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Manual Therapy Techniques

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Manual therapy interventions for the wrist have been associated with improvements in pain and function in individuals with lateral epicondylalgia (LE) and carpal tunnel syndrome (CTS).

Lateral Epicondylalgia (LE):
There is one low-powered trial that investigated the effectiveness of wrist joint manipulation for individuals with LE. Struijs et al compared the effects of manipulation of the wrist to a combined treatment program of ultrasound, friction massage and muscle stretching and strengthening in patients with tennis elbow. Subjects in the wrist manipulation group attended regular treatment sessions consisting of repeated applications of a wrist/scaphoid manipulation. Subjects receiving manipulation demonstrated greater improvement in the primary outcome measure, which was “global measure of improvement”, at initial three week follow up. However at the six-week mark no differences between groups were found for this primary outcome or the majority of secondary outcome measures. Although the results and methodological shortcomings of this study limit the ability to draw firm conclusions regarding the efficacy of this technique, the work by Struijs et al. does suggest there may be a role for wrist manipulation in the management of LE.
Struijs, 2003, Phys Ther

Carpal Tunnel Syndrome (CTS):
Tal-Akabi and colleagues compared 2 distinct manual therapy approaches in patients with CTS. Individuals with CTS awaiting surgical intervention were randomized to one of three groups: a group receiving carpal bone mobilizations, a group receiving neurodynamic mobilization and a control group. After 3-weeks of treatment, the two groups receiving either manual therapy intervention demonstrated greater improvements in pain and wrist range of motion than individuals in the control group. Additionally, fewer subjects in either manual therapy group continued with surgery compared to the control group. There were no differences observed in clinical outcomes between the group receiving carpal mobilizations and neurodynamic mobilizations.

Burke et al., conducted a pilot study to compare two soft-tissue mobilization (STM) procedures in individuals with mild to moderate CTS. Subjects were randomized to receive either STM delivered manually by the practioners hands or STM administered with a metal instrument (Graston technique). At 4-weeks following the intervention period both groups demonstrated statistically and clinically meaningful improvements in wrist range of motion, grip/pinch strength and severity of symptoms. Improvements observed at 4-weeks were largely maintained at 3 months for both groups, however the severity of symptoms did increase slightly in the group receiving manual STM compared to the instrumented (Graston technique) STM.
Tal-Akabi, 2000, Man Ther
Burke, 2007, J Manipulative Physiol Ther


Walker, 2004, J Orthop Sports Phys Ther
Russell, 2003, J Maipulative Physiol Ther
Backstrom, 2002, J Orthop Phys Ther
Bialosky, 2009, J Orthop Phys Ther



Goetz, 2010, Clin Biomech


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