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Manual Therapy 16 (2011) 264e269

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Manual Therapy

journal homepage: www.elsevier .com/math

Original article

Effects of taping on thumb alignment and force application during PAmobilisationsq

Thomas Walsh a,*, Eamonn Delahunt a,b, Ulrik McCarthy Persson a

aSchool of Public Health, Physiotherapy and Population Science, University College Dublin, Republic of IrelandbInstitute for Sport and Health, University College Dublin, Ireland

a r t i c l e i n f o

Article history:Received 4 March 2010Received in revised form8 November 2010Accepted 10 November 2010

Keywords:Thumb painTapeSpinal manipulations [Mesh]

q Work was conducted in: School of Public Health, PScience, University College Dublin, Health SciencesRepublic of Ireland. Tel.: þ353 1 716 6500; fax: þ353* Corresponding author. Carralavin, Bonniconlon, C

Tel.: þ353 87 2704269.E-mail address: Thomaswalsh20@hotmail.com (T.

1356-689X/$ e see front matter � 2010 Elsevier Ltd.doi:10.1016/j.math.2010.11.006

a b s t r a c t

Work related thumb pain (WRTP) is a major problem among manipulative physiotherapists. Therapistswho maintain the thumb joints in an extended alignment during PA mobilisation experience less WRTP.The purposes of this study were to investigate what effect taping of the thumbs has on thumb alignmentduring mobilisation and to gain normative data on the mobilisation forces applied by student physio-therapists. Forty final year student physiotherapists participated and were asked to apply a grade III PAmobilisation onto the C7 vertebra of one of 32 asymptomatic models. Participants were then instructedto apply the same mobilisation onto a force measurement instrument, in both the tape and no tapeconditions, while the alignment of their metacarpophalangeal (MCP) and interphalangeal (IP) joints wasnoted via video recorder. Thumb alignment improved in 72.5% of participants post taping, with signif-icant increases in the number of MCP joints maintained in a neutral alignment (p < 0.05). The mean peakmobilisation force applied by the students was 70.9 N. Taping of the thumbs prior to PA mobilisationimproved thumb alignment during mobilisation in this cohort of undergraduate students, thus poten-tially influencing one of the contributory factors to WRTP.

� 2010 Elsevier Ltd. All rights reserved.

1. Introduction

Themanual nature of practicewithin physiotherapy predisposesto the development of musculoskeletal disorders (Bork et al., 1996;Cromie et al., 2000; West and Gardner, 2001). It is reported that asmany as one in six physiotherapists have moved within or left theprofession as a result of occupational musculoskeletal injuries(Cromie et al., 2000). The hand and wrist has been found to be thesecond most common site of occupational injury in physiothera-pists (Bork et al., 1996; West and Gardner, 2001).

Work related thumb pain (WRTP) is a major problem amongstmanipulative physiotherapists, with career prevalence reported as74e83% (Power and Fleming, 2007; Wajon and Ada, 2003). Oftherapists who experience WRTP, 74e88% report modifying theirtreatment techniques secondary to pain (Power and Fleming, 2007;Snodgrass et al., 2003; Wajon et al., 2007). This practice of alteringtechnique due to the therapist’s WRTP rather than to enhancetreatment benefit, may decrease the proven efficacy of manual

hysiotherapy and PopulationCentre, Belfield, Dublin 4,1 716 6501.o Mayo, Republic of Ireland.

Walsh).

All rights reserved.

therapy as a cost effective treatment (Korthals-de et al., 2003),potentially increasing healthcare costs (Snodgrass et al., 2003).

