Background: Various treatments are being tried for lumbar neuropathy. Among them, neural mobilization aims to reduce peripheral nerve sensitivity by stimulating them directly. Similarly, applying kinesiotape stimulates skin and joint receptors around the nerves, thereby affecting nerve function and movement. Objectives: To investigated the effect of low back pain on the neural mobilization and kinesiotaping. Design: Randomized controlled trial. Methods: Thirty patients with chronic low back pain were randomly allocated to three groups: the neural mobilization exercise with kinesiotaping group (NEKTG, n=10), the neural mobilization exercise group (NEG, n=10), and the kinesiotaping group (KTG, n=10). Each group performed six intervention sessions over two weeks. The results were analyzed by measuring the numeric pain rating scale (NPRS) and straight leg raise (SLR) before and after the intervention in each group. Results: NEKTG, NEG, and KTG all indicated a significant decrease in the back pain index before and after the intervention. However, there were no differences observed between the three groups. The SLR angles before the experiment were identical across the three groups. The SLR angles before and after the intervention were as follows: the SLR angle significantly increased in NEKTG. Furthermore, there was a significant increase in the SLR angle in NEKTG compared to both NEG and KTG. Conclusion: Neural mobilization combined with kinesiotaping provided better therapeutic effects regarding pain reduction and neurodynamic improvement compared to alone kinesiotaping and mobilization with chronic low back pain.

Background: Most non-pharmacological interventions for tension-type headache (TTH) focus on direct intervention in areas associated with headaches, with limited research exploring the indirect effects of interventions utilizing the fascia. Objectives: To investigate the effects of superficial back line (SBL) stretching and head-neck massage interventions on the range of motion (ROM) and neck disability index (NDI) of TTH. Design: Randomized controlled trial. Methods: The study participants were randomly allocated into three groups: SBL stretching group (n=9), head-neck massage group (n=9), and combined group (n=9). Prior to the intervention, measurements were taken for neck flexion ROM, straight leg raising test (SLRT) ROM, and NDI. The intervention consisted of 30-minute sessions conducted twice a week for 8 weeks. The second measurement took place 4 weeks after the intervention, followed by a third measurement conducted after an additional 4 weeks of intervention. Results: Comparing neck flexion ROM within each group, a significant increase was observed in the SBL stretching group after 8 weeks compared to before the intervention (P<.05). Regarding the comparison of SLRT ROM within each group, a significant increase was noted after 8 weeks compared to before the intervention in the SBL stretching, head-neck massage, and combined groups (P<.05). In terms of the comparison of NDI within each group, a significant decrease was observed in all three group after the intervention compared to before the intervention (P<.05). Conclusion: 8-week intervention involving SBL stretching, head-neck massage, and their combined application demonstrated effectiveness in improving neck flexion ROM, SLRT ROM, and the NDI for individuals with TTH.

Background: Chronic back pain not only causes physical discomfort and decreased functionality but also affects emotional well-being, resulting in feelings of anxiety, depression, and other psychological issues. Studies have indicated that cognitive functional therapy and motor control exercises can alleviate chronic low back pain and associated psychological issues. Objectives: To investigated the effect of chronic low back pain on the cognitive functional therapy (CFT) and motor control exercises (MCE). Design: Quaxi-experimental study. Methods: Forty patients with chronic low back pain were randomly assigned and divided into 20 cognitive functional therapy group with motor control exercises group (CFTMG) and 20 patients in motor control exercises group (MCEG). After applying CFT with motor control exercises and motor control exercises for 8 weeks, changes in numeric pain rating scale (NPRS), Oswestry disability index (ODI) and Fear-avoidance beliefs questionnaire (FABQ) were observed. Results: In the CFTMG, statistically significant changes were observed in NPRS, ODI, and FABQ before and after the intervention. In the MCEG, statistically significant changes were observed in VAS and ODI before and after the intervention. Conclusion: The application of CFTM and MCE in patients suffering from chronic low back pain has demonstrated effectiveness in alleviating pain, enhancing back function, and reducing kinesiophobia associated with the condition.

