane S. Sacramento; Paula R. Camargo; Aristides L. Siqueira-Júnior; Jean P. Ferreira; Tania F. Salvini; Francisco Alburquerque-Sendín
      Abstract: Publication date: Available online 16 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Luciane S. Sacramento, Paula R. Camargo, Aristides L. Siqueira-Júnior, Jean P. Ferreira, Tania F. Salvini, Francisco Alburquerque-Sendín
      Objective The primary objective of this study was to compare the number of myofascial trigger points (MTPs) and the pressure pain thresholds (PPTs) in the shoulder girdle, on the dominant and nondominant sides, between healthy children and adults. The secondary aim was to assess the correlations between the number of MTPs and the PPTs in these populations. Methods A cross-sectional study was performed. Thirty-five children (aged 9.1 ± 1.7 years) and 35 adults (aged 23.4 ± 3.4 years) with no history of shoulder or cervical pathology were included. All participants were examined for MTPs in the shoulder muscles and assessed for PPTs in the neck, shoulder, and tibialis anterior. Parametric and nonparametric tests, effect sizes, and odds ratios were used to determine the differences between groups and sides. Spearman’s σ test was used to assess correlations between latent MTPs (LTPs) and PPTs in each group. Results Children had fewer LTPs than adults did (P = .03). The upper trapezius was the muscle with the largest number of LTPs, affecting 13 adults on the dominant side. Children had lower PPTs compared with adults (P < .05). Correlations between the number of LTPs (on both sides and in total) and PPTs were observed only in adults. Conclusions Healthy children have fewer LTPs and lower PPTs in the shoulder girdle than healthy adults. A relationship was observed between sensitivity to pressure and the presence of LTPs in adults, in whom lower PPT was associated with more LTPs. This relationship was not detected in children.

      PubDate: 2016-11-19T02:49:28Z
      DOI: 10.1016/j.jmpt.2016.10.007
       
  • Robot-Assisted Rehabilitation of Hand Paralysis After Stroke Reduces Wrist
           Edema and Pain: A Prospective Clinical Trial
    • Authors: Alberto Borboni; Jorge H. Villafañe; Chiara Mullè; Kristin Valdes; Rodolfo Faglia; Giovanni Taveggia; Stefano Negrini
      Abstract: Publication date: Available online 12 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Alberto Borboni, Jorge H. Villafañe, Chiara Mullè, Kristin Valdes, Rodolfo Faglia, Giovanni Taveggia, Stefano Negrini
      Objective The purpose of this study was to determine whether passive robotic-assisted hand motion, in addition to standard rehabilitation, would reduce hand pain, edema, or spasticity in all patients following acute stroke, in patients with and without hand paralysis. Methods Thirty-five participants, aged 45 to 80 years, with functional impairments of their upper extremities after a stroke were recruited for the study from September 2013 to October 2013. One group consisted of 16 patients (mean age ± SD, 68 ± 9 years) with full paralysis and the other groups included 14 patients (mean age ± SD, 67 ± 8 years) with partial paralysis. Patients in the both groups used the Gloreha device for passive mobilization of the hand twice a day for 2 consecutive weeks. The primary outcome measure was hand edema. Secondary outcome measures included pain intensity and spasticity. All outcome measures were collected at baseline and immediately after the intervention (2 weeks). Results Analysis of variance revealed that the partial paralysis group experienced a significantly greater reduction of edema at the wrist (P = .005) and pain (P = .04) when compared with the full paralysis group. Other outcomes were similar for the groups. Conclusion The results of the current study suggest that the partial paralysis group experienced a significantly greater reduction of edema at the wrist and pain when compared with the full paralysis group. The reduction in pain did not meet the threshold of a minimal clinically important difference.