Regular application of manual therapy has been suggested asa causative factor in WRTP (Atkinson and Maher, 2004; Power andFleming, 2007; Snodgrass and Rivett, 2002; Snodgrass et al., 2003;Wajon and Ada, 2003). Postero-anterior (PA) mobilisations involvethe use of the thumb tips to impart a rhythmical, oscillatory, passiveaccessory movement to the vertebrae (Wajon et al., 2007) and arereported to be an aggravating factor in 85% of physiotherapists withWRTP (Wajon and Ada, 2003). The mean peak force appliedthrough the thumbs, during a grade IV PA mobilisation to thecervical spine is 92 N (Snodgrass et al., 2009). Therefore the highassociation between the mobilisation and WRTP is not surprising,considering the thumb is not designed to deal with forces along itslongitudinal axis (Atkinson and Maher, 2004; Moulton et al., 2001).

The forces applied by experienced clinicians during PA mobi-lisations to the cervical spine have been well examined (Conradieet al., 2004; Hu et al., 2009; Snodgrass et al., 2006, 2009). Trialsinvestigatingmobilisations by student physiotherapists are few andmostly involve Australian students (Hardy and Napier, 1991;Langshaw, 2001; Smit et al., 2003; Snodgrass et al., 2010). Onlyone of these trials was identified as being of high quality withsufficient number of participants. Investigation into the mobi-lisation forces applied by Irish student physiotherapists is pertinent

Table 1Demographic data of participants and models.

Basic data Participants(N ¼ 40) mean (SD)

Models(N ¼ 32)mean (SD)

Age (Years) 21.5 (1.5) 21.7(1.6)Gender (Male/Female) 12/28 10/22Height (cm) 171.1 (8.5) 171.8 (7.9)Weight (Kg) 71.5 (13.2) 72.2 (13.2)BMI (kg/m2) 24.3 (3.4) 24.3 (3.5)

(BMI) ¼ Body Mass Index.

T. Walsh et al. / Manual Therapy 16 (2011) 264e269 265

as these forces may be too low to produce the desired clinical effector excessively high, resulting in undue stress on the patient andtherapist (Snodgrass et al., 2006).

Wajon et al. (2007) found that physiotherapists, who maintainboth their metacarpophalangeal (MCP) and interphalangeal (IP)joints in extension during PAmobilisations, experience significantlyless WRTP than therapists who do not. These findings have impor-tant clinical implications. Retaining this extended thumb alignmentduring PA mobilisation could reduce the incidence of WRTP.

Buckingham et al. (2007) investigated the ability of studentphysiotherapists to sustain an extended thumb alignment duringPA mobilisations. They noted that only 8% of the participants wereable to hold an extended position whilst reaching a target force.This is a concerning finding, which viewed in conjunction with thefindings of Wajon et al. (2007), suggests that students will beparticularly vulnerable to developing WRTP upon entering theworkforce. In fact, 58% ofmanipulative physiotherapists withWRTPreport the onset of painwithin the first ten years of practice (Powerand Fleming, 2007).

Taping provides support and stability to a joint and restrictsunwanted movements which cause insult to the joint (Reese, 1994).Taping has been shown to restrict range of motion (Verhagen et al.,2001), and has been linked with increased subjective ratings ofjoint stability and task specific confidence (Sawkins et al., 2007).Taping of the thumb prior to PA mobilisation could conceivablyrestrict unwanted thumb movement and aid thumb alignmentduring mobilisation. This would be a way in which to influencea proven contributory factor to WRTP (Wajon et al., 2007).

The purpose of this study is to investigate what effect taping ofthe thumb has on thumb alignment during performance of PAmobilisations. This study will also aim to gain normative data onthe forces applied by Irish student therapists during grade III PAmobilisations at the C7 vertebra.

2. Methods

2.1. Participants

Forty final year under-graduate BSc Physiotherapy students atUniversity College Dublin consented to partake in the projectfollowing recruitment, out of a possible 56 students. Final year

Fig. 1. Step 1: An anchor is applied at the wrist. Step2: Tape is applied from the wrist anchoris extended over the thumb tip and continued along the palmar aspect of thumb to terminatis placed around the IP joint and another at the base of the proximal phalanx. Step 5: A tearthumb tip and pad.

students included had formal training in the mobilisation tech-nique during their third year and had completed a musculoskeletalplacement. Exclusion criteria were; an upper limb injury within thelast six weeks, a known inflammatory, joint or neurologicalcondition affecting the upper limbs.

