Indiana University-Purdue University Indianapolis (IUPUI) / SASTMTM is a myofascial technique used to mobilize soft tissue and aid in the elongation of soft tissue and create physiological change. The purpose of the study was to determine the acute effects of Sound Assisted Soft Tissue Mobilization (SASTMTM) on lower extremity hamstring strength (isokinetic & isometric) and flexibility. Thirty division III male athletes with limited ROM of ≤ 90o of knee extension with 90o of hip flexion while lying supine consented to volunteer. Each subject was treated and measured through a double-blinded experimental design where the subjects and tester were unaware of the real treatment being administered and measured. The research consisted of 4 visits (familiarization/baseline, and 3 data collection session). Testing sessions were conducted a week after the baseline session, followed by two sessions, 2 days and a week after the 1st session. Three different modalities (SASTMTM, Therapeutic Ultrasound and “The Stick”) were performed on a treatment leg, and the opposite leg served as a control. Data collection consisted of a warm-up on a cycle ergometer followed by one randomly chosen modality on the treatment leg. Data collection was conducted using a Cybex 300-isokinetic device and a digital goniometer. Isokinetic strength testing was performed at 60, 180 and 240o/s. Isometric testing was collected at 45o of knee flexion. Repeated two-way ANOVA’s (3-Treatment x 3-Time) were used for statistical analyses to determine the effects of interventions and the time on strength and flexibility. The statistical analyses resulted in no significant results (p≤.05) for acute effects for either strength or flexibility with respect to time, treatment or treatment and time interactions.

Indiana University-Purdue University Indianapolis (IUPUI) / Ligament injury is one of the most prevalent musculoskeletal disorders that may lead to disability or disease, such as osteoarthritis. Conservative interventions which accelerate or augment ligament healing are needed to enhance therapeutic outcomes. The purpose of this research agenda was to investigate the tissue level effects of a type of manual therapy, cross fiber massage (CFM), in particular instrument-assisted CFM (IACFM), on ligament healing. Bilateral knee medial collateral ligament (MCL) injuries were created using an established rodent model where one MCL received IACFM treatment and the other untreated MCL served as a within subjects control. The short and long term effects of IACFM on the biomechanical and histological properties of repairing ligaments were investigated. Tensile mechanical testing was performed to determine ligament mechanical properties. Ligament histology was examined under light microscopy and scanning electron microscopy. IACFM was found to accelerate early ligament healing (4 weeks post-injury), possibly via favorable effects on collagen formation and organization, but minimal improvement was demonstrated in later healing (12 weeks post-injury). Regional blood flow and angiogenesis were investigated as possible mechanisms underlying the accelerated healing found in IACFM-treated ligaments. Laser Doppler perfusion imaging was used to investigate vascular function. Micro-computed tomography was used to determine vascular structural parameters. Compared to untreated contralateral injured controls, IACFM-treated injured knees demonstrated a delayed increase in blood flow and altered microvascular structure, possibly suggesting angiogenesis. Mechanotransduction is discussed as a mechanism for the beneficial effects of CFM in that application of a mechanical force was found to enhance biomechanical and histological properties as well as vascular function and structure acutely in healing ligaments. Although this thesis focused on IACFM treatment of injured knee ligaments, it is plausible for concepts to apply to other manual modalities that offer conservative alternatives to invasive procedures or pharmaceuticals in the treatment of soft tissue injuries.

