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Results for “Manipulation, Spinal”

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PubMed2000

Qualitative review of studies of manipulation-induced hypoalgesia.

BACKGROUND: The number of studies that have investigated the direct analgesic effect of a spinal manipulation on spinal or referred pain is small, making knowledge of this crucial aspect of manipulation sparse. This paper reviews a set of studies that measure the immediate effect of manipulation on pain or pain-related phenomena in the spinal and peripheral soft tissues. METHODS: The literature was accessed through MEDLINE. Key words used were "manipulation," "pain," and "chiropractic." This search was complemented by citation reviews of important research and chapters on the topic. Only studies that directly measured the effect of at least a single spinal manipulation on pain (eg, tenderness, biochemical assay, referred pain) were selected. The selected studies were reviewed descriptively; no systematic assessment of their quality was conducted. RESULTS: The electronic search yielded 738 citations. Six hundred and forty-two were relevant to chiropractic. Of these, most were clinically descriptive articles about diagnostic and therapeutic procedures or case management. Most of the remaining articles were clinical trial reports or letters to the editor. Only 5 studies were selected according to the established criteria. Thus less than 1% of the indexed literature on chiropractic, manipulation, and pain involved studies that explored the mechanism of the putative effect of spinal manipulation on pain mechanisms. Six other studies were retrieved from citation reviews. These 11 studies were reviewed in order publication. CONCLUSION: Few studies have investigated the effects of spinal manipulation on pain directly. If the theory of manipulation exerting its therapeutic effects posits that the sensory input created by the intervention results in some form of inhibition of pain, then the results of these studies are largely consistent with one another and with this theory. This review has highlighted the deficiencies in the extant studies and many remaining questions. Only more high-quality research will permit a full elucidation of the hypoalgesic effects of spinal manipulation.

Analgesia↗

PubMed2006

Inconsistent grading of evidence across countries: a review of low back pain guidelines.

OBJECTIVE: The aim of this study was to report clinical treatment recommendations for low back pain (LBP) based on 5 international guidelines and best evidence from the Cochrane database of systematic reviews. METHODS: Five LBP guidelines available in English language were appraised, including 4 studies published since the seminal work by Koes et al (Spine 2001;26:2504-5213). The guidelines were examined for treatment recommendations concerning nonspecific LBP and guideline quality with application of the Appraisal of Guidelines for Research and Evaluation instrument. Secondly, a systematic literature search for reviews and randomized controlled trials was conducted using a modified version of the search strategy recommended by the Cochrane Back Review Group. Two systematic reviews were identified. RESULTS: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.

Evidence-Based Medicine↗

PubMed2005

Extrinsic risk factors for compromised blood flow in the vertebral artery: anatomical observations of the transverse foramina from C3 to C7.

The vertebral artery (VA) is often involved in the occurrence of complications after spinal manipulative therapy. Due to osteophytes compressing the VA anteriorly from the uncinate process or posteriorly from the facet complex, the VAs are susceptible to trauma in the transverse foramina. Such altered anatomical configurations are of major clinical significance, as spinal manipulations may result in dissection of the VA with serious consequences for the blood supply to the vertebrobasilar region. The purpose of this study is to describe numerous structural features of the third to seventh cervical vertebrae in order to contribute to the understanding of pathological conditions related to the VA. The minimal and maximal diameter of 111 transverse foramina in dry cervical vertebrae were studied. The presence of osteophytes and their influence on the VA were evaluated at the vertebral body and at the superior and inferior articular facets. The diameter of the transverse foramina increased from C3 to C6, while the transverse foramina of C7 had the smallest diameter. At all levels the mean dimensions of the left foramina were greater than those of the right side. Osteophytes from the uncinate process of C5 and C6 vertebrae were found in over 60% of dry vertebrae. Osteophytes from the zygapophyseal joints were more frequent at C3 and C4 vertebrae. About half of the osteophytes of the uncinate and of the superior articular process partially covered the transverse foramina. This was less common with those of the inferior articular facets. Osteophytes covering the transverse foramen force the VAs to meander around these obstructions, causing narrowing through external compression and are potential sites of trauma to the VAs potentially even leading to dissection. We strongly advocate that screening protocols for vertebrobasilar insufficiency (VBI) be used prior to any manipulation of the cervical spine and should include not only extension and rotation but any starting position from which the planned manipulation will be performed.