2.1.1. ModelsThirty two asymptomatic models were recruited. Asymptomatic

models were chosen in order to minimise any sources of errorwhen comparing the applied mobilisations (Snodgrass et al., 2009).Exclusion criteria were an injury to the neck within the last sixweeks, or current neck pain (Table 1).

2.2. Taping technique

A rigid, zinc oxide tape was used. The taping technique appliedwas a variation from a previously described technique (Reese,2004) and was designed to assist in retaining extension of thethumb joints during spinal mobilisation. It aimed to restrict flexionand hyperextension at the IP andMCP joints, while not diminishingsensory feedback during mobilisation. It was applied by theresearcher prior to mobilisation during the taped test condition(Fig. 1).

2.3. Instruments

2.3.1. Force measurementThe force measurement device was a digital pinch/grip analyser

(MIE Medical Research Ltd, 6 Wortley Moor Road, Leeds, LS12 4JF,UK) mounted onto a wooden support (Fig. 2). The maximal forcecapacity of the device is 1000 N, with a resolution of 1 N. Data wascollected on a computer via clinical analysis software for windows(Win CAS, MIE Medical Research Ltd, 6 Wortley Moor Road, Leeds,LS12 4JF, UK) and saved as a Microsoft Excel� file (Microsoft Office,2007; Washington, USA).

2.3.2. QuestionnaireThe questionnaire was constructed to investigate the subjective

benefits associated with the tape. The questionnaire consisted offive short questions. Questions 1e3 related to the subjectivechanges to; joint stability, ability to maintain an extended jointposition and task specific confidence, respectively. Question 4queried whether the participant would consider using the tapingtechnique clinically. Question 5 sought any additional commentsthe participants may have pertaining to the technique.

2.4. Procedure

Ethical approval for the study was received from the UniversityHuman Research Ethics Committee. Participants signed aninformed consent form upon arrival to the testing session. Thesession comprised of a testeretest format, with the order of testing

along the dorsal aspect of the 1st metacarpal continuing to the thumb tip. Step 3: Tapee at the ulnar styloid. A second anchor is the applied at the wrist. Step 4: A locking stripis made in the tape above the IP locking strip and the tape is peeled back to expose the

Fig. 2. (A and B) The mobilisation was performed with and without tape onto the force measurement instrument.

T. Walsh et al. / Manual Therapy 16 (2011) 264e269266

randomised. The participant was asked to repeat the test procedureunder two test conditions, with those conditions being: (1 e notape, and 2 e tape).

Following adjustment of the plinth to their comfort, theparticipant palpated the C7 vertebra on an asymptomatic modeland marked the area. The participant was subsequently asked toapply at least 10 oscillations of a grade III central PA mobilisationonto the vertebra. This allowed the participant a reference as tohow they would apply the mobilisation clinically. This mobilisationsite and grade were chosen as they involve large amplitudes andforce of mobilisation, while a therapist is unlikely to use the pisi-form to mobilise in the cervical spine. The participant was providedwith the definition of a grade III mobilisation (Maitland et al., 2005)to further standardise the technique (Snodgrass et al., 2006). Oncethe participant was familiarised with the mobilisation, they wereasked to immediately apply 30 oscillations to the same force,amplitude and oscillation frequency onto the force measurementinstrument (Fig. 2a and b). The time between mobilisations on themodel and device was kept to a minimum to reduce any discrep-ancy between mobilisations. The force applications were recordedby a video-camera positioned at a fixed distance from the lateralaspect of the participants’ thumbs. This view has been validated todetermine the alignment of the hand in a non invasive way(Vergara et al., 2003). Following completion of the procedure, inboth taped and non-taped test conditions, the participant filled outa short questionnaire on the subjective benefits of the tapingtechnique.

