Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip: A randomized controlled trial

Objective: 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). Design: Parallel-group randomized trial with 3-month follow-up. Setting: Two chiropractic outpatient teaching clinics. Participants: 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. Interventions: 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. Main Outcome Measures: Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Results: 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). Conclusions: 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

The comparative effect of muscle energy technique vs. manipulation for the treatment of chronic recurrent ankle sprain

Background: Ankle injuries account for 23,000 inversion sprains daily. Lateral ankle sprains are predisposed by previous injury and a decrease in balance. This prospective randomized clinical trial compared the use of high-velocity, low-amplitude (HVLA) manipulation and Muscle Energy Technique mobilization in the treatment of chronic ankle sprains Methods: Forty candidates diagnosed with chronic recurrent ankle sprain were randomized into the trial. The primary outcome measures were the One Leg Standing Test and the Numerical Pain Rating Scale-101. Results: The One Leg Standing Test and Numerical Pain Rating Scale-101 had statistically significant and clinically meaningful intra-group changes. The One Leg Standing Test eyes closed showed an increase with High Velocity Low Amplitude manipulation of 10.24 seconds and with Muscle Energy Technique mobilization of 10.05 seconds, both t-tests p=.003 suggestive of a centrally mediated positive neurological effect on the function of the locomotive system. The Numerical Pain Rating Scale-101 showed significant decrease in High Velocity Low Amplitude manipulation of 37.1 points and Muscle Energy Technique of 39.6 points, both t-tests p<0.000. Conclusion: Both High Velocity Low Amplitude manipulation and Muscle Energy Technique mobilization significantly increased balance, range of motion, and function while decreasing shortterm pain. These promising results merit further research with a fully powered trial

Manipulative therapy and rehabilitation for recurrent ankle sprain with functional instability: A short-term, assessor-blind, parallel-group randomized trial

Objective The purpose of this study was to compare manipulative therapy (MT) plus rehabilitation to rehabilitation alone for recurrent ankle sprain with functional instability (RASFI) to determine short-term outcomes. Methods This was an assessor-blind, parallel-group randomized comparative trial. Thirty-three eligible participants with RASFI were randomly allocated to receive rehabilitation alone or chiropractic MT plus rehabilitation. All participants undertook a daily rehabilitation program over the course of the 4-week treatment period. The participants receiving MT had 6 treatments over the same treatment period. The primary outcome measures were the Foot and Ankle Disability Index and the visual analogue pain scale, with the secondary outcome measure being joint motion palpation. Data were collected at baseline and during week 5. Missing scores were replaced using a multiple imputation method. Statistical analysis of the data composed of repeated-measures analysis of variance. Results Between-group analysis demonstrated a difference in scores at the final consultation for the visual analogue scale and frequency of joint motion restrictions (P ≤ .006) but not for the Foot and Ankle Disability Index (P = .26). Conclusions This study showed that the patients with RASFI who received chiropractic MT plus rehabilitation showed significant short-term reduction in pain and the number of joint restrictions in the short-term but not disability when compared with rehabilitation alone

Preference and torque asymmetry for elbow joint Preferência e assimetria de torque na articulação do cotovelo

Extensively unilateral recruitment for daily activities may determine performance asymmetries in favor of the preferred side eliciting functional adaptation. Our study evaluated asymmetries in elbow torque output between preferred and non-preferred limbs. Eighteen subjects performed maximal elbow flexor and extensor isometric contractions at five different elbow joint angles (0º, 30º, 60º, 90º, 120º) and five different angular velocities (60, 120, 180, 240, 300º.s-1) on an isokinetic dynamometer. Higher flexor torque in favor of preferred arm was observed at 90º of flexion (p<0.05), which also corresponded to the highest torque produced (p<0.05). The fact that joint angle influenced torque asymmetries, whereas angular velocity did not, suggest that the observed asymmetry is likely related to preferential recruitment of elbow flexors at a 90º joint angle for daily tasks requiring high levels of force production. Muscle functional adaptation to frequent stimuli at this joint angle in healthy subjects may explain these results.<br>O frequente recrutamento unilateral de membros superiores pode determinar assimetrias de desempenho em favor do lado preferido, resultando em adaptação funcional. Assimetrias no torque gerado pelos músculos do cotovelo entre o membro preferido e não-preferido foram avaliadas. Dezoito sujeitos realizaram contrações máximas de flexo-extensão do cotovelo em cinco ângulos articulares (0º, 30º, 60º, 90º, 120º) e cinco velocidades angulares (60, 120, 180, 240, 300º.s-1) em um dinamômetro isocinético. Torque flexor mais elevado em favor do lado preferido foi encontrado no ângulo de 90º (p<0,05), que também correspondeu ao ângulo de maior torque (p<0,05). O fato de o ângulo articular determinar assimetrias no torque (enquanto a velocidade angular não) sugere que o recrutamento preferencial dos flexores do cotovelo em um ângulo de 90º nas tarefas da vida diária que requerem força elevada é responsável pela assimetria. Adaptação funcional a estímulos frequentes nesse ângulo articular pode explicar esses resultados em sujeitos saudáveis