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Article in English | WPRIM | ID: wpr-922530


Spinal manipulation is a manual treatment technique that delivers a thrust, using specific biomechanical parameters to exert its therapeutic effects. These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy. So far, however, there has not been a unified approach to standardize these biomechanical characteristics. In fact, it is still undetermined how they affect the observed clinical outcomes of spinal manipulation. This study, therefore, reviewed the current body of literature to explore these dosage parameters and evaluate their significance, with respect to physiological and clinical outcomes. From the experimental studies reviewed herein, it is evident that the modulation of manipulation's biomechanical parameters elicits transient physiological responses, including changes in neuronal activity, electromyographic responses, spinal stiffness, muscle spindle responses, paraspinal muscle activity, vertebral displacement, and segmental and intersegmental acceleration responses. However, to date, there have been few clinical trials that tested the therapeutic relevance of these changes. In addition, there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust. Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.

Animals , Humans , Manipulation, Spinal
Revista brasileira de ciência e movimento ; 29(1): [1-15], nov. 2021. tab, ilus
Article in Portuguese | LILACS | ID: biblio-1348199


: A cervicobraquialgia (CB) é caracterizada por uma dor com origem em diferentes níveis estruturais da coluna cervical baixa (C3- C7), com irradiação bilateral ou unilateral para o membro superior. Considerando as causas e consequências advindas da CB, novas modalidades de tratamento têm sido propostas na tentativa de promover intervenções efetivas. Entre os procedimentos fisioterapêuticos encontram-se as técnicas de terapia manual como liberação miofascial, quiropraxia, mobilização articular, estabilização segmentar e a mobilização neural (MN) que procura restabelecer a função do tecido neural, sua condução elétrica, elasticidade, movimento e fluxo axoplasmático. Sendo assim, o objetivo do estudo foi avaliar sistematicamente as evidências sobre o efeito da MN no tratamento da dor em indivíduos com CB. A busca bibliográfica foi realizada no período entre Novembro de 2018 a Junho de 2019, sem limite de ano de publicação, nas bases de dados: PEDro, PubMed, Biblioteca Virtual em Saúde (Lilacs, Scielo e Medline) e Cochrane Library. A análise foi restrita aos ensaios clínicos randomizados. Para a análise etodológica dos artigos aptos a inclusão, foi utilizada a escala PEDro. Foi encontrado um total de 38 artigos. Após remoção de duplicatas, 14 artigos foram elegidos por resumo, 8 artigos foram recuperados para leitura completa e analisados quanto a sua adequação, dos quais 3 foram excluídos por não cumprirem os critérios de elegibilidade, ao fim 5 artigos foram incluídos na revisão. Houve redução significativa da dor, em pacientes tratados com MN. Considerando os resultados obtidos nesta revisão, foi possível concluir que a MN demonstra ser eficaz na redução da dor presente na CB. Embora os estudos mostrem que os resultados da MN como tratamento da CB são significativamente inferiores ao efeito do Ibuprofeno, deve-se ter em consideração as consequências a longo prazo para a saúde sobre a utilização de anti- inflamatórios orais.(AU)

Cervicobrachialgia (CB) is characterized by pain originating from different structural levels of the lower cervical spine (C3-C7), w ith bilateral or unilateral irradiation to the upper limb. Considering the causes and consequences of CB, new treatment modalities have been proposed in an attempt to promote effective interventions. Among the physical therapy procedures are manual therapy techniques such as myofascial release, chiropractic, joint mobilization, segmental stabilization and neural mobilization (NM) that seeks to restore the function of neural tissue, its electrical conduction, elasticity, movement and ax oplasmic flow . Thus, the objective of the study w as to evaluate systematically evaluate the evidence on the effect of NM on pain management in individuals w ith CB. The bibliographic search w as performed from November 2018 to June 2019, w ithout limit of year of publication, in the databases: PEDro, PubMed, Virtual Health Library (Lilacs, Scielo and Medline) and Cochrane Library. The analysis w as restricted to randomized controlled trials. For the methodological analysis of the articles eligible for inc lusion, the PEDro scale w as used. A total of 38 articles w ere found. After removal of duplicates, 14 articles w ere elected by abstract, 8 articles w ere retrieved for full reading and analyzed for suitability, of w hich 3 w ere excluded for not meeting eligibility c riteria, at the end 5 articles w ere included in the review . There was a significant pain reduction in patients treated w ith NM. Considering the results obtained in this review , it w as concluded that NM demonstrates to be effective in reducing pain present in CB. Although studies show that the results of NM as a treatment for CB are significantly low er than the effect of ibuprofen, consideration should be given to the long-term health consequences about the utilization of oral anti-inflammatory drugs.(AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Pain , Pain Management , Neural Conduction , Neuralgia , Physical Education and Training , Chiropractic , Physical Therapy Modalities , Manipulation, Spinal , Heat Conduction , Musculoskeletal Manipulations , Upper Extremity , Elasticity , Joints
Article in Chinese | WPRIM | ID: wpr-879411


