Manual Therapy Research Review is out!

In this issue we have a contribution from Dr Steve Karas from Chatham University in Pittsburgh. Thanks to Steve, as this is the first contribution to the Research Review other than from me. Steve has reviewed a paper on vertebral artery blood flow. I welcome other such contributions in future. We also have in this issue other papers on the relationship of cervical dysfunction to lateral elbow pain and one on the effects of manual therapy in osteoarthritic knees. Quite a broad mix!

Read the full review here or read the summary below.

Quesnele, J, Triano, J, Noseworthy, M & Wells, G. (2014). Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation. Journal of  Manipulative and Physiological Therapeutics 37 1, 22-31

This study appears to support IFOMPT’s guidelines for arterial assessment prior to cervical OMT intervention. The subjects were healthy males with no history of injury and no current symptoms, therefore seemingly ruling out the need for cranio-vertebral ligament testing, neurological assessment, and symptom differentiation. However, in contrast to IFOMPT, and absent in the authors’ evaluation of the subjects, were assessment of blood pressure, carotid pulse, and a true pre-manipulative hold. Also appar- ent was the use of a high velocity thrust to the upper cervical spine in end range rotation, which is advised against in the IFOMPT guidelines. While small changes were noted in these healthy individuals, perhaps greater questions arise: what changes would occur in unhealthy individuals such as those with a history of upper cervical injury or arterial pathology, or those with atypical upper cervical anatomy? Perhaps clinical reasoning is needed more so than MRI given that the signs and symptoms of arterial pathology discovered while using IFOMPT’s guidelines, would potentially lead to a clinical decision not to perform this type of high velocity thrust.

Taylor, L, Wilken, J, Deyle, G & Gill, N. (2014). Knee Extension and Stiffness in Osteoar- thritic and Normal Knees: A Video-fluoroscopic Analysis of the Effect of a Single Session of Manual Therapy. Journal o f Orthopaedic and Sports Physical Therapy 2014 44(4), 273- 282. February 2014. doi:10.2519/jospt.2014.4710 

Whilst this study is only a single session of manual therapy, it does show very clearly that manual therapy has a significant physical effect on joint motion. The use of the video- fluoroscopy is a great methodology to help demonstrate this. While these machines are not used in clinical practice, this type of research is great to help inform clinicians that they are actually moving joints with manual therapy. This study would also provide some further validation for a study out- lined in a previous research review by Abbott et al (2013) which also demonstrated effectiveness of mobilisation and manipulation in the management of OA of the knee and hip. The results of my own research demonstrated stretching interventions to the OA knee also increased knee extension, would also add to this manual therapy approach (Reid& McNair, 2011). Physiotherapy has a lot to offer to those with OA!

Coombes, B, Bissett, L and Vincezino, B Bilateral Cervical Dysfunction in Patients with Uni- lateral Lateral Epicondylalgia without Concomitant Cervical or Upper Limb Symptoms. A Cross Sectional Case Control Study. Journal of Manipulative and Physiological Therapeutics 2014 37, 79-86

It has often been a common clinical finding that those with lateral elbow pain have asso- ciated neck symptoms. This study demonstrates that at least a third of those presenting with lateral elbow pain will have associated neck findings even if they do not explicitly complain of neck pain.
The other interesting finding is the association between increased neurodynamic responses and the level of resting arm pain. This increase sensitivity of the nervous system is therefore important to take into consideration and examine particularly when the patient has higher levels of irritability whereby symptoms take longer to settle. The ability to look more widely than the area of the pre- senting symptoms is critical to ensure the patients have a more complete package of care to resolve an often persistent condition. Problems like lateral epicondylalgia are not just about the tendon and the co-existing changes in tendon structure but a wider set of variables. 


For all those clinicians that are frustrated at not being able to get access to key journals Elsevier has now made available free access to past editions of Manual Therapy.

If you would like to make any contributions to the Manual Therapy Research Review please contact Dr Duncan Reid on [email protected]