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To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA).
Parallel-group randomized trial with 3-month follow-up.
Two chiropractic outpatient teaching clinics.
Convenience sample of eligi...
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Citations
... The management of HOA primarily relies on conservative treatments, with surgical options like total hip arthroplasty typically reserved for severe cases (Räsänen et al. 2007). In previous years, new conservative approaches have been developed to manage pain associated with HOA, including orthopedic manual therapy (OMT) (Bennell et al. 2014;Brantingham et al. 2012;French et al. 2013;Hoeksma et al. 2004;Poulsen et al. 2013). Two systematic reviews showed that OMT positively influenced self-reported pain and physical function of patients with HOA (Cowan et al. 2010;French et al. 2013). ...
Background
Orthopedic manual therapy is currently considered as an alternative approach for treating hip osteoarthritis. However, studies assessing its efficacy in low‐income countries in Sub‐Saharan Africa are scarce.
Objectives
Investigating the effectiveness of Maitland passive joint mobilization (Maitland PJM) compared to self‐rehabilitation in patients with hip osteoarthritis in Benin, a low‐income country, in Sub‐Saharan Africa.
Methods
This was a pragmatic, single‐blind, two‐arm randomized trial involving 66 participants randomly assigned into two groups (Maitland PJM group, n = 33, and self‐rehabilitation group, n = 33). Both interventions took 5 weeks. The primary outcome (pain) was evaluated using numerical rating scale. Secondary outcomes (passive hip range of motion, muscles strength, walking, and quality of life) were assessed using goniometry, medical research council, 10 m walk test, and short‐form 36. Participants were assessed at baseline, after interventions and 3‐month follow‐up.
Results
Forty‐nine patients (Maitland PJM group, n = 22, self‐rehabilitation, n = 27) completed the sessions. Within‐group analyses showed a significant improvement in body function, walking speed, and quality of life ( p < 0.05) after interventions and at 3‐month follow‐up within both groups. No significant differences in any outcomes were observed between the Maitland PJM and self‐rehabilitation groups, after interventions and at the 3‐month follow‐up ( p > 0.05).
Conclusion
Maitland passive joint mobilization and self‐rehabilitation similarly improved function, walking speed, and quality of life in Beninese patients with hip osteoarthritis.
Trial Registration
PACTR201911553990405
... The manual therapy intervention was a traction manipulation, in the limited position of the hip, using a high velocity thrust, similar to our design. 12 They concluded that manual therapy was far superior to exercise therapy in improving hip function in patients with OA. 12 Brantingham et al. 39 investigated the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip OA. The treatment consisted of a targeted hip manipulation, using high-velocity, low-amplitude thrust-type along with pre-and post-treatment stretching of the same hip. ...
... The treatment consisted of a targeted hip manipulation, using high-velocity, low-amplitude thrust-type along with pre-and post-treatment stretching of the same hip. 39 They concluded that there was no statistically significant difference between the two groups however, both groups did have improved Western Ontario and McMasters Osteoarthritis Index (WOMAC) scores. 39 There was a statistically significant improvement in numeric pain scale scores for both the manipulation treatment and the alternative treatment. ...
... 39 They concluded that there was no statistically significant difference between the two groups however, both groups did have improved Western Ontario and McMasters Osteoarthritis Index (WOMAC) scores. 39 There was a statistically significant improvement in numeric pain scale scores for both the manipulation treatment and the alternative treatment. However, when the two treatments were compared, there was a statistically significant difference in the magnitude of improvement for the manipulation treatment. ...
Objectives:
This study aims to determine whether manipulative therapy of the hip joint can increase range of motion (ROM) and/or decrease pain in individuals experiencing symptomatic hip pain.
Methods:
Non-disabled young adults were recruited on campus of a chiropractic college for this randomized crossover study. Subjects' hip active and passive ROM and pain perception were measured. Subjects then received a drop-piece hip manipulation (DPHM) or an alternative treatment, followed by measurement of active and passive ROM and pain.
Results:
Eight males and 12 females (n=20) between the ages of 21-32 years completed the study. Statistically significant improvements in numeric pain scale (NRS) and passive abduction were observed for the manipulation group when compared to the alternative treatment. No significant change was observed for all other hip ranges.
Conclusions:
DPHM of the symptomatic hip joint in a small sample of young adults resulted in statistically significant improvements in pain and passive abduction when compared to sham manipulation. Due to low sample size, further research is recommended.
