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Dynamic Chiropractic – June 3, 2008, Vol. 26, Issue 12

JMPT Abstracts for March/April 2008 Volume 31 - Issue 3

The JMPT is the premiere scientific journal of the chiropractic profession, dedicated to the advancement of chiropractic health care. ACA general members receive the JMPT as a membership benefit, as the ACA recognizes the JMPT as its official scientific peer-reviewed journal.

The National University of Health Sciences, owner of the journal, upholds the journal's compliance with the highest publication standards, which expressly support editorial freedom and best publication practices. The JMPT is an independent publication that strives to provide the best scientific information that improves health care practice and future research.

Predictors for Immediate and Global Responses to Chiropractic Manipulation of the Cervical Spine
Haymo W. Thiel, DC, PhD, Jennifer E. Bolton, PhD

Objective: Patients with nonspecific musculoskeletal disorders may vary in their response to treatment. This study set out to identify the predictors for either improvement or worsening in symptoms for which cervical spine manipulation is indicated.

Method: A large prospective study recorded details on patients, their presenting symptoms, and type of treatment. At the end of the consultation, any immediate improvement or worsening in presenting symptoms was noted. At the follow-up visit, information was collected on the patients' self-reported improvement.

Results: Data were collected from 28,807 treatment consultations (19,722 patients) and 13,873 follow-up treatments. The presenting symptoms of "neck pain," "shoulder, arm pain," "reduced neck, shoulder, arm movement, stiffness," "headache," "upper, mid back pain," and "none or one presenting symptom" emerged in the final model as significant predictors for an immediate improvement. The presence of any four of these predictors raised the probability for an immediate improvement in presenting symptoms after treatment from 70% to ~95%. With regard to immediate worsening, "neck pain," "shoulder, arm pain, "headache," "numbness, tingling upper limbs," "upper, mid back pain," and "fainting, dizziness, light-headedness" emerged as predictors; and the presence of any four of these raised the probability for immediate worsening from 4.4% to ~12%. For global improvement, only two predictors were identified; but these did not enhance the postprediction probability.

Conclusions: This study is the first attempt to identify variables that can predict immediate outcomes in terms of improvement and worsening of presenting symptoms, and global improvement, after cervical spine manipulation. The predictor variables were strongest for immediate improvement.

Postural Control in People With Osteoarthritis of the Cervical Spine
Pierre Boucher, DC, PhD Martin Descarreaux, DC, PhD, Martin C. Normand, DC, PhD

Objective: This study examines whether there is a relationship between clinical correlates of osteoarthritic changes of the cervical spine and changes in postural stability.

Methods: This was a control group study with repeated measures. Twenty-three patients were recruited from a chiropractic university clinic to participate in this study. The presence and severity of osteoarthritic changes of the cervical spine were determined radiologically. Balance control was evaluated by testing subjects' postural stability on a force platform with and without vision. A general clinical assessment of the neuromusculoskeletal system was performed to screen for any physical condition that could affect postural stability. Participants' characteristics were compared between each group using a one-way analysis of variance for independent samples, and postural stability variables were submitted to a two-way repeated measures analysis of variance.

Results: Subjects with signs of osteoarthritis of the cervical spine showed an increased range of sway, a faster sway speed, and a greater excursion than control subjects. They also showed a larger degree of lower limb neuropathy than control subjects.

Conclusion: The postural instability shown by the osteoarthritic group may be due to the effects of the lower limb peripheral neuropathy alone or due to a combination of both cervical degenerative changes and peripheral changes. Further research is needed to clearly isolate the effects of the degeneration of the cervical spine on postural control.

Comparison of Three Physical Therapy Modalities for Acute Pain in Lumbar Disc Herniation Measured by Clinical Evaluation and Magnetic Resonance Imaging
Zeliha Unlu, MD, Saliha Tasci, MD, Serdar Tarhan, MD, Yuksel Pabuscu, MD, Serap Islak, MD

Objective: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH).

Methods: A total of 60 patients were enrolled in this study and randomly assigned into one of three groups equally according to the therapies applied, either with traction, ultrasound or LPL. Treatment consisted of 15 sessions over a period of three weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at one and three months after treatment.

Results: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the three treatment groups at any of the four interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups.

Conclusions: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

The Refractory Period of the Audible "Crack" After Lumbar Manipulation: A Preliminary Study
David E. Bereznick, DC, PhD, Cosma G. Pecora, DC, J. Kim Ross, DC, PhD, Stuart M. McGill, PhD

Objective: This study evaluates if side-posture lumbar manipulation is associated with a refractory period of the audible "crack" and if so, to quantify this refractory period across subjects.

Methods: Three subjects were exposed to multiple "baseline" side-posture manipulations until no further audible cracks were recorded. "Test-refractory period" manipulations were administered after a set time (i.e., potential refractory period), at which point the number of audible cracks was recorded. The refractory period was declared when a minimum of 50% of the baseline audible "cracks" had recovered during the test manipulations. The study design included two clinicians who performed side-posture lumbar manipulation on asymptomatic subjects ranging from 38 to 49 years of age.

Results: The refractory period was 40 minutes for subject A, 70 minutes for subject B and 95 minutes for subject C. The average refractory period across subjects was 68.33 minutes. The audible "crack" recovery was maintained for the remaining test days once the refractory period had been met.

