BACKGROUND: The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP.
OBJECTIVE: The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals.
METHODS: This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling\'s progressive inhibition of neuromuscular structures and Mulligan\'s spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization.
RESULTS: The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with \"side-lying\" being the most practiced sexual position and \"standing\" being the least practiced sexual position by females. While \"lying supine\" was the most practiced sexual position and \"sitting on a chair\" was the least practiced sexual position by males.
CONCLUSIONS: This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

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UNASSIGNED: Manipulative treatment can effectively improve knee pain and function, but no previous studies have shown that lumbar osteopathic manipulative treatment can improve knee symptoms. To explore the influence of lumbar manipulation on KOA and analyze its principlerelationship between coronal position of lumbar spine and KOA.
UNASSIGNED: Patients were divided into OMT group and DT group according to treatment. WOMAC scores were compared between the two groups, and X-ray examinations before and after treatment were performed in OMT group to analyze the imaging changes.
UNASSIGNED: Both OMT group and DT group showed significant improvement in WOMAC score after treatment, and the improvement in OMT group was better than that in DT group. After OMT treatment, cTMI(P = 0.034), mL-SOD (P < 0.001), mΔL-KOD (P = 0.001), LL (P = 0.036), and FTA(P = 0.026) were significantly changed.
UNASSIGNED: Compared with drug therapy, lumbar manipulation can better improve WOMAC scores in KOA patients. It relives symptoms by loosening muscles and correcting small joint disorders to improve local knee alignment.

OBJECTIVE: Manual therapy is a crucial component in rehabilitation education, yet there is a lack of models for evaluating learning in this area. This study aims to develop a foundational evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method, and to analyze the theoretical basis and practical significance of this model.
METHODS: An initial framework for evaluating the fundamentals of manual therapy learning was constructed through a literature review and theoretical analysis. Using the Delphi method, consultations were conducted with young experts in the field of rehabilitation from January 2024 to March 2024. Fifteen experts completed three rounds of consultation. Each round involved analysis using Dview software, refining and adjusting indicators based on expert opinions, and finally summarizing all retained indicators using Mindmaster.
RESULTS: The effective response rates for the three rounds of questionnaires were 88%, 100%, and 100%, respectively. Expert familiarity scores were 0.91, 0.95, and 0.95; coefficient of judgment were 0.92, 0.93, and 0.93; authority coefficients were 0.92, 0.94, and 0.94, respectively. Based on three rounds of consultation, the model established includes 3 primary indicators, 10 secondary indicators, 17 tertiary indicators, and 9 quaternary indicators. A total of 24 statistical indicators were finalized, with 8 under the Cognitive Abilities category, 10 under the Practical Skills category, and 6 under the Emotional Competence category.
CONCLUSIONS: This study has developed an evaluation model for manual therapy learning among rehabilitation students, based on the Delphi method. The model includes multi-level evaluation indicators covering the key dimensions of Cognitive Abilities, Practical Skills, and Emotional Competence. These indicators provide a preliminary evaluation framework for manual therapy education and a theoretical basis for future research.

Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects.

Background: Mulligan\'s mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.

UNASSIGNED: To evaluate the effectiveness of trigger point manual therapy (TPMT) in treating rotator cuff related shoulder pain (RCRSP).
UNASSIGNED: Randomized controlled trials that compared the effects of TPMT with no or other conservative treatments in patients with RCRSP were included. Primary outcomes were shoulder pain intensity and function. Secondary outcomes were pressure pain threshold (PPT) and number of myofascial trigger points (MTrPs). The Cochrane Risk of Bias 2.0 tool, PEDro scale and GRADE approach were employed.
UNASSIGNED: Ten studies were included in this systematic review and seven in the meta-analysis. Very low to low quality of evidence showed no statistically significant difference between TPMT and other conservative treatments in rest and activity pain reduction in the short term (3 days to 12 weeks), and the difference in shoulder function was statistically significant in favor of TPMT. Furthermore, TPMT was found to be effective in the improvement of PPT and the inactivation of active MTrPs in the short term.
UNASSIGNED: TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term, and slightly more effective for functional improvement. TPMT seems to be effective to treat the active MTrPs in RCRSP.
UNASSIGNED: CRD42023409101.
Trigger point manual therapy (TPMT) seems to be effective to treat the active trigger points of rotator cuff related shoulder pain (RCRSP) in the short term (3 days to 12 weeks).TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term (3 days to 12 weeks), and slightly more effective for functional improvement.TPMT may be recommended for use in comprehensive treatment programs which may include active components such as exercise therapy and education for the rehabilitation of RCRSP.

Cervicogenic somatic tinnitus (CST) is a subgroup of somatosensory tinnitus that arises from altered sensory input from the cervical spine due to changes in anatomical and physiological functions. Unlike primary tinnitus, usually caused by auditory system issues, CST is due to somatosensory disruptions from the cervical region. Conditions such as degenerative disc disease, cervical spondylosis, whiplash injuries, and neck muscle stress or spasms are commonly associated with CST. The pathophysiology of CST involves complex interactions between the cervical spine\'s somatosensory inputs and central auditory pathways, particularly affecting the dorsal cochlear nucleus (DCN) in the brainstem, leading to enhanced excitability and synaptic reorganization, giving rise to tinnitus. Accurate diagnosis and management of CST require a comprehensive approach, including patient history, physical examination, audiological assessments, and imaging studies. Treatment strategies encompass physical therapy, medications, interventional procedures, and complementary therapies, aiming to reduce tinnitus perception, alleviate neck dysfunction, and improve overall quality of life. Emerging therapies, such as neuromodulation and regenerative medicine, show promise in further improving CST management. This multidisciplinary approach highlights the importance of addressing both musculoskeletal and auditory health in the effective treatment of CST.

BACKGROUND: Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip.
METHODS: Randomized crossover study conducted in a university biomechanics laboratory.
METHODS: Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (Fpeak) and average mean forces (Fmean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland-Altman plots were assessed.
RESULTS: The clinicians\' average Fpeak ranged from 3.0 N to 11.6 N and average Fmean from 1.9 N to 8.1 N. Fpeak CVs for all instruments ranged from 14% to 31%, and Fmean CVs ranged from 15% to 35%. Bland-Altman plots indicated that for both Fpeak and Fmean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9 N (91.8 g) to 4.1 N (418.1 g) for Fpeak and from 1.0 N (102.0 g) to 2.8 N (285.5 g) for Fmean. Thus, CVs, box and density plots, and Bland-Altman plots supported general force application consistency.
CONCLUSIONS: Trained IASTM clinicians produced consistent treatment application forces (ie, Fpeak and Fmean) within treatment sessions during 2-handed simulated application.

In this letter to the editor, we discuss additional viewpoints and identify relevant literature to supplement the evidence statement of the authors. We want to make a positive contribution to the discussion about Pediatric Manual Therapy.