The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report

Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series

CONTEXT

Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain.

CASE PRESENTATIONS

Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found.

MANAGEMENT AND OUTCOMES

All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients.

CONCLUSIONS

This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.

Are YouTube videos claiming to describe lumbar spinal manipulation techniques adequate?

BACKGROUND AND OBJECTIVE

YouTube has become a digital visual library in almost all fields of life, including medicine. Healthcare professionals and students frequently use YouTube to gain new skills and knowledge; however, the content of these videos has not been scientifically evaluated. Therefore, this study aimed to determine the descriptive adequacy and quality of YouTube videos on lumbar spine manipulation techniques (LSMTs) prepared by different healthcare professionals.

METHODS

The first 50 most relevant videos retrieved on searching YouTube for the keyword 'lumbar spinal manipulation techniques' were included in the study. The video metrics (total duration, number of views, time since upload, number of comments, number of likes, and number of dislikes) that could be accessed from video descriptions were recorded. However the videos were scored according to manipulation definition criteria proposed by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT manipulation description score - AAOMPT-MDS) and benchmark criteria for quality of digital content by the Journal of American Medical Association's (JAMA). The video metrics, AAOMPT-MDS and JAMA scores of the videos prepared by medical doctors, chiropractors, osteopaths, and physiotherapists were compared.

RESULTS

Video metrics of groups were similar. The mean AAOMPT-MDS of the videos was 2.40 ± 1.57 out of 6.00 (higher score was better), and the mean JAMA score was 2.14 ± 1.05 out of 4.00 (higher score was better). Videos created by all professional groups had statistically comparable AAOMPT-MDS and JAMA scores (p > 0.05).

CONCLUSION

Although YouTube videos on LSMTs offer valuable information for professionals and students, creators should follow the proposed recommendations when producing these videos to ensure quality content and systematic presentation.

The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review

Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.