OBJECTIVE@#To observe the clinical effect of lever positioning manipulation for the treatment of lumbar disc herniation and its effect on Cobb angle.@*METHODS@#From December 2017 to November 2018, 67 patients with lumbar disc herniation were included in the study. The patients were randomly divided into treatment group and control group by digital table method. There were 34 cases in the treatment group, including 20 males and 14 females, with an average age of (36.09±8.26) years old and a course of (13.79±15.50) months. Treatment group was treated with lever positioning manipulation. There were 33 cases in the control group, including 18 males and 15 females, with an average age of(36.48±7.81) years old and a course of (12.82±15.68) months. Control group was treated with lumbar slanting manipulation. Two groups were treated 3 times a week, once every other day, 6 times for a course of treatment, after 2 courses of treatment, the changes of Cobb angle before and after treatment were compared between two groups by imaging. The symptoms and signs were scored with reference to clinical evaluation standard;overall efficacy was evaluated with reference to "Diagnostic Efficacy Criteria of Traditional Chinese Medicine Syndrome" issued by the State Administration of Traditional Chinese Medicine for lumbar disc herniation.@*RESULTS@#One patient in each group dropped out. The symptom and sign scores of treatment group and control group before treatment were 18.56± 4.81, 18.61±3.72, while after treatment were 9.41±5.19, 13.55±3.68;treatment group was significantly lower than control group after treatment (@*CONCLUSION@#Both the lever positioning manipulation and the lumbar slanting manipulation methods are effective for the treatment of lumbar disc herniation, but clinical effect of lever positioning method on lumbar disc herniation is more significant, and the effect on Cobb angle is more obvious. It is worthy of promotion.

Adult , Female , Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement/therapy , Lumbar Vertebrae , Male , Manipulation, Spinal , Medicine, Chinese Traditional , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-773831


OBJECTIVE@#To explore the influence of individual characteristics of patients on the kinematics parameters of sitting lumbar spine manipulation.@*METHODS@#From January 2016 to December 2016, 30 patients with degenerative lumbar spondylolisthesis were treatede, including 18 males and 12 females, aged from 45 to 61(52.33±2.34) years old, with a course of 2 to 72(29.13±3.23) months. Motion capture technique was used to measure the kinematics parameters of the same manipulator in sitting lumbar spine manipulation for 30 patients, including rotation time, maximum speed and maximum acceleration. The parameters of the left and right hands of the operator were different. The effects of individual characteristics on the kinematics parameters of sitting lumbar spine manipulation were analyzed.@*RESULTS@#The kinematic and mechanical parameters of manipulation were as follows:spin time, maximum speed, maximum acceleration, the manipulation done by right or left hand showed the similar parameters(>0.05). According to multivariate linear regression, there was a significant correlation between the age of the patient and the rotation time of the operator(<0.01); the height of patient had a significant correlation with the maximum speed and maximum acceleration of the operator(<0.01).@*CONCLUSIONS@#There is no difference between the manipulation of left and right hand in clinical application. Age and height are important influencing factors of sitting lumbar rotation manipulation.

Biomechanical Phenomena , Female , Humans , Lumbar Vertebrae , Male , Manipulation, Spinal , Middle Aged , Range of Motion, Articular , Sitting Position
Article in English | WPRIM | ID: wpr-717706


We describe the case of a patient who had infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. Two weeks ago, he was treated by a chiropractor for intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA; V1/2 junction) as a result of the dissection of the VA. Angiography revealed complete occlusion of the left PICA and arterial dissection was shown in the extracranial portion of the VA. He was treated with antiplatelet therapy. Three weeks later, he was discharged without any sequelae. The possibility of VA dissection should be considered at least once in patients presenting with cerebellar dysfunctions with a recent history of chiropractic cervical manipulation.

Adult , Angiography , Arteries , Brain , Cerebellar Diseases , Cerebral Infarction , Chiropractic , Emergency Service, Hospital , Humans , Infarction , Lateral Medullary Syndrome , Magnetic Resonance Imaging , Manipulation, Chiropractic , Manipulation, Spinal , Neck Pain , Pica , Vertebral Artery , Vertigo
Int. arch. otorhinolaryngol. (Impr.) ; 21(1): 46-57, Jan.-Mar. 2017. tab, graf, ilus
Article in English | LILACS | ID: biblio-840784


Abstract Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3Dtrunk- excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.