Cervical Vertebrae↗

PubMed2000

Highlighting of intervertebral movements and variations of intradiskal pressure during lumbar spine manipulation: a feasibility study.

OBJECTIVES: To demonstrate relative movement of the vertebrae and variations in intradiskal pressure during 2 different lumbar spinal manipulations, in flexion or extension, in 2 unembalmed cadavers. DESIGN: A pressure sensor was inserted into the L3-4 disk in cadaver 1 and into the L1-2 to L4-5 disks in cadaver 2. Two adjacent vertebrae (L3 and L4 in cadaver 1, and L4 and L5 in cadaver 2) were each equipped with 2 monoaxial accelerometers to record acceleration in the caudocranial axis and a biaxial accelerometer to record acceleration in the "horizontal" anatomic plane. SETTING: Laboratory study. RESULTS: During the thrust, relative intervertebral movements were demonstrated; movements differed with the type of manipulation (in flexion or extension). Intradiskal pressure initially increased, then decreased. CONCLUSIONS: Lumbar spinal manipulations have a biomechanical effect on the intervertebral disks, producing a brief but marked change in intradiskal pressure. This effect, which differs slightly with the different types of manipulation studied, is the consequence of movements of the adjacent vertebrae.

Aged↗

PubMedDate not supplied

Complementary and alternative approaches to the treatment of persistent musculoskeletal pain.

OBJECTIVE: To review common complementary and alternative treatment modalities for the treatment of persistent musculoskeletal pain in older adults. METHODS: A critical review of the literature on acupuncture and related modalities, herbal therapies, homeopathy, and spinal manipulation was carried out. Review included 678 cases within 21 randomized trials and 2 systematic reviews of herbal therapies: 798 cases within 2 systematic reviews of homeopathy; 1,059 cases within 1 systematic review of spinal manipulation for low back pain, and 419 cases within 4 randomized controlled trials for neck pain. The review of acupuncture and related modalities was based upon a paucity of well-controlled studies combined with our clinical experience. RESULTS: Insufficient experimental evidence exists to recommend the use of traditional Chinese acupuncture over other modalities for older adults with persistent musculoskeletal pain. Promising preliminary evidence exists to support the use of percutaneous electrical nerve stimulation for persistent low back pain. While some herbals appear to have modest analgesic benefits, insufficient evidence exists to definitively recommend their use. Drug-herb interactions must also be considered. Some evidence exists to support the superiority of homeopathic remedies over placebo for treating osteoarthritis and rheumatoid arthritis. The benefits of spinal manipulation for persistent low back and neck pain have not been convincingly shown to outweigh its risks. DISCUSSION: While the use of complementary and alternative modalities for the treatment of persistent musculoskeletal pain continues to increase, rigorous clinical trials examining their efficacy are needed before definitive recommendations regarding the application of these modalities can be made.

Acupuncture↗

PubMed2001

Missed lumbar transverse process fractures in a high school football player.

