Abstract Background Physician referral rates to chiropractors remain low in Quebec, and few multidisciplinary clinics include both professions. Yet these settings represent a unique opportunity to study interprofessional collaboration in musculoskeletal care. This study aimed to identify facilitators and barriers to physician-chiropractor collaboration in multidisciplinary clinic settings, and to evaluate perceptions regarding the effectiveness of collaborative efforts on patient care. Methods An explanatory sequential mixed-methods design was employed. Between February and November 2024, quantitative data were collected via surveys of 23 chiropractors and 19 physicians practising in multidisciplinary clinics including both professions. Qualitative data were collected through a semi-structured focus group with seven chiropractors and individual semi-structured interviews with five physicians. Survey data were reported with descriptive statistics, and qualitative data were analyzed using thematic analysis. Results Survey results indicated that nearly 70% of physicians referred patients to chiropractors at least monthly, driven primarily by established relationships or patient requests. Despite broadly positive mutual attitudes, physicians expressed concerns about the safety of cervical manipulation and professional liability. Chiropractors identified personal knowledge of other providers and physical proximity as the strongest enablers of collaboration with physicians, while clinical workload and patients’ financial constraints were the primary barriers. Both professional groups attributed high value to interprofessional collaboration; most chiropractors and physicians reported that collaboration improved patient satisfaction, clinical outcomes, and overall quality of care. Qualitative analysis revealed three themes: perception, organization of care and services, and communication. Perceptual barriers included educational silos, historical professional tensions, and variability in chiropractic practices. Structural obstacles included out-of-pocket costs, exclusion from public care settings, and administrative burdens. Facilitators included personal experience with chiropractic care, co-location, clear referral pathways, and direct communication modalities. Conclusions In multidisciplinary clinic settings, interprofessional collaboration between physicians and chiropractors is valued and perceived as beneficial by both professional groups. Despite a favourable relational environment, collaborative practice remains heavily reliant on informal, relationship-driven interactions rather than embedded organizational structures. Our findings underscore the need for education, organizational integration, and communication infrastructure to improve interprofessional musculoskeletal care.
Abstract Background This commentary describes perspectives from workshop attendees at a North American educational conference on the chiropractic profession and its relationship with whole health. Whole Health is a paradigm shift within healthcare settings and funding agencies in the United States that utilizes a systems framework to transform healthcare. Whole health frameworks emphasize biopsychosocial well-being as defined by individuals, families, and communities, and leverages interprofessional, team-based approaches to promote well-being, disease prevention, and restoration of health. Main body Two separate, 60-minute workshop sessions were convened at the 2025 Association of Chiropractic Colleges Education Conference and Research Agenda Conference to discuss whole health and chiropractic. Attendees ( n = 105) included chiropractic academicians, researchers, practitioners, students, and organizational leaders from institutions largely based in the United States. Participants in 14 small groups discussed (1) ways the chiropractic profession aligns with whole health, and (2) how chiropractors can contribute to whole health in clinical practice and healthcare education. Notes taken by group scribes were collected from each workshop and generated 401 distinct comments. Thematic analysis with an inductive approach was used to group and define key topics that emerged from the data. Aspects of the chiropractic profession were described as historically being aligned with whole health for its foundational philosophy in innate healing and resilience, and for espousing person-centeredness and patient values. Themes describing the future contribution of chiropractic to whole health include evidence-based practice; communication and advocacy; integration into the broader healthcare system; and forward-facing education. There was overlap between past and future when considering holism; therapeutic alliance and patient empowerment for self-care; direct access; therapeutic conservatism; preventive health and lifestyle medicine; and longitudinal care. Conclusions The whole health paradigm presents an opportunity for chiropractors to be recognized contributors within multidisciplinary teams, using their expertise to aid chronic disease prevention, patient empowerment, and health care delivery innovations. Continued education and training, policy changes, and further research are required for the chiropractic profession to best serve patients and provide value within a whole health framework.
This is the second of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. This article deals with the Methods and Results sections. We start by explaining the purpose and content of these sections and then provide a practical guide for planning the structure of each section as preparation for writing the full text later. Thus, we describe ten steps for structuring the Methods section and six steps for structuring the Results section. We illustrate our explanations with text examples selected from this journal to show how authors have approached various aspects of these two sections. After some tips for constructing informative tables and figures, we discuss the use of artificial intelligence when preparing the Methods and Results sections. The Methods section is fundamental to your reader understanding your study and trusting the validity of your findings, while the Results section provides answers to your stated research objectives or questions. Transparency and completeness are essential in both sections to assist your reader and reflect your academic integrity.
