Physical Therapy Techniques for Pain
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Florida Gulf Coast University
Disqualifiers: Concussion, Traumatic brain injury, Stroke, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This study is designed to evaluate the if there is a predictable patterns in brainwave activity and to see how this changes with external physical therapy interventions such as manipulation, soft tissue massage, and exercise.
Will I have to stop taking my current medications?
The trial protocol does not specify whether you need to stop taking your current medications. However, if you are taking medications that affect bone health, you may not be eligible for the manipulation group.
What data supports the effectiveness of the treatment Physical Therapy Techniques for Pain?
Research suggests that techniques like high-velocity low-amplitude thrust (HVLA) manipulation and mobilization can help reduce pain and improve satisfaction in people with neck pain. These methods, when combined with advice and exercise, may lead to better overall improvements compared to advice and exercise alone.
12345Is physical therapy, including techniques like joint manipulation and soft tissue massage, generally safe for humans?
Physical therapy techniques such as joint manipulation and mobilization are generally safe, but they can be associated with rare serious adverse events and more common mild ones, like temporary pain or discomfort. It's important for patients to discuss potential risks with their healthcare provider.
678910How is the treatment of physical therapy techniques for pain unique compared to other treatments?
This treatment is unique because it combines exercise, joint manipulation, and soft tissue massage, which are manual therapy techniques that improve tissue flexibility, increase range of motion, and reduce pain without medication. These techniques are based on the latest research and are tailored to the individual's current functional state, making them a personalized approach to pain management.
111121314Eligibility Criteria
This trial is for adults aged 18-60 with no thoracic spine pain or injuries in the past 6 months. Participants should either be novice exercisers able to do a moderate workout for 15 minutes, or have healthy bones without conditions like osteoporosis. Those with a history of brain injury or central nervous system disorders cannot join.Inclusion Criteria
I am between 18 and 60 years old.
I haven't had any upper back pain or injuries in the last 6 months.
You are new to exercising and don't exercise regularly. You can handle doing 15 minutes of moderate intensity exercises without any problems.
Exclusion Criteria
I do not have weak bones or any condition that affects my skeleton.
I have a history of brain injury or disorder.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Resting Brainwave Activity Measurement
Identify typical resting brain wave activity in asymptomatic subjects using EEG
1 week
1 visit (in-person)
Physical Therapy Interventions
Subjects undergo physical therapy interventions including joint manipulation, exercise, and soft tissue massage, with brain wave response measured
2 weeks
3 visits (in-person)
Intervention in Symptomatic Subjects
Repeat measures and interventions in subjects experiencing pain, including FGCU college athletes with recent ankle sprains
2 weeks
3 visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after interventions
4 weeks
Participant Groups
The study aims to observe changes in brainwave activity during physical therapy interventions such as joint manipulation, exercise, and soft tissue massage to identify any predictable patterns.
3Treatment groups
Experimental Treatment
Group I: Soft tissue massageExperimental Treatment3 Interventions
Instrument assisted soft tissue massage
Group II: Joint manipulationExperimental Treatment3 Interventions
Grade V-Thrust manipulation with audible sound and without audible sounds of C1-C2, T7, MTP 2 and MCP2 joints.
Group III: ExerciseExperimental Treatment3 Interventions
Aerobic, anaerobic, and yoga exercises
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Florida Gulf Coast UniversityFort Myers, FL
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Who Is Running the Clinical Trial?
Florida Gulf Coast UniversityLead Sponsor
References
Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories. [2022]When the clinical efficacy of spinal manipulative treatment for spinal pain has been assessed, high-velocity low-amplitude thrust (HVLAT) manipulation and mobilization have been regarded as clinical interventions giving identical and equivalent biologic effects. The objective of this review is to critically discuss previous theories and research of spinal HVLAT manipulation, highlighting reported neurophysiologic effects that seem to be uniquely associated with cavitation of synovial fluid.