2.5. Statistical analysis

2.5.1. Thumb alignmentAnalysis of thumb alignment was descriptive, negating the need

for a true lateral view of the thumbs. Video footage was viewed byall three researchers over two viewing sessions. Two of the

Table 2Number and percentage of thumbs which were categorised into each thumb alignment acjoints during performance of PA mobilisations.

Thumb alignment MCP joint position IP joint position No

1 Hyperextension Hyperextension 112 Hyperextension Extension 63 Hyperextension Flexion 64 Extension Hyperextension 175 Extension Extension 116 Extension Flexion 17 Flexion Hyperextension 278 Flexion Extension 19 Flexion Flexion 0

Data is reported for both the no tape and the tape condition. 40 participants were inclu* Significant at p < 0.05.

researchers were supervisors of the project, who did not partake indata collection and were blinded to participant identity. The videofootage only contained a view of the participant’s hand and wrists,making identification by the blinded supervisors unlikely. Thumbalignment was described during the last five oscillations of mobi-lisation. The alignment of theMCP and IP joints of each thumbweredescribed as either flexed, extended or hyperextended with no tapeinitially, and again with the taping technique in situ. Any differ-ences observed between the two videos were noted and described.If necessary, video footage was viewed several times untilconsensus was reached. Therewas never a disagreement or lengthydiscussion required between the researchers. Each thumb wascategorised into one of nine possible thumb alignments (Table 2)and every MCP and IP joint were categorised based on the jointsposition (Table 3). A McNemar test was used for nominal scalecomparison within each alignment category before and after theapplication of tape (p < 0.05) (Hicks, 2005).

2.5.2. ForceA mean peak force over the 30 oscillations was calculated for

each participant, excluding the first and last oscillations due to highvariability for these two measurements. Data was input into SPSS(version 15.0, SPSS Inc. Chicago, IL, USA) and a paired t-test wasused to analyse ratio scale comparison between the mean peakforces of the tape and no tape test conditions. Pearson’s correlationcoefficient were carried out for each of age, weight, height and bodymass index to establish any correlation to mean peak forceproduction. An independent t-test was used to compare the meanpeak forces applied by males and females (p < 0.05) (Hicks, 2005).

2.5.3. QuestionnaireQuestionnaire data was described based on the frequency of

participants choosing each specific answer and represented ingraphical form (Fig. 3). Written answers from question 5 were

cording to the positions of the metacarpophalangeal (MCP) and interphalangeal (IP)

tape (Number) No tape (%) Tape (Number) Tape (%)

13.75 10 12.57.5 5 6.257.5 1 1.25

21.25 25 31.2513.75 16 201.25 2 2.5

33.75 19 23.75 *

1.25 2 2.50 0 0

ded in the analysis with both the left and right thumb included, n ¼ 80 thumbs.

Table 3Number, percentage and positions of the metacarpophalangeal (MCP) and inter-phalangeal (IP) joints during performance of PA mobilisations.

Joint No tape Tape

Number % Number %

Number of MCP joints inhyperextension

23 28.75% 16 20%*

Number of MCP joints in extension 29 36.25% 43 53.75%*Number of MCP joints in flexion 28 35% 21 26.25%Number of IP joints in

hyperextension55 68.75% 54 67.5%

Number of IP joints in extension 18 22.5% 23 28.75%Number of IP joints in flexion 7 8.75% 3 3.75%

This is reported for both the no tape and tape condition. 40 participants (80 thumbs)were included in this analysis. Columns total to 200% for percentage and 160 fornumber as both MCP and IP joints for each thumb are considered in each column.* Significant at p < 0.05.

T. Walsh et al. / Manual Therapy 16 (2011) 264e269 267

analysed to identify keywords, from which themes of answeringwere identified. Prevailing or common themes were described.

3. Results

3.1. Thumb alignment

In the no tape condition the most common alignment was oneof flexion at the MCP joint and hyperextension at the IP joint(alignment 7) (Table 2). The least common alignment, in both theno tape and tape condition, was one of flexion at both the MCP andIP joints (Alignment 9).

