• Medial disc protrusion
• If disc protrusion is medial to nerve root, then traction force may increase impingement of disc on the nerve

• When severe pain resolves fully with traction
• Could mean that traction has increased compression on nerve root leading to complete nerve block
• Claustrophobia or other psychological aversion to traction
• Manual or positional traction may be better
• Inability to tolerate prone or supine position
• Cervical traction may be applied in sitting
• Disorientation
• May become entangled in belts/harness
• Recommended that only manual traction techniques be used if the patient is disoriented

• Temporomandibular joint problems
• Precaution when performing cervical traction; recommend
halter which applies force at occiput and avoids pressure
on mandible
• Dentures
• Keep dentures in place during cervical traction to maintain alignment of TMJ

Question

Does circulating cold water cryotherapy with or without intermittent pneumatic compression (IPC) influence shoulder joint position sense (JPS) compared to no intervention in recreationally active adults?

Population/Patient

Recreationally active adults

Intervention/Indicator

Circulation cold water cryotherapy with IPC

Control/Compare

Circulating cold water cryotherapy without IPC and no intervention

Outcome

Shoulder joint position sense (JPS)

Clinical Bottom Line

            This study found that neither circulating cold water cryotherapy without IPC, nor circulating colder water cryotherapy with IPC had any significant affect on shoulder joint position sense in recreationally active adults. As such, these modalities may not be suitable for enhancing proprioceptive acuity in this population.

Summary of Key Evidence

1.      Study Design

Randomized crossover trial

2.      Sample

20 recreationally active adults (mean age: 24.3 +/- 3.2 years)

3.      Procedure

Participants underwent three conditions in a randomized order:

·         Circulating cold water cryotherapy with IPC

·         Circulating cold water cryotherapy without IPC

·         Control (no intervention)

Each intervention lasted 15 minutes, with a 48hr washout period between sessions. Shoulder JPS was assessed before and after each intervention using a laser pointer repositioning task.

4.      Outcome Measures

Shoulder joint position sense measured by absolute error in degrees during a repositioning task.

5.      Results

No significant differences were observed in shoulder JPS across the three conditions. Both cryotherapy interventions (with and without IPC) did not significantly alter JPS compared to the control.

Appraisal

Strengths of the study

Randomized Crossover Design: each participant served as their own control, reducing inter-subject variability and enhancing the study’s internal validity.

Practical Relevance: The interventions studied are commonly used in sports and rehab settings, making the findings directly applicable to clinical practice.

Weaknesses of the study

Limited Participant Information: No details on the demographics of the participants such as age, gender, or specific activity levels are disclosed which leads to generalization. Results may vary amongst other groups.

Lack of Detailed Methodology: Lacked specifics regarding duration and intensity of the interventions. No exact methods we given to assess JPS, diminishing the study’s rigor.

Short-Term Assessment: The study appears to assess immediate or short-term effects. Long term effects of these interventions on proprioception remains unknown.

Citation

Stanhope, E.N., Warnett, R.L., Burt, D.G., Cutler, S.W., Kell, J.W.G., & Naemi, R. (2024). The influence of circulating cold water cryotherapy with or without intermittent pneumatic compression on shoulder joint position sense (JPS) in recreationally active adults: A randomized crossover trial. Journal of Bodywork and Movement Therapies, 40, 1008-1013. https://doi.org/10.1016/j.jbmt.2024.07.022

Appraised by:    Brett Bucey_____         Appraisal Date:  04/25/2025___

Question

Does the use of NMES improve muscle strength in adults diagnosed with acute or late septic shock in the ICU compared to no intervention?

Population/Patient

Adults diagnosed with acute or late septic shock in ICU settings

Intervention/Indicator

Physical therapy with neuromuscular electrical stimulation (NMES)

Control/Compare

Physical therapy without NMES

Outcome

Muscle strength, functional capacity, ICU length of stay, mortality

Clinical Bottom Line

Physical therapy combined with NMES does not significantly improve muscle strength, functional capacity, or clinical outcomes compared to physical therapy alone in patients with septic shock. Current evidence does not support routine use of NMES in this setting.

Summary of Key Evidence

1.      Study Design

Randomized crossover clinical trial

2.      Sample

ICU patients with acute and late septic shock

33 patients

3.      Procedure

Participants received two interventions (physical therapy with and without NMES) in a random order with a 48hr washout period

Interventions applied within 72hrs of ICU admission

4.      Outcome Measures

Muscle strength (Medical Research Council scale)

Functional capacity

ICU length of stay and mortality rates

5.      Results

No significant differences in strength, functional performance, or clinical outcomes between groups

Time in ICU and mortality were not influenced by NMES

Appraisal

Strengths of the study

Crossover design enhances internal control and reduces variability

Early intervention aligns with clinical interest in early mobilization

Outcome measures are clinically relevant

Weaknesses of the study

Small sample size may limit statistical power

Short intervention and follow-up period      

Only single sessions assessed – no long-term NMES exposure

Generalizability limited to similar ICU settings

Citation

Lago, A. F., Basile-Filho, A., de Oliveira, A. S., de Souza, H. C. D., dos Santos, D. O., & Gastaldi, A. C. (2022). Effects of physical therapy with neuromuscular electrical stimulation in acute and late septic shock patients: A randomised crossover clinical trial. PLOS ONE, 17(2), e0264068. https://doi.org/10.1371/journal.pone.0264068

Appraised by:    ____Brett Bucey_______     Appraisal Date:  04/25/2025____