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Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial
Abstract
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.
... The manual traction mobilisation technique is used to increase the range of motion. This technique applies a linear, non-rotational joint movement, increasing tension in all the capsuloligamentous structures, increasing joint mobility and decreasing symptoms [23,24]. Some authors suggest that the decreased joint pressure and changes in capsular elasticity and surrounding muscles caused by joint distraction would explain the improved mobility and analgesic effects after applying manual techniques [23,25,26]. ...
... This technique applies a linear, non-rotational joint movement, increasing tension in all the capsuloligamentous structures, increasing joint mobility and decreasing symptoms [23,24]. Some authors suggest that the decreased joint pressure and changes in capsular elasticity and surrounding muscles caused by joint distraction would explain the improved mobility and analgesic effects after applying manual techniques [23,25,26]. The response in the capsuloligamentous tissue would depend on the traction force applied in the joint mobilisation [27,28]. ...
... Finally, high force (applied beyond the first stop) is used to improve function and movement gain. [23,24]. These effects are modulated by the magnitude of the force applied or the degree of mobilisation [23,24]. ...
Background: The effect of tibial fixation on the movement of the talus during the tibiotarsal axial traction technique (TATT) is unknown. The aim was to evaluate the effect on the tibiotarsus when applying three different intensities of TATT force with or without tibial fixation in healthy subjects, and to assess the reliability of detecting the different forces applied. Also, the discomfort generated during the technique would be analysed. Methods: A cross-sectional study was conducted in thirty lower limbs. Three magnitudes of TATT force in an open-packed position were applied in tibial fixation and non-fixation conditions. The axial traction movement was measured by ultrasound, and the magnitudes of the force applied during low-medium and high TATT force were recorded in both conditions. Patients were asked about the level of discomfort perceived during the technique. Results: The most significant distance increase (mm) was observed in the tibial fixation condition at all magnitudes of the TATT (F = 102.693, p < 0.001). The discomfort sensation (numeric rating scale, "NRS") was higher in the non-fixation condition (p > 0.05). The application of the technique showed good reliability (>0.75 ICC) for the detection of the applied force. Conclusions: The TATT in the tibial fixation condition produced more significant axial movement of the talus (mm) relative to the tibia than the non-tibial fixation condition did. The detection of the magnitudes of movement showed good reliability (ICC: 0.75 to 0.92). The technique was well tolerated at all force magnitudes, with the tibial fixation condition being the most tolerable.
... 7-10 Additionally, several studies have investigated the effects of hip mobilization on both short and long-term changes in hip A clinical crossover trial of the effect of manipulative therapy on pain and passive and active range of motion of the painful hip ROM. [11][12][13][14][15] Beselga et al. 11 found significant improvements in hip flexion after a single treatment of mobilizations with movement. Hoeksma et al. 12 compared a manual therapy program including manipulation and mobilizations to an exercise program and found significantly better outcomes in pain, stiffness, hip function, and hip range of motion after 5 weeks. ...
... Mosler et al. 13 studied changes in hip range of motion after a 4-week manual therapy program in junior elite male water polo players and found significant improvement in passive IR and ER. Estébanez-De-Miguel et al. 14 examined the effects of three treatment sessions of high force long axis distraction mobilization on passive hip ROM when compared to low and medium force long axis distraction mobilization. They found significant improvements in passive flexion, extension, abduction, adduction, IR, and ER in the high force group and no significant changes in the low and medium force groups. ...
... They found significant improvements in passive flexion, extension, abduction, adduction, IR, and ER in the high force group and no significant changes in the low and medium force groups. 14 Stathopoulos 15 did a systematic review and meta-analysis regarding the efficacy of mobilizations with movement on ROM of various joints and found statistically and clinically significant improvements in ROM consistently for hip pain. Currently, there is limited evidence examining multiple ranges of motion with a single intervention. ...
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.
... 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). These preliminary studies have shown that LADM reduces pain, increases hip ROM and improves physical function in hip OA patients (Hoeksma et al., 2004;McDonald et al., 2006;Vaarbakken and Ljunggren, 2007;Estébanez-de-Miguel et al., 2018). ...
... 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). These preliminary studies have shown that LADM reduces pain, increases hip ROM and improves physical function in hip OA patients (Hoeksma et al., 2004;McDonald et al., 2006;Vaarbakken and Ljunggren, 2007;Estébanez-de-Miguel et al., 2018). McLean (2002) and Jull and Moore (2002) suggested that a specific intensity of force mobilization appears to be necessary to achieve a specific therapeutic result. ...
... McLean (2002) and Jull and Moore (2002) suggested that a specific intensity of force mobilization appears to be necessary to achieve a specific therapeutic result. According to this, Estébanez- de-Miguel et al. (2018) demonstrated that a high force LADM in open packed position significantly increased hip range of motion (ROM) compared to a medium or low force mobilization in patients with hip OA. Several studies have shown that the magnitude of the manual force applied affects the degree of analgesia during active movement (McLean et al., 2002;Nougarou et al., 2013) and muscular response (McLean et al., 2002;Colocca et al., 2003;Nougarou et al., 2013). ...
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.
... Musculoskeletal impairments such as back and limb pain, range-of-motion limitations, and leg weakness occur in many people and have been amenable to manual therapy in other populations [17][18][19][20][21][22][23]. Spinal mobilization is recommended across disciplines when used in combination with active exercise and education for pain reduction and improved function [17][18][19]. ...
... Spinal mobilization is recommended across disciplines when used in combination with active exercise and education for pain reduction and improved function [17][18][19]. Spinal or peripheral joint mobilization can also increase short-term range-of-motion restricted by joint and fascial stiffness [20,21]. Passive hip joint mobility, in particular, can affect functional mobility and muscle function [22] which tends to improve immediately following lumbar manipulation [23]. ...
Background:
Most people with lower-limb loss (PLL) have musculoskeletal conditions and range-of-motion and muscle performance impairments. Such impairments limit potential for functional movement but can be reduced with manual therapy. Manual therapy, however, is rarely used for PLL. This case demonstrated how integrating manual therapy, exercise, and functional training led to lasting benefits for one low functioning PLL.
Case description:
A 54-year-old woman more than 1 year after transtibial amputation due to peripheral artery disease presented with multiple comorbidities and yellow flags. Her function remained limited to the Medicare K-1 household walking level with slow gait speed <0.25 m/s. Treatment included four weekly sessions each beginning with manual therapy, followed by exercise and functional training.
Outcomes:
After 1 month, performance-based strength, balance, walking speed, and physical activity increased. She advanced to the K-2 limited community walking level and maintained her functional level without further treatment after 3 months.
Discussion:
Improvements maintained without treatment expanded upon research that lacked follow-up and excluded K-1 level walkers. Marked improvement after only four sessions was noteworthy since exercise protocols require ≥4 sessions.
Conclusion:
Manual therapy followed by exercise and functional training may optimize movement potential and contribute to improving strength, balance, gait, and physical activity among PLL.
