This study aimed to investigate the immediate effects of manual therapy (MT) on the respiratory functions of healthy young individuals. The study included 104 participants, consisting of university students (87 females, 17 males, mean age 20.1 ± 2.2). Participants were randomly assigned to the MT (experimental; n = 52) and sham-MT (control; n = 52) groups. The experimental group underwent thoracic manipulations and mobilizations along with diaphragm mobilization. In the control group, the hands were placed on the same regions, but no specific intervention was applied. All participants underwent respiratory function testing before and after the intervention using a portable spirometer (PEF- Peak expiratory flow; FEV 1- Forced expiratory volume in 1 s; FVC- Forced vital capacity and FEV1/FVC- Tiffeneau index). In the experimental group, there was a significant increase in the mean PEF value following MT application from 296.3 ± 110.8 to 316.1 ± 119.1 (p = 0.018). Conversely, the mean PEF value in the control group showed a slight decrease from 337.1 ± 93.3 to 324.5 ± 89.2 (p = 0.002). No significant changes were observed in FVC, FEV1, or FEV1/FVC values pre- and post-intervention in either groups. A single MT session led to a significant improvement in PEF in healthy young individuals. Further research is needed to explore the long-term effects of MT on respiratory functions and its potential implications in clinical practice.Trial registration ClinicalTrials.gov: NCT05934240 (06/07/2023).

The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.

2024 marks the 50th anniversary of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). IFOMPT became the first subgroup of World Physiotherapy. IFOMPT aims and works for global promotion of excellence and unity in clinical and academic standards for manual/musculoskeletal physiotherapists. This dissertation reflects on some of IFOMPT\'s initiatives and achievements as an international organisation in its first 50 years as well as challenges for next 50 years. IFOMPT has achieved in several initiatives. These include the development of an international educational curriculum in manipulative/musculoskeletal physiotherapy which underpins education standards for membership. Educational standards for membership is a relatively unique requirement of a professional organisation. IFOMPT has achieved in developing several initiatives to disseminate knowledge for best standards of practice for its members and the wider community. The pinnacle is its four yearly international scientific conferences where the latest issues in both research and practice are presented and discussed. IFOMPT has also developed frameworks to guide clinical practice in key areas for safe practice - vascular pathologies of the neck, a clinical reasoning pathway to identify \'red flags\', and the use of spinal manipulation in paediatrics. Other resources include on-line lectures, podcasts and research reviews. IFOMPT has challenges for the future. These include increasing the number of member countries and further establishing its profile and position of leadership in manual/musculoskeletal physiotherapy in the international context, particularly with decision makers in world health.

Spinal manipulations for chronic non-specific neck pain (CNNP) include cervical, cervicothoracic junction, and thoracic spine (CCT) manipulations as well as upper cervical spine (UCS) manipulations. This study aimed to compare the short-term effects of UCS manipulation versus a combination of CCT spine manipulations on pain intensity, disability, and cervical range of motion (CROM) in CNNP patients. In a private physiotherapy clinic, 186 participants with CNNP were randomly assigned to either the UCS (n = 93) or CCT (n = 93) manipulation groups. Neck pain, disability, and CROM were measured before and one week after the intervention. No significant differences were found between the groups regarding pain intensity and CROM. However, there was a statistically significant difference in neck disability, with the CCT group showing a slightly greater decrease (CCT: 16.9 ± 3.8 vs. UCS: 19.5 ± 6.8; p = 0.01). The findings suggest that a combination of manipulations in the CCT spine results in a slightly more pronounced decrease in self-perceived disability compared to UCS manipulation in patients with CNNP after one week. However, no statistically significant differences were observed between the groups in terms of pain intensity or CROM.