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work. Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work. Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56). Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Made available in DSpace on 2016-06-02T20:19:21Z (GMT). No. of bitstreams: 1 5121.pdf: 13124971 bytes, checksum: 6e287fe7f29cdce25264d37ed5bc3045 (MD5) Previous issue date: 2013-02-21 / Financiadora de Estudos e Projetos / Background: There is a lack of studies that evaluated within day and between day reliabilities of 3-D scapular kinematics during elevation and lowering of the arm in different shoulder conditions, as well as studies about low-amplitude and high-velocity thoracic spine manipulation (TSM) effects on scapular kinematics in subjects with shoulder dysfunctions. Objective: To establish within day and between day reliability of scapular motion during elevation and lowering of the arm and at rest position and to evaluate the immediate effects of a TSM on pain and scapular kinematics during elevation and lowering of the arm, both in subjects with and without shoulder impingement syndrome (SIS). Methods: Kinematic data were collected using Flock of Birds® electromagnetic device. Subjects were divided in 2 groups: control and impingement. For reliability kinematic data were collected during elevation and lowering of the arm and at rest position on 2 different occasions separated by 3 to 5 days. Forty-nine subjects were tested for within day reliability. Forty-three subjects were reassessed for between day reliability. For kinematic evaluation pre- and ppost-manipulation, scapular kinematics was collected during elevation and lowering of the arm before and immediately after the intervention. Numeric pain rating scale was used to assess shoulder pain during arm movement at pre- and post- intervention. Fifty subjects (31.76 ± 10.91 years) with SIS and 47 subjects (25.76 ± 5.01 years) asymptomatic for shoulder dysfunctions were randomly assigned to one of the groups: manipulation or sham. Results: There was very good within day reliability for assessing scapular internal and upward rotations and tilt from both groups during elevation and lowering of the arm (ICC=0.92-0.99). In general, there was good between day reliability for assessing scapular motion during elevation and lowering of the arm from both groups (ICC=0.54-0.88). There was also good and very good between day reliability for assessing scapular rest position in both groups (ICC=0.66-0.95). Study 2: Subjects with SIS experienced reduced shoulder pain (from 3.29 to 2.45, p<0.01) during arm movement immediately after TSM. Subjects with and without SIS who received TSM and asymptomatic subjects who received sham intervention showed significant increase in scapular upward rotation at post-intervention. Increase in scapular anterior tilt at postmanipulation was also observed in asymptomatic subjects who received TSM. Conclusion: Flock of Birds® electromagnetic tracking system is a reliable device for measuring 3-D scapular motion during elevation and lowering of the arm and at rest position in subjects with and without impingement symptoms over time. TSM is associated with improved shoulder pain and scapular upward rotation in subjects with SIS. Although with questionable clinical relevance, TSM may not be immediately favorable to scapular tilt in asymptomatic subjects. / Além da escassez de evidências a respeito da confiabilidade entre repetições e dias da avaliação cinemática 3-D da escápula durante a elevação e descida do braço em diferentes condições do ombro, estudos sobre os efeitos da manipulação torácica de alta velocidade e baixa amplitude (MT) na cinemática escapular em sujeitos assintomáticos e portadores de disfunções no ombro também são bastante escassos. Objetivo: Determinar a confiabilidade entre repetições e entre dias das medidas do movimento 3-D da escápula durante a elevação e descida do braço e na posição de repouso e avaliar os efeitos imediatos de uma MT na dor e na cinemática da escápula durante a elevação e descida do braço, ambos em sujeitos assintomáticos e portadores da síndrome do impacto (SI). Métodos: Para a avaliação cinemática foi utilizado o dispositivo eletromagnético Flock of Birds®. Os sujeitos foram divididos em 2 grupos (controle e impacto). Os dados cinemáticos para a confiabilidade foram coletados durante a elevação e descida do braço e na posição de repouso em duas ocasiões diferentes separadas por 3 a 5 dias. Quarenta e nove sujeitos foram avaliados para a confiabilidade entre repetições e quarenta e três sujeitos foram avaliados para a confiabilidade entre dias. Para a avaliação pré e pós-manipulação os dados cinemáticos foram coletados durante a elevação e descida do braço antes e imediatamente após a intervenção. A escala numérica de dor mediu a dor durante o movimento do braço antes e após a intervenção. Cinquenta sujeitos (31,76 ± 10,91 anos) com SI e 47 sujeitos (25,76 ± 5,01 anos) assintomáticos para disfunções no ombro foram aleatoriamente designados a um dos seguintes grupos : manipulação ou sham. Resultados: A confiabilidade das medidas entre as repetições foi excelente para as rotações medial e superior e para a inclinação da escápula em ambos os grupos durante a elevação e a descida do braço (CCI=0,92-0,99). No geral, confiabilidade entre dias para avaliar os movimentos escapulares durante a elevação e a descida do braço para ambos os grupos foi boa (CCI=0,54-0,88). A confiabilidade entre dias também foi boa e excelente para as rotações escapulares durante a posição de repouso em ambos os grupos (ICC=0,66-0,95). Houve melhora significativa da dor nos sujeitos com SI (de 3,29 para 2,45, p<0,01) durante o movimento do braço imediatamente após a MT. Os sujeitos com e sem SI que receberam a MT e os sujeitos assintomáticos que receberam a intervenção sham apresentaram significativo aumento na rotação superior da escápula após a intervenção. O aumento na inclinação anterior após a manipulação também foi observado nos sujeitos assintomáticos que receberam a MT. Conclusão: O Flock of Birds® é um dispositivo eletromagnético confiável para medir ao longo do tempo o movimento 3-D da escápula durante a elevação e descida do braço e na posição de repouso em sujeitos assintomáticos e portadores de SI ao longo do tempo. A MT está associada com a melhora da dor e da rotação superior da escápula nos sujeitos com SI. E, apesar da questionável relevância clínica, a MT pode não ser imediatamente favorável para a inclinação escapular nos sujeitos assintomáticos.

