Background: Proprioception in the ankle joint is important for maintaining balance. There is a correlation between joint position sense (JPS), balance and ankle dorsiflexion range of motion (DF-ROM). Objectives: The purpose of this study was to compare the effects of talocrural joint mobilization (TJM) and muscle energy technique (MET) of plantar flexor muscle (PF) on improving joint position sense (JPS) and static balance. Design: Cross-over randomized trial research. Methods: Sixteen participants (male 10, female 6; 20’s of their age) without ankle instability were recruited. In a randomized, three conditions, no intervention, talocalcaneal mobilization, and PF-MET were all applied to 16 participants. For TJM, the Kaltenborn grade 3 joint gliding method, in which the talus moves posteriorly perpendicular to the tacrocrural joint plane, were used. In the PF-MET, MET method were applied gastrocnemius muscle and soleus muscle with 25% of 1 Repeat Maximum of each muscle. The all participants performed PF-MET and TJM for 18 minutes. DF-ROM measured the weightbearing lunge test. JPS measured using the active joint angle reproduction test. Static balance was measured displacement of center of pressure parameter. Results: PF-MET and TJM had significant differences in DF-ROM and AP displacements. PF-MET significantly increased at 5° and 15° of plantar flexion and 5° of dorsiflexion, and COP velocity significantly decreased in JPS compared to TJM. Conclusion: PF-MET and TJM are effective in increasing DF-ROM. However, PF-MET has a more positive effect on improving JPS and static balance than on talocrural joint mobilization.

Background: As sedentary life increases, people's thoracic vertebra joint movement decreases, and the resulting associated pain is complaining of a lot of discomfort. This is also affecting the autonomic nervous system. Objectives: The purpose of this study was therefore to find out the effect of thoracic vertebra joint mobilization on heart rate variability in upper back pain patients. Design: Randomized controlled trial. Method: Thirty subjects in this study were randomly assigned to two groups of 15 persons each using a randomization tool. Maitland's grade III joint mobilization, hot pack, and interferential current therapy (ICT) were applied to T1-L2 and hot pack and ICT were applied to the control group. The intervention was performed 3 times a week for 4 weeks. Results: There were statistically significant changes in Visual Analog Scale (VAS), Standard Deviation of all Normal R-R Intervals (SDNN), Low Frequency (LF), High Frequency (HF) and LF/HF ratio in the study group, and statistically significant changes in VAS, SDNN, and LF/HF ratio in the control group. In comparison of differences, there were statistically significant changes in VAS. Conclusion: Positive effects were found on SDNN and LF/HF ratio in both the joint mobilization group and the control group compared to before the study. In particular, even LF and HF were positive in the joint mobilization group showed influence.

Background: Despite its high prevalence, interventions in plantar fasciitis remain inconclusive. To improve the daily life of plantar fasciitis patients, it is necessary to identify appropriate interventions to improve pain and foot pressure and balance. Improving the interventions for plantar fasciitis is one of the main goals for rehabilitation. Objectives: To investigate the changes in pain and static-dynamic foot pressure and balance through the evaluation of 42 plantar fasciitis patient before and after the foot stretching and joint mobilization interventions. Design: Randomized controlled trial. Methods: The 42 subjects of the study were divided into a stretching group and a joint mobilization group with 21 subjects being assigned to each group. The results before and after the experiment were analyzed by applying stretching and joint movement interventions for a total of 6 weeks. Results: Before and after the intervention, there were significant improvements in the pain index and static-dynamic foot pressure and static balance in both stretching and joint mobilization groups. However, the between-group comparison indicated no significant differences. Conclusion: The stretching and the joint mobilization can improve the pain and static-dynamic foot pressure and static balance in plantar fasciitis patients.

Background: If the weakness of the knee muscles persists and there is pain at the same time, lumbar mobilization can be used. Objectives: This study investigated the immediate effect of lumbar joint mobilization on postural sway and knee pain in elite volleyball players. Design: Randomized controlled trial. Methods: Twelve male elite volleyball players were recruited for this study. Lumbar joint mobilization was performed in all study subjects. Evaluation items were static and dynamic balance and knee pain change. All evaluations were made immediately after the intervention. Results: C90 area, trace length, and STD Y deviation in the open static balance were significantly decreased after intervention (P<.05). C90 area, trace length, Velocity, STD X deviation, and STD Y deviation in static balance with closed eyes decreased significantly after intervention (P<.05). In dynamic balance, the left and right side. COPs were significantly increased. Pain significantly decreased after intervention (P<.05). Conclusion: This study found that lumbar joint mobilization is an effective method for improving postural sway and knee pain in elite volleyball players.

