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At least 811 records · Page 45Linked to original sources
PubMed2006

Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain.

Mapping studies of pain elicited by injections into the sacroiliac joints (SIJs) suggest that sacroiliac joint syndrome (SIJS) may manifest as low back pain, sciatica, or trochanteric pain. Neither patient-reported symptoms nor provocative SIJ maneuvers are sensitive or specific for SIJS when SIJ block is used as the diagnostic gold standard. This has led to increasing diagnostic use of SIJ block, a procedure in which an anesthetic is injected into the joint under arthrographic guidance. However, several arguments cast doubt on the validity of SIJ block as a diagnostic gold standard. Thus, the effects of two consecutive blocks are identical in only 60% of cases, and the anesthetic diffuses out of the joint in 61% of cases, often coming into contact with the sheaths of the adjacent nerve trunks or roots, including the lumbosacral trunk (which may contribute to pain in the groin or thigh) and the L5 and S1 nerve roots. These data partly explain the limited specificity of SIJ block for the diagnosis of SIJS and the discordance between the pain elicited by the arthrography injection and the response to the block. The limitations of provocative maneuvers and SIJ blocks may stem in part from a contribution of extraarticular ligaments to the genesis of pain believed to originate within the SIJs. These ligaments include the expansion of the iliolumbar ligaments, the dorsal and ventral sacroiliac ligaments, the sacrospinous ligaments, and the sacrotuberous ligaments (sacroiliac joint lato-sensu). They play a role in locking or in allowing motion of the SIJs. Glucocorticoids may diffuse better than anesthetics within these ligaments. Furthermore, joint fusion may result in ligament unloading.

Diagnosis, Differential↗
PubMed2004

Far-lateral disk herniation: case report, review of the literature, and a description of nonsurgical management.

OBJECTIVE: To review the history and examination of a far-lateral lumbar intervertebral disk herniation (FLLIDH), as well as the treatment and outcomes of a nonsurgical approach. CLINICAL FEATURES: A 60-year-old healthy male subject had a 3-week history of right buttock and calf pain. He initially had a left lateral list and asymmetrical pelvic landmarks. Range of motion (ROM) of the lumbar spine revealed full and pain-free lumbar flexion, right-sided pain with lumbar extension and left side bending, and painful and restricted left side bending. Neurologic examination was unremarkable. INTERVENTION AND OUTCOME: The patient was treated with a lumbar epidural and nerve root injection, as well as manipulation. Physical therapy consisted of deweighting treadmill, autotraction, and strengthening exercises. Outcomes were measured by using the Modified Oswestry Questionnaire, as well as a numerical pain rating scale. His initial Oswestry was 73%, pain 9/10 at presentation. Upon discharge, the Oswestry was 0% and pain was rated as 0/10. CONCLUSION: A significant decrease was noted in both the Oswestry Questionnaire, as well as the pain rate. The patient returned to running on alternate days for a minimum of 30 minutes, which was his primary goal. This case demonstrated a positive outcome using a multidisciplinary approach in a patient diagnosed with a FLLIDH. He obtained his goals and his function was fully restored.

Humans↗
PubMedDate not supplied

Popliteal aneurysm as a cause of leg pain in a geriatric patient.

OBJECTIVE: To discuss the management of a patient with unilateral lower extremity pain as a consequence of a popliteal aneurysm. CLINICAL FEATURES: An 85-year-old male had difficulty in ambulating due to low back and lower extremity pain. Standard tests demonstrated and reproduced pain at the lower back while inspection, palpation, and auscultation revealed a pulsatile mass in the popliteal fossa of the right knee. INTERVENTION AND OUTCOME: Specific joint manipulation for relief of low back pain was performed. Comanagement of the patient with a vascular surgeon and subsequent surgical intervention resulted in relief of lower extremity pain. CONCLUSION: Resolution of pain and guarded gait was accomplished by a multidisciplinary approach combining conservative care and invasive techniques.

Aged↗
PubMed2005

A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus. A contraindication for manipulation of the cervical spine?

OBJECTIVE: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. INTERVENTION AND OUTCOME: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. DISCUSSION: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. CONCLUSION: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.

Cadaver↗
PubMed2005

Bone setting for prolonged neck pain: a randomized clinical trial.

