Archive for category Research

Abstract

Musculoskeletal disorders affect 5-7% of the  population in Canada. Neck pain is one of the more common  musculoskeletal complaints. Spinal manipulative therapy attempts to  reduce pain and increase range of motion. Treatments from any profession  require valid evidence of efficacy. This study examines two popular  treatments used by Canadian chiropractors, a mechanically assisted  device commonly known as the Activator Adjusting Instrument ™, and  spinal manipulative therapy. Fourteen subjects were randomly into two  groups. Each subject was assigned by a blind examiner and then given one  of the two treatment interventions provided by an experienced  chiropractor. The outcome measures used were lateral flexion and a  subjective pain rating scale. The results revealed that there were no  statistically significant differences before and after the  interventions. Further study is required using larger sample sizes  before conclusions can be made regarding the efficacy of the selected  interventions. However, the importance of the need for future  comparative studies is discussed.


Chiropr Tech 1996; 8(4):155-62.

Author information: Yurkiw D, Mior S. Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.

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Abstract

STUDY DESIGN:

Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present.

OBJECTIVES:

To assess the evidence for the efficacy and complications of cervical spine manipulation and mobilization for the treatment of neck pain and headache.

SUMMARY OF BACKGROUND DATA:

Although recent research has demonstrated the efficacy of spinal manipulation for some patients with low back pain, little is known about its efficacy for neck pain and headache.

METHODS:

A structured search of four computerized bibliographic data bases was performed to identify articles on the efficacy and complications of cervical spine manual therapy. Data were summarized, and randomized controlled trials were critically appraised for study quality. The confidence profile method of meta-analysis was used to estimate the effect of spinal manipulation on patients’ pain status.

RESULTS:

Two of three randomized controlled trials showed a short-term benefit for cervical mobilization for acute neck pain. The combination of three of the randomized controlled trials comparing spinal manipulation with other therapies for patients with subacute or chronic neck pain showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipulation compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipulation provided short-term relief for patients with tension-type headache. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations.

CONCLUSIONS:

Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.


 

Spine (Phila Pa 1976). 1996 Aug 1;21(15):1746-59. [PMID: 8855459]

Author information: Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. RAND, Santa Monica, CA, USA.

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Abstract

OBJECTIVE:

To create a statistical model using three-dimensional (3D) head kinematics and range of motion (ROM) to distinguish between people with whiplash syndrome and asymptomatic controls.

STUDY DESIGN:

Cross-sectional study to estimate validity of diagnostic measures.

METHODS:

Fifty-one asymptomatic controls (most of whom were women), 18-35 yr old and 30 matched whiplash trauma patients seeking care from suburban outpatient clinics were sought. 3D kinematic parameters of head motion were obtained during tracking tasks (e.g., flexion, extension, etc.) and cervical ROM was measured via a head mounted inclinometer. Their level of pain and disability was assessed via a self-administered neck disability index questionnaire and visual analog pain scale (VAS).

RESULTS:

A scoring system of biomechanical abnormalities derived from the vertical piercing point, its second derivative and symmetry during oblique tasks. The scores ranged from a minimum of 0 to a maximum of 3. A cutoff of > or = 0.5 correctly identified the greatest number of subjects and minimized false positives (sensitivity 77%, specificity 82%, likelihood ratio 4.5). ROM performed similarly well at a cutoff of 1 SD below the normative mean (sensitivity 77%, specificity 84%, likelihood ratio 3.9).

CONCLUSIONS:

There is potential for biomechanical analysis to objectively detect abnormalities. The statistical model yielded moderate to high sensitivity and specificity using 3D helical-axis parameters of the head and standard ROM. The model development will continue via this process in future studies. These data could be a first step toward the creation of useful, noninvasive protocols for the diagnosis and management of soft tissue trauma of the neck.


J Manipulative Physiol Ther. 1996 May;19(4):231-7. [PMID:8734397]

Author information: Osterbauer PJ, Long K, Ribaudo TA, Petermann EA, Fuhr AW, Bigos SJ, Yamaguchi GT. Gait Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.

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Abstract

OBJECTIVE:

To determine the general nature of the biomechanical response of the vertebrae to small forces, such as spinal manipulative therapy (SMT).

DESIGN:

Perturbation theoretical methods of physics and mechanical energy considerations are used to derive the equations of motion of the vertebral bodies moving under the combined influences of ligamentous and discogenic forces, applied forces and dissipative forces attributable to surrounding tissues.

RESULTS:

The allowable solutions to the equations of motion determine that the mechanical response of any vertebra to SMT should consist of a superposition of damped oscillations. This is based on the most general assumptions about the spine that are consistent with clinical observations, namely, that patients can lie stably motionless, and is independent of the specifics of any spinal model.

DISCUSSION:

The extant data are shown to be consistent with this theory. The implications for future research and clinical practice are explored.