Background: Forward head posture leads to resulting in posture instability and changes in spine alignment. To treat this condition, numerous studies have shown the effectiveness of joint mobilization. However, only a few studies have reported on the intervention location of joint mobilization or its effects on heart rate variability. Objectives: To investigated the effects of joint mobilization intervention at the lower cervical spine on pain, head posture, and heart rate variability (HRV) in patients with a forward head posture. Design: A randomized controlled trial. Methods: Twenty patients with forward head postures who met the study inclusion criteria were recruited. A randomization program was used to divide the subjects into experimental and control groups. Each group consisted of ten subjects. The intervention was performed for four weeks, three sessions per week, 15 min per day, and non-simultaneously throughout the 12-week study period. Results: A significant decrease in neck pain was shown in both the experimental and control groups. In contrast, significant changes in craniovertebral angle (CVA), cranial rotation angle (CRA), and HRV were found only in the experimental group. Conclusion: The mobilization of the cervical spine is an effective intervention for improving pain, head posture, and HRV.

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 stroke have core muscle weakness and limited rib cage movement, resulting in restrictive lung disease. Objectives: To examine the comparison of effects of rib cage joint mobilization combined with diaphragmatic breathing exercise and diaphragmatic breathing exercise on the pulmonary function and chest circumference in patients with stroke. Design: A cluster randomized controlled trial. Methods: Twenty-four patients were randomly assigned to an experimental group (rib cage joint mobilization combined with diaphragmatic breathing exercise group) and control group (diaphragmatic breathing exercise group). Patients in the experimental group underwent rib cage joint mobilization for 15 min and diaphragmatic breathing exercise for 15 min. The control group underwent diaphragmatic breathing exercise for 30 min. Both groups underwent exercise thrice a week for 4 weeks. The pulmonary function and chest circumference were measured using the MicroLab spirometer and a tape measure, respectively. Results: After the intervention, the pulmonary function and chest circumference significantly improved in both groups. These improvements were significantly higher in the experimental group than those in the control group. Conclusion: Rib cage joint mobilization combined with diaphragmatic breathing exercise improves pulmonary function and chest circumference in patients with stroke.

Background: Although various exercises have been performed for patients with chronic low back pain (CLBP), the effects of these exercises including joint mobilization, gym ball exercises, and breathing exercises on flexion relaxation ratio (FRR) have not been compared. Objective: To compare the effects of joint mobilization, gym ball exercises, and breathing exercises on the flexion relaxation phenomenon (FRP) and pain in patients with chronic low back pain. Design: Randomized pretest-posttest control group design. Methods: Thirty-six patients with chronic low back pain who were undergoing rehabilitation at a rehabilitation center were included. The patients were randomly divided into three groups: joint mobilization group (JMG; n=12), gym ball exercise group (GBG; n=12), and breathing exercise group (BEG; n=12). The exercises were performed for 40 minutes a day, twice a week, for a total of 12 weeks. Results: There were no significant differences in FRR between the three groups (P>.05). Significant decreases in the modified visual analog scale (MVAS) scores after intervention between the groups were found (P<.05). The GBG was significantly decreases from the JMG in the MVAS (P<.05). However, there were significant improvements between the pre- and post-interventional findings on FRR and MVAS in the three groups (P<.05). Conclusion: We demonstrated that intervention using joint mobilization, gym ball exercises, and breathing exercises improve FRP and pain in patients with CLBP.

Background: Posterior shoulder tightness, which is a problem mainly seen in patients with shoulder impingement syndrome, disrupts the scapulohumeral rhythm between the humerus and scapulae. Objects: The aim of this study was to compare the effects of joint mobilization and stretching on shoulder muscle activity and internal rotation range of motion (ROM) of the glenohumeral joint in patients with impingement syndrome with posterior shoulder tightness. Methods: The research subjects included 22 in-patients with impingement syndrome with posterior shoulder tightness. They were randomly divided into two groups: one group (12 patients) was treated with joint mobilization and the other group (10 patients) was treated with stretching for the posterior shoulder tightness. Each treatment was performed five times a week for two weeks, and there were 15 sessions for each treatment. The ROM of the internal rotation and muscle activities of shoulder joint were evaluated pretest and posttest in each group. Electromyography data were collected from the upper, middle, and lower trapezius and serratus anterior during shoulder abduction of 90°, 120°, and 150°. Results: Both the joint mobilization and stretching groups showed significant decreases in muscle activity in the upper, middle, and lower trapezius on the posttest (p < 0.05). There was a significant difference in serratus anterior at 150° (p < 0.05), but there was no significant difference between group in post-hoc analysis (p > 0.025). The internal rotation ROM was significantly increased in the stretching group compared to that in the joint mobilization group (p < 0.025). Conclusion: This study found that both joint mobilization and stretching for posterior shoulder tightness were effective in muscle activity during arm abduction, also in order to increase internal rotation ROM of shoulder joint, stretching was effective in patients with impingement syndrome with posterior tightness.