Submitted by Bruna Rodrigues (bruna92rodrigues@yahoo.com.br) on 2016-10-03T12:59:30Z No. of bitstreams: 1 TeseMNH.pdf: 1453015 bytes, checksum: dc886893af7e51ac61e4ea5fdd4b63b6 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T14:22:00Z (GMT) No. of bitstreams: 1 TeseMNH.pdf: 1453015 bytes, checksum: dc886893af7e51ac61e4ea5fdd4b63b6 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T14:22:09Z (GMT) No. of bitstreams: 1 TeseMNH.pdf: 1453015 bytes, checksum: dc886893af7e51ac61e4ea5fdd4b63b6 (MD5) / Made available in DSpace on 2016-10-10T14:22:17Z (GMT). No. of bitstreams: 1 TeseMNH.pdf: 1453015 bytes, checksum: dc886893af7e51ac61e4ea5fdd4b63b6 (MD5) Previous issue date: 2015-11-18 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Background: Shoulder impingement syndrome (SIS) is a common cause of shoulder pain complains and numerous treatment strategies are available in the clinic. Questions remain regarding the effects of Thoracic Spinal Manipulation (TSM) on SIS and concerning the efficacy of available techniques on the treatment of this population. Objectives: In a clinical trial, the objective was to evaluate short-term effects of a TSM on pain, function, scapular kinematics and scapular muscle activity in individuals with SIS. In a systematic review, the objective was to summarize current evidence regarding effectiveness of physical therapy to improve pain, function and range of motion in this population. Methods: In the clinical trial, participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Shoulder pain, shoulder function (DASH and WORC questionnaires), scapular kinematics and scapular muscle activity were measured. A blinded assessor evaluated the outcomes at day 1, day 2-pre, day 2-post and day 3. In the review, Pubmed, Web of Science, CINAHL Cochrane, Embase, Lilacs, Ibecs and Scielo databases were searched up to April 2015. Randomized controlled trials investigating different modalities of physical therapy in the treatment of patients with SIS on pain, function/disability or range of motion were included. Results: In the clinical trial, TSM group improved pain (1.1 points) and tended to improve function (5.0 points on WORC) over the sham-TSM group after 2 intervention sessions. Scapular upward rotation increased 4.0°, 5.3° and 3.3° at day 2-pre, day 2-post and day 3, respectively, in the TSM group during lowering of the arm. Changes in scapular internal rotation and tilt were not different between groups. Upper and lower trapezius activity decreased in the TSM group and both groups, respectively, during elevation and lowering of the arm. Serratus anterior activity increased in the sham-TSM group. In the review, sixty-two RCTs were included. The majority had a low to moderate risk of bias. Exercise therapy provided high evidence of improvements to the treatment in the short, mid or long-term. Dynamic humeral centering, proprioceptive exercises and manual therapy associated with conventional exercises enhance the improvements in the short-term. Low-level laser, ultrasound, pulsed electromagnetic field and kinesio taping provided moderate and high evidence level towards no benefits to the treatment of SIS. Microwave diathermy, transcutaneous electrical nerve stimulation and isolated manual therapy or acupuncture provided limited evidence of benefits. Conclusion: TSM may be worthy to achieve short-term reduction of shoulder pain, increase of scapular upward rotation and decrease of upper trapezius activity facilitating the application of other movement-based interventions in individuals with SIS. Exercise therapy should be used as the first choice to improve pain, function and range of motion, and the association of manual therapy should be the best choice to accelerate symptoms decrease and progress exercise therapy quickly. Low-level laser therapy, ultrasound, pulsed electromagnetic field and kinesio taping do not provide significant