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PubMed2006

The use of nonthrust manipulation in an adolescent for the treatment of thoracic pain and rib dysfunction: a case report.

STUDY DESIGN: Case report. BACKGROUND: Back pain is a common presentation of patients in the orthopedic physical therapy setting. In an athletic environment, back pain can limit an athlete's ability to perform running, cutting, and throwing. This case report describes the use of a spinal nonthrust manipulation in conjunction with therapeutic exercise for the management of thoracic and rib pain in an adolescent athlete. CASE DESCRIPTION: A 16-year-old male presented to the outpatient clinic without physician referral. His chief complaint was right-sided thoracic and rib pain during running, jumping, cutting, and kicking that began 1 month before the initial physical therapy visit. He had no previous episodes of pain or associated injuries. A screening examination for serious underlying pathology was negative. After physical examination, it was determined that manual therapy was indicated. A thoracic nonthrust manipulation was applied to the painful area (the right-side thoracic facet joints of segments 5-7). OUTCOMES: Immediately after the thoracic nonthrust manipulation, the patient experienced a decrease in tenderness to palpation of the thoracic erector spinae musculature and the associated intercostal spaces of ribs 6 through 8 (a decrease of 1-2 points on the pain scale), an increase in thoracic side-bending active range of motion recorded at T3 and T9, and improved chest expansion, which had been limited by pain before treatment. DISCUSSION: This case report demonstrates the use of a spinal nonthrust manipulation that seems to have helped an adolescent return to pain-free sports activity, with an immediate decrease in pain after 1 visit. Follow-up telephone calls were made 1 month and 9 months after treatment, in which no return of symptoms was reported.

Adolescent↗
PubMed2000

Massage for low back pain.

BACKGROUND: Low back pain is one of the most common and costly musculoskeletal problems in modern societies. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function. OBJECTIVES: To assess the effects of massage therapy for non-specific low back pain. SEARCH STRATEGY: We searched Medline, Embase, Cochrane Controlled Trials Register, Healthstar, CINAHL and Dissertation abstracts from 1966 to 1999 with no language restrictions. References in the included studies and in reviews of the literature were also screened. Contact with content experts and massage associations were also made. SELECTION CRITERIA: This review included randomized, quasi-randomized or controlled clinical trials that investigated the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific low back pain. DATA COLLECTION AND ANALYSIS: One reviewer applied the selection criteria and extracted the data. Two reviewers (one blinded to authors, institutions and journals) independently assessed the quality of each trial. A qualitative analysis (best-evidence synthesis) was performed due to clinical heterogeneity among the included trials and insufficient data reported. MAIN RESULTS: Four randomized controlled trials met the inclusion criteria. Two trials were of high and two of low methodological quality. None evaluated massage as the main intervention. Rather, it was the control intervention in studies evaluating manipulation, electrical stimulation, and a lumbar corset. There is limited evidence showing that massage is less effective than manipulation immediately after the first session and moderate evidence showing it is less effective than TENS during the course of sessions in relieving pain and improving activity. At the completion of treatment and at 3 weeks after discharge there is no difference among massage and manipulation, electrical stimulation or corsets, but this evidence is limited. REVIEWER'S CONCLUSIONS: Based on the studies reviewed, there is insufficient evidence to recommend massage as a stand-alone treatment for non-specific low back pain. There is a need for high quality controlled trials to further evaluate the effects of massage for this condition.

Adult↗
PubMed2002

Differentiation of engrafted neuronal-restricted precursor cells is inhibited in the traumatically injured spinal cord.

Differentiation of pluripotent neural stem cells engrafted into the adult normal and injured spinal cord is restricted to the glial lineage, suggesting that in vitro induction toward a neuronal lineage prior to transplantation and/or modification of the host environment may be necessary to initiate and increase the differentiation of neurons. In the present study, we investigated the differentiation of neuronal-restricted precursors (NRPs) grafted into the normal and contused adult rat spinal cord. NRPs proliferated through multiple passages in the presence of FGF2 and NT3 and differentiated into only neurons in vitro in the presence of retinoic acid and the absence of FGF2. Differentiated NRPs expressed GABA, glycine, glutamate, and ChAT. Two weeks to 2 months after engraftment of undifferentiated NRPs into adult normal spinal cord, large numbers of surviving cells were seen in all of the animals. The majority differentiated into betaIII-tubulin-positive neurons. Some transplanted NRPs expressed GABA and small numbers were glutamate- and ChAT-positive. NRPs were also transplanted into the epicenter of the contused adult rat spinal cord. Two weeks to 2 months after transplantation, some engrafted NRPs remained undifferentiated nestin-positive cells. Small numbers were MAP2- or betaIII-tubulin-positive neurons. However, the expression of GABA, glutamate, or ChAT was not observed. These results show that NRPs can differentiate into different types of neurons in the normal adult rat spinal cord, but that such differentiation is inhibited in the injured spinal cord. Manipulation of the microenvironment in the injured spinal cord will likely be necessary to facilitate neuronal replacement.