Background: Surgery has been known as an inefficient approach to reduce back pain in patients with lumbar spinal stenosis; therefore, non-surgical treatments are necessary. However, there has been little research to analyze the effect of non-surgical treatments on lumbar spinal stenosis pain. Objective: To identify the effectiveness of 2 physiotherapeutic treatment approaches to relieve pain due to lumbar spinal stenosis. Design: Randomized controlled trial Methods: The participants were 36 lumbar spinal stenosis patients who were randomized in the joint mobilization group (JMG) and transcutaneous electrical nerve stimulation group (TENSG). Joint mobilization (JM) was conducted at the posteroanterior joint in the spinous process of the lumbar spine with stenosis. Transcutaneous electrical nerve stimulation (TENS) was applied on the lumbar spine with stenosis at a high frequency and intensity. Results: Visual analog scale (VAS) pain score significantly decreased in both groups, and the VAS value decreased more after JMG than that after TENSG. The pain thresholds of both groups also significantly increased, and that of JMG increased more compared to TENSG. In both the groups, significant improvements in VAS and pain thresholds were found, and JMG showed better results than TENSG. Conclusions: JM and TENS showed significant relief in both pain threshold and painpain, and JM showed more advanced relief compared to TENS.

The purpose of this study was to assess the changes in balance and proprioception of adults with limited ankle joint dorsiflexion, after the application of talocrural joint mobilization. The subjects of this study included 23 college students in their twenties with limited ankle joint dorsiflexion. The students were randomly assigned to the ankle joint mobilization group (AJMG, n=12) and the control group (CG, n=11). After 2 weeks of intervention using grade III talocrural joint mobilization in the anterior-posterior movement, the balance and proprioception of the subjects were assessed. Static/dynamic balance capabilities and ankle proprioception were analyzed using paired t-test and independent t-test. The dynamic balance and proprioception of AJMG were significantly improved after intervention (p<.05), In the comparison between the groups after the intervention, the dynamic balance and proprioceptive sense of AJMG were significantly improved compared to the control group (p<.05). This study suggests that AJMG can help improve the dynamic balance and proprioception.

The purpose of this study was to identify the effect of proprioceptive neuromuscular facilitation (PNF) stretching exercise and joint mobilization on ankle joint range of motion (ROM), plantar pressure, and balance in subjects with stroke. Thirty patients (n=30) were organized into three groups, each of which received different treatments: PNF stretching (n=10), joint mobilization (n=10), and joint mobilization and PNF stretching combined (n=10). Each group received three exercise sessions per week for four weeks. The ankle ROM was measured using a goniometer, and plantar pressure and balance ability were measured using BioResque static posturography. In comparison within each group, the joint mobilization group and the joint mobilization with PNF stretching group showed significant improvements in ankle ROM, plantar pressure, and balance ability (p<.05). In comparison between the groups, a statistically significant difference was found in SECS change between the PNF stretching group, joint mobilization group and the joint mobilization with PNF stretching group. This study found demonstrates that the joint mobilization and joint mobilization with the PNF stretching methods were effective in improving ankle ROM, plantar pressure, and balance ability in stroke patients.

The purpose of this study was to evaluate the effect of joint mobilization and manual stretching exercises in patients with hallux valgus. Twenty-three participants were divided into two groups; joint mobilization (n=11) and manual stretching exercises (n=12). The subjects participated in the experiment for 15minutes, three times a week, four weeks. The joint mobilization (Grade III, Maitland) was performed to experimental group for a minute and then rested for 10 seconds for each set. The manual stretching was performed to control group with three exercise session (preparatory and finishing exercises, agonist contraction exercises, agonist contraction and hold-relax exercises). In the results of the study, intragroup comparison of the deformity angles (DA) was shown to decrease from 15.18° to 13.09° in the joint mobilization group (p<.05) and from 19.00° to 16.83° in the stretching exercises group (p<.05). However, left static foot pressure (LSFP), right static foot pressure (RSFP), left dynamic foot pressure (LDFP) and right dynamic foot pressure (RDFP) did not significantly increase or decrease after the experiment. Intergroup differences also were not statistically significant in all variables (p>.05). The current study suggests that JM and MSE are effective in decreasing the DA in patients with hallux valgus.

The purpose of the study was to determine the effect of joint mobilization with respiratory muscle taping on pulmonary function and chest expansion ability in patients with chronic stroke. Thirty subjects (n=30) were randomly divided into three groups: a joint mobilization group (n=10), a respiratory muscle-taping group (n=10), and a joint mobilization with respiratory muscle-taping group (n=10). Measurements for pulmonary function and chest expansion were performed to assess its effectiveness. A spirometer was used to measure the pulmonary function, and a tape measure was used to assess the chest expansion. In the joint mobilization group, peak expiratory flow (PEF) was increased. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and upper and lower chest expansion were also increased. All of variables of respiratory muscle-taping group also were increased. FEV1 and FVC were significantly different between joint mobilization with respiratory muscle-taping and respiratory muscle-taping group. The results of the present study suggest that mobilization with respiratory muscle taping increase the pulmonary function and chest expansion.