OBJECTIVES: To study the natural history of prolonged neck pain and the effectiveness of bone setting as its treatment. METHODS: A randomized clinical trial with blinded outcome assessment and 1-year follow-up was completed. Forty-two working-aged patients with nonspecific neck pain for at least 1 month and no contraindications to manipulative therapies were recruited. They were randomly allocated into 5 weekly sessions of bone setting provided by 2 experienced folk healers (22 patients) or follow-up without therapy (20 patients). The primary outcomes were neck mobility after the 5-week therapy period and the Million scales modified for neck pain at 5 weeks, and 3, 6, and 12 months after baseline. Secondary outcomes included self-rated improvement and pain drawing at 5 weeks, and 3, 6, and 12 months after baseline, Beck depression scales at 5 weeks and 12 months after baseline, and sick leaves, additional therapies, and pain medication during 1 year after baseline. RESULTS: At baseline, neck pain was reported constant or increasing by 51% and episodic by 49% of the patients with mean duration of symptoms of 4.3 years for the bone setting and 8.4 years for the control group. Seventy-eight percent of the patients participated in the clinical measurements at 5 weeks, and 90% returned the questionnaires after 1 year. The cervical mobility of the bone setting patients increased 29% in the frontal, 23% in the sagittal, and 16% in the horizontal plane, whereas the figures for the control group were -1.4%, 1.0%, and 3.0%, respectively. The mean Million index of the bone setting group (50.6 mm at baseline) was 18.5 mm at 5 weeks, 21.2 mm at 3 months, 22.9 mm at 6 months, and 14.2 mm at 1 year. The figures for the control group were 53.2 mm at baseline, and 4.0, 6.2, 5.4, and 5.5 mm at the corresponding follow-up points. After 1 year, improvement was reported by 80% of the bone setting and 28% of the control patients. CONCLUSION: In this study, manual therapy had a measurable effect on the mobility of cervical spine at 5 weeks and an effect on pain that lasted for at least half a year.

Adult↗
PubMedDate not supplied

Validation of a sham manipulative procedure for the cervical spine for use in clinical trials.

OBJECTIVE: To develop a sham manipulation procedure for the cervical spine for use in randomized clinical trials of cervical disorders. METHODS: A single-group, single-intervention study design was used. Adult neck pain subjects underwent a screening examination that included palpation for a site of cervical spine joint dysfunction. Eligible subjects underwent measurements of regional cervical ranges of motion as well as pressure algometry (tenderness) at the site of cervical joint dysfunction. Subjects were instructed that they would receive one of several types of manipulative procedures. A newly developed sham manipulation was delivered once. Subjects were then remeasured for ranges of motion and tenderness. They were asked if they had experienced any pain during the procedure, if they had experienced a "cavitation" sound, and if they thought that the procedure they received was a "real" manipulation. Finally, they were debriefed as to the deception involved in this study. A prior level of 65% was set for endorsement that the procedure was a real manipulation. Changes in pre-post measures of ranges of motion and tenderness were analyzed descriptively for clinically important differences. RESULTS: Twenty eligible subjects were included (12 males, 8 females) with an average age of 30.4 (2.8) years. Twelve of the subjects were not students, with 3 of these having no prior experience with chiropractic treatment; 8 were students. Of the total sample (N = 19), 8 (42.1%) indicated that the procedure was a "real adjustment"; of the 12 nonstudents, 8 (58.3%) indicated similarly. None of the procedures in the final sample resulted in a cavitation, and none of the subjects registered the procedure as painful. None of the measures for ranges of motion or tenderness showed clinically important changes. CONCLUSIONS: The sham cervical manipulation studied here appears to approximate the necessary features of a placebo maneuver in that it is perceived by a majority of nonstudent neck pain subjects to be a real manipulation, although it does not produce any important change in cervical status. The small sample size of nonstudent participants precludes a strong recommendation for this procedure at this time.

Adult↗
PubMedDate not supplied

Patient recall of the mechanics of cervical spine manipulation.

OBJECTIVE: To determine how accurately patients with neck pain and/or headache can recall the mechanics of their cervical spine manipulative therapy immediately after its administration. METHODS: A survey analysis of immediate patient recall after cervical spine manipulative therapy was performed in a private clinic. The group consisted of 94 sequentially presenting neck pain and/or headache patients with 54 (57%) females and 40 (43%) males. The mean age of the patients was 41.9 years (SD = 13.8; range, 17-96 years). Patients received diversified cervical spine manipulative therapy using a standardized set-up of lateral flexion coupled with flexion. Immediately after the cervical spine manipulative therapy, each patient completed a one-page questionnaire regarding the mechanics of the procedure. Patient responses were analyzed to determine the accuracy of their recall of head positioning. RESULTS: Among the patients, 78.7% reported that they experienced a component of rotation and/or extension, although the technique used involved a premanipulative set-up of lateral bending coupled with flexion. CONCLUSION: Patients with primary complaints of neck pain and/or headache, when asked to recall the mechanics of their recently applied cervical spine manipulative therapy, displayed a low rate of accuracy. Rotation and/or extension of the cervical spine were the most frequently given incorrect responses.