effects to the therapy and therefore could be avoided. More studies are necessary to improve evidence concerning effects of diacutaneous fibrolysis, microwave diathermy, transcutaneous electrical stimulation, acupuncture and isolated manual therapy techniques in the treatment of SIS. / Introdução: A Síndrome do Impacto (SI) é uma causa comum de dor no ombro e inúmeras estratégias de tratamento estão disponíveis na clínica. Os efeitos da manipulação torácica e a eficácia de muitas técnicas de tratamento da SI ainda não estão claros na literatura. Objetivos: Em um ensaio clínico, os objetivos foram avaliar os efeitos a curto-prazo de uma manipulação torácica na dor, função, cinematica scapular e atividade muscular em indivíduos portadores de SI. Em uma revisão sistemática, o objetivo foi sintetizar a atual evidência a respeito da efetividade da fisioterapia para melhorar a dor, função e amplitude de movimento nessa mesma população. Métodos: No ensaio clínico, os participantes foram distribuídos aleatoriamente ao grupo manipulação (n=30) ou grupo sham (n=31) e receberam 2 sessões de intervenção durante 1 semana. Foram medidos dor e função do ombro (questionários DASH e WORC), cinematica e atividade muscular da escápula. Um avaliador cego coletou as variáveis no dia 1, dia 2-pré intervenção, dia 2 pós-intervenção e no dia 3. Na revisão sistemática, as buscas foram realizadas nas bases de dados Pubmed, Web of Science, CINAHL Cochrane, Embase, Lilacs, Ibecs e Scielo até abril de 2015. Foram incluídos ensaios clínicos randomizados controlados que investigaram o efeito de diferentes modalidades fisioterapêuticas no tratamento de pacientes com SI na dor, função e amplitude de movimento. Resultados: No ensaio clínico, o grupo manipulação apresentou diminuição da dor (1.1 pontos) e uma tendência de melhora na função (5.0 pontos no WORC) comparado ao grupo sham após 2 intervenções. A rotação superior da scapula aumentou 4.0°, 5.3° e 3.3° no dia 2 pré-intervenção, dia 2 pós-intervenção e no dia 3, respectivamente durante a descida do braço. As mudanças na rotação interna e na inclinação da scapula não foram diferentes entre os grupos. Atividade do trapézio superior e trapézio inferior diminuiu no grupo manipulação e em ambos grupos, respectivamente. A atividade do serrátil anterior aumentou no grupo sham. Na revisão sistemática, 62 estudos controlados randomizados foram incluídos. A maioria dos estudos apresentou baixo risco de vies. Os exercícios terapêuticos apresentaram alta evidência de melhora no tratamento a curto, médio e longo prazo. Os exercícios proprioceptivos e a terapia manual associada com exercícios convencionais aumentam as melhoras a curto prazo. O laser de baixa intensidade, ultrassom, campo pulsado eletromagnético e o tape proporcionaram evidência moderada e alta de nenhum benefício ao tratamento. As terapias com ondas curtas, estimulação transcutânea eletromagnética, a terapia manual aplicada de forma isolada e a acupuntura apresentaram evidência limitada de benefícios. Conclusão: A manipulação torácica parece proporcionar a curto prazo redução da dor no ombro, aumento da rotação superior da scapula e diminuição da atividade do trapézio superior facilitando a aplicação de outras terapias focadas no restabelecimento do movimento em pacientes com SI. Os exercícios terapêuticos devem ser utilizados como primeira opção para melhorar a dor, a função e a amplitude de movimento, e a associação dos exercícios com a terapia manual deve ser a melhor opção para acelerar a melhora dos sintomas. O laser de baixa intensidade, ultrassom, campo eletromagnético pulsado e o tape não proporcionam efeitos significativos à terapia, portanto, devem ser evitados. Mais estudos são necessaries para aperfeiçoar a evidência a respeito da terapia com ondas curtas, miofibrólise, estimulação elétrica transcutânea, acupuntura e terapia manual aplicada isoladamente no tratamento da SI.