This is the last of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. The current article aims to help authors produce relevant and stringent Discussion sections that reflect clarity of thought and critical analysis, with contents driven by the research objectives. We first describe the purpose of the six typical elements of the typical Discussion section: (i) Summary of Findings, (ii) Explanation of Findings, (iii) Comparison of own results with other studies, (iv) Critique of own work, (v) Perspectives, and (vi) Conclusion. We show different placements and combinations of these and explain what they should include. We then suggest how to write a simple Summary of Findings and how to avoid re-writing the Background section in the Explanation of Findings. We show how to use the previously identified research gaps when comparing own results with similar studies, suggest different approaches for Critique of own work, define the types of Perspectives that are common in clinical and epidemiological studies, and explain how to provide relevant and memorable information in the Conclusion. Examples of how authors have dealt with different elements of the Discussion section have been selected from this journal. Finally, we discuss the use of artificial intelligence in the writing process. We hope that the three articles will help authors to plan their writing in a meaningful manner, thus saving time for themselves and resulting in articles that are easy to read and understand.
This is the first of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. This article deals with the Background section, with extra focus on the research objectives. We introduce the four typical elements of a Background section: (i) justification of the study topic, (ii) sufficient information for the reader to understand the research project, (iii) presentation of the research gaps that justify the research objectives, and (iv) well-constructed research objectives that indicate the study design and may include a purpose statement. Because the whole text is driven by the research objectives, we first suggest some tips for making these as informative as possible. We then provide a step-by-step approach for planning the structure and contents of the Background section as preparation for writing the full text later. We illustrate our explanations with text examples selected from this journal to show how authors have approached crucial aspects of the Background section. Finally, we discuss some pros and cons of using artificial intelligence during the writing process, and how its use can be reported. We hope that this practical guide to the structuring process will provide authors with a useful framework for the later addition of the full text and relevant references.
Abstract Background Musculoskeletal (MSK) pain is a leading cause of disability worldwide, with low back and neck pain among the largest contributors to years lived with disability. For many people with persistent pain, mechanisms are increasingly understood as arising from altered regulation at multiple loci rather than simple ongoing tissue injury. This challenges chiropractic’s long-standing reliance on body focused explanatory models centred on correcting structural lesions or dysfunction. Main Body Active Inference (AIF) provides a contemporary framework for understanding pain perception as an embodied, context-sensitive process of sense-making. Here, inferences concerning threat or safety are informed by information generated across multiple interacting levels (neural, physiological, psychological, behavioural, and socio-cultural), and pain emerges when threat-related inferences remain persistently weighted as trustworthy. From this perspective, manual therapy may be understood as a coherent ensemble of interacting sensory, affective, interpersonal, and contextual cues that together reshape expectations, meaning, and action. We revisit the concept of Contextually Aided Recovery (CARe), a lens that sees the therapeutic encounter as a rich space of potential contextual modulation and affordances and argue that chiropractic’s distinctive contribution lies in combining skilled manual contact with the deliberate shaping of context to support adaptive regulation. Conclusion We propose that integrating AIF and CARe offers the chiropractic profession a coherent, evidence-aligned route toward a more contemporary identity, with implications for practice and education.