The paper introduces professor ZHANG Weihua\'s experience in treatment of cervical spondylotic radiculopathy (CSR) with ulna-tibia needling therapy combined with decompression-loosening manual manipulation. Using \"palpating, detecting and imaging observing\", professor ZHANG Weihua gives the accurate diagnosis for the location, the stage and the severity of the disease. According to the nature of the disease, CSR is treated in three stages. He proposes the academic thought, \"taking the tendons as the outline, regarding the meridians as the essential, rooting at qi and blood, co-regulating tendons and bones\". The ulna-tibia needling therapy and decompression-loosening manual manipulation are combined in treatment. In the ulna-tibia needling therapy, the acupuncture is delivered at the lower 1/3 of the cutaneous regions of taiyang and shaoyang meridians, on the ulnar region (belt-like distribution). The decompression-loosening manual manipulation is operated in 3 steps, i.e. relaxing the nape region, decompressing and relaxing (includes positioning rotational wrenching, upward and backward elevation) and supination wrenching, and analgesia and regulating tendons; and the manipulation for analgesia and regulating tendons is supplemented to enhance the effect.
介绍张卫华教授运用尺胫针疗法结合减压松动手技治疗神经根型颈椎病的经验。张卫华教授采用“二摸三查两阅”法对疾病的病位、分期、程度进行精确诊断，根据疾病的性质认为神经根型颈椎病当从3期论治，提出“以筋为纲，以经为要，以气血为基，筋骨并调”的学术思想，运用尺胫针疗法结合减压松动手技进行治疗。尺胫针选取太阳、少阳经尺部之区带的下1/3皮部（带状）范围进针；减压松动手技分为放松颈项、减压松动（包括定位旋转扳法、上抬后顶法、仰侧扳法）、镇痛理筋3步，并配合镇痛理筋手法加强疗效。.

BACKGROUND: Chronic low back pain (CLBP) is a common musculoskeletal disorder. Effect of massage in the management of CLBP has been documented, but it is not clear which massage regimen is more effective. This study was carried out to compare the effect of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being among patients with CLBP.
METHODS: The study included 30 participants who were randomly assigned to one of three intervention groups: the connective tissue massage group (CTMG; n = 10), the classical massage group (CMG; n = 10), and a standard physiotherapy/control group (CG; n = 10). The interventions were administered three times a week for four consecutive weeks. Assessments were conducted at baseline and at the end of the fourth week. Pain severity (Visual Analog Scale), lumbar mobility (Modified Schober Test), function (Back Pain Functional Scale), disability (Roland Morris Disability Questionnaire), and well-being (Short Form-36/SF-36) was evaluated.
RESULTS: All groups exhibited improvements in pain, lumbar mobility, function, and disability after 4 weeks (p < 0.05). The CMG showed enhancements in physical function, bodily pain, role physical, and role emotional subgroups of SF-36. The CTMG demonstrated improvements in all subgroups of SF-36 except general health (p < 0.05), while the CG only improved in the physical function subgroup (p < 0.05). A 2-way repeated measures ANOVA revealed a significant group-time interaction for MST (p = 0.04), Bodily Pain (p = 0.025) and Role Physical (p = 0.015).
CONCLUSIONS: The findings obtained from this study showed that CTMG was superior to CMG and CG in increasing lumbar mobility, and both massage applications were superior to the CG in increasing the well-being.

BACKGROUND: Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS); however, high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.
OBJECTIVE: Craniosacral therapy (CST), Bowen therapy and exercises have been found to influence the autonomic nervous system, which plays a crucial role in sleep physiology. Given the paucity of evidence concerning these effects in individuals with FMS, our study tests the effectiveness of CST, Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.
METHODS: A placebo-controlled randomized trial was conducted on 132 FMS participants with poor sleep at a hospital in Bangalore. The participants were randomly allocated to one of the four study groups, including CST, Bowen therapy, standard exercise program, and a manual placebo control group that received static touch. CST, Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks; the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks. After 12 weeks, all study participants performed the standard exercises at home for another 12 weeks.
METHODS: Sleep quality, pressure pain threshold (PPT), quality of life and fibromyalgia impact, physical function, fatigue, pain catastrophizing, kinesiophobia, and positive-negative affect were recorded at baseline, and at weeks 12 and 24 of the intervention.
RESULTS: At the end of 12 weeks, the sleep quality improved significantly in the CST group (P = 0.037) and Bowen therapy group (P = 0.023), and the PPT improved significantly in the Bowen therapy group (P = 0.002) and the standard exercise group (P < 0.001), compared to the static touch group. These improvements were maintained at 24 weeks. No between-group differences were observed for other secondary outcomes.
CONCLUSIONS: CST and Bowen therapy improved sleep quality, and Bowen therapy and standard exercises improved pain threshold in the short term. These improvements were retained within the groups in the long term by adding exercises. CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.
BACKGROUND: Registered at Clinical Trials Registry of India with the number of CTRI/2020/04/024551. Please cite this article as: Ughreja RA, Venkatesan P, Gopalakrishna DB, Singh YP, Lakshmi VR. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: a randomized controlled trial. J Integr Med. 2024; 22(4): 474-484.