Adolescent↗
PubMedDate not supplied

Intraexaminer reliability of identifying a dysfunctional segment in the thoracic and lumbar spine.

OBJECTIVE: To examine the intrarater reliability of identifying a manipulable lesion in the lumbar and thoracic spine. METHODS: An experienced osteopath used dynamic and static examination to assess 12 asymptomatic subjects for signs of joint dysfunction in the thoracic and lumbar spine. The selected segment was marked with an UV invisible mark. A second examiner visualized these marks with an UV lamp and recorded them on acetates for analysis; this process was then repeated an hour later. The distance from the marks to a fixed point was measured and within-day intrarater reliability was calculated using intraclass correlation coefficients (ICCs). RESULTS: The ICC(1,1) for the thoracic spine was 0.70 (95% confidence interval [CI], 0.27-0.90). In the lumbar spine the ICC(1,1) was 0.96 (95% CI, 0.87-0.99). CONCLUSION: This study shows that the lumbar spine joint perceived to be the joint most likely to benefit from a high-velocity low-amplitude thrust can be identified with good within-day reliability in an asymptomatic sample using a defined examination protocol. However, the reliability in identifying a joint exhibiting signs of segmental dysfunction in the thoracic spine was poor.

Adult↗
PubMedDate not supplied

The effect of sacroiliac joint manipulation on feed-forward activation times of the deep abdominal musculature.

OBJECTIVES: To determine the incidence of delayed feed-forward activation (FFA) times in a group of healthy young males; to retest those subjects who showed delayed FFA after 6 months to determine the reliability of the measure in the absence of treatment or injury in the intervening period; and to determine the effect of sacroiliac joint manipulation on delayed FFA times. METHODS: Ninety young males were assessed for the FFA of their deep abdominal muscles in relation to rapid upper limb movements. Those who met the criteria for delayed FFA (failure of deep abdominal activation within 50 milliseconds of deltoid activation) were then reassessed 6 months later. These subjects then underwent sacroiliac joint manipulation on the side demonstrating decreased joint movement during hip flexion and lateral flexion. Feed-forward activation times were then reassessed after joint manipulation. RESULTS: Seventeen (18.9%) of 90 subjects met the criteria of impaired FFA. Thirteen of 17 were available to be remeasured at 6-month follow-up. The intraclass correlation coefficient for FFA at this time was greater than 0.70 for all movement directions. There was a significant improvement (38.4%) in FFA times for this group when remeasured immediately after the sacroiliac joint manipulation. CONCLUSIONS: Delayed FFA is a highly reproducible measure at long-term follow-up. This technique appears to be a sensitive marker of the neural effects of sacroiliac joint manipulation. Future prospective studies are needed to determine if delayed FFA times are a marker for those at risk for developing back pain.

Abdominal Muscles↗
PubMed2006

A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study.

OBJECTIVE: The objective of this study was to describe the clinical outcomes of patients with cervical radiculopathy (CR) treated nonsurgically after a diagnosis-based decision rule. METHODS: A prospective observational cohort study on consecutive patients with CR was performed. Data on 35 consecutive patients were collected at baseline, at the end of the active treatment, and at a minimum of 3 months after cessation of treatment. Disability was measured using the Bournemouth Disability Questionnaire. Pain intensity was measured using the Numerical Pain Rating Scale. Patients were also asked to self-rate their improvement. RESULTS: Complete outcome data were available for 31 of the 35 patients. Twenty-seven patients were reached for long-term follow-up. The mean number of months from last treatment to follow-up was 8.2 months. Seventeen patients (49%) reported their improvement as "excellent" and another 14 (40%) did so as "good." The mean patient-rated improvement was 88.2%. The mean percentage of improvement in the Bournemouth Disability Questionnaire score was 78%. The mean percentage of improvement in the Numerical Pain Rating Scale score was 72%. Twenty-four of 31 (77.4%) patients had a clinically significant improvement from baseline to the end of treatment, and 25 of 27 (92.6%) had a clinically significant improvement from baseline to long-term follow-up. CONCLUSIONS: The management strategy that we studied yielded favorable outcomes in this patient sample and appears to be a safe option for patients with CR. However, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized clinical trials are necessary to distinguish treatment effects from the natural history of CR.

Adult↗
PubMed2006

Development of a hand dynamometer for the control of manually applied forces.