      PubDate: 2016-11-19T02:49:28Z
      DOI: 10.1016/j.jmpt.2016.10.003
       
  • Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A
           Systematic Review
    • Authors: Ruth Ballestero-Pérez; Gustavo Plaza-Manzano; Alicia Urraca-Gesto; Flor Romo-Romo; María de los Ángeles Atín-Arratibel; Daniel Pecos-Martín; Tomás Gallego-Izquierdo; Natalia Romero-Franco
      Abstract: Publication date: Available online 11 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ruth Ballestero-Pérez, Gustavo Plaza-Manzano, Alicia Urraca-Gesto, Flor Romo-Romo, María de los Ángeles Atín-Arratibel, Daniel Pecos-Martín, Tomás Gallego-Izquierdo, Natalia Romero-Franco
      Objective The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). Methods A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. Results The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Conclusion Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.10.004
       
  • Effects of a Resistance and Stretching Training Program on Forward Head
           and Protracted Shoulder Posture in Adolescents
    • Authors: Rodrigo Miguel Ruivo; Pedro Pezarat-Correia; Ana Isabel Carita
      Abstract: Publication date: Available online 11 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rodrigo Miguel Ruivo, Pedro Pezarat-Correia, Ana Isabel Carita
      Objective The purpose of this study was to evaluate the effects of a 16-week resistance and stretching training program applied in physical education (PE) classes on forward head posture and protracted shoulder posture in Portuguese adolescents. Methods This prospective, randomized, controlled study was conducted in 2 secondary schools. One hundred and thirty adolescents (aged 15-17 years) with forward head and protracted shoulder posture were randomly assigned to a control or experimental group. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and Postural Assessment Software. The American Shoulder and Elbow Surgeons Shoulder Assessment was used to assess shoulder pain, and neck pain during the last month was self-reported with a single question. These variables were assessed before and after a 16-week intervention period. The control group (n = 46) attended the PE classes, whereas the exercise group (n = 84) received a posture corrective exercise program in addition to PE classes. Results A significant increase in cervical and shoulder angles was observed in the intervention group from pretest to posttest (P < .05). For the shoulder pain scores in both groups, there were no significant changes after the 16 weeks. Conclusions A 16-week resistance and stretching training program decreased forward head and protracted shoulder postures in adolescents.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.10.005
       
  • Current Practices in Lumbar Surgery Perioperative Rehabilitation: A
           Scoping Review
    • Authors: Andrée-Anne Marchand; Julie O’Shaughnessy; Claude-Édouard Châtillon; Karin Sorra; Martin Descarreaux
      Abstract: Publication date: Available online 9 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Andrée-Anne Marchand, Julie O’Shaughnessy, Claude-Édouard Châtillon, Karin Sorra, Martin Descarreaux
      Objective The objective of this review was to identify current practices and relevant patient-reported and objective outcome measures with regard to rehabilitation protocols directed at the lumbar spine in perioperative procedure settings in order to inform clinical practice and future research. Methods A literature search was performed in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Central Register of Controlled Trials, PEDro (Physiotherapy Evidence Database), and PubMed using terms relevant to surgical interventions, rehabilitation, and the lumbar spine. Results Twenty-nine studies met the inclusion criteria, and 28 investigated postoperative forms of rehabilitation. Patient-reported outcomes typically used were pain and disability, although a wide range of objective measures based on physical capacities were often reported. Rehabilitation programs, for the most part, included some form of strengthening exercises alone or in combination with stabilization exercises, aerobic conditioning, stretching, or education. Despite most studies reporting statistically significant results between intervention groups, considering clinically significant improvement within intervention groups yielded a different portrait. Conclusions A wide range of objective and subjective outcomes is used to document changes after active rehabilitation. Program components include both active and assisted interventions combined with various means of education and discussion. Multimodal rehabilitation protocols after lumbar surgery may be used to improve patient-reported and objective outcome measures such as pain, disability, and physical function. Further research should be conducted on the effects of preoperative rehabilitation programs.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.08.003
       