Background: Research has been conducted on pain neuroscience education (PNE) for the relief of pain and symptoms associated with chronic neck pain (CNP). Focusing on the neurophysiology and neurobiology of chronic pain, pain processing, and particularly the function of the central nervous system for chronic pain, PNE helps patients to understand the causes of pain. Objectives: To investigate and systematically review interventional studies on the effectiveness of PNE for patients with CNP and to analyze the effect size by performing a meta-analysis. Design: A systematic review and meta-analysis protocol. Methods: The following databases and electronic collections will be searched for primary studies without time limits: PubMed, MEDLINE, OVID Embase, and CENTRAL in the Cochrane Library. Reference lists from identified studies will be manually hand-searched for additional relevant works. Patients 18 years of age and older with nonspecific neck pain lasting 3 months or longer will be included in the study, with exclusion criteria as follows: cancer pain, fractures of the spine or surgical intervention, cognitive impairment that does not allow the patient to follow the PNE program, pregnancy, chronic fatigue syndrome, fibromyalgia, and other related pathologies that may prevent full participation in the PNE program. There are no geographic restrictions; however, non- English studies will be excluded. Discussion: This study aims to evaluate the effects of PNE on pain and disability in chronic neck pain. Its results will help clarify whether the use of PNE alone can improve chronic pain. The advantages of systematic reviews include clear definitions and inclusion and exclusion criteria, standardized search formats, and objective independent reviews.

Background: Pain neuroscience education (PNE) with other therapeutic approaches can reduce pain intensity in patients with Chronic musculoskeletal pain and chronic spine pain by improving quality of life and disability. However, in various clinical trials and reviews, the optimal dose of an intervention combined with PNE is still an area to be studied. Objectives: To investigated the effect of forward head posture (FHP) with chronic neck pain on the PNE combined with cervical and thoracic mobilization. Design: A non-randomized, controlled intervention study. Methods: Thirty-two subjects were allocated to pain neuroscience education combined with cervical and thoracic mobilization group (PCTMG, n=17) and cervical and thoracic mobilization with TENS group (CTMG, n=15). For 6 weeks, the PCTM group applied PNE and cervical and thoracic mobilization and the CTM group applied cervical and thoracic mobilization and TENS. Changes in intervention pre-post pain and kinesiophobia were observed. Results: Results from the study indicated that statistically significant decrease in VAS and TSK-11 in PCTMG. In CTMG, there was a statistically significant decrease in VAS. And in PCTMG, there was a statistically significant decrease in VAS and TSK-11 than in CTMG. Conclusion: Therefore, this study confirmed that PNE combined with cervical thoracic mobilization is an effective intervention compared to ervical thoracic mobilization alone in reducing pain and kinesiophobia in FHP with chronic neck pain.

Background: Previous studies have reported that improving the spinal stability could be more effective in the prevention and treatment of recurrence. Lumbar stabilization exercise is known to strengthen the lumbar extension muscles and enhance physical, psychological and social functions. Objectives: To investigated the effect of lumbar spiral stenosis on the kinetic link training and lumbar stabilization exercise. Design: A randomized controlled trial. Methods: Study was preformed by randomly allocated 28 LSS participants into a kinetic link training group (KLT, n=14) and a lumbar stabilization exercise group (LSE, n=14). Kinetic link training and lumbar stabilization exercise were performed to subjects in both groups 5 times a week for 6 weeks. To verify the effect of LSS, changes in VAS, ODI, and proprioception before and after intervention were observed. Results: In KLT, statistically significant changes were found in VAS, ODI, and Proprioception before and after intervention. In LSE, there were significant changes in VAS and ODI before and after intervention. KLT and LSE before and after intervention indicated significant differences in proprioception. Conclusion: KLT and LSE are applied to LSS, there are effects of pain decrease, lumbar recovery and proprioception improvement.

Background: Women patients who have undergone high tibial osteotomy need management to control walking and balance and to enable functional daily life. In that way, land-based physical therapy and aquatic physical therapy were performed. Objectives: To investigated the effect of land-based and aquatic physical therapy on the balance and walking of women who had undergone high tibial osteotomy. Design: Randomized control trial. Methods: In all, this randomized controlled trial enrolled 21 patients with high tibial osteotomy who received land-based physical therapy (LP, n=7), aquatic physical therapy (AP, n=7), and land-based and aquatic physical therapy (LAP, n=7). Single-leg standing balance, 10-m walk test, and Knee injury and Osteoarthritis Outcome (KOOS-12) scores were. The intervention period was 3 days per week for 6 weeks. Results: One-leg standing balance and 10-m walk test increased statistically, and KOOS-12 score also increased statistically. All three groups have improved. As a result, the variable changes were compared in three groups, and although there was no significant difference between the land-based and aquatic physical therapy groups, the land-based and aquatic physical therapy combined programs improved further than the previous two groups. Conclusion: The balance and walking of female patients with high tibial osteotomy were found to have been very effective in land physical therapy and aquatic physical therapy. In addition, the land-based and aquatic physical therapy combination program can improve balance and walking more effectively.