Humans , Manipulation, Spinal , Nystagmus, Pathologic , Transcutaneous Electric Nerve Stimulation , Brachiocephalic Trunk/physiology , Electronystagmography
J. appl. oral sci ; 24(3): 188-197, tab, graf
Article in English | LILACS, BBO | ID: lil-787538


ABSTRACT Objective To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison. Subjects Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. Outcome measures Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient. Results Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06). Conclusions The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

Humans , Female , Adult , Young Adult , Temporomandibular Joint Disorders/therapy , Cervical Vertebrae/physiopathology , Manipulation, Spinal/methods , Muscle Stretching Exercises/methods , Patient Positioning/methods , Pressure , Temporal Muscle/physiopathology , Time Factors , Pain Measurement , Facial Pain/physiopathology , Facial Pain/therapy , Temporomandibular Joint Disorders/physiopathology , Surveys and Questionnaires , Analysis of Variance , Treatment Outcome , Pain Threshold , Statistics, Nonparametric , Self Report , Masseter Muscle/physiopathology
Article in Chinese | WPRIM | ID: wpr-304265


<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of three different spinal rotation manipulations for the treatment of lumbar disc herniation.</p><p><b>METHODS</b>From September 2011 to April 2013,180 patients diagnosed as lumbar disc herniation were randomly divided into seat fixed rotation group (A), lateral position rotation group (B) and supine position rotation group (C) by using a digital table. Finally 10 patients were excluded and dropped, 170 patients were included in the study. There were 57 patients in group A, 57 patients in group B and 56 patients in group C. Baseline demographic characteristics of patients, clinical findings and indexes of health status had no statistically differences among three groups (P > 0.05). The manipulation was performed every other day, and the treatment duration for all patients was 3 weeks. Body pain (BP), Physical function (PF) in SF-36, Oswestry Disability Index (ODI) and adverse reactions were observed statistically 6 weeks, 3 months, 6 months, one year and two years after finishing treatment.</p><p><b>RESULTS</b>BP, PF scores in 3 groups were significantly improved and ODI scores were significantly lower than those before treatment and the differences were statistically significant (P < 0.05); However, there was no significant difference among three groups in the BP, PF and ODI scores (P > 0.05). There were no obvious and serious adverse reactions among these groups.</p><p><b>CONCLUSION</b>Based on the theory of dislocation of bone joints in TCM, three kinds of spinal rotation manipulations can be used safely for the treatment of lumbar disc herniation, and the efficacy was similar.</p>

Adolescent , Adult , Case-Control Studies , Female , Humans , Intervertebral Disc Displacement , Therapeutics , Male , Manipulation, Spinal , Methods , Middle Aged , Rotation , Treatment Outcome , Young Adult
Fisioter. pesqui ; 22(1): 54-60, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-744389


Manipulation of the spinal column is a manual therapeutic resource characterized by passive thrust of a given joint at a high velocity and low amplitude within the limits of anatomic integrity. The objective of the present study was to assess the immediate effects of upper thoracic manipulation on skin temperature in the vertebral region in healthy women. Thus, a randomized controlled blind trial was realized in the university community. Twenty-six healthy women were randomly allocated into an experimental group (n=13) and a placebo group (n=13). A single session of upper thoracic spine manipulation (segment T3) was performed. Infrared thermography was used to determine changes in skin temperature in the vertebral region. Images were taken prior to, immediately after and both five and 10 minutes after manipulation. Two-way repeated measures analysis of variance with post hoc Bonferroni test was used for inter and intragroup comparisons. The level of significance was set to 5%. No significant differences were found between the different evaluation times in either group (p>0.05). In the intergroup analysis, no statistically significant differences were found in any of the comparisons (p>0.05). Based on the method employed, thoracic spine manipulation of the T3 vertebral segment does not promote changes in skin surface temperature in the region manipulated in asymptomatic individuals.

A manipulação da coluna vertebral é um recurso da terapia manual caracterizado por um impulso passivo de alta velocidade e baixa amplitude dentro dos limites de integridade anatômica de uma articulação (thrust). O objetivo do presente estudo foi avaliar os efeitos imediatos da manipulação torácica alta sobre a temperatura superficial cutânea da região vertebral em mulheres saudáveis. Para tal, foi realizado um estudo clínico randomizado cego na comunidade universitária. Vinte e seis voluntárias saudáveis foram alocadas de forma randomizada em um grupo experimental (n=13) e um grupo placebo (n=13). Uma sessão de manipulação torácica alta (segmento T3) foi realizada. Foi empregada a termografia infravermelha para determinar alterações na temperatura cutânea na região vertebral. Imagens foram capturadas antes, imediatamente após, cinco e dez minutos após a manipulação. Foi usada análise de variância com medidas repetidas (dois critérios) seguida do teste de Bonferroni para as comparações inter e intragrupos. Adotou-se um nível de significância de 5%. Não foi encontrada diferença significativa nas diferentes avaliações ao longo do tempo (p>0,05). Na análise intergrupos, não foi constatada diferença significativa nas comparações realizadas (p>0,05). Com base na metodologia empregada, a manipulação torácica do segmento vertebral T3 não promoveu alterações na temperatura superficial cutânea na região manipulada.