With the taping technique in situ there was a change in theoverall distribution of thumb alignments. There was a significant,decrease (29.6%) in the number of participants categorised to be inthumb alignment 7 post application of the tape (p ¼ 0.039). Therewere also trends towards an increase in the number of participantsin alignment 4 (p ¼ 0.057) and alignment 5 (p ¼ 0.063) in the tapecondition, however these proved non significant (p > 0.05).

A post hoc power analysis was carried out using G power soft-ware Version 3.1.2 (Faul et al., 2007) for thumb alignment 5. Thisdemonstrated that in order to achieve a power of 0.8 for theobserved effect size, and an alpha value of 0.05; a sample of 87thumbs or 44 participants was required.

Subjective effects of taping

0% 20%

No Effect

Decreased

Increased

No Effect

Decreased

Increased

No Effect

Decreased

Increased

Resp

on

se

"Level of stability"

"Ability to

maintain

thumb joints

in

extension"

"Level of

confidence"

Fig. 3. Frequency of responses to the questionnaire data. X-axis: Response. Y-axis: Percenchanged the level of stability at your thumb joints during the performance of PA pressures”. Ithat the applied taping technique changed your ability to maintain your thumb joints in exEffect ¼ 5. Study N ¼ 40. Question 3: “How do you feel that the applied taping techniqDecreased ¼ 3, No Effect ¼ 19. Study N ¼ 40.

3.1.1. MCP AlignmentThe number of MCP joints in extension significantly increased

by 48% with the addition of tape (p ¼ 0.001) (Table 3). There wasalso a significant decrease (30%) in the number of MCP joints cat-egorised to be in hyperextension post application of tape (p¼ 0.04).The tape served to resolve the deviation from extension in 14(17.5%) MCP joints, reduce the deviation from extension in 15(18.75%) MCP joints, and had no effect on the remaining 20 (25%)MCP joints not already in extension. There were however 2 (2.5%)MCP joints in which the deviation from extension increased in thetape condition compared with no tape.

3.1.2. IP AlignmentThere was no significant increase in the number of IP joints in

extension with the addition of tape (p ¼ 0.125). The tape served toresolve the deviation from extension in 5 (6.25%) IP joints, reducethe deviation from extension in 27 (33.75%) IP joints and had noeffect on the remaining 30 (37.5%) IP joints not already in extension.No IP joints were found to increase in their deviation fromextension.

3.1.3. OverviewIn total, 72.5% (N ¼ 29) of the participants were observed to

decrease in their deviation from extension at one or more thumbjoints in the tape condition compared with no tape. A further 9participants (27.5%) showed no change in thumb alignment, while2 (5%) participants were observed to increase in their deviationfrom extension, at one thumb joint.

3.2. Force

The mean peak force produced by the study participants, duringa simulated grade III central PA mobilisation to the C7 vertebra was70.9 N (SD � 27.4). During the taped intervention there was nosignificant (t ¼ 0.266, p ¼ 0.79) change in the mean peak force(70.3 N, SD � 28.3).

There was no significant correlation between the mean peakforce applied duringmobilisation and any of age (r¼ 0.24, p¼ 0.14),weight (r ¼ 0.14, p ¼ 0.40), height (r ¼ 0.29, p ¼ 0.07) or BMI(r¼�0.23, p¼ 0.89). There was a trend toward a higher mean peak

during PA mobilisation

40% 60% 80% 100%

Percentage

tage of participants. Question 1: “How do you feel that the applied taping techniquencreased ¼ 36, Decreased¼ 1, No Effect ¼ 3. Study N ¼ 40. Question 2: “How do you feeltension during the performance of PA pressures”. Increased ¼ 33, Decreased ¼ 2, Noue changed your level of confidence when applying PA pressures”. Increased ¼ 18,

T. Walsh et al. / Manual Therapy 16 (2011) 264e269268

force in themale gender (82.5 N, SD� 28.4 range¼ 39.8 Ne127.0 N)than the female gender (65.8 N, SD� 25.9 range¼ 33.5 Ne124.3 N),however this proved to be non significant (t ¼ �1.8, p ¼ 0.08).