OBJECTIVE: To discuss the case of a football player who had suffered a transverse process fracture of the lumbar spine that was overlooked on initial chiropractic and medical examination. CLINICAL FEATURES: A 17-year-old male football player had been speared in the back by another player. He reported severe initial pain that caused him to fall to the ground, and there was a moderate degree of pain at the time of his chiropractic examination 1 week after injury. INTERVENTION AND OUTCOME: Initial chiropractic treatment consisted of spinal manipulation to the lumbar spine. Follow-up care consisted of lumbar spine radiographs that showed evidence of a lumbar transverse process fracture at 2 levels. The boy was referred to his medical doctor, who was not convinced of the presence of a fracture and returned him to play. A computed tomography scan was subsequently performed; this confirmed fractures of the transverse processes of L2 and L3. The patient was precluded from contact sports for 4 weeks. Chiropractic care 3 weeks after injury included physiotherapy and drop table mobilization to the sacroiliac joints. The patient returned to play 4 weeks after the injury. CONCLUSION: Transverse process fractures commonly occur secondary to blunt trauma in contact sports such as football. With high-force direct trauma, radiographs should be performed to rule out fracture before returning the athlete to play or commencing spinal manipulation.

Adolescent↗

PubMed2006

Cost-effectiveness of complementary therapies in the United kingdom-a systematic review.

OBJECTIVES: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. DATA SOURCES: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005. REVIEW METHODS: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. RESULTS: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than pound10 000. The complementary therapy represented an additional health care cost in five of the six studies. CONCLUSIONS: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment. Estimates of the incremental cost of achieving improvements in quality of life compare favorably with other treatments approved for use in the National Health Service. Because the specific efficacy of the complementary therapies for these indications remains uncertain, and the studies did not include sham controls, the estimates obtained may represent the cost-effectiveness non-specific effects associated with the complementary therapies.

Journal Article↗

PubMed2000

Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis.

BACKGROUND: Evidence suggests that spinal manipulation is an effective treatment for mechanical neck and low-back pain (LBP). Treatment efficacy is important to establish for these symptoms because combined they account for a considerable amount of disability and substantial associated direct and indirect costs to society. OBJECTIVE: The purpose of this study was to examine the outcome of patients undergoing chiropractic treatment for mechanical neck or LBP. DESIGN AND SETTING: A retrospective, outcome-based analysis was done for patients seeking care at a private chiropractic practice over a 1-year period. A total of 512 files were reviewed, with 119 patients selected for inclusion. Patients were included if their chief symptom was uncomplicated mechanical neck or LBP. Diagnoses included cervical, lumbar, or sacroiliac joint sprain/strain (International Code of Diagnostics version 9 [ICD-9] code: 847.1, 847.3, 846.1, respectively), discogenic LBP (ICD-9: 722.1), and headaches (ICD-9: 784.0) because many patients with neck pain presented with concomitant headaches. Disability and pain were measured with the modified Oswestry scale (for the patients with LBP), Neck Disability Index, and an 11-box visual analogue pain scale before and after treatment. Treatment consisted of spinal manipulation, various soft-tissue techniques, home-care instructions, and ergonomic and return-to-activity advice, including rehabilitative exercises. Patients received an average of 12 treatments over a 4-week period. Statistical analysis was performed on pretreatment and posttreatment values for both disability and pain. Stratification was based on duration (acute/subacute, chronic, acute exacerbation of a chronic condition) and severity (mild, moderate, or severe) of symptoms. RESULTS: Statistically significant reductions in disability and pain scores were achieved in all groups. An average 52.5% and 52.9% reduction in pain and disability, respectively, was achieved in the low-back group. The chronic LBP group realized a less statistically significant reduction of pain and disability (19.7% and 19.8%, respectively) than the acute/subacute (66.8% and 62.5%) or the chronic/recurrent group (56. 5% and 63.4%). The differences were statistically significant. Patients with neck pain had an average 53.8% and 48.4% reduction in their pain and disability, respectively. Patients with concomitant neck pain and headaches had statistically significant higher pretreatment and posttreatment disability and pain scores than those with only neck pain. There was no statistically significant difference in outcomes between groups stratified according to pain intensity. CONCLUSIONS: Patients attending a private chiropractic clinic for treatment of mechanical neck pain or LBP had statistically significant reductions in their pain-related disability after treatment. These results indicate that chiropractic manipulation is beneficial for the treatment of mechanical neck pain and LBP. However, care must be taken when drawing conclusions from these outcomes. The study design does not account for the natural history of low back- or neck pain-related disability and therefore does not allow for claims of treatment efficacy. In addition, it has been suggested that patients presenting to medical doctors with these symptoms have significant overlying comorbidity when compared with patients presenting to a chiropractor.

