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Results for “Manipulation, Spinal”

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At least 541 records · Page 30Linked to original sources

PubMed2004

Paraspinal muscles and intervertebral dysfunction: part one.

BACKGROUND: One of the diagnostic characteristics of the manipulable spinal lesion--a musculoskeletal disturbance detected by manual palpation and corrected with manipulation--is said to be altered segmental tissue texture. Various manual therapy authors have speculated on the possible nature of this tissue change, with some authors hypothesizing that it represents deep segmental muscle overactivity. OBJECTIVES: To review the literature relating to the detection and nature of altered paraspinal tissue texture, proposed explanations for altered tissue texture, evidence for the plausibility of paraspinal muscle spasm, and evidence of muscle dysfunction associated with low back pain (LBP). DATA SOURCE: MEDLINE and CINAHL databases were searched using various combinations of the keywords paraspinal, muscle, palpation, EMG, spine, low back pain, pain, myofascial, hardness, manipulation, reliability, and somatic dysfunction, along with searching the bibliographies of selected articles and textbooks. DATA EXTRACTION: All relevant data were used. RESULTS: Little direct evidence exists for the nature of abnormal paraspinal tissue texture detected by palpation. Palpation for tenderness is more reliable than palpation for tissue texture change. Indirect evidence from animal studies and experimental muscle inflammation support the plausibility of protective paraspinal muscle contraction. Increased paraspinal electromyographic (EMG) activity observed in subjects with LBP appears to be a result of voluntary and nonvoluntary changes in motor control, modified by psychophysiological responses to perceived stress rather than a simple protective reflex. CONCLUSION: Although little direct evidence exists of the nature of clinically detected paraspinal tissue texture change, the concept of reactive muscle contraction appears plausible. Increased paraspinal EMG activity associated with LBP does not appear to be mediated by a simple protective reflex.

Electromyography↗

PubMed1998

Therapists' conceptualization and characterization of the clinical concept of spinal stiffness.

BACKGROUND AND PURPOSE: The clinical concept of spinal stiffness provides one basis for applying spinal manipulation. Because the terms used to describe the perceptual results of manual spinal stiffness testing are poorly defined, the nature and number of attributes contained in the concept remain unclear. This study attempted to clarify the concept of spinal stiffness by examining the relationships among 31 published spinal stiffness descriptors using cluster analysis. SUBJECTS AND METHODS: Each stiffness descriptor was printed on a magnetized rubber strip. Physical therapists in Houston (Tex) and Sydney (New South Wales, Australia) judged the similarity of the stiffness descriptors by arranging them on a board. The squared Euclidean distance between words was calculated, and cluster analysis was performed using Ward's method. RESULTS: Cluster analysis reduced the 31 stiffness descriptors to three superclusters (limited mobility, increased mobility, and viscoelasticity) in both the Houston and Sydney data. CONCLUSION AND DISCUSSION: In a step toward improving the reliability of spinal stiffness judgments, this study has identified the fundamental characteristics of the clinical concept of spinal stiffness. Research is now needed to clearly define these characteristics and then develop protocols that will allow physical therapists to reliably rate these attributes.

Cluster Analysis↗

PubMed2003

[Cervical spine manipulation: risks--benefit--assessment].

Cervical manipulation is a widely used method indicated in non-specific mechanical neck pain and cervicogenic headache. Cervical manipulation can cause severe neurologic complications which are both rare and generally unpredictable, which can be compared with the accidents occurring with other treatments (nonsteroidal anti-inflammatory drugs...). To decrease this risk, we propose five recommendations developed by consensus: --unwanted effects, however minor (e.g. nausea or vertigo), of prior manipulation should be searched for routinely and taken as contraindications for future spinal manipulations; --a thorough physical examination, including a neurological evaluation should be performed prior to manipulation; --all know indications and contraindications should be followed; -- manipulations should be performed only by physicians experienced in this technique; --special caution should be exercised when performing first-line cervical manipulation and simple, honest and easily understandable information about these risks should be included when informed consent is obtained.

