Archive for category Research

Abstract

OBJECTIVE:

To describe a novel orthopedic test (Polk’s test) which can assist the clinician in differentiating between me- dial and lateral epicondylitis, 2 of the most common causes of elbow pain. This test has not been previously described in the literature.

CLINICAL FEATURES:

The testing procedure described in this paper is easy to learn, simple to perform and may provide the clinician with a quick and effective method of differentiating between lateral and medial epicondylitis. The test also helps to elucidate normal activities of daily living that the patient may unknowingly be performing on a repetitive basis that are hindering recovery. The results of this simple test allow the clinician to make immediate lifestyle recommendations to the patient that should improve and hasten the response to subsequent treatment. It may be used in conjunction with other orthopedic testing procedures, as it correlates well with other clinical tests for assessing epicondylitis.

CONCLUSION:

The use of Polk’s Test may help the clinician to diagnostically differentiate between lateral and medial epicondylitis, as well as supply information relative to choosing proper instructions for the patient to follow as part of their treatment program. Further research, performed in an academic setting, should prove helpful in more thoroughly evaluating the merits of this test. In the meantime, clinical experience over the years suggests that the practicing physician should find a great deal of clinical utility in utilizing this simple, yet effective, diagnostic procedure.


J Chiropr Med. 2002 Summer;1(3):117-21. [PMID:19674572]

Author information: Polkinghorn BS. Private Practice of Chiropractic, Santa Monica, CA.


Free PMC Article

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Abstract

OBJECTIVE:

To develop a mathematical model capable of describing the static and dynamic motion response of the lumbar spine to posteroanterior forces.

DESIGN:

Static, impulsive and oscillatory forces with varying thrust angles and offsets were applied to the model, and the resulting motion responses were compared to experimental data published for spinal mobilization and manipulation of prone-lying subjects.

BACKGROUND:

Methods are sought to improve understanding of the dynamic force-induced displacement response of the lumbar spine during spinal mobilization and manipulation treatment.

METHODS:

The thorax, pelvis and five lumbar vertebrae were represented as seven rigid structures and eight flexible joint structures. Flexible joint structures were modeled using spring and damper elements with three displacement degrees-of-freedom (posterior-anterior and axial displacement, and flexion-extension rotation). The resulting 21 degrees-of-freedom lumped parameter model was solved in modal space.

RESULTS:

The fundamental natural frequency of vibration was 5.24 Hz. Simulations performed using 100 N static and dynamic posteroanterior forces applied to the L3 vertebrae indicated that peak L3 segmental displacements were up to 2.40 mm (impulsive) and 8.23 mm (oscillatory at 2 Hz). Appreciable axial displacements (0.41 mm) and flexion-extension rotations (1.49 degrees ) were also observed for oscillatory forces at L3. The posteroanterior motion response of the lumbar vertebrae was relatively insensitive to both the thrust force angle and thrust force offset, but axial displacements and flexion-extension rotations showed a large change (2-fold or greater) for thrust angles greater than -5 degrees (caudal) in comparison to vertical thrusts. Intersegmental motion responses for static, impulsive and oscillatory loads were more comparable than their segmental counterparts.

CONCLUSIONS:

The model predicts lumbar segmental and inter-segmental motion responses to manipulative forces that are otherwise difficult to obtain experimentally.

RELEVANCE:

This study assists clinicians to understand the biomechanics of posteroanterior forces applied to the lumbar spine of prone-lying subjects. Of particular clinical relevance is the finding that greater spinal mobility is possible by targeting specific load-time histories.


Clin Biomech (Bristol, Avon). 2002 Mar;17(3):185-96. [PMID:11937256]

Author information: Keller TS, Colloca CJ, Béliveau JG. Department of Mechanical Engineering, University of Vermont, 119C Votey Building, Burlington VT 05405-0156, 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

STUDY DESIGN:

Twenty asymptomatic volunteers each received three spinal manipulative treatments to the thoracic spine. The treatments consisted of a straight posterior-to-anterior high-speed, low-amplitude thrust to the transverse process of T3-T10 using a reinforced hypothenar contact. All treatments were given by a full-time practicing clinician with 3 years of experience.

OBJECTIVES:

The primary objective of this study was to quantify local measures of loading applied by the clinician on the volunteers during spinal manipulative treatments and to compare these local measures of loading with previously described global measures.

SUMMARY AND BACKGROUND DATA:

The sparse information on the mechanics of spinal manipulative treatments deals exclusively with global force or pressure measurements. On the basis of these global data, incorrect conclusions may be drawn about the beneficial effects of spinal manipulative therapy, the loading of internal structures, and the risks associated with these treatments.