  • High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due
           to Disc Herniation: A Preliminary Randomized Trial
    • Authors: Marie-Eve Isner-Horobeti; Stéphane Pascal Dufour; Michael Schaeffer; Erik Sauleau; Philippe Vautravers; Jehan Lecocq; Arnaud Dupeyron
      Abstract: Publication date: Available online 9 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Marie-Eve Isner-Horobeti, Stéphane Pascal Dufour, Michael Schaeffer, Erik Sauleau, Philippe Vautravers, Jehan Lecocq, Arnaud Dupeyron
      Objective This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation. Methods A randomized double blind trial was performed, and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight (BW; LT50, n = 8) or low force traction at 10% BW (LT10, n = 9) for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28. Results Significant (P < .05) improvements were observed in the LT50 and LT10 groups, respectively, between day 0 and day 14 (end of treatment) for VAS (–44% and –36%), EIFEL score (–43% and –28%) and overall patient evaluation (+3.1 and +2.0 points). At that time, LT50 specifically improved in the finger-to-toe test (–42%), the straight-leg-raising test (+58), and drug consumption (–50%). No significant interaction effect (group-by-time) was revealed, and the effect of traction treatment was independent of the level of medication. During the 2-week follow-up at day 28, only the LT10 group improved (P < .05) in VAS (–52%) and EIFEL scores (–46%). During this period, no interaction effect (group-by-time) was identified, and the observed responses were independent of the level of medication. Conclusions For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.09.006
       
  • Utilization of Chiropractic Care at the World Games 2013
    • Authors: Debra D. Nook; Erik C. Nook; Brian C. Nook
      Abstract: Publication date: Available online 9 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Debra D. Nook, Erik C. Nook, Brian C. Nook
      Objective The purpose of this study was to describe chiropractic care use at the World Games 2013. Methods In this retrospective study, we reviewed treatment charts of athletes and non-athletes who sought chiropractic care at The World Games in Cali, Colombia, from July 25 to August 4, 2013. Doctors of chiropractic of the International Federation of Sports Chiropractic provided care. Chart notes included body region treated, treatment modality, and pretreatment and posttreatment pain ratings. Results Of the participants, 537 of 2964 accredited athletes and 403 of 4131 accredited non-athletes sought chiropractic treatment; these represent utilization rates of 18.1% for athletes and 9.8% for non-athletes. A total of 1463 treatments were recorded for athletes (n = 897) and non-athletes (n = 566). The athletes who were treated represented 28 of 33 sports and 68 of 93 countries that were present at the games. Among athletes, the thoracic spine was the most frequent area of treatment (57.2%), followed by the lumbar spine (48.7%) and the cervical spine (38.9%). Myotherapy was the most frequently used treatment method (80.9%), followed by chiropractic manipulation (78.5%), taping (38.0%), and mobilization (24.6%). Reports of acute injury were higher among athletes (45.4%) compared with non-athletes (23.8%). Reported pain was reduced after treatment (P < .001), and 86.9% patients reported immediate improvement after receiving chiropractic treatment. Conclusions The majority of people seeking chiropractic care at an international sporting competition were athletes. For those seeking care, the injury rate was higher among athletes than among non-athletes. The majority of patients receiving chiropractic care reported improvement after receiving care.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.09.005
       
  • Immediate Effects of Mobilization With Movement vs Sham Technique on Range
           of Motion, Strength, and Function in Patients With Shoulder Impingement
           Syndrome: Randomized Clinical Trial
    • Authors: João Flávio Guimarães; Tania Fátima Salvini; Aristides Leite Siqueira; Ivana Leão Ribeiro; Paula Rezende Camargo; Francisco Alburquerque-Sendín
      Abstract: Publication date: Available online 6 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): João Flávio Guimarães, Tania Fátima Salvini, Aristides Leite Siqueira, Ivana Leão Ribeiro, Paula Rezende Camargo, Francisco Alburquerque-Sendín
      Objective The purpose of this study was to compare the immediate effects of mobilization with movement (MWM) with sham technique on range of motion (ROM), muscle strength, and function in patients with shoulder impingement syndrome. Methods A randomized clinical study was performed. Participants (mean age ± standard deviation, 31 ± 8 years; 56% women) were divided into 2 groups: group 1 (n = 14), which received the MWM technique in the first 4 sessions and the sham technique in the last 4 sessions; and group 2 (n = 13), which was treated with the opposite order of treatment conditions described for group 1. Shoulder ROM, isometric peak force assessed with a handheld dynamometer, and function as determined through the Disabilities of the Arm, Shoulder and Hand and Shoulder Pain and Disability Index (SPADI) questionnaires were collected at preintervention, interchange, and postintervention moments. Results Two-way analysis of variance revealed no significant group-by-time interaction for any outcome but did reveal a main time effect for shoulder external rotation (P = .04) and abduction (P = .01) ROM, Disabilities of the Arm, Shoulder and Hand (P < .01), SPADI Pain (P < .01), SPADI Function (P < .01), and SPADI Total (P < .01). Only abduction movement and SPADI Pain overcame the clinical relevance threshold. The isometric peak force tests revealed no effects. Conclusion The MWM technique was no more effective than a sham intervention in improving shoulder ROM during external rotation and abduction, pain, and function in patients with shoulder impingement syndrome.

