Archive for category Research

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

OBJECTIVE:

To describe a case of symptomatic lumbar disc herniation, successfully treated via chiropractic intervention using Activator Methods Chiropractic Technique.

CLINICAL FEATURES:

A 26-yr-old man suffered from a chronic multisymptom complex composed of low back pain, left groin pain, left leg pain, left foot drop and associated muscle weakness with atrophy. The symptoms had persisted for more than 2 yr after an athletic injury. Magnetic resonance imaging evaluation revealed a 6-mm focal central disc protrusion with accompanying deformation of the thecal sac, consistent with the presenting symptoms. Lumbar spinal surgery had been recommended to the patient as the appropriate medical management for optimal outcome.

INTERVENTION AND OUTCOME:

The patient elected to pursue chiropractic treatment in an effort to resolve his condition via conservative management. Chiropractic intervention consisted of mechanical-force, manually assisted short-lever adjusting procedures, rendered via an Activator Adjusting Instrument (AAI). The patient responded favorably and his multisymptom complex resolved within 90 days of treatment. No residuals or recurrences were noted at examination over 1 yr later.

CONCLUSION:

This report suggests that chiropractic treatment of lumbar disc disorders may be effectively implemented, in certain cases, via mechanical-force, manually assisted adjusting procedures using an AAI. We speculate that the use of an AAI, combined with Activator methods, may provide definitive benefits over side-posture manipulation of the lumbar spine in treatment of resistive disc lesions, because of the lack of torsional stress imposed upon the disc during instrumental spinal adjustment. Further study should be made in this regard to determine the safest and most effective method to treat lumbar disc lesions in a chiropractic setting.


J Manipulative Physiol Ther. 1998 Mar-Apr;21(3):187-96. [PMID:9567239]

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

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Abstract

PURPOSE:

To abstract the essential elements of chiropractic prone leg checking and subject them to controlled, experimental parametric testing.

DESIGN:

Controlled, objective, repeated-measure analysis of the dynamic response of leg positions to distractive and compressive loading conditions.

SETTING:

Research laboratory in a chiropractic college.

PARTICIPANTS:

Twenty-five compression and 30 distraction subjects, most of whom were male, asymptomatic chiropractic students.

INTERVENTION:

The subjects were lowered to the prone position on a table optimized to detect dynamic leg positions, with separate sliding segments supporting each leg. A trial consisted of a 2-min control run, followed by two 2-min experimental runs in which compressive or distractive loads were applied incrementally to the table-leg segments.

MAIN OUTCOME MEASURE:

An optoelectric system measured real-time absolute and relative leg positions.

RESULTS:

Right legs showed a greater average response than left legs under both distractive and compressive loads, and tended to respond more proportionately to incremental load increases. The average response to compression exceeded the response to distraction. Both legs showed a greater average response in the second half of the trials. Correlation of weights with responses was about four times greater in traction than compression.

CONCLUSION:

The functional short leg is confirmed as a stable clinical reality, a multitrial mean of unloaded leg positional differences. The prone leg check may be a loading procedure, albeit unmeasured, that detects non-weight-bearing, functional asymmetry in loading responses. These probably reflect differences in left-right muscle tone, joint flexibility and tissue stiffness. The relatively nonmonotonic, nonlinear quality of left leg responses is consistent with asymmetric neurological responses.


J Manipulative Physiol Ther. 1998 Jan;21(1):19-26. [PMID:9467097]

Author information: Jansen RD, Cooperstein R. Palmer Center for Chiropractic Research, Palmer College of Chiropractic West, San Jose, CA 95134, USA.

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Abstract

OBJECTIVE:

The purpose of this study was to measure the relative movements of vertebrae during manipulative thrusts to unembalmed post-rigor mortis human cadavers.

SETTING:

The investigation was conducted in the gross anatomy laboratory at the University of Calgary.

SUBJECTS:

Two 77-yr-old, unembalmed, post-rigor mortis, male cadavers were used.

INTERVENTIONS:

The movements of vertebrae were investigated by using high-speed cinematography to record the movements of bone pins threaded into T10, T11 and T12 during spinal manipulative therapy to unembalmed post-rigor human cadavers. A single clinician delivered a series of posterior-to-anterior (p-to-a) thrusts to the right transverse process of either T10, T11 or T12, using a reinforced hypothenar contact. Relative p-to-a and lateral translations, as well as axial and sagittal rotations, in T10-T11 and T11-T12 were calculated. Corresponding p-to-a forces exerted by the clinician onto the cadaver were recorded using a pressure pad.

MAIN RESULTS:

Significant relative movements were measured primarily between the targeted and immediately adjacent vertebrae during the thrusts. Vertebral pairs remained slightly ‘hyper-extended’ after the rapid thrusts to T11, when the p-to-a forces returned to preload levels.

CONCLUSIONS:

These findings may be useful for the understanding of the deformation behavior of the vertebral column during therapeutic manipulation. A fully three-dimensional analysis of all six degrees of freedom, using a larger number of unembalmed cadavers, would be useful in clarifying the relationship between the externally applied forces and the observed relative movement patterns of the vertebrae.


