BACKGROUND: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown.
METHODS: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership.
RESULTS: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care.
CONCLUSIONS: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP\'s Western-centered perspective.

BACKGROUND: Cystic fibrosis (CF) is a severe genetic condition that affects multiple organ systems and imposes a substantial treatment burden. Regarding the lungs and airways, the progressive pathophysiological changes place a significant strain on the musculoskeletal components of the respiratory system for people with CF. This pilot study investigated the effectiveness of manual therapy interventions (MTIs) on thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain.
METHODS: A study with a pretest-posttest design was conducted with 15 eligible people with CF at the Sahlgrenska University Hospital CF Centre. After an initial set of diagnostic tests at baseline, the participants underwent eight weekly 30-min MTIs. The MTIs included passive joint mobilisation and soft tissue manipulation of primary and secondary anatomical areas of the musculoskeletal respiratory system. On the day of the final intervention, the baseline measurements were repeated.
RESULTS: Trends of increased thoracic mobility were observed following the intervention, with a statistically significant increase in respiratory muscle strength. No change in lung function was observed. Musculoskeletal pain before and after the intervention showed a significant decrease in tender points, and all participants reported positive experiences with MTIs.
CONCLUSIONS: MTIs may improve thoracic mobility, alleviate pain, and enhance respiratory muscle strength in people with CF. Further research is needed to confirm their potential role as a CF physiotherapy supplement.
BACKGROUND: NCT04696198.

Manual therapies are commonly used by healthcare professionals when caring for children. However, few prospective studies have evaluated their adverse events (AEs). This study aims to assess the feasibility of a pragmatic prospective study aiming to report the immediate and delayed (48-hours post-treatment) AEs associated with manual therapies in children aged 5 or younger. Preliminary data on AEs frequency are also reported.
Between July 2021 and March 2022, chiropractors were recruited through purposive sampling and via a dedicated Facebook group for Quebec chiropractors interested in pediatrics. Legal guardians of patients aged 5 or younger were invited to fill out an online information and consent form. AEs were collected using the SafetyNET reporting system, which had been previously translated by the research team. Immediate AEs were collected through a questionnaire filled out by the legal guardian immediately after the treatment, while delayed AEs were collected through a questionnaire sent by email to the legal guardian 48 h after the treatment. Feasibility was assessed qualitatively through feedback from chiropractors and quantitatively through recruitment data.
Overall, a total of 28 chiropractors expressed interest following the Facebook publication, and 5 participated. An additional two chiropractors were enrolled through purposive sampling. In total, 80 legal guardians consented to their child\'s participation, and data from 73 children were included for the analysis of AEs. At least one AE was reported in 30% of children (22/73), and AEs were mainly observed immediately following the treatment (16/22). The most common AEs were irritability/crying (11 children) or fatigue/tiredness (11 children). Feasibility analysis demonstrated that regular communication between the research team and clinicians, as well as targeting clinicians who showed great interest in pediatrics, were key factors for successful research.
Results suggest that it is feasible to conduct a prospective pragmatic study evaluating AEs associated with manual therapies in private practices. Direct communication with the clinicians, a strategic clinicians\' recruitment plan, and the resulting administrative burden should be considered in future studies. A larger study is required to confirm the frequency of AEs reported in the current study.
ClinicalTrials.gov., NCT05409859, Registered on June 3 2022. https://clinicaltrials.gov/study/NCT05409859 .