Abstract Background Up to one osteopathic consultation out of four involve infants and children. Although the clinical effectiveness of osteopathic care in paediatric populations remains inconclusive, available evidence suggests that it is generally safe. In contrast, high velocity, low amplitude technique (HVLA) has been associated with potential adverse effects. To inform a professional position on the use of HVLA techniques in paediatric care, this study investigated (1) the use of HVLA techniques by osteopathic practitioners in the treatment of infants, children, and adolescents, and (2) the extent to which HVLA techniques are included in osteopathic training programmes for these paediatric age groups. Methods Two online cross-sectional surveys were conducted. The first targeted osteopathic practitioners and consisted of seven close-ended questions. The second survey was directed at osteopathic education institutes (OEIs) in Europe, Australia, Brazil, Israel, and New Zealand and consisted of three close-ended questions. Surveys were implemented via REDCap and made available in 11 languages. Participants were recruited between October 2025 and January 2026. Results Among responding practitioners (n = 2607, response rate: 10.7%), 6.5% reported using HVLA in newborns or infants, 43.5% in children, and 78.3% in adolescents. Most respondents (54%) who apply HVLA to newborns and infants reported doing so “rarely”. Of the 62 responding OEIs (response rate: 30.7%), 91.4% offered osteopathic paediatric education; however, only 4.8% reported teaching HVLA for newborns and infants, 11.3% for children, and 56.4% for adolescents. Most respondents (70.2%) held an HVLA-opposed stance. Among the distinct practitioner profiles identified in the prioritisation of conditions for HVLA use in newborns and infants, the precaution-informed stance (11.2%) was the most strongly associated with paediatric practice and with the highest reported HVLA use in this age group. Conclusions Most respondents did not use HVLA in newborns and infants, with utilisation increasing in older paediatric age groups, and the majority expressed opposition to paediatric HVLA. More permissive stances were associated with greater HVLA use and more training. The generalisability of the findings is limited by potential coverage and self-selection bias, possible duplicate responses, and the low and variable response rate to the survey of osteopathic practitioners. Given its continued application, an evidence-based position statement and robust research on the safety and effectiveness of HVLA in paediatrics are urgently needed.
Abstract Background Cervical artery dissection (CeAD) remains a rare but clinically important condition that has generated longstanding debate regarding its potential association with cervical spinal manipulative therapy (cSMT). Although biomechanical and epidemiologic studies have examined this relationship, little is known about how chiropractic educational programs address CeAD or how individual faculty member’s perceptions shape instructional practices. This study surveyed chiropractic faculty members who actively teach cervical manipulation to understand how educators conceptualize CeAD risk and incorporate safety considerations into curricula. Methods An anonymous twelve-item electronic survey was distributed via Qualtrics to institutional gatekeepers from 28 English-speaking chiropractic programs between February and March 2025. Gatekeepers then distributed the survey to instructors with hands-on experience teaching cervical manipulation within the prior five years. Survey items assessed teaching setting, beliefs about the cSMT–CeAD relationship, and whether perceived risk influenced screening procedures and technique modification. Quantitative data were analyzed using descriptive statistics, Pearson’s chi-square tests, and Fisher’s exact test; qualitative free-text responses underwent keyword extraction and keyword-based thematic analysis. Results Individual faculty members from 17 of the 28 invited chiropractic programs participated (61% program response rate), yielding 103 responses with 85 meeting inclusion criteria (46 classroom, 38 clinical, 1 undisclosed). Teaching setting was significantly associated with faculty perspectives of CeAD causation (p = 0.013); classroom faculty more frequently characterized the cSMT – CeAD relationship as associational (73% vs. 27%), while clinical faculty more frequently endorsed a causal relationship mediated by modifiable risk factors (63% vs. 33%). Most respondents (72%) reported that CeAD risk influenced their instructional approach, primarily through pretreatment screening and technique modification. Qualitative analysis of free-text responses (n = 19) identified four themes: Clinical Assessment & Management (89.5% of responses), Risk & Safety (52.6%), Education & Training (31.6%), and Evidence Base (21.1%). Conclusions Teaching setting significantly influenced how chiropractic faculty members conceptualize and communicate CeAD risk. Findings reveal opportunities to strengthen evidence-aligned patient safety education and establish instructional guidance across chiropractic programs. The gatekeeper-led sampling approach limits individual level response rate calculation and generalizability.