CONCLUSIONS:

Vertebral motion in response to SMT seems to occur in two distinct phases: an initial, (passive) oscillatory response to the SMT thrust, governed by ligamentous and discogenic forces, and a later, less regular motion, probably caused by muscular reflex contractions. Evidence of this includes direct measurement of oscillations, surface electromyogram measurements of muscle responses and detection of multiple spinal resonances. Further research on the muscular reflex responses to SMT is necessary. Most SMT should initiate some of the normal-mode oscillations of the vertebrae. There may be up to 144 different frequencies of vertebral oscillatory motion in each individual in any posture; those frequencies detected thus far are consistent with the predicted relationship between frequencies, vertebral body masses and coefficients of stiffness. Further data are needed to confirm the detailed validity of this theory.


J Manipulative Physiol Ther. 1996 May;19(4):238-43. [PMID:8734398]

Author information: Solinger AB. Research Department, Life Chiropractic College-West, San Lorenzo, CA, USA.

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COMMENTARY:

In the past three decades, chiropractic researchers have given a great deal of attention to the audible release (1); it is known to be sometimes caused by joint cavitation, as in the metacarpophalangeal joints, for example (2, 3), and is sometimes assumed to be associated with joint cavitation during spinal manipulation therapy (SMT) (4, 5). Recently, an excellent review of the literature on the audible release associated with joint manipulation was published by Brodeur (6). In this review, Brodeur concluded:

“that the cavitation process provides a simple means for initiating the reflex actions and that without the cavitation process, it would be difficult to generate the forces in the appropriate tissue without causing muscular damage.”

This conclusion contains two basic ideas: 1) cavitation in itself initiates reflex actions; and 2) without cavitation, SMT aimed at eliciting reflex responses could cause muscular damage. In this commentary, I will address these two issues with the use of arguments based on known experimental observations.

Does the Cavitation Process Provide a Simple Means for Initiating Reflex Actions? Does Cavitation Help to Reduce the Incidence of Muscular Damage Caused by SMT?

Conclusion: Based on research of the reflex response associated with chiropractic SMT, it  seems unlikely that cavitation causes reflex responses in the spinal musculature. Furthermore, it seems unlikely that active muscular forces produced by the stretch-reflex response would ever (substantially) resist the joint distraction forces produced by high-velocity chiropractic treatments of the spine.


Reference: Walter Herzog, PhD. J Manipulative Physiol Ther.  1996 Mar-Apr;19(3):216-18.

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Abstract

Overview:

The chiropractic concept of vertebral subluxation has served the purpose of unifying early DC’s by contrasting a unique approach to health problems offered by chiropractors to allopathic medicine. However, confusion over the use of this term, and the concepts surrounding it, has existed because of a lack of consensus among chiropractors. A variety of methods has been offered to identify and measure the effects of vertebral subluxation in order to provide evidence regarding its existence. How the chiropractic profession deals with its belief systems and model building in this era of increasing accountability may be more important than the search for the subluxation itself.

Approach:

In order to assist practitioners to cope with this dilemma, an overview of selected subluxation assessment procedures is provided including a qualitative review of relevant studies examining reliability and validity of the various approaches. Criteria for assessing technology are presented, and recommendations are made regarding the value of a number of currently available assessment strategies. A discussion of future technology assessment issues is offered.


Top Clin Chiropr 1996; 3: 1-9.

Author information: Osterbauer, PJ.

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Abstract

STUDY DESIGN:

Task-specific and subject-specific lumbar trunk muscle function, muscle geometry, and vertebral density data were collected from 16 men. A biomechanical model was used to determine muscle strength and the compressive forces acting on the lumbar spine.

OBJECTIVES:

To develop an anatomic biomechanical model of the low back that could be used to derive task-specific muscle function parameters and to predict compressive forces acting on the low back. Several model-specific constraints were examined, including the notion of bilateral trunk muscle anatomic symmetry, the influence of muscle lines of action, and the use of density-derived vertebral strength for model validation.

SUMMARY OF BACKGROUND DATA:

Clinical and basic science investigators are currently using a battery of diverse biomechanical techniques to evaluate trunk muscle strength. Noteworthy is the large variability in muscle function parameters reported for different subjects and for different tasks. This information is used to calculate forces and moments acting on the low back, but limited data exist concerning the assessment of subject-specific, multiaxis, isometric trunk muscle functions.

METHODS:

A trunk dynamometer was used to measure maximum upright, isometric trunk moments in the sagittal (extension, flexion) and coronal (lateral flexion) planes. Task- and subject-specific trunk muscle strength or “gain” was determined from the measured trunk moments and magnetic resonance image-based muscle cross-sectional geometry. Model-predicted compressive forces obtained using muscle force and body force equilibrium equations were compared with density-derived estimates of compressive strength.