J Manipulative Physiol Ther. 1997 Jan;20(1):30-40. [PMID:9004120]

Author information: Gál J, Herzog W, Kawchuk G, Conway PJ, Zhang YT. Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Alberta, Canada.

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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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Abstract

OBJECTIVE:

To determine the effect of spinal manipulation upon the intensity of emotional arousal in phobic subjects exposed to a threat stimulus.

DESIGN:

Randomized, controlled, double-blind clinical trial.

SETTING:

Community college campus.

SUBJECTS:

Eighteen phobic community college student volunteers randomized into treatment and control groups.

INTERVENTION:

Visual analog scale (VAS) and pulse rates were obtained in response to the subjects’ viewing their phobogenic stimulus. Spinal manipulation was performed while the subjects experienced emotional responses. Manual muscle testing was utilized to ascertain the associated spinal segments and involved emotion.

RESULTS:

Data were analyzed using analysis of variance for a repeated measures experimental design and Least Significant Differences (LSDs) for mean comparisons. Baseline, preintervention and postintervention pulse rates were not statistically different for the control and treatment groups (p = .0807). VAS postintervention mean for the spinal manipulation group was significantly lower than the control means (p = .05) and from its corresponding preintervention mean (p = .001).

CONCLUSION:

Spinal manipulation significantly decreased the intensity of emotional arousal reported by phobic subjects. The mechanism for this effect is not known.


J Manipulative Physiol Ther. 1997 Nov-Dec;20(9):602-6. [PMID: 9436145]

Author information: Peterson KB. Private practice of chiropractic, Hermiston, OR, USA.

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To the Editor:

We write concerning the recently published article by Klougart  et al, (Klougart N; Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic  practice. Part II: Treatment to the upper neck and the rate of  cerebrovascular incidents. J Manipulative Physiol Ther 1996; 19:563-9).  The authors should be commended for their exhaustive efforts in  evaluating the occurrence of cerebrovascular incidents in chiropractic  practice, a topic of great interest and importance to the profession (1,  2). Based on earlier conclusions by these authors (1); their  present study (2) and the findings of other authors (3-5), cervical  spine .rotational maneuvers have been found to be clearly more  associated with cerebrovascular accidents (CVAs) and cerebrovascular  incidents (CVIs), after spinal manipulation than other techniques.  Perhaps because of this fact, and the knowledge of the effects of  rotation upon vertebral artery blood flow (6), the authors attempted to  classify technique procedures as “rotation’. or “nonrotation” in their  retrospective analysis to estimate the occurrence of CVI s after  chiropractic treatment to the cervical spine.

Although the authors had good intentions in their survey to  attempt to identify what techniques might be associated with CVIs,  inherent problems exist in administering such a. survey to  chiropractors. The shortcomings may include (a) the failure to report  the use of several different techniques in a given treatment session (7,  8); (b) the reporting of a practitioner that they are using a  particular system (i.e., Gonstead), when in actuality they are not using  the appropriate protocols, screening procedures, case management,  set-ups, lines of drive, segmental contact points and vectors or  magnitude of force as taught and recommended by such a system and (c) a  wide variation of competency among practitioners (9). These issues  complicate the meaningfulness of any evaluation of a particular  chiropractic technique.

Although the authors acknowledged that “the unwanted side  effects” of the Gonstead technique may have been due to a modification  of the technique by the chiropractor, and that it may “include a  stronger element of rotation/extension than is generally thought,”  several questions still arise. Pertaining to the six cases reportedly  classified as “Gonstead,” were any of the treating practitioners trained  in the Gonstead technique, and how many hours of study were dedicated  to such training? Were any of the chiropractors certified in the  Gonstead technique? Did the practitioners use the protocols and  screening procedures suggested by the Gonstead system (10)? Did the  reported “Gonstead” practitioners use elements of rotation in the  set-up, or thrust procedure and to what degree (e.g.,-in case 10 it was  reported that no rotation was used, but in the other 5 cases it was not  mentioned whether rotation was used or not).

Moreover, assuming that “rotation” refers to rotation of the  cervical spine, or + or – 0 Y designation suggested by White and Panjabi  (11), for any valid conclusions to be made in a study of technique  comparison, differentiation must be made between techniques that provide  a thrust at the end range of the motion and those that only exhibit  limited + or – 0 Y rotation in the set-up and thrust. Classification of a  particular technique into one of three categories (rotational, low  rotational or nonrotational) instead of two (rotational or  nonrotational) would be more appropriate for significance. The authors  classified Gonstead as “mainly nonrotation,” yet elements of + or – 0 Y  are routinely included in both the set-up and thrust procedures for the  cervical spine in the Gonstead technique (10). Gonstead, therefore,  should have been classified under rotational or “low rotational,” which  would have significantly affected the extrapolated estimates for  rotation and nonrotation treatments regarding risk estimates for CVIs  among technique procedures.