... This is a substantial change when considered as a proportion of the hip IR ROM found in this study (e.g., for tester 1 and the left hip, the mean IR was 41.4 • ). The MDCs are also considerably higher than reported improvements in hip rotation ROM following interventions [35,36]. For example, a recent randomized controlled trial investigating the effect of manual therapy on hip ROM, reported a 7.6 • improvement in mean hip IR and 5.6 • improvement in mean ER, following three sessions of passive hip joint mobilization [35]. ...
... The MDCs are also considerably higher than reported improvements in hip rotation ROM following interventions [35,36]. For example, a recent randomized controlled trial investigating the effect of manual therapy on hip ROM, reported a 7.6 • improvement in mean hip IR and 5.6 • improvement in mean ER, following three sessions of passive hip joint mobilization [35]. In order to effectively assess hip rotation ROM, across different sessions and different testers, a higher level of inter-and intra-rater reliability is desirable. ...
The clinical assessment of hip rotation range-of-motion (ROM) is important for managing hip and groin injuries in footballers. Previously published reliability studies on hip ROM have employed protocols that are difficult to replicate under everyday clinical conditions. This single trial, intra- and inter-rater reliability study included 41 male academy football (soccer) players, aged 14–15 years, from one European football academy. Passive hip internal rotation (IR) and external rotation (ER) ROM were measured in supine with hip and knee flexed to 90°. The ROM was determined using a smartphone application, with the smartphone attached to the lower leg. The tests were performed on two separate occasions, one week apart, by two different physiotherapists and on both sides (left and right hips). Reliability was evaluated using Intra-Class Correlation Coefficients (ICCs) and Minimal Detectable Change (MDC). Hip IR and ER ROM displayed moderate to good intra-rater agreement (ICCs 0.54–0.75), with MDCs ranging from 10.9° to 16.4°. Inter-rater reliability displayed poor to moderate reliability (ICCs 0.33–0.75), with MDCs ranging from 11.7° to 16.5°. A hip rotation ROM test using a smartphone application and a protocol closely reflecting everyday clinical conditions displayed moderate to good intra-rater reliability and poor to moderate inter-rater reliability. Due to the high MDCs, the practical applicability of this test procedure is limited and further refinement is necessary.
... In a recent study by Estebánez-de-Miguel et al. [42], they found that, to achieve tissue elongation in the hip joint, at least 45 s were needed. No data have been found on the glenohumeral joint, but the time may be similar. ...
Background:
Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation.
Methods:
Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation.
Results:
The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application.
Conclusions:
Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.
... Few laboratory-based studies explored the effects of different dosages of shoulder joint mobilisation on physiological outcomes (eg, scapular and shoulder muscle activity levels) in asymptomatic individuals or patients with other shoulder diseases. [22][23][24][25] The findings suggest higher dosage of joint mobilisation reduced the activity levels of scapular and shoulder muscles in asymptomatic individuals, but lower dosage mobilisation did not. 22 23 In patients with frozen shoulder, the high-grade mobilisation technique was more effective than the low-grade mobilisation technique to improve shoulder mobility and reduce disability. ...
Introduction
Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive.
Objectives
To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage.
Methods and analysis
We will follow the methodological framework outlined by Arksey and O’Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis.
Ethics and dissemination
Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.
... Although subjects were instructed to remain relaxed during the technique application, a defensive response to traction could occur and made the physical therapist increase the intensity of the technique. The reliability of detection of the grades of movement has already been evaluated in other studies, showing a good or an excellent intra-observer [30,[34][35][36][37][38][39]. Ultrasound measurements have been shown to be a reliable tool to evaluate inferior gliding to humeral head [35,36]. ...
Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05–0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force.
... 36 Other forms of manual therapy, such as soft tissue or neurodynamic mobilizations, can involve movement of a joint, but they are designed to selectively affect the overlying soft tissue or nerve. Trials examining other chronic conditions show that joint mobilizations can improve local range of motion 37,38 and mechanosensitivity, 39 reduce spinal cord hyperexcitability, 40,41 and facilitate centrally mediated conditioned pain modulation. 42 Furthermore, systematic reviews have found that joint mobilization alone or in conjunction with other therapies can address both pain and function in conditions involving pain and central sensitization. ...
Objective
The purpose of this review is to identify the role of joint mobilization for individuals with Carpal tunnel syndrome (CTS).
Methods
A systematic search of 5 electronic databases (PubMed, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and SPORTDiscus) was performed to identify eligible full-text randomized clinical trials related to the clinical question. Joint mobilization had to be included in one arm of the randomized clinical trials to be included. Two reviewers independently participated in each step of the screening process. A blinded third reviewer assisted in cases of discrepancy. The PEDro scale was used to assess quality.
Results
Ten articles were included after screening 2068 titles. In each article where joint mobilization was used, positive effects in pain, function, or additional outcomes were noted. In most cases, the intervention group integrating joint mobilization performed better than the comparison group not receiving joint techniques.
Conclusion
In the articles reviewed, joint mobilization was associated with positive clinical effects for persons with CTS. No studies used joint mobilization in isolation; therefore, results must be interpreted cautiously. This review indicates that joint mobilization might be a useful adjunctive intervention in the management of CTS.
... Another study observed similar differences when comparing the effectiveness of high, medium, and low mobilization MT on hip ROM in patients with OA. Hip ROM was significantly increased in the high-force group for all directions [19]. The long-term benefits of physical therapy were supported by a study that observed the effect of MT in patients with OA. ...
Purpose of review:
Osteoarthritis (OA) is a highly prevalent cause of chronic hip pain, affecting 27% of adults aged over 45 years and 42% of adults aged over 75 years. Though OA has traditionally been described as a disorder of "wear-and-tear," recent studies have expanded on this understanding to include a possible inflammatory etiology as well, damage to articular cartilage produces debris in the joint that is phagocytosed by synovial cells which leads to inflammation.
Recent findings:
Patients with OA of the hip frequently have decreased quality of life due to pain and limited mobility though additional comorbidities of diabetes, cardiovascular disease, poor sleep quality, and obesity have been correlated. Initial treatment with conservative medical management can provide effective symptomatic relief. Physical therapy and exercise are important components of a multimodal approach to osteoarthritic hip pain. Patients with persistent pain may benefit from minimally invasive therapeutic approaches prior to consideration of undergoing total hip arthroplasty. The objective of this review is to provide an update of current minimally invasive therapies for the treatment of pain stemming from hip osteoarthritis; these include intra-articular injection of medication, regenerative therapies, and radiofrequency ablation.
... Witness patients suffering from phase II frozen shoulder or symptomatic disc herniation [100,101]. On the contrary, or progressively upon decrease in pain, patients with joint limitations and mild/moderate pain elicitable at the end of the joint range (whom Maitland defines as "stiffness dominant") will benefit from more intense, longer-lasting techniques carried out at the end of the joint range, possibly with the reproduction of a symptomatology during application, which have proven capable of improving both pain and ROM in these patients [102,103]: phase III frozen shoulder or osteoarthritis clinical pictures can be considered as emblematic examples [100,104]. ...