Animals↗
PubMed2002

How does recombinant human bone morphogenetic protein-4 enhance posterior spinal fusion?

STUDY DESIGN: A rabbit posterolateral intertransverse process fusion model was used to evaluate the effect that different doses of recombinant human bone morphogenetic protein-4 delivered in a porous hydroxyapatite-tricalcium phosphate ceramic had on osteogenesis and spinal fusion. OBJECTIVE: To study the biologic effect and threshold dose of recombinant human bone morphogenetic protein-4 in enhancing spinal fusion. SUMMARY OF BACKGROUND DATA: Biologic manipulation for spinal fusion is an area undergoing active research. The enhancing effects of recombinant human bone morphogenetic proteins 2 and 7 on spinal fusion have been proved, and clinical trials of their application are in progress. Recombinant human bone morphogenetic protein-4 is another osteoinductive protein that has the ability to induce heterotopic bone formation, and its potential for enhancing spinal fusion has not yet been studied. METHODS: For this study, 24 adult New Zealand white rabbits underwent single-level unilateral posterior intertransverse process spinal fusion at L5-L6. The animals were divided into four groups using different graft materials: allograft as well as hydroxyapatite-tricalcium phosphate augmented with 0, 1.25, and 5 microgram of recombinant human bone morphogenetic protein-4, respectively. The local changes were evaluated by sequential radiograph, manual palpation, histomorphology, and microradiography. RESULTS: At week 7, ossification in the intertransverse process area ceased in groups without recombinant human bone morphogenetic protein-4, whereas active multicentric endochondral bone formation was demonstrated in groups with this growth factor. The success rate of contiguous bony bridging was found to correlate positively with the dose of recombinant human bone morphogenetic protein-4. CONCLUSIONS: Recombinant human bone morphogenetic protein-4 effectively enhances new bone formation and accelerates fusion in the rabbit posterolateral posterior spinal fusion model. The effective dose of recombinant human bone morphogenetic protein-4 is 10 times lower than the reported dosage of recombinant human bone morphogenetic proteins 2 and 7.

Animals↗
PubMed1999

[Physiotherapy as manual therapy].

Manual therapy includes methods where the therapist's hands are used to stretch, mobilize or manipulate the spinal column, paravertebral structures or extremity joints. The aims of these methods are to relieve pain and improve function. In Norway only specially qualified physiotherapists and chiropractors are authorized to perform manipulation of joints (high velocity thrust techniques). To become a qualified manual therapist in Norway one must have a minimum of two years of clinical practice as physiotherapist followed by two year full time postgraduate training in manual therapy (a total of six years). Historically the Norwegian manual therapy system was developed in the 1950s by physiotherapists and medical doctors in England (James Cyriax and James Mennell) and Norway. As a result doctors allowed physiotherapists to use manipulation as a treatment method of both spinal and peripheral joints. In 1957 the Norwegian health authorities introduced reimbursement for manual therapy performed by physiotherapists.

Chiropractic↗
PubMed1977

Hyperthermic effects of morphine: set point manipulation by a direct spinal action.

U Rats were implanted with chronic indwelling catheters in the lumbar spinal subarachnoid space in order to study the effects of morphine on body temperature. 2 Morphine administered intrathecally produced a dose-dependent rise in body temperature that was antagonized by naloxone. 3 The rise in body temperature evoked by a given dose of morphine appeared to be independent of the environmental temperture ((4 degrees C to 32 degrees C) and was consistently associated with coordinated thermoregulatory responses (i.e. shivering and tail vasoconstriction). The fall in body temperature observed in these hyperthermic animals, following naloxone, was associated with a vasodilatation which coincided with the fall to the premorphine temperature level. 4 Morphine administered systemically also produced hyperthermia. This was only partially reversed by intrathecal naloxone. In animals made tolerant to the hyperthermic effects of systemic morphine, the intrathecal administration of naloxone produced a fall in body temperature. 5 Naloxone alone, administered either intrathecally or systemically, had no effect upon body temperature. 6 We suggest that morphine exerts a direct, pharmacologically specific effect on the spinal cord, which results in an altered thermoregulatory set point in the rat.

Animals↗
PubMed2004

The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up.