Low back pain (LBP) is regarded as a major health and economic problem in western industrialised countries even at this time in the twenty-first century. Researchers estimate that it has increased to affect about 45% of the population in 2011. This increase creates a major burden on the health care services, social structures and the economy in terms of absenteeism from work. CNSLBP is still poorly understood. Main reasons for the poor understanding of CNSLBP discussed in this study are the limited understanding of the effect of the spine as kinetic chain which includes the head and pelvic girdle and with its attachments to the scapulae . The process of development of ISMS dysfunction are discussed as a combination of abnormal spinal loading, soft and neural tissue plasticity that result in biomechanical malalignment, adaptive and maladaptive movement patterns, pain processing integrated with psychosocial factors that influence the biomechanical, pain processing and psychological responses are discussed as possible mechanisms in the development of CNSLBP. The researcher developed a multidimensional manual therapy model to manage patients with CNSLBP based on metacognitive reflection on her clinical reasoning over a period of 40 years as the research methodology. The metacognitive reflection has been performed within the interpretive paradigm The model that resulted from the metacognitive reflection is dialectic in nature because it entails the understanding of the patient‘s problem from an interpretive as well as from an empirico-analytical perspective. The model is conceptualised in three stages: Firstly the conceptualisation of the integrated spinal movement system (ISMS), to indicate that the spine, head, shoulder and pelvic girdles function as a closed kinematic chain. Secondly the process of the development of ISMS dysfunction as a major concept in the clinical picture of patients with CNSLBP is based on functional anatomy of the ISMS and the researcher‘s clinical observation in clinical practice. The researcher indicates how the development of ISMS dysfunction and characteristic adaptive behaviour are integrated components of the patient‘s complex heterogenic clinical picture. The underlying process for the development of ISMS dysfunction as a possible mechanism for CNSLBP is described as plasticity of soft and neural tissues (including the brain) which result in chronicity over time. Thirdly a multidimensional manual therapy model to manage patients with CNSLBP‘s heterogenic condition is discussed. The model indicates how the mechanisms underlying the development of ISMS dysfunction is addressed in a multidimensional approach to patient management. Finally the multidimensional manual therapy model is discussed in relation to other relevant intervention approaches. The model finally serves as a point of departure for planning and conducting appropriate research in basic and clinical sciences. The multidimensional manual therapy model for the management of patients with CNSLBP has been developed in clinical practice and is presented as a practicetheory in the form of a model. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiotherapy / Unrestricted

Avec le vieillissement de la population, il est à prévoir que les chiropraticiens traiteront plus souvent des patients vieillissants. Les comorbidités et les changements musculosquelettiques observés lors du vieillissement nécessitent que les chiropraticiens modifient les soins de thérapie manuelle qu’ils prodiguent afin de ne pas occasionner d’effets indésirables chez ces patients. Quoique des recommandations aient été proposée par Hawk et al. (2017), la façon dont les chiropraticiens traitent les patients vieillissants et la façon dont ils appliquent ces recommandations sont inconnues. L’objectif de cette recherche était donc d’identifier et de comprendre les croyances et les perceptions relatives aux pratiques et comportements qui sous-tendent la façon dont les chiropraticiens adaptent leurs soins, plus particulièrement l’exécution des thérapies manuelles, chez un adulte vieillissant. Cette étude qualitative s’est intéressée aux pratiques et aux croyances relatives aux stratégies d’adaptations utilisées par les chiropraticiens à l’aide de questionnaires et d’une entrevue semi-dirigée d’une heure. Des chiropraticiens avec plus de 5 ans d’expérience clinique ont été recrutés. Les données