RESULTS:

Individual task-specific muscle gain values differed significantly between subjects and between each of the tasks they performed (extension > flexion > lateral flexion). Significant differences were found between left side and right side muscle areas, and the lines of action of the muscles deviated significantly from the vertical plane. Model-predicted lumbar compressive forces were 38% (lateral flexion) to 73% (extension) lower that the L3 vertebral compressive strength estimated from vertebral density.

CONCLUSION:

The present study suggests that biomechanical models of the low back should be based on task-specific and subject-specific muscle function and precise geometry. Vertebral strength estimates based upon vertebral density appear to be useful for validation of model force predictions.


Spine (Phila Pa 1976). 1996 Feb 15;21(4):427-33. [PMID:8658245]

Author information: Gzik DC, Keller TS, Szpalski M, Park JH, Spengler DM. Department of Mechanical Engineering, University of Vermont, Burlington, USA.

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Abstract

OBJECTIVE:

To compare the immediate effects on pain of Meric and Activator adjustments in patients with acute low back pain (LBP).

DESIGN:

Adjustments were compared using a randomized, controlled clinical trial for relative effectiveness.

SETTING:

The study was conducted at a private chiropractic clinic in Tulsa, Oklahoma.

PATIENTS:

Thirty consecutive established patients presenting with acute LBP were studied. Sixteen subjects were randomly assigned to the Meric group and 14 to an Activator group. The mean (SD) age was 53.5 (9.5) for the Activator group and 51.8 (10.3) for the Meric group.

INTERVENTION:

The subjects received either a single Meric or Activator adjustment to the posterior joints involved.

MAIN OUTCOME MEASURES:

Before and immediately after the adjustments, subjects rated their pain intensity on a visual analog pain scale.

RESULTS:

The mean reduction in pain for the Activator group was means = 22.2, SD = 21.7; for the Meric group means = 21.8, SD = 21.5. The results indicate that there is no significant difference between Meric and Activator adjustments in reducing acute LBP (F = .005, df = 2, 27, p = .941).

CONCLUSION:

This study demonstrated no advantage of one procedure over the other for the reduction of pain.


J Manipulative Physiol Ther. 1995 Sep;18(7):453-6. [PMID:8568427]

Author information: Gemmell HA, Jacobson BH. Department of Health, Physical Education and Recreation, Oklahoma State University, USA.

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Abstract:

The objective of this article is to describe  several cases (n = 3) in which patients with plantar fasciitis,  associated with heel spurs, were successfully treated via chiropractic  adjustments, emphasizing the correction of posterior calcaneal  subluxation.

This particular group of patients presented with heel pain  varying from 2 months to over 4 years in duration. Radiological  confirmation of heel spur was evident in each case. Previously  unsuccessful treatment regimens included oral anti-inflammatants,  steroid injections, orthotics, and sustaining physical therapy. Two of  the patients had been deemed candidates for surgical removal of the  spurs but had declined to pursue that option, electing instead to use  chiropractic care and conservative management in an effort to resolve  the condition.

All patients were treated with short-lever mechanical force,  manually assisted chiropractic adjusting procedures, with special  emphasis to the foot, ankle, and calcaneus. Although the specific nature  of the relevant subluxations varied with each patient, a common  denominator with this particular patient population group was the  occurrence of a posterior subluxation of the calcaneus. All adjustments  were delivered via the use of an Activator Adjusting Instrument and were  comfortably tolerated by each patient. Said treatment resulted in a  complete resolution of all symptoms in this studied group of patients,  with no recurrence being demonstrated over a protracted follow-up period  of time.

The conservative management of heel spur syndrome may be  effectively implemented through the use of specific chiropractic  adjusting procedures in selected patients presenting with this  particular problem Attention to the possibility of posterior subluxation  of the calcaneus should be emphasized during the chiropractic  examination process. Although other pedal subluxations can be involved  as well, the posterior calcaneus is often a common denominator in the  subluxation complex associated with this condition. The use of a  mechanical force, manually assisted short-lever adjusting technique,  such as with an Activator Adjusting Instrument, can provide effective  delivery of the chiropractic treatment. Further study, involving larger  patient populations, should be provided to more thoroughly investigate  this treatment on a wider scale.


Chiropr Sports Med 1995b; 9(2):44-51.

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

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Abstract

Patients often present themselves for  chiropractic treatment with conditions that may include  contraindications for manipulative therapy. This report describes  successful chiropractic treatment of acute shoulder pain involving a  patient who presented with mixed metastatic carcinoma affecting the  humerus, scapula, and clavicle using an Activator Adjusting Instrument.

The successful outcome of the case demonstrates the possible value of  instrumental chiropractic adjustment in treating neuromusculoskeletal  cases where a forceful, high-velocity adjustment or manipulation would  be contraindicated because of the underlying osseous pathology involved.  Further study into this possibility should be provided to help train  those physicians who are called upon to treat these cases and to help  further define risk management protocols for the chiropractic  profession.


Chiropr Tech 1995; 7(3):98-102.

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

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