OBJECTIVE: To describe the chiropractic management of a patient with paresthesia on the entire left side of her body and magnetic resonance imaging (MRI)-documented cervical spinal cord deformation secondary to cervical spinal stenosis. CLINICAL FEATURES: A 70-year-old special education teacher had neck pain, headaches, and burning paresthesia on the entire left side of her body. These symptoms developed within hours of being injured in a side-impact motor vehicle accident. Prior to her visit, she had been misdiagnosed with a cerebrovascular accident. INTERVENTION AND OUTCOMES: Additional diagnostic studies revealed that the patient was suffering from cervical spinal stenosis with spinal cord deformation. Two manipulative technique systems (Advanced Biostructural Therapy and Atlas Coccygeal Technique) unique to the chiropractic profession and based on the theory of relief of adverse mechanical neural tension were administered to the patient. This intervention provided complete relief of the patient's complaints. The patient remained symptom-free at long-term follow-up, 1 year postaccident. CONCLUSION: There is a paucity of published reports describing the treatment of cervical spinal stenosis through manipulative methods. Existing reports of the manipulative management of cervical spondylosis suggest that traditional manual therapy is ineffective or even contraindicated. This case reports the excellent short-term and long-term response of a 70-year-old patient with MRI-documented cervical spinal stenosis and spinal cord deformation to less traditional, uniquely chiropractic manipulative techniques. This appears to be the first case (reported in the indexed literature) that describes the successful amelioration of the symptoms of cervical spinal stenosis through chiropractic manipulation. More research into the less traditional chiropractic systems of spinal manipulation should be undertaken.

Accidents, Traffic↗
PubMed2006

Genetic manipulation of intraspinal plasticity after spinal cord injury alters the severity of autonomic dysreflexia.

Severe spinal cord injuries above mid-thoracic levels can lead to a potentially life-threatening hypertensive condition termed autonomic dysreflexia, which is often triggered by painful distension of pelvic viscera (bladder or bowel) and consequent sensory fiber activation, including nociceptive C-fibers. Interruption of tonically active medullo-spinal pathways after injury causes disinhibition of thoracolumbar sympathetic preganglionic neurons, and intraspinal sprouting of nerve growth factor (NGF)-responsive primary afferent fibers is thought to contribute to their hyperactivity. We investigated spinal levels that are critical for eliciting autonomic dysreflexia using a model of noxious colorectal distension (CRD) after complete spinal transection at the fourth thoracic segment in rats. Post-traumatic sprouting of calcitonin gene-related peptide (CGRP)-immunoreactive primary afferent fibers was selectively altered at specific spinal levels caudal to the injury with bilateral microinjections of adenovirus encoding the growth-promoting NGF or growth-inhibitory semaphorin 3A (Sema3a) compared with control green fluorescent protein (GFP). Two weeks later, cardio-physiological responses to CRD were assessed among treatment groups before histological analysis of afferent fiber density at the injection sites. Dysreflexic hypertension was significantly higher with NGF overexpression in lumbosacral segments compared with GFP, whereas similar overexpression of Sema3a significantly reduced noxious CRD-evoked hypertension. Quantitative analysis of CGRP immunostaining in the spinal dorsal horns showed a significant correlation between the extent of fiber sprouting into the spinal segments injected and the severity of autonomic dysreflexia. These results demonstrate that site-directed genetic manipulation of axon guidance molecules after complete spinal cord injury can alter endogenous circuitry to modulate plasticity-induced autonomic pathophysiology.

Adenoviridae↗
PubMed2001

Phrenic paresis--a possible additional spinal cord dysfunction induced by neck manipulation in cervical spondylotic myelopathy (CSM): a report of two cases with anatomical and clinical considerations.

The clinical records of two male subjects with severe cervical spondylotic myelopathy (CSM) who developed respiratory insufficiency after the cervical manipulation involved in preoperative anesthetic intubation were examined. Their cervical imaging was analyzed with respect to the known anatomic relationships of the spinal phrenic nerve nuclei to the spondylotic compressive lesions in an attempt to provide the anatomic and pathologic rationales that may explain this phrenic paresis as a possible traumatic complication of severe CSM. Perusal of extant literature revealed extensive descriptions of CSM symptoms, but none had previously reported an associated neuromuscular weakness of the diaphragm. Magnetic resonance imaging analyses indicated that the existing degree of upper cervical cord compression, when reinforced by the additional posterior and anterior pressures consequent to cervical spinal extension and flexion, could readily account for the functional impairment of phrenic nerve neuron cells and/or their efferent fibers. Thus, the anatomic relations of the phrenic nerve nuclear columns and their efferent tracts predispose them to interference by compressive lesions found in CSM, and undue manipulation of the cervical spine when advanced stenosis is known to be present should be recognized as a possible cause of cervical spondylotic myelopathic-phrenic paresis.

Aged↗
PubMed1998

Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms.

