Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.
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Biomechanical Phenomena↗
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Results for “Manipulation, Spinal”
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The influence of a chiropractic manipulation on lumbar kinematics and electromyography during simple and complex tasks: a case study.
OBJECTIVE: To investigate whether a more sophisticated and detailed analysis of both simple and complex tasks may yield more information regarding the short-term influence of an adjustment on spine biomechanics. METHODS: The study used a single-subject, before-after design. Three-dimensional spine kinematics and trunk muscle electromyography were assessed during a variety of tasks performed by a professional golfer exhibiting non-specific, chronic, low back pain. The patient received a right-to-left and left-to-right spinous pull adjustment. RESULTS: After the adjustment, changes were seen in all 3 axes of motion during a golf swing, with concomitant muscle responses. In addition, changes in the off axes of motion were seen during simple movement tasks. CONCLUSIONS: A more detailed spine kinematic analysis, specifically analysis of motion in the nonprincipled axes, yielded more information regarding the short-term influence of an adjustment on lumbar spine motion and muscle function.
Adult↗
Missed cervical spine fracture: chiropractic implications.
OBJECTIVE: To discuss the case of a patient with an anterior compression fracture of the cervical spine, which had been overlooked on initial examination. CLINICAL FEATURES: A 36-year-old man was seen at a chiropractic clinic 1 month after diving into the ocean and hitting his head on the ocean floor. He chipped a tooth but denied loss of consciousness. Initial medical examination in the emergency department did not include radiography, but an anti-inflammatory medication was prescribed. Radiographs taken at the chiropractic clinic 1 month later revealed an anterior compression fracture of the C7 vertebra, with migration of the fragment noted on flexion and extension views. INTERVENTION AND OUTCOME: The patient was referred back to his medical doctor for further evaluation and management.He was instructed to wear a Philadelphia collar for 4 weeks. During this time period, he reported "shooting" pain and tingling from his neck into his arms. The patient reported resolution of his neck and arm symptoms at 2.5 months after injury. Follow-up radiographs at 6 months after injury revealed fusion of the fracture fragment with mild residual deformity. At that time, the patient began a course of chiropractic treatment. CONCLUSION: After head trauma, it is essential to obtain a radiograph of the cervical spine to rule out fracture. Chiropractors should proceed with caution, regardless of any prior medical or ancillary evaluation, before commencing cervical spine manipulation after head and neck trauma.
Adult↗
Preliminary study of the effects of a placebo chiropractic treatment with sham adjustments.
OBJECTIVE: To identify aspects of the delivery of placebo chiropractic treatments by using sham adjustments that may cause a treatment effect and that may affect the success of blinding. DESIGN AND SETTING: Two-period crossover design in a chiropractic college research clinic. SUBJECTS: Eighteen volunteer staff, students, and faculty of the chiropractic college who reported low-back pain within the last 6 months. INTERVENTIONS: Flexion-distraction technique was used to perform chiropractic adjustments, and a hand-held instrument (Activator adjusting instrument) with the pressure gauge set on the 0 was used to perform sham adjustments. The treatment period was 2 weeks, with a total of 4 visits. MAIN OUTCOME MEASURES: The Visual Analog Scale (VAS) for pain and Global Well-Being Scale (GWBS). RESULTS: Although VAS and GWBS scores improved with both treatments, a somewhat greater improvement occurred in most cases with the active treatment. Eight of 14 patients interviewed believed that the placebo had a treatment effect. CONCLUSION: This study provided preliminary information that was useful in planning the protocol for a placebo chiropractic treatment in the randomized clinical trial for which it was designed.
Adult↗
Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms.
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Humans↗
Chiropractic management of a patient with myasthenia gravis and vertebral subluxations.
