Cyriax and Cyriax advocated the use of deep transverse friction massage in combination with Mill's manipulation in treating lateral epicondylalgia. Evidence comparing this approach with other physical therapies is lacking. The purpose of this randomized clinical trial was to compare the effectiveness of deep transverse friction massage with Mill's manipulation versus phonophoresis with supervised exercise in managing lateral epicondylalgia. Sixty patients age 30-60, presenting with the teno-periosteal variety of lateral epicondylalgia with symptom duration greater than one month, were randomized into two groups. The control group received phonophoresis with diclofenac gel over the area of the lateral epicondyle for 5 minutes combined with supervised exercise. The experimental group received 10 minutes of deep transverse friction massage followed by a single application of Mill's manipulation. Both groups received treatment 3 times per week for 4 weeks. Outcomes of interest included pain via visual analog scale (VAS), pain-free grip strength, and functional status measured with the Tennis Elbow Function Scale. Data were analyzed using a one-way ANOVA. Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (p<0.05) improvements regarding pain, pain-free grip, and functional status for the experimental group compared to the control group. The results of this study demonstrate that Cyriax physiotherapy is a superior treatment approach compared to phonophoresis and exercise in managing lateral epicondylalgia.

Currently, large levels of practice variability exist regarding the clinical deactivation of trigger points. Manual physical therapy has been identified as a potential means of resolving active trigger points; however, to date the ideal treatment approach has yet to be elucidated. The purpose of this clinical trial was to compare the effects of two manual treatment regimens on individuals with upper trapezius trigger points. Sixty patients, 19-38 years of age with non-specific neck pain and upper trapezius trigger points, were randomized into one of two, 4 week physical therapy programs. One group received muscle energy techniques while the second group received an integrated neuromuscular inhibition technique (INIT) consisting of muscle energy techniques, ischemic compression, and strain-counterstrain (SCS). Outcomes including a visual analog pain scale (VAS), the neck disability index (NDI), and lateral cervical flexion range of motion (ROM) were collected at baseline, 2 and 4 weeks after the initiation of therapy. Results revealed large pre-post-effect sizes within the INIT group (Cohen's d 5 0.97, 0.94 and 0.97). Additionally, significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group (0.29-0.57, 0.57-1.12 and 0.29-0.57) at a 95% CI respectively. The findings of this study indicate the potential benefit of an integrated approach in deactivating upper trapezius trigger points. Further research should be performed to investigate the long-term benefits of the current treatment approach.

Previous case reports, case series, and pilot studies have suggested that slump stretching may enhance the effects of spinal mobilization and stabilization exercises in patients with non-radicular low back pain (NRLBP). The purpose of this trial was to determine if slump stretching results in improvements in pain, disability, and fear and avoidance beliefs in patients with NRLBP with neural mechanosensitivity. Sixty patients, 18-60 years of age presenting with NRLBP with symptom duration .3 months, were randomized into one of two, 3-week physical therapy programs. Group one received lumbar spinal mobilization with stabilization exercises while group two received slump stretching in addition to lumbar spinal mobilization with exercise. Outcomes including the modified Oswestry disability index (ODI), numeric pain rating scale (NPRS), and the fear-avoidance belief questionnaire (FABQ) were collected at baseline, and at weeks 1, 2, 3, and 6. A doubly multivariate analysis of variance revealed a significant group-time interaction for ODI, NPRS, and FABQ. There were large within-group changes for all outcomes with P,0.01 and large betweengroup differences at weeks 3 and 6 for the ODI and weeks 1, 2, 3, and 6 for the NPRS and FABQ at P,0.01. A linear mixed-effect model comparing the composite slopes of the improvement lines revealed significant differences favoring the slump stretching group at P,0.01. The findings of the present study further support the use of slump stretching with spinal mobilization and stabilization exercises when treating NRLBP.

Aim Genuine stress urinary incontinence (GSI) is a common, disruptive and potentially disabling condition in which involuntary loss of urine occurs as a result of stress, and in the absence of involuntary detrusor contractions. The purpose of this trial was to investigate the additive effect of interferential therapy over pelvic floor exercises alone, in the management of genuine stress urinary incontinence. Methods One hundred and two women suffering from GSI were randomized into one of two 4-week physical therapy programmes. Fifty two women had interferential therapy (IFT) as well as doing set pelvic floor exercises (PFM), while 50 women did the pelvic floor exercises, without any undergoing other treatment. The relevant treatment/exercises were done three times a week for 4 weeks, totalling 12 treatment sessions. The outcomes of interest, including one hour pad test, frequency volume chart, quality of life questionnaire and a visual analogue score for incontinence were collected at baseline, 1-week, 2-weeks, 3-weeks and 4-weeks after initiation of therapy. Results The results revealed significant (p<0.05) improvement for all outcome measures in each group. Significantly (p<0.05) greater improvements were detected in the group which combined pelvic floor exercises with IFT. Conclusions The findings of the present study indicate a potential benefit to including IFT with pelvic floor exercises when treating GSI.

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