      PubDate: 2016-11-12T02:33:45Z
      DOI: 10.1016/j.jmpt.2016.08.001
       
  • Information for Readers
    • Abstract: Publication date: October 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 8


      PubDate: 2016-11-12T02:33:45Z
       
  • Interrater Reliability in the Clinical Evaluation of Myofascial Trigger
           Points in Three Ankle Muscles
    • Authors: David Rodríguez Sanz; César Calvo Lobo; Daniel López López; Carlos Romero Morales; Carlos Sosa Marín; Irene Sanz Corbalán
      Abstract: Publication date: Available online 2 November 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): David Rodríguez Sanz, César Calvo Lobo, Daniel López López, Carlos Romero Morales, Carlos Sosa Marín, Irene Sanz Corbalán
      Objective The purpose of this study was to evaluate interrater reliability in the diagnosis of myofascial trigger points (MTrPs) in the tibialis anterior, peroneus brevis, and extensor digitorum longus muscles. Methods A reliability research study was performed. Three physical therapists with clinical experience in myofascial pain functioned as raters and randomly and bilaterally evaluated the ankles of 40 subjects in the Madrid public health care system. The absence or presence of MTrPs, nodules in taut bands, patterns of referred pain, local twitch response (LTR), and jump-sign were evaluated. Results We calculated the pairwise interrater agreement and κ-value concordance of the presence or absence of trigger points (55%-85%; κ = 0.12-0.60), palpable nodules in taut bands (63%-90%; κ = 0.24-0.60), referred pain (63%-85%; κ = 0.20-0.54), and jump sign (62%-89%; κ = 0.15-0.72) in the 3 studied muscles. The LTR could only be evaluated in the tibialis anterior (43%-70%; κ = 0.05-0.21), and evaluation was not possible for the other muscles. Conclusions Three blinded raters were able to reach acceptable pairwise interrater agreement (percentage of agreement value ≥70%) for the presence or absence of MTrPs and LTR in the tibialis anterior, as well as for nodules in taut bands, referred pain, and the jump sign for the extensor digitorum longus. The peroneus brevis showed a wide percentage of agreement value, ranging from 31% to 82%. The results of this study showed that expert raters can agree, with slight-to-moderate concordance, with regard to the clinical testing of muscle trigger points by direct palpation of the 3 muscles studied: the tibialis anterior, the extensor digitorum longus, and the peroneus brevis. Interrater reliability seems to be muscle dependent, especially with regard to the depth of the muscle.

