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Joints In Motion therapy is based on well-researched, industry-respected evidence. Below are several scholarly articles that have influence the Joints In Motion approach to successful physical therapy.

Cited below are extensive sources of Joints In Motion evidence-based research regarding:

Deconditioning / Risk of Falls

Try Joints In Motion PT First For Deconditioning/Risk Of Falls

Outcome: Patients received little therapy and had low levels of physical activity. Bernhardt, J (2007). Little therapy, little physical activity. Pub Med, 1, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Patients with Parkinson’s disease improve their physical performance and activities of daily living through exercise. Crizzle, A (2006). Is physical exercise beneficial for persons with Parkinson's disease? Pub Med, 5, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Aerobic exercise and weight training improves physical function and knee pain in individuals with comorbidity. Mangani, I (2006). Physical exercise and comorbidity. Pub Med, 5, Retrieved Aug 17, 2007, from http://ncbi.nlh.nih.gov/sites

Outcome: Supervised exercise program leads to better improvement after lower limb bypass surgery for ischemia. Badger, S (2007). Benefits of a supervised exercise program after lower limb bypass surgery. Pub Med, 1, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Functionally limited older adults who maintain a structured exercise program for 16 weeks exhibit increased functional ability. Fahlman, M (2007). Structured exercise in older adults with limited functional ability. Pub Med, 6, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Patients that received balance under dual-task conditions showed dual-task training benefits. Silsupadol, P (2006). Training of balance under single and dual task conditions in older adults with balance impairment. Pub Med, 2, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Patients affected by PD with and without the tendency to fall quantify the effects of physical therapy on balance. Stankovic, I (2004). The effect of physical therapy on balance of patients with Parkinson's disease. Hooked on evidence, 1, Retrieved Aug 24, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Patients with bilateral vestibular loss improve their perception of dizziness and imbalance and their outcome measures of gait and balance following physical therapy. Brown, K (2001). Physical therapy outcomes for persons with bilateral vestibular loss. Hooked on evidence, 10, Retrieved Aug 24, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: The effectiveness of physical therapy for older people living in residential care facilities has important implications. Physical therapy that can prevent, delay, or reverse functional decline can serve to prolong the independence of older people. Harada, N (1995). Physical therapy to improve functioning of older people in residential care facilities. Hooked on evidence, 9, Retrieved Aug 24, 2007, from http://hookedonevidence.com/searchresults.cfm

Try Joints In Motion PT First For The Shoulder

Outcome: Patient improved impairments from 83% to 1.5%. Haddick, E (2007). Management of a patient with shoulder pain and disability. Pub Med, 6, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: After five days, a corticosteroid injection and high-intensity physical therapy, participants sustained significant lower amounts of pain and increased range of motion. Laroche, M (1998). Adhesive capsulitis of the shoulder followed by an interaarticular corticosteroid injection and immediate physical therapy. Hooked on evidence, 5, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Stretching of the soft tissue around the shoulder, contributed to the recovery of frozen shoulder. Mao, C (1997). Frozen shoulder, correlation between the response to physical therapy and follow-up shoulder arthrography. Hooked on evidence, 8, Retrieved Aug 27, 2007, from http://hookedonedidence.com/searchresults.cfm

Outcome: Manual physical therapy is better than exercise alone for increasing strength, decreasing pain, and improving function in patients with shoulder impingement syndrome. Bang, M (2000). Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Hooked on evidence, 3, Retrieved Aug 27, 2007, from http://hookedonedidence.com/searchresults.cfm

Outcome: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms. Bergman, G (2004).Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. American College of Physician. 141, 432.

Try Joints In Motion PT First For The Hip

Outcome: Frail elderly adults after hip fracture can benefit by extending their rehabilitation in a supervised exercise setting, working at high intensities in order to optimize gains in strength and physical function. Host, H (2007). Training-induced strength and functional adaptations and hip fracture. Pub Med, 3, Retrieved Aug 17, 2007, from http://ncbi.nlm.nih.gov/sites

Outcome: An exercise program that emphasizes weight bearing and postural stability improves muscle strength, stability and self perceived function. Trudelle-Jackson, E (2004). Effects of a late-phase exercise program after total hip arthroplasty. Hooked on evidence, 7, Retrieved Aug 27, 2007, from http://hookedonedidence.com/searchresults.cfm

Outcome: Physical therapy after a hip fracture surgery is associated with better mobility after two months. Penrod, J (2004). Physical therapy and mobility 2 and 6 months after hip fracture. Hooked on evidence, 7, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Try Joints In Motion PT First For the Ankle

