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William E. Prentice

Various techniques of manual therapy are available to the sports therapist supervising a rehabilitation program. Joint mobilization and proprioceptive neuromuscular facilitation (PNF) techniques can be effectively used in rehabilitation of the injured knee for achieving normal joint range of motion and for strengthening the weak components of a movement pattern. Joint mobilization is used to restore normal accessory motion to the joint. The PNF strengthening techniques are used for improving normal physiological motion. These manual therapy techniques allow the sports therapist to concentrate on the rotational component of motion at the knee joint, which is often neglected in rehabilitation programs.

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William S. Quillen, John S. Halle and Leon H. Rouillier

The sports therapist or athletic trainer will frequently encounter individuals who have difficulty regaining normal shoulder joint motion following injury. This tends to occur in spite of the recent advances in arthroscopic surgical techniques, use of constant passive motion (CPM) devices, and sophisticated functional postoperative rehabilitative regimens. A typical approach to the restricted shoulder involves manual therapy techniques. This paper will review the basic physiological and therapeutic principles of mobilization, a primary manual therapy technique. Mobilization procedures are illustrated for the most commonly encountered shoulder restrictions.

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Trey Morgan, Stevie D. Stevens and Thomas Palmer

Edited by Darin Padua

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Erik A. Wikstrom, Sajad Bagherian, Gary Allen and Kyeongtak Song

measure of neuromuscular control which plays an important role in dynamic joint stability. 2 , 4 Multiple treatment approaches are available for patients with CAI and recent research has highlighted the benefits of manual therapy techniques such as ankle joint mobilizations at improving dorsiflexion

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Elizabeth Swann and Susanne J. Graner

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Graig R. Denegar, Jay Hertel and Sayers John Miller

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Haley Dvorak, Christina Kujat and Jason Brumitt

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Tricia Majewski-Schrage and Kelli Snyder

Clinical Scenario:

Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements.

Focused Clinical Question:

Does MLD improve patient- and disease-oriented outcomes for patients with orthopedic injuries?

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Cameron J. Powden, Kathleen K. Hogan, Erik A. Wikstrom and Matthew C. Hoch


Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).


Examine the immediate effects of talocrural joint traction in those with CAI.


Blinded, crossover.




Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering “yes” to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.


Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.

Main Outcome Measures:

The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.


No significant treatment effects were identified for any variables.


A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

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Jeffrey G. Williams, Hannah I. Gard, Jeana M. Gregory, Amy Gibson and Jennifer Austin

efficacy of cupping for treating soft-tissue pathology in the lower-extremity musculature has not been explored. Examining the effects of cupping on the hamstring musculature and subsequent ROM might provide evidence for clinicians wishing to select and apply such a manual therapy technique in the