Archive for category Cervical Spine

Abstract Objective The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET). Methods Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy […]

Figure 3: Regional activation (left) and deactivation (right) after spinal manipulation therapy (SMT) using an activator adjusting instrument. Glucose metabolism is increased in regions including the anterior cingulate cortex and cerebellar vermis but is relatively reduced in many sites, including the prefrontal cortex, after SMT. The voxel height threshold is p<0.05, corrected for multiple comparisons; the extent threshold is 10 voxels minimum

Abstract

Objective

The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET).

Methods

Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT) intervention (treatment condition) and once after resting (control condition). We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS) activity, as well as muscle tension and subjective pain intensity in each subject.

Results

Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.

Conclusion

The findings of the present study demonstrate how stimuli to the mechanoreceptors of the joints and skin during SMT are processed in the brain. Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity.


Evidence-Based Complementary and Alternative Medicine, Volume 2017 (2017)

Author information: Akie Inami, Takeshi Ogura, Shoichi Watanuki, Md. Mehedi Masud, Katsuhiko Shibuya, Masayasu Miyake, Rin Matsuda, Kotaro Hiraoka, Masatoshi Itoh, Arlan W. Fuhr, Kazuhiko Yanai, and Manabu Tashiro. Tohoku University, Sendai, Japan.


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Dr. Fuhr’s Commentary

This is now the fourth clinical trial published since 1996 comparing Activator-assisted manipulation to manual thrust manipulation for neck pain. Overall, it is a well designed study. However, the results are inconsistent with the findings from three previous clinical trials which reported that manual-thrust manipulation and Activator-assisted manipulation were equally effective in the treatment of neck pain.

Strengths: All Instrument-assisted manipulations were administered using an Activator IV instrument on a setting of “2” with the manipulative force delivered to the pedicle-lamina junction of the involved segment in an anterior, superior, and slightly medial line of drive. Furthermore, the manipulations were administered by a practitioner with 29 years of clinical experience in instrument manipulation.

Weaknesses: In this trial, the instrument was used only as a biomechanical device, and no Activator Method analytical protocols were used. The choice of which level of the cervical spine to address was at the discretion of the clinician following static palpation. Also, each type of treatment was delivered by a single clinician, and it is possible that part of the treatment response was due to indirect contextual factors related to participant-provider interaction, rather than the direct effect of the treatment alone.

The results are not definitive, and further research investigating the nature of these changes is warranted, but I applaud the efforts of my Australian research colleagues.


Abstract

OBJECTIVE:

The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP).

METHODS:

Participants with MNP of at least 1 month’s duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention.

RESULTS:

Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1).

CONCLUSION:

This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique.


J Manipulative Physiol Ther. 2016 Jun;39(5):319-29. [PMID: 27180949]

Author information: Gorrell LM, Beath K, Engel RM.  Macquarie University, Sydney, NSW, Australia.


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Dr. Fuhr’s Commentary

This is now the fourth clinical trial published since 1996 comparing Activator-assisted manipulation to manual thrust manipulation for neck pain. Overall, it is a well designed study. However, the results are inconsistent with the findings from three previous clinical trials which reported that manual-thrust manipulation and Activator-assisted manipulation were equally effective in the treatment of neck pain.

Strengths: All instrument-assisted manipulations were administered using a single thrust with an Activator IV instrument on a setting of “2” with the manipulative force delivered to the pedicle-lamina junction of the involved segment in an anterior, superior, and slightly medial line of drive. Furthermore, the manipulations were administered by a practitioner with 29 years of clinical experience in instrument manipulation.

Weaknesses: In this trial, the instrument was used only as a biomechanical device, and no Activator Method analytical protocols were used. The choice of which level of the cervical spine to address was at the discretion of the clinician following static palpation. Also, each type of treatment was delivered by a single clinician, and it is possible that part of the treatment response was due to indirect contextual factors related to participant-provider interaction, rather than the direct effect of the treatment alone.

Bottom Line: The results are not definitive, and further research investigating the differences from previous trials is warranted, but overall I applaud the efforts of my Australian research colleagues.