To expound further, another case in question, specifically case  6, was considered a case of “definite nonrotation,” which involved a  patient who developed CVI-related symptoms after receiving “Traction”  and “Activator” combined in the treatment. The authors used this data to  formulate their conclusion, “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.”

Because both traction and Activator were used in the treatment  of the patient in case 6, and the methodology of neither treatment was  neither explained nor discussed, it is impossible to draw a conclusion  specific to the use of Activator or a “nonrotation” technique in this  case, which deserves mention. The authors failed to provide discussion  of this issue, as they did pertaining to “Gonstead technique” in the  preceding paragraph regarding the modification of the technique by the  individual chiropractor. We want to make it clear that practitioners  trained in use of the Activator Adjusting Instrument (AAI) and Activator  Methods Chiropractic Technique (AMCT) are not taught to incorporate  traction into treatment regimens and, furthermore, that cervical spinal  adjustments/manipulations are performed in the prone neutral position  (12-14). Because there are several types of traction in use in  chiropractic practice, some of which contain postures away from neutral  including flexion and extension (15), the authors understandably  referenced how the vertebral artery can be affected through traction  (16). They further noted that “toggle” and “Activator” techniques seem  not to be under suspicion in CVIs after spinal manipulation.


J Manipulative Physiol Ther. 1997 Oct;20(8):567-8. [PMID:9345689]

Author information: Colloca CJ, Fuhr AW. Activator Methods International Ltd., Phoenix, AZ.

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Abstract

Statement of Intent:

Activator Methods Chiropractic Technique (AMCT) seeks to conduct a systematic analysis of basic body biomechanics, under the general belief that disturbed mechanics leads to disturbed function. A series of diagnostic provocative maneuvers and leg checks are used to identify the location of subluxation; the therapeutic goal is to restore proper body mechanics through the application of low-force adjustments. The use of the activator adjusting instrument is thought to promote increased safety for patient and doctor.

Overview:

According to Fuhr, AMCT is a synthesis of several analytic systems and low-force adjustive procedures, including Logan Basic, Derifield-Thompson leg checking and VanRumpt’s Directional Non-Force Technique (DNFT), the latter of which features thumb thrusts and a system of leg length analysis [1]. Subluxations, detected primarily by the leg check procedure, are addressed with a mechanical percussive tool (Activator Adjusting Instrument or, simply, “Activator”). The leg checking procedure also serves to establish correction of the subluxations.


Chiropr Tech 1997; 9(3):108-14.

Author information: Robert Cooperstein, MA, DC.  Associate Professor, Palmer College of Chiropractic West, San Jose, CA.

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Excerpt:

Chapter 22 | Activator Methods Chiropractic Technique (Mosby)

The prevalence and economic impact of acute  and chronic back pain (BP) and the understanding that many BP problems  have mechanical origins have prompted clinicians and researchers to the  search for improved analytic and experimental methods to quantify the  biomechanical characteristics of the normal and abnormal human spine.  This chapter provides a brief review of the biomechanics of spinal  manipulation, which is followed by a detailed summary of the dynamic  response of the human spine to the Activator Method of chiropractic  posterior anterior (PA) manipulation.

Basic Spine Biomechanics: The spinal column combines an  intricate architectural arrangement of bone, muscle, and soft tissue  components to form a structure of mechanical as well as physiologic  significance. Not only does the spinal column serve to protect the  spinal cord but it also transmits, attenuates, and distributes the  static (time-invarying) and dynamic (time-varying) forces associated  with daily activities. Although the spinal column provides the  structures for load transmission and attenuation, the pathways for load  transmission and attenuation may be greatly altered during voluntary  (postural changes) and involuntary (fatigue) activities, producing  unstable and pathologic changes to the kinematic behavior of the spinal  column. Segmental instability and pathology of the spine are believed to  produce abnormal patterns of motion and forces, which may play a  significant role in the etiology of low back pain (LBP).2° The ability  to quantify in vivo spine segment motion or kinematics, tog ether with  the concomitant forces or kinetics, is therefore, of clinical  significance in terms of both diagnosis and treatment of spinal  disorders and back pain.


Reference: Keller TS. Engineering – in vivo transient  vibration analysis of the normal human spine. Section VIII, Chapter 22, pp 431-450, in Fuhr AW,  Green JR, Collaca CJ, Keller TS. Activator Methods Chiropractic  Technique textbook, St. Louis: Mosby, 1997.

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From the Publisher

Introducing the first book published on this low-force adjusting technique! It offers a how-to approach to the AMC technique, guiding you from basic scan protocols through more advanced course work. Written in a clear, concise, and easy-to-follow form, it first introduces the technique and then discusses how it is applied to every region of the body. Also provides valuable clinical information on specific symptoms, ways to rule out particular conditions, contraindications, and treatment suggestions.


Author information: Fuhr AW, Colloca CJ, Green JR, Keller TS. Activator Methods Chiropractic Technique. St. Louis: Mosby, 1997

 

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