METHODS:

Twenty asymptomatic subjects each received three posterior-to-anterior, high-speed, low-amplitude spinal manipulative treatments to the transverse process of the thoracic spine. Total force, local force, contact area, peak pressure, and average pressure at the contact interface between clinician and subject were measured continuously by use of a thin, flexible pressure pad. Local and global measures of loading were compared and analyzed by use of nonparametric statistics (alpha = 0.01).

RESULTS:

The average peak total force was 238.2 N. The average peak local force over a target area of 25 mm2 was 5 N, indicating that global measures of loading vastly overestimate the local effective forces at the target site. The peak pressure point moved, on average, 9.8 mm during the course of the manipulation.

CONCLUSIONS:

To the authors’ best knowledge, this is the first study to quantify local, effective measures of loading and compare them with the global measures typically used. The conclusions are limited because the study used a single clinician. The effective loading of specific target sites is much smaller than the global measures might suggest. This result occurs because as the forces during spinal manipulative treatment increase, so does the contact area; therefore, much of the total treatment force is taken up by non-target-specific tissues. Because of the vast discrepancy between the global and local measures of loading, it is suggested that risk-benefit assessments of high-speed, low-amplitude spinal manipulative treatments should be made, including local measures of loading. Finally, because theoretical approaches and the inverse dynamics approach can provide only global measures of loading, the results of such studies should be interpreted with caution.


Spine (Phila Pa 1976). 2001 Oct 1;26(19):2105-10. [PMID:11698887]

Author information: Herzog W, Kats M, Symons B. Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada.

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Abstract

BACKGROUND:

Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants in discriminating between patients who are asymptomatic and those who have low back pain. However, little objective evidence is available concerning variations in PA stiffness and their clinical significance. Moreover, although several studies have assessed only load input in relation to stiffness, a more complete assessment based on dynamic stiffness measurements (force/velocity) and concomitant neuromuscular response may offer more information concerning mechanical properties of the low back.

OBJECTIVE:

To determine the stiffness and neuromuscular characteristics of the symptomatic low back.

STUDY DESIGN:

This study is a prospective clinical study investigating the in vivo mechanical and muscular behavior of human lumbar spinal segments to high loading rate PA manipulative thrusts in research subjects with low back pain (LBP).

METHODS:

Twelve men and 10 women, aged 15 to 73 years (mean age of 42.8 +/- 17.5 years) underwent physical examination and completed outcome assessment instruments, including Visual Analog Scale, Oswestry Low Back Disability Index, and SF-36 health status questionnaires. Clinical categorization was made on the basis of symptom frequency and LBP history. A hand-held spinal manipulation device, equipped with a preload control frame and impedance head, was used to deliver high-rate (<0.1 millisecond) PA manipulative thrusts (190 N) to several common spinal landmarks, including the ilium, sacral base, and L5, L4, L2, T12, and T8 spinous and transverse processes. Surface, linear-enveloped, electromyographic (sEMG) recordings were obtained from electrodes (8 leads) located over the L3 and L5 paraspinal musculature to monitor the bilateral neuromuscular activity of the erector spinae group during the PA thrusts. Maximal-effort isometric trunk extensions were performed by the research subjects before and immediately after the testing protocol to normalize sEMG data. The accelerance or stiffness index (peak acceleration/peak force, kg-1) and composite sEMG neuromuscular reflex response were calculated for each of the thrusts.

RESULTS:

Posteroanterior stiffness obtained at the sacroiliac joints, transverse processes, or spinous processes was not different for subjects grouped according to LBP chronicity. However, in those with frequent or constant LBP symptoms, there was a significantly increased spinous process (SP) stiffness index (7.0 kg-1) (P <.05) in comparison with SP stiffness index (6.5 kg-1) of subjects with only occasional or no LBP symptoms. Subjects with frequent or constant LBP symptoms also reported significantly greater scores on the visual analog scale (P =.001), Oswestry (P =.001), and perceived health status (P =.03) assessments. The average SP stiffness index was 6.6% greater (P <.05) and 19.1% greater (P <.001) than the average sacroiliac stiffness index and average transverse process stiffness index, respectively.

CONCLUSIONS:

This study is the first to assess erector spinae neuromuscular reflex responses simultaneously during spinal stiffness examination. This study demonstrated increased spinal stiffness index and positive neuromuscular reflex responses in subjects with frequent or constant LBP as compared with those reporting intermittent or no LBP.


J Manipulative Physiol Ther. 2001 Oct;24(8):489-500. [PMID:11677547]

Author information: Colloca CJ, Keller TS.Postdoctoral and Related Professional Education Department, Logan College of Chiropractic, St. Louis, MO, USA.

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Abstract

OBJECTIVE:

To rate specific chiropractic technique procedures used in the treatment of common low back conditions.

DESIGN AND METHODS:

A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process.

RESULTS:

For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain.

CONCLUSIONS:

The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.