OBJECTIVE: The chiropractic management of a patient with myasthenia gravis and vertebral subluxation is described. We discuss the pathophysiology, clinical features, and treatment of patients with these diseases. CLINICAL FEATURES: The 63-year-old male patient suffered from complaints associated with the disease myasthenia gravis along with signs of vertebral subluxation. The patient had an initial complaint of dysphagia. In addition, the patient experienced swelling of the tongue, nausea, digestive problems, weakness in the eye muscles, difficulty breathing, myopia, diplopia, and headaches. Balance and coordination problems resulted in walking difficulties. INTERVENTION AND OUTCOME: Contact specific, high-velocity, low-amplitude adjustments were applied to sites of patient subluxation. Myasthenia gravis is no longer debilitating to the patient; he is medication free and has resumed a "normal life." CONCLUSION: The clinical aspects of the disease, including the possible role of chiropractic intervention in the treatment of patients suffering from myasthenia gravis, are also discussed. This case study encourages further investigation into the holistic approach to patient management by chiropractors vis-a-vis specific adjustments of vertebral subluxation.
Cervical Vertebrae↗
Effect of premanipulative tests on vertebral artery and internal carotid artery blood flow: a pilot study.
BACKGROUND: Neck manipulation occasionally causes stroke after trauma to the vertebral or internal carotid artery. Premanipulativ e tests involving cervical spine rotation or extension have been recommended to detect patients at risk of neurovascular ischemia. However, the effect of these procedures on extracranial blood flow is not well established, and their validity is thus controversial. OBJECTIVE: To determine the effect of premanipulative tests involving cervical spine rotation or extension on vertebral artery and internal carotid artery blood flow parameters. DESIGN: Two-group experimental study. SUBJECTS: Twenty subjects consisting of 16 patients treated with physiotherapy and four volunteers. METHODS: Subjects were tested with a recommended premanipulative protocol by both an independent physiotherapist and an investigator. One group consisted of 10 subjects with signs or symptoms indicative of neurovascular ischemia on premanipulative testing, with 10 subjects with no signs or symptoms indicative of neurovascular ischemia on premanipulative testing comprising the second group. Hemodynamic measurements for both vertebral and both internal carotid arteries were taken by use of duplex Doppler ultrasonography with color-flow imaging with the subjects in the following positions: neutral, end-range extension, 45 degrees contralateral rotation, end-range contralateral rotation, and combined end-range contralateral rotation/extension. RESULTS: The reliability of premanipulative testing was supported. Significant changes in flow velocity of the vertebral artery (and to a lesser extent of the internal carotid artery) were shown in end-range positions involving rotation and extension. No meaningful significant differences were found between the two groups. CONCLUSIONS: Screening procedures that use rotation and extension may be useful tests of the adequacy of collateral circulation. A larger study is needed to determine whether subjects testing positive significantly differ from those testing negative.
Adult↗
Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine.
OBJECTIVE: To assess the intraexaminer and interexaminer reliability of clinicians trained in flexion-distraction technique to determine the need for chiropractic adjustment of each segment of the lumbar spine. DESIGN: This was an intraexaminer and interexaminer reliability study of commonly used chiropractic assessment procedures, including static and motion palpation and visual observation. SETTING: Chiropractic college; by four licensed chiropractors trained in flexion-distraction technique, two with more than 20 years' experience and two with 3 or fewer years' experience. SUBJECTS: Subjects were 18 volunteers; 16 were symptom free, and 2 had low back pain at the time the study was conducted. MAIN OUTCOME MEASURE: The kappa statistic was computed for all comparisons and interpreted in categories ranging from "poor" (<0.00) to "almost perfect" (>0.80). RESULTS: Intraexaminer reliability was greater than interexaminer reliability. For intraexaminer reliability there was considerable variation by segment and among the four examiners, but intraexaminer reliability appeared generally higher than interexaminer reliability. Overall, more subluxations were identified on the second examination than on the first. For interexaminer reliability, kappa scores were generally in the "poor" to "slight" categories. DISCUSSION: The results of this study, similar to those of other studies, indicate that even chiropractors trained in the same technique seem to show little consensus on the indications for the necessity to adjust specific segments of the spine. A more standardized assessment approach might be helpful in improving the reliability of diagnostic assessments.
Adult↗
Chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.
OBJECTIVE: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator Methods Chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II). CLINICAL FEATURES: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief. INTERVENTION AND OUTCOME: Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment. CONCLUSION: Chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.