Outcome: Rehabilitation improves functional limitations with patients who have chronic ankle instability. Hale, S (2007). The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. Pub Med, 6, Retrieved Aug 17, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Sensory-level electrical stimulation as an adjunct to physical therapy in children with cerebral palsy helps the children to acquire new muscular activities and set goals. Maenpaa, H (2004). Effect of sensory-level electrical stimulation of the tibilis anterior muscle during physical therapy on active dorsiflexion of the ankle of children with cerebral palsy. Hooked on evidence, 1, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Static and ballistic stretches have different effects on passive resistive torque and tendon stiffness and should be considered for training and rehabilitation program. Mahieu, N (2007). Effect of static ballistic stretching on the muscle-tendon tissue properties. Pub Med, 3, Retrieved Aug 27, 2007, from http://www.ncbi.nih.gov/sites

Outcome: A structures program of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programs. Grethe, M (2005). Exercises to prevent lower limb injuries in youth sports. Pub, Retrieved July 17, 2005, from http://www.pubmedcentral.nih.gov/articlerender

Try Joints In Motion PT First For The Back

Outcome: Early access to physical therapy resulted in greater improvement in perceived pain at six months compared to later access. Nordeman, L (2006). Early access to physical therapy treatment for subacute low back pain in primary health care. Hooked on evidence, 6, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Physical therapy is a cost-effective primary care management strategy for low back pain. Whitehurst, D (2007). A brief pain management program compared with physical therapy for low back pain. Pub Med, 3, Retrieved Aug 27, 2007, from http://ncbi.nlm.nih.gov/sites

Outcome: Manual therapy is suggested to be an alternative for back and neck pain. Skillgate, E (2007). Naprapathic manual therapy or evidence-based care for back and neck pain. Pub Med, 5, Retrieved Aug 27, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Physical therapy significantly reduces pain levels and decreases levels of depression. Ritvanen, T (2007). Dynamic surface electromyographic responses in chronic low back pain treated by traditional bone setting and conventional physical therapy. Hooked on evidence, 1, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: After adjustment for the base-line differences, chiropractic groups had less severe symptoms than the booklet group at four weeks, and there was a strong trend toward less severe symptoms in the physical therapy group. Cherkin, Daniel (1998). A comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain. The New England Journal of Medicine, 339, Retrieved Jan 20, 2006, from http://content.nejm.org

Outcome: Thirty-two patients have success with the manipulation intervention. Patients with low back pain likely to respond to manipulation can be accurately identified before treatment. Flynn, T (2002).A clinical Prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 27, 2835.

Outcome: Nonspecific low back pain should not be viewed as a homogenous condition. Outcomes can be improved when sub grouping is used to guide treatment decision making. Brennan, G (2006).Identifying subgroups of patients with acute/sub acute "nonspecific" low back pain. Spine. 31, 623.

Try Joints In Motion PT First For The ACL

Outcome: Proprioceptive training alone can induce isokinetic strength gains, restoring and increasing quadriceps strength is essential to maximize functional ability of the operated knee joint. Liu-Ambrose, T (2003). The effects of proprrioceptive or strength training on the neuromuscular function of the ACL reconstructed knee. Pub Med, 2, Retrieved Aug 27, 2007, from http://www.ncbi.nlm.gov/sites

Outcome: Neuromuscular exercise training should be a part of rehabilitation programs following ACL reconstruction. Risberg, M (2007). Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction. Pub Med, 6, Retrieved Aug 27, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: The addition of exercise after ACL reconstruction induced superior short-term results in strength, performance, and activity level after surgery. Gerber, J (2007). Safety, feasibility, and efficacy of negative work exercise via eccentric muscle activity following anterior c cruciate ligament reconstruction. Pub Med, 1, Retrieved Aug 27, 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Knee-specific training improved lower extremity kinetics and kinematics, indicating reduced knee stiffness during demanding activities. Von Porat, A (2007). Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury, the effects of twelve weeks of knee-specific training. Pub Med, 8, Retrieved Aug 27, 2007, from http://www.ncbi.nlm.nih.gov/sites

Try Joints In Motion PT First For The Knee

Outcome: Subjects appeared less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment. Deyle, G (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Hooked on evidence, 12, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Results suggest physical therapy will help patients with difficult functional problems after total knee arthroplasty. Ulrich, S (2007). Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Pub Med, Retrieved 2007, from http://www.ncbi.nlm.nih.gov/sites

