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New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 17743

Special Issue Editors

Dr. Marcos José Navarro-Santana

E-Mail Website
Guest Editor
Department of Radiology, Rehabilitation and Physical Therapy, Universidad Complutense de Madrid, Madrid, Spain
Interests: musculoskeletal pain; physical therapy; statistical analysis; ultrasound imaging; myofascial pain syndrome; low back pain
Special Issues, Collections and Topics in MDPI journals
Dr. Ignacio Cancela-Cilleruelo

E-Mail Website
Guest Editor
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
Interests: pain; network; neuropathic; sensitization; anxiety; musculoskeletal pain; prevalence

Special Issue Information

Dear Colleagues,

Musculoskeletal disorders and traumatic injuries represent a significant global health burden, affecting millions of individuals and reducing their quality of life. Advances in physical therapy have played a crucial role in improving the assessment, treatment, and prevention of these conditions. Exercise-based therapies, manual techniques, and emerging invasive physical therapy approaches, including dry needling and percutaneous electrolysis, are showing promising outcomes in managing pain, enhancing function, and accelerating recovery. Despite these advancements, challenges remain regarding the optimization of treatment protocols, patient-specific interventions, and the integration of innovative technologies. This Special Issue will gather high-quality research and reviews exploring the latest developments in musculoskeletal and orthopedic physical therapy. We invite contributions addressing clinical applications, the underlying mechanisms, and outcome-based studies to further refine evidence-based practices and improve patient care.

Dr. Marcos José Navarro-Santana
Dr. Ignacio Cancela-Cilleruelo
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • musculoskeletal disorders
  • exercise therapy
  • manual therapy
  • invasive physical therapy
  • rehabilitation

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Published Papers (5 papers)