Adult↗
Intraexaminer and interexaminer reliability of the Gillet test.
OBJECTIVES: The purpose of this study was to determine the intraexaminer and interexaminer reliability of the Gillet test. STUDY DESIGN: In a test-retest study the incidence of asymmetric or symmetric sacroiliac joint motion was investigated with the Gillet test. METHODS: Forty-one male subjects volunteered for this study (mean age, 23 +/- 2.24 years). Thirty-eight subjects were examined in the first test procedure, and at least 4 days later 37 subjects were examined again. The subjects were subdivided into symptomatic and asymptomatic groups on the basis of certain criteria. RESULTS: To obtain the intraexaminer and interexaminer reliability values, Cohen's kappa, the percentage agreement, bias-adjusted kappa, and prevalence-adjusted bias-adjusted kappa were used. The mean Cohen's kappa did not exceed the value of 0.081. Only the percentage agreement of the symptomatic group did exceed the minimum level of 80%. When kappa was positive, the prevalence-adjusted bias-adjusted kappa was markedly higher than kappa; when kappa was negative, the prevalence-adjusted bias-adjusted kappa was only slightly higher than kappa. Only small differences were found between kappa and bias-adjusted kappa. CONCLUSION: The Gillet test, as performed in this study, does not appear to be reliable.
Adult↗
Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation.
OBJECTIVE: To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation. CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation. INTERVENTION AND OUTCOME: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions. CONCLUSION: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.
Adult↗
Changes and implications of blood flow velocity of the vertebral artery during rotation and extension of the head.
OBJECTIVE: To study the effects of extension and extension-rotation of the head on the blood flow velocity of the vertebral artery experimentally and clinically. DESIGN: Randomized experimental clinical study. SETTING: Institute of Clinical Anatomy and Biomechanics and the Department of Ultrasound, NanFang Hospital of the First Military Medical University, Guangzhou, China. SUBJECTS: The fresh spines from T1-2 to the occipital bone were obtained from persons who died of acute brain death (n = 10). For the transcranial Doppler measurement, 27 asymptomatic subjects with routine physical examination results and 23 students from the above-mentioned university took part in the test. INTERVENTIONS: The instillation experiment in the cadavers was made. Clinical measurements of blood flow velocity in the vertebral artery in the subjects and students were taken and recorded. MAIN OUTCOME MEASURES: Changes in the drop of the vertebral artery were measured by the instillation test in the experimental sample. The blood flow velocity was measured with transcranial Doppler sonography during extension and extension-rotation of the head. RESULTS: During one-sided rotation of the head with extension of the head, measurements in the contralateral vertebral artery and the bilateral vertebral arteries were both reduced in the instillation experiment. The blood flow velocity in the bilateral vertebral arteries decreased during extension and extension-rotation of the head in the subjects and the students. The pulsatility index in the right vertebral arteries increased more than that in the left in extreme extension and that in the bilateral vertebral arteries in neutral position. CONCLUSIONS: Extreme rotation and extension are dangerous to patients who have abnormal vertebral arteries when extreme rotatory and extension manipulations are applied. Doctors should be very careful when rotating the patient's head to the right side.
Adult↗
Manipulative management of post-Colles' fracture weakness and diminished active range of motion.
OBJECTIVE: To discuss the management of a patient with wrist weakness and a diminution in active range of motion resulting from Colles' fracture. CLINICAL FEATURES: A 58-year-old woman complained of persistent loss of grip strength and mobility in her right wrist. These complaints were from Colles' fracture occurring 19 months before initiation of care. Dynamometer and goniometric testing revealed significant loss of grip strength and range of motion compared with the uninvolved, nondominant wrist. INTERVENTION AND OUTCOME: Specific joint manipulation for improvement in mobility and grip strength of the wrist was performed. The patient's right wrist was evaluated for grip strength and active range of motion over a 3-week period, providing a baseline of function before treatment. After 4 visits of baseline measurements, a series of 4 treatments and 4 reevaluations was performed. The patient exhibited a significant increase in grip strength and active range of motion. CONCLUSION: Appropriate intervention of chiropractic manipulation and examination procedures culminated in a successful resolution of this case. When such cases are recognized, appropriate management may occur conservatively with judicious application of joint manipulation and reevaluation procedures.