3.3. Subjective effects

The taping technique influenced participants’ perception ofstability, confidence and ability to maintain the thumbs in anextended alignment during PA mobilisations (Fig. 3). The greatestsubjective changes noted was in the level of stability at the thumbjoints, with 90% (N ¼ 36) of participants reporting increasedstability with the taping technique in situ. A similar percentage ofparticipants (82.5%, N ¼ 33) perceived an increased ability tomaintain their thumb joints in extension with the addition of tape.Subjective perceptions of confidence were also higher in the tapecondition than in the no tape condition.

When asked the question “Do you think you would considerusing this taping technique in a clinical setting, prior to performingPA mobilisation?”, and asked to elaborate on the reason foranswering “Yes” or “No”, 60% (N ¼ 24) of participants answered“Yes”. Common themes of answering associated with theseparticipants included; the tapewould reduce stresses placed on thethumbs duringmobilisation, reduce future incidence of thumb painand improve the quality and efficacy of the mobilisation.

The subsequent 40% (N ¼ 16) claimed they would not use thetechnique clinically with common themes associated with theseparticipants including; difficulty due to time constraints, difficultywith self application and discomfort associated with the tape.

4. Discussion

Many studies have investigated WRTP and its contributoryfactors (Bork et al., 1996; Cromie et al., 2000; Power and Fleming,2007; Snodgrass et al., 2003; Wajon and Ada, 2003; Wajon et al.,2007; West and Gardner, 2001), however few have sought toinfluence these factors. Wajon et al. (2007) investigated the asso-ciation between thumb alignment during PA mobilisations andWRTP. They established that thumb alignments which deviate fromextension during mobilisation are contributory to WRTP (Wajonet al., 2007).

In this study there was a non significant (p ¼ 0.063) increase inthe number of thumbs in extension at both the MCP and IP jointswith the addition of tape. Based on post hoc analysis, had four moreparticipants been recruited there would have been adequate powerto detect a significant result. However, despite this lack of signifi-cance in the increased number of thumbs in extension post taping,there were a number of other positive findings which suggest thattape may aid in the reduction of WRTP.

Hyperextension at the MCP joint during mobilisation has beensuggested as a causative factor in WRTP (Snodgrass and Rivett,2002). Moulton et al. (2001) illustrated that applying loadthrough a hyperextendedMCP joint, encourages dorsal subluxationof the metacarpal shaft, contributing to development of osteoar-thritis at the metacarpal base and thumb pain. Wajon et al. (2007)however, did not find an association between hyperextension at theMCP joint and WRTP, instead finding that an extended MCP posi-tionwas favourable to the reduction ofWRTP. This taping techniquewas shown to significantly reduce the number of MCP joints inhyperextension and significantly increase the number of MCP jointsin extension (p < 0.05).

There was no significant increase in the number of IP joints inextension post application of tape. However, one should considerthe large number of IP joints (27) at which the deviation fromextensionwas decreased, bringing these joints away from an end ofrange position. Continuous movement of a joint into end of range,

leads to repetitive stress on the joint capsule and ligaments and hasbeen suggested as a causative factor in the development of WRTP(Buckingham et al., 2007). This effect of the tape, in bringing thejoint into extension or preventing the joint from reaching its end ofrange, could prevent the development of WRTP.