      PubDate: 2016-11-05T02:08:05Z
      DOI: 10.1016/j.jmpt.2016.09.002
       
  • Reference Values for the Scalene Interval Width During Varying Degrees of
           Glenohumeral Abduction Using Ultrasonography
    • Authors: Ross Mattox; Patrick J. Battaglia; Aaron B. Welk; Yumi Maeda; Daniel W. Haun; Norman W. Kettner
      Abstract: Publication date: Available online 27 October 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ross Mattox, Patrick J. Battaglia, Aaron B. Welk, Yumi Maeda, Daniel W. Haun, Norman W. Kettner
      Objective The aim of this study was to establish reference values for the width of the interval between the anterior and middle scalene muscles using ultrasonography during varying degrees of glenohumeral joint (GH) abduction. Reliability and body mass index (BMI) data were also assessed. Methods Interscalene triangles of asymptomatic participants were scanned bilaterally in the transverse plane. Images were obtained at 0°, 90°, and 150° of GH abduction with the participant seated. Width measurements were taken between the anterior and middle scalene muscle borders by bisecting the C6 nerve root as it passed superficial to the posterior tubercle of the C7 transverse process. Intra- and interexaminer reliability and BMI correlation were studied. Statistical significance was defined as P ≤ .05. Results Images of 42 scalene intervals were included from 21 participants (11 female). Mean participant age was 25.3 ± 3.9 years; mean BMI was 25.4 ± 2.7 kg/m2. Scalene interval measurements at 0°, 90°, and 150° of GH abduction were 4.5 ± 0.5 mm, 4.6 ± 0.5 mm, and 4.4 ± 0.7 mm, respectively, without a significant difference (P = .07). Intraexaminer reliability was excellent (0°: intraclass correlation coefficient [ICC] = 0.82; 90°: ICC = 0.89; 150°: ICC = 0.90). Interexaminer reliability was good to excellent (0°: ICC = 0.59; 90°: ICC = 0.85; 150°: ICC = 0.89). Body mass index was positively correlated only at 0° of GH abduction. Conclusions This study establishes previously unreported reference ultrasonography values for the width of the scalene interval. Intraexaminer reliability was excellent at all glenohumeral positions, and interexaminer reliability was determined to be good to excellent. Body mass index was positively correlated only at 0° of GH abduction.

      PubDate: 2016-10-28T21:52:08Z
      DOI: 10.1016/j.jmpt.2016.08.002
       
  • Ultrasonography Comparison of Peroneus Muscle Cross-sectional Area in
           Subjects With or Without Lateral Ankle Sprains
    • Authors: César Calvo Lobo; Carlos Romero Morales; David Rodríguez Sanz; Irene Sanz Corbalán; Alejandro Garrido Marín; Daniel López López
      Abstract: Publication date: Available online 25 October 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): César Calvo Lobo, Carlos Romero Morales, David Rodríguez Sanz, Irene Sanz Corbalán, Alejandro Garrido Marín, Daniel López López
      Objective The purpose of this study was to quantify the cross-sectional area (CSA) of the peroneus brevis, the peroneus longus, and connective tissue; to compare these measures in participants with and without lateral ankle sprains (LAS); and to determine the intraexaminer reliability of the protocol used to acquire these measures. Methods A cross-sectional case-control study was undertaken. B-mode ultrasound imaging was performed to measure the resting CSA and circular perimeter of the muscles and connective tissue and the total area and ratio between the CSA of the peroneus longus and the peroneus brevis. The imaging was performed for 56 feet, 28 with LAS and 28 without LAS (the mean numbers ± SD of total LAS, grade-I LAS and grade-II LAS were 4.1 ± 3.6, 2.71 ± 3.2, and 1.39 ± 0.9, respectively). A univariate correlation analysis using Pearson (r) and the Kendall tau_b (τB) coefficients was performed to evaluate the ultrasound imaging measurements (α = 0.05). Results Statistically significant differences (P < .05) were observed between the 2 groups, with a moderate negative correlation for the circular perimeter of the peroneus longus (P = .001; r = −0.444) and a weak association for the CSA of the peroneus longus (P = .002; τB = − 0.349), the ratio between the CSA of the peroneus longus and the peroneus brevis (P = .008; τB = −0.293), and the circular perimeter of connective tissue (P = .013; τB = −0.277). Conclusions The peroneus longus CSA is reduced in participants with LAS compared with that in participants without LAS. The intraexaminer reliability of the ultrasonography protocol was excellent when quantifying the peroneus brevis and the peroneus longus muscle tissues and acceptable when quantifying connective tissue.