OBJECTIVE: The aim of the study was to develop a prototype tool capable of providing instantaneous feedback about manually applied forces, and to use it to determine (1) whether force constancy can be maintained during different application postures and (2) whether sensitivity to stiffness using the tool is different from sensitivity when assessing stiffness with the hands. METHODS: Subjects were students and staff in a health sciences faculty. A series of grade II and IV mobilizing forces were delivered using a mobilizing tool, a modified JAMAR dynamometer fitted with a molded handle. Forces were executed without feedback at application points on a plinth that were near, midway, and far from the body. Thereafter, discrimination between elastic stiffness was determined with hands alone or using the tool. RESULTS: Force was maintained at grade II when the point of application was moved away from the body, but attempts to replicate grade IV mobilization forces in similar postures showed a decrease despite increased effort. Variation in force produced was substantial both within and between subjects. Stiffness discrimination was not significantly different whether hands or the tool was used. CONCLUSION: There is substantial variation in manually applied forces that could be controlled if instantaneous force readout was available. Reports of hand injury in manual therapists motivate further development of devices that maintain sensitivity and allow for control of applied force and spread the load over a greater surface area on the hands.

Equipment Design↗
PubMed2006

The 2005 conference on the biology of manual therapies.

A historic and critically important scientific workshop for all professions involved with manual therapies was held at the National Institutes of Health (NIH) on June 9 and 10, 2005. The conference was jointly sponsored and organized by the NIH and the Canadian Institutes of Health Research and was the first ever national or international research conference to focus on the biologic mechanisms that underlie a broad range of interventions, which can be described as "manual therapies." Leading scientific experts from North America and Europe presented their latest findings and theories related to 5 different areas of science relevant to manual therapies: neuroscience, biomechanics, endocrinology, imaging, and immunology. During the conference, breakout groups composed of scientists, physicians and therapists, and patient advocates were formed in the relevant disciplines. These groups developed consensus statements on key unanswered research questions, which were then submitted back to the conference for comment and approval. The outcomes of this workshop have subsequently been incorporated into a new initiative by the NIH and Canadian Institutes of Health Research for funding research on the biology of manual therapies. This editorial includes presentation summaries and 13 key consensus recommendations relating to mechanisms of action for manual therapies.

Animals↗
PubMed2006

Coupling behavior of the cervical spine: a systematic review of the literature.

OBJECTIVE: The purpose of this study was to investigate evidence of consistency of reported directional coupling patterns among selected studies and to determine its use in manual medical treatment. METHODS: The study was a systematic literature review of English-only journals using PubMed and CINAHL. The keywords included "cervical vertebrae," "biomechanics," "coupling," and "three-dimensional movement" and required coupling directional assessment of individual spine segments. RESULTS: Four 2-dimensional and 8 3-dimensional studies met inclusion criteria. This study found 100% agreement in coupling direction (side flexion and rotation to the same side) in lower cervical vertebral segments (C2-3 and lower) and variation in coupling patterns in the upper cervical segments of occiput-C1 (during side flexion initiation) and C1-2. Dissimilarities may be explained by differences in measurement devices, movement initiation, in vivo vs in vitro specimens, and anatomical variations. CONCLUSIONS: These findings suggest that use of 3-dimensional analyzed cervical coupling patterns for the lower cervical vertebral during apposition and treatment application may show clinical use for manual clinicians. The use of directional coupling based on 2-dimensional cervical coupling patterns or upper cervical spine coupling that addresses C1-2 should be questioned.

Biomechanical Phenomena↗
PubMed2007

Manual forces applied during cervical mobilization.

OBJECTIVE: Manual therapists routinely use passive accessory mobilization techniques to treat patients with mechanical neck disorders, but little is known about the manual forces applied. The aim of this study was to quantify the manual forces applied to the cervical spine during joint mobilization. METHODS: Ten physiotherapists performed posterior-to-anterior mobilizations to C2 and C7 (both centrally and unilaterally, 1 right and 1 left, grades I-IV) on a single asymptomatic male subject. Manual forces were measured in 3 planes using an instrumented treatment table. RESULTS: The instrumented table showed excellent reliability (intraclass correlation coefficient [2,1], 0.99; 95% confidence interval, 0.97-1.00) and accuracy (mean absolute error; vertical force, 1.1 N; SD, 1.5). There were considerable differences between therapists for mean peak force, force amplitude, and oscillation frequency for each technique and grade. Mean peak forces (grade I, 21.8 N; SD, 15.0; grade II, 34.9 N; SD, 20.9; grade III, 58.2 N; SD, 27.5; grade IV, 61.0 N; SD, 29.9) were considerably lower than previously reported lumbar mobilization forces. Intratherapist repeatability for all mobilization parameters was high. Force amplitude and oscillation frequency measures indicated that therapists generally adhered to the published definitions of the grades of mobilization when applying force, but when asked, provided quite different definitions of the grades. CONCLUSIONS: This study provides preliminary evidence that cervical mobilization forces vary considerably between therapists, but intratherapist repeatability is high.

Adult↗