The purpose of this study was to identify the immediate effects of Maitland joint mobilization with kinematic taping in subacromial impingement syndrome patients. The Maitland joint mobilization was applied glenohumeral joint. The mobilization was performed at the end of rage to Grade IV. After that, kinematic tape was attached to shoulder joint (supraspinatis, infraspinatis, and trapezius muscles). The intervention period was four days. The measurement was done five times. The shoulder pain, range of motion (flexion, abduction, and rotation of the shoulder joint), muscle tone and stiffness (upper trapezius and deltoid muscle) were measured. The shoulder pain decreased. The range of motion (ROM) was increased all flexion, abduction, and rotation of the shoulder joint. Muscle tone and stiffness were decreased, especially upper trapezius of those was greatly decreased. The findings of present study suggest that Maitland joint mobilization with kinematic taping is effective in decreasing pain, muscle tone and stiffness, and in increasing shoulder ROM in patients with subacromial impingement syndrome.

The aim of this study was to observe the effects of kinesiotaping and joint mobilization on the metatarsophalangeal joint angle and pain in hallux valgus patients Twenty-one female hallux valgus patients in their 20s were divided into two groups, a Kinesiotaping group (KT, n=10) and another group with the addition of joint mobilization (KTJM, n=11). After undergoing 6 weeks of intervention, the change in the metatarsophalangeal joint and pain were measured. Metatarsophalangeal joint angle was significantly increased both the KT and the KTMJ group after intervention. In the change of pain, both the KT and KTJM groups on an individual basis also experienced a significant decrease in pain, though comparison between the two groups failed to represent a significant difference. These findings suggest that Kinesiotatping and joint mobilization increased the joint angle and reduced pain.

The purpose of this study was to apply the joint mobilization technique to the level of segments with pain and to the level of segments with hypomobility respectively and compare the immediate effects of the joint mobilization technique on the pain, the active cervical range of motion (ROM), and treatment satisfaction of patients with acute mechanical neck pain. After the baseline assessment, forty-two patients were randomized into two groups: a painful group (n1=21) that received joint mobilization at the most painful cervical spine level and a hypomobile group (n2=21) that received joint mobilization at the most hypomobile cervical level. The patients received an intervention that applied unilateral posterior-anterior gliding for 5 minutes and two repetitions of 10 times of active extension motion with distraction. In the Wilcoxon signed-rank test, the painful group and the hypomobile group were improved significantly in all pain variables (p<.001), while the painful group was improved significantly in the active cervical flexion (p<.001), extension (p<.001), left side-bending (p<.01), right side-bending (p=.001), left rotation (p<.001), and right rotation (p<.001). The hypomobile group was significantly improved in active cervical flexion (p=.001), extension (p<.001), left side-bending (p<.05), right side-bending (p=.001), left rotation (p=.001), and right rotation (p<.01) after intervention. In the Mann-Whitney U test, there was no significant difference in any of the dependent variables after the intervention between the two groups, but the painful group was slightly superior to the hypomobile group in all variables except for the right lateral flexion ROM and treatment satisfaction. These outcomes suggest that the cervical joint mobilization may be applied to either the level of painful segments or the hypomobile segments for the treatment of patients with acute mechanical neck pain.

The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 (n1=16, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 (n2=16, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group (n3=16, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects’ pain level was measured using a 100 ㎜ visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

This study was conducted to investigate the effect of FES and ankle mobilization on the ankle motion and the quality of gait of chronic hemiplegic patients with limited ankle joint motions. As research subjects, 24 chronic hemiplegic patients who could walk independently, regardless of assistive aids, were selected. Then, 8 subjects received mobilization randomly and 8 subjects received FES and 8 subjects received mobilization and FES, at the same time. The dorsiflexion PROM significantly increased in the group of mobilization therapy, mobilization and FES all together(p<.01). There were statistically significant differences among the three groups(p<.01). The 10m walking test significantly decreased in the group of mobilization therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.01). The gait velocity significantly increased in the group of mobilization therapy, FES therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.01). The stride length significantly increased in the group of mobilization therapy, mobilization and FES all together(p<.05). There were statistically significant differences among the three groups(p<.05). In conclusion, these findings demonstrate that rather than only using one treatment technique, applying mobilization and FES together brings a more satisfactory result to hemiplegic patients with limited ankle joint motions.