Manual therapy is one of the conservative managements for lateral elbow tendinopathy (LET), but evidence regarding its effectiveness on clinical outcomes has not been synthesized in Japanese. Therefore, the aim of this overview was to systematically evaluate the effectiveness of manual therapy for people with LET. We searched systematic reviews using PubMed, CENTRAL, and PEDro in Feburuary 2022, and used A Measurement Tool to Assess　Systematic Review 2 for the assessment of methodological quality of included reviews. Two independent reviewers selected reviews, extracted data, and evaluated their methodological quality. We included three reviews and qualitatively synthesized. Manual therapy included mobilization，neural tension，deep friction massage (DFM) and Mill’s manipulation. The three reviews had inadequate pre-registration of review protocols. The certainty of evidence was evaluated for the effectiveness of DFM on pain and function outcome only, and they were very low certainty. In conclusion, there is insufficient evidence to examine the effectiveness of manual therapy for LET. Future studies should investigate using standardized outcome sets.

[Purpose] To determine the effect of manual therapy on ankle dorsiflexion range of motion (ROM) in patients with ankle and foot fractures by a systematic review and meta-analysis. [Methods] Two independent reviewers searched and screened articles through July 1, 2022, using five databases to identify randomized controlled trials that studied the effect of manual therapy intervention on ankle dorsiflexion ROM in patients with ankle and foot fractures. A meta-analysis was conducted to compare the effects on dorsiflexion ROM between intervention and control groups. [Results] Three studies were included (a total of 172 patients), and the intervention consisted mainly of joint mobilization. No significant differences were found between the manual therapy and control groups in the effect on ankle dorsiflexion ROM (standardized mean difference 0.05; 95% confidence interval -0.50, 0.60). [Conclusions] The present systematic review and meta-analysis suggested that joint mobilization for patients with ankle and foot fracture had no significant effect on ankle dorsiflexion ROM. Further high-quality randomized controlled trials are needed.

Recent evidence has consistently shown that one-size-fits-all interventions primarily targeting peripheral issues or separate interventions from multiple disciplines are associated with poor treatment outcomes for people with chronic pain. Notably, recent findings related to nociplastic pain and biopsychosocial models have clearly suggested that chronic pain is attributed to multifactorial pain mechanisms involving biological, psychological, and sociocultural factors. In this article, I introduce interdisciplinary pain management that aims to address the multiple factors contributing to the chronic pain experience. Further, expectations for physical therapists within an interdisciplinary pain management team and novel physical therapy interventions potentially ameliorating nociplastic pain are also introduced.

This narrative review summarises the theoretical background and clinical applications of graded motor imagery (GMI). As its name suggests, GMI is a series of assessments and treatments using graded motor imagery tasks. Current evidence suggests that GMI may be effective for complex regional pain syndrome, phantom limb pain, frozen shoulder, distal radial fracture and upper-limb neuropathic pain. It has also been applied to manage other chronic pain conditions, such as low back pain. Conventional GMI involves three graded motor imagery tasks: the Left/Right Judgement Task, Explicit Motor Imagery and Mirror Therapy. GMI can be an effective approach for treating chronic pain, when conventional manual therapy or exercises are not indicated.

Guidelines should be consulted as a valuable source of information providing evidence-based physical therapy. Clinical Questions (CQ) 1-10 in the second edition of the Physical Therapy Guidelines for Cervical Dysfunction were judged to be weak recommendation, conditional recommendation, or conditional recommendation against, all with a strength of evidence of D (Very low). In CQ, which compares the intervention group to other conservative therapies rather than wait-and-see, the true effect of the intervention group remains unclear. One reason for the change in recommendations between CQ1 in the second edition and manual physical therapy in the first edition is that CQ1 in the second edition describes the therapeutic effect of joint mobilization alone. Many of the recommendations in the second edition of the Physical Therapy Guidelines for Cervical Dysfunction differ slightly from those in the European and American guidelines. However, the conclusions are almost the same as those of the European and American guidelines, and further studies are awaited. The recommendations of the second edition of the Physical Therapy Guidelines for Cervical Dysfunction Physical Therapy must be considered comprehensively, including evidence from systematic reviews and the knowledge and skills of the physical therapists themselves, and the final decision on application must be made in collaboration with the patient.