Outcome: Patella taping along with exercise is more effective than exercise alone. Whittingham, M (2004). A combination of daily patella taping with a 4-week daily exercise program has been shown to be more effective than placebo taping and exercise or exercise alone in reducing pain and improving function in patients with PFPS. Evidence in motion, 34, Retrieved Aug 27, 2007, from http://evidenceinmotion.com

Outcome: Physical therapy intervention aimed at reducing pain and disability through improving the neuromotor control of the vasti successfully increasing the amount of stance phase knee flexion in individuals with patellofemoral pain. Crossley, K (2005). Physical therapy improves knee flexion during stair ambulation in patellofemoral pain. Hooked on evidence, 2, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: A structures programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programs. Grethe, M (2005). Exercises to prevent lower limb injuries in youth sports. Pub, Retrieved July 17, 2005, from http://www.pubmedcentral.nih.gov/articlerender

Try Joints In Motion PT First For Manual Therapy

Outcome: Manual therapy increased range of motion and grip strength in wrists affected by CTS to within normal limits. Burke, J (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Hooked on evidence, 1, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Both stretching exercises and manual therapy considerably decreased both neck pain and disability. Ylinen, J (2007). Stretching exercises vs. manual therapy in treatment of chronic neck pain. Hooked on evidence, 2, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: The evaluation and treatment of the participant emphasizes the functional interdependence of the SI joints and demonstrates how the evaluation of sacroiliac dysfunction can guide physical therapy intervention. Beissel, M (2000). Role of manual therapy in the evaluation and treatment of a surgically stabilized pelvis. Hooked on evidence, 8, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Participants with plantar heel pain treated with an impairment based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and return to activities. Young, B (2004). A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain. Hooked on evidence, 11, Retrieved Aug 27, 2007, from http://hookedonevidence.com/searchresults.cfm

Outcome: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms. Bergman, G (2004).Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. American College of Physician. 141,432.

Outcome: Thirty-two patients have success with the manipulation intervention. Patients with low back pain likely to respond to manipulation can be accurately identified before treatment. Flynn, T (2002).A clinical Prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 27, 2835.

Physiotherapy interventions for shoulder pain.

Green S, Buchbinder R, Hetrick S.

Australasian Cochrane Centre, Monash University, Australasian Cochrane Centre,
Locked Bag 29, Clayton, Victoria, Australia
sally.green@med.monash.edu.au

BACKGROUND: The prevalence of shoulder disorders has been reported to range from seven to 36% of the population (Lundberg 1969) accounting for 1.2% of all General Practitioner encounters in Australia (Bridges Webb 1992). Substantial disability and significant morbidity can result from shoulder disorders. While many treatments have been employed in the treatment of shoulder disorders, few have been proven in randomised controlled trials. Physiotherapy is often the first line of management for shoulder pain and to date its efficacy has not been established. This review is one in a series of reviews of varying interventions for shoulder disorders, updated from an earlier Cochrane review of all interventions for shoulder disorder.

OBJECTIVES: To determine the efficacy of physiotherapy interventions for disorders resulting in pain, stiffness and/or disability of the shoulder.

SEARCH STRATEGY: MEDLINE, EMBASE, the Cochrane Clinical Trials Regiter and CINAHL were searched 1966 to June 2002. The Cochrane Musculoskeletal Review Group's search strategy was used and key words gained from previous reviews and all relevant articles were used as text terms in the search.

SELECTION CRITERIA: Each identified study was assessed for possible inclusion by two independent reviewers. The determinants for inclusion were that the trial be of an intervention generally delivered by a physiotherapist, that treatment allocation was randomised; and that the study population be suffering from a shoulder disorder, excluding trauma and systemic inflammatory diseases such as rheumatoid arthritis.

DATA COLLECTION AND ANALYSIS: The methodological quality of the included trials was assessed by two independent reviewers according to a list of predetermined criteria, which were based on the PEDro scale specifically designed for the assessment of validity of trials of physiotherapy interventions. Outcome data was extracted and entered into Revman 4.1. Means and standard deviations for continuous outcomes and number of events for binary outcomes were extracted where available from the published reports. All standard errors of the mean were converted to standard deviation. For trials where the required data was not reported or not able to be calculated, further details were requested from first authors. If no further details were provided, the trial was included in the review and fully described, but not included in the meta-analysis. Results were presented for each diagnostic sub group (rotator cuff disease, adhesive capsulitis, anterior instability etc) and, where possible, combined in meta-analysis to give a treatment effect across all trials.

