The effects of connective tissue manipulation on balance and proprioception among university students: Randomized controlled study

Background and Purpose: Manual therapy approaches (MTA) could stimulate the proprioceptors of the fascia. Connective tissue manipulation (CTM) is an MTA that could affect musculocutaneous and nervous systems together. Thus, it could be a more promising technique than other MTA to stimulate the fascial proprioceptors. This single-blind randomized-controlled study aimed to investigate the effects of CTM applied to the lumbar, thoracal, and cervical regions on balance and proprioception. Materials and Methods: 40 university students were randomly divided into exercise (16 females, 4 males; mean age: 20.87 ± 3.15) and exercise+CTM (14 females, 6 males; mean age: 22.55 ± 2.39) groups. Both groups performed home exercises to improve balance, flexibility and strength for 2 sessions a week for 6 weeks. Additionally, CTM was applied in exercise+CTM group for 6 weeks, twice-a-week. Before/after assessments were done with Biodex Balance System, Cervical Range of Motion Tester, and StabilizerTM Pressure Biofeedback Unit. Results: Exercise group showed a significant improvement in proprioception only for cervical flexion to the right with (p = 0.021) and without (p = 0.002) vision while balance was improved especially on dynamic platforms (p < 0.05). Exercise+CTM group showed an improvement in without-vision cervical proprioception in flexion (p = 0.001), flexion to the right (p = 0.003) and left (p = 0.010) and lumbar proprioception (p ≤ 0.001). Balance scores were improved in both static and dynamic platforms (p < 0.05). Improvements in proprioception of cervical flexion with (p = 0.017) and without vision (p = 0.044), and posterior pelvic tilt (p ≤ 0.001) differed between the groups after the study. Unilateral balance scores on static platform (left foot p = 0.016, right foot p = 0.001), and right-foot-stance and bilateral-stance balance scores on dynamic platform (p = 0.008 and p = 0.048 respectively) were improved more in exercise+CTM group. Conclusion: CTM with exercise improves cervical/lumbar proprioception and balance, especially static balance in comparison to exercise only. Future studies should be done with different populations such as patients with neurological conditions or athletes.