Manual Therapy is one of the most widely used therapeutic solutions in the treatment of pain and musculoskeletal disorders. Its evolution began several centuries ago and culminated in the modern reference methods in the field of physiotherapy, osteopathy, and chiropractic, which mainly address the treatment of joint and myofascial tissues. The advent of evidence-based medicine and the ever-growing literature available in the field of Manual Therapy has led this therapeutic approach to be heavily criticized on the basis of studies that have shown its limitations with regard to manual and palpatory assessment techniques, the poor biomechanical validity of therapeutic methods, and the poor long-term results in the treatment of patients with musculoskeletal pain. A better understanding of the mechanisms underlying the effectiveness of Manual Therapy, as well as of the mediators of the medium- and long-term effectiveness of musculoskeletal rehabilitation processes, has made it possible to reconsider the role of Manual Therapy and the healthcare professionals specializing in manipulative therapy within the framework of the biopsychosocial model, which focuses on the patient and their functionality.
Background: Cadaveric models are sometimes used to test the effect of manual techniques. We have not found any
studies comparing the effect of tibiotarsal joint distraction on cadaveric models versus live models for clinical
use. The aim was to compare the effect on tibiotarsal joint distraction movement when applying three force
magnitudes of tibiotarsal axial traction technique force between a cadaveric model and volunteers. In addition,
to compare the magnitude of force applied between the cadaveric model and volunteers. Finally, to assess the
reliability of applying the same magnitude of force in three magnitudes of tibiotarsal axial traction force.
Methods: A cross-sectional comparative study was conducted. Sixty ankle joints were in open-packed position and three magnitudes of tibiotarsal axial traction technique force were applied. Tibiotarsal joint distraction movement
was measured with ultrasound.
Findings: No differences were found in applied force or tibiotarsal joint distraction between volunteers and cadavers
in each magnitude of force (p > 0.05). The application of the technique showed moderate reliability for
detecting low forces in both models. For medium and high force, it showed good reliability in the in vitro model
and excellent reliability in the live model.
Interpretation: The amount of distraction produced in the tibiotarsal joint was similar in volunteers and cadavers.
The cadaveric model is a valid model for testing and investigating orthopaedic manual therapy techniques. The
force applied was similar in the two models. Medium and high force detection showed good reliability, while low
force showed moderate.
Osteoarthritis (OA) stands as a prevalent degenerative joint ailment, demanding immediate attention towards the development of efficacious therapeutic interventions. Presently, a definitive cure for OA remains elusive, and when conservative treatment modalities prove ineffective, resorting to a joint prosthesis becomes imperative. Temporary distraction emerges as a pivotal joint-preserving intervention in human OA patients, conferring both clinical amelioration and structural enhancements. Although extant clinical investigations exist, they are characterized by relatively modest sample sizes. Nonetheless, these studies furnish compelling evidence affirming that joint distraction engenders sustained clinical amelioration and structural refinement. Despite substantial strides in the last decade, a bibliometric analysis of joint distraction within the realm of osteoarthritis treatment research has been conspicuously absent. In this context, we have undertaken a comparative investigation utilizing bibliometric methodologies to scrutinize the landscape of joint distraction within osteoarthritis treatment. Our comprehensive analysis encompassed 469 scholarly articles. Our findings evince a consistent escalation in global research interest and publication output pertaining to this subject. The United States emerged as the frontrunner in international collaboration, publication count, and citation frequency, underscoring its preeminence in this domain. The journal “Osteoarthritis and Cartilage” emerged as the principal platform for disseminating research output on this subject. Notably, Mastbergen SC emerged as the most prolific contributor in terms of authorship. The identified keywords predominantly revolved around non-surgical interventions and joint arthroscopy procedures. This bibliometric analysis, augmented by visual representations, furnishes invaluable insights into the evolutionary trajectory of joint distraction as an osteoarthritis treatment modality spanning from 2003 to 2023. These insights will serve as a compass for the scientific community, facilitating further exploration in this promising domain.
Objective:
To analyze the changes over time in the strain on the inferior ilio-femoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes.
Design:
A cross-sectional laboratory cadaveric study.
Setting:
Anatomy laboratory.
Participants:
Thirteen hip joints from nine fresh-frozen cadavers (mean age, 75.6 ± 7.8 years).
Interventions:
High-force LADM in open-packed position was sustained for a period of 5 minutes.
Main outcome measure(s):
Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15s for the first 3min and every 30s for the next 2min.
Results:
Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15s (7.3 ± 7.2 %). At 30s, the increase in strain was 10.1 ± 9.6 %, the half of the total increase at the end of the 5-minute high-force LADM (20.2 ± 8.5 %). Significant changes in strain measures were shown to occur at 45s of high-force LADM(F= 18.11; p<0.001).
Conclusion:
When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45s to produce a significant change in the strain of capsular-ligament tissue.
Resumen
Objetivo
Evaluar la fiabilidad intraexaminador e interexaminador de la aplicación Clinometer para medir el rango de movimiento (RDM) de la cadera en pacientes con artrosis de cadera y su correlación con el goniómetro universal.
Métodos
Se diseñó un estudio de medidas repetidas en el que se incluyeron 35 pacientes con artrosis de cadera. Se registró el RDM de rotación interna, externa, flexión y extensión de cadera mediante la aplicación Clinometer por 2 examinadores independientes. Se calculó la fiabilidad intraexaminador e interexaminador utilizando el coeficiente de correlación intraclase, y se calculó el error estándar de medición y el cambio mínimo detectable. Se utilizó el coeficiente de correlación de Pearson para correlacionar la aplicación Clinometer con el goniómetro universal.
Resultados
La aplicación Clinometer mostró una fiabilidad excelente tanto intraexaminador (coeficiente de correlación intraclase: 0,82-0,96) como interexaminador (coeficiente de correlación intraclase: 0,81-0,95) para todos los RDM de la cadera valorados. La correlación entre este instrumento y el goniómetro universal mostró ser fuerte para todos los RDM de la cadera (r > 0,70).
Conclusión
La aplicación Clinometer ha mostrado unos niveles de fiabilidad excelentes para la medición del RDM de rotación interna, externa, flexión y extensión de la cadera en pacientes con artrosis y presenta una fuerte correlación con el goniómetro universal.
Objective:
To 1) Determine if specific dosing parameters of manual therapy are related to improved pain, disability, and quality of life outcomes in patients with hip osteoarthritis and 2) to provide recommendations for optimal manual therapy dosing based on our findings.
Design:
A systematic review of randomized controlled trials from the PubMed, CINAHL, and OVID databases that used manual therapy interventions to treat hip osteoarthritis was performed. Three reviewers assessed the risk of bias for included studies and extracted relevant outcome data based on predetermined criteria. Baseline and follow-up means and standard deviations for outcome measures were used to calculate effect sizes for within and between-group differences.
Results:
Ten studies were included in the final analyses totaling 768 participants, and half were graded as high risk of bias. Trends emerged: 1) large effect sizes were seen using long-axis distraction, mobilization and thrust manipulation, 2) mobilization with movement showed large effects for pain and range of motion, and (3) small effects were associated with graded mobilization. Durations of 10 to 30 minutes per session, and frequency 2-3 times per week for 2-6 weeks were the most common dosing parameters.