MAIN RESULTS: Twenty six trials met inclusion criteria. Methodological quality was variable and trial populations were generally small (median sample size = 48, range 14 to 180). Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease (RR 7.74 (1.97, 30.32), and longer term benefit with respect to function (RR 2.45 (1.24, 4.86). Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease. Laser therapy was demonstrated to be more effective than placebo (RR 3.71 (1.89, 7.28) for adhesive capsulitis but not for rotator cuff tendinitis. Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis (RR 1.81 (1.26, 2.60) and RR 19 (1.16, 12.43) respectively). There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone. There is some evidence that for rotator cuff disease, corticosteroid injections are superior to physiotherapy and no evidence that physiotherapy alone is of benefit for Adhesive Capsulitis

REVIEWER'S CONCLUSIONS: The small sample sizes, variable methodological quality and heterogeneity in terms of population studied, physiotherapy intervention employed and length of follow up of randomised controlled trials of physiotherapy interventions results in little overall evidence to guide treatment. There is evidence to support the use of some interventions in specific and circumscribed cases. There is a need for trials of physiotherapy interventions for specific clinical conditions associated with shoulder pain, for shoulder pain where combinations of physiotherapy interventions, as well as, physiotherapy interventions as an adjunct to other, non physiotherapy interventions are compared. This is more reflective of current clinical practice. Trials should be adequately powered and address key methodological criteria such as allocation concealment and blinding of outcome assessor.

Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review.

Desmeules F, Cote CH, Fremont P.

Laval University Hospital Research Centre, Laval University,
Quebec, Canada.

OBJECTIVE: To review randomized controlled trials evaluating the effectiveness of therapeutic exercise and orthopedic manual therapy for the treatment of impingement syndrome. DATA SOURCE: Reports up to October 2002 were located from MEDLINE, the Cochrane Database of Systematic Reviews, the Physiotherapy Evidence Database (PEDro), the TRIP database, and the Cumulative Index to Nursing & Allied Health Literature (CINAHL) using "shoulder" and "clinical trial"/"randomized controlled trial" as search terms.

STUDY SELECTION: Studies were included if (1) they were a randomized controlled trial; (2) they were related to impingement syndrome, rotator cuff tendinitis, or bursitis; (3) one of the treatments included therapeutic exercise or manual therapy.

DATA EXTRACTION: Two independent observers reviewed the methodological quality of the studies using an assessment tool developed by the Cochrane Musculoskeletal Injuries Group. Differences were resolved by consensus. DATA SYNTHESIS: Seven trials met our inclusion criteria. After consensus, the mean methodological score for all studies was 13.9 +/- 2.4 (of 24). Four studies of 7, including the 3 trials with the best methodological score (67%), suggested some benefit of therapeutic exercise or manual therapy compared with other treatments such as acromioplasty, placebo, or no intervention.

CONCLUSIONS: There is limited evidence to support the efficacy of therapeutic exercise and manual therapy to treat impingement syndrome. More methodologically sound studies are needed to further evaluate these interventions.

Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial.

Martinez-Segura R, Fernandez-de-las-Penas C, Ruiz-Saez M, Lopez-Jimenez C, Rodriguez-Blanco C.

Escuela de Osteopatia de Madrid,
Madrid, Spain.

PURPOSE: The objective of this study is to analyze the immediate effects on neck pain and active cervical range of motion after a single cervical high-velocity low-amplitude (HVLA) manipulation or a control mobilization procedure in mechanical neck pain subjects. In addition, we assessed the possible correlation between neck pain and neck mobility.

METHODS: Seventy patients with mechanical neck pain (25 males and 45 females, aged 20-55 years) participated in this study. The lateral gliding test was used to establish the presence of an intervertebral joint dysfunction at the C3 through C4 or C4 through C5 levels. Subjects were divided randomly into either an experimental group, which received an HVLA thrust, or a control group, which received a manual mobilization procedure. The outcome measures were active cervical range of motion and neck pain at rest assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation of the patient. Intragroup and intergroup comparisons were made with parametric tests. Within-group effect sizes were calculated using Cohen's d coefficient.

RESULTS: Within-group changes showed a significant improvement in neck pain at rest and mobility after application of the manipulation (P < .001). The control group also showed a significant improvement in neck pain at rest (P < .01), flexion (P < .01), extension (P < .05), and both lateral flexions (P < .01), but not in rotation. Pre-post effect sizes were large for all the outcomes in the experimental group (d > 1), but were small to medium in the control mobilization group (0.2 < d < 0.6). The intergroup comparison showed that the experimental group obtained a greater improvement than the control group in all the outcome measures (P < .001). Decreased neck pain and increased range of motion were negatively associated for all cervical motions: the greater the increase in neck mobility, the less the pain at rest.

CONCLUSIONS: Our results suggest that a single cervical HVLA manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain.

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