Background: Scoliosis can be caused by postural changes. The effects of Schroth exercises and Kinesio taping for scoliosis have been reported independently, but there are few studies on the effects of combining both methods. Objectives: To investigated the effects of Schroth exercises and kinesio taping on the Cobb angle and dynamic balance ability in patients with scoliosis. Design: Quaxi-experimental study. Methods: Participants were divided into the taping (n=3) and non-taping (n=3) groups. Pre-tests for the Cobb angle and dynamic balance were performed prior to the first intervention, and post-tests were performed after the intervention was completed. The non-taping group performed Schroth exercises for a total of 12 35-minute sessions thrice a week for 6 weeks. Meanwhile, in the taping group, Kinesio tape was attached before performing the same exercises and was maintained for 24 hours after the exercises were finished. Results: In the taping group, there was no significant change in the Cobb angle and dynamic balance ability pre- and post-intervention (P>.05). Similarly, there was no significant change in the Cobb angle and dynamic balance ability pre- and post-intervention (P>.05) in the non-taping group. Furthermore, there was no significant difference upon comparing the two groups (P>.05). Conclusion: Kinesio taping combined with Schroth exercises did not give additional benefits in terms of the Cobb angle and dynamic balance ability than that in the application of Schorth exercises alone.

Background: Volleyball is a team sport that requires a lot of movement and explosive movement. Volleyball players have different roles depending on their position. The reason is that the spiker or center is tall and the libero or setter is relatively small compared to other positions. Objectives: To investigate a difference in basic physical fitness according to the positions of volleyball players and to examine the correlation between basic physical fitness items. Design: Correlational research designs. Methods: A total of 33 male professional volleyball players were recruited for each position by position: 15 spikers, 7 centers, 5 setters, and 6 liberos. Muscle endurance, power, agility, and balance ability were measured as basic physical fitness items. Results: There was a statistically significant difference in agility according to each position (P<.05), and a positive correlation was indicated in muscle endurance and power (P<.05). Conclusion: A training program can be developed based on the correlation between training and basic physical fitness according to the positions of volleyball players.

Background: Short foot exercise, which is an intrinsic foot muscle exercise proposed by the foot core system, is used to improve the strength of intrinsic foot muscles and sensory input and function of the foot. However, there is a lack of studies that assessed the improvement in foot function after short foot exercise in patients undergoing rehabilitation after a modified Broström operation of the ankle joint. Objectives: To investigate the effects of short foot exercise on intrinsic foot muscle cross-sectional area and balance ability in patients who had undergone a modified Broström operation of the ankle joint. Design: A single blind, randomized controlled trial. Methods: Sixteen patients who were undergoing ankle rehabilitation exercises following the modified Broström operation were randomized into two groups. General physical therapy, short foot exercises, and ankle rehabilitation programs were performed in the experimental group (n=8), whereas general physical therapy and ankle rehabilitation programs were performed in the control group (n=8). For outcome measures, the intrinsic muscles of the foot were imaged using the Sonimage HS1 musculoskeletal ultrasound system. The Y-balance test and RS-foot scan system were used to confirm dynamic balance ability and static balance ability. Results: The cross-sectional area of the abductor hallucis and dynamic balance ability significantly improved in the experimental group that underwent short foot exercise compared to the control group (P<.05). In contrast, static balance ability was not significantly different between the two groups (P>.05). Conclusion: Short foot exercise successfully increased the cross-sectional area of the abductor muscle and improved dynamic balance after a modified Broström operation

Background: Stroke patients have dosiflexor weakness. Functional electrical stimulation (FES) for motor and sensory threshold stimulation has been applied to patients with stroke. Objectives: To investigate effects of FES intervention for motor and sensory threshold on balance and gait in subacute patients with stroke. Design: A randomized controlled trial. Methods: In all, 34 patients with subacute stroke were recruited and randomly assigned to the motor threshold (MTG, n=17) and sensory threshold group (STG, n=17). The measured variables were static balance (BioRescue), dynamic balance (BBS), and gait (TUG test). The study period was 5 weeks, twice a day, 5 days a week. Results: There was a significant difference in all variables except the speed variable (open eye Romberg test) after the intervention; MTG improved more significantly except for the speed variable of the Romberg test (open eye). BBS score increased significantly only in the MTG group after the intervention, and the increase was more significant in the MTG group than in the STG group. The TUG test significantly decreased in both groups after the intervention, and the decrease was more significant in the MTG group than in the STG group. Conclusion: FES for motor threshold applied to patients with subacute stroke appears to be more effective in improving balance and gait ability than FES for sensory threshold.