BACKGROUND: Various treatment modalities have been employed for mechanical low back pain (MLBP), but evidence of their efficacy varies greatly. Objectıve: This randomized controlled trial aimed to assess the outcomes of Mulligan concept applications, including sustained natural apophyseal glides (SNAGS) and natural apophyseal glides (NAGS), in obese patients with MLBP.
METHODS: The study, conducted between January 2021 and June 2022 at a tertiary hospital, involved randomizing patients into two groups. Both groups underwent six sessions of stretching and strengthening exercises every other day. The Mulligan group received additional intervention with SNAG and NAGS techniques. Measurements were made regarding the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score and range of motion (ROM) for the patients\' MLBP level.
RESULTS: Post-interventions, both groups exhibited positive changes in flexion ROM, extension ROM, right and left rotation ROM, right and left lateral flexion ROM, VAS score, and ODI score compared to pre-intervention (p < 0.001 for both groups and variables). The Mulligan group showed a higher increase in ROM and a more significant decrease in VAS and ODI scores. Conclusıons: Mulligan mobilization techniques prove significantly beneficial for enhancing ROM in all directions, reducing pain levels, and alleviating disability in obese individuals with MLBP.

OBJECTIVE: What is the effect of a 4-week regimen of Mulligan manual therapy (MMT) plus exercise compared with exercise alone for managing cervicogenic headache? Is MMT plus exercise more effective than sham MMT plus exercise? Are any benefits maintained at 26 weeks of follow-up?
METHODS: A three-armed, parallel-group, randomised clinical trial with concealed allocation, blinded assessment of some outcomes and intention-to-treat analysis.
METHODS: Ninety-nine people with cervicogenic headache as per International Classification of Headache Disorders (ICHD-3).
METHODS: Participants were randomly allocated to 4 weeks of: MMT with exercise, sham MMT with exercise or exercise alone.
METHODS: The primary outcome was headache frequency. Secondary outcomes were headache intensity, headache duration, medication intake, headache-related disability, upper cervical rotation range of motion, pressure pain thresholds and patient satisfaction. Outcome measures were collected at baseline and at 4, 13 and 26 weeks.
RESULTS: MMT plus exercise reduced headache frequency more than exercise alone immediately after the intervention (MD between groups in change from baseline: 2 days/month, 95% CI 2 to 3) and this effect was still evident at 26 weeks (MD 4 days, 95% CI 3 to 4). There were also benefits across all time points in several secondary outcomes: headache intensity, headache duration, headache-related disability, upper cervical rotation and patient satisfaction. Pressure pain thresholds showed benefits at all time points at the zygapophyseal joint and suboccipital areas but not at the upper trapezius. The outcomes in the sham MMT with exercise group were very similar to those of the exercise alone group.
CONCLUSIONS: In people with cervicogenic headache, adding MMT to exercise improved: headache frequency, intensity and duration; headache-related disability; upper cervical rotation; and patient satisfaction. These benefits were not due to placebo effects.
BACKGROUND: CTRI/2019/06/019506.

BACKGROUND: Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated.
OBJECTIVE: The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months.
METHODS: Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment.
RESULTS: The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment.
CONCLUSIONS: The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.