Clinical Question: In adults with cervicogenic headache (CGH), what are the effects of a clinician-applied Mulligan Concept C1–C2 rotational sustained natural apophyseal glide on cervicogenic symptomology? Clinical Bottom Line: Both Level 2b and Level 4 evidence of Grade B quality exists to support using the C1–C2 rotational sustained natural apophyseal glide to decrease CGH severity and participant-reported neck disability immediately posttreatment, while also increasing cervical range of motion in adult patients with CGH headaches and a positive flexion–rotation test. Further research should examine the long-term effects of the C1–C2 rotational sustained natural apophyseal glide technique on cervical range of motion, flexion–rotation test results, and CGH frequency and severity. In addition, the flexion–rotation test should be explored as a standard diagnostic assessment in CGH cases.
ObjectiveThe purpose of this study was to examine whether the forces used by trained clinicians during a simulated instrument-assisted soft tissue mobilisation (IASTM) treatment varied across five different instruments during one-handed and two-handed IASTM grips.MethodsNine athletic trainers who previously completed IASTM training and used the technique in professional practice were included in the study. A skin simulant was attached to a force plate and used to evaluate force production during a simulated IASTM treatment scenario. Peak (Fpeak) and mean (Fmean) forces were recorded for both one-handed and two-handed grips for each participant across the five instruments. Data were analysed using separate 2 (grip type) × 5 (IASTM instrument) repeated measures analysis of variance for both Fpeakand Fmean.ResultsData for Fpeakdemonstrated a significant main effect for grip type (F(1, 8)=46.39, p<0.001,ηp2=0.34), instrument (F(4, 32)=4.61, p=0.005,ηp2=0.06) and interaction (F(2, 16)=10.23, p=0.001,ηp2=0.07). For Fmean, there was also a statistically significant main effect for grip type (F(1, 8)=60.47, p<0.001,ηp2=0.32), instrument (F(4, 32)=4.03, p=0.009,ηp2=0.06) and interaction (F(2, 19)=7.92, p=0.002,ηp2=0.06).ConclusionsClinicians produced greater IASTM forces when applying a two-handed grip than a one-handed grip. Instrument weight may matter less than instrument shape, size and bevelling for influencing force production as instrument length appears to influence force production when using one-handed or two-handed grips. Although the effects of IASTM force variation on patient outcomes remains unknown, these findings may be considered by clinicians when making instrument and grip choices.
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