Background: Patients with stroke may show impaired balance due to the limited range of motion of the ankle resulting from abnormal soft tissues surrounding the ankle joint. Changes in the viscoelasticity of soft tissues and decreased mobility of the ankle impair the balance and lead to problems in the daily life of patients with stroke. Joint mobilization and stretching are effective methods of improving balance by increasing the viscoelasticity of soft tissues and range of motion of the ankle. Objectives: To effects of ankle joint mobilization and calf muscle stretching on balance in patients with stroke. Design: A randomized controlled trial. Methods: A total of 20 patients with stroke were randomly assigned into two groups. The joint mobilization group (JMG) underwent anteroposterior joint mobilization of the talocrural joint, while the stretching group (SG) received calf muscle stretching. Functional reach test (FRT), berg balance scale (BBS), and timed up and go test (TUG) were used to assess balance. Results: The FRT, BBS, and TUG results significantly improved in the JMG and SG after invention (P<.05). However, the improvements were greater in the JMG group than those in the SG group (P<.05). Conclusion: Joint mobilization was an effective intervention to improve soft tissue performance and range of motion of the ankle, thereby improving balance in patients with stroke.

Background: Patients with stroke have limited ankle range of motion (ROM) due to soft tissue abnormalities around the ankle and thus experience functional impairment. Increased muscle tension and reduced ankle ROM impair gait and hinder the activities of daily living. Joint mobilization and stretching are effective interventions that improve gait performance by enhancing the ankle ROM. Objectives: To investigate the effects of ankle joint mobilization and calf muscle stretching on gait speed and gait performance in patients with stroke. Design: This was a randomized controlled trial. Methods: Twenty patients with stroke patients were randomized into two groups. The joint mobilization group (JMG) underwent anteroposterior mobilization of the talocrural joint and the joint mobilization stretching group (JMSG) underwent calf muscle stretching in addition to joint mobilization. Gait speed and gait parameters were measured using the 10-meter walk test and the GAITRite. Results: Both the JMG and JMSG groups showed significant improvements in gait speed, affected-side step length, and cadence after the intervention (P<.05). Conclusion: Joint mobilization and stretching were effective interventions for improving gait performance by enhancing ankle function in patients with stroke.

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients’ quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, MyotonⓇPRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

Background: The spinal nerves, which start at the lumbar level, are connected to the nerve innervation in the knees. Currently, there is a lack of research on the treatment of knee pain through lumbar mobilization. Objectives: To investigate the effects of lumbar joint mobilization (LJM) and transcutaneous electronic nerve stimulation (TENS) on proprioception and muscular strength in volleyball players with chronic knee pain. Design: Two group pre-posttest. Methods: A total of 26 professional volleyball players with chronic knee pain were allocated to the LJM (n=13) and TENS (n=13) groups. In the LJM group, grade III - IV amplitude was applied 3 times for 1 minute (80 times per minute) at the affected lumbar (L2-3) facet joint in the prone position. In the TENS group, the TENS treatment device was used to directly apply or 15 minutes to the area of chronic knee pain (100 Hz, 150 ㎲). Proprioception was measured by knee flexion and extension angles, and muscle strength was evaluated using an isokinetic test. Measurements were taken before and after interventions. Results: In the eye opened conditiond, proprioception significantly increased during both knee extension and flexion after LJM, while only knee extension was significantly increased in the TENS group. There was also a significant difference in knee extension between the two groups. In the eye close conditiond, proprioception was significantly improved only during knee extension in the LJM group, and the difference in knee extension between the groups was also significant (P<.05). The maximum torque of the affected knee joint was significantly improved at 60°/sec in both groups (P<.05); however, there was no difference between the two groups. There was no significant difference in the maximum flexion torque within or between the groups. Conclusion: This study suggests that LJM improved proprioception and muscular strength in volleyball players with chronic knee pain.