Acute Disease↗

PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure]. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

Adult↗

PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Adult↗

PubMed2000

In vivo transient vibration assessment of the normal human thoracolumbar spine.

OBJECTIVE: The objective of this study was to quantify the mobility characteristics (dynamic stiffness and mechanical impedance) of the normal human thoracolumbar spine with a transient vibration analysis technique. DESIGN: This study is a prospective clinical investigation to obtain normative biomechanical data from the human male and female spine in vivo. SETTING: Musculoskeletal research laboratory, university setting. SUBJECTS: Twenty asymptomatic subjects (age range, 20-60 years) with no recent history of musculoskeletal complaints. MAIN OUTCOME MEASURES: Mechanical impedance, effective stiffness, and resonant frequency analyses were used to quantify the dynamic stiffness of the thoracolumbar spine in this subject population. Data were obtained from posteroanterior mechanical thrusts delivered with an activator adjusting instrument equipped with a load cell and accelerometer by means of a portable computer. RESULTS: In response to the activator adjusting instrument thrusts, the thoracolumbar spine typically exhibited an impedance minimum at frequencies ranging between 30 and 50 Hz. The maximum posteroanterior impedance and corresponding maximum effective stiffness of the thoracolumbar spine and sacrum was roughly 2 to 8 times greater than the magnitude of the impedance minimum. Statistically significant differences in mobility between male and female subjects were noted, particularly for frequencies corresponding to the maximum mobility (40 Hz) and minimum mobility (10-20 Hz, 70-80 Hz). For most subjects (both male and female), the lumbar region exhibited a higher impedance and stiffness (less mobility) when compared with the thoracic region. CONCLUSIONS: The posteroanterior mechanical behavior of the human thoracolumbar spine was found to be sensitive to mechanical stimulus frequency and showed significant region-specific and gender differences. In the frequency range of 30 to 50 Hz, the lumbar spine of this subject population is the least stiff and therefore has the greatest mobility. From a biomechanical point-of-view, the results of this study indicate that dynamic spinal manipulative therapy procedures will produce more spinal motion for a given force, particularly when the posteroanterior manipulative thrust is delivered in frequency ranges at or near the resonant frequency. In this regard, spinal manipulative therapy procedures designed to target the resonant frequency of the spine require less force application. Both magnitude and frequency content of manual and mechanical thrusting manipulations may be critical elements for therapeutic outcome.

Adult↗

PubMedDate not supplied

Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease.

BACKGROUND AND OBJECTIVES: Several theories have been put forth in attempts to explain the possible mechanisms by which patients presumed to be suffering from any of a variety of internal organ diseases are occasionally found to respond quickly and dramatically to therapies delivered to purely somatic structures (e.g., spinal manipulation). The purpose of this review is to examine the scientific bases upon which these sorts of clinical phenomenaight be interpreted. DATA SOURCES: A review was conducted of over 350 articles that have appeared in the scientific literature over the last 75 years. Initially, a MEDLINE search was performed; however, because of the variability of indexing terms employed by investigators within a wide variety of biomedical disciplines, most of this literature had to be located article by article. DATA SYNTHESIS: At present, there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy represents a valid curative strategy for the treatment of any internal organ disease. Furthermore, current scientific knowledge also fails to support the existence of a plausible biological mechanism that could account for a causal segmentally or regionally related "somato-visceral disease" relationship. On the other hand, it has now been firmly established that somatic dysfunction is notorious in its ability to create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease. CONCLUSIONS: The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines.

Chiropractic↗

PubMed2003

[Complications following vertebral manipulation-a survey of a French region physicians].