... Seven randomized clinical trials were identified that have measured the pain intensity of hip OA by subjecting subjects to a TM intervention compared to a control group of which 4 (34,36,37,(40)(41)(42)(43)(44)(45)(46)(47) (Table III) (Table III). ...
... Four randomized clinical trials were identified that have measured the pain intensity of hip OA when subjecting subjects to an intervention with MT + Ex in conjunction with exercises, within which 2 studies used the Visual Analog Scale (34,36,37,40,45,46) to measure the intensity of pain. The remaining 2 studies used the NPRS (37) and the WOMAC pain section (36) ( Table IV) ...
... This panoramic literature review provides an overview of the systematic reviews included in the literature on the scientific evidence for the conservative management of hip osteoarthritis, the studies analyzed (32)(33)(34)(35)46,48,49) reported in favor of manual therapy, but due to the lack of statistical power of the results, these cannot be categorical as the standard conservative intervention in the management of hip OA. Osteoarthritis of the hip is a complex condition that often requires surgical management, which is always a complex conditioner for patients and for the management of the deleterious condition to any type of surgery (43,50). ...
Introduction: Osteoarthritis (OA) is the most common joint disease, increases with age and it is estimated that in those over 60 years of age more than 80 % have OA in at least one joint. Currently, the evidence regarding MT in hip OA has had unclear results. Therefore, the main objective of this study is to determine the effectiveness and recommendation of MT in the hip OA. And secondary objectives, (I) review the existing literature on the intervention of MT in hip OA, (II) calculate the effectiveness of TM techniques in hip OA and (III) determine if there are benefi ts after the MT intervention in hip OA. Methods: A systematic search was carried out in electronic databases, in order to compile the available literature between the years 2000 and 2019, taking as reference the PRISMA statement for systematic reviews. Letters to the editor, bibliographic reviews and gray literature were excluded. Results: After reviewing 30 articles, we included 7 RS and 14 RCTs. 7 RCTs measured pain intensity of OA in response to MT vs. a control group. 4 RCTs measuring pain intensity in hip OA using MT + Ex. Seven RCTs measured function in subjects with hip OA in response to MT vs. CG. Two RCTs evaluated the effects of MT + Ex on function. Discussion: Although the results were in favor of manual therapy, compared to the control group, these were not statistically signifi cant, so we propose to car
... Seven randomized clinical trials were identified that have measured the pain intensity of hip OA by subjecting subjects to a TM intervention compared to a control group of which 4 (34,36,37,(40)(41)(42)(43)(44)(45)(46)(47) (Table III) Table III). ...
... Four randomized clinical trials were identified that have measured the pain intensity of hip OA when subjecting subjects to an intervention with MT + Ex in conjunction with exercises, within which 2 studies used the Visual Analog Scale (34,36,37,40,45,46) to measure the intensity of pain. The remaining 2 studies used the NPRS (37) and the WOMAC pain section (36) ( Table IV) ...
... This panoramic literature review provides an overview of the systematic reviews included in the literature on the scientific evidence for the conservative management of hip osteoarthritis, the studies analyzed (32)(33)(34)(35)46,48,49) reported in favor of manual therapy, but due to the lack of statistical power of the results, these cannot be categorical as the standard conservative intervention in the management of hip OA. Osteoarthritis of the hip is a complex condition that often requires surgical management, which is always a complex conditioner for patients and for the management of the deleterious condition to any type of surgery (43,50). ...
... Manual therapy has demonstrated its effectiveness to reduce pain and improve physical function in patients with mild to moderate hip osteoarthritis (OA) (Brantingham et al., 2012;Beselga et al., 2016;Cibulka et al., 2017). Long-axis distraction mobilization (LADM) is one of the most reported manual therapy techniques in studies with hip OA patients (Hoeksma et al., 2004;MacDonald et al., 2006;Vaarbakken and Ljunggren, 2007;de Luca et al., 2010;Strunk and Hanses, 2011;Hando et al., 2012;Estébanez-de-Miguel et al., 2018). ...
... Finally, only one therapy was applied. Clinical practice guidelines recommend manual therapy combined with exercise as part of the management of patients with mild to moderate hip OA (Brantingham et al., 2012;National Institute for Clinical ...
Background:
Long-axis distraction mobilization (LADM) of the hip has been shown to reduce pain and improve physical function in hip osteoarthritis (OA). The optimal intensity of mobilization force necessary to reduce pain and improve physical function is unknown.
