Atlantoaxial Subluxation Caused by Spinal Manipulation: A case report

A 29 years old woman had suffered from posterior neck and right shoulder pain for one year. She was given a spinal manipulation that was by a non-licentiate at a non-hospital. Posterior neck and shoulder pains were worsened and headache was developed after the spinal manipulation. She was recommended to be kept on the manipulation. Although physical finding was non-specific, radiologic findings of CT and MRI revealed atlantoaxial subluxation. After cervical immobilization and anti-inflammatory drug medication for three months, she recovered and did return to her work. We expect that atlantoaxial subluxation after spinal manipulation is not rare even in healthy young person without underlying pathology and can progress to serious complications unless detailed examination and management are undertaken.

The Effect of Passive Stretching on the Spasticity of Ankle Plantar Flexor Muscles

OBJECTIVE: This study was designed to evaluate the effect of stretching on decreasing spasticity of ankle plantar flexor muscles by biomechanical assessments. METHOD: Twenty two ankle joints of nineteen patients with upper motor neuron lesion were included. The spasticity was assessed both clinically and biomechanically before and after stretching of ankle plantar flexor muscles by tilt table. For clinical assessment modified Ashworth scale (MAS) was used. For biomechanical assessment, ankle plantar flexor muscles were stretched isokinetically while EMG signals were recorded simultaneously and peak eccentric torque, stiffness index and stretch reflex threthold speed (SRTS) were measured. RESULTS: Two cases showed improvement in MAS after stretching but the others did not. SRTS of ankle plantar flexor was increased significantly while peak eccentric torque and stiffness index were unchanged. CONCLUSION: Passive stretching of ankle plantar flexor muscles decreased the stretch threshold, that is a neural component of spasticity but it did not decrease the mechanical component of spasticity.

The Quantitative Assessment of Ankle Plantar Flexor Muscle Tone

OBJECTIVE: We designed this study to evaluate muscle tone by using a biomechanical method and to provide data for the future studies about muscle tone. METHOD: We evaluated 29 subjects without known neuromuscalar diseases using the biomechanical method. Both plantar flexors of each subject were passively stretched by isokinetic dynamometer from 30degrees plantar flexion position to 10degrees dorsiflexion position. Peak eccentric torque (PET) and torque threshold angle (TTA) were calculated at angular velocity of 10degrees/sec, 90degrees/sec and 300degrees/sec. Regression lines from torque/position curve at 10degrees/sec and 300degrees/sec were considered an intrinsic stiffness index (ISI) and total stiffness index (TSI). Stretch reflex threshold speed (SRTS) was defined as the minimum speed of plantar flexion movement in which EMG reflex activity in plantar flexor muscles is induced. RESULTS: The mean of TTA was higher in 10o/sec than in 300degrees/sec. The means of ISI and TSI were 0.11+/-0.08, and 0.18+/-0.04. The mean of SRTS was 125.2+/-48.3degrees. No statistical difference in each parameter was found according to the side or gender. CONCLUSION: ISI, TSI, PET, TTA and SRTS using a biomechanical method are thought to be useful parameters for the quantitative assessment of muscle tone change of ankle plantar flexors.