démographiques des participants ont été analysées de manière descriptive. Une analyse thématique incorporant les thèmes abordés par Hawk et al. (2017) et des thèmes émergents a été effectuée à partir des questionnaires, des entrevues et des notes de l’interviewer. Neuf chiropraticiens ont été inclus dans cette étude. Quatre thèmes ont été identifiés, soit la définition d’un patient vieillissant, les raisons des modifications des soins de thérapie manuelle, 6 les stratégies d’adaptation des soins de thérapie manuelle et les objectifs ultimes poursuivis. La définition d’un patient vieillissant est beaucoup plus complexe, car elle incorpore d’autres facteurs que seulement l’âge et varie d’un participant à l’autre. Les chiropraticiens ne modifient donc pas leurs soins seulement en fonction de l’âge, mais plutôt en fonction de l’état de santé de leurs patients vieillissants. Ce qu’ils considèrent être une contre-indication à certaines interventions varie. Les stratégies d’adaptation qu’ils utilisent sont des techniques qu’ils considèrent comme étant de force plus faible que la manipulation articulaire. Les techniques utilisées varient cependant d’un participant à l’autre. Ils considèrent qu’en faisant cela, ils limitent le risque de survenue d’effet secondaire et d’être impliqués dans des recours légaux, tout en assurant la sécurité des soins. Cette étude démontre l’importance de considérer d’autres facteurs que l’âge lorsqu’il est question d’étudier les patients vieillissants. Quoique certaines pratiques et croyances communes ont été identifiées, il semble exister plusieurs différences entre les participants quant aux raisons qui sous-tendent les modifications des soins et les techniques de thérapie manuelles utilisées. Il apparaît essentiel d'investiguer la provenance de ces pratiques et croyances ainsi que l'adéquation entre celles-ci et les pratiques réelles des chiropraticiens. / As the population ages, it is to be expected that chiropractors will be treating aging patients more frequently. The comorbidities and musculoskeletal changes seen with aging require chiropractors to modify the manual therapy care they provide minimize the risk of adverse effects in these patients. Although recommendations have been proposed by Hawk et al. (2017), how chiropractors treat aging patients and how they apply these recommendations is unknown. The aim of this research was therefore to identify and understand the beliefs, practices and behaviours that underpin how chiropractors adapt their care, specifically the performance of manual therapies, in an aging adult. This qualitative study investigated the practices and beliefs related to adaptive strategies used by chiropractors, using questionnaires and a semi-structured interview. Chiropractors with more than 5 years of clinical experience were recruited. Participant demographic information was analyzed descriptively. A thematic analysis method incorporating themes addressed by Hawk et al. (2017) and newly emerged themes was performed based on questionnaires, interviews and interviewer notes. Nine chiropractors were included in this study. Four themes were identified: definition of an aging patient, reasons for changes in manual therapy care, strategies for adapting manual therapy care and ultimate goals pursued. The definition of an aging patient is much more complex than just age and varies from one participant to another. Chiropractors therefore do not modify their care solely according to age, but rather according to their patients' state of health. What 8 they consider to be a contraindication to certain interventions varies. The coping strategies they use are techniques they consider to be of lower strength than joint manipulation. The techniques used also vary from participants to participant. They consider that by doing so, they limit the risk of side effects and of becoming involved in legal proceedings, while ensuring safe care. This study demonstrates the importance to considerate other factors rather than just age when caring for older adults. Although some common practices and beliefs were described, there appeared to be many differences between participants as to the reasons behind the changes in care and the manual therapy techniques used. It seems essential to investigate the origins of these practices and beliefs as well as the link between these with the real practices of chiropractors.