Conclusions:
There were varied effect sizes associated with pain, function, and quality of life for both thrust and non-thrust mobilizations, and mobilization with movement into hip flexion and internal rotation. Due to the heterogeneity of MT dosage, it is difficult to recommend a specific manual therapy dosage for those with hip osteoarthritis.
Context:
Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip.
Objective:
To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol.
Design:
A prospective exploratory study.
Setting:
Two research labs.
Patients or other participants:
The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg).
Interventions:
Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week.
Main outcomes measures:
Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test.
Results:
A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM.
Conclusion:
Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.
Background
The mechanical effects of hip joint mobilization on hip capsular-ligament tissue have never been studied.
Objective
To evaluate the strain on the inferior ilio-femoral (IFF) ligament after 5 min of high-force long-axis distraction mobilization (LADM) and to analyse the immediate effects on hip range of motion (ROM).
Design
Cross-sectional laboratory cadaveric study.
Methods
Thirteen hips hip joints were mobilized from nine fresh-frozen cadavers (mean age, 75.6 ± 7.8 years). High-force LADM in open-packed position was maintained during 5 min. Strain on IFF ligament was measured with a microminiature differential variable reluctance transducer at the beginning and just before the end of high-force LADM. Hip flexion, extension, abduction and internal rotation ROM were assessed using a universal goniometer before and after joint mobilization.
Results
The strain on IIF ligament increased 20.2 ± 8.5% after 5 min of high-force LADM, showing a significant increase (p = 0.004). Hip ROM also increased significantly (p < 0.05) with large effect sizes (d > 0.8).
Conclusion
The strain on IIF ligament and hip ROM increased significantly after 5 min of high-force LADM. The improvements on hip ROM appear to be related to the changes in the strain on capsular-ligament tissue after high-force LADM.
Background
No study has evaluated the mechanical effect of different magnitudes of long axis-distraction mobilization (LADM) force on hip joint space width (JSW) or the association between the separation of joint surfaces and the strain on hip capsular ligaments.
Objective
To compare the joint separation when applying three different magnitudes of LADM forces (low, medium and high) and to analyse the correlation between joint separation, strain on the inferior ilio-femoral ligament and magnitude of applied force.
Design
Repeated measures controlled laboratory cadaveric study.
Methods
Three magnitudes of force were applied to 11 cadaveric hip joints (mean age 73 years). Ultrasound images were used to measure joint separation, and strain gauges recorded inferior ilio-femoral ligament strain during each condition.
Results
The magnitude of joint separation was significantly different between low (0.23 ± 0.19 mm), medium (0.72 ± 0.22 mm) and high (2.62 ± 0.43 mm) forces (p < 0.001). There were significant associations between magnitude of force, joint separation and the strain on the inferior ilio-femoral ligament during LADM (r > 0.723; p < 0.001).
Conclusion
Hip joint separation and ligament strain during LADM are associated with the magnitude of the applied force.
Background
Hip impingement syndrome can occur after total hip arthroplasty (THA). Nonoperative treatment is inconsistently recommended, and surgical options include iliopsoas tenotomy. The current case report describes the unique case of a patient with persistent groin pain after THA and iliopsoas tenotomy.
Case Description
The 72-year-old male had persistent groin pain after right THA and an unsuccessful iliopsoas tenotomy. He had pain and limited right hip range of motion during active and passive hip flexion, abduction, and external rotation. Treatment consisted of high-grade joint mobilization to improve the range of motion of the right hip and an exercise program.
Outcomes
The patient was treated for six visits over 3 weeks. Clinically important improvements were noted in pain, function, and perceived level of improvement. Pain during hip flexion improved on the Numeric Pain Rating Scale, and function improved on the Lower Extremity Functional Scale. Improvements in the range of motion and strength were also observed. At 6-month follow-up, he reported maintenance of improvements.
Discussion
Joint mobilization and exercise were effective for improving range of motion, groin pain, and function in a patient with a 4-year history of persistent groin pain after THA and subsequent iliopsoas tenotomy.
Background
Several studies have suggested that the changes in elasticity of the joint capsule and surrounding muscles during a hip long-axis distraction mobilization (LADM) could explain the pain-relieving and mobility-improving effects of the technique.
Objective
To compare the strain on the inferior ilio-femoral ligament and psoas muscle when applying three different magnitudes of force during LADM.
Design
Repeated measures controlled laboratory cadaveric study.
Methods
Eleven hip joints were mobilized from six fresh-frozen cadavers (mean age, 73.4 ± 5.7 years). Three magnitudes of force (low, medium and high) were applied during a hip LADM in open-packed position according to grades of joint mobilization.
Strain on the inferior ilio-femoral ligament and psoas muscle were measured with strain gauges. The magnitude of the force applied during LADM was recorded.
Results
Strain on the inferior ilio-femoral ligament during a high-force LADM was significantly higher than strain on the inferior ilio-femoral ligament during low (p < 0.001) and medium-force LADM (p < 0.001). The strain on the inferior ilio-femoral ligament during a medium-force LADM was significantly higher than during a low-force LADM (p = 0.004). No changes in strain on psoas muscle were observed. The magnitude of force applied during LADM showed a significant progressive increase from low to high-force LADM.
Conclusion
The different magnitudes of forces applied during LADM produce different strains on the inferior ilio-femoral ligament but not on the psoas muscle. The strain on the inferior ilio-femoral ligament during LADM depends on the magnitude of the mobilization force.
Joint mobilization is a common technique used to restore joint motion; however, documentation of its effectiveness is lacking. The purpose of this study was to determine if joint mobilization is effective in counteracting joint stiffness and decreased active range of motion of the metacarpal-phalangeal joint. It was hypothesized that there would be a significant increase in range of motion in those patients who received joint mobilization. Eighteen subjects who had been immobilized for the treatment of metacarpal fractures were randomly assigned to a treatment group that received joint mobilization or a control group that received no treatment. Measurements of active range of motion and torque range of motion prior to and after treatment/rest sessions were obtained for three sessions over a 1 week period. Analyses of variance were performed on the mean changes in excursion between groups and across sessions. The joint mobilization resulted in a significantly greater increase in excursion for subjects in the treatment group over subjects in the control group (p < 0.05). Joint mobilization does appear to be able to counteract the effects of immobilization and alter joint mechanics. J Orthop Sports Phys Ther 1992;16(1):30-36.
Study design:
Randomized controlled trial. Objective To determine if force magnitude during posterior-to-anterior mobilization affects immediate and short-term outcomes in patients with chronic, nonspecific neck pain.
Background:
The optimal dose of mobilization to effectively treat patients with neck pain is not known.