La manipulación de la espina dorsal es un recurso de terapia manual que se caracteriza por un impulso pasivo de alta velocidad y baja amplitud de los límites de integridad anatómica de una articulación (thrust). Esta investigación tuvo por objetivo evaluar los efectos inmediatos de la alta manipulación torácica de la temperatura superficial de la piel en la región vertebral en mujeres sanas. Para eso, se ha realizado un estudio clínico aleatorizado ciego en la comunidad universitaria. Veintiséis voluntarias han sido puestas de forma aleatorizada en un grupo experimental (n=13) y un grupo placebo (n=13). Ha sido realizada una sesión de manipulación torácica alta (segmento T3). Se ha empleado el término infrarrojo para determinar alteraciones en la temperatura de la piel en la región vertebral. Se han capturado imágenes antes, inmediatamente después, cinco y diez minutos tras la manipulación. Se ha hecho un análisis de los cambios con medidas repetidas (dos criterios) seguido de la prueba de Bonferroni para las comparaciones inter e intragrupal. Se ha adoptado un nivel de significancia de 5%. No ha sido encontrado diferencias significativas en las diferentes evaluaciones al largo del tiempo (p>0,05). En el análisis intergrupal, no ha sido constatado diferencias significativas en las comparaciones realizadas (p>0,05). Basándose en la metodología empleada, la manipulación torácica del segmento vertebral T3 no cambió la temperatura superficial de la piel en la región estudiada.

Humans , Female , Young Adult , Manipulation, Spinal , Skin Temperature , Spine , Thermography/methods , Randomized Controlled Trials as Topic , Single-Blind Method
Article in Chinese | WPRIM | ID: wpr-241005


<p><b>OBJECTIVE</b>To compare clinical effects of spinal leveraging manipulation and medicine for the treatment of degenerative scoliosis in pain and function.</p><p><b>METHODS</b>From July 2010 to June 2013, 38 patients with degenerative scoliosis were randomly divided into spinal leveraging manipulation group and medicine group by coin tossing. In manipulation group, there were 9 males and 11 females aged from 58 to 74 years old with an average of (66.63±7.73), the courses of diseases ranged from 3 to 8 months with an average of (5.65±2.58), spinal leveraging manipulation(following meridian to straighten tendon,relieving spasm, osteopathy and massage, clearing and activating the channels and collaterals) were performed for 30 min, once a day, 4 days for a period treatment, totally 9 courses. In medicine group, there were 8 males and 10 females aged from 57 to 70 years old with an average of (63.51±6.61) the courses of diseases ranged from 3 to 5 months with an average of (4.82±1.43), celecoxib with eperisone hydrochloride were orally taken, 4 days for a period treatment, totally 9 courses. VAS score, Cobb angle and ODI score were measured.</p><p><b>RESULTS</b>After treatment, VAS score in manipulation group was (5.38±0.99), (6.36±1.31) in medicine group,and had significant meaning (t=2.618, P<0.05); there was significant differences in Cobb angle between manipulation group (16.51±4.89)° and medicine group (19.85±5.03) °(t=2.074,P<0.05); and had obviously meaning in ODI score between manipulation group (20.20±2.93) and medicine group (26.01±3.11) (t=5.592, P<0.05).</p><p><b>CONCLUSION</b>Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both side of spine, correct coronal imbalances in spine, recover normal sequence of spine, reduce and remove opperssion and stimulation of nerve root, relieve pain in leg and waist and further improve quality of life.</p>

Aged , Case-Control Studies , Celecoxib , Female , Humans , Lumbar Vertebrae , General Surgery , Male , Manipulation, Spinal , Middle Aged , Propiophenones , Pyrazoles , Scoliosis , Drug Therapy , Therapeutics , Sulfonamides , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-255222


<p><b>OBJECTIVE</b>To investigate the effects of spinal manipulation (SM) on brain functional activity in patients with lumbar disc herniation (LDH).</p><p><b>METHODS</b>Eleven patients with LDH were recruited in the study. All patients received 6 times of lumbar SM treatment and then clinical efficacy was evaluated. All patients received brain functional magnetic resonance imaging (fMRI) scans before and after SM treatment.</p><p><b>RESULTS</b>Three subjects dropped out and 8 subjects completed the study, among whom 4 cases were effective and 4 ineffective after SM treatment. The required pressure value producing the same level (VAS 50) pain was (7.43 ± 1.47) kg and (10.53 ± 0.55) kg before and after SM treatment in effective patients(P<0.05); however, there was no significant difference in ineffective patients (P>0.05). Compared to pre-treatment level, the brain functional activity in effective patients was mainly inhibited, the inhibited areas were located in the right side of prefrontal cortex and cerebellum; while the brain functional activity was generally enhanced in ineffective patients.</p><p><b>CONCLUSION</b>SM can affect the brain functional activity of patients with LDH, the inhibited areas is mainly located in prefrontal cortex and cerebellum when SM treatment is effective.</p>

Brain , Humans , Intervertebral Disc Displacement , Therapeutics , Lumbar Vertebrae , Pathology , Magnetic Resonance Imaging , Manipulation, Spinal
Article in Chinese | WPRIM | ID: wpr-251584