Low back pain (LBP) is the leading cause of disability worldwide. Despite guidelines advising against routine imaging, a significant proportion of patients are referred for lumbar spine magnetic resonance imaging (MRI) without an appropriate indication. This study aims to assess the impact of the intervention on the appropriateness of referrals and the proportion of referred patients from general practitioners (GPs) who underwent lumbar MRI. A quasi-experimental design with pre- and post-intervention periods was employed. We included GP referrals for lumbar spine MRI at Silkeborg Regional Hospital, Denmark, among adults ≥ 18 years from 1 January 2019 to 31 August 2023. The intervention, which consisted of template-based correspondence letters and a guidance booklet, was implemented on 1 September 2022. Referrals were classified as either ‘appropriate’ or ‘inappropriate’ according to international guidelines. Interrupted time-series analysis with segmented regression was applied to evaluate change over time in referral appropriateness and the proportion of lumbar MRIs within 90 days of referral. A total of 5222 referrals were received (80.6
The Imposter Phenomenon (IP)—doubting one’s abilities despite clear achievements—is well-documented among healthcare professionals but has never been studied among practicing chiropractors, who face unique challenges including professional isolation and ambiguous healthcare identity. This study aimed to determine IP prevalence among South African chiropractors and investigate associations with age, gender, years of experience, and province. A cross-sectional survey using the validated Clance Imposter Phenomenon Scale (CIPS) was distributed via email to all 960 chiropractors registered with the Allied Health Professions Council of South Africa. Data were collected online from 25 March to 17 May 2024. Descriptive statistics, independent-samples t-tests, and one-way ANOVA were used; results are interpreted through effect sizes (Cohen’s d) and 95
Imaging does not improve the management of non-specific spinal pain in randomised trials (RCTs) conducted in medical care settings. No RCTs have been performed to assess the benefit of imaging in chiropractic clinical settings, where it is postulated imaging may identify contraindications to, or inform application of, spinal manipulation. We aimed to assess the feasibility of performing a large-scale RCT to test whether obtaining spinal radiographs for patients receiving chiropractic care for spinal pain changes patient outcomes. Chiropractor and patient recruitment occurred from February 2021 to June 2022. Chiropractors from Sydney, Australia screened consecutive patients for inclusion in the pilot RCT. The key inclusion criteria were being an adult with a new episode of spinal pain and uncertain need for radiographs (i.e., no definitive indications or contraindications for imaging). Participants were randomised to receive spinal radiographs, or not. Clinical outcome data were collected at baseline, 2-, 6-, and 12-weeks. Chiropractors participated in semi-structured interviews regarding their experience in the trial. Feasibility outcomes were reported descriptively, including: proportion of chiropractors and patients agreeing to be involved, patient cross-over, loss to follow-up, and acceptability. Eleven chiropractors screened 135 patients (mean 12, SD 17.0, range 0–56), with 33/135 (24
Abstract Background Paediatric spine pain is common, yet little is known about the influence of patient characteristics on diagnostic classification in hospital settings. Objective Describe diagnostic code variation by age, sex, parental spine diagnoses, and child comorbidity burden. Methods Nationwide historical (2007–2022) register-based cohort study including Danish 0-17-year-olds with a hospital-based spine-related diagnosis. Diagnoses were classified as specific or non-specific by ICD-10 codes. Patient characteristics were examined descriptively and with logistic regression. Results Of 49,596 children, 63% received a non-specific diagnosis. Non-specific diagnoses were more common among older children (OR ~ 0.22–0.27), children with parental spine-related diagnoses (OR = 0.77), male children (OR = 1.07), or children with lower comorbidity burden (OR ~ 1.09–1.13). Conclusions Diagnostic classification of paediatric spinal pain varies systematically by patient characteristics. Most children receive non-specific diagnoses, underscoring the need for the development of appropriate care pathways including greater use of primary care for non-specific spinal pain.
Abstract Background Global unmet need for rehabilitation remains substantial. Chiropractors commonly manage musculoskeletal conditions that may benefit from rehabilitation. However, barriers and facilitators to chiropractors’ delivery of rehabilitation in health systems have yet to be well described. Therefore, this study aimed to identify local, regional, and global barriers and facilitators to the delivery of rehabilitation within health systems. Methods Data were collected from participants attending the 18th World Federation of Chiropractic (WFC) Biennial Congress, held in Copenhagen, Denmark, on May 10, 2025. A deductive, manifest-directed content analysis, framed by the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework, was conducted on responses collected during a rehabilitation workshop. Participants completed free-text responses to four SWOT-based prompts on the delivery of rehabilitation by chiropractors within health systems. Responses were categorized into SWOT domains and coded according to an adaptation of predefined barriers and facilitators to rehabilitation delivery. Results A total of 369 responses were recorded and catalogued into strengths (n = 89), weaknesses (n = 103), opportunities (n = 84), and threats (n = 93). Commonly reported strengths included education, clinical, and leadership and policy categories. Weaknesses were primarily related to categories of facilities/logistics, finances, education, and leadership and policy. Opportunities primarily included facilities/logistics, leadership and policy, and education categories. Threats were primarily related to leadership and policy, cultural, and political categories. Conclusion This study highlights local, regional, and global factors influencing the delivery of rehabilitation in health systems by chiropractors. Findings underscore the need for targeted implementation strategies, policy advocacy, and expanded professional training to optimize chiropractors' contributions to the global rehabilitation workforce.