[Purpose] The aim of this paper is to provide evidence for the effectiveness of physical therapy for pain and gait disturbance of patients with lumbar spinal stenosis. [Methods] A systematic search of randomized controlled trials in English or Japanese up to June 2019 using five different databases was conducted and a meta-analysis was performed. [Results] Four RCTs that met the criteria were included. The meta-analysis showed significant medium-term and long-term improvements for pain in the intervention group with complex physical therapy compared to the control group. With regard to walking ability, significant medium-term and long-term benefits were observed in the intervention group. [Conclusion] Complex physical therapy showed limited evidence of effectiveness for back and lower limb pain and continuous walking distance. It was not possible to determine what should be selected as the optimal physical therapy.

Current guidelines for the physical therapy management of patients with primary frozen shoulder include patient education, activity modification, exercise, stretching, and manual therapy. Two systematic reviews of the effectiveness of manual therapy for frozen shoulder have been published since the publication of the Clinical Practice Guidelines. A qualitative analysis showed moderate evidence for joint mobilization, and a meta-analysis supported the effectiveness of mobilization with movement. In order to provide optimal physical therapy for patients with frozen shoulder in a clinical setting, there is a need to clarify the effectiveness of manual therapy. This paper summarizes the currently available evidence to answer the question, "Are there any manual therapies supported by systematic reviews and meta-analyses as a treatment for patients with primary frozen shoulder?" Among the 17 systematic review articles related to manual therapy for primary frozen shoulder published through October 2022, meta-analyses were conducted in 5. Based on the results of these meta-analyses, mobilization with movement and joint mobilization may be effective in reducing shoulder pain and improving range of motion for patients with primary frozen shoulder in the freezing or frozen phase. The applicability of manual therapy for patients in the inflammatory phase, the optimal dosage of manual therapy treatments (frequency and total duration), and the expected benefits when combined with exercise therapy remain unknown and are subjects for future research.

The second edition of Physical Therapy Guidelines was completed and published in October 2021. It includes “physical therapy guidelines for physical therapy of wrist and hand dysfunction” and includes a clinical question on carpal tunnel syndrome as a target disease. The most common conservative physical therapy interventions for carpal tunnel syndrome are manual physical therapy interventions with nerve and tendon gliding exercises and carpal bone mobilization. The effectiveness of this approach is evidenced by improvements in pain and sensory disturbance, which reduce the psychological burden factor of the patient. However, a lot of this evidence is still very weak, and it is hoped that future high-quality research will be conducted. We hope that this guideline will be widely used to further improve the quality of physical therapy as well as the implementation of physical therapy above a certain level in daily clinical situations.

[Objective] The purpose of this review was to examine the effectiveness of manual therapy for osteoarthritis (OA) of the hip. [Design] A systematic review was prepared with reference to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) Statement. [Setting] Searches were conducted using MEDLINE/PubMed, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) untilfor papers up to March 31, 2022. The target population iswas hip OA patients over 40 years of age. [Results] As a result of the survey, identified 4,630 papers were extracted, and 13 papers were selected that met the eligibility criteria. NThere were no reports from Japan. Twelve papers demonstrated high research quality, scoring 8 or higher on the PEDro scale. Manual therapy has been reported to be more effective in improving hip OA pain, physical function, quality of life, and increasing QALYs compared tothan general and non-manual therapies. However, three reports have questioned its effectiveness. [Conclusions] The effectiveness of manual therapy for hip OA is not as clear-cut as other treatment modalities. Since there are no reports from Japan, it is advisable to conduct an independent investigation.

This review compares and summarizes the grading of recommendations in terms of physiotherapy for osteoarthritis of the knee of five world-wide guidelines: NICE 2022, AAOS 2021, VA/DoDEBPWG 2020, OARSI 2019 and ACR/AF 2019. Education, self-management, and exercise were recommended strongly or moderately as good treatments. However, thermal modalities, transcutaneous electrical nerve stimulation, use of a brace or cane, acupuncture, massage, laser, meditation, Tai-chi, yoga and cognitive behavioral therapy had different recommendations among guidelines. Therefore, a patient registry system needs to be provided for investigating the effectiveness of physiotherapy among patients with different characteristics, and enhanced multi-institutional joint research.