Dr. Arlan W. Fuhr

Abstract

OBJECTIVE:

The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP).

METHODS:

Participants with MNP of at least 1 month’s duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention.

RESULTS:

Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1).

CONCLUSION:

This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique.


J Manipulative Physiol Ther. 2016 Jun;39(5):319-29. [PMID: 27180949]

Author information: Gorrell LM, Beath K, Engel RM.  Macquarie University, Sydney, NSW, Australia.


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Abstract

OBJECTIVE:

To describe the chiropractic care of a geriatric patient with complaints of cervicalgia, arm paraesthesia and adhesive capsulitis using Activator Methods Chiropractic Technique (AMCT).

CLINICAL FEATURES:

A 67-year-old male presented to the New Zealand College of Chiropractic, Chiropractic Centre with severe cervicalgia, right arm paraesthesia of two years duration, and adhesive capsulitis of his left shoulder of 20 years duration. His cervicalgia was constant and rated 8/10 at its worst on the Numeric Pain Scale, and his left shoulder abduction was restricted to 90°.

INTERVENTION AND OUTCOME:

The patient’s vertebral subluxations were addressed using Activator Methods Chiropractic Technique. After 4 visits spread over 4 weeks he regained the full range of motion in his left shoulder and the cervicalgia subsided to 1/10 with no right arm paraesthesia.

CONCLUSION:

The findings of this case suggest that chiropractic care using Activator Methods protocol for reduction of vertebral subluxations had a positive effect on cervicalgia and adhesive capsulitis in an elderly patient with a complex clinical history.


A Vertebral Subluxation Res. October 8, 2015, pp 163-166.

Author information: David (June-ki) Ham, BSC, Tae Bum Lim, Graham Dobson, DC.  New Zealand College of Chiropractic, 6 Harrison Rd, Mt Wellington, Auckland 1060, New Zealand.

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Abstract

BACKGROUND:

Neck pain of a mechanical nature is a common complaint seen by practitioners of manual medicine, who use a multitude of methods to treat the condition. It is not known, however, if any of these methods are superior in treatment effectiveness. This trial was stopped due to poor recruitment. The purposes of this report are (1) to describe the trial protocol, (2) to report on the data obtained from subjects who completed the study, (3) to discuss the problems we encountered in conducting this study.

METHODS:

A pragmatic randomised clinical trial was undertaken. Patients who met eligibility criteria were randomised into three groups. One group was treated using specific segmental high velocity low amplitude manipulation (diversified), another by specific segmental mobilisation, and a third group by the Activator instrument. All three groups were also treated for any myofascial distortions and given appropriate exercises and advice. Participants were treated six times over a three-week period or until they reported being pain free. The primary outcome measure for the study was Patient Global Impression of Change (PGIC); secondary outcome measures included the Short-Form Health Survey (SF-36v2), the neck Bournemouth Questionnaire, and the numerical rating scale for pain intensity. Participants also kept a diary of any pain medication taken and noted any perceived adverse effects of treatment. Outcomes were measured at four points: end of treatment, and 3, 6, and 12 months thereafter.

RESULTS:

Between January 2007 and March 2008, 123 patients were assessed for eligibility, of these 47 were considered eligible, of which 16 were allocated to manipulation, 16 to the Activator instrument and 15 to the mobilisation group. Comparison between the groups on the PGIC adjusted for baseline covariants did not show a significant difference for any of the endpoints. Within group analyses for change from baseline to the 12-month follow up for secondary outcomes were significant for all groups on the Bournemouth Questionnaire and for pain, while the mobilisation group had a significant improvement on the PCS and MCS subscales of the SF-36v2. Finally, there were no moderate, severe, or long-lasting adverse effects reported by any participant in any group.

CONCLUSIONS:

Although the small sample size must be taken into consideration, it appears that all three methods of treating mechanical neck pain had a long-term benefit for subacute neck pain, without moderate or serious adverse events associated with any of the treatment methods. There were difficulties in recruiting subjects to this trial. This pragmatic trial should be repeated with a larger sample size.