Methods:
Patients with neck pain of at least 3 months in duration (n = 64) were randomized to receive a single treatment of posterior-to-anterior mobilization applied with 30 N or 90 N of mean peak force (3 sets of 30 seconds) or a placebo (detuned laser) on the spinous process at the painful spinal level. Pressure pain threshold, pain measured with a visual analog scale (range, 0-100 mm), cervical range of motion, and spinal stiffness at the painful spinal level (measured with a custom device and normalized as a percentage of C7 stiffness) were assessed before, immediately after, and at a mean ± SD follow-up of 4.0 ± 1.8 days following treatment. Repeated-measures analysis of covariance and Bonferroni-adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow-up.
Results:
At follow-up, the 90-N group had less pain than the 30-N group (mean difference, 11.3 mm; 95% confidence interval: 0.1, 22.6 mm; P = .048) and lower stiffness than the placebo group (mean difference, 17.5%; 95% confidence interval: 4.2%, 30.9%; P = .006). These differences were not present immediately after treatment. There were no significant between-group differences in pressure pain threshold or range of motion after treatment or at follow-up.
Conclusion:
A specific dose of mobilization, in terms of applied force, appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain. Changes were not observed immediately after mobilization, suggesting that its effects are not directly mechanical.
Trial registration:
Australian and New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/): ACTRN12611000374965.
Level of evidence:
Therapy, level 1b-.
Describe short- and long-term outcomes observed in individuals with hip osteoarthritis (OA) treated with a pre-selected, standardized set of best-evidence manual therapy and therapeutic exercise interventions.
Fifteen consecutive subjects (9 males, 6 females; mean age: 52±7.5 years) with unilateral hip OA received an identical protocol of manual therapy and therapeutic exercise interventions. Subjects attended 10 treatment sessions over an 8-week period for manual therapy interventions and performed the therapeutic exercise as a home program.
Baseline to 8-week follow-up outcomes were as follows: Harris Hip Scale (HHS) scores improved from 60.3(±10.4) to 80.7(±10.5), Numerical Pain Rating Scale (NPRS) scores improved from 4.3(±1.9) to 2.0(±1.9), hip flexion range of motion (ROM) improved from 99 degrees (±10.6) to 127 degrees (±6.3) and hip internal rotation ROM improved from 19 degrees (±9.1) to 31 degrees (±11.5). Improvements in HHS, NPRS, and hip ROM measures reached statistical significance (P<0.05) at 8-weeks and remained significant at the 29-week follow-up. Mean changes in NPRS and HHS scores exceeded the minimal clinically important difference (MCID) at 8-weeks and for the HHS scores alone at 29 weeks. The 8 and 29 week mean Global Rating of Change scores were 5.1(±1.4) and 2.1(±4.2), respectively. Improved outcomes observed following a pre-selected, standardized treatment protocol were similar to those observed in previous studies involving impairment-based manual therapy and therapeutic exercise for hip OA. Future studies might directly compare the two approaches.
Osteoarthritis (OA) has traditionally been classified as a noninflammatory arthritis; however, the dichotomy between inflammatory and degenerative arthritis is becoming less clear with the recognition of a plethora of ongoing immune processes within the OA joint and synovium. Synovitis is defined as inflammation of the synovial membrane and is characteristic of classical inflammatory arthritidies. Increasingly recognized is the presence of synovitis in a significant proportion of patients with primary OA, and based on this observation, further studies have gone on to implicate joint inflammation and synovitis in the pathogenesis of OA. However, clinical OA is not one disease but a final common pathway secondary to many predisposing factors, most notably age, joint trauma, altered biomechanics, and obesity. How such biochemical and mechanical processes contribute to the progressive joint failure characteristic of OA is tightly linked to the interplay of joint damage, the immune response to perceived damage, and the subsequent state of chronic inflammation resulting in propagation and progression toward the phenotype recognized as clinical OA. This review will discuss a wide range of evolving data leading to our current hypotheses regarding the role of immune activation and inflammation in OA onset and progression. Although OA can affect any joint, most commonly the knee, hip, spine, and hands, this review will focus primarily on OA of the knee as this is the joint most well characterized by epidemiologic, imaging, and translational studies investigating the association of inflammation with OA.
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 eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively.
Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period.
Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes.
Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively).
There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.
Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional “number of criteria present” format and “classification tree” techniques.
Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation ≥15º, pain present on internal rotation of the hip, morning stiffness of the hip for ≤60 minutes, and age >50 years, or 2) hip internal rotation <15º and an erythrocyte sedimentation rate (ESR) ≤45 mm/hour; if no ESR was obtained, hip flexion ≤115º was substituted (sensitivity 86%; specificity 75%).
Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR <20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%).
The “number of criteria present” format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an ostophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.
The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC(95,) was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant's knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration.
Cross-sectional study.
To compare functioning and disability in patients with hip osteoarthritis (OA) not candidates for surgery, to a matched control group, and thereby to examine the relationship between the functioning and disability components used in this study in patients with hip OA.
It is well known that patients with severe hip OA have deficits in functioning and disability. However, in patients with hip OA not candidates for surgery, the knowledge regarding functioning and disability is sparse.
Twenty-six patients (12 men, 14 women; mean age, 60 years) with radiographic and symptomatic hip OA were matched to 26 controls without hip pain. The following variables were measured: muscle strength using isokinetic peak force, hip passive range of motion, submaximal aerobic capacity using a cycling test, walking ability using the 6-minute walk test, self-reported pain, stiffness, and physical function using the Western Ontario and McMaster University Osteoarthritis Index, and health-related quality of life using the SF-36.
The patients with hip OA had mild to moderate pain, as indicated by the Western Ontario and McMaster University Osteoarthritis Index, and significantly lower knee extension strength (mean difference [95% confidence interval {CI}]: -19.5 [-34.3, -4.7] Nm). Hip range of motion was significantly less in the patients with hip OA, with mean (95% CI) differences of -10° (-14°, -6°) for extension, -18° (-26°, -11°) for flexion, -9° (-14°, -4°) for abduction, -2° (-5°, 0°) for adduction, -16° (-23°, -9°) for internal rotation, and -21° (-28°, -14°) for external rotation. The patients with hip OA walked a significantly shorter distance in 6 minutes (mean difference, -75 m; 95% CI: -131, -20 m). There were no significant differences in hip extension/flexion, knee flexion, ankle dorsiflexion/plantar flexion muscle strength, or aerobic capacity between the 2 groups. There were significant associations between body function and activity components.
Physical therapists should consider including quadriceps-strengthening and hip range-of-motion exercises when developing rehabilitation programs for patients with hip OA, with mild to moderate pain, aiming to improve functioning and reduce disability.