      PubDate: 2016-10-28T21:52:08Z
      DOI: 10.1016/j.jmpt.2016.09.001
       
  • Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain: A
           Preliminary Descriptive Survey
    • Authors: Rune Mygind Mieritz; Kirsten Thorhauge; Axel Forman; Hanne Beck Mieritz; Jan Hartvigsen; Henrik Wulff Christensen
      Abstract: Publication date: Available online 21 October 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rune Mygind Mieritz, Kirsten Thorhauge, Axel Forman, Hanne Beck Mieritz, Jan Hartvigsen, Henrik Wulff Christensen
      Objective The purpose of this study was to determine the prevalence of musculoskeletal dysfunctions based on a standardized clinical examination of patients with chronic pelvic pain (CPP) who were referred to a specialized tertiary care center for laparoscopic examination. In addition, we stratified levels of self-reported pelvic pain, self-rated health, education, and work status based on musculoskeletal dysfunction status. Methods This study used a cross-sectional design to determine the prevalence of musculoskeletal dysfunctions in women with CPP who were referred to a tertiary care center specializing in care of women with CPP. The women completed a questionnaire and underwent a blinded systematic objective clinical examination of the musculoskeletal system by a doctor of chiropractic who then categorized the patients as having or not having musculoskeletal dysfunction. Results Ninety-four patients returned the questionnaire, completed the clinical examination, and fulfilled the inclusion criteria. More than half of the referred patients with CPP (48 out of 94) had musculoskeletal dysfunctions in the lumbar/pelvic region. No statistically significant differences were found between the groups with respect to self-rated health, education, work status, and pain level. Pain location was significantly different after Bonferroni correction in 1 out of the 36 aspects. Conclusions In this sample of CPP patients, 51% were categorized as having a musculoskeletal dysfunction. Overall, CPP patients were similar with respect to certain characteristics, such as age, body mass index, and pain level, regardless of their classification; however, patients with musculoskeletal dysfunction tended to report more pain in the front and back of the lower limbs.

      PubDate: 2016-10-21T18:10:35Z
      DOI: 10.1016/j.jmpt.2016.09.003
       
  • Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood
           Pressure: Results of a Pilot Sham-Controlled Trial
    • Authors: John F. Hart
      Abstract: Publication date: Available online 13 October 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): John F. Hart


      PubDate: 2016-10-15T00:33:44Z
      DOI: 10.1016/j.jmpt.2016.08.008
       
  • Establishing the ACORN National Practitioner Database: Strategies to
           Recruit Practitioners to a National Practice-Based Research Network
    • Authors: Jon Adams; Amie Steel Craig Moore Lyndon Amorin-Woods David Sibbritt
      Abstract: Publication date: Available online 5 October 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jon Adams, Amie Steel, Craig Moore, Lyndon Amorin-Woods, David Sibbritt
      Objectives The purpose of this paper is to report on the recruitment and promotion strategies employed by the Australian Chiropractic Research Network (ACORN) project aimed at helping recruit a substantial national sample of participants and to describe the features of our practice-based research network (PBRN) design that may provide key insights to others looking to establish a similar network or draw on the ACORN project to conduct sub-studies. Methods The ACORN project followed a multifaceted recruitment and promotion strategy drawing on distinct branding, a practitioner-focused promotion campaign, and a strategically designed questionnaire and distribution/recruitment approach to attract sufficient participation from the ranks of registered chiropractors across Australia. Results From the 4684 chiropractors registered at the time of recruitment, the project achieved a database response rate of 36% (n = 1680), resulting in a large, nationally representative sample across age, gender, and location. This sample constitutes the largest proportional coverage of participants from any voluntary national PBRN across any single health care profession. Conclusions It does appear that a number of key promotional and recruitment features of the ACORN project may have helped establish the high response rate for the PBRN, which constitutes an important sustainable resource for future national and international efforts to grow the chiropractic evidence base and research capacity. Further rigorous enquiry is needed to help evaluate the direct contribution of specific promotional and recruitment strategies in attaining high response rates from practitioner populations who may be invited to participate in future PBRNs.