Hintergrund: Das subacromiale Schmerzsyndrom (SAPS) ist ein häufiges muskuloskelettales Krankheitsbild. Patienten haben eine eingeschränkte schmerzhafte Schulterbeweglichkeit. Der Pathomechanismus ist noch nicht ganz geklärt. Umliegende Gelenke können durch Bewegungseinschränkungen das SAPS beeinflussen. Die vorliegende Bachelorthesis soll eine Literaturübersicht über osteopathische Behandlungsmöglichkeiten beim SAPS geben. Methodik: Sieben medizinische Datenbanken wurden auf zwischen 2010 und 2023 veröffentlichte relevante Artikel durchsucht. Eingeschlossen wurden randomisierte klinische Studien (RCT), in deutscher und englischer Sprache, in denen osteopathische Techniken, bei menschlichen Probanden mit einem SAPS, eingesetzt wurden. Die Ergebnisse wurden mit einer Kontrollgruppe oder anderen Interventionen verglichen. Ergebnisse: Die Suche ergab 782 einzelne Artikel. 14 Studien erfüllten die Einschlusskriterien und wurden in der PICO Übersicht eingeschlossen. Zehn Studien verwendeten Manipulationstechniken und vier Studien Weichteiltechniken mit Heimübungen. Die Ergebnisse zeigen, dass die Techniken sich positiv auf das SAPS auswirken. Eine Signifikanz zwischen den Gruppen ist häufig nicht vorhanden. Schlussfolgerung: Alle Studien zeigen nach osteopathischen Behandlungen eine Verbesserung der Beschwerden mit SAPS. Manipulation reicht als alleinige Behandlung nicht aus, um einen Langzeiteffekt zu erzeugen. Eine individualisierte Kombinationstherapie mit verschiedenen Behandlungstechniken und Heimübungen, ist für die effektive, klinische, Patientenbehandlung besser geeignet. Zukünftige Untersuchungen sollten vermehrt osteopathische Techniken untersuchen, um das positive Bild der osteopathischen Behandlung zu festigen und das mögliche Ausmaß der Verbesserungen zu ermitteln. / Background: Subacromial pain syndrome (SAPS) is a common musculoskeletal condition. Patients have limited painful shoulder mobility. The pathomechanism has not yet been fully elucidated. Surrounding joints can affect the SAPS through movement restrictions. This bachelor thesis is intended to provide a literature review on osteopathic treatment options for SAPS. Methods: Seven medical databases were searched for relevant articles published between 2010 and 2023. Included were randomized clinical trials (RCT), in German and English, in which osteopathic techniques were used on human subjects with SAPS. The results were compared to a control group or other interven-tions. Results: The search returned 782 individual articles. 14 studies met the inclusion criteria and were included in the PICO review. Ten studies used manipulation techniques and four studies used soft-tissue techniques with home exercises. The results show that the techniques have a positive effect on the SAPS. Significance between groups is often absent. Conclusion: All studies show an improvement in symptoms with SAPS after osteopathic treatments. Manipulation alone is not enough to produce a long-term effect. An individualized combination therapy with different treatment techniques and home exercises is more suitable for the effective, clinical, patient treatment. Future investigations should examine more osteopathic techniques in order to consolidate the positive image of osteopathic treatment and to determine the pos-sible extent of the improvements.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Myofascial Pain and Dysfunction (MPD) is a diagnosis commonly encountered by practitioners, hence, there are several treatment approaches employed by various practicing physicians. Practitioners are required to perform evidence-based protocols on patients; however, such intervention becomes increasingly difficult with the increasing volume of evidence available with regards to treatment of MPD. A systematic review provides a well-structured, critical analysis of the available protocols, and as such, provides practitioners with an evidence-based summary of the available modalities and the effectiveness of these modalities. Thus, the aim of the study was to systematically review and evaluate the literature to determine the effects of various non-invasive modalities on MPD. Objectives: Studies investigating various non-invasive modalities were identified, evaluated against the inclusion criteria and then reviewed against PEDro criteria to present current available evidence regarding their effectiveness as a source of treatment for MPD. Methods: A literature search was conducted, based on key terms including: active and latent myofascial trigger points, manual therapy, manipulation, acupressure, massage, muscle stretching, ultrasound, transcutaneous electric nerve stimulation, electric stimulation therapy, magnetic field therapy, and exercise therapy. Databases searched were: PubMed, EBSCOhost, Medline, CINAL, Proquest, Health Source, Sport Discus, Science Direct, Springer Link, Google Scholar and Summons. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. Thereafter, the articles were reviewed by four independent reviewers and the researcher. The PEDro Scale was used to determine methodological rigor of the included studies. The results were then analysed and ranked. Results: Following the screening process during data collection for this study, a total of 25 studies were identified and included. The review and ranking of these studies revealed a moderate level of evidence present for the effectiveness of Topical Agents. A limited level of evidence was noted for TENS, Ischemic Compression, Ultrasound, Laser and Other Modalities. Approximately 25% of the reviewed studies involved combination therapies; hence their outcomes cannot be applied to the effectiveness of individual modalities. Conclusion: Upon comparison of the quality of evidence available for the various types of modalities present for the treatment of MPD, it was noted that Topical Agents were supported by a stronger level of evidence than TENS, Ischeamic Compression, Ultrasound, Laser and Other Modalities. However, due to a lack of strong overall evidence for any of these modalities it has been concluded that more research is required to establish which modality is in fact the most effective.

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