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Research

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13 pages, 1145 KB  
Article
Adding Multimedia Animations to Exercise Therapy Provides No Additional Benefit for Rotator Cuff–Related Shoulder Pain: A Randomized Clinical Trial
by Irene Pérez-Porta, Fernando García-Pérez, María Ángeles Pérez-Manzanero, María Alicia Urraca-Gesto, Aurora Araujo-Narváez, María Velasco-Arribas, Marcos José Navarro-Santana, Gustavo Plaza-Manzano, Elia Pérez-Fernández and Mariano Tomás Flórez-García
J. Clin. Med. 2025, 14(22), 7964; https://doi.org/10.3390/jcm14227964 - 10 Nov 2025
Cited by 1 | Viewed by 1026
Abstract
Background: Exercise therapy is essential in managing rotator cuff-related shoulder pain. Multimedia tools may enhance adherence and engagement, but their added value over traditional materials remains uncertain. Objective: To compare an exercise program delivered through paper-based materials with or without addition of multimedia [...] Read more.
Background: Exercise therapy is essential in managing rotator cuff-related shoulder pain. Multimedia tools may enhance adherence and engagement, but their added value over traditional materials remains uncertain. Objective: To compare an exercise program delivered through paper-based materials with or without addition of multimedia animations in individuals with rotator cuff-related shoulder pain. Method: A single-center open-label randomized clinical trial was conducted in [Blinded] between April 2023 and December 2024 Patients with rotator cuff-related shoulder pain were included. Both groups received seven face-to-face exercise sessions with a physical therapist and were randomized into receiving or not multimedia animations. The main outcome measure was Shoulder Pain and Disability Index at 6-week follow-up. Other outcomes were pain intensity (rest, during movement and at night), patients’ satisfaction, perceived improvement and expectations and patients’ adherence to the exercise program. Furthermore, patients’ perceived usability, usefulness and satisfaction with multimedia animations were also measured. Subjects were followed for 24 weeks. Adequate multilevel regression models were implemented. Results: A total of 154 subjects were included (80 in the control group and 74 in the experimental group). Both groups improved over time, but there were no significant between-group differences regarding Shoulder Pain and Disability Index, pain intensity, patients’ satisfaction, perceived improvement or expectations. Subjects showed a decrease in adherence to exercise over time, without significant between-group differences. Conclusions: The implementation of multimedia animations may not provide additional benefits when a well-designed paper-based program and therapist support are already established. Full article
(This article belongs to the Special Issue New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy)
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14 pages, 2128 KB  
Article
Effectiveness of Graded Weight-Bearing Exercises on Pain, Function, Proprioception, and Muscle Strength in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial
by Ammar Fadil, Qassim Ibrahim Muaidi, Mohamed Salaheldien Alayat, Moayad S. Subahi, Roaa A. Sroge, Abdulaziz Awali and Mansour Abdullah Alshehri
J. Clin. Med. 2025, 14(21), 7685; https://doi.org/10.3390/jcm14217685 - 29 Oct 2025
Viewed by 3476
Abstract
Background/Objectives: Knee osteoarthritis (OA) is a prevalent degenerative joint disorder associated with pain, impaired proprioception, and reduced physical function. While closed kinetic chain exercises (CKCEs) are commonly prescribed to enhance joint stability, their weight-bearing nature may exacerbate symptoms. Graded weight-bearing exercises (GWBEs) using [...] Read more.
Background/Objectives: Knee osteoarthritis (OA) is a prevalent degenerative joint disorder associated with pain, impaired proprioception, and reduced physical function. While closed kinetic chain exercises (CKCEs) are commonly prescribed to enhance joint stability, their weight-bearing nature may exacerbate symptoms. Graded weight-bearing exercises (GWBEs) using anti-gravity treadmill training provide a novel approach to reduce joint loading while maintaining functional mobility. This study aimed to evaluate the effectiveness of GWBEs compared with CKCEs and open kinetic chain exercises (OKCEs) on pain, function, proprioception, and quadricep strength in patients with knee OA. Methods: Forty-five adults aged 40–60 years with radiographically confirmed knee OA were randomized into three groups: (1) GWBE + OKCE, (2) CKCE + OKCE, or (3) OKCE alone. Interventions were conducted three times per week for six-weeks. Outcomes included pain (Visual Analogue Scale), physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 6-Minute Walk Test), proprioception (joint repositioning error at 45°), and quadriceps strength (isokinetic peak torque at 60°, 120°, and 180°/s). Results: All groups demonstrated significant improvements in pain and function (p < 0.05). Proprioception improved in the GWBE + OKCE and CKCE + OKCE groups but not in the OKCE group. No significant changes were observed in quadriceps strength across groups. The GWBE + OKCE group showed significantly greater improvements in pain, function, and proprioception compared to both comparator groups (p < 0.05). Conclusions: GWBE combined with OKCE is more effective than CKCE + OKCE and OKCE alone in improving pain, function, and proprioception in patients with knee OA. Full article
(This article belongs to the Special Issue New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy)
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12 pages, 526 KB  
Article
Influence of Rolfing Structural Integration on Lower Limb Mobility, Respiratory Thorax Mobility, and Trunk Symmetry: A Retrospective Cohort Study
by Robert Schleip, Helen James, Katja Bartsch, Eric Jacobsen, David Lesondak, Marilyn E. Miller and Andreas Brandl
J. Clin. Med. 2025, 14(17), 6123; https://doi.org/10.3390/jcm14176123 - 29 Aug 2025
Viewed by 2883
Abstract
Background: Previous research highlights the potential of Rolfing structural integration (SI)—a force-based mobilization of fascia—in modifying postural alignment and joint mobility. This retrospective cohort study builds upon prior work to explore the influence of SI on lower limb mobility, trunk symmetry, and [...] Read more.