INTRODUCTION: Recent studies have emphasized the incidence and the general underestimation in literature of spinal manipulation (SM) linked accident. The aim of this study was to estimate the frequency and the incidence of strokes, myelopathies, radiculopathies or osteoarticular accidents in a major French area. MATERIAL AND METHOD: We made a survey among 240 neurologists, neurosurgeons, rhumatologists and physicians concerning the number of accidents observed during the preceding two years. RESULTS: We obtained a response from 133 physicians and 93 cases of complication were reported. Most of these complications were radiculopathies (69%). Approximatively 50% occurred at the cervical level, less than 24 hours after SM with or without sligth aftereffects in 68%. The incidence of vertebro-basilar accidents was 30 times higher than in published series. CONCLUSION: Spinal manipulations should remain under very strict medical control. Physicians who practice SM should be able to choose the manual treatment and perform it themselves in order to minimize risks of complications, especially at the cervical level.

Adult↗

PubMed2005

Manual treatment effects to the upper cervical apophysial joints before, during, and after endotracheal anesthesia: a placebo-controlled comparison.

OBJECTIVES: In this preliminary, placebo-controlled clinical trial, two different manual treatments were compared, spinal manipulation and postisometric relaxation, for dysfunctional motion segments of the upper cervical spinal column. The influence of the muscular portion on the joint-play restriction of a motion segment can be ignored in anesthesia, and the manual evaluation of this joint-play restriction must be focused on nonmuscular structures. By retesting in anesthesia, it is possible to examine whether mobilization and manipulation affect exclusively the muscular structures or also affect the other parts of the motion segment. Conclusions can be drawn about the superiority of one or both treatments and about the structural basis of the restricted joint play and its palpation. DESIGN: A total of 26 inpatients at the surgical or orthopedic department of the University of Rostock were examined manually at four testing times: before and after manual treatment, in anesthesia, and within 24 hrs of completing anesthesia. They were randomized into three groups: postisometric relaxation (mobilization), spinal manipulation (thrust technique), and placebo. RESULTS: A highly significant effect for both treatments was found posttherapeutically (P < 0.01) but not for placebo. In anesthesia, the treatment effect of spinal manipulation was further significant (P < 0.01) when compared with placebo. For postisometric relaxation, however, it was not (P = 0.160). A significant difference between spinal manipulation and postisometric relaxation was not found in anesthesia (P = 0.137). The treatment effect postnarcotically was further significant when compared with placebo only for spinal manipulation (P = 0.011). CONCLUSIONS: Both treatments are superior to placebo. Postisometric relaxation seems to affect mainly the muscular parts of the treated segments and less so the other parts, such as the joint capsule or the segmental affiliated ligaments and fascia. Spinal manipulation seems to influence all other segmental parts more effectively, and the treatment effect persists longer. A joint-play restriction cannot be an exclusively muscular tension phenomenon. Segmental motion dysfunctions show a high variability in their spontaneous course.

Adult↗

PubMed1987

Use of manipulative therapy for mechanical pain of spinal origin.

Manipulation of the spinal joints for the relief of pain is an ancient remedy that is in widespread use today. Clinical trials investigating the effectiveness of manipulative therapy are briefly reviewed, and some experimental evidence suggesting possible causes of spine pain is presented. The rationale for the use of spinal manipulative therapy within the context of R. A. McKenzie's diagnostic and therapeutic system is detailed and explicitly stated. Spinal mobilization and manipulation are presented as a logical treatment progression from the use of postural instruction and exercise therapy. Extensive description of technique is not given, but the clinical signs that indicate the need to use or avoid mobilization and manipulation in a particular direction are detailed.

Back Pain↗

PubMed2002

A survey to examine attitudes and patterns of practice of physiotherapists who perform cervical spine manipulation.