OBJECTIVE: To provide a rationale for active chiropractic rehabilitative treatment that extends beyond the single goal of resolution of symptomatic complaints. DATA COLLECTION: A manual search of available reference texts and a search of MEDLINE were collected with an emphasis on tissue healing sequelae and the role of mechanical loading on this process. RESULTS: The reviewed material indicates that all tissue growth and repair is influenced by mechanical loading and body posture and is positively affected by body postures that normalize/minimize adverse mechanical stresses and strains. Altered alignment of the human frame may lead to poor healing of the body tissues and eventual pathological architectural changes may occur in muscle, ligament, bone and central nervous system. Minimization of altered postural/structural loading of the human frame may take longer than resolution, or maximal reduction, of offensive symptoms. By itself, a patient's perception of pain is not a valid indicator of health. CONCLUSION: Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues. Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve. Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation. Chiropractic studies that demonstrate structural improvements are sorely lacking and needed. The use of passive treatment modalities as the sole means of chiropractic intervention for the management of patients suffering with neuromusculoskeletal dysfunction no longer has a place in modern chiropractic practice after the acute phase of healing has passed.

Biomechanical Phenomena↗
PubMed1987

Techniques of spinal cord surgery in fetal rats.

These experiments were done to develop techniques to expose and manipulate the spinal cord in fetal rats, techniques that could be used to study spinal cord regeneration and transplantation. Adequate maternal anesthesia required a mixture of acepromazine-ketamine supplemented by thiopental. Fetal rats were operated on at 16 to 22 days of gestation. Fetal mortality increased as the age of the fetus decreased. Microsurgical techniques were developed to expose, divide, and transplant the distal spinal cord.

Anesthesia↗
PubMed1999

The frequency of positive common spinal clinical examination findings in a sample of premenstrual syndrome sufferers.

OBJECTIVE: As part of a randomized clinical trial to determine the efficacy of chiropractic therapy on premenstrual syndrome (PMS), subjects were evaluated for initial underlying spinal dysfunction. SUBJECTS: Fifty-four subjects with diagnosed PMS (using a Moos PMS questionnaire plus daily symptom monitoring) and 30 subjects with no diagnosable PMS were recruited by newspaper advertising and referrals. DESIGN: All subjects underwent a full history and physical and chiropractic examination carried out by 1 of 2 fully qualified and registered chiropractors, each with a minimum of 10 years experience. The results of the assessment for the PMS group were compared with those of the non-PMS group. SETTING: RMIT teaching clinics. DATA ANALYSIS: The data collected were entered into a spread sheet and contingency tables were created. The data were analyzed by use of chi-squared tests, with the statistical significance being set at P < .05. RESULTS: The PMS group had a higher percentage of positive responses for each of 12 measured spinal dysfunction indexes except for range of motion of the low back. The indexes where the increase was statistically significant (P < .05) were cervical, thoracic, and low back tenderness, low back orthopedic testing, low back muscle weakness, and the neck disability index. An average of 5.4 of the 12 indexes were positive for the PMS group compared with 3.0 for the non-PMS group. CONCLUSIONS: A relatively high incidence of spinal dysfunction exists in PMS sufferers compared with a comparable group of non-PMS sufferers. This is suggestive that spinal dysfunction could be a causative factor in PMS and that chiropractic manipulative therapy may offer an alternative therapeutic approach for PMS sufferers.

Adolescent↗
PubMed1998

Managing acute low back pain.

Back pain is very common. In the UK, there were about 14 million GP consultations for back pain in 1993 and around 60-80% of the population will have had it at some time during their lives. Many attacks resolve quickly but some patients go on to develop chronic back pain and a few develop severe, long-term disability. Here we discuss the natural history, diagnosis and management of acute low back pain, focusing on simple low back pain, in which the pain is uncomplicated by nerve root involvement or serious spinal pathology.

Acute Disease↗
PubMed1999

A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle.

OBJECTIVE: To examine the neurophysiologic basis and anatomic relationship between the dura mater and the rectus capitis posterior minor muscle in the etiologic proposition of cervicogenic headache. DATA SOURCES: On-line searches in MEDLINE and the Index to Chiropractic Literature, manual citation searches, and peer inquiries. RESULTS: Connective tissue bridges were noted at the atlanto-occipital junction between the rectus capitis posterior minor muscle and the dorsal spinal dura. The perpendicular arrangement of these fibers appears to restrict dural movement toward the spinal cord. The ligamentum nuchae was found to be continuous with the posterior cervical spinal dura and the lateral portion of the occipital bone. Anatomic structures innervated by cervical nerves C1-C3 have the potential to cause headache pain. Included are the joint complexes of the upper 3 cervical segments, the dura mater, and spinal cord. CONCLUSION: A sizable body of clinical studies note the effect of manipulation on headache. These results support its effectiveness. The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache. This proposal would further explain manipulation's efficacy in the treatment of cervicogenic headache. Further studies in this area are warranted to better define the mechanisms of this anatomic relationship.

Cervical Plexus↗