Background: Previous research highlights the potential of Rolfing structural integration (SI)—a force-based mobilization of fascia—in modifying postural alignment and joint mobility. This retrospective cohort study builds upon prior work to explore the influence of SI on lower limb mobility, trunk symmetry, and respiratory thoracic expansion. Methods: We conducted a retrospective secondary analysis of data drawn from the archive of clinical records as in our previous publication. A total of 563 subjects (aged 18–60 years, BMI 19–29) who completed 10 SI sessions were included. Outcomes evaluated included passive hip flexion (right/left), passive knee flexion mobility (right/left), trunk length symmetry, and chest diameter at normal breath as well as in full inspiration. Wilcoxon signed-rank tests were used for statistical analysis. Results: All parameters showed statistically significant improvements post-intervention (p < 0.001), including increased thoracic expansion, enhanced trunk symmetry, and improved mobility in hip joint flexion and knee flexion. Conclusions: Ten sessions of SI were associated with statistically significant improvements in lower limb mobility, trunk symmetry, and respiratory thoracic mobility. These findings support the role of SI in addressing postural and mobility-related dysfunctions through fascia-oriented mobilization. Full article
(This article belongs to the Special Issue New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy)
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17 pages, 2002 KB  
Article
Passive Blood-Flow-Restriction Exercise’s Impact on Muscle Atrophy Post-Total Knee Replacement: A Randomized Trial
by Alexander Franz, Luisa Heiß, Marie Schlotmann, Sanghyeon Ji, Andreas Christian Strauss, Thomas Randau and Frank Sebastian Fröschen
J. Clin. Med. 2025, 14(15), 5218; https://doi.org/10.3390/jcm14155218 - 23 Jul 2025
Cited by 1 | Viewed by 5434
Abstract
Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in [...] Read more.
Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in this early phase. This pilot study examined the feasibility, safety, and early effects of pBFR initiated during hospitalization on muscle mass, swelling, and functional recovery after TKA. Methods: In a prospective, single-blinded trial, 26 patients undergoing primary or aseptic revision TKA were randomized to either a control group (CON: sham BFR at 20 mmHg) or intervention group (INT: pBFR at 80% limb occlusion pressure). Both groups received 50 min daily in-hospital rehabilitation sessions for five consecutive days. Outcomes, including lean muscle mass (DXA), thigh/knee circumference, 6 min walk test (6 MWT), handgrip strength, and patient-reported outcomes, were assessed preoperatively and at discharge, six weeks, and three months postoperatively. Linear mixed models with Bonferroni correction were applied. Results: The INT group showed significant preservation of thigh circumference (p = 0.002), reduced knee swelling (p < 0.001), and maintenance of lean muscle mass (p < 0.01), compared with CON, which exhibited significant declines. Functional performance improved faster in INT (e.g., 6 MWT increase at T3: +23.7%, p < 0.001; CON: −7.2%, n.s.). Quality of life improved in both groups, with greater gains in INT (p < 0.05). No adverse events were reported. Conclusions: Initiating pBFR training on the first postoperative day is feasible, safe, and effective in preserving muscle mass and reducing swelling after TKA. These findings extend prior BFR research by demonstrating its applicability in older, surgical populations. Further research is warranted to evaluate its integration with standard rehabilitation programs and long-term functional benefits. Full article
(This article belongs to the Special Issue New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy)
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8 pages, 844 KB  
Case Report
Percutaneous Tibial Nerve Stimulation for Neurogenic Bladder Due to Severe Lumbosacral Disc Herniation
by Do-Young Kim, Ji-Sung Yeom, Ye-Rim Yun, Joon-Seok Lee, Won-Jeong Ha, In-Hyuk Ha, Yoon Jae Lee and Doori Kim
J. Clin. Med. 2025, 14(7), 2262; https://doi.org/10.3390/jcm14072262 - 26 Mar 2025
Viewed by 3350
Abstract
Background: Neurogenic bladder (NB), resulting from neurological disorders, significantly affects quality of life and increases healthcare costs. Although percutaneous tibial nerve stimulation (PTNS) is an established therapy for central nervous system-related lower urinary tract dysfunction (LUTD), its efficacy in treating intervertebral discogenic LUTD [...] Read more.
Background: Neurogenic bladder (NB), resulting from neurological disorders, significantly affects quality of life and increases healthcare costs. Although percutaneous tibial nerve stimulation (PTNS) is an established therapy for central nervous system-related lower urinary tract dysfunction (LUTD), its efficacy in treating intervertebral discogenic LUTD remains unexplored. This study presents the first documented case of PTNS applied to NB secondary to severe lumbosacral herniated intervertebral disc (HIVD). Methods: A 39-year-old female, hospitalized twice for worsening HIVD, presented with LUTD, including urgency, weak stream, and nocturia. Magnetic resonance imaging confirmed progressive L5-S1 disc extrusion with sacral nerve compression. PTNS, delivered via electronic stimulation through acupuncture needles at SP6 and KI3, was administered daily for 10 days during hospitalization. Symptom scores relating to LUTD, pain, and physical disability were evaluated. Result: The American Urological Association symptom score showed significant improvement (from 20 to 6 and 22 to 15 at 12 weeks after the first and second hospitalizations, respectively). Recovery of voiding function was slower during the second hospitalization, possibly due to increased sacral nerve compression and chronic pathologic condition. Pain and functional disability, assessed using the NRS and ODI, improved by approximately 50% (from 55 to 25 and 80 to 45 during the first and second hospitalizations, respectively) and two-thirds (from 66 to 42 and 93 to 66, respectively). Conclusions: This case suggests that PTNS may be a viable conservative therapy for HIVD-associated LUTD. Further research is required to elucidate its mechanistic effects and clinical efficacy in peripheral nerve-related bladder dysfunction. Full article
(This article belongs to the Special Issue New Advances in Musculoskeletal Physiotherapy: Exercise, Manual Therapy and Invasive Physiotherapy)
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