Guidelines as Topic↗

PubMed1991

Cerebral stroke in a semi-pro football player: a case report.

Cervical spine trauma can clearly result in neurologic injury. An unusual traumatic event is a vascular insult of the vertebral arteries, potentially leading to stroke. The vertebral arteries are vulnerable to compression at several sites in the cervical spine. The high degree of physiologic rotation at the atlanto-axial joint places the vertebral artery at risk through normal daily activities as well as following forceful trauma, including manipulative treatment. Cerebrovascular insufficiency is an uncommon but serious complication of cervical spinal manipulation, which can lead to posterior circulatory impairment. Comprehensive diagnostic studies may be required to differentiate primary intracranial pathology from cerebral symptoms secondary to vascular compromise.

Adult↗

PubMed1989

Spinal mobilisation and manipulation.

Used in a general sense, manipulation refers to the use of hands in a skillful manner for therapeutic techniques. Hence it can refer to any manual technique involving a passive movement be it specific manipulation, mobilisation, traction, soft tissue techniques or massage. In this paper manipulation refers to those manual techniques that apply a high velocity thrust at the end range of the joint; and mobilisation refers to a gentle repetitive rhythmic movement.

Humans↗

PubMed2006

The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain.

OBJECTIVE: To determine the relationship between an audible pop with spinal manipulation and improvement in pain and function in patients with low back pain. METHODS: In this pragmatic study, 70 patients from a multicenter clinical trial were randomly assigned to receive high-velocity thrust manipulation and included in this secondary analysis. Patients were managed in physical therapy twice the first week, then once a week for the next 3 weeks, for a total of 5 sessions. A single high-velocity thrust manipulative intervention purported to affect the lumbopelvic region was used during the first two sessions. Therapists recorded whether an audible pop was heard by the patient or therapist. Outcome was assessed with an 11-point pain rating scale, the Oswestry Disability Questionnaire, and measurement of lumbopelvic flexion range of motion. Repeated measures analyses of variance were used to examine whether achievement of a pop resulted in improved outcome. RESULTS: An audible pop was perceived in 59 (84%) of the patients. No differences were detected at baseline or at any follow-up period in the level of pain, the Oswestry score, or lumbopelvic range of motion based on whether a pop was achieved (P > .05). The odds ratios and 95% confidence intervals for achieving a successful outcome at each of the follow-up periods all approximated a value of 1, suggesting no improvement in the odds of successful outcome among patients in which an audible pop occurred. CONCLUSIONS: The results of this pragmatic study suggest that a perceived audible pop may not relate to improved outcomes from high-velocity thrust manipulation for patients with nonradicular low back pain at either an immediate or longer-term follow-up.

Adult↗

PubMed1998

[Effectiveness of manipulative therapy in low back pain: systematic literature reviews and guidelines are inconclusive].

In the Dutch general practitioners' guidelines spinal manipulative therapy (SMT) is not recommended for treatment of acute low back pain. This is in contrast to the recent American and English guidelines, which explicitly recommend SMT for this indication. Randomized clinical trials (RCTs) on SMT are on average of low methodological quality. Most systematic reviews, however, lead to positive conclusions. The potential sources of discrepancy between the recommendations in the national guidelines are: interpretation of the available RCTs and systematic reviews, composition of the guideline-setting committee, values of the participants and appreciation of direct and indirect costs. Definite conclusions on the efficacy of SMT for (acute) low back pain cannot yet be drawn. Therefore, more RCTs in various settings and on different indications are clearly needed.

Guidelines as Topic↗

PubMedDate not supplied

Motions of the head and thorax during neck manipulations.