<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of manipulative reduction combined with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF) using meta-analysis method, in order to provide a reference for clinical treatment.</p><p><b>METHODS</b>A systematic computer-based search (from January 1987 to April 2014) from CNKI, Wanfang database, Web of Science and PubMed were performed for the collection of controlled clinical researches on manipulative reduction combined with PVP or PKP in treating OVCF. The quality of selected researches was evaluated. Meta-analysis was adopted to evaluate visual analog scale, Cobb angle, anterior height ratio of the injured vertebra.</p><p><b>RESULTS</b>A total of 7 researches of 410 patients were included in the present analysis, there were 5 RCTs and 2 non-RCTs and all come from China. Manipulative reduction combined with PVP could got better improvement in Cobb angle (WMD=-7.35; 95%CI: -12.15, -2.54) and anterior height ratio of the injured vertebra (P<0.01) than simple PVP, but no significant difference was found in improvement of visual analog scale (WMD=-0.01; 95%CI: -0.45, 0.42). There were no significant differences in the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra between manipulative reduction combined with PKP and simple PKP (P>0.05).</p><p><b>CONCLUSION</b>Compared with simple PVP, manipulative reduction combined with PVP may result in more clinical efficacy on the improvement of Cobb angle and anterior ratio of the injured vertebra. And compared with simple PKP, manipulative reduction combined with PKP has no obvious advantages on the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra. However, the number and quality of the literatures, may resulted in the effect of mistrust, so more large sample and high-quality RCTs are needed in future.</p>

Combined Modality Therapy , Fractures, Compression , Therapeutics , Humans , Manipulation, Spinal , Methods , Minimally Invasive Surgical Procedures , Methods , Osteoporotic Fractures , Therapeutics , Spinal Fractures , Therapeutics
Article in Chinese | WPRIM | ID: wpr-251574


<p><b>OBJECTIVE</b>To investigate clinical effect and safety of bone-setting manipulation in treating isolated systolic hypertension combined with cervical spondylosis.</p><p><b>METHODS</b>From January 2012 to January 2015, 320 patients suffered from isolated systolic hypertension combined with cervical spondylosis were randomly divided into treatment group and control group. In treatment group, there were 160 patients including 84 males and 76 females with an average age of (39.82 ± 10.33) years old, average blood pressure was (149.61 ± 10.75)/(81.01± 8.25) mmHg, NPQ score was 24.61 ± 8.14; treated with flexion top spin and lock bone-setting manipulation of cervical spine, once every two days for 20 days. While in control group, there were 160 patients including 90 males and 70 females with an average age of(41.37 ± 9.42) years old, average blood pressure was (151.48 ± 11.32)/ (79.65 ± 9.32) mmHg, NPQ score was 25.78 ± 9.53; treated with manipulation of reposition cervical spine by rotation, once every two days for 20 days. Blood pressure and NPQ score were tested and compared for evaluating clinical effects.</p><p><b>RESULTS</b>Before and after a period treatment, systolic pressure in treatment group was (149.61 ± 10.75) mmHg and (129.67 ± 12.26) mmHg; (151.48 ± 11.32) mmHg and (132.02 ± 11.73) mmHg in control group. After treatment, systolic pressure in both two groups was obviously decreased, and treatment group was better than control group. Before and after a period treatment, diastolic pressure in treatment group was (80.01 ± 8.25) mmHg and (78.15 ± 10.34) mmHg, (79.65 ± 9.32) mmHg and (76.89 ± 9.79) mmHg in control group, and there was no significant difference between two groups. NPQ score in treatment group was 24.61 ± 8.14 before treatment, 12.46 ± 7.94 after treatment, while in control group was 25.78 ± 9.53, 14.17 ± 8.86; NPQ score of the two groups after treatment was better than before treatment, while there was no obviously significance between two groups after treatment. The whole clinical effect in treatment group was better than control group.</p><p><b>CONCLUSION</b>Bone-setting manipulation for isolated systolic hypertension combined with cervical spondylosis at early stage could receive good clinical result, and flexion top spin and lock bone-setting manipulation of cervical spine was better and safety than manipulation of reposition cervical spine by rotation.</p>

Adult , Case-Control Studies , Cervical Vertebrae , Female , Humans , Hypertension , Therapeutics , Male , Manipulation, Spinal , Methods , Middle Aged , Spondylosis , Therapeutics , Systole
Article in English | WPRIM | ID: wpr-183095


OBJECTIVE: Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors. METHODS: We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group. RESULTS: Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05). CONCLUSION: The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed.

Animals , Constriction, Pathologic , Hematoma , Humans , Incidence , Lordosis , Magnetic Resonance Imaging , Manipulation, Spinal , Radiculopathy , Retrospective Studies , Risk Factors , Spinal Stenosis
Coluna/Columna ; 13(4): 269-274, 12/2014. graf
Article in English | LILACS | ID: lil-732419


Objective: To analyse changes in the range of motion (ROM) and pain after spinal manipulation of the cervical spine and thoracic spine in subjects with mechanical neck pain. Methods : Spinal manipulations were performed in the cervical and thoracic spine with the Gonstead and Diversified DTV techniques. To assess cervical ROM an inclinometer was used. Cervical pain was assessed by Visual Analogue Scale (VAS). The participation of 73 patients was obtained. Ages ranged from 18 to 63 years, with an average of 42.27 years. The subjects of this study were characterized by having mechanical neck pain and restricted cervical ROM. Results: We observed a reduction in the intensity of pain perceived by patients and increased cervical ROM. There were significant differences between pre-treatment values (first visit) and the fifth and tenth visits (p<0.01), and between the fifth and tenth visits (p<0.01) in all parameters except in the cervical extension of 70º. Conclusions: The results of this study suggest that spinal manipulation of the cervical and thoracic regions with the Gonstead and Diversified DTV techniques could subjectively reduce pain and produce considerable increase in cervical ROM in adults with mechanical neck pain. .