Abstract Background Instrument-assisted soft tissue manipulation (IASTM) is widely used, yet clinicians mostly rely on their subjective perception of applied force which can lead to variability. No studies have determined intra- and inter-examiner reliability of three-dimensional (3D) IASTM force–motions applied to humans. The objective of this study was to evaluate whether real-time visual monitoring enhances consistency of applied IASTM force. Methods This study was an observational reliability study with blinded assessors. 45 healthy adults were enrolled between June to December 2021. Clinicians (two novice, two experienced) applied 1-inch IASTM linear strokes using two quantifiable soft tissue manipulation (QSTM) smart devices (localized; dispersive) to lumbar and calf regions under two conditions: (1) applying self-perceived “medium” force without visual monitoring, and (2) applying force guided by real-time visual monitoring from a graphic visual interface (GVI). Triaxial (3D) average peak force (primary variable), stroke frequency, and angle were measured. Linear mixed models and variance components evaluated repeatability and reproducibility within and between clinicians and across two sessions. Results Visual monitoring substantially reduced variability in average peak force across clinicians, regions, devices, and sessions. Standard deviations (SDs) were significantly larger and ranges meaningfully broader without monitoring compared to with monitoring. Monitoring improved intra- and inter-examiner consistency by ≥ 30% in nearly all conditions, with medium to very large effect sizes. Effects on stroke frequency were mixed, and influence on angle minimal. Conclusions Visual monitoring in real-time significantly improved the consistency of 3D IASTM force applications on humans. Optimal reliability is foundational to practice fidelity, training, and more rigorous investigation of dose–force response relationships in manual therapy. Trial Registration : The study was prospectively registered at ClinicalTrials.gov (Identifier: NCT04923633).
Abstract Poor sleep quality is a health concern in older adults, with low back pain (LBP) as a hypothesized risk factor. We aimed to synthesize evidence on the association between LBP and sleep quality among adults ≥ 60 years. We conducted a systematic review, registered protocol (Open Science framework #u7bc4) and reported it according to PRISMA. We searched MEDLINE, Embase, CINAHL, and PsycINFO (inception to December 2025). We included cross-sectional, cohort, and case–control studies on LBP and sleep quality among adults ≥ 60 years. We utilized a combination of OpenAI’s ChatGPT and fluent members in our team to translate non-English studies after which we screened and assess their quality. We synthesized evidence from low and moderate risk of bias studies. Our search retrieved 2394 articles. After removing duplicates, we screened 2237 citations for eligibility, with 191 studies eligible for full-text screening. 13 studies were relevant and appraised. Our synthesis includes five studies of moderate to low risk of bias (three cross-sectional and two cohort studies). Although measures of LBP and sleep quality varied across the included studies, all demonstrated an overall positive small association between the two constructs. Chronic LBP is positively associated with poor sleep quality in aging adults. Our study highlights methodological limitations in existing research and calls for more rigorous epidemiological studies.
Abstract Background Despite the availability of guidelines such as the Consolidated Standards of Reporting Trials (CONSORT) Harms extension, adverse event (AE) reporting in randomized controlled trials (RCTs) of spinal manipulative therapy (SMT) remains inconsistent and incomplete. Many trials fail to provide essential AE details hindering the accurate assessment of SMT-related risks. Mapping the current landscape of AE reporting and identifying deficiencies is critical to improving transparency and advancing patient safety in SMT research and practice. Purpose To provide a comprehensive overview of AE reporting in randomized controlled trials (RCTs) investigating high-velocity, low-amplitude SMT for spinal pain, including AE types, characteristics and reporting practices. Study design/setting Scoping review based on a previous systematic review. Methods We searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022 and conducted an updated systematic search in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Index to Chiropractic Literature from January 1, 2018, to September 12, 2023, with a final update on March 8, 2026. Eligible studies were RCTs involving SMT for spinal pain in adults, including multimodal SMT trials. Studies were included if published in English, Spanish, Portuguese, French, German, Norwegian, Swedish, or Danish. AE data were extracted in three steps: whether AEs were mentioned, collected, and reported. For studies reporting AEs, detailed data on type, severity, duration, onset, relatedness, and additional care were categorized into meaningful subgroups. Summary statistics and visualizations were used to describe reporting patterns. Results Of 253 included RCTs, 55% mentioned AEs, 53% collected them, and only 28% reported their occurrence. AE characteristics were inconsistently reported, with wide variation in terminology and classification. Pain-related AEs were most common, typically described as mild in severity. However, characteristics such as duration, onset, and additional care required were often omitted. Relatedness was also inconsistently assessed. Conclusion AE reporting in SMT RCTs remains suboptimal and inconsistent with established standards. Improved adherence to standardized reporting frameworks, such as the CONSORT Harms extension, and a cultural shift toward treating AE monitoring as a core component of trial design are urgently needed to enhance transparency and strengthen patient safety.