Conclusions: The audible "crack" heard during side-posture lumbar manipulation is believed to originate from the zygapophyseal joints. This is supported by the presence of a refractory period and by the number of audible "cracks" found per manipulation.

Induced Static Asymmetry of the Pelvis Is Associated With Functional Asymmetry of the Lumbo-Pelvo-Hip Complex
Rafal Gnat, PhD, Edward Saulicz, PhD

Objective: This study evaluates the hypothesis that triggering and eliminating induced static pelvic asymmetry (SPA) may be followed by immediate change in functional asymmetry of the lumbo-pelvo-hip complex.

Methods: Repeated measures experimental design with two levels of independent variable, that is, induced SPA triggered and induced SPA eliminated, was implemented. Three series of measurements were performed, that is, baseline, after triggering SPA, and after eliminating SPA. A group of 84 subjects with no initial symptoms of SPA was studied. Different forms of mechanical stimulation were applied aiming to induce SPA, and the two manual stretching-manipulating techniques were performed aiming to eliminate it. A hand inclinometer was used to measure SPA in standing posture. Selected ranges of motion of the hip joints and lumbar spine were used to depict functional asymmetry of the lumbo-pelvo-hip complex. The functional asymmetry indices for individual movements were calculated. Repeated measures design of analysis of variance, dependent data Student t test, and linear Pearson's correlation test were used.

Results: Assessment of the SPA showed its significant increase between baseline and series 2 measurements, with a subsequent significant decrease between series 2 and series 3 measurements. Values of the functional asymmetry indices changed accordingly, that is, they increased significantly between series 1 and series 2 and had returned to their initial level in series 3 measurements.

Conclusions: Induced SPA shows considerable association with functional asymmetry of the lumbo-pelvo-hip complex.

Principal Components Analysis of the Atlas Vertebra
Christopher A. Meseke, PhD, Stephen M. Duray, PhD, Sebastien R. Brillon, DC, MS

Objective: This project explored morphological asymmetry of the atlas by comparing multiple structural variables bilaterally using multivariate statistics.

Methods: Two hundred thirty-seven atlases were obtained from the Hamann-Todd Osteological Collection (Cleveland Museum of Natural History, Cleveland, Ohio). The following dimensions were bilaterally measured: anteroposterior length of the superior articular facet, width of the superior articular facet, length of the transverse process, width of the vertebral canal, anteroposterior diameter of the inferior facet, height of the lateral mass, transverse diameter of the inferior articular facet, width of the inferior lateral mass, slope of the inferior facet, convergence angle of the superior facet, circumference of the inferior articular facet, and circumference of the superior articular facet. Principal components analysis (varimax rotation) was used to determine sources of variation within the dataset. Multivariate analysis of variance and paired t tests were used to identify statistical differences between right and left sides for each variable.

Results: More than 99% of variance was accounted for across 11 eigenvectors, with most eigenvectors dominated by a single variable. Bilateral comparison of variables showed a significant difference between sides for the anteroposterior length of the superior facet, the width of the superior facet, the width of the vertebral canal, anteroposterior diameter of the inferior facet, and convergence angle of the superior facet (all significant at P < .05).

Conclusion: Based on statistical analysis of the atlantal variables, vertebral canal width and the morphology of the superior and inferior articular facets showed significant asymmetry. The role of these asymmetries related to the biomechanics of the C0 through C1 and encroachment on the spinal cord warrant further investigation.

Effects of Myofascial Release After High-Intensity Exercise: A Randomized Clinical Trial
Manuel Arroyo-Morales, PT, MD, PhD, Nicolas Olea, MD, PhD, Manuel Martinez, PhD, Carmen Moreno-Lorenzo, PT, MD, PhD, Lourdes Daz-Rodrguez, PhDAmparo Hidalgo-Lozano, PT

Objective: The usefulness of massage as a recovery method after high-intensity exercise has yet to be established. We aimed to investigate the effects of whole-body massage on heart rate variability (HRV) and blood pressure (BP) after repeated high-intensity cycling exercise under controlled and standardized pretest conditions.

Methods: The study included 62 healthy active individuals. After baseline measurements, the subjects performed standardized warm-up exercises followed by three 30-second Wingate tests. After completing the exercise protocol, the subjects were randomly assigned to a massage (myofascial release) or placebo (sham treatment with disconnected ultrasound and magnetotherapy equipment) group for a 40-minute recovery period. Holter recording and BP measurements were taken after exercise protocol and after the intervention.

Results: After the exercise protocol, both groups showed a significant decrease in normal-to-normal interval, HRV index, diastolic BP (P > .001), and low-frequency domain values (P = .006). After the recovery period, HRV index (P = .42) and high-frequency (HF) (P = .94) values were similar to baseline levels in the massage group, whereas the HRV index tended (P = .05) to be lower and the HF was significantly (P < .01) lower vs. baseline values in the placebo group, which also showed a tendency (P = .06) for HF to be lower than after the exercise. Likewise, diastolic BP returned to baseline levels in the massage group (P = .45) but remained lower in the placebo group (P = .02).

Conclusion: Myofascial release massage favors the recovery of HRV and diastolic BP after high-intensity exercise (three Wingate tests) to pre-exercise levels.

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