A feasibility study assessing manual therapies to different regions of the spine for patients with subacute or chronic neck pain. [2023]The purpose of this project was to develop and test protocols for a randomized clinical trial of a combined therapeutic approach (thoracic spine and sacroiliac joint high-velocity, low-amplitude spinal manipulation [HVLA SM] + cervical spine postisometric relaxation) and cervical spine HVLA SM for patients with subacute or chronic neck pain.
Manual therapy with or without physical medicine modalities for neck pain: a systematic review. [2018]Manual therapy interventions are often used with or without physical medicine modalities to treat neck pain. This review assessed the effect of 1) manipulation and mobilisation, 2) manipulation, mobilisation and soft tissue work, and 3) manual therapy with physical medicine modalities on pain, function, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults with neck pain. A computerised search for randomised trials was performed up to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (RR) and standardised mean differences (SMD) were calculated when possible. We included 19 trials, 37% of which had a low risk of bias. Moderate quality evidence (1 trial, 221 participants) suggested mobilisation, manipulation and soft tissue techniques decrease pain and improved satisfaction when compared to short wave diathermy, and that this treatment combination paired with advice and exercise produces greater improvements in GPE and satisfaction than advice and exercise alone for acute neck pain. Low quality evidence suggests a clinically important benefit favouring mobilisation and manipulation in pain relief [1 meta-analysis, 112 participants: SMD -0.34(95% CI: -0.71, 0.03), improved function and GPE (1 trial, 94 participants) for participants with chronic cervicogenic headache when compared to a control at intermediate and long term follow-up; but no difference when used with various physical medicine modalities.
The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review. [2020]In manual therapy, high velocity low amplitude (HVLA) cervical manipulation techniques are frequently used, but often the physiological and biomechanical effects that can be obtained are not completely clear. The techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is yet known about the possibility of using them in order to achieve better performance on healthy subjects. The objective of the study is to describe how cervical manipulation can impact on a musculoskeletal disorder. A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020. Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles. The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020. The included intervention was thrust manipulation or HVLA directed towards the cervical spine region. After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question. The results of the research show that HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility and strength both in the treated area and at a distance. Cervical manipulations are effective in management of cervicalgia, epicondylalgia, temporomandibular joint disorders and shoulder pain. With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter. Cervical manipulations can also have risks for the patient if applied when not appropriate but the frequency of complications due to vertebral manipulation are very low. However, the manipulation techniques might be limited by low patients tolerance or the presence of contraindications. In addition, the optimal number of manipulations to be performed and the long-term benefits produced are unknown.
The outcomes of manipulation or mobilization therapy compared with physical therapy or exercise for neck pain: a systematic review. [2021]Study Design Systematic review. Study Rationale Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit.
Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review. [2022]Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.
Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective. [2022]Rare, serious, and common, benign adverse events (AE) are associated with MT techniques. A proposed standard for defining AE in manual therapy (MT) practise has been published but it did not include the patient perspective. Research comparing clinician and patient reporting of AE demonstrates that several differences exist; for example, the reporting of objective versus subjective events. The objective of this study was to describe how patients define AE associated with MT techniques. A descriptive qualitative design was employed. Semi-structured interviews were used with a purposive sample of patients (n = 13) receiving MT, from physiotherapy, chiropractic and osteopathic practises in Ontario, Canada. The interview guide was informed by existing evidence and consultation with content and methodological experts. Interviews were audiotaped and transcribed verbatim. Date were analysed by two independent team members using thematic content analysis. A key finding was that patients defined mild, moderate and major AE by pain/symptom severity, functional impact, duration and by ruling out of alternative causes. An overarching theme identified multiple factors that influence how the AE is perceived. These concepts differ from the previously proposed framework for defining AE that did not include the patient perspective. Future processes to create standard definitions or measures should include the patient viewpoint to provide a broader, client-centred foundation.
Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. [2022]Adverse events (AE) are a concern for practitioners utilizing cervical manipulation or mobilization. While efficacious, these techniques are associated with rare but serious adverse events. Five bibliographic databases (PubMed, CINAHL, PEDro, AMED, EMBASE) and the gray literature were searched from 1998 to 2009 for any AE associated with cervical manipulation or mobilization for neck pain. Randomized controlled trials (RCTs), prospective or cross-sectional observational studies were included. Two independent reviewers conducted study selection, method quality assessment and data abstraction. Pooled relative risks (RR) were calculated. Study quality was assessed using the Cochrane system, a modified Critical Appraisal Skills Program form and the McHarm scale to assess the reporting of harms. Seventeen of 76 identified citations resulted in no major AE. Two pooled estimates for minor AE found transient neurological symptoms [RR 1.96 (95% CI: 1.09-3.54) p .05]. Forty-four studies (58%) were excluded for not reporting AE. No definitive conclusions can be made due to a small number of studies, weak association, moderate study quality, and notable ascertainment bias. Improved reporting of AE in manual therapy trials as recommended by the CONSORT statement extension on harms reporting is warranted.
Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review. [2017]Cervical high-velocity low-amplitude (HVLA) manipulation technique is among the oldest and most frequently used chiropractic manual therapy, but the physiologic and biomechanics effects were not completely clear.
Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists. [2022]High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries.
Joint mobilization. [2005]Therapeutic touch has been used in human beings to soothe aches and pains. Most dogs also seem to enjoy being touched. Manual therapy techniques are skilled hand movements intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. The intent of this article is to provide an overview of the principles of manual therapy, followed by selected treatment techniques for the hip, stifle, elbow, shoulder, carpus.and thoracic and lumbar spine. The techniques of G.D. Maitland, an Australian physical therapist who developed a clinically based approach in the 1960s and 1970s, are emphasized.
[Special methods and techniques applied in orthopedic rehabilitation]. [2022]The latest information about tissues, their physiology or the anatomy itself contributed to the development of innovative special physiotherapeutic metods related to manual therapy. They are based on the latest knowledge supported by research, having its theoretical "foundation" based on the knowledge already known. Some of the methods and techniques are based on hard tissue therapy. These techniques include, among others joint mobilization, which consists in performing passive movements on the joints. Manipulation is also such a technique, characterized by a quick joint impulse and traction method is leading to the separation of the articular surfaces. Other special methods focus on treating soft tissues. They include, among others, muscle energy techniques or trigger point therapies. The former require the patient to perform precise isometric and isotonic tensions, while during the therapy of trigger points, the physiotherapist eliminates the increased tension in the muscle fibers. When improving the patient one should take into account his or her current functional state and individually select the appropriate method and technique of rehabilitation.
Manual therapy in veterinary rehabilitation. [2016]As it matures, the field of animal rehabilitation is welcoming utilization of interventions that have proven efficacy in the specialty of physical therapy for human patients. More recently, manual therapy techniques have become more accepted. Range-of-motion and stretching techniques; mobilization or manipulation of soft tissues, peripheral joints, and the spine; neuromuscular facilitation techniques; techniques unique to osteopathy; chest physical therapy; manual lymphatic drainage techniques; and neural mobilization techniques are now commonly incorporated in clinical practice, and these interventions are more commonly cited in the veterinary literature. The following is a brief review of these manual therapy approaches including the goals, effects, indications, precautions, and contraindications.
Nonpharmacological treatments for musculoskeletal pain. [2019]Several types of physical therapy are used in the management of painful musculoskeletal disorders. These treatment modalities can be broadly categorized as electrotherapy modalities (e.g., transcutaneous electrical nerve stimulation), acupuncture, thermal modalities (e.g., moist heat, ultrasound), manual therapies (e.g., manipulation or massage), or exercise. Within each of these broad categories significant variations in treatment parameters are possible.