Abstract Background Rehabilitation is described as the care needed when a person is experiencing, or is likely to experience, limitations in everyday functioning. In 2019, it was estimated that 2.4 billion people were living with a condition that could benefit from rehabilitation. Chiropractors have contributed meaningfully to the delivery of rehabilitation due to their training in musculoskeletal health and person-centred care. Building on the World Federation of Chiropractic’s chiropractic rehabilitation competency framework, this commentary highlights chiropractic's role in strengthening rehabilitation in health systems. Under the “Role of Chiropractic in Rehabilitation”, we explore the postoperative setting, sports injury recovery, and neurorehabilitation. We share how the “Integration of Chiropractors into Health Systems” exists in multidisciplinary rehabilitation teams, publicly funded health systems and in hospitals. We discuss the “Economic and Social Impacts” of the chiropractic profession in low- and middle-income countries, for equity, diversity and inclusion, and regarding cultural competencies. We present “Challenges for the Chiropractic Profession” that include varying legislations within and between countries, limited recognition among other healthcare professionals, and advanced integration within multidisciplinary rehabilitation programs. Finally, we make a “Call to Action” for theory driven implementation strategies, to advocate for improved recognition of the chiropractic profession, and to enhance interprofessional education and advance rehabilitation in chiropractic curricular. Conclusions Chiropractors can play an important role in strengthening rehabilitation in health systems as they deliver interventions for rehabilitation for people with health conditions throughout the life course, and across the continuum of care. However, barriers remain. As a profession we must align with global rehabilitation priorities and uptake taxonomies to enable equitable access to chiropractors focused on optimising function and participation.
Abstract Objective Percussive therapy (PT) is increasingly used for post-exercise recovery, but its effects and dose-related responses after exercise-induced muscle damage remain uncertain. This review evaluated the effects of PT on neuromuscular performance, muscle soreness, and biochemical markers after acute exercise. Methods The study adhered to PRISMA guidelines. A comprehensive search was conducted across PubMed, Embase, Web of Science, the Cochrane Library, and CNKI for Randomized Controlled Trials (RCTs) published through November 26, 2025. Risk of bias, methodological quality, and certainty of evidence were assessed using RoB 2, PEDro, and GRADE. Data analysis was performed using Stata-MP 18.0 software. Results Twelve RCTs were included. PT improved countermovement jump recovery compared with control (k = 13, g = 0.78, 95% CI 0.26 to 1.29, p < 0.01; low certainty) and reduced creatine kinase levels (k = 7, g = − 0.87, 95% CI − 1.57 to − 0.17, p = 0.02; very low certainty). PT did not clearly improve maximum voluntary contraction recovery (k = 8, g = 0.12, 95% CI − 0.10 to 0.34, p = 0.28; moderate certainty) or delayed onset muscle soreness (k = 17, g = 0.14, 95% CI − 0.19 to 0.48, p = 0.40; very low certainty). Exploratory analyses suggested that longer treatment (> 5 min per muscle group) was associated with larger countermovement jump effects, whereas 2.5–5 min protocols at higher frequency (≥ 50 Hz) were associated with creatine kinase reduction. Longer treatment was also associated with higher delayed onset muscle soreness scores. Conclusion PT may improve explosive performance recovery and reduce early creatine kinase levels, but current evidence does not support clear benefits for maximum strength recovery or soreness relief. Dose-related findings are preliminary and should not be interpreted as prescriptive thresholds.