This study quantifies the mean peak force applied by studenttherapists during grade III cervical PA mobilisations. In recentstudies, the forces applied by qualified physiotherapists and phys-iotherapy students during cervical PA mobilisation were examined(Snodgrass et al., 2009, 2010). The mean peak forces reported forthe vertical component of a grade III central PA at C7 was 68.7 N forqualified therapists (Snodgrass et al., 2009) and 55.5 N for studenttherapists (Snodgrass et al., 2010), lower than the 70.9 N found inthis study. This may be due to differences in the instruments usedto quantify forces between studies and possibly due to differentteaching methods employed between the universities in which thestudents were trained. This study found that student therapistsapply a similar level of force during mobilisation as qualifiedtherapists. It also suggests that the participating Irish physio-therapy students applied slightly higher mobilisation forces thantheir Australian counterparts.

In this study 40% of the participants claimed they would not usethis technique clinically. A frequent reason offered was timeconstraints. This technique does take time to self apply, howeverfollowing frequent applications this time can be greatly reduced.The technique may also not be suitable for therapists who haveadequate stability at their thumb joints or therapists not comfort-able with tape in situ.

This technique would likely be used by manipulative physio-therapists practicing frequent manual therapy. However a therapistis likely to have a diverse caseload, not necessitating the use of thetechnique for each patient, while the pisiform is often used tomobilise in lower areas of the spine. In the interest of patienthygiene the technique may need to be reapplied for each appro-priate patient. Alternatively, wearing a disposable latex glovewhilst treating the patient would negate the need for tape removaland reapplication. Considering the possible benefits of the tech-nique for long term health and work capabilities, then timeapplying the technique may be justified.

Several preventative strategies have been suggested forreducing WRTP. Among these are splinting, exercise and the use oftools (Snodgrass and Rivett, 2002). A thumb splint would poten-tially have an advantage over taping as it would involve lessapplication time. However at present there are fewwidely availablesplints specifically designed for physiotherapists during mobi-lisation. The use of current artificial devices has been found to beuncomfortable for both the physiotherapist and patient (Maheret al., 2002). The use of this taping in conjunction with othertechniques may be a useful strategy in reducing WRTP inphysiotherapists.

4.1. Limitations

In this study, an artificial device was used for force measure-ment, which is unlikely to offer the same resistance as the spineand surrounding soft tissue structures. Snodgrass et al. (2009, 2010)used an instrumented treatment table to measure force, howeverarguably this will only measure the forces absorbed by the tableand not those at the patientetherapist interface (Snodgrass et al.,2006). An asymptomatic model was used as a reference point inthis study to attempt to counterbalance the difficulties associatedwith using an artificial device. However it should be noted that therepeatability of the forces produced between the model and theartificial device were not assessed.

T. Walsh et al. / Manual Therapy 16 (2011) 264e269 269

Palpation of the C7 vertebra was carried out by each participantusing a standard palpation technique. This was a possible limitationas the inter-tester reliability for identification of a radiologicalnominated landmark has been found to be poor for C7 (Robinsonet al., 2009). The palpation procedure was carried out by eachindividual as it was considered to be more congruent to a clinicalsetting.

The video footage was viewed over two viewing sessions withinone week of each other. However since a direct comparison wasbeing made between videos, paired videos were analysed consec-utively, thus possibly introducing an element of recall bias.

In this study the analysis of thumb alignment was descriptiveand carried out by the principal researcher and two supervisors. Asimilar methodology was used in two comparable studies(Buckingham et al., 2007; Wajon et al., 2007). However this isa limitation of the current study since it was not possible to blindthe reviewers as to the taping condition of the participant. This mayhave introduced an element of bias to the results, however in mostcases the alignment of the thumb joints was obvious to all threeresearchers on initial viewing and the process of consensusdiscussion and review was thought unlikely to bias to the results.

5. Conclusion

This study found that 72.5% of participants improved theirthumb alignment during mobilisation post taping. Taping of thethumbs prior to vertebral PA mobilisation reduces a provencontributory factor to WRTP. It is the recommendation of theauthors that this taping technique could be incorporated intoa management programme to reduce WRTP in physiotherapists.Future study should investigate whether this taping can reduceWRTP through a longitudinal, prospective cohort study.

Acknowledgement

The authors would like to thank Louise McGinty for her excel-lent design input for the article illustrations.

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