      PubDate: 2016-10-08T14:29:03Z
       
  • Relationship of Modic Changes, Disk Herniation Morphology, and Axial
           Location to Outcomes in Symptomatic Cervical Disk Herniation Patients
           Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A
           Prospective Study
    • Authors: Michel Kressig; Cynthia K. Peterson; Kyle McChurch; Christof Schmid; Serafin Leemann; Bernard Anklin; B. Kim Humphreys
      Abstract: Publication date: Available online 28 September 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Michel Kressig, Cynthia K. Peterson, Kyle McChurch, Christof Schmid, Serafin Leemann, Bernard Anklin, B. Kim Humphreys
      Objective The purpose of this study was to evaluate whether cervical disk herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes. Methods Magnetic resonance imaging (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated. MRI scans were assessed for CDH axial location, morphology, and MCs. Pain (0-10 for neck and arm) and Neck Disability Index (NDI) data were collected at baseline; 2 weeks; 1, 3, and 6 months; and 1 year. The Patient’s Global Impression of Change data were collected at all time points and dichotomized into “improved,” yes or no. Fischer’s exact test compared the proportion improved with MRI abnormalities. Numerical rating scale and NDI scores were compared with MRI abnormalities at baseline and change scores at all time points using the t test or Mann-Whitney U test. Results Patients who were Modic positive had higher baseline NDI scores (P = .02); 77.8% of patients who were Modic positive and 53.3% of patients who were Modic negative reported improvement at 2 weeks (P = .21). Fifty percent of Modic I and 83.3% of Modic II patients were improved at 2 weeks (P = .07). At 3 months and 1 year, all patients with MCs were improved. Patients who were Modic positive had higher NRS and NDI change scores. Patients with central herniations were more likely to improve only at the 2-week time point (P = .022). Conclusions Although patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.

      PubDate: 2016-09-30T14:09:56Z
      DOI: 10.1016/j.jmpt.2016.08.004
       
  • Assessment of Lumbar Spine Height Following Sustained Lumbar Extension
           Posture: Comparison Between Musculoskeletal Ultrasonography and
           Stadiometry
    • Authors: Virginie Poortmans; Jean-Michel Brismée; Bernard Poortmans; Omer C. Matthijs; Pierre-Michel Dugailly; Stéphane Sobczak
      Abstract: Publication date: Available online 13 September 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Virginie Poortmans, Jean-Michel Brismée, Bernard Poortmans, Omer C. Matthijs, Pierre-Michel Dugailly, Stéphane Sobczak
      Objectives The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). Methods Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. Results Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). Conclusions In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

      PubDate: 2016-09-15T14:24:59Z
      DOI: 10.1016/j.jmpt.2016.07.003
       
  • Effects of Motor Control Exercise Vs Muscle Stretching Exercise on
           Reducing Compensatory Lumbopelvic Motions and Low Back Pain: A Randomized
           Trial
    • Authors: Kyue-nam Park; Oh-yun Kwon; Chung-hwi Yi; Heon-seock Cynn; Jong-hyuck Weon; Tae-ho Kim; Houng-sik Choi
      Abstract: Publication date: Available online 3 September 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kyue-nam Park, Oh-yun Kwon, Chung-hwi Yi, Heon-seock Cynn, Jong-hyuck Weon, Tae-ho Kim, Houng-sik Choi
      Objectives The purpose of this study was to investigate the effectiveness of a 6-week motor control exercise (MCE) vs stretching exercise (SE) on reducing compensatory pelvic motion during active prone knee flexion (APKF) and intensity of low back pain. Methods Thirty-six people in the lumbar-rotation-extension subgroup were randomly assigned equally into 2 exercise groups (18 people in each an MCE or SE group). A 3-dimensional motion-analysis system was used to measure the range and onset time of pelvic motion and knee flexion during APKF. Surface electromyography was used to measure the muscle activity and onset time of the erector spinae and the hamstrings during APKF. The level of subjective low back pain was measured using a visual analog scale. Results The MCE group had more significant decreases in and delay of anterior pelvic tilt, pelvic rotation, and erector spinae muscle activity during APKF, as well as reduced intensity of low back pain compared with the SE group (P < .05). Conclusions For rehabilitation in patients in the lumbar-rotation-extension subgroup, MCE was more effective than SE in reducing compensatory pelvic motion and muscle activity during APKF and minimizing low back pain.

      PubDate: 2016-09-06T06:33:40Z
      DOI: 10.1016/j.jmpt.2016.07.006
       
 
 
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