THE OBJECTIVE OF THIS STUDY WAS TO COMPARE THE EFFECTIVENESS OF TWO COMPILED PHYSIOTHERAPY PROGRAMS: one including forceful traction mobilizations, the other including traction with unknown force, in patients with hip disability according to ICF (the International Classification of Functioning, Disability and Health, 2001; WHO), using a block randomized, controlled trial with two parallel treatment groups in a regular private outpatient physiotherapy practice. In the experimental group (E; n = 10) and control group (C; n = 9), the mean (+/-SD) age for all participants was 59 +/- 12 years. They were recruited from outpatient physiotherapy clinics, had persistent pain located at the hip joint for >8 weeks and hip hypomobility. Both groups received exercise, information and manual traction mobilization. In E, the traction force was progressed to 800 N, whereas in C it was unknown. Major outcome measure was the median total change score >/=20 points or >/=50% of the disease- and joint-specific Hip disability and Osteoarthritis Outcome Score (HOOS), compiled of Pain, Stiffness, Function and Hip-related quality of life (ranging 0-100). The mean (range) treatments received were 13 (7-16) over 5-12 weeks and 20 (18-24) over 12 weeks for E and C, respectively. The experimental group showed superior clinical post-treatment effect on HOOS (>/=20 points), in six of 10 participants compared with none of nine in the control group (p = 0.011). The effect size was 1.1. The results suggest that a compiled physiotherapy program including forceful traction mobilizations are short-term effective in reducing self-rated hip disability in primary healthcare. The long-term effect is to be documented.
Joint mobilization is a common technique used to restore joint motion; however, documentation of its effectiveness is lacking. The purpose of this study was to determine if joint mobilization is effective in counteracting joint stiffness and decreased active range of motion of the metacarpal-phalangeal joint. It was hypothesized that there would be a significant increase in range of motion in those patients who received joint mobilization. Eighteen subjects who had been immobilized for the treatment of metacarpal fractures were randomly assigned to a treatment group that received joint mobilization or a control group that received no treatment. Measurements of active range of motion and torque range of motion prior to and after treatment/rest sessions were obtained for three sessions over a 1 week period. Analyses of variance were performed on the mean changes in excursion between groups and across sessions. The joint mobilization resulted in a significantly greater increase in excursion for subjects in the treatment group over subjects in the control group (p < 0.05). Joint mobilization does appear to be able to counteract the effects of immobilization and alter joint mechanics. J Orthop Sports Phys Ther 1992;16(1):30-36.
Joint traction and other mobilization techniques are commonly used in physical therapy for patients with osteoarthrosis. The aim of this study has been to: (a) measure the separation of the joint surfaces in the normal hip joint during application of different forces; (b) investigate whether or not the degree of separation was influenced by the position of the joint; (c) compare hip joint laxity in men and women; (d) find the traction force needed to cause the appearance of vacuum phenomena. To achieve a separation in the hip joint, a traction force of at least 400 N must be applied. The distraction was greater in the loose packed position than in the close packed position at equal force and in both males and females. Vacuum phenomena appeared at between 400 and 600 N of traction, varying with joint position.
To establish the relationships between the range of joint motion (ROM) and disability in patients with osteoarthritis (OA) of the knee or hip. Two related issues were addressed: (1) the inter-relationships between ROMs of joint actions, and (2) the relationship between ROM and disability.
Data on 198 patients with OA of the knee or hip were used. The ROM was assessed bilaterally for the hip and knee, using a goniometer. Disability was assessed using a self-reporting method (questionnaire) and an observational method. Correlation and factor analysis were used to establish the inter-relationships between the ROMs of joint actions. Correlation and multiple regression analyses were carried out to establish the relationships between ROM and disability.
Close inter-relationships were found between the ROMs of the same joint action of the lateral and contralateral joints; inter-relationships between ROMs of different joint actions were substantially weaker. Low ROMs were associated with high levels of disability, both self-reported and observed. Some 25% of the variation in disability levels could be accounted for by differences in ROM. In both knee and hip OA patients, flexion of the knee and extension and external rotation of the hip were found to be most closely associated with disability.
Restricted joint mobility, especially in flexion of the knee and extension and external rotation of the hip, appears to be an important determinant of disability in patients with OA.
Reduced muscle strength is regarded as a risk factor for pain and disability in osteoarthritis (OA). Currently, various indices for muscle strength are used when assessing determinants of pain and disability. The goal of the present study was to evaluate these indices of muscle strength.
Isometric muscle strength was measured for 16 muscle actions around the knees and hips in 52 patients with OA of the hip and 70 patients with OA of the knee. Various indices of muscle strength were derived from these measurements, applying five alternative approaches. These approaches ranged from a single overall index to a set of 16 separate indices. The internal consistency of these indices was determined (Cronbach's alpha), and it was determined to what extent they could reveal the association between reduced muscle strength on the one hand and pain and disability on the other hand.
Internal consistency was satisfactory for all indices (Cronbach's alpha >0.74). As expected, reduced muscle strength was associated with increased disability, but no clear relationship could be established between muscle weakness and pain. The strength of these associations did not depend on the approach used to derive the indices for muscle strength.
The indices did not show major differences with regard to internal consistency or the extent to which the association with pain and disability could be revealed. For reasons of parsimony, approaches resulting in few indices appear to be most useful. However, muscle strength was found to be significantly reduced around affected joints, compared with muscle strength around unaffected joints. Therefore, the most suitable approach for reducing muscle strength data into indices is one that results in as few indices as possible, but with separate indices for muscle strength around affected and unaffected joints.
Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia. In this study, mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation.
Seven women and 17 men (mean age=48.5 years, SD=7.2) with chronic lateral epicondylalgia participated in the study.
A placebo, control, repeated-measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation.
The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation. Improvements in pain resulted in increased pain-free grip force and pressure pain thresholds. Sympathoexcitation was indicated by changes in heart rate, blood pressure, and cutaneous sudomotor and vasomotor function.
This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations.
In clinical trials, at the group level, results are usually reported as mean and standard deviation of the change in score, which is not meaningful for most readers.
To determine the minimal clinically important improvement (MCII) of pain, patient's global assessment of disease activity, and functional impairment in patients with knee and hip osteoarthritis (OA).
A prospective multicentre 4 week cohort study involving 1362 outpatients with knee or hip OA was carried out. Data on assessment of pain and patient's global assessment, measured on visual analogue scales, and functional impairment, measured on the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) function subscale, were collected at baseline and final visits. Patients assessed their response to treatment on a five point Likert scale at the final visit. An anchoring method based on the patient's opinion was used. The MCII was estimated in a subgroup of 814 patients (603 with knee OA, 211 with hip OA).
For knee and hip OA, MCII for absolute (and relative) changes were, respectively, (a) -19.9 mm (-40.8%) and -15.3 mm (-32.0%) for pain; (b) -18.3 mm (-39.0%) and -15.2 mm (-32.6%) for patient's global assessment; (c) -9.1 (-26.0%) and -7.9 (-21.1%) for WOMAC function subscale score. The MCII is affected by the initial degree of severity of the symptoms but not by age, disease duration, or sex.
Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients.
In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder.
One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study.
Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively.
Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group.
In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small.
Physiotherapists often employ lower limb joint mobilization to reduce pain and increase function. However, there is little experimental data confirming its efficacy. The purpose of this study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. The study employed a double-blind, controlled, within-subjects repeated-measures design. Thirty-eight subjects with mild to moderate knee pain participated. The effects of a 9-min, non-noxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions. Pressure pain threshold (PPT) and 3-m 'up and go' time were measured immediately before and after each intervention. Results demonstrated a significantly greater mean (95% CI) percentage increase in PPT following knee joint mobilization (27.3% (20.9-33.7)) than after manual contact (6.4% (0.4-12.4)) or no-contact (-9.6% (-20.7 to 1.6)) interventions. Knee joint mobilization also increased PPT at a distal, non-painful site and reduced 'up and go' time significantly more (-5% (-9.3 to 0.8)) than manual contact (-0.4% (-4.2 to 3.5)) or no-contact control (+7.9% (2.6-13.2)) interventions. This study therefore provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population.
Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise.
Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients were treated with manual physical therapy followed by exercises to maximize strength and range of motion. Six of 7 patients completed a Harris Hip Score at initial examination and discharge from physical therapy, and 1 patient completed a Global Rating of Change Scale at discharge.
Three males and 4 females with a median age of 62 years (range, 52-80 years) and median duration of symptoms of 9 months (range, 2-60 months) participated in this case series. The median number of physical therapy sessions attended was 5 (range, 4-12). The median increase in total passive range of motion of the hip was 82 degrees (range, 70 degrees-86 degrees). The median improvement on the Harris Hip Score was 25 points (range, 15-38 points). The single patient who completed the Global Rating of Change Scale at discharge reported being "a great deal better." Numeric pain rating scores decreased by a mean of 5 points (range, 2-7 points) on 0-to-10-point scale.
All patients exhibited reductions in pain and increases in passive range of motion, as well as a clinically meaningful improvement in function. Although we can not infer a cause and effect relationship from a case series, the outcomes with these patients are similar to others reported in the literature that have demonstrated superior clinical outcomes associated with manual physical therapy and exercise for hip osteoarthritis compared to exercise alone.
Objective
The purpose of this study was to investigate the immediate effects of manual traction of the hip joint on joint space width (JSW) on asymptomatic subjects.
Methods
Asymptomatic, healthy male volunteers (n = 15), aged 25 to 34 years were included in this study. Three radiographs were obtained with the subjects in the supine position, before and after loading with 10% of his body weight, and after manual traction on only the right hip joint. Joint space width was measured by a radiologist at the point described by Jacobson and Sonne-Holm.
Results
There were significant changes in JSW on the right hip joint and left hip joint between the baseline (before loading) and immediately after loading. We also observed a significantly increased JSW on only the right hip joint between periods that followed loading and manual traction on the right hip joint. There was no significant change in JSW on the left hip joint between periods that followed loading and manual traction on the right hip joint.
Conclusions
The results of this study suggest that a significant increase in JSW in young, healthy male patients can occur immediately after manual traction of the hip joint.
Importance
There is limited evidence supporting use of physical therapy for hip osteoarthritis.Objective
To determine efficacy of physical therapy on pain and physical function in patients with hip osteoarthritis.Design, Setting, and Participants
Randomized, placebo-controlled, participant- and assessor-blinded trial involving 102 community volunteers with hip pain levels of 40 or higher on a visual analog scale of 100 mm (range, 0-100 mm; 100 indicates worst pain possible) and hip osteoarthritis confirmed by radiograph. Forty-nine patients in the active group and 53 in the sham group underwent 12 weeks of intervention and 24 weeks of follow-up (May 2010-February 2013)Interventions
Participants attended 10 treatment sessions over 12 weeks. Active treatment included education and advice, manual therapy, home exercise, and gait aid if appropriate. Sham treatment included inactive ultrasound and inert gel. For 24 weeks after treatment, the active group continued unsupervised home exercise while the sham group self-applied gel 3 times weekly.Main Outcomes and Measures
Primary outcomes were average pain (0 mm, no pain; 100 mm, worst pain possible) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0 no difficulty to 68 extreme difficulty) at week 13. Secondary outcomes were these measures at week 36 and impairments, physical performance, global change, psychological status, and quality of life at weeks 13 and 36.Results
Ninety-six patients (94%) completed week 13 measurements and 83 (81%) completed week 36 measurements. The between-group differences for improvements in pain were not significant. For the active group, the baseline mean (SD) visual analog scale score was 58.8 mm (13.3) and the week-13 score was 40.1 mm (24.6); for the sham group, the baseline score was 58.0 mm (11.6) and the week-13 score was 35.2 mm (21.4). The mean difference was 6.9 mm favoring sham treatment (95% CI, −3.9 to 17.7). The function scores were not significantly different between groups. The baseline mean (SD) physical function score for the active group was 32.3 (9.2) and the week-13 score was 27.5 (12.9) units, whereas the baseline score for the sham treatment group was 32.4 (8.4) units and the week-13 score was 26.4 (11.3) units, for a mean difference of 1.4 units favoring sham (95% CI, −3.8 to 6.5) at week 13. There were no between-group differences in secondary outcomes (except greater week-13 improvement in the balance step test in the active group). Nineteen of 46 patients (41%) in the active group reported 26 mild adverse effects and 7 of 49 (14%) in the sham group reported 9 mild adverse events (P = .003).Conclusions and Relevance
Among adults with painful hip osteoarthritis, physical therapy did not result in greater improvement in pain or function compared with sham treatment, raising questions about its value for these patients.Trial Registration
anzctr.org.au Identifier: ACTRN12610000439044
Objective:
To evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee.
Design:
In this 2 × 2 factorial randomized controlled trial, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee OA were randomly allocated to receive manual physiotherapy (n = 54), multi-modal exercise physiotherapy (n = 51), combined exercise and manual physiotherapy (n = 50), or no trial physiotherapy (n = 51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation.
Results:
Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0-240. Intention to treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 (95% confidence interval (CI) 9.2-47.8) for usual care plus manual therapy, 16.4 (-3.2 to 35.9) for usual care plus exercise therapy, and 14.5 (-5.2 to 34.1) for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy (P = 0.027). Physical performance test outcomes favoured the exercise therapy group.
Conclusions:
Manual physiotherapy provided benefits over usual care, that were sustained to 1 year. Exercise physiotherapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the two therapies.
Trial registration number:
Australian New Zealand Clinical Trials Registry ACTRN12608000130369.
Objectives:
To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention.
Design:
Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up.
Setting:
Four academic teaching hospitals in Dublin, Ireland.
Participants:
Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43).
Interventions:
Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65).
Main outcome measures:
The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.
Results:
There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group.
Conclusions:
Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.
To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA.
A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee.
Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA.
These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA.
A randomised, double blind, repeated measures study was conducted to investigate the initial effects of an accessory mobilisation technique applied to the ankle joint in 13 patients with a unilateral sub-acute ankle supination injury. Ankle dorsiflexion range of motion, pressure pain threshold, visual analogue scale rating of pain during functional activity and ankle functional scores were assessed before and after application of treatment, manual contact control and no contact control conditions. There were significant improvements in ankle dorsiflexion range of motion (p = 0.000) and pressure pain threshold (p = 0.000) during the treatment condition. However no significant effects were observed for the other measures. These findings demonstrate that mobilisation of the ankle joint can produce an initial hypoalgesic effect and an improvement in ankle dorsiflexion range of motion.