OBJECTIVE: The purpose of this study was to determine the amplitudes and variations of preload positioning and displacements of the head and thorax during spinal manipulative therapy (SMT) applied to C2. DESIGN: This experimental study measured the biomechanics of SMT applied to C2. SETTING: Biomechanics Laboratory, Mechanical Engineering and Applied Mechanics, University of Michigan and Spinal Ergonomics and Joint Research Laboratory, National College of Chiropractic. PARTICIPANTS: Eighteen healthy volunteers from the University of Michigan and the National College of Chiropractic were manipulated by a total of eight experienced chiropractic physicians licensed in the state in which they participated. INTERVENTION: Sixty-six Direct Break (DB) and twenty-three Rotary Break (RB) diversified procedures were administered to C2. Randomization of the DB was made on two variables, direction and intended load intensities. The RB was administered only from the right by each physician. MAIN OUTCOME MEASURES: Linear and angular displacement time histories for the head and thorax mass centers were monitored during the preload setup of each procedure and the dynamic delivery of the treatment procedures. CONCLUSIONS: DB procedures were found to have sagittally symmetric positioning and displacements as a function of intended direction of the procedure. Both DB and RB methods consisted of preload positioning with head flexion. RB rotation and lateral bending preload positions approached the maximal voluntary ranges of motion for the upper cervical spine. Variations among procedures by one manipulator were approximately the same as for variations among manipulators. Data indicates that SMT procedures can be successfully modified to control amplitude and direction of body segment displacements that arise.

Adult↗

PubMedDate not supplied

Chiropractic clinical research: progress and recommendations.

OBJECTIVE: The purpose of this white paper is to help inform the chiropractic clinical research agenda with a focus on the United States. METHODS AND DISCUSSION: The recommendations and action items from 2 previous articles published in 1997 are discussed within the context of 3 broad topics: research culture, research infrastructure, and clinical research studies. Progress made toward the action items in these areas is summarized. A summary of findings is presented of the most influential clinical research studies during the past decade performed by or with major contributions by chiropractic investigators. In light of the current evidence and previous recommendations, new clinical research recommendations are proposed. CONCLUSIONS: Based on the assessment of the scientific literature and research currently underway, it is evident that members of the chiropractic research community have made important progress in becoming active players in the clinical research arena. During the past decade, the work of chiropractic researchers has contributed substantially to the amount and quality of the evidence for or against spinal manipulation in the management of low back pain, neck pain, headache, and other conditions.

Chiropractic↗

PubMed1992

Mechanical force, manually assisted short lever chiropractic adjustment.

OBJECTIVES: Chiropractic mechanical force, manually assisted short lever adjusting is a spinoff of the specific toggle recoil adjusting techniques, which were based on the original chiropractic subluxation theory propounded by Daniel David Palmer in 1895. This article reviews: a) the principles of the chiropractic subluxation complex from the standpoint of its historical origin and present-day scientific status; b) the purpose and objectives of specific spinal manipulative techniques; c) the use of mechanical adjusting instruments to effect a velocity/direction controlled adjustive thrust; and d) an assessment of scientific and clinical data relating to the biomechanical and neurological aspects of mechanical force, manually assisted short lever adjusting. DATA SOURCES: Prime sources were from the National Library of Medicine's on-line Index Medicus database, the Chirolars Research Resource Retrieval database, the Chiropractic Research Abstract Collection and the Chiropractic Library Consortium's reference works. Direct search of other nonindexed chiropractic sources was limited to those available in the collection of the National Institute of Chiropractic Research. Early information never documented by publication was obtained by written personal communication. STUDY SELECTION: The principal author selected articles reporting data (as opposed to anecdotal reports) from conference proceedings and peer-reviewed journals. DATA EXTRACTION: Data quality was assessed based on experimental conditions such as sample size, study design and statistical analysis. DATA SYNTHESIS: While mechanical force, manually assisted short lever adjusting seemingly is capable of beneficially altering the cause/effect relationship of spinal subluxations, more research in the nature of controlled clinical trials is needed to ascertain its benefits in the chiropractic treatment of specific conditions. CONCLUSIONS: Basic research is needed in order to establish the scientific basis for the chiropractic subluxation syndrome regardless of the technique employed.

Biomechanical Phenomena↗

PubMed1986

Sudden sensorineural hearing loss following manipulation of the cervical spine.