Abstract Introduction Patellofemoral pain (PFP) is a common cause of anterior knee pain, particularly among physically active individuals. High-intensity laser therapy (HILT) has shown analgesic effects in several musculoskeletal conditions; however, its role in PFP remains unclear. Objective To evaluate the effects of HILT in people with PFP. Method Randomized controlled trials (RCTs) evaluating HILT for PFP were identified through searches in PubMed, Scopus, Web of Science, CINAHL, MEDLINE, ScienceDirect, the Cochrane Library, and PEDro, with additional screening of reference lists and gray literature (last search: May 1, 2026). The primary outcome was pain intensity, while functional outcomes were considered secondary. Risk of bias was assessed using the Cochrane RoB 2 tool. Meta-analyses were conducted using standardized mean differences (SMDs) with 95% confidence intervals under a random-effects model. Certainty of evidence was evaluated using the GRADE framework. Results Four RCTs were included, with 77 participants allocated to HILT combined with exercise and 92 to control groups. The overall RoB was assessed as high across all included trials, primarily driven by concerns related to outcome measurement and selective reporting. All HILT protocols were delivered alongside therapeutic exercise (strengthening and/or stretching), and no included trial evaluated HILT as a standalone intervention. HILT resulted in a statistically significant reduction in pain at post-treatment (SMD = − 0.66; 95% CI − 0.98 to − 0.35; p < 0.01) and at follow-up (SMD = − 1.08; 95% CI − 1.89 to − 0.26; p < 0.01); however, the certainty of evidence was rated as very low due to high RoB across included trials, substantial heterogeneity (I 2 > 50%), and imprecision related to small sample sizes. No significant between-group differences were observed for functional outcomes (Kujala scale), for which the certainty of evidence was also very low due to similar methodological limitations. Conclusion HILT combined with therapeutic exercise may reduce pain in individuals with PFP; however, its independent effect cannot be determined. The very low certainty of the evidence limits confidence in these findings, and improvements in functional outcomes remain unclear. High-quality randomized controlled trials are required to clarify the role of HILT in PFP rehabilitation and to determine its potential contribution within multimodal treatment approaches. Trial registration CRD42025631248 (PROSPERO) (December 24, 2024).
Abstract Background Low back pain (LBP) is the leading cause of years lived with disability globally and a major contributor to disease burden in Australia. Superficial heat is recognised as a non-pharmacological intervention for LBP. However, its clinical use among chiropractors and osteopaths remains unclear. Objective To examine how chiropractors and osteopaths in Australia use superficial heat in the management of LBP, explore their perceptions of its role and effectiveness, and assess their awareness and application of clinical practice guidelines for LBP. Methods A cross-sectional survey was conducted between June and October 2022 among registered chiropractors and osteopaths in Australia. The online 43-item questionnaire captured demographic, practice, and clinical data. This included frequency and method of superficial heat use, perceived effectiveness, and awareness of clinical practice guidelines for LBP. Descriptive statistics were used to summarise findings. Results A total of 341 practitioners completed the survey (78.3% chiropractors, 21.7% osteopaths). This represents approximately 3.5% of the total registered chiropractic and osteopathic workforce in Australia. Approximately half of all respondents (44.6%) reported using superficial heat for LBP in the preceding 12 months. Among those, chiropractors were more likely to use superficial heat for chronic LBP (44.6%) than for acute LBP (13.8%), whereas osteopaths were more likely to use it for acute LBP (20.3%). Superficial heat was acknowledged by 71.3% of respondents to have a role in LBP management, while 66.0% regarded it as an adjunct to spinal manipulation. In contrast, superficial heat was recommended for self-management by 34.1% of chiropractors and 28.4% of osteopaths. Awareness of LBP clinical guidelines was moderate, with 58.4% of practitioners reporting they knew how and where to access them. Chiropractors most commonly referred to the American College of Physicians (ACP) guidelines, whereas osteopaths more frequently used the UK NICE guidelines. Conclusion Despite its recognised clinical value, the use of superficial heat for LBP was limited, with 44.6% of practitioners reporting its use in practice, and fewer chiropractors (34.1%) and osteopaths (28.4%) recommending it for patient self-management. These findings indicate a gap between awareness and guideline-concordant care, highlighting the need for targeted education and clearer clinical guidance to support its consistent integration within multimodal LBP management.