The ilio-femoral ligament is known to cause flexion contracture of the hip joint. Stretching positioning is intended to elongate the ilio-femoral ligaments, however, no quantitative analysis to measure the effect of stretching positions on the ligament has yet been performed. Strains on the superior and inferior ilio-femoral ligaments in 8 fresh/frozen trans-lumbar cadaveric hip joints were measured using a displacement sensor, and the range of movement of the hip joints was recorded using a 3Space Magnetic Sensor. Reference length (L(0)) for each ligament was determined to measure strain on the ligaments. Hip positions at 10 degrees adduction with maximal external rotation, 20 degrees adduction with maximal external rotation, and maximal external rotation showed larger strain for the superior ilio-femoral ligament than the value obtained from L(0), and hip positions at 20 degrees external rotation with maximal extension and maximal extension had larger strain for the inferior ilio-femoral ligament than the value obtained from L(0) (p<0.05). Superior and inferior ilio-femoral ligaments exhibited positive strain values with specific stretching positions. Selective stretching for the ilio-femoral ligaments may contribute to achieve lengthening of the ligaments to treat flexion contracture of the hip joint.
Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multicenter study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylarthropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the "classification tree" method were 92% sensitive and 98% specific. The "traditional format" classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.
A pilot investigation of the influence of different force levels on a treatment technique's hypoalgesic effect.
Randomised single blind repeated measures.
Optimisation of such biomechanical treatment variables as the point of force application, direction of force application and the level of applied manual force is classically regarded as the basis of best practice manipulative therapy. Manipulative therapy is frequently used to alleviate pain, a treatment effect that is often studied directly in the neurophysiological paradigm and seldom in biomechanical research. The relationship between the level of force applied by a technique (e.g. biomechanics) and its hypoalgesic effect was the focus of this study.
The experiment involved the application of a lateral glide mobilisation with movement treatment technique to the symptomatic elbow of six subjects with lateral epicondylalgia. Four different levels of force, which were measured with a flexible pressure-sensing mat, were randomly applied while the subject performed a pain free grip strength test.
Standardised manual force data varied from 0.76 to 4.54 N/cm, lower-upper limits 95 CI, respectively. Pain free grip strength expressed as a percentage change from pre-treatment values was significantly greater with manual forces beyond 1.9 N/cm (P=0.014).
This study, albeit a pilot, provides preliminary evidence that in terms of the hypoalgesic effect of a mobilisation with movement treatment technique, there may be an optimal level of applied manual force.
This study indicates that the level of applied manual force appear to be critical for pain relief.
Translational mobilization techniques are frequently used by physical therapists as an intervention for patients with limited ranges of motion (ROMs). However, concrete experimental support for such practice is lacking. The purpose of the study was to evaluate the effect of simulated dorsal and ventral translational mobilization (DTM and VTM) of the glenohumeral joint on abduction and rotational ROMs.
Fourteen fresh frozen shoulder specimens from 5 men and 3 women (mean age=77.3 years, SD=10.1, range=62-91) were used for this study. Each specimen underwent 5 repetitions of DTM and VTM in the plane of scapula simulated by a material testing system (MTS) in the resting position (40 of abduction in neutral rotation) and at the end range of abduction with 100 N of force. Abduction and rotation were assessed as the main outcome measures before and after each mobilization procedure performed and monitored by the MTS (abduction, 4 N m) and by a servomotor attached to the piston of the actuator of the MTS (medial and lateral rotation, 2 N m).
There were increases in abduction ROM for both DTM (mean=2.10 , SD=1.76 ) and VTM (mean=2.06 , SD=1.96 ) at the end-range position. No changes were found in the resting position following the same procedure. Small increases were also found in lateral rotation ROM after VTM in the resting position (mean=0.90 , SD=0.92 , t=3.65, P=.003) and in medial rotation ROM after DTM (mean=0.97 , SD=1.45 , t=2.51, P=.026) at the end range of abduction.
The results indicate that both DTM and VTM procedures applied at the end range of abduction improved glenohumeral abduction range of motion. Whether these changes would result in improved function could not be determined because of the use of a cadaver model.
To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip.
A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life.
Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks.
The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.
The objective of this review was to evaluate the evidence for the consistency of force application by manual therapists when carrying out posterior-to-anterior (PA) mobilization techniques, including the factors that influence the application and measurement of mobilization forces.
Studies were identified by searching 6 electronic databases up to April 2005, screening the reference lists of retrieved articles, and contacting experts by e-mail. Relevant articles were defined as those that described the measurement of forces applied during spinal mobilization or discussed the reliability of measurement of manual forces.
Twenty studies described the quantitative measurement of applied force during a PA mobilization technique, with most focusing on the lumbar spine. When defined by magnitude, frequency, amplitude, and displacement, PA mobilization forces are extremely variable among clinicians applying the same manual technique. Variability may be attributed to differences in techniques, measurement or reporting procedures, or variations between therapists or between patients.
The inconsistency in manual force application during PA spinal mobilization in existing studies suggests that further studies are needed to improve the clinical standardization of manual force application. Future research on mobilization should include forces applied to the cervical and thoracic spines in addition to the lumbar spine while thoroughly describing force parameters and measurement methods to facilitate comparison between studies.
To examine the relative and absolute intrarater test-retest reliability of muscle strength and range of motion (ROM) measurements of the hip performed in people with hip osteoarthritis.
Repeated measures.
Human movement laboratory of a university.
Participants (N=22; 10 men, 12 women; age range, 50-84y) with hip osteoarthritis.
On 2 separate occasions, at least 1 week apart, isometric torque measurements were obtained from the hip rotators, flexors, abductors, and extensors. Passive ROMs in hip rotation, flexion, abduction, and extension were also determined.
Relative reliability was estimated using the intraclass correlation coefficient, model 2,2 (ICC(2,2)). Absolute reliability was estimated using the coefficient of variation (CV) and the standard error (SE) of measurement.
For measurements of muscle strength, ICC(2,2) ranged from .84 to .97, and the CV ranged from 8% to 15.7%. Hip extensors and internal and external rotators showed high ICC(2,2) (>.96) and low CV (<9.8%); hip abductors showed the lowest ICC(2,2) (.84) and the highest CV (15.7%). For ROM measurements, ICC(2,2) ranged from .86 to .97 and SE ranged from 3.1 degrees to 4.7 degrees . Hip flexion ROM showed the highest ICC(2,2) (.97) and an SE of 3.5 degrees ; hip extension ROM showed the lowest ICC(2,2) (.86) and the highest SE (4.7 degrees ).
Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability.
Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial
- C Beselga
- F Neto
- F Alburquerque-Sendín
- T Hall
- N Oliveira-Campelo
Beselga, C., Neto, F., Alburquerque-Sendín, F., Hall, T., Oliveira-Campelo, N., 2016.
Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Man. Ther. 22, 80-85.
Orthopaedic Manual Physical Therapy from Art to Evidence
- C H Wise
Wise, C.H., 2015. Orthopaedic Manual Physical Therapy from Art to Evidence. F.A. Davis
Company, Philadelphia.
Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial
- Beselga