Objective:
To compare the effects on pain and physical function of three different intensities of LADM mobilization force in hip OA patients.
Design:
Randomized controlled trial.
Methods:
Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of LADM. Pressure pain thresholds (PPT) at hip, knee and heel, physical function (Western Ontario and McMaster Universities physical function subscale, timed up and go and 40 m self-placed walk test) and pain after the physical function tests (visual analogic scale) were assessed before and after the intervention.
Results:
The three treatment groups showed significant improvements in pain and in physical function (p < 0.05). The low-force group showed the largest effects size for pain (d = 2.0) and the greatest mean percentage increase in PPTs (hip = 30.3%, knee = 34.6%, heel = 25.6%). The high-force group showed the largest effects size for physical function (d = 0.5-0.7).
Conclusion:
A low-force LADM produced the largest reduction in pain and a high-force LADM the largest improvement in physical function in hip OA patients. The improvements in pain and physical function after LADM in hip OA patients appear to be modulated by the intensity of the mobilization force.
... Clinical practice guidelines recommend manual therapy as part of the management of patients with mild to moderate hip OA (Hochberg et al., 2012;National Institute for Clinical Excellence, 2014;Cibulka et al., 2017). Manual therapy (thrust, non-thrust and soft tissue mobilization) is used with the aim of improving hip range of motion (ROM) and reducing pain (Brantingham et al., 2012;Abbott et al., 2013;Bennell et al., 2014;Beselga et al., 2016) Manual therapy techniques can be applied in different dosages in terms of force, amplitude, rate, repetition and duration (Snodgrass et al., 2006). There is a lack of evidence on the different aspects of treatment dosage which could affect the outcome of the manual treatment. ...
Background:
Manual therapy has been shown to increase range of motion (ROM) in hip osteoarthritis (OA). However, the optimal intensity of force during joint mobilization is not known.
Objective:
To compare the effectiveness of high, medium and low mobilization forces for increasing range of motion (ROM) in patients with hip OA and to analyze the effect size of the mobilization.
Design:
Randomized controlled trial.
Methods:
Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of long-axis distraction mobilization (LADM) in open packed position and distraction forces were measured at each treatment. Primary outcomes: passive hip ROM assessed before and after each session.
Secondary outcomes:
pain recorded with Western Ontario and McMaster Universities (WOMAC) pain subscale before and after the three treatment sessions.
Results:
Hip ROM increased significantly (p < 0.05) in the high-force mobilization group (flexion: 10.6°, extension: 8.0°, abduction:6.4°, adduction: 3.3°, external rotation: 5.6°, internal rotation: 7.6°). These improvements in hip ROM were statistically significant (p < 0.05) compared to the low-force group. There were no significant changes in the low-force and medium-force groups for hip ROM. No significant differences in hip pain were found between treatment groups.
Conclusion:
A high force LADM in open packed position significantly increased hip ROM in all planes of motion compared to a medium or low force mobilization in patients with hip OA. A specific intensity of force mobilization appears to be necessary for increasing ROM in hip OA.
... Conservative treatment is the first line treatment for HOA [9]. Up until now, Manual Therapy (MT) is associated with level B research evidence as an individual intervention and is conditionally recommended as part of a multimodal program in conjunction with therapeutic exercise [9,10,11,12]. Abbott [13], found that MT as a single intervention, had short and long-term improvement in HOA and knee osteoarthritis (KOA) patients, while Hoeksma [14], showed that the MT outweighs exercise as a therapeutic approach in short-term improvements in pain, functionality, and range of motion ROM. French [15], did not find any additional benefit, when MT added in the exercise program, while Bennell [16], found no clinical improvement after an integrated physical therapy program implementation compared with control group. ...
Background: Postural hypnosis can lead to cervical pain or bad cosmetic appearance.There is a lack in the literature supporting the efficacy of spinal mobilization techniques in restoring normal thoracic curvature.Mulligan and Maitland's mobilization were used to improve range of motion and referred pain not to restore normal kyphotic angle. The purpose: this study was conducted to compare the efficacy of Mulligan and Maitland spinal mobilization on a kyphotic angle in postural kyphosis. Subjects: seventy-five male subjects with postural kyphosis their age (17-21) years were included in the study by initial postural examination and were randomly assigned into three equal groups.