Chiropr Osteopat. 2010 Jul 9;18:20. [PMID:20618936]

Author information: Gemmell H, Miller P. Anglo-European College of Chiropractic Bournemouth, Dorset, UK.


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Abstract

OBJECTIVE:

To examine radiological changes of the lateral cervical curve in patients who received chiropractic care after motor vehicle collisions.

DESIGN:

A retrospective case series. Thirteen patients who had received chiropractic care after motor vehicle collisions were selected from a northeastern Washington chiropractic office. Patients had a lateral cervical radiograph taken prior to the initiation of chiropractic treatment and a comparative lateral cervical radiograph subsequent to a period of care. Cases were included if they met the previously stated criteria and if the radiographs were of sufficient quality to determine the lateral cervical curve from C2-C7.

RESULTS:

Adjustments rendered using an Activator Adjusting Instrument. Eleven of the subjects were also instructed to perform stretching exercises. Compared to the initial lateral cervical radiograph, the comparative radiographs demonstrated a mean increase in cervical lordosis between C2 and C7 of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees.

CONCLUSION:

There was a mean increase in the cervical lordosis of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. We were not able to determine the individual effects of adjustment, stretching, and natural progression of the condition. The results suggest that further study of this phenomenon should be undertaken.


J Manipulative Physiol Ther. 2003 Jul-Aug;26(6):352-5. [PMID:12902963]

Author information: Coleman RR, Hagen JO, Troyanovich SJ, Plaugher G. Adjunct Research Faculty, Life Chiropractic College West, Othello, Wash, USA.

 

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Abstract

OBJECTIVE:

To describe a case of postsurgical neck pain, after multiple spinal surgeries, that was successfully treated by chiropractic intervention with instrumental adjustment of the cervical spine.

CLINICAL FEATURES:

A 35-year-old woman had chronic neck pain for over 5 years after two separate surgeries of the cervical spine: a diskectomy at C3/4 and a fusion at C5/6. Surgeries were performed 6 months apart in an attempt to resolve persistent neck pain and spasm of the cervical musculature. Neither surgery was effective in relieving the patient’s pain. Five years after the second surgery, a third surgery was recommended by the patient’s physicians to alleviate the chronic pain. The patient sought chiropractic evaluation of her condition to avoid further surgical intervention.

INTERVENTION AND OUTCOME:

The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care.

CONCLUSION:

Chiropractic treatment of postsurgical neck syndrome may be effectively treated, in certain cases, by mechanical force, manually assisted adjusting procedures with an AAI. The use of instrumental adjustment methodology may provide chiropractic physicians with an effective alternative to manual manipulation in those cases in which the patient’s surgical history or presenting symptoms make forceful manipulation of the spine, particularly performed at end range, inappropriate. This approach may be contemplated by physicians faced with managing this type of condition. Further study should be made in this regard, in an academic research setting, to determine the safest and most effective approaches to managing postsurgical patients in a chiropractic setting.


J Manipulative Physiol Ther. 2001 Nov-Dec;24(9):589-95. [PMID:11753333]

Author information: Polkinghorn BS, Colloca CJ. Private practice of chiropractic, Santa Monica, Calif., USA.

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Abstract

OBJECTIVE:

To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thrust cervical manipulations in the treatment of cervical spine dysfunction.

DESIGN:

Prospective, randomized, comparative clinical trial.

SETTING:

Outpatient chiropractic clinic, Technikon Natal, South Africa.

PATIENTS:

Thirty patients diagnosed with neck pain and restricted cervical spine range of motion without complicating pathosis for at least 1 month were included in the study.

INTERVENTIONS:

The patients were randomized into 2 groups. Those in one group received mechanical force, manually assisted (MFMA) manipulation to the cervical spine, delivered by means of a hand-held instrument (Activator II Adjusting Instrument). Those in the other group received specific contact high-velocity, low-amplitude (HVLA) manipulation consisting of standard Diversified rotary/lateral break techniques to the cervical spine. Each group received only the specific therapeutic intervention, no other treatment modalities or interventions (including medication) being used, until asymptomatic status was achieved or a maximum of 8 treatments had been received.