Objetivo: Analisar as alterações da amplitude de movimento (ADM) e da dor após manipulação da coluna cervical e dorsal, em indivíduos com cervicalgia mecânica. Métodos: Foram realizadas manipulações na coluna cervical e dorsal com as técnicas Gonstead e Diversificada DTV. Para avaliar a ADM cervical, utilizou-se o instrumento inclinômetro. A dor na coluna cervical foi avaliada por meio da Escala Visual Analógica (EVA). Obteve-se a participação de 73 pacientes. As idades oscilaram entre 18 e 63 anos, com média de 42,27 anos. Os indivíduos do estudo foram caracterizados por apresentar cervicalgia mecânica e restrição da ADM cervical. Resultados: Constatou-se redução da intensidade da dor percebida pelos pacientes e aumento da ADM cervical. Houve diferenças significativas entre os valores pré-tratamento (primeira consulta) e na quinta e décima consultas (p<0,01) e entre a quinta e décima consultas (p<0,01) em todos os parâmetros, exceto na extensão cervical de 70º. Conclusão: Os resultados deste estudo sugerem que a manipulação vertebral da coluna cervical e dorsal com as técnicas Gonstead e Diversificada DTV poderiam ocasionar redução subjetiva da dor e produzir aumento considerável ...

Objetivos: Analizar las alteraciones en la amplitud de movimiento (ADM) y algias tras la manipulación vertebral en la columna cervical y dorsal, en sujetos con cervicalgia mecánica. Métodos: Fueron realizadas manipulaciones en la columna cervical y dorsal con las técnicas Gonstead y Diversificada DTV. Para evaluar la ADM cervical se utilizó un inclinómetro. El dolor en la columna cervical, fue evaluado mediante la Escala Visual Analógica (EVA). Se obtuvo la participación de 73 pacientes. Las edades oscilaron entre los 18 y los 63 años, con una edad promedio de 42,27 años. Los sujetos de esta investigación se caracterizaron por presentar cervicalgia mecánica y restricción en la ADM cervical. Resultados: Se observó una reducción en la intensidad del dolor percibida por los pacientes y un aumento en la ADM cervical, obteniéndose diferencias significativas entre los valores pretratamiento (primera cita) y las citas quinta y décima (p<0,01), y entre las citas quinta y décima (p<0,01) en todos los parámetros excepto en extensión cervical 70º. Conclusión: Los resultados de este estudio sugieren que la manipulación vertebral, con las técnicas Gonstead y Diversificada DTV, en la columna cervical y dorsal, podría provocar una reducción ...

Humans , Manipulation, Spinal , Range of Motion, Articular , Treatment Outcome , Neck Pain
Article in Chinese | WPRIM | ID: wpr-337242


<p><b>OBJECTIVE</b>To compare the difference in the efficacy on cervical type of cervical spondylosis (CS) between the combined treatment of sword-like needle and chiropractic spinal manipulation (the combined therapy) and the simple chiropractic spinal manipulation.</p><p><b>METHODS</b>One hundred and thirty-eight cases of cervical type of CS were randomized into a combined therapy group (76 cases) and a simple chiropractic spinal manipulation group (62 cases). In the combined therapy group, the sword-like needle therapy was applied at Fengchi (GB 20), Tianzhu (BL 10) and Jiaji (EX-B 2) C3-C5. The chiropractic spinal manipulation was used in combination. In the chiropractic spinal manipulation group, the simple chiropractic spinal manipulation was adopted. The treatment was given once every other day in the two groups, 10 days made one session. One session of treatment was required. Visual analog scale (VAS) score was observed before and after treatment in the two groups and the efficacies were compared between the two groups.</p><p><b>RESULTS</b>VAS score after treatment was reduced obviously as compared with that before treatment in the patients of the two groups (both P < 0.01) and VAS score after treatment in the combined therapy group was lower than that in the simple chiropractic spinal manipulation group (1.50 +/- 0.58 vs 1.87+/-1.05, P < 0.01). In the combined therapy group, 48 cases were cured, 20 cases remarkably effective, 8 cases improved and 0 case failed. In the chiropractic spinal manipulation group, 30 cases were cured, 16 cases remarkably effective, 15 cases improved and 1 case failed. The overall efficacy in the combined therapy group was better than that in the chiropractic spinal manipulation (P < 0.05).</p><p><b>CONCLUSION</b>The sword-like needle therapy combined with chiropractic spinal manipulation relieve effectively pain in cervical type of CS and the efficacy is superior to the simple chiropractic spinal manipulation.</p>