Background: Adults with forward head posture (FHP) often suffer from thoracic hyperkyphosis and thoracic dysfunction, and including reduction of the craniovertebral angle (CV angle) and tightening of the superficial neck muscles. In order to treat thoracic dysfunction, interventions aimed at improving thoracic mobility are necessary. Objectives: To examine the effects of maitland manual mobilization therapy on the thoracic spine in adults with FHP. Design: Single-blind randomized controlled trial. Methods: Thirty adults with FHP who met the selection criteria were randomized to the thoracic multiple joint mobilization (TMJM; n=15) group and the thoracic general joint mobilization (TGJM; n=15) group. Joint mobilizations were performed for 23 minutes a day for 4 weeks continuously, two times per week. Outcome measures were ImageJ, BTS FREE EMG 1000, neck disability Index (NDI). Results: Although changes in the left sternocleidomastoid muscle activity and NDI scores over time between the two groups differed, other variables were noted only changes observed over time. Muscle activity in the right sternocleidomastoid increased again in the TGJM group post-intervention and 2 weeks after the end of the experiment, but changes in other variables were retained or improved, confirming the lasting effects of thoracic joint mobilization. Conclusion: Thoracic multiple joint mobilization may be recommended as a more effective intervention for adults with FHP.

Background: The effect of mobilization on lumbar back pain has been fully described in several clinical aspects, but evidence for muscle strength would be still less clear. Objective: To assess the effect of lumbar mobilization on lower limb strength in healthy individuals. Methods and Analysis: Healthy people aged 18-65 will be included regardless of race or sex. Original peer-reviewed primary reporting randomized controlled trials (RCTs) will be included. Electronic databases, such as MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Pedro, CINAHL, ClinicalTrials.gov will be searched from inception until July 30. Only studies published in English will be included in this review. Two reviewers will complete the screening for eligibility independently, and the other two reviewers will also complete the risks of data extraction and bias assessment independently. Lower Limb strength will be assessed as primary outcome, and particular intervention or participant characteristics will be assessed as the secondary outcomes. Meta-analysis will be conducted using Review Manager 5.3.3, and evidence level will be assessed using the method for Grading of Recommendations Assessment, Development and Evaluation. Outcomes will be presented as the weighted mean difference or standardized mean difference with 95% CI. If I2 ≤ 50%, P>.1, the fixed effect model will be used, otherwise, random-effects model will be used. Ethics and dissemination: This review might not be necessary ethical approval because it does not require individual patient’s data; these findings will be published in conference presentations or peer-reviewed journal articles. PROSPERO registration number: CRD42020150144.

Background: Spinal Mobilization is one of the manual therapy technique that clinicians have used to treat pain, however, there is still a lack of research on changes in strength in healthy people. Objectives: To investigate the effect of posterior-anterior lumbar mobilization on lower limb strength in healthy individuals. Design: Two-group pretest-posttest design. Methods: In this study, 23 healthy subjects aged 20 years were assigned to 12 lumbar mobilization group (LMG) and 12 sham group (SG) to perform intervention and measurement through pre- and post-design. Intervention was performed in LMG with grade III~IV on L3-5 of the lumbar spine, and lumbar mobilization was performed for each segment. After intervention, knee flexion and extension strength were measured. To measure the main effect on muscle strength, a comparative analysis was conducted using paired t-test and independent t-test. Results: In LMG, knee flexor and extensor strength were increased significantly at 60°/s (P<.05). In addition, the extensors of LMG and SG were significantly different only at 60°/s, and the flexors were significantly different between groups at both 60°/s and 180°/s (P<.05). Conclusion: In healthy individuals, lumbar mobilization results in improvement of strength of knee flexor and extensor, and additional experiments on the effect of mobilization on the lumbar spine on functional changes in the lower limbs will be needed.

Background: Neurodynamic mobilization is divided into slider mobilization and tensioner mobilization. However, movement direction in neurodynamic mobilization has been overlooked in neurodynamic exercise program. Objective: To examine the effect of movement direction in neurodynamic mobilization on upper limb mobility and pain. Design: Quasi-experimental study Methods: Twenty-two adults positive for neurodynamic test for the median nerve were recruited for participation in this study. Twenty-two subjects were allocated to the applied neurodynamic mobilization at limited side group (ANTLS, n=7), the applied neurodynamic mobilization at contralateral limited side group (ANTCLS, n=7), and the applied neurodynamic mobilization at bilateral side group (ANTBS, n=8). Before the intervention upper limb limited was measured neurodynamic test for the median nerve, pain was measured using visual analogue scale (VAS), movement direction in neurodynamic mobilization was applied to each group, and then re-measured using neurodynamic test for the median nerve and VAS. Differences the Intra-groups before and between the intergroups after intervention were analyzed. Results: In the ANTLS and ANTBS groups, a statistically significant increase in ROM and decrease in VAS score in the population before and after intervention were indicated. Statistically significant differences in VAS and ROM from before to after intervention were found among the ANTLS, ANTCLS, and ANTBS groups. Conclusions: The results of the present study indicate that movement direction in neurodynamic mobilization must be considered within the limits of its selected range of the neurodynamic exercise program.