UNASSIGNED: The purpose of this report is to describe the course of chiropractic care for an adult male experiencing persistent anterolateral thigh pain due to bilateral meralgia paresthetica.
UNASSIGNED: A 40-year-old male U.S. Veteran was referred to chiropractic care for a two-year history of bilateral anterolateral thigh pain and paresthesia that worsened with inguinal pressure and hip extension activities.
UNASSIGNED: A total of six chiropractic visits, including a combination of telehealth and in-person appointments, took place over a period of 10 weeks. Treatments included patient education, soft-tissue therapy, therapeutic exercise prescription, and spinal manipulation directed toward the lumbar spine. The patient\'s pain was reduced from a 6/10 rating to a 0/10, he was able to reengage in recreational activities without discomfort, and sustained improvement was reported.
UNASSIGNED: In this case, a trial of chiropractic care was associated with a resolution of the patient\'s bilateral meralgia paresthetica symptoms.
UNASSIGNED: Le but de ce rapport est de décrire l’évolution des soins chiropratiques pour un homme adulte souffrant d’une douleur persistante à la cuisse antérolatérale due à une méralgie paresthésique bilatérale.
UNASSIGNED: Un vétéran américain de 40 ans a été recommandé à la chiropratique pour une histoire de deux ans de douleur et de paresthésie antérolatérale bilatérale à la cuisse qui s’aggravait avec la pression inguinale et les activités d’extension de la hanche.
UNASSIGNED: Un total de six visites chiropratiques, comprenant une combinaison de rendez-vous par télémédecine et en personne, ont eu lieu sur une période de 10 semaines. Les traitements comprenaient l’éducation du patient, la thérapie des tissus mous, la prescription d’exercices thérapeutiques et la manipulation de la colonne vertébrale lombaire. La douleur du patient est passée de 6/10 à 0/10, il a pu reprendre ses activités récréatives sans gêne et une amélioration durable a été constatée.
UNASSIGNED: Dans ce cas, un essai de soins chiropratiques a été associé à une résolution des symptômes de la méralgie paresthésique bilatérale du patient.

BACKGROUND: Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN.
METHODS: A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment.
RESULTS: Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group.
CONCLUSIONS: In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.

BACKGROUND: Somatosensory tinnitus represents a clinically significant subgroup of chronic tinnitus. Although not completely understood, increasing evidence suggests interactivity between the somatosensory and auditory systems is responsible for both the development and maintenance of tinnitus.
OBJECTIVE: The aim of this study is to provide an overview of the evaluation of somatosensory tinnitus and to propose an examination protocol to support the diagnosis and treatment of this patient group.
METHODS: In addition to patient history, various clinical examination maneuvers are presented to establish the diagnosis of somatosensory tinnitus.
RESULTS: The maneuvers can be divided into examinations of the cervical spine, temporomandibular joint, and soft tissue near the jaw. The maneuvers should be performed in a quiet environment and usually in comparison between sides.
CONCLUSIONS: Accurate and efficient diagnosis of somatosensory tinnitus is essential to initiate appropriate treatment. The clinical maneuvers presented here are well suited for this purpose.
UNASSIGNED: HINTERGRUND: Somatosensorischer Tinnitus stellt eine klinisch bedeutsame Untergruppe des chronischen Tinnitus dar. Obwohl das Verständnis der Pathogenese des somatosensorischen Tinnitus noch unvollständig ist, zeigen einige wissenschaftliche Erkenntnisse Verschaltungen zwischen dem somatosensorischen und dem auditorischen System, welche für die Entstehung und Aufrechterhaltung des Tinnitus verantwortlich zu sein scheinen.
UNASSIGNED: Das Ziel dieser Arbeit ist es, einen Überblick über den somatosensorischen Tinnitus zu geben und ein Untersuchungsprotokoll vorzuschlagen, welches in Diagnostik und Therapie dieser Patientengruppe unterstützend sein soll.
METHODS: Neben der Anamnese werden diverse klinische Untersuchungsmanöver vorgestellt, um die Diagnose eines somatosensorischen Tinnitus zu stellen.
UNASSIGNED: Die Manöver werden eingeteilt in Untersuchungen der Halswirbelsäule, des Kiefergelenks sowie kiefergelenknahe Weichteilpalpation. Diese sollten in ruhiger Umgebung und meist im Seitenvergleich durchgeführt werden.
UNASSIGNED: Die korrekte Diagnosestellung eines somatosensorischen Tinnitus ist essenziell, um eine entsprechende Behandlung dieser Patientengruppe einzuleiten, wobei die hier vorgestellten klinischen Manöver dafür gut geeignet sind.

Many fascial therapies have been demonstrated to positively affect the range of motion, pain sensitivity, balance, daily functioning, and participation in social activities. Among these therapies, myofascial release has been extensively studied and widely used in clinical trials. The fascial distortion model was recently introduced, and it has received much attention due to its rapid onset of action and ease of application.
This study aims to compare the effects of myofascial release and the fascial distortion model on range of motion, pain sensitivity, and balance, with the goal of helping therapists select the most appropriate treatment.
Sixteen healthy adults were included in a prospective, randomized, single-blind study. The subjects were randomly assigned to either the myofascial release or fascial distortion model groups. The outcome measures were functional reach test, pain pressure threshold, straight leg-raising test angle, and finger floor distance.
The myofascial release and fascial distortion model groups showed significantly increased straight leg-raising angle and finger floor distance, but no between-group differences were observed (p > .05). The fascial distortion model group demonstrated significantly better pain control (p < .05), which was also better than in the myofascial release group (p < .05). The myofascial release group showed significantly improved balance control (p < .05); however, there was no difference between the two groups (p > .05).
Either myofascial release or fascial distortion model can be chosen to improve the range of motion. However, if pain sensitivity is the goal, it is expected that the fascial distortion model will be more effective.