Methods: Group I each subject in this group received mulligan mobilization in addition to back exercises as conservative treatment, Group II each subject in this group received Maitland mobilization in addition to back exercises as conservative treatment, Group III this group was considered as a control group. Subjects within this group will perform exercises only as a conservative treatment. Kyphotic angle was measured by using formetric raster-stereography pre and post treatment.
Result: The result of the study showed a significant effect of Mulligan mobilization in reducing kyphotic angle in patients with postural kyphosis p-value was (0.001), and there was no significant effect on Maitland mobilization on a kyphotic angle and the p-value was (0.256).
Conclusion: Mulligan mobilization is effective in restoring normal kyphotic angle in cases of postural kyphosis
... Conservative treatment is the first line treatment for HOA [9]. Up until now, Manual Therapy (MT) is associated with level B research evidence as an individual intervention and is conditionally recommended as part of a multimodal program in conjunction with therapeutic exercise [9,10,11,12]. Abbott [13], found that MT as a single intervention, had short and long-term improvement in HOA and knee osteoarthritis (KOA) patients, while Hoeksma [14], showed that the MT outweighs exercise as a therapeutic approach in short-term improvements in pain, functionality, and range of motion ROM. French [15], did not find any additional benefit, when MT added in the exercise program, while Bennell [16], found no clinical improvement after an integrated physical therapy program implementation compared with control group. ...
... badali skuteczność ćwiczeń w sadowisku wodnym [20,21]. Istnieje grupa doniesień zawierających połączenie zastosowania ćwiczeń z różnymi działaniami z zakresu terapii manualnej [22][23][24][25][26][27][28][29][30][31]. Wśród nich na uwagę zasługuje doniesienie o słuszności stosowania TM jako części kompleksowego usprawniania [22]. ...
... Brantinghan i wsp. [29] porównywali terapię w dwu grupach pacjentów za pomocą częściowo różniących się koncepcji zawierających techniki terapii manualnej, ćwiczenia i stretching mięśni. Różnica polegała na zastosowaniu w jednej z grup autorskiego programu terapii manualnej (Full kinetic chain). ...
... Średnio wynik u pacjentów podwyższył się o 12,9˚. Uzyskany po terapii wynik mieścił się w granicach normy tego zakresu ruchu [29], która to wynosi 20-30˚ dla osób w przedziale wiekowym grupy badawczej. W ruchu rotacji zewnętrznej różnica ta była podobna (10,2˚). ...
Introduction: Degenerative changes are one of the most often appearing causes of the affliction located in the locomotor system where the hip joint is one of the most common locations. One can observe such symptoms as: limited movement, pain and muscle weakness. One of the therapy methods that are aimed at improving movement and reducing the affliction are techniques used in manual therapy (e.g. mobilization). The Kaltenborn-Evjenth method has been applied in physiotherapy practice for many years. The aim of the research was to assess the effectiveness of mobilization techniques directed at the synovial capsule (manual therapy) while treating degenerative changes of the hip joint. In literature no report that refers precisely to the subject mentioned above was found. Being assessed was the influence of therapy on the range of the joints movement and the level of pain.
Material and methods: A group of 20 people with degenerative changes of the hip joint were examined (16 women and 4 men, average age - 65 years). Measurements of the hip joint range movement were performed (the flexion, extension, abduction, adduction and rotation) and the assessment of the level of felt pain (VAS) before and after the therapy. The therapy using mobilization techniques taken from the Kaltenborn-Evjenth concept was conducted in a series of 6 therapy sessions lasting 2 weeks.
Results: In all comparisons of the range of motion in the hip joint an increasing was stated (p < 0.001) after the therapy. In the case of pain level a decreasing was observed (p < 0.001) after the therapy.
Conclusions: It seems right to use manual therapy techniques in physiotherapy proceedings in the course of the degenerative disease of the hip joint, aimed on for e.g. the synovial capsule.
... 6 The organization sponsored and/or participated in the development of a number of "best practices" recommendations on various conditions. [21][22][23][24][25][26][27][28][29][30][31][32] With respect to chiropractic management of LBP, a CCGPP team produced a literature synthesis 8 which formed the basis of the first iteration of this guideline in 2008. 9 In 2010, a new guideline focused on chronic spine-related pain was published, 12 with a companion publication to both the 2008 and 2010 guidelines published in 2012, providing algorithms for chiropractic management of both acute and chronic pain. ...
Objective:
The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain.
Methods:
This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus.
Results:
Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process.
Conclusions:
The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.