Acupuncture Therapy , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Manipulation, Chiropractic , Manipulation, Spinal , Middle Aged , Spondylosis , Therapeutics
Article in Chinese | WPRIM | ID: wpr-318483


<p><b>OBJECTIVE</b>To compare the difference in the clinical efficacy on primary trigeminal neuralgia (PTN) between the comprehensive therapy of electroacupuncture (EA) at qi streets acupoints combined with spinal regulation method and medication with carbamazepine (CBZ).</p><p><b>METHODS</b>Sixty patients were randomized into a comprehensive therapy group (30 cases) and a medication group (30 cases). In the comprehensive therapy group, the acupoints at qi streets on the head such as Taiyang (EX-HN 5) and Sishencong (EX-HN 1) and those at qi streets on the chest and abdomen such as Shenshu (BL 23), Zhongwan (CV 12) and Guanyuan (CV 4), etc. were selected. After arrival of qi, EA was attached on 2 to 4 groups of acupoints. After acupuncture, the spinal regulation method was applied. This comprehensive therapy was given once a day. In the medication group, CBZ was used for oral administration, 100 mg at the first time, twice a day, and 400 to 600 mg each day as the maintenance dose. Separately, before and after treatment, in 2 and 6 months in follow-up, pain rating index (PRI), life satisfaction index B (LSI-B) and hamilton depression scale (HAMD) were adopted to evaluate comprehensively the clinical efficacy in the two groups and compare the adverse reaction during the treatment between the two groups.</p><p><b>RESULTS</b>After treatment, the curative and markedly effective rate in the comprehensive therapy group was 76.7% (23/30), which was better than 63.3% (19/30) in the medication group (P < 0.01). The difference in PRI was not significant after treatment between the two groups (all P > 0.05). In 2 and 6 months follow-up, PRI grade in the comprehensive therapy group was superior to that of the medication group (both P<0. 05). After treatment and in follow-up, HAMD score was all reduced in the two groups (P < 0.01, P < 0.05) and the result in follow-up in the comprehensive therapy group was significant as compared with that in the medication group (all P<0. 05). After treatment, LSI-B score was increased obviously in the two groups (all P < 0.05) and the result in the comprehensive therapy group was better than that in the medication group (P < 0.05). The incidence of adverse reaction in the comprehensive therapy group was 16.7% (5/30), which was lower than 30.0% (9/30, P < 0.01) in the medication group.</p><p><b>CONCLUSION</b>The comprehensive therapy of EA at qi streets acpoints combined with spinal regulation method achieves the long-term efficacy on PTN as compared with oral administration of CBZ in terms of the improvement of psychological condition, analgesia and life quality. It is the safe, effective and stable therapy.</p>

Acupuncture Points , Adult , Aged , Combined Modality Therapy , Electroacupuncture , Female , Humans , Male , Manipulation, Spinal , Middle Aged , Trigeminal Neuralgia , Therapeutics
Rev. med. (Säo Paulo) ; 92(3): 173-182, jul.-set. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-730797


Este artigo de revisão apresenta a quiropraxia, uma profissão na área da saúde que se ocupa do diagnóstico, tratamento e prevenção de condições neuromusculoesqueléticas, em especial algias vertebrais e sintomas associados. São abordadas inicialmente a definição e área da atuação, seguindo-se uma revisão da história da profissão no Brasil e no mundo. A formção profissional, que consiste de cursos superiores com quatro anos de duração é discutida. São apresentados os dois cursos superiores de Quiropraxia em atividade no Brasil, sua história e importância para a implantação da profissão no país. A avaliação biomecânica realizada por quiropraxistas é descrita, em especial técnicas de palpação articular, bem como os métodos terapêuticos utilizados por quiropraxistas, em especial a utilização de técnicas de terapia manual. A terapia de manipulação articular e seus efeitos fisiológicos são detalhados. Contra indicações e complicações são discutidos. Por fim, é feita uma breve revisão da literatura relativa a estudos clínicos sobre a eficácia do tratamento com quiropraxia.

This is a review about Chiropractic, a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system, with a special emphasis on the treatment of vertebral pain and associated symptoms. The profession is initially defined and an overview of the history of chiropractic in the world as well as in Brazil is presented. Professional education, consisting of four years of university-level graduation programs is described. The two chiropractic programs in activity in Brazil are presented and their importance to the establishment of the profession in this country is discussed. The biomechanical evaluation performed by chiropractors is explained, with special emphasis on techniques of joint palpation. Treatment procedures used by chiropractors are summarized, particularly techniques of manual therapy. Spinal manipulation therapy and its physiological effects are then detailed. Contra-indications and complications are discussed. Finally, a brief review of the medical literature with respect to clinical trials on the efficacy of chiropractic therapy for the treatment of specific conditions is outlined.