Review of the otolaryngologic literature reveals no reports of sudden sensorineural hearing loss resulting from manipulation of the cervical spine. Indeed, in previously reported cases of vertebrobasilar artery injury following spinal manipulation, hearing loss has received little attention. Two patients with sudden sensorineural hearing loss following cervical spine manipulation are presented. The audiologic findings and cerebral arteriograms are reviewed and treatment is discussed. A review of the anatomy and pathophysiology is also included, and a possible mechanism of injury to the vertebral artery is proposed.

Adult↗

PubMedDate not supplied

[Multiple disc herniation after chiropractic manipulation].

We present a case of multiple cervical spine disc herniation in a previously healthy patient following chiropractic manipulation. The aim of this paper is to review the medical literature about the complications following spinal manipulation to emphasize the potential risks of this widely extended therapeutic procedure, performed in many cases by non-qualified personnel without medical training.

Adult↗

PubMedDate not supplied

The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study.

OBJECTIVE: The objective of this pilot study was to investigate the effect of spinal manipulation for the relief of chronic headache of cervical origin, utilizing a specific technique, toggle recoil, to treat the two upper cervical vertebrae. This study will help delineate the design for a future, larger study. DESIGN: Twenty-six patients were accepted for a continuous time series analysis (6 wk) design. SETTING: Chiropractic outpatient research clinic. PATIENTS: The patients--16 females (average age 42.1 yr, SD 11.03) and 10 males (average age 52.1 yr, SD 10.69) all had chronic headaches (> 3 mo) with upper cervical joint dysfunction. INTERVENTION: All the patients received four upper cervical toggle recoil adjustments over a 2-wk period. MAIN OUTCOME MEASURES: Standardized headache history, daily questionnaires for the duration of the trial, measuring; frequency; and severity of the headache, plain film with dynamic spinal radiographs and motion palpation. RESULTS: The results indicate statistically significant outcomes (p < .001) that indicate changes in headache frequency, duration and severity in all but two of the patients. The overall duration of headaches decreased from 110 hr pretreatment to 25 hr posttreatment, a decrease of 77%. The overall score for severity dropped from 55 to 22--a 60% improvement in perceived pain. The frequency of headaches over a 2-wk period dropped from 18 to 7, an improvement of 62%. CONCLUSIONS: Since the results of this pilot study were not adequately controlled they cannot be seen as proof supporting the clinical efficacy of manipulation for chronic headaches. However, as a group for duration, severity and frequency all measures were significant. These findings would suggest that further study of upper cervical manipulation for the treatment of chronic headaches with upper cervical joint dysfunction in a randomized, controlled clinical trial is needed.

Adult↗

PubMed1992

The effect of manipulation on pain and range of motion in the cervical spine: a pilot study.

OBJECTIVE: The objective of this pilot study was to determine the number of patients required for a randomized controlled trial of spinal manipulation for neck pain and to determine if there is a relationship between pain and range of motion (ROM) in the cervical spine. DESIGN: Fifty consecutive outpatients were studied in a pretest-posttest design without long-term follow-up. SETTING: The patients were taken from a primary cae outpatient teaching clinic specializing in back pain. PATIENTS: All patients had unilateral neck pain without neurological deficit. The patients were selected as a consecutive sample. INTERVENTION: All the patients received a single cervical manipulation. MAIN OUTCOME MEASURES: Prior to and immediately after the treatment, cervical ROM was recorded on a goniometer, and pain intensity was rated on the 101-point numerical rating scale. RESULTS: The results show an increase in all planes of post-treatment ROM and a decrease in post-treatment pain scores. Partial correlations between post-treatment ROM and 101-point numerical rating scale scores reveal a significant relationship between a decrease in pain and an increase in cervical rotation (p < .005). CONCLUSIONS: Since the results of this pilot study are not controlled, they cannot be seen as proof supporting the clinical efficacy of manipulation for neck pain. However, the correlation between an increase in cervical rotation and a decrease in pain is clinically instructive. In addition, the outcome measures used in this study could prove to be useful in the design of future randomized controlled trials of cervical manipulation.