J Manipulative Physiol Ther. 2001 Sep;24(7):449-56. [PMID:11562653]

Author information: Gatterman MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ.

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Abstract

STUDY DESIGN:

The diagnostic performance of a newly described  variable was assessed in an in vivo model of disc degeneration using a  split-pair experimental design.

OBJECTIVE:

To determine if vertebral displacement measures  generated from ultrasonic indentation could distinguish between  experimental and control groups of animals.

SUMMARY OF BACKGROUND DATA:

Few procedures are available that  noninvasively assess subcutaneous vertebral mechanics. Information from  such a procedure would be of value in determining potential clinical  relevance of spinal mechanics with respect to low back pain.

METHODS:

Eight adolescent pigs underwent endplate perforation  surgery to initiate lumbar disc degeneration. After 4 months of  recovery, these and eight age-matched controls were assessed by  ultrasonic indentation, a noninvasive procedure that quantifies  vertebral displacements in the plane of loading-indentation. Each animal  then received a facetectomy and was reindented at the same location as  confirmed by ultrasonic imaging. Discal materials were removed  postmortem for analysis.

RESULTS:

Degenerative discs exhibited morphologic changes  consistent with early degenerative disc disease. Prefacetectomy  comparison of vertebral displacement measures between control and  experimental animals resulted in sensitivity, specificity, and  diagnostic accuracy values of 75.0%, 83.3%, and 77%, respectively. After  facetectomy these values increased to 87.5%, 83.3%, and 85%,  respectively. These measures of diagnostic performance were comparable  or superior to those of existing clinical techniques (invasive or  otherwise) used to assess degenerative conditions of the spine.

CONCLUSIONS:

The results of this study suggest that noninvasive  measures of vertebral displacement are clinically significant and  possess the additional advantages of being objective and noninvasive.


Spine (Phila Pa 1976). 2001 Jun 15;26(12):1348-55. [PMID:11426151]

Author information: Kawchuk GN, Kaigle AM, Holm SH, Rod Fauvel O, Ekström L, Hansson T. Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.

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The authors suggest Activator Methods care as a natural way to treat fibromyalgia and chronic myofascial pain.

Synopsis

The symptoms include chronic, widespread musculoskeletal pain,  accompanied by multiple tender or trigger points, painful or restricted  movement, and persistent fatigue. For an estimated 26 million Americans,  the underlying condition is fibromyalgia syndrome (FMS) or myofascial  pain syndrome (MPS) or both, in the form of FMS/MPS Complex.

Despite the widespread occurrence of .these conditions, the  average FMS or MPS patient suffers for five years and spends thousands  of dollars on medical bills before receiving an accurate diagnosis. And,  even then, effective treatment may still prove elusive, as few doctors  are trained to understand or respond to these conditions.

Fibromyalgia & Chronic Myofascial Pain Syndrome offers the  first comprehensive patient guide for managing these conditions. You’ll  start by learning what FMS and MPS are, evaluating your own symptoms,  and identifying the tender and/or trigger points that are crucial for  treating them. The manual covers chronic pain, sleep problems, and other  “Internal affairs,” shows you how you can use your mind to counteract  physical symptoms and the numbing effects of “fibrofog,” and provides an  extensive set of healing tools-including information on the latest  medications, a nutritional program, and tips for using bodywork and  other less commonly known treatments. Its comprehensive survival  strategies include suggestions for coping with family and work  situations, getting support, and dealing with the health care system.


Reference: Devin J. Starlanyl, M.D.; Mary Ellen  Copeland, M.S., M.A.; Fibromyalgia & Chronic Myofascial Pain  Syndrome – A SURVIVAL MANUAL; New Harbinger Publications, Inc pages 144,  244-246

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Abstract

In a previous article, the author discussed current trends in utilization rates of chiropractic “Name Techniques” in Canada, and provided recommendations for their inclusion into the curriculum at the Canadian Memorial Chiropractic College. In this article, a review of the literature on “Name Techniques” was conducted, with interpretation and synthesis by the author. One hundred and eleven articles were found. These were: technique discussions (N = 39), case studies (N = 25), case series (N = 5), experimental studies (N = 25) and clinical trials (N = 17). The literature suggested that prone leg length testing and some x-ray mensurations may have acceptable inter and intra-rater reliability. In addition, there are several case studies that reported significant clinical benefits by patients receiving Activator, Alexander, and Upper Cervical treatments. Patients also reported improvements in quality of life while under either Upper Cervical or Network Spinal Analysis care. This information may help develop professional practice guidelines, and it may have implications for chiropractic research and education.

J Can Chiropr Assoc. 2001 Jun; 45(2): 86–99. [PMCID: PMC2505043]

Author information: Brian J. Gleberzon. Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, Canada M4G 3E6.


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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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