BACKGROUND: Knee osteoarthritis (KOA) considered as one of the most common degenerative diseases of synovial joint. KOA is mostly managed by physical therapy, focused on pain management, the range of motion and muscle strengthening but muscle flexibility is usually neglected. A study was conducted to evaluate the effectiveness of dynamic soft tissue mobilization (DSTM) in comparison with the proprioceptive neuromuscular facilitation (PNF) stretching in the management of hamstring tightness, reduction of pain intensity and improvement of physical functionality in KOA.
METHODS: Forty eight patients with KOA were randomly allocated to group A receiving DTSM and group B receiving PNF stretching. The cryotherapy and isometric strengthening exercises were also given to both groups. Total treatment duration consisted of 4 weeks, 3 sessions per week and total 12 sessions per patient. Each treatment session comprised of 30 min. At baseline and post treatment, Active knee extension test(AKET), Visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess hamstring flexibility, pain intensity level and physical functional capability respectively. The continuous variables were shown as mean and standard deviations. For the comparison of outcome within and between groups, paired sample and independent t-test was applied. Considerable p value was less than 0.05.
RESULTS: The between group analysis of VAS, right AKE test, and left AKE test showed non-significant (p > 0.05) mean difference as 0.2 (95% CI= -0.29, 0.70), 1.79 (95% CI= -1.84, 4.59), 1.78 (95% CI= -1.6, 5.19) respectively. KOOS domains of symptom, pain, ADLs, sports and recreational, and quality of life had also non-significant (p > 0.05) mean difference as 1.12 (95% CI= -4.05, 6.3), -5.12 (95% CI= -12.71, 2.46), -2.55 (95% CI= -7.47, 2.38), -2.7 (95% CI= -9.72, 4.3), and - 0.68 (95% CI= -7.69, 6.36) respectively. Significant (p < 0.001) improvement was shown in both groups for all outcome measures after 12 sessions.
CONCLUSIONS: DSTM and PNF stretching, both treatments are equally beneficial in KOA for hamstring flexibility, pain reduction and functional mobility in terms of AKET, VAS, and KOOS respectively.
BACKGROUND: ClincalTrials.Gov with ID: NCT04925895, 14/06/2021, retrospectively registered.

Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain.
Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness.
Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6.
Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.

UNASSIGNED: Decreased axial rotation, impaired coordination between axial segments and axial tone contribute to gait, balance and postural disorders in Parkinson\'s Disease.
UNASSIGNED: The aim of our study was to examine the acute effects of lumbosacral mobilization on balance and functional activities in patients with idiopathic Parkinson\'s Disease.
UNASSIGNED: This study was a randomized controlled clinical trial conducted at Hacettepe University. The study included 28 patients with Parkinson\'s Disease who were between stage 2-3 according to the Modified Hoehn&Yahr Staging Scale. Participants were randomised to the study group, including 10 minutes of lumbosacral mobilization, or the control group, including no intervention. The Unified Parkinson\'s Disease Rating Scale (UPDRS), Modified Parkinson\'s Activity Scale (MPAS), Dynamic Gait Index (DGI), and static posturography test (Modified Clinical Test of Sensory Interaction and Balance - mCTSIB) were all examined twice.
UNASSIGNED: The UPDRS, MPAS, DGI values and the composite score with the soft ground eyes open condition in the mCTSIB were improved in the study group (p < 0.05). DGI and MPAS values reached the level of significance between the groups (p < 0.05).
UNASSIGNED: This study is the first to examine the effect of lumbosacral mobilization on balance and functional activities in patients with Parkinson\'s disease. Lumbosacral mobilization is an effective method in PwPD. Lumbosacral mobilization may be an alternative way for these patients to improve their balance and functional activities.