Adult↗

PubMedDate not supplied

Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988.

BACKGROUND: Problems in ascertaining cases and in determining the total number of treatments have made it difficult to establish the rate of cerebrovascular accidents (CVA) after spinal manipulative therapy. OBJECTIVES: To estimate the occurrence of cerebrovascular accidents after chiropractic treatment to the cervical spine. DESIGN: Information was sought on cases of CVA in Denmark during the period 1978-1988 inclusive, through several sources and through a survey of the Danish Chiropractors' Association. Information was sought also on proportion of consultations consisting of cervical treatment and preferred type of therapy. The incidence rate of CVA was calculated for several denominators. PARTICIPANTS: Targeted sample in survey 1: all 226 practicing members of the Danish Chiropractors' Association in 1989 [i.e., 99% of the chiropractors in Denmark at that time (response rate 54%)]. In survey 2, a random sample of 40 chiropractors (response rate 72.5%) was used. OUTCOME MEASURES: The number of CVAs in relation to the number of chiropractor-years, number of consultations, consultations including neck treatment, upper and lower neck treatment, and type of technique used. MAIN RESULTS: Five cases of CVA were identified; one resulted in death and the others in permanent neurological sequelae of varying severity. One case of CVA appeared for every estimated 1.3 million cervical treatment sessions and 1 for every 0.9 million upper cervical treatment sessions. Rotation techniques were over-represented in relation to their estimated frequency of use. CONCLUSION: Although the incidence of CVA after chiropractic SMT was confirmed to be low, there seems to be sufficient evidence to justify a firm policy statement cautioning against upper cervical rotation as a technique of first choice.

Adolescent↗

PubMed1998

Manipulation for cervical spinal dislocation under general anaesthesia: serial review for 4 years.

Manipulation under anaesthesia is an important method to reduce cervical spinal dislocations in the acute stage. Causes of failure have not been clearly identified and neurological complications can be the major concern. All cervical dislocations have been traditionally treated by manipulation under anaesthesia in the Christchurch Spinal Injuries Unit as the primary treatment. We reviewed all 31 patients treated from 1991-1995, with detailed documentation of neurological progression and final outcome. Three patterns were identified: bilateral dislocation, unifacet dislocation and fracture dislocation. Most of the dislocations (74%) were successfully reduced by manipulation alone with minimum complications. The remaining 26% patients required open reduction. The predominant causes of failure of reduction by manipulation were co-existing fractures. The success rate of reduction by manipulation was 90% for pure bifacet and unifacet dislocations, but was only 22% for the fracture dislocations. The study concluded that manipulation under anaesthesia is a safe and effective procedure for pure cervical spinal dislocations. Fractures related to the dislocation should be identified early and open reduction be considered.

Adolescent↗

PubMed2003

[Bilateral vertebral artery dissection after chiropractic treatment].

A 31-year-old woman suffered a brainstem infarction secondary to chiropractic neck manipulation. A dissection of both vertebral arteries could be demonstrated by MR tomography. This case report should alert therapists to be aware of vertebrobasilar complications after spinal manipulations.

Adult↗

PubMed2004

Anaesthesia for caesarean section in a patient with syringomyelia and Arnold-Chiari type I malformation.

A 37-year-old primiparous woman with syringomyelia and Arnold-Chiari type I malformation was scheduled to undergo elective caesarean section for a fetus in the breech presentation. Caesarean section was performed under general anaesthesia without complications; all we observed was an exaggerated response to atracurium. The patient was discharged home 7 days after the operation without neurological deterioration. General anaesthesia was chosen in this patient to avoid any spinal manipulation that could increase intracranial pressure or reduce intraspinal pressure and cause deterioration of neurological symptoms. Syringomyelia is a progressive myelopathy characterised by cystic degeneration within the spinal cord, which causes severe neurological deficits. The anaesthetic management is discussed.

Adult↗