Colles' Fracture↗
Effects of altering cycling technique on gluteus medius syndrome.
OBJECTIVE: We discuss how altering the cycling technique of a cyclist receiving periodic chiropractic care helped in the management of gluteus medius syndrome. CLINICAL FEATURES: A 24-year-old male amateur cyclist had numbness and tingling localized to a small region on the superior portion of the right buttock. The area involved demonstrated paresthesia to light touch sensory evaluation. The cyclist had received chiropractic adjustments 2 days before the onset of the symptoms. One week earlier, the patient began riding a new bicycle with different gearing than his previous one. Manual-resisted muscle testing created soreness in the lumbosacral area and buttocks. Trigger points were identified in the right gluteus medius. Standing lumbar spine flexion was 70 degrees, limited by tight hamstrings. INTERVENTION AND OUTCOME: Because the patient was already receiving periodic chiropractic care, no passive therapy was used. Patient education regarding the difference in gear selection in bicycles of a higher quality was provided. He was instructed to train in lower gears than he had previously used and to maintain a cadence of 70 to 90 revolutions of the pedals per minute. After 2 days, the paresthesia on the right buttock resolved. The trigger points were only mildly tender with minimal residual soreness of the involved muscles. CONCLUSION: Management of gluteus medius syndrome by altering the cadence and gear development for a bicyclist is discussed. Either frank or cumulative injury to the gluteus medius muscle is the typical etiologic factor for this syndrome. Repetitive strain of the patient's gluteus medius muscle as a result of poor cycling technique appeared to be the cause here. Knowledge of bicycle fitting, training techniques, and bicycle mechanics appeared necessary to resolve the problem.
Adult↗
How real is the subluxation? A research perspective.
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Chiropractic↗
Motion palpation: it's time to accept the evidence.
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Chiropractic↗
The displacement, velocity and frequency profile of the frontal plane motion produced by the cervical lateral glide treatment technique.
OBJECTIVE: To investigate the specificity of linear and angular displacement, peak velocity and frequency of oscillation of the frontal plane motion produced by the lateral glide treatment technique of the cervical spine. DESIGN: A within-subjects design was used. BACKGROUND: The lateral glide treatment technique of the cervical spine has previously been shown to produce specific neurophysiological effects, whereas the technique's biomechanical effects remain uninvestigated. A relationship may exist between a technique's biomechanical effects and its clinical outcome. METHODS: Eight asymptomatic subjects participated in the study. Retroreflective markers were placed dorsally at the occiput, and the C5, T1, T3 and T5 vertebrae. Movement of these markers was recorded by a video processor. The same physiotherapist applied the treatment technique to each subject. RESULTS: Linear displacement (3.336 cm) and peak velocity (13.643 cm/s) between C5 and T1 markers was greater than between T1 and T3, Occiput and C5, and T3 and T5. Angular displacement about C5 (26.5 degrees ) was twice that about T1 and T3, but unlike T1 and T3 occurred in the opposite direction to that of the treatment technique. Frequency of oscillation was 1. 255 Hz. CONCLUSION: The lateral glide treatment technique produced a characteristic ipsilateral displacement rather than side flexion, predominantly at its region of application. RELEVANCE: This study provides the basis for further investigations of the mechanisms of action of the lateral glide treatment technique. It also provides clinicians with guidelines for the application of this technique.
Adolescent↗
Management of the athlete with low back pain.
The evaluation of an athlete with LBP using the classification system proposed by Delitto et al has been outlined. For outpatient orthopaedic practice, evidence in the literature is available documenting the reliability and the effectiveness of treatment guided by TBC. This classification system provides framework for the clinician to evaluate athletes with LBP because it investigates the presence of serious pathology, considers the severity of the disease process, and provides matched treatment based on the athlete's clinical presentation. When treating athletes with episodes of acute LBP, pain modulation and return to daily function are the primary treatment goals. When treating athletes with episodes of chronic LBP, return to sport and prevention of recurrence are the primary treatment goals.
Adolescent↗