Low Back Pain , Manipulation, Chiropractic , Manipulation, Spinal/methods , Musculoskeletal Manipulations/education , Musculoskeletal Manipulations , Health Personnel/education , Chiropractic/education , Chiropractic/history , Delivery of Health Care
Fisioter. mov ; 26(2): 337-348, abr.-jun. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-679287


INTRODUÇÃO: A relação entre a orientação dos segmentos e os ajustes que podem ser desencadeados por calços e palmilhas em pacientes escolióticos durante a manutenção da posição ortostática é pouco conhecida. OBJETIVO: Verificar alterações estáticas e associadas com mudanças unilaterais de calços na orientação postural de indivíduos com escoliose idiopática. MATERIAIS E MÉTODOS: Grupo experimental com dez indivíduos com escoliose idiopática com curva dupla (menor 10°) e grupo controle com dez indivíduos sem escoliose (faixa etária de 13 a 24 anos). Participantes foram filmados na posição ortostática sem calço, com calço baixo (1 cm) e com calço alto (3 cm); estes foram colocados sob o pé direito e pé esquerdo dos indivíduos. Em cada condição, o participante manteve a posição estática durante 15 segundos e marcadores refletivos foram colocados em pontos anatômicos específicos. Foram calculados ângulos posturais: torácico alto; torácico médio; toracolombar e lombar e ângulos segmentares: ombro; escápula; pelve e joelho. RESULTADOS: Na condição sem calço, diferenças foram observadas entre grupos para os ângulos posturais toracolombar e lombar e para o ângulo segmentar do ombro. Com calço baixo e alto, sob o pé direito, diferença foi observada entre calços para os ângulos lombar, da pelve e do joelho. Com calço baixo e alto, sob o pé esquerdo, diferença foi observada entre grupos para o ângulo toracolombar e entre calços para os ângulos da pelve e do joelho. CONCLUSÕES: A utilização de calço promove reorientação nas regiões mais baixas da coluna e nos segmentos da pelve e do joelho. Estes resultados sugerem que nas escolioses duplas, manipulação da base de apoio modifica o alinhamento do tronco que pode provocar reorganização das estruturas e busca de um novo arranjo entre segmentos em indivíduos com escoliose idiopática.

INTRODUCTION: The relationship between the orientation of the segments and the adjustments that can be triggered by shoe lift and insoles in scoliotic patients during maintenance of standing position is unclear. OBJECTIVE: To verify static changes and those associated with unilateral manipulations of shoe lift in the postural orientation in people with idiopathic scoliosis. MATERIALS AND METHODS: Experimental group composed of ten patients with idiopathic scoliosis with double curve (less 10°) and control group with ten participants without scoliosis (aging from 13 to 24 years). Participants were videotaped in upright stance, standing with no, low (1 cm), and high (3 cm) shoe lift, which were placed under right and left shoe. In each condition, the participant maintain upright stance for 15 seconds and reflective markers were affixed on specific anatomical places. Postural angles were obtained: high thoracic; medium thoracic; thoracolumbar; and lumbar, as well segmental angles: shoulder; scapula; pelvis; and knee. RESULTS: In the no shoe lift condition, differences were observed between groups for high and medium thoracic angles and for shoulder. With low and high shoe lift under the right foot, difference was observed between shoe lift heights for high thoracic, for pelvis and knee angles. With low and high shoe lift under the left foot, differences between groups were observed for thoracolumbar angle and between shoe lift heights for pelvis and knee angles. CONCLUSIONS: The shoe lift promotes reorientation in the lower regions of the spine and segments of pelvis and knee. It might be suggested that in the scoliosis with double curves, manipulation in the basis of support changes the alignment of the trunk that might promote structural reorganization and the search of new adjustments among segments in individuals with idiopathic scoliosis.

Humans , Adult , Manipulation, Spinal , Physical Therapy Modalities , Posture , Scoliosis , Spine , Physical Therapy Specialty
Scientific and Research Journal of Army University of Medical Sciences-JAUMS. 2013; 11 (2): 150-156
in Persian | IMEMR | ID: emr-132984


Spinal manipulation is a manual technique commonly used for the treatment of low back pain. The physiologic mechanisms of spinal manipulation are largely unknown. One basic physiologic response to spinal manipulation [SM] is alternation in Moto neuronal activity, as assessed by the Hoffmann reflex [H-reflex] technique. The purpose of this study was to determine the effect of spinal manipulation on amplitude and onset latency of H-reflexes and on H/M amplitude ratio in patients with low back pain. It was a clinical trial with IRCT201203069222N1 Registration code. Ffifty eight patients with low back pain aged between 20-60 years were included. Tibial nerve H reflex and M wave were recorded before and after Lumbosacral spinal manipulation. The data was analyzed by SPSS 16. Lumbosacral manipulation significantly decrease amplitude of H reflex and H/M amplitude ratio [P<0.05]. It had not significantly effect on H reflex latency or M wave amplitude and latency [P>0.05]. Lumbosacral manipulation produces attenuation of alpha motoneuronal excitability. These findings support of this theory that manual spinal therapy can lead to reduction in muscle tone.

Humans , Adult , Middle Aged , Manipulation, Spinal , Lumbosacral Region , Motor Neurons , H-Reflex