MAIN OUTCOME MEASURES:

Both treatment groups were assessed through use of subjective (Numerical Pain Rating Scale 101, McGill Short-Form Pain Questionnaire, and Neck Disability Index) and objective (goniometer cervical range of motion) measurement parameters at specific intervals during the treatment period and at 1-month follow-up. The data were assessed through use of 2-tailed nonparametric paired and unpaired analysis, descriptive statistics, and power analysis of the data.

RESULTS:

The results indicate that both treatment methods had a positive effect on the subjective and objective clinical outcome measures, no significant difference being observed between the 2 groups (P < .025). The subjective data from all 3 questionnaires showed statistically significant changes from initial to final consultations as well as from initial consultation to 1-month follow-up (P < .025). The objective range of motion measures showed statistically significant changes in the MFMA group for left and right rotation and left and right lateral flexion from initial consultation to final consultations and for right rotation and right lateral flexion from initial consultation to 1-month follow-up. The HVLA group showed only the change in left rotation from initial to final consultations and from initial consultation to 1-month follow-up to be statistically significant.

CONCLUSIONS:

The results of this clinical trial indicate that both instrumental (MFMA) manipulation and manual (HVLA) manipulation have beneficial effects associated with reducing pain and disability and improving cervical range of motion in this patient population. A randomized, controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings.


J Manipulative Physiol Ther. 2001 May;24(4):260-71. [PMID:11353937]

Author information:Wood TG, Colloca CJ, Matthews R. Department of Chiropractic, Technikon Natal, South Africa.

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Subject: Cervical Spine Related Studies

 

Reference: Polkinghorn BS. Treatment of Cervical Disc  Protrusions Via Instrumental Chiropractic Adjustment. J Manipulative  Physiol Ther 1998; 21(2):114-21

 

Abstract: Objective: To present a case of post-traumatic cervical syndrome involving multiple protrusions intervertebral discs, successfully treated with conservative  instrumental chiropractic adjusting procedures. Discussion includes a  review of the relevant literature regarding the possible advantages that  instrumental adjustments may have over their manually delivered  counterparts in treatment of certain atypical cases.

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Abstract

BACKGROUND:

Circumstances surrounding cerebrovascular accidents after cervical manipulation need further clarification. In particular, more information is needed on the importance of specific techniques.

OBJECTIVES:

To estimate the occurrence of cerebrovascular incidents (CVI) after chiropractic treatment to the cervical spine in relation to both the estimated number of treatments given to the upper and lower cervical spine and the techniques used.

DESIGN:

Retrospective data were collected from questionnaires covering the period 1978-1988 inclusive; in a second survey, chiropractors provided information obtained through inspection of their own case records.

PARTICIPANTS:

All 226 practicing members of the Danish Chiropractors’ Association in 1989 (response rate 54%) and a random sample of 40 chiropractors (response rate 72.5%) from the same population were invited to participate in the study.

OUTCOME MEASURES:

Survey 1: Estimated proportion of consultations that involved treatment to the cervical spine, number and clinical particulars of CVI. Survey 2: proportion of treatment sessions on a specific day that included the neck, upper/lower neck and the type of treatment (nonrotation or rotation techniques) preferred.

MAIN RESULTS:

Among the respondents, the reported incidence of CVI between 1981 and 1988 was about one for every 120,000 cervical treatment sessions, and SMT to the upper neck was about four times more commonly associated with CVI than treatment of the lower neck. Rotation procedures to the upper cervical spine were almost twice as often linked to CVI as nonrotation procedures of that area.

CONCLUSIONS:

Although there seems to be a link between upper cervical rotation manipulative techniques and cerebrovascular incidents, treatment to the lower neck and the use of other techniques are implicated as well.

Comment in


J Manipulative Physiol Ther. 1996 Nov-Dec;19(9):563-9. [PMID: 8976474]

Author information: Klougart N, Leboeuf-Yde C, Rasmussen LR. Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark.

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