As part of the process of developing a Clinical Practice Guideline (CPG) on cervical spine manipulation (CSM), a working group sent out an 82-item postal survey to 150 randomly selected Ontario physiotherapists (PTs) who perform spinal manipulation, to collect information on the socio-demographics, practices, opinions of risk, and attitudes towards CPGs of these PTs (n = 118; response rate = 79%). Of the 118 respondents who performed spinal manipulation, 41 performed CSM. Respondents strongly agreed with three out of six indications listed in the survey for applying CSM: segmental fixation, stiff but stable joint, internal derangement (over 70%). Respondents also strongly agreed (over 88%) that all screening tests listed in the survey should be performed prior to applying CSM: tests for irritability, stability, vascular and neurological systems. Respondents rated patient education, other manual therapy, and exercise as the most common adjuncts to CSM (over 88%). Respondents reported seeing mild complications or side effects only rarely following the application of CSM. Fourteen percent of respondents reported having a written CSM policy or CPG on CSM in their work setting. Feedback from this survey will be used in developing a CSM CPG. A future survey will evaluate changes in clinical practice and in attitudes toward CPGs some time after the dissemination of the CSM CPG.

Adult↗

PubMed2002

Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice.

OBJECT: The authors report a series of 22 patients in whom major complications developed after cervical spinal manipulation therapy (CSMT). A second objective was to estimate the regional incidence of these complications and to compare it with the very low incidences reported in the literature. METHODS: During a 5-year period, practioners at a single group neurosurgical practice in Tulsa, Oklahoma, treated 22 patients, who were markedly worse during, or immediately after, CSMT. The details of these cases are reported. The 1995 US Government National Census was used to define the regional referral population for Tulsa. The published data regarding the incidence of serious CSMT-related complications and the rate of CSMTs undertaken nationally were used to estimate the expected number of CSMT-related complications in the authors' region. The number (22 cases) reported in this series was used to estimate the actual regional incidence. Complications in the series included radiculopathy (21 cases), myelopathy (11 cases), Brown-Séquard syndrome (two cases), and vertebral artery (VA) occlusion (one case). Twenty-one patients underwent surgery. Poor outcomes were observed in three, outcome was unchanged in one, and 17 improved. The number of patients in this series exceeded the expected number for the region. CONCLUSIONS: Cervical spinal manipulation therapy may worsen preexisting cervical disc herniation or cause disc herniation resulting in radiculopathy, myelopathy, or VA compression. In cases of cervical spondylosis, CSMT may also worsen preexisting myelopathy or radiculopathy. Manipulation of the cervical spine may also be associated with higher complication rates than previously reported.

Adult↗

PubMedDate not supplied

Rationale for assessing the effects of manipulative therapy on autonomic tone by analysis of heart rate variability.

BACKGROUND: For more than 100 years, chiropractors have asserted that overall health can be improved through the use of spinal manipulative therapy. The autonomic nervous system is known to control and regulate all involuntary physiologic activities by controlling the activities of the internal organs, glands, and circulation. Recent studies document a potential relationship between the vertebral subluxation complex, autonomic tone, and cardiac function. OBJECTIVE: This discussion reviews how it is possible to use heart rate variability analysis to calculate a quantitative index of autonomic function, which accurately reflects the sympathetic and parasympathetic tone and the sympathovagal balance. DISCUSSION: The technique of heart rate analysis known as heart rate variability could be extremely useful in assessment of treatment outcomes in clinical chiropractic practice. At present, heart rate variability is in widespread use in the fields of neurology, cardiology, psychology, psychophysiology, obstetrics, anesthesiology, and psychiatry. CONCLUSION: Further studies in this area may lead to a better understanding of the effects of spinal manipulation on (1) the general health of an individual, (2) an individual's susceptibility to lowered immunity and recuperative capacity, and (3) conditions that lie outside the scope of musculoskeletal therapeutics and are more in line with classical chiropractic concepts. This can also contribute to a better-informed interprofessional cooperation between allopathic and chiropractic health care providers.

Autonomic Nervous System↗